OCD and Addiction: Understanding How Obsessive Thoughts and Substance Use Can Overlap

Every October, OCD Awareness Week gives us a reason to talk about a condition that most people have heard of but don’t necessarily understand.

This year, October 11–17, the International OCD Foundation is encouraging people to learn more about obsessive-compulsive disorder (OCD) and what it’s like for those who are living with it.

We have some catching up to do.

We’ve all heard someone say they’re “so OCD” because they like their kitchen clean or their desk organised. Maybe they arrange their books by colour or can’t stand seeing dishes in the sink. Somewhere along the way though, OCD became another way of describing someone who’s particular about things.

Meanwhile, people living with the actual condition may be spending hours worrying about thoughts they don’t want to have, repeating behaviours they wish they could stop, or trying to convince themselves that something terrible isn’t going to happen.

Some people also turn to alcohol or drugs to deal with the anxiety, which can create another set of problems. And when someone is struggling with addiction, OCD symptoms aren’t always recognised.

The OCD symptoms we rarely hear about

When most people think about OCD, they picture someone washing their hands repeatedly or checking that the stove is turned off. Those can certainly be symptoms, but OCD can also involve thoughts and behaviours that nobody else ever sees.

The National Institute of Mental Health explains that OCD can involve unwanted thoughts, images, or urges that a person finds difficult to shake. These are called obsessions. Someone may then feel compelled to do certain things, sometimes over and over, to ease the anxiety. 

These compulsions might involve checking, washing, or repeating something in their head. Even when they know their fears are unlikely to come true, resisting the urge to do something about them can be incredibly difficult.

Some people have fears about germs or contamination. Others worry about accidentally hurting someone, making a terrible mistake, or doing something that goes against their values.

A person might spend hours thinking about something they said to a friend, wondering whether they were offensive. They replay the conversation and examine every word, and eventually ask the friend if everything is okay. The friend assures them that nothing is wrong. Still, the doubt returns.

Someone else might experience a frightening thought about harming a loved one and become terrified that having the thought means they’re capable of acting on it. They may avoid certain situations or spend hours trying to prove to themselves that they would never do such a thing.

Of course, having an intrusive thought doesn’t mean someone wants to act on it. But imagine being afraid of your own thoughts and then being too embarrassed to tell anyone about them. Because so much of OCD happens internally, a person may appear perfectly fine to everyone around them. They’re going to work, raising children, paying bills, and doing all the things they’re supposed to do. Nobody sees what’s happening in their head.

Why some people don’t recognise their own OCD

Many people have lived with OCD for years without realising that’s what they’re experiencing.

Maybe they’ve always considered themselves worriers, or they grew up believing they were overly sensitive or needed to stop overthinking everything. They might even recognise that some of their behaviours are unusual but assume it’s “just how their mind works.”

There’s also the embarrassment. Imagine telling a therapist that you’ve spent three hours worrying about whether you accidentally hurt someone’s feelings last Wednesday. Or admitting that you’ve been having violent intrusive thoughts about someone you love.

People worry about what others will think, especially when the thoughts themselves are frightening, so they keep them to themselves.

The International OCD Foundation has discussed how shame and embarrassment can make it difficult for people with co-occurring OCD and substance use disorders to talk openly about their symptoms.

Someone might finally seek help for drinking but never mention the thoughts that have been keeping them awake at night. They may also talk about anxiety without describing the rituals they perform to manage it. Unless someone asks the right questions, those symptoms can stay a secret.

When alcohol or drugs become part of the picture

People drink or use drugs for all sorts of reasons. Some enjoy the social aspect, and others are trying to manage stress and anxiety.

For someone living with OCD, alcohol or drugs might seem to offer a little relief from thoughts that never seem to leave them alone.

A few drinks might make the anxiety feel less intense, and they notice they’re not thinking about the conversation quite as much.

It’s easy to understand why someone might remember that the next time they’re overwhelmed, but alcohol and drugs don’t treat OCD. Whatever relief someone experiences is temporary, and regular substance use can eventually lead to dependence and additional mental health problems.

According to research discussed by the International OCD Foundation, approximately one-quarter of people with OCD experience a substance use disorder at some point in their lives. That doesn’t mean everyone with OCD will develop an addiction. But the number does raise questions about how often people may be using substances to manage symptoms they haven’t been able to explain or understand.

If nobody recognises the OCD, treating the addiction may become more complicated.

What happens when OCD gets missed in addiction treatment?

When someone begins addiction treatment, the immediate concerns usually involve their substance use. Clinicians need to know what they’re taking, how often, and whether they’re experiencing withdrawal symptoms or other health problems.

But what if the person also has OCD and nobody knows?

Perhaps they mention being anxious but leave out the intrusive thoughts or they describe having trouble sleeping without explaining that they spend hours mentally reviewing conversations or checking things before bed. They might not even realise those behaviours are symptoms worth mentioning.

There’s another complication. Some OCD behaviours can look like anxiety or perfectionism. A person might repeatedly ask a therapist whether they’re doing well in treatment or whether they’ve completed an assignment correctly.

Most of us seek reassurance occasionally, but when someone with OCD repeatedly asks the same question to relieve an obsession, the reassurance itself can become part of the problem. They feel better for a few minutes, then the doubt returns. So they ask again.

A therapist who understands OCD can recognise these patterns and help the person respond differently. Without that understanding, well-intentioned reassurance may actually keep the cycle going.

This is one reason a thorough mental health assessment is so important when someone seeks treatment for addiction. Sometimes the symptoms that aren’t immediately obvious are the ones that have been causing the most stress.

The difficulty of treating both conditions

Someone might stop drinking and make considerable progress in addiction treatment but continue struggling with obsessive thoughts.

They’re attending therapy and making changes they’ve wanted to make for years. Yet they’re still spending hours worrying about things. They may begin wondering why they aren’t feeling better.

The opposite can happen, too. Someone receiving treatment for OCD may find it difficult to participate fully in therapy if they’re continuing to drink heavily or use drugs.

The International OCD Foundation has discussed some of the challenges people face when trying to access treatment for both conditions. Some programmes focus primarily on addiction, while others specialise in OCD but may not be equipped to manage active substance dependence.

That can leave someone in a frustrating position. They need help with both conditions, but finding treatment that addresses them together isn’t always straightforward.

What treatment might involve

One of the most effective treatments for OCD is exposure and response prevention (ERP), a form of cognitive behavioural therapy. During ERP, people gradually face situations or thoughts that trigger their obsessions while practising not performing the compulsions they usually rely on to relieve anxiety.

For example, someone who repeatedly asks their partner whether they’re upset might work with a therapist to resist asking again. They’ll probably feel uncomfortable, particularly if reassurance has become something they depend on throughout the day. They can learn to tolerate that uncertainty without needing someone else to make the feeling go away.

For someone struggling with addiction, treatment might include counselling, medication, or help dealing with cravings. But if they’re also living with OCD, that needs attention, too. Otherwise, they may stop drinking or using drugs and find themselves still struggling with the same obsessive thoughts and anxiety that made substances appealing in the first place.

Someone who’s been using alcohol to manage obsessive thoughts may need additional support as they begin learning how to handle those thoughts without drinking. And someone with significant substance dependence may need medical care before they’re ready to participate fully in OCD therapy.

The work can be uncomfortable, especially when a person has spent years relying on certain behaviours to manage anxiety.

Why OCD Awareness Week matters

Awareness campaigns are most useful when they make us reconsider something we’ve taken for granted, and OCD is a good example.

We’ve spent years joking about being OCD because we like our kitchens clean or our books arranged a certain way. Meanwhile, people experiencing frightening intrusive thoughts or exhausting mental rituals may have no idea that what they’re dealing with has a name.

Some may also be struggling with alcohol or drugs, which can make everything worse.

OCD Awareness Week is an opportunity to learn what the condition actually involves and recognise symptoms that don’t fit the stereotypes. It’s also a reminder for those working in addiction treatment to ask questions about obsessive thoughts, compulsions, and the ways people manage their anxiety.

At Centres for Health & Healing, we know that mental health difficulties and substance use can be closely connected. Our treatment approach considers the experiences and symptoms that may be contributing to someone’s addiction, including mental health conditions that may have gone unrecognised.

Perhaps the next time someone says they’re “so OCD” because they like things tidy, we can remember that there’s a great deal more to the condition than that. 

If you or someone you love is struggling with OCD symptoms, substance use, or both, contact Centres for Health & Healing to learn more about treatment and support.

References:

• Conroy, S. C. (2026). Co-occurring OCD and substance use disorder: What the research tells us. International OCD Foundation.
• Conroy, S. C. (2016). Treating co-occurring OCD and substance use disorder: What professionals need to know. International OCD Foundation.
• National Institute of Mental Health. (n.d.). Obsessive-compulsive disorder: When unwanted thoughts or repetitive behaviors take over.