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OCD and Substance Abuse

OCD and Substance AbuseIf you’ve ever found yourself worrying that you left a door unlocked or forgot to turn off the stove, you’ve had a glimmer of what it’s like to have obsessive-compulsive disorder, or OCD. OCD is an anxiety disorder characterized by overwhelming fears that intrude on your day-to-day thoughts, interfering with your normal life.

In order to ease the anxiety of these overpowering fears, people with OCD perform repetitive, ritualistic behaviors such as:

  • Hand-washing
  • Cleaning one’s living environment
  • Counting objects
  • Combing hair
  • Picking at skin
  • Touching things
  • Hording objects

These compulsive behaviors can be extremely time-consuming, making it difficult to maintain a social life or hold down a job. A person with OCD may spend so much time washing their hands, touching objects in a certain order, or grooming their hair that they miss important appointments or activities. Because of the nature of OCD, the individual is unable to stop the behavior — in spite of its destructive effects on his or her life. Worst of all, the behavior that is supposed to relieve tension and distress usually only feeds and perpetuates these fears.

The obsessive worries of OCD vary from one individual to another, but certain themes tend to appear over and over in this population:

  • Fears of dirt or germs
  • Fears of communicable diseases or parasites
  • Fears of hurting oneself or others
  • Obsessions about sexual activities
  • Obsessions with religion

Alcohol and drugs may temporarily relieve the anxiety and depression associated with OCD, but eventually these substances make OCD symptoms worse. Using substance abuse to self-medicate can lead to health problems, financial troubles, legal conflicts, unemployment and addiction.

The only way to successfully recover from a dual diagnosis of OCD and an addictive disorder is to receive treatment that addresses both the psychiatric illness and the substance abuse.

Recognizing OCD

Estimates of the prevalence of OCD in the American population range from 1 to 3 percent of adults; however, according to the American Journal of Psychiatry, these estimates may be too low. It is possible that many individuals with OCD remain untreated, or that the disorder too often goes undiagnosed. Among adults, OCD affects more women than men, but among teenagers, the disorder affects more boys than girls. Many people in this population have co-occurring psychiatric conditions, such as depression, other anxiety disorders, personality disorders, substance use disorders, or schizophrenia. These conditions can mask or overshadow OCD symptoms, making it hard to recognize the signs of obsessive-compulsive behavior. In addition, many people with OCD deliberately hide their behaviors out of guilt, embarrassment, or fear of being stigmatized by others. The International OCD Foundation states that it takes up to 17 years, on average, for most people with OCD to get the right kind of treatment.

How can you tell if you or someone you care about has OCD? OCD does not look or feel like everyday stress or worrying. Individuals with this disorder spend inordinate amounts of time dwelling on specific fears, which usually have no basis in reality. They may spend an hour or more each day organizing and reorganizing drawers or locking and unlocking the doors in their home. These thoughts and behaviors are so persistent that they have a noticeable, negative impact on the individual’s life. While some people with OCD realize that their fears and compulsive rituals are irrational and destructive, others do not. The acts themselves may or may not have anything to do with the source of their fear. Whether or not they are aware that their behavior is abnormal, people with OCD become extremely anxious when they’re prevented from performing their obsessive acts. Regardless of the nature of the activity, they feel compelled to do it over and over again.

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Origins of Obsessive-Compulsive Behavior

Where does OCD begin? Many psychiatric professionals believe that it has a genetic component, because the disorder is often found in close family members.

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Because OCD often runs in families, it may involve an element of learned behavior. Children whose parents display obsessive fears and compulsive behaviors may grow up modeling these attitudes. Stressful or traumatic experiences may also precipitate the disorder. The neurobiological theory of OCD holds that the disorder is related to chemical imbalances in the brain. Neurotransmitters like serotonin, which affects emotional states, may be low in people with obsessive behaviors. The need to compulsively repeat certain actions in order to soothe internal distress is a form of anxiety, which can often be relieved by taking antidepressant medications that elevate serotonin levels.

Addiction and OCD

Drug and alcohol abuse are common in people who suffer from anxiety disorders — including OCD. The results of a study published by the Journal of Anxiety Disorders showed that 27 percent of a sample of 323 adults over the age of 18 met the diagnostic criteria for a substance use disorder within their lifetime. Out of this number, 11 percent met the criteria for alcoholism, and 3 percent met the criteria for drug addiction.

The combination of OCD and substance abuse affected these individuals’ lives in the following ways:

  • People with OCD and substance abuse were more likely to be unemployed and living on disability benefits.
  • Substance abusers with OCD were more likely to be confined to home by their compulsive behaviors.
  • People with OCD who abused drugs or alcohol were more likely to have been hospitalized for their symptoms.
  • OCD and substance abuse were associated with a higher rate of suicide attempts than OCD alone.

Substance abuse and OCD can be interrelated in several important ways. In most individuals, OCD symptoms precede substance abuse. However, drug or alcohol use can trigger OCD episodes and make the compulsive behavior worse. Some of the symptoms of substance abuse, such as anxiety, restlessness and depression, can resemble the physical symptoms of OCD. Finally, the imbalances in brain chemistry that are associated with OCD may predispose these same individuals to alcoholism or drug use.

Can OCD Be Cured?

OCD is a chronic psychiatric condition that may never be completely cured, but the disorder does respond to treatment. According to Harvard Medical School, up to half of patients who are treated for OCD improve with therapy, medication and other modalities; unfortunately, only about 10 percent achieve a full recovery. Symptoms tend to come and go throughout a person’s lifetime, with the incidence of OCD decreasing significantly in the elderly population. Treating a complicated disorder like OCD requires a combination of therapeutic strategies, including: Behavioral modification therapy.
The compulsive behaviors of OCD can be effectively addressed through a therapy called “exposure and response prevention.” Through repeated exposure to the source of their fears, along with new coping strategies for dealing with those fears, compulsive behaviors can be greatly reduced. People with milder forms of OCD may respond to this form of therapy alone.
Antidepressant medications.
Drugs that reduce anxiety can be extremely helpful at minimizing the symptoms of OCD. In particular, selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac), escitalopram (Lexapro) and sertraline (Zoloft) are now considered to be the first line of treatment for OCD symptoms. When taken consistently according to a doctor’s instructions, these drugs correct the chemical imbalances that contribute to obsessive-compulsive behavior.

Atypical anti-psychotic drugs.
After three months of treatment with SSRIs, approximately half of OCD patients experience an adequate relief of symptoms, according to Dialogues in Clinical Neuroscience. For those who don’t respond to antidepressants alone, atypical anti-psychotics may be recommended. These drugs — including risperidone (Risperdal), quetiapine (Seroquel), olanzapine (Zyprexa) and haloperidol (Haldol) — may be prescribed along with antidepressants to augment their effects.

Deep brain stimulation surgery.
Severe, debilitating cases of OCD may be treated with deep brain stimulation (DBS), which was approved in 2008 for the treatment of this disorder. DBS surgery involves the implantation of electrodes in areas of the brain that affect OCD symptoms. DBS is recommended only for patients who have not responded to medication or psychotherapy.

Treatment for OCD and Substance Abuse

The co-occurrence of substance abuse and OCD makes treatment all the more challenging. Therapists must find creative ways to overcome the obstacles that OCD presents to substance abuse treatment. Addicts with OCD may have more difficulty focusing and may need shorter therapy sessions to accommodate their symptoms. They may have higher levels of anxiety about group therapy sessions and other recovery activities that require social interaction. In general, people with anxiety disorders and substance abuse problems are more likely to relapse into substance abuse or experience a return of their psychiatric symptoms after treatment. Dual diagnosis treatment for OCD and substance abuse takes the individual’s needs into account throughout the recovery process. Beginning with the intake stage and continuing through detox and rehab, treatment plans are personalized to reflect the client’s psychiatric history as well as his or her addiction. Treatment approaches include:

Healing from OCD and substance abuse is a long-term process that requires the support of a team of compassionate professionals. At Futures, we offer individualized treatment that targets each client’s unique needs. At our residential facility in Palm Beach County, FL, we provide a full spectrum of recovery services. Call our admissions counselors today for a confidential discussion of your needs.

Some services listed may not be included in our core program. An admissions counselor will be able to provide you a complete list of core services. Information provided for educational purposes. Premium services or programs may be arranged through your therapist or case manager.