Exercise as Part of Therapy
Many addiction treatment programs make exercise part of treatment. The idea behind this is that after clients emerge from the medical detox that purges their bodies of the effects of the drugs and alcohol they were abusing, they are physically weak (as a result of the vomiting, diarrhea, fever, muscle pain, and cramping they endured).
For that reason, treatment centers make it a point to give their clients nutritious meals, carefully selected and prepared, to build up strength after detox. A part of that reconstruction involves exercise; for example, private rehabilitation centers may offer mixed martial arts, basketball, and swimming as part of their services, along with an onsite gym.
According to the American Psychological Association, physical exercise staves off clinical depression by the simple act of giving people something to do, and something from which they can derive a sense of accomplishment and satisfaction. Sticking with a formula for a set number of hours a day, for a set number of days per week, can result in measurable markers of success, such as losing weight, lifting heavier weights, running greater distances for longer periods of time, etc. Achieving these markers gives the person a tangible, concrete sense of self-worth and success, both of which help stave off the typical feelings of uselessness and helplessness that come with depression.
Exercise as an Antidepressant
Consistent, challenging exercise works on the same parts of the brain that antidepressant medications work on, when such medications are prescribed for the treatment of depression and anxiety. Studies conducted on animals have shown that when the animals performed exercise, their brains increased the production of neuromodulators such as serotonin and norepinephrine. In humans, serotonin conducts electrical signals between the brain and the central nervous system, and it is responsible for mood, social behavior, appetite, digestion, sleep, memory, and even the sex drive. A deficiency of norepinephrine can cause fibromyalgia and chronic fatigue syndrome, both of which have depression as a symptom.
The International Journal of Psychosocial Rehabilitation goes so far as to suggest that the way exercise increases production of the serotonin and norepinephrine neuromodulators is the same effect that antidepressant medication (like SSRIS, selective serotonin reuptake inhibitors sold under brand names, such as Lexapro, Zoloft, and Prozac) has on people who are struggling with depression, suggesting that exercise can be used to reduce dependence on pharmaceuticals. The writers of the article in the journal even refer to this as exercise therapy, suggesting that exercise in and of itself can become an arm of treatment.
Another neurological effect of exercise is that, during a workout session, the brain releases another neurotransmitter called dopamine. Dopamine is what gives rise to feelings of pleasure, satisfaction, and reward anticipation, which run along the same neural pathways that are hijacked by drugs and alcohol. The chemicals in controlled substances force the brain to pump out enormous and unhealthy amounts of dopamine, to such an extent that the brain never fully recovers from the experience. This is what makes certain drugs so instantaneously addictive to certain people and why these people are driven to consume more and more drugs.
With exercise, on the other hand, the amount of dopamine released by the brain is entirely within normal boundaries, and unlike with drugs and alcohol, the brain is allowed to reabsorb the dopamine, allowing neurological activity (and life) to return to normal. In fact, an exercise physiologist at the University of Adelaide went so far as to compare the chemical changes brought about by consistent and focused exercise with the chemical effects of taking drugs, saying that “exercise can be like a pill.”
Exercise, Sleep, and Withdrawal
Exercise can take on many forms, such as yoga, running, weight training, and even dancing. Whatever the format, a good session of working out leaves the brain flushed with endorphins and serotonin, both of which go a very long way in boosting self-esteem and self-image. Endorphins even cause a “euphoric sensation,” akin to the burst of energy and intensity that drugs create when they first make contact with a person’s brain. But unlike drugs, exercise-inspired endorphins are a natural booster, shoring up the immune system, normalizing and improving sleep patterns, and even priming the body to cope with stressful and tense situations.
In 2012, the Journal of Abnormal Psychology found that getting better sleep can help balance the mood swings and imbalances in energy that can arise in cases of particularly severe withdrawal from drugs and alcohol, what addiction specialists refer to as post-addiction withdrawal syndrome (PAWS)., 
Moving Blood to the Brain and the Risks of Poor Self-Image
Research suggests that exercise can increase the development of nerve cells (neurons), a process known as neurogenesis. The Journal of Psychiatry and Neuroscience referred to this as the “antidepressant effects of exercise,” with a study’s authors writing that “exercise should alleviate the symptoms of [major depressive disorder].” Furthermore, other work done on the subject points to the antidepressant effects of exercise lasting well beyond the actual time spent exercising, and that the benefits of exercise are not limited to alleviating the symptoms of depression. A June 2015 TED Talk by Sandrine Thuret, a neural stem cell researcher, describes this in simple terms of “moving blood to the brain.”
On the other end of the spectrum, those with a low perception of themselves, their bodies, or how they look may be vulnerable to depression (depression and low self-esteem often go together, according to Psych Central). Those looking to recover after a substance abuse problem are still very psychologically sensitive, and thinking poorly of themselves could spiral into depression and relapse. People who have depression are twice as likely to turn to drugs and alcohol to help them cope. Of people who experience a period of depression in a calendar year, 30 percent will abuse drugs (legal or illegal, recreational or prescription).
Exercise as Group Therapy
The virtues of exercise in helping people recover after addiction are so well known that working out has become part of recovery culture. As part of aftercare support and networking, former drinkers have been known to join gyms or form exercise groups, in order to reap the physical and psychological benefits of working out, while simultaneously strengthening their social rehabilitation.
The advantage of working out in a group also helps with giving a newly-sober person a reason not to fall into the trappings of boredom and isolation. This is very important, because not everyone can understand the importance of having a sense of structure and discipline in post-therapy life. There is no having a drink to take the edge off the day, or going bar-hopping with friends on a long weekend. That sense of disconnection can be difficult to deal with, so much so that social withdrawal is a very common red flag for depression and relapse., 
Support and Accountability
As much as therapy and treatment seeks to help people reconnect to the friends and family they may have hurt as a result of their addiction, it is equally vital that individuals seek out the company of others in recovery. Such people know the difficulties and challenges that a sober person faces in the real world, and group exercise is one way to break the ice and form bonds with other recovering individuals.
As with other forms of aftercare recovery, working out in a group also provides a foundation of accountability for a newly-sober person. Like the classic New Year’s resolution, the decision to exercise regularly will be tested once real life sets in. As the number of missed exercise sessions pile up, the resolve
to get back on the workout wagon diminishes, and the thoughts of shrugging off the physical and psychological benefits entirely start to seep in.
Having a team of people who can keep a person accountable to workout plans, however, changes the dynamic entirely. Making excuses for not working out is not as easy when other people know the importance of staying regular with exercise. If there is a bigger problem behind faltering commitment to the program (such as a relapse of depression), then the members of an aftercare group are the best people to pick a newly-sober person up and back on track (or on the treadmill).
Yoga as Exercise in Recovery
One form of exercise that has proven popular for millennia, and is enjoying newfound popularity in new contexts and cultures, is yoga.
The original concept of yoga is defined as a union between the body and spirit. The stretches and poses that make up the physical component of yoga are meant to bring about a sense of harmony between the tangible and the intangible, between the body and the mind. Holding positions and controlling breathing are thought to aid in a kind of quasi-spiritual discipline.
While yoga stretches back thousands of years, its health benefits are plentiful and relevant. The National Council on Alcoholism and Drug Dependence says yoga increases awareness and mindfulness of both body and mind. Simple actions, like counting breaths, clearing out all conscious thoughts and stretching the body in new and creative ways teaches people to connect with themselves on a deeper level, and not the external factors that are behind sources of stress, anxiety, tension, depression, and temptation.
Centering on the Present
Like any other form of exercise, yoga encourages its practitioners to hold themselves to a standard of discipline (sometimes quite physically and literally). The theory behind this is that sharpening and tempering the body will have a similar effect on the mind, purging negative impulses and promoting a healthier, cleaner perspective, both outwards and within, on a level that be construed as being either spiritual in nature or more centered on the self than on an external higher power.
That standard of discipline entails accepting oneself, warts and all, and not trying to escape or bury aspects of character or history by taking drugs or alcohol. The Huffington Post says that yoga’s call to eschew judgment or self-criticism fosters a sense of compassion and forgiveness towards the self, putting a person in the present moment instead of the shadows of the past.
Mindfulness and Meditation
In addition to reducing stress and improving physical and mental awareness, yoga can also reduce cravings. Any recovering person will know that one of the hardest parts of sobriety is saying “no” to the bevy of temptations and stressors in the real world. However, the mindfulness in meditation that yoga imparts to all its practitioners bears similarities to Mindfulness-Based Relapse Prevention (MBRP), a behavioral treatment that targets the deep, burning sense of wanting to get high or drink again that every former addict knows. In the same way that MBRP encourages clients to accept uncomfortable situations without reacting “automatically” (the way they may have done before receiving therapy), the mindful meditation of yoga calls on people to make peace with the parts of their nature (or the world around them) that may be likewise uncomfortable or challenging, without falling back on a harmful (and possibly addictive) behavior. Mindfulness (and meditation) quite possibly changes the way the brain is wired to react to craving, and might go so far as to even reverse or fix the damage caused by drug or alcohol abuse, further reducing the risk of relapse.
The breathing and relaxation techniques that are part of yoga can also help with improving mood in people going through addiction recovery. A specific set of breathing exercises in a form of yoga helped people who had finished one week of detox for alcoholism. Slow, deep breathing and forced inhalation and exhalation for 12-15 minutes, followed by a deep relaxed state of 20 minutes, were found to engender markedly reduced symptoms of depression and lower stress hormones in a matter of weeks.
A study conducted on a group of imprisoned men who were diagnosed with substance abuse found that six weeks of this kind of yoga, at daily sessions of 25 minutes, resulted in improved functioning, lower levels of anxiety, and greater levels of positive wellbeing.
The Huffington Post explains that “addiction is a disease of lack.” People who are addicted to drugs and alcohol feel they don’t have enough control, confidence, love, power, fun, and happiness – enough of anything that makes them feel complete and whole. But yoga channels focus and perspective through its exercises, techniques, and approach, filling that void with personal awareness and strength to give people in recovery a sense of fulfillment and satisfaction.
Dance as Recovery Therapy
Music has long been known to have therapeutic qualities, so what if music therapy were combined with exercise? The idea of dance as therapy for addiction recovery is not a very farfetched one; moving to music appears to be a natural human response, according to a study in the Proceedings of the National Academy of Sciences journal. The study, conducted on infants between 5 months and 2 years old, found that not only did the infants dance to the music that was played to them, they also smiled a lot.
So, if music and dancing had this effect on babies, can it help people in recovery? A dance therapist and instructor of movement therapy and counseling tells The Fix that the theory behind dance therapy is “finding the movement of the body.” Art therapy is less about making people take a class in art, and more about giving them a way to express themselves in a positive and healthy manner, and the same is true about dance therapy. Speaking to The Fix, the therapist explains that her department doesn’t make people dance, but helps them find “an inner impulse,” a lively one that they feel most comfortable expressing as a form of dance.
Therapy in Motion
The idea of harmonizing the body and mind to build recovery in the aftermath of an addiction is similar to yoga, in that dance therapy teaches participants to take stock of their internal and external centers of control. People who struggle with addiction, temptation, or a depressive or anxiety disorder tend to focus on things they cannot control: the unknown, the future, how others might perceive them, etc. Movement therapy, like yoga or dancing, teaches individuals how they can be mindful of their physical presence in the world around them, and how their behavior affects their external environment. Fears of the unknown or negative impulses can be similarly controlled, maybe even banished, by carefully guided and structured movements. In yoga, these take the form of ritual poses and breath control; in dance therapy, it is set to music.
Like yoga, participants in dance therapy are encouraged to use and move their bodies in innovative and creative ways, in the company of other people on the same journey. It may seem embarrassing or silly at first, but a good therapist will help people find the fun and meaning in discovering a new sense of their physical selves, in a healthy and uplifting social context. According to the American Dance Therapy Association, the end result is that an individual receives “emotional, cognitive, physical and social integration,” which is what addiction recovery boils down to: helping formerly addicted individuals rebuild and rethink themselves, and the world around them.
The Importance of Exercise in Recovery
For those who have been through therapy and are in recovery, one of the biggest threats to sobriety comes from the intrusive and obsessive thoughts that try to creep into their new lives – thoughts about the pressure of being clean, the frustration of not being able to have fun anymore, and resentment towards others about the way everyone else can enjoy a drink. These thoughts come from the same place that played a part in developing the initial addiction, but The Fix explains that exercise provides an outlet for these thoughts – one that didn’t exist before. That’s why the Anxiety and Depression Association of America throws its weight behind the idea. Physical workouts, they say, are critically important for maintaining mental health and fitness, and the anxiety disorders that plague 40 million people across the country – including the many such disorders that tempt a person toward relapse – can be brought under control by consistent and organized exercise programs.
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