Diabetes: An Addiction Similar to Alcoholism
By Greg Goodchild LMFT
Diabetes is a growing ailment in the USA. Approximately 18.2 million people have this physical disease – 13 million have been diagnosed and it is estimated that 5.2 million people have the disease and remain undiagnosed. 1
There are at least three types of Diabetes in the US. Pre-Diabetes is where one has elevated blood sugars of 101mg/dl to 125 mg/dl on the Fasting Plasma Glucose Test but not above the 126 mg/dl levels which would be diagnosed as having Diabetes or 139 mg/dl to 199 mg/dl on the Oral Glucose Tolerance Test 200 mg/dl would be diagnosed as Diabetes. It is estimated that there are 20.1 million Americans with this type of problem and are already experiencing some types of long-term damage in the heart and circulatory systems. 2 Type I Diabetes is when the Pancreatic cells are not producing enough Insulin to manage the blood sugar levels in the body. This Insulin reduction can be caused by genetic problems or by Pancreatic trauma. Type II Diabetes is where the body is still making Insulin but is not able to manage the blood sugar levels. This type of Diabetes is caused by some genetic pre-disposing factors, family incidence, increased weight, decreased exercise, and increased stress factors which can produce increased amounts of Cortisol which assists in regulating insulin and blood sugar regulation. A potential fourth type of Diabetes is developing which some have called “Double Diabetes”. It appears, to some researchers, that the obesity increases in the US are producing symptoms of both Type I and Type II Diabetes at the same time. 3
Among the many problems with Diabetes is that when glucose levels get too high the body reacts in a number of ways and increased incidence of hypertension, heart disease, strokes, kidney disease, neuropathy, visual complications, and amputations can occur. If the Diabetes is not controlled it kills approximately 70,000 deaths each year directly and is a contributing factor in over 213,000 deaths per year. 4
The part of Diabetes that is especially tragic is that 90% of diagnosed cases of Diabetes is that of Type II Diabetes. This type of Diabetes can be controlled by the individual if they would be willing to make fundamental changes in their lifestyle. Obviously one can not control whether they have inherited from their family and, as in the case of Type I Diabetes, and of course one can not control trauma to the Pancreas. But in Type II Diabetes one should be able to control the amount of physical exercise, dietary input, stress management, medication compliance, and weight control. But statistics indicate that while amenable to treatment issues 30-50% of Diabetics do not control their lifestyles and as a result they experience end stage trauma and approximately 70,000 Diabetics die per year. 5
In many ways Diabetics respond to treatment in a manner similar to that of Alcoholics. Diabetics appear to be otherwise normal people who face a life threatening problem, yet many of them act in a way that undermines their well being. The data seems to indicate that up to 50% of Diabetics practice a form of relapse and return to a lifestyle that is pleasant to the taste but harmful to the body. 6 Education seems to help to some degree but there appears to be emotional/spiritual issues that undermine the ability of the Diabetic to make the long-term changes necessary to ensure health. With all of the data on the Internet available to the individual with Diabetes it would seem that the Diabetic would be able to absorb the data and implement it into their lives. Yet it appears that many Diabetics respond in a manner that is self-destructive. With the information at hand many Diabetics appear to practice a form of denial of their disease and refuse to cooperate with treatment requirements. This self-destructive behavior is reminiscent of the disease of Alcoholism.
It is the purpose of this writer to present the idea that Diabetes is not only a physical disease but also an addiction. If accepted as an addiction, as well as a physical disease, then those things that work well for the treatment of Alcoholism may be experimented with in the treatment of Diabetes. This would allow us to see if there are ways that those Diabetics who clearly are food addicts, or lifestyle addicts, can get the help they need.
In classical treatment for addiction/dependency we must have an agreed upon idea of what a dependency is. The DSM IV definition of dependence is a generally accepted outline of the issues involved in making a diagnosis of dependence. The following points are listed as follows:
1. Tolerance – the ability to use higher amounts of a substance than the person was once able to tolerate.
2. Withdrawal – a negative response of the body to the removal or reduction of the addictive substance. This could be an emotional or physical withdrawal symptoms.
3. The person often takes in larger amounts of the substance over longer periods of time than intended.
4. Persistent desire, or unsuccessful efforts, to cut down or control use of the substance.
5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from the effects of use.
6. Important social, occupational, or recreational activities are given up, or reduced due to the use of the substance.
7. Continued use in spite of knowledge of persistent physical or psychological problems caused by or exacerbated by the substance.
To diagnose someone as being dependent three or more of the above seven factors would need to be in place over a twelve-month period of time.
With the above in mind it would not be difficult at all to see Diabetes fitting the dependency diagnosis if applied to food, sugar, or excess fat producing foods, or a lifestyle that incorporated these factors and produced the symptoms of Diabetes. The30-50% of Type II Diabetic that have a high relapse activity rate, who can see themselves deteriorating and yet continue to live the negative lifestyle that produces Diabetes must be practicing some kind of denial. As the practicing Diabetic “sees” more and more physical problems, suffers physically and financially from their disease, watch their families suffer, lose out on pleasant activities as a result of the disease, and eventually may die as a result of the disease and yet still can not stop participating in this lifestyle would appear to be classic dependents.
If one comes to the conclusion that they have lifestyle qualities that fit the above diagnostic criteria and concluded that they are dependent the next logical question is what can they do about it. For many Diabetics denial is one way of handling the issue of dependence. It would appear from the research that McLellan et al have conducted Diabetics and Alcoholics have similar styles of denial and a return to a lifestyle that tears one down rather than builds one up. McClellan’s research indicates that less than 60% of type I Diabetics comply with their medication schedule and less than 30% Diabetics comply with their diet and behavioral change program. 7
Another way of dealing with Diabetes as an addiction is to accept ones disease and to take the steps necessary to make changes. Obviously some people make the changes necessary and go on to live productive lives. For those who can’t change by themselves I would like to suggest some things that could be done. If one were to accept the dependency diagnosis they could use the major points of assistance that Alcoholics use for treatment and change.
1. They could band together in mutual support groups. Groups encourage one another to maintain their recovery regimens.
2. They could get explore counseling to deal with emotional issues which can influence their behaviors.
3. They could develop sponsor programs and share the lifestyles of those who are successful in recovery through teaching and role modeling.
4. They could promote interaction with one another with the focus of learning how to handle stress issues.
5. They could incorporate dietary training with the specific goal of reducing sugar intake, fat intake, and develop a comprehensive dietary lifestyle change.
6. They could incorporate a lifestyle that encourages increased physical activity.
7. They could borrow the 12 steps of Alcoholics Anonymous and adjust them to deal with Diabetes. Similar to the Overeaters Anonymous model.
8. They could incorporate a system of trust, which encourages the need to share successes with other Diabetics.
9. They could develop small group support providers to make the above opportunities available in many local settings to cut down on the relapse concerns – availability, cost, information, trained support teams.
10. They could teach about the impact of other lifestyle issues that can effect Diabetes management such as alcohol and drug consumption, smoking cessation, psychosocial issues.
In conclusion it is my hope that Diabetes will continue to be seen as a physical disease and continue to utilize all of the available medical knowledge. It is also my hope that the similarities between Diabetes and Alcoholism can be seen clearly. It is also my hope that if there are beneficial treatment issues that could be shared with either disease that these would be made available by hospitals, or small clinics to assist those people who can not get recovery on their own. Perhaps one day there will be a support group network for the treatment of Diabetes as there currently is for Alcoholics. Perhaps small clinics will be able to provide Diabetes support groups along the lines of outpatient drug treatment programs and that they will be able to provide comprehensive education and therapy groups that combine the medical model as well as a recovery model in one group. One of the goals of this paper is to help people not to pigeonhole recovery issues to Alcoholics and Drug Addicts but to be able to share these recovery issues with all others with similar problems and to help the most people possible.
1. American Diabetes Association – “Diabetes Statistics” See www.diabetes.org
2. American Diabetes Association – “What is Pre-diabetes?”
3. “Obesity’s New Peril – ‘Double Diabetes’ by Dorsey Griffith Sacramento Bee Medical Writer. July 11, 2005
4. American Diabetes Association – National Diabetes Fact Sheet – pg 4
5. References for #4 and #7.
6. CME article “Relapse” July 8,2004 at www.texmed.org
7. McLellan et al Jama Vol 269 No. 15 April 21, 1993
269 No. 15, April 21, 1993
Vol. 269 No. 15, April 21, 1993