Thursday, March 23, 2017: 8:30 AM-9:45 AM
Background:
There is a correlation between substance use and eating disorders, with cannabis as most abused among specific eating disorders. Research argues that cannabis has negative side-effects, interfering with treatment, while others argue for its use. It is important to have an understanding of the relationship and the implications on treatment.
Objectives:
1. Identify the prevalence of cannabis use amongst individuals with eating disorders
2. Identify the neurological consequences of cannabis use
3. Identify the pros and cons of cannabis in treatment for eating disorders
I. Correlation between substance use and eating disorders A. Research data: co-morbidity from 17%-46% B. Research data: co-morbidity up to 50% II. Cannabis use among individuals with eating disorders A. Anorexia: 1. Research results: lower likelihood in comparison with bulimia, with purging type having a higher incidence than restricting type B. Bulimia: 1. Research results: 33% of girls with bulimia abuse cannabis weekly 2. Research results: increased risk for abusing cannabis as compared to those who do not engage in purging behaviors C. Binge eating disorder: 1. Research results: indicator of increased likelihood for substance use, and more likely to use cannabis than tobacco or alcohol III. Results of cannabis use on brain function A. Decision making: 1. Research results: duration of cannabis use was associated with greater activity in brain regions that are involved in decision making. B. Addictive properties 1. Research results: Cannabis use was found to alter the activity of reward pathways that is consistent with other abuse drugs. IV. Complications associated with cannabis use A. Medical complications B. Psychotropic medications C. Decision-making D. Addictive properties V. Consequences of cannabis use coupled with eating disorder diagnosis A. Research suggests there are more negative consequences related to illicit drug use for people with eating disorders than non-eating disordered individuals VI. Cannabis abuse interferes with eating disorder treatment A. Increasing exercise abuse B. Causing psychic disturbance 1. Research results: increased incidence of attempted suicide, stealing, and sexual intercourse, but was not related to age or intentional SIB. C. Cannabis withdrawal syndrome D. THC interfering with psychotropics VII. Cannabis use aids in eating disorder treatment A. Research results: facilitate weight gain B. Research results: THC regulating endocannabinoid levels VIII. Discussion of research: A. What really is the relationship between eating disorders and cannabis? 1. Argument this is a clinical concern and should be monitored throughout treatment B. How does cannabis influence the brain? C. Is cannabis use necessary in eating disorder treatment? D. Do we need to pay attention to the effects on psychotropic medication? E. What should we encourage if we find our patients to be using cannabis?
There is shown to be a strong correlation between substance use and eating disorders, with research showing data from 17%-46% comorbidity (Harrrop & Marlatt, 2009), and other research indicating co-morbidity as high as 50% (The National Center on Addiction and Substance Abuse at Columbia University, 2003). Per Wiederman and Pryor (1996), nearly 33% of girls with a bulimia nervosa diagnosis were using cannabis weekly. Ross and Ivis’s (1999) research also shows that people with binge eating disorder were more likely to use cannabis than tobacco and alcohol. Studies have shown cannabis to be the most commonly abused illicit drug among individuals with specific eating disorders (Root, Pinheiro, Thornton, Strober, Fernandez-Aranda, Brandt, Crawford, et al., 2010). Furthermore, various studies suggest that cannabis use can negatively influence the efficacy of psychotropic medications (Wilens, Biederman, & Spencer, 1997) and compromise decision making (Vaidya, Block, O’Leary, Ponto, Ghoneim & Bechara, 2012). Current neurological studies assessing cannabis use also show that there are addictive properties associated with this use, specifically evidenced by various imaging studies of reward pathways (Lupica, Riegel, & Hoffman, 2004). Dunn, Larimer, and Neighbors (2002) report that individuals with bulimia nervosa have more negative consequences related to illicit drug use than non-eating disordered individuals. Per Herzog, Dorer, Keel, Jackson, & Manzo (2006), drug abuse in women with eating disorders is an area of clinical concern and should be monitored routinely throughout the treatment process. There is sufficient evidence to argue that cannabis abuse interferes with eating disorder recovery (Andries, Gram, Klinkby, & Stoving, 2015). Interestingly, various studies also make a case that cannabis, in pill form with the Delta-9-tetrahydrocannabinol compound (THC), can be used as a form of eating disorder treatment (Andries, Frystyk, Flyvbjerg, & Stoving, 2013). Given the controversy regarding the utilization of THC in treatment, the negative consequences surrounding cannabis use, and the high comorbidity rates, it is important to have a greater understanding of the influence of cannabis on eating disorder behaviors, the utilization of cannabis as a treatment for eating disorders, and the influence of cannabis on brain function, particularly for those with eating disorder related medical complications.
Primary Presenter:
Sarah Burney, LCSW
Sarah Burney is an Associate Clinical Social Worker who completed her graduate studies at the University of Southern California, earning a Masters of Social Work with a concentration in Mental Health. For the past 3 years, Sarah has worked with Center For Discovery at the residential and outpatient levels of care. Prior to working with Center for Discovery, Sarah provided mental health services for individuals with a history of trauma, substance abuse, eating disorders, teen pregnancy, family discord, and behavioral challenges. Sarah’s background also includes implementing applied behavioral analysis interventions and providing case management and social services.
