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by Michelle Hook, MSN, RN, Enterhealth Ranch Executive Director

The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that around half of patients with eating disorders abuse alcohol or illicit drugs, a rate that is nearly five times higher than the general population. On the other side of that equation, SAMHSA found that up to 35 percent of individuals who abuse or are dependent on alcohol or illicit drugs also suffer from eating disorders, a rate 11 times higher than the general population.

At Enterhealth, we see these numbers pan out in real life. Between patients seen at Enterhealth Ranch (our inpatient facility located outside Dallas) and Enterhealth Outpatient Center of Excellence (our outpatient facility located in Dallas), we have found approximately 20 to 30 percent of patients who come in seeking treatment for alcohol or drug addiction also suffer from an eating disorder.

Why is there so much overlap?

Both eating disorders and drug and alcohol addiction share a number of key risk factors and root causes, including:

  • Family history
  • Family dynamic
  • Low self-esteem
  • Compulsive behavior
  • Social isolation
  • Depression
  • Anxiety
  • Social pressure

In addition, the diagnostic criteria for addiction and most eating disorders are nearly identical, leading many to broaden the scope of what is traditionally considered to be an addiction. In fact, the National Institutes of Health (NIH) has identified both addiction and eating disorders as chronic brain diseases.

Eating disorders typically fall into the category of behavioral addictions (sometimes referred to as process addictions or non-substance-related addictions), which are increasingly recognized as treatable forms of addiction.

Research suggests there is a strong genetic component to both, as addiction is linked to various chemical processes in the brain, as well as similar personality traits such as impulsiveness, risk-seeking behavior and emotional maturity.

Both eating disorders and addiction commonly develop as a response to stress. Often, people turn to things like drugs, alcohol, binge eating or compulsive exercising to cope with difficult emotions or to self-medicate for physical and mental health issues such as chronic pain, fatigue, depression, anxiety and emotional trauma.

The most common age group to experience this overlap is young adults, who experience much higher levels of societal expectation and social pressure. When these expectations are not met, or the pressure becomes too much, many young adults turn to drugs and alcohol as an escape.

In addition, the expectation or pressure may be to conform to a certain body type, leading some to starve themselves, exercise compulsively or both. The media also tends to glamorize drug and alcohol use and frequently presents us with unrealistic expectations of beauty and the human body.

They share the same dangers

Drugs and alcohol not only put a heavy burden on the body, taking a toll on vital organs, but they also alter the chemistry – and certain functions – of the brain. What Enterhealth wants the public to recognize is that eating disorders have many of the same effects on the body and the brain. What makes eating disorders unique are the compulsions to go to extremes to make weight loss happen through starving, purging or excessively exercising.

As a result of constant stimulation from drugs, alcohol or eating disorders, the brain is inundated with “feel-good” neurotransmitters. Our brains have special reward centers that are stimulated by certain behaviors, such as receiving praise, feeling love, taking care of ourselves and exercising. These substances and behaviors have the ability to hijack this system, causing the brain to block unpleasant feelings in response to the stimulus (alcohol, drugs or food), leading people to desperately crave the substance or behavior.

There is a reason the National Institutes of Health (NIH) classify both of these disorders as chronic brain diseases – they both cause damage to the brain.

Specific challenges with eating disorders

Despite the similarities between addiction and eating disorders, there are a few important distinctions to make between treatment of the two issues.

Those who are addicted to drugs and alcohol can – and are highly encouraged to – sever their relationships with these substances as well as the people they associated with when they were using them. On the other hand, those with eating disorders cannot abstain from food, and they are likely to spend time with the same people they always have.

Another aspect unique to treating those with eating disorders is their self-evaluation is dependent on things like weight or appearance, and they allow these factors to determine their self-worth.

For this reason, therapists need to work with patients to help them form a sense of identity separate from their eating disorder. In addition, these treatment programs need to address both the disordered eating as well as patients’ broader relationships with food. Even for those without an eating disorder, these two steps can be difficult.

Concurrent treatment increases chances for recovery

At Enterhealth, we are uniquely positioned to treat both conditions at the same time, a process often referred to as dual-diagnosis treatment. This kind of treatment is surprisingly rare to find, as most addiction treatment providers simply are not equipped to deal with the level of care those with eating disorders typically require. This includes services such as nutrition and meal support, intensive medical monitoring and access to therapists specializing in eating disorders. However, a growing body of research shows this approach consistently produces better recovery outcomes.

Often, when addiction and eating disorders are treated separately, one condition gets better while the other is exacerbated. For example, a patient may seek help for an eating disorder and get back to eating correctly, but they may start using alcohol or drugs more frequently to deal with stress and emotions. Reverse the situation and you often see the same results – once a patient stops using a substance, their eating disorder flares up as they try to cope with their life situation. In both cases, the patient ends up bouncing from one facility to another in a cycle of relapse and readmission.

Treatment through Enterhealth

The correlation between addiction and eating disorders is too often overlooked, and as a result, many people are improperly treated or undertreated – or worse – stop seeking treatment all together. The good news is the board-certified medical team at Enterhealth specializes in the diagnostic and treatment challenges of dual-diagnosis disorders, meaning we can help those suffering from addiction and eating disorders.

Enterhealth offers the latest scientific, evidence-based treatments such as eye movement desensitization and reprocessing (EMDR) and psychological assessments. We also utilize a variety of tried-and-true therapeutic techniques and modalities, including cognitive behavioral therapy, motivational enhancement therapyacceptance and commitment therapy and more. And because we believe family plays a critical role in the recovery of our patients, we also offer family group therapy and couples group therapy.

Our treatment plans are tailored to each patient by a team of addiction-trained nurses, physicians, therapists and psychiatrists, beginning with a thorough medical and psychological assessment. Treatment plans include education about the disease and development of coping skills needed to handle various life challenges and sustain long-lasting recovery.

To learn more about treatment at Enterhealth as well as the latest additions to our evidence-based addiction treatment programs, please visit our website or call 1-800-388-4601.