Breathwork and pranayama in substance use disorders: Mapping the evidence and clinical integration pathways

Substance use disorders remain associated with high relapse rates despite standard treatments combining pharmacotherapy and psychosocial interventions (Krishnan, 2024). In this context, there is growing interest in complementary and integrative approaches, including those derived from breathwork, yoga, and meditation practices.

Beyond the field of addiction, breathwork interventions have gained increasing scientific attention in other areas of mental health. A scoping review on anxiety disorders reported that various breathing techniques were associated with significant improvements in anxiety symptoms among patients diagnosed according to DSM-5 criteria (Banushi et al., 2023).

These findings suggest that breath-based interventions may target transdiagnostic mechanisms such as stress regulation, physiological arousal, and emotional states, which are also central to substance use disorders.

Within addiction research, yoga- and mindfulness-based interventions have shown potential benefits on key processes involved in relapse, including craving, emotional regulation, and stress (Khanna & Greeson, 2013). Specific breathing techniques, such as Sudarshan Kriya, have been associated with improvements in well-being, reductions in substance use, and effects on stress-related biomarkers (Krishnan, 2024; Yadav et al., 2021). Earlier work also suggests that rhythmic breathing practices may contribute to reductions in tobacco use and to changes in certain immune markers, although these findings remain preliminary

(Kochupillai et al., 2006). Other pranayama techniques may also support stress reduction in individuals experiencing substance-related challenges (Kumar, 2018).

However, the current literature remains fragmented. Existing studies either focus on multimodal interventions combining several components, such as yoga, meditation, and spirituality, or on isolated techniques, without providing a structured synthesis of breathwork and pranayama as a distinct category of intervention (Shankar et al., 2014; Khanna & Greeson, 2013; Krishnan, 2024). Additionally, some complementary approaches in addiction are described in conceptual or non-standardized ways, limiting their integration into evidence-based clinical frameworks (Solanki et al., 2022).

To address this gap, a scoping review is currently underway. It aims to identify and map studies published over the past 15 years examining the effectiveness of breathwork and pranayama techniques in the prevention and treatment of substance use disorders across diverse populations. Data extraction is ongoing, and findings will be presented for the first time at the conference.

This work aims to contribute to a clearer understanding of the role of breathwork and pranayama in both prevention and treatment trajectories of substance use disorders. By structuring existing knowledge, this review may support clinicians in integrating breath- based interventions as complementary self-regulation tools, particularly for managing stress, craving, and emotional states, while informing the development of more structured and evidence-based integrative care approaches. It may also help assess the relevance of more formally integrating these practices into certain addiction services, including rehabilitation settings.