Addiction to drugs and alcohol is a major public health problem worldwide that has negative physiological, psychological, metabolic, and economic impacts. Some of the most abused substances include alcohol and opioids. Addiction and healthcare specialists report the COVID-19 pandemic had a significant impact on nationwide alcohol consumption. In a Johns Hopkins-University of Maryland-Baltimore survey, 60.1% of participants reported drinking more alcohol after March 1, 2020, in correlation with skyrocketing alcohol sales. Drug use has also increased since COVID-19, resulting in rising overdoses.
With increased usage, comprehensive substance abuse treatment in inpatient and outpatient recovery programs is more important than ever. Registered dietitian nutritionists (RDNs) are essential members of the addiction treatment team. RDNs identify and develop personalized nutrition care plans to address malnutrition and nutrient deficiencies and provide individual counseling, which may include nutrition education.
Substance Abuse and Malnutrition:
Malnutrition refers to nutrient deficiencies, excesses, or imbalances that have adverse health outcomes. Human studies have demonstrated malnutrition and micronutrient deficiency prevalence in substance abusers. Decreased nutrient intake may result from eating less food overall, eating less nutrient-dense foods or impaired nutrient utilization. Some substances, like cocaine, may decrease appetite, and other substances may increase appetite and intake, leading to unwanted weight gain. Dietitians assess a patient’s risk or presence of malnutrition by assessing patients’ biochemical blood labs, food and intake history, weight trends, and nutrition-focused physical exams. Healing malnutrition may require supplementation, meal planning guidance, education, and coordination with a patient’s care team. Readjustment of nutrition plans are often needed.
Macronutrients, Mood & Recovery:
Macronutrients, such as carbohydrates, proteins, and fats, are key to balancing chemicals in our bodies that affect mood. Psychoactive substances, such as crack cocaine and ecstasy, have toxic effects on brain chemistry that may lead to or exacerbate psychiatric problems. Poor nutrition, such as protein absorption, results in decreased neurotransmitters that normally illicit happy or rewarding feelings. Feelings of depression and irritation in recovery are unpleasant mood imbalances that may alter recovery and result in relapse. It’s thought that these imbalances disappear over a period of weeks but may last as long as one year after an addict becomes sober. Below is a breakdown of how each macronutrient impacts mood:
- Carbohydrates are the body’s main source of energy that balances blood sugar and serotonin levels. Serotonin facilitates a happy, stable mood, and normal sleep patterns. Without carbs, the brain can’t function properly, and feelings of irritation, anxiety and substance cravings occur. Complex carbohydrates such as whole grains, fruits, vegetables, and beans are fiber-rich and support blood sugar stabilization.
Preferences for simple carbohydrates and sugary sweetened food and beverages are consistent for those that abuse of various substances. Examples of simple carbs include white bread, candy, and fruit juices. Because of gastrointestinal delays during recovery, some may choose simple carbs because they are “easier” to digest. Selection of high-sugar foods replaces the intake of more nutrient-dense foods and may lead to unwanted weight gain. In addition, simple carbohydrates may cause spikes or dips in blood sugar that amplify feelings of low mood and restlessness.
- Amino acids, the building blocks of protein, also are the foundation of neurotransmitters such as serotonin and dopamine, both of which provide positive feelings. When neurotransmitters are disrupted, aggression and cravings for drugs and alcohol may occur. Protein sources such as eggs, poultry, low-fat dairy, nuts, and fish are recommended to support mood.
- Dietary fat affects inflammation in the body, which can result in more depressive symptoms. Omega 3 fatty is specifically advantageous to decreasing inflammation and improving mood and can be found in oily fish, flaxseed, and nuts.
Vitamins, Minerals & Recovery:
Other vitamins important for mental health include iron, folate, and vitamins B6 and B12 found in fortified cereals, animal proteins, beans, and lentils. Deficiencies of any of these nutrients can mimic mental health problems such as depression, fatigue, poor attention, and altered sleep. In addition, one study revealed that 70% of addicts suffered vitamin D deficiency and low levels of vitamin C, and another showed that 50% were deficient either in iron or vitamins (vitamins A, C, and E being most common) during detox. A once-a-day, low-potency multivitamin/mineral supplement may be useful for those unable to consume a calorically adequate diet and those with dietary limitations.
Caffeine and Recovery:
Caffeine is found in coffee, tea, and sodas and triggers the same reward centers of the brain as substances. Too much caffeine can lead to irritability, anxiety, and poor sleep – all impacting recovery and relapse. Low caffeine intake (along with smoking cessation) has been shown to improve long-term sobriety.
Alcohol abuse alters carbohydrate, fat, and protein metabolism and affects absorption and metabolism of vitamins and minerals. Literature suggests patients have poor diet quality during treatment with excess sugar, fat, and energy intake and inadequate intake of fruits, vegetables, and fiber. Six micronutrients that may be lacking include folate, vitamin C, calcium, magnesium, and fiber. Prioritization of low-fat dairy, fruits, vegetables, and whole grains is particularly important to replenish these nutrients. If not corrected, these deficiencies may lead to depression, anemia w/fatigue, and altered blood sugar levels, impacting one’s ability to recover and increasing the risk of relapse.
Nutrition Goals for All:
Goals for nutrition therapy start by identifying nutrient deficiencies with a thorough review of the patient’s intake history, laboratory markers, and weight changes. Individualized nutrition plans are created with the patient’s input and participation and may include menu/meal guidance, nutrition education and counseling, supplements, and additional lab and weight monitoring. Encouraging a well-balanced, nutrient-dense diet is encouraged for all to reduce cravings, and if indicated – caffeine and sugar reduction.
Submitted by Emily Burke, RD, LDN, CNSC
Emily has worked with Unidine as the Regional Director of Nutrition and Wellness for Healthcare and Corporate Culinary Groups since April 2018. As an experienced Registered Dietitian and Certified Nutrition Support Clinician, she supports clinical, wellness and patient services programs and is passionate about leveraging Undine’s fresh food approach to improve the lives of customers, patients, and clients.
At Unidine, the Directors of Nutrition support the development of dietitians through clinical documentation evaluation and teaching clinical skills to improve quality of care to the patients served. Our competency training for dietitians centers around performing the NFPE, documenting malnutrition criteria and obtaining a diagnosis of malnutrition so dietitians are prepared, knowledgeable and able to make informed interventions to improve patient outcomes.
Girard, et al. Academy of Dietetics: Revised 2018 SOPP for RNDs (competent, proficient, and expert) in Mental Health and Addictions. JPEN 2018 Pages 1975-1985