Compensatory Eating Behaviors Related to Alcohol Consumption (CEBRACS)

Abstract

The Compensatory Eating Behaviors Related to Alcohol Consumption (CEBRACS) is a specialized 21-item psychological scale developed to systematically measure disordered eating and purging behaviors specifically linked to the intake of alcohol. This phenomenon is often colloquially referred to as “drunkorexia.”

The scale addresses the purposeful modification of eating habits, restriction, and purging occurring before, during, or after alcohol consumption. The primary motivations quantified by the CEBRACS are the desire to offset the caloric content of alcoholic beverages and the attempt to potentiate or accelerate the intoxicating effects of the alcohol.

Developed and validated in 2012 by Rahal and colleagues, the CEBRACS is a crucial instrument for research examining the comorbidity and intersection of eating disorder psychopathology and substance use, particularly within high-risk demographics such as college students and young adults.

Keywords

Drunkorexia, Alcohol-related eating pathology, Compensatory behaviors, Eating disorder, College students, Alcohol use, Psychological scale, Restriction, Purging.

Authors

C.J. Rahal, J.B. Bryant, J. Darkes, J.E. Menzel, J. Kevin Thompson.

Purpose

The central objective of the CEBRACS scale is to provide a precise, quantitative assessment of the frequency and nature of restrictive and compensatory behaviors specifically tied to anticipated or actual alcohol consumption. These behaviors are fundamentally driven by two co-occurring goals: managing body weight concerns related to caloric intake from alcohol, and manipulating physiological state to intensify the desired intoxicating effects.

The measure is designed to capture behaviors across three distinct temporal phases—pre-drinking, during intoxication, and post-effects—offering a highly granular insight into how individuals manage the caloric and physiological impact of alcohol across the drinking episode. This detailed approach is vital for researchers and clinicians seeking to identify populations at risk for co-occurring substance use and eating disorder symptoms, thereby facilitating targeted prevention and intervention strategies.

Construct

The CEBRACS scale rigorously operationalizes the construct known as alcohol-related compensatory and restrictive eating pathology. This construct acknowledges that disordered eating is not always generalized but can be highly context-specific, manifesting as the deliberate convergence of typical eating disorder behaviors (e.g., restriction, purging, excessive exercise) with specific substance use goals.

The instrument specifically measures behaviors reflecting both bulimic tendencies (such as self-induced vomiting or the misuse of laxatives and diuretics) and restrictive tendencies (such as skipping meals or choosing low-calorie alternatives), provided these actions are performed in direct relation to the intake of alcohol. The scale’s utility lies in its ability to differentiate these specific behaviors, which are motivated by the dual concerns of body image and alcohol intoxication seeking, from general, non-alcohol-related disordered eating patterns.

Validity

Initial validation studies conducted by Rahal et al. (2012) established the psychometric integrity of the CEBRACS. Construct validity was robustly supported via the application of exploratory and confirmatory factor analysis, which successfully confirmed that the scale measures a coherent, multidimensional construct of alcohol-related compensatory behaviors.

Furthermore, criterion validity was demonstrated through significant correlations between CEBRACS scores and established measures of related psychological phenomena. Specifically, high scores on the CEBRACS were found to correlate positively with increased severity on general eating disorder psychopathology scales and heightened measures of heavy episodic drinking, underscoring the scale’s relevance and utility in both clinical assessment and research settings.

Reliability

The reliability of the CEBRACS scale, specifically its internal consistency, has been consistently demonstrated through high Cronbach’s alpha coefficients reported across the total score and all four primary subscales in the validation literature. These strong coefficients attest to the high interrelatedness among the 21 items, ensuring that the instrument reliably and consistently measures the underlying complex construct.

The confirmed internal reliability suggests that the CEBRACS is a stable measurement tool suitable for accurately assessing the frequency of these specialized compensatory behaviors. This stability makes the scale appropriate for use in both large-scale cross-sectional assessments and rigorous longitudinal studies designed to track behavioral changes over time within target populations.

Factor Analysis

The CEBRACS scale is comprised of 21 items designed to map onto four distinct latent factors, which were identified and confirmed through rigorous factor analysis during the scale’s development. These factors temporally and behaviorally categorize the compensatory actions related to alcohol consumption:

• Factor 1: Alcohol Effects (Items 1, 3, 6, 7, 9, 12, 14): This factor aggregates behaviors centered on restriction of food intake immediately before or during drinking, intended specifically to intensify or accelerate the psychoactive effects of alcohol.
• Factor 2: Bulimia (Items 5, 8, 13, 15, 17, 19): This factor measures purging and related behaviors, including the use of laxatives, diuretics, or self-induced vomiting, utilized specifically to compensate for the caloric load associated with alcohol.
• Factor 3: Diet and Exercise (Items 2, 10, 11, 16, 18, 20): This factor encompasses behaviors related to caloric offset and energy expenditure, such as exercising before or after drinking, or the deliberate selection of low-calorie alcoholic beverages or low-fat foods.
• Factor 4: Restriction (Items 4, 21): This factor captures severe restrictive behavior, specifically the skipping of entire meals or whole days of eating, implemented as a direct strategy to compensate for the calories consumed through alcohol.

Instrument

Test Type: Self-report psychological scale.

Format: 21 items rated on a 5-point Likert scale (1=Never, 2=Rarely (about 25% of the time), 3=Sometimes (about 50% of the time), 4=Often (about 75% of the time), 5= Almost all the time). The required reference period for all items is the past three months.

Language Available: English (Original validation).

Population Group: Individuals engaging in alcohol consumption who concurrently exhibit body image concerns or disordered eating patterns.

Age Group: Primarily validated among young adults and college students.

Population Details: The scale’s initial development focused heavily on college students, a demographic characterized by high rates of both heavy episodic drinking and body image dissatisfaction, making them the critical population for assessing these specialized compensatory behaviors.

Test Methodology: Respondents are instructed to indicate the frequency with which they engaged in each specific compensatory behavior related to alcohol during the preceding three months, with items temporally categorized as occurring Before, While, or After the effects of drinking.

Keywords

Body image, Purging, Restriction, Laxative use, Diuretic use, Alcohol abuse, Compensatory behaviors, Binge drinking, Factor analysis.

Authors

Author ORCID Identifier: Not provided in source content; contact author for details.

Affiliation Email addresses: J. Kevin Thompson: [email protected]; [email protected].

Correspondence Address: J. Kevin Thompson, Ph.D, Department of Psychology, University of South Florida, 4202 Fowler Ave, Tampa, FL 33620-8200.

Permissions & Fee and Test Year

The original development and validation of the CEBRACS scale occurred in 2012. For researchers seeking permission to utilize the measure and for information regarding any associated usage fees, direct contact must be made with the corresponding author, J. Kevin Thompson, Ph.D. The instrument itself and related research information are accessible online at: https://sites.google.com/site/bodyimageresearchgroup/measures/compensatory-eating-behaviors-related-to-alcohol-consumption-cebracs

Reference’s

• Rahal CJ, Bryant JB, Darkes J, Menzel JE, Thompson JK.2012. Development and validation of the Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale (CEBRACS). Eat Behav. 2012 Apr;13(2):83-7.
• Bryant JB, Darkes J, Rahal C. 2012. College students’ compensatory eating and behaviors in response to alcohol consumption. J Am Coll Health. 2012;60(5):350-6.

Items of the Compensatory Eating Behaviors Related to Alcohol Consumption (CEBRACS)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Response Scale: 1=Never, 2=Rarely (about 25% of the time), 3=Sometimes (about 50% of the time), 4=Often (about 75% of the time), 5= Almost all the time

BEFORE drinking

1. In the past 3 months, I have eaten less than usual during one or more meals before drinking to get DRUNKER.
2. In the past 3 months, I have exercised before drinking to make up for the calories in alcohol that I anticipated consuming.
3. In the past 3 months, I have eaten less than usual during one or more meals before drinking to feel the effects of alcohol FASTER.
4. In the past 3 months, I have skipped one or more meals before drinking to make up for the number of calories in alcohol that I anticipated consuming.
5. In the past 3 months, I have taken laxatives before drinking to make up for the calories in alcohol that I anticipated consuming.
6. In the past 3 months, I have skipped one or more meals before drinking to feel the effects of alcohol FASTER.

WHILE under the effects of alcohol Instructions: For each of the following statements, think about behaviors you have engaged in WHILE you were drinking or under the effects of alcohol (e.g. while you were drinking during a wedding reception, party, bar, club, football game). This also includes situations where you may have been done drinking, but the effects of alcohol had not completely worn off. As an example, imagine arriving home from a party where you had been drinking and you could still feel the effects of alcohol even though you had stopped drinking earlier in the night.

7. In the past 3 months, I have eaten less than usual while I was drinking because I wanted to feel the effects of the alcohol FASTER.
8. In the past 3 months, I have taken diuretics while I was drinking to make up for the calories in alcohol that I was consuming.
9. In the past 3 months, I have not eaten at all while I was drinking because I wanted to feel the effects of the alcohol FASTER.
10. In the past 3 months, I have eaten low-calorie or low-fat foods while I was drinking to make up for the calories in alcohol that I was consuming.
11. In the past 3 months, I drank low-calorie beer or alcoholic drinks to get fewer of the calories that are in alcohol.
12. In the past 3 months, I have eaten less than usual while I was drinking because I wanted to get DRUNKER.
13. In the past 3 months, I have taken laxatives while I was drinking to make up for the calories in alcohol that I was consuming.
14. In the past 3 months, I have not eaten at all while I was drinking because I wanted to get DRUNKER.

AFTER effects from alcohol have worn off

15. In the past 3 months, I have taken diuretics to make up for the calories in alcohol that I had consumed previously while I was under the effects of alcohol.
16. In the past 3 months, I have eaten low-calorie or low-fat foods during one or more meals to make up for the calories in alcohol that I had consumed previously while I was under the effects of alcohol.
17. In the past 3 months, I have taken laxatives to make up for the calories in alcohol that I had consumed previously while I was under the effects of alcohol.
18. In the past 3 months, I have exercised to make up for the calories in alcohol that I had consumed previously while I was under the effects of alcohol.
19. In the past 3 months, I have made myself vomit to make up for the calories in alcohol that I had consumed previously while I was under the effects of alcohol.
20. In the past 3 months, I have eaten less than usual during one or more meals to make up for the calories in alcohol that I had consumed previously while I was under the effects of alcohol.
21. In the past 3 months, I have skipped an entire day or more of eating to make up for the calories in alcohol that I had consumed previously while I was under the effects of alcohol.