Prevalence, Burden, and Disability Associated with Co-occurring Binge Eating Among U.S. Adults with Cannabis-Involved Drug Use Disorder

Despite established appetite-stimulating effects of cannabis use, binge eating is seldom assessed in these samples. Its prevalence, clinical importance, and demographic reach among people with cannabis-involved drug use disorder are largely unknown. We analyzed 12,591 adults from the Collaborative Psychiatric Epidemiology Surveys who completed the eating disorder and substance use modules. Using design-weighted estimation, we estimated prevalence of binge eating among adults with a cannabis-involved drug use disorder and examined whether binge eating marks greater burden and disability and whether it differs by demographic group. Recurrent binge eating affected 11.2% of adults with a cannabis-involved drug use disorder (95% CI [8.4, 14.7]). Separately, 5.5% met criteria for DSM-IV binge eating disorder. Prevalence rose across levels of cannabis involvement (adjusted OR per level = 2.11, 95% CI [1.75, 2.55]). Adults with both conditions had the highest prevalence of suicidal ideation, suicide attempts, major depression, and generalized anxiety disorder. At least one lifetime suicide attempt was reported by 27.8% of this group and by only 3.3% of adults with neither condition. Binge eating alone was associated with a level of functional disability comparable to cannabis-involved drug use disorder alone, while adults with both conditions had the highest WHODAS time out of role and role impairment scores. Among adults with cannabis-involved drug use disorder, binge eating also marked a more damaging drug course. Among adults with a cannabis-involved drug use disorder, recurrent binge eating was more prevalent among women (17.4%) than men (8.6%). Men nevertheless made up an estimated 54.1% of affected adults. Prevalence ranged from 9.7% to 12.3% across racial and ethnic groups. Findings indicate that binge eating is common and linked with adverse outcomes among those with cannabis-involved drug use disorder, thus warranting targeted interventions.