Substance use and Eating Disorders

There is so much stigma around substance use. When we hear that term, our minds refer to what we have been taught, which is to view these individuals with shame. What we don’t realize is that by perpetuating that image, it makes it even more difficult for someone who is willing to seek help and a diagnosis because of the stigma associated to it.

We see a lot of parallels between substance abuse and eating disorders. I had a great conversation on my podcast with one of our therapists here at The Balanced Practice, Katrina. I realized how many resemblances there can be between the two, and how so much needs to change with our system, and also our perspective of mental health so we can provide better support towards recovery.


What is Substance use?

This can refer to anyone who has a kind of problematic use of a substance. That could be somebody who might feel like they’re using too much every once in a while, or pretty consistently. I’m not speaking specifically to anyone who might be diagnosed with a substance use disorder, because regardless of how the person may use a substance, it can still impact their life, their work and their relationships.

Substance Use and Eating Disorders

There are a lot of theories around this. Unfortunately, there is not one clear answer.

We don’t even realize it, but our culture is subconsciously pushing people to adopt these behaviours. Just like the messages we receive about body image and disordered eating has been normalized, the same can be said about substance use. Think about it: usually during holidays in Canada, we gather around and consume a certain substance, perhaps even more because it’s a holiday. Similarly, there is discussion around food restriction, overeating etc. and it’s as though our culture encourages these types of behaviours.

There is some conflicting research on this, however some researchers say that eating disorders may be a type of addiction. There have been discussions around the shared biological and genetic factors, environmental risks, trauma, other mental health issues etc. that may result in substance use and/or disordered eating as a way to cope.

For some people, one will develop before the other, and for others, they will rise simultaneously, which is why it can be a little complicated. For this reason, there are few practitioners who are able to support both, as both as very niche diagnoses, but are also more commonly comorbid to one another.

It has happened where people will go somewhere for eating disorder treatment and are told that they need to get their substance use under control first. Then the same happens on the other side. When a person goes to a substance use inpatient treatment unit, they are told to get their eating disorder managed before coming.

When we only focus on one of these diagnoses, often what can happen is that the other gets exasperated. They end up going to treatment, struggling even more than when they were initially trying to get services.

So how do we fix this? How can people with eating disorders/disordered eating and substance use get the care they need?

Well, obviously this is a loaded question with a complicated answer. Part of it, is recognizing and understanding as a clinician, that this “one at a time” approach is more often than not, unhelpful and worse for long term treatment. Substance use and eating disorders are often a coping mechanism (we will explore this later on). So, by denying people a service they absolutely need, until they take away one of their coping mechanisms and try to work on treating the other, is just not going to work. We need to figure out how to overhaul the system so that people can actually access services they need.

Looking to find Food Freedom but don’t know where to start?

Check out my FREE Class to learn more about my Guilt Free Method so that you can find food freedom and feel good in your body.

Our Innate Survival Mechanism

We’ve probably all heard of the 3Fs – Fight Flight and Freeze as a human response to danger and survival.

Our nervous system has two branches, one that brings us up (fight and flight response) and one that brings us down (freeze response).

  • Freeze: If we are frozen, maybe we’d feel some kind of numbness. So, you may be having a conversation with someone, enter the freeze mode (as a survival/protective tactic) and have to ask “sorry, what did I say?”.
  • Flight: think of flying away – this is an avoidant behaviour, so when something is deemed unsafe, you might avoid it completely. For example, not showing up to your appointment.
  • Fight: think of it as an argument – so you are constantly defensive or needing to argue over something to maintain a safe place.

Disordered eating and substance use can be used as a means of bringing you into more of a numbed-out place, like that frozen place. When we talk about your nervous system, the ultimate goal is how to help people figure out how to feel safe enough and connected. I want to also recognize that some people aren’t in safe environments and so maybe they’re doing these things in order to help them survive. When you’re not safe, emotionally, physically, or otherwise, sometimes we do things in order to cope.

This can be hard if we aren’t in a place of safety to begin with, for recovery anywhere, and for any type of recovery. We also need to be in a space where we are able to access that support. You’re feeling all these new things, you’re having to rearrange relationships and your life. So, of course, you’re wanting to go back to this thing that you’re trying to stop doing or trying to change the way you’re doing it and being in a safe space and having access to these safe spaces is important.


Eating Disorder and Substance Use as a Coping Mechanism

To take the stigma away from eating disorders and substance use, it’s important to acknowledge that the person starts this for a reason. Sometimes it will be in our control, sometimes it will be for fun, sometimes it will be a means of connecting with the people in your life, etc.

Once you figure out why and how it has presented itself in your life, it becomes easier to understand how to approach it.

Before we take something away, that has helped the person survive for X amount of time, the reality is that no matter how harmful it is, it helped them survive. It helped them get there and we need to figure out another way for them to meet that need. Often what we notice is that these behaviours surge because there is an underlying unmet need.

It’s like the log in a storm…

Imagine there is a big storm with really intense waves. You find a log floating near you and you grab onto that log to support you and carry you through this storm. If you didn’t have that log, you may have drowned. Eventually, the storm passes, and you find yourself on the beach. You’re still holding onto that log because you’ve had to hold onto it for a really long time. When it comes time to realize that you have found a safe place, it become difficult to let go on that log because in terms of safety and coping, it’s all you know.

There is the fear that you might not be strong enough without the log, and it you shame yourself for being so reliant on the log. Eventually, you will learn to slowly let go of the log because now, you are on the beach. You are not in the storm. You may find other coping tools along your stroll on the beach, that will be supportive for you to regain that sense of purpose and safety.


Approach to treatment and finding support

Because of the complexities of these two disorders, the treatment will be very different and unique to everyone. As the mental health and health care professional, they will need to provide tools that are suitable for you.

For some people, abstinence is the way to go, whereas for others, a harm reduction approach might be best. There are all sorts of different ways of learning to cope. If we think again about our culture, some people will always be around certain substances, because there’s people using them, and if they want to keep those people in their life, it will be important to find new tools to uncover a new way of coping and assessing safety. It’s really about figuring out a new way of being in the world.

Shame can be a big barrier to seeking support. A big part of healing is to address the shame the person is feeling and speak to it. When we feel shame, we naturally want to hide, but we need to connect with other people and speak to it.

Brene Brown “Shame cannot survive being spoken. It grows exponentially in secrecy, silence and judgment.”

What can you do if you or your loved one is suffering from both disorders?

First and foremost, the most impactful things are finding someone in your life you can trust. I hope that people have that out there, and I know not everybody does. If that’s the case, there are resources in the city for free, because I want to recognize that not everyone can afford to access therapy, through private practice.

Second, a lot of people who are experiencing this, feel very isolated. Remind them and reassure them that they are not alone. There are many people who struggle with this and many people who are open and willing to help them, without shame.

Third, Practicing self-compassion. We tend to be so mean to ourselves when in fact, what we deserve is self-compassion and understanding that we have been brought to a certain place for a reason and that’s okay. The more we approach this from a curious lens and not a furious lens, the better the outcome will be.

Substance use and harm reduction resources


There are many similarities between substance use and eating disorders. The reality is, that these disorders have presented themselves a long time ago, and they have helped you survive something really difficult. You are strong and able to recover. Although recovery isn’t easy, but it’s possible.

I hope you learnt something new form this blog post and that it has provided you with a different perspective on the severity of these disorders, but also sparked your interest in wanting to learn more. Education is what will provide more understanding and with that, we can continue to support people who need it, without judgment.


Huff Post. (2013). Brené Brown on Shame “I cannot survive empathy”.  Retrieved from:


Hear me explore this topic more in depth in this week’s solo podcast episode! Access it by clicking on any of the icons below!

Need support?👇

The Balanced Practice is a team of professionals specialized in eating disorder outpatient treatment, disordered eating. Our mission is to help as many folks heal their relationship with food and their bodies so they can live happily outside of diet culture!

We strive to provide evidence based nutrition counselling to support you, or your loved one, in achieving full recovery. Schedule a connection call now.


Marie-Pier Pitre-D’Iorio, RD, B.Sc.Psychology
Lead Registered Dietitian and Founder of  The Balanced Practice

Eating disorders are complex illnesses | The Balanced Practice Inc | Ottawa, ON

Thank you for taking the time to read this blog post!

Eating disorders are complex illnesses | The Balanced Practice Inc | Ottawa, ON

If you are looking for more support from our team - We are happy to help

Book a free connection call

Join our Monthly Workshop

The Joy of eating | The Balanced Practice Inc | Ottawa, ON

Every month, The Balanced Practice offers a low-cost workshop on topics related to eating disorders/disordered eating. Check out the next one coming up!

Learn more
The Joy of eating | The Balanced Practice Inc | Ottawa, ON