The term “chocoholic,” usually said with a smile, actually nods to a potentially serious question: can a person become addicted to food? There are three essential components of addiction: intense craving, loss of control over the object of that craving, and continued use or engagement despite bad consequences. People can exhibit all three of these in their relationships with food. It’s most common with foods that deliver a lot of sugar and fat — like chocolate — because they trigger reward pathways in the brain. In some animal studies, restricting these foods induced a stress-like response consistent with the “withdrawal” response seen in addiction. Much of the scientific discussion about food addiction has been sparked by the epidemic of obesity sweeping the U.S. and many other countries. Many people who are overweight crave food, lose control over eating, and experience negative health effects that should, but don’t, serve as a deterrent. The influence of stress on eating provides another link between food and addictive behavior.
It’s easy to think of doctors as paragons of the health and wellness they try to restore in their patients or help them maintain. Some are, and some definitely aren’t. One in 10 physicians develop problems with alcohol or drugs at some point during their careers. Those who admit they have an addiction to alcohol or drugs, as well as those who slip up and get reported, usually have to go through an intense substance abuse program before they can practice medicine again. Such physician health programs are pretty effective, helping around 80% of doctors recover from their problems. But these programs raise some ethical questions, according to Harvard Medical School’s J. Wesley Boyd and John R. Knight, who wrote a review of physician health programs in the Journal of Addiction Medicine. They should know, having spent a total of 20-plus years as associate directors physician health programs.
Why is it so incredibly hard to quit smoking—even when you are desperate to do so? For some people, the answer may be in their genes. In a report published online in the American Journal of Psychiatry, a team led by Dr Li-Shiun Chen of the Washington University School of Medicine identified a “high risk” version of a nicotine receptor gene that is more common in heavy smokers. Those with the high-risk gene took two years longer to quit smoking. But there was a silver lining: smokers with the high-risk gene were three times more likely to respond to smoking cessation therapies. The study provides hope for even hardcore smokers. However long it takes, quitting is beneficial. In a study published in the Archives of Internal Medicine, quitting smoking reduced the risk of dying—even in people in their 80s. “Even older people who smoked for a lifetime without negative health consequences should be encouraged and supported to quit,” the researchers wrote.
For people who are obese, the operation known as gastric bypass surgery has been hailed as something of a miracle. In addition to rapid weight loss, it can reverse diabetes and reduce the risk of heart disease. A new study reveals potential darker side—an increase in alcohol abuse. In a presentation at yesterday’s annual meeting of the American Society for Metabolic and Bariatric Surgery, researchers reported that almost 11% of nearly 2,000 men and women who underwent gastric bypass surgery (the most common type of obesity surgery) got in trouble with drinking by the second year after surgery. About 7% drank too much before the operation, representing a 50% increase. This finding shouldn’t steer people who could benefit from gastric bypass surgery away from the procedure. But it should prompt them—and their doctors—to be on the lookout for changes in alcohol use or abuse afterward.
Drinking in the workplace may be an emerging trend, but it isn’t necessarily a healthy one. Although drinking on the job may not be as widespread as portrayed on the hit TV show Mad Men, it is still with us. About 8% of full-time employees report having five or more drinks on five or more occasions a month, and one survey showed that 23% of upper-level managers reported drinking during work hours in the prior month. In the United States, excessive drinking costs $223 billion a year. Some of these costs are generated by the nearly 18 million Americans who are alcoholics or have alcohol-related problems. But some also comes from a nearly invisible group, “almost alcoholics.”
It’s hard for someone who has never battled an addiction to understand how or why a person can’t break free of one. An exchange on the radio about pop star Whitney Houston’s addictions underscores the misconceptions many people have about addiction. Addictions retrain the brain in a way that couples liking something with wanting it. There are important gender differences in addiction. Although men are more likely than women to become addicted to drugs or harmful behaviors, women who have an addiction face tougher challenges.
We tend to think that stopping an addictive behavior means joining a group, seeing a therapist, going to a treatment center, or taking a medication that helps with cravings. Some people manage to break an addiction without any help. These “natural recoverers” tend to take two key steps: They find a new hobby, challenge, or relationship to help fill the void left by the addiction. And they start exercising. Exercise is important because it acts as a natural antidepressant. It also prompts the body to release its own psychoactive substances—endorphins—that trigger the brain’s reward pathway and promote a feeling of well-being. Natural recovery isn’t a sure thing, and the more severe the addiction, the harder it is to do.
Eating disorders don’t afflict only adolescents and young women, but plague older women, too, and may be shrouded in even greater shame and secrecy. Many women don’t seek help, especially if they fear being forced to gain weight or stigmatized as having a “teenager’s disease.” As reported in the February 2012 Harvard Women’s Health Watch, clinicians are reporting an upswing in requests from older women for help with eating disorders. For some of these women, the problem is new; others have struggled with anorexia, bulimia, binge eating, or another eating disorder for decades. Eating problems at midlife and beyond stem from a variety of causes, ranging from grief and divorce to illness, shifting priorities, and heightened awareness of an aging body.
Many people have trouble quitting smoking even after learning they have cancer, according to a new study from Harvard-affiliated Massachusetts General Hospital. Five months after learning they had cancer, just over one-third (37%) of smokers diagnosed with lung cancer and two-thirds (66%) of those with colorectal cancer were still smoking. The results underscore how difficult it can be to quit smoking. A diagnosis of cancer can be a powerful motivator, but it isn’t always enough—extra help is often needed to quit. Kicking a smoking habit is good for health anytime. It is even more important after a diagnosis of cancer.
With Veterans Day and Halloween behind us, we are moving full steam ahead to the holidays, the stretch from Thanksgiving to New Year’s Day (or Super Bowl Sunday, depending on your perspective). The holidays can be a wonderful time, full of friends, family, and fun. But they can also generate pressures and situations that undermine health. To help you enjoy a healthy and happy holiday season, Harvard Health Publications is offering three Special Health Reports that focus on common holiday challenges: depression, overuse of alcohol, and healthy eating.