The relationship between eating pathology and substance use is well established, with up to 50% of people with eating disorders using alcohol or drugs and up to 35% of those dependent on substances having eating disorders. The co-occurrence of these issues makes it difficult to determine which is the primary problem, and subclinical eating pathology often emerges during recovery. Treating substance use, eating pathology, and body image issues simultaneously is often necessary. Recovery can disrupt internal hunger cues, leading to increased appetite, overeating, and weight gain due to biochemical changes.