Eating Disorders and Chemical Dependency

Those of us who have been in and around the “recovery community” are all too aware of the prevalence of eating disorders among the chemically dependent. The purpose of this article is to heighten awareness of both the nature and prevalence of eating disorders particular to the community of recovering alcoholics and drug addicts.

Current research would suggest that a conservative estimate, among alcoholic and chemically dependent women who “qualify” as eating disordered, is in the neighborhood of twenty to forty percent. There are no gender-specific studies regarding “cross-addiction.” However, there is evidence to suggest that, of all the cases diagnosed in the general population, at least ten percent are male. Certainly, when we speak of “disordered eating,” we are including all those suffering from varying forms of anorexia, bulimia and compulsive overeating. Although many individuals suffering with an eating disorder may appear significantly overweight or underweight, like most alcoholics and drug addicts, one cannot identify someone with an eating disorder simply by appearance alone.

At this juncture, many of you may be asking how an eating disorder can be considered an addiction? How can anyone be addicted to food or “dieting”? This confusion, much like the confusion and misunderstanding concerning the true nature of alcoholism in years past, explains the difficulty among many people with eating disorders to recognize an eating disorder as a “first cousin” to the chemical dependency family. The fact is there is significant evidence that many eating disorders meet the accepted medical criteria for substance abuse (e.g. bulimia, compulsive overeating).

The body of research investigating the “biochemistry” of what I will term “food addiction” has been growing in recent years. To date, we know that a significant number of eating disorders have a biological base in addition to the behavioral elements associated with dysfunctional eating. For example, both bulimics and binge eaters have a tendency to self-medicate via overeating and/or purging. In fact, a similar mechanism exists for those turning to restricting their food intake by self-induced starvation (anorexia).

We know, for instance, that foods which are high glycemic (e.g. sugar and flour products, highly processed simple carbohydrates) trigger a reaction in the body of many binge eaters to “over secrete” insulin. The effect is a rapid rise in blood sugar followed by an increase in seratonin and beta endorphin levels. Unfortunately, this reaction causes a rapid drop in these levels shortly after – the result being a “withdrawal-like” syndrome marked by depression, anxiety, insomnia, fatigue, and a craving of the substance (high glycemic foods) to relieve the distress. If this sounds familiar to the alcoholic, it’s no coincidence. Alcohol converts to pure sugar as it is digested in the stomach. Alcoholics who abstain from drinking and find themselves craving sugar, caffeine, and nicotine do so because these substances tend to alleviate some of the same symptoms associated with both alcohol and, yes, sugar withdrawal.

Couple the physical elements these addictions have in common with having learned to self-medicate depression vis-à-vis substances and compulsive behaviors and the similarities become obvious. There is little coincidence of the phenomenon of “cross-addiction.”

Recovering from an eating disorder is much like recovery from any addition. Effective treatment begins with following a set of directions. Addictions all have in common a degree of physical and psychological issues which separate the “addict” from the “non-addict.” On the physical side, a good first step is to eliminate or seriously limit refined carbohydrates (e.g. sugar, flour) from your diet. To be sure, this does not always mean to eat less, it means to eat differently. An ever-increasing body of research has demonstrated that many eating disordered people manifest an increased sensitivity to these substances, much like the effect of alcohol upon alcoholics.

This “sensitivity” translates to an excessive secretion of insulin, leading to a pronounced drop in blood sugar and, thereby, an increase in physical hunger and depressed mood. In other words, if you are eating disordered, chances are these substances play a part in the compulsive eating pattern, as well as directly effecting the neurotransmitters which influence your mood (first making you “feel” better, then leading to a depressed state of mind). Whether the above is a primary mechanism for an eating disorder or plays a lesser role is not known. A similar phenomenon appears to exist for the individuals suffering with anorexia. Here the “addictive solution” is avoiding food altogether or resorting to excessive exercising and/or purging. Ultimately this results in an addictive cycle of depending upon starvation or purging to “stave off” depression and avoid weight gain. In this case as well, an abstinent food plan* serves as a guideline for healthy eating. (See definition of “abstinence” below.)

Following an abstinent food* (e.g. low glycemic) in conjunction with weighing and measuring portions, (for those who tend to either over or under estimate portions), is an integral part of the foundation from which a recovery lifestyle is built. The goal of this process is to provide a “blueprint” from which someone is able to construct an eating pattern relieving one from the tendency to either over estimate or under estimate their nutritional needs. Without such a blueprint, one is left with good intentions, but no means of constructing a personal recovery program that can withstand the inconsistencies of everyday living. From our experiences, “doing is believing”.

Defining Abstinence:

From a medical perspective, abstinence refers to the simple cessation of addictive or compulsive behaviors as it applies to the behavioral patterns associated with an eating disorder. For the compulsive overeater, it means refraining from overeating, regardless of the type of food or frequency of eating. For the bulimic sufferer, it means abstaining from binging and purging. For the anorexic, it represents no longer restricting caloric intake and/or the cessation of purging.

The definition of abstinence from the addiction perspective is the same with one important caveat. An essential tool for achieving the above includes an abstinent food plan. One might say an abstinent food plan amounts to limiting, or in some cases, eliminating, flour and sugar products as well as weighing and measuring portions. Again, this is neither a “license” for the anorexic sufferer to eat less or obsess about calories – it is a means of eating an adequate amount of healthy, nutritious foods and not underestimating portions.

In effect, this approach to eating is recommended for those who otherwise have yet to achieve abstinence from their eating disorder. The analogy with treating alcoholism is one that differentiates between two perspectives - that of recommending the alcoholic try “controlled drinking” versus achieving “abstinence.” It may, indeed, be possible for some to “control” their eating disorder (or alcoholism) by self-discipline. For others there may be a physical factor beyond self-discipline and will power. In these cases experience has shown that “such intervals of control are often brief, almost always followed by an even worse relapse.” ( borrowed from the “Big Book” of AA)

Getting Help

Recognizing an eating disorder as an addictive process suggests the treatment process needs to address the physical, emotional, and spiritual aspects of the illness. In the beginning this often means finding a treatment center able to provide the tools necessary to enter recovery. Once gaining a “foothold” on the recovery path, adhering to a healthy food plan, regular attendance at relevant support groups (e.g. OA, EDA, etc.), and working with other recovering people remains the essence from which long term recovery is built.

For more information about finding an eating disorder treatment center and details about support resources you might like to visit the Pale Reflections treatment finder. Alternatively, you can find the Milestones in Recovery Web site at milestonesprogram.org or contact Marty Lerner at (800) 347-2364        .

Marty Lerner, Ph.D is Executive & Clinical Director of Milestones in Recovery. For more information, visit milestonesprogram.org .