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

 

When the Food Addiction Concept Caught On

DSC_0188Recently, Childhood Obesity News looked at a fascinating study in which alternative high school students – with at least one behavioral “strike” against them – were interviewed three years after going through a drug abuse prevention project. The researchers were curious about multiple addictions in the young. One reason why this phenomenon has not been studied more extensively is that when a researcher gets a chance to question a teenager, it’s usually only for the length of a 50-minute academic class. Quite often, such an investigation is carried out with a paper questionnaire, a rather limiting tool.

When teenagers talk about their addictions, they are not using definitions from any edition of the Diagnostic and Statistical Manual; even the experts disagree about these definitions. In this case, the researchers readily concede that what they are trying to measure might more usefully be called “self-perceived addictions.” While some scholars applaud this effort, self-reporting is not exactly the most accurate method of collecting data. It incorporates far too much subjectivity for many scientists to be comfortable with. Also, say the researchers:

There is a great deal of redundancy in the measurement of various addictions, which may share in common such features as involving appetitive motives (e.g., pleasure, arousal or sedation, and nurturance), brief periods of satiation, preoccupation, loss of control, and accumulation of a variety of negative life consequences….Such redundancy is burdensome to measure.

At the end of the day, the researchers admitted that the study suffered from at least five limitations. Still, they were excited by the methodology, explaining it like this:

While an addiction matrix measure does not extensively measure any addiction, and validation studies of such measures have not been conducted, this approach is practical, economical, and may actually tap different addictive behaviors….

Apparently David R. Cook, back in 1987, was the pioneer in using a matrix measure with addictive behaviors. Below is a sample of what the American Psychological Association says about Cook’s “Self-identified addictions and emotional disturbances in a sample of college students.” (In this context, of course, the capital S means “subject.”)

Data are presented bearing on the incidence of various addictions and the extent to which Ss identifying themselves as addicted to one experience also reported addiction to one or more other experiences. Results support S. Peele’s (1985) assertion of the validity of self-reports of addictions and also indicate the co-occurrence of addictions that include alcohol, drugs, anorexia, physical violence, gambling, and sex.

The only popular addicting experience that Cook did not include was the internet, because it didn’t exist in any kind of available, user-friendly form at the time. When Cook did his research among college students, the self-reported addiction with the highest prevalence was relationships/love, which affected one fourth of the subjects. The next most prevalent was caffeine, then work, sex, shopping, alcohol, and cigarettes (which, surprisingly, did not even score as high as 10 percent).

A similar study of college students by other researchers in 1999 found that exercise addiction had the highest prevalence, followed by caffeine, television, alcohol, cigarettes, and chocolate, which equaled cigarettes at 23 percent. This probably does not mean that a greater number of young adults were actually hooked on chocolate, but that in the interim of more than a decade, the popular imagination had adjusted to thinking of edible substances as potentially addictive.

Your responses and feedback are welcome!

Source: “Prevalence and co-occurrence of addictive behaviors among former alternative high school youth,” NIH.gov, 03/03/14
Source: “Display Record,” APA.org, 2012
Image by Saiko Weiss

Dr. Vivek Murthy, the New Surgeon General

Murthy

Guess what happened during the busy and distracting month of December? After more than a year of foot-dragging, the United States Senate confirmed a new Surgeon General. Dr. Vivek Murthy had made the mistake of tweeting that guns are a health care issue, and many members of Congress held it against him. Many Americans (who voted for those politicians) believe that when citizens show up in the emergency room with holes in them, how they got there is irrelevant, and the medical profession should just mind its own business. Doctors should, in other words, shut up and sew up the holes.

Dr. Murthy went to two Ivy League universities, and believes that doctors should have some say in designing and administering the health care system that couldn’t exist without them. An internal medicine specialist, he is all about prevention. During the Senate hearings that led to his confirmation, he promised to focus on reducing tobacco use, increasing vaccination rates, and fighting childhood obesity. Although he has accomplished many things, Dr. Murthy has not yet done much with childhood obesity, so it will be an exciting adventure.

The New York Times noted that the new Surgeon General was a founder of the 16,000-member Doctors for America, which was also held against him during his hearings. The organization used to be called Doctors for Obama, and it had a lot to do with establishing the Affordable Care Act, a.k.a. Obamacare, which some people don’t like. So there were two strikes against him. But, Sabrina Tavernise says:

Dr. Jerry Avorn, a colleague of Dr. Murthy’s at Brigham and Women’s, pointed out that past surgeons general took strong and unpopular positions — on smoking in 1964 and on AIDS in the 1980s — and were remembered as courageous fighters for what was right for public health… [Dr. Avorn said,] “He understands that health and illness are intimately connected to social issues and even political decisions.”

For MedPageToday, Molly Walker rounded up expert opinions on the matter. Dr. Robert L. Wergin, president of the American Academy of Family Physicians, sees Murthy’s strengths as his ability to connect with a diverse community and his facility with new communication systems (though it was a Twitter posting that caused so much trouble, and the account was shut down right around the time when he was originally nominated for the Surgeon General position). Dr. Wergin said:

It is the Surgeon General who helps nonmedical people understand what they need to do to stop smoking, or how important it is for all of us to maintain a healthy weight, or what we need to do to avoid infectious diseases.

Some observers are less sanguine about the new Surgeon General’s prospects. Alan P. Sager, Ph.D., of the Boston University School of Public Health, told the reporter “prevention always fails inevitably.” In a different venue, family physician Mike Sevilla sounds close to despair:

What impact can this surgeon general, or any surgeon general, have on policy making, given the Washington political environment? How much impact can this surgeon general, or any surgeon general have on America’s health? What can the surgeon general really do?

Your responses and feedback are welcome!

Source: “New surgeon general approved despite remarks on guns, contraception,” LATimes.com, 12/15/14
Source: “Vivek Murthy, the New Surgeon General, Isn’t Afraid to Take a Stand,” NYTimes,com, 12/16/14
Source: “Friday Feedback: Do We Need a Surgeon General?,”
MedPageToday.com, 12/19/14
Source: “Vivek Murthy is now surgeon general, but what can he really do?,” KevinMD.com, 12/31/14
Image by Twitter.com

 

Obesity and Addiction, the Discussion Goes On

Kudzu takes over Spartanburg

Kudzu takes over Spartanburg

There has been a lot of public discussion about how to classify obesity, compulsive eating, and food addiction. It is the kind of talk that proliferates like kudzu, which would be fine if we had nothing better to do than sit around and wag our chins. But even as we speak, millions of children are panting and sweating, bursting through the seams of their clothes, and feeling like shameful failures at life.

Obesity exists without addiction. Addiction exists without obesity. Someone has listed over 100 possible causes for obesity. To stop people’s compulsive behavior, what is justifiable? Can consumers insist that insurance companies pay for, just as a random example, cognitive behavioral therapy? And if the patient doesn’t get better, can he try another thing, like acupuncture? And if that doesn’t work, can the insurance company insist that the person be lobotomized?

How far can a society go to protect itself from the destructive extremes of individual behavior? How far can it go to protect children? Don’t people have the right to do as they please with their own bodies? How much human behavior should be criminalized? Should the legal system just leave everyone alone to flush themselves down the drain in their chosen ways? Should the energy go instead to more funding of research?

Speaking of Research…

One conclusion of a study titled “Prevalence and co-occurrence of addictive behaviors among former alternative high school youth” is that there are not enough other studies of the same kind. Written by Steve Sussman, Thalida Em Arpawong, Ping Sun, Jennifer Tsai, Louise A. Rohrbach, and Donna Spruijt-Metz, and well worth reading in its entirety, it concerns youth with functional problems, who were enrolled in non-mainstream schools designed to give them a second chance.

One interesting aspect of this document is how it harks back to the First International Conference on Behavioral Addictions as a landmark event. It took place in Budapest in March 2013, and Dr. Pretlow, who called it an “an extremely valuable meeting,” spoke on the topic of “Addiction model intervention for obesity, implemented as a smartphone app: A pilot study.”

Depending on what parameters are set by the designers of research, it can be shown that, for instance, nearly 50 percent of American adults are addicts, or that 75 percent of college students are addicted to something – neither of which is necessarily true. Still, enough voices are heard, from enough different directions, to suggest that a new approach is needed. The creators of this particular study do not doubt that addiction is widespread, and more so than we are comfortable in admitting. “Focal addictive behaviors” include:

…cigarettes, alcohol, illicit drugs, eating disorders [obesity, anorexia, and bulimia], gambling, shopping, relationships/love, sex, exercise [running], and work), along with additional addictions (e.g., caffeine), violence, and emotional disturbance constructs…
Theoretically, as an example, one might think of these 11 addictions as grouping to reflect active-nurturance (e.g., Internet, shopping, work), active-pleasure seeking (e.g., sex, love, exercise), and passive-pleasure seeking (alcohol, cigarette, other drug use, eating) motives.

This might be over-thinking it. But the researchers MacLaren and Best made even finer distinctions in 2010, when they…

…examined the factor structure of a set of 16 addictions. Three factors were identified:
(a) nurturant (e.g., compulsive helping [dominant and submissive], work, shopping, food [binging and starving], exercise, relationships [dominant and submissive]),
(b) hedonistic (illegal drugs, alcohol, tobacco, and sex) factors, and
(c) another hedonistic-like factor (prescription drugs, gambling, caffeine).

Your responses and feedback are welcome!

Source: “Prevalence and co-occurrence of addictive behaviors among former alternative high school youth,” NIH.gov, 03/03/14
Image by Char

The Possibilities of Obesity

My Red-headed Stepchild

Childhood Obesity News has been comparing and contrasting the basic qualities of the “red-headed stepchild,” food addiction, with various other conditions that the Diagnostic and Statistical Manual (DSM-5) recognizes as real and legitimate.

One of the awkward things about discussing the idea of food addiction is that not all foods affect people with such enthusiasm that they are in danger of becoming hooked. The fact that many foods are incapable of inspiring devotion at the addiction level has made comprehension more difficult. If compulsive overeating is meant to fill a person’s emotional empty places, not every food can do the job. Some provide the illusion of doing so – at least temporarily – but it would be too complicated to break the syndrome down into cheese addiction, sugar addiction, potato chip addiction, etc.

Another Take

There might be a different way of looking at food addiction. The experts who composed DSM-5 determined that gambling resembles a substance addiction in every way, except that it is not a substance. So is it possible that an unhealthy dependency that actually does involve a consumable substance could paradoxically fall under a totally different category? What if it is actually a behavioral addiction that just incidentally happens to involve substances? Then these distinctions would not matter. It sounds complicated, but Mark D. Griffiths of Nottingham Trent University says:

Behavioural addiction has become a topic of increasing research interest. There is now a growing movement that views a number of behaviors as potentially addictive including many that do not involve the ingestion of a drug (such as gambling, sex, exercise, work, videogame playing and social networking).

A brief look at the 53-page document outlining the Plenary Presentations at the 1st International Conference on Behavioral Addictions reveals a wealth of intriguing phrases and concepts that could somehow come into play, as understanding of food-related problems grows. There are mentions of Reward Deficiency Syndrome, subthreshold conditions, holistic intervention, impulsivity, craving, identity, compulsive buying, death anxiety, and social judgments of behavioral versus substance-related addictions.

One presentation was titled “Associations of negative affect and impulsiveness with disordered eating and problem gambling in a community-based sample of adults.” What are those things all doing together in one title? And how about “Mental stress, sleeping disorders, and risk of Internet addiction and eating disorders: New public health challenges among university students”? How is research progressing on these fronts?

In any case, experts are splitting ontological hairs and counting angels on the heads of pins and engaging in learned speculation about just where each ailment resides in their taxonomy of dysfunction. Meanwhile, out in the real world, real children and teenagers and young adults are living in misery due to their problems with food. Whatever labels are ultimately bestowed on these conditions, millions of kids need help right now.

Your responses and feedback are welcome!

Source: “1st International Conference on Behavioral Addictions
mat.org, 2013
Image by Anthony Crider

Obesity and the Agonizing Choices of Definition

Overweight adults

With the determination to understand what the members of the DSM-5 Work Group (who invented the definitions) were thinking, Drs. Henrietta Bowden-Jones and Luke Clark tackled the subject when the book was still being assembled. They wrote of the similarity of clinical expression and what they characterized as an “overlap” between substance use disorders and what was then called “pathological gambling.”

Like substance abusers, problem gamblers show signs of tolerance, tending to gamble with increasingly high stakes. They become irritable when trying to reduce their habit – in other words, like substance abusers, they go through withdrawal. (Those two traits are universally recognized as “hallmarks of addiction” – yet somehow, when it comes to food addicts, nobody is paying attention.)

In gambling, common risk factors have been identified, such as an impulsive personality and genetic markers that influence the transmission of dopamine in the system. (But when similarities are found between food addicts and other substance abusers, the reaction is “So what?”) Here is a fascinating quotation from Clark and Bowden-Jones:

In addition, the most validated drug medications for pathological gambling are the opioid antagonists (e.g. naltrexone); drugs that were initially trialled in pathological gambling based on their efficacy in drug and alcohol dependence.

They do not mention that, by amazing coincidence, a combination of naltrexone and bupropion has also been auditioned as a weight-loss drug. This is the segue into how, last time, Childhood Obesity News speculated about where food addiction might eventually fit into the next Diagnostic and Statistical Manual, or DSM-6. It will be many years before another edition is published, and who knows what might happen in the interim. Meanwhile, professionals in the addiction field continue to cite the hallmarks of unhealthy dependency upon a substance – one of which is escalating and uncontrollable use. Another sign that addiction might be a proper diagnosis is when the pursuit and use of the substance gains ascendency over all other activities.

Uncomfortable similarities

To an addict, finding employment or even keeping the job one already has seems unimportant. School and other activities slide down the priority list. Human relationships narrow to a bottleneck, reduced to a single question: “Can this person help me get hold of my substance of choice?” Does the friend or relative have money, connections, transportation, and/or the requisite gullibility to help the user score? If so, they might be allowed to stick around a little longer. If not, too bad.

Everyone is totally familiar with tolerance, and knows all about withdrawal, and the culture of addiction has become as routine as a bedtime story we’ve all heard a hundred times. Yet when these same signs and symptoms apply to a morbidly obese person who is committing slow-motion suicide with food, the world does not vigorously affirm – “Yes, that is addiction.”

Unhelpful comparisons

As we mentioned, the guidebook is strangely coy about using the A-word. It’s almost as if time and progress are flowing backward, and we are still in the era where “cancer” was only whispered by genteel people who believed that if they never said it out loud, they couldn’t catch it. Even in the case of nicotine, which is universally acknowledged as being addictive, the people hooked on it have Tobacco Use Disorder, according to the book.

Unsatisfied with the way alcohol is handled by DSM-5, Dr. Stuart Gitlow wrote for Drugfree.org an article explaining his objections in great detail. In his opinion, the terminology and defining structures outlined by the manual are for a “new set of illnesses,” and not applicable to alcoholism as we have come to understand it. He sees adherence to the DSM criteria as leading to absurdity:

A patient who ends up in the ER only once each year due to a suicide attempt, car accident, slip/fall, barroom brawl, each time after imbibing considerable alcohol, does not meet criteria for even a mild alcohol use disorder. And a college student who is not an alcoholic does meet criteria for a mild alcohol use disorder if he has tolerance and hangovers.

Bowden-Jones and Clark did mention that at least 30 percent of pathological gamblers, and probably more like half of them, also have accompanying substance abuse problems. This lends credence to the notion that all addictions are just one big addiction wearing different masks, and it also sounds like a lot of food addicts, who tend to have comorbidities that include alcoholism and drug dependency. In fact let’s return to Dr. Gitlow for a final quotation:

Now it’s up to us to remember that addictive illness is still addictive illness; it remains unchanged despite the arrival of DSM-5.

Your responses and feedback are welcome!

Source: “Pathological gambling: a neurobiological and clinical update
bjp.rcpsych.org, 2011
Source: “Commentary: DSM-5: New Addiction Terminology, Same Disease
Drugfree.org, 06/07/14

Image by Next TwentyEight

Reflections on Obesity and DSM-5

food-is-one-of-my-favorite-parts-of-the-day_1552

Childhood Obesity News has been examining the premise that food addiction, in some form, under some nomenclature, should have been recognized in the latest edition of the Diagnostic and Statistical Manual (DSM-5). Okay, maybe calling food an addictive substance is not appropriate for whatever reason – perhaps because it is too vague or because the foods to which people become addicted are as mystifyingly diverse as chocolate and cheese. Dr. Pretlow has suggested that perhaps,

…overeating/obesity constitutes a behavioral addiction, where food’s pleasurable taste is the high, in conjunction with the displacement behavior of eating action. This is similar to gaming and gambling, where winning is the high, in conjunction with the displacement behavior of gaming and gambling action.

That idea is especially suggestive in conjunction with where gambling actually ended up in DSM-5: under the category heading of “Substance-Related and Addictive Disorders,” where it is the only member of the class “Non-Substance-Related Disorders.” In other words, even though gambling is not a substance, the disorder earned its place as a special case in the box where other substance-related disorders are cached. That is a stretch, but one that the creators of the book were comfortable with, while food addiction was left out in the cold.

It did not even get a spot under “Feeding and Eating Disorders,” along with anorexia and bulimia, where it might have appeared as an “Other Specified Feeding or Eating Disorder,” or even an “Unspecified Feeding or Eating Disorder.” But no. As Dr. Pretlow also remarked, “It’s a matter of semantics as to what constitutes addiction, and the addiction field is very much in flux.” In a spirit of academic cooperation, he began to consider whether we might be dealing with a Body-Focused Repetitive Behavior (BFRB).

BFRBs in DSM-5

In the book that is considered the Bible of the diagnostic art, the BFRB barely even exists. There is only a paragraph in a subsection of the “Obsessive Compulsive and Related Disorders.” The examples given are nail, cheek, and lip biting, mentioned here as “Other Specified Related Disorders.” In this section of DSM-5 where food addiction might conceivably have fit in, nail, cheek, and lip biting are described:

These symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Well, compulsive overeating certainly fits that description. When a person is prevented by obesity from occupying a school desk or an airplane seat, or from being a cousin’s bridesmaid or groomsman, or from getting a job, function is certainly impaired and distress is most definitely a result. Maybe this is where food addiction belongs.

But wait – here is an interesting detail. The book includes a couple of other conditions that could potentially apply. Under Movement Disorders, there is a “Stereotypic Movement Disorder.” Could the constant and repetitive motion of bringing food to the mouth be one of those?

Two other possibilities are even more promising, though neither has even made the book yet. Instead, they hang out at the end, among the 8 “Conditions for Further Study,” meaning they might make the grade someday. The two disorders are “Nonsuicidal Self-Injury” and, better yet, “Suicidal Behavior Disorder.” Why not?

Your responses and feedback are welcome!

Source: “DSM-5 Table of Contents,” Psychiatry.org, 2013
Source: “What the DSM-5 Says About: Body-Focused Repetitive Behaviours,” CanadianBFRB,org, 06/27/14
Image by Tumblr

Addiction is its Own Thing

Whack a Mole Fever

Recently, Childhood Obesity News has considered how food addiction is not recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), while similar maladies are granted official recognition. It seems as if the compilers of the manual reached strenuously to include some things, while ignoring the obvious parallels between compulsive overeating and other addictive disorders. Gambling, for instance, is uncomfortably shoehorned in alongside Substance-Related Disorders, even though it is not a substance.

Although food addiction has not been granted the DSM-5 imprimatur, many psychologists and physicians, including Dr. Pretlow, persist in treating it anyway. Washington Post reporter Jennifer LaRue Huget once interviewed psychoanalyst Marilyn Mertzl, who characterized addicts as people for whom “the source of all pleasure has become the source of all pain.” Dr. Mertzl went on to say:

Addiction to food operates on the same neurobiological highway as addiction to drugs, sex, gambling or alcohol…With food addicts, they eat all day, and they eat all night. The turnoff valve is broken…Usually by the time they come to me, they’ve tried a variety of unsuccessful interventions.

“Persistent desire or unsuccessful efforts to cut down or control opioid use” is one of DSM-5’s checklist items for diagnosing Substance Use Disorder. Heroin addicts and users of other substances have often, in the words of Dr. Mertzl, “tried a variety of unsuccessful interventions,” before they finally get straight. The same is true of food addicts, yet somehow that doesn’t count.

Alcoholism is also generally recognized as a disease. Comic Jamie Kilstein wrote a fascinating piece for Jezebel.com about how the realization that he was an alcoholic led to the conviction that his relationship to food was also addictive. These quotes are only fragmentary, for several reasons including explicit language:

You feel alone. You feel hungry. You feel like your problems aren’t real, so you don’t fix them. Then, you feel full… Then you hate yourself. Then you hate yourself for hating yourself. Then you eat. Then you feel sick….

Kilstein is an expert in fatlogic and also in persuasive psychology for a good cause – “You’re gonna give in to those giant corporations that profit on you hating yourself?”

It’s All the Same Mole

Dr. Vera Tarman very much wanted to see food addiction included, along with other substance abuse disorders, as a legitimate diagnosis in DSM-5. For RecoveryWire Magazine she wrote a piece with the unequivocal title, “Finally Sober, Suddenly Fat: Food Addiction is Another Drug Addiction.” Based on her observations of some 6,000 patients, Dr. Tarman finds that addiction follows what some call the “Whack-a-Mole” pattern – it may be suppressed in one area, but will pop up somewhere else. She writes:

A person would come into treatment to be treated for their alcoholism. They eat voracious amounts of food, usually to their horror, frequently gaining as much as 20 – 30 pounds in the three weeks of treatment… After treatment, this pattern of over eating and binge eating continues. It is as if they can not stop.

Patient histories reveal that many alcoholics were uncontrollable comfort eaters before developing a drinking problem, and when the alcoholism is treated, the comfort eating returns with full force. “The phenomenon of addiction does not favor one drug over another,” Dr. Tarman warns. Addiction is its own thing, and will happily glom onto whatever is available, including potato chips and sticky buns. She says:

Food can be a drug like any other, and can fuel the addictive cycle, which impedes recovery and sobriety… The answer to sobriety and serenity is in what you eat and especially, what you don’t eat.

Your responses and feedback are welcome!

Source: “Conquering Food Addiction,” WashingtonPost.com, 01/18/11
Source: “DSM-5 Substance Use Disorder,” buppractice.com, Undated
Source: “I’m an Alcoholic Dude With an Eating Disorder. Hi.,” Jezebel.com, 09/03/13
Source: “Finally Sober, Suddenly Fat: Food Addiction is Another Drug Addiction,” RecoveryWireMagazine.com, 05/02/13
Image by TPapi

More DSM-5 Oddities

Las Vegas Boulevard South

In a couple of Childhood Obesity News posts last week, we asked the following question about the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5): while other, similar disorders are included in the manual, how did food addiction get left out? Binge Eating Disorder has the Feeding and Eating Disorder category all to itself – while food addiction receives nary a mention! Really, is this fair?

We recalled how most people who are unable to control their eating, are pretty much captivated by one problem food, or a handful of them. So when we say “food” we are not talking about all foods (where are the broccoli fiends?) or even one particular kind. For the purpose of this discussion, “food” is whatever a patient (or worse yet, not even a patient, but just a troubled person running around at large) finds heinously irresistible.

The Disorder of Gambling

Even gambling shows up in DSM-5 with a fancy title – it’s a “Non-Substance-Related Disorder,” and it’s the only one of those, but subsumed into a larger category called “Substance-Related and Addictive Disorders.” We will call this category SRAD for short. All the other disorders in the SRAD category are based on substances – alcohol, caffeine, cannabis, hallucinogens, inhalants, opiods, sedatives, stimulants, and tobacco. Since gambling is not substance-related, it must then logically be the titular Addictive Disorder.

So, gambling is just off-handedly granted addictive status, while food addiction, which has been struggling for years to be recognized, is ignored. But that’s not all. The SRAD category adopted every stray dog on Addiction Street by including “Other or Unknown Substance-Related Disorders,” a real slap in the face to food addiction, which was not mentioned at all.

Then the SRAD category went ahead and shoe-horned in a disorder that isn’t even about any substance: gambling. Elsewhere in the book, even Binge Eating Disorder was allowed through the gate, as a Feeding and Eating Disorder. Of course, there was no mention of food addiction in that neighborhood, either. The compilers of the book wrote,

Many scientists and clinicians have long believed that problem gamblers closely resemble alcoholics and drug addicts….

They had the nerve to say such a thing, and yet totally ignore the overwhelming resemblance between overeaters and people addicted to alcohol and drugs. They say gambling is a behavior that has common elements with substance use disorders. What about the fact that food addiction also has common elements with substance use disorders? First of all, food is a substance, which gambling is not. And yet food, a perfectly tangible substance if ever there was one, was not invited to the ball.

Your responses and feedback are welcome!

Source: “DSM-5 Table of Contents
Psychiatry.org, 2013
Image by David Stanley

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