What Happens When Addiction and OCD Intertwine?

Obsessive-compulsive disorder or OCD is a condition that is often talked about but rarely given the respect it deserves. OCD is a term that is exaggerated and thrown around as a joke. Because it is used as a catchphrase to elicit laughter or to use as a verbal weapon, most people do not really know what it is – or how it can and often does affect people and their loved ones. Add this to the fact that OCD is often misdiagnosed, and myths and inaccuracies, and you get unfair labeling and stigmatization, along with a lot of emotional hurt and pain.

No one wants to have OCD, yet it is out of their hands. The endless loop of obsessions and/or compulsions can be nerve-wracking, leading some to feel as if they are going insane. And, because OCD sufferers are often afraid to tell others how they feel or what they are experiencing, the shame and guilt intensify, and the OCD cycle of stress and anxiety, obsessions, and compulsions continue.

Although there are plenty of treatments available for OCD, when they fail it can lead to a host of upsetting emotions, such as anger, frustration, confusion, desperation, fear, anxiety, and/or depression. These emotions can lead to self-medication in the form of alcohol and drug use and misuse. Living with OCD can be hard – really hard, but when it is combined with alcohol the effects can be even more pronounced – and devastating.

What Is The True Definition of OCD?

Obsessive-compulsive disorder (OCD) is one of the most common mental health conditions in the US. OCD is a type of anxiety condition that involves recurring and unwanted thoughts, fears, urges, doubts, emotions, visions (obsessions), and/or ritualistic behaviors (compulsions). These obsessions and compulsions tend to require a considerable amount of time, energy, and effort. In fact, an OCD sufferer may be unable to develop or maintain a healthy and productive daily routine, while trying to ignore or stop their OCD symptoms.

OCD involves a cycle of obsessions and/or compulsions that can affect almost all areas of a person’s life. If left untreated, this anxiety condition can cause anxiety, depression, and even suicidal ideation (thoughts and attempts). Stress from non-stop obsessions, failed OCD treatments, and/or the mere nature of OCD compulsions can lead to addiction. Keep in mind, however, that all addictions are interrelated, which means that OCD can and often is linked to any addiction whether it be a drug and alcohol addiction or a behavioral addiction (i.e., gambling, shopping, or eating addiction).

When OCD is paired with addiction, the resorting mental and physical damage tends to escalate. When there is an OCD and addiction comorbidity, like OCD and drug and alcohol addiction, it is imperative that the person seek treatment for both conditions as soon as possible.

How is OCD Treated?

Obsessive-compulsive disorder (OCD) is addressed through a multi-treatment approach involving cognitive-behavioral therapy (CBT), exposure-response and prevention (ERP) therapy, a form of CBT that consists of being exposed to your OCD triggers. Other therapies may include acceptance and commitment therapy (ACT), art therapy, music therapy, hypnotherapy, individual therapy, group therapy, family therapy, couples counseling, addiction counseling, and/or trauma therapies.

Researchers suggest that the most effective therapy for OCD is ERP therapy. When therapy alone does not work, one or two medications may be added to it. The most common medications for OCD are antidepressants and antipsychotics. And, the first-line medication for OCD is SSRI antidepressants.

Natural remedies and self-help tools, like mindfulness meditation, a balanced diet, healthy coping skills and mechanisms, CBD, OCD forums or support groups, and online OCD recovery treatment programs like Impulse Therapy, have also proven to be effective OCD treatment aids. It is usually when these treatment methods fail that drug and alcohol addiction arises.

What is Addiction?

Addiction is a healthy repetitive behavior that often comes with a host of negative consequences. Addictive behaviors, like compulsive shopping, eating, gambling, or drug and alcohol abuse can look a lot like an OCD compulsion, but it is not. But because of the similarities between OCD compulsions and addictive behaviors, some researchers suggest that both conditions are behavioral addictions. Whether this is true is up for debate. More research is needed to determine if OCD is a behavioral addiction.

What is the Link Between Addiction and OCD?

Numerous studies indicate that there is a link between addiction and OCD. But although the two conditions are linked they are not the same. Researchers have found that OCD-like compulsions are linked to internet addiction among lonely adolescents.

One possible reason for this is the involvement of the same brain circuitry for OCD and addiction. Another possible reason for the link between OCD and addiction is that both conditions are reward-driven. The reward for drug and alcohol addiction may be relaxation, relief, happiness or euphoria, or escape. Or, the reward for gambling may be the ability to win lots of money. OCD compulsions, like addiction, involve some type of reward. With OCD compulsions, the reward is designed to reduce a person’s stress and anxiety – at least for a little while.

Because OCD often comes with both mental and emotional distress and pain, OCD sufferers are prone to self-medication with drugs and alcohol – or some other vice. In fact, approximately 25% of people who seek treatment for OCD also grapple with drug and alcohol addiction. The truth is living with OCD symptoms (obsessions and/or compulsions) can be overwhelming and exhausting. On the flip side, self-medicating with drugs and alcohol can provide respite from the pain and suffering that comes with having this condition.

Because the mind and body start to equate relief, happiness, escape, etc., (rewards) with drugs and alcohol, the OCD sufferer continues to return to it whenever they start to experience obsessions or compulsions. Over time and with continual abuse, the sufferer eventually develops an addiction to drugs and alcohol.

Is Addiction the Same As OCD Compulsions?

No, they are not.

Addictions are not the same as OCD compulsions.

However, they do have some things in common.

Similarities

Compulsions are actions or behaviors that are almost impossible to control or stop.

Similarities between addiction and OCD compulsions include:

• Continuously engaging in repetitive behaviors or actions
• An inability to control or stop unhealthy and recurring behaviors or actions
• Behaviors that consume a significant amount of a person’s time
• Continuing to engage in the behavior or action even though it comes with negative consequences, such as the loss of a partner, home, job, etc.

How is Addiction Different From OCD Compulsions?

A person who has an addiction receives satisfaction from engaging in the behavior or performing the action. Conversely, a person with OCD experiences stress, anxiety, shame and guilt, and/or emotional distress from engaging in compulsions (repetitive rituals or routines). 

For instance, a person with OCD likely knows that nothing will probably happen if they leave their home to go visit a friend or loved one; yet, they cannot help but worry excessively about it – so much so that they “hole up” in their home to protect themselves from harm. 

A person with an addiction may experience relief, happiness, or satisfaction from taking a hit of drugs or drinking until they are drunk. If they are high or drunk they cannot think about all of their problems. Engaging in addictive behaviors offers these individuals a temporary reprieve from life issues.

Can OCD Symptoms Resemble Addiction Symptoms?

Yes, they can.

OCD usually presents during adolescents (teens to early 20s), however, it can also rise earlier or later than this time. Because the teenage years are when drug and alcohol abuse is the highest, the risk of having OCD and experimenting with drugs and alcohol and forming a dependency on them is also the highest. Teenagers who suffer from OCD are especially susceptible to using, misusing, and abusing drugs and alcohol.

Teenage and adult OCD sufferers may resort to self-medication with drugs and alcohol to manage their OCD symptoms. OCD obsessions can cause emotional distress, which in turn can cause people with OCD to socially isolate or withdraw from their friends and loved ones. These obsessions can also destroy friendships and romantic relationships and make it harder to make new friends, date, or marry someone.

Both scenarios can lead to stress, anxiety, and depression – which can lead to self-medication with drugs and alcohol. The stress and angst that comes with OCD obsessions and compulsions can trigger addiction (as a temporary escape from the non-stop intrusive, and unwanted thoughts, urges, worries, visions, emotions, and repetitive rituals or routines. ) in OCD sufferers.

Can OCD-Related Social Isolation Lead to Addiction?

Yes, it can.

OCD-related social isolation can lead to addiction, especially drug and alcohol addiction. OCD sufferers are fully aware that their obsessions and compulsions are illogical, yet, they are powerless to stop them. OCD sufferers like addicts often feel ashamed of their thoughts, urges, and behavior.

And, similar to drug and alcohol addiction, OCD can cause people to withdraw from the outside world – i.e., their careers, families, friends, romantic partners, and life. OCD, like addiction, is lonely. People with OCD may intentionally avoid people and activities so that others do not detect their OCD symptoms. Thus, shame and guilt, loneliness, and physical withdrawal from society can lead to a full-blown addiction.

Can OCD and Addiction Be Treated at The Same Time?

Absolutely!

The key to addressing comorbid conditions like addiction and OCD is treating the conditions at the same time. CBT, ERP, and ACT, along with trauma therapy, and/or addiction counseling are effective ways to treat addiction and OCD. OCD therapists can teach sufferers who are grappling with OCD symptoms and addiction how to cope with their thoughts and urges in healthier ways, so they do not feel the need to return to unhealthy ways (i.e., drugs and alcohol, gambling, shopping, porn, video game, etc.) of managing their OCD symptoms.

Antidepressants, especially SSRI antidepressants, along with natural remedies like crystal therapy, mindfulness meditation, CBD, and/or hypnosis can also help OCD sufferers manage their symptoms in natural and safe ways. Common medicines used to treat OCD symptoms include fluvoxamine (Luvox CR), paroxetine (Paxil, Pexeva), fluoxetine (Prozac), sertraline (Zoloft), or clomipramine (Anafranil).

What is It Like to Struggle With OCD and Addiction?

Listed below are real-life accounts of what it is like to simultaneously live with OCD and addiction:

• “I am an addict with OCD. I have been sober for over ten years, but I am sure there is a correlation between the two.”

• “I have definitely fallen back on substances to cope with my OCD. I smoked marijuana around the clock for a few years, and although a lot of negatives came with this, it helped my OCD a lot. I haven’t smoked in a couple of years but my OCD can be bad depending on whether I’m on, off, or transitioning meds. When I am at my wit’s end I usually find myself drinking.”

• “I have addictive tendencies to the point where I would describe them as a fundamental feature of my personality. I have struggled with drinking/drugs, porn compulsions, food, and video games. Basically, anything my brain perceives as pleasurable is a magnetic pull for me.

  I do not think it is uncommon for people with OCD to have these problems, I think there is a very clear relationship between addictive behavior and obsessive-compulsive behavior. Even before I got hold of ‘adult vices’ I was like a crack fiend with shutting doors and faucets, I would just sit in one place doing the same thing over and over like it was the best thing in the world, and it was like pulling teeth to stop what I was doing.”

• “OCD and addiction are labels/terms of language that we have created to describe sets of behavior. There are huge similarities between addictive behavior and compulsions. Addictive behavior is compulsive, after all… we don’t have control over it. Although, I will say that the physical and mental experience of an “urge” from my porn addiction is different from compulsion from my OCD.

  And, the difference is FEAR. My compulsions were driven by a feeling of unease, which in its extreme form became unbridled FEAR. My urges to watch porn are more of an uncontrollable desire or need, not driven by FEAR but by DESIRE. All of these things are linked, and I wouldn’t be surprised to see a high correlation between people with OCD and addiction problems, but I still think that there is enough difference that the distinction is useful.”

• “I found that once my OCD kicked in that I struggled more with my sobriety.”

Final Thoughts

Obsessive-compulsive disorder (OCD) and addiction are connected, but not the same. Perhaps, OCD sufferers become addicted due to changes in brain circuitry (i.e., a serotonin deficiency or imbalance), or maybe, it is due to the constant stress of non-stop intrusive and unwanted thoughts, urges, emotions, visions, and/or repetitive behaviors. Regardless, both conditions contain compulsive behaviors, however, however, these compulsions look different in each condition.

Still, it is important to keep in mind that having OCD increases your risk of also developing an addiction. Also, understand that alcohol and drugs can trigger or worsen OCD symptoms, making it harder to treat, and the addiction harder to stop. If you believe that you are struggling with OCD and addiction, seek OCD help as soon as possible.

References

• Rector, N. A., Richter, M. A., Katz, D., & Leybman, M. (2019). Does the addition of cognitive therapy to exposure and response prevention for obsessive-compulsive disorder enhance clinical efficacy? A randomized controlled trial in a community setting. The British Journal of Clinical Psychology, 58(1), 1–18. Retrieved from https://doi.org/10.1111/bjc.1218
• Figee, M., Pattij, T., Willuhn, I., Luigjes, J., van den Brink, W., Goudriaan, A., Potenza, M. N., Robbins, T. W., & Denys, D. (2016). Compulsivity in obsessive-compulsive disorder and addictions. European Neuropsychopharmacology, 26(5), 856–868. Retrieved from https://doi.org/10.1016/j.euroneuro.2015.12.003
• Abramovitch, A., & McKay, D. (2016). Behavioral impulsivity in obsessive-compulsive disorder. Journal of Behavioral Addictions, 5(3), 395–397. Retrieved from https://doi.org/10.1556/2006.5.2016.029The
• The University of Helsinki. (2021). Lonely adolescents are susceptible to internet addiction. ScienceDaily, 22. Retrieved from www.sciencedaily.com/releases/2021/02/210222124640.htm
• Conroy, S. (n.d.). Co-occurring OCD and substance use disorder: What the research tells us. International OCD Foundation (IOCDF). Retrieved from https://iocdf.org/expert-opinions/co-occurring-ocd-and-substance-use-disorder-what-the-research-tells-us
• Bapat, M. (2022). How does OCD affect addiction risk and treatment? GoodRx. Retrieved from https://www.goodrx.com/conditions/obsessive-compulsive-disorder/ocd-and-addiction