The Link between Substance Abuse and Eating Disorders
I have always been very open about my past struggles with alcohol abuse and eating disorders. I also struggled with generalized anxiety disorder, panic disorder, and self harm. I often felt like the only one who struggled with so many comorbid diagnoses. The reality is people rarely struggle with only one disorder. We simply do not fit in the pretty boxes of diagnoses, nor are we supposed to.
Statistics on Substance Abuse and Eating Disorders
Data suggests roughly 50% of individuals with eating disorders are also abusing drugs and/or alcohol. There is a strong association between alcohol use disorders (AUD) and women with anorexia nervosa binge-eating/purging type (ANBP), bulimia nervosa (BN), binge eating disorder (BED), & eating disorders not otherwise specified (EDNOS). Also, in general, women with SUD (substance use disorders) have higher rates of disordered eating than the general population. Nearly 35% of alcohol or illicit drug abusers have eating disorders compared to 3% of the general population.
Addictions Comorbidity, Dual Diagnosis
I often think of the perfect storm analogy with addictions and eating disorders. To me they both are ways to manage, control, react and cope with life and its struggles. Yes, there are biological inclinations, and neuroscience is starting to show more links to why we may struggle with the disorders we have, but to me they are a complex relationship that is far more common than I thought when I was struggling. These struggles are dangerous and deadly.
"For many young women, eating disorders like anorexia and bulimia are joined at the hip with smoking, binge drinking and illicit drug use," said CASA president and former US Secretary of Health, Education and Welfare, Joseph A. Califano, Jr. "This lethal link between substance abuse and eating disorders sends a signal to parents, teachers and health professionals- where you see the smoke of eating disorders, look for the fire of substance abuse and vice versa."
I never heard these statistics when I was struggling. My parents never knew it was common when they couldn’t find me a residential facility that would be able to treat both substance abuse and eating disorders. These statistics need to be shared because they help not only the people who struggle feel less alone, but they help see the lack and need for research on comorbid conditions.
Struggles in the Treatment of Substance Use Disorders and Eating Disorders
There is a challenge sometimes to integrate treatment for substance use disorders and eating disorders. Some clinicians refer patients out to handle their substance abuse before the eating disorder treatment, which makes sense since substance abuse often can require detox. My first thought is, how much money this will cost a person struggling.
Some clinicians may not be knowledgeable for the treatment of both disorders. There is a science/practice gap between and within the substance use disorders and eating disorder fields. In general, there is a huge need for cross-training & research collaboration between these two fields necessary to identify best evidenced based treatment (EBT). There is also a huge difference in identification and conceptualization of eating disorders and substance abuse disorders.
The Need for Multi-Disciplinary Treatment
When I went to my residential vacation for 30 days, I was in an addiction specialized place. I think it was a life saver for me, helped me get sober, but wasn't everything I needed. When I got out, I went to AA (Alcoholics Anonymous) for several months, got a therapist, a psychiatrist, but had no support with my eating disorders. I wish I had seen a multi-disciplinary team that would have helped me with my eating disorder and alcohol addiction. I didn’t know how to eat, how much to eat, how to cope with eating disorder urges. With alcohol or drugs, we can be abstinent, but when we add eating disorders, we have to eat. There are a lot of challenges, and a multi-disciplinary team can help best address the variety of struggles people may be going through.
There is so much more to the comorbidities picture with addictions. People with addictions struggle not only with eating disorders, but with mood disorders, personality disorders, anxiety disorders, etc. I hope with this blog to delve more in the future to create dialogues, and create awareness of them.
Sebelius, K. (2011, June 16). The Link between Substance Abuse and Eating Disorders, HealthyPlace. Retrieved on 2021, May 12 from https://www.healthyplace.com/blogs/debunkingaddiction/2011/06/the-link-between-substance-abuse-and-eating-disorders
Author: Kendra Sebelius
I have several coexisting illnesses that I have suffered with since my early teens, if not before, I'm 47. I have improved greatly but still have anorexic tendencies when I feel stressed. I have 14+ years of sobriety thanks to the women's AA meetings I attend and the love of my husband. None of my inpatient stays tried to help me with everything, or more than what they viewed as the most deadly at the time. I've found what trips me up the most is my ptsd. I've been through many forms of trauma. Fortunately I have a therapist who cared about the "whole" me. She is understanding, patient and extremely knowledgeable. We need more professionals that are cross trained in many, if not all psychiatric illnesses and how they interact with each other. Then, the largest challenge will be to get all insurance companies to pay for brains disorders the same way they pay for other parts of our body.
Was good to learn that it is only the drugs and alcohol that are abused but also food. Thanks a lot from your article.
Eating disorders was an abuse from the article is where i learnt that. Thanks a lot. i shared with my friends.
Great article! Comprehensive treatment that covers both diagnoses is long overdue (although available in a handful of places so far).
Not only are the disorders often found together, but the symptoms and behaviors can often exacerbate each other. For example, I know quite a few individuals whose alcohol use goes up significantly as their food intake goes down. It would seem that not only are there genetic and behavioral links, but perhaps food restriction itself puts someone at risk for overconsumption of alcohol, as alcohol is often viewed as being 'different' than 'normal food' for those who are restricting, and the more drunk someone gets, the more their physical hunger and need for caloric intake can drive their behavior.
I don't think that's the main issue with the eating disorder / substance abuse co-morbidity, but it does seem to be an interesting part of the pattern.
I have been working in the field of Chemical Dependency and Eating Disorders for about 30 years now as a clinical social worker. I agree with your assessment regarding the challenges of treatment for these (in addition to other psychiatric co-occurring illnesses as well). I have seen people who need treatment for both ED and CD similtaneously, or they will only symptom substitute back and forth. Often, we send someone for treatment for whichever illness is likely to kill them first, hoping the other illnesses will be addressed once one is stabilized. Still, the therapy revolving door is often the result. I am running an out-patient group for ED/CD with a Cognitive Behavioral and Dialectical Behavioral Therapy focus and hope that this will be a helpful model for other groups and programs to come. Unfortunately, insurance companies don't cover group therapy, which is mind-boggling since groups are EBT of choice for both ED and CD! Thanks for your work.
After getting treatment/education for my own alcohol addiction and ED, my guess is that "mom" also was alcoholic, had an ED and was probobly Manic Depressive. I never learned to be "normal" when I was younger, and had no way to get the coping skills I needed to get along, successfully and healthfully without being high, when I got older. At 49 years old, I'm just starting to learn how to have fun without substance abuse, altho food-as-a-substance is still a problem. It all starts with trauma and trying to find ways to not think about it all the time (even when you don't think you are thinking about it).
Let's hope the professionals start listening to patients like us, and figure out ways to work around the HMO/Insurance Beast to get us the multiple-specialist care we need. Of course, if we get well, the profits we help generate will go away :(
The more I share my story of struggling with multiple disorders, more people share their story with me. I really appreciate you having and sharing your voice. I think recognizing our family history, genetics, triggers, struggles all help as a part of treatment for our struggles. It is important to address all of who we are, and address our multiple struggles and find an individualized treatment plan that works for us. I think a treatment plan modality is really effective for those with co-morbodities. When you have a psychiatrist, therapist, nutritionist/RD, support, mentor, etc it can help in all areas of our life. Sometimes we have to find our own way, and pave our own path through this journey. But it is possible!
Oprah Winfrey is running a series called "Addicted To Food" That's my #1 addiction, but I have struggled with alcohol and gambling in the past.
In the series, there seems to be a lot of blame put on the mother. When they asked "Did your mother tell you to eat your vegetables"? I would have to say NO, because her mother died when she was 9, and my grandfather married an alcoholic who physically abused her. How on earth can I blame my mother/
I watched the first episode only so I cannot speak with knowledge of the entire series, but I am shocked there seems to be blame on the mother! How outdated is that information???? Seriously frustrating when we are trying to share actual information and awareness of contributing factors to eating disorders. I appreciate your coming here, sharing your voice and vulnerability in your story!
there's a huge correlation also with trauma and eating disorders (and the other substance abuses). myself and some other patients used to get bounced back and forth between the inpatient trauma unit and the eating disorders unit (at different hospitals early on).
It was crap. at the eating disorders unit in the beginning they forbid us to speak of our traumas and did not provide us any trauma specialists for individual or group therapy. for me, I'd be forced to eat stuff that triggered my trauma symptoms, so then my ptsd would get aggrivated and before long I'd be on the trauma unit again.
on the trauma unit, they provided no support for the anorexia, and it was human ping pong for me and several others I knew.
on the eating disorder unit, every wed they had a patient/staff meeting (can't remember the name they gave it) I began each week to advocate for a trauma group. they'd give this or that lame reason why they couldn't do it.
eventually (several years down the road) we got trauma specialists on the eating disorders unit. and OT's too. then, eventually (a couple more years) they moved the eating disorder unit to the same hospital with the trauma unit, and added group as well as individual therapy for the trauma survivors.
Also, at first, when I would speak of my anorexia in terms of being an addiction, staff would dispute me. I'd explain to them that i was addicted to the comfortably numb feeling a good starve provided me. I'd argue that food is a substance.
eventually, they came to understand this. we got addictions specialists on the eating disorder unit too. (they still sent people off unit to meetings on the trauma unit though, and no support for eating disorders on the trauma unit either.. hope that has improved since I moved away)
I didnt' fight this battle alone, along the way other patients would speak up too.
I'm not entirely sure I was the first to speak out on the crap of the human ping pong and the need for a more comprehensive treatment program, but I do know I was the most frequent squeeky wheel on the issue for a while. so much so that before those wed meetings staff used to ask me not to bring it up this week. they were required to take patient requests/questions to a staff meeting then report back the next week. it was when I refused to be silent until we got heard that other patients began to share their voices on the issue as well.
hope you can begin to squeek to the program directors where you find treatment.
On the matter of outpatient options. Where I was there were AA meetings daily (hourly in some areas), but eating disorder support group was monthly (and sparsely located). by a case of serendipity, I discovered the usefulness of NA. that was very helpful. they recognized that, since food is a mood altering and mind altering substance, I belonged at the meetings since I was abusing a mood/mind altering substance.
they used to modify some of the slogans for me. sometimes just with inflection. one was; for the mainstream members - If you don't pick it up, it won't get in. said with the tone of Don't Pick it Up. for me... same words, "if you don't pick it up, it won't get in" but said with a tone that said. dude! pick it up!
they were very compassionate about the fact that I could act on my addiction by going to meetings. just by restricting the (avoiding, passing up) the refreshments being shared.
Also, in the early years, insurance didn't want to cover outpatient dieticians. you might want to check for a nutritionist offering medical nutrition therapy. they can be a valuable resource for that problem you speak of with not being able to recover from disordered eating by the same means as with drug or alcohol addiction. we simply can't just never pick it up again and that's that. we have to pick it up, in the right varieties, in the right quantities, with the right frequency. and this "right" business isn't easy to make a habit.
I found your comment very timely and hugely important to many people with eating and substance use disorders. Now teams need to be established, as you note, with all skills on board and this also requires the notion that all are biologically based disorders (which they are and as more research is published this will become clearer) and the folks who have them need and deserve comprehensive completely covered treatment that insurance companies will pay for.
Thank you so much Jennifer. I am finding more and more people who are being open about their struggles with both and absolutely agree that we need a better comprehensive plan. The insurance piece is a huge problem, I know that when I was struggling I was grateful and lucky to have substance abuse because the insurance company covered everything, and hopefully with the FREED act we will start to see eating disorders coverage get the change they deserve as well!