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Bermuda Mental Health Foundation is pleased to have dedicated partners around the world that keep up on the latest mental health news. Dr. Lerner has written an article on eating disorders and chemical dependency. Please read and let us know what you think and/or share your story.


by: Marty Lerner, Ph.D.

Those of us who have been in and around the “recovery community” are all too aware of the prevalence of eating disorders among the chemically dependent. The purpose of this article is to heighten awareness of both the nature and prevalence of eating disorders particular to the community of recovering alcoholics and drug addicts. Current research would suggest that a conservative estimate, among alcoholic and chemically dependent women who “qualify” as eating disordered, is in the neighborhood of twenty to forty percent. There are no gender-specific studies regarding “cross-addiction.” However, there is evidence to suggest that, of all the cases diagnosed in the general population, at least ten percent are male. Certainly, when we speak of “disordered eating,” we are including all those suffering from varying forms of anorexia, bulimia and compulsive overeating. Although many individuals suffering with an eating disorder may appear significantly overweight or underweight, like most alcoholics and drug addicts, one cannot identify someone with an eating disorder simply by appearance alone. At this juncture, many of you may be asking how an eating disorder can be considered an addiction? How can anyone be addicted to food or “dieting”? This confusion, much like the confusion and misunderstanding concerning the true nature of alcoholism in years past, explains the difficulty among many people with eating disorders to recognize an eating disorder as a “first cousin” to the chemical dependency family. The fact is there is significant evidence that many eating disorders meet the accepted medical criteria for substance abuse (e.g. bulimia, compulsive overeating). The body of research investigating the “biochemistry” of what I will term “food addiction” has been growing in recent years. To date, we know that a significant number of eating disorders have a biological base in addition to the behavioral elements associated with dysfunctional eating. For example, both bulimics and binge eaters have a tendency to self-medicate via overeating and/or purging. In fact, a similar mechanism exists for those turning to restricting their food intake by self-induced starvation (anorexia). We know, for instance, that foods which are high glycemic (e.g. sugar and flour products, highly processed simple carbohydrates) trigger a reaction in the body of many binge eaters to “over secrete” insulin. The effect is a rapid rise in blood sugar followed by an increase in seratonin and beta endorphin levels. Unfortunately, this reaction causes a rapid drop in these levels shortly after – the result being a “withdrawal-like” syndrome marked by depression, anxiety, insomnia, fatigue, and a craving of the substance (high glycemic foods) to relieve the distress. If this sounds familiar to the alcoholic, it’s no coincidence. Alcohol converts to pure sugar as it is digested in the stomach. Alcoholics who abstain from drinking and find themselves craving sugar, caffeine, and nicotine do so because these substances tend to alleviate some of the same symptoms associated with both alcohol and, yes, sugar withdrawal. Couple the physical elements these addictions have in common with having learned to self-medicate depression vis-?-vis substances and compulsive behaviors and the similarities become obvious. There is little coincidence of the phenomenon of “cross-addiction.”

Recovering from an eating disorder is much like recovery from any addition. Effective treatment begins with following a set of directions. Addictions all have in common a degree of physical and psychological issues which separate the “addict” from the “non-addict.” On the physical side, a good first step is to eliminate or seriously limit refined carbohydrates (e.g. sugar, flour) from your diet. To be sure, this does not always mean to eat less, it means to eat differently. An ever-increasing body of research has demonstrated that many eating disordered people manifest an increased sensitivity to these substances, much like the effect of alcohol upon alcoholics. This “sensitivity” translates to an excessive secretion of insulin, leading to a pronounced drop in blood sugar and, thereby, an increase in physical hunger and depressed mood. In other words, if you are eating disordered, chances are these substances play a part in the compulsive eating pattern, as well as directly effecting the neurotransmitters which influence your mood (first making you “feel” better, then leading to a depressed state of mind). Whether the above is a primary mechanism for an eating disorder or plays a lesser role is not known. A similar phenomenon appears to exist for the individuals suffering with anorexia. Here the “addictive solution” is avoiding food altogether or resorting to excessive exercising and/or purging. Ultimately this results in an addictive cycle of depending upon starvation or purging to “stave off” depression and avoid weight gain. In this case as well, an abstinent food plan* serves as a guideline for healthy eating. (See definition of “abstinence” below.) Following an abstinent food* (e.g. low glycemic) in conjunction with weighing and measuring portions, (for those who tend to either over or under estimate portions), is an integral part of the foundation from which a recovery lifestyle is built. The goal of this process is to provide a “blueprint” from which someone is able to construct an eating pattern relieving one from the tendency to either over estimate or under estimate their nutritional needs. Without such a blueprint, one is left with good intentions, but no means of constructing a personal recovery program that can withstand the inconsistencies of everyday living. From our experiences, “doing is believing”. Defining Abstinence: From a medical perspective, abstinence refers to the simple cessation of addictive or compulsive behaviors as it applies to the behavioral patterns associated with an eating disorder. For the compulsive overeater, it means refraining from overeating, regardless of the type of food or frequency of eating. For the bulimic sufferer, it means abstaining from binging and purging. For the anorexic, it represents no longer restricting caloric intake and/or the cessation of purging. The definition of abstinence from the addiction perspective is the same with one important caveat. An essential tool for achieving the above includes an abstinent food plan. One might say an abstinent food plan amounts to limiting, or in some cases, eliminating, flour and sugar products as well as weighing and measuring portions. Again, this is neither a “license” for the anorexic sufferer to eat less or obsess about calories – it is a means of eating an adequate amount of healthy, nutritious foods and not underestimating portions. In effect, this approach to eating is recommended for those who otherwise have yet to achieve abstinence from their eating disorder. The analogy with treating alcoholism is one that differentiates between two perspectives – that of recommending the alcoholic try “controlled drinking” versus achieving “abstinence.” It may, indeed, be possible for some to “control” their eating disorder (or alcoholism) by self-discipline. For others there may be a physical factor beyond self-discipline and will

power. In these cases experience has shown that “such intervals of control are often brief, almost always followed by an even worse relapse.” ( borrowed from the “Big Book” of AA) Getting Help Recognizing an eating disorder as an addictive process suggests the treatment process needs to address the physical, emotional, and spiritual aspects of the illness. In the beginning this often means finding a treatment center able to provide the tools necessary to enter recovery. Once gaining a “foothold” on the recovery path, adhering to a healthy food plan, regular attendance at relevant support groups (e.g. OA, EDA, etc.), and working with other recovering people remains the essence from which long term recovery is built. Dr. Lerner is the executive director of the Milestones In Recovery Eating Disorders Program. Dr. Lerner is a licensed and board certified clinical psychologist who has specialized in the treatment of eating disorders since 1980. He is the author of several publications related to eating disorders appearing in the professional literature as well as numerous magazines and newspapers. A friend of the recovering community here in South Florida, Dr. Lerner makes his home in Davie with his wife Michele and daughters Janelle and Danielle.

©2002 Marty Lerner, Ph.D. Reprinted with permission.


April 24, 2012 Comments Off on FAQ’s

Where can I go to find therapy?

Different kinds of therapy are more effective based on the nature of the mental health condition and/or symptoms and the person who has them (for example, children will benefit from a therapist who specializes in children’s mental health). However, there are several different types of treatment and therapy that can help.


Where can I learn about types of mental health treatment?

Mental health conditions are often treated with medication, therapy or a combination of the two.  However, there are many different types of treatment available, including Complementary & Alternative Treatments, self-help plans, and peer support. Treatments are very personal and should be discussed by the person with the mental health conditions and his or her team. Here is a list of a few:

Behavior Therapy is a form of psychotherapy used to treat a variety of psychopathology. Its philosophical roots can be found in the school of behaviorism which states that psychological matters can be studied scientifically by observing overt behavior, without discussing internal mental states. Classical conditioning (often associated with the work of Pavlov) is another important feature of behavior therapy. As a result of experience, or associative learning, individuals often respond in predictable ways to certain stimuli or life events which may no longer be appropriate. These techniques follow from the premise that maladaptive behaviors are learned, and therefore can be unlearned as well. Among the behavioral techniques employed are training in both assertiveness and relaxation, and gradual desensitization to feared objects.

Cognitive-Behavioral Therapy (CBT) is a psychotherapeutic approach comprised of both cognitive and behavioral techniques. The premise underlying a cognitive-behavioral orientation is that difficulties in living, relationships, general health, etc., have their origin in (and are maintained by) both cognitive and behavioral factors. CBT aims to influence problematic and dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure. CBT is often brief and time-limited and is used in individual therapy as well as group settings.

Cognitive Therapy essentially involves helping an individual think in more effective ways and aims to uncover the irrational and problematic thinking styles that often accompany psychological distress. The goal of cognitive intervention is to challenge, and ultimately change, maladaptive, self-defeating cognitions, and allow the client to lead a more productive and satisfying life. Simple to learn cognitive strategies provide clients with practical and powerful skills that can be applied over a lifetime as effective tools in life-management.

Group Psychotherapy or group therapy is a form of psychotherapy which one or more therapists treat a small group of clients together as a group. In group psychotherapy the group context and group process is explicitly utilized as a mechanism of change by developing, exploring and examining interpersonal relationships within the group.

Electroconvulsive Therapy (ECT), also known as electroshock, is most often used as a treatment for severe major depression which has not responded to other treatment, and is also used in the treatment of mania, catatonia, schizophrenia and other disorders. Treatment can be either on an inpatient or outpatient basis and usually in a course of 6-12 treatments administered 2 or 3 times a week. After treatment, drug therapy can be continued, and some patients receive continuation/maintenance ECT. Certain types of ECT have been shown to cause persistent memory loss, whereas confusion usually clears within hours of treatment.

Individual Psychotherapy see Psychotherapy

Inpatient Services is the care of patients whose condition requires hospitalization. Progress in modern medicine and the advent of comprehensive out patient programs ensure that patients are only admitted to a hospital when they are extremely ill.

Intensive Short-Term Dynamic Psychotherapy (ISTDP) offers psychiatric evaluation and psychotherapeutic treatment enhanced by techniques derived from a psychotherapy model developed by Habib Davanloo, MD. ISTDP’s primary goal is to help the patient overcome internal resistance to experiencing true feelings about the present and past which have been warded off because they are either too frightening or too painful. The technique is intensive in that it aims to help the patient experience these warded-off feelings to the maximum degree possible; it is short-term in that it tries to achieve this experience as quickly as possible; it is dynamic because it involves working with unconscious forces and transference feelings.

Pharmacotherapy is the treatment of mental illness or mental disorders with medication. This type of treatment can be combined with psychotherapy and can also stand alone.

Psychiatric Evaluation is an examination or assessment of the mental health of an individual and is the mental equivalent of a physical examination. A psychological evaluation may result in a diagnosis of a mental illness or disorder.

Psychoanalytic Treatment is a therapeutic partnership focused on helping each patient become aware of underlying sources of his or her difficulties, not just intellectually, but emotionally by re-experiencing them with the analyst, in ways that lead to deep and lasting changes in the patient’s life.

Psychotherapy or Individual Psychotherapy is an interpersonal relational intervention used by psychotherapists to help individuals, couples, families or groups in problems of living. Psychotherapists employ a range of techniques based on experiential relationship building, dialogue, communication and behavior change that are designed to improve the mental health of the individual or to improve group relationships. Psychotherapy may be performed by practitioners with a number of different qualifications, including psychiatrists, psychologists, therapists, licensed clinical social workers, counselors, psychiatric nurses, music therapists and creative arts therapists.Typically, the patient comes four or five times a week, lies on a couch, and attempts to say everything that comes to mind.


What are the different types of mental health professionals?

There are many types of mental health professionals. Finding the right one for you may require some research, but here is a list of several.

Psychiatrist – A psychiatrist is a medical doctor and the only professional that specializes in mental health care and can prescribe medications. (Family doctors often prescribe medications for mental health concerns, but do not have specialized training or background in treating mental disorders.) Most psychiatrists focus on prescribing the appropriate medication that’s going to work best for that individual and their concerns; a few also do psychotherapy.

Psychologist – A psychologist is a professional who does psychotherapy and has a doctorate degree (such as a Ph.D. or Psy.D.). Psy.D. programs tend to focus on clinical practice and result in the professional having thousands of hours of clinical experience before they enter practice. Ph.D. programs can focus on either clinical or research work, and the amount of clinical experience a professional will gain varies from program to program. Psychologists receive specific training in diagnosis, psychological assessment, a wide variety of psychotherapies, research and more.

Clinical Social Workers – Typically a clinical social worker will have completed a Master’s degree in social work (M.S.W.) and carry the LCSW designation if they are doing psychotherapy (Licensed Counselor of Social Work). Most programs require the professional to go through thousands of hours of direct clinical experience, and the program focuses on teaching principles of psychotherapy and social work.

Psychiatric Nurses – Most psychiatric nurses are trained first as a regular registered nurse (R.N.), but get specialized training in psychiatry and some forms of psychotherapy, typically including up to 500 hours of direct clinical experience. Psychiatric nurses in most states may also carry prescription privileges, meaning that they can often prescribe the same kinds of medications that a psychiatrist can.

Marriage & Family Therapist – These therapists tend to have a Master’s degree (but can have as little as a Bachelor’s degree or less in some states) and typically have between hundreds to thousands of hours of direct clinical experience. Because this designation varies from state to state, the quality of the professional may also vary significantly from person to person. (Not to be confused with California’s Marriage, Family and Child Counselors, which have much more stringent requirements, including a Master’s degree and 3,000 hours of direct clinical experience.)

Licensed Professional Counselor – The requirements for this designation, which can be in addition to the professional’s educational degrees, vary from state to state. Most are Master’s level professionals who have had thousands of hours of direct clinical experience.

Other – There are a wealth of other professional designations and initials that follow professionals’ names. Most of these designate a specialty certification or the like, not an educational degree.

Where can I go to find a support group?

Many people find peer support a helpful tool that can aid in their recovery. There are a variety of organizations that offer support groups for consumers, their family members and friends. Some support groups are peer-led, while others may be led by a mental health professional.

Learn more about finding a support group. Please contact Winston Rodgers at Mid- Atlantic Wellness Institute by calling 236-3770.

Where can I go to find inpatient care?

If you or someone you know is in crisis, inpatient care can help. Inpatient care can help people stabilize on new medications, adjust to new symptoms, or get the help they need. Click here to learn more.


Where can I go to find other local services?

There are likely plenty of resources that can be used to help you find mental health treatment in your community.  These resources can help you find the right therapist, and enable you to better understand viable treatment options and the treatment process.

Click here to learn more

Where can I learn more information about clinical trials?

Sometimes, consumers of mental health services may consider participating in a research study when they have not experienced improvement despite having tried a variety of medications and treatments. Research studies (also known as clinical trials) may involve the use of new medications or new treatment approaches whose safety and effectiveness is being tested. While we support innovation in the field, consumers should be cautioned that there are risks associated with clinical trials – make sure you’re aware of them before you enroll.

Learn more about clinical trials