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Other MH Policy · comorbidity_awareness

Federal: Other MH Policy

Official titleHere’s How to Support People with Both Eating and Substance Use Disorders

Federal · Relevance score 32 of 100 (tangential). low impact.

Informational only

This summary is informational and is not legal advice. Read the source text before acting on it.

The itemStructured facts, then the operational reading.

What this policy change does.

Jurisdiction
Federal
Published
January 21, 2026
Impact score
32 of 100, from analysis of the full text: tangential
Primary source
SAMHSA

Impact on your practice

This is clinical guidance for treating a specific comorbid population. While valuable for therapists specializing in eating and substance use disorders, it does not affect policy, reimbursement, licensing, or practice operations.

Key facts

  • SAMHSA educational content on co-occurring eating disorders (EDs) and substance use disorders (SUDs)
  • Addresses treatment barriers for dual diagnosis populations
  • Highlights need for integrated, comprehensive treatment approaches
  • Clinical education for providers
The readingGenerated from the full source text, and labelled as analysis rather than fact.

What it would mean for a practice.

This SAMHSA guidance document does not impose new reimbursement mandates, licensing requirements, or compliance obligations on your practice. However, it signals a federal priority shift that will likely shape training expectations, insurance coverage decisions, and referral network development over the next 12-24 months. If you treat substance use or eating disorders—or if your clients present with both—you should expect increased scrutiny from supervisors, insurers, and accreditation bodies regarding your ability to identify and manage comorbid presentations. Your documentation must now reflect screening for both conditions, even if you don't specialize in both. Insurers may begin denying claims for eating disorder treatment if you haven't documented corresponding SUD screening, or vice versa. More significantly, the federal emphasis on 'integrated care' may pressure your agency or practice to hire or partner with specialists you currently lack. If you're a solo practitioner, this means building referral relationships with substance abuse counselors and registered dietitian nutritionists now, before demand spikes. The guidance also highlights peer support services as 'vital'—your practice may face expectations to incorporate or collaborate with peer specialists, which could require contracting, supervision protocols, or outcome tracking you don't currently have in place.

Background

This guidance emerges from a well-documented clinical reality: comorbid eating and substance use disorders are far more common than historically recognized, particularly among women. The epidemiology cited here (25% of people with eating disorders also meet SUD criteria; 35% of those with alcohol or other SUDs have eating disorders) reflects decades of underdiagnosis and fragmented treatment systems. Historically, eating disorders and substance use have been treated in separate silos—different agencies, different funding streams, different provider networks. The federal government has increasingly recognized this fragmentation as clinically harmful and economically inefficient. This guidance document, released by SAMHSA's Center for Substance Abuse Treatment in January 2026, is part of the Trump administration's 'Make America Healthy Again' initiative, which prioritizes addressing chronic disease through integrated, evidence-based approaches. The timing matters: SAMHSA has simultaneously released a formal advisory (Evidence-Based Care for Clients with Co-Occurring Substance Use Disorders and Eating Disorders) that will inform training standards, grant funding priorities, and likely future reimbursement policies. States and insurers typically follow SAMHSA guidance within 6-18 months.

What you should do

  • Review your intake assessment and screening tools immediately. Ensure you systematically screen for substance use if you treat eating disorders, and vice versa. Document the screening results in every chart, even if negative, to demonstrate compliance with emerging best-practice standards before insurers mandate it.
  • Audit your clinical knowledge: if you specialize in one domain (SUD or ED), identify gaps in your competency with the other. Enroll in a continuing education course on comorbid ED-SUD treatment this year. Many state licensing boards are beginning to require this as part of addiction or eating disorder specialty credentials.
  • Map your referral network now. Identify at least two substance abuse treatment providers and two eating disorder specialists (ideally both LCSWs/LPCs and RD-LDs) within your insurance network and geographic area. Establish formal collaborative relationships, including joint intake protocols and communication templates. If you cannot build these partnerships, document your efforts and inform your clinical director or supervising physician of the gap.
  • Clarify your scope of practice with your licensing board and malpractice insurer. Ask explicitly whether treating clients with comorbid ED-SUD presentations is within your credential's scope, or whether you must co-treat with a substance abuse specialist. Get written confirmation, as this will protect you if a claim is denied or a complaint filed.
  • If you work in an agency or group practice, advocate for peer support integration. Review your organization's current peer specialist hiring, credentialing, and supervision policies. If peer support is absent, submit a proposal to leadership—frame it as risk management and outcomes improvement, not just clinical best practice.

Notable excerpts

More than one in four individuals with an ED will also meet the criteria for a co-occurring SUD. Similarly, up to 35 percent of those with alcohol use disorder or other SUDs have eating disorders.
People must receive compassionate, integrated care for both disorders in order to have the best chance at recovery.
Integrated care addresses EDs and SUDs concurrently through holistic, person-centered approaches. By considering physical, mental, and emotional health—including evidence-based therapies and medical and nutritional support—integrated care plans reduce the risk of return to misuse and promote long-term recovery.
View full source text
Date: January 21, 2026 Categories: Substance Use, Treatment, Mental Health, Substance Use Disorder (SUD) By: Berlina Wallace-Berube, MACP, MEd, LPC, NCC, Senior Public Health Advisor, Center for Substance Abuse Treatment For a lot of Americans, eating disorders (EDs) and substance use disorders (SUDs) are not distinct challenges. Many live with both. In fact, more than one in four individuals with an ED will also meet the criteria for a co-occurring SUD. Similarly, up to 35 percent of those with alcohol use disorder or other SUDs have eating disorders. These co-occurring conditions occur at higher rates among women. Research indicates that approximately half of all women with EDs also have an SUD, and about 16 percent of women with an SUD report having an ED. The co-occurrence of these conditions is a pressing public health concern with profound impact on individuals and their families. They’re tangled together in ways that may make recovery feel overwhelming – but it’s not out of reach. People must receive compassionate, integrated care for both disorders in order to have the best chance at recovery. This aligns with President Trump’s Make America Healthy Again (MAHA) initiative and its commitment to addressing the chronic disease epidemic impacting Americans. Evidence-based, whole-person approaches to treating co-occurring EDs and SUDs will advance MAHA’s vision of a healthier, more resilient America. Understanding the link between EDs and SUDs Co-occurring EDs and SUDs often share underlying causes, including genetic predisposition, trauma, and emotional dysregulation (difficulty managing feelings and emotions). Factors such as adverse childhood experiences and norms also contribute. Both disorders involve compulsive behaviors, cravings, and use of food and/or substances as a coping mechanism. Traits such as impulsivity and perfectionism may exacerbate risks for both conditions. SUDs and EDs can exacerbate each other, creating a cycle that complicates recovery for both. For instance, individuals with binge eating disorder may misuse prescription stimulants or use illicit stimulants for appetite suppression, perpetuating a dangerous cycle. Recognizing symptoms early is critical. Early intervention provides individuals the best chance for lasting recovery. Delayed treatment increases risks of severe health consequences and complicates recovery efforts. Integrated care paves a road to recovery Treating both disorders together is vital to improving outcomes. SAMHSA’s recently released advisory Evidence-Based Care for Clients with Co-Occurring Substance Use Disorders and Eating Disorders contains information to help health care providers identify clients who have possible co-occurring SUDs and EDs; make appropriate referrals; create recovery-friendly, supportive treatment environments; and help clients sustain recovery from both SUDs and EDs. Integrated care addresses EDs and SUDs concurrently through holistic, person-centered approaches. By considering physical, mental, and emotional health – including evidence-based therapies and medical and nutritional support – integrated care plans reduce the risk of return to misuse and promote long-term recovery. Recovery from co-occurring SUDs and EDs is possible with the right resources and support. Normalizing discussions about dual diagnoses helps reduce stigma and encourages more individuals to seek the help they need. Community and family involvement are also key components of recovery. Peer support services play a vital role in the recovery journey of individuals who have SUDs and EDs. These services provide a sense of connection, encouragement, and hope by allowing people to engage with peer support workers who have lived similar experiences and understand the challenges associated with these conditions. Peer support fosters empowerment, reduces stigma, and helps individuals build the confidence and resilience needed to sustain long-term recovery. Resources for people who have eating disorders, substance use disorders, or both If you or someone you know is dealing with eating disorders, substance use disorders, or both, don’t wait to reach out for help. Educate yourself and others about the realities of co-occurring EDs and SUDs. Share resources, participate in community events, and advocate for inclusive, comprehensive treatment approaches that address the complexity of these dual diagnoses. The U.S. Department of Health and Human Services (HHS) offers a wealth of resources for people who have SUDs and EDs, as well as families and providers: - Substance Use – a comprehensive resource where you can learn about substances, prevention, treatment, and recovery. - SAMHSA: Substance Use Disorder Treatment – a comprehensive resource with information about substance use, resources, and treatment options for substance use disorders and co-occurring disorders. - SAMHSA: Eating Disorders – a resource providing information about eating disorders and how to get help. - Office on Women’s Health: Eating Disorders – a resource containing information about specific eating disorders, including their impact on pregnancy and breastfeeding. - NIH National Institute of Mental Health: Eating Disorders – a resource consisting of eating disorders research, outreach materials, and links to resources. - AHRQ: Eating Disorder Resources for Clinicians and Patients – a webpage with information about eating disorders and links to resources for clinical providers and individuals with eating disorders. - FindSupport.gov – designed to help people identify available resources, explore unbiased information about various treatment options, and learn how to get support for issues related to mental health or substance use. - FindTreatment.gov – a confidential and anonymous resource for persons seeking treatment for mental health conditions and substance use disorders. - 988 Suicide & Crisis Lifeline – a lifeline for individuals in need of support or in crisis. Call or text 988 or chat 988lifeline.org. Each of us can help to foster a world where recovery is possible for everyone. By supporting individuals on their recovery journeys, we honor their courage and resilience. The time to act is now – together, we can make a difference. Let’s work together to create a future where recovery is within reach for all.
SourceThe tracker does not paraphrase a secondary source and present it as the item.

Read the original policy source.

Primary source text, linked directly.

https://www.samhsa.gov/blog/how-to-support-people-with-both-eating-and-substance-use-disorders

Read the original
Analysis by
Therapy Companion policy engine
Confidence
high
Analyzed
July 28, 2026
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