Addiction treatment is rarely straightforward. People with addictions often struggle on and off for long periods of time and relapse is part of the process. As much as we wish that it were as easy to “just stop,” that is simply not the reality of addiction. Scientists have long known that addiction is a disease with many complex contributing factors (including biological, genetic, behavioral, social, and psychological factors), and yet society still blames people for their addictions.  

This societal stigma often makes treatment even more difficult. In addition, with so many contributing factors to why people even experience addiction in the first place, there is no singular “cure” for addictions and it must be treated with a multifaceted approach. One such approach that is frequently overlooked, but might be incredibly powerful in the recovery process, is exercise. This article will talk about the evidence regarding the efficacy of exercise in addiction recovery.

Addictions

Within the Diagnostic and Statistical Manual (DSM), addictions are broken into two categories, including those that are substance-related and those that are behavioral (shopping, gambling, etc.). Addiction is when a person feels a compelling need or urge to repeat the activity or substance they are addicted to, often in increasing amounts, despite knowing there are/will be significant negative consequences for the behavior. 

This article is primarily focused on substance-related addictions, but that doesn’t mean it couldn’t be helpful for folks with other types of addictions. More research is needed to explore those relationships.

Current addiction treatment(s)

Addiction treatment is not straightforward. There is no single cause nor cure for addictions. It is often a journey with much trial and error to determine what works best for any given individual. It often takes a combination of multiple approaches all used together to work. That being said, there are several common approaches to the treatment of addictions (National Institute on Drug Abuse, 2019).

• Behavioral counseling: Addictions come with many attitudes and behaviors that serve to sustain the life of the addiction. Stressful situations and environmental cues are often triggers for cravings for the addictive substance or behavior. Therefore, behavioral counseling serves to help manage these impacts on the addiction process, helping folks to modify their attitudes/behaviors, increase healthy coping skills, and persist with other forms of treatment. Behavioral counseling can be part of either inpatient or outpatient treatment. 
   
• Medication: Medications are particularly helpful for the management of the withdrawal symptoms that accompany the detox process. People will often be treated using a harm reduction model, which suggests that we can replace high risk behaviors with access to resources that make withdrawal and recovery safer. When it comes to medications, there are certain medications that act on the same chemical receptors within the brain as the person’s drug(s) of choice in order to reduce cravings and/or block or blunt the effects of that drug if the patient were to take it. While detox isn’t necessarily a treatment itself, it is considered a necessary step prior to engaging in other forms of addictions treatment. However, there are many different types of medications used to aid in the treatment of addictions including (but not limited to) medications for managing cravings, those for a medical detox, and those used for substitution. In my experience, the changes in the brain that need to be made in the treatment process cannot be made while someone is actively using.
   
• Evaluation and treatment for co-occurring disorders: Addictions rarely occur in isolation. Folks with addictions commonly experience other mental health concerns either prior to, during, or after the development of the addiction. In particular, past experiences with trauma are commonly associated with greater levels of substance abuse. Sometimes, the substances or behaviors feel like the only thing that can help people cope with their life circumstances or mental health concerns. Therefore, an incredibly important component of treatment for addictions involves an evaluation for other possible co-occurring mental health concerns and appropriate concurrent treatment for that concern.
   
• Relapse prevention: As I mentioned earlier, relapse is an expected component of addiction recovery. While we hope that relapse doesn’t happen, expecting that it will helps us to plan what to do and be prepared when it does. Several types of talk therapy interventions and medical interventions have been shown to be helpful in the prevention of relapses in the addiction recovery process. 

Exercise as adjunctive treatment

There is a growing evidence base that physical activity and exercise can help to improve, sustain, and even treat symptoms of addiction (Patterson et al., 2022). There are several reasons why exercise benefits folks in treatment for addictions. Research shows that people with addictions have poorer levels of physical health (fitness levels, reduced blood flow, cell loss in the brain), mental health (anxiety and depression, specifically), and less helpful coping mechanisms (Zangeneh et al., 2007). Exercise helps folks to obtain a similar positive pleasurable state without substances, reduce mental health symptoms, decrease stress and increase coping mechanisms, and increase levels of self-efficacy (Brown et al., 2007). 

In one study, participants in an addictions rehabilitation clinic were offered yoga classes to supplement their treatment, and found that the yoga helped to increase their levels of confidence, strength, positive body image, and self-efficacy. They also experienced a decrease in anxiety and stress that often accompanies addictions (Fitzgerald, 2017). Another study asked participants in an alcohol addiction program to participate in a 12 week aerobic intervention, working their way up from 20 minute bouts of aerobic exercise to 40 by the end of the 12 weeks. Participants in this program showed good adherence to the intervention and saw significant increases in cardiorespiratory fitness as well as the percentage of days they spent abstinent from alcohol (Brown et al., 2009). Therefore, we know there are significant physical and mental health benefits to participating in exercise as an adjunct to addictions treatment. 

There is even evidence that exercise can work as a preventive treatment for addictions. In a study with rats, when given the option between amphetamines and a saline solution, rats who exercised regularly were less likely to take the amphetamine compared to the rats who did not exercise (Fontes-Ribeiro et al., 2011). While we cannot necessarily claim that the behavior of rats will directly transfer to humans, this suggests that exercise might be one possible avenue to help even with the prevention of addictions. 

Exercise is certainly not a “cure” for anything, but is an incredibly powerful tool that can help us to manage so many mental and physical health concerns that you may experience. If you or someone you know is struggling with addiction, it is important to seek support from professionals who have experience treating addictions. However, it may be helpful to directly ask this professional how physical activity and/or exercise might fit into your treatment plan. This article serves as a very brief introduction to addictions and how exercise can help to both prevent addictions in the first place and in the process of addiction recovery. 

Let me know if you would like to hear more about addictions and, if so, what facets of addiction are you interested in? 

References

Brown, R. A., Abrantes, A. M., Read, J. P., Marcus, B. H., Jakicic, J., Strong, D. R., Ramsey, S. E., Kahler, C. W., Stuart, G., Dubreuil, M. E., Gordon, A. A. (2009). Aerobic exercise for alcohol recovery: Rationale, program description, and preliminary findings. Behavior Modification, 33(2), 220-249. 

Fitzgerald, C. M. (2017). Capitalising upon the physical: exercise and addiction recovery (Doctoral dissertation, University of Sheffield).

Fontes-Ribeiro, C. A., Marques, E., Pereira, F. C., Silva, A. P., & Macedo, T. R. A. (2011). May exercise prevent addiction? Current Neuropharmacology, 9, 45-48. 

National Institute on Drug Abuse. (2019, January). Treatment Approaches for Drug Addiction DrugFacts. National Institutes of Health.  

Patterson, M. S., Spadine, M. N., Graves Boswell, T., Prochnow, T., Amo, C., Frances, A. N., Russell, A. M., & Heinrich, K. M. (2022). Exercise in the treatment of addiction: A systematic literature review. Health Education & Behavior, 0, 1-19. 

Zangeneh, M., Barmaki, R., Ala-leppilampi, K., & Peric, T. (2007). The potential role of physical exercise in addiction treatment and recovery: The social costs of substance misuse. International Journal of Mental Health and Addiction, 5(3), 210-218.