Yoga and Coping with Harmful Addictions (Part 1)

Dr. Karel Nespor (Sannyasi Swaroopmurti)*1

What is substance dependence?

According to the International Classification of Diseases (see appendix) it is possible to diagnose substance dependence only with regard to certain types of substances. To fulfil the diagnostic criteria for substance dependence one has to meet at least three of six symptoms:

  1. Craving
  2. Impaired or lost control
  3. Withdrawal
  4. Increased tolerance
  5. Neglect of alternative pleasures or interests
  6. Persisting with substance use despite evidence of harmful consequences.

Besides substance dependence, there are various forms of addictive diseases such as pathological gambling, workaholism and compulsive shopping. These addictive diseases obviously cannot be diagnosed as substance dependence, but their symptoms are very similar (craving, impaired control, etc.). The treatment approaches to these addictive diseases are in many respects the same as in the treatment of substance dependence. Some yogic and meditation practices are useful both as prevention and treatment (e.g. Lohman, 1999, Lavasa, 1992), usually as part of broader treatment strategy.

Practice

What kind of addictive tendencies have you noticed in yourself and what kind of consequences has it had?

1. Craving

We have dealt with craving in more detail elsewhere (Nespor and Csemy, 1999). Strategies which our patients considered useful to cope with craving are as follows:

  • Avoiding situations which elicit craving.
  • Awareness of negative consequences of relapse.
  • Distraction (suitable publications and music, writing a letter, cooking, bathing, etc.).
  • Remembering past unpleasant experiences with alcohol, drugs or gambling.
  • Remembering the advantages of abstinence.
  • Physical activity, physical work, walking in the country.
  • Sleep or rest.
  • Recognizing craving in the beginning, when it is weaker.
  • Remembering one's health.
  • Talking about one's feelings during craving (with a therapist, a relative, by phone or directly).
  • Sex.
  • Relaxation techniques - complete or partial relaxation (e.g. the hands, the stomach or the face).
  • Going to places where addictive substances, etc. are not available.
  • Drinking a beverage without alcohol.
  • Asking for help.
  • Disputing risky ideas or creating opposite thoughts.
  • Thinking about the causes of craving.
  • Using tools, talismans and symbols recalling abstinence.
  • Using medicine prescribed by a physician.
  • Describing the feelings during craving silently or loudly.
  • Asking somebody to keep one's money.
  • Practising deep yogic breathing.
  • Being aware of breathing.
  • Observing feelings during craving as far as possible in a calm and relaxed manner.
  • Self-monitoring (write down when craving appears, how long it lasts and what helps to cope with it).
  • Offering help to somebody.
  • Other.

It is clear that some of these approaches are similar to some yogic and other traditional techniques. For example, passive observance of thoughts is part of the practice of antar mouna but is present even during simple yogic relaxation (shavasana). It is interesting to mention here the five ways of overcoming negative thoughts according to the Buddhist tradition:

  1. Creating opposite (i.e. positive) thoughts.
  2. Realizing the adverse consequences of these negative thoughts.
  3. Observing negative thoughts passively and with detachment without responding to them.
  4. Searching for the causes of negative thoughts.
  5. Clenching the teeth, pressing the tongue against the gums and resisting negative thoughts.

Practice

Overcoming negative thoughts: Compare the effects of the above-mentioned methods. Generally speaking, the second method (to realize adverse effects) is very effective for overcoming an acute crisis, but the least pleasant. The most inspiring and pleasant may be, on the other hand, the first method (opposite thoughts, or pratipaksha bhavana in yoga). The fourth method can enhance self-understanding, but sometimes it may open up unresolved traumatic experiences.

Seetkari and sheetali pranayama: According to the Hatha Yoga Pradipika, these practices can help to overcome hunger, thirst, sleep and laziness. Sheetali may even 'counteract poisons'. It is not certain whether these practices can help overcome cravings as well, but it is worth trying, especially in alcohol dependence, where craving for alcohol and thirst are often related. Seetkari can also be practised inconspicuously with the mouth only gently open during normal daily activities.

2. Impaired self-control

Impaired self-control and craving are not identical. One can experience intense craving and still maintain self-control; on the other hand, people who are not sufficiently aware of their feelings may not recognize craving and behave in an uncontrolled addictive manner.

One factor which contributes to impaired self-control is learned helplessness. An addicted person may have tried to overcome his/her problem, but because it had no positive effect he/she gave up. That is why it is important for him/her to experience just the opposite: that his/her effort can make a difference and that he/she can influence his/her mental and physical state and his/her life. Yogic relaxation, sankalpa and many other practices can be useful in this respect. On the other hand, the passivity of many addicted patients should be accepted in the beginning. Their treatment program should have a clear structure. When using yoga, the therapist should assume an active role (e.g. he/she should guide the patients during relaxation training).

Decreased control may be enhanced further by the futile effort of many addicted persons to try and change things which cannot be changed. Maybe because of this, the Serenity Prayer is often used in Alcoholics Anonymous meetings: "God give me serenity to accept the things I cannot change, courage to change the things I can and wisdom to know the difference."

There are many ways to improve self-control in yoga:

  • a) Negative impact on self-control may also be caused by unsuitable substance-abusing friends and lack of social skills (e.g. refusal skills). These topics are often addressed in treatment programs. The most important factor to increase self-control is abstinence from addictive substances and avoidance of high risk environments and substance-abusing people. Yoga classes may help the substance dependent patient to find new, safer friends and to build a better social network.
  • b) Most of the approaches which decrease craving at the same time improve self-control, such as opposite thoughts and passive observation of one's thoughts and emotions (during antar mouna or yogic relaxation).
  • c) Yoga enhances self-awareness both on the physical and the mental level. Many yoga practices can be used for this purpose. Swami Niranjanananda emphasizes improved self-awareness as the important part of yoga therapy for addictive diseases (Niranjanananda, 2000). Improved self-awareness enables early and timely response to negative emotions, tiredness and other states which may otherwise impair self-control. Yogic asanas, breathing practices and meditation also enhance coping with these risky states.
  • d) Yoga teaches slow, controlled movements instead of reflexive, automatic behaviours. This may be useful also during normal daily activities when coping with stimuli which triggered addictive behaviour before.
  • e) A healthier and more regular lifestyle with a reasonable amount of work, rest and healthy moderation, as taught by yoga, also improves self-control. Excessive stress and exhaustion should be prevented by relaxation, meditation, lifestyle modifications and other methods.
  • One day a fisherman was lying on a beautiful beach, with his fishing pole propped up in the sand and his solitary line cast out into the sparkling blue surf. He was enjoying the warmth of the afternoon sun and the prospect of catching a fish.
    About that time, a businessman came walking along the beach, trying to relieve some of the stress of his work day. He noticed the fisherman sitting on the beach and decided to find out why he was fishing instead of working harder to make a living for himself and his family. "You aren't going to catch many fish that way," said the businessman to the fisherman. "You should be working rather than lying on the beach!"
    The fisherman looked up at the businessman, smiled and replied, "And what will my reward be?" "Well, you can get bigger nets and catch more fish!" was the businessman's answer. "And then what will my reward be?" asked the fisherman, still smiling. The businessman replied, "You will make money and be able to buy a boat, which will then result in larger catches of fish!" "And then what will my reward be?" asked the fisherman again. The businessman was beginning to get a little irritated with the fisherman's questions. "You can buy a bigger boat and hire some people to work for you!" he said.
    "And then what will my reward be?" repeated the fisherman. The businessman was getting angry. "Don't you understand? You can build up a fleet of fishing boats, sail all over the world and let your employees catch fish for you!" Once again the fisherman asked, "And then what will my reward be?" The businessman was red with rage and shouted at the fisherman, "Don't you understand that you can become so rich that you will never have to work for your living again! You can spend the rest of your days sitting on this beach, looking at the sunset. You won't have a care in the world!"
    The fisherman, still smiling, looked up and said, "And what do you think I'm doing right now?"
  • f) Certain ethical principles which are internally accepted may help keep life simpler and more controllable and thus enhance self-control. That is why yogic codes of conduct (yama and niyama) could be introduced (see below).

Practice

Self-awareness: To make this topic more attractive, we may ask the patients what Buddhist realm of existence they are experiencing now. These realms include the craving hungry ghosts' realm, the hell, the instinctive animals' realm, the humans' realm with the best potential for growth, the realm of jealous and fighting demigods, and the heavenly realm.

Physical self-control: The relationship between slowing down and self-awareness and self-control can be demonstrated by physical movement. For example, it is possible to compare the experience of assuming shashankasana from marjari-asana during one exhalation and during five breath cycles.

Counteracting negative emotions: Both physical exercise and relaxation improve depression, anxiety and anger. Similar effects also come from certain yogic postures (such as shashankasana) and breathing practices.

Antar mouna: First three stages.

Increased self-confidence and self-esteem: It is better for people with low self-esteem and the tendency to harm themselves to meditate on their eternal inner Self, their Buddha nature or on a kind loving God instead of meditating on the universality of suffering and death in some lonely graveyard. Mantras such as So-Ham (I am That) and suitable stories can be used.

Acceptance of things which cannot be changed: Beside the above mentioned Serenity Prayer, Upekkha Bhavana (see appendix) can be used.

Surrender: The Twelve steps of Alcoholics Anonymous and similar organizations for drug addicts and pathological gamblers deal with powerlessness and surrender:

  1. We admitted we are powerless over alcohol - our lives had become unmanageable.
  2. Came to believe that a power greater than ourselves could restore us to sanity.
  3. Made a decision to turn our will and our lives over to the care of God as we understand Him.

Admitting the powerlessness and surrender paradoxically enhances self-control and coping with addictive problems.

In yoga, surrender is most often emphasized in bhakti yoga, but Swami Satyananda mentions it as one of the ways to arouse kundalini. Surrender is accepted even by jnana yogis such as Ramana Maharishi.

Let us surrender for a while to our Inner Self or God as we understand Him. You may or may not use your mantra at the same time. Maybe you will find that the surrender with which Alcoholics Anonymous begins is rather a challenging topic, even for people who have practised yoga for many years.

3. Withdrawal

Serious withdrawal syndromes require medical aid, but some simple yogic practices can also be useful. Practices should be rather simple, pleasant and relaxing.

Practice

Yogic relaxation (shavasana) and pawanmuktasana part I. Yoga can be combined with psychotherapy. For example, when working with substance dependent patients, first we discussed the various substance-related problems which they experienced. After this, we practised shavasana. During relaxation I asked the patients to see themselves as healthy and free of their substance dependence. Afterwards they should ask their subconscious mind what should be done to achieve this state.

4. Increased tolerance

This means that in order to achieve effects originally produced by lower doses, increased doses of the substance are required. A sharp increase in tolerance is typical of heroin dependence - the heroin dependent person often uses doses of the drug which would be lethal for somebody with normal tolerance. This is why after detoxification patients should be informed that their tolerance will have decreased and that they should avoid high doses of the drug.

Practice

Naikan: Naikan was developed by the Japanese monk Yoshimoto Ishin and it is practised in many countries all over the world. The three basic questions of a Naikan practitioner are:

  • What have I received from?
  • What have I given to?
  • What troubles and difficulties have I caused to?

In this way, on a given day a practitioner may reflect on a relationship with a certain person, a certain period of life or a certain life event.

It is quite common that substance dependent persons are increasingly demanding and increasingly less grateful to their parents, relatives and good friends. Alcoholics Anonymous mentions self-pity and perceived injustice as a sweet poison which is too dangerous for them. On the other hand, the self-confidence of substance dependent persons is low and it may not be the best idea to increase their feelings of inferiority. Therefore, I have modified the above mentioned technique in the following manner.

Thankfulness meditation: Reflect for a while on how other people have benefited you, what they have taught you and how they have helped you. Of course, they have also harmed you sometimes, you need not deny it, but do not think about it and pass by it broadmindedly. You can practise this meditation on a person, life period or some event.

5. Progressive neglect of alternative pleasures or interests

When treating substance dependence, we usually recommend a return to previous healthy hobbies and interests and/or to find new ones. Yoga can definitely be one such safe and helpful interest.

Practice

Your favourite exercise: Which yogic exercises do you like most? If it is appropriate, you can practise them right now.

(Part 2 of this article appeared in the November issue.)

*1 Dr. Karel Nespor is a psychiatrist with the Dept of Addictions, Prague Psychiatric Hospital, Czech Republic. This paper was presented in Prague in March, 2001.