Assessing a Client`s Nutritional Status

While the primary goal of addiction counseling is to assist the client to alter behavior related to use of addictive chemicals, a secondary goal is to help the client recover from the damage done to his/her life and body. A balanced diet has been noted as important to recovery.1 For some clients, poor eating habits and the substitution of alcohol for food result in malnutrition.

Alcohol provides calories (so the body has energy) but not the essential nutrients required to maintain the body. Some people with substance abuse problems ignore the need for food because they lack funds (they spend on drugs or alcohol rather than food), they want to feel the effects of the drug or alcohol faster (which is likely if no food is in the stomach), or they don't feel that they are worth the time, energy, or money spent on food.

Malnutrition also results from damage to the stomach, small intestine, and liver caused by alcohol and other drugs of abuse. Substance abuse's toxic effects impair nutrient absorption and the ability to store nutrients for future use. Abstinence from substances will bring about some improvement in nutritional condition, but abstinence alone is insufficient to rebuild damaged body tissues and promote health.

Beasley and Knightly note that long before the discovery of psychiatric drugs, doctors of all cultures used food as part of their treatment for mental illness.2 The popularity of nutritional interventions has waxed and waned over the years, even though the nutritional approach always has been one of the safest and most effective ways of preventing and healing disease. Fortuna describes the importance of nutrition for recovering individuals.3

Every client deserves a detailed assessment of the problems present, and a treatment plan that addresses those problems. Nutritional assessment is an essential aspect of understanding overall health, and assessment of nutritional status and dietary patterns will assist the counselor in establishing a treatment plan and support for the recovering client. The following information will assist the intake and assessment counselor in documenting issues that might be related to dietary patterns and nutritional status.

Determining risk

Adults are considered to be at nutritional risk if one or more of the following conditions is present:

• involuntary loss or gain of more than 10% of the usual body weight within six months, or more than 5% of the usual body weight in one month, or a weight of 20% over or under ideal body weight;

• chronic disease;

• recent illness, surgery, or trauma;

• inadequate food intake; and

• difficulty absorbing nutrients (diarrhea, vomiting)4

Assessment and treatment planning are most effective when the client and the counselor work together and when the client has a role in determining the course of action. Asking the client about health issues as part of the addiction assessment may provide a basis for further evaluation of nutritional status. A client who is asked about food intake often will report eating what he/she thinks should have been eaten, rather than what was actually consumed. Asking about what foods are eaten most often can provide a better picture of actual dietary patterns.4

Nutrition screening is the process of identifying characteristics known to be related to nutritional problems. Each facility or setting is responsible for determining the most appropriate means of screening clients; however, very few screening tools have been validated.4

A skilled counselor is able to read nonverbal cues and to ask for information that might not be included in assessment questionnaires. When conducting a nutrition assessment, the professional must ask about the ways in which the client obtains and prepares food, as well as what foods are consumed. Client attitudes toward food offer important clues related to compliance with an altered dietary plan. The table lists physical indicators of nutritional problems that should be looked for in clients; these symptoms indicate the need for a more thorough assessment by a physician and/or dietitian.

Table. A checklist ofobservable symptoms ofnutritional imbalance

• Height and weight

• Is this person alert?

• Groomingdoes the individual seem to care about appearance, but hair looks as if it has not been combed?

• Does the fit of clothing indicate weight gain or loss? (note indications such as different belt settings, or tight- or loose-fitting clothing)

• Note any indications of nutritional problems, including the following:

  • Bruises (ask about what happened to cause the bruise and how long it has been there)

  • Wounds that appear not to be healing or that healed and then opened again

  • Cracks or scars at the corners of the mouth

  • Dark areas over the cheeks or under the eyes

  • Dry skin

  • Red eyes

  • Tremors

  • Indications of muscle weakness

  • Sparse, dry, dull hair

  • Pale color of nails, lips, palms

  • Missing teeth

  • Dentures

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In addition to asking the usual questions about prescription medications that are part of the intake assessment for addiction clients, the counselor needs to ask about over-the-counter medications, nu-tritional supplements, and herbal products. Addicts often think they can negate the damage done by drug use by taking nutritional and herbal supplements.

Some clients, especially women, are concerned about gaining weight or want to lose weight after treatment, because eating more regularly has resulted in weight gain. Some use fad diets and others go from one addiction to another in the form of an eating disorder. The physical damage resulting from an eating disorder can be as serious as that caused by substance abuse. The damage is compounded in clients with a co-occurring addiction and eating disorder.

During assessment, questions about symptoms indicative of eating disorders are important.2 The following factors are important indicators:

• sense of a lack of control over eating;

• eating more or less than the average person would eat under similar conditions;

• eating more rapidly than normal;

• eating until feeling uncomfortably full;

• eating large amounts of food when not feeling hungry;

• fear of gaining weight or becoming fat; and

• more than 25% under desired body weight.5

Conclusion

In an ideal treatment agency with sufficient resources, nutrition screening and treatment would be regular parts of the program. Dietary changes would be implemented to enhance the treatment experience and promote sobriety. Yet most agencies do not have the expertise or the resources to integrate nutritional therapies into every client's treatment.

This article's guidelines give counselors the tools to conduct a basic nutritional assessment that will support dietary change. Referral to a dietitian or physician knowledgeable in nutrition and substance abuse will give the client further support in improving health through nutrition.

References

1. Miller M, Gorski T, Miller DK. Learning to Live Again: A Guide for Recovery from Chemical Dependen-cy. Independence Mo.:Independence Press; 1982. 135-8.
2. Beasley JD, Knightly S. Food for Recovery: The Complete Nutritional Companion for Recovering from Alcoholism, Drug Addiction, and Eating Disorders. BioTreatment Medi-cal Center, 2000;46-9.
3. Fortuna JL. Food, Brain Chemistry and Behavior. 2nd ed. Boston:Pearson Custom Publishing; 1998. 186-8.
4. Charney P Malone A, eds. ADA Pocket Guide to Nutrition Assessment. Chicago American Dietetic Associa-tion; 2004.
5. Woolsey MM. Eating Disorders: A Clinical Guide to Counseling and Treatment. Chicago:American Dietetic Association; 2002. 4-5.