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Battling Bulimia & Addiction
Reviewed by: Jacquelyn Ekern, MS, LPC
Bulimia and substance abuse are both difficult diseases to treat. The footpath to recovery for each diagnosis is long, rocky, and oftentimes scattered with relapse.
Substance Abuse
Even tougher to treat is someone with both bulimia and substance addiction, which can co-occur as one mountain to climb. Though the mount is mighty, it is surmountable.
How best to simultaneously treat co-occurring bulimia and substance abuse is still relatively uncertain. We’re finally realizing how prevalent the problem, but little research has been done on we tackle it.
About 50 percent of people with an eating disorder also abuse drugs and/or alcohol, a rate 5 times greater than what’s seen in the general population, according to the National Eating Disorder Association.
People with bulimia and/or “bulimic” behaviors, like binging and purging, statistically have a far greater propensity for substance abuse than those with anorexia nervosa. In fact, women who binge-and-purge use/abuse more substances than women with other eating disorders and women, in general, according to one study.
The study analyzed over five years 2,436 female inpatients with anorexia, bulimia, and eating disorder not otherwise specified (EDNOS). Of the patients with bulimia, 34 percent had a substance disorder, which was decidedly more than the other patients: anorexia binge-purge subtype (20%), EDNOS (20%), and anorexia restricting type (5%).
Higher Usage Rates
Research finds the reverse was also true. About 35 percent of people who abused alcohol or drugs have had eating disorders, compared to 3 percent of the general population, according to a report from the National Center of Addition and Substance Abuse (CASA).
With such similarities to substance abuse, some hypothesize eating disorders themselves are an addiction, but this assertion, like many regarding the comorbidity of bulimia and substance abuse, remains a hypothesis.
“Comorbidity presents with unique challenges, and often, worse outcomes,” according to a review of research on the co-occurrence of eating disorders and substance abuse.
“Though comorbidity rates are high, little research has been done concerning treatment,” the researchers concluded. “Given the high prevalence rates of these comorbid disorders, a specific treatment needs to be developed that targets both disorders simultaneously.”
Treatment for Both
Programs that address both bulimia and substance abuse are ideal but rare, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).
The organization recommends that a person with both an eating disorder and substance-abuse problem, once he or she is medically stable, first address substance abuse disorder (SUD) “because a client with an active SUD will be less likely to engage in and benefit from eating disorder (ED) treatment.
“In addition, many specialized ED programs are not prepared to treat a client who also has an SUD.” The reverse is also true. Few addiction treatment programs attempt to treat eating disorders, and the ones that do have a more medical approach to addiction and are more likely to prescribe psychiatric medications, according to survey of publicly funded addiction treatment programs.
Only half of the programs screened patients for eating disorders.
“Generally patients with co-occurring eating and substance abuse disorders do not appear to receive structured assessment or treatment for eating disorders in addiction treatment programs,” the researchers concluded.
Eating disorder treatment professionals have historically existed a world apart from their peers who treat substance addiction, while some of their clients live with both diseases. Screening for eating disorders in substance addiction treatment, and vice versa, can bring these professionals together and help people struggling with these two diseases.
The screening should occur at intake and continue throughout treatment, suggests SAMHSA, because symptoms of either substance abuse or bulimia can show up any time during treatment.
When both disorders are present in one individual, it can be a game of “Whack-A-Mole.” Quitting drugs and their ability to numb feelings could drive someone to bulimic behaviors to numb out. When someone stops bingeing and purging, they may lean on drugs and/or alcohol as a psychological escape.
This is another challenging aspect of treating the comorbidity, but again, not an insurmountable one.
Community Discussion – Share your thoughts here!
Recovering from bulimia and substance addiction can be difficult, but it is possible. What successes have you achieved in your recovery? What treatments have worked well for you?
About the Author:
Leigh Bell holds a Bachelor of Arts in English with minors in Creative Writing and French from Loyola Marymount University in Los Angeles. She is a published author, journalist with 15 years of experience, and a recipient of the Rosalynn Carter Fellowship for Mental Health Journalism. Leigh is recovered from a near-fatal, decade-long battle with anorexia and the mother of three young, rambunctious children.
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.
