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Jeffrey Lang 2011
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NJPN ATLANTIC CITY 2013
“Nutritional and Holistic Aspects of Alcohol
Dependence Treatment: Improved Outcomes”
by Jeff Lang, PhD, LCADC, CCS, CPRP� [email protected]
Nutrition in Addiction CounselingQuestions to be answered:
What is the primary purpose of addiction counselors?
WHAT IS OUR PRIMARY PURPOSE?....OUR PRIMARY GOAL?????
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Our Primary Goal? To help as many of our clients as possible achieve sobriety/recovery and be well.
I believe drug and alcohol counselors would move mountains to obtain the skills and treatment techniques needed to help just ONE more client get well………..
IMPROVED NUTRITION AND TOBACCO CESSATION
Research now clearly supports improved treatment outcomes when nutritional and health needs are incorporated in treatment delivery
Research now clearly supports Tobacco Cessation as a factor in improved treatment outcomes (a best practice) (Prochaska/ file below)
http://smokingcessationleadership.ucsf.edu/publications08/prochaska_drug_alcohol_dependence_2010.pdf
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NUTRITION IS FULLY ENTWINED IN THE PROCESS OF ADDICTION AND THE PROCESS OF RECOVERY…THE MOST PROFOUND IMPACT ALCOHOL HAS ON THE PHYSIOLOGY OF THE DRINKER… IS MALNUTRITION………
Nutrition and Addiction
IS THERE EVIDENCE???
(Historical investigation of Nutrition’s positive role in substance abuse recovery)
Williams (1952)
Goodhard (1955)
Bill Wilson (letter to AA 1961)
Guenther (1984)
Grant (2004)
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“Show Me The Proof!” “Nutrition education is positively associated with substance abuse treatment program outcomes (Grant, 2004) utilized the Addiction Severity Index (ASI) and control group studies in inpatient treatment with six month outcome follow up to show the positive impact on outcomes for substance use treatment that includes nutrition. (grant, 2004)
Dr. Cynthia Grant (2004)Nutrition Education is Positively Associated with Substance Abuse Treatment Program Outcomes
http://www.ncbi.nlm.nih.gov/pubmed/15054346
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THE TWO HEADED MONSTER
Nutritional Deficits during active addiction
Nutritional Deficits in active recovery!
EMPTY HARVESTJensen & Anderson (1990)
Your clients may finish Rehab and still be malnourished.
“ I already eat good”….but assume deficient eating patterns do exist.
Understand the realities of convenience, cost, and accessibility of processed foods….and mass produced vegetables and fruits.
Clients may make seemingly good food choices which have limited nutritional value..
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A Sad Reality I bring up the sad reality of the quality of food in general in this country for a specific treatment reason….
if you are treating someone who has been alcohol dependent….
you can assume significant physiological damage from the malnutrition related to the alcohol dependence….
and today’s food will struggle to contribute to the person’s level of needed healing!
Mortality Rates of Treated vs. Untreated Alcoholics
Classic study, “A Five Year Mortality Study of Alcoholics”(Pell & Alonzo, 1973)
Results: the mortality rate for both treated and untreated alcoholics remains 3 X’s higher than the general population
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Alcoholics, Recovering or Not, Lose Many Years of Their Life Span
Treated alcoholics have almost the same mortality rate as drinking alcoholics, about 3X’s higher than the general population.
Degenerative diseases, set in motion by heavy alcohol/drug use, are not halted by counseling.
Biochemical intervention and physical repair must take place.
(S. Pell and C Alonzo, "A Five Year Mortality Study of Alcoholics", Journal of Occupational Medicine 15 No 2 (Feb 1973): pp 120-125)
What Causes this Startling Life Expectancy Findings???
Research has been in conflict as to the primary causes of this issue….initial research did “pin the blame” on the poor nutrition of alcohol dependent individual’s during active addiction and in recovery….but more recent research equates this to tobacco use….or a combination of the two!!!!!
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Malabsorption and Metabolic Problems
B vitamins and all water soluble vitamins are depleted, which is commonly known and treated.
Additionally, fat soluble vitamins such as A,D,E,and K are depleted.
(NIAAA, 2004)
Inhibited Protein Uptake is Related to
Many Issues
The body’s efforts to metabolize alcohol creates byproducts that impact lipid and protein breakdown.
Amino Acid Deficiencies Reduces the bodies storage of Zinc Essential nutrients are not retained. Nutrients are
rapidly eliminated through the kidneys.
(Balch&Balch, 2000)
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Malabsorption Impacts All the Major Organs
What about the major organs?
Brain (NIAAA, 2004)
Liver (Griffith & Schenker, 2009)
Pancreas (Apte, 1997)
Kidneys
Cardiovascular
Wernicke‐Korsakoff Syndrome.
DEGENERATIVE DISEASES…SET IN MOTION and CONTINUE Alcohol dependence sets in motion some
degenerative and eventually life ending illnesses. (Heart Disease, Atrophy, Bone)
These continue to progress even during prolonged recovery.
“Nutritional Starvation” can be contributing…despite observable physical appearances such as weight.
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So…what foods are indicated and what foods are counter indicated???
First lets set some boundaries about appropriate scope of practice:
Drug and Alcohol Counselors CANNOT tell a client (for example) …they should take B vitamins ….or eat Fish….only a physician or registered dietician can outline a plan of eating…
Appropriate Scope of Practice It is within the scope of practice to share with clients educational materials that are evidence and fact based related the known physiological impact alcohol dependence has on malnutrition.
It is appropriate to educate on foods that experts have found appropriate for nutritional healing needs…and it is very appropriate to share with patients any evidence based research that shows better outcomes for individuals who improve nutritional patterns during recovery……
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We Educate Clients About the Facts Our Clients all have a unique and personal path to take as they move thru their recovery….nutritional improvement should be one of the many tools that they are exposed to …for their own consideration …as they would choose any other tool of recovery…….
BIO / PSYCHO/ SOCIAL / SPIRITUAL
BIO: Physical Healing/ Nutrition
PSYCHOLOGICAL: Our beliefs and fears addressed
SOCIAL: Coffee & Birthday cake (EVERY DAY) It’s a tough world out there for this issue
SPIRITUAL: Correct eating is a sign of self love and self care
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Bio/Psycho/Social ‐ Spiritual
BIO
In substance recovery:
1) MAT (Medication Assisted Therapy)
(GENETIC MARKER ADVANCES WILL HELP)
2) Nutrition/Exercise
FOOD VALUE SYSTEM: Local Organic
EAT LIKE YOUR GRANDPARENTS Avoid Avoid Modern, Marketed, Extended Shelf Life
The Platinum Standard – Local Organic Recommend local non-organic over organic shipped from
far away (Mexico…California…etc) Organic: The closer it was grown the better nutritional value
(how they ripen during shipping)
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The Real Issue Here Is…. We should bring FOCUS to the clients need to consider nutritional efforts and improvements….
We support nutritional improvement and tobacco cessation as a means to improve efforts to recover….
WE DON’T…tell clients what to eat……we motivate them to work on these issues and share with us their efforts and progress……(but it does help to know what direction they should be going in!)
FOOD SABOTAGE??? The American Fast Food
Industry is very aggressive.
Old habits are hard to break…self care and alcohol dependence do not go hand in hand.
America’s best psychologists may be employed by the American Food Industry to create misleading and enticing advertisements.
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Our Client’s Nutritional Knowledge Base
The average American has limited insight into nutritional needs…and this may be true of the average addiction recovery therapist.
The government as a primary educator of nutrition has been heavily lobbied by special interests which lead to confusing standards.
(PCRM,1997)
Is SugarAlcohol’s Little Sister?
Without the use of alcohol to address feelings of anxiety and depression…an increased reliance on sugar products may take place in an effort to “Self Medicate” these feelings….
This produces a “yo-yo” effect of relief and then increased agitation and promotes continued overuse of the pancreas.
AA to OA???
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Is SugarAlcohol’s Little Sister?
Review “ Compulsive Overeating as an Addiction Disorder: A review of theory and evidence”
http://dionysus.psych.wisc.edu/coursewebsites/PSY741/Articles/NonDrugAddictions/DavisC2009a.pdf
Neurobiological parallels between the pleasure pathways response to alcohol and man made processed sugars
Question To Be AnsweredIs there any evidence that treating nutritional needs during alcohol dependence treatment improves outcomes???
Findings support the position that nutrition education is an essential component of substance abuse treatment programs and can enhance substance abuse treatment outcomes. (Grant, 2004, Nutrition education is positively associated with substance abuse treatment program outcomes )
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Question To Be AnsweredShould CADC’s and LCADC’s include nutritional information and promote nutritional healing as part of their counseling services???
Yes…….it is an Evidence Based Practice and fully supported by research as a course to improve treatment outcomes.
DAVID AND GOLIATH?
WHAT WEAPONS DO WE HAVE to promote improved nutritional intake???
RESEARCH / EVIDENCE
AND THE FACT THAT THE PARADIGM FOR NUTRITIONAL HEALING FITS THE SAME PARADIGM USED FOR MODERN ALCOHOL DEPENDENCE RECOVERY…. (Which is……………..)
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Recovery is a Unique and Personal Journey As clinicians we…..
Offer Education and evidence based information
Offer Suggestions
Motivate
Motivate some more!
And seek to provide a sense of HOPE
Final Thoughts for TodayIncluding Nutrition and Tobacco Tx. Services within the structure of Addiction Treatment services will:
1) Increase positive treatment outcomes
2) Promote increase longevity for those in recovery
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THANK YOU!!!!!!!!!!!Jeffrey J. Lang, PhD, LCADC, CCS, CPRP
Lakeview Commons, 146 S. Lakeview Drive, Gibbsboro, NJ, 08026
609-980-3514
References
Apte, M., Wilson, J., Korsten, M., (1997). Alcohol‐Related Pancreatic Damage, Alcohol Health & Research World, Vol. 21, No. 1, 1997
Balch, P. & Balch, J. (2000). Perscription
For Nutritional Healing. Penguin – Putnam Inc., New York, NY, WWW.penquin‐putnam.com
Griffith, C., & Schenker, S., (2009). The Role of Nutritional Therapy in Alcohoic Liver Disease. NIAAA Publications.
http: pubs.niaaa.nih.gov/publications/arh294/296‐306.htm
Jensen, B., & Anderson, M., (1990). Empty Harvest. Avery Publishing Group, NY,NY. ISBN 0‐89529‐558‐x
NIAAA (National Institute on Alcohol Abuse and Alcoholism) (2004). Alcohol’s Damaging Effects on the Brain. Number 63, October, 2004
Physicians Committee for Responsible Medicine, (1997). Editorial: Racial Bias in Food Guidelines. http: www.pcrm.org/magaine/gm97autumn/gm97autumn11.html