Caging the Lion – Treatment Substance Addictions in Eating Disorder Treatment
It has been said that recovering from a substance addiction is like caging a lion. Overcoming an Eating Disorder is like caging a lion and then taking it for a walk several times a day. Food is something which we cannot simply avoid, we need it to live, so rather than simply locking it away, we need to learn to work with it.
Eating disorders and substance addiction often occur simultaneously. Both are such challenging issues to recover from that sometimes the prospect of doing so is quite daunting. There has been a long-standing, and somewhat outdated believe that a person’s substance addiction must be treated first, before they can work on any other issue such as an Eating Disorder. However, the nature of these conditions is such that you really cannot treat one successfully without treating the other simultaneously. This is in part due to a phenomenon called symptom substitution or symptom switching, in which once the symptoms of one condition are contained, the symptoms of the other condition escalate. Itcreates this game of whack-a-mole where a person is constantly trying to suppress different symptoms as they come up. It is challenging and frustrating not only for them, but for treatment providers helping them.
In addition, what makes treating these two co-occurring conditions so tricky is that they both serve a similar function psychologically, which must be addressed. Beyond being a physiological addiction, both substance abuse and eating disorder behaviors have a numbing characteristic whereby they attempt to prevent a person from experiencing psychological pain. Part of the treatment process is providing individuals with alternative skills and developing the ability to cope with psychological pain without the use of these self-destructive numbing behaviors. If one is only chasing symptoms, it is practically impossible to make sustainable progress, which may account for the high relapse rate involved in these conditions.
So how do we treat these issues simultaneously? How can we cage the lion and gently leash it up to take it for a stroll around the neighborhood? For cases in which the behaviors exist and cannot be reduced without external containment, eating disorder residential treatment is extremely helpful. Through the format of residential eating disorder treatmentat Cielo House, offer containment not only for the eating disorder behaviors but also for substance abuse and other addictive behaviors. Unfortunately, the reverse is not true of substance abuse residential treatment. We have heard from many of our clients who have been in substance abuse residential programs that once they were blocked access to the substances, their eating disorders escalated because of the symptom substitution phenomenon.Which is not to say that this is the fault of substance-abuse treatment, it’s just not what it was designed to do. But because of the way Eating Disorder treatment at Cielo House is designed, we can successfully treat both issues. For example, we provide a substance-free environment to ensure sobriety, then as the eating disorder behaviors escalate we provide containment and treatment for them. To provide substance-specific treatment, we adjunctively connect clients into the 12-step community in the area. We also have specialized addiction groups within our therapeutic curriculum and because of our engaging, experiential approach using nature and creativity, clients learn that there are natural ways to cope without the use of extreme behaviors. Once a person in treatment is allowed to experience the psychological pain and emotions they have been avoiding without using self-destructive behaviors to numb from it, they see that they can handle it without them.
Caging lions is not easy, but through a treatment approach that simultaneously treats them all at once, individuals don’t just tame the lion, they actually make peace with it.
By Matt Keck, MFT
Cielo House Founder and CEO