Marianne T. Marcus

Refined food addiction: a classic substance use disorder.

Overeating in industrial societies is a significant problem, linked to an increasing incidence of overweight and obesity, and the resultant adverse health consequences. We advance the hypothesis that a possible explanation for overeating is that processed foods with high concentrations of sugar and other refined sweeteners, refined carbohydrates, fat, salt, and caffeine are addictive substances. Therefore, many people lose control over their ability to regulate their consumption of such foods. The loss of control over these foods could account for the global epidemic of obesity and other metabolic disorders. We assert that overeating can be described as an addiction to refined foods that conforms to the DSM-IV criteria for substance use disorders. To examine the hypothesis, we relied on experience with self-identified refined foods addicts, as well as critical reading of the literature on obesity, eating behavior, and drug addiction. Reports by self-identified food addicts illustrate behaviors that conform to the 7 DSM-IV criteria for substance use disorders. The literature also supports use of the DSM-IV criteria to describe overeating as a substance use disorder. The observational and empirical data strengthen the hypothesis that certain refined food consumption behaviors meet the criteria for substance use disorders, not unlike tobacco and alcohol. This hypothesis could lead to a new diagnostic category, as well as therapeutic approaches to changing overeating behaviors.

Community-based participatory research to prevent substance abuse and HIV/AIDS in African-American adolescents

Adolescence is a time for exploration and risk-taking; in todays urban environment, with the twin threats of substance abuse and HIV/AIDS, the stakes are particularly high. This paper describes a community-based participatory research project to design, implement, and evaluate a faith-based substance abuse and HIV/AIDS prevention program for African-American adolescents. A coalition of university-based investigators and African-American church member stakeholders collaborated on all aspects of Project BRIDGE, the 3-year intervention to reduce substance abuse and HIV/AIDS in African-American adolescents. Our results support the use of community-based participatory research to create desirable change in this setting. Adolescents who participated in Project BRIDGE reported significantly less marijuana and other drug use and more fear of AIDS than a comparison group. Project BRIDGE has been designated an official ministry of the church and the program has been extended to others in the larger metropolitan community. The church now has a well-trained volunteer staff. University faculty developed skills in negotiating with community-based settings. The coalition remains strong with plans for continued collaborative activities.

Change in stress levels following Mindfulness-Based Stress Reduction in a therapeutic community

ObjectivesThis pilot was designed to study identified changes in the psychologic and physiological stress response of individuals who participated in a Mindfulness-Based Stress Reduction intervention while in treatment of substance abuse in a therapeutic community. MethodsTwenty-one participants in a residential therapeutic community received the intervention, which consisted of training in 5 mindfulness practices. Stress response was assessed by measuring awakening salivary cortisol and the Perceived Stress Scale (PSS) pre- and post-intervention. ResultsAwakening salivary cortisol levels were significantly lower (P < 0.0001) following the intervention. Although there was a decrease in self reported stress between the baseline measurement and the post-intervention measurement, the change in the PSS was not statistically significant (P = 0.65). ConclusionsThese results suggest that a Mindfulness-Based Stress Reduction intervention may influence the physiological response to stress for individuals in a therapeutic community. The results also support the use of salivary cortisol as an indicator of the stress response in this setting. Future studies are needed to determine the value of this intervention as an adjunct to therapeutic community treatment.

Associations of mindfulness with nicotine dependence, withdrawal, and agency

ABSTRACT Quitting smoking is a major life stressor that results in numerous aversive consequences, including persistently increased level of post-cessation negative affect and relapse. The identification of factors that may enhance behavioral and emotional regulation after quitting may be useful in enhancing quit rates and preventing relapse. One factor broadly linked with behavioral and emotional regulation is mindfulness. This study examined baseline associations of mindfulness with demographic variables, smoking history, dependence, withdrawal severity, and agency among 158 smokers enrolled in a cessation trial. Results indicated that mindfulness was negatively associated with level of nicotine dependence and withdrawal severity, and positively associated with a sense of agency regarding cessation. Moreover, mindfulness remained significantly associated with these measures even after controlling for key demographic variables. Results suggest that low level of mindfulness may be an important predictor of vulnerability to relapse among adult smokers preparing to quit; thus, mindfulness-based interventions may enhance cessation.

Mindfulness-Based Stress Reduction in Therapeutic Community Treatment: A Stage 1 Trial

Objective: This trial compared Mindfulness-Based Stress Reduction, adapted for therapeutic community treatment (MBTC), with treatment as usual (TAU) for reducing stress and increasing retention in a residential facility for substance use disorders. Method: Four-hundred and fifty-nine participants, who met DSM-IV criteria for substance dependence were recruited (TAU = 164, MBTC = 295). Results: A survival analysis of time to dropout did not show a significant difference between groups, however level of participation in MBTC was associated with decreased likelihood of dropout (p = < .01), and higher Symptoms of Stress Inventory (SOSI) scores at baseline were associated with increased likelihood of dropout (p = .03). Conclusion: The association between retention and level of stress on intake as well as level of participation in MBTC provides support for further research on integrating MBTC into therapeutic community treatment.

Endogenous Sex Hormones and Cognitive Function in Older Adults A Systematic Review

Estrogen and testosterone may influence cognition in older adults, but the relationship between sex hormones and cognitive function is complex. The aim of this systematic review is to examine the role of sex hormones in cognitive function among older adults. A comprehensive, electronic review of literature was performed. Inclusion criteria were original quantitative research, written in English, used human subjects with a mean age of ≥60 years, and published from January 1997 through May 2012. Findings were mixed, although potential patterns were identified. Estradiol levels were potentially associated with benefits to episodic memory, semantic memory, verbal memory, and verbal learning in females only. The association between testosterone and cognitive function was mixed in both genders. Mixed findings may have been influenced by methodological differences and future studies should include research designs with ample rigor, sufficiently powered samples, consistent cognitive measurements, and clear descriptions of handling and storage of biological specimens.

Associations Between Mindfulness and Implicit Cognition and Self-Reported Affect

ABSTRACT Theory suggests that mindful individuals exhibit enhanced attentional processing (e.g., attentional control) and that they maintain a detached perspective to problematic stimuli. For smokers, smoking and affective stimuli are problematic stimuli when they try to quit. In this cross-sectional study, smokers (n = 158) completed 3 modified Stroop tasks (to assess attentional control), 3 Implicit Association Tests (IATs; to assess detached perspective), and a battery of self-report assessments. Degree of mindfulness was negatively associated (P < .05) with self-reported negative affect, perceived stress, and depressive symptom severity, and positively associated (P < .05) with positive affect. Degree of mindfulness was not associated with the ability to disengage attention from smoking or affective stimuli. On the depression IAT, more mindful participants exhibited a more negative IAT effect, suggesting that they may have developed a detached perspective to depression-related stimuli. Theoretical and clinical implications of the data are discussed.

Mindfulness-based meditation in a therapeutic community

Therapeutic communities (TCs) for the treatment of drug-use disorders provide a highly structured social learning environment designed to encourage positive changes in behaviour, attitudes and emotions. The TC experience is restrictive and stressful, an arduous process described by residents as requiring unique strategies to cope with recovery in this setting. The aims of this study were to investigate the effectiveness of a mindfulness-based meditation programme in (I) reducing psychological problems and symptoms of psychopathology, and (2) increasing positive coping styles, in persons recovering from addictive disorders in a TC. Study subjects were 36 TC residents; 18 subjects were in the experimental group, and 18 subjects were in the control group. Though not statistically significant, there was a trend toward increased anger control, self-control, seeking social support coping behaviours, and decreased hostility in the experimental group. The authors discuss the need for a larger study to validate these promising findings.

Substance abuser impulsivity decreases with a nine-month stay in a therapeutic community.

Background: Substance abuse continues to be a major public health problem. Keeping substance abusers in treatment is a challenge, and researchers continue to investigate ways to increase retention. Objective: The aim of this study was to investigate the relationship between impulsivity in substance abusers and length of stay in the context of therapeutic community. Methods: The Barratt Impulsiveness Scale– 11 (BIS-11) was used to assess impulsivity in 138 substance abusers at admission and at nine months in a therapeutic community. Results: Impulsivity significantly decreased in subjects who completed nine months in the therapeutic community. Legal stipulation increased length of stay, on average, by three months. On admission, female participants were on average more impulsive than their male counterparts. Conclusion: Impulsivity decreased in subjects who remained in therapeutic community for nine months although self-reported impulsivity at baseline did not seem to be associated with retention. Scientific Significance: Therapeutic community factors contribute to a decrease in self-reported impulsivity and these factors might be enhanced to increase retention in therapeutic community.

Changing Careers: Becoming Clean and Sober in a Therapeutic Community

Substance abuse remains a major threat to public health. Recovery is complex and variable, occurring with and without intervention. Therapeutic communities (TC) offer a unique long-term approach to recovery. The purpose of this study was to describe the experience of individuals in a TC. Grounded theory provides the methodological basis for the study. Interviews were conducted with 13 individuals in 3 settings. The findings indicate that recovery is analogous to changing careers and suggest a theory that explicates incremental stages in the redirection of the self to achieve a more productive lifestyle. Whereas TCs often purport to bring about character change, the findings of this study emphasize the importance of residual strengths of the previous self-strengths that must be valued to achieve success.