Nutrition Education in California Non-medical Substance Use Disorder Treatment Programs

Abstract

Substance use disorder (SUD) is the continued use of drugs or alcohol that causes problems in health and personal or professional relationships and responsibilities. In the United States, SUD affects 14.5% of people over 12 years old. Nutrient deficiencies are common among persons with substance use disorder (PWSUD) due to altered eating behaviors and potential metabolic changes, increasing their risk of diet-related chronic disease. Once in recovery, PWSUDs often experience cravings, low restraint, overeating, and weight gain, further increasing the previously stated risk. However, research suggests that nutrition education (NE) can help reduce these risks and improve recovery success, but limited data exist on the extent to which NE is used to help facilitate recovery. This study explored how California non-medical residential SUD treatment centers incorporate NE into their recovery programs.

The study used a sequential mixed methods design that included an initial survey of all SUD treatment programs on file with the California Health and Human Services (CHHS) (n = 537). The survey served as a screening tool for participation in the interview. Those programs that offered NE were invited to participate in the subsequent interview, which obtained details about the survey responses.

I collected data from 37 surveys and five interviews. Using descriptive analysis of the survey results, I found that 22 facilities offered NE, and eight had nutrition professionals on staff. Nutrition education was of low importance, with management often more focused on other requirements placed on the program. I then analyzed the information gathered from the interviews for emergent themes using descriptive qualitative analysis.

Lower importance and nonmaleficence were identified as the two main themes. Lower importance was divided among three subthemes: management focus, deprioritization, and marginalization. The lack of management attention left NE a lower priority, often delivered by staff who were not nutrition experts, resulting in nutrition being a side topic rather than a specific focus. The lack of NE can contribute to long-term harm by increasing nutrition-related chronic disease risk.

I recommend that these themes be addressed by (a) additional research expanding on the current sample pool, (b) exploring barriers to offering NE, (c) using action research to create a tailored NE program that could be readily implemented, (d) establishing best practices and guidelines incorporating NE into SUD treatment, (e) requiring nutrition training and continuing education for SUD professionals, and (f) increasing oversight of nutrition offerings at the regulatory level.