Drunkorexia: Where Eating Disorder Meets Substance Use

What is Drunkorexia? 

Drunkorexia is a non-medical term and is not a DSM-V Diagnosis. Drunkorexia refers to either the restriction of calorie intake before drinking alcohol or binge eating behaviors after drinking due to lack of inhibition and associated starvation and compensatory behaviors, such as vomiting or over-exercising the next day, to get rid of calories from alcohol or food consumption.  

Eating Disorders and Comorbid Substance Use Disorder 

Substance use disorders (SUDs) are highly prevalent, with approximately 14.5 percent of individuals age 12 or over had a diagnosable SUD in the past year, including about 10.2 percent with an alcohol use disorder and 6.6 percent with an illicit drug use disorder. Illicit drug use and nonmedical use of medications alone or in combination with alcohol are associated with a substantial proportion of emergency department visits in the United States. The United States Centers for Disease Control and Prevention's National Center for Health Statistics estimated that there were 105,752 overdose deaths in the 12-month period ending October 2021.  

The essential feature of a substance use disorder is a cluster of cognitive, behavioral and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems. An important characteristic of SUD’s is an underlying change in brain circuits that may persist beyond detoxification, particularly in individuals with severe disorders. The behavioral effects of these brain changes may be exhibited in the repeated relapses and intense drug craving when the individuals are exposed to drug-related stimuli. The diagnosis of a substance use disorder is based on a pathological pattern of behaviors related to use of the substance.  

On the surface it can seem as though eating disorders and substance use disorders are completely different. But underneath the surface, they can develop for similar reasons. Both eating disorders and substance use disorders can develop as a result of trying to escape pain, anxiety, depression or stress. Because of this, we see a high comorbidity between substance use disorders and eating disorders. Both also share a significant amount of common risk factors, including brain chemistry, family history, low self-esteem, depression, anxiety and social pressures.  

Eating disorders and substance use disorders are so closely linked that nearly 50% of people with an eating disorder are also abusing drugs and/or alcohol and up to 35% of individuals who were dependent on alcohol or other drugs have also had eating disorders. The highest prevalence of substance use disorder occurs in those with bulimia nervosa (27%), followed by those with anorexia nervosa (27%) and those with binge eating disorder (23%). 

Outside of alcohol, substances frequently abused by individuals with eating disorders or with sub-clinical symptoms include caffeine, tobacco, laxatives, emetics, diuretics, amphetamines, heroin and cocaine. SUDs have an additive effect on excess mortality in patients with eating disorders, therefore the prevention and treatment of SUDs in this patient group is of the utmost importance to reduce mortality. 

Blacking Out with Drunkorexia 

Drinking on an empty stomach will cause an individual to get drunk faster, leading to a quick spike in blood alcohol content in a short amount of time. This can pose great risk and cause an individual to go from feeling fine to blacking out quickly. Blacking out refers to the temporary loss of memory due to excessive alcohol consumption.  

During a blackout, an intoxicated person can still function normally, but due to lowered inhibitions may participate in behaviors they might not have otherwise. Many people who black out later learn that they participated in risky behaviors, including drugs use, driving, dangerous stunts and vandalizing property.  

Alcohol can also affect autonomic responses, including the gag reflect. A person who’s blacked out is at risk for vomiting while sleeping, and due to loss of reflex control may choke or suffocate on their vomit. Loss of coordination is also common, making it likely for an intoxicated person to fall or injure themselves, which can be particularly dangerous for individuals with eating disorders suffering from low bone mineral density. 

Chronic alcohol consumption can cause neurological complications including cognitive dysfunction, ventricular enlargement, Wernicke encephalopathy, Korsakoff syndrome, Alcoholic cerebellar degeneration, Marchiafava-Bignami disease (a rare condition particularly in malnourished alcoholics) and neuromuscular complications including peripheral neuropathy and myopathy.  

Dehydration and Malnutrition 

Excessive alcohol consumption can cause dehydration. Alcohol is a diuretic (substance that increases production of urine), causing your body to remove fluids from your blood through your renal system at a much quicker rate than other liquids. If not enough water is being drunk alongside alcohol, you can become dehydrated quickly. Dehydration can exacerbate existing complications of an eating disorder and malnutrition: 

• Tiredness 

• Headache or confusion 

• Dizziness, weakness or light-headedness 

• Hypotension 

• Constipation 

How Much Alcohol is Too Much? 

According to the National Institute on Alcohol Abuse and Alcoholism, alcohol consumption is divided into three levels: 

• Moderate Drinking: limiting alcohol intake to two drinks or less in a day for men or one drink or less in a day for women.  

• Binge Drinking: a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08% or higher. For a typical adult, this pattern corresponds to consuming 5 or more drinks (men), or 4 or more drinks (women), in about 2 hours. 

• Heavy Drinking: drinking more than four drinks on any or more than fourteen drinks per week (men) or drinking more than three drinks on any day or more than seven drinks per week (women) 

Treating Eating Disorders and Alcoholism 

As a patient begins to address behaviors related to their eating disorder, alcohol addiction problems can increase since they may be trying to “replace” their eating disorder with another maladaptive coping mechanism or reduce the stress associated with recovery, treatment and life change.  

If a patient is experiencing severe complications because of their eating disorder, it is imperative to refer the individual to a specialized medical stabilization unit for eating disorders that can also address alcohol withdrawal symptoms. In this case, medical stabilization is the first step in recovery before a patient can be transferred to a lower level of care where they can continue both their eating disorder and substance use recovery.  

The management of alcohol withdrawal is directed at alleviating symptoms and identifying and correcting metabolic derangements. Benzodiazepines are used to control psychomotor agitation and prevent progression to more severe withdrawal. Supportive care, including intravenous fluids, nutritional supplementation, and frequent clinical reassessment including vital signs, is important.  

Get Help for a Severe Eating Disorders

If you or someone you care about is experiencing severe medical complications due to an eating disorder, ACUTE can help. Reach out to us today to learn more about medical intervention for severe and extreme eating disorders with our experts at ACUTE. With proper care provided by experienced experts, we can help you restore your weight, regain your health and assist with substance detox. 

References

• Charness, M. E. (2018). Overview of the chronic neurologic complications of alcohol. UpToDate. 

• Hoffman, R. S. & Weinhouse, G. L. (2021). Management of moderate and severe alcohol withdrawal syndromes. UpToDate. 

• Mellentin, A. I., Mejldal, A., Guala, M. M., Støving, R. K., Eriksen, L. S., Stenager, E., & Skøt, L. (2022). The Impact of Alcohol and Other Substance Use Disorders on Mortality in Patients With Eating Disorders: A Nationwide Register-Based Retrospective Cohort Study. American Journal of Psychiatry, 179(1), 46–57. 

• Blacking Out: The Dangers and Causes. Alcohol Rehab Guide. 

• Dehydration: Causes & Symptoms. Cleveland Clinic.  

• National Institute on Alcohol Abuse and Alcoholism. Drinking Levels Defined.  

• Position Statement 33: Substance Use Disorders. (2017, December). Mental Health America. 

• Substance Use and Co-Occurring Mental Disorders. National Institute of Mental Health (NIMH).