The Link Between Eating Disorders and Substance Use

By: Natalie Newton, LPC, Director of Clinical Services, Alsana

We’re sharing a post originally published on the Alsana Blog exploring the link between eating disorders and substance use. 

Eating disorders and substance use disorders are mental illnesses – not moral failings. The co-occurrence of both types of disorders, known as “dual diagnosis” or “co-occurring disorders,” is not uncommon. With early detection, treatment intervention, and ongoing support, recovery is possible.

What Are Substance Use Disorders?

Substance use disorders (SUDs), formerly referred to as substance abuse or substance dependence, are a group of mental health conditions characterized by the chronic and compulsive use of substances, including alcohol and drugs, despite adverse consequences. These disorders can significantly impact an individual’s physical, emotional, and social well-being.

EDs and SUDs – Similarities and Differences

Eating disorders and substance use disorders both involve compulsive behaviors. Just as someone with an eating disorder may feel like they can’t stop restricting or binging, someone with a substance use disorder may feel as though they can’t stop using drugs or alcohol. 

The two issues can feed off each other, making it even harder to break the cycle.

Similarities:

  • Compulsive Behaviors: Both eating disorders and substance use disorders often involve compulsive behaviors. Individuals may feel driven to engage in these behaviors, even if they know they are harmful.
  • Escapism: People with both types of disorders may use their behaviors as a way to escape from emotional or psychological distress. This can provide temporary relief from difficult emotions.
  • Secretive Behavior: Individuals with eating disorders and substance use disorders may engage in their behaviors secretly, often trying to hide their actions from others.
  • Tolerance and Withdrawal: Both types of disorders can lead to the development of tolerance, where more of the substance or behavior is needed to achieve the same effect, and withdrawal symptoms when the behavior is reduced or stopped.
  • Impact on Relationships and Daily Life: Both types of disorders can have a profound impact on personal relationships, work, and daily life. They can lead to social isolation and interfere with one’s ability to fulfill daily responsibilities.
  • Triggered by Stress: Stress can be a significant trigger for both eating disorders and addiction. 
  • Common Risk Factors: These include genetics, family history, a history of trauma, low self-esteem, and co-occurring mental health conditions such as depression and anxiety

 

Differences:

  • Substance vs. Food: The primary difference is the target of the behavior. In substance use disorders, the focus is on using drugs or alcohol, whereas in eating disorders, the focus is on food, body image, and control over eating.
  • Physical Health Effects: While both types of disorders can have severe physical health consequences, the specific health risks and complications differ. Substance use disorders can lead to a wide range of physical and medical problems, while eating disorders often focus on issues related to weight, nutrition, and digestion.
  • Diagnostic Criteria: Eating disorders, such as anorexia nervosa, bulimia nervosa, and binge eating disorder, have their own diagnostic criteria separate from substance use disorders. Each type of disorder has its own set of recognized symptoms and criteria.
  • Treatment Approaches: While there are commonalities in the treatment approaches for both eating disorders and substance use disorders (e.g., therapy and support groups), there are also specialized treatments and interventions tailored to each disorder’s unique characteristics.

 

Food addiction is similar to drug addiction in that both can lead to changes in the brain’s structure and function.  The cravings for either food or substance come from the same neural pathways.  The same is true for withdrawal. When a person resists these cravings they may face mood swings, anxiety, irritability and physical symptoms.

Statistics

  • Both clinical and community studies have reported high co-occurrence of EDs among women with SUDs.
  • The rate of substance use disorders among those with eating disorders is high; approximately half of all women with eating disorders also struggle with addiction.
  • Up to 35% of individuals dependent on alcohol or other drugs have also had eating disorders, a rate 11 times greater than the general population.
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) has reported that of those admitted for substance use disorder treatment, 16% of women and 3% of men had also reported an eating disorder. This cross-over of conditions suggests that these disorders are not independent of each other but rather, have common root causes or triggering factors.
  • Another study published in the Journal of Substance Abuse Treatment found that patients with both eating disorders and substance use disorders had significantly higher rates of mood disorders, anxiety disorders, and personality disorders. This indicates that the co-occurrence of these disorders may further exacerbate mental health conditions, highlighting the need for integrated and comprehensive treatment strategies.
  • Up to 50% of individuals with eating disorders use alcohol or illicit drugs, a rate five times higher than the general population.
  • Women with either an SUD or an ED are more than four times as likely to develop the other disorder as were women who had neither disorder.
  • Roughly one in five individuals with an ED will develop an a SUD at some point in their lifetime.

Treatment: Breaking the Cycle

Eating disorders can contribute to the development of a substance use disorder, just as addiction can contribute to the development of an eating disorder. Left untreated, symptoms of either condition can and do impede healing from other mental health conditions. 

For those who are in eating disorder recovery, it’s important to remember that not only can substance use significantly impact the healing progress, but it can make eating disorder behaviors much more dangerous

EDs and SUDs frequently reinforce and perpetuate each other due to the similarities in their presentations and risk factors. That’s why treating comorbid eating disorders and substance use disorders effectively requires simultaneous consideration of both conditions.

Treatment for Substance Use and Eating Disorders

The presence of an eating disorder or substance use disorder can increase the risk of developing the other, which helps explain why these conditions often  occur together. When they do,  treatment is more challenging. However, addressing both disorders together is crucial for long-term recovery. In fact, treating only one condition while ignoring the other can be counterproductive and may lead to relapse in the untreated disorder or even both disorders.

Treatment programs that integrate ED & SUD treatment can be hard to come by. However, it is important to understand the effects of ED & SUD to help maintain client’s recovery. Likewise, it’s beneficial for SUD counselors to understand eating disorders so individuals can be properly screened. The presence of an eating disorder or substance use disorder can increase the risk of developing the other, which helps explain why these conditions often occur together. When they do, treatment is more challenging. However, addressing both disorders together is crucial for long-term recovery. In fact, treating only one condition while ignoring the other can be counterproductive and may lead to relapse in the untreated disorder or even both disorders.

Given these complexities, individuals with co-occurring substance use disorders and eating disorders require specialized treatment programs that can address both conditions simultaneously. Keep in mind that early intervention and a comprehensive assessment of the individual’s unique needs are essential for successful treatment and recovery. 

Here are some things to look for in a treatment program:

Specialization

Integrated treatment programs that provide specialized care for individuals with co-occurring EDs and SUDs are available to help address the complex needs of those affected by both conditions. Look for treatment programs that offer treatment for co-occurring disorders or conditions, also known as dual diagnosis or dual disorders. These programs have experience and expertise in treating individuals with both substance use and eating disorders. 

Whole-Person Approach

Because EDs and SUDs can impact many areas of a person’s life, treatment programs that facilitate healing on multiple levels can be extremely effective. Consider programs that take a holistic, whole-person approach to treatment, addressing clients’ physical, emotional, nutritional, relational, and overall well-being. 

Medical Supervision

Given the potential health risks associated with both substance use and eating disorders, it’s important that the program has medical professionals who can monitor and manage the physical health of the individuals throughout treatment.

Comprehensive Assessments for Individualized Care

Recovery requires an individualized approach  to treatment. Treatment plans for people with eating disorders and co-occurring SUDs should be tailored to the individual’s needs, taking into account the specific combination of disorders they are facing. One-size-fits-all approaches are often less effective in dual-diagnosis cases.

To create a treatment roadmap that meets each unique individual where they are on their recovery journeys, treatment programs should conduct thorough assessments to:

  • Understand the severity of the substance use disorder.
  • Accurately assess and diagnose the eating disorder.
  • Identify any other co-occurring mental health conditions and medical concerns.
  • Recommend  the most appropriate level and method of care for each individual.

A Continuum of Care

Recovery is an ongoing process, therefore treatment programs should offer a continuum of care to help individuals transition back to their daily lives while maintaining their progress. Successful recovery requires ongoing support. Seek programs that offer post-treatment support and relapse prevention strategies.

Involving family members in the treatment process can also be beneficial, so look for programs that offer educational resources and other support for family members and supportive others. 

Eating Disorders and Alcoholism

Eating disorders and alcoholism are two distinct but often interconnected conditions that can co-occur and mutually exacerbate one other. The relationship between these two disorders is complex. Alcoholism can be a risk factor for eating disorders, and eating disorders can be a risk factor for alcoholism. The relationship between these two conditions is bidirectional.

Eating disorders and alcoholism share several similarities. For example, they can both serve as coping mechanisms for individuals dealing with stress, emotional distress, trauma, or other psychological issues. Some people turn to food restriction, overeating, or purging as a way to manage their emotions, while others may use alcohol to numb or avoid their feelings.

Eating disorders and alcoholism share several risk factors, including genetics, family history, a history of trauma, low self-esteem, and co-occurring mental health conditions such as depression and anxiety, and both disorders can affect the brain’s reward pathways and neurotransmitter systems

Individuals struggling with eating disorders and alcoholism may face compounded health risks and engage in high-risk behaviors. These conditions can also lead to impaired judgment and decision-making.

What is “Drunkorexia?”

Drunkorexia” is a colloquial term used to describe a pattern of behavior where individuals engage in disordered eating, restrictive eating, or overexercising to compensate for the calories they anticipate consuming through alcohol consumption, particularly in the context of heavy drinking or binge drinking. While not clinically recognized medical or psychiatric term or formal diagnosis. Rather, it highlights problematic and potentially harmful behaviors associated with alcohol use and disordered eating.

Drunkorexia can involve:

  • Calorie Restriction: Individuals may skip meals or significantly reduce their food intake before a night of heavy drinking to “save” calories for alcohol.
  • Compensatory Measures Some people may engage in intense exercise to burn calories in anticipation of drinking alcohol (excessive exercise): In some cases, individuals may engage in purging behaviors such as vomiting or using laxatives after drinking to eliminate the calories consumed from alcohol.

Eating Disorders and Cannabis Dependence

Cannabis dependence, often referred to as cannabis use disorder (CUD), is a condition in which an individual experiences significant problems related to their use of cannabis. While cannabis is generally considered less physically addictive than substances like opioids or alcohol, it can lead to dependence and have a range of physical and psychological effects, including impacts on eating patterns and behaviors. The co-occurrence of EDs and CUD can also complicate treatment and recovery.

The relationship between cannabis use and eating disorders can be complex and varies from person to person. Some individuals with eating disorders may use cannabis as a form of self-medication to cope with stress, anxiety, or body image issues. Unfortunately, for some individuals in recovery from eating disorders, the appetite-stimulating effects of cannabis can be problematic, as it may lead to a recurrence of disordered eating behaviors. 

Cannabis use can also affect judgment and impulse control, potentially contributing to binge eating or purging behaviors in individuals with eating disorders.

Sources:

Merlo, L. J., Stone, A. M., & Gold, M. S. (2009). Co-occurring addiction and eating disorders. In R. K. Ries, D. A. Fiellin, S. C. Miller, & R. Saitz (Eds.), Principles of addiction medicine (4th ed.). Philadelphia: Lippincott Williams & Wilkins.

Gadalla, T., & Piran, N. (2007). Co-occurrence of eating disorders and alcohol use disorders in women: A meta analysis. Archives of Women’s Mental Health, 10, 133–140

Gilchrist, G., Gruer, L., & Atkinson, J. (2007). Predictors of neurotic symptom severity among female drug users in Glasgow, Scotland. Drugs: Education, Prevention, and Policy, 14(4), 347–365. 

Harrop, E. N., & Marlatt, G. A. (2010). The comorbidity of substance use disorders and eating disorders in women: Prevalence, etiology, and treatment. Addictive Behaviors, 35, 392–398. 

Klump, K. L., Bulik, C. M., Kaye, W. H., Treasure, J., & Tyson, E. (2009). Academy for Eating Disorders position paper: Eating disorders are serious mental illnesses. International Journal of Eating Disorders, 42(2), 97–103.

Hudson, J. I., Hiripi, E., Harrison, G. P., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3), 348–358. 

SCOFF Sources:

Morgan, J. F., Reid, F., & Lacey, J. H. (1999). The SCOFF questionnaire: Assessment of a new screening tool for eating disorders. British Medical Journal, 319, 1467–1468. Used with permission from the primary author, John F. Morgan, M.D., M.R.C.Psych. 

Parker, S. C., Lyons, J., & Bonner, J. (2005). Eating disorders in graduate students: Exploring the SCOFF questionnaire as a simple screening tool. Journal of American College Health, 54(2), 103–107.

man holding bottle of alcohol with his hand on head and a distressed look.

Eating disorders and substance use disorders are mental illnesses – not moral failings. With early detection, treatment intervention, and ongoing support, recovery is possible.