The Link between Substance Abuse and Eating Disorders
I have always been very open about my past struggles with alcohol abuse and eating disorders. I also struggled with generalized anxiety disorder, panic disorder, and self harm. I often felt like the only one who struggled with so many comorbid diagnoses. The reality is people rarely struggle with only one disorder. We simply do not fit in the pretty boxes of diagnoses, nor are we supposed to.
Statistics on Substance Abuse and Eating Disorders
Data suggests roughly 50% of individuals with eating disorders are also abusing drugs and/or alcohol. There is a strong association between alcohol use disorders (AUD) and women with anorexia nervosa binge-eating/purging type (ANBP), bulimia nervosa (BN), binge eating disorder (BED), & eating disorders not otherwise specified (EDNOS). Also, in general, women with SUD (substance use disorders) have higher rates of disordered eating than the general population. Nearly 35% of alcohol or illicit drug abusers have eating disorders compared to 3% of the general population.
Addictions Comorbidity, Dual Diagnosis
I often think of the perfect storm analogy with addictions and eating disorders. To me they both are ways to manage, control, react and cope with life and its struggles. Yes, there are biological inclinations, and neuroscience is starting to show more links to why we may struggle with the disorders we have, but to me they are a complex relationship that is far more common than I thought when I was struggling. These struggles are dangerous and deadly.
"For many young women, eating disorders like anorexia and bulimia are joined at the hip with smoking, binge drinking and illicit drug use," said CASA president and former US Secretary of Health, Education and Welfare, Joseph A. Califano, Jr. "This lethal link between substance abuse and eating disorders sends a signal to parents, teachers and health professionals- where you see the smoke of eating disorders, look for the fire of substance abuse and vice versa."
I never heard these statistics when I was struggling. My parents never knew it was common when they couldn’t find me a residential facility that would be able to treat both substance abuse and eating disorders. These statistics need to be shared because they help not only the people who struggle feel less alone, but they help see the lack and need for research on comorbid conditions.
Struggles in the Treatment of Substance Use Disorders and Eating Disorders
There is a challenge sometimes to integrate treatment for substance use disorders and eating disorders. Some clinicians refer patients out to handle their substance abuse before the eating disorder treatment, which makes sense since substance abuse often can require detox. My first thought is, how much money this will cost a person struggling.
Some clinicians may not be knowledgeable for the treatment of both disorders. There is a science/practice gap between and within the substance use disorders and eating disorder fields. In general, there is a huge need for cross-training & research collaboration between these two fields necessary to identify best evidenced based treatment (EBT). There is also a huge difference in identification and conceptualization of eating disorders and substance abuse disorders.
The Need for Multi-Disciplinary Treatment
When I went to my residential vacation for 30 days, I was in an addiction specialized place. I think it was a life saver for me, helped me get sober, but wasn't everything I needed. When I got out, I went to AA (Alcoholics Anonymous) for several months, got a therapist, a psychiatrist, but had no support with my eating disorders. I wish I had seen a multi-disciplinary team that would have helped me with my eating disorder and alcohol addiction. I didn’t know how to eat, how much to eat, how to cope with eating disorder urges. With alcohol or drugs, we can be abstinent, but when we add eating disorders, we have to eat. There are a lot of challenges, and a multi-disciplinary team can help best address the variety of struggles people may be going through.
There is so much more to the comorbidities picture with addictions. People with addictions struggle not only with eating disorders, but with mood disorders, personality disorders, anxiety disorders, etc. I hope with this blog to delve more in the future to create dialogues, and create awareness of them.
Sebelius, K. (2011, June 16). The Link between Substance Abuse and Eating Disorders, HealthyPlace. Retrieved on 2019, July 20 from https://www.healthyplace.com/blogs/debunkingaddiction/2011/06/the-link-between-substance-abuse-and-eating-disorders
Author: Kendra Sebelius
Not only are the disorders often found together, but the symptoms and behaviors can often exacerbate each other. For example, I know quite a few individuals whose alcohol use goes up significantly as their food intake goes down. It would seem that not only are there genetic and behavioral links, but perhaps food restriction itself puts someone at risk for overconsumption of alcohol, as alcohol is often viewed as being 'different' than 'normal food' for those who are restricting, and the more drunk someone gets, the more their physical hunger and need for caloric intake can drive their behavior.
I don't think that's the main issue with the eating disorder / substance abuse co-morbidity, but it does seem to be an interesting part of the pattern.
Let's hope the professionals start listening to patients like us, and figure out ways to work around the HMO/Insurance Beast to get us the multiple-specialist care we need. Of course, if we get well, the profits we help generate will go away :(
In the series, there seems to be a lot of blame put on the mother. When they asked "Did your mother tell you to eat your vegetables"? I would have to say NO, because her mother died when she was 9, and my grandfather married an alcoholic who physically abused her. How on earth can I blame my mother/
It was crap. at the eating disorders unit in the beginning they forbid us to speak of our traumas and did not provide us any trauma specialists for individual or group therapy. for me, I'd be forced to eat stuff that triggered my trauma symptoms, so then my ptsd would get aggrivated and before long I'd be on the trauma unit again.
on the trauma unit, they provided no support for the anorexia, and it was human ping pong for me and several others I knew.
on the eating disorder unit, every wed they had a patient/staff meeting (can't remember the name they gave it) I began each week to advocate for a trauma group. they'd give this or that lame reason why they couldn't do it.
eventually (several years down the road) we got trauma specialists on the eating disorders unit. and OT's too. then, eventually (a couple more years) they moved the eating disorder unit to the same hospital with the trauma unit, and added group as well as individual therapy for the trauma survivors.
Also, at first, when I would speak of my anorexia in terms of being an addiction, staff would dispute me. I'd explain to them that i was addicted to the comfortably numb feeling a good starve provided me. I'd argue that food is a substance.
eventually, they came to understand this. we got addictions specialists on the eating disorder unit too. (they still sent people off unit to meetings on the trauma unit though, and no support for eating disorders on the trauma unit either.. hope that has improved since I moved away)
I didnt' fight this battle alone, along the way other patients would speak up too.
I'm not entirely sure I was the first to speak out on the crap of the human ping pong and the need for a more comprehensive treatment program, but I do know I was the most frequent squeeky wheel on the issue for a while. so much so that before those wed meetings staff used to ask me not to bring it up this week. they were required to take patient requests/questions to a staff meeting then report back the next week. it was when I refused to be silent until we got heard that other patients began to share their voices on the issue as well.
hope you can begin to squeek to the program directors where you find treatment.
On the matter of outpatient options. Where I was there were AA meetings daily (hourly in some areas), but eating disorder support group was monthly (and sparsely located). by a case of serendipity, I discovered the usefulness of NA. that was very helpful. they recognized that, since food is a mood altering and mind altering substance, I belonged at the meetings since I was abusing a mood/mind altering substance.
they used to modify some of the slogans for me. sometimes just with inflection. one was; for the mainstream members - If you don't pick it up, it won't get in. said with the tone of Don't Pick it Up. for me... same words, "if you don't pick it up, it won't get in" but said with a tone that said. dude! pick it up!
they were very compassionate about the fact that I could act on my addiction by going to meetings. just by restricting the (avoiding, passing up) the refreshments being shared.
Also, in the early years, insurance didn't want to cover outpatient dieticians. you might want to check for a nutritionist offering medical nutrition therapy. they can be a valuable resource for that problem you speak of with not being able to recover from disordered eating by the same means as with drug or alcohol addiction. we simply can't just never pick it up again and that's that. we have to pick it up, in the right varieties, in the right quantities, with the right frequency. and this "right" business isn't easy to make a habit.