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Emotional EATING COMFORT FOODS

From Smoking To Drinking Finding The Link Starting YOUNG One Size Fits All

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INSERT 2 StartingYoung Insight into adolescent addiction comes as new guidelines urge early prevention

Treatment providers have known for years that adolescents are more susceptible to drug use and consequently, addiction. But now they might know why. Researchers recently discovered a specific pathway in the brain that makes adolescents more prone to problematic substance use, which could lead to stronger prevention efforts. By studying how cocaine affected the behavior of young and adult mice differently, researchers found that a mechanism in the brain which regulates specific protein production also controls addictive behaviors. By manipulating that mechanism, researchers were able to mitigate cocaine’s addictive effects. “Now we have a bidirectional switch that can turn on and off the cocaine-induced changes in the brain,” says lead researcher Dr. Mauro Costa-Mattioli of the Baylor College of Medicine.

“ The excitement of this study is that now perhaps we have a signalling pathway that could be targeted for the treatment of addiction. ”

- Dr. Mauro Costa-Mattioli, Baylor College of Medicine

One size fits all What’s most exciting about the study is that the pathway does not appear to be specific to cocaine. A second study examining nicotine returned similar results, leading researchers to believe any treatments targeting the pathway would be effective for all substances. “In the case of nicotine, it’s exactly the same thing,” Dr. Costa-Mattioli says. “All the drugs of abuse, they reduce the activity, they hijack or change this mechanism.” Researchers say they’re still interested to see if the mechanism plays a role in the transition from social substance use to more problematic use. But they say simply identifying such a crucial link of the substance use chain could lead to significant prevention methods. “Of course, the excitement of this study is that now perhaps we have a signalling pathway that could be targeted for the treatment of addiction,” Dr. Costa-Mattioli says.

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Total improvement Experts say the benefits of implementing early intervention efforts far outweigh the cost. Although limited data exists, studies show investing just one dollar can produce anywhere from a few dollars to $26 in cost savings down the road. “Thus a well-designed, well- implemented early childhood intervention can dramatically benefit the community and society as well as improve children’s and families’ quality of life,” Dr. Volkow says. But the benefits of early intervention go beyond substance abuse. Experts say many of the risk factors for substance abuse are the same indicators for other social, behavioral and academic problems. They say creating a prevention program to address and reduce the risk of substance abuse will pay big dividends across the board. “Interventions designed to reduce early risk factors show benefits in a wide range of areas,” Dr. Volkow says. “Including improved personal and social functioning, better performance in school, and less involvement with the juvenile justice system or mental health services.” 

“ Early childhood intervention can dramatically benefit the community and society as well as improve children ’ s and families ’ quality of life. ” - Dr. Nora Volkow, NIDA director

First eight years To address adolescent drug use, experts say prevention efforts have to start earlier than most would expect.The National Institute on Drug Abuse (NIDA), the government’s top agency on substance use, recently released new guidelines suggesting prevention education should start in the first eight years of a child’s life. Officials acknowledge that early childhood is not a time period normally associated with drug use. But they say factors with family, school and community environments can shape development of certain emotional and behavioral issues that can manifest in substance abuse problems even decades later. “Central to intervening early is the idea of shifting the balance of risk and protective factors in a way that builds a foundation for optimal social development and resilience,” says NIDA Director Dr. Nora Volkow.

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By Heather Hateld | WebMD Feature | Reviewed by Charlotte E. Grayson Mathis, MD EMOTIONAL EEAATTIINNGG EMOTIONAL AT

ere are several di erences between emotional hunger and physical hunger, according to the University of Texas Counseling and Mental Health Center web site: 1. Emotional hunger comes on suddenly; physical hunger occurs gradually. 2. When you are eating to ll a void that isn’t related to an empty stomach, you crave a specic food, such as pizza or ice cream, and only that food will meet your need. When you eat because you are actually hungry, you’re open to options. 3. Emotional hunger feels like it needs to be satised instantly with the food you crave; physical hunger can wait. 4. Even when you are full, if you’re eating to satisfy an emotional need, you’re more likely to keep eating. When you’re eating because you’re hungry, you’re more likely to stop when you’re full. r e

Are You an Emotional Eater?

You are an emotional eaters if you answer yes to any of the following questions: Do you ever eat without realizing you’re even doing it? Do you often feel guilty or ashamed after eating? Do you often eat alone or at odd locations, such as parked in your car outside your own house? After an unpleasant experience, such as an argument, do you eat even if you aren’t feeling hungry? Do you crave specic foods when you’re upset, such as always desiring chocolate when you feel depressed? Do you feel the urge to eat in response to outside cues like seeing food advertised on television? Do you eat because you feel there’s nothing else to do? Does eating make you feel better when you’re down or less focused on problems when you’re worried about something? If you eat unusually large quantities of food or you regularly eat until you feel uncomfortable to the point of nausea, you have a problem with binge eating. Please speak to your health care professional.

5. Emotional eating can leave behind feelings of guilt; eating when you are physically hungry does not. COMFORT FOODS When emotional hunger rumbles, one of its distinguishing characteristics is that you’re focused on a particular food, which is likely a comfort food. “Comfort foods are foods a person eats to obtain or maintain a feeling,” says Brian Wansink, PhD, director of the Food and Brand Lab at the University of Illinois. “Comfort foods are often wrongly associated with negative moods, and indeed, people often consume them when they’re down or depressed, but interestingly enough, comfort foods are also consumed to maintain good moods.” Ice cream is rst on the comfort food list. After ice cream, comfort foods break down by sex: For women it’s chocolate and cookies; for men it’s pizza, steak, and casserole, explains Wansink. And what you reach for when eating to satisfy an emotion depends on the emotion. According to an article by Wansink, published in the July 2000 American Demographics, “ e types of comfort foods a person is drawn toward varies depending on their mood. People in happy moods tended to prefer … foods such as pizza or steak (32%). Sad people reached for ice cream and cookies 39% of the time, and 36% of bored people opened up a bag of potato chips.”

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By Jennifer R. Scott | Updated February 15, 2014 Emotional eating can be a di£cult challenge when you are trying to lose weight. It’s a di£cult habit to break once it’s a part of your life, but by understanding what causes it and nding ways to cope that don’t involve food, you can overcome it. Read on to learn how to prevent and Prevent and Cope with Emotiona l Eating Before you can learn to cope with emotional eating, you must rst understand what it is. As the name implies, emotional eating is characterized by repeatedly eating in response to feelings rather in response to hunger to gain physical nourishment. Emotional eaters often consume large amounts of food at one sitting, which is sometimes referred to as a binge. Understand the Emotional Cues Many emotional eaters eat in response to ve common cues, which include boredom, loss of control and anger. Only you can know if these cues prompt you to eat emotionally: Eating a snack a few times a week because you are bored may not be a problem; eating a container of ice cream each time you’re angry probably is. Understanding these cues and learning how to choose another response — such as exercising to release pent-up anger —will help you end the cycle of eating in response to these feelings. Identify Your Triggers While many emotional eaters share cues in common, there may be certain feelings or situations that trigger you to eat that do not a ect someone else. One of the best ways to understand your own personal emotional eating triggers is to keep a “food and feelings” food diary. In it, you simply record what you eat and how you were feeling before, during and after your binge. Stress A ects Your Eating Habits Stress is one of the most common reasons that women in particular overeat. Stress is alleviated by eating certain foods and many women get in the habit of reducing tension by enjoying these foods rather than dealing with the source of their tension. By creating self-care skills that allow you to identify non-food solutions to tension-causing situations, you will be much less likely to cope with emotional eating. What is Emotional Eating?

(Please note: Extreme feelings of hopelessness are typical of chronic depression. Please talk to a mental health professional if you nd yourself feeling perpetually hopeless.) Lack of Control You think: My life is out of control. ere is nothing in it that I am in charge of. Everyone and everything around me rules my life. Except for eating…I can eat whatever I want, whenever I want it. So I will. Feeling Unappreciated Perhaps you’ve accomplished something exceptional at work and no one has noticed. Or maybe you’ve made a personal achievement you’d dreamed of for years. But no one at home shares your pride. You nd yourself tempted to congratulate yourself by “treating” yourself to a binge. Boredom ere’s nothing to do. Nowhere to go. Perhaps you feel lonely, too. ere’s nothing at home to occupy your mind or your hours. But there is a pantry full of comfort food that will kill some of that empty time. If you t into any one of these ve proles, try sitting down with a piece of paper and brainstorming to nd alternative behaviors to eating. You may be surprised at the solutions you come up with…and at just how well they work once you try them. en, write your ideas on notecards and post them where you will see them in your moment of need — how about on the refrigerator door or next to the pantry? Accepting why you eat the way you do can be a big step towards breaking the cycle of emotional eating.

eat emotionally after a stressful day. Let Go of All or Nothing inking

All or nothing thinking means you feel like you must do something perfectly or you should not do it at all. We often are either “on” our diets or “o ” of them. e sense of failure this brings can cause negative emotions that in turn trigger a binge. By allowing yourself the freedom to face every day as a fresh start and see every decision as independent of the one before it, you may nd emotional eating is much easier to avoid.

5 Common Emotiona l Eating Cues Emotional eating is the practice of consuming large quantities of food — usually “comfort” or junk foods — in response to feelings instead of hunger. Some of the common emotional eating cues are: Anger Whether you’re angry at yourself, another person or a situation, you stiªe your feelings using food rather than confronting them and releasing them. It’s easier to smother a problem than to By Jennifer R. Scott | Updated February 15, 2014

deal with it. Hopelessness

You think: Nothing really matters anyway. Nothings ever going to change or get better for me. So, why should I care about my health or weight? Besides, eating makes me feel better.

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FIGHTING FIRE WITH FIRE

“I think this opens up a large world view with regards to this system in the brain.” - Dr. Heath Schmidt

“These results are very provocative and suggest these compounds could be repur- posed for drug addiction.” - Dr. Heath Schmidt,

University of Pennsylvania

D espite years of stigma, medication-assisted treatment (MAT) is steadily gaining in popularity among treatment providers. Government groups like the U.S. Department of Health and Human Services are actively campaigning to get more providers to offer MAT as a potentially vital resource for patients. While such groups often promote well-known medications such as methadone and buprenorphine, drug researchers are looking for new medications that could be a lifeline to patients in need. But new medications can cost millions to research and take years to get on the market. That’s why some researchers are taking a closer look, and finding success, with drugs already approved by the FDA. CURBING COCAINE USE Researchers at the University of Pennsylvania say a drug already on the market for diabetes may be able to curb cocaine use. The FDA-approved drug Byetta, used to regulate blood sugar in diabetic patients, is derived from a natural hormone known as GLP-1. The research team looked at how the hormone functioned in rats and found that the same hormone that regulates food intake could be used to suppress cocaine consump- tion. “These results are very provocative and suggest these compounds could be repurposed for drug addiction,” says Dr. Heath Schmidt, one of the lead researchers. “We have seen a reduction in cocaine consumption…but it doesn’t completely abolish it.” Currently, there is no FDA-approved drug for the treatment of cocaine abuse. But because Byetta and a similar drug have already gained federal approval, researchers say that leaves fewer hurdles before they could be used in treatment settings. Although still far from human trials, research- ers say they’re optimistic, especially because their research suggests the hormone is not specific to cocaine and could be used in treatment of other substance abuse disorders. “I think this opens up a large world view with regards to this system in the brain,” Dr. Schmidt says. “There’s really a lot to be explored here and I think it’s really an exciting time to be in the field and exploring the GLP- 1 system.”

ADJUSTING ALCOHOL CONSUMPTION Another team of researchers at the University of Queensland in Australia believe the FDA-approved drug pindolol could be used to stop alcohol abuse. Pindolol is an anti-hypertensive medication used to treat high blood pres- sure. But because of the way it interacts with neurotransmit- ters in the brain, they believe it could also be effective in treating alcohol use disorders (AUDs). To study the drug’s effect, the team used mice and exposed them to an alcohol consump- tion regimen similar to a binge drinking cycle common in humans. For mice also given pindolol, the team found they were able to reduce drinking in the long term (after at least 12 weeks). The team did not see as positive of results in the short term (only four weeks), but they say they’re still excited about its potential uses. “Although further mechanistic investigations are required, this study demonstrates the poten- tial of pindolol as a new treat- ment option for AUDs that can be fast-tracked into human clin- ical studies,” the authors wrote.

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“There’s a lot of information that can be gained from when somebody relapses.” - Dr. Stephanie Carreiro, University of Massachusetts

Fitness trackers could help prevent relapses

Dr. Carreiro says wearable biosensors can detect a relapse event for some substances (like heroin and cocaine) by sensing a change in heart rate or other physical conditions. The treatment provider can then use the fitness tracker’s other information, like the time and location of the relapse event, to develop a profile about the conditions that prompt a patient to use. “It gives us very specific contextual information and serves as that reminder to the patient that someone could potentially know right away when they relapse,” Dr. Carreiro says.

Fitness trackers, or wearable biosensors, like Fitbit and Jawbone are the latest fitness trend to gain widespread popularity. But some believe they could be used to treat addiction as well. New research suggests the devices can be used to reliably detect relapses, which could then give treatment providers the information they need to prevent relapses in the future. “There’s a lot of information that can be gained from when somebody relapses,” says Dr. Stephanie Carreiro, a researcher from the University of Massachusetts.

ACCOUNTABILITY MATTERS That accountability to someone who could see the relapse is an important step in moving past simple self-reporting and drug testing. People can lie during self-reports and drug testing will only show that drugs were used, but not information like how much was used, when it was used, and where. Because the sensors can be easily removed, the system will only work for patients who are truly motivat- ed to stay sober. Dr. Carreiro says rather than a big brother scenario with treatment providers tracking a patient’s movements, the devices simply connect a patient to their support network. “We could potentially trigger an interaction with a patient just seeing if they’re okay and need some help,” Dr. Carreiro says.

“It definitely served as a reminder that there was something motivating them to stay sober.”

- Dr. Stephanie Carreiro

SIMPLE REMINDER In a study of 15 patients, nearly everyone kept wearing the devices even when relapsing. Dr. Car- reiro says that’s because many people are already used to wearing fitness trackers, and the treatment plan simply fits into the daily routines they’ve al- ready established. Researchers also say just having a physical object on a patient’s wrist to remind them about their dedication to sobriety can be enough to prevent a relapse. “Multiple people looked at it and thought of going back to jail or being there for their children,” Dr. Carreiro says. “It definitely served as a reminder that there was something motivating them to stay sober.”

WHAT ABOUT PREVENTION? The ultimate goal is to prevent relapses and keep patients on the path to sobriety. While the tech- nology is advancing quickly, researchers say the collective knowledge base simply isn’t there yet to predict a relapse event. But as they conduct more studies and develop better algorithms with the information gained, they should be able to tailor interventions to a specific patient and hopefully keep them from relapsing. “We need to continue to define different pro- files so that we can get a more complete under- standing of what’s happening,” Dr. Carreiro says. “That’s when it will be the most powerful.”

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Marijuana users are five times more likely to develop an alcohol abuse disorder, according to a new study

When it rains it pours. The old idiom may be familiar to many drug users who often find themselves battling more than one addiction. While previous research has shown multiple substance abuse disorders often go hand in hand, a new study suggests simply using marijuana can lead to a much higher risk of developing an alcohol use disorder.

Finding the Link Researchers at Columbia University analyzed data from 27,461 people who had used marijuana at the time of first testing, but had no history of alcohol related disorders. When researchers checked back three years later, they found marijuana users were five times more likely to have developed an alcohol abuse disorder.

Researchers said they were surprised the link wasn’t between marijuana use disorder, but simply marijuana use itself. “I think it’s important for people to be aware that there are certain behaviors that come with specific risks,” says Dr. Renee Goodwin, one of the lead researchers. “It would be particularly useful for youth.” Because youth are at a higher risk of experimenting with both drugs and alcohol, researchers said educating them about the total scope of risk is not only important, but could help curb problematic behaviors. “Preventing or delaying the onset of marijuana use could prevent or delay the onset of alcohol use disorder,” Dr. Goodwin says. “Statistically it should.”

“I think it’s important for people to be aware that there are certain behaviors that come with specific risks.” -Dr. Renee Goodwin

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“Preventing or delaying the onset of marijuana use could prevent or delay the onset of alcohol use disorder.” -Dr. Renee Goodwin

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Uses In Treatment For those already struggling with marijuana or alcohol use disorders, researchers said the knowledge that the two behaviors are linked could help people see the bigger picture of their addiction, and could prove useful in their journey toward recovery. “In some ways it may seem self- evident, but it may not be,” Dr. Goodwin says. “If you’re trying to quit drinking, it’s good to know that quitting marijuana could increase your chance of being successful.”

Zero relationship to mood and anxiety disorders As marijuana use has increased in the U.S., with some states even voting for legalization, some have wondered what the psychological cost will be to users. To investigate the question further, other researchers at Columbia University also conducted a recent study to determine if a link exists between increased marijuana use and psychiatric disorders. Although the results, published in the journal JAMA Psychiatry, mimicked previous research in showing a strong relationship between marijuana use and other substance abuse disorders, the findings in regards to psychiatric disorders were much different. The study showed no relationship between marijuana use and increased instances of mood and anxiety disorders, only substance abuse disorders. But despite the lack of a connection, researchers still cautioned against public policy that could lead to increased marijuana use. “The lack of association between more frequent cannabis use with increased risk of most mood and anxiety disorders does not diminish the important public health significance of the association between cannabis use and increased prevalence and incidence of drug and alcohol use disorders,” the authors wrote. 

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