It’s no secret that alcohol appeals to many people for a number of reasons. Primarily, the sense of euphoria, relaxation, and giddiness that one feels when alcohol acts on the brain is its siren call. For many people who suffer from OCD, the feeling of calm and elevated mood is a welcome reprieve from the nagging fear of the intrusive thoughts or compulsive behaviors that burden them. However, that momentary relief often culminates in more severe symptoms.
OCD and Substance Use
OCD is widely understood as a chronic condition in which a person experiences persistent and unwanted thoughts, images, urges, or doubts (known as obsessions) that produce feelings of fear, anxiety, or distress. In response to those feelings, people with OCD engage in repetitive behaviors, or mental acts, aimed at reducing distress.
For many people with OCD, coping with constant fear or doubt can be debilitating. The level of severity of OCD symptoms is contingent on many factors, such as the presence of another mental disorder, a person’s genetic makeup, or substance use. Clinically significant alcohol or drug use has been found in 24-40 percent of people with OCD, with alcohol being the most commonly abused substance.
Alcohol Can Take OCD Symptoms From Bad to Worse
It’s difficult to define what severe symptoms of OCD are, as the disorder is experienced at varying levels. According to the most recent edition of Diagnostic and Statistical Manual (2013, 5th ed.) published by the American Psychiatric Association, symptoms considered time-consuming cause significant distress or impairment in “social, occupational, or other important areas of functioning” are typical of the disorder. If bad is the baseline, then the addition of alcohol actually makes OCD symptoms much worse.
It is helpful to think of severity in terms of rate, frequency, and intensity with which symptoms are experienced. The rate, frequency, and intensity of symptoms might increase drastically, or gradually, following alcohol consumption or substance use. For example, some people with OCD might—over the course of a week following a night of drinks with friends—notice that they are performing repetitive behaviors more frequently or for longer durations. Perhaps they feel a greater sense of urgency to do compulsions that were previously well-managed or extinct. Other people might suddenly experience worsening, recurrent intrusive thoughts or disturbing images, which produce more intense fear or anxiety, bodily sensations, or bodily urges.
The answer to why alcohol tends to worsen symptoms of OCD might be found in the structural and hormonal differences in the brains of people with OCD, as compared to non-OCD brains. In other words, the brains of people with OCD may function and feel differently from the brains of others.
The OCD Brain Functions and Feels Differently
According to a report published by the University of Michigan’s Research Lab, the OCD brain functions on a “loop of wrongness,” whereby signals telling the individual to stop doing a behavior are not sent or received as they should be. The brain instead responds to the errors in brain signaling themselves, which repeats, causing a never-ending loop of failed signaling and response.
Imagine this process as waiting to cross a busy intersection. The ‘walking man’ light signals that it is safe to cross, then stops, then starts again—over and over. Imagine that the person who begins to cross returns to the sidewalk when the light stops signaling, then begins to cross again when the light signals it is safe. This cycle repeats over and over and the person never makes it across the street.
Signals in the brain are sent by little messengers called neurotransmitters (hormones, or other brain chemistry elements). When a neurotransmitter is released from one area to the brain, it travels along neuropathways, using elements called neurotransporters, to another area of the brain. Certain mental illnesses involve issues in brain chemistry where too many neurotransmitters are released or received (i.e., anxiety), and others involve issues in the brain where too few are released or received (i.e., depression).
Why Does Alcohol Worsen OCD Symptoms?
When it comes to why alcohol worsens OCD symptoms, the role of neurotransmitters and their transmission is pertinent. One such neurotransmitter is a well-known hormone called serotonin. Serotonin is commonly known as the body’s natural mood-stabilizer and is typically present in the body in stable amounts. When at healthy levels, serotonin encourages a sense of well-being, greater focus, and emotional stability. But when at unhealthy levels, serotonin can produce psychological symptoms, such as depression or anxiety, or physiological symptoms such as jitters, diarrhea, or muscle tension. In severe cases, extremely high levels of serotonin can result in a serious condition called Serotonin Syndrome.
A study published in the Journal of Neurotransmission found that people with OCD have reduced availability of serotonin transmitters (transporter mechanisms that carry serotonin to receptors in the brain). This means that when serotonin is produced, the brain cannot adequately regulate the amount sent to receptors in the brain because there are too few transmitters. A review of research in this area found that in people with OCD, the brain also has a reduced capacity for serotonin uptake (receipt). This means that the brains of people with OCD not only have fewer transporters, but when the serotonin reaches its destination, the brain has a reduced capacity to accept it.
The impact of alcohol has been heavily researched and is similar in how it acts on serotonin transmission in the brain. Alcohol has been shown to increase serotonin production in the brain—giving consumers the giddy, calm, ‘tipsy’ feeling. Alcohol is a central nervous system (CNS) depressant, which means that it suppresses or stops the communication between the brain and the body—the CNS controls most functions of the body, as well as nearly all functions of the mind. For this reason, drinking too much alcohol produces poor motor control (e.g., walking in a straight line during a sobriety test), impaired speech and cognition (e.g., slurred speech and forgotten lyrics during karaoke), and eventual “blackout” (i.e., loss or near loss of consciousness). Basically, when you’re ‘drunk,’ your brain is failing to function as it should.
Serotonin has also been linked to the development of Alcohol Use Disorder (alcohol dependency) in human and in animal studies. A review of research in this area found that low serotonin levels were linked to alcoholism and that people with OCD are more likely to develop dependence after the development of OCD symptoms.
OCD and Alcohol: More Bad Than Good
Alcohol might have symptom-relieving qualities when it acts on the brain of people with OCD because it produces an increase of serotonin activity in the brain. This effect of alcohol on the levels of serotonin in the brain can occur after just one drinking session and are short-lived (meaning OCD symptoms return, often worsening, once effects of alcohol wear off). This might be why some people who were not experiencing OCD symptoms prior to drinking, report a return of OCD symptoms after drinking.
When the effects of alcohol wear off, levels of serotonin drop, often to levels lower than they were prior to consumption. In people who do not suffer from mood disorders, this reduction in serotonin often results in the commonly experienced psychological symptoms of withdrawal (i.e., depressed “hangover”). But for people with OCD, the result is more severe symptoms.
On a usual day, when no alcohol is consumed, the OCD brain’s diminished capacity to transmit serotonin has been linked to symptom severity. In a study conducted by Reimold and colleagues, (2007, Journal of Neurotransmission) the reduction of serotonin transmission was correlated with 83% of OCD symptom severity in non-medicated people with OCD. This means that of 100% of OCD symptoms reported by participants in the study, 83% of symptoms could be linked to poor transmission of serotonin in their brain.
While alcohol has been found to increase the activity of serotonin transporters in the brain, it also depletes existing Serotonin in brain cells. Translation: drinking alcohol gives a rush of good feelings, then a period of bad feelings. Coupled with the predisposition that those who suffer with OCD have for poor serotonin regulation, it makes sense that people with OCD often complain of worsening symptoms!
In a Nutshell: Treat Alcohol with Caution
Many people with OCD do, in fact, experience increased symptom severity due to the effect of alcohol on the unique structure and function of the OCD brain, though this will not be the case for all. The OCD brain does not regulate serotonin, the body’s natural mood regulator, effectively; which lends people with OCD to increased symptom severity. The addition of alcohol may worsen symptoms in well-managed OCD, or contribute to relapse. The decision to consume alcohol as a person with OCD must be made with the awareness that alcohol acts differently on the brain of those with OCD and that those with OCD are prone to developing an addiction to alcohol or other substances.
Someone with OCD can take extra precautionary steps around their drinking, like:
- Know what abnormal drinking levels are: There is a common misconception regarding alcohol consumption and what “normal” levels of consumption are. An important first step is becoming more aware of what normal drinking habits are and examining whether you or someone you love, might have a drinking problem. For information on moderate, binge, and heavy drinking definitions and descriptions visit the National Institute on Alcohol and Alcoholism.
- Know what your drinking looks like: Keep track of your drinking by journaling or using mobile apps. While no one app is specifically recommended, as there are many to choose from, look for one that allows tracking in cans, bottles, or glasses (instead of units like mL or oz). This will make keeping track of what you drink much less difficult. Also, choose an app that has notification features for when you have consumed more than the recommended guidelines for “moderate drinking.” Having this feature might help keep the amount of alcohol you drink in check when you are drinking socially.
- Know whether you are gaining tolerance: For many people, awareness of problem drinking occurs once they realize that two beers no longer does the trick. When drinking, make a note (pull out your phone and jot it down in an app, or send yourself a text) of how many drinks it took to begin to feel the effects of alcohol. Note what kind of drink you had as well. Do this for each occasion. After a few occasions, are you finding that it requires more alcohol for you to get a “buzz”?
- Know whether you find it difficult to choose to drink less, or not at all: Have you found it difficult to stop drinking, once you start? Have others told you that you drink more than you should, or that you drink too much? If the answer to any of these questions is yes, you might benefit from reaching out to your mental health provider, medical doctor, or another qualified medical professional for help. Contact the SAMHSA National Helpline (1800-622-HELP) which is available 24 hours a day, seven days a week for free and confidential assistance if you think you might have a problem with drinking. SAMHSA is not a counseling or treatment service; however, SAMSHA can connect you with services in your community.
If you’d like to seek help with managing your OCD in healthy ways, contact NOCD. Our licensed therapists are specialty-trained in treating OCD and can assist you in handling spikes in OCD symptoms or relapses due to alcohol intake. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP. At NOCD, all therapists specialize in OCD and receive ERP-specific training
By working with NOCD, you’ll also receive ongoing support from our self-help tools and peer communities in between sessions when you may be more likely to experience real-time concerns related to alcohol. To learn more about working with one of our OCD therapists, schedule a free 15-minute informational session with our team.
References:
Reimold, M., Smolka, M., Zimmer, A. et al. Reduced availability of serotonin transporters in obsessive-compulsive disorder correlates with symptom severity – a [11C]DASB PET study. J Neural Transm 114, 1603–1609 (2007). https://doi.org/10.1007/s00702-007-0785-6