The Link Between Eating Disorders and Drug or Alcohol Addiction
While Flatirons Recovery specializes in supporting individuals recover from substance use disorders and/or mental health disorders, we recognize that addictions can present under almost innumerable guises. The American Society of Addiction Medicine defines “addiction” as “a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences” (and if you’ve been following our blog, you have probably memorized this by now…but we’re all about repetition and practice around here!).
If you’re addicted to substances and want to recover, the most obvious first step is to eliminate the substance. But what if you’re “addicted” to something critical for your own survival – such as food? Is it even possible to say someone can be “addicted” to food?
Our society has an almost unfathomably complex relationship to this basic thing we all need to survive: food. The only basic needs we have that take precedence over food are having air to breathe and water to drink. [As a side note: while I’m not sure if there’s ever been a reported case of “air addiction” – which would arguably affect 100% of us – even water can become problematic, such as for marathon runners who are so intent on staying sufficiently hydrated that they overdo their water intake and die of hyponatremia (insufficient salt in the bloodstream, caused by excessive dilution).]
But food – our third-in-line most basic need for survival – and the behaviors surrounding our food? These are seriously complicated, pervasive, persistent, and often life-threatening issues affecting people throughout the world. Contrary to popular belief, eating disorders do not only affect the Western world, and they don’t only affect females either; they are equal opportunity conditions.
National surveys estimate that 20 million women and 10 million men in America – or 1 in 20 people – will have an eating disorder at some point in their lives. It’s a significant statistic, and a worrisome one – especially since people with eating disorders are almost 30% more likely to suffer from co-occurring substance use disorders than those who don’t have eating disorders.
There are many types of eating disorders; while anorexia nervosa (severe food restriction or self-imposed starvation) and bulimia nervosa (which involves the use of a compensatory mechanism, such as self-induced vomiting or laxative abuse, after eating large quantities of food) are the most widely known, people struggling with disordered eating may exhibit a constellation of behaviors that range in severity. In substance abuse disorder treatment, we often treat clients whose problems with drugs or alcohol occur concurrently with disordered eating and/or exercise habits. For some, the disordered eating habits started long before their abuse of substances, and simply have gone under the radar. Other clients only begin to exhibit troubling patterns in their eating/exercise habits as they gain more traction in their sobriety.
The associations between eating and substance abuse disorders are very complex, and it can be difficult to ascertain where one ends and the next begins. Recent research suggests that these types of disorders share a genetic predisposition. Clients struggling with co-occurring bulimia nervosa and substance use disorders, for instance, often exhibit traits such as increased impulsiveness that may predispose them to the development of both disorders. Other factors in common include:
- Shared brain chemistry (impact on dopamine and serotonin brain systems)
- Common family history (A family history of either substance abuse or eating disorders may increase the risk for the
development of the other disorder.)
- Low self-esteem, depression, or anxiety
- Onset after stressful events
- Unhealthy social norms and peer pressure
- Vulnerability to messages from the media
- History of childhood abuse
Patients with eating disorders who also have a substance use disorder have more severe symptoms, higher relapse rates, more severe medical complications, and are more seriously impaired than individuals with eating disorders alone. Both eating and substance use disorders can lead to death; research suggests that when they co-occur, the mortality rate is even greater than the mortality rate for each alone.
As a therapist who’s worked in many substance use treatment facilities, I always feel concerned when I notice one of my patients, embarking on the tough journey of early recovery from substance abuse, becoming more rigid or compulsive about their eating and/or exercise habits. Of course, it is critical for our clients to eat well, get plenty of exercise and sleep, and develop other life-sustaining habits. But when these new habits become obsessive or compulsive in nature, it’s usually an indicator that the addiction – one of the sneakiest of all afflictions – may be shifting course. While it’s still somewhat unclear, from a scientific perspective, how substance use disorders are similar to or different from eating disorders, they can both act as sophisticated (if extremely maladaptive) mechanisms for coping with painful life experiences.
Some of the warning signs of disordered eating we look for in clients in early recovery may include:
- exercising strenuously for more than 1-2 hours per day, especially if at the exclusion of other activities
- overly strict adherence to a new, rigid diet and/or eating schedule;
- excessive concern about their caloric intake or refusing to eat;
- preoccupation with their body shape/size and/or body weight or weighing themselves multiple times per day;
- frequently feeling out of control or numb while eating, or eating to avoid painful feelings
- use of diuretics, laxatives, evidence of vomiting after meals, or other signs of purging
We’re so worried about symptoms like these because the health consequences of eating disorders can be devastating – and can happen in an instant. Self-induced vomiting, for instance, can cause someone’s esophagus to rupture or lead to sudden and severe electrolyte disturbances – both of which can cause death within minutes. Prolonged compulsive exercise can lead to musculoskeletal injuries or even bone loss/osteoporosis, especially when combined with restricted food intake. Prolonged food restriction leads, of course, to malnutrition – which can pave the way for a sudden heart attack due to weakened cardiac muscle.
The list goes on and on; it’s a very extensive and scary list.
Recovering from a substance addiction requires cultivating the ability to acknowledge and tolerate difficult feelings, sensations, and thoughts without acting upon them impulsively or dangerously. If we don’t cultivate that ability, we end up looking for other ways to fill the void the substances left behind and to regain a sense of control when life seems to have turned upside-down. Unfortunately, all of the factors that predispose people to substance addictions seem to predispose them to other, similarly harmful behaviors – such as those found in eating disorders.
At Flatirons Recovery, we talk about these things. We don’t ignore the red flags – nor do we just panic or send people out the door if we or they notice they’re struggling with symptoms of an eating disorder. While we specialize in helping people get off and stay off substances, we also specialize in recognizing and understanding the process of addiction – and the many forms it can take.