Understanding OCD and Intrusive Thoughts: When Obsessions and Addiction Intersect

Intrusive thoughts are a hallmark symptom of OCD. They are distressing mental images, urges, or ideas that repeatedly enter a person’s mind, even when they are unwanted. These thoughts are often violent, sexual, blasphemous, or otherwise disturbing—causing intense shame and fear. 

It’s important to recognize that intrusive thoughts do not reflect a person’s values or desires. In fact, the very reason they cause so much anxiety is because they are so inconsistent with the person’s identity. 

Common examples of intrusive thoughts include: 

• Fear of harming a loved one, despite having no intention or desire to do so 

• Sexual thoughts involving inappropriate or taboo scenarios 

• Persistent fears of contamination or illness 

• Obsessive doubt about one’s actions (e.g., “Did I lock the door?”)  

For someone with OCD, these thoughts can trigger compulsive behaviors or rituals meant to neutralize the anxiety they cause. Over time, this cycle of obsession and compulsion can interfere with work, relationships, and emotional well-being. 

Living with untreated OCD can be mentally exhausting. In an effort to quiet the noise of intrusive thoughts or ease the pressure to perform compulsive rituals, some individuals may begin to self-medicate with drugs or alcohol. 

Research suggests that individuals with OCD are at greater risk for developing a substance use disorder than the general population. This may be due to: 

• The chronic stress of managing OCD symptoms 

• Co-occurring anxiety or depressive disorders 

• Difficulty accessing effective, specialized treatment 

Unfortunately, substance use tends to worsen OCD symptoms over time. It can impair impulse control, increase anxiety, and reduce a person’s ability to engage in evidence-based therapy. As substance dependence increases, the individual may also experience shame or isolation, which further reinforces the OCD cycle. 

Effective treatment for co-occurring OCD and substance use requires an integrated, personalized approach. At Alta Mira, we combine advanced psychological and medical care to ensure that each client receives the comprehensive support they need. 

Treatment options may include: 

Cognitive Behavioral Therapy (CBT): This is the most evidence-based therapy for OCD. A specific subtype, Exposure and Response Prevention (ERP), helps clients gradually face their intrusive thoughts without engaging in compulsions. 

Medication Management: Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for OCD. When combined with therapy, they can significantly reduce intrusive thoughts and compulsions. 

Substance Use Treatment: We offer detoxification support when needed, along with a full continuum of care to address the physical and psychological aspects of addiction. 

Individual and Group Therapy: Our therapeutic community model encourages peer support and personal insight, helping clients feel less alone in their struggles. 

Trauma-Informed Care: Many individuals with OCD and addiction have a history of trauma. Our clinicians are trained to recognize and address these underlying issues with compassion and sensitivity. 

Located in beautiful Sausalito, California, Alta Mira offers a serene and private setting for healing. Our clients have access to a world-class team of psychiatrists, psychologists, and therapists who specialize in treating complex co-occurring conditions. From the moment you walk through our doors, we are here to support your unique journey toward recovery. 

Our residential program offers: 

• 24/7 clinical and emotional support 

• Advanced psychological testing to clarify diagnosis and guide treatment 

• A structured daily schedule of therapy, education, and skill-building 

• The option to bring a pet, which can provide comfort and emotional grounding 

• Chef-prepared meals and luxury accommodations to support physical wellness and emotional comfort  

At Alta Mira, we believe that true healing involves understanding the full picture—both the visible behaviors and the internal experiences that drive them. If you or someone you love is struggling with OCD and substance use, we are here to help.