Just as eating behavior can range from normal to problematic to dangerous, there is also a range of alcohol use behavior. Alcohol use may be characterized as absent, present but not problematic, problematic at times, abusive (frequently problematic), or dependent. The latter two descriptors – abusive and dependent – represent a DSM-5 diagnostic category of alcohol use disorders. The National Institute on Alcohol Abuse and Alcoholism can provide detailed information on what constitutes an alcohol use disorder.
Eating Disorders and Alcohol Use Disorders
The relationship between eating and substance disorders is well established.
- Studies indicate that approximately 50% of patients with an eating disorder exhibit difficulty with alcohol or substance use, compared with approximately 9% of the general population.
- Of all eating disorders, bulimia nervosa most commonly co-occurs with alcohol use disorders.
- Alcohol use problems are more prevalent in the binge-purge subtype of anorexia nervosa than the restricting subtype.
- Higher frequencies of binge eating and purging behaviors have both been associated with higher levels of substance use.
To learn more about the overlap of eating disorders and other diagnoses, see this related post.
Hazardous Intersections of Alcohol Use, Eating Behavior, and Body Image
Whether or not you meet strict criteria for an eating disorder or alcohol use disorder, there are many ways in which external behaviors and internal experiences related to eating, alcohol use, and body image intersect. If any of the examples listed below (or others like them) feel familiar, speak with your physician and/or your therapist for further evaluation of your alcohol use patterns.
*Please note: The examples listed below are not direct quotes — they are fictionalized samples of commonly described behaviors/contexts.*
“One glass of wine and the next thing you know, I’ve eaten and drunk way more than I planned.”
Even mild alcohol use can prompt eating behavior changes: eating differently than previously planned, eating in the absence of hunger, or binge eating. Lowered inhibitions may also diminish your in-the-moment desire not to purge, and/or your ability to use other strategies you developed not to act on an urge to purge. If one drink leads to another and another after that, the resulting hangover can hamper your best intentions in normalizing eating the next day too; depending on the type of eating problem, this can lead to undereating or overeating.
“I can’t eat that. I’m meeting my friends for beers later, and would rather not waste calories on food.”
This thought pattern, which centers on a concept of “banking” or saving calories for later, is common among people who eat very restrictively. If this resonates with you, keep in mind that undereating can set off a cascade of other issues – low energy, irritability, subsequent over- or binge-eating, poor tolerance for alcohol—that are likely to get in the way of your good time with your friends. Developing flexibility in eating a broad variety of foods at regular intervals throughout the day is a cornerstone of eating disorder treatment and recovery, as well as a healthy relationship with both food and booze. Choosing alcohol over adequate nutrition is, simply put, a risky choice.
“Once I have a drink in me, I don’t think so much about my body. It really helps me not to worry at all or feel self-conscious.”
For many people, alcohol serves as a social lubricant, helping them to “loosen up” in awkward situations such as meeting new people, dating, or socializing with colleagues. Similarly, if you feel self-conscious about your appearance, alcohol’s promise to distract you from this can be, in and of itself, intoxicating. But if you try to avoid the feeling (be it anxiety about appearance or talking to others) by sipping that drink, you deprive yourself of the opportunity to learn that the feeling can change over time or that with practice, you can focus your attention elsewhere. Moderate to heavy alcohol use can also lead to rebound anxiety – heightened anxiety in the hours or day after use – effectively undoing any perceived benefits to drinking in the first place.
“I decompress each day with a cocktail or two. It helps me wind down and fall asleep.”
Regularly using alcohol to “take the edge off” of stress is a problematic self-medication plan. Though alcohol reduces the time it takes to fall asleep, it worsens overall sleep quality. If you have an eating disorder, daily use is likely to affect your appetite, eating behavior, and body image. Alcohol use may mask the important factors underlying your stress and keep you from developing other, healthful outlets for this stress (for example, mindfulness meditation, seeking out members of your support network, or physical exercise).
Learning More about Problematic Alcohol Use
Here are resources to increase alcohol awareness:
- What is a standard drink?
- Drinking levels, defined.
- Facts and stats about the impact of alcohol use.