Koru Springs

Eating Disorder Recovery Center from Lakeview Health

It´s time to heal

Lakeview Health is excited to announce the opening of Koru Spring.
Taking patients April 2023


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At Koru Spring, we offer a restorative environment for adult women of all identities to address and heal from the impacts of eating disorders.

High staff-to-resident ratios

Highly trained MD care team

Dual-diagnosis care

On-site, medically monitored detox care

24/7 medical care with nasogartic (NG) tubes

RTC, PHP, IOP, & Supported Living

Nutrition education:
wkly meal planning, meal exposure, & cooking experientials


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OUR PURPOSE

Breakdown barries so that recovery is possible

Helpful Articles​

Koru Spring Team

Drunkorexia” or alcohol anorexia is a colloquial term that is a mash-up of alcohol abuse and anorexia nervosa (AN) and refers to the restriction of eating to either speed up the uptake of alcohol or to offset the high caloric value of most alcoholic beverages. It is estimated that up to 80% of young drinkers engage in disordered eating behaviors prior to drinking alcohol, with college-aged women being 1.5 times more likely to restrict their food intake. The term is most often used within the context of college campuses, but can apply to many people across the lifespan.  

“Drunkorexia” is not an eating disorder or medical diagnosis, but should still be taken very seriously as it still has harmful side effects. While “drunkorexia” may not fully meet the diagnostic criteria for anorexia or alcohol use disorder, disordered eating behaviors and bingeing on alcohol is not healthy and can increase the risk of developing these disorders.  Should those behaviors develop into an eating disorder or substance use disorder, both can be life-threatening and require specialized treatment. 

Causes of “Drunkorexia” 

Studies indicate that “drunkorexia” is most often associated with a fear of gaining weight from the high caloric value of alcohol. There is a significant relationship between college binge drinking behaviors and negative body image beliefs. Increased alcohol consumption has also been linked to decreased caloric intake and feeling less hunger. Alcohol deprivation was also linked to increased food consumption in those who had become accustomed to regular drinking. 

What is Binge Drinking? 

A “standard drink” or single drink in the US contains 14 grams of ethanol. Different alcoholic beverages have different alcohol content, often shown on the container as a percentage. On average, a “standard drink” could be: 

  • 12 ounces (about 355 ml) of regular beer at 5% alcohol 
  • 5 ounces (about 148 ml) of wine at 12% alcohol 
  • 1.5 ounces (about 44 ml) of distilled spirits at 40% alcohol 

Although the CDC recommends abstaining from alcohol, especially if you currently don’t drink, they also have guidelines outlining moderate drinking, binge drinking and heavy drinking for those of legal drinking age.  

Moderate drinking: 

  • 1 or fewer standard drinks for women 
  • 2 or fewer standard drinks for men 

Binge drinking: 

  • 4 or more standard drinks for women within 24 hours 
  • 5 or more drinks for men within 24 hours 

Heavy drinking: 

  • 8 or more drinks per week for women 
  • 15 or more drinks per week for men 

The CDC stresses that certain people should never drink any alcohol, such as: 

  • Pregnant individuals 
  • Those under 21 
  • People who have medical conditions or take medication that interacts poorly with alcohol 
  • People who are in recovery for alcohol use disorder or anyone who cannot limit how much they drink 

Side Effects Associated with “Drunkorexia” 

There can be serious health risks associated with drinking alcohol while restricting caloric intake, including: 

  • Overconsumption of alcohol 
  • Malnutrition (including not having enough of the nutrients required to metabolize alcohol) 
  • Gastrointestinal problems (due to restrictive eating and the increased bacterial growth in the intestines due to alcohol consumption) 
  • Impaired judgement 
  • Impaired balance and vision 
  • Weakness, fainting and black-outs 
  • Increased blood pressure 
  • Damage to internal organs 
  • Increased risk of certain cancers 
  • Increased strain on the pancreas and more risk of contracting pancreatitis (due to restrictive eating and the high sugar content of alcoholic beverages) 
  • Decreased immune function 
  • Increased risk of developing an eating disorder or substance use disorder 

Signs and Symptoms of Anorexia and Alcohol Use Disorder 

The risk of developing an eating disorder (such as anorexia nervosa), substance use disorder or a dual diagnosis of both disorders is a serious possible consequence of “drunkorexia”. If you or a loved one shows any of these signs, seek medical advice from a trained medical professional or a treatment center, such as Koru Spring. The earlier these disorders are diagnosed and treated, the better the prognosis of sustained recovery. 

Anorexia is most often characterized by: 

  • Low body mass
  • Persistent restricted food intake 
  • Distorted body image 
  • An intense fear of gaining weight 

It can be further broken down into anorexia nervosa restrictive type (AN-R) and anorexia nervosa bingeing/purging type (AN-BP). This is determined by whether the person has engaged in binge-eating or purging in the last 3 months (bingeing/purging type) or not (restrictive type).  

A person with anorexia may misuse substances associated with appetite suppression or increased metabolism with the initial intention of changing body weight or shape. One study found that there was a significant relationship between college binge drinking behaviors and negative body image beliefs.  

The risk is that the substance use may graduate from a maladaptive behavior that is associated with the eating disorder to becoming an addiction. This may lead to physical and psychological dependence on the substance, independent from the ED, and the development of a substance use disorder (SUD). 

Substance use disorders are characterized by: 

  • Inability to control the use of the substance 
  • Social impairments (such as isolating themselves or poor work or school performance) 
  • Using substances in risky environments or situations 
  • Continued use of the substance despite negative consequences 
  • Tolerance and withdrawal 

Anxiety and “Drunkorexia” 

Substance addiction and eating disorders often co-occur with other mental health disorders. Common co-occurring disorders include mood disorders, post-traumatic stress disorder, obsessive-compulsive disorder, and anxiety disorders. Anxiety can play an important role in increasing the risks of “drunkorexia” developing into alcohol use disorder and/or anorexia. Researchers believe that alcohol (and drug) use could mask symptoms of anxiety and might be abused as an unhealthy coping mechanism. The reinforcing effects of alcohol (or other drugs) can be enhanced by food restriction and can result in severe short- and long-term consequences, including the development of eating disorders and substance use disorders.  

How to Avoid “Drunkorexia” 

Although “drunkorexia” is not limited to college students, it seems that much of the motivation for restricting calories during episodes of binge drinking is peer pressure and the social perceptions of body shape and size. Alcohol anorexia is harmful and can have serious consequences. It is important to be mindful of your food and drink intake and: 

  • Drink in moderation 
  • Do not restrict calories or change your eating habits when drinking 
  • Ensure that your body has access to the right nutrients to help it to metabolize alcohol  
  • Ensure that you have a balanced diet that includes proteins, carbohydrates, fats and other minerals and nutrients 
  • Seek help if you or a loved one shows any signs of dependence on alcohol or an eating disorder 
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Deanna McMichael

Facts Behind Eating Disorders and Substance Abuse 

Co-occurring substance use disorders (SUDs) and eating disorders (EDs) can present significant challenges for individuals seeking treatment and recovery. Over their lifetime, about 29% of people with an ED will experience a co-occurring substance use disorder, with 7% experiencing symptoms from both psychological disorders simultaneously.   

Substance use disorder, is a chronic condition characterized by the continued use of licit or illicit substances, resulting in physical and psychological dependence with negative consequences, such as health problems, social problems, and difficulties with work or school. Eating disorders are serious mental health conditions that involve unhealthy eating behaviors and beliefs around food and body image. EDs also have serious negative consequences, many of which overlap with those of SUD. Both are serious mental illnesses and can be life-threating, so it is important to find a treatment facility where both disorders can be treated simultaneously. 

Common licit substances which are misused by those with EDs include: 

  • Alcohol 
  • Tobacco 
  • Caffeine
  • Laxatives 
  • Emetics 
  • Diuretics 

Examples of illicit substances that may be used by those with a co-occurring ED include: 

  • Amphetamines 
  • Heroin 
  • Cocaine 

Risk Factors and Causes of Eating Disorders and Addiction 

Eating disorders and substance use disorders share many common risk factors. This overlap is believed to contribute to their high rate of co-occurrence. Risk factors do not determine whether or not  a person develops an ED or SUD, but are contributing factors that may play a role in the development and/or maintenance of these disorders.   

Some common risk factors shared by both eating disorders and substance use disorders include:  

  • Brain chemistry (neurotransmitter availability and neuroreceptor functionality) 
  • Family history and genetic predisposition 
  • Low self-esteem 
  • Co-occurring depression, anxiety, personality disorders or other illnesses 
  • Social pressures  
  • Compulsive behavior 
  • Social isolation 
  • Risk of suicide and self-harm 

Signs of Co-occurring Eating Disorders and Addiction 

Signs and symptoms of substance use disorders and eating disorders can be difficult to identify, especially because there are so many different disorders that fall under these large umbrella terms. While each SUD and ED may have specific identifiers, they do have some signs and symptoms that are common to many disorders within the various diagnoses. If you or a loved one shows any signs or symptoms of an ED or SUD, please reach out and seek advice from a trained medical professional or a treatment team, such as Koru Spring 

Some signs that are common to many eating disorders include

  • Preoccupation with body shape and size, food, nutritional values, dieting, etc. 
  • Not wanting to eat when other people are around 
  • Restrictive eating and/or eating until uncomfortably full 
  • Bingeing and/or purging 
  • Distorted body image 
  • Social withdrawal and isolation 
  • Depression, anxiety, self-harm or suicidal thoughts 
  • Dry skin and brittle hair and nails 
  • Problems with sleep 
  • Mood swings 
  • Gastrointestinal pain or problems 
  • Continued eating behaviors or restrictions, despite negative consequences 

Substance use disorders are characterized by

  • Inability to control the use of the substance 
  • Social impairments (such as isolating themselves or poor work or school performance) 
  • Using substances in risky environments or situations 
  • Continued use of the substance despite negative consequences 
  • Tolerance and withdrawal 

Prevalence of Substance Use Disorders with Co-occurring Eating Disorders 

The relationship between addiction to substances and eating disorders is complex and may be bidirectional. People experiencing an eating disorder use alcohol or other illicit drugs at a rate that is about 5 times higher than that of the average population. About 50% of people with an ED misuse substances. About 35% of those with a substance use disorder also experience an ED (which is a rate that is about 11 times higher than that of the general population).   

One study found that those who were diagnosed with an eating disorder most often misused: 

  • Tobacco  
  • Caffeine  
  • Alcohol  

Researchers have noted that some behaviors associated with specific ED subtypes (such as binge eating) were also associated with different substance use behaviors or choices of substance used. For example, those who engage in binge eating, such as subtypes of bulimia nervosa (BN) and lifetime anorexia and bulimia (ANBN), were more likely to use both licit and illicit substances. Increased frequency of bingeing and purging behaviors were also associated with increased substance use. 

The NCS-R reports that, within the US, between 23% -36% of people diagnosed with anorexia, bulimia or binge eating disorder also have a substance use disorder. Current research tends to focus on co-occurring substance use disorders in individuals with anorexia nervosa, bulimia nervosa and binge eating disorder, leaving room for future research into other EDs and the misuse of specific substances. To understand the complex relationship between an eating and substance use disorder, it is important to remember that the person has developed these unhealthy behaviors as maladaptive coping mechanisms, not as a choice.  

Co-occurring Anorexia Nervosa and Substance Use Disorders 

Sometimes further categorized into anorexia nervosa restrictive type (AN-R) and anorexia nervosa bingeing/purging type (AN-BP), anorexia is most often characterized by: 

  • Low body mass 
  • Persistent restricted food intake 
  • Distorted body image 
  • An intense fear of gaining weight 

As such, substances associated with appetite suppression or increased metabolism might be taken with the initial intention of changing body weight or shape. Misuse of nicotine, prescription pills (such as Adderall), cocaine and methamphetamines can lead to physical dependence on these substances and the development of associated substance use disorders.  

Anorexia nervosa (AN) may be one of the most researched eating disorders. Based on a systemic research review, about 16% of those people with anorexia also have a substance use disorder, including: 

  • Alcohol use disorder (AUD) in 10% of those with anorexia 
  • Cannabis use disorder in 6% of those with anorexia 
  • Amphetamine use disorder in 5% of those with anorexia 
  • Cocaine and polysubstance use disorder in 3 % of those with anorexia 
  • Narcotic and sedative/hypnotic use disorder in 1% of those with anorexia 
  • Other substances made up for 4% of substances misused by those with AN 

The reinforcing effects of alcohol (or other drugs) can be enhanced by food restriction and can result in severe short- and long-term consequences, including the development and maintenance of eating disorders and substance use disorders. Risk factors of high rigidity and perfectionism are found for both AN and SUDs. 

Co-occurring Bulimia Nervosa and Substance Use Disorders 

Bulimia nervosa is characterized by episodic binge eating that is followed by behaviors that are believed to compensate for the high intake of food. These behaviors can include vomiting, using diuretics or laxatives and excessive exercise. While co-occurring bulimia and SUD has been less researched than a dual diagnosis of AN and SUD, bingeing/purging subtypes of eating disorders are the most likely to co-occur with a substance use disorder.  

Of those who have a dual diagnosis of an ED and a substance use disorder in the US: 

  • Alcohol use disorder (AUD) was found in 34% of those with bulimia 
  • Other substances where misused by 37% of the patients diagnosed with bulimia 
  • Illicit drugs (such as cocaine, tranquilizers, amphetamines, barbiturates and marijuana) were more often used by individuals with bulimia, with the highest reported use found in those with BN who engaged in bingeing and purging. 

Misused substances may be used to support or increase the effects of compensatory purging behaviors, such as laxatives, diuretics, restricting medications (such as injected insulin) and emetics. In those with co-occurring bulimia and substance use disorders, the misuse of substances and bingeing behaviors may both be linked to increased impulsivity and low self-directedness. 

Co-occurring Binge-Eating Disorder and Substance Use Disorders 

Binge-eating disorder is often linked to body size and shape dissatisfaction, leading to binge eating. This may lead to weight gain and feelings of shame or self-hatred. Binge-eating episodes are characterized by the person experiencing three (or more) of the following: 

  • Eating faster than usual 
  • Eating until they feel uncomfortably full 
  • Eating large amounts of food when they don’t feel hungry 
  • Eating alone to hide how much they are eating and associated feelings of shame 
  • Feeling ashamed, depressed or extremely guilty after a binge-eating episode  

Binge eating disorder is three times as common as anorexia and bulimia combined, making it the most common eating disorder in the US. Co-occurring substance use disorder (SUD) has been reported in 23%-68% of those people diagnosed with binge-eating disorder (BED). Both share common symptoms including the loss of control over food or substance intake and the continued use of both despite negative consequences. BED and addiction also share mechanisms which may contribute to the development of co-occurring BED and SUD, such as 

  • Reward dysfunction 
  • Cravings 
  • Emotion dysregulation 
  • Impulsivity 

Alcohol use disorder (AUD) seems to be the most common dual diagnosis found with binge-eating disorder, with a systematic review reporting that about 20% of those with BED also have a lifetime prevalence of AUD. This is 1.5 higher than in those people without a binge-eating disorder. Scientists believe that both binge-eating and alcohol misuse might trigger a reward-response in the brain, which may lead to the development of BED and AUD. They may also use this reward system as an unhealthy coping mechanism to numb or reduce negative emotions or feelings.  

Despite many similarities between addiction to substances and binge-eating, it is important to remember that they are not the same disorder and have key differences. Binge-eating is not simply “food-addiction” and must be treated as a separate disorder from SUD. 

Treatment 

The adverse effects of both eating disorders and substance use disorders can be severe, including malnutrition, electrolyte imbalances, heart-failure and death. Co-occurring disorders require specialized treatment that may include detoxification, medical management of either or both disorders and a holistic and integrated treatment plan. 

Co-occurring ED and SUD can increase the complexity of treatment, as both disorders may require different treatment approaches and strategies. Unique to SUDs and EDs, is that they can be interconnected both physiologically and psychologically. For example, the eating disorder behaviors of restrictive eating may increase the reinforcing effects of the substance. Treating both disorders simultaneously can improve the chances of successful and lasting recovery. 

Some important considerations in the treatment of a dual diagnosis of an ED and SUD include 

1. Addressing underlying issues: Both eating disorders and substance use disorders can be linked to underlying issues or risks, such as trauma, anxiety and depression. Treating these underlying issues may be necessary for long-term recovery. Treatment for SUD and other psychiatric disorders has been shown to be more successful when both disorders were treated simultaneously with an integrated approach. Inpatient centers that offer gender-responsive treatment and trauma-informed care, such as Koru Spring, create integrative treatment spaces where many of the common underlying issues for both ED and SUD can be explored in a safe and supportive space.    

2. Comprehensive treatment: Treating dual diagnosis requires a comprehensive treatment approach that addresses both the eating disorder and the substance use disorder. This may involve a combination of therapies, such as individual therapy, group therapy, and medication management. This may require going to multiple treatment centers or finding a residential treatment program that offers access to many medical professionals on a single campus, such as Koru Spring. 

3. A strong support system: Having a strong support system, including family, friends, and professionals, is important for individuals with co-occurring disorders. Support groups, such as Eating Disorders Anonymous and SMART Recovery, can also be helpful for individuals with ED or SUD. 

Overall, dual diagnosis can significantly impact the treatment of eating disorders and substance use disorders and often results in poorer prognosis and higher rates of dropping out of treatment. To combat this, it is important to seek help from professionals who have experience treating both. A comprehensive and integrated approach to treatment that addresses common underlying issues and accounts for both psychological and physiological treatment is crucial to a successful recovery journey. 

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Deanna McMichael

Gender-responsive treatment is an approach to eating disorder treatment that recognizes and addresses the unique needs and experiences of individuals based on their gender identity or expression. It is estimated that about 20 million women (about the population of New York) and 10 million men will have an eating disorder during their lifetime. Tailoring treatment interventions promotes trust and fosters a sense of community, leading to more effective and inclusive care. 

Understanding Gender-Responsive Treatment 

Research shows that women and men often experience eating disorders differently and therefore require different types of treatment. For example, women are more likely to experience body dissatisfaction and to place a higher value on being thin. Men, on the other hand, may be more likely to place an extreme focus on building muscle and enhancing physical fitness. 

Gender-responsive treatment recognizes these differences and tailors the approach accordingly. This type of treatment can help individuals feel understood and supported throughout the recovery process.  

By focusing on the unique experiences of each gender, gender-responsive treatment can help individuals build a stronger sense of self-awareness, develop healthier coping skills, and learn to appreciate their bodies in a positive way. 

Benefits of Gender-Responsive Treatment 

There are numerous benefits associated with gender-responsive eating disorder treatment. These include: A safe and comfortable environment:

  • With gender-responsive treatment, residents have the opportunity to engage with individuals who have shared experiences. This allows for a greater sense of safety and comfort, which in turn facilitates a more open and honest dialogue. It also creates a safe and inclusive environment where individuals can connect with others who share similar gender-specific experiences. Group therapy or support groups specifically designed for individuals of the same gender can provide a sense of belonging, validation, and support.
  • Improved outcomes: Research shows that individuals who participate in gender-responsive eating disorder treatment experience better outcomes compared to those who receive traditional treatment.
  • Tailored treatment plans: Gender-responsive treatment acknowledges the unique needs and experiences of individuals, resulting in more individualized and effective treatment plans.
  • Greater support and understanding: Individuals in gender-responsive treatment programs have the opportunity to engage with therapists and peers who understand the complexities of gender and how it intersects with eating disorders.
  • Addressing Co-occurring Mental Health Concerns: Eating disorders frequently co-occur with other mental health conditions such as depression, anxiety, and trauma-related disorders. Gender-responsive treatment recognizes the intersection of gender and mental health and provides integrated care that addresses these co-occurring concerns. By addressing both the eating disorder and underlying mental health issues, it promotes comprehensive healing and improved mental well-being.
  • Increased self-esteem: Many individuals with eating disorders struggle with low self-esteem and body image issues. Gender-responsive treatment can help individuals develop a more positive self-image and improve their confidence while diving into the unique perspectives that each gender has. Connecting with others who understand their struggles and can offer empathy and encouragement can enhance self-esteem.

 

Examples of Gender-Responsive Treatment Practices 

Gender-responsive treatment for eating disorders is designed to address the unique experiences and challenges that individuals of different genders face when dealing with these complex conditions. Here are some examples of gender-responsive practices that may be used in the treatment of eating disorders: 

  • Group Therapy: In group therapy, individuals are given the opportunity to connect with others who share similar experiences. In gender-responsive treatment, group therapy sessions may be separated by gender, allowing individuals to share their experiences with those who have faced similar challenges and create a more supportive environment. 
  • Nutrition Education: Men and women often have different nutritional needs and dietary concerns. Gender-responsive treatment will take this into consideration and provide education that is tailored to meet the specific nutritional needs of individuals of different genders. 
  • Body Image Focus: While both men and women can struggle with body image issues, they may do so in different ways. In gender-responsive treatment, therapists will help individuals to identify their unique body image concerns and develop strategies to overcome them. 
  • Addressing Trauma: Women are more likely to experience trauma than men, which can contribute to the development of eating disorders. Gender-responsive treatment will focus on addressing the underlying causes of an individual's eating disorder, including any trauma they may have experienced. 
  • Coping Mechanisms: Men and women may have different coping mechanisms that they use when dealing with stress and difficult emotions. In gender-responsive treatment, therapists will help individuals to identify healthy coping mechanisms that are specific to their gender and culture. 

By providing treatment that is specifically tailored to the unique needs of individuals of different genders, gender-responsive eating disorder treatment can improve outcomes and help individuals achieve long-lasting recovery. 

Overcoming Barriers and Challenges 

While gender-responsive eating disorder treatment can provide significant benefits to individuals seeking recovery, there may be some potential downsides that should be considered. Some individuals may feel uncomfortable or excluded in a treatment program that is exclusively geared toward a particular gender identity. Transgender and nonbinary individuals may face unique challenges in a gender-specific program and may benefit more from a program that is inclusive and affirming of diverse gender identities. 

It is important for treatment providers to be mindful of these potential risks and work to create a program that is welcoming and supportive for individuals of all gender identities. By promoting a culture of inclusivity and diversity, gender-responsive treatment can become a powerful tool in the fight against eating disorders. 

If you or a loved one are struggling with an eating disorder Koru Spring in Jacksonville, Florida is ready to help you on your journey to recovery.  

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