Outrunning Addiction: When Exercise Becomes the Problem

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Not long ago, a guy named Brian emailed me and told me the tragic story of a friend of his, a master swimmer and “finisher of many Ironman triathlons,” as Brian recalled. He was also a “meeting-a-day guy." He was well regarded in 12-step circles for his “willingness”—a key ingredient, they say, to recovery. He was in perfect shape—evidently happy, reliable, he was one of those guys in the program who have what you want.

And then, one day,  he committed suicide.

“I can’t stop thinking about it,” wrote Brian, himself a triathlete with 30 years sober. Endurance athletics are a big part of Brian's recovery, in much the same way they were for his late friend. He’d always compared physical fitness with the “spiritual fitness” that people who work the 12 steps say is necessary to recover from addiction. I clicked over to the online guest book for the man who’d taken his own life and read the comments, which mostly expressed shock.

Many people in recovery turn to exercise when they get sober. It's not a novel concept. Working out can help channel the obsessive thoughts associated with addiction. Many turn to yoga, running, Pilates, kickboxing, triathlons—the list is long (the exercise industry earns at least $20 billion in the US, ironically the same amount that is earned annually by the addiction industry)—but tragedies like Brian's friend's point to a small but growing chorus that wonders if exercise can actually "turn" on an addict—much like drugs and alcohol once did. In the most extreme situation, can it lead to suicide?

Brian made some provocative points: Maybe athletics can be used, like a drug, to avoid emotional pain? "I think about how hard my friend tried," he said. "How hard he worked it"—both his program and his athletic regimen—"and I wonder now about the limits of trying, doing, working and as we say 'working it'—at least when all that comes at the expense of acceptance."

At least one study is looking hard at the question, and coming up with some surprising results. Madhukar H. Trivedi, M.D., a psychiatrist and director of the Dallas-based Mood Disorders Research Program and Clinic at the University of Texas Southwestern Medical Center, has long researched exercise regimens as treatments for depression. Trivedi is in the middle of a two-year randomized clinical trial to study the effects of intensive exercise to treat addiction to cocaine, amphetamines, and other illegal stimulants.

Compared to, say, nicotine addiction, says Trivedi, “there are very limited treatment choices available for cocaine and methamphetamine abuse.” As a doctor, he’s also very interested in pharmacological options, “but they aren’t the answer for everything, and we need additional treatments for these diseases. When a patient says, ‘Tell me all the things that work for cocaine and methamphetamine abuse,’ we want to add exercise to that.”

Supported by the National Institute on Drug Abuse, Trivedi’s study is dividing 330 stimulant addicts into two groups, each starting in residential rehab. One group performs an intensive inpatient fitness regimen for three months, with weekly outpatient followups over the next six months. Meanwhile, a control group receives health education classes. Subjects in the exercise group are prescribed a “dose” of exercise: they run on treadmills at 85 percent of maximum heart rate for 30-50 minutes, depending on their baseline fitness level, gradually ramping their doses up over the 12 weeks, with pre-workout warm-up and post-workout stretching.