Historically, yoga has been looked at as a ‘complementary therapy’ in addiction treatment. Now, scientific research, with more continuing to emerge, shows yoga can be a clinical game-changer for those in addiction recovery. How is this possible? Yoga has the power to hack the nervous system and restore this complicated region of the body.
As part of our Addiction: Head to Toe series, we take a look at the central nervous system (CNS), the peripheral nervous system (PNS), and it’s subdivision, the autonomic nervous system (ANS), and how these regions are affected by substance use disorders (SUD). We then explore the latest research, insight from thought leaders in SUDs, and original interviews with certified addiction recovery yoga instructors on how this ancient practice may be our best defense in re-balancing the nervous system and sustaining abstinence for those in addiction recovery.
The Central Nervous System and Addiction
Consisting of the brain and spinal cord, the central nervous system controls most body and mind functions. Prolonged substance abuse affects the CNS and the peripheral nervous system, consisting of sensory neurons, ganglia, and nerves connecting to one another and the CNS (Medline Plus, 2016). Depressants, such as alcohol, slow the CNS, affecting the neurotransmitter gamma-aminobutyric acid (GABA), which leads to feelings such as relaxation. Stimulants such as amphetamines excite the CNS by stimulating dopamine release causing euphoria and impaired decision-making. When someone stops using a substance, different pathways within the brain and nervous system go into overdrive. This period of withdrawal from drugs or alcohol produces various adverse effects depending on the dosage and misuse length. One region within the PNS significantly affected by chronic drug and alcohol use is the autonomic nervous system.
The Autonomic Nervous System, Stress, and SUDs
The peripheral nervous system and its subdivision, the ANS, include the sympathetic and parasympathetic regions. The sympathetic nervous system (SNS) activates the fight or flight response during a threat or perceived danger. The parasympathetic nervous system (PNS) is responsible for the body’s rest and digestion response – undoing the SNS’s work after a stressful situation (Science Direct, 2020). “When these mechanisms switch on, they cause you to experience such things as a knot in your belly, tension in your chest, constriction in your throat, pain in your head, and the desire to freeze, fight, or flee. You may also experience a mixture of emotions – including rage, fear, or helplessness (Miller, R.C., 2015).” But what is happening physiologically? During stress, the SNS signals the adrenal glands to release adrenalin (epinephrine) and cortisol. According to the American Psychological Association (APA), these hormones, together with direct actions of autonomic nerves, causes responses such as:
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Increased heart and respiration rate
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Dilation of blood vessels in the arms and legs
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Increased glucose levels in the bloodstream
Chronic substance use and withdrawal from drugs and alcohol can trigger the same SNS responses in individuals. For example, studies show that alcohol stimulates high cortisol levels in those with an alcohol use disorder. When the same individual abstains from alcohol, withdrawal is also associated with increased basal cortisol levels (Wemm, S. & Sinha, R., 2019). Some may feel the effects even longer during addiction recovery – a condition called Post-Acute Withdrawal Syndrome (PAWS). This condition refers to impairments that can persist for weeks or months after abstaining from substance use. According to UCLA’s Semel Institute for Neuroscience and Human Behavior, PAWS has symptoms similar to those found in mood and anxiety disorders, including:
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Mood swings
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Fatigue or insomnia
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Increased levels of anxiety
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Nervousness, agitation, tremors, and twitchy behavior (Semel Institute)
Addiction Recovery Therapy and Limitations
During addiction recovery, the ANS needs to be toned down and re-balanced. Treatment for withdrawal symptoms often includes Medical Assisted Treatment (MAT) such as beta-blockers combined with counseling and similar behavioral therapies. While current addiction treatments are necessary and effective, significant national problems remain. According to Science Advances (Xu, B. & LaBar, K., 2019), in the U.S. alone, there are more than:
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50 million illicit drug users (4.4 million had a marijuana use disorder)
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16 million heavy alcohol drinkers
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10 million individuals who misuse opioids
Additionally, more than 67,300 Americans died from a drug-involved overdose in 2018, including illicit drugs and prescription opioids, according to the National Institute on Drug Abuse (NIDA, 2020). With these staggering statistics still looming in the U.S., it is time to take a hard look at other clinical interventions in treating addiction, including exercise and yoga.
Yoga As Targeted Treatment in Addiction Recovery
Traditionally yoga has been regarded as a ‘complementary therapy’ during addiction recovery. However, times are changing, and a revolution is taking place. Research shows that yoga, and similar mind-body exercises, activate the brain and body in a way that mitigates the adverse effects of addiction and calms anxiety. For example, one study suggests that lactate, a metabolic byproduct of exercise, positively affects mental health. After muscles release lactate during exercise like yoga, it travels through the bloodstream to the brain, where it can reduce anxiety and protect against depression (Karnib, N. et al., 2019). Yoga also helps alleviate chronic pain for individuals with substance use disorders and provides an alternative coping strategy (Lutz, D.J. et al., 2019). Another study states that mind-body exercises ease withdrawal symptoms and significantly reduce daily use and craving for cannabis in marijuana-dependent adults. The research also found that mind-body exercises like yoga, Tai Chi Quan, and Qigong can be an effective and persistent treatment for abstinence in SUD patients. (Wang, D. et al., 2014).
A study published in the Journal of the American Medical Association compared Kundalini Yoga practice to cognitive behavioral therapy (CBT). The results found that yoga was 54 percent more effective than the stress education control group. While CBT still showed 71 percent efficacy, the results provide solid evidence that yoga helps patients with a generalized anxiety disorder (Simon, M.N. et al., 2020). How does yoga hack the ANS and help restore the balance between the sympathetic and parasympathetic regions during treatment? It all starts with the breath.
How Yoga Hacks The ANS and Restores the Body
According to Bessel van der Kolk, M.D., and his book The Body Keeps the Score, “Scientific methods have confirmed that changing the way one breathes can improve problems with anger, depression, and anxiety. Yoga can positively affect such wide-ranging medical problems and bring balance to the autonomic system (Van der Kolk, B., 2014).” The SNS uses chemicals like adrenaline to fuel the body and brain to take action. In contrast, the PNS uses acetylcholine to regulate body functions like digestion, wound healing, and sleep. When an individual takes a deep breath, they activate the SNS. The resulting burst of adrenaline speeds up the heart. Exhaling, in turn, activates the PNS, which slows down the heart. During yoga, individuals pay attention to the exhalation, since deep, long breaths help calm the system. During this action, two successive heartbeats are never the same. A measurement called heart rate variability (HRV) tests this system’s flexibility, and the more fluctuation, the better. Good HRV signifies that the brake and accelerator in the arousal system are both functioning properly and in balance (Van der Kolk, B., 2014).
Recovery-Infused Yoga in Michigan, a non-profit yoga group for those in addiction recovery, is one center using yoga to demonstrate how this practice can help relieve withdrawal symptoms and balance the ANS. Founder, Lindsay Belcastro tells Endominance, “During our classes, students are looking inward and sitting with emotions for the first time since treatment. I would ask them to close their eyes and place their hand on their heart. Many students would become anxious because they weren’t used to feeling anything during addiction. I see students go from feelings of anger, distrust, and fear at the beginning of class to become more relaxed, calm, trusting, and happy throughout the session. It’s amazing the transformation that happens to their system within an hour.”
One Project Making Major Transformations
Endominance also spoke with Mike Huggins, the founder and board chairman of the Transformation Yoga Project (TYP) and author of Yoga for Recovery: A Practical Guide to Healing on the physiological benefits of yoga during recovery. TYP serves people impacted by trauma, addiction, and incarceration through trauma-sensitive mindfulness-based yoga. A registered yoga instructor, Huggins teaches in addiction recovery centers, prisons, and hospitals. He explains how a breath-centered yoga practice “Decreases anxiety and depression symptoms, activates the relaxation response [parasympathetic region], and reduces stress. It’s used to help those in recovery connect the mind and body, something they aren’t used to during active addiction.” Huggins goes on to state, “There is a definite link between trauma and substance use disorders. Incorporating trauma-informed methods like yoga into recovery treatment can help people heal from trauma and sustain lifelong recovery.”
Huggins also reveals one powerful example where one of his students, a veteran with severe PTSD, was able to associate a memory that caused anxiety with something positive. “During one of our more rigorous yoga classes, we also had students do the mountain pose. This is where you stand tall and hang the arms beside the torso – similar to a military pose. I wanted to help my student equate this pose, which would typically induce anxiety and war memories, with something strong, relaxing, and positive.” However, the benefits of this pose did not end in the classroom. Huggins reveals, “The same student told me that he used this pose to help calm his anxiety during a tense situation with someone at a bus stop. The student explained, ‘I was able to pause, think clearly, not react, and take a breath.’ This situation, which would typically have resulted in anger or worse for this person, was deescalated entirely.” The student could associate the feelings of anxiety with something positive, something he could control. The fear memory started to fade in contrast to a healthy one taking shape.
The mind and body are highly interconnected, especially when it comes to addiction. Growing research continues to reveal how yoga, combined with SUD treatment, may be our best defense in sustaining abstinence, reducing anxiety, and improving health for those in addiction recovery. When taking a granular look at what happens to the nervous system during active addiction, we see that yoga can be a vital clinical tool in mitigating negative health consequences and improving the mind-body connection.
Follow us as we continue our Addiction: Head to Toe series examining the latest research and insight from healthcare professionals on how exercise may be our best defense in sustaining abstinence and preventing relapse for those in addiction recovery.
Disclaimer: The exercise and medical information in this paper should not be followed without first consulting a medical health professional. This article is for informational purposes only and is not intended to prevent, cure, or treat any diseases.
References:
American Psychological Association (APA). Stress Effects on the Body. Retrieved September 8, 2020 from https://www.apa.org/helpcenter/stress/effects-nervous#:~:text=When%20the%20body%20is%20stressed,cortisol%20(see%20Endocrine%20System)
Karnib, N. et al. (2019). Lactate is an antidepressant that mediates resilience to stress by modulating the hippocampal levels and activity of histone deacetylases. Neuropsychopharmacology. 44(6), 1152-1162. Doi: 10.1038/s41386-019-0313-z
Lutz, D.J. et al. (2019). Yoga as an adjunct for the treatment of substance abuse. Practice Innovations. 4(1), 13–27. Doi.org/10.1037/pri0000079
MedlinePlus (2016). Neurosciences. Retrieved September 7, 2020 from https://medlineplus.gov/ency/article/007456.htm
Miller, R.C. (2015). The iRest Program for Healing PTSD: A Proven-Effective Approach to Using Yoga Nidra Meditation and Deep Relaxation Techniques to Overcome Trauma. New Harbinger Publications.
National Institute on Drug Abuse (NIDA). Overdose Death Rates. (March, 2020). Retrieved September 8, 2020 from https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates
Science Direct (2020). Parasympathetic Nervous System. Retrieved September 10, 2020 from https://www.sciencedirect.com/topics/neuroscience/parasympathetic-nervous-system
Simon, N.M. et al. (2020). Efficacy of yoga vs cognitive behavioral therapy vs stress education for the treatment of generalized anxiety disorder: a randomized clinical trial. JAMA Psychiatry. Published online. doi:10.1001/jamapsychiatry.2020.2496
Van der Kolk, B. (2015). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Penguin Books.
Wang, D. et al. (2014). Impact of physical exercise on substance use disorders: A meta-analysis. PLoS ONE. 9(10). Doi: 10.1371/journal.pone.0110728
Wemm, S. & Sinha, R. (2019). Drug-induced stress responses and addiction risk and relapse. Neurobiology of Stress. 10. Doi.org/10.1016/j.ynstr.2019.100148
Xu, B. & LaBar, K. (2019). Advances in understanding addiction treatment and recovery. Science Advances. 5(10). Doi: 10.1126/sciadv.aaz6596