Substance Abuse Counseling: An Interview

An interview with JS, a substance abuse counselor who works with people from all walks of life.

JS is a certified substance abuse counselor who works at a residential treatment center in northern Virginia. The following article is about his work, thoughts on relapse, what it’s like to lose a client, stigma, and valuable advice for anyone considering a career in addiction counseling.


Interview: “They Are Just People”

JS works at an intermediate-length residential center for adults with substance use and mental health disorders. The clients live in shared dorms and adhere to a daily schedule that includes counseling, psychoeducation, groups, 12-step meetings, and medication therapy.

Once a client successfully completes the inpatient portion of treatment, they transition to “re-entry.” In re-entry, clients reside in sober living homes and receive continuing care services. They are able to look for employment, start working, and “re-enter” the larger community. JS provides counseling and support services for this component.

Inspired to help

JS has personal experience with addiction. “I am a person in recovery… About a decade ago I found myself in a very dark place and had to get help… I met a substance abuse counselor [who] changed my life. He educated me, engaged me, and challenged me. He was instrumental in turning my life around.”

With his counselor’s encouragement and support, JS made the decision to get back on track. He realized that he wanted to help others who struggled. “My own experiences with addiction allow me to have an incredibly deep empathy for the clients I serve and the fulfillment I receive in return is unreal.”

“Addiction does not discriminate”

JS works with people from all walks of life. He’s worked with individuals who are homeless to young fathers to successful businessmen; from people in their teens to adults in their late 80’s. “There is no age, sex, gender, race, sexual orientation, religion, occupation, or economic class that is safe from addiction.”

As for the substances abused, the list is never ending, but JS regularly sees people addicted to alcohol, opiates (including heroin), cocaine, methamphetamine, and PCP. Many of the clients he counsels also have mental illness such as depression, anxiety, or bipolar disorder.

No typical days

According to JS, “typical” days don’t exist where he works. “There is no way to describe a typical day in this field. One day I could be [providing therapy] and another day could involve a trip to the emergency room or helping out with chores… I never know what to expect and I never get bored.”

Effective treatment planning is important for substance abuse counselors; JS meets with his clients to develop an individualized service plan. Clients come up with their own goals, and JS supplies interventions to help them achieve their goals over the next couple of months.

According to JS, client goals vary, ranging from attending 12-meetings to obtaining a driver’s license to enrolling in school; basically, a goal can be any life skill a person may need for success. Corresponding interventions could include providing bus tokens to get to AA meetings, linking to driving school, and helping to fill out college applications and apply for financial aid.

JS explained that adults who have been incarcerated or dealing drugs for a living miss out on major milestones such as learning to drive, attending college, renting an apartment, etc. Furthermore, basic skills that many of us take for granted, such as filling out an online form or depositing a check can be overwhelming for someone newly in recovery who never learned how.

JS meets with his clients at least once per week for therapy sessions. I asked what comes up in a typical session and his response was “anything and everything.” Sessions may involve reviewing goals, learning coping skills, poop jokes (his clients are all men), or processing childhood trauma.

Substance abuse and relapse

“Not good” was JS’s response when I asked what the success rate was for someone who completes re-entry. He explained that this is a reflection of the general rates of recovery in substance abuse, which are low. “It can be disheartening, working with someone for months and when they leave, they relapse in less than a week.”

JS explained that while relapse is a deterrent to the field for some counselors, he sees it differently. “For me, it will never be a deterrent. My battle with addiction was not easy, nor was it accomplished in a single attempt. Relapse is a part of my story. I would not be here if people gave up or lost hope that I could get better. For that, I will never give up or lose hope that my clients can recover, no matter how many times they relapse.”

For JS, losing a client, not relapse, is the hardest part of the job. “I’ve worked with many clients who didn’t make it. I’ve lost clients to overdose, suicide, and homicide. It never gets easier.”

JS grieves for his lost clients. “I find myself wading through the stages of grief until I reach some level of acceptance.”

What everyone needs to know about substance abuse

“The people I work with are just people. They are your sister, your cousin, your neighbor, or the guy in line at the grocery store. They are people with families, jobs, hobbies, and dreams.”

JS discussed ignorance and stigma; he shared that individuals with substance use disorders are often subjected to mistreatment, even from professionals in the field. “There are substance abuse counselors who perpetuate harmful addiction myths, once widely accepted as fact, but discredited by the scientific community decades ago.”

JS shared examples of common myths:

  • “All addicts are liars.”
  • “Addicts are lazy and selfish.”
  • “It’s not a disease, it’s a choice.”

“The lack of compassion when it comes to substance abuse is mindboggling and painful to encounter. Often, it stems from a lack of understanding or knowledge about substance abuse and those with substance use disorders. They are just people who are struggling with something far beyond their control. And those in treatment? They are just people trying to get better. And in case I didn’t make it clear; they are just people.”

Advice for new substance abuse counselors

“Be willing to learn. The field of addiction treatment is constantly changing. Standard practices from 20 years ago are now ineffective and outdated. If you want to do this work, be open to learning the newest treatment models, medications, and research on addiction. This field is not static, and we do our clients a major disservice when we quit learning.”

As a last piece of advice, JS suggested self-care for substance abuse counselors as a way to combat burnout. “Identify ways to decompress. This job is not easy. Some of the people you help will die. Compassion fatigue is a real thing and you must take care of yourself to care for others.”

“They are just people.”

JS

Powerful Therapy Metaphors

Effective analogies to illustrate growth, self-care, emotions, addiction, grief, counseling, and life concepts

By Cassie Jewell, M.Ed., LPC, LSATP

Puzzle pieces to show how metaphors link ideas together
Image by Gerd Altmann from Pixabay

As a counselor, you probably have a few “go-to” therapy metaphors that you use in sessions. For example, the “airplane oxygen mask” metaphor is a powerful analogy that demonstrates the significance of meeting your own needs before attempting to help others.

Another example of a therapy metaphor is the “rearview mirror” analogy. If you’re driving, and your entire concentration is on what’s behind you, you’ll crash. Good drivers, in contrast, focus ahead, but also regularly check the rearview mirror. The “rearview mirror” metaphor effectively illustrates how recovery from drugs and alcohol requires learning from, but not dwelling on, past mistakes and regrets.

Powerful Therapy Metaphors: Analogies in Counseling

The following is a list of helpful therapy metaphors and analogies for growth, self-care, emotions, addiction, grief, counseling, and life.


For additional therapy metaphors, click here.

For commonly used therapy questions and phrases, see Do You Speak Therapist?


Metaphors for Growth & Self-Care

Forming a new habit is like carving a path in the jungle. You trod through the undergrowth and take the same route over and over again, until a clear path is formed. Meanwhile, older pathways become overgrown and wild, disappearing from sight with unuse.

A habit forms the way water carves a new stream or river.

You can’t see the grass growing, but after a week or so, you can see that the lawn needs mowing.

You can’t pour from an empty cup.

Mind the “check engine” light in your car. It indicates that something is wrong; if you ignore it, the problem will likely become worse. The longer you ignore internal cues, the greater the damage to your “car.”

A plant requires the right amount of water, sunlight, and fertilizer to grow and thrive.

You are a battery that needs to be recharged every so often.

Metaphors for Emotions

Our emotions are like a thermometer in the window. You can see clouds or rain or sun, but without a thermometer, you won’t know if it’s 90 degrees or 17 below. Emotions impact how you experience the outside world.

Life is like a heart monitor; there are ups and downs. If it goes flat, you’re dead.

The more you bottle up your emotions, the more likely you are to explode.

Repressing anger is like stuffing trash in a garbage can. Eventually, it’s going to spill over if you don’t take out the trash.

When you resent someone, it’s like drinking poison and expecting them to die.

Anxiety is a hungry monster that gets bigger when you feed it.

Worrying is like riding a stationary bike; you can peddle as hard as you can, but you’ll never get anywhere.

Therapy Metaphors for Addiction

Addiction is a disease of the soul.

When you’re in active addiction, you’re a shadow of yourself.

Addiction is like being in a toxic relationship. It’s all-consuming, lust-worthy, and even thrilling at times… but at the cost of your health and well-being. You have to break up in order to move on with your life.

Addiction is like a tornado, ravaging everything in its path. After the storm, it’s time to rebuild. It won’t look exactly the way it did before the tornado hit… but there’s potential for things to be even better.

Addiction is like other chronic health conditions in that there’s no cure, but it’s 100% manageable with treatment and lifestyle changes.

The longer you sit and stare at a plate of cookies, the more likely you are to give in to temptation. Set yourself up for success by avoiding triggers when possible.

If you hang out in a barber shop long enough you’ll end up getting a haircut.

Temptation is like a muscle that grows weaker with use until it finally gives out.

Living life without drugs or alcohol is like any skill; you first learn how to do it and then you have to practice. You may slip up, but don’t give up; learn from your mistakes. You can’t excel at anything without practice.

Cravings are like waves; ride them out until the wave recedes.

Attempting to save someone from drowning is dangerous. In their frantic efforts for oxygen, they’ll claw over and push the person trying to help underwater. This is an unconscious survival instinct. When your loved one is in active addiction, they’ll fight anyone and anything that gets in their way of a gulp of air.

Metaphors for Grief

Grief is a deep wound that takes time to heal. The wound is raw and painful, but will eventually scab over, although leaving behind a permanent scar.

Every person you lose takes a little piece of you with them.

Metaphors for Counseling

Going to therapy is akin to filling your toolbox with tools.

In a car, your therapist is a passenger in the front seat, but you’re behind the wheel. A passenger offers assistance with reading the map and providing directions, but it’s up to you to choose the turns you’ll take, and ultimately, the destination.

A counselor doesn’t provide the answers, but offers the tools to find them.

Going to therapy is like going to the gym; you may feel sore and you won’t see immediate effects, but the long-term results are gratifying and well-worth the investment.

Therapy Metaphors for Life

Problems in life are like bad smells; you can attempt to mask them or cover them up, but you have to remove the source before they can truly go away.

You can’t choose the canvas or paint in life, but you decide the picture you’ll paint.

Your life is a book with many chapters and pages. Every day is a new page. You write your own story.

Life is like a “choose your own adventure” book. You make decisions, but you can’t always predict the outcome.

Sometimes you’re dealt a really sh**** hand. How are you going to play your cards?

The only difference between a rut and a grave are the dimensions.


Post your “go-to” therapy metaphors in a comment!

Recommended Memoirs About Mental Illness & Addiction

A list of some of the best memoirs detailing personal experiences with mental illness, substance use, and recovery

Compiled by Cassie Jewell, M.Ed., LPC, LSATP

Disclaimer: This post contains affiliate links. As an Amazon Associate I earn from qualifying purchases.

Image by Free-Photos from Pixabay

Recommended Memoirs About Mental Illness & Addiction

Drinking: A Love Story (1997) by Caroline Knapp

Amazon Description: “It was love at first sight. The beads of moisture on a chilled bottle. The way the glasses clinked and the conversation flowed. Then it became obsession. The way she hid her bottles behind her lover’s refrigerator. The way she slipped from the dinner table to the bathroom, from work to the bar. And then, like so many love stories, it fell apart. Drinking is Caroline Kapp’s harrowing chronicle of her twenty-year love affair with alcohol.”

A Drinking Life: A Memoir (1994) by Pete Hamill

Amazon Description: “Hamill explains how alcohol slowly became a part of his life, and how he ultimately left it behind. Along the way, he summons the mood of an America that is gone forever, with the bittersweet fondness of a lifelong New Yorker.”

Dry: A Memoir (2003) by Augusten Burroughs

Amazon Description: “You may not know it, but you’ve met Augusten Burroughs. You’ve seen him on the street, in bars, on the subway, at restaurants: a twentysomething guy, nice suit, works in advertising. Regular. Ordinary. But when the ordinary person had two drinks, Augusten was circling the drain by having twelve; when the ordinary person went home at midnight, Augusten never went home at all. Loud, distracting ties, automated wake-up calls and cologne on the tongue could only hide so much for so long. At the request (well, it wasn’t really a request) of his employers, Augusten lands in rehab, where his dreams of group therapy with Robert Downey Jr. are immediately dashed by grim reality of fluorescent lighting and paper hospital slippers. But when Augusten is forced to examine himself, something actually starts to click and that’s when he finds himself in the worst trouble of all. Because when his thirty days are up, he has to return to his same drunken Manhattan life―and live it sober. What follows is a memoir that’s as moving as it is funny, as heartbreaking as it is true. Dry is the story of love, loss, and Starbucks as a Higher Power.”

Girl, Interrupted (1993) by Susanna Kaysen

Amazon Description: “Kaysen’s memoir encompasses horror and razor-edged perception while providing vivid portraits of her fellow patients and their keepers. It is a brilliant evocation of a “parallel universe” set within the kaleidoscopically shifting landscape of the late sixties. Girl, Interrupted is a clear-sighted, unflinching document that gives lasting and specific dimension to our definitions of sane and insane, mental illness and recovery.”

Go Ask Alice (1971) by Alice

Amazon Description: “It started when she was served a soft drink laced with LSD in a dangerous party game. Within months, she was hooked, trapped in a downward spiral that took her from her comfortable home and loving family to the mean streets of an unforgiving city. It was a journey that would rob her of her innocence, her youth—and ultimately her life.”

Loose Girl: A Memoir of Promiscuity (2008) by Kerry Cohen 

Amazon Description: “Loose Girl is Kerry Cohen’s captivating memoir about her descent into promiscuity and how she gradually found her way toward real intimacy. The story of addiction–not just to sex, but to male attention–Loose Girl is also the story of a young girl who came to believe that boys and men could give her life meaning.”

A Million Little Pieces (2005) by James Frey

Amazon Description: “At the age of 23, James Frey woke up on a plane to find his front teeth knocked out and his nose broken. He had no idea where the plane was headed nor any recollection of the past two weeks. An alcoholic for ten years and a crack addict for three, he checked into a treatment facility shortly after landing. There he was told he could either stop using or die before he reached age 24. This is Frey’s acclaimed account of his six weeks in rehab.”

Parched: A Memoir (2006) by Heather King

Amazon Description: “In this tragicomic memoir about alcoholism as spiritual thirst, Heather King—writer, lawyer, and National Public Radio commentator—describes her descent into the depths of addiction. Spanning a decades-long downward spiral, King’s harrowing story takes us from a small-town New England childhood to hitchhiking across the country to a cockroach-ridden “artist’s” loft in Boston. Waitressing at ever-shabbier restaurants, deriving what sustenance she could from books, she became a morning regular at a wet-brain-drunks’ bar—and that was after graduating from law school. Saved by her family from the abyss, King finally realized that uniquely poetic, sensitive, and profound though she may have been, she was also a big-time mess. Casting her lot with the rest of humanity at last, she learned that suffering leads to redemption, that personal pain leads to compassion for others in pain, and, above all, that a sense of humor really, really helps.”

Prozac Nation: Young and Depressed in America (1994) by Elizabeth Wurtzel

Amazon Description: “Elizabeth Wurtzel writes with her finger in the faint pulse of an overdiagnosed generation whose ruling icons are Kurt Cobain, Xanax, and pierced tongues. In this famous memoir of her bouts with depression and skirmishes with drugs, Prozac Nation is a witty and sharp account of the psychopharmacology of an era for readers of Girl, Interrupted and Sylvia Plath’s The Bell Jar.”

Smashed: Story of a Drunken Girlhood (2005) by Koren Zailckas

Amazon Description: “Garnering a vast amount of attention from young people and parents, and from book buyers across the country, Smashed became a media sensation and a New York Times bestseller. Eye-opening and utterly gripping, Koren Zailckas’s story is that of thousands of girls like her who are not alcoholics—yet—but who routinely use booze as a shortcut to courage and a stand-in for good judgment.”

Tweak: Growing Up on Methamphetamines (2009) by Nic Sheff

Amazon Description: “Nic Sheff was drunk for the first time at age eleven. In the years that followed, he would regularly smoke pot, do cocaine and Ecstasy, and develop addictions to crystal meth and heroin. Even so, he felt like he would always be able to quit and put his life together whenever he needed to. It took a violent relapse one summer in California to convince him otherwise. In a voice that is raw and honest, Nic spares no detail in telling us the compelling, heartbreaking, and true story of his relapse and the road to recovery. As we watch Nic plunge into the mental and physical depths of drug addiction, he paints a picture for us of a person at odds with his past, with his family, with his substances, and with himself. It’s a harrowing portrait—but not one without hope.”

13 Sites for Self-Help

Free online self-help and personal development

Compiled by Cassie Jewell, M.Ed., LPC, LSATP

Image by stokpic from Pixabay

Free Self-Help Resources & Online Support

Are you searching for free self-help? This is a list of links to various sites and services providing self-help.


For free therapy workbooks, handouts, and worksheets:


1. Counselling Resource

Take psychological self-tests and quizzes, read about symptoms and treatments, compare types of counselling and psychotherapy, learn about secure online therapy, and more

2. DBT Self-Help

A site for individuals seeking information on DBT. This site includes DBT skill lessons, flash cards, diary cards, mindfulness videos, and more.

3. Healthy Place

Mental health information, including online assessments and breaking news

4. HelpGuide.org

Collaborates with Harvard Health Publications to provide a wide range of unbiased, motivating resources and self-help tools for mental, social, and emotional. 100% nonprofit; dedicated to Morgan Leslie Segal, who died by suicide when she was 29.

5. Internet Mental Health

A free encyclopedia for mental health information on the most common mental disorders. Created by psychiatrist Dr. Phillip Long.

6. Mental Health Online

Create an account to access free mental health services for mental distress, including programs for anxiety, depression, OCD, and other disorders

7. Moodgym

Interactive self-help book for depression and anxiety. (This resource used to be free, but now there’s a small fee.)

8. National Mental Health Consumers’ Self-Help Clearinghouse

A peer-run resource center

9. Psych Central

Information on mental health, quizzes, and online self-help support groups. The site is owned and operated by Dr. John Grohol, inspired by the loss of his childhood friend to suicide.

10. Psychology Help Center

A consumer resource featuring information related to psychological issues that affect emotional and physical well-being

11. Sources of Insight

Providing the principles, patterns, and practices needed for personal development and success; a source for skilled living and personal empowerment

12. Succeed Socially

An extensive, completely free collection of articles on social skills and getting past social awkwardness. It’s written by someone who’s struggled socially himself, and who has degrees in psychology and counseling.

13. Verywell Mind

An online resource for improving mental health. All content is written by healthcare professionals, including doctors, therapists, and social workers.


Guest Post: My Experience with Depression

“I had absolutely no direction in my life. I was a loose cannon. An unguided projectile… I viewed life in a negative, nihilistic, cynical, and overall pessimistic way.”

By Kevin Mangelschots

Image by Gerd Altmann from Pixabay


Note: Kevin’s guest post or parts of it are also posted on other blogs. It is not entirely unique to this site.


Depression, also known by some as the silent killer. And for good reasons.

Little did I know I was going to find this out firsthand.

Early on in life, before the age of 16, everything was perfect. I had loving parents and, in general, a loving family. I had plenty of friends. I excelled in sports and did well in school.

Things were easy back then. The only ounce of responsibility I had was making sure I got passing grades. And what if I didn’t listen in school and got detention as a result? Well, he’s still a young kid who’s figuring out life. Got into a fight? Well, he’s still a young boy who doesn’t always thinks before he acts.

But my perfect world didn’t last.

My Experience with Depression

Around the age of sweet 16, my life started changing rapidly.

I stopped feeling happy and optimistic. At first, I thought it was just a phase everyone my age went through and that it would pass as quickly as it came. But it didn’t. I had a difficult time adjusting to my ever-changing environment and handling the pressure I believed was being put on me.

I didn’t know what I wanted for my future. My friends and schoolmates already knew what they were going to study when they went to college the next year. I, however, did not. I had no direction in life. I was a loose cannon, an unguided projectile, an immature and wild kid, busy with partying and drinking.

I started getting into frequent fights; I’m not a violent person, but the anxiety, negative emotions, feelings of helplessness, and an overall sense of feeling lost in this world led to physical confrontations with others. The fights were a reflection of my poor mental state.

Image by Annabel_P from Pixabay

Then I turned 18. My parents told me it was time to start taking responsibility for my choices and actions because this time “it was for real.”

In college, I decided to pursue the field of nutrition. Not because I had a strong desire to become a dietician, but rather, because people I knew from my home town were going this route, and I figured since I was interested in exercise/health, it might be a good fit.

Newsflash, it wasn’t.

I quit school two months in. Turns out choosing what course to study based on friends rather than what you want in life is not the smartest idea. (Who would’ve thought, right?)

The following year, I gave it another try. This time I studied occupational performance. Long story short, I managed to earn a college degree despite my depression.

After I graduated and started working as an occupational therapist in a physical rehabilitation center, things got better. I was motivated to help people relearn lost skills, improving their quality of life.

But in time, my thoughts turned dark again, becoming negative and nihilistic. I slept less and my sleep quality was poor. I would randomly wake up at night and cry because I felt so terrible. I withdrew from friends and family. I even discovered a way to measure the severity of my depression; when my mood worsened, I craved alcohol. Drinking was a way to self-medicate.

Image by succo from Pixabay

I continued to plow away at work, but an excessive sense of responsibility, perfectionism, and anxiety was eating away at my mental health. I was head deep into my depression.

One day, I woke up and found I couldn’t get out of bed. I had nothing left in the tank. I realized I needed to take some time off work to deal with my depression and get my life in order again. I called my parents and asked to come home.

At first, I didn’t leave the bedroom. There were successive days I didn’t get up to eat or shower. I was in constant mental pain. It was hell on earth.

One evening, I managed to get out of bed and sat down to eat dinner with my parents. They were silent, and looked tired and sad. Until this moment, my depressive haze prevented me from seeing how my illness impacted my family. I decided: that’s it, no more. It was my guilt that fueled the decision to fully contend with my mental illness.

Up until now, I was only living for myself, not participating and valuing what my parents, family, and others did for me. So, something needed to change. I needed to turn my life around. And with my life, my attitude.

I started seeing a psychologist and taking antidepressants. I took a sincere look at self, including undesirable traits I’d been afraid to face. I set goals for myself. And when I had zero desire to get out of bed, I pushed through. I made sure I did something useful every day.

After several months of therapy and medication, life became manageable. I talked more, was less irritable, and as a result, my life and that of those around me improved. At times I even looked forward to things!

How Depression Changed Me


Although the depression was tough on me, and there were times I didn’t know if I was going to make it, it brought about some positive changes.

I became more mature and resilient; I learned to put things in perspective and take necessary responsibility. But the two most significant aspects that changed were my so-called “intellectual arrogance” and the pessimistic way I viewed life.

Before, I considered myself a fairly intelligent fellow. The problem with this was that I overvalued intelligence, viewing other aspects in life as inferior.

Moreover, my attitude was overwhelmingly cynical and negative. What I failed to realize is that focus shapes experience. And if you only pay attention to the negative, you miss the beauty life has to offer. Now, I actively search for the good and beautiful things happening around me.

What Helped Me Get My Depression Under Control

In addition to medication and therapy, I found the following to be helpful:

  • Seeking help. We can’t do everything on our own, no matter how much we’d like to. There are times when you will need help to cope with your depression. In addition to professional help, seek support from family and trusted friends. You may find that feeling heard and understood is what carries you through the darker days.
  • Setting goals. I had no desire to do anything in life. I had no goals. For severe depression, I would advise setting smaller goals you think you would mind doing the least (minimal effort) and/or goals which you found important in the past (before your depression took over).
  • Taking responsibility. Although depression can be debilitating, practice taking responsibility for the things in life under your control. For me, it was easy to blame others for everything that went wrong, believing the world to be wretched and unfair, but it didn’t do me any good.
  • Exercising. Mental health and physical health go hand-in-hand. Exercise releases endorphins, the “feel good” brain chemicals related to pleasure. If you don’t enjoy exercise, try a hobby that requires some level of physical exertion. As an additional benefit, engaging in exercise can take your mind off the stressful things in life.
Image by Free-Photos from Pixabay

My Depression Warning Signs

For me, there are clear signs that indicate my depression is coming back or worsening. Keep in mind that warning signs vary from individual to individual. What might be a warning sign for me may not for you.

  • My desire to do anything decreases. Hobbies I enjoy like weightlifting and running suddenly mean very little to me. But it’s not just about hobbies. Things like getting out of bed and showering suddenly become difficult because I have zero motivation or energy.
  • My thoughts get darker and more negative. It becomes increasingly tough to see the positive things in life or the positive in people. I become cynical and pessimistic.
  • Overthinking. I tend to overthink when things go bad, which is basically what depression is for me: feeling bad.
  • Anxiety. Negative thoughts and overthinking lead to increased levels of anxiety. My anxiety about the little things in life may seem insignificant to others who don’t have a mental illness, but a simple act such as calling or visiting a friend can freak me out and lead to rumination.
  • Ruminating. Intrusive thoughts run through my head and there’s no “off” switch.
  • Irritability. I become increasingly irritable; I’m in a foul mood all of the time and the smallest things piss me off.
  • Increased desire to self-medicate. I experience a strong desire to drink. Alcohol impacts the brain by triggering a release of dopamine. This rush of dopamine creates feelings of pleasure and happiness.
  • Decreased sleep quality. My overall sleep quality gets worse, partly due to constant overthinking and ruminating. Anxiety and stress are also big factors. And when I’m able to fall asleep, I wake up throughout the night.

Conclusion

Depression is a terrible disease that may go unnoticed if the signs aren’t recognized or known. A person with depression might attempt to maintain a positive front, possibly because they don’t want to complain or they’re afraid of being misunderstood.

There are multiple symptoms of depression; my symptoms went hand-in-hand, playing off one another and creating a vicious circle of negative thoughts that sucked the energy and lust for life from me.

Depression symptoms are different for different people. Learning to identify the symptoms will help you to recognize depression in others. Furthermore, an increased awareness enhances empathy and enables you to better support someone with depression.

I give the following advice to anyone with depression:

  • Don’t give up.
  • Seek professional help.
  • Seek support from your family and close friends.
  • Set goals and work hard to achieve them.
  • Take responsibility for the things you can control.
Image by Free-Photos from Pixabay

Is there a cure for depression? No. Do I think I will ever be totally depression-free? Maybe. What I do know for sure is that my illness is manageable and livable at the moment. I look forward to what the future has in store for me. Which is a lot more than I anticipated at first.


About the Author:

Kevin Mangelschots is a writer and occupational therapist with seven years of experience in the field of physical rehabilitation. He is a long-time fitness enthusiast. Kevin lives in Belgium and has created a platform for other bloggers to share their life stories where he writes about his own experience with depression at retellinglifestories.com.

Resources for Suicide Prevention & Recovery

A resource list with links to useful sites, free assessment tools, low-cost trainings, printable PDF toolkits/guides, and more

Compiled by Cassie Jewell, M.Ed., LPC, LSATP

Image by sreza24595 from Pixabay

This is a resource guide for suicide prevention and recovery. The guide includes links to educational sites, a list of free assessments, links to trainings, recommended books, helpline information, links to online support communities, recommended mobile apps, and more.


Education & Advocacy Sites

At-Risk Youth

Assessment & Screening

Low-Cost & Free Trainings

Toolkits & Guides

Suggested Books

Disclaimer: This section contains affiliate links. As an Amazon Associate I earn from qualifying purchases.

Dying to Be Free: A Healing Guide for Families After a Suicide by Beverly Cobain & Jean Larch

I Wasn’t Ready to Say Goodbye: Surviving, Coping and Healing After the Sudden Death of a Loved One by Brook Noel & Pamela D. Blair, Ph.D.

No Time For Goodbyes: Coping with Sorrow, Anger, and Injustice After a Tragic Death, 7th Edition by Janice Harris Lord

Reasons to Stay Alive by Matt Haig

Thirteen Reasons Why by Jay Asher

When Bad Things Happen to Good People by Harold S. Kushner

Suicide Survivors

Image by Roman Hörtner from Pixabay

Crisis & Chat Lines

Online Support

MOBILE Apps


Book Review: The Sober Survival Guide

The Sober Survival Guide provides readers with an opportunity to explore their drinking habits and determine if an alcohol-free life may be right for them. It also serves as a handbook for coping with everyday life situations that may lead to cravings or relapse. (Includes a quote from the author and exclusive details about his next book, which is set to be released by the end of this year!)

Reviewed by Cassie Jewell, M.Ed., LPC, LSATP

The Sober Survival Guide: How to Free Yourself from Alcohol Forever – Quit Alcohol & Start Living! (2019) by Simon Chapple (Published by Elevator Digital, Ltd.)


Message from the Author, Simon Chapple:

“I didn’t ever set out to write a book, but as my blog grew and more people were visiting my website and finding the articles I was writing helpful, I was getting a lot of comments that I should do something more substantial, from here the book began to evolve.

The more I wrote, the more immersed I became in writing a book that I felt would have helped me at the time I wanted to quit. Right through the process I asked myself ‘would this help someone who wants to change their relationship with alcohol?’, if the answer was no, I removed it. 

I wanted to create something unique in the ‘quit lit’ sector, that would not only help readers learn the best strategy for quitting drinking that worked for me, but would also help set them up for long-term success when it comes to dealing with the challenges that arise in the months and years after getting sober.

I decided to split [The Sober Survival Guide] into two parts. The first part deals with the process of actually quitting drinking and guides readers along the path to freedom, the second part addresses specific situations that come up after quitting, such as social events, vacations, parties and events, relationships with friends, partners and family and dealing with ‘coming out’ about being ‘alcohol-free’.

My whole approach to sobriety is around our mindset, I believe that living alcohol-free should be seen as a positive lifestyle-choice that we make for ourselves, rather than feeling like we have been deprived and have to get by on willpower because we have had something special taken away from us.

I recently completed the manuscript for my second book – How to Quit Alcohol in 50 Days, which is a one-chapter a day roadmap to becoming alcohol-free and I am excited about the release at the end of this year.”

-Simon Chapple, August 7, 2020

Image by Markus Spiske from Pixabay

Can you relate to any of the following statements about alcohol?

  • “I can’t have fun without it. Imagine going to a party without drinking!”
  • “It makes me feel less anxious or depressed.”
  • “It helps me sleep.”
  • “I can’t relax without it.”
  • “It makes me entertaining to be around.”
  • “It fits the lifestyle of my boozy friends.”
  • “I like the taste.”
  • “It’s cool and sophisticated.”
  • “I’m not confident enough to talk to new people without it.”
  • “It helps me deal with all the problems that life throws my way.”
  • “It stops me from worrying, especially about how much I’m drinking.”

-Source: The Sober Survival Guide, pg. 6


Maybe you’ve questioned your drinking habits or wondered if you have a problem with drinking. Maybe you’ve thought about quitting, but can’t imagine a life without alcohol. You may, at times, wonder if you’re an alcoholic, but are quick to dismiss the idea because you haven’t hit “rock bottom” and you can’t relate to the 12-step concept of being utterly powerless over a disease.


Simon Chapple is not an alcoholic, nor is he in recovery; he is a person who doesn’t drink. In his book, The Sober Survival Guide, Chapple explains that he doesn’t deem it necessary to carry a label for the rest of your life (as many in AA and NA do). “Remember that you hold the power to be who you want to be, and you can choose what labels you use for yourself” (pg. 11).

In The Sober Survival Guide, Chapple shares about his personal journey as a heavy drinker to discovering sobriety and living an alcohol-free life. He discusses alcoholism and the stigma surrounding certain labels (i.e. “alcoholic”) in the first part of the book, which “sets the scene for you to explore what an alcohol-free life might look like for you” (pg. 21). You are also given the opportunity to examine your relationship with alcohol along with your beliefs about drinking.

The second part of the book serves as a practical handbook for anyone who wants to stop drinking; it includes helpful tips for navigating everyday life situations that could trigger a desire to drink. Some of the problems and challenges you may face include stress, accountability, special events/parties, boredom, sleep, and sober sex, among others.

Image by Pexels from Pixabay

Throughout the book, Chapple encourages the reader to examine their core beliefs about drinking by asking thought-provoking questions. These questions can serve as journaling prompts for the person who is wondering, “Am I an alcoholic?”

The last few pages of the book provide the reader with helpful resources, including Chapple’s blog and free online support community.


The Sober Survival Guide is an easy read with clearly-presented information. The book has a non-judgmental feel to it, unlike much of the 12-step literature that suggests your drinking is related to character flaws. (The language and concepts of AA can be off-putting and difficult to relate to for individuals at the lower end of the alcohol use disorder spectrum.)

Furthermore, The Sober Survival Guide empowers the reader to make changes; you don’t have to admit powerlessness over a disease and turn your will over to a higher power to quit drinking. Chapple’s message is hopeful and inspiring; plus, many of his strategies are based on evidence-based practices, including CBT and mindfulness.

Image by klimkin from Pixabay

If you are currently questioning whether or not your drinking habits are “normal,” The Sober Survival Guide will provide answers. This book will lift you up and inspire; as you read through the chapters, you may also feel an enormous sense of relief. Furthermore, you will be equipped with a wealth of effective strategies if you do choose to cut down or quit drinking. (Quitting drinking is not easy, but 100% doable, providing you put in the effort and have supports.)


I recommend reading The Sober Survival Guide if you’ve ever wondered if you’re an alcoholic. (You may not see yourself as a “problem drinker,” but you sometimes experience problems related to your alcohol use.) I also recommend this book if you’ve already made the decision to quit or cut down on alcohol. And if you’re a heavy drinker, but are unsure if you want to stop, The Sober Survival Guide has the power to motivate and inspire. Friends and family members of a heavy drinker will also benefit from this book.

Additionally, The Sober Survival Guide is recommended for anyone working in the mental health field. If you have a client who is worried about their drinking or unsure if they have a problem, this book offers answers while providing a refreshing perspective on alcohol use. (It’s proven that people are better equipped to make sustainable change when presented with a variety of options instead of just one. Don’t contribute to the myth that AA is the only way to get sober!)

Image by bruce lam from Pixabay

Is there anyone who should not read this book? In some ways, The Sober Survival Guide oversimplifies addiction; it does not take into account the complex relationship between trauma and substance use. Some of the techniques described in the second part of the book are not trauma-informed. Additionally, if you’ve been diagnosed with a serious mental illness (i.e. major depressive disorder, bipolar disorder, schizophrenia, etc.), your recovery requires a co-occurring approach in order to treat both the addiction and the mental disorder. Lastly, if you have a severe addiction and are physically dependent on alcohol, it’s likely you’ll require extensive, ongoing treatment in order to fully recover; the tips in the book aren’t sufficient (which is noted by the author).


In sum, if you’re tired of the role alcohol plays in your life, consider reading The Sober Survival Guide! You have nothing to lose, but much to gain.


For Simon’s newest book (Kindle version), How to Quit Alcohol in 50 Days: Stop Drinking and Find Freedom, which is set to be released by the end of this year, click here! Check back for an exclusive review on Mind ReMake Project prior to the release date.


Journal Prompts from The Sober Survival Guide

Chapple recommends journaling as a tool for reflection and change. The following prompts are based on material from The Sober Survival Guide. (Download a printable PDF version below.)


Reflect on the following:

✒ What are your drinking habits now? How much? How often? What drinks do you have? What were your drinking habits one year ago? What were your drinking habits five years ago? (Compare your answers. Are you drinking more now than you were before?) (pg. 29)

✒ Calculate the time (per week) you spend drinking alcohol. Consider calculating the time spent planning to drink or recovering from the effects of alcohol. (pg. 147)

✒ List the reasons your life is better because of alcohol. Next, challenge each reason. (pg. 44)

✒ Does labeling yourself as an “alcoholic” or “addict” help or harm you? Why? (pg. 10)

✒ Do you believe you have to hit “rock bottom” to recover? Why or why not? (pg. 41)

✒ Have you ever hit “rock bottom”? Describe the incident in detail. If you haven’t had a “rock bottom” experience, what do you think it would look like? (pg. 41)

✒ What are your current beliefs surrounding alcohol? For each belief you list, write a challenging statement. (Example: “I fail at everything I do – I doubt I can [quit alcohol].” Challenge with “If I don’t try, I won’t ever know. I’ll approach this with an open mind and a sense of curiosity.”) (pg. 38)

✒ Record your current feelings surrounding drinking. (pg. 58)

✒ List specific fears you have about quitting drinking. (Examples: What if my friends think I’m boring sober? What if I fail? What if I can’t have fun anymore?) (pg. 79)

✒ Create a cravings log. List the times of day you experience cravings and what is happening at those times. (pg. 78)

✒ List the pros and cons of drinking. (pg. 77)

✒ List some of the reasons you want to stop drinking. Write about how you want your life to change. (Be specific!) (pg. 25)

✒ List the ways alcohol has negatively impacted your health. Include health concerns you may not have experienced yet. (pg. 28)

✒ List all of the occasions or special events you’ve put alcohol ahead of and reflect on your answers. (pg. 33)

✒ List all of the people, situations, and events you’ve neglected in favor of drinking. Then, for each item, write how the same situation/event would have looked like if you hadn’t been drinking. (pg. 36)

✒ List your justifications for drinking. (Examples: “I work hard; I earned this drink.” “It’s just a beer, not hard liquor.” “I never drink alone.” “I only drink on weekends.”) (pg. 32)

✒ Review your list of current beliefs surrounding alcohol. Assign an emotion to each belief. (Example: “Without drinking each day, I’ll never be happy.” The underlying emotions are worry and sadness.) Next, replace each belief with a truthful statement, something that could become. (Example: “I am happy because [insert reason(s) here], but I have a hard time not drinking every day. So I’m working on this to become stronger.”) (pg. 47)

✒ Write a “breakup” letter to alcohol. (pg. 55)

✒ List all the things you want to do or experience once you are alcohol-free. (pg. 69)

✒ Create a list of ways you can celebrate your success. (Be sure to calculate how much money you’ll save by quitting drinking.) (pg. 84)

✒ Create a sober bucket list. (pg. 148)

✒ List everything you may lose if you start drinking again. (pg. 83)

✒ Create a personal accountability statement. (pg. 83)

✒ List ways you can respond to others when they ask why you’re not drinking. (Examples: “I’m driving.” “Not now, no thanks.” “Not tonight, maybe another time.”) (pg. 74)

✒ When you have an upcoming event that’s potentially triggering, visualize what you will do, say, etc. Write your detailed vision in your journal. (pg. 97)

✒ Create a list of coping skills for when you’re experiencing a low mood. (pg. 116)

✒ Create a gratitude list. (pg. 117)

✒ Create a daily thought log. What are some of the thoughts you have about drinking throughout the day? (pg. 120)

✒ If you experience a lapse or relapse, describe what happened. Pinpoint the exact moment you decided to drink. (pg. 66)

✒ Review what you wrote (in the previous entry) about your lapse or relapse. Identify the triggers you experienced. (pg. 78)

✒ Write a statement of commitment to an alcohol-free life. (pg. 168)


Bonus Material: Checklist for the Problems and Challenges You’ll Face

Alcarelle: A Hangover-Free Alternative to Alcohol

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!

By Cassie Jewell, M.Ed., LPC, LSATP

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.

Nutt, who specializes in the research of drugs that affect the brain, especially in the areas of addiction, anxiety, and sleep, discovered the substance while researching alcohol’s effects in hopes of developing a “sober up” (alcohol antagonist) pill.

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 with Alcarelle.

Currently, Alcarelle is in the development stage. Nutt’s plan is for Alcarelle 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 Alcarelle. 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.    

Image by congerdesign from Pixabay

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.”

Book Review: Staying Sober Without God

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.

Reviewed by Cassie Jewell, M.Ed., LPC, LSATP

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.

Image by congerdesign from Pixabay

The Practical 12 Steps are as follows:

  1. Admitted we were caught in a self-destructive cycle and currently lacked the tools to stop it
  2. Trusted that a healthy lifestyle was attainable through social support and consistent self-improvement
  3. Committed to a lifestyle of recovery, focusing only on what we could control
  4. Made a comprehensive list of our resentments, fears, and harmful actions
  5. Shared our lists with a trustworthy person
  6. Made a list of our unhealthy character traits
  7. Began cultivating healthy character traits through consistent positive behavior
  8. Determined that the best way to make amends to those we had harmed
  9. Made direct amends to such people wherever possible, except when to do so would cause harm
  10. Practiced daily self-reflection and continued making amends whenever necessary
  11. We started meditating
  12. 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.”

Image by xxolaxx from Pixabay

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.

Image by m storm from Pixabay

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.

Kratom: A Safe Alternative to Heroin?

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.

By Cassie Jewell, M.Ed., LPC, LSATP

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.

Image by GOKALP ISCAN from Pixabay

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.

Image by Abel Tadesse from Pixabay

Harm-Reduction

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 and 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.

Image by Simon Orlob from Pixabay

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.

Image by StockSnap from Pixabay

Bottom Line

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.


  • References
  • Apryani, E., Hidayat, M. T., Moklas, M. A. A., Fakurazi, S., & Idayu, N. F. (2010). Effects of mitragynine from mitragyna speciosa korth leaves on working memory. Journal of Ethnopharmacology129(3), 357-360.
  • Burke, D., Shearer, A., & Van Cott, A. (2019). Two cases of provoked seizure associated with kratom ingestion. Neurology, 92(15), 4.5-030.
  • Coe, M.A., Pillitteri,J.L, Sembower, M.A., Gerlach, K.K., & Henningfield, J.E. (2019). Kratom as a substitute for opioids: Results from an online survey. Drug and Alcohol Dependence, 202, 24-32. ISSN 0376-8716, https://doi.org/10.1016/j.drugalcdep.2019.05.005
  • Eggleston, W., Stoppacher, R., Suen, K., Marraffa, J. M., & Nelson, L. S. (2019). Kratom use and toxicities in the United States. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy.
  • Gutridge, A.M., Robins, M.T., Cassell, R.J., Uprety, R., Mores, K.L., Ko, M.J., Pasternak, G.W., Majumdar, S., & van Rijn, R.M. (2019), Therapeutic potential of g-protein-biased kratom-derived and synthetic carfentanil-amide opioids for alcohol use disorder. The FASEB Journal, 33:1, 498.3-498.3.
  • Halpenny, G.M. (2017). Mitragyna speciosa: Balancing potential medical benefits and abuse. ACS Medicinal Chemistry Letters, 8(9), 897-899. DOI: 10.1021/acsmedchemlett.7b00298
  • Hassan, Z., Muzaimi, M., Navaratnam, V., Yusoff, N.H.M., Suhaimi, F.W., Vadivelu, R., Vicknasingam, B.K., Amato, D., von Hörsten, S., Ismail, N.I.W., Jayabalan, N., Hazim, A.I., Mansor, S.M., & Müller, C.P. (2013). From kratom to mitragynine and its derivatives: Physiological and behavioural effects related to use, abuse, and addiction. Neuroscience & Biobehavioral Reviews, 37:2,138-151, ISSN 0149-7634. https://doi.org/10.1016/j.neubiorev.2012.11.012
  • Hassan, Z., Suhaimi, F., Dringenberg, H. C., & Muller, C. P. (2016). Impaired water maze learning and hippocampal long-term potentiation after mitragynine (kratom) treatment in rats. Front. Cell. Neurosci. Conference Abstract: 14th Meeting of the Asian-Pacific Society for Neurochemistry. doi: 10.3389/conf. fncel (Vol. 58).
  • Hassan, Z., Suhaimi, F. W., Ramanathan, S., Ling, K. H., Effendy, M. A., Müller, C. P., & Dringenberg, H. C. (2019). Mitragynine (kratom) impairs spatial learning and hippocampal synaptic transmission in rats. Journal of Psychopharmacology, 0269881119844186.
  • Hemby, S. E., McIntosh, S., Leon, F., Cutler, S. J., & McCurdy, C. R. (2018). Abuse liability and therapeutic potential of the mitragyna speciosa (kratom) alkaloids mitragynine and 7‐hydroxymitragynine.  Addiction Biologyhttps://doi.org/10.1111/adb.12639
  • Hughes, R. L. (2019). Fatal combination of mitragynine and quetiapine–a case report with discussion of a potential herb-drug interaction. Forensic Science, Medicine and Pathology15(1), 110-113.
  • Jaliawala, H. A., Abdo, T., & Carlile, P. V. (2018). Kratom: A potential cause of acute respiratory distress syndrome. DRUG INDUCED LUNG DISEASE: CASE REPORTS, A6604-A6604, American Thoracic Society.
  • Khor, B.S., Amar Jamil, M.F., Adenan, M.I., & Chong Shu-Chien, A. (2011). Mitragynine attenuates withdrawal syndrome in morphine-withdrawn zebrafish. PLOS ONE 6(12):e28340, https://doi.org/10.1371/journal.pone.0028340
  • Kumarnsit, E., Keawpradub, N., & Nuankaew, W. (2007). Effect of mitragyna speciosa aqueous extract on ethanol withdrawal symptoms in mice. Fitoterapia, 78:3, 182-185. ISSN 0367-326X, https://doi.org/10.1016/j.fitote.2006.11.012
  • Meepong, R., & Sooksawate, T. (2019). Mitragynine reduced morphine-induced conditioned place preference and withdrawal in rodents. Thai Journal of Pharmecutical Sciences, 43:1, 21-29.
  • NIDA. (2019, April 8). Kratom. Retrieved from https://www.drugabuse.gov/publications/drugfacts/kratom on 2019, July 19
  • Olsen, E.O., O’Donnell, J., Mattson, C.L., Schier, J.G., & Wilson, N. (2019). Notes from the field: Unintentional drug overdose deaths with kratom detected – 27 states. MMWR Morb Mortal Wkl Rep, 68:326-327.
  • Palasamudram Shekar, S., Rojas, E.E., D’Angelo, C.C., Gillenwater, S.R., & Martinez Galvis, N.P. (2019). Legally lethal kratom: A herbal supplement with overdose potential. Journal of Psychoactive Drugs51(1), 28-30.
  • Raffa, R.B., Pergolizzi, J.V., Taylor, R., & Ossipov, M.H (2018). Nature’s first “atypical opioids”: Kratom and mitragynines. J Clin Pharm Ther, 43: 437-441. https://doi.org/10.1111/jcpt.12676
  • Sakaran, R., Othman, F., Jantan, I., Thent, Z. C., & Das, S. (2014). An insight into the effect of mitragyna speciosa korth extract on various systems of the body. Global J Pharmacol8, 340-346.
  • Saref, A., Suraya, S., Singh, D., Grundmann, O., Narayanan, S., Swogger, M.T., Prozialeck, W.C., Boyer, E., Chear, N.J.Y., & Balasingam, V. (2019). Self-reported prevalence and severity of opioid and kratom (mitragyna speciosa korth) side effects. Journal of Ethnopharmacology, 238, 111876. ISSN 0378-8741, https://doi.org/10.1016/j.jep.2019.111876
  • Singh, D., Chye, Y., Suo, C., Yücel, M., Grundmann, O., Ahmad, M. Z., … & Mϋller, C. Brain magnetic resonance imaging of regular kratom (mitragyna speciosa korth) users: A preliminary study.
  • Singh, D., Müller, C.P., & Vicknasingam, B.K. (2014). Kratom (mitragyna speciosa) dependence, withdrawal symptoms and craving in regular users. Drug and Alcohol Dependence, 139, 132-137. ISSN 0376-8716, https://doi.org/10.1016/j.drugalcdep.2014.03.017
  • Singh, D., Narayanan, S., Müller, C.P., Swogger, M.T., Rahim, A.A., Abdullah, M.F.I.L.B., & Vicknasingam, B.K. (2018). Severity of kratom (mitragyna speciosa korth) psychological withdrawal symptoms. Journal of Psychoactive Drugs, 50:5, 445-450. DOI: 10.1080/02791072.2018.1511879
  • Singh, D., Narayanan, S., Müller, C. P., Vicknasingam, B., Yücel, M., Ho, E. T. W., … & Mansor, S. M. (2019). Long-term cognitive effects of kratom (mitragyna speciosa korth) use. Journal of Psychoactive Drugs51(1), 19-27.
  • Swogger, M.T., & Walsh, Z. (2018). Kratom use and mental health: A systematic review. Drug and Alcohol Dependence, 183, 134-140. ISSN 0376-8716, https://doi.org/10.1016/j.drugalcdep.2017.10.012
  • Tayabali, K., Bolzon, C., Foster, P., Patel, J., & Kalim, M.O. (2018). Kratom: A dangerous player in the opioid crisis. Journal of Community Hospital Internal Medicine Perspectives, 8:3, 107-110. DOI: 10.1080/20009666.2018.1468693
  • Veltri, C., & Grundmann, O. (2019). Current perspectives on the impact of kratom use. Substance Abuse and Rehabilitation10, 23–31. doi:10.2147/SAR.S164261
  • Yusoff, N. H. M., Suhaimi, F. W., Vadivelu, R. K., Hassan, Z., Rümler, A., Rotter, A., Amato, D., Dringenberg, H. C., Mansor, S. M., Navaratnam, V., & Müller, C. P. ( 2016). Abuse potential and adverse cognitive effects of mitragynine (kratom). Addiction Biology21:98– 110. doi: 10.1111/adb.12185