We feature an expert in the mental health and substance use disorder field to answer questions. This issue we talk to Dr. Lynsey Miron of Rogers Behavioral Health about Obsessive Compulsive Disorder (OCD) and how it relates to substance abuse disorders.
Q: What is OCD?
Obsessive-compulsive disorder (OCD) is characterized by obsessions, compulsions, or both, that cause significant distress or difficulty in day-to-day functioning.
Obsessions are recurrent thoughts, urges, or images which are intrusive and unwanted, and they lead to a great deal of anxiety or distress in most individuals. Examples of obsessions include a fear of germs or contamination, a need for perfection, or fear of harm. Individuals with obsessions may attempt to ignore or suppress those thoughts, urges, or images, or to neutralize them by engaging in a compulsion or ritual.
Compulsions are repetitive behaviors or mental acts that are done in response to an obsession or according to rigidly applied rules. Examples of compulsions includes washing, hoarding, and repeating actions. These behaviors or mental acts are completed in order to prevent or reduce anxiety or keep a feared event from occurring. The behaviors are either clearly excessive or not logically connected to the feared event.
Q: How is OCD different than anxiety? How are they similar?
This is a really common question, and it’s important that we differentiate OCD from anxiety disorders. Anxiety is a more general reaction to experiences characterized by emotional responses, such as fear or worry; physical responses like a racing heart, shortness of breath, stomach upset, or sweating; and cognitive responses such as “I’m in danger” or “Something bad is going to happen.” OCD on the other hand is a specific type of anxiety disorder.
Q: What is the relationship between OCD and substance use disorders (SUD)?
It’s really interesting because, at a glance, it may seem like OCD and substance use disorder are very different. However, both conditions include unwanted repetitive behaviors, frequently with negative consequences on someone’s ability to work, maintain personal relationships, keep up with school, and take part in social activities.
In both disorders, the individual tries to escape from emotional, physical, or cognitive distress by engaging in behaviors that, over time, become unwanted and time consuming. For OCD this may involve rituals, while for SUD this involves the repeated search for and use of a substance. But in both instances, the relief is very temporary, and those unwanted symptoms eventually return, leading to a difficult-to-break cycle.
Additionally, studies have found that about 25% of individuals suffering from OCD may also suffer from a substance use disorder, so we know it’s quite common. These individuals may seek relief from their obsessive thoughts and rituals by using a substance, or they may incorporate substance use into their existing OCD rituals.
Q: What is the most effective type of treatment for OCD that is evidence-based?
The most effective treatment for OCD is exposure and response/ritual prevention, or ERP. In ERP, individuals learn to control their fears while also resisting urges to perform rituals in a prolonged, repetitive, and gradual manner. ERP is evidence-based, meaning there has been substantial clinical research demonstrating that the treatment works well for a wide range of people and presentations.
Our goal with ERP is to reduce anxiety, help people become more confident in their ability to tackle challenges, and help them learn that many of the things they have been avoiding because of a specific feared outcome either do not occur or are much more manageable than expected.
Q: Is this treatment effective for depression, anxiety, trauma, and substance use disorders?
While ERP is a behavioral therapy specifically utilized with some anxiety disorders, such as OCD, behavioral or exposure therapy in general (doing things that have become too challenging or are avoided) is an effective treatment for a wide range of conditions, including depression, trauma, substance use disorders, and other forms of anxiety. ERP coupled with strategies to reduce and cope with urges to use substances would be an effective choice for someone struggling with both OCD and SUD.
Lynsey Miron, PhD, is a licensed clinical psychologist and Clinical Supervisor for the adult, child and adolescent partial hospitalization and intensive outpatient programs at Rogers Behavioral Health in St. Paul, MN. Dr. Miron provides training and supervision that promotes evidence-based treatments for OCD, anxiety, depression, PTSD, and substance use disorders.
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Last Updated on September 8, 2021