One of the most rewarding parts of my role as Clinical Program Director at Casa Capri recovery is helping women overcome the challenges associated with substance use and co-occurring disorders. On its own, a substance use disorder or an eating disorder can be devastating. When they happen concurrently, however, they can leave a client feeling hopeless.
At Casa Capri, we’ve noticed a trend: many women seek treatment for substance use disorders only to find that their eating disorder, which had been in remission, then emerges as a primary concern. This pattern is not coincidental—it’s a reflection of the ways substance use disorder and eating disorders tend to feed off one another. So, when a client is dealing with both, which one should practitioners address first?
Eating Disorders: Control and Obsession
At its heart, an eating disorder is about control and obsessive ways of thinking. Food control is often the first “drug” a person with an ED turns to, marking the beginning of their journey into addictive behaviors. Consequently, many women start using substances as a way to cope with their eating disorder. Drugs and alcohol, in this context, offer a temporary relief from the unbearable weight of their thought life. This is why addressing both the substance use disorder and the eating disorder concurrently is vital. At Casa Capri, we emphasize the importance of emotional regulation and strategies to cope with the original urge to “not feel” or to avoid the obsessional thoughts. These skills help in the realms of both the substance use and the eating disorder.
How We Treat
When a client arrives, she undergoes a comprehensive assessment conducted by our clinical team and our registered dietitian. This initial evaluation determines the most appropriate treatment path, which may include admission into Grace House, our specialized nutrition house. Grace House offers all the programming available to our other clients, with a few key differences tailored to the needs of those with eating disorders. For example, while all clients participate in group meals, those in Grace House dine separately under close staff supervision to ensure a supportive environment tailored to their recovery needs.
Our approach to eating disorders at Casa Capri is distinguished by several unique aspects, including our emphasis on psychoeducation, nutrition, and the promotion of social connectedness through shared meals. We challenge the notion of “bad foods,” advocating instead for a balanced approach to eating where moderation is key. One of the most transformative experiences for our clients is the weekly outing to a restaurant, followed by a process group. This activity not only encourages clients to confront their “fear foods” but also facilitates social integration and the re
Building Independence and Intuition
Guiding women to freedom from the anxiety of eating disorders is one of the things that excites me most about our program. Casa Capri’s philosophy is tried-and-true, and it’s grounded in the gradual transition from structured to less structured environments, fostering a sense of trust and autonomy in our clients. We introduce the concept of intuitive eating, a practice that many with eating disorders find challenging initially. Through careful guidance and support, we teach our clients how to trust their bodies again, a process that can be profoundly liberating. Our approach is not just about treating symptoms but about empowering our clients to rediscover their strength, ensuring they have the tools and support necessary for a lasting recovery.
I believe wholeheartedly in the way we treat substance use and co-occurring eating disorders at Casa Capri, and it is a joy contributing to our clients’ recovery.
By Liz Miller
Clinical Program Director and Therapist at Casa Capri Recovery
