On today’s episode, Dr. Karen Nelson is joined by Dr. Alison Sharpe-Havill, licensed clinical psychologist at Melrose. Dr. Karen Nelson and Dr. Alison Sharpe-Havill discuss what it looks like when someone is suffering from both an eating disorder and substance use disorder, as well as the type of care and treatment they will need in order to recover.
On today’s episode, Dr. Karen Nelson is joined by Dr. Alison Sharpe-Havill, licensed clinical psychologist at Melrose. Dr. Karen Nelson and Dr. Alison Sharpe-Havill discuss what it looks like when someone is suffering from both an eating disorder and substance use disorder, as well as the type of care and treatment they will need in order to recover.
For a transcript of this episode click here.
Dr. Karen Nelson: [00:00:00] Eating disorders thrive in secrecy and shame. It's when we create a safe space for honest conversation that we'll find the opportunity for healing. Hi there, I'm Dr. Karen Nelson, licensed clinical psychologist at Melrose Center, welcoming you to Melrose Heals: a conversation about eating disorders. A podcast designed to explore, discuss, and understand eating disorders and mental health. On today's episode, I'm joined by Dr. Alison Sharpe-Havil, licensed clinical psychologist here at Melrose. Today we will discuss what it looks like when someone is suffering from both an eating disorder and substance use disorder. When these illnesses are combined, the results can be life threatening, but healing is possible. Now, before I begin, I invite you to take a deep breath and join me in this space.
Dr. Karen Nelson: Welcome. I'm [00:01:00] so happy you're here.
Dr. Alison Sharpe-Havil: Oh, thanks, Karen. It's really an honor.
Dr. Karen Nelson: Well, before we get started, Alison, I would love it if you could introduce yourself and tell us about your role here at Melrose.
Dr. Alison Sharpe-Havil: I'm Dr. Alison Sharpe-Havil, and I'm an outpatient therapist at Melrose Center. I work in the St. Louis Park facility, which is also where we have our higher levels of care, but I primarily work with outpatient folks.
Dr. Karen Nelson: You and I specifically today are talking about that intersection between eating disorders and substance use disorders. But maybe for our listeners, Alison, I would love it if you could help them know, we're going to use that term a lot, substance use disorder. What does that mean?
Dr. Alison Sharpe-Havil: Yeah. Well, so there are a number of different criteria that, that are used to kind of assess whether or not a pattern of use of a substance, typically we identify that as mood altering substance, but that's a sticky phrase as well. But, you know, what we think about alcohol, marijuana, [00:02:00] methamphetamine, and other stimulants, opioids like heroin, codon, those kinds of things, those are all, you know, kind of different classes of substances that we think of as causing a use disorder. A couple years ago, when the DSM 5, I believe it was in 2015, was revamped, they really changed substance use disorders, and rather than being sort of either you have one or you don't, and you kind of had this higher bar that you needed to meet, they lowered the kind of minimum number of criteria that need to be met, too. And that can be anything from, you know, developing tolerance, which means you need more and more of the same substance in order to get the same effect, you know, whether that's getting high or just, you know, experiencing a reduction of pain. People use substances for a lot of different things. If you experience withdrawals when you stop using something, that's another criterion. It can be, you know, falling down in your ability to show up in a [00:03:00] strong way and a dependable way for things that are important to you, like your family or your job, your school. It can involve risky behaviors like driving. You know, there are a lot of folks who get into fights, you know, kind of have patterns of aggression related to some substances.
Dr. Karen Nelson: Absolutely. So it sounds like maybe the, the understanding or our understanding as a care community that kind of shifted the criteria of what does it mean to be potentially struggling with a substance.
Dr. Alison Sharpe-Havil: Yep, exactly.
Dr. Karen Nelson: Do you think the science has changed around our understanding of substance use disorder? Do we know anything different or has it evolved over time? What's your experience of that been?
Dr. Alison Sharpe-Havil: For a very long time it was treated as a moral failing, a failure of character and, you know, public drunkenness or that kind of thing was just incredibly shameful and treated, you know, as a legal issue and kind of a characterological issue. We've really [00:04:00] moved away from that. The introduction of the medical model, treating addiction as a disease of the brain was revolutionary. I think what we've learned more recently that has really created more nuance and just a better understanding of what a substance use disorder entails and how to treat it is the development of the biopsychosocial model. So we're looking at, you know, both the things in our brains that get altered when we sort of establish these patterns of use because things do change, you know, our reward pathways, we sort of learn how to light those up and then our brains lose their ability to do it as effectively without the presence of the substance or, you know, maybe we just, we don't produce enough neurotransmitters to, to get that positive feeling.
Dr. Karen Nelson: So that's the biology piece, right? Biopsychosocial. Those are big, jargony words that you and I use, right?
Dr. Alison Sharpe-Havil: Right.
Dr. Karen Nelson: So like, the biology piece, the psychology piece, and then the social piece.
Dr. Alison Sharpe-Havil: Exactly.
Dr. Karen Nelson: So the biology piece is like, our brain. [00:05:00] Right? Okay. Right.
Dr. Alison Sharpe-Havil: And that really kind of speaks to, I think, we often hear about or think about people self medicating. I'm saying that with quotes around it because we use a lot of things to do that, but substances are kind of a fast track for that. Somebody's really struggling with depression, using a stimulant will, in fact, improve mood. If somebody sort of stumbles on solution of, you know, maybe they, they're born with attentional problems and they find that if they drink a lot of caffeine or, you know, borrow their friend's Adderall, they learn that, wow, that really helps my concentration, but, you know, I think temporarily is the kicker there. And so, you know, these don't create lasting change, they just create temporary relief, but that's an important piece of it.
Dr. Karen Nelson: Absolutely. Again, kind of rounding out that model, so biopsychosocial, social influence to potentially engage with, with substances. What might that look like?
Dr. Alison Sharpe-Havil: Yeah. There are so many opportunities [00:06:00] to socialize around substances.
Dr. Karen Nelson: That’s right.
Dr. Alison Sharpe-Havil: You know, you think about the rise of craft brews and brewery culture, it's a recent development.
Dr. Karen Nelson: It’s trendy.
Dr. Alison Sharpe-Havil: It's super trendy. You know, think about the number of, you know, “moms drinking wine” t-shirts that you see. It's really become popularized and normalized to use alcohol for socializing, for relaxation, for recreation. So, you know, that would be an example of kind of social pressures to use or continue using substances. There are also lots of patterns of addiction within families. We often engage in behaviors that we grew up seeing our family members engage in. And so, you know, if mom and dad just always have a beer in hand or, you know, if that's always part of a family get together, then that feels really normal.
Dr. Karen Nelson: So all of those aspects, biological, psychological, and social, they become potential influential factors.
Dr. Alison Sharpe-Havil: Absolutely.
Dr. Karen Nelson: Or we can call them maybe risk factors or [00:07:00] ways that we are influenced to engage with substances.
Dr. Alison Sharpe-Havil: Yes.
Dr. Karen Nelson: When we think about that, Alison, do we understand, why is it then that some people are maybe more impacted than others around maybe some of those risk factors?
Dr. Alison Sharpe-Havil: I sort of made reference earlier to this idea that some people's brains perhaps produce a different brew of chemicals. For somebody who maybe doesn't produce enough dopamine, that's kind of a pleasure and motivation and kind of, you know, pep you up brain chemical. For somebody who doesn't produce enough of that, stimulants are going to supplement that lack of natural dopamine production. And so that’s, for that person, you know, if they stumble across something that helps to stimulate their dopamine production, that's going to be a real risk factor that's just lying in their body. From a psychological standpoint, a lot of disorders and depression, anxiety. Trauma or somebody maybe with [00:08:00] PTSD or just who's experienced a lot of traumatic experiences across their lifetime is also going to be at increased risk simply because there are ways that chemicals interact with their experience of the symptoms that are really going to help to ease those symptoms.
Dr. Karen Nelson: That understanding can help us develop this space of compassion. We may hurt. for a variety of reasons, right? Family influences, you know, maybe we're struggling with physical health issues. And of course, I don't want to hurt. And when we can just name and hold that, I think it helps us develop a sense of compassion, or I don't know, what do you think about that? Is that helpful to think about it in that way?
Dr. Alison Sharpe-Havil: Absolutely. And we know from, from Freud, he had a lot wrong, but you know, a few things that he really nailed. I think this idea of pursuing pleasure and avoiding suffering, these are just basic human drivers.
Dr. Karen Nelson: I love that. So let's transition and talk about that [00:09:00] intersection of eating disorder and substance use disorder. How might those two show up in unison with each other?
Dr. Alison Sharpe-Havil: They frequently do. We know that for somebody who has either an eating disorder or a substance use disorder, that person's going to be about four times more likely to also experience the other than the average person. There are a lot of ways in which we kind of socially come to associate some substance use with eating. You know, it's very normal to in many cultures and in some religious traditions to pair food or a meal with a glass of wine or a beer. And you know, for many people, that's not a problem. For somebody with an eating disorder, there are all these sort of complex ways in which that, that wine or that beer at a meal might intersect with the eating disorder. For somebody who is, you know, who has a lot of restriction, maybe somebody with anorexia nervosa, they may [00:10:00] be very concerned about the calories in alcohol, which can kind of go in two different directions. It can either lead them to maybe avoid alcohol, in which case that I guess I'd argue that the restriction may be a protective factor, but for somebody who's really interested in engaging in, in, having the wine or the beer, they may end up compensating by restricting their food even further. It's not unusual for some folks who end up in, you know, kind of our highest levels of care to, uh, you know, almost have been sort of subsisting on a liquid diet essentially of maybe wine prior to coming in, which obviously has just incredible physical and psychological health consequences for that person.
Dr. Karen Nelson: Can it work for people who maybe are experiencing other eating disorder behaviors? So could it show up in the intersection between binge eating and substance use disorders? What have you seen?
Dr. Alison Sharpe-Havil: Absolutely. It's not unusual for folks with binge [00:11:00] eating disorder to also have an alcohol use disorder. You know, there are some folks who, if they're using marijuana or cannabis products, that may be, you know, an appetite enhancement. And so maybe, you know, kind of lead to feeling out of control with some eating, some binging behaviors. Some people do, in fact, try to self medicate some of their restriction symptoms by smoking marijuana to try and stimulate appetite. Some folks have this very kind of unusual, but we do see it certainly at Melrose, kind of paradoxical reaction to marijuana called cannabis hyper emesis syndrome, which means if you smoke marijuana, you throw up a whole bunch. And so, you know, for those folks, they may use that reaction to facilitate purging, you know, for somebody maybe with bulimia, which is, you know, kind of a pattern of typically restrictive eating and then periods of binging followed by purging.
Dr. Karen Nelson: So, it really can show up [00:12:00] in all spaces around the eating disorder. There's this intersection that really can happen and, and someone may be struggling with both, right? Both an eating disorder and substance use. We call it, we use the word co occurring a lot, right?
Dr. Alison Sharpe-Havil: Yes.
Dr. Karen Nelson: Meaning, they just occur together. Which also means that the level of care or, or the level of kind of nurturing and acknowledging that both of those are existing together is important. Are there any differences between eating disorder behaviors and substance use?
Dr. Alison Sharpe-Havil: Absolutely. I think important differences. One is around the stigma that we attach. We know that within eating disorders, there's sort of this hierarchy of symptoms, right? And, you know, for some folks who maybe do a lot of restriction or have an over exercise pattern of behavior that can be really glorified sometimes in, in sort of how they are received socially. You don't find a lot [00:13:00] of glorification of substance use disorders. We certainly, we condone and kind of glorify, you know, drinking for fun and we paint it as this really, you know, kind of social, cool behavior and it's great to do with your friends, but kind of the minute it gets out of control, it just gets embarrassing. And so, you know, I think folks are really stigmatized around that piece of it to an extent that I think maybe doesn't exist with the eating disorder symptoms. Another really important difference between any substance and trying to sort of achieve recovery from a substance use disorder and trying to achieve recovery from an eating disorder is the eating disorder recovery needs to have a level of sort of flexibility and nuance and still including that substance, the substance being food in your life that doesn't need to be the case with a substance use disorder. You know, I think the, one of the most common ways that we [00:14:00] treat substance use disorders is we try to get the person to stop using the substance or replace it with something that's going to be a lot less harmful for them. We can't do that with food.
Dr. Karen Nelson: That's right. So very different in that space and just the level of complexity I would imagine, right? It's just far more complex. I like how you use the word flexible, right? That, you know, eating disorders, when we're attempting to treat an eating disorder, having that idea of flexibility. You know, the thing that really comes up for me, I think you, you named it so beautifully, is the aspect of shame and how when we feel shame, we probably don't want to talk about the things that are causing us that distress. And so we see it many times as people are beginning their work around the eating disorder that maybe they've never talked about it before. Maybe they've even been in therapy, and they've never talked about it before. And so making sure that we're really exploring, is there any potential disordered [00:15:00] use around substances? Well, let's talk about some of the risk factors for someone who is uniquely struggling with both an eating disorder and substance use disorders. Are there potential risks about the combination of both of those occurring for someone at the same time?
Dr. Alison Sharpe-Havil: Yeah. I feel like this is a tired reference, but you know, you, you'd hear about people talking about playing whack-a-mole where, you know, bop one down and something else pops up someplace else. And I think that's really, that, that really applies to this co-occurring relationship between eating and substance use disorders. You know, a good example is maybe somebody who, let's think about alcohol use because that's, you know, it's a pretty common one. So for somebody who has been maybe been using alcohol to manage or just to eat, you know, to manage appetite or just to, you know, kind of drink until they lose consciousness in the evening so they don't have to deal with dinner. If you effectively treat [00:16:00] that alcohol use, and you sort of take that out of the equation, all of a sudden, that person is faced with, “Oh my gosh, how do I go about navigating meals with my family? What do I do in the evenings, you know, to sort of keep myself interested because I used to just kind of sleep through it.” You know, it just presents all of these different challenges, a lot of which are going to kind of be superimposed on the things that make the eating disorder recovery hard.
Dr. Karen Nelson: Which makes sense to me that we have a space to hold both, that we don't just talk about, it's intimately important, right, to work on, you know, recovery from substance abuse, as well as intimately important to hold that sometimes, like you said, decreasing one increases an urge around another, and just holding and naming that, and then working to develop skills, right, on how to manage it. When we think about a level of seriousness around having an eating disorder and substance [00:17:00] use disorder, is it risky to be struggling with both?
Dr. Alison Sharpe-Havil: It's absolutely risky to be struggling with both. You know, there are certain physiological things that make it more risky. And for somebody who maybe has had, you know, some weight loss as part of their eating disorder, that's going to really change their ability to tolerate some substances. They're going to be more easily affected because of their lower body rate. For somebody who maybe has purging as part of their eating disorder symptoms, they're already, you know, at an increased risk for cardiac problems and electrolyte balance problems. And there are some substances like maybe a stimulant that can put further stress on the heart. So, you know, those are real risks. And when you add, you know, maybe excessive alcohol use on top of that or opioid use, that creates a great vulnerability and it really increases the risk of death.
Dr. Karen Nelson: Absolutely. And so I think we really want to acknowledge that we know that eating [00:18:00] disorders are severe and or they can be quite severe and the they actually are the second leading risk of death for mental health disorders.So the first being opioid addiction or addiction type behaviors. But then the second one is eating disorders. They're very risky. And so when we combine it eating disorder behaviors with substance use disorder, it brings us to a space of severity that we absolutely do not want to dismiss or ignore. And that we absolutely want to be talking about or assessing if someone does potentially, maybe they're entering into treatment for eating disorders, we absolutely want to be exploring if there is any substance use there.
Dr. Alison Sharpe-Havil: Yeah, so for anyone in a position of assessing, I think it's important both to communicate how critically important this is. I mean it's kind of, that's an emergency, and do that without creating more [00:19:00] shame and more stigma.
Dr. Karen Nelson: For sure. Again, through that space of compassion, and then also being able to offer a path of recovery.
Dr. Alison Sharpe-Havil: Yes.
Dr. Karen Nelson: That we do understand the intersection and there is treatment and hope, and we can't do that unless we're really understanding the intersection of all of it. And so having some very open, honest conversations, intimately important. As we are identifying that people can struggle with both an eating disorder and a substance use disorder, how might treatment start for that? That, you know, having this kind of almost niche treatment, right, of, I need to acknowledge that the eating disorder is present and that there's substance use, potentially concerning substance use that's happening.
Dr. Alison Sharpe-Havil: It's important that they be integrated. It's important to hit them both at once. That said, you can't really, you know, have two things be first priority, right?
Dr. Karen Nelson: Good point.
Dr. Alison Sharpe-Havil: And so I think ensuring that the person is able to meaningfully participate in [00:20:00] therapy is the first order of business. And for a lot of people, that is a combination of sort of removing the substance use from interfering in the therapy space. They're able to be in a supportive environment where they can, you know, uh, safely detox and sometimes they, they need medical support for ending their substance use with like alcohol or some of the sedatives can be dangerous just to, to stop cold turkey. And so it's important to support people getting that kind of help if that's what they need. Ensuring that they're not using substances prior to coming to therapy sessions because that, you know, again, if we're numbing emotional experience, having some emotional experiences in a safe space is sort of one of the pillars of therapy, so that's an important piece of it. And then the other piece is ensuring that the eating disorder is sort of, again, I'm talking with air quotes, stable enough, that they're able to really be present. If somebody is [00:21:00] so malnourished that their brain just isn't able to sort of stay on track or process new information in a really meaningful way, then it's super important to, to ensure that they're eating and getting nourished again.
Dr. Karen Nelson: So it becomes a, a, a quite an individualized experience of, of really assessing which one do we immediately focus on and then how do we, with this knowledge that they're both occurring together, treat both at the same time is what I'm hearing you say.
Dr. Alison Sharpe-Havil: Absolutely different for every person.
Dr. Karen Nelson: For sure. I think it's really important that you acknowledge this aspect of almost like readiness for therapy. And when I say readiness, I'm not talking about even really motivation, right? Like, do I want to come to therapy? I'm talking about is my brain able to even be in the same room with my therapist. And if I am intoxicated in some way or have a high level of dependence on a substance or if I am so underweighted that [00:22:00] we know there's a lot of brain changes, I can't quite show up in therapy in the way that I need to. Does that resonate or am I getting it?
Dr. Alison Sharpe-Havil: Absolutely. I think you just nailed it.
Dr. Karen Nelson: And I think we clearly identify, especially on this podcast, that recovery is hard and, and we want to name and hold that, but it's not impossible. And as your therapist or any person on your care team, we absolutely are going to meet you in that vulnerable space, but we need you to show up in a way that you are ready to participate and engage. And when. I'm potentially, you know, using a substance just before coming to therapy, I’m, I'm most likely not going to be engaging in a way that might be beneficial.
Dr. Alison Sharpe-Havil: That's so well put. I, and I think part of sort of selling that to the patient is [00:23:00] acknowledging that there's going to be some grief, as goofy as that sounds, there's a real loss around giving up either, you know, the eating disorder behaviors or the substance. You know, there aren't a lot of people who experience, you know, kind of strong addiction to, say, heroin that don't, they probably really want to be free of the addiction. But also there's a sense of loss when that sort of coping response is taken away, even though it might have harmed them, it might have harmed relationships, it might have cost them so much. But also it's been sort of a constant companion through probably some pretty gnarly stuff and helped them cope in the moment. And so I think it's important for us to honor that as part of helping people be ready to step into therapy.
Dr. Karen Nelson: Absolutely. I think acknowledging this was a, this is always a helpful concept I think sometimes to hear is that two opposite things can be true at the very same time, and it makes neither [00:24:00] one less true, right? So I can have acknowledgement that I don't want to be engaging with these substances at the exact same time feeling so fearful to give up my interaction with these substances. We talk often about the function of something, right? What is the function of the eating disorder? It's to, it's to manage our pain. What is the function of substance abuse? Because we don't want to hurt. And I think, again, when we name that, it just helps our patients not only grow compassion for themselves because when we talk about that space of shame, boy is that real, but it also helps us start in kind of this collaborative space of like, of course you don't want to hurt and let's move together to find you recovery. When we're looking at recovery from eating disorder behaviors and substance use, our listeners know [00:25:00] what might that look like or when we even use this kind of broad term of like recovering from an eating disorder or substance use?
Dr. Alison Sharpe-Havil: Both eating disorders and substance use disorders are, for many folks, chronic, lifelong conditions, which is not to say it's a life sentence. It doesn't mean you need to be stuck in it. It doesn't mean you need to be in active engagement with it, but it just, it means it's going to need some care and tending perhaps across a lifetime or at least across some years. For many folks, 12 step programs like AA, NA are wonderful resources in part because of, you know, the steps and the process and, you know, kind of methodology behind that, but I think almost equally as importantly because of the community and the fellowship aspects of it. I think, you know, for people with eating disorders, it can feel really hard to identify other people who are also in recovery just because, you know, we have many fewer eating disorder anonymous [00:26:00] types of support communities, and a lot of people don't talk about that. With substance use disorders, there's a lot more easy access to different communities. You know, there are especially here in the Twin Cities, there's a very strong and robust recovery community and there are lots of events put on by the recovery community that are, you know, kind of explicitly labeled as sober events, sober concerts, sober bowling. And so, you know, I think being really intentional about putting things around yourself that are going to sort of act as a buffer between you and some of these social stresses. Something that's different about substance use disorders than eating disorders is sometimes that means making a pretty radical change in your friend group. You know, if you sort of have your group of drinking buddies or people that you always hang out with and smoke up and get high. Maybe you can still be friends with them, and maybe you need to do that differently. And maybe there are some folks that, that you just, you can't be in an active [00:27:00] relationship with now or for a while. Those are some of the things that, that I think we see in people in recovery.
Dr. Karen Nelson: I wonder if you and I could define what does a healthy relationship look like?
Dr. Alison Sharpe-Havil: Oh boy.
Dr. Karen Nelson: I know.
Dr. Alison Sharpe-Havil: Go.
Dr. Karen Nelson: You start.
Dr. Alison Sharpe-Havil: This is a different podcast. Come on, Karen.
Dr. Karen Nelson: Seriously, I'm taking notes. Alison, help me.
Dr. Alison Sharpe-Havil: I think, you know, this idea, we talk a lot about respect and what does that mean? And I think, you know, to some extent it's about the words that we use, but I mean, it's also about sort of how we value and honor both my needs and your needs, right? They both have to be, you can't have two things that are top priority, but they kind of both need to be top priority in this situation. And I think, you know, so, so finding ways to sort of communicate in ways that, that, that reflect respect, that ref, that reflect, you know, I see you, I see what you need [00:28:00] and here's what I need and how can we make those work together. It's kind of that inter, that wise mind integration again that you talked about.
Dr. Karen Nelson: I mean, the word that was kind of zipping through my brain as I was hearing you talk about that is boundaries.
Dr. Alison Sharpe-Havil: Yes.
Dr. Karen Nelson: Establishing boundaries.
Dr. Alison Sharpe-Havil: Absolutely.
Dr. Karen Nelson: And dang, why is it so hard?
Dr. Alison Sharpe-Havil: It's so hard.
Dr. Karen Nelson: What, I mean, just really hard to have a space where I say, “I care about you and I also care about myself, right?” Two things can be true at the same time. It doesn't make anyone less true.
Dr. Alison Sharpe-Havil: Yes.
Dr. Karen Nelson: And, and that, those are things that we talk about in therapy, that we explore and grow, and again, notice. Never in a space to judge, but in the space of curiosity to say, “I may have spent a lot of time taking care of everybody else, and not potentially focusing in on what my needs are.”
Dr. Alison Sharpe-Havil: Yeah, I think a place where that challenge of establishing good and mutually respectful boundaries is a real challenge [00:29:00] within, you know, maybe a, a couple where, you know, both used to drink alcohol and now one doesn't drink alcohol anymore. And, you know, obviously the easiest thing would be if both of them just stopped drinking alcohol, but that may or may not be a goal for the partner, that may or may not be something that is, is sustainable, there may be a lot of tension in the, in that relationship around that. And so, you know, perhaps boundaries for the person in recovery involves saying, “Okay, you do you, and I can't go to these events with you, or we can't have alcohol in the house, or it needs to be kept in this place that I'm not going to be accessing.”
Dr. Karen Nelson: I would love to hear your thoughts. Any interactions that you have noticed with families as they're kind of working to set boundaries?
Dr. Alison Sharpe-Havil: Absolutely. You know, I think the idea of whether or not there's alcohol served at family gatherings is really important, you know, and just kind of putting some guardrails around that or saying, “You know, for the family, maybe when [00:30:00] we entertain at our house, we don't serve alcohol,” you know, it's a way of sort of supporting and communicating respect for that person. You know, unlike food, there are no substances that people actually have to ingest in order to sort of maintain their health and their life, with the exception of, you know, somebody who has a physiological dependence and it would be unsafe, but I mean, for the vast majority of people, this is really just about recreational use. And so, you know, I think it sort of challenges the whole family system and the whole friend system to examine their ideas about what is necessary for a good time. Can you have fun at, you know, at a bowling event if there's not a pitcher of beer? Turns out you can. You just need to be intentional and recognize that it's going to feel different for a little bit.
Dr. Karen Nelson: Well, I think the space of vulnerability for someone who is maybe working on recovery to maybe start those conversations or even bring up like, “I would love to attend, you know, [00:31:00] my cousin's birthday party, but if there's alcohol there, I just don't think I can be present,” and in bringing up that conversation, those are the things we work on in therapy. About, number one, how to tolerate just the emotion of that, and then how might we have that conversation becomes intimately important in someone's recovery.
Dr. Alison Sharpe-Havil: And there's so, that's a great place where shame comes in because it feels bad to, to ask something of other people that they make an accommodation for our recovery, right? But it’s, I think we forget sometimes that people want to help out. We're inherently pro social beings.
Dr. Karen Nelson: That's right.
Dr. Alison Sharpe-Havil: We want to connect to other people. We generally, in most situations, want to make life easier and better for those we care about. And so, you know, I think sometimes people hesitate to ask things that would be freely given if it was just known that there was that need. Or, you know, it's a wedding or something like that, so ask somebody to [00:32:00] be your sober buddy. Make sure, you know, you, you make it through the buffet line and you don't hit up the cash bar, right?
Dr. Karen Nelson: That's right. What might be the best approach if you are concerned about someone who potentially you think, again, this is for family members or loved ones, if you worry that your loved one is, is struggling with an eating disorder and potentially substance use, what might be the best approach on how we talk about that?
Dr. Alison Sharpe-Havil: I think ensuring that they aren't intoxicated when you start the conversation, you know, do it, sort of strike when the iron's cold, right? Wait until, you know, don't do it in a moment of anger or conflict, do it in a moment of gentleness and caring. And, you know, I think approaching with kindness and being prepared not to be put off by sort of dismissive assurances that everything's fine, you know, and I think making it about our observations of what we see and what makes us feel concerned rather than, you know, coming [00:33:00] at the person with, “Well, you're doing this and that,” and that, that can trigger defensiveness in any of us. So I think, you know, when we speak to our own experience, it's a lot harder to brush that off.
Dr. Karen Nelson: Are there supportive things that you can do for someone who is in treatment? Any, any tidbits that you could offer?
Dr. Alison Sharpe-Havil: Absolutely. I mean, I think offering to have a meal in maybe in a restaurant or a home where there's not going to be any alcohol served, seeking out activities that, you know, don't involve alcohol or other substances, you know, maybe if you were part of a friend group where you all used together, maybe getting together with that person one on one, if you can ensure that you're going to remain sober and not, you know, be making references to you know, kind of glorified memories of past use. I think those are things that just help the, the person in recovery feel normal and like they're still part of something, feel that sense of belongingness without needing to engage in harmful [00:34:00] behavior.
Dr. Karen Nelson: I love that. Well, Alison, is there anything else that you'd like to share that I haven't asked you today?
Dr. Alison Sharpe-Havil: I've been so heartened by the national movement toward decriminalizing both possession and use of small amounts of marijuana. That is such an important piece of destigmatizing. We have such a strong connection between the criminal justice system and substance use. And that's a pathway that a lot of people come into treatment. I am hoping that, you know, we're sort of moving into an era where there are much easier pathways, much more direct pathways to treatment options and to recovery than, you know, having to sort of get in trouble and get burned first.
Dr. Karen Nelson: Absolutely. And the more we talk about it, the more potential access we may have, right?
Dr. Alison Sharpe-Havil: Absolutely.
Dr. Karen Nelson: If it just lives in shame, I'm probably not going to talk about it.
Dr. Alison Sharpe-Havil: Yep.
Dr. Karen Nelson: Absolutely. Well, Alison, I cannot thank you enough. This has just been a joy to sit with you today. Just so appreciate all your [00:35:00] insight.
Dr. Alison Sharpe-Havil: Oh, it's such a pleasure for me. I'm grateful to have been invited. Thanks, Karen.
Dr. Karen Nelson: That's it for today. Thanks for joining me. We've covered a lot, so I encourage you to let it settle and filter in. And as I tell my patients at the end of every session, take notice, pay attention, and we'll take it as it comes. I'll talk to you next time. To learn more about Melrose Center, please visit melroseheals.com. If you or a loved one are suffering from an eating disorder, we're here to help. Call 952-993-6200 to schedule an appointment and begin the journey towards healing and recovery. Melrose Heals, a conversation about eating disorders, was made possible by generous donations to the Park Nicolette Foundation.