The term anorexia means a loss of interest in food that leads to unhealthy weight loss. Many conditions, from mental illnesses to chronic illnesses to drug abuse, can cause this kind of weight loss. However, when most people use the word anorexia, they actually mean anorexia nervosa, which is a mental illness involving an intense fear of weight gain, leading to intentionally eating very little and losing an amount of weight that leads to an unhealthily low body mass index (BMI).
What Is Anorexia, and How Is It Related to Addiction?
There are two subtypes of anorexia nervosa. These are:
1. Restricting type: The individual drastically restricts the amount of food or calories they consume.
2. Binge eating/purging type: The person eats normally or even overeats, but attempts to avoid absorbing those calories through vomiting, diuretics, laxatives, or enemas.
A person can develop anorexia of either type if they struggle with:
- Consistent, obsessive worry about weight or body shape
- Anxiety disorders
- Negative self-image
- Family history of mental health problems, domestic violence, or substance abuse
- Specific cultural ideas regarding beauty
- Concern with perfection
Risk factors for anorexia include genetics, family history, environment, age, and gender. Women typically comprise 80 percent or more of those undergoing treatment for anorexia. While eating disorders in general are on the rise among the male population, for the most part, women are more prone to eating disorders, including anorexia. Additionally, adolescents and young adults are more likely to struggle with anorexia and other eating disorders. People who experience physical and emotional stress – such as changes in weight, job transitions, or the loss of a loved one – are more likely to develop anxiety disorders, and anorexia and anxiety are often correlated.
Stress, mental health, and substance abuse are also often correlated, so people who struggle with anorexia are more likely than the general population to develop substance abuse issues. One statistic from the National Center on Addiction and Substance Abuse (CASA) at Columbia University found that 35 percent of people struggling with alcohol or drug addiction had eating disorders, including anorexia, compared to 3 percent of the general population. People who are diagnosed with the binge type of anorexia are more likely to struggle with substance use disorders, but both types are more likely to develop a problem with drugs or alcohol compared to the average American adult. A 2010 review conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that women who had either a substance abuse disorder or an eating disorder, such as anorexia, were four times more likely to develop the other condition, compared to women who had neither disorder.
Addiction Causing Anorexia
In SAMHSA’s report, researchers found that 14 percent of women who had a substance abuse disorder developed anorexia. This could be related to desire to control one’s environment and oneself; however, there are also substances that can induce anorexia, although not anorexia nervosa. Drugs like amphetamines, cocaine, and opiates (both prescription and illicit) can cause weight loss due to appetite changes, which can lead to anorexia as a symptom of the substance abuse.
For example, symptoms of prescription drug abuse include anxiety, which can lead to anorexia or another eating disorder, and abdominal cramps, nausea, and vomiting, which can lead the person to avoid food in favor of more of the drug. Alcohol can also cause weight loss, as the person struggling with alcohol use disorder is more likely to focus on alcohol consumption than eating. In addition, upset stomach and indigestion related to alcohol abuse can lead to food avoidance. Stimulants such as Adderall and cocaine suppress appetite and increase energy, leading to rapid weight loss.
Co-Occurring Anorexia and Addiction
Intoxicating substances like alcohol, tobacco, cocaine, and amphetamines trigger the area of the brain linked to physical satiety, or the sensation of having enough. This area of the brain is sometimes involved in food cravings or the sensation of hunger, but when drugs are introduced, that area may send signals that the body is satisfied or has enough nutrition when this is not true.
Rates of lifetime comorbid substance abuse associated with anorexia are outlined below:
- Alcohol abuse or dependence: 24.5 percent
- Illicit drug abuse or dependence: 17.7 percent
- Any substance use disorder: 27 percent
People who struggle with other mental health issues may develop both a substance abuse problem and anorexia in order to ease symptoms of the underlying condition. For example, people with obsessive-compulsive disorder, panic disorder, or social phobia may seek out a variety of ways to reduce stress related to these conditions. Substances can help to relax the brain, but the individual may also seek a way to control their environment, which substance abuse does not accomplish. Instead, the impulse to control a world that otherwise feels chaotic can turn into self-destructive behaviors, including anorexia.
Anorexia Leading to Addiction
Some people develop a pattern of substance abuse in order to facilitate their anorexia. For example, girls with anorexia are more likely to smoke cigarettes than their peers because they are trying to avoid eating and suppress hunger. Diet pills, speed, and cocaine are all addictive substances that suppress appetite while increasing energy, which can lead to increased levels of exercise, and this can speed up weight loss. Although alcohol is often high in calories, it can suppress appetite while also facilitating painlessness, relaxation, vomiting, and dehydration, which can all increase weight loss.
The 2010 SAMHSA review found that both men and women who had an eating disorder like anorexia were more likely to develop a substance use disorder, which became more severe as the eating disorder became worsened. Bingeing was associated with alcohol abuse, while purging was associated with increased use of amphetamines and sleeping pills.