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"Addiction" versus "Dependence"

RobD520RobD520 Posts: 420Member Member Posts: 420Member Member
I often see someone post that he or she is addicted to a food. When this happens, someone invariably responds with something like ________ addiction is "not a thing." (I suppose sugar is the most common example.)

When this happens, the person responding is confounding two related but different clinical concepts.

ADDICTION occurs when someone carves something so strongly that they consume the substance, or repeat the behavior, even when that substance or behavior is doing substantial harm. Note that the craving alone does not suggest an addiction. It is the inability to fight off this craving even though satisfying the craving causes damage.

Physical DEPENDENCE occurs when someone would experience withdrawal symptoms when stopping the substance. (In many cases, the user will also build tolerance over time, and need more of the substance to be satisfied._ In the case of drug dependence, withdrawal can even be life threatening. In other situations, such as caffeine, for example, withdrawal may mean a couple days of headaches.

A person can, of course, be addicted AND dependent. Drug addiction often falls into this category. But a person can be addicted and NOT dependent. There is, for example, extensive psychiatric literature on the treatment of gambling addiction. Obviously, physical dependence does not play a role here.

Dependence can occur without an addiction. I know many people who consumer caffeine daily in moderation who would get mild withdrawal headaches if they were to stop. Nevertheless, their pattern of use does not suggest they are doing themselves harm, so there is no addiction present.

So when someone says they are addicted to food, I am disinclined to immediately correct them. When people post this, they are not usually asking for their definitions to be corrected. They are usually seeking strategies to avoid overindulging.
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Replies

  • msemotanmsemotan Posts: 23Member Member Posts: 23Member Member
    HI! I liked your post as I am someone who just posted with a title about sugar addiction. It was more meant to just be a silly illustration about how I feel (taken pretty seriously by a lot of people, I wish I would not have titled it that), but you are right to say I was looking for some help and encouragement about strategies to avoid overindulgence. Sometimes you just get a little off track for the short term and are trying to get back to the healthy lifestyle you have been working at.

    I "know" the right thing to do but you need some people to help influence and encourage you. For me, being healthy is a big mental game. That is one thing I love about MyFitnessPal. It is a tool to connect with people and help you keep accountable to your health and fitness goals. Sweets are always something I have struggled with and I think those who don't have those kind of specific food related struggles have trouble understanding where you are coming from. In no way am I a person who thinks anything about my decisions "are not my fault"... but I do often think of sugar is the devil for me personally as it tempts me. Sometimes I do not do well regarding eating and feel defeated by the choices I have made, but I know they are my choices and I can change them. This encourages me to think that changing my thoughts on this (e.g. thinking of sugar as the devil at times, not all the time) it will help me to be stronger in the face of temptation. Something to work on.

    I did think the definitions you gave were a good read. What I am not sure is if you are saying it is possible to have a food addiction or dependence? RobD, I would be interested to hear what you think. I have never read much about it, but know a lot of people who experience something similar to your definition of addiction to food.

  • msemotanmsemotan Posts: 23Member Member Posts: 23Member Member
    Clarification to my question, RobD. I think your post stays people become food dependent but not food addicted. Am I reading it right?
  • RobD520RobD520 Posts: 420Member Member Posts: 420Member Member
    @msemotan given that addictions can be entirely behavioral/psychological, I do believe food addictions occur. In other words, people do having cravings that are so strong that they engage in eating behaviors that badly endanger their health.

    Outside of foods with substances such as caffeine in them, based upon what I have read, I am skeptical that any one has physical dependence on food.

    It is important to note that the presence of an "addiction" DOES NOT mean that the individual has no responsibility for their situation.
  • RobD520RobD520 Posts: 420Member Member Posts: 420Member Member
    msemotan wrote: »
    Clarification to my question, RobD. I think your post stays people become food dependent but not food addicted. Am I reading it right?

    In my opinion, it is likely the very opposite.
  • lemurcat12lemurcat12 Posts: 30,886Member Member Posts: 30,886Member Member
    There have been a number of pieces on this topic lately due to Prince's death. Here are a couple:

    http://www.slate.com/articles/health_and_science/medical_examiner/2016/05/prince_s_death_reveals_we_have_no_idea_what_addiction_really_means.html

    http://www.patheos.com/blogs/ellenpainterdollar/2016/05/prince-chronic-pain-opioids-why-dependence-is-not-a-pathology/

    I liked the Slate one in particular, and thought this was relevant:
    In contrast with physical dependence, however, a definition of addiction is harder to reach. Neuroscientists call it a brain disease. Others think it is simply a choice or a moral failing. I prefer to say that addiction is a behavioral state of compulsive and uncontrollable drug craving and seeking. Many of those treated for chronic pain will not become physically dependent. And even in those who do develop dependence, only a small fraction will become addicted, and even a smaller number will overdose. It would be cavalier to suggest that physical dependence upon an opiate is an entirely benign condition; we would best avoid it. But we should also avoid the notion that treating chronic pain creates “addicts.” Sufferers of chronic pain are not compulsively craving and seeking drugs. They are looking for relief from their pain.

    My problem with the use of "addiction" on MFP in connection with a trigger food, like ice cream or sugary sweets in general, is that people typically do make claims about dependence (more addictive than heroin is intended to include such a claim, no question), AND because even in light of the unsatisfying definitions of addiction it is still wrong. As I understand it, an addiction really screws up your life (and I don't think being overweight when you don't want to be is the same thing, sorry) and basically replaces the things that really should matter. To define this down as "constantly craving and seeking" = "I love cookies so want to eat more than I should, and feel a little out of control about it" I DO think is offensive or at least way missing the point of why addictions are so horrible (and for the people around the addict just as much) -- in a true addiction the subject of the addiction replaces all that should matter the most such that the person is increasingly narrowly focused on that, above all else.

    I think it's to the credit of the people here who struggle with food that they don't behave like addicts -- they may love their cookies and feel out of control somewhat, but they'd never put sweets over close relationships, a job, everything else that should matter. There's no danger that they will eventually get to the point where nothing else matters but the addiction.

    There are, indeed, some exceptions, which is why I believe that eating addiction is a thing. But to suggest there's any comparison with an addiction that takes over and ruins a life (and often the lives of others around them) and misusing or feeling out of control of eating habits (which I have also experienced) just makes me shake my head. I don't bother fighting it anymore, insensitive as I think it is, but I think it's way missing the point of what makes an addiction a terrible thing.

    And in saying this I am not at all claiming addicts are less responsible for themselves, less to blame, better, whatever. Quite the opposite -- I think a real addiction tends to make someone an awful person. That was true for me, for sure, and for the various other addicts I've known, including many close family members. A weakness for certain food items or failure to control eating habits on the other hand, no.
  • lemurcat12lemurcat12 Posts: 30,886Member Member Posts: 30,886Member Member
    RobD520 wrote: »
    So when someone says they are addicted to food, I am disinclined to immediately correct them. When people post this, they are not usually asking for their definitions to be corrected. They are usually seeking strategies to avoid overindulging.

    This, I agree with, and I also think (unfortunately) that more often that not the self-definition comes less from them as from the idiocy on the internet telling everyone who enjoys sweets that they must be addicted to sugar, and -- to a lesser extent -- even people who like cheese it's an addiction or perhaps even protein (there's a book "Proteinholic", after all).

    I will (and feel obligated to by conscience vs. seeming to go along with something I disagree with) say upfront that I don't believe addiction is really the correct word, but personally I don't think those threads are the right place for a discussion of the term so I quickly acknowledge the feeling out of control, ask helpful (IMO) questions about the specifics, and talk about my experience with the same sort of thing and what helped me.

    Unfortunately, someone else not the OP almost invariably jumps in, takes issue with my expression of opinion, and insists that sugar is exactly like heroin or cocaine, but worse -- thereby starting the argument that people say should not happen in those threads. (I now will direct them to a thread here when that happens.)
  • msemotanmsemotan Posts: 23Member Member Posts: 23Member Member
    Lemurcat, thank you for your post. I did not realize I was being insensitive and appreciate you pointing it out. Sometimes we don't realize how the things we say impact people, but if no one ever points it out, we keep doing it. I apologize for the flippant use of the term, and will be more considerate in future posts.
  • lemurcat12lemurcat12 Posts: 30,886Member Member Posts: 30,886Member Member
    msemotan wrote: »
    I did think the definitions you gave were a good read. What I am not sure is if you are saying it is possible to have a food addiction or dependence?

    Not RobD, but we are all dependent on food, so talking about a food dependence in a general sense doesn't really work. The ultimate withdrawal is starvation, after all -- it's not that our body gets hooked so that we suffer when we go off it, but that as an essential part of our nature we need food to live.

    When it comes to specific foods, no, I don't think there's a dependence, and it's illustrative, I believe, that when people claim "addiction" they usually single out specific foods and not others that are in essence (in terms of macros, ingredients) just the same. That shows it's about liking, not anything physical.

    I discussed above why I don't think addiction is typically the right word (although I won't jump on anyone for using it, even though the desire that some have to claim the term puzzles me and I do think it's often a misunderstanding or desire to deny responsibility -- which I don't actually think addiction gives you, being an addict doesn't mean indulging is not your fault/responsibility, after all). I do think feeling out of control around food (specific foods, usually) or eating behaviors is common, and I have experienced it myself. I think habit is the major driver there.

    Eating addiction seems to me to exist, but to be pretty rare.
  • lemurcat12lemurcat12 Posts: 30,886Member Member Posts: 30,886Member Member
    RobD520 wrote: »
    So when someone says they are addicted to food, I am disinclined to immediately correct them.

    If addiction means craving something so strongly that you willingly harm yourself to get it, and obesity is harmful, and caused by overeating ... maybe some of these people are correct to begin with.

    The problem with this is that bad eating behaviors are easily and fully explained (in most cases) by a combination of habit and people being horrible at weighing consequences when those consequences are long-term vs. short-term. If eating one cookie (or having one bad eating day) directly caused serious negative consequences and people still did it, that would be one thing, but I bet given a choice between a "cheat" day and heart disease or a "cheat" day and their job, virtually none of the self-proclaimed sugar addicts on MFP would choose the "cheat" day (those suffering from BED may be an exception, but I think BED is a separate thing).

    The issue with weight is that one cookie or even a box doesn't seem to make much difference in the long run. It's always easy to think "well, I'll start tomorrow," because the benefits of losing weight seem so far away and non concrete and many don't even believe that the sacrifice will achieve them.

    This is why I think an important "motivation" for weight loss is to really address this, make it concrete, realize what you are choosing between in 3 months and 6 months and a year, but that's often hard for people.

    It's often hard in other areas too, in which we don't insist it must be an addiction. For example, many people choose not to focus on school work or their job as much as they should vs. shorter term pleasures, despite the fact that they suffer negative consequences. The consequences are too remote and the benefit of the sacrifice seems too uncertain. It's basically the same with food. Add to that bad habits, and it's really the most understandable thing in the world, no need to claim it must be addiction.
    edited May 2016
  • chocolate_owlchocolate_owl Posts: 1,431Member Member Posts: 1,431Member Member
    @msemotan I think a lot of people who start threads like that do so with the same intent as you - trying to be silly/funny /witty/generally make light of the situation while reaching out for strategies on how to limit their sugar consumption. I don't think most people truly believe they are addicted, though some definitely do, and the ones that do are the reason why "addiction" here is problematic. It downplays real addictions while perpetuating the notion of sugar as bad, always, regardless of context. No one jumped all over the guy who said he was addicted to deadlifts yesterday because there's not a myth floating around that deadlifts are addictive and life-ruining. However, plenty of people have bought into this idea that sugar is addictive and toxic and can't be consumed at all, even though moderation is the route to success for most.

    I think lemurcat's approach to these threads is sensible and hard to interpret as hostile or discouraging. If the goal is to educate people and help them gain self-control and responsibility, this is a good way to go about it.
  • RobD520RobD520 Posts: 420Member Member Posts: 420Member Member
    Carlos_421 wrote: »
    @lemurcat12 hit on a valid point. There's a biiiiiiiig difference between "I'm craving these cookies so much that I'm going to eat them even though they will make me fat" and "I'm craving cookies so badly that I'm willing to steal from family members, abandon relationships and sell my body for a hit of tollhouse."

    I woul argue that the 600 pound person who persists in overeating despite being bedridden fits your definition. In extreme examples, people have devistated their families.

    But the degree of damage you describe is NOT required for something to be a clinical addiction.
  • lemurcat12lemurcat12 Posts: 30,886Member Member Posts: 30,886Member Member
    @msemotan I think a lot of people who start threads like that do so with the same intent as you - trying to be silly/funny /witty/generally make light of the situation while reaching out for strategies on how to limit their sugar consumption.

    Yeah, I agree with this, and don't want to seem like some humorless word police. When this is the intent I don't usually say anything and just give strategies, since I know what the person means and I understand the non-serious use of the term or the frustration being expressed.

    What bugs me (although I try to not argue, just disagree) are things where it's clear the direct comparison is intended or, especially, where it's asserted it's just like heroin (or whatever) or often "even worse than any other addiction, since you can't stop eating food." Yeah, it's just not.
  • lemurcat12lemurcat12 Posts: 30,886Member Member Posts: 30,886Member Member
    100df wrote: »
    Carlos_421 wrote: »
    Generally, from what I've experienced here on MFP, when people say "I'm addicted to sugar" they are really saying two things:
    1) It's not my fault I'm fat
    2) Sugar is the devil

    Sugar addiction is not a thing.

    I disagree.

    If an addiction thread is able to continue without the "yes it is, not it isn't" stuff, there's great insights and strategies to help people. No one says they are giving up and using the addiction to stay obese or overweight. It is inaccurate to say that the people that want to talk about addictions related to food should be in the category of "its not my fault I am fat".

    Sugar can be very harmful to some people. Sugar can be the main ingredient in foods that they overeat. Overeating those foods are why some people are obese and morbidly obese. Obese and morbidly obese is usually harmful to people.

    I would say that excess sugar can be very harmful. Agree with the rest, although that doesn't make sugar unique. I mostly overate savory foods, and doing that was why I was obese.

    The question is what this has to do with what Carlos said. It doesn't seem to bear on the "addiction" issue.
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