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Alcohol Use and Eating Disorders

While eating disorders are the most common mental health condition, they often occur alongside other common mental health issues. Oftentimes, individuals with an eating disorder diagnosis will have already been experiencing co-occurring conditions like depression, panic disorders, obsessive-compulsive disorder and/or substance abuse issues. 

Research shows that up to half of all people diagnosed with an eating disorder have also abused alcohol or illicit drugs—a rate that is 5 times higher than that of the general population. Sometimes referred to as dual disorders, co-occurring disorders should be taken seriously, with early intervention greatly increasing the chances that individuals will be able to enjoy successful, long-term recovery. Keep reading to learn more about the risks of substance abuse and eating disorders.

How Do Common Eating Disorders and Substance Abuse Issues Develop?

Common eating disorders like anorexia nervosa and bulimia nervosa are the result of a very complex combination of factors. There is no one reason that they develop. But they can affect people of all ages, genders, sexual orientations, races, and social backgrounds. Leading research suggests that eating disorders develop due to any combination of genetic, psychological, biochemical, environmental and cultural factors. If an individual is experiencing one or more of these factors, they are at risk of developing an eating disorder and possibly other co-occurring disorders are well.

While there are many different misconceptions as to what causes eating disorders, experts urge people to understand that they are rarely about a desire to look a certain way or avoid specific food types. Instead, those with an eating disorder typically use disordered behaviors like yo-yo dieting, bingeing and purging, calorie restriction, and excessive exercise to cope with overwhelming feelings and stressful situations. While these disordered behaviors do provide affected individuals with short term feelings of relief from stress and anxiety, the long-term mental and physical health consequences are very serious.

Similarly, alcohol and substance abuse can be caused by a wide variety of factors like genetics, environmental issues, psychological issues, cultural factors and more. A family history of drug or alcohol abuse can increase the chances that an individual will also pick up these negative coping habits. This biological factor may also help to explain why abusing drugs or alcohol may lead others to form bonds with substance-abusing peers, further perpetuating the problem. Other commonalities between these co-occurring mental health disorders include social isolation, compulsive behaviors, and risk for suicide.

Why Do People Often Develop One Condition Alongside the Other?

Because the brain is such an intricate and delicate organ, it doesn’t often surprise people when alcohol and drug abuse lead to the symptoms of other mental health conditions. Drugs and alcohol change the way that the brain works, and even though people who abuse these substances may experience a temporary “buzz” or “high,” long-term use can affect the way the cells in the brain communicate.

But why do some people with an eating disorder diagnosis also abuse drugs and alcohol? One theory is that drug and alcohol use is a form of self-medication, used to mask many of the negative feelings associated with eating disorder behaviors. If someone is dealing with feelings of shame, guilt, or disgust following a purging episode, they may turn to alcohol or illicit drugs to provide another form of temporary relief. Essentially, the use of alcohol and many common illicit drugs can act as an emotional regulator for those who have developed an eating disorder.

What Are the Risks of a Dual Diagnosis?

While people of all ages and genders are at risk of developing co-occurring disorders, studies suggest that men are more likely to have a dual diagnosis. Additionally, other groups may have a greater risk of developing an eating disorder and substance abuse problems alongside each other. These include those who have other general medical illnesses, military veterans, and those with a lower socioeconomic status.

Because there are many different combinations of co-occurring conditions, the symptoms that an individual may experience with a dual diagnosis also vary quite dramatically. Parents and family members who are concerned about the mental health status of a loved one should look out for any combination of the following symptoms:

  • Sudden behavioral changes
  • Withdrawal from friends, family, and activities that once brought joy
  • Hiding and/hoarding food
  • Excessive exercise or sticking to and rigid exercise routine despite illness, weather and other potentially harmful conditions
  • Substance use under dangerous conditions
  • Development of food rituals that may include excessive chewing, avoiding certain food groups, calorie counting, and yo-yo dieting
  • Engaging in risky behaviors when under the influence of drugs or alcohol
  • Increased use of alcohol or drugs in a relatively short period
  • Going to great lengths to maintain the new habit
  • Developing a tolerance to alcohol or drugs
  • Limiting or restricting calories to use alcohol (also known as drunkorexia)
  • Expressing feelings of dependency on drugs or alcohol

Without proper treatment, people with a dual diagnosis are at risk for developing a wide range of long-term health issues. These include electrolyte imbalances, heart attack, malnutrition, drug and alcohol dependency, certain cancers, and even death.

Treatment for Alcohol/Drug Use and Eating Disorders

It is common for many people who have been referred to an eating disorder treatment program to see an increase in alcohol or drug use once they begin to address the disordered behaviors they have concerning food, eating, and exercise or other restrictive behaviors. If these issues are unknown to medical and psychiatric professionals during treatment, this increase in substance abuse can disrupt the eating disorder treatment process. In this case, the person may be referred to an addiction treatment program. This can slow down the entire recovery process, even if the person is committed to changing their disordered behaviors and replacing them with positive coping mechanisms.

To avoid a possibly vicious cycle of going back and forth between different treatment programs, it is helpful to search for a treatment center that uses an integrated approach to recovery and can address all underlying issues associated with a dual diagnosis. 

What is Integrated Intervention?

With an integrated treatment plan, individuals can receive care for a specific eating disorder and substance abuse. However, because there are many different factors to consider with co-occurring conditions, there is no “one size fits all” treatment option available for those with a dual diagnosis. Some of the most common treatments included in integrated intervention include:


This is often the greatest hurdle to overcome for those with an eating disorder and substance abuse issues. To help give individuals the best possible chance at long-term recovery, they must complete an inpatient detoxification program where they will be monitored around the clock by trained medical staff. The detoxification process can last for up to 7 days and is often much more successful if completed within a treatment center than on an outpatient basis. With inpatient treatment, individuals can feel safe in a comfortable and controlled environment with access to medical professionals and zero risk of exposure to people and places that are associated with their substance abuse behaviors.

Residential Eating Disorder Treatment

When a person is experiencing a serious mental health condition like anorexia nervosa or bulimia nervosa alongside dependent patterns with alcohol or drugs, they are likely to benefit most from a residential eating disorder recovery program. In a residential treatment program, like those offered at Monte Nido, clients have access to the highest level of medical and psychiatric care outside of a hospital setting, With access to 24/7 care, they can expect to participate in individual and group therapy, receive medical support, medication management, and a combination of other necessary health services like yoga, meditation, and nutritional care.


Depending on the needs of each client, some treatment programs may use medication to help address different aspects of co-occurring disorders. Often, medications can play a vital role in the recovery process for those with a dual diagnosis. Certain medications have been proven to help recovery from substance abuse. In particular, they may help to ease withdrawal symptoms and aid in long-term recovery. While used most often in the detoxification process, these medications may be prescribed during eating disorder recovery and on a more long-term basis as individuals transition to outpatient treatment.


Psychotherapy is another treatment option that has proven to be very effective in helping those with a dual diagnosis. Helping clients to understand how their illness and developed beliefs influence their thoughts and behaviors has proven to help form new, positive coping skills. This type of treatment has also been successful in treating both eating disorder clients and those with substance abuse issues. One of the most common psychotherapy treatments, cognitive-behavioral therapy or CBT has shown to be particularly helpful in helping those with a dual diagnosis learn how to cope with and change ineffective thinking patterns that are dangerous for their mental and physical health.

Support Groups

A dual diagnosis can be challenging to overcome without a solid support group at home or in treatment. Because the symptoms related to substance abuse and eating disorders can be so isolating, it is often vital that clients seek out support from friends, family, and other peers during recovery. Group therapy and outside support groups make it possible for individuals to share their experiences, whether those be daily frustrations, relapse worries, or success stories. Having a strong support group around during the recovery process also makes it possible for individuals to find access to the best community resources and even referrals for continued care after completing residential treatment.

Learn More About Treatment for Co-Occurring Disorders at Monte Nido

While receiving a dual diagnosis from one’s doctor can be a frightening experience, it’s important to remember that there are a variety of resources available out there for those who have an eating disorder and substance abuse issues. Monte Nido’s residential and day treatment programs include an integrative approach to co-occurring disorders. Some of the services available to clients with a dual diagnosis include cognitive behavioral therapy, dialectical behavioral therapy, cognitive processing therapy, nutritional programming, support group meetings, and psychiatric sessions. When clients are ready to leave residential treatment, we also offer day treatment programs to help make sure that each client has the best chance of enjoying a long-term recovery. 

Because early intervention is such an important aspect of the recovery process, it’s important to act quickly when family or friends notice common eating disorder or substance abuse symptoms. If you or a loved one is experiencing the symptoms of co-occurring disorders like anorexia nervosa and drug or alcohol abuse, now is the time to get the professional help you need. Please contact Monte Nido today to schedule an appointment with our experienced eating disorder treatment team or to learn more about the treatment programs we have available. 


Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.