Comprehensive Treatment for OCD and Co-Occurring Substance Abuse

OCD presents differently from person to person, but the overall dynamics remain consistent: obsessive thought creates anxiety, compulsive behavior reduces some level of anxiety, and the cycle continues indefinitely until treatment is found.

Below are the most common symptoms:

Common obsessive thoughts

• Contamination and germ fears
• Intrusive thoughts about causing harm to self or others
• Need for symmetry, order, and exactness
• Unwanted sexual, religious, or violent thoughts
• Fear of losing control or “going crazy”

Common compulsive behaviors:

• Excessive cleaning and hand-washing
• Checking behavior (locks, appliances, safety)
• Counting, tapping, and repeating an action a specific number of times
• Arranging objects in precise or symmetrical ways
• Seeking reassurance repeatedly from others
• Mental compulsions like reviewing, praying, or mentally neutralizing intrusive thoughts

OCD symptoms are time-consuming, cause significant emotional distress, and negatively interfere with daily activities, interpersonal relationships, and work or school.[3] It is also essential to clinically distinguish compulsive behavior from addictive behavior. OCD compulsions are primarily motivated by anxious responses to obsessive thoughts, while addictive behaviors are most commonly associated with substance use driven by craving, reward, and physical dependence.[4] Both can co-occur and reinforce each other.

OCD and substance use disorders co-occur at a high rate, with research finding that approximately 27% of people with OCD will meet criteria for a substance use disorder during their lifetime, a rate higher than would be expected in the general population.[5] The main reason for this co-occurrence is self-medication — people who experience chronic anxiety from their intrusive obsessive thoughts will often turn to drugs, alcohol, opioids, and cannabis to calm it.

Alcohol, in particular, is very common.[6] Many people struggling with OCD find that alcohol’s sedative qualities can temporarily reduce the anxiety and hyperarousal that fuel obsessions. Similarly, opioids and cannabis may also be used to reduce mental tension and disrupt intrusive thought processes. Although somewhat counterintuitive, stimulants are also used to override OCD-related paralysis and the cognitive fog that accompanies severe compulsive episodes.

Neurobiologically speaking, there is substantial overlap between OCD and addiction. Both are influenced by dysregulation in the dopamine and serotonin neurotransmitter systems — the chemical messengers responsible for reward, motivation, and compulsive behavior.[7] When OCD and substance use disorders occur together, addressing both conditions as part of treatment is associated with better outcomes than treating either condition in isolation.[8]

Substance use worsens OCD symptoms over time.[9] Withdrawal from alcohol and opioids worsens anxiety significantly, increasing obsessive thoughts and compulsive urges.[10] The temporary relief substances once provided diminish as tolerance builds, leading to more and more use, all while the underlying OCD remains unaddressed and worsens over time. The secrecy and shame that often surround OCD and addiction also serve to further isolate people from receiving the support needed. Integrated treatment can break this cycle by addressing all of these issues in a single, coordinated program.

Obsessive-compulsive disorder is a treatable illness; however, it can deteriorate over time, especially if substance use is involved. 

Below are some signs that your OCD and substance use need professional support:

• Using alcohol or drugs to manage OCD-related anxiety or intrusive thoughts
• Noticeably increased OCD symptoms when withdrawing from substances or during early sobriety
• A history of addiction treatment that didn’t address the compulsive thought patterns contributing to your addiction
• OCD treatment that didn’t account for substance use interfering with medication efficacy or therapeutic progress
• Compulsive behavior and substance abuse feel like they are reinforcing each other
• Substance use and OCD have severely impaired your daily functioning, relationships, or employment

If you don’t currently have a formal OCD diagnosis and are interested in seeking treatment, please contact us. We will complete a comprehensive assessment at the beginning of your admission and help determine what type of services would be best suited for your needs.

Our integrated dual diagnosis program at Agape Detox Center treats both the obsessive-compulsive disorder and the co-occurring substance use disorder at the same time. Each member of our clinical team understands the complex relationship between OCD and addiction and will engage with you using effective treatments for both disorders.

• Comprehensive Assessment: Each person admitted to Agape undergoes a comprehensive psychiatric and psychological evaluation upon admission. This evaluation assesses for co-occurring OCD, determines the severity of symptoms and how they affect the client’s functioning, and uses that information to create an individualized treatment plan that guides each client’s care.
• Evidence-Based Therapies: Agape Detox uses evidence-based therapy to address both OCD and substance abuse. No two treatment plans look the same; however, some of the modalities that may be used in your plan include Cognitive Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP). The primary form of psychotherapy for OCD treatment is cognitive behavioral therapy (CBT) with Exposure and Response Prevention (ERP).[11] ERP is considered the gold standard psychotherapeutic treatment for obsessive-compulsive disorder.[12] 
• Medication Management: The most commonly prescribed medications for OCD are serotonin reuptake inhibitors (SRIs) such as fluoxetine, sertraline, and fluvoxamine.[13] Our team coordinates medication management and other pharmacologic interventions to maximize each client’s overall recovery plan.