Originally published on "thefix.com" on 6/23/11:

At the end of an AA meeting recently, I mentioned to a friend that I had to go speak at a meeting for compulsive overeaters. He looked at me quizzically and said, “But you’re not fat.” To which I replied, “Yes, and you’re in AA and you’re not drunk.”

I’m intrigued by the lack of understanding from people within the recovery community towards addictions they don’t have. And I’m not talking about newcomers but about people with 20 or more years in one program or another. Then again, when I think about a compulsion I don’t share—compulsive gambling, for example—the initial thought that pops in my head is “Why don’t they just not do that?” Of course the answer is simple: “It’s an addiction, stupid.” I seem to remember any number of people suggesting I should stop drinking long before I did—usually people standing over me while I was flat on my back on the floor. After 30 years in various programs, I know that addiction can take many forms.

The question of which addiction is more severe can lead to engaging debates. And we all know the answer: Our addiction is the worst and yours is not so bad. From the subjective view of our own experience, it’s true. When I tell people I believe food addiction is harder to grapple with than many chemical addictions, their response tends to be less than respectful. “Food? Puh-leeze! So what happens, they find you in the gutter with a bag of Twinkies? Do they send you off to the Betty Crocker Clinic?”

I’ve found food addiction to be something of a punch line in other programs. And yet I’ve buried two sponsees in my food program and none in AA. There are dozens of people with food addictions I’ve known that didn’t make it. One of the most poignant situations was an absolutely brilliant guy I knew who weighed over 600 pounds; he died in a fire because he was too big to get out. Research has proven that eating disorders have the highest mortality rate of any mental illness. Studies have shown that about 20% of anorexics will die prematurely due to complications of their disease, including heart problems and suicide. Obesity is associated with a myriad of chronic health conditions—including diabetes, heart disease and cancer. A person who is moderately obese can expect their lives to be shortened by about five years.

Recovery from food addiction is, in my opinion, a more challenging road.

I am not diminishing the recovery process from alcohol and drugs—it took me a few years to get sober myself. Once I had some sober time under my belt and continued my recovery by working the steps, the day-to-day urges to drink diminished—as I think they do for many with chemical addictions. Also, being forewarned about the dangers, I removed myself from drinking environments and avoided “slippery” places until my sobriety became stronger. But, there’s no getting away from food.

Think what it would be like if sobriety involved having three drinks a day—no more, no less. How long would that sobriety last? People who are addicted to food talk about having to “take the tiger out of the cage for a walk three times a day.” Food is much more integrally involved in our psychological make up. It represents mother, love, nurture, reward, and comfort, among many other things. Food is part of our celebrations and traditions and so much of what makes us human. When asked what substance he was first addicted to, Eric Clapton answered “sugar.” Most addicts have at least a decade or two of life before they begin using heavily but food addicts are introduced to their substance as infants.

Food is also much more socially acceptable. It is omnipresent in every office and every social gathering. It’s also very easy to want to minimize. After all, there are many people who can over-indulge in food, gain some weight, then go on a diet and take it off again. The great delusion of food addicts is that they can do this as well.

There is another quirk to 12-step recovery when it comes to food. Society has mostly come to see the 12-step method as the most effective for recovery from alcoholism and drug addiction. Most recovery programs have adapted the 12 steps into their programs in some manner. There certainly aren’t a lot of groups out there who have been successful at convincing alcoholics that they can drink safely again. If there were, my guess is every one of us would have given all of them a shot before making it to AA.

Now imagine that there are hundreds, even thousands, of such alternatives. That’s part of the problem compulsive eaters face. The plethora of “easier, softer ways” that constantly bombard the active compulsive eater is staggering. There is a billion dollar business out there trying to convince compulsive eaters that they can have their cake and eat it too.

This extra “competition” contributes to another difference between food programs like OA and chemical addiction programs like AA and NA. People don’t tend to show up to “audit” AA or NA meetings. By the time you’ve decided to dabble in AA, you’ve probably needed it for a long time. But people do dabble in programs like OA. For some of them, it’s another step between commercial weight loss groups and gastric surgery. This means that the eating groups have a far higher rate of “turnover” than other 12-step programs.

Another factor with food addiction is how it is often inextricably linked to one’s sexuality.A number of food addicts were either molested or received other types of inappropriate sexual advances as children. As a result, while one part of the food addict desperately wants to lose weight and be “normal,” another part is terrified of becoming thin and attractive. This is one cause of recidivism in many young women—the attention becomes overwhelming and they turn back to the food.

The main issue, however, that makes food addiction harder has to do with how it delivers its pain. At some point in most alcohol and drug addicts’ lives, some critical incident—or series of incidents—happens to cause them to hit a bottom. While this is usually acutely painful, it is the stimulus to get the addict to open his eyes and ask, “What the hell am I doing?” That’s the first step to recovery.

Food’s pain is not acute—it is a dull, chronic pain. It allows food addicts (especially the smart ones) to continually keep moving the goalposts. One of my deceased sponsees had a genius-level mind. Had I been able to go back in time to his college years and tell him that someday he’d be 600 pounds, he would have laughed me out of the room. But the weight doesn’t go instantly from 250 to 600. It moves from 250 to 275, then 275 to 300, and onward—slow enough to allow the mind games to adjust. We food addicts continually learn to accept that which was previously unacceptable. Compulsive eating is a slow, chronic pain that makes the sufferer realize that they should do something about their problem, but it doesn't cause them enough pain to make them *willing* to actually do so.

Another interesting wrinkle is that the addiction to compulsive overeating can take different forms and each of these forms may need a different approach. Some food focused 12-step programs (such as FAA or CEA-HOW) are very structured, attempting to equate the addictive nature of food with the addictive nature of alcohol. They have a structured and clearly defined approach to abstinence (the food equivalent of sobriety). Other groups (such as OA), which focus more on the process of compulsive overeating, encourage the individual to define their own abstinence.

The downside of a more flexible program such as OA is that it’s up to the addict and their sponsor to determine which foods and behaviors cause them problems and which ones do not. While this is good in theory, if the addict does not have a good sponsor or is not honest about their addiction, it is like giving the inmates the keys to the asylum. As a good friend says, “You can’t fix a broken brain with a broken brain.”

One of the other problems that sometimes occurs in more flexible programs like OA—even among people working a strong program—is the slow, insidious creeping back toward overeating. It’s not like people in AA don’t have slips—they do. But at least they know they are doing it. It’s easy, however, for someone in OA to have a slip and not know it until they are knee deep in it.

Finally, for many addicts, food is “the last house on the block.” Often people with addictions find alternatives when they get recovery from their primary addiction. Food often becomes the “go to” substance for such a switch (the AA Big Book even suggests that newly sober alcoholics who are struggling should turn to chocolate). I think that for some, the idea of having to admit that food is yet another addiction becomes quite threatening. If they start examining their own behavior around food, they might be forced to then have to put down that “last drug.”

The one thing I have to keep telling these “crossovers” is that the credits don’t transfer. It’s very difficult for people who might be circuit speakers in one program to hear that they need to sit down and become a newcomer again.

In the end, trying to compare which addiction is worse is absurd. There are too many variables that make all such comparisons an apples versus oranges debate. I just hope that food addiction won’t continue to be a punch line.