The final body of evidence supporting the reality of food addiction comes from work with alcohol and other substance abusers. Studies have shown that that those who are addicted to alcohol and drugs are often helped in their recovery by abstaining both from alcohol/drugs and sugar. We actually have clear evidence that cross-addiction from alcohol and other drugs to specific foods is a significant problem in the recovery community.

We have known for a long time that many alcoholics in early treatment will gain weight—and some need to, given the ravages to their bodies many have experienced by forgoing nutritious eating in favor of a diet of almost exclusively nothing but alcohol.. It also is common knowledge that many members of Alcoholics Anonymous, while sober, use cigarettes, coffee and sugar/flour/fat products in abundance both in and out of meetings. All of these substances have similar, sometimes identical, biochemically addictive ingredients.

What is not as well known is that there exists a large subset of members of Overeaters Anonymous and other food-related recovery programs made up of recovered alcoholics and drug addicts. Oftentimes after a few years of sobriety from drinking and using drugs, members of this group not only find themselves gaining weight (or using anorexic or bulimic methods to try to control their weight), but also eating in very similar ways to how they once used alcohol and drugs—by obsessing, bingeing, isolating and lying. A complementary research finding is that as bingeing on food increases, there is a tendency for alcohol and drug use to decline.

Considering bariatric surgery for a moment, in recent years we have seen a new and disturbing trend in the addictions field: 6-8 percent of those who have had some form of intestinal surgery have developed alcoholism serious enough to warrant in-patient treatment. Their secondary chemical dependency on alcoholism has universally been classified as a cross-addiction. Unfortunately, even this has had little effect in calling for the diagnosis and treatment of possible food addiction prior to making the decision to undergo bariatric surgery.

Today, food addiction remains a medical problem fully established by scientific research, but not yet officially accepted by the medical and health insurance industry. Amy Teeple writes on www.docshop.com

, “A recent topic of debate, food addiction is now viewed by many scientists as a disorder as real as a drug or alcohol addiction. Although most people’s weight problems are not caused by an addiction, some people … [do] seem to gain weight because they are addicted to food.”

If, as Teeple contends, addiction or dependence can be defined as “the compulsive reliance on a behavior or substance by an individual,” anyone considering bariatric surgery would be well advised to look at least for the possibility that they may be struggling with something beyond the reach of simple will power. She states firmly:

“Addictive behavior will remain after bariatric surgery if the patient does not address the issues that led to the original addiction.”

Perhaps even more convincing is this comment the writer captures from a gastric bypass surgery patient with “no regrets” for having had the operation: “I really think that I would be dead if I hadn’t had it … [but] to do it without counseling built in, as I did, is stupid because you aren’t addressing the issues. Your issues with food are still going to be there …”

Teeple’s writings are echoed by those of Katie Jay, MSW. Jay is a nationally recognized expert on weight-loss and weight-loss surgery and the author of Dying to Change: My Really Heavy Life Story, How Weight-Loss Surgery Gave Me Hope for Living. She comments, “Weight loss surgery can be a great tool to help control your eating, but if you had trouble with food before surgery, there is high risk of eating compulsively, overeating or even just obsessing about food after surgery.”

Two additional authors (today there are hundreds) clearly support the notion that food addiction is real and is not treated by bariatric surgery alone. On www.beyondchange-obesity.com, Cynthia Buffington, Ph.D., reports that studies by bariatric psychologists found that “nearly 80 percent of gastric bypass pre-surgical patients suffer from food addiction.” She adds, “Our collaborative studies found that more than 90 percent of pre-surgical morbidly obese patients use avoidance stress coping behavior to handle emotions, seeking comfort from negative feelings and stressful situations through the use and, sometimes, abuse of food.”

Buffington goes on to support brain chemistry as a primary factor in the etiology of food addiction:

“Serotonin defects … in the brain cause depression and anxiety. Smokers, alcoholics, drug addicts, and the obese (particularly females) have serotonin defects … Low serotonin and stress-induced activation of the limbic-hypothalamic-pituitary-adrenal (LHPA) axis … are known to increase, by an unknown process, the risk for substance-abuse and food addiction through another ‘feel good’ pathway, the dopamine reward system. The euphoria or pleasure derived from the use of heroin, amphetamines, cocaine, alcohol and nicotine are, in part, due to stimulation of the actions of dopamine. Eating foods high in sugar or fat, or even the smell or taste of an individual’s favorite food, activates the dopamine reward system, producing pleasure and satisfaction ... It is possible, therefore, that individuals with food addictions may be eating more and more food to increase dopamine activities and improve their mood.”

Although like my colleagues and me, Buffington passes no judgment on the efficacy of bariatric surgery and in fact sees it as a viable alternative for those who are morbidly obese, she offers this note of caution:

“Abstinence from the abused substance helps to reverse or improve many of the neurochemical defects associated with addictions. Bariatric surgery, by limiting the amount of food and type of food that can be consumed, and by enhancing mood through the euphoria of weight loss, is also effective in improving neurochemical defects contributing to addictive behavior. However, such improvements are often short-lived. Food cravings, as well as depression, may reoccur over time, along with weight regain.

“The neurochemical defects contributing to food dependency among post-bariatric surgical patients may reappear over time because the behaviors responsible for initiating the cascade of events leading to such defects are not resolved by the surgery.”

In his 2007 article titled “Addiction: From Drugs to Donuts, Brain Activity May be the Key,” Paul Park offers further support for the actuality of food addiction. He comments that a “particularly significant set of findings shows that obese subjects exhibit qualities of addiction, not unlike those of individuals who engage in substance abuse.” He goes on to quote Dr. Mark S. Gold of the University of Florida (mentioned in an earlier section):

“Today there is a convincing convergence of evidence … that supports the hypothesis that there are important similarities between overeating highly palatable and hedonic foods and the classic addictions.”

A final expert mentioned in Park’s writing is Dr. Gene-Jack Wang, head of a team of researchers from the U.S. Department of Energy’s Brookhaven National Laboratory. Wang conducted experiments to “observe how the brain’s chemistry encouraged overeating by associating positive feelings with consumption,” he writes. What Wang learned is that “the same brain circuits that trigger cravings play a substantial part in consumption behaviors linked to comforting negative emotions.” Wang summarizes an interesting “chicken and egg” question with regard to brain chemistry and food addiction that has yet to be answered:

“It’s possible that obese people have fewer dopamine receptors because their brains are trying to compensate for having chronically high dopamine levels, which are triggered by chronic overeating. It’s also possible that these people have low numbers of dopamine receptors to begin with, making them more vulnerable to addictive behaviors including compulsive food intake.”

“Despite the mounting evidence supporting a direct relationship between brain activity and tendencies toward abnormal eating patterns, Dr. Wang stresses that obesity is a complex disease with a host of factors—genetics, cultural background, and cerebral mechanisms among many others—that contribute to its presence in those who are overweight. "However, the results of these various tests affirm that, when overeating is an addictive behavior, the treatment is similar to rehabilitation from drug use.”