Understanding Nutrition in Addiction Recovery

It has been known for some time that individuals with substance use disorders (SUDs) have significant vitamin and mineral deficiencies. In the past decade, investigators have begun to explore alterations in both neuro-circuitry and nutrition-related hormones in the SUD population to better understand eating behavior during drug use, recovery, and long-term abstinence. The connections between nutrition behavior and addiction recovery have important implications that are not frequently addressed in clinical practice.

Food Addiction

Given that weight gain following abstinence from drugs is a source of major personal suffering, there is a pressing need for a more detailed understanding of the effects of drug addiction on dietary intake.-David A. WissHighly palatable food can stimulate endogenous opioid release and trigger dopamine activity in the brain. Palatable food is processed food that typically contains added sugars, salt, and fat. Recent evidence depicts dopamine circuits as a major site of convergence where metabolic/hormonal and visceral sensory cues interact to regulate eating behavior by way of a “gut-brain dopamine axis.” Food addiction has been associated with binge eating disorder as well as obesity. Given that weight gain following abstinence from drugs is a source of major personal suffering, there is a pressing need for a more detailed understanding of the effects of drug addiction on dietary intake.

Disordered Eating

Drug abuse is a risk factor for eating disorders and has been shown to have both genetic and environmental influences. Even a remote history of SUD can negatively impact weight loss in adults and adolescents. Sobriety time has been positively associated with increased sugar use. Substance abuse linked to low distress tolerance can lead to excessive consumption of food. In one study, nearly 40 percent of women in SUD treatment met criteria for an eating disorder most commonly binge eating disorder followed by bulimia nervosa. Men in SUD treatment reported bingeing and the use of food to satisfy drug cravings during the first six months, with weight concerns and distress about efforts to lose weight during months 7 through 36.

Nearly 40 percent of women in SUD treatment met criteria for an eating disorder most commonly binge eating disorder followed by bulimia nervosa. Men in SUD treatment reported bingeing and the use of food to satisfy drug cravings during the first six months…-David A. Wiss

Addiction and Physical Health

The most substantial health burden arising from addiction lies not in the direct effects of intoxication but in the secondary effects on physical health. There is strong evidence to support that food and drugs are competing for overlapping reward mechanisms. When the immediate crisis of substance abuse has been resolved, there is a likely compensatory increased drive for food intake to achieve weight recovery and a likely overshoot, leading to increased adiposity.

Ravenous food consumption may be due to “rebound appetite” in the wake of the hypothalamic suppression from drug use. Making healthful food choices after abstinence has been achieved may be very challenging. Sobriety is associated with new emotions, anxiety, and uncertainty. It is easy to seek a predictable and comforting response from food. This may lead to overeating, relapse, compromised quality of life, and the development of chronic disease. Caffeine and nicotine abuse should also be addressed since they are highly addictive substances that can perpetuate substance-seeking behavior. Additionally, the impact of stress and adequate sleep should not be ignored, as they too can have profound effects on the endocrine and reward systems.

Given that individuals with a history of SUD are at higher risk for developing food-intake-related dysfunction, there is a substantial need for nutrition interventions in addiction recovery, and registered dietician nutritionists should be vital members of the… team.-David A. Wiss

Given that individuals with a history of SUD are at higher risk for developing food-intake-related dysfunction, there is a substantial need for nutrition interventions in addiction recovery, and registered dietitian nutritionists should be vital members of the treatment team. Currently, there is no requirement for nutrition education and counseling in substance abuse treatment.

Anecdotal reports suggest that most treatment centers allow unlimited or excessive amounts of highly palatable foods to patients. While food restriction can lead to relapse, over-indulgence can perpetuate the cycle of addictive behavior and contribute significantly to healthcare burden. The best intervention appears to lie somewhere in between these extremes, which will require additional clinical expertise in treatment settings. The need for firm commitment to intervention protocols as well as ongoing supervision is warranted for successful program implementation in residential treatment facilities.

A Call to Order for Data Collection

Side Note Picture Preventing over-exposure to highly palatable foods is critical in repairing addictive processes in the brain. From my own experience in clinical practice, utilizing several small feedings throughout the day is an effective approach towards preventing spikes and subsequent drops in insulin, which impacts hunger and mood. The mantra I encourage with my SUD patients is “never hungry, never full” and the evidence reviewed herein provides strong support for this approach. Gradual increases in fiber intake throughout the recovery process can improve gut function, minimize undesirable insulin spikes, and promote satiety.



The current trend towards over-medicating SUD patients while failing to address and improve nutrition behavior should be aggressively challenged. Consider this is a call to order for data collection linking drug addiction to reward-related hormones, specifically demonstrating the importance of medical nutrition therapy in SUD recovery over short periods (1 to 6 months) and longer periods (6 to 36 months). Without this data, it will be difficult to substantiate the need for nutrition interventions in addiction recovery at the policy level. Nutrition interventions during recovery may prevent or minimize the onset of chronic illness, improving resource allocation. Public health measures should be considered critical.

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