1. The Role of Wellness and Nutrition in the Prevention and Treatment of Substance Use Disorders
Barbara Koffske Reid, Ph.D., M.A., M.Ed., LMFT
Core Faculty, Cambridge College
Chair, Bachelor of Science in Wellness & Health Promotion

2. Why Wellness & Nutrition
Increased risk and co-occurrence of physical health problems
Increased risk and co-occurrence mental health problems
Those with substance use disorders often have poorer nutritional status
Stress well known risk factor for substance use disorders
Elements of wellness have been shown to be effective in conditions that often co-occur in substance use disorders (managing stress, reducing symptoms of depression)
Nutrition & wellness initiatives can increase protective factors that may positively affect treatment and recovery

3. Particularly Relevant for Women
Women report significantly higher levels of chronic stress than men (Matud,2004)
Rate their life events as more negative and less controllable than men (Matud,2004)
Women more likely to report stress related health problems such as hypertension, depression, anxiety and obesity (APA, 2012)
Stress increases the likelihood of alcohol and drug use - can precipitate relapses following treatment (Sinha, 2007)
Mood and anxiety disorders higher in women with & without SUD’s (Conway et al., 2006)

4. Particularly Relevant for Women
Depression, 2nd leading cause disability globally 2020 – twice as common in women (WHO, 2013)
High rates of PTSD/trauma in women and substance use disorders – poorer treatment outcomes (Shafer & Najavits, 2007)
Women who abuse opioid medications have an almost 200 percent greater chance of developing PTSD (Meier et al., 2014)
Women typically enter treatment with more medical, behavioral, psychological and social problems than men (Hernandez-Avila et al, 2004)

5. Elements of Wellness
Stress Reduction
Exercise
Sleep
Nutrition

6. Stress Reduction
Help to lessen the negative effects of chronic stress reduce stress hormones like cortisol and activate hormones such as serotonin, GABA and oxytocin
Breathing exercises
Meditation
Guided visualizations
Yoga
Music
Mindfulness

7. Mindfulness Being fully in the present moment.
Awareness without judgment, mindful savoring practice, nature, smells, colors, appreciating the present moment
Contemplative practices and a psychological state of awareness
Non denominational – a tool/function that may enhance sacred and everyday experiences
People have become dulled to the joys of everyday life
Mindfulness meditation can reorient them to appreciating the present moment Garland, 2008

8. Mindfulness
Mindfulness-based cognitive therapy effective in treating depression (Segal et al., 2010)
Positive effect on mood, may be useful preventing relapse (Zhunag et al., 2013; Bowen & Kurz, 2010)
Mindfulness-Oriented Recovery Enhancement (MORE) reduce cravings for opioid drugs
Helping patients find happiness in their day to day experiences – the more meditation – brain scans revealed more activity – less cravings for opioids
Garland, 2008

9. Exercise Sedentary lifestyle – changes in technology (Eaton, 2005)
4th leading risk factor – mortality (WHO, 2013)
Biking, swimming, walking, dancing, sports, aerobic, high intensity, strength training
Numerous physical & mental health benefits
Improve mood
Increase energy
Better physical health
Reduce stress, anxiety,
With many populations

10. Exercise in SUD Reduced cravings Reduced substance use
Increased energy
Overall wellbeing
Aerobic strength
Muscle capacity
Endurance
Youth active or involved with sports less likely to use – although context matters
Better treatment outcomes
(Rosseler, 2010; Dolezal, 2013; Brown et al, 2009; Terry-McElrath et al., 2011)

11. Standard American Diet
Highly refined, processed foods
High in refined sugars
High in unhealthy fats, animal fats
High in omega 6’s (veg, corn & soy oils)
Lower consumption of nutrient dense foods
Low in omega 3’s (avocados, cold water fish, walnuts, dark green leafy veggies) & other essential nutrients
Low in plant-based foods, veggies, fruits, seeds
Low in fiber
Implications for brain health and mental health
(Grotto & zeid,2010; Hibbeln, 2009; Wiles, 2009; School et al., 2003; Waylon, 2008)

12. Problem..... High omega 6’s inflammation DISEASE
Omega 6’s INCREASE inflammation
Omega 3’s decrease inflammation
Ideal ratio 1:1 to 4:1
Our ratio 15:1 – 30:1
High omega 6’s inflammation DISEASE

13. Nutrition and Omega 3’s Elements of nutrition key to brain health
Vitamin B, D, Antioxidants, Essential Fatty Acids
Vision, memory, cognitive function, mood, CNS
Essential Fatty Acids - Omega 3’s
Critical to every cell
Development, structure & functioning of the brain
Development of fetus, neuronal pathways, vision
Maintain fluidity of cells & aid in communication
Tend to reduce inflammation
Must be obtained through diet
Up to 90% of population deficient

14. Omega 3’s & Mental Health
Deficiencies reported in a variety of mental health conditions – schizophrenia, ADHD, dyslexia, depression, bipolar disorder
Low levels associated with self harm & impulsivity
Positively associated with depression
Associated with suicidal behavior in depressed patients
Low levels increased depression in women
Supplementing decreased symptoms of depression in pregnant & post partum women

15. Omega 3’s and SUD
Decrease in anger, anxiety & aggression (Burdens-Branchey et al., 2008)
Decrease in depressive symptoms, suicidality and a greater ability to cope with stress (Hallahan et al, 2007)
Reduced relapse vulnerability (Burdens-Branchey & Branchey, 2009)
Decrease in anxiety when given supplementation - results lasting three months after treatment (Burdens-Branchey & Branchey, 2006)
Reduced depression with increased omega 3’s (Beydun et al., 2013)
Less neuroinflammation (Tajuddin et al., 2013)

16. Move Towards Wellness Shifting to a more comprehensive approach
SAMHSA - integrating wellness & health promotion strategies 
Strong evidence base on elements of wellness
Stress reduction strategies
Meditation
Mindfulness strategies
Exercise
Nutrition

17. Bureau of Substance Abuse Services
Integration of wellness and nutrition as part of Approved Addictions Educational Providers
“Holistic and nutritional approaches to recovery: Awareness that a range of approaches support recovery, including (but not limited to) acupuncture, naturopathic/homeopathic medicine, chiropractic, healthy eating/exercise, and mindfulness”
Careers of Substance – careersofsubstance.org
Wellness & Nutrition in Substance Abuse Treatment
Self-Care for Providers
Trainings on Wellness & Nutrition in Treatment