Search the Library

Abstract: Eating disorders (ED) and substance use disorders (SUD) commonly co-occur, especially in conjunction with posttraumatic stress disorder (PTSD), yet little is known about ED and ED symptoms in women presenting to addiction treatment programs. This study examined the association between ED symptoms and substance use frequency and severity in a sample of women with a DSM IV diagnosis of current SUD and PTSD enrolled in SUD treatment. Participants were 122 women from four substance abuse treatment sites who participated in a multi-site clinical trial through NIDA’s Clinical Trials Network (CTN). The Eating Disorder Examination-Questionnaire (EDE-Q), the Clinician Administered PTSD Scale (CAPS), and the Addiction Severity Index (ASI) were administered at baseline and correlational analyses were performed. Variables that significantly correlated with EDE-Q total and subscale scores were entered into a linear regression analysis. Results found that scores on the EDE-Q Global scale, as well as the Eating Concern, Weight Concern, and Shape Concern subscales of the EDE-Q were significantly associated with Caucasian race/ethnicity, past 30 day opiate use, higher ASI Psychiatric Subscale score, and lower ASI Employment Subscale score. Conclusions: Women in recovery from SUD and PTSD reported concerns about weight, shape, and eating at a higher rate than in the general US population of women. The finding that past 30 day opiate use was associated with EDE scores may indicate that opiates also play a substantial role in disordered eating symptoms. Though exploratory, these findings suggest that there may be a relationship between addiction severity, use of certain drugs of abuse, and eating disorder symptoms, particularly those involving weight and shape concerns in women with comorbid PTSD and SUD. Comprehensive and integrated treatment approaches need to be developed to address this complex but common comorbidity. Related protocols: CTN-0015, CTN-0015-A-1

Abstract:

Though behavioral and pathological similarities between binge eating disorder and substance use disorders are known to researchers, associations between them are poorly studied. We compared pre-treatment BMI in substance users from 7 National Drug Abuse Treatment Clinical Trials Network (CTN) clinical trials with BMIs for age, race and gender comparable participants from the National Health and Nutrition Examination Survey (NHANES). Standardized Prevalence Ratio (SPR) of obesity (BMI>=30kg/m2) was estimated and adjusted for age, gender, and race. ANOVA test was used to compare adjusted mean BMI. Cigarette smoking status was also adjusted for in a subset of participants with available data. Results: CTN participants had lower BMI (N=2017, mean=26.6kg/m2) than NHANES participants (N=10966, mean=28.6kg/m2, p<0.0001). Crude obesity prevalence was 23% and 37% in CTN and NHANES participants, respectively. Adjusted obesity prevalence in CTN participants was 32% lower than NHANES (SPR=0.68, 95% CI: 0.62-0.74). Obesity prevalence in NHANES participants was 2.75 times that in CTN opiate users (N=908, SPR=2.75, 95% CI: 2.27-3.38), but only 1.21 times that in CTN stimulant users (N=1109, SPR=1.21, 95% CI: 1.09-1.34). After further adjusting for smoking, obesity prevalence in CTN stimulant users was not different from NHANES participants (SPR=0.99, 95% CI: 0.90-1.10). BMI for CTN opiate users (mean=25.1kg/m2) was lower than for stimulant users (mean=28.2kg/m2, p<0.001), while obesity prevalence in stimulant users was 2.54 times that in opiate users (SPR=2.54, 95% CI: 2.29-2.81).

Conclusions: Obesity prevalence was significantly lower in substance abusers from CTN trials than in a matched sample of general population. The difference was driven by significantly lower BMI and obesity prevalence in opiate than stimulant users, suggesting substance-specific effects on energy homeostasis and weight regulation. These results warrant further research on relationships between substance use, diet and weight.

Abstract:

Eating disorders (EDs) and substance use disorders (SUDs) commonly co-occur, especially in conjunction with PTSD, yet little is known about ED symptoms in women presenting to addiction treatment programs. This ancillary investigation of data from National Drug Abuse Treatment Clinical Trials Network (CTN) study CTN-0015 (“Women’s Treatment for Trauma and Substance Use Disorders”) hypothesized an association between severity of ED and SUD symptoms in a sample of treatment seeking women with comorbid SUD and PTSD. Participants were 122 women from four treatment sites participating in the original CTN protocol. The Eating Disorder Examination-Questionnaire (EDE-Q) and the Addiction Severity Index (ASI) were administered at baseline. Scores on the Eating, Weight, and Shape Concern subscales of the EDE-Q were significantly correlated with past 30 day cocaine, methadone, other opiate, and polysubstance abuse. All 4 EDE-Q subscale scores were significantly correlated with the number of days experiencing drug problems in the past 30 days. There were also significant correlations with number of years of use of opiates, hallucinogens, and sedative/hypnotics.

Conclusions: These findings suggest a positive relationship between addiction severity and eating disorder symptoms, particularly those involving weight and shape concerns. Assessing and addressing eating disorder symptoms in addiction treatment programs may improve the treatment needs of this patient subgroup.

Related protocols: CTN-0015

Abstract:

The National Institute of Drug Abuse’s National Drug Abuse Treatment Clinical Trials Network (CTN) was established to foster translation of research into practice in substance abuse treatment settings. The multi-site, translational clinical trials of the CTN provide a unique opportunity to examine the outcomes of treatment interventions targeting vulnerable subgroups of women, the comparative effectiveness of gender-specific protocols to reduce risk behaviors, and gender differences in clinical outcomes. This review examined gender-related findings from published CTN clinical trials and related studies from January 2000 to March 2010. CTN studies were selected for inclusion if they focused on treatment outcomes or services for special populations of women with substance use disorders (SUDs) including those with trauma histories, pregnancy, co-occurring eating and other psychiatric disorders, and HIV risk behaviors; or implemented gender-specific protocols. Overall, the CTN has randomized 11,500 participants (41% women) across 200 clinics in 24 randomized controlled trials in community settings, of which 4 have been gender-specific.

Conclusions: These published studies have expanded the evidence base regarding interventions for vulnerable groups of women with SUDs as well as gender-specific interventions to reduce HIV risk behaviors in substance-using men and women. The results also underscore the complexity of accounting for gender in the design of clinical trials and analysis of results. To fully understand the relevance of gender-specific moderators and mediators of outcome, it is essential that future translational studies adopt more sophisticated approaches to understanding and measuring gender-relevant factors and plan sample sizes that are adequate to support more nuanced analytic methods.

Abstract:

A strong association between substance use disorders (SUD) and eating disorders (ED) in women has been established. Yet, little is known about the rates and impact of ED symptoms in women presenting to addiction treatment. This ancillary investigation assessed the prevalence of ED symptoms and their affect on treatment outcomes in a sample of substance abusing women with co-occurring posttraumatic stress disorder (PTSD) enrolled in outpatient substance use programs. Participants were 122 women from four of the CTPs participating in a multi-site clinical trial comparing two behavioral treatments for co-occurring SUD and PTSD (protocol CTN-0015, “Women’s Treatment for Trauma and Substance Use Disorders”). The Eating Disorder Examination self-report (EDE-Q) and measures of PTSD and SUD symptoms were administered at baseline, during treatment, and at four follow-up points. Two subgroups emerged; those reporting binge eating in the 28 days prior to baseline (Binge group; n=35) and those who reported no binge eating episodes (No Binge group; n=87). Women in the Binge group endorsed significantly higher ED, PTSD, and depression symptoms at baseline than those in the No Binge group. Though all participants showed significant reductions in PTSD symptoms and improvements in abstinence rates during the study period, the improvements for the Binge group were significantly lower.

These findings suggest that a sub-group of women with co-occurring PTSD and SUDs who endorsed binge ED symptoms responded differently to SUD/PTSD group treatment. Identification of eating disorder symptoms among treatment-seeking women with SUDs may be an important element in tailoring interventions and enhancing treatment outcomes.

Related protocols: CTN-0015-A-1

Abstract:

This study, a product of the CTN Gender Special Interest Group (SIG) surveyed publicly funded addiction treatment programs to increase understanding of treatment options for persons with co-occurring eating and substance use disorders. Data were collected between 2002 and 2004 from face-to-face interviews with program directors of a nationally representative sample of 351 addiction treatment programs. It was found that half of the programs screen patients for eating disorders, of which 29% admit all persons with eating disorders, and 48% admit persons with eating disorders of low severity. Few programs attempt to treat eating disorders. Programs that admit and treat patients with eating disorders are more likely to emphasize a medical-psychiatric model of addiction, use psychiatric medications, admit patients with other psychiatric disorders, and have a lower caseload of African-American patients.

In conclusion, it appears that, generally, patients with co-occurring eating and substance abuse do not appear to receive structured assessment or treatment for eating disorders in addiction treatment programs. These results highlight the need for education of addiction treatment professionals in assessment of eating disorders.