Most people can relate to having thoughts they can’t get rid of from time to time.
Maybe it was something you said three days ago, a conversation you keep replaying, or something that happened years ago that your brain has apparently decided needs another look.
You tell yourself to stop thinking about it, and for a little while, you do manage to forget about it.
Then you’re lying in bed at eleven o’clock, trying to sleep, and there it is again.
Most of us know what it’s like to get stuck in our own heads. We overthink conversations and worry about things that haven’t happened. But for someone living with obsessive-compulsive disorder (OCD), unwanted thoughts can become so persistent and distressing that they interfere with daily life.
A few drinks might take the edge off the anxiety. Maybe they notice they’re not worrying quite as much or going over the same conversation for the tenth time. And if drinking seems to help, it’s easy to understand why they might do it again.
But what happens when the thing you’ve been using to quiet your mind starts causing problems of its own?
OCD is more than wanting things a certain way
We throw the term OCD around pretty casually. Someone likes their kitchen spotless, arranges their books by colour, or can’t stand a crooked picture frame.
I’m so OCD about that.
We’ve used the term so loosely that we’ve lost sight of what the condition actually involves.
Obsessive-compulsive disorder involves unwanted thoughts, images, or urges that cause significant distress. These are called obsessions. To relieve the anxiety they create, someone may develop repetitive behaviours or mental rituals known as compulsions.
According to the National Institute of Mental Health, people with OCD may have persistent fears about germs, accidentally hurting someone, or losing control. To ease the anxiety, they might wash their hands repeatedly, check things several times, or ask others for reassurance.
For example, someone might check that they’ve locked the front door before leaving for work. They know they locked it, but by the time they get to the car, they’re doubting themselves. What if they only thought they locked it? They go back to check, feel better for a moment, and then start questioning themselves all over again.
That must be exhausting, especially when you know, somewhere in the back of your mind, that the door is probably locked. But knowing something and feeling certain about it are apparently two very different things.
You can walk away from an uncomfortable situation or avoid a conversation you don’t want to have. Your own thoughts are a little harder to escape.
Which brings us to alcohol and drugs.
When alcohol or drugs quiet the mind
One of the more interesting questions we can ask about addiction is what alcohol or drugs were doing for someone before they became a problem.
Maybe drinking helped them sleep or made social situations easier. Maybe it gave them a few hours when they didn’t have to think about something painful.
For someone with OCD, the appeal might be the possibility of having a quieter, calmer mind.
Imagine spending most of your day questioning things, checking things, worrying about whether you’ve made a mistake, or trying to get rid of a thought that frightens you. Then you have a couple of drinks and notice that you’re not quite as anxious. The thoughts might still be there, but they don’t seem to bother you as much.
You remember that feeling the next time the anxiety gets bad, and perhaps you reach for another drink. The trouble is that alcohol and drugs don’t treat OCD. Whatever relief someone experiences is temporary, and regular substance use can eventually lead to dependence, withdrawal symptoms, and more anxiety.
Someone who started drinking to feel less anxious may eventually find themselves worrying about how much they’re drinking, whether they can stop, and what will happen if they try.
According to research discussed by the International OCD Foundation, roughly one in four people with OCD will also experience a substance use disorder during their lifetime. There are plenty of reasons someone might develop an addiction, and having OCD certainly doesn’t mean they will. But I wonder how many people have turned to alcohol or drugs to deal with obsessive thoughts without even realising that’s what they were doing.
When OCD and addiction become entangled
There are some interesting similarities between OCD and addiction, especially when you look at the behaviours involved.
Someone with OCD might ask their partner the same question five times because they need reassurance that everything is okay. Someone with an alcohol problem might wake up determined not to drink that evening and find themselves pouring a glass of wine at 4 PM.
Both may recognise what they’re doing and wish they could stop.
Of course, the conditions work differently. OCD compulsions are generally attempts to reduce anxiety or prevent something frightening from happening. Addiction involves cravings and changes in the brain’s reward system. A person can experience both, but one doesn’t necessarily explain the other.
Then there’s shame. People with OCD sometimes experience intrusive thoughts that are so disturbing or out of character that they’re afraid to tell anyone. They may worry that having a particular thought means they’re capable of acting on it, or that it reveals something awful about who they are. In reality, an unwanted thought isn’t evidence of someone’s intentions.
Addiction brings its own secrets. Hidden bottles, lies about how much someone has had to drink, and promises to cut back that never work out. Imagine trying to explain both conditions to someone, especially if you’re not entirely sure you understand them yourself.
A person might talk openly about their drinking but never mention the thoughts that keep them awake at night. Or they might describe their anxiety while leaving out how much alcohol they’re using to manage it.
That’s where treatment can become complicated. A therapist needs to understand what’s happening, but people aren’t always ready to talk about the things that frighten or embarrass them most.
What happens when you stop drinking but the thoughts remain?
Imagine someone entering addiction treatment after years of relying on alcohol to manage their anxiety, and overall they’re doing well. They’ve stopped drinking, they’re sleeping better, and their relationships are beginning to improve.
However, the obsessive thoughts are still there, and perhaps louder than ever.
Without alcohol to dull the anxiety, the person is suddenly dealing with thoughts and compulsions they haven’t had to face without substances in years. They might find themselves checking things repeatedly, seeking reassurance, or spending hours worrying about something they know probably isn’t going to happen.
They thought getting sober would make them feel better, and in many ways, it has, but they’re still struggling.
This is something that gets overlooked in conversations about addiction recovery. We sometimes talk about sobriety as though removing alcohol or drugs will somehow put everything else back in order. While stopping substance use can make an enormous difference, the mental health difficulties that existed before someone started drinking don’t necessarily disappear. Sometimes they’re easier to see.
Someone might spend months working on their addiction and wonder why they’re still so anxious. They may have developed healthier routines and learned new coping skills, but if OCD remains untreated, they’re still dealing with something that affects their everyday life.
The same problem can happen in reverse. Someone receiving treatment for OCD may find it difficult to participate in therapy while they’re continuing to use substances heavily.
This is why understanding both conditions matters so much.
Treating OCD and addiction together
The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends integrated treatment for people experiencing mental health and substance use disorders at the same time. Essentially, clinicians work together to address both conditions rather than treating them as unrelated problems.
One treatment that’s been particularly effective for OCD is exposure and response prevention (ERP), a type of cognitive behavioural therapy. The idea is to gradually face whatever triggers the obsessive thoughts without falling back on the usual compulsions.
Remember the person who keeps checking the front door? A therapist might have them practise leaving the house without going back to check the lock. They’ll probably feel anxious, especially at first, but over time, they can learn to live with that uncertainty without needing to do anything about it.
That sounds fairly straightforward until you consider how frightening uncertainty can feel to someone with OCD.
ERP can help people become less dependent on compulsions. Certain medications, particularly selective serotonin reuptake inhibitors (SSRIs), may also help manage symptoms.
Treatment for addiction might involve therapy, medication, or learning how to manage cravings without turning to alcohol or drugs. When someone also has OCD, their treatment needs to take that into account. If they’ve spent years drinking or using drugs to cope with obsessive thoughts, they’ll need help managing those thoughts as well, which will take time and practice.
Living with uncertainty
One thing I’ve come to understand about mental health is how much time we spend trying to control what happens inside our heads.
We want to stop worrying. We want to know we’ve made the right decisions, that nobody is upset with us, and that everything is going to work out. We’d like our minds to cooperate.
Our minds have a way of bringing up things we’d rather not think about, usually at the most inconvenient times. Sometimes we get so caught up in a thought that we forget we don’t actually have to do anything about it.
For someone with OCD, learning this can take a lot of work. They might feel the urge to check something again or ask for reassurance, but therapy can help them resist that urge and get on with their day, even when they’re still feeling anxious.
For someone recovering from addiction, part of the work may involve learning to sit with uncomfortable feelings without immediately reaching for alcohol or drugs.
Neither comes easily, particularly when those behaviours have been part of someone’s life for years.
We sometimes underestimate how difficult it can be to change the things we’ve relied on to get through the day, even when we know they’re causing us problems.
Understanding what’s really going on
How many people spend years trying to fix what they believe is their biggest problem without realising there’s something else going on?
They stop drinking but continue struggling with obsessive thoughts. They seek treatment for anxiety but never mention how much they’re using substances to cope. They make progress in one area of their lives and can’t understand why things still feel so difficult.
Maybe nobody has asked the right questions.
At Camino Recovery, we understand that addiction and mental health difficulties frequently overlap. Treatment considers someone’s experiences, symptoms, and the circumstances that may have contributed to their substance use, rather than assuming everyone arrives with the same problems or needs the same approach.
There’s something important about asking people what they were trying to escape when they started drinking or using drugs. Sometimes the answer is obvious. Other times, it takes a while to understand what was happening.
And for someone living with OCD, recognising how obsessive thoughts and substance use have become connected may help them begin addressing both.
If you or someone you love is struggling with OCD, substance use, or both, contact Camino Recovery to learn more about our approach to treatment and recovery.
References:
- International OCD Foundation. (n.d.). Co-occurring OCD and substance use disorder: What the research tells us.
- National Institute of Mental Health. (n.d.). Obsessive-compulsive disorder: When unwanted thoughts or repetitive behaviors take over.
- Substance Abuse and Mental Health Services Administration. (2025). Co-occurring disorders.
