Eating Disorders and Substance Abuse: Risk Factors

Eating Disorders and Substance Abuse: Risk Factors, “Drunkorexia,”and Treatment

Table of Contents

Eating disorders such as bulimia, anorexia, laxative abuse, and binge eating are serious but treatable mental and physical illnesses that can affect people across all genders, ages, races, ethnicities, and body types. Research estimates that 10 million men and 20 million women in America will have an eating disorder at some point in their lives. Having an eating disorder is incredibly challenging to deal with on its own, but add substance abuse to the mix, and this life-threatening disorder can result in a multidimensional health crisis. According to the National Eating Disorders  (NED) organization, “Up to 50% of individuals with eating disorders abused alcohol or illicit drugs, a rate five times higher than the general population. Up to 35% of individuals who abused or were dependent on alcohol or other drugs have also had eating disorders, a rate 11 times greater than the general population.” Alcohol, amphetamines, heroin, and cocaine are some of the most frequently abused substances by those struggling with an eating disorder. 

Substance Use and Eating Disorders – A Complex Relationship

Unfortunately, since both eating and substance abuse disorders are so closely related in terms of common risk factors, it is often hard to distinguish which one came first. What researchers have found is that trauma, especially childhood trauma, is a major factor in developing both disorders, individually and collectively. Traumatic events, especially those involving violence, have been found to be significant risk factors for the development of a variety of psychiatric disorders, including eating disorders, particularly those involving bulimic symptoms, such as binge eating and purging (NED). These co-occurring disorders also share a number of common risk factors, including:

  • Family history
  • Low self-worth, self-esteem
  • Social isolation and pressures
  • Brain chemistry 
  • Depression and anxiety
  • Compulsive behaviors

Those suffering from co-occurring disorders need to treat both the addiction and eating disorder in order to psychologically and emotionally heal as well as find sobriety. Early intervention is key to a full road to recovery. 


The colloquial term “drunkorexia” refers to altering eating behaviors to either offset for planned caloric intake from alcohol or to speed-up the effects of alcohol (NED). Though not always seen as a formal clinical issue, drunkorexia is becoming such a major problem on college campuses that many clinicians are trying to have the term added as an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM). According to a recent article in the Washington Post, “rather than filling up before a night of partying, significant numbers of students refuse to eat all day before consuming alcohol. This is a high-risk behavior colloquially called “drunkorexia,” which is one part eating disorder, one part alcoholism, a very dangerous combination for college-age students. The term drunkorexia, which can also include excessive exercise or purging before consuming alcohol, was coined about 10 years ago, and it started showing up in medical research around 2012. Drunkorexia addresses the need to be the life of the party while staying extremely thin, pointing to a flawed mindset about body image and alcoholism among college students, mostly women.

In the same article, Tavis Glassman, a professor of health education from the University of Toledo, Ohio, states that students who drink with nothing in their system, face the same issues as with any high-risk drinking such as:

  • Blackouts
  • Returning home safely
  • Sexual assault 
  • Unintentional injury and fights 
  • A decline in attendance and grades
  • Emergency room visits from alcohol poisoning 

Health Risks

In terms of the health risks involved with drunkorexia, registered dietitian Ginger Hultin offers that if “alcohol is prioritized over food, it could result in nutrient deficiencies such as calcium, B-vitamins, magnesium, fiber, and protein. Alcohol can negatively affect the liver or gastrointestinal system; it can interfere with sleep, lower the immune system and is linked to several types of cancers.” Regardless of whether drunkorexia is listed in the DSM, the relationship between food restriction and high levels of alcohol use puts individuals at risk for significant medical complications in both the short term and long term. 

Women and College Students Are at a Higher Risk

While anyone can engage in drunkorexia behaviors, they are most commonly used by younger people, especially women. Women suffer from a disproportionate amount of pressure to stay thin, compared to men. As a result, they are more susceptible to peer pressure. Australian researchers studied female university students and discovered that 82.7% of them had practiced drunkorexia behaviors in the previous three months. More than 28% were found to regularly engage in such actions. Too often, students and other young people believe they are merely being smart about their caloric consumption. They pass along what they do to others in their peer group as if they are harmless diet tips.

Drunkorexia is not considered an eating disorder, nor is it listed as a type of addiction, but it is directly related to disorders from both behavioral health concerns. It is a relatively new buzzword, but more and more treatment professionals understand how important it is to take it seriously. A study of over 25,000 U.S. students showed they were more likely to use many different eating disorder behaviors. The University of South Florida has gone so far as to suggest naming this particular phenomenon ‘Food and Alcohol Disturbance,’ in an attempt to publicize how serious and common it has become.

Treatment Options

Since drunkorexia is not considered an official medical diagnosis, it can be challenging to know how best to approach it. A trained clinician familiar with it can begin by addressing both the eating disorder and addiction aspects of the condition. It is often eye-opening for someone who engages in drunkorexia behaviors to find out that what they are doing is dangerous and has the potential to develop into a full-blown addiction, eating disorder, or both. In addition, overuse of alcohol can contribute to mental health issues such as depression or anxiety, further complicating their ability to change their behaviors

Eating Disorders, Addiction, and Getting Help

Substance abuse and eating disorders are serious conditions, especially co-occurring, that require specific treatments for healthy, long-term outcomes. A few ways to begin your journey to healing should include:

  • Find an eating disorder specialist that can also address substance use disorders and addiction.
  • Make sure the eating disorder treatment center is equipped to deal with individuals who abuse substances and can offer medical detox.
  • Research treatment centers that tailor recovery plans specific to your needs.

If you or someone you love is struggling with addiction and eating disorders, call a specialized treatment center that can address co-occurring disorders. At Silver Lining Recovery, we understand the challenges of a dual-diagnosis and focus on an individual’s holistic healing in all aspects of their life – social, emotional, physical, and cognitive. Our customized treatment program offers one-on-one therapy sessions with highly-trained, compassionate, and experienced counselors that guide you step-by-step to slowly unravel unresolved issues that may be fueling the addiction to continue. By identifying the root causes of eating and substance use disorders, you can begin your journey to true self-healing and sobriety. You have the ability to bring about positive changes in your life and feel whole again, let us help you by calling Silver Lining Recovery today at (833) 844-4769.