What is addiction?

Many people consider addiction to be a problem of personal weakness, initiated for self-gratification and continued because of an unwillingness or lack of sufficient willpower to stop. However, within the medical and scientific communities, the notion that pleasure-seeking exclusively drives addiction has fallen by the wayside. Clinicians and scientists alike now think that many people engage in potentially addictive activities to escape discomfort — both physical and emotional. People typically engage in psychoactive experiences to feel good and to feel better. The roots of addiction reside in activities associated with sensation seeking and self-medication.

People allude to addiction in everyday conversation, casually referring to themselves as “chocolate addicts” or “workaholics.” However, addiction is not a term clinicians take lightly. You might be surprised to learn that until the current Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), the term addiction did not appear in any version of the American Psychiatric Association’s diagnostic manual, the reference book that physicians and psychotherapists use to identify and classify mental health disorders. In this most recent edition, addiction is included as a category and contains both substance use disorders and non-substance use disorders, such as alcohol use disorder and gambling disorder, respectively.
A revised view of addiction

It might seem strange to group gambling problems in the same category as a problem with drugs or alcohol. But addiction experts are beginning to move away from the notion that there are multiple addictions, each tied to a specific substance or activity. Rather, the Syndrome Model of Addiction suggests that there is one addiction that is associated with multiple expressions. An object of addiction can be almost anything — a drug or drug-free activity. For addiction to develop, the drug or activity must shift a person’s subjective experience in a desirable direction — feeling good or feeling better.

Several scientific advances have shaped our contemporary understanding of this common and complex problem. For example, brain-imaging technologies have revealed that our brains respond similarly to different pleasurable experiences, whether derived from ingesting psychoactive substances, such as alcohol and other drugs, or engaging in behaviors, such as gambling, shopping, and sex. Genetic research has revealed that some people are predisposed to addiction, but not to a specific type of addiction.

These findings suggest that the object of addiction (that is, the specific substance or behavior) is less important than previously believed. Rather, the new thinking reflects the belief that addiction is functional: it serves while it destroys. Addiction is a relationship between a person and an object or activity. With addiction, the object or activity becomes increasingly more important while previously important activities become less important. Ultimately, addiction is about the complex struggle between acting on impulse and resisting that impulse. When this struggle is causing suffering related to health, family, work, and other activities of everyday life, addiction might be involved.
There are many routes for recovery, and the road may take time

Addiction is a chronic and often relapsing disorder. It is often preceded by other emotional problems. Nevertheless, people can and do recover from addiction, often on their own. If not on their own, people can recover with the help of their social network or a treatment provider. Usually, recovery from addiction requires many attempts. This can lead to feelings of frustration and helplessness. Smoking is often considered one of the most difficult expressions of addiction to change. Yet, the vast majority of smokers who stopped quit on their own! Others stopped smoking with the help of professional treatment. It is important to remember that the process of overcoming an addiction often requires many attempts. Each attempt provides an important learning opportunity that changes experience and, despite the difficulties, moves recovering people closer to their objectives. There are many pathways into addiction and many routes to recovery. Think about recovery from addiction as a five-year process that will have its ups and downs; after about five years, life can and will be very different. As life becomes more worth living, addiction loses its influence.
Going out for dinner can be a nice way to unwind with family or friends. But if you’re watching your salt intake, restaurants aren’t always so relaxing. Much of their fare is loaded with sodium, a main component of salt. In fact, some entrees at popular chains contain far more than 2,300 milligrams (mg) of sodium — the recommended limit for an entire day’s worth of food.

Limiting sodium is especially important for people with high blood pressure, because excess salt worsens this common condition, leaving you more prone to heart attack and stroke. If you eat out only once a month, you probably needn’t worry too much. But Americans tend to eat out far more frequently — about five times a week, on average.
For starters, do your prep work

But there are plenty of strategies for staying within your salt budget when eating out, starting before you even leave home, says Debbie Krivitsky, director of clinical nutrition at the Cardiovascular Disease Prevention Center at Massachusetts General Hospital. When possible, check the restaurant’s website to look up the nutrition information (including sodium) for different menu items beforehand. You can also search for your favorite dishes at CalorieKing, which includes nutrient data for foods from hundreds of popular nationwide chains. Federal law now requires all restaurants with more than 20 locations to provide this information.

Not surprisingly, the highly processed fare at fast-food restaurants is quite salty (for example, a Big Mac has 950 mg of sodium). Beware of unexpected sources: a Dunkin’ Donuts reduced-fat blueberry muffin contains 540 mg of sodium. But sit-down restaurants aren’t all that much better. “The typical meal at a chain sit-down restaurant contains about 2,100 mg of sodium for every 1,000 calories,” says Krivitsky.

Certain cuisines tend to have higher sodium levels than others. Asian restaurants use a lot of sodium-rich soy and fish sauces, and Italian food (especially pizza) has high-sodium sauces, cheeses, and cured meats, such as pepperoni and prosciutto.
Fresher options and menu tweaks

A better option (if available) is a “farm-to-table” restaurant. These newly fashionable eateries focus on fresh and often locally grown or raised foods. While they may not provide nutritional information, these establishments — as well as other neighborhood and smaller “mom-and-pop” places — may be willing to work with you to prepare a lower-sodium meal. These days, with more people following gluten-free and vegan diets, they’re used to making adjustments. And it’s in their best interest to make their customers happy.

If you’re comfortable doing so, tell your server you have a medical condition or are taking medication and need to limit your salt. They may be more inclined to take you seriously, says Krivitsky. Then say, “Please tell the chef to grill, broil, or steam my food with no added seasonings or sauces.” If you’re ordering a piece of meat, chicken, or fish, find out the weight of the serving size. Have the server bring you a plate with only the amount you want to eat and bag the rest to take home.

If you’ve got your heart set on a special entree that’s over your sodium budget, ask the server to box up half of the dish to save for the next day before bringing it to your table. That way, you can enjoy the portion without being tempted to pick at the rest just because it’s in front of you.
Harvard Medical School (HMS) has a bicycle-friendly campus. Faculty, staff, and students who commute by bike can park their wheels in secured cages, wash off road grime in showers, buy new helmets at a discount, and receive a monthly reimbursement for bike maintenance costs. HMS encourages bicycle commuting not just to relieve parking congestion and foster cleaner air, but also because observational studies have suggested that cycling, like other forms of exercise, is good for us.

A recent study suggests that bicycle commuting, like recreational cycling, is not only associated with a lower risk of serious disease, but with a longer life as well. For that study, researchers from the University of Glasgow followed more than 263,450 commuters in England, Scotland, and Wales for an average of five years. The group was composed of 52% women and 48% men ages 40 through 69.

The researchers divided the participants into five groups based on how they got to and from work on a typical day — walking, cycling, riding in a car or on public transportation, mixed walking (a combination of walking and riding), and mixed cycling (cycling and riding). They found that compared with riding to work, bike commuting was associated with a lower risk of being diagnosed with cardiovascular disease or cancer, or dying of any cause during the five-year period. Walking was associated with a lower risk of developing cardiovascular disease.
The benefits of biking outweigh the risks

“The benefits of regular physical activity are well documented, but there have been concerns that traffic crashes may negate the benefits from commuting by bicycle,” says Dr. Walter Willett, professor of epidemiology and nutrition at Harvard T.H. Chan School of Public Health, and a bicycle commuter himself. “This study is important because it confirms, with a much larger sample size, previous findings from other countries. Moreover, it shows that the benefits strongly outweigh the risks.”

The study also provides some assurance to cyclists in the US, where biking conditions are similar to those in the United Kingdom and less friendly than in many European countries. For example, in the Netherlands the bicycle is the major mode of transportation for more than a third of the population, who have access to separated cycle tracks, networks of bicycle paths, and ample dedicated bike parking, and where traffic laws give them the right of way over cars, trucks, and buses. A 2015 analysis conducted by researchers at the University of Utrecht determined that cycling prevents about 6,500 deaths each year in the Netherlands and is responsible for adding six months to the life expectancy of the average Dutch person.

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