1 Qigong and Sobriety Karel Nespor, M. D., Ph.D.

Addictions are a global problem Worldwide, alcohol is a leading cause of ill health and premature mortality. It accounts for 1 in 17 deaths, and for a significant proportion of disabilities, especially in men (OECD, 2015). Beside alcohol tobacco and many other addictive substances are abused. There are a great number of pathological gamblers; many people suffer from shopping addiction etc. Simple, effective and inexpensive forms of treatment are needed to tackle these widespread problems.

Some problems related to addictions Typical symptoms of addictions include craving and impaired self-control. These people continue their addictive behaviors despite adverse consequences, such as health, psychological and relationship problems. Their energy level is low. Restlessness and irritability are caused by blocked qi and yin depletion (empty fire). The internal organs as understood by traditional Chinese medicine are impaired. The kidney system is usually depleted, especially in the users of street drugs. Lack of sleep, fear and insecurity impairs the kidney system of almost all addicted persons and pathological gamblers. “The kidneys store the will power” and this may create a vicious circle. The liver system: Toxic effects of alcohol, drugs, lack of physical activity, stress and improper nutrition cause liver problems of various degrees. Moreover, Serrano (2002) mentioned constrained qi and blocked emotions. The heart system is impaired especially in alcohol dependent persons (the liver is the mother of the heart), in the people addicted to stimulant drugs (methamphetamine, cocaine) and in tobacco addicts. According to Bobbins (2003) “Addiction blocks the opening to the heart. When blocked, the spirit cannot communicate with the heavenly influences. “ The spleen system suffers because of many reasons: Irregular and low quality food, the effects of alcohol and drugs on the digestive organs, chaotic life-style and insolvable problems. The spleen is impaired also indirectly because of the weakening of other organs, such as the liver. Phlegm (tan) produced by poor digestion rises upward to the heart. It is considered a common cause of mental disorders. Mental disorders appear in addicted people very often. Moreover phlegm can injure all main organs and block the flow of qi. The lung system is impaired because of smoking tobacco or other drugs and improper breathing. Depression harms the lungs and it is common in addicted people because of hangovers, withdrawal states and failures in relationships, education or work.

Short literature review I am aware only of few papers dealing with the use of qigong in the treatment of addictive diseases (e. g. Chen, 2010). On the other hand there is plenty of indirect evidence to support its use in addicted people. Fatigue, anxiety and depression are common among addicted people. Chan et al. (2014) report that qigong practices alleviate depression and anxiety in chronic fatigue like syndrome. Chang et al. (2013) described positive psychological, immunological and physiological effects of a Laughing Qigong Program on adolescents. Qigong practice also alleviates stress (Chan et al., 2013, Hwang et al., 2013). Abbott and Lavretsky (2013) recommend taiji and qigong to reduce depressive symptoms, stress, anxiety, and mood disturbances. Qigong is useful not only for patients but also for therapists (Saganha et al., 2012).

Craving, Chinese medicine and qigong Characters craving Craving is a typical symptom of addictive diseases, including pathological gambling. Craving has much in common with strong emotions like anger. What are the typical features of craving? 1. It is usually caused by triggers. They can be external (e.g. risky environment) and internal (e. g. 2 fatigue or boredom). 2. Craving motivates to addictive behavior and makes self-control difficult. 3. Craving is accompanied by stress. 4. Attention is focused on addiction related stimuli, consciousness is narrowed, memory and decision-making significantly deteriorate. Because of it, the most effective techniques to overcome craving are those which are simple and well learned. Why is it important Knowing the features craving enables to detect in time when craving is weak. In addition, the features of craving suggest how to cope with this problem: 1. Avoiding internal and external triggers or reduce their impact. 2. Increasing the motivation to stay sober. 3. Stress relief (physical activity, laugher, breathing into the abdomen, relaxation techniques etc.). 4. Enhancement of decision making.

How can qigong help? * Various forms of physical activity are helpful, especially those during which the legs are active to pull the energy down. It may be walking, standing qigong practices or shaking the whole body which is intense and easy to learn. * Breathing into the abdomen, or "cultivating a ball". Abdominal breathing calms down, replenishes and anchors it behind the navel1. * Acupressure: Great many points may be effective, but not so many can be used as self-help in a daily life. Some points at the Pericardium meridian (PC6, PC7, and PC8) can be easily located treated gently and discreetly. Easily accessible is also a HT7 (Shenmen) that calms the spirit and dissolves the phlegm tan. Some ear points may also help. The effect of acupressure can be enhanced by quiet abdominal breathing, smile and autosuggestions, such as "Calm, wise, sober". One may also imagine the stream of light entering the point which is treated2.

Simple dietary recommendations We recommend adequate intake of water and warn especially from trans fat, sweets and chemicals in food to protect the liver, heart and spleen.

Situation and setting At present, I am the head of the Male Addiction Treatment Department at Psychiatric Hospital Prague. We have 3 wards and 111 beds for alcohol or drug dependent patients and pathological gamblers. A typical patient has health problems and his concentration and memory is not good, especially at the beginning of his treatment. After overcoming acute medical problems, patients participate in the complex treatment program. It consists mainly of psychotherapy, education and Alcoholics Anonymous, Narcotics Anonymous or Gamblers Anonymous meetings. All this requires a lot of sitting. To practice with these patients Big Tree stance for 30 minutes of one hour lasting silent meditation would not be acceptable for most patients. I try to be flexible and make the practice pleasant, funny and interesting.

Some practice which we use On the working days, I practice qigong and yoga with our patients for at least 30 minutes. Beside this, I use simple qigong practice during psychotherapy to enhance concentration and vitality. Some of our favorite practices follow (most of them are described by Sü Ming-thang and Martynovova, 2013). Hand clapping: I use this simple practice stimulating the heart at the beginning of the sessions. It can be combined with some rhyme, such as “Staying sober is much better”3. Shaking the body: I often combine this practice with laughter and ask: “How do people laugh after

1 Video: https://youtu.be/ihMO0pJi_ZM 2 Video: https://youtu.be/nqaV5dZDOWE 3 Video: https://youtu.be/EALrHNZ4xz4 3 3, 6 and 12 years of sobriety?”4 Removing bad qi: I compare this practice to the cleaning the hard disk of a computer. Afterwards, we install new programs, such as wisdom, kindness, discipline, trust and honesty. Immortal crane drinks water: Sometimes I say that this crane is also sober, because it likes water. Beside this, the crane has the small brain and there is no room for problems. Our patients like this gentle and nice ZYQ practice. Note: Thirst often induces craving for alcohol. Drinking water is usually enough to overcome it. Therefore, we recommend to patients to carry water with them always. Yang-qi-gong: We call this practice “Cultivating a Ball” and consider it crucially important for many reasons. It has calming effects and replenishes energy. If practiced at night, it can alleviate sleep disturbances. Moreover, it can be used discreetly during daily activities which do not require full attention. It helps to control cravings and negative emotions. To motivate our patients to use this practice, I reveal them the Great Ball Truth: “Some people have problems. I do not. I have my ball. If I am successful, I practice bigger, smaller. If there are problems, I do the same.” Mysterious dragon in a sea bottom: The advantage of this practice is that everybody can choose the range of movement according his fitness. The practice for the eyes and liver: We take with the hand the green energy of trees and send it from our palms to the closed eyes. After a while, we pull this energy down to the lover dantian. This practice has calming effect, pulls down the ascending “rebellious” liver qi and is good for the eyes and the liver. Cultivating positive emotions: We lift up the energy ball at the heart level and open and close the middle dantian. At the same time, light and inner peace are sent to oneself, people around us, to this city, country, continent, to the whole world, to everybody overcoming his/her addiction and again to oneself. It is a variant of the Buddhist motionless Loving Kindness Meditation (Metta). Modern psychological research confirmed its positive effects on prosocial behavior, relationships (Hutcherson et al., 2008), creativity and mental health (Galante et al., 2014). Guided relaxation in a supine position: It usually lasts about ten minutes and consists of body scan and the awareness of the energy ball behind the navel. It is followed by visualization of the internal organs as happy and healthy. A sea gives energy to the kidneys, trees to the liver, red morning Sun to the heart, yellow earth to the spleen and white clouds to the lungs. Before the end, I ask them to repeat silently three times: “Calm, wise and sober”. Qigong self-massage: We use it at the end of our sessions or as needed. Other techniqes: I am a qigong practitioner and use techniques that are not rational in terms of Western medicine. For example I may throw an energy ball to the room when we will practice. Or I may include everybody around into a big ball and send energy there. I believe that it is effective, even if I cannot prove it.

Conclusion Addictions are chronic diseases and inpatient treatment should continue ambulatory for many years. I encourage our patients to go on with their qigong practice and provide them with relaxation recordings and videos. They are free at www.drnespor.eu and www.youtube.com/drnespor. If somebody wishes, I give him contacts to qigong teachers outside the hospital. I cannot present any hard data here. Even so, I consider qigong to be a valuable component of our treatment program. Many of our former patients report to use especially “the Ball” (Yang-qi-gong).

Acknowledgements: I gratefully appreciate the suggestions by Jan Soldan, PhD. (Chengdu).

References Abbott R, Lavretsky H. Tai Chi and Qigong for the treatment and prevention of mental disorders. Psychiatr Clin North Am. 2013; 36(1):109-19. Bobbins S. Understanding Addiction: Part One. Acupuncture Today March 2003; 4(3).

4 Video: https://youtu.be/ebqX6TmTGCQ 4 www.acupuncturetoday.com/mpacms/at/article.php?id=28159 Chan ES, Koh D, Teo YC, Hj Tamin R, Lim A, Fredericks S. Biochemical and psychometric evaluation of Self-Healing Qigong as a stress reduction tool among first year nursing and midwifery students. Complement Ther Clin Pract. 2013; 19(4):179-83. Chan JS, Ho RT, Chung KF, Wang CW, Yao TJ, Ng SM, Chan CL. Qigong exercise alleviates fatigue, anxiety, and depressive symptoms, improves sleep quality, and shortens sleep latency in persons with chronic fatigue syndrome-like illness. Evid Based Complement Alternat Med. 2014; 2014:106048. Chang C, Tsai G, Hsieh CJ. Psychological, immunological and physiological effects of a Laughing Qigong Program (LQP) on adolescents. Complement Ther Med. 2013; 21(6):660-8. Chen KW, Comerford A, Shinnick P, Ziedonis DM. Introducing qigong meditation into residential addiction treatment: a pilot study where gender makes a difference. J Altern Complement Med. 2010; 16(8):875-82. Galante J, Galante I, Bekkers MJ, Gallacher J. Effect of kindness-based meditation on health and well-being: a systematic review and meta-analysis. J Consult Clin Psychol. 2014; 82(6):1101-14. Hutcherson CA, Seppala EM, Gross JJ. Loving-kindness meditation increases social connectedness. Emotion. 2008; 8(5):720-4. Hwang EY, Chung SY, Cho JH, Song MY, Kim S, Kim JW. Effects of a brief Qigong-based stress reduction program (BQSRP) in a distressed Korean population: a randomized trial. BMC Complement Altern Med. 2013; 13:113. OECD: Tackling Harmful Alcohol Use, Economics and Public Health Policy, 2015. http Saganha JP, Doenitz C, Greten T, Efferth T, Greten HJ. Qigong therapy for physiotherapists suffering from burnout: a preliminary study. Zhong Xi Yi Jie He Xue Bao. 2012; 10(11):1233-9. Serrano RB. An Integrated TCM Way for Healing Chemical Dependency. www.freedomhealthrecovery.com/dependency.html; 2002. Sü Ming-thang, Martynovova T. Cchi-kung Čung-juan, spodni tantien, uvolneni těla. Bratislava: Eugenika 2013; 379. (Czech translation) Wang CW, Chan CH, Ho RT, Chan JS, Ng SM, Chan CL1. Managing stress and anxiety through qigong exercise in healthy adults: a systematic review and meta-analysis of randomized controlled trials. BMC Complement Altern Med. 2014; 14:8.

Karel Nespor, M. D., Ph.D. [email protected] www.drnespor.eu www.youtube.com/drnespor