A Compassionate Conversation on Eating Disorders & Substance Use

Treating an eating disorder while ignoring substance use is like trying to put out a fire while a second one burns behind you. We sit down with Leslie Plaia, Executive Director of Magnolia Creek and a licensed counselor with deep experience in eating disorder treatment, addiction recovery, and program leadership, to talk about what integrated, dual diagnosis care actually looks like when someone is dealing with both.

We get practical about the clinical realities: why many programs require a primary eating disorder diagnosis while still addressing co-occurring substance use, what medical stabilization and nutrition therapy need to consider during detox and early recovery, and how cravings and appetite shifts can show up with alcohol and opioid history. Leslie also breaks down how the two conditions feed each other through routines, triggers, and symptom swapping, from restricting to drink more to using substances to numb body image distress.

Then we go where a lot of conversations stop: stigma and bias. We unpack the harm done by “you don’t look like you have an eating disorder” and the ways poor screening questions can miss the full story. We also talk harm reduction, why multiple pathways of recovery matter, and how family therapy and honest communication help loved ones support recovery without becoming robotic or resentful.

If you care about eating disorder recovery, substance use recovery, trauma-informed care, or better mental health treatment, this conversation will challenge how you think about “the real problem” and what effective support can be. Subscribe, share this with someone who needs it, and leave a review so more people can find it.

For more information about Odyssey Eating Disorder Network and Magnolia Creek:

https://magnoliacreek.com/

https://odysseybehavioralhealth.com/odyssey-eating-disorder-network/

Show notes:

Trigger warning: this show is not medical, nutrition, or mental health treatment and is not a replacement for meeting with a Registered Dietitian, Licensed Mental Health Provider, or any other medical provider. You can find resources for how to find a provider, as well as crisis resources, in the show notes. Listener discretion is advised.

Resource links:

Alliance for Eating Disorders: https://www.allianceforeatingdisorders.com/ 

ANAD: https://anad.org/

NEDA: https://www.nationaleatingdisorders.org/

NAMI: https://nami.org/home

Action Alliance: https://theactionalliance.org/

NIH: https://www.nimh.nih.gov/

How to find a provider: 

https://map.nationaleatingdisorders.org/

https://www.psychologytoday.com/us

https://www.healthprofs.com/us/nutritionists-dietitians?tr=Hdr_Brand

Suicide & crisis awareness hotline: call 988 (available 24/7)

Eating Disorder hotline: call or text 800-931-2237 (Phone line is available Monday-Thursday 11 am-9 pm ET and Friday 11 am-5 pm ET; text line is available Monday-Thursday 3-6 pm ET and Friday 1-5 pm ET)

If you are experiencing a psychiatric or medical emergency, please call 911 or go to your nearest emergency room.

Transcript

Health, Triggers, And Disclaimers

SPEAKER_00 0:00

Join us as we redefine, reclaim, and restore the true meaning of health.

SPEAKER_02 0:04

Let's dive into the tough conversations about mental health, nutrition, eating disorders, diet culture, and body image. This is Nourish and Empower. This episode is brought to you by Hilltop Behavioral Health, specializing in eating disorder treatment.

SPEAKER_00 0:26

Hilltop offers integrated therapy and nutrition care in one compassionate setting.com because healing happens here. Hi everyone, welcome to this week's episode of the Nourish and Empower Podcast. Today we have with us Leslie Playa. She's the executive director of Magnolia Creek. She's a licensed professional counselor and certified eating disorder specialist with 14 years of clinical experience in substance use, primary mental health, and eating disorders. She also brings nine years of leadership experience across nonprofit and for-profit organizations with a focus on program development, operations, and community collaboration. Leslie has deep roots at Magnolia Creek, having served as a therapist, clinical program coordinator, and later clinical director nearly 10 years ago. Prior to rejoining Magnolia Creek, she served as executive director of a national nonprofit dedicated to providing resources and tangible solutions to address addiction and mental health challenges. Her recent leadership roles also include Director of Clinical Services for National Eating Disorder Treatment Center and founding program director of the Recovery Resource Center in Birmingham, Alabama. In that role, she works to increase access to treatment for individuals with substance use disorders, reduce barriers to care, and eliminate stigma surrounding addiction and recovery across the state. Trigger warning: we are identifying the following triggers that will be discussed but are not limited to eating disorders, substance use, and mental health. Listener discretion is advised. This show is not medical, nutrition, or mental health treatment and is not a replacement for meeting with a registered dietitian, licensed mental health provider, or any other medical provider. You can find resources for how to find a provider as well as crisis resources in the show notes. Like take a breath.

Recover Out Loud And Why It Helps

SPEAKER_00 2:26

Hi, Leslie. Welcome. We're so happy you're here.

SPEAKER_01 2:29

I feel so obnoxious that I had you read all that.

SPEAKER_00 2:33

No, I loved it.

SPEAKER_02 2:35

It's so good though. I love always hearing the bios because, and you know, me as a therapist, the more information give me, the more I'm gonna love it. I know it's great.

SPEAKER_01 2:44

Love it.

SPEAKER_02 2:46

Oh my goodness. But yes, thank you so much for coming. This is such a topic I feel like that's not discussed a lot, like it's like especially the co-occurrence with eating disorders and substance use. So I'm very excited to pick your brain today.

SPEAKER_01 2:59

Yeah, love it. Me too. This is my favorite topic. If somebody would have told me when I was in graduate school that I would have picked these two specialties, I would have told them they were crazy. But then at the same time, it makes sense because I'm in recovery from both. So it just feels natural for me to gravitate towards this work, you know.

SPEAKER_02 3:20

Is that something, if you don't mind me asking, we can absolutely not go down this road. But is that are you open with self-disclosing with that with clients when you work with them? Yes.

SPEAKER_01 3:33

And a lot of that is related to I cut my teeth in substance use treatment, and that's very normalized there. And a lot of times it's an instant rapport builder. And I remember that when I was using a variety of behaviors, I just felt so disingenuous and inauthentic. And I told myself that I would just always be open about my recovery. And so I've done that through many different roles. I've done it with clients where it's appropriate because to me, it feels really important to recover out loud and whatever that looks like. You know, it's not the same for everyone. Some people really want to stay private about it, and there are things absolutely that I'm private about, but I think it's just really important to be open.

SPEAKER_02 4:26

I love that. I'm already seeing the content mags of like recover out loud. I love that saying because I just think it's so powerful, right? Especially because we talk so often about how recovery or eating disorders and substance use, right? They thrive in secrecy. So like recover out loud, I feel like is such a good slogan, mantra, whichever word you want to use, of like owning that power and taking back, you know, the space of this is mine and I want to heal and like I'm going to be, and I'm always loud. So like right there, it's very much up my alley. So like I just love, I really do love that so much.

SPEAKER_01 5:03

Yeah, absolutely. And also, I think it's important to remember too that sometimes we are the people who identify in recovery, they may be the only person that someone out, you know, outside of treatment or whatever meets that's in recovery. And so being an example of that, that also can carry a lot of pressure. But I think that also helps eliminate the stigma associated with any type of mental health issues, treatment and recovery in general.

SPEAKER_00 5:33

Yeah. Yeah.

What Magnolia Creek Treats

SPEAKER_00 5:36

Yeah. So when clients are coming to Magnolia Creek, is Magnolia Creek eating disorder primary? And like, could you explain that a little bit just to have an understanding? Yeah, absolutely.

SPEAKER_01 5:49

So Magnolia Creek, we have both an adult and teen programs for residential and PHP, so partial hospitalization program as well. And you have to have a primary eating disorder in order to be admitted. However, we take a lot of folks that do have a secondary substance use disorder or other co-occurring mental health conditions. So obviously, a lot of our clients have PTSD, have anxiety, OCD, whatever it, whatever it is. We want to make sure that we are treating that concurrently so that we are minimizing potential recurrence of behaviors in the future or potential readmission to treatment. So our facility, the adult program has 14 residential beds, the teen program has 10 beds. And then again, we offer PHP. We have a small living space on campus for PHP, as well as the opportunity for folks to commute if that feels appropriate for them. So we see biological females ages 12 and up. Usually 14 is kind of that sweet spot. Um, and for our teens, we do obviously offer school and a lot of family support. So I love that we have that on our campus. We are located about 40 minutes outside of Birmingham. So we're in a little place called Columbiana, but for a lot of folks, it's just easier to say Birmingham. And we are on 36 acres, so it's pretty secluded, a beautiful property with walking trails. We have a huge like lake or pond behind the house that we do outdoor groups, we take the clients fishing, all of these different activities. Because we really want to ensure that people are in a peaceful environment as well as it being very cozy. So our property, it actually used to be an old house, an old farmhouse, an old farm and barn was on the property. And so we've converted a lot of that. So a lot of times if somebody was just to drive up on property, which would not happen because it is secure. However, when you drive up, sometimes we'll have clients ask us, Am I actually in the right place? Like, yeah, it just it looks like it looks like some old houses, but that's uh like it doesn't look like a treatment center. No, it doesn't, it doesn't, except for you know the locked bathroom doors and different different things like that on the inside, exactly, exactly a little different on the inside, yeah.

SPEAKER_02 8:27

That does just sound so peaceful, and like I the treatment center just sounds so nice that like I understand why treatment centers become so safe for people because if you're telling me I'm going to treatment and that's the serenity, in my words, I know it's not serenity having to do all of the work that you do in a treatment, but like if you're telling me there are walking paths, it's like, and I people are going to be shocked by this, but I do love a good farm and I love horseback riding. So, like I'm a very Jersey Italian girl, but put me on a farm and I will be a happy camper. Okay. Two two not conflicting things can live in the same space. And you know, it very much like that it sounds like I want to go right to Mongolia Creek because it just sounds so nice. So I understand why people would want to go back to a tree to go back to something like that, then to be in like the chaos of life sometimes.

SPEAKER_01 9:22

Absolutely.

Why A Peaceful Setting Matters

SPEAKER_01 9:23

And I think the fact that it is so secluded, and then we will take when people are clinically, nutritionally, and medically appropriate, we go on outings, and so we have that space to be able to go on meal outings, and then we have our fun outings as we call it. So a couple of weeks ago, we took the clients who were appropriate to the zoo and packed snacks for everybody, spent the afternoon at the zoo. And so that was a big thing that we talked with the clients about. I asked them, like, when's the last time that you did that and you weren't so preoccupied on food or how many calories you were losing, or you know, whatever it is. And sometimes people will get really honest and say, Hey, this was really hard and here's why. And sometimes people say, I can't even believe that I did that. Like, I don't remember that. Yeah.

SPEAKER_00 10:14

I'm so glad that we're talking about this because I feel like in times when I've had to have higher level of care conversations, I feel like a lot of people have like just a really warped perception of what treatment centers are like and kind of maybe picture like more of like the Hollywood portrayal of a treatment center. And you know, and we as providers always try to explain like what you're describing, but I'm so glad that we're talking about this in like a larger extent too, so that way people have an understanding of like, yes, it is treatment, but that there's also there are things like outings and there is outdoor space and you know, like some of those, like just you said earlier, right? Like some of those like comforting elements that can come in too.

SPEAKER_02 10:58

Yeah, because even if like, because I know sometimes for clients, if we're talking about higher levels of care, like I will show them the facility that we're sending them to, especially if it's a residential, because the residential houses are really nice. Like when you look at them from the outside, like I'd live there, like I'd buy that as my own home one day. You know what I'm saying? Like you like, it's such a that's what I love about them is that they look like a home. Like it doesn't look like a facility. So when you do drive up, it is like shocking of well, that's where I'm staying. Like that's what we're like, this is what the the center that's supposed to be helping me, but it doesn't look like a center, so it doesn't feel like a center. It's much more normalized. And like I imagine that's on purpose, you know what I mean? And so like it does give such a different feel to the experience. And I so I I do that all the time of just showing them like, no, no, this is where you're going. Like it's not that terrible to look at.

SPEAKER_01 11:55

Exactly. And I think it's an interesting juxtaposition too, because I tell the clients all the time, I want to acknowledge that this work is brutal. There's nothing, there's nothing like wonderful about when you first go to treatment because you're you have made a decision to essentially save your life and unpack years of behaviors, trauma, you know, fill in the blank. And that can feel so just tumultuous and overwhelming. And so I would I've told them I said I would love that everything feels comfortable because I know that your insides do not feel comfortable right now. So if that means I get you more bean bags or more, like we have these beautiful hammocks that are in the back, which clients really love, like if that means that I'm getting you some more hammocks, we're doing more art, we're doing these things that can help ground you because inside you feel all over the place, you feel scattered, absolutely. I'm I'm gonna do that.

SPEAKER_00 13:07

100%.

Integrated Care For Co-Occurring Disorders

SPEAKER_00 13:08

So, Leslie, from a treatment perspective, what does an integrated approach look like when you all are supporting somebody with an eating disorder and with substance use as well?

SPEAKER_01 13:23

So what it's really focused on is making sure that we are not treating one issue while ignoring the other. Obviously at Magnolia Creek, as I've talked about, we're primary eating disorders. So that's going to be the main focus, but we also recognize that those behaviors don't live in a vacuum, right? Because they're often so deeply interconnected. So some studies indicate that, you know, 35 to 50 percent of individuals with eating disorders will also experience co-occurring substance use. The reason why that is kind of a broader number, one has to do with the studies, and two has to do with the interviewing and the questions, which I can definitely get into later. Um, I can go on a rabbit hole about that. So when we are looking at treating the two simultaneously, we're looking at that medical stabilization, we're looking at nutrition, we're also looking at based on that person's drug of choice, what is that person's body typically craving? So, what we see is for individuals with alcohol use disorder, they're used to this flood of glucose, they're used to that sugar. And that's why, more often than not, when people, you know, abstain from alcohol, they start craving sugar. And same with people with opioid use disorder as well. Also, that's related to kind of these different dopamine hits that people want as well. But we want to make sure that we're understanding are there certain nutritional gaps that this person has separate from the eating disorder that we just need to be aware of. We're also looking at the at trauma. We're looking at any factors that are contributing to both the eating disorder and the substance use. And so what that could look like is something like a timeline of eating disorder behaviors, a timeline of your life, timeline of eating disorder behaviors, and then where did substance use come in? And how are these two connected to potential traumatic episodes, potential life events, also different experiences with substances, like if there's some sort of association that's there, we want to look at that as well. We also want to look at how do those two feed into one another. So I remember that I have had clients in the past that would tell me that before going into a binge purge episode, they would clean their whole house. That was like part of their association. So it's the same with substance use. It could be, okay, in order to pre-game, I'm restricting all of my food so that I can drink more, not be as worried about the caloric intake, and feel the effects more, right? So we're looking to see how those two are related. We also see a lot of marijuana use and that quote, helping people eat or be so disconnected that they're not even caring about the eating disorder behaviors and so numbing their brains so that they're able to actually engage in nutrition in some way. So we want to see how that works. With that, though, you know, what we do in typical treatment, just in general, we're looking at coping skills and how do we implement those. We're looking at that nervous system regulation, we're looking at those relationships, the healthy and unhealthy relationships, and how those maybe impact the behaviors as well as all the underlying emotional pain, right? So we're looking at all of that and kind of holding that all in a container and being aware of it. This is very similar to how someone would talk about their self-harm and how it relates to their eating disorder. It's just a different mechanism of discussing it because there are some different things at play there, right? So because you have somebody that maybe is detoxing from a substance, they're experiencing postables in some way, and that is escalating certain behaviors, or we've taken the substances away. The eating disorder feels like the only option. So what do I do about that? Right. And what it what it boils down to is people are wanting to escape, numb, dissociate, go, just get away from whatever they're experiencing. And that's what we try to look at. That's such good

When One Problem Hides Another

SPEAKER_01 18:11

info.

SPEAKER_02 18:11

So I know you were like touching upon this. And so, like to go like a little bit deeper, like how would you say substance use can mask or complicate the identification and treatment of an eating disorder, or even like vice versa? Like, can any eating disorder behaviors mask substance use?

SPEAKER_01 18:33

Yes, absolutely. I think, hmm, which way to start with this? Oftentimes one can be masked by the other based on uh perceived severity. So, for example, let's say that you have someone who is shooting heroin, but they also have eating disorder behaviors. Sometimes people say this is the bigger deal. So the heroin is the bigger deal. It's more dire. And so because this is the bigger issue, we're gonna treat this first and then worry about the eating disorder later. The reverse of that is what, yep. And the reverse of that is when somebody has an eating disorder and maybe they maybe they have an alcohol use disorder, maybe they are a binge drinker, right? Then the thought is we'll just worry about that right now because this person is so underweight that we really need to make sure their nutrition is in gear. And so that's what happens. It just it's like playing whack-a-mole almost. Yeah.

SPEAKER_02 19:43

Because even when you said that, it's like how do you identify which is the most severe? Right. Like that's such a hard call to make.

SPEAKER_01 19:54

And I don't even know if I can tell you the best way to do that. Because I think even with a variety of assessments, until you get a person in the center, sometimes that tells you, oh, okay, this is this is a little bit more than what we thought. And that could be based on client report, it could be based on the interview itself. You know, if you ask a question just the right way, so to speak, like clients know how to answer it, right? And so, not because people are intentionally being manipulative or withholding, but it's just based on their own understanding. So sometimes people will come to treatment, even if people are going to primary substance use treatment and they're like, I don't have, I don't have a drug problem. I'm not one of those people. And that's another thing that I think can mask our own stereotypes and our own biases against what we believe eating disorders are are supposed to look like, what we believe substance use is supposed to look like. That's what's gonna cause people to either be misdiagnosed or just completely written off in some ways. So, so think of so many times when people are like, Oh, you don't look like you have an eating disorder. Oh, you don't, you don't, you don't look like one of those people. That's one of my favorites. That's how I roll my eyes of like, you don't look like a drug addict. Like, first of all, that's stigmatizing. Like to just call work like point blank calling people drug addicts, stigmatizing. There's some different language, but also we know that substance use disorders, eating disorders, they can affect anybody. But what we also know, and and I'm preaching to the choir on this, is like black women are gonna be misdiagnosed or underdiagnosed or completely ignored, right? And then oftentimes people will be misdiagnosed with certain substance use disorders or believe that somebody has a substance use disorder because. Of you know, seeking pain medication, and then they get put in this box based on, oh, this person's drug seeking or whatever. So a lot of that is related to the different clinical interviews that we do. Are we even screening people appropriately? I don't think in my life I've ever had an eating disorder screening done for me, unless it was like in the context of my therapist, right? So, like physicians, they they're not always informed in that capacity, right? As we know, it's the same with substance use, right? So sometimes you depending on your physician, you're answering questions about substance use, but not always. So a lot of times it's related to that clinical interview and how or or HP or whatever it might be and how we're asking those questions. Because the other piece of that, too, is let's say you're in primary eating disorder treatment and you have disclosed some substance use. And if you're asking questions like, do you think you have a drug problem? What is that answer gonna be? No. Oh, I don't have a drug problem. What do you mean? Right.

SPEAKER_02 23:13

Just like asking someone with an eating disorder, do you think that you have a disordered relationship with food in your body?

SPEAKER_01 23:18

No, that's exactly it. That's exactly it. And so if you're asking questions like, tell me about your history with substances. And when I say substances, I'm talking about prescribed medications, I'm talking about over-the-counter medications, I'm talking about alcohol, I'm talking about weed, I'm talking about all these different things. And so if you define it, there you go. This is very similar with substance use because people with primary substance use disorders sometimes don't realize that they may be engaging in either disordered eating or have a full-blown eating disorder diagnosis. And a lot of that, I think, is related to that severity piece that we talked about. You know, diet culture is so normalized, eating disorders to some degree, those behaviors are so normalized that oh, I don't, I don't have a problem with that. Everybody else is doing this. I'm just, I'm just glad I'm not using heroin anymore. I'm just glad I'm not using alcohol anymore. It's just a diet, right? And so if that is co-signed by professionals, then that just feeds into that narrative. Like, I'm actually not, I'm not that sick. I'm okay. Yeah.

SPEAKER_02 24:32

I feel like that kind of goes into like what you said earlier, and maybe it doesn't, and we can completely scratch this because I'm putting things together in my brain, but like of like the underlying factors that like contribute to them being co-occurring,

Symptom Swapping After Getting Sober

SPEAKER_02 24:45

right? Of like it's symptom swapping, right? And sometimes like you were saying before, like the like how self-harm can also be that, like, okay, I'm not restricting, but am I cutting, or like whatever the behavior might be. And you know, I'm curious too what so a few things I'm gonna try and make this concise. Do you ever see that like one catapults the other or causes the other to form because of that symptom swapping? Where like maybe they weren't they weren't really using alcohol, but like they weren't like have you seen I wasn't an alcoholic, but because I recovered from one, I just so happened like it leaned into the other. And like what other factors do you feel like contribute to them being co-occurring?

SPEAKER_01 25:32

Absolutely. I think one of the biggest ones that I have seen is in the substance use community, especially. I can think of, I mean, countless times where someone goes to treatment for substance use, they are they've not been taking care of themselves in any capacity, and they gain weight. And then everybody goes on a diet. When you first get sober and you start gaining weight, everybody then goes on a diet and everybody starts exercising more because then it's like, oh, well, I need this dopamine and I haven't been taking care of myself, so it's okay because I'm exercising more. And then what we've also seen is I a pretty large prevalence of steroid use. And so that's contributing as well to body image, to all of that, right? And so ultimately it's about okay, that feeling of I'm not enough in some way, or I need to mask whatever this is, and the thing that I was doing was no longer working, and I realized how detrimental that was, but I can control this. This isn't that bad. This is so, and that happens with primary eating disorder clients too. Let's take substance use out of it. How many times have people have said, Well, I'm just restricting now because I'm not purging anymore?

SPEAKER_02 27:02

Yes, right?

SPEAKER_01 27:03

So it's that same sort of thing. It's like it's still, you still have to look at what need is that meeting. Yes, and yes, it may it what's hard about that too is that sometimes people will say, Well, it's it feels different. Well, of course it feels different, especially if one, you know, there's like almost like a honeymoon period with with different behaviors. And it's like, well, of course, it feels more functional at this time. And history tells us that you are not successful at at quote, dieting, right? Like because it is meeting a specific need, right? And and I think just looking at what are what are your motivations there? Yeah, absolutely.

SPEAKER_02 27:52

One other question I have for you. And I'm so sorry, I know I'm asking all of the questions. Remember how I started our conversation with mom brain? It's happening. It's happening. Hold on a second. Where was I going with this? Oh,

Is An Eating Disorder An Addiction

SPEAKER_02 28:05

okay. So I'm actually so even more excited of having you on because you have both frameworks. Because one of the things I always try and like educate parents on, or like even with clients, and you can either approve like side with me or you can debunk me. And I'm really excited for either. Or I always like to say that like eating disorders is a type of addiction, right? It's not the same as substance, it's more of a process addiction than it is like a substance addiction, right? Like we're addicted to the act of binging, purging, or restricting. We're not addicted to the food and things of that nature. And I just really want to pick your brain on like your thoughts about that and if I should stop, because you can tell me, or if it like makes sense, and if it does make sense, what makes them similar in that addictive nature?

SPEAKER_01 28:56

So that is a tricky one, and I'll and I'll tell you why. Because I think probably 10 years ago, I would have said, absolutely process addiction. Let's use medical model of the disease model regarding eating disorders and substances and all of that. I think there is still space for that. I think there is also a bigger conversation, especially in the substance use community, about harm reduction and about is a substance use disorder, is it have we been leaning too much into the disease model? And do we need to look at it as like, what are the other functions of this? I think in some in some areas, we're kind of splitting hairs with that. I think recognizing whether somebody believes that a substance use disorder is a disease, an eating disorder is a disease, or whatever, I think the bigger thing is recognizing that because somebody has a substance use disorder or misuses substances or just uses substances in a way that they deem problematic for themselves, same with an eating disorder, looking at it as it's not a moral failing, it is meeting a need, right? And so, how can we educate people and have them understand that it's about the food, but it's not about the food? And so sometimes that's where the behaviors themselves that they are so drawn to that is also meeting a specific need. And so because they've been in that pattern, we need to figure out how to rewire your brain so that you're no longer in that pattern. I think increasing that understanding is a little more helpful. It is a process addiction, but I think sometimes too, especially with recovery and addiction, just in general, when I think about substance use recovery, that has been co-opted by like, hey, abstinence is the only way. And realistically, we have to look at many pathways of recovery. Now, am I saying that, oh, people can leave treatment and just like use eating disorder behaviors willy-nilly? Like, no, I'm not advocating for that. But also, you know, in treatment, we have a harm reduction approach. We can't we cannot expect somebody who is purging 10 times a day to enter treatment and immediately they're fine, they're eating 100%, they're not purging, you know, and it's having those conversations and especially with family members, them understanding like, hey, this is meeting a specific need. You don't have to understand a hundred percent of where they're coming from. You just have to be open to the possibility that they are experiencing something and have an understanding of something that's different than your own. 100%.

SPEAKER_02 32:00

We always say, like, your behavior is communicating something. Yes. And so, like, what is that behavior saying to you? And I think sometimes like parents, support people, and even clients going through it, they don't get that. And so that's why sometimes I like to start with the we're addicted to the process and the behavior because it's filling a need, it's filling a void to then allow them to understand like conceptually and then go into so what is it telling us? What are you trying to say right?

SPEAKER_01 32:28

Right, right. Exactly. Exactly.

Harm Reduction In Substance Use Treatment

SPEAKER_00 32:33

So we actually we have an episode coming up where we're gonna talk to somebody about her own lived experience with a harm reduction eating disorder approach or treatment. But I'm curious, Lizzie, if you could clarify or like give some examples. What does a harm reduction approach for treatment look like with substance use?

SPEAKER_01 32:51

So for substance use, it really can look like decreasing the amount that somebody is using over time. Sometimes it can be something like medication-assisted treatment or medication-assisted recovery. So maybe somebody has been shooting heroin and then they get on Suboxone. Like that could be something that's helpful. I think that when we look at harm reduction, sometimes people think that harm reduction as it relates to substance use means that, oh, we're just gonna get somebody to decrease their use until they're abstinent. And that's not always the case for folks. It's examining somebody's relationship with that substance. And maybe they address whatever issues they have, and maybe they can use that substance recreationally later on. Maybe it's that they, you know, can have stepped away from that substance, but they use others. I know tons of people who identify in recovery that maybe still drink alcohol, but they've put down their drug of their specific drug of choice because they're engaged in support meetings, they're engaged in therapy, they're looking at what those underlying factors are and recognizing that, okay, in this circumstance, this doesn't, this doesn't kind of live all together and I can keep it separate. And just being open and having those conversations. I think when we have the closed-minded approach, that's where people, people die, right? There's so, I mean, even I think like 12 to 14 years ago, so many treatment centers not using things like Suboxone or Vivitrol or any other type of mechanisms that help people, and just saying to people like, oh, like good luck, and that killed people, right? I think it's just having those open conversations around it as well. Now, people have their own experiences and their own feelings about that, especially. I think there is, there are a lot of people who again identify as being in recovery that maybe are not abstinence from from substances. And sometimes they don't feel part of the recovery community because that's been really kind of a landscape of abstinence, which is fine. Like that, again, it's multiple pathways of recovery. Just because my recovery looks a certain way doesn't mean that somebody else's has to look the exact same way. And we have to ensure that that we're looking at those things that feel those behaviors so that we don't get into a circumstance where we have had like a significant recurrent use of behaviors and there's an overdose or some or you get hurt in another capacity, right? So just examining that closely.

Family Support And Real Communication

SPEAKER_00 35:54

And how do you all bring like loved ones and support people into treatment and like into these conversations?

SPEAKER_01 36:03

So at Magnolia Creek in particular, we have a crew of family therapists who meet with support systems and and a lot of times we'll say family members, but we want some sort of supportive loved one, right? So especially because we know that oftentimes our family systems are not very healthy or not very helpful in that moment. So we want to do some general education about substance use or excuse me, meat substance use disorders for some of our folks, eating disorders for others, as well as looking at what are these behaviors communicating and defining support. What does support look like? What does it not look like? That's one of my favorite conversations to have with clients in particular. I did a group on this last week, and many of them have talked about, I don't feel like I can even ask for support because I'm supposed to have it all together, right? So how do we break that down not only in a group, but in the context of a family session as well? And so how do we get everybody on the same page with that? And then when people are maybe having, they're going on passes when they're in PHP or doing some sort of supportive outings with loved ones, planning around that, talking through meal plan, talking through expectations, and really again defining that support. Hey, when I feel escalated, this is what's helpful for me. This is what's not helpful for me. And really having that open conversation and family members are gonna mess it up. Absolutely. And what do we then do next? Can the family member say, uh my fear was activated and I got really concerned and worried and I overdid it? So it's that acknowledgement of it too, because everybody is impacted, everyone is impacted. And we we also have a family support group and a family alumni group. But the other thing, too, that I always encourage people is if you're not as a family member, if you're not in your own therapy, you better start because you are just as impacted by all of this, and you deserve a space where you can process that too and not feel like you are dumping on your loved one, especially when you have so many different things that maybe you don't quite understand. And you don't oftentimes it's not appropriate to work that out on your loved one who's in treatment. And so, how are you working that out elsewhere? I'm so obsessed with this.

SPEAKER_02 38:43

And I always love when this happens because we just put out an episode yesterday about support people and support systems and things like that. And we had some, we had a very similar conversation that mirrored the concept of like communication has to happen both ways, and you have to be accepting that both sides are human. And like you want your support person to just get it and to do it and to know the boundaries and to just be almost like now thinking about it, like almost robotic, that like they're not gonna have an emotional reaction, they're not going to have like their own thoughts, feelings, or experiences. They're just there. And like, right, I even have conversations with clients where it's like, it was my trauma, it's not their trauma. I went through the eating disorder, not them. And it's like, yes, and and right, like you can have your like I'm and one doesn't take away the other, one isn't more impactful than the other. It's just two different experiences going through the same thing differently. And like, how do you, and so like here's a question for you how do you navigate that if a client, whether for substance abuse or for eating disorders, how do you navigate if a client is like, this did not affect them, they're making this about them, and this is a me thing. How do you navigate that to show that both sides are affected? Because it's true, they are. Really put me on the spot. Sorry.

SPEAKER_01 40:08

No, that's a that's a great one. I think breaking that down and having that conversation and and really just spelling that out and saying, hey, this is how this other person is affected, and having the client say, You are making this about you, and and having that open conversation and being able to say for the loved one to say, Hey, actually, that's not what it feels like for me. And so, how do we have that open dialogue where sometimes feelings might get hurt, but that is that open communication is going to be better than the resentment that's building up? And then all of a sudden, like we've shut that person out completely. We're using behaviors again, like whatever it may be, right? And so, how do we have that conversation where we say in a respectful way, hey, this is what this feels like, this is what it's bringing up for me, and this is what I need you to do differently. And the other person saying, That that's not my experience. I can either work on that or we need to adjust your approach as well. I think it, I think too, sometimes, and I say this as a person who, like, I always want to be right, I always want to like, you know, but sometimes I have to remember my therapist put me in my place recently, and she was like, Maybe this was like not about you, like maybe it was about so and so. And I was like, How dare you? And she was like, But I'm right. I'm like, you are, and so sometimes we have to have, I oh, I'm never gonna I might tell her, hey, I admitted to that in a podcast that you but that's a conversation that we have with clients of like, hey, in in this circumstance, it is about you, but maybe it's not all about you. And so, how do we do that in a way that doesn't feel like the pendulum has swung from I am the most important person in the world to I am a speck of dirt on the floor? Do not talk to me. Correct, right? And so a lot of that is also gonna be like those CBT, those DBT skills, and how do we how do we just increase that level of communication there?

SPEAKER_02 42:22

Yeah. And even just to say, like, yes, it's about you because it's your eating disorder. Yes, and it's not about you in the sense of whatever your parents are going through, like the the differences there, and like how to identify the difference between it is about you and it's about your eating disorder and their experience of the like it's so intertwined, but I always find that so fascinating and like so important to allow space for.

SPEAKER_01 42:53

The other thing, too, is that sometimes clients really want to cling to that idea that the eating disorder did not affect their loved ones because that shame is so big. And if they actually acknowledge, oh my gosh, somebody cares about me enough to be concerned, then that just oh, it feels too much. If that it can feel so overwhelming, that's where all that shame is. And that's where I I want to challenge people and say, gosh, what amazing it is. What an amazing feeling to be known and to be seen, and how uncomfortable at the same time. Mm-hmm. Mm-hmm.

Provider Bias And Who Gets Missed

SPEAKER_00 43:41

Is there anything that you that we didn't talk about that you feel like you wish more people understood when it came when it comes to eating disorders or substance use?

SPEAKER_01 43:52

We had talked about it a little bit, but I think the biggest thing is remembering that your understanding. Of eating disorder behaviors or substance use is not the only understanding of it, right? Just you have to have your bias in check and asking yourself, especially as providers, like, am I am I actually doing harm by not addressing my own bias? Am I doing everything that I can to treat these clients? Because that to me, you know, loved ones, the general public, I get that, right? Like sometimes we're gonna have that level of stigma. There's no excuse as providers. And so, how do we challenge ourselves and do the research, admit when we're not an expert in something, and and refer out? You know, there are certain clients that like maybe their needs are not my forte. So the ethical thing for me to do is to refer them out, right? To a provider who can give them the care that they need. But I think if we are not recognizing our own filter, then we're doing some some serious harm. I and I that comes up a lot for me, especially with substance use, but also with eating disorders with people of color. Like that's kind of the biggest thing because so often eating disorders are can are considered as there for thin white women. And there's the whole, there's people of color, there's the LGBTQ community, there's all of these different things. And so, like, as providers, look at your bias, look at like your narrow-mindedness and figure out a way around it, figure out a way to expand and broaden your horizons so that you can be the person that looks in someone at someone and says, Hey, actually, maybe there is something else there, and and I want to figure out how to help. So, yeah.

Magnolia Creek Links And Closing

SPEAKER_00 46:12

Thank you. So, if people are interested in learning more about Magnolia Creek, can you share with us like website, social media, anything like that?

SPEAKER_01 46:23

Yeah, so our website is magnoliacreek.com. We are also on LinkedIn and it's Magnolia Creek Treatment Centers for Eating Disorders. If you Google us, we are we are there. We pop up our nice little place in Alabama. But probably through the website is the best way, and that has a link to our admissions department, which is through Odyssey Behavioral Health, is our parent company, owns a bunch of different facilities, not only eating disorders, but mental health and substance use as well. And so that our admissions team is really skilled and adept at taking people where they need to go.

SPEAKER_00 47:01

Wonderful. Thank you. Thank you.

SPEAKER_02 47:04

Thank you. This was such a good conversation. I'm so happy we got to talk about it. Cause I don't even think we've had like the conversation or anyone else on here to discuss like the co-occurrence between the two. So thanks for thanks for starting it up with us.

SPEAKER_01 47:18

You're so welcome. I'm I'm always willing to have this conversation. It's it just it feels so important and it's evolved so much over the years. So I just I love that we're even entertaining it. Yeah. Yeah. Absolutely.

SPEAKER_02 47:35

Well, thank you so much, Leslie, for being here today. And thank you so much, everybody, for listening. And we will catch you guys on the next one. Bye. Thank you so much for listening to this episode of the Nourish and Empower Podcast.

SPEAKER_00 47:51

We hope this episode helps you redefine, reclaim, and restore what health means to you.

SPEAKER_02 47:58

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