Substance use disorder and eating disorders are both serious illnesses that can lead to dangerous health consequences. They’re often talked about together because they tend to appear together; people with substance use disorder are much more likely to also have an eating disorder than the general population.
On top of that, eating disorders and substance use disorders also share many similarities — so many that some experts say that eating disorders are actually a type of addiction in themselves. But are eating disorders and substance use disorders actually the same illness?
Let’s go over how addiction and eating disorders are linked, and the similarities between the two.
What Is Substance Use Disorder?
Substance use disorder, or SUD, is a diagnosable illness that affects a person’s brain and causes them to become addicted to drugs and/or alcohol. People who have SUD can become addicted to different types of drugs, which leads to different diagnoses (for example, alcohol use disorder or stimulant use disorder) — but all types of SUD share similar symptoms.
The symptoms of SUD are:
- Spending most or all of your time using the substance, withdrawing from the substance, or figuring out how to get the substance
- Having strong urges or cravings to use the substance
- Experiencing physical or psychological withdrawal symptoms when you stop using the substance
- Needing more and more of the substance to achieve the same “high”
- Failed attempts to cut down on or quit using the substance
- Continuing to use the substance despite problems it’s causing in your life (such as relationship difficulties or trouble at work)
SUD is extremely common. 10% of Americans face a drug problem at some point in their lives. The rates of alcohol abuse are even higher. 
Substance Use Disorder and Eating Disorders Are Highly Linked
Although we need more research to define the exact relationship between substance use and eating disorders, we know one thing: they are highly linked.
Research shows that around half of people with eating disorders also abuse drugs and alcohol, compared with less than 10% of the general population. 
The reverse is also true: Over a third of people with substance use disorder also have eating disorders, compared with only 3% of the general population. That means people with substance use disorder are around ten times more likely to have an eating disorder than people who don’t struggle with addiction.
It’s clear that these two types of disorders frequently appear together, and researchers have come up with several explanations for this.
Shared risk factors between substance use disorder and eating disorders
One explanation for the high correlation between substance use disorder and eating disorders is that the two types of disorders share the same risk factors.  A three-year study, published by The National Center on Addiction and Substance Abuse, found several risk factors that can lead to both substance use disorder and eating disorders, including:
- Being a victim of sexual or physical abuse
- Low self-esteem
- History of depression or anxiety
- Time of occurrence (both disorders tend to occur during times of high stress)
- Family history and genetics
- Brain chemistry
- Unhealthy peer pressure
- Being highly susceptible to media and advertising
- Being raised by a parent with unhealthy parenting behaviors
Any of these factors can raise your risk of developing eating disorders and/or substance use disorders.
Does an eating disorder cause addiction, or vice versa?
It’s difficult to answer the question of which comes first: the eating disorder or the addiction. Some people may develop an eating disorder first, and others may live with addiction for a while before developing an eating disorder. Having either of these disorders can heighten your risk for the other.
Some people develop an eating disorder first. They may start using drugs and alcohol to cope with the negative thoughts and feelings that often accompany eating disorders.
Some drugs may also help them with weight loss and appetite. For example, stimulants like cocaine often cause people to lose weight. People with an eating disorder like anorexia may try to use these substances to be able to eat less and not get hungry. In one study, researchers found that over a third of the women in treatment for methamphetamine use disorder (a stimulant drug) started using it in order to lose weight. 
Other times, substance abuse comes first. For example, withdrawal from certain drugs can increase your appetite. Using substances can also decrease your impulse control. This might lead to an eating disorder like binge-eating disorder, in which someone eats uncontrollably during a short span of time.
Is an eating disorder an addictive behavior?
Some experts have suggested that eating disorders are actually a type of addiction. And the two types of disorders certainly share many similarities, which we’ll discuss in more detail later. But are they the same thing?
Some experts say that eating disorders are similar enough to drug and alcohol addiction that they can be considered a drug addiction themselves.  People with substance use disorder use drugs and alcohol for two primary reasons: to avoid pain or to seek pleasure. The more often they use, the more their brain starts to associate the substances with pleasure and reward.
The same could be said for eating disorder behaviors. Engaging in unhealthy eating behaviors could engage the brain’s reward circuit.
One study found that people with anorexia or bulimia scored highly on the Addiction Scale of the Eysenck Personality Questionnaire.  This suggests that people with anorexia and bulimia have what’s called an “addictive personality,” or are more likely to become addicted to things (both outside substances and behaviors). People with binge-eating disorder may also have an “addiction” to food, although the concept of “food addiction” itself is a controversial one.
There is also a theory that anorexia is actually a physical addiction to your body’s self-produced opioids. This theory, called the anorexia auto-addiction opioids theory, says that self-starvation causes certain chemicals to be released in the brain. Anorexia, therefore, can be seen as an addiction to the body’s production of endogenous opioids. Proponents of this theory claim that this means eating disorders like anorexia are biologically and psychologically identical to substance abuse. More research is needed to prove this theory.
For now, we can say with certainty that eating disorders and substance addictions share a lot of similarities. But many experts say there are enough differences between them to make them distinct disorders. We need more research to be able to say whether these two disorders are etiologically the same thing.
Similarities Between Eating Disorders and Substance Use Disorder
Although they may not be the same illness, eating disorders and substance use disorder have many characteristics in common. These similarities include:
Cravings and secret rituals around the addictive behaviors
Both eating disorders and substance use cause people to have ritualistic and secretive behaviors. People with eating disorders may have secret rituals around food; for example, they may hide “forbidden” foods away to eat privately, or purge in secret after eating a meal. People with substance use disorder often behave in similar ways; they may lie about their substance use or sneak away to use substances.
People with eating disorders tend to engage in compulsions around food. This might include binge-eating episodes for people with bulimia nervosa or binge-eating disorder. But it could also be a compulsion to eat only certain kinds of foods or to purge after eating. People with substance use disorder use drugs and alcohol compulsively; they may have urges to use that feel irresistible to them.
Inability to stop compulsive behaviors
Both people with eating disorders and substance use disorder may try to stop their compulsive behaviors but have no success. For example, someone with substance use disorder might try to stop using drugs, only to relapse a short time later. Someone with an eating disorder may try to refrain from binge-eating episodes but then give in to the craving.
Many experts say that eating disorders and substance use disorders share biological similarities, and affect the brain in similar ways. Both intense exercise and starvation affect the dopamine level and reward center in the brain — the same pathways that are affected by drug and alcohol use. Starving yourself, strenuously exercising, and purging all increase endorphins in the brain, which may make these behaviors addictive in the same way that drugs are addictive.
Another factor that people with eating disorders and people with substance use disorders share is that they usually engage in these unhealthy behaviors as a way to try to cope with painful emotions or stress. For example, someone might engage in binge-eating, starvation, or drug use to try to feel better about whatever they’re going through.
Both eating disorder behaviors and drug or alcohol abuse are self-destructive behaviors. People might feel like these behaviors are helpful for them emotionally, but they actually only hurt your mental and physical health. People with eating disorders and/or substance use disorder may know these behaviors are self-destructive, but continue engaging in them.
Co-morbidity is the medical term that refers to two disorders which occur at the same time. Both eating disorders and substance use disorder often appear together with depression, anxiety, obsessive-compulsive disorder, and post-traumatic stress disorder (PTSD).
Negative interference with life
Lastly, both eating disorders and substance use disorders create significant problems in people’s lives. People with anorexia, for example, are often so rigid in their eating rituals that they start to drive loved ones away. In a similar way, people with SUD may spend so much time using or trying to get access to the drug, they no longer have time for friends and family.
Treatment for Co-Occurring Eating Disorders and Substance Use Disorder
Eating disorders and SUD are so intertwined they need to be treated together when someone is facing both. But integrative treatment programs that actively address both issues at the same time are still rare. If you can’t find a treatment center near you that can treat both conditions, then you need to treat them both separately.
The important thing is that your treatment team addresses both conditions. Tell your treatment team about all of your symptoms. They can make the right decision about whether your substance use disorder or eating disorder needs to be treated first.
At The Center • A Place for HOPE, we screen all of our clients in our eating disorder treatment program for co-occurring conditions, including substance use disorder. In this way, we can make sure we’re taking care of you holistically — instead of just addressing one diagnosis.
Here are some of the most effective treatment options for you if you’re facing both an eating disorder and a substance use disorder.
Nutritional and medical stabilization
If you have a severe eating disorder and are facing malnutrition, electrolyte imbalance, or a dangerously low BMI, you may first need to go through a stabilization process at a medical facility. A trained medical team can make sure that you safely recover from the physical health consequences of the eating disorder.
You might also have to go through refeeding. If you’ve been malnourished for a long time, then suddenly increasing your nutrient intake could be dangerous. In a medical unit, your team can slowly introduce calories and nutrients into your body in a safe way.
Medical stabilization might also be necessary because of a drug or alcohol addiction. For example, if you’ve overdosed on a drug or are going through withdrawal, then you may need medical intervention.
After you are medically stable and your health is no longer in danger, then you may choose to enter into a residential treatment program. In a residential program, you live at the same facility where you receive treatment. Treatment usually consists of individual, group, and family therapy. You can also receive medication consultation, nutritional counseling, and other holistic wellness interventions.
Residential treatment may be especially helpful for people with eating disorders and/or substance use disorder because it gives you extra support and supervision when you’re in the early stages of recovery. This makes it easier to resist the usual temptations you face that might make you slip into old negative behaviors.
In a residential treatment program, you’ll also be surrounded by a community of people who are going through the same thing you are. And often, healthy meals are prepared for you — which is essential during eating disorder recovery.
Therapy for eating disorders and SUD can be delivered in a residential treatment center or in an outpatient clinic. Some specific types of therapy that are helpful for eating disorders and addiction include:
- Maudsley family therapy: This type of family therapy is based on the family systems approach. It’s been shown to be effective for adolescents with anorexia nervosa or bulimia nervosa. In this therapy, the parents take control of the client’s eating habits at first, but control is slowly given back to the client with time.
- Dialectical behavior therapy (DBT): One pilot study had promising results for DBT when it was used to treat co-occurring SUD and eating disorders.  DBT teaches people coping skills to deal with strong emotions and improve their relationships.
- Cognitive-behavioral therapy (CBT): CBT is a widely-used evidence-based intervention for a whole host of disorders, from depression to chronic pain. It has been used widely in the treatment of SUD, and can also be tailored to treat eating disorders.
- Interpersonal psychotherapy (IPT): IPT focuses on improving interpersonal relationships. Since both eating disorders and SUD disrupt relationships, this approach can be helpful for people struggling with both.
Residential Treatment for Eating Disorders and Substance Abuse
Recovery from both eating disorders and substance use disorder may be challenging — but not impossible. Our team at The Center will be with you every step of the way. We believe in you, and we know that recovery is possible for you.
Both eating disorders and substance use disorder are too serious to ignore. And if left untreated, both of these disorders can lead to serious consequences. But having these disorders doesn’t have to mean the end of the road for you. There is effective treatment that can help you develop a healthy relationship with food and your body.
The Center • A Place of HOPE has over three decades of experience helping people like you recover from eating disorders, and our team truly cares about helping you heal your relationship with food. Our residential treatment program for eating disorders accepts many different insurance plans, and financing is also available.
There are specialized programs for women, men, and adolescents at our program. All of our programs are whole-person based, which means that we see you as a complete human being, not just a patient.
To learn more about our admissions process and how you can start your treatment journey with us, get in touch with us today.