Substance Use Disorders and Eating Disorders

Dealing with increased risk when the two coexist.

Co-occurrence of eating disorders and substance use disorders is common, and also challenging for clinicians. Most treatment programs are very comfortable with the disorders they typically treat (ED or SUD) but view the co-occurrence of the two as risky. A new study underscores and supports that perception of increased risk.

In the study, Mellentin and colleagues used Danish data registers to examine mortality in patients with both ED and SUD (Am J Psychiatry. 2021; 1-11, doi: 10: 10-1176/appi.ajp.21030274). Data were included on 20,759 people with EDs; information was also available on abuse of alcohol, cannabis, or “hard drugs.”

Results showed that having an SUD increased the risk of dying. For those with ED but not SUD, there was also a higher risk of death (Hazard Ratio (HR) 2.85). This fits with what we already knew: that those with EDs are at higher risk of death. In this study, having an SUD markedly increased risk. Substances that directly increased risk included alcohol (HR 11.84), cannabis (4.55), and “hard drugs” (14.16). For those with all three (HR 22.99), the risk was even higher.

These figures make clear the risk of co-occurring ED and SUD. They should be taken as a strong endorsement of the need for more combined ED-SUD treatment programs.

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