Eating Disorders and Co-Occurring Substance Abuse: What’s the Connection?

Although not common knowledge, eating disorders often co-occur with substance abuse. Studies suggest that 50% of those suffering from an eating disorder are also abusing substances, a rate five times greater than that of the general population. Other research shows that 30%-50% of all people suffering with bulimia have a co-occurring substance us disorder, while it is less common in those with diagnosed with anorexia, but they do occur.

What is a substance use disorder?

According to SAMHSA, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), no longer uses the term substance abuse, but refers to it as substance use disorders, occurring when “the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home.” Defined as mild, moderate, or severe to indicate the level of severity, substance use disorders are based on evidence of impaired control, social impairment, risky use, and pharmacological criteria.  They are characterized into 10 classes that include the following substances:

  • Alcohol
  • Caffeine
  • Cannabis
  • Hallucinogens
  • Inhalants
  • Opioids
  • Sedatives, hypnotics, or anxiolytics
  • Stimulants
  • Tobacco
  • Other unknown substances

What are the similarities between the two disorders?

There are similarities between the physiological conditions, neurotransmitters, and personality traits of eating disorders and substance use disorders. As it does with eating disorders, genetic, biological, environmental, and psychological factors also influence substance abuse.

Other links between these disorders include:

  • Coping Mechanism: Those suffering from an eating disorder will often use drugs or alcohol when they are feeling depressed or have low self-esteem. Someone with a substance use disorder may develop an eating disorder when they use food to satisfy cravings or to avoid withdrawal symptoms.
  • Weight Control: For some, substances may cause appetite suppression leading to weight loss, which can, in turn, trigger an eating disorder. Other drugs, such as cocaine, are often used to increase metabolism.

What are common eating disorders?

While substance use disorders can co-occur with any eating disorder, research has shown a stronger correlation between bulimia and substance use and anorexia and substance use.

There are three common types of eating disorders:

  • Self-starvation and excessive weight loss characterize anorexia. Studies show that 10%-20% of those suffering from anorexia will die from complications related to it, giving it the highest mortality rate of any mental illness. Sufferers often have low self-esteem and need to control their emotions and surroundings.
  • A cycle of binge eating followed by purging characterizes bulimia. The goal of someone with bulimia is to rid the body of unwanted calories and the sensation of being overly full. Many of those suffering report they have little or no control over their hunger when they binge.
  • Recurrent binge eating in a short period with a sense of loss of control and shame characterizes binge eating disorder. Binge eating disorder affects an estimated 3.5% of women and 2% of men, making it the most common eating disorder in the U.S.

What treatment is available for a dual diagnosis?

When an eating disorder co-occurs with substance use, the consequences, assessment, treatment, and recovery are more difficult for both disorders than just one. Treatment for dual diagnosis is an integrated way to help reduce the pattern of patients wavering between an eating disorder and substance abuse.

Magnolia Creek provides treatment that addresses both disorders at the same time. Our program is comprehensive and strengths-based, incorporating elements of spirituality, mindfulness, nutrition, art, movement/exercise, and psychotherapy. For a person with a true dual-diagnosis we use the principles of 12-step recovery, and require attendance at least three 12-Step or SMART recovery meetings per week.

Those suffering from co-occurring disorders often struggle with poor self-esteem, and feelings of guilt. Through weekly individual therapy sessions, daily psychoeducational groups, and weekly meetings with the clinician and dietary staff, clients learn ways to cope with stress, express emotions, learn distraction and self-soothing skills, balance wants versus needs, and handle conflict. With the guidance of our certified dietitian, clients develop an individualized meal plan to nourish the body’s needs. Our comprehensive treatment approach helps to end the behaviors contributing to the dual diagnosis.

There is a high rate of relapse for those struggling with the dual diagnosis, so relapse prevention strategies are a common part of most treatment programs, as well. At Magnolia Creek, we help our clients to identify triggers and develop coping skills to manage their urges to reduce the risk of relapse. We also offer real life challenges in partnership with our clients to practice trigger management skills.

Eating disorders and co-occurring mental health conditions greatly impact families, and there is a greater chance for a full recovery when there is a reliable support system. Involvement from friends and family is important and a critical part of the treatment process at Magnolia Creek. Family therapy is designed to provide education, advocacy, and therapy for family members. Clients meet with their treatment team to establish the family and relationship goals and determine their support system with whom they would like to work in family therapy. Our therapists are available to meet with the family via phone or in-person sessions.

Educate yourself, be proactive and know that both these disorders are treatable. If you or someone you love is struggling with an eating disorder and abusing substances, please do not hesitate to reach out to Magnolia Creek. We would be happy to talk with you about resources and ways to get the support needed. Call us at 205-409-4220 or complete our contact form.



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