Food addiction, and why words matter

Years ago I had a friend who used to talk about being “addicted to being a victim”. I thought it very deep and clever at the time (I was a teenager, and he an aspiring poet).

That was before I really cared – or thought that others should really care – about how we use words, or understood that how we use words can *actually* be deep and important.

(For the record, I don’t actually use the word “deep” anymore.)

Last week I came across this confessional from The Guardian on food addiction (and how it’s “killing” the author), which had to say, inter alia,

Astonishingly, the jury is still out on food addiction. The DSM 5 only includes alcohol, drugs, cigarettes and caffeine as the types of “substance-use disorders”. Twelve-step programs say an addiction is a physical compulsion, coupled with a mental obsession.

Whatever addiction is, an addiction to food has defined my entire life.

Without any disrespect to someone who shared intimate details of her struggle with food in a public space, that last sentence is one which troubles me deeply, because it invokes some po-mo “entitlement” to give words whichever meaning you wish them to have, and which is ultimately the kind of thing that results in nefarious (to give it its most recent moniker) “fake news”.

If I say, ‘whatever gluten/[insert whatever] intolerance is, an intolerance to gluten/[insert whatever] has defined my entire life’, I’m basically giving up the right to call what I suffer from an “intolerance”, and I (and my readers) could be better served by me simply saying that I struggle with/don’t like/like too much that particular thing (in the absence of coeliac disease, or the like, of course).

The DSM (The Diagnostic and Statistiscal Manual of Mental Disorders, currently in its 5th edition) is of course not without contention, because for something to be recognised as an addiction in it relies largely on whether a treatment is yet available for that particular condition, which unsurprisingly generates a number of sceptical responses about whether it’s simply in the service of “Big Pharma” (or “Big Shrink”).

But as influential as that manual can be – and is – when it comes to acknowledging someone as having something that is a “disorder” (no doubt in little measure for health care/insurance purposes), more interesting is the recent recognition by the AP Style Guide that the term “addiction” is widely misused:

Unlike many matters of style, these changes aren’t mere semantics or political correctness. Widespread media misunderstanding of the fundamental nature of addiction has led to some deadly misconceptions about how it should be managed. The AP provides news to around 15,000 media organizations and businesses, and its stylebook is highly influential in setting standards for usage. If its more accurate terms are adopted and understood by institutions like The New York Times and CBS News, it could genuinely help improve drug treatment and policy amid an overdose crisis that shows no signs of slowing.

“Around the beginning of the year, in January, we noticed that there was a hole in our guidance on addiction,” says Jeff McMillan, an AP enterprise editor who was the lead author of the new section. He adds, “As we began talking to experts, we learned that the language that was traditionally used is changing, and we thought it would be good to give people a vocabulary.”

A key result of this has been a change to encourage journalists to make a careful distinction between “dependence” and “addiction” (previously used interchangeably):

While the AP doesn’t spell this out, journalists and readers should understand why it matters. In essence, “dependence” means relying on a substance to function normally. People who take certain medications for blood pressure, depression, and addiction will suffer withdrawal if these medications are stopped abruptly, but that does not mean they’re addicted. This is true even for those taking opioids like methadone or buprenorphine to treat addiction. When people are stabilized on an appropriate individualized dose of either addiction treatment medication, they are not impaired at all because of the precise way this specific class of drugs affects the brain and causes tolerance.

By contrast, addiction is a medical disorder marked by compulsive drug use despite bad consequences like impairment. So while addiction is always a problem, dependence may not be. Understanding this is critical for good pain care. Patients taking opioids over a long period of time are often physically dependent, but unless they experience negative consequences and compulsive use, they are not addicted.

It’s a fascinating and important corrective to the way ‘we’ bandy about the word addiction” in contexts where it doesn’t belong. Sure, the two are not necessarily distinct – according to the AP’s definition, dependence may lead to addiction, or vice versa, but the two do not have to coexist.

But it still goes to show that dictionaries, rather than psychiatric manuals, should probably be where we look to for how to use words, and to understand the nuance between different ones that look the same-ish. As the editor of Merriam-Webster (dream job!) recently put it in the context of contestation of “facts” that a certain current US administration is a master at,

[T]here was a hunger for clarity, I think. And answers. And also, that sort of objective, neutral resource. That maybe if you can’t trust media, can’t trust cable, who can you trust? I think that’s terrific. As a dictionary editor, I hope people trust the dictionary, and they turn to dictionaries in that kind of moment.

So here’s to Samuel Johnson (the father of dictionaries), and to those who acknowledge – perhaps unlike Johnson who likely sought to capture the meaning of words once and for all – that language, like science, doesn’t stop.