Eating Disorders and Substance Abuse: The Link

Each year, more than five million Americans suffer from eating disorders such as anorexia and bulimia. Millions more are affected by alcohol and other substance abuse problems. Many don't realize that these two disorders actually seem to be related.

In "Food for Thought - Substance Abuse and Eating Disorders" (CASA), researchers found that up to half of all eating disordered patients also struggle with alcohol and substance abuse. This is compared to the approximately nine percent of the general population dealing with alcohol and drug abuse (CASA).

Patients with bulimia were the most likely to alcohol or drug problems of all the other eating disorders. Depending on which study you are going by, bulimics experience alcohol or substance abuse fourteen to forty-nine percent for alcohol abuse or dependence and from eight to thirty-six percent for other drug abuse or dependence. Binge eating/purging anorexics showed similar substance abuse likelihood (Lilenfeld 1996).

Patients with anorexia exhibited significantly less alcohol and substance abuse problems. Alcohol abuse or dependence among restricting anorexics ranged from zero to six percent. Patients with anorexia experienced drug abuse or dependence ranged from five to nineteen percent (Lilenfeld 1996).

The general female population has been found to have a twelve percent abuse or and ten percent for other drug abuse or dependence (1996).

Why is there such a large difference in frequency in substance abuse in the two disorders? One main theory is that it is an impulse control issue (among other factors). Patients with bulimia and purging anorexia have trouble controlling their impulses to binge. This is also true of binge eating disorder or compulsive eating disorder. The inability to control food intake is likened to inability to control alcohol or drug intake.

Another theory is that as binging is a way of numbing one's feelings and emotions, so is consuming alcohol or drugs.

Anorectics had significantly lower incidence of alcohol abuse. One reason anorectics have such a higher rate of drug use than alcohol is simple: calories. Alcohol contains the second most calories per gram, second only to fat. Therefore, a person with anorexia will most likely not allow themselves to consume that many extra calories. There are other, more complex issues in play as well.

There is another interesting finding in the relationship between alcohol and substance about and eating disorders. In one study of alcohol dependent patients, it was found that thirty percent had histories of eating disorders. One third had been diagnosed with anorexia nervosa and two thirds were diagnosed with bulimia nervosa. In these patients, the eating disorder usually came before the alcohol or substance abuse (Lilen feld 1996).

Another similar study of alcoholic women found that one third of the twenty alcoholic women had a "serious eating disorder, usually bulimia. Additionally, thirty percent of women in treatment for substance abuse disorders showed evidence of current eating-related problems" (Schuckit 1996).

This suggests that while anorectics rarely exhibited alcohol abuse during the life of their eating disorder, they were more likely to suffer from alcohol problems after their so-called "recovery."

There is obviously a link between eating disorders, past and present, and alcohol/substance abuse problems. Patients with anorexia, bulimia, and binge eating/compulsive eating disorders all seem to have a higher life-long chance of developing substance abuse problems.

Parents, schools, and treatment providers need to be conscious of this apparent connection between eating disorders and substance abuse. Education can be widened to spread awareness of this phenomenon. More research is warranted to more thoroughly understand the connection between these two disorders affecting so many Americans.

Sources:

Heidtke, Annsley. Eating Disorders and Substance Abuse. http://www.vanderbilt.edu/AnS/psychology/health_psychology/substance.htm

The National Center on Addiction and Substance Abuse (CASA). Eating Disorders, Substance Abuse Linked. http://alcoholism.about.com/cs/nutrition/a/blcasa040128.htm