Medical Examiner

Learning How to Eat Again After Recovering From Addiction

As part of a growing movement to provide comprehensive care to people in recovery, a new class aims to help them re-establish a relationship with food.

Hands chop mushrooms on a wood cutting board.
Photo illustration by Slate. Photo by KucherAV/iStock.

Before opioid addiction unraveled Mike Wallace’s life, food was his livelihood. Wallace, now in recovery, worked for years as a dishwasher and line cook. And on a recent sunny Boston morning, he again found himself in the kitchen.

Wallace was one of about a dozen people at a cooking class at Boston Medical Center tailored for people recovering from addiction. Tracey Burg, a dietician and chef who runs the medical center’s demonstration kitchen, which offers classes on how to cook for medical conditions from diabetes to heart disease, led participants through choosing and cooking healthful foods. Burg extolled the virtues of whole grains while preparing a one-pan chicken, vegetable, and pasta dish along with a fruit parfait.

The class is among the first of its kind in the nation and is part of a growing recognition that addiction is a complex chronic health condition that deserves care and attention on many fronts. Nutrition class is no replacement for the life-saving medicines that can be used to treat addiction or reverse an overdose. But even when someone with addiction is stabilized on treatment, many remain far from healthy. By addressing the vital role nutrition plays in recovery, the class fills a key but overlooked space, experts say.

Addiction often takes an incredible toll on the body, both due to the substances’ effect on physical health and the way healthy eating often takes a back seat when a person is in the throes of addiction. Alcohol, for example, can strip the body of vital nutrients, leading to dangerously low levels of thiamine and folate. “Substance use disorder and lack of proper nutrition often go hand-in-hand,” says Ginger Hultin, a Seattle-based registered dietitian.

But the obstacles to nutrition people with addiction face often go deeper than vitamin deficiencies. Lack of access to food or a way to prepare it can often create disordered eating patterns, say Hultin and Burg. The odds of a person with a substance use disorder being homeless—and therefore without a place to store or prepare food—is more than 2.5 times that of other people. That instability and lack of access to nutritious options can make it tricky to eat well, says Burg. Plus, unhealthy food is often easier to find than more nutritious choices, particularly when an addiction is exerting a dominating force on one’s time and energy.

Burg’s class walks participants through various ways to move toward healthful eating habits. She wants to drive home the fact that is easy for all of us to forget: The food we put in our mouths plays a vital role in how we feel and perform. “In order to really heal from your addiction, you have to heal and replenish your body,” says Burg. “You have to give your body what it needs, and if it has been years or months since it hasn’t been fed correctly, it’s going to take a little time.”

Learning how to eat healthfully can also play a role in preventing relapse. That’s because people struggling with addiction may trade the highs and lows of a drug for those from sugary, fatty foods, or caffeine, and learning how to better manage such cravings can help people in recovery find stability. A woman recovering from addiction told Burg she needed to eat three bags of cotton candy daily, including a bag at night to relax enough to fall asleep. Burg helped her transition from cotton candy to fruit.

“Teaching people how to cook for themselves, and to support good nutritional habits, can have an impact on reducing cravings that are often a hallmark of people in recovery from addiction,” says Michael Botticelli, executive director of Boston Medical Center’s Grayken Center for Addiction.

In the demonstration kitchen, for example, there’s an emphasis on moving away from foods that might offer fleeting satisfaction toward those that offer sustained energy. Fresh spinach, red peppers, sunflower seeds, and cans of chickpeas sit beside a sign that says, “Mood enhancers: Helps reduce cravings.” On the opposite end of the counter sits a sign with the words “Mood depressors: Increase cravings,” accompanied by photos of cola, candy, and french fries.

Often, the focus on food and meal prep offers an intimate glimpse into a person’s life. People recovering from addiction may not be accustomed to self-care—and may not even believe they deserve it. Years of struggling with addiction and its stigma can chip away at self-esteem. A history of abuse and trauma, which is linked to a higher risk of addiction, can also be a barrier to taking care of oneself.

“I ask patients, ‘What were you doing when you were last well? How did you feel?’ ” says Heather Tick, a professor of family medicine and anesthesiology at the University of Washington specializing in nonpharmacologic pain management. This question “often uncovers lifelong unwellness,” Tick says. “After they get past their shock, they start to cry because they haven’t thought about being well in so long.”

The act of cooking a simple meal can be a reminder of better times—no matter how many years back—and of a world where life’s natural rhythm has been restored. For Wallace, attending the class has driven home the importance of nutrition in keeping addiction at bay – something he knows his life depends on. “Food will help with my depression, and the years of abuse to my body,” he says.

The class also reminded Wallace what it’s like to work with his hands, he says, and to prepare a product that means something. He’s starting a job search in the restaurant world, he tells me, adding that he “can’t wait to get to work.”

Allison Bond is a resident physician in internal medicine at Massachusetts General Hospital.