^■ Introduction

Globally, the prevalence of substance abuse remains significant. According to World Drug Report, in 2021, an estimated 1 in 17 individuals (aged 15-64) used drugs in the past 12 months. Between 2011 and 2021, the estimated number of drug users increased significantly from 240 million to 296 million, representing around 5.8 percent of the global population aged 15-64 [1]. Drug dependence impacts physical as well as mental health, family life and society [2], affects the brain, which impairs decision-making, self-control, planning and moti­vation [3]. Drug dependence often coexists with psychological conditions like depression, anxiety and stress, which not only aggravate substance abuse but also increase the likelihood of relapse, perpetuating the destructive cycle [4].

Drug dependence is a chronic and relapsing condition that affects the brain and causes compulsive drug-seeking behaviour, even when it leads to harmful consequences. Substance abuse is used to describe the unsafe use of psychoactive substances and includes both alcohol and illegal drugs. This results in the development of dependence syndrome characterised by a group of behavioural, cognitive and physiological symptoms that arise after repeated substance use [5]. Glo­bally, relapse in substance use disorders (SUDs) remains prevalent, with post-treatment relapse rates ranging from 40% to 75%, particularly in low and middle-income countries, posing significant challenges to social development and increasing the burden on social services [6]. The complex nature of dependence suggests a multifaceted therapeutic approach [7]. Yoga has emerged as an effective complementary intervention, demonstrating benefits for brain health and nervous system regulation. It helps mitigate stress, anxiety and depression, while promoting balanced dopamine release and addressing Reward Deficiency Syndrome (RDS) making it a promising adjunct in SUD treatment [8].

Yoga is recognised for improving quality of life and is recommended as a low-cost, low-risk treatment, especially in India [9]. It includes body, mind, breath and behaviour practices. Yoga promotes a healthy lifestyle; due to its health benefits, yoga, a mind-body practice of ancient Indian origin, has gained significance in recent times [10]. The growing popularity of mind–body fitness programmes like yoga has made it necessary for healthcare professionals to gain a better understanding of yoga essence and the proven advanta­ges of its therapeutic uses [11].

Aristotle stated that happiness is more than just a feeling of pleasure; it is the ultimate goal and purpose of life. According to him, happiness depends on virtue, which involves realising one’s full potential as a human being [12]. In maintaining health, happiness is a vital concept; happy people are more energetic, forgiving, creative, focused and less affected by disease in comparison to those who are depressed [13]. Yoga practice can positively impact happiness as they can reduce the formation of the stress hormone, cortisol and increase the formation of gamma-aminobutyric acid (GABA), a neurotransmitter that regulates individual mood and anxiety. The parasympathetic nervous system is stimulated by asanas and prana­yama that stimulate relaxation, reduce stress and increase calmness [14]. Serotonin, a neurotransmitter that is responsible for mood and happiness is also associated with yoga [15].

Initial drug usage induces euphoric feelings but prolonged usage leads to addiction and severe nega­tive consequences. On the other hand, scientific research has demonstrated that yoga can reduce stress levels and enhance mood, providing a healthier alternative for promoting happiness and overall well-being. Yoga practice is linked to reduced stress levels, increased happiness and decreased need for drugs [16]. An eight-week yoga programme has been shown to significantly reduce depression, anxiety and stress among male drug addicts in rehabilitation, thereby supporting its use as a holistic complementary therapy to improve psychological well-being during recovery [17].

The purpose of this study was to assess the happiness levels of drug addicts in rehabilitation at a drug rehabilitation centre in Shimla, Himachal Pradesh. The study focused on the impact of practicing yoga on mood and overall happiness. We hypothesised that there will be no significant difference between the adjusted mean score of happiness among the Asana, Pranayama and Control groups of drug addict persons by considering their pre-test happiness variable as covariates.

The objective of this research is to contribute a better understanding of the potential benefits of yoga in enhancing emotional well-being among individuals recovering from drug dependence. The methodology used in this study is extensive and includes assessments conducted before and after the intervention to measure changes in happiness levels. The serene and natural environment of Shimla provides an ideal setting for this research as it offers a peaceful atmosphere that complements the healing process.

The study was conducted in a drug rehabilitation centre located in Shimla, Himachal Pradesh. This setting provided a controlled environment to evaluate the effectiveness of yoga in improving psychological well-being among those in dependence recovery.

^■ Material and methods

Participants

For this study, 60 drug addicts in rehabilitation at drug rehabilitation centre in Shimla, Himachal Pradesh were chosen. Participants were randomly
assigned to one of four groups i.e., Experimental group 1 (Asana group), Experimental group 2 (Pranayama group), Experimental group 3 (combined Asana + Pranayama group) and a Control group.

Inclusion criteria

• The study was limited to male individuals.

• The age of them ranged from 25 to 50 years.

• They had been drug-free for a minimum of
2-3 months.

Exclusion criteria

• Persons with acute psychiatric conditions.

• Persons with physical disabilities.

Ethical approval

This study received ethical approval from the Clinical Trial Registry – India under the CTRI/
2023/04/051937 approval number. The study protocol was also approved by the Institutional Ethical Committee (IEC) of Lakshmibai National Institute of Physical Education (LNIPE) Gwalior, Madhya Pradesh. All participants were informed of details concerning research and provided written consent. Confidentiality and partici­pant privacy were maintained throughout the research process.

Assessment

Happiness was assessed using the Oxford Happiness Questionnaire [18]. This questionnaire includes 29 items rated on 6-point Likert scale ranging from 1 (strongly disagree) to 6 (strongly agree). Items 2, 3, 4, 7-9, 11, 12, 15-18, 20-22, 25 and 26 were positive, while items 1, 5, 6, 10, 13, 14, 19, 23, 24, 27 and 29 were negative. Scores can range from 1 to 6, with an average score of 4.30. This scale provides a thorough assessment of an individual’s experienced level of happiness. Assessments were conducted at baseline and at the end of the 12-week intervention period.

Study design

This study employed a randomised controlled trial design. Each group consisted of 15 participants to ensure statistical significance. The programme lasted for 12 weeks, with sessions held three times per week. Each session lasted appro­ximately half an hour. The Asana group applied a series of physical postures, the Pranayama group engaged in breathing exercises, the Asana + Pranayama group combined both practices while the Control group received no yoga but continued with standard rehabilitation activities.

Intervention

The various yoga-based programmes were supervised by trained yoga therapists at the rehabi­litation centre. The training programme consisted of three weekly sessions, each spanning 30 minutes, for 12 weeks.

1. Asana group: Table I showing the yoga practice and detailed programme of asana training. This group received asana training for three days in a week for twelve weeks.

This group participated in sessions comprising 8 asanas, each repeated twice. The training was divided into three phases, each lasting 4 weeks. In the initial phase, no holding positions were included. The second phase involved holding positions for 15 seconds, while the final phase included holding for 30 seconds.

2. Pranayama group: Table II showing breathing exercise and detailed programme for Pranayama group. This group received Pranayama training for three days in a week for twelve weeks.

This group participated in sessions including five pranayama. Training was divided in three phases with each phase had 4 weeks. In first phase of training, each pranayama lasted 2.5 minutes followed by 1.5 minutes rest. In second phase, pra­nayama of 3 minutes was followed by 1 minute rest and pranayama of 3.5 minutes was followed by a 30 sec rest in the third phase.

3. Asana + Pranayama group: This group received yoga postures and breathing exercises, integrating the benefits of both practices. Table III
showing yoga practice and breathing exercise along with detailed programme for this group. This group received Asana + Pranayama training for three days a week for twelve weeks.

This group participated in sessions comprising 6 asanas and 3 pranayama. Training was divided in three phases and each phase had 4 weeks. Each asana was repeated twice and there was no holding position in the first phase. The second phase had a 15-second holding position and there were 30 seconds of final position holding in the third phase. In the first phase of training, each pranayama lasted 2.5 minutes followed by a 1.5-minute
rest. In the second phase, the pranayama was 3 minutes long, followed by a minute’s rest and the third-phase pranayama lasted 3.5 minutes followed by a 30-second rest.

4. Control group: This group did not participate in any yoga practice but continued with regular rehabilitation activities.

^■ Results

The impact of the yoga training programmes was evaluated by comparing the pre-test and post-test for each group by using a paired sample t-test. To determine the most effective training programme for promoting happiness in a particular group, ANCOVA (one-way analysis of covariance) was used. The study examined the interaction effects of different groups to determine the impact of specific training programmes. All inferential statistics were significant at a 95% confidence level.
The data analysis was performed using version 27.0 of SPSS (Statistical Package for the Social Sciences).

The results of the Shapiro-Wilk test assessing the normality of Pre-Happiness scores across four groups: Asana, Pranayama, combined Asana + Pra­-
nayama and a Control group. The Asana group results (0.970, Sig. = 0.855) indicate normal distribution. The Pranayama group (0.893, Sig. = 0.075) and the combined group (0.920, Sig. = 0.190) also indicate normality. The Control group (0.890, Sig. = 0.066) shows a slight deviation from norma­lity, but since 0.066 is greater than 0.05, we can say that the data are normally distributed. Therefore we concluded that the data among all the groups was normally distributed (Table IV).

Table V confirms that the assumption of variance homogeneity in happiness was met as indicated by non-significant Levene’s test coefficients. Since the p-value for the dependent variable exceeds 0.05, the null hypothesis was retained. Consequently, it was assumed that there was equal variance across the Asana, Pranayama, Asana + Pra-
nayama and Control groups.

Table VI showing descriptive statistics for four pairs of samples, assessing changes before and after engaging in yoga intervention: Asana, Pranayama, Asana + Pranayama and the Control group. Each activity was tested with 15 participants. The mean value generally increased in post-test, indicating improvements due to the interventions. Specifically,
the Asana training group showed an increase in mean from 3.67 to 4.83 and the Pranayama training group from 3.48 to 4.94. The yoga intervention labelled Asana + Pranayama group showed the most significant increase, from 3.47 to 5.10. However, the Control group was an exception, where the mean slightly decreased from 3.39 to 3.37. The standard deviations in all activities decreased post-intervention, suggesting a reduction in variability among participant responses after the activities (Figure 1).

Table VII summarise the result from paired samples t-test analysing the effect of four different trainings (Asana, Pranayama, Asana + Pranayama and Control group) on participants. The paired t-test showed significant improvements in happiness scores after yoga interventions when compared to pre-intervention levels across all three groups: Asana, Pranayama and combined Asana + Pranayama. Specifically, Post-Asana and Pre-
Asana groups showed mean increase of 1.16 with t-value of 12.89 and p-value of < 0.001. Similarly, the Post-Pranayama and Pre-Pranayama groups displayed mean increase of 1.45 with t-value of 15.96 and also p-value of < 0.001. The combination group, Post-Asana + Pranayama and Pre-Asana + Pranayama, revealed the highest mean increase of 1.63 with t-value of 19.05 and p-value of < 0.001. All these groups indicated highly significant improvements. In contrast, the Control group (Post-Control group and Pre-Control group) showed negligible decrease in happiness scores with a mean change of –0.02, t-value of –1.68 and non-significant p-value of 0.114. These results strongly suggested that yoga interventions effecti­vely enhance happiness, with no significant change observed in the Control group.

According to Table VIII it is evident that the F-value of the group consisting of Asana, Pranayama, Asana + Pranayama and Control group was 251.98, which is significant at the 0.05 level with df = 3.56. This indicated that the adjusted mean score of happiness of subjects belonging to the Asana, Pranayama, Asana + Pranayama, and Control group differs significantly when the Pre-
Happiness score was taken as covariate. There was no significant difference in adjusted mean scores of Asana, Pranayama, Asana + Pranayama and Control group by taking their Pre-Happiness score as covariate was rejected as per the null hypothesis. To ascertain which group adjusted mean score was significantly different, the data were further analysed with the help of a LSD (least significant difference) and the results are shown in Table IX.

Table IX outlines the differential impact of various Yoga practice on the dependent variable Happiness. Each row represented a comparison between two Yoga practice groups, labelled (I) and (J).
The significant differences between the groups were indicated by an asterisk (*). The Asana group, in comparison to Pranayama showed small but significant decrease in Happiness by –0.149 (p = 0.041). When compared to the combination of Asana + Pranayama, the difference increases to –0.315 (p < 0.001), and compared to the Control group, Happiness increases significantly by 1.401 (p < 0.001). Conversely, Pranayama in comparison to Asana showed an increase of 0.149 in Happiness (p = 0.041). Against Asana + Pranayama, there was decrease of –0.166 (p = 0.020), and against Control group, a more substantial increase of 1.550 (p < 0.001) was observed. Asana and Pranayama combined, when compared with Asana alone, show an increase in Happiness of 0.315 (p < 0.001), and a smaller increase of 0.166 when compared with Pranayama alone (p = 0.020). Against Control group, the increase was the largest at 1.716 (p < 0.001). Lastly, the Control group showed significant decrease in Happiness compared to all other groups: –1.401 compared to Asana (p < 0.001), –1.550 compared to Pranayama (p < 0.001) and –1.716 compared to Asana + Prana­yama (p < 0.001).

These comparisons suggested differential effects of various Yoga practice on happiness, with combined practices generally showing greater increases in happiness compared to single or no interventions. The adjusted mean scores of all the groups i.e., Asana, Pranayama, Asana + Pranayama
and Control group for the Happiness Score was considered at 0.05 as shown in the Table X.

Table X provides estimates for the dependent variable Happiness across various groups subjected to different interventions: Asana, Pranayama, Asana + Pranayama and Control group. The ana­lysis incorporated Pre-Happiness as a covariate, set at 3.5010. The mean values indicated that Happiness was highest in the Asana + Pranayama combined group at 5.107, followed by Pranayama alone at 4.941 and Asana at 4.792, each showing relatively low standard errors and tight confidence intervals, reflecting precise estimates (Figure 2). Conversely, the Control group recorded significantly lower mean of 3.391, highlighting the substantial impact of the interventions on increasing happiness compared to no intervention as seen in the confidence intervals that differentiate between the group’s effects.

^■ Discussion

The observed significant increase in happiness scores among the experimental groups validate yoga as a potent complementary therapy in dependence rehabilitation, supporting the hypothesis and aligning with previous findings. The study highlights the significant role of yoga practice, particularly the combination of Asana and Prana­yama, in enhancing happiness and mental balance among individuals recovering from drug dependence. The findings align with previous research emphasising yoga’s mental and emotional benefits. For instance, yoga alleviates depressive symptoms, which are common in drug addiction recovery, by promoting mindfulness and self-regulation [19]. Similarly, yoga improves emotional resilience and stress management, both critical factors in reducing relapse rates [20].

The calming effects of yoga and meditation on the mind can be attributed to their regulation of the autonomic nervous system, cortisol reduction and enhancement of the release of serotonin and dopamine neurotransmitters associated with happiness. Additionally, yoga may reduce stress and anxiety by decreasing cortisol production and promoting a shift towards parasympathetic nervous system dominance [21]. By incorporating these practices into rehabilitation programmes, patients can achieve greater psychological stability,
making them less likely to succumb to addictive behaviours. The present study confirms these effects, showing that participants who engaged in combined yoga practice reported higher happiness levels than those who receiving a single practice or no practice at all.

An interdisciplinary approach, integrating yoga and meditation with conventional treatment me­thods such as medication and behavioural therapies, has been consistently shown to be more effective for rehabilitation; for instance, mindfulness-based relapse prevention strategies, which emphasise the integration of meditation into treatment plans [22]. This approach has been proven to reduce cravings and improve self-awareness.

The findings suggest that yoga and meditation are vital tools, not just for physical rehabilitation but also for fostering inner peace, which is essential in mitigating the psychological triggers of dependence. The inclusion of these holistic practices offers a non-invasive, cost-effective complement to existing treatment modalities, supporting long-term recovery and quality of life.

^■ Conclusions

This study suggested that various yoga practice (Asana) influence happiness, with combined breathing practices (Asana + Pranayama) resulting in greater increases in happiness compared to single interventions or no interventions at all in drug addicts. Individuals recovering from drug dependence who participated in yoga exercises exhibited higher levels of happiness and mental balance compared to the control group. This could be attributed to mind-calming effect of yoga practice. An interdisciplinary treatment approach appeared to be more effective for treating and rehabilitating drug addicts. In addition to medication and behavioural therapies, the treatment of drug addicts should include yoga and meditation as essential components. Various treatment options are available for drug addicts, and most individuals suffering from dependence will receive a combination of approaches. Both yoga and meditation offer patients inner peace, helping them avoid thoughts of addiction.

Conflict of interest/Konflikt interesów

None declared./Nie występuje.

Financial support/Finansowanie

The funds for the research were given by the University Grants Commission, New Delhi (INDIA) to Shubham Kumar under the scheme UCG NET (JRF). / Środki finansowe na badania zostały przekazane Shubhamowi Kumarowi przez Univercity Grant Commission w New Delhi (INDIE) w ramach programu UCG NET (JRF).

Ethics/Etyka

This study received ethical approval from the CLINICAL TRIAL REGISTRY – INDIA under the CTRI/2023/04/051937 approval number. The study protocol was also approved by the Institutional Ethical Committee (IEC) of Lakshmibai National Institute of Physical Education (LNIPE) Gwalior, Madhya Pradesh. / Badanie uzyskało akceptację etyczną
CLINICAL TRIAL REGISTRY – INDIA numer CTRI/2023/04/051937. Protokół badania został również zatwierdzony przez Institutional Ethical Committee (IEC) w Lakshmibai National Institute of Physical Education (LNIPE) w Gwalior, Madhya Pradesh.

The work described in this article has been carried out in accordance with the Code of Ethics of the World Medical Association (Declaration of Helsinki) on medical research involving human subjects, Uniform Requirements for manuscripts submitted to biomedical journals and the ethical principles defined in the Farmington Consensus of 1997.

Treści przedstawione w pracy są zgodne z zasadami Deklaracji Helsińskiej odnoszącymi się do badań z udziałem ludzi, ujednoliconymi wymaganiami dla czasopism biomedycznych oraz z zasadami etycznymi określonymi w Porozumieniu z Farmington w 1997 roku.

References/Piśmiennictwo