OCD and addiction
OCD is one of the most misread mental illnesses because people confuse it with neatness, high standards, or being particular. The reality is messier and harsher. OCD is intrusive thoughts that hit like a punch, followed by compulsions that feel like the only way to breathe again. The person usually knows the fear is irrational, but their nervous system does not care about logic. It demands certainty, it demands neutralising, it demands a ritual, and it demands it now. That is why OCD and addiction can become best friends without anyone noticing, because addiction is also about escaping discomfort quickly, and OCD creates discomfort on demand, all day, every day.
In South Africa, OCD is often hidden behind competence. People keep their rituals private, they check quietly, they wash quietly, they redo tasks quietly, they confess and seek reassurance in subtle ways, and they act like they are just stressed or a bit intense. Families can live with it for years without naming it. Then a substance enters the picture, alcohol, cannabis, sleeping tablets, pain pills, stimulants, whatever is available and socially defended, and the person discovers something dangerous, for a short while the internal noise drops. It feels like relief. It feels like space. It feels like a normal brain. That moment can become the hook that turns OCD management into substance dependence.
Why quick relief is so tempting
OCD is not a preference, it is a threat signal that will not switch off. The intrusive thought is often about contamination, harm, causing an accident, making a mistake, being a bad person, or failing morally in some hidden way. The content varies, but the feeling is similar, a surge of dread and responsibility that feels urgent and personal. The compulsion is the action taken to neutralise the dread, checking locks, checking stoves, washing hands, repeating prayers, repeating phrases, rereading messages, seeking reassurance, mentally reviewing memories, or avoiding certain objects and places.
The compulsion works for a moment, which is why it repeats. It gives brief relief, and then the brain produces a new doubt. That cycle trains the brain to fear uncertainty, and it trains the person to treat uncertainty like danger. If you live like that, you are constantly tense, and when you are constantly tense, you will eventually reach for anything that turns the volume down. Substances do that quickly, which is exactly what makes them so risky for OCD sufferers. They become a fast track out of the obsession, even if the track leads into another trap.
How substances become part of the OCD cycle
When someone with OCD drinks, smokes, or uses pills to calm down, they are not always chasing a buzz. Often they are chasing quiet. The substance becomes a coping tool, but because OCD spikes repeatedly, the person ends up using repeatedly. They might drink to stop the checking. They might smoke to tolerate intrusive thoughts. They might take a pill to handle the fear of leaving the house. They might use stimulants to counter the exhaustion caused by hours of rituals and mental reviewing. The brain learns an association, obsession equals discomfort, discomfort equals use, use equals relief. Once that association is built, the person starts reaching for substances earlier in the cycle, not after they have spiralled, but the moment the first intrusive thought arrives.
This is where families get confused, because it does not look like a stereotypical addiction. The person might not be partying or acting wild. They might be using at home, alone, quietly, like medicine. They might be high functioning at work and emotionally wrecked at home. They might be secretive and defensive, but they will justify it as anxiety or stress, and everyone around them will accept that explanation because it sounds respectable. The addiction then grows under the umbrella of mental health, which makes it harder to confront.
OCD and addiction both promise control
OCD is often driven by a need to control risk, control uncertainty, control responsibility. Addiction also begins with control, I can handle this, I can stop when I want, this is just to take the edge off. Both are illusions. OCD demands more and more rituals to maintain the same level of relief. Addiction demands more and more substance to maintain the same level of relief. The person ends up living a life where relief is the main objective, not meaning, not connection, not growth, just relief.
The real cost is time and identity. OCD steals time through rituals, and addiction steals time through preoccupation and recovery from use. The person starts declining invitations because they are afraid of triggers. They avoid travel because it disrupts their rituals. They avoid relationships because relationships bring uncertainty. Then they use substances because loneliness and fear feel unbearable. Families often see the withdrawal and interpret it as moodiness, when it is actually the person’s world shrinking to fit their coping system.
Stop debating feelings, start naming patterns
Families often get trapped in emotional arguments, you don’t understand, you’re being harsh, you’re making me worse. OCD and addiction both use emotion as a shield because emotion shuts down logic. The more useful conversation is behavioural and specific. We are seeing checking for hours. We are seeing you drink whenever anxiety spikes. We are seeing you avoid responsibilities and use substances instead. We are seeing secrecy and defensiveness. We are not attacking you, we are naming a pattern that is harming you and everyone else.
Boundaries are not punishment. Boundaries are what allows the home to stop feeding compulsions and feeding addiction. That might mean refusing to participate in reassurance. It might mean refusing to fund substances. It might mean insisting on assessment and treatment. It might mean setting conditions for living arrangements. The goal is not to shame the person, because shame fuels OCD and fuels addiction. The goal is to remove the comfort that keeps the disorder running the show.
Online mental health culture that confuses coping with recovery
There is a trend online where people normalise OCD traits and turn them into jokes, and there is another trend where people promote substances as self care. Both trends can be dangerous for someone with real OCD. If you are using alcohol or cannabis to manage intrusive thoughts, you are not recovering, you are sedating. Sedation is relief, not healing. Healing is the ability to face uncertainty and still live your life without rituals and without chemical escape.
If you build your life around avoiding discomfort, OCD and addiction will grow. If you build your life around increasing capacity, tolerating uncertainty, and staying accountable, both problems can shrink. People with OCD can recover functioning, and people with addiction can rebuild stability, but it requires an honest plan that treats the two as linked, not as separate issues. If you are reading this as a family member, the biggest shift is this, stop trying to make the person comfortable, and start helping them get well, because comfort is often what keeps the disorder alive.