Substance Abuse

Circadian Rhythms & Mental Health Video

David Wiss MS RDN founder of Nutrition in Recovery walks you through some of the latest research on circadian rhythms linked to mental health. Key take-away points:

  • Both sleep and nutrition are part of circadian rhythms
  • Circadian rhythms are easily disrupted by binge eating and substance use
  • Associations between circadian rhythms and health are mediated by hormones and more recently the gut microbiome
  • Novel treatments for behavioral health disorders have begun looking into the circadian clock
  • Changing health behaviors can reverse circadian disruption over time
  • “When” you eat is often just as important as “what” you eat 
4:14

Nutrition in Recovery is a group practice of Registered Dietitian Nutritionists and other health professionals who specialize in the treatment of addictions, eating disorders, body image, mental health, as well as general wellness.

We send out a monthly Newsletter summarizing the latest research linking nutrition and mental health. Each newsletter will include a short video with some helpful hints and actions you can implement to improve mental, spiritual, and physical wellbeing for yourself and for your clients. You will be among the first to hear the findings and insights from cutting-edge data, and we are providing references so you can do your own research if interested.

View previous video on Nutrition During Childhood

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Biopsychosocial Opioid Video 6:42

 The opioid crisis has reached epidemic proportions in the United States with rising overdose death rates. Identifying the underlying factors that contribute to addiction vulnerability may lead to more effective prevention strategies. Supply side environmental factors are amajor contributing component. Psychosocial factors such as stress, trauma, and adverse childhood experiences have been linked to emotional pain leading to self-medication. Genetic and epigenetic factors associated with brain reward pathways and impulsivity are known predictors of addiction vulnerability. This review attempts to present a biopsychosocial approach that connects various social and biological theories related to the addiction crisis. The emerging role of nutrition therapy with an emphasis on gastrointestinal health in the treatment of opioid use disorder is presented. The biopsychosocial model integrates concepts from several disciplines, emphasizing multicausality rather than a reductionist approach. Potential solutions at multiple levels are presented, considering individual as well as population health. This single cohesive framework is based on the interdependency of the entire system, identifying risk and protective factors that may influence substance-seeking behavior. Nutrition should be included as one facet of a multidisciplinary approach toward improved recovery outcomes. Cross-disciplinary collaborative efforts, new ideas, and fiscal resources will be critical to address the epidemic.

Read more and get access to the article HERE

6:42
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The Relationship Between Alcohol and Glycohemoglobin: A Biopsychosocial Perspective

Download the full article HERE

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Beyond Risk and Back Podcast

While David Wiss MS RDN was presenting this year at the Cape Cod Symposium on Addictive Disorders he met Aaron Huey of Fire Mountain Programs and they decided to do a podcast together on the importance of nutrition in mental health recovery. This particular episodes focuses on the role of nutrition in early addiction recovery, specifically with teens. In this episode they discuss gastrointestinal health, neurotransmitters, blood sugar, and overall problems with successfully implementing healthful eating in today’s youth. This was an epic episode of Beyond Risk and Back!

36:38
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NUTRITION IN RECOVERY CURRICULUM

Nutrition in Recovery Group Curriculum is now Available! 

Nutrition in Recovery Curriculum

In 2012, I ran my first weekly nutrition group at a residential drug and alcohol treatment center in Los Angeles where I taught people about the link between nutrition and behavioral health.  We did not have a TV, so I put together various handouts as reading material for group discussions, based on information that I learned through my own treatment in 2005 & 2006. I’ll never forget the excitement of my first year running Nutrition in Recovery groups and building out the curriculum, and becoming a specialist working with this unique population. The experience was magical – I’ve enjoyed being contacted over the years and people sharing memories of that first nutrition group; someone recently told me that my trip with them to the grocery store while they were in treatment changed their life, and they are now sober working as a chef. This is in part due to the Nutrition in Recovery curriculum.

Nutrition in Recovery took off quickly and by 2013, I was running groups at several different treatment centers, conducting individual counseling and occasionally leading hands-on nutrition workshops. I took on dietetic interns and built out a legendary team of dietitians. We have run groups both locally in Southern California as well as internationally and have hosted various forms of staff training. To date we have contracted with over 30 treatment centers, including facilities that treat eating disorders as well as general mental health. During these years, I have refined the Nutrition in Recovery curriculum based on feedback from attendees as well as the facilitators, and of course the rapidly changing nutrition landscape. 

I have always tried to be available, but have never shared any curriculum, until now. The legendary Nutrition in Recovery curriculum is available to you. The content is designed to be delivered by a registered dietitian but can be done by someone who has a proficient background in nutrition and is attuned to recovery culture. Many of the slides have notes under them to help guide you through it all. If you or anyone you know is interested in conducting research using the curriculum, let’s talk.

The Nutrition in Recovery curriculum consists of 24 weeks of educational presentations, handouts, videos, games, activities, and discussion topics, all of which build upon the previous weeks, but can also be used in any order. Some groups include homework, recipes to keep, and are all designed to stimulate excellent discussion. There is no nutritional agenda embedded into the curriculum, it is flexible to a wide range of approaches. It is also eating disorder informed and friendly, and the best part about it is that you will get the actual PowerPoint and Word docs whenever available, so you can customize the curriculum as you see fit! 

  • Week 1: The Basics
  • Week 2: The Nutrition in Recovery Method 
  • Week 3: Fiber the Missing Nutrient
  • Week 4: Incorporating More Fiber
  • Week 5: Budgeting Food During Recovery
  • Week 6: Smoothie Workshop 
  • Week 7: Sugar, Salt, Fat
  • Week 8: Let’s Talk Breakfast
  • Week 9: Substance Substitution 
  • Week 10: Oats Workshop 
  • Week 11: Conversations About Sugar
  • Week 12: Emotional Eating 
  • Week 13: Exercise in Recovery 
  • Week 14: Whole Grains and the Mediterranean Diet 
  • Week 15: Artificial Sweeteners 
  • Week 16: Salad Dressing Workshop 
  • Week 17: Fads and Myths 
  • Week 18: Guess that Plant 
  • Week 19: Binge Eating Solutions 
  • Week 20: Body Image and Disordered Eating 
  • Week 21: Chocolate Bites Workshop 
  • Week 22: So Many Different Approaches 
  • Week 23: Mindful Eating 
  • Week 24: Food Safety 

The cost of the curriculum is $695 and as a limited-time bonus includes a 30-minute consulting session with David Wiss MS RDN within 3 months of purchase. David will also send you his range of academic publications related to nutrition, substance use disorders, and eating disorders. You can use the 30-minute session either to seek clarification on the curriculum, to dive deeper into the research and learn more about the link between nutrition and mental health, or to pick David’s brain about anything. Lastly, those who purchase the curriculum will be added to a special mailing list where we will eventually form a group of nutritionists who work in addiction treatment centers sharing ideas, challenges, and victories. The goal is to one day have a recognized certification, and those who get in now will likely end up as the original leaders. Let’s join forces! 

Questions? Email davidawiss@nutritioninrecovery.com

Ready to make a payment? Use credit card HERE. 

Please make sure to include the proper email address for correspondence. You will be asked to sign a non-disclosure before receiving the Nutrition in Recovery curriculum. 

 

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David Wiss Speaking Schedule 2019

Mr. Wiss has three big conferences coming up, and hopes that you will be able to join him at one of them!

We are excited to announce his speaking schedule over the next several months. Please let us know if you will be attending so we can plan a meet up! Cape Cod, London, and Philadelphia here we come!

Cape Cod Symposium on Addictive Disorders (CCSAD) 

September 5-8, 2019, Hyannis MA

Saturday September 7, 10:45am-12:15pm

“Nutrition for Addiction Recovery: Exploring Links Between the Gut and Brain”

Register HERE

International Society of Nutritional Psychiatry Research (ISNPR)

October 20-22, 2019, London UK

Tues October 22, 11:00am-12:30pm

“Moving Toward Nutrition Standards in Substance and Alcohol Use Disorder Treatment”

Register HERE

Food and Nutrition Conference and Expo (FNCE) 

October 26-29, 2019, Philadelphia, PA

Pre-FNCE workshop hosted by Dietitians in Integrative and Functional Medicine (DIFM) 

Saturday October 26, 8:15am-9:30am 

“More than Meets the Eye: How Unseen Factors Impact Nutrition and Health” 

Register HERE 

More information on Wiss Speaking Schedule for Winter 2019-2020 coming soon!

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A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health

I spent an entire year working on this manuscript! It was quite an undertaking because employing an “overview perspective” of something as vast as the opioid crisis requires expertise in several different domains. Specifically, this paper covers environmental factors (i.e. exposure to pharmaceutical pain killers) as well as psychosocial factors (e.g. stress, trauma, childhood adversity) in conceptualizing susceptibility to opioid addiction. The most novel contribution relates to the role of nutrition in recovery from opioid use disorders. The model created can be used to conceptualize substances other than opioids, including food.

The article is OPEN ACCESS and can be read and downloaded HERE

Open Access article by David Wiss
A Biopsychosocial Perspective on Substance Consumption by David Wiss.
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The Opioid Crisis- Getting Vulnerable

The Opioid Crisis- Getting Vulnerable 

I gave an academic talk the other day where I shared some personal experience with the opioid crisis. I don’t normally open up this way because my anecdote can bias my research, however my story can also bring my work to life in some meaningful ways. Thus, I am selective about what I share in certain non-recovery settings. I told the story of my friend Brad who I grew up who was my first close friend to die from an overdose, in 2005. I had lost a few other friends prior to that, but Brad’s death really struck me because I had gotten high with him shortly before it happened. I shared that since getting sober in 2006 I have lost about 20 friends to drug-related overdose. I shared that my brain has started to block those memories out and I probably couldn’t even list off the names. At some point I stopped going to memorials. And at some point, I even stopped making friends. People were shocked. Was this true? I did say it. In reflection I have realized that it takes a while for me to become close to someone these days, particularly if they are in recovery. I have wounds. And complex trauma wounds can be so subtle that we sometimes don’t even know we have them. And the truth is, I have been to many memorials, just not all of them. 

Why Are So Many People Dying?

I’m a big city kid. I live in West Los Angeles. But the opioid crisis has swept the entire nation. Overdose is more common in rural areas compared with urban settings1with higher prevalence among whites compared to nonwhites2and is a growing risk among adolescents.3Prescription opioid injection misuse is higher among males4but some data suggests that non-medical opioid use is higher among female adolescents.5Female adolescents? There is something going on here. This is about more than just “peer pressure” or growing up in socially disadvantaged settings. Of course, environment factors matter. Of course, it has to do with the pharmaceutical industry and with irresponsible prescribers, but where does all the pain come from in the first place? Why do these opioids feel so darn good? Why are so many people dying? This fentanyl thing is out of hand. The opioid crisis has gone too far.

Pain Management 

Pain management is the medical specialty that treats a variety of conditions including cancer, traumatic pain, postsurgical pain, and end of life issues. By far the most common opioid analgesics are codeine, hydrocodone, oxycodone, morphine, and fentanyl. OxyContin sales went from $48 million in 1996 to $1.1 billion in 2000. I am guessing you have seen the news about Purdue Pharma and the Sackler family. It’s quite disheartening but also exciting to see shifts happening. There are lots of new policies and procedures for opioid prescribing, as well as efforts to move patients toward non-opioid approaches to pain management, such as yoga, acupuncture, etc. Meanwhile, adoption and implementation of new policies and procedures in emergency departments (e.g. better screening) have been slow and not without administrative challenges.6

A Veterans Health Administration study found high opioid prescription rates among veterans with unexplained gastrointestinal (GI) symptoms (e.g. irritable bowel syndrome) where opioids have no clear role.7The authors identified psychiatric comorbidity as a mediator of unexplained GI symptoms, potentially driving opioid misuse. While opioids may provide some short-term relief of GI-related issues, these benefits are likely to fade as tolerance increases, and can leave patients with opioid-induced bowel dysfunction. Mental health screening before prescribing has also been recognized as an important risk mitigation strategy during the crisis8but has not been widely implemented. As a nutritionist, I am very much interested in the link between opioids and gastrointestinal function. I do think there will be some exciting findings in the next few years. However, nutrition never gets the attention it deserves on the medical stage, and sometimes I am even offended by the idea that nutrition is “alternative medicine.” It makes a big difference- it is just slow and therefore difficult to measure. But it matters. Nutrition matters. 

The Biopsychosocial Perspective 

In order to truly understand the opioid crisis, it is critical to examine it from all perspectives, including social and environmental factors, psychosocial factors such as stress, trauma/PTSD, and childhood adversity. And biological factors: genetics, epigenetics, microbiome, nutrition, etc. A biopsychosocial approach looks at all possibilities and more importantly at the interactions between influencing forces, from the microscopic to the planetary level. Some experts believe that the biopsychosocial approach lacks foundation and does not identify specific quantifiable mechanisms that demonstrate a causal chain of events.9The biopsychosocial model has also been criticized as being anti-medicine, but it has also been argued that it may improve psychiatric intervention.10

In my opinion, this perspective is exactly what we need to combat the opioid crisis, as reductionistic approaches such as new medications to treat opioid addiction can only address parts of the issue. We need a systems approach. For example, a biopsychosocial perspective on pain suggests an interaction with psychological factors such as depression and anxiety which lead to psychosocial interventions (e.g. behavioral and cognitive therapies) based on an individual assessment in addition to psychopharmacology.11

Furthermore, the “nature vs. nurture” controversy related to addiction has decreased in the past two decades given strong evidence for both, as well as the emerging field of epigenetics representing convergence between genetic and environmental factors. There is so much new information related to the intersection of social and biological factors, and we need to embrace multidisciplinary efforts in order to fully understand them. Multi-modal = multiple modalities. 

Psychosocial Factors 

The role of trauma and chronic stress have been identified as important vulnerability factors in the development of addiction. In some cases, a trauma history may serve as a proxy measure for addiction severity. The self-medication hypothesis describes one’s tendency to find ways to anesthetize unresolved pain. This perspective of underlying risk factors for opioid use disorder can include negative childhood experiences that are psychological/emotional (e.g. leading to depressive symptoms) or physical (e.g. pain). Advocates of this theory suggest that individuals self-medicate in response to physical and psychological experiences of pain, such as victimization.12Adverse Childhood Experiences, also known as ACE scores, are a major part of my current work and research. I can’t wait to share more about this with you soon. The original ACE study showed that individuals who had 4 or more ACEs were at a 12-fold increase in risk of drug addiction.13We need to start screening for ACEs and intervening early on. 

Policy and Environmental Interventions

The environmental theory of the opioid epidemic is impossible to deny. Legal action against Purdue Pharma have implicated the role of the pharmaceutical industry in disseminating misleading claims about the addictive potential of OxyContin. Irresponsible prescribing is another important part of the supply side theory, as countless “pill mills” have been raided in the last ten years across the US. Finally, increased accessibility of illicit opioids such as heroin have continued to plague communities across the nation. Policy interventions targeting all three of these problems are essential. Environmental enrichment has shown promise in reducing opioid administration.14But we obviously need to go much further. Where to?

Psychosocial Interventions

Painful life experiences increase vulnerability to addiction. It is well established that early life adversity can compromise adult mental health through multiple stress-related pathways,15including transmission of atypical HPA axis regulation.16The psychosocial theory describes the stress, trauma, and ACEs that are often influenced by socioeconomic status, and which appear to modify reward pathways in the brain. One solution is trauma-informed mental health services, and the other is to improve the social factors in susceptible populations. So much work that needs to be done here. Trauma-informed therapy is the key. But sadly, only those with financial resources are likely to access this. We need high quality trauma-informed care in underserved communities. 

Nutrition Interventions?

YES. This is where my current efforts are headed. I don’t want to spill the beans, but I do want to get you excited about work that is being done. My recent book chapter can be found HERE and I assure you a very exciting publication is coming soon. 

Future Directions

There is a need for more research on how stress, trauma, and ACEs impact reward functioning in the brain. Given what is known about the link between psychosocial factors and the opioid crisis, it would be helpful to further elucidate the neurobiological underpinnings. This direction has recently been described as a “syndemic” approach, examining the pathways from socioenvironmental conditions to biological states, and the drivers behind disease clustering,17which has been observed in the opioid crisis. Given that opioid use disorder is also prevalent in socially advantaged groups, it may be useful to examine how socioeconomic status impacts treatment outcomes in all directions. There is a vast array of social issues that still need to be resolved, particularly on the supply-side of the opioid demand, where new prescribing policies are underway. And there is so much we need to know about opioids and the microbiome, particularly how opioid use can affect mental health through the gut-brain axis. Stay tuned! 


1. Dunn, K. E.et al.Opioid overdose experience, risk behaviors, and knowledge in drug users from a rural versus an urban setting. Journal of Substance Abuse Treatment71,1–7 (2016). 

2. Martins, S. S. et al.Changes in US Lifetime Heroin Use and Heroin Use Disorder: Prevalence From the 2001-2002 to 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry74,445–455 (2017). 

3. Sheridan, D. C. et al.Association of Overall Opioid Prescriptions on Adolescent Opioid Abuse. The Journal of Emergency Medicine51,485–490 (2016). 

4. Jones, C. M. Trends and key correlates of prescription opioid injection misuse in the United States. Addictive Behaviors78,145–152 (2018). 

5. Vaughn, M. G., Nelson, E. J., Salas-Wright, C. P., Qian, Z. & Schootman, M. Racial and ethnic trends and correlates of non-medical use of prescription opioids among adolescents in the United States 2004–2013. Journal of Psychiatric Research73,17–24 (2016). 

6. Weiner, S. G. et al.Opioid‐related Policies in New England Emergency Departments.Academic Emergency Medicine23,1086–1090 (2016). 

7. Sayuk, G. et al.Opioid medication use in patients with gastrointestinal diagnoses vs unexplained gastrointestinal symptoms in the US Veterans Health Administration. Alimentary Pharmacology & Therapeutics47,784–791 (2018). 

8. Brady, K. T., McCauley, J. L. & Back, S. E. Prescription Opioid Misuse, Abuse, and Treatment in the United States: An Update. American Journal of Psychiatry173,18–26 (2016). 

9. Lane, R. D. Is it possible to bridge the Biopsychosocial and Biomedical models? BioPsychoSocial Medicine8,1–3 (2014). 

10. Pilgrim, D. The biopsychosocial model in Anglo-American psychiatry: Past, present and future? Journal of Mental Health11,585–594 (2009). 

11. Campbell, L. C., Clauw, D. J. & Keefe, F. J. Persistent pain and depression: a biopsychosocial perspective. Biological Psychiatry54,399–409 (2003). 

12. Young, A., McCabe, S., Cranford, J. A., Ross-Durow, P. & Boyd, C. J. Nonmedical Use of Prescription Opioids Among Adolescents: Subtypes Based on Motivation for Use. Journal of Addictive Diseases31,332–341 (2012). 

13. Felitti, V. J. et al.Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine14,245–258 (1998). 

14. Eitan, S., Emery, M. A., Bates, M. L. S. & Horrax, C. Opioid addiction: Who are your real friends? Neurosci Biobehav Rev83,697–712 (2017). 

15. Jones, T. M., Nurius, P., Song, C. & Fleming, C. M. Modeling life course pathways from adverse childhood experiences to adult mental health. Child abuse & neglect80,32–40 (2018). 

16. Scorza, P.et al.Research Review: Intergenerational transmission of disadvantage: epigenetics and parent’s childhoods as the first exposure. Journal of Child Psychology and Psychiatry(2018). doi:10.1111/jcpp.12877 

17. Singer, M., Bulled, N., Ostrach, B. & Mendenhall, E. Syndemics and the biosocial conception of health. The Lancet389,941–950 (2017). 

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Eating Disorders and Substance Use Podcast 1

Eating Disorders and Substance Use Podcast

Eating Disorders and Substance Use Podcast – Interview with Tabitha Farrar

In this excellent conversation Tabitha and David Wiss discuss the co-occurrence of eating disorders and substance use disorders, and the challenges faced by treatment providers. David discusses how many people with EDs can “hide out” in addiction treatment.

Eating Disorders and Substance Use
LINK HERE

Tabita Farrar is an eating disorder recovery coach with lived experience. She was a pleasure to chat with and has a fantastic podcast.

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Nutrition for Mental Health Webinar

Nutrition for Mental Health Webinar

Hot Topic: Nutrition for Mental Health

David Wiss MS RDN presents to students at California State University Northridge about the connection between nutrition and mental health. This presentation covers the microbiome, substance use disorders, disordered eating, depression, recovery, and more. It’s just over 50 minutes long, but worth every second! Why? Because nutrition for mental health is the future! Read more about this topic and check out some recent references HERE

Nutrition for Mental Health 53:34 #GutBrainAxis
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