1
|
Devoe DJ, Dimitropoulos G, Anderson A, Bahji A, Flanagan J, Soumbasis A, Patten SB, Lange T, Paslakis G. The prevalence of substance use disorders and substance use in anorexia nervosa: a systematic review and meta-analysis. J Eat Disord 2021; 9:161. [PMID: 34895358 PMCID: PMC8666057 DOI: 10.1186/s40337-021-00516-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/25/2021] [Indexed: 12/24/2022] Open
Abstract
AIM Individuals with anorexia nervosa (AN) often present with substance use and substance use disorders (SUDs). However, the prevalence of substance use and SUDs in AN has not been studied in-depth, especially the differences in the prevalence of SUDs between AN types [e.g., AN-R (restrictive type) and AN-BP (binge-eating/purge type]. Therefore, this systematic review and meta-analysis aimed to assess the prevalence of SUDs and substance use in AN samples. METHOD Systematic database searches of the peer-reviewed literature were conducted in the following online databases: MEDLINE, PsycINFO, Embase, and CINAHL from inception to January 2021. We restricted review eligibility to peer-reviewed research studies reporting the prevalence for either SUDs or substance use in individuals with AN. Random-effects meta-analyses using Freeman-Tukey double arcsine transformations were performed on eligible studies to estimate pooled proportions and 95% confidence intervals (CIs). RESULTS Fifty-two studies met the inclusion criteria, including 14,695 individuals identified as having AN (mean age: 22.82 years). Random pooled estimates showed that substance use disorders had a 16% prevalence in those with AN (AN-BP = 18% vs. AN-R = 7%). Drug abuse/dependence disorders had a prevalence of 7% in AN (AN-BP = 9% vs. AN-R = 5%). In studies that looked at specific abuse/dependence disorders, there was a 10% prevalence of alcohol abuse/dependence in AN (AN-BP = 15% vs. AN-R = 3%) and a 6% prevalence of cannabis abuse/dependence (AN-BP = 4% vs. AN-R = 0%). In addition, in terms of substance use, there was a 37% prevalence for caffeine use, 29% prevalence for alcohol use, 25% for tobacco use, and 14% for cannabis use in individuals with AN. CONCLUSION This is the most comprehensive meta-analysis on the comorbid prevalence of SUDs and substance use in persons with AN, with an overall pooled prevalence of 16%. Comorbid SUDs, including drugs, alcohol, and cannabis, were all more common in AN-BP compared to AN-R throughout. Therefore, clinicians should be aware of the high prevalence of SUD comorbidity and substance use in individuals with AN. Finally, clinicians should consider screening for SUDs and integrating treatments that target SUDs in individuals with AN. Individuals with anorexia nervosa (AN) may also present with substance use or have a substance use disorder (SUDs). Thus, we conducted a systematic review and meta-analysis to determine the prevalence of substance use and substance use disorders in individuals with AN. We examined published studies that reported the prevalence of either substance use or SUDs in individuals with AN. We found that substance use disorders had a 16% prevalence and that drug abuse/dependence disorders had a prevalence of 7% in those with AN. These rates were much higher in individuals with binge-eating/purging type compared to the restrictive AN. However, many specific substance use disorders and substance use types were low in individuals with AN. Nonetheless, clinicians should be aware of the high prevalence of SUD comorbidity and substance use in individuals with AN.
Collapse
Affiliation(s)
- Daniel J Devoe
- Department of Psychiatry, Cumming School of Medicine, Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Gina Dimitropoulos
- Department of Psychiatry, Cumming School of Medicine, Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Faculty of Social Work, University of Calgary, Calgary, Canada
| | - Alida Anderson
- Department of Psychiatry, Cumming School of Medicine, Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Anees Bahji
- Department of Psychiatry, Cumming School of Medicine, Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Jordyn Flanagan
- Department of Psychiatry, Cumming School of Medicine, Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Andrea Soumbasis
- Department of Psychiatry, Cumming School of Medicine, Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Scott B Patten
- Department of Psychiatry, Cumming School of Medicine, Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Tom Lange
- Department of Psychiatry, Cumming School of Medicine, Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Georgios Paslakis
- Ruhr-University Bochum, University Clinic for Psychosomatic Medicine and Psychotherapy, Campus East-Westphalia, Lübbecke, Germany
| |
Collapse
|
2
|
Horvath SA, Kolp HM, Andersen CV, Johnson EE, Racine SE, Borsari B, Stuart GL, Gidycz CA, Shorey RC. Emotion dysregulation moderates the relationship between alcohol use and eating pathology among heavy-drinking college men. J Clin Psychol 2021; 77:1763-1775. [PMID: 33971020 DOI: 10.1002/jclp.23157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 04/02/2021] [Accepted: 04/12/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES There is limited research examining the relationship between alcohol use and eating pathology in men or factors that may moderate this association. The current study investigated the relationship between alcohol use and eating pathology, and examined emotion dysregulation as a moderator of this association, among heavy-drinking college men. METHOD Men mandated to receive an alcohol intervention (N = 88; average age = 19 years) completed questionnaires related to alcohol use, emotion dysregulation, and eating pathology. RESULTS Results demonstrated positive relationships between alcohol use and some eating pathology, and a significant interaction between alcohol use and emotion dysregulation. However, results were contrary to hypotheses, such that there was a positive relationship between alcohol use and eating pathology at low levels of emotion dysregulation. CONCLUSION Future studies should continue to examine the overall presentation of eating pathology in men and investigate factors that may impact the relationship between alcohol use and eating pathology.
Collapse
Affiliation(s)
- Sarah A Horvath
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | - Haley M Kolp
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | | | - Ellen E Johnson
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | - Sarah E Racine
- Department of Psychology, McGill University, Montreal, Qubec, Canada
| | - Brian Borsari
- Department of Psychiatry, University of California, San Francisco, California, USA
| | - Gregory L Stuart
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | | | - Ryan C Shorey
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| |
Collapse
|
3
|
Binge eating and alcohol consumption: an integrative review. Eat Weight Disord 2021; 26:759-769. [PMID: 32424561 DOI: 10.1007/s40519-020-00923-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 05/06/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To identify the relationship between binge eating and alcohol consumption. METHODS This is an integrative literature review of publications from 2015 to 2019, using the Pubmed, Cinhahl, Psynet, Lilacs, Embase and Web of Science virtual databases and the descriptors ("Binge-Eating" OR "Bulimia") AND Alcohol* in English, Spanish and Portuguese. RESULTS A total of 964 articles were found. After reading the titles and abstracts and excluding duplicates, 36 articles were included in the final sample (35 in English and one in Portuguese). They were grouped into three thematic categories: "sample profile and characterization", "genetic and environmental factors", and "emotions and behavior". CONCLUSIONS The data indicate the existence of a relationship between binge eating and alcohol use, and some factors were associated with this comorbidity. Still, there were few publications on the theme at the national level, indicating the need for developing more research. These findings may support therapeutic actions and strategies for identification of cases, embracing approaches and more effective treatments to meet the individual's biopsychosocial demands. LEVEL OF EVIDENCE Level V, narrative review.
Collapse
|
4
|
Michael ML, Juarascio A. Differences in eating disorder symptoms and affect regulation for residential eating disorder patients with problematic substance use. Eat Weight Disord 2020; 25:1805-1811. [PMID: 31612371 DOI: 10.1007/s40519-019-00789-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/27/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The aim of the current study was to investigate differences in treatment outcomes for residential eating disorder (ED) treatment patients diagnosed with comorbid substance use disorders (SUDs), particularly differences in ED pathology and affect dysregulation. METHOD Secondary data analysis was conducted on data from a previous study of 140 patients at a residential ED facility. SUD was diagnosed by a staff psychiatrist upon admission, and SUD diagnosis was extracted from electronic health records for the current study. Self-report measures of eating pathology and affect dysregulation from pre-treatment and post-treatment assessments were analyzed. RESULTS 20.1% of the sample (n = 29) were diagnosed with a substance use disorder at the start of treatment. Contrary to hypotheses, those with comorbid SUD did not significantly differ in eating pathology severity, depression symptoms, emotion dysregulation, or psychological acceptance at baseline. Also contrary to hypotheses, individuals with comorbid SUD and ED evidenced slightly larger improvements in certain areas of eating pathology and affect dysregulation throughout treatment than those with ED diagnosis only. CONCLUSIONS These findings suggest that residential ED treatment is an appropriate treatment choice for individuals with comorbid SUD. The observed improvements in affect dysregulation combined with a period of forced abstinence from maladaptive affect regulation behaviors may explain these positive results, though more research is needed to test the mechanisms of action of residential treatment for this population. LEVEL OF EVIDENCE IV, multiple time series analysis.
Collapse
Affiliation(s)
- Megan L Michael
- Center for Weight and Lifestyle Sciences, Drexel University, Philadelphia, PA, 19104, USA.
| | - Adrienne Juarascio
- Department of Psychology, Drexel University, Philadelphia, PA, 19104, USA
| |
Collapse
|
5
|
Evans J, Horn K, Cowan D, Brunero S. Development of a clinical pathway for screening and integrated care of eating disorders in a rural substance use treatment setting. Int J Ment Health Nurs 2020; 29:878-887. [PMID: 32233124 DOI: 10.1111/inm.12722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/20/2020] [Accepted: 03/04/2020] [Indexed: 11/28/2022]
Abstract
Eating and substance use disorders frequently co-occur in clinical samples. This comorbidity presents a particular challenge due to increased medical complications, higher relapse rates, psychiatric comorbidity, and poorer overall outcomes for both disorders, and is associated with specific medical and psychiatric difficulties that contribute to complexity in diagnosis and treatment. However, patients with co-occurring substance use and eating disorders do not widely receive structured standardized assessment or treatment for eating disorders in substance use treatment settings. Focus groups were conducted to seek clinician's knowledge and perceptions of screening and care planning for eating disorder presentations in a rural substance use treatment setting. The study adheres to COREQ guidelines. To analyse the focus group data, the authors utilized thematic analysis and three major themes emerged as follows: beliefs about clients (stereotypical views, complexity of comorbidity, client expectations), understanding of self (lack of knowledge/skills, professional role), and organizational barriers and enablers. Whilst identifying a significant number of clinician and organizational barriers to providing screening and treatment of eating disorders in a substance use treatment setting, focus group discussions also highlighted a number of potential enablers. Most notably clinicians identified a willingness to provide screening and care planning if they were provided with education, a clinical pathway and access to screening tools. A consensus conferencing approach facilitated construction of a clinical pathway to enable the service to provide screening, assessment, and treatment planning for clients with comorbid eating disorder.
Collapse
Affiliation(s)
- Jocelyn Evans
- Port Macquarie Drug and Alcohol Service, Mid North Coast Local Health District, Port Macquarie, New South Wales, Australia
| | - Kristine Horn
- Port Macquarie Drug and Alcohol Service, Mid North Coast Local Health District, Port Macquarie, New South Wales, Australia
| | - Darrin Cowan
- Port Macquarie Drug and Alcohol Service, Mid North Coast Local Health District, Port Macquarie, New South Wales, Australia
| | - Scott Brunero
- South Eastern Sydney Area Health Mental Health Service, Randwick, New South Wales, Australia
| |
Collapse
|
6
|
Robinson LD, Kelly PJ, Deane FP, Reis SL. Exploring the Relationships Between Eating Disorders and Mental Health in Women Attending Residential Substance Use Treatment. J Dual Diagn 2019; 15:270-280. [PMID: 31519142 DOI: 10.1080/15504263.2019.1660019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Comorbid eating disorders (EDs) and ED symptoms are highly prevalent among women with substance use disorders and may be a barrier to recovery. Higher rates of psychiatric illness are common when more than one disorder is present. Yet little is known about the rates and risk factors for EDs/ED symptoms in women attending treatment centers in Australia. The primary aim is to examine the prevalence of ED symptoms among women attending treatment centers. This study also examines past physical and sexual abuse and mental health as specific predictors of EDs/ED symptoms. Methods: Participants were 1,444 women attending residential treatment for substance use issues provided by the Salvation Army in Australia. Measures included the Addiction Severity Index, the Eating Disorder Screen for Primary Care, medication use, hospitalization, mental health, and past abuse. Results: Alcohol was the primary substance of concern for 53.3% of the women, followed by amphetamines (17.5%), and the mean age was 37.83 years (SD = 10.8). Nearly 60% of women screened positive for ED symptoms and 32% reported a previous or current ED. Women with a history of sexual abuse had significantly greater odds (1.96) of positive screening for an ED compared to those without a history of sexual abuse. Similarly, compared to women without a history of physical abuse, those who did have a history had significantly higher odds (1.59) of a positive screen for an ED. These women were also significantly more likely to have had a health care provider recommend they take medications for psychological or emotional problems in the past 30 days, χ2(1) = 8.42, p = .004, and during their lifetime, χ2(1) = 17.89, p < .001. They also had a significantly greater number of overnight hospitalizations for medical problems compared to those who screened negative, t(137) = -2.19, p = .03. Conclusions: Women with comorbid substance use issues and EDs are highly likely to have a history of past abuse. This combination of comorbidities makes treatment and recovery difficult. Increased awareness and research are required to explore integrated approaches to treatment that accommodate these vulnerabilities and improve long-term outcomes.
Collapse
Affiliation(s)
- Laura D Robinson
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Institute for Mental Health, University of Wollongong, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Institute for Mental Health, University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Institute for Mental Health, University of Wollongong, Wollongong, Australia
| | - Samantha L Reis
- School of Psychology, University of Wollongong, Wollongong, Australia
| |
Collapse
|
7
|
Limbers CA, Cohen LA, Gray BA. Eating disorders in adolescent and young adult males: prevalence, diagnosis, and treatment strategies. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2018; 9:111-116. [PMID: 30127650 PMCID: PMC6091251 DOI: 10.2147/ahmt.s147480] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Males have largely been underrepresented in the eating disorder (ED) peer-reviewed literature. The current review paper examines prevalence rates, ED symptom presentation, and assessment and treatment strategies relevant to adolescent and young adult males. Adolescent and young adult males often report a greater desire to be bigger and more muscular compared to their female counterparts. Due to concerns that contemporary ED assessment tools are over reliant on items that evaluate stereotypically feminine indicators of ED pathology, male-specific ED measures, such as the Eating Disorder Assessment for Men, have been developed. Further validation work is necessary to establish the psychometric properties of these male-specific measures, particularly in adolescent male populations. Attention to a heightened prevalence of comorbid substance abuse disorders and the role that competitive sports play in perpetuating ED pathology are two factors that have been identified as important in the treatment of adolescent and young adult males with EDs.
Collapse
Affiliation(s)
- Christine A Limbers
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA,
| | - L Adelyn Cohen
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA,
| | - Bethany A Gray
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA,
| |
Collapse
|
8
|
Elmquist J, Shorey RC, Anderson S, Stuart GL. Experiential Avoidance and Bulimic Symptoms among Men in Residential Treatment for Substance Use Disorders: A Preliminary Examination. J Psychoactive Drugs 2017; 50:81-87. [DOI: 10.1080/02791072.2017.1368746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- JoAnna Elmquist
- Ph.D. Candidate, Department of Psychology, University of Tennessee, Knoxville, TN, USA
| | - Ryan C. Shorey
- Assistant Professor, Department of Psychology, Ohio University, Athens, OH, USA
| | - Scott Anderson
- Clinical Director, Cornerstone of Recovery, Louisville, TN, USA
| | - Gregory L. Stuart
- Professor, Department of Psychology, University of Tennessee, Knoxville, TN, USA
| |
Collapse
|
9
|
Wiss DA, Brewerton TD. Incorporating food addiction into disordered eating: the disordered eating food addiction nutrition guide (DEFANG). Eat Weight Disord 2017; 22:49-59. [PMID: 27943202 PMCID: PMC5334442 DOI: 10.1007/s40519-016-0344-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/16/2016] [Indexed: 12/18/2022] Open
Abstract
Although not formally recognized by the DSM-5, food addiction (FA) has been well described in the scientific literature. FA has emerged as a clinical entity that is recognized within the spectrum of disordered eating, particularly in patients with bulimia nervosa, binge-eating disorder and/or co-occurring addictive disorders and obesity. Integrating the concept of FA into the scope of disordered eating has been challenging for ED treatment professionals, since there is no well-accepted treatment model. The confusion surrounding the implications of FA, as well as the impact of the contemporary Westernized diet, may contribute to poor treatment outcomes. The purpose of this review is twofold. The first is to briefly explore the relationships between EDs and addictions, and the second is to propose a new model of conceptualizing and treating EDs that incorporates recent data on FA. Since treatment for EDs should vary based on individual assessment and diagnosis, the Disordered Eating Food Addiction Nutrition Guide (DEFANG) is presented as a tool for framing treatment goals and helping patients achieve sustainable recovery.
Collapse
Affiliation(s)
- David A Wiss
- Nutrition in Recovery LLC, 8549 Wilshire Blvd. #646, Beverly Hills, CA, 90211, USA.
| | - Timothy D Brewerton
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| |
Collapse
|