Session: Eating Disorders, Chronic Pain, and Substance Abuse: Assessing and Treating These Challenging Patients (2009 Symposium: Reclaiming the Body: Attachment, Somatics, and Image (March 4-8, 2009))

Saturday, March 7, 2009: 2:00 PM-3:30 PM

Casablanca (Westin Long Beach)

Between 25-50% of females diagnosed with eating disorders also have diagnoses of substance use. Complicating this situation is when patients also have chronic pain! Treating these multiple disorders is a true challenge. Which do you treat first? Do treatments for one compromise treatments for the others? These questions, as well as the biology of addiction and the parallels in recovery from these disorders, will be discussed.

Eating Disorders, Chronic Pain, and Substance Abuse:
Assessing and Treating These Challenging Patients
Kevin Wandler, MD
Executive Medical Director
Remuda Ranch Treatment Systems
I.    Overview—Treating Patients with Substance Abuse and Chronic Pain who have an Eating Disorder
        a.      Challenges
        b.      Risks
        c.      Benefits
II.   DSM-IV Diagnosis of Eating Disorders
        a.      Anorexia
        b.      Bulimia
        c.      ED, NOS
III.  DSM-IV Diagnosis of Substance Abuse
        a.      Alcohol, Tobacco, Nicotine
                i.      Identification and Detoxification
        b.      Benzodiazepines
                i.      Identification and Detoxification
        c.      Narcotics and Opiates
                i.      Identification and Detoxification
IV.  Case Study
V.   Chronic Pain Types
        a.      Neuropathic Pain
        b.      Postoperative Pain
        c.      Musculoskeletal Pain
        d.      Cancer Pain
        e.      Fibromyalgia
VI. Controversy: treat patients with chronic pain
        a.      Maintain addiction
        b.      Manage pain and detoxify
        c.      Compromise
VII. Pain-relieving Drugs
        a.      Opiods
        b.      Antidepressants
        c.      Antiepileptic drugs
        d.      Muscle relaxants
        e.      Non-steroidal anti-inflammatory drugs
        f.        Others
VIII. Other Treatments
        a.      Biofeedback
        b.      Heating pads/ cold pads
        c.      Physical Therapy
IX.  Case study
X.   Question and answers.

While most eating disorder treatment centers do not look at the diagnosis of an eating disorder as an “addiction”, the medical basis of binge/purge and restricting behaviors has addiction qualities. There are also similar comorbid conditions for both individuals who are abusing substances and those who have eating disorders, such as depression, anxiety, and trauma. Often, when a dually diagnosed woman comes into treatment and stops drinking or using drugs, her eating disorder behaviors intensify. In addition, her withdrawal symptoms can be difficult to predict.
Complicate this situation by adding chronic pain that requires narcotics. Narcotics can control the pain, but they also control emotions and impact hunger and eating! Most of the patients in our treatment centers who are using narcotics use them to control both emotional and physical pain and they are often addicted. When the narcotics are decreased, the treatment focus and goals can become moving targets. Common questions that will be answered are: What diagnosis do you treat first? What are the signs and symptoms of withdrawal? What settings are equipped to treat this triple diagnosis? What are the similarities and differences between eating disorder, substance use, and chronic pain treatments? Do treatments for one condition compromise treatments for the others, and if so, how do we balance the treatment approaches?

Primary Presenter:

Kevin Richard Wandler, MD

Dr. Kevin Wandler has been the Vice President of Medical Services/Medical Director of Remuda Ranch Treatment Centers for thirteen years. He specializes in the treatment of women with eating disorders and co-occurring conditions. He is Board Certified in Psychiatry; has added qualification from the American Board of Psychiatry and Neurology in Addiction Medicine; and has certification from the American Society of Addiction Medicine. Before Remuda Ranch, he was in private practice, specializing in treating adolescents and adults with substance use disorders and attention deficit/hyperactivity disorder. Dr. Wandler presents frequently at national eating disorder and chemical dependency conferences.

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