Treatment for OCD and Substance Use Disorder

By Stacey Conroy, LICSW, MPH, LADC1 and Patrick McGrath, PhD

Fear, frustration, anger, and shame are known emotions for those with obsessive compulsive disorder (OCD) and substance use disorder (SUD), and are the foundations of the stigma that leads to a greater sense of isolation. In addition to this isolation, those suffering often face obstacles even if they are motivated for, and want to get, help. OCD providers state that the SUD needs to be stable BEFORE they will begin treatment, and SUD providers don’t know what to do with the OCD thoughts and rituals, leaving far too many patients in a vicious cycle.

“They said I had to have 90 days in recovery, so I got 90 days, then they said I couldn’t be on Suboxone while in their program, I came of the Suboxone and started treatment. I relapsed and it was over.”

“I was supposed to go to AA meetings while I was in the house [program] but I had to go back and check that I hadn’t hurt someone when I walked by them and never got to the meeting, or got there really late. I got reported for not going to AA and I couldn’t tell them why, so I got discharged.”

These are statements from two different individuals who have both OCD and SUD. Each tried to access treatment for themselves and in both cases, the program or provider could not give concurrent treatment for both the OCD and SUD, leading to both patients being discharged.

This is the reality for many with OCD and SUD as the struggle to find effective treatment often leads to fear, frustration, and anger. Those emotions are turned outward towards a treatment system without the resources to meet their treatment needs, as well as turned inward, where stigma grows stronger, as well as shame and isolation.

What if treatment for OCD and SUD was possible? IT IS!!

The reality is there are Evidenced-Based Practices (EBPs) that can treat each disorder, and they can be provided at the same time. Through the 1980’s, the practice theory held that individuals needed 1 year in recovery from substances before they addressed any mental health issues. This was not effective for many, as the realities of the mental health issue would often cause such stress that the individual would relapse on substances.

The treatment community acknowledged that waiting to treat mental health issues wasn’t working well, and dual diagnosis treatment was developed. Individuals could be treated for anxiety and SUD, depression and SUD, and later a protocol for PTSD and SUD concurrent treatment was developed. However, OCD does not respond to the type of Cognitive Behavioral Therapy (CBT) often utilized in dual diagnosis treatment.

OCD SUD Training at the 25th Annual OCD Conference

Professionals in BOTH the OCD and SUD communities need to receive specific training to treat OCD and SUD concurrently, and that training is available at the 25th Annual OCD Conference. This year there will also be an OCD SUD Pre-Conference Training dedicated to teaching professionals how to provide concurrent treatment. Professionals can gain the knowledge, tools, and recourses to provide concurrent treatment to those with OCD/SUD. It is estimated, through various research studies, that the lifetime prevalence of OCD/SUD is 25%, so having the ability to provide concurrent treatment is an essential component to your professional practice.

Hope For the Future

Those who live with OCD and SUD, stay in the fight! OCD programs are listening and there are those that have started to provide concurrent treatment. Advocacy for oneself is needed, but then you have to be willing to do the work. It’s hard, but there are those who are in recovery from both their OCD and SUD. A few will be at the IOCDF conference sharing their stories, and there is an OCD/SUD support group at the conference as well.

Together we can stop the vicious cycle and fight back against the fear, frustration, anger and shame. It will take many voices to move this forward, and the IOCDF conference is where we can meet each year to share our experiences, strengths, resources, and HOPE!

To learn more about the OCD SUD programming at the 25th Annual OCD Conference, click here.