ATLANTA – Eating disorders and substance abuse often go hand in hand, and treatment of patients with both is often improved when there is a focus on body reclamation, Adrienne Ressler said at a conference jointly sponsored by the National Association of Addiction Treatment Professionals and the Medical College of Georgia.
Studies suggest that the prevalence of substance abuse in patients with eating disorders is eight times greater than in the general population and that the prevalence of eating disorders in substance abuse patients is five times greater than the general population, said Ms. Ressler, national training director at the Renfrew Center in Coconut Creek, Fla.
She noted that bulimia patients–who are more likely than anorexic patients to use drugs and alcohol–have higher suicide rates when they have comorbid substance abuse.
Eating disorders often appear to develop after a substance use disorder is treated, “but I'm not sure that the eating disorder wasn't always there … that the drive for thinness did not put some of these women on a path that got them hooked,” she said.
Drugs used to suppress appetite–alcohol, amphetamines, cocaine, diet pills, caffeine, and nicotine–are addictive, and some addictive drugs, such as laxatives and alcohol, can also be used to induce purging, she explained.
Regardless of which disorder comes first, or if the two are linked, concurrent treatment can be beneficial and is the current trend, Ms. Ressler said.
In her experience treating women, when the two disorders aren't treated together, one tends to get worse while the other improves.
A key part of treatment for women involves reclaiming the body.
This may seem paradoxical for eating disorder patients who are constantly obsessed with their bodies, but rather than living in their bodies, they are living in a world of images and recurring voices telling them how their bodies should look, Ms. Ressler explained.
It is important for them to take back the control, and doing so requires that they identify what they are longing for. Integrated mind-body medicine can be useful for this, she commented.
Massage, meditation, and “drumming” have been shown to be useful in these patients. As an adjunct to psychotherapy, meditation can promote general well-being, reduce anxiety and pain, and promote self-awareness and self-regulation.
This is important because there is growing evidence that compulsive eaters and chronic dieters are disengaged from internal self-regulatory systems of control and are overly influenced by external cues, belief, systems, and emotional signals, Ms. Ressler noted.
In one pilot study, meditation was used to reduce stress, and this lowered binge-eating episodes from 4 to 1.25 per week, she said.
In another study, massage performed on bulimia patients twice weekly for 5 weeks in conjunction with their therapy had an immediate beneficial effect on anxiety, depression, levels of serotonin and dopamine, and body image.
Rhythmic therapy, such as drumming, also appears to have soothing effects. It has been suggested that drumming can increase body awareness, build self-esteem, and strengthen impulse control, she said at the meeting.
These approaches to treatment can be beneficial in patients with eating disorder and substance abuse because the body is the controller in these patients, and they often come to hate their bodies because of that–the body can become the target for self-harm such as burning, skin picking, and self-cutting.
“These patients have an adversarial relationship with the body. … We need to help them calm the body and learn to self-soothe,” Ms. Ressler said.