Exploring the Relationships Between Eating Disorders and Mental Health in Women Attending Residential Substance Use Treatment

Sex differences in the characteristics of stimulant offenders with a history of substance use disorder treatment

We analyzed the results of a nationwide questionnaire administered to 699 stimulant offenders and examined sex differences in the association between various psychosocial problems and treatment history for substance use disorder. Based on their attributes, we predominantly evaluated the treatment and support provided to women with substance use disorder. The rates of childhood (before the age of 18) traumatic experiences (physical, psychological, and sexual abuse and neglect) and lifetime intimate partner violence were significantly higher in women than in men. The history of treatment for substance use disorder was also significantly higher in women than in men, at 15.8% for men and 42.4% for women [χ2 (1) = 41.223, p < 0.001]. Logistic regression analysis was performed using the treatment history of substance use disorder as the dependent variable. The results showed that treatment history was significantly associated with the total drug abuse screening test-20 score and suicidal ideation in men and with survivors of child abuse and eating disorders in women. A comprehensive assessment is required for several issues, such as child abuse, domestic violence, trauma symptoms, eating disorders, and drug problems. Moreover, an integrated treatment for substance use disorder, trauma, and eating disorders is required for female stimulant offenders.

Integrated treatment for comorbid eating disorders and substance use disorders: a scoping review protocol

OBJECTIVE

This review will identify and summarize the literature on the integrated treatment of comorbid eating disorders and substance use disorders, focusing on clinical practice guidelines and treatment studies.

INTRODUCTION

Eating disorders and substance use disorders are the deadliest psychiatric conditions, frequently co-occur, and are linked to greater symptom severity and poorer treatment outcomes. Despite repeated calls for their integrated treatment, such an approach has rarely been empirically evaluated. To advance the development of integrated treatments for comorbid eating disorders and substance use disorders, a critical first step is to describe existing treatment guidelines and summarize research evidence for this approach.

INCLUSION CRITERIA

This review will consider all peer-reviewed and gray literature describing the integrated treatment of comorbid eating disorders and substance use disorders, focusing on i) clinical practice guidelines; and ii) treatment studies. We will not place limitations on populations, types of eating disorders, types of substance use disorders, or other contextual factors.

METHODS

Databases to be searched will include MEDLINE (Ovid), Embase, CINAHL (EBSCOhost), PsycINFO (EBSCOhost), Scopus, and clinical practice guidelines databases identified by CADTH Grey Matters. No date or language limits will be applied to the search. At the screening stage, we will only consider literature in English or French. Two independent reviewers will screen studies at the title/abstract and full-text levels, and extract relevant studies. Disagreements will be resolved through discussion. Findings will be presented in tabular format and a narrative summary.

REVIEW REGISTRATION

Open Science Framework https://osf.io/za35j/.

The impact of body image dissatisfaction on psychological distress and health-related quality of life among patients in methadone treatment

BACKGROUND AND OBJECTIVES

Minimal research has examined body image dissatisfaction (BID) among patients receiving methadone maintenance treatment (MMT). We tested associations between BID and MMT quality indicators (psychological distress, mental and physical health-related quality of life [HRQoL]) and whether these associations varied by gender.

METHODS

One hundred and sixty-four participants (n = 164) in MMT completed self-report measures of body mass index (BMI), BID, and MMT quality indicators. General linear models tested if BID was associated with MMT quality indicators.

RESULTS

Patients were primarily non-Hispanic White (56%) men (59%) with an average BMI in the overweight range. Approximately 30% of the sample had moderate or marked BID. Women and patients with a BMI in the obese range reported higher BID than men and patients with normal weight, respectively. BID was associated with higher psychological distress, lower physical HRQoL, and was unrelated to mental HRQoL. However, there was a significant interaction in which the association between BID and lower mental HRQoL was stronger for men than women.

DISCUSSION AND CONCLUSIONS

Moderate or marked BID is present for about three in 10 patients. These data also suggest that BID is tied to important MMT quality indicators, and that these associations can vary by gender. The long-term course of MMT may allow for assessing and addressing novel factors influencing MMT outcomes, including BID.

SCIENTIFIC SIGNIFICANCE

This is one of the first studies to examine BID among MMT patients, and it highlights MMT subgroups most at risk for BID and reduced MMT quality indicators due to BID.

Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span

BACKGROUND

Multiple published sources from around the world have confirmed an association between an array of adverse childhood experiences (ACEs) and other traumatic events with eating disorders (EDs) and related adverse outcomes, including higher morbidity and mortality.

METHODS

In keeping with this Special Issue's goals, this narrative review focuses on the ACEs pyramid and its purported mechanisms through which child maltreatment and other forms of violence toward human beings influence the health and well-being of individuals who develop EDs throughout the life span. Relevant literature on posttraumatic stress disorder (PTSD) is highlighted when applicable.

RESULTS

At every level of the pyramid, it is shown that EDs interact with each of these proclaimed escalating mechanisms in a bidirectional manner that contributes to the predisposition, precipitation and perpetuation of EDs and related medical and psychiatric comorbidities, which then predispose to early death. The levels and their interactions that are discussed include the contribution of generational embodiment (genetics) and historical trauma (epigenetics), social conditions and local context, the ACEs and other traumas themselves, the resultant disrupted neurodevelopment, subsequent social, emotional and cognitive impairment, the adoption of health risk behaviors, and the development of disease, disability and social problems, all resulting in premature mortality by means of fatal complications and/or suicide.

CONCLUSIONS

The implications of these cascading, evolving, and intertwined perspectives have important implications for the assessment and treatment of EDs using trauma-informed care and trauma-focused integrated treatment approaches. This overview offers multiple opportunities at every level for the palliation and prevention of EDs and other associated trauma-related conditions, including PTSD.

A multi-methods yarn about SMART Recovery: First insights from Australian Aboriginal facilitators and group members

INTRODUCTION

SMART Recovery is a popular mutual support group program. Little is known about its suitability or perceived helpfulness for Indigenous peoples. This study explored the cultural utility of SMART Recovery in an Australian Aboriginal context.

METHODS

An Indigenous-lensed, multi-methods, exploratory study design was used to develop initial evidence of: (i) attributes of Aboriginal SMART Recovery facilitators and group members; (ii) characteristics of Aboriginal-led SMART Recovery groups; (iii) perceived acceptability and helpfulness of SMART Recovery; and (iv) areas for potential improvement. Data were collected by synthesising Indigenous qualitative methods (research topic and social yarning) with western qualitative and quantitative methods (participant surveys, program adherence rating scale, group observations and field notes). Data were analysed using thematic analysis.

RESULTS

Participants were a culturally diverse sample of male and female Aboriginal facilitators (n = 10) and group members (n = 11), aged 22-65 years. Aboriginal-led SMART Recovery groups were culturally customised to suit local contexts. Program tools 'goal setting' and 'problem solving' were viewed as the most helpful. Suggested ways SMART Recovery could enhance its cultural utility included: integration of Aboriginal perspectives into facilitator training; creation of Aboriginal-specific program and marketing materials; and greater community engagement and networking. Participants proposed an Aboriginal-specific SMART Recovery program.

DISCUSSION AND CONCLUSIONS

This study offers insights into Aboriginal peoples' experiences of SMART Recovery. Culturally-informed modifications to the program were identified that could enhance cultural utility. Future research is needed to obtain diverse community perspectives and measure health outcomes associated with group attendance.

Nutritional and metabolic alterations arising from stimulant use: A targeted review of an emerging field

People with stimulant use disorders are usually underweight. Current accepted knowledge is that they are skinny because stimulants suppress appetite - they eat less. But is it that simple? Here we review the relationship between stimulant use, food intake, metabolism and body weight, and highlight key points that may challenge current knowledge: 1) Stimulants interact with the hormonal signals that regulate appetite including ghrelin and leptin, and can produce long-term alterations in the ability to monitor and compensate energy deficits. 2) The diet of people with stimulant use disorders might be characterised by altered nutritional geometry, rather than overall reduction of food intake. 3) Long-term changes in homeostatic signals and nutrient intake can produce metabolic deficits that contribute to unhealthy low weight. Based on this knowledge we advocate for increasing awareness about the nuances of stimulant-related nutritional and metabolic deficits among addiction clinicians, and increased research on the interaction between stimulant use, appetite signaling, and metabolic deficits.