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Connection between eating disorders and substance use disorder

By Lindsey Hall

Understanding the Co-Occurrence of Eating Disorders and Substance Use Disorders

It was 2015 when I first publicly proclaimed that I struggled with “drunkorexia” in a post on my now defunct blog.

Looking back, I had no idea what I signed up for that day, but over the years I somehow became the actual Wikipedia image of the nonmedical (but kind of medical) term “drunkorexia.”

My parents are so proud, let me tell you. (I joke. They do support my work very much but I’m sure that was difficult for them.)

An important subject, I don’t regret speaking out about the mixture of eating disorders (EDs) and alcohol. Someone needed to do it, and I’d witnessed this lifestyle of alcohol and EDs being normalized since I was 18 in a sorority house in Arkansas.

Still it has ended up positioning me in an interesting place in life where I’ve often had to take a big microscope to my going-out habits and frame them in the context of whether they’re driven by my ED or something else entirely. And I’ve done so while in the media and on social media.

In truth, I’ve been on a journey with alcohol since I first started writing about the co-occurrence of EDs and substance use in that fateful blog, where I publicly proclaimed: “The truth is I’m not recovering from an eating disorder anymore − I’m recovering from a lifetime of bad habits.”

It’s been a long 7 years, with appearances on “The Today Show” and more, but I wouldn’t take any of it back. And I continue that journey today so long as it allows others to step back, for even a moment, and ask themselves what their relationship to food and alcohol is.

According to the National Center on Addiction and Substance Abuse, 50% of individuals with EDs have also abused alcohol or illicit drugs, with the rate of substance abuse in people with EDs five times higher than in the general population.

The numbers go both ways when you look at the data: 35% of individuals with substance use issues have also had an ED, which equates to 11 times higher than the general population.

Why is this? Why did I use wine as a means of fueling my ED in my 20s? And frankly, why was I surrounded by humans that often referred to dinner as the “liquid diet” like it was a normal wisecrack?

Leah Young, LCPC, Clinical Manager of Addiction Recovery and Comprehensive Help Integrated Services at ERC and Pathlight, explains: “Often people use substances in their eating disorders to help give themselves permission to eat.”

And as we all know, disordered eating is prevalent and everywhere.

I read somewhere that many people with EDs tend to experience emotions with great intensity, prompting coping skills that help to reduce the weight of those feelings. Food restriction and binge eating, two primary symptoms of EDs, often serve to regulate emotions, even if that momentary subsiding is just that… momentary. But this was the story of my life.

I wanted to be the “perfect” version of myself. I was grieving my best friend’s death at 18, struggling with low self-esteem, and feeling lost. Sometimes I used my ED as a means to show all of this, without having to say it. Because I didn’t know how to say these things.

Substance use disorders (SUDs) often function in the same way, i.e., substances are used to self-medicate for strong negative emotions. Put the two together and the result is a melting pot of questionable coping mechanisms. As a culture, we’re taught these things work in the moment. The real question is, to what extent and with what consequence?

I made a lot of poor choices in my early 20s, fueled by alcohol, which often was fueled by my desire to skip dinner and just “drink the calories,” or which on occasion gave me permission to eat and, as Leah Young put it, “engage more fully in our ED behaviors” by reducing the anxiety about eating.

In turn, I hurt myself, hurt others, put myself in dire situations, and even ended up in jail one night, which only led to new emotions of guilt or shame, which led to more ED behaviors or substance use. This ultimately put me into a cycle that was incredibly difficult to stop.

While this was my personal journey, others may have different experiences. Leah Young notes that it can be challenging to spot disordered eating in people recovering from substance abuse because for such individuals the cultural emphasis on exercise and “healthy eating” can lead to and mask further disordered behaviors.

Research suggests that EDs and SUDs may frequently co-occur because they share key risk factors. As one multicenter study found, individuals with eating and alcohol use disorders reported more depressive and anxiety disorders, certain personality disorders, impulsivity, and perfectionism traits. Other research has shown that childhood trauma increases the odds of developing an ED, as well as many other comorbidities, like alcohol use disorder and SUD. In fact, comorbid ED and SUD is associated with higher rates of childhood trauma and post-traumatic stress disorder than either disorder alone.

When a person has found comfort in a maladaptive coping skill and used it to manage emotions, there comes a time when that “skill” is problematic and the person tries to stop. “We need to be vigilant about our relationship with substances and eating,” Leah Young offers.

For long-term recovery, EDs and SUDs should be treated simultaneously. Many treatment centers understand that for some patients it is tempting to get treatment for only one disorder. People often choose to get treatment for their substance addiction but are less ready to part with their ED, which is constantly reinforced as being more culturally acceptable.

Yet I can testify from experience that without treating both, it is hard to recover from either. If you are struggling in these ways, know that there are many people out there who understand and have gone through something similar.

For more information, see below for Leah Young’s insights into EDs and SUDs. If someone you love is struggling with an ED, an SUD, or both, comprehensive support and evidence-based treatment are key. Please contact us at 877-825-8584.

Written by

Lindsey Hall

Lindsey Hall is an award-winning eating disorder recovery speaker and writer, focusing on what she refers to as "the nitty gritty topics not discussed." Having struggled with the eating disorder cycle…

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