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Understanding OCD
Signs, Symptoms, and Treatment for OCD and Substance Abuse
Obsessive-compulsive disorder, or OCD, is a chronic mental health disorder involving recurrent, distressing intrusive thoughts (obsessions) and repetitive actions or mental processes (compulsions) that disrupt normal functioning. For many individuals with OCD, it may be experienced in conjunction with other mental health disorders, including substance use disorders (SUDs), which frequently occur in conjunction with OCD, particularly among those self-medicating to alleviate distressing symptoms.
In some cases, OCD may worsen other disorders and emotional dysregulation and delay the person’s ability to recover from either.
The most effective treatment for OCD includes addressing symptoms unique to OCD and patterns of substance use in an evidence-based and structured manner. Once these components of treatment are in place, patients can begin reducing the severity of their symptoms, improving the control they have over their daily functioning, and building new, adaptive coping strategies that maintain ongoing stability.
Key Points
- OCD is characterized by unwanted intrusive thoughts and compulsive behaviors that create significant distress.
- While compulsive behaviors may temporarily alleviate an individual’s distress, they also reinforce the cyclical nature of OCD.
- OCD is classified as an anxiety disorder according to the DSM-5.
- It is estimated that at least half of the people living with OCD have experienced symptoms from early childhood, adolescence, or early adulthood.
- Without appropriate treatment, OCD symptoms can worsen to the point where people begin to avoid places, people, or use substances to cope.
What Is Obsessive-Compulsive Disorder?
Obsessive-compulsive disorder is characterized by unwanted intrusive thoughts or obsessions and compulsive behaviors that can create significant distress.[1] Obsessions often involve fears related to germs, fear of causing hurt to self or others, moral issues, and a lack of control. Compulsions are behaviors performed in response to the obsessive thoughts that relieve anxiety or “prevent” something bad from happening.
While these compulsive behaviors may temporarily alleviate distress and anxiety, they also reinforce the cyclical nature of OCD and ultimately increase the severity of symptoms over time. Furthermore, OCD symptoms can be time-consuming, have an impact on an individual’s normal functioning, cause work or relationship problems, and impact their overall well-being.
Common Signs and Symptoms of OCD
Despite wide variation in presentation and severity, OCD symptoms generally fall into two general categories: obsessive thoughts and compulsions.[2]
The following are examples of common obsessions:
- Persistent fears of contamination or illness
- Intrusive thoughts about harm or danger
- Unwanted aggressive or taboo thoughts
- Excessive need for symmetry, order, or perfection
The following are examples of common compulsive behaviors:
- Repetitive cleaning or handwashing
- Checking behaviors
- Counting, repeating, or arranging objects
- Mental rituals such as praying or reviewing events
When left untreated, OCD symptoms often escalate and may lead individuals to avoid situations, withdraw socially, or rely on substances for temporary relief.
The Connection Between OCD and Substance Abuse
Although OCD compulsions can look similar to some other behaviors associated with addiction, they are motivated by different mechanisms. Compulsions are performed to relieve anxiety that is caused by unwanted or intrusive thoughts. Addiction involves craving a substance, loss of control over the addictive substance, and continued use of that substance despite negative effects.
Those with both OCD and substance use disorders will often exhibit overlap in their behaviors. They will use or desire substances to relieve their anxiety, and experience cravings for or be dependent on substances. This necessitates treatment that addresses both behaviors simultaneously.
Compulsive Behavior vs Addiction
Although OCD compulsions can look similar to some other behaviors associated with addiction, they are motivated by different mechanisms. Compulsions are performed to relieve anxiety that is caused by unwanted or intrusive thoughts. Addiction involves craving a substance, loss of control over the addictive substance, and continued use of that substance despite negative effects.
Those with both OCD and substance use disorders will often exhibit overlap in their behaviors. They will use or desire substances to relieve their anxiety, and experience cravings for or be dependent on substances. This necessitates treatment that addresses both behaviors simultaneously.
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Risk Factors for OCD and Substance Use Disorders
There are many factors that can contribute to an increased risk for OCD, substance abuse, or both.[5]
- Family history of mental illness or genetic vulnerability.[6]
- High levels of anxiety or emotional sensitivity.
- Difficulty tolerating distress.
- Exposure to trauma or chronic stress.
- Early onset of OCD symptoms.
Substance use has also been evidenced to trigger an increase in the severity of OCD symptoms when use is frequent or heavy.[6]
Evidence-Based Treatment for OCD
At Agape Treatment Center, OCD treatment is directed at helping the person reduce the intensity and frequency of their obsessions and compulsions by improving emotional regulation and helping them function better on a daily basis. Treatment is focused on the use of evidence-based therapy, integration of behavioral health and holistic therapy into medical care, and the treatment of the whole person, not just the symptoms.
These evidence-based treatments can include:
- Cognitive-Behavioral Therapy (CBT): Particularly, exposure and response prevention (ERP).
- Individual Therapy: Focuses on coping applications and distress tolerance.
- Group Therapy: For support and insight
- Medication Management: Combined with the above methods when appropriate.
When a co-occurring disorder, such as substance abuse or depression, is present, treatment plans must be modified to treat both conditions.
Moving Forward With Treatment for OCD and Substance Abuse
Living with OCD and substance abuse can feel overwhelming, but effective treatment is available. With the right treatment, people living with OCD and substance abuse will be able to alleviate the intensity of their symptoms, enjoy a higher quality of life, and regain confidence in their ability to deal with everyday challenges.
Agape Treatment Center’s treatment for OCD is both structured and individualized, with the goal of helping people who struggle with OCD and also have a co-occurring substance use disorder. Treatment can be accessed at varying levels of care to address individual clinical needs and the recovery phase.
Amanda Stevens is a highly respected figure in the field of medical content writing, with a specific focus on eating disorders and addiction treatment. Amanda earned a Bachelor of Science degree in Social Work from Purdue University, graduating Magna Cum Laude, which serves as a strong educational foundation for her contributions.
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FAQ
Frequently Asked Questions About Obsessive Compulsive Disorder Treatment
Is there a link between OCD and addiction?
Yes. People with OCD frequently have substance use disorders. Many people with OCD will use alcohol or other drugs to try to alleviate anxiety or to stop their obsessive or compulsive thoughts or behaviors. Although substances may relieve OCD symptoms in the short term, they further aggravate OCD symptoms over time, worsen emotional dysregulation, and further entrench the co-occurrence of both conditions.
What substances can make OCD symptoms worse?
Alcohol, marijuana, stimulants (including methamphetamine), and some prescription medications can increase your OCD symptoms. Substances can increase anxiety, impede impulse control, and disrupt serotonin regulation, which is an important neurotransmitter in the pathogenesis of OCD.[8]
What is the root cause of OCD?
Although there is no one cause of OCD, it is thought to arise from a combination of biological, biochemical, and environmental factors. Commonly, there will be dysregulation of the brain circuitry involving the neurotransmitter serotonin and circuits related to decision-making, which are associated with OCD behaviors.
What are common OCD obsessions and compulsions?
Common OCD obsessions are unwanted intrusive thoughts about contamination, fear of harm, moral issues, symmetry, and fear of loss of control. Common OCD compulsions are repetitive behaviors or mental rituals such as checking, counting, reassuring oneself, or mentally reviewing an activity. Although compulsions are performed to alleviate anxiety, the relief is short-lived.
What type of OCD is hardest to treat?
The success of treatment for OCD is determined more by the individual’s level of severity than by the subtypes of OCD. However, subtypes of OCD that co-occur with substance use disorders, untreated trauma, or sustained avoidance may necessitate a higher level of treatment intensity than non-complicated subtypes.[9] The use of Integrated evidence-based treatment can provide positive outcomes in more complicated subtypes of OCD.
Does substance abuse cause OCD?
Substance abuse does not directly lead to the development of OCD; it may act as a trigger for its onset, particularly in genetically vulnerable individuals. Repeated use of alcohol or drugs may manifest as increased anxiety, impulsivity, or obsessive thoughts, which will make the management and treatment of OCD more difficult.
Can people with OCD live normal, independent lives?
Yes. With appropriate treatment, support, and guidance, many people develop the ability to lead normal and independent lives. Treatment focused on developing skills, emotional regulation, and behavioral change will help the individual to manage their OCD symptoms, decrease compulsive behaviors, and experience improved daily functioning.
Sources
[1] [2] National Institute of Mental Health. (2024, May). Obsessive-compulsive disorder. U.S. Department of Health and Human Services. https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd
[3] [4] [7] Substance Abuse and Mental Health Services Administration. (2016). Advisory: Obsessive-compulsive disorder and substance use disorders. U.S. Department of Health and Human Services. https://library.samhsa.gov/sites/default/files/sma16-4977.pdf
[5] National Institute of Mental Health. (2024, May). Obsessive-compulsive disorder: When unwanted thoughts take over. U.S. Department of Health and Human Services. https://www.nimh.nih.gov/health/publications/obsessive-compulsive-disorder-when-unwanted-thoughts-take-over
[8] Fontenelle, L. F., Oostermeijer, S., Harrison, B. J., Pantelis, C., & Yücel, M. (2011). Obsessive-compulsive disorder, compulsions, and the CSTC loop. Dialogues in Clinical Neuroscience, 13(3), 333–352. https://pmc.ncbi.nlm.nih.gov/articles/PMC3181951/
[9] International OCD Foundation. (2024). Treating co-occurring OCD and substance use disorder: What professionals need to know. https://iocdf.org/expert-opinions/treating-co-occurring-ocd-and-substance-use-disorder-what-professionals-need-to-know/
