When rituals and substances team up
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.
What OCD really feels like
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.
The control illusion
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.
Reassurance that accidentally feeds both problems
Families often respond to OCD with reassurance. They answer the same questions repeatedly, are you sure the door is locked, are you sure I didn’t contaminate you, are you sure you didn’t hit someone with the car. They do it because they want to help and because they hate seeing the person panic. The problem is that reassurance becomes part of the compulsion. It gives relief, and then OCD demands more. Families also accommodate. They change routines, they avoid certain words, they avoid certain places, they take over tasks, they check for the person, they wash things “properly,” they keep the peace by making the world smaller.
If substances are involved, accommodation becomes even riskier. The family may tolerate drinking because it seems to calm the person. They may ignore pill misuse because it prevents meltdowns. They may fund the habit indirectly because it keeps the household quiet. In reality, they are building a house where OCD and addiction can live comfortably. It is not about blaming families. It is about being honest, because honesty is what finally breaks the cycle.
Why half measures fail
Treating addiction without treating OCD often leads to relapse, because the person becomes raw and overwhelmed and they return to the one thing that used to quiet the obsession. Treating OCD without treating substance use often fails because the person cannot do the work properly while their brain is being chemically altered and their coping remains avoidance based. The correct approach is integrated. It starts with an assessment that takes both problems seriously, including whether there is withdrawal risk, whether there is depression, panic, trauma, or other mental health conditions alongside the OCD.
Therapy for OCD needs to be specific. General talk therapy can help emotional support, but OCD often requires structured methods such as exposure and response prevention, delivered properly, at a pace that builds capacity. The whole point is learning to tolerate uncertainty without doing the compulsion. That is hard work, but it is effective when done consistently. If the person is using substances to escape discomfort, they will struggle to tolerate exposure. That is why stabilisation matters, and why the person may need a rehab setting where substance use is removed and the therapy is structured.
Capacity is recovery
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.