A Systematic Review on the Prevalence of Comorbid Substance Use Disorder in Obsessive–Compulsive Disorder Among the General Population
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThe paper is a systematic review on the prevalence of Comorbid Substance Use and Obsessive Compulsive Disorder among the general population. The research aimed to measure the prevalence of obsessive-compulsive disorders in groups of patients diagnosed with substance use.
It is interesting that between alcohol and cannabis the prevalence of the former is increasingly higher... I would have said the opposite due to the fact that cannabis "relaxes" leaving the person who uses it with a perception of greater clarity than alcohol. The topic is certainly of interest and generates further questions which will certainly need to be explored in depth to try to clarify some doubts.
The topic is relevant, as it investigates DOC as a comorbidity with SUD, which is poorly investigated in the literature. However, we consider it essential to investigate OCD in this type of patient as rigidity and compulsivity are aspects in common between the two clinical conditions. References to the literature are appropriate and make the discussions rich in clinical considerations.
Despite the strong practical implications of the study, the results should be read in light of the primary limitation. In particular, involving cross-sectional studies does not allow to highlight the primary condition from the secondary one.
It is suggested that the limitations of the study be further discussed. In this way, the quality of the work could improve in preparation for its publication.
Author Response
Reviewer 1 Report
We thank the reviewer for their comments and effort taken to review our Manuscript.
Comment 1
“It is interesting that between alcohol and cannabis the prevalence of the former is increasingly higher... I would have said the opposite due to the fact that cannabis "relaxes" leaving the person who uses it with a perception of greater clarity than alcohol. The topic is certainly of interest and generates further questions which will certainly need to be explored in depth to try to clarify some doubts.”
Response 1
Thank you for your insightful feedback. We have now expanded the result session to implement feedback as highlighted on page 15.
We agree with your point that Cannabis relaxes individuals post use, providing them with a better clarity than alcohol, which one might expect a higher prevalence when compared with alcohol use. However, our study indicated a higher prevalence in alcohol use which might be due to multifactorial factors. These may include the easy accessibility to alcohol in the society, it’s use in social gatherings, legal and cultural acceptance of use. These historically have contributed to alcohols widespread use.
Additionally, there is a significant comorbidity between OCD and alcohol use disorders (AUD). Studies have shown that individuals with OCD have a higher prevalence of AUD compared to the general population, with approximately 24% of those with OCD meeting the criteria for an AUD at some point in their lives https://pmc.ncbi.nlm.nih.gov/articles/PMC8887883/
Secondly Cannabis effects are less predictable and can sometimes exacerbate anxiety and paranoia, which may deter its use in this population https://www.sciencedirect.com/science/article/pii/S0920996421004084
Further research will be required to explore in detail the multiple factors that increase the prevalence of alcohol when compared with Cannabis.
Comment 2
“The topic is relevant, as it investigates OCD as a comorbidity with SUD, which is poorly investigated in the literature. However, we consider it essential to investigate OCD in this type of patient as rigidity and compulsivity are aspects in common between the two clinical conditions. References to the literature are appropriate and make the discussions rich in clinical considerations.”
Response 2
Thank you for your feedback and we agree that this topic is indeed relevant.
In our study, we aimed to identify the prevalence of OCD and SUD. Our included studies discussed, different types of SUD including alcohol, cannabis and nicotine and identified their prevalence with OCD. This provides insight on the prevalence of comorbid OCD and SUD and emphasizes the need for effective and specific treatment and management.
We agree with you, that both OCD and SUD share common traits of rigidity and compulsivity with common biochemical characteristics. Our study shared some insight on their overlapping phenomenology however, there are limited resources linking their shared symptoms to their aetiology. This is highlighted in yellow in our introduction (pages 1 and 2) and discussion (pages 16 and 17).
Further research focusing on this comorbidity is important and will provide more insight and improve clinical outcome for patients. We have ensured our references are detailed and relevant which can provide more depth and insight to the topic to interested readers.
Comment 3
“Despite the strong practical implications of the study, the results should be read in light of the primary limitation. In particular, involving cross-sectional studies does not allow to highlight the primary condition from the secondary one.” It is suggested that the limitations of the study be further discussed. In this way, the quality of the work could improve in preparation for its publication.
Response 3
Thank you for valuable feedback. We agree that our study included mostly cross-sectional studies which is a primary limitation. We have expanded our paragraph on the limitation section to indicate this.
We note that the use of cross-sectional studies despite it providing insight into the prevalence of comorbid OCD and SUD, it does not allow us to establish a temporal or causal relationship between comorbid OCD and SUD.
Despite this limitation, we believe our findings captured the prevalence on OCD and SUD.
Thank you.
Author Response File: 
Author Response.docx
Reviewer 2 Report
Comments and Suggestions for AuthorsThe study explores the prevalence of Comorbid Substance Use Disorder in Obsessive Compulsive Disorder, which is an interesting topic. However, there are some important problems with the draft and it is recommended that it be rejected.
1. The manuscript's literature review is not logical enough, the literature cited is not comprehensive and reasonable enough, and lacks theoretical innovation.
2. The current study adopts the method of meta-analysis, but it does not analyze or elaborate the mechanism of symbiosis between Substance Use Disorder and Obsessive Compulsive Disorder. It only synthesizes the data of different papers. To get the incidence of different Substance Use Disorder, lack of theoretical contribution and practical value.
3. There are many problems in paper writing that do not meet scientific and normative requirements. For example, Substance Use Disorder(SUD) and Obsessive Compulsive Disorder(OCD) occur repeatedly, usually only when they occur for the first time. Only use the full name or abbreviation when it appears later.
Author Response
Review report 2
Comment 1
“The manuscript's literature review is not logical enough, the literature cited is not comprehensive and reasonable enough, and lacks theoretical innovation.”
Response 1
We thank the reviewer for their feedback and for taking the time to review our manuscript.
We have reviewed the manuscript and unclear paragraphs in the introduction have been explained better and highlighted in yellow.
To the best of our knowledge, we have rigorously reviewed the literature and cited literature(s) that covered a comprehensive review of recent research on comorbid OCD and SUD, symptoms and characteristics of both disorders and pathogenesis of SUD.
Our manuscript aimed to review the prevalence of comorbid OCD and SUD among the general population. Understanding the prevalence level, helps provides more insight on the impact of SUD amongst patients with OCD which informs early intervention strategies and resource allocation, ultimately contributing to improved clinical care and public health outcomes.
Comment 2
“The current study adopts the method of meta-analysis, but it does not analyze or elaborate the mechanism of symbiosis between Substance Use Disorder and Obsessive Compulsive Disorder. It only synthesizes the data of different papers. To get the incidence of different Substance Use Disorder, lack of theoretical contribution and practical value.”
Response 2
Thank you for your feedback. We would like to clarify that our manuscript is a systematic review and we did not adopt a meta-analysis method due to its heterogeneity which presents challenges in conducting a meta-analysis.
We have reviewed our materials and methods section and limitation section to further explain why a meta-analysis was not feasible.
Comment 3
“There are many problems in paper writing that do not meet scientific and normative requirements. For example, Substance Use Disorder(SUD) and Obsessive Compulsive Disorder(OCD) occur repeatedly, usually only when they occur for the first time. Only use the full name or abbreviation when it appears later.”
Response 3
Thank you for pointing out the issue to us. I agree with your valuable feedback that abbreviations should be used after Substance Use Disorder (SUD) and Obsessive Compulsive Disorder(OCD) appears in the manuscript. We have reviewed the manuscript and ensured that abbreviations are used appropriately as required in a scientific report.
Implementing your suggestions have helped improved our manuscript. Thank you.
Author Response File: Author Response.docx
Reviewer 3 Report
Comments and Suggestions for AuthorsThe authors have submitted a systematic review article of demonstrating the prevalence of comorbid substance use disorder (SUD; abused drugs such as cannabis, alcohol, stimulants, and so on) in obsessive compulsive disorder (OCD) among general population. The authors searched a range of eligible literature, from well-known classical, and latest research regarding an association of the possible pathogenesis of SUD with pathological property of OCD, which are primarily attributed to the discussion for a possible comorbidity. The authors discussed, although the co-occurrence of OCD and SUD has been well-documented, it underscores the need for further research on the relationship between these conditions. This issue is of interest, but impact of their review is moderate. My overall concern with the review describing the current available data regarding a possible comorbidity listed in this review is that information provided may offer something substantial that helps advance our understanding of effective management which draws novel mechanism of action of effective treatment for comorbidity available in clinic. The reference list may be useful for readers who are interested in this issue.
As discussed on page 16, while SUD and OCD share common biochemical characteristics such as serotonin levels, the treatments for the two disorders are quite different, suggesting that they do not share a common cause. It is not appropriate to assume that the prevalence of SUD is high in patients with OCD; rather, it is necessary to consider the fact that the two disorders rarely occur together. The authors should discuss this aspect.
Author Response
Reviewer 3
Thank you for your time and effort to provide us with your valuable feedback.
Comment 1
“As discussed on page 16, while SUD and OCD share common biochemical characteristics such as serotonin levels, the treatments for the two disorders are quite different, suggesting that they do not share a common cause”.
Response 1
We thank the reviewer for their comment and highlighting a possibility of various relationship between OCD and SUD. We agree with this comment that despite shared biochemical characteristics like serotonin in both OCD and SUD, the pathophysiology and clinical symptoms varies which may indicate different aetiology, with each disorder requiring different treatment.
We have expanded our discussion section on the manuscript on page 17 to reflect suggestions. We have also cited the papers by Chang, Lin & Lane, 2020; Pittenger, Bloch & William, 2011 to support this information as well.
Research have also reported that although OCD and SUD have both compulsive behaviour, they disorders are not identical at the brain functional systems https://doi.org/10.1016/j.neuroimage.2011.08.003
Further research to ascertain the link between the aetiologies and shared biochemical characteristics of OCD and SUD is required and will contribute to early interventions and improved outcome for both disorders.
Comment 2
“It is not appropriate to assume that the prevalence of SUD is high in patients with OCD; rather, it is necessary to consider the fact that the two disorders rarely occur together. The authors should discuss this aspect.”
Response 2
We thank the reviewers for their feedback.
We have revised the manuscript to indicate the variability in the prevalence of OCD and SUD. This is indicated on page 16 of the manuscript and highlighted in yellow.
Although, the prevalence of OCD with other co-morbidities like other anxiety disorders and depression is higher when compared with that of SUD, our study shows varied prevalence rates between OCD and the different SUDs. While it is not appropriate to assume a high prevalence of SUD in patients with OCD, the varied prevalence can complicate treatment of both disorders.
Author Response File: Author Response.docx
Round 2
Reviewer 3 Report
Comments and Suggestions for AuthorsThe authors have addressed properly all the issues raised by reviewers including me. I have no more comments, and now recommend that this manuscript is acceptable for publication in the journal Psychoactives.
