Supporting Addiction Recovery
Lisa Murray, RDN LD
It’s hard to get away from the headlines about the American opioid crisis, as the US is experiencing an overdose epidemic unparalleled in our history. We hear a lot about it these days; this truth is making its way up the political chain into public policy. But this isn’t just an opioid painkiller crisis; it’s an addiction epidemic involving legal and illegal drugs of all kinds, including alcohol abuse, which has been a longstanding problem in our society.
As an integrative practitioner, you may have been asked by a patient or client if there is anything you can do to help them “get over” their addiction. The answer is yes; what we can offer is very valuable to any person seeking recovery from addiction. But it depends on the patient and their readiness and willingness to change.
The bottom line is there are no new natural miracle cures. When the overarching presenting problem appears as addiction, it’s probably not what the majority of us feel well equipped to treat. The real problems are underneath the symptom called “addiction”. Recovery is an extended process, but there are studies and resources affirming the very big role that nutrition has in supporting both withdrawal and recovery, and most importantly, preventing relapse. Substance abuse negatively impacts nutrition status in many cases to the point of overt malnutrition and universally changes neurochemistry. So, in order to really understand how we fit into the picture, consider the long-term goal, which is really to help this person the same way we try to help everyone else:
- Help them improve their overall health
- Alleviate their symptoms and normalize physiology by balancing their biochemistry
- Encourage the patient to explore a variety of modalities which help reduce physical and emotional pain
Assessment can start with asking how their addiction developed and why they started using (I was taught that you have to ask “why” five times in a row to come closer to understanding the root cause). For many, it may have started with an injury or surgery and the use of pain medication. For others, it may have started as self-medication for diagnoses of PTSD, ADHD, anger, depression, or anxiety. It’s important to dig and to screen for underlying diagnoses, which are usually masked by the substance abuse. In any case, if the patient successfully withdraws from substance abuse, the symptoms of coexisting health conditions will begin to emerge more clearly over time.
Where to Start
The most important thing we can do is to ensure they have a very robust nutrition plan. This can be a huge challenge because often money is an issue and buying supplements may be problematic. Address macronutrient intake to support proper glucose metabolism. Erratic blood sugar can trigger moodiness, anger and cravings to use. People with addiction have become used to substituting substances for food. Strategies include food preparation for the week ahead of time, which makes frequent small meals and grabbing and going possible. Another very important strategy for this population is the use of smoothies, which include high nutrient raw fruits and veggies like blueberries and spinach along with protein powder or Greek yogurt.
Protein is really critical for this population, as it repairs tissues and organs affected by chronic substance abuse and inadequate nutrition. Protein should be incorporated into all meals and snacks as much as possible. Eggs, chicken, fish, red meat, cottage cheese, Greek yogurt, nut butters, and protein powders are all good high-protein options. Keeping hard boiled eggs, cold chicken, cottage cheese, Greek yogurt and nuts on hand for quick high-protein snacks improves nutrition status and helps keep blood sugar more stable.You can educate on an anti-inflammatory diet, high in good fats, legumes, and veggies, and low in simple carbs. A simple, healthy, whole food meal plan will provide necessary nutrition. If at all possible, encourage the patient’s family members or friends, who may be available as cooks and caregivers, to help prepare meals and to ensure the person is receiving adequate nutrition. Eating very well is an important key to successful recovery, and many patients will need solid resources and support in making this a reality. This also gives loved ones a very real and tangible way to help, which assists in building a community around the recovering individual.
Begin with the assumption that deficiencies in omega-3 fatty acids, magnesium and vitamins C, K, A, D and especially B vitamins will need correction. Choose the highest potency cost-effective supplements available. Begin repletion with a robust multivitamin high in active B vitamins (or the addition of a B complex), which are co-factors in the production of neurotransmitters, necessary in the detoxification process and necessary for energy metabolism. Fish oil supplementation will ensure proper balance of omega-3. While there are many studies linking omega-3 supplementation with good mental health outcomes, of note is a 2006 study published in the Journal of Clinical Psychopharmacology, showing that supplementation with three grams of EPA+DHA over three months resulted in a significant decrease in the anxiety scores of substance abusers.
Once again, it’s important to “heal the gut” because many drugs have a large impact on the digestive system. More than half of substance abusers report GI complaints, though truly everyone will be affected. This often manifests as disordered eating because users can’t digest their food well and malnutrition can result. Disorder in the “gut–brain axis” is involved in any number of physical, mood, and cognitive disorders and is worsened by stress. Digestive enzymes, probiotics, magnesium, and glutamine can all be helpful in restoring gut health and function. Probiotics can help with the digestion, absorption, and also metabolism of nutrients as well as neurotransmitters, which are all very important at helping restore normal brain function.
Once the foundations are in place then additional considerations can be addressed. For detoxification and liver support, consider adding taurine, NAC, silymarin (or milk thistle seed extract), and curcumin or turmeric extract. For mood and sleep support, consider L-theanine, 5HTP, inositol, passionflower, honokial, ashwagandha, holy basil, and magnesium glycinate. Anecdotally, individuals posting in withdrawal forums on the web have repeatedly stated that B-Vitamins and passionflower seem helpful during the withdrawal phase.
Supporting those who are in pain in every way requires a truly integrative approach to be successful; I believe “it takes a village”. Whether you can create this team formally, or organically through a chain of referrals, it will be in the best interest of the patient and provide for the most comprehensive and long-lasting positive outcome. A team who together can support a truly holistic environment of care for the body-mind-spirit integration of the whole person would be ideal. This might include a team of professionals who can provide acupuncture, mental health services, nutrition services, medical services, and energetic or spiritual care. The long-term goal is to help this patient feel whole again, feel happiness, feel normal, be able to value and care for themselves, learn to accept life as it is for them and function in society. Each of us can provide a piece to this puzzle.
Below are a few resources you might find useful in learning more about this subject:
Drug Withdrawal Research Foundation. http://withdrawalresearch.org/nutrition.html
Townsend Letter, February/March 2016. “Updates on the Treatment of Drug Addiction” by Carolyn Ross, MD, MPH. http://www.townsendletter.com/FebMarch2016/drug0216.html
Journal of Addiction Research & Therapy. “The Use of Sobriety Nutritional Therapy in the Treatment of Opioid Addiction. Citation: Cunningham PM (2016) The Use of Sobriety Nutritional Therapy in the Treatment of Opioid Addiction. J Addict Res Ther 7:282. doi: 10.4172/2155-6105.1000282