Thursday, January 03, 2008

Eat, Drink, & Be Merry

Today, I sat around and did nothing. Well, not exactly nothing. . . I read a memoir, caught up on emails, did the crossword, closed my eyes a few times, took a long lunch. . . . In short, I attended jury duty.

My book? Caroline Knapp's, Drinking: A Love Story, which so far, I highly recommend. You might know Knapp better from the chronicle of her struggle with anorexia, Appetites: Why Women Want, published posthumously* in 2004. In reading, Drinking, I'm compelled to think more formally about the similarities between eating disorders and addictions. Since I specialize in both, I'm often struck by how analogous they seem, how sometimes my language involves mere word substitution in order to convey the difference. We use alcohol or substances the way we use (or don't use) food. To escape. To distract. To numb. To cope.

Knapp writes about attending an AA meeting, where alcoholism was described as a "fear of life." Sound familiar? She goes on to write about how she, personally, would diagnose alcohol dependence:
Are you driven by a feeling of hunger and need? When someone sets a bottle of wine on the dinner table, do you find yourself glancing at it subversively, possessively, the way you might look at a lover you long for but don't quite trust? When someone pours you a glass from the bottle, do you take careful note of the level of liquid in the glass, and measure it secretly against the level of liquid in the other glasses, and hold your breath for just a second until you're assured you have enough? Do you establish an edgy feeling of relationship with that glass, that wine bottle; do you worry over it, care about it, covet it, want it all for yourself? Can you bear the thought that it might run out, that you'll be left sitting there without it, alone and unprotected?
See what I mean? Substitute food for wine, and you've just diagnosed emotional eating.

Both alcohol/substance abuse and eating disorders are coping mechanisms, which allow us to tolerate difficult emotions, to manage our lives more effectively, until, of course, the coping strategy itself becomes problematic. Both represent behavioral addictions designed to ward off distress, triggered by similar internal/external stimuli. Both involve oral (in the case of most substances) fixation, signaling, in psychobabble, unmet dependency needs. Both destroy the lives of others and ourselves.

Not uncommonly, patients will present with both an eating disorder and alcohol/substance abuse. When one remits, the other, sometimes, will worsen. It's not surprising. The bottom line is, we need a way to cope, and when we're robbed of one weapon, we're quick to return to the arsenal to determine what remains. On my two-train commute home, the walls of one advertised Weight Watchers, the other Stolichnaya.

*A quick Google search reveals that the sober Knapp, a long-time smoker, died of lung cancer in 2002.


azusmom said...

The new WW ads make me just roll my eyes. "Stop Dieting." Just count every morsel you put in your mouth and every second of exercise.

My father used to work with Caroline Knapp. She was a cool lady.

æ said...

I echo your recommendation of this book, for so many reasons. It's an excellent portrayal of the inside world of addiction, and a touching autobiography.

I also think it does a nice job of highlighting the role "normal" looking families might play in addictions/compulsions.

take care,

swimfan93 said...
This comment has been removed by the author.
Chaoticheartt said...

That was the last book I read in 2007. I really enjoyed it too.

Anonymous said...

To your point, I read in a New York Magazine article about gastric bypass that at some WLS clinics, up to 1/3 of patients go on to have serious drinking problems.

Anonymous said...

Dr. Stacey, to me, *this* is a really intriguing idea--I've never read anything before about eating disorders and substance abuse going hand in hand like that. Maybe that should be your second book?

What about treatment? The emotional dynamics underlying each disorder may be similar, but my understanding is that the behavioral modification goals are different and possibly in opposition to each other. An anorexic has to learn to give up their obsessive control over their eating and relax into their impulses to eat and drink. An alcoholic has to *establish* obsessive control over their impulse to drink, and learn to be absolutely unyielding to their cravings for alcohol. So what does a therapist do with an anorexic alcoholic? How do you get someone to *start* going with the flow on food and *stop* going with the flow on drinking without getting everything all mixed up? (And how does an anorexic tolerate all the calories in alcohol anyhow? Does the power of the disease create a blind spot in them about that?)

I loved Caroline Knapp's writing about shyness and dog ownership, and felt terrible when she died so young.

swimfan93 said...

I have been (and still am) in treatment for anorexia and drug abuse. And I'm only 14 yrs old.
It has ruined my life, but diseases completely controlling me, driving me to 5 suicide attempts and multiple hospitalizations. But make you so isolated, which makes it so much harder to recover (without the support of friends).

disordered girl said...

I love that A&E's show Intervention includes people with Eating Disorders, because I really wish more people associated EDs with addictions. Before falling into an ED myself, I could read about addictions and intellectually understand the theory behind them. Now, when I watch that show I completely understand the fear and emotions driving them. No matter what coping mechanism their particular addiction is.

Sarah said...

This is a very good post, Dr. Stacey. As someone who struggles with an eating disorder and is in recovery from alcoholism, I think you are right on the money here. My ED has been a lot more prominent since I became sober. I'm astounded by the number of women I know in AA who also have or had EDs.

Another great alcoholism memoir I would recommend is "Parched" by Heather King.

Thanks for highlighting this important subject.

azusmom said...

Swimfan93, you are an amazing, strong woman. I know it doesn't feel like it right now, but you have so much going for you! Most people twice your age might not be able to deal with what you deal with every day, but here you are, doing it. You are a hero!
When we were 12, my best friend tried multiple times to kill herself. She was in and out of the hospital and treatment centers. Now we are both in our late 30's, she's married with 3 kids and a great career, and is very happy. I know you must hear people all the time say "you've got your whole life ahead of you," and you're probably tired of hearing it. But PLEASE keep fighting the good fight!

Tiptoe said...

I read Drinking awhile back and felt more kin to it than Appetites. There were many relevances for me although I've never struggled with alcoholism. I do think for some, there is a component of addiction to an eating disorder. And then with that, you can actually look at it in terms of biological value which is being studied more, giving a better validation.

drstaceyny said...

am--I agree (on both counts!)

ae--good point. Though the fact that her dad was an analyst should have clued most ppl in that the family wasn't so normal after all! ; )

sf--true, those in recovery certainly have to be careful re: their reading material! Some can be v. triggering. I understand your point abt e.d.'s being difficult to recover from b/c we have to eat. I don't, however, think (as you might agree) that food is the problem--it's the behaviors around food. I'll try to clarify this more soon.

ch--glad you enjoyed it!

anon--now that you mention it, I remember seeing that, too! Sad, and I wonder if it's even avoidable, given the psychological screen. . .

anon2--interesting question. I'll come back to this later (as I wrote above), but for now. . . I've seen a number of anorexic alcoholics who will tolerate the calories in alcohol (instead of solid calories). While the behaviors might differ (and seem to be in opposite directions), I think the underlying factors are similar and treatment can follow from that--recovery involves tolerance of emotions and enactment of healthier coping skills, rendering compulsive (anorexia) and impulsive (drinking) behaviors less likely.

sw--wow. I hope that you're getting good treatment and that you're finding a support network in person and online. I never would have guessed you were 14. All your experiences have surely wisened you.

dg--I agree. They seem so similar at the root.

sarah--you're welcome, and thanks for the additional book rec. Memoirs are my favorite genre.

am--what a nice thing to write. I'm happy to hear your friend pulled through.

tt--I haven't read Appetites, but I will. I'm glad you could identify w/Drinking. The research on the biology/genetics of e.d. can be immensely validating.

WifeMomChocoholic said...

Wow -- that description of the wine at the table was so totally me -- just substitute a great dessert. Ironically, I have never been a drinker because I didn't want to waste the calories!

butterfly said...

a really interesting read :)
currently i am really struggling with the battle to accept the calories of alcohol but am enjoying the escapism. i wonder why the lines become so blurred & the rules change.

it has been true for me, that when one behavior is under control another may flare up. i guess it all comes back to that escape/distract/numb, states that i crave far too frequently.

wandoflakes said...

Can someone get addicted to the feeling of an empty stomach? With alcohol one can achieve feelings of euphoria while fasting. The ultimate high. For me this state induces creative thoughts otherwise bottled up by day-to-day drudgery.

The troubles with A's said...

I just started a blog to discuss my problems with the two, and stumbled across yours. Though I am in recovery, I can ascertain that it is possible to have both and I think that more people should address it. The two A's have led me down a very dark path, especially when I learned alcohol makes it so much easier to be anorexic. Thanks for the article! It is nice to see that I am not alone in my personal struggle.