OCD and substance use disorders (SUD) often occur at the same time, with drugs and alcohol providing a temporary escape from intrusive thoughts and compulsions.
If you have obsessive-compulsive disorder (OCD), you know how anxiety-inducing and distressing the seemingly endless loop of intrusive thoughts can be. As a result, many people use drugs and/or alcohol as a way to cope with their OCD symptoms.
Substance use disorder (SUD) and OCD commonly occur together. While they are both distinct mental health conditions, SUD and OCD both involve cycles of repetitive behaviors and make you feel like you don’t have control over your own life. They also can reinforce one another—and OCD can be harder to identify when SUD is severe.
Fortunately, addiction and OCD are both treatable mental health conditions, and it’s possible to address OCD symptoms while you are in recovery for substance use (and vice versa).
What is OCD?
OCD is a complex, chronic mental health condition characterized by a cycle of obsessions and compulsions. Obsessions are intrusive thoughts, images, urges, feelings, and sensations that cause recurring anxiety or distress. In response, you may perform compulsions, which are repetitive physical or mental behaviors done to relieve distress or prevent something terrible from happening.
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All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
What is addiction?
Substance use disorder (SUD) is a problematic pattern of substance use that ranges from mild to severe. Alcohol, cannabis (marijuana), and opioids are the most commonly used substances.
SUD affects a person’s brain and behavior, leading to strong or uncontrollable urges to use a substance—also known as addiction. Because of the physical and psychological dependency SUD creates, people with addiction issues will continue to drink, use drugs, etc., despite the negative consequences.
Why do OCD and SUD co-occur?
Several factors link obsessive-compulsive disorder and substance use disorder. These include:
Self-medication and safety behaviors
Many people with OCD may self-medicate with drugs or alcohol to ease anxiety or quiet intrusive thoughts, explains Tracie Ibrahim, LMFT, CST, NOCD’s Chief Compliance Officer.
Using substances is a safety behavior—an action that is done to provide temporary relief from distress. However, instead of learning how to tolerate discomfort, people with OCD may become more dependent on drugs or alcohol to cope. The more someone uses substances to manage OCD symptoms, the harder it becomes to stop.
Genetics
According to Ibrahim, people are more likely to develop OCD and SUD if there’s a family history of the conditions. One study revealed that people with first-degree relatives (parent or sibling) with alcohol dependence have an increased risk of having OCD.
Trauma
Experiencing a traumatic event has been linked to the onset of OCD. Exposure to traumatic experiences—particularly during childhood—have been shown to increase the chances of developing SUD.
Impulsivity
According to Patrick McGrath, PhD, Chief Clinical Officer at NOCD, addiction is more closely linked to impulsivity than compulsivity. While compulsions are done to prevent perceived danger, impulsivity involves acting on urges without thinking. However, studies show that people with OCD often self-report higher levels of impulsivity, meaning they may feel strong urges to act on things impulsively, even if they don’t always follow through with compulsions.
What’s the difference between an addiction and a compulsion?
It’s easy to assume that since OCD compulsions are repetitive, they must be addictions. While both compulsions cause urges that can be hard to resist and can lead to significant distress if you don’t engage, they are completely different symptoms.
“Addiction can go away over time as you get sober, and you won’t have to struggle in the same way you used to,” explains Ibrahim. “Compulsions are something we do because OCD triggers a false alarm, convincing us that we must solve this ‘terrible’ thing right now.”
Ibrahim also adds that addiction is more intentional than a compulsion. For example, if someone has an SUD, they would be aware that they’re driving to a bar to get a drink. If you have OCD, you could be ruminating for up to 30 minutes trying to solve a problem without realizing it. While both addictive behaviors and compulsions can feel involuntary, Ibrahim says you can have more control and awareness of an addiction than OCD.
How substance use affects OCD symptoms
Substance use can increase intrusive thoughts and compulsions. For example, stimulants (e.g., Adderall, Dexedrine, Ritalin, cocaine) can significantly increase anxiety and distress, which, in turn, can trigger more intrusive thoughts and compulsions. This means that even when the effects of the drug wear off, the anxiety and OCD symptoms can persist or become worse.
On the flip side, while SUD can make OCD worse, OCD itself fuels substance use even more, says Dr. McGrath. Many people with OCD turn to substances as a way to escape intrusive thoughts or relieve anxiety from compulsions. However, this creates a cycle, reinforcing both conditions and making them more difficult to treat.
Getting help for OCD and addiction
If you have OCD and SUD, treatment is available to manage both conditions.
Treating OCD
The first-line treatment for OCD is a form of cognitive behavioral therapy (CBT) called exposure and response prevention (ERP) therapy.
During ERP, a therapist will gradually guide you through exercises that help you address your fears head-on while resisting the urge to engage in compulsions, a process known as response prevention. Over time, ERP teaches you to sit with the discomfort from intrusive thoughts without resorting to compulsions.
Treating addiction
SUD treatment is highly individualized, but experts recommend a combination of therapy and peer support. Some examples of treatment include:
- Counseling: You’ll work with a therapist to better understand the addiction, your triggers, and your reasons for using substances. There are several SUD therapies, including CBT, contingency management (CM), motivational enhancement therapy (MET), and motivational interviewing (MI).
- Medication: People with dependency on opioids may be prescribed medications such as buprenorphine, methadone, and naltrexone to lessen the effects of withdrawal symptoms and maintain their recovery.
- In-patient care: Inpatient treatment programs (sometimes called detox or rehab) are intensive programs designed to treat severe SUD and help people safely withdraw from using drugs and alcohol.
- Support groups: Peer support meetings like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), SMART Recovery, and Women for Sobriety allow people to share their experiences and encourage others who are getting sober.
Does getting sober make OCD worse?
When someone with OCD stops using substances, they lose a coping mechanism that they depended on for relief. This can increase anxiety and make intrusive thoughts feel more intense at first, leading some to worry if sobriety is making their OCD worse.
However, according to Ibrahim, it’s not sobriety itself that worsens OCD—it’s the anxiety and stress that can come with withdrawal and adjusting to life without substances.
Without drugs or alcohol to “quiet” intrusive thoughts, you may experience an urge to engage in compulsions more frequently—at least in the short term. However, over time, staying sober allows for more effective OCD treatment, as ERP may be harder to do while using substances.
Ibrahim compares getting sober from an SUD to getting “sober” from compulsions in ERP. “You identify the things you’re doing, you stop doing them, and then your symptoms start to get better, and you get more control,” she says.
What if I relapse during OCD treatment?
A relapse—using substances after a period of sobriety—during ERP therapy doesn’t always mean a major setback. However, the severity of the relapse matters, notes Ibrahim. While having a bad day or minor slip-up won’t hinder your progress in ERP, a more serious relapse—like blacking out or overdosing—can be dangerous and may require shifting the focus of treatment to getting sober first.
If you are concerned about relapsing, it’s important to have an open conversation with your ERP therapist. They can determine whether or not to continue ERP, adjust it to accommodate your needs, or temporarily halt it until you have a stable foundation of sobriety.
Relapse can feel discouraging, but it is a common experience in recovery from drugs and alcohol. Both OCD treatment and SUD recovery are challenging but gradual processes, and setbacks are a normal part of healing.
Bottom line
If you’ve been using drugs or alcohol to cope with your OCD, you’re not alone. SUD and OCD often co-occur, and it’s possible to find relief with the right treatment plan.
When reaching out to an OCD specialist, be honest about your substance use habits. Together, you can create a recovery plan to break free from the cycle of OCD and learn to stop relying on substances as a safety behavior.
Key takeaways
- OCD and substance use disorders often co-occur due to factors like genetics, trauma, and self-medication.
- Substances can worsen OCD symptoms over time by reinforcing compulsive behaviors.
- Getting sober may feel like it worsens OCD at first, but over time, sobriety helps with more effective treatment.