ABSTRACT
In an attempt to investigate the sequence of bulimia and drug abuse, Bulik and colleagues (1992)8 analyzed temporal patterns of hinging, purging, alcohol, cigarette, and laxative use. They studied 42 women with bulimia nervosa and 29 women with anorexia nervosa who were hospitalized for the duration of the study. Their results showed that these behaviors increased throughout the day and peaked during the evening hours. Thus, they observed a sequential relationship: as hinging and purging increased, drug use increased. They suggested that the repeated dieting and fasting associated with eating disorders may subsequently enhance the reinforcing effects of drugs. There is a related case report regarding three young women diagnosed with bulimia nervosa who abused toxic levels of caffeine as an appetite suppressant29. In this case drug use appeared to be secondary to the eating disorder. These studies suggest that fasting increases the reinforcing effects of drugs, and this may account for the high rate of drug abuse in bulimic patients. However, carefully designed prospective studies with long-term follow-up are needed to identify causal relations. Fasting may not be the only important variable, as anorexia nervosa patients also fast, but prevalence of drug abuse in that population is low.
