What are eating disorders?
Like substance use disorders, eating disorders are behavioral conditions that can be serious and even lethal if untreated.
What is the link between eating disorders and substance use?
Having a substance use disorder makes it more likely to develop an eating disorder, and vice versa. Having both conditions at the same time can make their effects worse.
Treatment for co-occurring eating and substance use disorders
Find a trained health care professional who can screen and treat co-occurring eating and substance use disorders. Access an online screening tool and get more information and support at the National Eating Disorders Association website.
People with eating disorders have a greater than average risk for misusing or becoming dependent on alcohol or drugs. Research shows that among people receiving treatment for eating disorders, 25% to 50% also have a substance use disorder.
If you have these conditions, you are not alone. Recovery from eating and substance use disorders is possible, and treatment works.
If you or someone you know is experiencing an eating disorder, get help by visiting the National Eating Disorders Association (NEDA) website.
If you or someone you know is in crisis or having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline at 988 or chat online at 988lifeline.org. In an emergency, call 911.
Both eating disorders and substance use disorders are behavioral conditions that can be serious and even lethal if left untreated.
An eating disorder is a mental health condition that disrupts people’s eating patterns and causes negative thoughts and emotions associated with eating.
A substance use disorder (SUD) is a mental health condition that occurs when the repeated use of one or more substances (i.e., alcohol and other drugs) causes significant harm to a person’s health and ability to carry out home, school, or work responsibilities.
Roughly 9% of Americans develop an eating disorder in their lifetime, and approximately 16.5% of people develop an SUD in a given year. Eating disorders and opioid use disorder have the highest mortality rates of all mental health diagnoses.
Both conditions on their own are harmful to health, but they are even more dangerous when combined — in other words, when they co-occur. According to one estimate, around 22% of people with an eating disorder develop an SUD during their lifetimes. Another study found that nearly half of people with an eating disorder misuse alcohol or illicit drugs, compared with 9% of the general population.
When present in combination with an SUD, eating disorders carry even greater risks of serious health complications, including death.
Anorexia nervosa, often simply called anorexia, is an eating disorder with two subtypes. People with the more common, restrictive version avoid, restrict, or limit their food intake. People with the binge-purge version of anorexia binge on large amounts of food and then try to purge it from their system (e.g., by vomiting or using laxatives or diuretics).
Although some people with anorexia may be dangerously underweight, the disorder can affect anyone. You cannot tell whether a person has anorexia based on their appearance.
Anorexia nervosa can cause serious health consequences, including death. And people with anorexia and a co-occurring substance use disorder face an even higher death rate — up to 22 times that of people without either condition.
People with bulimia nervosa experience episodes of uncontrolled eating, after which they may induce vomiting, avoid food, engage in extreme exercise, or take diuretics or laxatives. Like anorexia nervosa, bulimia nervosa can be dangerous and even fatal. Those with bulimia and a co-occurring substance use disorder have a chance of dying up to 11 times that of people without either condition.
People with this common diagnosis experience chronic episodes of overeating and feelings of shame and embarrassment. About 25% of people with this disorder are diagnosed with an SUD during their lifetimes.
Once called “selective eating disorder,” ARFID entails limiting food intake and variety but does not include concerns about body issues or weight gain. Adults and children can be diagnosed with this condition, although prevalence rates in either population are not well known. Children with this condition risk stunted growth and development from lack of nutrients.
If you’re age 13 or older, use the NEDA Eating Disorders Screening Tool to find out whether it’s time to talk with a health care professional about an eating disorder.
NEDA has partnered with Start Your Recovery to help those with eating and substance use disorders get the information and help that they need. Visit the NEDA website to learn more about the different types of eating disorders, signs and symptoms, and risk factors.
For many people, an SUD can lead to an eating disorder, or the other way around. And having both conditions at the same time can make their effects worse.
These conditions can also affect people in recovery. People in recovery from substance misuse may begin disordered eating as a coping mechanism, and people in recovery from eating disorders may begin to misuse alcohol or drugs. And recovery is not always linear; many people return to disordered eating or substance use (or “relapse”) during their recovery. If this happens, seek treatment or support — and remember that a relapse is not a sign of weakness or failure.
There are important differences between SUDs and eating disorders that influence the way they are treated. Treatment for an SUD usually involves stopping use of alcohol or other drugs, whereas treatment for eating disorders involves creating a healthier relationship with food. Patient-centered treatment programs must address these separate dynamics during recovery.
Co-occurring eating and substance use disorders can affect anyone — people of all genders, races, ethnicities, backgrounds, body shapes, weights, socioeconomic statuses, and age groups. There are various types of risk factors common to these co-occurring conditions:
One in 5 people diagnosed with an eating disorder develop a substance use disorder in their lifetime.
The prevalence of eating disorders in people with SUDs is around 10 times the prevalence of eating disorders in the general population.
Among people receiving treatment for eating disorders, 25% to 50% also have a substance use disorder. Tobacco and alcohol are the substances most commonly misused by people with these co-occurring conditions: 36.1% of those with an eating disorder have a tobacco use disorder, and 20.6% have an alcohol use disorder.
Eating disorders, addiction, and trauma
National Eating Disorders Association
Treatment for co-occurring eating disorder and substance use
National Eating Disorders Association
Eating disorders: It's time to talk about it
National Eating Disorders Association
Excerpts from the Experts center on the stories and work of innovators, researchers, clinicians, and those with lived experiences. In this video, Kim Dennis, MD, CEDS discusses the overlap between eating disorders, addiction, and trauma, and the treatment of these co-occurring illnesses.
CloseExcerpts from the Experts center on the stories and work of innovators, researchers, clinicians, and those with lived experiences. In this video Amy Baker Dennis, PhD, FAED discusses what treatment should look like for co-occurring eating disorders and substance use and shares takeaways for individuals and families looking for such treatment.
CloseEveryone should get screened for an eating disorder. These illnesses often hide in plain sight, so whether you have serious concerns or just an inkling about yourself or a loved one, take the screening. Eating disorders have the highest mortality rate of any mental disorder but recovery is absolutely possible and early intervention greatly improves the chances of success. It’s no exaggeration when we say three minutes can save a life.
CloseTreatment is a key step to better health. People who are successfully treated for eating disorders are far less likely to later be diagnosed with an SUD or another condition. Proper treatment also reduces the risk that people will develop an SUD to handle the stress of recovering from an eating disorder (or vice versa).
Start by finding a trained health care professional who can screen and treat co-occurring eating disorders and SUDs. Treatment should be specific to your eating disorder and SUD diagnoses and should be responsive to your readiness and goals for recovery. If you are experiencing a medical emergency, dial 911 or visit the nearest urgent care clinic or trauma center.
Treatment for an eating or substance use disorder, or for both disorders together, typically begins with a medical needs assessment.
In the case of an eating disorder, a medical professional would assess what you need in order to become medically stabilized, nutritionally rehabilitated, and mentally healthy. This may involve medication, counseling or therapy, and residential treatment. Some residential or inpatient centers that treat eating disorders can also address a co-occurring SUD.
In the case of a substance use disorder, a medical professional would assess what you need in order to become medically and mentally stabilized. This includes determining which detox (withdrawal management) setting is best, whether medication treatment is needed to manage symptoms of withdrawal, and which type of ongoing treatment and rehabilitation is right for you.
Various therapies can safely and effectively treat co-occurring eating and substance use disorders, including:
It’s important to find a therapist who specializes in the type of therapy that can address your specific concerns. Learn more about therapy.
In addition to these therapies, there are several innovative treatments that can help regulate food and drug intake. These include new technologies in transcranial magnetic stimulation, transcranial direct current stimulation, and deep brain stimulation. Self-help techniques have also shown promise in treating eating, substance use, and other disorders.
If you or someone you know is experiencing an eating disorder, visit the National Eating Disorders Association website to find resources and support.
If you or someone you know is in crisis or having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline at 988 or chat online at 988lifeline.org. In an emergency, call 911.
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Insatiable Hungers: Eating Disorders and Substance Abuse, Social Work Today, 2008
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Substance Abuse and Eating Disorders, National Eating Disorders Association
Substance Use Disorders Are Deadly, The American Journal of Psychiatry, Jan. 1, 2022
The Risk of Substance Use Among Adolescents and Adults With Eating Disorders, Cureus, September 2020
What Are Eating Disorders? American Psychiatric Association, February 2023
Overdose Prevention and Treatment, Centers for Disease Control and Prevention