The ABC’s of University:
Anorexia, Bulimia and Cocaine        
Morgan Faulkner - Fourth Year Journalism Student

Kneeling on a cold bathroom floor inside a residence building at Carleton University, a thin brown-haired 21-year-old girl sniffed a line of cocaine. She snorted five more in the next two hours. The girl thought she had overeaten earlier that day, in March of 2006. She needed a way to make up for the excess calories she consumed. And fast.  

So she snorted cocaine, just as she had done many times before when she wanted to lose weight. Lindsay, whose real name has been withheld, partied hard with some friends for about an hour. Then she felt her head pounding and her heart racing. Soon she started having seizures. The next thing Lindsay remembers is seeing two members of the school’s emergency response team at her bedside.  

“They kept asking me who was in the pictures by my bed and I remember my head hurt so much I didn’t know,” she says. “The next morning I discovered it was me they were asking about.” 

Then, paramedics loaded her into an ambulance on a stretcher. On her way to the Ottawa Civic Hospital, Lindsay asked the paramedics if she was going to die. No one responded.  

“I remember thinking well that’s it, I’m never going to be able to finish school now,” she says. “I screwed it up and people are going to know I died from drugs.” 

Lindsay is not the only person to use cocaine to lose weight. While an estimated 85,000 teens and young adults in Ontario struggle with an eating disorder, it is impossible to know how many of these individuals also abuse drugs because most cases are never reported. But some experts say incidents of these dual conditions are common.  

In the report “Food for Thought- Substance Abuse and Eating Disorders,” researchers at the United States’ National Center on Addiction and Substance Abuse found that almost half of people with eating disorders also abuse alcohol or drugs. Cocaine is the drug of choice for many of these individuals because it suppresses appetite. 

Angie Changez, a therapist who treats eating disorders and drug addiction, says the two conditions are ways of coping with stress. In both cases, there is almost always an underlying depression. It is also common to see low self esteem, anxiety, sexual or physical abuse, negative peer pressure and unhealthy relationships with parents. People struggling with either problem often experience intense cravings and mood swings, become secretive and develop obsessive or compulsive behaviour.

“Almost half of people with eating disorders also abuse alcohol or drugs. Cocaine is the drug of choice for many of these individuals because it suppresses appetite.”

Lindsay, now 23, has had an eating disorder since she was 16. For about two years, she was anorexic, meaning she limited her diet without ever eating high-calorie foods or binging. Finding it impossible to maintain this lifestyle, Lindsay then developed bulimic tendencies. She would sometimes overeat and find ways to quickly get rid of the calories she consumed. So Lindsay would fast, take laxatives, over-exercise and make herself throw up. At 5-foot-eight-inches tall, she has weighed between 96 and 135 pounds during the seven years she has struggled with an eating disorder.  

But any time Lindsay saw the numbers plummeting on the scale, she didn’t feel any better about herself. Even at her lowest weights Lindsay says she felt “fat and disgusting.”  
Changez says this is typical because Lindsay was still coping with the same issues that led her to starve herself.

Lindsay’s mother was diagnosed with a life-threatening disease and her parents were often fighting. She felt depressed if she didn’t do well in school because of the immense pressure her parents placed on her to get A-grades.  

To top it off, Lindsay was raped by a co-worker at the restaurant where she worked when she was 19. She contracted HPV as a result of her rape. This sexually transmitted infection can cause cervical cancer. 

After that, Lindsay’s depression sunk to an all-time low and her eating disorder took on a new form. Lindsay says she didn’t want to be attractive to men and she thought that paring down her curves would help her cause.  

“I felt like I needed to be really small so that I wouldn’t be seen,” she says, “so no one would be attracted to me in that way.” 

“I felt like I needed to be really small so that I wouldn’t be seen,”
she says, “so no one would be attracted to me in that way.”

Seven months after her rape, Lindsay was admitted into Homewood Mental Health Care Centre in Guelph where she took part in an eating disorder program. There, other girls with eating disorders taught her how to make herself puke. And, towards the end of her three-month stay, Lindsay met a girl with bulimia who had just completed an addiction program. Lindsay was immediately intrigued when the girl told her she used cocaine as an appetite suppressant to help her lose weight.  

Lindsay snorted cocaine for the first time a month after leaving Homewood. She spent $30-$60 a week on cocaine for about a year and a half after that.   

Matthew Holahan, Professor of Neuroscience at Carleton University says cocaine use stops the digestive system’s activity so a person doesn’t feel hungry while they are on the drug. That’s why cocaine is sometimes used to fuel an eating disorder.  

“When on cocaine, I would think about how much my weight’s going to go down the next morning,” Lindsay says.  

But the drug is highly addictive and can produce intense cravings. When you snort cocaine, Holahan explains, the drug enters your lungs and travels through the bloodstream towards your brain. It takes about five minutes to enter the brain, where it activates the pleasure-producing “dopamine system.” Dopamine is released and sticks to receptors. Holahan compares this to a lock and key system where dopamine acts as a key and the receptor as a lock. When the receptor is “unlocked” it causes pleasure. Then, the dopamine is recycled and stored until something reactivates the cycle. For example, food, alcohol and sex trigger a release of dopamine.  

People who suffer from depression often have fewer receptors or they don’t work well. When you take cocaine, the brain produces more dopamine and it bombards the receptors. The dopamine system becomes more effective and you feel pleasure and satisfaction.  
“I liked the feeling,” Lindsay says of her first time trying cocaine. “It makes you really talkative and happy and you feel like you can run a marathon.” 

However, cocaine sticks to the dopamine and doesn’t let it be recycled. The dopamine builds up and there is so much of it when a person comes off a high that the brain severely slows its production. Then, there ends up being less dopamine than the person had before taking cocaine and they become even more depressed.  

This is how a cocaine addiction starts. The more depressed a person gets, the more they become dependent on the drug to give them a high.  

Holahan says the digestive system starts working again once the cocaine wears off. Eating is a good way to boost dopamine levels once they’ve dropped after a high.  

 “Sometimes I would get really hungry and it would scare me,” Lindsay says of coming off a high. “I would usually be ok without cocaine for a few days, until I felt like I went overboard with a binge.” 

Finding effective treatment for an eating disorder and subsequent substance abuse is nearly impossible, as Lindsay found out when she started snorting cocaine.  

The night she took the drug in residence and was rushed to a hospital Lindsay told a doctor she sniffed cocaine to help her lose weight. 

“That’s not an eating disorder,” the doctor told her, “that’s a drug addiction.” He urged Lindsay to seek help for her cocaine abuse, which he said was the predominant issue Lindsay was facing.  

“This was a plea for help,” says Changez, the therapist, “and the doctor ignored it.”  

Changez had a private practice in Ottawa from 2000 to 2005. Since then, she has been running one out of Campbellford, a small town located midway between Ottawa and Toronto. She says some doctors are quick to diagnose problems like Lindsay’s without accepting that the issue may be deeper than they think.

Changez says few therapists or doctors are equipped to deal with eating disorders and subsequent substance abuse. Many ignore the links between these two conditions. Because of this, professionals are likely to target one problem or the other. But Changez says it’s more effective to treat the issues as a whole. Usually, the key to helping a patient solve their problem is in the first or second thing they tell their therapist.  

For example, Lindsay says it’s rare that she will start a therapy session by saying “I think I’m fat and need to lose weight.” Instead, she might say, “I’m so frustrated. I wish I could be normal.” 

Changez says this type of statement is “an in” to digging deeper and finding out why a person is eating disordered and taking drugs.

“The problems are layered and layered,” she says.
“An eating disorder is just one of the layers. Cocaine use is another.”

Changez says programs like the one Lindsay participated in at Homewood can be effective if the patients are committed to recovering. However, they often serve as breeding grounds to share tips on losing weight. 

It can also be difficult to be admitted into a program since cost and availability often act as barriers. During her first stay at Homewood, Lindsay was offered one of three OHIP beds for patients with eating disorders. Six months after her discharge, once Lindsay had started taking cocaine, her parents wanted to send her back. But they couldn’t afford the $35 000 for treatment and their insurance company would not cover it, claiming Lindsay’s case was not life threatening.  

So she put her name on a waiting list for the only bed at the health care centre that would be fully covered by OHIP. Cuts in public funding led to the removal of the two other OHIP beds. So, during the two years that Lindsay waited, she continued sniffing cocaine, barely eating, over-exercising and making herself throw up. 

Lindsay has faced similar barriers trying to find out-patient treatment. Changez charges $120 per therapy session. This is a typical cost for therapists in Ottawa. Lindsay, a Carleton University student who pays her tuition with a student loan, can’t afford treatment. Changez, however, has a sliding scale and will go as low as $50 per session if a patient can’t pay the full cost. Some insurance companies and work benefits will cover treatment. Others won’t.  
Even if a person does find a qualified professional to help them overcome an eating disorder and subsequent substance abuse, they’re not guaranteed to get better. Changez says a person’s attitude towards their recovery will make or break their progress. Often, patients are not fully committed to ditching their problems.
 
The first time Lindsay was treated at Homewood, she went largely because her parents wanted her to and not because she wanted to get better.
 
“When I left Homewood,” Lindsay says, “I thought, great, now I can start losing weight again.” 
Many therapists, including Changez won’t hesitate to give a patient the boot if they just aren’t getting better.  

“The problems are layered and layered,” she says. “An eating disorder is just one of the layers. Cocaine use is another.”

“You have to draw the line sometimes,” Changez says. “It’s like you want to shake a person up and say, what are you doing?” 

Lindsay was kicked out of an out-patient treatment program two months after her first stay at Homewood. She wasn’t following the program’s instructions and continued to lose weight while being treated. She was given one warning, didn’t change her habits and wasn’t allowed back.   
“I really want to get out of this and live a normal life,” Lindsay says, “but I get scared when I do start to get better and that’s when I slip back.” 

Instances of relapse are high. It is most likely to happen when a person is depressed and in an environment where they used to engage in harmful behaviours.  

Lindsay cut back her cocaine use when she started university in September 2005. When she went home for reading week at the end of February, her friends noted that she looked healthier than when she left for school.  

“Healthy to me is fat,” Lindsay says. And she quickly sought out cocaine and brought some back to Ottawa. For about a week, she took a little bit each time she felt she overate until the night she was rushed to hospital.  

Lindsay has been in and out of treatment for the past five years. Despite her efforts to get better, she says she still wants to be skinny and will go to great lengths in order to stay that way. This is a reality for many individuals with eating disorders who use drugs to lose weight.
Changez says it’s times like this that she needs to ask a patient how much their life is worth to them.