By David Wiss, MS, RDN
Our food tastes in early recovery are like… teenagers!
Introducing the concept of nutrition into an addiction treatment program is not an easy task. Many addicts in early recovery are not ready for health behavior change, since most are simply trying to get past the immediate crisis of addiction and the associated life adjustments of abstinence. In fact, sobriety can magnify pre-existing dysfunctional eating behavior. Many addicts began using drugs and alcohol in their early teens and never developed a healthy relationship to food.
Often times, drug addicts in early recovery have food preferences of a juvenile and prefer candy, juice, cereal, grilled cheese, peanut butter and jelly, ice cream, etc. In addition to childlike food preferences, many may have damaged their guts through the use of:
- other psychoactive substances
Needless to say, most addicts in early recovery have little interest in fibrous foods such as fruits, vegetables, whole grains, beans, nuts, and seeds.
Damages to the reward center in the brain
Additionally, the reward deficiency syndrome created by chronic exposure to addictive substances often requires that the food consumed be highly rewarding to the brain. These foods are typically sweet, salty, high fat, easy to digest, or some combination of these traits. Other examples include chips, cookies, and most processed snack foods. If addicts in early recovery are given unlimited access to highly rewarding food, they will predictably overeat.
While excessive weight gain is certainly an issue and can lead clients back to using substances, the bigger problem is malnourishment-which limits the ability of the brain to heal from the ravages of addiction. Low quality food leads to low quality thoughts and a low quality life, and can lead back to using drugs and alcohol.
Why not just take a multivitamin and eat for pleasure?
It is a common mistake to assume that the daily consumption of a multivitamin will “cover all of the nutritional bases.” Of course, supplemental nutritional can be helpful if the person has a compromised ability to eat or has a limited diet. But too often, patients in early recovery fall into the trap of using multivitamins to assume they do not have to concern themselves with the nutritional quality of their food.
For starters, supplemental vitamins will never be able to contain the antioxidant potency of real food. Phytochemicals that flourish in real food cannot always remain stable in a supplemental form. Second, arguably the most important nutrient for addiction recovery is fiber, which is found in fruits, vegetables, whole grains, beans, nuts, and seeds. It is of paramount importance to eat fiber from food (not fiber supplements) to improve gut function and achieve balance in the microorganisms that live throughout the GI tract. Lastly, consumption of highly processed junk food throughout the day can significantly hinder the recovery process in numerous ways:
- Unstable blood sugar impacts mood and concentration
- Nutrient-void food can leave patients feeling sluggish and reliant upon caffeine (for the illusion of energy)
- Refined grains, added sugars, and added fats will negatively alter the microbiome (which we are discovering has an impact on mental health)
- Highly palatable food will condition the brain to expect food to taste a certain way, perpetuating the cycle of food addiction and promoting substance-seeking behavior. For example:
- Eating candy will make eating fruit become less appealing.
- Sweetened beverages will make drinking water less appealing.
- Heavily seasoned and sauced food will make plain food be less appealing.
How do most people in early recovery eat?
Obviously there is a wide range of ways people in recovery eat, and there are many factors such as food availability, financial resources, and food philosophy of the treatment program. But to generalize about the average addict in sober living, it might look something like this:
BREAKFAST: No breakfast, or if there is breakfast, it is typically bacon, eggs, hash browns, and/or sugary cereal or pop tarts. Instead, most people in early addiction recovery tend to consume:
- coffee with flavored creamer and sweeteners (often several cups)
- cigarettes (or “vape”)
- energy drink (or several)
LUNCH: The first real meal of the day, sometimes there are snacks before lunch. Lunch will typically be a (white flour) sandwich, burger, wrap, or pizza, all of which lack fruits and vegetables. Often lunch will be from a fast-food restaurant.
SNACKS: People in recovery might snack throughout the day. These types of snacks tend to include:
- cereal bars
- energy drinks
- sweetened coffee
DINNER: Dinner typically consists of protein and starch (i.e., pasta and meatballs, teriyaki chicken and rice) and most patients will skip any vegetables (which may or not be served).
NIGHTTIME: Nighttime (10pm-1am) is when the real eating occurs. Many patients are on night meds (such as Seroquel) that can lead to loss of control and increased food consumption. Typical nighttime snacks:
- sugary cereal
- ice cream
- white flour products (bread, bagel, tortilla) with melted cheese
- frozen foods (pizza, taquitos, etc.)
- other highly processed foods that can lead to a full blown binge episode.
It is also common for addicts to eat during the middle of the night, sometimes without their knowledge (night eating syndrome).
So what is someone in early recovery supposed to eat?
The answer is simple: real food.
If a patient in early recovery is offered a choice between addictive food and nutritious food, most will select the more “rewarding” choice. The problem is that this “reward” generated by the brain gives the patient the illusion that they are getting what they need, when in reality they are just stimulating dopaminergic neural pathways. What they really need is a diet high in:
- omega-3 fatty acids
At Nutrition in Recovery we use six (6) food groups: fruits, vegetables, grain, dairy, animal protein, plant protein (beans, nuts, seeds). The goal is to get representation from all six (6) food groups at least twice/day and to avoid “foods” that cannot be classified into this food group system.
Sample meal plan for addiction recovery
1. Breakfast: A fruit smoothie with mixed frozen berries, banana, spinach, unsweetened Greek yogurt, flax seeds, unsweetened almond milk
2. AM Snack: 1 piece of cinnamon raisin sprouted whole grain bread with almond butter, hard-boiled egg
3. Lunch: A large plate of mixed raw veggies topped with tuna or chicken salad, lentil soup (or other bean or grain soup)
4. PM Snack: A piece of fruit, string cheese, handful of nuts
5. Dinner: – Quinoa (or other whole grain such as farro)
……………– Salmon (or other animal protein such as beef)
……………– Asparagus (or other cooked vegetable)
……………– Green salad topped with pine nuts (or other nut/seed)
6. Snack: Bowl of frozen cherries topped with unsweetened Kefir and cocao nibs (or other nut/seed).
What gets in the way of healthful food plans in recovery?
The biggest barrier to a healthy meal plan during formal addiction treatment is that medical insurance plans do not cover nutrition services for addiction recovery. This is likely due to a shortage of data about the efficacy of nutrition interventions in addiction recovery. For a partial hospitalization program (PHP) or intensive outpatient (IOP) program to include nutrition education and counseling, it will become a financial drain for the program. Some medical billers will be able to get reimbursement for a nutrition education group if there is proper documentation by the dietitian, but there is no coverage for individual counseling unless there is an official eating disorder diagnosis.
The biggest challenge to rehab, however, is the need to change the food service system. A nutrition group should educate patients about proper eating and be synchronized with the food being served. Teaching about the importance of nutrition in addiction recovery and then serving highly processed snack foods undermines the goals of recovery, especially for patients residing in a sober living facility that is essentially a toxic food environment.
Further, the food served to rehab clients is generally purchased in bulk from discount stores by operations staff, often someone in early recovery themselves. Many facilities hire chefs to prepare meals, but the chefs often prepare food to please patients by creating highly palatable meals that light up the pleasure centers in the brain. It is my strong belief that a registered dietitian nutritionist should supervise the menu in addiction treatment settings.
We need to embrace healthful eating in addiction treatment
Most addicts will choose addictive food on a daily basis, instinctively selecting food that is highly rewarding and avoiding food that is not. Until upper management in treatment settings embraces the concept of nutrition in recovery, progress will be slow.
Currently, there is no requirement for nutrition education or the need for consultation with a registered dietitian nutritionist. A majority of treatment programs in Los Angeles, for example, serve and allow junk food, and seldom make fresh fruits and vegetables available. Understandably, real food is more expensive than highly processed snack foods that do not spoil. It does cost more to serve nutritious food, but when we serve non-addictive food, the addict eats less. When a treatment center or sober living attempts to save money on food, the entire recovery process continues to suffer.
What can we do?
Consider this a call to action to implement nutrition guidelines in your treatment facility. Consult with a registered dietitian nutritionist, particularly ones that have training and expertise in the addiction population. Examples that can be implemented include:
- No sweetened beverages (sodas, sports drinks, etc.) including “diet” drinks
- No candy (or highly sweetened foods)
- No fried foods (i.e. chips)
- No refined grains (use whole grains only)
- Cereals should have more grams of fiber than grams of sugar
- Dessert should only be served as dessert (once per day)
The primary focus should not be about what not to eat, and should always be about what to eat. The way to convey this message is by having a weekly nutrition education group run by a registered dietitian. Nutrition should never seem punitive, but rather be framed as a helpful component of the recovery process. This should be a required part of every program.