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Alcohol use disorder (AUD) is the most common substance use disorder (SUD) giving rise to major socioeconomic and health consequences, with an estimated 208 million people affected worldwide. Current pharmacotherapies are minimally ineffective, and none target the direct neurological effects of ethanol. To identify promising pharmacological approaches for the treatment of AUD, understanding of the complex psychophysiological influences of SUD is necessary. Thus, we first review psychophysiological aspects of SUD, including a brief review of the brain disease model of addiction and the psychophysiological overlap between SUD and obsessive compulsive disorder (OCD). We expand on the preoccupation stage of the addiction, proposing a hypothesis where substance use can become the obsessive focus in those with underlying obsessive-compulsive pathology, leading to development of SUD …