Tuesday, September 20, 2011

Food Reward and Addiction Pt I

Source: here and here

According to Nora Volkow, head of the National Institute on Drug Abuse (AKA, the US Government's official scientist and spokesperson on drug abuse), "Addiction is all about the dopamine".

So what is addiction? According to this NY Times article on Nora Volkow:
All addictive substances send dopamine levels surging in the small central zone of the brain called the nucleus accumbens, which is thought to be the main reward center. Amphetamines induce cells to release it directly; cocaine blocks its reuptake; alcohol and narcotics like morphine, heroin and many prescription pain relievers suppress nerve cells that inhibit its release.

Addicts and first-time users alike get the high that correlates with the dopamine wave. Only a minority of novices, however, will develop the compulsion to keep taking the drug at great personal cost, a behavior that defines addiction.
Anything that is done at great personal cost is addiction? That would mean that ALL obese people are addicted to food. The great personal cost of being fat is well-known: reduced mobility, reduced sexual attractiveness, reduced health, etc. That is something most people can agree on. Yet fat people keep over-eating at great personal cost!

No fair using quoting a NYT "science" journalist's definition of addiction? Okay, here's the official definition of substance dependence from DSM-IV:
When an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped.
Notice that the definition is limited to "alcohol and drugs". Isn't food a substance? What is the psychiatric definition of drug?
The term drug may refer to any non-food chemical substance or preparation administered for the purpose of correcting or attenuating a disease process (therapeutic drug) or for pleasure (recreational drug). Almost all drugs of interest in the realm of behavioral health care achieve their primary effects in the brain (central nervous system) and may also be referred to as psychoactive or psychotropic.
So if I eat food (which is made up of chemicals, shockingly enough) for pleasure it's just eating food. If I eat a non-food chemical substance for pleasure or for a disease it's a drug. This crap is making me tired and I've barely gotten started. I'd just like to point out, even if I hate these terribly vague definitions in a field that purports to be scientific, I don't think psychiatrists are "witch doctors" (although some of them certainly are, but then some GPs are also).

One obvious difference between difference between foods and drugs is that no has to take drugs, right? Well there's the therapeutic kind, of course, antibiotics and such, those are necessary. But not the recreational kind, right? Those are totally unnecessary. If only we had the power to make the bad chemicals disappear from the face of the Earth.
As Dr. Volkow said to a group of drug experts convened by the surgeon general last month to discuss the problem, “In the past, when we have addressed the issue of controlled substances, illicit or licit, we have been addressing drugs that we could remove from the earth and no one would suffer.”

But prescription drugs, she continued, have a double life: They are lifesaving yet every bit as dangerous as banned substances. “The challenges we face are much more complex,” Dr. Volkow said, “because we need to address the needs of patients in pain, while protecting those at risk for substance use disorders.”

In other words, these drugs must be somehow legal and illegal, encouraged yet discouraged, tightly regulated yet easily available.
There's so much arrogance and ignorance there it makes me shudder. Ignorance from a well-renowned scientist and researcher with a bajillion degrees? Absolutely. Being an expert on dopamine reuptake doesn't make one an expert on human nature, politics or civil liberties. Making doctors even more afraid to prescribe opiates to people in chronic pain just in case some high school kid might pop some of granny's pill or whatever is idiotic. And what makes Volkow so smugly sure she and her ilk know what chemical substances ought to be removed from the earth? If it turns out wheat has opioid properties would Dr Volkow recommend making it a controlled substance so that it could be both "legal and illegal"?

If Nora Volkow wants to be "general in the drug war" lets give her a rifle and a hardhat and send her off to northern Mexico so she can lead from the front.

OK, so I obviously despise Volkow's ideas as a drug warrior. But what about her research (and research in general) on dopamine and addiction and her assertion that "it is all about dopamine"? If obesity is an addiction, and addiction is all about dopamine, then is obesity all about dopamine?

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