Loitering on the sidewalk outside the building’s entrance, a mismatched group of individuals chat away while smoking cigarettes. Once inside, they’ll be offered coffee and a sugary snack, such as cookies or doughnuts, before taking their seats.
It’s the typical, almost cliché, scene at most 12-step meetings for people in recovery from alcohol or other drugs – and it’s emblematic of recovery culture.
With sobriety being the top priority, healthy habits can easily fall to the wayside. Cigarettes and junk food are often considered acceptable coping mechanisms and are embraced widely among people recovering from substance use disorder.
“I was personally told by people in recovery to carry around a bag of candy because my body needs it,” said Olivia “Liv” Pennelle. “That’s the most bullshit thing I’ve ever heard.”
Pennelle is a Portland-based journalist and founder of Liv’s Recovery Kitchen, a website aimed at helping people in recovery make positive and healthy choices.
She points to how AA's book, "Living Sober," encourages members to eat sweets to satisfy cravings. Even the recovery bible, “The Big Book of Alcoholics Anonymous,” notes that sugary snacks can be beneficial.
But many people find themselves gaining weight rapidly once they stop using drugs and alcohol and start eating regularly. Turning to junk food only compounds the problem, and the excessive weight gain itself can trigger the desire to use again.
For Pennelle, getting sober meant gaining weight and facing the underlying body dysmorphic disorder she’d struggled with since childhood.
“I was a couple years sober, but I was miserable,” she said.
She had traded alcohol for carbs and sweets.
“I was binge eating. I stopped purging at that point, because for some reason in my mind, purging wasn’t really congruent with recovery, but somehow binging felt less harmful,” she said.
She ended up working with a health coach to change her relationship with food, and she hopes to help others do the same.
“I started my blog because I wanted other women in recovery to know that this has become an issue,” she said. “The more people I interviewed, the more I realized that, my God, this is a global issue; not enough people are talking about the holistic aspects of recovery.”
Because a person’s body can change so quickly in recovery, Pennelle said, body-image issues are prevalent in early recovery, often leading to dieting, which doesn’t work for sustained weight loss.
She’s known people who have returned to using as a result of body-image issues.
“Women in particular have such an unhealthy relationship with their bodies that they can’t quite fathom that they’re never going to have the body that they had when they were using drugs,” she said. “The reason they had that body was because they weren’t eating. That’s not a realistic expectation to have, but our brains are programmed, ‘Well, I used to look like that, so why can’t I?’ It’s the same comparison of a women in her 40s trying to get the body that she had when she was in her 20s.”
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According to a recent study on barriers to methamphetamine recovery, hallucinations and weight gain were the most common side effects of withdrawal that led people to begin using meth again. The qualitative study, published last year in the journal Drugs: Education, Prevention Policy, found that “numerous users described weight gain as a significant barrier to recovery.”
It took Emily Fox only about two months to gain 40 pounds when she entered a drug and alcohol treatment program about a year and a half ago. By the time she was six months into her recovery, she had gained nearly 50 pounds.
Fox has used drugs and alcohol since she was 10. Before entering recovery, she was using methamphetamine and was active with a trim physique.
Now 37, this was the only time she’d been in a recovery program, and the weight gain became a trigger. None of her clothes fit, and she felt lethargic all the time.
Fox entered an in-patient treatment program through the Housing Rapid Response program, a collaborative effort of Multnomah County, Portland Police Bureau and Central City Concern that provides housing and wraparound services to people experiencing homelessness.
She didn’t smoke when she entered the program, but she soon picked up the habit. She described the food as “barely a step up from jail food.”
“It’s like, smoke and eat shitty, because that’s better than being on drugs,” she said. “It is, but it isn’t.”
She said nutrition and body-image issues were never really discussed; the focus was dealing with one thing at a time.
“But for me, it got me really depressed and got me really wanting to use again because I just felt so shitty about my physical self that I just could hardly stand it,” Fox said. “I couldn’t even tie my shoes without getting out of breath.”
Part of the problem can be explained by neuroscience. Comfort foods and recreational drugs both target the reward circuit in the brain, releasing dopamine. After a period of chronic drug use, a person is left with fewer dopamine receptors. In his New York Times op-ed “What Cookies and Meth Have in Common,” psychiatrist Richard Friedman explained, “These people are far less sensitive to rewards, are less motivated and may find the world dull, once again making them prone to seek a chemical means to enhance their everyday life.”
For some, that chemical is sugar. But limiting exposure to sugary treats and other high-calorie foods will help the brain naturally reset to find pleasure in healthier foods, Friedman explained.
According to Nerissa Heller, outpatient manager at De Paul Treatment Centers of Portland, “it is very common for us in the substance-use-addiction world to see people have body changes when they start to engage in recovery.”
She said while everyone’s experience is unique, “a side effect of some mental health medications and some medication-assisted treatments – particularly methadone – can also impact people in a way that causes them to gain weight in a fairly rapid way.”
Heller has worked with “countless” people who’ve identified weight gain as a trigger, especially men and women who’ve struggled with stimulant use disorder, she said.
“That tends to be a substance where people are not eating regularly, they’re not used to feeling hunger, so it’s really expected that they’re going to gain weight when they stop using.”
But weight gain isn’t the only physical challenge facing people new to recovery. Years of hygiene neglect, untreated skin conditions and chronic pain that’s been numbed from substance use all pop up during recovery.
“Individuals who have had a history of poor dental hygiene because of their addiction have much more significant shame around having others identify that perhaps they have had an addiction because they have multiple teeth missing,” she said. “Unfortunately, due to limited resources, for many individuals, it can take a while to save up money or find access to getting things like partial dentures or some of those more physical appearance issues addressed.”
She said at De Paul, a peer support team follows patients from detox to in-patient and then to outpatient, working to connect them with community resources that help address some of these needs. Peers will accompany patients to their first dental appointment, too, if they need the support.
Heller said De Paul also takes a more holistic approach to recovery, educating patients about nutrition and the neurology behind addiction. Healthy snacks are always available, and patients are taught how to eat and prepare whole foods on a budget.
That last piece is crucial. Many people exit recovery with less than $200 a month in food stamps.
That was the case for Fox. She was basically living off her food stamp card when she left in-patient treatment, she said. She wanted to join a gym to work off the weight she was gaining, but she just couldn’t afford it.
Her situation changed after she attended an AA meeting in Northeast Portland about a year ago. Someone there told her about Recovery CrossFit, a free program of the Alano Club of Portland that’s run out of the CrossFit X-Factor’s Recovery Gym in Northwest Portland.
She was intimidated, but knew she needed to do something, so she went anyway.
“I was absolutely mortified. I didn’t know what to expect,” she said. “I was really embarrassed about the state of my physical self.”
After the first class, she was so sore she could barely move, but she kept going back.
“Pretty soon I started losing weight. I got out of this bad relationship I was in, I stopped smoking, I started eating better, I found community and support there – and a sense of empowerment I never had at any time in my life,” she said.
Now, one year later, she’s lost all the excess weight she gained, and she’s working as a CrossFit instructor at the gym. She’s also on her way to earning a nutritional coach certification. She plans to visit local alcohol and drug treatment centers to discuss healthier meal options for patients that are more in line with a holistic approach to treatment, because she thinks it will help more people stay in recovery over the long term.
“Because you are what you eat,” she said. “And for me, the more that I’m engaged in a healthy lifestyle, it pushes me away from a lifestyle of using.”
Fox said many people come to the Recovery Gym because they’ve gained a lot of weight in early recovery, but most don’t stick it out.
“I think it’s because a lot of the recovery culture is caught up in the standard that you go to your 12-step meetings, and that’s the only way, and you smoke your cigarettes,” she said. “I’m trying to find ways to get people more engaged, but it’s not for everybody.”
Pennelle used to attend Alcoholics Anonymous meetings but thought they fell short.
“AA only deals with one aspect of the issue,” she said. “But the problem is you can’t isolate the issue. Substance use disorder is so complex that it affects the whole body, so dealing with it as a spiritual issue is not really going to be that effective, which is perhaps why AA success rates are not higher.”
For Fox, it wasn’t until she found CrossFit that she found truly holistic recovery, a process that she said “ignited” healing of her mind, body and spirit.
Resources for holistic recovery
In Portland, there are other options for people in recovery who are looking for ways to combat the weight gain or find other ways to recover holistically, without spending a bunch of money on a gym membership.
The Recovery Gym hosts a trail running series every Tuesday night through the end of the month.
The Alano Club of Portland, a free club for people in recovery, offers Recovery Yoga twice a week, mindfulness meditation, alternatives to 12-step classes, and many other activities.
For recipes and other recovery resources, visit Olivia Penelle’s website, Liv’s Recovery Kitchen.
All classes at Yoga on Yamhill in downtown Portland are donation-based and open to the public.
For people ages 18 to 35 in recovery, 4th Dimension Recovery Center offers a gym and yoga classes.
On Sept. 28, Oregon Recovers’ 2-mile Walk for Recovery fundraiser will bring together thousands of people in recovery, kicking off with a rally in Shemanski Park.
Did we miss your favorite recovery activity? Post a link or more information in the comments.
Email Senior Staff Reporter Emily Green at emily@streetroots.org. Follow her on Twitter @greenwrites.