Doctoral Dissertations

Date of Award

12-2004

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Human Ecology

Major Professor

Dileep S. Sachan

Committee Members

Betsy Haughton, James Bailey, Bill Wallace

Abstract

The objectives of the current research were to assess the use and extent of nutrition intervention in Department of Veterans Affairs (VA) substance abuse treatment (SAT) programs and to determine an association between nutrition intervention and SAT outcomes. The research was divided into three parts. A descriptive, single, cross-sectional survey was developed and tested to measure associations with nutrition services and changes in Addiction Severity Index (ASI) domains. Nutrition services most likely to be offered included nutrition screening, nutrition assessment, nutrition education, drugnutrient interaction instruction, meal service, individualized supplemental feedings and physician-prescribed vitamin/mineral supplementation. Positive associations between individualized and group-nutrition SAT education were noted with psychological, medical and family/social ASI domains (P<0.05). Vitamin/mineral supplementation per dietitian recommendation was noted to be associated with the alcohol domain and food preferences was associated with the employment domain (P<0.05). Programs that offered group nutrition education tended to offer significantly more nutrition services to patients (P<0.01).

The second phase of the current research was to determine if an association existed between patient participation in nutrition education and patient-specific SAT outcomes. For this a descriptive, retrospective, cohort review was conducted with a random sample of medical records (n=77) for patients with primary diagnoses of alcohol dependence, alcoholism, or alcohol withdrawal admitted to a VA outpatient SAT program during a two year period. Dependent measures were days abstinent, number of days to first drink, number of drinking days, number of non-drinking days and ratio of drinking to non-drinking days. Subjects were grouped according to participation in group nutrition education, individualized nutrition education, both group and individualized nutrition education or no nutrition education. Days to first drink was significant (P<0.05), but this significance dissipated when controlled for length of stay. There were no significant differences among substance abuse treatment outcome measures with type of nutrition education.

Finally, substance abuse treatment outcomes of the outpatient setting were compared with those of a random sample of medical records of patients enrolled in a residential setting (n=88), again grouping subjects by group, individualized, both group and individualized or no nutrition education. Subjects in each sample were sufficiently similar to allow comparisons. Far fewer outpatients as a percentage of the population were exposed to nutrition education than were residential patients. Substance abuse behaviors were similar between programs, but outcome measures were significantly different within programs. Associations between days abstinent, days non-drinking and days drinking: non-drinking days ratio were detected with participation in nutrition education, particularly group nutrition education (P<0.05).

Some overall inferences may be drawn as a result of this study. Nutrition services offered to patients enrolled in SAT programs, both outpatient and residential based, tended to vary greatly between programs. Substance abuse treatment programs that offered nutrition education offered a significantly (P<0.05) greater depth of nutrition services overall, and tended to display more positive changes in program-based outcome indicators. Nutrition education should be included as a component in residential substance abuse treatment programs. Greater effort to incorporate nutrition education into outpatient SAT programs may be warranted.

Key Words: Nutrition, education, substance abuse, treatment, alcohol, alcoholism.

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