25th Cape Cod Symposium on Addictive Disorders September 6-9, 2012 at the Resort & Conference Center at Hyannis, Hyannis, Cape Cod, Massachusetts
Thursday, September 6th:
8:30 – 10:00 am
Psychodrama experiential approaches are essential to eating disorder and addiction treatment because it facilitates a much needed journey into feelings. Psychodrama techniques increase access to emotions that otherwise create barriers to recovery. The open minded practitioner can use these visual and action oriented techniques to help their patient “break-through” defenses and provide “a picture” of unresolved core issues. Practitioners will observe a family sculpt, then learn techniques such as empty chair, roles, inner child, anger discharge approaches, grief work, and the use of props. These techniques will support a client’s ability to see how their eating disorder and addiction history are interrelated, with emphasis on how to work with trauma without “re-traumatizing” your client. This two-part presentation includes didactic and experiential learning, so beginning to advanced practitioners will have an opportunity to learn skills as well as practice it in real time.
Friday, September 7th:
As a board certified addiction psychiatrist, Dr. Karp brought 20 years of addiction treatment knowledge to his work with eating disorders. Dr. Karp’s then inexperience with eating disorders gave him the freedom to create his own method to simultaneously treating eating disorders and addictions. Dr. Karp will discuss noteworthy findings such as how psychiatric medications may complicate rather than improve recovery and why psychological insight into previous emotional injuries is necessary. The discovery that “food is the best medicine” was a pivotal moment for Dr. Karp, particularly for medication effectiveness in the eating disorder-addicted client. Debbie Richardson, RD, will talk about how mal nutrition contributes to cognitive impairment, body image problems, and thought distortions with interventions such as weight restoration, rehydration and meal planning. Beginning to advanced professionals will learn assessment and treatment tools to be applied in any setting that works with co-occurring eating disorders and addictions.
Adolescents with both eating disorders and self-injury pose difficult challenges for mental health professionals. This workshop will provide an up-to-date, comprehensive research review to help understand the prevalence of self-injury in teens and the dynamic relationship between self-injury and eating disorders. Co-morbid diagnosis including behavioral patterns and personality traits that accompany this unique population will be discussed. The main focus of this presentation will be on how professionals can integrate motivational approaches and effective strategies to help this population, including families. Case examples, tools, and assignments will be demonstrated to provide attendees practical methods to use with their clients.
Eating disorder clients have extraordinary relapse-rates post treatment. This dynamic presentation includes case studies emphasizing resistance and resilience, including highlighting differences and similarities between eating disorder and traditional chemical dependency interventions. Speaking from his own recovery from bulimia nervosa, crystal meth, tobacco and alcoholism, Brad Lamm is empathic to the struggle while exercising well-honed skill in dealing with the distorted thinking and denial that keeps the client in the chaos of the food. Brad’s believes the family and friends (the “voices that matter”) are uniquely poised to interrupt the illness and enable change and healing through their own spoken “eyewitness accounts.” Brad has lead the industry charge across multiple media platforms and living rooms to help families recovery together using his Invitation to Change method of intervention fused with 183-day Family Class programming. Beginning to advanced practitioners will learn skills on how, and when to intervene with the food-addicted client.
In eating disorders treatment, clinicians continually face the challenge of intervening at the risk of dys-regulating or overwhelming clients’ already delicately balanced emotional and cognitive system, contributing to the chronicity of symptoms. This presentation will address the relationship between eating disorders and trauma and how eating disorder behaviors are attempts at self-regulation from a trauma stress response. Based on the Somatic Experiencing approach to trauma, presenters will illustrate applications for eating disorders treatment, and the often co-occurring self-destructive behaviors, PTSD or other medical complexities. Presenters will demonstrate how clinicians can successfully interweave Somatic Experiencing techniques to facilitate their clients’ ability to listen and respond to their embodied selves. Participants will experience how these techniques can rapidly reduce clients’ anxiety, diminish negative self-talk, and improve ability to engage in treatment. Presenters will address individual and group interventions and will provide case examples helpful to clinicians in all treatment settings.
Saturday, September 8th :
8:45 – 10:00 am
Substance use commonly occurs in eating disorders (ED) and disordered eating has been reported in individuals receiving treatment for substance use disorders. Eating disorders are rarely addressed or even adequately assessed in substance abuse treatment programs. Addressing both disorders concurrently has several advantages, namely increased efficiency and cost effectiveness, reducing attrition that is more likely to occur with sequential treatment. Effective evidence-based treatments such as motivational interviewing/motivational enhancement therapy has been adapted across a variety of chronic disorders including ED. Motivational interviewing has been shown to increase readiness to change, which is predictive of successful clinical outcomes. Treatment goals are aimed at mobilizing change using the patient’s inner resources rather than imposing goals from the outside. This workshop will introduce the principles of motivational interviewing and discuss strategies to help patients resolve ambivalence related to targeted behavior change.
Family members generally show up for treatment intending to help their loved one who has an eating disorder or addiction to get better. Family members can unknowingly perpetuate the cycles of illness, relapse, and loss which are apparent in the patient and more insidiously infect all members of the family. Using family systems theory informed by our emerging understanding of trauma, a new model of family system illness, Stress-Induced Impaired Coping™ will be presented. Attendees will consider family trans-generationally transmitted wounds, identify environmental characteristics, and illuminate the impaired coping methods members have adopted to repeat cycles of loss. Clinicians will learn techniques to open clinical conversations in wounded family systems, better understand counter-transference reactions to sustainably do this work by promoting resiliency and mindfulness and create a grounded stance, sacred place, or sustainable posture from which to conduct a meaningful inquiry into these patients’ psyches, systems, and lives.
1:45 – 3:15 pm
This workshop will present an overview of the ways in which eating disorders overlap with addictive disorders. Overlapping phenomenology, epidemiology, etiology, comorbidity, neurobiology, and treatment aspects will be reviewed. Eating disorder patients with bulimic symptoms (bingeing and/or purging), have higher rates of substance use disorders, including both abuse and dependence, and conversely, patients with substance use disorders have higher rates of eating disorders. In addition, the phenomenology of eating disorders resembles that of addictions in various ways. Eating disorder patients may abuse substances to promote vomiting (emetics), retard food absorption (fat binders, such as orlistat), promote elimination (laxatives, diuretics), and suppress appetite (stimulants, caffeine, alcohol, nicotine). In addition, they may compulsively engage in maladaptive behaviors, such as dieting, vomiting, and exercising, that are suggestive of addictive behaviors. Anorexia nervosa has been previously conceptualized as “starvation dependence.” More recently, the issue of food addiction has been of particular scientific interest, especially in light of the new definition of addiction published by the American Society of Addiction Medicine (ASAM). Highly palatable foods, such as sugar, fat and salt, have been reported to have addictive properties in animals and humans. Both food ingestion and drug use trigger dopamine release in brain areas that mediate pleasure and emotion, and the quantity of dopamine released correlates with the sense of subjective reward or experience of pleasure. Similar patterns of brain activation in response to food and drug cues have also been found in studies using functional magnetic resonance imaging (fMRI). Other studies demonstrate that food can stimulate the opiate system and that there are striking similarities in use and withdrawal patterns of sugar and of classic drugs of abuse. In addition, there often appear to be reciprocal relationships among food and other substances. For example, people may gain weight when they stop smoking or drinking, and conversely, dieting behavior has reported to result in increased alcohol intake. These observations support the supposition that food and classic addictive substances compete for the same brain pathways and may serve the same purposes psychologically. In conclusion, eating disorders overlap with addictive disorders in several important ways that are relevant to clinical practice.
Stumbling Blocks to Stepping Stones: Two Therapists in Recovery from an Eating Disorder and Addiction by Jennifer Lorey, LCSW and Gary Grahl, MA, LPC
Our most empathic mentors are those who’ve walked the road they teach to others. Turning stumbling blocks to stepping-stones, Jennifer Lorey and Gary Grahl are both masters level clinicians in recovery from an eating disorder. Jennifer will present her story of recovery from an eating disorder and addiction. Gary will present his story of recovery from an eating disorder. Both will reveal issues related to gender, counter-transference, self-disclosure, compassion fatigue, when to refer out, and the importance of good supervision. Professionals will hear about the rewards and struggles of being a therapist in recovery while working with those in the depths of an eating disorders or comorbid addiction. This presentation will offer support for recovering, or non-recovering therapists, who find themselves overwhelmed when treating clients with eating disorders.
Sunday, September 9th:
10:30 – 12:00 pm
Process Addictions are considered to be activities where people spend many hours a day thinking, planning or engaging in the behaviors such as gambling, eating or shopping. Used to mask feelings, these activities can become so involved they take over a person’s life, to the point of becoming an addiction. With early intervention, process addictions may not turn into an addiction. Dr. Perlmutter will discuss the early stages of an eating disorder that fit criteria as a process addiction. While research is beginning to show the similarities between eating disorders and addictions, this discussion will focus more on the ways food is used in a habitual way to manage feelings.