Eating disorders and substance use disorders, such as alcohol addiction, often go hand in hand. In fact, research suggests that 25%-50% of people who are in treatment for an eating disorder also have a substance use disorder, and around 35% of people who seek treatment for a substance use disorder also suffer from an eating disorder .
People who have eating disorders may abuse a variety of substances, including alcohol, methamphetamine, cocaine, and heroin, as well as medications like caffeine pills, diuretics, and laxatives.
Eating disorders that co-occur with alcohol addictions are especially common, with one study finding that 30.1% of women who sought treatment for alcohol use disorder also received an eating disorder diagnosis . While studies show that bulimia and alcohol addictions co-occur at particularly high rates, it is also common for people to struggle with alcohol addictions that occur with anorexia.
How Alcohol Use Can Lead to Anorexia
Anorexia, also called anorexia nervosa, often involves an overwhelming fear of weight gain, an unhealthy focus on body weight or size, and a distorted image of one’s body. People who suffer from anorexia also severely limit their food intake, which means that their bodies do not get the nutrients and energy supply they need to be healthy. Some people who have anorexia also engage in purging behaviors like self-induced vomiting and laxative abuse.
Alcohol use disorder, the clinical term for alcohol addiction, involves alcohol intake that severely impairs someone’s functioning or causes them intense distress. Often, someone who is struggling with an alcohol addiction continues to drink alcohol despite the significant harm it brings to their life. Also, people who are suffering from alcohol addictions often prioritize alcohol consumption over other healthier activities.
At first glance, anorexia and alcohol addiction might not seem like they have much in common. However, their symptoms can be closely related, and in some cases, a person’s struggles with alcohol abuse may increase their risk for developing an eating disorder like anorexia.
Here’s how this might happen: Excess alcohol consumption can suppress someone’s appetite and lead to poor eating habits, malnutrition, and, potentially, weight loss. These outcomes may, in turn, increase the risk for eating disorder symptoms. Because alcohol contains empty calories, letting alcohol displace food may reinforce harmful dieting behaviors that could contribute to dangerous emotional and physical outcomes later.
What Is Drunkorexia?
Drunkorexia is a slang term that describes a pattern of disordered eating behavior and alcohol use. It primarily involves restricting food intake to compensate for calories consumed while drinking alcohol. Drunkorexia is not a clinical disorder, but its prevalence may offer some insight into the connections between alcohol abuse and disordered eating — as well as the risks.
According to Lindsey Hall, a writer who blogs about eating disorder recovery, warning signs of drunkorexia might include :
- Eating less food or replacing food with alcoholic drinks during meals
- Engaging in unhealthy eating and drinking habits with friends
- Avoiding food before drinking to feel better in an outfit
- Engaging in binge eating after consuming alcohol
- Blacking out due to a lack of food before drinking
When someone engages in a pattern of replacing food with alcohol, it can lead to many harmful complications. Drinking on an empty stomach can intensify the effects of alcohol, increasing the risk for alcohol poisoning, poor judgment, impaired coordination, risk-taking behavior, injuries, and other serous harms.
Dangers of Using Alcohol To Lose Weight
People may also turn to alcohol to distract themselves from hunger cues or to directly suppress their appetites. When someone uses alcohol for weight loss purposes or as a coping strategy for disordered eating, they can suffer from destructive consequences ranging from physical health problems to addiction and poor mental health.
Abusing alcohol when you’re in a state of poor nutrition can lead to negative consequences like hypoglycemia (decreased blood sugar), vitamin deficiencies, organ damage, and alcoholic ketoacidosis. Alcoholic ketoacidosis is a condition that causes ketones, which are acids, to accumulate in your blood. Alcoholic ketoacidosis can be life-threatening.
Alcohol abuse can also directly affect how the body utilizes available nutrients. Alcohol use can negatively affect nutrient digestion, absorption, and utilization, potentially compounding the harm from other eating disorder symptoms that may be present.
Why Alcohol Addictions & Anorexia Commonly Co-Occur
There are a variety of reasons why alcohol addictions and anorexia might occur together. One possibility is that the two disorders share some similar risk factors. For example, someone may be susceptible to the societal values that promote dysfunctional eating as well as those that condone unhealthy drinking behaviors . These combined social pressures may make the person more likely to suffer from anorexia and alcohol abuse together.
Additionally, among people who have both anorexia and alcohol addictions, there are commonalities in the types of traits and co-occurring conditions that may be present. For example, in one study, women who had both anorexia and alcohol addictions scored higher on measures of impulsivity and had higher rates of depression and borderline personality disorder than women who had anorexia only .
Among people who have anorexia, alcohol addictions are more common in those who engage in binge eating or purging behaviors. This suggests that there may be shared vulnerabilities between people who struggle with these behaviors and people who suffer from symptoms of alcohol use disorder .
What may be most important to realize is that both anorexia and alcohol use disorder come with a high risk for serious physical and mental health complications. Someone who is suffering from a dual diagnosis of both disorders can benefit from integrated treatment that addresses each condition in a nuanced, compassionate, and personalized way. If someone is struggling with these two distressing conditions, it’s crucial that they receive the support they need to heal and move toward a healthier and happier life.
 Devoe, D.J., Dimitropoulos, G., Anderson, A., Bahji, A., Flanagan, J., Soumbasis, A., Patten, S.B., Lange, T., & Paslakis, G. (2021). The prevalence of substance use disorders and substance use in anorexia nervosa: A systematic review and meta-analysis. Journal of Eating Disorders, 9, Article 161. https://doi.org/10.1186/s40337-021-00516-3
 Eskander, N., Chakrapani, S., & Ghani, M.R. (2020). The risk of substance use among adolescents and adults with eating disorders. Cureus, 12(9), Article e10309. https://doi.org/10.7759/cureus.10309
 Wolters, C. (2022, October 24). Drunkorexia: When drinking meets diet culture. Verywell Health. https://www.verywellhealth.com/drunkorexia-when-drinking-meets-diet-culture-6754099
 Baker, J.H., Thornton, L.M., Strober, M., Brandt, H., Crawford, S., Fichter, M.M., Halmi, K.A., Johnson, C., Jones, I., Kaplan, A.S., Klump, K.L., Mitchell, J.E., Treasure, J., Woodside, D.B., Berrettini, W.H., Kaye, W.H., & Bulik, C.M. (2013). Temporal sequence of comorbid alcohol use disorder and anorexia nervosa. Addictive Behaviors, 38(3), 1704–1709. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558554/
About Timberline Knolls
Timberline Knolls is a residential treatment center located on 43 beautiful acres just outside Chicago, offering a nurturing recovery environment for women and girls age 12 and older who are struggling with eating disorders, addiction, trauma, and co-occurring mental health conditions. An adult partial hospitalization program (PHP) is available for step-down and for women to directly admit. By serving with uncompromising care, relentless compassion, and an unconditional joyful spirit, we help our residents and clients help themselves in their recovery. For more information, please visit www.timberlineknolls.com.
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published on March 15, 2023. Published on EatingDisorderHope.com
Reviewed & Approved by Jacquelyn Ekern, MS, LPC on March 15, 2023