OCD and Substance Use: Understanding the Connection

OCD can cause persistent, unwanted thoughts and repetitive behaviors that people use to manage anxiety and distress. Some people turn to substances to quiet obsessive thoughts or ease anxiety temporarily. Over time, relying on substances for relief can contribute to substance use disorder (SUD).

When OCD and SUD occur together, each condition can complicate the treatment of the other. Integrated treatment that addresses both conditions together can help people work toward lasting recovery.

If you’re in Acton or the greater Boston area and are seeking an assessment for co-occurring OCD and substance use disorder, contact Engage Wellness Acton at (978) 721-5948  to learn about your options.

What OCD Actually Is (and What It Isn’t)

Some people use the term OCD to describe a preference for neatness and organization. However, obsessive-compulsive disorder involves much more than these traits, even though some people with the condition may appear neat and well-organized.

OCD is a mental health condition that causes individuals to become fixated on repeatedly performing tasks like washing their hands to avoid contamination or checking their door locks.[1] The condition features two main aspects: obsessions and compulsions.[2] People with this condition have intrusive thoughts that are impossible to ignore (obsessions). They also experience compulsions to act on those thoughts to prevent a feared outcome.

People with OCD may seem high-functioning outwardly, but their obsessions can cause missed deadlines, difficulty concentrating at school and work, and strain in relationships.[3]

Why OCD and Substance Use Often Co-Occur

Untreated mental health disorders can lead to substance use as a coping mechanism. Conditions such as depression and anxiety are often diagnosed alongside substance use disorder (SUD) due to their troubling symptoms. This is called a dual diagnosis.[4] Research suggests that up to 25% of people with obsessive-compulsive disorder (OCD) have a co-occurring substance use disorder (SUD) during their lifetime.[5] Substance use may develop as a way to cope with OCD-related distress, although the relationship between the two disorders varies among individuals.

The Self-Medication Cycle

Substances that slow the central nervous system can temporarily relieve anxiety, guilt, or panic associated with obsessive thoughts. However, once the effects wear off, OCD symptoms may return with greater intensity. This can lead to increased reliance on the substance to manage distress and find relief.

Shared Risk Factors That Raise Vulnerability

Both obsessive-compulsive disorder (OCD) and substance use disorder share several risk factors, including anxiety sensitivity, trauma history, genetic predisposition, chronic stress, and avoidance coping. Additionally, some individuals with OCD also experience other mental health conditions such as ADHD (Attention Deficit Hyperactivity Disorder) or depression, which can further complicate diagnoses.[6]

How Substances Can Worsen OCD Symptoms Over Time

Substance use can worsen OCD symptoms over time by disrupting sleep, increasing baseline anxiety, and impairing impulse control. Stimulants may cause panic attacks  and cognitive impairment, while alcohol and cannabis tend to increase rumination and avoidance.[7][8]

Signs You Might Be Dealing With OCD + Substance Use Disorder (Dual Diagnosis)

Substance use disorder and OCD share many similarities. You may be dealing with OCD and SUD if you experience any of the following signs:

• Avoiding ERP/therapy because substance use is easier
• Using drugs or alcohol to interrupt intrusive thoughts and feel normal
• Increasing drug or alcohol use before or after triggers
• Having failed attempts to cut back on substance use due to spikes in OCD symptoms
• Repeated substance use and rituals preoccupy your time and disrupt relationships and work

Note: The signs listed above can point to many other health conditions. This is why it’s important to avoid self-diagnosing. If you are experiencing these disruptions and feel you may have OCD, SUD, or a combination of the two, contact a healthcare provider for an assessment.

Why Treating Only One Side Usually Doesn’t Work

Because SUD and OCD share overlapping symptoms and cause significant distress, treating one condition without addressing the other is often ineffective.

If You Only Treat Addiction…

If you treat the addiction through detox and other evidence-based models without treating OCD, obsessive triggers remain, which increases the risk of relapsing. Unfortunately, chronic relapses can increase the risk of an overdose.

If You Only Treat OCD…

Treating OCD without addressing substance use disorder (SUD) can undermine treatment efforts. Substance misuse can disrupt therapy, create inconsistencies in treatment, interfere with sleep, and affect medication response. This is why an integrated treatment that addresses both OCD and addiction is the most effective path.

What Integrated OCD and Addiction Treatment Looks Like

Integrated treatment addresses both disorders at the same time rather than treating either in isolation.[9] This approach allows clinicians to treat overlapping symptoms and help individuals struggling with OCD and SUD develop healthier coping strategies.

Treatment begins with assessment and planning and continues to the implementation of evidence-based treatments.

Assessment and Personalized Planning

To determine the most appropriate treatment approach and level of care, you’ll first meet with a licensed clinician for an assessment. The assessment evaluates the severity of OCD and SUD symptoms, along with safety concerns, withdrawal risks, trauma, anxiety disorder, depression, and other co-occurring disorders. The clinician will also review your medications, including selective serotonin reuptake inhibitors (SSRIs), to identify potential interactions with substances you use.

The treatment team goes over the assessment and develops a treatment plan to address symptoms and recovery goals.

Evidence-based OCD Treatment Components

The gold standard treatment for OCD is Exposure and Response Prevention (ERP).[10] This behavioral approach to care encourages gradual exposure to triggers that cause distress while providing coping skills to resist compulsive behaviors. Over time, this reduces anxiety and discomfort without giving in to compulsions.

Cognitive behavioral therapy (CBT) is also used to address OCD. It teaches patients to recognize compulsive and unhelpful thought patterns that lead to negative behaviors.[11] Distress tolerance skills, which are CBT and DBT-informed skills, help participants to manage intrusive thoughts and replace them with more helpful ones.

Evidence-based Addiction Treatment Components

Evidence-based addiction treatments help patients recognize patterns and triggers that lead to substance use and develop strategies to manage cravings.

Commonly used evidence-based treatments include:[12]

• Coping skills: evidence-based ways to manage stress, regulate emotions, and respond to cravings.
• Group therapy: a peer support approach to therapy. It brings together individuals facing similar challenges. They can share strategies, discuss challenges, and encourage one another to stay sober.
• Motivational interviewing: helps patients explore why they want to change and strengthen their commitment to staying sober.
• Relapse prevention planning: involves a plan to help patients identify triggers, recognize warning signs, and manage cravings to avoid relapsing after abstinence.

Coordinating Both Without Overwhelming the Patient

Treating both OCD and SUD requires a delicate approach to stave off feelings of overwhelm. Clinicians often prioritize treating the SUD to stabilize the patient before implementing evidence-based treatments like ERP. These interventions will be adjusted along the way to continue managing symptoms and cravings.

OCD IOP in Massachusetts: When an IOP Is the Right Level of Care

Is an OCD IOP in Massachusetts the right level of care for you? It could be if you need structured treatment that does not include clinically supervised detox and involves more than one therapy session per week to address triggers and cravings.

What “IOP” Means (Simple Definition)

IOP stands for intensive outpatient program.[13] It is a step down from residential care, which is reserved for individuals who need detox and closer monitoring, and a step up from outpatient care, which requires a much lower time commitment.

IOP involves daytime treatment at the facility multiple days a week for several hours each day. Unlike inpatient or residential treatment, where participants reside at the facility or sober living residence, enrollees in IOP return home after treatment.

Who Benefits Most From IOP-level of Care?

Those who benefit the most from an IOP level of care are individuals whose symptoms are impairing their daily life, but not enough to require 24/7 supervision. It is also beneficial for those needing more structure than weekly therapy, which is often the case for those at an increased relapse risk.

What an IOP Plan May Include for OCD + SUD

A typical IOP plan for someone with OCD and SUD may include:

• Exposure planning support
• Medication coordination
• Specialist referrals
• Recovery support and relapse prevention
• Distress tolerance skills training and anxiety management
• Individual therapy sessions
• Family therapy

OCD and SUD Treatment in Acton and the Greater Boston Area

Engage Wellness Acton offers integrated treatment programs for individuals living with OCD and substance use disorder in the Acton, Middlesex County, and greater Boston areas. Our specialized programs help with managing obsessive thoughts and compulsions while offering coping skills and evidence-based therapies to address substance use disorders. Contact us to verify your insurance and program availability.

Practical Coping Strategies (While You’re Seeking Help)

Common strategies to cope with OCD and SUD include:

• Tracking triggers and problematic patterns such as Obsession leading to anxiety and anxiety leading to substance abuse
• Delaying use by 10 minutes and implementing grounding techniques
• Reducing your exposure to addictive substances/triggers
• Crafting a craving and compulsion plan which includes who to call and what to do

Safety note: While it may be tempting, do not suddenly stop substance use if withdrawal risks exist. Seek medical guidance to avoid dangerous complications.

How to Choose the Right Program for OCD and Addiction Treatment

Ask these questions to determine if the program of your choice is the right fit for OCD and SUD integrative treatment:

• Do they offer dual diagnosis treatment?
• Is ERP and other therapy available?
• Can the facility support co-occurring anxiety or depression?
• What does a typical weekly schedule look like?
• How does the program handle relapse and medication management?
• Do they offer step-down care?

Getting Help in Acton and the Greater Boston

If you’re seeking OCD and addiction treatment in Massachusetts, Engage Wellness Acton is here to help. Our friendly admissions team can help you determine the right level of care and develop a personalized plan to support your safe recovery.

Start by requesting a brief confidential assessment. You may also want to discuss insurance benefits and what to expect at the facility.

Frequently Asked Questions