Eating Addiction Needs a Strategic Relapse Prevention Protocol

Posted on Friday, August the 15th at 12:00pm

By Dr. Stephen F. Grinstead, LMFT, ACRPS, CADC-II

I first saw the need to develop a relapse prevention protocol for compulsive overeaters, food addicts and binge eaters in the mid-1990s. These terms describe people who use eating and food to manage feelings and cope with life problems. Many of my patients also had chronic pain conditions with coexisting disorders and when both of those conditions were stabilized I began to notice a pattern—they started using food to cope with their problems instead of for fuel which sabotaged their pain management and addiction recovery.

At the time there were many programs offering treatment for Eating Disorders, but none of them included a strategic, systematic relapse prevention treatment plan. I addressed this oversight by collaborating with Terence T. Gorski, founder and president of the CENAPS® Corporation, to develop the Food Addiction-Relapse Prevention Workbook which was published in 2001.

Some people with eating problems have dealt with other addictions (alcohol/other drugs) and report difficulties trying to use the identical tools to deal with inappropriate eating. There are many similarities, no matter what the chemical or behavior is being used to mood-alter, or change feelings, but there is distinction that needs to be made. Alcoholics never have to drink alcohol again, whereas eating addicts must continue to eat food in order for the human body to survive.

Eating Addicts may be a normal weight, if their metabolism is such that they don't gain weight, or some of them may purge calories through excessive exercise. However, many of them will probably be overweight, or “see-sawing” up and down as they try one magic pill, diet or program and then another. Some may be obese, which means they are more than 20 percent over the weight suggested by actuarial tables. These people may know they are destroying and distorting their body, but are unable to stop eating compulsively. That is why a specific protocol for these problems was necessary. Eating addicts in recovery need to learn how to identify and then abstain from compulsive or other unhealthy eating behaviors.

In early 2008 after discussions with my colleague, Dr. Shari Stillman-Corbitt, the Clinical Director of Sierra Tucson, it became clear to me that it was time to change the focus of the original Food Addiction workbook. Dr. Stillman-Corbitt and I collaborated on this project that also resulted in a new name—The Eating Addiction Relapse Prevention Workbook which will be published in the Fall of 2008.  We also updated the corresponding pamphlet, Eating Addiction High Risk Situations, which you can order at www.relapse.org.

Although the primary purpose of this new workbook is to help people with eating addictions develop a recovery and relapse prevention plan, as well as create a schedule of activities to assist in that goal, Dr. Corbitt and I believed that Eating Addicts must first develop a definition of abstinence that works for them. We also thought it was critical for them to design an effective recovery plan that is life enhancing—a “Healthy Living Plan.” Therefore, The Eating Addiction Relapse Prevention Workbook is designed to increase a person’s knowledge and understanding of the nature of eating addiction. The remainder of this article is copied from the Goals section of The Eating Addiction Relapse Prevention Workbook.

Exercise 1: Looking at the principles of a Healthy Living Plan from a Biopsychosocialspiritual perspective, then listing your personal triggers in each of those categories and creating your own Healthy Living Plan.

Exercise 2: Learning how to develop your personalized definition of abstinence as an important component of your recovery and Healthy Living Plan.

Exercise 3: Completing the Eating Addiction Problem Checklist to help determine your level of problem (past and/or present) with compulsive use of eating.

Exercise 4: Looking at the pros and cons concerning the way you have used eating in the past and making a decision to stop using eating as a coping tool.

Exercise 5: Creating a craving management plan and an early relapse intervention plan designed to help you avoid relapse in the early stages of your recovery.

Exercise 6: Looking at your presenting problems with eating and personalizing your own Healthy Living Contract.

The last five exercises in this book help you identify and manage high risk situations that could set you up for relapse despite your commitment to your Healthy Living Plan (recovery), as well as developing an effective recovery plan designed to help you manage those high risk situations. 

Exercise 7: Defining high risk situations and picking your own personal high risk situation that you would like to learn to manage.

Exercise 8: Mapping (exploring) past ineffectively managed and effectively managed high risk situations, then using that information to project and explore a future high risk situation.

Exercise 9: Learning to identify and manage personal reactions to high risk situations by exploring your automatic thinking, feelings, urges, actions, and social reactions that drive the relapse process and are triggered when you encounter a high risk situation.

Exercise 10: Developing a personalized recovery plan by selecting and scheduling recovery activities that will help you identify and manage future high risk situations.

Exercise 11: Completing a final evaluation process that asks you to complete a check list to determine how well you believe you did completing this workbook.

In Eating Addiction recovery many have found it is critically important to abstain from addictive behaviors around eating. This means changing basic eating behaviors or eating patterns that support compulsive overeating, such as abstaining from gobbling, eating all the time rather than only at meal times, eating while driving, standing, etc. This is similar to alcoholics in recovery being told to stay away from drinking juice in a wineglass or non-alcoholic beers in a bar. These suggestions help addicts avoid the triggering of cravings and possible relapse.

Addictive behaviors around eating can also trigger relapse. That is why compulsive overeaters find it helpful to be mindful of not just what they eat (a healthy meal plan), but also how they eat (healthy eating patterns); when they eat (a healthy meal schedule); and how much they eat (healthy portion control). Getting clear on what, how, when, and how much, you eat will make your recovery process smoother with less cravings. It will also reduce your incidences of and length of relapse.

• What to Eat → Meal Planning
• How to Eat → Eating Patterns
• When to Eat → Meal Scheduling
• How Much to Eat → Portion Control

This workbook is not another "diet book." Knowing what to eat and how to eat can be learned through your medical provider, a nutritionist or registered dietician, or any of the many books available. Likewise, we do not want to discuss biochemistry (though we know it is important) or differences in metabolism and nutritional needs.

What this workbook is designed to do is assist you in discovering and understanding your personal relapse triggers whether they are in response to specific foods, particular experiences, or certain feelings. We call these high risk situations (HRS). By not recognizing or ignoring them you put yourself at risk for a relapse. You will create a definition of abstinence for yourself – your “sober” pattern of eating that will support you in avoiding random or spontaneous eating behaviors.

Finally, you will also create a Healthy Living Plan which will outline the necessary ingredients for your recovery. Because this plan is individualized, you will develop a personalized Craving Management Plan and Relapse Intervention Plan. This will require you to involve trusted others, who have been told (by you) what to look for and how to intervene, should they see behaviors that you have described as high risk.

The Eating Addiction Relapse Prevention Workbook, and the research that went into it, was written to offer hope to those who use eating to avoid feelings and cope with life problems. We do not address anorexia or bulimia, but focus only on compulsive or addictive overeating. Our goal is to help people define their abstinence and find tools for living so that excess eating will no longer be needed to numb, medicate, or push down feelings. This workbook is not a “one size fits all.” It is more of a road map and certainly not a straitjacket. It was designed to help people create an individualized, highly personalized recovery plan. For this workbook to be effective, a person needs to determine whether or not they have a compulsive/addictive eating problem. Those who have crossed the line and no longer have predictable control of their eating, even when it is harmful to them in some way, have an addiction/compulsion to eat. We are speaking here of the simplest description of addiction: the continued use of a mood-altering substance or behavior, despite negative consequences.

The challenge of recovery is never really over. It seems that once we start a recovery process, we are either growing or we’re dying. There is no standing still. We either commit ourselves each day to improving and refining our recovery skills, or we become complacent and slowly move toward meaninglessness, misery, and relapse. We must make a conscious choice each day about which path we’ll follow.