Yoga for Deaddiction Module

Purpose of this Module
The MSJE under its jurisdiction has a number of IRCAs across the length and breadth of India. It has been a constant endeavor of the Ministry to provide assistance in various ways leading to improvement in the quality of life of individuals previously addicted to drug or substance i.e. individuals undergoing rehabilitation. One of the services provided to these individuals is Yoga. It cannot be over-emphasized that the discipline of Yoga being inherently holistic goes a long way in rehabilitation, preservation and promotion of health. Regular practice of Yoga can contribute immensely to the well-being and quality of life of these individuals.

Indian Yoga Association (IYA) is an association of all the important Yoga Institutions in the country. The expertise of Yoga in India is the possession of IYA. With its innumerable Member Institutions spread all over the country, IYA is in an advantageous position to fulfill the need of MSJE in providing Yoga training to the addicted or previously addicted individuals as mentioned above.    

This Module is envisaged to serve as a broad framework or protocol for the Yoga Teachers / Trainers who will impart Yoga training to the participants / inmates of De-addiction Centers across the country.

Care and respect towards human beings per se is an essential cultural trait of ancient Indian culture. One of the ways of taking care of these individuals is fulfilled by providing them with the benefits of Yoga practices towards health and happiness.

Yoga, the Great Gift from India

Yoga is an integral part of the rich ancient Indian heritage. The ‘Art and Science’ of Yoga is one of the greatest gifts from India to the world. Yoga traces its origin to the Vedas, the most ancient treasure house of human knowledge. Yoga is as old as humanity! Evidence from ancient civilization extracts show that Yoga existed from the beginning of human civilization. Realizing the importance of Yoga as the best form of practice for holistic health and well-being of humanity, the United Nations General Assembly, on the recommendation of the Hon’ble Prime Minister of India, Shri Narendra Modi, declared 21 June as the International Day of Yoga (IDY). Since 2015, this day is celebrated all over the world with the practice of the Common Yoga Protocol (CYP).

The Discipline of Yoga

Yoga is unique as the best practice to fulfill the twin purposes of human life of experience and emancipation, Samsara and Kaivalya. Accordingly, it addresses the two main segments of the human system, the Material and the Spiritual, i.e., Body and Mind on one side and the Spirit or Consciousness on the other side. It has immense potential as follows:

• As a preventive discipline, it improves immunity and wards off illnesses.
• It preserves and promotes good health.
• As an alternate therapy, it provides relief in illnesses.
• As a healing procedure, it helps in rehabilitation and emotionally empowers an individual to bear the stress and strain of life.
• It increases the life span.
• It enables to control the mind by increasing the power of concentration of the mind.
• It is the best anti-dote to stress and adverse effects of stress.
• On the spiritual front, it transforms consciousness by increasing awareness levels.
• It provides meaning or purpose to human life. 

Yoga is for All

Yoga is for all and everyone irrespective of age, gender, caste, creed, profession, race, religion, region, and nationality. It offers solutions to the problems faced by human beings as such. As an adhyatmic manav samskriti or spiritual human culture it is instrumental in raising the quality of human life and creating better specimen of human beings. To the question “why should one do Yoga?”, the most appropriate answer is, “to become a better human being”. With the popularity of Yoga increasing in geometric progression today, Yoga has the potential of becoming the binding or cohesive force unifying humanity at the universal level for health, harmony and happiness. Modern science has been investigating the efficacy of Yoga from all angles. There are already well-established scientific findings which point towards the positive changes that Yoga brings on the practitioner. Be it to address any type of illness or to improve productivity or to improve the quality of life, Yoga is the Panacea.

Philosophical Root of Yoga

Yoga is one of the six orthodox ancient Indian philosophies (shad aastika darshanas).
The basic text of Yoga darshana or Yoga philosophy is Patanjali’s Yoga Sutras. This sutra work propounds the Aṣṭāñga Yoga or Yoga with eight limbs.

Aṣṭāñga Yoga in Brief

The great sage Patañjali, based on his deep contemplation of the Vedic Wisdom, formulated, and gave to humanity the systematized form of the ‘Eight-limbed Yoga Practice’ known as ‘Aṣṭāñga Yoga’.  It is holistic in that it caters to eight dimensions of human personality, namely, the Social, Personal, Physical, Physiological, Mental, Psychological, Intuitive and Spiritual. Like all other ancient Indian philosophies (except Charvakas), the ultimate purpose of Yoga is to achieve a state of freedom from human sufferings or duhkha. The eight limbs or practices of the Aṣṭāñga Yoga are:

1. Yama (Observances / restraints – Social dimension)
2. Niyama (Observances / restraints – Personal dimension)
3. Āsana (Physical postures)
4. Prāṇāyāma (Breathing practices – Physiological / Mental dimensions)
5. Pratyāhāra (Control of senses by withdrawing them inwards – Mental dimension).

6 to 8. The last three angas viz.  Dhāraṇā (Concentration), Dhyāna (Meditation) and Samādhi (Spiritual Absorption) are together considered as Meditation in Yoga. They cater to the Psychological, Intuitive and Spiritual dimensions of human personality.

Other Traditions of Yoga

In addition to Patanjali’s Ashtanga Yoga, there are several other traditions of Yoga which provide effective practices for mankind. Some of these traditions are as follows: Hatha Yoga, Mantra Yoga, Nada Yoga, Kundalini Yoga, Kriya Yoga, Swara Yoga, Karma Yoga, Bhakti Yoga, Jnana Yoga, etc.
In fact, yogic practices which are popular today viz. shudhi kriyas, asanas, pranayama, bandhas, mudras, etc are sourced in Hatha Yoga. Patanjali’s Yoga Sutras provide principles for the practices of Yoga. Meditation is the highest practice in Yoga.

Note on Addiction[1]

A. What is addiction? What does it do?

The term ‘addiction’ originally meant ‘attachment’ or ‘devoting oneself to another’. It had mainly positive connotation. Only after the 19th century, ‘addiction’ came to be seen as a disease, a type of physical and mental illness. Today it is understood mainly as a psycho-neurological disorder as also a bio-social disorder mainly associated with drugs or substances and alcohol. Addiction can be understood as irresistible or irrepressible attachment to drugs, etc. it is a type of mania called dipsomania.
Addiction can be towards various drugs like marijuana, amphetamine, heroin, cocaine, ecstasy or MDMA, opioids, etc.
Persistent and intense urge for usage of drugs, despite severe harm and serious negative consequences, deteriorates into a neuro-physiological disorder. Prolonged drug consumption alters brain functioning such that craving is perpetually present and resistance is progressively weakened. Addiction is characterized by immediate gratification (short-term reward) along with delayed harmful effects (long-term cost). The latter takes a toll on the addict’s physical and mental health, personal and social adjustment, his capacity to be a productive member of society, at self-control, to handle stress situations, and loss of meaning in life and also life. There is incessant seeking of drug in all situations and circumstances. Addiction may be classified as mild, moderate and severe.  The term ‘drug addiction’ is taken as synonymous with ‘severe’ addiction.
While drug addiction is the compulsive use of a drug or substance, drug dependence is a disorder in which cessation of drug use results in an unpleasant state of withdrawal, which can lead to further drug use. Although the two often go together, they can exist independent of each other. 
Physical dependence occurs when the body has adjusted by incorporating the substance into its “normal” functioning – i.e., attains homeostasis – and therefore physical withdrawal symptoms occur upon cessation of use.
Tolerance is the process by which the body continually adapts to the substance and requires increasingly larger amounts to achieve the original effects. Withdrawal refers to physical and psychological symptoms experienced when reducing or discontinuing a substance that the body has become dependent on. Symptoms of withdrawal generally include but are not limited to body aches, anxiety, irritability, intense craving for the substance, nausea, headache, hallucinations, tremors, cold sweat, etc.

B. Causes of Addiction

Adolescence, or say the teenage, is the period most vulnerable for falling into the trap of addiction. During this period, the incentive-reward system of the brain overshadows the cognitive control functions. Hence, the adolescents can act on impulse without considering the consequences of their actions. Once trapped, they are more resistant to treatment and more liable to relapse. Thus most addicts are exposed to and use addictive drugs for the first time during their teenage years.
In older people drug addiction may be caused due to increased intake of medicines, social isolation, financial worries, etc. 
Though addiction can begin experimentally in social contexts or can arise from use of prescribed medications there are several factors, genetic and environmental, which may lead to addiction. These factors make an individual vulnerable towards addiction. Some of these factors may be as follows:

• Adverse childhood experiences like unhappy childhood, absence of parental love / supervision in childhood, child abuse, exposure to violent crime, etc.
• Peer pressure coupled with weak personality
• Easy availability and usage of drugs by friends
• Feelings of economic discrimination due to poverty
• Unemployment
• Lack of meaning in life
• Coping mechanism and craving for a ‘quick high’
• Mental Disorders like depression, anxiety, attention-deficit/hyperactivity disorder (ADHD) or post-traumatic stress disorder, etc.
• Abuse liability or using drugs for euphoria, mood changing, sedation, etc

C. Signs and Symptoms of Addiction

An individual betrays the fact of his addiction by showing tell-tale signs and the fact is ascertained by certain unfailing symptoms. Some of these signs and symptoms may be as follows:

• Some general signs and symptoms – Urge to use drug regularly and in progressively increasing dosage despite knowledge of adverse consequences; ensuring a stable supply of the drug irrespective of financial state & strain; unsuccessful attempts to stop drug use due to withdrawal symptoms; personal and professional life affected;
• Some physical signs and symptoms – weight changes, speech defects, indifference to physical appearance, body odor, impaired physical movements, etc.
• Some behavioral signs and symptoms – conflicts (frequent arguments, quarrels, etc.), denial / disguising / hiding certain actions, volatile mood and temperament, increase in anxiety, fear, paranoia, anger, irritation and activity, lack of motivation for anything, etc.
• Some social signs and symptoms – change in friends, friendships and hobbies, always in need of money, indifference to self-respect, etc.  

  D. Some Negative Consequences of Addiction

• Disruption in carrying out normal day-to-day functions
• Disruption in goal-oriented functions viz. attention, response to stimuli, mental flexibility, memory, planning and organizing, sustained focus, etc.
• Loss of capacity to deal with out-of-ordinary situations
• Physical health issues – functional and structural
• Mental Health issues
• Lack and loss of meaning in life; loss of self-esteem
• Resorting to illegitimate and illegal activities
• Feeling out of place in any normal social gathering
• Becoming untrustworthy and hence incapable of healthy relationships

E. Approach towards Rehabilitation for addiction (Some relevant factors for consideration)

1. De-addiction is a long-drawn process with regular ups and downs. Hence the teacher / therapist has to necessarily have extreme patience without losing compassion. It should be an individual-specific and person-centered approach.
2. The feelings of shame and guilt attached to the stigma of addiction can prevent the addict from seeking help. Therefore, there needs to be total understanding and empathy towards the addicted recognizing addiction as a chronic illness instead of a punishable moral offense. It should be seen as a social rather than individual problem. Assurance and encouragement need to be provided to those who are struggling with the issue. Confidence needs to be instilled that they are not alone and healing is possible.
3. There has to be progressive strengthening of total personality which will prevent relapse into old ways.
4. Provision of sustained emotional and psychological support is indispensible. Arrangement of full-time support system is critically necessary. “Satsang” is the need!
5. Counseling will provide an avenue for externalization of repressed and unconscious emotions of the addict, promoting the development of a more integrated and harmonious self.
6. Make the individual feel himself socially useful by engaging in social and charitable activities, in helping others. 
7. Instead of saying ‘don’t do A’, the therapist has to say, ‘do B’. So there has to be a provision of a worthwhile B for every individual. This happens when the potential of each individual is brought to light in Counseling sessions.
8. Addiction adversely affects the individual in all dimensions of his life – personal, interpersonal or social, physical, mental, psychological, professional, spiritual, etc. It has biological, psychological, social, cultural and spiritual elements. Since the issue of addiction is multi-dimensional, the approach towards rehabilitation should also be multi-dimensional. No single exclusive practice or line of therapy will work totally.
9. The approach thus has to cater to the physical and mental health of the individual, unburdening of the psyche, self-acceptance by the individual and social acceptance of the individual, correction in perspective towards life, provision of meaningful activity, strengthening of personal relationships, etc.
10. Change in environment should be brought about where accessibility to drugs is not there and the resultant craving is fulfilled by alternative activities.
11. Resorting to medication, where necessary, needs to be continued.
12. Daily sweating or perspiration (through aerobic activity like running, etc) is an inevitable part of any approach undertaken towards de-addiction. Sweat or perspiration results in removal of physical as well as mental toxics. Any activity which results in perspiration changes the mental environment.
13. Involvement in some form of art can go a long way towards dealing with de-addiction. Creative activities like painting, sculpting, music, dancing (which is aerobic and also an art form) and writing can help people express their feelings and experiences in safe and healthy ways thereby resulting in sublimation. 
14. Introduction of Spiritual activities into life can go a long way in strengthening the resolution for de-addiction.

Yoga for IRCAs

Aṣṭāñga Yoga, the Eight-limbed Path of Yoga, enunciated by Sage Patañjali offers a holistic solution in dealing with human suffering and provides over-riding principles for the practices of Yoga. The eight limbs are:

• Yama (Social observances / restraints) for social adjustment
  • Ahimsa (Non-injury)
  • Satya (Truth)
  • Asteya (Non-stealing)
  • Brahmacarya (Continence / Moderation in Sensual & Sexual pleasures)
  • Aparigraha (Non-hoarding)
• Niyama (Personal observances / restraints) for personal adjustment
  • Sauca (Cleanliness – Physical & Mental)
  • Saṁtoṣa (Contentment)
  • Tapas (Austerity)
  • Svādhyāya (Study of the Self)
  • Īśvarapraṇidhāna (Surrender to the Īśvara, Supreme Consciousness)
• Āsana (Physical postures) – for physical health
• Prāṇāyāma (Breathing practices) – for physiological and mental health
• Pratyāhāra (Control of senses by withdrawing them inwards) for mental health
• Dhāraṇā (Concentration)………)
• Dhyāna (Meditation)…………..) for psychological, intuitive and spiritual purposes
• Samādhi (Spiritual Absorption).)

Of the eight limbs stated above, Yama and Niyama principles are to be cultivated and followed up throughout life for happy living. Dhāraṇā, Dhyāna and Samādhi, for practice purposes are together taken up as Meditation). Also, Pratyāhāra (withdrawal of senses inwards) is achieved as an outcome of maturity and wisdom on the path of spiritual evolution. Thus, the three important components of the Aṣṭāñga Yoga which are taught and practiced are:

• Physical postures (Āsana) and Suryanamaskar
• Breathing practices (Prāṇāyāma)
• Meditation (Dharana, Dhyāna & Samadhi)

In addition to the above practices, some subtle exercises (sukshma vyayama) and some shuddhi kriyas (purification practices), mudras and mantra chanting as also relaxation practices form essential practices for inmates of Drug addiction Rehabilitation Centers.
Yoga Nidra can be specifically designed for de-addiction purposes  
The practices prescribed should be general and individual-specific. Depending upon the individual’s psycho-physical constitution and particular needs, a set of Yoga practices can be tailor-made for that individual. Emphasis in the practice of Asanas can be advantageously put on dynamism and movement rather than on being static.
The role of continuous counseling and provision of emotional / psychological support cannot be over-emphasized. Round the clock emotional and psychological support should be afforded to the inmates of these rehabilitation centers. The dormant potential and interests of the inmates have to be revitalized so that they can get satisfactorily concentrated and not fall prey time and again to relapse. 

Rationale of Yoga Practices for IRCAs

Addicts in Rehabilitation Centers may often lack motivation and interest in initiating and undertaking any activity on their own due to obvious reasons. Hence, these practices, when done in a group, come as a welcome relief to them to bring back their zest and jubilance to life and living. They have something to look forward to, a fulcrum around which the other activities in the day can be rearranged.
Yoga is a holistic discipline catering to all dimensions of human personality and, in the process, providing a meaning to life.
The aim of using Yoga for rehabilitation from addiction should be to gradually strengthen the personality of the individuals, bring in discipline in their lives by getting actively involved in the practices, thereby keeping body and mind gainfully active, to preserve and improve physical health, attain mental focus and keep the awareness level intact.
The mind-control techniques of Yoga like ektattva abhyasa, pratipaksha bhavana, citta prasadana technique, etc. provide the individuals with a rich repertoire which can prevent them from falling prey to craving for drugs or other temptations with short-term rewards.
Yoga necessarily makes an individual inward looking / introspective. Being a universal human culture (manav samskriti), the goal of Yoga practice is to create better or refined human beings. 
The goal of taking Yoga to the IRCAs is also for the inmates to be introduced to and become aware of our age-old traditional practices that were inculcated as part of everyday routine and to promote healthy body, happy and cheerful mind and evolved spirit.
What follows is a suggested Module of Yoga for inmates of IRCAs, generally applicable to all the participants.

Some Precautions while Teaching and Practicing

While teaching Yoga in the IRCAs, the following points should be kept in mind:

• The principle of “yatha shakti” i.e. “as per one’s limit / capacity” should be adhered to at all times and in every practice. Every participant should be allowed to practice only up to his / her limits. For instance, insistence on achieving the final postures (Āsanas) should be totally avoided. The process of doing the practice is more important than reaching the final point.
• Suitable modifications / variations should be suggested for those who are unable to practice as per prescription.
• Contra-indications of practices should be explained before doing any practice.
• Benefits of the practices should also be listed during rest phases i.e. in-between practices.
• It is advisable to use demonstrators to show the practice and the teacher can then simultaneously explain the nuances of the practice.
• As far as possible, practices should be done under the watchful eyes of the teacher, particularly when new practices are introduced.
• Competition should be avoided in any and all practices.
• Instructions should be clear and, in a language, understood by all the participants.
• Ideally, a practice should be first demonstrated and then the participants should be made to do the same.
• Proper protocol should be followed while effecting corrections in the practice of participants.
• Combining breath with postures will help in eliminating the injuries.
• Holding of breath beyond the capacity should be avoided.
• Practices could be done while sitting on a chair wherever applicable and necessary.
• Maximum precautions should be taken to ensure that there are no untoward accidents resulting in injuries to the participants.
• Discipline as regards starting and ending time of the Sessions should be strictly adhered to.

Logic behind the Structure of the Module of Practices

The Module of Practices incorporates several practices under various heads like Shuddhi Kriyas, Sukshma Vyayama, Asanas, Pranayama, Mudras, Mantra Chanting, Relaxation Practices, Meditation, Yoga Nidra, etc.
The Teacher can choose from these practices depending upon the needs and capacities of the participants in the group.
Sukshma Vyayama is ideally suited and very effective particularly in the case of these IRCA inmates. It is intended to open out the joints and loosen the muscles thereby to bring the beneficial effects in blood circulation, flexibility, etc. It also helps to improve the Pranic fow through the Nadis , thereby improving mind-control.
Shudhi Kriyas can immensely benefit by removing the toxics from the body, by stimulating unhindered flow of prana in the body and making the body fit for doing asanas and pranayama.
Āsanas aim at beneficially affecting the structure and functions of the body and thereby restoring health. They can ideally become tools for honing concentration of the mind.
Before teaching pranayama practices, it is essential to ensure that the basic breathing pattern is correct. This is applicable to all the participants. Pranayama practices generally increase energy and awareness level. With equalized flow of breathing through both nostrils, the mind experiences harmony, is controlled and is ready to move towards concentration and meditation. These breathing practices can be accompanied by mental chanting of AUM. 
Various Mudras can be incorporated in the sessions exclusively or along with Asanas, Pranayama and Meditation practices.
Meditation practices bring the mind to the state of rest and calmness and are capable of providing the experience of the blissful no-mind state. 
Yogic Relaxation must be certainly included as part of the protocol. In fact after every practice compulsory relaxation of a few seconds or minutes should be given to feel the effects of the practices fully. This would ensure mind-body healing, recuperation and regeneration.
Yoga Nidra should be specially designed as regards its sankalp (resolution), suggestions and Visualization.
Counseling tips should be adhered to while interacting with the inmates.
The Yoga Teachers should be adequately prepared by means of Workshops for imparting Yoga practices to the inmates of IRCAs in the most optimum manner. 

Conclusion

The content of this Module, the list of practices incorporated in the Module and guidelines suggested in the Module are meant for providing a framework for imparting the benefit of Yoga practices to the participants / inmates of IRCAs. Abiding by the framework, the Yoga Teachers have freedom to choose the particular practices to be taught to the participants and time allocation inter-alia various practices. However, the overall aim should be to render health, good cheer and happiness to the participants thereby bringing about total freedom from addiction.

[1] When the word ‘addiction’ is used in this Module, it refers to Drug or Substance addiction.

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