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Treating Co-occurring Disorders Together: It’s Time for Change

A tragic story was reported in the news earlier this month; it centered on a young man’s effort to obtain treatment for alcoholism and bulimia. After getting bounced around from clinic to clinic in Arizona and California, Brandon Jacques ultimately died of sudden cardiac arrest. He was the victim of negligent treatment and multiple flaws in the health care systems from which he sought help.

These flaws involved clinical ignorance in the area of assessment and treatment of dangerous co-occurring disorders, such as eating disorders along with substance use disorders. Additionally, he was on the receiving end of shockingly unethical admission procedures, rooted far more in making money than helping people.

Although Brandon died four years ago, the story only came to light recently due to the settling of a law suit by his parents. They won a substantial judgment for their son’s wrongful death.

I believe this tragedy underscores the absolute and dire necessity to treat co-occurring disorders simultaneously. We know a strikingly high rate of co-occurrence exists between eating disorders and substance use disorders. Despite this knowledge there is a paucity of training programs to equip clinicians with the tools to identify and treat both. As a result, very few treatment centers offer the expertise required to truly recognize and effectively treat both disorders. Add to this already grim picture the fact that those with anorexia nervosa have the highest premature mortality rate of any mental illness, and of that population, those most at risk of sudden death are those with binge-purge behaviors who also abuse substances, and the stage is set for more tragedies.

Eating disorders and substance abuse are both addictions, and as such, similar therapeutic approaches can be utilized to achieve recovery. Addressing them together not only makes sense, but research studies indicate that this strategy yields better long term outcomes for patients.

Honestly, why would a program help an adolescent beat an addiction to cocaine, only to return home still an anorexic? Why would a facility treat a man with binge eating disorder without addressing his addiction to alcohol? In each of these examples, treatment is simply inadequate.

Even more important than incomplete care is the need to have a treatment team that understands the complex medical, physical, psychological and spiritual issues inherent to each illness as well as the entire package of illnesses. In the case of this 20-year-old man, he died from ramifications of bulimia (low potassium levels and other electrolyte imbalances) while receiving treatment for alcoholism in a substance abuse clinic where the focus was detox. No doubt, those providing “care” were unaware of Brandon’s co-occurring eating disorder, which essentially resulted in his death.

Those with more than one addiction or disorder deserve quality care and thorough treatment, and quite literally, their lives depend on it. It is time for simultaneous treatment of co-occurring eating and substance use disorders to serve as the rule throughout our country, rather than the exception.

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