Everything, Everywhere, All at Once: Treating Co-Occurring Eating and Substance Use Disorders by Ellen Scollins, M.Ed., LCPC, CADC
When eating disorders and substance use disorders collide, a complicated landscape emerges that can be overwhelming for both individuals and healthcare providers to navigate. It is increasingly recognized that these disorders frequently overlap, leading to a situation where the symptoms of one can mask or exacerbate the other, prolonging suffering and preventing clear diagnosis and effective treatment. A complete understanding of both conditions is essential for long term recovery.
Understanding Co-Occurring Disorders
Eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder. These disorders often share psychological, biological, and sociocultural factors with substance use disorders, like alcohol and drug addiction. Heredity, emotional sensitivity, societal and cultural pressures, perfectionism, trauma and low self-esteem can all predispose someone to develop either or both disorders.
Research shows that about 50% of individuals with eating disorders also abuse substances. This bidirectional relationship can intensify symptoms, making it essential for treatment strategies to address both conditions at once. For instance, someone who restricts food intake may also misuse drugs to suppress appetite, creating a cycle that can be difficult to break. Those struggling with urges to binge food may also binge with alcohol and other drugs, perpetuating a cycle of deep shame and emotional avoidance. Identifying the role of each disorder and the interplay between them can feel overwhelming and relieving all at once. Understanding the overarching framework that these disorders have provided in emotional regulation gives clinicians the lens through which we can identify, process and replace each behavior with a coping skill more in alignment with an individual’s personal values system.
The Importance of Integrated Treatment
Integrated treatment is often the most effective way to tackle co-occurring eating and substance use disorders. A holistic approach acknowledges that these disorders can heavily influence each other and therefore require therapies that treat both conditions in an interconnected way.
Typically, this holistic treatment involves a multidisciplinary team of healthcare professionals, including therapists specializing in addiction, dietitians, psychiatrists and often medical doctors. Together, they can develop a comprehensive treatment plan that addresses psychological, nutritional, and medical needs. Family and loved ones may also be considered part of a treatment team designed to provide structure and support at home, through appropriate boundary setting and mutual accountability.
Common therapeutic modalities include:
Cognitive-Behavioral Therapy (CBT)
This method helps individuals identify and change negative thought patterns. Studies indicate that CBT can lead to significant improvements in both eating disorder symptoms and substance abuse.
Motivational Interviewing
This technique encourages individuals to find motivation for recovery and supports behavior change.
Dialectical Behavioral Therapy (DBT)
DBT views relapse as a problem to solve; therefore, therapists help the individual assess the events that led to the relapse and work to help them repair the harm they caused themselves and others as a result.
EMDR
EMDR targets the trauma that may underlie addiction by addressing the distressing memories and beliefs that may have fueled both eating disorder and substance abuse. By using an EMDR protocol, therapists help clients process and reframe these memories, reducing the emotional intensity attached to them.
Common Challenges in Treatment
Even though integrated treatment is effective, several challenges can occur. Stigma remains a significant barrier. Many people living with co-occurring disorders face societal shame that can discourage them from seeking help. This stigma can lead to feelings of isolation, making communication about struggles hard. Group support such as 12 step meetings or clinical group therapy can decrease this sense of “otherness” and prompt a very needed connection with others.
Moreover, the symptoms associated with each disorder can complicate treatment. Some clients will at times require inpatient care for substance use which can provide an opportunity to restrict calories, or those seeking to cope with emotional avoidance as they release their eating disorder may turn to drugs or alcohol as a means to reconnect with others. This cycle of moving from one disorder to the other is exhausting and feels defeating, and most always requires specialized care.
Practical Strategies for Individuals Seeking Help
For those struggling with co-occurring eating and substance use disorders, embarking on the path to recovery can be intimidating. Below are some practical strategies that can aid in securing the right treatment and navigating this complex intersection:
Seek Professional Help
Find a healthcare provider who specializes in co-occurring disorders. They can provide a thorough assessment and design a personalized treatment plan tailored to your needs.
Establish a Support System
Reach out to supportive friends, family, and support groups. Having people who understand your struggle can greatly reduce feelings of isolation.
Prioritize Self-Care
Engaging in moderate physical activity ( as long as this is cleared by a medical professional and a Dietitian) , practicing mindfulness, and maintaining balanced nutrition can improve overall well-being. Identifying and avoiding triggers that intensify symptoms is also vital.
Educate Yourself
Learning as much as you can about each disorder as well as understanding the relationship between them can empower you to better advocate for your needs during treatment.
Relapse Prevention is Everything
Relapse can be a major concern for those recovering from co-occurring disorders. Establishing a proactive relapse prevention plan early on is crucial. This plan might include identifying personal triggers, developing healthy coping strategies, and adhering to a structured schedule of support. Often, recovery from one disorder may trigger a desire to return to the other, so regular communication with the clinical treatment team can help to reassess and adapt treatment plans as necessary.
Finding community and “your people” in therapeutic and support groups can also reinforce commitment to recovery and help prevent relapse. There are many free resources for community-led support available both online and in person including Y12, NEDA and AA programs.
Moving Toward Recovery
Understanding and accepting co-occurring eating disorders and substance use disorders is a vital step toward any recovery journey and frequently requires a completely honest evaluation of all areas of life that have been affected. The complex relationship between these conditions calls for an integrated treatment approach that nurtures the interconnected nature of both disorders. With a focus on empathy, education, and support, individuals can more effectively navigate their own paths to healing.
The journey may pose a LOT of challenges, but with the right resources and assistance, living a healthier, more fulfilling life is completely attainable. Overcoming the narrative that managing both disorders at once is insurmountable, or that seeking help not a sign of weakness but rather a strong step toward recovering power can be the type of support those suffering need to hear from loved ones in order to face the work ahead.
To learn more or connect with someone from our team please reach out to Lotus Therapy Group at 708-552-7330 or email us at lotustherapygroup@gmail.com.
