Updated: Apr 29, 2022
Written By Granite Recovery Centers
Clinically Reviewed By Cheryl Smith MS,MLADC
July 7, 2021
Most people think about anxiety and depression when mental illness is mentioned because these are two of the most common conditions. Another very common but underrecognized mental illness is obsessive-compulsive disorder, OCD. Mainstream depictions of OCD make it seem like a condition where people want order or obsessively wash their hands, but true OCD is broader, causes great anxiety for those suffering from it, and takes hours to comply with the rigorous compulsions. Today we’ll talk about OCD, what true OCD looks like, the likelihood of suffering from addiction at the same time, and common treatment methods for both disorders.
What Is OCD?
OCD is a very common but also very misunderstood mental illness. You have likely seen it referenced in shows and movies. Mainstream OCD appears to be anyone who likes their items to be orderly, or those who are excessively neat. Many people also claim to have OCD if they want things a certain way. While all of these might be symptoms of OCD, the truth is that this mental illness can be quite broad and is very difficult to manage.
According to the International OCD Foundation, OCD is broken down into two fundamental parts. There are the obsessions and the compulsions.
Obsessions refer to unwanted and intrusive thoughts that cause significant anxiety. Mainstream depictions of OCD show people who are afraid of germs and contamination. This might be an obsession, but that’s only part of the picture. Obsessions can also be related to fears of losing control, harming oneself or others, or superstitious ideas. Sometimes, obsessions are of a religious nature. It is also important to note that those with OCD do not wish to act on these thoughts. The obsessions are intrusive and cause anxiety. The obsessions then lead to compulsions.
Compulsions are any behavior or activity that reduces the anxiety generated by the obsessions. Drawing again from mainstream depictions, this could be someone who washes their hands dozens or hundreds of times. It could also be checking doors or locks, frequently checking with others to see if a mistake was made, repeating routine activities to ensure they were right, doing things a specific number of times because the number is lucky, and so on. The compulsion reduces anxiety, but this also reinforces doing the compulsion over and over again as it seems to help.
It is also important to note that the obsessions and compulsions don’t always coincide. Sometimes, the two seem to work together, such as obsessions about contamination and handwashing compulsions. Other times they don’t, such as the same obsession but having to check the door three times every hour.
Along with the qualifying obsessions and compulsions, there is one other component to a successful OCD diagnosis. It must take a minimum of one hour to satisfy the compulsions. Remember that this is a minimum. Many OCD sufferers find themselves using half the day trying to reduce their anxiety.
You might be wondering if mental illness and substance use can occur at the same time. We actually have a term for that. It’s known as dual diagnosis or co-occurring diagnosis. This is a broad term that refers to any two or more conditions along the lines of mental health and substance use.
This could be used to refer to depression and alcohol use, anxiety and heroin use, OCD and cocaine use, and so on. Any combination is applicable here as long as at least one condition is mental health and the other is substance use. We have found that, while it can be a chicken-or-egg argument about which came first, the important thing to note is that we work together on treating both sides of your condition so that you can properly heal. Treating the OCD by itself won’t make the substance use go away nor will treating substance use necessarily improve your OCD. We must treat both simultaneously.
OCD and Substance Use
We covered above how any mental illness, such as OCD, and co-occurring substance use qualifies as a dual diagnosis. We’ll get a little deeper into how often OCD sufferers have to battle with substance use. A fairly large percentage of those with this condition find themselves struggling with substance use.
While there are varying accounts, the National Institute of Health reports that about 27% of OCD sufferers would classify as dual diagnosis clients. You might also be wondering what the most common substances are.
The most frequently used substance in the above study was alcohol. About 12% of the participants only used alcohol. Close to that was 11% of participants who used both alcohol and another substance. Only 3% used a substance without any alcohol. Cocaine and cannabis were found to be the most common substances used. A small percentage of participants used opioids or sedatives.
This study also discovered some other interesting facts about OCD and substance use. Most of the participants reported that they began suffering from OCD at least one year before using substances as a coping mechanism. About 70% of those suffering from co-occurring OCD and substance use reported to have suffered initially from OCD. About 24% reported that their substance use occurred before suffering from OCD. The remaining 6% claimed that both occurred within the same year.
While the substances were used to help cope with the symptoms, this study found that most substances worsened the OCD symptoms. A younger age of onset was positively associated with increased rates of substance use.
Many in the study also suffered from comorbid borderline personality disorder, BPD. The presence of BPD increased rates of substance use and was most prevalent for drug use.
If you are suffering from substance use, regardless of an OCD diagnosis, then a medical detox program might be the right step for you to take. Many substances can cause painful, uncomfortable, or even fatal withdrawal symptoms once you stop using them. For example, severe alcohol withdrawals can lead to fatal seizures.
Granite Recovery Centers provides medical detoxification for people who do not need immediate medical intervention, are not a danger to themselves, and are capable of self-evacuation in the event of an emergency. Our medical detox program connects you with a trained doctor who will check your symptoms and ensure that your detox is going properly. This might be especially helpful if you’re suffering from OCD. You might feel compelled to ask if the detox is going properly and correctly. A doctor will be the best one to know if your symptoms are or aren’t expected. They can also adjust the tapering schedule as needed based on how you feel.
A medical detox program is helpful if you find it difficult to discontinue on your own, which is very common with substance use disorder. It isn’t weakness. This is a service that helps you discontinue in the safest and most comfortable way possible.
At the same time, keep in mind that detox only helps one part of the problem. This removes the substance from your body. Many people find that they still have the behaviors associated with use. That is why we recommend further treatment to improve your chances of long-lasting recovery.
Suffering from both OCD and substance use can be very difficult. You might find it hard to balance your symptoms with substance use, or the substance use might become part of your compulsions. This makes it very hard to manage both conditions on your own, so inpatient care might be best for you. We can help you determine if this is the right course of action for your needs.
Inpatient care consists primarily of partial hospitalization and residential treatment. Both of these ensure that you are monitored for part or all of the day as you learn coping mechanisms to manage stress and symptoms.
How long you stay at our facility depends on the level of care. If partial hospitalization is better for you, then this means that you will stay at the facility for half the day. You will have access to nurses, doctors, and therapists while you are on the premises. You’ll then be able to return home to sleep in your own bed. This can be helpful if your environment is supportive of recovery, but you need extra time to work on yourself.
If your environment isn’t supportive of recovery or you need additional support, then residential treatment might be better. This is similar to partial hospitalization, but the important difference is that you’ll live at the facility for the entire day. This allows you to focus 100% on your recovery without worrying about work, stressors at home, or anything else. This also ensures that you have 24-hour access to medical staff.
If your symptoms are mild to moderate or you have successfully completed inpatient care, then outpatient treatment would be best for your needs. This also includes two major levels of care that are often combined to be as effective as possible.
Outpatient treatment, also known as individual sessions, is when you meet individually with your counselor to discuss your progress while also learning coping mechanisms to help support your recovery. This is typically a weekly visit, but twice a week or biweekly might be better depending on your presentation. Many people find this helpful because you’ll be able to discuss your needs in private.
Intensive outpatient, IOP, is a higher level of care that consists of three sessions per week. Each session lasts for three hours. This is a group therapy format, which means that you will meet with others who are also in recovery along with a trained therapist. You will have time to learn from others in their recovery journey while increasing your sober support network.
Many clients find it useful to combine both levels of outpatient care. This allows you to discuss overall concerns and to learn from others during IOP group therapy, and you can also discuss more private concerns during your individual session.
Be sure to discuss your needs when you contact us. We will create a treatment plan that respects your decisions and where you are in your recovery journey. Not only will we listen to you, but we will also draw on our experience to help you know which level of care is most appropriate for your needs.
OCD can be a difficult mental illness to cope with as it generates intrusive thoughts, significant anxiety, and compulsions that can take hours from your daily life. Many people turn to substances to help cope with their OCD, but that often makes everything even worse. We, at Granite Recovery Centers, have helped clients just like this recover from both their substance use and OCD.
Contact us today, and we can begin helping you no matter where you are in your recovery journey. Whether you need an intensive program or just a weekly session, we can assist you by giving you the support that you need.
For over 10 years, Granite Recovery Centers has been transforming the lives of alcohol and drug dependent adults from New England and well beyond. Visit them here.