Generally, when we discuss eating disorders, we are talking about Anorexia Nervosa, Binge Eating Disorder, and Bulimia Nervosa. When we discuss opiate addiction, we are talking about opiates, a natural substance or narcotic analgesic derived from the poppy plant, and opioids, a narcotic analgesic that is at least part synthetic, not found in nature. Many use the two words interchangeably today. Opiates can be smoked, inhaled, injected, or consumed.
1 There are similarities at the biological level, for example, starvation and strenuous exercise are a catalyst for the dopaminergic (DA) reward pathway of the brain. (Bergh, Sodersten,1996; Casper, 1998) The resulting auto-addiction opioid theory, which suggests that chronic eating disorders are an addiction to the body’s production of endogenous opioids and is therefore identical to substance abuse in physiology, psychology, and in general. (Huebner, 1993; Marrazzi and Luby, 1986) What they are saying is that because the circulating levels of endorphins (Chemically identical to exogenous opiates) are delivered through starving, binging, and strenuous exercise and are as addictive potentially because they can stimulate DA in the brain’s mesolimbic reward centers.
The general stereotype of what people think about eating disorders and who suffers from them has led to a reluctance to accept the common etiology of substance abuse disorders and eating disorders. In the past decade, there has been a paradigmatic shift in eating disorder research with a movement away from relying solely on psycho-social factors to more focus on neurotransmitter pathways and other brain function.
2 Addiction has been defined by the Surgeon General as the most severe form of substance use disorder, associated with the compulsive or uncontrolled use of one or more substances. Addiction is a chronic brain disease that has the potential for both recurrence (relapse) or recovery. Relapse is defined as the return to the use of substances after a significant period of abstinence.
The latest research in neuroscience suggests that the process of addiction is a three-stage cycle starting with binge and intoxication, then withdrawal and negative effect, and preoccupation and anticipation. The cycle becomes more severe over time with continued use and abuse of the substance. Dramatic changes in brain function lesson an individual’s ability to control their substance use.
Disruptions in the basal ganglia, the extended amygdala, and the prefrontal cortex enable cues to trigger substance seeking, reduce brain sensitivity systems in the experience of reward or pleasure and heighten activation of brain stress systems and reduce the executive control systems which regulate decision making, actions, emotions, and impulses. These changes in the brain remain long after the individual stops using substances.
Euphoric feelings motivate people to continue to use the substance despite the risks; all addictive substances have powerful effects on the brain. Continued misuse of substances cause progressive changes in the structure and function of the brain, these are called neuroadaptations. These lead the change from controlled or occasional use to chronic misuse; they may produce continued, periodic cravings for the individual’s drug of choice that can be the catalyst to relapse.
In some individuals, starvation, or food restriction reportedly may actually reduce anxiety; this may occur because of reduced serotonin activity in individuals with over activity in this neurotransmitter system. (Kaye, 1999) Certainly, it is well known that both anxiety and depression are frequent premorbid characteristics present in many individuals suffering from chemical dependencies and those suffering with eating disorders. Some individuals will suffer from both eating disorders and substance abuse disorders in their lives.
Some research suggests that eating disorders are in fact in and of themselves a form of drug dependency and addiction. Since their characteristics satisfy all of the clinical and biological criterion for conventional addictions such as alcoholism and smoking. The progressively compulsive nature of the behaviors even in when facing dire consequences to health and risks to safety. (Heyman, 1996; Robinson and Berridge, 1993) Individuals require a progressive use to produce the same reinforcing effect. (Berridge and Robinson, 1995) Cravings can increase even after long periods of abstinence it seems that substance users have a string tendency to resume addictive behaviors even after getting treatment, and for chronic relapsing. (Robinson and Berridge, 1993) These characteristics find direct parallels with core eating-disorder behaviors such as binge eating, over exercising, and dieting. All of them become progressively excessive with time. Clients tend to have a strong compulsion to follow through with these types of behaviors no matter the risks to health and serious medical complications. This is shown in the prolonged morbidity and the relapse rate. (Herzog et al, 1999; Strober er al, 1999)
Characteristics common to both SUDs and EDs
3 Individuals with substance abuse disorders and/or eating disorders display similar characteristics. These include:
• A preoccupation with the behavior — drinking alcohol, using drugs, eating too much or not eating at all, purging, and other unhealthy eating behaviors.
• Secrecy, rituals, engaging in compulsive behaviors.
• Substance abuse and eating disorders may produce mood-altering effects in the individual.
• Substance abuse and eating disorders require intensive, professional treatment.
• Both SUDs and EDs are chronic diseases/disorders with high rates of relapse.
• Substance abuse disorders and eating disorders may be life-threatening.
Treatment for eating disorders and substance abuse disorders starts with the screening process. Today it’s common practice at treatment facilities to screen for co-occurring disorders. Research has shown that it’s best to treat multiple disorders at the same time. Armed with the knowledge today, that eating disorders and substance abuse disorders share many of the same characteristics, and risk factors, treatment professionals are carving out case specific treatment plans tailored for the individual to work on both problems simultaneously. Residential treatment programs seem the most effective because of the complexities involved.
While there is no cookie-cutter treatment for these complex individuals, treatment programs are in a much stronger position to provide the help, hope, and care needed to save and change lives moving forward. Is there a connection between eating disorders and opiate addiction; I believe the answer is clear!