Nutritional aids for recovery

 During treatment and in early recovery, when individuals often are being asked to process many changes in their lives simultaneously, programs have to strike a delicate balance when encouraging patients to implement tools for a healthier lifestyle.

An improved diet, possibly aided by nutritional supplements, clearly constitutes an important goal in regaining overall health, but efforts in this area sometimes can be met with patient resistance or utter hostility. Also in some cases, individuals have suffered so much physical damage in the throes of their addiction that their progress must occur incrementally, as they might not be able immediately to derive full benefits from standard supplements or other nutritional guidance.

Addiction Professional asked two individuals who offer nutrition guidance to substance use patients in diverse settings to discuss their perspectives on nutritional support, including the use of supplementation.

Two goals

Victoria Abel, founder and director of the Center for Addiction Nutrition, offers nutrition therapy to patients at the addiction treatment facilities Decision Point Center and Pia’s Place in Arizona. She says she keeps two objectives in mind when considering recommendations of supplementation for patients: inroads in healing damage from past substance use (she considers doses of vitamins C and E and possibly amino acids as useful here), and then maintenance efforts that could help individuals lessen the severity of cravings and stay sober.

At the same time, Abel remains mindful of patient attitudes about supplements that could prove counterproductive. “The perspective of, ‘I take a multivitamin, so therefore I don’t need to take care of my nutrition—that’s frightening to me,” she says.

She adds, “There has to be a balance. You’re wasting a lot of money on supplements if you’re not balancing it with good food.” Unfortunately, she says, she generally doesn’t see an emphasis on either diet or supplementation in addiction treatment and recovery planning, at a time when by contrast interest in anti-craving medications and other pharmacological treatments seems to her to be soaring.

Abel employs nutrition assistance as part of an overall health strategy, and says it works well to consider dietary changes and supplementation simultaneously as opposed to sequentially. But oftentimes patients must start with relatively basic goals as they emerge from a period where their bodies endured significant damage from heavy substance use and lack of attention to overall health.

“Sometimes I might just say, ‘Let’s start with [eating] breakfast every day,’” she says. She adds that many of the patients with whom she works know a great deal already about nutrition and supplements, but have struggled to put any of the knowledge into practice lately because addiction derailed them.

Abel says it is not possible to say that one regimen of supplements will work for every patient. Coming up with a strategy requires a close look at each individual’s blood work and how the person is processing various nutrients.

In addition, a program might have to address any immediate-term health concerns a person is experiencing. Someone with a damaged gastrointestinal tract might have to take liquid forms of vitamins as opposed to tablets or capsules. Changes in diet usually can relieve the constipation that is so common with individuals in early recovery.

Abel says she most commonly focuses on four nutritional supplements when working with the addiction patient. High doses of vitamins C and D can help heal damage done by addiction, she says. She is also a strong believer in the reparative power of omega 3 fatty acids, and she employs B complex vitamins to a significant extent.

In educating patients about supplementation, Abel says it is important to make any regimen “usable, easy and affordable, so it can become part of the patient’s lifestyle.” At the same time, she points out, it is essential to buy high-quality supplements and not necessarily the cheapest and easiest-to-find product out there.

Emphasizing diet

Programs need to be mindful of their target population and its tendencies when looking at the issue of supplementation. Renée Hoffinger is a dietician and clinical specialist who works with veterans in group work as part of the Substance Abuse Residential Rehabilitation Treatment Program at the North Florida/South Georgia Veterans Health System, and she often sees clients who have been homeless and whose dietary habits have caused significant harm.

For this group, supplementation might pose a danger if these individuals then get the notion that “they can relax for the rest of the day and eat trash,” Hoffinger says. In addition, some of the men with whom she works will tend to go overboard when they start exercising again, thinking they need to raid the shelves at the local health food store for multiple bodybuilding supplements, she says. “This is part of the whole obsessive thing, and lack of balance,” she says.

So while Hoffinger will recommend a multivitamin for some patients, she focuses on diet in her patient education. Each Friday morning while patients are in the 30-to-90 day residential program, they attend a class taught by Hoffinger, in which she discusses the role of diet in recovery. Topics addressed in these classes include the effects of substances on the body, how a healthy diet can replenish nutrients, and how foods affect individuals’ mood.

“Then, just so that they don’t see this as just a bunch of hot air, I conduct cooking classes along with an occupational therapist,” Hoffinger says. These also take place once a week, with an effort to keep the classes to no more than eight participants at a time to emphasize the hands-on aspect. Her students’ abilities going into these classes have run the gamut, from “guys who have been five-star chefs to guys who have never sliced a tomato.”

Hoffinger, who at press time was scheduled to present an educational session on nutrition and recovery at this year’s National Conference on Addiction Disorders (NCAD), tries to emphasize assisting her male clients in taking back some control and responsibility in this area of their lives. “Many have always had a woman do this for them, whether a mother or a wife or girlfriend,” she says.

Part of this effort to take responsibility involves being more open to trying new foods. “I always insist that they take a little taste of something,” she says. She also teaches them about healthy substitutions—even ways to make a dish as comforting and fattening as Mom’s macaroni and cheese a healthier option.

Hoffinger says these patients’ physicians sometimes will recommend expensive supplements for them, despite their limited resources. She says she prefers to focus on “getting people eating real food instead of cheeseburgers.”

While she acknowledges that some of the men she counsels approach this overall subject with some hesitation at first, most come to enjoy becoming more open to trying healthier food choices, as well as becoming accustomed to working with others in a kitchen setting. “When people cook together, they get ownership,” she says.