Drinking on an empty stomach? You might have ‘drunkorexia’ and should question your relationship with alcohol. Here’s why

Substance abuse specialists and mental health advocates have been pushing to recognize different forms of alcoholism – and there’s one that, while common, is only beginning to get national attention: drunkorexia.

The colloquial term is used to describe the habit of engaging in diet-related behavior – such as restricted eating, excessive exercising, or bingeing and purging – prior to consuming alcohol. Unlike traditional alcoholism, the quantity of alcohol isn’t as significant, as it doesn’t take very much to get drunk on an empty stomach. Drunkorexia also seems to disproportionately affect women. 

A 2016 study presented by the Research Society on Alcoholism of 1,184 American college students found that 80 percent of them had engaged in drunkorexic behavior in the past three months. And a May 2020 study by the University of South Australia of 479 female Australian university students found that one in three of them had engaged in drunkorexic behavior in the past three months, and more than 28 percent were regularly skipping meals. Which begs the question: if this is such a common practice, why haven’t we heard about it? 

One of the issues is that we don’t really have an official clinical code for it yet. 

“‘Drunkorexia’ isn’t a clinical term; some people have proposed the term ‘alcoholemia’ or ‘food and alcohol disorder,’” Aaron Weiner, PhD, a licensed clinical psychologist and addiction treatment specialist, told me. “But it’s definitely a pattern that’s been noticed.” 

Another issue is that, because it’s a combination of an eating disorder and an alcohol abuse disorder, it can be very difficult to spot. A friend of mine who now identifies as drunkorexic said that, for years, she was convinced her drinking was manageable because it wasn’t egregiously excessive. 

“I’d have two or three glasses of wine per night, which isn’t healthy but isn’t what we’d consider indicative of a serious problem,” she said. “But when I didn’t eat, I’d often get blackouts, or go home with strangers and not remember what happened the next day, or have debilitating hangovers.” 

Another reason that drunkorexia can be difficult to spot is because the reasons for it aren’t quite as clear cut as simply wanting to get drunk, which means it can creep up on you. 

“There are several reasons someone might not eat while drinking, many of which can interact with one another,” Ned Presnall, an adjunct professor of Social Work at Washington University in St. Louis, and the owner/director of the outpatient counselling center Plan Your Recovery, told me. 

“The most obvious answer is that the person could be drinking with an eating disorder in which they are heavily restricting calories,” he said. “Another possible reason is to get a stronger effect from alcohol. Drinking on an empty stomach does inject the alcohol into the bloodstream more quickly. However, because their blood alcohol concentration rises so quickly, people who drink without eating are at higher risk for not only actions such as drunk driving, but also health complications like alcohol poisoning. People who engage in this behavior may not have a diagnosable eating disorder, but they can certainly suffer severe consequences.”

According to Presnall, a third consideration is that “it is common for people with alcoholism to lack an appetite,” which means that people who drink a lot might not eat because they feel full, which can lead them to become “extremely nutritionally deficient, even to the extent that they are at risk for certain brain diseases.” The risk increases if you’re also using Adderall or vaping (both very popular substances, especially with young people), which are also appetite suppressants. 

And a final consideration is that there is a “high comorbidity between eating disorders and addictive disorders, as both are a way to control emotions, and to create a type of escape.” Which means that someone with an eating disorder might use alcohol as a way of self-medicating the emotional pain of their body image issues and, conversely, someone with an alcohol abuse disorder might be restricting their calorie intake so they can get drunk without gaining weight. It all depends on the person. 

In my friend’s case, she wasn’t consciously trying to restrict her calorie intake, but she believes the subconscious motivation must have been there. 

“I never thought, ‘Oh, a bottle of wine is 600 calories, so I’m not going to eat dinner because that’s already a full meal,’” she said. “But I was bulimic in high school, and anorexic a lot throughout my 20s, and once you’ve developed that kind of unhealthy relationship with food, it never fully goes away.” 

Indeed, that’s one of the things that makes these issues so insidious: you think you’ve kicked your eating disorder to the curb because you no longer obsessively count calories, and don’t realize that it’s just shape-shifted into something else, like not eating while drinking. 

Another issue is that, anecdotally, I can say that drunkorexia seems to affect people that look like they don’t have any issues at all. My friend is a young, beautiful, wealthy, well-educated white woman. She’s as far from the sad-old-man-with-a-beer-in-a-paper-bag stereotype as you can get. 

“I used to watch Real Housewives of New York City and think it was funny that these rich white ladies were just cleaning out the open bar while turning down all the canapes,” another friend of mine recently said. “But now I look at that and think: this is alcoholism.” 

Alcoholism is a spectrum, which is why mental health experts today recommend questioning your relationship with alcohol rather than labeling yourself as an ‘alcoholic’ or not. 

“The problem isn’t the substance itself,” Weiner said. “The problem is doing something to your body that you know will hurt you. It’s a self-respect issue.” 

If you think you might have any symptoms of drunkorexia, first of all, don’t feel bad about it, because it’s far more common than you might think. Secondly, don’t be afraid to seek help. 

“If you have a doctor or a therapist, talk to them about it,” Weiner said. “Whether you have an addiction or an eating disorder, it’s a very difficult problem to solve on your own.” 

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