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Eating Disorders & Alcohol Use Disorder
Eating disorders and alcohol use disorder are serious mental health diagnoses that often co-occur. Either can come first and increase the likelihood of developing the other. Not only that, when these two disorders occur simultaneously, the impact on the body, mind, and life of the individual can be devastating. Read on to learn how these disorders are related as well as recommended treatments and relapse prevention.
Alcohol Use Disorder Definition
The basic understanding of alcohol use disorder is that it involves excessive use of alcohol with an inability to stop or reduce use despite a desire and effort to do so. Beyond this understanding, there are more specific behaviors that indicate a diagnosable mental illness of alcohol use disorder.
Alcohol Use Disorder DSM-5 Criteria
The Diagnostic & Statistical Manual of Mental Disorders (DSM-5) provides criteria that an individual must meet to be diagnosed with any mental illness. It is this criteria that makes the difference between an individual that struggles with excessive alcohol use and an individual that struggles with a diagnosable addiction to alcohol. The DSM-5 specifies the following criteria for alcohol use disorder:
- “A problematic pattern of alcohol use leading to clinically significant impairment or distress as manifested by at least two of the following, occurring within a 12-month period:
- Alcohol is often taken in larger amounts over a longer period than was intended.
- There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
- A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
- Craving or a strong desire or urge to use alcohol.
- Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
- Continued alcohol use despite having persistent or recurrent social or occupational problems caused or exacerbated by the effects of alcohol.
- Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
- Recurrent alcohol use in situations in which it is physically hazardous.
- Alcohol use is continued despite knowledge or having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
- Tolerance, as defined by either of the following:
- A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
- A markedly diminished effect with continued use of the same amount of alcohol.
- Withdrawal, as manifested by either of the following:
- The characteristic withdrawal syndrome for alcohol.
- Alcohol (or a closely related substance, such as benzodiazepine) is taken to relieve or avoid withdrawal symptoms .”
Alcohol Use Disorder ICD-10 Code
To communicate Alcohol Use Disorder in any country regardless of terminology used in that culture or language, the International Classification of Disease (ICD-10) Code is F10 followed by a severity specifier of either .10 (Mild), .20 (Moderate), or .30 (Severe). As an example, the ICD-10 code for Mild Alcohol Use Disorder would be F10.10 .
Signs & Symptoms of Alcohol Use Disorder
The following symptoms may be present if you or a loved one are showing signs of alcohol use disorder:
- Wanting to cut down on the amount an individual drinks.
- Multiple unsuccessful attempts at reducing or ceasing alcohol intake.
- Memory impairment .
- Poor coordination .
- Slurred Speech .
- “Diverting energy from work, family, or social life in order to drink .”
- Engaging in risky behavior.
- Being secretive or dishonest about the extent of drinking behaviors.
- Hiding alcohol.
- Drinking to excess when alone.
- Becoming distressed at the prospect of not having alcohol.
- Utilizing alcohol as a consistent means to cope with life stressors.
- Feeling unable to cope with uncomfortable emotion-states without alcohol.
The Connection Between Alcohol Use & Eating Disorders
Alcohol use disorder is the most commonly seen co-occurring substance use disorder with eating disorders . As mentioned above, the relationship between alcohol use and eating disorders does not move in only one direction, meaning that eating disorders can increase risk of developing alcohol use disorder and vice-versa. Even so, research does indicate that those with anorexia nervosa and bulimia nervosa tend to develop substance use disorders after eating disorder onset whereas binge eating disorder tends to present after substance use disorder onset .
Regardless of which presents first, alcohol use disorder and eating disorders are similar in that they involve behaviors that are often used as maladaptive coping skills and that are viewed as addictive patterns. There are further similarities between alcohol use and each individual eating disorder as well.
The Link Between Alcohol Use & Anorexia
Anorexia Nervosa involves restrictive eating patterns as a means to alter the body and cope with distorted body image. Anorexia Nervosa and Alcohol Use Disorder have similar risk factors such as inability to cope with emotional dysregulation and distress, low self-worth, distorted sense of self, lack of social support, history of trauma and/or adverse childhood experience, and co-occurring mental health diagnoses such as Major Depressive Disorder, Generalized Anxiety Disorder, etc.
These disorders also co-occur in a pattern of behavior known as “drunkorexia,” when an individual restricts food intake in order to “save room” for the calories they anticipate drinking. Drunkorexia also involves eating less food to maximize the impact of alcohol use.
Bulimia & Alcohol Use
Research indicates that individuals may engage in both alcohol use and bingeing and purging behaviors to cope with challenging and negative emotion-states. These disorders share the risk factors to anorexia nervosa identified above as well as others such as a tendency for impulsive behaviors and disconnection from the physical body.
The relationship between bulimia and alcohol use disorder is also dangerous because individuals might use alcohol in order to induce purging, which is incredibly harmful and can increase severity of both behaviors.
Alcohol Use Disorder Facts
Research continues to grow on Alcohol Use Disorder, as it is an important and all-too-common problem in the United States. Below are some statistics that provide a picture of this disorder:
- “The 2019 National Survey on Drug Use and Health (NSDUH) reports that 139.7 million Americans age 12 or older were past month alcohol users, 65.8 million people were binge drinkers in the past month, and 16 million were heavy drinkers in the past month .”
- The 2019 NSDUH also learned that “2.3 million adolescents aged 12 to 17 in 2019 drank alcohol in the past month, and 1.2 million of these adolescents binge drank in that period .”
- Approximately 14.5 million people ages 12 and older meet criteria for alcohol use disorder .
- “Excessive alcohol use can increase a person’s risk of stroke, liver cirrhosis, alcoholic hepatitis, cancer, and other serious health conditions .”
- 29 people in the United States die daily in motor vehicle crashes that involve an alcohol-impaired driver .
Eating Disorder and Alcohol Use Disorder Treatment
Both eating disorders and alcohol use disorder are highly treatable, however, receiving professional help is often necessary, as these disorders are incredibly complex.
It is common knowledge that medication that reduces depression, anxiety, trauma, or other mental health symptoms might be helpful in treating alcohol use disorder, however, many individuals are unaware that medication can actually be used to treat Alcohol Use Disorder itself. The Food & Drug Administration has approved 3 medications for the treatment of alcohol use disorder:
- Acamprosate (Brand Name – Campral)
- Disulfiram (Brand Name – Antabuse)
- Fluoxetine (Brand Name – Prozac) .
If you are curious about how these drugs work and if they might help you or a loved one, reach out to your Primary Care Doctor or Psychiatrist.
There currently are no FDA-approved medications for the treatment of eating disorders, however, as mentioned above, medications that reduce other mental health symptoms can be effective in supportive eating disorder recovery.
Engaging in therapy can be helpful in moving toward recovery from both eating disorders and alcohol use disorders. It is important that this therapy does not focus solely on one disorder. These disorders interact with one another and, therefore, must be treated simultaneously. Treatments such as Cognitive Behavioral Therapy, Dialectical Behavior Therapy, support groups, exposure-based treatments, and family-based therapy are shown to be effective in treating both of these disorders.
Relapse Prevention & Aftercare Support
The most important aspect of maintaining recovery from both an eating disorder and alcohol use disorder is to continue engagement of maintenance treatment over time. An individual does not need to receive weekly, or even monthly, treatment, however, maintaining a relationship with a Therapist, Dietitian, and Primary Care Doctor can help an individual to maintain mental and physical wellness as well as receive support if challenging moments arise.
Resources American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).  Unknown (2021). Alcoholism: list of symptoms and signs of alcohol abuse. American Addiction Centers. Retrieved from https://americanaddictioncenters.org/alcoholism-treatment/symptoms-and-signs.  Bahji, A. et al. (2019). Prevalence of substance use disorder comorbidity among individuals with eating disorders: a systematic review and meta-analysis. Psychiatry Research, 273.  Unknown (2021). Alcohol, tobacco, and other drugs. Substance Abuse & Mental Health Services Administration. Retrieved from https://www.samhsa.gov/find-help/atod.  Winslow, B. T., Onysko, M. (2016). Medications for alcohol use disorder. American Family Physician, 15:93(6).
Author: Margot Rittenhouse, MS, LPC, NCC
Page Last Reviewed and Updated By: Jacquelyn Ekern, MS, LPC on October 20, 2021