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The Latest on Co-Occurring Eating and Addiction Disorder

This combination may be surging, but we’re learning how to fight it.

Key points

  • As many as 50 percent of people with eating disorders also abuse alcohol or drugs, a five times higher rate than the general population.
  • Up to 35 percent of people with serious drug or alcohol issues also have an eating disorder.
  • New strategies and protocols in treating addiction and eating disorders offer hope for a full recovery.

The public awareness of eating disorders probably peaked in the 1990s when the “heroin chic” look among fashion models dominated the advertising industry. That warped beauty ideal did a lot of psychological damage to countless young women who became obsessed with their body image, weight loss, and eating habits.

But despite some progress made by the ad industry in getting away from that unhealthy look, eating disorders such as bulimia, anorexia, and bingeing are still very much with us. And, as always, people with eating disorders are also at high risk of alcohol and drug addiction.

The Numbers Make It Clear

As much as 50 percent of people with eating disorders also abuse alcohol or drugs, a rate that is five times higher than the general population. Looking in the opposite direction, up to 35 percent of people with serious drug or alcohol issues also have an eating disorder. That’s 11 times the rate of eating disorders among the general population.

This strong connection between addiction and eating disorders makes a lot of clinical sense, given that the two conditions share several risk factors. These include brain chemistry, family history, low self-esteem, depression, anxiety, and certain social factors.

What I See at My Addiction Clinic

At the treatment center in Jacksonville, Florida, where I am the chief medical officer, we see certain patterns and tendencies in our patients with co-occurring substance use and eating disorders. It will be useful to look closely at some of these now.

Often, when a patient arrives, we don’t know about the eating disorder part. (The patient isn’t always aware of it either.) When the person gets out of detox and then benefits from a few days of sobriety, the eating disorder starts to appear.

A lot of that is about control. When people come into treatment, we ask them to surrender control. We ask them to trust us, to let go, to stop fighting against themselves, and to be open to the possibilities of treatment.

But giving up control is hard for people with addiction. For those with co-occurring eating disorders—either latent or known—when they give up control of their addiction, they compensate by controlling their eating instead. This can quickly become compulsive and may cause their eating disorder to reveal itself in a big way.

At our center, we’re always watching out for this, in part because it’s so common, especially among our female residents. Our goal is to help people better understand and recover from their eating disorders and addiction.

Another pattern we see in this population is all about calorie replacement. When people come into treatment with alcohol addiction and no longer have access to alcohol, their brain tells them they need to replace those calories with something else. That’s when some patients engage in binge eating as a way to make up for the lost calories. Again, we’re always on the lookout for this, and we help patients work through it.

A Different Kind of Brain Drain

As you can see, there are a lot of interconnections between addiction and eating disorders—a lot of overlapping behaviors and shared brain chemistry. And a lot of ingrained patterns with each condition. This is why it is so necessary to treat these two conditions simultaneously in an integrated manner. If you only treat one of the conditions, the other is still there, and it doesn’t go away by magic.

That interconnectedness brings me to a classic cycle I want to cover that goes like this: People with co-occurring substance use and eating disorders often have very poor diets. Because they don’t get the nutrients they need, they can’t manufacture enough of the healthy brain chemicals they require, including serotonin and dopamine.

These are brain chemicals that help you feel pleasure and happiness. When you don’t have enough of them, you feel depressed. At that point, your brain’s entire mood center can get out of whack.

How do people deal with this depression? In many cases, by self-medicating with alcohol or drugs or abusing food. That leads to poor nutrition, a drop in healthy brain chemicals, and the cycle continues.

Social Media Is Not Helping Matters

I mentioned earlier that the advertising industry is somewhat better about portraying reasonable body types. Unfortunately, social media may now be doing as much damage in this area as the ad industry ever did. With powerful and omnipresent options like Facebook, Instagram, and TikTok, young women especially are bombarded with images of perfect women with perfect bodies living so-called perfect lives. That can do a lot of psychological and emotional damage.

Recent research makes it clear that young women with low self-esteem (and who doesn’t occasionally have low self-esteem when they’re young?) become vulnerable on these sites with their sneaky algorithms that learn your “likes,” desires, insecurities, and tendencies—and keep feeding you more of them.

Many young women can become almost hypnotized by all this. Suddenly they receive messages about extreme weight loss advice, warped body image photos, purging tips, and so on. They hardly notice how wildly inappropriate it all is. From there, it’s a short and slippery slope to self-medicating to feel better, and soon enough, the person can become addicted to drugs or alcohol.

Throw social isolation into that mix, as is happening with Covid, and it’s no wonder we see surges in eating disorders and addiction.

Bottom Line: Treatment Works

I know I’m painting a grim picture, but I’m just trying to describe what we’re up against. That said, please know there’s always hope for a full recovery for women and men who are struggling with co-occurring substance use and eating disorders. It’s a difficult combination to treat, but we’re getting better at it. We’re learning new strategies and protocols all the time.

One example: Many leading treatment centers are finding success with an evidence-based method called dialectical behavior therapy, or DBT. An offshoot of cognitive behavior therapy, DBT was originally developed to treat people with personality disorders and high emotional responses to their environment. DBT is now helping many people with co-occurring substance use and eating disorders.

The more important remedy for co-occurring addiction and eating disorders is to catch it early or stop it from happening in the first place. Prevention is so key, and successful prevention happens every day.

Care, vigilance, love, and empathy from a person’s family, along with guidance from a family doctor or therapist, all come into play when helping someone steer clear of this debilitating combination.

To find a therapist, visit the Psychology Today Therapy Directory.