Substance use is a broad term that refers to the use of alcohol, drugs (prescription and illicit) and other addictive substances (such as tobacco and caffeine). Some substances that are commonly used by people with eating disorders are alcohol, tobacco, caffeine, stimulants, prescription medications, laxatives, diuretics and the illicit drugs- amphetamines, heroin and cocaine.  

Substance misuse is when the use of substances becomes excessive, unmanageable, is distressing, and is impacting significantly on a person’s ability to engage in life. Some substances are highly addictive and when used often, people can become physically and psychologically dependent on them.  

It is important to recognise when substance use has become a problem – there are some common signs to look out for listed below: 

• Physical symptoms – becoming more tolerant to the substance and requiring more the experience the same effects, withdrawal when not using the substance.   
• Inability to control use of the substance – being unable to reduce or stop using the substance.  
• Using the substance alone or in secret. 
• Neglecting responsibilities and becoming disengaged from activities previously enjoyed (for example work, family, sport, social events). 

Research tells us that about 50% of people with an eating disorder also engage in substance misuse, (compared with 9% of the general population). People who experience binge eating and purging behaviours report higher rates of substance misuse. 

Substance misuse can have negative impacts on a person’s health and when combined with an eating disorder this increases the risk of medical complications and even mortality. We also know that people with an eating disorder that engage in substance misuse can have a higher rate of relapse and overall longer recovery period.  

People with eating disorders may use substances to help cope with and mask negative emotions. Often these same negatives emotions (or the ability to regulate emotions) can be a root cause of the eating disorder. It is also very common for people to use substances alongside restrictive behaviours of eating disorders. You can see then how an eating disorder and substance use can easily become intertwined and dependent on the other.  This creates a vicious cycle for the person and means that it is very important the person seek professional support to assess and treat the eating disorder and substance use together.  

Researchers have made great efforts to understand the reasons behind why people with eating disorders are more likely to engage in substance misuse and have found some past experiences, personality traits and thinking patterns make certain people at greater risk. These include: 

• Problems with regulating moods and emotions. 
• Low self-esteem. 
• Past experience of abuse or trauma. 
• Co-occurring anxiety and/or depression. 
• A tendency to partake in impulsive behaviours.  

There also some evidence to suggest that genetics may play a role in eating disorders and substance use. 

If you (or someone you know) is experiencing symptoms of an eating disorder and/or substance abuse, remember that you are not alone and there are many treatment and support options available. 

It is extremely common to feel unsure, anxious, ashamed, intimidated and unworthy about seeking support for an eating disorder and difficulties with substance use. You can be assured that all options are judgement free and the earlier you seek professional support, the greater the chance of a full recovery. It is important to know that eating disorders and substance use disorders are treatable and full recovery is possible with adequate care and professional support. 

Because many of the issues underlying eating disorders and substance use are similar, it is important to treat both conditions at the same time. We know that if just one condition is treated it can cause the other to deteriorate meaning a longer and more difficult recovery process and higher chance of relapse.  

When seeking treatment for an eating disorder it is important to be open and honest and discuss with your GP or other health professional if you think you may have difficulties managing your alcohol or other drug use. Full recovery from an eating disorder and substance use issues is much more likely if they are identified and treated together.  

The actual treatment will vary depending on the needs of the person, but will generally involve a ‘team’ of health professionals who will provide medical, nutritional and psychological support – including your GP, psychologist, psychiatrist and dietician.  

You may expect any of the following interventions during treatment from a trained health professional: 

• Support for your physical health, including any medical complications associated with eating disorder behaviours and substance use. 
• Psychoeducation to provide information on eating disorders, substance use, and how these can impact on a person’s health and wellbeing. 
• Support from a mental health practitioner/clinician to help you to explore the underlying reasons that contribute to the eating disorder and substance use, minimise the harm associated with substance use and help you to build skills and develop strategies to be able to manage without the eating disorder and substance use.  
• Relapse prevention training. 
• Replacing destructive thinking surrounding food with a more balanced perspective on eating. 
• Developing healthy coping skills for managing cravings and destructive emotions. 
• Abstinence from the substance causing issues. 
• Dietary education and planning. 

Note that some eating disorder treatment services may require you to complete a supported detox/methadone programme before accessing treatment. This will be assessed on a case-by-case basis and health providers will advise and link you with services that can help.  Below you can find contact details for a range of eating disorder and alcohol and drug support organisations who will be able to assist you with any specific questions. 

There are safe and judgement free support groups available for people who are experiencing an eating disorder and substance use issues.  

The EDV COSMO group meets online every fortnight and welcomes individuals with any type of eating disorder that are also having difficulties with alcohol and drug use.  

There are other eating disorder support groups available through the Butterfly Foundation. 

Below are some self-access support groups and services available for those with substance use issues: 

• Directline – 1800 888 236 – is a free and confidential 24/7 telephone service for people affected by addition. They also offer information about local support groups and meetings.  
• Counselling Online – 24/7 free and confidential online chat support service for people affected by drug or alcohol use.  
• Turning Point – website outlines a range of alcohol and drug use treatment and support services.  
• Alcoholics Anonymous – community based recovery program for people who have experienced addiction to alcohol. 
• Narcotics Anonymous Victoria – community based recovery program for people who have experienced addiction to narcotics. 

Outside of business hours for immediate crisis support, please contact: 

Lifeline – www.lifeline.org.au – 13 11 14 

You can read more about eating disorders and substance use on the following webpages: 

National Eating Disorder Association – Substance Abuse and Eating Disorders 

National Eating Disorder Collaboration – The Link Between Drugs, Alcohol and Eating Disorders 

Eating Disorder Hope – Alcoholism, Substance Abuse and Eating Disorders 

Lifeline factsheet – Substance misuse – alcohol & other drugs 

Bahji, Anees, Mazhar, Mir Nadeem, Hudson, Chloe C, Nadkarni, Pallavi, MacNeil, Brad A, & Hawken, Emily. (2019). Prevalence of substance use disorder comorbidity among individuals with eating disorders: A systematic review and meta-analysis. Psychiatry Research, 273, 58-66. 

Fouladi, Farnaz, Mitchell, James E, Crosby, Ross D, Engel, Scott G, Crow, Scott, Hill, Laura, Steffen, Kristine J. (2015). Prevalence of Alcohol and Other Substance Use in Patients with Eating Disorders. European Eating Disorders Review, 23(6), 531-536. 

Franko, D. L., Keshaviah, A., Eddy, K. T., Krishna, M., Davis, M. C., Keel, P. K., et al. (2013). A longitudinal investigation of mortality in anorexia nervosa and bulimia nervosa. American Journal of Psychiatry, 170, 917–925. 10.1176/appi.ajp.2013.12070868. 

Gregorowski, C., Seedat, S., & Jordaan, G. P. (2013). A clinical approach to the assessment and management of co-morbid eating disorders and substance use disorders.
The National Center on Addiction and Substance Abuse at Columbia University. (2003). Food for Thought : Substance Abuse and Eating Disorders. Nancy Reagan Linda Johnson Rice George Rupp, (December), 73. 

Killeen, T., Brewerton, T.D., Campbell, A., Cohen, L.R., Hien, D.A., (2015). Exploring the relationship between eating disorder symptoms and substance use severity in women with comorbid PTSD and substance use disorders. Am. J. Drug Alcohol Abuse 41 (6), 547–552.  

Kirst. S. (2018). Choosing recovery from my eating disorder and drinking problem. From NEDA. 

Lozano-Madrid, María, Clark Bryan, Danielle, Granero, Roser, Sánchez, Isabel, Riesco, Nadine, Mallorquí-Bagué, Núria, Fernández-Aranda, Fernando. (2020). Impulsivity, Emotional Dysregulation and Executive Function Deficits Could Be Associated with Alcohol and Drug Abuse in Eating Disorders. Journal of Clinical Medicine, 9(6), 1936. 

Munn‐Chernoff, Melissa A, & Baker, Jessica H. (2016). A Primer on the Genetics of Comorbid Eating Disorders and Substance Use Disorders. European Eating Disorders Review, 24(2), 91-100. 

The National Center on Addiction and Substance Abuse (CASA) at Columbia University. Food for Thought: Substance Abuse and Eating Disorders. The National Center on Addiction and Substance Abuse (CASA) Columbia University; New York: 2003. 

Wetzler, Sara, Hackmann, Corinna, Peryer, Guy, Clayman, Kelsey, Friedman, Donna, Saffran, Kristina, . . . Pike, Kathleen M. (2020). A framework to conceptualize personal recovery from eating disorders: A systematic review and qualitative meta‐synthesis of perspectives from individuals with lived experience. The International Journal of Eating Disorders, 53(8), 1188-1203.