Obsessive Compulsive Disorder (OCD) and Addiction Dual Diagnosis

Everyone experiences obsessive thoughts or concerns, such as a fear that the oven has been left on or that something bad will happen if a loved one is late. But when these thoughts are all-consuming and interfere with day-to-day responsibilities, it can be classified as obsessive-compulsive disorder (OCD).[1]

People with OCD feel overwhelmingly compelled to complete rituals—such as washing their hands repeatedly or locking doors multiple times—that interfere with work, school, or home life. Although OCD affects a small percentage of the population, individuals with OCD have a higher risk of misusing alcohol or drugs as a way of self-medicating their condition.

WRITTEN Review by:

Amanda Stevens, BS

On: Dec 12, 2023
Medical Review by:

Dr. Po Chang Hsu MD, MS

On: May 12, 2024
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    Common Symptoms of OCD

    OCD used to be classified as an anxiety disorder, but in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), it has been placed in a separate category that includes other conditions with repetitive behaviors or obsessive fears.[2]

    With OCD, anxieties creep into the person’s thoughts and interfere with their day-to-day activities. Some of the symptoms include:

    • Fear of germs
    • Fear of unclean environments or substances
    • Fear of harming others or themselves
    • Fear of a loved one being harmed
    • Fear of illness
    • Fear of forgetting important tasks or losing possessions
    • Fear of offending a religious deity
    • Preoccupation with superstitions
    • Obsessions with symmetry, order, or exactness
    • Obsessions with counting objects
    • Obsessions with sexual images or words
    • Obsessive fear of being perceived as “bad” or “evil”[3]

    People with OCD engage in rituals in an attempt to relieve their anxiety and distress, but they’re usually not effective at completely relieving the anxiety. Despite this, the rituals often need to be repeated over and over.
    Here are some examples of repetitive rituals with OCD:

    • Superstitiously counting objects
    • Showering, handwashing, tooth-brushing, or other grooming tasks
    • Cleaning the home or specific rooms
    • Sorting things in a specific order
    • Checking work for mistakes
    • Checking the body, skin, or hair for flaws
    • Reviewing actions over and over to ensure that a “sin” hasn’t been committed
    • Repeating activities or movements a certain number of times
    • Hoarding or collecting items that have little value[4]

    People with OCD often realize that their ritual behaviors and intrusive thoughts are irrational or unrealistic and want to be free of them, but they can’t overcome the anxiety they feel if they don’t complete rituals.

    Rehab for OCD

    Often, when people with OCD and substance use disorder seek treatment, their disorders are addressed separately. Some OCD treatment programs refer individuals with substance use disorders to drug and alcohol rehab as a prerequisite of admission, and some substance use disorder programs do not screen specifically for OCD.

    In some cases, people with OCD or substance use disorder under-report or deny symptoms upon intake to avoid these situations.

    Co-occurring disorders like OCD and substance use disorder influence and impact each other, so they must be treated at the same time with dual diagnosis treatment. Dual diagnosis addresses these conditions concurrently with comprehensive, integrated treatments:

    Medically Assisted Treatment Process: Paramount Wellness Retreat


    Detoxification is the initial step for people with substance use disorders, particularly with alcohol. Withdrawal from drugs and alcohol can be extremely uncomfortable – and life-threatening, in some cases. Medical detox provides around-the-clock medical supervision to ensure safety and comfort while the substances clear the system.

    Medical Detox Process: Paramount Wellness Retreat

    Inpatient Treatment

    Inpatient OCD treatment programs, also known as residential OCD treatment, provide constant supervision with a comprehensive care team to manage symptoms of both substance use and OCD. This involves staying in a facility 24/7 to receive therapy, psychiatric care, education, and medication as needed.

    What Does Treatment For Anxiety And Addiction Look Like in Connecticut

    Intensive Outpatient Treatment

    Intensive OCD treatment programs on an outpatient basis provide a higher level of care for people who need to balance recovery with daily life but require more intensive treatment than outpatient treatment provides. They’re free to live at home or off-site while attending rigorous treatment sessions during the day.

    MAT: Paramount Wellness Retreat

    Outpatient Treatment

    Outpatient treatment is similar to both OCD residential treatment and intensive outpatient treatment programs (IOP) in the therapies offered, but you’re not required to live on site or attend intensive sessions. This level of care is ideal for people who need ongoing care and therapy but have other responsibilities outside of their recovery.

    Aftercare provides ongoing support, such as mutual help groups for OCD in Connecticut


    Aftercare or continuing care provides ongoing support, such as mutual help groups for OCD and substance use disorder, individual therapy, and other therapies to help with the transition from a formal treatment environment to a day-to-day life.

    Though these are general overviews of dual diagnosis treatment for OCD, the care plan is completely tailored to the needs of the individual and their specific goals and challenges. The therapies may include:

    Cognitive behavioral therapy (CBT): CBT is a research-based talk therapy that improves an individual’s coping skills by identifying unhelpful thought patterns and behaviors to change them.

    Dialectical behavior therapy (DBT): DBT uses mindfulness and self-awareness to improve an individual’s emotional state and reduce undesirable behaviors, such as substance use.

    Contingency management: Contingency management encourages healthy behaviors by offering incentives for desired outcomes, such as successfully passing a drug test.

    Support groups: Mutual-help groups or support groups are tailored to the co-occurring disorders to bring together people with similar struggles to share and support one another in recovery.

    OCD Statistics

    OCD occurs less frequently than some other psychiatric disorders, but based on the diagnostic interview data from the National Comorbidity Survey Replication (NCS-R), the prevalence of OCD among US adults aged 18 and older was 1.2% in the past year in 2007.[5] The incidence was higher in females than males, and the lifetime prevalence of OCD was 2.3%.[6]

    Of adults with OCD, the degree of impairment ranged from mild to severe. Based on the scores on the Sheehan Disability Scale, about one-half of adults with OCD had serious impairment.[7] About 34.8% of adults with OCD had moderate impairment, and 14.6% had mild impairment.

    How (and Why) Drug Detoxification Works

    OCD and Addiction

    Substance abuse is often used to self-medicate the anxiety and internal tension of OCD. Unfortunately, the use of alcohol or drugs can make the symptoms of the disorder worse.

    According to the Journal of Anxiety Disorders, of 323 adults with OCD, 27 met the criteria for a substance use disorder.[8] OCD and alcohol use are most commonly comorbid, followed by dependence on both drugs and alcohol. People with OCD who abuse drugs but not alcohol make up a small percentage of the people with OCD who have substance use disorders.

    There are several possible reasons why addiction is more prevalent among people with OCD. Often, people with OCD isolate themselves because of their fears, increasing the risk of depression and making them more vulnerable to drug or alcohol use. It becomes a vicious circle in which the worse their drug or alcohol dependence, the more isolated and depressed they become.

    Side Effects of Medical Detox

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    Frequently Asked Questions about OCD

    Is OCD Linked to Substance Abuse? Chevron Down
    Is OCD an Impulse Disorder? Chevron Down
    What Is Substance-Induced OCD? Chevron Down