How Is Food Addiction Addressed at U.S. Substance Use Disorder Treatment Facilities? Perspectives of Service Providers

Background: Substance use disorders (SUDs) are a leading public health concern in the United States. Food addiction (FA), as a common comorbidity or substitute addiction of SUDs, is not currently a fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnosis, with overlaps with SUDs and eating disorders (EDs). How FA is addressed in SUD treatment is understudied. Methods: Cross-sectional survey interviews with service providers (N = 85) from 68 SUD treatment facilities across 20 U.S. states asked an open-ended question on how FA was addressed. Descriptive statistics of FA prevalence were reported; Chi-square tests were used to assess bivariate associations between facility funding sources, FA treatment, and referral availability. Thematic analysis was conducted to identify emerging over-arching themes regarding FA-related practice. Results: Eight themes were identified: formal treatment offered at the facility; no treatment; referral for treatment; education; screening; monitoring; comorbidities or triggers of FA; and potential misunderstandings of FA. Among the 80% of facilities observing FA issues, 29% provided explicit/formal treatment, and 53% made referrals to ED treatment facilities. Facilities that accept insurance ( P = .046) and self-pay ( P = .008) were more likely to make referrals. Methamphetamine use, substitute addiction, trauma, homelessness experience, and malnutrition were potential FA triggers. Potential misconceptions about FA and EDs may undermine appropriate treatment. Conclusions: Formalizing FA assessment and diagnosis, and improving reimbursement mechanisms, may reduce potential health inequities between market-driven and publicly funded SUD treatment centers in FA treatment and referral resources. More training on FA, integrating evidence-based FA screening, monitoring, and treatment measures, is warranted to improve holistic SUD treatment quality and outcomes.