Eating Disorders and drug and alcohol addiction: What’s food got to do with it?

Written by Sandy Richardson

Addiction comprises a complex set of biochemical and behavioral factors which are not limited to a specific substance. When one substance or behavior is restricted, addicts often switch to another compulsion. There is consensus among the experts that many clients with drug and alcohol addiction also frequently have clinically significant symptoms of anorexia, bulimia, or compulsive overeating eating disorders which can interfere with treatment and sobriety. In fact, while researchers report varying occurrence of eating disorders in populations with primary substance abuse disorders, it appears that both clinical and subclinical eating disorders (particularly bulimia) are overrepresented in women receiving treatment for substance abuse.

In a sober living community, restriction of addictive substances and behaviors is a necessary part of recovery. Eating disorders present a unique challenge in a sober living community since abstinence from the substance (food) is not possible. Access to and consumption of food cannot be restricted and monitored as closely as in a program designed to specifically treat eating disorders. Research shows that individuals who binge experience food cravings similar to urges for drugs. These cravings can be extremely difficult to control when residents are responsible for meal planning, grocery shopping, and food preparation. If he or she chooses, each resident has the opportunity to engage in unhealthy food behaviors as a way of continuing an addiction.

There are many similarities in eating disorders and substance abuse, in spite of the differences in substance and behaviors. For instance, parallels between alcoholism and bulimia include lack of control over the abused substance, preoccupation with the substance, and failed attempts to control behavior surrounding the substance. In addition, both disorders often impair physical and social functioning and involve deception and secrecy. Therefore, treatment for eating disorders and substance abuse disorders can be similar; cognitive behavioral therapy, motivational interviewing, and dialectical behavior therapy all have been found effective. While the traditional treatment approaches to alcohol and drug addiction and eating disorders are very different; both feature impulse control deficits, and similar coping skills can be effective with both disorders. It has proven helpful to treat dual diagnoses of eating disorders and substance abuse with an integrated approach including psychotherapy and 12 Step self-help support groups.

The primary focus of substance abuse treatment is abstinence from alcohol and non-prescribed psychoactive substances. In a residential treatment setting, access to such substances can be largely controlled (recognizing of course the creativity of addicts). Because abstinence from food is a primary feature of anorexia nervosa, it is obviously not an effective treatment goal. Instead, abstinence from behaviors such as bingeing, purging, and restriction of calories are the main focus of treatment for eating disorders. There are differences in behaviors of alcohol and drug addiction and eating disorders, but cognitive therapy and basic coping skills can improve issues common to these disorders, particularly improvement of self-esteem and self-control. Treatment of co-occurring eating and substance abuse disorders is particularly important because once sobriety from drugs and/or alcohol has been achieved, eating disorder symptoms often intensify and vice versa.

A combination of the Twelve Steps and cognitive and behavioral techniques can achieve sobriety from eating disordered behaviors similar to that achieved from abstinence from drugs and alcohol. The goal is for clients to apply the Twelve Steps of Alcoholics Anonymous to all addictive issues; inclusion of cognitive and behavioral techniques could augment application of Twelve Step principles through increased understanding of cognitive patterns which interfere with sobriety.

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