OCD and obsessive-compulsive symptoms linked to increased risk of substance misuse: JAMA

Sweden: Individuals with obsessive-compulsive disorder (OCD) or obsessive-compulsive symptoms have an elevated risk of substance misuse, states an article published in the JAMA Network Open. The findings challenge the notion that OCD is protective against developing substance misuse. Therefore, regular screening for substance use and problems should be included in the routine clinical management of patients with OCD.

The worldwide prevalence of obsessive-compulsive disorder (OCD) is approximately 2% of the general population. OCD is a common mental health disorder that comes with serious consequences. Individuals with OCD are at greater risk for developing substance use disorders as they use substances as a coping strategy. Neurobiological models have predicted shared neural mechanisms between obsessive-compulsive disorder (OCD) and substance use disorders, but various clinical and epidemiological studies show conflicting results and even suggest that OCD may be protective against substance misuse.

Ralf Kuja-Halkola, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden, and his team of investigators conducted a study to assess the association of OCD and obsessive-compulsive symptoms with substance misuse and the extent to which shared genetic and/or environmental factors play role in this association.

For this cohort study, investigators included 6 304 188 individuals (median [IQR] age, 30.5 years; 48.9% women), of whom 27 342 had a diagnosis of OCD, from the Swedish nationwide registers (1997-2013) and 9230 individuals (60.1% women) from the Child and Adolescent Twin Study in Sweden (CATSS). Substance misuse was defined as registered substance use–related disorder, criminal conviction, or death (population cohort), and self-reported alcohol and drug dependence symptoms at 18 and 24 years of age (CATSS cohort).

Key findings of the study are,

• OCD was found to be associated with an elevated risk of substance misuse (HR, 3.68).

• At 18 years of age, obsessive-compulsive symptoms were associated with increased symptoms of alcohol dependence and drug dependence.

• The relative contribution of genetic and environmental influences to the covariance between OCD and obsessive-compulsive symptoms and substance misuse or dependence were determined to be 56-68% (genetic) and 32-44 %(environmental).

Investigators conclude that the study shows that OCD and obsessive-compulsive symptoms are associated with an elevated risk of substance misuse, thus corroborating findings from earlier cross-sectional surveys. The association was not entirely explained by genetic factors but study findings are also compatible with an environmentally mediated relationship (eg, the self-medication hypothesis).

For the present study, the reverse association between substance misuse and OCD was not examined and this may serve as a comorbidity that confounds the current data that suggests an association, the authors commented.

Reference:

Virtanen S, Kuja-Halkola R, Sidorchuk A, et al. Association of Obsessive-Compulsive Disorder and Obsessive-Compulsive Symptoms With Substance Misuse in 2 Longitudinal Cohorts in Sweden. JAMA Netw Open. 2022;5(6):e2214779. doi:10.1001/jamanetworkopen.2022.14779