People with obsessive compulsive disorder (OCD) are twice as likely as the average person to experience problems with alcohol.1 Both OCD and alcohol use disorder (AUD) involve strong urges, compulsive behaviors, and poor impulse control, which could help explain this connection.2, 3, 4 Some may also use drinking as a way to mitigate or cope with symptoms.1
What Is OCD?
People with Obsessive compulsive disorder (OCD) ruminate on distressing thoughts (obsessions) and engage in ritualistic behaviors (compulsions) to cope with 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 two defining symptoms of OCD include:2
- Obsessions: Intrusive, upsetting thoughts, words, images or urges that a person ruminates on or repeats in their mind. These result in intense feelings of distress or anxiety
- Compulsions: Ritualistic behaviors or mental actions that a person feels a strong urge to do or repeat in order to neutralize, silence, or control unwanted thoughts, obsessions, or feelings of discomfort or anxiety
OCD & Alcohol Abuse
While having any diagnosed mental illnesses may increase a person’s risk for developing an addiction, there’s a particularly strong relationship between OCD and alcohol dependence. Studies indicate 24-30% of people with OCD meet criteria for AUD, which is much higher than the general population.1, 3, 4, 6
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
There are also some similarities between OCD and alcoholism that 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
Risks of Using Alcohol to Cope 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
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
How Does Alcohol Affect OCD Symptoms?
Drinking poses unique risks for people with OCD and can worsen symptoms. Alcohol affects one’s mood, thinking, and ability to make decisions, thus increasing certain symptoms.10 This is especially true for people taking prescribed medications, which commonly 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 leading to bad or risky decisions when intoxicated.
- Negative interactions with prescribed medications, like SSRIs or antipsychotics.
- Chemical imbalances in the brain that can affect mood and anxiety levels.
- Possible irreversible brain damage.
- Impaired problem solving, planning, and reasoning ability.
- Impaired motor functioning, balance, and coordination.
5 Ways to Responsibly Drink With 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.
Below are five tips for responsible drinking with OCD:11
1. 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
2. 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.
3. 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 coping skills to utilize during times of distress. Examples of these may include exercising, meditation, journaling, or reaching out to your support system.
4. Practice Resisting Urges
Both OCD and AUD are linked to impulsivity, which can worsen when you give into 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.
5. Consult With a Healthcare Professional
People taking prescribed medications should always consult with their prescriber before drinking, as negative interactions between alcohol and medications are common. They can also 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 exposure and response prevention (ERP) for OCD, behavior therapy, cognitive behavioral therapy (CBT), or acceptance and commitment therapy (ACT)
- Psychiatric medication: It may be helpful to consult with a psychiatrist or medication provider to explore prescription options available for helping to treat OCD symptoms 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
Impaired executive functioning and poor impulse control are features common to both alcoholism and OCD1, 2, 4, 6 Some people with OCD turn to alcohol to cope with their symptoms, which can create more serious problems down the line.9 Because of this, practicing impulse control, using healthy coping skills, and seeking professional help are some of the best strategies for managing comorbid OCD and AUD.