Individuals with bulimia may have co-occurring substance use disorders, which add to the complications of an eating disorder. Substance abuse can occur before, during or throughout the recovery phase of bulimia.

Co-occurring disorders occur when a mental health disorder and a substance use disorder are present together. Individuals with bulimia may have co-occurring substance use disorders, which add to the complications of an eating disorder. Substance abuse can occur before, during or throughout the recovery phase of bulimia. It is unknown whether substance usage happens first, which may intensify symptoms of bulimia, or whether bulimia develops first, which may lead to eventual self-medication with substances.  

Drug Abuse as a Hindrance to Bulimia Treatment

Bulimia treatment focuses on terminating the binging and purging cycle and on re-establishing healthy eating patterns. Irrational cognitive thoughts centered on body image, weight and eating are challenged and emotional issues contributing to the disorder’s development are addressed. A combination of psychotherapy, psychotropic medication and nutritional counseling is utilized as a treatment protocol.   

Individuals with bulimia and an accompanying substance use disorder can be challenging to treat, as many do not seek treatment or believe that they do not have a problem in the first place. Also, there is a greater risk for recurrence of use, elevated mortality rates and less successful treatment outcomes overall.  

An integrated treatment model, also termed dual diagnosis treatment, addresses co-occurring disorders at the same time with equal attention. Thus, bulimia and substance use disorders are treated concurrently to achieve a successful outcome.

When a co-morbid substance use disorder is present, it makes treatment more difficult, as recovery can no longer focus solely on the eating disorder. Both disorders intensify each other and magnify avoidance behaviors, making treatment more complex. People with bulimia are secretive to maintain their disorder and substance use can intensify deceit and prompt misdiagnosis. Substance abuse magnifies personality factors such as impulsivity and mood, which makes recovery more difficult.

Effects of Substance Abuse on Bulimia

Bulimia and substance abuse have several commonalities, including:

  • Loss of control that climax in compulsive behaviors
  • Actions are representative of poor coping abilities
  • Stubborn opposition to treatment and high recurrence of use
  • Obsessive fixations and ritualistic behavior
  • Instigates reinforcement and reward centers in the brain
  • Prompts mood changes
  • Genetic, societal risk factors or exposure to trauma

Substances are risky for people that abuse them. Substance abuse intensifies these risks to an individual suffering from bulimia. Drug abuse impacts the brain through several avenues, including personality and reward centers and takes a toll on the body’s organ systems and general overall health. Substance abuse has a great impact on the liver, stomach, heart and neurological systems, which are already compromised by bulimia and malnutrition.  

Bulimia’s impact on the circulatory system can include dehydration, weakened heart muscles and an erratic heartbeat, caused by recurrent vomiting. Substance abuse can impact the circulatory system by either increasing or decreasing heart rate, causing an irregular heartbeat and prompting fluctuations in blood pressure. Therefore, the combined effect can be extremely problematic, if not deadly.  

Alcoholism and bulimia can cause significant medical concerns, as both disorders unfavorably impact various body systems. The co-occurring conditions can lead to malnourishment, which can intensify the effects of each disorder leading to further complications. Bulimia also can affect the reproductive system by interfering with menstruation, which is also a characteristic of alcohol abuse.

Other effects of substance abuse on symptoms of bulimia include:

  • Brain’s reward system experiences fulfillment
  • Causes changes in body temperature
  • Influences appetite suppression or expression, resulting in weight loss or gain.
  • Instigates changes in personality
  • Produces mood swings and behavior changes
  • Causes a lack of energy or sedation
  • Gastrointestinal changes, such as slowed digestive system, constipation, intestinal issues and flulike symptoms

Statistics on Bulimia Nervosa and Drug Abuse

  • One in ten individuals with bulimia has a co-occurring substance use disorder
  • More than 13 percent of female patients with bulimia abuse substances  
  • As many as 50 percent of individuals with an eating disorder simultaneously abuse drugs and of the 50 percent, 20 percent meets the criteria for long-term alcohol abuse and addiction
  • Up to 50 percent of individuals with eating disorders, especially bulimia, abuse drugs or alcohol (five times more than the general population) compared to 9 percent of the general population
  • Individuals with disorders experience higher rates of substance abuse than the general population, and people who binge and purge are more likely than restricting anorexics to engage in substance abuse  
  • 3 in 100 women have bulimia
  • 90 percent of women are impacted by the disorder

Bulimia and Alcohol

Alcohol is commonly abused with eating disorders, as people tend to self-medicate in response to stressors from the eating disorder. In several studies, alcoholism in women with bulimia links to poorer outcomes in treatment but it has not been a consistent finding in all research studies. Women with co-occurring alcoholism and bulimia may have a higher risk of developing other mental health conditions or personality disorders.  

The frequency of alcohol use among females with bulimia varies between 20 to 25 percent. Individuals with bulimia may use alcohol more frequently compared to people without an eating disorder.  

Bulimia and Marijuana

People with bulimia may use marijuana to cope with anxiety and to deal with the pressure of maintaining secretive behaviors. Marijuana is a relaxant but can have the reverse effect by causing increased stress and paranoia.

Research shows that 25 percent of people with bulimia use marijuana, and binge eating in young adults may lead to further marijuana use. Because marijuana prompts hunger, people with bulimia may use it frequently.

Bulimia and Stimulants

Stimulants are one of the most frequently abused substances in conjunction with an eating disorder. Stimulants are commonly abused to facilitate purging behaviors and curb appetite.

Individuals with eating disorders may utilize stimulants to manage their hunger and to provide energy for exercise. High rates of cocaine are found in people with eating disorders, with weight loss being the main reason for using cocaine. Studies show that individuals who use laxatives, diuretics and diet pills for weight management may also use stimulants.  

Drug Abuse as a Cause of Bulimia

Eating disorders and substance abuse are two conditions with similar characteristics. Both include an addictive nature, alterations to brain chemistry and a loss of control that is made worse with compulsive behaviors. The statistics are clear that there is a definite link, as the prevalence of substance abuse is higher in people with an eating disorder.  Despite this, it is unclear if bulimia causes drug abuse or if drug abuse causes bulimia.

Drug abuse can cause changes in personality, such as increased impulsivity and decreased inhibitions, which could prompt an eating disorder. Someone who drinks heavily may become bulimic to vomit the excessive alcohol intake. If someone binges on alcohol, they can merely vomit it back up so that they can continue drinking. Drug abuse could also prompt intense cravings, which could impact an individual’s weight and prompt an eating disorder.  

Research has concluded that bulimics may have a genetic predisposition or modifications to their central nervous system, making them more susceptible to addictive behaviors.  The direction of this causation is still unknown, but thankfully there are various treatment options that can assist individuals in treating both disorders simultaneously.

If you are struggling with bulimia and substance use disorder, contact the Recovery Village to learn about your treatment options.

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Editor – Thomas Christiansen
With over a decade of content experience, Tom produces and edits research articles, news and blog posts produced for Advanced Recovery Systems. Read more
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Medically Reviewed By – Tracy Smith, LPC, NCC, ACS
Tracy Smith is a Licensed Professional Counselor, a Nationally Certified Counselor, an Approved Clinical Supervisor, and a mental health freelance and ghostwriter. Read more
Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.