An Integrative and Functional Nutrition Approach to Substance Abuse and Recovery

Substance abuse is a concerning and prevalent issue today, affecting thousands of individuals and their families. In 2020 it was estimated that 40.3 million Americans 12 years old or older had a substance use disorder (SUD) in the past year. Many who struggle with substance abuse also have co-occurring mental health conditions. The role of nutrition has previously been an overlooked part of substance abuse and recovery treatment. However, more and more research demonstrates nutrition's significance in this process.

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What is Functional or Integrative Nutrition?

Functional or Integrative Nutrition looks at the interplay of our genes, environment, nutrition, and lifestyle factors in modulating illness while optimizing wellness. Functional nutrition aims to restore functioning and balance amongst the systems in the body while recognizing the impact this has on the mind and overall well-being.  

The Link Between Nutrition and Substance Abuse Recovery

Nutritional deficiencies are evident in those currently suffering from the vicious cycle of substance abuse and those in recovery. This is because it takes the body time to repair and heal following the damage of prolonged substance abuse. Substance abuse (whether drugs or alcohol) results in a loss of essential vitamins, minerals, antioxidants, amino acids, and fatty acids, which are critical for all aspects of our physical and mental health.

Learning about nutrition's influential role in recovery can be incredibly helpful to those affected by this severe and prevalent illness. Substance abuse takes an incredible toll on the body as multiple bodily processes and organ systems are often involved.

The liver, for instance, is significantly compromised, as is digestion, gut microbiome balance, and overall absorption of nutrients. These can all further impede mental health, which may likely be a solid underlying factor for those suffering. This is because nutrition is vital for emotional regulation, cognition, and mood health.

Also, with repeated substance abuse, levels and turnover rates of several neurotransmitters important for mood are compromised as brain changes emerge. This can further contribute to poor mental health and reinforce the drug or substance of choice by making one more susceptible.

Signs Of Substance Abuse

Substance Use Disorder (SUD) characterizes a group of physiological, cognitive, and behavioral symptoms that occur from substance use, including alcohol or drugs, despite the significant dysfunction it may be causing in other parts of their life. Signs of this disorder include taking the substance of choice in larger amounts or for a longer time than intended, a persistent desire to cut down or regulate misuse, and an intense desire or urge for the substance. An increase in tolerance is also a sign of substance abuse as well as withdrawal symptoms.

Causes of Substance Abuse

The etiology of substance abuse is multifaceted and complex, including genetic, physical, emotional, and psychological factors. Our environment, adverse childhood experiences (ACEs), and attachments with our caregivers can all play a role in substance use disorder (SUD). Biochemical variations in neurobiology, like the stress response, can also make one more susceptible to substance use disorder, among other genetic predispositions.

Preexisting Mental Health Disorders

As noted, SUD has high comorbidities with mental health disorders and often chronic stress levels. The substance is often used as a way for the individual to cope or self-medicate. Over time, this can create a vicious cycle as more and more of the substance is needed to achieve desired effects. This can lead to physiological and psychological tolerance and dependence. The body, over time, can become dependent on the drug or substance to function. Alterations in brain regions have also been well evidenced in the literature, which speaks to the emotional, mental, and behavioral symptoms associated with substance abuse.

Depression and anxiety are often evident in substance abuse and recovery and can become more exacerbated by nutritional deficiencies and compromised biochemical processes in the body.

Poor Nutrition & Nutrient Deficiencies

Gut microbiome imbalances, poor digestion, and detoxification are often evident, affecting nutrient absorption and mood. The gut microbies and the brain are in constant communication. When digestion is off, and gut bacteria are out of balance, this affects the production and regulation of neurotransmitters necessary for mood health.

Nutrition plays a profound role in those struggling with substance abuse and recovery. Substances like alcohol can deplete the body of many nutrients as it is a diuretic. Notably, B vitamins, in particular, are significantly deficient, as well as other vital nutrients. For example, amino acid and fatty acid imbalances are also apparent in substance abuse.

The substance or drug of choice provides short-term bouts of energy for the individual, so often, those with substance use disorders develop irregular and dysfunctional eating patterns. Also, the body can't absorb nutrients efficiently under the influence of a substance or drug, causing more profound deficiencies.  

Poor Methylation

Methylation is often impeded upon in those with substance use and is thought to play a role in addiction. Insufficient amounts of B vitamins from the diet can cause a reduction in neurotransmitter synthesis as well as compromise nervous system health. Current research suggests that those experiencing depressed or anxious moods could be deficient in vital B vitamins, and B vitamins are required for methylation.

Functional and Integrative Nutritional Labs for Support of Substance Abuse and Recovery

Commonly used functional medicine labs in support of substance abuse and recovery may include the following:

Comprehensive Stool Test

This test measures several important markers relative to gut health, including systemic inflammation and gut microbiome imbalances. Often those who have struggled with substance abuse or are in recovery have inflammation and imbalances in their microbiome. This can impact the production of neurotransmitters, among other vital processes in the body, such as digestion and detoxification.

Organic Acids Test

Organic acids provide insight into the metabolic functions of the body that could be compromised and need support. Specifically, this test helps determine metabolic imbalances relative to methylation, inflammation, toxicity, and oxidative damage. This test also evaluates imbalances in amino acids, antioxidants, neurotransmitter turnover rate, and nutrition, helping to individualize the need for supplement treatment.

Micronutrient Testing

Many micronutrient deficiencies are prevalent in those struggling with substance abuse or recovering. Nutrition is significant for restoring balance in the body and is essential for mental health, which is often prevalent in those struggling with these conditions. This test measures many important vitamins, minerals, antioxidants, amino acids, and fatty acids that could be compromised.  

Comprehensive Metabolic Profile

This test evaluates 13 metabolites in the blood, providing important information about the body's metabolism and chemical balance. The Comprehensive Metabolic Panel assesses liver functioning (often compromised in those suffering from substance abuse), blood sugar regulation, and electrolyte balance, which is essential for fluid balance, among other important roles in the body. This test helps to shed light on any abnormal imbalances from substance use to restore functioning more efficiently.

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Functional and Integrative Nutrition Treatment for Substance Abuse Recovery

Functional and Integrative Nutrition approaches for substance abuse and recovery include reinforcing new coping skills and lifestyle habits to support new neural pathways in conjunction with the following to address physiological imbalances that can manifest in compromised mental health. Addressing nutritional deficiencies, including restoring amino acid and fatty acid balance, hydration, and antioxidant status, are crucial for recovery. In addition, supporting GI microbiome balance, digestion, inflammation, and methylation pathways that support detox will aid in substance abuse recovery.

Diet for Substance Abuse Recovery

Nutrition can help address and modulate several processes in the body and how the brain functions. This can support recovery as it can help with decision-making, regulating emotions, and uplifting mood. As noted, mental health and substance abuse disorders often have high comorbidity. Nutritional support is needed to improve and enhance physical, psycho-social, mental, and emotional well-being.

Nutrient Dense Diet

Nutrition has a significant role in modulating brain function and other vital processes in the body relative to health and well-being, all of which have substantial roles in substance abuse recovery. Consuming a nutrient-dense, whole foods, and primarily plant-based diet has shown to be supportive for substance abuse recovery.

Adequate Hydration

Sufficient hydration is necessary to support biochemical processes that may be compromised by substance abuse and assist the body with detoxification. Adequate consumption of pure filtered water and warm lemon water has also been found to support substance abuse and recovery as it supports digestion, detoxification, and liver function.

Nutrient-dense vegetable soups are strongly recommended for those struggling with substance abuse or recovery, as these aid in restoring nutrients that may be depleted. Soups and broths provide electrolytes vital for nervous system function, digestion, detoxification, and improving overall absorption. This is important as many of those struggling with SUD have electrolyte and Vitamin B deficiencies and compromised digestion.

Support Gut/Liver Health & Methylation

Foods that are rich sources of probiotics and prebiotics are also recommended to support gut health, microbiome balance, and liver function. Sources of probiotics include tempeh, pickles, and yogurt. Prebiotics include asparagus, beets, garlic, chicory, onion, artichoke, honey, banana, tomato, and seaweed.

Leafy greens like spinach, kale, and broccoli help promote gut and liver health and provide the body with many nutrients, like B vitamins, which are imperative for nervous system functioning, energy, and neurotransmitter synthesis. Several B Vitamins are also necessary for the important process of methylation in the body, which is often compromised in substance use disorder. Supporting the body with methylation is also important to aid in these processes.

Other vegetables are particularly supportive of liver health. Beets are choleretic, helping to induce less strain on the liver. Sweet potatoes have been shown to attenuate liver injury, and yams have been evidenced to inhibit enlarged liver. Bitter greens such as dandelion, arugula, and nettle help to promote digestion and healthy liver function as they support bile flow.

Support Cravings & Metabolic Health

Cravings for intoxicants can result from imbalances in the body and mind. This is because intoxicants alleviate symptoms of physiological and psychological distress in the body in the short term while exacerbating these in the long term. Support metabolic health by regulating blood sugar. Refined carbohydrates, processed foods, and high sugary foods and drinks can all cause spikes in blood sugar that may increase cravings for the substance or drug. Therefore, refraining from overconsumption of these foods is recommended, and instead, choosing balanced meals with nutrient density and complex carbohydrates for sustainable energy while avoiding fluctuations in mood.

Restore Amino Acid & Fatty Acid Balance

Balancing neurotransmitters such as Dopamine, Serotonin, and GABA with foods or amino acid support can be helpful, as these are often compromised due to substance abuse.

Probiotic and prebiotic-rich foods help to modulate the synthesis of important neurotransmitters that are often deficient in those in recovery, such as the inhibitory neurotransmitter, Gamma-aminobutyric acid (GABA). GABA is present in fermented foods such as tempeh, yogurt, kimchi, and sourdough and has some implications for mental health and substance use recovery. Fermented foods also support the production of Serotonin and Dopamine as these neurotransmitters are also synthesized in the gut.

Foods that also aid in serotonin synthesis include oatmeal, turkey, nuts, spinach, bananas, and egg whites, as these contain Tryptophan. Tryptophan is a precursor to serotonin. Foods that may support Dopamine production include animal products, avocados, beets, olive oil, green leafy vegetables, coffee, almonds, and green leafy vegetables as they contain the amino acid L-Tyrosine.

Sources of Omega-3 fatty acids such as wild-caught salmon, flaxseed, chia seeds, and sardines are important as these are often deficient in those in recovery. These help to reduce inflammation while providing the body with important nutrients like Vitamin B12, fiber, and protein, all of which support restoring the body and mind.

Supplements and Herbs for Substance Abuse Recovery

The following supplements and herbs have been recommended for substance abuse recovery:

Vitamins and Minerals

While a micronutrient test can help personalize specific nutrient repletion regimens, the following vitamins, and minerals are notorious for being deficient in this population. For example, Vitamin C deficiency has been shown to be a result of excessive alcohol consumption, and it has also been shown to contribute to chronic alcohol use. While specific dosing has not been established for this particular population, an upper limit for healthy adults is 2,000 mg daily.

NAC is a powerful antioxidant. When taken at doses of 2,400-3,600 mg per day, research shows that it can act as an anti-relapse agent for those suffering from substance abuse and who are motivated to quit.

B Vitamin Complex includes the majority (or all) of the B vitamins. Because many B vitamins are typically depleted in those suffering from substance abuse, A B complex supplement is a beneficial way to reestablish healthy levels. B vitamins also help to support the body and mind in several processes relative to nervous system function, metabolism, and mood.

Magnesium can reduce the intensity of addiction. It works at the neuroglial level to reduce the action of glutamate, an excitatory neurotransmitter. There are various types of magnesium supplements. Magnesium glycinate and magnesium citrate are well absorbed and tolerated, and doses range from 310-320 mg daily for adult females and 400-420mg daily for adult males.

Vitamin D supports inflammation, digestion, and mood health. It has also been suggested to be deficient in those with substance abuse and may have positive implications for recovery. Research has shown 50,000IU supplementation of vitamin D every other week for 12 weeks assisted the well-being of individuals recovering from opioid addiction.

Herbs for Substance Abuse Recovery

Milk Thistle is an herb containing silymarin, both an anti-inflammatory and a powerful antioxidant with important implications for liver health. It has historically been used to treat various liver conditions, including alcoholic liver disease.

Amino Acids for Substance Abuse Recovery

The amino acid Tryptophan supports the production of Serotonin, an essential neurotransmitter for mood, sleep, and digestion that is often very much compromised in those struggling with substance abuse or in recovery. Tyrosine may be recommended for low levels of Dopamine, which is often evident in those in substance abuse and recovery. Tyrosine increases dopamine availability which can support restoring and improving mood health.

Fatty Acids for Substance Abuse Recovery

Finally, Omega 3 fatty acids may be a promising supplement for substance abuse disorders as they have been suggested to help negate cravings. In this randomized, double-blind study, male inpatients with alcohol dependence were randomized to a placebo or intervention of Omega-3 fatty acids. Those who were supplementing with Omega-3 fatty acids had fewer days of drinking following discharge than the placebo group at 2 and 3 months.

Complementary and Integrative Medicine for Substance Abuse Recovery

Mindfulness Meditation has been found to be supportive for those with substance use disorder (SUD). It has been suggested to improve symptoms related to anxiety and depression, as well as reduce dependence and cravings.

Yoga has been found to reduce stress- in the body and mind– and stimulate the vagus nerve, all having protective benefits for those in recovery. In fact, the effect of yoga as an intervention for those with substance abuse disorder was found to have significant positive outcomes in 7 out of 8 randomized controlled trials (RCTs) in conjunction with medication.

Sauna use is associated with a reduction of toxins, stress, as well as inflammation. In this study, 109 participants reported improved energy, quality of life, clarity, emotional stability, and reduced cravings from sauna use as part of their substance abuse treatment.

Forms of exercise such as cardio or weight training in recovery have also been suggested to have protective benefits regarding substance use disorder.

The NADA Protocol for Substance Abuse Recovery

NADA is an auricular acupuncture protocol that involves the placement of five tiny, sterilized disposable acupuncture needles into specific sites on each ear. The NADA Protocol is used to help with addictions, mental health, and emotional trauma.

The five points used in the NADA protocol are:

Sympathetic, Shen Men, Kidney, Liver, and Lungs provide balance and yin nourishment with the presumptive diagnosis of yin deficiency, "empty fire," which translates to the conventional medicine diagnoses of behavioral health.

Once the needles are placed in the ears, the recipients sit quietly in a group setting for 30-45 minutes allowing the treatment to take effect.

This protocol is commonly used in addiction recovery centers, veteran's affairs clinics, and group acupuncture clinics. Combining NADA with counseling, education, medical support, and self-help groups such as AA and NA enhances opportunities for success.

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Summary

The various causes of substance abuse are complex and multifaceted, including a combination of genetic, biochemical, environmental, and lifestyle factors. Nutrition helps to restore balance and function in the body's systems, helping to support mental and physical health. Taking an integrative and functional nutrition approach to substance abuse and recovery can be influential in maintaining hope and improved quality of life.