Frequency of Substance Use in Adolescents With Eating Disorders and its Association With Eating Disorder Medical Severity.

ObjectiveThe developmental characteristics of adolescence make them more susceptible to eating disorders (ED) and substance use (SU). We aimed to compare the prevalence of SU in adolescents with ED and controls, and among ED subgroups; and to examine the relationship between SU and the medical severity of EDs.MethodsWe enrolled 510 adolescents with ED and 520 age- and sex-matched controls. Current SU (≥1 occasion in the past 30 days) was obtained from psychosocial interviews. Medical severity parameters were examined for anorexia nervosa (AN)/atypical AN (AAN) and bulimia nervosa (BN).ResultsTobacco use was higher in the ED group than in the control group (p = 0.002). Adolescents with BN reported more tobacco and alcohol use than AN and AAN (p < 0.001). There was no SU in adolescents with avoidant/restrictive food intake disorder (ARFID). Smoking was associated with higher medical severity in BN (p = 0.047), but not in AN/AAN.ConclusionsWe found that SU is more common in ED than healthy controls and in binging-purging subgroups than restrictive subgroups in ED. In addition, smoking was associated with medical severity in BN. The absence of SU in ARFID and subgroup differences underscore the need for longitudinal studies, to clarify the future impacts.