The Addicted Brain (19 page)

Treatment for pathological gambling has been mainly behavioral, involving counseling, family therapy, twelve-step programs (Gamblers Anonymous), and the like. The use of medications has not yet been well studied but it is getting attention. There are also treatment centers for gamblers, although their number is very small compared to the centers for treating substance abuse. Overall, pathological gambling
seems to be similar to drug addiction, and it will undoubtedly benefit from the extensive work done for drug addiction. But, more studies specific to gambling need to be carried out.

There is some controversy about whether or not sexual “addiction” really exists.
³
But again, one could look at the main criteria for addiction and see that certain extremes of sexual behavior are similar. Sue Williams Silverman, a writer, speaker, and teacher at the Vermont College of Fine Arts, has written
Love Sick: One Woman’s Journey Through Sexual Addiction
(W.W. Norton and Co., 2001) that describes her problem and her treatment. She says that she was addicted not only to sex but also to danger, and an addiction to drugs seems similar to her descriptions. She tells of her obsessions, fantasies, and her experiences with strangers, friends, and her father. Her emotional struggle is told with an engaging clarity that makes the reader both wince and struggle with her. Whether or not experts can agree on the term “addiction,” sex is a behavior that can be taken to extremes and create problems in our lives.

Although it does mention various sexual disorders, the
DSM-IV TR
, the latest official diagnostic manual of the American Psychiatric Association, does not list the disorder “Sexual Addiction.” It doesn’t list gambling as an addiction either, but it describes pathological gambling. The
DSM-IV TR
has been put together by teams of thoughtful and experienced professionals. It seems likely that behaviors like pathological gambling will be eventually recognized as an addiction. Perhaps a good question is this: Can the addiction model be usefully applied so that treatment of gambling is helped? This is an important and real goal worth pursuing.

Many people can’t control their eating, and some think of themselves as addicted to food. Margaret Bullitt-Jonas, an Episcopal priest, is
someone who has written and lectured about what she refers to as her eating addiction. She describes her feelings of being hopelessly and painfully lost, in danger of losing her health, and having little idea of how it happened or how to get free. She says that food was not delicious nor was eating pleasurable—it was done compulsively. Her father’s problem with alcohol stressed the family and played into her own vulnerability. Eventually, she reached bottom emotionally, and her path to health involved meditation, accepting the presence of a higher power, and attending Overeaters Anonymous. Her recovery was holistic—physical, emotional, and spiritual. Her story is one of great courage and commitment.

The media tell us that chocolate, carbohydrates, and fats improve mood, cause craving, and are the objects of binging. Carbohydrates have even been called a new cocaine, because they cause signals in the same parts of the brain that cocaine does. Interestingly, it has been acknowledged that cocaine works through brain pathways involved with natural rewards such as food. Although the assertion that carbs are like cocaine is true, it’s not anything we don’t already know. Carbs, particularly those made with white flour such as bread and pasta, are sometimes said to be addicting. Signs of this addiction are suggested to be morning cravings, inability to stop eating them, or having withdrawal symptoms consisting of mood swings and irritability when you stop eating them. The potential to develop diabetes and obesity is present as well. Although much of this sounds like addiction, we should be cautious in labeling the behavior.

Pathologic overeating of any food can be like drug seeking and taking, and various laboratory findings support this similarity. For example, Drs. Gene Wang, Nora Volkow, Joanna Fowler, and others showed, in an imaging study, that obese subjects had lower dopamine receptors than non-obese subjects (see
Figure 10-2
); this is exactly what was found with drug-addicted individuals and implies that excess food can be like a drug (see
Chapter 7
, “The Brain Is Changed—For a Long Time,”
Figure 7-2
). Also, binge eating has been connected to the genetics of the dopamine transporter in brain (see “
The Dopamine Transporter Is Connected to Binge Eating
”
in
Chapter 6
, “Why Are Drugs So Powerful?”). Binging on sugar is also accompanied by an increase of dopamine output in the nucleus accumbens. We can find individuals who crave sweets, who have tried to stop but relapse, and who feel that their food choices are affecting their health, through obesity or diabetes. Taken together, these findings connecting food binging to dopamine, craving, relapsing, and negative impacts on health, suggest that obesity, at least in some forms and conditions, might be like drug addiction.

Figure 10-2. D2 dopamine receptors are reduced in obese subjects. PET scans of D2 dopamine receptors showed that the receptors are lower in obese subjects (right side) compared to normal subjects (left side). The relative size and level of the bright area shows the levels of receptors. The larger and brighter the area, the more receptors it has. This is similar to what is found in addicted subjects. A review of
Chapter 7
(
Figures 7-1
and
7-2
) might be helpful. (Reprinted from The Lancet, 357, Gene-Jack Wang, Nora D. Volkow, Jean Logan, Naomi R. Pappas, Christopher T. Wong, Wel Zhu, Noelwah Netusll, and Joanna S. Fowler, Brain dopamine and obesity, 354-357, Copyright [2001], with permission from Elsevier.)

But, overeating and obesity are also questioned as being properly called addictions even though it appears that many of the characteristics of addiction apply to these disorders. Dr. Bartley Hoebel at Princeton and others have discussed these questions.
⁴
In a sense, it might not matter, and an important question is, “How can people with these kinds of problems be helped?” It would be interesting if using methods similar to those from the drug abuse field were useful in treating eating disorders. In any case, whether addiction or not, obesity and eating disorders can be serious, and consultation with a physician is needed.

Is referring to someone as an “addict” used as a scare tactic to motivate people who have a problem with obesity (or another behavior)? Calling someone an addict can certainly get his or her attention. But it seems unlikely that this tactic is done by professionals who are certified to treat people with problems. It does seem possible that well-meaning friends or family members might do this. They might even be justified, but it can backfire, creating more fear that only hinders getting treatment.

The reverse question is also important—is the label “addict” used by some as an excuse to continue their self-destructive behavior that is difficult to stop. “I’m an addict” is a declaration that seems to reduce harsh judgments about people doing repetitive, destructive behaviors. This seems to be true particularly if you can say that it’s genetic. “My parents were the same way.” That seems to be a great excuse. However, placing the blame solely on genetics is not a good excuse, not only because heredity is only one of many risk factors, but also because a genetic predisposition does not guarantee a life of addiction

There are several extreme behaviors such as pathological gambling, excessive sexual activity, binge eating, and others (excessive Internet use, shopping, and so on) that can be consuming; they take a lot of time, energy, and resources, and can result in significant personal distress and negative consequences for the individual. They might not be accepted as addictions in the strict scientific sense, although it seems that they exhibit many of the important signs found in drug-addicted individuals. Nevertheless, this comparison with drug abuse can be informative and helpful. Treatment methods that are successful for drug users might be useful for them as well, but it is best left to the experts to decide on a course of treatment.

¹
Actually, that is a simplified definition that is useful, particularly for those who are wondering about having a problem with drugs; however, the definition used by professionals for purposes of diagnosis is more detailed and contains more elements. For example, they question the amount of time that the user has been involved in the activity, how many times the user has tried to stop doing the drug, whether the user needs to take more drug to get the same effect, whether the user has withdrawal, and it asks for a more detailed description of the negative consequences. These are described in the
DSM-IV TR
and in Endnote 1 in
Chapter 1
, “What’s In This Book, and Why Should I Read It?” A useful summary of behavioral addictions is in Grant J.E. et al. “Introduction to Behavioral Addictions.”
Am J Drug Alc Abuse
, 36: 233–241, 2010. If someone has a concern about addiction, he or she should consult a professional.

²
Some examples of studies on gambling are as follows: Breiter, H.C et al. “Functional Imaging of Neuronal Responses to Expectancy and Experience of Monetary Gains and Losses.”
Neuron
, 30: 619–639, 2001; Goudriaan, A.E et al. “Brain Activation Patterns Associated with Cue Reactivity and Craving in Abstinent Problem Gamblers.”
Addiction Biology
, 15: 491–503, 2010; Reuter, J. et al. “Pathological Gambling Is Linked to Reduced Activation of the Mesolimbic Reward System.”
Nature Neurosci
, 8: 147–148, 2005; Van Holst, R.J. et al. “Brain Imaging Studies in Pathological Gambling.”
Curr Psychiatry Rep
, 12: 418–425, 2010.

³
Some publications that touch on the issue of sexual addiction are as follows: Kelley, A.E. and K.C. Berridge. “The Neuroscience of Natural Rewards: Relevance to Addictive Drugs.”
J Neurosci
, 22(9): 3306–3311, 2002; Potenza, M.N. “Should Addictive Disorders Include Nonsubstance-Related Conditions?”
Addiction
, 101 (Suppl 1): 142–151, 2006; Schneider, J.P. and R.R. Irons. “Assessment and Treatment of Addictive Sexual Disorders:
Relevance for Chemical Dependency Relapse.”
Subst Use Misuse
, 36(13): 1795–820, 2001.

⁴
Volkow, N.D. and C.P. O’Brien. “Issues for DSM-V: Should Obesity Be Included as a Brain Disorder?”
Amer Journ of Psychiatry
, 164: 708–710, 2007. Avena, N.M. et al. “Sugar and Fat Bingeing Have Notable Differences in Addictive-Like Behavior.”
Journal of Nutrition
, 139: 623–628, 2011. Corsica, J.A. and M.L. Pelchat. “Food Addiction: True or False?”
Curr Opin Gastroenterol
, 26: 165–169, 2010. Rogers, P.J. and H.J. Smit. “Food Craving and Food Addiction: A Critical Review of the Evidence from a Biopsychosocial Perspective.”
Pharmacol Biochem Behav
, 66: 3–14, 2000.

“I was a heavy drinker for years, ignoring all the warnings about chronic alcoholism. Now, my doctor says that I’ve got end-stage liver disease with little chance for a cure. I’m kicking myself now. Why did I ever start drinking in the first place?”

Although each drug has its own particular, seductive attraction, each one has some bad side effects. This chapter is mainly about the side effects of the substances rather than the rewarding and reinforcing effects. But the addicting properties of a substance and the harm it causes can be related (see
Figure 11-1
).
Chapter 1
, “What’s in This Book, and Why Should I Read It?” lists many of the abused drugs and provides a reference to a site where more information can be found about each drug. Remember that the effects of drugs are dose-dependent and time-dependent, meaning that the effects the user experiences depend on how much of the drug the user has had, the amount of time since the last dose, and for how long overall the user has been taking it. There is individual variability in responding to drugs, as they affect some people differently. Many drug users use multiple drugs at the same time; of course, this makes things worse. Read on, and heed the fear in your heart!