CASA probes complexities of symptoms indicating possible food addiction

The National Center on Addiction and Substance Abuse's (CASA's) first foray into subject matter beyond alcohol and drug addiction addresses the eating-related symptoms that resemble patterns in substance addiction, while emphasizing that food addiction officially remains an unrecognized disorder.

CASA on Feb. 1 announced the release of the report Understanding and Addressing Food Addiction: A Science-Based Approach to Policy, Practice and Research. Prepared under the direction of CASA's director of policy research and analysis, and informed by comments from several field experts, the report issues a number of recommendations, including routine healthcare screening for symptoms that could indicate food addiction.

Some of the report's suggestions regarding reducing the accessibility of addictive food components, such as through financial rewards or penalties to food manufacturers in order to encourage development of healthier foods, resemble lofty objectives to say the least.

Mark S. Gold, MD, who chairs the scientific advisory boards for RiverMend Health and was one of the experts offering his commentary to CASA on drafts of the report, tells Addiction Professional, “We have made great progress over the past four decades of work in thinking about and defining the overlap between overeating and addictions. This report summarizes the progress and is a call to action.”

CASA cited its new research and policy collaboration with Yale University as a factor in its expanded focus into behavioral addictions.

Greater understanding

The report points out that authors of the Diagnostic and Statistical Manual of Mental Disorders have considered but have not approved inclusion of food addiction as a listed disorder. In addition, the report emphasizes that not all overweight persons present with patterns that resemble an addiction, and not all individuals who exhibit addictive patterns are overweight or obese. Yet they add that research has documented strong cravings and patterns of compulsive use that resemble those seen in persone with substance addictions.

In addition, the report stresses that the availability of the validated Yale Food Addiction Scale (YFAS) has given the field an instrument with which to screen for symptoms, including in young people. The YFAS requires the presence of at least three of its key symptoms, along with clinically significant impairment or distress within the past year, for meeting its criteria for food addiction. The symptoms mirror criteria for substance addiction and include persistent desire or repeated unsuccessful attempts to quit; continued use despite knowledge of adverse consequences; and characteristic withdrawal symptoms.

All of this is complicated, of course, by the simple fact that individuals cannot abstain from eating in the way they could from alcohol or illegal drug use, although they can steer away from the addictive properties of the sugar, salt and fat found in high quantities in many readily available processed foods.

The report states that while research remains limited on the specific factors that exacerbate risk for developing a food addiction, risk factors for obesity and for eating disorders such as binge eating disorder can shed light on the individual and environmental characteristics that could contribute to food addiction. The report discusses the complexities of the dopamine and endogenous opioid systems, both of which are implicated in the addictive disorders that food addiction resembles.

The report's recommendations emphasize preventive strategies, stating, “Using tobacco control and, to some extent, alcohol prevention as a model, much can be done to change the landscape of eating in this country.” Target groups for preventive messages should include expectant or new parents, children, educators and health professionals, the authors state.

Further research

Near the conclusion of the report appears a call for greater inquiry into relatively untapped areas of research, including the validity of the food addiction construct, reliable diagnostic criteria for food addiction, and risk and protective factors.

Gold, retired professor and chair of psychiatry at the University of Florida College of Medicine, saw his career in addiction research begin in memory research and then explore opiate and stimulant addictions before focusing on food issues in recent years. He says he sees “new hope for medical and psychological treatments based on treatments we normally associate with addiction therapy and treatment programs. Many of the pharmacological treatments recently approved for overeating and obesity are combinations of addiction treatments.”