College students with OCD conditions had 11-14% higher odds of moderate/high-risk substance use and more than double the odds of disordered eating compared to peers without OCD.
College health professionals, psychiatrists, and OCD treatment providers.
College students with OCD had 2.28x higher odds of disordered eating and 11-14% higher odds of substance use
What the researchers found
Among 92,757 undergraduates, OCD conditions were associated with increased odds of moderate/high-risk tobacco (aOR=1.12), cannabis (aOR=1.11), alcohol (aOR=1.14), and disordered eating (aOR=2.28). Effects persisted after adjusting for stress, depression, and anxiety. Gender differences emerged: cis-female students with OCD had elevated risk across all substances, while male students only showed increased disordered eating risk.
Why it matters
OCD is increasingly recognized in young adults, and understanding its association with substance use can help college health services screen for and address these co-occurring risks.
The numbers in context
92,757 students from 216 colleges. OCD and cannabis: aOR=1.11 (95% CI 1.04-1.18). OCD and alcohol: aOR=1.14 (95% CI 1.05-1.24). OCD and tobacco: aOR=1.12 (95% CI 1.05-1.21). OCD and disordered eating: aOR=2.28 (95% CI 2.13-2.43). TGNC students with OCD: aOR=1.24 for tobacco, aOR=2.14 for disordered eating.
How the study worked
Analysis of 92,757 undergraduate students aged 18-24 from 216 colleges using the ACHA-NCHA III (Fall 2021-Fall 2022). Regression models adjusted for covariates and school clustering.
What this study cannot tell us
Cross-sectional design. Self-reported OCD conditions may include subclinical presentations. College students may not represent all young adults. Cannot determine if OCD drives substance use or vice versa.
How to read the evidence
Very large, multi-institutional sample (92,757 students, 216 colleges) with appropriate statistical adjustments. Cross-sectional design is the main limitation.
When this study was published
2025 publication with 2021-2022 data.
The bigger picture
The finding that OCD independently predicts substance use risk even after controlling for depression and anxiety challenges the assumption that substance use in OCD is simply driven by comorbid mood disorders.
Questions still open
- Do students use cannabis specifically to manage OCD symptoms?
- Would treating OCD more effectively reduce co-occurring substance use?
Read the original research
Substance use and disordered eating risk among college students with obsessive-compulsive conditions.
PloS one, 20(1), e0316349
Citation
Jacobs, Wura; DeLeon, Angela; Bristow, Alane; Quinn, Patrick; Lederer, Alyssa. (2025). Substance use and disordered eating risk among college students with obsessive-compulsive conditions.. PloS one, 20(1), e0316349. https://doi.org/10.1371/journal.pone.0316349
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