The blog is intended to share some of the research and collective experiences of those of us who have come to recognize anorexia, bulimia, binge eating, food addiction, compulsive overeating as variants of the same "tyrant"-namely addiction. Equally important is defining the solution once we've come to recognize the real problem.

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Cross Addiction: Eating Disorders and Chemical Dependency

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Those of us who have been in and around the “recovery community” are all too aware of the prevalence of eating disorders within the recovering alcohol and drug community. The purpose of this article is to heighten awareness of both the nature and prevalence of eating disorders particular to the community of recovering alcoholics and drug addicts.

Current research would suggest, even by conservative estimates, alcoholic and chemically dependent women who “qualify” as eating disordered is in the neighborhood of twenty to forty percent. Also, although there are no gender-specific studies regarding “cross-addiction” with eating disorders and chemical dependency, we know that at least 10-15 percent of males also would met the clinical criteria for an eating disorder within the general population when "food addiction" and binge eating are looked at.

Certainly, when we speak of “disordered eating,” we are including all those suffering from varying forms of anorexia, bulimia and compulsive overeating [aka food addiction]. Although many individuals suffering with an eating disorder may appear significantly overweight or underweight, like most alcoholics and drug addicts, one cannot identify someone with an eating disorder simply by appearance alone.

At this juncture, many of you may be asking how an eating disorder can be considered an addiction? How can anyone be addicted to food or “dieting”? The confusion, much like the misunderstanding about the true nature of alcoholism in years past, helps explain the difficulty many people with an eating disorder have recognizing thier illness is a “first cousin” within the family of chemical dependencies. The fact is, there is mounting evidence showing most, if not all, eating disorders meet the accepted medical criteria for substance abuse and dependency *(see prior article defining an eating disorder as an addiction).

The body of research investigating the “biochemistry” of what I will term for now, “food addiction,” has been growing in recent years. To date, we know eating disorders display a set of genetic and biological markers in addition to the behavioral elements associated with dysfunctional eating. Like most addictions, there is a relationship between the nature of the substance(s) and the nature / predisposition of the person. For example, both bulimics and binge eaters have a tendency to self-medicate via overeating and/or purging. In fact, a similar mechanism exists for those turning to restricting their food intake by self-induced starvation (anorexia). These attempts at self medication involve the stimulation and excretion of endorphins as well as neurotransmitters such as dopamone and serotonin [feel good chemicals in the body]. We know, for instance, that foods which are high glycemic (e.g. sugar and flour products, highly processed simple carbohydrates) trigger a reaction in the body of many binge eaters to “over secrete” insulin in addition to releasing excess dopamine and serotonin. The effect is a rapid rise in blood sugar followed by an increase in serotonin and beta endorphin levels. Unfortunately, this reaction causes a rapid drop in these levels shortly after – the result being a “withdrawal-like” syndrome marked by depression, anxiety, insomnia, fatigue, and a craving of the substance (high glycemic foods) to relieve the distress.

If all this this sounds familiar to the cravings an alcoholic experiences during the early stage of abstinence, it’s no coincidence. Alcohol converts to pure sugar as it is digested in the stomach. Alcoholics who abstain from drinking and find themselves craving sugar, caffeine, and nicotine do so because these substances tend to alleviate some of the same symptoms associated with both alcohol and, yes, sugar withdrawal. Couple the physical elements these addictions have in common with having learned to self-medicate depression vis-à-vis substances and compulsive behaviors and the similarities become obvious. "There are no coincidences..." Hence, the phenomenon of “cross-addiction.”

Recovering from an eating disorder is much like recovery from any addition. Effective treatment begins with following a set of directions. Addictions all have in common a degree of physical and psychological issues which separate the “addict” from the “non-addict.” On the physical side, a good first step is to eliminate or seriously limit refined carbohydrates (e.g. sugar, flour) from your diet. To be sure, this does not always mean to eat less, it means to eat differently. An ever-increasing body of research has demonstrated that many eating disordered people manifest an increased sensitivity to these substances, much like the effect of alcohol upon alcoholics. This “sensitivity” translates to an excessive secretion of insulin, leading to a pronounced drop in blood sugar and, thereby, an increase in physical hunger and depressed mood. In other words, if you are eating disordered, chances are these substances play a part in the compulsive eating pattern, as well as directly effecting the neurotransmitters which influence your mood (first making you “feel” better, then leading to a depressed state of mind). Whether the above is a primary mechanism for an eating disorder or plays a lesser role is not known. A similar phenomenon appears to exist for the individuals suffering with anorexia. Here the “addictive solution” is avoiding food altogether or resorting to excessive exercising and/or purging. Ultimately this results in an addictive cycle of depending upon starvation or purging to “stave off” depression and avoid weight gain. In this case as well, an abstinent food plan* serves as a guideline for healthy eating. (See definition of “abstinence” below.)

Following an abstinent food* (e.g. low glycemic) in conjunction with weighing and measuring portions, (for those who tend to either over or under estimate portions), is an integral part of the foundation from which a recovery lifestyle is built. The goal of this process is to provide a “blueprint” from which someone is able to construct an eating pattern relieving one from the tendency to either over estimate or under estimate their nutritional needs. Without such a blueprint, one is left with good intentions, but no means of constructing a personal recovery program that can withstand the inconsistencies of everyday living. From our experiences, “doing is believing”.

Defining Abstinence:

From a medical perspective, abstinence refers to the simple cessation of addictive or compulsive behaviors as it applies to the behavioral patterns associated with an eating disorder. For the compulsive overeater, it means refraining from overeating, regardless of the type of food or frequency of eating. For the bulimic sufferer, it means abstaining from binging and purging. For the anorexic, it represents no longer restricting caloric intake and/or the cessation of purging.

The definition of abstinence from the addiction perspective is the same with one important caveat. An essential tool for achieving the above includes an abstinent food plan. One might say an abstinent food plan amounts to limiting, or in some cases, eliminating, flour and sugar products as well as weighing and measuring portions. Again, this is neither a “license” for the anorexic sufferer to eat less or obsess about calories – it is a means of eating an adequate amount of healthy, nutritious foods and not underestimating portions. In effect, this approach to eating is recommended for those who otherwise have yet to achieve abstinence from their eating disorder. The analogy with treating alcoholism is one that differentiates between two perspectives - that of recommending the alcoholic try “controlled drinking” versus achieving “abstinence.” It may, indeed, be possible for some to “control” their eating disorder (or alcoholism) by self-discipline. For others there may be a physical factor beyond self-discipline and will power. In these cases experience has shown that “such intervals of control are often brief, almost always followed by an even worse relapse.” ( borrowed from the “Big Book” of AA)

Getting Help

Recognizing an eating disorder as an addictive process suggests the treatment process needs to address the physical, emotional, and spiritual aspects of the illness. In the beginning this often means finding a treatment center able to provide the tools necessary to enter recovery. Once gaining a “foothold” on the recovery path, adhering to a healthy food plan, regular attendance at relevant support groups (e.g. OA, EDA, etc.), and working with other recovering people remains the essence from which long term recovery is built.

SO...What are your thoughts and experiences. "Inquiring minds want to know"

Licensed psychologist and an active participant within the recovering community, living in South Florida with my wife, Michele, two daughters,Janelle and Danielle, and our dog [Golden-Doodle] Reggie for the past 25 years. Founder and executive director at Milestones In Recovery, a residential and outpatient program treating eating disorders.

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