Around one out of every 40 adults in the United States will suffer from obsessive-compulsive disorder, or OCD, at some time in their lives, the National Alliance on Mental Illness (NAMI) publishes. OCD is a significant mental health disorder that interferes with an individual’s ability to function normally in everyday life.
Obsessions are repeated thoughts, actions, images, or urges that lead to anxiety, while compulsions are behaviors that are repetitive and in response to obsessive urges or thoughts. Common obsessions may include needing things to be symmetrical, unwanted “taboo” thoughts that may involve religion, violent behavior or sex, self-harming thoughts or aggressiveness, fear of becoming contaminated or of germs, and self-doubt or fear of having not done something correctly like lock a door. Compulsions are things like compulsive counting, repetitive need to check on things like locked doors, continual handwashing and cleaning, precise organization or arrangement of things, and intrusive thoughts leading to mental checks of things. Individuals suffering from OCD can’t control these behaviors or thoughts, even when they can recognize that they are detrimental and extreme, and they spend at least an hour a day engaging in them. These actions do not make them feel happy, although they may seem to temporarily relieve anxiety. The National Institute on Mental Illness (NIMH) states that OCD usually manifests by age 19 and is likely heritable with a combination of genetic, biological, and environmental risk factors involved in its onset.
Connection between Addiction and OCD
Addiction is a chronic and relapsing disease of the brain involving circuitry and chemistry related to mood regulation, memory formation, feelings of pleasure, and impulse control. The National Survey on Drug Use and Health (NSDUH) estimates that in 2014 around one out of every 12 American adults battled a drug or alcohol use disorder. Individuals suffering from OCD may struggle with drug and alcohol abuse and addiction at higher rates than the general population. Rates of lifetime co-occurrence of an alcohol use disorder (AUD) with OCD, as published by the Journal of Addictive Disorders, are close to 24 percent while those for a co-occurring drug use disorder are 18 percent. OCD came first in 70 percent of those individuals battling co-occurring substance use disorders (SUDs), the Journal of Anxiety Disorders further publishes.
The high rate of co-occurrence of OCD and an SUD may be due to several factors, such as:
- Involvement of the same regions of the brain: Some parts of the brain may be underdeveloped or dysfunctional, leading to increased risk for OCD and/or addiction.
- Genetic or biological predisposition: Both addiction and OCD may have genetic contributors.
- Environmental factors: High levels of stress may contribute to both OCD and addiction rates.
- Age of first use or trauma at young age: Early disruption of the brain due to substance abuse or childhood trauma can predispose people to developing OCD or addiction.
Alcohol, marijuana, and opiates may be popular drugs of abuse in those battling OCD, as these substances may seem to temporarily relieve OCD symptoms or urges, and an individual may then use them as a method of self-medication. Stimulant drugs may serve to increase pleasure temporarily; however, they likely make OCD symptoms worse.
When someone abuses drugs, brain chemistry is changed, increasing pleasure and providing a momentary “escape” from reality. Regular abuse of mind-altering substances causes some of the brain structure and circuitry to be altered. The parts of the brain that work to control impulses, make sound decisions, regulate moods, and produce feelings of happiness are affected. Physical drug dependence may set in, creating significant drug cravings and negative withdrawal symptoms when the substance then wears off. Individuals may lose control over their ability to use drugs, the amount they use, or the length of time they use them, leading to physical and psychological addiction.
Complications for Treatment
OCD can significantly impede a person’s ability to complete everyday tasks, and addiction can further take over, creating a plethora of negative consequences as a result. Relationships may become strained, finances can suffer, legal troubles may crop up, physical health often declines, and mental illness symptoms may be exacerbated by chronic substance abuse. Someone who suffers from OCD may already be anxious and have low self-esteem, which can be worsened by addiction and drug withdrawal symptoms. The risk for suicide in individuals battling OCD is five times greater than in the general population, and the odds of dying from a suicide attempt are ten times higher, per findings published in the journal Molecular Psychiatry. Combining OCD with substance abuse and addiction only adds to the risk.
When OCD and addiction co-occur, individuals may require a longer time in treatment and more specific treatment methods, the Journal of Anxiety Disorders warns. Treatment compliance may be compromised, and it may be more difficult to encourage individuals to refrain from drug or alcohol use and remain in treatment long enough to sustain recovery. Medications useful in managing OCD may need to be modified and prescribed with caution in those who also abuse substances. When two disorders, such as OCD and addiction, co-occur, the best recourse is a highly specialized and integrated treatment program.
Finding Help for OCD and Addiction
The first step in treating co-occurring disorders is for a complete and thorough evaluation to be done by highly trained medical and mental health professionals. A drug screening and mental and medical health assessment can help to determine what level of care is best. Individuals who are significantly dependent on drugs or alcohol may be best served in medical detox before entering into a more comprehensive program, in order to safely remove the substances from the body. Medical detox can provide close supervision and medical management of withdrawal symptoms to stabilize a person physically first. After detox, both residential and outpatient treatment programs can provide therapeutic and supportive tools for managing both disorders. Medical and mental health providers should work in tandem with substance abuse professionals, ensuring that all are on the same page and working toward recovery together.
Mood-stabilizing medications like selective serotonin reuptake inhibitors (SSRIs) and serotonin reuptake inhibitors (SRIs) are often considered effective tools for managing OCD symptoms, NIMH reports. Cognitive Behavioral Therapy (CBT) is also beneficial in helping to treat OCD and also addiction. CBT helps individuals to become self-reliant, learning healthy stress management techniques and methods for coping with potential triggers. Holistic measures that enhance the mind and body connection, such as nutrition planning, fitness programs, yoga, creative or art therapy, and mindfulness meditation are all great complementary and adjunct treatment methods for co-occurring disorders.
New research is constantly being done to find innovative ways to treat mental illness and substance abuse concerns. For example, in a study published by the journal Biological Psychiatry, a specific brain chemical was found to be involved in obsessive-compulsive behaviors in mice that, when deactivated, caused anxiety and the negative behaviors to cease. These results show promise for a better understanding of OCD and how future treatments might be related. Addiction too, is a brain disease involving brain chemicals, and scientific advances are constantly being made to further treatment in this field. Specialized care facilities with the capacity to treat multiple disorders simultaneously, and with the highest and most advanced level of care, can help individuals to manage symptoms of both OCD and addiction and lead healthy and full lives.