The association between drug abuse and eating disorders (EDs) is not new. Since the 1970s, doctors have reported higher incidents of self-medication and drug abuse in a subset of eating disorder patients. Drugs, in this context, cover everything from laxatives and diet pills, to alcohol and street drugs.
The association between drug use and EDs is not shocking; however, the extent of the problem is likely overlooked.
In a report detailing the most comprehensive review on the topic, the National Center on Addiction and Substance Abuse concluded: “Individuals with eating disorders are up to five times likelier to abuse alcohol or illicit drugs and those who abuses alcohol or illicit drugs are up to 11 times likelier to have eating disorders.”
The report is freely available online and I highly recommend reading the entire document.
SUMMARY OF MAIN FINDINGS
The link between drug use and eating disorders is strong:
- Between 30-50% of bulimia nervosa (BN) patients and 12-18% anorexia nervosa (AN) patients abuse/are dependent on alcohol/ drugs, compared to roughly 9% of the general population. This may be an underestimation, as the rates do not include many individual with eating disorders who smoke or abuse prescription medication. (Eating disorders not otherwise specified (EDNOS) and binge eating disorder (BED) were not in these data. However, the report did note that individual with BED are more likely than obese individuals to abuse illicit drugs. )
The link between drug use and eating disorders is reciprocal:
- Up to 35% of individuals who abuse/are dependent on alcohol/ drugs also have an eating disorder, compared to up to 3% in the general population.
The link between drug use and eating disorders starts young and occurs even in subclinical cases:
- Preadolescent and adolescent girls and boys with strong weight concerns are roughly 2x as likely to start smoke, compared to those less concerned about their weight.
- Girls who engage in unhealthy dieting behaviors (fasting, diet pills, or bingeing and purging) as twice as likely to begin drinking (and drink more) than non-dieting peers.
The link between drug use and eating disorders is stronger for BN than AN:
- Alcohol abuse is more common in people with BN who report higher rates of suicide attempts, anxiety/personality/conduct disorders and other substance dependence than in non-alcoholic BN patients.
- BN patients, compared to AN, are more likely to have abused amphetamines, barbiturates, marijuana, tranquilizers and cocaine.
- The highest rate of illicit drug use is associated with BN binge-purge type, some of whom use heroin to facilitate vomiting. Stimulants (cocaine, Ritalin and Adderall) are used to suppress appetite and to induce a sense of self-control. Similar results are found in a sample of women including both college students and community members, who exhibit disordered eating behaviors but do not have an ED diagnosis.
The link between drug use and eating disorders is rising:
- In males, athletes and racial/ethnic minorities, though no current data exists on concurrent drug abuse in this population.
The link between drug use and eating disorders is not well understood.
EDs and substance abuse share many risk factors and this may explain the high rate of co-occurrence. Risk factors include:
- Biological factors: Both disorders use on the same reward and motivational systems in the brain, precipitating an obsessive preoccupation with a substance, intense cravings, and compulsive behavior.
- Personality risks: Both disorders may represent ways for certain people to cope with stress and transition. High-risk personality traits include low self-esteem, depression, and anxiety. The strong link between BN and drug abuse may be partially explained by high impulsivity that is common among people with both disorders.
- Parental and environmental risks: Both disorders may be influenced by unhealthy parental behavior, social pressure and the advertising, marketing and entertainment industries
It is difficult to pinpoint which risk factors are the main contributors to the development of each or both disorders. However, these shared traits may explain why in some cases ED predisposes the person to substance abuse (and vise-versa).
The prevention and treatment of co-occurring EDs and substance abuse will have to depend on many parties, including parents, schools, health professionals, policy makers and researchers. Parents and schools are especially important in educating young individuals, by modeling and promoting messages about healthy eating and dangers of drug use. Health professionals need to recognize and screen for the co-occurrence of both disorders.
Unfortunately, at the time of the report (late 2003), few effective treatment programs exist for addressing both disorders simultaneously. At the moment, the body of literature concerning this topic tends to be more descriptive (“a link exists”) than mechanistic (“this is why it exists.”)
Researchers will need to work with clinicians to develop better approaches to preventing, assessing, diagnosing and treating substance abuse and eating disorders. Specific guidelines are outlined in Chapters 3 and 4 of the report.
Finally, the dangers of co-occurring drug abuse and ED cannot be overstated. ED patients often suffer hair loss, tooth decay, osteoporosis, and weakening of the heart. Stimulants, such as Adderall, Ritalin, cocaine and nicotine (found in tobacco) further stress the cardiovascular system, which can lead to high blood pressure, stroke and even heart failure. With the rise of “study drug” abuse in both students and professionals, these dangerous consequences are becoming increasingly relevant to those with EDs.
Once again, I recommend reading the full report “Food for Thought: Substance Abuse and Eating Disorders.” I’d love to hear your thoughts: why do you think some individuals with EDs are more likely to abuse drugs? Or is substance abuse inherent in some types of EDs, as a symptom?
The National Center on Addiction and Substance Abuse at Columbia University. (2003). Food for Thought: Substance Abuse and Eating Disorders. Retrieved from: http://www.casacolumbia.org/articlefiles/380-food%20for%20thought.pdf.