Yoga moves toward mainstream of treatment

It has become axiomatic that there are many pathways to recovery and each is equally valid. The same can be said for yoga. My pathway in yoga started in high school as a reason to avoid physical education classes. I have scant memories from this time about yogic benefits, but Parvatatanas (gastric wind-relieving pose) was definitely something my all-male class understood to be healthy and liberating.

Years later while traveling in India, I stumbled into a bookstore and found Swami Saraswati’s classic text Asana Pranayama Mudra Banda. Only then did the power of yoga to change my life become clear. Almost immediately I enrolled in an intensive 30-day training program focusing on yoga practice and philosophy. The highly regimented program presented yoga as a lifestyle that goes far beyond striking poses on a mat.

Those enrolled in the program were asked to follow rules about how to treat themselves and other living things. Accepting the imposition of strict guidelines contrasted starkly with my Western upbringing. In doing so I learned not only how to twist my body in ways I never imagined possible, but also how attention paid to self and surroundings can lead to a richer, healthier and fuller existence.

To understand how yoga can improve addiction treatment and recovery outcomes, understanding a few basic principles and procedures are in order. Asana translates to “pose,” simply the postures assumed while practicing. There are thousands: Lotus pose, Tree pose, Fish pose, Cow-faced pose, and the universal favorite Corpse pose. Pranayama refers to control of the breath. Prana, the first half of the word, is often defined as vital energy and breath. Yama, the latter half, can be understood to mean something akin to discipline. Control of breath refers not only to command over the speed and duration of breath but also specific techniques such as Ujjayi, the breath one would use to fog a mirror.

Mudra, meaning “gesture” in Sanskrit, refers to positions, predominantly of the hands, used to influence the mood and energies in the body. Gyan mudra is perhaps the most iconic. It is formed by joining the tip of the index finger and thumb while extending the three remaining fingers. Banda more or less translates to “lock” or “hold.” It is a tightening of a specific body region in order to lock in energy or direct its flow to a specific area. Many people, unbeknownst to them, are likely familiar with mula banda. This banda at its most basic level involves the contracting the pelvic floor. This can be very helpful on long car trips.

In the West, yoga is often understood through these physical elements. Fitness programs promote the practice as a good addition to a weight control program or stretching routine. The Western perspective suggests that its importance lies in flexibility, and that spiritual gains might come as a bonus. But my yoga practice has led me to understand myself as a spiritual being with physical experiences, rather than the reverse. If one accepts the premise that we are in fact spiritual beings enjoying physical experiences, many of the elements not typically focused on in the West become the basis for personal transformation.

Inherent in yoga is a moral code. Yamas and niyamas represent a series of "right living" or ethical rules within yoga. They are a form of moral imperatives. Ahimsa speaks most directly to recovery, as it asks practitioners to avoid harm to self and others. They encourage us to treat ourselves with dignity and respect by avoiding substances or thought patterns that are detrimental to wellness. Svadhyaya refers to the practice of self-reflection. It asks practitioners to recognize strengths, flaws, motivations and biases. It emphasizes the importance of studying both the present moment and recognizing the journey one makes through life. Finally, ishvara pranidhana asks us to surrender to a higher power.

Mindfulness and meditation are essential to yoga practice. Mindfulness refers to maintaining focus on the internal and external qualities of the present moment. Meditation refers to a much broader engagement of the mind intended to restructure the consciousness. When I provide yoga to incarcerated youths, I often use the words “concentrate” and “focus” to encourage an attention to a specific a part of their being, such as their breathing or a sensation of stretching a certain part of their body. These types of directions seek to have youths engage in more mindful behaviors. In contrast, at the start and end of these classes I ask the students to remain silent and still in a comfortable position while they attempt to slow down and clear their mind of thoughts. This practice, albeit brief, aligns more closely with meditation. Meditation may support and enhance the development of mindfulness, but mindfulness can be learned and practiced without meditation.

Shelley Richanbach is both a person in long-term recovery and a certified addiction counselor. In her practice she combines 12-Step discussions with movement and meditation activities to tap into past traumatic experiences that may underlie a person’s compulsive behavior. The body serves as a metaphor for the entire life experience, not only as a source of felt phenomena, but also as living action. Imagining the body as a map and changing the patterned body structure, she believes, results in a different way of experiencing, moving and acting in the individual’s life.

Richanbach explains in a personal communication, “My belief is that the body is the key to becoming aware and to identify issues, confront them, to feel and find release, and to eventually heal. That the body and mind can change and that there’s the potential for growth, including becoming aware and awake to one's spirit, perhaps for the first time.

“Interventions can include developing mindfulness and awareness of one’s physical presence using relaxation and meditative techniques; movement in order to promote a deeper physical awareness and to expand one’s capacity to feel and express emotions; and breathing techniques to increase awareness of and improve functioning of the breath. This is where I first acknowledged the early childhood trauma that lived in my body, and the years of self-medicating an unresolved pain that manifested into an addiction.”

Richanbach is a strong proponent of the program Yoga of 12-Step Recovery, founded in 2012 (www.y12sr.com). The approach is described in part this way: “… we weave together the ancient wisdom of yoga and the practical tools of 12-Step programs. We recognize that the 'issues live in our tissues' and through our intentional, themed yoga practice, guided by our breath, we invoke the God of our understanding to help us release whatever is being held. This group is no way a replacement for 12-Step meetings, a sponsor, or any other part of a 12-Step recovery program. It is an adjunct providing what we believe is another helpful tool in addressing the physical, mental and spiritual dis-ease of addiction.

“Our sharing and practice are based in the 12-Steps. Just as the practices of yoga bring us into alignment, the 12-Steps bring us into right alignment with something greater than ourselves.”

What the research suggests

The first challenge in understanding the contribution that yoga can make to treatment and recovery outcomes lies in teasing out the differences between research into mindfulness and meditation and those studies specifically focused on yoga practice. Complicating the task is the interrelatedness of mindfulness and meditation in yogic practice.

Many anecdotal reports and some studies indicate that mindfulness and meditation may be beneficial to persons in addiction treatment. A 2009 article published in Substance Abuse describes the mechanism:

“Mindfulness has been defined as the intentional, accepting and non-judgmental focus of one's attention on the emotions, thoughts and sensations occurring in the present moment. Such a purposeful control of attention can be learned through training in techniques such as meditation. … As such, meditation may be a valuable technique for SUD-affected persons, whose condition is often associated with unwanted thoughts, emotions and sensations (e.g., craving), the tendency to be on 'auto-pilot,' and pre-occupation with the 'next fix,' rather than 'being in the present moment.' Meditation may also be a component of maintaining lifestyle balance, with meditation-acquired skills complementing and enhancing CBT effects for SUDs.”(1)

Mindful meditation practice has called into question traditional approaches to addiction triggers and cravings associated with early recovery. Rather than practicing avoidance and suppression tactics, learning to expect and navigate these internal processes can be important to healing and stabilization. This approach, sometimes referred to as “urge surfing,” accepts the thoughts of “using” as a normal, albeit transient, process. Like other thoughts, it carries only the emotional load or danger attached by the individual.

The University of Washington (UW) conducted an ambitious effort known as the Vipassana Meditation Research Project in the late 1990s, focusing on incarcerated individuals at the King County North Rehabilitation Facility (NRF) in Seattle. Vipassana, which literally means “to see things as they really are,” is one of India's most ancient techniques of meditation. The researchers stated, “The preliminary results of the UW-NRF Vipassana Research Project are noteworthy because of the potential ability of a mindfulness practice, as taught in the 10-day Vipassana meditation course, to significantly impact problem behaviors such as alcohol and drug abuse which are often associated with re-offense. The preliminary results suggest that a 10-day Vipassana meditation course offered in jails or prisons could provide a relatively low-cost and effective rehabilitation program for some substance-abusing offenders.”(2)

Yoga as augmentation to treatment

Not too many years ago, the idea of incorporating yoga into an addiction treatment regime would have been thought at best unusual, and at worst downright kooky. The historical focus of treatment, especially 12-Step facilitation therapy, was clear: Expose the person to a 12-Step mutual aid group and teach skills to prevent relapse.

As professional treatment became more sophisticated, clinical strategies to restore the individual to holistic health (relapse prevention, motivational interviewing, sexual health in recovery, etc.) were incorporated. While there has always been some acknowledgement that health, mental states and physical well-being were important to recovery, exercise and healthy habits were often an afterthought.

Today, many treatment programs, especially so-called high-end private providers, offer yoga as both a component of clinical services and a marketing practice that increases the program's attractiveness to potential clients. Addiction conferences regularly offer workshops on yoga and meditation, and the number of therapists specializing in yoga and addiction recovery is growing. An Internet search will yield any number of websites about yoga and recovery, and how-to videos are readily available.

An early adopter of yoga as a “therapeutic component in treating chemical dependence”(3) was the Rockland County Alcohol and Substance Abuse Outpatient Rehabilitation Program in Pomona, N.Y. Despite their early resistance, patients came to look forward to the yoga sessions each day, comparing their yoga experiences to “drug encounters: freedom, detachment, a rush of energy, total relaxation, escape and floating sensations.” A report concluded, “Yoga and meditation used as an adjunct to treatment can be an effective means in accelerating the rehabilitation process. In providing both of these services, patients would derive an abundance of self-help tools for stress management and self-actualization.”

The San Diego-based treatment organization Practical Recovery incorporates yoga as part of its holistic approach to treatment. “We want a variety of holistic services as a way for clients to take a break from their painful thoughts and emotions, and to focus on something else,” says Practical Recovery founder Tom Horvath. “In the course of the therapeutic day their internal experience can become intense.”

Horvath continues, “It is also generally beneficial for our residents to develop multiple methods of self-care as part of a comprehensive continuing care plan. Yoga in particular is inexpensive and widely available, and can include a spiritual component for those who resonate with it.”

In 1999 Richard Lohman published an article that appears on the Therapeutic Communities Open Forum. It provides a general overview of yoga and a summary of four treatment settings that incorporate yoga as an aid to addiction treatment.(4)

The addiction treatment and recovery movement is constantly evolving. Relatively recent innovations, such as change theory and integrated treatment, have significantly improved outcomes. The inclusion of yoga practice at both the program and personal levels has benefits that are just beginning to be appreciated.

Colin de Miranda is a certified yoga instructor and a student in the MSW program at San Jose State University. He can be reached at demirandacolin@gmail.com.

References

1. Zgierska A, Rabago D, Chawla N, et al. Mindfulness meditation for substance use disorders: a systematic review. Subst Abus 2009;30:266–94.

2. Parks GA. The University of Washington Vipassana meditation research project at the North Rehabilitation Facility. American Jails Magazine; July/August 2003.

3. Calajoe A. Yoga as a therapeutic component in treating chemical dependency, Alc Treatm Quarterly 1987;3:33-46.

4. Lohman R. Yoga techniques applicable within drug and alcohol rehabilitation programmes. Therap Commun 1999;20:61-72.