ABSTRACT
Chapter 21 reviews the relationship between substance use disorder and eating disorders. Up to half of patients with eating disorders also abuse drugs (cannabis, stimulants, cocaine, sedatives) as well as caffeine, tobacco, or alcohol. In patients with substance use disorder, up to 35 percent also report an eating disorder. Patients who binge and purge have the highest prevalence of substance use, while patients who only restrict have the lowest prevalence. “Drunkorexia” refers to individuals who restrict calories or purge to avoid weight gain from drinking (often excessive) alcohol. Food is not an addiction. The biopsychosocial model best describes comorbid eating disorders and alcoholism or drug abuse. Substances can satisfy a novelty seeker’s quest for adventure, serve as self-medication for uncomfortable emotions or undiagnosed and unmedicated psychiatric comorbidities like bipolar disorder, and can potentially aide in weight loss. Patients with comorbid eating disorders and substance use disorder have worse treatment outcomes, with high rates of leaving treatment early. Treatment should take place in centers that have expertise in both diagnoses. Excellent residential eating disorder programs that have a substance abuse track are best.
