Diet

Clients of AOD treatment services tend to have poor dietary habits, eating nutrient-poor, energy-dense food, often to excess [246, 247]. It is common for people accessing AOD treatment to report unhealthy eating patterns, weight gain and obesity, which suggests that energy-dense diets are sometimes used to substitute AOD during recovery [248, 249]. AOD use also impacts nutrition directly by reducing available energy and nutrient absorption, and disrupting hormones which monitor the feeling of fullness after eating and other food cues [246, 250]. People accessing mental health treatment also frequently demonstrate poor dietary habits such as skipping breakfast, consuming more calories in the evening, avoiding foods that require chewing, and a lack of structure for mealtimes [194]. Programs targeting the preparation of nutritional food can produce lasting weight loss and improvements in mental health symptoms among people with mental health conditions [194], and AOD workers can assist by encouraging clients to follow Australian dietary guidelines (see Figure 11). Specifically, clients should be encouraged to [237]:

• Eat a variety of foods that are high in fibre and low in fat.
• Eat seven or more fruits and vegetables per day.
• Drink plenty of water.
• Make healthy food choices and eat regularly.
• Manage healthy eating patterns (e.g., ensuring that breakfast is eaten every day, and eating patterns are maintained on weekends and weekdays).

Enjoy a wide variety of nutritious foods from these five food groups every day. Drink plenty of water.

Adapted from the NHMRC [251].

AOD workers may also find the spending structure displayed in Table 20 useful. Developed under the FOODcents program to promote healthy eating on a limited budget, the spending structure was designed to be utilised alongside the Australian Government Department of Health’s healthy eating guidelines [252]. It is recommended that 60% of food budget is allocated to food from the ‘eat most’ group, and 10% to the ‘eat least’ group.

While the FOODcents program is no longer available, Food Sensations is a similar education program for families, funded by the Western Australian Department of Health, which also provides information on healthy diet, food budgeting, meal planning, reading food labels, and food safety. At the time of writing, free online programs are provided for organisers and participants, delivered over four weeks. Further information and additional resources are available via the Food Sensations website: https://www.foodbank.org.au

Source: Western Australian Network of Alcohol and other Drug Agencies [253], and FOODcents [252].

There has been increasing attention paid to the connection between the mind and gut in recent years, including how diet quality impacts mood. Growing evidence has highlighted the relationship between microbiota in the gut and anxiety and depressive behaviours, which suggests that modifying the gut microbiome can impact symptoms of stress, anxiety, and depression [254, 255]. Although the communication pathways between the gut microbiome and brain are not fully understood, the immune and hormonal systems, as well as the vagus nerve, are thought to be involved [256]. While more rigorous research is needed to establish how microbiota can be utilised in treatment approaches, one promising microbiota-focused treatment involves the use of probiotics, which have been shown to improve depressive symptoms among people with depression and schizophrenia [257–259].

Evidence has also supported the relationship between diet quality and mood, with foods believed to be beneficial for mental health. Omega-3 fatty acids, niacin, folate, vitamin B6, and vitamin B12 have been associated with improved mental health and mood, while saturated fats and simple sugars have been associated with poorer mental health and mood [260, 261]. ‘Western’ dietary patterns involving a high intake of red meat, confectionary, and refined or processed foods are similarly associated with poorer nutrition [262], whereas the Mediterranean diet [263] and diets that include more fish, reduced red meat, and/or more fruits and vegetables [264] have been associated with high nutritional quality and improved mood. However, it is also important to tailor diets to individual clients depending on differences in preferences, activity levels and metabolism. Although the effects of dietary interventions on overall mood are yet to be robustly evaluated, evidence from several systematic reviews suggest interventions involving dietary changes (e.g., adhering to a specific diet), nutrient supplementation, and/or nutritional counselling may be an effective adjunct to psychotherapy and/or pharmacotherapy for improving depressive symptoms [264–268].