screening oCD Patients for substance addictions
All patients should undergo a screen for substances of abuse. Asking patients about what alleviates or worsens their OCD is a starting point. If alcohol and drugs are part of their answer to that question, follow-up questions to establish frequency of use and whether use is problematic (i.e., interferes with functioning) are needed.
Urine toxicology testing is a useful, easy, and quick way to screen for many drugs of abuse. Also, if certain drugs are found on testing (amphetamine/methamphetamine, cocaine), many times the OCD may be improved by informing the patient that abstinence from these drugs can ameliorate the severity of the OCD symptoms.
If opiates are being used, the patient may not want to stop use if they find some benefit for their OCD. In that case, education needs to be provided to let the patient know that other options may benefit him but without the addictive potential and other health, legal, and social problems of illicit opiates.
Screening Patients with Substance Addiction for oCD
Substance addiction in OCD patients is often an unplanned consequence of untreated OCD, therefore when patients present with Substance Use Disorders, be careful to screen for OCD. Because certain psychoactive substances, such as opiates or marijuana, may be enticing for individuals with OCD as they may potentially alleviate obsessional symptoms, patients with OCD may develop an addiction to opiates or marijuana.
When a substance addiction is recognized, many clinicians fail to screen for OCD assuming that the addiction is the primary problem. Treatment of the substance addiction may result in continued relapse, however, until the underlying OCD is addressed. Screening all substance addicted patients for OCD, therefore, is necessary to help the OCD as well as the substance addiction.