Co-occurrence of an Eating Disorder and a Substance Use Disorder<br />

 The co-occurrence of an eating disorder and a substance use disorder is a complex and challenging issue that many individuals face. These two disorders often intertwine, creating a cycle of physical and emotional distress that can be difficult to break. Understanding the relationship between eating disorders and substance use disorders is crucial for effective treatment and recovery. 

Many eating disorder patients hide out in addiction treatment, and many people with drug addictions hide out in eating disorder treatment. Patients may attempt to mask their true condition and may not be aware of it. Clinicians not trained in both spectrums may fail to identify their primary diagnosis.

Understanding the Connection

Both eating disorders and substance use disorders are characterized by compulsive behaviors, obsessive thoughts, and a loss of control. Individuals with eating disorders may use substances as a means of coping with their feelings of guilt, shame, or low self-esteem related to their eating behaviors. On the other hand, substance use can also contribute to the development of disordered eating patterns, as certain substances may suppress appetite or alter body image perception.

Individuals in early substance abuse recovery describe dysfunctional eating practices, including binge eating and the use of food to satisfy drug cravings. Early recovery can be very stressful, which can lead to craving, compulsivity, and relapse risk. However, there is a difference between an individual with substance use disorder who binge eats and a patient with binge eating disorder who uses drugs; however, some individuals display characteristics of both. Successful treatment should identify the primary diagnosis, as nutrition therapy for eating disorders is oftentimes at odds with nutrition therapy for addictions.

Risk Factors

Several risk factors can contribute to the co-occurrence of eating disorders and substance use disorders, including:

  • Genetics: A family history of either disorder can increase the likelihood of co-occurrence.
  • Trauma: Individuals who have experienced trauma or abuse may be more susceptible to developing both disorders as a way of coping with emotional pain.
  • Co-existing Mental Health Conditions: Conditions such as depression, anxiety, or personality disorders can increase the risk of developing both eating and substance use disorders.

Integrated Treatment Approaches

Effective treatment for co-occurring eating and substance use disorders requires an integrated approach that addresses both conditions simultaneously. Here are some strategies commonly used in integrated treatment programs:

Comprehensive Assessment

A thorough assessment of the individual’s physical and mental health, substance use, and eating behaviors is essential for developing a personalized treatment plan.

Dual Diagnosis Treatment

Dual-diagnosis treatment programs are designed to address both eating and substance use disorders concurrently, utilizing a combination of psychotherapy, medication, nutritional counseling, and support groups.

Cognitive Behavioral Therapy (CBT)

CBT can be effective in helping individuals identify and change the negative thought patterns and behaviors associated with both eating and substance use disorders.

Nutritional Counseling

Registered dietitians specializing in eating disorders can provide guidance on developing a healthy relationship with food and addressing nutritional deficiencies resulting from disordered eating or substance use.

Support Groups

Peer support groups can provide individuals with a safe and understanding environment to share their experiences, gain insight, and receive encouragement from others facing similar challenges.

Intervention Strategies

Nutrition In Recovery attempts to normalize disordered eating patterns for individuals in early recovery, stressing that disordered eating is likely related to altered brain chemistry and type of food consumed and does not necessarily indicate an eating disorder. New research is attempting to formulate treatment modalities for co-occurring eating disorders and substance use disorders, addressing both issues simultaneously.  If you or someone you know is struggling with co-occurring eating and substance use disorders, seeking professional help is the first step towards healing and reclaiming a healthy, balanced life.

Nutrition & Substance Abuse Resources:

    Dr. David Wiss became a Registered Dietitian Nutritionist (RDN) in 2013 and founded Nutrition in Recovery, a group practice of RDNs specializing in treating eating and substance use disorders. In 2017, David received the “Excellence in Practice” award at the National Food and Nutrition Conference and Expo. The California Academy of Nutrition and Dietetics awarded him the “Emerging Dietetic Leader Award” in 2020. He earned his Ph.D. from UCLA’s Fielding School of Public Health in the Community Health Sciences department (with a minor in Health Psychology) by investigating the links between adverse childhood experiences and various mental health outcomes among socially disadvantaged men. His treatment philosophy is based on a biopsychosocial model which incorporates an understanding of biological mechanisms, psychological underpinnings, and contextual factors that integrate the social determinants of health. Wise Mind Nutrition is an app-based interactive treatment program available for download now -

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