The Connection Between Eating Disorders and Substance Abuse
Eating disorders and substance use disorders frequently co-occur, yet this overlap is often missed in treatment. Research suggests that about half of women with eating disorders (EDs) also struggle with a substance use disorder (SUD), and having one puts you four times at risk for developing the other. Despite how common this pairing is, many individuals are treated for one condition while the other quietly persists.
So why does this matter?
When only part of the picture is addressed, recovery can stall. In early recovery especially, individuals may unknowingly shift from one coping behavior to another, like using food to manage distress after stopping substances, or turning to substances when eating disorder behaviors become harder to maintain.
In this article, we’ll explore how eating and substance use disorders intersect, common warning signs, and what to look for in treatment. If you are struggling with your relationship to food, substances, or both, you are not failing. You may be responding to distress in the only way you have learned. And with the right support, these patterns can change.
“Drunkorexia” and Other Common Intersections
Drunkorexia describes a pattern in which someone limits or skips food to “save room” for the calories from alcohol.
Beyond the basic definition, this behavior often reflects deeper concerns about weight, body image, and control. Someone engaging in this pattern may skip meals, exercise excessively, or drink to the point of vomiting to counteract calories from alcohol.
While drunkorexia isn’t a clinical diagnosis, the term highlights how disordered eating and problematic drinking can intertwine and harm both physical and mental health. This combination is especially common among young adults and college-aged individuals where social drinking and appearance pressures are high. Research suggests that 22-66% of college-age women report inducing vomiting to compensate for calories from alcohol.
Other Ways Eating Disorders and Substance Use Intersect
Drunkorexia is far from the only example of how these behaviors can overlap. Some people engage in binge drinking alongside binge eating, using alcohol or food to cope with stress, anxiety, or other difficult emotions. For someone recovering from an eating disorder, substances may become a way to manage the challenges of recovery. Likewise, someone in substance use recovery might engage in disordered eating to fill the void left by substances.
At their core, both EDs and SUDs often function as attempts to regulate emotions and avoid distress. In one case, food or restriction becomes the primary coping strategy; in another, substances take on that role. While the behaviors may look different on the surface, the underlying function is often similar.
By addressing this shared vulnerability and building healthier ways to tolerate distress, treatment can help reduce the risk of one disorder replacing the other.
Signs Someone Might Be Struggling
While EDs and SUDs focus on different behaviors — one centered on food, the other on substances — many warning signs overlap. Recognizing patterns early can help individuals and loved ones find appropriate support.
Since eating disorders vary widely, symptoms can differ from person to person.
Eating Disorder Warning Signs
Compulsive or excessive exercise
Dramatic weight changes
Significant calorie restriction
Cheek or facial swelling
Food wrappers in odd places or food “disappearing”
Bathroom visits immediately after meals
Calluses on the back of the hands or knuckles
Noticeable behavior changes
Isolation or withdrawal
Increased mood swings, irritability, or anxiety
Emotional numbness or lack of emotion
Substance use disorders also present in different ways depending on the diagnosis.
Substance Abuse Warning Signs
Very small or dilated pupils
Loss of appetite or increased appetite
Weight changes
Flu-like symptoms
Isolation from friends and family
Sudden changes in friends, hobbies, or activities
Secretive behavior
Moodiness or unusual giddiness
Missing alcohol from the home
Hidden empty bottles
As you may notice, there is meaningful overlap, particularly around secrecy, isolation, mood shifts, and physical changes. When someone is struggling with both conditions, these patterns often become more pronounced or interconnected.
Possible Signs of Co-Occurring ED & SUD
Secretive behavior
Isolation or withdrawal
Using food or substances to cope with distress
Unexplained weight changes
Frequent illness or appearing run down
Noticeable mood or behavior changes
Appearing bloated or swollen
Restricting food to “save calories” for alcohol
Frequent vomiting
Strong urges or cravings related to food or substances
Continuing behaviors despite negative consequences
Having one or even several of these signs does not automatically mean someone has an eating or substance use disorder. Everyone’s experience is different, and some symptoms may remain largely internal or easy to miss. However, noticing patterns early can support more comprehensive care.
Treatment and Recovery
ED and SUD recovery share meaningful similarities. Both involve learning to regulate emotions, tolerate distress, identify triggers, and reduce reliance on harmful coping mechanisms. Strong support systems and building healthier coping skills are central to both processes.
However, there are also key differences that treatment must account for. Substance use treatment often emphasizes abstinence, while eating disorder recovery cannot involve abstinence from food! Instead, ED treatment focuses on nutritional rehabilitation and building a sustainable, flexible relationship with food.
Because of this complexity, seeking specialized, integrated care is essential. After all, treating one condition while overlooking the other can increase relapse risk. When evaluating programs, here are some things to consider:
Dual-diagnosis expertise: Look for programs that specialize in co-occurring disorders and address both conditions simultaneously.
Medical support: Make sure there is medical oversight, as both EDs and SUDs carry serious physical, and life-threatening, risks.
Individualized treatment planning: Be cautious of one-size-fits-all approaches. Treatment should be based on a thorough assessment that evaluates the type and severity of both disorders. From there, the program should recommend the level and type of care that best fits the individual’s needs.
Continuum of care: Bonus points if the program offers a full continuum of care. Strong programs provide ongoing support as individuals transition back into daily life, including post-treatment resources and relapse prevention planning.
Recovery from any disorder is deeply personal and unique. You may find a program that looks great on paper but doesn’t feel like the right fit. Because therapy is inherently relational, the connection and rapport you have with your providers are just as important as the treatment itself. With the right support and a treatment approach that addresses the full picture, recovery from both eating disorders and substance use is absolutely possible.
Conclusion
Eating disorders and substance use disorders often overlap in ways that are easy to miss but deeply important to understand. When these patterns co-occur, they can reinforce one another and complicate recovery if only one piece of the puzzle is addressed. Early awareness, thorough assessment, and integrated treatment make a significant difference.
Most importantly, recovery is possible. With the right support, individuals can build healthier coping strategies, improve their relationship with food and substances, and move toward a more stable and fulfilling life. If you or someone you love is struggling, reaching out to a provider who understands co-occurring disorders can be an important first step.
Because every person’s experience is unique, treatment should always be individualized, compassionate, and holistic. You deserve care that sees the full picture. Remember, healing is not about perfection; it’s about making meaningful progress with the right support along the way.
