Substance use and eating disorders are often co-occurring. In fact, the National Center on Addiction and Substance Use reported the following findings: 
- Individuals with eating disorders were up to 5 times as likely as those without eating disorders to abuse alcohol or illicit drugs
- Those who abused alcohol or illicit drugs were up to 11 times as likely as those who did not to have had eating disorders
- Up to 50% of individuals with eating disorders abused alcohol or illicit drugs, compared to 9% of the general population
- Up to 35% of individuals who abused or were dependent on alcohol or other drugs have had eating disorders, compared to 3% of the general population
More specifically, the highest reported rates of co-occurrence appear to be in individuals with bulimia nervosa and alcohol use disorders . Binge eating disorder has been more likely to occur in individuals with substance use disorders than in those without substance use disorders .
The strongest associations between SUD and ED involve bulimic behaviors such as binge eating, purging, and laxative use . Whether or not substance use begins before, during, or after the development of an eating disorder varies.
Some individuals struggling with an eating disorder also abuse substances such as alcohol, laxatives, emetics, diuretics, amphetamines, heroin, and cocaine for various reasons including for weight loss, energy, or to regulate mood or emotions [1- 4].
Some individuals may experience “behavior swapping,” where they notice an increase in either substance use or eating disorder behaviors when working to decrease the other behavior.
Individuals who find themselves exchanging one problematic behavior for another are often seeking a way to cope with unpleasant physical or emotional sensations.
However, these behaviors are ultimately ineffective and dangerous coping methods.
Substance use and eating disorders share the same vulnerability or risk factors that make a person susceptible to developing the disorder. This includes genetic predispositions, trauma history, brain chemistry, low self-esteem, depression, anxiety, and social pressures. Other shared characteristics include compulsive behavior, social isolation, and risk for suicide. [1, 3]
Recovery from co-occurring substance use and eating disorders is possible. It is recommended that those struggling with co-occurring substance use and disordered eating seek treatment from medical and mental health professionals who specialize in both substance use disorders and eating disorders. [1, 3]
1. National Eating Disorder Association. Substance abuse and eating disorders. Retrieved from https://www.nationaleatingdisorders.org/substance-abuse-and-eating-disorders on Aug 12, 2019.
2. National Center on Addiction and Substance Use (CASA). Food for thought: Substance abuse and eating disorders. Columbia University; 2003. Retrieved from http://www.casacolumbia.org/templates/Publications_Reports.aspx on Aug 12, 2019.
3. Brewerton TD, Brady K. (2014) Eating Disorders, Addictions and Substance Use Disorders: Research, Clinical and Treatment Perspectives. New York: Springer.
4. Spindler A, Milos G. Links between eating disorder symptom severity and psychiatric comorbidity. Eat Behav. 2007; 8(3):364–373.
About the Author:
Chelsea Fielder-Jenks is a Licensed Professional Counselor in private practice in Austin, Texas. Chelsea works with individuals, families, and groups primarily from a Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) framework.
She has extensive experience working with adolescents, families, and adults who struggle with eating, substance use, and various co-occurring mental health disorders. You can learn more about Chelsea and her private practice at ThriveCounselingAustin.com.
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published on August 15, 2019, on EatingDisorderHope.com
Reviewed & Approved on August 15, 2019, by Jacquelyn Ekern MS, LPC