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ContentsForeword: The Doctor’s Opinion by Dr. Ronald Hoffman............xiIntroduction ..................................................... 1Dianne’s Story: My Addiction, My Recovery........................ 5PART ONE: THE PROBLEM: FOOD ADDICTION ............ 29 1. The Disease Concept of Addiction: The Biopsychosocial Definition of Addiction ...................................... 31 2. What Is Food Addiction?..................................... 50 3. Little Food Addict in Training: An Illustration of How Food Addiction Develops .................................... 91 4. Little Food Addict in the “War Zone”: Damaged Characteristics and Resulting Adaptation ...........118 5. Food Addiction: The Precursor/Gateway to Chemical Dependency....................................147 6. Understanding Metabolism and the Development of the Disease of Food Addiction.............................156 7. The Culprits and Triggers ...................................175 8. Denial and Other Defense Mechanisms.......................197PART TWO: THE SOLUTION: ABSTINENCE ............... 217 9. What Is Abstinence? ........................................21910. The Basics of Nutrition .....................................22611. Realization Center Food Plan for True Recovery from Food Addiction .......................................237

PART THREE: DEALING WITH FOOD ADDICTION .........25712. Compliance versus Surrender................................25913. The Language of Feelings and Food Addiction ................28314. Self-Esteem and the Family System...........................30915. Family and the Food Addict.................................357PART FOUR: TREATMENT AND RECOVERY ..............38316. 12 Step Food Recovery Fellowships and Relapse Prevention—Tools of Recovery ..............................38517. Sabotage and Relapse.......................................41218. Therapy and Treatment for Food Addiction...................43319. Recovery . . . Discovery.....................................449Conclusion: Last Words.........................................463Appendix: “Am I Addicted to Food?” Questionnaire ..............465Acknowledgments..............................................468Resources......................................................471Endnotes ......................................................473Index..........................................................483About Realization Center .......................................499About the Author ..............................................501

50CHAPTER 2What Is Food Addiction?Food addiction destroys. It robs us of our dreams. It isolates and alienates us from friends and family. It can even kill. But our food addiction doesn’t have to keep us from having a long, fulfilling life. Finding the solution begins with identifying the problem.We all have to eat; it’s the way we survive. Food is the fuel for our bodies. Eating is a fundamental activity of life. So how can it be an addiction? Let’s discuss what happens when a person can no longer con-trol how much or what they are eating or not eating—which is addiction.Some “eating disorder” professionals and institutions reject the very idea that food could be an addiction. They see it as an emotional/mental disorder and strive to help their patients or clients eat in moderation. They believe that they can help a person eat, for example, one cookie, then stop and want no more, or one brownie and stop. I don’t believe this is possible for someone who has lost control. As you are aware, I believe that eating problems are addiction, and are first and foremost based in the brain chemistry of the suffering individual.Addiction is a pathological relationship to any mood-altering experience (substance, person, behavior, or process) that has life-damaging consequences.Historically, aberrant eating behaviors were thought to be caused by lack of willpower. Our beliefs are being altered by our deeper understand-ing of the genesis of these behaviors. As Ann Crumpler, licensed clinical social worker/therapist experienced in treating addictions, states in her Summer 2006 article for Paradigm titled “Understanding Addictions”:“The idea that addicts lack willpower has long ago been debunked.

What Is Food Addiction? 51Blaming attitudes keep individuals from seeking treatment, which fos-ters shame and fear around their illness. Addicts and those who love them are often the last to accept the disease concept, since they are engrossed in shame, denial, and the need to prove they are in con-trol. Shaming addicts for their behavior is counterproductive; it creates barriers to recovery and complicates the recovery process. Addicts use substances/behaviors to medicate shame, fear, anger, and pain. Adding to the shame spurs increased addictive behaviors.”27Common characteristics are shared by all addictions; they follow a sequence of experiences that leads to loss of control and inability to manage daily living. Addiction causes changes in the brain, which include physiological, chemical, and even anatomical changes, with accompa-nying thought and behavioral changes. Initially, the substance/activity causes feelings of pleasure and concomitant changes in emotion. This initial euphoria creates an obsession to reconnect with that experience. In other words, addiction is both a physical and psychological dependence, independent of the need to avoid the pain of withdrawal. The body devel-ops a physical tolerance to the substance/activity so that addicts must take/engage in increasingly larger doses to get the same effect. Removal of the drug/activity, inevitably, causes painful withdrawal symptoms.According to Dr. Sam Sugar of the Pritikin Longevity Center & Spa in Florida, food addiction is a very real, everyday dilemma. He says:“If you want to take a look at what’s the most addictive, other than heroin and narcotics, go to a fast food place and see what they have been selling for the past 40 years. High salt, high sugar, meat, fat, cheese and chocolate—all of which are the most addictive foods known to man. Deep in our brains we know that those over-processed breads, decadent desserts, and soft drinks aren’t the healthiest things we could be eating, but another deeper, darker part of our brain is prompting us to eat more of them. The brain works on a simple ‘make me happy or suffer’ level.”28Dr. Sugar goes on to say that these foods cause a significant elevation in the brain’s dopamine levels, and the attendant feelings of pleasure and reward are thought to be similar to what addicts experience when using drugs, as touched upon in the previous chapter. The more you eat, the more you want. This is why supersizing is so popular.

52 The Big Book of True Recovery from Food Addiction and BeyondAs with all addictions, the body/brain builds up a tolerance to these foods and the pleasure circuit gets blunted. The food addict needs more and more to get the needed reward.With the easy availability of foods of all kinds, it’s no wonder that so many people are dealing with addiction and epidemic obesity. What we are seeing for the first time in 3.5 million years is that people are more likely to die of obesity than starvation. Though starvation is a stranger to most people in the United States, our brains are still programmed to store calories.A major benefit of food addiction recovery (abstinence) is that by removing the “trigger/culprit” foods (e.g., sugar, artificial sweeteners, flour, wheat, high fat, high salt, hard cheese, caffeine, and alcohol) from the diet and creating a structured plan of eating, we give the brain a chance to rewire itself and become less dependent on the harmful “treats” for those good feelings. Let’s examine the nature of this.More Definitions of AddictionDisease: any condition of a human being that makes a part of their body or themselves unable to function in a healthy way.Stop for a moment and think about this definition. Which part of it jumps out and/or has the most meaning for you? Is it “any condition,” or “their body or themselves,” or “unable to function […] in a healthy way”? (For me, it’s the “functioning” part; to me, being able to function well is everything! One wants to be highly functional to the end.)The word “addiction” comes from the Latin root addictus, which means “to be enslaved” (interesting that the Romans had a word for this terrible affliction). Using this meaning to develop a definition of addic-tion yields:Slavish physical and/or emotional dependence on a mood-altering sub-stance and/or behavior.Again, think about this in relation to your behavior with food. What in this definition stands out for you? Slavish? Physical/emotional depen-dence? Mood-altering?●Slavish—Does eating/not eating dictate your behavior?

What Is Food Addiction? 53●Physical/emotional dependence—Do you make life decisions based on your access to specific foods?●Mood-altering—Because of your eating/not eating behavior, do you experience mood swings? Do you look to eating to alter your mood?The treatment field now officially recognizes alcoholism and addic-tion as a disease. As we discussed earlier, Alcoholics Anonymous (AA) has done this since the 1930s. In 1950, the medical establishment (AMA) officially recognized addiction as a disease, listing it in the Diagnostic and Statistical Manual of Mental Disorders, or DSM (the diagnostic “bible” used to define mental/behavioral conditions and illnesses) with the rele-vant diagnostic codes for alcoholism, cocaine addiction, opiate addiction, and so on. Sixty-one years later, the establishment took a critical next step. Sadly, the wheels of understanding and acceptance turn very slowly.As presented earlier, in 2011, the American Society of Addiction Medicine published a long-awaited definition that finally officially rec-ognized the biological basis of addiction. It’s not simply a behavioral or social or moral problem. This definition finally opened the door to eating issues being included as an addiction. Although I included this definition earlier, I am including it here again to emphasize it:Addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social, and spiritual manifesta-tions. This is reflected in an individual pathologically pursuing reward and/or relief by substance abuse and other behaviors.Addiction is characterized by the inability to consistently abstain from the problem behavior, impairment in behavioral control, craving, dimin-ished recognition of significant dissonance with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic conditions and diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive, and can result in advancing disability or premature death.29Consider the first word—primary—which means “first or main.” So, how many primaries can one have? Just one. Now think about who,

54 The Big Book of True Recovery from Food Addiction and Beyondor what, is your primary relationship. Is it yourself, your spouse, your girlfriend or boyfriend, your parent, your child, or maybe your higher power? Really think; take your time. . . . Whatever you just said or thought—it’s wrong!As long as you are addictively using any substance, that is your pri-mary relationship—for example, are you smoking or vaping? Do you have to have sugar or other sweetener every day? Would your life not be worth living if you had to “give up” Entenmann’s cake, soda, coffee, or something else? To what lengths have you gone to make sure you have your “stuff”? Are you always careful to make sure you have enough cigarettes? Ice cream? Cookies? Cake? Candy? Sweet cereal? NutraSweet or other sweetener? How much space in your brain does the concern about maintaining your stash take up? Does it take up more space than you assign to what or who you designated as your primary relationship?The word “primary” in this definition actually means “coming first”—that nothing precedes it. It isn’t a secondary symptom of some-thing else. So addiction is an illness in and of itself; it isn’t a symptom of another underlying disease.Food addiction is a primary disease. It stands alone, with its own causes and history. It is not an outgrowth of other disease processes such as emotional or psychiatric problems but an illness in its own right. It’s not caused by, or a response to, a difficult life situation such as stress, external abuse, childhood trauma, or a bad marriage; it’s not a substitute for something psychologically lacking, such as love, self-esteem, or con-fidence; and it’s not the result of a moral deficiency, like weak will. The common belief that these conditions cause a person’s overeating allows for the misunderstanding that “fixing” them will stop the problematic eating. How many food addicts sought psychotherapy to solve their eating issues—trying to get insight, understanding of their psyche, moti-vations, and pain, in hopes it would solve their eating problems? I have never met anyone, personally or professionally, who was “therapized” out of any addiction, including food addiction.One of the secondary symptoms of being a food addict is weight gain. Most people have had the experience of losing weight. Most often, the weight comes back, plus. Gaining weight is not the problem, nor is losing weight the solution. The primary problem is food addiction. That’s why diets don’t work—they don’t address the addiction, only the symptom!

What Is Food Addiction? 55In her wonderful 1988 book Lick the Sugar Habit, Nancy Appleton, Ph.D., discusses cases of people with major secondary health problems that resolved when sugar was removed from their diets. Her work high-lights how the medical field and those with health problems wrongly believe they have primary illnesses and focus all their attention on the symptoms. (Not to say that there aren’t individuals who suffer from ill-nesses/diseases that are primary.) The point is that until the food addict sees the secondary issues of weight gain, depression, gas, constipation, etc., as stemming from food addiction, these conditions cannot be cleared up.“Pathological” means changed by the course of a disease, something that is diseased, or arising from disease. We know this word from the phrase “pathological liar”—someone who lies and can’t help it. The body/brain of the food addict reacts differently to trigger foods (see page 46) than that of a non-food addict and experiences the phenomenon of craving—resulting in compulsive behavior with food—i.e., overeating, purging, and restricting—with the menu of adverse effects.A comprehensive definition of addiction is found in the literature of the 12-Step Program Sex and Love Addicts Anonymous:The use of a substance or activity for the purpose of lessening pain or augmenting pleasure, by a person who has lost control over the rate, frequency, or duration of its use and whose life has become progres-sively more unmanageable as a result.Let’s narrow this down to a specific definition.Food Addiction: Pathologically pursuing pleasure/reward by engaging in unmanageable episodes of overeating, undereating, and/or eating/purging despite the adverse consequences, injuring health, and/or inter-fering with social, economic, or emotional functioning on a continual basis, by a person who has lost control over the rate, frequency and duration of their behavior.The substance most often abused is sugar as well as foods that are quickly converted to sugar (glucose) in the body. These foods, or binge foods, include the obvious sugary foods such as candy and ice cream, but also include refined carbohydrates such as flour products (breads, cookies, and pasta).30

56 The Big Book of True Recovery from Food Addiction and BeyondEXAMINING THESE “ADVERSECONSEQUENCES”Food addiction has far-reaching physical, emotional, and social conse-quences, as discussed in this section.Injuries to Health/Medical IssuesPossible medical complications vary according to the specific food addic-tion. The following is a brief discussion of each. Also see the further dis-cussions in Chapter 4: Little Food Addict in the “War Zone” and Chapter 12: Compliance versus Surrender.●In anorexics—Anorexics are often thin to the point of emaciation but are deathly afraid of gaining weight. Medical complications of anorexia can include liver and kidney problems, metabolic and bone changes, and damage to the endocrine system. Symptoms related to severe weight loss include dry skin and hair, cold hands and feet, gen-eral weakness, constipation and other digestive problems, insomnia, and amenorrhea (a cessation of menstruation). In addition, the body begins to grow hair (called lanugo) in an effort to keep itself warm. As weight loss progresses, more severe problems may develop, such as increased susceptibility to infections, stress fractures, ketosis (severe chemical imbalance), and progressive weakness of the heart muscle, which can lead to death.●In bulimics—Bulimics may be of average weight or, more usually, slightly above average weight. They do most of their bingeing and purging secretly and experience rapid weight gains and losses. They purge through self-induced vomiting, abusing laxatives and diuretics, and/or fasting or overexercising. They are subject to medical problems occasioned by their purging methods as well as their eating habits.Vomiting causes the body to release endorphins, natural chemicals that make us feel good. Eventually the bulimic may make herself vomit even if she has not overeaten, so she can feel good. Soon the bulimic loses control over the binge-purge cycle. Repeated vomiting, fasting, exercising too much, or misuse of laxatives, diuretics, ipecac syrup, or enemas will eventually cause serious, long-term health problems in a variety of organ systems. Bulimia can result in dehydration, consti-pation and other digestive disorders, esophageal tearing, severe dental damage, and muscle weakness.

What Is Food Addiction? 57As bulimia progresses, ulcers and life-threatening cardiac irregu-larities (from electrolyte imbalance) and heart failure may develop. Excessive laxative use can destroy natural bowel function and tonicity and can lead to ongoing diarrhea and rectal bleeding. As with repeated induced vomiting, abuse of laxatives can, in extreme instances, lead to death. Overuse of medications such as ipecac syrup to induced vom-iting can lead to diarrhea, weakness, low blood pressure, chest pain, and trouble breathing. Prolonged overuse of these medications can lead to death.●In compulsive overeaters—Compulsive overeaters are often over-weight and may develop obesity. Overweight and obesity can lead to hypertension, stroke, varicose veins, and heart attack. Issues with overweight and obesity may also lead to metabolic syndrome, heart and related problems (high blood pressure, fluid retention, and so on), diabetes, digestive problems (reflux, indigestion, GERD, gas, bloating, constipation, diarrhea, colon polyps, diverticulitis, diverticulosis), some cancers, sleep issues (apnea), joint problems (e.g., arthritic con-ditions), fogginess (decline of brain function), cravings, and loss of libido.Interference with Social FunctioningPeople with food addiction often isolate themselves, preferring to stay home, eat, and watch TV or read. They may feel uncomfortable in social settings because of their weight, so they avoid these gatherings. When they do socialize, it is often with “eating buddies” where the focus is on eating. They may feel so tired that the idea of being with other people is too much and avoid going out with friends. They look to food for nurturing, not realizing that true nurturing comes only from people; see Chapter 3: Little Food Addict in Training. Studies have shown that diet-ers and/or restrictors who maintain their weight at lower-than-normal levels (starvation mode) may experience loss of the sense of caring about others, love, and compassion. Breakdown of family ties is also seen where a person can become a loner, mistrustful, malicious, and even cruel to family members. A person in starvation mode shuts down physically, mentally, emotionally, and spiritually, and heightens his or her attention to food.

58 The Big Book of True Recovery from Food Addiction and BeyondInterference with Economic FunctioningPeople with food addiction often spend more than they intended to on their binge foods, including fast food, even though it is relatively inex-pensive. They may miss days at work as a result of their eating, eating/purging, and/or restricting behavior, and lose income due to their absence as a result. In some cases, they may work at a job that pays less than they are capable of earning because their motivation and energy level are compromised.Interference with Emotional FunctioningThis is the big one. When emotional functioning is unstable or dysfunc-tional, nothing else in the food addict’s life can work right; health, social, and economic functioning are all affected. The eating behavior causes the addict’s blood sugar level to “roller-coaster,” causing a host of symptoms such as irritability, crankiness, depression, nervousness, anxiety, panic attacks, sweaty palms, lightheadedness, headache, occasional migraine, brain dysfunction (fogginess, poor focus and concentration, memory and thought-processing issues, poor decision-making, poor perception, poor judgment, low motivation), and/or craving (when the food addict is in craving mode, obsession takes over and nothing else matters). Executive functioning is exponentially affected, leading to poor judgment, poor decision-making, and avoidable errors. The components of executive functioning are discussed in the inset on page 59.With regard to emotional functioning, in Facts On: Food Addiction by Nancy Fiorentino and Katie Regan, the authors write:“Food addiction also has emotional and spiritual dimensions. Emo-tional dimensions may include loss of self-esteem, anxiety, and an emo-tional ‘roller-coaster’ ranging from hysteria to depression, and often including suicidal thoughts. Spiritual dimensions may include hopeless-ness, the perception of a ‘void’ in one’s life, and an absence of faith and trust in oneself or others. Addiction suppresses the ability to ask for, give, or receive help, and isolation is the result.”31

What Is Food Addiction? 59WhAt iS executive fuNctioNiNG?The executive functioning of the brain is impaired in the food addict. Executive functions of the brain include the ability to monitor one’s own performance in social situations (e.g., getting along with people); ability to properly and simultaneously attend to, and track more than one task (e.g., time management); ability to shift set; abstract thinking/creativity; appropriate and adaptive responses to novel stimuli; attentional processes; categorization; conceptualization (e.g., learning and synthesizing informa-tion); goal-directed behavior; inhibition of unwanted behavior: insight and judgment (e.g., from what to wear to whom to marry); memory; mental flex-ibility; planning and decision-making; rule application; special processing (e.g., musical, artistic skills); and the ability to appropriately and appreciate consequences (instant gratification versus long-term satisfaction/impulse control/criminal behavior). All of these features are subsumed under the neuropsychological rubric of “executive function” or, when impaired, “executive dysfunction.” Fortu-nately, this impairment is not permanent and is repaired by “The Solution” (discussed in Part Two: The Solution: Abstinence).FURTHERING OUR UNDERSTANDING OF FOOD ADDICTIONIllustrating the impact of the consequences of food addiction and how we have adapted to and normalized them, an anonymous letter published in the “Letters to the Editor” in the October 2005 edition of The Sun magazine encapsulates the syndrome:What kind of day I’m having depends on what I’ve eaten. Some fruit and a plain waffle? Good day. Just coffee? Great day! Chocolate and cookies? Bad day. I’ve never been overweight. When I was fifteen, I was anorexic and weighed just a hundred pounds. Look at all those other people eat-ing, I would think. They have no self-control. I was often light-headed, cranky, and reclusive, but I was thin. Sometimes I still long to feel that empty and light, to believe again that I have control.32Do you identify with this? Does this sound like someone you know?

60 The Big Book of True Recovery from Food Addiction and BeyondTo increase our understanding of food addiction, we must closely examine its characteristics, which are similar to those of chemical dependency and other addictions. These characteristics include denial, primary, chronic, fatal, tolerance and progression, craving, obsession/preoccupation, com-pulsion, time wasted, loss of control, physical dependency, treatable, and more. Let’s take a look at each characteristic in turn in the following sections.DenialThere is an extensive discussion of denial in Chapter 8, but let’s touch upon it here, too. Addiction is a disease that says, “You don’t have a disease.” Addiction is so powerful that it convinces you that it’s not a problem, and according to Marilyn J. White, “It’s the only disease that allows you to enjoy your own death!”33 Think about how much of one’s health and functioning is compromised and diminished by a pathological and addictive relationship with food.For overeaters who do not purge, weight is usually the symptom that gets the attention. Most people with weight issues have attempted many diets. If they are successful, we don’t hear about them again. But if they aren’t, what we hear is that they have to go on another diet. Their denial was a failure to admit that what wasn’t working really wasn’t working. They would diet, lose weight, and regain it, and while their denial was operative, they would say, “I have to try again.” They think they didn’t work hard enough. “I have to do better, more, put more effort into it.” However, it was the diet that failed, not the dieter.It’s important to understand that when it comes to addiction, denial works against, or covers up, the physiological/biochemical issue: there is a craving for a substance that leads to obsession. The reason for this is that the addict’s body finds it more critical to get food than to act rationally. To put it into “food language,” the body mistakes hunger for starvation. The overeater/food addict felt hungry but acted as if she were starving. She isn’t eating to just satisfy hunger; she’s eating to avoid dying. Hungry people eat until they’re satisfied and then stop. They can do that because their biochemistry, genetics, and brain chemistry are not dysfunctional in the way a food addict’s are.It is understood clinically what happens when a person is starving: they start obsessing about food and can think of nothing else. That’s not

What Is Food Addiction? 61hunger; it is a chemical-medical state. In a food addict, however, hunger perceived as starvation is a biochemical reaction; there’s nothing the addict can do about. Think about this: If your body is having a reaction to hunger, it is making an erroneous connection and then thinking it is starving and then the brain starts figuring out how to get food. The addict gets a brain-biochemical message that she is starving and will eat regardless of what she’d been thinking before that happened. Then, it is like a patient trying to stay alert when they have been given an anesthetic prior to an operation. All of a sudden, they enter into a euphoric state, start thinking about other things, and then they are gone. That’s the power biochemistry has over our bodies as addiction progresses.The problem is that same faulty biochemistry produces all sorts of lies. In addition to telling us we’re starving when we’re just hungry, it also tells us that it’s okay to eat even though we committed not to. It tells us to think, I’ll start my diet tomorrow, even though I said this is the most important thing in my life. The biochemistry says it’s okay to starve myself as a way of not letting this happen; it says it’s okay to purge every day so I can continue to eat as much as I want and not gain weight. All of this seems crazy—that is, unless you’re in the mind of the food addict: Well, that makes sense; I can eat all I want and just have to throw it up—perfect solution! I can eat as much as I want and get to weigh just what I want, not realizing, or forgetting, what’s happening to my body—hydrochloric acid coming back up and starting to gnaw at the enamel on my teeth, burning my throat, starting to change the electrolyte balance in my body. As I’m beginning to purge more and more, I’m having to hide it as I’m starting to purge on my good clothes, as I’m lying to my friends about why I’m purging.Denial is a hallmark of addiction, and food addicts need to fail more than one test of various “Do you have food addiction?” questions before they begin to believe that their relationship to food is addictive. (See Appendix: “Am I Addicted to Food?” Questionnaire.)In the 1990s publication Facts On: Food Addiction, Nancy Fiorentino and Katie Regan discuss this destructive, dangerous characteristic this way:“Denial of food addiction is especially pervasive, since overeating is as socially acceptable in American culture as motherhood and apple pie. It is extremely difficult for even the most committed 12-step member

62 The Big Book of True Recovery from Food Addiction and Beyondin stable, long-term recovery from alcohol and other drug addiction to believe that obesity is a result of addiction to food. Many simply believe that their addictive behavior is under control and that eating a bag of chocolate-covered raisins can hardly be considered a lack of spiritual centeredness. This polarization of mind and body is another form of denial, and another way of maintaining an addiction.”34Denial on an individual level is about saying, “It’s okay, it’s just cook-ies, it’s not like I’m using [drugs and alcohol].” Societal denial is also a factor as it does not attach the same level of seriousness to the “use” of food as it attributes to drug and alcohol use and abuse.PrimaryAs stated previously, addiction is the disease, not a symptom of some other disease. And it’s not an outgrowth of another condition.ChronicThis characteristic means that the condition is ongoing and will not go away on its own. The dictionary definition of chronic is constant, con-tinuing, constantly recurring, of long duration. In Disease Concept of Food Addiction, Charles and Peggy Starks clarify this characteristic:“Food addiction, like alcoholism, is not a temporary misalignment, nor is it a product of faulty learning or psychological trauma. It is not something that is outgrown. Like the alcoholic, the food addict who remains abstinent for a long period can return to full-blown addiction in a heartbeat if the addictive chemical is taken into the body. This is true regardless of the reason that the addictive chemical is used. The body does not know the difference between the drink of Champagne that celebrates a daughter’s wedding and the shot of whiskey gulped from a hidden flask. Similarly, the body cannot discriminate between the piece of cake eaten at a parent’s fiftieth wedding anniversary and the candy bar scarfed down in the grocery store parking lot. When the addict’s body experiences some, it craves more. This is true today, tomorrow, and for the next 40 years.”35The disease of addiction, any addiction, is a permanent condition, and not curable and, therefore, must be managed on a daily basis. The disease progresses even when we are doing the work of recovery. When