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College students are experiencing not only the typical academic and personal stressors of college but also the difficult task of maintaining emotional, social and behavioral stability in the presence of eating disorders and substance use struggles.

College campuses across the nation are becoming increasingly aware of the interactions among alcohol, drugs and disordered eating behaviors. Historically, impulsivity has been associated with both substance use and eating disorders. Moreover, emerging adults are known for engaging in more risk-taking behaviors. Recent trends have brought new questions concerning these complicated interactions. Weight control motivation among female college students has led to the intentional use of alcohol and limitation of food intake as a mechanism of weight regulation. The term “drunkorexia” has recently been coined and describes the process of using alcohol and food restriction as a means of weight control. Female college students are more at risk of practicing in this form of weight loss than other groups. For this reason, it is important to understand the diagnostic underpinnings of both eating disorder and substance use psychopathology.

EATING DISORDERS 101

For the purposes of this article, anorexia nervosa, bulimia nervosa and a general overview of substance use disorders will briefly be introduced. Anorexia nervosa has a prevalence rate of 0.4 percent and is more commonly diagnosed in females. Diagnostically, anorexia is comprised of both a restriction of food intake, which leads to a significantly low body weight, and the simultaneous intense fear of gaining weight. Bulimia nervosa has a base rate of 1 to 1.5 percent among young females and is highest among college-aged females. Bulimia includes recurrent episodes of binge eating characterized by a lack of control and excessive food intake in discrete periods of time coupled with recurrent compensatory measures to prevent weight gain (e.g., self-induced vomiting, misuse of laxatives, etc.).

To be diagnosed with a substance use disorder, an individual must present with a pattern of behaviors that falls into four categories: impaired control, social impairment, risky use and pharmacological effects over a 12-month period. Impaired control refers to when an individual has developed an increased tolerance to a substance; made unsuccessful attempts to decrease their substance use; spent excessive time searching for, using or recovering from a substance; and experienced intense cravings for the substance. Social impairment focuses on an individual’s inability to fulfill major role obligations at work, school or home; continued substance use despite persistent and recurrent interpersonal problems related to the substance use; and lack of engagement in previously enjoyed activities. The risky use of substance refers to the hazardous nature of substance use and the continued use despite recurrent psychological and physical problems directly caused by the substance. The final category emphasizes the pharmacological or biological effects of substance use including tolerance and withdrawal symptoms. Prevalence rates for substance use disorders widely range depending on the class of drug. For instance, the 12-month prevalence rate for alcohol use disorder is estimated to be 16.2 percent for those 18 to 29 years old, but the rate for opioid use disorder is estimated to be only 0.37 percent among those over the age of 18 years.

THE NATIONAL COLLEGE HEALTH ASSESSMENT

College-aged or emerging adult populations are primed for a variety of presenting mental health concerns as that period of transition is marked by increased independence, freedom and a general lack of supervision. Emotional instability, characterized by symptoms of depression and anxiety, is common among those 18 to 24 years old and may bias an individual toward more risk-taking behavior. In a recent national survey organized by the American College Health Association (ACHA), 63,497 college students across the United States responded in the spring of 2017 to questions regarding their habits, behaviors and perceptions regarding a variety of wellness topics.

The ACHA 2017 findings revealed the universal nature of mental health issues across college campuses, as males and females endorsed a diverse range of mental health symptoms. Of the respondents, 1.7 percent indicated being diagnosed with anorexia in the past year, 1.3 percent diagnosed with bulimia and 1.2 percent diagnosed with a substance use disorder. There is a high incidence of comorbidity among those diagnosed with an eating disorder and a substance use disorder, meaning they frequently occur together for many individuals. Approximately 50 percent of adults diagnosed with an eating disorder meet for a substance use disorder diagnosis, and approximately 35 percent of adults diagnosed with a substance use disorder meet for an eating disorder diagnosis. These prevalence rates suggest a much greater occurrence of these behaviors than seen in the general population. Lifetime prevalence estimates of eating disorders among college students range between 8 to 17 percent. The U.S. National Comorbidity Survey-Revised revealed a lifetime prevalence rate of 16.9 percent for alcohol use disorders and 9.7 percent for cannabis use disorders among 18- to 32-yearolds. Consequently, many college students are experiencing not only the typical academic and personal stressors of college but also the difficult task of maintaining emotional, social and behavioral stability in the presence of eating disorders and substance use struggles. Experience of these mental health issues are likely related to several adverse effects during their college experience, and many of these students would likely benefit from psychological treatment to promote a healthier lifestyle and decision making.

COMMON BARRIERS TO SEEKING TREATMENT

Adults with a chemical dependency and a co-occurring eating disorder often benefit from residential care due to needing both time and space to develop a sense of trust in themselves and in their surroundings to let their guard down during the healing process. Seeking treatment, for any mental health issue, can be delayed by personal or societal barriers. For many, the thought of seeking residential care for themselves or a loved one can be overwhelming. It is important to recognize that this process toward treatment is difficult for most and taking care to be patient with yourself and your loved one is necessary. Barriers to selecting the best course of treatment include both financial and everyday practical considerations. Additionally, in many instances, families who see their loved one suffering from addiction and/or eating disorders and recognize their motivation for change and sobriety may be more willing to help with some of the additional financial cost. For women with work or family responsibilities, hesitation to enter treatment may be related to those responsibilities; just a phone call with the residential facilities’ admission office can help determine timelines associated with treatment and a better understanding of the course of treatment recommended. This will help reduce most uncertainties associated with being away from home. Planning for visits with loved ones while in treatment is also possible; moreover, regular visitation with family and friends is not only allowed but also strongly encouraged at many treatment facilities.

Another common barrier to seeking treatment is the myths or falsehoods surrounding eating disorders. Some of the most well-known include:

  • Individuals of normal weight cannot have an eating disorder.
  • Eating disorders are not serious and are a lifestyle choice.
  • Dieting is just a normal part of life.
  • Eating disorders are a cry for attention.
  • Parents are to blame for their child having an eating disorder.
  • Eating disorders only affect white, middle-class females.
  • You can easily tell by looking at someone whether they have an eating disorder.
  • Men don’t usually have an eating disorder.
  • Purging is an effective way to lose weight.
  • Anorexia is the only life-threatening eating disorder.
  • Recovery from an eating disorder is rare.
  • There is no such thing as too much exercise.

As these misunderstandings circulate, individuals are more reluctant to seek treatment for behaviors that can be life-threatening. As mentioned earlier, there are effective and successful treatments for eating disorders and chemical dependency that provide individuals with the skills to remain in recovery.

THE BENEFITS OF TREATMENT

The benefits of obtaining residential care include not only 24/7 staff access but also an opportunity for learning time management, gaining encouragement and support for age-appropriate sober recreational activities, and improved mindfulness skills. The current research associated with brain health lists mindfulness practices as a necessary component of both recovery and increased self-efficacy.

Most residential 12-step modeled programs offer psychotherapy, as well as time and support to build an ongoing relationship with an outside supportive and sober community.

In the process of determining the appropriate residential program for yourself or a loved one, it is helpful to familiarize yourself with the selected residential program’s treatment philosophy. Many bright and promising individuals struggle with addictive behaviors, including college students and other young adults. The message to students needing residential help for chemical addictions and co-occurring eating disorders should be, “Seeking services shows a personal strength, not weakness.” The good news is that emerging adults can experience freedom from both addictive behaviors and disordered eating behaviors once they have the knowledge and tools to make different choices. Breaking patterns of addiction interactions and contexts can happen with time and support from knowledgeable and trained staff. Learning to build a fun sober life will allow healthy social development and optimal career exploration.

A facility’s treatment approach is an integral component of an individual’s success in recovery. For instance, at Pine Grove Behavioral Health & Addiction Services’ Women’s Center, a program that provides residential and partial hospitalization levels of care in Hattiesburg, Mississippi, patients can focus solely on their recovery and personal growth in a supportive environment, which provides the necessary tools and relationships to help them achieve their personal and professional goals. In many of these treatment communities, women develop relationships and bonds that provide them an opportunity to share their story while building caring relationships with other women in recovery. These connections and opportunities for personal development allow women to gain the skills necessary to support renewed hope and initiate the beginning phases of lasting emotional and mental health. For some women, this may be the first time they feel accepted and welcomed in a group of women. Through the process of learning to be open, honest and direct, women can be empowered to speak their own truth and rebuild a life of integrity and sobriety.

Written by Mallory L. Malkin, PHD, and Stephanie Smith, DSW


Mallory L. Malkin, PhD, is a licensed psychologist providing assessment services for children, adolescents and adults at Pine Grove Behavioral Health & Addiction Services in Hattiesburg, Mississippi.

Stephanie Smith, DSW, is the clinical director of the Women’s Center at Pine Grove Behavioral Health & Addiction Services.

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