OCD and Substance Use Disorders

Because substances like alcohol and drugs are often used to try to suppress thoughts and feelings, people affected by obsessive-compulsive disorder (OCD) are at greater risk for developing substance use disorders. Although alcohol and drug use may initially mask OCD symptoms, in the long run using substances can make symptoms worse, interfere with treatment and disrupt supportive relationships. 

What Is a Substance Use Disorder?

Before examining the relationship between OCD and substance use disorders, we first need to outline what a substance use disorder is. There are two main kinds of substance use disorders: substance dependence and substance abuse.

Substance Dependence

To be diagnosed with substance dependence, you must have three or more of the following symptoms at any time within the same year:

• Greatly increased tolerance, meaning that you need more and more of the substance to get the desired effect.
• Psychological (e.g., anxiety, depression) and/or physical withdrawal symptoms (e.g., shakes, nausea) when you stop using the substance.
• Use of larger amounts of the substance than was intended or use of the substance over a longer period of time than planned.
• A strong desire, but lack of ability, to quit the substance or many unsuccessful efforts to stop using the substance.
• A great deal of time spent obtaining the substance, using the substance or recovering from its effects.
• Giving up important social, occupational or recreational activities to use the substance.
• Continued use of the substance despite psychological or physiological problems caused by it.

Substance Abuse

To be diagnosed with substance abuse, you must demonstrate one or more of the following symptoms within the same year:

• Recurrent substance use that leads to failure to fulfill obligations at work, school or at home.
• Repeatedly using a substance in situations in potentially dangerous situations, such as driving a car or operating a machine.
• Recurrent problems with the law because of substance use.
• Continued use of the substance despite interpersonal problems caused by the substance.

OCD and Substance Use Disorders

It has been estimated that nearly 30% of people with OCD have had a substance use disorder at some point in their lives. This is nearly double the rate of the general population. Although the rate of substance use disorders is high among people with OCD, it is lower than those of many other forms of mental illness including bipolar disorder or schizophrenia.

Even though the OCD symptoms of people who develop substance use disorders are similar to those with OCD who do not, research has demonstrated that those who develop substance use disorders are often less educated, often have other forms of mental illness in addition to OCD, and had OCD symptoms that began at an early age. Indeed, most people report that their OCD symptoms started well before they developed a substance use disorder.

It's important to note that people with OCD who develop substance use disorders are at a greater risk for suicide and hospitalization.

Substance Use Disorders and the Treatment of OCD Symptoms

Many people with OCD begin to use substances as a form of self-medication either to directly reduce the severity of their obsessions or compulsions or to decrease the distress associated with the consequences of living with OCD, including problems in relationships or difficulties at work.

In effect, substance use can be thought of as a coping strategy. However, substance use is a particularly poor coping strategy if it allows you to avoid dealing with the actual source of your distress. So, while using substances may make you feel better temporarily, your OCD symptoms will continue to get worse and your relationships will continue to deteriorate. This, in turn, may cause more substance use, which only helps you avoid the problem even more. In addition, by masking your anxiety, substances can interfere with the exposure exercises that are essential to many psychological treatments for OCD.

If you have a substance use disorder, your treatment needs to focus on substituting substance use with more adaptive coping strategies. These include strategies to help you gain more comfortable dealing directly with symptoms and their associated difficulties. While this can initially generate even higher levels of anxiety, the long-term payoff is developing better tools for dealing with OCD symptoms.