Dual Diagnosis – Addiction and Eating Disorders

Contributed Article by Staff of Timberline Knolls Residential Treatment Center.

When a person has more than one illness at any given time, it is referred to as a dual diagnosis or co-occurring disorder. Today, more and more women struggle with two disorders simultaneously: an eating disorder and addiction.

Up to 35% of alcohol or illicit drug abusers have eating disorders compared to only 3% of the general population.[1] Similarly, up to 50% of those with eating disorders have a problem with drug or alcohol abuse.[2] Girls with eating disorders are four times more likely to use inhalants and cocaine.

Connection between Addiction and Eating Disorders

It is not too difficult to imagine why a woman or girl with an eating disorder would abuse drugs. If the goal is to be skinny, those with anorexia often become dependent on caffeine, nicotine, diet pills and stimulants such as Adderall to suppress  appetite or ramp up metabolism. These women and girls may graduate to cocaine, meth and even crack to maintain that desired goal. Similarly, women with bulimia often abuse diuretics, stimulants and laxatives for purging purposes.

Beyond Weight Loss

Fully understanding the link between addiction and eating disorders necessitates a deeper comprehension of the “whys” behind a food-related disorder. We know that at their core, eating disorders are less about food and more about feelings and identity. An eating disorder is an unhealthy method of coping with unpleasant thoughts, painful life experiences and commensurate cycles of painful emotions such as hurt, sadness, loneliness, rage or terror. Drugs and alcohol are often used to achieve the same end. When a girl is high or drunk, she is not sad, lonely, anxious or depressed. The emotions involved with the boyfriend breakup; the fight with her best girlfriend; the stress over grades all vanish. In other words, the function, meaning what both the eating disorder and substance abuse do for the girl is similar.

Biological Factors

Drug abuse and eating disorders are developmental in nature, meaning that onset is usually during adolescence when the brain is still developing. Additionally, studies show increased risk for eating disorders and substance abuse if one or both parents have alcoholism.

Onset of these disorders is often a combination of genetics and environment. Certain people are genetically predisposed to having food –related disorders or problems with alcohol and drugs. It is this same genetic component that makes these individuals more likely to experience environmental triggers associated with growing up with a family history of alcoholism or addiction–trauma, stress, neglect and early drug or alcohol exposure. Additional complexities involve personality factors, brain chemistry and functional changes in the reward center of the brain. Therefore, conditions that might inspire one young woman to become eating disordered or involved with drugs would not have the same impact on another.

Consider this example:  two young women enter college at the same time; one has a genetic predisposition toward eating and drug-related disorders, while the other does not. Each experiences the same stress related to academic expectations, new social systems, distance from home, and even the possibility of the dreaded freshman weight gain. One young woman recognizes the pressure and copes with it in a healthy fashion. She eats well, exercises regularly, prays, and remains connected to close friends and family for support. The other freshman does the opposite. She does not get adequate sleep and healthy exercise; she becomes overwhelmed, anxious and worried. She restricts caloric intake to avoid weight gain and to mitigate her intense feelings. She begins taking stimulant medication to help her study.

Two young women living in the same environment, experiencing similar stressors, adopting different coping strategies, and ultimately resulting in two drastically different outcomes.

Treatment of Co-occurring Disorders

Recognizing the connection between eating disorders and substance abuse is extremely important, especially regarding the treatment process. A treatment team for a woman with both and eating disorder and substance abuse must be comprised of experts in both. Ideally these professionals are well-versed in treating co-occurring addictive disorders and offer a unified treatment philosophy to help her recover in all areas. Fortunately, with the correct diagnosis and proper care, full recovery is possible.

1 and 2 National Center on Addiction and Substance Abuse (CASA) at Columbia University. (2003). Food for Thought: Substance Abuse and Eating Disorders. New York, National Center on Addiction and Substance Abuse.


Last Reviewed By: Jacquelyn Ekern, MS, LPC on April 5, 2017

Page last updated: April 5, 2017
Published on EatingDisorderHope.com, Information & Resources for Treating Eating Disorders