Journal of Community Health

, Volume 44, Issue 1, pp 88–94 | Cite as

Rapid Assessment of Nutrition Services in Los Angeles Substance Use Disorder Treatment Centers

  • David A. WissEmail author
  • Maria Schellenberger
  • Michael L. Prelip
Original Paper


The objective of this study was to determine the prevalence of nutrition services and utilization of registered dietitian nutritionists at substance use disorder treatment centers in Los Angeles. This cross-sectional descriptive study utilized phone interviews with facilities within a 25-mile radius of the Los Angeles metropolitan area using the Substance Abuse and Mental Health Services Administration Treatment Services Locator to identify facilities that included a listing of substance abuse as primary focus of care (n = 128). Facilities were asked if they offered any kind of nutrition services, the type of services that were offered, and the credential of the professional providing the services. We compared facilities that offered a residential level of care to those offering outpatient services only. The Fisher’s exact test was used to determine statistical significance. The study showed that only 39 sites (30.5%) offered any type of nutrition services on site, and the odds of a residential level of care offering nutrition services was 2.7 times higher than outpatient only facilities (p = 0.02). Of the 39 facilities offering nutrition services, only 8 (20.5%) utilized a registered dietitian nutritionist. Overall fewer than 7% of the facilities utilized the services of a dietitian. Recovery programs for substance use disorder should consider using a registered dietitian nutritionist as a member of the treatment team, which may contribute to better clinical outcomes.


Alcohol use disorder Opioid use disorder Substance-related disorders Nutrition Treatment 


Author Contributions

MS collected the data and contributed sections to the manuscript. DW assisted with data collection protocols and wrote the first draft of manuscript. MP edited and contributed to the manuscript. All authors reviewed and commented on subsequent drafts of the manuscript.

Compliance with Ethical Standards

Conflict of interest

David Wiss is the founder and owner of Nutrition in Recovery LLC which provides nutrition services to substance use disorder treatment facilities in Los Angeles, CA, including some in the sample. Mr. Wiss was not involved in contacting any of the facilities.

Ethics Approval

This study was approved by the University of Southern California University Park Institutional Review Board under Study ID: UP-16-00334.


  1. 1.
    Center for Behavioral Health Statistics and Quality, Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51). 2016.Google Scholar
  2. 2.
    U.S. Department of Health and Human Services Centers for Disease Control and Prevention. (2014). Increases in heroin overdose deaths: 28 states, 2010 to 2012. Morbidity and Mortality Weekly Report, 63(29), 849–854.Google Scholar
  3. 3.
    American Dietetic Association, Position of the American Dietetic Association. (1990). Nutrition intervention in treatment and recovery from chemical dependency. Journal of the American Dietetic Association, 90(9), 1274–1277.Google Scholar
  4. 4.
    Pelican, S., Batchelor, B., Belshaw, J., Osborn, W., Pearce, J., & Przekurat, C. (1994). Nutrition services for alcohol/substance abuse clients. Indian Health Service’s tribal survey provides insight. Journal of The American Dietetic Association, 94(8), 835–836.CrossRefGoogle Scholar
  5. 5.
    Engel, G. L. (1980). The clinical application of the biopsychosocial model. American Journal of Psychiatry, 137(5), 535–544.CrossRefGoogle Scholar
  6. 6.
    Griffiths, M. (2009). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10(4), 191–197.CrossRefGoogle Scholar
  7. 7.
    McLellan, A. T., Luborsky, L., O’Brien, C. P., Woody, G. E., & Druley, K. A. (1982). Is treatment for substance abuse effective? JAMA, 247, 1423–1428.CrossRefGoogle Scholar
  8. 8.
    McLellan, A. T., Luborsky, L., Woody, G. E., O’Brien, C. P., & Druley, K. A. (1983). Predicting response to alcohol and drug abuse treatments: Role of psychiatric severity. Archives of General Psychiatry, 40, 620–625.CrossRefGoogle Scholar
  9. 9.
    McLellan, A. T., Woody, G. E., Metzger, D., McKay, J., Durell, J., Alterman, A. I., & O’Brien, C. P. (1996). Evaluating the effecitveness of addiction treatments: Reasonable expectations, appropriate comparisons. The Milbank Quarterly, 74(1), 51–85.CrossRefGoogle Scholar
  10. 10.
    O’Brien, C. P., & McLellan, A. T. (1996). Myths about the treatment of addiction. The Lancet, 347, 237–240.CrossRefGoogle Scholar
  11. 11.
    McLellan, A. T., Alterman, A. I., Cacciola, J., Metzger, D., & OʼBrien, C. P. (1992). A new measure of substance abuse treatment: Initial studies of the treatment services review. The Journal of Nervous and Mental Disease, 180(2), 101–110.CrossRefGoogle Scholar
  12. 12.
    McLellan, A. T., Hagan, T. A., Levine, M., Gould, F., Meyers, K., Bencivengo, M., & Durell, J. (1998). Supplemental social services improve outcomes in public addiction treatment. Addiction, 93(10), 1489–1499.CrossRefGoogle Scholar
  13. 13.
    Substance Abuse and Mental Health Services Administration. (2017). National Survey of Substance Abuse Treatment Services (N-SSATS): 2016.Google Scholar
  14. 14.
    Santolaria-Fernández, F. J., Gómez-Sirvent, J. L., González-Reimers, C. E., Batista-López, J. N., Jorge-Hernández, J. A., Rodríguez-Moreno, F., et al. (1995). Nutritional assessment of drug addicts. Drug and Alcohol Dependence, 38(1), 11–18.CrossRefGoogle Scholar
  15. 15.
    Islam, S. N., Hossain, K. J., Ahmed, A., & Ahsan, M. (2002). Nutritional status of drug addicts undergoing detoxification: Prevalence of malnutrition and influence of illicit drugs and lifestyle. British Journal of Nutrition, 88(5), 507–513.CrossRefGoogle Scholar
  16. 16.
    Ross, L. J., Wilson, M., Banks, M., Rezannah, F., & Daglish, M. (2012). Prevalence of malnutrition and nutritional risk factors in patients undergoing alcohol and drug treatment. Nutrition, 28(7–8), 738–743.CrossRefGoogle Scholar
  17. 17.
    Baptiste, F. (2009). Drugs and diet among women street sex workers and injection drugs user in Quebec City. Candian Journal of Urban Research, 18(2), 78–95.Google Scholar
  18. 18.
    Kampov-Polevoy, A., Garbutt, J. C., & Janowsky, D. (1997). Evidence of preference for a high-concentation sucrose solution in alcoholic men. American Journal of Psychiatry, 154(2), 269–270.CrossRefGoogle Scholar
  19. 19.
    Neale, J., Nettleton, S., Pickering, L., & Fischer, J. (2012). Eating patterns among heroin users: A qualitative study with implications for nutritional interventions. Addiction, 107(3), 635–641.CrossRefGoogle Scholar
  20. 20.
    Saeland, M., Haugen, M., Eriksen, F. L., Wandel, M., Smehaugen, A., Böhmer, T., & Oshaug, A. (2011). High sugar consumption and poor nutrient intake among drug addicts in Oslo, Norway. British Journal of Nutrition, 105(4), 618–624.CrossRefGoogle Scholar
  21. 21.
    Alves, D., Costa, A. F., Custódio, D., Natário, L., Ferro-Lebres, V., & Andrade, F. (2011). Housing and employment situation, body mass index and dietary habits of heroin addicts in methadone maintenance treatment. Heroin Addiction and Related Clinical Problems, 13(1), 11–14.Google Scholar
  22. 22.
    Leclercq, S., Cani, P. D., Neyrinck, A. M., Stärkel, P., Jamar, F., Mikolajczak, M., et al. (2012). Role of intestinal permeability and inflammation in the biological and behavioral control of alcohol-dependent subjects. Brain, Behavior, and Immunity, 26(6), 911–918.CrossRefGoogle Scholar
  23. 23.
    Leclercq, S., Matamoros, S., Cani, P. D., Neyrinck, A. M., Jamar, F., Stärkel, P., et al. (2014) Intestinal permeability, gut-bacterial dysbiosis, and behavioral markers of alcohol-dependence severity. Proceedings of the National Academy of Sciences, 111(42):E4485–E4493.CrossRefGoogle Scholar
  24. 24.
    Volpe, G. E., Ward, H., Mwamburi, M., Dinh, D., Bhalchandra, S., Wanke, C., & Kane, A. V. (2014). Associations of cocaine use and HIV infection with the intestinal microbiota, microbial translocation, and inflammation. Journal of Studies on Alcohol and Drugs, 75(2), 347–357.CrossRefGoogle Scholar
  25. 25.
    Cowan, J. A., & Devine, C. M. (2008). Food, eating, and weight concerns of men in recovery from substance addiction. Appetite, 50(1), 33–42.CrossRefGoogle Scholar
  26. 26.
    Warren, C. S., Lindsay, A. R., White, E. K., Claudat, K., & Velasquez, S. C. (2013). Weight-related concerns related to drug use for women in substance abuse treatment: Prevalence and relationships with eating pathology. Journal of Substance Abuse Treatment, 44(5), 494–501.CrossRefGoogle Scholar
  27. 27.
    Bonfa, F., Cabrini, S., Avanzi, M., Bettinardi, O., Spotti, R., & Uber, E. (2008). Treatment dropout in drug-addicted women: Are eating disorders implicated? Eating and Weight Disorders, 13(2), 81–86.CrossRefGoogle Scholar
  28. 28.
    Bulik, C. M., Slof, M., & Sullivan, P. (2004). Comorbidity of eating disorders and substance-related disorders. Medical Psychiatry, 27, 317–348.Google Scholar
  29. 29.
    Ho, V., Arbour, S., & Hambley, J. M. (2011). Eating disorders and addiction: Comparing eating disorder treatment outcomes among clients with and without comorbid substance use disorder. Journal of Addictions Nursing, 22(3), 130–137.CrossRefGoogle Scholar
  30. 30.
    Glasner-Edwards, S., Mooney, L. J., Marinelli-Casey, P., Hillhouse, M., Ang, A., & Rawson, R. & Methamphetamine Treatment Project Corporate Authors. (2011). Bulimia nervosa among methamphetamine dependent adults: Association with outcomes three years after treatment. Eating Disorders, 19(3), 259–269.CrossRefGoogle Scholar
  31. 31.
    Gadalla, T., & Piran, N. (2007). Eating disorders and substance abuse in Canadian men and women: A national study. Eating Disorders, 15(3), 189–203.CrossRefGoogle Scholar
  32. 32.
    Rieder, R., Wisniewski, P. J., Alderman, B. L., & Campbell, S. C. (2017). Microbes and mental health: A review. Brain, Behavior, and Immunity. Scholar
  33. 33.
    Keightley, P. C., Koloski, N. A., & Talley, N. J. (2015). Pathways in gut-brain communication: Evidence for distinct gut-to-brain and brain-to-gut syndromes. Australian & New Zealand Journal of Psychiatry, 49(3), 207–214.CrossRefGoogle Scholar
  34. 34.
    Skosnik, P. D., & Cortes-Briones, J. A. (2016). Targeting the ecology within: The role of the gut-brain axis and human microbiota in drug addiction. Medical Hypotheses, 93, 77–80.CrossRefGoogle Scholar
  35. 35.
    Temko, J. E., Bouhlal, S., Farokhnia, M., Lee, M. R., Cryan, J. F., & Leggio, L. (2017). The microbiota, the gut and the brain in eating and alcohol use disorders: A ‘Menage a Trois’? Alcohol Alcoholism, 52, 403–413.CrossRefGoogle Scholar
  36. 36.
    Mutlu, E. A., Gillevet, P. M., Rangwala, H., Sikaroodi, M., Naqvi, A., Engen, P. A., et al. (2012). Colonic microbiome is altered in alcoholism. American Journal of Physiology-Gastrointestinal and Liver Physiology, 302(9), G966–G978.CrossRefGoogle Scholar
  37. 37.
    Gorky, J., & Schwaber, J. (2016). The role of the gut-brain axis in alcohol use disorders. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 65, 234–241.CrossRefGoogle Scholar
  38. 38.
    Prakash, M. D., Tangalakis, K., Antonipillai, J., Stojanovska, L., Nurgali, K., & Apostolopoulos, V. (2017). Methamphetamine: Effects on the brain, gut and immune system. Pharmacological Research, 120, 60–67.CrossRefGoogle Scholar
  39. 39.
    Alcoholics Anonymous World Services. (2001). Alcoholics anonymous. New York: Alcoholics Anonymous World Services, Inc.Google Scholar
  40. 40.
    Popkin, B. M., & Gordon-Larsen, P. (2004). The nutrition transition: Worldwide obesity dynamics and their determinants. International Journal of Obesity and Related Metabolic Disorders, 28(Suppl 3), S2–S9.CrossRefGoogle Scholar
  41. 41.
    Hall, K. D. (2018). Did the food environment cause the obesity epidemic? Obesity, 26(1), 11–13.CrossRefGoogle Scholar
  42. 42.
    National Center for Chronic Disease Prevention and Health Promotion. (2017). National Diabetes Statistics Report.Google Scholar
  43. 43.
    Balhara, Y. P. S., & Kalra, S. (2017). Drug addiction and diabetes: South Asian action. Recent Advances in Endocrinology, 67(6), 954–956.Google Scholar
  44. 44.
    Mies, G. W., Treur, J. L., Larsen, J. K., Halberstadt, J., Pasman, J. A., & Vink, J. M. (2017). The prevalence of food addiction in a large sample of adolescents and its association with addictive substances. Appetite, 118, 97–105.CrossRefGoogle Scholar
  45. 45.
    Hardy, R., Fani, N., Jovanovic, T., & Michopoulos, V. (2018). Food addiction and substance addiction in women: Common clinical characteristics. Appetite, 120, 367–373.CrossRefGoogle Scholar
  46. 46.
    García-García, I., Horstmann, A., Jurado, M. A., Garolera, M., Chaudhry, S. J., Margulies, D., et al. (2014). Reward processing in obesity, substance addiction and non-substance addiction. Obesity Review, 15(11), 853–869.CrossRefGoogle Scholar
  47. 47.
    Edge, P. J., & Gold, M. S. (2011). Drug withdrawal and hyperphagia: Lessons from tobacco and other drugs. Current Pharmaceutical Design, 17(12), 1173–1179.CrossRefGoogle Scholar
  48. 48.
    Hodgkins, C., Frost-Pineda, K., & Gold, M. S. (2007). Weight gain during substance abuse treatment: The dual problem of addiction and overeating in an adolescent population. Journal of Addictive Diseases, 26(Suppl 1), 41–50.CrossRefGoogle Scholar
  49. 49.
    Emerson, M. H., Glovsky, E., Amaro, H., & Nieves, R. (2009). Unhealthy weight gain during treatment for alcohol and drug use in four residential programs for Latina and African American Women. Substance Use & Misuse, 44(11):1553–1565.CrossRefGoogle Scholar
  50. 50.
    Calero-Elvira, A., Krug, I., Davis, K., López, C., Fernández-Aranda, F., & Treasure, J. (2009). Meta-analysis on drugs in people with eating disorders. European Eating Disorders Review, 17(4), 243–259.CrossRefGoogle Scholar
  51. 51.
    Dennis, A. B., Pryor, T., & Brewerton, T. D. (2014). Integrated treatment principles and strategies for patients with eating disorders, substance use disorder, and addictions. In T. D. Brewerton & A. B. Dennis (Eds.), Eating disorders, addictions and substance use disorders. Berlin: Springer.Google Scholar
  52. 52.
    Leppert, W. (2015). Emerging therapies for patients with symptoms of opioid-induced bowel dysfunction. Drug Design, Development and Therapy, 9, 2215–2231.CrossRefGoogle Scholar
  53. 53.
    Reid, B. K. (2014). Assessment of wellness and nutrition in residential alcohol and drug abuse treatment, in Heller School for Social Policy and Management, Brandeis University ProQuest.Google Scholar
  54. 54.
    Cowan, J. A., & Devine, C. M. (2012). Process evaluation of an environmental and educational nutrition intervention in residential drug-treatment facilities. Public Health Nutrition, 15(7), 1159–1167.CrossRefGoogle Scholar
  55. 55.
    Cowan, J. A., & Devine, C. M. (2013). Diet and body composition outcomes of an environmental and educational intervention among men in treatment for substance addiction. Journal of Nutrition Education and Behavior, 45(2), 154–158.CrossRefGoogle Scholar
  56. 56.
    Curd, P., Ohlmann, K., & Bush, H. (2013). Effectiveness of a voluntary nutrition education workshop in a state prison. Journal of Correctional Health Care, 19(2), 144–150.CrossRefGoogle Scholar
  57. 57.
    Grant, L. P., Haughton, B., & Sachan, D. S. (2004). Nutrition education is positively associated with substance abuse treatment program outcomes. Journal of The American Dietetic Association, 104(4), 604–610.CrossRefGoogle Scholar
  58. 58.
    Lindsay, A. R., Warren, C. S., Velasquez, S. C., & Lu, M. (2012). A gender-specific approach to improving substance abuse treatment for women: The healthy steps to freedom program. Journal of Substance Abuse Treatment, 43(1), 61–69.CrossRefGoogle Scholar
  59. 59.
    Barbadoro, P., Ponzio, E., Pertosa, M. E., Aliotta, F., D’errico, M. M., Prospero, E., & Minelli, A. (2011). The effects of educational intervention on nutritional behaviour in alcohol-dependent patients. Alcohol and Alcoholism, 46(1), 77–79.CrossRefGoogle Scholar
  60. 60.
    Moore, K. (2016). Hands-on nutrition and culinary intervention within a substance use disorder residential treatment facility. Journal of the Academy of Nutrition and Dietetics, 116(9), A20.CrossRefGoogle Scholar
  61. 61.
    Wiss, D. A., Schellenberger, M., & Prelip, M. L. (2017). Registered dietitian nutritionists in substance use disorder treatment centers. Journal of the Academy of Nutrition and Dietetics. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • David A. Wiss
    • 1
    Email author
  • Maria Schellenberger
    • 2
  • Michael L. Prelip
    • 1
  1. 1.Fielding School of Public Health, Community Health SciencesUniversity of California Los AngelesLos AngelesUSA
  2. 2.Leonard Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesUSA

Personalised recommendations