Oğuz TAN, D. Adnan ÇOBAN
Addicta The Turkish Journal On Addictions - 2026;13(3):322-330
Unlike most psychiatric disorders that are strongly associated with addiction, obsessive-compulsive disorder (OCD) displays a paradoxical relationship with substance use. While addiction rates are high in community samples, they appear lower in clinical OCD populations but rise again in more severe cases. To investigate this pattern, we conducted a cross-sectional observational study examining smoking status in a clinical sample of 719 OCD patients (94 treatment-naïve and 625 treated) and 345 age- and sex-matched controls. Smokers were categorized as current smokers, former smokers, and never smokers. Illness severity was assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Hamilton Depression Rating Scale-17 Items (HDRS-17), and Beck Anxiety Inventory (BAI). Treatment-naïve patients had the lowest rate of current smoking (23.40%), compared to controls (44.06%, p<0.001) and treated patients (37.76%, p<0.01 ). Treated patients also showed higher Y-BOCS and BAI scores, earlier OCD onset, earlier treatment initiation, and longer illness duration. These findings suggest that OCD may initially offer some protection against smoking. However, as the illness progresses and becomes more severe, smoking prevalence approaches that of the general population, possibly reflecting a shift from compulsive avoidance to compulsive engagement with addictive behaviors.
