The clinical term “comorbidity” refers to two separate conditions that impact the same person at the same time. It’s a common condition in medicine. For example, people who are obese often develop diabetes. Either condition could cause the other, but when put together, they form a tight bond and they tend to make one another much worse. Eating disorders and substance abuse issues tend to form tight relationships like this. In fact, it’s extremely common for people to have both conditions at the same time. According to the National Center on Addiction and Substance Abuse at Columbia University (CASA), up to 50 percent of people who have eating disorders also abuse alcohol or drugs.
Both of these conditions can cause physical problems, mental health problems or both. And, addressing just one issue while leaving the other in place could cause a relapse of both conditions. That’s why most addiction programs begin with a thorough assessment for comorbid issues like eating disorders. When these additional issues are spotted, effective treatments can be used to keep the issues from growing stronger or returning once treatment is over.
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Understanding Eating Disorders
People who have eating disorders have an unhealthy relationship with food and weight. They often believe that they’re much too heavy to be attractive, and they’re desperate to lose weight and gain control of the problem. Unfortunately, the methods people use to obtain this weight loss can be disastrous for their long-term health.
- Eat extremely small amounts of food
- Eat only low-calorie foods such as celery or crackers
- Discuss their weight repeatedly
- Make food for others, without eating on their own
- Use cola or tea to feel full, instead of eating
People who have anorexia may desperately want to eat. In fact, many report that they think about food almost all the time. In the same breath, however, these people may report extreme fear of gaining any weight, and this fear keeps them from eating as they should.
Bulimia nervosa is another form of eating disorder, and it’s slightly more common than anorexia nervosa. The National Institute of Mental Health reports that 0.6 percent of all adults in the United States have dealt with bulimia nervosa at least once. People who have bulimia nervosa also desperately want to lose weight, but in order to do so, they eat normally and try to keep their bodies from absorbing the foods they’ve ingested. By forcing themselves to vomit or using laxatives, they hope to stop calories from entering their bodies. This is rarely effective, however, and many people who have bulimia nervosa are at a normal weight or they’re slightly overweight. This is particularly true of people who binge and then attempt to purge the food they ate. During a binge, the person might take in thousands of calories, and a good portion of those calories will have been absorbed by the body by the time the purging begins.
Some people develop a compulsion to binge eat, similar to the compulsion felt by those with bulimia nervosa, but this group doesn’t attempt to purge the calories they took in. They might also eat thousands of calories in a sitting, and since they do not purge those calories, these people might be significantly overweight or even obese.
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While people might dabble in drug and alcohol use from time to time, some people develop a compulsive pattern of substance use. These people may know that the drugs they use are harmful for their physical and mental health, yet they are compelled to keep using, no matter the consequences. They do not intend to harm others with their use, but often, they can cause a serious amount of damage to their families and friends through their exclusive focus on drug use. It is a serious problem, and it’s a disease that can relapse and become chronic in nature. Many drugs alter the physical structure of the brain, changing the amount of chemicals the brain produces and reducing the ability of the brain to respond to the chemicals it has access to. These changes serve to strengthen the addiction, as they reduce the person’s ability to think clearly, make good decisions and deal with cravings.
While anyone can develop an addiction to drugs and alcohol, the National Institute on Drug Abuse states that people who begin using drugs at an early age tend to be more likely to progress to serious drug use, compared to people who begin using drugs later in life. During adolescence, the brain is developing and changing at a rapid pace, and these changes can leave the brain vulnerable to addiction.
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Exploring the Connection
Eating disorders and addictions have a significant amount in common. For example, both conditions seem to appear during adolescence. Teen girls may be vulnerable to eating disorders as they are particularly concerned with issues of appearance as they grow and change. Similarly, teens of both genders can be vulnerable to substance abuse as they begin to experiment with powerful substances in order to fit in with friends who are also using drugs. Adolescence is a time when people want to fit in and seem like everyone else, and both substance abuse disorders and eating disorders seem to fit this model.
In addition, both eating disorders and addictions seem to be disorders revolving around compulsion. People with eating disorders can’t seem to control the way that they eat, and people with addictions can’t seem to control how they use those substances. This has led some researchers to believe that the two diseases share some sort of chemical pathway. Perhaps a genetic loss of a specific type of neurotransmitter would lead people to develop one disorder or the other.
Other experts believe that there might be psychiatric illnesses that lie beneath both disorders, and those conditions should also be included in part of the treatment mix. For example, an article on the issue published by the National Institute on Alcohol Abuse and Alcoholism states that people who have both substance abuse issues and eating disorders often have major depression or post-traumatic stress disorder. In other words, they may have a mental illness they’re attempting to deal with alone, and they may turn to unhealthy eating behaviors or substance abuse as part of that process.
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How They Work Together
Eating disorders and substance abuse issues tend to augment one another, allowing the person to continue to engage in destructive behavior. For example, an article in the magazine Social Work Today suggests that some people with eating disorders use substances in order to help them lose weight and forget about food. Smoking cigarettes or smoking drugs gives the hands and the mouth something to do, and it can help to quench the appetite. Secondly, the euphoria these drugs bring can ease the psychological distress the person might feel about wanting to eat or needing to eat, and being unable to do so normally. The substance abuse can make the eating disorder easier to live with.
Some people alternate their behaviors, binge eating on one day to relieve psychological distress and then binge drinking the next day in order to deal with the same issue. These people may be trying multiple approaches to deal with the same problem, but they may still find no relief from the original source of the pain. However, since they aren’t binge eating or binge drinking each and every day, they may find it easier to hide the symptoms of both conditions from the people they live with or care about. By alternating between the two approaches, they can mask the severity of both problems, which might allow both problems to grow stronger.
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Consequences of Missed Treatment
- Heart failure
- Kidney failure
Untreated bulimia can lead to tears in the esophagus or severe dehydration due to laxative abuse. Untreated binge eating can lead to heart disease, obesity and diabetes. All of these conditions can be life threatening, and they should be taken seriously.
Untreated addiction can cause similarly dire outcomes. Some drugs do damage to the heart or the lungs. Others can cause mental health problems such as schizophrenia. And abuse of illegal drugs can lead to law enforcement action, including incarceration. It’s not something anyone wants in their life.
People who have both conditions at the same time may face additional issues. For example, a study in the journal Addictive Behaviors found that people who had eating disorders who also abused substances had an increased risk of attempted suicide and they were also more likely to steal, compared to people who did not have both conditions at once. The two conditions seem to make risky, desperate behavior more common, and this can be incredibly dangerous.
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Since addiction and eating disorders do seem to be connected, many addiction programs screen people for eating disorders. Similarly, a urine screening for drug use is also commonly provided to people who enter treatment programs for eating disorders. When the two conditions are spotted, therapists can then create a treatment program that addresses both conditions at the same time.
Many addiction treatment programs revolve around the use of cognitive behavioral therapy (CBT). Here, the addict is taught that the mind often relays negative information that causes such distress that the person is compelled to act in a similarly negative way. This therapy can also be used to assist with eating disorders. For example, a girl who believes she is unattractive might feel an urge to starve herself or to use drugs. By teaching the girl to replace the word “unattractive” with “pleasing,” and helping her to then behave in a way that is not destructive, both the addiction and the eating disorder might be effectively treated.
Some therapists use the Maudsley Approach to help their adolescent clients. According to the Substance Abuse and Mental Health Services Administration, this therapy allows the family to take over responsibility for what the teen eats. As the teen begins to gain weight, the control of eating is slowly given back to the teen. Throughout the process, the family attends counseling sessions to learn how to develop appropriate relationships and power structures. This can be an important technique for teens who have severe cases of anorexia, and those who need to gain large amounts of weight in order to stay alive. Teens undergoing this therapy for anorexia might use CBT in other sessions with a counselor, to assist with the addiction. The family might also keep tight control over the addict’s access to medications and/or alcohol in order to prevent the teen from using any substances at all as the therapy moves forward.
Some people also benefit from attending self-help groups, such as Overeaters Anonymous or Eating Disorders Anonymous. Here, the person is connected with others who are also dealing with eating disorders, and as a group, they share information about their histories and their hopes for the future. Both addiction and eating disorders can be isolating, and the person might be accustomed to hiding his/her true feelings and lying to others a significant amount of the time. Having the opportunity to open up in a group setting, knowing that others involved will not be judgmental or critical, can be an important part of the healing process as it allows the person to remember what it’s like to be part of a community. For some, this is a transformational step that’s important to the recovery process.
At Axis, we can assist in treating comorbid disorders, such as eating disorders and addiction. We know that having two conditions at once makes treatment more complicated, and more crucial, and we’ve developed a host of innovative programs that can help. If you’re dealing with an eating disorder issue and a co-occurring addiction issue, we urge you to contact us today to find out more.
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