Michael is an alcoholic with seven months sobriety. When he entered treatment for alcoholism, the 5’ 10” self-proclaimed former exercise enthusiast said “I jogged two to three times a week to disguise the fact that I was an alcoholic.” During the first seven months in recovery from alcoholism, Michael ate compulsively. He packed 60 pounds on to his 5’ 10” frame and wound up at his heaviest weight ever. His energy for exercise depleted, Michael, at 285 pounds, realized that he had traded one addiction for another and sought treatment for his eating disorder.

Many people in recovery from alcohol and drugs have previously not eaten on a regular basis or binged when they realized they were hungry, so they often fall into the trap of medicating themselves with food and nicotine and incur much of the same chaos that surrounded them when they were actively using. According to researchers, in 1990, tobacco ranked highest in leading causes of preventable deaths in the United States at 37.7 percent, followed by diet/activity at 28.3 percent. Michael, a smoker, found himself battling the vicious cycle of addiction yet again. He is not alone, however. Smoking and eating increases for many alcoholics and addicts who have opted to treat their addiction only to face another. How do recovering addicts reclaim their physical health, and find balance with their emotional and mental health as well, during that first critical year of recovery?

Honoring the body

A college professor, when asked difficult questions, would comment “God only knows and He ain’t telling.” Many therapists feel that way about the body as they observe the battles clients play against the backdrops of the body. There are battles with size, weight, shape, what’s been done to them, for them and those in the treatment field often forget the fragility, purpose and ultimately the balance that they want to bring home to the body.

This type of connection is related to a study done at the Stone Center — Wellesley College in Wellesley, Massachusetts, on the outcomes of disconnections (nonmutual or abusive relationships). The study concerns relationships with others but it also correlates to relationships with one’s self and one’s body. The outcomes of nonmutual and abusive relationships resulted in:

1) diminished zest or vitality

2) disempowerment

3) confusion and lack of clarity

4) diminished self-worth

5) shunning relationships

The researchers, on the other hand, found growth-fostering relationships produce the following:

1) each person feels a greater sense of “zest” (vitality, energy)

2) each person feels more able to act and does act

3) each person has a more accurate picture of her/himself and the other person

4) each person feels a greater sense of worth

5) each person feels more connected to the other person(s) and has a greater motivation for connections with other people beyond those in the specific relationship

In the field of treatment, psychotherapists want to ensure that their clients and patients move forward into the arena of growth-fostering relationships where they’ve found the balance between the physical / spiritual / emotional / social and intellectual. All too often, however, they observe people using the physical component as a channel to fix all the issues of confusion, diminished self-worth and disempowerment.

In treatment, counselors are often caught up in addressing the presenting problems. Research of 73 eating-disorder patients with previous recovery in chemical dependency that entered the relapse program at The Willough at Naples, in Naples, Fla, suggests that many of them are cross-addicted and mask their eating disorder with alcoholism or drug addiction, with the body and weight often being the focus. When they drug, they don’t drink or eat and will use drugs to decrease appetite. When they drink, they won’t drug or eat so they decrease calories. When they eat, they don’t drink or drug and, through purging, or use of laxatives or exercise, they make sure the body doesn’t validate the disorder.

America’s preoccupation with physical appearance imposes on our culture impossible rules and guidelines about how we are supposed to look that leave many people desperate to measure up.

• Eighty percent of American women have dieted by age 18
• Eleven percent of high-school seniors have eating disorders
• The number of people undergoing plastic surgery has escalated in the last 10 years
• Between 1981 and 1990, liposuction procedures mushroomed 95 percent
• Breast implants actually increased in popularity from 1988 to 1990 in spite of recent controversy
• Steroid use to build strength has skyrocketed
• Up to one third of all plastic surgery candidates are men (compared to 6 percent 10 years ago)
  

In addition to dieting, exercise and plastic surgery options, cultural beauty values have taught us to pursue self-improvement over self-acceptance. We have learned to judge our inside by our outside and to strive for unattainable physical perfection.

Many issues focused on obsessive exercise are really issues of negative body image, where one may hate their legs so they exercise and exercise to change their legs, when in reality, they may need to work on accepting their bodies and focus on what’s balanced and healthy. With a supportive team, which may include family, a dietician, nutritionist, a trainer, sponsor, therapist or a 12-step program, many people can more easily stop compulsive relationships with their body and substances such as food, drugs or alcohol, or behaviors such as exercise, work or gambling.

Bulimia: one woman’s story

Like many young girls in our thin-conscious society, Debbie’s fear of becoming fat started as a teen. At 15, she had become very weight- and body-focused, and began her war against food. To maintain her image as a model, a gymnast and cheerleader in high school, she restricted her food intake, attended aerobics classes, lifted weights, and suffered bouts of bulimia and anorexia. “Looking good was very important,” admits Debbie.

Although never more than 10 pounds overweight, Debbie’s obsession with weight was fostered by her mother, a compulsive overeater who did have a weight problem. Debbie never ate three square meals a day during high school. Her snacks were diet pills — not Doritos. She started bingeing and purging late in high school. Her favorite binge food was sweetened cereal and milk. “It was quick to go down and easy to bring back up,” she said.

Debbie’s craving for sugared cereal points out an important aspect of bulimia. Research reveals that the disorder is not only a psychiatric problem, but also a metabolic one. There is evidence to suggest that refined carbohydrates can be addictive to some bulimics and trigger the binge cycle by intense cravings. Once an eating disorder is firmly established, it is much like alcoholism in that it is addictive and very difficult to break the pattern.

Debbie’s years at Arkansas State weren’t the fun-filled, exciting times she thought they’d be. Instead, Debbie lived with fear, pain and suffering because of bulimia. Because she was in a new setting where she didn’t know anyone, she was able to keep her secret and continue to binge and purge in relative isolation. She shared a bathroom with two girls who were frequently away and unaware of her eating disorder. For privacy, she would lock her bedroom door to binge and lock the bathroom door to purge. She always ran the shower to cover the sound of her purging.

“I always binged in private; and if I binged on other people’s food, I would replace it so they wouldn’t find out,” says Debbie. “I tried to avoid any social activity where there was food, but if I had to eat out, I would leave the table as soon as possible to purge. If anyone knew what I was doing, they never said anything to me.”

Fearful of being found out, Debbie would hide in the bathroom after purging and apply cold compresses to her eyes to decrease the puffiness around them.

“After a binge/purge episode, I always felt so guilty,” Debbie says. “Sometimes, the guilt and shame were so great, I would binge and purge again because I had to numb the pain.”

Debbie would also exercise a minimum of two to three hours a day. She would schedule her classes around her exercise times, and would skip class to exercise. She chose to work as a server in a busy restaurant, because she was required to walk a lot.

In her sophomore year, a knee injury and subsequent surgery forced Debbie to stop exercising. It was then that she turned to laxatives, sometimes taking a full box in one day. She had difficulty concentrating in class because she was distracted and physically uncomfortable. Occasionally she would become light-headed and dizzy due to her body’s electrolyte imbalance from purging.

While in graduate school, Debbie began to starve herself, a behavior that is typical of an anorexic. That was not unusual, because bulimics and anorexics will often display similar behavior. In fact, 50 percent of anorexics will do some type of purging. “I got a charge out of not eating,” she said. “I had my clothes altered twice.”

Debbie endured 10 years of personal agony, including a separation and divorce, before she sought treatment. Extremely underweight at 25, and working in a treatment hospital, Debbie began to be late for work, miss deadlines and have lapses in concentration. It was during a visit from her best friend from college that Debbie realized the severity of her own condition. “She hugged me and said I was skin and bones,” said Debbie. “She was well aware of what I had been doing in school.”
In 1989, Debbie received comprehensive treatment at The Willough. Now, 10 years later, she is happily married and a therapist specializing in eating disorders. She eats three meals a day and a snack, has a healthy support system, follows a balanced exercise routine and, perhaps most important, has learned that “food is not the enemy” —that it’s all about keeping a balanced life.

Bob’s battle with substance abuse and obesity

Bob has been in recovery for cocaine addiction for four years and alcohol dependency for two years. While he has made great strides in his recovery from those addictions, he unwittingly succumbed to the abuse of another substance — food. He binged daily and used diet-pills and exercise to purge before undergoing treatment for bulimia.

Bob, 34, single and at 267 pounds a self-described “binge/purge exerciser,” says he has exercised extensively to lose weight and keep the weight off. He walks and runs six to seven days a week. Recently, at a health spa, where Bob had intended to lose weight with extensive exercise, a doctor confronted him. “You need to do something deeper — more than just exercise for yourself,” he said. The confrontations from his group and this doctor led Bob to explore the possibilities of undergoing inpatient treatment. He acknowledges binge eating approximately four to five times a week — which he calls a “moderate binge” and then has even heavier binge patterns perhaps once or twice a week. For him, a defining moment occurred on a recent trip to Hawaii. While Bob was trying to relax in a nice restaurant, his guest, aware of his eating disorder, asked that bread not be brought to the table. Bob became very angry, and insisted that the loaf of bread be brought. His friend firmly asserted that it was in Bob’s best interest that there was no bread on the table. After becoming very angry and allowing some time to pass, Bob realized the extent of his food addiction. He also realized that his justification to continue binge eating was “I’ll work out next week.” His rationalization for combining binge eating and exercise was, “I guess this is better than doing drugs.” Bob’s binge foods tend to be breads, carbohydrates.

“I am disgustingly full and then I go to sleep,” says Bob. “Then the next morning and during the day I don’t eat at all until nighttime comes. Then beginning with dinner, there I go again.” Bob also uses two- to three-day juice- and water-fasts as a way to lose weight.
Bob has also used acupuncture, hypnosis, diet programs and a variety of appetite suppressants prescribed by doctors. Bob was addicted to cocaine from 1975 – 1984. He used cocaine for the high he got from it and to suppress his appetite and lose weight. Bob admits that his binge eating and the various ways that he attempts to lose weight are completely out of control. He feels a consequent sense of low self-esteem, shame and guilt over being out of control. He is overly concerned about his body weight, size and shape, and feels bad about his appearance.

Bob’s feelings of low self-esteem over his eating disorder have affected his interpersonal relationships and the quality of his work. While he is satisfied that he has done well in managing his business, he feels that if he had not been bingeing, restricting calories and using the aforementioned behaviors, that he would have been a better manager.

Several months ago, Bob underwent a one-week treatment program for ACOAs. Bob’s father was an active alcoholic. He believes that his mother has been a compulsive overeater all of her life, and that all his aunts and uncles are alcoholic.

Of his childhood, Bob recalls.... “We were pretty affluent; Dad was always a workaholic, he would get drunk on Fridays, weekends and holidays.” Bob feels that he was spoiled as a child and that “Everyone left as soon as they could to get away from the house.” He had a “love/hate” relationship with his “emotionally unavailable” dad.
In high school, Bob worked booking a rock band for various engagements. He did so well, that he took this up fulltime, during his late high school and early college years. He started using cocaine in 1976 and in 1979 he started his own company.

Bob qualifies for dependent-personality disorder with narcissistic self-defeating grandiose and “codependent features.” This personality disorder, with its traits, has gone a long way to fuel and provide the habit structure for his eating-disordered symptoms. In fact, he describes himself as a “professional codependent” and in many ways, his personality disorder makes him a setup for the lifestyle that he leads. Bob says that this work is very much a metaphor for trying to save the various family members, especially his father. These character traits will be interpreted as to their defensive nature, function and purpose so that the steam will be taken out of the momentum of his eating disorder.
Bob has been in recovery from drug addiction since 1984; alcoholism since 1986; and his eating disorder since 1988. During this time, he has relapsed several times with his eating disorder. With the help of his trainer, who has taught him how to focus, balance, be accountable and not compulsive or obsessive, Bob has found the key to being committed and dedicated to his exercise program. Through service to others, Bob has found a comfortable balance between the mental, spiritual and physical components of his program.

The common thread throughout these case studies is the use of exercise to fix the problem and change the external so the internal will feel better. In the scheme of things, the physical is only one part, a necessary part, but each of the recovery components must be exercised to stay in balance.

The blend of intellectual, physical, spiritual, social and emotional components

What is balanced exercise? The American College of Sports Medicine recommends exercising at least three times a week for up to 60 minutes at a time. If you are doing aerobic exercise, experts recommend exercising at between 60–75 percent of your maximum heart rate. This is determined by subtracting your age from 220 and then multiplying that figure by 60 percent or 75 percent. Aerobic exercises include:

• walking
• swimming
• bicycling
• jogging
• rowing
• aquacise
• Air-Dyne bicycling
• Nordic Track exercise

One can get many of the emotional and physical benefits by exercising 20-30 minutes, three times a week. There is a point where exercise becomes counterproductive, increasing the risk of muscle and joint injuries when someone exercises more than three days a week or for longer than 60 minutes at a time.

The form of exercise to do should depend on two criteria: 1) Does the person like it? and 2) What do they want to accomplish? Sometimes clients need to change the kind of exercise they do to keep from getting bored. Team sports might be right for your client, but they need to make it fun. In regard to health, different categories of exercise will help them accomplish different goals. Aerobic exercise can help clients increase their overall fitness, strengthen their heart muscles and build endurance. Weight training is good for strengthening muscles with Nautilus equipment and free weights the most popular. Lifting more repetitions of a lighter weight, helps tone the muscles, while fewer repetitions at higher weights encourage muscle growth. When trying to build muscle, most professionals recommend at least one day in between workouts. This allows the muscles to recover and helps prevent injury.

Just as recovery from addiction nurtures the body, mind and spirit, exercising the body regularly is not about losing weight or fighting your body, but loving it and respecting its limits.

Mary Bellofatto, LMHC, NCC, CEDS, LCSW, is national training and aftercare director at the Willough at Naples, FL.

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