DSM-5, Scientific Advances, and the A-Word

Don't tell your mother

For members of the Task Force concerned with the conceptual evolution of DSM-5 (Regier, Narrow, Kuhl, and Kupfer), the primary goal was “to produce diagnostic criteria and disorder categories that keep pace with advances in neuroscience.” This is where we return, as promised, to the words of Prof. Graham Davey:

DSM-5 has continued the process of attempting to align its diagnostic criteria with developments and knowledge from neuroscience, when there is in fact very little new evidence from neuroscience that helps define specific mental health problems…

What? What was Dr. Davey thinking? Since the previous edition of the Diagnostic and Statistical Manual came out in 1994, the advances in neuroscience have been enormous. That was, after all, almost 20 years ago. Surely one of the more attention-getting obesity news events of 2011 was the publication of “Neural Correlates of Food Addiction,” in which brain scans showed:

Similar patterns of neural activation are implicated in addictive-like eating behavior and substance dependence: elevated activation in reward circuitry in response to food cues and reduced activation of inhibitory regions in response to food intake.

In other words, when you put certain people into MRI machines and tell them to think about milkshakes, their brains light up just like those of cocaine addicts contemplating their drug of choice. This was big news!

That study, and subsequent brain-scan explorations, have undeniably sparked discussion about the validity of the food addiction paradigm. In laboratories from coast to coast, lab rats have shown neuronal changes and addiction-like behaviors. Study authors Adrian Meule and Ashley N. Gearhardt wrote:

This increased scientific interest in this topic was in part driven by the rise of neuroimaging and subsequent findings that obesity and binge eating are associated with alterations in dopaminergic signaling and food-cue elicited hyperactivation of reward-related brain areas which are comparable to processes seen in drug users.

How did the DSM-5 Task Force, or Dr. Davey, or anyone, manage to hold onto a notion that the advances in neuroscience in the last 20 years have been negligible or nonexistent? Actually, the newest edition does acknowledge that the hallmark of addiction is the activation of the brain’s reward system, though it does this without using the word “addiction.” Medical writers interpret freely and just kind of work around it. This example is from addiction expert Elizabeth Hartney, PhD, specifically outlining “DSM 5 Criteria for Substance Use Disorders”:

While the pharmacological mechanism for each class of drug is different, the activation of the reward system is similar across substances in producing feelings of pleasure or euphoria, which is often referred to as a “high.”

Another example is from TranscendRecoveryCommunity.com:

The DSM explains that the activation of the brain’s reward system is the key to drug abuse problems. Once the cycle of addiction activates the internal reward system, a rush in the brain, that behavior can become the sole focus of one’s life to the exclusion and detriment of other life-activities.

Your responses and feedback are welcome!

Source: “Changes in DSM-5,” Blogspot.com, 02/13/13
Source: “Neural Correlates of Food Addiction,” YaleRuddCenter.org, 04/04/11
Source: “Food addiction in the light of DSM-5,” NIH.gov, 09/06/14
Source: “DSM 5 Criteria for Substance Use Disorders,” About.com, 09/03/14
Source: “From Addiction to Recovery: Learning Leads the Way,” TranscendRecoveryCommunity.com, 05/14/14
Image by torbakhopper

How was Food Addiction Left Out?

Read the Sign

As Childhood Obesity News has discussed before, the latest edition of the Diagnostic and Statistical Manual managed to omit recognition, in any way, shape, or form, of the reality of food addiction. What causes this ongoing delay? The medical establishment in Great Britain, as in other places, seems to have made up its mind. For a BBC Radio 4 program titled “Constant Cravings: Does Food Addiction Exist?” journalist Frankie Mullin wrote:

Addiction is defined by the National Health Service as “not having control over doing, taking or using something, to the point where it could be harmful to you.” Although addiction is most commonly associated with gambling, drugs, alcohol and nicotine, the NHS goes on to say that it is possible to be addicted to “anything.”

Yes, that word is “anything.” But DSM-5 is strangely silent on the addictive potential of edible products. Its chapter on “Feeding and Eating Disorders” includes anorexia and bulimia, but nothing about the most prevalent eating disorder on the planet, the one that causes millions to morph into grotesque, bloated caricatures of human beings. While anorexia and bulimia are serious and even life-threatening, they affect a very small fraction of the populace compared, for instance, to the devotees of chips or soda.

Maybe that explains the silence. If the Drug Enforcement Agency had to define chips and soda as Schedule I or II substances along with heroin, methamphetamine, and cocaine, it would lead to a legislative nightmare and a great deal of societal awkwardness. For instance, school sports teams, which are not currently allowed to let South American drug cartels pay for their uniforms, would no longer be allowed to accept sponsorship from food and beverage corporations.

The easiest and most superficial reason for the omission of food addiction could be that while experts do recognize the basic phenomenon, they just haven’t been able to classify it to their own satisfaction. Does compulsive overeating stem from the addictogenic nature (either inherent or contrived) of some foods? Or has it really been a behavioral addiction all along? But still — many other disorders are included and acknowledged as illnesses, even though they are not understood in every detail.

Is There Motion? Yes. Is it Body-Focused? Yes. Repetitive? Yes.

Food addiction might have fit into the book under “Obsessive Compulsive and Related Disorders.” Consider a person’s need to repeatedly cut a slab of meat with a knife; or to repeatedly clench a pizza slice between the teeth and sever a bite; or to repeatedly plunge the hand into a popcorn bag and then bring the fingers to the mouth; or to repeatedly chew or swallow. A case could be made that all those things are body-focused repetitive behaviors, or even (in a different chapter) stereotypic movement disorders.

Why not? When someone compulsively bites her or his own lip, cheek, or nails, “These symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.” That’s according to the book — which, by omitting compulsive eating, seems to imply that the daily habit of robotically ingesting many pounds of food somehow does NOT cause distress and impairment.

But we know that it does — in every possible functional realm, not just occupational and social, but in basic physical health. Indeed, compulsive overeating is so destructive, it could easily fit into the section on “Nonsuicidal Self-Injury” or even make its debut as star of the “Suicidal Behavior Disorder” category. Again — why not?

By the way, anyone who thinks that the newest edition of the Diagnostic and Statistical Manual makes sense, even to professionals, or who believes that the latest set of changes went down easily, is invited to read Dr. Stuart Gitlow’s “DSM-5: New Addiction Terminology, Same Disease.”

Your responses and feedback are welcome!

Source: “Food addiction: know the facts,” Food.UK.MSN.com, 01/05/2013
Source: “DSM-5 Table of Contents
Psychiatry.org, 2013
Image by Valerie Everett

More Addiction Lore

Elvis

Recently, Childhood Obesity News talked about the advantages and pitfalls of self-reporting as a research tool, and there is more to say on the subject. More was, in fact, said at the most recent European Childhood Obesity Group meeting, where Session 4 included Dr. Pretlow’s invited keynote talk, “Treatment of Child/Adolescent Obesity Using the Addiction Model.”

In the scientific realm, reports must fulfill certain criteria in order to be published. Publication implies that at least some of a researcher’s colleagues find plausibility in the proposed new addition to the literature. On the question of successfully treating obesity as an addiction, it seems that only two programs — Overeaters Anonymous and Energy Up — have published material, and both depend on their human subjects to self-report honestly.

Not long ago, we looked at Pathways to Health, a school-based program with an interesting origin story. It began as a way of dealing with substance abuse and violence. What do those behavioral problems have in common with the compulsive overeating that leads to obesity?  All three stem from an inability to regulate emotions, make good decisions, or control impulses. But even this highly-regarded program has a weakness — it is based on self-reported information. As Healio.com described, students fill out surveys with over 100 questions.

Inquiry … included questions such as, “How often did you eat any fruit, fresh or canned?” Questions about physical activity asked students to self-report how often they were very active in certain situations or whether they were involved in sports. Other questions were posed based on sedentary activity, such as amount of time spent watching television or playing video games.

Is it churlish to wonder how much fudging of the truth, or even how much self-deception, might be involved in self-reporting situations? But what alternative could be satisfactory? Unlike lab animals, humans cannot be observed 24 hours a day. When they are, the psychological disruption is enough to negate the usefulness of any experimental results.

From a website called StepsToRecovery.com, we learn that eating disorders  and substance misuse disorders often co-exist in the same person, and “they both involve urges to abuse the body.” This recalls how the singer Elvis Presley ate and drugged himself to death, surrounded by a cadre of sycophantic enablers:

Elvis demanded that every day he receive 3 separate doses of drugs that he called “attacks.” Each “attack” contained a dangerous combination of pills or shots of Valium, Nembutal, Demerol, Quaalude, and Seconal. David Stanley says the first “attack” was usually given between 2 and 3 a.m:
“After he’d take his attack, attack one, he would have a couple of cheeseburgers, potatoes. The “attack one” effect would get him groggy and sleepy…”
After sleeping for a few hours, Elvis would receive “attack” number two:
“That would last for several hours… Then it would be attack 3, which was the same contents of attack one and 2.”

Here was a man with all the fame and fortune the world could offer, who wanted nothing more than to assault his body with potent toxic chemicals, in between consuming equally suicidal meals. His story clearly shows the importance of treating underlying problems.

Your responses and feedback are welcome!

Source: “Childhood eating habits influenced by peers,” Healio.com, 2014
Source: “Starving Yourself to Achieve the Impossible Figure of Barbie,” StepsToRecovery.com, undated
Image by Ian Burt

Childhood Obesity and Cross-Addiction

Needle Exchange

People who get hooked on nicotine, alcohol, and street drugs all have something in common: they are also likely to be addicted to food. As food addiction expert Phil Werdell says:

They often come to Overeaters Anonymous or one of the other food–related 12 Step fellowships because they find themselves reacting to food just like they had reacted to alcohol or their drug of choice many years before…

This is how we know food addiction  exists. The conviction is not based on overheard cute remarks, made by ladies who lunch, about irresistible chocolate mousse. No. Legitimate, bona fide recovering addicts from other genres have identified food addiction as a reality, and they should know. Werdell says, “Often they will identify sugar, flour or fat as a substance that is acting in their bodies like a narcotic.”

But in the context of more exigently life-threatening drug and alcohol habits, the specter of food addiction has traditionally taken a back seat. The Alcoholics Anonymous (AA) guidebook recommends using candy to help fight the drinking urge. Sure, weighing 300 pounds is not a desirable state, but when compared to crawling inebriated through a gutter, it is considered the lesser of two evils.

The Other Addictors

Ex-smokers are notorious for gaining weight. Once the cigarettes are gone, many people find that the fingers and the oral cavity need something to do — in many cases, the solution is to eat. The hands and the mouth are habituated to engaging in activity, which is hard enough to deal with, but there is more to it than that.

Werdell brings up the fact that tobacco is often cured with sugar. Perhaps through the cigarettes, the reformed smoker was getting enough sugar to sustain that habit, as well as the jones for nicotine. Sadly, the absence of cigarettes leaves behind not only a behavioral addiction centered around mouth pleasure and manual occupation, but a lonely, orphaned sugar addiction that now needs another feeding source.

The All-or-Nothing Dilemma

The big, unavoidable hitch for recovering food addicts, even if they successfully beat alcohol with AA or another 12-step program, is that food doesn’t fit the paradigm that allows for abstention. You can decide not to drink liquor, but you can’t decide not to eat food — not without bringing on a whole raft of new, different, and potentially lethal problems. The author writes:

It is difficult to move from the “all or nothing” model of no alcohol to a structured eating plan… It is not possible to just “not be around food” the way it is possible to avoid alcohol or smoking.

Plus, ex-drinkers face the same deprivation as ex-smokers. However much sugar was being supplied by their liquor of choice, that chemical is now missing from their diet. In fact, Werdell seems to almost suggest that alcoholism is just a variety of food addiction, albeit more blatantly intoxicating and obviously psychoactive.

What is alcohol but grain and a form of sugar? The most common addictive foods are sugar and flour. A majority of these sober alcoholic food addicts can quickly remember using and abusing food years before they picked up alcohol… When raw emotions came up in early alcohol recovery, one could still use food to cope.

For hard drugs, the case is similar:

Foods can break down in the digestive symptom into bio-chemical compounds that are similar to the opioids in narcotics. The dosage and effect of using morphine, heroin or cocaine is much stronger, but once these are out of their blood, some physically sober drug addicts can get high and chemically addicted just by using more and more food.

Detoxification from food can be worse than getting over the other substances. Food issues bring a person all the way back to the beginning, to the breast and the bottle and the sugar-saturated formula, and the attention or the lack thereof, and the basic equation of nourishment with love that keeps millions of people enslaved to substances.

What’s It to Us?

Now, what does this have to do with childhood obesity? Very few children use nicotine, alcohol, or street drugs. They do not typically sign in to a program with other addictions, or with a history of either failure or success in beating those life-threatening habits. So, why are we even thinking about this stuff?

Because we don’t want our kids who are rescued from food addiction to be vulnerable to other addictogens. We want them treated and helped and healed in such a way that NO other substances or behaviors can swoop into the emptiness and opportunistically colonize that void. We want treatment that proofs them against the alluring false promises of any substances or habits – with no empty spaces left to fill.

Your responses and feedback are welcome!

Source: “Cross Addictions,” FoodAddiction.com, 05/02/13
Image by Todd Huffman

 

Self-Reporting Addiction: the Pros and Cons

Filling Out The Official Paperwork

After the most recent Gallup-Healthways Well-Being Index was published, an uncredited writer at Conscienhealth.org questioned the means by which the 10 fattest and leanest states, and similar lists, are generated. The page states that “most of the coverage has been free of any critical thinking about the conclusions presented as definitive facts,” and goes on to say:

All these obesity prevalence numbers are based on how tall and heavy people say they are in anonymous interviews. Such numbers have two big problems. First, people are always taller and lighter when they get to self-report. And second, the little fibs people tell about their height and weight are not uniform.

The expression “pros and cons” is shorthand for the Latin words that mean for and against. But in this instance, the modern meaning of “pro” as a professional person, and “con” as a deceptive person, as in “con artist,” are strangely appropriate. If all you seek are public relations talking points and a bit of entertainment, these numbers may be acceptable. But for any serious purposes, they are not, because “comparisons based on self-reported data are inherently flawed.”

The Only Game in Town

Still, in the soft sciences, self-reporting is often the only tool in the shed. Childhood Obesity News has mentioned a piece by Steve Sussman and five colleagues that appeared in the Journal of Behavioral Addictions last March. For starters, “Prevalence and co-occurrence of addictive behaviors among former alternative high school youth” distinguished itself by saluting the importance of the First International Conference on Behavioral Addictions, a 2013 convocation at which Dr. Pretlow spoke.

The article by Sussman et al. offered numerous paragraphs that hinted at jumping-off places from which to visit complex questions worthy of entire books in themselves. The mere mention of so many byways and side roads shows an awareness that there are no simple answers. For instance, take this short, almost throwaway observation:

Future studies might address shifting trends in addictions and the implications of being addicted to certain behaviors versus others. That is, self-reported prevalence on measures of addiction may change as the acceptability of being addicted to certain behaviors changes, along with varying associations.

Inevitably, the more open-ended the questions posed by researchers, the more the results will be skewed. Humans being what they are, the acceptability factor is huge. People’s self-esteem is almost entirely other-directed, and they really, really care what the neighbors think.

For instance, even in the most securely anonymous survey, engineered to ensure truthfulness in self-reporting, how many people will report their nose-picking addictions? What about people with the behavioral addiction of messing around with barnyard animals? How many will be honest enough to out themselves?

Still, self-reporting is the best current source of information about addiction. On the question of whether a person will walk a mile in a blizzard at 3 a.m. for a pack of smokes, only the nicotine addict knows for sure. From people excessively attached to food, some equally disturbing admissions have been heard.

Your responses and feedback are welcome!

Source: “Obesity top 10 lists — the fattest and leanest states,” Conscienhealth.org, March 2014
Source: “Prevalence and co-occurrence of addictive behaviors among former alternative high school youth
NIH.gov, 02/03/14
Image by slgckgc

Cross-Addiction’s Long Reach

Julia Sweeney

When interviewed by Marc Maron, Saturday Night Live cast member Julia Sweeney revealed how alcoholism  affected some members of her family, but not her:

Sometimes I think I’m so lucky that my drug was food, actually, because you can survive that. Unless you really go crazy, that’s a much more survivable stress-reducing mechanism than alcohol. When I feel stressed out, I want to eat … My blood pressure goes down, I get focused. It absolutely does the job, and I know that’s the feeling my brother and dad had, for example, and what did that was alcohol.

Physicians are aware of “cross-addiction” and of how easy it is to upset the equilibrium of a patient in recovery by accidentally prescribing a drug that will undermine sobriety and cause a relapse. The trouble is that a lot of substances increase the release of dopamine, which the brain’s pleasure center likes too much for the patient’s own good. A recovering alcoholic can be sabotaged by a prescription that was meant to assuage anxiety, pain, sleeplessness, or even attention deficit disorder.

But the situation may be even more serious, and the danger even more pervasive. In addiction studies, one school of thought holds that all addictions are one. According to this theory, attachment to a certain addictor, whether it is a substance or a behavior, can be severed – but another addictogenic behavior or substance will certainly step in to fill the void. Childhood Obesity News explored this idea recently, citing Dr. Vera Tarman’s essay, “Finally Sober, Suddenly Fat: Food Addiction is Another Drug Addiction.”

Not Even a Substance

A reader who found that article interesting and helpful sent an email to express appreciation, and also described the website she had connected with to make weight loss more fun by adding monetary rewards and penalties. Having read the definitions and rules, she signed on for a 6-month DietBet game. Becoming more familiar with the intricacies of the program, she said…

…made me take note of all the players who were actively enrolled in more than one “game” and made me wonder how many of them are shifting from an addiction to food, to addiction to tracking/gambling.

The same reader sent along the link to a fascinating article titled “The Dark Side of Activity Trackers.” Electronic devices and their applications do an excellent job of providing immediate feedback and increasing self-awareness, and can definitely save lives when used properly. But just like anything else, this tracking technology can be abused by humans. Journalist Anna Medaria Miller spoke with psychology professor Mary Pritchard about her area of expertise, where the combination of eating and exercise can morph into pathology. Dr. Pritchard says:

[For] anyone who has any existing eating disorder or excessive exercise tendencies, using a fitness tracker is a very bad idea because it just makes them even more obsessive and compulsive about the fact that they’re not meeting their unrealistic goals.

These questions are worth wondering about. If all addictions spring from a common root, the recovering opiod addict, for instance, must avoid not only other drugs of the same family, but every potentially addictive substance and behavior on the planet, from overexercise to chocolate-covered bacon. This way of looking at things shows, more obviously than ever, the importance of healing a person’s most basic psychological problems.

Your responses and feedback are welcome!

Source: “Episode 553 – Julia Sweeney,” wtfpod.com, 11/24/14
Source: “The Dark Side of Activity Trackers,” USNews.com, 01/06/15
Image by Franco Folini

 

The Up Side of Fat Acceptance

Nikki P

Plus-Size Model Nikki P

 

America, where tolerance is a national virtue, truly is the land of opportunity. Acceptance is viewed as a positive value, even when intuition tells us it may be doing harm. But in the realm of personal behavior, spiritual leaders and psychologists alike will affirm that people cannot change until and unless they have been accepted for who they are. And some people are okay with not changing.

At a Hollywood party, Ari Shaffir’s attention was captured by an unusual sight – a pretty young woman enthusiastically devouring the hors d’oeuvres with seemingly no thought for calories or their effect on her waistline. The young woman, Jamie Caparulo, agreed to a recorded interview, and divulged that she was raised in the Midwest, where you ate what your parents put on your plate, whether you were full or not.

Her life partner is hefty professional comedian John Caparulo, and their marriage operates on its own rules, with fat acceptance as one of its pillars. He used to be thin; she used to have a serious alcohol problem. As a couple, they enjoy hanging out together, watching TV, and eating not just snacks, but full meals, in bed.

Some entrepreneurs take acceptance to the next level, and turn it to their advantage. Just ask Justin Harrison, author of a very grown-up book called Confessions of a Fat Player: A Big Man’s Guide to Dating Beautiful Women.

Since 1985 – a period of not quite 30 years – the average American woman’s dress size has gone from 8 to 14. To put it another way, the average increases by one dress size every five years. If that mathematical progression continues, by 2050 the average American woman could be up to dress size 20.

Fashion for Big Women

The concept of high fashion for bigger women has caused tremors in the bedrock of the clothing industry. Of course, some established retail giants branched into plus-size offerings a long time ago, but the product tended to be dull and shame-driven, with the “tent to hide your body” look. Creators of full-figured fashion now strive to depart from that aesthetic. Complacent old-timers have been forced to reassess their options and step up their game.

For plus-size garments that look nice and have some ooomph, entrepreneurs (and established clothiers who saw which way the wind blew) have been rewarded to the tune of well over $15 billion in a single year. Still, insiders are frustrated that national brands like Macy’s are still peddling clothes to size-24 women by photographing the garments on size-12 models.

“Fat is where it’s at!” – Root Boy Slim

For the New Yorker, Lizzie Widdicombe related how Full Figured Fashion Week was invented six years ago by former plus-size model Gwen DeVoe, whose confidence in the concept was such that she threw in some of her own money to get it started. Of course DeVoe accessed funds from investors, too, who are happy that they got on board. The annual main events are accompanied by many peripheral exhibits and retail operations such as:

…an Indie Designer show, which displayed the work of eleven plus-size designers from cities around the country… and a runway show, which featured larger companies…

Alexandra Boos, another former plus-size clotheshorse, divulged to the journalist that big fashion models are sometimes mistreated at photo shoots. Unlike the skinny haute couture models, they often have to do their own makeup. They put up with the same grinding work schedules and routines as superstars like Heidi Klum, with only a fraction of the fame or the income. Still they remain, as stated by the motto of the PhatGirlFresh website, “Passionate, Happy, Appreciative, True.”

“Rubenseque” women are also appreciated by such artists as Root Boy Slim, who says:

She’s got a shape that makes me drool
Lord I’m just a fat girl’s fool
She weighs in at two-oh-two
That’s fine with me, I’m portly too

Your responses and feedback are welcome!

Source: “Ari Shaffir’s Skeptic Tank #91: Good Fatitude (with Jamie Caparulo),” Arithegreat.com, 12/10/13
Source: “The Plus Side,” NewYorker.com, 09/22/14
Source: “Root Boy Slim “Dare to Be Fat”,” YouTube.com, 02/20/09
Image by PhatGirlFresh.com

 

Obesity and the World of Addiction Studies

Cleaning up the mess

Many health professionals believe that all addictions are one addiction. Furthermore, some believe that all addictions are symptoms. The addiction is not the problem, but the outward and visible sign of the problem. And unless the problem is eliminated, it will manifest by showing up as a different addiction, then another and another.

Childhood Obesity News recently mentioned the theory that a person addicted to a substance might make the switch to a less destructive and more socially acceptable addictogen, such as exercise or housecleaning, while still remaining an addict forever. A therapist with a pragmatic worldview understands that a complete cure is rare, and while substitution might not be the most desirable outcome, it can be acceptable.

The sufferer could change from a compulsive eater to an equally compulsive calorie-counter, and although a form of behavioral addiction is still in place, on the whole it’s a net gain. For starters, conversion to a less physically harmful compulsion leaves the person alive with the potential to grow and improve; and perhaps one day to abandon the obsessive calorie counting.

At the influential 1st International Conference on Behavioral Addictions, Marc N. Potenza asked the question, “How might food addiction relate to drug and behavioral addictions?” He learned that individuals have different neural responses, including diminished activation of the brain’s reward mechanism in obese people with binge-eating disorder. About the fMRI study he worked on, Potenza said:

Certain obese individuals, for example those with binge-eating disorder (BED), appear to share more features of addictions (diminished self-control, elevated impulsivity) than do obese individuals without obesity…

Obese individuals with BED and those without showed divergent findings, with the binge-eating group showing similarities to findings observed in pathological gambling and nicotine and alcohol dependence…

Rarely does one scientific paper hold as many provocative ideas as “Prevalence and co-occurrence of addictive behaviors among former alternative high school youth,” by Steve Sussman, et al. For one thing, there is a suggestion that while treatment programs for alcohol, overeating, and gambling addictions are all well and good, “perhaps a ‘generic’ perspective of addiction might be applied across large populations.” The idea that all addictions are one thing is treated like a well-established and universally-accepted truism in Sussman’s paper. Instead of concentrating on a subset of potentially problematic substances called “drugs,” why don’t schools sponsor inclusive addiction-prevention programs that embrace all possible addictogens?

Even more astonishing, the authors inject a mild-mannered sentence that needs a repetition or two before it sinks in and reveals itself as nothing less than a call for the complete restructuring of the world as we know it:

Finally, it is possible that societal-level changes are needed to reduce modern lifestyle predictors of addictions…

What a terrific prescription! Simply put an end to family strife, poverty, injustice, success-obsession, highway traffic, and a few other obstacles. Reduce the number of irritants that cause so much trouble by driving people into addiction, and all will be well. Who could disagree?

Your responses and feedback are welcome!

Source: “1st International Conference on Behavioral Addictions,” mat.org, 2013
Source: “Prevalence and co-occurrence of addictive behaviors among former alternative high school youth,” NIH.gov, 03/03/14
Image by Toms Baugis

 

Addiction Studies Cover New Ground

inside the alchemist

In the old days, it was clear what the addictors or addictogens were: heroin, cocaine, amphetamines, alcohol, and nicotine. Then came the recognition of unhealthy and counter-productive attachment to activities that had seemed neutral or even benign, and the world acknowledged the existence of shopaholics, workaholics, exercisaholics, and so on. Process addictions became a regular feature of the landscape.

Then came a suspicion that maybe all addictions are behavioral addictions. In that scenario, compulsive overeating is not so much about dependence on a particularly irresistible type of food, but largely about dependence on the activity or process of eating.

As Childhood Obesity News mentioned, the 1st International Conference on Behavioral Addictions is regarded as a milestone in some circles. A presentation by Robin Elizabeth Pope of the Max Planck Institute, called “A periodisation analysis to see how to reduce behavioural addictions,” offered some interesting ideas along with a schema of how a gambling addiction might be interpreted under this paradigm. Pope writes:

Pharmaceutical solutions are based on a static theory that behavioral addictions stem from chemical imbalances. This theory has minimal efficacy…

Her approach is to instead investigate how people get common sense and how they learn and implement good decision-making. In other words, how they get the coping abilities or life skills that keep people sane and happy, and prevent them from falling prey to addiction of any variety.

At the same conference, a researcher from the IM Sechenov Institute of Evolutionary Physiology and Biochemistry spoke about a new way of classifying nonchemical addictions. Alexei Egorov does allow for the existence of chemical addictions, but is strongly interested in behavioral addictions as well. He identifies the six characteristics that both kinds share: salience, mood changes, tolerance, withdrawal symptoms, conflict, and relapse.

World Full of Addictors

The possible non-chemical addictions are so numerous they could encompass almost anything. (Perhaps Egorov has contemplated the possibility that he is addicted to enumerating non-chemical addictions.) As for classifying them, he recognizes five major categories, each with its accompanying sub-categories. The first four major groups encompass gambling, erotic, socially acceptable, and technological addictions. The fifth is food addictions, divided into overeating and starvation. Egorov says:

Long-term experience shows that one addiction can easily transform into the other, which happens both in chemical and nonchemical addictions.

His overarching idea is that addicts are not so much cured as diverted into socially acceptable addictions. Often this doesn’t work out well. To be a former alcoholic and a current sugar, coffee, and cigarette addict is not such a great thing. An addict may never be truly healed, but replacement therapy can transform a person by substituting a socially acceptable nonchemical addiction such as exercise. Sometimes that is the best a therapist can do, and it’s nothing to sneeze at.

Your responses and feedback are welcome!

Source: “1st International Conference on Behavioral Addictions,” mat.org, 2013
Image by Tom Stohlman

 

Addictor: The Missing Word

addictor

People have trouble grasping the idea that all addiction is one phenomenon, expressed in various ways. Perhaps that might be because there is no recognized word for “an addictive thing” whether that thing is food or gambling, nicotine or Internet use, a substance or a behavior. For that concept, there is only the inaccurate and misleading use of “addiction.”

Logically, “addictor” should be that universally accepted word, but it isn’t. Almost the only instance of it is found in a book by Gene Smith and Lane Neihardt, which features the artwork shown on this page, with the caption, “I am habit, you’re chemical beings. I’ve GOTCHA!”

Addiction is a state or condition – and it takes a human person to be in that condition or state. An addiction is a strong interest or a need – which can only be experienced by a human. It is using something, which only a human can do. It is dependence, which only a human can experience.

“Addicted” is a state, like “allergic” is a state. A person can have an allergy, and a person can have an addiction. A person can be allergic to peanuts, but peanuts themselves are not “an allergy,” because an allergy is a condition, which only a human can experience. A person can be addicted to chocolate, but chocolate itself is not “an addiction,” because an addiction is a condition, which is experienced by a human.

The misuse of that single word has probably been responsible for a lot of the confusion in the field. So, what should the thing that causes the addiction be termed? “Addictogen” has been used occasionally, and fits the need quite well. Here are some examples of how “addictogenic” has been accepted as the adjective form:

“The propensity to produce “dependence”… is the red flag that sets apart this relatively small class of drugs, including alcohol, from the millions of other known chemical compounds. They are addictogenic… The exact molecular mechanism of addictogenesis is still the focus of scientific investigation.”

Cocaine is a powerful stimulating agent of the central nervous system and a highly addictogenic drug.”

“America has devolved into an addictogenic culture….”

“Addictogenic” is an adjective with a clear and accepted meaning. So, why not make full use of the noun form? Something that is addictogenic is an addictogen, a much more sensible and logical word choice than what is currently, sloppily, and inaccurately applied. Either “addictogen” or “addictor” should be widely used. It is time to stop incorrectly saying “addiction” to denote what is really the addictor or addictogen.

It would not make sense to describe a test tube of pollen as an allergy. The pollen is not the allergy, but the substance that provokes an allergic reaction in people. A person can have an allergy, but an object cannot be an allergy. The gambling is not the addiction, it’s the activity that brings out an addictive reaction in people. A person can have an addiction, but an object can’t be an addiction. The wrong usage of that word only worsens an already confusing situation.

Your responses and feedback are welcome!

Source: “If Alcohol Were Invented Today,” blogspot.com, 10/30/10
Source: “Cocaine addiction,” sigmaaldrich.com, 05/01/13
Source: “Jane Unchained,” janeunchained.com, 11/28/14
Image by Gene Smith and Lane Neihardt

 

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