William R. Corbin

Food addiction: an examination of the diagnostic criteria for dependence.

The evidence for food’s addictive properties is steadily growing. In addition to clinical and evolutionary plausibility, the possibility of addiction to food is supported by animal model research and increasingly by research with humans. Much as classic drugs of abuse “hijack” the brain, accumulating evidence with food suggests a similar impact, but with weaker effects. Although neurobiological evidence for food addiction is compelling, dependence as conceptualized with respect to alcohol and other drugs of abuse is fundamentally a behavioral disorder. Thus, we review the current state of food addiction research in the context of each of the diagnostic criterion for dependence (ie, tolerance, withdrawal, loss of control) and briefly explore other relevant addiction topics such as expectancies, reinforcement, and incentive salience. There is substantial evidence that some people lose control over their food consumption, suffer from repeated failed attempts to reduce their intake, and are unable to abstain from certain types of food or reduce consumption in the face of negative consequences. Although there is some evidence for other dependence criterion, further research is needed to examine tolerance and withdrawal to high-fat sweets, time spent in obtaining, using, and recovering from excess food consumption and the degree to which important activities are given up due to overconsumption. As science continues forward and both the public and elected leaders become aware that food may trigger an addictive process, this information will likely be used to inform policy. Thus, researchers need to carefully consider the implications of their work and the way in which the results may be interpreted.

Behavioral Risks during the Transition from High School to College.

The transition from high school to college is an important developmental milestone that holds the potential for personal growth and behavioral change. A cohort of 2,245 students was recruited during the summer before they matriculated into college and completed Internet-based surveys about their participation in a variety of behavioral risks during the last 3 months of high school and throughout the 1st year of college. Alcohol use, marijuana use, and sex with multiple partners increased during the transition from high school to college, whereas driving after drinking, aggression, and property crimes decreased. Those from rural high schools and those who elected to live in private dormitories in college were at highest risk for heavy drinking and driving after drinking.

Prevention of heavy drinking and associated negative consequences among mandated and voluntary college students.

The Lifestyle Management Class (LMC) was evaluated as a universal and targeted alcohol prevention program among voluntary and mandated college students. The relative efficacy of peer- and professional-led group interventions was also tested in this randomized, controlled design. LMC participants showed decreases in driving after drinking relative to control participants. Changes in heavy drinking varied as a function of treatment condition, readiness to change, and gender, with a trend toward larger decreases among voluntary LMC participants high in readiness to change and a comparable though nonsignificant advantage for male LMC participants in the mandated sample. The LMC was comparably effective for mandated and voluntary students, with no clear advantage for peer- or professional-led groups.

The Role of Alcohol Expectancies and Alcohol Consumption Among Sexually Victimized and Nonvictimized College Women

The present study investigated alcohol expectancies, alcohol consumption, sexual assertiveness, and the number of consensual sexual partners as potential risk factors for sexual assault among three groups of college women: nonvictimized, moderately victimized, and severely victimized. Women with severe victimization histories (attempted or completed rape), compared with nonvictims, reported more consensual sexual partners, less perceived assertiveness in their ability to refuse unwanted sexual advances, greater weekly alcohol consumption, and more positive outcome expectancies for alcohol including tension reduction, sexual enhancement, and global positive change. In addition, for both victimized and nonvictimized women, consumption of alcohol and expectancies of social enhancement following alcohol use independently accounted for a significant portion of the variance of sexual activity following alcohol consumption. Findings are discussed with respect to research aimed at reducing sexual assault among women who are at highest risk for sexual violence.

Subjective response to alcohol: a critical review of the literature.

BACKGROUND Subjective response to alcohol (SR), which reflects individual differences in sensitivity to the pharmacological effects of alcohol, may be an important endophenotype in understanding genetic influences on drinking behavior and alcohol use disorders (AUDs). SR predicts alcohol use and problems and has been found to differ by a range of established risk factors for the development of AUDs (e.g., family history of alcoholism). The exact pattern of SR associated with increased risk for alcohol problems, however, remains unclear. The Low Level of Response Model (LLR) suggests that high-risk individuals experience decreased sensitivity to the full range of alcohol effects, while the Differentiator Model (DM) asserts that high risks status is associated with increased sensitivity to alcohols positive effects but decreased sensitivity to negative effects. AIMS The current paper (1) reviews two prominent models of subjective response, (2) reviews extant laboratory-based research on subjective response, (3) highlights remaining gaps in our understanding and assessment of subjective response, and (4) encourages collaborative efforts to address these methodological and conceptual concerns. METHODS This paper reviews studies which employed placebo-controlled and non-placebo-controlled alcohol challenge paradigms to assess a range of alcohol effects including impairment, stimulation, and sedation. RESULTS The research literature provides at least partial support for both the LLR and DM models. High-risk individuals have been shown to have a reduced response to alcohol with respect to sedative or impairing effects, particularly on the descending limb of the blood alcohol curve (BAC). There is also evidence that ascending limb stimulant effects are more pronounced or operate differently for high-risk individuals. DISCUSSION Despite commendable advances in SR research, important questions remain unanswered. Inconsistent results across studies may be attributable to a combination of an inadequate understanding of the underlying construct and methodological differences across studies (e.g., number and timing of assessments across the BAC, inclusion of a placebo condition). With respect to the underlying construct, existing measures fail to adequately distinguish between cognitive/behavioral impairment and sedation, aspects of which may be perceived positively (e.g., anxiolysis) due to their ability to act as negative reinforcers. CONCLUSIONS Addressing the concerns raised by the current review will be integral to making meaningful scientific progress in the field of subjective response.

Trajectories and Determinants of Alcohol Use among LGB Young Adults and Their Heterosexual Peers: Results from a Prospective Study.

Lesbians, gays, and bisexuals (LGBs) are at increased risk for alcohol use during young adulthood, but the mechanisms remain inadequately understood. The aim of the present study was to examine the trajectories and determinants of alcohol use among LGB young adults who were sampled prospectively. The sample included 111 LGB individuals (47 women and 64 men) and 2,109 heterosexuals (1,279 women and 830 men), who were assessed at three time points: during the summer after their senior year of high school and during the fall and spring of their freshman year of college. Hierarchical linear modeling analyses indicated that lesbians consumed more alcohol than their heterosexual peers during high school, whereas gay men increased their alcohol use at greater rates than heterosexual men during the initial transition to college. Positive alcohol expectancies and social norms mediated this relation for both men and women. The results extend the generalizability of these processes and highlight the importance of considering normative social-cognitive influences in the development of alcohol use among LGB young adults.

Alcohol use and serial monogamy as risks for sexually transmitted diseases in young adults.

Alcohol and condom use were assessed using global, situational, and event-level analyses in a sample of young adults (N = 305). Results varied by methodology, event, and partner type; an inverse association between alcohol and condom use was found only at the event level. Participants with strong sex-related expectancies used condoms less frequently when drinking at the time of 1st intercourse with their current partner. For most recent event with a regular partner, alcohol use was unrelated to condom use, but gender, relationship duration, and oral contraceptive use accounted for more than 25% of the variance. Thus, alcohol may increase risky sex early in a relationship, whereas partner familiarity and alternate contraceptive use play a larger role as relationships develop.

Measurement of alcohol-related consequences among high school and college students: application of item response models to the Rutgers Alcohol Problem Index.

The Rutgers Alcohol Problem Index (RAPI; H. R. White & E. W. Labouvie, 1989) is a frequently used measure of alcohol-related consequences in adolescents and college students, but psychometric evaluations of the RAPI are limited and it has not been validated with college students. This study used item response theory (IRT) to examine the RAPI on students (N = 895; 65% female, 35% male) assessed in both high school and college. A series of 2-parameter IRT models were computed, examining differential item functioning across gender and time points. A reduced 18-item measure demonstrating strong clinical utility is proposed, with scores of 8 or greater implying greater need for treatment.

Development of the Yale Food Addiction Scale Version 2.0.

Parallels in biological, psychological, and behavioral systems have led to the hypothesis that an addictive process may contribute to problematic eating. The Yale Food Addiction Scale (YFAS) was developed to provide a validated measure of addictive-like eating behavior based upon the diagnostic criteria for substance dependence. Recently, the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) was released, which included significant changes to the substance-related and addictive disorders (SRAD) section. In the current study, the YFAS 2.0 was developed to maintain consistency with the current diagnostic understanding of addiction and to improve the psychometric properties of the original YFAS. In a sample of 550 participants, 14.6% met criteria for food addiction. The YFAS 2.0 demonstrated good internal consistency, as well as convergent, discriminant, and incremental validity. Elevated scores on the YFAS 2.0 were associated with higher rates of obesity and more severe pathological eating (e.g., binge eating). The YFAS 2.0 also appeared to capture a related, but unique construct relative to traditional eating disorders. In a separate sample of 209 participants, the YFAS and YFAS 2.0 were directly compared. Both versions of the YFAS were similarly associated with elevated body mass index, binge eating, and weight cycling. However, exceeding the food addiction threshold was more strongly associated with obesity for the YFAS 2.0 than the original YFAS. Thus, the YFAS 2.0 appears to by a psychometrically sound measure that reflects the current diagnostic understanding of addiction to further investigate the potential role of an addictive process in problematic eating behavior.

Food-addiction scale measurement in 2 cohorts of middle-aged and older women

BACKGROUND Excess weight is a major threat to public health. An addiction-like tendency toward certain foods may contribute to overeating. OBJECTIVE We aimed to describe the prevalence and associated characteristics in relation to a food-addiction scale in middle-aged and older women. DESIGN We examined the prevalence and associated characteristics of a food-addiction scale measure in a cross-sectional analysis of 134,175 women participating in 2 ongoing prospective cohort studies of US nurses. RESULTS Overall, 7839 (5.8%) of the women surveyed met the criteria for food addiction measured by using the modified Yale Food Addiction Scale. The prevalence of food addiction was 8.4% in the younger cohort of women aged 45-64 y and 2.7% in the older cohort of women aged 62-88 y. In the multivariate model, body mass index (BMI; in kg/m²) ≥ 35.0 (compared with 18.5-22.9) was associated with food addiction, a prevalence ratio (PR) of 15.83 (95% CI: 12.58, 19.91) in the younger cohort of women, and a PR of 18.41 (95% CI: 11.63, 29.14) in the older cohort of women. Several other demographic characteristics and other factors were associated with the food-addiction measure in both cohorts of women. CONCLUSIONS To our knowledge, for the first time in a large, US-based population of women, we documented the prevalence of food addiction by using a novel measurement scale in middle-aged and older women. The results may provide insight into the strong association between behavioral attributes of food consumption and the development of obesity.