What is the SUGAR® Diagnostic Instrument?
SUGAR® stands for Sugar Use General Assessment Recording. It is the first and only diagnostic tool in the world developed specifically for assessing addiction to sugar, flour, carbohydrates, and ultra-processed food.
Developed by Bitten Jonsson RN and Börje Dahl of Dahl & Dahl Prevention & Addiction Center, SUGAR® is administered as a structured interview. It examines a person's full relationship with sugar and food — including the history of that relationship, its consequences, and the patterns that have developed over time. Bitten Jonsson RN brings nearly four decades of experience in sugar and carbohydrate addiction treatment to the tool's development.
If you are a GP or health professional looking for clinical information about the SUGAR® assessment and how to refer patients, please visit our dedicated professional page.
Who can use SUGAR®?
Only practitioners who have completed the SUGAR® certification and licensure programme are authorised to use this tool. I am a certified and licensed SUGAR® Diagnostic Instrument practitioner, trained directly under Bitten Jonsson RN.
What the SUGAR® assessment makes visible
One of the most powerful things about the SUGAR® process is what happens when people see their own history mapped clearly for the first time. The addiction development curve shows how the pattern has developed over time — how it has progressed, what it has affected, and why the other approaches haven't worked.
For most people, seeing this is a moment of recognition rather than shock. It's not your fault. It's progressive. And there is a path back to yourself.
That path involves an abstinence-based food plan — removing the substances that are driving the dependency. The SUGAR® assessment helps identify which of three dietary approaches is most appropriate for you specifically, because there is no single plan that works for everyone. Finding the right one may take some adjustment and time. But for people who have spent years trying to moderate something their biology won't allow them to moderate, the experience of mental calm that comes with the right food plan can feel like something they had forgotten was possible.
Why it matters
Before SUGAR® was developed, there was no comprehensive diagnostic instrument available for sugar and food addiction. Screening tools existed — the Yale Food Addiction Scale, UNCOPE/S, and various self-assessment questionnaires — but none were designed to provide a full clinical picture of addiction to sugar and carbohydrates specifically.
SUGAR® fills that gap. It is based on the internationally recognised diagnostic criteria for harmful use, pathological use, and addiction as defined by the WHO's ICD-11 and the American Psychiatric Association's DSM-5.
A critical distinction
One of the most important things SUGAR® does is distinguish between two conditions that look similar but require very different treatment approaches:
Harmful use — where someone is experiencing damaging consequences from their relationship with food, but is not chemically addicted. Stress eating and emotional eating often fall into this category. For some people, a moderation-based approach can work here.
Pathological use (addiction) — where the person is chemically dependent on sugar or ultra-processed food. This is a chronic, complex, and serious condition. Moderation does not work here. The appropriate treatment model is abstinence (Ifland, Preuss & Marcus, 2018; Jonsson, 2023).
Getting this distinction right changes everything about the path forward. Without it, people spend years trying to moderate something that their biology will not allow them to moderate — and blaming themselves when it doesn't work.
Addiction Interaction Disorder
Embedded within the SUGAR® assessment is a screening for Addiction Interaction Disorder (AID) — the recognition that addiction is rarely confined to a single substance (Ifland, Preuss & Marcus, 2018). Many people struggling with sugar and food addiction also have complex relationships with alcohol, prescription medications, or other substances. The SUGAR® tool screens for this because understanding the full picture is essential for making appropriate recommendations.
Dahl & Dahl Prevention & Addiction Center, who co-developed SUGAR®, also developed ADDIS — a widely used diagnostic instrument for alcohol and drug dependence. The Addiction Interaction Disorder screening within SUGAR® draws on that same clinical tradition, bringing established addiction medicine methodology to the assessment of food and sugar addiction.
The addiction development curve
Every SUGAR® assessment produces an addiction development curve — a visual map showing how a person's relationship with sugar and food has developed over time, from the beginning of harmful use to the present day (Jonsson, 2023).
This curve has proven to be one of the most powerful motivational tools available in addiction treatment. Seeing your own history mapped clearly — including the connections between your food use, your weight, your mood, and other substances — makes the picture undeniable. It removes the space for denial and creates a foundation for real change.
Practitioners consistently report that using this approach reduces treatment fatigue and prevents the circular arguments that often characterise addiction work. The curve does the talking.
Sugar addiction comes in all shapes and sizes
Not everyone who struggles with sugar and ultra-processed food has weight to lose. Many people who come to this work look perfectly healthy from the outside. They may have tried dieting, food plans, or even medical interventions to control their eating — or they may never have thought of themselves as having a "food problem" at all.
What they share is a pattern they can't explain and can't break. They can be disciplined for a while. They can follow a plan, avoid the foods they know cause problems, feel like they're back in control — and then the substance breaks through anyway. Not because they lack willpower. Because sugar and ultra-processed food are chemically dependency-forming substances, and for some people, the biology does not allow for moderation no matter how hard they try (Ifland et al., 2009; Ifland, Preuss & Marcus, 2018).
The root cause of that pattern — the cravings, the cycling, the symptoms that nobody has been able to explain — may be sugar dependence. And that's something that can be assessed, understood, and addressed. You can start your journey with the (free) UNCOPE screening tool below. With a positive screening, it’s suggested to continue with the full SUGAR® diagnostic. Any questions — please feel welcome to contact me.
References and further reading
Andres-Hernando, A., Orlicky, D.J., Garcia, G.E., et al. (2025). Identification of a common ketohexokinase-dependent link driving alcohol intake and alcohol-associated liver disease in mice. Nature Metabolism, 7, 2250–2267.
Ifland, J., Preuss, H.G., Marcus, M.T., Rourke, K.M., Taylor, W.C., Burau, K., Jacobs, W.S., Kadish, W., & Manso, G. (2009). Refined food addiction: A classic substance use disorder. Medical Hypotheses, 72(5), 518–526.
Ifland, J., Preuss, H.G., & Marcus, M.T. (Eds.) (2018). Processed Food Addiction: Foundations, Assessment, and Recovery. CRC Press.
Jonsson, B. (2023). SUGAR® Diagnostic Instrument. Dahl & Dahl Prevention & Addiction Center.
Lustig, R.H. (2010). Fructose: metabolic, hedonic, and societal parallels with ethanol. Journal of the American Dietetic Association, 110(7), 1307–1321.
Palmer, C. (2022). Brain Energy: A Revolutionary Breakthrough in Understanding Mental Health. BenBella Books.
Ede, G. (2024). Change Your Diet, Change Your Mind. Balance Publishing.
Tarman, V., & Werdell, P. (2014). Food Junkies: Recovery from Food Addiction. Dundurn Press.
For more information about SUGAR® certification and training, visit bittensaddiction.com or nutrition-network.org.