Integrated Treatment of Eating Disorders and Substance Abuse

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Cathy Reto, Ph.D.

The treatment of eating disorders and substance abuse has become increasingly more complex and the presentation of women with dual diagnosis and co-occurring disorders has become normative in both residential and outpatient treatment. Currently, the prevalence of substance use disorders (SUD) found in individuals diagnosed with eating disorders (ED) is as high as 50% compared to about 9% in the general population. Likewise, the incidence of eating disorders found in substance use disorder patients is close to 36% as compared to about 1-3% in the general population. The debate as to whether eating disorders are conceptualized and treated as an addictive disorder or a psychological phenomenon has been an ongoing one and argued since the disorder’s introduction in 1980. Likewise the conceptualization of a “sugar addiction” continues to be studied and clinically practiced in many treatment centers, particularly those that deal specifically with substance abuse. Current neurobiological research in the field of addiction shows a relationship between eating disorders and substance abuse via both the reward system as well as the serotonin systems. Likewise, neuro-imaging researches regarding food and drug cues as well as food and drug cravings indicate similar areas of brain activation. Clinical research also demonstrates that that the symptom profiles of women who present with concurrent ED/SUD are different than ED alone. Although recent findings are compelling, the evidence for conceptualizing eating disorders as a variant of an addictive disorder is inconclusive at best and raises more questions regarding the relationship between these two disorders than it answers. Regardless of the debate, the evidence of common pathways has become particularly salient for women who struggle with both an eating disorder and substance abuse disorder.

The staff at Pine Groves’ Women’s Center have embraced this difficult therapeutic challenge and developed a specialized track that provides for the comprehensive treatment of an eating disorder in conjunction with their substance use disorder. As part of our commitment to this specialized population our staff consists of full time therapists who are trained in both eating disorders and chemical dependency. Our patients also enjoy the benefit of a full time nurse, dietician, and a board certified addictionologist. Although those women with a co-occurring diagnosis receive the full compliment of addiction treatment that includes specialized groups of relapse prevention, trauma work, relationship work, experiential/expressive therapy, CBT, 12-step, and Big Book studies; they also receive specific treatment for their eating disorder such as two eating disorder groups, therapeutic lunch, experiential meal and food experiences, meal support with processing, and body image work.. Additionally all patients attend daily community therapy, core therapy groups, a weekly ROPES course, yoga, and exercise.

Our integrated approach to treatment really offers our dual diagnosis women an opportunity to understand how their eating disorder and their substance abuse relate and interact. For some, they may find that one disorder facilitates the other. For example it is not uncommon to hear that the disinhibition that stems from alcohol allows women to binge more freely or allow them to verbalize angry emotions in a way that their eating disorder won’t allow them to do. Likewise a woman may come to the understanding that she needs something to help with the strong emotions and memories of a traumatic history and may use her eating disorder and substance either together or interchangeably as a way to cope and numb. In addition, we find that approaching co-occurring disorders in this way has a significant positive impact on underlying issues such as trauma, attachment issues, and personality disorders. As a result, our women are finally able to break that pattern of chronic relapse that just seems to alternate between their eating disorder and their substance use.

In addition to our dynamic approach to treatment, we have some exciting things on the horizon. We are in the process of introducing a new therapeutic treatment based on an individual’s heart rate variability. Here patients learn to change their heart rhythm patterns to create a state of “coherence”; a scientifically measurable state that serves to balance psychological and physiological processes. This cutting edge technology has implications for both eating disorders and addictions and is sure to become an important piece in the patients overall recovery work. In addition we are in the process of launching a major research project in conjunction with the University of Southern Mississippi, exploring personality and behavioral variables that may differentiate women who struggle with both and eating disorder and substance abuse disorder versus those that that may only struggle with an eating disorder or chemical dependence alone.

The Women’s Center program is steeped in the 12-step tradition and is also committed to the best of evidenced based and cutting edge treatments and research. This combination in conjunction with a committed, caring staff makes the Women’s Center a place for patients to truly recover, heal, and thrive.

Pine Grove Behavioral Health and Addiction Services is an extension of Forrest General Hospital, located in Hattiesburg, Mississippi. Pine Grove’s world renowned programs focus on treating gender specific chemical addiction including a specialized track for co-occurring eating disorders. Additionally, Pine Grove offers a focused substance abuse healing program for adults age 55 and over. Other Pine Grove specialty programs include a dedicated professional’s treatment curriculum and a comprehensive evaluation center. Pine Grove also features a program for patients with sexual and intimacy disorder issues. Pine Grove was established in 1984 and has provided nationally and internationally recognized health care for over 30 years.

Visit www.pinegrovetreatment.com or call 1-888-574-HOPE (4673) for more information.

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