Alcohol - Typically individuals with anorexia don't consume alcohol, due to its high calorie content. However, for people with bulimia and a sub-group of those with anorexia who also binge and purge, alcohol is frequently consumed, then eliminated through vomiting. Caffeine - It's consumed in the form of black coffee or diet drinks to fill the stomach and it staves off hunger. Caffeine also serves as a diuretic, and people with eating disorders confuse temporary fluid loss with actual weight loss. In addition, those with bulimia in general use liquids because self-induced vomiting is easier when the stomach is full of fluid. Amphetamines and Cocaine - These substances are used because they suppress appetite and provide energy in the absence of adequate food intake. Nicotine - Nicotine is an appetite suppressant that can increase metabolism in females as much as 10 percent. It's not uncommon for girls with eating disorders to take up smoking to control appetite in an effort to lose unwanted pounds. Laxatives, Diuretics and Over-the-counter Diet Pills - Like so many over-the-counter medications, these drugs are intended to address a specific medical need during a limited time frame. Although laxatives and diuretics are not often considered drugs of abuse or dependence, individuals can become dependent on them. With prolonged use, users can develop tolerance and withdrawal. A recent study found that in a sample of 200 bulimics, 31 percent used diuretics.

"It can take the body months to recover from laxative and other over-the-counter substance abuse," adds Dr. Wandler. "It's important to get professional help before the abuse escalates."

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