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Drug Abuse and Alcoholism in Women with Eating Disorders
December 12, 2010
Men are twice as likely as women to be affected by alcoholism (Peveler & Fairburn, 1990). Drug abuse is prevalent in 13.8% of men, compared to only 7.1% of women (Herzog, Frank, Dorer, Keel, Jackson, & Manzo, 2006). This startling data makes it clear that men tend to have more of a preference twoards achieving an altered consciousness than the fairer sex. Eating disorders, on the other hand, is almost entirely dominated by women. The relationship between substance abuse (whether the substance be alcohol or narcotics) and eating disorders is an interesting one because they can both be treated in the same manner. Programs such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Anorexics and Bulimics Anonymous (ABA) all use the same “12-Step Program” to manage and control addiction or disease. Peveler and Fairburn (1990) point out that many individuals who have recovered from substance abuse problems are at risk for developing a different addiction problem post-recovery. It is also more likely for food-deprived humans to increase drug intake to cope with their hunger (Krahn, 1991). Through this logic, it makes sense that a woman who is currently suffering or recovering from an eating disorder would be more at risk than the rest of the female population to develop an alcohol or drug problem. The eating disorders that will be examined in this paper will be anorexia nervosa (AN), bulimia nervosa (BN), and EDNOS (Eating Disorder, Not Otherwise Specified). It can be deduced from the various studies cited that women with eating disorders do tend to have a higher use of drugs and alcohol than the general female population, particularly drugs with appetite-suppressing properties like cocaine or amphetamines. The main cause for this correlation is that both substance abuse problems and eating disorders are simply different ways to deal with similar underlying problems.
Alcoholism and Eating Disorders
The relationship between eating disorders and alcohol abuse has been studied extensively throughout the years. A strong correlation between the two poses a danger to doctors because an expert in one field might not be able to detect the accompanying issue, and this oversight can hurt the effectiveness of treatment (Peveler & Fairburn, 1990). Goldbloom, Naranjo, Bremner, and Hicks (1992) conducted an experiment on 73 females (18-45 years old) with alcohol problems who were recommended by the Addiction Research Foundation and 96 women (18-45 years old) with eating disorders from the Toronto Hospital. There was a very thorough interview process conducted before the research commenced in order to verify that the women selected for the study did in fact have the necessary symptoms. It was found that 26.9% of the women with eating disorders showed signs of alcohol dependence while 30.1% of the sample with alcohol problems exhibited symptoms characteristic of eating disorders (Goldbloom et al., 1992). There was no control group because there are already generally accepted numbers for percentages of women with eating disorders (1-2%) and women with alcoholism (approximately 1%). The percentages found in this study are alarmingly high for both surveys. It seems that women who have trouble with alcohol abuse are extremely at risk to develop an eating disorder, as well as vice-versa.
Drug Abuse/Dependence and Eating Disorders
Until Herzog et al. (2006) conducted a comprehensive nine-year study on the correlation between drug addiction and eating disorders, most studies focused on alcoholism or simply asked patients whether or not they had ever used a particular illegal narcotic. This study used a sample of 246 individuals with 51 suffering from anorexia nervosa-restrictive type (ANR), 85 participants with anorexia nervosa-binge/purge type (ANBP), and 110 subjects diagnosed with bulimia nervosa. Drug abuse was only attributed to subjects if they met a specific criterion such as using cocaine over five times or using marijuana daily for over a month. Also in the criteria for drug abuse are phrases like “Occupation/Financial problems” and “Out-of-character behavior: fighting, stealing, brandishing weapons.” These requirements ensure that the data is accurate, unlike the former studies that considered one-time use of an illicit drug to constitute a pattern of abuse. Drug dependence is even harder to be diagnosed with under the guidelines of the study, requiring “Apparent inability to stop or control usage” or “Withdrawal” (Herzog et al., 2006). The frequent assessments of the subjects allowed the researchers to compile extremely detailed descriptions of the severity of abuse in order to make the most accurate study possible. While detail is the study’s strength, the ever-changing definition of what constitutes drug abuse has created a weakness. The research is conducted under the RDC criteria, while today’s diagnostic standard is outlined by DSM-IV. The RDC criteria tend to be stricter than that of DSM-IV, so the study probably underestimates cases of drug use disorder.
The study found a lifetime history of drug use disorder in 42 of the women involved (17.1%). This number is dramatically higher than the percentage found in the general female population (17.1% compared to 7.1%). Twenty-two, or 52.3%, of these women suffered from AN while the remaining twenty were bulimic. Four of the 22 AN and six of the 20 BN patients were diagnosed with a drug problem for the first time in their life during the study while the remaining patients had previous episodes of abuse (Herzog et al., 2006). This means that the risk of drug abuse for a woman with an eating disorder continues over time and should not be ruled out as a future danger.
Anorexics diagnosed with the binge/purge subtype suffered from drug abuse at a higher rate than those diagnosed as restrictive. Herzog et al. (2006) attribute this discrepancy to the bulimic symptoms found in ANBP patients that promote a greater probability of engaging in impulsive and dangerous behaviors. Overall, there is no significant difference between abuse in women with AN and BN.
Most Common Illicit Drugs in the Eating Disorders Population
It should not come as a surprise that the most common drugs abused in the eating disorders population happen to be drugs that suppress appetite. Krahn (1991) documented a high incidence of eating disorders in females calling for help with cocaine abuse and dependence, primarily those suffering from AN. High-school students with bulimia or bulimic behaviors, on the other hand, were reported to have much higher usage rates for marijuana and cigarettes than normal, as well as more episodes of drunkenness (Krahn, 1991).
Herzog et al. (2006) also documented the different drugs used by their subjects and were able to find exactly what types of preferences the differently diagnosed women had. Anorexics tended to use amphetamines at a considerably higher rate than the bulimic patients, while bulimic patients were slightly more inclined to abuse cocaine. LSD and solvent use was virtually nonexistent in the sample and there was an equal amount of experimentation with sedatives in both the BN and AN diagnostic groups (Herzog et al., 2006).
Alcohol abuse is particularly high in BN patients. Krahn (1991, page 241) explains this through some Freud-based reasoning:
“Chronic patients who have progressed to a state of overeating and vomiting not infrequently appear to become dominated by oral behavior, and [are] sometimes present with alcoholism”
So while alcoholism is still quite common in anorexic women, it is found most often in those who tend to purge through the act of vomiting.
Possible Reasons for the Correlations
There are numerous suggestions as to why substance abuse and eating disorders seem to accompany each other at such a high rate. It is obvious why a woman who does not want to eat a normal amount would abuse an a stimulant that doubles as an appetite-suppressant like cocaine, but alcohol abuse is more common in the eating disorders population than cocaine dependence and there are no ties between alcohol and the suppression of the appetite. Peveler and Fairburn (1990, page 1636) present two different hypotheses: that alcohol and drugs are used to reduce the “dysphoria and isolation” that comes with a typical eating disorder, or that women with eating disorders tend to come from families with abnormally high rates of alcohol and narcotics abuse. Interestingly enough, Krahn (1991) presents two identical theories in his study. He cites studies that found 30% of bulimics to come from families with alcoholism versus 10% of control families and that 51% of women with BN had at least one first-degree relative with a serious substance-abuse problem (Krahn, 1991). It is clear from these numbers that having substance abuse in your genetics is a risk factor for acquiring eating disorders but there is no dominant relationship here. The main cause for the correlation between substance abuse and eating disorders is that substance abuse can appear as an escape from the pain felt by a woman suffering from an eating disorder. By the age of 35, half of bulimic patients have developed problems with abusing alcohol (Krahn, 1991). Bulimics who are eventually diagnosed with a substance abuse problem increase their daily alcohol consumption 41.1% of the time after the initial bulimia-onset. Substance abuse appears to be a coping method for those suffering from an eating disorder. Genetics and hunger-suppression are certainly important factors in the substance abuse-eating disorder relationship, but the most pertinent reason for the link is that one disease seems to be secondary to the other.
It is clear that there is a relationship between eating disorders and alcohol or drug abuse. This is an important relationship to notice because of the possible clinical consequences. Treatment of an eating disorder might not be as effective if the treating doctor is unaware of a substance abuse problem or vice-versa. Doctors must take not of this correlation and examine patients to see if they are at risk.
Goldbloom, David S., Claudio A. Naranjo, Karen E. Bremmer, and Lisa K. Hicks. "Eating Disorders and
Alcohol Abuse in Women." (1992). Web.
Herzog, David B., Debra L. Frank, David J. Dorer, and Pamela K. Keel. "Drug Abuse in Women with
Eating Disorders." (2006). Web.
Krahn, Dean D. "The Relationship of Eating Disorders and Substance Abuse." (1991). Web.
Peveler, Robert, and Christopher Fairburn. "Eating Disorders in Women Who Abuse Alcohol." (1990).
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