Both Obsessive-Compulsive Disorder (OCD) and Substance Use Disorder (SUD) are complex mental health conditions that can drastically affect your quality of life. They are often misunderstood and stigmatized, making it even more challenging for those who suffer from these conditions to seek help.
While both these conditions can be bad enough on their own, they can be even worse when combined, feeding off each other to make each other worse than they would be alone.
Co-occurring disorders, also known as dual diagnosis, are when a person has two or more mental health disorders at the same time. Dual diagnosis is not uncommon, and it requires a comprehensive treatment approach that addresses both disorders simultaneously.
For most people with co-occurring disorders, treating one or the other isn’t enough — you have to treat both simultaneously. While you might be able to get away with treating one first to get it under control, eventually you have to address both.
It’s not at all uncommon for people with co-occurring disorders to focus on one disorder, let the other one go untreated, and then end up with a relapse on their hands. This is especially true for Substance Use Disorder.
What usually happens is that the person with SUD gets sober — often by going to rehab or detox, or maybe even a sober living facility — and the effort it took to get sober is so huge that they don’t have the energy to deal with the other disorder.
This is totally understandable, but it’s a deadly path to follow. Many people with co-occurring disorders can directly tie relapses to a flare-up with the other disorder.
For example, the distressing obsessions in OCD might drive a person towards substance use, while the withdrawal symptoms of SUD might intensify OCD symptoms.
Every disorder is unique, so it’s helpful to understand exactly how OCD works to better see how a flare-up could cause a relapse on your drug of choice.
Obsessive-Compulsive Disorder, or OCD, is a chronic and long-lasting disorder in which a person has uncontrollable, recurring thoughts (obsessions) and behaviors (compulsions) that they feel compelled to repeat over and over.
The cycle starts with an obsession. These obsessions trigger distressing feelings of anxiety or stress that drive you toward repetitive actions — known as compulsions.
For example, you might have an obsession with germs or dirt, leading you to wash your hands repeatedly. Or you might have unwanted, intrusive thoughts of causing harm to others, leading you to avoid certain places or people.
OCD, like many disorders, can range from mild to severe. These obsessions and compulsions can take a significant toll on your daily life in more severe cases, interfering with your regular activities and causing a great deal of distress.
Unfortunately, OCD has become something of a buzzword online lately, with many people joking about having OCD or claiming to have OCD when they actually don’t.
It's essential to remember that OCD is not about being a “perfectionist” or liking things in a particular way. It’s a serious mental health condition that can cause significant distress and impairment in functioning. If you simply like things to be orderly, that’s not the same as having OCD.
The disorder generally needs to be diagnosed by a psychiatrist or doctor — it helps if they specialize in the disorder as it’s less common than other mental health conditions, like depression or anxiety.
Substance Use Disorder, commonly referred to as SUD, is a medical condition characterized by an intense and uncontrollable desire to use substances despite knowing their harmful consequences.
When you have SUD, you might find it challenging to control your use of these substances, even when it starts affecting your health and relationships.
You may continue using the substance despite facing negative consequences, and you might experience withdrawal symptoms when you try to stop. It's a long-term condition that can lead to significant problems in your day-to-day life.
Remember, SUD is not about a lack of willpower or moral failure — It’s a disorder that affects your brain and behavior, and it requires professional help to overcome.
For most people, this means going to a detox facility at the very least. For others, sober living or an intensive outpatient program (IOP) might be enough, and rehab is also very common.
It can be difficult — if not impossible — to stop using or drinking on your own. Most people with SUD try to stop or moderate at some point before seeking help — they usually fail. If you’ve found that, no matter how hard you try, you can’t seem to stop, then you probably need to consider getting treatment.
Research shows that people with OCD are more likely to develop SUD compared to the general population. People with SUD often exhibit OCD symptoms, even if they haven’t been directly diagnosed with the disorder.
One possible explanation for this connection is that people with OCD might use substances to self-medicate and alleviate their distressing symptoms. On the other hand, the use of substances can exacerbate OCD symptoms, creating a vicious cycle that can be challenging to break.
There is some research that shows a genetic link between OCD and SUD, which suggests that one is not necessarily causing the other or the result of the other, but rather that they’re just both more likely to occur together.
Environmental factors, like stress and trauma, can also contribute to the development and exacerbation of these disorders.
One of the most common things you’ll hear in a rehab setting is to, “Change your people, places, and things.” This means that, if you’re around people who are a bad influence or places/things that cause stress or anxiety in your life, you might be more likely to relapse, indicating how much of an influence your environment can have on you.
Both disorders are characterized by involuntarily engaging in a behavior that you know is harmful in some way. Many addicts and alcoholics will talk about how much they wanted to stop using or drinking and then continuing to do so despite serious consequences.
Though OCD is much less well known, they will report the same types of problems — they know that their compulsions are a problem, that they’re even harmful, but they’ll continue doing them anyway.
Both OCD and SUD may affect or be affected by changes in the prefrontal cortex, where behavioral control and decision-making occur, which could be another reason they occur together. Both disorders also are characterized by abnormal levels of glutamate in the brain and problems with dopamine.
However the disorder is caused, the impact of the disorder can be serious — and even deadly.
If you have either of these disorders, you already know how heavily it can impact your life. There’s nothing that can escape from it. Relationships, jobs, money, time, school, kids, health, hobbies — all can and will be affected by these disorders if they get out of control.
Having OCD can be distressing and debilitating, and when coupled with SUD, it can make your struggle so much worse. The compulsive behaviors in OCD can interfere with daily activities, while the intense cravings and withdrawal symptoms in SUD can make it challenging to maintain sobriety.
And once you’ve relapsed, it’s likely your entire life will go into a tailspin if you’re in the later stages of your addiction. While some people are able to maintain their addiction for a period of time, eventually it always spirals out of control.
When this happens, any work you might be doing to reduce the symptoms of your OCD will likely stop, or even regress. OCD has a variety of treatments, but they all require you to be stable and sober. If you’re actively using or drinking, it’s unlikely that the treatments will be effective.
On top of that, the stigma associated with both disorders can lead to social isolation and keep you from seeking help. People with OCD are often ashamed of their behavior, knowing that it’s “weird” or “crazy” and that “normal” people wouldn’t understand.
As a result of isolating, boredom and loneliness creep in, which can be powerful triggers for using or drinking.
As you can see, it’s a terrible cycle that generally doesn’t break until you finally decide to seek help for both disorders.
Treating co-occurring OCD and SUD requires a comprehensive approach that addresses both conditions simultaneously. Cognitive-Behavioral Therapy (CBT) has proven to be effective in treating SUD, and a form of CBT known as Exposure Response Prevention (ERP) is most effective when treating OCD.
CBT helps people understand their thoughts and behaviors more deeply. It then helps them see how they contribute to their symptoms. You and your therapist will use this knowledge to come up with specific strategies to use when problematic thoughts and behaviors occur.
Many people struggling with SUD find that they are able to better manage cravings and triggers using CBT techniques in combination with other, more traditional approaches, like a 12-step program.
ERP, on the other hand, is all about confronting the thoughts or situations that you fear. You then attempt to make a choice to not engage in the compulsive behavior you would usually engage in.
Essentially, you expose yourself to gradually more intense triggers, training yourself not to respond to those triggers with the compulsive behavior you’d normally do. This has proven more effective than other forms of CBT for OCD.
For people with OCD and SUD co-occurring, it’s critical to work with a therapist who will combine these practices together as part of a comprehensive treatment plan.
In addition to therapy, medication can also be beneficial in managing these disorders. Selective serotonin reuptake inhibitors (SSRIs) are often used to treat OCD, while medications like naltrexone and buprenorphine can be used for SUD.
It's important to remember that treatment is a personal journey, and what works for one person might not work for another. Therefore, it's crucial to work with a healthcare provider to develop a personalized treatment plan that fits your unique needs and circumstances.
There are numerous case studies that highlight the successful treatment of co-occurring OCD and SUD.
For instance, a study published in the Journal of Clinical Psychiatry reported a case of a 35-year-old man with severe OCD and alcohol use disorder. After undergoing a combined treatment of CBT and medication, the patient reported a significant reduction in his OCD symptoms and alcohol use.
Another study published in the Journal of Substance Abuse Treatment highlighted the case of a 30-year-old woman with OCD and cocaine use disorder.
After receiving dual-diagnosis treatment, the patient showed a considerable decrease in her OCD symptoms and cocaine use, demonstrating the effectiveness of treating both disorders simultaneously.
If you’re struggling with either of these disorders, you don’t have to struggle alone.
There are many options for getting sober and getting your OCD treated at the same time, and you don’t necessarily have to go to a treatment center — it’s possible you can effectively treat both disorders through an IOP program or sober living program.
Are you looking for addiction treatment in Texas? At ASIC Recovery, our Intensive Outpatient Program (IOP) is dedicated to helping you develop healthier coping skills and build a supportive recovery network.
Cristal Clark, LPC-S, is the Medical Reviewer for ASIC Recovery Services. She reviews all website content for quality and medical accuracy. She is a master’s level Licensed Professional Counselor Supervisor and graduated from Liberty University in 2011. She has worked in the behavioral and mental health field for over 12 years and has a passion for helping others. She has been clinical director and CEO of a 200 plus bed facility, PHP, and IOP, with experience managing a team of counselors, individual/group/and family therapy, and coordinating continuum of care. Cristal is trained in EMDR and certified in non-violent intervention. She is a member of American Counseling Association and American Association of Christian Counselors.