Can you really be addicted to chocolate—or any other food for that matter? We all have our favorite foods, and most of us have overindulged from time to time. Who can resist that second piece of pumpkin pie on Thanksgiving?  Sometimes, we get powerful cravings for sweets or other foods we love.  Not only is eating a very pleasurable and often social activity, but it is also just as necessary as air and water for our very survival. So, can we really become addicted to something we need to survive?  First, we must understand what addiction is, and what it isn’t, to determine if eating behaviors and food can become addictions, with the symptoms and consequences associated with other types of addictions, like drug or alcohol addiction.  Only then can we understand why many professionals believe that we can, indeed, become addicted to food.

Defining Addiction

The most recent version of the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-V), published in May 2013, is the book used by most behavioral health professionals to diagnose psychiatric disorders, including substance use disorders. The section addressing addiction underwent significant changes in the newest version of this diagnostic manual.

In the new DSM-V, the categories of substance dependence and substance abuse have been removed.  Instead, a person can be diagnosed with a Substance Use Disorder, with varying degrees of severity, depending on the number of diagnostic criteria that are met, and the type of substance (Hartney, 2013).  Some of the criteria that must be met for a person to be diagnosed with a substance use disorder, or addiction, include:

1. Taking the substance in larger amounts or for longer than the person intended
2. Wanting to cut down or stop using the substance but not managing to do so
3. Spending a lot of time getting, using, or recovering from use of the substance
4. Cravings and urges to use the substance
5. Not managing to do what should be done at work, home or school, because of substance use
6. Continuing to use, even when it causes problems in relationships
7. Giving up important social, occupational or recreational activities because of substance use
8. Using substances again and again, even when it puts the person in danger
9. Continuing to use, even when the person knows they have a physical or psychological problem that could have been caused or made worse by the substance
10.  Needing more of the substance to get the wanted effect (tolerance)
11.  Development of withdrawal symptoms, which can be relieved by taking more of the substance (Hartney, 2013).

The DSM-V also allows behavioral health professionals to specify how severe a substance use disorder is.  Two or three symptoms would indicate a mild substance use disorder, four or five symptoms indicate a moderate substance use disorder, and six or more symptoms indicate a severe substance use disorder (Hartney, 2013).

Addicted to food?

Given this definition, and the diagnostic criteria outlined in the DSM-V, the first question that comes to mind when it comes to food addiction is this:  Can food really be considered a “substance”, similar to alcohol, marijuana, or opiates?  Or, is addiction to food more like a gambling addiction, which is a behavioral addiction, instead of a substance addiction.  Many scientists and clinicians have long believed that problem gamblers share many characteristics of those with alcohol or drug addiction, not only from the external consequences of problem finances and destruction of relationships, but, increasingly, on the inside as well. 

According to the Substance-Related Disorders Work Group for the DSM-V, brain imaging studies and neurochemical tests have made a “strong case that gambling activates the reward system in much the same way that a drug does.”  Pathological gamblers report cravings and highs in response to gambling. Additionally, gambling addiction may also run in families, often along with other addictions (Reilly and Smith, 2013).  To date, gambling addiction is the only behavioral addiction included in the DSM-V.

If gambling can activate the same processes in the brain (the reward system) as a substance, could food or eating act in the same way?  Evidence that food can have some addictive properties has increased in recent years.  Similar to how drugs or alcohol “hijack” the brain, research with food suggests a similar, but perhaps weaker effect (Gearhardt, Corbin, & Brownell, 2009).  When we consider food consumption in the context of addiction, using the DSM-V criteria for dependence (e.g. increased tolerance, loss of control, and withdrawal symptoms), there is evidence that people do experience some symptoms of dependence. 

People can lose control over their food consumptions, and they do suffer from repeated failed attempts to control their eating.  Additionally, people may be unable to stop themselves from eating certain types of food, despite negative consequences.   Like addictive drugs, tasty foods can trigger the release of feel-good brain chemicals, like dopamine, into the brain’s reward pathway.  Foods that are fatty, salty, or sweet, in particular, can cause a person to want to quickly eat again.  To make matters worse, really delicious foods may override signals of fullness, resulting in overeating (Food Addiction Signs and Treatment, 2014).  More research is needed to determine if people actually experience withdrawal related to certain types of foods (high- sugar or high-fat foods).  We also need to learn more about how eating behaviors may cause people to give up certain activities (Gearhardt, et al, 2009).

Recognizing Food Addiction

Although, addiction to food is not a disorder in the current DSM-V, eating behaviors and a person’s relationship with food can cause significant emotional pain and distress, and even impairment in daily functioning.   The first step is recognizing that eating habits have become a problem, or even out of control.   Researchers at Yale University's Rudd Center for Food Science & Policy have developed a list of some signs that a person may have a food addiction (Food Addiction, 2014):

• Eating more than planned when eating certain foods—can’t seem to stop once started
• Keep eating certain foods even when no longer hungry
• Eat to the point of feeling ill
• Worry about not eating certain types of foods or worry about cutting down on certain types of foods
• When certain foods aren't available, go out of the way to obtain them
• Eat certain foods so often or in such large amounts that you start eating food instead of working, spending time with the family, or doing recreational activities
• Avoiding professional or social situations where certain foods are available because of fear of overeating
• Problems functioning effectively at work or school because of food and eating
• Eating in secret, when no one else will see
• Feelings of anxiety or agitation related to food and eating
• Eating food causes problems such as depression, anxiety, self-loathing, or guilt or shame
• Needing to eat more and more food to reduce negative emotions or increase pleasure—self-soothing with food
• Eating the same amount of food doesn't reduce negative emotions or increase pleasure the way it used to

Problems with food, eating, and weight are very real, and can have a significant impact on a person’s quality of life.   A participant in Food Addicts in Recovery Anonymous (FA) describes her experiences with food and other addictions in this way:

“I came into FA when I was 24 years old because I was desperate to stop bingeing. I was already a little under my goal weight and knew I was thin, but I felt like I could shoot back up the scale at any time. At that time, I had been in AA for two years and had two years of sobriety from alcohol, pot, and pills like Xanax. As soon as I was sober from those things, I gained 25 pounds, so I knew I had replaced the alcohol with food. I realized I'd used other substances to try to control how much I ate. I had used cigarettes, caffeine, busyness, relationships, exercise, card shopping, to try to control my eating and my weight.  I began to learn that food addiction is a real addiction” (Stories of Recovery, 2014).

Overcoming Food Addiction

There is a lot that people can do to help themselves overcome challenges related to food and eating.  Acknowledging the problem, getting educated about food addiction, and taking action can be empowering.  Some ideas for managing problem eating behaviors include:

• Manage stress. Find alternate ways, other than eating, to handle stress. These may include exercising, meditating, using relaxation strategies, and practicing simple breathing exercises.
• Eat 3 meals a day and healthy snacks.  Stick to scheduled mealtimes, as skipping meals often leads to binge eating later in the day.
• Avoid temptation. You’re much more likely to overeat if you have junk food, desserts, and unhealthy snacks in the house.
• Stop dieting. The deprivation and hunger of strict dieting can trigger food cravings and the urge to overeat. Focus on eating in moderation. Avoid banning certain foods as this can make you crave them even more.
• Exercise. Not only will exercise help you lose weight in a healthy way, but it also lifts depression, improves overall health, and reduces stress. The natural mood-boosting effects of exercise can help put a stop to emotional eating.
• Fight boredom. Instead of snacking when you're bored, distract yourself. Take a walk, call a friend, read, or take up a hobby.
• Get enough sleep. If you're tired, you may want to keep eating in order to boost your energy.
• Listen to your body. Learn to distinguish between physical and emotional hunger. If you ate recently and don't have a rumbling stomach, you're probably not really hungry. Give cravings time to pass
• Keep a food diary. Write down what you eat, when, how much, and how you're feeling when you eat. You may see patterns emerge that reveal the connection between your moods and binge eating.
• Get support. You're more likely to succumb to binge eating triggers if you lack a solid support network. Talking helps, even if it’s not with a professional. Lean on family and friends, join a support group, and if possible consult a therapist (Binge Eating Disorder, 2014).

Following these guidelines can help get food addiction, or other problematic eating behaviors under control.  But, it’s also important to seek professional help when things become overwhelming, or are just not getting better. There are effective treatments available for people who believe they may be struggling with an addiction to food. A skilled counselor can help people manage the compulsion to binge, exchange unhealthy habits for newer healthy ones, monitor eating and moods, and develop effective coping skills (Binge Eating, 2014).  Three types of therapy that can be helpful in the treatment of food addiction, or eating disorders include:

• Cognitive-behavioral therapy focuses on the thoughts and behaviors involved in dysfunctional eating behaviors.  Counselors can help people recognize unhealthy eating triggers and learn how to avoid or combat them. Cognitive-behavioral therapy for binge eating disorder also involves education about nutrition, healthy weight loss, and relaxation techniques.
• Interpersonal psychotherapy focuses on the relationship problems and interpersonal issues that can contribute to problematic eating behaviors. Counseling can help improve communication skills and relationships with others.
• Dialectical Behavior Therapy (DBT) combines cognitive-behavioral techniques with mindfulness skills. The emphasis of therapy is on teaching people with food addiction how to accept themselves, tolerate stress better, and regulate their emotions (Binge Eating, 2014).

 Help is available for people struggling with food addiction, or other eating disorders.  Many people will have challenges with food, eating behaviors, or weight.   If you feel like you’re stuck in a vicious cycle with food, it’s important to recognize the signs that your relationship with food has become unhealthy, and get the help and support you need to regain control of the foods you love.

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Binge eating disorder. (2014). Retrieved August 18, 2014, from http://www.helpguide.org/mental/binge_eating_disorder.htm

Food addiction signs and treatments. (2014). Retrieved August 18, 2014, from http://www.webmd.com/mental-health/mental-health-food-addiction

 Gearhardt, A., MS, Corbin, W., PhD, & Brownell, K., PhD. (2009). Food Addiction: An Examination of the Diagnostic Criteria fo... : Journal of Addiction Medicine [Abstract]. Journal of Addiction Medicine,3(1), 1-7. Retrieved August 18, 2014, from http://journals.lww.com/journaladdictionmedicine/Abstract/2009/03000/Food_Addiction__An_Examination_of_the_Diagnostic.1.aspx

Hartney, E., PhD. (2013, June 30). DSM 5 Criteria for Substance Use Disorders. Retrieved August 18, 2014, from http://addictions.about.com/od/aboutaddiction/a/Dsm-5-Criteria-For-Substance-Use-Disorders.htm

 Reilly, C., & Smith, N. (2013). The Evolving Definition of Pathological Gambling in the DSM-5. The Evolving Definition of Pathological Gambling in the DSM-5. Retrieved September 18, 2014, from http://www.ncrg.org/sites/default/files/uploads/docs/white_papers/ncrg_wpdsm5_may2013.pdf

Stories of recovery. (2014). Retrieved August 18, 2014, from http://www.foodaddicts.org/stories-of-recovery