Evaluation of Yoga for Preventing Adolescent Substance Use Risk Factors in a Middle School Setting: A Preliminary Group-Randomized Controlled Trial

Abstract

Adolescence is a key developmental period for preventing substance use initiation, however prevention programs solely providing educational information about the dangers of substance use rarely change adolescent substance use behaviors. Recent research suggests that mind–body practices such as yoga may have beneficial effects on several substance use risk factors, and that these practices may serve as promising interventions for preventing adolescent substance use. The primary aim of the present study was to test the efficacy of yoga for reducing substance use risk factors during early adolescence. Seventh-grade students in a public school were randomly assigned by classroom to receive either a 32-session yoga intervention (n = 117) in place of their regular physical education classes or to continue with physical-education-as-usual (n = 94). Participants (63.2 % female; 53.6 % White) completed pre- and post-intervention questionnaires assessing emotional self-regulation, perceived stress, mood impairment, impulsivity, substance use willingness, and actual substance use. Participants also completed questionnaires at 6-months and 1-year post-intervention. Results revealed that participants in the control condition were significantly more willing to try smoking cigarettes immediately post-intervention than participants in the yoga condition. Immediate pre- to post-intervention differences did not emerge for the remaining outcomes. However, long-term follow-up analyses revealed a pattern of delayed effects in which females in the yoga condition, and males in the control condition, demonstrated improvements in emotional self-control. The findings suggest that school-based yoga may have beneficial effects with regard to preventing males’ and females’ willingness to smoke cigarettes, as well as improving emotional self-control in females. However additional research is required, particularly with regard to the potential long-term effects of mind–body interventions in school settings. The present study contributes to the literature on adolescence by examining school-based yoga as a novel prevention program for substance use risk factors.

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Acknowledgments

We are thankful to the KYIS intervention teachers and program mentors: Janna Delgado, Iona Smith, Jordan Grinstein, Renee Merrill, Lucie Kasova, Monica Laitner-Laserna, Cara Masullo, Katherine Olson, and Mikki Pugh. We also acknowledge the headmaster, assistant headmasters, school staff, physical education teachers, and students at the school who facilitated and/or participated in the project. We are grateful to Mark Greenberg for providing guidance during the development and implementation of this project. We also thank Frankye Riley who assisted with preparing this paper for publication.

Funding

This work was funded by grants from the Institute for Extraordinary Living of the Kripalu Center for Yoga & Health and the National Institute on Drug Abuse (Grant No. R34 DA032756).

Authors’ Contributions

BB coordinated the study, conducted statistical analyses, and drafted the manuscript. AL assisted with the execution of the study and drafted portions of the manuscript. SHS and SBSK conceived of the study, supervised the coordination of the study, and drafted portions of the manuscript. All authors read and approved the final manuscript.

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Authors

Corresponding author

Correspondence to Bethany Butzer.

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Conflict of interest

The authors report no conflicts of interest.

Ethical Approval

This study was reviewed and approved by the Brigham and Women’s Hospital Institutional Review Board (Partners Human Research Committee). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Written parental consent and written child assent were obtained from all individual participants included in the study.

Appendices

Appendix: Sample Yoga Intervention Curriculum Materials

Lesson 5: Sticking Through Stressful Experiences

Lesson Overview

Introduction

Lesson 5 explores the concept of noticing one’s experience while sticking with stressful situations rather than giving up or checking out. When faced with a challenge, the instinctive response is often to give up and avoid the challenge entirely, or check out and stay in the challenging situation, but mentally disconnect from the experience. This lesson invites students to practice remaining both physically and mentally engaged with a challenging experience.

Learning Goals

Participants

  • Explore the idea that they can choose how to respond to stress

  • Identify their habitual responses to stress

  • Practice observing and accepting stressful experiences as they are

  • Practice breathing techniques to focus and quiet the mind.

Key Concepts

  • Noticing stress and sticking with it

  • Mindful breathing

Key Practices

Three-Part Breath

Ocean Breath

  • Foundational yoga postures

  • Introduction to longer holds with an emphasis on “sticking with stress”

Materials and Room Setup

  • Blocks (Low Lunge series and Triangle)

  • Visual aid

  • Ocean Breath poster

Lesson Plan: Session 5

Didactic Content

  • Options for responding to stress

  • Start by asking students what they think are good things to do when they’re stressed out. Or start by asking them if they’ve heard people say “take a deep breath” or “count to 10 before you react,” and then ask them if they think those things work.

  • Introduce the concept of “sticking with stress”

Benefits of Ocean Breath

  • Relieves insomnia and promotes sleep

  • Soothes the nervous system

  • Settles the mind

Experiential Activity

  • Yogi Twisters

  • Call out names of body parts, e.g., “just one foot,” “two hands,” “just your sitz bones.” Students can only touch the floor with the body parts called out. Encourage creativity. If appropriate, have the students take turns being the caller.

Centering and Breathwork

  • Three Letting-Go Breaths

  • Silent check-in

  • Three supine belly breaths

  • Three supine breaths into the rib cage

  • Three supine breaths into the chest

  • Supine Three-Part Breath

  • Introduction to Ocean Breath

    • Establish steady and even Three-Part Breath. Open the mouth, constrict the back of the throat, and whisper the syllable “eeeee” on the inhalation and “haaaaaa” on the exhalation, cultivating a steady, smooth sound. Then close the mouth and continue whispering “eeee” and “haaaa” to create this soft, smooth sound from the back of the throat.

    • How do you identify stress? Stress can feel different to different people—some breathe shallowly or hold their breath, some get headaches or stomach pain, some feel antsy or exhausted. Start by sharing your own experience of what stress feels like for you and ask students to share their experiences. Use this discussion of how to identify stress to lead into the discussion of how to respond to it. The sound produced by Ocean Breath settles the mind by giving it a sensory focal point. You could say this breath “tricks” the mind into focusing on the present moment, which allows space for relaxation, healing, and building energy. Making louder sounds than normal while breathing may feel strange, so acknowledge the possibility that students may feel uncomfortable at first. Creating the audible sounds of Ocean Breath increases awareness—as the mind processes the sounds of the breath, the mind and body link.

Warm-Up

  • Low Lunge series with blocks

  • Extended Low Lunge to Hamstring Stretch

  • Extended Low Lunge

    • From Down Dog, step the right foot forward in between the hands and bring the back knee down to the mat. Keep both hips squaring off toward the front of the mat as you drop them forward and down. Raise the arms overhead, reaching fingertips toward the ceiling and lifting the sternum.

  • Hamstring Stretch

    • Place both hands on the ground and straighten the front leg, bringing the hips back toward the back heel. Keep the hips lifted off the heel and extend the torso forward, bringing the chin toward the extended knee.

  • Knee-Down Twist

    • With the right foot forward, bring the left hand down next to the right foot and lift the right fingertips toward the ceiling, twisting toward the right knee. Return the right hand to the ground outside the right foot and lift the left arm in the air, twisting toward the left side of the room.

  • Lateral Stretch

    • With the right foot forward, bring the right hand down to the ground or a block beside the right hip and reach the left hand up and over to the right, keeping the pelvis pressing forward and down. Return to the starting position and laterally stretch the spine to the other side.

Yoga Poses

  • Full Sun Salutation weaving in:

  • Five-breath hold of Plank and Chair

  • Fundamentals of Warrior I

  • From Down Dog, step the right foot forward between the hands.

  • Keeping the back heel lifted, inhale the arms overhead.

  • Keep the front knee stacked over the ankle and press the back knee up toward the ceiling.

  • Flying Warrior I

  • From Warrior I, inhale to reach up through the fingertips.

  • On the exhale, reach forward, down, and then back, bringing the hands by the hips with the palms facing down and lowering the torso to a 45-degree angle.

  • Inhale to reach the arms up, lifting the torso and bringing the biceps up by the ears.

  • Repeat for a few more rounds of breath.

  • Exhale the arms down to the ground, step the right foot back, and repeat on the other side.

  • Fundamentals of Warrior II

  • Begin in a wide-legged stance facing the left side of the mat so that the right foot is near the front of the mat.

  • Rotate the right toes to face the front of the mat and bend the right knee to bring it over the right ankle.

  • Keep the hips squared off toward the side of your mat—if the hip bones were headlights they would be pointing straight ahead.

  • Bring your arms up parallel to the mat and reach through the fingertips, looking over your right shoulder.

  • Release and repeat on the opposite side.

  • Triangle

  • Child

  • Supine Twist

If students are struggling with the longer holds, give them the option of dropping their knees in Plank or placing their hands on their thighs in Chair.

Relaxation and Integration

  • Rest pose with lengthened exhales

  • Guide students to inhale to a slow count of three, and exhale to a slow count of six. Count aloud for them during the first couple rounds of breath, then guide them to continue the count silently to themselves.

Closure

At the end of class, bring everyone up to seated and ask the students to take a minute for another silent check-in, guiding them to tune in and become mindful of where they are in the moment.

Bring closure to the lesson as a group. Options include, but are not limited to,

  • Ring bell or singing bowl

  • Bring hands to chest and feel heartbeat

  • Collective breath (big breath in, sigh it out)

  • Clasp hands behind back and fold forward over crossed legs

  • Three Sun Breaths.

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Butzer, B., LoRusso, A., Shin, S.H. et al. Evaluation of Yoga for Preventing Adolescent Substance Use Risk Factors in a Middle School Setting: A Preliminary Group-Randomized Controlled Trial. J Youth Adolescence 46, 603–632 (2017). https://doi.org/10.1007/s10964-016-0513-3

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Keywords

  • Yoga
  • Substance use
  • Adolescence
  • Meditation
  • Mindfulness
  • School
  • Addiction