Nutritional Guidance Often Missing from Substance Abuse Treatment

First author Maria Schellenberger MSNHL '17
Maria Schellenberger MSNHL ’17

Even with more than 21 million Americans struggling with substance abuse issues, many addiction recovery programs overlook how nutritional support can increase treatment safety and success, says USC Leonard Davis School of Gerontology student Maria Schellenberger.

Schellenberger, a student in the Master of Science in Nutrition, Healthspan and Longevity program, says patients in recovery often face very high risks for malnutrition, eating disorders, dramatic weight changes and other challenges. She and her mentor, fellow USC alumnus and founder of Nutrition in Recovery David Wiss, recently authored an article on the need for dietetic support during addiction recovery for the Behavioral Health Nutrition newsletter of the Academy of Nutrition and Dietetics.

“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 says of the nutritional problems that often accompany drug abuse. “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 towards teaching about nutrition and cooking skills to enable continued proper nutrition post-rehab.”

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 adds.

“Often, nutrition is overlooked, and facilities provide unlimited access to foods that are highly palatable, such as refined sugars and fried foods,” Schellenberger explains. “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.”

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 utilize after rehab; however, there are currently only a few studies addressing nutrition guidance and the role it plays in substance abuse interventions, she adds. 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 says. “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 says. RDN educational programs, such as the MSNHL program at the USC Leonard Davis School, 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 says. “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.”