Treating an eating disorder while ignoring substance use is like trying to put out a fire while a second one burns behind you. We sit down with Leslie Plaia, Executive Director of Magnolia Creek and a licensed counselor with deep experience in eating disorder treatment, addiction recovery, and program leadership, to talk about what integrated, dual diagnosis care actually looks like when someone is dealing with both.
We get practical about the clinical realities: why many programs require a primary eating disorder diagnosis while still addressing co-occurring substance use, what medical stabilization and nutrition therapy need to consider during detox and early recovery, and how cravings and appetite shifts can show up with alcohol and opioid history. Leslie also breaks down how the two conditions feed each other through routines, triggers, and symptom swapping, from restricting to drink more to using substances to numb body image distress.
Then we go where a lot of conversations stop: stigma and bias. We unpack the harm done by “you don’t look like you have an eating disorder” and the ways poor screening questions can miss the full story. We also talk harm reduction, why multiple pathways of recovery matter, and how family therapy and honest communication help loved ones support recovery without becoming robotic or resentful.
If you care about eating disorder recovery, substance use recovery, trauma-informed care, or better mental health treatment, this conversation will challenge how you think about “the real problem” and what effective support can be. Subscribe, share this with someone who needs it, and leave a review so more people can find it.
For more information about Odyssey Eating Disorder Network and Magnolia Creek:
https://magnoliacreek.com/
https://odysseybehavioralhealth.com/odyssey-eating-disorder-network/
Show notes:
Trigger warning: this show is not medical, nutrition, or mental health treatment and is not a replacement for meeting with a Registered Dietitian, Licensed Mental Health Provider, or any other medical provider. You can find resources for how to find a provider, as well as crisis resources, in the show notes. Listener discretion is advised.
Resource links:
Alliance for Eating Disorders: https://www.allianceforeatingdisorders.com/
ANAD: https://anad.org/
NEDA: https://www.nationaleatingdisorders.org/
NAMI: https://nami.org/home
Action Alliance: https://theactionalliance.org/
NIH: https://www.nimh.nih.gov/
How to find a provider:
https://map.nationaleatingdisorders.org/
https://www.psychologytoday.com/us
https://www.healthprofs.com/us/nutritionists-dietitians?tr=Hdr_Brand
Suicide & crisis awareness hotline: call 988 (available 24/7)
Eating Disorder hotline: call or text 800-931-2237 (Phone line is available Monday-Thursday 11 am-9 pm ET and Friday 11 am-5 pm ET; text line is available Monday-Thursday 3-6 pm ET and Friday 1-5 pm ET)
If you are experiencing a psychiatric or medical emergency, please call 911 or go to your nearest emergency room.
