THE EFFICACY OF YOGA WITH ADDICTIONS:

A SYSTEMATIC REVIEW OF EVIDENCE

By Alexander El Amanni

The Salvation Army – Addiction Caseworker

University of Auckland – Master of Health Practice

Matua Raki 9th National Addiction Research Symposium 2018

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• Addiction effects 3.5 percent of the New Zealand population (Oakley Browne, Wells, & Scott, 2006)

• The combined total social and treatment financial costs of addiction in New Zealand are an estimated 1.8 billion dollars annually (McFadden Consultancy, 2016)

• Common tertiary addiction interventions include psychosocial rehabilitation and inpatient detox

• The relapse rates post psychosocial rehabilitation are 25-70% within 12-18 months (Vanderplasschen, et al., 2013)

• The relapse rates post inpatient detox could be as high as 95% (National Addiction Centre & Matua Raki, n.d.)

• Yoga has been suggested as a complementary therapy in addiction treatment to enhance recovery and prevent relapse (Harris, 2015; Khanna & Greeson, 2013; Posadzki, Choi, Soo Lee, & Ernst, 2014; Sarkar & Mohit, 2016)

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• Traditional addiction treatments are no ‘cure’, neither is yoga with addictions pitched as a definitive ‘cure’

• Yoga with addictions is complementary therapy not a replacement

• Eastern World 2500 years; ‘Western’ World 50 years (Harris, 2015)

• Brain GABA levels increase after a session of yoga (Streeter, et al., 2007)

• Yoga helps with depression by lowering plasma-cortisol levels, and adrenocorticotropic ACTH hormones (Cramer, Lauche, Langhorst, & Dobos, 2013)

• Yoga reduces stress hormone levels (Vedamurthachar, et al., 2006)

• Recent theses have found interesting evidence (Next slide) (Harris, 2015; Holthaus, 2004; Griffiths, 2007)

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• Mantra is chanting sounds and humming vibrations, and may include clenching/pulsing back molar teeth.

• The meridian palate:

• Tuning in to the Gurus,

Masters, and Teachers,

to channel energy.• “84 meridian points, located on the palate behind the teeth … contain

information about self-perception and include deeply rooted belief systems, automatic personality traits, and habits. When the tongue struck the meridians, this stimulates the endocrine system and the hypothalamus, pituitary, and pineal glands respond. By using this built-in technology, habits can be re-formulated by chanting mantra” (Harris, 2015, p. 41).

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The objective was to perform a search on the EBSCO Host, ProQuest, and Google Scholar databases using the search strategy; "yoga AND addictions OR (substance use disorders)”.

Exclusion criteria is any articles published in 1996 or later, and/or not specifically related to yoga interventions used with a sample of substance use disorder subjects. Ten articles were selected for the sample.

Using the (n=10) representative articles, a systematic review has been produced which employs a mixed-methods approach to the methodology and is designed as a narrative-style, scoping search.

The PRISMA checklist was followed.

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• (1) What are the outcomes of implementing yoga as an intervention tool with substance users in ten peer reviewed articles?

• (a) In which areas have substance users improved their health and life where yoga has been implemented as a complementary intervention tool, in the ten representative articles?

• (b) What types of yogic interventions have proven to be effective in the ten representative articles with the treatment of substance use disorders?

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First author

(year)

Study design Type of

addiction (n)

Experimental

intervention

Control

intervention

Primary

outcome

measure

Main result (between

group differences or

otherwise)

Follow

up(s)

Author conclusions

Anand

(2013)

RCT* pilot with 2 par

llel groups

Drugs (n=20) SN* & YA*, 2 hrs per

day for 6 wks

Standard

Treatment

1. SCI*

2. OPAS*

1. Sig (P<0.001)

2. Sig (P<0.001)

None Yoga therapy is effective

in addi ction treatment.

Anju

(2015)

RCT with 2 parallel

groups

Opioids (n=84) SKY*, 12 hrs over 3

days, 30 mins a day

FU*

Standard

Treatment

1. WHO .

QOL*

1 Sig (P<0.05) phy

Sig (P<0.001) psy

Sig (P<0.001) env

Baseline, 3-

m & 6-m*

SKY can improve QOL at

6-m FU.

Chen

(2010)

Controlled clinical

trial pilot

Drugs &

Alcohol

(n=207)

Qigong Medit ation,

x10 per wk, for 4 wks

Standard

Treatment +

SMART*

1. TCR*

2. VAC*

3. SAS*

1. 92%sg 78%cg

2. N.s (P=0.69)

3. N.s (P=0.76)

Baseline, 1-

wk & 2-wk*

Mostly females will

benefit from Qigong.

Devi

(2016)

RCT with 2 parallel

groups

Drugs &

Alcohol (n=66)

M*

Yoga, 1 hr per day, 7x

a wk, for 4 wks

Waiting List 1. PSQI*

2. RSES*

3. BDI II*

1. Sig (P<0.001)

2. Sig (P=0.005)

3. Sig (P<0.001)

Baseline, &

4-wk*

Improvement to self-

esteem using yoga.

Hallgreen

(2014)

RCT pilot with 2 para

llel groups

Alcohol (n=14) Yoga, 10x 1.5 hour

sessions

Treatment As Usual 1. RAC*

2. HADS*

3. SDS*

1. N.s (P=0.17)

2. N.s (P=0.67)

3. N.s (P=0.79)

Baseline, &

6-m

Study was limited by

small sample size.

Khalsa

(2008)

Qualitative case

study pilot

Drugs &

Alcohol (n=8)

Kundalini Yoga, 3x per

day, x90 days

No Control Group 1. PSS*

2. BASIS*

3. QRI*

1. N.s (P=0.44)

2. Sig (P<0.05)

3. Sig (P<0.05)

Baseline,mi

d,end, 1-m

Yoga had a significant

impact on subjects.

Manju

(2017)

Cohort survey study Alcohol

(n=127)

Active Life Style

Factor Yoga, ongoing

No Control Group Null/alternate

(𝐻𝑎) h

ypothesis

Sig 𝐻𝑎 =(P<0.01)

(r =0.724)

N.m Correlation between

yoga and sobriety.

Marefat

(2011)

RCT with 2 parallel

groups

Drugs (n=24) Yoga, 60 mins, 3x per

wk, for 5x wks

Waiting List 1. BDI*

2. STAIT*

1. Sig (P=0.048)

2. Sig (P=0.023)

None Positive effect on

anxiety and depression.

Shaffer

(1997)

Crossover RCT with 2

groups

Drugs (n=61) HY* + MM*, 75min

per day for 22 wks

MM + Psycho-

therapy

1. SCL*

2. ASI*

3. GSI*

1. N.s

2. N.s

3. N.s

None HY+MM not more

effective than control.

Vedamurthachar

(2006)

RCT with 2 parallel

groups

Alcohol

(n=60)

SKY*+NY* 1hr per day

for 2 wks

No Intervention 1. BDI*

2. ACTH*

3.Cortisol

1. Sig (P<0.001)

2. Sig (P<0.001)

3. Sig (P<0.001)

None SKY has antidepressant

effects on alcoholics.7

First author

(year)

Study design Type of

addiction (n)

Experimental

intervention

Control

intervention

Primary

outcome

measure

Main result (between

group differences or

otherwise)

Follow

up(s)

Author conclusions

Anand

(2013)

RCT* pilot with 2 par

llel groups

Drugs (n=20) SN* & YA*, 2 hrs per

day for 6 wks

Standard

Treatment

1. SCI*

2. OPAS*

1. Sig (P<0.001)

2. Sig (P<0.001)

None Yoga therapy is effective

in addi ction treatment.

Anju

(2015)

RCT with 2 parallel

groups

Opioids (n=84) SKY*, 12 hrs over 3

days, 30 mins a day

FU*

Standard

Treatment

1. WHO .

QOL*

1 Sig (P<0.05) phy

Sig (P<0.001) psy Sig

(P<0.001) env

Baseline, 3-

m & 6-m*

SKY can improve QOL at

6-m FU.

Chen

(2010)

Controlled clinical

trial pilot

Drugs &

Alcohol

(n=207)

Qigong Medit ation,

x10 per wk, for 4 wks

Standard

Treatment +

SMART*

1. TCR*

2. VAC*

3. SAS*

1. 92%sg 78%cg

2. N.s (P=0.69)

3. N.s (P=0.76)

Baseline, 1-

wk & 2-wk*

Mostly females will

benefit from Qigong.

Devi

(2016)

RCT with 2 parallel

groups

Drugs &

Alcohol (n=66)

M*

Yoga, 1 hr per day, 7x

a wk, for 4 wks

Waiting List 1. PSQI*

2. RSES*

3. BDI II*

1. Sig (P<0.001)

2. Sig (P=0.005)

3. Sig (P<0.001)

Baseline, &

4-wk*

Improvement to self-

esteem using yoga.

Hallgreen

(2014)

RCT pilot with 2 para

llel groups

Alcohol (n=14) Yoga, 10x 1.5 hour

sessions

Treatment As Usual 1. RAC*

2. HADS*

3. SDS*

1. N.s (P=0.17)

2. N.s (P=0.67)

3. N.s (P=0.79)

Baseline, &

6-m

Study was limited by

small sample size.

Khalsa

(2008)

Qualitative case

study pilot

Drugs &

Alcohol (n=8)

Kundalini Yoga, 3x per

day, x90 days

No Control Group 1. PSS*

2. BASIS*

3. QRI*

1. N.s (P=0.44)

2. Sig (P<0.05)

3. Sig (P<0.05)

Baseline,mi

d,end, 1-m

Yoga had a significant

impact on subjects.

Manju

(2017)

Cohort survey study Alcohol

(n=127)

Active Life Style

Factor Yoga, ongoing

No Control Group Null/alternate

(𝐻𝑎) h

ypothesis

Sig 𝐻𝑎 =(P<0.01)

(r =0.724)

N.m Correlation between

yoga and sobriety.

Marefat

(2011)

RCT with 2 parallel

groups

Drugs (n=24) Yoga, 60 mins, 3x per

wk, for 5x wks

Waiting List 1. BDI*

2. STAIT*

1. Sig (P=0.048)

2. Sig (P=0.023)

None Positive effect on anxiety

and depression.

Shaffer

(1997)

Crossover RCT with 2

groups

Drugs (n=61) HY* + MM*, 75min

per day for 22 wks

MM + Psycho-

therapy

1. SCL*

2. ASI*

3. GSI*

1. N.s

2. N.s

3. N.s

None HY+MM not more

effective than control.

Vedamurthachar

(2006)

RCT with 2 parallel

groups

Alcohol

(n=60)

SKY*+NY* 1hr per day

for 2 wks

No Intervention 1. BDI*

2. ACTH*

3.Cortisol

1. Sig (P<0.001)

2. Sig (P<0.001)

3. Sig (P<0.001)

None SKY has antidepressant

effects on alcoholics.

1 SIG

2 SIG

3 SIG

4 SIG

5 SIG

6 SIG

7 SIG 8

0 1 2 3 4 5

QoL

Anxiety

Urges/Cravings

Depression

3

3

4

5

Number of Outcome Measures with Statistically Significant Results

Are

a o

f H

eal

th o

r Li

fe

Outcome Measure Themes

9

0 1 2 3 4 5

Self-Efficacy

Sleep

Stress

Withdrawal Symptoms

Social Functioning

2

2

2

2

2

Number of Outcome Measures with Statistically Significant Results

Are

a o

f H

eal

th o

r Li

fe

Outcome Measure Themes

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Types of yoga Description Effectiveness

Active Life Style Factor Physical work out, emotional psychology, inhibits dopamine surge Low

Hatha yoga Yoga postures, breathing and deep relaxation techniques Low

Kundalini yoga Chanting, mindful meditation, kriya, mindful breathing Low

Qigong meditation Relaxation, breathing, guided imagery, inward attention,

mindfulness, and tranquil states

Low

Surdarshan Kriya Yoga (SKY) Breathing techniques and exercises High

Surya Namaskar & Yogic

Asanas

Asanas, kapal bhatti, pranayama and meditation Low

Yoga practice/exercise/

intervention

Not described Unknown

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• One RCT evidenced that Hathya Yoga is equally as effective as GPT

• One RCT was limited by small sample size

• One cohort study was limited by not being randomised nor controlled

• One case study pilot used Kundalini yoga as the main intervention; it is was difficult to determine the cause of the benefits

• One study was a controlled clinical trial but was not randomised

• Only one type of yoga was rated as effective (SKY)

• Due to the nature of the intervention, there is no patient/subject blinding

• The heterogeneity of the data was compromised by too many different outcome measures; the differing study designs, and control interventions; creating too many confounding variables. 12

• Five RCTs were considered empirically sound, and provided strong evidence about the positive effects of yoga with addictions (p=<0.05).

• Yoga with addiction is most effective as a complementary intervention

• Yoga stimulates physiological and biochemical activity – no matter what the patients beliefs and values are about spirituality or yoga (Matus, 2013)

• Yoga helps with depression by lowering plasma-cortisol levels, and adrenocorticotropic ACTH hormones (Cramer, Lauche, Langhorst and Dobos, 2013)

• There is now a growing body of epistemological evidence detailing the benefits of yoga as a complementary therapy in the treatment of substance use disorders

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• The evidence of the studies suggests that yogic interventions, such as SKY, are suitable to recommend to patients with a substance use disorder and co-existing depressive symptoms, as a complementary intervention.

• More longitudinal clinical trials are needed to measure the relapse prevention efficacy of yoga with addictions.

• Conclusions are limited by both a high risk of bias due to no patient blinding, and an excess of differing outcome measures which created too many confounding variables.

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• Anand, M., Alagesan, J., & Prathap, S. (2013). Effect of yoga therapy in rehabilitation of drug addicts. Medical Science, 2(7), 153-154.

• Anju, D., Anita, C., Raka, J., Deepak, Y., & Vedamurthachar. (2015). Effectiveness of yogic breathing intervention on quality of life of opioid dependent users. International Journal of Yoga, 8, 144-146.

• Chen, K., Comerford, A., Shinnich, P., & Ziedonis, D. (2010). Introducing Qigong meditation into residential addiction treatment: A pilot study where gender makes a difference. The Journal of Alternative and Complementary Medicine, 16(8), 875-882.

• Cramer, H., Lauche, R., Langhorst, J., & Dobos, G. (2013). Yoga for depression: A systematic review and meta-analysis. Depression and Anxiety, 30(11), 1068-1083.

• Devi, N., & Singh, T. (2016). A randomised control trial of the effect of yoga on quality of sleep, self-esteem and depression in substance abusers. International Journal of Multidisciplinary Approach and Studies, 3(4), 9-11.

• Griffiths, M. (2007). Teaching yoga in addiction recovery: A social work perspective (Unpublished masters thesis). Melbourne, Australia: University of Melbourne.

• Hallgren, M., Romberg, K., Bakshi, A., & Andréasson, S. (2014). Yoga as an adjunct treatment for alcohol dependence: a pilot study. Complementary therapies in medicine, 22(3), 441-445.

• Harris, W. (2015). Beyond addiction: Kundalini yoga and mindfulness meditation for recovery from opioid dependence. (Unpublished doctoral thesis). LA, United States of America: California School of Professional Psychology.

• Holthaus, S. (2004). A phenomenological study: Yoga during recovery from drugs or alcohol (Unpublished doctoral thesis). Carpinteria, CA: Pacifica Graduate Institute.

• Khalsa, S. B., Khalsa, G. S., & Khalsa, M. K. (2008). Evaluation of a residential Kundalini yoga life style pilot programme for addiction in India. Substance, 7(1), 67-80.

• Khanna, S., & Greeson, J. (2013). A narrative review of yoga and mindfulness as complementary therapies for addiction. Complementary Therapies in Medicine, 21, 244-252.

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• Manju, E., & Chandrasekav, K. (2017). A study on recovery from substance addiction by yoga with active life style factor. Asian Journal of Applied Science and Technology, 1(7), 95-97.

• Marefat, M., Peymanzad, H., & Alikhajeh, Y. (2011). The study of the effects of yoga exercises on addicts' depression and anxiety in rehabilitation period. Procedia - Social and Beahavioural Sciences, 30, 1494-1498.

• McFadden Consultancy. (2016). Research report: The New Zealand drug harm index 2016 (2nd ed.). Wellington, New Zealand: Ministry of Health.

• Shaffer, H., LaSalvia, T., & Stein, J. (1997). Comparing Hatha yoga with dynamic group psychotherapy for enhancing methadone maintenencetreatment: A randomised clinical trial. Alternative Therapies in Health and Medicine, 3(4), 57-66.

• National Addiction Centre & Matua Raki. (n.d.). Orientation to the addiction treatment field Aotearoa New Zealand. Retrieved from www.otago.ac.nz/nationaladdictioncentre/pdfs/orientation.pdf

• Oakley Browne, M. A., Wells, J. E., & Scott, K. M. (Eds.). (2006). Te rau hinengaro: The New Zealand mental health survey. Wellington, New Zealand: Ministry of Health.

• Posadzki, P., Choi, J., Soo Lee, M., & Ernst, E. (2014). Yoga for addictions: A systematic review of randomised clinical trails. Focus on Alternative and Complementary Therapies, 19(1), 1-8.

• Sarkar, S., & Mohit, V. (2016). Yoga and substance use disorders: A narrative review. Asian Journal of Psychiatry, 25, 191-196.

• Streeter, C., Jensen, E., Perlmutter, R., Cabral, H., Tian, H., Terhune, D., . . . Renshaw, P. (2007). Yoga asana sessions increase brain GABA levels: A pilot study. The Journal of Alternative and Complmentary Medicine, 13(4), 419-426.

• Vanderplasschen, W., Colpaert, K., Autrique, M., Rapp, R., Pearce, S., Broekaert, E., & Vanderveld, S. (2013). Therapeutic communities for addictions: A review of their effectiveness from a recovery-orientated perspective. (V. D. Shioiri, Ed.) Scientific World Journal, 2013(427817).

• Vedamurthachar, A., Janahiramaiah, N., Hegde, J., Shetty, T., Subbakrishna, D., Sureshbabu, S., & Gangadhar, B. (2006). Antidepressant efficacy and hormonal effects of Sudarshana Kriya Yoga (SKY) in alcohol dependent individuals. Journal of Affective Disorders, 94, 249-253. 16

Ka Kite Ano Au I A KoutouThank you all for listening

Any questions?

Presentation, speech notes, full paper, and research proposal, all made available via email.

aela387@aucklanduni.ac.nz

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