Insatiable Hunger – Eating + Substance Use Disorders

shared risk factors presenters at CMHAM conference

Lori Kehoe, MA, Sanford Founder Rae Green, JD, LPC, CAADC, and Dr. Anna Flores presented at the 24th Annual CMHAM Substance Use & Co-Occurring Disorders Conference.

According to the National Eating Disorder Association (NEDA), up to 50% of those with eating disorders also use drugs or alcohol. This is a rate five times higher than the general public. For those with an alcohol or drug dependency, up to 35% also have an eating disorder, a rate 11 times greater than the general population. Eating disorders impact at least 9% of the population worldwide, and the prevalence of substance use disorders (SUD) is 2.2%.


In a presentation to the Community Mental Health Association of Michigan, Sanford Behavioral Health team members addressed the shared risk factors and diagnostic similarities between eating and substance use disorders. Rae Green, JD, LPC, CAADC, Dr. Anna Flores, and Lori Kehoe, MA, busted myths and stigma and provided statistics of co-occurrence associated with these disorders at the 24th Annual CMHA Michigan Substance Use & Co-Occurring Disorders Conference.


The Mental Health and Trauma Link

Approximately 1 in 5 adults in the United States (18.5%) experience mental illness yearly. 61% have experienced at least one traumatic event in their lifetime, and almost 9% have experienced multiple traumas. 80% of Vietnam Veterans seeking PTSD treatment also have an alcohol use disorder. What does this mean? It means that trauma and associated mental health and mood disorders play a role in developing SUDs and eating disorders. Psychological factors may include anxiety, depression, low self-esteem, or impulsive behavior.


Life changes that affect mental health can also be factors in developing eating and substance use disorders. Changes such as moving, starting a new job, the death of a loved one, or even a new relationship can trigger behaviors that lead to mental disorders.


Shared risk factors iceberg diagram - what you see and do not see

The underlying issues in the iceberg are all based on pain. That is why we must treat the whole person.


Shared Risk Factors of Eating and Substance Use Disorders

Both eating disorders and substance use disorders (SUD) are serious, life-threatening illnesses. Further, eating disorders are one of the deadliest mental illnesses, second only to opioid overdose deaths. Eating disorders cause 10,200 U.S. deaths each year, 140,000 people in the U.S. die from alcohol-related deaths, and 80,000 people die of opioid overdoses.


Shared Risk Factors and Characteristics Include:

Risk Factors

  • Occurrence in times of transition or stress​
  • Common family history ​
  • Low self-esteem, depression, anxiety, or impulsivity ​
  • History of sexual or physical abuse ​
  • Unhealthy peer norms and social pressures ​
  • Vulnerability to messages from advertising and


  • Obsessive preoccupation, craving, compulsive, secretiveness, and rituals ​
  • Experience social isolation ​
  • Linked to other psychiatric disorders or suicide ​
  • Difficult to treat, life-threatening​
  • Require intensive therapy ​
  • High rates of relapse

Eating and substance use disorders have a similar relationship with the “reward center” of the brain.


The “Reward Center” of the Brain

Another reason these co-occurring conditions exist is because eating disorders and substance use disorders have a similar relationship with the “reward center” of the brain. In eating disorders, the brain reward center is stimulated (dopamine) by food-related acts such as bingeing or restricting. In the case of bingeing, the reward center becomes reduced, resulting in an individual consuming more and more food to feel satisfied.


The brain reward center is similar for those with substance use disorders; the brain becomes stimulated by a substance like alcohol or other drugs. However, eventually, the substance loses its pleasurable effect, causing increased use.


Disorder Similarities and Differences

Approach/Avoidance Relationship

  • SUD: In search of – and moving towards the substance
  • ED: Avoidance of affect and moving towards behaviors


  • SUD: Restriction or abstinence 
  • ED: Cannot abstain since food is needed to sustain life. Instead, practice alternatives from the symptoms (starvation, rigid dieting, binge eating, purging, etc.)

Claiming the Disease

  • SUD: AA/NA- “Hello, my name is ___, and I am an alcoholic.”
  • ED: Shifting away from claiming the disease. Embracing that the eating disorder is not their identity is integral to recovery. Instead of claiming an authentic self. Shift from “I am an anorectic.” to “I have my own identity, and I suffer from anorexia.”


Integrative Treatment for Eating and Substance Use Disorders

At Sanford Behavioral Health, our goal is to improve the overall health of the residents in our state and beyond by embracing recovery-oriented systems of care. Our integrative programs offer patients the following:

  • Education
  • Prevention Tools
  • Assessment and Diagnosis
  • Full Continuum of Treatment
  • Management of the Condition
  • Long-Term Recovery Support

We take a comprehensive approach to treatment, focusing on the individual and providing safe, clinical care tailored to each person. In addition, we use outdoor excursions, creative expression, and other activity-based modalities to help restore physical and psychological well-being through our Real-Life Recovery programs.


Sanford Behavioral Health is licensed and accredited as an addiction, eating disorder, and co-occurring mental health treatment facility, serving all of Michigan and beyond. Each of Sanford’s facilities in Greater Grand Rapids is carefully and diligently crafted to create a welcoming and comforting environment. Sanford is led by a psychiatrist-led team of medical, clinical, and support personnel providing medication-assisted, evidenced-based treatment to residential, outpatient, and telehealth patients. For more information, visit