Eating Disorders, Substance Abuse, and Substance Abuse Disorders

Thrive • March 24, 2022

By Thrive Reno Therapist Alexandra Corona, MFT-Intern, CADC-Intern

Eating disorders commonly co-occur with substance abuse and substance use disorders (SUD), which are behavioral health conditions that develop when addiction is present. Individuals with eating disorders most typically abuse alcohol, laxatives, emetics, diuretics, amphetamines, heroin, and cocaine. Although researchers are still exploring the relationship between eating disorders and substance abuse, the prevalence of co-occurrence is evident as exemplified in the statistics below. 

THE RELATIONSHIP BETWEEN EATING DISORDERS AND SUBSTANCE ABUSE

Both eating disorders and substance use disorders are extremely complex. When the two kinds of disorders co-occur, they become even more complicated, and researchers are still working to understand the associations between them.

Some individuals develop an SUD before an eating disorder, while others develop an eating disorder before an SUD. Furthermore, some theories identify disordered eating behaviors, such as binging and purging, as types of addiction in themselves. Eating disorders and SUD do share some of the same risk factors and characteristics which may help explain the high prevalence of co-occurrence.

Shared Risk Factors and Characteristics

  • Family history: Many individuals with eating disorders have a family member who also experienced one. The same goes for substance use disorders. Because stigma surrounds both illnesses, many families veil them in secrecy. As a result, individuals are frequently unaware that they have a loved one who has struggled with an eating disorder or substance abuse. 
  • A history of trauma, abuse, or neglect: Painful experiences involving trauma, abuse, or neglect increase the risk of developing both eating disorders and substance use disorders. Both drug abuse and disordered eating behaviors can be attempts by individuals to cope with emotional pain caused by trauma, abuse, or neglect.  
  • Brain chemistry: Eating disorders and substance use disorders are illnesses that affect the brain. Additionally, the behaviors associated with both illnesses can become ingrained within the brain.
  • Low self-esteem : Many individuals who struggle with substance abuse and/or eating disorders also struggle with low self-esteem, which can lead to feelings of worthlessness and drive unhealthy behaviors.
  • Lack of family and social connection: Commonly, individuals who develop substance abuse or eating disorders lack a healthy connection with their families. Additionally, individuals who struggle with substance abuse and/or eating disorders tend to withdraw from normal social interactions. To mitigate feelings of loneliness and increase feelings of support, most treatment programs for eating disorders and substance abuse emphasize the power of establishing healthy relationships with one’s family, friends, and community.
  • Impulsive personality types: Many individuals who struggle with substance abuse and/or eating disorders possess personalities that are prone to impulsivity and extremes, two characteristics of many behaviors associated with substance abuse and eating disorders.  
  • Compulsive behavior: Both substance abuse and eating disorders involve destructive behaviors that effectively overtake one’s life and interfere with their ability to carry out daily activities.
  • Social pressures: Both substance abuse and eating disorders tend to spread within social circles, and one’s peers can influence whether they begin to engage in behaviors associated with substance abuse and eating disorders.

THE DANGERS OF DRUNKOREXIA

At the intersection of eating disorders and substance abuse, drunkorexia is a colloquial term that describes the combination of disordered eating and binge drinking, seen most often in young adults. Individuals who engage in drunkorexia behaviors may restrict their food intake, use diuretics, purge their food, or exercise excessively in order to offset the calories taken in while drinking alcohol and/or increase the feeling of intoxication. When combined, these behaviors of food restriction and drinking can cause medical consequences including dangerous blood-alcohol levels, severe dehydration, vitamin depletion, and organ dysfunction. 

TREATMENT FOR EATING DISORDERS AND SUBSTANCE ABUSE

The stigma and secrecy that surrounds substance abuse and eating disorders alike can make it scary for individuals who are struggling with either or both to seek support. A simple conversation with a mental health professional, however, can put you on a path towards healing. At Thrive, we provide both outpatient and inpatient treatment that targets your mental, behavioral, and physical health. Reach out to learn more about our therapeutic services and treatment programs for co-occurring eating disorders and substance abuse. 

About the Author

Thrive Reno Therapist Alexandra Corona, MFT-Intern, CADC-Intern

Alexandra “Alex” Corona was born and raised in Reno, Nevada and boasts both a bachelor’s degree in human development and family studies (HDFS) from the University of Nevada, Reno and a master’s degree in marriage and family therapy (MFT) from Capella University. As a therapist at Thrive Wellness Reno, she currently supports clients who are struggling with eating disorders and perinatal mood and anxiety disorders (PMADs). Additionally, she offers outpatient therapy services for both individuals and families, specializing in trauma, anxiety, depression, and addiction. Alex is actively working towards becoming a licensed substance abuse counselor and certified sex therapist, as she is particularly passionate about helping others improve their lives in these aspects. She finds great fulfillment in encouraging individuals to form deeper connections with themselves and with their loved ones in order to reach their full potential authentically and unapologetically.

In her personal time, Alex enjoys living life to the fullest and adventuring with family, friends, and her three dogs.

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August 21, 2025
When Emma was 8, her parents noticed her food choices shrinking. At first, they assumed it was just picky eating — “She’ll outgrow it,” friends said. But by 10, Emma would only eat crackers, cheese, and chicken nuggets. Family dinners became nightly struggles, her growth slowed, and she skipped birthday parties to avoid “strange food.” Her parents felt powerless, her brother grew frustrated, and outings dwindled. What began as food avoidance soon reshaped the rhythm of the entire household. When children avoid food, most parents expect it’s a passing stage. But when restriction deepens, shrinks to only a few “safe foods,” and begins affecting growth or health, families suddenly find themselves in unfamiliar territory. This is often where Avoidant/Restrictive Food Intake Disorder (ARFID) emerges — with effects that extend far beyond the plate. As providers, we need to be attuned to these patterns. It’s tempting to dismiss them as “no big deal,” yet for many families, they are life-altering. Sadly, Emma’s story is not unusual. Mealtimes as Battlegrounds Families living with ARFID often describe mealtimes as emotionally charged, exhausting, and unpredictable. What should be a chance to connect around the table can feel more like a negotiation or even a standoff. Parents wrestle with whether to push their child to try a new food or give in to the same “safe foods” again and again to avoid tears, gagging, or complete meltdowns. This ongoing tension can make mealtimes dreaded rather than cherished. Siblings, too, are affected. Some may feel resentful when family meals are limited to what only one child will tolerate. Others may act out in response to the constant attention the child with ARFID receives. Over time, the dinner table shifts from a place of nourishment and bonding into a stage for conflict, anxiety, and guilt — a pattern that can erode family cohesion and resilience. Social Isolation and Missed Experiences ARFID impacts more than what happens at home; it influences how families engage with the world around them. Everyday events — birthday parties, school lunches, vacations, even extended family dinners — become sources of stress. Parents may pack special foods to avoid confrontation or, in many cases, decline invitations altogether to protect their child from embarrassment or overwhelm. This avoidance can lead to an unintended consequence: isolation. Families miss out on milestones, friendships, and traditions because of the unpredictability surrounding food. The child may feel left out or ashamed, while parents grieve the loss of “normal” family experiences. This social withdrawal can compound the anxiety already present in ARFID and deepen its impact across generations. Emotional Toll on Parents The emotional strain on parents navigating ARFID is significant. Many describe living in a constant state of worry — Will my child get enough nutrients? Will they ever grow out of this? Am I doing something wrong? This worry often spirals into guilt and self-blame, particularly when outside voices dismiss the disorder as mere “picky eating.” In addition, the pressure to “fix” mealtimes can strain marital relationships, creating disagreements over discipline, feeding strategies, or medical decisions. Parents may also feel emotionally depleted, pouring all their energy into managing one child’s needs while inadvertently neglecting themselves or their other children. Without support, this chronic stress can lead to burnout, depression, and disconnection within the family system. The Role of Providers For clinicians, ARFID must be viewed not only as an individual diagnosis but as a family-wide challenge. Effective care requires attention to both the clinical symptoms and the family dynamics that shape recovery. Parent Support: Educating caregivers that ARFID is not their fault, offering psychoeducation, and helping them reframe mealtime struggles as part of the disorder — not a parenting failure. Family-Based Interventions: Coaching families in structured meal support, communication strategies, and gradual exposure work so parents don’t feel powerless. Holistic Care: Involving therapists, dietitians, occupational therapists, and medical providers ensures that the family does not shoulder the weight of treatment alone. When families are validated, supported, and given practical tools, the entire household can begin to heal. Treatment is not only about expanding a child’s food repertoire but also about restoring peace, resilience, and connection at home. Moving Forward ARFID may begin with one individual, but its ripple effects are felt across the entire family system. By addressing both the psychological and relational dimensions, providers can help transform mealtimes from a source of conflict into an opportunity for healing and connection. For those who want to go deeper, we invite you to join our upcoming training on ARFID , where we will explore practical strategies for supporting both clients and their families.
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As a parent, noticing alarming behaviors around food or routines in your child can raise some important questions. You might be asking yourself, “Is this an eating disorder, obsessive-compulsive disorder (OCD), or something else entirely?” Understanding the signs and differences between these disorders is key to getting your child effective, timely treatment. In this blog, we’ll break down the overlap between OCD and eating disorders, what signs to watch for, and how to get professional help. If you're a parent wondering “Is my child’s eating disorder actually OCD?” or “OCD vs eating disorder in teens,” know that you’re not alone and you’re in the right place to find specialized care for your child. What Is OCD? Obsessive-Compulsive Disorder (OCD) is a mental health condition where unwanted thoughts (obsessions) cause anxiety, leading to repetitive behaviors (compulsions) intended to ease that anxiety. OCD can be focused on any subject. Common obsessions include contamination, perfectionism, scrupulosity, and harm, but sometimes, the content of obsessions can be focused on food, body image, or weight. What Is an Eating Disorder? Eating disorders , like anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant/restrictive food intake disorder (ARFID) involve disturbed eating behaviors and intense concerns about body weight or shape. These conditions go beyond dieting or “picky eating” and can become life-threatening without professional intervention. The Overlap: Why It Can Be Confusing OCD and eating disorders often share similar symptoms : Ritualistic eating (e.g., needing to eat foods in a certain order or at a certain time) Rigid rules about food (like only eating certain food groups or certain amounts of food) Excessive checking (like weighing food or body or repeated checking of expiration dates or thorough cooking) Avoidance behaviors ( like avoiding carbs, fats, or other food groups or avoiding places or objects that can trigger obsessions) Distress when routines are disrupted (either around mealtimes or exercise routines) So, How Can You Tell the Difference? Use the following chart to compare and contrast symptoms of OCD and eating disorders.
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