Off the Drugs, Onto the Cupcakes

By ABBY ELLIN, NY Times

Rodney Zimmers was 21 years old and 135 pounds when he got off heroin and cocaine for good. Three years later, he was still drug free but had ballooned to 250. He blames his weight gain on the high-calorie, high-sugar food served in rehabilitation. “Once I got sober, I continued to eat all this awful stuff,” said Mr. Zimmers, now 29 and the founder of Blueprints for Recovery, an all-male treatment facility near Prescott, Ariz. “I learned how to be sober, but I didn’t learn how to take care of all of me. I didn’t know how to cook or grocery shop because I’d never done it. I didn’t learn any life skills or how to live like an adult.” His story is familiar to those in recovery, who often gain significant weight on their road to well-being. It’s not all their fault; most rehabilitation programs haven’t devoted much thought to nutrition. “The main focus was just, ‘get them off their substance,’ and the rest will take care of itself,” said Dr. Carolyn Coker Ross, an eating disorder and addiction medicine specialist in Denver who has been a consultant to various rehab centers. While fruits, vegetables and a variety of proteins were served in rehab, so were refined sugars, sodas, energy drinks, sugary juices and sugary/fatty/salty snacks (the so-called ”hyperpalatables”), all of which are relatively inexpensive and easy to buy in bulk. Sugar was also considered a harmless replacement for drugs and alcohol. In fact, AA’s “Big Book” — the 12 Step bible — suggests that recovering addicts keep candy on hand. (This may explain why cookies, coffee and plumes of cigarette smoke are often staples at so many 12 Step meetings.) But though sweets may have eased some people’s drug cravings, many ended up “transfer addicting” from their substance of choice to sugar. “Once off the drugs, the brain craves the uber rewards of the hyperpalatables — Mint Milanos, Oreos, any sugar. An apple’s reward doesn’t cut it,” said Dr. Pamela Peeke, an assistant professor of medicine at the University of Maryland and author of “The Hunger Fix.” “So you end up with the transfer addiction,” she added. “Off the cocaine, onto the cupcakes.” Research has found that food and drugs have similar influence on the brain’s reward center. A 2013 study published in The American Journal of Clinical Nutrition reported that sugar, not fat, stimulates cravings. And a widely cited study from that year found that Oreo cookies activated the nucleus accumbens, the brain’s pleasure or reward center, as much as cocaine and morphine, at least in laboratory rats. This has an effect not only on the addict’s neural pathways, but also on the addict’s psyche and self-esteem. “Some relapse because they’re so disgusted with the amount of weight they’ve put on,” said Dr. Marianne Chai, the medical director at the New York Center for Living, a recovery facility for adolescents, young adults and their families in Manhattan. “The mind-set is, ‘I want immediate results.’ They don’t want to invest the four to six months of strict diet and exercise. So they live on caffeine and stimulants or sometimes cocaine to lose weight.” Now, with more awareness of sugar’s effects on the brain, some rehab facilities are overhauling their meal plans and hiring “culinary nutritionists,” certified chefs who are also registered dietitians. “We’re not asking them to live on arugula,” said Dr. Peeke, who is also the senior science adviser to Elements Behavioral Health, which operates addiction and eating disorders treatment centers. “We come upon creative, delicious entrees and snacks that will compete with the junk they’ve been doing all along, to reclaim that reward center. We’re switching them from bad fixes to healthy fixes.” The Center for Living offers on-site cooking classes for patients and their parents, along with lectures on nutrition and healthy eating. Patients grow their own herbs and vegetables on a roof garden, and they are not allowed processed sugars, caffeine or energy drinks. “Most of the young adults don’t know anything about how to pick out food; they’re living on deli and fast food, and a lot of parents fail and struggle with self-care and modeling self-care,” said Dr. Chai, who believes that maintaining a proper diet can play a pivotal role in helping maximize one’s ability to recover in a “sustainable, lasting way.” Victoria Abel, a certified addiction nutritionist in Prescott, Ariz., who customizes nutrition programs at recovery facilities, said she had “no clue how desperate the field was for this.” “Patients are so malnourished, their body’s starving,” she added. She leads weekly grocery shopping excursions, where clients learn about healthy foods and how to read food labels. They’re not allowed to buy any item if the first four ingredients are some kind of sugar, and dessert is permitted only once a week. “I’m trying to teach moderation,” she said. Not every expert agrees with this treatment path. Dr. Mark Willenbring, the founder of Alltyr, an addiction treament clinic and consultancy in St. Paul, says he does not believe that healthy eating is the missing ingredient to help patients stay drug and alcohol free. “I think it’s rehab’s responsibility to provide a nutritious diet with plenty of fruits and vegetables, not too much red meat and not too much fat, because it’s healthy,” said Dr. Willenbring, the former director of the Division of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism. “But is it going to affect recovery? I don’t think so.” But those in the trenches are hopeful that the focus on nutrition is a step in the right direction. Christopher Kennedy Lawford, the author of many books on addiction, including the recent “What Addicts Know,” said: “When you’re used to shooting heroin or drinking a bottle of vodka, sugar seems really benign. It’s hard to take it seriously.” But Mr. Lawford, who was been drug and alcohol free for 23 years and said his first drug was sugar, is adamant that rehabilitation programs start treating addicts holistically. “You can’t get an addict into recovery until you deal with every aspect of their life,” he said. “What you think, how you think, how you relate to people, what you put in your body, how you exercise — it’s all related. And we need to get smarter about it.”