Eating Disorders and Substance Abuse

Clinicians involved in substance abuse treatment have been aware for some time that women with alcohol or other drug abuse problems also frequently suffer from eating disorders. Some of the similarities, such as feelings of shame, need to hide the behavior, and the compulsive quality have led to speculations of an underlying common dynamic, and possibly to common organic predisposing factors. The treatment challenge is complex: One does not have the luxury of postponing the exploration of anxiety-producing issues until abstinence (sobriety) is well secured. Eating disorders are health threatening and some-times life threatening, and are frequently closely connected with the alcohol or other drug abuse pattern. This article focuses on bulimia and anorexia nervosa, omitting obesity because it is not characteristically associated with a distinct psychological or behavioral pattern (Norman 1984). It aims to clarify some of these issues and to provide recommendations to the treating clinician: guidelines on when to tackle the problem within the context of the substance abuse treatment and when to refer the clients elsewhere. It will also describe the major treatment approaches in the eating disorders field and offer criteria for selecting a program or therapist with whom to collaborate.