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Those of us who have been in and around the recovering community are all too aware of the fact that alcoholics and drug addicts rarely limit their addiction to one substance or behavior. For instance, cigarettes smoking, coffee drinking and donut eating take on fresh meaning to the newly recovering alcoholic or drug addict. Less obvious compulsions related to a "reawakening" are compulsions related to work, money, sex, gambling, shopping and eating. The purpose of this article is to heighten awareness of the nature and prevalence of eating disorders within the recovering community.
Current research would suggest that a conservative estimate, among alcoholic and chemically dependent women who "qualify" as eating disordered, is in the neighborhood of twenty to forty percent. There are no gender-specific studies regarding "cross-addiction." However, there is evidence to suggest that, of all the cases diagnosed in the general population, ten percent are men. Certainly, when we speak of "food addiction," we are including all those suffering from varying forms of anorexia, bulimia and compulsive overeating. 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.
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? This confusion, much like the confusion and misunderstanding concerning the true nature of alcoholism in years past, explains the difficulty among "food addicts" to recognize eating disorders as a "first cousin" to the chemical dependency family. However, there is significant evidence that many eating disorders meet the accepted medical criteria for substance abuse.
The body of research investigating the "biochemistry" of food addiction has been growing in recent years. To date, we know that a significant number of eating disorders have a biological base in addition to the behavioral elements associated with dysfunctional eating. Food addicts 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). We know, for instance, that foods which are high glycemic (sugar and flour products) trigger a reaction in the body of food addicts to "over secrete" insulin. The effect is a rapid rise in blood sugar followed by an increase in seratonin 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 (more sugar and flour) to relieve the distress. If this sounds familiar to the alcoholic, it's no coincidence. Alcohol converts to pure sugar as it enters the stomach. Alcoholics craving sugar, caffeine, and nicotine do so because it tends to alleviate some of the same symptoms associated with both alcohol and sugar withdrawal.
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 refined carbohydrates (e.g. sugar and flour) from your diet. An ever-increasing body of research has demonstrated that most 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. The end result is a tendency to retain more energy in the body in the form of adipose (fat) tissue. 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. The same 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 to avoid "retaining" calories. In this case, an abstinent food plan serves as a guideline for healthy eating. (See definition of "abstinence" below.)
Following an abstinent food plan in conjunction with weighing and measuring portions is 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 addiction 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. The primary tool in achieving the above is following an abstinent food plan. One might say and abstinent food plan, eliminating flour and sugar in addition to weighing and measuring meals, is the principle tool to achieve abstinence. The analogy I would suggest differentiating between the two perspectives is that of treating the alcoholic by means of "controlled drinking" versus "abstinence." It may, indeed, be possible for some to "control" their eating disorder (or alcoholism) by self-discipline. However, experience has shown that "such intervals of control are often brief, almost always followed by an even worse relapse." (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 12-step meetings (e.g. OA, FAA), and working with other recovering food addicts remains the foundation from which long term recovery is built. For more information about finding an eating disorder treatment center and details about support resources you can visit the Milestones In Recovery web site at www.milestonesinrecovery.com or contact the author at (800) 347-2364.
Dr. Lerner is the executive director of the Milestones In Recovery Eating Disorders Program. Dr. Lerner is a licensed and board certified clinical psychologist who has specialized in the treatment of eating disorders since 1980. He is the author of several publications related to eating disorders appearing in the professional literature as well as numerous magazines and newspapers. A friend of the recovering community here in South Florida, Dr. Lerner makes his home in Davie with his wife Michele and daughters Janelle and Danielle.
next: Eating Disorder, Type 1 Diabetes a Dangerous Mix
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