Nutritional counseling, nutrient replacement, and rehydration are key components of recovery from substance abuse. Heavy alcohol and drug use depletes the body of the vitamins, minerals, and energy stores that are necessary for an active life. Drugs can interfere with normal metabolic and hormonal function, causing weight loss or gain.
One of the most important goals in restoring clients’ health is to help them reestablish healthy eating habits through counseling and professional meal planning. The Journal of the American Dietetic Association found that nutrition education can significantly improve the outcomes of substance abuse treatment in those recovering from drug or alcohol addiction. To reinforce the benefits of nutritional education, many rehab centers offer organic meals prepared by trained chefs, as well as counseling by nutritionists or registered dietitians who specialize in nutritional support in recovery.
Nutritional recovery helps strengthen the body and mind, so clients are prepared to take on the work of rehab and the challenges of life in the aftercare stage. Balanced meals and adequate hydration can reduce drug cravings, help individuals stay on track with recovery goals, and reduce the risk of a relapse. Along with a nutritious diet and proper hydration, clients in recovery must learn the importance of adequate rest, sleep, and exercise to maintaining overall health.
Goals for Nutrition in Recovery
Poor nutrition can affect a person in recovery in a number of ways. Malnutrition can cause anxiety, depression, confusion, or fatigue, all of which can trigger the desire to use drugs or alcohol. Many people who enter rehab have neglected their diet for months or years, or they may never have learned how to nourish their bodies in the first place. They may come from households where there is little or no support for balanced eating habits.
The key goals of nutritional support in recovery include:
- Stabilization: replacing nutrients and fluids to restore mental and physical balance
- Education: teaching clients and loved ones about healthy eating
- Restoration: regaining weight or building lean muscle mass
- Motivation: encouraging healthy food choices
Many clients come to rehab in a state of dehydration and malnutrition, and one of the first goals in the detox process is to start replacing lost nutrients and fluids. Clients who have been abusing stimulants like meth or cocaine may have little or no desire to eat, and their appetites must be gradually restored. Clients whose primary drug of abuse was alcohol may require intravenous hydration and electrolyte and vitamin replacement.
As clients advance from detox to rehab, they may meet with a nutritionist or dietitian who will review their diet, identify deficiencies, and provide education on how to plan healthy meals. In order to ensure that clients maintain the benefits of good nutrition after rehab, spouses and other loved ones must be involved. Maintaining healthy eating habits at home requires the support of the whole family, who can also benefit from a balanced program of eating, rest, and exercise.
How Drugs and Alcohol Affect Nutritional Status
As part of the admission process to rehab, the treatment team should assess incoming clients’ nutritional status. Most heavy substance abusers have some form of nutritional deficiency. They may be underweight or overweight, sleep-deprived, and dehydrated. The specific effects on clients’ nutritional status will depend on the drug or drugs that they have been using. Each category of substances affects the body in different ways:
- Alcohol: According to the National Library of Medicine, alcohol abuse is one of the major causes of malnutrition in the US. Alcohol depletes vitamins in the B-complex group, especially B6, B12, thiamine, and folate. The B vitamins are crucial to healthy brain and nerve function, and a deficiency in these nutrients can cause serious neurologic damage. Alcohol abuse damages the liver, which is responsible for the production of proteins and the clearance of toxins from the body, and the pancreas, which helps to regulate blood sugar levels and produces digestive enzymes. Heavy drinkers often suffer from poorly regulated blood sugar, which can lead to type 2 diabetes. They may also be overweight, with a high concentration of abdominal fat, a condition that can contribute to high cholesterol, heart disease, and an increased risk of heart attack and stroke.
- Stimulants: Central nervous system stimulants, such as cocaine, crack, meth, and amphetamines, as well as hallucinogenic drugs like ecstasy, accelerate the activities of the brain and nerves and increase the body’s metabolic rate. Those struggling with an addiction to stimulants are often underweight and may suffer from muscle wasting. By the time they enter detox, they are often sleep-deprived, malnourished, and dehydrated, with little or no appetite. Like heavy drinkers, those addicted to stimulants frequently suffer from deficiencies of B vitamins, vitamin C, vitamin A, and iron, as well as electrolytes like potassium and calcium. Cocaine abuse can lead to a deficiency of omega-3 fatty acids, which help to regulate mood and prevent anxiety and depression.
- Opioid drugs and medications: Opioids include all drugs — synthetic or naturally derived — that are chemically based on opium. This broad category encompasses heroin, a powerfully addictive illicit drug, as well as common prescription pain relievers like oxycodone (OxyContin, Percocet), hydrocodone (Vicodin, Norco), hydromorphone (Dilaudid), morphine, codeine, and methadone. Opioids are central nervous system depressants, which slow down the activities of all the body’s systems, including digestion. The effects of opioids on the gastrointestinal tract can cause chronic constipation, appetite loss, and malabsorption of nutrients. In detox, clients withdrawing from opiates may experience nausea, vomiting, diarrhea and anorexia, or a lack of desire to eat. Diarrhea and vomiting can lead to potentially dangerous fluid and electrolyte imbalances, namely a deficiency of potassium.
- Marijuana: Marijuana, or cannabis, has become the most commonly abused illicit drug in the US, according to the National Institute on Drug Abuse, with nearly 20 million Americans reporting that they have used the drug in the past 30 days. Tetrahydrocannabinol (THC), one of the active chemical compounds in marijuana, can act as an appetite stimulant. In fact, medical forms of marijuana are legitimately prescribed to encourage patients with serious illnesses to eat. In the average user, however, this increase in appetite can cause unhealthy weight gain, as some users report craving high-fat or sugary junk foods when they are under the influence of cannabis.
- Tranquilizers and sedatives: Tranquilizers in the benzodiazepine family, including lorazepam (Ativan), alprazolam (Xanax), diazepam (Valium), and others are among the most widely prescribed drugs in the country. Yet these prescription medications, as well as other sedatives or sleep aids, can be habit-forming and can have a negative impact on the user’s overall health. The potential side effects of anti-anxiety medications like Xanax, according to drugs.com, include appetite changes (either an increase or decrease in appetite), weight gain, nausea, and diarrhea, all of which can affect the user’s nutritional intake and health status. Because tranquilizers and sedatives are central nervous system depressants, they can also slow down the activities of the gastrointestinal tract, causing sluggish digestion and constipation.
For heavy drug and alcohol users, food is often treated as an inconvenience rather than a vital source of life and health. The substance abuser tends to choose foods based on their taste appeal, convenience, and affordability rather than their freshness or nutritional content. Sweets, junk foods, and fast foods are often the easiest and cheapest options, and these items tend to appeal to people whose appetites have been blunted by drug abuse.
Sugar can simulate some of the sensations produced by drugs or alcohol. A study of drug-addicted individuals published in the British Journal of Nutritionfound that 61 percent of the study participants displayed a strong preference for sugary foods, and that approximately 30 percent of their caloric intake came from added sugar. This preference may be partly explained by the fact that sugary foods can increase levels of dopamine, one of the brain chemicals involved in the euphoric reactions to drugs or alcohol. According to Neuroscience, eating large quantities of sugar can produce responses in the brain that are similar to opioid addiction. A high-sugar diet can also contribute to the depletion of vitamins, elevated blood sugar levels, high cholesterol, and an increased risk of diabetes and heart disease.
Nutritional Deficiencies Caused by Drugs or Alcohol
Substance abuse depletes the body of the nutrients required to produce energy, protect the immune system, support healthy brain and nerve function, and heal from the effects of environmental damage. As a result, many people who abuse alcohol or drugs suffer from chronic illness, skin problems, foggy thinking, and unwanted weight loss. A study of 67 heavy alcohol and/or drug users published in Nutrition reported the following results:
- 24 percent of participants were malnourished
- 88 percent had poor appetites and needed nutritional support and guidance
- 50 percent were deficient in iron and/or vitamins and minerals
- 18 percent were low in iron
- 8 percent were low in vitamin C
- 12 percent were low in potassium
- 21 percent were low in vitamin A
Many heavy drinkers are low in B vitamins — especially B6, B12, thiamine, and folate — which support metabolism, energy production, and brain and nerve function. A shortage of these vitamins can cause depression, anxiety, restlessness, and confusion, according to Today’s Dietitian.
Through weeks or months of self-neglect, most drug users become deficient in macronutrients, or the major categories of food that provide energy to sustain life. Macronutrients include protein, which forms the building blocks of the human body; carbohydrates, which provide energy for all of our daily activities; and fats, which insulate the organs and provide a sustained source of energy. Replacing the body’s energy stores and building materials is one of the primary objectives of nutrition therapy in rehab.
Tips for Healthy Eating in Recovery
Most of us know that healthy eating in recovery is important, but what kind of changes do we need to make to support a sober lifestyle? Eating a wide variety of fresh, colorful, unprocessed foods is a good place to start. The U.S. Department of Agriculture and the U.S. Department of Health and Human Services, which publish dietary guidelines for Americans, recommend filling half your plate with vegetables or fruit at every meal. Some of the other important rules of thumb for healthy eating in recovery include:
- Maintain a stable level of fullness throughout the day to avoid hunger and cravings.
- Include a balance of lean protein, complex carbohydrates, and healthy sources of fat – such as olive oil, nuts, or avocados – in each meal.
- Limit your intake of table salt and high-sodium foods, including processed foods, fast foods, and convenience items.
- Limit your intake of solid fats, added sugar, and sugar-sweetened foods.
- Choose whole foods – like fresh vegetables and fruits, whole grains, nuts, or lean meats – over processed, high-calorie foods whenever possible.
- Keep healthy snacks available all the time, such as nuts, to maintain mood and energy levels and reduce the risk of cravings.
- Drinking enough water and other non-caffeinated, unsweetened beverages to remain hydrated throughout the day, especially on active days.
Overcoming Barriers to a Healthy Diet
Learning how to follow a balanced diet and make healthy choices in other areas of life isn’t easy. Even for people who do not struggle with addiction, our society makes it easy to choose foods that are high in fat, salt, and calories, and low in nutritional value. In addition to our cultural emphasis on fast and convenient foods, there are other serious obstacles that get in the way of a person’s goals for better nutrition:
- Co-occurring mental illness, which results in low motivation and lack of concentration
- Lack of nutritional education
- Lack of support from loved ones
- Lack of money/low income
Overcoming these obstacles requires a multidisciplinary support team made up of therapists, nutritionists, family counselors, and case managers trained in the treatment of mental illness and substance abuse. Mental health disorders like depression or anxiety may be treated with psychiatric medications as well as intensive therapy, behavioral modification, and participation in peer support groups.
Family and marriage counseling can help to encourage support in loved ones who may have poor nutritional habits themselves. In these cases, the client’s spouse, partner, or other members of the household can benefit from nutritional education, as well. Topics emphasized in family nutritional counseling include meal planning, grocery shopping, stocking a healthy kitchen, and choosing healthy liquids. Family therapy sessions can help to overcome resistance to change and motivate the client’s loved ones to create a more supportive environment at home.
The lack of money to purchase fresh, wholesome food is a common problem in the US. Organic and freshly grown foods are often more expensive than cheap, processed foods with low nutritional value. Nutritionists and dietitians can advise clients on how to choose healthy foods on a limited budget. Case managers and social workers can provide referrals to occupational counseling, educational programs, or financial assistance plans that can help to gradually increase their income levels.
Healthy Nutrition after Rehab
After an individual finishes a rehab program, a balanced diet can be one of the strongest protective factors in the prevention of relapse. Avoiding hunger and thirst — common triggers for substance abuse — can help to curb drug or alcohol cravings. But recovering individuals must be careful to avoid the trap of substituting food for their former drugs of choice.
A study of men in recovery, published in the journal Appetite, revealed that emotional eating, binge eating, and the use of food to manage cravings are common practices in people recovering from addiction. Weight gain was also common in this study group.
“Food itself can be an addictive substance if it is used to manage emotional stress, generate feelings of happiness, or ward off depression.”
Certain foods, especially sugar, can replicate the brain’s responses to alcohol or drugs and trigger a craving for those substances. Recovering alcoholics, in particular, are prone to sugar addiction as their bodies attempt to adjust to alterations in blood glucose levels.
For many recovering addicts, it can be difficult to find pleasure in everyday activities like planning meals, cooking, or eating. This loss of pleasure, known as anhedonia, is especially common in people recovering from an addiction to stimulants like cocaine or methamphetamine, according to American Family Physician. These individuals are at risk of turning to sugary, high-calorie foods or beverages in an attempt to recover the euphoric sensations that they found in drug abuse. Planning meals with a nutritionist, or shopping and cooking with sober partners or friends, may help them discover the healthier pleasure that comes from preparing and eating nutritious food. Learning how to manage stress and cope with intense emotions through participation in support groups, exercise, meditation, or other sober activities can help to reduce cravings and prevent relapse.
In the aftercare phase of recovery, it is more important than ever to maintain a balanced approach to eating, and to use food as a source of energy and health rather than a source of emotional comfort or self-expression. Follow-up visits with a nutritionist or dietitian, along with regular checkups with a physician, can help prevent emotional eating, binge eating, or food addiction.