Addiction & Eating Disorders: How Common is a Dual Diagnosis

Woman struggling with dual diagnosis

In recent years, there has been a significant connection between addictions and eating disorders. This dual diagnosis is becoming more apparent, especially in women.

Studies have shown that up 35% of individuals with eating disorders also have an alcohol or substance abuse comorbid disorder, compared with 3% of the general population [1]. Both groups share many risk and personality factors.

Associated Risks

Those who struggle with eating disorders are at a higher risk to also have substance abuse issues compared to those in the general population. For some, the lure of addictive substances is for weight loss in the beginning.

Appetite suppression and chemical changes in the reward center of the brain encourage with continued use of substances such as alcohol, nicotine, amphetamines, and cocaine, are used. For some, addiction issues may be present prior to the onset of the eating disorder.

There are many shared characteristics for eating disorders coupled with addictions. Often early childhood trauma or abuse has shown a causal link [1].

Often the use of both offer maladaptive coping skills to rely on eating disorder and addiction symptomatology to ease the struggle one feels internally, to protect oneself from danger or memories of trauma, and to numb from current issues due to the dual diagnosis.


Often triggers for both occur when high levels of stress or change happen. As noted above, both eating disorders and addictions activate the reward and pleasure area of the brain, and there is commonly shared environmental and trauma characteristics.

Many times, individuals struggle with impulse control, high- risk behavior, low self-esteem, and depression. Individuals who engage in both disorders often socially isolated and have multiple diagnoses and suicidal ideation.

Both disorders also require intensive therapy and treatment concurrently to treat both diseases.

In further studies, those with bulimia nervosa and addictions have higher rates of this dual diagnosis than those with other eating disorders and substance use [2]. In a study of over 3000 women, 31% of these with bulimia also had a history of alcohol abuse.

Those who were diagnosed with bulimia were two times as more likely to have alcohol abuse/dependence issues than those who had anorexia or binge eating disorder.

Man with addiction standing in the snowThey were also three times more likely to have a dual polysubstance abuse and eating disorder diagnosis than the other two groups [2].

Most individuals who are diagnosed with bulimia also tend to use different addictive substances to self-medicate or manage symptoms.

Often substances most commonly used are cocaine, alcohol, marijuana, and prescription drugs. Also commonly used are other drugs such as laxatives, emetics, diuretics, and diet pills.

Many times the substances are used for weight loss or weight management, but when the person wants to stop usage, they are unable to do so.

Certain EDs at a Higher Rate for Addictions

One potential reason for those with bulimia to have a higher rate of substance abuse is the fact that they may also have underlying impulse control issues. Other addictive behaviors such as gambling, shoplifting, and promiscuity may also be present.

These individuals have also been shown to have higher rates of post-traumatic stress disorder as well, which in other research studies have shown to have higher rates of substance abuse.

Typically eating disorders are common in those who abuse substances. Approximately 20% of men and women self-report binge eating and substance abuse concerns and 12% report a form of inappropriate weight-control behaviors [3].

Often adolescence is a significant time for substance abuse and prevalence of eating disorders. In a study of college women, considerable dieting behaviors were associated with increased rates of alcohol, nicotine, and drug use [3].

In youth in middle school, among 6th graders, dieting behaviors predicted future alcohol use possibly connecting the theory that food deprivation can increase alcohol and other substance use later in teen years or early adulthood.

Chemicals and its Effects

Within the chemical workings of the brain and addiction, the endogenous opioid peptide has been shown to influence both alcohol, substances, and food consumption. This has been connected to impulse and control in these areas.

Woman near lake

Neurotransmitters including serotonin, gamma-aminobutyric acid, and dopamine areas also activated in both addictive behaviors and eating disorders.

Nicotine use is significantly high among those with an eating disorder. Up to 75% of those with bulimia, and 60% of those with anorexia use nicotine, amphetamines, cannabis, and cocaine as a way to manage or control symptoms [4].

Emetics are also frequent, and up to 9% of those with a dual diagnosis of bulimia abuse them.

The overuse of artificial sweeteners, such as soda, is also abused in those with eating disorders. It typically is used to trick the body and mind into feeling fuller, and weight control methods.

Often sugar packets are also used on low-calorie foods for further weight control practices, becoming addictive. In studies on animals of food deprivation/starvation and substance abuse, the craving and use of substances are significantly higher [4].

Addiction and eating disorders are a common dual diagnosis that is often seen in treatment facilities. Many times, individuals develop both disorders together as a way to self-manage symptoms of underlying psychological issues.

Working with a treatment team and exploring dual diagnosis programs for treatment is recommended for the best success rates.

Recovery is possible through work in both outpatient and inpatient settings. Depending on the severity of the eating disorder and addiction, it may be wise to look into a higher level of care first to address detoxification and weight restoration.

Many times through multiple treatment options that are used simultaneously is the best practice for gaining recovery.

Image of Libby Lyons and familyAbout the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.
Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.


[1] Ressler, A. (2008). Nsatiable Hungers: Eating Disorders and Substance Abuse. Retrieved October 15, 2017, from
[2] Substance Abuse in Women With Bulimia Nervosa. (n.d.). Retrieved October 15, 2017, from
[3] Eating Disorders and Alcohol Use Disorders. (n.d.). Retrieved October 15, 2017, from
[4]Review, E. D. (2017, January 30). A Dangerous Comorbidity: Eating Disorders and Substance Abuse. Retrieved October 15, 2017, from

The opinions and views of our guest contributors are shared to provide a broad perspective of addictions. These are not necessarily the views of Addiction Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Addiction Hope understand that addictions result from a combination of environmental and genetic factors. If you or a loved one are suffering from an addiction, please know that there is hope for you, and seek immediate professional help.

Published on January 1, 2018
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About Jacquelyn Ekern, MS, LPC

Jacquelyn Ekern founded Addiction Hope in January, 2013, after experiencing years of inquiries for addiction help by visitors to our well regarded sister site, Eating Disorder Hope. Many of the eating disorder sufferers that contact Eating Disorder Hope also had a co-occurring issue of addiction to alcohol, drugs, and process addictions.