Recovery from addiction is rarely a straight line. Many people who stop drinking or using drugs find themselves months later with another struggle—one that often goes untreated because it doesn’t look like the problem they originally sought help for. They may compulsively eat, restrict their eating, or find that food has become a source of comfort and control in a way that is disturbingly familiar.
This phenomenon—sometimes called cross-addiction or addiction transfer—is more common than most people think, and the science behind it helps explain why.
The brain does not distinguish between compulsions
Substance use disorders and disordered eating show more than superficial similarities. Essentially, both involve the brain’s reward system—specifically, how dopamine signals pleasure, influences behavior, and adapts over time.
When someone repeatedly uses alcohol, opioids, or stimulants, the brain adapts. Dopamine receptors are less sensitive, meaning more substances are needed to feel the same effect. The brain essentially recalibrates around the compulsive behavior.
Foods—especially foods high in sugar, fat, or salt—activate the same reward pathways. Because someone whose brain has been rewired by drug usehighly palatable foods can fill a neurological void when the original substance is removed. The mechanism that controls behavior is largely the same; only the essence has changed.
That’s partly why binge eating disordercompulsive overeating and other disordered eating patterns appear at increased rates among people recovering from addiction. It’s not a matter of weak willpower or poor coping—it reflects real changes in brain chemistry that don’t simply reverse when substance use stops.
What the research shows
Studies of co-occurring disorders consistently show significant overlap between substance use disorders and eating disorders. Research suggests that people with bulimia nervosa and binge eating disorder are significantly more likely to develop alcohol or drug use disorders than the general population.
The relationship goes both ways. Eating disorders can precede substance use – some people use stimulants, for example to suppress appetite or to control weight. And substance use can prevent disordered eating, as the brain seeks alternative sources of reward once access to the original substance is removed.
Impulsivity is another thread that connects the two. Difficulty controlling impulses is a core feature of addiction and plays a significant role in binge eating and other compulsive eating patterns. This common feature points to overlapping neurological profiles rather than two completely distinct conditions.
Why is this often missed during treatment?
Traditional addiction treatment programs are built to treat substance abuse. Disordered eating, unless it rises to the level of clinical severity, can fly under the radar. Meanwhile, eating disorder treatment programs may not be suitable for treating co-occurring substance use.
The result is that many go through the treatment without anyone connecting the dots. A person can only achieve sobriety if they develop a severe binge eating disorder that is left untreated. Or someone in recovery from an eating disorder may relapse into substance use after the eating disorder has been treated in isolation.
That’s one reason why integrated treatment—the kind that assesses and addresses the whole picture—is important. For those dealing with compulsive behavior in multiple areas, inpatient and residential behavioral health treatment it can offer the structured environment needed to deal with the two simultaneously, rather than lining them up as if they were independent problems.
The role of medication in overlap
One of the more telling indicators that these diseases have common biological roots is how they respond to the same drugs.
Naltrexone, originally developed to treat opioid and alcohol addiction, works by blocking opioid receptors in the brain—effectively dulling the reward signal associated with drug use. Researchers and clinicians have since found that it can also reduce the reward for compulsive eating, especially binge eating behavior. The same mechanism that reduces the attraction to alcohol also appears to reduce the compulsive attraction to food.
Topiramate, an anticonvulsant also used to treat addictions, has been shown to be effective in reducing binge eating episodes. Metformin, a drug that has long been associated with metabolic health, is also increasingly being investigated in the context of weight-related compulsive behaviors.
The fact that drugs developed to treat addiction show promise in treating compulsive eating – and vice versa – is no accident. It reflects the extent to which these conditions operate through common neurobiological pathways. For people navigating bothtreatment of compulsive eating It represents a significant advance in how the field is beginning to treat the whole person.
The emotional undercurrent
Biology is only part of the story. Both drug use and disordered eating often reacts to something – trauma, anxiety, depression, chronic stress or deep discomfort with heavy emotions. Compulsive behavior, be it substance or food, becomes a way of dealing with internal states that otherwise seem unmanageable.
That is why treating the emotional and psychological dimension is just as important as treating the neurological dimension. Someone who stops drinking but hasn’t developed alternative tools to deal with emotional pain hasn’t solved the underlying drive—they’ve just removed an outlet. Another, whether food or something else, can take its place.
Effective treatment recognizes this dynamic and is based on supporting emotional regulation, not just behavioral change.
This is what a more integrated approach looks like
Increasing awareness of these connections is slowly changing the way behavioral health treatment is designed. The most comprehensive programs screen for both substance use and disordered eating right from the start, concurrent conditions are treated not one after the other, but together, and behavioral therapies are combined with medical and, where appropriate, pharmaceutical support.
For individuals, recognizing the relationship can be meaningful in itself. Understanding that reversing a compulsion isn’t a personal failure—it’s a reflection of the brain’s ongoing search for reward and relief—can reduce shame and open the door to more fully seeking help.
Recovery doesn’t have to deal with just one thing at a time. The more the field treats these as overlapping conditions with common roots, the better the outcomes for people navigating the two.
