How can the benefits of dietetic care be integrated into the treatment of patients undergoing alcohol withdrawal?

The relationship between excess alcohol consumption and nutritional status is complex. This includes alcohol’s contribution to weight gain [1], replacing other nutrient dense foods in the diet and contributing to malabsorption that can ultimately lead to malnutrition and nutritional deficiency [2]. It is also important to consider other social and environmental factors that may influence alcohol consumption and ultimately influence health and nutrition outcomes [3]. These may include living situations, support from significant others, and access or storage of safe food (food security). The benefits of considering how dietetic care can be integrated into the treatment of patients undergoing alcohol withdrawal has recently been published as a commentary in Drug and Alcohol Review [4].

In our commentary [4] we note that the dietitians’ role certainly has been previously noted as being pivotal in addiction treatment [5, 6], but there is limited clarity of the role of dietitians’ specifically when considering providing nutrition care to patients hospitalised for alcohol withdrawal. Admission to hospital can last 2-5 days and influence the extent of nutritional intervention [7]. In shorter admissions, the focus may focus on identification and treatment of malnutrition and refeeding syndrome while also discussing how approaches to food and nutrition can contribute to harm minimisation. A conversation around food and nutrition may be a non-confrontational way to expose nutrition-related information about the patient’s living situation (e.g. do they have food storage such as a refrigerator or can they afford to go to the shops or prepare meals). This information may trigger referrals and discussions with wider team members (if available) that may help address social or environmental factors that influence nutritional outcomes (e.g. referral to the social worker regarding access to food or providing recommendations on micronutrient or electrolyte supplementation).

For longer hospital admissions or in residential rehabilitation settings the dietitian may have an extended role regarding nutrition interventions. When acute clinical concerns have been resolved this role may involve education emerging from  nutrition assessment. It also provides the opportunity to discuss practical issues and advice regarding budgeting, shopping and meal preparation with limited resources [6]. In circumstances where resources allow, the dietitian may integrate their intervention through interactions with other health care professionals. For example, meal preparation and cooking issues may extend beyond nutrition and involve other healthcare professionals, such as occupational therapists, with evaluations of cognitive and physical function [8]. The integration of dietitians into local alcohol and other drug teams may extend dietitians the opportunity to more comprehensively address nutritional care.

In some instances, dietitian capabilities may influence the implementation of nutrition interventions. This may be exacerbated by stigmatised views of this patient group that may further influence their approach to care and therefore outcomes [9]. A strengths-based approach to individualised person-centred care may assist health professionals understand behaviours and care needs of complex and vulnerable patient groups [10]. Dietitians new to working with patients with alcohol and/or other drug problems should consider undertaking further training that promotes understanding, skill development and problem solving [11]. While there are many learning and development opportunities available to challenge stigma, dietitians might firstly reach out to their local alcohol and other drug and/or mental health care teams who may be able to provide further support and direction.

Our commentary highlights how the benefits of dietetic care can be successfully integrated into the treatment of alcohol withdrawal to contribute to improved nutrition and health outcomes. This may be best supported through the development of local guidelines and integrating dietitians into local alcohol and other drug teams.

Cameron McLean^1,2, Linda Tapsell¹, Sara Grafenauer³, Anne-Therese McMahon²

¹ Nutrition and Dietetics Department, St George Hospital, Sydney, Australia.

² School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, Australia.

³ School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia.

Full paper is available Open Access:

McLean C, Tapsell L, Grafenauer S, McMahon AT. How can the benefits of dietetic care be integrated into the treatment of patients undergoing alcohol withdrawal?. Drug Alcohol Rev. Published online 13 October 2024. doi:10.1111/dar.13963

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