Alcoholism and Obsessive-Compulsive Disorder

Having two mental health conditions is clinically known as dual diagnosis. Common dual diagnoses include substance use disorders—like alcoholism—and mood, personality, or anxiety disorders. 1 Both OCD and alcohol use disorder (AUD) involve an imbalance of neurotransmitters in the brain.2 This dual diagnosis can complicate and amplify the symptoms of either disorder.

In this article: 

The Relationship Between Alcoholism and OCD

Alcoholism and OCD can develop independently. Many people develop OCD before using drugs or alcohol.3 They may turn to substances to manage their OCD symptoms. Chronic substance misuse can develop into an addiction. Studies indicate that people who begin to experience OCD symptoms at a younger age are more likely to misuse substances as a coping mechanism.3

OCD can also be classified as “substance-induced,” meaning that the OCD or related disorder happens after and due to substance misuse. Substance-induced OCD may or may not lead to the development of a substance use disorder—such as alcoholism.4

Alcohol use itself can become an OCD behavior. You may feel a strong urge to drink compulsively. You may develop other rituals around your alcohol use, including how you acquire it, store it, or drink it. 3

Other risk factors that may contribute to OCD and alcohol misuse or alcoholism include:3,5

  • Genetics
  • Lifestyle
  • Environmental factors
  • Brain chemistry
  • Family history
  • Past traumas

Some people find that using alcohol temporarily relieves or reduces the intensity of their OCD symptoms. The brain creates a connection of feeling better with the use of alcohol.3 This association, a form of self-medicating, can lead to short and long-term risks.

However, drinking alcohol can trigger depression or anxiety that can lead to more obsessive thinking, even for those who did not have OCD before drinking. This creates a vicious cycle of coping with symptoms by drinking alcohol.3

What Is Alcoholism?

Alcohol misuse is not the same as alcoholism. Alcoholism is a clinical disorder in which chronic alcohol misuse leads to being unable to control how you use alcohol due to a strong desire or craving for alcohol. Even if you experience negative consequences from using alcohol, you do not feel able to stop. You may have developed a physical and psychological dependence on alcohol.6

If you have developed alcoholism, you may experience any of the following symptoms:6

  • Using alcohol to relax or cope with difficult emotions and situations
  • Feeling guilt about your alcohol use or your behavior while drinking
  • Using more alcohol than you intend to
  • Trying to stop drinking unsuccessfully
  • Hearing from friends and family that they are concerned about your drinking
  • Experiencing the need to use more alcohol to achieve the same effects you experienced when you first started drinking
  • Experiencing withdrawal symptoms when you try to stop drinking or don’t have access to alcohol

Withdrawal symptoms can range from mild to severe and may include the following:7

  • Nausea, vomiting, and digestive issues
  • Extreme cravings
  • Muscle spasms, aches, and pain
  • Flu-like symptoms
  • Tremors and shaking
  • Headaches
  • Kidney or liver malfunction
  • Heart palpitations
  • Seizures

What Is Obsessive-Compulsive Disorder?

Obsessive-compulsive disorder was formerly considered an anxiety disorder. 8 OCD is now separated from anxiety disorders and phobias in the DSM-5. Clinically, people with anxiety disorders may experience recurrent and intrusive thoughts that are similar to those present with OCD. However, in an anxiety disorder, these thoughts typically center on real-life concerns even if those concerns are magnified in an extreme way. 4 In OCD, these thoughts are more likely to present in a magical, irrational, illogical, or unusual way. 4 When a clinical phobia is present, a person may experience an irrational fear reaction to an object or situation, however, the rituals of OCD are not present. 4

In the DSM-5, OCD and related disorders are in their own category. Disorders in this category include hoarding disorder, body dysmorphic disorder, and trichotillomania (hair-pulling disorder). 4

OCD is characterized by the presence of obsessions, compulsions, or both. 4 Obsessions are persistent and reoccurring images, urges, or thoughts that most individuals find disturbing or anxiety-inducing. 4 Obsessions can lead to compulsions as the individual attempts to neutralize or ignore the distressing and intrusive urge or thought.4

Compulsions are defined by repetitive behaviors that the individual feels driven to perform according to specific rules. 4 These rituals are performed to prevent or reduce negative emotions, or to prevent an event the individual believes they have control over. However, the ritual often does not connect in any meaningful way to the perceived outcome and is likely to be excessive in nature. 4

While obsessions and compulsions are often highly specific to an individual’s life experience, common obsessions incude:8

  • Fear of contamination
  • Extreme concern with order, symmetry, or precision
  • Recurrent intrusive thoughts of sounds, images, words, or numbers
  • Fear of losing or discarding something important

Obsessive thinking can lead to some common compulsions, like:8

  • Handwashing, showering, brushing teeth, or toileting repetitively or ritualistically
  • Repeated cleaning
  • Arranging items in a particular way
  • Repeatedly checking locks, switches, or appliances
  • Repeated counting to a certain number
  • Drinking alcohol to excess, especially in a ritualistic way

Risks of Alcoholism and OCD

A dual diagnosis of OCD and alcohol use disorder can lead to physical and psychological problems, including:9

  • Increased anxiety and stress
  • Increased obsessions
  • Stronger compulsions
  • High blood pressure
  • Liver disease
  • Problems at work
  • Problems with interpersonal relationships
  • Financial problems
  • Risk of alcohol overdose

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Treatment for Alcoholism and OCD

Treatment for a dual diagnosis is most effective if both disorders are treated at the same time.10,11 If you enter treatment for a substance use disorder and receive treatment for that issue only, you may be at a higher risk of relapse, especially if the other mental health condition developed due to substance misuse.10,11

Dual-diagnosis treatment starts with an evaluation to assist mental health and substance misuse specialists in creating a plan for your recovery. Because alcohol can present medical risks during the detox process, your treatment may begin with a medically supervised detoxification.9,10

Detox for Alcohol and OCD

Detoxification is a process that eliminates alcohol from your system. Detox is necessary for individuals with moderate or severe alcoholism whose withdrawal symptoms pose a medical risk. It takes place in a hospital or specialized clinical environment with the help of physicians, nurses, and therapists to manage the withdrawal symptoms that can appear.10,11

At the sign of withdrawal symptoms, your doctor may prescribe medicine to help. You may also need medication to assist with cravings for alcohol or an increase in anxiety. You can meet with therapists to help you cope with any returning OCD symptoms or new mental health issues. You may be prescribed medication specific to your OCD.10,11

Rehab for Alcohol and OCD

Inpatient rehab takes place in a residential environment to give you continued access to clinicians. It is where the work for both OCD and alcohol use disorders begins. In inpatient rehab, you will participate in medication-assisted therapy and behavioral counseling. Working with mental health specialists, you will learn how to cope with irrational thinking and behaviors so they do not become obsessions and compulsions.12

Dual-diagnosis treatment centers use a formula called integrated treatment. Its success comes from drawing on an extensive base of therapies to create an individualized care plan. Behavioral counseling often involves cognitive-behavioral therapy (CBT), motivational interviewing, exposure and response prevention, imaginal exposure, and habit reversal training. These therapies can also help in treating alcoholism.12

Dual-diagnosis treatment also involves helping family members learn how to support your recovery. In addition to the family, you learn to create a support group of friends and community.12

Continued Treatment Options

Healing does not stop after you complete rehab. While in detox and inpatient rehab, you are in a safe environment with medical and therapeutic assistance available around the clock. Transitioning from rehab back into your home environment can reintroduce you to some of your old triggers and obstacles.

To make the transition more successful, additional treatment is available. Below are programs you can complete to help you maintain recovery from alcoholism and OCD:

  • Sober living—This alternative housing allows you to live in a recovery environment outside of a hospital or clinical setting. You reside with peers, continue treatment in an aftercare capacity, and practice what you learned during inpatient treatment.12
  • Intensive outpatient (IOP) services—IOP programs can be a way to step down in treatment intensity when you return home. IOP allows you to attend treatment for alcoholism and OCD for ten or more hours each week. You can also work or attend school and keep up with other responsibilities.10
  • Outpatient counseling—Continued therapy is the final step down in the process of integrated treatment. During your transition out of intensive treatment, you meet at least once a week with a mental health and addiction specialist to discuss your obstacles and successes to stay accountable.10 You may choose to stay in therapy with a different appointment frequency after you feel ready.
  • Peer support meetings—Peer support groups, like Alcoholics Anonymous (AA), can be a resource for you throughout your recovery. These groups are not formal therapy or treatment, but can provide community support. Many peer support groups are organized for a specific demographic, such as people with a dual diagnosis. These groups can be useful because they are typically low-cost or free and readily available, making them a good way to work through difficult moments, fill treatment gaps, and maintain recovery when you do not need a higher level of care.

If you are struggling with alcohol use disorder and obsessive-compulsive disorder, give us a call at 800-839-1686Who Answers? to discuss which level of treatment will best meet your needs. One of our call center specialists can provide detailed information on treatment of alcoholism and OCD as co-occurring disorders.

Resources

  1. National Institute of Mental Health. (2021). Substance Use and Co-occurring Mental Disorders.
  2. Banerjee, N. (2014, January). Neurotransmitters in alcoholism: A review of neurobiological and genetic studies. Indian Journal of Human Genetics, 20 (1), 20-31.
  3. Burchi, E., Makris, N., Lee, M. R., Pallanti, S., & Hollander, E. (2019). Compulsivity in alcohol use disorder and obsessive compulsive disorder: implications for neuromodulation. Frontiers in Behavioral Neuroscience, 13, 70.
  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  5. Mancebo, M. C., Grant, J. E., Pinto, A., Eisen, J. L., & Rasmussen, S. A. (2009, May). Substance use disorders in an obsessive-compulsive disorder clinical sample. Journal of Anxiety Disorders.
  6. The U.S. National Library of Medicine. (2021). Alcohol Use Disorder. MedlinePlus.
  7. S. Department of Health and Human Services. What are symptoms of alcohol use disorder? – Rethinking Drinking – NIAAA. National Institute on Alcohol Abuse and Alcoholism.
  8. Substance Abuse and Mental Health Services Administration. (2016). Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health. Table 3.13DSM-IV to DSM-5 Obsessive-Compulsive Disorder Comparison.
  9. Woody, G. (1996). The challenge of dual diagnosis. Alcohol Health and Research World.
  10. Kelly, T. M., & Daley, D. C. (2013). Integrated treatment of substance use and psychiatric disorders. Social Work in Public Health. Social Work in Public Health, 28(3-4), 388-406.
  11. Substance Abuse and Mental Health Services Administration. (2005). Substance Abuse Treatment for Persons with Co-occurring Disorders. Treatment Improvement Protocol (TIP): No. 42.
  12. Polcin, D. L., Korcha, R., Bond, J., & Galloway, G. (2010). What did we learn from our study on sober living houses and where do we go from here? Journal of Psychoactive Drugs, 42(4), 425-433.

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