Substance Abuse and Eating Disorders

Contributor: Leigh Bell, BA, writer for Eating Disorder Hope

Handsome man playing guitar.The relationship between eating disorders and substance abuse is both undeniable and unsettling, and yet, after extensive research, experts can’t definitively explain why. We do know when eating disorders and substance abuse co-occur, treatment must simultaneously, and with equal intensity, address both conditions to be successful.

About 50 percent of people with an eating disorder also abuse drugs and/or alcohol, a rate 5 times greater than what’s seen in the general population, according to the National Eating Disorder Association.

Substance Abuse in Bulimia or Binge Eating

People with bulimia and “bulimic” behaviors, like binging and purging, statistically have a far greater propensity for substance abuse than those with anorexia nervosa. In fact, women who binge-and-purge use/abuse more substances than women with other eating disorders and women, in general.

Blinder et. al. analyzed over five years 2,436 female inpatients with DSM-IV diagnoses of anorexia, bulimia, and eating disorder not otherwise specified (EDNOS). Of the patients with bulimia, 34 percent had a substance disorder, which was decidedly more than the other patients: anorexia binge-purge subtype (20%), EDNOS (20%), and anorexia restricting type (5%).

A Strong Correlation Between Eating Disorders and Substance Abuse

問診をする医師Research finds the reverse was also true. About 35 percent of people who abused alcohol or drugs have had eating disorders, compared to 3 percent of the general population, according to a report from the National Center of Addiction and Substance Abuse (CASA).

How or why one disorder sparks the other is uncertain, yet eating disorders and substance abuse share defining characteristics, the CASA report states, such as:

  • Reinforcement and reward motivational systems in the brain
  • Obsessive preoccupation with a substance (drug or food), craving, and compulsive behavior characterized by a loss of control
  • Ritualistic behaviors, like cutting a line of cocaine or slicing a piece of food
  • Mood-altering effects, particularly feelings of calm or numbness
  • Continued use as a coping mechanism, despite negative consequences
  • Resistance to treatment and high risk of relapse

Are Eating Disorders an Addiction?

With such similarities to substance abuse, some hypothesize eating disorders themselves are an addiction, but this assertion, like many regarding the comorbidity of eating disorders and substance abuse, remain a hypothesis.

Research does find between the two diagnoses extraordinarily similar risk factors:

  • Mood disorders
  • Personality traits
  • Genetics
  • Family modeling
  • Exposure to trauma
  • Cultural or outside influences

Depression and certain personality traits are research-proven components in the link between eating disorders and substance abuse. Depression, symptoms of depression, and a family history of depression exist both in those with eating disorders and people with substance abuse, according to the CASA report.

“People with eating disorders who have high rates of depression also tend to have high rates of substance use disorders,” the report says.

The Role of Personality

Young woman sitting on the floor near wall ,doing yogaPersonality is another statistically plausible factor but only for those with bulimia and “bulimic” behaviors. People prone to bulimia and to substance abuse have high “Novelty Seeking” scores, which means they may be more impulsive and excitable, quick to anger, have unstable moods, and avoid frustration.

The same research reveals substantially higher novelty-seeking scores in bulimics who have a substance-abuse problem than bulimics who don’t.

Societal Pressure

Societal pressure to be “thin” is another voice in this conversation. Girls who diet in the sixth grade are more likely to use and/or misuse alcohol in the ninth grade; and the more frequently these sixth-grade girls diet, the heavier they drink or do drugs as ninth-graders.

The study expounds this data to surmise girls who cave to cultural pressures to be thin, may also buckle when friends push drinking or drugs.

Decades-old studies find both eating disorders and substance abuse have genetic links, but recent research reveals some of these links may be the same, potentially tying the disorders together with DNA. The same genetic factors may underlie both the liabilities to alcohol dependence and the binge-purge cycle in both men and women.

The research, based on data from almost 6,000 Australian adult twins, found a statistically significant genetic correlation between binge eating and alcoholism.

Risk Factors for Developing Both Disorders

Research proves certain risk factors increase the likelihood someone will develop an eating disorder or substance abuse, but not necessarily both. These risk factors include:

  • Childhood abuse
  • Exposure to trauma
  • Anxiety
  • Low self-esteem
  • Societal pressures
  • Stress

Close-up of businesswoman is typing on her keyboardIf these factors cause eating disorders and substance abuse, then a natural conclusion is they could simultaneously cause both. Data has hard time backing this up.

For example, parental modeling helps determine someone’s vulnerability to substance abuse and to eating disorders. Linking together these propensities, one study found female teenagers with an alcoholic parent were far more likely to have poor body image and eating-disorder behaviors, like binge-eating and vomiting.

Still a more recent study found no relationship across generations between eating disorders and substance abuse. Such contradictions underscore the complexity of this comorbidity.

How to Address the Problem

Despite the perplexity, the recent and continued focus on the co-occurrence of eating disorders and substance abuse brings new insight into the origins and treatment of both. More and more treatment centers are addressing both problems simultaneously and with great care each disorder deserves, realizing when one is in remission the other may surface.

Focus on this diagnostic relationship has also brought more research efforts into the physiology of both eating disorders and substance abuse, whereas, historically the illnesses have mostly been viewed as psychological ones.

Community Discussion – Share your thoughts here!

Have you or someone you loved experienced an eating disorder co-occurring with substance abuse issues? Do you believe the two go hand in hand, why or why not?


About the Author:

Leigh Bell holds a Bachelor of Arts in English with minors in Creative Writing and French from Loyola Marymount University in Los Angeles. She is a published author, journalist with 15 years of experience, and a recipient of the Rosalynn Carter Fellowship for Mental Health Journalism. Leigh is recovered from a near-fatal, decade-long battle with anorexia and the mother of three young, rambunctious children.


  1. Blinder BJ, Cumella EJ, Sanathara VA. Psychiatric comorbidities of female inpatients with eating disorders. Psychosomatic Medicine. 2006;68:454-462.
  2. Wiseman, C., Sunday, S., Halligan, P. Korn, S., Broan, C., & Halmi, K. In: National Center on Addiction and Substance Abuse. (2003). Food for thought: substance abuse and eating disorders. National Center on Addiction and Substance Abuse.
  3. Kane, A. (n.d.). Substance Misuse and Alcoholism Among Women with Eating Disorders. Retrieved January 14, 2015.
  4. Krahn, D., Piper, D., King, M., Olson, L., Kurth, C., Moberg, D.P. (1996). Dieting in Sixth Grade Predicts Alcohol Use in Ninth Grade. Journal of Substance Abuse. 8, 293-301.
  5. Munn-chernoff, M., Duncan, A., Wade, T., Agrawal, A., Bucholz, K., Madden, P., … Heath, A. (2003). A Twin Study of Alcohol Dependence, Binge Eating, and Compensatory Behaviors. Journal of Studies on Alcohol and Drugs, 74(5), 664-673.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on February 21st, 2015
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