Understanding Nonenrolment in Add-on Yoga Trial Among Patients with Substance Use Disorders in a Tertiary Care Setting.

Background: Yoga is increasingly recognized for its therapeutic benefits in managing chronic medical and psychiatric conditions, including substance use disorders. Despite its growing clinical acceptance, challenges remain regarding its real-world feasibility, particularly in medically oriented settings. Objectives: This analysis aimed to explore reasons for nonparticipation in a randomized controlled trial evaluating the efficacy of add-on yoga (dhyana meditation) in patients with opioid dependence who were stable on pharmacological treatment. Design, Setting, Participants, and Interventions: This sub-analysis was part of a larger randomized controlled trial of add-on yoga conducted at a tertiary care addiction treatment center in north India. Patients on stable doses of medications for opioid use disorder treatment were approached for participation in yoga that included 7 consecutive days of training followed by yoga practice or wait list control. Main Outcome Measures: The main outcome measures for the present analysis were the reasons for nonparticipation. Results: Only 24% (n = 120) of approached participants consented to join the trial. The most common reason for refusal was lack of time (73.2%), followed by logistical challenges and lack of familiarity with yoga. Education level was significantly associated with participation (p = 0.018). While 80.3% of nonparticipants believed yoga could be beneficial, few expressed interest in online formats or reduced-frequency visits, indicating limited practical feasibility. Conclusion: Despite a general belief in yoga's benefits, participation was limited by time and logistical constraints. Future interventions should consider hybrid or digital formats, flexible scheduling, and tailored recruitment strategies. Understanding nonparticipation reasons can enhance engagement and guide future yoga-based trials in clinical populations.