Yoga can help cut severe, initial opioid-withdrawal period in half, study finds

Just 10 sessions of yoga can cut the length of the initial, most severe period of opioid withdrawal nearly in half, dramatically increasing the odds of successful recovery, new research shows.

The first days of withdrawal pose highest risk of dropout and relapse as they are marked by often severe sleeplessness, anxiety, pain, and other symptoms, according to Associate Professor of Psychiatry Kevin Hill of Beth Israel Deaconess Medical Center’s Division of Addiction Psychiatry and an author of the study.

“If we can make the treatment period shorter and more pleasant we have a better chance of success,” Hill said.

In the study, which ran April 2023-March 2024, researchers from India’s National Institute of Mental Health and Neuroscience, Harvard Medical School, and Beth Israel Deaconess Medical Center found that 10 group sessions of 45 minutes each spread out over two weeks cut the withdrawal period from nine days to five.

Researchers also saw improvement in secondary measures, including anxiety reduction, reduced time to fall asleep, and average pain perception.

The study, published in January in JAMA Psychiatry, examined 59 men, ages 18 to 50, who were experiencing mild to moderate withdrawal symptoms. The subjects also received treatment with buprenorphine, a drug that reduces cravings without intoxicating effects.

Opioid addiction has become a global problem, with an estimated 60 million nonmedical users worldwide, according to the study’s authors. Only one in 11 of those with an opioid use disorder receives treatment. The study, led by Hemant Bhargav of the National Institute of Mental Health and Neurosciences, was conducted in India, where opioid use is growing and users make up an estimated 2.1 percent of the population.

Matcheri Keshavan, the Stanley Cobb Professor of Psychiatry at HMS and BIDMC and an author of the paper, said that during withdrawal, the normal balance between the sympathetic and parasympathetic nervous systems becomes disrupted.

The sympathetic nervous system, responsible for “fight or flight” responses, becomes overly active, boosting stress, anxiety, and cravings. That imbalance is manifested by sweating, shakiness, and increased heart rate variability, a key measure linked to greater cravings and increased risk of relapse.

Yoga and other meditative practices promote the parasympathetic nervous system, calming the body and regulating breathing and heart rate.

While medication is used to blunt cravings, meditation and cognitive behavioral therapy are often used to address sleeplessness, anxiety, and stress reactions due to the sympathetic nervous system imbalance.

The problem, however, is that the distress and impaired concentration common during withdrawal can make initiating meditation or cognitive behavior therapy a challenge. Yoga’s blend of physical postures, breathing techniques, meditation, and relaxation can be initiated more easily during withdrawal.

The study, supported by private funding, used yoga modules designed to address sympathetic nervous system hyperactivity. They included relaxation practices, mindfully performed postures, sectional breathing, stimulation and relaxation through slow breathing practices, and guided relaxation with affirmation.

A shorter withdrawal period is associated with recovery success but is just the first step of a long process, Hill said.

Withdrawal, often done in an inpatient setting, is usually followed by an outpatient program that allows greater freedom while continuing intensive daily therapy. Subsequent phases become less restrictive as the patient resumes the activities of daily life.

“If you complete treatment and get to one to three months of abstinence, the odds of success go up dramatically,” Hill said.

The beneficial impact of yoga on withdrawal wasn’t completely unexpected, Keshavan said, since yoga’s calming, parasympathetic-boosting effects are well known. In fact, he said, because of those effects, it is already used to treat anxiety and depression.

The study, however, is the first randomized control trial to document its utility in the context of addiction and withdrawal, providing counselors and addiction specialists evidence for an effective and inexpensive tool that could improve prospects for recovery success.

“We are excited about this,” Keshavan said. “Hopefully, this will stimulate a larger application of this mode of intervention across multiple substance-use disorders, not just opioid dependence.”  

Also important, Keshavan said, is that yoga is relatively easy to learn. Those 10 sessions provide a foundation for individuals to develop their own practice, a potential resource in their battle with addiction.

“An intervention like yoga is something that these individuals are likely going to practice even after they end the treatment,” Keshavan said. “So it could have long-term benefits.”