Dear readers –
this is meant as a brief preview:
there seem to be intriguing similarities between OCD and substance use disorders (SUDs). One of the key terms here is: inhibition, or perhaps better: deficits in inhibition.
I won’t go into the question whether ‘free will’ plays a role here, that is for later. Folks having OCD, and these include yours truly, know that OCD never was ‘wanted’ in the first place; it is something that comes over you and that you can’t do anything about; eventually it may hijack that what others see as their personal freedoms, life choices, and it may severely incapacitate and impair one’s quality 0f life in all aspects.
Substance addiction is increasingly believed to limit the volitional capacities of an addict along similar lines, and seen in this light, expressions like ‘weak willpower’ or ‘lacking character’ are insults, and not to be used to coerce addicts into abstinence, or more sober life.
People with OCD, as well as those with SUDs, are, metaphorically speaking, ‘sentenced’ to do what they do. Their choices are limited. There are people who lose their partner, their job, perhaps more, through OCD, and the same applies to people who are addicted.
I think that both groups have, by some imbalance in their brain, to choose the short-term type of decreasing intense fears over other considerations. One may have important job application appointment, and still be under the shower for two hours after the appointment already was canceled by the potential employer (my example). An addict may visualize his life partner leaving her/him, say, in two months time if she/he doesn’t stay sober, and still the drug has to be taken to find a form of inner peace.
These behaviours defy anything that is understood as: common sense, grip on reality, or, more precisely put: rational behaviour.
The rituals, be they intrusive thoughts and accompanying rituals (including habits in a motor system sense of the word) have to be performed first, no matter what, and even if the patient realizes in full what she/he is putting at stake. Fear and anxiety overrule reason, at great cost.
Now, I hear some people thinking: but hey, in how far are people with SUDs to be blamed for their behaviour? They started taking their substances themselves in a situation where their will was unimpaired, no?
That in itself might be true, but in a much more limited way than we thought, is the modern take on these things. People may have a disposition towards ingesting substances in ever increasing quantities; of a genetic and environmental nature, and as a means to suppress social anxiety, for instance.
There are many questions in this field, that may get partially resolved in the near future. I will return shortly with more detailed information on this topic.