Compulsions vs Addictions

Many confuse addictive behavior with compulsions. More specifically, addicts often wonder if they have OCD (Obsessive Compulsive Disorder).

People with OCD:

  • have repeated thoughts or images about many different things, such as fear of germs, dirt, or intruders; violence; hurting loved ones; sexual acts; conflicts with religious beliefs; or being overly neat.
  • do the same rituals over and over such as washing hands, locking and unlocking doors, counting, keeping unneeded items, or repeating the same steps again and again.
  • have unwanted thoughts and behaviors they can’t control.
  • don’t get pleasure from the behaviors or rituals, but get brief relief from the anxiety the thoughts cause.
  • spend at least an hour a day on the thoughts and rituals, which cause distress and get in the way of daily life.

People who suffer from addiction have repeated thoughts and images and do engage in ritualistic behavior BUT they get pleasure out of it. Some would argue that after a while they don’t really get any pleasure out of drinking or drugging but they do it anyway because they can’t seem to stop themselves. That’s where it gets confusing and complicated.

A 2009 study compared OCD and addiction. It concluded that “knowledge that a behavior is maladap­tive does not preclude the sufferer from carrying it out, a key clinical feature of both OCD and addiction”. Two frontal regions of the brain, the anterior cingulate cortex (ACC) and the orbitofrontal cortex (OFC), are involved in evaluating the future conse­quences of one’s own actions and inhibit­ing inappropriate behaviors. We need the OFC particularly to make good choices. Study concluded that these regions of the brain are both effected in patients with OCD and addiction disorders. Researchers observed brain lesions in the OFC area for both groups. However the ACC and OFC are under-active in addiction, and over-active in OCD.  This means that addicts have a limited regard for the future and are more likely to succumb to drug-related behaviors, whereas OCD patients are excessively concerned about the future consequences of their actions. Studies like this are important because if we can treat OCD with medication that works at the brain level, and OCD and addiction work similarly on that level, then maybe we can find new ways to treat addiction with medication.

Surely, medication is not enough in treating addiction or OCD. Surely, medication is not for everyone. That’s why therapy is an important resource for people. But I have always been a big advocate of medication assisted treatment for addiction. Maybe the stigma associated with addiction will eventually go away if we realize that addiction is not just a reflection of “weakness”, “character defects” or “lack of willpower”.

And if the main difference between OCD and addiction is the pleasure aspect, are we mistaking pleasure for choice? How far can willingness to change, will power and self-confidence take us in our efforts to getting better? Pretty far if you ask me. But we can’t ignore the brain. If all we needed was a will to stop, then why do so many people struggle with relapse? And if counseling alone is enough, how come we still haven’t figured out a way to accurately predict success?

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