CEU Event: Addicted to Chaos, Starving for Control: Understanding Eating Disorders in the Treatment of Substance Abuse

Abstract:

Eating disorders have the second highest mortality rate of all psychiatric illnesses, behind only opioid use disorder—yet they remain frequently overlooked, misdiagnosed, or left untreated until serious medical complications arise. Research indicates that up to individuals with an eating disorder misuse alcohol or substances, and 1 in 5 individuals with an eating disorder will develop a substance use disorder during their lifetime. Given the high rate of co-occurrence, it is essential that clinicians working with substance use disorders are equipped to identify warning signs, risk factors, and problematic behaviors, particularly in the early stages of substance use recovery.

This presentation will provide an overview of the most common eating disorder diagnoses, explore the shared emotional, biological, and behavioral characteristics underlying eating disorders and substance use disorders, and identify evidence based interventions to help clients achieve full recovery from both disorders.

Learning Objectives/Goals:

1. Describe the Signs and Symptoms of Eating Disorders

• List diagnostic criteria and key features for each disorder, with a focus on symptom presentation.
• Identify the cognitive, behavioral, and physical symptoms characteristic of each eating disorder.

2. Examine the Intersection of Eating Disorders and Substance Use Disorders

• Analyze the prevalence rates and comorbidity of eating disorders and substance abuse disorders.
• Discuss the increased vulnerability to disordered eating behaviors in individuals in early recovery.
• Identify shared risk factors that contribute to the development of both disorders.
• Explore the biological and psychological mechanisms that underlie the development and persistence of eating and substance use disorders.
• Discuss concept of addiction replacement and explain how symptom substitution hinders full recovery.

3. Explore treatment strategies and identify potential challenges when treating eating disorders and co-occurring substance use disorders.

• Identify common medical complications and critical considerations when treating clients with dual diagnoses.
• Recognize when symptoms warrant further assessment, targeted intervention, or referral to specialized care providers.
• Highlight the importance of collaboration and consultation with a multidisciplinary team, identifying key team members and their roles
• Discuss evidence-based interventions and identify additional resources for collaboration and support.
• List short-term and long-term treatment goals to guide treatment.

4. Examine the impact of malnutrition on medical stability and cognitive functioning.

• Differentiate between the functioning of a malnourished brain and a well-nourished brain, with emphasis on executive functioning, emotional regulation, and treatment engagement.
• Identify common medical complications associated with eating disorders, including electrolyte imbalances, cardiac risk, gastrointestinal issues, and hormonal disruption.
• Discuss how prolonged malnutrition and dietary restriction impair insight, increase rigidity, and reduce the capacity for therapeutic change.
• Recognize when medical instability requires urgent intervention or referral to a higher level of care.

5. Discuss role of nutritionist in eating disorder treatment and how this applies in the context of substance abuse recovery.

• Describethe role of nutritional rehabilitation in eating disorder treatment, particularly in clients in early recovery from substance use.
• Explainhow nutritional stabilization supports emotional regulation, cognitive functioning, and engagement in early recovery.
• Discussthe importance of incorporating a registered dietitian into the multidisciplinary team to support individualized meal planning, nutritional education, and coordinated care.
• Explainhow nutritional interventions can reduce relapse risk, improve treatment adherence, and support sustained recovery from both disorders, allowing for clients to achieve full recovery.

6. Differentiate between disordered behaviors and health-promoting choices in eating and exercise.

• Define orthorexia and compulsive exercise, and contrast these behaviors with flexible, health-supportive lifestyle habits.
• Explore how clean eating, food rules, and exercise rituals may be socially reinforced yet psychologically harmful.
• Identifycommon food-related rituals, restrictive eating patterns, and nutritional deficiencies that may emerge during addiction recovery, and discuss how these behaviors can function as maladaptive coping strategies or signal the onset of disordered eating behaviors.
• Identify clinical indicators of rigidity, distress, and impairment related to food and exercise behaviors.
• Discuss strategies for assessing client motivation and guiding behavior change without reinforcing disordered patterns.

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Approved through: • Florida Board of SW, MFT, MHC • Florida Certification Board • Florida Board of Nursing • Florida Board of Psychology

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Presenters: Toni Falcone, Psy.D., CEDS & Kerry McCarthy, MS, RD, LDN, CES-C

Toni Falcone, Psy.D., CEDS

Dr. Toni Falcone is a licensed psychologist and IAEDP Certified Eating Disorder Specialist with over 15 years of experience working across residential, partial hospitalization, and outpatient levels of care. Her interest in addictions and co-occurring disorders began during her undergraduate internship at Coney Island Hospital’s dual diagnosis (MICA) program. She went on to earn her Master’s and Doctorate degrees in Clinical Psychology from Nova Southeastern University. Dr. Falcone’s clinical training includes positions at nationally recognized eating disorder treatment programs, where she gained extensive experience working with complex and co-occurring presentations. She now provides outpatient therapy in her Florida-based private practice, where she works with adolescents and adults. Dr. Falcone frequently collaborates with multidisciplinary professionals to deliver individualized, comprehensive care to individuals, couples, and families.

Kerry McCarthy, MS, RDN, LDN, RYT, CEDS-C

Kerry is an IAEDP Certified Eating Disorders Specialist and an IAEDP Approved Consultant, Certified Intuitive Eating Counselor and Registered Yoga Teacher who specializes in the treatment of eating disorders, disordered eating and body image dissatisfaction. Her interest and experience with yoga philosophy and mindfulness allow for unique crossover with her work as a dietitian. In addition to working with her private clients, Kerry frequently collaborates with other health professionals and universities to educate on the importance of collaborative care in the treatment of eating disorders. She is the active President for IAEDP South Florida Chapter. Kerry is also the Fundraising Chair for South Florida Academy of Nutrition and Dietetics (SFAND). Outside of work, Kerry enjoys cooking up something delicious and being outdoors with her husband, two daughters and black lab, Lyla.