Substance use provides an escape that many people with severe behavioral health conditions such as obsessive-compulsive disorder (OCD) use to avoid disease symptoms.
Nationally and at the Institute of Living (IOL), part of the Hartford HealthCare Behavioral Health Network, more than a third of those with OCD also have substance use disorders (SUD).
“We see a significant number of individuals with co-occurring OCD and substance use disorders,” said David Tolin, PhD, ABPP, director of the IOL’s Anxiety Disorders Center. “In most cases, we recommend patients receive specialized treatment for substance use and treatment for their OCD.”
A recent study showed a high rate of people with OCD have a behavioral addiction, including gambling and video games, an area Dr. Tolin called more “controversial.”
“It is not clear at this time whether an addiction to something like video games or gambling is the same thing as addiction to a substance, but certainly there is overlap from a behavioral perspective,” he said.
When digging into the histories of patients with OCD, Dr. Tolin said the disorder apparently manifests first with SUD or technology providing a means of escape. OCD is a condition causing intrusive thoughts, such as a house fire, that prompts repetitive behavior like checking the stove knobs over and over to ease the thoughts.
“I suspect the substance use began as an unhelpful coping strategy for dealing with OCD and related symptoms,” Dr. Tolin noted.
The results, however, are temporary and create a vicious cycle.
“It might help the person feel less anxious in the moment but, in the long run, it probably makes things worse,” Dr. Tolin said. “Avoidance of negative emotions prolongs the problem. In the long run, the person must use more substances to try to ‘chase’ their symptoms.”
People with OCD, which is characterized by compulsivity, might turn more to substances because the disorder can also trigger a heightened level of impulsivity, Dr. Tolin explained.
“I suspect compulsivity and impulsivity are two extremes of a continuum,” he began. “Most people with OCD are compulsive, meaning they don’t find their behaviors pleasant but they don’t feel they can stop because they are so fearful. On the other extreme, people with SUDs tend to be impulsive, meaning the behavior is perceived as pleasurable and the person doesn’t have a good set of internal ‘brakes.’”
Those with both OCD and addiction require added layers of treatment to break the cycle, he continued, as SUD can “interfere significantly” with OCD treatment. At a behavioral level, numbing the emotions with substances makes patients less able to face their fears. At a biological level, Dr. Tolin says substances interfere with the brain changes needed during therapy.
“We typically recommend someone with a substance use disorder receive treatment for that disorder prior to, or at the same time as, treatment for OCD,” Dr. Tolin said.