Associations between disordered eating behaviors and licit and illicit substance use and abuse in a university sample
Introduction
The co-occurrence of eating disorders and substance use and abuse has been well documented in both clinical (e.g., Bushnell et al., 1994, Corcos et al., 2001, Corte and Stein, 2000, Grilo et al., 1995, Stock et al., 2002, Wiederman and Pryor, 1996a, Wiederman and Pryor, 1996b) and non-clinical (e.g., Kashubeck and Mintz, 1996, Lundholm, 1989, Ross and Ivis, 1999, Saules et al., 2004, Stewart et al., 2000, Von Ranson et al., 2002, Welch and Fairburn, 1996, Welch and Fairburn, 1998, Xinaris and Boland, 1990) samples. Several reviews of the research literature regarding the association between eating disorders and substance related disorders have been published (e.g., Corcos et al., 2001, Holderness et al., 1994, Wolfe and Maisto, 2000).
The study of comorbidity between disordered eating patterns and substance use in non-clinical female populations has included community, high school, and university samples. In non-clinical community-based adult populations, associations have been found between the syndrome of bulimia nervosa and alcohol drinking, cigarette smoking, marijuana use, amphetamine use and tranquilizer abuse (Dansky et al., 2000, Welch and Fairburn, 1996, Welch and Fairburn, 1998). Using a behavior specific approach (Corte & Stein, 2000) in a community-based sample, Piran and Robinson (2005) found that as disordered eating behaviors became more severe, or were clustered together, the number of substance classes used increased. In addition, particular eating disordered behaviors were differentially related to the use of various substance classes.
The study of the comorbidity between disordered eating and substance use in middle and high schools samples tended to focus on the association between attitudes toward eating, weight, and shape and tobacco smoking, alcohol drinking, and marijuana use (Field et al., 2002, Fisher et al., 1991, Striegel-Moore and Huydic, 1993). Nonetheless, several school-based studies have also reported on associations between tobacco smoking, alcohol drinking, and marijuana use in relation to bingeing, purging and dieting behaviors (Killen et al., 1987, Krahn et al., 1996, Lock et al., 2001, Neumark-Sztainer et al., 1998, Tomori et al., 2001). However, only a few investigations have included a broader range of substance classes while investigating associations between disordered eating attitudes and behaviors and substance use in school-based studies (Ross and Ivis, 1999, Von Ranson et al., 2002). Ross and Ivis (1999) found an association between binge eating, with compensatory behaviors, and the use of alcohol as well as one or more of a list of licit and illicit drugs, while Von Ranson et al. (2002) found an association between the revised EDI subscales of Binge Eating, Body Dissatisfaction, and Compensating Behaviors, and the use of a wide range of illicit drugs.
There are a small number of studies that have examined the relationship between problematic eating patterns and substance use in university samples (Anderson et al., 2005, Dunn et al., 2002, Kashubeck and Mintz, 1996, Krahn et al., 2005, Lundholm, 1989, Saules et al., 2004, Stewart et al., 2000, Xinaris and Boland, 1990). Several of these studies have focused on the relationship between bulimic symptomatology and substance use (Dunn et al., 2002, Krahn et al., 2005). For example, Dunn et al. (2002) found no difference in patterns of alcohol use among college-age non-treatment seeking females with and without bulimia nervosa. The investigators did, however, find differences between the groups in their reported use of marijuana, opiates, and barbiturates. Krahn et al. (2005) found that the quantity and frequency of alcohol consumption were positively associated with a measure that assessed the combined severity of engagement in bingeing, dieting, and purging behaviors. In their study, smoking cigarettes, even at very low levels, was also related to the measure of combined disordered eating behaviors.
Other university-based studies have explored the relationship between disordered eating attitudes and behaviors as measured on the Eating Disorder Inventory (EDI) and substance abuse (Kashubeck and Mintz, 1996, Lundholm, 1989). Kashubeck and Mintz (1996) reported a positive significant, albeit small, association between problematic alcohol use in female undergraduate students and the EDI subscales of Bulimia and Interoceptive Awareness, but no such correlation with the other EDI subscales. No significant relationships were found between EDI subscales and use of other substances, including: marijuana, nicotine, cocaine, amphetamines, tranquilizers, and psychedelics. Similarly, Lundholm (1989) examined the relationship between alcohol abuse and disordered eating among female undergraduate students. They found that females who scored higher on measures of alcohol abuse scored significantly higher on the EDI Bulimia and Interoceptive Awareness subscales, but not on the EDI Body Dissatisfaction or Drive for Thinness, compared with females who scored lower on measures of alcohol abuse.
Only a handful of university-based studies have followed a behavior specific approach in studying relationships between particular eating disordered behaviors and substance use (Anderson et al., 2005, Benjamin and Wulfert, 2005, Saules et al., 2004, Stewart et al., 2000, Xinaris and Boland, 1990). These investigations have revealed associations between bingeing, purging, and dieting and problematic alcohol use and cigarette smoking. However, none of these studies included a broader range of substance classes in their investigations. Benjamin and Wulfert (2005) found a positive association between frequency of binge eating episodes and frequency of drinking in the past month in a sample of undergraduate women. Xinaris and Boland (1990) also reported moderate associations between bingeing as well as dietary restraint and the use of alcohol among female undergraduates. They found no associations between indices of disordered eating and cigarette smoking. Stewart et al. (2000) reported that a measure of restrained eating, including dietary restraint (chronic attempts to restrict food intake due to concerns about body weight) and dietary disinhibition (history of body weight fluctuations), among undergraduate women, was significantly associated with drinking quantity, composite measure of drinks per week, binge drinking, and yearly excessive drinking. However, no relationship was found between measures of restrained eating and drinking frequency. Saules et al. (2004) found that dieting concerns, as well as depression and alcohol-related problems among college-aged women, were predictive of smoking initiation. Anderson et al. (2005) compared 20 female college students who purged and 20 students who did not exhibit such behaviors and described that students who purged reported greater alcohol use.
Overall, out of the university-based studies reviewed, only two, a study using the EDI (Kashubeck & Mintz, 1996), and a study of the syndrome of bulimia nervosa (Dunn et al., 2002), included a wider range of substances, in addition to alcohol, tobacco, and marijuana, in their examination of the relationship between disordered eating and substance use and abuse. The present study aimed to add to the existing literature by studying various patterns of disordered eating behaviors and examining their relationship, in comparison to a non-eating disordered group, to the consumption of a broad range of substances, both licit and illicit. The investigation included a breakdown of individual disordered eating behaviors as well as various clusters of disordered eating behaviors in the analyses. Such a behavior specific analysis allows for the examination of the intricate nature of the relationship between particular types of eating disturbances and the use of numerous substances and has been advocated by such researchers as Welch and Fairburn (1996) and Corte and Stein (2000). In addition, in light of growing evidence of increasing rates of illicit prescription drug use among adolescents and young adults (Johnston et al., 2004, McCabe and Boyd, 2005, Zacny et al., 2003), the study included the abuse of various prescription drugs. To our knowledge there have been no studies that have investigated associations between the abuse of a range of prescription drugs and engagement in specific types of disordered eating behaviors in university samples.
Section snippets
Participants
The participants included female undergraduate students recruited from the University of Toronto. Using a behavior specific approach, women with particular clusters of eating disordered behaviors were selected from the larger pool of women (N = 526) who filled out a detailed survey on various issues related to women's health. An analysis of the demographic composition revealed that the subjects were of heterogeneous ethnocultural backgrounds. For example, 1% identified themselves as Native or
Results
The first set of analyses compared the percent of substance use found between the two specific single categories of eating disordered behaviors, Binge Only and Severe Diet Only, and the Control group (Table 2). Analyses revealed that participants who belonged to the Binge Only category engaged in severe alcohol use at a marginally greater rate (p = .057) than controls. On the other hand, the Severe Diet Only group engaged in hallucinogens/heroin use significantly more than controls.
The second set
Discussion
This investigation considered the relationship between disordered eating behaviors and substance use in a university sample. A broad range of licit and illicit substance classes was considered separately and symptoms of disordered eating were examined in two ways: as discrete behaviors and as clusters of symptoms.
Examining discrete eating disorder behaviors in relation to substance use revealed a marginally significant association between severe levels of alcohol consumption and binge eating.
Acknowledgements
This research was supported by the Social Sciences and Humanities Research Council (Canada) to the first author.
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