Treating Co-Occurring Drug or Alcohol Addiction and OCD
Approximately half of those with a mental health condition, such as obsessive-compulsive disorder, will also experience a substance use disorder and vice versa.1 This is known as a co-occurring disorder, which often requires professional services to effectively treat.
This article will discuss what obsessive-compulsive disorder is, the connection between OCD and substance use disorders, and what kinds of treatments are available.
What is Obsessive-Compulsive Disorder?
Obsessive-compulsive disorder (OCD) is a psychological disorder that consists of an individual displaying both obsessions and compulsions.2 For many years, this disorder was classified with other disorders that were primarily fueled by anxiety (Anxiety Disorders); however, the American Psychiatric Association in its most recent update of its Diagnostic and Statistical Manual for Mental Disorders has placed the disorder in its own category (Obsessive-Compulsive and Related Disorders).
Commonly depicted in the media and entertainment industry as a rather quirky type of disorder, in reality, obsessive-compulsive disorder is a serious psychological disorder that is often debilitating and can be very difficult to treat. It is a serious psychiatric/psychological disorder that significantly affects the lives of people who have it.
Obsessive-Compulsive Disorder vs Obsessive-Compulsive Personality Disorder
It is important to note that there are two different disorders that are classified as being obsessive-compulsive: obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder.
Obsessive-compulsive personality disorder is more common than obsessive-compulsive personality disorder, affecting men more than women. However, obsessive-compulsive disorder affects both men and women at similar rates.4 Each condition can present difficulties and challenges for individuals who do not seek appropriate treatment for them.
Symptoms of obsessive-compulsive disorder can include, but are not limited to, the following:3
- Recurrent, persistent thoughts that may be upsetting and/or intrusive
- Feeling driven to repeat compulsive behaviors
- Thoughts (or “obsessions”) taking up a significant amount of the individual’s life
- Engaging in behaviors that are designed to help prevent an event/situation/occurrence
Obsessive-compulsive personality disorder presents with different symptoms, including:3
- Being preoccupied with order, organization, details, or rules.
- Displaying perfectionism that stands in the way of completing tasks.
- Showing inflexibility regarding morals, beliefs, or values.
- Experiencing difficulty giving a task to someone else to complete for fear of them not executing it exactly as they’d like.
What Are The Different Types of OCD?
There are four subtypes of obsessive-compulsive disorder, including contamination, checking, hoarding, and rumination. Each OCD subtype presents with its own set of symptoms and can include the following:
- The contamination subtype: This subtype manifests with obsessions regarding cleanliness, being infected, etc. Compulsions can consist of repetitive hand washing, repetitive cleaning, repetitive avoidance of feared “dirty” situations, etc. This is the most common subtype of OCD and certainly one of the most common presentations of OCD presented in the popular media.
- The checking subtype: This subtype involves constantly checking or investigating aspects of one’s life that are connected to obsessions regarding being unsafe or worrying that something bad will happen when one leaves the home, etc.
- The hoarding subtype: This subtype involves being constantly concerned with not disposing of certain types of items or not disposing of anything at all including garbage.
- The rumination (intrusive thought) subtype: This subtype involves intrusive thoughts of a religious, mystical, or even violent nature, and performing obsessions associated with these intrusive thoughts.
All manifestations of OCD present with obsessions and compulsions. Some people may recognize that their behaviors are irrational and disrupt their lives. Others may believe them to be perfectly functional and may actually believe their actions to be useful to them despite suffering serious ramifications from their behavior.
The Connection Between Substance Abuse and OCD
OCD appears to have high comorbidity rates with depression, anxiety disorders, bipolar disorder, personality disorders, and ADHD. Any individual diagnosed with nearly any type of formal psychological/psychiatric disorder is at higher risk to also develop a substance use disorder, which is also commonly referred to as a “dual diagnosis.”
While there are some factors that affect co-occurring OCD and substance use disorders separately, it is also true that individuals with OCD also tend to have higher rates of substance use disorders than others. While any type of substance use disorder can be comorbid with OCD, it appears that alcohol use disorders are among the most common substance use disorders associated with having a diagnosis of OCD.
In many cases, it appears that the symptoms of OCD may have preceded the substance abuse issues and that at least some individuals with OCD appear to address their own substance use. Their substance use may have somehow resolved over time without formal treatment (although it is not clear how this occurs from research studies). While this does not suggest that individuals who have OCD and a co-occurring substance use disorder do not need to have their substance abuse treated, it does suggest that in some cases individuals with OCD appear to be able to recognize and curb their substance abuse, whereas they are not able to recognize and curb the symptoms of their OCD. These findings also suggest that recognizing and treating OCD early in its course or presentation may lead to the avoidance of issues with substance use disorders in many individuals.
How to Treat Co-Occurring OCD and Addiction
OCD is most commonly treated by using some form of cognitive behavioral therapy (CBT) that assists clients in identifying their irrational thoughts and replacing them with more functional thoughts and beliefs. In addition, CBT helps clients to develop a set of behaviors that are more in line with reality and more functional. Additionally evidence-based therapies and practices have also shown to help effectively treat those with OCD and a co-occurring substance use disorder.
Substance abuse treatment for individuals with this particular disorder should be initiated along with the therapeutic modalities they are receiving for OCD. It is well known that treating one disorder without addressing the other is counterproductive to recovery and treatment progress for either disorder. Individuals who have substance use disorders in addition to OCD need to follow empirically validated treatment protocols for their substance use disorders.
Treatment may include:
- Inpatient treatment as required for detox or for serious substance use issues that require removal of the client from a potentially toxic environment.
- Medically assisted management of withdrawal symptoms and other issues associated with substance use disorders.
- Longer-term outpatient treatment that includes individual and group therapy to address the issues that fueled the substance abuse and help the individual develop coping skills to prevent relapse in the future.
- Social support from family and/or in the form of 12-Step group participation.
- Other important supports as needed, such as vocational counseling, placement services, etc.
- A long-term aftercare program to assist the individual through all phases of recovery and ensure that the individual has support down the road.
There are also a number of pharmacological interventions that can be used to assist in the treatment of OCD; however, these interventions are not long-term solutions. Medications can complement therapy, but they are not the best overall solution for the treatment of OCD in the majority of cases. The goal of treatment should be to help the individual become as functional and autonomous as possible, and therapy will help the individual realize these goals.
The treatment of OCD is generally effective; however, like any psychological disorder, there are some potential setbacks. Recovery can be a long and sometimes difficult process. In addition, there are some cases that do not respond to standard treatment. For example, a small subset of individuals is noted to have very severe OCD symptoms that are not responsive to medication or therapy. In these cases, certain types of psychosurgery and deep brain stimulation may be helpful in curbing obsessions and compulsions.
Co-Occurring Disorder Treatment at Oxford Treatment Center
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