People with obsessive compulsive disorder (OCD) are at an increased risk of developing substance use disorders, which includes alcohol use disorder (AUD).1 Comorbid OCD and alcoholism are common, with data suggesting that around 24% of individuals with OCD meet lifetime criteria for an AUD.1 This is slightly lower than general population estimates of 29.1% of adults meeting lifetime criteria for an AUD.2
OCD is a complex mental health disorder, and our understanding of it has evolved in recent years. In fact, the latest version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Health Disorders (5th edition) moves OCD out from under the category of anxiety disorders, where it appeared in previous editions, and into its own category of obsessive-compulsive and related disorders.3 The APA specifically notes in the introduction to this new category that this new group of disorders maintains “close relationships with anxiety disorders.”3 This relationship is demonstrated in the high prevalence of comorbid anxiety disorder and OCD, with 76% of adults with OCD having a lifetime diagnosis of an anxiety disorder.3
OCD as well as anxiety disorders and AUD appear to influence each other. Having an AUD or OCD can increase the likelihood of developing the other; similarly, each disorder can worsen symptoms of the other.1 Addiction and OCD also appear to share similarities in terms of compulsive behavior—both addiction and OCD are characterized by repetitive behavior that limits a person’s voluntary control over urges, and also involves an inability to delay or stop the behavior.2
Self-medication, in other words, substance use as a maladaptive coping mechanism to suppress symptoms, may be a contributing factor to the relatively prevalent co-occurrence of anxiety and OCD with substance use disorders.1
If you or someone you know have these co-occurring disorders, help is available; and with the proper treatment, individuals can work toward recovery from alcoholism while developing healthier ways to manage OCD long-term. Keep reading to learn more about OCD, alcohol abuse, the reasons they may co-occur, and the types of treatment that can be beneficial for both.
What Is OCD?
Obsessive-compulsive disorder (OCD) is a type of mental health disorder that causes distress due to uncontrollable thoughts (obsessions) and actions (compulsions).4 People with OCD experience obsessions that cause initial feelings of distress while also developing compulsive behaviors in an attempt to soothe or minimize the obsessions. 4,5 They also feel unable to stop the cycle of obsessions and compulsions; this typically leads to serious impairment and causes distress in everyday life.5
Around 1.2% of American adults had OCD in the past year, with 56% of those people suffering from serious impairment due to the disorder.3,4 Additionally, OCD seems to be more common in females than males, with the National Comorbidity Survey Replication showing rates of 1.8% in women as compared to 0.5% in men.3,4
Signs and Symptoms of OCD
The signs and symptoms of OCD primarily involve obsessions and compulsions. Obsessions are distressing thoughts that are experienced as intrusive and unwanted.3 People can experience many different fears and unwanted thoughts, and these beliefs can reflect perfectionism and an intolerance of uncertainty, as well as include an inflated sense of responsibility and a tendency to overestimate threats.3 Some common types of thoughts that may occur in OCD include:6
- Fear of contamination or germs.
- Fear of misplacing or forgetting things.
- Unwanted thoughts about sex, religion, or harm.
- Having hostile thoughts about yourself or others.
Compulsions are repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that applied rigidly.3 Like obsessions, people can have many different compulsions, but some of the common types include:6
- Needing to constantly check things, such as repeatedly checking to make sure you turned off the stove if you leave the house.
- Excessive cleaning or hand washing.
- Compulsive counting.
- Keeping things ordered and arranged in a certain way.
Up to 30% of individuals with OCD also have tic disorder, which means they make uncontrollable and unintentional repetitive movements, such as eye blinking, shoulder shrugging, or throat clearing.2,7
Not everyone who has distressing thoughts or occasional repetitive behaviors has OCD; for example, everyone double-checks things from time to time.7 The difference is that people with OCD experience significant distress and impairment from their thoughts and behaviors.7
People with OCD are unable to control their obsessions and compulsions even when they know that they are irrational and excessive.5,7 Those with mild to moderate symptoms of OCD may spend 1-3 hours each day obsessing or doing compulsive behaviors.3 While they may not feel pleasure from their ritualistic behaviors, they often feel some degree of relief once they have completed the compulsive behaviors.7
Who is at Risk of Developing OCD?
People are usually diagnosed with OCD by age 19, and boys tend to be diagnosed with it earlier than girls; though, sometimes people can be diagnosed after age 35.7 While the exact causes are unknown, certain risk factors are thought to play a role, including:3,7,8
- Genetics. This means that if someone in your family has OCD, you may have an increased risk of developing the disorder.
- Brain changes. Specifically, abnormalities in the structure of the frontal cortex and subcortical structures are thought to be involved, as well as changes in serotonin levels. Brain structures communicate via neurotransmitters like serotonin. The connection with OCD and brain changes is not yet fully understood, yet when people with OCD take medications or receive cognitive-behavioral therapy, brain imaging studies have shown that their serotonin levels become more normal.
- Your environment. Some research has associated physical and sexual abuse and other forms of childhood stress and trauma with OCD. Sudden onset of OCD has also been associated with other environmental aspects, including exposure to various infectious agents, including streptococcal infection, and post-infectious autoimmune syndrome.
What is Alcohol Abuse?
Alcohol abuse means that a person engages in problem drinking that causes significant impairment in their lives. People who are unable to control their alcohol use and continue to drink excessively despite the negative consequences are said to have alcoholism, also known by the clinical diagnosis called alcohol use disorder (AUD).9
People do not necessarily need to drink alcohol daily to have a problem with it. Binge drinking and heavy alcohol use are types of problem drinking that do not always involve drinking every day. Binge drinking means that a man has 5 or more drinks, or a woman has 4 or more drinks, in about 2 hours.10 Heavy alcohol use means that man has 4 or more drinks on a day or more than 14 drinks in a week, or a woman has 3 or more drinks on a day or more than 7 drinks a week.10 Both binge drinking and heavy alcohol use can increase a person’s risk of AUD.10
Additional factors can also raise your risk of developing AUD, such as how much alcohol you consume, and how quickly you drink it.11
Risk Factors of Alcohol Abuse
Genetics, brain changes, and your environment (including exposure to trauma) can all be risk factors for alcohol abuse.11 Drinking at an early age can also affect your chances of developing AUD.11 A study reported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) indicates that people who started drinking before age 15 were 5 times more likely to develop AUD than those who waited until they were 21 to start drinking.11 Additionally, mental health conditions like anxiety or depression, as well as antisocial or impulsive behavior, can increase the risk of AUD.11 The World Health Organization reports that other factors, such as cultural issues (like easy access to alcohol), and socioeconomic factors, can also play a role.12
For those with OCD, a younger onset of OCD (prior to age 15) is associated with an increased risk of developing an AUD later on in life.1
Treating Co-Occurring OCD and Alcoholism
Treating both disorders is recommended when you have a dual diagnosis, also called a co-occurring disorder or comorbid disorders. The combined treatment of OCD and AUD is known as an integrated approach. An integrated approach to treatment allows treatment providers to address the interactions between each illness that can worsen the course of both.13,14
Substance abuse is treated with a variety of methods that typically involve medication and cognitive-behavioral therapy (CBT) or other behavioral interventions.11 OCD is also typically treated with medication and CBT.6
If you only treat the AUD, you ignore the symptoms of OCD, and vice versa, which can be detrimental as each disorder can worsen the other. Abusing alcohol can make it more difficult to treat symptoms of OCD, and having OCD can make it more difficult to overcome AUD.14 Integrated treatment may involve:13,15,16,17
- Detoxification: This allows you to safely stop drinking and withdraw from alcohol. Inpatient detox appears to be more successful than outpatient detox at helping people attain sobriety and stay safe, according to the National Alliance on Mental Illness.
- Inpatient rehab: This means you live at a treatment facility and receive round-the-clock care and monitoring. This is beneficial for people with a dual diagnosis because they have constant access to medical and mental health care, including medication, therapy, support, and necessary medical services.
- Psychotherapy: This typically involves CBT. CBT helps people identify and change unhelpful or ineffective thought and behavior patterns, which is why it is typically used to treat both AUD and OCD. One type of CBT that is particularly effective for OCD is known as exposure and response prevention (ERP). This involves exposing yourself to triggers that make you feel anxious under the guidance of a therapist.
- Medication: According to a study in the Journal of Addictive Behaviors and Therapy, some of the types of medication used to treat alcohol withdrawal include naltrexone, acamprosate, and disulfiram. Different medications are commonly used to treat OCD and typically include selective serotonin reuptake inhibitors, or SSRIs.
- Self-help, or mutual-help, groups: This can include 12-step groups like Alcoholics Anonymous (AA), non-12-step groups like SMART Recovery, or a 12-step mutual support group specifically designed for people with a dual diagnosis known as Double Trouble in Recovery.
Get Help for OCD and Alcoholism
If you’re struggling with alcohol abuse or alcoholism and are experiencing co-occurring OCD, it may be time to seek treatment and work toward recovery from alcohol. Alcohol.org is a subsidiary of American Addiction Centers (AAC), a nationwide provider of addiction treatment facilities.
Our facilities are equipped to treat co-occurring disorders and our team of treatment staff are knowledgeable in treating alcoholism as well as mental health illnesses. As a patient with us, your therapeutic team can tailor your mental health and recovery treatment plans to best address the comorbidity.
While there may be no cure for mental illnesses and alcohol use disorders, comprehensive treatment along with long-term aftercare support can help you successfully manage both disorders.
To learn more about your treatment options, our facilities, our approach to rehab, call our admissions navigators at 1-888-685-5770 . All calls are 100% confidential and there is no obligation to make any decisions upon your first call. Fill out the form below to see if your insurance covers treatment within an AAC facility.Top of Form
. Mancebo, M. C., Grant, J. E., Pinto, A., Eisen, J. L., & Rasmussen, S. A. (2009). Substance Use Disorders in an Obsessive-Compulsive Disorder Clinical Sample. Journal of Anxiety Disorders, 23(4), 429–435.
. Grant BF, Goldstein RB, Saha TD, et al. Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015;72(8):757–766.
. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing:235,242.
. National Institute of Mental Health. (2017). Obsessive-Compulsive Disorder (OCD).
. International OCD Foundation. (n.d.). About OCD.
. MedlinePlus. (2021). Obsessive-Compulsive Disorder.
. National Institute of Mental Health. (2019). Obsessive-Compulsive Disorder.
. International OCD Foundation. (n.d.). What Causes OCD?
. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Alcohol Use Disorder.
. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Drinking Levels Defined.
. National Institute on Alcohol Abuse and Alcoholism. (2021). Understanding Alcohol Use Disorder.
. World Health Organization. (2018). Alcohol.
. National Alliance on Mental Illness. (2020). Substance Use Disorders.
. National Institute on Drug Abuse. (2018). Comorbidity: Substance Use Disorders and Other Mental Illnesses.
. International OCD Foundation. (n.d.). Exposure and Response Prevention (ERP).
. Nguyen, A., Mirbaba, M., Khalegi, F. & Tsuang, J. (2017). Current Treatment Options for Co-Morbid Anxiety and Alcohol Use Disorders: A Review. Journal of Addictive Behaviors and Therapy, 1:3.
. Substance Abuse and Mental Health Services Administration. (n.d.).Understanding Obsessive-Compulsive Disorder.