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Drunkorexia: Calorie restriction prior to alcohol consumption among college freshman


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Using a sample of 692 freshmen at a southeastern university, this study examined caloric restriction among students prior to planned alcohol consumption. Participants were surveyed for self-reported alcohol consumption, binge drinking, and caloric intake habits prior to drinking episodes. Results indicated that 99 of 695 (14%) of first year students reported restricting calories prior to drinking, with 6% reporting this behavior to avoid weight gain and 10% to enhance alcohols effects; no significant differences were found between males and females. Based on the study findings, practical campus-based and student-centered education and prevention strategies are presented to explore solutions to reduce drunkorexia. Effective evidence-based behavior change brief interventions such as Motivational Interviewing and the Brief Alcohol Screening and Intervention for College Students (BASICS) program are presented and discussed.
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August, 2010
Volume 54(2), 17-35.
Drunkorexia: Calorie Restriction Prior to
Alcohol Consumption among College Freshman
Sloane C. Burke1, Jennifer Cremeens1, Karen Vail-Smith1, Conrad L. Woolsey2
East Carolina University1
Oklahoma State University2
Using a sample of 692 freshmen at a southeastern university, this study examined caloric
restriction among students prior to planned alcohol consumption. Participants were
surveyed for self-reported alcohol consumption, binge drinking, and caloric intake habits
prior to drinking episodes. Results indicated that 99 of 695 (14%) of first year students
reported restricting calories prior to drinking, with 6% reporting this behavior to avoid
weight gain and 10% to enhance alcohols effects; no significant differences were found
between males and females. Based on the study findings, practical campus-based and
student-centered education and prevention strategies are presented to explore solutions to
reduce drunkorexia. Effective evidence-based behavior change brief interventions such as
Motivational Interviewing and the Brief Alcohol Screening and Intervention for College
Students (BASICS) program are presented and discussed.
The misuse of alcohol and disordered eating are both major concerns on college
campuses nationwide. Several studies have examined alcohol use among college
students. In 2002, O’Malley and Johnston reviewed findings from several national data
sets which examined alcohol use among college students including the: College Alcohol
Study, the Core Institute, Monitoring the Future, and the National College Health Risk
Behavior Survey. Results of these national surveys are consistent indicating that
approximately 70% of college students report using alcohol in the past month and about
40% report binge drinking (defined as 4 drinks for women and 5 for men in one sitting).
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In 2008, more than three-fourths of college students reported alcohol use in the past
month (American College Health Association). Despite increased education and
prevention efforts over the past 15 years, the misuse of alcohol does not appear to have
changed much. In 2001, Hingson, Heeren, Zakocs, Kopstein, and Wechsler found that
the frequency of binge drinking among college students had remained the same since
1993. Despite increased efforts to prevent alcohol misuse among college students, the
prevalence of binge drinking remained fairly stable between 1993 and 2001, and the
prevalence of frequent binge drinking (3 or more times in the past two weeks) increased
from 19.7% to 22.8% (Wechsler, Lee, Kuo, Seibring, Nelson, & Lee, 2002).
Additionally, the percentage of students who reported drinking on 10 or more occasions
in the past 30 days increased (18.1% to 22.6%) and student who reported being drunk
three or more times in the past 30 days increased (23.4% to 29.4%). To reach these
conclusions about alcohol consumption patterns, Wechsler et al. (2002) examined four
waves of data from the 1993, 1997, 1999, and 2001 College Alcohol Study. Compiled
together, these studies indicate that the majority of college students use alcohol and a
large number (nearly half) participate in binge drinking episodes. Additionally, results
suggest that students who are binge drinkers binge more frequently today than in the past
(Ford, 2007).
Many college students engage in binge drinking and it appears that the majority of
alcohol consumed is done so by students who engage in this behavior (Wechsler, Molnar,
Davenport, & Baer, 1999). The College Alcohol Study (CAS) conducted at Harvard
University found that “frequent binge drinkers,” defined as those who engaged in binge
drinking on three or more occasions in the past two weeks, only constituted 19% of the
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sample, but consumed 68% of the 87,008 total drinks (Wechsler et al., 1999). In this
study, frequent binge drinkers also consumed an average of 17.9 drinks in a week. In
comparison, Infrequent binge drinkers, defined as those who engage in binge drinking no
more than two times in the past 2 weeks comprised 24% of the sample and only
consumed 23% of the total alcohol averaging 4.8 drinks a week. This study is just one of
many that demonstrate the ubiquitous nature of excessive alcohol consumption on college
First-year college students have been identified as a high-risk population for
engaging in the behavior of binge drinking (Larimer & Cronce, 2002). Research
indicates that freshman are the most vulnerable to experience serious alcohol related
problems in their first few months of school, with this being a time that they are likely to
engage in high-risk drinking behaviors (Larimer & Cronce, 2002). Several studies have
reported an increase in quantity and frequency of alcohol consumption among first-year
students (Baer, Kivlahan, & Marlatt, 1995; Bishop, Weisgram, Holleque, Lund, &
Wheeler-Anderson, 2005; Grekin & Sher, 2006; Weitzman, Nelson, & Wechsler, 2003).
Some factors that have been indentified for contributing to this increase are: First-year
students are faced with heightened academic rigor, college campus social norms
promoting alcohol use, and a drastic decline in parental supervision during the transition
to college life (Baer, 2002; Baer & Bray, 1999; Baer, Kivlahan, & Marlatt, 1995;
Schulenburg & Maggs, 2002; Schulenburg et al., 2001). First-year students also make up
the majority of students attending parties at dorms and Greek houses where alcohol is
most commonly consumed in the form of binge drinking on Thursday, Friday, and
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Saturday nights (Del Boca, Darkes, Greenbaum, & Goldman, 2004; Harford, Wechsler,
& Seibring, 2002;).
Disordered Eating
Disordered eating is also a significant issue on college campuses. According to
the National Eating Disorder Association (2006), approximately 20% of college students,
both male and female, reported that they have had an eating disorder at some point in
their lives. Studies have also discovered other subclinical disordered eating behaviors
among college students which include: binge eating, chronic dieting, fasting or purging to
control weight, self-induced vomiting, and the use of diet pills or diuretics (Forman-
Hoffman, 2004; Mints & Betz, 1988; Tylka & Subich, 2002.). Furthermore, the
freshman year of college is marked by an increase risk in disordered eating and the
perpetually rumored “freshman 15,” at term used to describe weight gain thought to
typically occur during this time period (Anderson, Shapiro, & Lundgren, 2003; Hoffman,
Policastro, Quick, & Lee, 2006; Striegel-Moore, Silberstein, & Rodin, 1986). Therefore,
while the general college student population may engage in extreme behaviors relating to
weight control, freshman may be at an even greater risk for such behaviors due to the
additional stress and environmental changes in this transition year.
The co-occurrence of eating disorders and alcohol misuse has been noted in many
research studies (Dansky, Brewerton, & Kilpatrick, 2000; O’Brien & Vincent, 2003;
National Center on Addiction and Substance Abuse at Columbia University [CASA],
2001). A 2001 CASA report, estimated that 30-50% of individuals with bulimia and 12-
18% of individuals with anorexia either abuse or are dependent on alcohol. In addition,
results indicated a distinct comorbidity between substance dependency and eating
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disorders with approximately 35% of people with alcohol or drug dependency also being
identified to have an eating disorder. Among college students, studies have demonstrated
an association between alcohol use and unhealthy eating patterns. This association
extends beyond those clinically diagnosed with an eating disorder to include those with
less severe disordered eating behaviors such as binge eating (Cooley & Toray, 1996;
Krahn, Kurth, Gomberg, & Drewnowski, 2005; Anderson, Simmons, Martens, Ferrier, &
Sheehy, 2006; Krahn, Kurth, Demitrack, & Drewnowski, 1992). Krahn et al. (1992)
noted a positive relationship between dieting severity and frequency of alcohol
consumption and binge drinking. Stewart, Angelopoulous, Baker, & Boland (2000) found
similar results, which indicated that higher levels of dietary restraint were associated with
increased excessive drinking episodes and the likelihood of being classified as a binge
Among a population who is already at-risk to suffer from serious alcohol related
consequences, the restriction of calories or not eating prior to alcohol consumption makes
the use of alcohol even more dangerous. Studies among those who engage in disordered
eating behaviors such as vomiting after eating, binge eating, caloric restriction, taking
laxatives or stimulants for weight loss, etc. indicate a higher propensity to experience
alcohol-related negative consequences, such as doing something regretted, engaging in
forced intercourse, and blacking-out (Anderson, Martens, & Cimini, 2005; Dams-
O’Conner, Martens, & Anderson, 2005; Dunn, Larimer, & Neighbors, 2002; Krahn,
Hurth, Gomberg, & Drewnowski, 2004; White, A, 2004). For women, the effects of not
eating prior to alcohol consumption are a great concern as women are already at an
increased risk to suffer from serious alcohol related consequences due to differences
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between the sexes. Women generally weigh less, have less alcohol metabolizing
enzymes (alcohol dehydrogenase), and typically have less total body water to dilute
alcohol in the blood. Freeze et al. (1990) found that gastric alcohol dehydrogenase
activities were 70-80% higher in nonalcoholic men than nonalcoholic women. These
differences in alcohol metabolism make women more vulnerable than men to the
development of cirrhosis, brain damage, and other health conditions resulting from
alcohol misuse (National Institute on Alcohol Abuse and Alcoholism [NIAAA]; 1993).
Regardless as to whether one is male or female, drinking on an empty stomach allows
alcohol to get into the body faster, which raises blood alcohol levels higher and leads to
increased risks for brain impairments (blackouts) and resultant negative health and
behavioral consequences (White, 2004).
The term “drunkorexia” was coined by popular media in 2008 to describe the
practice of restricting calories so more alcohol can be consumed without gaining weight
(CBS News, 2008; Kershaw, 2008; Smith, 2008; Stopper, 2008). Drunkorexia joins an
increasing list of eating disorder “diagnoses” not recognized or condoned by the medical
community, including “manorexia” (anorexia in men), diabulimia (diabetics using insulin
restriction to purge) and even “bridorexia” (brides starving to fit into a certain size
wedding dress).
Several studies explore the relationship between disordered eating behaviors and
alcohol consumption, but few examine the eating motives among individuals engaging in
such behaviors and only one looks at the issue of restricting calories (Anderson,
Simmons, Martens, Ferrier, & Sheehy, 2006; Giles, Champion, Sutfin, McCoy, Wagoner;
2009; Luce, Engler, & Crowther, 2007). Additional assessment of these behaviors on
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days proceeding nights of heavy drinking has yet to be explored therefore there is a need
for additional assessment of calorie restriction prior to alcohol consumption. This study
examines the frequency of disordered eating behaviors, specifically restricting caloric
intake on days when heavy alcohol consumption was expected. The research questions
for this study included: 1) Do freshman students who have consumed alcohol in the past
30 days restrict their caloric intake on the days they choose to drink? 2) Do freshman
students who have binge drank in the past 30 days restrict their caloric intake on the days
they choose to drink? 3) Does race/ethnicity impact one’s behavior to restrict caloric
intake on days when one chooses to drink? 4) Does gender impact one’s behavior to
restrict caloric intake on days when one chooses to drink? 5) Does BMI impact one’s
behavior to restrict caloric intake on days when one chooses to drink?
During the Spring semester of 2008, undergraduate students enrolled in a required
personal health course at a large southeastern university comprised the study population
(N = 2,005). The survey was administered online and completed by students outside of
class for extra credit at their convenience. Of the 2,005 students enrolled, 1,349 (67.3%)
completed the online survey. Since this research focused on first-year freshmen who
used alcohol, results included only the 692 respondents (70%) who met these criteria.
The 20-item survey included 13 personal/demographic items, two items soliciting height
and weight information, and two items inquiring about alcohol use. Because there is
limited research pertaining to restricting food consumption before drinking, an
established instrument was not available. Therefore, the researchers developed and
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included three items to explore this unique issue further. Content and face validity was
established by consulting experts in the field.
Using a paired samples t test, instrument reliability was tested via test re-test
method in a two-week interval during summer of 2008. A strong internal reliability was
found with a correlation reliability of .86 (McDermott & Sarvela, 2003). Differences
between age, gender, race/ethnicity, and BMI were analyzed using chi-square analysis to
test for significance between each group.
The study population comprised of 692 first-year college students who reported
drinking in the last 30 days. Table 1 displays the demographics of freshman students
studied. The age breakdown of the population with the majority of the respondents being
19 years of age (55%), followed by 18 year olds (44%) and 20 years of age (1%). The
majority of the sample was female (68%, n = 473) and Caucasian (87%, n = 584).
Almost all of the students sampled were full-time students and had never been married
(99% and 98% respectively). Eighty-four percent (n = 495) live in a college dormitory or
residence hall with 14% (n = 83) living in off-campus housing or an apartment. Six
percent (n = 40) of respondents lived alone and 88% (n = 518) lived with a roommate or
friend. Twelve percent (n = 72) of respondents were in a social fraternity or sorority.
Seventy-two percent (n = 451) did not work at all with 15% of those sampled working
with pay 10 hours or more a week.
Table 1: Demographics (N = 692)
44% (n = 304)
55% (n = 382)
1% (n = 6)
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68% (n = 473)
31% (n = 217)
87% (n = 584)
African American
8% (n = 63)
1% (n = 11)
Asian Pacific Islander
2% (n = 19)
2% (n = 15)
Frequency analyses revealed that 83% of the total population of first-year students
(n = 945) drank alcohol in the past 30 days, with the mean number of drinking days being
3.17 (SD = 1.47). See Table 2 for the alcohol use patterns among first year student
drinkers. The majority of respondents (26%) binged 6-9 days per month, followed by
25% of respondents reporting binge drinking on 3-5 days and 23% of the respondents
binge drinking on 1-2 days in the past 30 days (See Table 2). The mean number of days
binge drinking occurred was 3.11 (SD = 1.76).
Table 2: Alcohol use patterns among first year student drinkers
Current Use
1-2 days
3-5 days
6-9 days
10-19 days
20+ days
Chi-squared analyses revealed significant differences between males and females
(x2= 18.80; p < .05) and ethnicities for respondents who drank alcohol in the past 30
days. Consistent with previous alcohol research, Caucasians reported drinking more
frequently than black participants (x2=1.06, p< 0.05), particularly for the 6-9 (27% versus
13%) and 10-19 (22% versus 13%) day ranges. Females reported using alcohol less
frequently than males. The number of females who reported drinking was higher than
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males in all frequency categories during the past 30 days, with this difference becoming
less pronounced as the frequency of drinking occasions increased (See Table 3).
Table 3: Frequency of alcohol use among first-year students by ethnicity and gender. *
1 - 2
Ethnicity (%)
African Americans
* Results limited to current drinkers.
**Latino, Asian Pacific Islander, American Indian were too small to report.
Table 4: Alcohol use patterns among first-year students reporting restriction of calories
on days they knew they were going to drink.
Ninety-nine of 692 (14.2%) of first-year students sampled restricted their caloric
intake on days they knew alcohol consumption would occur. Of those first-year students
who engaged in this behavior, 70% (n = 70) were female and 29% (n = 29) were male.
Thirty-nine first-year students (72% females, 28% males) reported restricting calories
before drinking to avoid gaining weight. Sixty-eight respondents (68% females, 32%
males) reported restricting calories to feel alcohols’ effects better.
Alcohol consumption was significantly different between students who reported
restricting calories on days they knew they were drinking and those who did not engage
Current Drinkers
Binge Drinkers
% Diff.
% Diff.
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in such behaviors (x2=47.66, p<.01; See Table 4). The majority of students who restricted
calories (30%) reported drinking 10-19 of the last 30 days, followed by 6-9 days (25%)
and 3-5 days (23%). A Chi-square analysis also revealed statistical significance
(x2=36.86, p<.01) among first-year students who reported binge drinking when restricting
calories prior to drinking and the frequency of binge drinking occasions. Similar to
current drinkers, some of the calorie restrictors (33%) reported binge drinking 10-19
days, followed by 6-9 days (23%). However, approximately one-fifth (21%) of binge
drinking students who restricted calories reported binge drinking on more than 20 days in
the past 30 which showed that not only was restricting calories a problem, but binge
drinking when doing so was also quite common.
Although significance was found (p < .01), the sample size for those in a sorority
or fraternity (n = 72) and being on an NCAA sports team (n = 42) were both too small to
test for significance. No significance was found for BMI, sex, ethnicity, and calorie
restricting or non-restricting respondents.
Qualitative Results
Thirty-two students provided qualitative responses regarding why they restricted
calories before drinking. Five themes emerged from these responses: 1) increased ability
to drink; 2) to prevent being sick; 3) forgot to eat; 4) not hungry; and 5) lack of money.
The two most common responses as to why calories were restricted before drinking were
to prevent being sick and to increase their ability to drink more alcohol. Students
indicated that they “did not want to throw up” or “so that I would not feel sick with the
consumption of alcohol and food.” Students also shared that they did not eat prior to
drinking so the food would not take up the beer room, and because of not being able to
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drink as much”, and “beer lasts longer that way”. Only one student indicated that the
reason for restricting calories prior to drinking was to account for the extra caloric
content of alcohol.
The popular media has insinuated that drunkorexia is enough of a problem to
justify its own pseudo-medical diagnosis. Our findings suggest that the incidence of full
blown drunkorexia may not be as widespread as portrayed by the media, but we did find
that 99 out of 692 first year college student drinkers engaged in disordered eating and
reported restricting calories prior to consuming alcohol. The fact that 99 students in our
sample are engaged in this behavior illustrates that refraining from caloric intake prior to
drinking is a college health issue. In addition, results revealed that more than ¾ of the
freshman population reported drinking (the highest percentage drinking 6-9 days a
month) with over half reporting binge drinking episodes.
College students have already been identified as an at-risk group to suffer from
problems associated with alcohol use. Furthermore, among college students, Freshman
have been found to be more susceptible to negative alcohol related consequences such as
blackouts, motor vehicle accidents, and unwanted sexual activity. To what extent does
calorie restriction prior to alcohol consumption further contribute to alcohol related
problems? Findings from this study indicated that 14% of first-year college students are
restricting calories on days of planned alcohol consumption and those who restricted
calories were more likely to participate in binge drinking. This is a particular health
concern because not eating prior to alcohol consumption increases alcohols’ toxicity and
the subsequent health consequences such as brain and organ damage. Alcohol is also
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known for its vitamin (e.g., B-vitamins) and nutrient leaching qualities. By replacing
food calories with alcohol calories students are more likely to suffer from other health
problems related to nutritional deficits. College students also need to be aware that
alcohol alters the bodies’ normal metabolic processes and its ability to regulate blood
sugar levels. By drinking on an empty stomach, students are more likely to suffer serious
health consequences from alcohol induced hypoglycemia including traumatic brain
injuries, witnessed by memory lapses and blackouts. Students should be informed that
alcohol does not just kill our extra brain cells used to store memories, but it also kills
brains cells (neurons) which are responsible for our future learning and cognitive
abilities. Students should be well aware that drinking inhibits the storage and formation
of new memories and reduces cognitive functioning. Though not significant and
reflective of the sample, frequencies revealed that primarily female freshman restricted
calories when they knew they were going to drink. Of those who restricted calories,
some did so to avoid gaining weight, which may indicate disordered eating behavior
associated with drinking among this sample. Our findings are lower than previous
research which has shown 30-50% of individuals with bulimia and 12-15% of those with
anorexia abuse or are dependent on alcohol (Dansky et al., 2000; O’Brien & Vincent,
2003; CASA, 2001). It is important to note that there does not have to be a clinical
diagnosis of an eating disorder and the pathology of disordered eating may actually be
problematic but not severe (Cooley & Toray, 1996; Krahn et al, 2005; Anderson et al.,
2006; Krahn et al., 1992). In addition, more females than males (close to 70%) restrict
calories to feel the effects of the alcohol better. Interestingly, no association was found
between body mass index (BMI) and alcohol consumption patterns. The sample size was
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too small to draw conclusions regarding other specific campus groups associated with
high-risk alcohol consumption, such as students in Greek organizations or on athletic
teams, and their engagement in restricting calories. Future studies may want to focus on
these groups to better assess their engagement in this behavior.
Our findings confirm previous research by Baer et al. 1995 ; Bishop et al., 2005;
Grekin & Sher, 2006; Weitzman et al., 2003 who have reported an increase in quantity
and frequency of alcohol consumption among first-year college students. Binge drinking
among college Freshman may be a negative coping behavior to deal with pressures from
college life including academic pressure, financial stress, and stressors of new found
More qualitative studies are needed to further assess these reasons among all
college students, not just those in their first year. This study did begin to shed some light
in this area with respondents sharing that they did not want to get sick or vomit, they
wanted to be able to drink more alcohol, or that food prohibited them from feeling the
effects of alcohol. Regardless of the reason for engaging in this behavior, alcohol
prevention programs and campus-based education need to be aware that this behavior
This study was implemented in the spring semester of the academic year when
students may have had varied exposure to campus wellness efforts. It is also possible that
students were drinking less and experiencing less stress leading to drinking during their
second semester. Research suggests that students may encounter greater stress during
their first semester due to being away from home for the first time, living in a new
environment or home, and increased responsibility (Burke, Wallen, & Rager, 2008). If
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implemented again, it is recommended to assess the fall semester of new freshman to
control for these issues.
Future studies should examine calorie restriction prior to drinking among all
college students including other high-risk populations such as athletes and students in
Greek organizations. Incoming freshman should be educated about the increased health
risks associated with calorie restriction prior to alcohol consumption. Health
professionals should also be prepared to address concerns and questions about
drunkorexia. While the merits of using such a term are questionable, the media publicity
accompanying it does afford college health professionals a “moment of gestalt” to
promote healthy eating and responsible drinking behaviors.
Results of this study reiterate the continuing problem of risky drinking habits
among college Freshman. There are effective alcohol interventions available such as the
Brief Alcohol Screening and Intervention for College Students BASICS (Dimeff, Baei,
Kivlahan, & Marlatt, 1999). BASICS draws heavily from both cognitive-behavioral
skills training and Motivational Interviewing (MI). MI can be used as a student-centered
behavior change intervention strategy and has been clinically proven to be an effective
tool for managing resistance and ambivalence toward change. Motivational Interviewing
is a flexible intervention approach and has strong health behavior change theoretical ties
to many popular theories such as the Transtheoretical Model. In practice, MI focuses on
personal needs and positive motivations and has been shown to be particularly effective
when students are in the pre-contemplative and contemplative stages of change (Rollnick,
Miller, & Butler; 2008). The results of this study, suggest a possible need for
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modifications to existing alcohol education and prevention programs to include important
health information about the dangers of calorie restriction and drunkorexia.
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... However, a more novel pattern of behaviors, known as food and alcohol disturbance (FAD) has been recognized as problematic drinking behaviors (i.e., alcohol misuse) in co-occurrence with disordered eating as a way for individuals to compensate for calories gained from alcohol consumption [2,3]. Individuals engaging in FAD behaviors compensate for the calories consumed through alcohol by restriction of caloric intake prior, during, or after alcohol consumption or engaging in other weight-related compensatory behaviors (e.g., purging, over-exercising) [2,[4][5][6]. Individuals who engage in this unhealthy pattern of behaviors may be also motivated to increase the effects of intoxication through the engagement in disordered eating [2]. ...
... Disordered eating (e.g., skipping meals, caloric restriction) prior to consumption of alcohol can increase the effects of intoxication [7]. Prior literature examing FAD behaviors has shown that some individuals have engaged in disordered eating patterns prior to consuming alcohol to increase the effects of alcohol [1,2,[4][5][6]. ...
... Approximately 40% of college students have been found to restrict food and caloric intake prior to alcohol consumption [19]. Among college freshmen specifically, 14% of students have been found to engage in restricting caloric intake before drinking alcohol [6]. College students may be a particularly at-risk group for engagement in FAD behaviors because college is a significant life transition and social norms are commonly a predictor of maladptive behaviors [20,21]. ...
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Purpose Current research examining mental health and history of childhood trauma as risk factors of food and alcohol disturbance (FAD) is limited. College students may be at greater risk to engage in FAD behaviors because of the common co-occurrence of alcohol misuse and disordered eating behaviors within college populations. Therefore, the current study examined anxiety, depression, and adverse childhood experiences as possible risk factors of FAD behaviors in a college student sample. Methods Two-hundred and seven undergraduate students from a large Midwest university completed a cross-sectional survey assessing history of adverse childhood experiences, depressive symptoms, anxiety symptoms, FAD behaviors, and frequency of alcohol use. Results Current symptoms of generalized anxiety were significantly associated with engagement in FAD behaviors (Alcohol Effects subscale, β = 0.13, F(1, 204) = 4.10, p = 0.04; Bulimia subscale, β = 0.17, F(1, 204) = 6.19, p = 0.01; Diet and Exercise subscale, β = 0.19, F(1, 204) = 9.05, p < 0.01). Adverse childhood experiences were associated with engagement in FAD behaviors (Alcohol Effects subscale, β = 0.14, F(1, 204) = 4.27, p = 0.04). Current depressive symptoms were not significantly associated with FAD behaviors. Conclusions Study findings suggest that students who experience greater current symptoms of anxiety are at a greater risk to engage in FAD behaviors. Further understanding the role of anxiety in the development and maintenance of FAD behaviors may provide clinically useful information for the prevention and treatment of FAD behaviors. These findings highlight the need for further research to examine psychological distress as a risk factor for engagement in FAD behaviors longitudinally, in a larger, more diverse study sample. Level of evidence Level V, cross-sectional descriptive study.
... The results of the data extraction process included 22 articles meeting the eligibility of publication, authors, study design, sample size, age of participants, college student population, collection of self-identified gender information, and drunkorexia measurement (CEBRACS or DMBS) are listed in Tables 1 and 2. The article by Pietrabissa et al. 38 was included despite the age range (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) due to limited available studies that qualified and the closeness in age range for college students (17)(18)(19)(20)(21)(22). Of these 22 studies, 20 took place in the U.S. 11,12,[28][29][30][31][32][33][34][35][36][37][38][40][41][42][43][44][45][46][47] , and 2 were based in Italy. ...
... The results of the data extraction process included 22 articles meeting the eligibility of publication, authors, study design, sample size, age of participants, college student population, collection of self-identified gender information, and drunkorexia measurement (CEBRACS or DMBS) are listed in Tables 1 and 2. The article by Pietrabissa et al. 38 was included despite the age range (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) due to limited available studies that qualified and the closeness in age range for college students (17)(18)(19)(20)(21)(22). Of these 22 studies, 20 took place in the U.S. 11,12,[28][29][30][31][32][33][34][35][36][37][38][40][41][42][43][44][45][46][47] , and 2 were based in Italy. ...
ABSTRCT Background Drunkorexia includes calorie restriction, excessive exercise, and/or purging in combination with alcohol consumption. Exploring drunkorexia by gender could inform potential intervention to address varying rates of drunkorexia, blood alcohol concentrations, and alcohol-related consequences. Purpose The purpose of this systematic review is to examine potential gender differences in drunkorexia among college students. Methods Search engines were used to find studies utilizing college students (2012–2021) and drunkorexia measures, resulting in 22 studies. Results Weighted mean scores and independent-sample t-tests of subscales for both the Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale (CEBRACS) and Drunkorexia Motives and Behaviors Scale (DMBS) showed no significant differences between females and males. Discussion The lack of difference indicates the need to consider diet, purging, and exercise as separate drunkorexia control techniques as opposed to one drunkorexia construct and indicates trends by gender may have evolved over the last decade. Translation to Health Education Practice Understanding the unique direct and secondhand health effects of drunkorexia by gender might assist in counteracting negative alcohol consequences potentially exacerbated by drunkorexia (e.g., overdose, injuries, death), and inform multiple CHES® and MCHES® areas of responsibilities and competencies to improve interventions to reduce risky alcohol consumption among college students.
... Drunkorexia (also known as food and alcohol disturbance) refers to a pattern of restrictive and compensatory behaviors that are practiced when drinking is planned, in order to compensate for the calories consumed and/or to enhance the intoxicating effect of the alcohol [41][42][43]. These behaviors include self-imposed calorie restriction, fasting, purging, and excessive exercising [44]. ...
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The COVID-19 outbreak negatively affected young adults’ psychological well-being, increasing their stress levels and symptoms of anxiety and depression, and potentially triggering health-risk behaviors. The present study was aimed at investigating the psychological impact of the COVID-19 pandemic on alcohol abuse and drunkorexia behaviors among young adults living in Italy. Participants were 370 emerging adults (63% women, 37% men; Mage = 21.00, SDage = 2.96, range: 18–30) who were recruited through an online survey between November 2021 and March 2022. Participants completed measures of alcohol abuse, drunkorexia behaviors, negative life experiences, and post-traumatic symptoms related to the COVID-19 outbreak. The results showed that the emotional impact and negative life experiences associated with the pandemic predicted both alcohol abuse and drunkorexia behaviors, albeit in different ways. Specifically, the number of negative life experiences during the pandemic and the tendency to avoid COVID-19–related negative thoughts positively predicted alcohol abuse; and the presence of intrusive thoughts associated with the pandemic significantly predicted the frequency of drunkorexia behaviors. Implications for research and clinical practice are discussed.
... More specifically, this phenomenon is characterized by the following behaviors (Chambers, 2008): (1) skipping meals in order to save calories for later consumption of alcoholic beverages or to compensate for an increased caloric intake from previous alcohol consumption, (2) exercising excessively in order to compensate for the calories consumed by drinking, and/or (3) consuming enormous amounts of alcoholic beverages in order to become ill and purge previously ingested foods. Consequently, drunkorexia consists of three distinctive dimensions: consumption/abuse of alcoholic beverages, physical activity, and disordered eating; specifically, this combination is adopted as a means to offset caloric intake from alcohol use or even to potentiate alcohol intoxication as part of sensation-seeking tendencies (Burke et al., 2010;Hill & Lego, 2019). In addition to these different characteristics, drunkorexia has been shown to be correlated with eating disorder symptoms, such as low body esteem, body dissatisfaction, fear of gaining weight, and an extreme desire to be slim (Eisenberg & Fitz, 2014;Hill & Lego, 2019;Rahal et al., 2012). ...
Background: Drunkorexia is a food and alcohol disturbance described as being a range of disordered and compensatory eating behaviors that co-occur with excessive alcohol consumption. The remarkable correlation, highlighted in the literature, between dysfunctional cognitions and both eating disorders and substance use disorders is able to emphasize that cognitive phenomena can be an intrapersonal factor linked to drunkorexia disorder. The aim of this study was to assess the correlation between early maladaptive schemas (EMSs) and drunkorexia among a sample of Lebanese adults. Method: We conducted a cross-sectional study across all the Lebanese governorates (September-December 2020; N=258). The Drunkorexia Motives and Behaviors Scales, Drunkorexia Fails Scale, Drunkorexia during an Alcohol Consumption Event Scale, and Post-Drinking Compensation Scale were used to assess drunkorexia, whereas the Young Schema Questionnaire-Short Form 3 was used to measure EMSs. Results: Emotional deprivation and subjugation were significantly associated with more drunkorexia motives, whereas emotional inhibition was significantly associated with less drunkorexia motives. Failure was significantly associated with more drunkorexia behaviors. Abandonment and mistrust were significantly associated with more drunkorexia fails, whereas unrelenting standards was significantly associated with less drunkorexia fails. Subjugation was significantly associated with more drunkorexia during alcohol consumption on events. Social isolation was significantly associated with more post-drinking compensation, whereas unrelenting standards was significantly associated with less post-drinking compensation. Conclusion: Our findings showed that drunkorexia is positively associated with EMSs, delineating as well the specific relationships between dysfunctional cognitive schemas and drunkorexia’s maladaptive behavioral aspects. They support the hypothesis that EMSs might play an important role in drunkorexia’s development and perpetuation. This study could therefore serve healthcare professionals for the cognitive approach of patients with concomitant alcohol misuse and eating disorders while emphasizing the value of cognitive-behavioral interventions—namely schema therapy.
... drinking". 88 In a study of college freshmen, 89 although 14% of participants restricted calories before consuming alcohol, only 5.6% did so to avoid weight gain; the remaining students reported restricting calories to enhance alcohol's effects, which has also been shown in other studies. 90 In a similar vein, in an experimental laboratory study which involved exposing predominantly young adult university participants to energy labelling on an alcoholic drink, participants were asked about how they might use energy labelling in future. ...
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Alcohol is calorie dense, but unlike food products, alcoholic drinks tend to be exempt from nutritional labelling laws that require energy content information to be displayed on packaging or at point of purchase. This review provides a perspective on the likely efficacy of alcoholic drink energy labelling as a public health policy to reduce obesity and discusses key questions to be addressed by future research. First, the contribution that alcohol makes to population level daily energy intake and obesity is outlined. Next, consumer need for alcohol energy labelling and the potential impacts on both consumer and industry behaviour are discussed. Pathways and mechanisms by which energy labelling of alcoholic drinks could reduce obesity are considered, as well as possible unintended consequences of alcoholic drink energy labelling. Would widespread energy labelling of alcoholic drinks reduce obesity? The unclear effect that alcohol has on population level obesity, the modest contribution calories from alcohol make to daily energy intake and limited impact nutritional labelling policies tend to have on behaviour, suggest alcohol energy labelling alone may have limited impact on population obesity prevalence as a standalone policy. However, there are a number of questions that will need to be answered by future research to make definitive conclusions on the potential for alcohol energy labelling policies to reduce obesity. This article is protected by copyright. All rights reserved. Would widespread energy labelling of alcoholic drinks reduce obesity? We provide a perspective on the potential of this obesity policy" cd_value_code="text
... Indeed, drunkorexia refers to indulging in a purposeful calorie restriction pattern on days when drinking alcohol is planned. The tendency to counterbalance the calories consumed through alcoholic beverages to prevent weight gain, together with the inclination towards enhancing the more intoxicating effects of alcohol, seem to be the fundamental motives underlying such behavior [4,5]. In addition, several maladaptive behaviors have been reported to outreach the intended purposes, including fasting, skipping meals, using laxatives, self-induced vomiting, and strenuous exercising [6,7]. ...
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Background: Although metacognition processes are a core feature of restrictive eating and alcohol cravings and entail an individual to control both of his/her emotions and thoughts, yet, to our knowledge, a scarcity of research has examined their potential role in drunkorexia as cognitive and emotional predictors. The following study investigates the different associations between two emotion regulation strategies (i.e. emotional suppression and cognitive reappraisal) and drunkorexia behaviors in a sample of Lebanese adults, exploring the possible indirect effects of positive and negative alcohol-related metacognitions. Methods: This was a cross-sectional study that enrolled 335 participants (March-July 2021). Results: Higher problematic alcohol use (beta=5.56), higher physical activity index (beta=0.08), higher expressive suppression (beta=0.23), higher negative metacognitive beliefs about cognitive harm due to drinking (beta=0.75) and higher cognitive reappraisal (beta= 0.20) were significantly associated with more drunkorexic behaviors. The positive metacognitive beliefs about cognitive self-regulation significantly mediated the association between cognitive reappraisal and drunkorexia behaviors. Both the positive metacognitive beliefs about cognitive self-regulation and the negative metacognitive beliefs about the uncontrollability of drinking significantly mediated the association between expressive suppression and drunkorexia behaviors. Conclusion: This study demonstrated that emotional and metacognitive processes are associated with drunkorexia, addressing as well the mediating effect between deficient emotional regulation and risky behavioral patterns. Overall, our results would speculate that the lack of emotional and cognitive assets might enhance internal distress perceived out of control, leading individuals to indulge in maladaptive behavioral patterns for managing the underlying impairment.
... Unhealthy weight management behaviors combined with excessive alcohol consumption pose serious risks for adolescents' health, potentially resulting in unfavorable consequences. 7,51 The purpose of this study was to determine whether there was a relationship between drunkorexia behaviors and motivations, and trait mindfulness. Overall findings suggest a disposition toward NJ mindfulness is related to lower levels of drunkorexia. ...
Objective: Combined alcohol and disordered eating (drunkorexia) are alcohol fueled weight management behaviors. Mindfulness negatively relates to both disordered eating and alcohol use. Participants: Participants (n = 344, average age 20) were primarily female (85.2%, n = 293), and Caucasian (82.6%, n = 284). Methods: Students reported drunkorexia and mindfulness. Results: Drunkorexia behaviors were negatively correlated with Acting with Awareness (AA; full attention to a present moment; r = -.21, p < .001) and Nonjudgment (NJ; understanding and leniency toward oneself; r = -.22, p < .001). Drunkorexia motivations are significantly correlated with AA (r = -.13, p = .01) and NJ (r = -.18, p = .001). Structural equation modeling revealed higher levels of NJ related to higher levels of drunkorexia. Conclusion: The objective was to determine a potential relationship between drunkorexia behaviors and motivations, and trait mindfulness. Findings suggest a nonjudgmental disposition relates to lower levels of drunkorexia.
... Nevertheless, there are also significant differences between the two, which are just as important to recognise when exploring the links, particularly when looking at the at-risk population themselves, treatment options and recovery. For example, alcohol and eating disordered behaviours can be seen across all demographics yet the majority of research in this area focuses on younger, college student populations 8 . Furthermore, treatment and recovery are diametrically opposite for the two disorders in that, for alcohol disorders, the person is expected to restrict or abstain from the alcohol through treatment and into and after recovery, however, in the case of eating disorders, this is quite the opposite, and people are expected to regain a positive relationship with food in both treatment and recovery 2,9 . ...
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Food and drink. It’s basic. What could be simpler? Except that it’s not. We know from digging through the data, and from sitting and listening to people with alcohol misuse problems and people with eating disorders, that there’s a complicated relationship between alcohol use and disordered eating. And that relationship can be very different for different people. As part of our recent research we found that people who are dependent on alcohol, or in early recovery from very heavy drinking, often report unhealthy eating behaviours – particularly undereating. Dependent drinkers often say that they find food to be less important to them than alcohol. They don’t set out to avoid food; it just becomes less of a priority. They might deem spending money on food less important to keeping it to buy alcohol. They might also see their interest in food declining, or not feel the need to eat. For some, food exists in their minds as a component of loving and social relationships. If those relationships aren’t there – and they often aren’t for dependent drinkers – eating on their own can feel pointless and miserable. On a more positive note, drinkers told us that renewing caring social relationships around eating could well help them to eat much more healthily – that finding a new relationship with food, through sociable eating, could help to fill the void left when they decided to stop drinking. Our research indicates that alcohol misuse amongst people receiving treatment for eating disorders is much more common than previously thought. People who have an eating disorder say they misuse alcohol for various purposes. They tell us that they use alcohol to support their eating disorders: to suppress appetite, manage their emotions, promote binging and/or purging episodes, and to encourage exercise. Our research indicates that alcohol misuse amongst people receiving treatment for eating disorders is much more common than previously thought. On their own, alcohol misuse and disordered eating can each undermine a person’s physical and mental health. Going through both these problems together is especially difficult. In spite of this, staff working in both alcohol and eating disorder services report little knowledge of the relationship between eating and drinking. To better understand this relationship, we recommend that alcohol and eating disorder services work more closely together to better support this at-risk population. And that’s what we’re working to achieve.
Given the prevalence in obesity and other diet-related chronic diseases among adults in America, methods targeting dietary behavior change are essential. Interventions that aim to increase individuals' autonomous (i.e., self-driven) motivation to engage in health-promoting behaviors are highly effective, however, such interventions are difficult to scale. Thus, the current study tested the efficacy of a brief self-persuasion intervention to change participants' dietary goal content and increase intentions to make healthy dietary decisions, through autonomous motivation. The study also investigated the assumption that appearance-based goals decrease health-promoting behavior. The intervention was administered online to female college students (N = 300). Results showed that inspiring health-based and appearance-based goal content led to higher intentions compared to gaining others’ approval-based goals, indirectly through higher autonomous motivation. Appearance-based goal content also led to higher intentions compared to a control condition. Results imply that there is promise in using a brief, easily administrable, self-persuasion intervention to increase health-promoting dietary behaviors. Additionally, results reflect that bolstering appearance-based goal content can promote health-promoting behaviors, however, more research is necessary to delineate the parameters of the finding.
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La consommation d’alcool est un comportement de santé par rapport auquel les sportifs constituent une population à risque tant ils ont tendance à considérer les ivresses comme une pratique ordinaire. Ce sujet étant souvent raillé bien qu’avéré, le rôle joué dans cette consommation par divers facteurs démographiques, psychologiques, sociaux et environnementaux demeure mal connu. Ainsi, ce travail de thèse avait pour objectif d’identifier les facteurs de risque des alcoolisations des sportifs en prenant en compte la spécificité de cette population, avant de réaliser des interventions de prévention. Onze études portant sur des étudiants sportifs ou des rugbymen professionnels ont été menées. Les résultats révèlent que les sportifs masculins et les sportifs évoluant dans une discipline collective consomment davantage d’alcool, notamment par le biais des motivations à boire, des attentes envers la substance et des contextes de consommation rencontrés. De ce fait, l’environnement sportif, en fournissant un grand nombre d’occasions, facilite les alcoolisations qui se révèlent gages de cohésion. Ces consommations représentent alors un moyen pour les individus de se conformer à la norme de leurs coéquipiers, celle-ci étant par ailleurs généralement surestimée. Les résultats tendent également à considérer la dévaluation de la norme perçue et la motivation au changement comme des leviers à intégrer aux interventions visant à diminuer les alcoolisations. L’ensemble de ces éléments est discuté au vu de leurs applications possibles en termes de recherche ou de prise en charge des sportifs, en particulier sur la nécessité de développer des actions de prévention.
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Measures of weight management habits, body image, self-esteem, and degree of endorsement of sociocultural norms regarding thinness were administered to 682 undergraduate women. The 643 nonanorexic, nonobese subjects were then classified into one of six categories representing severity along an eating-behaviors continuum. The results indicated a high prevalence of both dieting and bingeing behaviors. Although only 3% were classified as bulimic, 61% were classified as having some intermediate form of eating-behavior problem. Only 33% of the subjects reported what could be considered normal eating habits. The degree of disturbed eating was strongly correlated with lowered self-esteem, more negative body image, greater tendency to endorse sociocultural beliefs regarding the desirability of female thinness, obsessive thoughts concerning weight and appearance, and interference of weight and appearance concerns with other life domains. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Objective: This study examines attendance and alcohol use at parties and bars among college students by gender, residence, year in school and legal drinking age. Method: The study participants were respondents in the 1997 and 1999 Harvard School of Public Health College Alcohol Study (CAS). The combined sample consisted of 12,830 students (61% women) who reported use of alcohol in the past 30 days prior to interview. Their responses provided information on attendance and alcohol use at parties (dormitory, fraternity, off campus) and off campus bars. Logistic regression analyses examined the influence of gender, residence, year in school and legal drinking age related to attendance, drinking/non-drinking and heavy drinking (5 or more drinks) at each select setting. Results: Consistent with the literature, fraternity/ sorority parties were occasions of heavy drinking (49%) among drinkers in those settings, yet they drew upon smaller proportions of students (36%) when compared to off-campus parties (75%) and off-campus bars (68%). Off-campus parties (45%) and bars (37%) were also occasions for heavy drinking among drinkers in these settings. College residence was shown to relate to differential exposure to drinking settings, but residence had less impact on the decision to drink and the level of heavy drinking. Attendance at parties decreased with advance in school years, but attendance at off-campus bars increased. Although heavy drinking at off-campus bars decreased with advancing grade year in school, slightly higher proportions of under-age students (41%) compared to Students of legal drinking age (35%) exhibited heavy drinking at off-campus bars. Conclusions: The identification of high-risk settings and their correlates serves to better understand the development of heavy drinking on college campuses. Off-campus parties, as compared to campus parties and bars, may pose greater difficulties related to successful intervention.
Objective: This article provides information on the extent of alcohol use and other drug use among American college students. Method: Five different sources of data are examined for estimating recent levels of alcohol (and other drug) use among college students: Harvard School of Public Health College Alcohol Study (CAS), the Core Institute (CORE), Monitoring the Future (MTF), National College Health Risk Behavior Survey (NCHRBS) and National Household Survey on Drug Abuse (NHSDA). Results: Alcohol use rates are very high among college students. Approximately two of five American college students were heavy drinkers, defined as having had five or more drinks in a row in the past 2 weeks. Alcohol use is higher among male than female students. White students are highest in heavy drinking, black students are lowest and Hispanic students are intermediate. Use of alcohol--but not cigarettes, marijuana and cocaine--is higher among college students than among noncollege age-mates. Longitudinal data show that, while in high school, students who go on to attend college have lower rates of heavy drinking than do those who will not attend college. Both groups increase their heavy drinking after high school graduation, but the college students increase distinctly more and actually surpass their nonstudent age-mates. Trend data from 1980 to 1999 show some slight improvement in recent years. Conclusions: Despite improvements in the past 20 years, colleges need to do more to reduce heavy alcohol use among students.
Objective. —To examine the extent of binge drinking by college students and the ensuing health and behavioral problems that binge drinkers create for themselves and others on their campus.Design. —Self-administered survey mailed to a national representative sample of US 4-year college students.Setting. —One hundred forty US 4-year colleges in 1993.Participants. —A total of 17592 college students.Main Outcome Measures. —Self-reports of drinking behavior, alcohol-related health problems, and other problems.Results. —Almost half (44%) of college students responding to the survey were binge drinkers, including almost one fifth (19%) of the students who were frequent binge drinkers. Frequent binge drinkers are more likely to experience serious health and other consequences of their drinking behavior than other students. Almost half (47%) of the frequent binge drinkers experienced five or more different drinking-related problems, including injuries and engaging in unplanned sex, since the beginning of the school year. Most binge drinkers do not consider themselves to be problem drinkers and have not sought treatment for an alcohol problem. Binge drinkers create problems for classmates who are not binge drinkers. Students who are not binge drinkers at schools with higher binge rates were more likely than students at schools with lower binge rates to experience problems such as being pushed, hit, or assaulted or experiencing an unwanted sexual advance.Conclusions. —Binge drinking is widespread on college campuses. Programs aimed at reducing this problem should focus on frequent binge drinkers, refer them to treatment or educational programs, and emphasize the harm they cause for students who are not binge drinkers.(JAMA. 1994;272:1672-1677)
Conference Paper
Stress and anxiety experienced by college students can have potentially negative effects on not only their academic performance, but also their health and quality of life. These effects may be compounded by the negative coping mechanisms some students may use in attempting to deal with their stress. To examine these stress-coping mechanisms, a convenience sample of 842 undergraduate students at a Southeastern university were surveyed for self-reported levels of stress/anxiety, and positive vs. negative behaviors they pursued to cope with their stress. The results showed that students with high levels of stress were more likely to practice negative coping behaviors, including drinking alcohol, using tobacco, taking recreational drugs, eating high-fat comfort foods, or spending excessive time on the Internet, and were less likely to pursue positive coping behaviors such as trying to get adequate sleep, exercising regularly, seeking support from family or others, involvement in social or religious activities, meditating/praying, practicing time management, or avoiding situations or people that cause them stress. Students who pursued negative behaviors reported a higher frequency of having trouble coping with their stress compared to those practicing positive coping. Female students were more likely than males to have higher levels of stress, and to have trouble coping. The findings from this study provide important information for developing tailored campus-based programs to support positive coping behaviors and skills among the college student population, with the goal of reducing their health risks, improving their productivity inside and outside of the classroom, and enhancing their quality of life.
Despite the emerging awareness among professionals that eating disorders occur along a continuum of degree for women and that maladaptive perceptions regarding weight control techniques may be important in the development and maintenance of women's disturbed eating behaviors, no research has examined perceptions of weight control techniques as a function of women's placement on the eating disorder continuum. Thus, perceptions of the effectiveness and safety of weight control techniques of 166 high school and college women were examined. Women who use maladaptive weight control techniques were found to rate the effectiveness and safety of these techniques higher than did women who do not use these techniques. Results also indicate that perceptions of effectiveness and safety vary in a linear fashion with respect to eating disorder continuum placement.
This study examined the association between restricting calories on intended drinking days and drunkenness frequency and alcohol-related consequences among college students. Participants included a random sample of 4,271 undergraduate college students from 10 universities. Students completed a Web-based survey regarding their high-risk drinking behaviors and calorie restriction on intended drinking days. Thirty-nine percent of past 30-day drinkers reported restricting calories on days they planned to drink alcohol, of which 67% restricted because of weight concerns. Restricting calories on drinking days was associated with greater odds of getting drunk in a typical week. Women who restricted were more likely to report memory loss, being injured, being taken advantage of sexually, and having unprotected sex while drinking. Men were more likely to get into a physical fight. These results highlight the importance of considering weight control behaviors in the examination of high-risk college drinking.
Patients with bulimia nervosa frequently have problems with alcoholism and other substance abuse. The goal of this study was to assess whether this relationship between eating abnormalities and substance abuse extends to subthreshold levels of dieting and substance use. A self-administered questionnaire assessing dieting and substance use (alcohol, cigarettes, and marijuana) was completed by 1,796 women prior to their freshman year in college. Using a scale derived from DSM-III-R criteria for bulimia nervosa and previous research in this population, subjects were categorized as nondieters, casual, intense, severe, at-risk or bulimic dieters. The relationship between the dieting-severity category and frequency and intensity of alcohol use and frequency of marijuana and cigarette use was assessed. DSM-III-R criteria for bulimia nervosa were met by 1.6% of the women. Only 13.8% of these women were nondieters. Increasing dieting severity was positively associated with increasing prevalence of alcohol, cigarette, and marijuana use and with increasing frequency and intensity of alcohol use. The bulimic and at-risk dieters were similar in their alcohol and drug use. The relationship between eating disorders and alcoholism and other substance abuse noted in clinical populations extends in a continuous, graded manner to subthreshold levels of dieting and substance use behaviors. Dieting-related attitudes and behaviors in young women may be related to increased susceptibility to alcohol and drug abuse.
After consuming comparable amounts of ethanol, women have higher blood ethanol concentrations than men, even with allowance for differences in size, and are more susceptible to alcoholic liver disease. Recently, we documented significant "first-pass metabolism" of ethanol due to its oxidation by gastric tissue. We report a study of the possible contribution of this metabolism to the sex-related difference in blood alcohol concentrations in 20 men and 23 women. Six in each group were alcoholics. The first-pass metabolism was determined on the basis of the difference in areas under the curves of blood alcohol concentrations after intravenous and oral administration of ethanol (0.3 g per kilogram of body weight). Alcohol dehydrogenase activity was also measured in endoscopic gastric biopsies. In nonalcoholic subjects, the first-pass metabolism and gastric alcohol dehydrogenase activity of the women were 23 and 59 percent, respectively, of those in the men, and there was a significant correlation (rs = 0.659) between first-pass metabolism and gastric mucosal alcohol dehydrogenase activity. In the alcoholic men, the first-pass metabolism and gastric alcohol dehydrogenase activity were about half those in the nonalcoholic men; in the alcoholic women, the gastric mucosal alcohol dehydrogenase activity was even lower than in the alcoholic men, and first-pass metabolism was virtually abolished. We conclude that the increased bioavailability of ethanol resulting from decreased gastric oxidation of ethanol may contribute to the enhanced vulnerability of women to acute and chronic complications of alcoholism.