Once withdrawal is achieved, maintenance of abstinence becomes the focus of treatment. Recently detoxed patients are often anxious, depressed, and under severe psychosocial and financial stress conditions that promote relapse. Sedatives, anxiolytics, and some sedating antidepressants must be used with caution due to the high risks of abuse and dependence. Mind-body practices can be valuable complementary treatments with standard rehabilitation services, counseling, and self-help groups such as Alcoholics Anonymous and Narcotics Anonymous. Sudarshan Kriya Yoga After one week of detoxification, 60 hospitalized, alcohol dependent patients were randomly assigned to receive two weeks of either Sudarshan Kriya Yoga SKY breathing or continued standard treatment with counseling and benzodiazepines for sleep. The SKY intervention was limited to the breath practices given 45 minutes every other day without the other group interventions used in the general courses. There were greater mean reductions in scores on BDI and levels of cortisol in the SKY group than in the control Vedamurthachar, Janakiramaiah, Hegde, Shetty, Subbakrishna et al., 2006.
While this study suggests a beneficial effect of SKY in reducing anxiety and cortisol levels in recently detoxed alcoholic patients, the statistical reporting needs some clarification and the study needs replication. In a two-week study, community clinic patients with opioid dependence DSM-IV on agonist maintenance were randomly assigned to standard treatment n=14 or to standard treatment plus a 5-day course called Nav-Chetna Shivir n=15 which included two to three hours per day of yoga breathing Sudarshan Kriya Yoga, meditation, singing, and discussing healthy living. At the end of two weeks, there was no significant difference between groups on the Addiction Severity Index. The WHO Quality of Life Brief scale showed significant change in the yoga augmented group in the physical p0.001, psychological p0.01, and social relationship p0. Domains compared to no significant change in the control group. The Stages of Change Questionnaire showed significantly increased motivation in the yoga group compared to the control Yadav, Dhawan, Sethi, & Chopra, 2006.
Hatha Yoga In a six-month study, 61 patients treated for opioid addiction in a methadone maintenance program were randomized to receive either conventional weekly group psychotherapy or a weekly Hatha Yoga group. After six months, there were no significant differences between the two groups on psychological, sociological, and biological measures. The study concluded that the alternative Hatha Yoga treatment was not more effective than conventional group therapy treatment Shaffer, LaSalvia, & Stein, 1997. The study highlights issues that can arise when researchers set up studies and interpret Eastern practices. The benefits of most mind-body techniques accrue from regular daily practice. The finding that once-a-week Hatha Yoga was as effective as once-a-week group psychotherapy is very promising. Framing the outcome as a negative may discourage further exploration of the documented positive effects. The findings of this study indicate that it would be worthwhile to evaluate the complementary effects of combining Hatha Yoga with standard treatment for methadone maintenance.
Many patients with substance abuse have comorbid psychiatric conditions that complicate their treatment. The following complex case illustrates some of the risks, benefits, and adaptations involved in treating such challenging patients. Case 1 Alcoholism, Marijuana Addiction, Bipolar Disorder, and Severe PTSD Throughout her childhood, Lenore had been horribly tortured and sexually abused by several males in her family. As an adult her memories of trauma were easily triggered. For example, anytime she felt slighted, criticized, or rejected by anyone she would start binge drinking and engage in dangerous behaviors. She had no control over these reactions. During one binge she fell out of a third-story window and had to be hospitalized. She was too erratic to take medications.
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