David T. Courtwright

 

On his book The Age of Addiction: How Bad Habits Became Big Business

Cover Interview of December 04, 2019

A close-up

Not everyone is happy with all the talk of expanding addiction. It bothers clinicians who fear stigmatization, libertarians who smell an excuse for indiscipline, social scientists who fear neuroscientific reductionism and imperialism, and philosophers who detect concept creep and equivocation, the misleading practice of using the same word to describe different things.

I shared many of these concerns and wanted to give the critics a hearing. Using the brain-disease model of food addiction as a case study, I wrote a dialogue that boiled down the arguments on both sides. Here’s a taste of the pros (P) and cons (C):

C: You can’t compare drugs and food. We don’t have to take drugs. We do have to eat.

P: Eat food, yes. Eat engineered food, no. People don’t overconsume corn. They overconsume corn processed into Cheetos, Doritos, and other mass-marketed, synthetically flavored products designed to maximized brain reward.

C: So take junk food off the grocery list.

P: Not so easy if you’re hooked.

C: Get unhooked. This is a bad habit, not a real brain disease like schizophrenia or multiple sclerosis. People quit bad habits all the time.

P: People don’t quit cravings or forget cues. They don’t restore lost receptors with a snap of the fingers.

C: But they can overcome bad habits by adopting other, healthier habits. They can change their routines. Start going to Weight Watchers, stop going to McDonald’s. What you call addiction has an element of choice and a developmental trajectory. People wise up as they get older. They outgrow addictions, often quitting on their own. Ex-tobacco smokers outnumber current smokers in several developed nations.

P: Yet people have to eat, as you say. And shop for groceries. Talk about cues. But, yes, there are workarounds like learning to prepare meals with fresh, carefully measured, low-fat ingredients. And avoiding fructose, which is nothing but a brain-pleasing additive.

C: The vast majority of people eat and drink fructose at least occasionally. Ditto other feel-good additives. Yet they don’t all become addicts.

P: You could say the same thing of drugs. Fewer than 20 percent of the people who ever try crack or heroin wind up as addicts. More people than that have trouble controlling their food intake, ruining their health in the process …

You can guess what follows. Is food addiction about dumb policies that make brain-altering and potentially addictive processed foods available at low cost to susceptible populations with few healthy alternatives? Or is it about dumb people who lack the discipline and future orientation to establish healthy regimes to maintain proper weight and nutrition?

Tell me what you think about food addiction—any addiction—and I’ll tell you what your politics are.