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A few months ago, I wrote a post about eating disorders and co-morbid disorders, meaning conditions that tend to occur along with eating disorders.  One of these co-occurring conditions was substance use, which can be used as a way to aid with eating disorder behaviors, or as another emotional self-regulatory measure. 

In fact, Tagay and colleagues (2014) found that in a study of over 2400 individuals with an eating disorder, 22% also exhibited an alcohol or substance use disorder. The National Center of Addiction and Substance Use reports that up to half of individuals with eating disorders abused illicit substances or drugs. Moreover, individuals with substance use disorders were found to be 11 times more likely to have an eating disorder compared to the general population (2003).

Does One Cause the Other?

There appears to be some type of relationship between eating disorders and substance use – does one lead to another?  There definitely are ways that substance abuse can contribute to an eating disorder. For instance, individuals with bulimia may drink excessive amounts of alcohol as a means to help them induce vomiting. Moreover, the use of marijuana can trigger food cravings that can contribute to a binge episode. Eating disorder behaviors are often used as an adjunct to substance use, with the aim of enhancing the effect of alcohol or the drug. For instance, some individuals engage in food restriction prior to consuming alcohol so that the alcohol could have a greater effect (a phenomenon called “drunkorexia”). 

Regardless of these connections, something extremely important to note is that eating disorder behaviors and substance use are just manifestations of the same problem – depression, anxiety, mania, trauma, or other sources of emotional dysregulation. Both eating disorder and substance use behaviors also share common risk factors such as low self-esteem, genetic vulnerabilities, brain chemical imbalance, and sociocultural pressures. Subsequently, the use of substances or disordered eating behaviors (binging, purging, restricting, excessively exercising, etc.) are symptoms, or ways that the individual is trying to cope with whatever underlying processes are occurring – both those that are in their awareness or unconscious. 

Thus, when someone tries to combat one of these disorders, they may face a “whack-a-mole” phenomenon, in that as some of their behaviors subside (e.g. purging), other behaviors or symptoms will “pop up” or increase (i.e. alcohol abuse). This process is an essential part of understanding eating disorders and substance use as symptoms that don’t just have to do with food, drugs, or willpower, but as maladaptive coping strategies that many use to deal with underlying mental health issues and attempt to regulate emotions. At a certain point, these techniques may no longer work to quell the person’s emotional distress, but the individual faces withdrawal or other immense physical or mental discomfort if they don’t engage in the behaviors, making them even harder to stop (National Center on Addiction and Substance Abuse, 2003).

The substances most frequently abused by individuals with eating disorders or types of disordered eating include both substances related to manipulating the body physically and/or mentally – these include laxatives, emetics, diuretics, tobacco, alcohol, diuretics, amphetamines, heroin, and cocaine.

What Happens If I Have Both?

Co-occurring substance use and eating disorders are not uncommon, and various treatment programs are equipped to handle both; many provide integrated treatment approaches. Other treatment modalities may call for addressing one condition before the other. This depends on the severity of each disorder and the individual’s mental and physical state. For instance, for an individual who is drinking alcohol heavily and functionally impaired but may not be in a severely malnourished state, addressing eating disorder behaviors initially and engaging in therapy around this will be ineffective, as the individual won’t be able to engage in their treatment when under the influence. Thus, alcohol detox and/or rehabilitation would be necessary initially to first address the individual’s substance use and restore their mental functioning, so that they are able to engage in eating disorder treatment.

Regardless of whether you exhibit eating disorder behaviors, substance abuse, or both, know that these are strategies you have developed to protect yourself. If you are reading this article, my guess is that these behaviors are no longer working for you and you are trying to find a way out. With appropriate treatment, consistent care, and your willingness, you can find better ways of living. 


Bahar Moheban, M.A. is a clinical psychology doctoral candidate and registered psychological assistant in Torrance under the supervision of Dr. Nazanin Moali. She provides individual therapy and facilitates a Body Image Group for adults and adolescents with disordered eating, body dissatisfaction, and comorbid disorders.  If you are struggling with bulimia nervosa or any other type of disordered eating, contact Bahar for a counseling appointment to repair your relationship with food and body image.


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