Most people don’t think about diet when they enter treatment for addiction. They think of withdrawal. They think of counseling sessions or group therapy. People in recovery talk about following the 12 Steps, finding purpose in life or developing a relationship with a higher power.
Eating a healthy, well-balanced diet is rarely mentioned.
“I don’t think anybody can be active in recovery if they aren’t nourished,” Advanced Recovery Systems dietitian Kurry Friedell told DrugRehab.com. “Eating properly, getting consistent sleep and being active boost the ‘good feeling’ hormones in your body that lead to a successful recovery.”
It’s easy to overlook nutrition. Everyone knows they should eat more fruits and vegetables. But most people eat what makes them happy — or what’s quick and easy — until a doctor tells them they’re at risk for diabetes, heart disease or other ailments.
Some diseases even contribute to poor nutrition or malnourishment. Addiction is one of those.
Regular consumption of alcohol or other drugs deprives the body of essential nutrients. Many drugs suppress or increase appetite. Meth users may go days without eating. Marijuana smokers are notorious for “having the munchies” and binge eating.
“I don’t think anybody can be active in recovery if they aren’t nourished.”
“Most of the time, eating is skewed because they’re using and staying up all night,” said Friedell, who assists people with substance use and eating disorders. “Because they aren’t taking in nutrients, they can be malnourished. They aren’t getting the macro- and micronutrients they need.”
Unhealthy diets inhibit recovery by causing headaches, sleep problems and low energy levels. Many of those symptoms are also caused by drug withdrawal, so it’s difficult for many people to know if they’re hungry or in withdrawal. A healthy diet aids the recovery process.
Metabolic syndrome increases the risk of diabetes and heart disease.
People who abuse alcohol or other drugs are 11 times more likely to have eating disorders than people who don’t have substance abuse issues.
“When you’re malnourished, hormone production starts to slow down. The more nutrients you have coming into the body, the more hormones can be produced.”
Counseling and therapy are key components of addiction treatment programs. They teach people in recovery healthy ways to cope with difficult emotions and behaviors. But it’s hard for a malnourished brain to learn.
“We have to refeed the person and get them nourished before the therapy can work,” Friedell said. “If their brain isn’t working, coping skills are going to go in one ear and out the other. If they’re eating properly, the psychiatrist can look at mood in a different way.”
The dietitian is involved in a person’s treatment program from the moment he or she walks into rehab.
“If their brain isn’t working, coping skills are going to go in one ear and out the other.”
“We look for disordered eating,” Friedell said. “We ask if they’re eating enough, what their weight is and what they were eating at home. We get a good idea of what their food and nutrients look like, and we look at lab reports.”
The assessment begins with weight, but dietitians also evaluate heart rate, cholesterol levels and other nutritional levels. They also make sure the person hasn’t turned to food as a coping mechanism. Dietitians try to start rehab clients on a healthy diet as soon as possible, but withdrawal complicates most meal plans.
Many rehab clients gain a lot of weight during detox. As drugs leave the body, appetite increases. Dietitians monitor weight closely because it’s dangerous to gain weight too fast. Eating too much can lead to obesity, diabetes, heart disease and other problems. However, increased appetite can be beneficial for people who enter recovery with low body weight.
Some people struggle to eat during medical detox. Alcohol and marijuana withdrawal can cause appetite loss. Withdrawal from opioids can cause nausea, diarrhea and vomiting. Dietitians have to make sure people recovering from these addictions don’t lose too much weight.
Some medications that are used during detox complicate diet plans. Naltrexone (Vivtrol) and disulfiram (Antabuse) can cause nausea and vomiting. Acamprosate (Campral) increases appetite and can make foods taste different. Methadone, buprenorphine (Suboxone) and bupropion (Wellbutrin) can cause constipation and changes in appetite.
By the time clients are done with detox, they’ve usually been on a structured meal plan for several days. The positive effects of a healthy diet are usually apparent when it’s time to start therapy.
“It can be really rapid if they’re in a structured environment,” Friedell said. “At our facilities, we serve breakfast, lunch, dinner and three snacks. The more structure you have, the more recovery is possible.”
The meal plans at ARS facilities include a balance of protein and carbohydrate sources. Each meal includes a fruit or vegetable, and clients have multiple meals to choose from at each meal time. At adolescent facilities, such as Next Generation Village, teens are served “kid-friendly” foods, Friedell said.
Nutrition therapy isn’t limited to making sure clients eat the right food during treatment. Dietitians teach clients the difference between hunger and drug-related cues or cravings. They also teach them how to create their own meal plan so they can shop for and prepare balanced meals at home.
“We ask them if they have access to a refrigerator or a stove,” Friedell said. “Who does the cooking? Do you have access to a car? Their shopping list will be different if they have a car or if they walk.”
Each of these factors affects the type of diet that’s realistic for people after they leave treatment. Dietitians work with people individually because each person’s nutritional needs are different.
People with co-occurring substance use and eating disorders require more intensive therapy than those without eating disorders. At ARS facilities, these people receive individual therapy and one-on-one dietitian appointments.
“For binge eating or purging, we talk about reducing the [problematic] behavior and staying safe,” Friedell said. “If they always purge when they have pizza, we’re probably not going to serve them pizza until they learn more coping skills. We try to teach them not to associate pizza with purging.”
Friedell said exposure therapy is commonly used to help people overcome anxiety associated with a certain food. Clients might also be offered “challenge foods” that they would avoid on their own.
“They practice dining out and practice not eating more than their diet plan,” Friedell said. “If they eat more, they’ll feel like they have to use the [problematic] behavior.”
Maintaining sobriety is easier when the body is healthy and nourished. That’s why comprehensive meal plans are key components of addiction treatment. People in recovery should learn to prepare and eat healthy meals to feel happier and more energized. Maintaining a healthy diet can help prevent relapse and aid a person’s recovery.
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