Malnutrition associated with
substance abuse can be either primary or secondary. Primary malnutrition occurs
when substance abuse displaces, reduces, or compromises food intake. Secondary
malnutrition occurs when the substance of abuse causes alterations in the
absorption, metabolism, utilization, and excretion of nutrients due to
compromised oral, gastrointestinal, circulatory, metabolic, and neurological
health. Malnutrition negatively impacts all body systems including the immune
system, leading to an inadequate response to disease. While the harmful effect
of alcohol on nutritional status has been well described, the mechanisms behind
illicit drug-induced malnourishment remain largely unknown. It is difficult to
differentiate between primary and secondary malnourishment within drug-addicted
populations. In addition, there are ethical and legal challenges in conducting
controlled trials using illicit substances, as well as difficulties with
patient follow-up. Most of the data that links nutritional deficiencies to
substance abuse is speculative, underpowered, and retrospective.
The Academy of Nutrition and
Dietetics (formerly the American Dietetic Association) published a position
paper in 1990 supporting the need for nutrition intervention in treatment and
recovery from chemical dependency. The paper promoted the concept that Registered
Dietitians (RDs) are essential members of the treatment team and that nutrition
care should be integrated into the protocol rather than “patched on.” Nutrition
professionals were urged to “take aggressive action to ensure involvement in
treatment and recovery programs." In the past 20 years, there has been
little progress in incorporating dietitians into drug rehabilitation programs,
despite the continued explosion of illicit drug abuse. The reasons for this are
multifactorial and include: lack of interest from RDs, limited funding for new
initiatives, non-collaboration between the public and private sector,
difficulties conducting research on this population, and the associated stigmas
of substance abuse.
Once sobriety has
been achieved, altered biochemistry and dysfunctional behavior resulting from
substance abuse often persists. The practice of making healthful food choices
while abstinent from drugs and alcohol may be challenging in the early stages
of recovery. Sobriety often creates new emotions, anxiety, and uncertainty. Patients
often seek a predictable and comforting response from food, which can lead to
overeating, relapse, compromised quality of life, and the development of
chronic disease. Increased caloric intake and excessive consumption of sugar,
salt, and fat often leads to obesity, diabetes, and hypertension, which in turn
increases the risk for cardiovascular disease and the clinical burden
associated with substance abuse. Recent findings suggest that even a remote
history of substance abuse can negatively impact weight loss. Evidence to date
indicates that individuals in recovery will benefit from learning new behaviors
with respect to food and nutrition. There is also an increasing body of
literature that suggests nutrition interventions in substance abuse treatment
lead to improved outcomes, yet we need more investigators willing to conduct
controlled trials. Please consider this topic for your Master's Thesis or Doctoral Dissertation.
