Interview: Ciera Buzzell, RD, on Nutrition Therapy
Ciera Buzzell is a Registered Dietitian who started off her year by joining the Delphi Behavioral Health Group team. Previously working at the Palm Beach Institute, Buzzell now works for all four of Delphi’s South Florida drug treatment facilities: Palm Beach Institute, Ocean Breeze Recovery, Pathway to Hope, and Arete Recovery and Detox.
Buzzell meets with most of her clients on a once-a-week basis, providing them education from the Nutrition Care Manual, which is based on scientific research from the Academy of Nutrition and Dietetics’ website, EatRight.org, and teaching them the Healthy Eating Plate method, which involves building meals on half a plate of vegetables, three ounces of protein, and a whole-grain.
We sat down with Buzzell for a few minutes to discuss how nutrition therapy can benefit clients recovering from addiction. Read below for the interview.
Discussing Nutrition Therapy and Addiction with Ciera Buzzell
Stephanie Torres: I’m sure it’s been pretty busy for you, working as a dietitian and running around to all of the facilities. What are some of your first impressions of Delphi and its Florida facilities, in regards to working with clients and such?
Ciera Buzzell: It’s great. I like the fact that each facility is a little different. And then there are the clinical aspects to the clients who come in with diabetes, HIV, or other serious disease states that require a dietitian to help them with their needs. The company really needed someone full time.
What kind of clients do you normally see?
It’s all different. A lot of clients are overweight, and that’s just America now with the obesity epidemic, not because people are overeating, but because of our food supply and what we’re taught to eat now. I see a lot of diabetic clients and clients with heart disease. One thing I do notice is cholesterol issues, which is associated with alcohol consumption. It’s all across the board. I don’t see a main age group, either. Young and old. All different walks of life.
Yeah. That’s the world of addiction. And with food, well, everyone eats.
Exactly. And for clients, I get excited, too, because a lot of clients who have been to other treatment centers, they’re like, “Wow, I wish that I came here first,” because now they have a dietitian, and they have nutrition groups that they didn’t have at their last facility. I’ve had clients say, “This is helping me get through this.” And maybe that’s why treatment didn’t work last time, who knows? But they feel like nutrition is important, too.
Do you think the facilities at Delphi are a little special in that way, by having nutrition therapy?
Oh, yeah. And what’s special about them is that it’s not only about someone with a certification, you have somebody who is a registered dietitian, who’s been to school, and is a nutrition expert—you know, helping these people with medical nutrition therapy on top of simple changes to making their diet healthier. I think that gives Delphi an edge over other treatment centers.
Not everyone realizes how important nutrition plays a part in recovery, so can you describe how nutrition therapy helps clients in addiction treatment? What do you discuss with clients?
Definitely. So, on top of meeting with clients individually, I do run groups. I talk about how certain macronutrients, carbohydrates, fats, and proteins rebuild the neurotransmitters that they’ve destroyed through drugs and alcohol, especially dopamine and serotonin. You can really help rebuild those with proper nutrition, so it has everything to do with recovery, I feel.
With chronic substance use comes a multitude of health problems, as you’ve explained, which also can include mental health issues, such as eating disorders. In your work, do you often come across a client who has to address an eating disorder on top of their addiction?
Yes. Basically, I see a lot of people with eating disorders—binge eating, anorexia, bulimia. It’s really common. In regards to drug addiction, most of the time when they’re on drugs and alcohol, it’s not a big issue until they’re back to being sober.
So as a dietitian, I teach clients who have eating disorders that food is fuel and that there are no “good” and “bad” foods. My main goal is to see where they’re at. You know, maybe if they’re eating an apple for breakfast and a piece of chicken at lunch, but then nothing for dinner, I build on those meals. Maybe I’ll add peanut butter to the apple for breakfast one week, and then for lunch, I’ll add greens the next week; whatever their safe food list consists of. Everyone is different.
With that, do you also address substitution addiction, like how some people use food as a coping mechanism? Some people, once they quit, will start eating too much food while other people will go in the other direction and start exercising all the time.
Right. There is definitely a binge-eating component and also sugar addiction. I always talk about that in my group. Because when you’re coming off alcohol and opiates especially, you have a lot of sugar cravings. With clients who have binge-eating disorders, I just have to teach them about mindful eating, to listen to their bodies by using a hunger scale. My biggest tool is to use a food journal with clients because with that, I can build on each week, and I can see what they’re doing versus what they’re telling me.
You’ve mentioned a “hunger scale.” Can you give an example?
So, you know, 1 is not being very hungry and 5 is your stomach’s growling. It all depends on the client. You have your general hunger cues, but some people are different. And then with the binge-eating clients, they don’t know enough of what a “full feeling” is—they’re not used to that—so I have to get them to practice mindful eating, like thinking about chewing, the taste, slow them down, so they can get that 20 minutes for their brain to tell their stomach they’re full.
What’s a sign that nutrition therapy is coming through to a client? How do you mark their improvement?
Well, a good tool is a food diary. I like the clients to keep them from when they started because they can actually see how their progress is. Maybe if their goal is weight loss, they see the weight loss on the scale. If their goal is weight gain through muscle mass, then they see their goal on the scale, too. A lot of times, it’s going to be their energy levels, whether they’re focused, how their skin’s looking. There are so many factors to gauging how someone is doing nutritionally. And it’s such a short period of time, so mainly I go on how the client feels.
So, how did you get into this field? What inspired you to join the addiction treatment world?
I just feel like there’s a huge need and demand for nutrition that the addiction field is really lacking in their services, so I thought it was important because not only are clients dealing with addiction, [but] they’re dealing with major health concerns, too, such as diabetes and cardiovascular disease. All of that can be controlled with diet, so why not teach them that important life skill? I mean, if food is your main fuel source—that’s what you need to survive—you can’t not eat food. It makes good nutrition important, healthwise.
What are your viewpoints on complementary and alternative medicine (CAM) then? Some people think diet is the only answer, so do you try to complement that with what other things clients are going through, like cognitive-behavioral therapy?
Yeah, I definitely think there’s not just a nutritional component to recovery. It goes hand-in-hand with behavioral. Say I have a client with an eating disorder. I can’t touch on the behavioral aspect of the eating disorder; I can just touch on the functional aspect of eating, actually getting them to want to eat. So, of course, the treatment team is important in relation to nutrition, on top of the medications they’re on, too. It all works together.
How do you feel when a client completes a session with you or their treatment?
For a lot of clients, it’s 45 days or sometimes longer, right? If they’re seeing me every week, I provide them with a huge amount of information and tools that they’re going to use for a lifetime. I feel like that’s plenty of time. Ideally, yeah, it’d be great to see them once a month after that to track their progress and check their labs, but I think my clients feel ready when they leave.
What do you most enjoy about your work?
I love when a client comes in when they first get to treatment, and they’re just really lethargic and not feeling well, and their diet’s a mess, and then every week you see a different person, literally. It’s because they’re following the recommendations, changing what they’re putting in their bodies. And that excitement. They get to see, “Oh my gosh, all it takes is eating a few more vegetables or drinking a little bit more water to feel good.” They’re mentally sharper, more focused, and more energetic. It’s the transformation that I really love.