When Eating and Substance Use Disorder Collide
by Robyn Cruze and Linda Lewaniak, LCSW, CAADC
I never thought I was abusing alcohol or drugs, and I certainly never thought I was dependent on them. My problem was an eating disorder, I told myself. Only, whenever I had some time under my belt at successfully avoiding eating-disorder behaviors, I had a propensity to pick up alcohol and use it the same way I’d use eating-disorder behaviors—to numb.
So, when I first began to recover from an eating disorder 15 years ago, I knew if I wanted a fighting chance at lasting recovery, I needed to give up alcohol first. I had to. “Just for now,” I told myself. Then, five years into my recovery, when I was a new mom and my own mom had passed, I decided to pick up alcohol again and drink just a little to take the edge off. “Everybody does it!” I told myself.
No one wants to get into recovery for one thing and be slammed with the label of another. For many of us, such labelling can bring up feelings of shame and a heightened sense of feeling out of control. Many believe that if we just tried harder, had more willpower and structure, we would be able to cope with our drinking in eating-disorder recovery. But, the truth is, those of us struggling with co-occurring illnesses such as Eating Disorder (ED) and Substance Use Disorder (SUD), tend to use numbing mechanisms to avoid coping with unwanted thoughts, feelings and memories. That’s why, when we put down one behavior, we pick up another. It doesn’t matter what we call it. It just matters what we do about it.
We are not alone. Did you know that approximately 50% of those facing eating disorders will be susceptible to substance use disorder behaviors?
- People who suffer from substance abuse are 10 times more likely than the general population to have an eating disorder.[i]
- Eating disorders have the highest mortality rate of any mental illness.[ii]
- SUDs increase the suicide rate in Anorexia Nervosa (AN) and Bulimia Nervosa (BN).[iii]
Over the years, my friend and colleague, Linda Lewaniak (LCSW, CAADC) and I have spoken to hundreds of professionals and individuals who want to know how to quickly identify when ED and SUD come together and how can we treat them. I’ve asked Linda to answer the following questions:
- How do we know we have the co-occurring illnesses of SUD and ED?
Assessing for both Eating Disorder and Substance Use Disorder at the same time is good start. The questions below are a combination of the SCOFF Questionnaire[iv] and the Cage Assessment[v] and are an effective way to identify co-occurring ED and SUD
- Do you make yourself Sick because you feel uncomfortably full?
- Do you worry that you have lost Control over how much you eat?
- Have you recently lost more than One stone (14 lb) in a 3-month period?
- Do you believe yourself to be Fat when others say you are too thin?
- Would you say that Food dominates your life?
- Have you ever felt you should cut down on your drinking?
- Have people annoyed you by criticizing your drinking?
- Have you ever felt bad or guilty about your drinking?
- Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (eye-opener)?
- What are the characterizations of those struggling with both ED and SUD?
Co-occurring populations tend to be characterized by:
- Harm avoidance: Self-consciousness and hypersensitivity. This results in anxiety management.
- Self-directedness: Strong feelings of insecurity, inadequacy, fragile ego. These feelings often result in a sense of uncertainty, a disconnect with values.
- Novelty seeking: Higher among the SUD population; seen with Bulimia Nervosa. Many will experience boredom and are quick with emotional reactions.
Note: The good news regarding the above is that when we are in recovery, we get to use these traits to achieve great stuff. All of these traits can be used positively!
- How do we treat co-occurring ED and SUD?
The goal is to treat both illnesses at the same time with a multidisciplinary treatment team that has both SUD and ED specialists. Psychoeducation and skills groups that discuss relapse prevention are key. Acceptance and Commitment Therapy (ACT) and Dialectical Behavioral Therapy (DBT) help to increase psychological flexibility and allow for a life of value-based living.
If you or someone you know is struggling with these co-occurring illnesses, please know that you are not alone, and recovery is so very possible!
To learn more about treatment for co-occurring Eating Disorder and Substance Use Disorder, please visit: www.eatingrecovery.com
For clinical assessment, call: 877-700-1925 or email: firstname.lastname@example.org
About the authors:
Born and raised in Australia, Robyn Cruze’s first profession was as a successful film, TV and theater actor. With a master’s degree in Solo Performance (Acting) from the Royal Conservatoire of Scotland, today, Robyn utilizes her performance skills across the United States as a professional public speaker and recovery advocate via story telling.
Robyn is a National Recovery Advocate for Eating Recovery Center (ERC.) and ERC’s online Facebook host within two online communities: Eating Recovery and Binge Eating Connection. Robyn helps individuals and their loved ones who are in recovery, or attempting to recovery from an eating disorder and body image issues. She also contributes via article writing and publicity appearances—being featured in numerous publications such as; Refinery29, Yahoo Style, Psychology Today, and The Mighty.
Robyn is the co-author of Making Peace with Your Plate, with Espra Andrus, LCSW, and the author of a children’s affirmation book Lovely Dreams (self-published.) She is a popular keynote speaker and educator, covering topics of; body image, eating disorder recovery (including comorbidity of substance use) and aging in an unrealistic body culture.
Linda M Lewaniak, L.C.S.W., CAADC is the Sr. Director of Clinical Operations and Substance Use Recovery (SUR) at Insight Behavioral Center in Illinois. Linda, a widely-respected therapist and administrator, has over 25 years of experience in the treatment of substance abuse and comorbid mental illness. As Program Director of Substance Use Recovery, she is responsible for the integration of Addiction Services across all programs and levels of care to most effectively treat the co-occurring diagnosis of substance abuse.
Leveraging her extensive clinical and operational background, she oversees the delivery of evidence-based, cutting edge substance abuse treatment at Insight’s Chicagoland treatment centers and provides clinical supervision to the multidisciplinary treatment team. Linda also collaborates closely with Eating Recovery Center’s senior clinical leadership across all 25 facilities nationwide to ensure holistic integration of addiction treatment. She provides substance abuse education, training and development for mental health professionals, educators and community resources.
Linda earned her Masters of Social Work degree with a concentration in Mental Health from Jane Addams College of Social Work at the University of Illinois.
[i] National Center on Addiction and Substance Abuse at Columbia University. (2003). Food for thought: substance abuse and eating disorders
[ii] Arcelus, Jon, et al. “Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies.” Archives of general psychiatry 68.7 (2011): 724-731.
[iii] Franko, D. L., Keel, P. K., Dorer, D. J., Blais, M. A., Delinsky, S. S., Eddy, K. T., . . . Herzog, D. B. (2004). What predicts suicide attempts in women with eating disorders? Psychological Medicine, 34(5), 843-853.