Nutritional guidance often missing from substance abuse treatment

Even as more than 21 million Americans struggle with substance abuse issues, many addiction recovery programs overlook how nutritional support can increase treatment safety and success.

Maria Schellenberger, a student in the USC Leonard Davis School of Gerontology Master of Science in Nutrition, Healthspan and Longevity program, said patients in recovery often face very high risks for malnutrition, eating disorders and dramatic weight changes, among other challenges.

“Many clients enter treatment with significant malnutrition and micronutrient deficiencies. For example, opiates decrease gastrointestinal motility and often clients experience severe constipation, whereas other drugs may cause bouts of diarrhea. Alcoholism is often accompanied by severe micronutrient deficiencies, including thiamine and other B vitamins,” Schellenberger said of the nutritional problems that often accompany drug abuse. Schellenberger and her mentor, fellow USC alumnus and founder of Nutrition in Recovery David Wiss, recently wrote an article on the need for dietetic support during addiction recovery for the Behavioral Health Nutrition newsletter of the Academy of Nutrition and Dietetics.

“Depending on the degree of malnutrition, it is important to supplement appropriately to avoid complications such as refeeding syndrome. As clients progress in their treatment and improve their overall health, focus should be shifted toward teaching about nutrition and cooking skills to enable continued proper nutrition post-rehab,” Schellenberger said.

In addition to the nutrient deficiencies faced by patients actively using drugs, the recovery process itself can present patients with other barriers to establishing a healthy diet, she noted.

“Often, nutrition is overlooked and facilities provide unlimited access to foods that are highly palatable, such as refined sugars and fried foods,” Schellenberger said. “In the long term, this is a great disservice to clients as they are not receiving proper nutrition to replete their likely inadequate storages. This can also lead to excessive weight gain, causing distress to many clients.”

Good meal plans

Having a registered dietician nutritionist (RDN) available to create healthful meal plans as well as provide education and counseling would allow clients to gain skills they will use after rehab; however, there are currently only a few studies addressing nutrition guidance and the role it plays in substance abuse interventions, she added. Her preliminary research indicates that both funding and beliefs about the need for nutrition guidance in recovery contribute to this shortfall in services available to individuals in treatment.

“Many facilities are not-for-profit and feel that they are unable to budget for an RDN for services,” she said. “The second most common barrier I have found is the perceived ‘lack of need’ for an RDN. Many counselors I have spoken with feel that the main concern is helping their clients achieve sobriety, and they do not see how nutrition has an impact on their recovery. If RDNs are to increase their presence in substance use disorder treatment facilities, we will have to prove that we are integral members of the treatment team.”

Early evidence suggests that treating either eating disorders or substance use disorders, instead of addressing both at the same time, often has poor outcomes due to the complex interactions between the two.

RDNs are uniquely equipped to address the complex combination of issues faced by patients who are both recovering from addiction and dealing with nutritional problems, Schellenberger said. RDN educational programs, such as the Master of Science in Nutrition, Healthspan and Longevity program at USC Davis, teach students to address issues of malnutrition, micronutrient deficiencies and eating disorder behavior as well as how to modify meal plans to assist with weight gain or weight loss and to provide proper nutrition.

“Many individuals with substance abuse problems have had little education about nutrition and often lack the skills necessary to purchase and prepare healthy meals for themselves. By including an RDN in the treatment plan, clients can address their nutritional concerns throughout treatment,” she said.

“Ideally, an RDN will be able to help minimize immediate issues in early recovery [e.g. malnutrition or gastrointestinal distress] and slowly educate clients to prepare their own meals once they are no longer in a treatment facility. This long-term support is necessary to bring about lasting changes.”