Co-Occurrence of Eating Disorder and Substance Abuse

One commonality between eating disorders and substance abuse is that they both demonstrate “addictive behaviors” and involve the use of a substance (food or drug) to alleviate stress.

And research findings are troubling — individuals with eating disorders are up to five times likelier to abuse alcohol or illicit drugs and those who abuse alcohol or illicit drugs are up to 11 times likelier to have eating disorders.

How is eating disorder linked to substance abuse?

Studies show that up to 50 percent of individuals with an eating disorder abuse alcohol or illicit drugs compared to approximately only nine percent in the general population. Up to 35 percent of alcohol or illicit drug abusers have an eating disorder compared to up to three percent in the general population.

The common “substances” that people use or abuse include caffeine, tobacco, alcohol, cocaine, heroin and over-the-counter medications such as appetite suppressants, diuretics, laxatives and emetics.

Reasons for eating disorder and substance abuse co-occurrence

There are no definitive research findings on the reasons for co-occurrence of eating disorder and substance abuse. One possible explanation is that both disorders are different expressions of the same underlying problem. Another explanation is that one disorder leads to the other disorder (e.g., the restriction of food intake leads to increased susceptibility to drug abuse).

Some researchers suggest that the “underlying problem” has much to do with family history of alcohol and other drug abuse as well as depression.

So, to help prevent eating disorders and substance abuse in the children, parents should model and promote healthy, positive and reasonable messages about eating and exercise as well as consistent messages about the dangers of substance use.

Treatment for eating disorder and substance abuse co-occurrence

In some treatment programs for “addictive behaviors,” individuals with eating problems are considered indistinguishable from individuals with substance abuse problems. Often these patients are grouped together under the term “addictive” without particular attention to how eating disorders and substance abuse might be different in etiology, symptom pattern, and treatment.

One researcher suggests that substance abuse treatment providers must become skilled in treating eating-disorder problems, and eating-disorder treatment providers must become adept at treating chemical dependency.

While severe cases of eating disorder may require inpatient treatment on a medical or designated eating disorder unit, more moderate cases of co-morbidity can be managed by the substance abuse specialist working in an inpatient or a day program setting.

Sources consulted:

  • Dean D. Krahn. 1991. The Relationship of Eating Disorders and Substance Abuse. In Journal of Substance Abuse, Vol. 3, pp. 239-253.

  • JACK L. KATZ, MD.. 1990. Eating Disorders: A Primer for the Substance Abuse Specialist 2. Theories of Etiology, Treatment Approaches, and Considerations During Co-morbidity With Substance Abuse. In Journal of Substance Abuse Treatment, Vol. 7, pp. 211-217.

  • Food for Thought: Substance Abuse and Eating Disorders. December 2003. The National Center on Addiction and Substance Abuse at Columbia University.

Learn more about GenPsych Eating Disorder Program and Substance Abuse Program.