Eating Disorders, Addictions and Substance Use Disorders: Research, Clinical and Treatment Perspectives

694 Pages·2014·5.96 MB·English

by  Timothy D. Brewerton

Eating Disorders,
Addictions
and Substance
Use Disorders
Research, Clinical and
Treatment Perspectives
Timothy D. Brewerton
Amy Baker Dennis
Editors
123
Eating Disorders, Addictions and Substance
Use Disorders
ThiSisaFMBlankPage
Timothy D. Brewerton (cid:129) Amy Baker Dennis
Editors
Eating Disorders,
Addictions and Substance
Use Disorders
Research, Clinical and Treatment
Perspectives
Editors
TimothyD.Brewerton AmyBakerDennis
PsychiatryandBehavioralSciences PsychiatryandBehavioralNeurosciences
MedicalUniversityofSouthCarolina UniversityofSouthFlorida
Charleston,SC,USA BloomfieldHills,MI,USA
ISBN978-3-642-45377-9 ISBN978-3-642-45378-6(eBook)
DOI10.1007/978-3-642-45378-6
SpringerHeidelbergNewYorkDordrechtLondon
LibraryofCongressControlNumber:2014934149
#Springer-VerlagBerlinHeidelberg2014
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To all the great teachers in my life,
especially my patients, who taught me how
to listen and to follow their lead, and to
Therese, for whom I am infinitely grateful
in so many ways
T.D.B.
To Daniel and our children,
Jessica, Nicole, Michelle, and Christopher
A.B.D.
ThiSisaFMBlankPage
Foreword
We spend so much time studying in our specific area, evaluating and treating
patients in our specialty, that we sometime lose sight of the forest for the trees.
Whileweseesmokingpatients,whostoponlytogain20poundsoverthenextyear,
or alcoholics and addicts who become ravenous upon successful abstinence, we
somehow rarely think about the overlaps and relationship between substance use
disorders and eating disorders. How often do we hear about a patient who has
sought treatment multiple times at a substance use residential treatment program,
neveraddressinghisorhereatingdisorder,onlytorelapseoverandoveragainuntil
finallyfindingtreatmentthataddressesboththeeatingandsubstanceusedisorders
(and vice versa)? It shouldn’t be surprising that cross-sectional studies of women
with eating disorders have a higher prevalence of alcohol and substance abuse
compared to the general female population as well; women with substance abuse
disordersreportahigherprevalenceofeating-disorderedbehaviormoreoftenthan
inthegeneralfemalepopulation.EatingDisorders,AddictionsandSubstanceUse
Disorders:Research,Clinical,andTreatmentPerspectivesisamanualthatislong
overdue and one that will help guide future research and treatment of patients in
bothofthesefields.
The intended audience of this book is researchers and clinicians who work in
either field (substance use disorders or eating disorders). It is likely that if a
clinicianworksineitherofthesefields,heorshe,inasense,worksinbothfields,
whether the clinician is aware or not. We can only begin to imagine how often a
patientwithadualdiagnosisofsubstanceuseandeatingdisorderpresentsseeking
treatment in either setting, yet only one problem is addressed or even recognized
uponpresentation.Thisbookservesasaguidefornewcliniciansandareminderfor
cliniciansalreadyawareoftheoverlapbetweenthesetwofields.Itisalsoatoolfor
the eating disorder specialist who is perhaps less familiar with working with
individuals with substance use disorders as well as a tool for the substance abuse
specialistwhoislessfamiliarwitheatingdisorders.
Inadditiontotheclinicalperspectivesofferedinthisbook,thebookalsooffers
newresearchthatisemergingthatsuggeststhattheoverlapbetweenthesetwoareas
isevenstrongerthaninitiallyexpected.Inparticular,thechapter,“Neuroimagingof
Eating Disorders, Substance Use Disorders and Addictions: Overlapping and
Unique Systems,” summarizes the most recent neuroimaging literature and
compares the similarities between eating disorders and substance use disorders.
vii
viii Foreword
While the neuroimaging literature on eating disorders is relatively limited com-
paredwithsubstanceusedisorders,thechapterhighlightsthesimilaritiesbetween
bulimia nervosa, binge eating disorder, and addiction while pointing out the
dissimilaritiesbetweenanorexianervosaandthesedisorders.Itisfascinatinghow
similarbulimianervosaandbingeeatingdisorderaretosubstanceusedisordersin
multiple studies that looked at executive control, motivation and reward, learning
and memory, emotion regulation, and interoceptive awareness. This parallels real
life as the overlap between substance use disorders and eating disorders tends to
occur primarily in individuals who have binge eating and purging behavior as
opposed to individuals with anorexia nervosa with restrictive subtype (who do
notengageinbingeeatingandpurgingbehaviors).
The implications of the overlap between eating disorders and substance use
disordersareprofoundastheycanpotentiallyguidefuturediagnosisandtreatment.
Basedonthesimilaritiesbetweenthetwo,onemayponderwhethereatingdisorders
are addictions and whether this has diagnostic and treatment implications. While
certainlyeatingdisordersareuniquefromsubstanceusedisorders,thesimilarities
arepowerfulenoughtosuggestthatmoreresearchisneededinthisarea.Whilewe
have focused on the brain and brain systems common to drug abuse, food
preferences, eating disorders, and food addictions, there is much more to this
field than our observation of it. If it looks like a duck and quacks, it is a duck.
ThiswonderfulbookconceivedandbroughttothispointbyTimBrewerton,M.D.,
andAmyBakerDennis,Ph.D.,andtakesthefieldandinterrelationshipstothenext,
verylogicalandcompellinglevel.Thanks,forthiswonderfuladditiontoourfield.
Gainesville,FL,USA AmeliaDavis
MarkS.Gold
Preface
In the past several decades, there have been numerous books published on the
scienceandtreatmentofeatingdisorders(ED)andhundredsofvolumeswrittenon
the diagnosis, assessment, and treatment of substance use disorders (SUD)/
addictions. At least to our collective knowledge, this is the first textbook to
completely focus on the co-occurrence of these disorders. This project was born
out of our surprise and deep frustration with both the lack of evidence-based
research and treatment protocols for this comorbid population and the lack of
availabletreatmentprograms,atalllevelsofcare,thateffectivelyserveconsumers
withbothEDandSUD.Withupto50%ofEDpatientsmeetingcriteriaforaSUD
or addiction and 1/3 of SUD patients reporting eating pathology, it is remarkable
howfewpeopleineitherfieldarefullytrainedtoaddressbothdisorders.Addition-
ally, we were hoping to strengthen connections between two fields that rarely
communicate. With these issues in mind, we felt the time was right to assemble
leadingexpertsfromeachfieldandaskthemtoworktogethertoproducea“state-
of-the-art”textbookthatcouldnotonlyeducatepractitionersinbothfieldsbutalso
promotecross-trainingandfurthercollaborativeresearch.
The 30 chapters of this volume are organized into three major parts. The first,
“Research Perspectives,” explores the science of ED, SUD, and addictions. Our
researchersweretaskedwiththeresponsibilityofreviewingandreportingonwhat
is known about each disorder independently and to discuss the similarities and
differencesbetweenthesedisorders accordingtotheirtopic.Inordertomakethis
part relevant to treatment providers, each author was asked to identify how this
researchcanguideandinformclinicalpracticewithduallydiagnosedpatients.The
first two chapters of this part focus on how animal research has informed our
understanding of biological and behavioral factors that contribute to the develop-
ment of ED and SUD as well as the relationship between eating and drug use
behaviors.Chapter3explorestheneurobiologicalmechanismsandneurotransmit-
ter/braincircuit alterations thatmaybecommon toboth disorders. Theauthorsof
Chapter 4 discuss the finding from neuroimaging studies that examine shared and
distinct domains of functioning (i.e., executive control, reward and motivation,
emotional reactivity, memory/learning, and interoceptive awareness) and outline
opportunities for future research to further clarify the relationship between
addictionsandeatingbehaviors.Chapter5reviewsthecurrentempiricalliterature
ix