Twenty-nine percent (N = 100) of the privately funded programs offer inpatient, 17% (N = 59) residential treatment and 67% (N = 232) intensive outpatient services. Three-quarters of the programs (N=253, or 74%) screen admissions for eating disorders at intake assessment, with 44% (N=150) screening all patients and 30% (N=103) screening patients only if an eating disorder is reported or suspected (i.e. low weight). Over one-quarter of the programs (N=73, or 29%) that conduct screenings and/or assessments reported using a standardized interview (21% of the total sample). When asked which standardized interview or questionnaire is used, most reported using assessment instruments that were either developed by the agency or were questions embedded in their standard intake assessment protocols. One program reported using the Eating Disorder Symptom Checklist and one program reported using the SCOFF Eating Disorder assessment. The remaining programs rely on an informal evaluation by a clinical staff member or the clinical history provided by the patient's primary care physician. Approximately 7% ± 9% of the patient population in programs that do screen are reported to have an eating disorder. One-fifth (N=69, or 20%) of programs admit all patients who screen positive for an eating disorder regardless of severity, whereas 67% (N=228) admit patients whose eating disorder is not deemed severe enough to interfere with addiction treatment. Almost all programs require a primary drug or alcohol use problem, with less than 12% (N=40) of programs admitting patients solely for eating disorder treatment. One in five programs (N=70, or 20%) attempt to treat eating disorders on site. Only 11% (N=25) have a formal referral arrangement to address eating disorders. The remaining programs do not offer any services to address eating disorders.
The programs were categorized into three groups based on eating disorder treatment: does not admit (N=45), admit but does not treat (N=223), and admits and treats (N=70). These categories included all programs that do and do not screen for eating disorders. Thus, patients with undetected eating disorders may unknowingly be admitted to the not admit category. Results indicated that the three types of programs are organizationally very similar. describes the program characteristics, which are displayed as either the percentage of programs or the average percentages (M/SD) reported for each of the three groups. The primary differences were between Admit and treat programs and the other programs. Admit and treat programs have more full-time equivalent employees than programs that do not admit and those that admit and do not treat (39 versus 16 for Not admit and 28 for Admit but not treat). The Admit and treat programs are significantly more likely to address patients' needs from a psychiatric perspective, as seen by their use of psychiatric assessments, use of selective serotonin reuptake inhibitors and admission of patients with other co-occurring psychiatric disorders. Also, Admit and treat programs have significantly higher caseloads of female patients.
Comparison of addiction treatment programs based on admission and treatment of patients with eating disorders.
Nearly all of the programs in this sample treat men and women (N=324, or 95%), whereas 4% (N=12) are women-only programs and 2% (N=5) are men-only programs. Due to the small number of women-only (N=3) and men-only programs (N=0) among the programs that treat eating disorders, we were not able to compare single gender and mixed gender programs in this regard. All but 4% (N=3) Admit and treat programs report having at least one staff member trained in eating disorders treatment, including a psychiatrist or other physician (N=36, 51%) or an addiction counselor trained to treat eating disorders (N=40, 57%). Thirteen programs (19%) reported employing a “certified” eating disorder specialist, although the type of certification was not reported. In most of the Admit and treat programs (N=58, or 84%) patients with eating disorders are integrated with other addiction treatment patients. Only eleven programs (16%) offer a separate track for treatment of eating disorders. Nearly all programs (N=66, 97%) use individual counseling, 71% (N=50) use group therapy, 69% (N=48) use family therapy, and 44% (N=30) use pharmacotherapy to address the eating disorders.
The 70 Admit and treat programs provided additional information on how they addressed eating disorders. There were several distinct ways in which the treatment of patients with co-occurring eating disorders differs from standard addiction treatment. Approximately 17 programs identify having some eating disorder protocol which includes food consumption behavior such as meal planning, meal observation, one-on-one supervision, bathroom monitoring following meals, weighing and/or keeping food diaries/journals. Ten programs provide dietary and/or nutritional services and eight programs have medical monitoring. Other components include providing education and cognitive-behavioral approaches focusing on food and triggers.
Several differences between privately versus publicly funded programs are noted. The privately funded programs (N=253) reported screening nearly three-quarters of patients for eating disorders compared to half the patients (N = 173) in the publicly funded programs (χ2 = 42.37, p < .001). Interestingly, approximately the same proportion of private and public programs (25%) use standardized instruments for screening and both types of programs identified approximately the same number of eating disorder patients (6–7%). However, privately funded programs appear more likely to admit patients with low severity eating disorders (67%) compared to publicly funded programs (48%)(χ2 = 22.85, p ≤ .001). Similarly, privately funded programs are more likely to treat eating disorders (20%) compared to publicly funded programs (15%) (χ2 = 4.02, p =.045). Characteristics of privately and publicly funded Admit and treat programs are presented as average percentages (SD) reported for each group in . The privately funded Admit and treat programs reported that on average 39% of patients have inpatient stays of less than 30 days versus 16% of patients in publicly funded Admit and treat programs. The private programs also reported that on average 67% of patients are admitted to intensive outpatient programs versus 49% of patients in publicly funded Admit and treat programs. When asked about the use of specific medications, privately funded Admit and treat programs were more likely to report using selective serotonin reuptake inhibitors than public Admit and treat programs (100% versus 63%, respectively).
Characteristics of Privately Funded and Publicly Funded “Admit and Treat” Programs.