Mixing alcohol and OCD

Obsessive-compulsive disorder is a mental health condition that affects approximately 1.2% of the population, and about three-quarters of those affected are women. OCD’s disproportionate effect on women may be one of the reasons that this condition is poorly understood, and often downplayed as excessive neatness or a quirky personality. Despite these misconceptions, OCD has a profound effect on the lives of the people it touches and is a highly distressing condition for those who suffer from it.

Types of OCD

While some forms of OCD are more common, they can manifest in many different ways. Some of the most common forms of OCD often involve:

• Checking
• Physical or mental contamination
• Orderliness
• Rumination and intrusive thoughts
• Hoarding

However, OCD is certainly not limited to these forms.

OCD often follows a cycle of trigger-avoidance-reassurance, and this will look different in different people. In the trigger stage, the cycle will be put into motion by contact with something that triggers deep anxiety in the person with OCD. In response to this, the person will attempt to avoid the trigger to manage their anxiety. In the reassurance stage, the person will ask others to reassure them, research via books or the internet to try to calm their anxiety, or engage in rituals or replay previous events in their mind to try to reassure themselves that nothing is wrong.

This cycle does not have to be external and does not necessarily mean the person with OCD will perform physical rituals – or even have physical triggers. In the case of Purely Obsessional OCD, this entire cycle can take place entirely within the person’s mind. Someone with Pure O may experience disturbing and unwanted intrusive thoughts. These thoughts are made more distressing because they usually take the form of a taboo – harm, relationships, sexuality and gender, and religious or moral thoughts. The person doesn’t want to have these thoughts and finds them frightening and repellant, and will engage in the cycle of avoidance and reassurance internally to try to banish the thought.

The OCD cycle, particularly the reassurance stage, is self-reinforcing. It cements the idea that the anxiety-provoking trigger is bad and that the person is not able to handle the accompanying anxiety in the person’s mind. Left untreated, this cycle can come to dominate the person’s life.

OCD and alcohol addiction

Alcoholism is a commonly occurring condition alongside OCD, and about 25% of people with OCD also have a substance misuse disorder. One study showed that 70% of those sampled reported that OCD preceded their substance misuse disorder, which strongly suggests they turned to substances to cope with their condition.

This is understandable. OCD is marked by high levels of often unbearable anxiety and a sustained effort to manage it. Alcohol works as an anxiolytic – in the short term, it can calm anxiety. But like OCD itself, alcohol addiction is a cycle – and this cycle can cause this anxiety to increase.

Impact on neurotransmitters

The first-line pharmacological treatments for OCD are drugs that work on serotonin, like SSRIs. We don’t know why these drugs are effective for OCD – only that studies have shown that they are (although they are not guaranteed to work for everyone). People with OCD generally need higher doses of SSRIs than those used for people with depression.

For people who are using alcohol to manage their OCD, this relationship between serotonin levels and OCD can be a problem. Alcohol is capable of boosting the body’s production of serotonin – temporarily – but in the long term, lowers levels of serotonin in the body.

Drinking can counteract the effects of SSRI medication, so you may not feel the benefit of taking it. In addition, drinking alcohol can cause the side effects of the SSRI medication to be more pronounced.

Alcohol misuse and anxiety

People with OCD are desperate to manage their anxiety, which can be extremely debilitating – but one of the common symptoms of alcohol abuse is increased anxiety, which risks intensifying OCD.

Heavy drinking over time depletes GABA, the brain’s calming neurotransmitter. Like serotonin, alcohol increases GABA in the brain in the short-term, which is one of the reasons it calms anxiety – but over time suppresses GABA production, leading to more anxiety overall. This feeds into the cycle of alcohol addiction, as it increases alcohol symptoms like anxiety, leading to drinking more to manage it.

Treatment

Treatment for OCD often involves SSRIs, but they aren’t the only treatment available. Medication is usually offered alongside psychotherapy. The two most common forms of psychotherapy for OCD are cognitive-behavioural therapy (CBT) and exposure and response therapy (ERP).

CBT is a talk therapy that focuses on problem-solving and the here and now rather than examining the past. CBT focuses on investigating alternative forms of thinking and challenging behaviours and thoughts that do not serve you. CBT is based on the concept that thoughts and feelings are connected and can trap you in a vicious cycle. CBT is used for a wide range of conditions – but this relationship between thought and behaviour means it’s well-suited to treating OCD.

ERP is a form of exposure therapy. It isn’t simply exposing yourself to your triggers in the hope that you become desensitised – it aims to break down the reassurance part of the OCD cycle. In ERP, you will be encouraged to face your triggers without trying to put them right with compulsions. Because this is the most reinforcing part of the OCD cycle, magnifying your perception of the risk that your triggers pose, and exposing yourself to your triggers without trying to neutralise them can be very effective in reducing their power over you over time.(14)

Dual diagnosis and treatment challenges

Dealing with two conditions simultaneously is a difficult situation. Because commonly used medications for OCD interact badly with alcohol, it can be difficult for someone struggling with alcohol misuse to take their medication as directed. For people who need to undergo medically supervised detox, the stress and anxiety of this process can be acutely challenging, as this extra anxiety can trigger their OCD.

People with both alcohol misuse disorder and OCD will benefit from an integrated treatment programme which treats both conditions at the same time. Studies show that this is a more successful approach than treating these conditions separately, with a higher success rate.

Professional support can be transformative for people struggling with dual diagnoses. At UKAT, we know that dual diagnoses are common, so they must be treated together effectively. Contact us today to find out more about our comprehensive treatment programmes for dual diagnoses.