Live-In Addiction Programs and Permanent Change


Many live-in addiction treatment centers include food addiction in their agenda, and a place called Shades of Hope, located in Buffalo Gap, Texas, specializes in “eating disorders and co-occurring addictions.” Oprah Winfrey is profiling this center in her new series, “Addicted to Food.” Here is the center’s definition of food addiction:

Food addiction is loss of control over food consumption. Food is used as medication to control and suppress negative feelings such as sadness, anger, depression, anxiety, loneliness or boredom.

The founder, Tennie McCarty, discovered through her own experience with an eating disorder that the addictive treatment modality can be a valid answer. Not surprisingly, the classic 12-step program formulated by Alcoholics Anonymous is the basis of the program. Eating disorders come in five varieties: compulsive overeating, morbid obesity, binge-eating, anorexia, and bulimia. The Center also treats chemical dependencies, together or separately — the classic drug dependencies in the overlapping categories of prescription drugs and narcotics, as well as alcohol and nicotine.

One of the things the Center is prepared to cope with is “process addiction,” which is addiction to an activity such as gambling or shopping… or eating. It appears that food addiction is even more complicated than it might appear at first glance. Is it a chemical addiction — to the food itself? Or is it a process addiction — to the activity of eating? More than likely, it can start as one or the other, and then transmute into both.

Addictive substances like sugar, salt, and high tech flavorings are deliberately added into processed foods to make them what we call hyperpalatable, hedonic foods. These substances may not seriously affect the occasional snacker who doesn’t ingest enough to get hooked. But someone who is into eating as a process is apt to become hooked on the substances, just through consuming so much of them. Conversely, someone who is using food as medication to control and suppress negative feelings such as sadness or boredom, may also become hooked on the process.

In contrast to the beliefs of The Shades of Hope about food addiction, Dr. Pretlow has observed the following in obese kids who post on the Weigh2Rock site:

Rather than a delayed chemical response analogous to a drug, it appears to be the immediate pleasure of food sensations in the mouth — taste, texture, chewing, and swallowing — on which these youth are addicted. For example, bulimic posts describe immediately purging foods eaten, yet still obtaining comfort from the foods and exhibiting addiction to the comfort eating behavior.

Dr. Pretlow further adds a new dimension to food addiction:

There is a thing called ‘displacement activity,’ which is an unrelated behavior exhibited in response to stress. Displacement activity is universal among the animal kingdom. Cats lick their lips when under stress, fish bounce on their heads, and birds peck and wildly eat anything, like rocks, grass, or twigs. Humans likewise exhibit displacement activity when under stress, such as nail biting, hair twisting, hangnail picking, and eating. Part of food addiction includes the action of eating — chewing, tongue movement, and swallowing — which is likely displacement activity, and, like nail biting, may be quite difficult to stop.

At any rate, Shades of Hope Treatment Center goes after the underlying issues that surround any addiction: anxiety, depression, self-harm, and trauma. The specialists on staff are interested in equipping clients with tools to cope with life once they have left the premises. It’s all about dealing with core issues and treating the whole person. The Center’s literature says,

We neither subscribe to nor promote easy and quick remedies for addictions. Our concern is for the development of healthy lifestyles which support good nutrition, exercise, positive behavior patterns, sound emotional health and spiritual growth through use of a 12-step program.

The staff evaluates the person and chooses from among a palette of approaches: cognitive behavioral therapy, group therapy, individual psychotherapy, emotive, desensitization, and body image therapy, and the management of anger, shame, and stress. Their commitment to treating the body, mind, and spirit includes sessions of meditation and yoga.

Success is measured by how well the person goes out and handles life. For the longer-term inpatients, family participation is seen as very important because family members are the support system that must recognize “that fine line between enabling addictive behavior and helping in a client’s recovery.”

In the helping professions, some things work for some people and nothing works for everybody. There are some patients who just are not going to get well no matter how effective a modality might be for others. I knew a guy in California who was proud of his 26 admissions to the substance abuse unit of a local hospital. He found great satisfaction in racking up the bills, which his father paid every time. For reasons best known to themselves, some patients are not going to get better.

Undeniably, live-in programs such as addiction treatment centers or summer camps are not available to everyone, and especially not to young people unless their parents have really good insurance. But this is one of the effective ways in which eating disorders, like food addiction, have been treated, resulting in real, sustainable improvement, and it is certainly worth thinking about how to create more live-in programs and how to make them accessible to more people.

Your responses and feedback are welcome!

Source: “What Does Shades of Hope Treat?,”
Source: “About Shades of Hope,”
Image by AlishaV (Alisha Vargas), used under its Creative Commons license.

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Profiles: Kids Struggling with Weight

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The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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