Like many mental and behavioral health issues, eating disorders (ED) and substance use disorders (SUD), or addiction, can go hand in hand. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), most individuals with an eating disorder struggle with some form of mental health or substance use disorder.1
Since eating disorders often begin during someone’s teen years, this is a particular concern and fear for many parents. Below, we’ll discuss what eating disorders are; how they interact with substance use; and what you can do to protect and support your loved one.
What are eating disorders?
Eating disorders are defined as conditions in which an individual experiences severe changes in their eating habits. These are often associated with distressing emotions and obsessive thoughts about food, weight loss, and body image.
While EDs are most common among girls and young women, anyone can develop them at any age, affecting as much as 5% of the U.S. population.2
Like addiction, an eating disorder is a disease that causes changes in the brain. As a result, individuals with eating disorders often require medical treatment to recover.
Some of the most common types of eating disorders include:3
Anorexia nervosa: Typically categorized by wanting and having a very low body weight through severely limiting food intake and exercising excessively.4
- Some individuals who have anorexia nervosa binge eat and purge their food instead of restricting their food intake.5
Bulimia nervosa: A disorder in which an individual eats a lot of food in a short amount of time and then “purges” the food through forced vomiting or use of laxatives.6
- Another type of bulimia is called “non-purging,” when someone does not purge their food but exercises excessively or fasts.
Binge eating: The most common ED in the United States, binge eating occurs when someone frequently eats large amounts of food in a short amount of time and is unable to control their food intake.7
Avoidant/restrictive food intake disorder (ARFID): unlike anorexia or bulimia, ARFID is usually not associated with negative feelings of self-worth or body image. it is a disorder that causes an individual to severely restrict the amount and type of food they eat.8
Symptoms of eating disorders include:9
- Extreme and/or unhealthy weight loss
- Constantly feeling weak and tired
- Difficulty concentrating
- Lack of appetite or interest in food
- Constipation
- Issues with sleep
- Constant sore throat and acid reflux from vomiting
- Bloating and diarrhea
- Teeth issues and decay
- Issues with work and/or academic performance
- Lack of interest in or withdrawal from relationships
- Depression and anxiety
Some of the most severe results of eating disorders include:10
- Poor nutrition
- Delayed puberty (if occurring in youth)
- Loss of monthly period
- Issues with bone density and growth
- Decrease in muscle mass
- Thoughts of suicide
- Heart issues
- Infertility
- Brain damage
- Organ failure
Eating disorders can also result in death. Anorexia nervosa is associated with highest death rate among all mental health disorders.11
Who’s at risk of developing an eating disorder?
Some youth may be at higher risk of developing an eating disorder. Some of these factors might include:12
Genetics. Some research shows that having close relatives with an eating disorder and/or mental health condition can increase a person’s risk of developing one themselves.
Existing mental health conditions. Anxiety, depression, and other mental health disorders are often associated with EDs.
Stress. Stress – whether it be from life changes, school troubles, or issues with friends – can trigger EDs.
Trauma. Many individuals with eating disorders have experienced or been exposed to trauma, especially at a young age.
Experiencing bullying. Studies have shown that the stress caused by discrimination and stigma – both around identity and body image – may be related to developing eating disorders.
Previous dieting. Individuals who frequently go on weight loss and diet plans can create problematic eating habits, which can then turn into EDs. Family members and close friends who diet can influence a teen’s own eating habits.
Sports. Many sports (e.g., football, wrestling, dance) require athletes to maintain a certain weight. Pressure to perform can lead to eating disorders.
Popular media. Sadly, certain body types are glorified in popular media. Teens can buy in to the idea that they need to look a certain way or weigh a certain amount to look good.
Social media. Young people increasingly turn to social media for guidance. “Instructional” TikTok videos on how to lose weight and videos promoting eating disorders as a “lifestyle” have become more popular in recent years. Research shows that these videos can be extremely harmful and may be responsible for making existing ED worse.13
How are eating disorders related to substance use disorders?
Research suggests that between 20-30% of individuals with an eating disorder also struggle with substance use.14 Often, individuals struggling with mental health and behavioral health conditions will turn to alcohol and other drugs to cope. Referred to as co-occurring mental health disorders, substances only make these conditions worse.
Individuals with SUD and those with ED are often likely to share similar risk factors, such as anxiety or depression, a family history, or trauma.
Eating disorders and substance use disorders also share similar qualities. Both cause changes to a person’s brain chemistry. For example, research has explored binge-eating as a “food addiction”; one study found that it affects parts of the brain responsible for self-control and habit forming.15 Other studies suggest that both disorders change normal dopamine levels, a feel-good chemical in the brain, that becomes unbalanced.
Additionally, individuals with eating disorders may use addictive substances to curb their appetite and/or lose weight, which can be very unhealthy and dangerous. They might start their use a way to lose weight, but quickly develop into a substance use disorder. Some are illegal drugs, but many can be purchased over the counter or online. These often include:
| Type of Substance | Examples | Why It’s Used | Main Risks |
|---|---|---|---|
| Prescription Stimulants (often used for ADHD) | Adderall, Ritalin, Vyvanse | Reduce appetite, boost energy | Heart problems, high blood pressure, addiction, anxiety, insomnia |
| Nicotine Products | Cigarettes, vaping | Suppress appetite | Addiction, lung disease, heart disease |
| Caffeine & Energy Drinks | Caffeine pills, high-caffeine teas, Monster, Red Bull | Boost energy, reduce appetite | Anxiety, heart rhythm issues, dehydration |
| Laxatives & Stool Softeners (OTC) | Ex-Lax, Dulcolax, Milk of Magnesia | Weight loss, trying to “feel empty” | Dehydration, electrolyte imbalance, long-term bowel damage |
| Diuretics | Diurex, herbal “water teas,” Lasix (Rx) | Reduce bloating or water weight | Severe dehydration, kidney damage, heart problems |
| Diet Pills / “Fat Burners” | Hydroxycut, Dexatrim, “slimming” or “detox” teas | Suppress appetite, boost metabolism | Heart/liver damage, anxiety, risks from unregulated products |
| Illicit Stimulants | Cocaine, methamphetamine, MDMA | Suppress appetite, increase energy | Addiction, heart attack, mental health problems, death |
| Fiber/Bulk Supplements | Excess psyllium husk, fiber powders | Feel full, reduce calorie intake | Digestive blockages, dehydration |
| Cold Medicines with Stimulants | Some OTC decongestants (e.g., Advil Cold & Sinus) | Mild appetite suppression | High blood pressure, heart strain, jitteriness |
| Alcohol or Sedatives | Beer, liquor, benzodiazepines | Cope with stress or guilt (often after binge eating) | Addiction, overdose risk, worsened depression/anxiety |
| GLP-1 Medications | Ozempic, Wegovy | Weight loss, appetite suppression | Severe vomiting, diarrhea, jaundice, impact on pancreas/kidney |
What are the warning signs of eating disorders and substance use?
It’s important to be aware of your loved one’s behaviors so you can recognize when something’s off. Some early signs of a potential eating disorder include:16
- Sudden or dramatic weight loss or gain
- Obsession with weight, body image, calorie counting, etc.; constantly weighing themselves or looking at themselves in the mirror
- Using the bathroom frequently, especially if right after eating
- Exercising too much
- Visibly restricting how much and what they eat; skipping meals or cutting out certain foods altogether
- Exhaustion and inability to concentrate
- Issues with menstruation
- Purchasing laxatives or related medicine
- Avoiding family and friends
Warning signs of problem substance use or a substance use disorder include:
- Negative shifts in mood or personality
- Inability to focus
- Sullen, withdrawn or depressed
- Less motivated
- Silent, uncommunicative
- Sullen, withdrawn or depressed
- Acting secretive
- Avoiding family and friends
- Loss of interest in school, work or other activities
- Poor hygiene and appearance
- Unusually tired or lethargic
- Sudden or dramatic weight loss or gain
How are eating disorders and substance use treated?
Eating and substance use disorders are both diseases that require medical treatment. If your loved one is struggling, consult with their primary care doctor or a mental health professional to help you determine the best course of action.
Eating disorders can be treated in several ways:17
Therapy. Strategies like talk therapy and cognitive behavioral therapy can help someone delve into their struggles and develop a better relationship with food and their body image. You can use Psychology Today to filter for therapists who specialize in eating disorders.
Medication. Medications to treat depression and anxiety may help treat underlying mental health conditions related to a person’s ED.
Outpatient treatment. Outpatient treatment, or day treatment, can include group and individual therapy, medical care, nutrition education, and other resources. Someone might attend these programs once a day, a few times a week, etc., while living at home.
Residential treatment. Residential treatment programs, where a person goes to live for a period of time to treat an eating disorder, can be particularly effective for people who have more severe symptoms.18
If your loved one is experiencing both eating and substance use disorders, it’s important to receive treatment that can address both. Many eating disorder treatment facilities in the United States also offer some form of substance use treatment. Be sure to ask treatment providers whether they’re equipped to do both.
Some new research suggests that there are emerging treatments for co-occurring ED and SUD. Ketamine, GLP-1 agonists (like Ozempic), and hormone therapies may be effective in treating different kinds of ED and SUD.19 For example, GLP-1 agonists (e.g. Ozempic) show promise in specifically treating binge eating and alcohol use disorder, while ketamine may help with anorexia nervosa. However, none of these have been FDA-approved, and studies are still underway.
For more information on treatment for substance use disorders, click here.
How can I protect my loved one?
Luckily, you can take action now to potentially help prevent your loved one from developing an eating disorder.20
Model healthy behaviors. If you’re frequently dieting or complaining about your weight – or commenting on someone else’s – your loved one may absorb it as something normal. Be kind to yourself.
Promote healthy habits. Make sure your loved one is eating healthy and well, but don’t be overly restrictive. If you or your child need to lose weight for medical reasons, consult with your health care provider or a licensed nutritionist instead of turning to a crash diet.
Communicate early and often. Be sure to watch for and address any of the risk factors mentioned above. It’s important to tackle them so that your child is able to handle them with healthy coping skills rather than turning to substances and/or developing an unhealthy relationship with food. Make sure they know they can come to you with any questions – or potential concerns about their own eating habits. By being the person they turn to for judgement-free advice, you’ll help prevent them from listening to an influencer instead.
Reinforce body acceptance. Make an effort to affirm your loved one’s appearance and let them know that all bodies are acceptable and beautiful.
It can be scary if your loved one is struggling with an eating disorder or a substance use disorder – or both. But you’re not alone. And with your love and support, you can help your child live a happy, healthy life. If you don’t know where to turn next, reach out to one of our certified specialists for guidance. We are here for you.