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On the path towards health and healing, it’s important to help people address their eating disorder and substance abuse simultaneously.

Some individuals with eating disorders also struggle with an addiction to alcohol and/or drugs. Given the interplay between the two disorders, a heightened risk for serious medical consequences, and the potential for symptom substitution, it’s very important to address both disorders simultaneously. The Center for Eating Disorders at Sheppard Pratt recognizes this need and provides patients with a specialized treatment track that integrates targeted treatment for both the eating disorder and the substance abuse.

Substance Abuse Disorders

Substance abuse disorders involve maladaptive patterns of substance use that lead to significant impairment or distress in one or more of the following ways: [source: DSM-V]

a)    A failure or inability to fulfill major role obligations at work, school or home
b)    Recurrent use of a substance in situations that would be hazardous such as while driving, supervising small children, or operating machinery
c)    Recurrent substance-related legal problems
d)    Continuing to use a substance despite persistent interpersonal or social problems that result from using the substance

Eating disorders and substance use are similar in that individuals often have an extremely difficult time refraining from the behavior or the substance, despite negative social, physical and psychological consequences. Substance abuse disorders can be related to illegal substances or the abuse /misuse of over-the-counter and prescription medications. These are just some of the common drugs of abuse:


  • Alcohol
  • Nicotine
  • Inhalants
  • Marijuana
  • Club drugs
    (i.e. Ecstasy, LSD, PCP)
  • Heroin
  • Cocaine
  • Depressants
  • Anabolic Steroids
  • Caffeine
  • Diet Pills
  • Diuretics
  • Laxatives
  • Prescription Medications
  • Over-the-counter medications

Abuse of substances such as laxatives and diuretics is fairly common among individuals with eating disorders. Use often begins with a misguided notion that these substances will facilitate weight loss.   Not only are these substances ineffective at promoting weight loss, abusing them can actually cause increased bloating, weight gain and chronic abdominal pain in addition to a number of very serious health problems. As is the case with many of the substances listed above, abuse often leads to a physical dependency on the substance.  As the body develops a tolerance to the substance the individual requires a larger amount to elicit the same results, and the cycle of addiction and abuse escalates.

Dual Diagnosis: Eating Disorders & Substance Abuse

About half of all individuals with eating disorders also struggle with a substance use disorder.  Research has shown that the risk for substance use disorders is highest among those with bulimia nervosa and those engaging in binge/purge behaviors, but substance abuse can occur alongside any type of eating disorder. There are various perspectives on the overlap between these two disorders and what causes them to occur together so frequently.  Generally, eating disorders and substance abuse are both considered biopsychosocial illnesses, meaning that they are believed to be a result of a combination of factors including genetics, biology, personality traits, social experiences, and family and cultural influences.  Part of the recovery process for both disorders may involve a personal and individualized exploration of the factors that may be contributing to the person’s illnesses.

Throughout this recovery process it’s also important to understand how the two disorders affect each other.  For example, substance abuse often amplifies innate personality traits such as impulsivity and mood instability which can make recovery from an eating disorder even more difficult.  Substance abuse also increases nutritional, hepatic, gastrointestinal, cardiac and neurological consequences of malnutrition in patients with eating disorders.  Furthermore, individuals who are treated for eating disorders without receiving substance abuse treatment, or vice versa, are at high risk for symptom substitution.  Symptom substitution, or switching from one problematic behavior to the other, can occur during the recovery process as an individual is able to refrain from acting on eating disorder symptoms but increases substance use as a way to cope with feelings or situations that used to trigger eating disorder behaviors.  Symptom substitution can create significant roadblocks in the recovery process.  At The Center for Eating Disorders, we encourage the development of healthy coping skills and tools that enable individuals to heal from substance abuse and eating disorders simultaneously.

Integrated Treatment helps individual move towards a full recovery

The Center’s Inpatient Program and Partial Hospital Programs offer a specialty track for patients who struggle with substance abuse and addiction issues. Individuals utilizing this specialty treatment track receive two, 3-hour blocks of group therapy each week dedicated specifically to the management of the substance use.  Each three-hour block consists of a 12-step component focused on the substance abuse.

In addition to helping patients learn how to manage their concurrent disorders, the Substance Abuse specialty track focuses on the relationship between the two disorders, understanding symptom substitution, and provides individuals the opportunity to develop an addiction recovery plan. This specialty track helps patients to identify coping skills to manage the co-concurring disorders, explores motivation to change and helps patients identify additional resources to aid in relapse prevention.

The specialty groups consist of psychoeducation, art therapy and process groups and the following topics are covered:

Understanding Addictive Behaviors:  Patients discuss the definition of addiction, as well as the stages of addiction. In addition, statistics on addiction are provided for patients. Patients also assess their use of defense mechanisms, as well as stages of denial.

  • Symptom substitution and recovery plans are evaluated. Patients also assess their support systems and motivation to change.
  • Patients look at the impact of addiction on the self. In addition, they discuss the impact of addiction on their loved ones. Patients are educated on codependency.
  • Patients assess powerlessness, as well as address their thoughts and identification with a higher power.
  • Triggers for relapse are identified and discussed. Relapse prevention techniques are taught and processed with group members.

If you have any questions about the Substance Abuse Specialty Treatment Track, please don’t hesitate to call us at (410) 938-5252.

Free Weekly Support Group

Join us each week from 7:00 to 8:30 PM for a recovery-focused support group open to anyone struggling with any type of eating disorder as well as friends, family and support people. This group is FREE and facilitated by a licensed clinician.

Every Wednesday

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#LetsCheckIn VIDEOS

These four video vignettes provide examples of real-life interactions, negative self-talk and disordered eating behaviors that indicate it might be time to check in more closely with a friend or family member.

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Free Weekly Support Group

Join us each week from 7:00 to 8:30 PM for a recovery-focused support group open to anyone struggling with any type of eating disorder as well as friends, family and support people. This group is FREE and facilitated by a licensed clinician.

Every Wednesday

Find out more