The objective of this study was to determine the prevalence of nutrition services and utilization of registered dietitian nutritionists at substance use disorder treatment centers in Los Angeles. This cross-sectional descriptive study utilized phone interviews with facilities within a 25-mile radius of the Los Angeles metropolitan area using the Substance Abuse and Mental Health Services Administration Treatment Services Locator to identify facilities that included a listing of substance abuse as primary focus of care (n = 128). Facilities were asked if they offered any kind of nutrition services, the type of services that were offered, and the credential of the professional providing the services. We compared facilities that offered a residential level of care to those offering outpatient services only. The Fisher’s exact test was used to determine statistical significance. The study showed that only 39 sites (30.5%) offered any type of nutrition services on site, and the odds of a residential level of care offering nutrition services was 2.7 times higher than outpatient only facilities (p = 0.02). Of the 39 facilities offering nutrition services, only 8 (20.5%) utilized a registered dietitian nutritionist. Overall fewer than 7% of the facilities utilized the services of a dietitian. Recovery programs for substance use disorder should consider using a registered dietitian nutritionist as a member of the treatment team, which may contribute to better clinical outcomes.
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Center for Behavioral Health Statistics and Quality, Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51). 2016.
U.S. Department of Health and Human Services Centers for Disease Control and Prevention. (2014). Increases in heroin overdose deaths: 28 states, 2010 to 2012. Morbidity and Mortality Weekly Report, 63(29), 849–854.
American Dietetic Association, Position of the American Dietetic Association. (1990). Nutrition intervention in treatment and recovery from chemical dependency. Journal of the American Dietetic Association, 90(9), 1274–1277.
Pelican, S., Batchelor, B., Belshaw, J., Osborn, W., Pearce, J., & Przekurat, C. (1994). Nutrition services for alcohol/substance abuse clients. Indian Health Service’s tribal survey provides insight. Journal of The American Dietetic Association, 94(8), 835–836.
Engel, G. L. (1980). The clinical application of the biopsychosocial model. American Journal of Psychiatry, 137(5), 535–544.
Griffiths, M. (2009). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10(4), 191–197.
McLellan, A. T., Luborsky, L., O’Brien, C. P., Woody, G. E., & Druley, K. A. (1982). Is treatment for substance abuse effective? JAMA, 247, 1423–1428.
McLellan, A. T., Luborsky, L., Woody, G. E., O’Brien, C. P., & Druley, K. A. (1983). Predicting response to alcohol and drug abuse treatments: Role of psychiatric severity. Archives of General Psychiatry, 40, 620–625.
McLellan, A. T., Woody, G. E., Metzger, D., McKay, J., Durell, J., Alterman, A. I., & O’Brien, C. P. (1996). Evaluating the effecitveness of addiction treatments: Reasonable expectations, appropriate comparisons. The Milbank Quarterly, 74(1), 51–85.
O’Brien, C. P., & McLellan, A. T. (1996). Myths about the treatment of addiction. The Lancet, 347, 237–240.
McLellan, A. T., Alterman, A. I., Cacciola, J., Metzger, D., & OʼBrien, C. P. (1992). A new measure of substance abuse treatment: Initial studies of the treatment services review. The Journal of Nervous and Mental Disease, 180(2), 101–110.
McLellan, A. T., Hagan, T. A., Levine, M., Gould, F., Meyers, K., Bencivengo, M., & Durell, J. (1998). Supplemental social services improve outcomes in public addiction treatment. Addiction, 93(10), 1489–1499.
Substance Abuse and Mental Health Services Administration. (2017). National Survey of Substance Abuse Treatment Services (N-SSATS): 2016.
Santolaria-Fernández, F. J., Gómez-Sirvent, J. L., González-Reimers, C. E., Batista-López, J. N., Jorge-Hernández, J. A., Rodríguez-Moreno, F., et al. (1995). Nutritional assessment of drug addicts. Drug and Alcohol Dependence, 38(1), 11–18.
Islam, S. N., Hossain, K. J., Ahmed, A., & Ahsan, M. (2002). Nutritional status of drug addicts undergoing detoxification: Prevalence of malnutrition and influence of illicit drugs and lifestyle. British Journal of Nutrition, 88(5), 507–513.
Ross, L. J., Wilson, M., Banks, M., Rezannah, F., & Daglish, M. (2012). Prevalence of malnutrition and nutritional risk factors in patients undergoing alcohol and drug treatment. Nutrition, 28(7–8), 738–743.
Baptiste, F. (2009). Drugs and diet among women street sex workers and injection drugs user in Quebec City. Candian Journal of Urban Research, 18(2), 78–95.
Kampov-Polevoy, A., Garbutt, J. C., & Janowsky, D. (1997). Evidence of preference for a high-concentation sucrose solution in alcoholic men. American Journal of Psychiatry, 154(2), 269–270.
Neale, J., Nettleton, S., Pickering, L., & Fischer, J. (2012). Eating patterns among heroin users: A qualitative study with implications for nutritional interventions. Addiction, 107(3), 635–641.
Saeland, M., Haugen, M., Eriksen, F. L., Wandel, M., Smehaugen, A., Böhmer, T., & Oshaug, A. (2011). High sugar consumption and poor nutrient intake among drug addicts in Oslo, Norway. British Journal of Nutrition, 105(4), 618–624.
Alves, D., Costa, A. F., Custódio, D., Natário, L., Ferro-Lebres, V., & Andrade, F. (2011). Housing and employment situation, body mass index and dietary habits of heroin addicts in methadone maintenance treatment. Heroin Addiction and Related Clinical Problems, 13(1), 11–14.
Leclercq, S., Cani, P. D., Neyrinck, A. M., Stärkel, P., Jamar, F., Mikolajczak, M., et al. (2012). Role of intestinal permeability and inflammation in the biological and behavioral control of alcohol-dependent subjects. Brain, Behavior, and Immunity, 26(6), 911–918.
Leclercq, S., Matamoros, S., Cani, P. D., Neyrinck, A. M., Jamar, F., Stärkel, P., et al. (2014) Intestinal permeability, gut-bacterial dysbiosis, and behavioral markers of alcohol-dependence severity. Proceedings of the National Academy of Sciences, 111(42):E4485–E4493.
Volpe, G. E., Ward, H., Mwamburi, M., Dinh, D., Bhalchandra, S., Wanke, C., & Kane, A. V. (2014). Associations of cocaine use and HIV infection with the intestinal microbiota, microbial translocation, and inflammation. Journal of Studies on Alcohol and Drugs, 75(2), 347–357.
Cowan, J. A., & Devine, C. M. (2008). Food, eating, and weight concerns of men in recovery from substance addiction. Appetite, 50(1), 33–42.
Warren, C. S., Lindsay, A. R., White, E. K., Claudat, K., & Velasquez, S. C. (2013). Weight-related concerns related to drug use for women in substance abuse treatment: Prevalence and relationships with eating pathology. Journal of Substance Abuse Treatment, 44(5), 494–501.
Bonfa, F., Cabrini, S., Avanzi, M., Bettinardi, O., Spotti, R., & Uber, E. (2008). Treatment dropout in drug-addicted women: Are eating disorders implicated? Eating and Weight Disorders, 13(2), 81–86.
Bulik, C. M., Slof, M., & Sullivan, P. (2004). Comorbidity of eating disorders and substance-related disorders. Medical Psychiatry, 27, 317–348.
Ho, V., Arbour, S., & Hambley, J. M. (2011). Eating disorders and addiction: Comparing eating disorder treatment outcomes among clients with and without comorbid substance use disorder. Journal of Addictions Nursing, 22(3), 130–137.
Glasner-Edwards, S., Mooney, L. J., Marinelli-Casey, P., Hillhouse, M., Ang, A., & Rawson, R. & Methamphetamine Treatment Project Corporate Authors. (2011). Bulimia nervosa among methamphetamine dependent adults: Association with outcomes three years after treatment. Eating Disorders, 19(3), 259–269.
Gadalla, T., & Piran, N. (2007). Eating disorders and substance abuse in Canadian men and women: A national study. Eating Disorders, 15(3), 189–203.
Rieder, R., Wisniewski, P. J., Alderman, B. L., & Campbell, S. C. (2017). Microbes and mental health: A review. Brain, Behavior, and Immunity. https://doi.org/10.1016/j.bbi.2017.01.016.
Keightley, P. C., Koloski, N. A., & Talley, N. J. (2015). Pathways in gut-brain communication: Evidence for distinct gut-to-brain and brain-to-gut syndromes. Australian & New Zealand Journal of Psychiatry, 49(3), 207–214.
Skosnik, P. D., & Cortes-Briones, J. A. (2016). Targeting the ecology within: The role of the gut-brain axis and human microbiota in drug addiction. Medical Hypotheses, 93, 77–80.
Temko, J. E., Bouhlal, S., Farokhnia, M., Lee, M. R., Cryan, J. F., & Leggio, L. (2017). The microbiota, the gut and the brain in eating and alcohol use disorders: A ‘Menage a Trois’? Alcohol Alcoholism, 52, 403–413.
Mutlu, E. A., Gillevet, P. M., Rangwala, H., Sikaroodi, M., Naqvi, A., Engen, P. A., et al. (2012). Colonic microbiome is altered in alcoholism. American Journal of Physiology-Gastrointestinal and Liver Physiology, 302(9), G966–G978.
Gorky, J., & Schwaber, J. (2016). The role of the gut-brain axis in alcohol use disorders. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 65, 234–241.
Prakash, M. D., Tangalakis, K., Antonipillai, J., Stojanovska, L., Nurgali, K., & Apostolopoulos, V. (2017). Methamphetamine: Effects on the brain, gut and immune system. Pharmacological Research, 120, 60–67.
Alcoholics Anonymous World Services. (2001). Alcoholics anonymous. New York: Alcoholics Anonymous World Services, Inc.
Popkin, B. M., & Gordon-Larsen, P. (2004). The nutrition transition: Worldwide obesity dynamics and their determinants. International Journal of Obesity and Related Metabolic Disorders, 28(Suppl 3), S2–S9.
Hall, K. D. (2018). Did the food environment cause the obesity epidemic? Obesity, 26(1), 11–13.
National Center for Chronic Disease Prevention and Health Promotion. (2017). National Diabetes Statistics Report.
Balhara, Y. P. S., & Kalra, S. (2017). Drug addiction and diabetes: South Asian action. Recent Advances in Endocrinology, 67(6), 954–956.
Mies, G. W., Treur, J. L., Larsen, J. K., Halberstadt, J., Pasman, J. A., & Vink, J. M. (2017). The prevalence of food addiction in a large sample of adolescents and its association with addictive substances. Appetite, 118, 97–105.
Hardy, R., Fani, N., Jovanovic, T., & Michopoulos, V. (2018). Food addiction and substance addiction in women: Common clinical characteristics. Appetite, 120, 367–373.
García-García, I., Horstmann, A., Jurado, M. A., Garolera, M., Chaudhry, S. J., Margulies, D., et al. (2014). Reward processing in obesity, substance addiction and non-substance addiction. Obesity Review, 15(11), 853–869.
Edge, P. J., & Gold, M. S. (2011). Drug withdrawal and hyperphagia: Lessons from tobacco and other drugs. Current Pharmaceutical Design, 17(12), 1173–1179.
Hodgkins, C., Frost-Pineda, K., & Gold, M. S. (2007). Weight gain during substance abuse treatment: The dual problem of addiction and overeating in an adolescent population. Journal of Addictive Diseases, 26(Suppl 1), 41–50.
Emerson, M. H., Glovsky, E., Amaro, H., & Nieves, R. (2009). Unhealthy weight gain during treatment for alcohol and drug use in four residential programs for Latina and African American Women. Substance Use & Misuse, 44(11):1553–1565.
Calero-Elvira, A., Krug, I., Davis, K., López, C., Fernández-Aranda, F., & Treasure, J. (2009). Meta-analysis on drugs in people with eating disorders. European Eating Disorders Review, 17(4), 243–259.
Dennis, A. B., Pryor, T., & Brewerton, T. D. (2014). Integrated treatment principles and strategies for patients with eating disorders, substance use disorder, and addictions. In T. D. Brewerton & A. B. Dennis (Eds.), Eating disorders, addictions and substance use disorders. Berlin: Springer.
Leppert, W. (2015). Emerging therapies for patients with symptoms of opioid-induced bowel dysfunction. Drug Design, Development and Therapy, 9, 2215–2231.
Reid, B. K. (2014). Assessment of wellness and nutrition in residential alcohol and drug abuse treatment, in Heller School for Social Policy and Management, Brandeis University ProQuest.
Cowan, J. A., & Devine, C. M. (2012). Process evaluation of an environmental and educational nutrition intervention in residential drug-treatment facilities. Public Health Nutrition, 15(7), 1159–1167.
Cowan, J. A., & Devine, C. M. (2013). Diet and body composition outcomes of an environmental and educational intervention among men in treatment for substance addiction. Journal of Nutrition Education and Behavior, 45(2), 154–158.
Curd, P., Ohlmann, K., & Bush, H. (2013). Effectiveness of a voluntary nutrition education workshop in a state prison. Journal of Correctional Health Care, 19(2), 144–150.
Grant, L. P., Haughton, B., & Sachan, D. S. (2004). Nutrition education is positively associated with substance abuse treatment program outcomes. Journal of The American Dietetic Association, 104(4), 604–610.
Lindsay, A. R., Warren, C. S., Velasquez, S. C., & Lu, M. (2012). A gender-specific approach to improving substance abuse treatment for women: The healthy steps to freedom program. Journal of Substance Abuse Treatment, 43(1), 61–69.
Barbadoro, P., Ponzio, E., Pertosa, M. E., Aliotta, F., D’errico, M. M., Prospero, E., & Minelli, A. (2011). The effects of educational intervention on nutritional behaviour in alcohol-dependent patients. Alcohol and Alcoholism, 46(1), 77–79.
Moore, K. (2016). Hands-on nutrition and culinary intervention within a substance use disorder residential treatment facility. Journal of the Academy of Nutrition and Dietetics, 116(9), A20.
Wiss, D. A., Schellenberger, M., & Prelip, M. L. (2017). Registered dietitian nutritionists in substance use disorder treatment centers. Journal of the Academy of Nutrition and Dietetics. https://doi.org/10.1016/j.jand.2017.08.113.
Conflict of interest
David Wiss is the founder and owner of Nutrition in Recovery LLC which provides nutrition services to substance use disorder treatment facilities in Los Angeles, CA, including some in the sample. Mr. Wiss was not involved in contacting any of the facilities.
This study was approved by the University of Southern California University Park Institutional Review Board under Study ID: UP-16-00334.
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Wiss, D.A., Schellenberger, M. & Prelip, M.L. Rapid Assessment of Nutrition Services in Los Angeles Substance Use Disorder Treatment Centers. J Community Health 44, 88–94 (2019). https://doi.org/10.1007/s10900-018-0557-2
- Alcohol use disorder
- Opioid use disorder
- Substance-related disorders