Editor’s Note: I met David Courtwright at an excellent addiction conference that he organized last fall and which is fortunately recorded online. His clear thinking about addiction, approached from the fresh perspective of a historian, provides some interesting and provocative ideas for clinicians as we cautiously begin to expand our field beyond substance use disorders. Here are some ideas that he shared with us about food and addiction.
“Food as a Drug: How Good Is the Analogy?” was the title of a presentation David Courtwright gave at a conference on “Addictions Old and New” at the University of Richmond in October of last year. Courtwright is the Presidential Professor in the department of history at the University of North Florida where he teaches courses in U.S. history and in medical, social and legal history.
“It is a good analogy,” he said in response to his own question, “because, in many cultures, foods have functioned as (and have been blended with) drugs and vice versa.” He went on to outline the numerous ways that food addicts look like other addicts and ultimately reached the conclusion that “some, though by no means all, of food’s potential harms are of an addictive character.”
Courtwright, who received a B.A. in English from the University of Kansas and a Ph.D. in History from Rice University, has authored books on drug use and drug policy, both in American and world history: Forces of Habit: Drugs and the Making of the Modern World (Harvard University Press, 2001) and Addicts Who Survived: An Oral History of Narcotic Use in America before 1965 (University of Tennessee Press, 2012). He is currently working on a book about pleasure and capitalism in the modern world.
Recently, Courtwright talked with Modern Addiction Recovery about his latest research on food addiction.
MAR: What led you to this particular area of inquiry?
Courtwright: I began my research on narcotics and alcohol use and then expanded into other substances, including cannabis. My book Forces of Habit was the first global survey of the history of psychoactive substances to bring the story down to the present. Even as I wrote about the drug-history developments, it occurred to me that there were other substances and behaviors that fall into the category of addictions.
MAR: Why does food fall into this category?
Courtwright: Eating used to be a fairly straightforward activity for most people. Diets were often monotonous. There wasn’t a lot of delicious food available to the masses during the Middle Ages, for example. But now we have engineered “hyperpalatable” foods loaded with sugar, salt, and fat, and they produce much more brain reward than basic fruits and grains and vegetables.
People who are food addicts can find themselves habitually wandering into kitchen at 3 a.m., opening the refrigerator, and eating, eating, and eating. There is truly an element of compulsion that deserves to be likened to a drug addiction. Of course, not everyone who’s overweight is an addict. However, for those who are, temptation is everywhere. In her TEDMED talk on addiction, neuroscientist Nora Volkow makes the point that, once you’ve developed this condition, you find yourself trapped in a hyperstimulating food environment.
MAR: Why is research into food addiction important?
Courtwright: I am interested in the emergence of a global economic order in which multinational organizations advertise, market, and distribute products—hyperpalatable foods among them—that have an increasing potential to addict at least some consumers. This issue is looming ever larger in public life, and it has serious individual and public health consequences, despite the continuing corporate profits.
From a historical perspective, the commercialization of vice was largely a function of the industrial revolution. Consider pornographic books, which were once relatively expensive and mostly owned by the wealthy. In the early 19th century, with the advent of steam presses, it became easier to mass-produce obscene literature, making it much more affordable.
As vices became cheaper and more ubiquitous, they provoked a wave of anti-vice activism in late 19th and early 20th centuries when there was an international attempt to rein in vice through stricter regulation or, in some cases, outright prohibition. However, since the 1930s, commercialized vice has made a comeback. It did so for various reasons, from the repeal of Prohibition, to the mass production and marketing of alcohol, to the rise of digital technologies, to the hunger of state legislatures for new revenue. 1964 one state had a lottery. Now most of them do. It seems like everyone is playing Powerball.
MAR: Within this culture of commercialized vice, how much do our behavior and habits come into play?
Courtwright: What we have now is a system in which temptations have become scientifically enhanced, highly commercialized, and central to the economic order. Some people are more vulnerable than others, for example those who grow up in families in which food discipline is not emphasized. Socialization definitely matters, but so do genetics and possibly epigenetics. Some research suggests that mothers who consume lots of sugar and fat during pregnancy produce offspring who are themselves likelier to become addicted to hyperpalatable foods. Broadly speaking, the sooner you are exposed to rich foods—or any other potentially addictive substance—the more likely you are to become a heavy user. It’s not for nothing that the makers of sugary cereals target kids.
MAR: What do you think of the requirement of posting calories in restaurants? Was that a step in the right direction?
Courtwright: It was a step in the right direction, though it won’t affect all groups equally. If the food addiction and obesity story follows tobacco history, the people who will heed the calorie postings will be those who are more educated. Middle-class and professional people were among the first to quit smoking. By the late 1980s and 1990s, tobacco use was concentrated among the lower socio-economic classes, at least in the United States. To the extent that people in those classes are more focused on the present, and to the extent that they have more co-morbid conditions associated with addiction, such as depression or ADHD, they will be less likely to heed warnings about calories in the same way they are less likely to heed warnings about the harms of smoking.
MAR: Do you think it’s important for food marketing reform to increase?
Courtwright: Yes. People in America and around the world are consuming too much sugar, fat, and salt. There should be an effort to reduce consumption of those substances because they contribute to serious health problems like diabetes and heart and kidney disease. Some people have proposed a tax on sugar or fat in foods. The idea is to raise prices of unhealthful and potentially addictive foods, while perhaps subsidizing purchases of healthier foods. I don’t think such measures would solve the problem overnight—the gains against tobacco were, after all, incremental. However, gradual policy shifts like these over the next 20 or 30 years would likely produce progress against both food addiction and obesity.
As part of the National History Center’s Congressional Briefing series, David Courtwright will be speaking on American drug policy and drug addiction epidemics from a historical perspective at the Cannon House Office Building in Washington, D.C. on May 9 at 10 a.m.