By: Michael Stone, MD, Addiction Medicine Specialist,
Director, Cornerstone of Southern California

Today I am going into some detail regarding the behaviors that can, in some people, become addictions and hopefully explain why.

My "Brain Chemistry" Article explained how different chemicals can be taken into our bodies and go to the "feeling center" in our brains. There, these chemicals either directly hit the receptors of the nerves or cause our own neurotransmitters (dopamine, norepinephrine, GABA, endorphins, enkephalins, and serotonin) to hit their receptors in higher concentrations than without these chemicals, causing us to get high, mellow, loaded, drunk, spaced, etc.

It has been found that the food we eat and our behaviors can affect this same neurotransmitter system.

FOOD - Sugar acts as a stimulant. A burst of glucose (the sugar our body uses as fuel) can go through the blood stream causing immediate stimulation of the brain similar to the effect of cocaine, nicotine and methamphetamine. This is why many of the best treatment centers try to keep their patient's use of sugar to a minimum. Sugars are carbohydrates. The best way to take in carbohydrates is not in the form of sugar, but in the form of complex carbohydrates - especially fruits and vegetables. The other way that carbohydrates (especially sugars) affect the way we feel is in their reaction with insulin in the body. Carbohydrates cause an increase in insulin, which causes the sugar to enter the cells faster. This begins a drop in sugar levels that can lead to low blood sugar and the feeling of tiredness. Therefore, sugar can led to initial stimulation and energy followed 2 to 3 hours later by lethargy and sleep.

Fats tend to lead to sedation. Proteins cause your sugar level to be more balanced. Neurotransmitters are all made from proteins and so a protein meal causes an increase in all the neurotransmitters at the same time, leading you to be in balance in your feeling center.

What is the ideal balance of foods in recovery? Low pure sugars. No caffeine (it is a direct stimulant). Slightly less grams of protein than complex carbohydrates like fruits and vegetables. Low fat, especially saturated fat.

There is a tendency to overeat in early recovery - beware - eat 3 small meals per day - remember sugared sodas with caffeine are stimulant drinks. Soy protein has a lot of healthy properties.

BEHAVIORS - Exercise, gambling, shopping, and work are all behaviors that can be addicting. To be addicting these behaviors have to cause chemical changes in our feeling center which in turn gets us "high". These behaviors are stimulating and affect the dopamine/norepinephrine system.

Let's pick gambling as our example. Most people feel excited, nervous, jittery and scared when they gamble. This is because of an increase in the dopamine and norepinephrine neurotransmitters in the feeling center caused by this behavior. Most people can stop gambling any time they want. Some people gamble compulsively, lose control, get into trouble, but continue to go back to it. This fits perfectly into my definition of Addiction explained in Article I.

Behavioral addictions tend to be stimulant/performance addictions. Exercise is an obvious stimulant-inducing behavior. After a lot of exercise, especially if you get some physical pain from the exercise (release of endorphins/enkephalins - opiates), you can get an additional high. First the stimulants (dopamine, norepinephrine) then the downers (endorphins, enkephalins) leading you to be tired and "relaxed".

Sex has two effects on the neurotransmitter system. Initially it is all excitement and stimulation, and afterwards it often leads to relaxation. This whole cycle can be addictive to some people. Doing it compulsively, losing control, having problems, but continuously doing it again is a sign of addiction.

By the way, starvation - as in anorexia - is when a person severely restricts the total food they eat. When they do eat it is often foods high in sugar/carbohydrates, that cause them to feel high. Starvation can lead to a condition in the body called "ketosis", which causes a person to feel "high."

So food, especially sugar and carbohydrates, can be addicting. Behaviors - exercise, gambling, sex and work can also cause chemical changes in the feeling center of the brain leading to addiction.

Whether the addict is using chemicals, food or behaviors to get "high", the treatment is basically the same for all, with some exceptions/modifications. It is perhaps easier to think of completely giving up alcohol, Valium, Vicodin or Cocaine than it is to give up food, work and sex.

I never said this is an easy area of medicine. The treatment of all addiction is similar. It should involve a team of helpers, be mostly performed in a group setting, and will need to be life-long.

MICHAEL STONE, MD, Addiction Medicine Specialist
Cornerstone of Southern California
714-730-5399

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Articles

Addiction the Disease

How do you know if you have this disease?

How do you know if a loved one, a colleague, an employee, a friend, or your cellmate has this disease? There are endless definitions but here is mine. There are five pieces of the puzzle and all have to be present to be sure it is an addiction.

First - compulsion. This is not all the time, it is not every day but it is obvious. The cocaine addict gets the urge to use cocaine, the alcoholic craves a drink and the Vicodin addict is driven to get the pills. Addicts get the compulsion to do "it" (what they are addicted to) ...

Second - they do "it". I believe it is possible to be an... Read More »

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Incidental Medical Services (IMS)

On January 1, 2016, Chapter 744, Assembly Bill 848 was enacted authorizing adult alcoholism or drug abuse recovery or treatment facilities that are licensed by the Department of Health Care Services (DHCS) to provide IMS. AB 848 amends sections 11834.03 and 11834.36, and adds sections 11834.025 and 11834.026 to the Health and Safety Code to allow licensed residential providers the option to apply to DHCS for approval to provide IMS in their facilities.

IMS are services provided at a licensed residential facility by a health care practitioner that address medical issues associated with either detoxification or the provision of alcoholism or drug abuse recovery or treatment services to assist in the enhancement of treatment services. IMS does not include the provision of general primary medical care. IMS must be related to the patient's process of moving into long-term recovery.

The following six categories of IMS services may be provided after receiving approval from DHCS:

  • Obtaining medical histories.
  • Monitoring health status to determine whether the health status warrants transfer of the patient in order to receive urgent or emergent care.
  • Testing associated with detoxification from alcohol or drugs.
  • Providing alcoholism or drug abuse recovery or treatment services.
  • Overseeing patient self-administered medications.
  • Treating substance abuse disorders, including detoxification.

https://www.samhsa.gov/medication-assisted-treatment

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