by Dr. Vera Tarman
I am the Medical Director of Renascent, which is a 21 day residential treatment centre in Toronto for people suffering from drug and alcohol addiction. I have been in the field of Addiction Medicine since 1993, and have had my specialization in addiction medicine (by the American Society of Addiction Medicine) since 2004.
In the last eight years of working at Renascent, I have seen over 1,000 new patients each year for substance abuse disorders. This has given me a large sampling from which to draw out some clinical patterns of behaviour from people who struggle with addiction and who are in the early stages of recovery. It has struck me from the outset that the phenomenon of addiction spans many substances: People who are addicted to alcohol frequently go on to develop an addiction to opiates. People who are addicted to cocaine come back to treatment for a new (or latent) addiction to alcohol. People who use marijuana to avoid opiate use end up as alcoholics.
Over the years, I have seen some typical patterns. A person would come into treatment to be treated for their alcoholism. They eat voracious amounts of food, usually to their horror, frequently gaining as much as 20 – 30 pounds in the three weeks of treatment. They find that they are eating candies incessantly, and cookies, muffins, bread, potatoes at each meal. Many would exclaim that they never ate that way before and find that they can not stop even if they want to. After treatment, this pattern of over eating and binge eating continues. It is as if they can not stop. I know of one heroin addict who quit his drug, only to start eating two large tubs of ice cream each night, every night. He knew he was eating dangerously. He had high blood pressure, he was obese, he was depressed. He died 10 years later, not from a heroin overdose, but from diabetes and a heart attack.
There was also a smaller group who admitted that prior to their own drinking problem, they used to eat for comfort – bags of chips or cookies or jars of peanut butter each night. They stopped eating in this way when they picked up their drug of choice – often in adolescence. Once in treatment, they stopped their drug, and discovered that the same pattern of eating reemerged. When told that they had to quit eating in this way, the typical response was that would be impossible. Most said that to not eat sugar was harder than to stop drinking or drugging. One recovered cocaine addict who attempted to stop, actually left the treatment, visibly upset. He felt that to stop eating his nightly regime of junk food might destabilize his recovery from cocaine addiction.
I concluded that many people who were addicted to any of the drugs I have mentioned, quickly develop a new addiction to food. The foods they became addicted to are almost always the sugars and carbs which we provide in abundance at the centre – we call it the ‘cheap and cheerful’ foods. They are cheap, and they are mood altering: they provide a surplus of neurochemicals, namely dopamine, serotonin, and endorphins. And they are ‘drugs’; the refined hyper palatable foods that we serve (muffins, pastry, popcorn, juices, candy) are not naturally real food. They are artificially constructed chemicals that the food industry has created so that we become addicted to eat more and more of them. The surplus of neurochemicals that result create a heightened sense of well-being that is the same as a drug intoxication. Look on a SPECT scan, a specialized radiological study of part of the brain, and you could not tell the difference between a sugar high and a cocaine high.
Another pattern that I discovered were the people who had once suffered from anorexic disorders coming into treatment for cocaine or crack addiction. They often admitted that they used crack as a form of inhibiting appetite i.e. the ‘Jenny Crack’ diet. When they started to gain weight, most said that they would choose to return to their drug use rather than relapse fully back to anorexic behaviours (which was always operating just under the surface) or worse to them, adopted uncontrollable bulimic behaviour. It was obvious to me that they were struggling with the same disease of compulsion and obsession, with just slightly different manifestations.
I maintain that the anorexic, while not eating, is experiencing a dopaminergic euphoria. She or he is experiencing an altered agitated ‘high’ as they obsess about food like any drug addict would over their drug of choice. We know that hunger creates dopamine – and the reward value of food heightens the hungrier a person becomes. This is the body’s attempt to entice the person to eat, to nourish itself. The anorexic does not eat food, but as he or she gets hungrier, she or he instead anticipates food – in the food preparation, in the food obsessions, in how she or he ‘plays’ (but does not eat) the food, – this is a dopamine high which builds and builds the hungrier the person gets. And, importantly, it stops the moment food enters the body. Anorexics resist food the same way as the drug addict resists withdrawal from their drug.
This understanding is important. While an eating disorder may be a dual diagnosis alongside an addiction for some, it is just as likely a possibility that it IS part of the addictive disorder itself. If the person is a food addict, rather than suffering from a true eating disorder, then the typical treatment used for eating disorders is not only not helpful (hence the high rate of recidivism and relapse in eating disorders), but actually dangerous. A modified food plan based on our Canadian food pyramid will actually undermine recovery from the addiction to the specific foods.
And since the phenomenon of addiction does not favour one drug over another ultimately, it may even undermine recovery from the addiction to other drugs latent in the person’s history. Food can be a drug, like any other, and can fuel the addictive cycle which impedes recovery and sobriety. If you are a recovered alcoholic and addict, and are still suffering from depression, anxiety, insomnia and cravings…. look to your diet. If you are not in recovery from a substance, and nevertheless are suffering from mood instability and are using food to self medicate your moods… look to your diet. The answer to sobriety and serenity is in what you eat and especially, what you don’t eat.