Registered Dietitian Nutritionists in Substance Use Disorder Treatment Centers

Optimizing Outcomes: A Systematic Review of Psychosocial Risk Factors Affecting Perinatal Black/African-American Women with Substance Use Disorder in the United States

INTRODUCTION

Despite studies having examined and discussed the various multifaceted risk factors affecting perinatal women with substance use disorder (SUD), the limited amount of research on Black/African-American (B/AA) women allows health disparities in this population to widen. Segmenting the needs of the low-income B/AA female population with SUD is crucial when creating multi-layered and multi-faceted innovative upstream evidence-based interventions. This review assesses and examines studies that investigate psychosocial, environmental, and systemic level risk factors related to implicit bias, trauma, toxic stress, food issues, and SUD.

METHODS

The principal investigator (PI) utilized PubMed, Google Scholar, ProQuest Dissertations and Theses Global to perform a systematic scoping review of the published literature. Research focused on risks factors affecting low-income perinatal B/AA women. The literature review examined articles published January 2010 through December 2020. Inclusion criteria incorporated risk factors, health disparities, and SUD. Studies selected for this review have been published in English and conducted in the USA.

RESULTS

Our research identified 509 articles, of which we chose to include 75. The literature highlights health disparities influenced by risks factors of implicit biases, trauma, and toxic stress, which construct physical and emotional barriers to healthy food and food resources in B/AA women with SUD.

CONCLUSION

The PI found limited or non-existent research on innovative interventions targeting perinatal B/AA women with SUD. This review recommends deconstructing hidden psychosocial, environmental, and systematic risk factors to assist in developing novel comprehensive strategies and wraparound support services.

Food insecurity partially mediates the association between drug use and depressive symptoms among men who have sex with men in Los Angeles, California

OBJECTIVE

To understand the relationship between drug use, food insecurity (FI) and mental health among men who have sex with men (MSM).

DESIGN

Cohort study (2014-2019) with at least one follow-up.

SETTING

Visits at 6-month intervals included self-assessment for FI and depressive symptoms. Urine testing results confirmed drug use. Factors associated with FI were assessed using multiple logistic regression with random effects for repeated measures. General structural equation modelling tested whether FI mediates the relationship between drug use and depressive symptoms.

PARTICIPANTS

Data were from HIV-positive and high-risk HIV-negative MSM in Los Angeles, CA (n 431; 1192 visits).

RESULTS

At baseline, FI was reported by 50·8 % of participants, depressive symptoms in 36·7 % and 52·7 % of urine screening tests were positive for drugs (i.e. marijuana, opioids, methamphetamine, cocaine and ecstasy). A positive drug test was associated with a 96 % increase in the odds of being food insecure (95 % CI 1·26, 3·07). Compared to those with high food security, individuals with very low food security have a nearly sevenfold increase in the odds of reporting depressive symptoms (95 % CI 3·71, 11·92). Findings showed 14·9 % of the association between drug use (exposure) and depressive symptoms (outcome) can be explained by FI (mediator).

CONCLUSION

The prevalence of FI among this cohort of HIV-positive and high-risk HIV-negative MSM was high; the association between drug use and depressive symptoms was partially mediated by FI. Findings suggest that enhancing access to food and nutrition may improve mood in the context of drug use, especially among MSM at risk for HIV transmission.

Efficacy of dietary interventions in individuals with substance use disorders for illicit substances or illicit use of pharmaceutical substances: A systematic review

BACKGROUND

Disordered eating habits, poor dietary intake and nutritional status, and altered body composition are highly prevalent among individuals with substance use disorders. This systematic review aimed to evaluate the efficacy of dietary interventions in adults with substance use disorders for illicit substances or illicit use of pharmaceutical substances.

METHODS

Eight scientific databases were searched using predetermined text word and subject heading (MeSH) searches for experimental studies published up to March 2020 that evaluated interventions aiming to improve dietary intake in adults with substance use disorders for illicit substances or illicit use of pharmaceutical substances, which included dietary intake outcomes.

RESULTS

Of 9299 articles identified, five studies were included. Three studies (60%) were conducted in outpatient/community clinic settings and two studies (40%) were conducted in inpatient/residential treatment centres. Dietary interventions ranged in duration from 5 weeks to 24 months. These included education and behaviour change advice for nutrition and other lifestyle behaviours (n = 3 studies), nutrition education and provision of healthy food choices within the residential treatment centre (n = 1 study), and polyunsaturated fatty acid supplementation (n = 1 study). Three studies (60%) reported small but significant change in one or more dietary outcome at post-intervention, including reductions in sweets, fast food or caffeine intake, as well as increases in fruit and vegetable intake.

CONCLUSIONS

This review has identified a small number of studies, despite the strong evidence that dietary intervention is needed in substance use rehabilitation. More research is needed to determine the most effective intervention approaches for this group, including robust study designs.

Staff-perceived barriers to nutrition intervention in substance use disorder treatment

OBJECTIVE

While organisational change in substance use disorder (SUD) treatment has been extensively studied, there is no research describing facility-wide changes related to nutrition interventions. This study evaluates staff-perceived barriers to change before and after a wellness initiative.

DESIGN

A pre-intervention questionnaire was administered to participating staff prior to facility-wide changes (n 40). The questions were designed to assess barriers across five domains: (1) provision of nutrition-related treatment; (2) implementation of nutrition education; (3) screening, detecting and monitoring (nutrition behaviours); (4) facility-wide collaboration and (5) menu changes and client satisfaction. A five-point Likert scale was used to indicate the extent to which staff anticipate difficulty or ease in implementing facility-wide nutrition changes, perceived as organisational barriers. Follow-up questionnaires were identical to the pre-test except that it examined barriers experienced, rather than anticipated (n 50).

SETTING

A multisite SUD treatment centre in Northern California which began implementing nutrition programming changes in order to improve care.

PARTICIPANTS

Staff members who consented to participate.

RESULTS

From pre to post, we observed significant decreases in perceived barriers related to the provision of nutrition-related treatment (P = 0·019), facility-wide collaboration (P = 0·036), menu changes and client satisfaction (P = 0·024). Implementation of nutrition education and the domain of screening, detecting and monitoring did not reach statistical significance.

CONCLUSIONS

Our results show that staff training, food service changes, the use of targeted curriculum for nutrition groups and the encouragement of discussing self-care in individual counselling sessions can lead to positive shifts about nutrition-related organisational change among staff.

A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health

The opioid crisis has reached epidemic proportions in the United States with rising overdose death rates. Identifying the underlying factors that contribute to addiction vulnerability may lead to more effective prevention strategies. Supply side environmental factors are a major contributing component. Psychosocial factors such as stress, trauma, and adverse childhood experiences have been linked to emotional pain leading to self-medication. Genetic and epigenetic factors associated with brain reward pathways and impulsivity are known predictors of addiction vulnerability. This review attempts to present a biopsychosocial approach that connects various social and biological theories related to the addiction crisis. The emerging role of nutrition therapy with an emphasis on gastrointestinal health in the treatment of opioid use disorder is presented. The biopsychosocial model integrates concepts from several disciplines, emphasizing multicausality rather than a reductionist approach. Potential solutions at multiple levels are presented, considering individual as well as population health. This single cohesive framework is based on the interdependency of the entire system, identifying risk and protective factors that may influence substance-seeking behavior. Nutrition should be included as one facet of a multidisciplinary approach toward improved recovery outcomes. Cross-disciplinary collaborative efforts, new ideas, and fiscal resources will be critical to address the epidemic.

Double jeopardy: a review of weight gain and weight management strategies for psychotropic medication prescribing during methadone maintenance treatment

Methadone maintenance treatment (MMT) is an important treatment tool for the opioid epidemic. One challenge is that many persons who present for MMT also have co-occurring psychiatric disorders. Individually, both methadone and psychiatric medications carry risk of weight gain. Therefore, concurrent prescribing of methadone and psychiatric medications places dual diagnosis patients at even greater risk. As a parallel obesity epidemic grows, results from clinical trials assessing weight gain and weight management strategies among MMT and psychiatric patients can both inform and guide clinical practice. This study reviews findings from a literature search for recent clinical trials that focused on weight gain and weight management strategies during MMT with concurrent psychotropic medication use. While several studies have documented weight gain during MMT and psychotropic medication treatment, this study failed to identify recent work that explored concurrent prescribing. Most weight management strategies involved the use of additional medications and available data suggests that MMT and concurrent use of psychotropic medications increases the risk for obesity. More robust research is needed on weight gain and potential mitigation strategies when these treatment modalities are jointly utilized. Clarification of underlying biological mechanisms and development of non-pharmacological interventions merit further consideration.