Editor’s note: RiverMend Health Center of Atlanta is one of the few rehab centers in Georgia to offer integrated care for addiction and eating disorders, including screening, assessment and therapy to help patients gain control of their lives and recover from both addiction and eating disorders.
The highly restrictive eating habits that mark eating disorders such as anorexia and the misuse of alcohol and drugs on first glance seem to be two very separate problems. Yet eating disorders and substance use disorders often go hand-in-hand.
“It’s incredibly common for patients to suffer from both an eating disorder and addiction,” said Angela Dainas, M.Ed, LMFT, Assistant Clinical Director at RiverMend Health Center of Atlanta who specializes in addiction and eating disorder treatment. “Many times, the eating disorder pathology is present prior to the onset of the addiction or the alcohol use disorder.”
Researchers are still working to fully understand the biological mechanisms that make an individual vulnerable to eating disorders and addiction. What’s clear is that “there are many ways that an eating disorder can progress to a substance use disorder,” said Dainas, who worked in residential and outpatient eating disorder treatment centers before joining RiverMend Health Center of Atlanta.
Individuals with eating disorders are more likely to also experience depression, anxiety or trauma-related disorders – and they may use alcohol or drugs to numb or alleviate those feelings. Patients may start taking Adderall (prescribed for ADHD) in an attempt to control their appetite and lose weight, and later progress to other amphetamines. Once patients get comfortable with a certain level of drug use, it’s easier to start experimenting with even harder drugs like heroin, she added.
After binging or purging, individuals with bulimia or binge eating disorder may experience a feeling of relief and emotional numbness. Some people with those disorders may look to drugs to provide a similar relief from underlying emotional or psychological pain.
Screening for eating disorders
According to the U.S. Substance Abuse and Mental Health Services Administration, eating disorders are characterized by disturbed eating patterns and dysfunctional attitudes toward food, eating, and body shape. The behaviors associated with eating disorders share many similarities with substance use disorders: compulsive use or behavior, loss of control, and continuing behavior despite negative consequences.
At RiverMend Health Center, Dainas conducts a screening and assessment at the outset of treatment to determine if patients have a co-occurring eating disorders.
Some patients have received a diagnosis of an eating disorder in the past. Often, she has to delve deeper into their relationship with food, body image and past behavior.
“A lot of times if I ask, ‘Do you have a history of an eating disorder, people will say no.’ But if you ask them if there was a time when they struggled with eating, or if they remember feeling very dissatisfied about their body, or about their weight fluctuations over their lifespan, they start to put things together,” Dainas explained. “They’ll say, ‘Oh yeah, I did throw up to keep myself from gaining weight. Sometimes it takes time for us to gain their trust and for them to see that certain patterns are signs of disordered eating.”
Healing the relationship with food and body image
While the negative behaviors associated with eating disorders revolve around food, the underlying issues typically aren’t about food per se but are ways of coping with psychological or emotional pain.
“When kids are young and dealing with difficult emotions and stress, it’s a lot more accessible to manipulate what they’re eating than start using substances. We’re seeing the body dissatisfaction and the food restriction starting as early as 8 year olds,” Dainas said. “The substance use tends to start when they’re a little older, 14 or 15. Both conditions can co-exist for a long time before someone becomes ill enough to seek treatment.”
Unless their heath is severely compromised due to eating disorder side effects, Dainas and the team at RiverMend Health Center typically first work with patients on detoxing and building a foundation for recovery. As people start to feel stronger and more secure in their sobriety, they’ll start to deal with issues around body image and eating. RiverMend Health Center refers patients as needed to a dietitian who has expertise in eating disorders.
“I had one client who is in recovery say to me that what feels really embedded in her, even more than the addiction, is her eating disorder and the way she thinks about her body,” Dainas said. “Eating disorders can hijack your brain in much the same way that substance use can. We work with patients to help them see that the eating disorder and the voice telling them they’re not good enough as they are isn’t ‘them,’ but is the voice of the disease. They start to see that they don’t have to answer to that voice.”