In the first two installments of this 3-part blog series, I discussed the dangers of developing cross-addiction by substituting food with other substances like drugs and alcohol, and possible predictors of cross-addictions in patients who undergo bariatric surgery. While the risk of cross-addiction is something that both patients and doctors should be aware of, there are healthy ways to replace the reward that some of us once experienced from eating.

One example of substituting an unhealthy source of reward with a healthy alternative comes from the story of a 55-year-old man who underwent gastric bypass surgery. After the surgery, he lost 243 lbs, and he maintained this weight-loss by adopting an intense exercise regimen. He runs and works out five times a week without fail. While exercise can be damaging when taken to the extreme, as can be seen in certain cases of eating disorders such as anorexia nervosa and bulimia nervosa, the level of exercise exhibited by this patient was within a normal range. He has seemingly substituted overeating with an activity that may have been difficult for him to enjoy when he was extremely overweight, but like overeating, is reinforcing. Exercise causes a release of the neurotransmitter dopamine in reward-related areas of the brain, just like excess consumption of cookies or cake can do, as well as endorphins. For those who aren’t avid exercisers, it can be painful at first, and its reward value may be tempered by the aches and pain we feel from being out of shape. With time, however, our body adapts, and physical activity feels good!

When we think of addiction, we often think of 12-step programs. These programs are helpful for some trying to gain and/or maintain control over one’s addiction to drugs or alcohol. Some have suggested that the 12-step program can be a substitute addiction in itself. Alcoholics Anonymous (AA), for example, has four basic principles to help treat alcoholism. They are external supervision, finding a substitute addiction, forming new interpersonal relationships, and finding religion. It has been argued that these four tenets of AA and other 12-step programs are “addictive” in themselves, as they encourage the formation of consistent, long-term habits to replace the former habit of compulsive substance use.

Finding alternative sources of reward has been shown to be more effective than simply removing the substance or behavior that’s being abused. AA encourages their members to participate in scheduled social and service activities to keep engaged and find reward in activities other than alcohol consumption. The formation of new relationships in AA is also important in establishing constant reminders of working towards recovery. The social bonding in itself could be rewarding; receptors for “bonding” neuropeptides such as oxytocin and vasopressin are found in high concentrations in areas of the brain associated with reward. While the religious component of AA is a more controversial aspect of this and other 12-step programs, a spiritual approach to treating addiction may act on similar circuits as those involved when forming new relationships, as well as provide an avenue for redemption for those who hurt others because of their addictions.

As with all substances and behaviors, there can be drawbacks to these substitutes if they are taken to the extreme. As mentioned earlier, exercise is a recommended part of a healthy lifestyle but for an addict, a strict exercise regimen could turn into an exercise addiction. Exercise addicts are at risk for physical injury and neglecting one’s responsibilities, much like substance addicts. The formation of new relationships is important for mental health, but this could also result in a dependence on other people. In 12-step programs, for example, forming a destructive, codependent romantic relationship with another member is termed “13th – stepping” and is highly discouraged.

With comprehensive support in all of these areas, 12-step programs have proved to be very successful in preventing relapse. Patients who have undergone bariatric surgery may benefit from looking to the above examples of healthy, alternative sources of reward for reference post-surgery. The transition from food-addiction to not being able, physically, to consume what was once very comforting, can leave patients susceptible to highly damaging addiction substitutes, namely alcohol and prescription pain killers. Support groups are in place for bariatric surgery patients and patients should take advantage of these groups, as they can offer some of the benefits conferred by groups like AA, such as external supervision (by the therapist involved) and new relationships with other group members. These groups can also offer rewarding therapy for the participant and may help to prevent a lapse into more dangerous methods for obtaining reward.

*Appreciation is extended to Ms. Susan Murray for her assistance with developing this post.

*Thanks for Nisa Beceriklisoy for her assistance with the writing and development of this post.

About the Author:
Dr. Nicole Avena is a research neuroscientist/psychologist and expert in the fields of nutrition, diet and addiction. She has published over 60 scholarly journal articles, as well as several book chapters on topics related to food, addiction, obesity and eating disorders. She recently edited the book,
Animal Models of Eating Disorders (Springer/Humana Press, 2013), and she has a book Why Diets Fail (Ten Speed/Crown) available for preorder now and to be released in January, 2014. Her research achievements have been honored by awards from several groups including the New York Academy of Sciences, the American Psychological Association, the National Institute on Drug Abuse, and her research has been funded by the National Institutes of Health (NIH) and National Eating Disorders Association. You can learn more about her research at her website (, or follow her on Facebook and Twitter.

Disclaimer: This blog post does not reflect the views of the OAC, the National Board of Directors or staff. Scientific information contained in this blog post has not been reviewed by the OAC National Board of Directors.