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Episode 48

Substance Contamination

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In today’s episode of Purely OCD, Lauren Rosen, LMFT, and Kelley Franke, LMFT, discuss obsessions related to contamination with Alcohol and Drugs.

1:16 They announce that they both will be presenting twice this weekend at the OCD SoCal Conference (an affiliate of IOCDF): once on mental compulsions and once on using humor in recovery and treatment (because that’s sometimes their jam). If you are interested in learning more go to http://ocdsocal.org/ for further information.   

Then they dive into the topic at hand:

2:21 “Today we are talking about contamination concerns related to [a mind-altering] substance. Going way back, I got to treatment because of my obsessions related to substances and substance contamination. Essentially we’re talking about illicit substance and or alcohol [contamination]. It happened to latch on for me because I’m sober, but it could latch on for anything.  I know I’m not the only one who’s experienced this. People might have obsessions around their drink getting spiked with something and then behaving inappropriately or being harmful…[or] taking action to harm someone or developing psychosis or what have you .”

– Lauren Rosen, LMFT

Kelley addresses listeners questions,

4:35 “A lot of the questions we got are, “What is substance contamination?” And like Lauren said, it can run the gamut. And a lot of people also asked about the chemical aspect of this versus straight contamination, versus what if I get Covid, versus the illicit stuff? It’s all the same but for this talk, we’re going to focus on the substance. So if somebody has a worry of, “What if I relapse?”, and they’re brushing their teeth or they’re using mouth wash. And I’ve seen it too with toothpaste even though there’s nothing in it, it doesn’t matter. OCD doesn’t care at all about logic. It can have 0% alcohol.”

            – Kelley Franke, LMFT

Lauren shares from her own experience,

5:36 “I laughed because yesterday I purchased mouthwash, and I haven’t purchased it in a while. But it reminds me of exposures around this. And to your point, it could be anything that might be near alcohol. And I know for me that it was even things that might have come into close contact with alcohol. So if I’m at a gathering with people, and we’re eating chips, and somebody passes a drink over the chips, my thought is, ‘Oh my gosh, what if the chips now have alcohol on them?’  The mind is endlessly creative ”

– Lauren Rosen, LMFT

Kelley talks about fear of harming others can intertwine with this theme:

6:30 “One time when we were hanging out in a gathering, there was alcohol involved. I was not drinking and obviously Lauren wasn’t. But we were all ordering drinks, a bunch of us, and we were getting nonalcoholic beverages. And I remember thinking, ‘Oh my gosh, what if I hand Lauren a drink that somehow has trace amounts of alcohol or the wrong drink, and I’ve caused her to relapse on OCD.’ It was more about harming you mentally.”

– Kelley Franke, LMFT

Sometimes OCD can latch onto sobriety by getting rigid about rules related to what it means to be sober.

Fears related to relapsing because of accidentally taking a sip of a drink that had alcohol in it or eating something that had some alcohol on it or in it are common. Of course, this anxiety makes so much sense in the context of people who come into recovery having gone through a pretty harrowing journey with alcohol or drugs.

Common obsessions related to sobriety involve:

• “What if I relapse?”
• “My life might become completely unmanageable again!”
• “ What if I’m lying to people?” (This is where moral scrupulosity can come into play). 

Other people’s primary fear is related to losing control.

• “I don’t feel lucid enough.”
• “What if I do something and I’ve lost control and I don’t remember?”
• “What if I drink and then I feel more anxious when I wake up and anxiety is bad? I can’t have anxiety?”
• “What if I get a contact high and lost touch with reality entirely?”

And this can dovetail into concerns about derealization/depersonalization, too.

If you’re having Existential OCD or you’re thinking, “Oh, my gosh, what does it mean that I’m having that feeling?” You might try to avoid that feeling [and therefore to avoid potential substance contamination].

– Lauren Rosen, LMFT

Lauren agrees,

Obsessions related to derealization/depersonalization secondary to substance contamination can sound like:

• “What if I lose my mind?”
• “I might go insane!”
• “What if I relapse from OCD recovery?”.

The two discuss compulsions around contamination related to contamination with a mind-altering substance and alcohol.

Some examples include:

• Avoidance of going to concerts
• Refraining from using mouthwash
• Not using rubbing alcohol.

Someone might even avoid using the same sink as the person who had drank the night before to brush their teeth, that fear of, “Oh, it could splash back into my mouth.” It can be as simple as avoiding chips at a party because you saw a drink passed over the chips.

And then there’s reassurance seeking…

At 14:22:

Reassurance seeking was one of my absolute favorites. In fact, nobody in my family can hear the word Tiramisu without  dying, “Oh, my God.” Because they heard me ask so many times whether or not I’d relapsed on Tiramisu. And I think that [reassurance seeking] comes up for a lot of people.

Lauren Rosen, LMFT

Other examples of reassurance seeking include:

• Asking questions
  • “Do I seem lucid right now?”
  • “Am I acting strangely?”
• Calling people if you offended anybody because you’re scared that maybe you said something you didn’t really want to say, that came out because your drink was contaminated.

Kelley talks about mental compulsions with fears of substance contamination (at 15:03):

• Emotional temperature checking
  • “Do I feel normal?”
• Checking your perception (perhaps by staring in the mirror)
• Retracing your memories.
  • “What are the steps I did last night when I had a sip of alcohol?”
  • “Did I talk to this person?”
  • “Were my hands appropriately placed?”

Lauren and Kelley discuss typical exposures for this type of sub-type (at 17:30):

The first one that came to mind was a contamination towel [touching a towel that has come into contact with some form of alcohol and refraining from compulsive washing].

[If you’re] compulsively going to AA meetings for fear of relapse, maybe [the exposure and response prevention] would be not going three times a day when you’ve been sober for 15 years, and you have no intense urge [to drink]…It has to be in keeping with that person’s values and their sobriety, of course. So it’s a fine line. But figuring out as a team what’s compulsive and what’s not. What’s excessive. [It’s important!]

[Exposure could look like] using that sink that the person last night used to brush their teeth in. To brush your teeth. Yeah. Taking the risk that maybe you’ll get a little back splash.

– Kelley Franke, LMFT

In this form of OCD, people often want to track to make sure a surface, food, drink, etc. is safe. Doing exposure and response prevention in this context would look like (at 18:57):

“I didn’t watch that drink being made. So is that safe or what if they put something in my drink?” There are, of course, circumstances in which we want to be thoughtful about that because there are people out there that are nefarious. But…if you’re in a party setting with some close friends, and that thought pops into your mind, we don’t necessarily want to respond to it.

My point, going back to exposures, is making the choice to drop the tracking and to say, “I don’t know, maybe somebody just poured alcohol into that bowl of chips. Unknown.

– Lauren Rosen, LMFT

Kelley talks about mental rumination (at 20:30):

As we said in our introduction, Lauren and I are doing a presentation with a few other folks this weekend. But Lauren is the leader of pack on the Mental Compulsion presentation. When we were reviewing it last night, I was thinking we really need to spend a whole podcast or two on mental rumination, because, in all of OCD, it’s such a huge component. And we just don’t talk about it enough.

I think it’s really disappointing for people, in a certain respect, when they come to treatment. They say, I heard that you’re going to give me a bunch of active exposures to do around “X”, whatever the obsession is. And for some people, that might be true. But for some people, it’s a lot about accepting that this is a really uncomfortable feeling and choosing not to ruminate, and that’s the exposure [and response prevention].

Kelley Franke, LMFT

Lauren agrees:

It’s tough because people are so gung ho, which is funny, because then you introduce them to exposures, they generally are not as gung ho. I think that a lot of that is down to thinking that exposures are going to resolve something as opposed to looking at exposures as this opportunity for practice and response prevention. So you’re totally right.

– Lauren Rosen, LMFT

Side note, because Lauren had obsessions related to the fear that she might have relapsed on a piece of tiramisu, her Therapist encouraged her to make the backdrops of her phone and computer pictures of tiramisu. Google Images can be a great resource for this. For example:

Lauren and Kelley answer questions about substance contamination:

Question 1: “Can this also encompass a fear of becoming addicted to a substance, for example, alcohol?” (at 22:52)

Lauren: There are certainly people who are terrified of becoming addicted, and this is where trauma can also seep in.  For example, if you’re the child of an alcoholic or you have a loved one or friend who died of substance use, it can be one of those things where there’s a lot of anxiety related. If you have OCD and it happens to latch onto this, it can be the whole smorgasbord of anxiety coming at you.

Kelley: It can be around anything, too… It could be like: “What if I become addicted to heroin?” and yet heroin is not at all in my life, and nobody in my family has ever used heroin or opioids of any sort. So it can also be wildly random.

Lauren: It doesn’t have to have any sort of relationship to your history, but obviously can. And when it does, it’s fun and explosive

– Lauren Rosen, LMFT

Lauren explains that fear related to developing an addiction can present in one of two ways:

– One is people who rarely have, if ever, used substances and who quite clearly seem to be at the opposite side of the spectrum and really aren’t having any problems OR

– Two, the people who have a tenuous relationship with alcohol who have OCD, which, by the way, that’s a lot of people with OCD… Depending on the study that you look at, some say 27%, some say 36%, some say 17% to 25%. So there’s a broad range, but there are a lot of people who have both.

[Regardless] I see people who are worried, “What if I become an alcoholic, or what if I am an alcoholic? And I don’t know.” And it’s funny because answering that question, it’s almost a red herring. If your having a problematic relationship to alcohol, it really doesn’t matter whether or not you’re going to call yourself an alcoholic, it’s probably more relevant to say, “Okay, well, do I want to keep engaging in this behavior or not?” And “Is it serving my values and my goals or not?”

Lauren Rosen, LMFT

Another viewer asks: “Is ERP essentially like making the choice not to confess?” (at 27:17)

Not confessing is, in essence, response prevention. Taking some action that you may feel inclined to confess about would be the exposure, and then the response prevention would be refraining from the confessing after the fact.   

Kelley brings up imaginal exposures as an exposure and response prevention exercise (at 28:11):

For folks where the substance is something that we don’t necessarily want to actively engage them in doing, it might be writing this Imaginal around it.

– Kelley Franke, LMFT

Lauren agrees,  

Imaginals are good.  If there’s an active substance use disorder, or you’re sober. If you’re worried about going into exposure therapy, the exposure isn’t going to be to drink, and it’s not going to be to act in a way that’s totally inconsistent with what you believe is right.

It’s mainly about trying to help you get your life back so that if you are spending long periods of time ruminating well, we probably want to start doing imaginal exposures so that you can learn to be in the presence of worry thoughts without responding by trying to figure it all out and getting lost in that indefinitely.”

Lauren Rosen, LMFT

As always, if you need support around these challenges, please seek out the support of a licensed mental health professional specializing in OCD in the context of therapy.

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Disclaimer: This information is meant to be general information not unique to any individual. Before following any guidance or advice found on this site or in the Purely OCD Podcast a visitor or listener should always consult with their own licensed healthcare practitioner. The Purely OCD Podcast and Website are not therapy or intended as a replacement for therapy. They are for educational purposes only.