Please cite this article in press as: Krug, I., et al., Present and lifetime comorbidity of tobacco, alcohol and drug use in eating disorders: A European multicenter study, Drug Alcohol Depend (2008), doi:10.1016/j.drugalcdep.2008.04.015 ARTICLE IN PRESS +Model DAD-3294; No. of Pages 11 Available online at www.sciencedirect.com Drug and Alcohol Dependence xxx (2008) xxx–xxx Present and lifetime comorbidity of tobacco, alcohol and drug use in eating disorders: A European multicenter study Isabel Krug a,b , Janet Treasure c,d,e , Marija Anderluh f , Laura Bellodi g , Elena Cellini h , Milena di Bernardo h , Roser Granero i , Andreas Karwautz j , Benedetta Nacmias h , Eva Penelo i , Valdo Ricca h , Sandro Sorbi h , Kate Tchanturia c,d,e , Gudrun Wagner j , David Collier c,d,e , Fernando Fern´ andez-Aranda a,b,* a Department of Psychiatry, Bellvitge University Hospital, Barcelona and Ciber Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Instituto Salud Carlos III, Spain b Department of Psychiatry, University Hospital of Bellvitge, c/Feixa Llarga s/n, 08907 Barcelona, Spain c Eating Disorders Unit and SGDP Research Centre, Institute of Psychiatry, London, UK d Department of Psychiatry, 5th floor, Thomas Guy House, Guy’s Hospital, London SE1 9RT, UK e South London and Maudsley Eating Disorders, IOP/King’s College, London SE 58AF, UK f University Children’s Hospital, University Medical Centre Ljubljana, Vrazov trg 1, 1000 Ljubljana, Slovenia g Department of Neuropsychiatric Sciences (DSNP), Fondazione Centro S. Raffaele del Monte Tabor, Via Olgettina 60, 20132 Milan, Italy h Department of Neurology and Psychiatric Sciences, University of Florence, Viale Morgagni 85I-50134, Florence, Italy i Departament de Psicobiologia i Metodologia, Universitat Aut` onoma de Barcelona, Facultat de Psicologia, Edifici B (Campus Bellaterra), 08193 Bellaterra (Cerdanyola del Valles), Spain j Medical University of Vienna, Department of Child and Adolescent Psychiatry, W¨ ahringer G¨ urtel 18-20, 1090 Vienna, Austria Received 3 January 2008; received in revised form 4 April 2008; accepted 13 April 2008 Abstract Objectives: To assess the differences in comorbid lifetime and current substance use (tobacco, alcohol and drug use) between eating disorder (ED) patients and healthy controls in five different European countries. Method: A total of 1664 participants took part in the present study. ED cases (n = 879) were referred to specialized ED units in five European countries. The ED cases were compared to a balanced control group of 785 healthy individuals. Assessment: Participants completed the Substance Use Subscale of the Cross Cultural (Environmental) Questionnaire (CCQ), a measure of lifetime tobacco, alcohol and drug use. In the control group, also the GHQ-28, the SCID-I interview and the EAT-26 were used. Results: ED patients had higher lifetime and current tobacco and general drug use. The only non-significant result was obtained for lifetime and current alcohol use. Significant differences across ED subdiagnoses and controls also emerged, with BN and AN-BP generally presenting the highest and AN-R and controls the lowest rates. The only exception was detected for alcohol use where EDNOS demonstrated the highest values. Only a few cultural differences between countries emerged. Conclusions: With the exception of alcohol consumption, tobacco and drug use appear to be more prevalent in ED patients than healthy controls. The differential risk observed in patients with bulimic features might be related to differences in temperament or might be the result of increased sensitivity to reward. © 2008 Elsevier Ireland Ltd. All rights reserved. Keywords: Eating disorders; Tobacco use; Alcohol use; Drug use; Cultural differences * Corresponding author at: Department of Psychiatry, University Hospital of Bellvitge, c/Feixa Llarga s/n, 08907 Barcelona, Spain. Tel.: +34 93 2607922; fax: +34 93 2607658. E-mail address: ffernandez@csub.scs.es (F. Fern´ andez-Aranda). 1. Introduction During the last two decades, a body of research has indicated that substance use problems are common among women with eating disorders (EDs) (e.g. (Bulik et al., 2004; Fernandez-Aranda et al., 2008; Karwautz et al., 2001, 2002; 0376-8716/$ – see front matter © 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.drugalcdep.2008.04.015