Eating Disorder Symptoms and Length of Stay in Residential Treatment for Substance Use: A Brief Report

Differences in eating disorder symptoms and affect regulation for residential eating disorder patients with problematic substance use

PURPOSE

The aim of the current study was to investigate differences in treatment outcomes for residential eating disorder (ED) treatment patients diagnosed with comorbid substance use disorders (SUDs), particularly differences in ED pathology and affect dysregulation.

METHOD

Secondary data analysis was conducted on data from a previous study of 140 patients at a residential ED facility. SUD was diagnosed by a staff psychiatrist upon admission, and SUD diagnosis was extracted from electronic health records for the current study. Self-report measures of eating pathology and affect dysregulation from pre-treatment and post-treatment assessments were analyzed.

RESULTS

20.1% of the sample (n = 29) were diagnosed with a substance use disorder at the start of treatment. Contrary to hypotheses, those with comorbid SUD did not significantly differ in eating pathology severity, depression symptoms, emotion dysregulation, or psychological acceptance at baseline. Also contrary to hypotheses, individuals with comorbid SUD and ED evidenced slightly larger improvements in certain areas of eating pathology and affect dysregulation throughout treatment than those with ED diagnosis only.

CONCLUSIONS

These findings suggest that residential ED treatment is an appropriate treatment choice for individuals with comorbid SUD. The observed improvements in affect dysregulation combined with a period of forced abstinence from maladaptive affect regulation behaviors may explain these positive results, though more research is needed to test the mechanisms of action of residential treatment for this population.

LEVEL OF EVIDENCE

IV, multiple time series analysis.

Development of a clinical pathway for screening and integrated care of eating disorders in a rural substance use treatment setting

Eating and substance use disorders frequently co-occur in clinical samples. This comorbidity presents a particular challenge due to increased medical complications, higher relapse rates, psychiatric comorbidity, and poorer overall outcomes for both disorders, and is associated with specific medical and psychiatric difficulties that contribute to complexity in diagnosis and treatment. However, patients with co-occurring substance use and eating disorders do not widely receive structured standardized assessment or treatment for eating disorders in substance use treatment settings. Focus groups were conducted to seek clinician's knowledge and perceptions of screening and care planning for eating disorder presentations in a rural substance use treatment setting. The study adheres to COREQ guidelines. To analyse the focus group data, the authors utilized thematic analysis and three major themes emerged as follows: beliefs about clients (stereotypical views, complexity of comorbidity, client expectations), understanding of self (lack of knowledge/skills, professional role), and organizational barriers and enablers. Whilst identifying a significant number of clinician and organizational barriers to providing screening and treatment of eating disorders in a substance use treatment setting, focus group discussions also highlighted a number of potential enablers. Most notably clinicians identified a willingness to provide screening and care planning if they were provided with education, a clinical pathway and access to screening tools. A consensus conferencing approach facilitated construction of a clinical pathway to enable the service to provide screening, assessment, and treatment planning for clients with comorbid eating disorder.

The Women's Recovery Group for Individuals with Co-occurring Substance Use and Eating Disorders: Feasibility and Satisfaction in a Residential Eating Disorders Program

Despite the high rate of co-occurring eating disorders (EDs) and substance use disorders (SUDs) in women, there is a lack of integrated treatment. This study implemented the Women's Recovery Group (WRG), a gender-specific group therapy for women with SUDs, in an ED residential treatment program to assess the feasibility and satisfaction of the WRG for women with co-occurring SUDs and EDs. Women (N = 24) were enrolled in the study if they were aged 18 years or older and engaged in the WRG as part of their treatment. Patient and therapist satisfaction with the WRG were assessed post-treatment, and craving to use substances was measured at enrollment and post-treatment. Participants reported moderate satisfaction with the WRG, and therapists reported above average satisfaction with the WRG. Craving to use substances in the environment in which one previously used significantly decreased from enrollment to post-treatment. In its current form, the WRG was feasible to implement in ED residential treatment. Participants indicated that they would have liked more information on co-occurring EDs, self-image/self-esteem, shame and guilt, and maintaining sobriety at college. These results support the need for modifications to the WRG to better integrate treatment for women with co-occurring EDs and SUDs.