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.