Benefits of Exercise in Addiction RecoveryAnna Ciulla
Millions of Americans are addicted to alcohol or drugs, and some take the proactive step of seeking treatment to overcome their addiction. However, addiction experts say that recovery is a long-term process, involving commitment to abstinence, adoption of healthier lifestyle habits, learning effective coping skills and techniques, continuing counseling, and developing and maintaining a supportive network. While exercise has long been a part of evidence-based therapeutic approaches in addiction recovery, what do we know about how exercise benefits recovery?
Considerable research on effective therapies—particularly non-pharmacological and non-traditional therapeutic methods—to help maintain abstinence and prevent relapse in addiction recovery have shown promising results. A 2011 study in Frontiers in Psychiatry delved deep into the potential benefits of exercise in addiction recovery and found conclusive evidence to support development of exercise-based interventions that may reduce compulsive drug use among clinical and at-risk populations.
SCOPE OF THE PROBLEM: SUBSTANCE USE DISORDERS
Before getting into the specifics of research on the subject of exercise and addiction recovery, it’s important to take a look at the scope of the problem. Nearly 20 million people in America struggled with a substance use disorder (SUD) in 2017, according to the 2017 National Survey on Drug Use and Health (NSDUH). Of these, an estimated 14.5 million had an alcohol use disorder (AUD), and 7.5 million an illicit drug use disorder, as follows:
- Marijuana use disorder – 4.2 million
- Opioid use disorder – 2.1 million
- Pain reliever use disorder – 1.7 million
- Cocaine use disorder – 966,000
- Methamphetamine use disorder – 964,000
- Tranquilizer use disorder – 739,000
- Heroin use disorder – 652,000
- Stimulant use disorder – 572,000
With so many people grappling with a SUD, however, only about four million actually received any substance use treatment in the past year, with 2.5 million of those getting help at a specialty facility.
EXERCISE AND SELF-ADMINISTRATION OF THREE DRUGS OF ABUSE
According to an analysis of epidemiological studies as reported in the 2011 Frontiers in Psychiatry, exercise, in some conditions, can produce euphoric feelings and well-being in humans, similar to drugs of abuse. Also, similar to drugs of abuse, exercise can produce positive affective states in some and negative ones in others, depending on exercise intensity and the context in which it occurs. Engaging in regular exercise is beneficial, however (while regular drug use is not).
Rodent studies looking at self-administration of three drugs of abuse, cocaine, amphetamine and methamphetamine found interesting results regarding the protective effects of exercise that may have usefulness in treating human drug users. Indeed, various studies reported exercise reduces drug self-administration during several transitional drug stages, such as acquisition, maintenance, escalation, binge and compulsive use, and relapse and return to drug use.
Preventing Drug Acquisition
Researchers are always keen to determine effective interventions to prevent individuals from acquiring drugs in the first place. Thus, results of studies with rats that found that aerobic exercise has a protective effect against self-administering cocaine and may prevent the start of regular patterns of substance use in certain at-risk populations may be useful with human drug users, particularly during initiation of drug use.
Protection During Drug Maintenance Phase
A number of studies looked at how exercise affects patterns of drug intake during drug self-administration during the maintenance phase of drug use. After researchers found that exercise reduced post-exercise self-administration of amphetamine, methamphetamine and cocaine, they suggested that exercise’s protective effects may extend beyond a single exercise session, and that greater exercise may offer even greater protection.
Protection Against Binge and Compulsive Use
A common pattern of compulsive alcohol and drug use involves brief but excessive consumption of drugs, known as binge episodes. Several studies with rodents found that exercise resulted in the animals terminating their binge behavior of self-administering cocaine 2.3 hours ahead of sedentary rats. The key takeaway from these data is that aerobic exercise could offer protection to humans against binge-like patterns of drug use when there are conditions of unlimited access, and beyond that serve as a viable treatment intervention among compulsive drug users.
Protection Against Escalation of Drug Use
Among experienced drug users, research with rodents found that exercise may reduce ramping up of cocaine use under conditions of extended access. Data suggest that exercise may be an effective intervention to prevent escalating patterns of drug use in experienced humans engaged in compulsive drug behavior.
EXERCISE AFFECTS DOPAMINERGIC AND GLUTAMATERGIC SIGNALLING
Dopaminergic and glutamatergic signaling are two neurotransmitter signaling pathways involved in excessive drug intake and development of addiction— and exercise affects both types of signaling. Since exercise has the ability to increase dopaminergic signaling, and in the reward pathway in particular, it may offer some protection against excessive drug use.
A 2018 study in Behavioral Brain Research using animal models found that exercise inhibited stress-induced return to cocaine condition place preference. The exercise consisted of six weeks of treadmill running for one hour per day, five days a week. The exercise decreased the cocaine-seeking behavior of the rats. Researchers’ findings suggested that the intervention of chronic aerobic exercise may cause adaptations of stress pathways and, further, that exercise may prevent stress-induced drug relapse. The research adds to a mounting body of evidence supporting the use of exercise as a means of combatting substance abuse and preventing cocaine relapse, when part of a comprehensive treatment program for recovering cocaine addicts.
EXERCISE MAY REDUCE DRUG-SEEKING BEHAVIOR AFTER ABSTINENCE AND PREVENT RELAPSE
Any thoughtful examination of the factors involved in addiction recovery must include a discussion of the risks of relapse and what can be done to help prevent it. Fortunately, a growing body of research points to the benefits of exercise, both as a therapy during treatment and as an effective tool in a comprehensive relapse prevention plan.
A 2010 study in Psychopharmacology using mice found that a single session of access to a running wheel was enough to reduce drug seeking to cocaine. Another 2010 study in Biological Psychiatry found that male rats with a running wheel in the cage during a 2-week forced abstinence experienced reduced return to drug use, with authors suggesting the effects persisted long after a single exercise session.
Corroborating both earlier studies, a 2011 study in Drug and Alcohol Dependence reported success in male and female rats with respect to reducing return to drug use when they had sustained access to a running wheel 6 weeks before initial drug exposure and three weeks after. Researchers said that while female rats were more responsive than males, exercise was an effective intervention for both sexes. These findings led researchers to suggest that exercise has two significant benefits regarding drug use: potentially reducing drug-seeking behavior after abstinence and preventing relapse in the human population seeking treatment to overcome drug use.
The National Institute on Drug Abuse (NIDA) is currently conducting research to develop improved methamphetamine addiction treatments that are non-traditional and non-pharmacological. A 2016 study in Brain Plasticity looks at the neuroplastic and neuromodulatory effects of exercise on methamphetamine addiction, including recent findings of therapeutic and protective effects associated with exercise. Researchers called for future studies:
- to better understand the possible link between “correlative” decreases in illicit drug use and addiction and increases in exercise output in animal models
- and, to hopefully determine if decreased neurotoxity from exercise has some behavioral bearing on preventing addiction to illicit drugs.
Results from human studies reported in Neuroscience & Biobehavioral Reviews found that brief exercise reduces desire to smoke and cravings during nicotine withdrawal, as well as the urge to drink in those who’ve undergone alcohol detox. Longer periods of exercise have also been found to improve outcomes of treatment in those in recovery from alcohol and illicit drugs when the exercise was part of an overall treatment program that included other therapies.
Researchers said the data seemed to suggest that exercise offers immediate and lasting protective effects against relapse, although the success rate of exercise may vary by drug, cues triggering drug craving, and exercise conditions (timing, intensity and contingency). Among the key takeaways from this study were that exercise may prevent drug use initiation (through dopamine interactions in the reward pathway), and relapse (through dopamine, glutamate and chromatin interactions), and serve as a useful intervention in treating drug addiction.
A 2017 study in Current Addiction Reports found that evidence from clinical and preclinical studies showed that exercise decreased withdrawal symptoms, including craving, in both men and women, and preclinical studies presented evidence that exercise may offer potential benefits in preventing relapse, noting its efficacy may be enhanced in men.
EXERCISE DECREASES COMORBID RISK FACTORS ASSOCIATED WITH SUBSTANCE USE
Since exercise has been shown to be an alternative, non-drug reinforcer to decrease drug self-administration, the expanding body of literature on the effects of exercise to reduce risk factors commonly associated with substance use is illuminating. Human and animal studies found that exercise decreases feelings of anxiety and depression.
Research from the Anxiety and Depression Association of America found that 14 percent of Americans use exercise to help them cope with stress. The NIDA cites studies that link stress with drug addiction, noting that addiction changes how the body responds to stress. A finding in lab animal studies that is likely applicable to human population is that exercise “normalizes the behavioral and neurobiological consequences of prolonged stress.” Researchers posit that exercise in animals produces some of its protective effects by reducing negative affective states involved in the initiation, acceleration, and maintenance of drug self-administration.
Furthermore, in human population, since exercise is well-known to increase feelings of self-esteem, well-being and self-efficacy—which are negatively correlated with substance abuse—exercise may serve as protection against developing a SUD.
EXERCISE AND OTHER DRUGS OF ABUSE
Marijuana is the illicit drug most commonly used in America, as well as in Europe, yet there are few studies that examine the effects of exercise on cannabis self-administration. The same holds true for the synthetic cannabinoids, or designer drugs, such as K-2, Spice, and amphetamine derivatives such as mephedrone.
Other areas worthy of research include potential sex differences on how exercise affects drug self-administration, and other types of exercise besides aerobic. For example, resistance and strength training exercise has largely been unstudied.
With the breadth of studies to-date, and the increasing interest in the benefits of exercise in addiction recovery, there are some clear recommendations:
- Any exercise – even brief — is likely beneficial.
- Both men and women are likely to experience therapeutic effects from exercise.
- Exposure to exercise early is likely to provide long-term benefits— even if begun after chronic inactivity.
- Perhaps most important is that exercise is both a likely preventative and treatment intervention for substance use, and should therefore be highly recommended in addiction recovery.
For more about exercise, addiction and recovery, check out these articles:
Anxiety and Depression Association of America. “Physical Activity Reduces Stress.” Retrieved from https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/stress/physical-activity-reduces-st
Behavioural Brain Research. “Chronic forced exercise inhibits stress-induced reinstatement of cocaine conditioned place preference.” Retrieved from https://www.sciencedirect.com/science/article/pii/S0166432818300524?via%3Dihub
Biological Psychiatry. “Aerobic exercise attenuates reinstatement of cocaine-seeking behavior and associated neuroadaptations in the prefrontal cortex.” Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2949528/
Brain Plasticity. “Evaluating Exercise as a Therapeutic Intervention for Methamphetamine Addiction-Like Behavior.” Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928557/
Contemporary Clinical Trials Communications. “A Complier Average Causal Effect Analysis of the Stimulant Reduction Intervention using Dosed Exercise Study.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29682627
Current Addiction Reports. “Exercise as a Sex-Specific Treatment for Substance Use Disorder.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29404264
Drug and Alcohol Dependence. “Access to a Running Wheel Decreases Cocaine-Primed and Cue-Induced Reinstatement in Male and Female Rats.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237846/
Frontiers in Psychiatry. “Exercise as a Potential Treatment for Drug Abuse: Evidence from Preclinical Studies.” Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276339/
National Institute on Drug Abuse. “Studies Link Stress and Drug Addiction.” Retrieved from https://archives.drugabuse.gov/news-events/nida-notes/1999/04/studies-link-stress-drug-addiction
Neuroscience & Biobehavioral Reviews. “Exercise as a Novel Treatment for Drug Addiction: A Neurobiological and Stage-Dependent Hypothesis.” Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3788047/
Psychopharmacology. “Reduction of extinction and reinstatement of cocaine seeking by wheel running in female rats.” Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3553548/
Substance Abuse and Mental Health Services. “Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health.” Retrieved from https://www.samhsa.gov/data/report/2017-nsduh-annual-national-report
Substance Abuse and Mental Health Services. “Recovery and Wellness Lifestyle—A Self-Help Guide.” Retrieved from https://store.samhsa.gov/shin/content//SMA-3718/SMA-3718.pdf