Authors Bulik, et al. (1992) compare BN and AN at length in their article. As with most other scholarly articles, there is a clear link between high rates of drug use and BN. Specifically a pattern of binge drinking episodes, diuretic, and laxative use particularly in evening hours was found. As I mentioned in reference to my first article, recognizing temporal patterns are important when discussing co-occurring ED and SUD. Moving from an observational to a treatment standpoint, it is reasonable to address the temporal drug use and disordered eating symptoms from a cognitive-behavioral therapy (CBT) standpoint. Bulik, et al. (1992) assert that analyzing these patterns may help bulimic women in developing appropriate treatment techniques for their ED. Therapies such as CBT are especially effective in identifying cues and situations which may be associated with certain behaviors and replacing them with alternate reinforcements at those particular times.
For example, if a women finds that she is most likely to binge drink and ultimately binge eat and purge every night around 8-10 pm, it is reasonable to assume that there are underlying feelings or triggers associated with thoughts or situations experienced at that time of day. CBT is helpful in analyzing thoughts and beliefs, identifying how they relate to a person’s actions, and replacing them with a healthier coping skill. With this information, it is also reasonable to suggest that CBT, when properly administered, can be used effectively to treat a co-morbid case of ED and SUD. By nature, patients suffering from one or both of these disorders may feel a need to hide it from mental health or health care workers. This inability to be honest and upfront initially suggests a need for thought based treatments such as CBT, and giving treatment workers a place to begin (such as temporal patterns) can be fundamental in the affectivity of such treatment.
As previously mentioned, women with a co-occurring ED and SUD tend to be at a high risk for lifelong drug dependence. The authors Herzog, et al. (2006) reiterates this point, also finding that a majority of the women surveyed most commonly abused cocaine and amphetamines. It was also found that there was a strong link between impulsivity, risk taking behaviors and drug abuse, which remains consistent with other studies. Also consistent with other articles I provided was the presence of depression in many of the subjects, which may serve as a risk factor for ED and SUD. Of most importance in this nine year study is the rate in which SUD was seen to have decreased over time. Firstly, most participants were of adolescent age upon entering the study, and one of the possible explanations for this may be accredited to age and maturity.
Drug use tends to be more common in adolescent years, and maturation over the nine year time period could account for a decrease in SUD. Secondly, simple reluctance to disclose any drug use may be an alternate explanation. Finally, response to treatment may be another explanation. This study sample had a high rate of treatment for SUD which may be the most encouraging explanation for a decrease in illicit substance use. If indeed the treatment efforts showed a positive rehabilitation rate in regards to the SUD portion of a co-occurring drug abuse disorder and ED, this may be a crucial first step towards overall recovery. Of course, positive treatment outcomes should not be the only method of SUD rehabilitation we focus on. Anything that may cause a decline in symptomology is of note and deserves critical examination.
