Regular self-evaluation is essential for mental health professionals. Use this daily assessment tool (downloadable PDF) to evaluate your ethical and self-care practices.
The 10th Step of Alcoholics Anonymous (AA) suggests taking daily self-inventory: “A continuous look at our assets and liabilities, and a real desire to learn and grow.” The founders of AA recommended that a person in recovery both “spot check” throughout the day in addition to taking a full self-inventory every evening, preferably a written one.
An honest self-evaluation can assess for resentment, anger, fear, jealousy, etc. According to the principles of AA, self-inventory promotes self-restraint and a sense of justice; it allows one to carefully examine their motives. Furthermore, it allows one to recognize unhealthy or ineffective speech/actions in order to visualize how they could have done better.
Similarly, for best practice, self-inventory or evaluation is essential for anyone who works in the mental health (MH) field. It doesn’t have to take place daily, or even weekly, but it’s a necessary measure for any active MH worker. If we don’t regularly examine our motives, professional interactions, and level of burnout, we could potentially cause harm to those we serve.
“As important as it is to have a plan for doing work, it is perhaps more important to have a plan for rest, relaxation, self-care, and sleep.”
Autonomy (self-sufficiency), or fostering the right to control the direction of one’s life;
Nonmaleficence, or avoiding actions that cause harm;
Beneficence, or working for the good of the individual and society by promoting mental health and well-being;
Justice (remaining just and impartial), or treating individuals equitably and fostering fairness and equality;
Fidelity (integrity), or honoring commitments and keeping promises, including fulfilling one’s responsibilities of trust in professional relationships; and
Veracity (genuineness), or dealing truthfully with individuals with whom counselors come into professional contact
The following is a format for MH professionals to evaluate both ethical and self-care practices. It’s meant to be used as a daily assessment tool.
Daily Self-Inventory for Mental Health Professionals
1. Did I cause harm (physical or emotional) today, intentionally or unintentionally, to self or others?
❒ Yes ❒ No
2. If so, how, and what can I do to make amends and prevent reoccurrence?
3. Have I treated everyone I’ve come across with dignity and respect?
❒ Yes ❒ No
4. If no, how did I mistreat others? What were my underlying thoughts/feelings/beliefs? How can I act differently in the future?
5. Have I imposed my personal values on a client (or clients) today?
❒ Yes ❒ No
6. If so, which values, and what steps can I take to prevent this? (Note: professional counselors are to respect diversity and seek training when at risk of imposing personal values, especially when they’re inconsistent with the client’s goals.)
7. Currently, what are my personal biases and how can I overcome (or manage) them?
8. Have I done anything today that has not been in effort to foster client welfare (i.e. self-disclosure for self-fulfilling reasons)?
❒ Yes ❒ No
9. If so, what were my motives and how can I improve on this?
10. On a scale from 1-10 (1 being the least and 10 the greatest), how genuine have I been with both colleagues and clients?
11. On a scale from 1-10, how transparent have I been with both colleagues and clients?
12. What specific, evidence-based counseling skills, tools, and techniques did I use today? Am I certain there is empirical evidence to support my practice? (If no, how will I remedy this?)
13. Have I practiced outside the boundaries of my professional competence (based on education, training, supervision, and experience) today?
❒ Yes ❒ No
14. What have I done today to advance my knowledge of the counseling profession, including current issues, evidence-based practices, relevant research, etc.?
15. What have I done today to promote social justice?
16. Have I maintained professional boundaries with both colleagues and clients today?
❒ Yes ❒ No
17. Did I protect client confidentially to my best ability today?
❒ Yes ❒ No
18. To my best knowledge, am I adhering to my professional (and agency’s, if applicable) code of ethics?
❒ Yes ❒ No
19. On a scale from 1-10, what is my level of “burnout”?
20. What have I done for self-care today?
Self-Care Activities I’ve Engaged In:
❒ Exercise
❒Healthy snacks/meals
❒ Meditation
❒ Adequate rest
❒ Adequate water intake
❒ Regular breaks throughout the workday
❒ Positive self-talk
❒ Consultation
❒ Therapy
❒ Other:
❒ Other:
❒ Other:
Areas for Improvement:
Areas in Which I Excel:
Download a PDF version (free) of the self-evaluation below. This assessment can be printed, copied, and shared without the author’s permission, providing it’s not used for monetary gain. Please modify as needed.
Alcarelle is a synthetic version of alcohol, providing all the “feel-good” effects of alcohol with none of the associated risks; this alcohol-alternative may be available in a bar near you within the next five years!
Alcarelle, providing liquid courage without the consequences of alcohol: no hangover, no calories, and no harmful impact on your health. Sound too good to be true? Maybe… but maybe not.
Alcarelle is a substance that mimics the effects of alcohol; the Alcarelle website proclaims, “Like alcohol, but better.” Essentially, it’s a synthetic, non-toxic version of alcohol that activates the same neurotransmitters as booze, inducing the “warm fuzzy” feelings of tipsiness. Created by English neuropsychopharmacologist, David Nutt, the active molecule in Alcarelle provides the relaxing and social lubricating qualities of alcohol with none of the associated dangers.
According to a 2019 interview in Men’s Health, the Alcarelle effect “plateaus” after three drinks. The implications are that you won’t get hammered or black out when you drink it.
Currently, Alcarelle is in the development stage. Nutt’s plan is for the alcohol-free substitute to be available within the next five years; it will likely be offered in the form of a concentrated extract to mix into drinks.
What role will Alcarelle play in the treatment of substance use disorders? It’s unknown if someone could build a tolerance for or become dependent on it. Could Alcarelle be the next harm-reduction or treatment method for alcohol use disorders? Could its use help with other addictions or mental health disorders? Could it potentially reduce the rates of alcohol-related accidents and diseases?
On the other hand, Alcarelle could lead to abuse and/or dependence (similar to how methadone, a treatment for opioid use disorders, produces powerful addictive effects). Also, it could end up being the equivalent of a “gateway” drug, increasing the user’s chances of later developing a substance use disorder.
Bottom line: too much is unknown at this point. Alcarelle may not make it past the testing phase. (Currently, only a prototype of the synthetic molecule exists and funding for the project is limited.)
While I’m hopeful that an alcohol-alternative could advance the treatment of substance use disorders (especially since I believe the ultimate treatment, while yet undiscovered, will be pharmacological), I don’t anticipate Alcarelle being a magical “cure-all.”
Don’t drink and drive! From 10:00 p.m. to 4:00 a.m., use WRAP’s Holiday SoberRide Promo Code (valid 12/20/19-1/1/20) for a free Lyft ride (up to $15).
In Virginia, a first offense DWI can cost up to $2,500 in fines plus court costs. Drunk driving may also result in license suspension and jail time (not to mention death!) #NeverWorthIt
In one study, participants who listened to upbeat music while actively trying to feel happier experienced improved mood as well as increased happiness over the next two weeks.
A 2017 study indicated that listening to your favorite songs impacts the brain circuit involved in internally focused thought, empathy, and self-awareness. Interestingly, it doesn’t matter what type of music you choose; the mood-boosting effect is consistent across genres.
Alternatively, consider a stroll in the park for a boost. Researchers found that individuals with depression who took an hour-long nature walk experienced significant increases in attention and working memory when compared to individuals who walked in urban areas. Interestingly, both groups of participants experienced similar boosts in mood; walking in an urban area can be just as effective!
More recently, researchers found that people who regularly commute through natural environments (i.e. passing by trees, bodies of water, parks, etc.) reported better mental health compared to those who don’t. This association was even stronger among active commuters (walking or biking to work). If you commute through congested or urban areas, consider an alternate route, especially when you’re feeling down.
Spending time outside does more than just improve your mood. A 2018 report established a link between nature and overall wellness. Living close to nature and spending time outside reduces the risk of type II diabetes, cardiovascular disease, premature death, preterm birth, stress, and high blood pressure. Exposure to green space may also benefit the immune system, reduce inflammation, and increase sleep duration.
Read/view something inspiring or humorous
Do you have a favorite inspirational book or collection of poems? Do you like viewing motivational TED Talks? Do you enjoy comedy shows? Maybe you like watching videos of baby goats or flash mobs on Facebook. (I do!)
One study found that viewing cat videos boosted energy and positive emotions while decreasing negative feelings (such as anxiety, annoyance, and sadness). Internet cats = Instant mood boost. However, if cyber cats are not your thing, search around to find something enjoyable to read or watch for your happiness quick-fix.
Plan your next adventure
I’m happiest when I’m traveling the world. Unfortunately, I have limited vacation days (as well as limited funds), which means I don’t get to travel as often as I’d like. Happily, planning a trip may produce the same mood-boosting effects as going on a trip.
In 2010, researchers found that before taking a trip, vacationers were happier compared to those not planning a trip. A 2002 study indicated that people anticipating a vacation were happier with life in general and experienced more positive/pleasant feelings compared to people who weren’t. In both studies, researchers attributed happiness levels to anticipation. (The brain releases dopamine during certain activities, causing us to feel pleasure. Dopamine is also released in anticipation of a pleasurable activity.) For a mood boost, start planning!
The next time you’re having a bad day, listen to your favorite song, go hiking in the woods, watch a TED Talks, start planning your next vacation, or spend some quality time with a furry friend… you’ll feel better!
Self-care is not a luxury; it’s necessary for survival when your loved one has a substance use disorder. By taking care of yourself, you gain the energy and patience to cope with your problems. Self-care promotes wellness and emotional intelligence; it puts you in a better space to interact with your loved one. Strategies include developing/building resilience, practicing distress tolerance, keeping perspective, and recognizing/managing your triggers.
When your loved one has a substance use disorder (SUD), it can be overwhelming, distressing, and all-consuming. When we’re stressed, we forget to practice basic self-care, which in turn makes us even less equipped to cope with the emotional chaos addiction generates. This post is about self-care strategies for when your loved one has an addiction.
(Side note: I strongly recommend reading Beyond Addiction if your loved one has an SUD or if you work in the field. This book will increase your understanding of addiction and teach you how to cope with and positively impact your loved one’s SUD by using a motivational approach. This is one of the best resources I’ve come across, especially for family members/significant others.)
Based on the premise that your actions affect your loved one’s motivation, taking care of yourself is not only modeling healthy behaviors, it’s putting you in a better space to interact with your loved one. Chronic stress and worry make it difficult to practice self-care. Self-care may even seem selfish.
However, by taking care of yourself and thus reducing suffering, you gain the energy and patience to cope with your problems (and feel better too). Furthermore, you reduce the level of pain and tension in your relationships with others, including your loved one with a SUD.
Self-care strategies include developing/building resilience, practicing distress tolerance, keeping perspective, and recognizing/managing your triggers. Therapy and/or support groups are additional options.
“An empty lantern provides no light. Self-care is the fuel that allows your light to shine brightly.”
Unknown
Self-Care Strategies When Your Loved One Has an Addiction
Resilience
The definition of resilience is “the capacity to recover quickly from difficulties” (Oxford Dictionary). Doctors Foote, Wilkens, and Kosanke wrote that having resilience is a way to “systematically reduce your vulnerability to bad moods, lost tempers, and meltdowns.”
While you cannot “mood-proof” yourself entirely, resilience helps when facing life’s challenges, setbacks, and disappointments. To maintain resilience, one must practice at least the most basic self care practices, which are as follows:
Self-care is not something you can push in to the future. Don’t wait until you have more time or fewer obligations. Self-care is not a luxury; it’s a necessity. The authors of Beyond Addiction pointed out that self-care is something you have control over when other parts of your life are out of control. If you find it challenging to implement self-care practices, tap into your motivations, problem-solve, get support, and most of all, be patient and kind with yourself.
“Taking care of yourself is the most powerful way to begin to take care of others.”
Bryant McGill
Distress Tolerance
On tolerance, Doctors Foote, Wilkens, and Kosanke suggested that it is “acceptance over time, and it is a cornerstone of self-care.” Tolerance is not an inherent characteristic; it is a skill. And like most skills, it requires practice. However, it’s wholly worth the effort as it reduces suffering. By not tolerating the things you cannot change (such as a loved one’s SUD), you’re fighting reality and adding to the anguish.
Self-care strategies and techniques for distress tolerance include distracting yourself, relaxing, self-soothing, taking a break, and creating positive experiences. (The following skills are also taught in dialectical behavior therapy (DBT), an evidence-based practice that combines cognitive behavioral therapy techniques and mindfulness. For additional resources, visit The Linehan Institute or Behavioral Tech.)
Distract Yourself
Switch the focus of your thoughts. The possibilities are endless; for you, this could mean reading a magazine, calling a friend, walking the dog, etc. The authors of Beyond Addiction suggested making a list of ideas for changing your thoughts (and keeping it handy).
Switch the focus of your emotions. Steer your emotions in a happier direction by watching corgi puppies on YouTube, reading an inspirational poem, or viewing funny Facebook memes. The writers of Beyond Addiction suggested bookmarking sites in your Internet browser that you know will cheer you up.
Switch the focus of your senses. This could mean taking a hot shower, jumping into a cold pool, holding an ice cube in your hand, walking from a dark room to one that’s brightly lit, looking at bright colors, listening to loud rock music, etc. Also, simply walking away from a distressing situation may help.
Do something generous. Donate to your favorite charity, pass out sandwiches to the homeless, visit a nursing home and spend time with the residents, express genuine thanks to cashier or server, etc. By redirecting attention away from yourself (and directing energy toward positive goals), you’ll feel better. In Beyond Addiction, it’s noted that this skill is especially helpful for individuals who tend to ruminate. Also, it’s important to brainstorm activities that are accessible in the moment (i.e. texting a friend to let them know you’re thinking about them) that don’t take multiple steps (such as volunteering).
“Body tells mind tells body…” Relaxing your body helps to relax your mind. It also focuses your thoughts on relaxing (instead of your loved one’s addiction). What helps you to relax? Yoga? A hot bath? Mindful meditation? (I recommend doing a mindful body scan; it’s simple and effective, even for the tensest of the tense, i.e. me.)
Soothe Yourself
In Beyond Addiction, self-soothing is described as “making a gentle, comforting appeal to any of your five senses.” A hot beverage. Nature sounds. A cozy blanket. A scenic painting. Essential oils. A cool breeze. A warm compress. A massage. Your favorite song. Find what works for you, make a list, and utilize as needed. Seemingly small self-care strategies can make a big difference in your life by creating comfort and reducing out-of-control emotions.
Take A Break
“Taking a break” doesn’t mean giving up; it’s a timeout for when you’re emotionally exhausted and is one of the best self-care strategies you can have. Learn to recognize when you need to step away from a situation or from your own thoughts. Find a way to shift your focus to something pleasant (i.e. a romantic movie, a nature walk, a day trip to the beach, playing golf for a few hours, traveling to a different country, etc.)
Doctors Foote, Wilkens, and Kosanke refer to this as “making it better,” not in the sense that you’re fixing the problem (or your loved one), but that you’re making the moment better by transforming a negative moment into a positive one. Suggested self-care strategies for creating a positive experience include the following:
Half-smile. Another mind-body technique, half-smiling tricks your brain into feeling happier.
Meditate or pray. As explained in Beyond Addiction, “meditation or pray is another word for – and effective channel to – awareness and acceptance. Either one can open doors to different states of mind and act as an emotional or spiritual salve in trying moments.”
Move. By moving, you’re shifting your focus and releasing energy. Stretch, run, play volleyball, chop wood, move furniture, etc.
Find meaning. The authors of Beyond Addiction wrote, “Suffering can make people more compassionate toward others. Having lived through pain, sometimes people are better able to appreciate moments of peace and joy.” Suffering can also inspire meaningful action. What can you do to find meaning?
Borrow some perspective. How do your problems look from a different viewpoint? Ask a trusted friend. You may find that your perspective is causing more harm than good.
Perspective
Perspective is “an understanding of a situation and your reactions to it that allows you to step back and keep your options open… [it’s] seeing patterns, options, and a path forward” (Beyond Addiction).
When Trish married Dave nearly 20 years ago, he rarely drank: maybe an occasional beer over the weekend or a glass of wine at dinner. After their fist daughter was born, his drinking increased to a few beers most nights. Dave said it helped him relax and manage the stress of being a new parent.
By the time their second daughter was born several years later, his drinking had progressed to a six-pack of beer every evening (and more on weekends). Currently, Dave drinks at least a 12-pack of beer on weeknights; if it’s the weekend, his drinking starts Friday after work and doesn’t stop until late Sunday night.
Dave no longer helps Trish with household chores or yardwork as he did early in their marriage. He rarely dines with the family and won’t assist with the cooking/cleanup; he typically eats in front of the TV. Dave occasionally engages with his daughters, but Trish can’t recall the last time they went on a family outing, and it’s been years since they went on a date.
Dave struggles to get out of bed in the mornings and is frequently late to work; Trish is worried he’ll get fired. They frequently argue about this. Dave is irritable much of the time, or angry. Most nights, he doesn’t move from his armchair (except to get another beer) until he passes out with the television blaring.
Trish is frustrated; she believes Dave is lazy and lacks self-control. When she nags about his drinking, he promises he’ll cut back, but never follows through. Trish thinks he’s not trying hard enough. She can’t understand why he’d choose booze over her and the kids; sometimes she wonders if it’s because she’s not good enough… maybe he would stop if she was thinner or funnier or more interesting? At times she feels helpless and hopeless and others, mad and resentful; she frequently yells at Dave. She wonders if things are ever going to change.
A different perspective would be to recognize that Dave has an alcohol use disorder. He feels ill most of the time, which affects his mood, energy level, and motivation. He wants to cut back, but fails when he tries, which leads to guilt and shame. To feel better, he drinks. It’s a self-destructive cycle.
If Trish understood this, she could learn to not take his drinking personally or question herself. Her current reactions, nagging and yelling, only increase defensiveness and harm Dave’s sense of self-worth. Alternative options for Trish might include learning more about addiction and the reasons Dave drinks, bolstering his confidence, and/or creating a supportive and loving environment to enhance motivation.
Triggers
In recovery language, a “trigger” is anything (person, place, or thing) that prompts a person with SUD to drink or use; it activates certain parts of the brain associated with use. For instance, seeing a commercial for beer could be triggering for a person with an alcohol use disorder.
You have triggers too. For example, if your loved one is in recovery for heroin, and you notice that a bottle of opioid painkillers is missing from the medicine cabinet, it could trigger a flood of emotions: fear, that your loved one relapsed; sadness, when you remember the agony addiction brings; hopelessness, that they’ll never recover. It’s crucial to recognize what triggers you and have a plan to cope when it happens. Being aware of your triggers is a self-care strategy.
Therapy & Support Groups
Lastly, self-care strategies such as therapy and/or support groups can be a valuable addition to your self-care regime. Seeing a therapist can strengthen your resilience and distress tolerance skills. Therapy may provide an additional avenue for perspective.
(Side note: A good therapist is supportive and will provide you with tools for effective problem-solving and communication, coping with grief and loss, building self-esteem, making difficult choices, managing stress, overcoming obstacles, improving social skills/emotional intelligence, and better understanding yourself. A good therapist empowers you. A bad therapist, on the other hand, will offer advice and/or tell you what to do, disempowering you.)
Regarding support groups, there are many options for family members, friends, and significant others with a loved one who has a SUD, including Al-Anon, Nar-Anon, and Families Anonymous. Support groups provide the opportunity to share in a safe space and to receive feedback, suggestions, and/or encouragement from others who relate.
“I have come to believe that caring for myself is not self indulgent. Caring for myself is an act of survival.”
Audre Lorde
In sum, self-care is not optional; it’s essential for surviving the addiction of a loved one. Self-care enhances both overall wellness and your ability to help your loved one; in order words, take responsibility for your health and happiness by taking care of yourself. Commit to engaging in at least one or two of the self-care strategies you learned about in this post.
Munn wrote this book because, as a nonbeliever, he felt the 12 steps of AA didn’t fully translate into a workable program for atheists or agnostics. This inspired him to develop the Practical 12 Steps.
I stumbled upon Staying Sober Without God while searching for secular 12-step literature for a client who identifies as atheist. Jeffrey Munn, the book’s author, is in recovery and also happens to be a licensed mental health practitioner.
Munn wrote the book because as a nonbeliever he felt the 12 steps of AA didn’t fully translate into a workable program for atheists or agnostics. (For example, the traditional version of Step 3 directs the addict to turn his/her will and life over to the care of God as they understand him. If you don’t believe in God, how can you put your life into the care of him? Munn notes that there’s no feasible replacement for a benevolent, all-knowing deity.)
The whole “God thing” frequently turns nonbelievers off from AA/NA. They’re told (by well-meaning believers) to find their own, unique higher power, such as nature or the fellowship itself. (The subtle undertone is that the nonbeliever will eventually come around to accept God as the true higher power.)
In Staying Sober Without God Munn asserts, “There is no one thing that is an adequate replacement for the concept of God.” He adds that you can’t just replace the word “God” with “love” or “wisdom.” It doesn’t make sense. So he developed the Practical 12 Steps and wrote a guide for working them.
The Practical 12 Steps for staying sober are as follows:
Admitted we were caught in a self-destructive
cycle and currently lacked the tools to stop it
Trusted that a healthy lifestyle was attainable
through social support and consistent self-improvement
Committed to a lifestyle of recovery, focusing
only on what we could control
Made a comprehensive list of our resentments,
fears, and harmful actions
Shared our lists with a trustworthy person
Made a list of our unhealthy character traits
Began cultivating healthy character traits
through consistent positive behavior
Determined that the best way to make amends to
those we had harmed
Made direct amends to such people wherever
possible, except when to do so would cause harm
Practiced daily self-reflection and continued
making amends whenever necessary
We started meditating
Sought to retain our newfound recovery lifestyle
by teaching it to those willing to learn and by surrounding ourselves with
healthy people
The Practical 12 Steps in no way undermine the traditional
steps or the spirit of Alcoholics Anonymous. Instead, they’re supplemental;
they provide a clearer picture of the steps for the nonbeliever.
Before delving into the steps in Staying Sober Without God, Munn discusses the nature of addiction, recovery, and the role of mental illness (which is mostly left untouched in traditional literature). He addresses the importance of seeking treatment (therapy, medication, etc.) for mental disorders while stressing that a 12-step program (secular or otherwise) is not a substitute for professional help. In following chapters, Munn breaks each step down and provides guidelines for working it.
The last few chapters of the book provide information on
relapse and what the steps don’t
address. Munn notes that sustainable recovery requires more than just working
the steps, attending AA meetings, and taking a sponsor’s advice. For a
balanced, substance-free lifestyle, one must also take care of their physical
health, practice effective communication, and engage in meaningful leisure
activities. Munn briefly discusses these components in the book’s final chapter,
“What the Steps Miss.”
Staying Sober Without God is well-written and easy to read. The author presents information that’s original and in line with current models of addiction treatment, such as behavioral therapy (an evidence-based approach for substance use disorder). Working the Practical 12 Steps parallels behavioral treatments; the steps serve to modify or discontinue unhealthy behaviors (while replacing them with healthy habits). Furthermore, a 12-step network provides support and meaningful human connection (also crucial for recovery).
In my opinion, the traditional 12 Steps reek of the moral model, which viewed addiction as a moral failure or sin. Rooted in religion, this outdated (and false) model asserted that the addict was of weak character and lacked willpower. The moral model has since been replaced with the disease concept, which characterizes addiction as a brain disorder with biological, genetic, and environmental influences.
The Practical 12 Steps are a better fit for what we know about addiction today; Munn focuses on unhealthy behaviors instead of “character defects.” For example, in Step 7, the addict implements healthy habits while addressing unhealthy characteristics. No one has to pray to a supernatural being to ask for shortcomings to be removed.
The Practical 12 Steps exude empowerment; in contrast, the
traditional steps convey helplessness. (The resulting implication? The only way
to recover is to have faith that God will heal you.) The practical version of
the steps instills hope and inspires the addict to change. Furthermore, the
practical steps are more concrete and less vague when compared to the
traditional steps. (This makes them easier to work!)
In sum, Munn’s concept of the steps helped me to better understand the 12-step model of recovery; the traditional steps are difficult to conceptualize for a nonbeliever, but Munn found a way to extract the meaning of each step (without altering overall purpose or spirit). I consider the practical steps a modern adaptation of the traditional version.
I recommend reading Staying Sober Without God if you have a substance use disorder (regardless of your religious beliefs) or if you’re a professional/peer specialist who works with individuals with substance use disorders. Munn’s ideas will give you a fresh perspective on 12-step recovery.
For working the practical steps, download the companion workbook here:
Note: The workbook is meant to be used in conjunction with Munn’s book. I initially created it for the previously mentioned client as a format for working the practical steps. The workbook is for personal/clinical use only.
Discover a new hobby with this diverse list of assorted leisure activities, which range from beekeeping to Kombucha brewing to knife throwing to ghost hunting.
Watch your favorite Netflix series, but make sure you become overly invested (borderline obsessed) with the storyline and characters in order for this to qualify as a legit hobby
Kratom is a tropical tree native to Southeast Asia. It’s becoming increasingly popular in the United States. It’s used for pain relief, mood enhancement, and to manage opioid withdrawal symptoms or reduce/stop opioid use. This post explores the use of kratom as a potential treatment for opioid use disorder.
Kratom (mitragyna speciosa) is a tropical tree native to Southeast Asia and, like coffee, is part of the Rubiaceae plant family. Ingesting the leaves produces a high. Taken in small amounts, it leads to stimulant-like effects (i.e. increased energy and focus – stronger than caffeine, less intense than cocaine). When taken in larger doses, the high is similar to that of an opioid (euphoria, drowsiness, “pinned” pupils, dry mouth, sweating, nausea, constipation, etc.) Kratom is unique in that it produces both stimulant and opioid-like effects.
Note: “Opioid” is the term used for any drug that binds to the opioid receptors in the brain. An “opiate,” on the other hand, is a naturally occurring chemical found in the poppy plant, such as morphine or codeine. All opiates are opioids.
In the United States, kratom users cite pain relief as a primary motive for use. It’s an opioid agonist, and works by binding to opioid receptors in the brain. It can be effective for both acute and chronic pain. Others report using kratom for energy, increased focus, lower levels of anxiety, to reduce/stop the use of opioids, to reduce symptoms of PTSD or depression, and to elevate mood.
Kratom is legal in Virginia; it’s sold at vape or “head” shops as
a loose powder or in capsules. (Alternatively, kratom can be purchased online.)
Packaging is typically labeled “botanical sample only; not for human
consumption.” The extremely bitter powder can be sprinkled over food or brewed
into a tea. It’s easily swallowed in capsule form.
What does kratom mean for the opioid epidemic in America? Will it one day play a key role in the treatment of opioid use disorders? Or will it fall into the “harm reduction” category? Is it a natural pain medication, a safe alternative to highly addictive opioid pain killers?
Or, will we find that kratom, like heroin, is habit-forming and
deadly? Currently, the research is mixed.
An Alternative
to Opioid Drugs
The results of a 2019 survey published in Drug and Alcohol Dependence revealed that 90% of respondents found kratom
effective for relieving pain, reducing opioid use, and easing withdrawal
symptoms.
In 2011, researchers discovered that kratom alleviated morphine withdrawal symptoms. A more recent study indicated that it may reduce morphine use.
Earlier this year, researchers found that kratom use was associated with significant decreases in the occurrence and severity of opioid adverse effects; it lessened the discomfort of opioid withdrawal. Multiple studies have substantiated these findings, suggesting that it could be a useful medication for opioid addiction and withdrawal.
Interestingly, in 2007, it was found that kratom reduced alcohol withdrawal behaviors. More recently, researchers discovered that it was associated with decreased alcohol use; this suggests that it may help those with alcohol use disorders (AUD) in addition to opioid addiction.
Compared to heroin, kratom is less addictive and has milder withdrawal symptoms. Furthermore, the risk of overdose is low. A 2018 literature review indicated that it may have harm-reduction potential for individuals who want to stop using opioids.
Dangerous & Addictive?
According to the CDC, there were 152 kratom-involved deaths between July 2016 and December 2018 (“kratom-involved,” meaning it was a factor). In seven of those deaths, kratom was the only substance found in toxicology tests (although it should be noted that the presence of other substances was not fully ruled out). It’s possible to overdose on kratom, and when combined with other drugs or medications, it can be fatal.
In rare cases, kratom has been linked to liver toxicity, kidney damage, and seizures. In the case of a 32-year-old woman who was using it for opioid withdrawal, it was likely the cause of acute lung injury. Use may also cause cardiac or respiratory arrest.
Kratom’s harmful effects are not limited to the body; a 2010 study linked chronic use to alterations in working memory. In 2016, researchers found that kratom use was associated with cognitive impairment. An additional 2016 study supported previous findings that it may affect learning. In 2019, researchers found that high doses were linked to memory deficits. In contrast, a 2018 study indicated that high kratom consumption was not related to long-term cognitive impairment. That same year, researchers found that long-term kratom use did not appear to cause altered brain structures. More research is needed in this area.
Regarding whether or not kratom is addictive, multiple studies have found that regular use leads to dependence, withdrawal symptoms, and cravings. Kratom cessation may also cause psychological withdrawal symptoms, such as anxiety and depression.
Will kratom step up as the hero of today’s opioid epidemic? Doubtful. And for kratom to be a viable treatment option, more conclusive research is needed. Additionally, researchers must study the safety of long-term use.
While it’s unlikely, kratom use could lead to adverse health
effects or cognitive impairment; it could also fatally interact with other
substances or medications. Furthermore, long-term use may lead to addiction. In
sum, the majority of the literature suggests that kratom is, by no means, safe.
That being said, when compared to shooting heroin, kratom is safe (a safer alternative, at least). And if someone chooses to use it to reduce/stop their opioid use, I’ll view it as harm-reduction. Until we have more answers, I will hold to the harm-reduction view… it has the potential to save lives.
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From Survival to Endurance to Fulfillment: Finding Meaning in Life
Without delving too deep into my past, I can tell you that my late teens and early to mid 20’s were not the best of times. They were dark. Lonely. Depressing. I was living a life of chaos and hopelessness. At one point, I didn’t think I was going to survive; I gave up on having a future. And I was strangely okay with it.
My turning point was a spiritual awakening of sorts. A
near-death experience led to a realization that I didn’t want to die; and it
was either die or change my life. I picked change.
What helped me to live again (and ultimately find fulfillment and meaning in life)? You might guess family or a relationship or God. But at the time, I wasn’t close with my family, I didn’t have any significant relationships/friendships, and God wasn’t a part of my life.
It was the following that helped me with finding meaning and becoming the person I am today:
A Therapist
Having not a single shred of self-esteem, I went to see a counselor. She created a safe space and then uplifted me, making me feel worthwhile. She normalized what I was going through; I felt less alone. She affirmed me for positive choices I made. She initiated the mending of my fragile self. I gradually gained confidence, not only in myself, but in the idea that I could live a better life as I started finding meaning.
She loved me unconditionally… and she depended on me fully. I knew that if I died, she would never understand why I left her. I couldn’t bear that idea; I wouldn’t do that to her.
She played a huge role in my recovery. I sometimes think she saved me. She was instrumental in finding meaning in life.
I’ve always known I have potential. I’m smart and creative and determined. But that potential died somewhere along the way in young adulthood. In moments of clarity, I mourned my lost potential. I wanted to be better and to do better with my life. I was meant, maybe not for great things, but for better things than living out of my car, broke and friendless. When I decided to live, my potential reawakened; it became a driving force – a bright, glowing beacon that revitalized and inspired me.
“You have to forgive yourself.”
Self-Forgiveness
I couldn’t bear to tell my therapist about some of the things I’d done. I was ashamed; late at night, lying in bed, I would think about the past. I’d feel sick to my stomach – then, an unpleasant head rush heart racing not able to get enough air… (That’s the feeling of shame seeping from your mind into your being.)
My therapist didn’t push me to share; instead, she said, “You have to forgive yourself.” It became my mantra, quietly uttered in the dark. I would repeat, “I forgive myself, I forgive myself, I forgive myself…” until I internalized it. (That being said, it didn’t happen overnight… it took weeks, months, years. But all was set in motion with that one simple statement.)
Education
I went back to school and was able to fully immerse myself in my studies. As a naturally curious person, learning is a sort of fuel for me. The more I learn, the thirstier I become. My classes provided me with not only knowledge, but with a spark that generated purpose.
Passion
While in school, I discovered a new passion; I fell in love with research. (#nerd) I thrived in my research/statistics class; my undergraduate study was even published in a national journal. It felt good to be passionate about something again; it stirred up (from the dust) long-forgotten loves, like reading and writing – passions I thought I’d left behind in childhood.
A Meaningful Career
After finishing college and starting graduate school, I became a counselor… finding meaning in helping others. My first job in the field was tough, heart-breaking at times, and deeply fulfilling. It solidified what my education had started to shape – I no longer needed to survive or endure life; I found my purpose and a meaning in life.
Professional development encompasses all activities that provide or strengthen professional knowledge/skills.
Ongoing professional development is a requirement for mental health practitioners in order to maintain competency and for keeping up-to-date on the latest research and evidence-based practices in an ever-changing field.
This is a list of ideas for counselor professional development.
Professional Development for Counselors
1. Find a mentor (and meet with them regularly). A mentor can provide guidance and support. They’ll help you grow by sharing their own experiences and expertise. A mentor can also help by talking through challenges and helping you to stay motivated when you’re discouraged.
2. Sign up for relevant e-mail lists. This is a great way to stay up-to-date on the latest research, treatments, training opportunities, and resources in the counseling field.
Here are a few email lists that I find informative and helpful for professional development:
3. Become a member of a professional organization (e.g., American Counseling Association). This provides opportunities for advocacy and for networking. Membership benefits may also include free CE trainings or subscriptions to professional journals.
4. Keep up-to-date on the latest research. If you are a member of a professional organization, take advantage of your member benefits, which may include access to professional journals. You can also browse sites like ScienceDaily or use an app like Researcher.
5. Facilitate professional trainings or manage a booth at a conference. Share your professional knowledge with others by leading a training or hosting a webinar. Alternatively, consider offering to help manage your agency’s booth at a professional convention.
6. Read counseling and psychology books (such as On Being a Therapist by Kottler or Mindsight by Siegel). Reading up on relevant topics in the field will help to ensure that you’re using effective and evidence-based treatments in your practice. Reading can be especially helpful to the new counselor who struggles with imposter syndrome or questions their abilities. Psychology books can also help counselors deepen their understanding of the human mind and behavior.
7.Practice self-awareness. Self-awareness is the ability to recognize and understand one’s own thoughts, feelings, and behaviors. It helps you to know your values, limitations, and personal biases as well. Self-awareness is important for recognizing how your own “stuff” may impact your work with clients. It may also help you to build stronger relationships. What’s more, by being self-aware, you can identify the early signs of burnout and take steps to prevent it.
8. Become familiar with local resources in your community. By learning about the available resources in the community, you’ll be better able to assist your clients with some of their case management needs.
9. Volunteer. Help out at a homeless shelter or a local food bank, pick up trash in your neighborhood, or visit with residents at a nursing home. If you have a special skill such as knitting or baking, consider using your talents to help others.
10. Join a professional counseling forum and participate in discussions. The ACA has several. You could also go the reddit route (i.e. r/psychotherapy).
11. Review your professional code of ethics on a regular basis. (Here’s the code for professional counselors: ACA Code.)
12. Attend webinars, trainings, and conferences. Stay informed by subscribing to email lists, participating in professional forums, and searching Eventbrite for local events for professional development. (For Eventbrite, enter “mental health” in the search box.) PESI is another resource for professional development, but the seminars can be costly.
13. Network/consult. Make it a point to network with other professionals that you meet at work or professional conferences.
14. Subscribe to psychology magazines like Psychology Today or Psychotherapy Networker. Reading about relevant topics in the field will help you to stay sharp.
15. Further your education by taking classes or earning a certificate. Consider specializing in something or enhancing your skillset.
16. Pick a different counseling skill (such as reflecting meaning or the ’empty chair’ technique) to strengthen each week. (You can even use flashcards to pick a new skill or simply review!)
17. Write an article or book (or book review!) If you’re gifted at writing, share your expertise with others by publishing an original work. If a writing a book or article is too much of an undertaking, consider writing book reviews or reviewing products online.
18. Take free online courses. There are plenty of sites and institutions that offer free classes. Take advantage of this opportunity to enhance your professional knowledge or learn new skills.
19. Listen to podcasts (like Therapy Chat or Counselor Toolbox). If you prefer listening over reading, podcasts are a highly convenient way to grow professionally.
20. Practice self-care on a regular basis to prevent burnout. Why is self-care included in a post on professional development? Because self-care is crucial for counselor wellness. A counselor experiencing burnout may even put their clients at risk. Self-care is essential for professional development.
