Do We Fully Understand and Account for Addiction in Vermont?

Last year, well over 100 Vermonters died of street and pharmaceutical drug overdoses. Like traffic deaths, we keep track and publicize annually our drug deaths both as an indicator of the problem and of societal instability. Overdose deaths are evident, tragic, and newsworthy. By contrast, the more common deaths from other addictions get recorded as disease deaths rather than deaths of addiction, even as they are often one and the same. Since we don’t record them as such, we have no idea how many people die of the broader range of addictive substances.

Admittedly, it’s harder to track deaths from smoking, alcohol, and eating disorders and yet they account for far more deaths annually than drug overdoses. And then there are the behavioral addictions (gambling, extreme exercise, sexual addiction, screen obsession and gaming) which are rarely lethal but affect quality of life and may lead to depression, substance addiction, or even suicide.

In terms of drug deaths, fentanyl now accounts for 85% of overdose deaths. In 2018, Vermont providers wrote 42 opioid prescriptions for every 100 Vermonters, lower than the national rate of 51 per 100. In the last two decades, overdose deaths in the U.S. have totaled 450,000 – more than 2/3rds the population of Vermont. The Sackler family, owners of Purdue Pharmaceutical whose net worth is estimated at $13B, have agreed to pay some $8.3B with no jail time in a recently announced settlement, leaving them an adequate retirement…, unlike the convicted street-dealer who will live out the rest of his or her life behind bars.

When we look at addiction, our minds go to drugs, alcohol, and tobacco, even though, according to the National Institutes of Health(NIH) addictive eating (obesity) is the second leading cause of domestic deaths. The most common eating disorders  for which statistics are kept are bulimia (binge-purge syndrome) and anorexia (self-starvation) But it’s addiction to refined carbohydrates (sugar, flour, and wheat) that underlies both disorders. The disorders emerge as the addictive eater tries in desperation to manage their weight and distorted body image by purging or starving.

Of Vermont’s ten leading causes of death (below), all but Alzheimer’s and Parkinson’s can be directly associated with substance addictions. Food addiction (obesity) by itself underlies heart disease, stroke, diabetes, and hypertension. 34 million Americans have diabetes and another 88 million are prediabetic, that’s one in three of us.

Tobacco addiction leads to cancer, respiratory diseases and heart attacks; alcohol to organ failure.

VT Leading Causes of Death, 2017 Deaths Rate*** State Rank* U.S. Rate**
1. Heart Disease 1,434 164.5 31st 165.0
2. Cancer 1,332 152.5 13th 152.5
3. Accidents 394 56.9 18th (tie) 49.4
4. Chronic Lower Respiratory Diseases 375 43.0 27th (tie) 40.9
5. Alzheimer’s disease 370 42.9 8th 31.0
6. Stroke 249 28.8 46th 37.6
7. Diabetes 163 19.2 38th (tie) 21.5
8. Suicide 112 18.3 19th 14.0
9. Hypertension 86 9.7 16th (tie) 9.0
10. Parkinson’s disease 81 9.7 8th 8.4

NIH statistics

At the peak of my own food addiction, I weighed just shy of 500 pounds and I had to weigh myself at the local Agway on a grain scale to record my actual weight before entering an addiction treatment facility that treated eating disorders. It had been years since I knew my actual weight, as most scales stopped at 250 or 300 pounds. Since then, the prevalence of obesity has since caused scale manufacturers to redesign their products.

In desperation, after years of trying to lose weight and failing, I signed into a 30-day addiction treatment facility and began to learn what I needed to know and do to recover from my addiction to food. By abstaining from refined carbohydrates – sugar, flour, and wheat – I was able to lose some 240 pounds safely over the course of two years. The first few weeks were hard but, in time, the compulsion to keep eating subsided with abstinence, as it does in recovery from alcohol, tobacco, and opioid abuse.

Americans consume on average 152 pounds of sugar a year –  mostly from high-fructose corn syrup. Look at a five-pound bag of sugar and imagine how to eat it in 12 days. Try to find sugar-free tomato sauce, crackers, or soups in the grocery store. Common ketchup is 28% corn syrup. Mexican drug cartels put heroin in candy to get young people addicted. How is adding sugar to everything any different?

My mother was obese. Growing up in the 1950s during the dawn of industrial processed food – Oleo, Campbell’s Tomato Soup, Frosted Flakes, Oreos, Cheese Whiz, Kool-Aid – our kitchen was well-stocked with addictive substances. I learned early, as do far too many children.

The $75B diet industry has a 90% failure rate, as most weight lost is soon regained. Medicine offers three levels of treatment for obesity: dietary restriction, surgical intervention, and drugs. The most effective current option among them is the most invasive and risky – surgery. Were we to acknowledge that certain refined foods can be addictive, we could treat the addiction more effectively through early childhood intervention, education, and residential treatment.

We’ve been effective at reducing tobacco addiction through education and punitive taxation, although the introduction of vaping has resurfaced tobacco addiction as threat to our young. Alcoholics Anonymous and residential treatment programs have been somewhat effective at treating those who acknowledge their addiction.

But we’ve done little or nothing from a policy perspective to stem the immense damage done by addiction to refined carbohydrates, which are propelled untaxed into our food systems and with government subsidy. The corn subsidy expands waistlines with sugar, marbles beef with fat, and clogs carburetors with ethanol – leaving one to wonder who exactly this subsidy benefits.

When I was writing a book about being a fat person, I spoke with Nora Volkow, Director of the National Institute on Drug Abuse(NIDA) at the NIH and, as it happens, great-granddaughter of Leon Trotsky. She clarified for me the breadth of the addiction research community’s understanding of addiction science, explaining that it results from a physical or psychological dependency on substances introduced into the body or personal behaviors that stimulate the body to produce drugs like dopamine or adrenaline on which the psyche becomes dependent.

In framing a coherent health policy for Vermont, we must understand and tally deaths from the full spectrum of addictions. A death by drug overdose is horrendous, but so are deaths resulting from morbid obesity, smoking, and alcohol. Each must be accounted for in the annals of morbidity and mortality and public policy must take all into account as we struggle to reduce the tragedy of addiction.

While it’s imperative to focus on reducing deaths from drug overdose, we’re shortsighted if we don’t acknowledge and tally the devastating effects of all substance and behavioral addictions Vermonters experience.