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Alcoholism often co-occurs with other medical and psychological disorders, including eating disorders. While study methodologies make data somewhat inconsistent, studies reveal a frequent co-occurrence between eating disorders and alcoholism or another substance use disorder.
Studies reveal that substance use disorders increase the risk of mortality in individuals with an eating disorder.
Co-occurring conditions can increase the behaviors or symptoms associated with the other, worsen the immediate or long-term side effects, and change the indicated treatment plan.
In this article:
How Do Eating Disorders and Alcoholism Co-Occur?
Many people with an alcohol use disorder notice that they eat a heavier meal when planning to use alcohol to decrease the intensity of the effects. When they are drinking, they may eat snack foods provided in a bar environment in larger amounts than they would when sober, and after using alcohol, they may eat specific foods to address hangover symptoms.
For individuals with an eating disorder, substance use has an even greater impact on their relationship with food, exercise, and body image.
They may also experience co-occurring substance use disorders, including alcoholism, at higher rates than the general population. Among people with alcohol and drug dependency, up to 35% have an eating disorder: a rate 11 times higher than the general population.
Research indicates that:
- You may use alcohol to cope with your eating disorder, including substituting alcohol for eating or distracting from negative feelings related to an eating disorder
- Co-occurring eating disorders and alcoholism are more likely to include impulsivity
- Binge eating disorders are more likely to trigger a larger intake of alcohol in one sitting and to do so more frequently than other eating disorders
- Binge drinking and eating are more likely to occur in situations that involve unpleasant emotions, social pressures, and physical discomfort or temptations
- The intensity of alcohol use and negative consequences associated with drinking correlate with bingeing behaviors, which are present in several types of eating disorders
- Individuals with bulimia nervosa are more likely to misuse alcohol as individuals with other eating disorders
What Are the Risk Factors for Co-Occurring Eating Disorders and Alcoholism?
Eating disorders are disturbances in eating and movement behaviors triggered by distressing thoughts and emotions. Eating disorders can negatively affect physical, psychological, and social health.
Risk factors can be biological, psychological, and sociocultural. Eating disorders are linked to lower dopamine and serotonin neurotransmitters in the brain. Eating disorders can co-occur with mental health conditions, like major depressive disorder, anxiety disorders, and substance use disorders.
Risk factors for developing an eating disorder are the same, regardless of the specific diagnosis. Common risk factors include:
- Having a higher childhood and adolescent weight
- Receiving a diagnosis of a mood disorder
- Focus on perfectionism, especially if it was cultivated in childhood by family or social circle
- Experiencing impulsivity
- Enduring significant trauma
Eating disorders are seen as a condition more commonly found in girls, teenagers, and women.
However, people of any gender can develop eating disorders. Research shows that individuals who identify as transgender or nonbinary have the highest rate of past-year eating disorder behaviors, 18%, compared to 1.8% in cisgender women and .2% in cisgender men (women and men who identify with the sex they were assigned at birth).
Eating disorders are also more prevalent among individuals who identify as gay, lesbian, bisexual, or any other non-heterosexual sexuality than among heterosexual cisgender women or men. The most commonly diagnosed eating disorders, any of which can co-occur with alcoholism, include the following.
Anorexia Nervosa
Anorexia nervosa is a multi-layered disorder.
Signs and symptoms may include:
- Intense fear of gaining weight
- Cold intolerance
- Constipation
- Irritability
- Distorted body image, which may lead to “body checking” behaviors
- Repeated weighing
- Food restrictions
- Compensatory exercise that may cause extreme fatigue, illness, or injury
The intense emotions related to body image and potential weight gain make it difficult to participate in weight restoration and maintain a safe, healthy weight over time. This happens even when the individual fully understands the health implications of their behaviors and a very low body weight.
Misuse of alcohol and anorexia may appear together. Individuals may use liquid—in this case alcohol—as a food replacement or use the effects of alcohol to cope with negative emotions, especially if underlying trauma is present.
Bulimia Nervosa
Bulimia nervosa is characterized by a strong need to binge on large amounts of food, often food that the individual otherwise restricts from their diet. This might include processed foods or pastries.
These binges can cause extreme guilt or shame afterward and create an urge to eliminate the food from the body. Binge eating may be followed by forced vomiting, using laxatives, excessive exercising, or fasting as purging behaviors.
Signs and symptoms of bulimia nervosa include:
- Intense fear of gaining weight
- Distorted body image
- Repeated weighing
- Compensatory exercise, including exercise causing extreme fatigue, illness, or injury
- Inflamed sore throat
- Swollen glands in the neck area
- Acid reflux disorder
- Tooth damage or decay
- Severe dehydration
- Illness related to chronic purging, such as aspiration bronchitis
Alcohol use may co-occur throughout the condition, including during binge or purging cycles, or as a coping tool to minimize feelings of shame.
Binge Eating Disorder
Binge eating disorder involves periods of binge eating, which are clinically similar to the binges observed in individuals who have bulimia nervosa.
However, individuals with binge eating disorder do not experience purging urges despite similar feelings of guilt, shame, and disappointment.
Binge eating disorder symptoms may include:
- Eating excessively large amounts of food in a short period
- Eating even though you are full or not hungry, or well past the point of fullness
- Eating in secret to conceal how much you eat
- Feeling a lack of control over what or how much you eat
- Binging at least once a week for a period of three months or longer
Individuals with binge eating disorder are most likely to misuse alcohol during binge periods, but may also use alcohol as a coping mechanism to manage the negative emotions related to the eating disorder.
Other Specified Feeding or Eating Disorder (OSFED)
This category encompasses conditions that fall outside the diagnostic criteria of other eating disorders, but still constitute a clinical eating disorder.
Examples include:
- Atypical anorexia nervosa
- Low frequency or limited bulimia or binge eating disorders
- Night eating syndrome
- Purging disorder
Multiple physical, behavioral, and emotional symptoms can appear with OSFED.
Any or all of the symptoms of eating disorders can be present, as well as the following:
- Hoarding or hiding food
- Feeling intense fear of eating in public
- Drinking excessive amounts of water or other fluids as a food replacement
- Constant use of mints or mouthwash
- Fainting
- Often sick due to the impact that eating disorder behaviors have on your immune system
Many people struggle with one or more disordered eating behaviors that do not rise to the clinical threshold of an OSFED or other eating disorder diagnosis. However, all disordered eating behaviors that co-occur with a substance use disorder can have an impact on your health.
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Eating disorders cause physical damage to the body, which can become life-threatening. A person with an eating disorder may develop:
- Thyroid disease
- Hypoglycemia
- Alopecia, or hair loss
- Hepatitis
- Respiratory failure
- Cerebral atrophy
- Mitral valve prolapse
Alcohol use disorder can affect your body and life. Side effects of misusing alcohol can include:
- Slurred speech
- Malnutrition
- Sexual dysfunction
- Hallucinations
- Blackouts
- Interpersonal problems
- Professional problems
- Financial difficulties
Alcohol and eating disorders can damage your health over time.
The most common health problems associated with alcohol include:
- Infectious diseases
- Cancer
- Diabetes
- Neuropsychiatric
- Diseases
- Cardiovascular disease
- Liver damage, which may lead to cirrhosis
- Pancreatic disease
- Unintentional and intentional injury
The combination of alcohol and eating disorders makes health issues related to nutrition, such as complications of Vitamin B1 (thiamine) deficiency, more likely to develop.
How Are Co-Occurring Eating Disorders and Alcoholism Treated?
An integrative treatment plan for persons with co-occurring eating disorders and alcoholism is critical for improving the potential for treatment success.
These programs are called dual diagnosis. During the evaluation process, a customized treatment plan is created. Addressing co-occurring conditions simultaneously is critical because the symptoms of one often worsen the other.
The evaluation examines biological, psychological, and physiological factors that contribute to both disorders. Depending on your level of alcohol use, detox may be needed to stabilize you medically and emotionally.
Three aspects of treatment are present in every type of treatment setting, including:
- Pharmacotherapy
- Behavioral therapy
- Recovery support
Pharmacotherapy
Medications for substance misuse and mental health disorders help reduce symptoms of withdrawal and rebalance neurotransmitters in the brain to improve mental health conditions that impede your rehab.
Working with a psychiatrist or treatment facility doctor, you are assessed for the type of medication that can help you with your current behaviors and symptoms.
Behavioral Therapy
One of the most common therapy modalities used in treating eating disorders and addiction is cognitive-behavioral therapy (CBT). CBT is a form of talk therapy that can be used in individual and group counseling settings.
Treatment teaches you to identify negative thoughts that lead to poor choices. CBT also teaches you to adjust those thought patterns, so your actions are realistic and not negatively focused.
CBT has several forms that help you deal with specific issues, like past traumas, eating disorders, and other mental health conditions that contribute to an alcohol use disorder.
Dialectical behavioral therapy (DBT) is another treatment that can be combined with CBT to help you learn emotional regulation and how to process complex ideas through mindfulness.
Your therapist may combine other modalities, such as psychotherapy or somatic therapy, as they find appropriate ways to address for your needs and treatment goals.
Recovery Support
While in treatment, you are introduced to recovery support services like Alcoholics Anonymous (AA) and the 12 Step program. Most programs recommend you attend these community groups once you are discharged from a higher level of care.
Recovery support can include a mutual support program led by peers and treatment staff that provides a safe learning and sharing environment when you are struggling. This includes both in-person and online recovery support programs.
The treatment services you receive must be comprehensive and should include the following:
- Extensive screening and assessment
- Access to a prescribing psychiatrist or physician
- Medication monitoring
- Psychoeducational classes
- Dual recovery treatment and support groups
- Relapse prevention skills classes
- Early recovery skills classes
- Family therapy
- Aftercare planning
If you are struggling with an eating disorder, alcohol use disorder, or both, help is available. Call
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