Yoga & Recovery

In Addiction Treatment

Yoga originates from an eastern spiritual philosophy, which is more than 5,000 years old. Yoga, in Sanskrit, means union.[1] The original usage of this term referred to the yoking together of horses or oxen. However, in the spiritual context, yoga refers to a path that is dedicated to the union of oneself and a higher power. Today, the public places its main emphasis on the flexibility driven yogic exercises (called asanas or postures) that are only one part of yoga. Looking at yoga as exercise alone is akin to focusing on one brick in the path to greater spiritual awareness rather than the path itself.

The seminal text on yoga is Patanjali’s Yoga Sutra (sutra means wisdom in Sanskrit).[2] Scholars believe the book to be at least 1,700 years old, though it may be older. According to Pantanjali, a student and teacher of yoga, the philosophy of yoga is composed of eight limbs that he translated into an eightfold path for living a healthy and balanced life. The eight limbs of yoga can be thought of in two groups: the first four limbs and the latter four limbs. The first four limbs relate to ethical behavior (yama), self-discipline (niyama), conscious breathing (pranayama), and exercise (asana). These initial four limbs are thought to lay the groundwork for the latter four limbs, which are intuition (pratyahara), concentration (dharana), meditation (dhyana), and an exalted state of awareness (samadhi).[3] When the entire framework of ancient yoga is considered, it becomes clear that the popular practice of yoga postures in America today is really only a sliver of what yoga can offer.

Although yoga purists may balk at the separation of yoga postures from its spiritual framework, yoga is versatile enough to meet different needs. Many Americans practice yoga as a form of exercise that is entirely separate from the greater spiritual awareness it offers to followers of eastern philosophy. Yoga can be thought of as a gift from the East to the West, and one that individual recipients can interpret and use in a way that comfortably fits their particular worldview.

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Health Benefits of Yoga

 

Research definitively shows that yoga has positive health effects. It is important to note that yoga can be beneficial at all different levels of intensity. Although yoga may be seen in an outsider’s eye as contortionist-like poses, that is only an extreme end of the spectrum of possibilities.

Yoga is an all-welcoming practice for persons of different shapes, sizes, and ranges of ability. Instruction on yoga postures can be tailored to those with no history of structured exercise to athletes who have made fitness integral to their livelihoods. As positive health benefits are available to anyone who practices yoga, it is helpful to know what research says about the advantages of yoga.

Two studies published in 2014 in a cancer research journal noted the positive impact of yoga for women with cancer. One of the study focused on women who were receiving radiation therapy.[4] The participants who did yoga reported less fatigue, a brighter mental outlook, and better regulation of cortisol, a stress hormone. The other study focused on women who had recently completed cancer treatment. The participants who practiced yoga had less inflammation, improved mood, and increased energy.[5] Although these research studies occurred in the context of cancer patients, the researchers of each study noted their belief that the benefits of yoga are far-reaching and can be beneficial in the context of different health afflictions.

The American Osteopathic Association highlights the close association between a yoga practice and reduced stress.[7] Stress can manifest in myriad ways, including neck ache, back pain, sleep troubles, poor concentration, and drug abuse. Yoga can potentially address these health conditions as it takes a combined mind, body, and spirit approach to healing.

In a typical yoga class (though there are considerable variations), a yoga instructor will lead the class in breathing exercises (pranayama), meditation (dhyana), and the yoga poses (asanas) that stretch and flex different muscle groups. Yoga is considered not only to improve physical health but also to help individuals create a more positive outlook on life and develop healthier coping skills in general.[8] In this way, yoga can be thought of as having a strong mental health component akin to psychotherapy (although yoga is not intended to replace psychotherapy, behavioral therapy, or any other form of therapy or mental health treatment).

While almost anyone can engage in, and benefit from, some individuals may receive a medical advisement not to practice yoga, or a person may not be mentally prepared to responsibly engage in the practice of yoga. A healthy yoga practice requires individuals to have compassion for themselves and their bodies as a way to avoid injury.

As discussed in an article published in The New York Times, Glenn Black, an A-list yoga instructor for nearly four decades, has witnessed how yoga has unintentionally undermined the health of some of his students.[9] As Black explains, a main goal of yoga is to unseat the ego’s control over the body and mind. However, the ego can remain powerful in the yoga practice and cripple students’ ability to listen to their bodies and breath because they are unduly preoccupied with achieving perfection in a pose, and that’s exactly when injuries can arise. The Times article does not undermine findings that yoga is a healthy practice, but it does caution practitioners of yoga to be mindful of how injuries can arise. In addition, Black emphasizes the need for yoga instructors to be mindful of how their egos can potentially push students too hard, an approach that runs contrary to the fundamental principles of yoga.[10]

Who Can Teach Yoga?

 

As CNN reports, there is no governmental agency or committee responsible for the oversight of yoga instruction in the US.[11] The yoga industry therefore must regulate itself, mainly kept in check by consumer satisfaction (which is known by participation rates and profits) and, some would argue, the Yoga Alliance. In an effort to ensure integrity and safety in the instruction of yoga, several veteran yoga instructors banded together in 1999 to create the Yoga Alliance, a nonprofit organization that has created a set of minimum standards for yoga teacher training programs.

A yoga teacher in training at a school that is registered with the Yoga Alliance will complete 200 or 500 hours of training. The theory and practice of yoga in a Yoga Alliance school must address five core principles: yoga methods (includes yoga poses), meditation, and breathing; general teaching methodology; anatomy and physiology; yoga ethics and philosophy; and supervised teaching under a senior yoga instructor. Students who complete training in a Yoga Alliance school are permitted to use the “RYT” trademark (registered yoga teacher) after their names.[12]

While the Yoga Alliance seal of approval may lend legitimacy to a teaching certification, it is not required in any state or locale. The Yoga Alliance credential can, however, improve an instructor’s likelihood of being hired to teach yoga. Some instructors, however, insist on an entirely free-market approach. But if a free-market approach means an instructor has little formal training, there is concern that students subsequently face a greater risk of injury.

In view of veteran instructor Glenn Back’s opinion discussed above, studying under a well-trained yoga instructor can help to ensure safety in the practice of yoga. When yoga instruction occurs in a facility that offers a different primary service, such as a drug rehab center, the program director makes the decisions regarding the people who are hired to teach yoga. As a drug rehab center provides professional grade services, it is likely that the program director will only hire yoga instructors who have sufficient experience, excellent references, and are particularly well-suited to working with individuals in recovery. As many drug rehab centers operate on the principle on transparency, a client can inquire about the instructor’s credentials if a yoga program is offered on site.

How Yoga Can Support Substance Abuse Recovery

 

As discussed in an insightful Social Work Today article, yoga is considered to be an effective adjunct therapy for the treatment of substance abuse. At least one study on yoga in those with depression and anxiety found that the practice of yogic postures improved these mental health disorders.[13] As mental health disorders often co-occur with substance abuse, yoga is particularly well-suited to the recovery treatment setting because it can help to alleviate the symptoms of substance use disorders and other mental health disorders.

Studies of the impact of yoga on the brain have found that this ancient practice increases GABA levels (the neurotransmitter gamma-aminobutyric acid). The connection between yoga and GABA is particularly significant in the addiction treatment context because persons experiencing substance abuse have been shown to have lower than average GABA levels in the brain.[14] An improvement in GABA levels supports recovery. Yoga is one of the most convenient and pharmacology-free ways to bring the benefits of increased GABA levels into a person’s recovery.

Studies on yoga and neuroplasticity support that those who incorporate yoga into their recovery program can receive a unique benefit. Neuroplasticity involves the brain’s ability to create new neural pathways that support new behaviors (as part of the brain’s readiness to adapt to external stimuli). It has been shown that neuroplasticity can be most solidly activated when the brain receives new insights (e.g., a drug-free life is desirable, achievable, and conducive to greater happiness) and is able to embody these insights (i.e., have a physical behavior, such as yoga poses, that are associated with this new thinking).[15]

Much of the literature about the benefits of yoga for recovering persons discusses the improvement in feelings of self-worth, confidence, body image, and general outlook on life. These benefits can also be said to draw on one underlying advantage: Yoga can help a recovering person to gain control over the impulse to self-harm and do drugs, which in turn contributes to improved self-image. Recovering persons who practice yoga can learn how to control their breathing and quiet their minds (which aid the neuroplasticity process). The mindfulness learned on the mat during yoga practice can organically cross over into every facet of recovering persons’ lives, including their recognition of drug use cues and ability to form healthy responses, such as calling a sponsor or going for a walk.

Yoga is also considered empowering because, irrespective of how much instruction a recovering person receives, yoga is a personal practice. As yoga requires minimal setup, can be practiced alone, and done nearly anywhere, recovering persons have the option to do yoga whenever they do not have access to a sponsor, a friend, a family member, or other form of support. In short, yoga can serve as a readily available tool in one’s recovery repertory. Although it is always advisable to establish a stable yoga practice, because of the benefits therein, yoga can also be engaged in as necessary as a relapse prevention strategy and method for developing a balanced life.

Developing a yoga practice a strong way for a recovering person to learn discipline. For this reason, yoga is considered a helpful and effective way for those in recovery to ready themselves for the aftercare process, particularly participation in 12-Step programs.[16] Yoga is a commitment to one’s wellness as is attendance at 12-Step meetings. Not only are these aftercare practices potentially effective relapse prevention tools, but they also help recovering persons to build a network of supportive individuals and to lay the groundwork for a drug-free life.

Teaching Yoga from Experience

 

Silhouette Of A Fitness Woman Exercising Yoga Meditation ExercisYoga instructor Tommy Rosen has been in recovery from acute drug addiction for over two decades.[17] Rosen began teaching yoga to recovering individuals in 2008 and notes that he is motivated by his own experience in addiction and rehab. While Rosen acknowledges that there is no one-size-fits-all approach to healing addiction, yoga is supportive of recovery. Rosen notes that a main difference between a yoga class for recovering persons versus the general public is the use of recovery language. Rosen incorporates the principles of recovery (such as 12-Step terms and concepts) into his instruction. But as Rosen aptly shares, anyone can benefit from the use of recovery language in his yoga instruction because it touches on universal experiences, such as feelings of powerlessness. Rosen’s advice to other yoga instructors who teach individuals in recovery is to use personal experience as a tool. It is a well-established tenet of teaching that instruction from personal experience, accompanied by meaningful insights, is one of the most effective ways to communicate new lessons to students.

Rosen is not alone in his approach. Yoga instructor Nikki Myers founded Yoga of 12-Step Recovery (Y12SR), a national organization that incorporates the principles of yoga and its practice into traditional 12-Step meetings.[18] To maintain the highest standards of yoga instruction and adhere to the 12-Step philosophy, Y12SR offers a certification process for teachers. Each Y12SR instructor in training must complete an intensive program and a leadership program. In the intensive segment, the instructor learns how the ancient principles of yoga (such as the eight limbs of Pantanjali) connect to the teachings of the 12-Step tradition. During the leadership training, future teachers learn how to conduct Y12SR meetings and ensure a safe environment for mutual aid and the practice of yoga. After training is complete, Y12SR instructors are certified to offer this service to their communities. There are currently Y12SR meetings across the nation.[19]

A discussion of, or interest in, yoga can lead into a talk about meditation. Meditation is an integral part of yoga (even if a yoga student doesn’t practice meditation, yoga poses are thought to be a way of preparing and quieting the body for meditation). The practice of meditation dovetails elegantly with certain psychotherapy approaches, such as Mindfulness-Based Cognitive Therapy.[20]

Some rehab programs may offer meditation, connected to or separate from yoga classes. Meditation is always available to a recovering person as part of a structured group practice or on one’s own. Meditation can be helpful to the aftercare process. Meditation meet-ups vary by locale and are typically based on different traditions, including Buddhism (although a person doesn’t have to be a Buddhist or subscribe to any spiritual philosophy to meditate).

Yoga in Substance Abuse Recovery Programs

 

As there are no laws prohibiting rehab programs from offering adjunct treatments, such as yoga, the decision to provide yoga classes is left to the discretion of the specific rehab center. As yoga requires minimal equipment and is relatively low-cost, it can be incorporated into any rehab center. Whereas a high-end rehab center or moderately luxurious one will typically offer yoga, programs that are entirely state-funded may not. Most rehab centers include information about their services on their official websites. If yoga is offered on site, it will typically be advertised. Recovering persons in outpatient programs that do not offer yoga can, as available, attend off-site classes (Y12SR, if available, or a general yoga class). The rehab center may have information on reputable local yoga studios.

 

When yoga is offered on site at a drug rehab center, it may be an optional service to be engaged during one’s free time or be directly incorporated into the curriculum (i.e., time is set aside on the treatment schedule to attend classes). There are at least 20 schools of theory on yoga in the US, and classes can be created that follow one method or incorporate different approaches.[21] The possibilities abound. Recovery programs have the discretion to offer those yoga classes that best complement their overall treatment philosophy.

For the purposes of providing a brief introduction to some of the main schools of yoga, this discussion will consider the principles of Vinyasa yoga (sometimes called flow yoga). Note: Bikram Yoga (a standardized form of hot yoga under the founder’s strictly guarded copyright) and other hot yoga is popular in the mainstream but is not likely to be offered in drug recovery programs because of the high temperatures involved.

Vinyasa, one of the most popular types of non-hot yoga, is a smooth flow method that has students cross from one pose to another without stopping (whereas in Bikram yoga, for example, a pose ends and the student begins set up and practice of a next pose).[22] Like in all yoga forms, the goal is to synchronize movement and breath. Typically, Vinyasa classes range from 60-90 minutes. Although there are myriad poses that can be added into a Vinyasa routine (largely at the teacher’s discretion), sun salutations one of the hallmarks of this practice. A common sequence in a short sun salutation practice involves poses called downward dog (on hands and feet with hips in the air), chaturanga (a slightly lifted plank-like pose), upward facing dog or cobra pose (legs and hands are on floor while chest and neck are lifted off floor, usually with eyes to the ceiling), and then back to standing position (extended flow sequences will involve different poses). Vinyasa yoga is considered to be exceptionally good for strengthening the body.[23]

Addiction recovery treatment is both a science and an art. It is well established in the treatment community that medication (if advisable under medical supervision) and therapy constitute effective addiction treatment. These two approaches are research-backed and can be thought of as the two backbones of treatment across all programs. Beyond these methods, rehab centers can and do implement any number of complementary therapies, including yoga.

These complementary therapies may also be backed by research, as is yoga, but are always intended to supplement, not replace, the combined medication and therapy approach. It is not advisable to try to treat addiction exclusively through yoga or other complementary holistic treatments, such as massage or acupuncture. Yoga is on the menu of options to help heal addiction and, for some persons, has proven to be instrumental in the recovery process.

 

[1]Definitions of Yoga.” (Jan 14, 2011). Big Shakti. Accessed Dec. 4, 2015.

[2]Who Was Patanjali?” (n.d.). Yoga Journal. Accessed Dec. 4, 2015.

[3] Lasater, J. (Aug. 28, 2007). “Yoga Sutras of Patanjali: The Ultimate Yogi Guide.” Yoga Journal. Accessed Dec. 4, 2015.

[4] Bergland, C. (Mar. 4, 2014). “Yoga Hast Potent Health Benefits.” Psychology Today. Accessed Dec. 4, 2015.

[5] Ibid.

[6] Ibid.

[7]The Benefits of Yoga.” (n.d.). American Osteopathic Association. Accessed Dec. 4, 2015.

[8] Ibid.

[9] Broad, W. (Jan. 5, 2012). “How Yoga Can Wreck Your Body.” The New York Times. Accessed Dec. 4, 2015.
[10] Ibid.

[11] Gallman, S. (Jan. 28, 2012). “Who Should Be Allowed to Teach Yoga?CNN. Accessed Dec. 4, 2015.

[13] Ricchuito, D. (Sept./Oct. 2012) “Yoga as Adjunct Therapy for Substance Use.” Social Work Today. Accessed Dec. 4, 2015.

[14] Ibid.

[15] Ibid.

[16] Ibid.

[17] Schware, R. (March 11, 2013). “Yoga: Helping the ‘United States of Addiction’ Recovery.” Huffpost Healthy Living. Accessed Dec. 5, 2015.

[18]What is Y12SR?” (n.d.). Y12SR. Accessed Dec. 5, 2015.

[19] Ibid.

[20] Jaffe, A. (Oct. 15, 2011). “Mindfulness, Meditation, and Addiction.” Psychology Today. Accessed Dec. 5, 2015.

[21]There Are So Many Kinds of Yoga. This Chart Can Help.” (Sept. 16, 2013). The Huffington Post. Accessed Dec. 4, 2015.

[22] Pizer, A. (n.d.). “Introduction to Vinyasa Flow Yoga.” About.Com. Accessed Dec. 4, 2015.

[23] Ibid.