Reviewed by Kim Dennis, MD, CED-S
As has been highlighted during the drug overdose epidemic in the U.S., substance use disorders (SUD) are well known to increase the risk of premature death, with a large body of research documenting mortality related to tobacco, alcohol, and other drugs. Eating disorders (ED) are also associated with high premature mortality rates and are among the most lethal of all the psychiatric disorders. Death rates for those with both ED and SUD are addictive, leaving those with co-occurring illness at a substantially elevated risk of premature death. Despite the increase in morbidity and mortality of comorbid ED and addiction, patients with this unique co-occurrence have been infrequently studied, leaving them often undiagnosed, untreated and underserved. According to a 2021 study published in the American Journal of Psychiatry, “A major driver of mortality in patients with eating disorders is substance use disorders…eating disorders and substance use disorders are each shown to be associated with high rates of mortality, but the combination of anorexia nervosa, bulimia nervosa, or unspecified eating disorders with a substance use disorder is particularly lethal because the risks of death from one are added to the other.”1
Up to 50% of individuals with eating disorders use alcohol or illicit drugs, a rate five times higher than the general population.2 Up to 35% of individuals who were dependent on alcohol or other drugs also have eating disorders, a rate 11 times greater than the general population.3 Despite the substantial overlap between these two illnesses, there remains a gap between eating disorders and addiction professionals, which impacts training, research and clinical care for those with co-occurring disorders. NEDA is invested in bridging this gap and advocating for the unique needs of this complex patient population.
People who have eating disorders may begin using substances before, at the same time or after eating disorder symptoms appear.2 Less frequently, people first use substances in a problematic way after achieving full recovery from their eating disorder. Those struggling with co-occurring substance use and disordered eating should speak with a trained professional who can understand, diagnose, and treat both disorders. It can be difficult to find providers who have in-depth understanding and experience with treating both diseases, but people who have both are best served by these professionals. Finding a clinician who understands both of these illnesses as brain diseases, with significant genetic underpinnings and bio-psycho-social-spiritual manifestations is critical. Clinicians with this understanding are equipped to provide you care that is free from shame or stigma, which is commonly (even if unintentionally) heaped on by providers who don’t understand one or the other of these illnesses.