The impact of prior substance abuse on treatment outcome for bulimia nervosa

Comorbidity of bulimia nervosa and alcohol use disorders: Results from the National Women's Study

“…The lack of differences between women in the BN+AA and BN−AA groups for most variables associated with psychopathology is consistent with results from studies that demonstrate that a lifetime history of AA or AD is not predictive of outcome after treatment for BN (Mitchell, Pyle, Eckert, & Hatsukami, 1990;Strasser et al, 1992). However, these treatment outcome results must be interpreted with some caution, since all women with a current SUD at time of study intake were excluded.…”

“…It is believed that by identifying characteristics specific to women with comorbid BN and AUDs, therapeutic interventions can be tailored to meet their needs and more accurate predictions regarding therapy prognosis can be made. In general, researchers have documented higher rates of psychiatric comorbidity, impulsivity, and Axis II pathology among the women with comorbid BN+SUD than in women with BN−SUD, although few differences have been found pertaining to symptoms of disordered eating (Bulik et al, 1994;Grilo, Becker, Levy, Walker, Edell, & McGlashan, 1995;Levy & Walker, 1995;Lilenfeld et al, 1997;Strasser, Pike, & Walsh, 1992). Researchers have also found that treatmentseeking women with BN with a past history of an SUD had significantly higher baseline scores on measures of anxiety and depression, more psychiatric inpatient hospitalizations, more suicide attempts, more disruption in work, more frequent stealing, and higher levels of diuretic use than treatment-seeking women with BN and no past history of an SUD (Hatsukami, Mitchell, Eckert, & Pyle, 1986;Strasser et al, 1992).…”

“…First, an overwhelming majority of the researchers utilized treatment-seeking samples of women with eating disorders. Second, several authors (Hatsukami et al, 1986;Lilenfeld et al, 1997;Strasser et al, 1992) studied AUDs and SUDs together as a single group without providing justifications for assuming that women with AUDs and those who misuse other drugs constitute a single homogeneous group. Similarly, women with a history of substance abuse were grouped together with women with a history of substance dependence.…”

The clinical utility of randomized controlled trials

“…Once under control, treatment for BN may not be selectively disadvantaged. A past history of substance abuse or dependence has been unrelated to treatment outcome (Mitchell, Pyle, Eckert, Hatsukami, & Soll, 1990;Strasser, Pike, & Walsh, 1992). Nevertheless, to the extent that alcohol or drug abuse is part of a more general pattern of impulsive behaviors in BN (what Lacey & Evans [1986] called ''multi-impulsive bulimia''), treatment outcome might be adversely affected.…”

Anorexia Nervosa and Bulimia Nervosa☆

“…Desipramine, a tricyclic antidepressant, is reported to be effective in decreasing binge eating independent of depression, history of addictive behavior, or diagnostic subtype of bulimia (Hughes et al, 1986;Barlow et al, 1988;Blouin et al, 1988;Blouin et al, 1989;Strasser et al, 1992. Desipramine is also effective when used in combination with cognitive behavioral therapy (Agras et al, 1992;Agras et al, 1994).…”