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An opportunity to improve lives and the bottom line

June 1, 2008
by Stuart Koman, PhD
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Addiction treatment centers should consider treating eating disorders

Imagine treating drug addicts who had to continue taking heroin to stay alive or alcoholics who had to continue drinking gin. Eating disorders have much in common with addictions, and yet total abstinence from the substance causing the problem is, of course, not an option.

Like drug addicts and alcoholics, binge-eaters lose control; they eat because they have an overwhelming compulsion to eat, even when they are full. Those with anorexia, conversely, have a similarly strong compulsion not to eat. And, ironically, even as they count every calorie, they are as obsessed with food as addicts are with their drug of choice.

So, can food be addictive? And if it can, should addiction treatment centers consider expanding their services to include eating disorders?

While addictions and eating disorders infrequently are treated together, doing so may be a valid business opportunity for some—and it may benefit the patient, as eating disorders and addictions frequently co-occur. At Walden Behavioral Care, where we take a “whole health” approach to healthcare, eating disorders and psychiatric disorders are treated in separate wings, and addictions are treated within the psychiatric wing.

Addiction treatment centers may consider adding treatment for eating disorders as a way to expand the business, as an additional source of revenue, and as a way of expanding services to existing clients. Putting eating disorder treatment and addiction treatment in the same facility isn't easy, but it helps that they both have much in common.

Similarities

People with eating disorders and those with addictive disorders typically have some similar traits, including:

  • Difficulty modulating or regulating emotions

  • A limited repertoire for handling stress

  • A feeling of being out of control

  • A tendency to worry a lot

A person trying to overcome binge eating, like a person trying to overcome drug or alcohol addiction, thinks constantly about the substance being abused. Planning for the next meal becomes a major part of the daily life of a binge eater, as it does for a person with anorexia or bulimia. It's not just an obsession; there's a fear of doing something and a compulsion to do it. People trying to recover from eating disorders, like those trying to overcome addictions, are consumed with fear of relapse—typically to the point at which it interferes with functioning normally in everyday life.

Factors leading to eating disorders and addictions may be similar too. In either case, individuals likely have a genetic disposition toward addiction and eating disorders. Other factors that may contribute to eating disorders or addictions include low self-esteem, peer pressure, and a traumatic event(s) such as sexual abuse, emotional abuse, physical violence, or parents' divorce.

Given these similarities, it's no wonder that eating disorders and addictions often co-occur. The National Center on Addiction and Substance Abuse (CASA) found that half of all people with eating disorders abuse drugs or alcohol, compared with 9% of the general population, while up to 35% of people who abuse drugs or alcohol have an eating disorder, compared with 3% of the general population. Likewise, anorexia patients sometimes take drugs to suppress their appetite, while those with bulimia may drink excessively to help themselves purge. The term “drunkorexia” increasingly is being used to describe those who drink excessively and either eat little or purge food and alcohol.

Walden Behavioral Care often treats patients who have eating disorders and addiction problems, and we have found that it is advantageous to treat both simultaneously. Otherwise, the untreated disorder tends to worsen. A patient may go through detox treatment, for example, to control an addiction, but the addiction tends to help keep the eating disorder under control, so it will worsen when the addiction is under control. Conversely, when eating-disorder patients with addictions are treated solely for their eating disorder, their addiction is likely to worsen.

Patients with co-occurring disorders typically require longer treatment than those with only an eating disorder or an addiction. Further complicating matters, those with co-occurring disorders may have three or even more disorders. Someone with an eating disorder and an addiction often has a third co-morbidity, as both behaviors frequently are linked to depression, obsessive-compulsive disorders, and anxiety disorders. It is especially common for women with bulimia to be addicted to alcohol or drugs, and many also have bipolar disorder.

Patients who have eating disorders and addictions require more complex treatment, including psychotropic medications to reduce cravings, group therapy, and nutrition therapy. Both addicts and patients with eating disorders are secretive about their problems and have difficulty acknowledging their illnesses. Those in the throes of addiction often deny that they have a problem, just as those with anorexia are in denial and see themselves as being overweight. However, binge eaters know they have a problem. They may not know what to call it, and they may not think of it as a disease. Yet they know that they eat too much and need to do something about it.

The Eating Disorder Epidemic

Given that eating disorders affect a similar population as addictions, it's no surprise that both are frighteningly common. Both affect men and women of all ages across the socioeconomic spectrum.

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