Having obsessive-compulsive disorder (OCD) can mean living with an extreme amount of anxiety each and every day. As the illness progresses, and the mind becomes harder and harder to control, it’s easy to understand why turning to drugs or alcohol might seem reasonable or even desirable. As the substances take over, the mind begins to slow and the anxiety can fade along with it. Unfortunately, what might seem like a clever coping technique in the moment could have dangerous consequences down the road. Abusing substances like this could lead to addiction issues, and those addictions could make the mental illness even harder to control.
Therapy can help to break this cycle, easing the symptoms of OCD and reducing the cravings that come with substance abuse. Through therapy, people can learn how to keep both conditions under control, and they can pick up tips they can use throughout the rest of their life. Read on to find out how the two conditions intersect, and find out more about how Dual Diagnosis therapy can help to break the connection for good.
Understanding Classic OCD
While OCD can take many forms, and people who have the disorder may differ from one another in significant ways, the disease is often described as having two separate, but distinct, phases. In the first phase, the obsession, the person becomes consumed with an unwanted thought or idea. While these obsessions could revolve around almost anything, the Anxiety Disorders Association of America reports that these obsessions are common:
- Fear of dirt, germs or contamination
- Fear of harming a loved one
- Unpleasant sexual images or thoughts
- Concern with order or symmetry
- Excessive doubt
To a person with OCD, these are more than passing thoughts that flit in and out of the mind. Instead, these obsessions are deeply disturbing and upsetting. The person feels genuine distress about these ideas, and may be desperate to remove those thoughts from the mind. For some people, the best way to remove those thoughts is to engage in ritualistic behavior. While some people may engage in behavior that is completely in line with the obsession – straightening books for hours due to a concern about symmetry, for example – other people may engage in behavior that has nothing to do with the obsession. For example, some people excessively worry that they will harm a person they love. To block this thought, they begin counting all of the boards in the floor, only stepping on boards that fall in “good” numbers. The person may know that counting floorboards has nothing to do with violence yet is unable to stop counting those boards, just in case it works this one time.
It’s easy to see the role addiction can play in this form of classic OCD. Drugs like alcohol and marijuana can slow the processing center of the brain, making it more difficult for the person to hang onto these disturbing thoughts. The drugs can also help to slow heart rate and breathing rates, making the person seem more calm and relaxed. It can be seen as a panacea for the distress the person is feeling.
The Line Blurs
According to the National Institute of Mental Health (NIMH), about 2.2 million adult Americans have OCD at any one time. For some people, the disease comes and goes with time, with symptoms growing worse due to stress and then easing up when life seems to be going in the right direction. Other people develop chronic forms of OCD that do not seem to abate with time.
Addiction and OCD can overlap in a variety of ways, and in fact, some researchers believe that people with significant and long-standing addiction issues may exhibit symptoms of OCD as a result of their addictions. For example, an author writing in the journal Addiction states that people addicted to substances tend to develop obsessive thoughts about using that drug. Those thoughts may be unpleasant and they may be completely unwanted, yet the person feels unable to block those thoughts from popping into the mind. As a result, the person feels compelled to engage in the drug use, and while using the drugs, the obsessive thought seems to disappear. This definition of addiction seems to also meet the definition for OCD, and it’s possible that the two problems are developing and becoming stronger together.
Some people also develop rituals surrounding their drug and alcohol use, and those rituals can be similar to the rituals used by people who have OCD and no addictions. For example, an alcoholic with OCD might shave the ice in precise squares before putting it in the glass, and measure out a drink with extreme precision, using the same type of liquor each time. The preparation becomes just as addictive as the drink itself. People with heroin addictions might also develop these rituals, as they need to go through a variety of very precise steps in order to prepare the drug and inject it. Again, the ritualistic movements can be just as addictive as the drugs themselves, causing the person’s mind to feel calm and relaxed, well before the drugs have even entered the person’s system.
Researchers performed a study on the overlap of OCD and heroin addiction in 2000, and the results of that study were published in the Journal of Nervous and Mental Disease. The authors interviewed 71 addicts and determined that 11.4 percent also met the criteria for OCD, which represents a rate that is four times higher than the rate of OCD in people who do not have addictions. It’s clear that there is significant overlap of OCD and addiction.
The First Step
Addiction treatment programs are customizable, allowing doctors to pull together treatments that are designed to help with the right problem at the right time. In order to provide this care, however, medical professionals need to spend a significant amount of time assessing the person to determine what – if anything – is occurring alongside the addiction issue. People who have not been diagnosed with OCD in the past, but who seem to be demonstrating some ritualistic behaviors and/or some compulsions they’re unable to control, might learn that they have OCD for the very first time when they enter a program for addiction.
There is no blood test or brain scan that can diagnose OCD. Instead, medical professionals ask questions such as:
- Do you have thoughts that seem silly or frightening?
- Are you worried you’ll be aggressive, when you would rather not act that way?
- Are you worried about germs?
- Does disorder and disarray bother you?
- How often do you wash your hands every day?
- Do you ever need to “check” things repeatedly to make sure they’re done right?
Positive answers to multiple questions like this can indicate that OCD is playing a role in the addiction issue. With this knowledge, medical professionals can begin to create the right program to address both problems at the same time.
As part of a comprehensive treatment program, the person might be provided with an antidepressant medication. It’s important to remember that using an antidepressant isn’t the same as using drugs or alcohol to treat OCD. An antidepressant is designed to correct a chemical imbalance in the brain that might be encouraging the person to abuse drugs or alcohol. Antidepressants don’t cause people to feel “high” and using the medications won’t get the person in legal trouble. They are valid treatments for the mental health issue the person faces.
NIMH reports that some people with OCD benefit from exposure-based psychotherapy. Here, the person with OCD works with a therapist to determine the triggers that seem to make an obsession develop and grow stronger. Then, the therapist and the person begin to slowly approach and work with that trigger, taking small steps closer and closer to the object until it seems to lose its power. For example, a woman with OCD might become convinced that she will hurt people if she walks through a crowd. In therapy, she might look at pictures of crowds, then stand near a crowd, then stand near two strangers and then enter the crowd. Throughout, her therapist will give her tips on managing her stress and dealing with her fears.
In addition, therapists work closely to help people manage their anxiety as they go through withdrawal symptoms from drugs and alcohol. Sometimes, withdrawal can make OCD symptoms much worse in the short run, and therapists can do their part to ease those symptoms with medications, extra therapy sessions and access to support groups. This targeted therapy, in which both the addiction and the OCD are given equal weight and both are managed appropriately, can help to make real recovery possible, in part, because people are more likely to stay enrolled in therapy programs when they feel those programs are truly providing help. A study published in the Journal of Substance Abuse Treatment found that people who received treatment for both their OCD and their substance abuse issue tended to stay in treatment longer than people who received help for only one issue and not the other. Dropping out of treatment often means returning to substance use and abuse, so it’s important for people to stay enrolled in treatment programs. By providing targeted treatments, therapists do their part to ensure that people stay engaged in the process of recovery.
Making a Choice
While Dual Diagnosis treatment might provide the best chances for a solid recovery, it’s not the sort of care that every program can provide. For example, some programs focus only on mental health issues, but they don’t have the ability to provide medical supervision required for withdrawal from drugs like heroin or prescription medications. Other programs provide supervision for drug abuse problems, but they don’t have mental health experts on staff to assist with OCD concerns. It’s incredibly important for people with a Dual Diagnosis to choose a program that can provide therapies for both issues at the same time. During a search for a facility, families can consider asking questions such as:
- What sorts of addictions do you treat?
- How many people with OCD have you treated?
- Do you have licensed therapists on staff?
- How do you tailor the programs you provide to meet the needs of your patients?
Programs that provide Dual Diagnosis services are happy to answer these questions, and discuss the care they provide. Programs that do not provide these services may not be able to answer these questions so easily, and they might best be avoided.
At Michael’s House, our programs are designed to meet the needs of people who have Dual Diagnosis issues. We have a significant amount of information to share with you about our treatment philosophy, success rates and more. Please contact us today to find out about our approach.