Eating disorders and substance use in adolescents: How substance users differ from nonsubstance users in an outpatient eating disorders treatment clinic

Abstract

Objective: The relationship between eating disorders (EDs) and substance use (SU) has only been briefly described in literature using mainly adult populations. This study examined the prevalence and characteristics of SU among patients of an adolescent ED outpatient treatment program.Method: A retrospective chart analysis was conducted to determine and subsequently compare medical status, psychosocial factors, treatment course and outcome between patients with and without SU.Results: Over 60% of patients with SU status (n = 203) reported regularly consuming substances. 33.4% of substance users received a diagnosis involving purging behaviors compared to 5.9% of nonusers. Females composed 96.4% and 81.7% of users and nonusers, respectively.Users reported significantly more self-harm (57.7% of users vs. 38.6% of nonusers) but did not differ significantly in terms of trauma (abuse or victimization; 48.3% of users vs. 44.9% of nonusers). The percentage of ideal body weight significantly improved throughout treatment and did not differ by SU with a mean increase of 5.29% (SD = 13.6) among nonusers compared to 5.45% (SD = 7.5) of users. While users and nonusers did not differ before and after treatment in ED severity, users were more likely than nonusers to drop-out of treatment (41.5% of users vs. 25.2% of nonusers).Discussion: Adolescents with SU benefit from ED outpatient treatment as much as those without SU, however, users are more likely to drop-out. Therefore, treatment should target these adolescents' emotional dysregulation to improve treatment compliance. Further research is necessary to determine the efficacy of such an approach.adolescent, anorexia, bulimia, feeding and eating disorders, outpatients, retrospective studies, self-injurious behavior, substance-related disorders

Non‐suicidal self‐injury among individuals with an eating disorder: A systematic review and prevalence meta‐analysis

“…However, when the mean age across studies is viewed, it becomes evident that most studies included for analysis centered around young adults, and therefore, the effect of age may not have been influential. Similarly, while NSSI has been associated more with BN than AN in the past, it appears to be following a similar pattern to substance use (another impulsive behavior; Kirkpatrick et al, 2019) such that diagnoses associated with impulsivity, such as AN‐BP and BN, have higher levels of NSSI than AN‐R. Since a low BMI and higher prevalence of NSSI have been found in AN‐BP, it suggests that the act of NSSI may be related to an underlying mechanism (e.g., impulsivity, cognitive processing) rather than BMI.…”

“…All diagnoses examined had a prevalence of NSSI greater than one in five. Previous studies have identified that other impulsive behaviors (substance use) and high impulsivity have been associated with lower engagement in and response to ED treatment (Kirkpatrick et al, 2019; Testa et al, 2022). Therefore, it is important that healthcare professionals working with individuals with an ED screen all patients for the presence of NSSI.…”

“…While impulsivity has been found to predict NSSI onset (Cassels et al, 2022), NSSI may not always be an impulsive act. Other impulsive behaviors, such as substance use, have been found to be associated with negative engagement in ED treatment (Kirkpatrick et al, 2019). Therefore, it is possible that the presence of self-injurious behaviors in individuals with an ED may negatively impact treatment engagement.…”