Eating disorders and substance abuse can be crafty and complex partners in crime. Research shows about half of people with eating disorders also abuse alcohol or other drugs. Over 35% of people with substance use disorders also engage in some form of disordered eating behavior. These patterns can take a few forms and may feed off each other, creating a vicious cycle of emotional pain, alcohol, drugs and weight loss.

Here’s what recent research has to say about eating disorders and drug and alcohol abuse:

Heroin and binge eating disorder (BED) – A 2017 study published in Eating and Weight Disorders journal found that men who met the DSM-5 criteria for binge-eating disorder were 21% more likely to also abuse opioids than those without BED. Alcohol abuse and bulimia – Researchers at the Medical University of South Carolina found that of over 3,000 study participants, 31% of women with bulimia also had a history of abusing alcohol.

Stimulant misuse and anorexia – Adderall drugs and weight loss side effects can encourage abuse by people with anorexia and bulimia. A few years ago a trend coined “Addorexia” became popular. People with eating disorders abused Adderall, a stimulant used to treat ADHD and narcolepsy, to lose weight.

Cocaine and eating disorders – In a sample of 259 cocaine abusers who phoned into the National Cocaine Hotline, 32% also struggled with anorexia, bulimia or both eating disorders.

Marijuana abuse and bulimia – Researchers at Ball State University found that one out of three adolescents with bulimia also used marijuana, tobacco and alcohol weekly.

Tobacco and eating disorders – A 2006 study published in the Eating Behaviors journal examined tobacco use in 1,524 women. The study found that those with eating disorders had higher rates of smoking cigarettes than controls. People with bulimia and binge-eating disorder used tobacco products the most across the different types of eating disorders.

Common Denominators Behind Eating Disorders and Addictions

Alcohol addiction, drug abuse and eating disorders often share many of the same underlying issues, which is why they frequently affect people at the same time. These core issues can include:

Impulsivity issues – Researchers theorize that impulsivity issues fuel eating disorders and substance abuse. Impulsivity issues occur when people are unable to control actions that are detrimental to their health, relationships, finances or careers. Impulse control disorders can range from compulsive gambling and shopping to sex addiction and uncontrollable rage. Aspects of eating disorders like binging, and characteristics of substance abuse that leave people feeling unable to stop abusing drugs or alcohol even with dire consequences, may be fueled by impulsivity issues.

Overlapping genetics – A 2013 study published in the Journal of Studies on Alcohol and Drugs found that some of the same genes that predispose a person to developing addiction can also predispose them to disordered eating. Data from almost 6,000 twins showed that genes that increased the risk for alcoholism also put people at risk for behaviors like binging, purging and laxative abuse.

Self-medicating – Drugs and weight loss from disordered eating behaviors are often tied to self-medication. People with addictions often haven’t developed healthy coping skills to manage underlying issues like mental health disorders and trauma. They use drugs and alcohol to cope. Similarly, behaviors like binging and purging, over-exercising and restricting can serve a similar purpose.

Challenging environments – Research shows difficult family situations, such as having a parent who abuses drugs and alcohol, puts people at risk for eating disorders, substance abuse and a number of other diagnoses like anxiety, depression and post-traumatic stress disorder. Poor interpersonal relationships, unpredictable anger, and attachment issues such as a neglectful, abusive or overly enmeshed parent may contribute to disordered eating and drug and alcohol abuse.

Mental health issues – Several studies show that substance abuse and eating disorders co-occur with similar underlying psychiatric conditions, especially mood disorders and personality disorders. When mental health disorders are undiagnosed or underdiagnosed, people may abuse drugs or alcohol or engage in disordered eating patterns to alleviate some of their symptoms. Alcohol and drugs and eating behaviors like binging act on the reward center of the brain in similar ways. These activities can make people struggling with mental health issues who are short in dopamine and other feel-good neurotransmitters feel better temporarily.

Risk of Addiction in Eating Disorder Recovery

People with eating disorders may be at risk for developing a substance use disorder once their bulimia, anorexia or binge-eating disorder symptoms are managed. This is what’s known as a cross addiction or

substitute addiction. Unless the underlying issues that drive people to engage in disordered eating behaviors are addressed in eating disorder treatment, there’s a possibility they’ll continue to rear their head in the form of another destructive behavior pattern, such as substance abuse. By the same token, people who get sober, but haven’t developed healthy coping skills or addressed some of the issues perpetuating drug and alcohol abuse, may be at risk for coping in unhealthy ways with food and diet.

Treating Addiction and Eating Disorders

Approaches that are effective in treating eating disorders and co-occurring issues like substance abuse and mental health disorders include:

Cognitive behavioral therapy (CBT) – Cognitive behavioral therapy is goal-directed and problem-focused. CBT helps people challenge distorted thinking that can accompany drugs and weight loss efforts that are obsessive. People learn to replace these thoughts with healthier thought patterns. They explore why substance abuse and eating disorders aren’t working for them and develop better ways to cope.

Dialectical behavior therapy (DBT) – DBT is similar to CBT but incorporates more mindfulness and distress tolerance skills. People learn to be more accepting of difficult feelings without trying to push them away or ruminate on them. Dialectical behavior therapy helps people learn to better regulate their emotions so they’re less likely to numb feelings with drugs or weight loss tied to disordered eating.

Medication management – Research shows non-addictive medications like SSRIs (Prozac®) and tricyclic antidepressants (Norpramin® and Norpramin®) may help decrease eating disorder symptoms. Medication-assisted therapy for opioid abuse and alcohol use disorders include drugs like naltrexone (Vivitrol®), buprenorphine (Suboxone®) or methadone. Medications for addiction, mental health disorders and eating disorders are most effective when people are also working on underlying issues in individual and group therapy.

Relapse-prevention training – In eating disorder recovery and addiction recovery, it’s necessary to develop healthy coping skills to replace urges to binge, purge, restrict, over-exercise or drink or use drugs when triggers arise. These skills may include practices like mindfulness, attending support groups and individual therapy, taking prescribed medication as directed, and learning to identify situations and feelings that may lead to relapse before it happens.

Family therapy – Substance abuse and eating disorders impact the entire family system. They’re often a symptom of core problems within the family that need to be addressed. Family therapy helps loved ones work through difficulties with the help of a trained professional. Family members learn how to communicate better and support each other in healthy ways while understanding the importance of taking care of themselves and not enabling loved ones.


Choose a better life. Choose recovery.