Eating Disorders With Substance Use Disorder 

Eating disorders and substance use disorders (SUDs) often coexist.

Researchers say up to 50% of people with diagnosed eating disorders use illicit drugs or alcohol, while 35% of people who are dependent on alcohol or drugs have an eating disorder. This represents rates 5 times and 11 times greater than what’s seen in the general population, respectively. [1]

Substance use and eating disorders

Scientists are continuing to uncover reasons why these two conditions so frequently overlap. But thankfully, a number of therapies have already been developed that can help people who are struggling with these co-occurring disorders.

If you have an eating disorder complicated by a substance abuse issue, it is possible to get better. But you will need a treatment program that addresses both issues at once. Leaving one problem untreated can allow both to keep negatively affecting your life and hindering a full recovery.

What Is a Substance Use Disorder?

People dealing with addiction and substance abuse become attached to certain substances, such as alcohol or drugs, or the ritual of obtaining and taking these substances. Oftentimes, these habits form as maladaptive coping mechanisms or attempts to self-medicate for any number of issues, including anxiety disorders or major depressive disorder.

Despite facing problems with their health, families, and communities, or even expressing the desire to stop, people with drug and alcohol addiction often continue using nonetheless.

That’s at least partly because drugs and alcohol can work to change brain chemistry. These substances can rewire the brain’s reward system, making someone actively crave or seek them out, or else feel physically and mentally unwell if they can’t continue using.

Stress and anxiety can lead to substance abuse.

Stress can also often change a person’s relationship with substances. For example, many people felt worried and concerned during the COVID-19 pandemic, and about 25.9 million people reported drinking alcohol “a little more or much more” than they previously did. [3] 

These types of changes don’t always lead to addiction, of course, but stress can be a compounding factor that leads to a developing substance abuse problem.

Common Types of Substance Use Disorders

Substance use disorders are sadly common. Some of the most frequently abused substances include: [2]

  • Alcohol: About 14.5 million people age 12 and older have an alcohol use disorder. 
  • Illicit drugs: About 8.3 million people age 12 and older have a SUD involving an illicit substance. 
  • Marijuana: About 4.8 million people age 12 and older have a SUD involving marijuana. 

A person could be a habitual or periodic user for years, until that relationship changes due to a trigger, such as experiencing a traumatic event. Still, other people have slightly altered brain chemistry, which makes it easier for them to form addictive or fixated thoughts and habits.

In either case, SUDs are treatable, but without the proper care, they can be difficult to overcome. Even after periods of sobriety and treatment, people may keep using or experience a relapse. 

What Is the Connection Between Substance Abuse & Eating Disorders?

Many people with SUD have co-occurring eating disorders, and many people with eating disorders experience drug addiction or other substance-induced disorders.

One reason the two may so frequently co-exist is the number of shared risk factors between eating disorders and SUDs, including: [6]

  • Triggering events: Both conditions can be triggered by stress, times of transition, or other types of traumatic events. 
  • Genetics: Substance use disorders and many types of eating disorders run in families. Genetics, biology, and family history likely all play a role in the risk of developing one of these conditions. 
  • History: Sadly, a history of sexual or physical abuse is one of the biggest risk factors for both conditions. Unhealthy behaviors learned from parents or family can contribute too. 
  • Social pressure: Some people feel compelled to change their eating habits or use drugs because others do. 

No matter why they developed, the combination of a SUD and an eating disorder is dangerous. The conditions tend to augment and worsen one another, further deepening the distress someone feels. 

Trends Among People With Co-Occurring Disorders

While incredible variety exists between eating disorders, and the same is true of SUDs, researchers have scoped out a few trends and underlying connections between the two conditions. 

Among people who struggle with bulimia nervosa (BN) and anorexia nervosa (AN), there are two types of substances in particular that are more commonly abused: [4]

  • Alcohol: About 15% of people with AN or BN also experience alcohol dependence. 
  • Marijuana: About 4% of people with AN or BN simultaneously deal with marijuana dependence. 

About 15% of people with anorexia or bulimia also have alcohol dependence. [4]

Some people who struggle with eating disorders may also turn to certain substances to help them maintain their condition. [5] For example, cocaine or other types of drugs actively suppress the appetite. And in a social situation, like a party, someone could drink alcohol instead of eating.

Best Treatment Options for SUDs & Eating Disorders

Treatment exists for eating disorders and SUDs of all types, and—partly due to the frequently overlapping triggers and risk factors—the techniques used to care for each condition are often the same.

Counseling, medications, and support group work all help people regain control of their thoughts and actions. But different types of therapy will emphasize different lessons, or help a patient build different skills.

Common Eating Disorder Treatments

When someone is struggling with an eating disorder, they may go to many different types of programs. Though, many of these plans have the same general goals, including: [7]

  • Nutrition: People with eating disorders of all types commonly suffer from malnutrition. Building back the proper nutrients, minerals, and fluids is a key goal of many programs. 
  • Reduction: The biggest part of treatment is helping people with eating disorders disengage from their learned unhelpful thoughts and behaviors. Numerous techniques can be used to help create a reduction of unhelpful behavior. 
  • Reframing: Shifting someone’s perspective can make a huge difference in their mental health. This stage of therapy helps people set goals to achieve a healthier lifestyle.

Unlike illicit substances, food is something that can’t be eliminated all-together, so many eating disorder programs include a larger focus on nuance and balance than those aimed at helping people recover from substance use disorder.

Common Substance Use Disorder Treatments

Like people in recovery for eating disorders, people in treatment for SUD are taught to learn new habits and find new ways to build a sense of happiness and higher self-esteem.

But rather than focus on the reduction of unhelpful behaviors, as people overcoming eating disorders must do, this group generally focuses on the overall elimination of substance use. 

Unfortunately, many people in the throes of addiction will reorganize vast swaths of their life around the substance of their desire, so building a sustainable recovery often involves the hard work of restructuring many aspects of the person’s life.

Treatments for Co-Occurring Disorders

While eating disorders and SUDs are commonly co-occurring phenomena, there’s no scientific consensus on how to best blend the treatment programs for these two conditions. Thorny questions remain about messaging, priorities, and other aspects of these programs.

Still, most of the best treatment programs for either condition will emphasize certain aspects of recovery, including:

  • Personalization: The personalization of someone’s treatment plan is paramount. Each individual has their own history, genetics, and experiences, which should all be taken into account. 
  • Change: The emphasis on making positive change is central to recovering from both a substance use disorder and an eating disorder. When it comes to treating both, this can also mean the adaptability within a treatment plan to cater to eating disorder symptoms or substance use disorder symptoms as they come up.
  • Collaboration: Separate teams may spearhead different aspects of recovery for someone with multiple diagnoses. A solid program will allow for these teams to collaborate, for the most optimal recovery. 
  • Relatability: It’s quite possible for someone’s SUD and eating disorder to stem from the same, or related, incident(s). It’s important for treatment teams to look for these types of overlaps, in order to help facilitate the most holistic approach to healing.

In general, some of the best treatment programs for eating disorders and SUDs include cognitive behavioral therapy (CBT), diagnostic behavioral therapy (DBT), and therapies for post-traumatic stress disorder (PTSD). These programs often have elements needed to address both conditions.

Still, sometimes programs must be tweaked, or other considerations—including medicine, nutritional counseling, or other types of therapy—are taken into account. It can take time to find or create just the right kind of solution. But when you do, it can make a huge and lasting improvement in your life.

Partial hospitalization programs

How to Find the Right Treatment Program for You

If you or a loved one are struggling with an eating disorder, a substance use disorder, or both, it’s important to seek treatment.

Many people start their recovery journey by talking with their doctors. Speaking with your primary care physician or your mental health therapist, you can ask for a formal diagnosis, or else seek their advice on your symptoms or any suggestions on finding programs that might be helpful. 

Other people may start by consulting their health insurance companies. If you choose this route, you can ask about coverage and get a list of programs that may accept payments through your insurance plan—though often, insurance companies will direct you back to your doctor first, for an official diagnosis, before pursuing further treatment.

Narrowing Down Treatment Options

No matter which path you choose, you’ll eventually have to narrow down the list of organizations you may be interested in working with.

One way to help determine which program is best for you is to ask each organization some, or all, of these questions:

  • Have you treated patients with eating disorders and substance addictions before?
  • How do you integrate the two issues into one plan?
  • What will my treatment program look like?
  • How much can I change or control my treatment program?
  • What therapy approaches will you use?
  • How long will the program last?
  • What follow-up care do you provide?

Most treatment providers are happy to answer questions and give information. They want you to get better, and they’re happy to talk about their approach. 

Moving Forward with Recovery

Once you choose which program you want to pursue, it’s important to stick it out. Remember: Eating disorders and substance use disorders are two of the most difficult conditions to recover from on their own; things can feel even more overwhelming when the two combine.

But also know that treatment, and lasting recovery, is possible.

Finding the help you need is one of the most crucial steps toward getting there, but once you learn some techniques to build self-esteem and find healthier coping mechanisms, you’ll be well on your way to recovery.

Committing to your health and healing may feel strange, selfish, or besides the point. But in the end, it’s likely something you won’t regret, and a step that can help you find a happier and healthier future.


  1. Substance Use and Eating Disorders. National Eating Disorders Association. Retrieved September 2022.
  2. Key Substance Use and Mental Health Indicators in the United States: Results From the 2019 National Survey on Drug Use and Health. (2020). Substance Abuse and Mental Health Services Administration. Retrieved September 2022.
  3. SAMHSA Releases 2020 National Survey on Drug Use and Health. (2021, October 26). Substance Abuse and Mental Health Services Administration. Retrieved September 2022.
  4. Devoe, D.J., Dimitropoulos, G., Anderson, A. et al. (2021, December 11). The Prevalence of Substance Use Disorders and Substance Use in Anorexia Nervosa: A Systematic Review and Meta-Analysis. Journal of Eating Disorders; 9(161).
  5. Eskander, N., Chakrapani, S., & Ghani, M. R. (2020). The Risk of Substance Use Among Adolescents and Adults With Eating Disorders. Cureus; 12(9):e10309.
  6. Ressler, A. (2008, July). Insatiable Hungers: Eating Disorders and Substance Abuse. Social Work Today, 8(4): 30. 
  7. Eating Disorders: About More Than Food. (2021). National Institute of Mental Health. Retrieved September 2022.

Last Update | 02 - 10 - 2023

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