Substance use, addictive, and eating disorders are chronic relapsing diseases, which are associated with long-lasting changes in the brain. They are characterized by compulsive reward-seeking behavior despite harmful consequences. Over 45 million people in the U.S. are afflicted with these disorders. They affect people of all ages and cultures, causing both individual and societal harm. Addictions may be linked to crime, violence, and an increased probability of high-risk behaviors. Currently, approved therapy options are limited; and the cost of treating these disorders and their subsequent consequences is significant. NIDA reports that substance use costs the U.S. over $600 billion annually. NIDA also reports that for every $1 spent on addiction treatments up to $12 is saved in criminal and healthcare costs.
Substance Use Disorders
The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that over 22.7 million people in the U.S. need treatment for a substance use disorder. Substances with the highest potential for abuse include heroin, cannabis, narcotic pain medications, and cocaine. Abuse of these substances can lead to impaired judgment and the carrying out of high-risk behaviors. Examples of high-risk behaviors are driving under the influence of drugs, unsafe sexual practices, and needle sharing. High-risk behaviors increase the risk of injury, death, and infectious disease.
The National Council on Problem Gambling (NCPG) reports that there are 2 million pathological gamblers in a given year and another 4 to 6 million would be considered problem gamblers (persons who meet one of more of the APA’s diagnostic criteria for gambling disorder).
Neuroscience and genetics research has played a key role in determining that addictive disorders, such as gambling disorder, are similar to substance use disorders in clinical expression, brain origin, comorbidity, physiology, and treatment. In addition, addictive disorders tend to exist among family members alongside other addictions. The American Psychiatric Association (APA) has responded by recently combining substance use and addictive disorders into a single disease group.
Gambling and drug use activate the reward circuitry using similar mechanisms. Pathological gamblers report cravings and highs in response to their stimulus of choice. For patients with addictive disorders such as gambling disorder, they become addicted to behaviors which cause an over-production of endorphins, the body’s natural opioid.
The National Association of Anorexia Nervosa and Associated Disorders (ANAD) states that over 30 million people in the U.S. struggle with eating disorders. Binge eating disorder (BED), bulimia nervosa, and anorexia nervosa are the most well-known of a large number of conditions.
BED is the most common eating disorder, affecting 8 million people in the U.S. The American Psychiatric Association defines BED as “recurring episodes of eating significantly more food in a short period of time than most people would eat under similar circumstances.” It also states that: “While overeating is a challenge for many Americans, recurrent binge eating is much less common, far more severe, and is associated with significant physical and psychological problems.”
For patients with eating disorders, eating highly palatable and calorically dense foods is thought to induce a release of endorphins, which contributes to negative reinforcing behavior. Because binge eaters feel a loss of control and persist despite negative consequences, BED patients and substance use disorder patients are thought to have a similar imbalance of the brain’s reward circuitry.