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Assessing a Client's Nutritional Status

March 1, 2006
by Anne S. Hatcher, EdD, CAC III, NCAC II
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Counselors can learn to detect common signs of malnutrition in addicts

While the primary goal of addiction counseling is to assist the client to alter behavior related to use of addictive chemicals, a secondary goal is to help the client recover from the damage done to his/her life and body. A balanced diet has been noted as important to recovery.1 For some clients, poor eating habits and the substitution of alcohol for food result in malnutrition.

Alcohol provides calories (so the body has energy) but not the essential nutrients required to maintain the body. Some people with substance abuse problems ignore the need for food because they lack funds (they spend on drugs or alcohol rather than food), they want to feel the effects of the drug or alcohol faster (which is likely if no food is in the stomach), or they don't feel that they are worth the time, energy, or money spent on food.

Malnutrition also results from damage to the stomach, small intestine, and liver caused by alcohol and other drugs of abuse. Substance abuse's toxic effects impair nutrient absorption and the ability to store nutrients for future use. Abstinence from substances will bring about some improvement in nutritional condition, but abstinence alone is insufficient to rebuild damaged body tissues and promote health.

Beasley and Knightly note that long before the discovery of psychiatric drugs, doctors of all cultures used food as part of their treatment for mental illness.2 The popularity of nutritional interventions has waxed and waned over the years, even though the nutritional approach always has been one of the safest and most effective ways of preventing and healing disease. Fortuna describes the importance of nutrition for recovering individuals.3

Every client deserves a detailed assessment of the problems present, and a treatment plan that addresses those problems. Nutritional assessment is an essential aspect of understanding overall health, and assessment of nutritional status and dietary patterns will assist the counselor in establishing a treatment plan and support for the recovering client. The following information will assist the intake and assessment counselor in documenting issues that might be related to dietary patterns and nutritional status.

Determining risk

Adults are considered to be at nutritional risk if one or more of the following conditions is present:

  • involuntary loss or gain of more than 10% of the usual body weight within six months, or more than 5% of the usual body weight in one month, or a weight of 20% over or under ideal body weight;

  • chronic disease;

  • recent illness, surgery, or trauma;

  • inadequate food intake; and

  • difficulty absorbing nutrients (diarrhea, vomiting)4

Assessment and treatment planning are most effective when the client and the counselor work together and when the client has a role in determining the course of action. Asking the client about health issues as part of the addiction assessment may provide a basis for further evaluation of nutritional status. A client who is asked about food intake often will report eating what he/she thinks should have been eaten, rather than what was actually consumed. Asking about what foods are eaten most often can provide a better picture of actual dietary patterns.4

Nutrition screening is the process of identifying characteristics known to be related to nutritional problems. Each facility or setting is responsible for determining the most appropriate means of screening clients; however, very few screening tools have been validated.4

A skilled counselor is able to read nonverbal cues and to ask for information that might not be included in assessment questionnaires. When conducting a nutrition assessment, the professional must ask about the ways in which the client obtains and prepares food, as well as what foods are consumed. Client attitudes toward food offer important clues related to compliance with an altered dietary plan. The table lists physical indicators of nutritional problems that should be looked for in clients; these symptoms indicate the need for a more thorough assessment by a physician and/or dietitian.

Table. A checklist ofobservable symptoms ofnutritional imbalance

  • Height and weight

  • Is this person alert?

  • Groomingdoes the individual seem to care about appearance, but hair looks as if it has not been combed?

  • Does the fit of clothing indicate weight gain or loss? (note indications such as different belt settings, or tight- or loose-fitting clothing)

  • Note any indications of nutritional problems, including the following:

    • Bruises (ask about what happened to cause the bruise and how long it has been there)

    • Wounds that appear not to be healing or that healed and then opened again

    • Cracks or scars at the corners of the mouth

    • Dark areas over the cheeks or under the eyes

    • Dry skin

    • Red eyes

    • Tremors

    • Indications of muscle weakness

    • Sparse, dry, dull hair

    • Pale color of nails, lips, palms

    • Missing teeth

    • Dentures