Eating Disorders and Substance Abuse

From the wasting body of a woman with anorexia to the ruptured stomach of a high school wrestler with bulimia, eating disorders have a profound effect on the 5 to 10 million Americans who struggle with them [1]. In some cases, living with an eating disorder is complicated by another mental health condition: substance abuse. If you or someone you love wrestles with both, you likely have questions about the conditions and the available treatment options, including drug rehab treatment. It’s important to understand the challenges and treatment issues related to those with both types of disorder. Shelly was a slender, attractive woman in her early 30s. Recently divorced and the now-single mother of two young children, she was struggling to cope on her own. Shelly had a long history of bulimia and alcohol abuse. She had been plagued with feelings of low self-esteem, having grown up with an alcoholic mother who was often emotionally abusive and frequently critical of Shelly’s appearance. By her teens, Shelly had already begun the vicious cycle of binging and purging. She also started drinking often, finding alcohol to be a convenient way to numb the emotional pain. As Shelly got older, she tried many times to curb her bulimia and cut back on her drinking. Unfortunately, her intense feelings of unworthiness and self-loathing led to a vicious cycle of binging, purging, and drinking to help her cope with the depression she felt each time she failed. She eventually began working with a therapist to address the depression, low self-esteem and bulimia. Although Shelly was initially in denial regarding the seriousness of her alcohol problem, she eventually agreed to enroll in a dual-diagnosis drug rehab treatment program. Shelly’s story is not uncommon. Research consistently shows individuals who struggle with an eating disorder, like Shelly, also frequently abuse alcohol or drugs. Some will use drugs like heroin and cocaine to boost weight loss and increase metabolism. It’s not uncommon for them to abuse over-the-counter medications that speed up their metabolism, suppress their appetite, or purge their body. People with eating disorders may also use alcohol or drugs to soothe themselves in the belief that self-medication will numb the emotional pain they’re experiencing. Some research indicates that while eating disorders and substance abuse frequently occur together, the link may be higher in those with bulimia than anorexia [2]. Severe bulimia has been linked, in particular, to alcohol abuse [3]. In addition, studies have found that a woman with either an eating or substance abuse disorder is more than four times more likely to develop the other disorder than a woman who has neither. The research also suggests that as an eating disorder becomes more severe, the number of different substances used increases [4]. People already in recovery from an eating disorder may be more vulnerable to substance abuse as well. Abusing alcohol or drugs may become a way to cope with the stress and anxiety of recovery [5].

Common Characteristics

Although it’s not yet entirely clear how these mental health conditions are linked, we do know they share a number of risk factors, including:

  • Occurrence during periods of stress or transition
  • Family history of the disorder
  • Low self-esteem, depression, or anxiety
  • History of sexual or physical abuse
  • Unhealthy peer norms

Eating disorders and drug or alcohol abuse also have shared features, including:

  • Feeling obsession and preoccupation with the behavior
  • Experiencing cravings
  • Engaging in rituals surrounding the behavior
  • Experiencing mood-altering effects
  • Living in social isolation
  • Requiring professional therapy, such as drug rehab treatment, to stop

Suicide Risk

Research has demonstrated that suicide is a major cause of death in those with anorexia and bulimia [6].Some studies estimate as many as 20% to 35% of eating disorder patients have attempted suicide [7]. Evidence now suggests that the suicide rate for people with both conditions may be higher; in one study, bulimic women who abused alcohol were more likely to commit suicide than bulimic women who did not [8].

Eating Disorder and Substance Abuse Treatment

If you live with an eating disorder and alcohol or drug abuse, you must receive professional treatment for both conditions. In the past, it was common to treat each disorder separately. For example, a person might undergo alcohol or drug rehab treatment first, and then enter therapy for the eating disorder. However, there’s a recent trend toward treating both conditions with one integrated plan. While treating both disorders together can be complex, it can be successfully done by an experienced mental health team. Treatment may start with hospitalization if you have an eating disorder and are dangerously malnourished, suffering related medical complications, or experiencing severe depression. Once physical health is stabilized treatment will likely begin with cognitive behavioral therapy (CBT). In this common treatment, which is preferred by many therapists, you’ll work to restructure the thinking patterns that trigger destructive behavior. It will also address the underlying roots of each mental health disorder. For example, a therapist can help examine emotions related to a childhood trauma and how they direct behaviors such as drinking alcohol or restricting food. An experienced therapist will work to resolve that trauma as well as repair self-esteem. Peer support groups are another tool for eating disorder and alcohol or drug rehab treatment. Your therapist may recommend joining a12-step-based group for substance abuse. In some areas, you may also have access to groups, such as Eating Disorders Anonymous (EDA) or Overeaters Anonymous (OA), focused on managing eating disorders. The treatment team may also recommend additional therapy. For instance, family therapy might be used to help an adolescent with anorexia. The clinician will start by giving parents the tools to control the teen’s eating disorder. As the child learns healthy behavior, he or she is gradually given more control over their eating habits. Nutritional counseling may be recommended as part of a drug rehab treatment plan that addresses both eating disorders and substance abuse. This is often necessary if your conditions have left you malnourished. Working with a professional, like a registered dietician, the goal will be to learn about proper nutrition and develop healthy eating habits that build a stronger body. The decision to enter eating disorder therapy and alcohol or drug rehab treatment can be scary; but the price of not treating these conditions is too high. If you or someone you love is struggling with eating disorders and substance abuse, talk to a mental health professional or treatment center with the skills and resources to treat both conditions. Choose to reclaim your health and your life by seeking treatment.

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