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The Link Between Eating Disorders and Substance Abuse

By Meghan Vivo

Human pain and suffering manifest in diverse ways. Some people steal, some people shop compulsively, some refuse to engage with the rest of the world. Many develop drug or alcohol addictions, gambling problems, or eating disorders (or a combination of the above) in an attempt to escape or control the pain.

Although all of these coping mechanisms share some commonalities, experts have found that eating disorders and substance abuse have a particularly strong association. In 2003, The National Center on Addiction and Substance Abuse at Columbia University (CASA) published the first comprehensive examination of the link between chemical dependency and eating disorders, which indicated that roughly one-half of individuals with eating disorders abuse alcohol or drugs, compared to 9 percent of the general population. The report, released by CASA president and former U.S. Secretary of Health, Education and Welfare, Joseph A. Califano, Jr., also found that up to 35 percent of substance abusers have eating disorders, compared to 3 percent of the general population.

Califano noted that “eating disorders like anorexia and bulimia are joined at the hip with smoking, binge drinking and illicit drug use,” and advised parents, teachers, and health professionals, “where you see the smoke of eating disorders, look for the fire of substance abuse and vice versa.”

The three-year study found a number of common characteristics and risk factors between the two populations, including the following:

Shared Risk Factors

  • Occur in times of transition or stress
  • Common brain chemistry
  • Common family history
  • Low self-esteem, depression, anxiety, impulsivity
  • History of sexual or physical abuse
  • Unhealthy parental behaviors and low monitoring of children’s activities
  • Unhealthy peer norms and social pressures
  • Susceptibility to messages from advertising and entertainment media

Shared Characteristics

  • Obsessive preoccupation, craving, compulsive behavior, secretiveness, rituals
  • Experience mood-altering effects, social isolation
  • Linked to other psychiatric disorders, suicide
  • Difficult to treat, life-threatening
  • Chronic diseases with high relapse rates
  • Require intensive therapy

According to Barbara Cole, MFT, Psy.D., clinical director at The Victorian of Newport Beach, a world-renowned facility for the treatment of women with eating disorders and co-occurring substance abuse issues in southern California, as many as 80 to 85 percent of eating disorder sufferers display co-occurring addictive behaviors of some type.
“What we commonly see in the treatment community is that when a client gives up one addiction, they take on another,” says Dr. Cole. “Whether it is laxative abuse, sex addiction, unhealthy relationships, workaholism, shopping, gambling, or some other destructive behavior, cross-addiction is a serious concern during treatment.”
“Eating disorders and addiction have a similar genesis,” explains Michele Lob, MA, MFT, program director of The Victorian. “Both tend to stem from low self-esteem or issues surrounding power and control, and both behaviors are used to cope with difficult emotions and experiences.”

Maggie Baumann, MA, a therapist at The Victorian, adds, “It’s all about trying to be happy with ourselves and our relationships, and eating disorders and addictions are, at base, variations on the effort to find happiness.”

Although it is unclear whether the association between eating disorders and addiction is caused by genetics, cultural influences, environmental factors, exposure to trauma, or some other source, it is clear that a strong link exists between the two conditions.

Treating Addiction and Eating Disorders Concurrently

Despite these shared characteristics, recovery from drug or alcohol addiction is markedly different from recovery from an eating disorder. For one, the goal of addiction treatment is abstinence from the substance, whereas eating disorder sufferers cannot abstain from food. Instead, those suffering from anorexia, bulimia, or binge eating must learn to develop a healthy relationship with food and abstain from behaviors like rigid dieting, excessive exercise, compulsive overeating, and purging.

In the past, experts recommended that individuals seek treatment for their substance abuse problem first, and then seek treatment for the eating disorder. However, the latest research has shown that the more effective approach is to treat the two simultaneously. When the two are not treated simultaneously, what frequently happens is that one condition gets worse while the other improves.

“Women who receive treatment for addiction work through their chemical dependency issues during drug rehab, but when they get back to the stresses and pressures of regular life, it is common for another addiction to rear its head,” says Baumann. “It’s like moving food across the plate – you can move it from one side to the other, but it’s still the same plate.”

The CASA report found that because health professionals often overlook the link between substance abuse and eating disorders, treatment options are “virtually nonexistent” for these co-occurring conditions. Susan Foster, vice president and director of policy research and analysis at CASA, explained that in order to be effective, “treatment and prevention programs must address the common co-occurrence of substance abuse and eating disorders.”

Dr. Cole, who worked as a clinician at the Betty Ford Center and directed 16 state-licensed residential drug and alcohol treatment facilities in northern California, has many years of experience determining which treatment methods best address chemical dependency and which are most effective for treating eating disorders.

“Resistance, discipline, and rigidity may work well in addressing chemical dependency issues, but they won’t get you anywhere with someone suffering from an eating disorder,” she says. “Some of the same concepts work for both disorders, and others don’t. The key is getting specialized treatment from a treatment team that knows when to utilize – and when to veer away from – traditional chemical dependency treatment methods.”

Treating eating disorders and co-occurring substance abuse issues is incredibly complex. “The pathology builds layer upon layer, each layer requiring different interventions,” explains Dr. Cole. “The woman’s treatment team has to be astute and well-trained to catch the wide range of issues and cross-addictions that can arise.”

Finding Dual Diagnosis Treatment

The Victorian of Newport Beach is one of a very small number of programs that concurrently and comprehensively treats women struggling with eating disorders and chemical dependency. The multidisciplinary treatment team at The Victorian understands the tendency toward cross-addiction, knows the warning signs that signal potential issues, and offers special processing groups for women struggling with the various problems that may surface.

The daily schedule at The Victorian is highly structured with women meeting with their nutritionist, therapist, and the clinical director at least once a week. In addition, the women go to the gym three times a week, practice yoga and meditation, and participate in process groups about anger management, relationships, nutrition, body image, and other relevant topics. Every Sunday, clients of The Victorian enjoy a recreational outing that may include museums, beach walks, harbor cruises, bowling, movies, or other activities.

Because The Victorian treats both substance abuse and eating disorders simultaneously, treatment is centered on the 12 Step approach, combined with Overeater’s Anonymous (OA) meetings, Anorexics and Bulimics Anonymous (ABA) meetings, and AA/NA meetings. Through dialectical behavioral therapy techniques like mindfulness, breathing, and distress tolerance, cognitive-behavioral therapy, and other therapeutic approaches, the ladies at The Victorian learn to identify and communicate their feelings and cope more healthfully with daily stressors.

Baumann, who formerly worked at an eating disorder program in a large hospital, was amazed when she began treating clients at The Victorian. “This program is unlike any other program out there,” she says. “We truly provide treatment for both substance abuse and eating disorders, and are equally strong in both areas. Many of our staff members have recovery experience in their own lives and intimately understand the intricacies of both disorders.”

Women struggling with addiction and eating disorders absolutely must receive individualized treatment for both conditions at the same time, according to Baumann. “We’ve seen women severely entrenched in both diseases for the past 10 years spend a few months in treatment at The Victorian and rejoin the community, return to school or work, and even go on to help other women overcome their disorders,” she says. “Recovery from these diseases is really hard work, but these women prove every day that it can be done.”

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