When substance use disorder and eating disorder intersect: an integrated care tool.

Background
This study focuses on the support needs of people with substance use disorder (SUD) and eating disorder (ED). Apparently, most care givers don’t feel well equipped to offer support and treatment when these disorders co-occur. In our aim to unravel the characteristics of the co-morbidity we explored theoretical concepts and protective or risk factors. Relevant research questions were: the prevalence of co-morbidity and how the severity of SUD increases the (risk of) ED and vice versa and the relation of these disorders with identity, emotion regulation, body image, experiences of embodiment, interoceptive awareness and self-compassion.
Methods
Data was collected among persons currently in treatment in residential or outpatient settings for SUD. The survey included following questionnaires: EDIII, AUDIT/DUDIT, SCIM/DIDS, ERSQ, BAS2, ESS, SCS and MAIA. In addition 20% of the clinical respondents were contacted again for a semi-structured interview on their experiences in SUD and ED.
Results
The risk on ED is determined by using following subscales of the EDI III: drive for thinness (DT), bulimia (BN) and body dissatisfaction (BD). 46% in the clinical group (n= 100, mean age 38y, male/female/X ratio 60/40/0) demonstrated a higher risk on one or more of the 3 main characteristics of ED. On the subscales DT, BN, BD, respectively 38.5%, 15.6% and 31.3% scored high. 11% has a high risk on dual diagnosis because they scored high on all 3 characteristics of ED. Since overcontrol is an important component of ED, this subscale was administered with 54% scoring highly. 
35% in the control group (n=101, mean age 28y, male/female/X ratio 28/71/1), mainly HOGENT students, illustrated an increased risk for 1 or more characteristics of an ED.  On the subscales DT, BN, BD respectively 26.5%, 18% and 17% scored high. 6% were highly at risk on all 3 characteristics of ED. 
Our research also focused on protective factors with regard to co-morbidity of SUD and ED:
- DIDS (identity formation): individuals who have a higher risk of DT and/or BN scored lower on identifying with a particular identity. The higher respondents scored on the ‘overcontrol' subscale, the more they had moments of ruminating. 
- SCS: Self-compassion (SC): people in SUD treatment have a lower to neutral score towards SC. A high risk of ED is correlated to lower feelings of SC. The lower a respondent scored on the subscale DT, BN or BD (EDI III), the higher the degree of SC. 
- ERSQ (emotion regulation): respondents who scored high on BN (EDI III) scored lower on ERSQ. 
- MAIA (interoceptive awareness): respondents who scored low on DT or BN (EDI III) scored high on 'confidence' and 'listening to body' subscales. 
Conclusions
Based on the results, a hybrid tool was designed. The tool can motivate care workers in working in an integrative way and being equipped to manage the coping mechanisms of SUD and ED. SC is proven to be a most significant protective factor and therefore highlighted in the tool.