Sadly, many of us have known someone who is dependent on drugs or alcohol — a condition known as substance abuse. Substance abuse and eating disorders may not seem all that alike, but they often occur together.

Previously, we’ve talked about drunkorexia — an eating disorder where people, often college-aged women, restrict caloric intake and/or over-exercise to compensate for binge drinking. However, many substance abuse conditions can coexist with an eating disorder, occurring before or during an eating disorder — or even during recovery.

Read on to discover the signs and symptoms of a substance abuse disorder so you can tell if you or someone you love may be struggling with both an eating disorder and substance abuse. We’ll also discuss the links between these two conditions and the various treatments available for each.

What is Substance Abuse?

Substance abuse can be defined as the problematic use of a substance — such as alcohol or drugs — to the extent that it causes clinically significant impairment to a person’s life. Substance use disorder, or the condition of abusing a substance, can occur on its own or alongside another mental health condition, such as an eating disorder.

Many times, people begin using alcohol or drugs as a means of coping with stressors in their life. Eventually, these people can begin to experience serious problems in their life due to their substance use — but they may continue using the substance anyways, often because they do not have alternative means of coping.

This psychological dependency may or may not be coupled with a physiological dependency on the substance, leading to symptoms of withdrawal when the use of the substance is slowed or stopped. Many substances that people become dependent on have a strong effect on the pleasure center of the brain, triggering a reward response when the substance is used.

People might continue to use the substance for the “high” it generates — yet over time, more and more of the substance is required to have the same effect on the brain. This is what we mean when we say that a person has “built up a tolerance” to a particular substance.

Why Do People Develop Substance Abuse?

Doctors have found that people develop substance abuse for three main reasons: physical characteristics, personal characteristics and other circumstances and disorders.

Physical characteristics include genetic factors. Researchers have long tried to identify specific factors linked to substance abuse, but have found few specific biochemical differences between substance users and non-substance users. Still, the American Psychological Association estimates that at least half of a person’s susceptibility to substance abuse can be linked to genetic factors.

Personal characteristics refer to personality traits. Some believe that traits like impulsiveness and high levels of risk-taking predispose a person to develop a substance use disorder. However, this so-called “addictive personality” described by behavioral scientists has very little research to back it up.

Certain circumstances and coexisting disorders seem to increase the risk of developing a substance use problem. For example, depressed or anxious mood can make a person more likely to turn to drugs or alcohol to cope. Patients with chronic pain, who often require opioid drugs for long-term relief, may also be at risk.

It’s important to remember that no one factor determines whether or not you will develop a substance use problem. Substance abuse is a complex disease that is considered multifactorial. In other words, it is influenced by all of the above criteria working together to create a substance use problem. Having one of the characteristics or traits linked to substance abuse does not guarantee that you will suffer from an .

Signs and Symptoms of a Substance Use Disorder

There are many misconceptions arising from the subject of substance abuse. Many people believe that taking an illicit substance makes someone an “addict,” but simply using an illegal drug does not qualify as a substance use disorder. Similarly, many legal substances, such as prescription drugs, are abused by those with substance use problems.

According to the DSM-V manual, which is used by psychologists to diagnose mental health issues, substance use disorders are defined according to the various problems arising from the person’s substance use. For example, a person with substance use disorder might….

• Take the substance in larger amounts or for a longer period of time than intended
• Want to cut down on their substance use, but be unable to do so
• Spend a lot of time getting, using or recovering from using the substance
• Experience cravings and urges to use the substance that can be described as “uncontrollable”
• Neglect responsibilities at work, school or home because of their substance use
• Continue to use substances even when it causes problems in relationships
• Give up important social, occupational or recreational activities because of substance use
• Use substances over and over again, even when it puts the person in danger
• Continue to use substances even when they know they have a physical or psychological problem that could be worsened by the substance use
• Build up a tolerance to the substance, or require more of the substance to result in the intended effect
• Develop withdrawal symptoms relieved by the use of the substance

Not all s are created equal. The DSM-V also allows clinicians to specify the severity of a substance use disorder. Two or three of the above symptoms indicate the mild presence of a substance use disorder, while six or more symptoms indicate a severe problem. They can also specify whether the person is in “early remission,” “sustained remission” or “on maintenance therapy” for the substance use disorder.

Commonly Abused Substances

Theoretically, an can develop from the use of any substance that produces a desired effect. Some have even proposed the idea of “food ” to describe the origin of binge eating disorder! However, some substances are more likely to be abused by those with a substance use disorder than others. These substances include:

• Alcohol. Alcohol is a commonly used drug, but some people go on to develop a dependency on it. Nearly six percent of all global deaths in 2012 could be attributed to alcohol abuse.
• Caffeine. Caffeine may be the most widely used drug, as it is found in beverages such as coffees, teas and sodas. When caffeine use becomes excessive and interferes with everyday life, it can lead to , dependency and withdrawal symptoms.
• Depressants. This category of medication includes barbiturates, benzodiazepines and sleep medications that depress the central nervous system, slowing movement and heart rate. If too much of the substance is taken, depressant abuse can lead to death.
• Hallucinogens. These drugs produce distortions in a person’s perception of reality, according to the National Institute on Drug Abuse. This category of drugs includes ketamine, LSD and PCP. Note that a form of ketamine is now approved for the treatment of drug-resistant depression, but that this drug should only be used under the supervision of a medical provider.
• Opioids. Opioids like Oxycontin and Vicodin are often prescribed by doctors for chronic pain conditions or following painful procedures, such as surgery. When taken for too long, people can become dependent on these drugs. Eventually, people who cannot gain access to opioids may turn to heroin, an opioid drug made from morphine.
• Cannabis. Also known as marijuana, the cannabis plant is a psychoactive substance that creates enhanced sensory perception and euphoria, followed by drowsiness and relaxation, according to the National Institute on Drug Abuse. Marijuana is becoming legal in many states, leading some to become concerned about its potential for abuse.
• Ecstasy. Ecstasy or “Molly,” otherwise known as MDMA, is a drug with similarities to both hallucinogenic and stimulant drugs. The use of ecstasy can lead to a sharp, dangerous rise in body temperature that can lead to death in some cases.
• Cocaine. Cocaine is a stimulant drug that produces feelings of euphoria. The drug poses severe cardiac risks, including death, with continued use. While most people recognize the drug as addictive and dangerous, as many as 1,800 Americans try cocaine for the first time each day.
• Methamphetamine. Methamphetamine, or “meth” for short, is an extremely addictive stimulant drug. Meth abuse has some telltale signs, such as “meth mouth” (severe dental problems) and skin sores from intense scratching while using this drug.
• Tobacco. Once widely used, tobacco use is on the decline because it is now recognized as dangerous to our health. However, tobacco remains on the market and continues to present with dangerous health effects, such as lung cancer (in the user) and birth defects (when used during pregnancy).

While not a substance, gambling is also worth noting, as it activates the same pleasure response in the brain as many addictive drugs. As a result, people can become addicted to gambling and experience dependency and withdrawal in the same manner as people addicted to illicit substances. Thus, the DSM-V groups gambling along with substance use disorders due to its similarities to substance abuse in presentation and treatment.

Linking Substance Abuse and Eating Disorders

Like many mental health conditions, eating disorders and substance use disorders often coincide. According to the National Eating Disorders Association (NEDA), as many as 50% of individuals with eating disorders reported abusing drugs or alcohol, a rate five times higher than that of the general population. Up to 35% of individuals who abused or were dependent on alcohol or other drugs reported having an eating disorder, a rate 11 times higher than that of the general population.

Why do people with eating disorders appear more likely to develop substance use disorders, and vice-versa? Some patients report anecdotal similarities between substance use and their eating disorder, such as an addictive “high” from skipping meals or sticking to a strict exercise regimen. Eating disorders also seem to share a set of risk factors with substance abuse that can predispose a person to developing both. These risk factors include genetics, low self-esteem, depression, anxiety and social pressure. 

Furthermore, some eating disorders are intricately linked with substance use; laxative, diuretic and diet pill abuse is seen in many patients with anorexia, bulimia or other eating disorders as a means of controlling their weight and/or appearance. According to NEDA, the substances most frequently abused by people with eating disorders (besides laxatives, diuretics and diet pills) include caffeine (often used as an appetite suppressant in place of meals), tobacco, alcohol, emetics, amphetamines (appetite suppressants), heroin and cocaine.

Some eating disorders appear to make a person more likely to abuse alcohol or drugs. Approximately one-third of patients with anorexia and one-fifth with binge-eating disorder display a concurrent substance use disorder, but nearly 40% of those with bulimia do. Women with bulimia may be at an especially high risk of substance use, as well as other risky behavior. For example, NEDA found that women with bulimia were also more likely to experience personality and conduct disorders, as well as previous suicide attempts.

Treatment for Substance Abuse and Eating Disorders

If you suspect you or a loved one are suffering from substance use and/or eating disorder, treatment is available to help you through The Meadowglade. Our trained clinicians know how to treat concurrent substance use and eating disorders in a way that is sensitive to both conditions and recognizes how the two often interplay with one another. Together, we can work to address the factors that lead to both substance abuse and eating disorder behavior!