OCD and Alcohol Treatment

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Obsessive-compulsive disorder (OCD) is a mental illness frequently portrayed in television shows and movies as someone who struggles with the uncontrollable urge to organize, check or wash things. Common examples include hand washing, checking the stove or door locks, or turning light switches on and off. Other examples may involve ordering (organizing) items by size or color and arranging pictures or books in a specific way. Unfortunately, cinematic portrayals of obsessive-compulsive disorder are frequently misrepresented, stigmatizing, and sometimes even minimize the true challenge someone with an obsessive-compulsive disorder must manage each day. On occasion, the "film version" of OCD goes so far as to make the disorder appear humorous or comical. For those who struggle with persistent OCD, it is none of the above. However, ongoing misrepresentations of the actual challenges of OCD continue to further a dangerous and unfortunate stigma. When combined with alcohol addiction, OCD symptoms can quickly become unmanageable and harmful to the individual's physical and psychological health.

Understanding Obsessive-Compulsive Disorder (OCD)

Obsessive-compulsive disorder is a mental illness characterized by two distinct sets of symptoms; obsessions and compulsions1. First, someone with OCD experiences obsessions, which are repetitive, unwanted thoughts and irrational urges to do specific things or repeat specific actions. Although the individual with obsessive-compulsive disorder may understand that their obsessions are irrational and illogical, they cannot stop them from occurring. In general, obsessions are often upsetting and can lead to significant anxiety, especially when they are not addressed. Unfortunately, even if one tries to suppress obsessive thoughts, it will inevitably lead to considerable fear and panic associated with the idea that the harmful thought could "come true" if they do not act on it. Eventually, obsessive thoughts become so strong that the individual will act upon their thoughts by performing compulsions "behaviors or activities" to reduce the intensity and severity of their obsessions.

Compulsions are the behaviors or activities brought about by obsessions. Compulsions are the repetitive acts such as hand washing, turning light switches on and off, organizing things, and checking things, that someone with OCD must perform to help manage obsessive thoughts. Someone who struggles with long-term obsessive-compulsive disorder will adopt these behaviors and activities as a way to cope with the intensity and severity of their symptoms. Because of how symptoms of OCD affect the mind, individuals who struggle with symptoms will believe that if they do not perform these rituals in a specific way each day, terrible things may happen to themselves or a loved one.

It is also important to note that there is more than one type or category of OCD. The Diagnostic and Statistical Manual of Mental Disorders (DSM) lists specific criteria for four main categories of OCD2. These include Symmetry and Ordering, Forbidden Thoughts, Cleaning and Contamination and Hoarding. Like many other mental illnesses, each person with OCD will experience symptoms and challenges related to the condition in unique ways. However, one common symptom that often occurs across all types of dimensions of OCD is the desire to reduce the intensity and severity of the anxiety and panic produced by obsessions. This often causes people who struggle with OCD to turn to alcohol as a way to self-medicate. Data provided by the National Institutes of Health suggest as many as 25% of people with obsessive-compulsive disorder meet the diagnostic criteria for an alcohol use disorder3.

How Successful is Dual Diagnosis Treatment for Alcohol and OCD?

When someone has an obsessive-compulsive disorder and an alcohol addiction, it is referred to as a dual-diagnosis or co-occurring disorder. When someone has a dual diagnosis, it is vital to seek treatment in a setting where providers are trained to address the unique nature of treating mental health and alcohol abuse conditions simultaneously. Although OCD  treatment can be complex, fortunately, many of the same therapies proven successful for alcohol addiction treatment are also effective for addressing an obsessive-compulsive disorder.

One of the most effective treatments used to address both alcohol use disorders and obsessive-compulsive disorder is cognitive-behavioral therapy or CBT. CBT aims to encourage participants to identify harmful emotions that lead to negative feelings or symptoms. For people with OCD, CBT therapy asks you to acknowledge the intrusive, destructive, and repetitive thoughts (your compulsions) that lead you to perform rituals or actions. For those who struggle with obsessive-compulsive disorder and an alcohol use disorder, CBT will help you understand how the painful emotions experienced as part of OCD symptoms may lead to harmful coping strategies in the form of drinking.

After you understand how thoughts and emotions can lead to behaviors such as rituals or even drinking, you will work with your therapist to change or correct your thoughts, exchanging them for ones that are beneficial and positive. CBT is meant to help someone struggling with OCD better understand the effects of failing to perform rituals with the goal of learning that adverse consequences are not an absolute outcome of ignoring obsessions. Depending on your specific treatment needs, your therapist may also incorporate medications into your treatment program to help reduce the intensity and severity of your symptoms. Using medications, if necessary, to help with symptom management allows you the ability to focus your attention on therapy and healing instead of cravings of OCD obsessions.

Not so long ago, an obsessive-compulsive disorder was considered untreatable4. Fortunately, mental health treatment providers have a better understanding of OCD today as compared to just a few short years ago. In fact, research from the Stanford University Medicine OCD Program states that as many as half of those who seek help to overcome OCD symptoms will see an improvement in their symptom occurrence and symptom severity using only behavioral therapy models such as cognitive-behavioral therapy. Also, as many as 75% of patients who complete a comprehensive therapy program continue to show improvement in their symptoms six months after their treatment program ended.

The success rate for the treatment of OCD and alcohol use disorders is dependent on seeking comprehensive and effective treatment at a rehab that specializes in dual diagnosis treatment. At a dual diagnosis treatment center, you will work with your treatment team to design a program that focuses on addressing the symptoms of both OCD and alcohol use disorders. A program that treats these conditions simultaneously ensures your treatment providers can adequately address the root causes and connections between the illness. This is a vital part of dual diagnosis treatment, as one condition can worsen the symptoms of the other. If you choose a program that only addresses OCD (or vice versa), your risk for relapse increases significantly.

Paying for Your Treatment

Dual diagnosis treatment programs that adequately and successfully help people struggling with OCD and alcohol use disorder are (usually) inpatient or residential programs. At an inpatient program, you will stay on-site at the rehab throughout the course of your treatment program while working with members of the therapy team to overcome addiction and get help to recover from OCD. Many inpatient programs last between thirty and ninety days. Some research indicates the ideal program duration for alcohol addiction recovery is a ninety-day treatment program.

When you seek help for a dual diagnosis, the duration of your program may be ninety days or more. The exact timeframe required to help you detox and accomplish your treatment needs and goals will depend on a range of factors unique to your treatment needs. With that in mind, it is essential to note that inpatient treatment programs can be expensive. However, there are many different payment options you can consider that will help reduce the out-of-pocket cost of treatment.

Insurance Coverage

In 2010, the Affordable Care Act or “Obamacare” reduced the restrictions many insurance companies were allowed to place on payments for mental health or addiction treatment services. Before 2010, both private and federally-funded insurance programs could limit how much they paid for treatment, apply lifetime treatment "caps" for services, and could identify many mental health or substance abuse conditions as "pre-existing conditions" and therefore deny payment. The Affordable Care Act (ACA) required insurance providers to cover addiction and mental health treatment as they would another medical or surgical condition. This has opened up treatment opportunities for millions who would otherwise be financially unable to cover their care needs.

State and Local Assistance

Some areas offer treatment assistance benefits as part of local and state human services programs. Although these programs may not cover a mental health or addiction treatment program in its entirety, they often provide a significant benefit that allows someone who otherwise could not afford treatment the benefits of inpatient care. It is also good to look for low-cost treatment centers in your area. Some programs offer free or reduced-cost services to residents of their community based on income-driven qualifications.

Sliding Scale Programs

Some rehabs will work with you directly to help manage the cost of treatment. As with state and local programs, these programs offered directly through the rehab, are based on income. In these cases, the amount you pay out of pocket for treatment will vary widely, so it is crucial to contact the treatment center directly to learn more about any payment options you might be eligible for before committing to a treatment program.

Self-Pay or Financing

It may also be beneficial to look into rehabs that offer financing programs or discounts for self-pay. The goal of these payment programs is to help those who may not be able to secure a personal loan or borrow money from family still get access to potentially life-saving treatment.

Should you Consider an Out-of-State Treatment Center?

There are positive and negative aspects to traveling for rehab. Depending on your location, you may find that treatment centers in other areas of the country offer treatment programs that more closely match your needs. Also, some people find that choosing an out-of-state treatment center is more beneficial to their recovery as it entirely removes key challenges to recovery, such as triggering people, places, or circumstances that exist close to home. Traveling out of state also provides the opportunity to get well in a setting away from the influence of work, family, and friends who may hinder your recovery progress.

Conversely, traveling out of state for treatment may have negative factors as well. Traveling out of state may add extra costs to the treatment process. Additionally, it will be important to check with your insurance company to make sure they cover treatment at an out-of-state location. 

Finding a Treatment Center for OCD and Alcohol Addiction

Suppose you or a loved one are struggling with obsessive-compulsive disorder and a co-occurring alcohol use disorder. In that case, it is essential to seek help at a rehab with providers skilled in addressing dual diagnosis conditions. Not all treatment centers are equipped to address the unique nature of dual diagnosis illness so, finding a treatment center that can help you overcome and learn to manage symptoms is a key element of lasting recovery. At a dual diagnosis treatment center, highly trained treatment staff will work with you at all stages of your treatment journey to ensure your therapeutic program addresses your physical, psychological, and spiritual needs.

If you have started researching treatment programs, it is possible you have found many different treatment options. Understanding the level of care and "type" of treatment a particular rehab offers can be confusing. However, choosing the right program specializing in dual diagnosis care for obsessive-compulsive disorder and alcohol use disorders is vital to achieving the best treatment outcomes.  It is also important to choose a program where you feel safe and supported as you begin your recovery journey. The steps of achieving sobriety from alcohol and maintaining lasting wellness are not always easy. The support and guidance of your treatment team are essential to helping you through the early and often most challenging days of treatment.