Substance use (and abuse) and poor nutrition don’t necessarily go hand in hand, but they are often connected. You need to eat well to feel well.
Take substance use disorder, also known as substance use disorder (SUD). When all people care about is feeding an addiction, they don’t usually make good nutrition choices. Once in rehab, that nutritional deficit needs to be corrected but too often is not.
People with substance use disorders are also more likely to have an eating disorder, which can lead to nutritional problems and other health issues.
How Nutrients Affect the Body
Nutrients aren’t just food or calories. They are a range of vitamins, minerals, and other elements necessary for good health. For the best health, there must be a balance.
People on diets need to make sure their reduced consumption contains enough essential nutrients for them to become and remain healthy.
There are two basic kinds of nutrients:
- Macronutrients are nutrients that the body needs in large amounts, such as proteins, fats, and carbohydrates. One of their main purposes is to provide energy.
- Micronutrients aren’t small nutrients; they are nutrients the body needs in smaller amounts. Nevertheless, they are in some ways more important. They include vitamins and minerals necessary to build bones; grow and regenerate organ tissues; produce blood and allow it to clot; and keep hair, skin, eyes, and the digestive system healthy.
Some vitamins are fat-soluble, so the body stores them. Others are water-soluble and so must be consumed throughout the day.
How Substance Use Disorder Disrupts Nutrition
The use, misuse, and abuse of alcoholic beverages, prescription medicines, illicit drugs, and other substances may create many health risks, of which the most obvious and reported are addiction—the need to continue using the substance to function or avoid withdrawal—and a possibly fatal overdose.
Another, less obvious or reported risk is malnutrition from micronutrient deficiencies. Food is the body’s fuel. What kind of food individuals decide to put in their bodies can affect performance, and people with substance use disorders don’t usually make the best decisions.
Alcohol dependency, for example, can lead to serious nutritional deficiencies that magnify the effects of addiction and prevent the brain from functioning optimally,
Dopamine-triggering, highly-processed foods (containing sugar, refined carbohydrates, and vegetable oils) taste great and also activate the brain’s pleasure rewards centers just like cocaine and heroin. At the same time, most of the nutritional value has been removed from these foods.
When individuals abuse alcohol and drugs, they:
- Eat less or choose less nutritious foods.
- Use up energy more quickly.
- Lose nutrients through vomiting and diarrhea.
- Can’t properly absorb nutrients because of damage to their gut.
- Feel irritable and anxious because they aren’t producing enough brain chemicals (neurotransmitters).
- Feel paranoid, tired, dissatisfied, or depressed because of stress.
Different drugs can cause deficits in different types of essential vitamins, minerals, and nutrients:
- Alcohol can lead to deficiencies of thiamine (vitamin B1) and other B vitamins.
- Opioids can cause severe constipation, which may lead to vitamin D deficiency.
- Other drugs can cause diarrhea, resulting in dehydration and affecting the absorption of electrolytes, vitamins, and nutrients.
Alcohol and drug use can also affect levels of other important micronutrients, including omega-3 fatty acids, folic acid or folates, zinc, choline, iron, copper, selenium, magnesium, calcium, and iodine.
When malnutrition occurs, there is also a danger in correcting it too quickly. This can lead to refeeding syndrome, when the reintroduction of nutrients prompts the body to readjust.
Refeeding syndrome can produce a shock to the system that can be fatal. Possible complications of this condition include respiratory failure, coma, paralysis, cardiac arrhythmia, convulsions, and seizures.
Co-Occurrence of Substance Use Disorder and Eating Disorders
Sometimes it’s not just about eating bad food. As many as 35% of individuals who are dependent on or otherwise abusing illicit drugs and alcohol—11 times the rate of the overall population—also have an eating disorder.
The reverse is true, too. Up to 50% of individuals with eating disorders also used or abused illicit drugs and alcohol, five times the rate of the population at large.
What Is an Eating Disorder?
An eating disorder is any unhealthy preoccupation with food. It is not just a compulsion to eat—that is an eating behavior—though eating disorders may include a compulsion to eat. Many eating disorders look similar to an extreme or picky diet or compulsive eating but are types of mental health issues.
The most common eating disorders include:
- Anorexia nervosa. When people have anorexia, they eat very little because they are terrified that they might gain weight. They think they are fat even if they look unhealthily skinny (hence “anorexic”). They may fast, use drugs, or exercise excessively.
- Binge eating disorder (BED). The opposite condition is BED: binging, the uncontrolled consumption of food in large amounts, even when not hungry. This may cause guilt and weight gain, sometimes severe.
- Bulimia. Similar to BED, bulimia causes binging but is often followed by purging: the use of laxatives, diuretics, emetics, or just a finger down the throat to eliminate most of the food before it is digested. They may also eat faster than most people or in secret. People with bulimia may be skinny, fat, or in-between.
- Avoidant/restrictive food intake disorder (ARFID). People with ARFID don’t eat much, but they are not anorexic. Instead of being afraid of gaining weight, they just don’t like and won’t eat many foods or are afraid of vomiting or choking.
Eating Disorders and Substance Use Disorder
People with eating disorders often experience other mental health disorders, such as substance use disorders (SUD), at the same time. This is known as a co-occurring disorder or a dual diagnosis.
If both conditions are not treated, preferably at the same time, they may continue or recur. The problem is that while both disorders may be connected, they aren’t always obvious.
Sometimes people with eating disorders who abuse drugs do so to help them lose weight or to cope with whatever pain the eating disorder was also meant to address: depression, anxiety, feeling unloved or isolated. The substances they most frequently abuse include:
- Heroin and other opioids
- Stimulants, including amphetamines and cocaine
There is a fourth class of substances that people with eating disorders abuse: diuretics, laxatives, and emetics. These are drugs that can make you urinate, defecate, and regurgitate. They have legitimate medical treatment purposes (constipation, poisoning) but are misused for weight loss, especially by people with eating disorders.
How Eating Disorders Affect the Body
While many of the harms caused by substance use disorders (SUDs) are obvious, eating disorders can be more subtle but just as deadly. An imbalance of electrolytes alone could cause stroke, heart attack, multiorgan failure, and brain damage.
Physical effects of eating disorders can include:
- With anorexia nervosa, low body weight and blood pressure, weak bones, irregular heartbeat, and dizziness or fainting.
- With binge eating, diabetes, high blood pressure, elevated cholesterol and triglyceride levels, fatty liver, and sleep apnea.
- With bulimia, low blood pressure, fewer electrolytes, irregular heartbeat, dizziness or fainting, and damage to the teeth and mouth.
- With ARFID, severe malnutrition, low weight, poor growth, and the possibility that people with the condition will need a feeding tube.
In addition to physical effects, eating disorders may cause psychological effects, including:
- Low self-esteem
- Obsessive compulsive disorder (OCD)
- Autism spectrum disorder
- Attention deficit hyperactivity disorder (ADHD)
- Thoughts of self-harm
- Difficulty handling anger or other strong emotions
The Role of Nutrition During Rehab
Rehab from substance use disorders (SUDs) typically includes abstinence and detoxification from the substance of abuse, behavioral therapy, a peer support group such as a 12-step program, and an aftercare plan to continue recovery for life. Even that may not be enough, however.
Many addiction specialists now believe that without guidance on proper nutrition and diet, what and how to eat during recovery and beyond, individuals in recovery are more likely to relapse.
With or without an eating disorder, by itself, SUD can cause nutritional deficiencies that contribute to a wide array of physical and psychological health problems, making individuals more susceptible to infection, illness, and despair.
Recovery from substance use disorder requires healing, changing behaviors, making better choices. A balanced diet is part of the process.
Whether clients with SUD also have a co-occurring eating disorder, proper nutrition during and after rehab is essential to long-lasting recovery. This is most important in the first year of recovery because the brain may confuse cravings for substances with cravings for food, making it harder to resist the substances and achieve complete recovery.
Nutrition tips for recovery and for life include:
- Avoid fast food. If you don’t, can’t, or won’t cook, skip the deep-fried options and stick to salads, grilled chicken, and smoothies.
- Eat whole foods. It’s harder for the liver to break down artificial or processed foods.
- Limit or eliminate sugars. Alcohol contains sugar, so one might trigger a craving for the other.
- Restrict caffeine. It can temporarily spike sugar levels. The eventual crash can trigger the desire for alcohol.
- Stay away from common allergens. Cutting wheat and dairy can eliminate alcohol cravings.
Boosting Recovery with a Healthy Diet
Rather than expecting individuals in recovery from substance use disorder to plan meals themselves, rehab centers may provide them with meals planned by a registered dietician nutritionist (RDN) or give them easy access to do-it-yourself healthy meal plans. (Here’s a suggested sample meal.)
A diet for recovery should include calories from:
- Complex carbohydrates such as whole grains, fruits, and vegetables (50% to 55%)
- Calcium-rich foods such as dairy products, tofu, and kale, two to three cups daily (5%)
- Proteins (meat, fish, tofu), two to four ounces, twice a day (15% to 20%)
- Good fats such as canola, olive, flaxseed, and fish oil (30%)
- Healthy diets also should contain:
- Fiber: bran and oat cereals or muffins, legumes
- Antioxidants: dark chocolate, pecans, berries, beets, artichokes, red cabbage, and spinach
- Prebiotics: apples, asparagus, bananas, garlic, leeks, and onions
- Amino acids: tryptophan, tyrosine, L-glutamine
- GABA-boosters: kefir (a fermented yogurt-like drink), shrimp, and cherry tomatoes
You can’t eat your way out of mental health issues such as substance use disorder and eating disorders, but proper nutrition is an important part of recovery.
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Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.
Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.