Identifying and Managing Eating Disorders in Persons Presenting for Addiction Treatment

Objectives:Eating disorders (ED) are common in substance use disorders (SUD), yet often go unrecognized when presenting for addiction treatment. Unrecognized ED can potentially worsen treatment outcomes for both SUD and ED. Means to screen, diagnose, and manage ED when a person presents for addiction treatment are reviewed.Methods:Systematic searches using MEDLINE, Google Scholar, and PubMed augmented by references of found articles were completed using the search terms: eating disorder, anorexia nervosa, bulimia nervosa, alcohol, drugs, substance-related disorders, comorbidity, screening, diagnosis, management and treatment. Screening instruments and treatment options applicable to ED or SUD were reviewed for their applicability to persons with comorbid ED and SUD.Results:The SCOFF, Eating Attitudes Test-26 item version and Eating Disorder Examination-Questionnaire are means to screen for ED in persons with SUD. There were no screening instruments designed for both ED and SUD nor were there any pharmacologic treatment trials for comorbid ED and SUD. Psychotherapy trials of DBT and mindfulness incorporated into CBT for comorbid ED and SUD are supportive. Data from studies of ED or SUD alone suggest potential roles for specific medications and other psychotherapies for comorbid ED and SUD.Conclusions:ED often go undetected when a person enters addiction treatment, potentially worsening treatment outcomes. Standardized screening for ED is recommended for all persons, particularly women, entering addiction treatment followed by monitoring of ED behaviors during recovery. Pharmacotherapy currently is only adjunctive, whereas DBT or mindfulness incorporated into CBT have best evidence for comorbid ED and SUD.