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The Need to Treat the Common Co-Occurrence of Eating Disorders and Substance Use Disorders

In the United States, 30 million people will be impacted by an eating disorder. Research tells us that nearly 50% of these individuals are also abusing drugs or alcohol. Eating disorders and substance abuse disorders are closely linked, in fact, individuals with eating disorders experience five times greater a risk for developing one than the general population. While evidence-based treatments have been developed and used to treat individuals for eating disorders and substance abuse separately, finding effective treatment that addresses both is critical.

Traditionally, when someone is struggling with both disorders and is seeking treatment, the disorders are treated concurrently in a parallel fashion or consecutively.  The trouble with treating the disorders one after the other is that one of the disorders goes untreated and often unaddressed, and in the meantime often progresses more quickly due to the increased stress of stopping the other addiction.

When trying to treat concurrently, the missing link is the lack of addressing the overlap of the two disorders which can leave the patient feeling frustrated, overwhelmed and often bouncing back and forth between disorders.  This can make the recovery process more difficult.  Therefore it is necessary to address both issues simultaneously and combined, in other words, using an integrated care model.

So how should the mental health professionals move forward in creating this integrated care model? There are a number of evidence-based treatments already in existence for substance use and eating disorders which may provide a good jumping off point. For substance abuse disorders, motivational interviewing, dialectical behavioral therapy, cognitive behavioral therapy and the 12 step model have all been commonly used as treatment practices. For eating disorders, cognitive behavioral therapy has been used to treat bulimia and binge eating disorder in adults.

It’s also equally important to identify the similarities between substance use disorders and eating disorders. Both of these disorders include the following similar risk factors:

Incidence in times of transition or stress;

  • Common brain chemistry;
  • Common family history;
  • Low self-esteem, depression, anxiety, or impulsivity;
  • History of sexual or physical abuse;
  • Unhealthy parental behaviors and low monitoring of children’s activities;
  • Unhealthy peer norms and social pressures; and
  • Vulnerability to messages from advertising and entertainment media

They also share these common characteristics:

  • Obsessive preoccupation, craving, uncontrollable behavior, secretiveness, and rituals;
  • Experience mood-altering effects, social isolation;
  • Linked to other psychiatric disorders or suicide;
  • Difficult to treat, life threatening;
  • Require intensive therapy; and
  • Prolonged diseases with high relapse rate

Using our knowledge of these shared risk factors and characteristics, we are then better able to develop an integrated care model using the evidence-based treatments that exist in a way that effectively treats both the substance use disorder as well as the eating disorder. If you or someone you know is living with both an eating disorder and substance use disorder, it is important to do your research to find a treatment facility that has expansive knowledge about both of these disorders and treats them with an integrated approach. Through therapy and counseling, treatment can help patients recover from both of these serious disorders.

By: Nancy Staycer, LCSW

NEDA Walks | National Eating Disorders Association. (n.d.). Retrieved February 11, 2015, from
Substance Abuse and Eating Disorders | National Eating Disorders Association. (n.d.). Retrieved February 2, 2015, from
Ressler, MA, LMSW, CEDS, A. (2008, July 1). Insatiable Hungers: Eating Disorders and Substance Abuse. Retrieved January 30, 2015, from