Objective:

To evaluate the effectiveness of controlled breathing interventions in reducing substance craving among patients with substance use disorders.

Approach:

• Study Identification: Investigators searched eight databases through November 14, 2025, identifying 20 studies that met inclusion criteria.
• Meta-Analysis: Fifteen studies were included in the meta-analysis, focusing on patients with alcohol, nicotine, opioid, stimulant, or polysubstance use disorders.
• Intervention Types: Interventions included controlled breathing techniques such as heart rate variability biofeedback (HRVB), resonant breathing, and yogic breathing.
• Outcome Measures: Substance use-related outcomes examined included craving, withdrawal symptoms, and substance dependence.
• Subgroup Analysis: A prespecified subgroup analysis compared HRVB with other breathing interventions.

Key Findings:

• Controlled breathing was associated with a small reduction in craving compared to control conditions across 12 studies.
• Heterogeneity was low, indicating consistent effects across studies.
• Four studies on withdrawal symptoms showed no statistically significant benefit compared to controls.
• Two randomized trials indicated significant pooled improvement in substance dependence, but based on few studies with substantial heterogeneity.
• No significant difference was found between HRVB and other breathing interventions in reducing craving.

Interpretation:

The evidence was strongest for craving reduction, while evidence for withdrawal symptoms and substance dependence was less certain.

Limitations:

• The analysis included quasi-experimental studies alongside randomized trials, leading to low certainty of evidence.
• Small number of studies evaluating dependence and withdrawal.
• Variability in intervention protocols and duration.
• Lack of long-term follow-up in many studies.
• Reliance on subjective outcome measures.

Conclusion:

Further high-quality randomized trials are needed to clarify the effects of controlled breathing on substance use-related outcomes.

Sources:

• Addiction