Whack a Mole! Eating Disorders & Addiction Treatment…

eating disorders carnival side show

For those battling alcohol or drug addiction, dormant eating disorders can resurface when least expected.


I’ve never liked the carnival game whack-a-mole. Bashing heads with a cartoon hammer, while an endless succession of new rodents appears. It is too stressful and unpredictable. But I could relate, when a friend in recovery said they thought eating disorders, popping up during addiction treatment, reminded them of playing whack-a-mole.


Wham! That came out of nowhere!

Because just when you think you’ve pounded down the substance use disorder (SUD) that was taking over your life, an unexpected eating disorder (ED) might come to the fore. And it’s hard to talk about. It’s embarrassing. When you have a binge or binge-purge disorder, it is not something that comes up in polite conversation. But it should. Especially during group therapy in an addiction treatment center. As high as 50% of those with eating disorders have co-occurring SUDs. And 35% of people with an SUD also have an eating disorder. (NIH)


And eating disorders affect both men and women…

Eating disorders and SUDs do not always present at the same time. In fact, one may flare up while the other is at bay or appear without forewarning. And for those battling alcohol or drug addiction, dormant eating disorders can resurface when least expected. Just like a whack-a-mole.


Treating SUDs and EDs Together…

We believe that the best treatment for an eating disorder involves a team of professionals providing a combination of approaches. The eating behavior is only a symptom of an underlying emotional conflict. However, it does need to be directly addressed as new and healthier coping mechanisms are being learned.



I have had the privilege of sitting in on a group session with guest speaker, Gail Hall, LMSW, DCSW, CEDS-S. Gail is a therapist who specializes in eating disorders. She is also the owner of Comprehensive Treatment for Eating Disorders (CTED), LLC. And she has a lot to say about eating impulse control.


It’s not about abstinence from food. It’s about abstinence from addictive behaviors.



Coping Mechanism for Anxiety and Depression

Gail Hall tells us that an eating disorder is a coping mechanism for anxiety and depression. And like substance misuse and addiction, there is often a genetic factor. Eating disorders run in families. Gail says that with new associations and tools to address underlying stressors, a person can fully recover from an eating disorder.


In therapy, Gail challenges the “food rules” her clients invent. She also addresses “fear food” (like pizza and doughnuts) by taking her clients to a fast-food restaurant. While there, she asks them to find something on the bill of fare to eat. For some (the author included), just entering a hamburger joint creates anxiety. And since eating disorders are often secretive and marked by shame and guilt, Gail encourages her clients to begin to explore the social aspects of eating.


Unlike a substance use disorder, a person can’t quit eating. So, we must separate the eating from the disorder and deal with the continuous barrage of potential triggers.



eating disorders carnival games

We must separate the eating from the disorder…


Types of Eating Disorders

Anorexia Nervosa

Characterized by self-starvation and excessive weight loss. Its symptoms include refusal to maintain body weight, fear of getting “fat”, extreme focus on shape and body weight, and loss of menstrual periods. Orthorexia is an addiction to exercise or “clean eating”. Anorexia/Orthorexia is not usually co-occurring with an SUD. Both are characterized by the need to control. This is not a characteristic of a substance use disorder.


Bulimia Nervosa

Bulimia is more commonly co-occurring with SUD. Bulimics eat excessive amounts of food in short periods of time. After the binge, they purge the calories by vomiting, taking laxatives or excessively exercising. Symptoms include eating beyond comfortable fullness; lack of control; frequent dieting or fasting; extreme concern with weight; and abuse of laxatives, diet pills, and diuretics.


Eating Disorder

Binge eating is commonly co-occurring with SUD. Binge eating disorder or compulsive overeating is characterized by uncontrolled continuous eating beyond the point of feeling comfortably full. Symptoms may include fasting or yo-yo dieting, feelings of shame or self-hatred, and changes in body weight or severe obesity.


Babies come into this world as intuitive eaters, eating disorders are learned behavior.



What’s the Solution to Eating Disorders?

For those who are in treatment or early recovery from a substance use disorder, it is tempting to treat oneself to sugary or processed foods. After all, when you are forgoing alcohol or other drugs it feels like you deserve to indulge in somethingSuddenly, food tastes good again, days seem long, and you’re getting a dopamine rush from those processed snacks.


Education and caution are key to managing eating disorders. An important part of healing is the introduction of healthy foods. And Gail believes that education is paramount to developing a healthy relationship with food for everyone. Until the obsession with body type and the societal requirements to look a certain way are changed, there will continue to be eating disorders.



Gail looks to parents and the schools to guide children and teenagers. She feels there is an inappropriate focus on thinking “thin”. This causes undue pressure and anxiety, and she intends to change things. She says it’s a difficult task, but she’s been a one-woman army for many years, and this is her mission.



Marilyn Spiller is a writer, sober coach, recovery advocate, and student of the world (she also holds a BA in English). Nine years sober herself, she penned one of the first sobriety blogs, "Waking Up the Ghost" in 2013. The blog garnered an international following, allowing Marilyn to communicate with thousands of folks in all stages of recovery. Marilyn is Sanford's Director of Marketing and serves as Editor-In-Chief for the Sanford online magazine, Excursions. She also developed and hosts the podcast Anatomy of Addiction and is Vice President of the Board, JACK Mental Health Advocacy.