We live in a culture of partial truths when it comes to food and alcohol. We tend to exaggerate our assets and minimize our liabilities. I used to do it too. I would go out on a Friday night and feel like a rock star after a few drinks, and not be honest about the bad behaviors and experiences that followed: the munchies and overeating, the unkind comments that I made to people I love, the crummy sleep, the difficulty functioning the next day while hung over, the blood sugar problems, the unsustainable cortisol levels, and the weight gain.
When most people think of addiction, an image of an alcoholic on the street with a bottle in a paper bag comes to mind. Or a junkie with track marks on their arms from injecting heroin. Or the opioid epidemic, or potheads. But what I’ve found in 25 plus years of medical practice is that it’s often a sticky relationship with more pedestrian substances like sugar or wine that holds my patients (and myself) back from greatness.
In those years of seeing patients—I’ve seen it all. I’ve witnessed many women who suffer from the harms of food addiction and alcohol use disorder. Puffy faces, puffy bodies, inflamed interiors. Cortisol dysregulation, loss of intestinal membrane integrity (leaky gut), dysbiosis, blood sugar problems, shrunken brains (hello, alcohol is a neurotoxin), fatty liver, breast cancer, and weight gain.
My Story with Addictive Tendencies
Food used to lie to me, especially when it came to flour, sugar, and quantities. Or more to the point, chocolate, wine, and French fries. Food would tell me I deserved it, that I had been working so hard and needed a break, that it would ease my discomfort. It was an old, maladaptive coping mechanism rooted in childhood. The full truth was those foods provided very short-term comfort and long-term problems: leaky gut, brain fog, blood sugar swings, insulin problems, a greater risk of breast cancer, and weight gain. I’ve overcome my food addiction and wrote a book about it, called The Hormone Reset Diet.
Alcohol used to lie to me. It told me I’m immune to the weight gain, brain fog, and other downstream consequences. It told me I could have one more glass, no big deal. It told me I’m a scintillating conversationalist and fantastic dancer. The full truth is that I’m much better at dialogue and dancing when I’m sober. And much more resourceful. While I’m not an alcoholic, it doesn’t matter. I’m no longer interested in the type of person that I became on alcohol. I love the freedom and leaner body of a sober person. Sober by choice.
Fortunately, food and alcohol no longer call to me, no longer tell me lies or half-truths. I got rid of the things with which I used to have a sticky relationship.
How Did We Get Here? The Stats
We overvalue the fun and undervalue the cost of addictive tendencies. In the moment, faced with a cupcake or a glass of fine wine, we don’t present value to what’s at stake. We don’t say to ourselves: “Darling, you’re hurting yourself. You don’t need to keep researching the topic and collecting more data. You’re aware of the cost, and it’s too high.” We don’t place enough importance on the cost of addictive behavior and realize our risk as women.
- Women are the fastest growing group of addicts in the United States.
- Women are more likely to be food addicts compared with men.
- Alcohol affects the female body very differently than it affects the male body. There are both sex and gender differences.
- Women are prescribed opioids more often than men. Women are more likely to become addicted to methamphetamines compared with men.
- Women more rapidly escalate from casual drug use to addiction, show more marked withdrawal with abstinence, and are less successful with treatment compared with men.
- Women tend to run low in progesterone starting in perimenopause (starting around age forty-three, give or take five to ten years), and research has shown that oral progesterone reduces cravings. It helped women but not men to experience less negative emotion and a more relaxed mood when provoked by stress.
- Social, behavioral, and biological factors that result in addiction are worse for women.
What’s the Root Cause?
So why do tell ourselves half-truths when it comes to food, alcohol, and technology? Cognitive distortions are one reason. Cognitive distortions are ways that our mind convinces us of something that isn’t completely true. These half-truths are used to reinforce negative thinking or emotions — telling ourselves things that sound rational and accurate, but really only serve to keep us feeling bad about ourselves.
Another root cause is hyperarousal. Women are more vulnerable to a heightened stress state in response to threat. We go into fight-flight-freeze. We forget our more resourceful strategies like tend-and-befriend. Signs of hyperarousal: sleep problems, difficulty concentrating, irritability, anger, and angry outbursts, panic, anxiety, feeling easily startled, and then there’s the self-destructive behavior, like addictive tendencies. You just feel all jacked up. Sometimes food and alcohol seem like the best solution to hyperarousal, but the very thing you hope you’re getting (relief) is being robbed from you. We need to work on a more effective medicine. I believe it’s personalized lifestyle medicine, the type of care I practice.
If I put on my neuroscience hat for a moment, another reason we get stuck in half-truths about our behaviors is biochemical. Addictive tendencies can be seen as abnormal dopamine activity in the brain’s reward center, the nucleus accumbens, which lights up like a Christmas tree when you seek pleasure from certain sources like sugar and alcohol. Dopamine triggers reward, but then your opioid receptors create pleasure, or the hook.  When you deny the craving—for sugar, alcohol, your smartphone, and the like—the dopamine levels in the nucleus accumbens drop precipitously, similar to when a user withdraws from a drug. When you relapse, dopamine, serotonin, and norepinephrine activity soars. So we need to work around this faulty physiological setting that promotes craving by creating an optimal zone—restore homeostasis—thereby avoiding the extreme of hyperarousal.
If you want to learn more about addictive tendencies and a functional medicine approach to healing, check out the Addiction Summit.
A Call to Action
We are in need of a revolution of smart women who stop turning to sugar, flour, quantities, and alcohol to deal with the daily exigencies of life—those small and petty discomforts that are inevitable and a source of distress. There are so many other options that work far better. We need to address our cognitive distortions. We need to heal our hypervigilance. We need to adopt lifestyle medicine.
Recovery and healing are possible. You can view a troubled relationship with food or alcohol as an initiation, a higher calling to a life that’s more able to serve you. Truly, it is a choice in each moment. It’s not a matter of just going to a health coach or buying an app to have the healing done to us; it’s a daily decision that we make to live a certain way, congruent with our highest values. It’s an inside job, where you focus on resetting stress response system and dopamine with specific strategies of lifestyle medicine, including food, supplements, and daily practices. The takeaway is that you can change your stress response and dopamine levels simply with what you eat and don’t eat, drink and don’t drink, supplement, and how you consciously think and move. Learn more strategies at the Addiction Summit, hosted by Paul Thomas MD.
Next, I need to work on my sticky relationship with technology.
How about you? Do you have a sticky relationship with food, alcohol, or technology? Are there half-truths that you tell yourself about one of these substances or another, that lead to adverse consequences? Let me know in the comments below.
 Carr, M. M., et al. “Measurement Invariance of the Modified Yale Food Addiction Scale 2.0 Across Gender and Racial Groups.” Assessment July 1 (2018): 1073191118786576. doi: 10.1177/1073191118786576. [Epub ahead of print]
 Milic, J., et al. “Menopause, ageing, and alcohol use disorders in women.” Maturitas 111 (2018): 100-109.
 “Annual surveillance report of drug-related risks and outcomes.” CDC National Center for Injury Prevention and Control https://www.cdc.gov/drugoverdose/pdf/pubs/2017-cdc-drug-surveillance-report.pdf, accessed September 16, 2017.
 Rungnirundorn, T., et al. “Sex differences in methamphetamine use and dependence in a Thai treatment center.” Journal of Addiction Medicine (2017).
 Becker, J. B. “Sex differences in addiction.” Dialogues in Clinical Neuroscience 18, no. 4 (2016): 395-402.
 Schweizer, E., et al. “Progesterone co-administration in patients discontinuing long-term benzodiazepine therapy: Effects on withdrawal severity and taper outcome.” Psychopharmacology 117, no. 4 (1995): 424-429; Michener, W., et al. “The role of low progesterone and tension as triggers of perimenstrual chocolate and sweets craving: Some negative experimental evidence.” Physiology & Behavior 67, no. 3 (1999): 417-420; Fox, H. C., et al. “The effects of exogenous progesterone on drug craving and stress arousal in cocaine dependence: Impact of gender and cue type.” Psychoneuroendocrinology 38, no. 9 (2013): 1532-1544; Milivojevic, V., et al. “Effects of progesterone stimulated allopregnanolone on craving and stress response in cocaine dependent men and women.” Psychoneuroendocrinology 65 (2016): 44-53.
 Other endogenous neuromodulators of addiction include serotonin, endocannabinoids, enkephalin, dynorphin, galanin, orexin/hypocretin, GABA (your inner anti-anxiety molecule, as covered in chapter 2), glutamate, and NMDA pathways (a glutamate receptor involved mostly in memory, chapter 8). The Hypothalamic Pituitary Adrenal (HPA) axis and circadian clock system are also involved. What I’ve found from taking care of patients with addiction is that you don’t need knowledge of neuroscience to recover, but a limited overview of the citations are provided below.
Maldonado, R., et al. “Endogenous cannabinoid and opioid systems and their role in nicotine addiction.” Current Drug Targets 11, no. 4 (2010): 440-449; Gardner, E. L. “Addiction and brain reward and antireward pathways.” Chronic Pain and Addiction 30, (2011): 22-60; Butelman, E. R., et al. “κ-opioid receptor/dynorphin system: Genetic and pharmacotherapeutic implications for addiction.” Trends in Neurosciences 35, no. 10 (2012): 587-596; Blum, K., et al. “Dopamine in the brain: Hypothesizing surfeit or deficit links to reward and addiction.” Journal of Reward Deficiency Syndrome 1, no. 3 (2015): 95-104; Klenowski, P., et al. “The role of δ‐opioid receptors in learning and memory underlying the development of addiction.” British Journal of Pharmacology 172, no. 2 (2015): 297-310; Parekh, P. K., et al. “Circadian clock genes: Effects on dopamine, reward and addiction.” Alcohol 49, no. 4 (2015): 341-349; Barson, J. R., et al. “Hypothalamic neuropeptide signaling in alcohol addiction.” Progress in Neuro-Psychopharmacology and Biological Psychiatry 65 (2016): 321-329; James, M. H., et al. “A decade of orexin/hypocretin and addiction: Where are we now?.” Behavioral Neuroscience of Orexin/Hypocretin, (2016): 247-281; Dravolina, O. A., et al. “mGlu1 receptor as a drug target for treatment of substance use disorders: Time to gather stones together?.” Psychopharmacology 234, no. 9-10 (2017): 1333-1345; Norman, H., et al. “Endogenous opioid system: A promising target for future smoking cessation medications.” Psychopharmacology 234, no. 9-10 (2017): 1371-1394; Volkow, N. D., et al. “The dopamine motive system: Implications for drug and food addiction.” Nature Reviews Neuroscience 18, no. 12 (2017): 741-752; Webb, I. C. “Circadian rhythms and substance abuse: Chronobiological considerations for the treatment of addiction.” Current Psychiatry Reports 19, no. 2 (2017): 12.
 Gilman, J. M., et al. “Why we like to drink: A functional magnetic resonance imaging study of the rewarding and anxiolytic effects of alcohol.” Journal of Neuroscience 28, no. 18 (2008): 4583-4591; Berrettini, W. “Opioid pharmacogenetics of alcohol addiction.” Cold Spring Harbor Perspectives in Medicine 3, no. 7 (2013): 97-113; Pattison, L. P., et al. “Changes in dopamine transporter binding in nucleus accumbens following chronic self‐administration cocaine: Heroin combinations.” Synapse 68, no. 10 (2014): 437-444.