Emaciated Addicts & Alcoholics: Is This a Form of Anorexia?

Man in addiction treatment

Recent research has found that eating disorders and substance or alcohol use disorders commonly co-occur [1]. Studies have also found that dual diagnosis increases mortality through either medical complications or suicide at rates greater than the general population.

Both addictions and eating disorders have roots in genetic components, family history, early trauma, history of abuse, as well as comorbid mental health issues, such as depression, anxiety, bipolar, and other mood disorders.

Often times, those with eating disorders will abuse alcohol and drugs to either assist in purging behaviors or dehydration. It is also used to curb appetite in the eating disorder individual, which can cause significant weight loss.

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Research has found that 27 percent of those with anorexia also have a concurrent substance use disorder [2]. When analyzing calls to a national hotline, 32 percent of female callers have addiction to cocaine and a comorbid eating disorder. In another study that looked at those seeking eating disorder treatment, 17 percent had dual diagnosis of substance abuse [2].

These findings lead researchers to believe that those with an initial eating disorder tend to lean towards drugs and alcohol to help achieve further weight loss, or as a further means to cope. Self-reports have found that the lower the weight, the higher the drive for substance abuse, especially alcohol, cocaine, and heroin.

Anorexia is a psychiatric disorder that includes self-starvation, weight loss, malnutrition, rigid and obsessive thinking and, often, compensating behaviors. Fear of becoming fat, feeling overweight when underweight, and failure to maintain a minimum ideal body weight. In females, it can mean a cessation of menstrual cycles and put bone health at risk [2].

Anorexia has two subtypes. The restrictive type is where the focus is on food and liquid restriction, and the binge/purge type is where the focus is on dietary restriction and episodes of binge eating, followed by compensating behaviors.

How do Anorexia and Addiction Overlap?

There are commonalities between both eating disorder and substance abuse behaviors.

Both tend to significantly forgo responsibilities in personal and professional life to pursue addictive behaviors. There are often unrelenting and uncontrollable urges to engage in either the eating disorder or addiction behaviors. Both tend to engage in behaviors to manage comorbid mental health issues, like depression, dysphoric mood, and anxiety.

Even with similarities, there are also differences between substance abuse and eating disorders.

With the person who is abusing alcohol and substances, the goal is for immediate relief from emotions, stress, or situations. With the person who has an eating disorder, the goal is to seek relief immediately, but also long-term through weight loss, pursuing body perfection, and a feeling of control over one’s life.

What is an Alcohol Addiction: Brain and Body

Addiction can be seen as a brain model [3]. There are several parts to the brain and its functioning.

Woman sitting on a bench

The brain stem, which is responsible for life sustaining activities, the limbic system which is responsible for the emotional, instinctual and motivation based needs.  The middle part of the brain is the part that focuses on Id-based activities, such as food, sleep, and sex, that are pleasurable activities.

The cortex, the top of the brain, is the area that allows us to think on a deeper level.

We reason, have insight, and complete executive functioning with this part of the brain.

Our brain works together to help us navigate our environment. When an addiction or eating disorder are present, it creates disbalance in our functioning. All areas are affected with both disorders and the brain begins to work overtime in other areas to try to compensate for the parts that are dysregulated by the disorder [3].

When a person is excessively drinking for long periods of time, they can develop Ketoacidosis, which is where the food or liquid or substance ingested is metabolized into acid [4].

When a person is excessively using alcohol and drugs and are not eating to the point they are emaciated, a person’s pancreas may stop producing insulin. This starts the process where the body uses fat stores for energy, which is known as ketone bodies.

This begins to build up in the bloodstream and can cause the life-threatening condition ketoacidosis, where the body begins to turn anything ingested into acid.

This process can be caused by both alcoholic ketoacidosis caused by excessive alcoholic consumption and starvation ketoacidosis, which occurs in those who are self-starving or pregnant women in their third trimester [4].

Excessive drinking causes ketoacidosis, which can cause malnourishment. Those who drink or abuse substances may not eat regularly or fast for long periods of time due to addiction. Also with addiction, current or frequent vomiting may occur to overdosing issues.

The Link Between Eating Disorders and Substance Abuse

Research over the years on patients who struggle with eating disorders and substance use disorders has found that deficits in impulse control are prevalent [5]. Those who struggle with substance use disorders also seem to show dieting and eating issues, especially among young adults.

In 1996, a research study found that teens who used cigarettes and drugs also had dieting behaviors [5]. Further research has found that food deprivation, as in anorexia or fasting with alcohol and drug use, can increase the use of substances, which can cause dysfunction in the central nervous system.

Man's faceAn eating disorder can develop after substance use has begun and appetite has been suppressed. It can be enticing for a person who is predisposed to addictive type behaviors to continue suppressed appetite or weight loss [6].

There are shared characteristics and differences to substance use disorders and eating disorders. They are not linked to being causal, yet share many genetic, environmental, and cultural factors for the development of each.

Being emaciated does not necessarily mean that the person has an eating disorder every time, but it can be a factor in weight loss with co-occurring substance abuse. Under all the symptoms, most substance use disorders and eating disorders work to manage underlying mental health disorders, stressors, and life situations.


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] Substance Abuse and Eating Disorders. (n.d.). Retrieved June 10, 2017, from https://www.nationaleatingdisorders.org/substance-abuse-and-eating-disorders
[2] Barbarich-Marsteller, N. C., Foltin, R. W., & Walsh, B. T. (2011, September). Does Anorexia Nervosa Resemble an Addiction? Retrieved June 10, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4438277/
[3] Anorexia, Addiction and the Three-Part Brain Model. (2013, August 27). Retrieved June 10, 2017, from http://www.eatingdisorderpro.com/2012/07/20/anorexia-addiction-and-the-three-part-brain-model/
[4] Burke, D., & Wells, D. K. (2016, November 15). Alcoholic Ketoacidosis. Retrieved June 10, 2017, from http://www.healthline.com/health/alcoholism/ketoacidosis#diagnosis4
[5] Eating Disorders and Alcohol Use Disorders. (2012). Retrieved June 10, 2017, from https://pubs.niaaa.nih.gov/publications/arh26-2/151-160.htm
[6] Company, I. G., & Ressler, A. (2008, June & july). Insatiable Hungers: Eating Disorders and Substance Abuse . Retrieved June 10, 2017, from http://www.socialworktoday.com/archive/070708p30.shtml
Volume 8 Number 4 Page 30

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 July 24, 2017
Reviewed By: Jacquelyn Ekern, MS, LPC on July 24, 2017.
Published on AddictionHope.com

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.