Berlina Wallace-Berube, MACP, MEd, LPC, NCC, Senior Public Health Advisor, Center for Substance Abuse Treatment | samhsa.gov
For a lot of Americans, eating disorders (EDs) and substance use disorders (SUDs) are not distinct challenges. Many live with both.
In fact, more than one in four individuals with an ED will also meet the criteria for a co-occurring SUD. Similarly, up to 35 percent of those with alcohol use disorder or other SUDs have eating disorders. These co-occurring conditions occur at higher rates among women. Research indicates that approximately half of all women with EDs also have an SUD, and about 16 percent of women with an SUD report having an ED.
The co-occurrence of these conditions is a pressing public health concern with profound impact on individuals and their families. They’re tangled together in ways that may make recovery feel overwhelming – but it’s not out of reach.
People must receive compassionate, integrated care for both disorders in order to have the best chance at recovery. This aligns with President Trump’s Make America Healthy Again (MAHA) initiative and its commitment to addressing the chronic disease epidemic impacting Americans. Evidence-based, whole-person approaches to treating co-occurring EDs and SUDs will advance MAHA’s vision of a healthier, more resilient America.
Understanding the link between EDs and SUDs
Co-occurring EDs and SUDs often share underlying causes, including genetic predisposition, trauma, and emotional dysregulation (difficulty managing feelings and emotions). Factors such as adverse childhood experiences and norms also contribute. Both disorders involve compulsive behaviors, cravings, and use of food and/or substances as a coping mechanism. Traits such as impulsivity and perfectionism may exacerbate risks for both conditions.
SUDs and EDs can exacerbate each other, creating a cycle that complicates recovery for both. For instance, individuals with binge eating disorder may misuse prescription stimulants or use illicit stimulants for appetite suppression, perpetuating a dangerous cycle.
Recognizing symptoms early is critical. Early intervention provides individuals the best chance for lasting recovery. Delayed treatment increases risks of severe health consequences and complicates recovery efforts.
Integrated care paves a road to recovery
Treating both disorders together is vital to improving outcomes. SAMHSA’s recently released advisory Evidence-Based Care for Clients with Co-Occurring Substance Use Disorders and Eating Disorders contains information to help health care providers identify clients who have possible co-occurring SUDs and EDs; make appropriate referrals; create recovery-friendly, supportive treatment environments; and help clients sustain recovery from both SUDs and EDs.
Integrated care addresses EDs and SUDs concurrently through holistic, person-centered approaches. By considering physical, mental, and emotional health – including evidence-based therapies and medical and nutritional support – integrated care plans reduce the risk of return to misuse and promote long-term recovery.
Recovery from co-occurring SUDs and EDs is possible with the right resources and support. Normalizing discussions about dual diagnoses helps reduce stigma and encourages more individuals to seek the help they need.
Community and family involvement are also key components of recovery. Peer support services play a vital role in the recovery journey of individuals who have SUDs and EDs. These services provide a sense of connection, encouragement, and hope by allowing people to engage with peer support workers who have lived similar experiences and understand the challenges associated with these conditions. Peer support fosters empowerment, reduces stigma, and helps individuals build the confidence and resilience needed to sustain long-term recovery.
Resources for people who have eating disorders, substance use disorders, or both
If you or someone you know is dealing with eating disorders, substance use disorders, or both, don’t wait to reach out for help. Educate yourself and others about the realities of co-occurring EDs and SUDs. Share resources, participate in community events, and advocate for inclusive, comprehensive treatment approaches that address the complexity of these dual diagnoses.
The U.S. Department of Health and Human Services (HHS) offers a wealth of resources for people who have SUDs and EDs, as well as families and providers:
- Substance Use – a comprehensive resource where you can learn about substances, prevention, treatment, and recovery.
- SAMHSA: Substance Use Disorder Treatment – a comprehensive resource with information about substance use, resources, and treatment options for substance use disorders and co-occurring disorders.
- SAMHSA: Eating Disorders – a resource providing information about eating disorders and how to get help.
- Office on Women’s Health: Eating Disorders – a resource containing information about specific eating disorders, including their impact on pregnancy and breastfeeding.
- NIH National Institute of Mental Health: Eating Disorders – a resource consisting of eating disorders research, outreach materials, and links to resources.
- AHRQ: Eating Disorder Resources for Clinicians and Patients – a webpage with information about eating disorders and links to resources for clinical providers and individuals with eating disorders.
- FindSupport.gov – designed to help people identify available resources, explore unbiased information about various treatment options, and learn how to get support for issues related to mental health or substance use.
- FindTreatment.gov – a confidential and anonymous resource for persons seeking treatment for mental health conditions and substance use disorders.
- 988 Suicide & Crisis Lifeline – a lifeline for individuals in need of support or in crisis. Call or text 988 or chat 988lifeline.org.
Each of us can help to foster a world where recovery is possible for everyone. By supporting individuals on their recovery journeys, we honor their courage and resilience. The time to act is now – together, we can make a difference. Let’s work together to create a future where recovery is within reach for all.
