Nourishing Recovery: An Interview with Janet McBride on the Role of Nutrition in Addiction Treatment

Janet’s work at Alta Mira starts with individual consultations to begin examining the specific physical needs of each client.

I start with the client’s physical health. As a clinical nutrition therapist, I am looking at their lab values, I’m looking at malnutrition parameters, I’m checking if there’s anything that needs to be done to get their physical body healed, and seeing how nutrition can help.

One particularly common concern amongst recovering addicts is malnutrition, as drug use has disrupted normal physiological function.

Alcohol displaces food and stimulants quell appetite—and depression alone often keeps people from feeding themselves.

Simultaneously, the neurochemistry of addiction itself may work to create cravings for fat, sugar, and salt, taking the place of healthy food and causing serious nutritional imbalances. Even when a healthy diet is implemented, disturbance of gastrointestinal tissues caused by alcohol and drug use may interfere with absorption, keeping a person from getting what he or she needs from meals.

Metabolic problems resulting from malnutrition and malabsorption can also be a major concern in early recovery. “Often a client comes into recovery having altered his or her metabolic rate because of chronic undereating or overstimulating,” Janet tells me. “With alcoholics, for example, they may have been displacing nutrients with alcohol, and even though they get a lot of calories, their body is interpreting it as undereating, so it lowers the metabolic rate.”

With a comprehensive picture of physical health, Janet is able to identify these issues and help you develop the skills you need to stabilize the body physiologically. Not only does this improve somatic well-being and ensure that your body is getting the nourishment it needs to heal, it also encourages psychological stability, as your brain chemistry is allowed to realign into a healthy state.

The purely physical, of course, is only one piece of nutritional therapy. For people in recovery, the relationship with food is often contentious and complicated, and diet can be a significant determinant in the probability of relapse. “I look at their risk of relapse as related to how they’re eating, which means looking at their relationship with food, food access, their belief system, and knowledge of nutrition and healthy eating habits,” Janet says.

Something as simple as not eating breakfast (or not on a regular schedule) increases the risk of relapse, because the body is in disequilibrium and is going to start sending out hunger messages, and the brain and body are not going to be functioning optimally. Hunger messages come from the same part of the brain as active addiction, in the hypothalamus, and they feel like the drive for the drug of choice. So I have to identify patterns of eating that would increase their cravings or increase their drive. These are very hard-wired survival mechanisms.

By educating clients about the relationship between nutrition, eating behavior, and cravings, and creating concrete solutions for restoring balance, Janet guides clients toward increased self-awareness and a sense of control over their own recovery.

In addition to identifying malnutrition or the risk of malnutrition, another important component of Janet’s practice is assessing clients for “disordered” eating and preventing cross-addiction. People with a history of eating disorders need specialized supports during treatment to address their relationship with food, both practically and psychologically. However, even people who do not come into treatment with an active eating disorder are at heightened risk for developing disordered eating behaviors while in treatment. Janet explains:

I have to look at the potential for cross-addiction because when we give up one addiction, our brain immediately wants to cross over to another one. With food, it’s extremely easy to do that because food stimulates dopamine and serotonin production, which are often what people are trying to self-medicate with in addiction.

In these cases, Janet can teach clients how to manage their carb and protein intake to promote serotonin and dopamine release in healthy ways that nurture physiological and somatic stability.

Cross-addiction is often also a way for clients to exercise control, particularly in a residential treatment environment where you haven given up some measure of autonomy. “That is often something we look for in the eating disorder assessment—the need to have control,” Janet says. Nutritional therapy presents critical opportunities for using that desire for control in healing ways. Control, after all, does not have to necessarily manifest in disordered eating. Rather, the knowledge and self-awareness gained through nutritional counseling, often in conjunction with psychotherapy, can spur a sense of healthy empowerment as you learn to nurture yourself and modulate your recovery process. “I’m assessing and supporting the client to deconstruct old ways of thinking and old belief systems about food and the body, while constructing new, healthier, thinking habits and beliefs.”