Weight Dissatisfaction and Drug Use

Do you have any friends who use drugs in an effort to lose weight?

A relatively large body of research suggests that women who struggle with body image and eating issues are likely to abuse substances (Bahji et al., 2019; Robinson, Walter, Deane, & Larance, 2023). For example, in a recent retrospective chart review of 182 women in treatment for an eating disorder, MacNeil and colleagues (2025) found that 34.6 percent reported using substances, with alcohol and over-the-counter (OTC) medications being most common. Similarly, a meta-analysis of substance use disorders in individuals with eating disorders found that 21.9 percent struggled with both during their lifetime (Bahji et al., 2019).

Why do eating disorders and substance use co-occur so often, especially in women? One of the main reasons is that many women are highly dissatisfied with their appearance and will engage in extreme behaviors to lose weight.

A Culture Obsessed With Thinness

In the United States and many Western cultures, thinness, fitness, and youth are prized physical attributes, especially for women. As such, many women feel tremendous pressure to maintain a thin and youthful appearance, because the cultural message is this: If you look beautiful, you will be successful, happy, healthy, and popular (Ata et al., 2015). Conversely, if you are overweight or “unattractive,” you are personally responsible and often described using a slew of negative attributes ranging from smelly and unstylish to lacking in moral integrity, socially inept, and intellectually slow compared to thinner people (Puhl & Heuer, 2010).

The strong cultural emphasis on looking young and thin is one reason that unhealthy dieting is rampant. Common dieting practices in the United States include the use of rigid meal plans, supplements, caloric restriction, skipping meals, fasting, “clean” eating, and cleansing (Vrany et al., 2018). Yet, for many, it also includes the use of legal and illegal drugs aimed at losing weight—everything from energy drinks to extreme caffeine use to misuse of prescription and OTC medications (such as enemas, laxatives, and pain medication) or stimulants (like cocaine).

Weight Loss and Drug Use

Although dieting can be done in a healthy way for those who would like and are medically advised to lose weight, dieting efforts in the United States are often extreme and dangerous. Overly restrictive dieting is associated with increased levels of anxiety, depression, and irritability (Vrany et al., 2018). In addition, many women are dissatisfied with their appearance and want to lose weight even when they are currently at a “healthy” body size.

The truth is that research suggests a large number of women report using drugs because of a desire to lose weight (Robinson et al., 2023). For example, in a sample of 297 women in substance use treatment, my colleagues and I (2013) found that 33 percent of the sample reported they started using drugs (at least in part) to lose weight. In addition, 45 percent were concerned that gaining weight could cause drug-related relapse after treatment, and 71 percent were concerned about weight gain during treatment.

The Naked Truth Is This:

Research increasingly highlights the link between weight dissatisfaction, disordered eating behavior, and drug use. For anyone struggling with body image and substance use, the National Eating Disorder Association website has a host of helpful tools and information on treatment options. For women who use substances because of a desire to lose weight, successful treatment must address body image disturbance and drug use simultaneously for sustained health.

Copyright Cortney S. Warren, Ph.D., ABPP

Note: This content is only for informational and educational purposes and should not be considered therapy or any form of treatment. I cannot respond to personal requests for advice over the internet. Best on your continued journey.

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