Eating Disorders and Substance Use: Why are the Two Often Linked?
One of the things we have understood clinically for a long time is that people who have eating disorders often struggle with substance use issues.
And, people with substance use disorder (SUD) also struggle with disordered eating.
Here are some facts on this topic:
It is estimated that more than 50 percent of people with eating disorders are abusing over-the-counter drugs, prescription medication, or alcohol. This is a rate 5 times higher than the general population!
Approximately 35 percent of patients seeking substance use treatment report some eating pathology. Compare this to the general population, where less than 2 percent of the population meet criteria for any one eating disorder diagnosis — although many more struggle with disordered eating. I’ll share more about that later.
Any way you look at it, there is significant overlap between the eating disorder world and the substance use world.
Why does this occur?
One’s genes contribute strongly to the development of both eating disorders and substance use disorders (genes are approximately 60-80 percent and 50 percent responsible, respectively). This supports what we know about the biopsychosocial model.
The biopsychosocial model helps us understand how disorders develop over time, and why someone may develop a disorder while other members of their families do not.
Certain people have the “right” DNA and temperament style that predisposes them to developing an eating disorder and substance-use disorder. Triggering life experiences — like dieting or drug experimentation — can “flip the switch” for the disorder to take over the person’s life.
It is possible for a person to develop an eating disorder or substance use disorder after a single exposure to a triggering event. But, more often, there have been many learning experiences around food/weight and/or substances in that person’s lifetime leading up to the development of the disorder.
For people vulnerable to the development of eating disorders and substance use disorders, it’s surprisingly easy to go from feeling like you’re in control of the behaviors to realizing that the behaviors are in control of you. Since both of these illnesses progress over time, some people with disordered eating will eventually develop an eating disorder, and some people who experiment with substances will go on to develop a substance use disorder.
Developing a disorder
When people are struggling with both an eating disorder and substance use, it’s much more common for the eating disorder to develop first, although there is always the potential for the opposite to occur.
The eating disorder and substance use disorder can become linked through the ways that the behaviors can be used to manage each other. Let me explain:
Some people with eating disorders may use substances to alter their mood, interrupt ED urges, and control hunger/fullness cues.
People with substance use disorders may have their normal eating patterns interrupted by drug use or may turn to food or exercise to cope when their substance of choice is no longer available.
Treating both eating disorders and substance use
When a person is ready to seek treatment for both an eating disorder and substance use issues, there are no shortage of treatment options for both diagnoses. However, there has been a long-held belief in both the eating disorder and substance use worlds that people who have comorbid diagnoses should have sequential treatment. The belief is that one must first complete a SUD program and then an ED program (or vice versa).
What we’ve learned at ERC/Insight is that sequential treatment is rarely a recipe for lasting recovery from either disorder, which is why we’ve developed integrated programs that offer skills and support for both an eating disorder and substance use disorder throughout a person’s recovery journey. Many of the treatment modalities we utilize — like cognitive behavioral therapy (CBT) and mindfulness-based interventions — offer benefits for both eating disorders and substance use disorders.
I once worked with a patient who was able to find lasting recovery from her bulimia and alcohol use disorder by integrating mindfulness practices into her treatment plan, which helped her increase her awareness of her urges to engage in disordered behaviors and then choose a safe coping skill instead.
Recovery from more than one illness is possible!
If a person has just an eating disorder OR a substance abuse problem, it can feel like an overwhelming and impossible challenge. When these diagnoses occur together, the mountain of recovery can seem that much tougher to climb.