Role of Yoga in Management of Substance-use Disorders: A Narrative Review

Integrative Treatment for Substance Use Disorders: Improving Outcomes Through Evidence-based Practice of Yoga-derived Breathwork and Meditation

BACKGROUND

Among 20.4 million US adults diagnosed with substance use disorders (SUDs), up to 60% return to use despite treatment or attempted abstinence. Standard care for SUDs is pharmacotherapy and/or behavioral interventions in either an inpatient or outpatient setting. Both national and international epidemiological data suggest this approach to treatment is insufficient and use of an integrative protocol can better promote recovery.

OBJECTIVE

To determine the efficacy of integrating yoga-derived breathwork and meditation into substance use treatment with emphasis on a specific practice, Sudarshan Kriya yoga (SKY).

METHODS

Literature review conducted in PubMed, OVID, and SCOPUS. The initial search term was " Sudarshan Kriya" alone. Subsequent searches combined the search term " Sudarshan Kriya" with a series of substance use-related terms using AND to link the terms.

RESULTS

SKY practice impacts quality of life, well-being, functioning, and substance use behavior. In patients with alcohol use disorder, SKY contributes to significant reduction in depressive symptoms, stress biomarkers, and alcohol use up to 6 months after treatment completion. SKY practitioners engaging in opioid partial agonist therapy may experience buprenorphine potentiation such that concurrent nonprescribed opioid use is eliminated. SKY practitioners can achieve tobacco cessation at a rate comparable to bupropion pharmacotherapy.

CONCLUSION

SKY has established efficacy in the treatment of anxiety, depression, and posttraumatic stress disorder. Currently available evidence also supports integration of SKY into the management of SUDs, and expanded SKY research can ensure optimal use of this promising intervention within this clinical subspecialty.

Evaluation of intervention components to maximize yoga practice among people with chronic pain taking opioid agonist therapy: A factorial experiment using the multiphase optimization strategy framework

BACKGROUND

Chronic pain affects up to half of individuals taking opioid agonist therapy (OAT; i.e., methadone and buprenorphine) for opioid use disorder (OUD), and yoga-based interventions may be useful for decreasing pain-related disability. Whereas more yoga practice (i.e., higher "dosage") may improve pain-related outcomes, it can be challenging for people with chronic pain taking OAT to attend class regularly and sustain a regular personal yoga practice. Therefore, we plan to optimize a yoga-based intervention (YBI) package in order to support class attendance and personal practice, thus maximizing the yoga dose received.

STUDY DESIGN

Using the Multiphase Optimization Strategy (MOST) framework, we will conduct a factorial experiment to examine four intervention components that may be added to a weekly yoga class as part of a YBI. Components include: 1) personal practice videos featuring study yoga teachers, 2) two private sessions with a yoga teacher, 3) daily text messages to inspire personal practice, and 4) monetary incentives for class attendance. The primary outcome will be minutes per week engaged in yoga (including class attendance and personal practice). We plan to enroll 192 adults with chronic pain who are taking OAT for OUD in this 2x2x2x2 factorial experiment.

CONCLUSION

Results of the study will guide development of an optimized yoga-based intervention package that maximizes dosage of yoga received. The final treatment package can be tested in a multisite efficacy trial of yoga to reduce pain interference in daily functioning in people with chronic pain who are taking OAT.

TRIAL REGISTRATION

Pre-registration of the study was completed on ClinicalTrials.gov (identifier: NCT04641221).

Exploring the Impact of a Trauma-informed Yoga and Mindfulness Curriculum for Multiple Populations: A Pilot Study

Individuals with trauma experience negative mental health impacts and are at risk of poor cardiovascular outcomes. Unmanaged, these conditions may worsen, compromising healing and wellbeing. Yoga, particularly trauma-informed, may improve outcomes. The current pilot study explores the impact of a novel trauma-informed yoga and mindfulness curriculum on wellbeing in two parts. The first examined mental health (stress, mood) outcomes in four trauma-impacted populations: adults who were incarcerated (INC), individuals in recovery from substance use disorders (SU), veterans (VA), and vulnerable youth (YTH) assessing both the impact of individual class participation and impact of attending at least four curriculum sessions. For the subgroup of incarcerated individuals, impact by theme was examined. After curriculum sessions, stress was reduced, and mood improved. Across multiple sessions both the largest decreases in stress and greatest increase in mood occurred after participant in the first session. Further, a specific exploration of curriculum class impact by theme for participants who were incarcerated indicated no difference in impact by theme. The second part of this study explored cardiovascular outcomes for the population of those in recovery from substance use. Reductions in systolic blood pressure occurred immediately after the first curriculum session, and diastolic blood pressure reduced over three consecutive sessions.

Characteristics and impact of physical activity interventions during substance use disorder treatment excluding tobacco: A systematic review

Substance use disorder is a worldwide issue that entails negative health and physical activity is a promising complementary therapy for alleviating the consequences. The objective of this reviews is to characterize physical activity interventions offered in the literature and explore their effects during treatment for people with substance use disorders with excluding studies focusing only on tobacco use. A systematic search of seven databases on articles including a physical activity intervention during a treatment for substance use disorder was done and an examination of the presence of bias was performed. A total of 43 articles including 3135 participants were identified. Most studies were randomized controlled trial (81%), followed by pre-post design (14%) and cohort studies (5%). The most common physical activity intervention identified was of moderate intensity, 3 times per week (≈ 1 hour) for 13 weeks. Cessation/reduction of substance use was the most studied outcome (21 studies, 49%), and 75% showed a decrease in substance use following physical activity intervention. Aerobic capacity was the second most studied effect (14 studies, 33%), with more than 71% of studies showing improvement. Twelve studies (28%) reported a decrease of depressive symptoms. Physical activity interventions in a treatment for substance use disorder seem to be a promising, but more methodologically rigorous scientific studies are needed.

Are We Witnessing a New Wave of Substance Use Disorders?: A Spotlight on Stimulant Use Disorders

Stimulant use disorders are emerging as a serious global threat to health. Although research, clinical, and policy efforts have largely concentrated on opioid use disorders over the past decade, exponential rises in prevalence and overdose deaths attributable to stimulant use disorders warrant renewed attention. To date, no approved medications are available to treat stimulant use disorders; however, behavioral interventions have been effective and should be proactively promoted. Similarly, complementary and integrative therapies and harm reduction services have emerging evidence for effectiveness in treating these conditions. Research, practice, and policy interventions should address stigma for medications for stimulant use disorders when available, vaccine hesitancy if vaccines are approved and safe, environmental surveillance to reduce population exposure to toxic effects of methamphetamines, and educational interventions for health providers to increase competency to reduce the long-term effects on various body systems. [Journal of Psychosocial Nursing and Mental Health Services, 61(3), 13-18.].

Exercise in the Treatment of Addiction: A Systematic Literature Review

BACKGROUND

Exercise has been recognized as a promising and emerging treatment for individuals recovering from addiction. The purpose of this article was to systematically review scientific studies using exercise as a means to improve, sustain, or treat addictions, and to provide suggestions for the future use of exercise as a treatment method for addiction.

METHODS

Using PRISMA guidelines, a database search was conducted for articles that tested the impact of exercise interventions on addiction-related outcomes. To be included, peer-reviewed experimental design studies had to use human subjects to investigate the relationship between exercise and the treatment of or recovery from addiction. Garrard's Matrix Method was used to extract data from reviewed articles (n = 53).

RESULTS

Nearly three quarters of the studies reviewed documented a significant change in addiction-related outcomes (e.g., more days abstinent, reduced cravings) in response to exercise exposure, particularly while someone was receiving treatment at an in or outpatient clinic. Many studies investigated the effect of acute bouts of exercise on nicotine dependence, and many studies had small sample sizes, leaving room for future research on how exercise might benefit people recovering from substance and process addictions.

CONCLUSION

Results affirm that exercise can be a helpful aspect of addiction treatment. Future researchers should investigate different exercise settings (e.g., group-based exercise vs individual) and explore exercise maintenance and the long-term outcomes following discharge from treatment facilities.

Yoga and mental health: what every psychiatrist needs to know

Yoga was developed primarily as a tool for self-mastery and spiritual progress. However, over the past few decades, the therapeutic applications of yoga in mental healthcare have been explored with promising results. This article aims to inform psychiatrists about the clinical usefulness of yoga for mental disorders. We discuss the rationale and latest evidence base for the use of yoga in psychiatric practice, including the neurobiological mechanisms and indications and contraindications for yoga therapy. We suggest practical yoga techniques that can be used as an add-on for managing common psychiatric conditions. Finally, we discuss the setting up and running of yoga clinical services in a tertiary psychiatric hospital in India and explore what can be learnt to facilitate yoga as a therapeutic approach in the Western world.

Effects of exercise in non-treatment seeking adults with alcohol use disorder: A three-armed randomized controlled trial (FitForChange)

BACKGROUND

Most individuals with alcohol use disorder (AUD) do not seek treatment. Stigma and the desire to self-manage the problem are likely explanations. Exercise is an emerging treatment option but studies in non-treatment seeking individuals are lacking. We compared the effects of aerobic exercise, yoga, and treatment as usual (phone-based support) on alcohol consumption in non-treatment seeking adults with AUD.

METHODS

Three-group parallel, single blind, randomized controlled trial. 140 physically inactive adults aged 18-75 diagnosed with AUD were included in this community-based trial. Participants were randomized to either aerobic exercise (n = 49), yoga (n = 46) or treatment as usual (n = 45) for 12-weeks. The primary study outcome was weekly alcohol consumption at week 13 (Timeline Follow-back).

RESULTS

A significant decrease in weekly alcohol consumption was seen in all three groups: aerobic exercise (mean ∆ = - 5.0, 95% C = - 10.3, - 3.5), yoga group (mean ∆ = - 6.9, 95% CI = - 10.3, - 3.5) and TAU (mean ∆ = - 6.6, 95% CI = - 8.8, - 4.4). The between group changes were not statistically significant at follow-up. Per-protocol analyzes showed that the mean number of drinks per week reduced more in both TAU (mean ∆ = - 7.1, 95% CI = - 10.6, - 3.7) and yoga (mean ∆ = - 8.7, 95% CI = - 13.2, - 4.1) compared to aerobic exercise (mean ∆ = - 1.7, 95% CI = - 4.4, 1. 0), [F(2, 55) = 4.9, p = 0.011].

CONCLUSIONS

Participation in a 12-week stand-alone exercise program was associated with clinically meaningful reductions in alcohol consumption comparable to usual care (phone counseling) by an alcohol treatment specialist.

Complementary therapies in substance use recovery with pregnant women and girls

Objectives:

Supporting women and girls who are pregnant and experiencing substance use challenges is a high priority for researchers, clinicians, and policymakers. Complementary therapies (CTs) can be effective forms of treatment in some contexts and populations; however, research on the use of CTs in substance use recovery with pregnant women and girls is scarce. To fill this gap, we conducted a mixed methods study using survey data collected at a women’s recovery center in Canada. Our objectives were to describe CTs provided at the program; identify what CTs are perceived by participants as most/least positive; and explore factors that may impact participant experiences with CTs.

Methods:

We analyzed feedback responses from 255 women and girls ( Mage = 27.5 years, range 15–64) using Pearson chi-square tests, logistic regression, and inductive content analysis.

Results:

The most frequently provided CTs were yoga, energy-related activities (e.g. reiki, reflexology), and meditation. Among the most common CTs, participants provided the highest endorsements for massage and physical activity, and the lowest endorsements for yoga and drumming. Across CTs, whether participants looked forward to an activity contributed significantly to whether they found it helpful, would like to do it again, and planned to continue engaging in the activity after leaving the program. Four broad contextual factors were identified that may impact experiences and perspectives about CTs: (1) goodness of fit, (2) self-awareness, (3) growth, and (4) healing and holistic wellbeing.

Conclusions:

This study provides novel evidence on the potential impacts of CTs in substance use treatment for pregnant women and girls, and important contextual factors to consider when implementing these approaches.

Program evaluation of trauma-informed yoga for vulnerable populations

BACKGROUND

Trauma is highly prevalent among vulnerable populations, including those who are incarcerated, in treatment for substance use, or seeking mental health services. Trauma-informed yoga seeks to create a safer yoga practice for individuals with a trauma history and may improve emotional and physical wellbeing. Thus, we conducted an evaluation of a trauma-informed yoga program to gain insight into participant experiences.

METHODS

Trauma-informed yoga classes were led by trained volunteers and held in three sectors that work with vulnerable populations: corrections and reentry, substance use treatment and recovery, and community and mental health. Data were collected via anonymous survey using a retrospective pre-post design. The survey instrument captured reasons for student participation and perceived effects of yoga on emotional and physical wellbeing.

RESULTS

Students were motivated to participate in yoga classes by expectations of physical, mental, and spiritual benefit. Students reported perceived improvements in emotional and physical wellbeing and greater use of self-regulation skills after starting yoga.

CONCLUSION

Our findings suggest trauma-informed yoga is perceived as beneficial by vulnerable individuals, especially those in the correctional system or recovering from substance use. Our results support the value of offering trauma-informed yoga in institutionalized and community settings. Improvements in emotional and physical wellbeing warrant formal study.

Naturalistic Evaluation of an Adjunctive Yoga Program for Women with Substance Use Disorders in Inpatient Treatment: Within-Treatment Effects on Cravings, Self-efficacy, Psychiatric Symptoms, Impulsivity, and Mindfulness

Addiction continues to be a major public health concern, and rates of relapse following currently-available treatments remain high. There is increasing interest in the adjunctive use of mindfulness-based interventions, such as yoga, to improve treatment outcomes. The current study was a preliminary naturalistic investigation of a novel trauma-informed yoga intervention in an inpatient treatment program for women with substance use disorder (SUD). Changes and differences in somatic symptoms, psychiatric symptoms, and psychological mechanisms were evaluated in women receiving treatment-as-usual (n = 36) and treatment-as-usual plus the yoga intervention (n = 42). For both groups, statistically significant within-subjects changes were present for somatic and psychiatric symptoms, cravings, self-efficacy, and multiple facets of impulsivity and mindfulness. Compared to standard treatment alone, participants in the treatment plus yoga condition significantly improved in range of motion and the Lack of Premeditation facet of impulsivity. Although most domains were not selectively affected, these initial within-treatment findings in this naturalistic evaluation suggest some promise for adjunctive yoga and a need for further evaluation, especially using larger samples and longer term follow-up.

Effectiveness of Interventions Based on Yogic Breathing Practices (IB-YBP) on Substance Use Disorders-A Systematic Review of the Randomized Control Trials and Quasi-Experimental Trials

Interventions based on Yogic Breathing Practices (IB-YBP) have shown promising results for substance use disorders (SUD). Research in this area is methodologically heterogeneous and only a few, but restricted, systematic reviews are available. The current systematic review aims to assess the effectiveness of IB-YBP for SUD. Materials and Methods: PubMed, Cochrane's Library, EBSCO-Medline, and Google Scholar databases were searched for the randomized- (RCTs) and quasi-randomized trials. Research involving participants with SUD, of either gender or any age, assessing the effectiveness of the IB-YBP either as a standalone intervention or as an adjuvant to standard treatment versus standard pharmacological/non-pharmacological treatment or no-intervention control were included. Studies having participants with co-morbid psychiatric illness and interventions not having IB-YBP as the predominant component were excluded. Results: The initial literature search yielded 396 articles and upon screening, only 14 studies were found eligible for this review. Most studies have researched IB-YBP as an adjunct to the standard treatment for SUD. Evidence for the effectiveness of IB-YBP is mostly available for tobacco and opioid use disorders, though only for short-term outcomes; however, literature is scarce for alcohol- and cocaine-use disorders. This review documented the effectiveness of the IB-YBP for substance use-related outcome parameters such as abstinence, quality of life (QoL), mood, craving, and withdrawal symptoms. Conclusion: IB-YBP may be an effective adjuvant to standard treatment for various SUD. However, more research is required to compare its effectiveness with standard treatment, and assessing its long-term efficacy, for it to be strongly recommended as a treatment strategy.

The Benefits of Physical Exercise on Mental Disorders and Quality of Life in Substance Use Disorders Patients. Systematic Review and Meta-Analysis

Physical exercise seems to have a promising effect on numerous variables related to the recovery of drug-dependent patients. However, some contradictions are found in the literature. The aim of this study was to perform a systematic review and meta-analysis in order to identify the effect of physical exercise on mental disorders, quality of life, abstinence, and craving, and make a comparison of the effect of exercise depending on the type of program. A search for articles was conducted using PubMed, Web of Science, and Scopus databases. Studies were selected that measured the acute effects or long-term effect (≥2 weeks) of exercise in patients who met criteria for alcohol use disorders or substance use disorders. A total of 59 studies were included. An effect of exercise on quality of life and mental disorders was identified. Subgroup analysis revealed an effect of exercise on stress (SMD = 1.11 (CI: 0.31, 1.91); z = 2.73; p = 0.006), anxiety (SMD = 0.50 (CI: 0.16, 0.84); z = 2.88; p = 0.004) and depression (SMD = 0.63 (CI: 0.34, 0.92); z = 4.31; p < 0.0001), and an effect of exercise on the eight variables included in the SF36 test. The results also showed a trend towards a positive effect on craving (SMD = 0.89 (CI: −0.05, 1.82); z = 1.85, p = 0.06). Body-mind activities and programs based on improving physical conditions produced similar results in mental disorders and quality of life. Available evidence indicates that physical exercise, both body-mind and physical fitness programs, can be effective in improving mental disorders, craving, and quality of life in drug-dependent patients.

Testing Mindful Awareness as a Moderator in the Association Between HIV-Related Stress and Drug and Alcohol Use Problems Among People Living with HIV

Objectives

People living with HIV (PLWH) are disproportionately affected by stressful life events. HIV-related stress adds to general life stressors to increase health risks among this population. Stress has not only been associated with HIV progression but it is also linked to HIV transmission risk behavior (e.g., substance use). Older adults living with HIV (OALWH) experience additional age-related stress and are at increased risk for substance use. Mindfulness buffers against stress for PLWH; however, research has yet to examine mindfulness as a buffer between HIV-related stress and substance use for OALWH.

Methods

Participants were 130 OALWH (M _age = 54.65, SD = 4.20) and 74.6% were Black. The majority were male (69.2%), and nearly half identified as heterosexual (48.5%). A hierarchical linear regression examined the main and interactive effects of mindful awareness and two types of HIV-related stress (e.g., stigma and rumination) on alcohol and drug use problems.

Results

In step one of the model, we examined HIV stigma (β = .231, p = .015) and found no significant interaction with mindful awareness. In step two, HIV rumination (β = .288, p = .001) was added. We found a significant interaction (β = .196, p = .020), indicating those with low mindful awareness and high rumination reported the greatest substance use problems. Exploratory analyses revealed an indirect effect of HIV stigma on substance use through HIV rumination as well as a significant effect for second-stage moderated mediation.

Conclusions

These findings support mindful awareness as a buffer against HIV rumination for OALWH. Further, our results have important implications for the utility of mindfulness-based interventions (MBIs) with OALWH and comorbid substance use disorders.

The effects of mindfulness-based yogic breathing on craving, affect, and smoking behavior

Breathing practices are often incorporated into treatments for tobacco dependence, but there is little direct research testing the efficacy of breathing practices. This study examined the effects of a mindfulness-based yogic breathing (MB) intervention versus active treatment (cognitive strategy [CS]) and no-treatment (NT) control groups on craving, affect, withdrawal, and smoking behavior. Smokers (N = 60; 50% female; 83% African American) were randomized to receive 20 min of MB, CS, or NT. Participants completed self-report measures before and after the manipulation and then took part in a 50-min smoking choice procedure. Afterward, participants were advised to use the techniques they learned and self-monitor smoking for 24 hr. They received 3 reminder text messages and returned to the lab the following day. MB and CS were more effective than NT in decreasing craving to smoke and perceived nicotine withdrawal. MB, but not CS, was more effective than NT in reducing negative affect. MB reduced the risk of smoking by more than twofold relative to both CS and NT during the smoking choice procedure. Participants in the MB condition smoked fewer cigarettes than those in the CS and NT conditions in the 24 hr following the manipulation. There were no differential effects of the manipulations on state mindfulness or positive affect. Mindful yogic breathing appears to be particularly effective in alleviating the acute negative effects of smoking abstinence and decreasing smoking behavior. Mindful breathing techniques are safe, simple, and cost-effective strategies that deserve additional research attention, especially among underserved populations of smokers. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

A pilot study assessing acceptability and feasibility of hatha yoga for chronic pain in people receiving opioid agonist therapy for opioid use disorder

The purpose of this project was to assess the feasibility and acceptability of a hatha yoga program designed to target chronic pain in people receiving opioid agonist therapy for opioid use disorder. We conducted a pilot randomized trial in which people with chronic pain who were receiving either methadone maintenance therapy (n = 20) or buprenorphine (n = 20) were randomly assigned to weekly hatha yoga or health education (HE) classes for 3 months. We demonstrated feasibility in many domains, including recruitment of participants (58% female, mean age 43), retention for follow-up assessments, and ability of teachers to provide interventions with high fidelity to the manuals. Fifty percent of participants in yoga (95% CI: 0.28-0.72) and 65% of participants in HE (95% CI: 0.44-0.87) attended at least 6 of 12 possible classes (p = 0.62). Sixty-one percent in the yoga group reported practicing yoga at home, with a mean number of times practicing per week of 2.67 (SD = 2.37). Participant mood improved pre-class to post-class, with greater decreases in anxiety and pain for those in the yoga group (p < 0.05). In conclusion, yoga can be delivered on-site at opioid agonist treatment programs with home practice taken up by the majority of participants. Future research may explore ways of increasing the yoga "dosage" received. This may involve testing strategies for increasing either class attendance or the amount of home practice or both.

Comorbidity of Personality Disorder among Substance Use Disorder Patients: A Narrative Review

Comorbidity of personality disorders (PDs) and substance use disorders (SUDs) is common in clinical practice. Borderline PD and antisocial PD are particularly found to be associated with SUDs. Our review suggests that the overall prevalence of PD ranges from 10% to 14.8% in the normal population and from 34.8% to 73.0% in patients treated for addictions. Even though the types of PD seen in patients with drug and alcohol use disorder are similar, the prevalence of any PD is higher among patients with drug use disorder than alcohol use disorder. The higher comorbidity between these two conditions has been explained by a primary personality pathology followed by a secondary development of a SUD. The comorbidity with PD positively correlates with the severity of the SUD. Comorbid PD among patients with SUDs is a predictor of poor prognosis in terms of poorer treatment response and outcome. Psychotherapy is the mainstay of treatment in comorbid condition with dialectical behavioral therapy, dynamic deconstructive psychotherapy, and dual-focused schema therapy having the most evidence base. Pharmacotherapy is primarily indicated for the acute crisis management or for the treatment of other comorbid conditions such as psychosis and depression. However, the evidence is insufficient as of now to suggest one treatment over the other. Further research is required to identify more efficacious treatment approaches for this comorbidity.