When OCD Commandeers Hard Won Sobriety: Navigating OCD and Twelve-Step Programs for SUD

Achieving sobriety from substance use disorder (SUD) is no easy task. So, when OCD suggests you relapsed on a cookie baked with vanilla or that your motives weren't pure when you took a cough medicine that had sedating properties, it can feel particularly terrifying. This is especially true if the bottom you experienced before getting sober included the loss of dignity, self-respect, and all things dear to you. While there are many programs available to help individuals achieve and maintain sobriety, one of the most common ways is through participation in a twelve-step program. Twelve step programs are peer support groups that help individuals recover from substance use disorders and addictive behaviors. These programs can be lifesaving for many. Still, they may feel inaccessible for some who struggle with OCD and anxiety. The aim of this blog is not to sway or compel individuals to join a twelve-step program. Instead, it serves as a resource for those with both OCD and SUD who want to benefit from these fellowships but find that their OCD hinders them from enjoying the gifts of their hard-earned sobriety.

You, Me, and OCD

Those who have experienced OCD over a lifetime often experience a collision of OCD with real-life problems. This makes it more challenging to recognize their OCD because the content is based on an actual event or has some kernel of truth that makes it seem different than previous obsessions. One of OCD's oldest tricks in the books is to say, "But this time is different." In this case, what may feel different is your recognition that without sobriety, all bets are off, that without sobriety, you can't live or function, and sobriety does not come easy.

Individuals with OCD who achieve sobriety with the help of a twelve-step program may feel disheartened to discover their OCD has latched on to sobriety itself, leading them to analyze rather than utilize the very program that helped them achieve sobriety. You may wonder how you can still make use of these programs when your OCD begins to question everything related to sobriety.

OCD is Still OCD

Regardless of what content OCD latches on to, it is still OCD because the process is the same. You have an intrusive thought (insert topic), which creates an urge to seek certainty, followed by a compulsion aimed at getting certainty and reducing your distress about the thought.  This process reinforces the obsession by pairing it with the distress-relieving compulsion. As in all content areas, OCD tends to attack things we care the most about. Often, when I meet with clients struggling with obsessions related to their sobriety, it is difficult for them to treat this obsession the same as they would any other obsession. The stakes seem too high. Isn’t that the case with most obsessions? Consider the mother who fears harming her child or the religious person who fears they’ve committed blasphemy. They too have difficulty identifying their OCD because the content feels out of bounds. What is important to remember is that OCD is an equal opportunist, and just because it has latched onto a real issue does not make it any different than any other obsession. The underlying problem is still the need for total certainty, which is ultimately unattainable.

Any behavior can become a compulsion if driven by a need to know and a sense of urgency. When one obsesses about sobriety, even a twelve-step program's tools themselves can become compulsive behaviors disguised as recovery. Below are some examples of common obsessions and compulsions in this theme.

Common Obsessions about Sobriety:

• What if I chose to have dinner at a bar because I covertly wanted to be around alcohol?
• What if I secretly knew there was alcohol in a food item and ate it anyway?
• What if my motives weren't pure when I ordered food that had alcohol in it?
• What if I lose my sobriety because I failed to be perfectly thorough in my step work?
• What if I lose sobriety because I left something off of my fourth-step inventory?
• What if I was accidentally dishonest with my sponsor?

Common Compulsions:

• Confessing thoughts about potential wrongdoings to a sponsor
• Attending an excessive number of meetings
• Seeking reassurance from the sponsor about decision-making in sobriety
• Calling a restaurant or bar to get reassurance that there was no alcohol in the food
• Compulsive self-inventories
• Ruminating about real intentions
• Rereading or repeating step work
• Compulsively looking up words from the literature to make sure you understand the exact meaning

Who's in Charge Here?

First and foremost, no rules or authorities exist in any twelve-step program. Twelve-step fellowships are entirely free, voluntary, and comprised of others who struggle with the same problem. While these programs can be an invaluable resource, some elements can pose challenges for those who have OCD. While these programs are not religious, the spiritual principals underlying the steps were developed out of Christian values which may lead those with OCD to struggle with similar challenges of those with religious scrupulosity obsessions. But twelve-step recovery can complement your recovery from OCD with a few basic tips.

Sponsorship 101

Obtaining a sponsor is one of the first suggestions when entering a twelve-step program. A sponsor is simply a person in the program who has been sober from a substance or behavior for some period and has experience working the twelve steps. The sponsor is a person to call who can share their experiences with sobriety and offer guidance about integrating the twelve steps as a way of life. One of the challenges that may arise in a sponsor-sponsee relationship is the propensity to perceive the sponsor as an authoritative figure, akin to an employer or a priest offering absolution. Suggestions given by a sponsor may be heard and interpreted as rules that need to be strictly adhered to rather than nonobligatory suggestions.

A sponsor can be an incredible resource when you understand their role in life is to support rather than provide all the answers or make rules to follow. The relationship is voluntary, and there is no long-term commitment if it doesn't feel like a good fit. It is essential when working with a sponsor that they understand that OCD is a psychiatric condition rather than a defect of character or an example of selfishness. A sponsor who wants to support you will be open to learning about how to offer support without exacerbating OCD symptoms. Be honest with them about how your OCD tends to show up and educate them about reassurance seeking so they don't inadvertently make your OCD worse.

Twelve Steps: Suggestions or Rules?

It is easy to get lost in the minutiae and miss the main point of the steps. The steps can help facilitate personal growth and spiritual development, leading to long-term sobriety. The steps are not rigid rules to adhere to; instead, they are spiritual principles that can serve as a map for navigating life's difficulties sober.

Working the steps can be transformative if approached and practiced with flexibility rather than rigidity. For example, step four calls for a searching and fearless moral inventory. A person with OCD may perceive this in an overly concrete way, leading them to compulsively search their history to make sure they don't miss a single thing. However, the true purpose of the exercise is objectively looking at resentments that get in the way of sobriety, not a log of shortcomings and mistakes. Inventorying can quickly evolve into compulsive ruminating aimed at being 100 percent fearless and thorough, which is impossible.

Another common challenge is the tendency to over interpret words in the steps and extrapolate hidden meanings. Words like must, thoroughness, diligently and constantly that appear in the twelve-step literature can seem like black-and-white directives. Perceiving these words as absolutes may lead to feeling as if any deviation from perfection could mean relapse. This is OCD at its finest. While it is true that relapse is always possible when you struggle with substance use or addiction, your OCD is bluffing when it shouts out the potential disaster that could befall you if you are not perfectly (impossibly!) vigilant in your program.

The following tips can help you navigate a twelve-step program when you have OCD:

• Focus on the spirit and overarching themes of the steps.
• Talk with your therapist and sponsor about how to navigate the challenges that having OCD may present for you.
• Steer clear of perfectionism by focusing on the journey of recovery rather than arriving at the non-existent finishing line.
• Watch out for overly strict interpretations of the steps and the associated literature. 
• Seek a sponsor who can offer support and guidance without imposing rigid beliefs or promoting strict adherence to their suggestions. 
• Provide education about how to compassionately respond to compulsive reassurance seeking without accommodating OCD.

Keep it Simple!

If you are new to this phrase, it is commonly used in twelve-step programs and applies to daily life. OCD likes to complicate things by demanding answers to fundamentally unanswerable questions. Since OCD doesn't understand anything about your sobriety, its questions and accusations are irrelevant. Keeping it simple means accepting things as they are in the present moment, the core concept behind mindfulness. Drop the judgment or endless speculation about your motivation for eating baked goods. By embracing simplicity, you can focus on the gifts of sobriety one day at a time.