There is a complex relationship between eating disorders and substance abuse that is not fully understood. For example, a substance use disorder can occur before, during, or after the onset of an eating disorder. In addition, it is unknown whether one condition replaces or obscures another, if one drives the other, or if they co-occur.
Eating disorders that co-occur with substance abuse can lead to a situation that makes both conditions more severe and potentially life-threatening because of the compounding of physical and mental health complications. Up to 35% of people with substance use disorders report having an eating disorder, compared with 1% to 3% in the general population.
Developing an addiction to alcohol or drugs may not seem obvious for individuals who suffer from eating disorders, but there could be a strong link between the two. The problem is that eating disorders often resemble addictions; Generally, eating disorders involve problematic dietary habits and unhealthy relationships with food, eating, and body image, while substance use disorders involve problematic alcohol or drug use habits that persist despite the negative consequences.
Why The Two May Be Connected
Despite the limited research on the link between eating disorders and substance abuse, people with eating disorders may see their drug and alcohol habits as helpful tools. Although drugs and alcohol can make living with conditions easier, they can also be insidious, causing profound changes in brain chemistry without people even being aware of them. In other words, even if a person believes that they are totally in control of their drug or alcohol use, a substance abuse problem could develop very quickly.
A person with an eating disorder may often feel out of sorts, upset, and defeated, which could lead them to turn to drugs. When life seems confusing and upsetting, a hit of drugs might offer a little bit of relief, which might be a mood boost these people need and cannot obtain in any other way.
There are diagnostic similarities between eating disorders and drug addiction, which involve compulsive behaviors that can be difficult to overcome. A person who suffers from an eating disorder and an addiction often uses one to cope with the other. People struggling with an addiction may use highly restrictive eating habits to feel more in control of their lives or vice versa. As a result, each mental illness feeds off the other, perpetuating the cycle.
Using stimulants like Adderall, meth, and cocaine, which suppress appetite, can worsen an eating disorder. Other substances, such as alcohol and other depressants, help people with eating disorders by relieving anxiety and stress surrounding food. People with eating disorders are most likely to abuse alcohol, amphetamines, heroin, and cocaine. If an individual with an eating disorder misuses drugs or alcohol to cope with symptoms or as a response to weight loss or gain, it’s understandable why they might become addicted.
It is also possible that alcohol can be helpful for people who suffer from anxiety-related eating disorders – those who feel anxious at the thought of eating might find that a drink relaxes them enough to eat. For them, alcohol is a useful tool that allows them to manage aspects of their disorders that they cannot cope with on their own.
Theories
Many theories exist regarding the link between eating disorders (EDs) and substance use disorders (SUDs), but there are similarities between them, including the following:
- Genetics: Genetic predisposition is responsible for 60 percent of addictions and eating disorders. In addition, eating disorders and drug addiction share several neurotransmitters.
- Environmental: There is often a tendency in popular culture to glorify extreme thinness and excessive alcohol consumption. As a result of peer pressure and the desire to fit in, cultural messages can contribute to addiction and eating disorders. However, it is also important to note that these can be powerful environmental triggers, especially in teenagers and young adults.
- Emotional And Physical Trauma: If left untreated, emotional and physical trauma can significantly affect present substance abuse or eating disorders. Addiction and eating disorders are usually symptoms of a much deeper problem.
- Mental Health: If a person suffers from depression, anxiety, or PTSD, they may develop an addiction or eating disorder to gain some control over their lives.
All types of people are susceptible to eating disorders and addictions, and these factors can increase the risk.
Substance Abuse-Related Eating Disorders
Each eating disorder has unique causes and symptoms, often requiring different treatment approaches; anorexia nervosa, bulimia, and binge-eating disorders are the most common eating disorders usually associated with substance abuse.
In people suffering from anorexia nervosa, there is a severe disconnect between what they see in the mirror and how they imagine themselves. As a result, despite being extremely underweight, they often perceive themselves as overweight, while most anorexics strive to lose even more weight.
- Those suffering from anorexia may also find drugs appealing because they offer unique benefits.
- Certain drugs may suppress appetite, which may make living with anorexia a little bit easier. Often, these people are desperate for food and will do anything to avoid giving in. To someone with anorexia, drugs that make hunger signals disappear may seem like useful tools.
- Alcohol abuse is unlikely among anorexics since they are trying to reduce calories as much as possible. Anorexia and substance abuse are most often associated with stimulants, which make people feel energetic and suppress their appetites.
Bulimia nervosa and substance use disorders share behavioral traits, such as increased impulsivity, that may predispose individuals to develop both disorders. In addition, both disorders are associated with several risk factors, including:
- Shared brain chemistry (effect on dopamine and serotonin systems)
- Common family history (the presence of either substance abuse or eating disorders in the family increases the risk of developing either condition.)
- Low self-esteem, depression, or anxiety
- Peer pressure and unhealthy social norms
- A vulnerability to advertising and media messages
- Adverse childhood experiences
Bulimia nervosa is characterized by frequent binges, in which a person consumes large amounts of food at one time. Following binge eating, people purge by vomiting or using excessive laxatives to “make up” for their compulsivity.
Abusers of alcohol often consume a large quantity of the substance at once, becoming profoundly drunk long before they intend to. As bulimics are well-versed in self-induced vomiting techniques, this might make things a little easier; after binging on alcohol, they may vomit the substance back up.
The symptoms of binge-eating disorder are similar to those of bulimia. Despite this, people with this disorder are usually overweight since there is no purging element. The U.S. population has almost 3% of people with binge-eating disorders at some point in their lives.
Body dysmorphic disorder causes people to focus on perceived flaws in their physical appearance. It is common for the flaws to be minor and not noticeable to others, yet they can cause the sufferer immense shame and anxiety. To cope with anxiety about their appearance, people with this disorder often use drugs and alcohol.
Avoidant Restrictive Food Intake Disorder
ARFID (avoidant restrictive food intake disorder) is a new diagnosis in the DSM-5. Similar to anorexia, ARFID involves restricting the amount and type of food consumed. The motivations, however, are different. ARFID patients control their food intake because of concerns about the food, such as unwanted textures. People with ARFID are often anxious, which may lead to them self-medicating with alcohol or drugs.
Treatment Options
People struggling with addiction and co-occurring disorders like eating disorders often focus solely on substance abuse and see other disorders as secondary. Substance abuse often negatively impacts a person’s life, resulting in issues like lost jobs or broken relationships. People often overlook eating disorders when seeking addiction treatment, but the best approach is finding a program specializing in treating people with dual diagnoses.
An individual with an eating disorder who also has a substance use disorder usually has more severe eating disorder and SUD symptoms, a higher relapse rate, more medical complications, and is impaired much more than an individual with an eating disorder alone. SUDs and eating disorders can both cause death; research suggests their combined mortality rate is even higher than their individual rates. The core issue cannot be fully addressed by treating addiction alone when there are concurrent or underlying conditions like trauma or eating disorders. To overcome addiction, all other underlying conditions must also be addressed.
The best chance of starting a successful recovery for people receiving treatment for multiple conditions is to consider residential treatment.
In addition to staying sober, making good food choices is highly challenging when eating disorders are involved. Participants in residential treatment benefit from 24/7 care and nutritional support, enabling them to stay on track.
If you or someone you know is struggling with an eating disorder and a co-occurring addiction, it’s never too late to get help. The path may feel impossible and intimidating, but it’s the only way to achieve what you deserve most: a life fulfilled. Call for a free consultation today at 855-808-4213 or contact us online for more about our team, mission, and treatment.
SOURCES:
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7544549/
- https://pubmed.ncbi.nlm.nih.gov/20926059/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2807480/
- https://store.samhsa.gov/sites/default/files/d7/priv/sma10-4617.pdf
- https://www.ut.edu/uploadedFiles/Academics/Acta_Spartae/AS_0501p1Colaianni.pdf
- https://www.ojp.gov/ncjrs/virtual-library/abstracts/food-thought-substance-abuse-and-eating-disorders
- https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2021.21101069
