The relationship between my alcoholism and my eating disorder

Co-occurring substance use and eating disorders are very common. I believe the statistics are that 50% of people with eating disorders struggle with substance use, while 35% of people who struggle with substance use also have eating disorders. That number is probably underreported because people who struggle with both rarely speak about it. Research has shown that eating disorder patients who abuse substances demonstrate worse symptoms and poorer outcomes than those with eating disorders alone, including increased general medical complications and psychiatric conditions, longer recovery times, and higher relapse rates. (Alcohol and Eating Disorder, n.d.)

My alcoholism came several years after my eating disorder developed. I always thought it was a symptom of my eating disorder that took on a life of its own. Before that, I was primarily a social drinker. In graduate school, I barely had time to drink because school was so demanding. But around my third year in the program, things shifted. I went from drinking socially, to drinking alone in my apartment nightly, blacking out every evening to escape feeling how unhappy and distressed I was in the graduate program.

I had been unhappy for a while. I realized early on I did not want to teach, which was primarily the only path for a musicologist, and musicology was far removed from the performance world that I had loved. I felt trapped in a lengthy PhD program. But everyone kept telling me to stick it out, it gets better, you’re doing so well. Not seeing a way out, I drank to cope.

Around this same time, my eating disorder shifted forms. During the first few years of my eating disorder, I primarily restricted and overexercised. When my drinking escalated, I shifted to more bulimic tendencies. The drinking and eating disorder played off each other. Eventually, it would morph into not eating throughout the day, then drinking, bingeing, and purging at night. I did that for years.

The way my disorders evolved is just one form they can take. Sometimes people restrict when they drink because they are concerned about the extra calories from drinking. This is dangerous because alcohol absorbs into the bloodstream at a faster rate on an empty stomach and can increase the risk of dehydration and electrolyte imbalances, causing damage to internal organs. Sometimes people binge drink and allow themselves to eat only on the weekends. However it plays out, eating disorders and drinking are often interrelated.

Off and on I would get the drinking “under control,” trying to be “good” and lose weight with the eating disorder. Sobriety was always about controlling my body. When my depression escalated around 2013, I self-medicated the depression with alcohol. Of course, the drinking only made the depression and suicidal thinking worse.

It is hard enough to recover from one disorder, let alone two. Treatment for both disorders simultaneously is so important. Failing to treat them at the same time increases the risk of relapse from both. 

Concurrent treatment for both disorders is just now starting to be more mainstream. When I went to treatment, I was lucky if there was a track for substance use. Of course, they put me in it, despite me being in complete denial there was a problem. Dual diagnosis centers were few and far between and completely out of pocket, which I could not afford.

I ended up in substance use treatment twice. The first time was not my choice, insurance told me I had to go because they thought the drinking was the primary problem. The fact they felt it was worse than my eating disorder tells you how bad it was. At the facility, my counselor helped me come to terms with the fact I had a problem. 

The second time, later that year, I wanted to stop drinking. But neither time did I stay sober long after treatment. That was my norm. Often when I discharged from eating disorder treatment, I would drink that same day, celebrating the fact I was now free.

What made the difference was finding the right depression medication. No longer needing to self-medicate, I was able to get sober about seven months later.

At first, I tried to moderate my drinking. Being just recently out of substance use treatment, I knew I couldn’t go back to how I used to drink. I would drink those little airplane bottles and think because I wasn’t drinking a whole bottle of alcohol, I was doing better. But of course, the number of airplane bottles I would allow just kept increasing. An alcoholic cannot moderate.

A few months into COVID, my job was thinking of going back to the office in person, which was arguably way too soon with how bad COVID was. But I knew I could not maintain that level of drinking and do the work that I needed to. So, I decided that my first day back in the office would be my first day sober. Of course, I drank up until that point, but I was sober that first day back and I have not drank since.

Up until that point, I was adamantly opposed to AA. I would go off and on over the years when my treatment team would make me attend a meeting. But I just never felt comfortable there. I even tried SMART Recovery and Recovery Dharma when I was desperate for a different approach to AA. The whole God thing was a major turn-off for me. I never went to church and I was not raised in any religion.

My substance use therapist told me of an agnostic group here in St. Louis. If I had to do AA, that felt doable. Plus, at the time, AA was strictly online, which made it easier to go. For some reason, I feared getting in my car and walking into a meeting.

That AA meeting got me sober. It became my home group. I met my sponsor there. I was lucky because my sponsor has been supportive of me with both disorders.

I realize I make it sound so easy. Decide not to drink and get sober. I can’t tell you the number of failed sobriety attempts I’ve had, the longing to do something different and not be able to was debilitating. The hopelessness at the possibility of recovery made me even more suicidal.

When I got sober, my eating disorder got a lot worse. I basically stopped eating. I was only treating one disorder at a time, so I struggled with my eating disorder. Sobriety felt hard and out of control and I needed something to hold on to. It was a classic example of symptom substitution, swapping the drinking for the eating disorder. But with a lot of time and hard work, and even going through a major eating disorder relapse along the way, I was able to heal the eating disorder too.

I will be four years sober in June. I have reached a point in my recovery where I no longer get thoughts or cravings to drink. I have zero desire to drink. I know if I started drinking again my whole life would fall apart. Drinking destroys everything. It’s not worth the risk.

I was doing some research on eating disorders and alcoholism and much of the literature tells you the dangers of having both disorders, but very few tell you how to cope.

What worked for me included connection, accountability, and doing the internal work. I went to AA – to a meeting that I connected with, I called my sponsor every night for a year, I worked the steps, I built new relationships with people in recovery who knew I was trying to stay sober, and the hardest one, I worked on recovering from my eating disorder.

I sought professional help. I saw a substance use therapist and an eating disorder specialist at the same time. When I got sober, I went into an intensive outpatient program (IOP) for my eating disorder, which got me back on my feet, for a time anyway. Outpatient treatment was ultimately the key for me, as I was highly motivated to recover, but I know many people who benefited from a higher level of care.

Recovery from both disorders is possible. If AA is not what you connect with, there are other secular programs out there. There are a lot of secular AA meetings, too, often accessible online. Addiction thrives in secrecy and isolation, so connection is key. 

When I got sober, I never expected to be sober long-term. I got sober in June and fully expected to be drinking by Christmas. No way could I make it through the holidays sober. But I took it literally one day at a time. I gave recovery time to stick and by the time Christmas came around, I did not want to drink. All you must do is stay sober today. Try it. And see how you feel tomorrow. You may surprise yourself.