Eating Disorders and Addiction
There is a strong link between substance abuse and eating disorders. Nearly half of individuals with eating disorders abuse alcohol or illicit drugs compared with 9% of the general population. Likewise, 35% of alcohol or drug users have eating disorders compared with 3% of the general population.
Although there are obvious parallels, addiction is generally recognized as a brain disease, while eating orders are usually attributed to psychosocial factors. In the past decade, however, new research has uncovered biological and genetic factors that may contribute to eating disorders, leading to speculation that addiction and ED may indeed share common origins.
Eating disorders and substance abuse share many common characteristics. For example:
- Higher incidence of anxiety and depression
- Comparable addictive personality characteristics
- Addiction to one behavior leaves the individual more vulnerable to developing another type of addiction
- Compulsive behavior despite serious health consequences
- With continual exposure, individuals typically require more of the behavior to produce the same effect
- Like illicit drugs, restriction, bingeing and compulsive exercise increase potentially addicting endorphin levels
Treating Co-Occurring Eating Disorders and Substance Abuse
Eating disorders and substance abuse are typically treated separately by specialized treatment centers. However, mounting evidence of the strong relationship between addiction and eating disorders makes clear the need for a more comprehensive treatment strategy.
Mirasol has witnessed a significant increase in the number of clients who are struggling with both eating disorders and addiction. In addition, during treatment for an eating disorder, we often uncover additional issues with substance abuse that may have been under-reported by the client.
Two Different Approaches
There are two possible approaches, according to Mirasol Executive Director Diane Ryan.
"You can come to Mirasol and address all your medicators simultaneously. There's a lot of evidence that this is the most effective option. But it's very difficult, because when clients are deprived of all their medicators, they become very uncomfortable."
Alternatively, clients can undergo substance abuse treatment and then transfer to Mirasol.
"This is a good way to at least rid the body of the chemical dependency," according to Ryan "but a 30-day substance abuse program is unlikely to address the deeper issues that are driving both the eating disorder and the substance abuse. Likewise, if you have an addiction, just dealing with your eating disorder will net you very minimal results. You won't be able to maintain any kind of recovery from your eating disorder once you have introduced another medicator."
"If you really want to recover," Ryan concludes, "you need to address both the eating disorder and the substance abuse, either simultaneously or in rapid succession."
New Protocols for Co-Occurring Disorders
All new clients are now assessed for alcohol abuse, and Mirasol has developed an alcohol withdrawal protocol to assist clients with co-occurring disorders. Acute clients requiring detox are transferred to an appropriate facility. Otherwise, residual symptoms of withdrawal can be addressed with a good meal plan and all of the integrative treatments we use to support someone who has been physically compromised.
In addition, Mirasol encourages all clients — including those with no apparent substance abuse issues — to attend up to four AA meetings per week.
Primary Therapist Katie Klein explains why.
"AA is a group of people working to better themselves and to support one another. And since AA is a worldwide organization with meetings almost anywhere, AA meetings can be an important source of support both during and after residential treatment."
Tools Accountability and Empowerment
Mirasol's core philosophy is to identify root causes and develop new skills for communicating and coping rather than focusing on symptom suppression and restrictive protocols. This is a marked difference from traditional treatment for substance abuse, where addicts are directed to acknowledge their lack of power over the illness and to completely sever their relationship with it. Individuals with eating disorders cannot sever their relationships with food, and a sense of powerlessness or lack of control may be partly responsible for the development of the eating disorder.
"We ask our clients to demonstrate a certain level of accountability," says Klein. "Of course we do room searches, but we don't monitor their every movement, and that's a different model than traditional substance abuse treatment. We ask our clients to step up, and to be open and honest about their cravings and what they're feeling, and decide whether or not they really want to get well."
"It's the same model we have found to be so effective in the treatment of eating disorders," according to Ryan. "We don't lock the bathrooms, and we will move mountains to support anyone who is struggling, but we're always looking for that part of the person that really wants recovery."
Ryan maintains that the experiential treatment model works particularly well for treating co-occurring disorders. "Low self-esteem is a hallmark of both eating disorders and substance abuse. Experiential activities challenge those negative beliefs by allowing clients to experience their bodies in new ways, to test their limits and find out that they are far more capable than they thought they were."
For additional insight into eating disorders and addiction, listen to the podcast below of a panel discussion by Mirasol therapists on the relationship between eating disorders and substance abuse, the role of PTSD and trauma, and the most effective methods of treating eating disorders with co-occurring substance abuse.
FREE Eating Disorder Support Group!
FREE weekly eating disorder support group for adults struggling with food issues, staffed by therapists from Mirasol Eating Disorder Recovery Centers. Thursdays from 5:30-6:45 pm at 3116 N Swan in Tucson. For more information, call 888-520-1700.
"Mirasol is light years ahead of any other program in the country."