Free Printable PDF Workbooks, Manuals, and Toolkits for Providers Who Work with Children, Adolescents, & Families

A resource list for providers who work with youth and families. Free PDF manuals for clinicians and handouts/guides for families.

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

Updated February 10, 2020

The original source for this list is my post, Free Printable PDF Workbooks, Manuals, and Self-Help Guides. However, the “Children, Youth, & Families” section was becoming too lengthy. The purpose of this post is to organize the youth and family resources so you can quickly find what you’re looking for. This post is divided into two sections: one for providers and one for families.

For Providers

Treatment Manuals/CURRICULUMs & Workbooks

Mood & Anxiety Disorders

Adolescent Coping with Depression Course: Leader’s Manual for Adolescent Groups (321 pages) | Student Workbook (199 pages) | Leader’s Manual for Parent Groups (139 pages) | Parent Workbook (73 pages) (Source: Kaiser Permanete for Health Research) (Find more information here)

The Adolescent Coping with Stress Course: An Eight-Session Curriculum Developed for the Prevention of Unipolar Depression in Adolescents with an Increased Future Risk: Leader Manual (118 pages) | Adolescent Workbook (79 pages) (Source: Kaiser Permanete for Health Research) (Find more information here)

The Adolescent Coping with Stress Course: A Fifteen-Session Class Curriculum Developed for the Prevention of Unipolar Depression in Adolescents with an Increased Future Risk: Leader Manual (112 pages) | Adolescent Workbook (82 pages) (Source: Kaiser Permanete for Health Research) (Find more information here)

Break Free from Depression: A 4-Session Curriculum Addressing Adolescent Depression (Source: Suicide Prevention Resource Center)

Managing Depression: A Facilitator’s Guide for Working with Groups of Women Living with Depression During Pregnancy, After Delivery and Beyond (Source: Best Start, 42 pages)

STEADY: Intervention Manual (107 pages) | Adolescent Workbook (87 pages) (Source: Kaiser Permanete for Health Research) (Find more information here)

Substance Use Disorders

Matrix Series (Intensive Outpatient Treatment for People with Stimulant Use Disorders): Counselor’s Family Education Manual (Source: SAMHSA, 176 pages)

A Modified DBT Group Therapy Manual

Partners In Parenting: A DATAR/FIRST CHOICE Treatment Manual (Source: Texas Institute of Behavioral Research at TCU, 294 pages) 2002

Trauma & Related Disorders

Dealing With Trauma: A TF-CBT Workbook for Teens (Source: The National Child Traumatic Stress Network, Medical University of South Carolina, 35 pages) (Link to facilitator training here)

The T.O.P. Workbook for Sexual Health: Facilitator’s Manual (Source: Resources for Resolving Violence, Inc., 87 pages) 2010 (Purchase additional workbooks/manuals here)

Triad Girls’ Group Treatment Manual (Source: The Louis de la Parte Florida Mental Health Institute, University of South Florida, 201 pages) (More information on the Triad Project here)

Anger

Getting Along and Keeping It Cool: How Anger Works (Therapist Group Manual) (Source: Centre for Clinical Interventions with YouthLink, 79 pages)

Self-Esteem

On My Own Two Feet Series: Identity and Self-Esteem (76 pages) | Understanding Influences (103 pages) | Assertive Communication (121 pages) | Feelings (83 pages) | Decision Making (113 pages) | Consequences (81 pages) | Work Cards (129 pages) (Source: Department of Education and Skills and Professional Development Services for Teachers) (Find more information here)

LGBTQ Youth

Growing Up Lesbian, Gay, Bisexual, or Transgender (Source: Department of Education and Skills and the Health Service Executive through the Social, Personal and Health Education Support Service, in conjunction with GLEN [Gay and Lesbian Equality Network] and BeLonG To Youth Services; and Professional Development Services for Teachers, 82 pages) (Find more information here)

It Gets Better: A Group Experience for LGBTQ Youth (Group Curriculum Outline) (Source: Catherine Griffith, Ph.D., 13 pages)

Latinix Youth

Latino Multifamily Group Program Manual, (Source: Valley Nonprofit Resources, 64 pages)

Health & Wellness

Be Real. Be Ready. (A comprehensive relationship and sexuality curriculum for high school students) (Source: Adolescent Health Working Group)

Healthy Living, Healthy Minds: A Toolkit for Health Professionals (Promoting Healthy Living in Children and Youth with Mental Health Challenges) (149 pages) | Healthy Living… It’s in Everyone (A Companion Workbook, 82 pages) (Source: BC Mental Health and Substance Use Services)

TRUST (Talking. Relationships. Understanding Sexuality. Teaching Resource.) Workbook (Source: National Council for Curriculum and Assessment; Department of Education and Science, the Health Service Executive, and Crisis Pregnancy Agency; and Department of Education and Skills and Professional Development Services for Teachers, 126 pages) (Find more information here)

Group Counseling Resources

A Collection of Icebreakers and Connection Activities (33 pages)

Favorite Therapeutic Activities for Children, Adolescents, and Families: Practitioners Share Their Most Effective Interventions (Source: Edited by Liana Lowenstein, MSW, 119 pages)

Group Counseling Guide (Group activities for children) (Source: Rita Zniber Foundation, 45 pages)

Toolkits & Guides

Alcohol Problems in Intimate Relationships: Identification and Intervention (A Guide for Marriage and Family Therapists) (Source: National Institute on Alcohol Abuse and Alcoholism, 83 pages)

Behavioral Health: Adolescent Provider Toolkit (Source: Adolescent Health Working Group)

Body Basics: Adolescent Provider Toolkit (Source: Adolescent Health Working Group)

Child Trauma Toolkit for Educators (Source: The National Child Traumatic Stress Network, 21 pages)

Community Reinforcement and Family Training Support and Prevention (Source: U.S. Department of Veterans Affairs, 103 pages)

A Practitioner’s Resource Guide: Helping Families to Support Their LBGT Children (Source: SAMHSA, 18 pages)

Promoting Emotional Resilience: Helping children to find ways to function in a world where bad things happen – A Resource Pack (Source: West Sussex CAMHS and School Attendance Project, 141 pages) 2008

Sexual Health: Adolescent Provider Toolkit (Source: Adolescent Health Working Group

Stress Lessons Toolkit (Source: Psychology Foundation of Canada in partnership with Pfizer Canada, 52 pages) 2012

Trauma & Resilience: Adolescent Provider Toolkit (Source: Adolescent Health Working Group)

The Use of a Full Family Assessment to Identify the Needs of Families with Multiple Problems (Source: UK Department for Education, 105 pages)

For Families

Workbooks For Children & Adolescents

Anxiety Toolbox: Student Workbook (42 pages)

COPE (CAPS COPING SKILLS SEMINAR): Student Workbook (Source: West Carolina University Counseling and Psychological Services, 28 pages)

Dealing With Depression: Antidepressant Skills for Teens (Source: Vancouver Psych Safety Consulting Incorporated, 68 pages)

Just as I Am Workbook: A Guided Journal to Free Yourself from Self-Criticism and Feelings of Low Self-Worth (Source: Queen’s University, 56 pages)

Lemons or Lemonade? An Anger Workbook for Teens (Source: Jane F. Gilgun, PhD, LICSW, Education4Health, 38 pages)

Mighty Moe: An Anxiety Workbook for Children (Source: Lacey Woloshyn, 79 pages)

Safe Spot Stress Management Series

Safe Spot: Stress Management Workbook 1 – What Is Stress? (45 pages)

Safe Spot: Stress Management Workbook 2 – Behaviour and Stress (27 pages)

Safe Spot: Stress Management Workbook 3 – Thought Patterns and Stress (29 pages)

Safe Spot: Stress Management Workbook 4 – Problem-Solving and Well-Being (27 pages)

Your Best You: Improving Your Mood (Source: Queen’s University, 103 pages)

Your Best You: Managing Your Anxiety (Source: Queen’s University, 169 pages)

Youth Transition Workbook (Source: Pennsylvania Youth Leadership Network/The Rhode Island Transition Council/The Rhode Island Department of Health Youth Advisory Council, 68 pages) 2017

Toolkits & Guides

For Parents & Caregivers

ADHD: Attention Deficit Hyperactivity Disorder (Information for Families) (Source: BC Mental Health and Substance Use Services, 12 pages)

After an Attempt A Guide for Taking Care of Your Family Member after Treatment in the Emergency Department (12 pages) | Spanish Version (14 pages) (Source: SAMHSA)

After a Loved One Dies – How Children Grieve and How Parents and Other Adults Can Support Them (Source: New York Life, 24 pages)

Bipolar Disorder in Children and Teens: A Parent’s Guide (Information Booklet) (Source: National Institute of Mental Health, Hosford Clinic, 27 pages)

Bipolar Disorder: Parents’ Medication Guide for Bipolar Disorder in Children & Adolescents (Source: American Academy of Child and Adolescent Psychiatry, 63 pages)

Borderline Personality Disorder: An Information Guide for Families (Source: CAMH, 72 pages)

Coping with Anxiety During Pregnancy and Following the Birth: A Cognitive Therapy-Based Self-Management Guide for Women and Health Care Providers (Source: BC Mental Health and Substance Use Services, 178 pages)

Coping with Depression During Pregnancy and Following the Birth: A Cognitive Therapy-Based Self-Management Guide for Women (Source: BC Mental Health and Substance Use Services, 118 pages)

Coping with Separation Anxiety Handbook (Source: BC Legal Services Society, 24 pages)

Emotional Intelligence Activities for Teens Ages 13-18 (Source: The Ohio National Guard, 34 pages)

Families in Transition: A Resource Guide for Families of Transgender Youth (Source: Central Toronto Youth Services, 56 pages)

A Family Guide to Concurrent Disorders (Source: CAMH, 222 pages)

Gaining Control of Your Life After Having a Baby: A Self-Help Workbook for Post-natal Depression (Source: Maternal Mental Health Alliance, 38 pages)

Managing Depression: A Self-Help Skills Resource for Women Living with Depression During Pregnancy, After Delivery and Beyond (Source: Best Start, 57 pages)

The Mind Body Connection and Somatization: A Family Handbook (Source: BC Mental Health and Substance Use Services, 46 pages)

Oppositional Defiant Disorder: A Guide for Families by the American Academy of Child and Adolescent Psychiatry (18 pages)

Patient & Family Guide to Second-Generation Antipsychotics (Source: BC Mental Health and Substance Use Services, 44 pages)

Postnatal Depression and Perinatal Mental Health (Source: Mind UK, 31 pages)

Recognizing Resilience: A Workbook for Parents and Caregivers of Teens Involved with Substances (Source: BC Mental Health and Substance Use Services, 104 pages)

A Resource Guide for Families Dealing with Mental Illness (Source: Michigan National Alliance on Mental Health, 40 pages)

Suicide Prevention for Consumers and Family Members (Source: Montgomery County Emergency Service, Inc., 26 pages)

Tools & Resources (Toolkit for Families) (Source: Kelty Mental Health, 25 pages)

What Community Members Can Do: Helping Children and Adolescents Cope with Violence and Disasters (For Teachers, Clergy, and Other Adults in the Community) (Information Booklet) (Source: National Institute of Mental Health, Hosford Clinic, 20 pages)

For Youth & Adolescents

Healthy Living for Teens (Source: BC Mental Health and Substance Use Services, 23 pages)

A Sibling’s Guide to Psychosis: Information, Ideas, and Resources (Source: Canada Mental Health Association, 34 pages)

Student Life (Source: Mind UK, 22 pages)

Unconventional Coping Strategies

A list of uncommon strategies for coping with stress, depression, and anxiety. Includes a free PDF version of the list to print and use as a handout.

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

With Lauren Mills, MA, LPC-Intern (Contributor)

Effective coping skills make it possible to survive life’s stressors, obstacles, and hardships. Without coping strategies, life would be unmanageable. Dr. Constance Scharff described coping mechanisms as “skills we… have that allow us to make sense of our negative experiences and integrate them into a healthy, sustainable perspective of the world.” Healthy coping strategies promote resilience when experiencing minor stressors, such as getting a poor performance review at work, or major ones, such as the loss of a loved one.

Like any skill, coping is important to practice on a regular basis in order to be effective. Do this by maintaining daily self-care (at a minimum: adequate rest, healthy meals, exercise, staying hydrated, and avoiding drugs/alcohol.)

As an expert on you (and how you adapt to stressful situations), you may already know what helps the most when life seems out-of-control. (I like reading paranormal romance/fantasy-type books!) Maybe you meditate or run or rap along to loud rap music or have snuggle time with the cats or binge watch your favorite show on Netflix. Having insight into/awareness of your coping strategies primes you for unforeseeable tragedies in life.

“Life is not what it’s supposed to be. It’s what it is. The way you cope with it is what makes the difference.”

Virginia Satir, Therapist (June 26, 2019-September 10, 1988)

Healthy coping varies greatly from person to person; what matters is that your personal strategies work for you. For example, one person may find prayer helpful, but for someone who isn’t religious, prayer might be ineffective. Instead, they may swim laps at the gym when going through a difficult time. Another person may cope by crying and talking it out with a close friend.

Note: there are various mental health treatment approaches (i.e. DBT, trauma-focused CBT, etc.) that incorporate specialized, evidence-based coping techniques that are proven to work (by reducing symptoms and improving wellbeing) for certain disorders. The focus of this post is basic coping, not treatment interventions.

On the topic of coping skills, the research literature is vast (and beyond the scope of this post). While many factors influence coping (i.e. personality/temperament, stressors experienced, mental and physical health, etc.), evidence backs the following methods: problem-solving techniques, mindfulness/meditation, exercise, relaxation techniques, reframing, acceptance, humor, seeking support, and religion/spirituality. (Note that venting is not on the list!) Emotional intelligence may also play a role in the efficiency of coping skills.

Current research

In 2011, researchers found that positive reframes, acceptance, and humor were the most effective copings skills for students dealing with small setbacks. The effect of humor as a positive coping skill has been found in prior studies, several of which focused on coping skills in the workplace.

A sport psychology study indicated that professional golfers who used positive self-talk, blocked negative thoughts, maintained focus, and remained in a relaxed state effectively coped with stress, keeping a positive mindset. Effective copers also sought advice as needed throughout the game. A 2015 study suggested that helping others, even strangers, helps mitigate the impact of stress.


Examples of coping skills include prayer, meditation, deep breathing, exercise, talking to a trusted person, journaling, cleaning, and creating art. However, the purpose of this post is to provide coping alternatives. Maybe meditation isn’t your thing or journaling leaves you feeling like crap. Coping is not one-size-fits-all. The best approach to coping is to find and try lots of different things!

The inspiration for this post came from Facebook. (Facebook is awesome for networking! I’m a member of several professional groups.) Lauren Mills sought ideas for unconventional strategies via Facebook… With permission, I’m sharing some of them here!    

Unconventional Coping Strategies

1) Crack pistachio nuts

2) Fold warm towels

3) Smell your dog (Fun fact: dog paws smell like corn chips!) or watch them sleep

4) Peel dried glue off your hands

5) Break glass at the recycling center

6) Pop bubble wrap

7) Lie upside down

8) Watch slime or pimple popping videos on YouTube

9) Sort and build Lego’s

10) Write in cursive

11) Observe fish in an aquarium

12) Twirl/spin around

13) Solve math problems (by hand)

14) Use a voice-changing app (Snapchat works too) to repeat back your worry/critical thoughts in the voice of a silly character OR sing your worries/thoughts aloud to the tune of “Happy Birthday”

15) Listen to the radio in foreign languages

16) Chop vegetables

17) Go for a joy ride (Windows down!)

18) Watch YouTube videos of cute animals and/or giggling babies

19) Blow bubbles

20) Walk barefoot outside

21) Draw/paint on your skin

22) Play with (dry) rice

23) Do (secret) “random acts of kindness”

24) Play with warm (not hot) candle wax

25) Watch AMSR videos on YouTube

26) Shuffle cards

27) Recite family recipes

28) Find the nicest smelling flowers at a grocery store

29) Count things

30) Use an app to try different hairstyles and/or makeup

31) People-watch with a good friend and make up stories about everyone you see (Take it to the next level with voiceovers!)

32) Wash your face mindfully

33) Buy a karaoke machine and sing your heart out when you’re home alone

34) On Instagram, watch videos of a hydraulic press smash things, cake decorating, pottery/ceramics throwing, hand lettering, and/or woodwork

35) Shine tarnished silver

36) Create a glitter jar and enjoy

37) Tend to plants

38) Color in a vulgar coloring book for adults


Download a PDF version (free) of “Unconventional Coping Strategies” below. This handout can be printed, copied, and shared without the author’s permission, providing it’s not used for monetary gain. Please modify as needed.


Lauren Mills, MA, LPC-Intern (Supervised by Mary Ann Satori, LPC-S) is a therapist in Texas and a current resident in counseling.     

I’d like to acknowledge all members of Therapist Toolbox – Resources & Support for Therapists who submitted ideas!

If you have an uncommon coping skill, post in a comment!


References

Association for Psychological Science. (2015, December 14). Helping others dampens effects of everyday stress. ScienceDaily. Retrieved January 13, 2020 from http://www.sciencedaily.com/releases/2015/12/151214084744.htm

Canisius College. (2008, January 26). Laughter is the best medicine. ScienceDaily. Retrieved January 13, 2020 from http://www.sciencedaily.com/releases/2008/01/080124200913.htm

Loyola University Health System. (2018, September 21). Boosting emotional intelligence in physicians can protect against burnout. ScienceDaily. Retrieved January 12, 2020 from http://www.sciencedaily.com/releases/2018/09/180921140200.htm

Scharff, C. (2016). Understanding and choosing better coping skills: You can change your mood without drugs. Psychology today. Retrived from https://www.psychologytoday.com/us/blog/ending-addiction-good/201609/understanding-and-choosing-better-coping-skills

University of Alberta. (2005, June 18). A good game of golf: Mind over matter. ScienceDaily. Retrieved January 13, 2020 from http://www.sciencedaily.com/releases/2005/06/050617235448.htm

University of Kent. (2011, July 14). Positive reframing, acceptance and humor are the most effective coping strategies. ScienceDaily. Retrieved January 12, 2020 from http://www.sciencedaily.com/releases/2011/07/110704082700.htm

Wiley-Blackwell. (2008, April 9). Humor plays an important role in healthcare even when patients are terminally ill. ScienceDaily. Retrieved January 13, 2020 from http://www.sciencedaily.com/releases/2008/04/080408112104.htm

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.    

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.”

DC Area Locals: Ride Free This Holiday Season

Ride free (and safe) this holiday season with Lyft using the SoberRide promo code!

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

According to WTOP, 4 out of 10 traffic fatalities during the holiday season involve drunk driving. Be safe and stay alive this year!

Self-Care Strategies When Your Loved One Has an Addiction

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.

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

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.  

In the book Beyond Addiction: A Guide for Families, the authors discuss the importance of self-care. This post reviews suggested strategies. (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

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:

  1. Eat well
  2. Sleep well
  3. Exercise enough
  4. Avoid mood-altering drugs (including alcohol)
  5. Treat illness (with prescribed medications, adequate rest, etc.)

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.

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

  1. 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).
  2. 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.
  3. 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.
  4. 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).

Relax

“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 techniques 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. 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.)

Create a Positive Experience

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 techniques include the following:

  1. Half-smile. Another mind-body technique, half-smiling tricks your brain into feeling happier.
  2. 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.”
  3. Move. By moving, you’re shifting your focus and releasing energy. Stretch, run, play volleyball, chop wood, move furniture, etc.
  4. 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?
  5. 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.

Therapy and Support Groups

Lastly, 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.

For more information on how you can help your loved one, visit The Center for Motivation and Change.

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

  • Staying Sober Without God by Jeffrey Munn, LMFT
  • Published in 2019, 165 pages

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.) Munn writes, “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 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.”

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.

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 kratom leaves produces a high. Taken in small amounts, kratom 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. Kratom, an opioid agonist, 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 kratom 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 kratom 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; kratom lessened the discomfort of opioid withdrawal. Multiple studies have substantiated these findings, suggesting that kratom is 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 kratom decreased alcohol use; this suggests that kratom may help those with alcohol use disorders (AUD) in addition to opioid addiction.

Harm-Reduction

Compared to heroin, kratom is less addictive and has milder withdrawal symptoms. Furthermore, the risk of deadly overdose is reduced with kratom use. A 2018 literature review indicated that kratom 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 kratom 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, kratom 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 kratom for opioid withdrawal, kratom was likely the cause of acute lung injury. Kratom use may also cause cardiac or respiratory arrest.

Kratom’s harmful effects are not limited to the body; a 2010 study linked chronic kratom 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 kratom may affect learning. In 2019, researchers found that high doses of kratom 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 kratom use leads to dependence, withdrawal symptoms, and cravings. Kratom cessation may also cause psychological withdrawal symptoms, such as anxiety and depression.

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 kratom 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 kratom to reduce/stop their opioid use, I won’t lecture about the “dangers” of kratom. Until we have more answers, I will hold to the view that kratom is a harm-reduction measure… and it has the potential to save lives.


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