Summary: Yes, breathing exercises can help addiction treatment in a variety of ways, including but not limited to their positive impact on stress, mental health symptoms, impulse control, attention, and emotion regulation.
Key Points:
- Controlled breathing exercises in addiction treatment are most often derived from/adapted from mindfulness, yoga, and other traditional health and healing practices.
- Evidence shows breathing exercises can help addiction treatment both directly and indirectly.
- Indirectly, breathing exercises improve emotional and psychological factors that exacerbate addiction and increase risk of relapse.
- Directly, breathing exercises can reduce physical factors that cause relapse.
Breathing, Emotions, and Health: We Know More Than We Think Do
There are times when we take a step back and wonder why the idea of using breathing exercises for therapeutic purposes is a hard sell for many people. We know that in clinical practice, evidence is everything. Without random controlled trials in humans that demonstrate the effectiveness of one therapy over a control group, or one therapy over another in comparison to a control group, and controlling for various variables, we cannot say definitively that this works better than this or conclude that one technique is superior to another.
With that essential information understood, here’s what we all know about breathing, which we all – okay maybe not every last one of us – learned when we were still kids:
Stepping back and taking ten deep breaths will calm us down, give us a minute to get our thoughts and emotions together, and return to rational behavior and interaction.
It can work for 6-year-olds in a tantrum, teenagers in reactive mode, and adults when they get hot under the collar. So why the resistance to using breathing techniques when controlling emotion is essential for healing, when the psychological stakes are high, and when our wellbeing depends on it?
Because when health and safety are factors, we need to prove they work – with math derived from data based on scientific observation.
That’s why a new study called “Controlled Breathing and Heart Rate Variability Biofeedback for Substance Use-Related Outcomes: A Systematic Review and Meta-Analysis” got our attention. While scores of studies verify the effectiveness of controlled breathing exercises on emotional health and wellness, there’s a notable lack of direct research on whether breathing exercises help addiction treatment, and this study is one step toward addressing that deficit.
The Study: Various Types of Controlled Breathing and Addiction Treatment
Here’s how the researcher team describes the goal of their meta-analysis:
“This study aimed to systematically review and meta-analyze the effectiveness of controlled breathing and heart rate variability biofeedback (HRVB) interventions in improving substance use-related outcomes among people using alcohol and other drugs, including nicotine.”
The research team assessed studies that used the following six (6) types of breathing exercises to help addiction treatment:
- Heart rate variability biofeedback (HRVBF): uses biofeedback to teach patients to learn to manage heart rate with paced and controlled breathing, with a target of six breaths per minute
- Resonant breathing: applies HRVBF techniques without the biofeedback device, training patients to control breathing, with a target of six breaths per minute
- Yoga breathwork: various approaches to breathing based on traditional yoga breathwork. Patients control inhalation, retention, and exhalation of breath for various goals, including relaxation, increased awareness, emotion regulation, and thought regulation.
- Rhemercise: technique that combines slow breathing with behaviors such as smiling, yawning, and “positive verbalization.”
- Mimic breathing: involves replicating the breathing pattern most common in cigarette smoking, without the cigarette: 5 second inhale, 2 second retention, 5 second exhale
- Three step breathing: involves approaches on taking deep breaths, retaining them while expanding either the lower, middle, or upper abdomen, then exhaling slowly.
To determine whether those breathing exercises help addiction treatment, the researchers examined data from 20 studies on participants in treatment for alcohol addiction, drug addiction, behavioral addictions such as gambling, and food addictions. They prioritized the impact of breathing exercises on the following outcomes.
- Cravings, assessed with metrics such as the Penn Alcohol Craving Scale (PACS).
- Withdrawal, assessed with metrics such as Clinical Opiate Withdrawal Scale (COWS).
- Substance dependence, assessed using the Severity of Dependence Scale (SDS).
Let’s take a look at what they found, starting with the impact of breathing exercises on substance-related cravings.
The Results: Controlled Breathing, Cravings, Withdrawal, Dependence
First, we’ll share the impact of breathing exercises on cravings for substances. For people with long-term addiction problems, cravings are a primary driver of relapse, and any technique that can reduce cravings can give people in addiction treatment a greater chance of sustained recovery.
Breathing Exercises and Cravings During Addiction Treatment
- Breathing exercises resulted in significant reductions in cravings for substances, compared to controls, with a small to moderate effect size
- Craving reduction identified as comparable to standard treatments with similar effect sizes, such as:
- Cognitive behavioral therapy (CBT)
- Non-specific addiction counseling/therapy
- Results consistent for different substances, including:
- Nicotine
- Alcohol
- Unspecified drug use
- Results were consistent in different settings including:
- Inpatient hospitalization
- Emergency hospital detox
- Outpatient treatment
- Community support groups, rural
- Community support groups, urban
The consistency across types of breathing and treatment milieu, i.e. where treatment occurred, implies that these techniques may have “overlapping mechanism of actions,” including, but not limited to:
- Regulation of the autonomic nervous system
- Psychological adaptability/flexibility
- Control of attention
In addition, five factors mean that even a small-to-moderate effect size can have clinical meaning and a positive impact on recovery:
- Low cost/no cost
- Highly acceptable to wide variety of demographic groups
- Low level of training required for facilitators
- Minimal time required for patients/participants to learn
- Practical/immediately useful
Overall, these outcomes for the impact of breathing exercises on cravings are important because they reinforce what many providers and patients understand through experience: controlled breathing is an effective way to manage the thoughts, feelings, and physical sensations associated with cravings. When a person in treatment can regulate and/or manage those thoughts, feelings, and sensations –thereby reducing cravings – the likelihood of relapse can decrease dramatically.
We’ll discuss the remaining outcomes below.
Impact on Withdrawal and Dependence: Potential Benefit, Statistically Inconclusive
We’ll focus on the impact on withdrawal, since there was insufficient data for effective analysis of the impact of breathing exercises on dependence.
Spoiler alert: the impact of breathing exercise on overall withdrawal requires further, more focused, and more detailed research that focuses on the use of breathing exercises during the withdrawal period following cessation of substance use.
With that said, the evidence for the impact of breathing exercises on withdrawal symptoms aside from cravings was promising, but inconclusive. In explanation, the study team hypothesized that core physical mechanisms associated with the wide and complex array of withdrawal symptoms – which vary both by substance and by individual – may not be influenced by breathing exercises and autonomic nervous system regulation alone.
However, the top-line outcomes of this study were decidedly supported the use of breathing exercises in addiction treatment. Here’s how the study team characterizes their results:
“In people who use substances, breathing-based interventions appear to lead to statistically significant reductions in craving compared with controls, supporting their potential as a low-cost and scalable strategy for managing craving in substance use disorders.”
That analysis aligns with our daily experiences in addiction treatment. And that’s why we use breathing exercise every day in our addiction treatment programs. They’re simple to teach, easy to learn, and effective across demographic groups and across various types of substance use disorder.
