Working with clients in recovery: A responsibility, not a trend

As more fitness professionals begin working with clients in recovery, knowledge and preparation matter. Nicole Golden explains why supporting people recovering from substance use disorder calls for education, humility and a commitment to ongoing learning.

Exercise is good for you, right? This is a huge understatement when it comes to recovery from substance use disorder.

Substance use disorder (SUD) is a neurological condition characterised by the compulsive use of substances despite harmful effects on mental and physical health. It involves complex interactions between brain chemistry, behaviour, environment and, in many cases, co-occurring mental health conditions. As treatment approaches evolve, there is increasing recognition of the role that holistic and lifestyle interventions – particularly exercise – can play in supporting recovery.

Exercise therapy: Does it really help?

It is well documented that exercise is an effective adjunct therapy for those in recovery for several reasons^1,3,7,8:

• Exercise helps to optimise neurotransmitter activity in the brain (i.e., serotonin and dopamine) – all chemicals that are involved in the process of addiction.
• Exercise therapy aids in improving mental health outcomes by reducing symptoms of anxiety and depression, which are two key factors that can contribute to the beginning of an addiction and relapse after treatment.
• Physical activity reduces cravings for substances. These reductions are noticeable after even just 10 to 20 minutes of exercise, which can be critical in helping to prevent a relapse.
• Regular physical activity provides structure and routine.
• It allows individuals in recovery to normalise metabolism and maintain a healthy weight, which is a positive prognostic indicator for maintaining sobriety.
• Group fitness training provides additional social support to those in treatment, which can continue outside of treatment.
• Up to 95% of patients in treatment for SUD indicate that they desire a fitness programme as part of their treatment plan.

An increasing number of rehabilitation facilities are offering exercise programming as part of ‘holistic therapy’ for the treatment of SUD in both the UK and US. As such, the need for qualified fitness professionals who possess the skills necessary to work with individuals in recovery is growing as the evidence to support its efficacy mounts. However, there is much more to working with this special population than just knowledge of basic fitness principles. A deep understanding of both the unique physiologic and psychological needs of this cohort is key to providing them with high-quality services which will support recovery efforts^2,9.

Understanding addiction, not just fitness

In my more than a decade of working with this population, I have really come to understand that the fitness professional must be aware of the causes, sequelae and treatment process of SUD in order to work effectively with those in recovery.

Addiction is a neurological disorder. It is not a lack of willpower. Not everyone who engages in drug and alcohol use develops substance use disorder. In fact, more research is providing us with better insights as to how SUD may have a genetic predisposition. Hautom et al (2023) conducted a multivariate meta analysis looking at the genetic code of one million individuals. The researchers were able to pinpoint specific genomes that were linked with SUDs in general and alcohol use disorder (AUD) specifically. This study supports the idea that there are individuals who are more susceptible to SUD than others⁵.

Addictions do not occur overnight with rare exceptions. There are several phases to the development of a true addiction.

Phase 1: Experimentation (Initiation)

• This is the first time use of the substance(s).
• Many individuals do not go on to develop an addiction during the experimentation phase.
• This can be driven by curiosity but, oftentimes, in individuals who go on to develop a full-blown SUD, there is an underlying trauma or mental health issue they may be trying to ameliorate.
• At this stage, use of the substance is only occasional.

Phase 2: Regular use

• The use of the substance becomes more frequent. This may turn into use several times per week with usage often planned ahead of time rather than spontaneous usage.
• The individual may develop warning signs such as inability to deal with stress or frequent emotional outbursts.

Phase 3: Tolerance

• Use continues despite negative consequences (i.e., missing school, work, neglect of friends and family, etc).
• The person may engage in reckless behaviours (e.g., driving intoxicated).
• Higher amounts of the substance are needed to get ‘high’.

Phase 4: Dependence

• The body is now adapted to the drug and much higher amounts are needed.
• Withdrawal symptoms will likely occur if the drug is stopped (e.g., anxiety, nausea/vomiting).
• Use of the drug is now necessary to feel normal.

Phase 5: Addiction 

• Cravings for the substance are very strong and become the top priority for the user.
• Life responsibilities are often neglected in favour of substance use.
• Use of the substance continues despite significant physical and mental health consequences.

Phase 6: Relapse^2,6

• The user returns to regular use of the substance after a period of abstinence.
• It is often triggered by similar factors (i.e., stress, mental health disorders, etc.) that initiated first use.
• Approximately 40-60% of users will relapse within the first year.
• The treatment goal in the US for individuals with SUD is complete abstinence while the clinical treatment goal in the UK is reduction of harm. This is an important distinction when reviewing relapse rates.

It is important that the fitness professional understands these phases, as the fitness professional may be the first one to detect a potential relapse.

Trauma-informed care

More than half of individuals struggling with SUD have a concurrent mental health diagnosis. Likewise, 75% of individuals with SUD have experienced a significant traumatic event. Therefore, fitness professionals should approach their work with the understanding that trauma exposure is highly prevalent in this population. Trauma-informed care is not optional – it is essential.⁴

Working with individuals in recovery, especially trauma survivors, can present unique challenges. These may include:

• complaints of physical pain or discomfort during exercise
• hesitation to participate in group settings due to fear of judgement
• class participants teasing peers (in a group setting)
• a client wishing to stop their workout after the warm-up or just a few minutes into it
• the client is not returning after their first or second training session
• signs of panic and anxiety, particularly if trauma-related triggers are present. These may be evident by body language, facial expressions or the client informing you of how they are feeling.

Recognising these responses as potential manifestations of underlying trauma or anxiety – rather than lack of motivation – is key.

There are several practical trauma-informed care strategies fitness professionals can utilise to create a safe and supportive environment⁴:

• Building trust with your clients is critical. They should feel comfortable telling you if they are feeling any unusual symptoms (pain, anxiety, etc.) and you should respond with care and concern rather than pushing them to just ‘get through it’.
• Allow flexibility during the session, including breaks and modifications if needed.
• Clearly explain everything that will occur in the training session ahead of time and frequently during the session.
• Having a regular and consistent training schedule is very important. It is not uncommon for trauma survivors to feel that no one cares about them. Cancellations should be avoided at all costs and appropriate substitutes (who your clients are comfortable with) should be utilised if available to avoid cancellation.
• Be mindful of potential PTSD triggers. This may be a discussion you should have with your client(s) before your first session or class.
• Be mindful of potential triggers, including music selection and group dynamics.
• If you are working in a group setting, encourage, but do not force, others who may be just watching to participate even if significant modifications are necessary.
• Give your client(s) some control over their workout and avoid rigidity in a training programme.
• Foster a supportive, non-judgemental atmosphere – humour and approachability can go a long way.

Thoughtful education, humility and ongoing learning

It is our responsibility as fitness professionals to stay current with the most up-to-date research and treatment modalities for our clients with a special health condition. Clients with SUD are no exception to this. Fitness professionals providing exercise therapy to clients in recovery is a part of their treatment team.

Exercise is a powerful and evidence-based complement to traditional treatment and, when implemented with a thoughtful understanding of addiction, trauma and individual variability, it can significantly enhance both physical and psychological outcomes in recovery. Well-educated fitness professionals are uniquely positioned to contribute to a more holistic model of care in the treatment of SUD. With the right knowledge and approach, they can help to support not only physical health, but long-term recovery and improved quality of life for their clients.

Learn more working with clients in recovery with Nicole’s CPD education on Drug and Alcohol Recovery Fitness Specialist
References

1. Abrantes, A.M., Battle, C.L., Strong, D.R., Ing, E., Dubreuil, M.E., Gordon, A. & Brown, R.A., 2011. Exercise preferences of patients in substance abuse treatment. Mental Health and Physical Activity, 4(2), pp.79–87. Available at: https://doi.org/10.1016/j.mhpa.2011.08.002 [Accessed 5th May 2026].
2. American Addiction Centers, 2024. The addiction cycle: Phases of the chronically relapsing disease. American Addiction Centers, 17th December. Available at: https://americanaddictioncenters.org/the-addiction-cycle [Accessed 5th May 2026].
3. Department of Health and Human Services, 2021. National Survey of Substance Abuse Treatment Services (N-SSATS): 2020 Data on Substance Abuse Treatment Facilities ii. Available at: https://www.samhsa.gov/data/sites/default/files/reports/rpt35313/2020_NSSATS_FINAL.pdf [Accessed 5th May 2026].
4. Golden, N., 2025. Understanding the Impact of Trauma in Clients in Recovery from Substance Use Disorders. 2025 Medfit Global Virtual Conference, 22nd October. Virtual.
5. Hatoum, A.S., Colbert, S.M.C., Johnson, E.C., Huggett, S.B., Deak, J.D., Pathak, G.A., Jennings, M.V., Paul, S.E., Karcher, N.R., Hansen, I., Baranger, D.A.A., Edwards, A., Grotzinger, A.D., Tucker-Drob, E.M., Kranzler, H.R., Davis, L.K., Sanchez-Roige, S., Polimanti, R., Gelernter, J. & Edenberg, H.J., 2023. Multivariate genome-wide association meta-analysis of over 1 million subjects identifies loci underlying multiple substance use disorders. Nature Mental Health, 1(3), pp.210–223. Available at: https://doi.org/10.1038/s44220-023-00034-y [Accessed 5th May 2026].
6. Nagy, N.E.S., Ella, E.I.A., Shorab, E.M., Moneam, M.H.E.-D.A. & Tohamy, A.A., 2022. Assessment of addiction management program and predictors of relapse among inpatients of the Psychiatric Institute at Ain Shams University Hospital. Middle East Current Psychiatry, 29(1). Available at: https://doi.org/10.1186/s43045-022-00246-5 [Accessed 5th May 2026].
7. Piché, F., Girard, S., Plourde, C. & Ahmed Jérôme Romain, 2024. Physical activity during a treatment for substance use disorder: A qualitative study. Mental Health and Physical Activity, 26, p.100590. Available at: https://doi.org/10.1016/j.mhpa.2024.100590 [Accessed 5th May 2026].
8. Smith, M.A. & Lynch, W.J., 2012. Exercise as a Potential Treatment for Drug Abuse: Evidence from Preclinical Studies. Frontiers in Psychiatry, 2. Available at: https://doi.org/10.3389/fpsyt.2011.00082 [Accessed 5th May 2026].
9. UK Addiction Treatment Centres, 2026. Holistic Therapy | Holistic therapy for addiction treatment. UK Addiction Treatment Centres. Available at: https://www.ukat.co.uk/rehab-treatment/therapies/holistic-therapy/ [Accessed 5th May 2026].