The Need for Evidence-Based Food Addiction Treatment

By Nina Ferrari 12/15/16

The 12 steps may uplift and transform – but, in this era, shouldn’t a person suffering from a disease have more to choose from than a spiritual remedy? 

Women in a group meeting

I didn’t grow up religious, but I imagine that my experience with Overeaters Anonymous has been similar to that of those leaving the religion of their youth. I’ve felt lost, confused, betrayed, conflicted, angry, guilty and more.

I had a profound spiritual experience upon first joining OA, and over time that experience morphed into a religious one. I went from feeling guided towards a personal connection to the Divine, to feeling bound by dogma and frustrated by hypocrisy.

As my disease continued to kick my ass despite my working the steps — not uncommon in a program riddled with relapse — I became desperate for an answer. I once asked a 12-step addiction counselor, “Why is the solution to this disease a spiritual one?”

“Because it’s a spiritual disease,” she replied.

I was confused. Wasn’t the disease psychological? Physical?

The truth is, I knew what was happening. The program was using my disease as a vehicle for spiritual awakening. I was wise to its aim, though I wasn’t against it. I was already walking a spiritual path and open to whatever came next.

But the minute the message that “This is the only way” became overwhelming (the formal party line is that there are many ways, and you are free to leave the program if you choose – but the not-so-hidden message says the opposite), and when the program failed to work even when I “worked it,” I had to re-examine that which I had come to regard as absolute. This was a painful process.

12-Step Programs are Nonprofessional and…Cultish?

The 12-step programs for food addiction are not professional nor evidence-based. While the program’s 12 Traditions state that it is nonprofessional, in the next breath its members “suggest” granting the program the highest authority in one’s life. I’m all for working a spiritual program, but, dear 12 steps, please do not claim a monopoly on addiction treatment (again, see formal party line vs. implied message).

Plenty of spiritual and religious people still visit the doctor to treat physical and psychological ailments. It is irresponsible and downright backwards in this day and age to capture the desperation of vulnerable, ailing people and convince them that a spiritual solution is the elixir to a psychiatric problem.

As I acquire psychological treatment for my maladies, I see in hindsight how rampantly mental illness runs in the rooms of OA. Throw in poorly developed egos, loneliness, and reams of trauma, and you have a recipe for, well, a cult.

I’ll say it: 12-step programs are cultish. I’m not the first to say it, but I hope I’m the only one who’s been yelled at by sponsors for raising the question. When it wasn’t sponsors yelling, it was fellows admitting that, yeah, they wonder, too, but…shrug. “If it is brainwashing me, good! My brain needs to be washed!”

In addition to peer support gone askew, the issue intensifies when it comes to professional treatment. Food addiction treatment is sparse. Following in the footsteps of the drug and alcohol rehab industry, what does exist is, of course, the 12 steps.

Here’s my problem with that. Again, 12-step programs are nonprofessional. Tradition Eight of the 12 Traditions states: “Overeaters Anonymous should remain forever nonprofessional.” Thus, to base a professional treatment program on the 12 steps is to both violate this tradition and undermine the validity of the treatment program.

Out of 12-Step Food Rehab

I paid $3,000 for five days of intensive treatment for food addiction by an organization that I’ll leave unnamed. This organization spearheads much of the treatment available to food addicts. It helps many food addicts to become abstinent.

Nevertheless, my experience of this treatment was…problematic. I emerged from it wholly dependent on 12-step living. My prescribed course of treatment was to attend as many 12-step meetings as possible, surrender my food to a sponsor, and partake in fellowship with others like me. Back home, I was once again left with meetings, phone calls, and talking to my sponsor, a layperson, about food. Where was the professional component?

Aspects of the intensive didn’t sit right with me. I (and I’m guessing others) tapped into deep trauma during our work, with no follow-up. Some of the exercises, like sharing all of our secrets, felt humiliating. I was given a food plan based on my weight according to my appearance — I was never weighed.

The other bulimic in attendance and I were given no different consideration from the non-bulimic participants. Our questions to the matter were met with silence. When I exhibited symptoms that were later explained by a mental health diagnosis, I was told that it was all part of my addiction. “Typical addict!” they chortled.

There is a lack of medical rigor here that concerns me.

The 12 steps may uplift and transform – but, in this era, shouldn’t a person suffering from a disease have more to choose from than a spiritual remedy? 

We Need More – Treatment Options, That Is

Overeaters Anonymous and other food-related 12-step programs represent the trenches of food addiction. While the scientific community hems and haws about this new area of research, speculating about the reality of the disease and whether or not it qualifies as an addiction, suffering food addicts pile into 12-step meetings with nowhere else to go. For those who live with food addiction, there’s no debate: it’s real. The question is, when are we going to get the help that we need?

Twelve Step programs ought to serve as a peer support group – not the be-all, end-all. A personal essay entitled “The Doctor’s Opinion,” written in 1939, is not a medical text (here I’m referencing a chapter of The Big Book, the bible of 12-step programs). Think about it: is a peer support group for people with cancer a substitute for chemotherapy? Would an oncologist tell patients to pray as a course of treatment?

Science and spirituality need not be at odds. This false dichotomy may be one of the greatest illusions of our time. Arguably, each has much to learn from the other. But when it comes to the treatment of food addiction, the scales are tipped too far in one direction. This needs to change.

Don’t Throw the Baby Out With the Bathwater

The 12 steps get a lot right. Plus, their practice and interpretation vary with time, culture and place. Spend any amount of time in a 12-step program and you’ll find subgroups scrambling for the best and most effective ways to work the Steps – much like denominations of major religions.

Different approaches to healing bleed into the fellowship, overlapping with 12-step methodology. Depending on who one talks to, one can receive drastically varied advice. Many program recommendations mimic evidence-based therapies. As Kevin Gray writes in “Does AA Really Work? A Round-Up of Recent Studies”: 

"Twelve-step programs serve up the same pragmatic tips and tools [as Cognitive Behavioral Therapy]: the idea of ‘stinking thinking’ for negative thoughts; learning what people, places and events will trigger your drinking or drugging; planning activities rather than running around helter skelter. [Likewise] CBT doctors encourage you to seek out support groups—like AA.

The program boasts the efficacy of one addict reaching another like few others can; the de-isolating effect of community and service; the lifting of shame that comes from sharing with others; the no-BS approach to shattering addict denial (less common in Overeaters Anonymous, which doesn’t ascribe to an addiction model of abstinence – but food addiction treatments and fellowships carry this benefit); the tools to make amends and repair relationships; and, certainly, the transformative power of cultivating a spiritual life.

Twelve Step programs contain useful, even lifesaving supports. But the 12 steps are in no uncertain terms a spiritual program. Personally, I felt called to wade into the 12-step world –despite its creepy visage. The Steps transformed me in a way that I give thanks for, even as red flags were hitting me in the face. The biggest of these was the exploitation of confusion, vulnerability and trauma in the service of transmitting a message."

The 12-Step Program Is Not a Cult. It’s a Religion.

The Big Book asserts doctors’ helplessness in the face of addiction, but advances made in medicine and psychology since 1939 abound. Virtually every aspect of alcoholism referenced in the book in vague, anecdotal terms, from the “physical allergy” to alcohol, to irrational sprees before an important event, have long been explained by the fields of medicine and psychology. We have the science of addiction — at least to drugs and alcohol — mapped out. So why does professional treatment still hinge on the 12 steps?

This is an important question considering that the 12 steps are, for all intents and purposes, a religion – a fact that gets danced around and covered up. In "The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry," Dr. Lance Dodes and Zachary Dodes write:

"If AA were simply presented as a religious movement dedicated to trying to comfort addicts through faith and prayer, the program would not be so problematic. What is troubling is how resolutely—and some might say disingenuously—AA has taken pains to dissociate itself from the faith-based methodology it encourages."

This sneakiness could be why the 12 steps feel like a cult. The program is arguably not a cult - it does not require members to worship a human figure, give money, or perform dangerous acts. It borders on cultish for a number of reasons, but so do religions. What the program unquestionably fits the definition of is a religion: it is “an organized system of beliefs, ceremonies, and rules used to worship a god” (Merriam-Webster) or “the belief in and worship of a superhuman controlling power, especially a personal God” (Oxford Dictionaries). A quick look at the 12 steps or any of the program literature confirms this.

Rather than owning it, however, the program poses as a nonpartisan addiction treatment. Program members constantly reassure newcomers that the program is not religious – but this is only true in the sense that no other religion will be pushed. Instead, a newcomer’s addiction gets used as fodder for proselytization into the 12-step system of faith. And while religion can be wonderful, my addiction is too messy, too physiological and too psychological for a religion to fix point-blank.

As echoed earlier, science and spirituality can merge at their apex. Psychology and spirituality certainly do, as the mind, emotions and spirit are inextricable. But science offers ethics, standards, evidence, peer review and logic. These are lacking in food addiction treatment, and people are suffering for it. Don’t throw the baby out with the bathwater, but for the love of God, let’s get rid of that dirty bathwater.

Beyond The 12 Steps

People arrive at the doors of a 12-step program in tatters. These newcomers have usually hit rock bottom and are isolated and lacking support. In other words, they’re vulnerable – and impressionable. Fast forward some years, and you can imagine the hold that the program’s ideology has on their minds, not to mention the significance of the relationships formed within the rooms.

Woven throughout the program’s culture and literature is the message: If you leave the program, you will “go out.” And die. And if you do manage to stay abstinent without us, you are just a “dry drunk” (or its food equivalent).

This is simply not true, provided one has access to viable alternatives. Personally, I’ve fared better using Dialectical Behavior Therapy than I did in OA. If anything, OA seemed to fuel my relapses with a vengeance.

To scientific researchers, doctors, psychiatrists, psychologists, counselors, policy makers and health authorities, I say: There’s a gap to fill. Food addiction is a real disease. We need concrete research to understand it fully, and we need effective and accessible treatment options. Please take notice. 

Nina Ferrari is the recovery-related pen name of a writer, artist and activist living in Vancouver, BC. Nina's road to food recovery began alongside her artistic journey, and she believes in deep, holistic healing for addicts and artists alike. She can be reached at [email protected]

Please read our comment policy. - The Fix