It’s Not a Game – Eating and Substance Abuse Disorders

eating disorders

Eating disorders don’t discriminate. But people with a history of substance use disorder are at a higher risk for developing a potentially life threatening eating disorder. Clients may get sober only to use eating disorder symptoms — bingeing, restricting/dieting, and/or purging — instead of their drug of choice to cope with challenging emotions. This is often described by providers as whack-a-mole. True recovery begins when this game of whack-a-mole ends. It’s hard work, but everyone benefits when eating disorders and substance use disorders are treated together by cross-trained providers.

Maddox’s Story

My name is Maddox, I’m a 23-year-old non-binary person. I consider my experience with disordered eating unique to my identities. As a first generation American and person of color, the way I experience disordered eating is different from a white American. I come from different cultural perspectives around food and eating and endured food insecurity for most of my life. As a bisexual trans non-binary person, my body image is shaped not only by beauty standards and “fat phobia,” but also by dual cultural values of beauty and gender dysphoria. It was meaningful to me to share with my providers and fellow group members all aspects of my identity, culture and experiences while in treatment. I learned how to understand and manage both my eating disorder and substance abuse in a cohesive and comprehensive manner.

A huge misconception people have about addiction and eating disorders is that they’re a compartmentalized aspect of a person’s mental health or personality; that if only we could get this person to stop drinking or stop purging the rest would follow suit. For me and many other people in the co-occurring program, our eating disorder symptoms and our substance use were inextricably linked. I would use eating disorder symptoms to heighten the effect of alcohol or use drugs to induce or suppress my appetite. I would also use substances to induce purging. Both my eating disorder and substance use were about control — having control in harming myself and only allowing myself to hurt me. By using an approach that dealt with all symptom use at once, I was forced to sit alone with myself in a way that I had numbed and masked for so long.

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Half the battle was just getting the meals and snacks in as well as staying sober, but various treatment methods including individual and group therapies, physical therapy, occupational therapy, and dialectic behavioral therapy were imperative to starting my process of recovery. Being able to learn skills and connect with others increased my ability to participate in the program and helped affirm that I wasn’t alone in my disorders.


If you share Maddox’s struggle with co-occurring eating disorder and substance use disorder, or are concerned for someone else, please know that hope and healing are possible. Visit this link to watch a short video of others sharing their struggles. In addition to co-occurring treatment, Melrose Center in conjunction with the Hazelden Betty Ford Graduate School of Addiction Studies, offers a unique training program for providers. Call 952-993-6555 for more information about the upcoming workshop on September 19.

Brenda Servais, PsyD, LP, LADC, is lead of Melrose Center Eating Disorders and Substance Use Disorder Program.

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