naadac 2013 atlanta eating disorders – addiction or psychiatric

NAADAC 2013 ATLANTA
EATING DISORDERS – ADDICTION OR PSYCHIATRIC
ILLNESS?
“All truth passes through three stages.
First, it is ridiculed. Second, it is
violently opposed. Third, it is accepted
as being self-evident.” – Arthur
Schopenhauer German philosopher
(1788 – 1860)
 Addiction Or Psychiatric Model?
 Hospital / RTF / Outpatient Settings?
 “The Great Food Debate:
Intuitive Eating Or Structured Food Plan –
Anything Goes Or Eliminating The Offending
Substances / Foods? “Focus on Weight?”
 Dual And Tri-diagnosed Patients“What Are We Dealing With Here”?
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Tolerance
Withdrawal [Physical / Psychological]
More For Longer Periods Than Intended
Unsuccessful Effort To Cut Back Or Control
Significant Time To Obtain Or Recover From Effects
Decreased Activities Due To Dependency [Isolation]
Continuation Despite Consequences
Question: How Many Of The Above Criteria Need To Be Met To
Qualify As Dependency –Aka Addiction?
Answer: 3, 4, 5, 6, Or All ?
* ASAM
 Nature of Substance, Nature of Person, and
Dose / Longevity of abuse are the variables
 Destruction of D2 Receptors with Bulimia and
Compulsive Overeating: Reward Circuits
 Refined / processed foods = High Glycemic Foods =
Increase in Eating Disorders and related illnesses
[Diabetes/ CAD/ Obesity, etc]
 Factors: Sugar / Flour / Volume / Caffeine…Likely dose
dependent and idiosyncratic
 156 LBS.
That's how much added sugar Americans consume
each year on a per capita basis, according to the U.S.
Department of Agriculture (USDA). Imagine it – 31 five
pound bags for each of us per year!
 42 LBS. was the average per capita consumption in
the early part of the 1900’s.
 Increase has to do with processed foods / additives
[high fructose corn syrup, etc.] Grew by more than
20% [per capita] from ‘87 to ’97
[Look at History of Tobacco Industry]
 Anorexia will show
elevated levels of
dopamine after a meal
 Restricting anorexics will
experience elevated levels
of dopamine as
unpleasant – anxiety
provoking
 Anorexics have a
tendency to dislike effects
of stimulants or
dopamine enhancing
drugs
 Binge Eating / Purging
will show elevated levels
of dopamine but few D2
receptors
 Binge eaters will
experience elevated levels
of dopamine as rewarding
/ pleasant
 Higher incidence of cross
addiction / abuse to both
alcohol and drugs as
effects are “pleasant”
U. Bailer– UCSD 2012 – Int’l Journal Eating Disorders
 Addiction is a primary, chronic disease of brain reward,
motivation, memory and related circuitry.
 Dysfunction in these circuits leads to characteristic biological,
psychological, social and spiritual manifestations. This is
reflected in the individual pursuing reward and/or relief by
substance use and other behaviors.
 The addiction is characterized by impairment in behavioral
control, craving, inability to consistently abstain, and diminished
recognition of significant problems with one’s behaviors and
interpersonal relationships. Like other chronic diseases, addiction
involves cycles of relapse and remission. Without treatment or
engagement in recovery activities, addiction is progressive and
can result in disability or premature death.
 Most Frequent Problems Accompanying
An Eating Disorder
• Mood Disorders [Clinical Depression, Anxiety Disorder, Bi-polar]…
Estimate 70-90%
• Substance Abuse / Dependency [Alcohol, Rx Drugs, Etc.]
Estimate 40-60%
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Personality Disorders [OCD, BORDERLINE] …
Estimate 20-30%
 Attention Deficit Disorders [ADD OR ADHD] …
Estimate 20-30%
 Compulsive Disorders And “Process Addictions”
− Gambling
− Sex / Multiple Relationships
− Spending / Shoplifting
− Compulsive approach to work, school, etc.
[perfectionism]
 Self Injury … Estimate 10-20%
 PTSD – History Of Sexual Or Emotional Trauma …
Estimate 40-60%
 Adderal and ADD / ADHD Medications
[Abused For Appetite Depressant Properties]
 Xanax, Ativan, Klonopin / Opiates
[Abused for appetite Suppressant Properties]
 Laxatives - Correctol, Ducolax, Etc./ Ipecac
[To Induce Emesis] / Exercise
 Sugar / White Flour / Volume
[Leading To Dopamine And Insulin Responses]
 Alcohol
 Drugs – Cocaine, Opiates, Amphetamines. Nicotine,
Caffeine [ Appetite Suppressant]
 Nicotine – Fear Of Weight Gain – Obstacle to Quitting
Nicorette [Used for Weight Loss]
 Process Addictions / Compulsive Behavior
[Shopping, Sex, Work, Gambling]
 Switching Forms Of Eating Disorders
-
Bulimia Solution Becomes Restricting
- Binge Eating Becomes Binging And Purging, Etc.
 Assumes an underlying issue requiring insight and
“working through” or “cognitive “restructuring” as a
prerequisite to recovery
 Approaches food / weight issues via “intuitive” eating
and/or learning to control either binge foods or
“forbidden / bad / high calorie” foods
 Does not ascribe to an “addictions” model and often
describes successful treatment as a “cure” rather
than “remission”: Not a life-long illness
 Poorest means to measure acuity of an eating
disorder is body weight. [DSM]
 Most effective way to assess an ED to the extent that
ED interferes with quality of life and functioning
[physical, emotional, spiritual]
 Tendency to “Switch positions on the Titanic” –
Bulimia to Restricting or Anorexia to Binge Eating
 Belief that “working through issues” is key [must
resolve “underlying issues” in order to be cured]
 Assumes ED is an addictive process with physical,
emotional, and spiritual [existential] components
 Assumes “disease” is life-long with periods of
prolonged remission and often punctuated by
relapses followed by continued recovery
 May incorporate CBT, DBT, Mindfulness, Medication,
and relevant 12-step community based support
groups when indicated
 Does not offer a “cure” and requires a lifelong
commitment to recovery
 Usually involves a structured food plan which limits or
eliminates “binge foods” / addictive behaviors [rituals]
 May not be suitable for “Restricting Anorexics”
with no history of “addictive relationship with food
or purging”
 Usually involves a need to treat cross-addictions and
“dual and tri-diagnoses” concurrently
“One Size Does Not Fit All”
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Inpatient (Hospital Based)
Residential (Non-Hospital Based)
Partial Hospital (Day Treatment)
Intensive Outpatient (Half-Day Treatment)
Outpatient (Therapist, Dietician, etc.)
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Blended Medical / Addiction Model
Role of Medication
Mindful Eating Model
Structured Food Plan
Cognitive Behavioral Techniques
“Constructive Living Model”
Treatment of Dual and Tri- Diagnoses
Therapeutic Environment
Into the Solution…
 Prescribed by a dietician familiar with eating
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disorders
Often involves weighing, measuring and
monitoring amounts
Schedule of eating 3 to 5 times daily
Limits or eliminates junk food
Focus on “mindful” eating
Blind “weights” monitoring
S.E.R.F. – Components
 S = Spirituality
 E = Exercise
 R = Rest
 F = Food Plan
Individual Rx for each of these components
depending on ED specifics
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MILESTONESPROGRAM.ORG - 800 347. 2364
ED Support Group PA, NY, FLA [800-347-2364]
OA (Overeaters Anonymous) OA.ORG
ABA (Anorexics and Bulimics Anonymous)
ANAD Support Groups
EDREFERRAL.COM
Guide to ED Recovery – download at iBooks [Free]
Discussion? Questions?
For information / Milestones in Recovery Program:
 MLERNER@MilestonesProgram.org
 800 347. 2364
800 347-2364