Background: This workshop will review the guiding principles behind integrated, evidence-based treatments that can be adapted for ED patients with co-occurring SUD, including: 1) Motivational Interventions; 2) Family therapy; 3) Cognitive behavioral therapy; 4) Mindfulness based approaches, e.g., DBT, ACT, and; 5) Self-help and support group interventions.
Outline of Presentation
I. Introduction of speakers and overview of workshop (Tim)
II. Discussion of the changes in DSM 5 diagnostic criteria for “Substance-Related and Addictive Disorders” and “Feeding and Eating Disorders” (Tim)
III. “Food Addiction” (Tim)
- Brief overview of the emerging science behind this concept
- Discussion of the controversy over this concept in the professional community as well as in the general public
IV. Similarities and Differences between ED and SUD (Amy)
V. Creating an integrated treatment program for patients with both ED and SUD (Amy)
- Barriers to integrated treatment
- Staff recruitment
- Staff development and cross-training
- Program components and necessary services
VI. Adapted evidence-based treatment for patients with ED and SUD
- Motivational approaches (Therese)
i. Brief overview of empirical support for Motivational Interviewing in SUD treatment
ii. Brief overview of empirical support for Motivational Interviewing in ED treatment
iii. Integrated motivational interviewing for the ED/SUD patient
- Mindfulness Approaches (Therese)
i. Brief overview of empirical support for Mindfulness approaches in SUD
ii. Brief overview of empirical support for Mindfulness approaches in ED
iii. Adapting DBT for patients with ED and SUD
- Family-Based Therapy (Tim)
i. Brief overview of empirical support for family based therapy for SUD
ii. Brief overview of empirical support for family based therapy for ED
iii. Adapting FBT for comorbid adolescent patients
- Cognitive Behavioral Therapy (Tim and Amy)
i. Brief overview of empirical support for CBT for SUD
ii. Brief overview of empirical support for CBT for ED
iii. Adapting CBT for comorbid patients
- Self-help and support groups (Tim and Amy)
i. Review of the empirical support for self-help and support groups in SUD
ii. Review of the empirical support for self-help and support groups in ED
iii. Integrated self-help and support for the ED patient with SUD
- Questions and Answers
It is well documented that many eating disorder (ED) patients also have substance use disorders (SUD). However, to date, no randomized treatment trials have been conducted or practice guidelines developed to provide direction to clinicians who treat this dual diagnosed population. Very few programs in either field have developed comprehensive, evidence-based, integrated approaches for this comorbid group. Treatment is often provided sequentially (SUD treated first and then the ED) or concurrently (by two different treatment providers or programs simultaneously). Unfortunately, this fragmented approach can lead to consumer and family confusion and poor treatment outcomes. Research suggests that individuals with co-occurring disorders have a greater chance of recovering from both disorders when they receive integrated treatment from the same practitioner. However, most substance abuse treatment providers are not well trained in the diagnosis, assessment and treatment of patients with ED. Likewise, ED specialists often have limited knowledge of the psychoactive properties of drugs of abuse, the clinical characteristics of substance abusers, or the philosophy and vernacular of abstinence based models or 12 Step approaches. Cross training is essential. It is vital that treatment providers in both fields acquire knowledge of the other and that research findings and empirically supported interventions from both specialties be incorporated to create an integrated approach to treatment and recovery.
In this workshop, we will review the changes set forth in the DSM 5 for both Substance-Related and Addictive Disorders, and Feeding and Eating Disorders followed by a brief discussion of the highly controversial topic of “Food Addiction.” We will then discuss the similarities and differences between ED and SUD and outline the basic guiding principles that underlie the creation of an integrated treatment program. Finally, we will present several evidence-based treatment that have been adapted specifically for ED patients with co-occurring SUD including: 1) Motivational Interventions; 2) Mindfulness based approaches including Dialectical Behavior Therapy and Acceptance and Commitment Therapy; 3) Family-based therapy; 4) Cognitive behavioral therapy and; 5) Self-help and support group interventions.
Dr. Brewerton is Executive Medical Director of the Hearth Center for Healing in Columbia, SC, and Clinical Professor of Psychiatry & Behavioral Sciences at MUSC in Charleston. Dr. Brewerton is Distinguished Fellow of the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry, and Founding Fellow of the Academy of Eating Disorders. He is a Past-President of the Eating Disorders Research Society and has published >125 articles/chapters. He edited the “Clinical Handbook for Eating Disorders: An Integrated Approach” and co-edited (with Amy Baker Dennis) “Eating Disorders, Addictions, and Substance Use Disorders: Research, Clinical and Treatment Aspects.”
Dr. Dennis has specialized in ED treatment for over 36 years. She has been: founding President of Eating Disorder Awareness and Prevention, Founding Fellow and Board member of the Academy for Eating Disorders, Founding member of the Eating Disorders Research Society, Founder and Board Member of the National Eating Disorder Association and Founding Fellow of the Academy for Cognitive Therapy. Her academic appointments include: Wayne State University School of Medicine, University of South Florida College of Medicine and Hamilton Holt Graduate School at Rollins College. She has published and lectured nationally/internationally and has received numerous awards for her contributions.
and Therese Kathleen Killeen, PhD, APRN
Dr. Therese Killeen PhD APRN BC is Associate Professor in Psychiatry at the Medical University of South Carolina. She has worked as a clinician, supervisor and researcher in the addiction and comorbidity field for over 22 years. Dr. Killeen has served as Principal and Co-investigator for numerous psychosocial and pharmaceutical studies involving substance use and comorbid disorders, including PTSD. She has conducted numerous Regional and National trainings in evidence-based treatments, with extensive experience training and supervising therapists in motivational interviewing, cognitive behavioral, contingency management and exposure based cognitive behavioral therapy for concurrent PTSD and SUD.