The Link Between Eating Disorders and Substance Abuse Explained

Substance use disorder affects users’ physical health, causing many harmful symptoms and side effects. One of the common and noticeable changes accompanying drug and alcohol abuse is weight fluctuations. Unfortunately, these rapid changes to a person’s weight aren’t only a side effect of substance use. They can represent signs of co-morbidity and can be an indicator of eating disorders. If you are struggling with addiction and other co-occurring disorders, we can offer you a safe environment to heal. At Little Creek Recovery PA, we have experience treating substance use disorder and all the common co-morbidities. Today, we would like to share our insights and explain the link between eating disorders and substance abuse.

What are Eating Disorders?

Eating disorders are classified as mental disorders that can cause harmful eating habits. The abnormal habits caused by eating disorders can directly affect an individual’s physical and mental health. There are several types of known eating disorders, most of which usually start occurring during adolescence.  Eating disorder symptoms can overlap, and a person’s diagnosis may change over time as their symptoms and behaviors change.

Research has documented diagnostic crossover between disorders such as anorexia nervosa and bulimia nervosa, making individualized clinical assessment important. An important distinction is that eating disorders do not include obesity, which is a separate medical condition. Another common occurrence with eating disorders is that they are frequently accompanied by other mental disorders. The most prominent co-occurring disorders are anxiety, depression, and substance use.

Treatment for eating disorders typically includes counseling and nutritional advice. Depending on the type of disorder a patient is dealing with, treatment can include medication or eliminating unnecessary exercise. However, individuals who suffer from eating disorders and substance abuse must undergo mental health counseling and addiction therapy. Eating disorders can cause individuals to obsessively monitor their weight or their perceived body image. Professional treatment is necessary because co-occurring disorders can make it hard to recover from obsessing over body weight and shape.

The Link Between Eating Disorders and Substance Abuse

Eating disorders and substance use disorders frequently occur together. According to the National Eating Disorders Association (NEDA), up to 50% of people with eating disorders use alcohol or illicit drugs—about five times the rate in the general population. NEDA also reports that up to 35% of people who are dependent on alcohol or other drugs have an eating disorder, roughly 11 times the general-population rate.

Excessive substance use has a profound impact on a person’s overall physical and mental health. Prolonged use of drugs or alcohol can cause numerous lasting harmful effects, and in extreme cases, even death. However, even casual drug or alcohol use can lead to weight fluctuations. These fluctuations are caused by dehydration, disrupted sleep patterns, lack of appetite, or gastrointestinal problems – all common symptoms of addiction. Over time these behaviors can become adopted as a routine and potentially cause eating disorders.

Can Substance Abuse Cause an Eating Disorder?

So far, no evidence exists that substance abuse can directly cause eating disorders. However, many troubling behaviors accompanying addiction can put users at risk of developing an eating disorder. For example, alcohol consumption can trigger binge eating in people with bulimia. In this case, continued alcohol use can lead to eating disorders or compound the effects of an existing one. Furthermore, both substance use disorder and eating disorders have shared risk factors. They are both predominantly influenced by genetic and environmental factors.

On the other hand, eating disorders can cause substance use disorder. People with an eating disorder experiencing other mental disorders or trauma are at risk of developing an addiction. Eating disorders often resemble addiction, and people can perform compulsive actions related to eating. They may abuse substances to deal with hunger or to accelerate weight loss. Alternatively, they can use alcohol as a replacement for their caloric intake.

Shared Risk Factors for Eating Disorders and Substance Abuse

To understand the leading causes of eating disorders and substance abuse, we must look at the shared risk factors. Besides a genetic predisposition, these risk factors can include:

• Peer pressure. Being part of a group where it is important to fit in can cause individuals to participate in dangerous behavior. Many adolescents start drinking or doing drugs to fit in with their friends. Similarly, being part of a group where appearances matter can cause group members to become obsessed with their looks.
• Susceptibility to advertising and pop culture. We live in a time when ads and magazines continually tell us we should exercise, lose weight, and look terrific. The pressures to conform to modern beauty standards can cause individuals to develop eating disorders. Some may even turn to drug use to rapidly lose weight or provide them with energy.
• Depression and anxiety. Mood and personality disorders can cause people to turn to substance use. However, depression and anxiety can also lead to eating disorders. People can develop extreme dissatisfaction with their appearance or even turn to stress eating.
• Physical or sexual abuse. Any abuse can cause lasting trauma. Unless resolved and processed, this trauma can cause problematic behaviors such as eating disorders and substance abuse.

Eating Disorders That Commonly Co-Occur With Substance Abuse

Research shows an association between certain eating disorders and substance abuse, but this does not mean that one directly causes the other. Some eating disorders occur alongside substance misuse more frequently than others. The three discussed below are anorexia nervosa, bulimia nervosa, and avoidant/restrictive food intake disorder (ARFID).

Anorexia Nervosa 

This body image disorder is characterized by low weight and limited food intake due to body image distortion. Individuals with anorexia nervosa experience a severe disconnection between what they see in the mirror and how they imagine themselves. They might see themselves as overweight although they have troublingly low body weight. Even when those individuals accurately see themselves, they might have the desire to lose more weight. These ideas can stem from viewing low body weight as beautiful or an aspirational ideal.

To lose weight, people suffering from anorexia will restrict their food intake and starve themselves. They also turn to excessive exercise to accelerate their weight loss. Unfortunately, sometimes even more dangerous methods are applied, such as taking laxatives or using hard drugs. However, regardless of which methods individuals use, anorexia is always dangerous and can cause harmful effects. Anorexia can lead to infertility, and women can stop having their periods. Osteoporosis, cardiovascular and brain damage are also common results of malnutrition.

Bulimia Nervosa

Binge-eating large quantities of food, followed by purging (either by vomiting or through laxatives), is typical for bulimia nervosa. Unlike other eating disorders, people suffering from bulimia may be of any weight. Individuals with bulimia often feel out of control and deal with their anxiety through substance use, primarily alcohol.

Avoidant/Restrictive Food Intake Disorder (ARFID)

Sometimes also called restrictive food disorder, is a type of eating disorder where people eat very restricted types of food. Individuals may limit the volume or variety of food which can lead to nutritional deficiencies. Sometimes these imposed limitations come from body image issues, while in other cases they can be unrelated to body appearance. In these situations, individuals can give various reasons for the limitation, such as food texture, taste, presentation, or even brand.

Substances Commonly Used Alongside Eating Disorders

Most forms of substance use will cause weight fluctuations due to how drugs affect our brains and metabolism. For example, cocaine is sometimes referred to as ‘the skinny drug’ because of the intense weight loss it causes. However, there are numerous short and long-term effects of cocaine use. Prolonged use of cocaine can damage the heart, lungs, brain, and digestive system, along with many other organs. If left untreated, cocaine addiction can even result in death. However, with the help of professional addiction treatment, most of the damage caused by cocaine can be reversed.

Another illegal drug that can cause sudden weight loss is heroin. It causes rapid weight loss by suppressing appetite and causing nutrient deficiencies. Addicts who use heroin frequently suffer from nausea which prevents them from eating. However, heroin use can also lead to rapid weight gain, particularly when combined with other drugs. For example, if affected individuals turn to marijuana to combat nausea, binge eating can lead to weight gain. Thankfully, individuals with heroin addiction can enter therapy and learn to overcome their cravings.

On the other hand, alcoholism is a form of substance use typically associated with weight gain. Regular drinking can significantly increase your caloric intake leading to weight gain. Sadly, being aware of this, some alcoholics will reduce their food intake to attempt to balance things out. This strategy can be extremely dangerous since it can deprive the body of necessary nutrients.

How Substance Abuse Can Worsen an Eating Disorder

Not only can substance abuse lead to eating disorders, but it can also worsen the symptoms of existing eating disorders. Studies show that patients who abuse drugs and alcohol have poorer expected outcomes for their eating disorder treatments. This is due to the numerous medical complications arising from excessive drug or alcohol use.

Patients undergoing treatment for their eating disorder who turn to substance abuse can expect a longer recovery time. Additionally, when the treatment is complete, there are generally poorer outcomes and a higher risk of relapse. For this reason, it is highly recommended to treat both disorders concurrently.

Patients who arrive at Little Creek suffering from substance use and a co-occurring disorder are given a dual diagnosis. This allows us to treat both disorders simultaneously leading to better-expected outcomes. During treatment, we also offer our patients dietary education and we stress the importance of self-care.

Signs a Loved One May Have an Eating Disorder and Substance Use Problem

Sadly, many people who suffer from eating disorders and substance abuse struggle to ask for help. When confronted, they might deny they have a problem or even get angry at you for bringing up the topic. However, the best way to help a loved one is to ensure they get the treatment they need. That’s why we made it our mission to raise family awareness by educating and informing the community regarding substance abuse. The first step must necessarily be realizing that a problem exists. Here are some obvious signs to look for:

• Weight fluctuations. One of the easiest ways to tell a loved one has an eating disorder is rapid weight changes.
• Worrying about their figure. Individuals with an eating disorder will frequently obsess about their weight and how they see themselves.
• Extreme exercising. While workouts are considered healthy, taking things to the extreme can be worrying. Especially when the exercise isn’t coupled with an adequate caloric intake.
• Excuses after meals. Odd behavior after eating might be an attempt to purge.

If you realize your loved one is suffering from eating disorders and substance abuse you should consider staging an intervention. Talking to your loved ones about their struggles is always difficult, but you must realize that addiction is a progressive disease. Things will only worsen if they don’t undergo rehab and get professional treatment. We understand how hard it is to confront your loved ones, and we offer family intervention services. Contact us if you need help staging an intervention and convincing your loved one into entering rehab.

How to Treat Eating Disorders and Substance Abuse

Treatment for eating disorders and substance abuse should address both conditions at the same time. The right plan depends on the person’s symptoms, substance use, physical health, and level of support needed. Care may include behavioral therapy, individual and group counseling, nutrition support, and residential or outpatient treatment.

Cognitive Behavioral Therapy and Dialectical Behavior Therapy

Behavioral therapies can help people recognize patterns that contribute to disordered eating and substance use. Cognitive behavioral therapy can help patients identify unhelpful thoughts, understand how those thoughts affect their behavior, and develop healthier ways to cope with stress and difficult emotions.

Dialectical behavior therapy can also help patients recognize triggers and manage strong emotions without turning to harmful behaviors. DBT focuses on practical skills such as emotional regulation, distress tolerance, mindfulness, and healthier coping strategies.

Individual and Group Therapy

Treatment may include both individual and group therapy. During individual sessions, patients can work privately with a therapist on personal triggers, coping skills, substance use, eating behaviors, and other concerns that may affect recovery.

Group therapy offers a different kind of support. Patients can hear from others facing similar challenges, share their own experiences, and practice healthier ways of responding to stress. Individual and group sessions may be included in both residential and outpatient programs.

Residential and Outpatient Treatment

Some people need the structure and support of a residential program, especially when their symptoms are severe or difficult to manage at home. During inpatient rehab, patients stay at the treatment center and receive ongoing support as they work on recovery.

Others may be able to receive care through outpatient addiction treatment services. Outpatient treatment allows patients to attend scheduled therapy sessions while continuing to live at home, which may make it easier to manage work, school, or family responsibilities.

Nutrition and Healthy Eating Support

For people with co-occurring eating disorders and substance use disorders, treatment may also include nutrition education and support for developing a healthier relationship with food, exercise, and body image. This care can work alongside behavioral therapy while helping address some of the physical effects of disordered eating and substance use.

Get the Right Support for Eating Disorders and Addiction

Eating disorders and substance abuse can affect your health, relationships, and life at the same time. When both are present, treating only one problem can leave the other active and make recovery harder. You may notice changes in weight, eating habits, mood, substance use, or how you cope with stress. These signs are worth taking seriously, especially when they start to affect your safety or routine. The right treatment can address both conditions together and help you build healthier ways to manage food, emotions, and substance use. You do not need to wait until things get worse to ask for support. If you are worried about yourself or someone you care about, reach out to our team and contact us.