Understanding the Link Between Obsessive-Compulsive Disorder and Addictions
Obsessive-Compulsive Disorder (OCD) and addictions, or Substance Use Disorder (SUD), are two challenging conditions that can profoundly impact an individual's life. While the conditions may appear distinct, a complex and often perplexing relationship exists between them. Below is a brief exploration of the connection between the conditions and how they influence and interact with one another.
A Coping Mechanism
Individuals with OCD frequently experience overwhelming anxiety and distress stemming from their obsessions and compulsions. The distress can be so intense that they often seek a means of escape. This is where substances like drugs or alcohol come into play as a coping mechanism. In the short term, these substances can provide temporary relief from the relentless anxiety experienced by individuals with OCD.
The act of self-medicating with substances offers an illusion of control and relief from obsessions and compulsions. It's a way to temporarily silence the intrusive thoughts and alleviate the anxiety that often accompanies OCD. Furthermore, self-medication can lead to a cycle where individuals with OCD turn to substances repeatedly to cope, which can result in the development of Substance Use Disorders (Starcevic et al., 2011).
Temporary Relief
For individuals with OCD, life can feel like a continuous struggle against their obsessive thoughts and compulsive behaviors. Substance use, whether through drugs or alcohol, can offer a fleeting respite from this unending cycle. The temporary relief gained from substance abuse can be addictive, as individuals seek to recreate that feeling of escape.
This relief is transitory and ultimately exacerbates the challenges associated with both OCD and addiction. The long-term consequences can be severe, leading to a deterioration in physical and mental health. Substance use may also create a cycle of addiction where the temporary relief gained from substances gives way to withdrawal symptoms and cravings, perpetuating the substance abuse problem (Starcevic et al., 2011).
Comorbidity
OCD doesn't exist in isolation. It often co-occurs with other mental health conditions, such as depression and anxiety disorders (Starcevic et al., 2011). When OCD and these co-occurring conditions combine, it creates a perfect storm that elevates the risk of developing SUD.
The co-occurring conditions often fuel one another. For instance, the anxiety experienced in OCD may lead to depression, which, in turn, can increase the urge to self-medicate with substances. This creates a vicious cycle that intensifies the addiction issues. When individuals with OCD are also struggling with comorbid mental health conditions, it's essential for treatment to address all these aspects simultaneously. Neglecting one condition can hinder progress in the other, making it crucial for mental health professionals to consider the holistic well-being of their clients (Starcevic et al., 2011).
Genetic Factors:
While not everyone who experiences OCD will develop SUD, there is evidence to suggest that genetic factors can play a role (Fontenelle & Hasler, 2008). Some individuals may be genetically predisposed to both OCD and addiction, increasing their vulnerability to developing SUD. Genetic research in this area is ongoing, and it highlights the need for a personalized approach to treatment (Fontenelle & Hasler, 2008).
Understanding the genetic component underscores the importance of a holistic approach to treatment. It's not just about addressing the symptoms but also considering an individual's unique genetic predispositions and tailoring treatment accordingly (Fontenelle & Hasler, 2008).
Evidence-Based Treatment Options
Exposure and Response Prevention (ERP) is a cornerstone of OCD treatment and addresses the cycle of obsessions and compulsions (Foa et al., 2012). By systematically exposing individuals to their obsessive triggers while simultaneously preventing them from engaging in compulsive behaviors, ERP helps desensitize individuals to their obsessions. It is one of the most effective therapeutic approaches for OCD (Foa et al., 2012).
ERP therapy is structured and gradual, beginning with relatively less distressing obsessions and moving towards more challenging ones. By facing their fears, individuals learn that they can tolerate the anxiety without relying on compulsions. ERP is not a quick fix but rather a gradual process that requires persistence and the guidance of a skilled therapist. The exposure hierarchies are customized to each individual's specific obsessions and compulsions, ensuring that the treatment is tailored to their unique challenges (Foa et al., 2012). To read more about ERP, check out my blog post here.
Eye Movement Desensitization and Reprocessing (EMDR) was initially designed for individuals with post-traumatic stress disorder (PTSD), EMDR can also be adapted to address the unresolved trauma often linked to OCD and addiction (Hase, Schallmayer, & Sack, 2008). EMDR helps individuals process traumatic experiences, reducing the compulsion to self-medicate with substances.
The EMDR therapy process involves eight structured phases, with bilateral stimulation, often in the form of eye movements (Hase et al., 2008). This bilateral stimulation facilitates the reprocessing of distressing memories, alleviating the distress and decreasing the need for substances as a coping mechanism.
EMDR is a versatile therapy that can be adapted to address the specific trauma or distress that may be fueling an individual's OCD and addiction (Hase et al., 2008). It can uncover and treat the underlying issues contributing to the disorders. To learn more about the eight phases, check out my blog post here.
Cognitive-Behavioral Therapy (CBT) is a versatile and widely used therapeutic approach that helps individuals identify, challenge, and change their negative thought patterns (Abramowitz, 2013). In the context of OCD and addiction, CBT helps individuals manage obsessions and compulsions while simultaneously developing healthier coping strategies for substance abuse.
In CBT, clients typically engage in one-on-one sessions where they learn to recognize the thought patterns contributing to their obsessions and compulsions (Abramowitz, 2013). They also gain a better understanding of the intricate links between OCD and addiction, empowering them to develop practical coping strategies. CBT can be tailored to address the specific obsessions and compulsions of individuals with OCD, as well as their triggers for substance use. It equips individuals with the tools needed to break the cycle of these co-occurring disorders (Abramowitz, 2013).
Medication-Assisted Treatment (MAT) is for individuals with severe SUD, Medication-Assisted Treatment can be a crucial component of their recovery. Medications such as buprenorphine, methadone, and naltrexone are commonly used in MAT (National Institute on Drug Abuse, 2018). These medications help reduce cravings, manage withdrawal symptoms, and support long-term recovery in individuals with substance use disorders.
The use of MAT requires careful evaluation and monitoring by healthcare professionals to ensure the best match between medication and the individual's specific needs (National Institute on Drug Abuse, 2018). Mental health professionals should work in collaboration with medical providers to determine the most suitable medications for their clients. Through an interdisciplinary team of providers, this form of treatment can be very effective.
Mindfulness-Based Cognitive Therapy (MBCT) seamlessly blends mindfulness techniques with traditional CBT, creating an approach that empowers individuals to become more aware of their thoughts and behaviors (Brewer, Bowen, Smith, Marlatt, & Potenza, 2010). This heightened awareness can help reduce obsessions, compulsions, and substance abuse.
MBCT incorporates mindfulness exercises and meditation to increase individuals’ awareness of the present moment, fostering an improved capacity to manage their thoughts and behaviors (Brewer et al., 2010). Mindfulness practices can be integrated into daily life, enabling individuals to apply these techniques when they encounter triggers for their OCD or substance use.
Integrated Dual Diagnosis Treatment (IDDT) is a holistic and comprehensive approach that combines mental health and substance abuse treatment (Mueser, Noordsy, Drake, & Fox, 2003). It focuses on addressing both conditions simultaneously, ensuring coordinated care to support individuals with co-occurring disorders.
IDDT incorporates individual and group therapy, medication management, and a broad range of support services (Mueser et al., 2003). It emphasizes the importance of addressing the individual's specific needs, not only from a clinical perspective but also from a social and environmental context. IDDT recognizes that recovery from co-occurring disorders requires a multifaceted approach. It provides individuals with the necessary support and resources to address their OCD and substance use simultaneously (Mueser et al., 2003). In this practice, collaboration with other physical and mental health professionals is encouraged and welcomed.
Empowering Your Journey to Recovery
The connection between OCD and Substance Use Disorders may appear complex, but with a wealth of evidence-based treatment options at your disposal, there's hope for recovery. By embracing treatment options such as ERP, EMDR, CBT, MAT, MBCT, and/or IDDT, you can embark on a journey toward healing and rediscover your true potential.
As a mental health counselor, I am trained in EMDR, ERP, and CBT. I have experience working with addictions and substance use disorder treatment. I am well-versed in MAT and IDDT concepts and philosophy, and I am dedicated to providing support and guidance to those facing the challenges of OCD and substance use issues. If you or someone you know is grappling with these issues, remember that you don't have to navigate this path alone. Seek assistance from a trained professional who can provide personalized guidance and support tailored to your unique needs.
Please keep in mind that this blog post serves as a source of information and should not replace professional medical advice or treatment. If you or someone you know is experiencing OCD and/or Substance Use Disorders, reach out to a mental health expert for personalized guidance and assistance on your path to recovery.
References:
Abramowitz, J. S. (2013). The practice of exposure therapy: Relevance of cognitive-behavioral therapy and science to substance use disorder treatment. *Behavior Therapy, 44*(4), 548-558.
Brewer, J. A., Bowen, S., Smith, J. T., Marlatt, G. A., & Potenza, M. N. (2010). Mindfulness-based treatments for co-occurring depression and substance use disorders: What can we learn from the brain? *Addiction, 105*(10), 1698-1706.
Foa, E. B., Yadin, E., & Lichner, T. K. (2012). Exposure and response (ritual) prevention for obsessive-compulsive disorder: Therapist guide. *Oxford University Press.*
Fontenelle, L. F., & Hasler, G. (2008). The analytical epidemiology of obsessive–compulsive disorder: Risk factors and correlates. *Progress in Neuro-Psychopharmacology and Biological Psychiatry, 32*(1), 1-15.
Hase, M., Schallmayer, S., & Sack, M. (2008). EMDR reprocessing of the addiction memory: Pretreatment, posttreatment, and 1-month follow-up. *Journal of EMDR Practice and Research, 2*(3), 170-179.
Mueser, K. T., Noordsy, D. L., Drake, R. E., & Fox, L. (2003). Integrated treatment for dual disorders: A guide to effective practice. *Guilford Press.*
National Institute on Drug Abuse. (2018). Medications to treat opioid use disorder. *https://www.drugabuse.gov/publications/research-reports/medications-to-treat-opioid-addiction/overview.*
Starcevic, V., Berle, D., Milicevic, D., Hannan, A., & Sammut, P. (2011). Substance use disorders in patients with obsessive–compulsive disorder: The case for a selective dual diagnosis. *Journal of Anxiety Disorders, 25*(6), 710-714.
