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Alcohol consumption is the seventh leading risk factor for both deaths and functionally adjusted years of life globally - this new study can help improve global public health by broadening the range of effective non-stigmatizing treatments available to people with alcohol abuse.
Common barriers to seeking help
Most people with alcohol abuse never seek or receive treatment despite negative consequences for both mental and physical health. According to the researchers, perceived stigma and dissatisfaction with available treatments are common barriers to seeking help. Therefore, more effective and non-stigmatizing treatments for alcohol abuse are needed.
Current treatments include psychological therapies and medication. These are effective, but relapse rates remain high, and these treatments do not directly address the somatic health problems commonly seen in those with AUD. To address this, we invested the effects on alcohol consumption of aerobic exercise - which is recommended for general health - and yoga, an increasingly popular form of exercise which may be suitable for people with AUD, says Mats Hallgren, Project Manager, Department of Global Public Health.
Yoga and aerobics training reduce alcohol consumption
The studies show that aerobics training and yoga were as effective in reducing alcohol consumption as regular care. 140 adults participated in the studies - they had never before sought help, were physically inactive and had been diagnosed with alcohol abuse.
Participants in the two physical activity groups were supported to exercise 3 times / week for 12 weeks. Assessments were made at the start and after 12 weeks - 90% completed the follow-up assessment.
Blood samples were taken to assess somatic health and changes in physical activity were measured using accelerometers. In the randomized controlled trial, they conducted an emergency training study, in which participants cycled intensively for 12 minutes. Changes in craving for alcohol, mood and anxiety were assessed before and after cycling.
Alcohol consumption reduced approximately equally in all three groups, with the largest absolute reduction seen among yoga participants - 6.9 standard drinks / week. The reductions were statistically significant and clinically meaningful. This is great news; it means there are potentially effective treatment options available for people who do not want to seek treatment through specialist clinics.
The researchers also found that occasional aerobics training sessions reduced the craving for alcohol, anxiety and improved mood.
This shows that the optimal time to exercise is when cravings are high - typically in the afternoon or evening. Repeatedly replacing alcohol with a brief session of exercise may be "re-wiring" the brain to respond positively to the rewards associated with exercise, resulting in less craving. Finally, we found that both forms of exercise reduced symptoms of depression and anxiety, with the largest reductions seen among yoga participants. Feeling anxious or sad increases the likelihood of alcohol use, so it's promoting that exercise was shown to reduce these symptoms.
Dopamine - the reward system
There are several mechanisms that can explain the benefits of exercise on alcohol consumption. Exercise tends to make us feel good; it reduces stress and anxiety through neurophysiological effects, which can indirectly affect alcohol consumption by reducing suction, improving cognition and making behavioral changes more likely.
– Exercise can improve self-esteem and the belief in one’s ability to control drinking. The anxiolytic effects of exercise are powerful, and anxiety is a known ‘trigger’ for drinking. Alcohol dependence is associated with dysregulation of the dopaminergic (reward) system, and exercise is shown to adjust dopamine synthesis in ways that may reduce cravings for alcohol. Our yoga classes emphasized physical postures, but relaxation and breathing exercises may confer additional health benefits relevant to those with AUD.
Efforts to improve physical activity
According to Mats Hallgren, the next step forward is to determine whether the benefits of training are maintained over time. And also, to study the effects exercise has on the cognition of people with alcohol dependence, as it is often impaired which can affect recovery. The dopamine hypothesis is biologically reasonable, but no studies have investigated this mechanism in humans using a training intervention.
– Encouraging people to exercise is challenging, but it can be done. To help people initiate and maintain new exercise regimes, intervention should include a parallel behavior change program. Another challenge is implementing these knowledge gains in clinical practice. Currently, primary and specialist healthcare is not set up to implement exercise intervention on a wide scale. We need to employ physical therapists to assess, prescribe, and monitor physical activity interventions in healthcare settings.
Read the publications
Hallgren M, Vancampfort D, Hoang MT, Andersson V, Ekblom Ö, Andreasson S, Herring MP
Drug Alcohol Depend 2021 03; 220 (): 108506
Gunillasdotter V, Andréasson S, Jirwe M, Ekblom Ö, Hallgren M
Drug Alcohol Depend 2022 03; 232 (): 109266
Effects of physical activity on symptoms of depression and anxiety in adults with alcohol use disorder (FitForChange): Secondary outcomes of a randomized controlled trial.Welford P, Gunillasdotter V, Andréasson S, Hallgren MDrug Alcohol Depend 2022 Aug; 239 (): 109601
Source/Credit: Karolinska Institutet | Linn Sjöberg