Dual Diagnosis: Obsessive-Compulsive Disorder (OCD) and Addiction
A dual diagnosis during a substance abuse battle can make the fight seem that much more difficult. Dual diagnosis often points to a connection between the addiction and the mental or physical health condition. It’s critical to treat both the addiction and the condition in a dual diagnosis for the best chance of recovery. One of the most common mental illnesses in the U.S. is the obsessive-compulsive disorder (OCD). OCD and substance abuse are often dually diagnosed.
Understanding What Is OCD
Obsessive-compulsive disorder is a mental health condition that describes a person getting stuck in a cycle of obsessions and compulsions. These obsessions are unwanted and take the form of intrusive thoughts. These ideas, images, or urges trigger intense distressed feelings in the person. The patient will then perform certain behaviors or actions to decrease the stress. A doctor will make a diagnosis of OCD if the obsessive-compulsive cycle interferes with the person’s life, such as getting in the way of meaningful activities. An estimated 2.2 million adults in the U.S. have OCD, though OCD can affect anyone, at any age. Signs of OCD include:
- Unwanted/intrusive Thoughts about Sex, Harm, and/or Religion
- Uncontrollable Thoughts and Behaviors
- Unfounded Fear of Contamination
- Aggressive Impulses
- Mental Images of Hurting a Loved One
- Fears of Being Harmed or Causing Harm to Others
- Constant Checking and/or Counting
- Obsessive Cleaning, Including Repeatedly Washing Hands
- Obsessively Arranging Items a Certain Way
These behaviors only qualify as OCD if they take up an hour or more of a person’s time every day. One must see a doctor for an OCD diagnosis. OCD is chronic and can interfere with all aspects of life. Individuals with OCD may struggle at sustaining relationships with others. They may feel isolated from society and lose friends because of their obsessions. They may lose their jobs for lack of ability to focus in the workplace or drop out of school for the same reason.
Some, though not all, people with OCD also have motor control tics, such as rapid eye blinking, squinting, and facial grimacing. They may have a compulsive head or shoulder jerking, shrugging, or other physical tics. A person with OCD may also have auditory responses such as repeated sniffing, grunting, or throat clearing. Symptoms of OCD may change over time and fluctuate in severity. Some situations can trigger OCD, so staying away from triggers is one of the ways a person can help to manage this condition.
The Link between OCD and Addiction
According to the Journal of Anxiety Disorders, more than 25 percent of people with OCD also struggle with substance use disorders. An addiction further complicates an OCD diagnosis and vice versa, and these two conditions often go hand in hand because of the compulsive nature of both disorders. Those with this dual diagnosis suffer because these kinds of co-occurring issues tend to affect one another. Symptoms of OCD can exacerbate symptoms of addiction and vice versa. Substance abuse can make the symptoms of OCD more severe. Likewise, OCD can make an addiction more acute, with a reduced chance of recovery.
People with OCD may turn to substances to relax, to find an escape from constant obsessive thoughts, and ease social situations or numb anxiety. Drugs and alcohol may offer temporary relief of OCD symptoms, but will ultimately make the mental health condition worse. Occasional substance use can quickly turn into addiction, whether a person has OCD or not. A substance abuse problem can make OCD worse, leading to consuming more substances, perpetuating the cycle.
Similarities between the Two Conditions
There are several similarities between OCD and addiction: Addiction also traps the mind in a cycle in which the person can’t stop taking the drug or drinking even if he or she wants to. Addiction can quickly take over a person’s life, despite the fact that most people don’t plan to get addicted when they start consuming drugs or alcohol. These substances eventually change the brain’s chemistry, making it difficult to break the cycle and get clean. Addiction is a disease, while OCD is a mental health condition. Together, they are a very dangerous combination.
Impulses control both OCD and addiction. In both cases, the person feels compelled to do something even if he or she knows it’s not in his/her best interest. Furthermore, both of these conditions appear to affect the same part of the brain – the prefrontal cortex. This area of the brain is in charge of decision-making and self-regulation. Substance abuse leads to changes in this section of the brain, altering the brain’s reward center and resulting in the lack of judgment.
The lines can become blurred between conditions for someone with this dual diagnosis. Since both share similarities involving compulsive behaviors, cravings, and obsessive thoughts, it can be difficult to see where OCD ends and addiction begins. Both can cause a person to do things he or she wouldn’t rationally do, and both are forms of obsessive-compulsiveness. Both can lead to a person feeling isolated, depressed, and alone. It’s easy to see that if a person has both of these conditions, the effects can be dramatic.
Dangers of This Dual Diagnosis
Struggling with both OCD and a substance addiction can take up most or all of a person’s time and energy. Obeying compulsive thoughts as well as the urge to consume drugs or alcohol can make it impossible to maintain a healthy daily routine. These distractions often are too much to lead a healthy, happy life. When left untreated, OCD can cause anxiety, depression, and thoughts of suicide. A substance abuse problem can also cause these feelings, as well as the risk of overdose. The combination can be potent, causing severe mental, physical, and emotional damage.
Getting trapped in an addictive cycle is what OCD is all about. When this addictive cycle involves harmful drugs and alcohol, it can lead to devastating health consequences. A person with this dual diagnosis is at risk of overdose, kidney and liver damage, brain damage, and myriad other problems connected with substance abuse. Turning to drugs or alcohol to ease symptoms of OCD will do the opposite, and lead to the obsessive-compulsive use of substances. Professional treatment at a rehabilitation facility is the best chance for a person with a dual diagnosis to attain a healthy, normal life.
The likelihood of relapse is high with this dual diagnosis, especially if a person does not visit a treatment center with experience in treating both OCD and substance-use disorder. A person fighting against both of these powerful compulsive disorders cannot hope to break the cycle alone. Trying to detoxify the body after an addiction without professional medical help is not only painful but can end in death. One of the greatest dangers of this type of dual diagnosis is failing to get the proper treatment, and exacerbating an addiction to the point of serious physical and mental harm.
Dealing with OCD and addiction can make it difficult to maintain close personal relationships. Obsessive rituals can make a person late for work, just as getting drunk or high can. Some people with OCD suffer from eating disorders or clinical anxiety on top of struggling with addiction. This dual diagnosis can lead to financial problems, hiding things from people close to you, and loss of interest in activities that you once valued. You may also engage in risk-taking behaviors that could lead to personal harm, such as unsafe sex.
OCD and substance abuse can make thoughts of suicide more recurring than struggling with just one condition or the other. Depression and anxiety can get the best of someone fighting against both of these dangerous conditions, ending in purposeful overdose or a suicide attempt. On top of this, the person will likely feel weak and fatigued, unable to engage in any daily physical activity. Substance abuse and OCD can destroy a person’s life, attacking every aspect until the individual has nothing but his or her conditions left. It’s crucial to seek treatment before this dual diagnosis wreaks permanent havoc.
There are treatment options for someone with a dual diagnosis of OCD and substance addiction. To have a chance at recovery from both conditions, the person will need to address both during treatment. It’s important to enter a dual diagnosis treatment program that has the specific tools and resources to treat both addiction and other mental health conditions. Addiction professionals who understand the intricate nature of OCD are necessary for the competent care of these individuals. Treating addiction but ignoring OCD may eventually lead to a relapse. Do your research to find a treatment center with experience handling both conditions at the same time.
OCD is typically a permanent mental health diagnosis, but there are proven forms of therapy that can help a person manage his OCD symptoms. Most treatment involves medication and/or exposure and response prevention (ERP). ERP is a type of cognitive behavior therapy that has the strongest evidence supporting its use as a treatment for OCD. ERP occurs in an outpatient setting, so the patient visits a therapist’s office one or more times per week. A licensed mental health professional must orchestrate treatment.
The exposure part of ERP involves exposing the person’s thoughts, images, and situations that create anxiety or trigger obsessive behaviors. Response prevention refers to making the conscious choice not to engage in the compulsive behavior once feelings begin. A therapist will guide a person with OCD through this process until, ideally, the patient can prevent responses on her own. Confronting anxieties head-on may seem as though it would make OCD worse. When it’s done in a safe, therapeutic environment where the patient is committed to not give in to compulsive behaviors, it can be successful.
ERP can “rewire” the brain using habituation to respond differently to the internal alarm that goes off due to compulsive thoughts. While someone with OCD may never be able to silence the alarm, they can learn to react to it in a different way. Instead of responding with compulsive behaviors or actions driven by fear, the patient can learn how to respond with calming techniques and self-placating. Learning this important skill will help control OCD, and will also reduce the chances of the person turning to drugs and alcohol for anxiety relief.
There are several different treatment approaches for substance use, depending on the type of drug use. No one treatment is right for everyone. Medical professionals need to work in close collaboration with the addict in a controlled setting, such as a rehabilitation clinic, to come up with a tailored treatment plan. A treatment plan for addiction typically involves:
- Medication to Ease Withdrawal
- Behavioral Therapy
- Holistic Therapy
- Evaluation and Treatment for Co-Occurring Issues, Such as OCD
- Long-Term Follow-up Plan
- Anti-Relapse Plan
Having a mixture of treatment strategies is often the key to success when battling an addiction. Treatment needs to include mental health services, especially in the case of a dual diagnosis including OCD. Follow-up care is vital for addiction treatment because the rate of relapse can be high depending on the circumstances. Follow-up may include attending community-based programs such as Alcoholics Anonymous or Narcotics Anonymous, as well as family-based recovery support systems.
Dual Diagnosis Treatments
There is hope for people with this dual diagnosis, but recovery is not without its roadblocks. It’s crucial for a person with OCD and a substance addiction to seek professional treatment and care from doctors. Battling one or the other is difficult enough, but fighting against both of these compulsion-related conditions can feel impossible. With the right support system, people can and do recover from these dual conditions – at least enough to manage symptoms and live a full life. Make it a priority to treat both conditions, addressing one alongside the other.