Contrary to the notion that the meaning of addiction is discoverable in a vial somewhere, definitions and the applicability of the addiction concept are historically and socially determined, as the current issue of the journal Addiction struggles to come to grips with.
The Stanton Peele Addiction Website, June 25, 2011. This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.
Is Food Addictive? (Who wants to know?)
The question, "Is Food Addictive?" is not easily resolved, as we shall see. And it isn't the most important question. That actually is, "Why do you want to know?"
The current (July 2011) issue of the journal Addiction has at its theme, food addiction. Although the journal is not well-known in the United States, particularly to the general public, it is perhaps the premier international journal in the field.
I feel some connection to this matter since, in 1985, I wrote for the journal, when it was the British Journal of Addiction, "What I Would Most Like to Know - How can addiction occur with other than drug involvements?" Sometimes, I like to feel I have been ahead of the curve in the addiction field.
The lead article in the July, 2011 issue of Addiction is "Can food be addictive ? Public health and policy implications" (by Ashley Gearhardt et al.). Of course, this question is reminiscent of the fact that the forthcoming version of DSM-5 (scheduled for publication in May 2013) proposes including gambling as a "behavioral" addiction, while reserving for continuing discussion the issues of whether Internet and sex addiction exist.
How do you decide if something is addictive? A technical journal feels obligated to question whether food acts on the brain's neural pathways like famously addictive drugs - such as heroin and cocaine - do. And the answer is (this is my paraphrase), "In some ways yes, in some ways no. Why do you ask?" The list of follow-up articles gives a good sense of what this debate looks like:
- Obesity - is food addiction to blame?
- Food and addiction - sugars, fats and hedonic overeating.
- Food addiction not helpful: The hedonic component - implicit wanting - is important.
- All foods are habit forming - what I want to know is which will kill me!
- Important next steps in evaluating food's addictive potential.
In fact, the history of addiction is replete with questions of when to split hairs and when to subsume new objects into the addictive pantheon - from nicotine and cocaine in the 1980s, to marijuana in the 1990s, moving forward to gambling and potentially the Internet and sex currently.
And the answer to the question, "What is addictive?" is:
- What society decides in a given epoch.
- What people feel about an activity or object.
- What is helpful (or thought to be helpful) from a public health standpoint.
The authors of the lead article's conclusion is: "Although there exist important differences between foods and addictive drugs, ignoring analogous neural and behavioral effects of foods and drugs of abuse may result in increased food-related disease and associated social and economic burdens. Public health interventions that have been effective in reducing the impact of addictive drugs may have a role in targeting obesity and related diseases."
Translation: "Well, not exactly, but in some important ways, yes. And some of the steps we take in combating drug addiction may be useful for food as well."
Here is an example of the technical approach :
Preclinical studies, beginning in Bart Hoebel's laboratory at Princeton University, have shown that rats overeating a sugar solution develop many behaviors and changes in the brain that are similar to the effects of some drugs of abuse [5,6], including naloxone-precipitated withdrawal , and others have shown complementary findings that suggest reward dysfunction associated with addiction in rats that overeat highly palatable foods . These studies are supported by clinical research showing similarities in the effects of increased body weight or obesity and abused drugs on brain dopamine systems, as well as the manifestation of behaviors indicative of addiction [9-12].
Here is the countervailing viewpoint :
At the outset it should be considered that over-consumption of food is one example of a more widespread acquisition of material objects well beyond any limits defined by personal need. People in industrial societies are encouraged to purchase more clothes, shoes, TVs, motor cars, refrigerators, furniture and palatable foods. . . . However, the acquisition of possessions beyond need extends well beyond the food repertoire. The prevailing socio-economic system encourages a philosophy of materialistic self-interest and unnecessary consumption (and purchasing) which is required in order to drive economic growth. Therefore, over-consumption takes place in a climate of abundance, aggressive advertising and easy accessibility in which food consumption is promoted strongly by the socio-economic market.
(Shades of Bruce Alexander !) As usual, the battle is between seeing the phenomenon from different levels of interpretation.
If I may be permitted, let me return to my Addiction article, which was summarized: "An increasing recognition of the possibility of addiction with regard to activities other than drug use seems to call for a re-evaluation of key strands of thought about the nature of addiction, namely its relationship to the biological substratum and the relevance of cultural and individual interpretation of experience in addiction."
My solution for bringing together the biological (and how people interpret these experiences), the clinical, the cultural, and the shifting sands of social and historical custom comes from my 1985 book, The Meaning of Addiction , on which my Addiction article was based:
People become addicted to experiences. The addictive experience is the totality of effect produced by an involvement; it stems from pharmacological and physiological sources but takes its ultimate form from cultural and individual constructions of experience. The most recognizable form of an addiction is an extreme, dysfunctional attachment to an experience that is acutely harmful to a person, but that is an essential part of the person's ecology and that the person cannot relinquish. This state is the result of a dynamic social-learning process in which the person finds an experience rewarding because it ameliorates urgently felt needs, while in the long run it damages the person's capacity to cope and ability to generate stable sources of environmental gratification.
Because addiction is finally a human phenomenon, it engages every aspect of a person's functioning, starting with the rewards (as interpreted by the individual) that an involvement provides and the individual's need for these rewards. The motivation to pursue the involvement, as compared with other involvements, is a function of an additional layer of social, situational, and personality variables. All of these elements are in flux as an individual grows up, changes environments, develops more mature coping mechanisms, loses and gains new opportunities for satisfaction, and is supported or undermined in forming new outlooks and self-conceptions.
There are indeterminate elements - for example those activated by the person's value commitments - affecting whether the person will continue to return to an experience that is progressively more damaging to the rest of the person's life. Even after the person has developed an addictive attachment, he or she can suddenly (as well as gradually) rearrange the values that maintain the addiction. This process is the remarkable one of maturing out, or natural remission in addiction.
I can hardly wait until they finally work all of this out shortly!