Understanding connections between eating disorders and opioid addiction
Note: This article, written by Laurie Loisel, originally appeared in a Hampshire Gazette column on March 26, 2018.
Common wisdom might have it that disorders such as anorexia and bulimia have absolutely nothing in common with opioid addiction. That is wrong — and those on the front lines of the opioid crisis are starting to take notice.
According to statistics presented this month at a workshop in Northampton, 33 percent of people with a substance use disorder also have an eating disorder — a rate that is 11 times higher than the general population. Nearly 50 percent of individuals with an eating disorder also suffer from substance use disorder, a rate five times greater than what’s seen in the general population.
Another telling statistic: In a study of 204 women receiving inpatient treatment for substance use disorder, 20 percent reported having experienced an eating disorder at some point in their lives.
Treatment professionals gathered this month for a workshop sponsored by Hampshire HOPE, the county-wide opioid prevention coalition run out of the Northampton Health Department, and Walden Behavioral Care. Walden, which operates a clinic in Amherst, treats all types of eating disorders in clinics and residential centers in Massachusetts, Connecticut and Georgia.
“We see these overlaps: the stigma; the ‘Why can’t you just quit’ mentality; the risk factors; recurring relapse,” said J. Cherry Sullivan, Hampshire HOPE coordinator, who opened the session March 9 at the Union Station Grand Ballroom. “These were two topics that we were working on in silos. We hope this is an opportunity to explore what we do about that.”
About 40 people, some of whom work with people suffering from a variety of eating disorders, and others deep in the struggle to turn back the tide on opioid-related deaths, attended the two-hour workshop. A board-certified addictions physician and representatives of Walden Behavioral Care outlined factors shared by the disorders that to an unpracticed eye might seem worlds apart.
One is that both start out as coping mechanisms that go awry, said Fiona LaRosa-Waters, community relations specialist at Walden. They may start innocuously, even as a source of pleasure but they become compulsive, harmful, and in some cases, life-threatening.
“All of this serves a purpose,” LaRosa-Waters said. “It works until it doesn’t.”
Very often, she noted, people bounce back and forth between disorders.
“When one coping strategy is taken away, another one pops up, and if we are not building up the adaptive strategies the maladaptive ones pop up,” she said.
Other traits eating disorders share with substance use disorders: Often, they are secretive, chronic and obsessive. They have high relapse rates and are difficult to treat. They carry increased risk of suicide, depression and social isolation.
Surrounding these disorders is misunderstanding that leads to stigma.
“We have to remember this is not a choice,” said Joanna Imse, assistant program director of Walden’s Amherst clinic.
Dr. Omar Faruk, founder and CEO of Right Choice Health Group, a Springfield-based medication-assisted treatment facility with several clinics in Hampden County, underscored her point.
“Addiction is a chronic relapsing brain disease,” he said. “We cannot ignore that.”
Faruk noted that between 2000 and 2016, 600,000 people in the United States died of opioid-related deaths. In 2016 alone, 64,000 people died.
“These are people’s sons, daughters, loved ones, person with addiction — not addict.”
In the 2017 Surgeon General’s Report “Facing Addiction in America,” former Surgeon General Dr. Vivek H. Murthy declares the United States to be in the midst of an addiction crisis, making the case that prevention, treatment and recovery programs must be a top public health priority nationwide.
“Making this change will require a major cultural shift in the way Americans think about, talk about, look at, and act toward people with substance use disorders,” the report states. “Negative public attitudes about substance misuse and use disorders can be entrenched, but it is possible to change social viewpoints,” it goes on. “This has been done many times in the past: For example, cancer and HIV used to be surrounded by fear and judgment, but they are now regarded by most Americans as medical conditions like many others.”
One aspect of this culture shift will be creating opportunities for medical and behavioral health practitioners to discuss the work they do, the ways different disorders impact one another and the treatments that work best. Treating people struggling with both substance use and eating disorders can be complicated, especially if one of the disorders remains hidden. This means providers need to ask questions that will uncover the fullest picture possible.
La Rosa-Waters said she was stunned by data that showed the prevalence of people with eating disorders who also suffer from substance use disorders.
“Really looking at that — half of our population — that’s mind-blowing,” she said.
When people are dealing with two disorders, an important consideration is what to focus on first.
“We have to look at both, said Imse. “What is the most intrusive medically; is there anything about either presentation that requires a higher level of care? It’s not that one is more important than the other, it’s simply is there one that is causing a higher level of harm at this moment.”
Panelists agreed that the best defense against both is prevention, which means finding ways to address underlying conditions that might lead to addictive patterns. A tall order, but the “addiction crisis” the former surgeon general refers to calls for collaboration and cross-training.
And that is what Hampshire HOPE is all about. Its big-tent approach pulls many sectors to the table to seek solutions together.
Laurie Loisel is director of community outreach and education for Northwestern District Attorney David E. Sullivan and part of the Hampshire HOPE opioid prevention coalition run out of the city of Northampton’s Health Department. Members of the coalition contribute to a monthly column in this space.