Understanding Addiction

Running on empty: where eating disorders and drug addiction meet

Written by

Marc

in

By  Elizabeth from the blog….

I am very pleased to present a guest post, created by Elizabeth, who has been a member of this blog community for at least a year. Thanks, Elizabeth, for your contributions until now, and especially for this fascinating post–

obesesemanThe present “obesity epidemic” has given rise to public concern about the level of refined sugars, especially high-fructose corn syrup, in the North American diet.  While we can all agree that an excess amount of sugar is probably not good for anyone, more controversial questions about the “addictive nature” of such sugar intake have also emerged.  Public policy measures to curb access to this “addictive substance” (see NYC soda ban) are designed with intentions to prevent individuals from developing a “sugar dependency” and hopefully curb the rising rates of obesity.  But, is overconsumption of these sweet and calorie-dense foods really reflective of a widespread “addiction” to sugar?  Perhaps there is some truth to the matter, and perhaps we can understand this phenomenon better by looking at studies of drug intake.

Several years back, researcher Roy Wise argued that drug intake could be viewed as an “ingestive behavior.” He noted that animals who were limited to short periods of drug access at regular times throughout the day show signs of ratsniffing“regulated drug intake” to maintain a steady blood serum drug level similar to “regulated food intake” to maintain energy balance.  When the self-administration studies were halted, these animals displayed little, if any, signs of withdrawal.  Thus, they were probably not really addicted or dependent on the drug at all.

So what could make this regulated intake spiral out of control?

Marc has provided a wealth of information regarding the predictors of drug addiction, including the effects of stress, low feelings of self-worth, and the need to compensate by “self-medicating.”   I won’t belabor these points.  What is interesting to me is that these factors seem to aid the development of “addiction-like” drug intake in animals — when the self-administering rodents escalate their use over time, pursue the drug in the face of punishment, and show physiological withdrawal symptoms. In other words, when they seem to become addicted.

So, additional factors — beyond drug availability — may be necessary to make the “ingestion” of drugs more “addiction-like.”  Does this mean that the ingestion of foods can also be normal, versus addictive, depending on external factors?

striatalactivityIndeed, stress and negative self-worth also play major roles in the development of eating disordered behavior (e.g., excessive caloric restriction, binge food intake, purging, etc..).  Food and drug rewards act on the same neurotransmitter systems, so disruptions in reward circuitry can confer drug addiction and, likewise perhaps, change the meaning of food. Get this: If you want to get an animal to REALLY want to take a drug, you can deprive it of food.  maneatingdonutsThis suggests that dysregulated food intake cross-sensitizes with dysregulated drug intake (kind of like how abuse of one substance can lead to abuse of another). Basically, since the brain interprets the value of both food and drug rewards through similar circuits, alterations in these circuits can cause EXCESSIVE pursuit of both.  The brain is saying “hey, I’m deprived of some necessary sustenance…give me more!  The next time I get that reward, it’s going to be REALLY reinforcing, so I will seek it harder and make SURE I get all I can!”  So, the next time drugs are encountered, we binge on them.  The next time we get access to a sweet treat, we are likely to binge on that as well.  In fact, there is a striking comorbidity between binge food intake and drug abuse.

shootingpuddingWhat this means is that there can be addiction-like components to both binge eating and drug taking.  The super-sensitivity to both rewards appears to be greatly influenced by the individual’s history:  Have there been significant life stressors?  Has the individual been deprived? (Think of those with eating disorders who have excessively restricted their caloric intake in order to look or feel thin.) These factors come together to promote a sort of “super-craving” — for food, drugs, or both.

I’m not sure that these factors are widespread enough to completely explain the obesity epidemic, but they sure help put it in context.

Comments

23 responses to “Running on empty: where eating disorders and drug addiction meet”

  1. Richard Henry

    For the last few years, food has become my primary addiction. I guess being dependent on drugs and alcohol for so many years, food was of no interest other then to stay alive. Cocaine was my treat, it satisfied all the rewards I get today with food. Although I have gained 50 lbs. I am aware of my behaviour and with a clear mind and can make healthier choices, unlike drugs and alcohol I was limited in my thinking. Sure I admit that I am now addicted to Pepsi, chocolate and ice-cream, the difference is that I have my right for choice back with a clear mind to make change.

    Reply
    1. Elizabeth

      Best of luck with that change!

      Reply
  2. Joe S

    Hello All: I quit drinking by replacing beer with food. I found many similar feelings of satisfaction, reduced anxiety and reduced craving. My ‘go to’ food was milk because like beer it was liquid, provided the right amount of calories and tastes good to me. At that point in my life I was totally isolated and drinking 24/7 about 20 beers/day. It worked quite well as I am abstinent now for 16 months. I convinced myself it would work with a lot of reading on the subject of alcoholism, habits and conditioning. In the past of course I scoffed at most of the “remedies” I was exposed to and, of course, they didn’t work for me. The revelation that one can quit is probably the most important factor. Believe in yourself and belive in your method.

    Reply
  3. Denise

    I’ve always blamed my lifelong sugar addiction on the fact that growing up in the ’50’s I started each day with a nice big bowl of Sugar Frosted Flakes (with milk, also sugar), Cocoa Puffs, Lucky Charms, etc. Ironically, my mother was obsessed with being thin, so after school when I wanted cookies and milk (my fix!) she said no, I’ll get fat and I should have carrots and celery instead! (A discussion of how the mixed message and depriving me of my fix impacted on my mood and state of mind will happen at another time.) Today, many of us (though not everyone!) cringe at the thought of starting the day with a bowl of sugar. What Elizabeth has written confirms my belief. My brain/nervous system was wired early on to crave sugar. Then, when my mother tried to control my sugar input I began to sneak Hershey’s with Almonds as soon as I was old enough to get out and buy them.

    Interestingly, I think two opposing trends are happening at the same time: we have an obesity epidemic, and we have many people who are more health conscious than ever, thus the health food and fitness industries. Societal factors play such a huge role in what happens to us. With the women’s movement and the economy driving a large percentage of women out to work (i.e., middle class women, as working class and poor women have always worked) many more kids are on their own during the day, and working moms who don’t have the time to cook have taken full advantage of the fast food, frozen food, and take out industries.

    So as much as people balk about Mayor Bloomberg’s initiative regarding soda, calling it fascist, etc., there is definitely something good about it.

    We live in a very stressful culture, and if we look closely, we’re all addicted to something, whether it’s physical or behavioral. As children we have little or no choice about our addictions. As adults, hopefully we do.

    Reply
    1. Elizabeth

      I find it very interesting that you point out a “deprivation” component that may have contributed to your described proclivity for sugar. I wonder how much the deprivation of the sugar itself and the stress surrounding it’s “forbidden” intake can superadditively influence the hedonic impact of the sugar once we get a hold of it. I also wonder if too much focus on removing sugar from our diets and instilling “fear” of the substance by imposing soda bans, like in NYC, will contribute to this “forbidden” perception of sugar. Could that do more harm than good?

      Reply
      1. Denise

        Who knows… probably in some cases the quality of forbiddenness will result in people craving the soda that much more. Then again, these same people would have been drinking it if it were readily available. So does the ban really make a difference? We’ll have to wait and see. One thing I’ve come to believe is that substances like alcohol that are legal and readily available have many people addicted to it who wouldn’t be otherwise. The fact that it is legal and easy to get makes converts of many who might resist it if it were illegal and hard to get. Look at what’s happened with cigarettes. As a social worker I worked with many severely mentally ill people (also with drug problems) who used to smoke constantly. In recent years their smoking has been curtailed mainly by the cost. Patients who were never without a cigarette between their fingers significantly cut down and some even stopped. So in that regard maybe fewer people will drink that huge bottle of soda.

        Reply
        1. Elizabeth

          Agreed, I guess the issue is pointing out just soda as the culprit. Personally, I’m against pinpointing ANY food as pure contraband. We shouldn’t impose feelings of guilt when we accidentally consume a “banned” substance, but certainly should encourage healthier choices. I totally agree that making healthier choices cheaper and more accessible is a good direction to take, and perhaps taxing those foods that are not part of a balanced diet? (figuring out exactly what those foods are may be a difficult task as well).

          Thanks for the input from the social worker’s perspective! You definitely have a lot of ecological evidence and insight to offer!

          Reply
  4. NN

    Elizabeth, these are excellent points, and although I’m only mildly experienced in ‘sugar addiction’ or ‘food addiction,’ the distinctions you suggest or imply are crucial, I think.
    .
    For example, I’m no biochemist or neuroscientist, but common sense suggests at least
    five basic types of ‘addiction’ (compulsive behavior around doing/ingesting, that’s to one’s detriment and hard to shake).

    1. Drugs that hit the neurotransmitters directly in their basic functions: heroin, cocaine.
    2. Drugs with secondary such effects
    3. Drugs/substances that merely mess you up –gasoline, nutmeg, dextromethorpan (though clearly through effects on basic brain processes).
    4. Activities based on intrinsic drives or needs: food, sex.
    5. Activities based on extrinsic acts, which come to have effects related to 1) and2)–gambling, cruising.

    ===
    Two classic studies, one easily available online are Aigner on rats, and Peele’s masterful survey. He makes the crucial point that it’s a (my term) psycho-physico- behaviorial-social gestalt that we’re looking at in ‘addictions’. And the ‘brain chemistry’,
    at least in simple terms, does NOT jibe with the experiences of compulsion: More people are ‘addicted’ to the LESS addictive substance, going by simple brain markers
    (which are behind various biochemists’ lists of ‘most addictive substances’),

    Not to go on too far, here, but one point in relation to your focus on 4): The AA approach, of “not one drink” cannot, in general, work, except for the most flagrant
    examples, e.g. eating jelly donuts. A food addiction can be fed on cornbread and raisins, just as a ‘sex addiction’ can be fed on a Victoria Secret, or even a Sears catalog. I can’t just this, but may alcoholics/sex addicts have told me that the latter is proving harder to ‘kick’ than alcohol (and the cite their alcohol sobriety years). So again the ‘grip’ of the compulsion seems almosts to have that reverse correlation that Peele mentions, as far as direct neurochemical effect, in the transmitters.

    Again, I can’t directly comment but other posters, relevantly have posted about a switch from alcohol to food, again suggesting the biospychosocial approach is relevant.

    Thanks, Elizabeth, for opening a vital topic and laying out the basics.
    NN.

    ===
    Rats ‘addicted’ to IV cocaine:
    Aigner, T. G., & Balster, R. L. (1978). Choice behavior in Rhesus monkeys: Cocaine versus food. Science, 201, 534-535.

    ====
    http://www.peele.net/lib/cocaine.php

    Published in Addiction Research, 6:235-263, 1998.
    Peele, S.

    [B]Cocaine and the Concept of Addiction:
    Environmental Factors in Drug Compulsions [/B]

    And the note at the end:

    //Benzodiazepine and caffeine addictions are often faceless, since this drug use is so readily accepted in our society and all of us know many nonaddicted users. When personal accounts of severe and problematic addiction were reported for tranquilizers in several first-person best sellers such as Barbara Gordon’s I’m Dancing as Fast as I Can and Betty Ford’s The Times of My Life, industry spokespeople pointed out that these cases were quite unusual. Indeed they are, as are cases of cocaine addiction. Nonetheless, it strikes most people as ludicrous to speak of tranquilizer and cocaine addiction in the same breath. One person for whom this is not the case is New York television newscaster Jim Jensen, who reported readily giving up a cocaine habit in treatment but being unable to shake his valium dependence: “Valium withdrawal soon plunged him into a massive depression that left him unable to eat or sleep. It took two more months in two hospitals for him to regain his mental and physical health” (Jensen, 1989, p. 67).”//

    Reply
  5. NN

    PS, Aigner’s article is available in full online at

    http://www.sciencemag.org/content/201/4355/534.short

    The lack of relation betweent this lab set-up and anything a mammal, primate or human will
    ‘naturally’ encounter, is patent.

    Reply
  6. Elizabeth

    I totally agree with you that a biopsychosocial understanding of all “addictions” is needed!

    In writing this post, I also thought about the differences between drug rewards, which act directly on reward circuits, and food rewards, which impact reward circuits, but also have action on hypothalamic and brain-stem regulatory centers that monitor nutrient intake. These centers also influence the reward pathways, making foods either more or less palatable, depending on current caloric needs (of course, we know that we can make these systems go out of control by dysregulating our food intake). Thus, food rewards are influenced by present nutrient needs to a greater extent than drug rewards. So, it gets difficult comparing the two, but there are certainly overlapping features there!

    Reply
  7. Persephone

    Excellent post, Elizabeth! Thank you!

    I have often wondered about the whole sugar/food “addiction” discussions, but particularly when it comes to sugar. I’ve found Dr. Robert Lustig’s campaigns to be very interesting, though I’m mainly baffled by everyone around me chugging down HFCS and other sugary foods/drinks when I find them to be repulsive in general.

    I remember an acronym from my treatment center that warns about becoming too hungry: HALT– don’t let yourself get too hungry, too angry, too lonely or too tired. (pardon the rather random link, there were too many, and all from addiction related sites, but google it for a better link perhaps: http://www.addictiondirections.com/halt-hungry-angry-lonely-tired/) I always found it interesting that these conditions were picked out in particular, though this isn’t based on anything scientific, just the conventional sort of sayings that go around recovery circles.

    One odd thing about being hungry when you’ve been addicted, depending on the substance/mode of ingestion, that sticks out for me is that hunger/empty stomach mean faster absorption. I do remember (well, I do occasionally remember some things!) feeling desperate to keep my stomach as empty as possible for faster absorption/stronger effect when I was taking pills. To this day, I feel a bit odd if my stomach is empty, as if it should be cueing some past behavior I no longer want to repeat. The rest of HALT (like most things in traditional recovery circles) doesn’t particularly speak to me, and I fear feeling hypoglycemic rather than relapse when hungry these days, but I figured I would add it if you weren’t aware of that acronym in terms of addiction treatment, especially as you write of other factors (emotional stresses, negative self worth) being involved.

    Excellent post, thank you!

    Reply
    1. kc

      This is exactly part of the problem, but I have a very hard time feeling these things consciously-for instance before I consciously KNOW I am hungry, i get shakey and have typical low blood sugar symptoms. This goes for nearly all strong emotions as well. Stressors I try to recognize them consciously as they occur or beforehand, because for the life of me, literally(/), my body/mind just didn’t recognize it before it is “too late.” U-know?

      Reply
  8. Elizabeth

    Oh yeah, they totally use HALT in the ED field as well. I guess the “hungry” part definitely makes sense in that scenario.

    Also, speaking of hungry, food= glucose for brain functioning. Wasn’t there a post by Marc a while back about executive control and fatigue of executive control contributing to relapse?

    Reply
    1. Persephone

      Not sure, I’ll take a look back through them, though. I like to reread most of these posts.

      Ahh, didn’t realize they used HALT there as well. I always find that treating EDs is a bit more difficult work than substance abuse. It’s obviously not a disorder for which “total abstinence” can work as a treatment model, eh? I should read up on a bit more about the modalities used for EDs for comparison. Odd though, while I was addicted, the one person I found I could commiserate with was a teenaged boy in my neighborhood who was anorexic. We had the exact same issues, it seemed. It also gave me insight into what others were feeling in terms of the “your addiction makes others suffer” aspect; watching him going into multiple organ failure and, well, dying, was intensely painful to me and everyone watching the process. (On a bright note, he did NOT die and is very healthy now.)

      Thanks for the insight!

      Reply
      1. Elizabeth

        Wow! What a fascinating and poignant account. Thanks for sharing :).

        Reply
    2. Marc

      Yes, I confess there was such a post. It was about what’s called ego depletion or ego fatigue, the tendency for self-control to become diminished when it’s kept up for too long. Ego depletion models executive control/inhibitory control as a resource-dependent process. In other words, it gives out over time, because it runs out of fuel. And the resource it seems to be dependent on is indeed glucose. A number of studies have shown that ego depletion can be counteracted by glucose consumption. But, as is often the case in psychology, other studies dispute this assertion. And just recently there’ve been a couple of studies indicating that merely the taste of glucose is enough to upgrade your capacity for self-control once it’s been depleted.

      This post from Psychology Today summarizes the literature in a palatable and tasty offering: http://www.psychologytoday.com/blog/fulfillment-any-age/201111/when-willpower-fails-how-build-your-resistance-temptation

      Reply
  9. gywn

    Great Stuff, Elizabeth! And YES!… these factors are widespread enough to completely explain the obesity epidemic and also the escalating gun violence in America! I said it before and I’ll say it again… Addiction is an American Commodity… and once we ALL “get it”, we can rise above it and move forward. We can stop blaming ourselves and our human weaknesses!

    In a Fall, 2011 graduate class, “Understanding the Nature of Addiction”, we were presented with a slide show including a brain diagram and a list of the neurotransmitters that affect it. Familiar with serotonin and dopamine, I was surprised to learn about the natural “glutamate” or the neurotransmitter that amounts to 4 lbs. of the average adult body and reaches its every last organ… but it was omitted after mere mention.

    Glutamate…. hmmmm…. MSG? Monosodium (1 salt!) Glutamate… My research revealed that this poisonous artificial substance has been added to food for 100 years and promoted as a flavor enhancer since the “Campbell’s Soup” days through creative mass marketing. After some controversy, today it is hidden in virtually every product on the grocery store shelf including cigarettes! There is no escaping it short of growing your own food and (ha ha!) tobacco.

    When I brought this up to the prof, he didn’t know what to say… Common sense says that if 4 lbs of the human body is natural glutamate and MSG dries up (because salt does!) that essential element of it, the body will instinctively and compulsively crave anything, physically or behaviorally, that will make it feel better. This, to me, explains how we unwittingly transfer from one substance or behavior to another in “recovery”.

    So, I believe that MSG is the main culprit for the Nation’s obesity epidemic as well as the pandemic of gun violence, because MSG makes U.S. ALL crave… something… even after we beat the drugs and alcohol, we crave… the sugar, the caffeine, the carbs, the diet soda, the chocolate, the sex, the gambling, the gaming… and the guns!

    The excitement and adventure of life in the Natural Order of Things is now extinct and we are ALL puppets to creative propaganda and to hegemonic greed.

    Reply
  10. Elizabeth

    Do you have any empirical articles that state this is a problem with MSG intake? I don’t know of any evidence that suggests MSG can contribute to lower global glutamate levels. It is also does not readily penetrate the blood-brain barrier. Perhaps there are some other factors at play, like the types of food that MSG may be found in? I’m interested to see if I’m missing something.

    Surely, there is probably a reason why whole grain, natural, unprocessed foods tend to make us feel better and help us exert greater executive control over our impulsive (and compulsive) behaviors. I’m just skeptical about MSG being the culprit.

    Reply
    1. gywn

      Elizabeth, I had specific articles collected before my house burned last June when I lost two computers. But I remember that one good website was: msgtruth.org. This site addresses aspertame as well and Autism, that is just a spiral down from the ADHD label of the last decade. More articles and studies are found at: http://www.pubmed.com by typing “MSG obesity” in the search box.

      With serious Lyme disease, misdiagnosed for 23 years, I’ve paid close attention to food and nutrition for myself as I’ve tried to maintain a safe, sane and healthy lifestyle, and now I’ve watched my 20 year old grandson follow in my footsteps. He is a 6′ 2″, 245 lb. toxic ball of angry confused poison and I know that if I had control of just his food intake, he wouldn’t be heading to jail.

      I was also part of a restaurant in the 90s that catered school lunches to three charter elementary schools and learned that 3 oz. of canned tomato sauce over processed pasta constitutes a serving of vegetables and that 5 of those rubber chicken nuggets from WalMart equal a serving of protein. So, these kids are eating not one drop of “real” food.

      As far as the whole grain, natural and unprocessed foods you mention, further research into the specific ingredients in those foods turn up some pretty nasty results.

      Reply
      1. Elizabeth

        The author of the website seems to imply that glutamate receptor abnormalities or polymorphisms associated with glutamate transmission relate to MSG consumption. Be very wary of these claims. This is a very big leap to generalize dietary intake to glutamate dysfunction that is reflective of genetic polymorphisms. There isn’t much, if any, evidence to support claims that dietary glutamate intake can penetrate the blood-brain-barrier to substantially alters baseline glutamate levels. Our brains are pretty good at maintaining their own (perhaps somewhat dysregulated) state of functioning.

        In terms of obesity, I think the jury is still out regarding how MSG contributes. It may be one of a multitude of factors, but who knows to what extent. It may even be that MSG-rich foods are typically nutrient poor and calorie dense, and, with those predictors in the model, the MSG effect falls out.

        Reply
  11. gywn

    Lyme disease makes me wary of everything I read and I appreciate your professional input to further enlighten me. While not a doctor or a scientist, my experiences with both in corporate America have led to the realization that they are compelled to praise and support the ideal behind their paycheck. So, when an independent professional challenges the corporate science, especially a woman, I will at least pay attention. I’m not saying she’s wholly correct because I don’t know the science, but there is some logic there.

    With that, and staying with your topic, sugar, I want to elaborate on how I think the MSG may fit in, as a better word than “culprit” to describe its contribution may be “glue”. When I read labels, and I read them all, it is the most common denominator. Even when it says “No MSG”, but says “natural flavors”, there’s MSG hidden there. I get very frustrated in the grocery store because I know what I need to stay healthy and it’s either not available or… I can’t afford it!

    When my Mom was diagnosed with diabetes, I read her dietary recommendations and I was floored that it listed margarine (motor oil) instead of butter or olive oil, and aspertame and sacharin instead stevia and agave as perfect substitutes for diabetics. It was nothing but artificial substances to entice her to eat all the pretty manufactured chemical mixtures designed to line the pockets of corporate America… and she does! Again, when you read the labels of these specialized products, “natural flavors”, or MSG is always there.

    Likewise, the processed sugars and the colorful dyes aren’t supposed to be ingested by the human body any more than the methylparabens, et al, found in baby lotion! should be absorbed by it, yet we’re convinced that these minuscule amounts of chemical exposure aren’t harmful. Is it not reasonable to think that there has to be a point where the body becomes so toxic with artificial substance(s) that these substances, and the volatile mixtures thereof, must cross the blood-brain barrier? And that human behavior is affected by that even without adding known mind-altering substances?

    Like any added ingredients and chemicals, MSG is NOT supposed to be in our bodies at all, and we are bound to react to it in some way, each in our own way, and it is more important to question/investigate, on a global level, how this unnatural chemical mixes (or reacts!) with/to other artificial ingredients, especially sugar, as well as to our own body chemistry.

    Personally, I do feel “dried up” when I’ve consumed MSG, as I am very aware of my reaction to every labeled ingredient I absorb. I have to be wary, since the infection that is Lyme disease crossed the blood brain barrier and in August, I was diagnosed with severe Encephalitis. I have to question, with my careful steps toward nutritional health, what’s the “glue” that made that happen? … if MSG is indeed an ingredient in manufacturing the capsules of many of the herbs and supplements I purchased that, for years now, have sustained me.

    Reply
  12. Elizabeth

    Wow! You definitely have some good insight into paying attention to what your body needs and what keeps it feeling good. I’m hoping to continue to make strides in that direction myself.

    Hopefully we will continue to support independent research (at least in the US) and produce the best research possible for all our benefit!

    Reply
  13. Marie

    Five years later…but…I just found Marc and this website this month.

    I am here to find information for my opioid-addicted son. I never took drugs, I don’t understand drugs; to me they’ve always been associated with darkness and seediness. In other words, I’ve been ill-equipped (from my ignorance) to help him. But that’s another story. I’m also trying to help myself.

    I realize that many addicts say that sugar addiction isn’t a real thing because people don’t steal from their grandmothers to feed a Twinkie craving. I get that. But what do you call it then? What do you call it when you wake up thinking about what/when you’ll have you’ll have your first treat of the day? What do you call that panicked feeling that you get when you’re supposed to start your diet (again) but can’t imagine going without pumpkin bread or cheesecake? What is it called when, at the end of several months of truly “stupid eating,” you can be simultaneously shoving a Reese’s cup down your throat while hating every taste of it…but yet still feeling compelled to do so? What do you call it when you are educated enough on plant-based, whole foods eating to teach a class on it–and you do, in fact, regularly eat those super healthy foods–but still chase your veggie chili and cauliflower steaks with sweet junk food? What do you call it when you literally feel like you’re going to die if you don’t get that box of caramel cremes???

    I actually don’t care what it’s labeled…I’m not interested in “having” something, as it sounds so victimish…but I am hoping to learn enough here to conquer this ingrained behavior that has affected so much of my life.

    Reply

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