Treatment for eating disorders and substance use disorders require specialized care. And when someone struggles with both, it’s important to find the right care to get help. Kindful Body recently met up with Leslie Plaia, M.Ed., LPC, CEDS-S, Director of Clinical Services at Alsana in Birmingham, to discuss substance use disorders and eating disorders. Leslie opened-up about latest research findings, along with a few worrisome statistics that are worth noting in this blog.

#DidYouKnow that 50% of individuals with eating disorders misuse alcohol or illicit substances – a rate five times higher than the general population. While up to 35% of individuals who misused, or were dependent on alcohol or other drugs, also had eating disorders – a rate 11 times greater than the general population. And, the most frequently misused substances by individuals with eating disorders include alcohol, laxatives, emetics, diuretics, amphetamines, heroin, and cocaine. These alarming statistics are why we wish to shed light on the matter, and bring awareness to help those who are struggling.

What are the Contributing Factors to Addiction?

There are several contributing factors to addiction, including biological, psychological, and environmental. However, trauma is often the root cause of most addictions. And like treatment for eating disorders, there is no one-size-fits-all approach to treating addiction. Addictions are multifaceted, and every individual experience is unique. Classes of substances that someone can become addicted to can include alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, stimulants, and tobacco.

Warning Signs and Symptoms of Substance Misuse

There are specific warning signs and symptoms to be aware of: physical changes, psychological changes, and/or behavioral changes.

Physical Changes:

Significant weight-loss or gain
Bloodshot eyes
Blackouts
Unusual smells
Changes in skin
Tremors
Changes in sleep patterns
Visible track marks

Psychological and Behavioral Changes:

Frequent class/work absences or excessive tardiness
Sudden mood changes
Irritability
Aggression
Secrecy
Isolation
Loss of interest in hobbies or activities
Depression
Financial problems
Change in peer group

Function of Substances Co-Occurring with Eating Disorders

Certain substances may be used for weight-loss or weight gain, depending on the person’s situation. For example, tobacco, caffeine, insulin, thyroid medications, stimulants, OTC medications (laxatives, diuretics) are used as a weight-loss mechanism, while cannabis may be used as a weight-gain mechanism. Additionally, some may use substances for mood stabilization or emotional regulation. Alcohol may also be used as a way to cope with an eating disorder, PTSD or underlying trauma.

Alarming Trend: Risky Alcohol Use & Disordered Eating

Alcohol misuse can have a significant impact on someone who is struggling with an eating disorder. For some, eating disorder behaviors, such as skipping meals, excessively exercising and purging food, are used to offset calories from drinking alcohol. This is a troubling trend in particular among young adults — a study found that eight out of 10 college students had recently engaged in at least one eating disorder behavior while drinking.

Inappropriate alcohol use can lead to higher rates of serious health issues when compared to people who drink and eat an appropriate amount of food beforehand. These concerns include blackouts, alcohol poisoning, hypoglycemia, and alcohol-related brain damage. Drinking on an empty stomach can intensify these outcomes, as well as raise blood-alcohol levels faster and decrease inhibitions, which may lead to risky alcohol-associated behaviors like driving under the influence. In the long term, the risk for alcohol-related health conditions is increased. These ailments often manifest themselves as liver disease, osteoporosis, cardiac problems, diabetes, or dementia.

“. . . In discussing substance use disorders, words can be powerful when used to inform, clarify, encourage, support, enlighten, and unify. On the other hand, stigmatizing words often discourage, isolate, misinform, shame, and embarrass . . .”
- From “Substance Use Disorders: A Guide to the Use of Language” published by CSAT and SAMHSA

Are You Perpetuating Stigma? Language Update

It is not uncommon for people to use the term “drunkorexia” to refer to the behavior of replacing meals with alcohol, or using compensatory measures to counteract the calories consumed from drinking alcohol; often in an attempt to control one’s weight. Yet the term “drunkorexia” can be stigmatizing towards those who are suffering, and we are grateful to Leslie Plaia from Alsana for sharing with us her understanding of this stigmatizing term. According to the National Institute of Health, “stigmatizing language can negatively influence health care provider perceptions of people with substance use disorder (SUD), which can impact the care they provide.” Here is language they recommend:

Instead of: abuser, junkie, addict, alcoholic

Use: Person in active addiction; person with a substance misuse disorder; person experiencing an alcohol / drug problem; patient (if referring to an individual receiving treatment services)

Instead of: abuse

Use: Misuse; harmful use; inappropriate use; hazardous use; problem use; risky use

Instead of: clean/dirty

Use: Negative; positive; or substance - free.

Instead of: user

Use: When referring to use, you might say “a person who misuses alcohol/ drugs.” While referring to misuse, you might say “a person engaged in risky use of substances.”

Instead of: recovering addict

Use: Person in long-term recovery from substance use.

What is the DSM-5 Criteria for Substance Use Disorders?

Some of the DSM-5 criteria are listed below. Mind you, the level of severity depends on the following factors:

Mild: Presence of 2 or 3 symptoms

Moderate: Presence of 4 or 5 symptoms

Severe: Presence of 6 or more symptoms

Substance is taken in larger amounts, or over longer periods than was intended
There is a persistent desire or unsuccessful effort to cut down, or control, substance use
A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects
Craving, a strong desire, or urge to use substance
Recurrent use of the substance is resulting in a failure to fulfill major role-obligations at work, home, or school
Continued use of substance, despite having persistent or recurrent social or interpersonal problems that are caused, or exacerbated by the effects of the substance
Important social, occupational, or recreational activities are given, or reduced, because of substance use.
Recurrent substance use in situations where it is physically hazardous
Substance use is continued despite knowledge of having a persistent, or recurrent, physical, or psychological problem that is likely to have been caused, or exacerbated by the substance
Tolerance, as defined by either of the following: a need for markedly increased amounts of the substance to achieve intoxication, or desired effect; A markedly diminished effect with continued use of the same amount of the substance
Withdrawal, as manifested by either of the following: (withdrawal does not apply for every substance.) - The characteristic withdrawal-syndrome for that substance (see additional criteria in DSM-5)

The substance is taken to relieve, or avoid, withdrawal symptoms.

Get Help Today

We understand how difficult it can be for those suffering with substance use disorder and eating disorders. For many, the agony is often a silent battle fought behind closed doors. Changing harmful patterns can sometimes feel overwhelming and hopeless. But you don’t have to do this alone. Many providers can support you in your recovery journey, including our team at Kindful Body.

Various treatment modalities are available to help treat substance use disorders and eating disorders, including Motivational Interviewing, Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Internal Family Systems (IFS) Therapy, and EMDR. Kindful Body therapists specialize in these therapeutic approaches and more. We are here to help you find healing and guide you down a path toward inner harmony.

Schedule a complimentary consultation with one of our therapists here to get the help you need. We offer eating disorder treatment in Los Angeles, San Francisco, San Jose, Orange County, CA, or anywhere online in California. We look forward to helping you on your recovery journey.

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Team Discussion: When Does Substance Use Need Treatment as Part of Eating Disorder Recovery?