Among adolescents with eating disorders, substance use was most common in those with bulimia nervosa, and older age was the strongest predictor of regular use.
Read this if you want to understand the overlap between eating disorders and substance use in teenagers.
48.7% of teens with bulimia nervosa reported lifetime substance use
What the researchers found
Lifetime substance use prevalence varied substantially by eating disorder diagnosis: 48.7% among adolescents with bulimia nervosa, 28.6% in eating disorder not otherwise specified, and 24.6% in anorexia nervosa. Regular substance use (monthly, daily, or binge patterns) or a substance use disorder was present in 27.9% of all patients.
In the final statistical models, older age was the only factor that consistently predicted regular substance use across all substances. Older age and non-white race were associated with greater alcohol and cannabis use specifically.
While binge-purge frequency and bulimia nervosa diagnosis were associated with substance use in initial analyses, these associations did not hold up once demographic factors like age, gender, and race were accounted for.
Why it matters
Co-occurring substance use and eating disorders in adolescents complicates treatment and worsens outcomes for both conditions. Understanding which subgroups are at highest risk helps clinicians screen more effectively and tailor interventions.
The numbers in context
290 adolescents studied. Lifetime substance use: 48.7% in bulimia nervosa, 28.6% in ED-NOS, 24.6% in anorexia nervosa. Regular substance use or disorder: 27.9% overall.
How the study worked
This cross-sectional study examined 290 adolescents aged 12-18 who presented for initial eating disorder evaluation at the University of Chicago Medicine between 2001 and 2012. Researchers assessed substance use patterns across alcohol, cannabis, tobacco, and other substances, along with DSM-5 eating disorder diagnosis, diagnostic scores, and demographic characteristics. Multinomial logistic regression tested associations between these factors.
What this study cannot tell us
This was a cross-sectional study at a single treatment center, so it cannot establish whether eating disorders lead to substance use or vice versa. Self-reported substance use may be underestimated, especially in a clinical setting. The sample came from one university medical center and may not represent the broader population of teens with eating disorders.
How to read the evidence
This is a cross-sectional study at a single site. It can identify associations but cannot determine causal relationships.
When this study was published
Published in 2014 with data from 2001-2012. The relationship between eating disorders and substance use remains an active area of research.
The bigger picture
The overlap between eating disorders and substance use disorders is well-documented in adults, but less studied in adolescents. This research supports routine substance use screening in adolescent eating disorder settings and highlights that demographic factors, particularly age, may be more important predictors than specific eating disorder features.
Questions still open
- Does treating one condition (eating disorder or substance use) improve outcomes for the other? Are there shared neurobiological mechanisms driving both conditions? Would integrated treatment programs be more effective than treating each condition separately?
Common questions
Why is substance use more common in bulimia than anorexia?
What substances were most commonly used?
Read the original research
Factors associated with substance use in adolescents with eating disorders.
The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 55(2), 182-7
Citation
Mann, Andrea P; Accurso, Erin C; Stiles-Shields, Colleen; Capra, Lauren; Labuschagne, Zandre; Karnik, Niranjan S; Le Grange, Daniel. (2014). Factors associated with substance use in adolescents with eating disorders.. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 55(2), 182-7. https://doi.org/10.1016/j.jadohealth.2014.01.015
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