[Addictive eating behavior: bulimia nervosa].
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Although addictive behavior is generally associated with drug and alcohol abuse or compulsive sexual activity, chocolate may evoke similar psychopharmacologic and behavioral reactions in susceptible persons. A review of the literature on chocolate cravings indicates that the hedonic appeal of chocolate (fat, sugar, texture, and aroma) is likely to be a predominant factor in such cravings. Other characteristics of chocolate, however, may be equally as important contributors to the phenomena of chocolate cravings. Chocolate may be used by some as a form of self-medication for dietary deficiencies (eg, magnesium) or to balance low levels of neurotransmitters involved in the regulation of mood, food intake, and compulsive behaviors (eg, serotonin and dopamine). Chocolate cravings are often episodic and fluctuate with hormonal changes just before and during the menses, which suggests a hormonal link and confirms the assumed gender-specific nature of chocolate cravings. Chocolate contains several biologically active constituents (methylxanthines, biogenic amines, and cannabinoid-like fatty acids), all of which potentially cause abnormal behaviors and psychological sensations that parallel those of other addictive substances. Most likely, a combination of chocolate's sensory characteristics, nutrient composition, and psychoactive ingredients, compounded with monthly hormonal fluctuations and mood swings among women, will ultimately form the model of chocolate cravings. Dietetics professionals must be aware that chocolate cravings are real. The psychopharmacologic and chemosensory effects of chocolate must be considered when formulating recommendations for overall healthful eating and for treatment of nutritionally related health issues.
Immoderate consumption of alcohol was found to be related to three other potentially addictive behaviors (illicit drug use, smoking, and caffeine consumption) in a randomly drawn sample (n = 1253) of American adults. In addition, alcohol consumption was found to be related to nutritional, life style, safety, and health monitoring preventive behaviors. Although the underlying mechanism for these behaviors is not clear, possibilities include the subsumption of both addictive and other preventive behaviors under a more generalized risk taking (or risk avoidance) dimension.
Despite some skepticism about the existence of sexual addiction, the addiction model has proven very useful for treating compulsive sexual behaviors. Addictive sexual disorders often coexist with chemical dependency and are a frequently unrecognized cause of chemical dependency relapse. Sex addiction also contributes significantly to the spread of HIV disease. This paper reviews the differential diagnosis of addictive sexual disorders, their assessment. their treatment, and their interaction with chemical dependency, and provides information about 12-step (mutual-help) resources.
OBJECTIVE: To offer a taxonomy of types of feedback and describe potential mechanisms of action particularly in the area of addictive behaviors. METHOD: Reviewed the literature to examine support for types-Generic, Targeted, and Personalized-and for mechanisms of feedback. RESULTS: Although it is not clear how it works, feedback is thought to offer important information, to create a sense of caring and helping relationship, to reach more directly decisional considerations, to increase engagement in the materials, to increase motivation, or to provide social comparison and norms. CONCLUSIONS: Avenues for future research in search of the most effective manner of using feedback to promote health behavior change are discussed.
This paper describes the major findings emanating from a long-term research program conducted in Baltimore, Maryland, on the drugs-crime relationship. It is the compilation of experiences, studies, and findings related to the research career of David N. Nurco, D.S.W., and his colleagues. Covering a period of over 30 years, the program of research, described in the report from the personal perspective of Dr. Nurco, has moved from the study of the nature and correlates of narcotic drug use to the development of data-based interventions. Topics investigated involve many aspects of narcotic addiction, including the relationship between addiction status and crime rates; changes in addict behavior over time; individual variation among addicts in the type, frequency, and severity of crime; and an examination of the early adolescent behavior of males who eventually become narcotic addicts in contrast to that of their never-addicted peers. It concludes with a description of the program's ongoing research, principally dealing with community-based interventions.
This article suggests that the field of addiction study and treatment remains in a state of conceptual chaos. The addictions is an emerging scientific field that lacks conceptual clarity. To develop the precision necessary for scientific advance, we must begin by developing improved definitions of substance use, abuse, dependence, and addiction. Complicating matters, psychoactive substance use is not a necessary and sufficient cause of addiction. For example, pathological gamblers experience addiction, including tolerance and withdrawal, often in the absence of any drug use. The neurobiology of subjective experience may be a more important factor in helping to explain addictive behaviors. Consequently, this article concludes that it is improper to consider drugs as the necessary precondition for addiction. Better operational definitions will advance addictions research.
Oxytocin (OT) has been implicated in neuroadaptive processes such as learning, memory, and social-affiliative behavior as well as in the regulation of physiological responses leading to adaptation to the changing external and internal environment. Drugs of abuse constitute a major challenge to the homeostasis of the body and behavior. Drug tolerance, dependence and addiction may involve neuroadaptive mechanisms related to learning and memory at cellular and systems levels. Considerable effort has been made toward the understanding the neurobiological mechanisms of addictive behavior. Neuropeptides OT and vasopressin (VP) might be involved in these processes based on their effects on neuroadaptation and on their neuroanatomical localization and pharmacological actions. It has been demonstrated that both OT and VP have modulatory effects on opiate and alcohol tolerance and dependence. This chapter summarize the effects of OT, and in lesser extent VP, on neuroadaptation to cocaine, a psychostimulant drug of abuse. We have shown that OT inhibits acute cocaine-induced locomotor hyperactivity, exploratory activity and stereotyped behavior in rodents. Furthermore, OT facilitated, whereas VP inhibited the development of behavioral sensitization to cocaine. In a different model, OT inhibited the development of tolerance to the stereotyped behavior-inducing effects of cocaine as well as cocaine intravenous self-administration in rats. We demonstrated that OT acts through its specific receptors in the basal forebrain and in the hippocampus. OT and VP contents in the hypothalamus and limbic structures were altered by acute and chronic cocaine administration in a dose-dependent and region-selective manner. The differential plasticity of the brain OT-ergic and VP-ergic neurotransmissions in response to cocaine may underlie the differences in the involvement of these neuropeptides in cocaine addiction. Interaction of OT with dopaminergic neurotransmission in the nucleus accumbens, a key brain structure in drug addiction, as well as OT-ergic regulation of hippocampal processes may be among the mechanisms of action through which OT modulates neuroadaptation to cocaine. A better understanding of the role of OT in neuroadaptation to cocaine may provide an insight into both the mechanisms of neuropeptide actions in the brain as well as into the neurobiology of drug addiction.
The literature on addictions treatment cost offsets suggests that resolving addictive disorders in the general medical setting will drive down the demand for health care, promote more efficient use of care by both patients and their families, and preserve scarce resources that can be deployed more wisely elsewhere. The demand to reduce waste and trim health care expenditures challenges the historic gulf between general medical practice and the management of addictive behaviors. An example of an addiction treatment technology developed in medical settings for use by medical personnel, brief intervention, is reviewed, with reference to its cost-saving potential under health care reform.
BACKGROUND: Relapse is a major problem in the treatment of addictive behaviors. Conditioning models of alcohol addiction suggest that stimuli associated with previous drug use (cues) may initiate relapse in a definite group of alcoholics. Event-related potentials (ERPs) might be useful to reveal the brain functional substrates of cue-reactivity. METHODS: In a preliminary investigation, 11 alcohol-dependent patients who did not take part in the electrophysiological study completed a structured interview to rate 80 words as to the degree of relatedness to alcohol. Based on these results, cue-reactivity for 15 alcohol-related and 15 unrelated word cues, each repeated eight times, was investigated in 19 alcohol-dependent men (44.2 +/- 8.5 years) and 19 healthy control men (42.5 +/- 12.5 years). RESULTS: A cue-reactivity that consisted of significantly higher amplitudes in the ERPs after alcohol-related words compared with unrelated words was found in alcohol-dependent patients, but not in controls, at the electrode location Pz [F(1,36) = 5.2,p < 0.05]. CONCLUSIONS: Consistent with the hypothesis, only alcohol-dependent patients were characterized by signs of increased cerebral activity associated with alcohol-related compared with unrelated cues. Therefore, the results support the concept of cue-reactivity in alcoholism based on a neurobiological measurement. Future investigations will show whether this cue-reactivity can be applied to assess the risk of relapse in individual alcohol-dependent patients.
Results of an investigation on the urinary excretion of codeine and morphine after oral ingestion of 1 mg.kg-1 b.w codeine are reported. The investigation run on seven clinically healthy subjects showed: low digestive absorption of codeine (# 20%); rapid biotransformation of codeine into morphine (first urines excreted after absorption); rapid disappearance of codeine from urines (#30 hrs); persistence of morphine alone (#68 hrs); rapid evolution of the codeine/morphine ratio (inversion of the ratio after #18 hrs); total elimination of morphine which can be greater than for codeine; very different half-life periods for codeine and morphine (5.1 and 13.6 hrs); no other codeine metabolites (nor-codeine and nor-morphine); very high individual variations; one subject with low activity of cytochrome P 450 dbl/buFL. Finally, in an epidemiological survey of drug addict behaviors and detection of drug addiction, it seems very difficult, may be even illusory and hazardous, to try and justify morphine found in urines (morphine, heroin, codeine, codethyline, pholcodine...) except in the very legitimate case where the ratio of urine concentrations of codeine and morphine is greater than one.
The stages of change model has shown promise in advancing knowledge about smoking behavior change and other negative addictive behaviors. The model was applied to the study of exercise, a healthy rather than unhealthy behavior. A stages of exercise behavior questionnaire was administered to a sample of 235 employees. Next, the ability of a second questionnaire measuring physical activity behavior to differentiate employees according to stage of exercise was tested. Results revealed that 51% of employees were participating in no physical activity (Precontemplation, Contemplatation) and 49% were participating in occasional or regular physical activity (Preparation, Action, Maintenance). Scores on physical activity behavior items significantly differentiated employees among the stages. This model developed on smoking and other behaviors can be generalized to exercise behavior. Understanding the stages of exercise behavior could yield important information for enhancing rates of participation in physical activity.
Modern approaches to the treatment of addiction have been influenced by several important factors. These include advances in our understanding of the nature of addiction based on longitudinal studies, and progress in elucidating the biological underpinnings of addictive behavior. In addition, changes in the system for delivery of services have begun to shape the way that addiction is treated.