Eating disorders are a lot more common than many people realize. And often, they are directly linked to substance abuse. An estimated 8 million people in America have eating disorders, 7 million of which are women. One in 200 women struggle with anorexia while 3 in 100 women suffer from bulimia. Even individuals not battling an eating disorder are often affected by one, since nearly half of Americans know someone with this mental illness.

Not only are eating disorders prevalent, but they are incredibly dangerous: They have the highest mortality rate of any mental illness. Anorexia alone carries four times the risk of death as major depression, and with a mortality rate of 5.1 deaths per 1,000 people, it is also deadlier than other mental illnesses, including schizophrenia and bipolar disorder. (It is important to note that anorexia refers to a general loss of appetite or interest in food, while anorexia nervosa refers to the mental illness that most people think about when they hear the word “anorexia”. In this guide, we will refer to anorexia nervosa as simply “anorexia” and to bulimia nervosa as “bulimia” for simplicity’s sake.)

When controlled substances are part of the equation, the danger is exponential. Consider that in the United States in 2013 alone, there were 46,471 drug-induced deaths, 29,001 alcohol-induced deaths, and 41,149 suicides (in which drugs and alcohol often play significant roles). A reported 50 percent of those with eating disorders also abuse drugs and/or alcohol, which is 5 times more than the general population.

A study by the National Association of Anorexia Nervosa and Associated Disorders found that between 5 and 10 percent of anorexics die within 10 years of contracting the disease, and up to 20 percent die after 20 years. Only between 30 and 40 percent ever fully recover.

Drug and alcohol addiction can lead to a number of medical problems, including cancer, heart disease/failure, stroke, HIV/AIDS, respiratory diseases, hepatitis B/C, digestive problems, kidney failure, liver failure, bone loss, tooth decay, and skin issues, not to mention social and relationship issues.

There has been a great deal of research pointing to similarities between eating disorders and drug and alcohol addiction. Given that these similarities exist and that both have to do with how the brain is stimulated as well as personality type (such as being prone to stress or impulsiveness), it’s no surprise that an individual dealing with one often faces the other.

Impulsiveness plays a significant role in bulimia because the disorder often involves eating a large amount of unhealthy foods – on impulse – with the mindset that it’s OK to do so because the purge will take care of the negative effects on weight. This mindset is also a breeding ground for other impulses, like substance abuse behavior.

Both eating disorders and substance abuse may also stem from life trauma such as physical, sexual, or emotional abuse, the passing of a friend or family member, or another major or unexpected life change.

In addition to related psychological factors, disorders and substance abuse are often related to factors that are genetic or environmental in nature. Genetic factors are estimated to account for 40 – 60 percent of one’s vulnerability to addiction.

Because both drug and alcohol addiction and eating disorders often go hand-in-hand, together they are particularly difficult – yet possible – to fully recover from.

Anorexia

A person who has anorexia starves themselves in an effort to lose weight or avoid weight gain. Anorexia often comes with feelings of anxiety, low self-esteem, anger, and loneliness, which are all similar reasons people give for abusing substances, even if they don’t suffer from an eating disorder.

Someone who suffers from both substance abuse and anorexia may be prone to suicidal thoughts, and those who have the disease are often addicted to drugs and/or alcohol. Both the anorexia and the addiction can feed off one another and have an impact on the brain’s endorphins, serotonin, and dopamine. Sufferers of the disease are prone to addiction in general, and this frequently includes addictions to caffeine, tobacco, laxatives, diuretics, and other over-the-counter medications.

Drunkorexia

A common practice among many anorexics is using alcohol in conjunction with skipping meals to facilitate weight loss. This practice, which has been described as a combination of anorexia and alcoholism, has acquired its own nickname – “drunkorexia” – because it is so prevalent. While alcohol use does come with calories, it also dehydrates, and in excess, often causes vomiting, which can contribute to the desired weight loss. In some cases, people are skipping meals specifically so they can drink and not suffer the effects of caloric intake from both meals and binge-drinking.

The practice is fairly popular among college students, particularly young women. In fact, the University of Texas at Austin’s student affairs division says that as many as 30 percent of women between 18 and 23 diet specifically so they can drink without worrying about the calories in the alcohol they consume.

With drunkorexia, a young woman will get drunk much more quickly than they would on a full stomach, which may lead to any number of dangers. These could range from impaired judgment and passing out to serious accidents or sexual threats that are also unfortunately rampant in some college campus environments.

CBS News has highlighted drunkorexia and how women’s bodies differ from men’s when it comes to how alcohol is processed. It cited studies finding that women are more likely to become dependent on the substance, and noted that they produce lower quantities of an enzyme that helps metabolize it. This means women are more susceptible to blackouts and cirrhosis. It also reports that drinking has been linked to higher incidences of breast cancer.

Bulimia

People with bulimia tend to binge-eat a lot of food at once before purging by vomiting or taking laxatives in order to maintain or lose weight. They often exhibit similar emotions to anorexics, such as low self-esteem, anger, and anxiety, as well as guilt, which is only compounded by their bulimic actions.

Once again, young women are the biggest group – making up as much as 90% – of people affected by this disorder. Body image, societal pressures, and depression are typically the causes.

In addition to laxatives, bulimics often abuse alcohol, which can lead to vomiting, and diuretics to lose water weight. These are obviously in line with the individual’s weight loss goals, but drugs and alcohol are also abused as a means of coping with the emotional distresses that are directly related to the person’s disorder. Addiction can come from either of these reasons for using or a combination of the two.

As with anorexia, bulimia can be fatal.

Symptoms and Characteristics of Eating Disorders

One of the best ways to help a loved one – or our self – with an eating disorder is to know the warning signs associated with the mental illness. Here are some red flags to watch out for.

Characteristics of someone who is anorexic include things like low self-esteem, depression, anxiety, and isolation, as well as a frequent fear of gaining weight or feeling that they are overweight when in fact they are underweight. An individual’s association of their self-esteem with body weight in general is something to be aware of.

Physically, anorexia is associated with anemia, infrequent menstrual cycles, swollen joints, brittle hair and nails, and constipation. Frequent use of laxatives or diuretics is also a warning sign of a larger issue.

When it comes to drunkorexia, it’s helpful to recognize the signs of binge drinking, which can include things like vomiting, difficulty in waking the person when they’re sleeping, and irregular breathing patterns.

Symptoms of bulimia also include constipation, infrequent menstruation cycles, and anemia, as well as dehydration, fatigue, dizziness, stomach pains, cramps, bloating, diarrhea, esophagus problems, ulcers, tooth cavities or loss of tooth enamel, kidney trouble, or even heart failure.

Signs that someone may be bulimic include frequent bathroom use (especially right after meals), rampant use of diet pills, laxatives, or other medications for urination, teeth problems, broken blood vessels in the eyes, rashes, pimples, and swollen cheeks.

Exercising regularly is certainly a good thing, but if someone is obsessively doing so, and other warnings signs are present, this could be another indication that someone may have an eating disorder.

The Effects of Harmful Substances on the Body

One reason substance abuse is so common among people with eating disorders is that use of some drugs can suppress appetite. It can “help” achieve the desired effect of weight loss. In some cases, this loss of appetite from drug abuse may actually lead to the eating disorder. A person with an eating disorder may also abuse drugs as a means to avoid eating by taking their mind off it. In other cases, people with eating disorders abuse drugs or alcohol in order to try and cover up other issues related to an eating disorder.

People with anorexia or bulimia may be more susceptible to drug overdose or alcohol poisoning because of their lower body weights, making substance abuse all the more dangerous.

Alcohol

Alcohol is among the most common substances to be abused by people with eating disorders for a variety of reasons. For one, it is generally easy to acquire, provided the person is of age. In excess, it leads to vomiting, and it also has a dehydration effect.

When binge-drinking and alcohol abuse coincide, dangers include alcohol poisoning (which can be deadly), brain damage, and sexual health issues stemming from poor judgment, such as sexually transmitted diseases or unintended pregnancies. If the drinker is already pregnant, this can lead to birth defects. Those with bulimia may suffer from bleeding and pain caused by exposure of alcohol to tissues damaged by vomiting.

Marijuana

People with eating disorders sometimes turn to marijuana and other relaxant drugs as a means to cope with the anxiety of the disorder and the pressure of trying to keep it a secret. Relaxants do just what their name implies and make many users feel as though they are in a more relaxed state, although not everybody reacts the same way to these drugs. For some, they may actually have the opposite effect and increase stress as a result of feelings of paranoia.

Beyond its impact on an eating disorder, marijuana can negatively impact brain development, and contribute to increased heart rate and breathing problems. It can also worsen symptoms of some mental disorders, such as schizophrenia.

Methamphetamine

Methamphetamine and other stimulant drugs are sometimes used by people with eating disorders because they can make them feel less hungry. Anorexics in particular can use these drugs to keep themselves from physically wanting to eat and to appease their disorder.

Methamphetamine has its own negative health effects, including high blood pressure (which can lead to heart attacks), sleeping problems, nausea, behavioral problems, irritability, panic, seizures, permanent brain damage, liver damage, lung damage, kidney damage, depression, and potentially death by overdose.

Other drugs, such as cocaine, inhalants, psychedelics, and prescription drugs may also be used by people with an eating disorder to deal with related stress and anxiety. These all have side effects that are damaging to the body.

Diet Pills and Weight Loss Supplements

Individuals with eating disorders often take diet pills or weight loss supplements. Those willing to starve themselves or binge and purge are generally willing to turn to just about any means of potential weight loss, including drugs that promise to help.

Use of such products can lead to increased blood pressure, kidney and liver damage, rectal bleeding, or diarrhea. Some products in this category have been banned or recalled due to potential health problems including heart disease, heart attack, stroke, lung disease, kidney damage, and liver damage.

Laxatives

Laxatives are frequently abused by people with eating disorders for multiple reasons. For one, they use them as a means of purging. Rather than vomiting after a meal, some will turn to laxatives to induce diarrhea and quickly remove food from their bodies. With constipation being an eating disorder symptom, people also turn to laxatives to facilitate bowel movements when not enough food has been consumed to lead to one that is healthy.

Abusing laxatives can be very detrimental to the body, as vital organs such as the colon and heart are deprived of nutrients necessary to their functioning. Laxative abuse also leads to severe dehydration, which can damage the kidneys or lead to death

According to the National Eating Disorders Association, laxative abuse can lead to a laxative dependency, which occurs when the colon stops reacting to normal doses of laxatives, requiring larger amounts to produce bowel movements. This can lead to organ damage, colon infection, irritable bowel syndrome (IBS), or liver damage. It may even contribute to colon cancer risk, the association says.

Diuretics

Diuretics are often abused in attempts to lose weight. These pills increase urine flow and reduce the amount of water in the body. This is an incredibly unhealthy means of weight loss, given the importance of water to a healthy body.

Abuse of diuretics can cause health issues that include headaches, dizziness, dehydration, kidney damage, nausea, heart palpitations, and even death.

Ipecac Syrup

Ipecac syrup, which induces vomiting, is commonly used by bulimics as a means to do just that, but this is not without its dangers either. It can cause diarrhea, choking, low blood pressure, chest pains, stomach pains, trouble breathing, and heart problems, all of which in severe cases can be fatal.

Caffeine

A 2009 study found that while people with eating disorders consume caffeine at a rate similar to the general population, they do so with a “kind of binge attitude”.

Caffeine has been linked to high blood pressure, increased risk of heart attacks among young adults, gout, breast tissue cysts, incontinence, insomnia, indigestion, headaches, reduced fertility, increased risk of bone fractures, and in excess, even early death.

Nicotine

Many people with eating disorders take to smoking cigarettes as a way to help them suppress their appetites. A 2006 study compared smoking prevalence and behaviors across eating disorders to those of people without eating disorders. It found women with eating disorders to smoke more and have a greater dependence on nicotine. Impulsive personality traits were said to be a factor, which may help explain why those with bulimia reported higher rates of smoking compared to other disorder types.

As is generally well-known, smoking has numerous effects that are damaging to health. The Centers for Disease Control and Prevention (CDC) considers it the leading preventable cause of death in the United States. Smokers are more likely to develop lung cancer and heart disease and are more likely to suffer strokes, and smoking can also lead to emphysema and chronic bronchitis or trigger asthma attacks.

While smoking is most commonly associated with lung cancer, it has also been linked to many other types of cancer, including bladder, cervix, colorectal, esophagus, kidney, larynx, liver, oropharynx, pancreatic, stomach, trachea, bronchus, and leukemia cancers.

Treatment

The fact that drug and alcohol addiction and eating disorders have a lot in common and that someone who suffers from one condition often has the other has led to forms of treatment that seek to address root causes of both. These therapies should be sought out when a person has both an eating disorder and a substance addiction.

As this guide has discussed, substance addiction and eating disorders can feed off of one another. Therefore, treatments that address both the substance abuse and the eating disorder together are ideal to help the addict not rely on one to cope with the other. The earlier a person is treated, the better. It’s a good idea to turn to a specialist or program that has experience in treatment for both substance abuse and eating disorders.

There are a variety of both inpatient and outpatient treatment options. Inpatient options are typically reserved for those who are medically unstable based on vital signs, lab findings, worsening symptoms, or risk of suicide.

Residential care is provided to those who are stable and do not need intensive medical care. Partial hospital care may be offered to those impaired by eating disorders, but who aren’t under an immediate risk, as well as those who need to be regularly assessed. Those who are stable, do not need daily monitoring, and have symptoms under control may be offered outpatient care.

In some cases, hospitalization may be required to treat anorexia or bulimia, but this is not always the case; it depends on the severity of the patient’s condition. A feeding tube may be used to get the necessary nutrients to the patient. Depending on the nature of symptoms exhibited, different types of doctors may be needed to treat specific types of health problems that have occurred as a result of substance abuse or the eating disorder.

Antidepressants and antipsychotic medications are sometimes prescribed to bulimics who are substance abusers. It is important these medications are not also abused, so management of these medications should be discussed with a doctor. For bulimics, there are programs (both inpatient and outpatient) in which meals are supervised.

Eating disorders such as anorexia and bulimia are unfortunately quite common among young women, and many sufferers also have a substance abuse problem. These disorders are incredibly dangerous even without the complications of drugs and alcohol, but the sad reality is that these behaviors frequently go hand-in-hand. Worse still, each works to fuel the other, making matters – and one’s overall health – even worse.

There is hope. There are treatments available for both eating disorders and substance abuse, and there are programs that will help patients address both issues together. It’s important to recognize the problems and seek treatment as early as possible. Whether you are victim of an eating disorder or substance abuse disorder or you believe a friend or loved one has an issue, do not delay seeking help!