Addiction Counseling and the Importance of Nutrition

Although more than 21 million people in the United States suffer from an addiction to some kind of substance, many addiction counseling programs fail to provide their patients with the proper nutritional support to aid their recovery.

Maria Schellenberger, a student in the USC Leonard Davis School of Gerontology Master of Science in Nutrition, Healthspan and Longevity program, stated that addiction counseling patients face a high risk of 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.

As of recently, Schellenberger and her mentor, USC alumnus and founder of Nutrition in Recovery David Wiss, constructed an article for the Behavioral Health Nutrition newsletter of the Academy of Nutrition and Dietetics about the supporting role diet plays in addiction recovery.

“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.

Furthermore, although people who use drugs face a high risk of nutritional deficiencies, the recovery process itself can prevent patients from maintaining a healthy diet, she said.

“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.”

She added that it is important to have a dietitian nutritionist (RDN) available to help create healthy meal plans for patients while educating them on health habits that they can apply to their lives after counseling. In her early research, she found that the lack of belief and funding in nutritional services is a shortfall to those 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.”

In addition, because most counseling centers only focus on eating disorders or substance use, instead of both issues at the same time, there are often unwanted outcomes in rehabilitation due to the complicated interactions between the two disorders.

RDNs are exceptionally prepared to address the complicated mixture of problems faced by patients who are dealing with nutritional issues and substance abuse problems, Schellenberger said. RDN educational programs, such as the Master of Science in Nutrition, Healthspan and Longevity program at USC Davis, educate students to address problems such as malnutrition, micronutrient deficiencies and eating disorder behavior, as well as how to adjust meal plans to help 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.”

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