At least half of everyone with eating disorders abuses alcohol or illicit drugs, five times more than people without eating disorders. Conversely, more than a third (35 percent) with substance use disorders (SUDs) meet criteria for an eating disorder (ED). The psychiatric manual, the DSM-5, recognizes anorexia nervosa (AN) with two subtypes—restricting or binge-eating/purging type. Another acknowledged ED is bulimia nervosa (BN), and a third is binge-eating disorder (BED).

In my 1992 paper, we analyzed research on concurrent eating disorders and drug use disorders. Patients with bulimia and binge eating had major risks for substance use disorders (SUDs). It is now known that some people with EDs have high risks for abusing cocaine/amphetamines, especially those with AN engaging in binge-purge cycles to suppress appetite or regulate weight.

Individuals with EDs may begin using substances before, during, or after the onset of eating disorders. According to the National Eating Disorders Association (NEDA), the largest nonprofit for individuals and families affected by eating disorders, premature deaths are substantially higher in those with an eating disorder and an SUD. Yet this group often goes undertreated, and there are only a few treatment settings equipped to address both conditions. Access to clinicians with expertise in both domains remains limited.

A new study by Sarah-Catherine Rodan et al. of thousands of people self-reporting eating disorders found 40 percent reported anorexia nervosa, 19 percent bulimia nervosa, and 11 percent binge-eating disorder (BED). Nearly two-thirds (65 percent) reported depression, 55 percent anxiety, 15 percent drug-related SUD, and 9 percent alcohol use disorder. Cannabis and psychedelics emerged as the most frequently used nonprescription substances perceived as helpful by users—particularly for anxiety, dysphoria, and obsessive food-related thoughts.

Among prescription medications, selective serotonin reuptake........

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