Food-Restricted Alcohol Consumption

by:  Baiyu Qu – Summer Research Fellow

September 12, 2019

Food-Restricted Alcohol Consumption (FRAC), misleadingly termed “drunkorexia” by the media, refers to a unique pattern of alcohol use and disordered eating where individuals restrict their food intake prior to alcohol consumption. The term “drunkorexia” is a misnomer because it implies that individuals with this behavioral pattern have anorexia nervosa, which is not necessarily accurate.1 Moreover, it makes light of a serious illness and a very serious combination of behaviors. Researchers have attempted to come up with alternative terms, such as “Behaviors of Weight Conscious Drinkers (BWCD)”,1,2 “Inappropriate Compensatory Behaviors to Avoid Weight Gain from Consuming Alcohol (ICB-WGA)”,3 and “Food and Alcohol Disturbance (FAD)”.4 None of these has really caught on. The first two terms only capture one of the motivations behind food-restricted alcohol consumption (i.e., maximizing the effects of alcohol), the second term is unwieldly, and the third term is too broad and nonspecific. Therefore, we have proposed the term Food-Restricted Alcohol Consumption (FRAC), which specifically refers to the behavior that individuals restrict food intake prior to alcohol consumption.

FRAC is prevalent in young adults, especially college students. In both men and women, the prevalence of FRAC ranges from 14% to 46% across college students in the U.S. and Canada.5,6 The reasons individuals engage in FRAC vary. Two of the more common reasons are to get drunk faster and to prevent weight gain by decreasing food calories to compensate for the calories contained in alcohol. Studies are mixed in terms of gender differences in FRAC. One study suggested that women are more likely to engage in FRAC than men,7 which could be explained by weight-control motivation, since women are more likely than men to diet in general.7 However, other studies have reported no sex differences in FRAC.8 Moreover, being a Greek member (i.e., belonging to a fraternity or sorority) increased the likelihood of engaging in FRAC,2 which aligns with the fact that Greek members are more likely to report alcohol use and disordered eating than their non-Greek peers.9,10

Why should we pay more attention to FRAC? FRAC is associated with multiple negative outcomes besides restricting food and alcohol misuse. For example, one study reported that college students who engaged in FRAC were also more likely to have other disordered eating symptoms, including excessive exercise, purging, and binge eating.3 FRAC has also been associated with low self-esteem, interoceptive deficits (not able to accurately perceive or cognitively interpret stimuli from the body),11 and emotional dysregulation.12 Much remains unknown about FRAC, including other conditions that may co-occur such as depression and anxiety, 13 as well as the impact of FRAC on college performance and educational attainment.

Because few studies have been done in this area, there are several gaps that future studies should address. First, a standard definition should be determined and used in all future studies. Second, more studies should examine demographic and psychological differences between individuals who engage in FRAC compared with those who do not. Third, longitudinal studies are needed since existing studies have only assessed FRAC at one time point. It is unclear whether FRAC contributes to or is a consequence of other psychological outcomes. In conclusion, FRAC is a health issue that is prevalent in young adults, particularly in college students. Given the limited research that has been done in this field, further studies are needed to help researchers and healthcare providers have a better understanding about FRAC to improve detection and treatment.

References: 1. Piazza-Gardner, A. K., & Barry, A. E. (2013). Appropriate terminology for the alcohol, eating, and physical activity relationship. Journal of American College Health, 61(5), 311-313. 2. Wilkerson, A. H., Hackman, C. L., Rush, S. E., Usdan, S. L., & Smith, C. S. (2017). “Drunkorexia”: Understanding eating and physical activity behaviors of weight conscious drinkers in a sample of college students. Journal of American College Health, 65(7), 492-501. 3. Hunt, T. K., & Forbush, K. T. (2016). Is “drunkorexia” an eating disorder, substance use disorder, or both? Eating Behaviors, 22, 40-45. 4. Choquette, E. M., Rancourt, D., & Kevin Thompson, J. (2018). From fad to FAD: A theoretical formulation and proposed name change for “drunkorexia” to food and alcohol disturbance (FAD). International Journal of Eating Disorders, 51(8), 831-834. 5. Osborne, V. A., Sher, K. J., & Winograd, R. P. (2011). Disordered eating patterns and alcohol misuse in college students: Evidence for “drunkorexia”? Comprehensive Psychiatry, 6(52), e12 6. Roosen, K. M., & Mills, J. S. (2015). Exploring the motives and mental health correlates of intentional food restriction prior to alcohol use in university students. Journal of Health Psychology, 20(6), 875-886. 7. Eisenberg, M. H., & Fitz, C. C. (2014). “Drunkorexia”: Exploring the who and why of a disturbing trend in college students’ eating and drinking behaviors. Journal of American College Health, 62(8), 570-577. 8. Burke, S. C., Cremeens, J., Vail-Smith, K., & Woolsey, C. (2010). Drunkorexia: Calorie restriction prior to alcohol consumption among college freshman. Journal of Alcohol and Drug Education, 54(2), 17-34. 9. Scott-Sheldon, L. A., Carey, K. B., & Carey, M. P. (2008). Health behavior and college students: Does Greek affiliation matter? Journal of Behavioral Medicine, 31(1), 61-70. 10. Piquero, N. L., Fox, K., Piquero, A. R., Capowich, G., & Mazerolle, P. (2010). Gender, general strain theory, negative emotions, and disordered eating. Journal of Youth and Adolescence, 39(4), 380-392. 11. Bruch, H. (1962). Perceptual and conceptual disturbances in anorexia nervosa. Psychosomatic Medicine, 24(2), 187-194. 12. Laghi, F., Pompili, S., Bianchi, D., Lonigro, A., & Baiocco, R. (2019). Psychological characteristics and eating attitudes in adolescents with drunkorexia behavior: An exploratory study. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 1-10. 13. Holderness, C. C., Brooks‐Gunn, J., & Warren, M. P. (1994). Co‐morbidity of eating disorders and substance abuse: Review of the literature. International Journal of Eating Disorders, 16(1), 1-34.