Substance Use & Eating Disorders: The Overlapping Risks and How to Address Them

Substance use and eating disorders (EDs) frequently co-occur, creating higher health risks and making recovery more challenging. Individuals with EDs may use substances to suppress appetite, control weight, numb emotions, or cope with distress. Because both conditions reinforce each other, treatment must address both the eating disorder and substance use simultaneously.

Why Do Eating Disorders & Substance Use Often Co-Occur?

Common Reasons for Substance Use in eating disorders:

·         Appetite Suppression & Weight Control

o   Stimulants (Adderall, cocaine, methamphetamine, nicotine, caffeine) reduce hunger

o   Laxatives, diuretics, or purging after substance use create a false sense of "control."

·         Emotional Escape & Numbing

o   Alcohol, marijuana, benzodiazepines (Xanax, Ativan) are used to ease anxiety, depression, or food-related distress

o   Opioids (painkillers, heroin) numb emotional and physical pain

·         Binge-Purge Cycle Reinforcement

o   Alcohol or marijuana lowers inhibition, leading to binge eating

o   Stimulants (cocaine, Adderall) can trigger purging after a binge

·         Perfectionism & High Achievement Pressure

o   Many individuals with EDs have perfectionist tendencies and use stimulants (Adderall, Ritalin) to maintain focus in school or work

·         Social Pressure & Party Culture

o   Alcohol, drugs, and restrictive eating are common in certain social settings (e.g., college environments, modeling, or athletic industries)

·         Substance use in eating disorders is often a coping mechanism to manage food, emotions, or social pressures

Commonly Abused Substances in Eating Disorders

Substances Commonly Used & Their Risks in ED Recovery:

Substance

Why It’s Used

How It Worsens ED Symptoms

Nicotine (Cigarettes, Vapes)

Appetite suppression, stress relief

Increased metabolic stress, heart issues, and anxiety

Caffeine (Energy Drinks, Coffee, Pills)

Appetite control, energy boost

Increased anxiety, dehydration, and binge-purge cycles

Alcohol

Social comfort, numbing emotions

Impairs judgment, increases binge eating, dehydration

Marijuana

Reduces stress, increases appetite

Triggers binges, emotional instability

Adderall, Ritalin (Stimulants)

Appetite suppression, focus, weight loss

Increases heart risks, compulsive behavior, and withdrawal crashes

Cocaine, Methamphetamine

Extreme weight loss, energy boost

High addiction risk, heart failure, and malnutrition

Opioids (Painkillers, Heroin)

Numb emotions, reduce physical discomfort

Slows digestion, worsens depression, and leads to dependency

Laxatives & Diuretics

Weight control, bloating reduction

Severe dehydration, organ damage, and electrolyte imbalance

Many substances provide temporary relief but worsen ED symptoms and long-term health.

The dangers of co-occurring eating disorders and substance use

·         Increased Risk of Medical Complications

o   Malnutrition + substance use leads to heart failure, kidney damage, and cognitive impairment

o   Electrolyte imbalances from purging + stimulant use can trigger fatal arrhythmias

·         Worsening Mental Health

o   Depression, anxiety, and suicidal thoughts are more common when EDs and substance use co-occur

o   Increased risk of self-harm or impulsive decisions

·         Stronger Addiction Cycle

o   Restrictive eating + stimulant use → Increased risk of stimulant addiction

o   Binge eating + alcohol/marijuana → Increased risk of binge-drinking patterns

·         Higher Dropout Rates from Treatment

o   Patients with co-occurring substance use and EDs are more likely to quit treatment early

o   Avoiding emotional work in recovery leads to relapse in both disorders

·         Eating disorders and substance use reinforce each other, increasing medical and psychological risks

How to approach treatment for co-occurring eating disorders and substance use

·         Integrated Treatment for Both Conditions is Essential

o   Treat both disorders at the same time

§  Ignoring one leads to relapse in the other

o   Use a harm-reduction approach

§  Gradual changes may work better than abrupt restrictions

o   Screen for trauma & mental health conditions

§  Many individuals with EDs & substance use have underlying PTSD, anxiety, or depression

·         Therapies That Help Both EDs & Substance Use Disorders:

o   Cognitive Behavioral Therapy (CBT-E)

§  Challenges thought patterns related to food & substances

o   Dialectical Behavior Therapy (DBT)

§  Teaches distress tolerance & emotional regulation

o   12-Step and Peer Support Groups

§  ED support (ANAD, EDA) + substance recovery (AA, NA) can be beneficial

o   Medication-Assisted Treatment (MAT) if necessary

§  SSRIs, naltrexone, or other meds may help

·         Nutritional & Lifestyle Adjustments:

o   Focus on balanced nutrition

§  Prevents substance cravings driven by malnutrition

o    Encourage hydration and electrolyte balance

§  Supports organ recovery

o   Develop new coping skills (yoga, journaling, music)

§  Reduces reliance on substances

·         Recovery requires a whole-body approach—medical, nutritional, and psychological healing.

Signs That Substance Use Is Interfering With ED Recovery

 Red Flags to Watch For:

·         Skipping meals but consuming excessive caffeine, nicotine, or stimulants

·         Binge eating episodes triggered by alcohol or marijuana use

·         Using laxatives or diuretics after drinking or using drugs

·         Prioritizing substances over meal plans or therapy sessions

·         Increased secretive behavior, withdrawal from support systems

·         Mood swings, anxiety, or worsening depression

·         If substance use is interfering with ED recovery, it's a sign that both disorders need simultaneous treatment

Steps to Overcome Co-Occurring EDs & Substance Use

·         Step 1: Recognize & Accept the Dual Struggle

o    Both disorders need attention—one cannot be ignored

o   Denial is common, but awareness is the first step toward healing

·         Step 2: Find Dual-Diagnosis Treatment

o   Seek professionals trained in both EDs & addiction

o   Inpatient, outpatient, or support groups may be needed

·         Step 3: Build a New Coping Toolbox

o   Replace substances with healthier stress-management techniques (mindfulness, exercise, creative outlets)

o   Address trauma or emotional pain fueling both disorders

·         Step 4: Rebuild a Healthy Relationship with Food

o   Structured meals prevent restriction-driven substance use

o   Focus on hydration, electrolyte balance, and gut healing

·         Step 5: Stay Accountable & Connected

o   Find support groups for both ED & substance recovery

o   Open up to trusted friends, family, or a mentor

Final Thought: Substance use and eating disorders create a dangerous cycle, but full recovery is possible with the right support. Addressing both disorders together leads to lasting healing.

Disclaimer: This information is intended for educational purposes and should not replace professional medical advice. If you or someone you know is in crisis or needs immediate help, please contact a healthcare professional or crisis intervention service immediately.