It is estimated that approximately 30-50% of bulimics also abuse alcohol or drugs. The number is much lower among anorexics. Some individuals developed an eating disorder after they became sober. They substituted one for the other. Individuals will go to great lengths to keep these problems hidden from people. They are very secretive about their behaviors, usually because they are very ashamed and feel guilty.

Alcohol and drugs are abused for much of the same reasons as food. Individuals use these substances to try and block out feelings and emotions. They abuse substances to numb themselves because they never learned how to cope with life's problems in a healthy way. Many bulimics are left with feelings of guilt and shame about their eating disorder behaviors, and some will turn to alcohol or drugs to help relieve these feelings. They try to self-medicate by abusing substances.

It is possible to become totally abstinent from alcohol and drugs, but it is not possible to abstain from food. The individuals will need a great deal of support when dealing with these problems together. Treatment may be started within a drug and alcohol rehabilitation center, but if the person's eating disorder is considered life threatening, then treatment should begin in an eating disorder program. If there is treatment program near you that treats both problems together, it would be best to go there for treatment. It is usually best to try and treat these problems simultaneously. It is usually beneficial for these individuals to attend a 12 step program and still continue with regular therapy. It's important that the individual deal with the underlying issues causing the behaviors, so that they can work to overcome them. Then they can begin to learn new ways of coping with difficult emotions and daily life problems.

Both eating disorders and substance abuse have high relapse rates and the individuals should be educated on how to avoid a relapse. They must also be assured that if they do relapse, that they don't have to hide it and they can ask for help. Most feel very guilty and ashamed after a relapse and try to keep it a secret, which usually leads to the continued abuse of the substance or a reoccurrence of the eating disorder.

Most individuals benefit more when they have a strong support system which should include family, friends, therapy, physicians and support groups such as AA, NA and OA.