Talking OCD & Addiction with Dr. Jan Weiner

Read the full transcript below:

1) What are common symptoms of addiction?

Addiction is the compulsive use of a substance and the inability to control the substances impact, despite the negative consequences that it has on one’s life, work, and interpersonal relationships.

Symptoms of addiction are the inability to control the intake of a substance, and the need to take more and more of that substance to achieve the desired effect. It could be that someone is beginning to avoid work or school, beginning fights with a spouse, spending a lot of time seeking out the substance, and becoming generally incapable of controlling their intake of a substance.

2) How does addiction related to OCD?

OCD relates to addiction in two ways. First, is that OCD sufferers and addiction sufferers are often trying to mitigate some emotional pain or anxiety. With OCD, you’re doing that through compulsions in order to reduce the anxiety. And with addiction, you’re doing that by taking a substance to decrease your negative emotional state. Both are also commonly “performed” in secret, and sufferers feel like they need to hide their symptoms. They don’t feel comfortable sharing what they’re going through.

3) Is someone with OCD more likely to form an addiction?

OCD sufferers are especially vulnerable to addiction because OCD is a negative state, meaning that they’re very anxious and will obsess about certain themes or topics and then will do their compulsion to remove that negative state or to try to decrease the anxiety associated with it. Addiction is very similar in the sense that you can use the substances for addiction to remove that state. Someone with OCD who is very anxious could either decide to take a couple drinks, or take a Klonopin or an Ativan to reduce their anxiety. Alcohol and benzodiazepines work very quickly to reduce anxiety, which leads to a more positive state. However, the drugs wear off very quickly and the negative state returns. Therefore, you’d want to take the substance again. People who have OCD tend to be a bit obsessive and compulsive in their behaviors in general, so it lends them vulnerable to drug seeking behaviors which can also have obsessive and compulsive attributes.

4) How does addiction relate to medication prescribed to help people with OCD?

The front line treatment for OCD are SSRIs which are Selective Serotonin Reuptake Inhibitors, like Prozac, Zoloft, and Luvox. These drugs have very low abuse potential. You take them every day, they have very long half lives, but they lack high abuse potential. They relieve anxiety over a long period of time. Shorter acting drugs like Benzodiazepines, Klonopin, Adavan, Xanax are much faster acting. They also have a short half life which means they do a great job in relieving anxiety, but they wear off relatively quickly. Normally in a matter of hours. Which leads them to have a much higher abuse potential because people will take more and more of the substance to achieve the desired effect.

5) What warning signs should I be concerned about?

Something people need to be aware of when they are taking drugs is the effect of withdrawal — symptoms like shakiness or panic attacks when the substance wears off. Make sure you’re not taking more than what was prescribed. If your psychiatrist said “take .25” as needed, that is not meant to be every 6 hours. If it’s prescribed to you in that way, then that’s a different story, but if you’re finding that you are taking more and more of that substance than originally suggested, you may be on a road to experiencing some signs of tolerance and withdrawal or addiction.

Often times, people with OCD will self medicate. They’ll think “I had a particularly rough day, I’ve been dealing with my obsessions. I'm exhausted. I’m just going to have a couple glasses of wine because I need a break from my thoughts.” Or, “I would like to go to sleep and have the volume of my thoughts turned down. I’m going to take a Klonopin tonight to relieve some of that.”

Sneaking or even just having them available to you is risky. I have clients who refuse to get on an airplane without the safety or reassurance of having their pills with them for those “just in case” episodes. When you start to feel a reliance or a dependance that you need these drugs in order to function, and that without them you’re going to have reduced ability to function (whether that’s at work or at home or getting through certain events) then I would say you’re starting the road down an addiction.

6) What does treatment look like for someone with OCD and addiction?

I would hesitate to see an outpatient practitioner for treatment for addiction. There are several programs throughout the country that deal with dual diagnosis in an inpatient setting, in a partial hospitalization setting, or intensive outpatient. The protocol is to really stabilize the addiction first. Have the person abstinent from the substance before doing the OCD work. When you’re taking a substance that’s going to reduce your anxiety, it’s really hard to do cognitive behavioral or exposure work when anxiety isn’t present or if the individual is drunk at that time. You want to treat the addiction first, or in one of these dual diagnosis programs, before outpatient therapy starts. Then you can focus on OCD coping skills, skill sets, and identifying triggers that may cause you to use again.

7) How can you help someone with an addiction?  

If your family member or friend or someone you love is struggling with an addiction, the best thing to do is talk to them. You’re likely going to be met with a high degree of resistance. Addiction is something that’s very difficult to treat and people tend to not get better unless they themselves are ready to confront the problem.

It’s challenging, but you will often not meet success the first time around. But making yourself and your family aware of the problem is the best thing to do.

8) What should sufferers remember?

That they’re not alone. That addiction to certain substances does work in relieving symptoms, which is why people often fall prey to it. There’s no shame in addiction, there’s nothing wrong with you for struggling.

Think of it from a medical perspective. It’s a disease of the brain. It doesn’t make you weak minded, and it’s not indicative of being unable to control yourself. There’s a whole genetic aspect to it and it’s best treated medically, instead of in private. It’s not your fault. Know that there’s help out there, and that you should seek it out.

For more videos from our OCD3 series, head to our YouTube channel here.