Alcohol and Drug Rehabititation

Written by:

Reviewedby:

D2.l

Mary Lu carpenter,MS RD LD/N, winter ParkMemorialHospital,

CarolynS. DeVries,RD, LDINI,andBeverlyJ. Kraus,RD, LDAI, Clinical
Dietitians,Shandsat AGH, Gainesville
JenniferNelson"RD LDA{, Winter ParkMemorialHospital,Winter Park

PRACTITIONER POINTS
RATIONALE

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Nutritional intervention is part of the

overall treatment for chemical dependency
and should include the identification and
correction of nutritional deficiencies, eating
problems and establishment of adequate
intake. Long term chemical dependencymay
lead to nutritional disorders and deficiencies
as well as organ damage. Alcoholic liver
diseaseis one of the top ten causesof death
among those aged 25 to 64 years in the
United States(l). Nutrition education should
include help to establish better eating habits
as a part of the patient's lifestyle.

or pleasure)(l). Althoughthe major effects

of drugs of abuseare not nutritional, their
use can induce nutritional problems,either
directly by reducing food intake drning
periods of altered state, or indirectly by
depletingmoneyfor food (Tablel) (l).
Table l.
EFFECTS OF SELECTEI)
DRUGSOF ABUSE ON APPETITE*
Amphetamines

Cocaine
Codeine

USE
This diet is designed for patients with
physiological and psychological dependence
on alcohol and/or drugs of abuse.
Nutritional care is essential to improve
nutritional status and educate the patient to
help maintain nutritional health.

Marijuana

Methadone

Decreasedappetite,
delayedonsetof hunger,
but tolerancedevelops,
effectcausedby blocking
the uptakeof
catecholamine
Lossof appetite
Lossof appetitewith
chronic use
Reportedto enhance
appetite,but not all
studiesagree;users
appearto be morelikely to
loseappetiteand weight
Lossof appetitewith
chronicuse

RELATED PHYSIOLOGY
Drugs of abuse is a general term that
includes such legal compounds as coffee,
tobacco, and alcohol, and illegal compounds
such as marijuana,cocaine,and crack (l). It
also includes substances with recognized
medical uses that are used for nonmedical
purposes
(e.g.,
barbiturates
and
amphetaminesused for mind-altering effects

Adaptedfrom Eoig MG: Pharmacologic

basisof drug-nutrientinteractionrelatedto drug
abuseduringpregnancy.Clin Nutr 6:235,1987
.
Substanceabuse can adverselyaffect
all of the body's physiologic systems (2).
Impairments in the cardiac, central nervous,
digestive, intestinal, hepatic, endocrine, and
musculoskeletalsystem may occur. Altered
nutrient needsresulting from substance

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Alcohol and Drug Rehabilitation

abuse and changes in appetite and food
intake can exacerbatethese impairments (2).
Drning detoxification the diet is
based on patients preference and tolerance.
Modifications may include increasing fluids,
carbohydrates, and calories. Smaller, more
frequent meals may be better tolerated.
Establishing a regular and prudent eating
pattern is important in recovery.
Secondarymalnutrition may occur as
a result of substanceabuse. Patients with
protein-energy malnutrition due to poor
intake during drug use may benefit from
high-calorie and/or protein modifications.
Reestablishing a normal eating pattern
usually remedies nutrient deficiencies and
weight problems associated with substance
abuse. In addition to the effects of
alcoholism on nutritional status, the drugs
used to treat these disorders may have
effects on appetite and gastrointestinal
function.(4)
The goals of nutrition education and
counseling are often to integrate a healthful
eating pattern with lifestyle choices and teach
daily living skills such as grocery shopping,
cooking and meal planning. The essenceof
recovery is changing negative behaviors into
positive ones. Substancesubstitution (using
excess sugar, caffeine, nicotine, tobacco,
food and supplements) can disguise
suppressedfeelings of loneliness,anger and
fear which may signal a need for
intervention.
NUTRIENTS MODIFIED
Nutrients most often depleted in
alcoholics are: thiamin, folacin, pyridoxine,
vitamin A, vitamin E, vitamin C, vitamin K,
vitamin D, zinc, magnesiunr,iron, calciurn,

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seleniunr, and potassium. (4,5,6) The

regular diet may need to be supplemented
with any or all of these, depending on the
patient's profi.le. Megadosesof vitamins and
minerals may be toxic to the already
are not
compromised system and
reconrmended.
Patients could benefit from a lowpotency
mineral
multivitamin
and
supplement. (3) Patients recovering from
alcohol abuse need 200 mg of thiamin per
Magnesium supplements are
day. (3).
recommended if a patient is at risk for
delirium tremens.
Thiamin is the vitamin most directly
affected by alcohol, either by inadequate
intake, decreasedabsorption in the intestine,
and decreasedstorage in patients with fatty
liver (2) Wernicke-Korsakoff syndrome is a
neurological disorder identified in long-term
alcoholicswith thiamin deficiency.
Currently, food intakes that maximize
the effect of dietary amino acids are
preferableto using supplements.(7)
To reduce cravings, a well-balanced,
high complex carbohydrate, nutrient dense
diet is recommended. Patients most benefit
from choosing their own food and
consumingsmall more frequent meals.
NUTRITIONAT ADEQUACY
When a variety of foods are selected,
this diet is adequatein all nutrients specified
by the 1989 Recommended Dietary
Allowances and Dietary Reference Intakes
(DRIs) for adult males and females unless
meet other therapeutic
adjusted to
restrictions.

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Alcohol and Drug Rehabilitation

REFERENCES
l. Diehl AM. Alcoholic Liver disease.fi/
Chobania,SJ, and Van Nesimm (eds).
Manuel of Clinical Problems in
Gastroenterologt,I 998.
Journal of Clinical Dietetics, American
Dietetics Association: 707, 1996.
3 . Hatcher SA. Nutrition supplementation
in alcohol and drug abuse treatment.
Dietetics
in
Developmental
and
Psychiatric Disorders. l2:1, 1993.

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4. FDA Diet Manual, 1995 edition, page

D2.2.
Brown
RI, Blum Il TrachtenbergMC.
5.
Anernodynamics
of relapseprevention:a
neuronutrient approach to outpatient
DUI offenders. J PsychoactiveDrugs.
22:173-187,
1990.
6. Wardlaw GM, Insel PM. Perspectives
in Nutrition. St. Louis, MO: MosbyYearBook Inc.; 1993.
7. Biery J& Williford Jr., JH. Alcohol
craving in rehabilitation:assessment
of
nutrition therapy. J Am Diet Assoc.
t991.
9l:463-466,

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