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There are currently no integrated treatments for co-occurring OCD and AOD use disorders, and evidence from only one RCT among people with comorbid OCD and AOD use favouring the concurrent treatment of these disorders [779]. Although there is limited evidence for the treatment of comorbid OCD and AOD use, results from single disorder OCD studies suggest there is strong and consistent evidence to recommend the use of ERP or CBT as the first line of treatment in single disorder OCD.

Box 18 illustrates the continuation of case study F, following Jenny’s story after the identification of her OCD had been made.

Box 18: Case study F: Treating comorbid OCD and AOD use: Jenny’s story continued

The AOD consultant liaison nurse arranged for Jenny to see both a mental health and AOD worker. With Jenny’s involvement, they devised a treatment plan. This involved consultation with Jenny’s GP, a home visit by a psychologist, comprehensive assessments, and concurrent treatment of Jenny’s OCD and alcohol and benzodiazepine use. Although Jenny’s AOD treatment was managed by the AOD service and her GP, it became evident that the supply of drugs from the Internet contained medication of varying dosage and qualities, which made it very difficult for clinicians to establish the quantity Jenny had been consuming.

Jenny received concurrent treatment of both pharmacotherapy and CBT with ERP, which addressed her OCD and alcohol and benzodiazepine use. In addition to the gastritis, Jenny had problems with her liver function, which required long-term follow up with a hepatologist. Jenny’s treatment for her OCD and AOD use took place over several months and included exposure to her previously avoided situations.When this phase of treatment was completed, a longer–term process of monitoring and support was put in place to ensure that her treatment gains were maintained.

Key points

  • OCD is a condition with a much higher prevalence than had previously been assumed, but symptoms can be mistaken for anxiety.
  • People with OCD commonly use substances that reduce their levels of anxiety, but may not necessarily reveal their use of AOD to health professionals.
  • There are considerable problems associated with the use of medications obtained from the internet.
  • There is a need to monitor ongoing physical health complications of comorbid disorders.