TREATING OCD AND ADDICTION​

What Is OCD?

Living with obsessive-compulsive disorder (OCD) can be challenging and debilitating. If left untreated, it can lead to anxiety, depression, and even suicidal thoughts.

For some, OCD can be the start of a vicious cycle of chemical dependency that causes depression, triggering anxiety and worsening the symptoms of OCD.
Integrated treatment is the best way to treat OCD and addiction. This treatment combines mental health treatment with a substance abuse treatment program. OCD, which stands for obsessive-compulsive disorder, is a severe mental illness that has two aspects:
  • Obsessions: intrusive thoughts, images, or impulses
  • Compulsions: the urge to do something over and over again
Actions, such as excessive hand-washing or checking things repeatedly, are often associated with OCD. However, although these actions may be examples of OCD tendencies, the actual disorder is much more severe.

How OCD Affects Life

People living with OCD have little control over their obsessive thoughts and compulsive behaviors. The time-consuming condition can negatively affect work, school, or social life.

Medical professionals still do not entirely understand the neurological roots of the disorder. A recent study published in the journal Biological Psychiatry found that people with OCD displayed more activity in the brain regions associated with recognizing an error but had less activity in areas of the brain that could stop an action.1

Some other studies have reported an association between OCD and childhood trauma. However, more research is needed to confirm the findings.2

How Common Is OCD?

According to the Anxiety and Depression Association of America (ADAA), 2.2 million adults, or 1.0% of the US population, has OCD. The condition is equally common in men and women, and the average onset age is 19.3
It’s estimated that on a worldwide level, around 2% of people have OCD.4

How Is It Diagnosed?

A simple blood or genetic test can not detect OCD. A doctor may do a physical exam and blood test only to rule out other medical conditions.
Generally, OCD is diagnosed through an interview with a skilled clinician to discuss thoughts, feelings, symptoms, and behavior patterns to see if the person has obsessions and compulsions that affect their quality of life.

How Are OCD and Addiction Connected?

The relationship between OCD and addiction is a complex one. Many people with OCD resort to substance use to subdue feelings of anxiety and stress.

Bipolar 1 Disorder

Bipolar 1 disorder is defined by periods of manic thoughts and behaviors which last around seven days. These manic episodes can become so disruptive and dangerous that immediate interventions may be needed to subdue the mania. Also, depressive symptoms can occur alongside manic symptoms, making treatment and diagnosis challenging.
One study published in the Journal of Anxiety Disorders found that:5
  • 27% of adults with OCD met the criteria for a substance use disorder
  • 12% met the criteria for an alcohol use disorder
  • 11% met the criteria for alcohol and a drug use disorder, and 3% met the criteria for a drug use disorder
People who started experiencing the symptoms of OCD in childhood or early adolescence have also been found to have increased rates of abusing substances.

Is OCD Social Isolation a Factor in Addiction?

People with OCD understand the severity of their condition and the irrationality of their actions. They understand the relationship between their obsessions and compulsions, although they have no control over it.
Not being able to break free from these thoughts and actions can be very distressing. As a result, some people with OCD retreat into their homes and distance themselves from their friends and family.
A possible side effect of this social isolation is depression, making the person even more susceptible to addiction.

OCD Effects

Obsessions

Obsessions can take many different forms, including:
    • Fear of contamination by dirt or germs
    • Worries about harming others
    • Preoccupations about numbers, patterns, or sexual identity
    • Concern with orderliness and symmetry
    • Fear of losing control over one's behavior

Effects of Obsessions

Some examples of effects caused by obsessions include:
  • Not touching objects that other people have touched
  • Doubts that you have locked the door or turned off the stove
  • Thoughts of driving your car into a crowd of people
  • Troublesome sexual images
  • Thoughts about acting inappropriately in public
  • Avoiding situations that can trigger obsessions

Addiction vs. Obsession

Although somewhat similar, there are some crucial distinctions between addiction and obsession.
When there is an addiction, there is little control over doing, taking, or using something to the point where it can be harmful. However, biological processes at work have been manipulated by substances over time, making it difficult to experience pleasure or euphoria unless the substance is present. Addictions are also frequently rooted in escaping from the real world to a desirable place.
On the other hand, an obsession a ritualistic routine that becomes part of a person’s everyday life. It’s possible to be obsessed with a story, a thought, an idea, an activity, or another person.
For example, an obsession may include repeated hand washing after touching someone or rechecking all the doors at night several times even though they’ve already been locked.
All of these obsessions are rooted in fear. Fear that if you do not lock the doors, a burglar will come into the house. Fear that if you do not wash your hands several times, you will catch some terrible disease.

Compulsions

Compulsions can take many different forms, including:
  • Excessive cleaning or washing
  • Meticulously arranging objects
  • Walking in predetermined patterns
  • Compulsive counting
  • Following a strict routine
  • Demanding reassurance

Effects of Compulsions

Some examples of compulsive behavior include:
  • Washing your hands until your skin becomes raw
  • Checking the stove multiple times to ensure it is off
  • Checking the door locks repeatedly to ensure they are locked
  • Arranging kitchen items to face the same way
  • Silently repeating a word, phrase, or prayer
  • Counting steps

Addiction vs. Compulsion

One significant difference between addiction and compulsion is that addiction has to do with pleasure, and compulsion does not. Using a substance like heroin or other addictive behaviors like gambling typically results in some sort of pleasurable experience, at least at first. In contrast, a person cleaning excessively or checking the door locks repeatedly does not get pleasure from the act.
The second significant difference is that people with a compulsive behavior are very aware of their compulsion’s negative effects on their quality of life. Addiction may not be as easy to identify.

Treating a Dual Diagnosis of OCD and Addiction

A co-occurring psychiatric condition or dual diagnosis is when there are a substance abuse disorder diagnosis and one or more mental health disorders.
Integrated treatment for dual diagnosis is more effective compared to treating individual disorders with separate treatment plans.6
Integrated treatment includes the use of multiple therapies such as the combination of psychotherapy and pharmacotherapy.
Therapies like Cognitive Behavioral Therapy (CBT) can help explore thoughts and beliefs surrounding substance use and ultimately change negative thinking patterns.
Medications such as selective serotonin reuptake inhibitors (SSRIs) can help people control their obsessions and compulsions. As OCD is associated with low serotonin levels, SSRIs can increase the brain’s serotonin levels by limiting its reabsorption by brain cells. Common SSRIs include citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline.
Integrated treatment programs may also include additional support services to help obtain long-term recoveries, such as housing, employment, and socialization.
Support groups such as Dual Recovery Anonymous can give emotional and social support. During these meetings, anyone can share their personal experiences regarding how they have learned to cope with their symptoms.
Integrated treatment is available as part of inpatient and outpatient care.
This information should not replace a visit to a doctor or treatment center. If you are concerned that you or a loved one might be suffering from tramadol addiction, ask for professional help today.

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