Statistics show that individuals with eating disorders abuse alcohol or drugs at a rate five times higher than the general population. These two conditions can put people at risk for a number of psychological and physical problems. Treating co-occurring addiction and bulimia may require inpatient treatment, such as the dual diagnosis treatment programs offered by Vertava Health.

Bulimia is a form of food addiction, so it’s not surprising that many people with this specific type of disordered eating also suffer from substance abuse addiction. The parallels have intrigued many researchers, and in recent years a strong link between the two has become apparent.

This connection seems to be more prevalent in binge eating and purging patterns observed in those who have bulimia, rather than restriction of food intake seen in anorexia nervosa.

What Is Bulimia?

An eating disorder can affect people of any age, race, gender, weight, or body type. It’s estimated that at least 30 million people suffer from an eating disorder in the U.S alone.

There are eleven different types of eating disorders. Bulimia is one of the most common and most well known. Females are more likely to have bulimia than males, and this condition often begins in the late teens or early adulthood.

Bulimia is an eating pattern of binging and purging. People with bulimia have a loss of control when eating and often consume abnormally large amounts of food in one sitting. They will then use different methods, such as forced vomiting, exercising excessively, or using laxatives and other stimulant drugs, in an attempt to rid themselves of the food (calories) they ingested.

Signs And Symptoms Of Bulimia

It can be more challenging to identify a person with bulimia because this type of eating disorder doesn’t always lead to excessive weight loss. Sufferers are usually either overweight or average weight. However, there are certain signs and symptoms that may be obvious when a person is suffering from bulimia.

Here are a few red flags that friends and loved ones may pick up on:

  • complaining about being “fat”
  • excessive worry about becoming overweight
  • negative body image
  • eating unusually large amounts of food in one sitting, especially foods the sufferer may consider “off-limits”
  • not wanting to eat in public or around others
  • going to the bathroom for long periods of time right after eating or during meals
  • excessive exercise
  • sores, scars, or calluses on the knuckles or hands
  • damaged teeth and gums
  • swelling in the hands and feet
  • dehydration
  • facial and cheek swelling from enlarged glands
  • changes in weight or frequent weight fluctuations
  • depression
  • absent or irregular periods in females

Co-Occurrence Of Bulimia And Addiction

Even though research has found that nearly half of all people with an eating disorder also abuse drugs or alcohol, this co-occurrence is frequently overlooked. Addressing one disorder and not the other can lead to an endless cycle of rehab hopping and relapse. It is crucial to recognize that where there are eating disorders, there’s often addiction and vice versa.

The painful feelings of low self-esteem and distorted body image can increase the chance that someone with an eating disorder will turn to alcohol or drugs as a way to numb the pain. The National Eating Disorders Association says that the substances most frequently abused by individuals with eating disorders are alcohol, laxatives, emetics, diuretics, amphetamines, heroin, and cocaine.

Alcohol seems to be the most frequent substance of choice. In a population-based study, nearly 23 percent of bulimic women had co-occurring alcohol dependence, and 48.6 percent regularly abused alcohol. Another study reported that by the age of 35, half of the individuals with bulimia met criteria for alcohol abuse or drug dependence at some point in their lives.

Several things can heighten the risk of developing or worsening a substance use disorder when someone has bulimia. Research has found that patients diagnosed with bulimia often report alcohol consumption as a strong trigger for wanting to binge eat. Other studies also suggest that individuals with bulimia report more negative substance use related consequences.

While not as common, addiction can also precede an eating disorder. Researchers believe this is primarily because eating disorders and addiction stem from a similar place and share many of the same causes. There could also be other scenarios to consider. An individual may develop an eating disorder when his or her appetite is suppressed through the use of substances. There is also the risk of developing an eating disorder while in recovery from addiction due to weight gain.

Similarities Between Bulimia And Addiction

While these two conditions share many similarities and concurrent treatment is suggested, each is a stand-alone disorder.

For people living with bulimia, the scale is never low enough, and the reflection in the mirror is never good enough. For individuals struggling with addiction, the high is never high enough. In both disorders, the victim is seeking instant results or gratification and always longing for better or more.

There is a long list of triggers that sufferers of eating disorders and addiction may share preceding the development of these conditions.

These influencing factors may include:

  • stressful life transitions
  • death of a loved one
  • a breakup or divorce
  • job loss
  • social pressures
  • family pressures
  • media messages
  • emotional trauma
  • physical abuse
  • sexual abuse
  • anxiety or other mood disorders

There also seems to be a few more profound commonalities, including things that could be genetic, neurological, or generational.


In addition to the above-mentioned influencing factors, researchers have found that genetic influences determine an astonishing 83 percent of the bulimia-addiction connection. Genetics do not necessarily mean someone will develop a disorder; however, it does seem to make a person more vulnerable.

Low levels of certain neurotransmitters in the brain are one genetic marker that researchers believe may be linked to the susceptibility of addictive disorders.

Neurological Factors

Other studies have looked at how the brain reacts to cravings. They discovered that similar areas of the brain were activated in people with bulimia and drug addiction when they craved food and drugs, respectively.

When someone has bulimia, they get intense cravings for a particular food that can seem impossible to overcome. Those suffering from addiction have this same feeling when attempting to resist the urge to use drugs or alcohol. The feeling of loss of control in the moments before binging/purging or using drugs is also shared.

Other studies have examined similarities in neurological patterns. When trying to abstain, many suffering from bulimia report the same type of withdrawal symptoms a person addicted to substances may have, such as anxiety, sleep issues, and intense cravings. There also seem to be similarities in terms of tolerance. With time, bulimics may need more substantial quantities of food to get the same emotional effect. The same applies to those suffering from substance addiction.

Additionally, other biological similarities have been noted. It appears that those with bulimia have similar dopamine abnormalities in their brains as people suffering from cocaine and alcohol addiction.

Generational Factors

Family history can also play a role. Individuals who witnessed a parent or sibling abusing drugs or struggling with an eating disorder are at a higher risk of developing the same behaviors.

Treatment For Bulimia And Addiction

In order to overcome these conditions, the root cause of each disorder needs to be addressed and treated. Because bulimia and addiction frequently co-occur, many rehab facilities like Vertava Health offer treatment that is tailored to address both conditions at the same time. This method is preferred, as integrated programs provide a much higher rate of full recovery and less chance for relapse.

Together, these two disorders are challenging yet possible to treat. Many of the same strategies used for eating disorders are applied to substance abuse and addiction.

A few types of treatment offered by Vertava Health that prove beneficial for both bulimia and substance addiction include:

  • individual psychotherapy that places an emphasis on building self-esteem
  • family counseling
  • group therapy sessions with others who have a dual diagnosis of an eating disorder and substance abuse or addiction
  • medication-assisted therapy (MAT)
  • holistic treatments like yoga, meditation, acupuncture, yoga, or massage

Relapse for both substance addiction and bulimia is fairly common. Between 30 to 50 percent of individuals who eliminate bulimia behaviors will begin again, and roughly half of those that recover from a drug or alcohol addiction will have at least one moment of weakness and start using again. This is why early and complete treatment is vital.

Where To Turn For Help

Both addiction and bulimia are dangerous in their own ways. When the two co-occur, the risks are far more severe. If you or a loved one is struggling with one or both of these conditions, there are several treatment options available to consider. Many of the Vertava Health’ rehab facilities offer treatment programs for co-occurring disorders like bulimia and substance addiction.

Reach out to one of our highly trained Vertava Health treatment specialists today so that we can help you or your loved one decide on the best treatment option.