My daughter has an eating disorder and an opioid use disorder. What do I do?

A: Dr. Nicole Avena

It is actually more common for those with eating disorders (EDs) to misuse substances than those without an ED. According to the National Center on Addiction and Substance Abuse, around 50% of women with eating disorders struggle with some kind of substance use disorder. The relationship between these disorders is multifaceted. Studies have shown that both EDs and substance use disorders can arise from the same set of personality traits or past experiences. Both kinds of disorders can be ways of coping with trauma in the past. Substance use can also be an enabler for the ED. Drugs can speed up metabolism or suppress appetite, which is desirable specifically for those suffering from anorexia.[1]


It is important, while seeking treatment, that individuals acknowledge that the same underlying issues for their disorders can be expressed in multiple ways. Post-traumatic Stress Disorder (PTSD) is seen as a common underlying factor in women suffering from both EDs and substance use disorder.[2]


Certain personality traits have also been cited as indicators for the propensity to develop multiple disorders. However, it is important to note that these personality traits, including self-destructive and erratic behavior, are much more consistent and obvious when comparing subsets of ED sufferers with and without the comorbidity of substance use disorder. Conversely, comparing ED sufferers with substance use sufferers leads to a much less significant correlation. This indicates that there is a very specific set of traits that intersect in individuals with both substance use disorders and EDs.


The exact type of eating disorder and substance use disorder is also important to consider, as it can help make a more specific diagnosis and a more highly-tailored treatment plan. For example, according to Clinical Psychology Review, a substance use comorbidity is more often seen with bulimia nervosa and binge/purge anorexia than with restrictive anorexia.[3] This occurs because of the similar physiological effects of using drugs and purging.


Opioids offer a rush of endorphins to the user, an effect that is also mimicked by the action of purging (4). Examining the differences between eating disorders – and why they often co-exist with other substance use disorders – can lead to answers about how to treat these disorders.


According to the National Eating Disorder Association, it is important to distinguish between the types of substance an individual is misusing. Most eating disorder clinics are familiar with abuse of laxatives, diuretics, and other over-the-counter drugs, but if serious addiction to illicit drugs is involved, treatment must involve professionals trained in that field.[5]


In terms of what parents can do, the best thing is to make sure that you are working with a practitioner that has experience in treating both conditions, so that there is a coordination of care. The ED and the substance use problem need to be addressed concurrently.





Nicole Avena, PhD


Dr. Nicole Avena is a Mt Sinai Medical School research neuroscientist and Princeton University expert in the fields of nutrition, diet and addiction.









An excerpt from Navigating Addiction and Treatment: A Guide for Families, Addiction Policy Forum, 2020.




A Note From Addiction Policy Forum


Substance use disorders get worse over time. The earlier treatment starts the better the chances for long-term recovery. Many families are wrongly told to “wait for rock bottom” and that their loved one needs to feel ready to seek treatment in order for it to work. The idea that we should wait for the disease to get worse before seeking treatment is dangerous. Imagine if we waited until stage 4 to treat cancer. Decades of research has proven that the earlier someone is treated, the better their outcomes—and that treatment works just as well for patients who are compelled to start treatment by outside forces as it does for those who are self-motivated to enter treatment.


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References:


1) Killeen, T., Brewerton, T. D., Campbell, A., Cohen, L. R., & Hien, D. A. (2015). Exploring the relationship between eating disorder symptoms and substance use severity in women with comorbid PTSD and substance use disorders. American Journal of Drug and Alcohol Abuse, 2015. 41(6): 547-552. www.ncbi.nlm.nih.gov/pmc/articles/PMC46894 37/

2) Cohen, L. R., Greenfield, S. F., Gordon, S., Killeen, T., Jiang, H., Zhang, Y., Hien, D. (2010). Survey of eating disorder symptoms among women in treatment for substance abuse. The American journal on addictions, 19(3), 245– 251. https://doi.org/10.1111/j.1521- 0391.2010.00038.x

3) Wolfe, W. L. & Maisto, S. A. (2000). The relationship between eating disorders and substance use: Moving beyond co prevalence research. Clinical Psychology Review, 2000. 20(5): 617-631. Retrieved from www.sciencedirect.com/science/article/pii/S02 72735899000094

4) Pew Research Center. (2017).  Nearly half of Americans have a family member or close friend who’s been addicted to drugs. Pew Research Center. Retrieved from www.pewresearch.org/facttank/2017/10/26/nearly-half-of-americanshave-a-family-member-or-close-friend-whosbeen-addicted-to-drugs/

5) National Eating Disorders Association. (2018). Substance Abuse and Eating Disorders. Retrieved from www.nationaleatingdisorders.org/substanceabuse-and-eating-disorders


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