Eating & Substance Use Disorders – Why They Coexist

eating and substance use disorders

Recovery from an eating disorder means learning to manage food day in and day out.


Did you know that 50% of individuals who struggle with eating disorders also misuse alcohol or other drugs? This is a rate 5 times higher than the general population.  Similarly, 35% of individuals who misused or were dependent on alcohol or drugs have also had eating disorders – a rate 11 times higher than the general population. (National Eating Disorders Association)


Coexisting Eating and Substance Use Disorders

Sometimes eating disorders and substance use disorders (ED, SUD) appear at the same time, or coexist. For others, the substance use disorder may appear during or after recovery from an eating disorder.  Or, once sober, the eating disorder issues may reappear. This phenomenon is sometimes called symptom substitution – that is, the underlying issues which led to the eating disorder have not yet resolved, so the individual turns to another means to numb feelings or establish a sense of control.


The substances most commonly misused by those with eating disorders are caffeine, tobacco, alcohol, laxatives/diuretics, appetite suppressants (amphetamines), heroin, and cocaine.  Coexisting SUD and ED are most common in the population with bulimia or binge eating disorder.


What causes this phenomenon?

What causes this phenomenon? There are many shared risk factors for the development of substance use and eating disorders. These factors are brain chemistry, family history, low self-esteem, anxiety, depression, and social pressures.  Brain chemistry predisposes someone to an addictive process with both the serotonin and dopamine centers at play.  Studies have shown individuals with SUD or ED will have stronger cravings for their substance of choice; and  their brains will flood them with “feel good” chemicals at a higher level response.


We know that both eating disorders and substance use disorders run in families, which strongly suggests a heritability factor.  Family genes, rather than behavior patterns, are likely involved. Both anxiety and depression may be present in an individual with substance use or eating issues.


This is the classic “chicken and egg” question.  Likely the mood disorder was present first, but persistent abuse of substances alters mood AND neurobiology, causing the sufferer to seek more and more of their drug of choice for the desired response. This keeps the individual locked in a downward spiral. 


eating and substance use disorders

if you see something which concerns you, say something!


One significant difference…

Although substance use and eating disorders share many common characteristics, there is one significant difference.  Recovery from a substance use disorder requires abstinence from drugs and alcohol. New patterns of social involvement are necessary to avoid peers or family members who use.


With eating disorders, “abstinence” from food is not possible, nor is avoiding places where food is served and peers or family members who eat. Recovery from an eating disorder means learning to manage food day in and day out, neither restricting or bingeing; and learning to deal with the feelings of guilt which may come from feeding one’s body in a normal, healthy way.


The Treatment of Coexisting ED and SUD

Both disorders are complex and multiply determined, and those individuals who struggle with both are best seen by a professional who is skilled in both areas. Many individuals with eating disorders recover in outpatient therapy; the same is true for individuals with substance use disorders. Sometimes it is possible in outpatient treatment to deal with the two disorders sequentially. In that case, it is best to achieve abstinence from alcohol and drugs first. However, dealing with them simultaneously may well require a residential stay.


Unfortunately, not many addiction treatment facilities have staff trained in eating disorders, or appropriate support and supervision for meals and snacks. Most facilities which treat eating disorders are prepared to deal with withdrawal from diuretics or laxatives, but not equipped to deal with an individual needing medical detoxification. It is important for individuals and their families to seek a treatment environment where both can be managed. 


If you are concerned about someone you love…

Denial of the problem, or of the seriousness of the problem, are common in individuals with both ED and SUD. Lying to cover behaviors is also common. If you are concerned about someone you love, expect defensiveness and anger when you first approach them. It is the symptoms of the illness talking.


It’s important to remain calm and to be specific about the behaviors you have witnessed. For example, say, “Those jeans fit you well when you left for school; now they are much too big. That tells me you have lost weight.” It is also important to insist that your loved one seek professional help. 


This may well be a process which requires several conversations. But don’t look the other way. If you see something which concerns you, say something. The earlier an individual gets to treatment, the better the chances for his/her long-term recovery.  And recovery IS possible.  Don’t lose hope!



gail hall bio pic

Gail Hall is a licensed social worker, certified Eating Disorder Specialist, and Supervisor with the International Association of Eating Disorder Professionals. She has been treating eating disorders for over 30 years. Gail founded Comprehensive Treatment for Eating Disorders which is now Sanford CTED. SCTED provides state-of-the-art treatment in a personalized, intimate setting in Greater Grand Rapids, Michigan, and beyond. In addition, SCTED offers residential, PHP, IOP, Supportive Housing, outpatient, and family support to eating disorder patients.