“I don’t want to play the rehab game anymore”

– Jeff Conaway, Celebrity Rehab 2

While I never thought I’d say this, on some level I can relate to Jeff (putting “treatment” or “recovery” in place of “rehab” in that statement). Treatment and/or recovery sound like a great idea–at least in theory. You go to therapy and talk about things that bother you. Get a dietitian’s input on what you’re eating. Relate to others with eating disorders in ED groups. Take a break from the other stressors in life to focus on yourself. Maybe draw some pictures in art therapy. Try yoga. Get medication that makes you feel better. Doesn’t sound too bad–right?

After some time, you hit a point where the “recovery game” isn’t so fun anymore. You are uncomfortable with your meal plan and with the weight that you are gaining. You don’t want to talk about certain things in individual therapy and the other people in group are triggering or frustrating. You’ve drawn the same picture in art therapy three weeks in a row. The new medications are making you drowsy, dizzy, irritable, etc. And most of all — You are missing things in your life that you want to be a part of.

I think that recovery can feel like a game at first because it is so different from the rest of your life. It’s nice to have others care about your wellbeing and there’s something about treatment that gives you permission to take care of yourself. Plus, there is so much positive reinforcement (gold star for following your meal plan over the weekend!). All of this doesn’t sound so bad… and I do believe you can make progress — even with this mindset.

When does the game end? Personally, I think this is when the disorder starts to feel threatened. There is something scary about recovering, and suddenly it doesn’t sound like a great idea anymore. I understand the panic that Jeff is experiencing.

However, because I do not struggle with a drug/alcohol addiction, it’s also easy for me to see that he has a long way to go in his recovery. His motivation to quit rehab is fueled by his addiction (and probably a lot of fear). It’s much harder for me to identify eating disordered thoughts. Treatment can be so tiresome–especially if it lasts for years. Jeff’s excuse for quitting is that he needs another back operation. I have plenty of excuses, too: I’m not underweight, I am so much better than before, I’m not getting anything out of therapy and need a break, I don’t think that therapy is the answer, there’s nothing that a dietitian can teach me (that I haven’t been told before), I have a life to get back to, etc.

I think that this is the point where you have to change your mindset and treat the ED as the life-threatening disorder that it is. Just going to appointments and sitting in groups isn’t going to make it go away — you are looking at necessary life changes. Your desire to quit is motivated by the eating disorder.

Treatment can feel like a never-ending game of Monopoly… and I don’t know about you, but Monopoly is not fun for me after the first couple of hours.

Eating disorders are different from drug / alcohol addictions, but there are definitely a lot of similarities. There are a lot of components of addiction treatment that I believe in and think are important, and should be applied to eating disorders:

Recovery is a lifelong, daily process — You may not struggle with food every day (heck, you could go years of being A-OK with it), but there’s always that risk. You don’t have the luxury of playing food games (and by playing food games, I mean even casual diets or schedules that don’t allow for normal eating). I would compare “I can have a couple of drinks” with “I can lose a couple of pounds.”

Denial, and not necessarily that you have a problem, but that you need help – Denial with EDs is particularly tough because they are not as black and white as other addictions… At what point does a lot of food become a binge? Where’s the line between health-consciousness and disordered eating? You may somehow know that your thoughts and behaviors aren’t completely normal… but not to a point where you require help. You’re still trying to convince yourself that you’re okay enough or that you can handle this on your own.

The importance of personal accountability – All the support in the world isn’t going to help you if you don’t take responsibility for the disorder. This means somehow sidestepping or pushing past the denial. No one is going to monitor your food intake forever, or follow you to the bathroom forever. If you’re not in a place where you can hold yourself accountable, then this means being responsible enough to arrange necessary help and support.

There’s no magic cure – 30 days of residential treatment doesn’t mean you’re recovered. Simply attending therapy doesn’t somehow fix things.

The disorder should be taken as seriously as any potential fatal disease — I really think that with eating disorder treatment, “slips” are much more tolerated and accepted than in addictions treatment. You can really get away with only putting forth a half-ass effort, because treatment isn’t necessarily your top priority. With drugs and alcohol, using once or twice is a big deal. With eating disorders… skipping a couple meals or losing a couple of pounds = not a big deal.

I personally find it interesting that you can dismiss so many little eating disordered things, because hey — people diet, you’re doing pretty well, it’s only a couple of pounds, purging every other month is insignificant compared to 3 times a day, etc. I respect Dr. Drew a lot because I always feel that he is saying, “no, these little things count — recovery is so important that any signs of disorderedness are significant.”

You are only as sick as your secrets…