Obsessive-compulsive disorder, or OCD, is a mental health problem characterized by two defining traits: unreasonable thoughts and fears, referred to as obsessions and repetitive behaviors, or compulsions, that the individual may be helpless to control. Compulsions may begin as a way to soothe or stop obsessive thoughts, but ultimately, the obsessions and compulsions feed into each other and disrupt normal activities like going to work or school and participating in social events.
Common expressions of OCD include a fear of germs that leads to constant handwashing; persistent images of accidental death, leading to compulsive checking of the stove, sharp objects, or potential dangers; or fear of spiritual harm from taboo activities, leading to avoidance of social situations.
The combination of obsessions and compulsions can be so disturbing that many people who struggle with this mental health disorder develop a substance use disorder as a way of self-medicating the symptoms of OCD. The Journal of Anxiety Disorders published a research article in 2008, which found that 27 percent of 323 study participants with OCD also had a substance use disorder; of those, 70 percent reported that OCD had preceded their addiction by at least one year, indicating that the mental illness led to self-medicating behavior. Addiction and OCD are very similar, according to an examination of the brain and behavior published in the Yale Journal of Medicine and Law.
To help people struggling with co-occurring addiction and OCD, it is important to understand what the potential treatment plan may entail. People with co-occurring disorders are more likely to suffer chronic medical, emotional, and behavioral problems. A relapse in one condition typically leads to a relapse in the other, so it is important to treat both OCD and addiction together.
When It’s More Than Substance Abuse
We Address & Treat Underlying Co-Occurring Issues
Treating Co-Occurring OCD and Addiction
The National Institute on Drug Abuse (NIDA) notes that the first step in any treatment for substance abuse involves detoxing, safely and with medical supervision, from the addictive drug. Addictions to many substances, like opioids or alcohol, may require maintenance medications to ease the person off the drug, so they do not experience dangerous or uncomfortable withdrawal symptoms. Other medications, like over-the-counter pain medications, anti-nausea drugs, or psychiatric medications to stabilize mood, can be used to treat more intense withdrawal symptoms. Withdrawing from most substances takes up to two weeks when completed with the help of a medical professional. In some instances, such as with benzodiazepine addiction, a tapered detox approach may be used.If a person struggling with addiction attempts to detox without the help of a doctor, they are more likely to relapse. If their body’s tolerance to the drug has lowered, they are more likely to overdose and need emergency medical attention. Medical supervision during detox is very important.If a person has co-occurring OCD, a psychotherapist will be able to accurately diagnose symptoms of this condition when the person enters a rehabilitation program. The therapist will monitor the person during and after detox to see if the symptoms change or dissipate as the person ends their physical addiction to intoxicating substances.
Counseling is the foundation of treatment for both addiction and mental illnesses like OCD. If a person struggles with a co-occurring disorder, it is important that counseling covers both the addiction and OCD.
- Addiction counseling: People who struggle with addiction often receive the greatest benefit from group therapy, where they talk with peers about their experiences with drugs and receive guidance from a counselor and other peers. Individual therapy is also a key component of helping people understand their addiction, develop better coping skills, and develop a plan to avoid relapse. Family therapy is important during rehabilitation because relationships with family and close friends can be damaged by the addiction.
- Cognitive Behavioral Therapy: This type of therapy helps the client recognize problematic behaviors as a reaction to thoughts, stress, or other situations. CBT helps the person change their behavioral response to stress or triggers. It is a very effective therapeutic approach for both addiction and OCD.
- Exposure and Response Prevention (ERP) Therapy: When treating OCD with therapy, the most consistently effective approach is Exposure and Response Prevention Therapy, a subset of Cognitive Behavioral Therapy. Exposure involves confronting obsessive thoughts and fears while response prevention involves unlearning compulsive rituals or responses to the obsessions. In follow-up studies ranging from six months to three years after treatment, 60-75 percent of people with OCD who received ERP had improved. ERP and other types of CBT can be applied in individual, group, and family therapy sessions.
People with OCD can benefit from mood-altering medications, and people who struggle with both OCD and addiction may also benefit from maintenance medications, depending on the substance they abused.
- Maintenance drugs for opioid, alcohol, or tobacco addiction: People who need to end their addiction to opioids like heroin or OxyContin, or other potent substances like alcohol and tobacco, may benefit from maintenance therapies. Buprenorphine is a maintenance medication used to help people overcome addiction to opioids. It binds to the same receptors in the brain, so it can prevent or reduce withdrawal symptoms, including cravings. However, it does not induce the same euphoria as other opioids.Alcohol addiction can cause dangerous withdrawal symptoms like seizures or delirium tremens, so medications like acamprosate or disulfiram may be prescribed. Many people overcoming tobacco addiction benefit from buproprion, which is an SSRI. These maintenance drugs are prescribed, then tapered over time, to help the person ease their body off dependence on the original intoxicating substance. Likewise, benzodiazepine withdrawal generally involves a tapered approach, in which dosages of a long-acting benzodiazepine are slowly reduced over time. After a few weeks or months, the person should be able to stop taking the maintenance therapy.
- Antidepressants for OCD: There are several antidepressants used to treat OCD, which can be very effective. Unlike drugs prescribed to treat addiction, however, OCD medications will likely be used indefinitely; psychiatrists will only stop or change the medication if it is not working for the client. For people with OCD and a co-occurring addiction, continuing a prescription drug may seem against their addiction treatment: however, psychiatric medications are only effective when used in conjunction with therapy, so therapy should continue to focus on avoiding drug abuse. Additionally, SSRIs are not considered addictive, as they do not take effect on the individual’s brain immediately or cause euphoria.Prescription medications used to treat OCD include:
- Clomipramine (Anafranil)
- Fluoxetine (Prozac)
- Paroxetine (Paxil, Pexeva)
- Sertraline (Zoloft)
People who struggle with mental health conditions like OCD will need consistent therapy and likely mood-stabilizing medication. They need consistent support to maintain their progress. Although relapse is part of both mental illness and addiction, continually seeing a therapist is the best way to stay healthy when treating co-occurring disorders. Additionally, individuals should remain engaged in various aftercare methods, such as 12-Step and other peer support groups.