Recovery Horizons: What Nature-Based Activities May Complement Care for PTSD and Substance Use Disorders?
A recent article in the American Journal of Lifestyle Medicine looks at an important question for people in recovery, families, and care providers: can nature-based activities—like walking or hiking, gardening, camping, surfing, or sailing—be helpful add-ons to treatment for people living with both posttraumatic stress disorder (PTSD) and substance use disorders (SUD)?
The authors, Shirazi and colleagues, note that PTSD and substance use problems often occur together and can make recovery more challenging than dealing with either one alone. While the most effective care typically addresses PTSD and substance use at the same time, staying engaged in treatment can be hard. Here, the authors consider whether guided engagement with nature could complement standard PTSD and substance use care. They summarize emerging intervention studies suggesting that structured engagement in natural environments may support recovery from both PTSD and substance use disorders through overlapping pathways. Across several small studies summarized in the review, nature-based activities were associated with reductions in PTSD symptom severity and decreases in substance cravings. The authors describe evidence linking exposure to green space with psychological well-being and suggest that outdoor physical activity and mindfulness may contribute to improvements in stress and psychological flexibility. Because these factors are relevant to both PTSD symptoms and substance use outcomes, the authors suggest that nature-based activities may offer complementary support within integrated treatment approaches.
Across the studies reviewed, nature-based programs were associated with changes in outcomes central to recovery, including PTSD symptoms, substance cravings, mood, and engagement in treatment. Though the evidence is still preliminary, several findings stand out. In one study, people in residential substance use treatment reported lower cravings after a one-hour walk in nature compared to an urban walk or staying on site. Other small studies of therapeutic camping and sailing-based programs reported improvements such as reduced alcohol cravings and negative thoughts, greater psychological flexibility, and, in one case, higher completion of residential treatment. A small study with veterans found that participants who took nature hikes showed greater improvements in PTSD symptoms over time than those who took urban hikes. The review also describes other approaches, including forest-therapy garden programs and water-based activities, often noting that participants found them acceptable and meaningful.
Although the research in this area is still developing, this review suggests that nature-based activities may serve as meaningful complements to established PTSD and substance use treatment. For people in recovery and their families, the findings point to additional, accessible ways to support well-being alongside therapy and medication. For clinicians and program leaders, the article underscores the importance of tailoring recommendations to individual needs, preferences, and safety considerations rather than adopting a one-size-fits-all approach. For researchers and policymakers, the review highlights the need for larger, well-designed studies to clarify effectiveness and inform responsible integration into clinical and community settings. As interest in recovery-oriented and community-based supports continues to grow, understanding how structured engagement with nature fits within evidence-based care will be an important next step. Providers looking for a practical tool to guide these conversations may find the Nature Prescription Handbook helpful: https://www.ecehh.org/research/nature-prescription-handbook/.
Reference
Shirazi, A., Brody, A. L., Soltani, M., & Lang, A. J. (2025). Recovery horizons: Nature-based activities as adjunctive treatments for co-occurring post-traumatic stress disorder and substance use disorders. American Journal of Lifestyle Medicine, 19(4), 626-638. https://doi.org/10.1177/15598276241300475