Controlled breathing interventions can reduce cravings in people who use substances, including alcohol, tobacco, and other drugs, according to a new review published in the scientific journal Addiction.
The review combined results from 20 studies (1,249 participants overall) that looked at how controlled breathing can help people using substances to reduce craving, withdrawal symptoms, or dependence. The breathing-based interventions included several types of controlled breathing: heart rate variability biofeedback (HRVB), resonant breathing, yogic breathing, rhemercise, mimicking smoking, and three-part breathing. See details below.
The review found that breathing-based interventions appear promising for improving substance use-related outcomes, with the strongest evidence showing small but statistically significant reductions in craving. While there was no difference in the effect of HRVB breathing vs non-HRVB breathing, the evidence for HRVB was concentrated in multi-session interventions targeting long-term craving reduction and thus had stronger evidence for these longer-term changes. Conversely, non-HRVB breathing studies spanned both formats, yielding stronger evidence for immediate, single-session craving relief.
The positive effects of controlled breathing were consistent across nicotine, alcohol, opiates, stimulants, other substances, and poly-substance use.
Evidence for the effect of controlled breathing on dependence and withdrawal was more limited, as these outcomes were based on fewer studies (two studies examining dependence and four examining withdrawal symptoms) that showed less consistent effects; however, the effect of controlled breathing on dependence was large and warrants further investigation.
According to lead author Dr Ariel Dart Roxburgh, of Monash University, “Our review suggests that breathing interventions can be an effective and low-cost add-on to addiction treatment. With more than three quarters of the world’s population owning a mobile phone, the potential benefits of low-cost smartphone-assisted breathing interventions are substantial. What we need next is larger, pre-registered trials with standardised measures and longer follow-up, so we can improve our understanding of how these interventions work.”
-- Ends –
For editors:
This Open Access paper will be available on the Wiley Online Library after the embargo has lifted ( https://onlinelibrary.wiley.com/doi/10.1111/add.70542 ) or you may request an early copy from Jean O’Reilly, Editorial Manager, Addiction , jean@addictionjournal.org .
To speak with senior author Dr Ariel Dart Roxburgh, please contact him at Monash University (Australia) by email: ari.roxburgh@monash.edu
Full citation for article: Roxburgh AD, Rowland B, Lubman DI, Kaur Bains S, Pek MA, Tso B, Manning V, and Arunogiri S. Controlled breathing and heart rate variability biofeedback for substance use-related outcomes: A systematic review and meta-analysis. Addiction . 2026. DOI: 10.1111/add.70542.
Primary funding: This work was not funded directly. Dan Lubman and Shalini Arunogiri are supported by NHMRC Fellowships (GNT1196892 and GNT2008193).
Declaration of interests: The authors have no competing interests to declare and have no financial or non-financial competing interests relating to this project.
Addiction ( www.addictionjournal.org ) is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, substances, tobacco, gambling, editorials, and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884.
Addiction
Systematic review
People
Controlled breathing and heart rate variability biofeedback for substance use-related outcomes: A systematic review and meta-analysis
30-Jul-2026
The authors have no competing interests to declare and have no financial or non-financial competing interests relating to this project.