Introduction
Most of us are affected by addiction in some way, either directly or through friends and family. “Drug addiction is the leading cause of preventable death in the U.S.” (Lynch, Peterson and Sanchez, Neural Science & Behavioral Review 2013, p1623).
Given that nearly half of the U.S. population “47% suffers from some form of maladaptive addiction disorder in a 12 month period” (YogaFit Training Systems Worldwide 2015-p11) (Sussman et al eval Health Prof. Mar.2011;34 (1):3-56).
Let’s build and implement safe, accessible and affordable treatment solutions.
There are four main category in research:
(Koob and Simon NIH 2009) (Lynch, Peterson and Sanchez) (YogaFit Training Systems Worldwide)
1. The Dopamine based incentive/motivation apparatus and serotonin.
2. The Opiate attachment reward pathways.
3. Stress response mechanism and norepinephrine.
4. Self-regulation and the prefrontal cortex, GABA & Glutamine.
Exercise impacts each category.
The relationship with Dopamine gets alot of attention.
According to the NIH, dopamine allows the brain to regulate movement as well as the feelings of pleasure that are seen as integral to addictions and drug use. (National Institute on Drug Abuse,p3)
And that is what makes it most interesting to me.
Cigarettes, alcohol and illicit drugs all increase dopamine levels in the brain. As does our insatiable impulse for scrolling & screentime.
Exercise does, in fact increase the body’s own capacity to make and use more dopamine. It can also support recovery by many other means.
An exercise scientist sees the incredible benefits of cardiorespiratory training. It turns out that moving large muscle groups in rhythmic patterns for 10 mins or more at a time has loads of immediate and long term benefits to the nervous system, to circadian rhythms, to the capacity for return to homeostasis as well as to the cardio vascular system itself.
When we move our bodies enough we sleep better, have less anxiety, more stress relief, improved energy, and improved mood. Food tastes better. We have increased sensations and the ability to feel more and better!
Strength training also builds the immune system, as well as the brain, muscles and nervous system’s ability to transmit messages more efficiently.
Stress and anxiety are clearly linked to beginning addiction as well as relapse.
Varied changed neuropathways carved through addiction can be shifted when we train the brain and body to react differently as it does as we learn new healthy exercise habits.
Physical activity (PA) can be used to treat addiction.
This article addresses the stages of recovery by looking at how the underlying physical realities: stress, anxiety, sleep problems, low energy and hyperexcitability can be ameliorated with PA.
The stages of addiction are organized here as :
1. Withdrawal or detox and cravings.
2. Abstinence-Maintenance
3. Relapse.
Stopping Addictive Behaviors
One of the first obstacles faced when trying to stop an addiction are withdrawal symptoms.
During withdrawal the body experiences low energy, anxiety, sleep and mood problems.
It’s not fun or pleasant as the body tries to adapt to the unfamiliar. And it IS biological.
Under the influence of drugs and alcohol the body adapts to use.
For example, let's look at dopamine. Remember dopamine is only one of the many implicated neurotransmitters.
If dopamine levels are too high from the action of ingested drugs then the body’s innate striving for health-safety-balance called homeostasis will kick in. Your body will restrict high circulation of dopamine by closing channels for access, the receptor sites.
With repeated consistent use of the drug and therefore repeated high circulating foreign dopamine, the body will effectively destroy these receptor sites.
Now less circulating dopamine will reach the cells.
This enhances the body’s tolerance for the substance but sets up a feedback loop that is likely to cause many negative long-term consequences.
When we remove the substance, or the familiar action in some cases, withdrawal ensues. As does cravings and physical and emotional pain.
The cravings, the physical pain and the mental and emotional weight of it all beg for relief by calling forth more cravings for the missed substance or behavior.
Because access points have been destroyed, the body’s ability to experience effects of normally circulating neurotransmitters is negatively impacted.
It takes time and abstinence from the behavior or substance in order for the body to readapt.
How Exercise Helps with Withdrawal and Cravings
Cravings
We can say that cravings are an intense desire, often overwhelmingly so. “Acute exercise reduces the desire to smoke” (Janse Van Rensburg, Taylor and Hodgson, Society for Study of Addiction, 2009).
The cravings are part of the body’s request for relief of these symptoms. These symptoms that effect all humans at some point: anxiety, nervous energy, stress and so on.
Zschucke et al, in their review of addictions studies databases showed proof for exercise as treatment for smoking addiction. However they concluded that there was not enough proper research to prove that exercise can treat illicit drug and alcohol addiction.
They do state that one possible mechanism through which exercise could treat addictions is by reducing cravings. (Zschucke, Heinz and Strohle, Scientific World Journal, 2012).
They also note that alcohol cravings are linked to dysfunction in opioid transmission, prefrontal cortex and glutamate processes and the dopamine apparatus.
Zschucke et al also showed that animal studies made it clear that exercise, immediate -acute and long-term -chronic changed the brain, nervous and endocrine system: “by modifying transmitter release, reuptake, turnover, or receptor density and sensitivity respectively”.
Lynch showed that exercise improved treatment outcomes by reducing cravings.
Withdrawal
Lack of pleasure and feelings of pain are hallmarks of the initial stopping of drug and alcohol use.
During this withdrawal stage from drugs of abuse, increases and decreases in specific neurotransmitters create more anxiety, sleep and mood problems.
Decreases in dopamine, serotonin, and opioid peptide all have effect of “dysphoria”. There is a state of unease or generalized dissatisfaction with life.
Decreases in GABA & y-aminobutyric acid create an increase in anxiety.
Increase in Norepinephrine, corticotrophin-releasing factor create more stress. (Koob and Simon)
Energy levels are also impacted.
Exercise can ease the suffering and thwart some withdrawal symptoms.
Wang and company’s meta-analysis of addictions research stated: “Overall physical exercise can effectively assist with withdrawal from addictive drugs” (Wang, Wang and Wang,PLOS Vancouver,2014) “Aerobic and mind body can attenuate withdrawal and ease anxiety symptoms in alcohol, nicotine and illicit drug addictions”.
In the review of animal studies they showed that voluntary running was protective against seizures for rats undergoing withdrawal from alcohol. (Lynch, Peterson and Sanchez)
Low Energy
Low energy is normal in recovery.
Physical damage and nutrition deficiencies ensue from the addiction itself and recovery healing takes necessary time, attention and energy.
Healing is also necessary from whatever preexisting history of pain before the drug use. Use may have likely been brought on by that pain or suffering.
It’s not surprising that you would feel exhausted during this process.
Low energy can be even more difficult if addressing an addiction to stimulants. Cardiovascular endurance training increases energy.
However as we use exercise for treatment and to alleviate some of the problems we want to be careful with over training and find the balance between building energy and creating too much fatigue.
There is a strong relationship with insomnia and low energy. It’s easy to get into a cycle of not having enough sleep to be able to function with energy to make it through the day. Exercise can help interrupt that cycle.
Sleep
Not only can lack of sleep worsen already low energy levels but it can also trigger stress and over excitability bringing on another downward spiral.
Functioning on the body’s own adrenalin to get through the day has its own detrimental consequences.
No sleep is a predictor for relapse (YogaFit Training Systems Worldwide)
Like lack of sleep, pain and anxiety can exacerbate excitability making it more difficult to relax into sleep.
During withdrawal increases in Glutamate have the outcome of hyperexcitability. (Koob and Simon)
Exercise decreases glutamate in the brain. (Lynch, Peterson and Sanchez).
Exercise can calm the mind.
Sleep is always a necessity for healing and an absolute requirement for recovery.
Exercise can also help with sleep by dissipating some of the pent up energy.
Cardiovascular endurance which increases blood flow and plasma volume (Merrill, Bryant and Green,American Council on Exercise 2011) can also help with joint pain that contributes to inability to sleep.
Mood Problems
The interplay between the neurotransmitter, the polypeptide and emotions is fascinating.
Hormones are our molecules of emotion. PA has a big impact on hormones and feelings.
Dysphoria affects the physical and emotional self.
It’s no surprise that we can see sadness in the body’s chemistry during withdrawal as a drop in neurotransmitters.
Zschucke notes exercise mechanism possibility of mood regulation as long as it is not too intense or too competitive. (Zschucke, Heinz and Strohle)
“Also, through interactions with dopamine, exercise may prevent the development of addiction by normalizing changes in dopamine that occur with repeated exposure and during drug withdrawal.” (Lynch, Peterson and Sanchez)
As we’ve seen exercise affects the body’s chemistry in other ways as well.
Serotonin is another hormone that is implicated in exercise as well as addiction.
We do think of it as the mood chemical that also affects impulse control. (Yoga Fit Training Systems Worldwide) Yoga and PA can have a positive impact on Serotonin levels.
Mental health and clinically diagnosed mood disorders can and should be treated with exercise. Those with co-occurring want even more exercise. (Abrantes, Battle, Strong, Ing,Dubreil, Gordon, Brown, Journal of Mental Health & Physical Activity,2011)
Anxiety
Reduction in anxiety is a negative predictor of treatment outcomes. (Zschucke, Heinz and Strohle)
Zschucke, Heinz and Strohle showed that with a minimum of 9 weeks of anaerobic and aerobic training there is a significant reduction in anxiety.
Decrease in y-amino butric acid during withdrawal means an increase in anxiety and pain as well as increases in glutamate make increase in excitability.
There are also decreases in GABA which also creates anxiety and panic attacks. (Koob)
Aerobic exercise specifically eases anxiety and depression symptoms during withdrawal. Mind body, TaiChi, Qi Gong and yoga have similar treatment effects as aerobic. (Wang, Wang and Wang)
“Like studies in humans, studies in animals show that voluntary wheel running decreases measures of stress, anxiety, and depression.” It also “reduces anxiety like behaviors in both morphine-dependent and morphine-withdrawn rats.” (Lynch, Peterson and Sanchez).
Abstinence Rates & Maintenance
Exercise can contribute to great gains in self-efficacy. It also cultivates internal reward systems.
The more we practice using our bodies to learn a new physical skill the closer we come to mastery.
Exercise is proprioceptive learning. We change our body’s responses as we learn and practice new ways of moving.
Studies on weight lifting show how there is physical change to mitochondria that affects the efficiency of the cells capacity to use energy and to respond and act quicker. (Merrill, Bryant and Green)
The American Council on Exercise personal training and health coach manuals explain how behavior change strategies and the readiness model prove that gains in self-efficacy promote openness and success in behavioral change.
This is a crucial key to building new habits.
Without the whole body, mind and heart integration of healthy actions and ways we cannot expect to stop harmful behaviors and maintain an addiction free life.
The feel good hormones that can happen with proper exercise training and enjoyable physical activity can help us maintain sobriety without undue damage of harmful substances or habits.
“Mechanistically, physical activity and exercise activate the same reward pathway as drugs of abuse, through increases in dopamine concentrations and dopamine receptor binding”. (Lynch)
Lynch also notes how the hormones that our body makes during exercise can make it so drug users will use less of the drug:
“ The endogenous opioid system also plays an important modulatory role in reinforcing effects of cocaine and alcohol,…exercise may serve to normalize this system[kappa opioid] during periods of excessive drug intake.”
They also show how exercise might protect the glutamine channels and how exercise could influence brain plasticity.
Other studies show how exercise can help maintain abstinence from alcohol, tobacco and illicit drugs.
The American College of Sports Medicine (ACSM) recommends a minimum of 150 minutes a week of moderate intensity exercise. Abstinence rates also increase.
Wang showed that aerobic exercise following the ACSM guidelines was an effective tool for abstinence.
Relapse and Prevention
Once through withdrawal and having learned new strategies to maintain abstinence relapse always remains an obstacle.
Wendy Lynch et al in their review of human and animal studies on addiction treatment noted that there is plenty of proof that exercise for prevention of drug use. “It also leads to changes within many neurotransmitter systems” For example rats with running wheel access are more likely to not transition from use into addiction. (Lynch, Peterson and Sanchez)
PA and Exercise are proven prevention strategies and should be used as treatment for relapse prevention.
Gains in self-efficacy and learning as well as taking advantage of brain plasticity can all play a part in the relapse prevention and return to sobriety after a lapse.
Stress is the great determinant in outcomes. There is no way to escape it. But we can mitigate by learning actions that help, and by moving our bodies, calming ourselves and breathing with movement.
Stress
Anxiety and stress too have their own negative sequelae or relational cycle and exercise has the potential to impact stress levels.
Stress reduces both opioid and dopamine receptors and during withdrawal phase increases in cortisol are found with increases of stress. (Koob)
Exercise affects stress reactivity and is protective against every stress. Overtime with regular exercise the body’s stress reaction decreases. (Merrill, Bryant and Green)
It can help by allowing both reaching out and reaching in. By being physically active you have the chance to cue into what your body is feeling. Being aware that you have improved and are capable of improving is that key of self-efficacy.
By participating in group exercise or attending a health club or community gym, social networks are expanded.
By practicing new forms of recreation you are opening whole new worlds’ of possibilities and it becomes easier to choose activities that help prevent and deal with rather than cause more stress over time.
Exercise has the potential to build healthy habits as way of life.
It can help reset the parasympathetic and sympathetic over reactivity. The parasympathetic can be attenuated so we can more easily rest and digest as opposed to chronic sustained flight or fight responses.
Neuroplasticity
Zchucke showed that in longitudinal studies that prevention is possible with regular physical activity regarding “alcohol intoxication, alcohol related problems and drug use.”
Lynch showed that both short term and long term exercise “lead to changes within many neurotransmitter systems.”
They noted: “EX has immediate as well as persistent effects protecting against relapse, but that it’s efficacy may vary by drug self-administered, cues used to trigger drug craving, and with the intensity, timing and contingency of the exercise conditions.
Conclusion & Considerations
There will be precautions. Overtraining can increase stress anxiety and the risks of injury. While Wang meta-analysis showed there was no significant difference in type or intensity of exercise on the value of the impact, Lynch was clear to point out that the effects can depend on timing and intensity.
They also note “exercise can sensitize the reward pathway and possibly increase an individual’s vulnerability to drug addiction under certain conditions.”
Regardless, people undergoing addictions treatment want physical activity and exercise programs designed specifically for recovery. (Abrantes)
The main barriers were affordability and motivation/low energy.
Personal Trainers that have the skills to design and monitor safe exercise programs can help.
A concern is how to make it accessible, safe, and to fund it?
Also to consider: there is no separating exercise and nutrition. Fuel for recovery from exercise is required to help with pain, digestion and the treatment and prevention of degenerative diseases.
There are many more endogenous chemicals including opioids: Met +Leu enkaphalin; Hepta + Octa peptide, Beta + Neo endorphin and Dynorphin A+B.(Koob)
Treatment research and studies needs to have an interdisciplinary foundation taking the whole body into account.
Further research could focus on evaluating how exercise might impact the endogenous chemicals.
At this point the priority is to fund treatment.
Health policy can mandate funding facilitators and teachers.
Even with lack of evidence based studies (Clean) we can start where we are. With the crisis in full swing already it is important to not get bogged down by details and start acting now. We can assess barriers and find solutions.
Bibliography
Richard A. Brown. "Exercise Preferences of patients in substance abuse treatment." Journal of
Mental Health and Physical Activity. 2011
1 A self-reported questionnaire of 97 people in treatment was assessed
2. We don't value people asking for. Included results in conclusion
3. The majority of people in treatment want exercise programs specifically designed for recovery
American Council On Exercise. "A.C.E. Personal Trainer Manual." SanDiego, 2010.
Janse Van Rensburg, Kate, Adrian Taylor and Tim Hodgson. "The effects of acute exercise on attentional bias towards smoking-related stimuli during temporary abstinence from smoking." Society for the Study of Addiction. Addiction , 18 May 2009. Addiction Research Report.
1. Psychology and sport science experiment with people. Random trial.
2.Focus on smoking but the idea of will to or desire could potentially be translated to other desires. I will use for craving quote. Personally not faimliar with a lot of the psychology language.
3."acute exercise reduces desire to smoke."
Koob, George F. and Eric J Simon. "The Neurobiology of Addiction:Where We Have Been and Where We Are Going." J Drug Issues. NIH, January 2009. Manuscript.
1. Summary of neurotransmitter stuff.
2. Great tables for effects and decrease or increases of specific transmitters as well as endogenous opiate list. Used for support throughout.
3. Increase of glutamate during withdrawal which has effect of hyperexcitability.
Lynch, Wendy J., et al. "Exercise as a novel treatment for drug addiction : A neurobiological and stage-dependant hypothesis." Neuroscience and Behavioral Reviews. Elsevier, 13 June 2013.
1.looks at animal and human studies at 4 stages of addiction: initiation of drug use, drug use to addiction, withdrawal and relapse.
2.Used throughout for support along with exercise science foundation.
3."PA and PE also decrease glutamate in the striatum, which may protect against overstimulation of glutamatergic receptors following chronic drug exposure."
Merrill, Sabrena, Cedric Bryant and Daniel Green. "Physiology of Training Chapter 5." ACE Essentials for Exercise Science for Fitness professionals. SanDiego, 2011.
National Institute on Drug Abuse. "Drugs, Brains, and Behavior: The Science of Addiction." NIH. July 2014
1.Class Assigned
2. Movement and dopamine idea, used in introduction, struck me and led really wanting to write this topic.
3. "Dopamine present in regions of the brain that regulate movement , motivation, emotion and feelings of pleasure"
Wang, Dongshi, et al. "Impact of Physical Exercise on Substance Use Disorders: A Meta-Analysis." PLOS. Vancouver: ONE, 16 October 2014. Open Source Journal Online.
YogaFit Training Systems Worldwide. "YogaFit for Addiction and Recovery Training Manual." YogaFit, 2015.
Zschucke, Elisabeth, Andreas Heinz and Andreas Strohle. "Exercise and Physical Activity in the Therapy of Substance Use Disorders." The Scientific World Journal Volume 2012. Berlin, 8 December 2011.
1.research review of effects of exercise as therapy for alcohol, nicotine and illicit drug abuse/dependence
2Foundational, support info and used as a counter.
3.I was surprised to read :"EX & PE are constantly gaining attention as adjuvant treatment for SUD"
Bibliography
Richard A. Brown. "Exercise Preferences of patients in substance abuse treatment." Journal of
Mental Health and Physical Activity. 2011
1 A self-reported questionnaire of 97 people in treatment was assessed
2. We don't value Abrantes, Anna, Cynthia L. Battle , David R. Strong, Eileen Ing, Mary Ella Dubreuil, Alan Gordon,
people asking for. Included results in conclusion
3. The majority of people in treatment want exercise programs specifically designed for recovery
American Council On Exercise. "A.C.E. Personal Trainer Manual." SanDiego, 2010.
Janse Van Rensburg, Kate, Adrian Taylor and Tim Hodgson. "The effects of acute exercise on attentional bias towards smoking-related stimuli during temporary abstinence from smoking." Society for the Study of Addiction. Addiction , 18 May 2009. Addiction Research Report.
1. Psychology and sport science experiment with people. Random trial.
2.Focus on smoking but the idea of will to or desire could potentially be translated to other desires. I will use for craving quote. Personally not faimliar with a lot of the psychology language.
3."acute exercise reduces desire to smoke."
Koob, George F. and Eric J Simon. "The Neurobiology of Addiction:Where We Have Been and Where We Are Going." J Drug Issues. NIH, January 2009. Manuscript.
1. Summary of neurotransmitter stuff.
2. Great tables for effects and decrease or increases of specific transmitters as well as endogenous opiate list. Used for support throughout.
3. Increase of glutamate during withdrawal which has effect of hyperexcitability.
Lynch, Wendy J., et al. "Exercise as a novel treatment for drug addiction : A neurobiological and stage-dependant hypothesis." Neuroscience and Behavioral Reviews. Elsevier, 13 June 2013.
1.looks at animal and human studies at 4 stages of addiction: initiation of drug use, drug use to addiction, withdrawal and relapse.
2.Used throughout for support along with exercise science foundation.
3."PA and PE also decrease glutamate in the striatum, which may protect against overstimulation of glutamatergic receptors following chronic drug exposure."
Merrill, Sabrena, Cedric Bryant and Daniel Green. "Physiology of Training Chapter 5." ACE Essentials for Exercise Science for Fitness professionals. SanDiego, 2011.
National Institute on Drug Abuse. "Drugs, Brains, and Behavior: The Science of Addiction." NIH. July 2014
1.Class Assigned
2. Movement and dopamine idea, used in introduction, struck me and led really wanting to write this topic.
3. "Dopamine present in regions of the brain that regulate movement , motivation, emotion and feelings of pleasure"
Wang, Dongshi, et al. "Impact of Physical Exercise on Substance Use Disorders: A Meta-Analysis." PLOS. Vancouver: ONE, 16 October 2014. Open Source Journal Online.
YogaFit Training Systems Worldwide. "YogaFit for Addiction and Recovery Training Manual." YogaFit, 2015.
Zschucke, Elisabeth, Andreas Heinz and Andreas Strohle. "Exercise and Physical Activity in the Therapy of Substance Use Disorders." The Scientific World Journal Volume 2012. Berlin, 8 December 2011.
1.research review of effects of exercise as therapy for alcohol, nicotine and illicit drug abuse/dependence
2Foundational, support info and used as a counter.
3.I was surprised to read :"EX & PE are constantly gaining attention as adjuvant treatment for SUD"
