Why Do Rehabs Neglect Good Nutrition?

By John Lavitt 09/21/16

Dietary habits in early recovery can be the difference between staying clean and relapsing.

Why Do Rehabs Neglect Good Nutrition In Early Recovery?
David Wiss knows the importance of nutrition. Stewart Baxter

As the opioid epidemic combined with a rise in illegal drug abuse spreads across the country, effective substance abuse treatment services and inpatient recovery options are needed more than ever before. Since the Affordable Care Act has made these services mandatory coverage, a much sharper lens has been focused on what is being offered and its success rate. As the founder of Nutrition In Recovery, David Wiss, MS, RDN, does not understand why the critical role of good nutrition in early recovery is being largely ignored by rehabs and sober living facilities. In long-term recovery himself, David intimately knows how challenging the struggle to restore personal health can be after the damage done by addiction. 

Whether a client resides in a low-cost, no frills sober living home or a fancy, ultra-expensive Malibu rehab, it is highly doubtful that their nutritional needs are being addressed. Given the fragile nature of early sobriety as the body slowly begins to recover from a toxic state of chemical abuse, good nutrition can play an essential role in keeping someone in early recovery on the right track. Why wouldn’t recovery professionals want to give their clients this added support in their battle to achieve sustainable sobriety? Yet, time and time again, David sees this pivotal element of biological recovery being ignored. At one clinic, David had to change the name of his group from "Nutrition In Recovery" to "Self-Care in Recovery" because the insurance company rejected nutrition as an acceptable modality of treatment. 

As David explains, "We live in tricky nutritional times. I do not have all of the answers. What I do know is that we can use nutrition for empowerment, rather than disempowerment. We can teach people in early recovery how to eat for nourishment rather than simply for 'reward' (stimulating dopamine activity). This practice can slowly rewire the brain, change the palate, and prepare the individual for a lifetime of wellness. Treatment outcomes should be much higher than they are, thus we need to address the biological aspects of addiction. This includes brain chemistry, hormones, and gut bacteria—all of which are profoundly impacted by what we eat. Sitting around all day in talk therapy groups with zero focus on nutrition is a major injustice to clients. The neurobiology of addiction demands more attention and action.” 

Instead of promoting a lifetime of wellness that begins in early recovery, most rehabs and sober livings simply give their clients practically whatever they want to eat within their food budget. Although the reasons behind such indulgence are profoundly different when you compare a low-end sober house to a high-end rehab, the results are essentially the same. Clients end up wanting the sugar high that mirrors the feelings of their past addictions—the dopamine rush—as opposed to embracing the good nutrition that can help save their lives. This frequently looks like consuming several energy drinks and sweetened coffee beverages per day. 

The problem is that clients in early recovery often have a compromised gut function combined with a strong preference for foods that are highly rewarding to the brain. The gut function has been revealed in recent years to be a primary component in overall health. If your gut microbes are working well, you feel well. If they are not, there is a vague sense of apathy, low energy and sickness. In one study of alcoholics in recovery, those with gut leakiness had higher scores of depression, anxiety, and craving. 

Other research has shown that inflammation in the gut can reach the brain, including the amygdala, which governs emotional reactions. This can prove to be trouble when compounded with the common problem of gut dysbiosis for clients in early recovery. Dysbiosis is a term for a microbial imbalance or maladaptation on or inside the body, such as the gut function. Gut dysbiosis from substance abuse can be long-lasting after abstinence has been achieved, thus dietary habits in early recovery can make or break success with sobriety. 

Rather than eat food that promotes the recovery of the gut function, people in early recovery are desperate to find a replacement for the best friend that they have lost—the drugs that have been making them feel good for countless years. They typically want food that stimulates the dopamine function in the brain, giving them the addiction-like sense of an immediate reward. Such foods are typically low in fiber while being high in added sugars, salt, saturated fats, and artificial additives. Mostly these foods are designed for convenience such as frozen foods (pizza), snack foods (chips), or sugary cereals, all of which have extended shelf lives and are relatively cheap. 

David points out that, "It is important to keep blood sugar stable by consuming slow acting carbohydrates such as oats, quinoa, and yams and avoiding fast acting carbohydrates such as white flour and sweetened beverages." Unfortunately, it is rare to find such items on the shopping lists of the vast majority of sober livings and even many high-end rehabs. As for the fast acting carbohydrates and sweetened beverages, they are destructive dietary staples of many such places.

David Wiss at the International Conference for Eating Disorders (Photo by David Wiss)

When given the choice between health-promoting recovery meals and highly palatable snack foods, snack foods will almost always win from the perspective of a client who is already feeling the loss of his or her drug of choice. People in early recovery are often unable to make healthy choices or advocate for themselves, and this is why rehabs and sober living facilities need to actively promote good nutrition. As David explains, the problem is that "addiction treatment is primarily a for-profit industry. The best way to generate profits is by keeping costs down. Unfortunately, when food costs are kept down, quality of recovery will suffer. When the operation becomes all about making money, nutrition takes the back seat."

When it comes to the money equation and finding the finances to promote good nutrition, it is a much bigger problem in sober living facilities and low-end to middle-of-the-road treatment centers that lack capital and resources. In Los Angeles alone, it is estimated that there are more than 2,000 sober living homes currently in operation. The managers of these facilities live on site and are usually young adults in their twenties with only a few years sober themselves and very little training in nutrition. Often competent, but overwhelmed on the whole, such managers are forced to juggle a number of different tasks and responsibilities, including purchasing food in bulk for the house. As a result, highly processed foods from Costco and Cash & Carry, like frozen dinners and microwavable canned meals, are the typical fare. Such low nutritional meal options are combined with chips, sodas, pop tarts, ice cream and the like. Since the clients love the sugar rush and the dopamine high of the low-nutritional offerings, they are given what they want. Adding to the compromised nutrition, clients sometimes eat the majority of their food after dark, often indulging in junk food all through the night.

Explaining his personal experience with this sober living model of poor nutrition and the difficulty of changing it, David Wiss tells a fascinating story that is both sad and not terribly surprising:

"I once ran a nutrition group in an outpatient clinic that was connected to a sober living. The clients were very excited about learning how to eat well, start cooking, and reclaim their health. Unfortunately, the sober living was not willing to buy any of the food I recommended. Rather, they bought frozen foods in bulk and other forms of inexpensive food that was high in calories and low in nutrients. Eventually, the staff rejected the information I was conveying to the clients. They told me that what I was teaching the clients could not be put into practice, such as eating fresh vegetables, whole grains, fish, beans, nuts, and seeds. It was too expensive. In the end, the group was discontinued because the clients were putting too much pressure on the sober living staff to buy different foods that were outside of their budget and standard grocery list."

Is it surprising that the recovery rate is so low? Given the low quality of the food, clients in residential addiction treatment often end up gaining excessive weight. The sugary junk food becomes a kind of replacement addiction that comforts them in the wrong way. The added weight can lead to body dissatisfaction and anger, directly resulting in relapse or the development of eating disorders. David Wiss has seen too many clients in residential treatment become bulimic or relapse as a response to this problem. 

What proves to be so frustrating from the perspective of a nutritional expert like David is that it’s not the fault of the clients. Being in early recovery, they are incredibly vulnerable and impulsive. Given the history of their addictive behavior, they often lack life skills in the kitchen and will tend to choose convenience over nutrition. Since the majority have had zero nutritional education, they often believe they are making reasonable choices. Since they don’t recognize the problem, they are unable to fix it. An added problem is that many clients smoke cigarettes. Smokers tend to require more salt and flavor on food. Without question, Wiss firmly believes that smoking is one more added barrier to nutrition interventions that include eating more fruits and vegetables. But, first things first.

Although the bad nutrition running rampant in sober livings and low-cost treatment centers is not terribly surprising, it is disheartening. Everyone in substance abuse treatment should be given the best possible chance to recover. In light of such a perspective, wouldn’t you think that high-end rehabs would be different? Given the tens to even hundreds of thousands being paid by clients for the very best that Malibu and Newport Beach have to offer, shouldn’t they be assured of good nutrition to help them foster long-term recovery? Unfortunately, this is not always the case.

Did you know that most high-end rehabs have a gourmet chef on staff? Well-paid with a background in restaurant culture, many rehab chefs are trained to please their customers. They will create delicious food to generate positive feedback. Such foods tend to be heavily seasoned and sauced, designed in a different way to trigger the dopamine response and the reward centers of clients in early recovery. In many cases, the chefs are told to give the clients what they want. Rather than promoting good nutrition, they are more concerned with receiving good reviews from the clients.

High-end rehab clients can be entitled and demanding. They are used to living in luxury and believe that the staff, including the chefs and anyone taking them out of the facility and on the town, is there to cater to their eating patterns. Rather than educating the clients about nutritional needs and the restoration of their compromised gut function, many of these rehabs will give their clients whatever they want.

Having experienced this firsthand while trying to provide his services to such clients, David shakes his head and says, “There is something odd about a 22-year old heroin addict who has been lying and stealing coming into a luxury treatment facility with a personal driver and personal chef. A culture of entitlement does not promote quality recovery. Rather than getting what they want when they want it, these young people should learn new life skills to prepare them for reintegration. They need to learn and experience firsthand how much basic nutrition can support their recovery.”

As a major advocate for the role of nutrition in recovery from addiction, mental health problems and eating disorders, David often feels like he’s fighting a losing battle. When it comes to the substance abuse treatment industry, he has hit walls all the way from cut-rate downtown L.A. sober living facilities to high-end Malibu treatment centers. Given his experience, he wishes such a negative trend would change.

Expressing his frustration, David says, “Food is a secret tool of oppression in our society. The best way to keep people down is to feed them low quality food. Low quality foods lead to decreased quality of life. I know as a nutritionist that we have the tools and the knowledge today to prevent this from happening. We can improve the long-term recovery chances of clients if we address this issue and promote good nutrition. We have the capabilities to help clients in early recovery begin to live full, rich, and healthful lives."

Living rich and healthful lives sounds great, but how can this actually be accomplished?  

David explains, "There should be cooking classes at every sober living and treatment center. If clients want to eat pizza and burgers, they should learn how to make it in the kitchen. Clients should learn how to grocery shop and plan ahead. Energy drinks should not be purchased or allowed by these facilities. Instead, clients should be encouraged to include a fruit or vegetable at every meal or snack. Nutrition should never be punitive. It should be framed as a helpful component of recovery. Eating represents our most profound interaction with nature on a daily basis. For some, eating plants can represent a deep and effective spiritual experience. Never underestimate the healing power of food!" 

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Growing up in Manhattan as a stutterer, John Lavitt discovered that writing was the best way to express himself when the words would not come. After graduating with honors from Brown University, he lived on the Greek island of Patmos, studying with his mentor, the late American poet Robert Lax. As a writer, John’s published work includes three articles in Chicken Soup For The Soul volumes and poems in multiple poetry journals and compilations. Active in recovery, John has been the Treatment Professional News Editor for The Fix. Since 2015, he has published over 500 articles on the addiction and recovery news website. Today, he lives in Los Angeles with his beautiful wife, trying his best to be happy and creative. Find John on Facebook, Twitter, and LinkedIn.