Tuesday, February 12, 2013

OA (Oh No?)

12-step programs have guided countless individuals to sobriety and recovery.  I've worked with patients who fully attribute their substance abuse recovery to participation in "the rooms."  While some patients never take to the fellowship, citing a variety of objections (e.g., don't like the idea of a higher power, feel the organization is cultish, etc.), many find these self-help groups to be helpful and supportive.

Do these same benefits translate to the world of overeating? Is Overeaters Anonymous helpful or hurtful?

We know that that there is something inherently addictive about alcohol and other drugs.  With food, I'm not so sure.  Despite plentiful claims in the popular media, we don't have any good research that suggests that "food addiction" exists.  For an interesting summary on this debate, check out this dietitian's blog.  We know that people can demonstrate an addictive relationship around food, but this doesn't mean that the food itself is addictive.  Rather, behaviors like restriction and bingeing can be incredibly habit-forming.

Moreover, most of the foods that people label as addictive (e.g., sugar, carbohydrates, fats, etc.) are foods that they've tried to restrict in some ways. Deprivation can, as we know, lead to overeating.  For instance, almost every patient I see who tells me she's addicted to sugar happens to be restricting her carbs.  Once she  supplements her carbohydrate intake, much of the sugar cravings subside.

The problem with OA is that many groups (not all, but many) conceptualize food or certain foods as addictive.  As a solution, they preach abstinence (similar to other 12-step programs).  OA members will speak of their abstinence from sugar, wheat, etc.  Some OA sponsors will prescribe their sponsees specific meal plans.  Any departure from the meal plan is considered a relapse (i.e., back to Day 1).

The problem with this approach, if you're not guessing this already, is that abstinence equals deprivation!  As a result, many who try out OA, find themselves developing even greater problems with bingeing or overeating, as a result of the diet-binge cycle.  We're able to carve out an existence without alcohol or drug. but abstinence from food is impossible and abstinence from certain foods increases the experience of deprivation.  By defaulting to abstinence, OA does not teach members how to eat in moderation (which, in my opinion, is necessary to be functional around food in this world), contend with emotions that lead to overeating, or heal one's relationship with food.  It only makes it worse.  OA members may practice abstinence from various foods until a time in which they're presented with that food/can't take it any longer/give up. . . leading to one colossal binge.  I've worked with a number of patients who come into treatment, precipitated by an increase in disordered eating, which they attribute to OA.

Now, it may be possible to find OA groups and/or sponsors that are less restrictive and offer the typical benefits associated with 12-step groups.  But unless that's possible, those who struggle with compulsive eating may be better served through Anorexics and Bulimics Anonymous or emotional eating groups run by private practitioners who espouse a more intuitive approach to eating and food.


*thanks to Meliss, who begged the question : )


HikerRD said...

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RecoveringClaire said...

I don't think that abstenance from ANYTHING is useful. In recovery (so far), i have been taught that it's OK to eat any drink anything i want to, in moderation. I really am not keen on any organization that encourages withdrawl of a certain food type.

I Hate to Weight said...

thank you for this post! yay!! i so appreciate your prospective. i wrote such a long response...

my own experience - thru the 12 step process - the steps themselves (with service and some fellowship), i live a pretty peaceful life. AND for the first and only time in my life, these last three years, i'm not afraid of food. AND i know that food can not and will not solve my problems. so, i love the Steps

that being said, i'm ambivalent about food abstinence. i completely agree with you that deprivation leads to binging. and we live in a big world of "forbidden" foods. sounds almost impossible.

BUT i also believe there is the moment before the binge or even well before the binge, before the first twinkie of 20 twinkies (much like before the first drink of 20 drinks) when the 12 Steps, themselves, can be very helpful.

Kara Thinksthinblogger said...

Yes, I agree. I actually think Weight Watchers is restrictive enough to have the same effect.

Hayley said...

The path to recovery is undeniably difficult and the methodology is of course personal, in that you must find what works for you. My own experience with OA was not particularly helpful.

Mimmicking the tenants of AA, I did not find comfort in that I must absolve all power over food. In fact, any dietician or therapist will tell you that developing a healthy relationship with food IS crucial to recovery. In other words, following OA's mantra of giving up your power over food, at least for me, resulted in an even greater feeling of helplessness.

Mainly, I found it impossible to relate alcohol (which the body does NOT need) to food, which is essential to our overall health. Simply substituting the word "food" for "alchohol" seemed like an adlib I could not stomach.

Anonymous said...

As a veteran of OA, although not in recovery at the moment (not due to OA itself but my own choices), everyone in OA is allowed to pick a different food plan. Some choose to restrict certain foods, some don't. OA is not just for overeaters either -- my sponsor, who has been abstinent from anorexia for 15 years, chooses not to restrict ANY food and eats everything in moderation.

People judge OA because they don't understand there are no rules in the program.

Some restrict not to deprive themselves, but because they genuinely have problems with certain foods, just as alcoholics have problems with alcohol. There's a reason why alcoholics can no longer drink moderately and that's why they completely abstain from it.

To the commenter who stated abstinence from anything is bad, tell a recovering heroin addict that they can use heroin in moderation.

Some people find complete abstinence works for them, and as long as they do not feel deprived, then I say do what works for them.

OA has worked for thousands of people. It's just a matter of finding which approach works best.