I also remember, years ago, the first time I entered an exam room and found the patient waiting for me tapping away furiously at a miniature keyboard with both thumbs. "My Crack-berry," he explained.
Is it appropriate or helpful to consider everything we eat/drink/do/watch/buy/use a lot an addiction?
(A separate question--one I addressed briefly in this review of a new book about drugs--is whether it's accurate to use "crack" as a synonym for "addictive").
In recent years, gambling, shopping, pornography, video games, Internet use, sex, and even relationships have joined drugs and alcohol as potentially addicting entities. Some feel we overuse the concept of addiction--that we have, in effect, become addicted to addiction. A new book by British journalist Damian Thompson called The Fix: How Addiction is Invading Our Lives and Taking Over Your World (excerpted here) argues that our brains are wired to seek pleasure and, in a world full of iPhones and giant gourmet cupcakes there's more pleasure readily available to more people than ever. In other words, we are all capable of addiction, given unlimited access to the stuff that turns us on.
In medicine, the question of whether we should call certain behaviors "addictive" is more than semantic. Addiction implies pathology, which cuts both ways: it can stigmatize the person labeled an addict, but may also encourage researchers and insurance companies to treat his or her behavior as an illness.
A recent study conducted at Boston Children's Hospital, nicely summarized here, showed that obese men who drank milkshakes containing rapidly digestible (high glycemic) carbohydrates, such as those found in processed sweet and starchy foods, demonstrated brain activity similar to that seen in addiction--and these kinds of carbs triggered cravings and overeating. Men who drank similar tasting milkshakes with slowly digested (low glycemic) carbs, such as those found in whole grains, fruits, and vegetables, did not exhibit this activity.
Though small, this study suggests that certain carbohydrates may be addictive and that obesity is, at least in part, a consequence of addiction. The study, coincidentally, appeared at about the same time as the AMA announced its decision to begin considering obesity a disease.
One misconception, I think, is that calling a person's behavior an addiction somehow brands that person as a victim who's not responsible for his or her behavior. In 2011, the American Society of Addiction Medicine revised its definition of addiction to include not only behavior, but brain dysfunction.
This definition recognizes the neuro-psychiatric roots of addictive behavior, but it doesn't give addicts a free pass. After all, the implication of the Children's study about high glycemic carbs and overeating is that many of us may have to address our "addiction" by avoiding the sweet, starchy foods we crave--and especially with Twinkies coming back on the market next week, that will be anything but easy.
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