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Care goes well beyond the disorder
By Stephanie Siek, Globe Staff | July 12, 2007

The young woman who entered Walden Behavioral Care's clinic in Waltham five weeks ago was close to death. She weighed just 72 pounds. She was so weak that to cross her left leg over her right, she had to lift it with both hands. Her pulse was so weak that she needed a trip to a hospital emergency room before the staff at the clinic could finish evaluating her. She was diagnosed with anorexia and obsessive-compulsive disorder.

It's not an uncommon scenario for staff at Walden, which specializes in the treatment of eating disorder patients -- some as young as 13 -- who are also fighting substance abuse, depression, anxiety, or other mental health issues. For the past four years, the clinic has been using a multifaceted approach to help patients deal with a complex web of problems, earning a reputation that attracts patients from as far away as Canada, Florida, and California.

James Greenblatt, the center's chief medical officer, said clinicians only recently began to treat problems concurrently. Even now, many patients fighting an addiction to drugs or alcohol along with anorexia, bulimia, or binge eating are left with few options.

Rehabilitation centers that focus on addictions don't provide the medical expertise needed to treat an eating disorder. Many eating disorder clinics aren't equipped to deal with anxiety, depression, or obsessive-compulsive disorder. And most of them, Greenblatt said, won't admit people until they're sober.

"We just got a call for a woman who drinks a bottle and a half of wine a day, and the eating disorder clinics won't take her," Greenblatt said of one candidate for admission. "If she were to go to detox, which she doesn't want to do, they're not able to treat the eating disorder."

A 2003 report by Columbia University's National Center on Addiction and Substance Abuse found that up to half of people with eating disorders also abuse drugs or alcohol, and up to 35 percent of drug and alcohol abusers also have an eating disorder. Greenblatt said services offered at the center include detox, nutritional counseling, structured and supervised meals, intensive individual and family therapy, medication for mental illness, nutrition supplements, eating disorder support groups, and Alcoholics Anonymous meetings.

Stuart Koman, president and chief executive officer of Walden Behavioral Care, said patients are usually in "pretty dire condition." Between a third and a half of the patients are referred by hospitals, whose first contact with the patient is often when they come to the emergency room.

The center, which is located on the second and fifth floors of the former Waltham Hospital, has a 140-person staff and can accommodate up to 66 patients -- 22 in their inpatient ward, 16 in their residential program, 14 to 16 in the partial hospitalization program, and 10 to 12 in intensive outpatient programs. A second campus in Northampton that can provide partial hospitalization services is due to open Oct. 1, and Walden hopes to open an outpatient binge-eating program in Dedham about the same time.

Koman said the expansion is driven by a pressing need for services and a dearth of multi disciplinary providers. "We take [patients] so far, but we always want to send them back to a competent place for continued care," Koman said.

That isn't always available in Western Massachusetts, or for that matter, the South Shore and northern New England -- places where Walden also has considered opening clinics. Patients at the Waltham facility can move through several levels of care as their treatment progresses. An eating-disorder patient might be admitted as an acute care case fed by a tube, then become well enough to move into a residential treatment program, and then graduate to a day program with therapy and structured meals.

The program also includes four apartments in the neighboring Longview Apartments, each housing up to four patients who slowly relearn how to have a day-to-day relationship with food. They cook in the apartment's kitchen, and go on grocery shopping trips and on group outings to restaurants. In a second-floor hallway of the facility, patients had written their hopes on half sheets of paper: "I hope for serenity." "I hope for a family with my husband." "I hope for spiritual healing."


What a great clinic that covers all the levels of recovery. I truly hope that other clinics follow suit and open the same type of program.


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The centre I recieve counselling for addictions also addresses PTSD, adult survivors of abuse. They have a bit of knowledge around eating disorders but I don't know how much. The first time in the 90's when I went for the counselling the first time no one would address the underlying causes of the addiction and people that looked at the addiction did it in isolation.

I'm glad there are some places that deal with the underlying causes of why we do what we do.
Wow that's weird. That's where I went for two and a half weeks.

I heard from the other patients in there that Walden is better than other places, and I can't really compare it to anywhere else, but I thought the therapy aspect of it was pretty weak. They feed you, do some feel-good fluffy group sessions and not much else.

The part about treating different problems like substance abuse...I was there a pretty long time compared to other people who come in and out usually in 4 or 5 day-long stays...and I didn't see them accept other types of patients. They have different wards for that. I remember one woman who was anorexic and threatened to kill herself, so they transfered her across the hall to the psych ward, where she was not treated for her ED as she later told us in the halls that no one punished her for not eating. So I don't know how accurate this article is. I'm sure Walden is better than a lot of other places, but I don't think it's as good as that.

And conveniently, the article does not mention INSURANCE. Most patients don't get the level of care because of insurance. Some people have to beg their insurance companies to let them stay 2 nights when they really needed a few weeks of treatment. If it weren't for stupid insurance companies, the programmes would work a lot better.


How interesting to get someone's first hand experience of a place instead of just reading it from an article. Thank you for sharing your experience with us.
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