Yoga for Substance Abuse: Scientific Rationale and Research Evidence
By Nikhil Ramburn, B.A. and Sat Bir Singh Khalsa, Ph.D.
Substance use disorder is marked by a dependency on alcohol or drugs to function, and may include impaired control and inability to moderate one’s substance use. It becomes clinically significant when the behavior pattern and day to day activities are impaired or the patient is under distress. The user may experience recurrent social or interpersonal problems and may find himself in physically hazardous situations. Another symptom is the increased tolerance for the substance along with substance-specific withdrawal syndromes. Substance use disorder and addictive behavior are complex conditions with numerous underlying psychological, behavioral and physical components. The pathological pursuit of relief through substance use or other addictive behaviors affects neurotransmission within reward structures of the brain, thereby altering motivational impulses and supplanting healthy self-care behavior. This leads the patient to adopt maladaptive behavior in seeking rewards such as food, sex, alcohol and other drugs. Another psychophysiological underpinning to this disorder is stress. Stress is correlated with negative health behaviors and physiological impairment, contributing to substance use and/or abuse and chronic disease development. Given the chronic nature of substance abuse, the likelihood of relapse is high. Therefore, treatment that is truly successful over the long term often involves a radical shift in perspective and a change of deeply rooted behaviors.
In 2011, the Centers for Disease Control and Prevention reported that there were more than 40,000 unintentional drug overdose deaths in the United States. The abuse of tobacco, alcohol, and illicit drugs costs more than $700 billion annually in expenses related to crime, lost work productivity and health care. It has been plausibly ascertained that 47% of the U.S. adult population suffers from maladaptive signs of an addictive disorder.
Yoga is widely recognized as an effective treatment for stress but the benefits of yoga in treatment of substance abuse may extend beyond stress relief alone. Yoga and meditation have been proposed as effective treatment for this condition because of their positive impact on several psychophysiological processes. Yoga has been demonstrated to reduce both the overt behavioral and underlying neuroendocrine components of stress. Those suffering from substance use disorder will often seek relief from daily stressors by using drugs or alcohol, and yoga may prevent relapse by offering a healthy way of managing stress. Yoga has also been shown to improve conditions of depression and anxiety and induce a higher state of consciousness that effectively replaces the attraction of substance-induced high. This is particularly important given the chronic nature of addiction and the pathological search for pleasure through substance use. Furthermore, yoga has been shown to improve self-awareness of one’s mental and physical state, thereby allowing for improved self-regulation and preventing destructive behavior before its onset. Moreover yoga can improve self-esteem and promote a better understanding between an individual and his/her social world.
There are a few notable studies of yoga for addictions, some of which have shown that it is successful in addressing some of the psychophysiological underpinnings of the disease. An older Indian study evaluating yoga for alcohol abusers, revealed that subjects receiving yoga treatment showed normalization of the stress hormones cortisol and catecholamines. At Ankang hospital in Tianjin, China, yoga was found to significantly improve mood and quality of life in women undergoing detoxification for heroin dependence. A Harvard researcher in Boston found that outpatient methadone clients undergoing weekly yoga classes showed equivalent improvements in psychological, sociological and biological measures to subjects undergoing psychotherapy over a six-month period. Finally, in another small Indian study, yoga was shown to offer statistically greater improvements in withdrawal symptoms for drug addicts.
One of Yogi Bhajan’s efforts on his arrival in the West was to provide Kundalini Yoga as a way out of drug use. 3HO SuperHealth® is a therapeutic yogic lifestyle developed by Yogi Bhajan that combines Kundalini Yoga, meditation, therapeutic dietary and juice formulas, and counseling and Humanology (applied psychology from the Kundalini Yoga perspective). 3HO SuperHealth® has been used to address dependency on alcohol, drugs, smoking, food issues, co-dependency, gambling, work, and computers. It also includes tools to manage stress, depression, fatigue and anxiety. SuperHealth® has been accredited by the Joint Commission on Accreditation of Healthcare Organizations and received its highest commendation, being rated in the top 10% of residential programs in the United States.
In 1991, a report on the 3HO SuperHealth® program running successfully for many years in Tucson, Arizona concluded that Kundalini Yoga and Kundalini Yoga meditations play a major role in treatment success for drugs, alcohol and anxiety, especially in maintaining recovery. After the SuperHealth® program, participants reported significant improvement in their spiritual life, peace of mind and ability to handle stress. Currently, 3HO SuperHealth®, spearheaded by Mukta Kaur Khalsa (author of Healing Addictive Behavior:Yogic Science for Transformation as taught by Yogi Bhajan) offers trainings around the world in this yogic approach to breaking addictive behavior.
More recently, a 90-day residential SuperHealth® program for substance abuse was conducted at a psychiatric hospital in Amritsar, India. This region in northern India is particularly prone to substance abuse due to its proximity to strong opium production and trafficking in Pakistan. The primary therapeutic modality was 45 days of thrice daily Kundalini Yoga as taught by Yogi Bhajan® supplemented by a variety of additional SuperHealth® and integrative medical therapies delivered by a number of Kundalini Yoga instructors and therapists. Study participants showed improvements on a number of psychological self-report questionnaires including the Behavior and Symptom Identification Scale and the Quality of Recovery Index. Qualitatively, participants reported greater emotional wellbeing, less pain, less reactivity and the ability to sleep better. These results were published in the peer-reviewed Journal of Ethnicity in Substance Abuse in 2008.
The results of these initial studies point out the effectiveness of yoga and yogic lifestyle as therapy in their own right and as complementary treatment to more conventional clinical practices. Yoga has been shown to effectively target the psychological, biological and behavioral functions implicated in the pathophysiology of addiction. However, more research is needed with larger sample sizes, over a longer timeframe and with replicable methodology to see if similar results are achievable across different programs.