Alcohol and Eating Disorders: Implications for Alcohol Treatment and Health Services Research Rajita Sinha and Stephanie S. O’Malley Background: This paper focuses on the co-occurrence of alcoholism and eating disorders and the clinical implications for treating this comorbidity in women with alcohol use disorders. There is substantial liter- ature that supports higher than expected rates of co-occurrence of these two disorders. In addition, there is evidence that the co-occurrence of alcoholism and eating disorders is more likely to occur in the presence of other psychiatric disorders. A critical analysis of the studies on the comorbidity of these disorders is conducted along with a review of the possible etiologic association between the two disorders. Crucial questions related to pharmacological and behavioral treatments for this subgroup of alcoholic women with eating disorders are raised from a health services research perspective. Conclusions: There is substantial evidence that alcoholism and eating disorders co-occur at high rates. However, as this review points out, several important research questions remain regarding both the clinical manifestations of each problem in women who are comorbid for both disorders and the treatment impli- cations. Key Words: Alcoholism, Eating Disorders, Comorbidity, Treatment, Women. T HERE IS INCREASING evidence that women with alcohol use disorders are more likely to have multiple problems, including a range of psychiatric symptoms (Kessler et al., 1996; Weisner and Schmidt, 1992). Among the psychiatric problems, eating disorders, in particular which have themselves been conceptualized as addictive disorders (Wilson, 1993), co-occur at a high rate with alco- holism, and are similar in clinical features, associated char- acteristics, and proposed etiology to alcohol use disorders (Goldbloom, 1993; Wilson, 1993). Other psychological dif- ficulties such as greater depressive and anxiety symptoms, along with low self-esteem, are common in both alcoholic women and those with eating disorders (Gomberg, 1993; Striegel-Moore et al., 1986). Both alcohol abuse and eating disorders in women are associated with higher rates of physical and sexual abuse and menstrual cycle disturbances compared with women without either disorder (Hall et al., 1989; Miller et al., 1987; Murray, 1989). Craving, loss of control, and a preoccupation with the substance, be it alcohol or food, are hallmark symptoms of both disorders. Despite the above similarities, treatments for each disorder have developed independently, without specific attention to the need to address their comorbidity. The purpose of this review is to present evidence that supports the link between alcoholism and eating disorders in women, and to discuss the treatment implications from a health services research perspective. In the context of alcoholism and eating disor- der comorbidity, we highlight the gaps in the understanding of this co-occurrence. Furthermore, directions for future research are outlined with the goal of improving the quality of clinical care for women with these alcohol problems. THE ASSOCIATION BETWEEN ALCOHOLISM AND EATING DISORDERS Prevalence Several studies have reported high rates of eating disor- ders among patients with alcohol abuse/dependence and high rates of alcoholism among patients with eating disor- ders. Beary et al. (1986) reported that 35% of alcoholic women admitted to an inpatient alcoholism treatment unit reported a prior eating disorder. Lacey and Mourelli (1986) found that 40% of hospitalized alcoholic women had a past or present eating disorder. Similar rates of prevalence have been reported in other studies (Goldbloom et al., 1992; Peveler and Fairburn, 1990). Taylor et al. (1993) reported eating disorder symptoms to be over-represented among women who present for inpatient and outpatient alcohol treatment, relative to a community sample. In a Japanese sample of inpatient and outpatient alcoholic women under 30 years old, 71% met criteria for an eating disorder From the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut. Received for publication September 7, 1999; accepted June 6, 2000. Supported by National Institute on Alcohol Abuse and Alcoholism Grants AA8033, AA10225, and KO2-AA110171. An earlier version of this paper was presented at the Conference on Women’s Health Services Research, “Women and Alcohol Problems,” spon- sored by the National Institute on Alcohol Abuse and Alcoholism, November 5– 6, 1998, Washington, DC. Reprint requests: Rajita Sinha, Ph.D., Associate Professor, Department of Psychiatry, Yale University School of Medicine, 1 Long Wharf, Box 18, New Haven, CT 06511; Fax: 203-789-6990; E-mail: rajita.sinha@yale.edu Copyright © 2000 by the Research Society on Alcoholism. 0145-6008/00/2408-1312$03.00/0 ALCOHOLISM:CLINICAL AND EXPERIMENTAL RESEARCH Vol. 24, No. 8 August 2000 1312 Alcohol Clin Exp Res, Vol 24, No 8, 2000: pp 1312–1319