Eating Disorders and Addiction
Panel Discussion with Clinicians from Mirasol Eating Disorder Recovery Centers
There is a very high correlation between eating disorders and addiction. According to NEDA, nearly half of individuals with an eating disorder also abuse drugs and/or alcohol. Is an eating disorder a form of addiction? If not, what are the differences? And more importantly, how can we effectively treat co-occurring eating disorders and substance abuse?
Clinical Director, Adult Program
Ann Twilley, MA,
Download Audio: M4A
Diane R: "Certainly, it's been highly researched that substance abuse and eating disorders co-occur frequently. Substance abuse is a risk factor for eating disorders and eating disorders are a risk factor for substance abuse. As a consequence we have had many clients over the years who have had both conditions. In my opinion, a really good way to treat substance abuse and eating disorders that co-occur is to get an initial handle on the substance abuse, go through whatever withdrawal there is from that and then really start to do the deep work that we do here."
In the early years at Mirasol, we weren't doing the depth work that we're doing now, so we'd have a client who would leave, and all of a sudden, their alcohol addiction would go through the roof, or their sexual addiction or relationship addiction would come up ... That was really helpful for us as a treatment center to really start looking at how we needed to get to those deeper issues, because otherwise, it's like "Whack a Mole", where you do the eating disorder piece and then something else pops up."
Ann T: "Especially in the early years at Mirasol, we weren't doing the depth work that we're doing now, so we'd have a client who would leave, and all of a sudden, their alcohol addiction would go through the roof, or their sexual addiction or relationship addiction would come up, and was often a product of not getting to those core issues. That was really helpful for us as a treatment center to really start looking at how we needed to get to those deeper issues, because otherwise, it's like "Whack a Mole", where you do the eating disorder piece and then something else pops up, and that's what we were seeing in the field."
Anne G: "Eating disorders themselves are not seen as addictions, but they really are."
Katie K: "The American Society of Addiction Medicine lists common characteristics of obsession – a person being obsessed with the behavior or the substance who will engage in the behavior despite the consequences. There's the compulsiveness of the behavior, which we see all the time with our eating disorder clients. There's the loss of control that comes with addiction, and we see that with our clients. There's the denial – huge piece of addiction which we see with our clients all the time. And there's the hiding the behavior."
Moderator: "When someone comes in and they have a dual diagnosis, how do we treat them differently? What do we do to take care of that?"
Anne G: "I think one of the most important things is removing the substances they have access to, so those emotions can be brought to the surface. A beautiful thing about residential treatment is stripping away access to all possible addictions to latch onto so the client is in this raw place where they really do need to face those things that come up."
Moderator: "You can remove all these other external medicators, like alcohol and drugs, but an eating disorder is one thing you can remove access to!"
Diane R: "Well, it's almost like having an alcohol substance abuse program where you force people to have half a beer a day. How well would that work? So that's just another indication of the complexity and the difficulty of working with eating disorders in general, and why we have to do so many integrative therapies in order to address those issues. Between the experiential model that we engage in, including the wilderness piece, and the body-centered therapies we do, we really are able to engage the whole person in the recovery process."
With substance abuse or an eating disorder ... when they come into treatment, and we take those medicators away, people are uncomfortable. So another part of how we treat is to allow them to be in that discomfort and expand their tolerance, and to know that it's okay and they will get through that piece, and they don't need to immediately jump to something that will medicate or numb."
Rachel N: "Addiction is a chronic disconnect to self or spirit. I think how art therapy plays into this is connecting to your emotions, expressing that, and being fluent within that, and not holding the emotions in. So, – at least with art therapy – treating an eating disorder or any other addiction, I approach it in the same way."
Maeve S?: "With substance abuse or an eating disorder, whatever that medicator is, it's medicating being uncomfortable. So when they come into treatment, and we take those medicators away, people are uncomfortable here. There's a lot of emotion coming up, a lot of feeling coming, past trauma coming up. And so another part of how we treat is to really allow them to be in that discomfort and expand their tolerance, and to know that it's okay and they will get through that piece, and they don't need to immediately jump to something that will medicate or numb."
Jamelynn E: "A lot of the work we do here is to help people be uncomfortable, be okay with being uncomfortable. I think one of the really big components of why recovery is so challenging, and why so many people don't move forward in recovery and keep getting stuck, is because as soon as we get uncomfortable we want those medicators back. But we are here to support you. We're here to give you tools, and encourage you to use those tools to learn how to be more tolerant of being uncomfortable."
Ann T: "So it's no surprise I'm bringing this part up, but 'tools, tools, tools' [laughter]. I tell clients this all the time, I work with them for a full year after they go home, and those people who use the tools are the ones who fare much better in recovery. They have new ways of handling the stressors that don't go away just because they come to treatment. I think sometimes people come to treatment thinking 'everything's going to be different when I leave here', but unfortunately the people at home aren't going to be very different at all. In fact, it's going to be harder because you're rocking the boat. You're destabilizing the whole family system or the friendships back home because you're really different. And that's going to rock people. That's going to make them feel unstable in that relationship."
I think sometimes people come to treatment thinking 'everything's going to be different when I leave here', but unfortunately the people at home aren't going to be very different at all. In fact, it's going to be harder because you're rocking the boat. You're destabilizing the whole family system or the friendships back home because you're really different.
Moderator: "Do you want to talk about some of the tools that you recommend people use when they go home after treatment?"
Ann T: "There are hundreds, it just depends on the person. For example, tapping. We teach them emotional freedom techniques, and we also have an alumni group that they can come to, no matter how long they've been gone, to continue that work. And mindfulness is hugely important." Audrey B: "Breathing. It's something so basic and so simple. Women, before they come to Mirasol, often take all their breaths from the upper chest, so just talking about something simple, like taking a deep breath, and seeing how that switches things up for you."
Ann T: "Being aware of your emotions – that's a tool! Just by saying to themselves, 'I'm sad' or "I feel this in my chest', the amygdala down-regulates, it calms down. We can literally change what's happening in our brains by acknowledging what we're experiencing."
Maeve S: "And also reaching out for support, and saying 'this is what I need right now' is a huge tool to be able to use."
Katie K: "And of course we can't forget the meal plan. What I've found with clients is that when they stick to their meal plans, they are much less likely to experience thoughts of wanting to use or drink or resort to other compulsive behaviors."
Ann T: "[A client] was telling me, 'I want to not be working so doggone hard at this. There's so much I have to think about to do.' But you look at what we consider 'normal' functioning people who don't have an addiction, how do they function? How do they cope with the things that come up in their lives? And they do things like this all the time, but they don't look at them as tools. They have normalized and they have incorporated it into their lives. And so when I have clients who have been gone for a while, and they've figured that out, they don't say 'I had to use these tools', they just say, 'this is how I took care of myself.' It's no longer a big task, it just becomes a part of what they do every single day."
Anne G: "I recently met someone who had been in recovery from an eating disorder for about 20 years and she said something really powerful, which was that the amount of time it took for that self-care, and using the tools and following the meal plan pales in comparison to the amount of energy and time she spent in her eating disorder."
Diane R: "Things like the adventure therapy component of our program encourages people to stretch themselves and see what's possible. When someone suffers from an eating disorder or addiction, their lives get very very small, and there's despair, and depression, and they're not having any fun. So once they come to Mirasol, one of the things we offer that I think is really important is the possibility of a world outside, and all kinds of things that they may not have ever considered or encountered before, but ways that they can look at themselves differently in terms of how they fit with themselves and with other people and with the greater world out there. And they can connect to nature, which can be an entry point for spirituality and a lot of other ways of being in the world that creates the motivation to do this very difficult, uncomfortable work."