Here’s How to Support People with Both Eating and Substance Use Disorders
Impact on your practice
This is clinical education content, not policy. Relevant to therapists' case conceptualization but not to billing, licensing, or regulatory compliance.
Key facts
Clinical guidance on treating comorbid eating and substance use disorders
Addresses prevalence of dual diagnosis and need for integrated treatment approaches
Useful for therapist education but not a policy or regulatory change
Therapy Companion analysis
This content is educational guidance rather than a regulatory or reimbursement mandate, so it does not directly change your billing practices, prior authorization requirements, or compliance obligations. However, it reflects a federal pivot toward integrated treatment for comorbid eating and substance use disorders—a population you may be underidentifying in your practice. If you primarily treat substance use disorder (SUD) or eating disorder (ED) patients in isolation, this guidance signals that payers and clinical oversight bodies expect you to screen for and address both conditions concurrently. This may influence how you document case conceptualization and treatment planning: you should now explicitly document whether you have screened for the co-occurring disorder and explain your clinical reasoning if you are not addressing both. For practitioners in group settings or agencies, this positions integrated care as an organizational best practice; you may face reimbursement advantages if your treatment plans reflect dual-disorder protocols rather than sequential or parallel referrals to separate providers. The emphasis on peer support services and family involvement also suggests that insurance companies and managed care organizations may increasingly reimburse for or expect evidence of these modalities in your treatment plans. Psychologists, LCSWs, LPCs, and MFTs working in addiction or eating disorder specialties should anticipate that regulatory bodies and insurers will begin reviewing clinical records for co-occurring disorder screening as a quality metric.
Background
The federal government, particularly through SAMHSA (Substance Abuse and Mental Health Services Administration), has historically treated eating disorders and substance use disorders as separate clinical silos with different treatment protocols, funding streams, and provider specializations. This guidance marks a shift in that approach. The prevalence data presented here—over 25 percent of individuals with an ED also meeting SUD criteria, and up to 35 percent of those with alcohol use disorder having an ED—indicates that the current siloed system is missing substantial treatment integration opportunities. The timing is significant: this January 2026 publication aligns with the administration's Make America Healthy Again (MAHA) initiative, which emphasizes whole-person, chronic disease management approaches. For therapists, this signals that the federal government is now framing integrated ED/SUD treatment as a public health priority, which typically precedes insurance coverage decisions, licensing board guidance, and accreditation standards. The emphasis on early intervention and the explicit mention of SAMHSA's newly released advisory on evidence-based care for co-occurring disorders suggests that training, competency expectations, and clinical standards will follow.
What you should do
Immediately review your current assessment and intake protocols: add explicit screening questions for eating behaviors and substance use if you specialize in only one disorder, and ensure your documentation shows that you evaluated for both conditions. Document your clinical reasoning if you determined one disorder was not present or not clinically significant at intake.
Obtain and review SAMHSA's 'Evidence-Based Care for Clients with Co-Occurring Substance Use Disorders and Eating Disorders' advisory to understand the integrated treatment framework; use it to restructure your case formulation template and treatment plan language to reflect concurrent, not sequential, treatment of both conditions.
Audit your current caseload for unidentified comorbidity: identify clients diagnosed with only an ED or only an SUD, and conduct targeted follow-up assessments using validated screening tools (e.g., SCOFF for ED, AUDIT or DAST-10 for SUD) to determine whether dual diagnosis exists but was not documented.
If you work in an agency or group practice, propose a clinical policy revision requiring co-occurring disorder screening for all ED and SUD clients; coordinate with colleagues to establish warm referral or in-house consultation protocols so clients do not experience fragmented care.
Document evidence of peer support engagement and family involvement in your treatment plans, even if minimal; anticipate that payers will increasingly audit for these modalities as indicators of integrated care quality, and position your practice to demonstrate compliance.
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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