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Peer Groups Work for Many Addicts

October 11, 2010

Galguerias

So many different fields have something to contribute to solving the childhood obesity problem, and there are a lot of things that can be done, both large and small. We’ve talked about change that can be undertaken right at home, like chewing more thoroughly and drinking lots of water, or even amateur aversion therapy. We’ve looked at measures like a junk-food tax and the removal of sweet fizzy drinks from schools, and community action like bringing better food to the inner city, or growing it there.

There’s a lot to be learned too, from the behavior of lab animals and from chemistry studies, and especially from the field of psychology. We looked at motivational interviewing, which, along with cognitive behavioral therapy and 12-step programs, has been surprisingly efficacious. When behavioral interventions that were developed for addiction management actually work to treat obesity in both children and adults, it’s a pretty good indication that there is such a thing as food addiction after all.

The granddaddy of all 12-step programs is, of course, Alchoholics Anonymous (AA). Wired Magazine recently published a very detailed piece by Brendan I. Koerner, titled “Secret of AA: After 75 Years, We Don’t Know How It Works.” He explains about the brain’s reward system, the mesolimbic pathway where a chemical called dopamine causes a state of bliss. Alcohol certainly brings it out. Koerner says,

For most people, that buzz simply isn’t momentous enough to become the focal point of their lives. Or if it is, they are able to control their desire to chase it with reckless abandon. But others aren’t so fortunate: Whether by virtue of genes that make them unusually sensitive to dopamine’s effects, or circumstances that lead them to seek chemical solace, they cannot resist the siren call of booze.

But all good things must come to an end, and eventually there is trouble in paradise. Alcohol interferes with the balance between other neurotransmitters, so the reward system doesn’t work so well. Drinking isn’t so much fun any more and, as if that weren’t bad enough, neither is anything else. But the drinking has always worked in the past — so maybe the answer is more booze…. Except, it’s not.

Other addictions work the same way, including addiction to highly pleasurable, or hedonic, foods. Where one cupcake used to open the door to heaven, a person eventually reaches a state where even a dozen cupcakes won’t do the trick. Meanwhile, the pounds pile on, life in general becomes less pleasant, and the tunnel vision of the addict still somehow persists in seeing cupcakes as the answer.

As for AA, sure, a lot of people drop out. But commitment pays off. The people who not only show up for meetings but become deeply involved in the program, Koerner says, “usually do well over the long haul.” AA has a very important characteristic in common with other forms of group therapy — namely, the group.

Researchers from Stanford University who studied a couple of hundred journal articles about group therapy found that the group factor is key. Bonds between people are formed, and they depend on the mutual influence exerted by acceptance and feedback. In other words, AA is effective because of the same force that is so demonized by frightened parents: peer pressure. Also, it seems to be true that the more you give, the more you get. Koerner says,

… [N]umerous studies show that AA members who become involved in activities like sponsorship — becoming a mentor to someone just starting out — are more likely to stay sober than those who simply attend meetings.

This participation factor also shows up in the success stories reported by kids on the Weigh2Rock website, who do better when they are helping others. As Dr. Pretlow says in Overweight: What Kids Say:

Once they have achieved some success at losing weight, they become a helper to those just starting out. Becoming a helper is a win-win, as helping someone else reinforces the changes the helper has made in themselves. Explaining what works to someone else, gives the helper a deep understanding of the process, and helping improves their own self-worth.

Getting back to Koerner’s AA research: He admits it’s no miracle cure, and introduces the idea of personalization in addiction medicine. Scientists that he interviewed suggest that the initial state of the brain is important, because some brains may be “primed” to accept and adopt certain therapeutic modes while others just don’t respond. A Childhood Obesity News blog reader named Bill Bohrer, who prefers to communicate by email rather than via the Comments section, nevertheless agrees to be quoted, and states the problem very succinctly:

We want One, Single ANSWER, to every problem, and there isn’t one. Personality, genetics, environment, all play a role in personal development, and different people react differently to the same drugs and the same stimulus and the same environmental factors. If there are 8 solutions and you have to find the right one that works for you, most people give up after 3 tries, max. I think it’s baseball’s fault — 3 tries, that’s all you get. You have to do some ANALYSIS, kids. It’s hard, boring work, but it pays off.

Your responses and feedback are welcome!

Source: “Secret of AA: After 75 Years, We Don’t Know How It Works,” Wired.com, 06/23/10
Source: “Overweight: What Kids Say,” Amazon.com
Image by Vacacion, used under its Creative Commons license.

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