Understanding the Links Between Alcohol Use Disorder and Food Addiction

During my residency, I was troubled by the number of patients admitted to the hospital with advanced alcohol-associated liver disease who also had metabolic risk factors. I also saw more evidence that alcohol consumption and metabolic disorders together accelerated the risk of advanced liver disease and its complications.

I decided to become board-certified in both addiction medicine and obesity medicine, as well as hepatology, so I could more comprehensively address patient risk factors and prevent the development and progression of liver disease.

Individuals with addiction, particularly substance use disorders, develop a neurobiological response in which they experience a three-stage cycle of preoccupation, anticipation, and binge/intoxication, followed by withdrawal symptoms from changes in the brain. Substance use is initially driven by positive reinforcement but can later be motivated by the relief of negative emotional states.

Both alcohol use disorder and food addiction share similar features. Alcohol use disorder is a type of unhealthy alcohol consumption with specific clinical criteria, including the development of tolerance, withdrawal symptoms, consumption despite negative consequences, and cravings to consume alcohol.

Food addiction is an emerging concept, and like alcohol use disorder, it involves an unhealthy consumption pattern, primarily of ultra-processed, high-sugar, and high-fat foods. Research indicates that these foods are more likely than other foods to trigger similar patterns of neurotransmitter signaling, including changes in dopamine.

There are well-established treatment options for alcohol use disorder, including behavioral treatments and medications. Behavioral therapies, such as individual or group counseling, can be adjusted in intensity depending on each person’s needs. There are several approved medications for alcohol use disorder that are effective and work best when combined with behavioral treatments and mutual aid resources. There is also a growing array of treatments for obesity, as well as surgical and procedural options. Unfortunately, treatment rates are low, with estimates showing that less than 5% of people with alcohol use disorder or obesity receive any form of treatment for their disorder.

Because food addiction is still an emerging concept, it does not yet have established clinical criteria within the Diagnostic and Statistical Manual for Mental Disorders, so there are no approved treatments for this specific condition. However, patients who have both obesity and food addiction may benefit from anti-obesity treatments that have shared mechanisms with treatments for alcohol use disorder. More studies are needed to determine the most effective treatment strategies and how these can be personalized based on the presence of elements of food addiction.

The vast array of treatment options and overlap between these conditions highlight the importance of integrated, multidisciplinary care to ensure we match the right treatments to each patient. Some of these treatment options are resource-intensive, which is why our team is interested in studying new models of care, identifying what works best for different subgroups of patients, and determining which methods are most scalable and lead to the best outcomes.

People often have multiple conditions, including addiction to more than one substance as well as cardiometabolic risk factors. Additionally, treating one substance use disorder may lead to changes in consumption of other substances or affect their eating habits.

One of my research interests is to better understand which interventions are most effective for subsets of patients with different addiction-related risk factors. For example, we use naltrexone to treat alcohol use disorder, and we use a naltrexone combination medication for weight loss. By measuring outcomes for both alcohol consumption and weight and metabolic parameters, we may be able to learn which strategies may be most effective for different groups of patients.

Similarly, early studies show there could be some benefit in prescribing GLP-1 receptor agonist medications, which are now commonly used to treat obesity, diabetes, metabolic dysfunction-associated steatotic liver disease, and other cardiometabolic conditions, to reduce alcohol consumption or use of other substances. This research is still in its infancy, but there is clearly an overlap between these fields.

By tailoring approaches to treat alcohol use disorder and other substance use disorders alongside obesity, metabolic risk factors, and emerging entities such as food addiction, we may be able to improve health outcomes and streamline care for patients by treating multiple contributors to disease simultaneously.