The effectiveness of breathing interventions for people who use drugs with Ari Roxburgh

The effectiveness of breathing interventions for people who use drugs with Ari Roxburgh

What are the common struggles and victories in addiction recovery? This conversation between Dr Tsen Vei Lim and clinical psychologist Dr Ariel (Ari) Roxburgh zooms in on something deceptively simple: breathing. Ari shares how a search for evidence around a specific breathing technique for alcohol use and craving snowballed into a full systematic review and meta-analysis on controlled breathing and heart rate variability biofeedback (HRVB) for substance use outcomes.

The chat keeps things grounded in practice, making it ideal for clinicians, researchers, students and people with lived experience who want evidence rather than hype. You’ll hear Ari explain why craving is so tightly linked to the sympathetic nervous system and why controlled breathing might help calm that "fight-flight" response.

As he puts it, heart rate variability is "like having a well-tuned car" that can speed up and slow down smoothly, and certain breathing techniques appear to nudge that system in a healthier direction. The key headline from the meta-analysis is that controlled breathing has a small but consistent effect on craving across 12 studies, comparable to other evidence-based interventions. Substance dependence showed promising results in two studies, while withdrawal outcomes were less clear.

Importantly, HRVB didn’t outperform other controlled breathing techniques; instead, longer-term HRVB seems better suited to ongoing craving, while simple in-the-moment breathing may be more helpful during acute urges. Ari is careful to stress that "we're not saying that you do breathing and you're going to be cured", framing it as a low-cost, low-risk adjunct to standard care.

He also shares practical tips from current work testing an app-based breathing programme, like choosing a regular time and place—anything from first thing in the morning to a quiet moment in the car after work. If you’re curious about adding something simple, cheap and evidence-informed to your recovery toolkit or clinical practice, this episode might spark some useful questions about how often, when, and with whom to use controlled breathing.