Substance abuse harms the body in two distinct ways:

• The effect of the substance itself
• Negative lifestyle changes, such as irregular eating habits and poor diet

For example, infants who were exposed to alcohol while in the womb often have physical and mental problems. The alcohol affects the growing baby directly by crossing the placenta. It affects the baby indirectly due to the mother's poor nutrition while she was drinking.

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

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

OPIATES

Opiates (including codeine, heroin, and morphine) affect the gastrointestinal system. Constipation is a very common symptom of abuse. Symptoms common during withdrawal include:

• Diarrhea
• Nausea
• Vomiting

These symptoms may lead to a lack of enough nutrients and an imbalance of electrolytes (such as sodium, potassium, and chloride).

Eating balanced meals may make these symptoms less severe (however, eating can be difficult due to nausea). A high-fiber diet with plenty of complex carbohydrates (such as 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. A lack of these nutrients causes anemia and nervous system (neurologic) problems. Korsakoff's syndrome ("wet brain") occurs when heavy alcohol use prevents nutrients from being properly absorbed.

Alcohol intoxication also impairs two major organs involved in metabolism and nutrition: the liver and the pancreas. The liver detoxifies harmful substances. 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:

• Diabetes
• Permanent liver damage (or cirrhosis)
• Seizures
• Severe malnutrition
• Shortened life expectancy

Laboratory tests for protein, iron, and electrolytes may be needed to determine if there is liver disease in addition to the alcohol problem. Postmenopausal women who drink heavily are at high risk of osteoporosis and need to take calcium supplements.

STIMULANTS

Stimulant use (such as crack, cocaine, and methamphetamine) significantly decreases appetite, and leads to weight loss and malnutrition. Abusers of these drugs may stay up for days at a time. They may be dehydrated and have electrolyte imbalances during these episodes. Returning to a normal diet can be difficult if there has been significant weight loss.

MARIJUANA

Marijuana can increase appetite. Some long-term users may be overweight and need to cut back on fat, sugar, and total calories.

Nutrition and psychological aspects of substance abuse

When people feel better, they are less likely to relapse. Because balanced nutrition helps improve mood and health, it is important to encourage a healthy 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

• Stick to regular mealtimes
• Eat a low-fat diet
• Get more protein, complex carbohydrates, and dietary fiber
• Vitamin and mineral supplements may be helpful during recovery (this may include B-complex, zinc, and vitamins A and C)

It is easier to start using the drug again when irregular eating habits cause blood sugar levels to go up and down. This is why regular meals are so important. People who are addicted to drugs and alcohol often forget what it's like to be hungry and instead interpret this feeling as a drug craving. 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. It is important to get enough fluids during and in between meals. Appetite usually returns during recovery. This may make you more likely to overeat, particularly if you were taking stimulants. Eat healthy meals and snacks and avoid high-calorie foods with low nutritional value (such as sweets), if possible.

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

• Eat nutritious meals and snacks
• Get physical activity and enough rest
• Reduce caffeine intake and stop smoking, if possible
• Seek help from counselors or support groups on a regular basis
• Take vitamin and mineral supplements

O'Connor PG. Alcohol Abuse and Dependence. In: Goldman L, Ausiello D. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 31.