What is a healthy lifestyle in recovery?



In this blog we will look at the benefits and necessity of having a healthy lifestyle in recovery and how having a healthy lifestyle greatly improves our chances of staying in recovery.


The relationship between health and addiction works both ways, i.e. addiction leads to an unhealthy lifestyle, and an unhealthy lifestyle makes us more prone to addiction and relapse. The most important elements of a healthy lifestyle are also the most basic. These are proper nutrition, exercise, adequate sleep and meaningful social connection.



Proper nutrition and hydration

Nutrition and hydration are key to the substance abuse healing process because they help restore physical and mental health and improve the chance of recovery. Macro- and micronutrient deficiencies can lead to symptoms of depression, anxiety, and low energy, all of which can lead someone to start using drugs or alcohol or trigger a relapse.


Before detoxification, neurotransmitters are decreased due to poor nutrition and altered amino acid absorption and utilization. This leaves addicts feeling depressed, agitated, and unregulated early in recovery. It's thought that these imbalances disappear over a period of weeks but may last as long as one year after an addict becomes sober.


For some, mood and behaviour abnormalities may have been present before the substance abuse. With proper diagnosis of any possible underlying mental health disorders, a healthful diet and education on how nutrition influences mood and brain chemistry, recovery can be enhanced.

An understanding of how food affects mood and the risk of substance abuse begins with macronutrients. Carbohydrates are the body's main source of energy; without this macronutrient, the brain can't properly function, blood sugar becomes unstable, and neurotransmitters become disrupted. Unstable blood sugar can lead to feelings of frustration, anxiety, and cravings.


Then folic acid and vitamins B6 and B12 help the synthesis of tryptophan to serotonin. Ensuring adequate intake of carbohydrates and tryptophan-rich foods, such as dairy and meats, helps stabilize these reactions.


Amino acids, the building blocks of protein, also are the foundation of neurotransmitters. Low levels of neurotransmitters, particularly dopamine, can trigger an individual to turn to substances to feel better, as most substances markedly impact the body's dopamine levels. Dopamine is made from the amino acid tyrosine, and serotonin is made from tryptophan. If an individual lacks either of these amino acids, synthesis of the respective neurotransmitter is disrupted, which affects mood, aggression, and the desire for drugs or alcohol.


Dietary fat also plays a role in maintaining mental health. Because it affects inflammation and cell membrane integrity, limiting dietary fat directly influences mood. Omega-3 fatty acid consumption may help with depression by assisting in the uptake of neurotransmitters and decreasing inflammation. Having a proper balance of omega-6 and omega-3 fatty acids helps neurotransmitter receptors function, which in turn helps increase the amount of neurotransmitters that can be active in the brain.


Drinking adequate amounts of hydrating fluids also will help to manage mood while ensuring adequate absorption of any medications taken to prevent side effects from withdrawal or underlying psychiatric disorders. Common symptoms of dehydration include irritability, trouble concentrating, and disorientation. Dehydration also commonly results from detoxification, so monitoring daily intake and output values will help determine appropriate fluid intake recommendations.


Caffeine intake should be monitored, as it triggers the same reward centres of the brain as do substances and can markedly impact anxiety and sleep. Low caffeine intake and smoking cessation have been shown to improve long-term sobriety for all addictions.



Exercise

Apart from the obvious and well known physical benefits of exercise, we have also learned that regular exercise has a significant positive impact on mental health.


Most of us find that a sunny walk or trip to the gym improves our mood in the short term. Exercise is well known to stimulate the body to produce endorphins and encephalin, the body’s natural feel-good hormones which can make problems seem more manageable. The simple act of focusing on exercise can give us a break from current concerns and damaging self-talk. Further, depending on the activity, people may benefit from calming exercises, be energized, and get outside or interact with others, all of which are known to improve mood and general health.


However, the idea that physical exercise might do something really fundamental for mental health is less immediately obvious—especially given the Western distinction between "mind" and "body" that implies mental and physical health can be separated.


In fact, increasingly robust evidence suggests that exercise is not only necessary for the maintenance of good mental health, but it can be used to treat even chronic mental illness. For example, it is now clear that exercise reduces the likelihood of depression and also maintains mental health as we age. On the treatment side, exercise appears to be as good as existing pharmacological interventions across a range of conditions, such as mild to moderate depression, dementia, and anxiety, and even reduces cognitive issues in schizophrenia.


Put simply: Exercise directly affects the brain. Regular exercise increases the volume of certain brain regions—in part through better blood supply that improves neuronal health by improving the delivery of oxygen and nutrients; and through an increase in neurotrophic factors and neurohormones that support neuron signalling, growth, and connections.


Of critical importance for mental health is the hippocampus—an area of the brain involved in memory, emotion regulation, and learning. Studies in other animals show convincingly that exercise leads to the creation of new hippocampal neurons (neurogenesis), with preliminary evidence suggesting this is also true in humans.


Evidence is accumulating that many mental health conditions are associated with reduced neurogenesis in the hippocampus. The evidence is particularly strong for depression. Interestingly, many anti-depressants—that were once thought to work through their effects on the serotonin system—are now known to increase neurogenesis in the hippocampus.


Psychiatrist Madhukar Trivedi, has shown that three or more sessions per week of aerobic exercise or resistance training, for 45 to 60 minutes per session, can help treat even chronic depression. Effects tend to be noticed after about four weeks (which incidentally is how long neurogenesis takes), and training should be continued for 10-12 weeks for the greatest anti-depressant effect.



Social Connection

“Face-to-face contact releases a whole cascade of neurotransmitters and, like a vaccine, they protect you now, in the present, and well into the future, so simply shaking hands, giving somebody a high-five is enough to release oxytocin, which increases your level of trust, and it lowers your cortisol levels, so it lowers your stress.” - Susan Pinker


Addiction or Substance Use Disorder destroys our ability to have deep, meaningful social connections. Although most substance use starts out as a social activity, the progressive nature of the disease always leads to social isolation. When we reach the stage of dependence, our entire lives become centred around our substance and the most meaningful connection we have is with our drug of choice.


Human beings are inherently social creatures. As far back as we can trace, humans have travelled, hunted, and thrived in social groups and for good reason. Humans who were separated from their tribe often suffered severe consequences. Social groups provide us with an important part of our identity, and more than that, they teach us a set of skills that help us to live our lives. Feeling socially connected, especially in an increasingly isolated world, is more important than ever. The benefits of social connectedness shouldn’t be overlooked.


Improve your quality of life: If you’ve ever moved away from your social “home base” then you have a good idea of just how much social connections shape your everyday life and well-being. One study showed that social connection is a greater determinant to health than obesity, smoking, and high blood pressure. And social connection doesn’t necessarily mean physically being present with people in a literal sense, but someone’s subjective experience of feeling understood and connected to others. One scale that experts use to determine a person’s subjective level of loneliness is the UCLA Loneliness Scale.


Boost your mental health: Friendships offer a number of mental health benefits, such as increased feelings of belonging, purpose, increased levels of happiness, reduced levels of stress, improved self-worth and confidence.


Help you live longer: Research has shown that social connections not only impact your mental health, but your physical health as well. A review of 148 studies (308,849 participants) indicated that the individuals with stronger social relationships had a 50% increased likelihood of survival. This remained true across a number of factors, including age, sex, initial health status, and cause of death.


Decrease your risk of suicide: There are a number of factors that put people at higher or lower risk for suicide. One of these factors is connectedness, which the Centres for Disease Control (CDC) defines as “The degree to which a person or group is socially close, interrelated or shares resources with other persons or groups.” Relationships can play a crucial role in protecting a person against suicidal thoughts and behaviours.


Reconnecting: If you’re not sure how to begin forming social connections start by looking inward. What are your interests or hobbies? What kind of personalities are you naturally comfortable around? Devote time to becoming active in your community, volunteering, or joining a club or social organization and if you meet a potential friend, create an opportunity to spend time together.


A great place for people suffering from substance use disorder to reconnect is at recovery fellowship/ support groups like Alcoholics Anonymous, Narcotics Anonymous, Project Exodus, Heal, or any other fellowship group where people with similar problems and similar goals get together for social support.


The effects of Alcohol and other drugs on mental and physical health:



Alcohol

Alcohol is a major cause of nutritional deficiency. Alcohol provides calories but little nutrition to the body. Many alcoholics are malnourished, either due to ingesting a nutritionally inadequate diet or changes in the body's ability to use the nutrients it receives.


Alcoholism affects every area of the body. It can cause insomnia, anorexia, weight changes, gastrointestinal cramping, decreased digestive enzymes, ulcers, muscle wasting, liver disease, and abnormal glucose levels depending on the amount of alcohol ingested. Those who take in more than 30% of their total calories in alcohol generally have a significant decrease in their intake of all macronutrients and deficiencies in vitamin A, vitamin C, and thiamine.


The reason we drink and the consequences of excessive drinking are linked with our mental health. Mental health problems not only result from drinking too much alcohol, they can also cause people to drink too much.


Put very simply, a major reason for drinking alcohol is to change our mood – or our mental state. Alcohol can temporarily alleviate feelings of anxiety and depression and people often use it a form of ‘self-medication’ in an attempt to cheer themselves up or sometimes help with sleep.


Evidence shows that people who consume high amounts of alcohol are vulnerable to increased risk of developing mental health problems and alcohol consumption can be a contributing factor to some mental health problems, such as depression.


One of the main problems associated with using alcohol to deal with mental health problems is that regular consumption of alcohol changes the chemistry of the brain. It decreases the levels of the brain chemical serotonin - a key chemical in depression. As a result of this depletion, a cyclical process begins where one drinks to relieve depression, which causes serotonin levels in the brain to be depleted, leading to one feeling even more depressed, and thus necessitating even more alcohol to then medicate this depression.


Marijuana


Although legalization activists and many marijuana users believe smoking pot has no negative effects, scientific research indicates that marijuana use can cause many different health problems.

When smoked, it begins to affect users almost immediately and can last for one to three hours. When it is eaten in food, such as baked in brownies and cookies, the effects take longer to begin, but usually last longer.


Short-Term Effects

The short-term effects of marijuana include:

  • Distorted perception (sights, sounds, time, touch)

  • Problems with memory and learning

  • Loss of coordination

  • Trouble with thinking and problem-solving

  • Increased heart rate

  • Psychosis


Sometimes marijuana use can also produce anxiety, fear, distrust, or panic.


Effects on the Brain

The active ingredient in marijuana, delta-9 tetrahydrocannabinol or THC, acts on cannabinoid receptors on nerve cells and influences the activity of those cells. Some brain areas have many cannabinoid receptors, but other areas of the brain have few or none at all. Many cannabinoid receptors are found in the parts of the brain that influence pleasure, memory, thought, concentration, sensory and time perception, and coordinated movement.



Effects on the Heart

Within a few minutes after smoking marijuana, the heart begins beating more rapidly and the blood pressure drops. Marijuana can cause the heartbeat to increase by 20 to 100% and blood pressure is slightly reduced.


According to a review published in 2017, marijuana users' risk for a heart attack ranges from four to five times higher within the first hour after smoking marijuana, compared to their general risk of heart attack when not smoking.


Effects on Your Bones

Research published in 2017 found that people who smoke large amounts of marijuana on a regular basis have reduced bone density, which can increase the risk of bone fractures.


Effects on the Lungs

Smoking marijuana, even infrequently, can cause burning and stinging of the mouth and throat, and cause heavy coughing. According to a review published in 2019. scientists have found that regular marijuana smokers can experience the same respiratory problems as tobacco smokers do, including:


  • Daily cough and phlegm production

  • More frequent acute chest illnesses

  • Increased risk of lung infections


Marijuana contains a similar amount of carcinogenic hydrocarbons as tobacco smoke and because marijuana smokers typically inhale deeper and hold the smoke in their lungs longer than tobacco smokers, their lungs are exposed to those carcinogenic properties longer, when smoking.


What About Cancer?

According to a review published in 2015, one study found that marijuana smokers were three times more likely to develop cancer of the head or neck than non-smokers.


Because marijuana smoke contains three times the amount of tar found in tobacco smoke and a number of carcinogens, it would seem logical to deduce that there is an increased risk of lung cancer for marijuana smokers.


Studies linking marijuana smoking to lung cancer have been limited by selection bias and small sample size. For example, the participants in those studies may have been too young to have developed lung cancer yet.  Even though researchers have yet to "prove" a link between smoking pot and lung cancer, regular smokers may want to consider the risk.


Effects of Exposure During Pregnancy

Several studies have found that children born to mothers who used marijuana during pregnancy exhibit some problems with neurological development. According to a 2018 review of those studies, prenatal marijuana exposure can cause:


Altered responses to visual stimuli Increased tremulousness Problems with sustained attention and memory Poor problem-solving skills


Side Effects of Cocaine


Whether used for short durations or extended stretches of time, any use is associated with side effects. Usage can lead to a serious heart attack, even in those that are young and otherwise healthy. Taking large amounts is associated with erratic and possibly violent behaviour.


Other side effects of use include:

  • Tremors.

  • Muscle twitches or tics.

  • Paranoia.

  • Vertigo.

  • Constricted blood vessels.

  • Dilated pupils.

  • Increased heart rate.

  • Increased blood pressure.

  • Increased body temperature.

  • Decreased sexual function.


Overdose from cocaine can result in:

  • Cardiac arrest.

  • Stroke.

  • Respiratory arrest.

  • Sudden death.


The risk of overdose is compounded when it is used with another dangerous substance like alcohol or other drugs. The combination of cocaine and heroin is particularly deadly. Known as a speedball—this mixture creates a serious risk of overdose.


The risk of overdose is compounded when it is used with another dangerous substance like alcohol or other drugs. The combination of cocaine and heroin is particularly deadly. Known as a speedball—this mixture creates a serious risk of overdose.


Lasting Health Effects

When short-term use crosses the line into long-term use, the risks increase for new and exaggerated negative results. These lasting health risks illustrate the drastic impact cocaine has on the abuser's physical health.


The potential health consequences of long-term use include:

  • Permanent damage to blood vessels of heart and brain.

  • High blood pressure, leading to heart attacks, strokes, and death.

  • Liver, kidney and lung damage.

  • Destruction of tissues in nose if sniffed.

  • Respiratory failure if smoked.

  • Infectious diseases and abscesses if injected.

  • Malnutrition, weight loss Severe tooth decay.

  • Auditory and tactile hallucinations.

  • Sexual problems, reproductive damage and infertility (for both men and women).

  • Disorientation, apathy, confused exhaustion Irritability and mood disturbances.

  • Increased frequency of risky behaviour.

  • Delirium or psychosis.

  • Severe depression


CAT


Similar to other stimulants, methcathinone can amplify the action of norepinephrine and dopamine. Unusual stimulation of these two neurotransmitters can cause strange behaviour in some individuals.


  • Negative effects can include:

  • Anxiety

  • Convulsions

  • Delusions

  • Fever

  • Hallucinations

  • Headaches

  • Insomnia

  • Irregular heart rate

  • Muscle twitching

  • Paranoia

  • Restlessness

  • Tremors Withdrawal Early withdrawal symptoms of anxiety and profuse sweating can precede convulsions, hallucinations, and severe depression.


Long-term effects

  • Paranoia

  • Hallucinations

  • Anxiety followed by depression

  • Tremors and convulsions

  • Anorexia, malnutrition, and weight loss

  • Dehydration and electrolyte imbalance

  • Stomach pains

  • Nausea

  • Nose bleeds and eventual destruction of nasal tissue

  • Elevated blood pressure

  • Elevated heart rate

  • Body aches

  • Permanent brain damage

  • Death


Crystal Meth


Research published in 2014 found that methamphetamine has neurotoxic effects, leading to damage to the serotonin and dopamine receptors in the brain.


The long-term use of methamphetamine can cause damage to the brain similar to other conditions that injure the brain. This brain damage lingers for months even after use has stopped.

The neurological effects of meth use can be permanent, even after a person quits. Researchers have found that methamphetamine use can lead to a higher risk of Parkinson's disease.


Methamphetamine misuse can also produce extreme anorexia. Even over a short period of use, methamphetamine can cause drastic changes in physical appearance.


Common Side Effects

Physically, meth can increase respiration, heart rate, and blood pressure. It can cause hyperthermia and an irregular heartbeat. There is also the potential for cardiovascular collapse.


Other effects of meth use on the central nervous system can produce symptoms like irritability, confusion, anxiety, paranoia, aggressiveness, delirium or psychosis. Some users also suffer from prolonged insomnia and tremors.


Hyperthermia and convulsions can be fatal. Methamphetamine can also cause irreversible damage to the blood vessels in the brain, which can result in a stroke.


Overdose is another danger associated with methamphetamine use. An overdose results in a rapid onset of physiological deterioration, eventually leading to a heart attack or stroke. Because of the speed of onset, death occurs suddenly and unexpectedly.


A meth overdose produces profuse sweating, rapid breathing, increased heart rate, and dilated pupils. A person who has overdosed on meth will have a high temperature, kidney failure, and cardiovascular collapse.  The truly scary part is that it will all happen very quickly.


Heroin


Repeated heroin use changes the physical structure and physiology of the brain, creating long-term imbalances in neuronal and hormonal systems that are not easily reversed. Studies have shown some deterioration of the brain’s white matter due to heroin use, which may affect decision-making abilities, the ability to regulate behaviour, and responses to stressful situations.


No matter how they ingest the drug, chronic heroin users experience a variety of medical complications, including insomnia and constipation. Lung complications (including various types of pneumonia and tuberculosis) may result from the poor health of the user as well as from heroin’s effect of depressing respiration. Many experience mental disorders, such as depression and antisocial personality disorder. Men often experience sexual dysfunction and women’s menstrual cycles often become irregular. There are also specific consequences associated with different routes of administration. For example, people who repeatedly snort heroin can damage the mucosal tissues in their noses as well as perforate the nasal septum (the tissue that separates the nasal passages).


Medical consequences of chronic injection use include scarred and/or collapsed veins, bacterial infections of the blood vessels and heart valves, abscesses (boils), and other soft-tissue infections. Many of the additives in street heroin may include substances that do not readily dissolve and result in clogging the blood vessels that lead to the lungs, liver, kidneys, or brain. This can cause infection or even death of small patches of cells in vital organs. Immune reactions to these or other contaminants can cause arthritis or other rheumatologic problems.


Sharing of injection equipment or fluids can lead to some of the most severe consequences of heroin use—infections with hepatitis B and C, HIV, and a host of other blood-borne viruses, which drug users can then pass on to their sexual partners and children.


Heroin use increases the risk of being exposed to HIV, viral hepatitis, and other infectious agents through contact with infected blood or body fluids (e.g., semen, saliva) that results from the sharing of syringes and injection paraphernalia that have been used by infected individuals or through unprotected sexual contact with an infected person. Snorting or smoking does not eliminate the risk of infectious disease like hepatitis and HIV/AIDS because people under the influence of drugs still engage in risky sexual and other behaviours that can expose them to these diseases.


People who inject drugs (PWIDs) are the highest-risk group for acquiring hepatitis C (HCV) infection and continue to drive the escalating HCV epidemic: Each PWID infected with HCV is likely to infect 20 other people.


Heroin use during pregnancy can result in neonatal abstinence syndrome (NAS). NAS occurs when heroin passes through the placenta to the foetus during pregnancy, causing the baby to become dependent, along with the mother. Symptoms include excessive crying, fever, irritability, seizures, slow weight gain, tremors, diarrhoea, vomiting, and possibly death. NAS requires hospitalization and treatment with medication (often morphine) to relieve symptoms; the medication is gradually tapered off until the baby adjusts to being opioid-free.


Sources:

Nutrition and Substance Abuse

https://www.todaysdietitian.com/newarchives/120914p44.shtml

Importance of Sleep

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Meier-Ewert HK, et al. Effect of Sleep Loss on C-reactive Protein, an Inflammatory Marker of Cardiovascular Risk, J Am Coll Cardiol. 2004 Feb 18; 43(4): 678-83.

Exercise

https://www.psychologytoday.com/za/blog/what-works-and-why/201803/how-your-mental-health-reaps-the-benefits-exercise

Social Connection

https://www.mindwise.org/blog/uncategorized/the-importance-of-social-connection/

Effect of Alcohol on Health

Today's Dietitian, Vol. 16 No. 12 P. 44

https://www.mentalhealth.org.uk/a-to-z/a/alcohol-and-mental-health

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Mental Health Foundation (2006). Cheers Report. [pdf] Available at https://www.mentalhealth.org.uk/publications/cheers-understanding-relationship-between-alcohol-and-mental-health

Marijuana

https://www.drugabuse.gov/publications/drugfacts/marijuana

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Cocaine

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CAT

https://www.health24.com/Lifestyle/Street-drugs/Psychoactives/What-is-the-drug-called-CAT-20141112

Crystal Meth

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Heroin

https://www.drugabuse.gov/publications/research-reports/heroin/what-are-long-term-effects-heroin-use

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