Justin Gillespie

How Focusing on Co-Occurring Disorders Can Help Your Addiction Recovery

The best way that I can sum up co-occurring disorders, previously known as dual diagnoses, is they are these annoying assholes that accompany your fake friend addiction.

Probably not the most professional or clinical way of saying it, however, I would argue that it is the most accurate way to describe them. Formally, co-occurring disorders are mental health diagnoses that coexist with your addiction. By coexist, I mean they can really cause a lot of issues and complications in your life. However, they are not impossible to overcome and thrive in recovery.

Co-occurring disorders are often thought of as mental health diagnoses connected to substance use-related issues, however, they can accompany any sort of addiction or other primary behavioral addictions/diagnoses. From substance use issues to eating disorders, to other severe mental health diagnoses, co-occurring disorders can be there. Sometimes we can overlook them because it may not be the “primary thing” we focus on.

My recovery story involves recovery from binge eating disorder. I had spouts of recovery here and there… or at times what I thought was recovery. At times I thought success in significant overeating meant not eating at all. That works short term in the early stages of recovery but often falls flat for long term success. It wasn’t until I entered therapy that I started seeing results and long term success patterns. I received counseling for my ADHD as well as unresolved family issues and trauma that I had not addressed or flat out ignored because “What is the point? I just need to not overeat significantly,” I thought.

To tell you the truth, in therapy we probably touched on eating-related issues and urges to binge no more than 20% of our sessions together. It was very mental health-focused, something that I did not think would even help me and ended up giving me a life full of joy, freedom, and tools ready for battle in case my eating disorder symptoms decide to rise up.

Statistics

According to Alta Mira Recovery Programs, “8.2 million American adults (3.4 percent [of the United States Population]) had a mental illness (AMI) as well as a substance use disorder within the past year. It also found a co-occurrence of serious mental illness (SMI) and a substance use disorder within 2.6 million (1.1 percent) of American adults.” According to SAMHSA, in a given study 36.7% to 41.3% of patients with an alcohol or substance use disorder had a confirmed co-occurring disorder between 2007 and 2011. These statistics show how common these co-occurring disorders are to us in recovery. This also shows how often these factors and diagnoses can be overlooked in theory since these are the ones that are 100% confirmed.

How a Co-Occurring Disorder Can Affect You

Let me give an example of physical health. Let’s say somebody has diabetes and they want to focus on that. That is great! However, they also have chronic back pain. They want to focus on their diabetes treatment and eating better, but they are not worried about other appointments for the back pain because they think they can handle it. Well, this is great in theory. However, what the person with diabetes failed to realize is that his eating habits are off because of his back issues. Maybe he uses the back pain as an excuse to lay down and eat unhealthy food all day and not cook well-balanced meals. He might use his back pain as an excuse to just go through the drive-through after his long day at the office and get something unhealthy there because it’s easier. He also uses his pain as an excuse to not utilize any sort of physical fitness, and to be fair, a certain level of back pain that might limit his mobility.

So, one day he decides to finally get his pain checked out. Not even thinking it might help his eating habits, but just to get it treated. Prior to getting back pain treatment, he was doing okay with his diabetes management but could do a lot better. He wasn’t completely following the orders of his doctor. Now, several months later and his back pain has been significantly reduced through his chiropractor and muscle relaxants. It is still there, but not as bad. Suddenly our example case is able to more easily follow his food plan, takes his medication regularly, and start to exercise three times a week. He’s feeling so much better he even joins a gym. All of a sudden, because of treating his back pain and therefore following his doctor’s plan, this person’s blood sugar levels are evened out.

In this case above, the diabetes diagnosis was considered the primary diagnosis, and the chronic back pain was considered the co-occurring diagnosis. Now, take this with addiction and mental health. You have an individual that has had a cocaine addiction for the last 10 years. She is attempting to stop her use yet only can go for a few days before using it again. Her counselor has identified that her triggers come from feelings of sadness and boredom, so it seems. They work on addressing these triggers and come up with a plan of tools to utilize when these feelings arise. They are successful some of the time, but not all of the time. So, why is the recovery plan not fully working?

Well, after a few weeks they decided to get her an assessment for mental health. Turns out, the client also has Major Depressive Disorder and a lot of the time is not just having feelings of sadness or boredom but rather symptoms of depression and fatigue related to the depression. Due to the decision of the client and counselor to get her assessed, not only does this provide the additional framework for the counselor to work within her treatment plan, but it also allows the client to have additional treatment options including group counseling, support groups, medication if needed, as well as gives the client a more holistic approach to what is going on with them and what they face.

Choosing Both Substance Use Treatment and Mental Health Treatment

If you are someone who is struggling with long term recovery, you are not alone. Also, if you are someone with a mental health diagnosis and a substance use disorder then you are most certainly not alone. They often go hand and hand and they are both able to be overcome with treatment. It’s could be a long battle and is going to be tough at first (I don’t sugarcoat it, it really is going to suck in the beginning, and that’s fine), but in time getting treatment for your mental health and addiction at the same time can be the ultimate difference between short-term and long-term recovery. Basically, if you have to choose between getting treatment for your addiction or getting treatment for your mental health… choose both anyway. They are equally important and, to be real, nobody is ever going to physically make you choose between the two. So, just get both checked on and live your best life!

Binge Eating Disorder vs. Food Addiction

To raise awareness for National Eating Disorder Week, Justin, one of the coaches at Workit is here to share his experience with identifying his binge eating disorder.

I discovered my Binge Eating Disorder when I was about 20 sitting in my first semester of college. I was taking my Human Behavior and the Social Environment class for my social work program. Studying to help others I realized that maybe I needed some assistance myself; go figure! I joined support groups in the hopes to arrest my disease, studied it independently, and then eventually sought therapy where I was “officially diagnosed.”

In between those stages, I ended up attending Overeaters Anonymous, a 12 Step group all-around compulsive food behaviors. Despite the misleading name, the group accepts anybody who has a problem with food, whether that be overeating, binge eating, purging, or severe restriction. During my first set of meetings, I took note of the language being used within the groups. I would often hear individuals identify themselves as a “compulsive overeater”, some would call themselves a “sugar addict” or simply an “addict”. In my mind, I thought me having binge eating disorder meant that I was an addict; I thought that they were synonymous. Later I discovered that while they overlap in areas, they technically have two different meanings; because of this, I identify as both, but someone may only identify as one or the other.

What are the differences?

The biggest differentiation between Binge Eating Disorder (BED) and Food Addiction is Binge Eating Disorder is a diagnosable mental health disorder within the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-V). There are certain symptoms and criteria to meet the requirements of any eating disorder, let alone any mental health condition. In order to meet criteria for BED alone, you have to meet both of the following requirements:

Consuming an abnormally large amount of food in a short period of time compared with what others might eat in the same amount of time under the same or similar circumstances
Experiencing a loss of control over eating during the episode

On top of those symptoms, you also must meet at least 3 of these symptoms:

Consuming food faster than normal
Consuming food until uncomfortably full
Consuming large amounts of food when not hungry
Consuming food alone due to embarrassment over how much one is eating
Feeling disgusted, depressed, or guilty after the binge

Finally, you must be experiencing these symptoms for at least 3 months and these symptoms cannot be related to any other disorder. An example of the latter would be if someone met the diagnostic criteria of Anorexia-Nervosa but was binge eating in an attempt to control their disorder, much like binge eaters do when they starve themselves to lose weight they have significantly gained and to attempt to gain control of their disorder for a short period of time. Another reason for this could be grief — losing a loved one that is close to you. For a few months, while you sort your feelings, you are eating your feelings. However, that would become an eating disorder if one or two years after that individual passed away you were still binge eating.

Food addiction is technically not a diagnosable disorder. The biggest reason for this is that our body needs food for nourishment and survival. So, it makes sense that it would not be professionally noted as an addiction. This is a very similar manner when it comes to sex addiction. We need sex for procreation, let alone enjoyment and intimacy, so how would we be addicted to something our bodies are naturally supposed to do? While food addiction in itself is not a diagnosable disorder, BED is the disorder most commonly associated with food addiction.

Now, there is a catch to this. While food and sex addiction are both not in the DSM-V as of right now, there is a movement of professionals that recognizes these compulsive behaviors and cravings as a real addiction. This is due to the impulse factor. Did you know that drug addiction is technically not in the DSM-V? Don’t believe me? Let’s take alcohol as an example. There is alcohol use disorder, alcohol withdrawal, and alcohol intoxication. Alcohol use disorder is the problematic use of alcohol, alcohol withdrawal is essentially when one is detoxing, and alcohol intoxication is when you are inebriated.

For me identifying as a binge eater in my program helped me because I liked the label that it implied (being an addict) to address the cravings and to get me through life events psychologically while BED in the title itself gave me a scientific mental health disorder to say “hey, my condition is real and it is treatable”. This is not to suggest that addiction itself is not real, as it truly is, but to meet criteria for an SUD Disorder specifically, the major points to hit are you have to depend on something (drug, food, action, etc.), it has to cause harm and consequences, and you have to continue to intake these actions or substances despite the consequences repeatedly. You can technically be addicted to something and it has not caused you harm yet, such as smoking cigarettes while not having any legal, financial, or work-related problems as a result of it.

Both terms, addict and binge eater (identifier with BED), have helped me, but for some labeling themselves as an addict is not helpful to them. One may prefer the mental health diagnostic label while others do not like the label of a mental health diagnosis because it is stigmatizing and makes them feel “crazy”. Some do not like either and just would say something like “I have a problem with food” or “I have an issue with drugs and alcohol”. All of this is fine. Labels help some while others do not enjoy them. For me personally, label me whatever you want as long as you label me “killing it out here!”.

Can You Really Exercise Too Much?

The answer is, yes you can!

Of course, that is not all I have to say on this subject, or we wouldn’t have a blog post. Let me explain! As someone in recovery from an eating disorder as well as mental health issues, I have found a new profound love of exercise. The activity I once despised is the activity I have found joy in. I’ve discovered that despised exercise because I was utilizing it incorrectly in my life.

My Binge Eating Disorder and exercise.

I have been in recovery from Binge Eating Disorder for just over 2 years now. Whenever I say “Binge Eating Disorder,” I generally get one of two reactions. The first one is confusion about what the hell I even mean. The second is the assumption that, “oh, so it’s like bulimia!” No, it is not. They are two totally different things. Bulimia involves binging and purging to lose excess weight. Binge Eating Disorder simply involves binging … that’s it. Believe me, I have tried to purge before. After trying for 2 hours on my bathroom floor in an attempt to control my eating disorder and my compulsive eating once and for all, I still could not make my body do it. No matter how many times I stuck my hand down my throat or even punched myself in the stomach, I could not seem to make my body throw up at will. (Yeah, those were some dark times.)

The one thing that I did do prior to recovery in an attempt to control my eating disorder was to diet and exercise. With Binge Eating Disorder, you often gain a lot of weight. Then you feel guilty for overeating. Because you feel guilty for months of binging, you eventually try to select another disorder in a vain attempt to recover from the disorder you already have. In my case, it would often be anorexia. Of course, because I was a binge eater, the anorexia symptoms often would not last long. I could go a few weeks eating barely anything, but then my stress and anxiety would flare up and I would simply say “fuck it.” Back on the binging wagon, I went.

“Overexercising can lead to an unbalanced relationship with food, nutrition, and wellness, and can lead to eating disorders.”

Prior to recovery, we binge eaters often try to arrest our disorder and our urges to significantly overeat through crash diets (or trying not to eat at all, as I mentioned) and then by overexercising. For me, this would often mean working out for 4 hours per day for scheduled sessions. And if I did slip up and eat (God forbid it!), I would feel required to add on a 10 mile bike ride and another hour of strength training. This pattern kept pushing me back and forth between active relapse in my eating disorder and starvation/exhaustion. My relationship was food was dysfunctional to say the least, and exercise was my punishment for being a bad person.

So why is overexercising bad for us?

Take a look at the following questions:

Am I exercising just to burn calories?
Is exercise making my body weaker rather than stronger?
Do I become moody if I exercise less?
Is working out more important to me than my family and friends, school or work?
Do I continue to exercise even when I have an injury?
Have friends or family expressed concern about how much I am working out?

If you answered “Yes” to any of these questions, you may want to look into possible professional assistance. No shame—I know I answered “Yes” to at least four of them for some part of my life. Truth be told, I catch myself having occasional flare-ups of some of these to this day. So if overexercising is dangerous, what are some of the consequences of it, exactly?:

Dysfunctional relationships with food.

If you have not caught on yet, overexercising can lead to an unbalanced relationship with food, nutrition, and wellness, and can lead to eating disorders. By exercising 4-5 hours per day in an attempt to stop my eating disorder, I ironically ultimately enhanced it. The combination of overexercising and not losing as much weight as I thought I should stressed me out. I reacted to that stress by just throwing it all away and binging for months afterward. This led me to gain back any weight I had lost, plus more.

Resentment of exercise.

This leads into the original point above. If you overexercise and use fitness as a punishment rather than a positive prosocial activity and coping skill, you will learn to hate it. You will avoid it at any cost, sending you back to a life of imbalanced living.

Poor self-esteem.

Do you see how these points tie into one another? Eating disorders often come with body image issues or self-worth issues—they just comes with the territory. When you have self-image issues and you overexercise as a means to control your eating disorder and/or weight, the scale does not move as fast as you would like. You want to see yourself thin, ripped, or jacked and yet you still look the same. Of course you do, because it has only been about 4 weeks! But in our dysfunctional way of thinking, we believe we should see an immediate change. “What is even the point?” we ask ourselves. We give up, we pity ourselves, and our self-esteem is now in the toilet.

Increased risk of serious injury.

This kind of goes without saying: if you lift something that is too heavy, you might get hurt. Unfortunately, overexercising is not just about time; it is also about how intensely you are working out. Perhaps you be okay after a 3-hour hike. However, if you are able to safely lift 100lbs, but you insist on lifting 300lb weights … maybe … you might be susceptible to injury. Also for those who are significantly overweight or obese as a result of Binge Eating Disorder, you can cause injury to yourself much more easily through overexercising simply by running. This can cause knee damage, broken bones, or other internal injuries.

Relationship issues.

If you spend more time at the gym than with your girlfriend, boyfriend, mother, father, etc., you might have some social issues as well. If you are in a constant mode of working out and obsessing about fitness, what else do you bring to the table? What else do you like to do? Are you a good friend? Are you being a good significant other? If you are one of those “Fuck everybody, I’mma do me!” people, then this might be acceptable to you. However, just know that you might not get invited to any family functions any time soon.

But you work out now! So is exercise really bad?

Did you not read this blog all the way through? (Sigh …) Yes, I do work out now. In fact, as a therapist, I have found fitness to be one of the greatest coping skills, prosocial activities, and life enhancers for those struggling with mental health and substance use disorders. It has transformed my life drastically in the last two years. However, much like in any other dysfunctional relationship, I needed to change my mindset and my actions. Today, I can work out for an hour or two and feel satisfied. I can miss a workout from time to time and not feel like it is life or death. I can eat a Kit Kat and only have one, rather than spiraling into a dilemma of, “Okay, do I go work it off now? Or do I have to eat 4 of them?”. It sounds cliché, but it is all about balance. Some things are cliché because they’re true.

Running to Recovery: How Fitness Helped Me Heal

Fitness isn’t just about looking good — it can lead to long-lasting mental health benefits. One member of the Workit team shares his personal experience with exercise in recovery from binge eating disorder.

Fitness is often something we think about as a means to get healthy; by “get healthy” we often think of this as losing weight, increasing strength, gaining muscle, and toning up. These can all be very healthy things for your physical health, however the mental health benefits of fitness and exercise are far too often overlooked or passed over like an afterthought.

For years I fought and battled binge eating disorder, an eating disorder that involves ingesting severely large quantities of food to the point of discomfort on a regular basis, as well as several other mental health issues. I battled my rapid increased weight the best way I knew how: intermittent fasting, at times starvation, and overexercising (yes, exercise can be unhealthy as well).

Boost Your Brain Chemicals With Exercise

Several years ago I discovered what exactly binge eating disorder was. The traits and qualities of it were very similar to substance use disorders. After several tries at recovery with support groups and therapy, my knowledge started to click and I started applying these skills. I learned to live a balanced life with fitness and discovered that I was using exercise as a punishment for gaining weight, which led me to despise it. When I learned that I could actually work out for 30 minutes to one hour per day, five to six times per week, versus the four to five hours per day, seven days per week that I was doing it truly changed my life. It really made me fall in love with fitness and love/appreciate myself.

I knew that exercise has great benefits for your mental health, if you apply it in a healthy manner. I researched exercise while in school to become a therapist, seeking alternative methods to assist others with mental health and addiction. It’s not too surprising that I ended up coming to Workit Health. However, because I was still using fitness as a punishment during that time, I really only knew that it could be a fun activity for you if you enjoyed it. I did not realize that it could be a major intervention that could truly enhance your life.

As I continued my research on fitness, I started using it on my clients in various mental health settings. Prior to Workit, I have worked for inpatient treatment centers and IOP programs for substance use disorders (community-based settings for people had a mental health or substance use disorder diagnosis). While implementing regular fitness into their sessions as well as their daily life, the mass majority of my clients reported an improvement to their quality of life and over half of these clients had longer-term success. The majority of these clients also began to speak much kinder of themselves.

The Science Behind Sweating It Out

Throughout our day our bodies are releasing endorphins, a group of hormones secreted within the brain and nervous system and having a number of physiological functions. Endorphins activate the body’s opiate receptors which makes us feel good or stable; however, they are released in small amounts so you do not feel “high” but rather stable. There are two types of endorphins: dopamine and serotonin. Dopamine causes you to feel more alert while serotonin assists with you not falling asleep; the body releases these two chemicals essentially to keep you awake and continuing to perform basic tasks such as cleaning, bathing, dressing, and walking from Point A to Point B. When we work out we can often feel a “Runner’s High”, where we feel euphoric and more than just stable.

“Implementing exercise into your everyday life in recovery not only assists with increasing positive prosocial activities and coping skills but also begins to repair your body from the harmful effects of substance use.”

When we are struggling with substance use disorders or mental health disorders, our bodies cannot naturally produce endorphins like they once did and therefore we often feel tired, sluggish, or even sick (especially in the first few weeks of recovery). Implementing exercise into your everyday life in recovery not only assists with increasing positive prosocial activities and coping skills but also begins to repair your body from the harmful effects of substance use. Certain mental health diagnoses can also mean that the production of endorphins may be halted as well, which can create a double-edged sword for those recovering. Therefore, the production of these endorphins can be vital. To sum this part up, think of endorphins as our “feel good” hormones; if we do not have them, then we do not feel so great.

Making Exercise A Healthy Habit

In order to make these a part of your life, there are four things that I have personally identified to make this a healthy BALANCED habit.

Pick what you like

There is no sense in doing something if you hate it, so why start? I’m sure there is something you can do that is active that you enjoy and other things that you cannot stand. For instance, I cannot stand running. It has taken me several years to jog a mile, which if I must say I am very proud of; however if that is where my fitness journey was going to begin especially for increasing my happiness you can forget about it. I did find that I liked walking and going to the park to workout. Something about being outside made it more fun for me. To this day, I have a backpack that I carry with me with resistance tubes, exercise dice, and cones that I can use at any park if I decide “you know, today I do not feel like being inside”. I also love learning about boxing and MMA as part of my workouts. If that is not your thing, do not do it but find something you love.
Schedule it

Make time for yourself. Fitness can be just like any other appointment you have. Put it on your calendar and stick to it. Make it a commitment. I would also encourage you to do this with any other self-care tasks for yourself. It sounds silly to schedule self-care, but it really works especially if you were like me and not in the habit of doing it to begin with.
Focus on the “non-scale victories”

This one is more so for those like me who struggle with eating issues, but the same principles apply,. Focus on the mental health benefits you get from fitness, and in turn, the physical benefits will follow along easily.
“Workit” every day…but balance it out

Like any other skill, balance is key. As said before, I would overexercise all of the time and stress myself out trying to fit workouts in. Many times I would over-exercise for weeks and then give up on it as I grew resentful of it. Giving myself balance and a break allows me to appreciate and miss fitness. Our bodies with exercise are similar to drug use as well. While exercise is a healthy alternative that can increase your moods with biological benefits, it can also make our bodies used to it much like our bodies got used to drug use. Over time, you will need to exercise more and more to get the same effects as you once did as your body is producing fewer endorphins again as it believes you do not need them. Thankfully our bodies begin production on them a lot faster when we stop exercising than we do when we are getting sober, so those rest days can be a day or two and you are ready to lace up those running shoes again in no time.