Addiction Treatment: Foreshadowing the Dangers of Corporate Eating Disorder Companies

Lately I have written about the risks associated with the takeover of the eating disorder residential treatment centers by financial investors. As the focus of care has shifted from patient recovery to financial gain, the risks and potential hazards are growing.

A foreshadowing of the possible outcomes is evident in the addiction industry. A recent episode of the podcast The Daily (search for the episode from January 18, 2018) chronicles the rise and fall of an addiction company. Started by a recovered addict eager to share his experience with fellow addicts, the company quickly grew from a small entity into a chain of centers.

Its growth was buoyed by a federal law that increased insurance coverage for mental health treatment. This influx of funds created a large cache that enabled rapid growth of the corporation. Calls to prospective clients transformed from a clinical assessment to a sales pitch. And clinical decisions similarly were tinged with the thoughts of financial gain.

The company grew until it went public and brought tens of millions of dollars into the coffers of the founder, but the slippery slope of commingling financial gain and clinical care eventually went awry.

One center decided to accept a patient too ill to be managed without more complete medical care solely to access insurance payments. The staff was unable to interpret clinical symptoms as signs of instability rather than typical withdrawal symptoms, and the patient died on his first night in treatment.

It’s not hard to see a similar process already playing out in the eating disorder treatment world, and the decisions are stark and risky. When a patient of mine goes to a residential center. My first contact is from an outreach coordinator rather than a clinician. Programs immediately urge all patients to follow the course of residential treatment and the various outpatient programs all run by the same company, ensuring insurance coverage for anywhere from six months to a year. First time diagnosis patients are given tube feedings immediately without a clear assessment of risk, a decision that increases the likelihood of readmission within the next year.

All of these decisions may have generalized clinical value, but the lack of individualized care implies insidious motives of financial gain.

The swift growth of centers and the increased corporate structure of these companies have conflated clinical decisions and financial ones. The downfall of an eating disorder company will be different from what happened to the addiction company. Eating disorder centers were often founded by recovered people who wanted to share their success with others. It’s clear that the powerful urge to heal rarely factors into the function of a corporate center. As the focus shifts from patient care to growth of wealth, only patients will suffer.

The Pros and Cons of Recovered Eating Disorder Professionals

The growing community of eating disorder support by clinicians and volunteers who are recovered has been a significant change in the treatment world. On the one hand, recovered people understand how hard it is to eat each meal and snack and know what the eating disorder thoughts mean and how strong they are. On the other hand, it can be hard to assess how recovered clinicians really are and also it can be easy to conflate one’s own experience with the different paths recovery can take.

This model for recovery to include recovered clinicians is an adaptation of addiction treatment. Both 12 step meetings and many treatment programs are run by former addicts. No one understands the strength of addiction the same way. Similarly, it’s easier for a former addict to identify dangerous behavior patterns and to acknowledge the kind of tough love that is often necessary to achieve sobriety.

The models that work for addiction are often used for eating disorders, and for good reason. The behaviors are both compulsive and often driven by irresistible urges. The pattern of recovery and relapse is similar, and the patience needed to slog through the long process to wellness is comparable.

What is fundamentally different is the source of the problem. Drug and alcohol use is a compulsive behavior driven by chemical addiction and by the irresistible urge to alter your mental state; however, these drugs are not necessary for life.

In any stage of eating disorder recovery, continuing to face food and eat many times per day is critical for survival. There is no way to cut out food.

These differences are reflected in brain function as well. The knowledge of brain-based causes of addiction is focused on the surge of various chemicals that create a high. Sobriety means relying on the brain to return to normal chemical levels. Eating behavior is ingrained in the most primitive parts of our brain because food behaviors are necessary for life. Since they are so automatic and unconscious, food behaviors demand enormous conscious attention to change.

Accordingly, it can be hard for recovered clinicians to recognize how different these experiences can be for people in recovery from their own. Like any treatment provider, one in recovery must learn the breadth of eating disorder treatment. Under those circumstances, they can use both their clinical knowledge and their personal experience to best help people in need.

Is Fighting an Eating Disorder like Fighting Cancer?

I have heard many people, patients and colleagues, ask why it is so easy for people to be compassionate when someone has cancer and so hard to do so when someone has an eating disorder. This comparison exposes one key hurdle in recovery.

Cancer is seen as an invasive illness, one that involves harmful cells that appear in someone’s body and puts their life at risk. We all potentially can be diagnosed with cancer and have to acknowledge this risk. There is no aspect of blame but simply the concept of fighting to live.

What makes it easy to have compassion is the apparently random nature of the illness and the universal fear of the diagnosis.

Ironically, we all can develop an eating disorder as well. If anyone is subjected to chronic starvation, they will develop disordered eating and that can lead to any type of eating disordered symptom. The incidence of eating disorders has skyrocketed due to socially acceptable starvation by sanctioned dieting. Although the collective incentive for dieting may be vanity, the reality is that individuals fall into these illnesses almost always by chance.

And once sick, people struggle enormously to fight a monstrous illness that takes over one’s mind and thoughts. Granted, it’s much harder to understand the nature of mental illness than the clear physical existence of cancer. When it comes down to the personal struggle, the fight for one’s life with what feels like an invading force, either a tumor or a strong internal voice, deserves as much compassion either way.

Clinicians, families and friends need to conceive of an eating disorder not only as an illness but of an invasive psychological process that co-opts normal brain function. Compassion makes much more sense in the context of not being to think clearly and act accordingly around a daily necessity like food. It makes the basics of each day extremely challenging. It really is a fight for one’s life.