Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Fears about drug overdose in OCD 

By Andrea Fine

Feb 13, 20237 minute read

Reviewed byPatrick McGrath, PhD

What is a fear of drug overdose?

Someone who is experiencing a fear of drug overdose may worry that they will die because of ingesting, inhaling, or otherwise coming into contact with too much of a harmful substance. Someone who regularly uses legal substances such as alcohol and marijuana, illicit substances such as heroin, cocaine, and methamphetamine, or prescription drugs that pose a risk of overdose may struggle with this fear, as well as people in public places where harmful drugs are used. 

In the past 20 years there has been a severe opioid epidemic in the US, involving the use and abuse of prescription opioids like Percocet, Norco, and Fentanyl. People will also misuse benzodiazepines such as Xanax, Ativan, and Valium. Alcohol, Opioids, and Benzodiazepine overuse present the biggest concerns for drug overdose, and any combination of substances creates an even greater risk for overdose. If someone is overusing, or at risk of overusing substances, the fear of drug overdose is realistic and this person should skip to the end of the article for treatment options and sources for support.

Today we will be focusing on the fear of drug overdose and how it may present in someone who has OCD when there is no or very little actual threat of drug overdose, but intense fears persist or interfere in one’s activities. 

Let’s take a look at an example to illustrate these health anxieties:

Stacey is a college student who has OCD presenting with contamination fears. She often engages in compulsions of excessive cleaning and takes extra precautions to be sure she is highly protected against any chemicals that could cause her harm. Recently she has started to become bothered by her boyfriend and his roommate when they drink or smoke marijuana. She worries that if she kisses her boyfriend the alcohol will get into her bloodstream and cause her to overdose because she has never drunk alcohol. She also worries about overdosing if she smells marijuana in her boyfriend’s apartment, on the street when she is out walking, or in the store. 

She has started to avoid kissing her boyfriend at all when he is drinking, and if she knows that he and others will be drinking she avoids going to their apartment. She won’t go to a restaurant anymore because she fears someone will slip a drug into her food that will make her overdose. Stacey is starting to have trouble just being on her college campus, fearing that if she touches a railing or a door knob that someone touched after using drugs, it will be absorbed through her skin and cause her to overdose. She spends about 2 or 3 hours per day researching the probability of accidental overdose due to becoming contaminated by drugs. This gives her some relief, but it doesn’t last, because she wonders if her environment puts her at particularly high risk that may not be reflected in clinical recommendations. 

Stacey’s compulsions are out of fear that certain people are more likely to be using drugs in certain classes. Her relationship with her boyfriend is affected because she barely feels safe around him anymore because of her overdosing fears. 

Common obsessions for someone struggling with drug overdose fears in OCD: 

  • I may overdose if I drink any alcohol because my body has never had it.
  • If I don’t go wash my hands, I may have drugs on them that will seep into my bloodstream.
  • Someone will put drugs in my drink or food and cause me to overdose.
  • Someone may have put drugs in grocery items.
  • I don’t have any tolerance for drugs so if I even smell it, I may overdose.
  • I am going to overdose and die and people will think it was on purpose.
  • Did that railing have drug residue on it?

Common triggers for fears about drug overdose in OCD may include:

  • Smelling marijuana while walking on the street
  • Being around people who are using alcohol or drugs
  • Kissing someone after they have used alcohol or drugs
  • Touching something in public spaces
  • Seeing something about overdose in a movie/show
  • Seeing a news report about someone overdosing
  • Unexpected physical sensations, like dizziness or nausea

Common compulsions done by people with a fear of drug overdose in OCD may include:

  • Handwashing after touching objects like doorknobs or railings
  • Researching online about drug overdose or related topics
  • Seeking reassurance from loved ones or doctors
  • Seeking medical attention because of fear of ingesting/inhaling drugs accidentally
  • Checking apartment, food, and surroundings to feel sure that there are no drugs
  • Body scanning to make sure there are no symptoms of drug influence
  • Avoiding all contact with drugs and similar substances in public or private spaces
  • Avoiding people who drink or use drugs
  • Wearing gloves or other protective gear far in excess of recommendations

How can I tell if I’m experiencing OCD, and not a healthy or reasonable concern for my safety?

To get a better sense of whether you’re struggling with OCD, you can ask yourself some questions that relate to the diagnostic criteria for OCD:

  • Are you experiencing repeated, unwanted, intrusive thoughts, images, or fears? 
  • How persistent are your thoughts and fears around the topic of the fear of drug overdose? Are the thoughts about this fear distressing or disturbing? 
  • Do you engage in certain behaviors in an attempt to reduce those thoughts or fears or prevent your fears from occurring, such as seeking reassurance, avoiding certain areas, or checking yourself repetitively for symptoms of overdose? 
  • Do these thoughts and behaviors take up a significant amount of time? 
  • Does this worry or behavior interfere with other important areas of your life? 

If the answer to some or all of these questions is yes, you may be suffering from OCD. Having an assessment with a trained OCD specialist can confirm whether you are experiencing OCD. 

How can I find reliable information on drug safety?

Substance Abuse and Mental Health Services Administration (SAMHSA) is a great resource for information on drug safety and treatment for Substance Use Disorders. If you or someone you know is struggling, please reach out to their 24-hour helpline. 

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations. You can also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service here.

How are fears about drug overdose treated?

If you think you may be struggling with OCD focused on a fear of drug overdose, you can get better. Doing exposure and response prevention (ERP) therapy with a trained ERP therapist is the best course of treatment. 

ERP therapy has been empirically validated by decades of clinical research, and has been found to be effective in the majority of people with OCD. Through ERP, people who struggle with OCD and the fear of drug overdose will work with their therapist to build an exposure hierarchy and begin working on one trigger at a time. Usually an ERP therapist will start with an exposure that is predicted to elicit a low level of fear and work up to the harder exposures where more fear may be present. Over time, one can habituate to their fears and build more tolerance for uncertainty and anxiety when they are exposed to their triggers. 

For example: 

Treatment for Stacey may involve creating a hierarchy of fear of getting drunk. First, we may ask her to be in her apartment with her boyfriend while he has a sealed bottle of alcohol out on the table. Next, she can be there with him while he opens a bottle but does not drink from it. Then, they can go out to a local restaurant that also serves alcohol but not order any for their table. Stacey could keep doing this to get more and more comfortable going out. Then, at home, she should not avoid her boyfriend’s apartment when he drinks, and when she is ready, even give him a kiss to learn that her fear that she will get drunk from his drinking and kissing her just does not happen. 

When she is used to this and learns to live with the discomfort, she can do similar approaches to school and touching things that she has avoided. By living the way that she did before the fear was there, she can learn to handle her fears, no matter how real they feel. 

If you’re struggling with OCD, you can schedule a free 15-minute call today with the NOCD care team to learn how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.

We look forward to working with you.

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