September/October 2012 Issue

Yoga as Adjunct Therapy for Substance Use
By April Dawn Ricchuito, DD, MSW
Social Work Today
Vol. 12 No. 5 P. 8

Substance use is a huge problem in America, not only for those who are using but also for the professionals treating them.

While funds have been allocated for prevention programs, finding cost-effective evidence-based treatments for substance users is much harder. Traditional talk therapies alone don’t have the success rates professionals would like to see, and they often do not provide the client with sufficient coping skills necessary to thwart drug cravings.

Although many therapies purport to be client centered, most treatment involves a relapse prevention plan that requires the client to depend on outside support systems that they may not have or that may be unreliable, contributing to the client remaining extrinsically focused, much like with using drugs.

Theories
There are many theories as to why people use substances, but perhaps one of the most widely accepted is the self-medication hypothesis. This hypothesis suggests that drug use is an attempt to relieve symptoms of an underlying disorder or condition, such as stress, depression, or anxiety.

Edward J. Khantzian, MD, a clinical professor of psychiatry at Harvard University, is one of those primarily credited for developing this hypothesis. He believes that an underlying disorder or condition combined with inadequate ego mechanisms (poor coping skills) lead to substance use. In this case, substance use becomes a coping skill; it is an avoidant behavior that promotes escapism, acting out on the brain’s biological wiring to avoid pain and seek pleasure.

With the self-medication hypothesis, the clinician also is given a conceptual framework with which to begin treatment: eliminate the root cause, teach healthy coping skills, and bring the client back into balance. Thus, the maladaptive behavior (substance abuse) is no longer necessary because the drivers contributing to the behavior (the underlying condition and poor coping skills) have been eliminated.

Another perspective, proposed by Alan Leshner, PhD, formerly of the National Institute on Drug Abuse, theorizes that the brain becomes “hijacked” by drug use—it becomes chemically dependent on drugs. While it is true that substance use alters brain chemistry, this theory does little to explain why the individual opted to use substances in the first place. It also fails to explain why some users don’t become chemically addicted.

Regardless of what hypothesis one subscribes to, growing bodies of research are showing that yoga, often thought of as a form of physical exercise, is an effective treatment for many conditions, including substance use and the underlying causes and conditions that contribute to it.

Yoga as Therapy
The field of yoga therapy—applying yoga in clinical settings, ultimately teaching people to attend to direct experiences to be free from suffering caused by vrittis (fluctuations) of the mind—is rapidly growing. Doctors, psychologists, psychiatrists, psychotherapists, social workers, and other clinicians are embracing the healing powers of yoga in clinical practice to treat everything from depression to food addiction to autism.

In 2010, American Family Physician published an article by Saeed and colleagues recognizing yoga as a legitimate treatment for depression and anxiety. More recent studies have shown that yoga increases the levels of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain. This is significant because people who are suffering from stress, anxiety, depression, and substance abuse are all found to have low levels of GABA. Yoga can treat this, regardless of which came first and what is causing the addiction: the underlying condition or the hijacked brain.

“Yoga treats the biology and the psychology of an addict,” said New York City addiction psychotherapist Mary Margaret Frederick, PhD, in an interview with Yoga Journal. “Addicts are profoundly out of control internally. They have knee-jerk panic reactions and tempers. The will and determination yoga requires helps people regain control over their body and their mind.”

A regular yoga practice also helps people develop the discipline needed to succeed in 12-step programs, which often are used as the primary method of treatment for many substance users. The mindfulness practices taught in yoga and the slow, controlled breathing are tools to help curb impulse control—something with which all substance abusers struggle.

“Yoga can be done by anyone, anytime, anywhere, making it extremely cost-effective for prisons, schools, 12-step programs, and even individuals,” says Stacey Sperling, a registered yoga teacher with the nonprofit organization Street Yoga, which brings yoga to underserviced populations such as foster youth, substance abusers, and the homeless.

It also empowers clients, providing them with real-world tools they can use anytime, anywhere on their own because yoga asanas (postures) and pranayama (breathing exercises) are readily accessible when a therapist or sponsor isn’t. People begin to learn the difference between pain and discomfort, to sit with discomfort instead of running from it as they experience different asanas. They are able to fully control their experience, modifying poses in ways that feel good for them and stopping when it hurts.

Yoga takes advantage of the brain’s neuroplasticity, which is often the same characteristic that makes change so difficult. Depression, anxiety, stress, and other negative emotions activate the body’s nervous system in addition to emotional regions of the brain. The body eventually settles into these patterns, and even if the mind has insight, the body will continue to activate these physiological patterns unless this insight is embodied—literally. While traditional therapies work only with the mind, yoga works with the mind and body simultaneously, allowing for the embodiment of insights.

The effect of yoga on neuroplasticity becomes even more important when the mind-body connection is further explored. Yoga also can have a positive effect on the lymphatic network, nervous system, and the immune system, all of which work together to play a role in emotional well-being and overall health.

— April Dawn Ricchuito, DD, MSW, is a New York City-based writer and integrative practitioner who combines traditional evidence-based therapies with ancient practices, such as yoga, and newer findings in contemplative techniques.