The Importance of Wellness in Recovery
The term wellness is used as an all-encompassing catchword to represent good health. Advertisements that include this term abound. But the concept of wellness deserves greater 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.” To further illuminate this definition, NWI describes wellness as having six dimensions, which are:
In this article, the spotlight is on the physical component of wellness. In particular, focus is paid to nutrition and exercise in the context of recovery from drug addiction. According to NWI, individuals can achieve physical wellness if they:
- Exercise regularly
- Learn about diet and nutrition and practice it
- Do not use illicit drugs, alcohol, or tobacco in excess
- Have a lifestyle that promotes physical strength, stamina, and flexibility
- Appropriately use the medical system to support optimal health
- Self-monitor to discover any warning signs of poor health and respond accordingly
- Have an understanding of the relationship between nutrition and the body’s performance
Addiction specialists universally agree that practicing wellness is a central component of the drug recovery process. The reason is twofold. Firstly, wellness can help a recovering individual to avoid a relapse. According to the National Institute on Drug Abuse, there is a 40-60 percent rate of relapse among individuals who are in recovery from substance abuse. But despite this statistic, lasting recovery is always possible. This statistic also means that up to 60 percent of individuals do not relapse. 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 increasing opportunity to build one good habit on top of another to the point where drug abuse becomes a thing of the past.
Nutrition and Addiction Recovery
The US is one of the wealthiest nations in the world and the epicenter of the health food industry, yet it is noted for being a junk food nation. Consider the following facts and statistics on nutrition in the US from the President’s Council on Fitness, Sports & Nutrition:
- The typical American diet takes in 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.
- Per the national recommended intakes, Americans consume a deficient amount of fruits, vegetables, grains, fruits, oils, and dairy products.
- An estimated 90 percent of Americans consume more sodium than they need for nutritional purposes.
- Among children and teens (2- 18 year olds), 40 percent of their average caloric intake comes from unhealthy solid fats and added sugars due to a disproportionately high intake of fruit drinks, soda, pizza, dairy desserts, and grain desserts (wheat-based deserts like apple pie and cake made with white flour).
Despite the apparent need for greater nutritional education in the US, nutritional science is not typically a part of medical school education. Even so, it is well established that nutrition impacts every facet of a person’s health. Part of the reason most doctors do not provide nutritional guidance is that Western medicine often does not treat patients holistically. Western doctors are typically trained to treat illnesses and diseases. As a result, a person who is dedicated to good health will likely have to separately visit a primary care physician or a specialist and a nutritionist/registered dietician. A doctor may provide a medication plan and state any known negative food interactions, for instance, but a registered dietician will explain how to optimize the effects of the medication through diet.
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. Recovering individuals most often need nutritional assistance, and nutrition is a science. In an insightful article published in Today’s Dietician, registered dietician Alyssa Salz advises that the intersection of nutrition and substance abuse reveals significant complexities. According to Salz, the following factors influence a recovering person’s nutritional plan:
- The types of drugs that were abused
- The presence of any co-occurring mental health disorders
- Whether the recovering person has a strong or weak social support
- Financial realities (for instance, poverty often has a negative impact on nutritional health)
Salz warns that while nutritional therapy may be readily available during a structured inpatient or outpatient rehab program, it can be difficult for a person to maintain a healthy diet on their own on a long-term basis. Personal vigilance, access to healthy foods, and adequate social support can help a recovering person to overcome any obstacles to maintaining a healthy diet. According to Salz, a healthy diet can help a recovering person:
- Stabilize mental health to decrease the risk of relapse: A good nutritional regimen can reverse the negative physical and mental health effects of macronutritional and micronutritional 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 send the body reeling into a nutritional void. Some drugs have the opposite effect and cause individuals to up their caloric intake, leading to weight gain and a possible host of health problems related to being overweight or obese.
- Reduce drug cravings: Drug abuse can cause dehydration, low blood sugar levels, and an off-balance diet. These physical conditions can trigger drug cravings, whereas regular meals and a balanced diet can stave off that desire.
- Improve mood at the level of neurotransmitters: During drug use, neurotransmitters can decrease as a result of improper nutritional support. In order to maintain brain health, a person needs an adequate supply of carbohydrates (macronutrients), 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.
As the drug addiction and recovery informational resource The Fix discusses, healthy 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. While nutritional education may be available during rehab, afterward, the recovering person will have to self-educate and seek out or be referred to the right types of professionals who can help. A registered dietician is one such professional.
Some insurance plans provide coverage for visits to a registered dietician. A recovering person may be able to find a registered dietician with an addiction-nutrition specialization. In some cases, a person may become a practicing nutritionist in this area because of a personal history with addiction and recovery. 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, such as the one the Academy of Nutrition and Dietetics makes available to the public.
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. Per the Academy of Nutrition and Dietetics, a registered dietician can:
- Provide clients with a realistic personalized diet plan that takes into account their health condition, most recent blood test results, any food allergies, and any 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 to 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 2-3 months and then once a month for 3-4 months in order to track overall progress; however, there are always other scheduling possibilities. When insurance plans cover visits to a registered dietician, there may limits on the number of visits. For that reason, if out-of-pocket payment is not feasible, it can help to talk with the insurance provider about plan allowances and limits before setting up a schedule with a registered dietician.
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 specialist have observed, sometimes a person who is in recovery from drug abuse substitutes one kind of abuse for another. The addictive behavior is still there, although drugs are not being abused. 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 to maintain a balanced relationship with food and nutrition, which can in turn support a more balanced lifestyle overall.
Exercise and Addiction Recovery
To young adults today, the name Jack LaLanne may vaguely ring a bell; however, the biography of this paragon of fitness reveals a heartfelt personal story. As a child, Jack LaLanne reportedly ate lots of junk food and had behavioral problems in school. But teen LaLanne’s life turned around when he heard a nutritionist speak at his school. At a time when exercise and nutrition were not popular, LaLanne motivated himself to start working out and eating a healthy diet. He saw an improvement in his mood and self-esteem and became a much lauded high school athlete.
As the self-improved LaLanne went into adulthood, he decided he wanted to share his experience with the entire world. To that end, LaLanne opened the first fitness gym in the US and hosted the first televised fitness show. He then went on to become hailed as the “godfather of fitness” and lived to be 96 years old. The LaLanne story highlights that greater fitness and improved health are always available to just about anyone at almost any time.
It is helpful to keep inspirational stories in mind when thinking about fitness and exercise because there are ample negative influences in the US that drive Americans into low activity levels. Consider the following facts and statistics on exercise in the US from the President’s Council on Fitness, Sports & Nutrition:
- Fewer than 5 percent of adult Americans engage in 30 minutes of physical activity each day.
- Only about 33 percent of Americans engage in the recommended amount of weekly physical activity.
- About 51.6 percent of Americans exercise regularly.
- Approximately 80.2 million Americans in the 6-and-older age group (28 percent) are physically inactive.
- Over 80 percent of American adults do not meet the recommended guidelines for aerobic and muscle-strengthening exercise; the same percent applies to youth measured against similar federal guidelines for this age group.
In view of the correlation between inadequate physical activity and low mood, which is a contributing factor to drug abuse, it is not surprising that the US faces a drug epidemic and an obesity epidemic. But for many Americans, poor physical health is reversible with exercise, including those individuals who are recovering from substance abuse.
As The Fix reports, there is a general consensus in the addiction treatment community and among individuals in recovery that engaging in a healthy exercise regimen can help to maintain abstinence. Again, it is well observed that many individuals in recovery use exercise as a tool to stay the course of sobriety. But, as The Fix notes, it is important to let science speak to whether exercise really helps people recovering from drug addiction.
Madhukar H. Trivedi, MD, is a psychiatrist and the founder of a clinical trial, known as the STRIDE study, 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, plus weekly outpatient visits thereafter, half of the group was assigned to an intensive fitness program while the other half received health education classes. The STRIDE study found that the group that engaged in intensive exercise received more benefits in the stimulant addiction recovery process than the group that only received 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.
According to Trivedi, 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. This uptick in brain chemicals improves mood, which in turn supports healthier practices and lifestyles. Even further, as these neurochemicals release in the brain during exercise, the brain — through a process known as neuroplasticity — can create pathways that make it easier for the recovering person to want to exercise. In short, the brain is flexible, and it can adapt to healthy behaviors as readily as to unhealthy ones.
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. Notes SMART Recovery, a network of mutual-aid recovery groups, exercise does not need to be complicated to be effective.
A low-impact exercise regimen, such as daily walks, can support recovery. Research reflects that walking 30 minutes a day for several days each week has numerous health benefits.
Fitness goals are a separate matter and require training. For instance, some individuals in recovery may create a personal goal of running a 5K, a half-marathon, a marathon, or completing a triathlon. The lesson here is that daily low-impact exercise, an intensive workout schedule, or a fitness regimen of varying levels can support recovery.
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.