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Substance Abuse and Eating Disorders

Many people think that eating disorders and addiction as two very different and distinct issues. People who have experienced these two conditions firsthand know that eating disorders and substance abuse often overlap. In fact, research shows there is a close link between the use of drugs or alcohol and eating disorders. Fortunately, treatment is available for those who have both eating disorders and substance abuse.

Both eating disorders and substance abuse are common in the United States. At least 32 million people in the nation have an eating disorder, according to the National Association of Anorexia Nervosa and Associated Disorders. About 17 million people have alcohol use disorder, according to DrugAbuse.com, and millions more are addicted to various types of drugs.

Eating disorders and addiction often go hand-in-hand. Doctors and mental health professionals refer to the combination as co-occurrence or a dual diagnosis. This means a person can have bulimia nervosa and alcohol addiction, anorexia nervosa and alcohol abuse, anorexia nervosa and drug addiction, or alcoholism and binge eating disorder.

Up to half of all people with eating disorders also abuse drugs or alcohol, according to the National Eating Disorders Association (NEDA). For comparison, the rate of substance abuse is five times higher in people in eating disorders than in the general population.

Conversely, up to 35 percent of people who abused or were dependent on drugs or alcohol also have eating disorders. The rate of eating disorders is 11 times higher in people with substance abuse issues than in the general population.

Similarities between Eating Disorders and Addiction

Researchers are learning more about eating disorders and addiction every day. As a result, scientists now understand that there are many similarities between eating disorders and substance abuse. Many of the mechanisms behind addiction also drive eating disorders, for example, and many of the behaviors in people with eating disorders are present in those with addiction too. Even screening methods for eating disorders are similar to methods used to screen for addiction.

Some of the similar behaviors include:

  • Obsessive preoccupation, cravings, and rituals focused on food and alcohol or drugs
  • An escalation in the intensity or frequency of bulimia nervosa, anorexia nervosa and drugs or alcohol over time
  • Ignoring other interests to focus on the addictive substance or behavior
  • Inability to quit engaging in the destructive behavior, despite repeated attempts to quit
  • Continuing to engage in the behavior, despite knowing about the negative consequences of doing so
  • The expressed concern from loved ones about the individual’s behavior

Shared Causes

Addiction and eating disorders have similar root causes, such as genetics, personality traits, changes in the brain, and environmental influences.

Research suggests that there is a strong genetic component to both eating disorders and substance abuse. The National Institute on Drug Abuse says that up to half of a person’s risk for developing an addiction to drugs or alcohol depends on his or her genetics. Other research suggests that genetics play a strong role in the development of bulimia and anorexia nervosa.

People with addiction and eating disorders may share personality traits, such as impulsivity. Social pressures, emotional trauma, media messages, family dynamics, and environmental triggers also play a role in both.

Both addiction and eating disorders are linked to certain chemical processes occurring in the brain. These changes in the brain reinforce addiction to and dependence on substances and reinforce the behaviors associated with anorexia nervosa and bulimia nervosa, as well as binge eating disorder.

Both eating disorders and substance abuse issues tend to develop during times of stress. These may be coping mechanisms or attempts to “self-medicate” oneself for depression, anxiety or another underlying mental health issue.

Finally, both substance abuse and eating disorders are chronic diseases that tend to be resistant to treatment and present high relapse rates. Both can also require long-term intensive therapy.

Concurrent Therapy

Eating disorders can be difficult to detect, even in people already in treatment for a substance abuse disorder. In fact, up to 35 percent of people in treatment for a substance abuse disorder exhibit eating disorder behaviors, according to the Association for Addiction Professionals. Without special training, the patient’s substance abuse treatment team many not detect the signs of an eating disorder. This means people who have both eating disorders and addiction, such as bulimia nervosa and alcohol use disorder, may not be getting the treatment they need to address both issues adequately.

Concurrent therapy offers treatment for both the eating disorder and substance abuse. Combining therapy for anorexia nervosa and alcohol use allows the individual to resolve both issues, for example, while combining alcohol and bulimia nervosa recovery can improve the recovery for both the eating disorders and addiction.

Treating problems with drugs or alcohol and eating disorders at the same time may improve outcomes by addressing the problems as individual issues and as co-occurring conditions.