When Drinking and Eating Disorders Collide: Review Reveals Hidden Overlap in Alcohol Treatment

People receiving treatment for alcohol use disorder may be fighting a second, largely invisible battle: a disordered relationship with food. A new scoping review published in the Journal of Eating Disorders has pulled together the evidence on how often these two problems co-occur in clinical populations, why they so frequently travel together, and what their entanglement means for recovery. The findings suggest that alcohol treatment services may be overlooking a significant driver of relapse and dropout, and that the psychological roots of binge eating and problem drinking run far deeper than either diagnosis alone captures.

The review, led by Anna Preece and colleagues at Bournemouth University with collaborators at the University of Southampton, the University of Exeter and a primary care practice in Poole, systematically searched five major research databases: EBSCO, PubMed, Scopus, Cochrane and Web of Science. Two reviewers independently screened the results, resolving disagreements through discussion, and the team included all published, peer-reviewed studies that examined clinical populations with alcohol use disorder, regardless of study design or country of origin. That broad net captured forty-four studies, spanning observational research and intervention trials, from which four key themes emerged: the prevalence of eating disorder symptomology, the psychological mechanisms underpinning both conditions, treatment engagement and outcomes, and differences across cultural, ethnic and gender lines.

The headline finding is one of sheer frequency. Disordered eating symptomology proved highly prevalent among people in alcohol treatment services, with bulimia nervosa the most frequently reported diagnosis. This is a striking pattern because much of the existing literature on eating and drinking comorbidity has focused on college students or on populations recruited from eating disorder clinics, groups whose experiences differ substantially from those of people actively receiving treatment for alcohol dependence. By concentrating specifically on clinical AUD populations, the review fills a gap that has left clinicians without a clear picture of who in their caseloads may also be struggling with binge eating, restrictive eating or compensatory behaviours.

Why should these two conditions be so intertwined? The review points to a set of shared psychological mechanisms that function as common engines for both behaviours. High levels of negative urgency, the tendency to act impulsively when experiencing intense negative emotions, were identified across studies, alongside emotional dysregulation and low self-esteem. In practical terms, this means that for many individuals, alcohol and food serve parallel functions: both can become tools for numbing, soothing or escaping difficult feelings. A person who drinks to blunt distress may also binge eat for the same reason, or swing between restriction and binging as another way of exerting control or coping with shame. The behaviours look different on the surface, but they may be two expressions of the same underlying vulnerability.

The consequences of this comorbidity are not merely additive; they compound. The review found that individuals with comorbid eating disorders were more likely to leave treatment services early or against medical advice, and that the presence of disordered eating was associated with increases in illness severity, mortality risk and recovery time. Demographic patterns also emerged: people with comorbid eating disorders were more likely to be Caucasian and less likely to be employed, findings that may reflect both differential risk and differential access to care. For treatment services, the message is sobering. A patient who abandons an alcohol programme prematurely may not simply be resisting abstinence; they may be struggling with an unrecognised eating problem that no one has asked about.

That last point leads to one of the review’s most provocative clinical implications: the possibility that abstinence-focused treatment models may inadvertently reinforce restrictive eating. Alcohol treatment is, by design, built around stopping a behaviour entirely. But if food is serving a similar emotional function for a patient, a treatment culture that frames all coping-through-substance as failure could push individuals toward restricting food instead, simply swapping one form of dysregulated consumption for another. The authors argue that this underscores the need for research into holistic, integrated approaches that address the shared mechanisms rather than treating each behaviour as an isolated target. A transdiagnostic model of diagnosis and intervention, one that cuts across diagnostic categories to target emotional dysregulation, impulsivity and self-esteem directly, may offer a more coherent framework than parallel but separate treatment pathways.

The review also raises a significant equity concern regarding gender. Although the evidence showed that disordered eating symptomology and its functional role were broadly similar in men and women, most research to date has focused on women, and gender-specific screening tools remain underdeveloped. Given that men make up the majority of people in alcohol treatment services in many countries, this gap means that men’s disordered eating may be going systematically unrecognised. A man in an alcohol programme who binges or restricts may never be asked about his relationship with food, because both the screening instruments and the research base were built primarily around female presentations of eating disorders. The authors call for research that recruits men and women equitably, so that the evidence base reflects the actual population of people seeking help.

Methodologically, the review is candid about the limitations of what it synthesised. The forty-four included studies varied widely in design, measurement instruments and populations, as reflected in the long list of questionnaires catalogued in the paper, from the Eating Disorder Examination Questionnaire and the Binge Eating Scale to the Difficulties in Emotion Regulation Scale and the Barratt Impulsiveness Scale. This heterogeneity makes it difficult to pool findings or draw precise prevalence estimates, and the field relies heavily on cross-sectional data that cannot establish whether disordered eating precedes alcohol problems, follows them, or emerges from the same vulnerabilities. The authors are explicit that there is a clear research need for adequately powered, longitudinal studies that follow people over time and include both men and women, which would allow researchers to untangle the direction of the relationship and identify when intervention would be most effective.

For clinicians working in alcohol services, the practical recommendation is comparatively simple: consider routinely asking about eating behaviours. Screening for disordered eating at intake, and monitoring it throughout treatment, could identify patients at elevated risk of dropout and relapse before those risks materialise. Because the two conditions share psychological underpinnings, interventions that build emotion regulation skills, address impulsivity and support self-esteem could plausibly benefit both problems simultaneously, though the review stops short of claiming that existing integrated treatments have been proven effective, since that evidence does not yet exist at scale. What the review does establish is that the status quo, in which eating behaviours go unassessed in AUD clinical settings, leaves a measurable and consequential blind spot.

The broader significance of this work lies in how it reframes addiction and eating disorders not as separate silos of psychiatry but as neighbouring expressions of shared vulnerability. As research on transdiagnostic mechanisms matures, the boundaries between diagnostic categories may become less clinically meaningful than the underlying processes that generate them. For the millions of people worldwide receiving treatment for alcohol use disorder, the review’s message is that recovery may depend on asking a question that services have rarely thought to ask: not just how much are you drinking, but how are you eating, and why?

Subject of Research: Comorbidity of disordered eating behaviour and alcohol use disorder in clinical populations

Article Title: Understanding the comorbidity of disordered eating behaviour and alcohol use disorder: a scoping review

Article References: Preece, A., Casey, C., Foote, G., Greville-Harris, M., McDermott, L., Murphy, J., & Sinclair, J. M. A. (2026). Understanding the comorbidity of disordered eating behaviour and alcohol use disorder: a scoping review. Journal of Eating Disorders. https://doi.org/10.1186/s40337-026-01788-3

Image Credits: AI Generated

DOI: 10.1186/s40337-026-01788-3

Keywords: alcohol use disorder, disordered eating, comorbidity, binge eating, bulimia nervosa, emotional dysregulation, impulsivity, scoping review, treatment dropout, transdiagnostic model, gender differences, screening