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Eating Disorders, Substance Abuse Linked

50 Percent With Eating Disorders Drink, Drug

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Updated January 29, 2004

"Food for Thought - Substance Abuse and Eating Disorders" -- the first comprehensive examination of the link between substance abuse and eating disorders -- reveals that up to one-half of individuals with eating disorders abuse alcohol or illicit drugs, compared to nine percent of the general population.

Conversely, up to 35 percent of alcohol or illicit drug abusers have eating disorders compared to three percent of the general population. The 73-page report by The National Center on Addiction and Substance Abuse (CASA) at Columbia University was released by CASA president and former U.S. Secretary of Health, Education and Welfare, Joseph A. Califano, Jr.

"For many young women, eating disorders like anorexia and bulimia are joined at the hip with smoking, binge drinking and illicit drug use," said Califano. "This lethal link between substance abuse and eating disorders sends a signal to parents, teachers and health professionals – where you see the smoke of eating disorders, look for the fire of substance abuse and vice versa."

The exhaustive report finds anorexia nervosa and bulimia nervosa as the eating disorders most commonly linked to substance abuse and for the first time identifies the shared risk factors and shared characteristics of both afflictions. The report lists caffeine, tobacco, alcohol, diuretics, laxatives, emetics, amphetamines, cocaine and heroin as substances used to suppress appetite, increase metabolism, purge unwanted calories and self-medicate negative emotions.

The report found that because health professionals often overlook the link between substance abuse and eating disorders, treatment options are virtually nonexistent for these co-occurring conditions.

"The public health community, parents and policy makers must educate our children about healthy body images from a very young age, and treatment and prevention programs must address the common co-occurrence of substance abuse and eating disorders," stated Susan Foster, vice president and director of policy research and analysis at CASA, who spearheaded the project.

"Advertisers put children at greater risk of developing an eating disorder through the portrayal of unrealistic body images," noted Mr. Califano. "The average American woman is 5'4" tall and weighs approximately 140 pounds, but the average model that purportedly epitomizes our standard of beauty is 5'11" tall and weighs 117 pounds." The report found that women's magazines contain more than ten times more ads and articles related to weight loss than men's magazines, which is the same gender ratio reported for eating disorders.

The report finds that while only 15 percent of girls are overweight, 40 percent of girls in grades one through five and 62 percent of teenage girls are trying to lose weight. These girls are especially vulnerable to eating disorders and related substance abuse problems.

Other notable findings include:

  • Middle school girls (10 – 14 year olds) who diet more than once a week are nearly four times likelier to become smokers.
  • Girls with eating disorder symptoms are almost four times likelier to use inhalants and cocaine.
  • 12.6 percent of female high school students take diet pills, powders or liquids to control their weight without a doctor's advice.
  • Bulimic women who are alcohol dependent report a higher rate of suicide attempts, anxiety, personality and conduct disorders and other drug dependence than bulimic women who are not alcohol dependent.
  • Hispanic girls are slightly more likely than Caucasian girls and significantly more likely than African-American girls to report having fasted for 24 hours or more and having vomited or taken laxatives to lose weight.
  • As many as one million men and boys suffer from an eating disorder; gay and bisexual males are at increased risk of such disorders.

Shared Risk Factors

  • Occur in times of transition or stress
  • Common brain chemistry
  • Common family history
  • Low self esteem, depression, anxiety, impulsivity
  • History of sexual or physical abuse
  • Unhealthy parental behaviors and low monitoring of children's activities
  • Unhealthy peer norms and social pressures
  • Susceptibility to messages from advertising and entertainment media

Shared Characteristics

  • Obsessive preoccupation, craving, compulsive behavior, secretiveness, rituals
  • Experience mood altering effects, social isolation
  • Linked to other psychiatric disorders, suicide
  • Difficult to treat, life threatening
  • Chronic diseases with high relapse rates
  • Require intensive therapy
The National Center on Addiction and Substance Abuse (CASA) at Columbia University is the only national organization that brings together under one roof all the professional disciplines needed to study and combat all types of substance abuse as they affect all aspects of society.

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