Practical Recovery Tips – Yoga in Opioid Addiction Treatment

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By Grace Cassidy MS, LAC, RYT 200, Therapist, Ocean Monmouth Care

Yoga for Recovery: Physical, Psychological, and Emotional Benefits

Grace Cassidy is 200-hour Yoga Alliance Certified and incorporates yoga therapy into her work as counselor at Ocean Monmouth Care in Brick, New Jersey.

A regular practice of yoga yields a variety of physical, psychological, and emotional benefits. Physical benefits include increased strength, flexibility, balance, and control. Psychological benefits include an increased sense of clarity, a balanced mental perspective, and the ability to remain calm when placed in stressful situations. Emotional benefits include a boost in self-esteem, a balanced emotional perspective, a level of comfort and acceptance of personal strengths and weaknesses, and an overall sense of well-being. For a person in addiction recovery, all these benefits can help access and achieve the type of mental and physical states beneficial for approaching therapy, doing the work of recovery, and mining the deep emotional spaces necessary for creating a full, thriving, and productive life in recovery, free of addiction and the related disruptive behaviors that cause problems with family, work, and relationships.

Also, on a simple level, yoga is a form of exercise. A daily yoga practice of just ten or twenty minutes is as good as – and maybe better- than a ten- or twenty-minute walk around the block. That’s why almost every addiction recovery program offers yoga, in some form, as an auxiliary or complementary therapy in their residential treatment programs.

These programs use yoga not because they think it helps people in recovery but because they know it does.

How?

There’s evidence-based research to back it up.

Research on Yoga + Medication-Assisted Treatment for Opioid Use Disorder (OUD)

Over the past several years, there’s been more research on the use of yoga in addiction treatment than ever before. This is particularly true with regards to treatment for opioid use disorder. The opioid crisis – followed by the COVID-19 pandemic – motivated both people in treatment and those who research new treatment approaches to consider yoga. That’s logical, because once someone learns the basics of yoga, they have that knowledge forever. It’s a tool they can apply at any time, almost any place, and enjoy the benefits of yoga.

Let’s take a quick look at the results of five recent studies on the use of yoga during treatment for opioid addiction:

Study 1

In “Yoga as an Adjunctive Intervention to Medication-Assisted Treatment with Buprenorphine+Naloxone,” researchers showed that for people with OUD in medication-assisted treatment  (MAT), a 12-week yoga program combined with substance use disorder (SUD) treatment significantly reduced levels of stress. This is significant because high levels of stress correlate with high levels of relapse. Yoga can play an important role in a comprehensive approach to stress management and relapse prevention.

Study 2

In “Effectiveness of Yogic Breathing Intervention on Quality of Life of Opioid Dependent Users,” researchers showed that in a group of people with OUD on MAT in India, a three-day yoga course, in combination with SUD treatment, significantly improved quality of life. This is significant because an improved quality of life correlates with decreased rates of relapse. This is another set of data that shows yoga can play an integral role in recovery and overall wellbeing.

Study 3

In the paper “Yoga Effects on Mood and Quality of Life in Chinese Women Undergoing Heroin Detoxification,” researchers showed that, in a group of women in treatment for heroin addiction in China, a six-month yoga training program, in combination with SUD treatment, significantly improved quality of life and improved daily mood. This study confirms and expands the findings in Study 2 above. In addition, the larger sample size and longer duration of the program indicates that yoga is a viable option as a component of a plan to achieve long-term, sustainable recovery.

Study 4

In a detailed case study called “Yoga as an Adjunct for Management of Opioid Dependence Syndrome: A Nine-Month Follow-Up Case Report,” researchers followed an individual participating in a targeted MAT + Yoga treatment plan for nine months. The case study showed that for this individual, his MAT/yoga program improved his physical and psychological wellbeing, and increase a sense of personal empowerment. While individual case studies don’t allow for generalizations, this one offers a glimpse into how clinicians can work with a person with OUD on MAT to incorporate yoga into an effective treatment/relapse prevention plan.

That’s the latest data – and it verifies the validity of yoga as an auxiliary/complementary approach for people with OUD in MAT programs.

But you don’t have to go to a yoga class to get started on yoga. You can give it a try right now – and if you like it, we recommend finding a teacher and taking your yoga practice to the next level.

Morning Yoga: Say Hello to Your Hamstrings

We’ll introduce a simple yoga routine, which, in reality, is something we all know how to do: a forward stretch where we try to bend over and touch our toes. But yoga is not about the result. It’s about the process. So remember: if you can’t touch your toes, or your legs won’t straighten, don’t worry. Simply be where you are, and the posture will work for you.

This routine takes about 3-5 minutes to complete, but you can make it last longer if you do it twice. You can use it any time, but most people like to use it in the morning, as a way to clear their mind, open their body, and prepare to meet the day with a fresh and clear perspective.

IMPORTANT NOTE: If you have back any back/spine issues, adapt these forward bends to your level of comfort. These exercises are very helpful and completely safe for people with back stiffness and occasional pain; in fact, they are often prescribed by physical therapists as part of a course of treatment. However, anyone who has undergone spinal fusion surgery should not practice these forward bends. Rule of thumb: if your back complains, bend your knees, place your hands on your knees, and use the combined strength of your arms and legs to return to Tadasana, the standing posture.

Ready? Here we go:

  • Stand with your feet shoulder distance apart, and your feet parallel, i.e. toes facing forward – not pigeon-toed in, or turned out – straight ahead, as if on a pair of railroad tracks. Relax and let your breath flow in and out naturally. Avoid locking your knees. Relax your pelvis. Allow your low back to lengthen. Tuck your tailbone just a tad. Lengthen your entire torso. Expand your chest. Loosen up your shoulders. Keep your neck free of tension. Lift the crown of your head to the sky: imagine you’re a puppet on an invisible wire, coming down from the sky. Your gaze should stay forward: don’t look up or down. The back of your neck should feel long, which means your chin is not sticking out or tucked in. Let your arms hang loosely, with no tension. You’re now in Tadasana, the Mountain Pose. Tadasana is the foundation pose for almost all forms of yoga.
  • Inhale and lift your arms over your head. Exhale and let them gently fall back down. Do this 8-12 times. Inhale on the way up, exhale on the way down. Think of reaching your arms out long as you lift them, and keep them long as you exhale. Imagine your arms are longer than they actually are. When you inhale and lift your arms, your spine will lengthen: keep that length as you relax your arms back down. When you finish your 8-12 repetitions, spend a few breaths back in Tadasana.
  • Next, starting in Tadasana, lift your arms up again and leave them over your head, palms facing in toward one another. You should look like a referee signaling a touchdown. Keep your arms directly over your shoulders. Think of two straight lines that start at the ends of your fingers and extend all the way down to the floor on each side. Stay there for several breaths.
  • From Tadasana, begin to bend forward, slowly, from the hips. For a moment, simplify the way you look at your body: think of it as two pieces of wood, joined together by a hinge joint at your hips. When bending forward, send the energy of the bottom half of your body down to the ground, and send the energy of the top half of your body up and out. Keep your legs firm, and the muscles of your thighs engaged, i.e. “turned on”. Forward bend halfway over, with a lengthening spine, or until you feel the muscles of the backs of your legs – the hamstrings – tell you to stop. In this part of the bend, your hamstrings are the limiter. Listen to them! For this part of the bend, your reference point will be halfway over, with a flat and lengthening spine, meaning that your torso will be parallel to the floor. If your hamstrings tell you to stop before your torso reaches parallel, then stop – you’ve just discovered your level of hamstring flexibility. This is your first chance to say good morning to your hamstrings. Stay in this position – bent forward, halfway over with a flat and lengthening spine – for one or two breaths.
  • Next, bend your knees a bit and lay your torso down on your thighs. Don’t bend your knees all the way down into a squat. Just bend them until they’re at about a 45-degree angle. Relax your arms completely and let them hang loosely in front of you. This bend should be comfortable enough for your torso to relax over your thighs. This position should feel nice and easy. Relax your head and shoulders completely. The top of your head should point towards the ground. The neck should be lengthening, rather than shortening. Your hands might reach the ground. They might not. It does not matter where your hands end up. Relax and let the arms be free.
  • From this bent-knee forward bend, take a nice breath in, and as you exhale, slowly lengthen your legs and straighten your knees. Keep the top of your head pointing toward the floor as you lift your hips up and lengthen your legs. This is the moment when you get to say a real good morning to your hamstrings. If your knees straighten completely, that’s great. If they don’t, that’s great, too – right now, all you’re doing is gathering information about your body. Your hands might reach the ground. They might reach your shins. They might reach your knees. It doesn’t matter where they end up. Simply note where they are without judgment and allow them to be there. You are now in a full forward bend – Uttanasana.
  • Stay in Uttanasana for at least four full breaths. Keep your breathing calm and steady. Allow your hamstrings to lengthen, and your back body to open and relax. Remember to keep your neck relaxed, and the top of your head pointing toward the ground. If you feel any twinges in your spine, bend your knees place your hands on your thighs, and return to Tasdasana, the standing posture, using your hands on your thighs to help your spine as you stand up (see #9 below).
  • To come out of Uttanasana, start by taking a nice breath in as you bend your knees, and then exhale and relax in this bent-knee forward bend, just as you did when you were entering Uttanasana. Take a breath or two here to give your hamstrings, spine, and torso a break.
  • Next, place your hands on your thighs as you inhale, and then, as you exhale, use the combined strength of your legs and arms to return all the way to Tadasana, the standing posture.
  • To finish this routine, repeat steps (1) and (2) above. As repeat those steps, pay attention to your body. What feels the same? What feels different? Tadasana is your ground zero. It’s your reference. Use it now to gather information – without judgment – about your body, and about how Uttanasana may or may not have changed how your body feels.

Congratulations!

You’ve just finished a yoga sequence that people have been practicing around the world for literally thousands of years.

A regular practice of this Uttanasana routine will lengthen and relax your spine, relieve tension in your neck and shoulders, open the muscles of your hips and calves, and increase your hamstring flexibility. Also, since you spend time focusing on your body and breath and not on the day-to-day worries of life, a regular practice of this Uttanasana routine will help to reduce overall stress and anxiety, as well as energize you to face whatever comes next in your day.

The materials provided on the Pinnacle Blog are for information and educational purposes only. No behavioral health or any other professional services are provided through the Blog and the information obtained through the Blog is not a substitute for consultation with a qualified health professional. If you are in need of medical or behavioral health treatment, please contact a qualified health professional directly, and if you are in need of emergency help, please go to your nearest emergency room or dial 911.