Medically reviewed by Kevin Wandler, MD, Chief Medical Advisor
Eating disorders are serious illnesses that affect both the body and the mind. They are not about vanity or willpower. They involve painful thoughts and behaviors around food, weight and body image that can take over a person’s life. Many people with an eating disorder also struggle with alcohol or drugs, and when the two conditions overlap, the medical and emotional risks rise.
This article explains how eating disorders and substance use connect, why the combination can be dangerous and why specialized eating disorder care is often needed. If you or someone you love is having thoughts of suicide, call or text 988. If someone faints, has chest pain, is confused or seems medically unstable, call 911.
Common Types of Eating Disorders
- Anorexia nervosa: severe restriction of food, intense fear of gaining weight and a distorted view of one’s body
- Bulimia nervosa: cycles of binge eating followed by behaviors like vomiting, laxative misuse, fasting or excessive exercise
- Binge-eating disorder: repeated episodes of eating large amounts of food with a sense of lost control, often followed by shame, without regular purging
- Avoidant/restrictive food intake disorder (ARFID): limiting food because of sensory issues, fear of choking or lack of interest in eating, rather than body image
Eating disorders affect people of every gender, age, race and body size. You cannot tell whether someone has one just by looking at them.
Why Eating Disorders and Substance Use Often Occur Together
Eating disorders and substance use disorders share many risk factors, including trauma, anxiety, depression, perfectionism, impulsivity and family history. Both can become ways to manage overwhelming emotions or regain a sense of control.
The behaviors can also feed each other directly. Some people use stimulants, nicotine or diet pills to suppress appetite. Some drink to numb guilt after eating or to quiet the constant noise of food-related thoughts. Others misuse laxatives, diuretics or prescription medications. People who binge eat may find that alcohol or cannabis lowers their inhibitions around food, which can deepen the cycle.
Why the Combination Is Dangerous
Both conditions place heavy strain on the body, and together they can be especially risky:
- Restricting, purging and substance use can all disrupt electrolytes, which can cause dangerous heart rhythm problems.
- Alcohol hits harder on an empty stomach and can drop blood sugar to dangerous levels.
- Stimulants add stress to a heart that may already be weakened by malnutrition.
- Withdrawal from alcohol or sedatives can be life-threatening on its own and more complicated in a malnourished body.
- Restarting normal eating after a period of starvation can cause serious complications and needs medical monitoring.
Warning Signs to Take Seriously
- Skipping meals, eating in secret or disappearing after eating
- Rapid weight changes, or constant talk about weight, calories or “earning” food
- Drinking on an empty stomach or using drugs to curb appetite
- Rigid exercise routines that continue despite illness or injury
- Dizziness, fainting, feeling cold all the time or dental problems
- Withdrawing from social events that involve food or drinking
Getting the Right Kind of Care
Eating disorders usually need specialized treatment. That often includes medical monitoring, nutritional rehabilitation with a registered dietitian and therapy designed specifically for eating disorders. When the eating disorder is the main concern, or when there are signs of medical instability, a dedicated eating disorder program is typically the right first step.
Promises Dallas-Fort Worth is not a specialized eating disorder program. It provides medical detox, residential and outpatient care for substance use and mental health conditions such as depression, anxiety and trauma, along with dual diagnosis treatment. If you are facing both an eating disorder and substance use, our admissions team can listen to your situation, talk through whether our programs are appropriate and help you think about next steps, including specialized eating disorder care. You can read more about co-occurring disorders on our blog.
Questions to Ask a Treatment Provider
When both an eating disorder and substance use are involved, the right questions can help you find care that fits. Consider asking:
- Do you have medical staff who can monitor nutrition, vital signs and lab work?
- Is a registered dietitian part of the treatment team?
- How do you coordinate with eating disorder specialists or substance use providers outside your program?
- How will you handle withdrawal safely if I am also underweight or restricting?
- What does aftercare look like for both conditions?
How Loved Ones Can Help
If you are worried about someone, focus on what you have noticed and how you feel rather than on their weight or appearance. Say something like, “I have noticed you are skipping meals and drinking more, and I am worried about you.” Avoid comments about bodies, even compliments. Encourage a checkup with a physician, since many medical effects of eating disorders are invisible. Our guide to supporting a loved one offers more ideas for starting hard conversations.
Frequently Asked Questions
Can someone have an eating disorder at an average weight?
Yes. Many people with serious eating disorders are at an average or higher weight. Behaviors and health effects matter more than appearance.
Which should be treated first, the eating disorder or the substance use?
It depends on medical risk and which condition is most severe. Often the two need coordinated care, with providers who understand both conditions communicating closely.
Does Promises DFW treat eating disorders?
Promises DFW does not operate a specialized eating disorder program. Our admissions team can discuss your needs and help you consider the right type of care.
Is it safe to stop drinking or using if I also have an eating disorder?
Stopping is an important goal, but it should be done with medical guidance. Withdrawal from alcohol or sedatives can be life-threatening, and malnutrition can add complications, so talk with a doctor before quitting.
Talk Through Your Options With Us
Figuring out where to turn when eating and substance use problems collide can feel overwhelming. Call our admissions team at (469) 546-9303 any time for a confidential conversation. You can also learn about insurance options or send us a message.