Managing the Substance Use Disorder client with a Co-morbid Eating Disorder
In my experience, approximately 40-50% of our population of women with Substance Use Disorder have also been diagnosed with an Eating Disorder, or display disordered eating behaviors.
Due to the severity of both illnesses, and in order to be a more effective therapist, I believe it is essential to treat these disorders concurrently.
To further complicate matters, co-morbidity is high among this population, including other disorders such as anxiety, depression, and personality disorders. Frequently SUD and ED clients will also have physical and medical complications due to their drug use and disordered eating patterns.
Typically, self-esteem and self-efficacy are low, given the nature of both diseases, and with the chronic patterns of failure and relapse. I believe it is vital that we treat the whole person: body, mind and spirit, and consider all problems and factors related to them as presented.
We often see clients who are diagnosed with AUD/SUD and Bulimia or Binge-Eating Disorder. They may also present with borderline or other deeply engrained personality traits. Often their history demonstrates a pattern of relapse with alcohol or other substances when, or soon after being active in their eating disorder. Alcohol and/or drugs typically will relieve some of the anxiety, stress and shame around ED. Both research/literature and experience indicate that these two disorders affect each other, and often have a cyclic and spiraling effect. One such example is that substance abuse often increases the intensity of personality traits like mood instability and impulsivity. This obviously adds to the difficulty in recovery from ED. In addition, those with SUD have increased risk of nutritional, gastrointestinal and cardiac consequences for those also diagnosed with an Eating Disorder.
Oftentimes, those with co-morbidity are treated for one disorder at a time and are at high risk for symptom substitution. They will switch from one problematic behavior to another. For example, once ED is treated and stabilized, women often relapse on alcohol or drugs as a way to cope with feelings, urges and/or situations that are triggering for her ED behaviors. And conversely, when in primary treatment for SUD, clients often begin acting out with ED behaviors, particularly with bingeing and/or purging. Therefore, I believe that it is imperative that we encourage and promote the development of healthy tools and coping mechanisms that will help our clients heal from these diseases at the same time.
I strongly believe that clinical supervision, consultation and referrals should all be considered and used depending upon the complexity of the case, and the client’s willingness and motivation to change. Mutual collaboration and a concerted team effort are vital if we are to be effective with treating this population. Referrals and important resources include, but are not limited to: addiction counseling and/or outpatient treatment, psychiatrists (with addiction specialty, as self-medication is a large concern with SUD/Co-Occurring), grief and/or trauma work (high incidence with this population given the number of OD deaths and risky/dangerous environments), outpatient treatment for Eating Disorder, and 12-step fellowship.
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Content retrieved from: https://www.alinalodge.org/rehab-blog/substance-use-and-ed/