Does Alcohol Make OCD Worse?

Ever watch a neat freak madly cleaning up their apartment — say Monica on the TV series Friends? — and automatically think “obsessive-compulsive”? In real life, “neat freak” doesn’t come close: Obsessive-Compulsive Disorder, or OCD, is a serious, complex, and often debilitating mental health condition. Add alcohol into the equation and dealing OCD can get even trickier. 

Anyone with OCD who reaches for a drink to decompress soon discovers alcohol has the opposite effect. Let’s take a closer look at the science behind OCD and alcohol and how they can fuel one another in a vicious cycle.

Understanding Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder (OCD) is a mental condition that is recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), the official manual for the diagnosis of psychiatric disorders. Prior to the fifth edition, OCD was categorized as an anxiety disorder, but it now more accurately appears under its own category — “Obsessive-Compulsive and Related Disorders.” 

The condition is characterized by recurring obsessions, compulsions, or both. The critical factor that determines diagnosis is that these obsessions and/or compulsions must significantly impact functioning: they must be time-consuming or cause clinically significant distress.

Obsessions are persistent, intrusive thoughts that cause anxiety. They can manifest in a variety of ways:

• Fear of contamination
• Fixation on worst-case scenarios
• Need for symmetry or orderliness
• Persistent thoughts of harming oneself or others
• Repetitive touching or counting objects 

Compulsions are impulsive, repetitive behaviors that can be a response to an obsession or aimed at reducing distress from a dreaded situation. Some common compulsive behaviors include the following: 

• Repetitive organizing and arrangin
• Excessive handwashing and cleaning
• Checking and rechecking
• Rigid rules of order or routine
• Collecting/hoarding

These obsessions and compulsions can torment those of us who experience them. It’s definitely not as lighthearted as wanting the dishes stacked nicely or the pillows arranged neatly. Obsessive thoughts and compulsive behaviors can prevent us from living a rich, full life. Also of concern are the coping mechanisms some of us develop to relieve symptoms — such as consuming alcohol.

Alcohol may seem like a good solution as it generally makes us feel calm and happy. Unfortunately, it can actually make things worse in the long run.

OCD and Alcohol: A Vicious Cycle

OCD causes unwanted thoughts and behaviors that can lead to distress and anxiety. Many of us with mental health conditions turn to drinking to self-medicate due to alcohol’s physical and mental effects. Unfortunately, OCD is often paired with other mental health conditions, which only amplifies this urge.

An analysis completed in 2010 outlines other conditions associated with OCD:

• Alcohol misuse and alcohol use disorder (AUD) affect a strikingly significant percentage of those with OCD — around 38%.

• Over 55% of people with OCD also suffer from impulse-control disorders.

• The most common co-occurring conditions are anxiety disorders, affecting over 75% of those of us with OCD.

Alcohol’s depressant effects may temporarily blunt intrusive thoughts or negative emotions caused by OCD, but this relief doesn’t last long — in fact, it tends to rebound worse than before. While mental health disorders have a strong correlation with substance use, certain unique features of OCD create an even more complex pattern.


OCD Guilt After Drinking

A common aspect of OCD is a higher likelihood of feelings of guilt. Those with OCD may replay or misconstrue a certain action or scenario that evokes a greater sense of wrongdoing or immorality. While everyone may experience feelings of guilt or regret at some point in their life (somehow always at night when we’re trying to fall asleep!), those of us with OCD can have excessive and irrational feelings of self-doubt and guilt.

Real-event OCD is a subtype that involves severe guilt and rumination that is not proportional to past actions or events. For example, those of us with real-event OCD may recall a mean comment directed at a classmate years ago and spiral into believing that we’re a horrible person who doesn’t deserve to have friends today.

Alcohol can also fuel shame and make us feel like we lack control, two major triggers for obsessive thoughts. These thoughts often lead to compulsive actions in an attempt to help alleviate our distress. In the case of drinking, the all-or-nothing thinking of OCD can cause us to drink more and more — creating a cycle of self-medicating and alcohol misuse.

OCD and Alcohol Abuse

OCD is linked to an increased risk for AUD and substance use disorder (SUD). Three reasons explain why: 

1. Drinking becomes a compulsion. Since alcohol can briefly relieve distress and anxiety, drinking can quickly turn into a compulsive behavior to avoid unwanted thoughts or feelings. 
2. Serotonin dysfunction. OCD is associated with reduced serotonin functionality. Serotonin is often called the “happy hormone” due to its role in mood regulation; a boost to serotonin is a boost to our mood. Serotonin increases when we start drinking, but as our body metabolizes alcohol the levels can fluctuate wildly, leading to mood swings and unpredictable OCD symptoms. With chronic use, alcohol can rewire serotonin pathways to reduce functionality, causing an overall increase in OCD symptoms.
3. Shared risk factors. AUD and OCD have shared risk factors that increase the risk that they’ll happen together. These include genetic, environmental, and neurochemical factors.

Now that we’ve confirmed the cyclical relationship in which alcohol and OCD are connected, let’s delve deeper into how alcohol affects OCD.

Alcohol’s Effects on OCD

Alcohol impacts our central nervous system, which is the processing center of all the signals that travel into and out of our brain.  The resulting changes affect our mood, judgment, and impulse control — all important factors in OCD. 

While Drinking Alcohol

When we drink, alcohol’s depressant effects slow down messaging in our brain. For those with OCD, that can mean a brief interruption to intrusive thoughts. The alcohol stimulatory effects prompt the release of neurotransmitters, which temporarily improve our mood. However, the harmful effects of alcohol far outweigh those that seem beneficial.

In the Aftermath

Long term, drinking alcohol can increase anxiety, lower mood, and disrupt sleep, aggravating OCD symptoms. After consuming alcohol, OCD’s intrusive thoughts may increase and heighten the urge to engage in compulsive behaviors to ease distress.  

Alcohol misuse and OCD are also shown to affect similar structures and molecules in our body. Abnormal levels of glutamine, an essential amino acid, are found in those with OCD and substance use disorder, although the relevance is still being studied. Both alcohol and OCD act on the prefrontal cortex — the part of the brain in charge of cognitive and behavioral control. When managing OCD, intentional responses are crucial to resisting urges, but alcohol’s inhibitory actions negatively impact this. 

We’ve established that alcohol can negatively influence OCD, but let’s take a closer look at the specific risks.

Risks of Drinking Alcohol With OCD

Since alcohol targets the CNS and consequently affects OCD, drinking can lead to a number of negative results. To make more intentional drinking decisions, it is important to keep these consequences in mind:

• Exacerbated OCD symptoms. Alcohol impacts similar areas of the brain and the neurotransmitters that influence our thoughts and behaviors. This leads to worsened OCD symptoms such as increased anxiety, impulsivity, decreased inhibitory control, and more frequent and severe intrusive thoughts. 
• Interactions with medication. Prescription medications are frequently used to treat symptoms of OCD. Alcohol can negatively interact with these medications and cause dangerous effects.
• Risk for developing AUD. Excessive drinking can lead to the development of AUD, especially with the shared risk factors between OCD and substance misuse.
• Increased difficulty in quitting drinking. The self-medicating aspect of OCD and the risk of developing drinking as a compulsion make the cycle difficult to break.
• Lower tolerance for anxiety. Alcohol impacts our stress threshold and increases our anxiety, making it more difficult to manage co-occurring OCD symptoms. 
• Impeded OCD treatment. Managing OCD requires intentional actions against obsessions and compulsions. Alcohol lowers our inhibitions, making it more difficult to act against the urges of OCD.

OCD is a complex condition on its own, and the addition of managing alcohol consumption is no walk in the park. Let’s review some helpful tips for navigating our relationship with alcohol with the co-occurrence of OCD.

Navigating a Relationship With Alcohol and OCD

Getting stuck in the debilitating cycle of OCD and alcohol can feel hopeless. However, committing to these five actions can help us break the cycle: 

• Identify triggers. Triggers will vary from person to person, but identifying what they are is crucial to overcoming a pattern of behavior.
• Find alternative coping strategies. Alcohol is frequently used as a coping mechanism to avoid intrusive thoughts or difficult emotions. Replace drinking with positive coping strategies such as meditation, journaling, or movement to help reduce alcohol consumption and mitigate exacerbated symptoms.
• Track drinking habits. Keep a record of alcohol consumption and the situations and feelings that occur before and after drinking to help identify harmful patterns. (The Reframe app has a customizable drink tracker to help you do exactly that!)
• Set goals. After identifying drinking triggers and patterns, we can set actionable goals to cut back or quit alcohol. For example, if social anxiety is a trigger, we can plan ahead to attend social events with an accountability buddy or prepare a response to politely decline an invitation. 
• Explore professional treatment options. Managing alcohol consumption and OCD is difficult, but we don’t have to face it alone. We can reach out to family and friends for support and explore different therapy options, such as medication, cognitive behavioral therapy, acceptance and commitment therapy, and exposure and response prevention.

Circling Back Around

Obsessive-Compulsive Disorder is a multifaceted mental health condition that is difficult to manage on its own — and much more so if alcohol enters the picture. It may seem tempting to have a drink now and then to buffer OCD. However, alcohol can be the trigger in a vicious cycle: we use alcohol to alleviate OCD symptoms, which then increase, so we try to relieve them with more alcohol... Breaking the cycle and developing a more positive relationship with alcohol is no easy feat, but as the wise American poet Robert Frost wrote, “The best way out is always through.”