When we think of obsessive-compulsive disorder (OCD), many of us think of the well-known behaviors associated with the condition, such as repetitive hand washing. Obsessive-compulsive disorder can take many forms outside of this stereotypical behavior. OCD is more than just a habit- it is a mental health disorder that can cause a great deal of distress and disruption in a person’s life.
People with OCD experience obsessions, or repeated thoughts, images, or urges that cause them a great deal of anxiety. They may be afraid of aggressive or unwanted thoughts, a fear of germs, or distress over orderliness, for example.
Common obsessions may include:
- Fear of harming oneself or family members due to carelessness
- Fear that one’s actions will determine whether something horrible happens
- Fear of offending God or other people
- Fear that one will forget crucial information
- Fear of losing items
- Fear of illness, injury, or death
These thoughts lead to compulsions, or repetitive behaviors that occur as a response to the unwanted thoughts. These may include (but are not limited to) repeatedly checking doors or appliances, arranging things repeatedly, or excessive cleaning or washing.1
It is important to note that the compulsive thoughts or feelings that occur in OCD are very distressing to the person who experiences them. A person who struggles with OCD may find the obsessive thought disturbing, confusing, or embarrassing. The behaviors that follow may or may not be truly protective, and the behaviors may not even associate with the compulsions in a clear way at all.2
For instance, an individual may experience fears and intrusive worries about a potential home invasion and then feel a compulsion to open and shut the door a certain number of times before locking it. While it is normal – particularly if one lives in a high crime area – to ensure one’s doors are locked, the repetitive behavior or ritual that takes place in this example indicates that a condition may exist.
A daily routine can be a healthy practice. Waking up every morning at the same time, fixing a cup of coffee, taking a shower and brushing one’s teeth may become rituals, or habits, if an individual completes these actions at the same time every day in the same order. This does not indicate a problem, because it does not cause disturbances or occur in an attempt to alleviate extreme anxiety as in OCD. However, a problem might exist if one believes catastrophic repercussions will occur if they are out of coffee grounds and cannot include this aspect of their morning ritual.3
When Substance Use Associated and Obsessive-Compulsive Disorder Occur Together
Obsessive-compulsive disorder and substance use disorder can occur at the same time. One study that was published in the Journal of Anxiety Disorders found that up to 70 percent of individuals who suffered from both conditions stated that the symptoms of obsessive-compulsive disorder came before their substance use disorder.4
For just a moment, picture yourself in the position of someone who might suffer from OCD. Every day, several times each day, you are assaulted by horrible thoughts and anxiety. If you don’t complete a certain task, your world will be destroyed. If you don’t wash your hands one more time, you will contract a horrible disease. Or, if you don’t get out of bed to check the windows one more time, someone will come into our home and steal your children. This is a frightening way to live.
Some individuals may not realize that this is a legitimate condition or that treatments are available. They only know that they want relief from the pressure and anxiety that haunts them every day. The use of prescription drugs or other substances may temporarily relieve some of this anxiety. While there are legitimate prescription medications available to help treat this disorder, misuse of drugs or alcohol will only make the problem worse.
Tim Z. knows first-hand what it’s like to live with obsessive compulsive disorder. Once it started, he says, “My thoughts began to go out of control. …I especially wanted to control other people. I had a really hard time with friends, especially girls. I was always worried that people might dislike me, or even hate me. But I don’t mean worried… I mean obsessed. I would concoct ridiculous stories in my mind where nightmare scenarios happened and my emotions would be on overdrive. Then, suddenly, I’d crash and become depressed for weeks at a time.
“I didn’t tell people about this,” he continues. “I mean, how could I? I didn’t understand it myself, and I didn’t think there was anything weird about it. I mean, this was just life for me. I thought everybody felt that way– and maybe they do, to an extent. The problem was that, for me, it took over my life. I would fully go through that cycle.”
Dangers of Unsupervised Drug Use Associated with OCD
The process of obtaining a legitimate prescription to treat any kind of condition is rather involved. Physicians often take great strides to ensure that their patients receive the right (and safe) medications in reasonable doses as needed. Doctors are bound to medical ethics in prescribing. The American Academy of Family Physicians has established a system that should be used prior to prescribing medications to anyone. These parameters are in place to ensure against later problems that might come from this diagnosis, misuse of the drugs, or even drug interactions.
These parameters include:
- Establish what is wrong with the patient.
- Determine what is hoped to be achieved by the medication.
- Choose the right drug to prescribe.
- Be specific as to how the drug should be used.
- Consider alternatives to medication or additional treatment options that do not include medication.
- Provide the patient with all the available information, including instructions and warnings about abuse potential.
- Consistently revisit the dosages of the medication as well as whether or not the desired outcome has been reached5
When it comes to drug misuse, the person who takes the substance has avoided the diagnostic process altogether. Someone suffering from OCD may have heard through the grapevine that doctors like to prescribe Xanax, for instance. He or she may have a friend who receives this prescription, but the friend always has leftover pills each month and doesn’t mind sharing. The person in this example can take too much of the drug, mix the drug with alcohol or other substances, or become dependent on or addicted to the medication.
Treatment Should Involve More Than Medication
There are better ways to overcome OCD. For instance, Cognitive Behavioral Therapy can help individuals overcome their obsessions and compulsions by retraining their thinking. Exposure therapy, or presenting real-world situations that create anxiety and discomfort in a specific individual, can also help them increase their tolerance for the activity. For instance, someone who is terrified of germs might be asked to repeatedly touch something they fear – the handle of an escalator or the door of a public restroom – without washing their hands immediately afterward. The overall goal of this type of therapy is for the individual to learn new and better ways to handle stress in life.6
If an addiction is already present, Cognitive Behavior Therapy is also used for the treatment of some types of drug addiction, which can be a benefit when treating the two conditions simultaneously.
“You are not your illness!” Tim Z. says at http://www.heroesinrecovery.com. “You can have OCD or BPD, but you are not them. They do not define you. You are still you, and you’re probably pretty awesome. Just like living with HIV, lupus, diabetes, etc., you LIVE WITH bipolar disorder, you MANAGE it. …Love yourself, even when your condition causes you to do things that seem like you should be embarrassed. You can only do the best you can with this. Elect to have people around you that understand.”
Treatment for Both Drug Use and Obsessive-Compulsive Disorder
If someone you love has resorted to using substances to alleviate the symptoms of OCD, simply treating the addiction alone will not fix the entire problem. Certainly, an individual can refrain from abusing substances while they are in a rehab setting, but if the OCD is left unchecked, the chances of that person returning to drug use remains.
It is important to address and treat the underlying issues behind substance use. The ongoing stress of OCD may cause a person to return to substance abuse after rehab. If you treat OCD and addiction issues at the same time, you stand a better chance for lasting recovery.7
If you’d like more information on treatment for substance abuse and OCD, call us here at Black Bear Lodge. We can answer any questions you may have and help you find care that will work for your unique circumstances.
1 National Institute of Mental Health. Obsessive-Compulsive Disorder. Jan 2016.
2 International OCD Foundation. What is OCD? Web. Accessed 18 Jan. 2018.
3 Selig, M. Routines: Comforting or Confining? Psychology Today. 14 Sept 2010.
4 Mancebo, Maria C. et al. Substance Use Disorders in an Obsessive Compulsive Disorder Clinical Sample. Journal of Anxiety Disorders.2009.429–435. PMC.
5 Pollock M., Bazaldua O., Dobbie A.Appropriate prescribing of medications: an eight-step approach. Am Fam Physician. 15 Jan. 2007.
6 Weg, A. Treat Obsessive Compulsive Disorder with Cognitive Behavioral Therapy. National Institutes of Health. 4 Aug. 2009.
7 NIDA. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). National Institute on Drug Abuse. 17 Jan. 2018.