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Medical Minute

Sunspire Health Network


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The Carnival Game You Don't Want to Play in Treatment
February 2nd, 2015 - Posted By Jonathan Horey, MD

Substance use disorders and eating disorders are two of the deadliest illnesses that psychiatrists treat. The complicated nature of these illnesses means that doctors and treatment facilities tend to specialize in one of these disorders, but not both. As a result, the illnesses are usually treated individually rather than concurrently. The main problem with sequential treatment, however, is the "whack-a-mole" phenomenon. Remember that game you played as a kid where you used a mallet to "whack" down some sort of plastic animal that would pop up from the surface of the game? As soon as you "whacked" that one, another one would pop up and sometimes two or three would be up at the same time. A person with an eating disorder and a substance use disorder is essentially playing "whack-a-mole" with their illnesses. What often happens is an eating disorder client will engage in treatment for their eating disorder but their substance use disorder is not addressed at all or not sufficiently. They may gain significant improvement in their eating disorder behavior but find themselves with increased cravings for their drug of choice and end up with even more severe substance use disorder symptoms despite managing their eating disorder symptoms well. The same phenomenon holds true for those patients who first address their substance use disorder rather than their eating disorder. Often eating disordered behavior, sometimes inactive for years, can begin to "pop up" again in sobriety and become even more severe than it was in the past. The reasons for this phenomenon can be explained in many ways from "cross addiction" theories to behavioral explanations to psychodynamic reasoning.

Regardless, experts in both fields of substance use and eating disorders agree that one of the keys to managing these co-occurring illnesses is to screen for both of them. This is especially important for those patients who may not have had active symptoms of one of the disorders and is presenting primarily for the other disorder. Knowing that the patient has had a previous problems with either eating disordered behavior or substance use allows the treatment team to be on the lookout for the whack-a-mole phenomenon. Unfortunately, there are very few facilities that have clinical expertise in both fields, making inpatient treatment especially difficult to find and outpatient treatment can require multiple providers to address both issues.

At Sunspire Health, we are proud to offer treatment for women suffering from both eating disorders and substance use disorders, using evidence-based, cognitive and behavioral therapy, supported by medication assisted treatment. We teach clients to understand what both illnesses have in common and how they differ. Most importantly, we ensure that they have the skills to manage both illnesses so that when they leave our treatment, they don't have to keep playing whack-a-mole.

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