Controlled breathing shows promise for reducing substance use cravings

Controlled breathing interventions can reduce cravings in people who use substances, including alcohol, tobacco, and other drugs, according to a new review published in the scientific journal Addiction.

The review combined results from 20 studies (1,249 participants overall) that looked at how controlled breathing can help people using substances to reduce craving, withdrawal symptoms, or dependence. The breathing-based interventions included several types of controlled breathing: heart rate variability biofeedback (HRVB), resonant breathing, yogic breathing, rhemercise, mimicking smoking, and three-part breathing. See details below.

The review found that breathing-based interventions appear promising for improving substance use-related outcomes, with the strongest evidence showing small but statistically significant reductions in craving. While there was no difference in the effect of HRVB breathing vs non-HRVB breathing, the evidence for HRVB was concentrated in multi-session interventions targeting long-term craving reduction and thus had stronger evidence for these longer-term changes. Conversely, non-HRVB breathing studies spanned both formats, yielding stronger evidence for immediate, single-session craving relief.

The positive effects of controlled breathing were consistent across nicotine, alcohol, opiates, stimulants, other substances, and poly-substance use.

Evidence for the effect of controlled breathing on dependence and withdrawal was more limited, as these outcomes were based on fewer studies (two studies examining dependence and four examining withdrawal symptoms) that showed less consistent effects; however, the effect of controlled breathing on dependence was large and warrants further investigation.

According to lead author Dr Ariel Dart Roxburgh, of Monash University, “Our review suggests that breathing interventions can be an effective and low-cost add-on to addiction treatment. With more than three quarters of the world’s population owning a mobile phone, the potential benefits of low-cost smartphone-assisted breathing interventions are substantial. What we need next is larger, pre-registered trials with standardised measures and longer follow-up, so we can improve our understanding of how these interventions work.“

• Heart-rate variability biofeedback (HRVB) uses real-time biofeedback (a sensor that tracks heart rate) to help people learn to pace their breathing to match their heart rhythm.
• Resonant breathing is like HRVB but can be done without biofeedback by approximating the pace of breathing to resemble what would be achieved with HRVB. This is usually 6 breaths per minute.
• Yogic breathing uses controlled patterns of inhalation, exhalation and sometimes breath retention. One example is Sudarashana Kriya Yoga breathing where participants are taught to follow three distinct breathing patterns that vary in speed, depth of breath, and breath hold length.
• Rhemercise is slow-paced breathing that incorporates additional behavioural components such as Duchenne smiling, yawning, and positive verbalisation coordinated with breathing.
• Mimicking smoking involves controlled deep breaths at set intervals to mimic the action of smoking (e.g. inhale for 5 seconds, hold for 2 seconds, exhale for 5 seconds).
• Three-part breathing is a set of three breathing techniques, each involving breathing in deeply and focusing on expanding a different portion of the body (e.g. abdomen, lower chest, upper chest).