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.
Trivedi thinks the addicts getting “doses” of exercise will go more days without using drugs than the other groups.
Here's how it works: Most people think exercise works to distract addicts from obsessing about using, but Trivedi believes it also boosts critical brain chemicals—dopamine, noradrenaline, and serotonin—the same chemicals sparked by most drugs of addiction. Trivedi’s team will be testing subjects not just for number of days abstinent but also gauging their improvements in mood, weight, sleep, quality of life. Trivedi cites animal studies that have shown exercise can spur the nervous system’s ability to heal itself, otherwise known as neuroplasticity. In short, he says, exercise re-grooves our memory pathways, which can often be battered by extensive substance use.
“There is an assumption that patients that have [addiction] are unable to imprint or engage—lay down—new memories that would help them avoid repeating the behavior that gets them to engage in drug-use,” Trivedi says. “But the brain can adapt very easily. You have to work at it, but the brain does adapt significantly. It’s not like you’re born with the brain and it never changes.”
Recovering addicts who are also elite athletes say exercise keeps their moods stable. For example Catra Corbett, 47, of the Bay Area, former meth addict and swiller of Bacardi 151, now cross-fit athlete, fast-packer, solo trail-runner and ultra-marathoner with 19 years sober and more than 200 ultras notched on her belt, more than a quarter of them 100-milers. She preaches the gospel of extreme fitness. "What drives me to run?" she has said. "Keeping me clean and sober and sane."
Todd Crandell, 45, a counselor and founder of the Toledo-based Racing for Recovery, a nonprofit organization whose mission is to prevent substance abuse by promoting health and fitness, says “I notice even the different types of exercise can make a difference in how it helps you to overcome a bad mood. If I run, I’m perfect for the day. If I have to cycle or swim, I’m just so-so.” Crandell quit living in his car and drinking two fifths of whisky in 1993. So far, he has finished 20 Ironman triathlons. Last year Crandell completed an Ironman in South Africa with a guy who had first seen Crandell’s story on TV while smoking in a crack house.
More than 4,500 addicts have come through his program, he says, and his organization has set up 5K races for thousands around the country.
Crandell started out his recovery with two years in AA, got tired of “talking about how much coke I snorted,” he says, then quickly found out he could set athletic goals for himself and master them, which gave him a sense of accomplishment and structure. He pushed himself all the way to finishing Ultraman races—three-day events that involve a 6-mile swim, 261-mile bike ride, and 52-mile run.
At one point, he says, exercise took over his life: he was running 50 to 70 miles per week, and he lost perspective and a great deal of time with wife and four kids.
“It was like, Dude—get a hold of yourself, there’s more to life than this. It started to cost me dearly,” he says. Now, he says, “I need six miles of running a day and I’m good. Exercise, to me, is an essential part of a balanced, holistic way of living.” In his counseling practice he coaches other recovering addicts on how to stay fit and maintain perspective.
Are they just trading one addiction for another? “For a lot of people exercise is definitely a form of disassociation. For me it’s not nearly to the degree as when I was drinking a fifth of liquor a day and shooting five bags of heroin,” says Shane Niemeyer, 36. In 2003, at 27, Niemeyer was arrested in Idaho for drug possession and burglary. In jail, he tried to hang himself and failed. While recuperating in a straitjacket he came across some magazine stories about triathletes. He turned the pages with his toes and decided that if killing himself hadn’t worked out, he’d—well—he’d become a triathlete. And he did. For the past two years he has raced in the Ironman World Championships in Kona, Hawaii.
“I was able to get something a lot of addicts will never have, and that was the ability to come to this conclusion that I’m done, that I’ll never drink or use drugs again,” says Niemeyer, who gives motivational speaking appearances and coaches clients—some of them obese, some recovering from cancer and other health threats, and some recovering from addiction—privately from his practice in Boulder, Colo. “I don’t regularly attend meetings, but exercise is a huge component of my recovery. I don’t believe anyone who’s an addict can just stop engaging in that behavior and have that be a sustainable situation. … For me exercise was a very constructive physical outlet for the emotions I had.”
Can exercise “turn” on you? Both Crandell and Niemeyer talk about exercise in terms of balancing obsessive desire to meet personal expectations against a need, as recovering addicts, to rest in the satisfaction of achievement. “After every race, there’s an element of complete and utter satisfaction, no matter how I did,” Niemeyer says. “I haven’t had many good races. When you’re done, it’s a good time to reflect on how things are now with you as a person. It’s a cause for perpetual introspection.”
Crandell knows about addicts and suicide: his mother and his uncle, both addicts, killed themselves. Crandell began drinking and using drugs early in his teens; a few years later, his addiction ended his potential pro hockey career. He knows obsessiveness is part of his nature, yet he is sincere in his assertion that he doesn’t give a shit whether he wins or loses.
“I remember a guy came up to me in Mexico and said, ‘I beat you in such-and-such a race.’ I’m like, ‘Dude, don’t put that on a resume—everybody beats me,’” he says. “I could care less about my times. I’m not one of these guys that’s like, I gotta beat my transition time by 30 seconds or my race is a failure. There’s nothing wrong with having goals and working your ass off to achieve those goals. But you have to enjoy the ride, and enjoy the accomplishment while you’re setting the next goal.”
“The old thing with people going to AA meetings and drinking coffee and smoking cigarettes—to me it’s not real recovery,” says Dan Cronin, 60, an addictions interventionist based in Pasadena who has 21 years sober from, as he says, “all of the above.” Cronin races Ironman triathlons to raise money for the Veterans Health Initiative, which provides treatment for addicted veterans. He has worked in substance abuse counseling for national-league hockey and major-league soccer for more than a decade.
And he conducts interventions for private, well-heeled clients who just want to stop drinking and using and who ignore the fact that their lives and bodies are falling apart. He uses exercise as a way into “the profound psychic change that recovery is supposed to be.”
“I tell them, ‘You’re sober, and now what?’” he says. “Most of these people haven't lost all their money, their wives, their families. What can you talk to them about? I ask them, ‘Is this what you worked your whole life for?—Your wife can’t stand you, neither can your kids. You’re 100 lbs. overweight, you look like crap, you’ve got a bad attitude, and you think you’re doing good because you’ve got money in the bank?’”
Cronin—a lifelong athlete who maintained his fitness, he said, even during the years he was getting loaded—works to help clients counter their unrealistic expectations: “We’re talking about people with obsessive qualities—they haven’t run in 10 years and they’re gonna go out and run a marathon.” He uses exercise to teach them how to gauge their own limitations and abilities. As they make progress, their blood-pressure, cholesterol, and stress levels decrease and their accountability and “manageability levels” rise. “I see people who not only feel better about themselves, but they feel better about everything.”
I asked him about the limits of trying, of recovery—physical, mental, spiritual, whatever—of working, as they say, “if you work it.” Is constant pressure to achieve better outcomes won at the expense of self-acceptance? At 60, is he bugged by the knowledge of all the limits on his abilities? To answer, Cronin talks about that mysterious thing that Trivedi calls “neuroplasticity,” and that people in recovery call “surrender.”
“I know I couldn’t run a three-hour marathon on a bet or with somebody chasing me. I know that,” he says. “I must play a million mind-games out there. There’s always one point during the [Ironman] run where I know that if I walked the rest of the course I’d finish in less than 17 hours—I tell myself, Somebody’s already gotten the $15K, I’m sure there’s still a T-shirt out there.
“There’s nothing like that feeling of just letting it go. Go for an easy run. It’s not always about having to train hard or train long. It’s more about just getting out there and doing it."