Special Clinical Circumstances
Obsessive Compulsive Disorder and Substance Addiction
Although research on OCD has improved treatment for individuals suffering from this disorder, relatively little attention has been paid to the influence of Substance Use Disorders (abuse and/or dependence) in this population and how best to treat individuals when both disorders co-occur. Among individuals with OCD, approximately 25% have a lifetime Substance Use Disorder (23.2% with a lifetime alcohol use disorder and 13.3% with a lifetime drug use disorder).
Rates of Substance Use Disorders are even higher among patients with Body Dysmorphic Disorder (BDD) than the rates found in OCD. Around 50% of people with BDD have a lifetime history of one or more Substance Use Disorders, and current Substance Use Disorders are likely to be present in approximately 20% of BDD patients.
Among individuals with OCD, approximately three-quarters (77%) report onset of OCD prior to developing the substance addiction. Therefore, OCD may also be a precipitating factor in the development of substance addiction.
The substances most often abused by OCD subjects are alcohol and cannabis, which patients can perceive as being capable of temporarily ‘relieving their anxiety’ or as a means of ‘getting away’ from symptoms and their consequences. Clinicians should emphasize to patients that while such substances may provide transient relief, in the long-term there is evidence that they can make mental health worse and even interfere with treatment success.