Short Report
Yoga as an adjunct treatment for alcohol dependence: A pilot study

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Summary

Objectives

This pilot study explores the feasibility of yoga as part of a treatment program for alcohol dependence.

Design

Eighteen alcohol dependent patients were randomized to receive either treatment as usual or treatment as usual plus yoga. Assessments were taken at baseline and six month follow-up.

Setting

‘Riddargatan 1’: an outpatient alcohol treatment clinic located in Stockholm, Sweden.

Interventions

Treatment as usual consisted of psychological and pharmacological interventions for alcohol dependence. The 10-week yoga intervention included a weekly group yoga session. Participants were encouraged to practice the yoga movements at home once per day.

Main outcome measures

Alcohol consumption (timeline follow-back method, DSM-IV criteria for alcohol dependence, and the Short Alcohol Dependence Data questionnaire), affective symptoms (the Hospital Anxiety and Depression Scale), quality of life (Sheehan Disability Scale) and stress (the Perceived Stress Scale and saliva cortisol).

Results

Yoga was found to be a feasible and well accepted adjunct treatment for alcohol dependence. Alcohol consumption reduced more in the treatment as usual plus yoga group (from 6.32 to 3.36 drinks per day) compared to the treatment as usual only group (from 3.42 to 3.08 drinks per day). The difference was, however, not statistically significant (p = 0.17).

Conclusions

Larger studies are needed to adequately assess the efficacy and long-term effectiveness of yoga as an adjunct treatment for alcohol dependence.

Introduction

Alcohol use disorders are among the most common of all psychiatric disorders with an estimated prevalence of 10.3% in Sweden,1 making them comparable with major health problems such as depression and diabetes.2 Poor help seeking has been identified as a problem. A survey in the United Kingdom found that only 1 out of 18 people who met the criteria for alcohol dependence (AD) had received treatment.3 One explanation is the perceived stigma of specialist clinics where most substance disorders are currently managed.

For decades, yoga has been used to improve mental and physical wellbeing. It involves learning relaxation techniques through controlled breathing, focused attention and mindfulness. The yoga postures used in this study aim to improve strength and agility and can be practiced by a broad spectrum of people.4 In recent years, yoga has become an increasingly popular option for health conscious persons, and could potentially increase the attraction for addiction treatment, if proven efficacious for this target group.

Several controlled studies have demonstrated positive associations between yoga and specific health outcomes, including epilepsy,5 high blood pressure,6 pain,7 mood disturbance and stress.4, 8, 9 To maximize treatment benefits and reduce relapse rates, alternative therapies for AD are sought that are non-stigmatizing (compared to conventional medical treatments) and easy to adopt. Support for yoga and mindfulness-based treatment of substance abuse is increasing.10, 11 A study exploring the effects of a 90 day residential Kundalini yoga program on substance use reported significant improvements in impulsive and addictive behaviors.12 Vedamurthachar et al. tested the antidepressant efficacy and hormonal effects of yoga in AD patients and found significant reductions in depression and cortisol levels in the yoga compared to control group.13

The aim of this pilot study is to briefly review the literature on yoga and AD treatment, to assess the feasibility of incorporating yoga as part of treatment for AD and to assess quantitative and qualitative approaches to study the outcome of this form of treatment.

Section snippets

Setting

The study was conducted at ‘Riddargatan 1’; an outpatient alcohol treatment clinic located in central Stockholm. Staffed by medical doctors and allied health workers, the clinic is trialing new treatment options with an understanding that AD is part of a spectrum of lifestyle imbalance; a notion that resonates well with many patients. Viewed this way, changing one's drinking behavior and taking up regular exercise is a natural progression toward a healthier lifestyle. Patients attending the

Results

Fig. 1 shows changes in alcohol consumption measures over time. No interaction effects were found. The improvement in drinks per drinking day and weekly alcohol consumption were larger in the TAU plus yoga intervention compared to TAU alone, but the differences were not statistically significant. Means and standard deviations for the outcome measures are shown in Table 1, including the average number of ‘standard’ drinks consumed per day and week. Both groups showed approximately equal

Discussion

Our results confirm that yoga is a feasible adjunct treatment for AD. At six-month follow-up, positive changes in alcohol consumption, affective symptoms, and quality of life were reported by both groups. The yoga intervention reported a larger (non-significant) reduction in alcohol consumption – the primary outcome measure in this study. This improvement could be due to a stronger treatment effect. Alternatively, it may reflect a regression to the mean caused by the higher baseline drinking

Acknowledgement

We wish to thank the Swedish Alcohol Retail Monopoly Council for Alcohol Research (Systembolagets råd för alkoholforskning) for funding this project.

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      Three prospective studies of non-randomised design compared PA with treatment as usual (Burling et al., 1992; Giesen et al., 2016; Sinyor et al., 1982); and one retrospective controlled study compared those who chose PA as a contingency management plan for preventing relapse with those who chose non-PA activities (Weinstock et al., 2008). Of the 19 studies, seven included biochemical verification of abstinence (e.g. urine toxicology, blood samples, or breath tests) (Cutter et al., 2014; De La Garza et al., 2016; Donaghy, 1997; Hallgren et al., 2014; Rawson et al., 2015; Trivedi et al., 2017; Weinstock et al., 2008), nine studies relied on self-reported measures (Abrantes et al., 2017; Brown et al., 2010, 2014; Buchowski et al., 2011; Colledge et al., 2017; Linke et al., 2019; Mamen et al., 2011; Roessler, Bilberg, et al., 2017; Sinyor et al., 1982), and three studies included data obtained from secondary sources such as hospital or clinical records (Burling et al., 1992; Giesen et al., 2016; Shaffer et al., 1997). The most commonly used measure for obtaining alcohol and other drug use was the Timeline Follow Back (TLFB) method (Sobell & Sobell, 1992) used for the primary alcohol and other drug use outcome in nine studies (Abrantes et al., 2017; Brown et al., 2010, 2014; Buchowski et al., 2011; Colledge et al., 2017; Hallgren et al., 2014; Linke et al., 2019; Roessler, Bilberg, et al., 2017; Trivedi et al., 2017).

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