Food and Eating Addictions May Not Be the Same
Anyone familiar with addictions is well aware of the discussions in this field about harm reduction (or controlled use) versus abstinence. In people where obesity is a consequence of an addiction, abstinence of course is not an option. Thus, the default in weight management is harm reduction.
Obviously, this does not make obesity management any easier. In alcohol dependence, abstinence is an option – no one would try to manage their alcohol addiction with a “drinking plan”. But in “food-addiction”, clients are often presented with and are expected to follow “diet plans”. When they fail to stick with these “plans”, they are simply labelled as non-compliant and often discharged from these programs.
In addition, it appear to me that “compulsive overeating” is perhaps as often a “process” addiction as it can be a “substance” addiction.
Readers may be aware that a process addiction is an addiction to an activity or process, such as eating, spending money, gambling, or working too much rather than an identifiable agent or substance. Unfortunately, these addictive behaviors can be as debilitating as those associated with substance addictions.
However, while with substance addictions, clients can be expected to simply give up or reduce use of the substance and can be monitored for compliance, process addictions provide much of their reward from the behaviour itself.
Sometimes, these behavioural patterns of process addictions can be transferred to other seeminlyg unrelated activities. Thus, as one speaker presented at this conference, people with gambling addictions, can get the same “reward” from running a yellow light, people with shopping addictions, an get hooked on the simple act of trying to find bargains or comparing prices. Thus, “eating addicts” can get “addicted” to the process of fantasizing about, finding, buying, preparing, and eating food – it may not be one food that they are addicted to, because their addiction it to the processes around acquiring food and eating it and not to a particular food or food group.
This adds a level of complexity to applying an addiction model to obesity, that may not be quite appreciated by the people who pass out the well-meant but useless “eat-less-move-more” (ELMM) mantra.
Indeed, it appears that applying an addiction model to obesity requires a level of sophistication that may well surpass what is normally provided in weight-loss programs.
Overall, I was fascinated by the many things I learnt at this addiction conference – the similarities between many of the issues relevant to treating addictions and obesity are striking and I must admit, often blindingly obvious.
My advice to anyone in the business of weight management – read and familiarize yourself with the addiction literature and embrace treatments that have worked in addictions (including relapse prevention) into your practice (and I mean more than just embracing motivational interviewing).
Hoping that someone, who meets the criteria for food (=substance) or eating (=process) addiction will change their behaviour simply by teaching them about healthy eating, is just as futile as hoping that a crack addict will stop using after attending a seminar on the dangers of crack use.