In any given year, the National Institute of Mental Health (NIMH) reports that 1 percent of the American adult population suffers from obsessive-compulsive disorder, or OCD. About half of the time, the disorder is considered severe, meaning that the symptoms interfere with a person's ability to function normally in everyday life. Intrusive thoughts cause anxiety, or obsessions, and repetitive behaviors, or compulsions, are attempts to reduce this heightened stress.
Common obsessions include fear of contamination or germs, keeping things in order and/or symmetrical, aggressive thoughts toward other people or oneself, and unwanted thoughts about things that are taboo or forbidden, involving things like violence, religion, or sex.
A compulsion is often a ritual action in response to anxiety-producing thoughts. These actions are repeated compulsively, and a person suffering from OCD may have no control over their ability to perform such rituals. Compulsive behaviors include frequent handwashing or cleaning, arranging things in a specific and orderly way, counting compulsively, and constantly checking on things like continually making sure doors are locked.
NIMH publishes that even when a person battling OCD realizes their behaviors are excessive, they may still be powerless to stop performing them and will often spend more than an hour each day repeating these behaviors or having anxious thoughts. The ritual behaviors will not necessarily make a person happy; however, they may temporarily relieve the anxiety that the intrusive thoughts induce.
People who suffer from OCD may commonly turn to alcohol or drugs as a way to minimize anxiety and symptoms of the disorder. The Journal of Anxiety Disorders reports that people struggling with OCD also battle alcohol use disorder at some time in their lives nearly a quarter of the time while close to 20 percent may struggle with drug addiction in their lifetime.
Alcohol is a depressant that can aid in temporarily relieving stress and anxiety by dampening certain nerve firings and interactions in the brain and along the central nervous system. Someone who suffers from OCD and engages in high-risk patterns of alcohol consumption is more likely to struggle with alcohol addiction and problematic drinking than the general public, however.
When a person battles both OCD and alcoholism at the same time, the disorders are said to be co-occurring. The Substance Abuse and Mental Health Services Administration (SAMHSA) publishes that close to 8 million adults in the United States struggled with co-occurring disorders in 2014.
Causes of OCD and Alcoholism
It is not certain exactly what causes OCD; however, there are several risk factors that can play a role. Genetics and biology are thought to be involved, as twin studies have shown a high heritability for OCD, the journal Psychiatric Clinics of North America publishes, and the manner in which a person's brain functions and its chemical makeup may play a role in the onset of OCD.
Environmental factors are also likely to have some bearing on why a person may develop OCD. High levels of stress, incidents of trauma, and other mental health disorders, including addiction, can increase a person's risk for OCD. Difficult emotions and stress that characterize OCD can increase the odds that a person will turn to alcohol or drugs as a way to self-medicate the symptoms of the disorder.
In similar fashion, heavy drinking and alcohol addiction can also trigger, or worsen, symptoms of OCD and anxiety. Comparable regions of the brain may be involved in the onset of alcoholism and the development of OCD. Family history of alcohol-related issues can also be a mitigating factor for people struggling with addiction, as can stressful life events, trauma, and other mental health concerns – just as is the case for OCD. Alcoholism and OCD can be very complexly intertwined, and each condition can complicate the other.
One particular risk factor for alcohol addiction is the manner in which a person drinks. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) publishes that over 85 percent of American adults report drinking alcohol at some point in their lives (as of a 2015 national survey). Alcohol consumption in and of itself is not necessary an issue. Drinking alcohol excessively, either through binge drinking or heavy drinking, can constitute a problem, however.
A typical drink is one beer (12 ounces, containing 5 percent alcohol), one glass of wine (5 ounces, containing 12 percent alcohol), one serving of malt liquor (8 ounces, containing 7 percent alcohol), or one shot (1.5 ounces) of 80 proof liquor or distilled spirits (containing 40 percent alcohol), the Centers for Disease Control and Prevention (CDC) explains. Binge drinking is when a man drinks five or more drinks (four or more for a woman) in one sitting, typically in about two hours, which raises the blood alcohol concentration (BAC) to 0.08 g/dL or above.
NIAAA reports that when a person binge drinks on five or more days in a month, it is considered heavy drinking. Heavy drinking is a risk factor for alcohol addiction, as regular patterns of excessive drinking create physical dependence on alcohol. As the brain and body begin to rely on alcohol's presence through dependence, significant withdrawal symptoms can occur when alcohol wears off. It may then become difficult to stop drinking or control episodes of drinking.
The National Council on Alcoholism and Drug Dependence (NCADD) publishes that one out of every 12 American adults battles alcohol abuse or dependence.
Risk Factors for Co-Occurring OCD and Issues with Alcohol
Alcohol may seem to alleviate some of the obsessions and compulsions related to OCD; however, it is merely a temporary fix and will actually make things worse down the line. Heavy drinking changes a person's brain chemistry, slowing life-sustaining functions of the central nervous system, like respiration, heart rate, and blood pressure, and lowering body temperature. Mood-altering neurotransmitters like dopamine are increased through alcohol's influence, which makes a person feel good and helps to reduce stress and anxiety. Alcohol also can impair judgment, however, and interfere with a person's ability to think clearly and rationally, make sound decisions, and remember things. Someone under the influence of alcohol is more likely to be the victim of a crime, get into an accident, become injured, or engage in risky sexual behaviors than someone who isn't. When you combine alcohol with a mental illness like OCD, the risks increase.
Alcohol can also trigger OCD symptoms and make them worse. It can also complicate treatment and interfere with medications a person may be taking to manage OCD. Someone who battles a co-occurring anxiety disorder and alcoholism is also more likely to suffer a relapse and have more severe outcomes, the journal Alcohol Research Current Reviews warns.
Alcohol dependence and withdrawal are signs of alcohol addiction, and they may be worsened by the presence of co-occurring OCD. Some of the side effects of alcohol withdrawal are in opposition to what a person feels while under its influence. For instance, alcohol often makes a person feel mellow, relaxed, happy, and sleepy while alcohol withdrawal can leave a person feeling anxious, depressed, jittery, tense, and wide awake. Physical symptoms of alcohol withdrawal can be potentially life-threatening and require professional medical care to manage.
Cravings and alcohol withdrawal symptoms may intensify OCD symptoms, and vice versa. Specialized treatment for co-occurring OCD and alcoholism can help to manage symptoms of both disorders and enhance recovery.
Treatment Options for Co-Occurring Disorders
Mayo Clinic reports that common treatments for OCD typically include therapies, such as Cognitive Behavioral Therapy (CBT), and medications. CBT helps people learn how to change thoughts and behaviors that may be negative or undesirable and shape them into more positive ones. Tools for managing stress are also introduced, practiced, and reinforced.
Exposure and Response Prevention (ERP) therapy is a form of CBT that may be beneficial when treating OCD. It safely and gradually exposes a person to whatever the obsession or anxiety-inducing object or thought may be and then teaches healthy coping mechanisms.
Medications like serotonin reuptake inhibitors (SRIs) or selective serotonin reuptake inhibitors (SSRIs) are often an important aspect of OCD treatment, as they may help to regulate brain chemistry and dampen anxiety. These antidepressant medications include clomipramine (Anafranil), fluoxetine (Prozac), sertraline (Zoloft), and fluvoxamine (Luvox), which are some of the commonly used medications to manage OCD symptoms.
Treatment for alcohol addiction may include both therapy and medications. The National Institute on Drug Abuse (NIDA) reports that there are three medications that are FDA approved to treat alcohol addiction: acamprosate (Campral), naltrexone (ReVia), and disulfiram (Antabuse). Topiramate (Topomax) is widely used as well. Medications may minimize and treat withdrawal symptoms as well as reduce cravings and work as a deterrent to further alcohol abuse. CBT and behavioral therapies are integral components of addiction treatment as well.
Generally, when co-occurring disorders are involved, the optimal course of treatment is integrated and simultaneous treatment of both disorders. Treatment teams should include mental health, medical, and substance abuse providers that all work together to form a treatment plan through detailed assessments and evaluations. Treatment plans should address both disorders at the same time in order to ensure that symptoms of both are managed. An integrated co-occurring disorder treatment program may be provided in either an inpatient (residential) or in an outpatient setting, and may include the following components:
- Detox: Medical detox can manage symptoms of alcohol withdrawal, which can be life threatening.
- Therapy: Individual, family, and group sessions all serve to manage symptoms and improve quality of life.
- Medications: Treatment providers should work together to determine which medications will be most beneficial for the treatment of alcohol dependence and OCD.
- Support groups: Meetings provide support in an empathetic and understanding environment that develops and fosters healthy peer networks for recovery.
- Relapse prevention and aftercare programs: These work to minimize relapse and sustain recovery.
When treatment providers work together, they can ensure that the medications and therapies prescribed to treat symptoms of one disorder complement the other. Some medications are better than others when addiction is also present, for example.
Both OCD and addiction greatly impede a person's daily life functioning, impacting a person's social, emotional, and physical health and wellbeing. A comprehensive treatment program can reduce and minimize relapse, and promote a long and healthy recovery.