About half of people with an eating disorder (ED) also have a co-occurring substance use disorder (SUD). This can make treatment more complex, but recovery is possible.
Genetics, trauma, and age are a few of the shared risk factors that may help explain the overlap between EDs and SUDs.
Co-occurring EDs and SUDs require treatment that addresses both concerns. This may include therapy, medication, group support, nutritional counseling, and medical oversight.
Eating disorders (EDs) and substance use disorders (SUDs) are different mental health concerns that frequently co-occur. Research shows that up to 50% of people with EDs [1] also have SUDs, a rate five times higher than the general population. So if you or someone you care about is living with an ED and SUD, know that you aren’t alone.
Both EDs and SUDs are characterized by compulsive behaviors — repeated, uncontrolled actions to reduce stress or other uncomfortable emotions. But experts are yet to understand why the two conditions show up together so frequently.
Fortunately, with early detection and ongoing support, ED and SUD recovery is possible. Learning more about how these conditions interact can help you find the treatment and support you deserve.
Why eating disorders and substance use often go together
Having an ED doesn’t automatically mean that you’ll develop an SUD, and having an SUD doesn’t automatically mean you’ll develop an ED. But a few factors may help explain why EDs and SUDs coexist so often.
These include:
Genetics: Having a first-degree family member [2] (like a sibling or parent) with an SUD or ED may make you more likely to develop one or both.
Trauma: Experiencing trauma can make it harder to regulate emotions. People may develop disordered eating habits or rely on substances to avoid or numb uncomfortable emotions.
Age: Adolescents are more likely to experience co-occurring EDs and SUDs [3]. This may be due to their stage of brain development and a lack of healthy coping skills.
ED type: People with bulimia nervosa [4] are more vulnerable to co-occurring SUDs — especially problematic alcohol use. Binging (and purging after) might happen because drinking lowers inhibitions.
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Screening for substance use and eating disorders
When you get screened for SUDs and EDs, your provider will thoroughly review your medical, social, and mental health histories. They’ll want to know when your symptoms started, how they impact your life and health, and what tends to make them better or worse. In some cases, you may need to seek a medical evaluation as well.
Getting an accurate diagnosis is an important step in getting effective care for EDs and SUDs. Your diagnosis, needs, preferences, and symptom severity will determine which level of care will best support your recovery.
The effects of co-occurring substance use and eating disorders
Unhealthy substance use has been shown to worsen ED symptoms and outcomes [5] (and vice versa).
Left untreated, co-occurring SUDs and EDs can lead to:
Medical complications
Poorer mental health overall
Increased risk of relapse
Longer recovery times
Impaired functioning at home, work, and school
Problems maintaining healthy relationships
Higher mortality rates
Treatment for substance use issues and eating disorders
If you’re living with a co-occurring SUD and ED, know that you’re not alone and recovery is possible. With whole-person care that addresses both concerns, you can achieve sobriety and heal your relationship with food.
Most people with SUDs and EDs benefit from personalized, ongoing care that takes into account how these conditions affect their minds and bodies. Depending on a person’s needs, they may need medical treatment before they’re able to engage with other forms of support. This may take place in inpatient rehabilitation facilities, hospitals, or other inpatient or outpatient settings.
Once they’ve achieved medical stability, a person can begin to explore other treatment options. This might include therapy, psychiatric care, nutritional counseling, or substance use support groups. You and your care team can determine which of these (or others) might be best for your needs. But keep in mind that addressing both the ED and SUD at the same time is essential. Not doing so may increase the risk of relapse [5] with both conditions.
If possible, try to find providers who offer integrated care for EDs and SUDs.
Look for providers or facilities that specialize in:
Treatment for co-occurring disorders, dual diagnosis, or dual disorders
Whole-person support for physical, emotional, nutritional, relational, and overall well-being
Medical and nutritional oversight to monitor the physical health risks associated with EDs and SUDs
A thorough assessment and personalized treatment planning process
Timely referrals and/or the ability to move to higher or lower levels of care as needed
Relapse-prevention planning and ongoing support
Opportunities to involve family members or loved ones in the healing process (when appropriate)
Keep in mind that ED and SUD recovery is a lifelong process. There may be ups and downs along the way, and that’s OK. What matters most is that you have access to the support you need to get back on track and recommit to your goals if relapse occurs.
A common trigger I see is a spike in shame or distress. When one compulsive behavior is reduced, the discomfort it was covering can surface quickly. Without other coping tools in place, the person may shift to a different behavior to regain relief.
Brandy Chalmers, LPC
Clinical reviewer
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SUDs and EDs are different mental health concerns that frequently co-occur. Having one may increase your risk for developing the other. This might be due to a combination of factors like genetics, trauma, age, and more.
Co-occurring conditions can make the treatment process more complex, but, with the right support, it’s possible to recover from an SUD or ED.
At Rula, we’re here to help you feel better. Rula makes it easy to find a licensed therapist or psychiatric provider who takes your insurance. That way, you don’t have to choose between great care and a price you can afford.
Rula patients pay about $15 per session with insurance, and 93% say they feel better after getting care through Rula. We have 21,000+ providers, and appointments are available as soon as tomorrow. We’re here to help you take the next step — wherever you are in your mental health journey.
References
- Substance Use and Eating Disorders https://www.nationaleatingdisorders.org/substance-use-and-eating-disorders/
- Shared genetic risk between eating disorder- and substance-use-related phenotypes: Evidence from genome-wide association studies https://pubmed.ncbi.nlm.nih.gov/32064741/
- The Risk of Substance Use Among Adolescents and Adults With Eating Disorders https://pmc.ncbi.nlm.nih.gov/articles/PMC7544549/
- Shared Genetic Risk between Eating Disorder and Substance Use-Related Phenotypes: Evidence from Genome-Wide Association Studies https://pmc.ncbi.nlm.nih.gov/articles/PMC7429266/
- A clinical approach to the assessment and management of co-morbid eating disorders and substance use disorders https://pmc.ncbi.nlm.nih.gov/articles/PMC4226257/
Liz Talago
Liz Talago, M.ed. is a mental health professional turned content writer and strategist based in the Detroit metro area. As an independent consultant for mental health organizations, Liz creates meaningful connections between brands and their audiences through strategic storytelling. Liz is known for championing diverse perspectives within the mental health industry and translating bold ideas into inspiring, affirming digital experiences.
In her free time, you can find her hiking with her two German Shepherds, puttering around her dahlia garden, or spending time with her family.
Brandy Chalmers, LPC
Having faced challenges like childhood abuse, neglect, and the loss of her father to suicide, Brandy Chalmers is deeply passionate about providing compassionate care. She is a Licensed Professional Counselor, Nationally Certified Counselor, and Registered Play Therapist with a Master’s Degree in Clinical Counseling and Marriage and Family Therapy.
Brandy also teaches at a university, sharing her expertise with future mental health professionals. With over a decade of experience in settings like inpatient care and private practice, she specializes in helping clients with perfectionism, trauma, personality disorders, eating disorders, and life changes.
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