What is a substance addiction?
Addiction to drugs or alcohol has been officially recognized as a type of mental health disorder called substance use disorder (SUD). It describes the chronic and compulsive use of drugs or alcohol despite the negative consequences.
While everyone experiences substance use disorder differently, some common features of a drug or alcohol addiction include:
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- Failing to quit or control useNeglecting previously enjoyed hobbies in favor of substance use
- Using substances in hazardous situationsExperiencing intense cravings for drugs or alcohol
- Spending a significant amount of time obtaining, using, or recovering from the effects of substances
- Continuing use despite physical or mental health conditions caused or worsened by use
- Continuing use despite occupational or social issues caused or worsened by use
- Requiring higher amounts of drugs or alcohol to feel desired effects (increased tolerance)
- Experiencing unpleasant or distressing symptoms when they cut down or stop use (withdrawal)
Which eating disorders commonly co-occur with addiction?
Certain eating disorders are more likely to co-occur with substance use disorders than others. In general, disorders involving binge eating and purging behavior to avoid gaining weight have been associated with greater frequency of drug and alcohol use.3
The purging subtypes of bulimia nervosa are most frequently associated with co-occurring drug and alcohol use.2 Individuals with these conditions are reported to use alcohol and other substances more frequently than patients with anorexia nervosa-restricting type and binge eating disorders.
Patients with anorexia nervosa-binge eating/purging type are also more likely to misuse substances than those with the restricting type.3 Though, some research has linked restricting subtypes of AN with a higher risk for alcohol use.
Broadly, when it comes to eating disorders, addiction often manifests as alcohol misuse.2 Still, people struggling with drug addiction and eating disorders may use many types of substances, including:5
How often do addiction and eating disorders co-occur?
While many studies have found a connection between addiction and disordered eating behaviors, the exact rate of overlap varies from study to study. A review of 51 case reports found co-occurrence can range anywhere from 0% to 55%.2
A nine-year longitudinal study concerning women with eating disorders found that 30% of women with bulimia nervosa and 18% of women with anorexia nervosa were also diagnosed with an addiction over the course of the study.4
Research estimates that 50% of those with an eating disorder also are dependent on drugs or alcohol.
Other research estimates that 50% of people with an eating disorder misuse or are dependent on drugs or alcohol, compared to 9% of the general population. And yet, other studies found that among people with a substance addiction, over 35% have an eating disorder.5
Regardless of the exact rate, it's clear that addiction and eating disorders often overlap. The two share a number of biological, psychological, and environmental risk factors, and the stress of dealing with one condition can often trigger the type of maladaptive coping mechanisms associated with the other condition.
Why do drug addiction and eating disorders commonly co-occur?
The relationship between eating disorders and substance use disorders is complex, and researchers are still not entirely sure why they frequently co-occur. However, there are likely several psychosocial and biological influences.4
Maladaptive coping mechanisms
What eating disorders and addiction have in common is that both manifest as maladaptive coping mechanisms. Generally, people with these conditions have a number of other related comorbid—or co-occurring—conditions, including a history of
trauma,
depression, and anxiety disorders. Controlling diet or using substances are methods people use to deal with these and other stressors.
In some cases, behaviors from one disorder may be "replaced" with behaviors from the other. For instance, some people in recovery from an eating disorder may turn to drugs or alcohol to help with anxiety and other unpleasant feelings rather than using disordered eating behaviors.
4 Similarly, someone who is recovering from an addiction may engage in
eating disorder behaviors to cope with or compensate for the absence of substances.
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Rather than replacing one disordered behavior with another, some people develop one to help "manage" the other. For example, some patients with BN and AN say they “self-medicate” with substances in order to cope with the distress of their eating disorder.
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Symptoms of one condition can encourage the development of the other. Stimulants or diet pills are also often used by those with eating disorders to control or decrease appetite, but for some people, this misuse can progress into addiction. On the other hand, some patients have reported developing an eating disorder after substances have suppressed their appetite.
Shared biological risk factors
Genes are also thought to play a significant role in the development of eating disorders and co-occurring addictions. That means a family history of either eating disorders or substance addictions may increase a person’s risk for the development of either or both disorders.
One study suggested there was a link between binge eating and compensatory behaviors in bulimia nervosa and alcoholism.7 Another study found that 83% of observable traits between bulimia nervosa and illicit drug use/dependence was accounted for by genetic influences.4
Other common traits
Other factors that can contribute to both drug addiction and eating disorders include:
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- Childhood trauma
- Childhood sexual abuse
- Common traits, such as impulsivity, novelty-seeking, and emotional dysregulation
- Witnessing important persons in one’s life engaging in disordered eating or substance use
- Shared symptoms, such as binging more amounts than intended, continuous binging/use despite negative consequences, and avoiding enjoyable activities due to binging/using
- Shared brain chemistry (disturbances in serotonin, dopamine, gamma amino-butyric acid, and endogenous opiates)
Finding treatment for co-occurring disorders
Eating disorders and addiction are both dangerous mental health conditions, and when combined, the effects can be deadly. In fact, substance addiction can lead to greater severity of disordered eating behaviors and an increase in life-threatening consequences, and can also complicate assessment, treatment, and recovery.2,7
When these conditions occur together, it's important to treat both at once. Aside from addiction and eating disorders often working off of each other, a common underlying complication is often at play, and that will need to be addressed to positively change behaviors related to either condition.
Unfortunately, programs that offer comprehensive treatment are comparatively rare. One study found that only 16% of 351 substance use programs offered treatment for comorbid eating disorders. What’s more, only 50% of the programs even screened for eating disorders, and just 3% of programs had formal referral arrangements with eating disorder treatment programs.7
At Within, our goal is to meet all of our patients where they are at. To do that, our clinicians conduct a biopsychosocial evaluation, which considers many factors of a person’s life—including psychological, social, and biological factors. As part of our first steps in treatment, we screen for eating disorders as well as co-occurring substance use disorders and mental health conditions.
Help is within reach
If you are looking for help for an eating disorder, whether for yourself or a loved one, our clinical care team is here for you. Call our team to learn about our virtual treatment and care programs, including comprehensive treatment for any co-occurring disorders.
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