Addiction Professionals: Working with a Client Who Also Has a Co-Occurring Eating Disorder

Young female therapist thinking about a Client Who Has a Co-Occurring Eating Disorder

Working with a client who has an addiction and co-occurring eating disorder can be a challenge. The therapist, depending on the severity of either issue will need to focus on the most life threatening disorder first.

A study through the National Center on Addiction and Substance Abuse (CASA) showed that up to one half of individuals with eating disorders abuse alcohol or illicit drugs compared with 9% of the general population. This study also showed that approximately 35% of alcohol or illicit drug users have eating disorders compared with 3% of the general population (CASA, 2003).

Both groups share risk factors and personality characteristics. It is important, therefore, when working with individuals, to screen for both substance abuse and eating disorders in the initial intake as either can be overlooked or missed.

The Shared Characteristics of Substance Abuse and Eating Disorders

Young woman with her back to us.When individuals present for substance use the client may be using substances (prescription or not) to help aid in weight loss or appetite suppressant. When withdrawal from substance abuse occurs, overeating may result.

In a three-year study in 2003 by CASA found common characteristics and risk factors between the two populations, including the occurrence of eating disorders and/or substance abuse with transition or stress, common brain chemistry changes, common family history (to include history of abuse), low self-esteem, depression, anxiety, or impulsivity, unhealthy parental behaviors and low monitoring of children’s activities, unhealthy peer norms and social pressures.

Other shared characteristics include obsessive preoccupation and cravings, behaviors, and rituals with eating disorder or substance, increased social isolation, increased risk for suicide and self-harm behaviors, and possible chronic diseases, and high rates of relapse.

When working with individuals who have co-occurring disorders it is important to remember that recovery is different with each disorder. The substance abuser must restrict or abstain from the substance and the individual with an eating disorder cannot abstain from the substance (food). Abstinence for those with eating disorders involves abstinence from its symptoms which include starvation, rigid dieting, binge eating, purging, and poor body image.

Rather than breaking the relationship with the substance, the individual with an eating disorder must work to form a new enhanced relationship with food, while the substance abuser traditionally severs the relationship with the substance.

Screening for Substance Abuse and ED’s

Young woman taking notes from her Therapist.Behavioral health professionals when assessing for addiction and eating disorders can use screening tools. To screen for substance use in individuals with eating disorders, the CAGE (Cut down, Annoyed, Guilty, Eye-opener) and the MAST (Michigan Alcohol Screening Test) are both effective. The EDI (Eating Disorder Inventory) and the SCOFF (Sick, Control, One Stone, Fat, Food) also may be used.


[1]: Ressler, A., 2008. Insatiable HungersL Eating Disorders and Substance Abuse. Social Work Today.

Image of Libby Lyons and familyAbout the Author:

Libby Lyons, MSW, LCSW, CEDS is a specialist in the eating disorder field. Libby has been treating eating disorders for 10 years within the St. Louis area, and enjoys working with individuals of all ages.

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.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on April 24, 2016
Published on

About Baxter Ekern

Baxter Ekern is the Vice President of Ekern Enterprises, Inc. He contributed and helped write a major portion of Addiction Hope and is responsible for the operations of the website.