Substance Use Disorders, Anorexia, Bulimia, and Concurrent Disorders

Abstract

Background: While the co-prevalence of eating disorders (ED) has been documented in individuals with substance use disorders (SUD), little is known about the co-occurrence of other disorders in this population. Examining this issue is critical for public health policy and treatment success. Objective: To identify and evaluate the co-occurrence of ED and other psychiatric disorders in men and women with SUD. Methods: The sample consisted of individuals seeking treatment for substance use. Semistructured interviews and the CAMH Concurrent Disorders Screener were completed to assess DSM-IV psychopathology. Results: Chi-square analyses suggested that more women scored positive for ED than men, EDs were more prevalent in both genders than in the general population, and the cooccurrence of other disorders was higher for clients with both SUD and ED than with SUD alone. Discussion: Individuals with both SUD and ED appear to have multiple needs that may not be readily assessed by existing addiction treatment programs. Assessment issues, treatment, potential prevention and health promotion implications are addressed.

Neurobiology of aversive states

“…Restricted eating with weight loss decreases extracellular dopamine in the NAc and significantly alters dopamine response to amphetamine, morphine, and food intake [92]. Chronic food deprivation and subsequent weight loss increases drug-seeking behavior and voluntary drug intake in animals [93–96] and individuals with Anorexia Nervosa (AN) have been found to have higher rates of substance abuse [97, 98]. Clinical studies also demonstrate decreased dopaminergic transmission in AN [99–101].…”

“…It is well-established that individuals in a chronic aversive state, such as depression, chronic pain, or eating disorder, are more likely to have co-morbid addictive disorders [97, 98, 175–178]. This underscores the overlapping systems implicated in reward and aversion.…”

Neurobiological and Clinical Variables Associated with Alcohol Abuse in Bulimia Nervosa

“…Substance use is a serious health problem, which is frequently detected in patients with bulimia nervosa (BN; Bulik, Sullivan, Carter, & Joyce, 1997;Corcos, et al, 2001;Courbasson, Smith, & Cleland, 2005;Stock, Goldberg, Corbett, & Katzman, 2002). Several models have been proposed to explain the association between substance-related disorders (SRD) and BN, including the consideration of BN itself as an addictive disorder (Davis & Claridge, 1998;Krahn, 1991).…”

Personality psychopathology differentiates risky behaviors among women with bulimia nervosa

“…[1][2][3][4] Depending on the specific risky behavior and assessment methodology used, researchers report that 16-44% of women with BN concurrently engage in some other form of risky behavior. [5][6][7] Engaging in risky behaviors is associated with significant health problems, [8][9][10] greater overall psychopathology, and poorer course of illness than engagement in bulimic behaviors alone. 6 However, there is a paucity of research examining factors associated with engaging in specific risky behaviors that occur independently or co-occur among individuals with BN.…”