Substance abuse harms the body in two distinct ways: via the effect of the substance itself and via negative lifestyle changes, such as irregular eating habits and poor dietary intake. For example, infants who were exposed to alcohol while in the womb often have physical defects and mental disabilities. In this case, the growing fetus has deficits both directly caused by the substance crossing the placenta and indirectly due to inadequate nutrition of the mother while she was drinking.

Recovery from substance abuse results in additional demands on the body -- including metabolism (processing energy), organ function, and mental well being. Proper nutrition may help the healing process. Nutrients supply the body with energy and substances to build and maintain healthy organs and fight off infection.

The specific impact of different drugs on nutrition is described below.

OPIATES

Opiates, which include codeine, heroin, and morphine, affect the gastrointestinal system. A very common symptom of abuse includes constipation. Symptoms common during withdrawal include diarrhea, nausea, and vomiting, which may lead to nutrient deprivation and electrolyte imbalances. Electrolytes include sodium, potassium, and chloride.

Eating balanced meals may decrease the severity of these symptoms, though this can be difficult due to nausea. A high-fiber diet with plenty of complex carbohydrates (such whole grains, vegetables, peas, and beans) is recommended.

ALCOHOL

Alcoholism is one of the major causes of nutritional deficiency in the US. The most common deficiencies are of pyridoxine (vitamin B-6), thiamine, and folic acid. Deficiencies in these nutrients cause anemia (low blood count) and neurologic problems. Korsakoff's syndrome ("wet brain") is caused by nutrient deficiencies related to absorption problems caused by heavy use of alcohol, rather than by the drinking itself.

Alcohol intoxication also impairs two major organs involved in metabolism and nutrition: the liver and the pancreas. The liver detoxifies harmful substances and the pancreas regulates blood sugar and absorption of fat. Impairment of these two organs results in an imbalance of fluids, calories, and electrolytes.

Other complications include permanent liver damage (or cirrhosis), seizures, diabetes, and severe malnutrition. Laboratory tests for protein, iron, and electrolytes may be needed to determine if there is liver disease in addition to the alcohol problem. Post-menopausal women who are alcoholic are at high risk of osteoporosis and require calcium supplementation.

STIMULANTS

Stimulant use, including use of crack, cocaine, and methamphetamine, results in a significant decrease in appetite, weight loss, and eventual malnutrition. Abusers of these drugs may stay up for days at a time and suffer dehydration and electrolyte imbalances during these prolonged episodes. Return to normal diet can be difficult if there has been profound weight loss.

MARIJUANA

Marijuana can increase appetite, so some long-term users may be overweight and need to cut back on fat, sugar, and total caloric intake.

Nutrition and psychological aspects of substance abuse

When people feel better, they are less likely to relapse. Since balanced nutrition helps improve mood and health, it is important to encourage an improved diet in people recovering from alcohol and other drug problems.

However, people who have just given up an important source of pleasure may not be ready to make other drastic lifestyle changes. It is more important that people avoid returning to substance abuse than that they stick to a strict diet.

General guidelines and assessment

Regular mealtimes are recommended daily. A meal plan that focuses on a low-fat diet, with increased intake of protein, complex carbohydrates, and dietary fiber is recommended. Due to deficiencies in vitamins caused by irregular eating habits during the period of substance abuse, supplementation with vitamins and minerals during recovery may be helpful.

Specific vitamins supplementation may include B-complex, zinc, and vitamins A and C.

Relapse to using the drug of choice is also more likely when blood sugar levels fluctuate due to the irregular intake of food, which is why regular meals are so important. Addicts and alcoholics often forget what it's like to be hungry and instead interpret this feeling as a drug craving, so they should be encouraged to consider the possibility that they may be hungry when cravings become strong.

During recovery from substance abuse, dehydration is common and it is important to emphasize adequate intake of fluids during and in between meals. Appetite usually returns during recovery, which may cause a tendency to overeat, particularly for people who were taking stimulants. The person should be instructed to consume healthy meals and snacks and to avoid high-calorie foods with low nutritive value, if possible.

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

• Physical activity and adequate rest
• Vitamin and mineral supplements
• Nutritious meals and snacks
• Reduce caffeine and eliminate smoking, if possible