OCD and Substance Abuse
“A physical sensation crawls up my arm as I avoid compulsions. But if I complete it, the world resets itself for a moment like everything will be just fine. But only for a moment.” — Mardy M. Berlinger
Obsessive Compulsive Disorder (OCD) was briefly discussed in the previous blog written about Anxiety Disorder and Substance Abuse Disorders. In this blog, we are going to dive deeper into this type of anxiety disorder. We are going to further our understanding of OCD and the misconceptions on how the term is used in society. For example, you may have heard someone say something along the lines of, “I totally have OCD. I’m such a neat freak”. Phrases like these are not intended to insult those with OCD, rather they are used to relate to others and are an attempt to feel understood. However, as someone with OCD, I am offended and frustrated when I hear things like this. OCD is so much more than just wanting things to be in order.
So what exactly is OCD and how does it differentiate between those who like cleanliness and/or those who experience intrusive thoughts?
Many people prefer clean environments but it does not haunt their day or confine them to their homes. Intrusive thoughts happen to everyone and are quite normal. An intrusive thought is an unwelcome involuntary thought, image, or unpleasant idea. Most of the time we are able to brush them off and move on with our day. However, people with OCD are not and these thoughts ruminate and become obsessions. These normal behaviors or thoughts become impairments for those with OCD.
OCD is a type of anxiety disorder, characterized by reoccurring thoughts that cause distress, anxiety and fear and cannot be easily brushed off. Some people with OCD attempt to relieve themselves from these disturbing thoughts by performing compulsions. This type of anxiety disorder is chronic, lifelong and can be extremely destructive to one’s life and relationships.
There are five subtypes of OCD:
- Contamination Obsessions with Washing/Cleaning Compulsions: Those with this type experience discomfort and excessively clean to avoid these anxiety provoking thoughts/fears of things being contaminated.
- Harm Obsessions with Checking Compulsions: Those with this type have distressing thoughts related to harming yourself or others and using compulsions/rituals to relieve your anxiety. This does not mean that those with these thoughts want to harm themselves or others. It’s actually quite the opposite. For example, you may have fear of running someone over and therefore pull over every couple minutes to check under your car to make sure that no one is there or hurt.
- Hoarding: This is a more commonly known type and has received media attention in shows like “Hoarding, Buried Alive”. This type actually has its own classification in the DSM. This type involves hoarding collecting numerous items that have limited value and eventually consume your living space. Hoarding is accompanied by a deep emotion attachment to these items and a fear of loosing these them. People with this type can obsessively collect anything from newspapers, old toys, to even trash and fecal matter.
- Obsessions Without Visible Compulsions: This type is often invisible since there are not visible compulsions but is instead characterized by unwanted obsessions relating to sexual, religious, or aggressive themes. Invisible compulsions include mental rituals such as reciting certain words, counting in your head, and excessively praying. People with this type usually avoid triggers because the thoughts that surface are so disturbing.
- Symmetry Obsessions with Ordering, Arranging and Counting Compulsions: People with this type feel a strong urge to rearrange things in a particular order that feels just right. People with this type usually exhibit perfectionism and will think or say things to themselves over and over again until it is performed “perfectly”.
There is also additional obsessive compulsive related disorders in the DSM: Skin Pricking Disorder, Hair-Pulling Disorder, Body Dysmorphic Disorder and OCD related disorders induced by a substance or another medical condition.
In most cases of OCD and in Substance Abuse Disorders, people feel helpless and controlled by their OCD and/or or their compulsions to use drugs and/or alcohol.
It is estimated that more than 25% of those who seek treatment for OCD also meet criteria for a Substance Abuse Disorder. Many times people with OCD will try to self medicate with alcohol or drugs to cope with the destructive and repetitive thoughts. And many times people with OCD and/or a Substance Abuse problem will try to hide their struggles.
Why is this dual diagnosis so dangerous?
- People with OCD and Substance Abuse disorder are more likely to be jobless and living on unemployment/ disability.
- Substance Abuse users with OCD are more likely to isolate themselves and be confined by their home.
- Hospitalization is more likely to occur.
- There is a higher risk of suicide for this suffering from both OCD and Substance Abuse Disorder.
- There is an increased possibility of relapse.
What does treatment look like for those diagnosed with OCD and Substance Abuse Disorder?
More often than not, people with OCD and Substance Abuse Disorder will not seek treatment themselves, which makes the involvement of family and friends vital. Intervention might be required as the first step before one can start treatment. The next step involves finding a treatment center that treats these dual diagnoses.
OCD may require treatment centers and professionals to personalize the treatment plan even more than normal. People with OCD may need shorter therapy sessions or may have anxiety in group therapy (a form of therapy used in Substance Abuse Disorder). However, these barriers make it impossible for recovery.
Treatment for OCD and Substance Abuse Disorder usually requires motivational interviewing (goal oriented and client focused counseling), cognitive behavioral therapy (negative thoughts are challenged to alter certain behaviors), group therapy, family counseling and education, and stress reducing therapies like meditation.
If you have or know anyone experiencing OCD and Substance Abuse Disorder, it may feel like a battle between two versions of yourself. But you don’t have to fight this battle alone or for long. Treatment and recovery is possible and everyone deserves to live a life with a healthy and integrated version of themselves.