NUTRITION and RECOVERY
Introducing the concept of nutrition into an addiction treatment program is not an easy task. Many addicts in early recovery are not ready for health behavior change, since most are simply trying to get past the immediate crisis of addiction, and the associated life adjustments of abstinence. In fact, sobriety can magnify pre-existing dysfunctional eating behavior. Many addicts began using drugs and alcohol in their early teens, and never developed a healthy relationship to food. Most never even considered the link between nutrition and recovery.
Often times, drug addicts in early recovery have food preferences of a juvenile, and prefer candy, juice, cereal, grilled cheese, peanut butter and jelly, ice cream, etc. In addition to childlike food preferences, many may have damaged their guts through the use of alcohol, pills, opiates, and other substances. Needless to say, most addicts in early recovery have little interest in brous foods such as fruits, vegetables, whole grains, beans, nuts, and seeds.
Additionally, the reward deficiency syndrome created by chronic exposure to addictive substances, often requires that the food consumed be highly rewarding to the brain. These foods are typically sweet, salty, high fat, easy to digest, or some combination of these traits. Other examples include chips, cookies, and most processed snack foods. If addicts in early recovery are given unlimited access to highly rewarding food, they will predictably overeat.
While excessive weight gain is certainly an issue and can lead clients back to using substances, the bigger problem is malnourishment, which limits the ability of the brain to heal from the ravages of addiction. Low quality food leads to low quality thoughts and a low quality life, and can lead back to using drugs and alcohol.
Why Not Just Take a Multivitamin and Eat for Pleasure?
It is a common mistake to assume that the daily consumption of a multivitamin will “cover all of the nutritional bases.” Of course, supplemental nutrition can be helpful if the person has a compromised ability to eat or has a limited diet. But too often, patients in early recovery fall into the trap of using multivitamins, to assume they do not have to concern themselves with the nutritional quality of their food. For starters, supplemental vitamins will never be able to contain the antioxidant potency of real food. Phytochemicals that flourish in real food cannot always remain stable in a supplemental form. Second, arguably the most important nutrient for addiction recovery is fiber, which is found in fruits, vegetables, whole grains, beans, nuts, and seeds. It is of paramount importance to eat fiber from food (not fiber supplements) to improve gut function and achieve balance in the microorganisms that live throughout the GI tract. Lastly, consumption of highly processed junk food throughout the day can significantly hinder the recovery process in numerous ways:
• Unstable blood sugar impacts mood and concentration
• Nutrient-void food can leave patients feeling sluggish and reliant upon caffeine (for the illusion of energy)
• Refined grains, added sugars, and added fats will negatively alter the microbi- ome (which we are discovering has an impact on mental health)
• Highly palatable food will condition the brain to expect food to taste a certain way, perpetuating the cycle of food addiction and promoting substance-seeking behavior.
• Eating candy will make eating fruit become less appealing
• Sweetened beverages will make drinking water less appealing
• Heavily seasoned and sauced food will make plain food be less appealing
What are the Challenges and Barriers to Implementing Nutrition in Recovery?
The biggest barrier is that medical insurance plans do not cover nutrition services for addiction recovery. This is likely due to a shortage of data about the efficacy of nutrition interventions in addiction recovery. For a partial hospitalization program (PHP) or intensive outpatient program (IOP) to include nutrition education and counseling, it can become a financial drain for the program. Some medical billers will be able to get reimbursement for a nutrition education group, if there is proper documentation by the dietitian, but there is no coverage for individual counseling unless there is an official eating disorder diagnosis.
The biggest challenge however, is the need to change the food service system. A nutrition group should educate patients about proper eating and be synchronized with the food being served. Teaching about the importance of nutrition in addiction recovery, and then serving highly processed snack foods undermines the goals of recovery, especially for patients residing in a sober living facility that is essentially a toxic food environment. Generally the food is purchased in bulk from discount stores by operations staff, often someone in early recovery themselves. Many facilities hire chefs to prepare meals, but the chefs often prepare food to please patients by creating highly palatable meals, that light up the pleasure centers in the brain. It is our strong belief that a registered dietitian nutritionist should supervise the menu in addiction treatment settings.
Most addicts will choose addictive food on a daily basis, instinctively selecting food that is highly rewarding and avoiding food that is not. Until upper management in treatment settings embraces the concept of nutrition in recovery, progress will be slow. Currently there is no requirement for nutrition education or the need for consultation with a registered dietitian nutritionist. A majority of treatment programs in Los Angeles serve and allow junk food, and seldom make fresh fruits and vegetables available. Understandably, real food is more expensive than highly processed snack foods that do not spoil. It does cost more to serve nutritious food, but when we serve non-addictive food, the addict eats less. When a treatment center or sober living attempts to save money on food, the entire recovery process continues to suffer.
Consider this a call to action to implement nutrition guidelines in your treatment facility. Consult with a registered dietitian nutritionist, particularly ones that have training and expertise in the addiction population.
This article was originally published in the February 2016 Keys to Recovery Newspaper