Substance abuse can lead to addiction, or a substance use disorder (SUD), which is defined by compulsive drug use despite harmful consequences. Obesity is a disorder involving too much body fat, or being substantially overweight, and affects nearly a third of all American adults. Both disorders are prevalent diseases associated with social stigma and discrimination.
Researchers and scientists are beginning to understand the relationship between substance abuse and obesity. Both disorders are related to how the brain responds to reward. When people use drugs or alcohol, they temporarily feel good or experience pleasure. The same is true for when people eat food. While each disorder is different, they both affect areas of the brain that make it difficult to stop overeating or abusing drugs or alcohol.
What Is The Relationship Between Obesity And Substance Abuse?
While it’s unclear if obesity leads to substance abuse, or vice versa, there is a complex relationship between the two.
Research shows there is a connection between substance abuse and obesity in the following areas:
- biology and genetics
- brain functioning
- environmental/developmental risk factors
- health risks
- intense urges and cravings
- social circumstances
- poor quality of life
- social stigma and discrimination
The unfortunate truth about both substance abuse and obesity is the harsh stigma attached to each disorder.
The Stigma Of Obesity And Addiction
Both obesity and addiction are stigmatized and dismissed as disorders of poor self-control. People chalk up these conditions as self-inflicted bad choices. But do people suffering from addiction want to be addicted to drugs or alcohol? Do people with obesity want to be obese?
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No one chooses to suffer from these debilitating and life-threatening disorders.
The stigma regarding obesity and addiction ignores one simple fact: to exhibit self-control, certain parts of the brain must be working properly to regulate our behavior. Nora Volkow, the director of the National Institute on Drug Abuse (NIDA), compares addiction and obesity to driving a car without brakes. No matter how hard you try, you won’t be able to stop.
Substance Abuse, Obesity, And The Brain
The brain is a complex, machine-like organ that determines everything we do. From behavior to feeling, the brain dictates our every move, thought and action. Brain functioning is similar for obesity and addiction because both disorders increase dopamine in the brain. There are profound similarities in the reward centers of the brain, for example, between an obese individual and an individual addicted to cocaine.
Dopamine is a chemical that signals reward in our brains. Whenever a person uses drugs or eats tasty food, dopamine levels go up. This surge in dopamine also affects other areas of the brain relating to self-control. When suffering from these disorders, the ability to control strong urges relating to food or drugs is compromised.
Our brains are hardwired to respond to rewards, which motivates our behavior and actions. For humans, gaining rewards is an essential function of survival. We eat food to maintain health and energy, and the taste of food is rewarding. Sex is pleasurable, but also produces children and is essential for human survival. Without reward, survival is compromised.
Sugary, Fatty And Salty Foods Are Like Drugs
Food, or the prospect of food, is everywhere. Just seeing a donut or smelling a hamburger causes the brain to predict you will eat a hamburger soon, increasing dopamine levels in anticipation of the reward. Just seeing it, smelling it, or being near it makes you want to eat it.
Once you eat, you feel full and satisfied, and eating more is no longer rewarding.
But, the problem is many of the foods we’re bombarded with don’t create that satiated feeling of fullness and satisfaction. Foods rich in sugar, fat, and salt can trigger compulsive eating in almost any person, and severely mess with the dopamine levels in the brain.
Highly rewarding foods, like many substances of abuse, produce short-lasting and intense feelings of pleasure. This increase in dopamine affects the ability to control strong urges to eat tasty and delicious foods, or to abuse drugs or alcohol. Obesity, like drug addiction, disrupts the systems in the brain that balance immediate reward and need with what we need to survive.
Diet, Withdrawal, And Relapse
Dieting usually requires abstinence from eating high-calorie foods. Unsuccessful dieting often leads to excessive amounts of overeating or bingeing on foods with high fat or sugar. This pattern is similar to withdrawal and relapse caused by substance use disorders (SUDs).
Certain triggers, like underlying stress or major life events, can lead to relapse. This is true for both overeating during a diet and for those in recovery from substance abuse and addiction. Compulsive behavior, like overeating or using drugs, cycles between withdrawal and relapse, which suggests similar brain functioning.
Because similar functioning occurs in the brain for people with obesity and substance abuse problems, they also share similar risk factors.
Risk Factors Of Addiction And Obesity
While it’s impossible to predict the causes of these conditions, the following factors increase the risk of developing each disorder:
- Genetics: The genes that people are born with, or their biology, can increase the risk of addiction if there is a family history of substance abuse or mental illness. For obesity, genetics affect how much body fat can be stored and where it goes in the body, also playing a role in how the body burns calories and converts food into energy.
- Social Circumstances/Environment: Peer pressure, sexual assault or abuse, stress and parental guidance can increase the likelihood of substance use and addiction. Children born from obese parents may imitate similar eating habits or a lack of physical exercise, with general family lifestyles increasing the risk of obesity.
- Developmental Track: The earlier a person abuses drugs or alcohol, the more likely they are to develop an addiction because their brains are still developing. As a person grows up, a less active lifestyle, as well as hormonal changes, can lead to obesity. As a child develops into adulthood, the interaction between genetics and social circumstances increases the risk of both obesity and substance abuse.
The Co-Occurrence Of Addiction And Obesity
The co-occurrence of addiction and obesity is unclear and requires more research. Some studies show it’s unlikely for stimulants, like cocaine and amphetamines, to co-occur with obesity. But other substances of abuse, like alcohol, are more likely to develop into an addiction in obese persons.
Obesity And Alcohol Abuse
Excessive alcohol use and obesity are among the leading causes of death in the United States. The connection between alcohol abuse and obesity is complex and under-researched, but heavy drinking, and binge-drinking is more likely linked to obesity than moderate to light alcohol use.
After drinking heavily, people may eat more. It’s unclear whether alcohol abuse leads to eating, but heavy drinking has shown to cause more intense cravings for food. Alcohol intoxication can change someone’s perception of appetite, meaning they may think they’re hungry when surrounded by options for food.
It’s also unclear whether alcohol abuse directly leads to weight gain. Studies have produced conflicting results, as some studies suggest long-term alcohol use may lead to obesity, while others saw no evidence to support such findings.
Overall, obesity is a complex condition determined by multiple factors, and it’s very difficult to determine if alcohol, or other substances of abuse, can lead to this condition.
Health Risks Of Obesity And Substance Abuse
Both obesity and substance abuse are major health concerns. To avoid the health risks associated with each condition, it’s imperative a person enter treatment or call for help.
Health risks of obesity can include:
- fatty liver tissue
- heart disease
- high blood pressure
- kidney disease
- pregnancy issues
- type 2 diabetes
Health risks associated with substance abuse and addiction may include:
- heart disease
- hepatitis B and C
- lung disease
- mental health problems
- oral health problems
People suffering from addiction and obesity are more at risk of developing serious health problems than the general population. Plus, struggling with both disorders can lead to a low quality of life.
Low Quality Of Life
Both addiction and obesity, whether comorbid or otherwise, can lower the overall quality of life. A person addicted to drugs or alcohol may make using substances their top priority, neglecting responsibilities at home or work. A person suffering from obesity may not be able to enjoy activities they once loved and avoid public places.
Both substance abuse and obesity can lead to:
- feelings of shame or guilt
- problems fulfilling responsibilities
- sexual/relationship problems
- social isolation
When a person suffers from both obesity and substance abuse, it’s important to seek treatment. Treatment can improve a person’s quality of life and help avoid further health risks.
Treating Obesity And Substance Abuse
Behavioral therapies, medications, and support groups may all be used to treat obesity or addiction. While treatment for each person is likely to differ and be based on individual needs, the following treatments may be used to treat each condition.
Behavioral therapy is the most common form of addiction treatment and aims to change a person’s thinking and attitudes towards drugs. Common behavioral therapies used to treat addiction include:
- 12-step facilitation therapy
- Cognitive behavioral therapy (CBT)
- Contingency management/Motivational incentives
- Dialectical behavioral therapy (DBT)
- Family therapy
- The matrix model
While many of these therapies are designed for substance abuse and mental illness, some are relevant for treating obesity as well. Cognitive behavioral therapy (CBT), while not directly attributed to weight loss, can reduce instances of binge-eating. Perhaps the most effective therapy for treating obesity involves nutritional counseling programs that target physical activity and eating behaviors.
For certain addictions, medications may be used to alleviate unpleasant symptoms of withdrawal, lessen physical dependence, reduce drug cravings and help people engage in and complete treatment. Addictions to both opioids and alcohol involve the use of government-approved medications.
Prescription medications used to treat obesity generally work in two ways: to reduce hunger (or feel more full) and to make it harder for the body to absorb more fats from food. Like medications used in addiction treatment, prescription drugs are used in combination with other therapies and treatment. For example, physical exercise, fewer calories and modifying unhealthy behaviors will likely coincide with medication.
Support groups, like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), are often used to supplement therapy and medications during addiction treatment. These groups can be effective for relapse prevention and peer support, which is essential for overcoming addiction.
Like addiction, obesity is also served by support groups. Overeaters Anonymous (OA) is a 12-step program for people with shared experiences relating to obesity and overeating. While this group isn’t a treatment for obesity, it can help people remain healthy in recovery and offer support for those struggling to lose weight.
Inpatient Rehab For Comorbid Obesity And Addiction
The best course of action for an obese person suffering from addiction is likely entering inpatient rehab. Inpatient rehab takes place in a residential setting and is effective because it provides around-the-clock medical care and observation, as well as a multidisciplinary approach to treat both substance abuse and obesity.
Co-occurring health conditions, like obesity, may complicate treatment, so it’s essential that a person enters a facility capable of addressing both disorders. Many inpatient rehab centers are staffed with a variety of healthcare professionals who can collaborate to provide an integrated approach and the highest level of care.
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