Substance Abuse Treatment: The Role of the Dietitian

The nutritional status of people with an alcohol or drug addiction is often poor (1).

Consequently, many people who seek substance abuse treatment are malnourished.

Malnutrition can interfere with the effectiveness of treatment and increase the likelihood of relapse if not treated and managed appropriately.

Fortunately, dietitians are in a unique position to help treat malnutrition and prevent it from occurring in the future, increasing the likelihood of recovery.

This article explains the role of the dietitian in substance abuse treatment and how they can improve the success of substance abuse recovery.

What are substance abuse treatment facilities?

Substance abuse treatment facilities help people recover from drug or alcohol addiction.

They may provide treatment on an outpatient basis, inpatient basis, or both.

Outpatient rehab

In an outpatient rehab program, patients live at home and go to the facility for treatment sessions at scheduled times, which may be daily or several times during the week.

Outpatient rebab tends to benefit patients who have mild-to-moderate substance abuse problems and require less intensive treatment.

The treatment sessions may provide counseling, education, and offer a network of support.

Inpatient rehab

In an inpatient rehab program, patients live at the treatment facility where they receive care.

The length of time a patient lives at the facility can vary from three weeks to three months or longer.

Inpatient rehab provides 24-hour support and intensive care, making this treatment option beneficial for patients with severe substance abuse problems that may also be complicated by other mental health conditions, such as depression, an eating disorder, or post-traumatic stress disorder (2).

As a component of inpatient rehab treatment, patients may require a detox program to help ease the side effects of alcohol or drug withdrawal symptoms, like seizures, agitation, anxiety, and nausea or vomiting.

Role of the dietitian in substance abuse treatment

Regardless of the setting — inpatient or outpatient — dietitians play an important role in substance abuse treatment.

They treat nutritional deficiencies

Alcohol and drug abuse can reduce the absorption or increase the loss of several vitamins and minerals, causing a nutritional deficiency.

Alcohol abuse, for example, can cause the following nutrient deficiencies (3, 4, 5):

• Folate: A B-vitamin naturally found in vegetables, fruits, nuts, beans, and meats, folate is necessary to make DNA and other cells. A deficiency can cause weakness, fatigue, and changes in skin, hair, or fingernail color.
• Thiamin: Also known as vitamin B1, thiamin plays an important role in energy production. Food sources of the vitamin include whole grains, meat, and fish. Symptoms of a thiamin deficiency include weakness, numbness, or pain from nerve damage and short-term memory loss.
• Vitamin B6: Found in a variety of foods like fish, meat, and legumes, vitamin B6 plays an important role in protein metabolism and immune function. A deficiency can cause scaling on the lips and cracks at the corners of the mouth, swollen tongue, confusion, and weakened immune function.
• Vitamin A: Found in dairy products, meat, eggs, and vegetables, vitamin A supports immune function, vision, and reproduction. Symptoms of a vitamin A deficiency include night blindness and increased risk of infections, especially diarrhea.

The use of alcohol and drugs can also displace other important nutrients in the diet like protein, leading to muscle wasting, a weakened immune system, and poor fluid balance.

Moreover, stimulant drugs like cocaine and methamphetamines can reduce appetite, leading to weight loss and increased risk of nutrient deficiencies (6).

By completing a thorough nutrition assessment, including a nutrition-focused physical exam, dietitians can quickly identify nutrient deficiencies and implement appropriate interventions.

In this way, dietitians can help optimize patients’ cognitive and emotional functioning so they can benefit more from treatment (7).

They prescribe therapeutic diets

Therapeutic diets eliminate, decrease, or increase specific nutrients in the diet to treat or manage a disease or clinical condition. While therapeutic diets generally control the consumption of specific nutrients, they also alter the texture of foods.

Alcohol or drug abuse can cause adverse health effects and conditions, many of which can be managed with a therapeutic or altered-textured diet.

For example, patients with alcohol use disorder may develop liver cirrhosis and benefit from a low-sodium, high-protein diet to reduce fluid buildup and improve nutrition status (8).

In other cases, patients with methamphetamine use disorder may have poor oral health and benefit from an altered-textured diet to make foods easier and less painful to chew (9).

In either case, the dietitian can prescribe a therapeutic diet as appropriate and educate the patient on the purpose of the diet, how to follow it, and address any barriers that may prevent him or her from following it.

They provide nutrition education and promote a healthy lifestyle

Dietitians can educate patients on the importance of nutrition in their recovery process, and how to maintain good nutrition once they are out of treatment.

This education might include how proper nutrition may improve mood, decrease alcohol or drug cravings, and increase energy levels (10, 11).

They can also educate patients on nutrition label reading, grocery shopping, cooking, and preparing foods.

Patients that have financial struggles or unstable living situations may also benefit from education on budget-friendly meal options and appropriate nutrition assistance programs.

Finally, dietitians can encourage other healthy lifestyle practices, such as maintaining a healthy weight, exercising regularly, and getting enough sleep.

Dietitians add value to substance abuse treatment facilities

Despite the importance of nutrition in substance abuse treatment, it’s often a neglected component of the recovery process.

However, as the dietitian’s role in treatment continues to gain recognition, substance abuse treatment facilities have increasingly hired or contracted with them to improve treatment outcomes but also separate themselves from their competitors.

In the inpatient setting, dietitians can also assist in creating healthy and tasty menus that reduce costs and food waste, provide in-service programs for the facility, and implement data-driven quality assurance performance improvement (QAPI) programs to ensure quality food- and nutrition-related services are provided to patients.

The bottom line

People who seek substance abuse treatment often have poor nutritional status.

Dietitians can improve treatment outcomes in these patients by restoring their nutritional status, prescribing therapeutic diets to manage health conditions brought on by alcohol or drugs, providing nutrition education, and promoting an overall healthy lifestyle.

Although nutrition therapy provided by a dietitian is an often missing component of substance abuse treatment, it’s important for improving treatment outcomes continues to gain recognition from the medical community and substance abuse treatment facilities.