The link between OCD and addiction: What to know

There is a link between all mental health conditions and addiction, including obsessive-compulsive disorder (OCD). People with OCD may turn to substances or behaviors that provide an escape from their symptoms.

This information is according to 2020 research.

OCD is an anxiety disorder that causes upsetting, intrusive thoughts. For example, a person may have frequent intrusive thoughts about an intruder breaking into their house. This is the “obsessive” part of the disorder.

In response, many people with OCD perform behaviors that ease the anxiety due to these thoughts. For example, they might repeatedly check the doors are locked. This is the “compulsive” part of the condition.

To an observer, these repetitive behaviors might look like addictions. And while compulsion and addiction can occur simultaneously, they are different.

In this article, we will explore the link between OCD and addiction, how they influence each other, and how health professionals treat both.

Addiction is generally common, but it is more prevalent among those with severe mental health conditions, including OCD.

Estimates vary for how many people with OCD also have addictions. In a 2019 study, researchers followed 38,157 veterans with OCD. More than a third (36.7%) had a substance use disorder. The most common substances were:

  • tobacco: 26.5%
  • alcohol: 17.1%
  • cannabis: 5.5%
  • opioids: 3.6%
  • cocaine: 3.37%
  • amphetamines: 1.5%

A 2022 study on behavioral addictions also found high rates of people with OCD and addictions. The researchers asked 150 people at an OCD clinic in India to report their symptoms. They then compared them with the symptoms of 131 individuals without OCD.

Among those with OCD, 70% of people reported symptoms of behavioral addiction. The percentage of those without OCD was 58%. Internet addiction was especially high, affecting 29.3% of individuals with OCD compared with just 3.1% without OCD.

However, other research suggests the correlation between OCD and addiction is not straightforward. A 2021 study found that, while people with mild or severe OCD symptoms were likely to have an addiction, those in the middle of the spectrum were less likely. On a graph, this creates a U-shaped curve.

Several theories suggest why addiction is more common in those with mental health conditions. It may be due to several factors, such as:

  • Self medication: People may use substances or behaviors to cope with their symptoms, as these may offer temporary relief or escapism. Doctors call this “self-medication.” As OCD is an under-reported condition, it may be that some self-medicate because they are not getting the support they need.
  • Overlapping risk factors: The risk factors for mental health conditions and addiction are similar. These include early stress and trauma, changes in brain structure or chemistry, and genetic changes that may make some people more vulnerable to both.
  • Substance side effects: Some addictive substances can cause or worsen mental health symptoms, either during use or when the substance wears off.

Some more specific theories explain the link between OCD and addiction. One idea is that there may be a relationship between compulsiveness and impulsiveness.

Impulsivity means someone is less able to regulate their behavior. They may act “on impulse,” following spontaneous urges to try substances or behaviors that are potentially addictive.

The authors of the 2021 study speculate that those with more severe OCD may have higher levels of impulsivity, which may explain why addiction rates are higher in this group.

The 2022 study also noted that individuals with behavioral addictions and OCD scored much more highly on impulsivity than other participants.

Another theory is that both OCD and addiction may affect the reward processing part of the brain. However, currently, experts do not fully understand this link, so more research is necessary.

From the outside, the repetitive or ritualistic behaviors that people with OCD have can look like addictions. Both compulsion and addiction create powerful urges that are difficult to resist. If someone cannot engage in them, they may become distressed.

However, compulsions and addiction are not the same.

Compulsions are actions a person feels they must do to avoid negative feelings, such as fear or anxiety. People with compulsions may feel that if they do not carry them out, bad things will happen.

Compulsions can be neutral behaviors, such as counting or tapping. They can even be unpleasant behaviors, such as excessive handwashing that leads to dry, cracked skin.

By contrast, addiction involves substances or behaviors that offer a reward. They may provide pleasure, excitement, or escapism. While they might be harmful overall, the activity itself is enjoyable, even if only temporarily.

So, while addiction is compulsive in that it is difficult to stop, compulsions are not usually addictions.

OCD and addiction are both treatable conditions. While a person may have some degree of OCD throughout their life, symptoms can improve significantly with the right support.

Treatment may involve:

  • Talk therapy: Both OCD and addiction can respond to talk therapy. In therapy, a therapist works with a person to understand the motives behind their behavior, address automatic thoughts, and develop new coping skills. They may also address potential root causes or contributors, such as trauma.
  • symptom management: Some people with OCD find that medications help reduce their symptoms. However, the effects may vary from person to person.
  • Medication-assisted treatment (MAT): If a person has a substance addiction, they may be eligible for MAT, an addiction treatment that helps the body adjust. For example, a doctor may prescribe methadone to someone with opioid use disorder. This reduces cravings and withdrawal symptoms.
  • Support groups or programs: Support groups for addiction or OCD can offer support, practical strategies, and reassurance from other people who have been through similar experiences. There are also structured programs that support individuals through the addiction recovery process.

However, it is important to treat both conditions simultaneously, as OCD and addiction can reinforce each other.

It is also crucial that people who use addictive substances do not try to quit “cold turkey.” Depending on the substance, this could be very dangerous.

People with OCD, addiction, or both can seek treatment at any time. Generally, earlier is better, as this reduces the risk of severe symptoms or complications.

A doctor or mental health professional can assess someone’s needs and create a treatment plan.

People should also seek support if they:

  • have upsetting thoughts they cannot control
  • have difficulty stopping certain behaviors, despite wanting to
  • experience withdrawal physical symptoms when they try to stop using a substance
  • are undergoing treatment but have new or worsened symptoms
  • were in recovery but are experiencing symptoms again

Addiction may involve substances, such as alcohol, or behaviors, such as gambling. Research suggests both types are more common in those with OCD.

There may be several reasons for this. Self-medication, similar risk factors, and changes in brain chemistry or structure may play a role.

Despite this, people do not have to live with OCD or addiction. Knowledgeable mental health professionals can offer treatment without judgment and help someone lead a full and healthy life.

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