Exercise participation offers advantages for individuals in “recovery” from any addiction as an effective relapse prevention strategy.
Incorporating exercise routines into a recovery program can offer individuals new skills to reduce the risk of relapsing into former behavior. A centered whole-system approach that includes exercise can be used to break the cycle of addictive behaviors by reducing stress and negative emotions, by creating a sense of self-awareness, self-control, and self-efficacy. Exercise has been shown likely to be effective as both a preventative and treatment intervention. According to the National Institute on Drug Abuse (NIDA) and experts in the Drug treatment centers, studies of the effects of exercise in abstinence and recovery are highly promising. Relapse is common in any addiction; up to 70% of substance abuse individuals relapse into use within the first year after treatment (Carrol et al., 1994).
According to the National Institute of Drug Abuse (NIDA) the odds of remaining abstinent in the first year of recovery is 36%, 66% between 1 and 3 years and after 3 years it goes up to 86%. The probability of relapse from substance abuse continues to be a risk through out an individual’s life. A relapse is a breakdown or setback in a persons attempt at modifying a target behavior after the intended the behavior change has been initiated. Treatment methods can reduce the symptoms of substance abuse but cannot cure the root cause. Having a variety of tools to negotiate the obstacles allows an individual to maintain without a relapse.
Relapse Prevention is an ongoing process of self-control where individuals learn behaviors to anticipate and cope with problem related to relapse. A preventative program integrates psychoeducational behavior skills and cognitive intervention techniques. The effects of regular exercise have been shown in many studies to be effective and beneficial for the promotion of prevention toward relapse and can serve as a non-drug alternative and reinforce to. Exercise serves as an alternative, non-drug reinforce to increase probability of abstinence.
The longer an individual remains abstinent the probability of relapsing at least once still remains high. A relapse can be an opportunity for growth in establishing a stronger commitment for health and wellness by learning new strategies, altering lifestyle changes, interventions or medications if necessary and make appropriate adjustments or create new strategies. A relapse is just a detour on the road of recovery.
Researchers have been exploring other methods of treatments to incorporate in programs that would be effective in sustaining long-term abstinence and prevention of relapse. Direct exposure to the substance and environmental stimuli are two main reasons that have been shown to be associated cues to relapse. Research indicates exercise decreases the pre-relapse effects of depression and anxiety that are associated with these risk factors . Many studies report that exercise helps to maintain abstinence.
Exercise releases endorphins that can elevate a person’s mood, which is crucial in maintaining abstinence as mood disorders such as depression and anxiety are many times the precipitator to relapse. Through consistent participation in an exercise program addicts can also benefit from the effects of improvement of overall appearance and self-confidence. An exercise program can also alleviate boredom and the time spent idly thinking about how to escape the negative emotions, exercise is a positive outlet for fellowship. Exercise in a group activity increases the social support and helps increase the social network that is paramount in recovery. (Humphreys, Moos, and Finney, 1995; Longabaugh, Wirtz, Weben, and Stout, 1998)
Exercise mimics the effects of drugs on the brain increasing the states of well-being and euphoria in the same manner as abused drugs. (e.g. Janal et al,.1984; Nabetani and Tokunaga, 2001). These findings suggest that exercise produces neurochemicals that are similar with psychomotor stimulants. Addictive drugs imitate the brain’s natural chemical messengers by over-stimulating the “reward pathway.” The brain is wired to repeat activities that fuel this reward system. The neurons in the brain manufacture one or more of these neurotransmitters, dopamine, serotonin, acetylcholine and many others that science has discovered. These neurotransmitters are associated with different effects on the brains function. Dopamine is concentrated in regions that regulate motivation to pleasure and reward, attention and memory. Drugs of abuse such as methamphetamine, amphetamine, cocaine increase indirectly or directly dopamine in the reward pathway. Studies in laboratory animals have shown that exercise reduces drug self – administration in animals by stimulating the same reward pathway as the substance used.
Studies have shown the effects of exercise are immediate on drug seeking behavior. In a study of female rats (Zlebnik et al. 2010) showed that in only a single session of exposure to a running wheel was enough to reduce the desire for cocaine. In a similar study (Lynch er al. 2010) male rats that were exposed to a running wheel for 14 days in a forced abstinence experiment was enough to reduce future and reduced cue induced reinstatement. In a similar study (Smith et al. 2011a) it was reported that access to a running wheel for 6 weeks before drug exposure and 3 weeks after initial drug exposure reduced the response to cue reinstatement to cocaine. These studies suggest that drug-seeking behavior may be reduced through exercise and could be effective at preventing relapse after a period of abstinence in treatment seeking populations.
In Marlatt’s relapse prevention model (Marlatt, 1985; Marlatt & Witkewitz,2015) one of the main components was lifestyle modifications and suggested that this is a component that has been least emphasized in relapse prevention programs for alcoholism and that long interventions, in particular physical activity can be valuable addition to alcohol treatment.
A study that looked at the physiological effects of exercise, individuals in a residential facility that were recovering from methamphetamine dependence participated in an 8 week exercise training program according to the American College of Sports medicines (ACSM) guidelines 3 times a week for an hour. The participants also continued the standard protocol of treatment that included individual and group therapy and included 12 step meetings. This was compared to a control group that received education 3 times a week for an hour. This study reports the positive adaptions that are consistent with those in the general population. Endurance and resistance training can have an impact on the success of recovery from MA dependency and should be considered as a part of a treatment protocol.
Physical exercise increases the abstinence rate in subjects with SUD and eases withdrawal symptoms, anxiety, and depression symptoms. Aerobic activities also known as “cardio” require oxygen uptake, by the heart to deliver oxygen to all working muscles. The heart and breath rated increase to sustain an exercise activity over time. Cardio machines, spinning, running, swimming, walking, hiking, aerobics classes, dancing, cross country skiing, and kickboxing all are forms of aerobic activity. A number of controlled studies indicate that aerobic exercise may alter mood and decrease symptoms of depression (Doyle et al., 1983) and serve as a complement to more traditional methods of treatment as in antidepressant medication (Babyak et al., 2000), cognitive-behavioral therapy (Freemont & Craghead, 1987)
Anaerobic exercise is a high intensity and short lasting activities that do not rely on an oxidative process, it relies on energy that is stored in the muscle to be used upon exertion. Anaerobic activities include mind-body exercises including Yoga, Tai Chi Quan and Qigong. They have similar treatment effects as to aerobic exercise. The Mayo Clinic has described exercise as “meditation in Motion” in an individual in recovery can use exercise to focus on the physical to experience the psychological and emotional benefits of meditation. Current findings support yoga and mindfulness promising complementary therapy for treating and preventing addictive behaviors by attending to physical and breathing exercises. Studies have found that anaerobic exercise activities produce positive psychological changes that are beneficial for those that have different fitness abilities. .
Findings have shown that specific quantity and frequency of aerobic exercise is necessary for the physical benefits but may not be necessary for the mental health benefits such as decreased anxiety and depression (Martinsen, Hoffart, & Solberg, 1989; Palmer et al, 1995)
In a study reported in the Journal of Substance Abuse they tested the attitudes and behaviors of clients in an intensive abstinence-orientated substance abuse outpatient treatment program. Upon detoxification from alcohol or other substances patients were submitted to a private hospital in Rhode Island. Treatment is six hour a day for five days. The program that operates in a group format, each day there are four treatment groups each lasting an hour and time for individual meeting with physicians, counselors or breaks.
Researchers designed a self -report survey to assess current exercise attitudes, preferences and behaviors. Assessments of the behaviors regarding exercise were to determine if individuals were meeting the American College of Sports and Medicine (ACSM) guidelines or at least 20 minutes, 3 times a week.
Out of the 105 participants 47% reported participating in regular exercise 3 times a week or more. Tension and stress reduction was perceived as the dominant benefit of exercise. Increase of self-confidence and hopefulness were some other added benefits. The data indicated that exercise is a desirable activity in recovery program. Some of the common barriers associated with exercise were that the cost being involved in an exercise program, time and lack of motivation. It was noted that nicotine dependence interfered with exercise self-efficacy the level of nicotine dependence was negatively associated with exercise activity level where alcohol dependence was not.
Relapse from any addiction is a process that remains over a lifetime. It is a physical, mental and emotional process of healing. A part of an individual in recovery wants to return to former behaviors. Emotions and behaviors can be obstacles that return them to pre-abstinent behaviors. Exercise is a way to keep balance physically, mentally and emotionally and can assist creating a stronger resilience to relapse. The endorphins released through exercise are the same endorphins released in substance abuse. The natural levels of endorphins released through exercise however don’t cause an imbalance that interferes with a person’s ability to feel pleasure, happiness and satisfaction. Exercise allows the body the body to regulate itself and remember that it is capable of balancing mood and brain chemistry in a healthy and natural way. Following a regular program of exercise an individual can focus on their own well being and forget for a period in time all that is going on in there life. With each session there is a feeling of accomplishment and pride that reinforces the goal of continued abstinence from any addiction. Ongoing research continues to determine optimal design and implementation of exercise based ongoing treatment and intervention.
Babyak, M., Blumenthal, J. A., Herman, S., Khatri, P., Dorais, S. M., Moore, K., et al. (2000). Exercise treatment for major depression: Maintenance of therapeutic benefit at 10 months. Psychosomatic Re- search, 62, 633–638.
Beiter, R. M., Peterson, A. B., Abel, J., & Lynch, W. J. (2016). Exercise during early, but not late abstinence, attenuates subsequent relapse vulnerability in a rat model. Translational Psychiatry, 6(4), e792–. http://doi.org/10.1038/tp.2016.58
Brown, R. A., Abrantes, A. M., Read, J. P., Marcus, B. H., Jakicic, J., Strong, D. R., . . . Gordon, A. A. (2009;2008;). Aerobic exercise for alcohol recovery: Rationale, program description, and preliminary findings. Behavior Modification, 33(2), 220-249.
Dolezal, B. A., Chudzynski, J., Storer, T. W., Abrazado, M., Penate, J., Mooney, L., … Cooper, C. B. (2013). Eight Weeks of Exercise Training Improves Fitness Measures in Methamphetamine-Dependent Individuals in Residential Treatment. Journal of Addiction Medicine, 7(2), 122–128. http://doi.org/10.1097/ADM.0b013e318282475e
Jennifer P Read, Ph.D. , Richard A Brown, Ph.D., Bess H Marcus, Ph.D., Christopher W Kahler, Ph.D., Susan E Ramsey, Ph.D., Mary Ella Dubreuil, R.N., John M Jakicic, Ph.D., Caren Francione, B.A Exercise attitudes and behaviors among persons in treatment for alcohol use disorders
Longabaugh, R., Wirtz, P. W., Zweben, A., & Stout, R. L. (1998). Network support for drinking, Alcoholics Anonymous, and long-term matching effects. Addiction, 93, 1313–1333.
Marlatt, G. A. (1985). Lifestyle modification. In G. A. Marlatt & J. R. Gordon (Eds.), Relapse prevention (pp. 280–344). New York: Guilford Press.
O’Neill, C. (2007, January). Yoga and Ayurveda to support recovery from drug and alcohol addiction. Townsend Letter: The Examiner of Alternative Medicine, (282), 60+. Retrieved from
Read, J. P., & Brown, R. A. (2003). The role of physical exercise in alcoholism treatment and recovery. Professional Psychology: Research And Practice, 34(1), 49-56. doi:10.1037/0735-7028.34.1.49
Smith, M. A., & Lynch, W. J. (2011;2012;). Exercise as a potential treatment for drug abuse: Evidence from preclinical studies. Frontiers in Psychiatry, 2, 82. doi:10.3389/fpsyt.2011.00082
Swendsen, J. D., Merikangas, K. R., Canino, G. J., Kessler, R. C., Rubio- Stipec, M., & Angst, J. (1998). The comorbidity of alcoholism with anxiety and depressive disorders in four geographic communities. Com- prehensive Psychiatry, 39, 176–184.
Wang, D., Wang, Y., Wang, Y., Li, R., & Zhou, C. (2014). Impact of physical exercise on substance use disorders: A meta-analysis. PloS One, 9(10), e110728. doi:10.1371/journal.pone.0110728