Walk into the home of a seasoned alcoholic and you may notice dishes that haven’t been washed, stacks of newspapers, piles of dirty clothes and general disarray. The overflow of clutter, unopened mail and belongings suggests one of the conditions that have come into the public eye in recent years: hoarding. You know or suspect that the individual deals with substance abuse issues. But how does this lead to hoarding? In reality, alcoholism does not specifically lead to hoarding and hoarding is not a symptom of substance abuse. Alcoholism and substance abuse may mean that a person neglects personal care or the upkeep of his or her space, but they do not specifically fuel the kinds of hoarding behaviors in which an individual is fixated on collecting and saving items—many of them worthless—such as fliers, trinkets or old books and clothing. Thus why alcoholics hoard is not exactly the question or the issue. It is more likely that alcoholism and substance abuse may be the result of hoarding. On the surface, hoarders appear to be people who overvalue junk, who are lazy about cleaning and organizing or who simply cannot let go of anything. Depending on the materials they collect and refuse to get rid of, they may also be seen as materialistic and selfish. But hoarding is not an arbitrary behavior. It is a mental disease, with many hoarders also suffering from obsessive compulsive disorder. They become fixated on the various objects they must save and become terrified of getting rid of anything. They cannot control the voices and impulses in their head warning them against discarding things. This kind of mental anguish, in turn, can fuel substance abuse. As hoarders sink deeper into their prison of possessions, they begin to isolate from the world, shunning the people close to them from fear of reproach. They also suffer the persistent negative thoughts motivating them to continue the behavior. They may want to stop but cannot, and this sense of powerlessness and hopelessness, combined with isolation and depression, can lead to substance abuse. The individual seeks some sort of emotional escape and may believe it can be found in drugs or alcohol. It is said that alcoholism is slow suicide, and it is easy to see why those who deal with disorders like hoarding or OCD would see substance abuse as an “out.” For some it will be a way to feel in control of a life that seems unmanageable. For others it will be step after step on a slow march to the end. They will despair of ever finding a way out. They may not be ready to pull the trigger, but they would welcome an end to the madness if it came. In the meantime, they will settle for being numb. But it doesn’t have to be this way. If you or a loved one struggles with hoarding, obsessive compulsive behaviors and/or substance abuse, there is hope for you. You do not have to fight this alone, nor do you have to give up. There is hope, there is healing, there is recovery.