OCD and Addiction: A Commonly Missed Comorbidity
At Mountain Valley Treatment Center, we believe in addressing the full picture of mental health—especially when diagnoses and symptoms are complex and overlapping.
Comorbidities are incredibly common, particularly with obsessive-compulsive disorder (OCD). A recent systematic review and meta-analysis by Sharma et al. (2021) found that 69 percent of people with OCD have at least one other comorbid mental health condition. The study highlights that the most common comorbidities are mood disorders (anxiety, depression, etc.), neurodevelopmental disorders (Autism Spectrum Disorder [ASD], Attention-Deficit/Hyperactivity Disorder [ADHD], etc.), and OCD-related disorders (Hoarding Disorder, Body Dysmorphic Disorder [BDD]).
However, one of the least recognized and acknowledged comorbidities with OCD is Substance Use Disorder (SUD) and behavioral addictions (technology addiction, sex addiction, gambling addiction, etc.).
In a recent episode of the Fear Less Podcast, our host and Executive Director, Zack Schafer, spoke with Jayme Valdez, LMHC, about the overlap between OCD and addiction. Jayme is the founder of Clearview OCD Counseling and specializes in treating OCD, anxiety, trauma, and addiction. She brings a wealth of insight into the topic of co-occurring OCD and addiction. The following are some highlights from their conversation.
Understanding the Relationship Between OCD and Addiction
In the episode, Jayme discusses empirical research on the co-occurrence of OCD and addiction. The International OCD Foundation (IOCDF) reports that roughly 25 percent (or one in four) individuals struggling with OCD meet the criteria for a co-occurring substance use disorder. Additionally, studies have shown that upwards of 70 percent of individuals with OCD have co-occurring behavioral addictions. Internet addiction, phone addiction, food addiction, sex addiction, and pornography addiction are commonly reported.
Although there is a clear correlation between OCD and addictive disorders, the nature of the relationship is still being explored.
Jayme and Zack note that, for some individuals, substance use or addictive behaviors serve the function of “self-medicating” their OCD. This is supported by research, with studies indicating that individuals with OCD who use substances such as alcohol or marijuana often report doing so to reduce anxiety, “drown out” intrusive thoughts, or cope with emotional distress.
In addition, Jayme and Zack explore the shared phenomenology of the two disorders that may help explain the high rates of comorbidity. Both OCD and addiction involve cyclical patterns—experiences of intrusive thoughts or urges, emotional distress, and compulsive or impulsive behavioral responses aimed at achieving temporary relief. This shared pattern is not merely coincidental; biological and neuroscientific research suggests that similar underlying brain pathways are involved in both disorders.
Treating OCD and Addiction: A Concurrent Model for Healing
Given the relationship between OCD and addictive behavior, it is not only necessary to create a treatment model that addresses both disorders—it may be more feasible than expected, given the overlap.
In the episode, Jayme draws from both her professional experience and personal recovery journey to explain how these co-occurring disorders can be treated concurrently.
Here are some key points from the discussion:
• Treatment Hierarchies:
When addressing a co-occurring disorder, it is essential to ask, “Where do we start?” Jayme explains that her first step is always to assess and address safety risks. Once those are managed, she focuses on the issue causing the greatest dysfunction in the individual’s life. Establishing a treatment hierarchy helps both the therapist and the individual stay focused on what matters most.
• Harm Reduction:
The goal of treatment does not always need to be “abstinence,” “extinction,” or “remission.” The focus should be on reducing the harm that addictive or compulsive behaviors cause in an individual’s life.
• Psychoeducation:
Both OCD and addictive behaviors are often misunderstood—even by those experiencing them. Providing thorough psychoeducation about the signs and symptoms, the cycles of OCD and addiction, and available treatment approaches is critical for success.
• Exposure and Response Prevention (ERP) Principles:
Although ERP is considered the gold standard treatment for OCD, its principles also apply to addiction. Exposing individuals to triggers and teaching them how to “surf the urge” to engage in compulsive or impulsive behaviors is central to effective treatment.
• Acceptance and Commitment Therapy (ACT):
ACT focuses on helping individuals accept internal experiences while taking values-driven action. Breaking the cycle of OCD and addiction depends on one’s motivation and willingness to change. Identifying personal values and aligning behavior with one’s aspirations is central to facilitating meaningful change.
Listen to the Full Conversation
This episode is rich with expert insight, personal vulnerability, and deep wisdom for professionals, families, and anyone navigating the complexities of co-occurring OCD and addiction. Jayme’s story and expertise offer hope to those feeling stuck in harmful cycles or struggling to find effective support.
