Integrated Treatment Principles and Strategies for Patients with Eating Disorders, Substance Use Disorder, and Addictions

Currently, there are no evidence-based treatments or established treatment protocols for patients that present with both eating disorders and substance use disorders/addictions. The lack of available integrated treatment programs, at all levels of care, has left the dually diagnosed patient vacillating between these two disorders. Eating disorder treatment programs frequently exclude patients with active substance use disorders, and addiction programs regularly exclude or do not effectively treat patients with eating disorders. Often, these patients are referred to addiction treatment programs prior to entering into eating disorder treatment. This approach is problematic, as both disorders are associated with high rates of relapse following treatment. Sequential treatments focus on the most acute disorder first, often utilizing multiple providers in different locations, with different theoretical orientations, staff training, and treatment protocols, which can make continuity of care quite difficult. Developing a comprehensive integrated approach to the treatment of comorbid patients will improve treatment delivery, reduce time in treatment, lower overall treatment costs, improve treatment outcome, and lessen consumer confusion. This chapter will provide a definition, rationale, and the basic principles of an integrated treatment model with applicability to those working to develop and provide integrated services for these dually diagnosed patients.