“Drunkorexia” or alcohol anorexia is a colloquial term that is a mash-up of alcohol abuse and anorexia nervosa (AN) and refers to the restriction of eating to either speed up the uptake of alcohol or to offset the high caloric value of most alcoholic beverages. It is estimated that up to 80% of young drinkers engage in disordered eating behaviors prior to drinking alcohol, with college-aged women being 1.5 times more likely to restrict their food intake. The term is most often used within the context of college campuses, but can apply to many people across the lifespan.  

“Drunkorexia” is not an eating disorder or medical diagnosis, but should still be taken very seriously as it still has harmful side effects. While “drunkorexia” may not fully meet the diagnostic criteria for anorexia or alcohol use disorder, disordered eating behaviors and bingeing on alcohol is not healthy and can increase the risk of developing these disorders.  Should those behaviors develop into an eating disorder or substance use disorder, both can be life-threatening and require specialized treatment. 

Causes of “Drunkorexia” 

Studies indicate that “drunkorexia” is most often associated with a fear of gaining weight from the high caloric value of alcohol. There is a significant relationship between college binge drinking behaviors and negative body image beliefs. Increased alcohol consumption has also been linked to decreased caloric intake and feeling less hunger. Alcohol deprivation was also linked to increased food consumption in those who had become accustomed to regular drinking. 

What is Binge Drinking? 

A “standard drink” or single drink in the US contains 14 grams of ethanol. Different alcoholic beverages have different alcohol content, often shown on the container as a percentage. On average, a “standard drink” could be: 

• 12 ounces (about 355 ml) of regular beer at 5% alcohol 
• 5 ounces (about 148 ml) of wine at 12% alcohol 
• 1.5 ounces (about 44 ml) of distilled spirits at 40% alcohol 

Although the CDC recommends abstaining from alcohol, especially if you currently don’t drink, they also have guidelines outlining moderate drinking, binge drinking and heavy drinking for those of legal drinking age.  

Moderate drinking: 

• 1 or fewer standard drinks for women 
• 2 or fewer standard drinks for men 

Binge drinking: 

• 4 or more standard drinks for women within 24 hours 
• 5 or more drinks for men within 24 hours 

Heavy drinking: 

• 8 or more drinks per week for women 
• 15 or more drinks per week for men 

The CDC stresses that certain people should never drink any alcohol, such as: 

• Pregnant individuals 
• Those under 21 
• People who have medical conditions or take medication that interacts poorly with alcohol 
• People who are in recovery for alcohol use disorder or anyone who cannot limit how much they drink 

Side Effects Associated with “Drunkorexia” 

There can be serious health risks associated with drinking alcohol while restricting caloric intake, including: 

• Overconsumption of alcohol 
• Malnutrition (including not having enough of the nutrients required to metabolize alcohol) 
• Gastrointestinal problems (due to restrictive eating and the increased bacterial growth in the intestines due to alcohol consumption) 
• Impaired judgement 
• Impaired balance and vision 
• Weakness, fainting and black-outs 
• Increased blood pressure 
• Damage to internal organs 
• Increased risk of certain cancers 
• Increased strain on the pancreas and more risk of contracting pancreatitis (due to restrictive eating and the high sugar content of alcoholic beverages) 
• Decreased immune function 
• Increased risk of developing an eating disorder or substance use disorder 

Signs and Symptoms of Anorexia and Alcohol Use Disorder 

The risk of developing an eating disorder (such as anorexia nervosa), substance use disorder or a dual diagnosis of both disorders is a serious possible consequence of “drunkorexia”. If you or a loved one shows any of these signs, seek medical advice from a trained medical professional or a treatment center, such as Koru Spring. The earlier these disorders are diagnosed and treated, the better the prognosis of sustained recovery. 

Anorexia is most often characterized by: 

• Low body mass
• Persistent restricted food intake 
• Distorted body image 
• An intense fear of gaining weight 

It can be further broken down into anorexia nervosa restrictive type (AN-R) and anorexia nervosa bingeing/purging type (AN-BP). This is determined by whether the person has engaged in binge-eating or purging in the last 3 months (bingeing/purging type) or not (restrictive type).  

A person with anorexia may misuse substances associated with appetite suppression or increased metabolism with the initial intention of changing body weight or shape. One study found that there was a significant relationship between college binge drinking behaviors and negative body image beliefs.  

The risk is that the substance use may graduate from a maladaptive behavior that is associated with the eating disorder to becoming an addiction. This may lead to physical and psychological dependence on the substance, independent from the ED, and the development of a substance use disorder (SUD). 

Substance use disorders are characterized by: 

• Inability to control the use of the substance 
• Social impairments (such as isolating themselves or poor work or school performance) 
• Using substances in risky environments or situations 
• Continued use of the substance despite negative consequences 
• Tolerance and withdrawal 

Anxiety and “Drunkorexia” 

Substance addiction and eating disorders often co-occur with other mental health disorders. Common co-occurring disorders include mood disorders, post-traumatic stress disorder, obsessive-compulsive disorder, and anxiety disorders. Anxiety can play an important role in increasing the risks of “drunkorexia” developing into alcohol use disorder and/or anorexia. Researchers believe that alcohol (and drug) use could mask symptoms of anxiety and might be abused as an unhealthy coping mechanism. The reinforcing effects of alcohol (or other drugs) can be enhanced by food restriction and can result in severe short- and long-term consequences, including the development of eating disorders and substance use disorders.  

How to Avoid “Drunkorexia” 

Although “drunkorexia” is not limited to college students, it seems that much of the motivation for restricting calories during episodes of binge drinking is peer pressure and the social perceptions of body shape and size. Alcohol anorexia is harmful and can have serious consequences. It is important to be mindful of your food and drink intake and: 

• Drink in moderation 
• Do not restrict calories or change your eating habits when drinking 
• Ensure that your body has access to the right nutrients to help it to metabolize alcohol  
• Ensure that you have a balanced diet that includes proteins, carbohydrates, fats and other minerals and nutrients 
• Seek help if you or a loved one shows any signs of dependence on alcohol or an eating disorder