Weight concern in women in drug treatment: A shared motivational factor for substance use and eating pathology

Although research suggests high rates of comorbidity between eating and substance use disorders, relatively few studies examine weight concern and its relationship to both substance use and eating pathology in women in drug treatment settings. This study explored these relationships in a clinical sample of 1,533 women in outpatient and residential treatment for substance use. Results revealed that 12.3% had a lifetime eating disorder diagnosis and 21% reported eating pathology without a formal diagnosis. About 44% strongly agreed that they started using substances for weight loss purposes and more than half were concerned about weight gain in recovery (59%). The most commonly endorsed appearance-related motivations for drug use were "drugs make me feel attractive" (59%) and "drugs help me stay thin" (53%). Concern about weight gain in treatment was positively correlated with weight-related substance use motivation, body dissatisfaction, binge eating, and general eating pathology. Regression analyses indicated that as motivation to use drugs for weight loss increased so did the severity of body dissatisfaction and binge eating. These findings suggest that conceptualizing weight concern as a multidiagnostic factor that can motivate, maintain or trigger both substance use and eating pathology would benefit many women in drug treatment.