Witnessing a loved one struggling with an Eating Disorder is devastating enough, but when combined with substance use like alcohol or drugs, it becomes catastrophic.
Many individuals affected by an Eating Disorder are also dealing with some form of substance use1. This can occur before, during or after the Eating Disorder. When the substance abuse happens concurrently with an Eating Disorder, it can be a method to further lose weight or numb the psychological torture of the disease. Starting after can be a way to replace the feelings of comfort that the disease gave.
The commonality of both disorders is that they originate in similar areas of the brain, as well as more likely to affect those with decreased self-esteem, depression, anxiety or compulsive behaviour. Concurrent substance abuse can lead to a more severe Eating Disorder and potentially, a more severe impairment1.
Treatment for an Eating Disorder becomes more difficult than it already is when you add substance abuse. In my experience, not only is there a lack of integrated treatment, there are also few, if any, centres that will take in a client who presents with both disorders.
I have witnessed this with my adult daughter who for years (some unknown to me) abused alcohol as a method of dealing with her severe bulimia, anxiety, and obsessive compulsion. She was refused by numerous treatment venues due to their not treating alcohol dependence concurrently with her Eating Disorder.
It was a very difficult combination to witness as a mother and caregiver. You find yourself asking: Which condition is the more urgent to treat? And…Is what I am witnessing driven by the Eating Disorder or the alcohol?
Both conditions are secretive and caused her to lie, hide effects and generally become more depressed, obstinate, and unreasonable when it came to treatment options. The concurrent substance disorder, by nature, made her more unwilling to seek treatment. She was at a high risk for falls and injury to a body already weak and abused from her Eating Disorder.
She was a shell of herself.
With firm boundaries she has since stopped drinking but still suffers from bulimia. She attends outpatient counselling and is making slow progress. She is a different person. Yes, her Eating Disorder symptoms have increased to compensate, but she can deal with them better.
This has been a long journey for her (and us), but one that is easier to plod through without the ugly head of alcohol abuse. We love her and are proud of her and support all her efforts BUT without the influence of alcohol.
1 Woodside, D.B., Garfinkel, P.E., Lin, E., Goering, P., Kaplan, A.S., Goldbloom, D.S., et al. (2001). Comparisons of men with full or partial eating disorders, men without eating disorders, and women with eating disorders in the community. American Journal of Psychiatry, 158(4), 570-4.
The large Ontario Mental Health Survey (Garfinkel et al., 1996; Woodside et al., 2001) referred to in the reference above provided information on co-morbidity in eating disorders where 34% of women and 15% of men with an eating disorder had a lifetime diagnosis of major depression; 37% of men and 51% of women had a lifetime diagnosis of anxiety disorders and 45% of men and 21% of women had a lifetime diagnosis of alcohol dependence.