Simultaneous Treatment of Substance Use Disorders and Eating Disorders
We are excited to present on the topic of treating Substance Use Disorders (SUD) and Eating Disorders (ED). It is not uncommon for providers and treatment programs to focus on one of these areas while possibly missing or neglecting the other. Research has demonstrated that these two disorders often co-occur, increasing the need for treatment to happen simultaneously. We hope you will check out our presentation to learn more and in the meantime, here’s an overview.
Why Treating Both Matters
Eating Disorders and Substance Use Disorders can often show up together. Many people who are struggling with one are also dealing with the other. Their initial reason for seeking treatment may have been for one of these concerns while the other struggle may not be discussed or go unseen. The struggles with these disorders are not “choices” or “phases” but rather behaviors that are serving a purpose, although detrimental to one’s health and overall wellbeing. These behaviors are real, complex health conditions that deserve compassion and effective treatment.
Let’s Bust a Few Myths
You can’t tell who has an ED or SUD just by looking at them. Eating Disorders affect people of all sizes, races and genders; Substance Use Disorders affect all socio-economic statuses, genders, and ages. Understanding these patterns comes from asking specific and detailed questions about the relationship with food, the body, and substances. It is very individualized and each person will have their own unique experience and reasons behind turning to these behaviors to help them through life. Reducing or abstaining from ED and SUD isn’t about having enough willpower and relapsing is often a part of the recovery process rather than a failure. Shame and stereotypes for both disorders make it harder for people to reach out for help, leading to a silent suffering.
How Are the Two Connected
Some of the shared underlying factors include:
- Trauma or painful past experiences
- Difficulty managing emotions
- Anxiety, depression, low self esteem
- Social pressure and stigma
- Family history of behaviors
Both ED and SUD can become ways to cope, numb out, or feel in control when life feels overwhelming.
How One Can Feed the Other
Substances may be used to aid the eating disorder by:
- Suppressing appetite (alcohol)
- Making eating feel easier (THC)
- Blocking uncomfortable emotions after eating
Eating Disorder behaviors may be used alongside substance use because:
- Enhanced effects of substances
- Food is less of a priority
- Decrease in hunger/fullness cues
When treatment focuses on addressing only one of these behaviors, the other may become more severe due to the continued need to manage emotions. Without both addictive behaviors working together to manage emotional distress, one disorder may need to work overtime to compensate for the loss of the other. When addictive behaviors are still being used during treatment to manage emotions, it is very challenging to address underlying causes, and therefore may result in limitations in progress and long term effectiveness. That is why treating both disorders together is so important. Connecting the underlying factors leads to a more well-rounded recovery.
Why Simultaneous Treatment Helps
Treating ED and SUD at the same time can reduce relapse, address the emotional pain, build healthier coping skills, and stop the “whack a mole” cycle where one behavior replaces another.
It isn’t always easy and many systems and agencies still separate ED and SUD treatment. Yet integrated care offers the best chance for overall improvement in mental health and lasting recovery.
What Treatment Can Look Like
The first step is to consider the level of care that is needed for the individual. This could range from the highest level of support being hospitalization for detox for SUD or medical invention due to ED behaviors. The lowest level of care which would be seeing providers at an outpatient level. There are several options for intermediate levels of care in between.
A well-rounded treatment approach will include many different professional team members including doctors, therapists, dietitians, and more. Treatment could also include Medication Assisted Recovery (MAR) services for medications like vivitrol, naloxone or suboxone. For the most effective treatment, the team will collaborate on addressing goals that improve the individual’s wellness across multiple factors including health, emotional wellbeing, social engagement, and spiritual connection.
The Bottom Line
The research statistics are alarming regarding the correlations between ED and SUD and solidifies the need for these addictions to be treated simultaneously. The lifetime percentages of ED in those with SUD (or SUD in those with ED) are significantly higher than in the general population. The prevalence of EDs among individuals with SUDs is 27%, in the lifetime. Similarly, the lifetime prevalence of SUD among individuals with diagnosed with ED is around 21%. Depending on the type of eating disorder and the substances used, these percentages can actually be even higher. This co-occurrence is such a major concern given that these conditions carry the first and second highest mortality risk of all mental health disorders.
ED and SUD are not character flaws or poor choices. They are human responses to pain, stress, biology, and environment as a way to seek comfort and control. Judgment and shame fuel the cycle of behaviors and keep people stuck in addiction. Treatment looks like seeing the whole person and addressing the underlying causes that contribute to both ED and SUD.
No one has to choose between treating “just the eating disorder” or “just the substance use.” Full recovery is possible.
Please check out our presentation, Simultaneous Treatment of Substance Use Disorders and Eating Disorders, to learn more!
References
Arcelus et al. (2011). Mortality in eating disorders. Archives of General Psychiatry.
Bahji, A., Mazhar, M. N., Hudson, C. C., Nadkarni, P., MacNeil, B. A., & Hawken, E. (2019). Prevalence of substance use disorder comorbidity among individuals with eating disorders: A systematic review and meta-analysis. Psychiatry Research, 273, 58–66. https://doi.org/10.1016/j.psyc...
Gregorowski, Seedat, & Jordaan (2013). Assessment and management of co-morbid EDs and SUDs. BMC Psychiatry.
Mestre-Bach, G., & Fernandez-Aranda, F. (2023). Co-occurring Substance Use and Eating Disorders. Psychiatric Times, 40(4). https://www.psychiatrictimes.c...
Nøkleby, Heid. (2012). Comorbid drug use disorders and eating disorders - A review of prevalence studies. Nordic Studies on Alcohol and Drugs. 29. 10.2478/v10199-012-0024-9.