Marla, a 40-year old woman, was trapped in a world where she had no choice but to compulsively wash her hands — sometimes more than a hundred times a day. Her all-encompassing fear of germs gradually led her to near-complete social isolation, but the hand-washing continued.
Marla knew that what she was doing wasn't healthy, but her initial attempts to use alcohol in to relax a bit and maybe escape from her compulsion ended up being a nose-dive into alcoholism. Marla had obsessive compulsive disorder. She wouldn't find out, however, until her substance abuse counselor noticed something was off as she kept running to the bathroom to — you guessed it — wash her hands.
Obsessive compulsive disorder: A living hell
You've probably heard it — someone with only the vaguest idea of the true meaning of obsessive compulsive disorder declaring that they're "totally OCD" about hoovering, wedding planning, keeping their home library alphabetized, or having dinner on the table by 6 pm sharp. OCD — and especially severe OCD — is so much more than those who'd make joking references to this serious mental disorder could ever begin to understand, however.
In medical terms, obsessive compulsive disorder is an extreme anxiety disoder characterized by intrusive involuntary thoughts and urges and the need to engage in compulsions to find relief from obsessive thoughts or prevent perceived impending doom.
More concretely, however, someone with OCD can have the strong and urgent, and very real-feeling, premonition that their mother and sister will die in a car crash in the next couple of hours unless they line the first meticulously-polished objects on their mantle up exactly so, and then pace around the room 33 times 33 times. Imagine all that responsibility on your shoulders.
Severe OCD can essentially imprison someone in their own home, rob them of their social life, and even cause dehydration to the point of kidney failure because the person hopes to avoid the bathroom or the compulsions they perform just don't give them enough time to drink enough water.
What is the link between substance addiction and OCD? It might be staring you right in the face
One study estimated that 24 percent of people suffering from the disorder will be addicted to alcohol at some point in their lives, while 18 percent will fall into the clutches of a drug use disorder, most often becoming addicted to cannabis or cocaine. One theory behind the higher rates of alcohol abuse compared to drug abuse is that people with OCD, being more risk-averse than average, see booze as the safer choice.
Some studies place the rate of substance abuse even higher, suggesting that up to 40 percent of OCD sufferers will have a substance use disorder at one point or another.
Why? Some might think that the same risk factors that increase a person's risk of obsessive compulsive disorder also often lead to substance addictions, and they might partially be right. It's more likely, however, that people with debilitating OCD abuse substances to help them cope with the symptoms of obsessive compulsive disorder — as a form of self-medication, in other words. Seventy percent of people suffering from both conditions shared, in one study, that their OCD symptoms showed up a year or more before they began to abuse alcohol or drugs.
What places someone with OCD at risk of a substance use disorder?
People whose obsessive compulsive disorder first manifested at age 15 or earlier were found to be more likely to become alcoholics, along with those who had borderline personality disorder as well as OCD. Previous suicide attempts and borderline personality disorder (again!) were, meanwhile, found to be predictors for drug abuse among OCD sufferers.
The combination of a substance addiction and OCD increases the odds someone will be on disability benefits, confined to their home because of the severity of their OCD, and to be hospitalized for mental health reasons. It also inceases the risk of suicide attempts, making the dual occurrence of OCD and substance abuse disorders quite literally life-threatening.
What's next? Treatment options for substance addiction and OCD
Do you believe you could have obsessive compulsive disorder, or do you think someone in your life does? Some people — like Marla — first find out what they are dealing with because they are aware they have a drug or alcohol problem and seek help for it. From here, it would be ideal if the treating clinician were able to recognize the symptoms of obsessive compulsive disorder, screen for it, and make a referral.
At the same time, the person should receive help for their substance addiction, which can be inpatient or outpatient with a variety of approaches. The treatment should be tailored to the person's needs, knowing that some settings may aggravate OCD symptoms.
Living with obsessive compulsive disorder is so difficult that it is no wonder so many sufferers turn to alcohol and drugs to suppress the symptoms even just a little — but evidence-based medical treatment is a much healthier way to find relief.