Substance use disorders (SUD) can lead to many adverse health effects including nutritional deficiencies and malnutrition.
Research shows that proper nutrition can have a positive effect on recovery outcomes, however it is not common practice for patients in substance abuse treatment to receive nutrition education and counseling.
Clients in early recovery tend to gain excessive weight only to become self-conscious and unhappy with their appearance, which may lead to anxiety and depression. Wiss (2013) found that SUD patients have more difficulty
controlling their eating when depressed. These experiences may cause significant distress and put individuals at risk of relapse (Cowen & Devine, 2012). Registered Dietitian Nutritionists (RDNs) should play a vital role in offering recovery services to drug addicts and alcoholics.
…SUD patients have more difficulty controlling their eating when depressed. These experiences may cause significant distress and put individuals at risk of relapse.-David Wiss, Kristie Moore
Cowen & Devine (2012) evaluated the implementation of a controlled, 6-week environmental and educational intervention called REHALTH (The Recovery Health Eating and Active Learning in Treatment Houses).The program was created to promote healthful changes in eating habits and to reduce excess weight gain of men in substance abuse treatment. A total of 107 men from 6 different SUD treatment facilities were invited to participate in this program.
The REHALTH program supported changes in the food environment of the treatment centers, offering healthier food choices as well as weekly nutrition and cooking classes. In sites where there was a higher participation rate from residents (in addition to support from staff) there was a significant decrease in total energy intake, as well as a reduction in daily servings of sweets, fats and oils, and lower BMIs. The findings from this study suggest that nutrition interventions can greatly contribute to positive behavior changes within this population.
Barriers to Healthy Eating
Nutrition and cooking interventions in SUD treatment facilities are quite scarce, as there is limited research specific to the SUD population.
Although not pertaining directly to individuals with addiction issues, research has found that barriers to healthy eating include a lack of confidence in one’s ability to shop for, choose, and prepare healthy foods (Reicks, 2014; Winkler and Turrel, 2009). The inability to prepare food for oneself may lead to a poor quality diet by increasing the intake of highly processed convenient foods (Reicks, 2014).
In a cross-sectional study by Winkler & Turrel (2009), it was found that fewer vegetables and raw produce were purchased by individuals who were less confident in their food preparation skills, compared to those with a higher confidence level.
Nutrition and culinary interventions that provide hands-on cooking instruction can offer cooking, shopping and food preparation skills, in addition to nutrition education. Acquiring these skills can increase the individual’s self-confidence in shopping for and preparing healthful foods, which would thereby decrease the intake of processed, convenience foods. Offering these health-promoting programs can increase the success rate for long-term recovery while reducing the person’s risk of becoming overweight or obese and decreasing the risk of chronic disease (Barbadoro et al., 2010; Cowan, 2008 & 2013).
Findings support the assertion that receiving nutrition education in a drug and alcohol rehabilitation environment can positively impact food choices and eating habits.– David Wiss, Kristie MooreA study by Barbadoro et al. (2011) investigated the impact of a nutrition education intervention on the nutritional knowledge and behaviors of 58 alcohol dependent participants in an inpatient treatment facility in Italy. The authors found a positive correlation between the nutrition intervention and the participants’ knowledge of the relationships among nutrition, food, and health, stating that: “Alcohol dependent individuals are receptive to educational messages regarding nutritional health.”
During a 6-month follow-up interview, 80% of the 45 participants who responded reported that they continued to practice the skills they obtained during the intervention. Findings support the assertion that receiving nutrition education in a drug and alcohol rehabilitation environment can positively impact food choices and eating habits.
It is especially important to begin the education process early in recovery to emphasize the importance of choosing nutritious foods, as well as the role that food plays in chronic diseases such as obesity and diabetes (Barbadoro et al., 2010; Cowan & Devine, 2013). This message will be critical as the client transitions to a lower level of care where they will be responsible for preparing their own meals and practicing self-care.
Hands-on Culinary Intervention
Our research project was conducted implementing a hands-on culinary and nutrition intervention at Breathe Life Healing Centers in Los Angeles, California. The 12-week study consisted of 4 separate groups, each lasting 3 weeks, with a total of 15 participants.
…participation in “hands-on” cooking classes led to improved attitudes, behaviors, and knowledge towards cooking and nutrition, compared to interventions in which participants observed a cooking demonstration or listened to a lecture.– David Wiss, Kristie MooreThe information offered during this intervention was intended to provide individuals in early recovery with the skills and confidence they need to make healthy food choices, as they begin to make the transition to more independent stages of treatment. The intervention included a grocery store tour and weekly nutrition education classes followed by a hands-on culinary component.
Data revealed a significant increase in the participants’ enjoyment of cooking after completion of the cooking classes. When asked during the program evaluation what part of the program they liked best, Grocery Store Tour, Nutrition Education, or Hands-on Cooking, 13 of the 15 participants chose “Hands–on Cooking.” Confidence level in relation to food preparation skills as well as a higher level of comfort in purchasing whole grain products also significantly increased. This finding is in accordance with previous research that has found that interventions containing both a nutrition education component and a “hands–on” cooking element increased the participants’ cooking confidence and skill level (Wrieden et al., 2006).
Research by Levy & Auld (2004) shows similar results, where participation in “hands-on” cooking classes led to improved attitudes, behaviors, and knowledge towards cooking and nutrition, compared to interventions in which participants observed a cooking demonstration or listened to a lecture.
Developing the skills and confidence to prepare healthful meals during SUD treatment is important for sustainable recovery.
Proper nutrition can help the body heal from years of damage, as well as decrease depression, anxiety, obesity, and other chronic diseases. Although the data analysis for this study found limited statistical significance in other areas, there was a positive trend found in the mean averages between the pre- and post-intervention data.
Self-efficacy and positive attitudes about cooking, purchasing, and preparing healthy foods increased after the nutrition and “hands-on” culinary intervention. Future studies utilizing a larger, more diverse sample are definitely needed to increase awareness of the important role that nutrition plays in recovery from substance abuse (Moore, 2015).
Expand for References
Barbadoro, P., Ponzio, E., Pertosa, M. E., Aliotta, F., D’Errico, M. M., Prospero, E., &
Minelli, A. (2011). The effects of educational intervention on nutritional behaviour in alcohol-dependent patients. Alcohol and Alcoholism (Oxford, Oxfordshire), 46(1), 77–9. doi:10.1093/alcalc/agq075Cowan, J., Devine, C. (2011). Diet and body composition outcomes of an environmental and educational intervention among men in treatment for substance addiction. J Nutr Educ Behav., 45(2), 154–158. doi:10.1016/j.jneb.2011.10.011.DIET
Cowan, J., & Devine, C. (2008). Food, eating, and weight concerns of men in recovery from substance addiction. Appetite, 50(1), 33–42. doi:10.1016/j.app
Levy, J., and Auld, G. (2004). Cooking Classes Outperform Cooking Demonstrations for College Sophomores. J Nutr Educ Behav., 36, 1997–203.
Moore, K. (2015). Hands–on Cooking and Culinary Intervention within a Substance
Abuse Treatment Center (Thesis Project).
Reicks, M., Trofholz, A. C., & Stang, J. S. (2014). Impact of cooking and home food
preparation interventions among adults”: outcomes and implications for future programs. Journal of Nutrition Education and Behavior, 46(4), 259
Winkler, E., & Turrell, G. (2010). Confidence to Cook Vegetables and the Buying. YJADA, 110(5), S52–S61. doi:10.1016/j.jada.2010.03.00710.1007/s
Wiss, D. A. (2013). Nutrition and substance abuse (Master’s thesis). Retrieved from http://hdl.handle.net/10211.2/3444
Wrieden, W. L., Anderson, A. S., Longbottom, P. J., Valentine, K., Stead, M., Caraher,
M., Lang, T., Gray, B., Dowler, E. (2007). The impact of a community-based food skills intervention on cooking confidence, food preparation methods and dietary choices – an exploratory trial. Public Health Nutrition, 10(2), 203–11. doi:10.1017/S1368980007246658
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