Substance Abuse and Eating Disorders: A Deadly Combination


In a recent study, people with eating disorders like anorexia nervosa and bulimia nervosa were found to be around 13% more likely than the general population to also have a substance abuse disorder (SAD). Alcohol, in particular, seemed to be the primarily abused substance, but cocaine and methamphetamine were also very common, especially in people with restrictive eating disorders.

Substance abuse disorders are well-known to co-occur with depression and anxiety much more commonly than they occur in the general population, but surprisingly, they seem to have a much higher rate in people with eating disorders. It’s not completely understood why this is so, but there are many reasons why a person suffering from an eating disorder might turn to various drugs or alcohol:

  • Short term coping with stress or trauma.
  • Relaxation from self-imposed stresses and negative feelings.
  • Relief from pain or other physical symptoms of a long-term eating disorder.
  • In severe cases of anorexia nervosa, alcohol abuse may constitute the majority of a person’s caloric intake, a deadly condition sometimes known as “drunkorexia.”

It’s essential that any substance abuse issues can be addressed while a person is getting help from an eating disorder treatment center. Before that, however, the person’s loved ones should be on the lookout for certain signs that there is an issue.

Identifying Signs of SAD

A person who is suffering from substance abuse may differ according to the severity f the addiction and the type of substance being abused. Some common physical signs of substance abuse are:

  • Weight loss
  • Lack of sleep
  • Bloating and poor skin tone — this is particularly evident in alcohol abuse
  • The shakes
  • Lack of concentration
  • Money problems
  • Insomnia / hypersomnia
  • Sweating

Identifying Signs of Eating Disorders

Physical symptoms of most eating disorders can be similar:

  • Extreme weight loss
  • Weight gain (binge eating disorder)
  • Kidney, heart, and endocrine problems
  • Lack of sleep
  • Poor skin quality
  • Impaired immune system
  • Lethargy
  • Complaints of being cold
  • Mottled hands and feet

Behavioral Symptoms of SAD and ED

For both substance abuse and eating disorders, the more common means of identification will be behavioral. Both diseases manifest very similarly:

  • Mood swings
  • Lack of interest in hobbies or social groups
  • Guarded behavior around food and alcohol; a person with alcohol dependency may act aversive to it when around others
  • Preoccupation with physical appearance

In particular, if you have a loved one who is already suffering from an eating disorder, it might be hard to see the symptoms of substance abuse. Sudden changes in mood or wild mood swings can be a sign that the person has begun to turn to alcohol or drugs to cope.

Successful eating disorder recovery begins with the identification of the disorder itself and any confounding variables, including substance abuse but also anxiety and depression, which go hand-in-hand with most disordered eating patterns.

Other Co-Occurring Disorders to Watch For

Anxiety disorders are common triggers that can lead a person to an eating disorder as a means of control. In some cases, however, anxiety can be a complication brought on by worrying and feeling guilt about disordered eating behaviors. Normally, treatment specialists are qualified in treating a variety of mental health illnesses, and the diagnostic assessment should be able to identify both.

In the course of treatment, if anxiety caused the ED, the treatment center will work to figure out the root of the anxiety and address it. That should make treating the eating disorder less complex.

Clinical depression is very common in people with eating disorders — around 50-90%, adjusting for all potential variables — but it’s not often a primary cause. In most cases, depression is a result of negative emotions and feelings of guilt or shame about disordered eating behaviors. Depression is also very treatable through therapy and sometimes medication.

Putting It All Together

Treatment of an underlying eating disorder requires confounding variables to be addressed. It is very common for a person suffering from disordered eating to be clinically depressed or anxious, and about 30% turn to substance misuse for self-medication. If the confounding variables can be identified, they can be treated and then a clear path to eating disorder recovery can be established.


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