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, 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.


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

Sites with Helpful Resource Lists

A list with links to other sites’ resource pages

By Cassie Jewell, LPC, LSATP

I have a knack for finding resources. To compile the lists for this blog, I spend countless hours searching the Internet.

My main resource list has grown tremendously since I started blogging. In my quest to compile the most comprehensive resource list ever, I came across a few lists that rival my own.

This post will link you to a variety of resource pages (in case you can’t find what you’re looking for on this site!) If a link isn’t working, try going to the site’s homepage or sitemap to look for the resource section.


Community Resources (ADAA)

From the Anxiety and Depression Association of America

DISCOVER AND RECOVER: Resources for Mental and Overall Wellness

A blog with tons of resources

Expert Resources from JED and Others

Resources for teens and young adults

Find Resources (CADCA)

An extensive searchable resource list from CADCA (for substance use disorder-related resources)

Free Mental Health Resources

A list compiled by blogger Blake Flannery (last updated 2015)

Links (Sidran Institute)

From the Sidran Institute… tons of sites I’d never heard of!

Links to Other Empowering Websites

From the National Empowerment Center

Mental Health and Psychology Resources Online

A list of online resources from PsycCentral

Mental Health Resources for Therapists and Clients

From the blog: Info Counselling – Evidence based therapy techniques. Compiled/last updated 2017.

Mental Health Resources List

A fairly comprehensive list similar to mine. Updated 2018.

Resources

Resources for child sexual abuse

Resources (Veto Violence)

A searchable resource database from Veto Violence (a CDC organization)

Self-Injury and Recovery Research and Resources

Resources for those who self-injure, their loved ones, students, and health professionals

Sites We Like

From S.A.F.E. Alternatives – Resources related to self-harm

Veteran Resources

A resource list from Lifeline for Vets (National Veterans Foundation)

Books and Resources for Therapists

A resource list for therapists and other mental health professionals, including book recommendations and sites that link to (free!) printable worksheets, handouts, and more.

By Cassie Jewell, LPC, LSATP

Updated July 12, 2019

This is a list of books and websites for mental health professionals. Please check back as I update regularly. If you have a suggestion, use the contact form on this site to send me a message.


Armstrong, C. (2015). The Therapeutic “Aha!” Strategies for Getting Your Clients Unstuck.

Belmont, J. (2015). The Therapist’s Ultimate Solution Book.

Finley, J., & Lenz, B. (2014). Addiction Treatment Homework Planner, 5th ed. Provides you with an array of ready-to-use, between-session assignments designed to fit virtually every therapeutic mode.


ACEs Connection

An ACEs community for connecting with others who practice trauma-informed care. You can also access the latest news and research related to ACEs; this site also has a huge resource section with guides, surveys, webinars, and more.

ACT Mindfully

A variety of free worksheets, handouts, book chapters, articles, and more. Acceptance and Commitment Therapy (ACT) is a unique and creative model for both therapy and coaching; a type of cognitive behavioural therapy based on the innovative use of mindfulness and values.

Association for Behavioral and Cognitive Therapies

Info and clinical resources, including archived Webinars and podcasts

CBT for Psychosis & Trauma & Psychosis Handouts

A short list of helpful handouts; this site is also a source for blog posts on psychosis and trauma (by Ron Unger, LCSW)

The Centre for Applied Research in Mental Health and Addiction – Tools and Resources

The Centre for Applied Research in Mental Health and Addiction (CARMHA) is an internationally recognized research centre based at the Faculty of Health Sciences, Simon Fraser University, Vancouver. CARMHA conducts innovative and interdisciplinary scientific research related to mental health and substance use, primarily in the areas of clinical or other intervention practice, health systems and population health and epidemiology. Access free downloadable workbooks for stress in the workplace, depression, coping with chronic pain, and other topics.

Centre for Clinical Interventions

Free downloadable workbooks on anxiety, self-esteem, eating disorders, panic, perfectionism, and more

Evidence-Based Behavioral Practice

Information on evidence-based behavioral practices; includes tools, assessments, videos, and free online training modules

Guided Self-Change

A great resource for SUD assessments, group materials, and handouts

Get Self-Help – Free Resources

This website provides CBT self-help and therapy resources, including a large collection of worksheets and information sheets and self-help mp3s; a useful tools for therapists or individuals seeking to manage a mental health condition.

Kim’s Counseling Corner – Therapy and Self-Help Worksheets

Kim Peterson, LPC-S, specializes in child and teen issues, parenthood, play therapy and relationships. She provides links to online worksheets or PDF versions that she has collected over time as a therapist. Topics include abuse, depression, anxiety, self-harm, and more.

Marriage Intelligence: “Love Tools”

Free downloadable worksheets for surviving infidelity, forgiveness, communication, etc.

Mind Tools

Free management, leadership, and personal effectiveness worksheets and tools. (Join the Mind Tools Club for a fee to access additional tools and online courses.)

National Center for PTSD for Professionals

Free handouts, toolkits, online trainings, and more

Oxford Clinical Psychology: Forms and Worksheets

A vast collection of forms, handouts, and assessments on anxiety, OCD, depression, parenting, substance use, and more

Personality Lab

Articles, assessments, dissertations, etc. on personality intelligence

Positive Psychology Program

This site contains a wealth of free assessments, PDF printables, activities, handouts, worksheets, and more. Search by category or browse blog posts.

PsyberGuide

A nonprofit organization that discovers and reviews mental health apps, which are rated as unacceptable, questionable, or acceptable. You can also search target conditions and treatments. Use this site to make recommendations to your clients.

Psychology Tools

Psychology Tools is a leading online resource for therapists. Download free worksheets, assessments, and guides.

PsychPoint

Articles and worksheets

Self-Care Starter Kit from University at Buffalo School of Social Work

Designed to prevent/treat burnout, this kit includes info on vicarious trauma, assessments, meditations, and helpful links to additional self-care resources

SMI Adviser

Search topics and find resources for SMI. You can also access a variety of free online courses to earn CE credits.

Society for the Advancement of Psychotherapy

Articles, book reviews, and more on relevant topics

Society of Clinical Psychology (Division 12)

A division of the American Psychological Association, this site provides an up-to-date list of evidence-based treatments, and includes links to free assessments, manuals, handouts, etc. for many of the treatments

Therapist Aid

An extensive collection of free evidence-based education and therapy tools. Download customizable worksheets or access articles and treatment guides. An invaluable resource for therapists.

TherapyAdvisor.org

A searchable database of empirically supported treatments for SUD and MH

Ultimate Solution Handouts

Free printable handouts for therapists (from Judith Belmont)

UW Medicine: Harborview Medical Center (Center for Sexual Assault and Traumatic Stress)

Handouts/worksheets for clients on coping with challenging thoughts, anxiety, anger, etc. The site also includes a list of assessments.

12-Step Recovery Groups

An extensive list of support groups for recovery

Compiled by Cassie Jewell, LPC, LSATP

Updated July 12, 2019

There are a variety of 12-step support groups for recovery. 12-step meetings are not facilitated by a therapist; they’re self-run. Support groups are not a substitute for treatment, but can play a crucial role in recovery.

The following list, while not comprehensive, will link you to both well-known and less-familiar 12-step (and similar) organizations and support groups for recovery.

Support Groups for Addiction

Alcoholics Anonymous (AA)

Narcotics Anonymous (NA)

heroin anonymous (HA)

pills anonymous (PA)

Cocaine Anonymous (CA)

Crystal Meth Anonymous (CMA)

Marijuana Anonymous (MA)

Nicotine Anonymous (NicA)

caffeine addicts anonymous (cafaa)

chemically dependent anonymous (CDA)

all addicts anonymous (AAA)

recoveries anonymous (R.a.)

pharmacists recovery network

international doctors in alcoholics anonymous (IDAA)

international lawyers in alcoholics anonymous (ILAA)

association of recovering motorcyclists (A.R.M.)

For Families and Others Affected by Addiction and Mental Illness

Al-Anon/Alateen (For Family and Friends of Alcoholics)

Nar-Anon (For Family and Friends of Addicts)

Adult Children of Alcoholics (ACA)/Dysfunctional Families

Families Anonymous (FA)

parents anonymous

NAMI Family Support Group (For Adults with Loved Ones Who Have Experienced Mental Health Symptoms)

S-Anon/S-Ateen (For Family and Friends of Sexaholics)

codependents of sexual addiction – COSA (for those whose lives have been affected by another’s compulsive sexual behavior)

gam-anon (for families and friends of gamblers)

Secular Alternatives

SMART Recovery (Self-Management and Recovery Training)

Women for Sobriety

Rational recovery

sECULAR aa

Secular Organizations for Sobriety (SOS)

LifeRing Secular Recovery

Religious Alternatives

Celebrate Recovery

Christians in Recovery

Addictions Victorious

alcoholics victorious

Alcoholics for Christ

overcomers in christ

overcomers outreach

the calix society

jewish alcoholics, chemically dependent persons and significant others (jacs)

BUDDHIST RECOVER NETWORK

REFUGE RECOVERY

Additional Support Groups & Organizations

violence anonymous (VA)

Adult Survivors of Child Abuse Anonymous (ASCAA)

Survivors of Incest Anonymous

lds family services

porn addicts anonymous (PAA)

Sex Addicts Anonymous (SAA)

Sexaholics Anonymous

Sex and Love Addicts Anonymous (SLAA)

sexual compulsives anonymous (SCA)

Sexual recovery anonymous (SRA)

Co-dependents Anonymous (CoDa)

Emotions Anonymous

Dual Recovery Anonymous

Depressed Anonymous

social anxiety anonymous (SPA/Socaa)

PTSD Anonymous

Self Mutilators Anonymous

obsessive compulsive anonymous

obsessive skin pickers anonymous (OSPA)

Clutters Anonymous (CLA)

Overeaters Anonymous (OA)

Food Addicts Anonymous (FAA)

Food Addicts in Recovery Anonymous

Recovery from Food Addiction

Eating Disorders Anonymous (EDA)

Debtors Anonymous (DA)

Underearners Anonymous (UA)

spenders anonymous

Workaholics Anonymous

Gamblers Anonymous

internet & tech addicts anonymous (ITAA)

Online Gamers Anonymous (OLGA)

offenders anonymous

reentry anonymous

GROw in america (peer support for mental illness)

hearing voices network

AA Sites for agnostics and atheists: AA Agnostica and AA Beyond Belief


Do you know of a 12-step support group not listed here? Share in a comment!

#JunkieLivesDontMatter

A person who struggles with a substance use disorder is choosing that life. Why interfere? (Especially when all that money could be spent saving more DESERVING lives.) “Junkies” don’t deserve second chances because #JunkieLivesDontMatter

By Cassie Jewell, LPC, LSATP

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Disclaimer: If you happen to believe that addiction is a choice – “They’d quit if they really wanted to” or “They made the choice to use; they made the choice to die” – then scroll on to the next blog. You’d only scoff at this post because #JunkieLivesDontMatter

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This blog post is inspired, in part, by a Facebook meme.

The meme said,

“So if a kid has an allergic reaction the parents have to pay a ridiculous price for an Epi pen. But a junkie who has OD’d for their 15th time gets Narcan for free? What a screwed up world we live in.”

Implications: “Junkies” don’t deserve a second chance at life. They’re a waste of resources because they lack the willpower to stop using. A person who struggles with a substance use disorder is choosing that life. Why interfere? (Especially when all that money could be spent saving more deserving lives.)

If you believe it’s screwed up for a “junkie” to have a chance at life (and recovery) because they “chose addiction,” your opinion is contrary to the National Institute of Health, the American Medical Association, the American Psychiatric Association, and decades of scientific research. You’re either ignorant (maybe willfully so) or impressively arrogant. (Alternately, you could just be a jerk.) You’re a part of the movement: #JunkieLivesDontMatter

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Many have joined the movement, as evidenced by the following Facebook posts:

“Out of all of the houses, 2 hobos decided to overdose on my front steps… thank god the medics got here in time to ensure they could die another day…”

“I think we had less ODs before Narcan came on board. They realize they can be saved if gotten to in time. Maybe they need to be locked up & not let out until they attend rehab while in jail.”

“If it can be easily established that they have a recent history of drug [abuse]… then yes… withhold the lifesaving drug because they chose this. It’s harsh, but justice is not served by saving them.”

“If you don’t have it figured [out] by the 3rd overdose, you are just prolonging the inevitable and wasting tax payers money.”

“If we are repeatedly saving your life and you are not willing to change this behavior, why should we be obligated to keep saving you?”

“My personal opinion is we can’t keep letting people overdose and saving them just so they can repeat the cycle.”

“By continuously administering Narcan, sure, we’re saving their life, but are they really living? I don’t think so.”

#JunkieLivesDontMatter

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“No CPR for You, Fatty — You Chose Soda and Fast Food… Now Suffer the Consequences!”

According the the American Psychiatric Association,

Addiction is a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequence. People with addiction (severe substance use disorder) have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their life. They keep using alcohol or a drug even when they know it will cause problems.

Addiction is a scientifically proven brain disease. Despite this, many persist in the belief that it’s a choice, or worse… a moral failing. (Note: This notion comes from an early model of addiction, “the moral model,” which was deeply rooted in religion. Addiction was attributed to a sinful nature and weakness of character. Therefore, the addict must repent… or suffer the consequences of his/her actions; addiction warranted punishment, not empathy. Unsurprisingly, this created stigma. It also prevented those struggling with addiction from seeking treatment. Centuries later, many hold on to the view that an individual suffering from a substance use disorder is lazy or weak.)

Today, in the midst of the opioid epidemic, stigma’s unrelenting grip perseveres. Stigma is a poison; it’s dehumanizing. It’s easy to forget a person is a person when you view them as garbage, trash… a “junkie.” Stigma tells us, “Take out the trash.”

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To fully recognize stigma’s impact, compare addiction to other diseases. Consider common medical emergencies; many are related to lifestyle. Imagine being hospitalized after your third stroke, and the doctor telling you, “This is the third time I’ve saved your life, yet you refuse to exercise. I shouldn’t be obligated to continue to provide life-saving care.” Or, imagine a long-time smoker who develops lung cancer; they’re not demeaned, called names, or denied treatment. Moreover, an EMS worker wouldn’t withhold CPR from an individual in cardiac arrest if they were obese. It’s not a debate.

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If You’re Dead, You Have a 0% Chance of Recovery

We’re in the midst of an epidemic.

According to the CDC, 115 Americans die from an opioid overdose every day.

In 2016, over 42,000 individuals died from opioid overdose.

Life expectancy in America is actually declining due to an increase in fatal overdoses.

Narcan does not enable addiction. It enables life. (A dead addict can’t recover.)

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#Recovery #Empathy #FightStigma #EndTheEpedemic #SaveALife


If you live in Fairfax County, sign up for a free REVIVE! Training!

Helping Vs. Enabling: How to Tell the Difference

If you’re unfamiliar with the term “enable,” it means “to provide with the means or opportunity.” When applied to substance use, it means a person in active addiction is provided with the means to continue to use. With substance use disorders, how can you know the difference between helping and enabling? This post explains how to tell the difference and provides 7 tips for helping a loved one who struggles with addiction.

By Cassie Jewell, LPC, LSATP

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With substance use disorders, how can you know the difference between helping and enabling? I’ve worked with family members who inadvertently fueled their loved one’s addiction. They “helped” by bailing them out of jail, giving them money, etc., which only permitted the individual to continue to get high. It’s hard for family members to differentiate between behaviors that help versus enable.

If you’re unfamiliar with the term “enable,” it means “to provide with the means or opportunity” or “to make possible, practical, or easy” (according to Merriam-Webster). When applied to substance use, it means a person in active addiction is provided with the means to continue to use.

When I worked at a substance use treatment center, I taught families and loved ones that helping a person in active addiction means supporting their basic needs, such as food, water, shelter, and clothing. (If someone is in jail or treatment, their basic needs are met; therefore, bailing them out would be enabling.) Thinking in terms of “needs vs. wants” helps you to recognize enabling.

Recently, I answered a woman’s question on Quora about how to distance herself from her heroin-addicted daughter. The following paragraph is from my response:

Distancing yourself (or setting a boundary) with your daughter will be difficult because you want to help. In the past, by “helping” her, you’ve enabled her addiction (which hurts her in the long run) and leaves you emotionally depleted. There’s a very fine line between helping and enabling; it’s not clear-cut. (Plus, it can be counterintuitive for a parent whose job has always been to protect your child.)

When a parent has a son or daughter who struggles with addiction, it’s especially difficult to make the distinction between helping and enabling. A parent’s natural inclination is to nurture and protect from harm. It’s heart-wrenching to see your child in pain. But if a parent doesn’t set (and adhere to) healthy boundaries, they will quickly become emotionally drained (as they enable their child’s addiction).

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Here are some suggestions for helping (instead of enabling) a loved one who’s actively using:

  1. Never (ever) offer money.

If asked for cash for food, for example, buy groceries instead (or offer to take them to lunch). I worked with a father who bought a bag of groceries for his son, who struggled with severe alcoholism and was homeless, on a weekly basis. This is an excellent example of helping a loved one versus enabling their addiction.

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  1. If asked for help paying bills, say no. 

If your loved one doesn’t have to pay the electric bill, they’ll spend the money on drugs or alcohol. Furthermore, if you protect them from the consequences of not paying bills (i.e. having the power shut off), your loved one is less likely to see a need for change. (People don’t change when they’re comfortable.)

  1. If your loved one is addicted to opioids (heroin, morphine, hydrocodone, etc.), attend a training or take an online course on opioid overdose reversal (Narcan [naloxone] administration).

If you’re unsure where local trainings are offered, a Google search for “Narcan training” or “opioid reversal training” will link you to resources in your area. Most trainings are free. Keep a Narcan kit on your person at all times. Provide your loved one with a kit (or two) as well. This is not enabling. This is potentially saving a life and offering an opportunity for recovery. (A dead opioid-user will never recover.)

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  1. Offer to help them get into treatment.

Become familiar with the different treatment options in your area. Don’t give ultimatums (i.e. “If you don’t get treatment, I’ll divorce you”) or make threats (especially if you’re not willing to follow through). Be supportive, not judgmental. Be patient; when your loved one is emotionally and physically drained from addiction’s painful consequences (or when they hit “rock bottom”), they may decide it’s time to get help. And you’ll be ready.

  1. Recognize that your loved one is not the same person they were before addiction.

Substance use disorder is a debilitating disease that damages the brain; it changes how a person feels and thinks. With addiction, the brain’s reward center is rewired, resulting in a biological “need” for drugs/alcohol. (Compare this to your need for food or water or air.) Your loved one’s addiction will lie to you; they will do whatever it takes to get their “needs” met. Your loved one’s addiction will steal from you. (Lock up your valuables if they have access to your home… and even if they don’t. I’ve worked with more than a few individuals who have broken into their parents’ home for either money for drugs or valuables to pawn for money for drugs.) Your loved one’s addiction will betray you. Accepting the nature of addiction allows you to set healthy boundaries.

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  1. Attend Al-Anon or Nar-Anon meetings.

By engaging with others with similar struggles, you’ll learn more about supporting your loved one (without enabling their addiction). You’ll also build a supportive network by connecting with others, strengthening your emotional health.

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  1. When in doubt, try asking yourself one (or all) of the following questions:

Will my actions allow my loved one to continue to drink or use? Is this a “want” versus a basic need? Will my actions prevent them from experiencing a natural consequence? If the answer is yes, it’s probably enabling.

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Addiction is a devastating, but treatable, disease. The road to recovery is difficult and long (with many detours). If your loved one has a substance use disorder, be kind and compassionate; they’re in an unthinkable amount of pain. They didn’t choose addiction. The best way to support them is by setting healthy boundaries to ensure you’re not enabling continued use. Boundaries allow you to help them without furthering their addiction. Boundaries also serve as protection for you and your emotional health; you’re in no position to help if you’re emotionally, financially, and spiritually depleted.

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Please share in a comment your suggestions for helping a loved one who is struggling with addiction.

Where Can I Find Help?

Where can you find the help you need? While there are plenty of resources out there for mental health and recovery, they’re not always easy to find… or affordable. (Plus, the Internet is full of scams!) This article is a starting point for getting help when you aren’t sure where to turn. This post offers practical guidelines; all of the resources in this article are trustworthy and reliable… and will point you in the right direction.

By Cassie Jewell, LPC, LSATP

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This post is not comprehensive; rather, it’s a starting point for getting the help you need. There are plenty of resources out there for mental health and recovery, but they’re not always easy to find (or affordable). The resources in this post are trustworthy and reliable… and will point you in the right direction.

If you need treatment for mental health or substance use, but aren’t sure how to find it…

If you have insurance, check your insurer’s website.

For substance use and mental health disorders, you can access the SAMHSA treatment locator. You can find buprenorphine treatment (medication-assisted treatment for opioid addiction) through SAMHSA as well.

Consider using Mental Health America’s interactive tool, Where to Get Help. NeedyMeds.org also has a locator to help you find low-cost mental health and substance abuse clinics.

Additionally, you could contact your local Mental Health America Affiliate for advice and/or referrals.

If you can’t afford therapy…

EAP (employee assistance programs) frequently offer free (time-limited) counseling sessions.

At campus counseling centers, grad students sometimes offer free or low-cost services.

You could look into community mental health centers or local churches (pastoral counseling).

In some areas, you may be able to find pro bono counseling services. (Google “pro bono counseling” or “free therapy.”) You may also be able to connect with a peer specialist or counselor (for free) instead of seeing a licensed therapist.

As an alternative to individual counseling, you could attend a support group (self-help) or therapy group; check hospitals, churches, and community centers. The DBSA peer-lead support group locator tool will help you find local support groups. Meetup.com may also have support group options.

Additional alternatives: Consider online forums or communities. Watch or read self-help materials. Buy a workbook (such as The Cognitive Behavioral Workbook for Depression: A Step-By-Step Program) from amazon.com. Download a therapy app.

Lastly, you could attend a free workshop or class at a local church, the library, a college or university, a community agency, or a hospital.

If you’re under 18 and need help, but your parents won’t let you see a counselor (or “don’t believe in therapy”)…

Some, but not all, states require parental consent for adolescents to participate in therapy. Start by looking up the laws in your state. You may be able to see a treatment provider without consent from a legal guardian. If your state is one that mandates consent, consider scheduling an appointment with your school counselor. In many schools, school counseling is considered a regular educational service and does not require parental consent.

Self-help groups, while not a substitute for mental health treatment, provide a venue for sharing your problems in a supportive environment. (If you suffer from a mental health condition, use NAMI to locate a support group in your state. If you struggle with addiction, consider AA or NA.)

Alternatively, you could join an online forum or group. (Mental Health America offers an online community with over 1 million users and NAMI offers OK2Talk, an online community for adolescents and young adults.)

You could also contact a Mental Health America Affiliate who would be able to tell you about local resources and additional options.

If you’re in crisis, call the Boys Town Hotline at 1-800-448-3000 or the National Suicide Prevention Hotline at 1-800-273-TALK. Alternatively, you can text HOME to 741741 to text with a trained crisis counselor.

Lastly, consider talking with your pastor or a trusted teacher, reading self-help materials, downloading a therapy app, journaling, meditation or relaxation techniques, exercising, or therapy podcasts/videos.

If a loved one or friend says they’re going to kill themselves, but refuses help…

Call 911. If you’re with that person, stay with them until help arrives.

If you are thinking about or planning suicide…

Call the National Suicide Prevention Lifeline or Veterans Crisis Line. Alternatively, you can text HOME to 741741 to text with a trained crisis counselor. Call 911 if you think you might act. 

If you are grieving…

Check local hospitals and churches for grief support groups; some areas may have nonprofits that offer free services, such as Let Haven Help or Community Grief and Loss Center in Northern Virginia.

Additionally, a funeral home or hospice center may be able to provide resources.

If you are a veteran, you and your family should be able to access free counseling through the VA.

The Compassionate Friends offers support after the loss of a child. Call for a customized package of bereavement materials (at no charge) or find a support group (in-person or online).

GRASP is a grief and recovery support network for those who have lost a loved one through substance use. You can find suicide support groups using the American Association of Suicidology’s directory or the American Foundation for Suicide Prevention’s support group locator.

Hello Grief provides resources and education for children and adolescents who are grieving.

There are also online communities, forums, and support groups, including groups for suicide survivors such as Alliance of Hope and Parents of Suicides – Friends and Families of Suicides.

If you are a victim of sexual assault or domestic violence…

If you are sexually assaulted, call 911 or the National Sexual Assault Hotline at 1-800-656-4673 (or live chat). Find help and resources at National Sexual Violence Resource Center.

For male survivors of sexual abuse: MaleSurvivors.org

For domestic violence: The National Domestic Violence Hotline

For gender-based violence: VAWnet

For teen dating abuse: LoveIsRespect or Break The Cycle

LGBTQ: National Coalition of Anti-Violence Programs for LGBT Communities

If you’re a victim of sex trafficking…

Access Coalition to Abolish Slavery and Trafficking or call National Human Trafficking Hotline at 1-888-373-7888 (or text 233733).

 

If you’re a victim of or stalking…

If you believe you are in immediate danger, call 911. Find help and info at Stalking Resource Center and Stalking Awareness Month.

 

If you can’t stop gambling…

Call or text the National Problem Gambling Helpline at 1-800-522-4700. Access screening tools and treatment at National Council on Problem Gambling. Attend a Gamblers Anonymous Group or other support group for problem gambling.

If you or a loved one has an eating disorder…

If you want to approach a loved one about his or her eating disorder, start by reading some guidelines (such as Helping Someone with an Eating Disorder from HelpGuide.org).

Contact the National Eating Disorders Helpline at 1-800-931-2237. (Alternatively, there’s a “live chat” option.) For support, resources, screening tools, and treatment options, explore the National Eating Disorder Association site.

Find support groups, recovery tools, and local treatment centers at Eating Disorder Hope.

Attend an Eating Disorders Anonymous meeting (in-person or online). You may also want to consider an Overeaters Anonymous meeting.

 

If you are engaging in self-harm and can’t stop…

Call 1-800-DONT-CUT or attend an online support group, such as Self Mutilators Anonymous.

Read personal stories, learn coping skills, and access resources at Self-injury Outreach and Support.

Join an online community like RecoverYourLife.com.

Try one of these 146 things to do instead of engaging in self-harm from the Adolescent Self Injury Foundation.

 

If you’re concerned about the drinking or drug use of a friend or family member, but they don’t want help…

If you’re considering staging an intervention, know that there’s little to no evidence to support the effectiveness of this tactic. 

Instead, read guidelines for approaching the issue (like What to Do If Your Adult Friend or Loved One Has a Problem with Drugs or How to Talk about Addiction). Learn everything that you can about addiction. Explore treatment centers in the area; if your loved one changes their mind, you’ll be prepared to help.

Explore Learn to Cope, a peer-led support network for families coping with the addiction of a loved one. Alternatively, you could attend Al-Anon or Nar-Anon.

Keep in mind that it’s almost impossible to help someone who doesn’t want it. You can’t control your loved one or force them into treatment. Instead, find a way to accept that there’s no logic to addiction; it’s a complex brain disorder and no amount of pleading, arguing, or “guilting” will change that.

If a friend or family member overdoses on heroin or other opioid…

Call 911 immediately.

How to recognize the signs of opiate overdose: Recognizing Opiate Overdose from Harm Reduction Coalition

You can receive free training to administer naloxone, which reverses an opioid overdose. Take an online training course at Get Naloxone Now. You can purchase naloxone OTC in most states at CVS or Walgreens.

For more information about how to respond to an opioid overdose, access SAMHSA’s Opioid Overdose Prevention Toolkit (for free).

 

If you want to quit smoking…

In addition to talking to your doctor about medication, the patch, and/or nicotine gum, visit Smoke FreeBe Tobacco Free, or Quit.com for resources, tools, and tips.

Call a smoking cessation hotline (like 1-800-QUIT-NOW) or live chat with a specialist, such as LiveHelp (National Cancer Institute).

Download a free app (like QuitNow! or Smoke Free) or sign up for a free texting program, like SmokefreeTXT, for extra support.

Attend an online workshop or participate in a smoking cessation course; your insurance provider may offer one or you may find classes at a local hospital or community center. You could also contact your EAP for additional resources.

If you or a loved one have a hoarding problem…

Read guidelines for approaching a hoarding issue with someone such as Hoarding: How to Help a Friend.

Learn more about hoarding and find help (support groups, treatment, etc.) at Hoarding: Help for Hoarding.

 

If your therapist is making unwanted sexual remarks/advances…

Contact the licensing board to file a complaint. Each state has a different licensing board. Additionally, contact the therapist’s professional association (i.e. American Counseling AssociationAmerican Psychological Association, etc.) Provide your name, address, and telephone number (unless filing anonymously). Identify the practitioner you are reporting by his or her full name and license type. Provide a detailed summary of your concerns. Attach copies (not originals) of documents relating to your concerns, if applicable.

Read NAMI’s How Do I File a Complaint against a Mental Health Care Facility or Professional?

 

If you want to take a confidential online assessment for mental health or substance use disorders…

Free and anonymous screenings: Screening for Mental Health, Inc. or Depression and Bipolar Support Alliance Mental Health Screening

For additional sites, self-help guides, literature, etc., check out the resource page.

If you know of a great resource, post in the comments below!