There is a high rate of co-occurring eating disorders and substance abuse disorders. Any person being treated for one should also be evaluated for the other. Regrettably, treatment professionals who are trained in the treatment of one disorder may not be trained in the treatment of the other. Substance use disorders (SUDs) and eating disorders are specific disorders that have been understood and treated differently.
Over the past several decades, eating disorders have been increasingly studied and compared to addictions, mainly substance use disorders.
Studies have shown that the dual diagnosis of eating disorders and substance abuse disorders co-occur at a high rate. This is especially true for people with bulimia nervosa or the binge-eating/purging type of anorexia nervosa.
Evidence suggests that binge eating and purging behaviors are more heavily associated with substance misuse, notably alcohol use disorder (AUD). Odds of having a co-occurring disorder were two or more times higher among those with an eating disorder than those without. It seems that the influence of eating disorders on AUD is greater than the influence of AUD on eating disorders.
Among patients with eating disorders, scores on a measure of addictive personality character traits were comparable to those seen in drug addicts and alcoholics. An addiction to one behavior supports a certain pattern of self-destructive behavior. This makes the person more likely to develop another type of addiction.
The National Center on Addiction and Substance Abuse (CASA) has reported that up to one-half of people with eating disorders (especially bulimia) abuse drugs or alcohol, compared to 9% of the general population. Up to 35% of drug abusers have eating disorders compared to 3% of the general population.
Many dual diagnosis treatment programs evaluate and treat both conditions at once. There is a high level of cross addiction between eating disorders and drug use. This type of treatment program is hard to find. This is because most addiction programs are not set up to engage in mealtime support. Eating disorder treatment requires providing access to specialists and intensive medical monitoring.
Conversely, most eating disorder programs aren’t experienced in treating addictions. But there is a large amount of research that shows that the simultaneous method of treatment is essential for a complete recovery. If treated separately, the individual gets treatment for one disorder, and when that goes into recovery, the other problem increases. Seeking help for the disorders separately can send the patient into an endless cycle of remission and relapse.
This supports the theory that these co-occurring conditions are used as a coping device. Without learning new coping skills, insights into their diseases, and some type of social support, the patient will be constantly fighting one or the other condition.
Sometimes, inpatient or residential treatment is necessary for patients with eating disorders and SUDs. The risk of medical problems increases when both disorders are present, so medical supervision is important. The use of medication can be unpredictable in treatment because of the difficulty of a starved body processing substances. Also, professionals may encourage changes in the patient’s diet and exercise. This could worsen the symptoms of an eating disorder.
Research suggests that cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT), which have both been successfully used in the treatment of both disorders, would be proper therapies for combined treatments.
Recovery is a long-term process with either condition alone and particularly with both at the same time. Thirty days of treatment is not likely to cure either disease. Studies have shown that 25% will recover and do well throughout their lives, especially if they get quality care early. Fifty percent will fall into the relapse-remit cycle, and 25% will continue to struggle. In the case of eating disorders, 10% of those who continue to struggle will eventually die from the disease.
Eating disorders and substance use disorders often co-occur in female populations. There is a noteworthy gender difference in the rate of eating disorders and substance misuse. Eating disorders tend to be “feminine” problems typically, and SUDs are typically “masculine” problems.
Eating disorders can be interpreted as an attempt to impose control of yourself. Substance use disorders can be seen as a loss of control of oneself. Arguably, women who tend to have less power or control in society may attempt to gain some semblance of control over their bodies. This results in an eating disorder for some. Conversely, men may have more power and responsibilities than they want and try to escape through substance use.
Some researchers suggest that eating disorders are, themselves, a form of drug addiction. Their characteristics fit all the clinical and biological criteria for common addictions like smoking, alcoholism, and cocaine use. Chief among them is the progressively obsessive character of the behavior, even in the realization of negative consequences to health and safety.
Also, with persistent exposure, individuals usually begin to require more of the behavior to produce the same reinforcing effect. Moreover, they tend to experience an increasing craving for the behavior that can last long after a period of abstinence. There is a strong likelihood to resume the addictive behavior after treatment and the tendency for the chronic relapsing characteristic of addiction.
These features have direct parallels in the core eating-disorder behaviors such as dieting, over-exercising, and binge eating. These behaviors tend to become more and more excessive over time. There is also a strong drive to continue these behaviors, regardless of serious medical complications. This is reflected in their prolonged despondency and a high rate of relapse.
At the biological level, some research indicates there may be similarities in the neural circuitry of individuals with eating disorders and those with an SUD. Addictive behaviors, such as those that occur with an eating disorder, may stimulate the same internal production of opiates as other external addictive substances, as well as naturally occurring neurotransmitters.
A more revolutionary addiction model, the auto-addiction opioid model, suggests that chronic eating disorders may be seen as an addiction to the body’s internal opioids. Appetite dysfunction (starving or bingeing) and strenuous physical activity are both able to stimulate endorphin activity. These endorphins may be as addictive as the external opioids due to their inherent reward characteristics.
Elevated levels of internal opioids have been reported in studies of anorexia nervosa, bulimia nervosa, and obesity. Dopamine neurotransmission, which is involved in resolving reward and reinforcement systems in the brain, also appears to play a role in eating behavior.
Starving, bingeing, and exercise all serve as drug delivery systems since they increase circulating levels of endorphins that are chemically identical to externally derived opiates.
Advocates of the addiction model of eating disorders believe bulimia nervosa is functionally compatible with other forms of addiction. Evidence shows that engaging in one form of addiction increases the risk for another, and as one form decreases, the other one increases.
Similarities between drug addiction and binge eating include:
Binge eaters often describe eating in response to emotional stress, anxiety, anger, boredom, and loneliness. It is often followed by a negative effect or guilt, which leads to more bingeing.
It has been suggested that a common set of personality traits make a person inclined to a range of behaviors that have the possibility to become excessive. There is evidence that anxiety and depression frequently precede the eating disorder and addiction characteristics.
The basic causes of drug addiction and eating disorders are similar. Eating disorders and addictions often develop during stressful times. These disorders develop as an attempt to cope with troublesome emotions or to self-medicate underlying mental health issues such as depression or anxiety. Both are chronic diseases with high relapse rates and resistance to treatment and need long-term therapy.
Although there are many similarities, and there are some important differences. Recovery from eating disorders and recovery from addictions are distinctly different processes. Addicts can cut off their relationship with drugs and alcohol. But individuals with eating disorders can’t abstain from food.
They face the questions of how to develop a healthy relationship with food, learning to sit at a dinner table, eat in public, and take part in other triggering situations without relapsing. This is why eating disorder treatment programs need to focus on both the disordered eating and the bigger relationship with food.
Another angle that is particular to eating disorders is that patient’s self-evaluation is dependent on their weight and/or appearance. Whether the person is severely underweight or overweight, their feeling of self-worth is overly affected by body shape or a number on a scale.
In some instances, the self-hating reaches the point of suicidality. The suicide rate for someone with anorexia is 57 times what would be typical in that age group.
In the substance abuse peer community, the individual is instructed to continue to claim the disease as part of his identity. Alcoholics Anonymous and Narcotics Anonymous meetings use the introduction “Hello, my name is_____, and I am an alcoholic (addict).”
For people with an eating disorder, moving away from claiming the disease is important. The inflexible body image statements that come with every glance in a mirror, every quarter-pound gained, bring severe self-loathing and piercing criticism. Over the years, they become part of a person’s identity. It is vital that they give up that identity and claim their real self or the self they can become through practice. The focus on the body and body image is the distinguishing feature of eating disorders. There is no such central focus in substance abuse disorders.
The issue of whether eating disorder or substance dependence occurred first elicits many possibilities. When the eating disorder is already present, substance use may help the individual with reducing or maintaining weight, or it might relieve psychological stress.
A person might develop an eating disorder after his or her appetite has been suppressed through the use of drugs, smoking, or alcohol. Overeating might happen when stimulation to the brain’s pleasure center is lowered due to withdrawal from substances.
Individuals who had a SUD before the eating disorder are more likely to be affected by obsessive-compulsive disorder, panic disorder, and social phobia. They are also typically dependent on more substances and to have begun their dependence at an earlier age.
Negative events in childhood have also been linked to many serious long-term and destructive health problems. A study done by Kaiser Permanente and the CDC revealed that issues such as trauma, parental neglect, and abandonment, parental substance abuse, a history of abuse are frequently the basis for long-range symptoms, which include eating disorders.
If you or someone close to you is suffering from an eating disorder and substance addiction, you have come to the right place.
If you have been stuck in the cycle of remission and relapse, it’s time to get off the ride. You need a treatment facility that can offer you a professional evaluation and the treatment you need to get started on the straight line to recovery. Footprints to Recovery can provide you with a comprehensive treatment of your substance use and eating disorders. Contact us today.
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