OCD & Alcohol: Understanding the Connections

What Is OCD?

People with obsessive compulsive disorder (OCD) ruminate on distressing thoughts (obsessions) and engage in ritualistic behaviors (compulsions) to cope with the anxiety caused by these thoughts.^2,5 As OCD progresses, a person’s obsessions and compulsions begin taking up more of their time, making it harder to function. Over half of people diagnosed with OCD report moderate or severe impairment as a result of their symptoms, making it one of the most debilitating forms of mental illness.⁵

The Relationship Between OCD and Alcohol

While having any diagnosed mental illness may increase a person’s risk of developing an addiction, there’s a particularly strong relationship between OCD and alcohol dependence. Studies indicate that 24-30% of people with OCD meet the criteria for alcohol use disorder (AUD), which is much higher than the general population.^1,3,4,6

Are People With OCD More Likely to Misuse Alcohol?

Research exploring the link between OCD and addiction has found that most people (70%) develop a substance use disorder one year or more after being diagnosed with OCD.¹ This suggests that drug and alcohol problems are often secondary to OCD, and may even begin in reaction to OCD. This was confirmed by further studies suggesting that “coping” was a primary motive in participants who reported problematic or heavy use of alcohol.⁷

Risk Factors for Alcohol Misuse & OCD

Some similarities between OCD and alcoholism could place someone at higher risk for both conditions. For example, OCD and AUD are linked to impairments in areas of the brain that help people resist urges and control impulses, making it harder not to act on them.^6,8

Alcohol Use as a Mask for OCD

Alcohol use can often be used as a way to dull someone’s OCD symptoms, as the use of alcohol can reduce some of the anxieties and compulsions those with OCD would otherwise focus on. Alcohol use can be an effective way to mask for those with OCD, as it is mind-altering, making someone less aware of their surroundings and mental state; however, the long-term use and dependence on alcohol to cope with or mask OCD symptoms is very dangerous.

How Alcohol Affects People With OCD

The effects of alcohol may appeal more to someone with OCD than those of other drugs. For instance, many people report feeling calmer and less tense or stressed when they drink. The problem is that drinking to cope is more likely to lead to alcohol dependence than social or recreational drinking.⁹

Does Alcohol Make OCD Worse?

Drinking poses unique risks for people with OCD and can worsen symptoms. Compulsive behaviors are fueled by strong impulses and urges. Acting on these brings temporary feelings of pleasure and relief, but is not helpful in the long term. This is true for compulsive drinking as well. Giving into these impulses reinforces them and makes them more challenging to overcome.⁶

Does Alcohol Make Intrusive Thoughts Worse?

While many people turn to alcohol as a way to cope with intrusive thoughts, it often makes things worse. Alcohol is linked to anxiety. It interferes with brain chemistry, leading to mood changes and worsened anxiety, which can feed intrusive thoughts. As a depressant, alcohol can lead to rumination, sadness, and feelings of isolation. It also has a negative effect on sleep, which can worsen OCD symptoms.

How Does Alcohol Worsen OCD Symptoms?

Alcohol affects someone’s mood, thinking, and ability to make decisions, thus increasing certain symptoms.¹⁰ This is especially true for people taking prescribed medications, which often negatively interact with alcohol.^10,11 Frequent or prolonged drinking may even cause damage and structural changes in the brain, which may or may not be reversible.

Potential risks of excessive drinking for people with OCD include:^10,11

• Increased risk of developing alcohol use disorder
• Pre-existing OCD diagnosis can complicate alcohol recovery
• Lowered ability to resist urges to engage in compulsive behaviors
• Impaired thinking can lead to errors in thinking or trouble stopping obsessive thoughts
• Poor judgment leads to bad or risky decisions when intoxicated
• Negative interactions with prescribed medications, like SSRIs or antipsychotics
• Chemical imbalances in the brain can affect mood and anxiety levels
• Possible irreversible brain damage
• Impaired problem-solving, planning, and reasoning ability
• Impaired motor functioning, balance, and coordination

Can OCD Make it Harder To Quit Drinking?

Having OCD can make it harder to quit drinking. Oftentimes, attempting to quit drinking can be a long process, and those with OCD may be using alcohol as a way of coping with their OCD. When this happens, trying to quit drinking becomes harder as the secondary gain of using alcohol as a coping mechanism can make it harder to stop.

7 Ways to Drink Responsibly If You Have OCD

Because people with OCD are at higher risk for developing an alcohol use disorder, it’s a good idea to exercise more caution when drinking. Depending on your situation, drinking history, and alcohol use patterns, this may mean carefully monitoring your alcohol consumption or stopping altogether.

Here are seven tips for responsible drinking with OCD:^5,11

1. Learn Your Triggers for When You Want to Drink

If you find yourself reaching for a drink at the end of the night, think about why. This helps to differentiate drinking for pleasure from drinking to dull OCD symptoms. If you find that you are feeling triggered and that you’re using alcohol as a solution to a negative feeling or experience, it is important to think about what that trigger was and come up with better ways to cope.

2. Watch for Signs of Alcohol Dependence

While some people at risk for alcoholism are able to moderate their drinking, others may need to avoid alcohol completely. Monitor your drinking habits and cut back or stop drinking if you start to notice early warning signs of dependence. If you are unable to control your alcohol use, frequently engage in binge drinking, or are experiencing long-lasting mental or physical health impairments, you may be suffering from an alcohol dependence or alcohol use disorder.²

3. Set Healthy Limits When Drinking

It’s a good idea for anyone who drinks alcohol to set healthy limits on how much and how often they drink. However, this is especially important for those with disorders like OCD. Talk with your healthcare professional about recommendations on what these limits should be, and be sure to follow these guidelines.

4. Avoid Using Alcohol to Cope

Drinking to cope or self-medicate increases the risk of alcoholism, so it’s best to avoid drinking when you’re anxious, stressed, or upset.⁹ Instead, work on developing healthier OCD coping skills to utilize during times of distress. Examples of these may include exercising, meditation, journaling, or reaching out to your support system.

5. Practice Resisting Urges

Both OCD and AUD are linked to impulsivity, which can worsen when you give in to alcohol cravings and compulsions.^3,4,6 When you have a craving or urge, try to pause and use “urge surfing” to allow it to rise, crest, and fall. Waiting until the impulse passes can help you feel more in control, and also makes it easier to avoid making bad decisions in a moment of temptation.

6. Understand How Alcohol Might Impact Your Medication

It is important to learn about how alcohol impacts your medication for OCD treatment. When on certain OCD medications, one drink can impact your body in more severe ways. When this happens, it can make it harder to manage your OCD. Drinking while on some medications can be dangerous, so make sure you talk to your provider about your specific medication before consuming any alcohol.

7. Consult With a Healthcare Professional

A medical professional can inform you of the negative physical or mental health effects of alcohol.^10,11 People who are experiencing symptoms of alcohol withdrawal or are unable to stop drinking on their own should consult with a licensed substance abuse counselor.

Treatment for Co-Occurring OCD & Alcohol Use Disorder

There are effective treatments available for those who struggle with OCD and alcohol use disorder, including inpatient and outpatient rehab, therapy options, and medications. Scheduling a diagnostic assessment with a licensed clinician is the best first step, as they will review and recommend treatment options for you.

Some of the treatments that may be recommended include:

• Addiction rehab: Addiction rehab focuses on establishing and maintaining sobriety, while also learning coping skills to avoid relapse
• Family therapy: Therapies for families or couples affected by OCD and AUD focus on improving communication, support, and accountability.
• Individual therapy: Individual psychotherapy may include therapies like ERP for OCD, behavior therapy, CBT for OCD, or ACT for OCD.
• Group therapy: Many people find group therapy helpful because they can gain wisdom and share experiences with people who are going through the same thing, under the care of a trained therapist.
• Psychiatric medication: It may be helpful to consult with a psychiatrist or medication provider to explore potential OCD medications and/or to manage alcohol cravings.
• Support or recovery groups: Many people with mental health and addiction issues benefit from attending 12-step meetings or other support groups where they can connect with others who struggle with similar issues.