Substance Abuse and Bulimia

Contributor: W. Travis Stewart, Licensed Professional Counselor, Revision Recovery Coaching

drugFirst a man takes a drink; then the drink takes a drink; then the drink takes a man.
—Japanese Proverb

Most alcoholics can relate to this Japanese proverb; that is, the feeling that once the drinking process begins, the ability to freely choose any outcome other than getting drunk, is futile. In the same way, many bulimics can also relate to the feeling of losing control over binging and purging repeatedly.

During my first week ever of working with eating disorders, I had the opportunity to observe a family counseling session with a woman with severe bulimia. This attractive, well-spoken and intelligent young woman was in the process of telling her family members the extent of her binging and purging behaviors.

The Shock of How Bad It Can Get

I was not prepared for what I heard because, if I had been walking down the street, I would not have not picked her for the eating disorder equivalent of a meth addict. When she was asked how many times a day she would binge and purge when she hit her lowest point she responded, “Up to 20 times a day.”

The fact that this woman was somehow alive and that her heart had not stopped working from cardiac failure was a miracle and the extent that she had lost control of her sense of choice was clear.

Feeling Like You’ve Lost Control

Sad and lonely woman / on the street / Novosibirsk / Siberia / 0This feeling of a loss of control is one of the common factors in both substance abuse and bulimia. The similarities do not stop there. And that is one reason these abuse of or addiction to substances often go hand-in-hand with bulimic behaviors.

The National Eating Disorder Association reports that “nearly 50% of individuals with an eating disorder (ED) are also abusing drugs and/or alcohol, a rate 5 times greater than what is seen in the general population.”1

Rates of Substance Abuse Among Those with Eating Disorders

Also, bulimic women who were alcohol-dependent reported a higher rate of suicide attempts, anxiety, personality and conduct disorders and other drug dependence than bulimic women who were not alcohol-dependent2.

The research also points to the finding that individuals with eating disorders experience higher rates of substance abuse than do those in the general population, and those who binge and purge are more likely than restricting anorexics to engage in substance abuse3.

Why Are Those With Eating Disorders More Likely to Become Addicted?

Why is this? Let’s look at some shared risk factors reported by the Center on Addiction and Substance Abuse at Columbia University (CASA).

In 2003, CASA published the first comprehensive examination of the link between substance abuse and eating disorders. The three-year study found common characteristics and risk factors between the two populations, including the following:

Shared Risk Factors:

  • Occurrence in times of transition or stress;
  • Common brain chemistry;
  • Common family history;
  • Low self-esteem, depression, anxiety, or impulsivity;
  • History of sexual or physical abuse;
  • Unhealthy parental behaviors and low monitoring of children’s activities;
  • Unhealthy peer norms and social pressures; and
  • Susceptibility to messages from advertising and entertainment media4.

According to this report, one thing that substance abuse and eating disorders share in common are the factors that increase an individual’s vulnerability through deficits and trauma to their sense of personal, social and mental health.


meat-569073_640Another factor in the relationship between substance abuse and bulimia appears to be the role that cravings play in the development and maintenance of the behavior.

Omar Manejwala, M.D., in his book, Craving; Why We Can’t Seem to Get Enough, describes a craving as “a strong desire that, if unfulfilled, produces a powerful physical and mental suffering.” These desires, which are more commonly called urges in the field of eating disorders, are a result of powerful brain chemistry that has developed over time, feel overwhelming, controlling and unstoppable.

The inability to resist the craving or use other coping skills to lower the craving to a manageable level are the cause of a great deal of distress for individuals and are a strong component of relapse in those who attempt recovery.

Common Dynamics Between Cravings for Food and for Alcohol and Drugs

Cravings for food or alcohol and drugs, share some common dynamics. All three are “substances” which, when consumed, bring about changes to mood, pleasure and brain chemistry. Cravings can cloud judgement and lead people to make choices that contradict their stated goals and values in life.

At times, individuals can experience a dissociative state where he or she is not fully aware of surroundings and other people (feeling like a zombie or acting on “auto-pilot”). Cravings can become so powerful that individuals can neglect work, school, friends and family.

This may have to do with what is happening in the brain once it becomes conditioned to the pleasure it experiences from the behavior. Once the reward system of the brain becomes accustomed to experiencing pleasure through the use of a substance or behavior, it will naturally want to move in that direction over, and over, and over again – damn the consequences.

Seeking Out Professional Help

Helping You Find Eating Disorder TreatmentSo, what can be done? First, seek out professional help. Bulimia, drugs and alcohol are all life-threatening and nearly impossible to quit without the help of a professional team, friends, family and a supportive recovery community.

Next, learn more about how the brain works and learn practical and proven techniques for managing cravings and rewiring the brain. Finally, find a few good books and learn more about overcoming cravings and teaching the brain a new lesson! Here are a few I recommend:

  • Craving; Why We Can’t Seem to Get Enough by Omar Manejwala, M.D.
  • You Are Not Your Brain by Jeffrey Schwartz, M.D.
  • Addiction and Grace by Gerald May, M.D.

Community Discussion – Share your thoughts here!

Have you suffered from substance abuse and bulimia, what advice do you have to share in regards to treating these issues simultaneously?

About the Author:

Travis Stewart is a Licensed Professional Counselor who has worked in the field of eating disorders since 2003. He also offers recovery coaching for individuals wanting to develop more autonomy, mastery and purpose in their lives.



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 discussion of various issues by different concerned individuals.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on June 11th, 2015
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