Integrated Treatment Principles and Strategies for Patients with Eating Disorders, Substance Use Disorder, and Addictions

Abstract

Currently, there are no evidence-based treatments or established treatment protocols for patients that present with both eating disorders and substance use disorders/addictions. The lack of available integrated treatment programs, at all levels of care, has left the dually diagnosed patient vacillating between these two disorders. Eating disorder treatment programs frequently exclude patients with active substance use disorders, and addiction programs regularly exclude or do not effectively treat patients with eating disorders. Often, these patients are referred to addiction treatment programs prior to entering into eating disorder treatment. This approach is problematic, as both disorders are associated with high rates of relapse following treatment. Sequential treatments focus on the most acute disorder first, often utilizing multiple providers in different locations, with different theoretical orientations, staff training, and treatment protocols, which can make continuity of care quite difficult. Developing a comprehensive integrated approach to the treatment of comorbid patients will improve treatment delivery, reduce time in treatment, lower overall treatment costs, improve treatment outcome, and lessen consumer confusion. This chapter will provide

Correlates of co-occurring eating disorders and substance use disorders: a case for dialectical behavior therapy

“…Overall, results demonstrating a greater number of comorbid diagnoses for the ED-SUD group support the need for integrated treatment, which is consistent with recent calls from experts within the field (Dennis et al, 2014). DBT takes a behavioral approach, treating behaviors, regardless of their diagnostic association, according to a specific hierarchy.…”

“…Thus, traditional treatment programs have targeted EDs and SUDs sequentially. However, interest in integrated treatment approaches has grown (Dennis et al, 2014), and research indicates that patients who do not receive integrated treatment have poorer treatment outcomes (e.g., Drake et al, 2001). Nevertheless, there is limited research on what such an integrated approach should optimally target, and there is no consensus in the field about the best treatment modality for the ED-SUD population.…”

Genetic overlap between alcohol use disorder and bulimic behaviors in European American and African American women

“…Nevertheless, these findings underscore the importance of including AA women and examining eating disorder symptoms -- which are more prevalent in women -- in genetically-informative alcohol research. Clinicians must address eating disorders when treating AUD and vice versa, a practice that is routinely ignored (Dennis et al, 2014), in order to decrease detrimental effects associated with this comorbidity.…”

The Relationship between Eating Disorder Symptoms and Treatment Rejection among Young Adult Men in Residential Substance Use Treatment

“…However, there are no empirically validated treatment protocols or interventions that target both EDs and SUDs. 45 Treatment often is sequential, with the most severe disorder being treated first, which is costly and ineffective. 45 There has been a growing emphasis on developing treatments that effectively target both disorders.…”

“…45 Treatment often is sequential, with the most severe disorder being treated first, which is costly and ineffective. 45 There has been a growing emphasis on developing treatments that effectively target both disorders. Hail et al 46 proposed an integrated cognitive behavioral therapy (CBT) that incorporates aspects of CBT for substance use and EDs.…”