I just wrapped up the Lifestyle Intervention Conference in Las Vegas where I was proud to present with author Brian Cuban on the topic of body image and eating disorders in males. He started off our keynote talk by sharing his story of developing an eating disorder as a teenager and following it up with a multi-decade descent into the hell of multi-substance addiction along with his bulimia. His is a compelling story. But it’s not as uncommon as those in the audience initially thought.
Truth is, after Brian and I spoke, dozens of therapists and treatment program directors came up to us to share the story of men and women in their programs who were struggling with these very same issues. While the clients may initially seek treatment for a substance issue, both genders are coming forward with tales of current or past eating disorder behaviors that span the spectrum of the disease. What happens all too often in these treatment programs is the addiction is addressed but the eating disorder is not. These folks go home and are going to AA or NA while continuing to binge, purge, restrict and compulsively exercise to hold on to their sobriety.
The latest studies suggest that upwards of 40 to 50 percent of those in substance abuse treatment have an active eating disorder. That’s staggering. But they slip through the cracks. Finding free assessment tools to identify the women who are at risk or actively engaging in an eating disorder is rather simple. You can look up the EAT-26, an online screening tool that’s been around for decades. It won’t pick up binge eating disorder (BED), nor will it pick up males. There are other tools, such as the BED-7, which is free and online for those who want to assess for that disorder. But for men there’s nothing out there free. However, there is the Eating Disorder Assessment for Males (EDAM) which can be purchased and I recommend most programs do.
But here’s the rub – just because we are assessing appropriately for eating disorders doesn’t mean we are treating them. Proper training and supervision is a must, and substance abuse counselors admittedly feel at a loss when confronted with this condition.Though the bigger problem is not treating both disorders at the same time appropriately. I’ve heard it said time and again from one program or another that a person needs to be sober first before they will treat the eating disorder, and vise versa. What happens all too often then is a client will pendulum swing between the two behaviors. They both serve to numb them out, take them away from their issues, serve as tools of control and manipulation, and mask the underlying issues of depression, anxiety, self-loathing, trauma and neglect.
This past year a family won a lawsuite against a California substance abuse program for admitting their 20 year old son for his addiction and said they could handle his bulimia as well. Instead the young man binged and purged so much he died from an eloctrolyte imbalance that led to sudden cardiac death. Now, I also wonder if this had been a woman, would they have been so ambivalent about his eating disorder, but that’s for another conversation.
We can do better. We have to take a stance of radical acceptance that these clients need and deserve comprehensive care from a team that understand both addiction and eating disorders. It’s a terribly rocky road to travel, but when done together the outcome is worth it. Insurance has to cover both issues at the same time. Families have to learn the language of both disorders and be the support systems for their loved ones. And we have to train all clinicians in how to assess for the toxic mix of substance abuse and eating disorders so nobody else is allowed to pendulum swing between the disorders.
By Andrew Walen, LCSW-C - Founder, Executive Director, Psychotherapist at The Body Image Therapy Center. If you would like to get in touch with Andrew please call 877-674-2843 or email firstname.lastname@example.org.