Substance Abuse And Eating Disorders
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Substance Abuse and Eating Disorders: Two Issues, One Recovery

Debra Wallace, MA.Ed, LPCC-S, LICDC-CS

Medically reviewed by

Debra Wallace, MA.Ed, LPCC-S, LICDC-CS

April 8, 2019

When most people think of needing a recovery or treatment program, they start looking for options designed to address a single major impending issue. However, there is often more than one problem or obstacle to overcome on the path to recovery, making a dual-diagnosis treatment center a better choice. These programs can help individuals manage their substance abuse and eating disorders in an effective way.

The Connection Between Eating Disorders and Substance Abuse

Research indicates that eating disorders and substance abuse often go hand-in-hand. In fact, one article published in Social Work Today indicates that as many as 50 percent of all people with eating disorders also abuse drugs and/or alcohol. This is more than five times the amount of someone without an eating disorder, as their risk of substance abuse is closer to 9 percent.

The opposite is also true. While around 3 percent of the population struggle with some type of eating disorder, that amount raises to around 35 percent if the individual has an issue with drugs and/or alcohol. What makes someone with an eating disorder more susceptible to drug and/or alcohol abuse issues or vice versa?

According to the same Social Work Today article, answering that question is not easy. First, you have to consider which one appeared earlier—the drugs and/or alcohol, or the eating disorder. For instance, if the eating disorder appeared first, then it’s possible that drugs and/or alcohol were used to either aid in the weight loss or to deal with the discomfort associated with the disorder itself.

And if the substance abuse issue appeared first, it’s possible that the eating disorder was sparked by either:

  1. the substance inhibiting appetite, thus resulting in an extremely low caloric intake, or
  2. by attempting to overcome the substance abuse addiction, which usually results in an increased appetite because drugs and alcohol are often appetite suppressants.

Identifying Risk Factors And Causes

After determining which issue began first, the next step is to identify the causes or risk factors that led to each one. While some studies point to poor impulse control contributing to this type of dual diagnosis, other pieces of research have found that there are often external contributing forces to the development of issues with eating and substance use.

Of these, abuse suffered in the person’s childhood is one that is frequently discussed. Anxiety and brain chemistry can also potentially play a role in the development of these two disorders, according to information provided by the National Institute of Mental Health.

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Another potential risk factor that scientists suggest plays a rather big role in both of these addictions is genetics. So big, in fact, that they estimate that a person’s genes alone can make him or her 40 to 60 percent more vulnerable to these types of behaviors.

While we tend to hear more about substance abuse treatment and recovery, eating disorders are less commonly discussed. Yet, statistics suggest that it remains a major issue that many people contend with today. Just how prevalent is it?

Eating Disorder Prevalence

The National Association of Anorexia Nervosa and Associated Disorders (ANAD) reports that approximately 30 million people in the United States alone suffer from some type of eating disorder. Of these, between 85 and 95 percent are believed to be female and the age range most affected is individuals between 12 and 25.8 years old, highlighting that these disorders have a high propensity of occurring in young people.

Sadly, as many as one out of every two teenage girls and one out of every three teenage boys have used some type of unhealthy behavior or behaviors in an effort to help control his or her weight. This includes skipping meals or fasting, throwing up, or taking an over-the-counter laxative. Athletes in this age range are highly impacted as well. That’s especially true in sports where a person’s figure is an issue (like gymnastics), with 42 percent exhibiting some behaviors consistent with an eating disorder.

Although ANAD further indicates that eating disorders “have the highest mortality rate of any mental illness,” due largely to either health issues caused by the disorder (like heart or organ failure) or suicide, only 10 percent of those afflicted actually receive some type of treatment.

That makes this particular issue a huge concern, not only because of its prevalence but also because of its lack of treatment. But what exactly is an eating disorder?

The 3 Most Common Eating Disorders

While there are many types of eating disorders, some are more common than others. According to the National Eating Disorders Association (NEDA), the American Psychiatric Association’s Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists the top three eating disorders as anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Anorexia Nervosa

Anorexia involves taking in too few calories, resulting in becoming extremely underweight, which is described as being 15 percent or more below “normal” body weight for the person’s age, sex, and height.

A person with this type of eating disorder has a self-image that relies heavily on body appearance alone, causing him or her to be overly fearful of gaining weight.

There are two types of anorexia:

1. Restricting Type: In this case, the person simply restricts his or her calorie intake by eating barely enough food to sustain healthy life function.

2. Binge-Eating or Purging Type: A person with binge-eating anorexia, also known as purging anorexia, binge eats and then either purges to reduce the number of calories digested or regularly uses other products to “lose weight” even though that’s not their intended use. These items include laxatives, diuretics, and enemas, all of which can cause damage to the person’s organs and bodily systems when used in this manner consistently over time.

Bulimia Nervosa

A person with bulimia tends to often overeat, subsequently hoping to reduce the amount of calories the body actually consumes by self-inducing vomiting.

Whereas a person with anorexia is typically underweight, a person with bulimia oftentimes is either normal weight or overweight. This is due to the higher number of calories consumed during the binge sessions, some of which are absorbed prior to the purging.

Furthermore, the binge-eating sessions typically make the person feel as if they’ve lost control and, like those afflicted with anorexia, this particular condition is also tied to a poor body image that leads to low self-esteem.

Binge-Eating Disorder

This third most common eating disorder is characterized by behaviors such as overeating and vomiting, but there are also frequently feelings of shame and guilt along with a feeling of lack of control during the binging sessions.

Additionally, a binge-eater often eats even when he or she isn’t hungry or already overly full, or because of emotional reasons (like the same and guilt this type of eating behavior typically creates).

There are other eating disorders, and they include binge-eating without purging, “night eating syndrome” (which involves overeating later at night), and pica (the eating of substances not ordinarily considered food, like paint or dirt). However, the three outlined above are the most common.

In order for any of them to be diagnosed, the criteria for each must be met for three months or more.

Signs of an Eating Disorder

How do you know if you or someone you love may be one of the 90 percent with an eating disorder that is currently undiagnosed?

Here are some behavior-related signs to watch for:

  • Obsession with food, especially with regard to whether certain foods are “good” or “bad”
  • Extreme restriction of food, subsisting on barely enough food to survive
  • Putting together foods that wouldn’t normally go together, which is common with binging
  • Irritability when it comes to food or eating rituals
  • Negative body image regardless of actual body size or fitness level
  • Excessive exercise habits, such as working out for numerous hours every day
  • Development of obsessive-compulsive eating rituals, such as cutting foods into extremely tiny pieces or chewing a specific number of times
  • Pushing the body to the point of physical exhaustion in an attempt to lose weight
  • Avoiding eating in front of others, even if they are the one who cooked the meal
  • Fear of eating in restaurants or other public places, often eating alone

There are also some physical signs that could signal an eating disorder. These include:

  • Appearance of fine body hair which is almost fur-like in nature
  • Skin that is dry and/or blotchy
  • Yellowish skin
  • Sunken in cheekbones, or cheeks that are swollen along the jaw area
  • Sunken in eyes, or eyes surrounded by dark circles (due to malnourishment)
  • Constant fatigue
  • Always feeling cold or dressing in heavy clothes, even in warmer weather (due to decreased body temperature)
  • For females, menstrual periods that become irregular or stop entirely, potentially causing infertility
  • Issues with constipation
  • Low blood pressure
  • Electrolyte imbalances
  • Calluses on knuckles (which often appear if the disorder involves purging)
  • Chronically sore throat or excessive tooth decay (again, appears with purging)
  • Decreased bone density
  • Anemia

Not all of these signs are indicative of an eating disorder. However, if several of these issues are present at one given time, it could indicate that some type of eating-related issue exists.

Dual-Diagnosis Treatment Options

Both eating disorders and substance abuse on their own can be extremely difficult to treat, but add them together and it can feel like an uphill battle. That’s why many dual-diagnosis treatment options involve inpatient recovery. This allows for control over the environment while also providing access to medical professionals should complications develop during detoxification and/or recovery (such as alcohol-related withdrawal symptoms or issues associated with extreme malnourishment, thereby affecting the organs).

Once your medical issues are stabilized and you’re cleared for treatment, the next step generally involves entering therapy with a trained professional. He or she can help rid you of your old negative behaviors and thought processes, replacing them with healthier, more productive ones. This typically involves learning new ways to deal with stress, anxiety, and other not-so-pleasant emotions in a way that doesn’t involve food or ingestion of unhealthy substances.

The ultimate goal of this type of intensive, inpatient therapy is to help you create a new relationship with food—one that doesn’t involve eating too little, eating too much, or purging. It is also to help you find effective ways to overcome your reliance on any outside substances to help you deal with normal emotions of life, such as sadness, frustration, and fear.

In some cases, medications may be prescribed to assist with the transition or to help with any other mental issues that could be inhibiting effective treatment, such as with depression. By dealing with all of these issues at the same time, it becomes easier to overcome all of your struggles as one is not left to aggravate the others.

How Can We Help?

If you have been diagnosed with an eating disorder and struggle with substance abuse or you’ve never sought treatment but believe that you are living with both of these issues, help is just a phone call away.

The caring and compassionate staff at Rehab Center is here to assist you 24 hours a day, 7 days a week. We can help connect you to the best program for you given your situation and needs.

Don’t wait one more day. Make today the first day of a bright and promising future—one in which you have a healthy relationship with food and don’t rely on substances like alcohol or drugs to bring you peace and happiness.

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