OCD Treatment Program

What is OCD?

OCD, short for obsessive-compulsive disorder, is an anxiety disorder that features unwanted thoughts and repetitive behaviors that you feel compelled to perform. Obsessive thoughts and compulsive behaviors become so intense that they interfere with daily life. 

Although it’s impossible to tell exactly how many people with OCD are also dealing with a substance use disorder (SUD). However, studies have found that people with OCD have a higher rate than the general population, at around 30%. And alcohol is the most commonly abused substance.

Repetition

It is normal, on occasion, to go back and make sure you turned off the stove, or to worry that you might have been exposed to germs, or even have a violent, unpleasant thought now and then. But if you have OCD, your brain gets stuck on a particular thought or urge, like a needle getting stuck on an old record.

You may check the stove 23 times to make sure it’s really off because you’re terrified of burning down your house. Or you might have to wash your hands constantly until they’re scrubbed raw because you’re afraid of germs. There is no feeling of pleasure from performing these actions repetitively, but they might give some temporary relief from the anxiety caused by the obsessive thoughts.

Obsessions and Compulsions

Common obsessive thoughts are involuntary thoughts, images, or impulses that happen over and over in your mind. You don’t try to have these thoughts, but you can’t stop them. Unfortunately, these obsessive thoughts are typically unsettling and distracting.

• Fear of being contaminated by germs or dirt or contaminating others. 
• Fear of losing control and hurting yourself or others.
• Invasive sexually explicit of violent thoughts and images.
• Excessive attention to religious or moral ideas.
• Fear of losing or not having what you need.
• Order and symmetry—the idea that everything must line up “perfectly.”
• Superstitions and excessive attention to something considered lucky or unlucky.

Compulsions are behaviors or rituals that you are driven to act on again and again. These are usually performed in an effort to make the obsessions go away. Someone who is afraid of germs or contamination might develop extensive cleaning rituals. Sadly, the relief never lasts, and the obsessive thoughts tend to come back even stronger. Then the compulsive rituals and behaviors wind up causing anxiety in themselves because they become more time-consuming and urgent. Thus is the vicious cycle of OCD.

OCD compulsions include: 

• Excessively double-checking things such as locks, appliances, and switches.
• Constantly checking in on loved ones to make sure they’re all right.
• Tapping, counting, repeating certain words, or doing other seemingly senseless things to reduce anxiety.
• Spending an exaggerated amount of time washing or cleaning.
• Arranging or putting things in order.
• Excessive praying or taking part in rituals triggered by religious fear.
• Gathering “junk” like old newspapers or empty food containers.

What Causes OCD?

The causes of OCD are not completely understood at this time. There are several theories about the causes including:

• Compulsions are behaviors that are learned and become repetitive and habitual when they are associated with relief from anxiety.
• Obsessive-compulsive disorder is because of genetic and hereditary factors.
• OCD is caused by chemical, structural and functional abnormalities in the brain.
• Distorted beliefs strengthen and maintain symptoms related to OCD.

Several factors may interact to trigger the development of OCD. Underlying causes may also be influenced by stressful life events, hormonal changes, and personality traits.

What is Addiction?

Addiction is a complicated brain disease that is revealed by compulsive use of a substance despite the harmful consequences. People with addiction have a fixation on using certain substances to the point where it takes over their life. They will keep using drugs or alcohol even when they know it will cause problems. 

You might try to avoid situations that trigger your OCD symptoms, but some people try to self-medicate with alcohol or drugs. If you are using drugs or alcohol to ease your OCD symptoms, you are on the road to a substance use disorder. 

Brain Functions

People with a SUD have twisted thinking, behavior, and body functions. Changes in brain chemistry cause people to have strong cravings for the drug and make it difficult to stop using it. Brain imaging research shows changes in the areas of the brain that affect judgment, decision making, learning, memory, and behavior control.

Using drugs and alcohol can cause harmful changes in the way the brain functions. The changes last long after the first effects of the drug—intoxication. Intoxication is the intense pleasure, calm, increased senses, or a high caused by the substance. Symptoms of intoxication are different for each drug.

After a while, people with addiction need more and more of the substance to feel the same effects that they felt at first. This is called tolerance. People who continue to build their tolerance are more likely to overdose because they tend to either use too much or use too often.  

Symptoms of Addiction

These are usually grouped into 4 categories:

1. Impaired control: A craving or strong urge to use the substance; failed attempts to quit or control substance use even though he wants to.
2. Social problems: Failure to finish major tasks at work, school, or home; giving up or cutting back on leisure and work activities because of substance use.
3. Risky use: Substance use in risky environments, continuing to use despite known consequences.
4. Drug effects: Tolerance and withdrawal symptoms.

Many people have both a mental disorder and addiction. This is called a dual diagnosis. The mental illness might have been present before the addiction. Conversely, the addiction may have made the mental disorder worse. That’s why they need to be treated at the same time.

OCD and Addiction

OCD sufferers might try to use drugs and alcohol to stifle the intensity of their obsessions and the significance of their related compulsions. However, these only temporarily relieve the discomfort of OCD. Over time, the amount of relief, as well as the duration, lessens. The individual then finds himself still battling the crippling symptoms of OCD as well as the challenges of addiction.

OCD and Alcohol

Alcohol appeals to many people for many reasons, mainly the happiness, relaxation, and giddiness that you feel when alcohol acts on the brain. But for people who have OCD, the calm and elevated mood is a much-needed relief. It’s a break from the nagging fear of the intrusive thoughts or compulsive behaviors that overwhelm them. However, that temporary relief often ends up with more severe symptoms.

Because OCD is experienced at varying levels, it’s difficult to say exactly what severe symptoms are. According to the Diagnostic and Statistical Manual published by the American Psychiatric Association, symptoms considered time-consuming cause substantial impairment in “social, occupational, or other important areas of functioning.” If bad is the typical standard, adding alcohol actually makes OCD symptoms worse.

From Bad to Worse

People with OCD might notice that after a night of drinks with friends, they’re performing their repetitive behaviors more frequently or for longer periods of time. It could be that they feel a greater sense of urgency to do compulsions that were well-managed before then. Some others might suddenly experience increasingly worse intrusive thoughts or disturbing images. These then produce intense fear or anxiety, bodily sensations, or bodily urges.

So, why does alcohol tend to make OCD symptoms worse? The answer appears to be found in the structure and hormonal differences in the brains of people with OCD, compared to non-OCD brains. OCD brains may function and feel differently from the brains of other people.

This is where the actions of neurotransmitters (chemical messengers in the brain) and their transmission is important. Serotonin, commonly considered the body’s natural mood stabilizer, is usually present in the body in stable amounts. When serotonin is at healthy levels, it encourages a sense of well-being, focus, and emotional stability. At unhealthy levels, it produces symptoms like depression or anxiety.

A study in the Journal of Neurotransmission discovered that people with OCD have reduced the availability of serotonin. The OCD brain can not efficiently regulate the amount sent to the brain because there are too few transmitters. Therefore, OCD brains not only have fewer transporters, but the brain has a reduced ability to accept the ones that make it to their destination.

Adding Alcohol to OCD

Alcohol has been shown to increase serotonin production in the brain. That’s what gives you the giddy, calm feeling. In this way, alcohol has symptom-relieving features when it acts on the brain of people with OCD because it produces an increase in serotonin activity in the brain. The effect of alcohol on the levels of serotonin can begin after just one drinking session. 

Unfortunately, it only brings short-term relief and the symptoms of OCD return after the effects of the alcohol wear off. Occasionally, some people who weren’t having OCD symptoms before drinking report a return of symptoms after drinking. This is because the serotonin levels drop when the alcohol wears off, often to levels that are lower than before drinking alcohol. 

For people who don’t have mood disorders, this drop in serotonin levels often results in psychological symptoms of withdrawal (depressed “hangover”). For individuals with OCD, the result is more severe symptoms.

Importance of Dual Diagnosis Treatment

A person with a mental disorder and a substance use disorder at the same time is considered to have a dual diagnosis. In fact, more than half of people who have a serious mental issue also have a SUD. Dual diagnosis is sometimes called co-occurring disorders or comorbidity. Comorbidity implies interactions between the disorders that can make both of them worse. 

Unfortunately, it can be difficult to find treatment for someone who has a mental illness and also uses drugs or alcohol. A lot of treatment programs that treat mental disorders are not prepared to treat SUDs, and programs that treat SUDs are not prepared to treat mental disorders. As a result, individuals with dual diagnoses often bounce from one program to another or are refused by single-diagnosis programs.

Dual Diagnosis Facts

• The more severe the mental disorder, the more likely that the person will use or abuse drugs or alcohol.
• Alcohol is the most commonly used drug, followed by marijuana and cocaine.
• Males ages 18 to 44 are at the greatest risk.
• Adolescents with behavioral problems are 7 times more likely to have used or abused alcohol or a drug in the past month.
• Substance abuse makes almost every aspect of care more complicated for a person with a mental illness.

Treating OCD and Addiction

The current standard of care for most clinicians when treating co-occurring OCD and addiction is to treat one first (usually the SUD) and then the other. One dual diagnosis treatment study showed positive results including reducing the severity of OCD symptoms, longer time in treatment, and higher abstinence rates as compared to the “treatment as usual” group.

Psychotherapy

• Exposure Response Therapy (ERP): ERP is a type of behavioral therapy that exposes the individual to the situations that prompt their obsessions and the distress that results. The therapy helps them prevent compulsive responses. The goal is to free people from the obsessive-compulsive cycle. This therapy is very effective for OCD.
• Cognitive Behavioral Therapy (CBT): This type of therapy helps the individual recognize negative or inaccurate thinking patterns and how they affect their behavior. This type of therapy is most effective for the treatment of SUDs. 

Medication

• Serotonin Reuptake Inhibitors (SRIs): This is the usual starting medication for OCD. It is typically used to treat depression and can take up to 12 weeks before having an effect. There aren’t any other medications currently developed specifically for OCD.
• Medications for SUDs: The medications for SUDs are specific to the substance being abused. Some assist with alcohol withdrawal and cravings but don’t affect marijuana withdrawal. Likewise, some medications help with heroin/opioid withdrawal and cravings but don’t have any effect on cocaine cravings.

Make Your Escape at Phoenix Rising

Sometimes it feels like there is no escape from your problems. You can create your own escape from the issues that are complicating your life. At Phoenix Rising, we have a staff of professionals whose only job is to help you get better. Contact us to get help for yourself or someone you love.

 

References:

www.psychiatry.org

www.betterhealth.vic.gov.au

www.castlecraig.co.uk

www.iocfd.org/expert-opinions

www.dartmouth.edu/eap/library