What Is OCD?
Obsessive-compulsive disorder (OCD) is a mental health condition characterized by two different components: obsessions and compulsions.[1]
Obsessions are intrusive thoughts, images, or urges that cause distress and are difficult to get rid of. Compulsions are repetitive behaviors or mental processes that occur as a result of those obsessive thoughts, done to relieve the anxiety created by the obsessions or prevent a feared negative outcome.
The American Psychiatric Association classifies OCD as a clinically significant psychiatric disorder that is time-consuming, causes distress, and can significantly disrupt daily life and damage personal relationships and job performance.[2] Approximately 2 to 3% of the general population is diagnosed with OCD; however, without professional assistance, the symptoms will typically continue and may worsen over time.[3]
Common Signs and Symptoms of OCD
People who experience OCD typically experience the following patterns:
Common Obsessions
- Fear of contamination or illness
- Unwanted aggressive, sexual, or religious intrusive thoughts
- Fear of injuring themselves or someone else
- An intense need for symmetry, order, or exactness
- Fear of losing control
Common Compulsive Behaviors
- Excessive cleaning or handwashing
- Checking behaviors such as locks, appliances, or safety
- Counting, arranging, or ordering objects in a specific way
- Repeatedly seeking reassurance from others
- Mental rituals such as reviewing or neutralizing distressing thoughts
OCD and Substance Abuse
There is a well-established relationship between obsessive-compulsive disorder (OCD) and co-occurring substance use disorders (SUDs). A large study published in 2022 in JAMA Network Open indicates a 3.7-times increased risk of substance abuse among OCD patients versus the general population.[4]
One of the major reasons for this association is that people with OCD use substances to self-medicate.[5] Alcohol, cannabis, and opioids can temporarily reduce anxiety and obsessive thinking. Eventually, however, substance use has a negative effect on the underlying OCD condition, increasing impulsive behavior and creating a new cycle of craving and withdrawal that adds to their distress.
The relationship between OCD and substance abuse is bidirectional and complicated. Using substances will reduce obsessive-compulsive symptoms for a short period of time, but in the long term, it continues to reinforce substance abuse, interferes with the serotonin system (which is thought to be involved in the development of OCD), increases the degree of impulsivity that makes resisting compulsions and cravings more difficult, and worsens anxiety and intrusive thoughts during withdrawal.[6]
Because of this, treating OCD and addiction as separate disorders typically does not work.
OCD and Alcohol Abuse
Alcohol is the most commonly used substance abused by people with OCD.[7] Alcohol is often used to self-medicate for chronic anxiety and intrusive thoughts because it produces calming effects, which interrupt obsessive thoughts and reduce the need to perform compulsive behaviors.
However, the effects of alcohol are short-lived. Alcohol interferes with sleep, which reduces the cognitive control required to handle obsessive thoughts, and produces very high levels of anxiety when a person stops drinking, which can greatly exacerbate obsessive-compulsive symptoms.[8] For people with both OCD and alcohol abuse, dual diagnosis treatment that addresses both the neurobiological and psychological aspects of OCD and SUD is critical for continued recovery.
Compulsive Behavior vs. Addiction
Both OCD and addiction involve repetitive behaviors that are hard to control. As a result of this similarity, some people wonder whether they are experiencing one condition, the other, or both. It is important to understand the difference because it affects treatment.
A person with OCD has compulsive behaviors because of anxiety, and they engage in the behaviors to prevent some type of threatened consequence. They do not enjoy the compulsive behaviors that they perform, but the anxiety they experience when thinking about not performing the behaviors is so overwhelming that they cannot stop performing them.
In contrast, a person with addiction initially engages in substance use for the rewards and pleasures associated with it. They want to experience the high, the energy, or the calming effects produced by the drug, or may be consuming them to avoid withdrawal symptoms. Many people with OCD also have a substance use disorder because they were using substances to self-medicate, and, over time, they become physiologically and psychologically dependent on them.
When a person is suffering from both conditions, both conditions require attention from a qualified mental health professional. If only one condition is treated, the other can make recovery more difficult and increase the risk that symptoms will continue or return over time.
