Chief Medical Officer Dr. Joel Jahraus, MD, FAED, CEDS is well-known and respected for his two decades of specialization in the medical management of patients with eating disorders. A board-certified physician for over 30 years, he is a recognized expert on diabetes and the medical complications of eating disorders. In this week’s blog post, Dr. Jahraus shares his insight and knowledge regarding diabulimia, a contemporary term for individuals with both Type I diabetes and an eating disorder where the individual purges by withholding his or her insulin.
1. How would you define diabulimia?
Diabulimia is a contemporary term for individuals with Type 1 diabetes and an eating disorder where the individual purges by withholding his or her insulin, thereby, making food ingested ineffective for use by the body. This action results in weight loss and severe systemic complications, including diabetic ketoacidosis which is potentially lethal.
2. Do you consider diabulimia to be a real diagnosis, or just a way to describe a variation of bulimia (since it is not specifically in the DSM 5)?
It is a contemporary word that bridges the terminology between diabetes and bulimia, but is not stated specifically as diabulimia as a mental health diagnosis in the DSM V.
3. How common is this type of eating disorder? Especially for women?
I co-chaired an international consensus panel on this evolving illness in 2009 in Minneapolis, MN. In doing that literature search we found it exists in the following percentages among different age populations:
2% of preteen girls
11-15% of midteen girls
30-39% of late teen girls
4. What are the top signs of this eating disorder?
The typical presentation is similar to other eating disorder patients with body image issues, and other mental health concerns. However, the difference is these individuals “purge” by withholding their insulin. Insulin is important in effectively utilizing calories ingested for health. Without insulin the body does not utilize these calories and the individual loses weight; the net impact is similar to anorexia or bulimia. However, the typical complications of diabetes are then much accelerated and the mortality or death rate from premature death increases dramatically:
Mortality rates (Nielson 2002):
Type 1 DM: 2.5%
Anorexia nervosa: 6.5%
Combined Type 1 DM and Anorexia nervosa: 34.8%
For November’s edition of First Wednesdays at OPC, Oliver-Pyatt Centers Director of Food Services Lissa Garcia, RD, LD/N and Clementine adolescent treatment program Nutritionist Alyssa Mitola, MS, RD, LD/N will present “The Kitchen’s Perspective: Creating a Safe Place Through Supported Exposures and Skill Development in the Treatment of Eating Disorders”. The presenters aim to enable the modern eating disorder clinician to empower clients using cooking and kitchen exposures. Through hands-on supported experiences, unaddressed issues can be revealed, allowing for moving corrective experiences and true peace with food. Discussion will include how co-occurring conditions impact the planning and approach for successful experiential activities. Attendees will learn different ways the eating disorder presents in the kitchen setting and key points of exposure support.
Through this presentation, participants will be able to identify three different kitchen exposures that can be utilized in the treatment of eating disorders, name two interventions to reduce anxiety during cooking exposures and define two co-occurring conditions that impact approaches to cooking exposures.
Breakfast begins at 9 am and the presentation will be from 9:30-10:30. 1 CE hour will be offered for: PhD, PsyD, LMFT, LMHC, LCSW, LPCC, and RD. If you would like to join OPC’s First Wednesdays on November 2nd, please RSVP to Florida Outreach Manager Callie Chavoustie at email@example.com or RSVP here by October 31st.
Dr. Stacey Rosenfeld is a licensed psychologist, certified group psychotherapist, certified eating disorder specialist, and the author of “Does Every Woman Have an Eating Disorder? Challenging Our Nation’s Fixation with Food and Weight”. Her work also focuses on substance use disorders, anxiety and mood disorders, fertility challenges, relationship concerns, and sport and exercise psychology. In addition to directing Gatewell Therapy Center in Miami, she is a cooccurring (eating disorders and addictions) consultant at Oliver-Pyatt Centers. Dr. Rosenfeld works with individuals, couples, families, and groups, using cognitivebehavioral therapy (CBT), dialectical-behavioral (DBT), psychodynamic therapy, and motivational interviewing approaches.
A significant percentage of those with eating disorders also struggle with alcohol and substance use disorders. In 2003, the National Center on Addiction and Substance Abuse issued the seminal report, “Food for Thought: Substance Use and Eating Disorders,” which highlights this relationship. (1) The report found that:
Individuals with eating disorders were up to 5 times as likely as those without eating disorders to abuse alcohol or illicit drugs, and those who abused alcohol or illicit drugs were up to 11 times as likely as those who did not to have had eating disorders. Specifically, up to 50% of individuals with eating disorders abused alcohol or illicit drugs, compared to 9% of the general population. Conversely, up to 35% of individuals who abused or were dependent on alcohol or other drugs have had eating disorders, compared to 3% of the general population.
Other research has offered similar findings. Struggling with an eating disorder or a substance use disorder increases one’s chances of developing the other disorder.
It appears that the most highly correlated eating disorder with substance misuse is Bulimia Nervosa (BN). A 2007 largescale study found that those with BN had a higher lifetime comorbidity estimate of substance use disorders (SUD) than those with Anorexia Nervosa (AN) or Binge Eating Disorder (BED). (2)
A more recent study documented a similar finding, with patients with BN using alcohol/other substances more commonly than those diagnosed with ANR (Restricting Type), BED, or Eating Disorder Not Otherwise Specified (now called Other Specified Eating and Feeding Disorder). This study also found that patients with ANBP (Binge Eating/Purging Type) used alcohol/substances with greater frequency than those with ANR and that participants’ frequency of binge eating and purging varied with the frequency of their substance use. (3)
Why might eating and substance use disorders so commonly cooccur? Let’s take a look at some possible explanations:
Common genetic underpinnings: We know that both eating disorders and substance use disorders have significant genetic components. Is it possible that the same genes are responsible for both disorders? One study suggests so. A 2013 twin study found significant genetic correlations between alcohol dependence and, in this case, binge eating, as well as between alcohol dependence and the use of compensatory behaviors (e.g., purging, use of laxatives/diuretics). The authors concluded that alcohol dependence and the tendency to engage in binge eating and compensatory behaviors are influenced by common genetic factors. (4)
Common psychological factors: Psychology and behavior are influenced by genes, biology and the environment. Those who struggle with eating disorders and alcohol/substance problems often have difficulty managing emotions and/or trouble with impulse control – both disorders may reflect these challenges. Symptoms of these disorders may serve a similar function in helping individuals selfmedicate anxiety, trauma, depression, etc.
Some substances are used specifically in the service of an eating disorder. Many patients report using substances to aid in restriction, bingeing, and purging. Even if unintentional, the frequent use of alcohol/drugs can lead to eating disorder symptoms, which, if unchecked, can spiral into disorder.
Using substances to cope with eating disorders symptoms: When asked to discuss the relationship between their eating disorders and alcohol/drug misuse, patients typically comment on the use of alcohol/drugs as a mechanism to “quiet” their eating disorders, particularly body image distress. What begins as a (maladaptive) coping strategy becomes its own disorder.
Symptom substitution: Many patients report that as they try to reduce their reliance on eating disorder symptoms (or alcohol/drugs), symptoms of the other disorder increase. We often discuss this as the “WhacAMole” phenomenon take away one behavior, and another develops/strengthens in its place. Symptom substitution highlights the importance of addressing both disorders simultaneously.
Some of the same approaches can be used to treat eating disorders and substance use disorders. These include CBT, DBT, family therapy, motivational interviewing and targeting other co-occurring conditions, including mood disorders, anxiety, trauma, self injury, etc. When eating disorders and substance use disorders co-occur, it is crucial that they be addressed in tandem to prevent symptom substitution or symptoms of one disorder triggering the other. Further, even moderate use of alcohol/drugs might impact those in eating disorder recovery, with many substances interfering with hunger/fullness cues and impacting judgment, impulsivity and emotion regulation. Patients with eating disorders who do not have co-occurring substance use disorders might still opt for a period of alcohol/drug abstinence until they are more stable in their eating disorder recovery.
3 http://onlinelibrary.wiley.com/doi/10.1002/erv.2410/abstract?userIsAuthenticated=true&deniedAccessCustomised Message=
Karin Lawson, PsyD is a licensed psychologist who is passionate about helping people create change in their lives through self-reflection, self-compassion, new perspective and new ideas. In her writing, Dr. Lawson offers some useful tips to help combat the fear you might be facing.
Fear is a feeling, but it’s one that is incredibly powerful and can stand in our way like no other. It is not always rational . . . most of the time it’s not, yet it is all too real and intense none the less. When someone is struggling with an eating disorder, may times common everyday fears are ramped up and intensified. Reasons for this amplification can include co-morbid anxiety disorder(s), poor sleep and malnutrition both of which impact our physiological experience of fear, faulty core beliefs, history of trauma (both big T and little t) to name a few. If you’re set up for a major battle with fear, take heart, because there are some choices you can engage in to help make it a little less overwhelming.
In the recent Ghost Busters remake, it wasn’t a lone person but a group of kick butt, like-minded women who faced their fears together. So find your recovery-oriented tribe. Join a psychotherapy group, find a pro-recovery Facebook group or reconnect with those who have supported you in the past. When people are standing together, there’s more courage, less fear. You don’t need to do this alone.
Find your safe space. Whenever we’re venturing out of our comfort zone, facing fears and taking risks, we also need that nurturing, soothing safe space to rejuvenate and recover. This could be a comfy chair with headphones and blanket nearby or a spot under a tree where you take your journal and your dog. Your safe space is yours, so only you know what makes sense, but take some time to recognize it and make it happen. Many times in therapy we talk about an imaginary safe space, which is still legit support, but I also encourage you to find that literal space where you can let your hair down and relax in a tangible way.
Find inspiration from risk takers out in the world. Find those people those are conquering their fears. These don’t always need to be related to eating disorder recovery. Look for those people out there in life. Whether it’s conquering the fear of traveling alone or applying for a school that has always tugged at their heart, people are out there doing it and writing about it. Find them and hear their truth. My bet is that they were not fearless, but balancing the opposing concepts of fearfulness and courage. This is another way to recognize that you are not alone in this. The exact fears may be different, but the feeling is the same. Know that it can be done. Fear does not have to lead.
Here are some of my favorite fear busters when I need a courage boost.
Brene Brown’s Courage Works http://www.courageworks.com/
The Courage 2 Create Blog http://thecourage2create.com/
100 Days Without Fear http://100dayswithoutfear.com/
For more information about Oliver-Pyatt Centers, Clementine adolescent treatment programs and Monte Nido, please call 866.511.HEAL (4325), visit our website, subscribe to our blog, and connect with us on Facebook, LinkedIn, Twitter, and Instagram.
Medical Director of Oliver-Pyatt Centers Joel Jahraus, MD, FAED, CEDS specializes in medical management of patients with eating disorders. He has been a board certified physician for over 30 years and is a recognized expert on diabetes and the medical complications of eating disorders. Dr. Jahraus shares his experience of treating patients with comorbid disorders. He explains how he uses a systematic approach in order to establish a strong rapport with the patient and then is able to assess and treat the complex case.
Over many years of treating medical complications of eating disorders I have watched an interesting trend of patients claiming to have more and more medical comorbid disorders. In fact it is not uncommon for me to see someone who says they struggle with food allergies, irritable bowel syndrome, lactose deficiency and gluten enteropathy. This creates a complexity that is challenging to say the least. It requires a well-coordinated effort between medical and mental health clinicians to truly evaluate the validity of the medical illness claims and their integration with anxiety, depression and other comorbid mental health disorders as well as the eating disorder itself.
Fortunately relatively definitive and objective guidelines are available to assess each of the comorbid illnesses. Yet too often patients come in either self-diagnosed or without a complete work up and have fully come to believe that they indeed have a food allergy or IBS. In addition there are often family issues related to medical disorders where the individual is told to even expect that they will have these disorders due to family history of the same. Given the typical challenges of refeeding with gastrointestinal symptoms and heightened anxiety this can easily throw the patient’s recovery off course. I have found that there are several caveats that will set the stage for a better-informed patient and family that often mitigates some of the challenges of refeeding. Education is power and food is medicine so I begin with that premise. Then I use a systematic approach to build trust with the patient as we progress through a workup:
1. I validate the patient’s concerns and reassure them that I will be sure to evaluate their physical concerns and help them understand physical versus emotional symptoms and how these symptoms are related to each other. I provide examples of emotional symptoms causing physical illness like stress and anxiety causing high blood pressure or stomach ulcers. I want them to understand that I am not dismissing their symptoms as “just emotional” but rather that finding their true cause will allow us to help them feel better whatever the cause.
2. I review the work up (or lack of one) regarding each condition and then outline what is needed to be complete and have an accurate diagnosis. I also tell them that even if they do have a physiologic medical illness it may well improve with achieving a healthy body weight and maintaining healthy nutrition and healthy eating habits while eliminating eating disorder symptoms.
3. I order appropriate consultations and testing as indicated and review the results with the individual outlining both medical and psychological treatments that will help them including the use of stress relaxation and medical and psychiatric medications whether prescription or over-the-counter meds including nutriceuticals and complimentary therapies.
4. I assure the individual that we will proceed through treatment with regularly scheduled appointments for follow up so they don’t need to worry that they are simply being dismissed.
With this approach I have had significant success in evaluating and treating these increasingly complex cases. We all know how rewarding it can be to have an individual so restricted by the complex medical and psychiatric illnesses associated with eating disorders to suddenly find new life and relief from the burdens of physical and emotional pain and worry!
For more information about Oliver-Pyatt Centers, Clementine adolescent treatment programs and Monte Nido, please call 866.511.HEAL (4325), visit our website, subscribe to our blog, and connect with us on Facebook, LinkedIn, Twitter, and Instagram.
Join us in reading inspirational and informative articles we have cultivated from across the web. If you have found an article you feel is inspirational, explores current research, or is a knowledgeable piece of literature and would like to share with us please send an e-mail here.
Anxiety, Fears, and Things That Go Bump in the Night Psychology Today
How Weight Information Can Increase Overeating/Binge Eating Dr. Stacey Rosenfeld
Yoga May Be Good for the Brain The NY Times
If We Treated Ourselves The Way We Treat Our Children Kantor & Kantor Law
How Anorexia Causes a ‘Starved Brain’ Dr. Jen Gaudiani
Understanding Anorexia Nervosa in Males Psychology Today
Stacey Rosenfeld, PhD is a licensed psychologist who specializes in eating disorders, addictions and group therapy. In her writing, Dr. Rosenfeld shares about World Eating Disorders Action Day, a day to help educate and raise awareness about eating disorders.
What Is It?
A wealth of misinformation surrounds the eating disorder field; we hear these myths all the time. Ideas such as “Only young, rich, Caucasian girls get eating disorders,” “You can tell if someone has an eating disorder by looking at him/her,” or “True recovery is impossible” cloud the eating disorder conversation.
The inaugural World Eating Disorders Action Day (World ED Day), happening on June 2nd, 2016, seeks to dispel these myths, raise awareness and understanding around eating disorders, and unite activists around the globe toward much-needed policy change.
World ED Day promotes the “Nine Truths about Eating Disorders”, a collaboration between the Academy for Eating Disorders, Dr. Cynthia Bulik (the truths are based on her 2014 talk of the same name), and other key eating disorder associations. The mission/vision of World ED Day is to “advance understanding of eating disorders as serious, treatable illnesses” and “unite eating disorder activists, professionals, parents/carers and those personally affected to promote worldwide knowledge of eating disorders and the need for comprehensive treatment.”
On June 2nd, activists around the world will come together to promote the “Nine Truths,” highlight the need for evidence-based treatment, increase funding for eating disorders research, and advocate for broad-based policy change that enables greater access to care.
Why Is It Important?
Eating disorders have the highest mortality rate of any psychiatric illness, but that does not mean they are untreatable. Recovery is possible, but we need to make sure that those who struggle have access to quality treatment. Too often, those who suffer aren’t able to access good care due to lack of sufficient resources, insurance limitations, limited information, or other interfering variables. For many others, treatment is based on an outdated understanding of eating disorder etiology. We now know that eating disorders have genetic, biological, and environmental influences. We know that parents can play a critical role in the treatment and recovery of adolescents with eating disorders. Unfortunately, these truths have not been adopted by all.
World ED Day seeks to reduce barriers to care, particularly in underserved populations, and supports increased diversity in narratives and in the media. Have you ever noticed that most eating disorder articles in mainstream media are accompanied by a stock image of a low weight, Caucasian woman? This needs to change. Eating disorders affect men and women of all shapes and sizes, races, and socioeconomic statuses. These illnesses cut across age, class, ethnicity, sexual orientation, and gender identity in a way that media, research, and policy do not adequately convey.
How Can You Get Involved?
World ED Day is calling for significant social media presence and engagement in the days leading up to, and including, June 2nd. The hope is that those who suffer from eating disorders (and their families), treatment professionals, healthcare organizations, and policy makers will take note of World ED Day’s key messages. The easiest and best way to get involved is to promote World ED Day through your own social media platforms. You can use the hashtags #WeDoAct and #WorldEatingDisordersDay and like/follow these World ED Day accounts:
There will be a 24-hour Tweetchat-a-Thon, accessing folks in all timezones, on June 2nd. Various organizations will present on topics such as Binge Eating Disorder and evidence-based treatment. Follow the hashtags to join the conversation. You can also participate in the Instagram project, which highlights images of diversity and challenges myths surrounding eating disorders (@worldeatingdisordersaction). Finally, please read and share the blog posts on the World ED site. Professionals, patients/carers, and advocates have written critical content begging for dissemination.
The inaugural World Eating Disorders Action Day is in our hands. We have the power, by raising our collective voices, to challenge misinformation, target underserved populations, increase research funding, and remove obstacles to care, toward the goal of treatment and recovery for all.
This article written by Stacey Rosenfeld, PhD.
Clinical Director Karin Lawson, PsyD and Primary Therapist Josephine Wiseheart, MS along with other esteemed professionals provide insight into ways to practice self-compassion when you have depression. Please find the link to the original publication at the conclusion of the article.
When you’re struggling with depression, the last thing you want to do is be self-compassionate. But this is precisely what can help. Self-compassion is “the capacity to find the wisdom and dignity in one’s experience (particularly suffering,) and to respond to it in an appropriately kind way,” according to Lea Seigen Shinraku, MFT, a therapist in private practice in San Francisco.
She believes all of us have this capacity. However, a depressed state of mind tends to impede access to it. That’s because “people who suffer with depression often have a core belief that there is something wrong with them; that they don’t deserve to be happy; that the world is a dark place; and/or that there’s no point in doing anything,” Shinraku said.
But you can still connect to your innate capacity. The key lies in practice.
“Don’t wait to feel motivated or believe that you ‘deserve’ self-compassion,” said Josephine Wiseheart, MS, a psychotherapist at Oliver-Pyatt Centers, and in private practice in Miami, FL. She doesn’t expect her clients to have a shift in self-worth and believe they suddenly deserve to be treated with kindness and understanding. Instead, she hopes that once they start practicing self-compassion, a shift will occur.
Here are nine tips for practicing self-compassion.
1. Start small.
“Simple acts of self-care can demonstrate that sense of kindness and nurturance to one’s self,” said Karin Lawson, PsyD, a psychologist and clinical director of Embrace, the binge eating recovery program at Oliver-Pyatt Centers. “This might be anything from taking a shower, getting a massage, nourishing yourself with food, or taking a leisurely walk”, she said.
You also might try self-compassionate gestures. “Take a deep breath, put your hand on your heart and let it rest there”, she said. Or “cup your face with your hands with a sense of gentleness. This safe physical touch can actually activate the parasympathetic nervous system and release neurotransmitters to help us… shift into a more compassionate headspace.”
2. Bring awareness to your experience without judgment.
According to Shinraku, by simply telling yourself, “I’m really having a hard time” or “I don’t know how to do this alone,” you can start to dis-identify from your depression. You can start to see depression as something you’re experiencing rather than who you are.
Shinraku shared these other examples: “I feel powerless; I wish I could see things differently.” “I don’t know how to accept myself as I am right now.”
3. Get curious.
When you’re struggling with depression, one of the hardest parts of self-compassion is relating to yourself with kindness, Shinraku said. If kindness feels too hard, or inauthentic, get curious instead. Because curiosity is “a potent form of kindness.”
For instance, get curious by journaling about these prompts:
“Even though my depression/inner critic seems to know, with absolute certainty, what’s happening right now, is it possible that I might not have the full story?” “If a friend was struggling the way I am, what might I say to her or him? What would I want that friend to know?”
4. Interrupt rumination by refocusing.
Instead of replaying the past or worrying about what might or might not happen, Shinraku suggested bringing attention to your breath or physical sensations. For instance, you can “count 10 inhales and 10 exhales.”
You also can do a body scan. Start with your toes, and notice the sensations present in your body, Shinraku said. “If you find areas of tension, imagine you are sending your breath to those areas as you exhale.”
5. Explore exceptions.
Your inner critic may like to speak in absolutes, such as “always” or “never.” When you hear such statements, seek out the exception, Wiseheart said. “Even if we have ‘failed’ or ‘disappointed,’ it does not mean that we always fail or disappoint. And it certainly does not mean that we are a failure or disappointment. No one can always or never do anything.”
6. Focus on self-compassionate statements.
Wiseheart suggested this exercise for practicing compassionate self-talk. Create two columns: On the left side of the paper, vent your negative, self-loathing statements. Then read each statement as if your child or loved one is reading them to you. Write a self-compassionate response to each negative statement.
7. Write a letter.
Lawson shared this exercise: Imagine your loved one is struggling with the same depressive thoughts. Write a letter to this person. “What would you say to him or her? What compassion, love and tenderness might you offer?” Then address the letter to yourself. Read it aloud.
8. Remember you’re not alone.
Another big part of self-compassion is common humanity or interconnectedness (per Kristin Neff’s definition.) You can connect to this by remembering you’re not alone, Shinraku said. In this very moment millions of people, all over the world, are struggling with depression.
Prominent individuals throughout history, including Abraham Lincoln, Georgia O’Keefe and Sigmund Freud, struggled, too, she said. Many famous people struggle today. Depression doesn’t discriminate.
According to Lawson, recognizing that everyone struggles may remind you that you don’t deserve self-criticism and harshness. As Shinraku added, “Depression doesn’t mean you are defective; it means that you are human.”
9. Practice loving-kindness meditation.
According to Lawson, “A loving-kindness meditation focuses on thinking loving and kind thoughts for those around you and includes yourself.” She recommended this meditation from psychologist Tara Brach and this meditation from psychologist Kristin Neff.
Seeking out resources to help with your depression is self-compassionate, too, Shinraku said. “If you feel depressed, and you are reading this article, you are already practicing self-compassion.”
Originally posted on PsychCentral by Margarita Tartakovsky, M.S.
For more information about Oliver-Pyatt Centers and newly expanding Clementine adolescent treatment programming please call 866.511.HEAL (4325), visit our website, subscribe to our blog, and connect with us on Facebook, LinkedIn, Twitter, and Instagram.
We hope you enjoy the final post in our four part series on the treatment of co-occurring disorders and eating disorders at Oliver-Pyatt Centers. Thank you to the Director of Substance Abuse Program Lisa Richberg, LMHC who speaks to treating the whole person. Check here for the first, second, and third posts within the series.
What is the true nature of the relationship between substance abuse and eating disorders? This is a question that has challenged the community for years. At Oliver-Pyatt Centers, we have sought to explain the relationship between these two devastating addictions and to treat them using a whole person, individualized approach.
Both eating disorders and substance abuse serve the same function. They help those suffering from anxiety, depression and hopelessness to cope with these emotions through disconnection. Over the years, I have observed that most of my clients are disconnected from themselves, their loved ones, and their own bodies. The disconnection often eases immediate, intense feelings of pain and anxiety, yet the relief from this manner of coping is short lived. Before long they realize that these methods of disconnection only serve to enhance the negative emotions.
In the development of the substance abuse program at Oliver-Pyatt Centers we have sought to create a model by which we treat the whole person. If clients fail to treat both eating disorder and co-occurring disorder issues at a higher level of care, chances are, when not engaging in one set of behaviors, they will use the other as a comfortable and familiar way of managing distress. Each individual comes to us with a unique set of circumstances and, therefore, we are charged with treating more than eating disorders alone. Working with the whole person we ensure that when clients leave our care they have a deeper understanding of the relationship between their addictions, a better understanding of what triggers urges to use their behaviors, and alternative ways of managing their distress.
(Substance Abuse Program Director Lisa Richberg, LMHC and Clinical Director Melissa McLain, PhD)
Thank you to our team contributors, Director of our Substance Abuse Program Lisa Richberg, LMHC and Clinical Director Melissa McLain, PhD for their insight into the difference between internal and external rock bottom for the second post in our four-part series on the treatment of both co-occurring and eating disorders at Oliver-Pyatt Centers.
The phrase “rock bottom” is often used loosely, in both the eating disorder and substance abuse treatment communities, to mean that someone has reached the lowest point in their disorder. Often times, this is the point at which the individual decides to give recovery a chance. Rock bottom is often associated with difficult life events – relationships ending, accidents, financial losses, academic failures; and is commonly sited as lowest points in a persons’ life. However, in exploring this experience with our clients, we have discovered it is not so much the external “rock bottom” events, but rather the internal emotional lows that matter most. It often seems to be that only by reaching her own internal “rock bottom” a person may be willing to risk attempting a different way of living. Rather than hinging on a major life event to trigger the need for change, this internal shift can take place long before, or after, a devastating event has occurred. This moment is often described as being immensely liberating. Recently, one of our patients shared her own experience:
“For me, my external bottom was when my materialistic life fell apart. I was asked to leave school, lost my spot on the softball team, totaled a car, lost most of my friends, spent all my money, and the list goes on. My external bottoms were extremely overwhelming, all consuming, and life ruining. You would think this would be enough to get me to recover, right? The reality was all of the inner turmoil was still very much alive inside of me. I still had unresolved insecurities, traumas, and chaos, which it is assumed an external recovery could fix. I was wrong… After many relapses, I hit a different kind of bottom. This was a bottom that was foreign and uncomfortable, and I wasn’t sure how to navigate it. For the first time I truly wanted to stop my eating disordered behaviors for myself, and not do it just for materialistic things or other people”
Exploring this idea can help an individual take time to do a personal inventory to assess where she is, and allow her to ask herself questions such as, “Have I had enough?” “Have I reached my own rock bottom?” Then she can reflect on what she truly wants for her future, and seek the help needed to make that a reality.
Thank you to our team contributor, Director of our Substance Abuse Program Lisa Richberg, LMHC for beginning our four-part series on the treatment of both co-occurring and eating disorders at Oliver-Pyatt Centers.
A substance abuse program within an eating disorder treatment center? Many have asked me what these two addictions have in common and why confuse things by treating them together?
I came to Oliver-Pyatt Centers three years ago, interested in exploring the relationship between these two populations. A native Miamian, I was excited to be back on my home turf after living in Manhattan where I managed a private substance abuse intensive outpatient program and worked in private practice. It was through these experiences I began to identify the deep connection between those suffering from eating disorders and substance abuse. I watched clients and their family members struggle to understand why they seemed to fluctuate between one set of behaviors and the other, sometimes relying on both in cases of extreme distress. I began to understand that these addictions are like different branches of the same tree. Both are means of coping with difficult situations and emotions.
So, when I joined OPC and was asked to develop substance abuse programming for the center’s already fantastic and whole person approach, I relished the opportunity. We began slowly at first, assessing client’s needs by asking more specific questions about drug and alcohol use during intake. As a result, co-occurring groups were created, in addition to 12-step meetings. Client feedback proved this new programming to be beneficial in helping individuals gain a better understanding of what drives their addictions, what triggers them, and how to better cope with these triggers. Clients reported feeling safer discussing substance abuse issues in smaller groups made up of women who share similar struggles.
In the past few years our program has continued to develop. Having learned the value of asking the right questions, we now offer comprehensive substance abuse evaluations to incoming clients who are often unsure as to whether their use is problematic. Education and discussion are essential, and we offer weekly co-occurring substance abuse psychoeducation and process groups, as well as the opportunity to attend several off-site 12-step meetings weekly. We identified a need for improved relapse prevention planning for clients stepping down into intensive outpatient programming or outpatient treatment, and created a program which pairs these clients with specially trained co-occurring recovery coaches. The recovery coaches and clients meet weekly to discuss their personalized relapse prevention plans and work on them at their own pace. We sit down with each of our clients as they are planning to transition out of our program into a lower level of care, and help them develop a solid, realistic recovery plan that meets their individual needs. Our co-occurring program will continue to grow, shaped by the needs of our most important advisors – our clients. I am excited to be heading this new and absolutely necessary program, and by how it will continue to enrich our already vibrant OPC community!