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Putting recovery on the menu

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Good nutrition helps clients take a bite out of addiction

By Astrid Van Den Broek

Thumb through any health and wellness magazine on the newsstand and you’re bound to catch headlines about food and mood—“Foods to eat to feel better today!” or “Boost your mood with these five foods!”

The connection between diet and mental health is well known, but what about the role of nutrition in recovery and relapse prevention with substance use problems? When clients are dealing with complex issues like housing security, income and family relations, nutrition rarely makes it to the top of the list. But for Maureen Tilley, a clinical dietitian at the Nova Scotia Hospital in Dartmouth, it’s critical. “Research shows that eating properly during recovery helps to decrease the chance of relapse,” she says.

This comes as no surprise to Anne S. Hatcher, a world-renowned nutrition and addiction expert and professor emeritus at the Center for Addiction Studies at the Metropolitan State College of Denver in Colorado. “Rarely do you find somebody who has abused drugs and alcohol who has good nutritional status,” she says.

That’s because alcohol and other drugs affect the body in complex ways. “Substances affect the body’s ability to absorb nutrients, and the digestive track may be destroyed by that substance,” says Tilley. Specific addictions bring on equally specific problems: Opiate addiction may cause constipation, diarrhea, nausea and vomiting. Alcohol addiction can lead to a dementia-type syndrome, and blood sugars can be affected. Stimulants such as cocaine can decrease appetite, whereas marijuana might increase it. Even with a non-substance–related addiction like gambling, nutrition can become an issue, particularly not having money for food. Added to those effects are lifestyle factors associated with substance use that impact nutritional status, such as irregular eating habits and spending money on the substance as a priority over food.

Recovery presents its own dietary challenges. Early in recovery, clients often crave sugar, caffeine and fat. Some clients have issues with overeating, others with under eating. “Helping clients normalize their eating habits so they get all the nutrients they need will help with any deficiencies,” notes Tilley. “During recovery, that will give them a better energy level, help nourish their brains and help control changes in mood that come with detoxifying and from being nutrient-deficient for so long.”

Normalizing eating habits may mean addressing client readiness and providing education. “Clients are dealing with the addiction and detoxing, so they may not be ready to take on diet or nutrition right now,” says Schwartz. “And they may have no knowledge of it to begin with, so it’s largely a matter of re-education. A lot of clients were never taught how to cook or they’re intimidated by the kitchen, so they buy frozen meals.”

But eating well for recovery is about more than knowing one’s way around the kitchen or which foods to avoid. Many clients face external barriers to eating healthy. “Finances are an issue—a lot of our clients are food insecure and rely on food banks, which often don’t provide a lot of fresh produce,” says Amanda Schwartz, dietitian-in-chief at the Centre for Addiction and Mental Health in Toronto. “And there’s a large majority who are either in group homes or shelters, where they don’t have control over what they eat.”

Lack of control over food choices extends to hospitals, where palatability is also an issue. Hospitals must follow federal and provincial nutrition standards to ensure they meet dietary needs, but that doesn’t mean that meals will suit everyone’s taste. “Inpatient hospitals are working within budget constraints, the problems of food production,” says Jan Klizs, a nutrition counsellor at the Victoria Cool Aid Society in British Columbia, which serves adults who are homeless. “They’re working with patients with acute illness, with culturally different populations, and that makes the job very challenging.”

So where does this leave clinicians, who are not trained in nutrition issues and who may not have access to an expert? “No registered dietitian would want a non-dietitian to be analyzing nutritional deficiencies, but I always say to practitioners that dieticians do not own Canada’s Food Guide,” says Schwartz. “They are a great place to start, for example, to learn about appropriate portions. You can use the guide to track how well your clients are eating. Not everyone has access to a dietitian, but one of the key factors in relapse prevention is eating every three to four hours to help manage blood sugars.”

Even bringing up the issue of diet in assessment is a good step toward incorporating nutrition into recovery. Clinicians can also keep an eye out for symptoms that may indicate an issue (see “Recovery on the menu” sidebar). For those recovery centres that don’t have an in-house registered dietitian, Klizs suggests accessing outside nutritional consultation and support. “Community networking is really important and we need to help our clients with food security issues,” she says. “We need to know where and when they can access food, whether it’s at a food bank, a soup kitchen, a community drop in or elsewhere.”

Hatcher encourages clinicians and clients to remember that, like recovery, nutritional improvement doesn’t happen overnight. “Recovery is a process—it took a long time to get to where you are today and changing your diet is not going to get you healthy and back on track immediately,” she says. But clinicians who recognize the role of diet can take steps to help nourish their clients on the road to recovery and better health.

Recipe for recovery: Tips for addressing nutrition with clients

While registered dietitians don’t advocate that clinicians move into the area of doing full nutritional assessments, clinicians can ask key questions and look for signs that could indicate nutritional problems. Our nutrition experts offer these tips:

  • Ask the obvious, like “Have you eaten today?” And when you meet with clients, keep your ears open for growling stomachs, says Klizs.
  • Klizs suggests asking about recent weight gain or loss or diarrhea. Other questions: “Do you have problems with reoccurring infections? Poor wound healing? Do you have a history of bone factures? Abnormal thirst? Frequent urination?”
  • Watch for physical signs, such as eyeballs that appear to sink in at the edges, a protruding clavicle, hair loss and skin changes, says Schwartz. “If a client says ‘I’m always tired,’ that could also be a sign of a nutrition problem.”
  • Ask about more subtle physical changes. Light sensitivity or difficulty adjusting to changes in light can indicate nutritional deficiencies, as can easy bruising and bleeding gums, says Hatcher.
  • Find out where your clients eat and who prepares their food,” suggests Hatcher, because addiction clients may rely on fast food or whatever is convenient, rather than on what is healthy.

Survey says …

From our consumer nutrition survey, 33 respondents identified as having substance use issues. These excerpts highlight the barriers they face to eating well and how frontline workers can help.

What challenges do you face to eating healthy?

“Eating is not a priority; money goes to feed the habit, not the body.”

“I was caught up in the cycle of using, working streets, scoring, repeat. Addiction becomes the primary concern; eating becomes secondary.”

“I binge on carbs and large quantities of food to try to avoid drinking. When I do drink, alcohol triggers my appetite and lowers my resistance to eating fatty snacks.”

“I’d get filled up on calories from alcohol, so I had no appetite for food.”

“Substance use interferes with your ability and frame of mind for meal preparation.”

“Unfortunately, putting together a healthy salad isn’t as easy for me as going to the bar across the road and having a beer.”

How can addiction workers help you to eat better?

“If you’re deep in addiction and your mental health isn’t great, you might not be well enough to go to a soup kitchen or food bank, so workers need to be more proactive,” wrote one respondent. Other respondents suggested how:

“Provide healthy snacks at group sessions on substance use and do a bit of teaching about healthy eating at each session.”

“Meet at places with a healthy menu. Use the [treatment] program’s budget to buy healthy food instead of coffee.”

“Help clients understand how healthy food can contribute to overall well-being and lead to harm reduction from certain substances.”

“Many addiction workers have poor dietary habits themselves and addiction (smoking). How can they teach good nutrition if they don’t practice it?”