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Substance Use Disorders and Eating Disorders

Research indicates that only 1 in 10 men and women struggling with ED receive treatment, and only 35% of those are at a specialized facility for eating disorders. Up to 30 million people of all ages and genders suffer from an ED in the US. Eating disorders also have the highest mortality rate out of any mental illness.

Furthermore, up to 50% of individuals with an ED abuse alcohol/illicit drugs, compared to 9% of the general population. Conversely, up to 35% of alcohol/illicit drug abusers have an ED, compared to 3% of the population. This indicates that treatment programs exclusively treating one of these disorders, or the other, will encounter a high percentage of clients presenting with a co-occurring disorder.

Contributing Factors

Eating disorders, substance abuse disorders, and body image/self-esteem issues are complex conditions that arise from a combination of long-standing factors, including:

  • Psychological (low self-esteem, depression, anxiety, loneliness)
  • Interpersonal (troubled relationships, difficulty expressing emotions, history of abuse)
  • Social (cultural pressures to be thin, narrow definitions of beauty, bias of physical appearance)
  • Biochemical and Biological (chemical imbalances, genetic predispositions)
Why Disorders Co-Occur

We have learned that overlapping genetic vulnerabilities, overlapping environmental triggers, stress, trauma, neglect, and early drug exposure are factors. Research also indicates that involvement in similar brain regions and areas such as the reward pathways, stress responses (limbic lobes), and prefrontal cortex in the brain are affected. Drug abuse and eating disorders are developmental disorders.

The most commonly shared risk factors found in SUDS and ED are: common brain chemistry and common family history, preoccupation with substance (food or a drug), intense craving, social isolation, risk for suicide, and the emergence in time of stress and transition. They are likely to occur with issues of self-esteem, depression, anxiety, and history of sexual abuse or physical abuse. Both disorders are chronic, have similar effects on the brain, and are recurring and life threatening.

Best Practices for Treatment and Therapeutic Interventions

In order to treat ED and SUD, it is essential to facilitate pre-assessment/screening, prioritize the client's treatment focus, and determine the level of care. In prioritizing treatment focus, we must look at treatment considerations, best practice for treatment, the treatment plan, types of treatment, and relapse prevention. Treatment approaches should involve choosing goals with the client based on stages of change. Medical safety and stability should be first and foremost. It is recommended that a clinician treat the substance abuse followed by the eating disorder, then followed by any mood disorders.

Brief therapy, family systems work, cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), emotion focused therapy (EFT), acceptance and commitment therapy (ACT), EMDR, psychodrama, and medication are all used as interventions. Additionally, medication, recreational, nutritional, and expressive arts are utilized for interventions.

Sources: National Association of Anorexia Nervosa and Associated Disorders, National Eating Disorders Association, The National Center on Addiction and Substance Abuse at Columbia University, National Institute on Drug Abuse, Stahl's Essential Psychopharmacology