Position of the American Dietetic Association: nutrition intervention in treatment and recovery from chemical dependency.

Position of The American Dietetic Association: Nutrition intervention in treatment and recovery from chemical dependency (1) The registered dietitian is an essential member of the treatment team for assessment and rehabilitation of nutrition needs in the recovery from chemical dependency. Improved nutritional status can improve the efficacy of treatment. Nutrition professionals should take aggressive action to ensure involvement in treatment and recovery programs.

Position statement

It is the position of The American Dietetic Association that nutrition intervention, planned and provided by a qualified nutrition professional, is an essential component of the treatment and recovery from chemical dependency.

The severity of malnutrition and the need for nutrition therapy in addiction vary. Mind-altering substances or social drugs (e.g., alcohol) are toxic to the body, causing physical adaptations, damage, and malnutrition [1,2]. More is known about alcoholism and its effect on nutritional status than about any other addictive drug, but similar impairments in eating behaviors and nutritional status seem to develop with all drug dependencies [3-5].

Because intervention techniques now seek to bring addicts into treatment earlier in the disease, individuals entering treatment today may demonstrate physical consequences less severe than those seen among classic end-stage alcoholics suffering from liver disease and neuropathy. However, references are consistent regarding the numerous effects and severity of nutrient deficiencies as alcoholism progresses [6,7]. Appetite and food intake have been impaired, perhaps to the point of causing nutrient deficiencies and clinical malnutrition. Abuse of drugs accelerates nutrition needs beyond normal, so that even a well-balanced diet may be inadequate. Nutritional problems are also caused by an increased nutrient requirement to detoxify and metabolize drugs, inactivation of vitamins and coenzymes needed to metabolize energy, inadequate nutrient storage in the damaged liver, malabsorption, poor utilization of nutrients, breakdown of muscles and organs, and increased losses of nutrients through diuresis and diarrhea [8,9].

Nutrition care is defined to include (a) an evaluation of the addict's nutritional status at detoxification, (b) supervision of nutritional rehabilitation through delivery of palatable, nourishing meals and supplements that encourage normal eating patterns, and (c) provision of nutrition education and counseling to help the addict and significant others develop an eating plan supportive of stable recovery. Such education seeks to integrate a healthy eating pattern with other new living skills and to discuss the ramifications of and alternatives to substance substitution.

Chemical dependence is a bio-psycho-social disease (Figure 1). Nutrition care in addiction treatment is practiced in a team environment that addresses patient needs in a comprehensive manner [10]. Along with other medical professionals and therapists, the registered dietitian should participate in developing patient care plans [9]. Observations of …