The Link Between OCD and Addiction

Content medically reviewed by Vicky Magobet, PMHNP-BC, on February 23, 2022.

Approximately half of the U.S. population diagnosed with mental health conditions also have a diagnosable substance use disorder at some point in their lives. When two or more of these issues coincide, treatment professionals call them co-occurring disorders, and they require simultaneous treatment to facilitate recovery. 

Obsessive-compulsive disorder links to substance use because many people with this condition use alcohol or drugs in a misguided attempt to manage their symptoms. Ongoing drinking and drug use will result in a chemical and psychological dependence, which can quickly progress into a substance use disorder. Learn more about the connection between OCD and addiction below.

What Is OCD?

Many misconceptions exist about OCD, partly due to television and movie portrayals that make the condition seem like a quirky personality trait instead of a severe illness. Rather than sharing helpful information, these representations of OCD are often inaccurate and create a stigma surrounding the issue that can make it challenging for people to identify OCD in themselves.

The truth is that OCD is a type of anxiety disorder affecting over 2 million Americans. Men and women experience OCD at similar rates with no disparity based on gender identity. Researchers believe genetics plays a significant role in your likelihood of developing OCD, since anxiety disorders typically run in families. The average onset age is 19, but some people start experiencing symptoms as early as 10. However, some people may not notice any symptoms until they are in their 20s.

OCD causes intense fear or anxiety related to intrusive or uncontrollable thought patterns. These thoughts translate into compulsive behaviors, varying from person to person. It can be challenging to overcome these ideas, and despite knowing their fears are irrational, someone with OCD typically can't control their behavior without treatment. 

Managing preoccupations can be time-consuming, preventing people with OCD from engaging in other activities. They also tend to socially isolate themselves to avoid triggering their habits. The combination of loneliness and unwelcome thoughts or behaviors can affect relationships, educational opportunities and careers. 

Symptoms of OCD

OCD presents itself differently in each person, but is usually a mixture of obsessions and compulsions. However, someone with OCD might have a single intense fixation that takes precedence over the others. While there's a lot of variation in OCD symptoms, there is some overlap. People with OCD often experience:

  • Elevated stress levels and constant anxiety
  • Fear of germs or getting dirty
  • Worries about harm befalling themselves or their loved ones
  • An intense desire for order and symmetry 
  • Intrusive thoughts replaying in the mind
  • Thoughts about self-harm or hurting others

Intrusive or inappropriate thoughts are one of the most predominant OCD symptoms. These unwanted thoughts can take multiple forms, ranging from religious to sexual. Sometimes, these thought patterns evolve into compulsive behaviors, such as:

  • Checking the locks on doors numerous times
  • Cleaning the house obsessively
  • Washing their hands excessively, even if they become raw
  • Following a strict routine or schedule 

Some people with OCD may also have patterned behavior. For example, someone with OCD may do everything in threes, such as locking a door or turning on a light three times. There's often an element of superstition or magical thinking with OCD, in which people believe they can prevent disaster by performing specific rituals.

Most people with OCD have a mixture of obsessions and compulsions. Some people also experience brief tics, known as unvoluntary, instead of involuntary, repetitive movements or vocalizations. A person may feel compelled to do or say something, and while they may suppress these feelings for some time, they will eventually give in to relieve their discomfort. Tics often interrupt daily behaviors. 

People with OCD tend to avoid situations that will trigger their obsessions, such as shaking hands or using the stove. These avoidance behaviors can cause people with OCD to socially isolate themselves, contributing to loneliness and depression. These emotions are one risk factor for developing a substance use disorder. Individuals might use drugs or drink alcohol to cope with anxiety or fear. 

If left untreated, the signs and symptoms of OCD tend to worsen with time, increasing the chance of addiction.

Compulsions and Addictions

People often think compulsion and addiction are synonymous, but distinctions exist. Knowing the difference is essential, so medical professionals can make an accurate diagnosis. 

Addiction is a broad term used to describe a condition where someone has developed a chemical or psychological dependence. The dependence on a substance or behavior creates a persistent need to continue these activities, despite the harm they might have. Eventually, addiction undermines relationships with family, friends and other loved ones. It can also impact other aspects of life, including work, education and physical health. 

Compulsions are more specific than addictions. A compulsion is an intense desire to do something, sometimes resulting in a particular activity. People who can't act on these urges experience discomfort, anxiety or fear. Someone with a compulsion is likely aware that their thoughts and actions aren't logical, but they can't stop themselves from acting. In contrast, substance abusers usually don't recognize there isn't sound logic behind their actions, and they sometimes fail to fully grasp the consequences. 

Someone with OCD may have compulsions to wash their hands frequently, check the locks on doors multiple times or clean their home obsessively. These compulsions arise from distracting thought patterns that induce fear or anxiety. 

While a compulsion is not the same thing as an addiction, there is some overlap. Compulsions have a role in addiction development. When someone starts drinking or misusing drugs, changes in their brain chemistry will give them a powerful desire to continue using the substance until a full-fledged addiction forms. 

One other difference between the two is the distinction between pleasure and relief. When someone with OCD acts on their compulsive thoughts, they will feel a sense of relief from their anxious thoughts or feelings but no pleasure. On the other hand, someone with an addiction will feel pleasure when drinking or using drugs. The expected pleasure is part of what drives someone to continue using a substance or engaging in specific behaviors.

How Can OCD Increase the Likelihood of Drug Addiction?

People with a substance use disorder often have a related mental health condition. Up to 20% of people with anxiety disorders such as OCD have a co-occurring substance use disorder. Those living with mental health disorders often use substances to cope with their symptoms. However, alcohol and drugs only provide temporary relief and can make mental health symptoms worse in the long run.

OCD symptoms can increase the likelihood of drug addiction for the same reasons. One characteristic of OCD is anxiety or fear, which results in compulsive thoughts or behaviors to calm these uncomfortable feelings. Some people with this condition perform rituals, such as constant hand-washing to clean contaminants off their skin or frequently sanitizing their house to get rid of perceived germs. While they might know their thoughts and behaviors are illogical, they can't stop themselves from acting on their compulsions. 

People living with OCD might stop spending time with friends and family if they're embarrassed about their condition. Isolation can lead to depression, which is a risk factor for developing an addiction. They may turn to alcohol or drugs to find relief from feelings of loneliness and their OCD symptoms, leaving the underlying cause of these emotions untreated. 

If someone with OCD continues drinking or using drugs, they'll develop a worsening chemical dependency, increasing feelings of depression and isolation. These emotions can increase the anxiety and compulsions associated with OCD. 

Co-occurring OCD and alcohol abuse increases the risk of destructive behaviors and the potential for hospitalization. Seeking treatment as soon as possible for these conditions is the best way to find long-term relief. 

Warning Signs

Spotting the red flags of OCD and substance use disorders is the best way to prevent dangerous behaviors and other risks associated with both these conditions. Some of the warning signs include the following.

  • Loss of interest in hobbies: Someone with OCD and drug addiction might lose interest in the activities they once enjoyed, such as art, sports or reading. OCD can cause preoccupations that leave little time to engage in other pastimes. Substance use also takes up a significant amount of time, and once an addiction has taken control of the brain and body, it can be challenging to think about or do anything else. When both these conditions exist simultaneously, people may completely disengage from their old hobbies.
  • Social isolation: People with OCD often isolate themselves to manage their fear and anxiety. They'll spend less time hanging out with friends or connecting with family. Someone with a substance use disorder might do the same due to feelings of judgment, shame or guilt. Social isolation increases the likelihood of depression, increasing the severity of both of these conditions.
  • Compulsive thoughts or behaviors: The predominant symptoms of OCD are obsessive thoughts or actions, but these are also hallmarks of addiction. A chemical or psychological dependency will create a compulsion to take a substance or engage in addictive behaviors, such as gambling.
  • Mood changes: Irritability is a common symptom of OCD and substance use. Someone with OCD might lash out at family or friends due to anxiety or fear caused by their compulsive thoughts. Similarly, mood swings are a typical withdrawal symptom associated with alcohol and other drugs. Irritability may also be a side effect of drug use, depending on the substance.
  • Inability to keep up with responsibilities: One of the characteristics of substance use is the inability to keep up with responsibilities, whether at home, work or in relationships. People with OCD may experience the same thing, particularly if they're isolating themselves at home to cope with their symptoms.

If you or someone you know is displaying these issues, it may indicate OCD, substance use or a combination of the two. Talk openly with a medical professional about what you're experiencing, so they can give you an accurate diagnosis.

Treating OCD and Addiction

People with OCD sometimes use substances to self-medicate. While this can bring temporary relief, substances often make OCD symptoms more severe, and addiction increases the chance for risky behaviors and hospitalization. 

When these conditions occur together, a treatment plan should focus on replacing the substance with healthy coping mechanisms, such as yoga, meditation, mindfulness or physical activity. People should also address and dismantle the thoughts and behaviors that drive them to abuse substances as a coping strategy.

If someone has a substance use disorder and OCD, they may benefit from medically assisted detox to lay the groundwork for their future health and well-being. These programs can help people overcome uncomfortable withdrawal symptoms in a safe, clinical environment. After completing a detox program, many people enter therapy to address thought patterns and behaviors that contribute to substance use and mental health conditions such as OCD.

Evidence-based solutions that have proven effective at treating OCD include the following.

  • Cognitive behavioral therapy: A professional will help you identify and change thought patterns that contribute to OCD symptoms. CBT allows you to understand your behaviors and teaches healthy coping strategies to overcome complex thoughts and feelings. 
  • Exposure and response prevention therapy: ERP is a specific type of CBT therapy that slowly and safely exposes individuals to situations that provoke particular behaviors or compulsions. The goal is to choose not to respond to the triggering circumstances. ERP is an effective strategy to treat OCD because it addresses specific obsessive thoughts and feelings and teaches people they can choose whether to give in to their urges. ERP helps reduce anxiety and fear associated with these thought and behavioral patterns.
  • Medication: People with OCD can also medicate to control their thoughts and behaviors. Antidepressants have proven benefits for treating OCD, and physicians frequently prescribe them. However, your doctor may prescribe antidepressants and psychiatric medications, depending on your symptoms' severity.

Let Diamond House Detox Help You With Co-Occurring Disorders

Treating OCD and a substance use disorder simultaneously is the best way to successfully recover from these conditions. At Diamond House Detox, we use dual-diagnosis treatment methods to address mental health and substance use symptoms. We strive to improve all our clients' quality of life through detoxification and counseling services. You'll learn healthy coping mechanisms and how to build a support network you can rely on.

Recovery is always possible. Our inpatient treatment facility offers 24-hour admissions so you can seek help when you need it most. Contact us today for more information about our services, and let us create a personalized treatment plan for your unique needs.

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Psychiatric Mental Health Nurse Practitioner at Diamond House Detox
Vicky is a board certified Family Psychiatric Mental Health Nurse Practitioner, certified by the American Nurses Credentialing Center. She began her nursing career in healthcare by working in the intensive care unit, and then an inpatient psychiatric hospital. After realizing the mental health needs of both the patients and the families she served, she became a Psychiatric Nurse Practitioner. Throughout her experience working with clients, she has developed a passion for those with dual diagnoses and specializes in helping individuals recognize the issues driving their substance use. This recognition has been crucial to the individual’s success in treatment. Vicky opened Diamond House Detox so that she can address these issues early on in a therapeutic environment to allow clients to transition to the next level in their recovery.
Vicky Magobet
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