Obsessive-Compulsive Disorder (OCD) is a mental illness involving recurrent, unwanted thoughts, or actions. In many cases, it is a combination of both. What is the relationship between OCD and drug addiction?
On occasion, many of us have obsessive thoughts or worries. For example, checking your house doors multiple times. This behavior is, however, not distressing and does not affect us in any way.
On the other hand, for someone with OCD, these thoughts and actions can become overbearing. They can interfere with the individual’s daily life and cause a lot of distress.
Struggles with addiction also cause a lot of distress. Dealing with both OCD and drug addiction at the same time certainly makes it harder to cope.
But, which of these usually comes first? Does one contribute to the other? How do you treat someone who has both OCD and drug addiction?
OCD is a condition that presents with recurrent and persistent thoughts (obsessions) or repetitive behaviors (compulsions).
Obsessions are recurrent and persistent thoughts, urges, or images. They are usually intrusive and unwanted. Thus, they cause severe anxiety or distress. Because of this, individuals try to ignore, suppress, or neutralize them with some thought or action.
Compulsions are repetitive behaviors or mental acts. The individual usually feels driven to perform compulsions in response to an obsession. In some cases, it is according to rigid rules. 
Examples of repetitive behaviors are hand washing and checking. Mental acts may include counting, praying, or repeating words silently.
The behaviors or mental acts are aimed at preventing or reducing anxiety or distress. In some cases, it is about preventing some dreaded event or situation. However, these behaviors or mental acts have no real connection with what the individual tries to neutralize or prevent. Sometimes, they are simply excessive.
Obsessive-Compulsive Disorder (OCD) has a lifetime prevalence of about 1 to 3 percent. It usually manifests as a cluster of symptoms. These include intrusive thoughts, rituals, preoccupations, and compulsions.
The symptoms of OCD can lead to severe distress as well as functional impairment. As such, this can affect your work, finances, relationships, and general quality of life. A combination of OCD and drug addiction is sure to make this even worse.
Some studies show that people with OCD have higher than average rates of drug or alcohol addiction. This relationship can make treating either condition harder.
If you have OCD and drug addiction, your OCD symptoms may be more severe. Self-destructive behaviors and hospitalization also tend to be more common.
Self-medication is common with OCD. The mental distress this disorder causes makes some people self-medicate with drugs and alcohol. According to the Journal of Anxiety Disorders, over 25 percent of those who seek treatment for OCD also meet the criteria for a substance use disorder.
Most of the participants in this study reported that their substance abuse started after they began to experience OCD symptoms. This research found that individuals who had OCD symptoms in childhood or early adolescence were more likely to abuse drugs or alcohol later in life.
People who have OCD know that coping with obsessions and compulsions can be exhausting. Self-medicating with drugs only leads to a short relief, if even. Repeated use of drugs to deal with these symptoms can very quickly get out of hand, thus leading to an addiction.
The distress and shame from symptoms of this disorder can lead to social isolation. It is common for individuals to avoid other people and also social settings to keep their obsessions and compulsions private. Unfortunately, this shame, loneliness, and isolation can lead to addiction to drugs and alcohol.
Obsessions and compulsions vary amongst individuals. The most common obsession is contamination, and this leads to washing or avoidance of the supposedly contaminated object.
The second most common pattern is an obsession of doubt. In this case, what follows is a compulsion of checking.
Intrusive thoughts tend to be the third most common OCD symptom. Symmetry or precision comes in fourth place.
OCD presents in children, adolescents, and adults. Symptoms may sometimes be of sudden onset and may be related to ongoing stressors. Treatment is available, and some studies show the following response:
According to the International OCD Foundation, there are about 2-3 million adults in the U.S. living with OCD. Symptoms are most likely to appear for the first time in childhood – usually between 8-12 years. Another typical age of symptom presentation is in later adolescence and young adulthood.
As we know, experimenting with drugs and alcohol usually starts in the teenage years. Thus, the potential for co-occurring OCD and drug addiction is high.
According to the U.S. National Library of Medicine, teens with OCD may be especially vulnerable to abusing drugs or alcohol. Sadly, this is the age where the most damage to the brain is likely to occur.
Previously, OCD was classified as an anxiety disorder. Even though this has changed, anxiety and fear still play a central role in people who have this disorder. Some common examples of OCD presentations are:
Obsessions cause a lot of internal tension and distress. Compulsions are an attempt to relieve these feelings. However, they do not entirely erase the misery. As a result, there is a tendency to repeat the compulsions over and over again.
Such compulsions include:
People who have substance use disorders, as well as mental illness, are diagnosed as having co-occurring disorders. This condition is also sometimes referred to as dual diagnosis.
Proper treatment of co-occurring disorders is vital to the success of your recovery from addiction. As we know, some people use drugs and alcohol to self-medicate their mental illness. Due to the distress from some mental conditions, some individuals begin to use illicit substances. Such use is, however, never a long term fix. 
Thus, when you become sober, you may experience a flare-up of your mental illness. The symptoms show up more because the drugs were masking them. It is for this reason that it remains crucial to always treat mental disorders in addition to a substance use disorder. Failure to do this could result in relapse.
Many people experience their OCD symptoms after they stop using drugs and alcohol. Because these substances mask the symptoms, treatment for OCD should begin promptly.
On another note, some people develop an obsession with cleanliness and health after they become clean. They may have shared dirty needles and paraphernalia in the past, lived in filth, with poor self-hygiene. For some people, it is a case of wanting to walk away entirely from their previous life. They suddenly realize the importance of taking care of their bodies and being alive.
The key to adequate treatment of these co-occurring disorders is treating both of them at the same time. Dual Diagnosis Treatment Centers can manage both the substance use disorder, as well as OCD. Such treatment can be outpatient or inpatient in a residential treatment facility.
Treatment of OCD includes the use of medications, therapy, or a combination of both. Transcranial Magnetic Stimulation (TMS) also has a role to play.
The best clinical outcomes occur by combining medications with therapy. Cognitive-behavioral therapy (CBT) is generally regarded as first-line treatment.
Exposure and response prevention (ERP) is the behavioral approach applied during CBT in the treatment of OCD. The exposure component of ERP involves exposing the patient to the feared stimuli.
This process works in combination with the response prevention component, which involves simultaneously preventing the ritual. An example of this would be gradually exposing you to a feared object or obsession, such as dirty socks, and having you learn healthy ways to cope with your ensuing anxiety.
Several studies have found ERP to have more extended benefits than medications alone. A combination of medication and therapy remains the best modality of treatment for severe OCD.
Additionally, family counseling and support groups help manage OCD and drug addiction.
Several Selective Serotonin Reuptake Inhibitors (SSRIs) have been approved by the U.S. Food and Drug Administration for the treatment of OCD. Examples include sertraline (Zoloft), paroxetine (Paxil), fluoxetine (Prozac), fluvoxamine (Luvox), and citalopram (Celexa).
The initial response occurs in about 4-6 weeks. However, the optimal effect may need to occur at much higher doses. It may also take as long as 8-16 weeks. There is no significant difference between the various SSRIs.
Clomipramine is an old antidepressant that helps with OCD treatment. In some cases, a combination of an SSRI with clomipramine is helpful for OCD symptoms. The addition of antipsychotic medications like risperidone (Risperdal) is sometimes beneficial for treatment-resistant OCD.
Studies have also shown that combining SSRIs with medications like lamotrigine and memantine appears to be helpful.
Some other medications, such as N-acetylcysteine, topiramate, and ketamine, have shown mixed results. D-cycloserine seems to have some benefits during the early stages of treatment. Benzodiazepines do not seem to have any beneficial effects in individuals with OCD.
Your healthcare professional will be able to work with you on the best medication for your symptoms.
Transcranial Magnetic Stimulation (TMS) is a non-invasive treatment for depression. It was approved by the U.S. Food and Drug Administration (FDA) in 2008.
TMS uses magnetic pulses to treat depression. This treatment is similar to the technology in an MRI machine. It is, however, not the same as Electroconvulsive Therapy (ECT) or “shock therapy.”
There are different brands of TMS machines. BrainsWay TMS now has clearance from the FDA for the treatment of OCD. This treatment seems to be generally well-tolerated, with minimal side effects, and can significantly improve patients suffering from OCD.
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The entire content of AddictionBlueprint, including content on drugs and alcohol, medications, therapies, facilities, spotlights, recommendations, and other features is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. This does not constitute a physician-patient relationship. Please seek the advice of your physician or other qualified health providers regarding your addiction, mental and medical issues.
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