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Making the case for food as a substance of abuse.

Eating Disorders, Overeating, and Pathological Attachment to Food: Independent or Addictive Disorders?

Mark S. Gold, M.D. (ed.)

Haworth Medical Press, Binghamton, N.Y. (800-429-6784), 2004.

ISBN: 0-78902-600-7. Paperback, 122 pages. $19.95

More than 10 years ago at an American Society of Addiction Medicine (ASAM) symposium, Mark Gold presented his hypothesis that a loss of control over eating that results in obesity may be another form of addictive behavior. While his presentation was persuasive, few research studies had looked at food as a substance of abuse, and more data were needed to convince the critics.

Gold was asked to revisit the topic at an ASAM symposium in 2003. By then, the Decade of the Brain had produced far more hard evidence.

"Today, there is a convincing convergence of evidence from neuroscience including PET and fMRI imaging and clinical experience that support the hypothesis that there are important similarities between overeating energy-dense, highly palatable and hedonic foods and the classic addictions," Gold said at that symposium. Those similarities include preoccupation, narrowing of interests, craving, continued use/behaviors despite adverse consequences, loss of control, and relapse or failed attempts to cut down.

This volume that Gold has edited--thin but densely packed--presents a compelling case for including overeating and obesity in the Diagnostic and Statistical Manual of Mental Disorders (DSM) by considering food as a substance in substance use disorders.

Gold poses the question, "If drugs of abuse hijack the brain, as has been suggested, where does this occur?" He writes that this hijacking certainly doesn't take place through the existing pathways for sex or water, adding that food reward is a prime target.

He goes on to note that tobacco causes weight loss, as do cocaine, amphetamine, MDMA (Ecstasy) and long-term opiate abuse. So we know that drugs of abuse have a powerful effect on eating. In this book, Gold means to show the relationships between eating messengers and targets for drugs of abuse and the possible connections.

In the book's seven chapters, basic researchers present their best evidence for Gold's hypothesis. The first chapter explores pathways in the brain that regulate appetite and craving, and examines the possibility that cellular and molecular events that underlie the appetite drive in response to the body's need to replenish its energy stores are akin to a drug craving during withdrawal.


The second chapter looks at the interaction between central satiety signals and reward responses to food stimuli. Here, Gold and colleagues from the University of Florida College of Medicine point out that because we are all physiologically dependent on food for survival, it can be argued that everyone suffers from tolerance and withdrawal--two of three specifiers necessary for a diagnosis of substance dependence. However, they say, when the criteria for physiological dependence are disregarded, food adequately fits the model for substance dependence: greater consumption of the substance than planned, failed attempts to cut back on consumption, etc.

The book goes into a great deal of detail about neurofunctional imaging and chemical activity in the brain. Much of it may be difficult reading for those not comfortable with heavy medical terminology. Chapters on adolescent drug treatment and weight gain, problem drinking and eating disorders, genetics, and socio-cultural contributions to the problem are easier to read.

However, for anyone interested in overeating as an addictive behavior, the sometimes difficult trek through these chapters will be worth the trip.

Gold is chief of the Division of Addiction Medicine at the McKnight Brain Institute at the University of Florida. This book was co-published as the Journal of Addictive Diseases (Vol. 23, No.3, 2004), by the Haworth Medical Press.
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Author:Jackim, Linda Watts
Publication:Addiction Professional
Article Type:Book Review
Geographic Code:1USA
Date:Mar 1, 2005
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