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The Connection Between OCD and Alcoholism

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Key Takeaways

  • Obsessive-compulsive disorder (OCD) and alcoholism are often co-occurring conditions
  • Studies show that people with OCD are more likely to abuse substances, including alcohol
  • Alcohol is often used to self-medicate symptoms of OCD, as OCD often goes undiagnosed and untreated
  • Treatment for OCD and alcoholism should be done simultaneously, using an array of therapies and techniques

What is OCD?

Obsessive-compulsive disorder (OCD) is a mental health disorder that affects 2.5% of the American population. OCD is characterized as experiencing unwanted or obsessive thoughts and repetitive compulsory actions. 

This cycle of obsessions and compulsions differs from typical worry or stress thoughts. To be classified as OCD, the obsessions and compulsions must be so extreme that they interfere with daily life and activities. 

Alcohol use disorder (AUD) is the inability to control the consumption of alcohol to the point of addiction and alcoholism. Often, OCD and AUD co-occur. 

Common obsessions that people with OCD may experience include:

  • Fear of deliberating harming yourself or others
  • Fear of germs, being contaminated by a disease, or infection
  • Fear of harming yourself or others by mistake
  • A need for things to be organized, symmetrical, or orderly

Common compulsive behaviors that people with OCD may experience include:

  • Hand washing and cleaning
  • Counting
  • Asking for reassurance often
  • Checking things over and over again
  • Hoarding things
  • Repeating words or phrases in their head
  • Rearranging and making things “orderly”
  • Avoiding places and situations that may trigger obsessive thoughts
  • Thinking neutral thoughts to try to counteract the obsessive ones

Some compulsions aren’t obvious. OCD can only be diagnosed by a medical professional and is unlikely to go away on its own. 

Is There a Link Between OCD and Addiction?

Like other mental health disorders, there is a link between OCD and addiction.

Alcohol, and other substances, may provide relief from symptoms related to OCD. Studies show that people with OCD are more likely to abuse substances, including alcohol.1  There are a few reasons why addiction is more likely in people with OCD. 

These include:

  • A way to self-medicate: Alcohol and other substances may give people with OCD relief from obsessive thoughts and compulsive actions. This type of self-medication may also arise if the person isn’t getting the support they need.
  • Worse side effects: Many addictive substances can worsen symptoms of OCD, either while they’re on them or as they wear off.
  • Similar risk factors: Some reasons people develop OCD or addiction overlap. Childhood trauma, early stress, and shifts in brain chemistry or genetics can all make you more susceptible to OCD and addiction.

It may also be that compulsions are linked to impulsive behavior.2 This could explain why addiction rates seem higher for people with OCD. The more impulsive you are, the more likely you might make impulse decisions about substance use.

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OCD and Alcohol Abuse

Alcohol can negatively impact people with OCD in unique ways. Alcohol can make you feel relaxed, euphoric, and at ease. However, it can also lower inhibitions and increase impulsivity. 

People with OCD may find it easier to ignore obsessive thoughts and compulsions that plague them when they’re sober. 

However, some experience increased OCD symptoms when the alcohol wears off. This may cause someone to avoid hangovers altogether, resulting in them drinking alcohol again.

The more you drink, the higher your alcohol tolerance gets. The need to drink more to feel the effects of alcohol can lead to an AUD. 

Why Does Alcohol Trigger OCD?

To explain why alcohol triggers OCD, you must look at the neurotransmitter serotonin. Serotonin is the body’s naturally occurring mood stabilizer. 

At healthy and stable levels, serotonin induces feelings of:

  • Well being
  • Emotional understanding and stability
  • Focus and productivity

At unhealthy levels, the lack of serotonin in the body can produce symptoms, such as:

  • Anxiety
  • Depression
  • Muscle tensions
  • Jitters
  • Diarrhea
  • Serotonin Syndrome (a rare yet serious condition)

One study shows that people with OCD have reduced serotonin transmitters, which help carry serotonin to receptors in the brain.3  This means that, although the brain may produce serotonin, there isn’t enough being delivered to the brain. 

Similarly, another study showed that people with OCD might be less able to process serotonin.4 So, even when transmitters bring serotonin to the brain, it has a reduced capacity to process and accept it.

Drinking alcohol increases serotonin production in the brain. People who have low levels of serotonin are more likely to develop alcoholism. Therefore, people with OCD are more likely to abuse alcohol.5

Risks of Drinking Alcohol With OCD

It’s very risky to use alcohol if you’re diagnosed with OCD. Some of these risks include:

  • Worsening OCD symptoms
  • Increased anxiety
  • High blood pressure
  • Overwhelming feelings of shame
  • Increased chance of developing an AUD
  • Intense withdrawals 
  • Binge drinking and blackouts
  • Liver failure 

What Causes a Person to Use Alcohol to Cope with OCD?

As mentioned, alcohol increases the production of serotonin in the brain. It also can induce feelings of euphoria and relaxation. These effects can be appealing to someone who struggles with OCD. 

Alcohol may allow people with OCD to “turn off” their obsessive thoughts and compulsions. Unfortunately, this relief can feel so good that it becomes addictive.

In addition, OCD is a highly underdiagnosed mental health issue.6 This is partly because many symptoms of OCD are kept private. Due to this, many people with OCD fail to be diagnosed for 10 years or more.

This lack of diagnosis and support may lead people to self-medicate with drugs and alcohol. 

Both OCD and alcoholism are familial. Therefore, if a person with OCD has a family history of AUDs, the chances of them also coping with alcohol is higher. 

Similarly, experiencing early childhood trauma or stress has been linked to OCD and alcohol use.7 Here, alcohol is used to numb or distract a person from internal distress.

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Signs of Alcohol Abuse

Alcohol use disorders can be spotted if you know what to look for. Some common psychological, behavioral, and physical signs and symptoms of excessive alcohol use are:

  • Memory loss or impairment
  • Slurred speech
  • Skipping events with family, work, and friends to drink
  • Lying or being secretive about the amount of alcohol used
  • Indulging in more dangerous behavior, like drunk driving
  • Impaired thinking or thought processes
  • Denial 
  • Distress when alcohol isn’t available 

For heavy drinkers, withdrawal symptoms after reducing alcohol use can begin as soon as two hours after their last drink. 

Symptoms of withdrawal can be intense, including:

  • Shaking
  • Anxiety
  • Sweating
  • Depression
  • Severe cravings 
  • Delirium tremens (DTs)

Delirium tremens (DTs) is a dangerous, life-threatening withdrawal symptom that can induce confusion, rapid heartbeat, and fever. 

If you or someone you know is experiencing DTs, seek emergency help immediately. 

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Treatment for Co-Occurring OCD and Alcoholism

Alcoholism and OCD are both treatable conditions. While a person may never be fully “cured” of either, symptoms and side effects can improve significantly with the proper treatment. 

Most healthcare professionals agree that co-occurring disorder treatment is the best way to overcome both conditions. This treatment addresses both OCD and alcoholism together to work towards a full recovery. 

Counseling

Both addiction and OCD can improve with talk therapy and counseling. A therapist or counselor can work with you to better understand your triggers, behavioral motives, and obsessive thoughts. 

Counseling can help to address traumas and dark life experiences to overcome them. A therapist can also help you practice healthy coping skills and ways to overcome triggers for both OCD and AUD. 

Medication

Several medications are used to treat OCD. Clomipramine (Anafranil), fluoxetine (Prozac), and sertraline (Zoloft) are some of the most common. 

Similarly, there are medications to aid a person in detoxification and withdrawal. For example, medication-assisted treatment (MAT) is an addiction treatment that helps reduce withdrawal symptoms and cravings. 

The most common drugs to help alcoholics quit drinking are: 

  • Naltrexone: Blocks the good feelings alcohol induces, which may result in less of an urge to drink
  • Acamprosate: Helps combat alcohol cravings once you’ve quit drinking 
  • Disulfiram: Causes unpleasant effects when alcohol is used, such as vomiting, headache, sweating, and more

Medication can be an essential part of treatment and recovery. However, medications should always be administered by a medical professional.

Rehab

People don’t go to rehab for OCD. However, rehab is often an important step in alcoholism recovery. You can take many different rehab routes to recover from an AUD. 

These include:

  • Outpatient treatment: Often considered a lower-intensity treatment. People can attend counseling and receive medication while still living at home.
  • Inpatient treatment: Also known as residential treatment. They can be low or high-intensity. However, people live in these treatment centers full-time. They also receive 24/7 care and support.
  • Intensive outpatient programs (IOPs) or partial hospitalization programs (PHPs): Specialized and coordinated outpatient care for people with complex needs. People generally spend less time here.

If you or someone you know is experiencing co-occurring OCD and alcoholism, consider consulting a professional. There are many treatments and services available to help overcome obsessive thoughts, compulsive actions, and addiction.

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Updated on October 19, 2022
7 sources cited
  1. McKay, D. “Addressing comorbid substance use/abuse in obsessive-compulsive disorder.” Advanced casebook of obsessive-compulsive and related disorders: Conceptualizations and treatment. Elsevier Academic Press, 2020.
  2. Tan O. “Is obsessive–Compulsive disorder preventive against addiction?.” J Neurobehav Sci, 2021.
  3. Reimold, M., et al. “Reduced availability of serotonin transporters in obsessive-compulsive disorder correlates with symptom severity – a [11C]DASB PET study.” J Neural Transm, 2007.
  4. Lin SH, Lee LT, Yang YK. “Serotonin and mental disorders: a concise review on molecular neuroimaging evidence.” Clin Psychopharmacol Neurosc, 2014.
  5. Sari Y, Johnson VR, Weedman JM. “Role of the serotonergic system in alcohol dependence: from animal models to clinics.” Prog Mol Biol Transl Sci, 2011.
  6. Brittany Stahnke. “A systematic review of misdiagnosis in those with obsessive-compulsive disorder.” Journal of Affective Disorders Reports, 2021.
  7. Mathews CA., et al. “Childhood trauma, and obsessive-compulsive symptoms.” Depress Anxiety, 2008.

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