Momentary Predictors of Binge Eating or Heavy Drinking Episodes in Individuals with Comorbid Binge Eating and Heavy Drinking
Authors:   , Wilkinson Megan Louise , Juarascio Adrienne S. 
Published: December 2022

The co-occurrence of binge eating and heavy drinking (BE+HD) is a serious concern due to the high prevalence rates and associated elevated severity. BE+HD has been hypothesized to be maintained by underlying traits (e.g., impulsivity, reward sensitivity) increasing vulnerability for binge eating or heavy drinking in response to momentary risk factors. Most of the research testing this hypothesized maintenance model have focused on either identifying the underlying traits associated with BE+HD or identifying situations that increase risk for binge eating or heavy drinking in BE+HD. Previous research has not tested: (1) whether individuals with BE+HD are more susceptible to binge eating or heavy drinking in response to momentary cues than individuals with binge eating only (BE-only) and (2) whether the momentary processes maintaining binge eating differ from those maintaining heavy drinking within individuals with BE+HD. Additionally, prior research has primarily used cross-sectional methods, which are unable to measure the real-time association between maintenance factors and behavior. Momentary assessment methods such as ecological momentary assessment (EMA) are needed to identify the momentary processes that contribute to the maintenance of BE+HD. Affect, social context, presence of food or alcohol, and dietary restraint have each been implicated in prior literature as potential momentary risk factors for binge eating or heavy drinking in BE+HD. The current study aimed to address limitations of prior research by using EMA to (1) test if BE+HD were significantly more likely to binge eat following momentary risk factors (i.e., increased negative affect, being alone, presence of food, prolonged dietary restraint) compared to BE-only, and (2) identify the momentary risk factors (i.e., affect, social context, presence of food or alcohol, dietary restraint) for binge eating episodes and heavy drinking episodes in individuals with BE+HD. Participants (N = 53) were adults with at least one binge eating episode per week in the past three months. Participants completed between 7 - 14 days of EMA prior to beginning treatment for binge eating. The EMA protocol included items measuring affect, social context, presence of food or alcohol, dietary restraint, and engagement in binge eating or heavy drinking. Participants were divided into two groups based on presence or absence of heavy drinking: BE+HD (N = 14) and BE-only (N = 37). Results found no differences between groups in terms of odds of binge eating following the presence of food or dietary restraint. Among BE+HD, the presence of alcohol and dietary restraint increased risk for subsequent binge eating and subsequent heavy drinking, and the absence of food increased risk for subsequent heavy drinking. The current study is the first to date to identify and compare momentary risk factors for binge eating and heavy drinking between individuals with BE+HD and BE-only. These results offer preliminary support for treatment interventions for BE+HD that aim to reduce dietary restraint and teach strategies for managing urges when in the presence of food or alcohol. More research in larger, more diverse samples and using other measurement or study design approaches is needed to improve our understanding of the maintenance mechanisms of BE+HD and inform treatment interventions.