How Is Food Addiction Addressed at U.S. Substance Use Disorder Treatment Facilities? Perspectives of Service...

Substance use disorders (SUDs) are a leading public health concern in the United States. Food addiction (FA), as a common comorbidity or substitute addiction of SUDs, is not currently a fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnosis, with overlaps with SUDs and eating disorders (EDs). How FA is addressed in SUD treatment is understudied.

Cross-sectional survey interviews with service providers (N = 85) from 68 SUD treatment facilities across 20 U.S. states asked an open-ended question on how FA was addressed. Descriptive statistics of FA prevalence were reported; Chi-square tests were used to assess bivariate associations between facility funding sources, FA treatment, and referral availability. Thematic analysis was conducted to identify emerging over-arching themes regarding FA-related practice.

Eight themes were identified: formal treatment offered at the facility; no treatment; referral for treatment; education; screening; monitoring; comorbidities or triggers of FA; and potential misunderstandings of FA. Among the 80% of facilities observing FA issues, 29% provided explicit/formal treatment, and 53% made referrals to ED treatment facilities. Facilities that accept insurance (P = .046) and self-pay (P = .008) were more likely to make referrals. Methamphetamine use, substitute addiction, trauma, homelessness experience, and malnutrition were potential FA triggers. Potential misconceptions about FA and EDs may undermine appropriate treatment.

Formalizing FA assessment and diagnosis, and improving reimbursement mechanisms, may reduce potential health inequities between market-driven and publicly funded SUD treatment centers in FA treatment and referral resources. More training on FA, integrating evidence-based FA screening, monitoring, and treatment measures, is warranted to improve holistic SUD treatment quality and outcomes.