A person who has a dual diagnosis (also referred to as co-occurring disorders) has two separate illnesses, which need to be treated simultaneously.
It’s happened to all of us. We’re about to leave the house for the day, and we wonder about the coffee pot. Is it turned off? What would happen if we left it on all day?
For many of us, the answer is simple. We walk back into the kitchen to look at that coffee pot. In one trip, we’ve solved the thought.
For someone with obsessive-compulsive disorder (OCD), things aren’t so simple. Even as they’re walking away from that kitchen appliance, the question pops up again. Is it really turned off? How can they be sure?
Vigilance and caution are crucial characteristics, and they can help us succeed in work, relationships, and life. But when they combine into a disorder that interrupts the way we view the world and the things we do each day, they can damage us.
To cope, we may turn to substance abuse. That decision can deepen our discomfort.
What’s It Like to Live With OCD?
OCD symptoms can be variable. Some people have two sets, while others have just one. It’s not uncommon for people to experience different types of difficulties as their disease worsens or improves.
Typically, OCD is described as an illness of obsessions and compulsions.
- Obsessions are unusual mental images, intrusive thoughts, or unwanted urges. They can involve contamination, impulse control, religion, crime, or sexuality.
- Compulsions are repeated behaviors used to make obsessions go away. They can take the form of cleaning, repeating, checking, or arranging.
Often, these two symptoms come in pairs. Someone develops an obsession, and the compulsion is somehow related to that intruding thought.
Someone with religious-based obsession might pray, while someone with a contamination obsession might clean.
How Are OCD Symptoms Different Than Habits?
We all have activities we enjoy. Some of us like to organize our collections, for example, and some people get a great deal of satisfaction from a neat and tidy house. The difference in OCD involves scope and depth.
The National Institute of Mental Health reports that people with OCD spend at least an hour each day on their thoughts or behaviors. They can’t skip one day even if they want to. The majority of their time is spent dealing with their symptoms.
Someone without OCD might spend the weekend cleaning, organizing, and tidying. But when Monday comes, that person can leave all of these tasks behind to go to work. Someone with OCD may feel compelled to stay home to clean the area just one more time.
The behavior may be the same, but the time spent on it is quite different.
We can also be obsessed with the things we enjoy. As the International OCD Foundation points out, the casual use of the word obsession has a tint of pleasure to it. We can be obsessed with new shoes or a particular television program. But it rarely interferes with our ability to think about our families, our hobbies, and our work.
For someone with OCD, the obsession is intrusive. It can crop up anywhere, at any time. And when it does, those thoughts spark an intense feeling of nervousness or anxiety. This isn’t at all pleasurable. It’s terrifying.
How Does OCD Develop?
OCD isn’t a bad habit, and it isn’t sparked by a personality flaw. It’s a mental health disorder, and it’s remarkably common.
The International OCD Foundation says the disorder strikes people of all:
Symptoms often appear between the ages of 8 and 12, but some people first notice changes when they’re entering adulthood.
The National Alliance on Mental Illness says about 1 person in 40 will be diagnosed with OCD at some point in life.
It’s not associated with sickness like the flu or with an accident like a car wreck. Often, it seems to simply appear in people who didn’t know they were at risk.
Coping With OCD Through Addiction
Intrusive thoughts and compulsive behaviors are both scary and irrational. People with OCD often know that the way they think and behave isn’t typical. But as much as they may try to stop, they feel powerless to do so. Drugs and alcohol provide the illusion of power.
Imagine that your mind is fixated on the idea that you’ll harm the person you love. It seems inevitable, and all of your attempts to make the thought go away just aren’t working. Wouldn’t a sip of alcohol or a dose of drugs seem helpful?
Many substances of abuse are sedating, including:
- Alcohol. This is a central nervous system sedative, and it’s capable of inducing a sleep-like state at high doses.
- Benzodiazepines. These substances calm electrical activity in the brain, leading to a false sense of relaxation.
- Opioids. Prescription painkillers also work on the central nervous system, and they produce sedation that can linger for hours.
- Opiates. Heroin and other injectable drugs deliver peace within minutes, and at high doses, they create profound sedation.
For people with OCD, abusive substances become the solution to intrusive thoughts and repetitive behaviors. Addictions quickly follow.
In a study published in the Journal of Anxiety Disorders, researchers found that 70 percent of people with substance abuse issues and OCD had the mental health issue for about a year before the addiction took hold.
Research suggests that shared brain vulnerabilities make addiction’s development likely.
CAMH says people with OCD have unusual levels of brain chemicals like serotonin, dopamine, and glutamate. These are the same substances abusive drugs elevate. It’s possible that people with OCD have a more significant response to drugs than others due to their brain chemistry shifts. That could make them more likely to develop addictions than other people.
But substance abuse isn’t the solution to OCD. Drugs just numb symptoms rather than making them go away. When sobriety returns, your OCD is still there.
Treatment Options for OCD
If drugs aren’t the answer, what is? For many people, formal treatment programs make all the difference.
Exposure and response prevention therapy (E/RP) is designed to address OCD at the source. In this type of therapy, you’ll discuss your obsessions directly, and you’ll learn new ways to cope that don’t involve compulsions.
Mental Health America reports that OCD can cause an irrational sense of fear. You can come to believe that your compulsions protect you from the damage of an obsession. If you don’t engage in the compulsive activity, something terrible will happen.
In E/RP sessions, you’re encouraged to both name your obsession and identify the triggers that set it off. Then, your therapist helps you understand how to deal with the thoughts without engaging in your typical compulsive activity.
In therapy, you’ll discover that nothing terrible happens when you don’t take compulsive action. You don’t burn down your house, contract Ebola, harm your family, or do any of the other terrible things your brain is convinced you’ll do if you don’t use your compulsive solutions. Your life will simply move forward, and the link between thought and behavior weakens.
You’ll need to practice within the therapist’s office, but you’ll also need to work outside of the therapy room. You’ll work on your recovery while you’re:
- At work.
- At home.
- On dates.
- On family outings.
You may tell people what you’re working on, but you don’t have to. But when you head back to your therapist’s office, you’ll need to talk about what worked and what didn’t. You can build on your successes and learn from your failures.
Medications may also be part of your treatment plan. These therapies help to amend chemical imbalances in the brain, and that can help to soothe the symptoms before they begin.
According to the International OCD Foundation, a combination of medications and E/RP can ease OCD symptoms in about 70 percent of people.
When addiction complicates OCD, your recovery can be your complex. You will need counseling to help you understand the triggers that lead to drug use, and you may also need medications to soothe your cravings for drugs. These therapies are baked into your recovery process, not split from them, so you’ll be working on both facets of recovery at once.
It can take you time to get better, but you can certainly get there. You’ll need to keep up with the work, and you will need to stick with your treatment plan. But do that, and you can feel the pain begin to fade and your life come back into focus.