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If one were to survey the adult population with a question regarding the percentage of Americans addicted to harmful substances, one would find a broad range of replies. Although it is difficult from public records to distinguish “abuse” from “addiction,” the CDC reports that at least 20 million Americans have used some kind of illicit drug in the past thirty days. While the use of illicit drugs has remained fairly stable over the past decade, the abuse of prescription drugs appears to have surged.If one broadens the search to include alcohol, one would find that 51% of the population consider themselves frequent drinkers, which does not necessarily constitute a health hazard. However, the NIH reports that 15% of the people living in the United States are considered “problem drinkers.” Of this 15%, 5%-10% of the males and 3%-5% of the females could be labeled as alcoholics.
If we broaden the margins a bit more, the figures become even more compelling. An estimated 43.8 million people, or 19.0% of all adults (aged 18 years or older), in the United States smoke cigarettes. Cigarette smoking is more common among men (21.6%) than women (16.5%). Although perhaps more common than “drug” or alcohol abuse, and therefore, potentially more socially acceptable, cigarette smoking is the leading cause of preventable death in the United States, accounting for more than 440,000 deaths, or one of every five deaths, in the United States each year. However, it is the addictive nature of cigarette smoking which is so devastating, and which makes efforts to stop so difficult and frequently unsuccessful. Nicotine is the psychoactive drug in tobacco products that produces dependence. Most smokers are dependent on nicotine. Nicotine dependence is the most common form of chemical dependence in the United States. Research suggests that nicotine may be as addictive as heroin, cocaine, or alcohol. Quitting smoking is difficult and may require multiple attempts. Users often relapse because of stress, weight gain, and withdrawal symptoms. Nicotine withdrawal symptoms may include irritability, anxiety, difficulty concentrating, and increased appetite.
If we expand our definitions even more, we might find that the addiction problem hits even closer to home. The recent epidemic of obesity in this country, with two-thirds of the adult population overweight and one third actually obese, has inspired a more sober evaluation of our diet. Although the problem is complex and cannot be attributed to diet alone, and certainly not to any one food substance in isolation, there is increasing evidence that sugar has an addictive nature. Although sugar is ubiquitous in fruit and many other healthy foods, what has changed in recent years is the processing of food to yield products with a high glycemic index – products which either contain refined sugar (or sugar surrogates, such as high fructose corn syrup) or which, because of their refined carbohydrate constitution (refined white bread, cake/cookies, etc.) are readily converted in the body to sugar. Aside from causing a spike in serum glucose and resultant spike in insulin production, which ultimately results in a “crashing” fall in serum glucose and craving/adrenalin surge, sugar also appears to affect many of the central nervous receptors most closely associated with drug addiction. Sugar and sweeteners (i.e. sugar substitutes may not provide protection from this addictive effect of sugar) can induce reward and craving in humans that are at least comparable in magnitude to those induced by addictive drugs. Sugar reward can be more rewarding than cocaine in addiction models in animals. The neural substrates of sugar and sweet reward are more complex and widespread than those of cocaine, and therefore more resistant to intervention. Clearly more research is necessary to better understand both the biologic substrate and neuropsychological manifestations of sugar addiction. It is in this realm of better understanding the molecular biology of diet that the Florida Heart Research Institute has taken a leading role. However, at this point, suffice it to say, that cardiovascular disease prevention efforts clearly need to recognize the powerful and diffuse impact that sugar has not only on weight gain, but on human behavior itself. It is important to realize that the presence of sugar in most naturally occurring foods is usually accompanied by a high fiber content, which slows absorption and may protect from the devastating glycemic effects, and may also prove to be much less “addictive” in nature. Moreover, with removal of refined sugar from the diet, the taste and associated cravings have been shown to disappear. There is no reason why a creature of habit cannot be empowered with solid information to choose to develop healthy rather than dangerous habits.
