SUBSTANCE ABUSE AND EATING DISORDERS Elizabeth Suti, M.A., M.F.T. Program Manager

1. SUBSTANCE ABUSE AND EATING DISORDERS Elizabeth Suti, M.A., M.F.T. Program Manager UCLA Substance Abuse Service

2. CASA The National Center on Addiction and Substance Abuse at Columbia University, New York, NY Food for Thought: Eating Disorders and Substance Abuse, CASA, 2003 www.casacolombia.org

3. CASA Mission Statement • Inform Americans of the economic and social costs of substance abuse and its impact on their lives. • Assess what works in prevention, treatment, and law enforcement. • Encourage every individual and institution to take responsibility to combat substance abuse and addiction. • Provide those on the front lines with the tools they need to succeed. • Remove the stigma of abuse and replace shame and despair with hope.

4. Summary Statement of CASA Report Results of a 3 year Study Between Substance Abuse and Eating Disorders --”Individuals with eating disorders are up to five times likelier to abuse alcohol or illicit drugs and those who abuse alcohol or illicit drugs are up to 11 times likelier to have eating disorders”. J. Califano, President, CASA

5. Key Findings of CASA Report --Eating disorders occur in 5 to 10 million Americans, mostly girls and women. Approximately 1 million boys and men suffer from eating disorders and it’s on the rise. --Up to 50% of people with an eating disorder abuse alcohol or other drugs compared to 9% in general population --Up to 35% of people who abuse substances have an eating disorder compared to 3% in the general population

6. Key Findings…Continued Many people with eating disorders abuse substances for weight control --caffeine to alleviate hunger/boost energy --cigarettes to suppress appetite or alternative oral activity to eating --heroin and cocaine facilitate weight loss by suppressing appetite --OTC drugs such as diuretics, emetics (ipecac), and laxatives facilitate purging

7. Key Findings…Continued --alcohol is common in eating disorders, especially bulimia (misconception that alcohol isn’t fattening) --bulimic women who are also alcohol dependent report a higher rate of suicide attempts, anxiety, depression and personality disorders than those who aren’t alcohol dependent (Food For Thought: Substance Abuse and Eating Disorders, CASA, 2003)

8. Diagnostic Features of Anorexia Nervosa DSM IV-TR --refusal to maintain body weight over a minimally normal weight for age and height (<85%) --intense fear of gaining weight or becoming fat, even though underweight --disturbance in the way that body weight, size, or shape is experienced --amenorrhea in females --2 subtypes: restricting vs binge-eating/purging

9. Diagnostic Features of Bulimia Nervosa DSM IV-TR --recurrent episodes of binge eating (lack of control over eating large amounts of food) --recurrent inappropriate compensatory behavior in order to prevent weight gain (i.e., vomiting, abuse of laxatives, diuretics, or other medications, fasting, or excessive exercise) --a minimum average of 2 episodes of binge eating and inappropriate compensatory behaviors per week for the past 3 months --self-evaluation unduly influenced by body shape and weight

10. Definitions…Continued Eating Disorders Not Otherwise Specified --clinically significant eating disorders, or “disordered eating” that does not meet all of the diagnostic criteria for anorexia or bulimia (Understanding and Diagnosing Eating Disorders, Garner & Gerborg, Handbook of Addictive Disorders, R. Coombs, 2004)

11. (Understanding and Diagnosing Eating Disorders, Garner & Gerborg, Handbook of Addictive Disorders, R. Coombs, 2004)

13. (Understanding and Diagnosing Eating Disorders, Garner & Gerborg, Handbook of Addictive Disorders, R. Coombs, 2004)

14. (Understanding and Diagnosing Eating Disorders, Garner & Gerborg, Handbook of Addictive Disorders, R. Coombs, 2004)

15. (What is Addiction, D. Smith, Handbook of Addictive Disorders, R. Coombs, 2004)

16. Characteristics of Addiction “Researchers and clinicians traditionally limit addiction to alcohol and other drugs. Yet neuroadaptation, the technical term for the biological processes of tolerance and withdrawl, also occurs when substance-free individuals become addicted to pathological gambling, pornography, eating, overwork, shopping, and other compulsive excesses.” (Robert Coombs, Introduction, Handbook of Addictive Disorders, 2004)

17. Characteristics of Addiction…Continued --Chronic and subject to relapse --Progressive disease of the brain (drug/behavior induced reward system dysfunction) --Denial – “the only disease that tells you you don’t have a disease.” --Potentially fatal – death, hospitals, institutions --Incurable, but eminently treatable --Remission – disease can be brought into remission through a program of abstinence and supported recovery (What is Addiction, D. Smith, Handbook of Addictive Disorders, R. Coombs 2004)

18. (What is Addiction, D. Smith, Handbook of Addictove Disorders, R. Coombs, 2004)

19. (What is Addiction, D. Smith, Handbook of Addictive Disorders, R. Coombs 2004)

20. Clinical Treatment Issues – Trauma & Abuse --Girls who were sexually or physically abused are twice as likely to smoke, drink, or use drugs as girls who were not abused --Childhood sexual abuse is associated with a three-fold increase in the risk for substance dependence --Sexual Abuse has been reported in up to 65% of women with eating disorders (higher for bulimics than anorexics) --Sexual abuse in women has been reported in up to 70% of women in substance abuse treatment (Windle, Physical & Sexual Abuse Among Alcoholic Inpatients, Am J. Psychiatry, 1995)

21. Clinical Treatment Issues – Affect Regulation --“Self-Medication” through addictive behaviors for relief of unpleasant or intolerable affect/Symptoms of PTSD --Mood altering effects may include euphoria, calmness, or numbness --Underlying psychological issues --Guilt and shame --Treatment of one disorder may lead to exacerbation of another disorder

22. Relapse Prevention Model --Identifying triggers, learning CB relapse prevention tools, attending 12 step programs --Stress is a major relapse indicator; if psychosocial stressors aren’t addressed the person can go from one addiction to another --Abstinence model, of course, doesn’t work with eating disorders --Active recovery vs. “Cure” for addiction

23. (Food for Thought: Eating Disorders and Substance Abuse, CASA, 2003)

24. Recommendations for Health Professionals --Educate patients about negative health effects of eating disorders and substance abuse --Screen patients routinely for both disorders and get patients into treatment --Address both SA and ED simultaneously in treatment, just as we are increasingly doing with other co-occurring disorders (Food for Thought…CASA, 2003) --Countertransference issues are common in treating co-occurring disorders

25. (Food for Thought: Eating Disorders and Substance Abuse, CASA, 2003)

26. Societal/Media Issues --Western culture idealizes thin women, and increasingly, thin men --Advertising, marketing and entertainment industries inundate children and adults with images of ideal beauty; a major force in the development of women’s body dissatisfaction, disordered eating attitudes and behaviors --commercial world -- diet, cigarette & alcohol industries have targeted women’s desire to be thin to promote their products (Food for Thought: Eating Disorders and Substance Abuse, CASA, 2003)