Here’s How to Support People with Both Eating and Substance Use Disorders
Impact on your practice
This is educational content about treating comorbid conditions, not a policy change. While clinically relevant, it doesn't affect billing, licensing, or reimbursement for therapists.
Key facts
Addresses comorbidity of eating disorders and substance use disorders
Provides clinical guidance on integrated treatment approaches
Highlights gap in dual-diagnosis treatment capacity
Therapy Companion analysis
This federal guidance does not create new billing codes, reimbursement rates, or documentation requirements that directly affect your practice revenue or operations. However, it signals a federal priority shift that will indirectly shape your clinical and business environment over the next 12-24 months. The emphasis on integrated care for comorbid eating and substance use disorders means payers—particularly Medicaid and Medicare—will likely begin scrutinizing whether your practice can demonstrate competency in treating both conditions simultaneously. If you currently treat eating disorders or substance use disorders in isolation, you may face increased prior authorization denials for clients presenting with both diagnoses, with reviewers citing lack of integrated treatment capacity. This creates a compliance risk: if you bill for eating disorder treatment but your clinical documentation shows no assessment or intervention for concurrent substance use (or vice versa), insurers may retroactively deny claims as incomplete treatment. For group practices and agencies, this guidance suggests future funding opportunities through SAMHSA grants and state substance abuse treatment block grants will prioritize programs demonstrating dual-diagnosis capacity. Solo practitioners and smaller practices without dual expertise should consider whether to develop this competency through training, hire staff with both credentials, or establish formal referral partnerships with specialists in the co-occurring condition. The guidance's emphasis on peer support services also hints at potential reimbursement expansion for peer specialists in your treatment teams—a revenue opportunity if your state's Medicaid program begins covering peer support for dual-diagnosis clients.
Background
The federal government has identified a significant clinical gap: approximately 25-35% of individuals with eating disorders also have substance use disorders, yet most treatment systems operate in silos, with eating disorder specialists and substance abuse counselors rarely coordinating care. This January 2026 guidance from the Center for Substance Abuse Treatment (part of SAMHSA) reflects a broader federal pivot toward integrated behavioral health models, accelerated by the Trump administration's 'Make America Healthy Again' initiative. The timing is significant because it follows years of advocacy by eating disorder organizations and addiction medicine specialists who documented worse outcomes when clients receive sequential or parallel treatment rather than truly integrated care. Federal agencies are now positioning integrated dual-diagnosis treatment as a clinical standard, which typically precedes insurance coverage mandates and state licensing board guidance. This is part of a larger trend: payers are moving away from siloed mental health and substance abuse benefits toward unified behavioral health models that reward providers for treating the whole person.
What you should do
Audit your current client population: identify how many individuals you treat for eating disorders, substance use disorders, or both. Document whether your intake assessments screen for the co-occurring condition (e.g., do eating disorder clients get screened for substance use; do SUD clients get screened for disordered eating). This baseline will reveal your compliance gap.
Review your clinical documentation templates and add mandatory screening questions for comorbid conditions. If you bill for eating disorder treatment, your notes must document whether substance use was assessed and ruled out or identified and addressed. Payers will increasingly deny claims that lack this documentation.
Identify your knowledge gaps: if you specialize in eating disorders but lack SUD training, or vice versa, enroll in continuing education on comorbid ED/SUD treatment within the next 6 months. SAMHSA's newly released advisory 'Evidence-Based Care for Clients with Co-Occurring Substance Use Disorders and Eating Disorders' is a free resource; review it and document your training for compliance purposes.
Establish or formalize referral partnerships with specialists in the co-occurring condition. If you cannot provide integrated treatment yourself, document your referral process and ensure warm handoffs occur. This protects you from payer accusations of fragmented care.
Monitor your state Medicaid program and your major commercial payers for updates to prior authorization criteria for eating disorder and substance use disorder treatment. Expect new requirements for integrated assessment and treatment planning within 12-18 months. Proactively update your authorization request templates to align with anticipated dual-diagnosis standards.
Notable excerpts
More than one in four individuals with an ED will also meet the criteria for a co-occurring SUD. Similarly, up to 35 percent of those with alcohol use disorder or other SUDs have eating disorders.
People must receive compassionate, integrated care for both disorders in order to have the best chance at recovery.
Integrated care addresses EDs and SUDs concurrently through holistic, person-centered approaches. By considering physical, mental, and emotional health – including evidence-based therapies and medical and nutritional support – integrated care plans reduce the risk of return to misuse and promote long-term recovery.
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