By Stephanie Hazard
National Eating Disorder Week raises awareness about this pernicious and quiet killer. Why Aren’t There More Treatment Options for People Who Struggle With Eating Disorders and Substance Use Disorder?
I went on my first diet when I was eleven years old. I set out to lose 10 pounds in 10 days. Mission accomplished! I was praised for achieving this goal (I was “chubby” and my mother was a model) by starving myself. That early experience plus the sexual trauma I experienced in my family of origin set me up for a lifetime of bingeing, purging, and restricting. I felt shame about what was happening behind closed doors, and I felt shameful about my body and eating behaviors.
As I got older, alcohol entered the picture, and I formed an alliance with that partner in crime which I used as an appetite suppressant. I began to depend on alcohol and eventually passed through the looking glass. At the age of thirty-four, I had blossomed into an alcoholic. One night, when I was purging from both ends in my bathroom, I heard my 6-year-old son cry out for me, and I couldn’t get to him. I vowed in that moment —never again. I never purged again, I got honest with my therapist about the eating disorder, and I got sober 2 years later.
Flash forward 24 years to today. I am now a professional substance use disorder (SUD) recovery coach as well as a CCI certified eating disorder (ED) coach. There aren’t many coaches who have this hybrid training. And what has become clear to me in my work is that I’m not the only one who had co-occurring disorders. In fact, many of my female clients struggle with both as well. In one recent study, alcohol abuse among individuals with restricting Anorexia Nervosa varied between 0% to 6%, while the rates of other drug abuse ranged from 5% to 19%. The corresponding rates in bulimics were significantly higher, ranging from 14 to 49% for alcohol.
So, here’s my concern: Why aren’t there more treatment options with parallel tracks and integrated services addressing the complexities of this patient population through combined treatment strategies? The challenging needs of individuals with both alcohol and other drug use disorder, and an eating disorder, necessitates distinct, diverse, and more intensive assessment and treatment strategies. Recently, I had one client who was literally kicked out of treatment because her eating disorder “flared up.” I had another client who was told she had to leave sober living because of her “abnormal” eating disorder behaviors. And, I had another client in long-term recovery from anorexia who went to treatment for cocaine addiction and lost 15 pounds in a month. Most often my clients are told that if they have an active eating disorder, they CAN’T be admitted to a SUD treatment program. And to add insult to injury, many ED treatment centers will not take a client with active SUD. But with co-occurring disorders that’s what happens. The disorders are intermingled, and often when one subsides the other one gets activated or reactivated.
We’ve got to do better than this! While researchers and clinicians haven’t determined the most effective treatment approaches for this population, it’s time to at least become better informed and have contingencies or strategies in place to help these individuals. Given that recovery coaches work as an adjunct to clinical teams, I’m wondering if perhaps treatment centers could bring in SUD or ED recovery coaches to help support individuals if they begin to struggle with this insidious form of whack a mole. Once they leave treatment, the continuum of care they receive makes all the difference. This time of transition is also an optimal opportunity for partnering with a recovery coach to turn the dial on wellness helping clients navigate challenges and practice coping skills vs. reverting to coping mechanisms.
Using a trauma informed lens, these individuals need to feel safe and supported to do the work—not marginalized, kicked out or underserved because they have co-occurring disorders. We need treatment centers who will treat both. Right now, it’s like finding a needle in a haystack. We know that anorexia has the highest case mortality rate and second-highest crude mortality rate of any mental illness. How can there not be better treatment options when so many lives are at stake?
Stephanie Hazard, CCIEDC, CARC, RCP
917-488-3094
