When we think about addiction we think of drugs, alcohol, gambling, but think about other forces
that drive our behavior too. Look carefully here and see that alcohol's addictive. This is
a nice list of what addiction actually looks like. But you can actually just take all those red words
and change them a little bit and this still makes sense, right? Food can fit in this model.
I happened to get a comment to the effect of, "Well, drugs and alcohol are chemicals."
But think about our food today pretty chemical if you go to a gas station around the corner, right?
Think about a Twinkie we're not physiologically wired to handle the
neural experience of a Twinkie. Where in nature will you find that amount of sugar
without any fiber and with that incredible amount of fat and mouth feel? You're not,
you're not going to hunt for a Twinkie in the wild, right? We didn't evolve for that
but the Diagnostic and Statistical Manual of Psychiatric Disorders, or the DSM for short,
lists these criteria for addiction and from this Ashley Gearhardt at the University of
Michigan has developed a tool that maps directly onto these criteria to measure food addiction.
Food addiction actually isn't a diagnosis in the DSM right now but she basically just took
what we used to diagnose other substance dependences and translated it for food. We also
use the reward based eating drive scale which I will talk about in just a little bit and as
Alyssa mentioned it is on our website and you'll be able to get it for free and read all about it.
So I just contrasted food and alcohol but I want to make another comparison for you
23 percent of people who use heroin go on to develop full-blown opiate addictions. That actually
means that most people who try, or use heroin, aren't actually becoming addicted to opioids.
When people who are addicted to opioids seek treatment for their addictions they
go to their doctor's offices. Doctors don't just say, "Aha, I have your solution, stop that!
Just don't do that." Right? That's not how it works they're more likely to refer them to
addiction treatment, help them find a clinic, hook them up with other services, right? It's not
just, "Oh!" But if we flip over to food about 20 percent of people meet criteria for food addiction.
Again, we just flip the words in the criteria slide I already showed to get there and since we all eat,
food isn't avoidable, this means that most people who eat food aren't actually addicted to food.
Right? Food addiction is more common among people who have overweight, or obesity,
who are women and who are 35 and older, but we know that it can affect anyone.
And when people seek treatment for food addiction, which often presents as an umbrella of weight loss treatment,
doctors often do just say, "I have your solution, stop eating that and go to this exercise class."
Poof, you're fixed. Right? But kind of like Bob Newhart did on Mad TV, I don't know if anybody is familiar
with this skit but it was a great skit where a patient would come in he'd say you pay up front
for your services he'd take their payment he'd tell them their problem, they'd tell him their
problem he would say, "I have your solution, stop that, check out with my secretary on the way out."
It was pretty funny but when it comes to treatment for obesity, people often know, "Oh you know, I really
should eat the salad and not the pizza." People know that. "I should go to the exercise class,
not sit on the couch for two hours." People know that. They don't need someone to tell them that.
And we debate about, you know, nutrition all the time and we could get into those nuances
but big picture, people don't really need a handout for this in cases like this.
Doctors may refer them to exercise programs, or a nutritionist,
but that's not hitting on the problem that they're actually suffering from,
feeling addicted to particular food additives, or particular food combinations, or particular foods.
So, I invoked this opioid model on the previous slide because it turns out that the opioid system
has a lot to do with our eating behavior. I'm going to briefly unpack the opioid system
here in a very, very broad sense. There's exogenous opioids for those that we actually introduce into
our bodies, that's like heroin, opiate medications. Then there's endogenous opioids and those are
naturally occurring in our bodies and we release them when we do pleasurable things like eating.
When we eat a tasty food we experience a release of these endogenous opioids which
act on specific receptor sites in our brains and remind us that, "Hey, this tastes good, this is
pleasurable, I should eat this again." Right? We learn which things taste good and which things don't.
We can alter our eating behavior and our preferences by actually
changing the action at these receptor sites and as an example from the overdose literature
with which many of you are probably aware of because it's been in the news a lot lately,
we can give an overdose person opioid antagonists, or Narcan, to save their life by acutely reversing
their high. Right? This action is happening at those receptor sites. Other studies have taken us to the
realm of food, things that we're working on. And when we administer opioid antagonists to animals
and to humans they find their food less tasty and they start to eat less of it. This is a really
big hammer, right? We're giving this drug to them, in their brains, so everything's going to be less
fun but it just so happens that the only thing that's in the rat cage is food. That's their
only option for fun, right? But this has a lot of implications for obesity treatment. Many folks
have begun looking at opioid antagonists and thinking, "Well, maybe we can use use this as a
weight loss medication." And you may be familiar with Contrave, that's bupropion with naltrexone.
So that's a combination drug that tries to antagonize opioid receptors to reduce eating but
these medications cause withdrawal effects, right? Because that's the point of the opioid
antagonists. Who would want to take a drug every day that makes you feel a little nauseated?
Going to stick with that? No, not so much. So, rather than use opioid antagonists as a treatment method
what we're looking at is how to use them to identify people in need of a different
kind of treatment than traditional diet and exercise programs for losing weight.
I just want to leave you with this idea, our endogenous opioid systems determine
a lot of our behavior. We do things because they feel good and we don't do other things because
they don't feel good and our opioid systems are what are mediating our experiences. Everyone in
this room has an endogenous opioid system. We shouldn't discount this powerful system and
think of our behavior as solely a product of our willpower because it's not. There are behavioral,
that is non-drug interventions for addictive-like behaviors, and they work.
We at the Osher Center tend to study a good deal of mindfulness training methods, like mindful
eating, mindfulness-based stress reduction, but Randomized Controlled Trials, or RCTS, have also
shown that motivational interviewing, different types of cognitive and behavioral therapies, they
can also reduce addiction symptoms. But that all said the field of food addiction is fast growing.
We're fortunate to be here today with some people to learn from the front lines
and there's way more to it than what I presented but I just wanted to communicate
to you this is a very powerful system in the brain and we should be paying attention.