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What’s on Your Plate? The Power of Nutrition for those in Recovery

September 10, 2019

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Fresh food and vegetables on the table

It is estimated that in 2017, 20.7 million people age 12 and older needed treatment for a substance use disorder.1 Alcohol is the third leading cause of death in the United States, and drug misuse and addiction costs more than $740 billion annually among lost workplace productivity, healthcare expenses, and crime-related costs.7,8 Although addiction is considered a highly treatable disease, the relapse rate for substance use disorders is estimated between 40% and 60%.9,10

Unfortunately, drug use has increased exponentially over the past few years, especially with the opioid crisis. More than 130 people die every day in the US from an opioid overdose, and the economic burden from opioids alone is $78.5 billion a year.11

There’s no argument that substance use remains a significant problem in the US, but fortunately, access to treatment isn’t quite as difficult as it was in the past. There are still barriers to getting treatment for many individuals, but the US now has over 14,500 specialized treatment facilities.3

Connection between nutrition and drugs

Despite the fact that many people still don’t have access to, or have difficulty accessing proper treatment, another problem remains, and that is the food environment all around us. It is increasingly easy to eat foods that are extremely tasty, but also low in nutrients, and high in fat and sugar. Although this is something that affects everyone, this type of food environment has a potentially more profound impact on individuals with substance use disorders.

Here’s why:

There is a wealth of research that shows both biological and behavioral similarities between drug addiction and overeating, such as alterations in dopamine expression, cravings, and relapse to highly palatable foods.5

Today, thanks to research in both animals and humans, there is also no longer a question of whether or not food itself can be addictive. Furthermore, processed foods, especially those that are high in sugar and/or fat, are typically the most addictive.5

So how exactly does a food addiction relate to drug use?

Let’s first talk about the relationship between dopamine and drugs. Dopamine, a “reward” hormone, plays a major part in why we choose to do pleasurable things again and again. Dopamine is released in the brain when you do something fun, try a new delicious food, or use drugs.

Drugs actually cause a major surge in dopamine, one that is much more powerful than say, booking a flight for your next vacation or finding a $50 bill on the ground. This surge of dopamine is largely responsible for the intense desire to seek out drugs, even at the expense of your social relationships, work duties, and quality of life.

The effect of food on our dopamine response is not that much different.

When we eat a new food, especially a highly palatable food (like a donut or chips, for example), dopamine is released in the brain, which gives us that rewarding sensation--telling us that what we’re eating is absolutely delicious.

Research shows that repeated exposure to this food may eventually wane the dopamine response, but if there’s a cue associated with the food (i.e. every time you have coffee you need a donut), the cue alone will eventually be enough to make you eat that food because of the pleasure that has been associated with it.6

What this means is that our bodies have evolved in a way that we can eat in the absence of hunger. Whether or not you’re hungry, having a cup of coffee means you are going to eat a donut, because you associate the two together, and it was, at one time, extremely pleasurable.

However, that high dopamine response will come back when you’re either eating a different palatable food, or if the previous one was restricted and then reintroduced. For example, if you go on a diet and restrict yourself from eating ice cream for two weeks, you are likely to binge the next time you eat it, thanks to a large release of dopamine.

So while drugs are widely available and abused, so are highly palatable and highly processed foods. We often eat these foods because of the stimulation they provide to our reward system, which is a dangerous pattern that shows up in drug addiction as well.

Taking drugs out of the picture typically leads someone (whether in recovery or not) to seek other sources of stimulation, and more often than not, that stimulation comes from food.

The Role of Nutrition in Recovery

At this point, the role of nutrition in drug and alcohol recovery can no longer be ignored. Research consistently shows that not only are individuals with a substance use disorder typically nutrient deficient, but in addition, substances of use and food (especially sweet food) stimulate similar areas of the brain.4 Food could potentially become a rewarding substitute for alcohol or drugs, and differentiating between a food craving and substance craving could possibly be difficult to tease apart.4

This leads us to two aspects of nutrition in recovery therapy that we need to consider. The first is that many patients with substance use disorders tend to have a poorer nutritional status than non-users. These drug users either have food insecurity or have increasingly worse nutritional habits.13 For example, one might consume less food, consume less nutritious food, skip meals, lose nutrients through vomiting and diarrhea, or have difficulty absorbing nutrients due to gut damage. Thus, reversing malnutrition and increasing knowledge of a healthy diet is important to address this issue.

The second is that those suffering from or in recovery from substance use disorders have difficulty controlling their food intake.13 For example, in place of seeking out drugs, one might start overeating instead. Knowledge of good food choices can help this, but skill building is especially important, considering the relationship between food cravings, drug cravings, and the dopamine reward system.

According to the World Health Organization international standards for treatment of drug use disorders, a primary goal of long-term residential treatment patients is to acquire a healthier lifestyle, achieved through proper nutrition, sleep, health monitoring and adherence to treatment.12 But how is nutrition actually addressed, if at all, in treatment centers?

Some treatment centers offer nutrition education as part of the recovery process. Several studies have looked at the effectiveness of nutrition education and found that it improves overall treatment outcomes.4.14 Proper nutrition education may help recovering individuals continue to abstain from drugs and maintain a healthy lifestyle well after receiving treatment.4

Whether or not nutrition education is a part of every treatment program, it’s clear that nutrition education is an essential part of not only the recovery process, but in the maintenance of recovery. Nutrition is important to anyone’s life, but considering the nutritional challenges that arise from substance use disorders, it’s especially important to those who are looking to make a healthy and successful recovery.

 

References:

  1. Substance Abuse and Mental Health Services Administration (2018). https://www.samhsa.gov/data/report/2017-nsduh-annual-national-report
  2. Alcoholics Anonymous (2018). http://www.aa.org/assets/en_US/smf-132_en.pdf
  3. National Institute on Drug Abuse (2018). https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states
  4. The importance of nutrition in aiding recovery from substance use disorders (2017). https://www.ncbi.nlm.nih.gov/pubmed/28806640
  5. What is the evidence for “food addiction?” (2018). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946262/
  6. Sugar Addiction: From Evolution to Revolution (2018).https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234835/
  7. National Institute on Drug Abuse (2017). https://www.drugabuse.gov/related-topics/trends-statistics
  8. National Institute on Alcohol Abuse and Alcoholism (2018). https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics
  9. National Institute on Drug Abuse (2018). https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
  10. New York State Office of Alcoholism and Substance Abuse Services (2012). https://www.oasas.ny.gov/pio/press/20120306Recovery.cfm
  11. National Institute on Drug Abuse (2019). https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis
  12. World Health Organization https://www.who.int/substance_abuse/activities/msb_treatment_standards.pdf
  13. Effectiveness of education programs on nutritional behavior in addicts referring to Baharan hospital, Zahedan (2014). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080462/
  14. Nutrition education is positively associated with substance abuse treatment program outcomes (2004). https://www.ncbi.nlm.nih.gov/pubmed/15054346

 

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Nicole Avena, PhD

Dr. Nicole Avena is a research neuroscientist and expert in the fields of nutrition, diet and addiction, with a special focus on nutrition during early life and pregnancy. She is Assistant Professor of Neuroscience at Mount Sinai School of Medicine and Visiting Professor of Health Psychology at Princeton University. Her research achievements have been honored by awards from several groups including the New York Academy of Sciences, the American Psychological Association, and the National Institute on Drug Abuse. Dr. Avena has written several books, including What to Eat When You’re Pregnantand What to Feed Your Baby and Toddler. She regularly appears as a science expert on the Dr. Oz Show, Good Day NY, and The Doctors,as well as many other news programs. Her work has been featured in Bloomberg Business Week, Time Magazine for Kids, The New York Times, Shape, Men’s Health, Details, and many other periodicals. Dr. Avena is a member of the Penguin Random House Speakers Bureau. She has a most watched TED-ED Health talk, How Sugar Affects Your Brain. Dr. Avena blogs for Psychology Today. You can also follow her on Twitter or Facebookand Instagram, and at www.drnicoleavena.com.