I was diagnosed with Obsessive-Compulsive Disorder (OCD), a type of anxiety disorder, at the age of 10 when I started performing rituals: Turning in circles in the shower as I washed my hair, counting and holding my breath on the school bus, checking under my bed a certain number of times before I went to sleep, and so on.

Approximately 20 years later, I developed alcohol use disorder. The pull toward alcohol felt eerily similar to my comparatively innocent compulsions as a child.

According to Stacey Conroy, LCSW, my story is not all that uncommon. In a 2020 town hall posted on ocdsud.com, she says that recent studies point to a 17 to 48 percent comorbidity rate for OCD and substance use disorder (SUD). In the same session, Dr. Patrick McGrath states that the primary method for treating OCD — Exposure Response and Prevention Therapy — can be used to treat SUD. 

Approximately 20 years later, I developed alcohol use disorder. The pull toward alcohol felt eerily similar to my comparatively innocent compulsions as a child.

If you are questioning whether or not you have OCD, check out the International OCD Foundation at iocdf.org to learn more about the disorder and to find a therapist with specific training in its treatment.

While therapy is often a crucial part of recovery from OCD, licensed professional counselor and OCD specialist Allie Wilson also refers clients to the book, Freedom From Obsessive-Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty by Dr. Jonathan Grayson, to function as either a self-guided workbook or a reference that that can complement the therapeutic relationship. One reason Wilson recommends the book, she says, is for its succinct explanation of the root of OCD. The book states that “the core of [the disorder] is trying to get rid of uncertainty in our lives…” This quest for certainty sounds ridiculous, but it is the brain’s way of reacting to highly anxiety-producing thoughts.

Recovering from co-occurring mental health issues is not easy, but I have found a way to live a good life in spite of (and because of) these obstacles. Here are some tips for managing OCD in tandem with alcohol use disorder (AUD) based on my experience in therapy and as a member of both Alcoholics Anonymous and Tempest. (Editor’s note: Tempest is the parent site of The Temper.)

Honesty and OCD

All recovery modalities that I’ve encountered — including 12-step and alternative programs — emphasize honesty as the cornerstone of recovery. Alcoholics Anonymous is particularly heavy-handed in this regard, stating in an oft-read portion of its basic text that honesty is the main criterion for recovery.

Given this emphasis on honesty, it is incredibly important for people with OCD to work with a therapist or another medical professional to discern what thoughts are true and what thoughts stem from their anxiety disorder — because this can sometimes be confusing.

In my own journey, I have sometimes struggled with guilt over thinking I am withholding secrets when in reality I am appropriately choosing not to share private information.

For example, someone who struggles with scrupulosity (see below) may think they have been dishonest simply because they had a certain thought. In my own journey, I have sometimes struggled with guilt over thinking I am withholding secrets when in reality I am appropriately choosing not to share private information.

To help discern what is true and what is OCD, Dr. Jonathan Grayson offers a handy trick. Essentially, you imagine yourself in a life and death situation and then pose a question or concern to yourself, such as “Is [insert thought] true or is this my anxiety talking?” The answer you would provide in this scenario helps you cut through the B.S. and identify the truth at a gut level.

Spirituality and OCD

For many of us, spiritual exploration is an important part of the recovery process. However, this could pose significant challenges if you struggle with scrupulosity, a form of OCD “involving religious or moral obsessions,” whereby individuals “are overly concerned that something they thought or did might be a sin,” according to the National Alliance on Mental Illness (NAMI). 

Ideally, you would work with a therapist who has in-depth training in OCD and Exposure Response Prevention therapy to recover from scrupulosity. If this is not an option, however, there are many resources specifically dedicated to scrupulosity that you can check out. The Liguori Mission, a Catholic order named after a saint who struggled with religious guilt, publishes a monthly newsletter called “Scrupulous Anonymous,” which may be helpful.

I connect to my higher power through the beauty of nature, through the collective strength of different recovery communities, and through gratitude lists and simple prayers.

Quite a few books have also been written about scrupulosity, such as Understanding Scrupulosity: Questions, Helps, and Encouragement, written by the former director of the aforementioned newsletter, and The Doubting Disease: Help for Scrupulosity and Religious Compulsions.

I do not struggle with scrupulosity, but I have a tendency to ruminate and overanalyze, so it has been helpful for me to focus on the basics when it comes to my spiritual life. I connect to my higher power through the beauty of nature, through the collective strength of different recovery communities, and through gratitude lists and simple prayers, such as “help, thanks, and wow,” the title of a book by Anne Lamott.  

Relationship Anxiety

Fear of contamination coupled with handwashing rituals is a form of OCD that gets a lot of press, but there are a variety of other OCD subtypes. These include Harm OCD, in which individuals suffer from intrusive thoughts that they will hurt their loved ones, and Relationship OCD, defined by Wilson as “really just a lot of assessing and reassurance seeking, checking to make sure your relationship is OK.”

Fretting over your relationship can increase any existing strain on you and your partner and even fuel your addiction, so it is important to quell your anxiety. 

Discussion of broken relationships abounds in recovery circles, which can trigger a person with this particular anxiety disorder to repeatedly question the status of their marriage or domestic partnership, even if it is a loving and committed one. Fretting over your relationship can increase any existing strain on you and your partner and even fuel your addiction, so it is important to quell your anxiety. 

Reassurance seeking is a compulsion in itself that only feeds your OCD. One thing you can do to combat this pattern, according to Wilson, is to limit questions to two per day, write them down in a journal, and ask your significant other to respond one time only in writing. The more you refrain from seeking your partner’s support, the more you will rebuild trust with yourself and reclaim your power.

Additional Resources

These suggestions are just a starting point, as OCD is a complex anxiety disorder that can manifest in many different ways. In my case, I thought I had completely recovered from OCD until it resurfaced in new ways in my late twenties and early thirties. I think it is also important to note that COVID has exacerbated my OCD quite a bit — and not because I am obsessively washing my hands. For the first time in my life, I have struggled with Harm OCD, likely because the pandemic has intensified my fear of losing those dearest to me. 

Today, I know I am not my OCD, just as I am not my addiction, and I know it is possible for all of us to recover from both. To get started, or if you can’t afford one-on-one therapy, check out the app, NOCD, the two aforementioned websites, iocfd.org and ocdsud.com, specifically geared toward individuals with OCD who suffer from substance use disorders. 

Take good care.