Fears about drugs

What is drug related OCD?

Obsessive-compulsive disorder (OCD) focused on a fear of drugs involves fears about either accidentally or intentionally taking drugs, exposing others to drugs, or having negative repercussions from drugs. People with this fear may find themselves irrationally believing that things that look like drugs actually contain drugs and avoid them as a result. They may fear that they have gotten drug residue on other people’s belongings and that those people may become harmed as a result. They may avoid any powder-like substances or worry about coming into contact with any powders. They may see someone they know who has taken drugs in the past touch something and avoid touching the same item. They could also fear inadvertently coming into contact with drugs and facing legal consequences or consequences at work. In OCD, these worries and fears cause distress and anxiety, often involving rumination on worst-case scenarios. The unwanted, intrusive thoughts, images, or fears about drugs are called obsessions. In response, people with OCD will perform compulsions, which can be mental or physical acts that serve to neutralize the uncertainty or worry that the obsession creates, or to prevent a feared outcome.  People with this form of OCD may frequently be on the alert for any residue on items, searching for anything that may look like it could be a drug. They may avoid anyone they fear could use or possess drugs. They may avoid even prescription medications or touching pill bottles for fear of getting substances on them and spreading them. Many times the person isn’t necessarily afraid for their own safety, but rather for the safety of those around them, worrying that others may be allergic or sensitive to prescription drugs. They often fear that they would accidentally cause harm to others if they are not vigilant in ensuring that no traces of drugs remain on them.

Fear of drugs – Common obsessions

• What if I get drug residue on me and contaminate someone else?
• How can I be sure this isn’t laced with a harmful drug?
• How do I know whether this medication hasn’t touched a different one?
• What if I accidentally ingest a drug and die?
• Are these the right pills? What if the pharmacist mixed them up?
• What if I touch something that touched a drug and someone else becomes sick?
• How can I be sure that someone hasn’t put drugs in this?
• Did I get drugs on my hands or in my hair?
• What if I lose my job because drugs got on me?
• Can that drug actually cause serious reactions?

Common triggers

People with fears of drugs may be triggered by situations involving seeing others use drugs, hearing about drug use, hearing about drug side effects, and seeing shows depicting drug use. They may be triggered by seeing things that look like they could be drugs, or by medications or pill bottles. 

Triggers for people with fears of drugs or being drugged may include:

• Seeing drugs
• Knowing someone who uses drugs
• Medications
• Seeing pills or medications
• Being at a hospital or pharmacy
• Hearing about drug use/abuse
• Television shows depicting drug use
• Hearing about side effects of drugs
• Being in clubs, bars, or places where people may use recreational or illicit drugs
• Hearing news stories about drug safety

How can I tell if I’m experiencing OCD focused on a fear of drugs, or if I’m just exercising appropriate caution?

This is an excellent question. To know if you may be suffering from OCD, you need to learn to recognize the OCD cycle.

The OCD cycle is composed of: 1) intrusive thoughts, feelings, images, or urges; 2) anxiety or distress that comes as a result; 3) compulsions performed to relieve distress and anxiety. Understanding this cycle can help you distinguish OCD from other conditions. Something to keep in mind is that if you are feeling an intense urgency to know something immediately and with certainty, but can never feel certain for long, that is a red flag that OCD may be at work.

Intrusive thoughts or doubts about drug safety can and do happen to everyone. Most people who do not have OCD are able to brush these thoughts off rather easily, trust safety information they have received, or trust in their own decisions and intentions. People with OCD struggle to do this, however, believing that they cannot tolerate the slightest uncertainty about drugs and the effects drugs will have on themselves or others.

Common compulsions

When people with OCD focused on fears about drugs experience intrusive thoughts, images, feelings, or urges that cause distress, they may engage in compulsions, which are physical or mental acts done to alleviate the distress and discomfort caused by intrusive thoughts or fears, or to prevent a feared outcome. Compulsions may provide temporary relief, but do nothing to keep obsessions from returning again and again, with an even stronger urge to perform compulsions. Performing compulsions inadvertently strengthens obsessions and fears, reinforcing the idea that obsessions posed an actual threat or danger.

Compulsions performed mentally or physically by people with fears about drugs may include:

• Avoidance of any and all medications
• Avoidance of people who they think may use drugs
• Avoidance of anything that resembles drugs or drug residue
• Excessive hand washing
• Excessive reassurance-seeking
• Self-reassurance about their cleanliness, etc.
• Researching drugs and side effects 
• Seeking drug tests or medical visits

How to treat fear of drugs

Fears about drugs can be debilitating and interfere with your life in many ways, but all themes of OCD are highly treatable. By doing exposure and response prevention (ERP) therapy with an OCD specialist, you can find freedom from constant fears about drugs. 

ERP is the gold standard of treatment for OCD and many other anxiety disorders. It is backed by decades of clinical research proving its effectiveness and shows promising results within 12-25 sessions on average. With ERP, you will learn effective ways to accept uncertainty around potential drug exposure and sit with anxiety and discomfort that come from your doubts and worries.

In ERP, you’re gradually and safely exposed to the thoughts and situations that are likely to trigger your fears about drugs and the resulting anxiety. With your therapist’s guidance and support, you will resist the urge to respond with compulsions like checking, avoidance, and cleaning. By doing this continually over time, you learn that you are able to tolerate anxiety, and you will feel more confident in your ability to sit with uncertainty and discomfort about drugs, living with confidence in your choices and intentions.

Examples of possible exposures done to treat OCD involving fears about drugs may include: 

• Watching videos about drugs and their effects
• Touching white powdery substances
• Taking medication you are prescribed
• Writing an imaginal script about the worst-case scenario of ingesting or spreading a drug and the harmful effects of this
• Looking at images of drugs online
• Not cleaning your phone or other belongings after being in public 
• Recording a loop tape of triggering words surrounding fears of drugs

If you’re struggling with OCD, I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment 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.