By far the most widespread area of confusion regarding addiction, especially food addiction, is that it's biochemistry that makes it difficult to break free; that the problem is one of physical dependence.
Some addictions are driven primarily by physical dependence, such as certain medications for sleeping, painkillers or antidepressants. The body becomes accustomed to the drug, adapting to the repeated introduction of these toxins as best it can. After some time, there can be significant difficulty readjusting physically whenever they're removed, and that's why they can be referred to as addictions.
Most, if not all, addictions have an element of physical dependence, but the addictive behaviours I'm most familiar with (nicotine and starchy carbohydrates) are mainly driven by something else: Pavlovian conditioning of the reward system. There is, of course, a biochemical aspect to this, but this is not the same as physical dependence. The far more important factor is the brain's reward system, and the crucial elements with this are pleasure, satisfaction and, especially, context.
Most people who overeat can see that they can control their eating in certain circumstances but not in others. For some, they're fine at home but tend to overeat in the context of social situations. For others it's the reverse, where their home is the context for endless snacking. Pavlovian conditioning sets you up to overeat in certain circumstances; it's the context that drives the behaviour. Physical dependence plays a part, but mostly the circumstance you are in creates an expectation of eating, based on what you've done in that context in the past. (1)
I cannot tell you how often this distinction between physical dependence and Pavlovian conditioning is confused. Food addiction in particular is usually not even acknowledged, but when it is, physical dependence is assumed.
This is why I get excited when I read (relatively recent) studies on food addiction written by researchers using fMRI brain-scanning technology. They have been able to see inside active human brains, so they know more than anyone where the addictive process occurs. One such researcher, Dr N. D. Volkow, Director of the (US) National Institute on Drug Abuse, says:
"Once you create a conditioned memory, it's just like Pavlov's dogs; the response becomes a reflex. This conditioned response underlies the drive both in drug addiction and compulsive eating." (2)
This conditioned response and the drive it creates is usually thought of in terms of craving, but this term may not be helpful or entirely descriptive. Craving is a tough word to define, but any definition I've ever seen has included the words 'intense desire'. What is regarded as intense is going to differ from person to person, but the intensity of the desire often comes, not from the Pavlovian conditioning itself, but from the reaction to it, in particular as a result of the denial of choice.
This is why craving - at least as many people think of it - isn't a necessary part of eating less. And it's misleading because the Pavlovian conditioning can easily show up as feeling hungry or not feeling full:
"Hunger caused by food cues is an adaptive mechanism for survival, and the learned cues can serve as a harmful force to promote over-indulgence in food despite satiety (fullness)." (3)
The conditioned desire can also show up quite simply as a preference for one item over another. For example, someone wanting a snack in the afternoon, faced with the option of an apple or a few chocolate biscuits, thinking that the apple doesn't stand a chance. Please note that I'm not telling you which one to choose; it's just that one of those options is more influenced by the processes of addiction than the other, for most people.
Most people overeat starchy carbohydrates, and dealing with this is about resolving a conflict. This conflict is between the immediate gratification of the addictive desire (and the pleasure and sense of satisfaction that brings) and the more delayed rewards of improved health and self-esteem which come from eating less.
The good news is that you don't need to change your biochemistry in order to begin. You could simply think of this as a process of changing your values. You cannot escape having values, even though you might not consider them too much. For example, every time you buy something, no matter what it is, you are acting on your values. You say, "this bag of organic carrots is more valuable to me than my £1." Which is a choice I made (quite easily!) last week.
For many people, overeating comes from acting on the value they place on immediate pleasure and satisfaction, possibly at the expense of improved health and self-esteem. I don't want to tell you what your values should be. For one thing, the potential problem with your health and self-esteem may not be that great at this time. And anyway, if that's the way you want to live, I honestly don't think it's my place to judge that.
My point is simply that you can, if you want, re-evaluate your values, any time. It's entirely possible, for example, that someone will overeat for years, prioritising immediate pleasure until they become unwell. That wake-up call means that they change their priorities, so their health then becomes more important to them than the satisfaction of their addictive desire.
This does depend on nutritional information regarding which foods are likely to be contributing to the poor health in the first place. And it certainly can depend on an ability to work through an addictive relationship with those foods, so that the intention to eat less - or eat less of certain things - can be successfully maintained.
This, of course, can be considerably more challenging than deciding to buy a few carrots for £1. The reason is that the addictive desire to eat (the Pavlovian conditioning) is produced in a different area of the brain than the area that connects you to your true values and intentions. These two areas of the brain evolved at different times in human history and are to some degree separate and mismatched. (4)
Many people trying to control overeating feel that they are 'in two minds' - determined to start the diet one minute, binging on biscuits the next. And if you feel guilt, regret or low self-esteem in connection with overeating, these can also be signs that you're not acting in line with your values, because you don't have the best possible communication between these two areas in your brain.
When you use the techniques I describe in EATING LESS, you build connections between these two areas, so that they work together in more integrated harmony. And that's why developing a peaceful, healthy and non-addictive relationship with food can be so very empowering.
Some thoughts:
- The glycemic index of carbohydrates is an important factor in addictive overeating, not so much in order to maintain blood glucose levels, but because they strongly reinforce Pavlovian conditioning. This is why, when a conditioned cue triggers your addictive desire to eat, you're more likely to fancy something containing sugar and/or wheat, rather than, say, raw vegetables.
- You don't need to be in poor health in order to make changes. For example, my health is excellent and my motivation about what I eat and don't eat is all about staying that way.
- Be as clear as you can about the specific benefits you hope to gain as a result of eating less. Often people just think, "I'm not supposed to be eating these..." and this can just be too vague to stand up against the Pavlovian conditioning.
NOTES
- "Experimental extinction in Pavlovian conditioning: behavioural and neuroscience perspectives" A R Delamater (2004) Quarterly Journal of Experimental Psychology 57(2):97-132
- "This is your brain on food" K L Ozelli (2007) Scientific American 297(3):84-85
- "Food addiction and neuroimaging" Y Zhang, K M von Deneen (2011) Current Pharmaceutical Design 17:1149-1157
- "Mindsight" Daniel Siegel, MD (Bantam, 2011)
