Four Seconds In, Two Held, Six Out: What a New Review of 1,249 People Reveals About Breathing Your Way Past a Craving

A Singular Point of View

If you have ever stood in the kitchen at half past nine with a craving pulling at you like a hand on your sleeve, and reached for a breath instead of the thing you actually wanted, this one is for you.

Picture your own chest right now, rising and falling without asking your permission, doing the thing it has done since the moment you were born. A craving does not begin in your mind. It begins here, in this small automatic engine — heart rate climbing, breath going short and shallow, your whole nervous system leaning towards something that feels, for a few seconds, unbearable and urgent. You know this feeling; you have lived inside it. Perhaps you are waiting for an assessment right now, still working out what to call the pull you feel. Perhaps a diagnosis arrived only recently and you are testing which parts of your life it explains. Perhaps you are a parent with a letter from school still on the side, trying to understand why your child’s impulses seem to arrive before your child does. Wherever you are standing, a large new review has just asked, on your behalf, a deceptively simple question: can you talk your body out of a craving, using nothing but the breath you already have?

What the researchers actually did

A team led by Dr Ariel Dart Roxburgh at Monash University has published a systematic review and meta-analysis in the journal Addiction, pulling together twenty studies and 1,249 participants to test whether controlled breathing — slowing, pacing and deepening your breath on purpose — reduces cravings in people who use nicotine, alcohol, opioids, stimulants, or a combination of substances. The answer, given cautiously and honestly, is yes. Not a cure. Not a replacement for treatment. A real, measurable, and strikingly cheap tool, available to you with nothing more than the air already in the room.

The review combined several distinct techniques. Heart-rate variability biofeedback, or HRVB, uses a sensor to show you your own heart rhythm in real time so you can learn to pace your breath to match it. Resonant breathing does something similar with no equipment at all, aiming for roughly six breaths a minute. Yogic breathing, including a structured practice called Sudarshan Kriya Yoga, moves you through three distinct speeds and depths of breath. There is even a technique the researchers call “rhemercise,” which pairs slow breathing with a genuine smile, a yawn, and a spoken positive phrase, and another that simply mimics the rhythm of smoking a cigarette without the cigarette itself.

Across all of these, you would have seen small but statistically significant reductions in craving — and the effect held whether the substance was tobacco, alcohol, opioids, stimulants, or several at once. Biofeedback-assisted breathing mattered most when practised repeatedly over several sessions, building a longer-term dampening of craving. The simpler, unassisted techniques showed their strength in the moment: the single session, the acute urge, your kitchen at half past nine.

Does that sound like something you could use tonight, rather than a finding tucked away in a journal? That is really the point of the study. This is not therapy you need a referral for. It is not a six-week waiting list. It is a skill you can begin in the next five minutes, wherever you are sitting as you read this.

Where this touches ADHD

The study was designed around substance use, and it would be dishonest of me to pretend otherwise — what follows is my own extension of the finding, not something the researchers tested. But the mechanism it describes, a deliberate physical pause dropped in front of a surge of urgency, will be recognisable to you if you live with ADHD or love someone who does. You will know how small the gap can be between feeling something powerfully and having already acted on it. Impulsivity and emotional dysregulation are core features of ADHD, not personality flaws, and if you are an adult with ADHD you carry a meaningfully higher risk of substance use difficulties than the general population. None of that was tested in this review, and I do not want the connection to do more work than the evidence allows. What was tested, carefully, is that a slowed breath can blunt a craving. Whether that same brief pause helps you with the wider family of ADHD urges — the unplanned purchase, the sharp retort, the third biscuit — is a reasonable question. It is not yet an answer.

What this cannot promise you

Let me slow down here, because hope without honesty helps no one. This is where I want to protect you from expecting more than the evidence can currently give.

The strongest evidence in this review is for craving, in the moment, in your body. The evidence for whether breathing reduces dependence or withdrawal is much thinner — built on only two studies for dependence and four for withdrawal — and while the effect on dependence looked large, the researchers themselves said it needs far more research before you should rely on it alone. It cannot tell you which technique suits your substance, your history, or your particular nervous system, because the twenty studies used different methods and were not built to compete against one another. And it cannot yet tell you how long any benefit lasts, because most trials were short and follow-up was limited. Dr Roxburgh was candid about this himself: “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.” If you are in active treatment for a substance use disorder, this belongs alongside your care, not instead of it. Tell whoever is supporting you that you are trying it, so it gets woven in rather than kept as a private experiment.

A breath you can try this week

You do not need equipment, an app, or a diagnosis to begin. The version below borrows from the resonant breathing tested in the review, close to what clinicians sometimes call paced breathing.

• Find somewhere reasonably still, and breathe in gently through your nose for a count of four.
• Hold that breath, without straining, for a count of two.
• Breathe out slowly through your mouth or nose for a count of six, letting the exhale run noticeably longer than the inhale.
• Keep going for two to three minutes, aiming for roughly six full breaths a minute.
• Notice, rather than judge, what has shifted in your chest, your jaw, and your shoulders by the time you finish.
• Use it the moment a craving or an urge first announces itself in you, not the moment after it has already taken hold.

The part that should make you feel, cautiously, better

More than three quarters of the world’s population now carries a mobile phone in their pocket, and Dr Roxburgh’s team pointed out, sensibly, that this makes smartphone-guided breathing one of the most scalable tools available anywhere in addiction support — no clinic, no cost, no waiting list standing between you and it. It was not there. Then, with practice, some measure of it was. That will not undo years of habit, and it will not replace the deeper work that recovery so often asks of you. But it gives you something to do in the exact second you most need something to do, and that is rarer in mental health research than it ought to be.

Next time your chest tightens and your hand reaches for something before your mind has caught up, try counting to four, then two, then six. It costs you nothing to find out what your own breath can do for you.

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Source: Roxburgh, A. D., Rowland, B., Lubman, D. I., Kaur Bains, S., Pek, M. A., 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. Press release via the Society for the Study of Addiction, 30 July 2026.