Obsessive-Compulsive Disorder and Addiction:

Identifying and Treating Your Dual Diagnosis

Though many don’t think of obsessive-compulsive disorder (OCD) as a common condition, it affects 2.2 million adults in the United States. Complex on its own, OCD is only further complicated when it co-occurs with another condition or disease. A dual diagnosis of OCD and a substance use disorder is the beginning to a rocky path, but one you can navigate through with the right help.

This guide will cover all that you need to know when it comes to co-occurring obsessive-compulsive disorder and addiction. It will help you understand if you’re showing signs of either condition, as well as why they occur in the brain and how they affect each other. Finally, it will discuss some of the options you have for treatment. Always seek the help of a professional to get an official diagnosis and treatment plan, and be sure to lean on loved ones throughout your journey.

Addiction and OCD: Recognizing the Signs and Understanding What’s Happening

Obsessive-compulsive disorder is a brain disorder that greatly impacts a person’s everyday behavior. About half of all cases begin by adulthood, but about a quarter occur before the mid-teens. It is often a lifelong battle for those diagnosed, although there are forms of therapy to keep symptoms manageable.

OCD is characterized by two main components: obsessions and compulsions. Obsessions are defined as intense repetitive thoughts, images, and/or urges that cause distress. Compulsions are repetitive thoughts or actions someone feels he or she must perform. Most of us can relate to taking only a certain route out of habit, having invasive thoughts, or performing some kind of ritual or repetitive behavior once in a while. But for people with OCD, these kinds of thoughts and actions are so overwhelming that those with severe forms may ritualize on and off all day. Often, these obsessions can cause problems at work, school, and home.

You’ll need to consult a professional to receive a formal diagnosis, but some signs and symptoms of obsessive-compulsive disorder include:

  • Unwanted, forbidden thoughts involving religion, sex, and/or harm
  • Uncontrollable thoughts or behaviors (even when consciously recognized as extreme)
  • Mental images that cause anxiety
  • Irrational fears of contamination
  • Aggressive thoughts toward self and others
  • Excessive cleaning or washing
  • Compulsive counting
  • Fixation on making things symmetrical and precise
  • Repeatedly checking and re-checking things

Though symptoms may worsen and ease over time, it’s important to note that these behaviors and thoughts must take up at least an hour each day to truly be considered OCD. If they cause significant problems in your daily life, you have genuine cause for concern. And while many of us may feel satisfied or content while performing some of our small compulsions, those with OCD don’t derive any pleasure from the action, though they may feel temporary relief from the persistent thoughts subsiding.

People with obsessive-compulsive disorder often attempt to hide their condition or compulsions from others. They may avoid stressful situations that could trigger them, perform ritual behavior only behind closed doors, or even prevent people from coming to their home. Some will even turn to drugs and alcohol to cope — unfortunately, though these substances may initially have a calming effect, their use often only leads to bigger problems.

In fact, about 20% of Americans with a mood or anxiety disorder (like OCD) have an alcohol or substance use disorder. The problem comes from the fact that these kinds of co-occurring disorders tend to affect each other: symptoms of one can make the symptoms of the other worse and vice versa. In this instance, OCD and the stress it brings may cause someone to abuse substances as a way to relax, facilitate smoother social interactions, or even just numb their anxiety. In turn, the substance abuse can actually make compulsions and obsessions associated with OCD even more severe.

Addiction has one major factor in common with OCD: it’s largely impacted by impulse. Addicts are unable to control their desire to use, even if there are negative, life-impacting consequences. As a result they end up feeling a compulsion to use even if they’re trying to get clean, and may not be able to fight the urge.

Further, OCD and addiction appear to affect the same area of the brain. Repeated substance abuse leads to changes in the prefrontal cortex, which carries out executive processes like self-regulation and decision-making. These brain alterations can decrease a person’s ability to resist strong urges. Similarly, researchers have compared the brain images of people with OCD to those without and found that there are differences in the prefrontal cortex. It makes sense, then, that when both conditions are present, they can have dramatic effects on each other.

If you’ve been diagnosed with obsessive-compulsive disorder and think you may also be grappling with an addiction, here are some critical signs of the disease to look out for:

  • Having intense cravings for the drug
  • Feeling like you must use the drug regularly
  • Building up a tolerance to the drug so your body requires more of it to get the same effect
  • Trouble at work, school, at home, or socially
  • Spending money you don’t have to keep up your habit
  • Participating in risky behavior while under the influence
  • Finding yourself unable to quit using and feeling withdrawal when you cut back

If you believe you’ve developed a co-occurring condition, talk to a health or mental care professional as soon as possible.

Treatment Options

While there may be no cure for obsessive-compulsive disorder or addiction, that doesn’t mean there isn’t help!

First, make it a priority to treat both of your conditions. It may take some time to figure out dosages of medications and the proper course of therapy, but it’s crucial that you don’t address one without the other.

OCD by itself is treated in a number of ways: medication, cognitive behavior therapy (CBT), or a combination of both. Though traditionally used to treat depression, serotonin reuptake inhibitors (SRIs) tend to be the most effective medication for OCD, though some doctors opt for selective serotonin reuptake inhibitors (SSRIs) that sometimes have less intense side effects. The downside of SRIs is that they can take up to 8 to 12 weeks to start working, though for some it doesn’t take as long. There have been studies on using antipsychotic medication to treat OCD, but it tends to be riskier and come with mixed results.

This year alone has brought important developments to the treatment of obsessive-compulsive disorder. A recent Duke University study’s findings suggested that OCD is likely highly treatable using a class of drugs already undergoing testing in clinical trials. Researchers found that by altering the brains of mice to replicate behaviors similar to OCD, the symptoms could be treated with this kind of medication.

Addiction treatment often includes several components, ranging from inpatient rehabilitation to medication to individual counseling. Many find it helpful to join a 12-step program, but there are countless styles of programs across the country so it’s important you find what will work for you.

Cognitive behavioral therapy (CBT) may be used to treat both OCD and addiction. For OCD, it’s typically directed to the area of exposure and response prevention. “Exposure” creates direct or imagined exposure to situations or things that trigger obsessions and/or compulsions. The goal is to lessen the anxiety caused by the trigger over time with repeated controlled exposure. “Response” deals with the ritual side of things and aims to help patients learn to resist the compulsion and eventually drop the behavior altogether. When it comes to addiction, CBT aims to help patients learn to stop negative patterns of thinking and behavior and redirect focus to healthy living.

Currently, there is no official therapy to treat both obsessive-compulsive disorder and addiction at the same time. It’s important for you to work one-on-one with a doctor, psychiatrist, or mental health professional to create your own plan of action to tackle your dual diagnosis. The good news is that you have different options for each, and can combine therapies as your doctor sees fit.

With some time, patience, and the right treatment, you can take back control of your life from both OCD and addiction.

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