Substance abuse wreaks havoc in your body in many ways. Directly it can make the absorption of nutrients much more difficult for your body, while indirectly substance abusers may neglect to consume nutrients in sufficient levels. Regardless there are specific nutritional treatments for each class of substance that has been abused; the following article explains and lists many of these, and discusses how to treat the debilitating psychological effects that inevitabely occur.
Substance abuse affects the body in two different ways: 1- Affect of the substance itself, 2- effect of the lifestyle such as irregular eating habits and poor dietary intake.
A clear example can be seen in the growing fetus where drug use causes altered nutrition directly by crossing the placenta and indirectly by lack of prenatal care. Infants who were exposed to drugs while in the womb often have physical and cognitive defects.
Recovery from any form of substance abuse causes additional stress on the body due to the changes in both physiology and lifestyle. Proper nutrition is a crucial element of the recovery process as it helps the body to reverse the effects of the substance while boosting the body’s ability to complete detoxification The terms detoxification, rehabilitation and recovery will be used interchangeably as they all refer to the process of cleaning the body from a habit-forming substance.
Patterns of drug use are different in different age groups. For example, while marijuana use is more common in adolescent teens, alcoholism is usually found in an older population.
Since, the effects of these drugs are different, nutritional recommendations may depend on the age group. In addition, people experience different symptoms of withdrawal from different substances. While general rules of proper nutrition apply to everyone who is in the recovery period, the specifics of nutritional needs for detoxification from several common classes of habit-forming substances are discussed below.
It is important to mention that while the discussion is limited to illicit substances and alcohol, tobacco is an important habit forming substance with health consequences. Tobacco smokers would benefit from following the general guidelines.
CLASSES OF SUBSTANCE ABUSE
1- Opioids: Example, heroine, morphine, etc. Use of this class of drugs affects food and liquid intake, taste preference and body weight. Changes in specific nutrient status include decreased calcium absorption, increased cholesterol levels and increase in body potassium. Potassium is an important mineral whose imbalance leads to cardiac arrest. Symptoms that occur during detoxification include diarrhea, nausea, and vomiting which lead to further nutrient deprivation. Eating balanced meals decreases the severity of these symptoms. Some people may experience constipation during recovery. Therefore, a high-fiber diet with plenty of complex carbohydrates (such whole grains, vegetables, peas and beans) is recommended.
2- Alcohol: Example, beer, vodka, etc. Alcoholism is one of the major causes of nutritional deficiency in the United States. Alcohol intoxication impairs absorption of nutrients by interfering with two major organs in the body: the liver and the pancreas. The liver detoxifies harmful substances and regulates consistency of blood. The pancreas regulates blood sugar and absorbs fat. Impairment of these two organs results in an imbalance of fluids, calories, and electrolytes. This in turn leads to liver damage (or cirrhosis), seizures, diabetes and severe malnutrition. The extent of cirrhosis is correlated with the extent of malnutrition. Laboratory tests for protein, iron, and electrolytes are recommended to assist in determining liver disease as well as nutritional status. The most common deficiencies are of pyridoxine, followed by thiamine and vitamin C. Hypertension may be a side effect of alcohol withdrawal. If hypertension is present, a low-sodium diet is recommended. Green leafy vegetables are encouraged, as they are high in vitamin K, a vitamin that is low in patients with cirrhosis. Post-menopausal women who are alcoholic are at higher risk of osteoporosis and require calcium supplementation.
3- Cocaine: Example, crack, rock, etc. Use of cocaine also affects food and liquid intake, taste preference and body weight. Cocaine users are often poly-substance users as their habits are coupled with alcohol abuse, and excess caffeine use. There is a strong component of anxiety in people who use cocaine, and alcohol is often used to relieve the associated anxiety. If there is alcohol abuse, please refer to the section on nutritional guidelines for alcohol recovery. Caffeine in itself interferes with calcium absorption; therefore, cocaine users are encouraged to supplement their diet with calcium and vitamin D. Hypertension is a serious risk during recovery.
4- Marijuana: Example, weed, cannabis, THC. As mentioned above, marijuana users are generally younger and have different nutritional requirements. Although there are no dependence or withdrawal symptoms associated with marijuana use, there is increased food intake in the form of snack feeding that leads to irregular weight gain.
It has also been shown that there is an increased incidence of eating disorders, such as anorexia or bulimia, among adolescents who use marijuana. Eating disorders are associated with severe electrolyte imbalance and malnutrition, which require immediate medical attention and are beyond the scope of the current discussion.
5- Hallucinogens: Example- LSD, acid, ecstasy. This class of drugs is again generally used by a younger population. Although no symptoms of withdrawal have been documented, there is a tendency for polysubstance use that puts this population at risk for malnutrition. Please refer to each specific drug category.
6- Stimulants: Example- speed, Ritalin, ephedra. The effect of this class of drugs is very similar to the action of cocaine.Please refer to the section on cocaine for detailed information. An important nutritional risk is excessive weight loss, rapid heart rate and high blood pressure.
NUTRITION AND PSYCHOLOGICAL ASPECTS OF SUBSTANCE ABUSE:
Malnutrition as well as habit-forming substances cause and coexist with many psychological illnesses.
Depression, for example, is often present in cases of substance abuse, and it is usually unclear whether it is caused by the substance itself or by malnutrition. Regardless of the source, a proper diet is related to less emotional stress.
A person with a stable emotional state is more likely to abstain from their drug of choice. Another example of the relationship between malnutrition and substance abuse is the distorted eating behavior in drug and alcohol dependent persons.
They are not only predisposed to eating disorders, but also to eating abuse that leads to obesity, compounding the effect of malnutrition. Obese alcoholics often have more severe liver damage.
Another pitfall of drug abuse is substance substitution. Substance substitution refers to replacing the drug of choice with nicotine, caffeine, or sugar. This type of substitution continues the addictive behavior and can compromise the person’s progress.
An addictive behavior if not replaced by a constructive pattern may result in transference of a drug addition to food addiction. Recovering people should be evaluated for this possibility.
Weight, eating habits, as well as food content should be monitored to assess progress.
GENERAL GUIDELINES AND ASSESSMENT:
Regular mealtimes are recommended daily. A meal plan that focuses on a low fat diet, with increased intake of protein, complex carbohydrates and dietary fiber, and an adequate amount of calories for weight maintenance at a healthy body weight, is recommended.
Attractively prepared and tasty meals make it more likely that the recovering person will eat the meals. Due to deficiencies in water-soluble vitamins caused by irregular eating habits during the period of substance abuse, supplementation with vitamins and minerals during recovery is necessary. Specific vitamins that require supplementation include: B-complex, zinc and vitamins A and C.
Relapse to using the drug of choice is also more likely when the blood sugar levels fluctuate due to the irregular intake of food and the timing of the meals. It has been shown that decreased sugar intake and hypoglycemia in alcoholics, results in decreased cravings and longer periods of abstinence.
During recovery from substance abuse, dehydration is common and it is important to emphasize adequate intake of fluids during and in between meals.
Appetite usually returns during recovery, which may cause a tendency to overeat. The person should be instructed to consume healthy meals and snacks and to avoid high-calorie foods with low nutritive value.
Assessment of a person in recovery will include checking body weight and certain laboratory tests; for example, it may be advisable to check for anemia or vitamin deficiency. A medical and nutritional assessment is necessary to treat medical conditions as well as nutritional deficiencies.
Recording daily dietary intake is helpful in this endeavor. Finally, an individual diet plan is devised. Actively involving the recovering person is key in this process and will prove most successful.
The following principles enhance the body’s abilities to succeed in the recovery period
- Physical activity and adequate rest
- Vitamin and mineral supplements
- NO caffeine, sugar, and nicotine
- Nutritious meals and snacks
EDUCATION AND SUPPORT:
As many substance addictions have an emotional component, the most effective nutrition counseling is one that addresses the needs of the person as a whole. Nutritional education as well as psychosocial support is an essential component of recovery from substance abuse. A successful recovery program incorporates nutrition as a fundamental component. Counselling on how to change eating habits may be combined with counseling on how to raise self-esteem and maintain responsibility. Family members involved with the food preparation should also be involved with the counseling and the support.
Since nutrition is vital in the recovery of a person with a history of substance abuse, a registered dietitian should do the nutrition consultation and the follow-up visits. Most substance abuse programs either have a dietitian on staff or a consultant’s services available. In addition to a registered dietitian, the physician is also an invaluable resource as is the entire health care team involved in the rehabilitation process.