Whack a Mole! When Eating Disorders Pop Up During Addiction Treatment…



I’ve never liked the carnival game, whack-a-mole. Bashing heads with a cartoon hammer, while an endless succession of new rodents appear, is too stressful and unpredictable. But, I could relate when someone in group said they thought eating disorders popping up during addiction treatment reminded them of whack-a-mole.


Wham! That came out of nowhere!

Because, just when you think you’ve pounded down the substance use disorder (SUD) that was taking over your life, a newfound obsession with jelly doughnuts might come to the fore. It’s not that the sugary treat is addictive per se, but the compensatory behavior is.


And it’s hard to talk about. It’s embarrassing. When you have a binge or binge-purge disorder, it is not exactly something that comes up in polite conversation. But it should. Especially during group therapy in an addiction treatment center. As high as 50% of those who have eating disorders also have co-occurring SUDs. And 35% of people with an SUD also have an eating disorder.


And eating disorders affect both men and women…


Eating disorders and SUDs do not always present at the same time. One may flare up while the other is at bay or appear without forewarning. And for those battling substance use disorders, dormant eating disorders can resurface when least expected. Just like a whack-a-mole…



Treating SUDs and Eating Disorders Together…


We believe that the best treatment for an eating disorder involves a team of professionals providing a combination of approaches. Although the eating behavior is only a symptom of an underlying emotional conflict, it does need to be directly addressed as new, healthier coping mechanisms are being learned. Gail Hall LMSW DCSW


I have had the privilege of sitting in on a group session with Sanford House guest speaker, Gail Hall. Gail is a therapist who specializes in eating disorders. She is also the owner of Comprehensive Treatment for Eating Disorders, LLC. And she has a lot to say about eating impulse control…


It’s not about abstinence from food. It’s about abstinence from addictive behaviors… Gail Hall


Gail tells us that an eating disorder is a coping mechanism for anxiety and depression. And, like substance reliance, there is often a genetic factor – the disorder runs in families. Gail says that with new associations and tools to address underlying stressors, a person can fully recover from an eating disorder.


In therapy, Gail challenges her clients’ “food rules”. She addresses “fear food” (such as pizza and jelly doughnuts) by taking her clients to a fast food restaurant and asking them to find something on the bill of fare to eat. For some (the author included…), just entering a hamburger joint creates anxiety. And since eating disorders are often secretive and marked by shame and guilt, Gail encourages her clients to begin to explore the social aspects of eating.


Unlike a substance use disorder, a person can’t quit eating. So we must separate the eating from the disorder and deal with the continuous barrage of potential triggers… Gail Hall


Types of Eating Disorders:

Anorexia Nervosa…

…is characterized by self-starvation and excessive weight loss. Symptoms include: refusal to maintain body weight; fear of getting “fat”; extreme focus on shape and body weight; and loss of menstrual periods. Anorexia/Orthorexia is not usually co-occurring with an SUD. Both are characterized by the need to control – not something characteristic of a SUD. Orthorexia is an addiction to exercise or “clean eating”.

Bulimia Nervosa…

…is more commonly co-occurring with SUDs. It is characterized by the binging and purging of food. Bulimics eat excessive amounts of food in short periods of time. After the binge, they get rid of calories by vomiting, taking laxatives or excessively exercising. Symptoms include: eating beyond comfortable fullness; lack of control, frequent dieting or fasting, extreme concern with weight; and abuse of laxatives, diet pills, and diuretics.

Binge Eating Disorder

… is also a commonly co-occurring with SUDs. Binge eating disorder or compulsive overeating is characterized by uncontrolled, continuous eating beyond the point of feeling comfortably full. Symptoms may include fasting or yo-yo dieting, feelings of shame or self-hatred; and changes in body weight or severe obesity.


Babies come into this world as intuitive eaters – this is learned behavior… Gail Hall


What’s the Solution?

blankFor those who are in treatment or early recovery from an SUD, it is tempting to “treat oneself” to sugary or processed foods. After all, when you are forgoing alcohol or other drugs it feels like you deserve to indulge in something. Suddenly, food tastes good again and days seem long. And processed foods are designed to give you a dopamine rush.


Education and caution are key to introducing healthy food back into the recovery diet without developing a new disorder. And Gail feels that education is paramount to developing a healthy relationship with food for everyone. Until the obsession with body type and the societal requirements to look a certain way are changed, there will continue to be eating disorders.



Gail looks to parents and the schools to guide children and teenagers. She feels there is an inappropriate focus on thinking “thin,” causing undue pressure and anxiety and she intends to change things. She says its a difficult task, but she’s a one-woman army and this is her mission.





Marilyn Spiller is a writer, sober coach, recovery advocate, and student of the world. (She also holds a Bachelor of Arts degree in English and Creative Writing). Seven years sober herself, she penned one of the first sobriety blogs "Waking Up the Ghost" beginning in 2013. The blog has garnered an international following. Marilyn is Sanford's Director of Marketing and serves as Editor-In-Chief for the Sanford online magazine, "Excursions".