Different Schools of Thought

Late in 2014, a lengthy contribution was added to the conversation about terminology. ” ‘Eating addiction’, rather than ‘food addiction,’, better captures addictive-like eating behavior” is the title of a report published by Neuroscience & Biobehavioral Reviews. The authors (13 in number) note that some people believe their relationship with problem foods constitutes an addiction, and if they seek help, they look to the addiction sector of therapeutic possibilities.

They also mention that food addiction means different things to different people, who are talking about either substance addiction or behavioral addiction, or both, and this ambiguity causes confusion. They prefer “eating addiction,” and proceed to explain why.

Observations

First, they say there is no evidence that it is a substance use disorder. Sure, there have been indications that the brain equally welcomes a rush from cocaine and an ecstatic experience from the chocolate sauce. But by and large, it has been difficult to pinpoint addictive substances in the food itself, although, of course, some results have been quite clear. But no one has tried to make the case that drug-like substances are in every type of food that obese people eat.

While they scoff at the idea that the substance use disorder category of the DSM-5 will ever recognize “Glucose/Sucrose/Fructose Use Disorder” as a diagnosis, they also concede that both rodent and human data are consistent with the existence of addictive eating behavior. Landing somewhere in the middle, they agree with contemporary experts who say it is “premature to conclude validity of the food addiction phenotype in humans from the current behavioral and neurobiological evidence gained in rodent models.”

Let’s roll with it

But for the time being, and because it works adequately for educational purposes, they will go with “eating addiction” because it highlights the behavioral component. The point of this paper is to discuss, from the behavioral, clinical, and neurobiological angles, how addiction and overeating are both the same and different.

And again, the terminology becomes the subject. Where is the line between occasional overeating and binge eating? In what ways does an eating addiction resemble binge eating (or not)? How do we make sense of addictive disorders that are not even substance-related?

Like so many other problems, overeating is multifactorial. The pros have to look at the severity, the degree of compulsiveness, and the “clinically significant level of personal impairment.” These authors regret that Binge Eating Disorder has become conflated with food addiction, for this reason:

The impaired control over eating behavior in “eating addiction” does not necessarily require that the affected individual experiences a sense of lack of control over eating during a single episode of overeating.

Your responses and feedback are welcome!

Source: “‘Eating addiction’, rather than ‘food addiction’, better captures addictive-like eating behavior,” ScienceDirect.com, November 2014
Images by Jesse Case and CC Runs via Twitter

Moderation Is or Is Not the Answer

Dr. Pretlow says,

A central barrier to the success of treatment for obesity that is distinct from drug addiction, is the fact that food consumption is essential for survival; thus, abstinence is not a feasible or appropriate treatment goal.

But what about moderation? In discussions of addiction and recovery, one of the first principles is that moderation fits in there somewhere. However, some believe it works, and others say it is impossible.

People in the eating disorder community, or the diabetes community, are all about eating normally. That is their goal. But an alcoholic can’t pursue the goal of “normal” social drinking, like two cocktails a week or whatever, because addiction does not work that way. “Harm reduction” or “moderate drinking” does not work for addicts.

Billi Gordon, Ph.D., who was a Research Associate at UCLA’s Center for the Neurobiology of Stress and Resilience, was never shy about sharing his own experiences, including his weight which at one point reached almost 1,000 pounds. In a Psychology Today piece called “Moderation — Strategy or Fantasy?” he wrote,

I am a food addict — and barbecue is my favorite fix… My ultimate comfort food.

In other words, his #1 problem food. This was because of childhood memories of social approval and attention at family gatherings, and particularly of time shared with his father. As he aged, this need for connection did not fade, but became stronger:

[T]he dependence on the symbolic interaction with the comfort food grows. So finding replacements that completely satisfy the needs your symbolic interaction with comfort foods only partially satisfied, is how you achieve moderation…

Sure, on one or more holidays he tried saying no to barbecue, and the results were severe depression and bingeing. Apparently, such an iconic comfort food cannot be replaced, as nothing else is capable of satisfying the symbolic interaction need.

In addition, Dr. Gordon had looked up behavioral studies on goal achievement, which showed that the more specific a goal is, the more achievable it is. He concluded that moderation is “very unspecific and determined by what one’s brain considers as normal,” a goal too nebulous to be effectively pursued. He wrote, “I need a strategy, not a fantasy, and moderation is a fantasy — at best.”

Dr. Gordon wrote extensively on the similarity between binge eating and compulsive eating, and drug addiction. He suggested an “underlying neurobiological process similar to addiction.” Dopamine, of course, is involved, activating the brain’s reward areas, and repeated indulgence in stress-relieving problem foods alters the dopaminergic pathways. He wrote:

[D]rug and food stimuli cause the same type of conditioned gene expression and neuronal plasticity in the mesolimbic-cortical pathway (reward circuitry) and regions associated with learning and memory, e.g., the ventral striatum, where habit formation occurs. Dopamine and endogenous opioids are implicated in adaptations to reward circuitry in compulsive overeating, as well as drug usage.

Your responses and feedback are welcome!

Source: “Moderation – Strategy or Fantasy?,” PsychologyToday.com, 07/06/16
Source: “Christmas Cookie Blue,” PsychologyToday, 12/06/13
Image by Kirt Edblom/CC BY-SA 2.0

Withdrawal’s Big Problems

The previous post talked about withdrawal, which sometimes, even in the case of legitimately prescribed pharmaceuticals, can be a full-scale life-threatening experience requiring medical support; or perhaps only put a patient through a period of malaise and general discomfort. In any case, subjective experience is a difficult thing to argue. Still, as long as there are people who believe that quitting problem foods is comparable in misery to quitting a hard drug, it is certainly a problem to be dealt with.

Some formerly obese people have reported cravings for a while, until the body readjusts to the new regime. Childhood Obesity News has mentioned Dwight Riskey, who is a cravings expert. He worked with a team at Monell Chemical Senses Center which found that “people could beat their salt habits simply by refraining from salty foods long enough for their taste buds to return to a normal level of sensitivity.” Sounds easy!

One school of thought holds that along with letting withdrawal happen, it is important to take active detox measures at the same time, and there are versions of this plan for every substance including food. Philip Werdell wrote extensively on the subject. When asked what happens, once a food addict begins treatment, he said:

When overeaters are separated from their primary binge foods, the first change is that they stop having physical cravings or, at minimum, the cravings are lessened to the point where they are no longer overpowering.

Even more important for long-term success, the mind of the detoxified food addict begins to change in remarkable ways. Where once they believed their own rationalizations (read: lies) about food, detoxification helps the food addict begin to see his or her past thinking as distorted.

Beat, a British organization for people with eating disorders, provides space for peer support and online development, and also works to inform the government about what kinds of backing and research are needed if the nation’s obese people are actually to be helped. Spokesperson Frankie Mullin described addicted people’s problem as “trying to fill a bottomless void and no amount of food will satisfy their cravings.”

Withdrawal from alcohol leads to a state of sobriety, which some people find very unpleasant indeed, and also compare to an endless chasm of emptiness. When writer Benjamin Davis got sober, he felt constant boredom, inability to sleep, and social anxiety, concluding that “if I didn’t find ways to solve those problems, I’d be back to drinking again.” Worse, he felt he had been misled, tricked into thinking that sobriety would cure all his problems, only to find that “actual solutions take time, patience, and continuous effort.” He started reading for several hours per night, dropped people who did not add value to his life, and conveyed the message to supportive friends:

People need more than support; they need solutions, alternatives, and creative thinking. Otherwise, best case scenario, we just get addicted to something else…

Your responses and feedback are welcome!

Source: “The Extraordinary Science of Addictive Junk Food,” NYTimes.com, 02/20/13
Source: “How emotional eating keeps you stuck,” OhThatsTasty.com, undated
Source: “Food addiction: know the facts,” Food.UK.MSN.com, 01/05/2013
Source: “The Art of Staying Sober,” medium.com, 07/25/21
Image by gunman47/CC BY-ND 2.0

Is Withdrawal a Thing?

There is a term, “definition monopoly,” meaning that somebody has the sole right to say what a word or expression means. Apparently, food addiction/eating addiction are areas where consensus is an elusive goal.

Some professionals believe that the term “withdrawal “should not be used in reference to food at all, because it is not a physically addicting drug, and because the problem is not the food per se, but the behavior of eating it inappropriately. It is also said that in psychological addictions, there is no such condition as withdrawal or tolerance buildup.

As we have seen, others, like Zoe Harcombe, find the concept useful. In listing the four stages of food addiction she writes,

3) We feel bad when we don’t have the food – we literally get withdrawal symptoms in the absence of our fix.

And from the other end of the spectrum, there is evidence that some populations habituated to opioids, including medical patients and Vietnam veterans, dropped their habits with very low or no consequences, once the time of acute need had passed.

The misnomer problem

Withdrawal seems to have a fairly nebulous meaning. Getting off some drugs (including prescriptions) can be a life-threatening ordeal, requiring medical supervision. Meanwhile, jokes are made about having “withdrawals” from one’s favorite peanut butter and banana sandwiches. At any rate, the topic seems worthy of discussion, because opinions differ.

To get to a diagnosis of addiction, some say, the presence or threat of an extremely painful experience must be a necessary condition. This is the trauma of physical withdrawal, as depicted in movies that are meant to scare viewers straight.

In online forums where regular people discuss their experiences, it is possible to find extreme statements, like a description equating the first few days of a diet to withdrawal from heroin. And who knows? Maybe it is like that. Maybe it is presumptuous to say anything about other people’s pain.

Letting go

As we have mentioned, the group FARE (Food Addiction Research Education) certainly acknowledges withdrawal symptoms as a very real and serious factor that prevents people from trying to end their dangerous dependency on the wrong kinds of food and too much of it, which in turn pulls them into serious problems like obesity, diabetes, and heart disease. FARE says,

Withdrawal symptoms can include severe anxiety, headaches, sadness, anger, sweating, shaking, disorientation and depression. They can last anywhere from days to weeks or even months after quitting.

Despite a strong desire to stop, the complexity of physical withdrawal symptoms and the accompanying emotions can lead an individual back to using mood-altering foods, which only perpetuate the addiction cycle.

Your responses and feedback are welcome!

Source: “What exactly is withdrawal?, FoodAddictionResearch.org, undated
Image by Nick Fisher/CC BY-SA 2.0

Relapse — Word of Dread

With a substance addiction, like nicotine, total abstention is a possibility, and a total quit gives a person much better odds of not relapsing. A cliché is that someone who has not smoked in years can be rehooked with astonishing rapidity. Even when people try hard, the relapse rate is discouraging. With certain substances, like cocaine and alcohol, moderation cannot be the answer in the overwhelmingly vast majority of cases. Quit means quit.

With food, the inability to totally abstain is the hardest thing. Someone compared it to divorce. With alcohol, heroin and many other substances, it’s like a divorce without kids. You can just say “We’re done” and never have to see the person again. But if there are children, you have to deal with shared custody and child support and then the grandkids… You’re tied to your ex forever. And common decency does not allow cutting them out of your lives like a bad habit.

With disordered eating, what forbids a person to walk away is basic survival. Sometimes, beating a food habit requires a great deal of ingenuity, or it might wreck a life in other ways. To consume food is our fate, but it does not have to be our doom.

Moderation is not an option

There is plenty of discussion about food addiction versus eating addiction, whether some foods are inherently addictive, and many other variables. Still, no matter what philosophy a striving person chooses or what program they choose, relapse is always an open door that extends the invitation to “walk right in, set right down.” Dr. Pretlow has written,

Despite often repeated attempts to reduce or quit using addictive substances, relapse is common in the addiction recovery process, just as those with obesity who attempt to regulate their food intake through dieting frequently relapse and return to their elevated body weight.

Just last month, writer Addy Baird looked back and described her young life as “largely defined by my obsessive food and body rituals.” Baird notes that studies hope to hone the definition of what eating disorder recovery actually looks like, gauged by “a combination of physical, behavioral, and psychological indicators.” She then goes on to say,

Notably, one study found that a group considered “fully recovered” had similar results to a control group, but elevated rates of anxiety disorders.

She quotes therapist Carolyn Costin, who defined recovery as accepting one’s body and not having a “self-destructive or unnatural relationship with food or exercise.” In Costin’s words,

When recovered, you will not compromise your health or betray your soul to look a certain way, wear a certain size, or reach a certain number on a scale.

Baird also shared with and learned from a sobriety community and especially from Michelle Callahan, a substance abuse treatment therapist who rejects the limited duality of complete recovery/abject relapse. She prefers the gentler word “lapse” and speaks of a flexible type of ongoing, ever-present recovery that may include a lapse now and then.

Callahan wants people to understand that not all steps point forward, and to never get overwhelmed, or think that all their hard work was for nothing, and especially never to feel shame. Here is the crux of the matter:

They can also feel like they are a failure, are bad, or weak, which are likely the core beliefs that pushed them into addiction or engaging in their problematic behaviors in the first place.

Instead, it can be useful to regard a lapse as a pop-up research lab that teaches the person what not to do next time. Addy Baird wrote,

As my healthy self got stronger and my relationship to my food and exercise began to transform, it became clear that giving myself more space to learn (and sometimes fail) was vital.

Your responses and feedback are welcome!

Source: “Giving Up On A Perfect Recovery Actually Helped Me Heal From My Eating Disorder,” BuzzFeedNews.com 03/25/22
Image by dynamosquito/CC BY-SA 2.0