Is food truly addictive?

Biological Psychiatry is proud to announce this week's publication of a special issue focusing on the question of food as an addiction.

Addiction is the continued or compulsive use of a substance, despite negative and/or harmful consequences. Over the years, addiction has come to be re-defined to include behaviors, as well as substances, and the term is now used to describe significant problems with alcohol, nicotine, drugs, gambling, internet use, and sex. The 'major' addictions, like alcoholism and drug abuse, stimulate significant amounts of research and are now largely well characterized, but others, like pathological gambling and internet addiction, are much less understood.

And then there is food. Food is a biological necessity, a distinction that makes it unlike any of the other substances or behaviors typically considered as addictive. It therefore also doesn't qualify when considering the typical conditions of abnormal dependence upon a substance – tolerance and withdrawal.

At the same time, research has long found similarities between food intake and addiction. And just recently announced, the updated version of the Diagnostic and Statistical Manual of Mental Disorders, commonly called the DSM, will now formally include binge eating disorder as a new diagnosis.

Neuroimaging work has revealed that the same regions of the brain process the reinforcing effects of food and the consumption of drugs of abuse. The overlap of these neural circuits, however, does not necessarily mean that food is, or can be, addictive.

This lack of clarity in the scientific literature prompted the publication of this cohesive look at the support for and against the application of the addiction model to food. This Biological Psychiatry issue was led by guest editors Drs. Dana Small and Ralph DiLeone, at the Yale School of Medicine. Their goal was to bring together original research findings, systematic reviews and opinions of key leaders in the field to objectively represent the state of the field and both sides of the debate.

"While it is attractive to use the addiction framework to 'jump start' and guide our understanding of how neural circuits of reward and self-control might contribute to understanding overeating and the obesity epidemic, the price of adopting an inappropriate framework would be high," note Small and DiLeone. "For example, an inappropriate adaptation might steer research towards evaluating variables that have been shown to be critical for addiction at the expense of those that are unique to obesity and perhaps key to understanding overeating."

Papers in this issue cover the common and divergent neurobiological mechanisms and characteristics of food and substances of abuse. One provides rationale for adopting the food addiction model, arguing that food addiction exists and that although food is less powerful than addictive drugs, this does not diminish the compulsive nature or lack of control associated with binge eating. In contrast, another paper argues that the concept of food addiction is problematic and its links to drug addiction are overstated.