Obsessive-Compulsive Disorder and Addiction

Obsessive-compulsive disorder (OCD) is a common mental health disorder that can often co-occur with addiction. When at least one mental health disorder occurs at the same time with at least one substance use disorder, this is known as a co-occurring disorder or dual diagnosis. Co-occurring disorders can contribute to each other and complicate recovery, often requiring a comprehensive treatment program to treat someone’s OCD and substance use disorder (SUD) simultaneously.1

This page will help you understand what obsessive-compulsive disorder is, how it relates to addiction, and the various forms of therapy and treatment interventions available to address both conditions.

What Is Obsessive-Compulsive Disorder?

Doctor explaining what OCD is to patientObsessive-compulsive disorder (OCD) is a chronic condition characterized by recurring, unwanted thoughts (obsessions) and compulsive behaviors (compulsions). These obsessions and compulsions often interfere with work, school, relationships, activities, and responsibilities.2

Obsessions are unwelcome thoughts that may include:3

  • Persistent thoughts (e.g., that something is contaminated).
  • Images (e.g., disturbing scenes).
  • Urges (e.g., to commit acts of violence).

People with OCD will often try to suppress these thoughts or avoid things that may trigger them.  Sometimes, they will perform compulsive or repetitive behaviors in an effort to neutralize obsessive thoughts. Compulsions can be physical or mental actions, such as cleaning or counting.2,3

For someone to be diagnosed with OCD, these obsessions or compulsions must be either or both time-consuming (taking more than 1 hour per day) and causing someone significant distress or problems to the point they have difficulty functioning. Additionally, these obsessions and compulsions must not be better explained by a differential diagnosis (e.g., persistent stress due to generalized anxiety disorder).3

Symptoms of OCD

People suffering from OCD can exhibit a wide variety of symptoms.

Examples of common intrusive thoughts or obsessions associated with OCD include:1

  • Fear of germs or contamination from interacting with others.
  • Need for order, such as where things might be placed in one’s living area.
  • Repeated doubts, like wondering if someone locked the door or not.
  • Religious concerns and anxiety about unknowingly sinning.
  • Recurrent sexual or violent mental images.
  • Aggressive impulses, sometimes to harm a child or parent.

Examples of common behaviors or compulsions associated with OCD may include:1

  • Checking and re-checking (e.g., that doors are locked, alarms are set, appliances are off).
  • Cleaning, such as excessive handwashing.
  • Hoarding or saving unnecessary items.
  • Repetitive mental acts such as counting, praying, and repeating words or phrases.
  • Ordering and re-ordering objects to achieve symmetry.
  • Constantly asking others for reassurance.
  • Repetitive actions like walking in and out of a doorway multiple times.

There are also many disorders with similar characteristics that are considered separate from, but closely related to OCD that are identified in the Diagnostic and statistical manual of mental disorders (5th ed.) (DSM-5). These include:3

  • Body dysmorphic disorder, which is the preoccupation with perceived flaws in one’s own body that are very minor or imperceptible to others.
  • Hoarding disorder, which is characterized by an unwillingness to discard possessions.
  • Trichotillomania (hairpulling disorder), which is characterized by the compulsion to pull one’s own hair out.
  • Excoriation (skin-picking) disorder, in which the afflicted person compulsively picks at their own skin.
  • Substance or medication-induced OCD or related disorder.
  • OCD or related disorder caused by another medical condition.
  • Other specified forms of OCD or related disorders such as body-focused repetitive behavior disorder, which involves recurrent behaviors such as nail or lip biting despite attempts to stop, and obsessional jealousy, which is the preoccupation with a partner’s perceived infidelity.

Obsessive-Compulsive Disorder and Addiction: A Dual Diagnosis

doctor holding chalkboard that says DSM-5, which contains diagnostic criteria for OCDWhile OCD and SUD both cause compulsive behavior, they are two distinct disorders. Unlike with OCD, the compulsion to seek drugs or alcohol among people with substance use disorders is largely due to the pleasure derived from these drug seeking behaviors.1

It is common to have both a substance use disorder and OCD. Estimations vary widely between a prevalence of 10% to 40% of individuals with OCD suffering from a SUD at some point in their lives. Additionally, the fact that fewer than 50% of individuals with co-occurring substance use disorders and obsessive-compulsive disorder (OCD) seek treatment for OCD suggests rates of co-occurrence are much higher than reported.1

Like OCD, diagnosis of SUD must be made by a clinician utilizing the criteria outlined in the DSM-5. A list of these 11 criteria, which encompass psychological, social, and physical indicators,3 can be found in our guide to addiction signs and symptoms.

How to Treat OCD and Substance Use

Research indicates that comprehensive, integrated treatment is more effective than treating each condition separately.4

A treatment facility must be equipped to treat co-occurring disorders simultaneously to meet each person’s specific needs most effectively.4

Therapy for OCD and Addiction

Exposure response and prevention therapy (ERP) is a type of cognitive-behavioral therapy that has been shown to be useful in treating obsessive-compulsive disorders. During exposure and response prevention therapy, the client spends time in the situation that triggers the compulsion (for instance, touching dirty surfaces or objects) but then is prevented from engaging in the subsequent compulsive behavior, like handwashing.2

It is effective in reducing compulsive behaviors, in conjunction with medications or for those who do not respond well to medications.2

There are many other types of therapy used in addiction treatment and the treatment of co-occurring disorders, including:5,6,7

  • Cognitive behavioral therapy (CBT), in which patients learn to identify situations that cause problematic thought patterns and make positive adjustments.
  • Dialectical behavior therapy (DBT), which is a form of CBT that teaches patients opposing coping strategies of change and acceptance.
  • Family behavior therapy (FBT). Families can play an important role in a patient’s recovery. FBT helps improve the way people and their loved ones interact and support one another by setting goals, rewarding progress, and encouraging family members to take an active role in the patient’s recovery.

Medications to Help with Obsessive-Compulsive Disorder and Substance Use

Medication, often used in conjunction with therapy, is an effective form of treatment for OCD and certain addictions.1,2

Antidepressant medications are often used to treat OCD symptoms,2 while other medications may be used stabilize someone during detox and in the long-term treatment of certain substance use disorders.8

Finding the Right Treatment Facility for OCD and Addiction Treatment

meeting during the pandemicThere is no one-size-fits-all approach to addiction treatment and recovery.9 Finding the right program or facility to meet a person’s specific needs is crucial.

There are many important things to consider when seeking treatment:10

  • Does the facility have detox services? Medical detox is often the first stage in the treatment process for people diagnosed with substance use disorders.
  • Which levels of addiction treatment are offered by the facility? Does the facility offer both inpatient addiction treatment services, outpatient co-occurring disorder rehab, or both? Do they utilize all forms of evidence-based treatment, including behavioral therapies and medication if necessary?
  • Does the program or facility tailor treatment to meet each person’s unique needs? Treatment should be individualized to address each person’s needs. This means medical, psychological, social, vocational, and legal problems should also be addressed during treatment.
  • Is treatment assessed and modified as a person’s needs change? Treatment is a process that often requires adjustments throughout.
  • The duration of treatment provided. The appropriate time spent in treatment (i.e., short-term rehab, month-long addiction treatment, long-term rehab) will vary based on the patient’s needs.
  • Whether the treatment center facilitates continuing care. Also referred to as rehab aftercare, continuing care involves ongoing support following formal treatment. Continuing care can help people continue to make healthy choices and to remain engaged in their recovery process.

How Can I Pay for My Rehab?

Due to federal mandates like the Affordable Care Act (ACA), people now have greater access to mental health and substance use disorder treatment. Additionally, most insurance companies are required to cover addiction treatment as they would medical and surgical procedures.11

The extent of coverage will vary between individual plans. Desert Hope Treatment Center accepts insurance coverage from many major insurers, including:

Coverage at Desert Hope can be verified within minutes using the confidential .

Other ways to pay for rehab are also available. Some facilities offer financing options or flexible payment schedules, while some also accept credit card payments.

Outlook on Long-Term Recovery from Addiction and OCD

Addiction and mental health disorders like OCD are complex and ongoing, but many people can manage their conditions and live fulfilling lives in recovery.

The importance of aftercare should not be underestimated. Staying engaged in recovery and building social support can be vital to long-term success. Support groups like 12-Step programs, as well as individual counseling, are examples of continuing care and are widely available.12

If you or someone you love suffers from obsessive-compulsive disorder and a substance use disorder, treatment can help. Call one of our admissions navigators as soon as possible to start a treatment program that is right for you or your loved one at .

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