Yoga and Coping with Harmful Addictions (Part 2)

Dr. Karel Nespor (Sannyasi Swaroopmurti)*1

6. Persisting with substance use despite clear evidence of harmful consequences

This symptom of dependence is closely related to craving and impaired self-control. Therefore, to overcome this many of the above mentioned approaches are useful. Beside this, 'tough love' by friends and relatives, combining emotional support with a reasonable amount of pressure to change, is also often useful. Denial of the addictive problem, which is common, can also be addressed indirectly, e. g. using stories or parables.

Once there was an emperor in the Far East who was growing old and knew the time was coming to choose his successor. Instead of choosing one of his assistants or one of his own children, he decided to do something different.

One day he called all the young people in the kingdom together. He said, "The time has come for me to step down and choose the next emperor. I have decided to choose one of you." The kids were shocked! But the emperor continued, "Today I am going to give each one of you a seed. One seed. It is a very special seed. I want you to go home, plant the seed, water it and come back here one year from today with what you have grown from this one seed. I will then judge the plants that you bring to me, and the owner of the one I choose will be the next emperor of the kingdom!"
There was a boy named Ling there and he, like the others, received a seed. He went home and excitedly told his mother the whole story. She helped him get a pot and some planting soil, and he planted the seed and watered it carefully. Every day he would water it and watch to see if it had grown.
After about three weeks, some of the other youths began to talk about their seeds and the plants that were beginning to grow. Ling kept going home and checking his seed, but nothing ever grew. Three weeks, four weeks, five weeks went by. Still nothing.
By now others were talking about their plants, but Ling didn't have a plant and he felt like a failure. Six months went by, and still nothing grew in Ling's pot. He just knew he had killed his seed. Everyone else had trees and tall plants, but he had nothing. Ling didn't say anything to his friends however. He just kept waiting for his seed to grow.
Finally a year went by and all the young people of the kingdom brought their plants to the emperor for inspection. Ling told his mother that he wasn't going to take an empty pot. But she encouraged him to go, and to take his pot and to be honest about what had happened. Ling felt sick to his stomach, but he knew his mother was right. He took his empty pot to the palace.
When Ling arrived, he was amazed at the variety of plants grown by all the other youths. They were beautiful, of all shapes and sizes. Ling put his empty pot on the floor and many of the other kinds laughed at him. A few felt sorry for him and just said, "Hey, nice try."
When the emperor arrived, he surveyed the room and greeted the young people. Ling just tried to hide at the back. "My, what great plants, trees and flowers you have grown," said the emperor. "Today one of you will be appointed the next emperor!"
All of a sudden, the emperor spotted Ling at the back of the room with his empty pot. He ordered his guards to bring him to the front. Ling was terrified: "The emperor knows I'm a failure! Maybe he will have me killed!"
When Ling got to the front, the emperor asked his name. "My name is Ling," he replied. All the kids were laughing and making fun of him. The emperor asked everyone to quieten down. He looked at Ling and then announced to the crowd, "Behold your new emperor! His name is Ling!" Ling couldn't believe it. Ling couldn't even grow his seed. How could he be the new emperor?
Then the emperor said, "One year ago today I gave everyone here a seed. I told you to take the seed, plant it, water it and bring it back to me today. But I gave you all boiled seeds which would not grow. All of you, except Ling, have brought me trees and plants and flowers. When you found that the seed would not grow, you substituted another seed for the one I gave you. Ling was the only one with the courage and honesty to bring me a pot with my seed in it. Therefore, he is the one who will be the new emperor!"

For dependence it is also useful to enhance motivation, and to teach proper self-care and self-respect. Previously experienced traumatic events are also common among substance dependent persons as well as post-traumatic stress disorder, which may increase the tendency of addicted people to act aggressively toward themselves. Many addicted persons behave addictively not only to alcohol or drugs but also in other areas of their lives. Yoga and psychotherapy can be used to provide 'corrective experience' and to help overcome these unfortunate tendencies.

Practice

Predicting consequences: We often use the following technique for substance dependent people to overcome automatic addictive behaviour. When used with yoga-minded people, this technique can be supplemented by thinking about the karmic consequences of different behaviours.

Yama and niyama: It is important not only to accept but also to be aware of emotions and thoughts not in accordance with these principles, such as anger, greed or aggression. Without this awareness, it is difficult to control these emotions.

Yama (self-restraints): Ahimsa (non-violence) practised even toward oneself, satya (truth, both internally and externally), asteya (honesty), brahmacharya (sensual abstinence), aparigraha (non-acquisitiveness).

Niyama (fixed rules): Shaucha (cleanliness), santosha (contentment), tapah (austerity), swadhyaya (self-study), Ishwara pranidhana (surrender to God).

I approached this topic in the following way. After a short relaxation practice, I asked the patients to try some of these principles in the same way as they would try on some new clothes. How they would see themselves in them and what they would feel? What kind of consequences and changes in their lives might they expect if they felt and behaved in this manner?

Techniques of self-care: It seems that simple techniques (such as conic breathing) are better accepted than too sophisticated imaginative approaches.

Conic breathing or prana shuddhi(Satyananda, 1981). We imagine that the incoming breath entering the nostrils moves along the triangle with its top between the eyebrows. In a similar manner we may 'breathe' in through the palms to the centre of the eyebrows and after this through the feet to the centre of the eyebrows. We may imagine that prana cleaning and purifying these areas. It is possible to practise anuloma viloma (i.e. mental nadi shodhana, Swami Bhaktipoornananda, 2000) in this way.

Cleaning the body with a group of small karma yogis who wash, polish, heal, etc. the body from the toes to the head (Swami Bhaktipoornananda, 2000).

Metta (loving kindness meditation) is usually practised as a meditation technique; I adapted it as a simple physical exercise (see appendix).

Yoga for the relatives of addicted people and therapists

Relatives often feel helpless and too much responsibility for the life of the addicted person. Beside this, their own life may be very stressful and unpredictable. To practise 'tough love', as is often recommended, may not always be easy.

Treating addiction is quite demanding also for therapists. He/she should be empathic but should not identify with a patient, appropriately active, flexible and able to cope with frustrations.

Both relatives and therapists should care sufficiently for their own mental and physical well-being. Psychotherapy, reasonable lifestyle and also yoga can be very helpful. Yogic techniques suitable for a given person would vary according to his/her interests, age, physical abilities or occupation. Overly involved wives may try Upekkha Bhavana (see appendix); various forms of relaxation are also helpful, especially for those experiencing considerable stress.

Conclusion

Coping with addictive problems is often a long-term matter and more than one treatment method is usually used. Yoga is definitely helpful both in treatment and prevention, but to experience its full benefit one has to practise it systematically and on a long-term basis.

Appendix

A. Substance dependence

According to the ICD-10 Classification of Mental and Behavioural Disorders, World Health Organization, Geneva, 1992, substance dependence is a cluster of physiological, behavioural, and cognitive phenomena in which the use of the substance takes on a much higher priority for a given individual than other behaviours that once had greater value. A central descriptive characteristic of the dependence syndrome is the desire (often strong, sometimes overpowering) to take the substance (which may or may not have been medically prescribed). There may be evidence that return to substance use after a period of abstinence leads to a more rapid reappearance of other features of the syndrome than occurs with nondependent individuals.

Diagnostic guidelines

A definite diagnosis of dependence should usually be made only if three or more of the following have been experienced or exhibited at some time during the previous year:

  • a) a strong desire or sense of compulsion to take the substance;
  • b) difficulties in controlling substance-taking behaviour in terms of its onset, termination or levels of use;
  • c) a physiological withdrawal state when the substance use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms;
  • d) evidence of tolerance, such that increased doses of the substance are required in order to achieve effects originally produced by lower doses (clear examples of this are found in opiate-dependent individuals who may take daily doses sufficient to incapacitate or kill non-tolerant users);
  • e) progressive neglect of alternative pleasures or interests due to substance use, increased time necessary to obtain or take the substance or to recover from its effects;
  • f) persisting with substance use despite clear evidence of overtly harmful consequences, such as depressive moods after periods of heavy substance use, or drug-related impairment of cognitive functioning; efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature and extent of the harm.

Narrowing of the personal repertoire of patterns of substance use has also been described as a characteristic.

It is an essential characteristic of the dependence syndrome that either substance taking or a desire to take the substance should be present; the subjective awareness of a compulsion to use drugs is most commonly seen during attempts to stop or control substance use. This diagnostic requirement would exclude, for instance, surgical patients given opioid drugs for the relief of pain, who may show signs of an opioid withdrawal state when drugs are not given but who have no desire to continue taking drugs.

B. Metta

The benefits of this practice, according to Buddha, are:

  1. Happily she/he sleeps.
  2. Happily she/he wakes.
  3. Dreams no bad dreams.
  4. Loved by human beings.
  5. Loved by non-human beings.
  6. Devas protect one.
  7. Fire, poison or weapons will not be experienced by that person.
  8. The mind calms down easily.
  9. The complexion of the face becomes clear.
  10. Death takes place without confusion.
  11. If it goes no further the person goes to the (heavenly) Brahma world.

Modern authors recommend metta to overcome anger, to build up concentration and to create healthy relationships (Sujiva, 1991). There are many meditative variations on this ancient technique. I adapted metta as a simple physical exercise (according to Buddha metta can be practised in any posture and even during walking).

Metta standing

Assume an upright standing posture (tadasana).

Fold the hands in front of the chest; the forearms are horizontal.

Repeat three times: "May I be well and happy."

Stretch the arms forwards, send the loving kindness in front of you and say mentally: "May all beings in front of me be well and happy." Repeat three times.

Move the arms so that the palms face backwards, send the loving kindness there and say mentally: "May all beings behind me be well and happy." Repeat three times.

Move the right arm to the right so that the palm faces right, look there, send the loving kindness there and say mentally: "May all beings to the right of me be well and happy." Repeat three times.

Move the left arm to the left so that the palm faces left, look there, send the loving kindness there and say mentally: "May all beings to the left of me be well and happy." Repeat three times.

Move the arms so that the palms face downwards, send the loving kindness there, bend the knees a little bit and say mentally: "May all beings below me be well and happy." Repeat three times.

Move the arms so that the palms face upwards and stretch the arms above the head, raise the heels coming up onto the toes, send the loving kindness there and say mentally: "May all beings above me be well and happy." Repeat three times.

With the hands folded in front of the chest repeat three times: "May all beings be well and happy."

C. Upekkha

Upekkha is usually practised as a meditation technique, but it can be done in a dynamic way similar to metta (see above) or in any posture. It is especially useful for people who are too involved in others' lives and affairs, and neglect themselves and their own matters.

Assume any upright sitting posture and let your upright body and mind relax.

Repeat three or more times: "I am the owner of my own karma." Feel respect for your karma; it gives you just the experience which you need for your spiritual growth.

Think about the beings in front of you and repeat three or more times: "They are the owners of their own karma."

Think about the beings behind you and repeat three or more times: "They are the owners of their own karma."

Think about the beings to the right of you and repeat three or more times: "They are the owners of their own karma."

Think about the beings to the left of you and repeat three or more times: "They are the owners of their own karma."

Think about the beings below you and repeat three or more times: "They are the owners of their own karma."

Think about the beings above you and repeat three or more times: "They are the owners of their own karma."

Repeat three or more times: "All beings have their own karma." Feel respect for their karma; it provides them with experiences that they need for their spiritual development.

At the end repeat three or more times: "I am the owner of my own karma."

D. Examples of yoga lessons for addicted people

The lessons are usually 30-45 minutes long and divided in to three parts. The first deals with asanas, the second with the full yogic breath and/or some simple pranayama and a short story, and the third deals with relaxation with sankalpa (resolve) and/or a simple meditation technique.

Examples

  1. Marjari-asana (cat stretch pose), vyaghrasana (tiger pose), ushtrasana (camel pose), trikonasana (triangle pose) or parighasana (beam or crossbar pose), full yogic breath, a story, shavasana with sankalpa.
  2. Dynamic tadasana (palm tree pose), tiryaka tadasana (swaying palm tree pose), dwikonasana (double angle pose), tiryaka bhujangasana (twisting cobra pose), shashankasana (pose of the moon or hare), full yogic breath, conic breathing, a story, shavasana with sankalpa.
  3. Pawanmuktasana part II (digestive/abdominal group), paschimottanasana (back stretching pose), sarpasana (snake pose), ardha shalabhasana (half locust pose), anandasana madirasana (intoxicating bliss pose), full yogic breath, bhramari pranayama (humming bee breath), a story, antar mouna, shavasana with sankalpa.
  4. Eight kinds of laughter, shashankasana, tiryaka bhujangasana, full yogic breath, uddiyana bandha (abdominal contraction), seetkari pranayama (hissing breath), a story, shavasana with sankalpa.

References

Lohman, R.: Yoga techniques applicable within drug and alcohol rehabilitation programmes. Therapeutic Communities, 20(1):61-71, 1999.
Lavasa, S.: Role of yoga therapy in chemical dependency states. 36th International Congress on Alcohol and Drug Dependence, Vol. I, Glasgow, Scotland, 16-21. 8.1992, (p. 189-196).
Nespor, K.: Yoga in addictive diseases - practical experience. Yoga and Addictions Conference, Paiania (Greece), March 24-26, 2000. Published in: Yoga, 11(6): 30-38, 2000.
Nespor, K., Csemy, L.: Strategies to cope with cravings. Alcohologia: European Journal of Alcohol Studies, 11(1):13-17, 1999.
Nespor, K., Csemy, L.: Craving (in Czech) FIT IN a Sportpropag, 1999, p. 76.
Saraswati, Swami Bhaktipoornananda: Yoga and the management of back pain, part III, Yoga, 11(5):23-25, 2000.
Saraswati, Swami Satyananda & Saraswati, Swami Muktibhodananda: Hatha Yoga Pradipika. Bihar School of Yoga, Munger (Bihar), India,1985, p. 720.
Saraswati, Swami Niranjanananda: Yoga and addiction. Yoga, 11(6): 2-7, 2000.
Saraswati, Swami Satyananda: Four Chapters on Freedom. Commentary on Yoga Sutras of Patanjali. Bihar School of Yoga, 1976 (3rd Australian edition, 1984, p. 288).
Saraswati, Swami Satyananda: Asana Pranayama Mudra Bandha. Bihar Yoga Bharati, Munger (India), 1996, p. 555.
Saraswati, Swami Satyananda, & Saraswati, Swami Nischalananda: A Systematic Course in the Ancient Tantric Techniques of Yoga and Kriya. Bihar School of Yoga, Munger (Bihar), India, 1981, p. 834.
Sujiva: Metta Bhavana, Kota Tinggi (Malaysia), 1991. Internet version: www.buddhanet/metta.
*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.

(continued from last months article)