At the age of 13, Sonia got her first prescription for diet pills, having been scared into a doctor's office by the onset of puberty.

At 26, after the birth of her first child, she was starving herself to drop the baby weight, and using Valium to control her escalating social anxiety.

By 49, the age at which her husband walked out on her, Sonia was full-blown anorexic — eating little more than a bran muffin and coffee each day — addicted to benzodiazepines, having thoughts of suicide and drinking heavily to numb her emotional pain.

Given the guiding quest for perfection, it's a paradoxically ugly picture. But, according to medical experts, it's one that's far more common than most Canadians would think.

Bellwood Health Services in Toronto reports that substance abuse is listed as a concurrent problem for fully 52 per cent of the 225 patients they've admitted for eating disorders. At 64 per cent, alcohol is the most commonly abused substance by patients with an eating disorder, followed by cocaine at 37 per cent, marijuana at 28 per cent and prescription drugs at 27 per cent.

"Twenty years ago, it was a bit of a 'two solitudes' situation," says Susan McGrail, clinical director at the Ontario facility. "The mental health system would tell you, 'Fix your eating disorder and then we'll help you,' while the eating disorder folks would say, 'Get your substance abuse in order and then we'll treat you.' And back and forth it went."

Sonia, whose name has been changed to protect her family, didn't even realize there was help out there until the age of 50 — fully four decades into her debilitating battle, and years after having "spiralled out of control" on starvation diets, pill-popping and binge drinking.

"I was very, very sick . . . and continually looking for something to help take the pain away," she recalls. "I had to be the perfect wife, the perfect mother, the perfect employee."

Talia Witkowski, a clinical psychologist based in Los Angeles, says compulsive spending, drinking, and marijuana addiction were all part of her own disordered-eating journey, which began with stealing diet wafers from her mother as a young girl.

"The eating disorder is usually the first addiction," says Witkowski, who now works as the director of marketing and outreach for Heal Your Hunger, the program that led to her recovery four years ago.

"Food acts as a gateway drug. It's the only substance available to a child."

In 2007, the journal Biological Psychiatry published a U.S. study of more than 2,900 people that found roughly 37 per cent of bulimics, 27 per cent of anorexics and 23 per cent of binge-eaters suffered from a substance-abuse problem of some kind. Eating disorders were positively linked to almost every recognized mood, anxiety and impulse-control disorder.

Another study, published in 2009 in the International Journal of Eating Disorders, similarly found binge-drinking among college-aged women was positively correlated with dietary restraint and coping using substances.

Simone Arbour, a research co-ordinator at Bellwood — one of a small but growing number of treatment centres with a dual focus on eating disorders and addiction — explains that anorexia and bulimia have been shown to activate the same reward centres in the brain as drugs and alcohol: "Almost like the person feels a high when they step on the scale and see that they've gone down two pounds," she says.

Catherine Cook-Cottone, a noted expert on eating disorders, observes that there are also higher rates of alcoholism in families of people with anorexia or bulimia, suggesting "similar traits and vulnerabilities" within households.

"We start to regulate around these simple, addictive things," says Cook-Cottone, an associate professor at the University at Buffalo. "While substance abuse and eating disorders complicate your life overall, in a strange way they can also seem to simplify your psychological life."

Instead of stressing over work, relationships and family, everything is distilled to a desired pant-size, or the chasing of a high: 'If I was just 10 pounds thinner, I'd be happy,' or 'If I could just smoke this joint, I'd be happy.'

"We're a culture of escape, avoidance, distraction," says Cook-Cottone. "But sensitivity . . . isn't something that's broken that people need to drink away, or fast away, or binge away; it's something they need to be 'in.'"

It's a message Sonia, who recently switched careers to become an addictions counsellor, has affirmed every day for the past eight years.

"It's never too late," says the Ontario woman, now fully recovered. "At 50, I learned that I'm not flawed, that I'm a good person, and that only I can take charge of my life."

mharris@postmedia.com

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Eating Disorders

- The lifetime prevalence of anorexia (obsessed with controlling eating, often through starvation) is 0.9 per cent in women and 0.3 per cent in men. For bulimia (characterized by cycles of bingeing and purging), the rate climbs to 1.5 per cent in women and 0.5 per cent in men. With binge-eating disorder (eating excessive amounts of food at one time), lifetime prevalence is 3.5 per cent in women and 2.0 per cent in men.

- Warning signs for anorexia include dieting obsessively when not overweight, making excuses for not eating, continuous denial of hunger, excessive exercise, and such physical symptoms as extreme weight-loss, hair loss, and loss of menstrual period.

- Warning signs for bulimia include excessive concern about weight, using the washroom after meals, avoiding socializing when food is involved, and such physical symptoms as unexplained cavities, sore throat, appearance of swollen glands and abrasions on the back of the hand.

- Warning signs for binge-eating disorder include eating quickly and in secret, and eating until uncomfortably full. About one in five obese people engage in binge eating.

- Celebrities who have publicly acknowledged an eating disorder at some point include Portia de Rossi, Mary-Kate Olsen, Christina Ricci, Billy Bob Thornton, Paula Abdul, Kelly Clarkson, Jessica Alba, Dennis Quaid, Princess Diana, and Elton John.

Sources: Nedic.ca, Bellwood Health Services