Unraveling the complexity of eating disorders and addictions

Risk factors can be countered through specialized treatment

The genetic information that contributes toward a student's natural abilities and talents may not only be a key risk factor in whether they develop psychiatric problems, but may also affect how they are able to withstand emotional distress. For young people who come from homes where parental addiction is present, there is also a greater chance that they may develop an eating disorder, a substance-use disorder or both.

Students who are at risk for depression, eating disorders, or substance-use disorders can learn to recognize the signs and seek help earlier in their lives. In addition to changes in routines and appearance, school professionals and parents should be aware that isolation, withdrawal from social activities and changes in mood can indicate a serious problem. When students with eating disorders or addiction are confronted about these changes, they may minimize the effects of their behaviors or deny that there is a problem. Specialized treatment at a 24-hour facility can help identify and address the issues preventing a student's recovery from disordered behaviors.

Specialized treatment addresses complex disorders

Theodore Weltzin, MD, FAED, is the medical director of Eating Disorder Services at Rogers Memorial Hospital in Wisconsin. Each year, he and his team of eating disorder specialists provide treatment for hundreds of adults and adolescents with eating disorders. A portion of these patients also have a significant history of substance use or addiction, severe anxiety, or depression. They seek treatment at Rogers' Eating Disorder Center, which provides residential treatment for eating disorders for people who need of this level of care. Patients reside in the facility for 45-60 days, have therapeutic outings in the community, and receive treatment in separate groups, depending on their gender, age and specific diagnosis.

Dr. Weltzin explains that in order for people to have the best chance at long-term recovery, they need treatment that addresses the complexity of their disorder. "These disorders are complicated, but can be treated with the right combination of treatment team members," he said.

Dr. Weltzin and his team work unravel complex symptoms and behaviors to find the best treatment plan, based on the contributing factors of each person's illness. "In many cases the development of an eating disorder would not be uncommon, based on their physiology and experiences. We help them learn to recognize their behaviors and develop healthy coping techniques," said Dr. Weltzin.

Individualized treatment plans allow patients to work with specialized therapists and participate in group therapy with others who have similar disorders, including co-occurring psychiatric and substance use disorders.

Michael M. Miller, MD, FASAM, FAPA, is the medical director of the Herrington Recovery Center, a facility that provides treatment for addiction at Rogers, where he oversees the residential treatment of persons who have a primary diagnosis of addiction. As a board-certified addiction psychiatrist and addiction medicine specialist, he has seen cases where patients use stimulants as an appetite suppressant, and then find themselves unable to stop using after developing an addiction. Dr. Miller knows that if he treats the addiction without addressing the eating disorder, the chances for a relapse are very high.

"A number of patients with bulimia or anorexia will misuse addictive drugs like appetite suppressants or cocaine, and some of those people don't have addiction, they just have a pattern of misuse," said Dr. Miller. "But if somebody with an eating disorder is predisposed to addiction through genetics or otherwise, and they begin to misuse stimulants, they can develop an addiction and need treatment for both problems."

Finding the most effective treatment

Dr. Weltzin, Dr. Miller and other specialists at Rogers work together to find the most effective treatment path for those who have developed co-occurring disorders. They frequently see people with anxiety disorders and include cognitive-behavioral therapy (CBT) in their treatment plans because CBT has been shown to be especially effective for treating anxiety disorders as well as addiction and bulimia. Dr. Weltzin notes that at the Eating Disorder Center, patients with co-occurring eating disorders and OCD or severe anxiety may dedicate 20 hours of their week to CBT.

Transitional treatment supports recovery

Dr. Miller emphasizes that the work patients do at Rogers is only the beginning. Once people leave, the important work of recovery begins, so the treatment teams at Herrington make sure each patient has a personal recovery plan. "The last thing you want to see happen is to have a co-occurring condition destabilize the person and lead to relapse," said Dr. Miller. "They are really vulnerable if you don't shore them up before they're discharged, or transition them to a partial program where they can solidify their relapse prevention program."

Dr. Weltzin and Dr. Miller agree that people who develop eating disorders and substance-use disorders generally begin showing symptoms and disordered behaviors at a relatively young age. Because of the life-threatening impact these disorders can have, the benefits of early treatment directly affect the person's chances for long-term recovery and a productive adult life.

"During treatment they can re-examine their relationship with meals, with food, with their family," said Dr. Weltzin. "They learn to nourish themselves as part of their recovery." "Nourishment is physiological, of course, with meal planning developed with registered dieticians at Rogers who have vast experience with eating disorders," Dr. Miller added, "but our treatment teams provide psychological nourishment to promote recovery as well."

Article Contributed by Rogers Memorial Hospital

© 2010 Screening for Mental Health, Inc.