Guidelines and Principles for the Integrated Treatment of Patients with Eating Disorders and Substance Use Disorders

It is well documented that many eating disorder patients are also abusing substances or have substance use disorders. 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 programs 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. This workshop will begin with a review of the guiding principles behind integrated treatment for individuals with ED/SUD, explore several of the common barriers to treatment and provide recommendations for staff training and treatment team composition, and program implementation. It will conclude with a discussion of case formulation and how to adapt evidence-based treatments for patients with both disorders.