Last Updated: February 16, 2023

Research has shown a strong relationship between eating disorders and addiction. Addressing them as co-occurring disorders can result in more effective treatment.

For many years, treating providers have addressed substance abuse and eating disorders separately. However, research has shown a strong relationship between the two. Studies support the need for integrating treatment approaches to address eating disorders and substance abuse as co-occurring disorders.

What Is an Eating Disorder?

An eating disorder is a serious mental health condition that can lead to severe health complications. People with eating disorders experience maladaptive thoughts about eating, food, weight, appearance, nutrition and health. These thoughts may lead to dangerous behaviors with severe and life-threatening consequences. 

Eating disorders are not a person’s choice about how they live, eat or exercise. An eating disorder is a serious medical illness that can lead to many severe and dangerous problems, such as:

• Nutritional deficiencies
• Systemic health issues
• Death

Types of Eating Disorders

Three main types of eating disorders exist, including binge eating disorder, bulimia nervosa and anorexia nervosa.

Binge eating disorders are the most common eating disorders in the U.S. Someone with a binge eating disorder can feel a lack of control regarding food. They will consume excessive quantities of food at once (a binge). Afterwards, many people feel ashamed, guilty or upset about the binge. Binge eating can lead to obesity due to excessive food consumption.

With bulimia nervosa, a person will repeatedly engage in binge eating. After the binge, they do something to counteract the food consumed during the binge. They might induce vomiting, use laxatives, fast, restrict food intake or exercise heavily. A person with bulimia nervosa may be overweight, underweight or an appropriate weight.

When someone has anorexia nervosa, they try to avoid eating, severely limit their food intake or only consume minimal amounts of specific food choices. They typically ruminate on their body and weigh themselves frequently. They often have a distorted sense of appearance and see themselves as weighing much more than they do. People with anorexia nervosa can die from the medical problems that develop. There is also a high risk of suicide.

Prevalence of Co-occurring Substance Abuse and Eating Disorders

In 2003, the National Center on Addiction and Substance Abuse [CASA] at Columbia University released study results identifying commonalities between eating disorders and substance use disorders.

The study identified the following common risk factors: 

• Higher prevalence during more stressful times
• Similar brain chemistry
• Family history
• Low self-esteem
• Depression
• Anxiety
• Impulsive behaviors
• Abuse history
• Social pressures

The study also identified common characteristics among people who have eating disorders and substance use disorders, including:

• Obsessive thought patterns
• Similar patterns of brain functioning
• Compulsive behaviors
• Socially isolate
• Increased risk for suicide
• Increased risk of dying
• Need for intensive treatment
• High relapse rates
• Chronic nature of the disorders

Statistics show that these common characteristics and risk factors lead to a high co-occurrence of eating disorders and substance use disorders:

• Up to half of the people with eating disorders will use alcohol or drugs.
• The rate of substance abuse among people with an eating disorder is five times higher than the general population.
• Up to 35% of people with substance use disorders (SUD) also have an eating disorder.
• The eating disorder rate among people with SUD is 11 times higher than the general population.

The Role of Substance Abuse in Eating Disorders

There is a strong relationship between substance abuse and eating disorders. Eating disorders and substance use disorders share common risk factors, and one condition may lead to the development of the other. This relationship can differ depending on whether the eating disorder or substance abuse developed first. 

Someone with an eating disorder might be more likely to develop a substance use disorder because: 

• Some drugs help with losing weight or keeping more control over weight.
• Using drugs or alcohol may help soothe or self-medicate mental health symptoms.

When someone engages in substance abuse or has a substance use disorder, they may develop an eating disorder due to the following:

• Appetite suppression from drugs or alcohol
• Overeating during withdrawal

Researchers have looked at other reasons to explain this high co-occurrence rate. Some theories have explanations, including:

• Eating disorders are an addiction disorder
• Genetics
• Similar brain chemistry
• Cultural patterns
• Adverse life experiences
• Trauma

Anorexia and Substance Abuse

Two subtypes of anorexia nervosa exist. When someone has the restrictive subtype, they place extreme, and often dangerous, restrictions on their food intake. With the binge-purge subtype, a person will restrict their food intake but also have occasions of binging. After the binge, they take measures to purge the food, possibly by inducing vomiting or using laxatives to compensate for overeating. 

People with anorexia have the lowest rates of substance use disorders (SUD). Approximately 12%–18% of adults with anorexia have a SUD. Research has shown that people with the binge-purge subtype are more likely to engage in substance misuse than those with the restrictive type. They commonly use alcohol, stimulants, cocaine and sedatives. Laxatives, diuretics, and other drugs to induce vomiting are also widely abused.

Bulimia and Substance Abuse

According to research, people with bulimia nervosa use alcohol and other substances at higher rates than those with anorexia or binge-eating disorders. Bulimia and alcohol use disorder have the highest rate of co-occurrence among eating disorders and substance use disorders. 

Research shows that 30%–70% of people with bulimia also have a substance use disorder, suggesting that people with the binging and purging patterns occurring with bulimia have a higher risk of developing a SUD. When someone with bulimia restricts their alcohol use because they fear the calories, they may binge on alcohol. 

Binge Eating and Substance Abuse

Approximately 25% of individuals with a binge eating disorder also have a substance use disorder. As with bulimia, the binging and purging pattern has a high relationship with the development of a SUD. 

Both conditions present similar addictive characteristics in the diagnostic criteria for binge eating and SUD. With a binge eating disorder, someone binges more food than planned. They continue to binge even though they have experienced problems from binging. They also do not participate in enjoyable activities due to binging. 

Treating Addiction and Eating Disorders Together

Due to this strong relationship between substance use disorders and eating disorders, combining prevention work, assessment processes and treatment can help those at risk more effectively. When treatment only addresses substance abuse or an eating disorder, people can spend more money and time on treatment and not appropriately address their co-occurring conditions. Treating providers may not treat one of the disorders when only focusing on the other. 

Addressing both disorders within the same setting will offer a stronger and more comprehensive treatment program. This integrated approach can begin with the intake assessment and continue throughout treatment. Patients in care can receive continued monitoring, goal-setting and interventions for changes in symptoms and behaviors as they move through treatment. Limited research has been done to identify the most effective integrated approach for treating addiction and eating disorders; however, some studies have supported using cognitive behavioral therapy (CBT).

Co-occurring Disorder Treatment in Ohio

The Recovery Village Columbus offers treatment for addiction and co-occurring mental health disorders. Patients can receive treatment across a full continuum of care depending on their needs and assessment. 

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