Quality of Health in Addiction Recovery (Derrick Mobley, M.D. and William White)

The Good News: More than 22 million Americans have resolved a significant alcohol or other drug problem during their lifetime

The Problem: People in recovery from addiction continue to suffer inordinate rates of respiratory disease, kidney failure, heart disease, diabetes mellitus, hypertension, stroke, cancer, and premature death. (Eddie et al., 2019; White et al., 2013)

The Solution: At a personal level, changing unhealthy lifestyle habits can enhance life expectancy and improve quality of life in long-term recovery. At a systems level, integrating addiction treatment and allied recovery support services with primacy health care could reduce the burden of disease experienced by people in addiction recovery. One potential framework for such integration is the emerging field of lifestyle medicine.

Lifestyle Medicine

Lifestyle Medicine/Healthcare is a relatively new medical specialty spawned by the discovery that changes in daily habits can reduce the likelihood of contracting non-infectious chronic diseases by 80% and cancers by 40% (ACLM)—all accomplished without a pill or surgical procedure. Lifestyle medicine is predicated upon six pillars:

1) Eating predominantly whole food, plant-based foods, and avoiding processed foods as much as possible – Food is medicine.

2) Establishing and maintaining regular, consistent, and age-appropriate physical activity – Exercise is medicine, too.

3) Managing unhealthy stress to avoid anxiety and depression and to bolster one’s immune system.

4) Practicing good sleep hygiene (7 to 9 hours per night) for the average adult to maintain a strong immune system and regulate metabolism.

5) Understanding social connection as essential for emotional resiliency. (Social isolation is associated with early mortality.)

6) Avoiding tobacco and other toxins that can lead to heart disease and numerous types of cancer.

There is also a sometimes-controversial 7th pillar. Many lifestyle medicine specialists contend that having a strong spiritual connection completes a holistic approach to health and wellness.

By honing these seven pillars of lifestyle healthcare and infusing them into a program of recovery, we can profoundly influence the quality of addiction recovery and population-level health.

Let us explore each of the Lifestyle Medicine/Healthcare pillars in a little more detail and relate them to the recovery community.

Nutrition This is one of the most important lifestyle changes available to enhance recovery outcomes. Poor dietary choices and irregular food intake is one of the hallmarks of addiction and the malnourishment or undernourishment that undermines long-term health. Eating mostly plant-based foods consisting of fresh vegetables, fruits, beans, nuts, whole grains, and seeds can restore the gut microbiota and help prevent/control hypertension, heart disease, and diabetes. Poor nutrition can aggravate mental health conditions such as mood disorders including anxiety and depression.

Physical Activity There is ample evidence that regular aerobic exercise can reduce illicit drug use. It is also tremendously important in preventing, treating, and even curing some of the chronic diseases that can develop during addiction and extend into one’s time in recovery. Regular physical activity can have salutary effects on cholesterol levels, hypertension, and insulin regulation. Getting such activity can be as simple as walking, gardening, dancing, or doing household chores. Exercise is currently the initial prescription by psychiatrists for patients with mild to moderate depression. Exercise can be thought of as “body prayers” to supplement the spiritual prayers commonly used in recovery.

Stress Management is an essential recovery tool that should be of immense importance to the recovery community. Excessive alcohol and drug use often begins as a negative response to a stress stimulus. Beyond abstinence, stress (distress) can lead to anxiety, depression, obesity, and immune dysfunction. Developing improved strategies for coping is an essential task within the process of long-term addiction recovery.

Sleep Hygiene is an area of lifestyle that is commonly undervalued by the recovery community and society at large. Poor sleep habits lead to sluggishness, low attention span, decreased sociability, depressed mood, increased hunger, and reduced caloric expenditure (weight gain). Think about how the life of every living organism from a huge blue whale to a tiny mosquito depends on sleep. Sleep is recovery refreshment.

Recovery mutual aid organizations emphasize the importance of the role of social connections and recovery-supportive relationships—a role that has become more difficult with the social distancing demands imposed by the COVID-19 pandemic. There is little doubt about the power of the group experience toward facilitating and augmenting sobriety ad recovery. Social relationships also promote physical, mental, and emotional health. The single most important predictor of human happiness and long life is having strong social connections—connections that also exert a powerful influence on the durability and quality of addiction recovery.

Environmental toxins potentiate the development of chronic diseases. Such toxins include tobacco smoking and exposure to secondhand smoke. Cigarette smoke remains the leading preventable cause of death in the United States causing more than 450,000 deaths annually – approximately one in five deaths. In fact, smoking causes more deaths than the combination of alcohol, firearms, HIV, illegal drug use, and motor vehicle accidents. Additionally, more than 10 times as many US citizens have died prematurely from cigarette smoking than have died in all the wars fought by the United States (Frates, 2019). Research reviews (See HERE and HERE) reveal that people with substance use disorders and those recovering from such disorders have higher rates of smoking, are more likely to be heavy smokers, and more likely to die from tobacco-related diseases than from other substances. Equally important is research confirming that smoking cessation improves recovery rates for other substance use disorders and enhances global health of people in recovery. Spiritual growth is a common element across numerous religious, spiritual, and secular addiction recovery programs. It is just as important in Lifestyle Medicine/Healthcare to address this essential component of human existence – the discovery of life meaning and purpose and its related values and practices.  Good spiritual health is important for good physical, emotional and mental health and can be nourished through such rituals as prayer, meditation, and mindful reflection.

While overcoming addiction is a laudable achievement, developing and sustaining healthy lifestyle habits enhances the quality of our recoveries and our service to family and community. Lifestyle Medicine /Healthcare offers all of us, regardless of age, socioeconomic status, ethnic identity or cultural persuasion, or geographical setting the opportunity to take control of our health naturally and inexpensively. Embracing principles of lifestyle medicine can help us embrace recovery as far more than removal of alcohol and other drugs from an otherwise unchanged life.

References:

American College of Lifestyle Medicine (ACLM), Infographic, education@lifestylemedicine.org

Eddie, D. E., Greene, M. C., White, W. L., & Kelly, J. F. (2019). Medical burden of disease among individuals in recovery from alcohol and other drug problems in the United States. Findings from the National Recovery Survey. Journal of Addiction Medicine, 13 (5), 385-395.

Frates, B., Joseph, R., & Peterson, J. A. (2019). Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits, Healthy Learning.

Kelly, J. F., Bergman, B., Hoeppner, B., & White, W. L. (2017). Prevalence, pathways, and predictors of recovery from drug and alcohol problems in the United States Population: Implications for practice, research, and policy. Drug and Alcohol Dependence, 181, 162-169.

Rippe, J. (2018). Lifestyle Medicine: The Health Promoting Power of Daily Habits an Practices, American Journal of Lifestyle Medicine, 12(6) 499- 512.

White, W.L., Weingartner, R. M., Levine, M., Evans, A.C., & Lamb, R. (2013) Recovery prevalence and health profile of people in recovery: Results of a Southeastern Pennsylvania survey on the resolution of alcohol and other drug problems. Journal of Psychoactive Drugs, 45(4), 287-296.