Co-occurring Eating Disorders And Substance Use Disorder

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Co-occurringEating Disorders andSubstance Use DisorderAndrea Zuellig, PhD, LP and Alison Sharpe-Havill, PsyD, LPMelrose Center Psychologists

What we seeWhat wedon’tSEEPhoto credit: pere

Feeding and Eating DisordersAnorexia NervosaBulimia NervosaBinge-Eating DisorderOther Specified Feeding or Eating DisorderUnspecified Feeding or Eating DisorderAvoida nt / Rest rict ive Food Intake D isord erRumination DisorderPica

Eating Behaviors ContinuumDieting, RestrictingNormal EatingExcessive or Binge Eating

SCOFF QUESTIONNAIRE1. Do you make yourself Sick because you feeluncomfortably full?2. Do you worry you have lost Control over how much youeat?3. Have you recently lost more than One stone (14 lbs) in a3-month period?4. Do you believe yourself to be Fat when others say youare too thin?5. Would you say that Food dominates your life?A score of 2 or more indicates possible risk for eatingdisorder and warrants further assessment

Binge - PurgeBingeCould be any food but patients often talk about sweetsBuPurgePC: Kevin Botto Self-induced vomitingAbuse of laxatives, diureticsRestrictingOver-exercising

Addiction Transference

Eating DisorderResearch had found that up to50% diagnosed with an eatingdisorder will struggle withsubstance abuse, whereas only 9%of the general population isdiagnosed with SUD.Substance AbuseConversely, 35% of those whoabuse substances have been foundto have an eating disordercompared to 3% of the generalpopulation diagnosed with ED

11xPerson with SUD is11x more likely tohave an eatingdisorder.5xPerson with ED is 5xmore likely to abusedrugs and alcoholthan a personwithout an eatingdisorder.

Prevalence of ED-SAAt least 25% of our patients at Melrose Centerstruggle with substance abuse

Shared Traits Lack of control over urges and behaviors Impulsive nature of symptom use Symptoms used as an unhealthy way to escape or regulate emotions

Other factors to consider and rule out Eating to cope with stress, emotions or trauma/abuse Food deprivation/starvation Food Insecurity

Risk Factors Eating Disorders have highest mortality rate ofany psychiatric disorder; increases with cooccurrence of SUD Individuals with AN are 19x more likely to diefrom SUD, mainly AUD Complex relationship ED and SA; most often getworse together

Risk factors Research has found that ED often comes first Early dieting is a key risk factor for not only eatingdisorders but also substance use disorders Restriction and drive for thinness in substanceabuse treatment predicts early drop-out

How Patients Experience the ConnectionAttempts to cope with the eating disorder:“I use pot so I can eat during family dinners”“Pot helps me eat and not purge after meals”“Alcohol allows me to have a break from following the rules of the ED”Attempts to engage more in the eating disorder:“I work out for hours and take pain meds to deal with the pain”“Drinking makes me feel full and then it's easier not to eat”“Drinking the night before helps me purge the next day”ED and SUD get worse together (dysregulation model):“When I drink alcohol, my awareness of food goes down and I tend to overeat”“If I drink, I won't eat because it's too many calories”“I binge eat really bad when I smoke pot”

The Voice of the Eating Disorder vs. Addiction?Food RulesVideo clip?Body Image Distortion

Quieting the Voice of ED and SUD

Starting the Conversation Approach in a concerned, non-judgmental manner Don’t be vague, ask specific questions Use “I” statements rather than “you” statements Avoid placing shame, blame or guilt on the personregarding their actions or attitudes Avoid giving simple solutions Consider getting some collateral information fromparents or other support people who may be withthem

Abstinence vs. Truce

I wish I had known

Support Structure?21

Treatment for ED-SAIntegrated, concurrent treatment of co-occurring disorderCross-trained staff and cross-organizational partneringNeed to address underlying issuestrauma, anxiety/depression,relational/interpersonal factors,developmental factors,neurobiological factorsLonger and more complicated treatment

Treatment for ED-SADetox and weight restoration (not enough!)Increase understanding of the connection between substance use and currentfunctioning/quality of life (Psychoeducation)Enhance motivation to change (MI, ACT)Develop capacity to regulate emotions (DBT, CBT)Encourage development of healthy relationships and consistent involvement inrecovery community (12-step, mentoring)Strengthen relapse prevention skills (CBT; medication management )

Melrose EDSAIntensive Outpatient ProgramsMelrose Center - St Louis ParkMon & Weds 9:30 – 4:00Tues & Thurs 9:30 – 4:00Evening Program:Monday and Thursday 4:00 – 7:00

Melrose Center Dedicated Provider Line952-993-58648:30 am- 5 pm Ask questions about patient signs/symptomsfrom knowledgeable Care Managers OR forurgent admissions Patient questions about insurance Make the call for Initial Assessment with thepatient, if possible If patient is reluctant, give them brochure withScheduling line: 952-993-6200

Check our website: Melrose Outreach Services952-993-6555

Feeding and Eating Disorders. Dieting, Restricting Normal Eating Excessive or Binge Eating Eating Behaviors Continuum. SCOFF QUESTIONNAIRE A score of 2 or more indicates possible risk for eating disorder and warrants further assessmen

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The Co-Occurring Center for Excellence (COCE), funded through the Substance Abuse and Mental Health Services Administration (SAMHSA), is a leading national resource for the field of co-occurring mental health and substance use . Eating disorders Sleep disorders Impulse-control disorders Adjustment disorders ersonality disorders P Disorders .

uniquely defined as co-occurring disorders (CODs). They may include any combination of at least two mental disorders and substance use disorders identified in the DSM-5. Sometimes co-occurring disorders are referenced as “dual disorders” or as “having a dual diagnosis” (SAMHSA, 2014b). The

What are eating disorders? Eating disorders are serious medical illnesses marked by severe disturbances to a person's eating behaviors. Obsessions with food, body weight, and shape may be signs of an eating disorder. These disorders can affect a person's physical and mental health; in some cases, they can be life-threatening.

Vancouver Coastal Health Eating Disorders Program New Client Referral 1 604-675-3894. Vancouver Coastal Health Eating Disorders Program . NEW CLIENT REFERRAL . Referral Criteria: The Eating Disorder Program provides treatment to clients with eating disorders as outlined in the DSM-5. Please See Page 5 for more information on diagnostic criteria.

co-occurring disorders Figure 6. Prescribing and medication arrangements at provider sites that reported serving patients with co-occurring disorders (n 98) Figure 7. Time to first appointment for MAT for people with co-occurring disorders Figure 8. Time to first outpatient appointment, by language spoken Figure 9.

Mar 04, 2014 · 2. Substance-induced disorders -- intoxication, withdrawal, and other substance/medication-induced mental disorders (psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders, obsessive-compulsive and related disorders, sleep disorders, sexual dysfunctions,

9 MATHEMATICS - Week 1 Lesson 2: Properties of Operations Learning Objectives: Students will be able to simplify computations with integers, fractions and decimals by using the associative and commutative properties of addition and multiplication, and