I have a history of addiction and eating disorders, and I know I am not alone. A 2003 study by the National Center on Addiction and Substance Abuse found that at the time, about half of people with eating disorders abused alcohol or drugs. Approximately 35% of people who abused substances had an eating disorder (ED).
Current estimates of co-occurrence rates between addiction and eating disorders are as high as 46%.
The two disorders have a lot in common. Both often start out being about control (control over food intake, control over what you feel and don’t feel, and many other variations), but tend to spiral out of the person’s control.
People with EDs and people with substance use disorders (SUDs) continue to engage in the behavior despite negative consequences. They often become fixated on it to the detriment of other things in their life. In many cases, people with EDs and SUDs are trying to numb out in response to trauma, stress, or another mental health disorder.
Research has found common risk factors. Both may be triggered by stressful events. Both have a high co-occurrence with depression and anxiety. Various studies have found links between levels of dopamine—a neurotransmitter that plays a large role in addiction—and eating disorders.
The prevailing theory is that people with anorexia overproduce dopamine, while people with bulimia and binge eating disorder underproduce it. Binge eating is significantly associated with dopamine release. Addiction is also widely known to affect dopamine levels. As addiction progresses, the brain reduces dopamine receptors to adjust for increased dopamine in the system.
Beyond the many root causes they have in common, substance use disorders and eating disorders interact with one another. People with eating disorders may abuse stimulants, diet pills, nicotine, or other drugs they believe will help them lose weight.
I would skip eating and over-exercise in order to drink as much as I wanted without gaining weight. I limited my caloric intake for both my ED and my addiction—while I needed to control my weight, I also needed to drink. Drinking on an empty stomach also allowed me to get drunk faster; my goal was always to get as intoxicated as possible.
In my particular case, thought patterns contributed to both disorders: obsessive ruminating, and all-or-nothing thinking. I don’t want to speak for everyone, but at least from anecdotal evidence, I don’t think I’m alone in this either.
My anorexia came first. I was a teenager. From the jump, it was a fixation—very nearly the only thing I thought about. My parents put me into treatment involuntarily.
After gaining weight from treatment, my all-or-nothing thinking entered the picture; now that I’ve gained weight, I might as well keep going. Binge eating coincided with binge drinking. That was my introduction to drinking.
Then I began abusing diet pills, another addiction. Eventually it turned back to restricting my eating and over-exercising in order to drink more—all of which became separate but equal obsessions.
I am doing as well as I ever have today because I got early treatment for my eating disorder, but also because I’m sober. Without removing substances, I wouldn’t have been able to work on the underlying anxiety—and other root causes—of both my addiction and eating disorder.
The interactions between co-occurring disorders are complex; they need to be treated by clinicians who understand this complexity. No matter how many disorders you are battling, there is always hope of long-term recovery.
If you are struggling with a mental health disorder or a co-occurring addiction, there is help available. Amatus Recovery Centers offers high-quality treatment for substance use and mental health disorders in facilities across the country. Our staff will help you process traumas and learn healthy coping skills. Call an admissions specialist at 410-593-0005.