Beyond the Primal Addiction

Food, Sex, Gambling, Internet, Shopping, and Work

Nina Savelle-Rocklin, Salman Akhtar, Nina Savelle-Rocklin, Salman Akhtar

• Publisher: Routledge
• Year: 2019
• ISBN:
  9780429619953
• Edition: 1
• Topic: Psychology
• Subtopic: Psychoanalysis
• Index: Psychology

Written by experienced practitioners in the fields of addiction and psychoanalysis, and illustrated by a range of moving vignettes, this groundbreaking book examines the psychological foundations of addiction in the areas of food, sex, gambling, internet usage, shopping, and work.

This book not only explores the roots of addictive behavior, explaining why popular treatment options such as the 12-Step Program often fail, it also provides insights for emotional resolution and strategies for behavioral change.

Beyond the Primal Addiction seeks to understand rather than pathologize addictive behaviours, now so pervasive in contemporary societies. It will be essential reading for psychoanalysts, psychotherapists, and other mental health professionals, as well as their clients.

Six syndromes

Chapter 2
Food addiction

Nina Savelle-Rocklin

People who binge or relentlessly overeat often believe that food is the problem. They describe themselves as “chocoholics” or “foodaholics” and fear they will always struggle with what they call an “addiction” to food. Many report that they never consume sugar or white flour. They think the only way to stay “clean” (as they put it) is to avoid all problematic or forbidden foods. Inevitably, they binge or overeat, experiencing intense feelings of shame and labeling themselves as hopeless addicts.

Yet, is food addiction a valid concept? In the last few years, there has been a great deal of media coverage of this topic. Last year, I posted in a public Face-book group that with respect to binge-eating, psychological triggers are far more influential than the food itself. One reader took offense, writing that it was “a proven fact” that sugar is as addictive as heroin. This person is not alone in her hyperbolic assertion that sugar and heroin are equivalent. Lately it seems that the notion of food addiction, especially sugar addiction, is accepted by the general public as scientifically factual, as is the idea of “detoxing” from sugar. This notion of detoxification is also false, since any food eaten, even pure protein sources, can be turned into sugar in the body through the process of gluconeo-genesis, a metabolic pathway that results in glucose being generated from non-carbohydrate foods.

The premise of a recent bestseller (Taubes, 2016) is that sugar is not only addictive, but is the principal cause of obesity, diabetes, coronary heart disease, and many other fatal diseases. This book and others (Jacoby and Baldelomar, 2016; Zinczenko and Perrine, 2016) assert that sugar is poisoning us, making us obese and unhealthy. Studies from the fields of neurology and obesity research have come to divergent conclusions. Some researchers (Spring et al., 2008; Avena et al., 2008; Corsica and Pelchat, 2010) believe that food may be considered addictive. These studies make a case for the reward theory of food addiction (Gearhardt et al., 2009; Volkow et al., 2013) correlating specific foods with increased dopamine levels. Dopamine is the chemical that mediates pleasure and motivation in our brains. The basic theory of food addiction is that sugar and other foods activate the release of dopamine. People eat sugar, get a dopamine rush and feel good, and then have to eat increasing amounts to get the same experience they previously felt with less. Food addiction theory points to these changes in the brain, specifically higher levels of dopamine, as evidence of addiction.

A plethora of other studies, though, refute these claims (Albayrak et al., 2012; Ziauddeen et al., 2012; Ziauddeen and Fletcher 2013; Pressman et al., 2015; West-water et al., 2016), deducing that there is little evidence to support the idea of any food as physiologically addictive, including sugar, which is the substance most often labeled as addictive. Nutrition researcher and neurobiologist, Stephan Guyenet (2017), reminds us that diet and lifestyle factors such as excess calorie intake, physical inactivity, cigarette smoking, alcohol, and illegal drug use contribute to obesity and other noncommunicable diseases. He further notes that these diseases are not all correlated with sugar intake, and points out that sugar intake has actually been declining in the past two decades, the same period in which both obesity and diabetes rates have dramatically increased.

Sugar does change our brains, as do certain drugs. Spending time with friends, playing games, having sex, shopping, and any other pleasurable activity also raises the dopamine levels in our brains. One study proved that listening to classical music has the same impact on our brains as cocaine (Salimpoor, 2011). Our brains also react differently to sugar than to drugs like cocaine or heroin. In research studies with rodents who were given cocaine (Di Chiara, 2005; Avena et al., 2008) their dopamine levels surged but did not return to baseline. The rodents needed more and more of the drug to maintain the baseline dopamine levels. That is not what happens with sugar or any other hyper-palatable or so-called “addictive” foods. After ingesting sugar, dopamine levels surge, yet later return to a baseline level and stay consistent.

Also, the studies that confirm that rats show more addictive behavior for sugar than for drugs such as cocaine and heroin are misleading. Humans are motivated by psychology as well as biology, but rats are motivated by survival. Rats do not turn to food to soothe hurt feelings, to numb themselves or distract from the painful exigencies of life. Rats are primarily food-seeking, and sugar is food. Naturally, they choose sugar over drugs like heroin or cocaine. Benton (2009) examines the animal model of sugar addiction and finds it baseless, deducing that there is no support for the notion of sugar as addictive.

Margaret Westwater and her colleagues (2016) also find little evidence to support sugar addiction in humans. They suggest that “addiction-like behaviours, such as bingeing, occur only in the context of intermittent access to sugar. These behaviours likely arise from (intermittent access) to sweet tasting or highly palatable foods, not the neurochemical effects of sugar” (p. 1). Westwater also differentiates between sugar per se, on its own, and sugary foods, which usually contain fat. She makes the point that most people do not eat spoonsful of sugar, but rather have food that contains sugar. The researchers also note the difference between cravings for food and for drugs. “Food cravings are relatively short-lived and subside with fasting as opposed to drug cravings, which persist and do not lessen in intensity with abstinence” (p. 65).

Similarly, another study (Marcus et al., 2017) concludes,

Sugar does not seem to contribute to weight-gain more so than other sources of energy in the diet. Instead, the current scientific community nowadays seems to reach consensus that “food addiction” (and its role in weight gain) might be better explained by “eating dependence” as a result of the unique individual experience with food and eating (instead of being caused by a specific food).

(p. 70)

Of course, self-described food addicts do not always identify sugar as their “drug” of choice. In the same study that refuted sugar as an addictive substance, Markus and his colleagues identified the types of foods that are most commonly associated with addiction-like behavior. Their research showed that “high-fat savory” foods are more likely to trigger addiction-like behavior. In fact, only one person in 20 reported addiction-like behavior for “mainly sugar-containing” foods. People have cravings for various types of food, some craving chocolate and others pizza, and they may find it difficult to eat those foods in appropriate quantities, yet that does not constitute a physical addiction. There are other reasons for this inability to stop eating a particular food. There is also a link between dieting and binge-eating (Polivy and Herman, 1985; Polivy et al., 2005). When people rely on willpower, telling themselves they cannot or should not eat a particular food, they are more likely to binge on that food later. Sometimes this is because deprivation leads to wanting more of what they cannot have, and sometimes it is a means of managing anticipated future deprivation. Many patients have said something along the lines of, “I’m going to eat this whole pizza, because after this I won’t be able to eat pizza for months.” Additionally, there is a link between the anticipation of dieting and binge-eating (Urbszat et al., 2002). The anticipation of deprivation of specific foods, as well as the actual deprivation experienced through restriction or dieting, therefore leads to overeating or bingeing. This highlights the importance of unconscious psychological motivations with regard to bingeing.

Clinical vignette 1

Ruth, 45, considered herself a food addict. She felt discouraged by her lack of control over food at night. Single, never married, and relatively new to the Los Angeles area, she had not formed any meaningful friendships in the area. Nor was she dating, believing that nobody would be attracted to her at her current weight.

Ruth easily made healthy choices at breakfast and lunch. Only in the evening, when she was home by herself, did food become a problem. She described how in those dark hours, an emptiness came upon her, slowly expanding until it was an unbearable void. When we explored that internal void, she spoke of a childhood marked by desperate loneliness, and I had the sense of her being enveloped by forlornness. But Ruth was not interested in talking about the past. From her perspective, the problem was in the here-and-now. I suggested that it was not a matter of control; I believed that her relationship to food was expressing something that her mind could not process or tolerate. When she was alone at night, she felt the echoes of that childhood loneliness and emptiness. By stuffing herself until she was full, she symbolically filled that emotional void with food, unconsciously swapping emotional emptiness for a full stomach. Instead of feeling emotionally uncomfortable, she experienced only the physical sensation of discomfort.

Ruth had been focusing on what she was eating instead of identifying and processing what was eating “at” her. The problem was not food, but rather her intense emotional hunger. Ruth looked dazed at this notion. “So, I’m not a food addict?” She considered this and sighed in relief. “All this time I thought there was something wrong with my brain that made me eat.”

We are in the midst of a cultural zeitgeist that increasingly privileges biology over psychology, and this extends to research in binge-eating. One recent study (Kessler et al., 2016) finds that binge-eating disorder “may be related to maladaptation of the corticostriatal circuitry regulating motivation and impulse control similar to that found in other impulsive/compulsive disorders” (p. 223). I believe this view of disordered eating as a brain-based illness is myopic. Yes, we have brains, the organ that is the physical control structure of our bodies, but we also have minds, which refers to a range of mental processes. Our minds allow us to think, feel, imagine, believe, remember, and perceive, on both a conscious and unconscious level. Our brains do not operate alone, nor do our minds function independently of our brains. Research that focuses exclusively on the brain as the primary source of the behavior ignores the powerful influences of the unconscious mind, as well as the familial, social, cultural, and other influences that impact our brains. People turn to food for a reason – for comfort, to alleviate anxiety, to distract from painful or upsetting thoughts, to sleep, symbolically fill a void, or calm down. Eating is a way of managing difficult internal states. It’s the mind’s way of protecting itself.

Another reader who responded to my Facebook post about the importance of psychological motives related to binge-eating shared that she had initially joined the “sugar is like heroin” message, which she believed actually caused her to binge on sugar, further reinforcing the idea that she was an addict. Then she noticed that her children had no problem eating sugar, “sometimes in small amounts, sometimes larger, and sometimes they couldn’t care less about it, and I realized I was the exact same way when I didn’t try to restrict it. I cautiously began allowing myself to have it, and it hasn’t been a problem and I finally feel empowered around it, instead of like a scared victim” (Facebook post, personal communication, 2018). She further noted that when she started allowing herself pleasurable activities through the day, then, “bingo, sugar wasn’t a thought.”

This aligns with my clinical experience treating individuals who struggle with binge-eating. Most enter treatment believing themselves to be sugar addicts, unable to keep cookies, candy, ice cream, or anything with sugar in the house, lest they consume it all. By the time they leave therapy, they are able to eat sugary foods in moderation, often without giving it another thought. Their brains have not changed, but their minds have undergone a structural transformation. Of course, the science makes little difference to patients who experience intense powerlessness and helplessness over their eating, and are preoccupied with food, often to the point of obsession. They eliminate what they consider forbidden foods, only to end up bingeing and feeling terrible. As one patient put it, “I may not be addicted to food but I sure feel like an addict.”

When it comes to eating issues, food actually serves as a temporary solution to the problem. Only by decoding the symbolism of eating and identifying the underlying conflict or deficit that is leading to the behavior, can permanent change be created. From this vantage point, the psychoanalytic perspective can be helpful and transformative.

An historical perspective of addictions

Early psychoanalytic theory offered what Khantzian (1995) deemed a “collective unempathic if not pejorative view of addicts” (p. 17. Classical theory viewed addicts as driven solely by pleasure, linking addiction with the gratification of frustrated drives (Glover, 1932; Radó, 1933). Problems in the early oral stages of development, which roughly corresponds to the first year of life, were seen as inhibiting the ability of addicts to deal with frustration. Glover (1932) noted that drug addiction serves defensive functions, such as “to control sadistic charges, which, though less violent than those associated with paranoia, are more severe than the sadistic charges met with in obsessional formations” (p. 315) and to protect against psychotic reactions during times of regression. Around the same time, Radó (1933) writes that, “not the toxic agent, but the impulse to use it, makes an addict of a given individual” (p. 2). In his earlier writings, Radó (1926) views addicts as having poor frustration tolerance, which leads them to drugs and alcohol as a way of re-experiencing what he called the “alimentary orgasm” (p. 408) and avoiding depression. This “alimentary orgasm” refers to a general feeling of well-being throughout the body, an experience that originates at the mother’s breast, since feeding is bound up with a blissful sense of security and warmth. Radio suggests that ingestion of narcotics recapitulates this experience, which addicts prefer to give to themselves by taking drugs rather than depending on another person.

By the mid-century, the psychoanalytic view of addiction had evolved to include broader, less pathologizing perspectives. Addicts were no longer viewed from a drive theory perspective of being pleasure seeking. Instead, they turned to drugs and alcohol as a means of self-regulation, whether to manage painful affects, including aggression (Khantzian, 1974) and anxiety (Goldstein, 1972). Krystal and Raskin (1970) posit that addicts use drugs as object substitutes. Thus, by the 1970s, drug addiction was commonly seen either as a defensive strategy to deal with painful affects or a way of compensating for internal conflicts or self-esteem issues. Wurmser (1974) considers all habitual drug use an attempt at self-treatment. In speaking of the addict, he states, “The importance of the effect of the drug in the inner life of these patients can perhaps be best explained as an artificial or surrogate defense against overwhelming affects (original italics)” (p. 829). Similarly, Khantzian (2003) proposes that taking drugs is a means of self-medicating, viewing addiction as a way of soothing painful and upsetting psychological states. He proposes that substance users experience dysphoric emotions as intolerable and overwhelming, and that they cannot manage these emotional states on their own, using drugs to calm themselves. Interestingly, in writing about the nature of addiction, Kohut (1978) compares it to the digestive process. He writes:

It is as if a person with a wide-open gastric fistula were trying to still his hunger through eating. He may obtain pleasurable taste sensations by his frantic ingestion of food, but, since the food does not enter the part of the digestive system that absorbs it into the organism, he continues to starve.

(pp. 846–847)

The latter twentieth century brought an innovative idea about addiction proposed by Dodes (1990, 1995, 1996, 2002, 2003), who suggests that all addictions are motivated by the state of helplessness and powerlessness. He says that addictive behavior represents a displaced way of dealing with helplessness, as well as a means of expressing the anger engendered by that state of helplessness. He concludes that all addictions have the characteristics of compulsions. Dodes states:

Rather than being a reflection of impulsivity or self-destructiveness, or a result of genetic or physical factors, addiction can be shown to be a psychological mechanism that is a subset of psychological compulsions in general. Addictive urges are never random, and when one understands the emotional factors that produce them, addiction can be mastered.

(personal communication, Dodes, May 21, 2017)

Helplessness is an experience that most people find unbearable, as it is associated with vulnerability and may also bring up conflicts about dependency. Dodes believes that helplessness triggers an addictive behavior as a way of reversing the helplessness. Whatever the behavior, whether it is drinking alcohol, taking drugs, gambling, working too much, or excessive shopping, or bingeing, that becomes what we call the addiction: alcoholism, drug addiction, gambling, workaholism, shopping addiction, food addiction.

Inherent in the state of helplessness is an unconscious rage at the very state of being helpless. Dodes (1995) describes how addiction is a response to the narcissistic rage that the state of helplessness produces. Whatever the form of addiction, it provides “a sense of internal emotional control” (p. 133) sufficient to temporarily give a sense of mastery over one’s helplessness. In a thorough explication of the analytic experience of helplessness, Hoffer and Buie (2016) point out that anger is an active state, whereas helplessness is passive. In my work with eating disorder patients, many of whom have binge-eating disorder, I have often been struck by the viciousness with which they attack themselves. Many become enraged with themselves for overeating, bingeing, or weighing too much, and castigate themselves in a notably vituperative manner. This can be understood as displaced anger to avoid the passivity of helplessness. Bingeing or any other addictive behavior is a way of undoing the passivity of helplessness, and the anger at one’s helpless state can also be turned against the self.

Food addiction

Specifically with respect to food, the notion of addiction was first described by Glover (1925) in his exploration of the oral character. He observes that gratification in the form of overeating is often followed by some sort of physical pain, implying that bingeing implicitly provides the pleasure of indulgence and simultaneously gives the pain of self-punishment. Glover notes, “In more extreme addictions, the punishment system is rarely based on injurious effects alone and the necessity...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• Acknowledgments
• About the editors and contributors
• Introduction
• Prologue
• Six syndromes
• Epilogue
• References
• Index