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BC Needs to Change: Lack of ED/SU Integrated Treatment Programs

**An open letter from students of the School of Population and Public Health


In Vancouver, eating disorders (ED) and substance use disorders (SUD) are conceived and treated independent of each other (Luongo, 2018). This is problematic, because these issues occur concurrently and are therefore more effectively managed if treated jointly (Dennis, Pryor and Brewerton, 2014). An analysis of the existing literature shows that there is a pressing need for more integrated treatment programs within Vancouver to successfully deter the high rates of eating disorders and substance use (Weisner, Mertens, Tam and Moore, 2001).

Eating disorders are influenced by the intersection of complex social, political, cultural, and economic factors in life. Substance use may be entangled with experiences of eating disorders, yet available eating disorder treatment typically exclude patients who use or use substances (Dennis, Pryor and Brewerton, 2014; Luongo, 2018). As such, patients with both ED and SUD have more severe ED symptomatology and outcomes compared to patients just suffering from disordered eating (Gregorowski, Seedat and Jordaan, 2013). A prominent example is using substances to aid in weight loss, such as caffeine, tobacco, and stimulants (Gregorowski, Seedat and Jordaan, 2013). This can develop into a pattern of impulsive behavior and ultimately, increase the susceptibility for addiction (Gregorowski, Seedat and Jordaan, 2013).

There exists a current shortage of accessible and available resources for individuals struggling with health concerns that are interconnected yet generally perceived as separate.  For example, to access Vancouver Coastal Health’s Eating Disorder Program, substance use cannot be the client’s primary presenting concern (Vancouver Coastal Health, n.d). For those who experience these issues concurrently, these requirements may present significant barriers to access treatment for populations that would benefit significantly from care.

After conducting phone conversations with multiple health organizations that provide services for individuals with eating disorders, we noticed that individuals experiencing both eating disorders and substance use disorders are typically treated in an isolated manner that fails to effectively address the complexity of these concurrent disorders. After speaking with a staff member from the Looking Glass Foundation, we found that a number of existing programs in the organization provide support for young individuals with eating disorders, but none of which accept clients “who are actively struggling with substance abuse” (Looking Glass Foundation, personal communication, March 7, 2018). Likewise, the Discovery Vista House is typically unable to admit clients who struggle with both an eating disorder and a substance use disorder, “unless the client has already made significant steps” towards sobriety (Discovery Vista House, personal communication, March 7, 2018).

We recognize that Discovery Vista House and Vancouver Coastal Health is committed to providing the best care for individuals with eating disorders. However, the Vista Guidelines document indicates that individuals currently abusing substances must “abstain from these behaviors for 6 weeks before admission in order to be eligible to access treatment programs” (Discovery Day Program & Vista Guidelines, 2013). This approach is particularly problematic, as it is common for patients being treated for only their substance use disorder to experience an increase in severity of eating disorder symptomatology (Dennis, Pryor and Brewerton, 2014). By limiting access to eating disorder resources by excluding those struggling with substance use, those who need immediate help may feel discouraged, feel it is ineffective, or feel unwelcome when seeking treatment.

Therefore, the lack of available integrated treatment programs for patients experiencing disordered eating and substance use lead to severe ramifications, such as higher rates of relapse, worsening of the untreated illness, and sub-optimal patient outcomes (Dennis, Pryor and Brewerton, 2014). There is evidence that when comorbid diagnoses are treated concurrently and integrated on-site, both treatment retention and patient outcomes improve significantly (Weisner, Mertens, Tam and Moore, 2001) Eating disorder programs, rather than viewing substance use as interferences to treatment, should view eating disorders as issues entangled in the complexities of patients lives, which can include substance use.

A comprehensive approach for patients with concurrent ED and SUD can improve treatment delivery, reduce time in treatment, lower treatment costs overall and improve patient outcomes (Dennis, Pryor and Brewerton, 2014). Therefore, we propose the adoption of a complementary treatment program that integrates and holistically addresses multiple factors, including substance use, to benefit patients and the program’s themselves.


Elements of a comprehensive treatment are as follows (Dennis, Pryor and Brewerton, 2014):

  • ● Comprehensive screening for eating disorders and substance use
  • ● Individualized treatment encompassing both disorders
  • ● Individual therapists and treatment teams trained in evidence-based treatment for both disorders and services being in the same location and by the same providers

Some elements of effective treatment are as follows (Dennis, Pryor and Brewerton, 2014):

  • ● Treatment should be readily available
  • ● Treatment should address multiple needs of the individual
  • ● Adequate treatment duration for the best outcomes
  • ● Counselling and other behavioural therapies are available
  • ● Treatment is continually assess and improve individual treatment with changing needs
     

Thank you for taking the time to read this letter.  We hope in the future that patients with disordered eating and substance are able to gain access to effective treatment.

References

  • Dennis, A. B., Pryor, T., & Brewerton, T. D. (2014). Integrated Treatment Principles and Strategies for Patients with Eating Disorders, Substance Use Disorder, and Addictions. Eating Disorders, Addictions and Substance Use Disorders, 461-489. doi:10.1007/978-3-642-45378-6_21
  • Gregorowski, C., Seedat, S., & Jordaan, G. P. (2013). A clinical approach to the assessment and management of co-morbid eating disorders and substance use disorders. BMC Psychiatry, 13(1). doi:10.1186/1471-244x-13-289
  • Luongo, N. M. (2018). Disappearing in plain sight: An exploratory study of co-occurring eating and substance abuse dis/orders among homeless youth in Vancouver, Canada.  Womens Studies International Forum, 67 , 38-44. doi:10.1016/j.wsif.2018.01.003
  • Providence Health Care. (2013). DISCOVERY DAY PROGRAM & VISTA GUIDELINES. Retrieved April 7, 2018, from http://www.providencehealthcare.org/sites/default/files/Discovery%20Program.pdf
  • Weisner, C., Mertens, J., Tam, T., & Moore, C. (2001). Factors affecting the initiation of substance abuse treatment in managed care. Addiction,96 (5), 705-716. doi:10.1046/j.1360-0443.2001.9657056.x
  • Vancouver Coastal Health. (n.d.). Eating Disorders Program - East Hastings Street. Retrieved March 11, 2018, from http://www.vch.ca/Locations-Services/result?res_id=896