The Connection Between Eating Disorders and Substance Use

Many individuals living with an eating disorder (ED) also struggle with substance use. According to the National Eating Disorders Association (NEDA), up to 50% of people with an eating disorder also misuse drugs or alcohol. Conversely, approximately 36% of individuals with a substance use disorder (SUD) also meet the criteria for an eating disorder.

This co-occurrence—referred to as comorbidity—is not coincidental. The connection between EDs and SUDs can be traced to shared psychological traits, underlying trauma, and a desire for control. Understanding the relationship between these conditions is key to developing effective, sustainable treatment strategies.

Common Types of Eating Disorders

Eating disorders involve harmful patterns of eating behavior that significantly affect physical and mental health. The most common include:

Anorexia Nervosa: Extreme restriction of food intake to maintain control over body weight.
Bulimia Nervosa: Binge eating followed by purging through vomiting, excessive exercise, or laxative use.
Binge Eating Disorder (BED): Repeated episodes of eating unusually large quantities of food, often in secret, accompanied by feelings of shame and distress.

Other Less Common Eating Disorders:

Avoidant/Restrictive Food Intake Disorder (ARFID): Severe avoidance of certain foods due to fear of choking, vomiting, or other aversions.
Pica: Persistent craving and consumption of non-food items (e.g., dirt, chalk, soap).
Rumination Disorder: Repeated regurgitation and re-chewing of food without medical cause.

Many individuals with EDs may also misuse laxatives, engage in self-harm, or experience co-occurring mental health conditions, such as anxiety or depression.

Why Are Eating Disorders and Substance Use Disorders So Connected?

Eating disorders and substance use disorders share several key characteristics:

Addictive and compulsive behaviors
Poor body image and low self-esteem
Impaired coping mechanisms
High impulsivity and emotional dysregulation

Some substances—like stimulants or appetite suppressants—are even misused specifically for weight control. Individuals with anorexia, for example, may use amphetamines, cocaine, caffeine, or diet pills to reduce appetite. Others may use alcohol or benzodiazepines to calm anxiety or numb emotional pain.

Key Statistics on ED and SUD Comorbidity:

27% of individuals with anorexia nervosa also develop a substance use disorder.
36.8% of those with bulimia nervosa develop a substance use disorder.
23.3% of binge eaters also have a substance use disorder.

These overlaps show the importance of treating these conditions simultaneously through integrated care.

Underlying Causes of EDs and SUDs

There is no single cause for either eating disorders or substance use disorders. Instead, several contributing factors may intersect:

1. Trauma and Adverse Childhood Experiences (ACEs)

Childhood abuse, neglect, or abandonment can lead to unresolved trauma, which increases the risk of developing addictive behaviors and maladaptive coping mechanisms later in life.

2. Personality Disorders

Certain personality disorders—especially those in Cluster B (e.g., borderline personality disorder)—are commonly associated with both EDs and SUDs. A person with borderline personality disorder (BPD), for example, may struggle with intense emotional instability and turn to disordered eating or substance use for relief.

3. Mood and Anxiety Disorders

Depression, anxiety, and post-traumatic stress disorder (PTSD) often co-occur with EDs and SUDs. These individuals may use food or substances to regulate their emotions or escape overwhelming stress.

4. Toxic Environments

Living in an abusive or chaotic environment can cause someone to develop disordered eating as a way to regain a sense of control, or to turn to substances to numb emotional pain.

How to Treat Co-Occurring Eating and Substance Use Disorders

Treating both conditions at the same time is crucial for recovery. The following approaches have shown strong effectiveness in helping individuals manage and overcome these challenges:

1. Medication Management

Antidepressants, anti-anxiety medications, and mood stabilizers may help regulate symptoms and reduce cravings or emotional triggers.
A psychiatrist or primary care physician can evaluate and prescribe medications to manage co-occurring mental health symptoms.

2. Cognitive-Behavioral Therapy (CBT)

CBT helps individuals recognize and reframe negative thoughts that contribute to harmful behaviors. It is particularly effective in:

Challenging disordered beliefs about food, body image, or worth
Reducing cravings or urges to use substances
Building healthier coping mechanisms

3. Dialectical Behavior Therapy (DBT)

Originally developed for BPD, DBT combines CBT techniques with mindfulness and emotional regulation strategies. DBT is especially helpful for:

Managing intense emotions
Improving interpersonal effectiveness
Building tolerance for distress
Reducing self-harming behaviors

4. Psychodynamic Therapy

This approach helps individuals uncover the root causes of emotional pain, such as childhood trauma or unmet emotional needs. Working through these core issues can:

Increase self-awareness
Break generational or behavioral patterns
Heal inner wounds contributing to both EDs and SUDs

Recovery Is Possible

It can feel overwhelming to face multiple disorders at once, but recovery is achievable. The first step is recognizing the problem and asking for help. With proper treatment—including medical care, therapy, and community support—many people fully recover and go on to live balanced, fulfilling lives.

If you or someone you love is struggling with disordered eating and substance use, don’t wait. Help is available.

For more information, please check out The Recovery Village’s comprehensive guide titled ‘What is The Connection between Eating Disorders and Addiction?‘

The Connection between Eating Disorders, Substance Use