One of the first things that people need to do is figure out if they are even talking about the same thing. This is especially true if they are using the same word while maintaining different mental pictures of what it means. One choice would be to bring in a different word, but then the people who are talking about that word already might take offense because they mean something different by it. Hashing out the differences is important, and can be exhausting.
It appears to Dr. Pretlow, as well as to leaders in addiction science, that addiction and obesity both stem from one source. They both “reflect the consequences of ingestive behavior gone awry.” This is apparent from the core similarities shared by the two conditions:
First, in terms of clinical diagnostic features, both addiction and obesity result from repetitive foraging and ingestion behaviors that intensify and persist despite negative and (at times) devastating health and other life consequences.
Second, only a subset of individuals who are exposed to substances with addictive potential develop addictive behaviors, just as not all people who are exposed to foods and diet patterns that pose difficulties with weight control become obese.
The first item includes the words “behaviors that intensify and persist.” Classically, intensification and persistence are hallmarks of addiction. So it feels natural to include people who can’t or won’t stop eating, no matter what. But then, other questions arise. What exactly are they addicted to? A substance, a certain ingredient in certain foods? Or to the fundamental physical satisfactions, and the ceremonies, of eating itself?
One hallmark of addiction is that it tends to continue, and get worse over time. To proponents of either substance addiction or behavioral addiction, this is a primary tenet, part of the definition.
But then along came studies that pointed out an unexpected trait in at least two groups of people, returning Vietnam vets who had been “self-medicating” while stationed overseas, and many stateside patients who had been legitimately medicated after surgeries. A large number of individuals in each category were found to be able to give up opioids with the ease of shaking the dust off a hat. Until somebody figures out that kind of mystery, how can dialogue about substance versus behavior even be initiated?
Subset of individuals
The second item covers part of that same ground. Not only are some people able to easily abandon what appeared to have been addictions; some people never catch habits in the first place. As Dr. Pretlow points out, not all who are exposed to potentially addictive substances will develop addictive behaviors — “just as not all people who are exposed to foods and diet patterns that pose difficulties with weight control become obese.” The surprising Rat Park studies revealed that, given alternative activities and some kind of basically satisfying lifestyle, even lab rodents might turn down the opportunity to become addicted to hard drugs.
The existence of so many anomalies is the source of unease in both the Food Addiction and the Behavioral Addiction schools of thought. It becomes tempting to ask, only half-facetiously, “Maybe the people are addicted to neither food as a substance, nor eating as a behavior, but to obesity itself?” Because on some days, that seems to make as much sense as anything else.
Your responses and feedback are welcome!
Image by Jason Wilson/CC BY 2.0