Substance abuse, dependence and eventual addiction affect all areas of a person’s life. As such, it can be thought of as a 1.physical condition (i.e. the cravings are a very real physical experience) 2. A psychological disorder (symptoms are often linked to past trauma and can be clearly seen in the neural patterning) or 3. as a social issue (addiction often runs in families and is found in particular socio-economic and social populations). Whilst its defined in the dictionary as ‘the state of being enslaved to a habit or practice or to something that is psychologically or physically habit-forming, as narcotics, to such an extent that its cessation causes severe trauma’ (LLC 2016). With a condition that touches so deeply every element of what it is to be human the definitions can differ slightly depending on the angle being taken. The American Psychological Association describes addiction as ‘a condition in which the body must have a drug to avoid physical and psychological withdrawal symptoms. Addiction’s first stage is dependence, during which the search for a drug dominates an individual’s life. An addict eventually develops tolerance, which forces the person to consume larger and larger doses of the drug to get the same effect’ (Shaffer 2012). A more medically influenced definition by the American Society of Addiction Medicine states that addiction is ‘A primary, chronic disease of brain reward, motivation, memory and related circuitry, reflected in the individual pursuing reward and/or relief by substance use and other behaviours’ (ASAM 2011), And from a neurological perspective Bechara (2005) states that “Addiction is the product of an imbalance between two separate, but interacting, neural systems that control decision making: an impulsive, amygdala system for signaling pain or pleasure of immediate prospects, and a reflective, prefrontal cortex system for signaling pain or pleasure of future prospects. Yucel et al. (2007) state “Across substances, individuals with long-term abuse consistently demonstrate neuropsychological impairments of executive (inhibitory) control, working memory and decision making, together with neurobiological abnormalities involving front temporal and basal ganglia circuits. In some instances these deficits are dose dependent, implying that they are a direct consequence of prolonged drug exposure. However, comorbid behavioural, personality and mental health problems are common among drug-using populations and are associated with similar neuropsychological deficits.
Although slightly differing in their angle, what is clear from all of these definitions is that substance dependence, whilst physical in its effects is also strongly linked to the mind and the way in which the brain can become wired into behaving unconsciously and impulsively in a way that is not healthy for the individual and creates habits that are hard to extremely break.
Historically, substances have been used by humans to alter consciousness for as far back as we have existed; becoming addicted to and reliant on substances to function, however is a much more recent phenomena that goes back only a couple of hundred years. Benezet (1774), a ‘self described lover of mankind’ is perhaps the earliest known American author to document alcohol abuse describing it as the ‘dreadful havoc made by the mistaken use as well as abuse of distilled spirituous liquors’.
Unsurprisingly as it is the most readily available, alcohol dependence is the most common form of substance misuse (The Mental Health Foundation 2016). Whilst drinking alcohol and taking recreational drugs are behaviours that span all social classes, addiction tends to be most prevalent in the most deprived areas of our society. Mental health provisions and prisons are full to bursting with drug-addicted people and much of the crime committed in the UK is linked to this epidemic. A study by Light et al. (2013) found that as many as 41% of prisoners in England and Wales reported committing offences in order to get money to buy drugs. While the more traditionally associated illegal addictive drugs such as crack, cocaine and heroin are still a major problem, a new emerging issue is the psychoactive substances, the so called ‘legal highs’ that are readily available in the high street and which contain unregulated, often unknown substances and are also highly addictive. These, alongside prescription medications mean that whatever you’re social standing, whether you are institutionalised, homeless, a socialite, rich or poor there is a substance out there available for you to abuse.
Whilst it is easy to see why people may recreationally enjoy partaking in the consumption of substances that alter perception (there are very few people who don’t enjoy the socially acceptable effervescent high of a glass of champagne for example) it is interesting to look at why people become addicted. Recognising that abuse, dependence and eventual addiction of a substance is not usually a planned consequence of the original act of taking the drug is important. By looking at the neurology behind addiction we can start to understand more easily how behaviour that begins casually and consciously, very quickly becomes an unconscious, and dangerous one.
The addicted brain.
The brain network most affected by drug abuse is the reward network, which runs on dopamine. All drug dependence increases the activity of dopamine (Mason & Hall 2014). Dopamine is a neurotransmitter that communicates between the emotional and logical parts of our brain and governs what we deem to be essential for survival. As the taking of substances (certainly at the beginning of an addiction) is a pleasurable experience, it quickly becomes something the brain recognises as good and valuable. The brain is designed to reinforce pleasurable experience by strengthening the pathways that are laid down, so when these experiences are created through the taking of addictive substances they are able to trick the brain into encouraging the behaviour by releasing dopamine each time. This means the drug taker becomes gradually and unconsciously more tolerant to and reliant on the substance as the brain is fooled into thinking it is important for survival. Subsequent changes in brain chemistry then mean that indeed the use of the substance is entrenched into the users survival. They are no longer taking the substance for pleasure but because without it they feel unwell and in extreme cases would die. They have taken the all to well-trodden path from use, to dependence to addiction.
Understanding the neurology of addiction and how behavior very quickly moves from a conscious decision to an unconscious need helps us to recognize how so many people can fall into this trap. It is a problem that has been building and shows no signs of going away. The World Health Organisation states that ‘The harmful use of alcohol results in 3.3 million deaths each year’ and that ‘At least 15.3 million people worldwide have a drug use disorder (WHO 2016). Closer to home this translates as an estimated 293,879 opiate and/or crack users in England in 2011/12; shockingly this corresponds to approximately eight out of a thousand people within the population aged 15-64 (Hay et al. 2011). These figures do not include the afore mentioned ‘legal highs’ that are growing increasingly popular due to their easy accessibility, with these taken into account this number would be significantly higher.
In short substance addiction is an enormous problem in the UK and worldwide that runs to the heart of our society, one that stems from a fundamental dissatisfaction with “what is” and a desire to alter experience without the respect or the understanding for the consequences of such actions.
As a mind-altering practice itself the use of yoga and meditation as a mode of recovery from addiction appears to make some sense. In this essay I will attempt to look at the scientific research undertaken in order to decipher the benefits it may offer; as well as looking at addiction and addiction recovery from a yogic perspective, in the hope that by understanding the yogi model of mind altering we may be able to learn something about the addicted brain and the way in which it can be treated.
The naturopathic doctor, author, and Kundalini Yoga teacher Sat Dharam Kaur states ‘from a yogic perspective, we are all addicted to our finite identity, the egoic personality, the known small self. We attach to this as “me.” But at some point in one’s yoga journey, the awareness comes that we are so much more than that. The practice of yoga and meditation can reveal to us that we are all connected as One Being, existing in a sea of universal energy, responding with our finite selves to the great creative consciousness as it flows through us, informs us and connects us’ (Kaur 2016).
Yoga and mindfulness research for substance and abuse and addiction recovery is unsatisfactory to say the least, however there are encouraging signs that as a therapeutic approach yoga may be more successful than behavioral based therapies and therefore may be a workable approach to take forward as a complementary therapy. A recent systematic review of randomized clinical trials by Posadzki et al. (2014) found that although encouraging in its findings, evidence to support the effectiveness of yoga for addictions is as yet inconclusive. They recommended that large RCT’s be employed to better determine its worth.
Having said that, in their narrative review of yoga and mindfulness as a complementary therapy for addiction Khanna and Greeson (2013) did conclude that by fully utilizing the whole yogic system of adaptive attitudes, perspectives, self-regulation skills and mindfulness meditation alongside other more traditional methods, optimal treatment and prevention outcomes may be attainable as seen in the figure below:
These encouraging findings are backed up by Marefat et al. (2011) who state ‘Yoga has a positive and significant effect both on depression and state anxiety level of addicts in rehabilitation period.’
Mindfulness has also been found to have positive results. In a study by Brewer et al. (2011), it was found that 16 individuals who received mindfulness training demonstrated greater reductions in smoking, which were maintained through the 17-week follow-up interview. (As cessation rates have shown little improvement in the past 30 years, these findings are surely encouraging). (Mottillo et al. 2009). (Brewer et al. 2011) also clearly showed that teaching techniques that target the addictive process (e.g., controlling craving) rather than the more traditional avoidance of cues that have been emphasized in previous treatments may be more useful to the recovering addict.
Garland et al. (2012) hypothesise that ‘mindfulness practice may decrease stress reactivity while increasing awareness and disrupting the automatic compulsion to consume psychoactive substances, leading to an increased ability to cope with emotional disruption and the urge to use drugs in response to stress’. Interestingly they suggest that mindfulness may be preferable to other more esoteric practices at it is deemed to be acceptable within recovery populations. Perhaps then, we need to find a way to make the more esoteric elements of yoga more ‘acceptable’ to the recovery population, without letting it loose its essence – the teaching of internal and external connection.
In a recent article Johan Hari quotes Professor Peter Cohen, director of The Centre for drug research; argues that ‘the opposite of addiction is not sobriety. It is human connection’ and that the solution to reduce societal drug abuse is to ‘build a system that is designed to help drug addicts to reconnect with the world and so leave behind their addictions’ (Hari 2016). Could this system be or at least include yogic knowledge?
If we take this suggestion, that a core reason for substance misuse and addiction is due to a lack of connection with the world then can we use our understanding of yogic and mindful practices to address some of the issues that are underlining the need for this self medication? If so, how do we put together what we know from the research about yoga and mindfulness for addiction as well as our understanding of the condition to meet the needs of this population in a safe and useful way? How can we help them to reconnect?
It seems there are various things we, as minded yoga therapists can offer, these include teaching; tolerance of sensation, embodiment in replacement of mental overwhelm, discipline, physiological regulation, concentration of mind, a shift in the psychological network and world view, a respect for ones own health, a shift out of denial and self respect, responsibility and management. A regular yoga and meditation practice empowers the practitioners to regulate their own emotional levels by cultivating acceptance. It promotes self- confidence and self-kindness as well as building resilience, which assist in coping with all too common disorders such as stress, anxiety and depression. Yoga allows the individuals to accept themselves completely and from there, go on to make positive and sustainable choices which assist not resists well being. In effect the yogic approach offers an extremely functional and holistic answer to someone who has already begun the journey towards sobriety.
An altered state of consciousness
We already know that very often if someone is found to be habitually using a mind altering substance it is because their reality is not ok for whatever reason, they are suffering, or at least their thoughts are telling them they are suffering. And altering one’s state of consciousness on a regular basis makes this suffering manageable in the short term, (in the long term of course this reaction brings with it a swath of negative consequences very often harder and more insufferable than the issues first facing the user). It is my understanding that often times the line is crossed into addiction in the absence of a feeling of power – power over one’s autonomy or ability to make changes, to accept circumstances, to overcome obstacles etc. Substance abuse becomes an escape from a difficult reality and is a relatively instantaneous way of escaping shame, thoughts, feelings, worries, stress etc. It can also be used as facilitation to search, perhaps looking for a spiritual connection, nurturing, soothing, an answer or a reason. Changing ones state of consciousness, the lens through which we experience, becomes a good option in order to survive adversity. If then, we can use asana, pranayama and perhaps most importantly meditation practices to alter consciousness in a new way, one that leaves the mind clear and clean and able to manage the truth of present moment reality then we set the recovering person on a path that meets their need to experiment with and change their perception without there having to be any negative consequences.
I am not my thoughts
Of course there are many factors that create suffering, not just our thoughts. There can be very real life circumstances that play an enormous role in feeling bad. But if we can recognize that where we are not necessary able to control the events that occur around us, we are able to control our reactions to them then we are often (not always) able to alter the way in which we relation with the world around us. This involves firstly recognizing that the worldview that we currently have is just that, a construct made up of our socialization (our family life, our past and present experience, our early years attachment etc.). Once we recognize that our thoughts are fluid in their expression, we can begin to observe the way in which they work from a more objective perspective. Rather than being overwhelmed with and governed by one’s thoughts we are able to become our own compassionate observer and watch how thoughts rise and fall without necessarily becoming effected by the stories they hold.
Swapping escapism for acceptance
And so how do we teach people who have spent a lifetime escaping their feelings and thoughts to embrace accepting their present moment truth? The fact is that although the immediate result of both escaping and accepting is the same (feeling better, fulfilled, less stressed, less bothered by thoughts, worries etc.) the process in which you get there is in fact the exact opposite process; absolute acceptance of the present moment as a replacement for escapism. In taking the yogic path to relieve suffering one is not reliant on anything other than oneself and is not taking a short cut to happiness which, will then require a payback of ‘coming down’ from the high. The high is grounded there in reality; there is nowhere to ‘come down’ from.
It is important to note here, that the principle of absolute acceptance is not an invitation for defeatism. One could easily misunderstand the concept as encouraging a lack of ambition, for encouraging giving up, but quite the opposite is in fact true. Yoga teaches someone wishing to make changes in their circumstance that they must first start from a place of acceptance. Starting from truth is the only real place from which to make a change. Saying to yourself “I am here and it is hard, impossible even, but I accept it is my reality” allows for the possibility to begin to make changes.
In Bruce Krubert’s documentary “Yoga in The Shadows” (Krubert 2010) we see a lecturer teaching “Suffering is the result of not accepting the pain that were feeling”, this short documentary highlights some of the work happening in America, where yoga and meditation techniques are being taught in prisons and rehabilitation center’s across the country.
Learning to be present, to live more in the now than in the past or future, to be less in your mind and more in your body, can result in a person more able to control their reaction to life – in particular painful or challenging situations. Suffering is a choice in this state. We learn to turn down the volume on the thoughts in our mind in order to give them less weight, to avoid being overwhelmed with the stories that reside there. The thoughts are recognized as simply thoughts, and not confused with reality. This self-acceptance that mindfulness offers is one of the primary components of recovery from addiction. It links into the swapping of escapism for acceptance discussed above and encourages a kindness and self-compassion often not afforded by addicts to themselves.
Yoga asana (physical poses) develop the ability to cultivate this self-compassion alongside present moment and sensation awareness. By using the mat as a practice place for relationing with the world we can start to undo some of the habitual and unconscious neural patterning that has led us to a place of addiction. In becoming very present on the mat, in observing the subtle ways in which the mind and body work, we can begin to understand ourselves on a new level and with this information can avoid the pitfalls of substance dependence. By experiencing the breath and body as an anchor, the practitioner is able to come to a state of oneness with themselves; present in each moment of their experience, thus avoiding any other state caused by thoughts or subsequent emotions.
Asana also teaches through a process of distress tolerance. Working within a safe range of tolerance, learning to be challenged on the mat builds resilience, which can then be translated into everyday life. Learning to be in challenging situations and to be ok, to experience what it feels like to trust yourself, to rely on yourself, to be uncomfortable out with your comfort zone is an extremely important one for someone who has become a slave to their own urges, impulses and cravings. To be stressed and react in a calm way, with full breath and absolute acceptance is a truly exhilarating, emancipating and empowering experience for a human being to manage, one that begins on the mat and eventually becomes a part of the regular practitioners toolkit for life.
Prana; the natural high
For someone who is mentally unwell, emotional and psychological resilience is not present; they are unable to swing with ease along the spectrum of emotions appropriate for the experiences life throws at them. Being stuck in extreme anxiety or in absolute depression is often the precursor to developing a substance addiction and so by teaching through pranayama the experience of moving easily from one state to another and back again we can begin to offer the chance to learn emotional resilience through the autonomic nervous system (a system that normally only works unconsciously). In teaching it on the mat consciously, over time this ability can filter into the unconscious and can also become a part of the practitioner’s life -skills.
It has been interesting for me to note whilst teaching pranayama exercises to recovering addicts that the sensation of prana (breath or life force energy) was noted by them as having similarities to the sensations associated with a substance induced high (feeling stimulated, alive, optimistic, euphoric). I have found again and again that those on the path of recovery are extremely open to experiencing sensation in their body. One of the main reasons for taking a substance is that it allows you to experience pleasant sensation and so as a population they are already finely tuned to notice this when it is presented to them through the practice of yoga. Despite being very un-embodied and trapped in their anxious minds on one level, they also have the introceptive ability to tune into and notice subtle changes and this skill is inherent to wellness for us as humans.
As a population they also easily change their conscious state and are un-phased and indeed very interested in experimenting with that. These are skills learned through drug and alcohol experimentation which, when used in the right way are useful tools for wellness.
Those who have been drawn to recreational drug and alcohol use over other harmful behaviors such as gambling, unsafe sex, self harming, restrictive eating etc. have already self selected to be of the right mindset for a yoga and meditation practice. In my opinion, their search for an ‘out’ through substance abuse leads them very nicely into an ‘in’ through yoga.
Spiritualism to replace addiction
The author Vine Deloria Jnr, famously said “Religion is for people who are trying to save themselves from Hell, Spirituality is for those who have been there”. The link that connects yogic practices with drug experimentation could be seen to be the search for spirituality. Very often addicts talk about something being missing from their lives. Could it be in their move towards altering consciousness they were in fact on a spiritual quest?
Kevin Griffin, author of One Breath at a Time: Buddhism and the Twelve Steps and cofounder of the Buddhist Recovery Network (BRN) states “Addiction itself can be a misguided spiritual search” and that “Many people who don’t see themselves as particularly spiritual find that when they get sober they have some longing in them, and that their addiction, in one form or another, has been a longing for connection. This is a very common experience.” (Griffin 2004).
If this is true (and it certainly has been my experience as a teacher working with the recovery population) then spiritual practices should inform a lot of what we offer in our work with them. Indeed, as early as 1977, the American Psychiatric Association suggested that meditation had the potential to be helpful in therapy, and encouraged research on the topic (Pruett et al. 2007).Perhaps this is why kundalini yoga (arguably the most spiritually facing of all the practices currently on offer today) is commonly used with this population. As someone looking to develop this work then, I would look to incorporate spiritual practices such as meditation, chanting, energetic and chakra practices that would allow this spiritual void to be filled.
Before offering the more esoteric elements of a yogic practice however, the participants must learn several things 1.how to ground themselves, 2.how to regulate their experience and 3. how to notice their early trigger signs so that they can control how far into an experience they go. We already know that generally speaking the recovery population is an anxious, traumatized group, who are primed to move up and out of control easily. (In yogic terms they are ungrounded, their kundalini rises easily, they are very active in their six and seventh chakras, and therefore need a lot of work in the lower chakras to ground that energy and ensure any spiritual experiences are safe and contained and transformative only in the most positive of ways.) As yoga teachers and therapists working in this world it is imperative for us to understand this.
12 steps and eight limbs
The founders of the 12 step program Bill Wilson and Dr.Bob Smith recognized the importance of spirituality within recovery as early as 1935. Their abstinence program includes in its 12 steps the recognition of a ‘higher power’ and has many references to god, “As he may express himself” they also include prayer and mediation practice within their twelve steps (Alcoholics Anonymous World Services Inc. 1981). This approach to recovery has been by far the most widely used across the world and has been adapted for many different kind of addictions over the years. The reference to god is loose enough that is can be translated in a way that works for anyone. It could relate to ones own power, free from ego or as the magnitude of the universe or even as a mountain or mother nature herself. In my opinion it’s all just a way of recognizing your inner knowing by breaking down your superficial self and becoming more humble.
Lindsey Clennell’s documentary “Addiction, Recovery and Yoga” (Clennell 2006) beautifully highlights how the journey to recovery can seamlessly link the principles of the twelve-step abstinence programme with the practices and philosophies of yoga. Clennell’s documentary describes the experience of beginning rehabilitation and how that process appears to universally open up people to a place of learning to heal themselves. Father Joe Pereira, founder of the Kripa Foundation, features in the documentary and describes how, when people who are challenged with addiction take the step to accept the hopelessness of the situation they are in, then able to embrace the hopeful idea of becoming healthy, and healing; “That healing process has to be recognized as a power higher than their ego”.
The documentary discusses “The gift of honesty and truthfulness” by demonstrating that yoga supports the twelve-step program in helping the participant in an ability to see the truth, to alleviate ego to see things as they are. “It keeps their feet firmly on the ground” says Father Pereira. Of course the twelve-step program is also based on the principle of one day at a time, which in an ideal of moment-to-moment living which of course is also one of the basic principles at the heart of the practice of yoga.
There are several experts in the field who have developed their own ways of working with the yogic worldview. American author and yoga teacher Tommy Rosen uses a combination of diet, lifestyle, spiritual and yogic practices in order to “Recover your identity so you can live according to your own unique truth “ (Rosen 2014). In the UK the Minded Addiction Recovery Kit (MARK), was developed by Shaura Hall and Heather Mason at The Minded Institute as an eight-week course to assist in the process of addiction recovery. (Mason & Hall 2014) Based on a neurological understanding of the brain, it uses yoga nidra as a mode of deep relaxation, teaching the recovering addicts what it feels like to become calm, in the hope that the neural pathways that govern relaxation can become awakened again (sober rather than artificially initiating relaxation using drugs or alcohol). Yoga nidra is used rather than savasana as it is fast passed and involves following instructions, which meets the recovering addict where they are, and then directs them inwards to a place of stillness. Yoga nidra has the added benefit that it produces dopamine in the brain (People who have been addicted to substances are often greatly lacking dopamine as supplies have been diminished). From a yogic perspective yoga nidra also offers the practicing person the chance to re-balance their energetic body (pranamayakosha) and by accessing the more subtle energies of the unconscious brain is able to re-frame past events and lift the ‘vale of illusion’ (help the person to see the truth more clearly), which can be massively transformative for someone who has been lost in a fog of substance usage for a long period of time.
Mason and Hall complement this with an energetic kundalini based kriya which is designed to lift the system through an aerobic physical practice, to release endorphins and to encourage coordinated, finely tuned, repetitive movements which should encourage neurogenesis in the brain, particularly if practiced in an enriched environment. It also offers that chance to become embodied and to experience present moment sensation, something extremely important for people who are governed by their thoughts.
Teaching mindful meditation and self enquiry is also then offered as a mode to encourage present moment awareness, to switch from habitual automatic pilot to a more responsive and less reactive person which is able to recognise the beginnings of the emotional overwhelm of the midbrain early enough that they can be overridden by the decision making forebrain.
Each one of these experts, many recovering addicts themselves, has found ways to use the ancient teachings of the yogis to create a new way of being. There are so many ways in which this can be done, and certainly no single right way. And whilst the benefit of yogic and mindful practices still needs to be researched and verified further, there is much anecdotal evidence (including my own) of the transformative way in which these practices can offer assistance on the road to life long sobriety. If our yoga teachers and therapists follow the lessons of ahimsa and seek to work within the window of tolerance set by each participant there is much that can be done to help support the recovery population.
THE AUTHOR’S SUGGESTED PRACTICES FOR ADDICTION RECOVERY:
- Grounding practices to feel safer
- Regulation practices to gain autonomy of experience
- Resilience practices to develop flexibility of state
- Energetic practices to purify and uplift
- Spiritual practices to connect to self and community
- Mindful practices to be present, accepting and conscious
- Lifestyle suggestions such as dietary recommendations, inspirational reading, journaling, nature and joyful activities
Laura is a yoga teacher and Minded Yoga Therapist. She tread her own path from substance abuse to yoga and has been teaching in recovery settings since 2013.
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