Eating disorders and addiction often occur in the same person, and each can feed the other. Research puts the lifetime prevalence of substance use disorders among people with eating disorders at about 22%. It puts the lifetime prevalence of eating disorders among people with substance use disorders at 27%. The two conditions share risk factors, and they are treated best together, by one team, with the most urgent medical and safety needs handled first.
This guide explains why the two overlap, what the combination does to health, what “drunkorexia” does and does not mean, and what integrated care looks like. It also covers how to decide when residential care is the right step.
TL;DR
- Eating disorders and substance use disorders frequently co-occur and share genetic, neurochemical, psychological and trauma-related roots.
- Having both usually means more severe symptoms, more medical complications and more hospitalizations than having either one alone.
- Federal guidance says both disorders need treatment for the best outcomes, starting with whatever threatens health and safety most.
- “Drunkorexia” is a popular label, not a formal diagnosis, but the behavior is real and worth taking seriously.
- If you or someone you love is struggling with substances and a mental health condition, our team at Sylmar Treatment Center is available around the clock to talk through admission.
Table of Contents
- How eating disorders and addiction are connected
- What drunkorexia is, and what it is not
- Warning signs when both conditions are present
- Why having both is riskier
- What integrated treatment looks like
- Why finding the right program is hard
- When residential care makes sense
- Perspective: what we see at Sylmar
- How we can help
- How to support someone you love
- FAQ
- Sources
How eating disorders and addiction are connected
The connection is not a coincidence, and it is not a character flaw. A SAMHSA-supported clinical advisory describes shared biological, genetic and environmental risk factors, including dysregulation in the brain’s reward pathways and neurotransmitter systems. The same advisory notes that both conditions involve compulsive behavior and cravings, and that both can become a way of coping with emotional distress or trauma.
In practice, the link tends to run through a few channels.
Shared roots
Genetics, brain chemistry, temperament and difficult life experiences all show up on both sides. The advisory lists genetics, neurochemical and psychological causes, and social experiences such as trauma and adverse childhood experiences as common contributors. A review of the overlap also argues that treatment should target shared transdiagnostic factors: the reward system, temperament, emotion regulation and stress-related symptoms.
Childhood trauma deserves a specific mention. Many people learn early that controlling food, or numbing feelings with a substance, is the one thing that makes overwhelming emotion bearable. If you want to understand how early experiences echo into adulthood, this overview of childhood trauma impacts on adult life is a good place to see how those patterns form.
Using one behavior to manage the other
Some people use stimulants or other substances to suppress appetite. Others drink or use drugs to quiet the distress that follows binge eating or purging. Others stop using a substance and notice that food, restriction or exercise takes its place. When this happens, the underlying problem, an unmanaged emotional state, has not changed. Only the tool has.
Not the same thing, though
It is tempting to call an eating disorder “a food addiction.” The science is more careful than that. Research on binge eating disorder finds real overlap with substance use disorders, but whether binge eating disorder, or a subgroup of it, can be called a food addiction remains unknown. A paper on anorexia nervosa reaches a similar conclusion, suggesting that fundamental differences exist between it and substance abuse. For a family, the practical point is simple: you do not have to settle the label to recognize that both problems need attention.
What drunkorexia is, and what it is not
“Drunkorexia” is a popular term for restricting food or exercising excessively to offset the calories from alcohol. A scoping review of the literature says it is not a clinically recognized term and has no systematic definition. Authors of another paper suggest classifying the behavior as a subcategory of OSFED (other specified feeding or eating disorder) and propose a more medically appropriate name, “alcoholimia.”
The label matters less than the pattern. Skipping meals to drink more, drinking on an empty stomach, or exercising hard to “earn” or cancel out alcohol are warning signs. The same scoping review concludes that effective treatment addresses both the eating disorder and the alcohol use together, with integrated care and support.
Warning signs when both conditions are present
No checklist replaces an assessment, but families often notice a cluster of changes. Watch for:
- Rigid rules about food or sudden changes in eating, combined with increased drinking or drug use.
- Secrecy around meals, bathrooms, supplies or exercise, alongside secrecy about substances.
- Using alcohol or other substances to manage appetite, or to cope after eating.
- Mood swings, withdrawal from friends, and irritability that gets worse over time.
- Frequent illness, fainting, dizziness or visible physical decline.
Federal guidance also puts responsibility on providers. The SAMHSA advisory recommends that substance use treatment providers screen clients for eating disorders and stay alert to red flags. If you are entering treatment for substance use, tell the team about your eating patterns, even if they feel unrelated or embarrassing. It changes how a safe plan is built.
Why having both is riskier
The combination is harder on the body and harder to treat. A systematic review of integrated treatment found that people with both disorders tend to have greater symptom severity, poorer treatment outcomes, and more medical comorbidities and hospitalizations than people with only one of them.
That has a practical implication around detox. Withdrawal from alcohol or certain other substances is a medical event, and a body already weakened by restricting, purging or malnutrition has less reserve. This is the situation where trying to stop alone at home is most risky. If you are eating very little and also drinking or using daily, talk to a physician or call a medically supervised detox program before you stop suddenly.
What integrated treatment looks like
Treating one disorder while ignoring the other is the pattern that tends to fail. The SAMHSA advisory states that both disorders must be treated for the best outcomes, although initial care should address the most serious immediate threats to health and safety. That might be withdrawal, dangerous electrolyte or heart problems, or suicidal thoughts.
The review of integrated treatment describes it as care delivered by a unified clinical team that screens and plans for both disorders in a coordinated way. Recommended psychological approaches include:
| Approach | What it helps with |
|---|---|
| Cognitive behavioral therapy (CBT) | Identifying and changing thought and behavior patterns around food, body image and substance use |
| Motivational interviewing | Building the person’s own reasons for change when ambivalence is high |
| Dialectical behavior therapy (DBT) | Managing intense emotions and distress without turning to food behaviors or substances |
It is also worth being honest about the state of the evidence. The same review notes that research on integrated treatment is early and that there are no known randomized controlled trials of it for co-occurring eating disorders and substance use disorders. The direction of guidance is clear, but families should expect clinicians to talk in terms of best available evidence, not guarantees.
Medication and psychiatric oversight
Depression, anxiety, trauma-related symptoms and OCD often travel with both conditions. Careful medication management, supervised by a psychiatric prescriber who knows the full picture, matters because substances, nutrition and medications all affect one another. This is a conversation for a licensed clinician, never something to adjust on your own.
Why group and family work matter
Shame keeps both conditions hidden. Peer groups and family involvement reduce that isolation. If you are exploring how this works, our articles on group therapy in dual diagnosis recovery and on creating an integrated treatment plan as a family walk through what to expect.
Why finding the right program is hard
Many programs treat only one side. A SAMHSA publication on clients with substance use and eating disorders found that, of 351 publicly funded substance use treatment programs surveyed, only 16 percent offered treatment for co-occurring eating disorders. That survey dates from 2011, so the current picture may differ, but it explains why families so often hear “we only treat one or the other.”
That is why the questions you ask matter. Before choosing a program, ask:
- Who is on the clinical team, and do they assess for both substance use and mental health conditions at admission?
- Is there a physician and psychiatric oversight during detox and afterward?
- Is the program licensed by the state and accredited by an independent body?
- How is the treatment plan built, and who updates it?
- If an eating disorder needs a level of care the program cannot provide, how does it coordinate or refer?
Our guide on what to ask programs about dual diagnosis and co-occurring disorders goes deeper on these questions, and what integrated treatment means for recovery explains the model in plain terms.
When residential care makes sense
Outpatient care works for many people. Residential care is worth serious consideration when:
- Withdrawal could be medically dangerous and needs supervision.
- Home is not a safe or stable setting for recovery.
- Earlier attempts at outpatient treatment have not held.
- Substance use and mental health symptoms are feeding each other fast enough that daily structure is needed.
- A court or legal process requires a documented, supervised placement.
If there is an immediate danger, such as thoughts of suicide, fainting, chest pain or an overdose, call 911 or go to an emergency room. You can also call or text 988, the Suicide & Crisis Lifeline, at any hour.
Perspective: what we see at Sylmar
We will be direct about what we do and what we do not. Sylmar Treatment Center is a six-bed residential program. We treat substance use disorders alongside co-occurring mental health conditions, with medically supervised detox, psychiatric oversight and individualized plans built from a comprehensive assessment. We are licensed by the California Department of Health Care Services (DHCS) and hold Joint Commission accreditation.
What the small size gives us is attention. With six beds, staff know each person, notice small changes, and can adjust a plan quickly. In a conversation about eating disorders and addiction, that matters, because the hidden behavior is often the one that explains why recovery keeps stalling. People rarely volunteer it at the first meeting. They tell someone they trust, after a few days.
What we would tell a family is this. Do not wait for the “right” label. If substance use is present and eating, weight, purging or exercise are also part of the story, say so during the first call. We will talk through the full picture, and if your needs call for a level of eating disorder care beyond what we provide, we will say so plainly rather than promise something we cannot deliver. The goal is that no one has to choose which part of their illness gets treated.
— Jim
How we can help
If substance use is part of what you or a family member is facing, our dual diagnosis support addresses addiction and co-occurring mental health conditions at the same time, in a setting small enough for real individual attention. Admissions support is available 24/7, and care can begin with medically supervised detox followed by residential treatment.
To talk through your situation, including any eating concerns, contact Sylmar Treatment Center. We do not publish program prices, so ask the admissions team about costs and insurance during your first call.
How to support someone you love
Families often feel they must fix the eating problem or the substance problem first. You do not need to pick. A few steps help:
- Speak from concern, not accusation. Describe specific things you have seen and how they worry you.
- Avoid commenting on weight or food. It tends to increase shame and secrecy.
- Learn the vocabulary. Understanding terms like co-occurring disorders makes calls with programs easier. Our overview of integrated treatment options for co-occurring disorders is a practical starting point.
- Look after yourself. Family members need support too.
- Ask for a medical evaluation early. A physician can check what the body can safely handle before detox or treatment begins.
Other conditions often join the picture, too. Anxiety, OCD, ADHD and autism can each raise the risk of substance use, and we have written about OCD and addiction treatment and ADHD and substance use for readers sorting through overlapping diagnoses.
FAQ
Can an eating disorder lead to addiction?
Yes, and the reverse is also true. Shared genetic, brain-based and trauma-related risk factors link the two, and each can become a way to cope with the distress the other causes. Having one is a reason to be screened for the other.
Is drunkorexia a real diagnosis?
Not as a formal one. Researchers describe it as a popular term for restricting food or over-exercising to offset alcohol calories, and some propose classifying it under OSFED. The behavior carries real risk, and treatment should address both the eating and the drinking.
Are eating disorders and addiction treated at the same time?
Guidance says both should be treated, with the most urgent threats to health and safety handled first. Integrated care means one coordinated team assesses and plans for both. Not every program offers this, so ask directly about screening and referrals before you choose.
Is binge eating a food addiction?
The research has not settled it. Binge eating disorder overlaps with substance use disorders, but whether it can be labeled a food addiction is still unknown. Treatment decisions do not depend on the label.
Does Sylmar treat people with substance use and mental health conditions together?
Yes. Our dual diagnosis support treats substance use alongside co-occurring mental health conditions, with psychiatric oversight and individualized plans. If you have eating concerns, tell our admissions team during your first call so we can assess whether we are the right fit.
Sources
- SAMHSA-supported advisory: evidence-based care for clients with co-occurring substance use and eating disorders
- Integrated treatment for comorbid eating disorders and substance use disorders, JBI Evidence Synthesis
- The Connection Between Eating Disorders and Substance Use
- The overlap between binge eating disorder and substance use disorders
- Does Anorexia Nervosa Resemble an Addiction?
- Drunkorexia: A New Term and Diagnostic Criteria (ERIC)
- Comprehensive Management of Drunkorexia: A Scoping Review
- SAMHSA: Clients With Substance Use and Eating Disorders
- List of Childhood Trauma Impacts on Adult Life