Substance use recovery and diet

Recovery from substance use also affects the body in different ways, including metabolism (processing energy), organ function, and mental well-being.

The impact of different drugs on nutrition is described below.

OPIATES AND OPIOIDS

Opiates and opioids (including codeine, oxycodone, heroin, morphine, and fentanyl) affect the gastrointestinal system. Constipation is a very common symptom of substance use. Symptoms that are common during withdrawal include:

• Diarrhea
• Nausea and vomiting

These symptoms may lead to a lack of enough nutrients and an imbalance of electrolytes (such as sodium, potassium, and chloride).

Eating balanced meals may make these symptoms less severe (however, eating can be difficult, due to nausea). A high-fiber diet with plenty of complex carbohydrates (such as whole grains, vegetables, peas, and beans) is recommended.

ALCOHOL

Alcohol use is one of the major causes of nutritional deficiency in the United States. The most common deficiencies are of the B vitamins (B1, B6, and folic acid). A lack of these nutrients causes anemia and nervous system (neurologic) problems. For example, a disease called Wernicke-Korsakoff syndrome ("wet brain") occurs when heavy alcohol use causes a lack of vitamin B1.

Alcohol use also damages two major organs involved in metabolism and nutrition: the liver and the pancreas. The liver removes toxins from harmful substances. The pancreas regulates blood sugar and the absorption of fat. Damage to these two organs results in an imbalance of fluids, calories, protein, and electrolytes.

Other complications include:

• Diabetes
• High blood pressure
• Permanent liver damage (or cirrhosis)
• Seizures
• Severe malnutrition
• Shortened life expectancy

A woman's poor diet when pregnant, especially if she drinks alcohol, can harm the baby's growth and development in the womb. Infants who were exposed to alcohol while in the womb often have physical and mental problems. The alcohol affects the growing baby by crossing the placenta. After birth, the baby may have withdrawal symptoms.

Laboratory tests for protein, iron, and electrolytes may be needed to determine if there is liver disease in addition to the alcohol problem. Women who drink heavily are at high risk of osteoporosis and may need to take calcium supplements.

STIMULANTS

Stimulant use (such as crack, cocaine, and methamphetamine) reduces appetite and leads to weight loss and poor nutrition. Users of these drugs may stay up for days at a time. They may be dehydrated and have electrolyte imbalances during these episodes. Returning to a normal diet can be hard if a person has lost a lot of weight.

Memory problems, which may be permanent, are a complication of long-term stimulant use.

MARIJUANA

Marijuana can increase appetite. Some long-term users may be overweight and need to cut back on fat, sugar, and total calories.

NUTRITION AND PSYCHOLOGICAL ASPECTS OF SUBSTANCE USE

When a person feels better, they are less likely to start using alcohol and drugs again. Because balanced nutrition helps improve mood and health, it is important to encourage a healthy diet in a person recovering from alcohol and other drug problems.

But someone who has just given up an important source of pleasure may not be ready to make other drastic lifestyle changes. So, it is more important that the person avoid returning to substance use than sticking with a strict diet.

GUIDELINES

• Stick to regular mealtimes.
• Eat foods that are low in fat.
• Get more protein, complex carbohydrates, and dietary fiber.
• Vitamin and mineral supplements may be helpful during recovery (this may include B-complex, zinc, and vitamins A and C).

A person with substance use is more likely to relapse when they have poor eating habits. This is why regular meals are important. Drug and alcohol addiction causes a person to forget what it is like to be hungry, and instead think of this feeling as a drug craving. The person should be encouraged to think that they may be hungry when cravings become strong.

During recovery from substance use, dehydration is common. It is important to get enough fluids during and in between meals. Appetite usually returns during recovery. A person in recovery is often more likely to overeat, particularly if they were taking stimulants. It is important to eat healthy meals and snacks and avoid high-calorie foods with low nutrition, such as sweets.

The following tips can help improve the odds of a lasting and healthy recovery:

• Eat nutritious meals and snacks.
• Get physical activity and enough rest.
• Reduce caffeine and stop smoking, if possible.
• Seek help from counselors or support groups on a regular basis.
• Take vitamin and mineral supplements if recommended by the health care provider.

Substance use recovery and diet; Nutrition and substance use

Kowalchuk A, Reed BC. Substance use disorders. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 50.

Weiss RD. Liebschutz JM. Drug use disorders. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 365.

Wiss DA. The role of nutrition in addiction recovery: what we know and what we don't. In: Danovitch I, Mooney LJ, eds. Assessment and Treatment of Addiction, The. Philadelphia, PA: Elsevier; 2019:chap 2.

Updated by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.