The Importance of Wellness in Recovery
The word wellness is often used as an all-encompassing term that represents good health and mindful living. Even though we all use this word without a second thought, the actual core concept really does deserve more elaboration. According to the National Wellness Institute (NWI), wellness is “an active process through which people become aware of, and make choices toward, a more successful existence.”1 To further illuminate this definition, NWI describes wellness as having six dimensions, which are:
This article puts a much-needed spotlight on the physical component of wellness with particular focus on nutrition and exercise in the context of recovery from drug addiction. These are often-overlooked components of recovery, but deserves more attention. Exercise and proper nutrition can help speed up the recuperative processes that occur during recovery. Equally important, paying close attention to physical wellness during recovery can help people mitigate some of the mental challenges they might experience while working through the recovery process.2 According to NWI, individuals can achieve physical wellness if they:
- Appropriately use the medical system to support optimal health
- Abstain from illicit drugs, alcohol, or tobacco in excess
- Exercise regularly
- Have a lifestyle that promotes physical strength, stamina, and flexibility
- Learn about and practice proper diet and nutrition
- Self-monitor to discover any warning signs of poor health and respond accordingly
According to the Substance Abuse and Mental Health Addiction Services Administration (SAMHSA), specialists universally agree that practicing wellness is a central component of the drug recovery process.3 The reason for this is twofold. The primary function of a dedicated approach to wellness ensures that a recovering person is better poised to avoid a relapse. The National Institute on Drug Abuse indicates that there is a forty to sixty percent relapse rate among individuals who are in recovery from substance abuse.4
Even in the face of this alarming statistic, the truth is that recovery is always possible. Even more promising is the fact that up to sixty percent of people in recovery don’t relapse, which means that it’s entirely possible to live a life without drugs and alcohol. Secondly, wellness can provide a recovering person with tools to build a healthy lifestyle. Recovery is a gradual process that occurs over the long-term; as a person gains distance from substance abuse, there is an increased opportunity to build one good habit on top of another to the point where drug abuse becomes a thing of the past. This is where physical wellness comes into play. As a person continues to recover from a drug or alcohol addiction, they can replace those bad behaviors with new, healthful, and beneficial behavior patterns instead.
Nutrition and Addiction Recovery
The US is one of the wealthiest nations in the world and the epicenter of the health food industry, but is also a nation that suffers from bad eating habits. The President’s Council on Fitness, Sports and Nutrition notes that the typical American diet includes more added sugars, refined grains (such as white flour), saturated fat, solid fat (such as butter, beef fat, and shortening), and sodium than federal guidelines recommend.5
Even more alarming are the following facts:
- Americans don’t consume enough fruits, vegetables, or whole grains.
- It’s estimated that almost all Americans (roughly 90%) consume more sodium than they need for nutritional purposes.
- Among children and teens, forty percent of their average caloric intake comes from unhealthy fats and added sugars. This is because of a high intake of drinks that included added sugar like “sports drinks” along with soda and fruit juices. This demographic also has a high consumption of other unhealthy items like pizza and grain/dairy-based desserts.5
Though experts all agree that we need more nutritional education in the US, this subject isn’t taught in primary or high schools and it’s not required coursework in medical school. This is a major oversight since a large body of research supports the idea that nutrition impacts every facet of a person’s health.
Some nutrition science advocates think that part of the reason Western medicine doesn’t address food as a core issue to health problems is because of the tendency to treat the problem and not the patient. As a whole, Western medicine rarely treats patients holistically. This means that for patients who are recovering from drug and alcohol abuse, their primary care doctors might not have the education or training necessary to approach a healthy eating plan.
Recovering individuals most often need nutritional assistance. Aware of the need for nutritional guidance, drug rehab centers may offer visits with an onsite registered dietician as part of a client’s treatment plan. An article in Today’s Dietician reported that the intersection of nutrition and substance abuse reveals significant complexities, namely what types of drugs were abused and the presence of co-morbid mental health disorders. Just as important is whether or not a person has strong social support for their recovery. Equally pressing is the socio-economic component to healthy eating, since it’s well-established that poverty often has a negative impact on nutritional health.6
Nutritionists warn that it’s often difficult for a person to maintain a healthy diet once they’ve left a treatment facility, namely because the person usually has minimal knowledge about how to construct a healthy diet and often has a negative relationship with food. Personal vigilance, access to healthy foods, and adequate social support can help a recovering person to overcome any obstacles to maintaining a healthy diet. When a person has a well-rounded diet and a plan in place to continue working toward healthy eating, it’s possible that their recovery becomes less challenging. That’s due in part to a stabilization of their mental health.
A good nutritional regimen can reverse the adverse physical and mental health effects of macro-nutrient and micro-nutrient deficiencies. Such deficiencies can cause depression and anxiety, which can, in turn, trigger a relapse.
- Restore healthy balance to metabolic functioning: Different drugs have different impacts on the body. For example, stimulant abuse can impair the body’s ability to process nutrients and cause malnutrition. Other drugs cause individuals to overeat, leading to weight gain and the medical challenges such as heart disease and diabetes that come with it.
- Reduce drug cravings: Drug abuse can cause dehydration, low blood sugar levels, and an off-balance diet. These physical conditions can trigger drug cravings. On the other hand, regular meals and a balanced diet can stave off that desire.
- Improve mood at the level of neurotransmitters: When a person abuses drugs and does not eat properly, neurotransmitters can decrease as a result of this improper nutritional support.6 To maintain neurological health, a person needs an adequate supply of macronutrients (such as carbohydrates), vitamins (such as iron, folic acid, and vitamins B6 and B12), amino acids (protein’s building blocks), omega-3 fatty acid, and an adequate amount of water.
Adequate, balanced nutrition can help a recovering person to strengthen their immune system, repair and rebuild any damage to organs and tissues, and build up levels of vitamins and minerals in the body.7 After rehab, a person needs to have enough knowledge to find the right kind of nutritional professionals who can help design meal plains to aid in recovery. Often, this role is filled by a registered dietician (RD).
Insurance coverage for registered dietician (RD) visits varies based on the plan, so it’s a good idea to do some preliminary research before making an appointment. There are some RDs who specialize in addiction-recovery nutrition.
To find a registered dietician, recovering individuals can ask a drug rehab center for a referral, inquire with a primary care physician, try to get a recommendation from other recovering individuals, consult their health insurance plan provider service directory, or search online directories like the one from the Academy of Nutrition and Dietetics.
A registered dietician provides both education and guidance. As nutritional support is a form of therapy, the registered dietician will typically talk with recovering clients about their drug abuse history, recovery process, any co-occurring conditions, and feelings. An RD can help with any of the following:
- Provide clients with a realistic personalized diet plan that considers their health condition(s), blood test results, food allergies, and any underlying diseases such as celiac disease, liver disease, or heart disease.
- Teach clients how to read food labels, understand the results of a blood test (such as blood sugar levels), and educate clients on healthy food substitutes (such as swapping baked kale chips for French fries)
- Help clients avoid falling into the trap of popular diet scams or a negative food cycle (such as extreme healthy eating followed by a crash into high junk food consumption)
- Serve as part of a support system to help keep clients on track with their goals
The Academy of Nutrition and Dietetics advises that a client typically meets with a registered nutritionist every two weeks for several months and then once a month for a longer period to track overall progress. However, the best RDs will also work with whatever scheduling limitations are currently in place, including being mindful of insurance limitations.
A nutritionist who specializes in nutrition and addiction recovery can also help clients to ensure their dietary practices do not mimic their former addiction behaviors. As drug addiction specialists have observed, sometimes a person who is in recovery replaces one kind of abuse with another. When this occurs, common substitutes for drugs are food, exercise, and work. A nutritionist, along with other service providers (such as therapists), can help a recovering person maintain a balanced relationship with food and nutrition, which can, in turn, support a more balanced lifestyle overall.
Exercise and Addiction Recovery
Even though we have access to countless resources that can encourage activities, Americans are very sedentary. According to the President’s Council on Fitness, Sports, and Nutrition, less than five percent of adult Americans engage in the recommended thirty minutes of physical activity each day.5
Even more alarming are the following statistics:
- Only about a third of all Americans get the recommended amount of weekly exercise.
- Approximately 80.2 million Americans above the age of 6 (about a quarter of the population) are physically inactive.
- A vast majority (about 80%) of American adults and youth fail to meet the recommended guidelines for aerobic and muscle-strengthening exercises.
As alarming as these statistics are, the truth is that it’s possible to reverse the negative effects of lack of exercise. This holds true for people who are recovering from substance abuse. Also, there is a general consensus in the addiction treatment community that engaging in a regular exercise plan can help prevent relapse.8 Many individuals in recovery use exercise as a tool to stay the course of sobriety. For researchers who study addiction, this is an exciting area to explore, since exercise might be a useful component of a recovery treatment plan.
Madhukar H. Trivedi, MD, is a psychiatrist and the founder of the STRIDE clinical trial, which considered the use of intensive exercise to treat addiction to illicit stimulant drugs. The study involved 330 participants in residential treatment programs for stimulant abuse. For three months, half of the group was assigned to an intensive fitness program while the other half received health education classes. The study showed that the group that engaged in intensive exercise received more benefits in the stimulant addiction recovery process than the group that only received recovery-focused education. Further, intensive exercise also improved sleep, mood, and cognitive function. The researchers advised the medical community that their clinical trial was also intended to serve as a call for research into treatment options for specific drugs of abuse.9
Results from the STRIDE trial reinforced what many in the addiction recovery community have long suspected to be true. Intensive exercise is not simply about substituting a drug high for an exercise high. Exercise causes an increase in neurochemicals such as serotonin, dopamine, and noradrenaline, which helps to improves mood. In turn, an improved mood helps to support healthier practices and lifestyles. As these neurochemicals released in the brain during exercise, the brain can create pathways that make it easier for the recovering person to want to exercise. This is a process called neuroplasticity, a concept that underlines the fact that the brain is flexible, and it can adapt to healthy behaviors as readily as to unhealthy ones.8
The STRIDE study focused on intensive therapy, but it is important to note that any level of exercise that follows a regimen can be helpful. SMART Recovery is a network of mutual-aid recovery groups that advance the message that exercise does not need to be complicated to be effective.
At the beginning of the drug recovery process, it is understandable that individuals will likely depend heavily on drug rehab services – but recovery is a lifelong process. Just like a person’s education doesn’t stop when they graduate from school, the recovery process doesn’t stop after completion of an intensive inpatient or outpatient program. Practicing wellness, including having a balanced diet and following an exercise regimen, is a main component of aftercare.
While help may initially be available from professionals, such as a registered nutritionist or a physical trainer, a recovering person must ultimately internalize the lessons learned and practice them in day-to-day life. Building oneself up from within through wellness efforts can restore the self-confidence that drug abuse so insidiously chips away at. Recovery is not just about overcoming drug abuse but empowering oneself to live a physically, mentally, and emotionally fulfilling life.
- National Wellness Institute. (n.d.) The Six Dimensions of Wellness.
- Smith, M. A., & Lynch, W. J. (2012). Exercise as a potential treatment for drug abuse: evidence from preclinical studies. Frontiers in psychiatry, 2, 82. https://doi.org/10.3389/fpsyt.2011.00082
- SAMHSA. (Nov. 6, 2019). National Helpline.
- National Institute on Drug Abuse. (July2018). Drugs, Brains, and Behavior: The Science of Addiction.
- President’s Council on Sports, Fitness & Nutrition. (Jan. 26, 2017). Facts & Statistics.
- Salz, A. (2014). CPE Monthly: Substance Abuse and Nutrition. Today’s Dietician, 16, 12, pp 44.
- Virmani, A., Binienda, Z., Ali, S., & Gaetani, F. (2006). Links between Nutrition, Drug Abuse, and the Metabolic Syndrome. Ann. N.Y. Acad. Sci. 1074: 303–314.
- Matesa, J. (Jan. 16, 2012). How Exercise Keeps You Sober. The Fix.
- Trivedi, M., Greer, T., Grannemann, B., et. al. (2011). Stimulant reduction intervention using dosed exercise (STRIDE) – CTN 0037: study protocol for a randomized controlled trial. Trials, 12, 206. https://doi.org/10.1186/1745-6215-12-206