Take psychological self-tests and quizzes, read about symptoms and treatments, compare types of counselling and psychotherapy, learn about secure online therapy, and more
Collaborates with Harvard Health Publications to provide a wide range of unbiased, motivating resources and self-help tools for mental, social, and emotional. 100% nonprofit; dedicated to Morgan Leslie Segal, who died by suicide when she was 29.
Information on mental health, quizzes, and online self-help support groups. The site is owned and operated by Dr. John Grohol, inspired by the loss of his childhood friend to suicide.
An extensive, completely free collection of articles on social skills and getting past social awkwardness. It’s written by someone who’s struggled socially himself, and who has degrees in psychology and counseling.
The Sober Survival Guide provides readers with an opportunity to explore their drinking habits and determine if an alcohol-free life may be right for them.
“I didn’t ever set out to write a book, but as my blog grew and more people were visiting my website and finding the articles I was writing helpful, I was getting a lot of comments that I should do something more substantial, from here the book began to evolve.
The more I wrote, the more immersed I became in writing a book that I felt would have helped me at the time I wanted to quit. Right through the process I asked myself ‘would this help someone who wants to change their relationship with alcohol?’, if the answer was no, I removed it.
I wanted to create something unique in the ‘quit lit’ sector, that would not only help readers learn the best strategy for quitting drinking that worked for me, but would also help set them up for long-term success when it comes to dealing with the challenges that arise in the months and years after getting sober.
I decided to split [The Sober Survival Guide] into two parts. The first part deals with the process of actually quitting drinking and guides readers along the path to freedom, the second part addresses specific situations that come up after quitting, such as social events, vacations, parties and events, relationships with friends, partners and family and dealing with ‘coming out’ about being ‘alcohol-free’.
My whole approach to sobriety is around our mindset, I believe that living alcohol-free should be seen as a positive lifestyle-choice that we make for ourselves, rather than feeling like we have been deprived and have to get by on willpower because we have had something special taken away from us.
I recently completed the manuscript for my second book – How to Quit Alcohol in 50 Days, which is a one-chapter a day roadmap to becoming alcohol-free and I am excited about the release at the end of this year.”
Can you relate to any of the following statements about alcohol?
“I can’t have fun without it. Imagine going to a party without drinking!”
“It makes me feel less anxious or depressed.”
“It helps me sleep.”
“I can’t relax without it.”
“It makes me entertaining to be around.”
“It fits the lifestyle of my boozy friends.”
“I like the taste.”
“It’s cool and sophisticated.”
“I’m not confident enough to talk to new people without it.”
“It helps me deal with all the problems that life throws my way.”
“It stops me from worrying, especially about how much I’m drinking.”
-Source: The Sober Survival Guide, pg. 6
Maybe you’ve questioned your drinking habits or wondered if you have a problem with drinking. Maybe you’ve thought about quitting, but can’t imagine a life without alcohol. You may, at times, wonder if you’re an alcoholic, but are quick to dismiss the idea because you haven’t hit “rock bottom” and you can’t relate to the 12-step concept of being utterly powerless over a disease.
Simon Chapple is not an alcoholic, nor is he in recovery; he is a person who doesn’t drink. In his book, The Sober Survival Guide, Chapple explains that he doesn’t deem it necessary to carry a label for the rest of your life (as many in AA and NA do). “Remember that you hold the power to be who you want to be, and you can choose what labels you use for yourself” (pg. 11).
In The Sober Survival Guide, Chapple shares about his personal journey as a heavy drinker to discovering sobriety and living an alcohol-free life. He discusses alcoholism and the stigma surrounding certain labels (i.e. “alcoholic”) in the first part of the book, which “sets the scene for you to explore what an alcohol-free life might look like for you” (pg. 21). You are also given the opportunity to examine your relationship with alcohol along with your beliefs about drinking.
The second part of the book serves as a practical handbook for anyone who wants to stop drinking; it includes helpful tips for navigating everyday life situations that could trigger a desire to drink. Some of the problems and challenges you may face include stress, accountability, special events/parties, boredom, sleep, and sober sex, among others.
Throughout the book, Chapple encourages the reader to examine their core beliefs about drinking by asking thought-provoking questions. These questions can serve as journaling prompts for the person who is wondering, “Am I an alcoholic?”
The Sober Survival Guide is an easy read with clearly-presented information. The book has a non-judgmental feel to it, unlike much of the 12-step literature that suggests your drinking is related to character flaws. (The language and concepts of AA can be off-putting and difficult to relate to for individuals at the lower end of the alcohol use disorder spectrum.)
Furthermore, The Sober Survival Guide empowers the reader to make changes; you don’t have to admit powerlessness over a disease and turn your will over to a higher power to quit drinking. Chapple’s message is hopeful and inspiring; plus, many of his strategies are based on evidence-based practices, including CBT and mindfulness.
If you are currently questioning whether or not your drinking habits are “normal,” The Sober Survival Guide will provide answers. This book will lift you up and inspire; as you read through the chapters, you may also feel an enormous sense of relief. Furthermore, you will be equipped with a wealth of effective strategies if you do choose to cut down or quit drinking. (Quitting drinking is not easy, but 100% doable, providing you put in the effort and have supports.)
I recommend reading The Sober Survival Guide if you’ve ever wondered if you’re an alcoholic. (You may not see yourself as a “problem drinker,” but you sometimes experience problems related to your alcohol use.) I also recommend this book if you’ve already made the decision to quit or cut down on alcohol. And if you’re a heavy drinker, but are unsure if you want to stop, The Sober Survival Guide has the power to motivate and inspire. Friends and family members of a heavy drinker will also benefit from this book.
Additionally, The Sober Survival Guide is recommended for anyone working in the mental health field. If you have a client who is worried about their drinking or unsure if they have a problem, this book offers answers while providing a refreshing perspective on alcohol use. (It’s proven that people are better equipped to make sustainable change when presented with a variety of options instead of just one. Don’t contribute to the myth that AA is the only way to get sober!)
Is there anyone who should not read this book? In some ways, The Sober Survival Guide oversimplifies addiction; it does not take into account the complex relationship between trauma and substance use. Some of the techniques described in the second part of the book are not trauma-informed. Additionally, if you’ve been diagnosed with a serious mental illness (i.e. major depressive disorder, bipolar disorder, schizophrenia, etc.), your recovery requires a co-occurring approach in order to treat both the addiction and the mental disorder. Lastly, if you have a severe addiction and are physically dependent on alcohol, it’s likely you’ll require extensive, ongoing treatment in order to fully recover; the tips in the book aren’t sufficient (which is noted by the author).
In sum, if you’re tired of the role alcohol plays in your life, consider reading The Sober Survival Guide! You have nothing to lose, but much to gain.
For Simon’s newest book (Kindle version), How to Quit Alcohol in 50 Days: Stop Drinking and Find Freedom, which is set to be released by the end of this year, click here! Check back for an exclusive review on Mind ReMake Project prior to the release date.
Journal Prompts from The Sober Survival Guide
Chapple recommends journaling as a tool for reflection and change. The following prompts are based on material from The Sober Survival Guide. (Download a printable PDF version below.)
✒ What are your drinking habits now? How much? How often? What drinks do you have? What were your drinking habits one year ago? What were your drinking habits five years ago? (Compare your answers. Are you drinking more now than you were before?) (pg. 29)
✒ Calculate the time (per week) you spend drinking alcohol. Consider calculating the time spent planning to drink or recovering from the effects of alcohol. (pg. 147)
✒ List the reasons your life is better because of alcohol. Next, challenge each reason. (pg. 44)
✒ Does labeling yourself as an “alcoholic” or “addict” help or harm you? Why? (pg. 10)
✒ Do you believe you have to hit “rock bottom” to recover? Why or why not? (pg. 41)
✒ Have you ever hit “rock bottom”? Describe the incident in detail. If you haven’t had a “rock bottom” experience, what do you think it would look like? (pg. 41)
✒ What are your current beliefs surrounding alcohol? For each belief you list, write a challenging statement. (Example: “I fail at everything I do – I doubt I can [quit alcohol].” Challenge with “If I don’t try, I won’t ever know. I’ll approach this with an open mind and a sense of curiosity.”) (pg. 38)
✒ Record your current feelings surrounding drinking. (pg. 58)
✒ List specific fears you have about quitting drinking. (Examples: What if my friends think I’m boring sober? What if I fail? What if I can’t have fun anymore?) (pg. 79)
✒ Create a cravings log. List the times of day you experience cravings and what is happening at those times. (pg. 78)
✒ List the pros and cons of drinking. (pg. 77)
✒ List some of the reasons you want to stop drinking. Write about how you want your life to change. (Be specific!) (pg. 25)
✒ List the ways alcohol has negatively impacted your health. Include health concerns you may not have experienced yet. (pg. 28)
✒ List all of the occasions or special events you’ve put alcohol ahead of and reflect on your answers. (pg. 33)
✒ List all of the people, situations, and events you’ve neglected in favor of drinking. Then, for each item, write how the same situation/event would have looked like if you hadn’t been drinking. (pg. 36)
✒ List your justifications for drinking. (Examples: “I work hard; I earned this drink.” “It’s just a beer, not hard liquor.” “I never drink alone.” “I only drink on weekends.”) (pg. 32)
✒ Review your list of current beliefs surrounding alcohol. Assign an emotion to each belief. (Example: “Without drinking each day, I’ll never be happy.” The underlying emotions are worry and sadness.) Next, replace each belief with a truthful statement, something that could become. (Example: “I am happy because [insert reason(s) here], but I have a hard time not drinking every day. So I’m working on this to become stronger.”) (pg. 47)
✒ Write a “breakup” letter to alcohol. (pg. 55)
✒ List all the things you want to do or experience once you are alcohol-free. (pg. 69)
✒ Create a list of ways you can celebrate your success. (Be sure to calculate how much money you’ll save by quitting drinking.) (pg. 84)
✒ Create a sober bucket list. (pg. 148)
✒ List everything you may lose if you start drinking again. (pg. 83)
✒ Create a personal accountability statement. (pg. 83)
✒ List ways you can respond to others when they ask why you’re not drinking. (Examples: “I’m driving.” “Not now, no thanks.” “Not tonight, maybe another time.”) (pg. 74)
✒ When you have an upcoming event that’s potentially triggering, visualize what you will do, say, etc. Write your detailed vision in your journal. (pg. 97)
✒ Create a list of coping skills for when you’re experiencing a low mood. (pg. 116)
✒ Create a gratitude list. (pg. 117)
✒ Create a daily thought log. What are some of the thoughts you have about drinking throughout the day? (pg. 120)
✒ If you experience a lapse or relapse, describe what happened. Pinpoint the exact moment you decided to drink. (pg. 66)
✒ Review what you wrote (in the previous entry) about your lapse or relapse. Identify the triggers you experienced. (pg. 78)
✒ Write a statement of commitment to an alcohol-free life. (pg. 168)
Bonus Material: Checklist for the Problems and Challenges You’ll Face
Initially, the idea of group therapy terrified me. What if I can’t “control” the group? What if I can’t think of anything to say? And the overly dramatic, What if everyone gets up and walks out?
Group facilitation wasn’t always comfortable, and I made many mistakes, but I grew. I realized it’s okay to be counselor and human; at times, humans say dumb stuff, hurt each other’s feelings, and don’t know the answer.
This resource guide provides practical information and tools for group therapy for mental health practitioners.
Group therapy is an evidence-based treatment for substance use and mental disorders. An effective group calls for a skilled clinician to meet treatment standards.
Professional associations, such as the American Group Psychotherapy Association, have developed best practice guidelines based on scientific data and clinical research. The Association for Specialists in Group Work created best practice guidelines for group work and guiding principles.
Fun Facts: My favorite icebreaker activity involves passing out blank slips of paper to each group member and instructing them to write a “fun fact” about themselves, something no one else in the group would know.
Depending on the crowd, you may want to tell clients not to write anything they wouldn’t want their peers to know. (I adopted this guideline after a client wrote about “sharting” himself.) Once everyone has written something, have them fold their papers and place in a container of some sort (a gift box, paper bag, plastic bowl, etc.) Group members take turns passing around the container (one-at-a-time) and picking a slip to read aloud. They must then guess who wrote it. (Give them at least three guesses before turning it over to the rest of the group.)
Icebreaker Question Cards: A similar but more structured activity is to write out questions ahead of time and have clients take turns drawing and answering the questions. Questions can be silly, thought-provoking, or to illicit a strong emotional response (depending on audience and goals).
People Search: This activity utilizes a list of traits, feats, talents, or experiences. Each client receives the list and is given x amount of time to find someone in the group who is a match; that individual will then sign off. The first person to have their list completely signed sits down; they win.
(Prizes optional, but always appreciated.) During the debriefing, it’s fun to learn more (and thereby increase understanding and compassion).
First Impressions: This works best with group members who don’t know each other well. It’s important for group members to at least know each other’s names (or wear name tags). Each group member has a sheet of paper with various “impressions.”
Clients write other group members’ names for each impression. In addition to enhancing a sense of community, this activity provides an avenue for discussing harmful stereotypes and stigma.
Affirmations Group: Affirmations groups can be powerful, generating unity and kindness. The effect seems to be more pronounced in gender-specific groups. There are a variety of ways to facilitate an affirmations group, ranging from each person providing an affirmation to the client on their right to individuals sharing a self-affirmation with the group to creating a self-affirmation painting.
Another idea is to give each client a sheet of paper. (Consider using quality, brightly-colored paper/posterboard and providing markers, gel pens, etc.) Clients write their name on it and then all the papers are passed around so each group member has the opportunity to write on everyone else’s sheet. Once their original paper is returned to them, they can read and share with the group. This can lead to a powerful discussion about image, reputation, feeling fake, etc.
Most Likely & Least Likely to Relapse: This activity works best with a well-formed group and may require extra staff support. It’s good for larger groups and can be highly effective in a therapeutic community.
Clients receive blank pieces of paper and are tasked to write the names of who they think is most likely and least likely to relapse. After writing their own name on the sheet, they turn it in to staff (effectively allowing staff to maintain a safe and productive environment). Staff then read each sheet aloud (without naming who wrote it). If they choose, clients can share what they wrote and provide additional feedback. (Most do.) Clients selected as “most likely” (in either category) have the opportunity to process with other group members and staff.
Access more group therapy worksheets and handouts here.
In need of fresh material? It can be easy to fall into a rut, especially if you’re burnout or working with a particularly challenging group. The following three PDF downloads are lists of ideas/questions for groups.
Practical Tips for Psychoeducation & Process Groups
As a group facilitator, consider incorporating some sort of experiential activity, quiz, handout, game, etc. each group to engage clients and keep them engaged.
Handout review (clients take turns reading) (5-10 minutes)
Group discussion/processing (10-15 minutes)
Restroom/smoke break (5 minutes)
Roleplay or short video clip (to visually present what was covered in the handout/discussion) (5-10 minutes)
Facilitator summarizes and asks group members how they will incorporate what they learned or how they’re feeling (5 minutes)
Group members have the opportunity to respond (5-10 minutes)
If an experiential or interactive exercise isn’t feasible, provide coffee or snacks; sitting for 45 minutes is difficult for some, and 90 minutes can be unbearable.
Another idea is to have a “fun” or “free” group. Ideas include going bowling, having a potluck, Starbucks run, game group, escape room, nature walk, etc.
Dealing with Challenges
Clients are not always willing therapy participants; some are court-ordered to attend or there to have privileges restored. Some attendees may be there “voluntarily,” but only to save their marriage or keep a job, not believing they need help. In residential treatment, clients attend mandatory groups as part of the daily schedule.
Even when attendance is truly voluntary, a group member may be in a bad space. Maybe they’re stressed about the rent or just got into a fight with their significant other. Or what if the AC is broken and the group room is 80 degrees?
Anticipating challenges is the first step to effectively preventing and managing them.
Click here for a helpful article from Counseling Today that addresses the concept of client resistance.
Tips for Dealing with Challenges
1. If possible, co-facilitate. One clinician leads while the other observes. The observer remains attuned to the general “tone” of the group (e.g., facial expressions, body language, etc.)
2. Review the expectations at the beginning of every group. Ask clients to recall the guidelines (instead of you telling them). This promotes a collaborative spirit.
3. After guidelines are reviewed, explain that while interrupting is discouraged, there may be times when you interject to maintain the overall wellness and safety of the group. (Knowing this, a client is less likely to get angry or feel disrespected when/if it happens.)
4. And if during group you must interrupt, apologize and explain the rationale.
5. Avoid power struggles at all costs, especially when a client challenges the benefits of treatment. Challenging the efficacy of treatment (or you as a clinician) is a defense mechanism. If the group is relatively healthy, you may want to illicit feedback from other group members before responding. Sometimes, the best response is simply “okay,” or none at all… and keep moving to avoid the group becoming a complaint session. You could also acknowledge the client’s perspective and ask to meet with them after group to discuss.
6. If a client becomes angry or tearful, give them time to vent for a moment or two (don’t “Band-Aid”); they may be able to self-regulate. (If they do self-regulate, share your observations and offer praise.)
7. If a client’s anger escalates to a disruptive level, ask them to take a break. At this point, their behavior is potentially triggering other group members. Don’t raise your voice. Stay calm and be respectful but firm. Direct them to step out and ask them to return when they’re ready.
8. If a client is disrespectful (cursing at you or another client, name-calling, insulting, etc.) while escalated, let them know it’s not okay, but don’t attempt to provide feedback. (A simple, “Hey, that’s not okay,” will suffice.) Bring it up with the client later when they’re able to process.
9. Once the escalated client exits the room, acknowledge what happened and let the group know you intend to follow up with that person. If a group member wants to talk about it, ask them to limit their share to how it made them feel, but stress that it’s not okay to talk about an absent group member. (“How would you feel if we talked about you when you weren’t here?”) Strongly suggest that they wait until the person returns (and is open) to have a group discussion (if appropriate).
10. After a major blow-up (and once everyone is calm), it can be beneficial for the group to process it with the person who escalated. Group members can empathize/relate, share their observations and/or how it made them feel, and offer feedback.
11. If other disruptive behaviors occur in group (side conversations, snoring, etc.) address them in the moment objectively (without shaming). Point out the behavior and explain how it’s disruptive to the group. Refer back to the group guidelines. Ask group members to comment as well. If you let a behavior persist, hoping it will eventually stop, you’re sending the message that it’s okay, not only to the person who is disruptive, but to the entire group. This impacts the integrity of the group and opens things up for additional disruptive behaviors.
12. For clients who monopolize, are constantly joking, or who attempt to intentionally distract by changing the topic, objectively point out your observations. When appropriate, ask other group members to comment on your observations and provide feedback to their peer.
13. If, on the other hand, one or several clients seem disengaged or unmotivated, consider asking why, privately or in the group, whichever is clinically appropriate.
14. If there’s a general level of disengagement, bring it up in the group. Remain objective and state your observations.
15. Anticipate that at times, people may not have much to say. (Consider that while there’s always something to learn or process, that doesn’t mean someone is ready to or has the emotional energy to.) Maybe they’re distracted or tired or feeling “talked out.” It’s good to have backup plans: watch a psychoeducational film, take a walk in the park, listen to meditations or music, provide worksheets, education reading material, or coloring sheets.
16. Always keep in mind a client’s stage of change, their internal experiences (e.g., hearing voices, social anxiety, paranoia, physical pain, etc.), external circumstances (e.g., recent medication change, loss of housing, conflict with roommates, etc.), and history of trauma. What looks like resistance may be something else entirely.
Adverse Outcomes in Group Psychotherapy | Roback, H. B. (2000). Adverse outcomes in group psychotherapy: Risk factors, prevention, and research directions. The Journal of Psychotherapy Practice and Research, 9(3), 113–122.
Differences that Make a Difference | Change-Caffaro, S., & Caffaro, J. (2018). Differences that make a difference: Diversity and the process group leader. International Journal of Group Psychotherapy, 00: 1-15.
Group Interventions| Ezhumalai, S., Muralidhar, D., Dhanasekarapandian, R., & Nikketha, B. S. (2018). Group interventions. Indian Journal of Psychiatry, 60(Suppl 4), S514–S521.
Group Therapy for Substance Use Disorders | Wendt, D. C., & Gone, J. P. (2017). Group therapy for substance use disorders: A survey of clinician practices. Journal of Groups in Addiction & Recovery, 12(4), 243–259.
Modeling Cohesion Change in Group Psychotherapy | Tucker, J. R. (2016). Modeling cohesion change in group psychotherapy: The influence of group leader behaviors and client characteristics. Graduate Theses and Dissertations, 15175.
Effective Group Therapy | (2023) Putting together a successful group involves thinking not only about the structure of the group but about the interactions between group members and how those interactions can support the therapeutic process. (Source: American Psychological Association)
Center for Group Studies | The Center provides a unique method of group training. Principles and techniques are based on the theory that the group is a powerful agent of change.
Group Dynamics | This blog provides some links and book chapters on various topics related to the study of groups. You can also find teaching resources related to group dynamics.
Management Library | This site provides free resources for managers, entrepreneurs, and leaders. Much of the content on facilitation and teams is applicable to group facilitation.
My Group Guide | A great tool for those who do not have the time to find worksheets/handouts for their clients, group activities, and other resources.
Resources in Group Psychotherapy | Helpful resources and links for group psychotherapy from the Sacramento Center for Psychotherapy, including an online forum.
Systems-Centered Training & Research Institute | SCTRI is an non-profit organization with members from all around the world that supports training and research in the systems-centered approach.
The following is a list of movies about addiction and mental disorders that are appropriate to show in treatment settings. This post includes movie summaries and downloadable PDF handouts with questions for discussion.
Please note that some of the films on this list are graphic and may not be appropriate for children or adolescents.
Hint: The handouts contain spoilers; do not provide until after the movie ends.
Movies About Addiction & Mental Illness
Disclaimer: This post contains affiliate links. As an Amazon Associate I earn a small commission from qualifying purchases.
103 minutes (1 hour, 43 minutes), R-rating for language and drug use
Summary: Julia Roberts plays a mother, Holly, whose 19-year old son, Ben, surprises her by returning home for Christmas. Ben is newly in recovery; his addiction has placed a tremendous strain on the family in the past. Ben’s younger siblings are happy to see him, but Holly, fearing that he is not ready, is apprehensive.
That evening, the family attends church. When they return, they find their home burglarized and the dog missing. Ben blames himself, believing someone from his past took the dog to get his attention; he leaves to look for the dog. Holly goes with him, but they’re later separated, and Holly attempts to track Ben. Eventually, she ends up at an abandoned barn where she finds her son on the floor, unresponsive. The movie ends with her administering Narcan to Ben.
127 minutes (2 hours, 7 minutes), R-rating for strong language and content relating to drugs, sexuality, and suicide
Summary: Winona Ryder plays Susanna, a young woman with borderline personality disorder, who is sent to a psychiatric hospital after a suicide attempt in the late 1960s. She befriends Lisa (Angelia Jolie), who carries a diagnosis of sociopathy (antisocial personality disorder). Initially, Susanna is in denial about her mental condition and is not open to treatment. However, she reaches a turning point after a tragedy.
123 minutes (2 hours, 3 minutes), PG-13 rating for mature thematic elements including substance abuse/recovery, some sexual situations, language, and brief violence
Summary: Trevor (Haley Joel Osment) starts a chain reaction of goodness for a social studies project with a plan to change the world for the better. In this film, Trevor is a high school student whose mother, Arlene (Helen Hunt), struggles with alcoholism and whose father is abusive. He rises above unfortunate circumstances with the kindhearted idea to do a good deed, but instead of requesting payback, asking the receiver to “pay it forward” to at least three people – and on and on. While the movie has a bittersweet end, the message is uplifting and powerful.
Summary: Charlie is an unpopular high school freshman, a “wallflower,” who is befriended by two seniors, Patrick and Sam (Emma Watson). The movie is about their friendship and Charlie’s personal struggles with the recent suicide of his friend and his own mental illness. Throughout the film, Charlie has flashbacks of his aunt, who died in a car accident when he was 7. It’s eventually revealed that Charlie’s aunt molested him; a sexual encounter with Sam triggers Charlie’s repressed memories. Charlie has a mental breakdown.
113 minutes (1 hour, 54 minutes), R-rating for language and brief sexuality
Summary: Anne Hathaway plays Kym, a troubled young woman, who returns from rehab to her family home for her sister’s wedding. The film portrays how Kym’s addiction has placed strain on the family.
Other great resources for using clinical films as therapeutic interventions include the book Movies & Mental Illness: Using Films to Understand Psychopathy, 4th ed. (by Danny Wedding and Ryan M. Niemiec) and the site Teach With Movies.
(Updated 11/28/23) If you’re a counselor or therapist, you’re probably familiar with Therapist Aid, one of the most well-known sites for providing no-cost therapy worksheets. But Therapist Aid isn’t the only resource for free clinical tools! This is a list of over 200 sites with free therapy worksheets and handouts.
See below for links to websites with free therapy worksheets and handouts for clinical use and self-help.
Click here for therapy worksheets, handouts, and guides posted on this site. Access additional free printables by joining Mind Remake Project’s Facebook group, Resources for Mental Health Counselors & Social Workers. 🆕
Sites with Free Therapy Worksheets & Handouts
Therapy Worksheets for Mental Health
91 Free Counseling Handouts | Handouts on self-esteem, emotions, recovery, stress, and more (Source: Kevin Everett FitzMaurice)
A Good Way to Think: Resources | Therapy worksheets and handouts on happiness, well-being, values, etc. (Source: A Good Way to Think by David)
Articles by Dr. Paul David | Clinical handouts on depression, relationships, substance use disorders, family issues, etc. (Source: Dr. Paul David, PhD)
Black Dog Institute: Resources & Support | Downloadable fact sheets, handouts, mood trackers, and more on a variety of mental health topics (Source: Black Dog Institute Australia)
Bryan Konik: Free Therapy Worksheets | A collection of therapy worksheets on stress management, anxiety, relationships, goal setting, and trauma (Source: Bryan Konik, Therapist & Social Worker)
Cairn Center: Resources | A modest collection of printable assessments, handouts, and worksheets on DBT, anxiety, depression, etc. (Source: Cairn Center)
Coping.us | Printable tools for coping (Source: James J. Messina, PhD & Constance Messina, PhD)
Cornell Health: Fact Sheet Library | A variety of handouts and tracking sheet on various health topics; only a few relate to mental health and addiction (Source: Cornell University)
Counseling Library Handouts | A collection of handouts on depression, trauma, personality, and more (Source: Morning Light Counseling, Carrie M. Wrigley, LCSW)
Downloads | A small collection of therapy worksheets/workbooks on boundaries, anger, anxiety/mindfulness, relationships, and more (Source: Christina Bell, Registered Psychologist)
DOWNLOADS from Get Self Help | Free therapy worksheets and handouts on a variety of topics (Source: Getselfhelp.co.uk)
EchoHawk Counseling: Materials and Resources | Articles, worksheets, and handouts on a variety of topics, including boundaries, emotions, grief, stress, trauma, etc. (Source: Lance Echo-Hawk)
Faith Harper: Worksheets and Printables | A small collection of therapy worksheets and handouts, including a gratitude journal (Source: Faith G. Harper, PhD, LPC-S, ACS, ACN)
Free Social Work Tools and Resources | Worksheets, workbooks, assessments, and other resources for adults and children (Source: SocialWorkersToolbox.com)
Self-Help Library | Multiple handouts on topics including communication, relationships, anxiety, ADHD, anger, depression, and more (Source: Present Centered Therapy)
Self-Help Toolkits | Articles and handouts on worry, depression, assertiveness, etc. (Source: Dr. Danny Gagnon, PhD, Montreal Psychologist)
Therapy Worksheets | A resource blog with links to free therapy worksheets on various mental health topics (Source: Therapy Worksheets by Will Baum, LCSW)
Tim’s Resource Notebook | A small collection of handouts on various topics such as relationships, emotions, and values (Source: Tim’s Resource Notebook)
Therapy Worksheets for Substance Use Disorders & Addiction
Substance Abuse | 12-page PDF packet (Source: Carleton University, Criminal Justice Decision Making Laboratory & Ontario Ministry of Community Safety and Correctional Services)
Relaxation | 15-page packet on relaxation skills for anxiety (Source: Michigan Medicine)
Stress Management | 5-page packet on stress management (Source: Inner Health Studio)
Stress Management – Patient Handouts | A collection of handouts on stress management; some of the other sections, including “General Health and Wellness” and “Nutrition” have links to handouts as well (Source: UMASS Medical School Department of Psychiatry)
Printable Grief and Loss Resources | A fairly extensive collection of printable handouts on grief and loss (Source: Hamilton’s Funeral & After Life Services)
Anger Management | 13-page PDF packet (Source: Carleton University, Criminal Justice Decision Making Laboratory & Ontario Ministry of Community Safety and Correctional Services)
Free Tools | Handouts, worksheets, and workbooks including mindful coloring sheets (Source: The Wellness Society)
Handouts and Worksheets | 21-page PDF packet with handouts and worksheets on self-care topics (Source: Psychological First Aid for Schools Field Operations Guide)
Online CBT Resources | Worksheets and questionnaires from Andrew Grimmer, a counselling psychologist and accredited cognitive behavioural psychotherapist in the UK (Source: Online CBT Resources)
Oklahoma TF-CBT Therapy Resources | Printable trauma-focused handouts and assessments for therapists to use with children and adolescents (Source: Oklahoma TF-CBT Therapy Resources)
Prevention Dimensions: Lesson Plans | Downloadable PDF handouts for children from kindergarten to sixth grade (Source: Utah Education Network)
Printable Worksheets | Worksheets for children on physical activity, substance abuse, nutrition, and more (Source: BJC School Outreach and Youth Development)
Just for Teens: A Personal Plan for Managing Stress | 7-page PDF handout (Source: American Academy of Pediatrics from Reaching Teens: Strength-Based Communication Strategies to Build Resilience andSupport Healthy Adolescent Development)
Oklahoma TF-CBT Therapy Resources | Printable trauma-focused handouts and assessments for therapists to use with children and adolescents (Source: Oklahoma TF-CBT Therapy Resources)
Oregon State University: Learning Corner | Student worksheets on time management, wellness, organization skills, etc. (Source: Oregon State University Academic Success Center)
The Relaxation Room | Self-care and stress management handouts for college students (Source: Andrews University)
Resilience Toolkit | PDF handouts for college students on resiliency (Source: Winona State University)
Self-Help Resources | Links to articles for college students on a variety of topics (not in PDF form) (Source: Metropolitan Community College Counseling Services)
Step UP! Resource Library | Worksheets/handouts for students on prosocial behavior and bystander intervention (Source: Step UP!)
Your Life Your Voice: Tips and Tools | Links to articles and PDF printables on a variety of topics for teens and young adults (Source: Your Life Your Voice from Boys Town)
Therapy Worksheets for Marriage/Relationships & Family
Attitudes and Behaviour | 9-page PDF packet on criminal thinking (Source: Carleton University, Criminal Justice Decision Making Laboratory & Ontario Ministry of Community Safety and Correctional Services)
Motivation To Change | 16-page PDF packet on motivation to change criminal behavior (Source: Carleton University, Criminal Justice Decision Making Laboratory & Ontario Ministry of Community Safety and Correctional Services)
Peers & Relationships | 12-page PDF packet on how associates impact criminal behavior (Source: Carleton University, Criminal Justice Decision Making Laboratory & Ontario Ministry of Community Safety and Correctional Services)
Alcarelle is a synthetic version of alcohol, providing all the “feel-good” effects of alcohol with none of the associated risks; this alcohol-alternative may be available in a bar near you within the next five years!
Alcarelle, providing liquid courage without the consequences of alcohol: no hangover, no calories, and no harmful impact on your health. Sound too good to be true? Maybe… but maybe not.
Alcarelle is a substance that mimics the effects of alcohol; the Alcarelle website proclaims, “Like alcohol, but better.” Essentially, it’s a synthetic, non-toxic version of alcohol that activates the same neurotransmitters as booze, inducing the “warm fuzzy” feelings of tipsiness. Created by English neuropsychopharmacologist, David Nutt, the active molecule in Alcarelle provides the relaxing and social lubricating qualities of alcohol with none of the associated dangers.
According to a 2019 interview in Men’s Health, the Alcarelle effect “plateaus” after three drinks. The implications are that you won’t get hammered or black out when you drink it.
Currently, Alcarelle is in the development stage. Nutt’s plan is for the alcohol-free substitute to be available within the next five years; it will likely be offered in the form of a concentrated extract to mix into drinks.
What role will Alcarelle play in the treatment of substance use disorders? It’s unknown if someone could build a tolerance for or become dependent on it. Could Alcarelle be the next harm-reduction or treatment method for alcohol use disorders? Could its use help with other addictions or mental health disorders? Could it potentially reduce the rates of alcohol-related accidents and diseases?
On the other hand, Alcarelle could lead to abuse and/or dependence (similar to how methadone, a treatment for opioid use disorders, produces powerful addictive effects). Also, it could end up being the equivalent of a “gateway” drug, increasing the user’s chances of later developing a substance use disorder.
Bottom line: too much is unknown at this point. Alcarelle may not make it past the testing phase. (Currently, only a prototype of the synthetic molecule exists and funding for the project is limited.)
While I’m hopeful that an alcohol-alternative could advance the treatment of substance use disorders (especially since I believe the ultimate treatment, while yet undiscovered, will be pharmacological), I don’t anticipate Alcarelle being a magical “cure-all.”
Don’t drink and drive! From 10:00 p.m. to 4:00 a.m., use WRAP’s Holiday SoberRide Promo Code (valid 12/20/19-1/1/20) for a free Lyft ride (up to $15).
In Virginia, a first offense DWI can cost up to $2,500 in fines plus court costs. Drunk driving may also result in license suspension and jail time (not to mention death!) #NeverWorthIt
Self-care is not a luxury; it’s necessary for survival when your loved one has a substance use disorder. By taking care of yourself, you gain the energy and patience to cope with your problems. Self-care promotes wellness and emotional intelligence; it puts you in a better space to interact with your loved one. Strategies include developing/building resilience, practicing distress tolerance, keeping perspective, and recognizing/managing your triggers.
When your loved one has a substance use disorder (SUD), it can be overwhelming, distressing, and all-consuming. When we’re stressed, we forget to practice basic self-care, which in turn makes us even less equipped to cope with the emotional chaos addiction generates. This post is about self-care strategies for when your loved one has an addiction.
(Side note: I strongly recommend reading Beyond Addiction if your loved one has an SUD or if you work in the field. This book will increase your understanding of addiction and teach you how to cope with and positively impact your loved one’s SUD by using a motivational approach. This is one of the best resources I’ve come across, especially for family members/significant others.)
Based on the premise that your actions affect your loved one’s motivation, taking care of yourself is not only modeling healthy behaviors, it’s putting you in a better space to interact with your loved one. Chronic stress and worry make it difficult to practice self-care. Self-care may even seem selfish.
However, by taking care of yourself and thus reducing suffering, you gain the energy and patience to cope with your problems (and feel better too). Furthermore, you reduce the level of pain and tension in your relationships with others, including your loved one with a SUD.
Self-care strategies include developing/building resilience, practicing distress tolerance, keeping perspective, and recognizing/managing your triggers. Therapy and/or support groups are additional options.
“An empty lantern provides no light. Self-care is the fuel that allows your light to shine brightly.”
Unknown
Self-Care Strategies When Your Loved One Has an Addiction
Resilience
The definition of resilience is “the capacity to recover quickly from difficulties” (Oxford Dictionary). Doctors Foote, Wilkens, and Kosanke wrote that having resilience is a way to “systematically reduce your vulnerability to bad moods, lost tempers, and meltdowns.”
While you cannot “mood-proof” yourself entirely, resilience helps when facing life’s challenges, setbacks, and disappointments. To maintain resilience, one must practice at least the most basic self care practices, which are as follows:
Self-care is not something you can push in to the future. Don’t wait until you have more time or fewer obligations. Self-care is not a luxury; it’s a necessity. The authors of Beyond Addiction pointed out that self-care is something you have control over when other parts of your life are out of control. If you find it challenging to implement self-care practices, tap into your motivations, problem-solve, get support, and most of all, be patient and kind with yourself.
“Taking care of yourself is the most powerful way to begin to take care of others.”
Bryant McGill
Distress Tolerance
On tolerance, Doctors Foote, Wilkens, and Kosanke suggested that it is “acceptance over time, and it is a cornerstone of self-care.” Tolerance is not an inherent characteristic; it is a skill. And like most skills, it requires practice. However, it’s wholly worth the effort as it reduces suffering. By not tolerating the things you cannot change (such as a loved one’s SUD), you’re fighting reality and adding to the anguish.
Self-care strategies and techniques for distress tolerance include distracting yourself, relaxing, self-soothing, taking a break, and creating positive experiences. (The following skills are also taught in dialectical behavior therapy (DBT), an evidence-based practice that combines cognitive behavioral therapy techniques and mindfulness. For additional resources, visit The Linehan Institute or Behavioral Tech.)
Distract Yourself
Switch the focus of your thoughts. The possibilities are endless; for you, this could mean reading a magazine, calling a friend, walking the dog, etc. The authors of Beyond Addiction suggested making a list of ideas for changing your thoughts (and keeping it handy).
Switch the focus of your emotions. Steer your emotions in a happier direction by watching corgi puppies on YouTube, reading an inspirational poem, or viewing funny Facebook memes. The writers of Beyond Addiction suggested bookmarking sites in your Internet browser that you know will cheer you up.
Switch the focus of your senses. This could mean taking a hot shower, jumping into a cold pool, holding an ice cube in your hand, walking from a dark room to one that’s brightly lit, looking at bright colors, listening to loud rock music, etc. Also, simply walking away from a distressing situation may help.
Do something generous. Donate to your favorite charity, pass out sandwiches to the homeless, visit a nursing home and spend time with the residents, express genuine thanks to cashier or server, etc. By redirecting attention away from yourself (and directing energy toward positive goals), you’ll feel better. In Beyond Addiction, it’s noted that this skill is especially helpful for individuals who tend to ruminate. Also, it’s important to brainstorm activities that are accessible in the moment (i.e. texting a friend to let them know you’re thinking about them) that don’t take multiple steps (such as volunteering).
“Body tells mind tells body…” Relaxing your body helps to relax your mind. It also focuses your thoughts on relaxing (instead of your loved one’s addiction). What helps you to relax? Yoga? A hot bath? Mindful meditation? (I recommend doing a mindful body scan; it’s simple and effective, even for the tensest of the tense, i.e. me.)
Soothe Yourself
In Beyond Addiction, self-soothing is described as “making a gentle, comforting appeal to any of your five senses.” A hot beverage. Nature sounds. A cozy blanket. A scenic painting. Essential oils. A cool breeze. A warm compress. A massage. Your favorite song. Find what works for you, make a list, and utilize as needed. Seemingly small self-care strategies can make a big difference in your life by creating comfort and reducing out-of-control emotions.
Take A Break
“Taking a break” doesn’t mean giving up; it’s a timeout for when you’re emotionally exhausted and is one of the best self-care strategies you can have. Learn to recognize when you need to step away from a situation or from your own thoughts. Find a way to shift your focus to something pleasant (i.e. a romantic movie, a nature walk, a day trip to the beach, playing golf for a few hours, traveling to a different country, etc.)
Doctors Foote, Wilkens, and Kosanke refer to this as “making it better,” not in the sense that you’re fixing the problem (or your loved one), but that you’re making the moment better by transforming a negative moment into a positive one. Suggested self-care strategies for creating a positive experience include the following:
Half-smile. Another mind-body technique, half-smiling tricks your brain into feeling happier.
Meditate or pray. As explained in Beyond Addiction, “meditation or pray is another word for – and effective channel to – awareness and acceptance. Either one can open doors to different states of mind and act as an emotional or spiritual salve in trying moments.”
Move. By moving, you’re shifting your focus and releasing energy. Stretch, run, play volleyball, chop wood, move furniture, etc.
Find meaning. The authors of Beyond Addiction wrote, “Suffering can make people more compassionate toward others. Having lived through pain, sometimes people are better able to appreciate moments of peace and joy.” Suffering can also inspire meaningful action. What can you do to find meaning?
Borrow some perspective. How do your problems look from a different viewpoint? Ask a trusted friend. You may find that your perspective is causing more harm than good.
Perspective
Perspective is “an understanding of a situation and your reactions to it that allows you to step back and keep your options open… [it’s] seeing patterns, options, and a path forward” (Beyond Addiction).
When Trish married Dave nearly 20 years ago, he rarely drank: maybe an occasional beer over the weekend or a glass of wine at dinner. After their fist daughter was born, his drinking increased to a few beers most nights. Dave said it helped him relax and manage the stress of being a new parent.
By the time their second daughter was born several years later, his drinking had progressed to a six-pack of beer every evening (and more on weekends). Currently, Dave drinks at least a 12-pack of beer on weeknights; if it’s the weekend, his drinking starts Friday after work and doesn’t stop until late Sunday night.
Dave no longer helps Trish with household chores or yardwork as he did early in their marriage. He rarely dines with the family and won’t assist with the cooking/cleanup; he typically eats in front of the TV. Dave occasionally engages with his daughters, but Trish can’t recall the last time they went on a family outing, and it’s been years since they went on a date.
Dave struggles to get out of bed in the mornings and is frequently late to work; Trish is worried he’ll get fired. They frequently argue about this. Dave is irritable much of the time, or angry. Most nights, he doesn’t move from his armchair (except to get another beer) until he passes out with the television blaring.
Trish is frustrated; she believes Dave is lazy and lacks self-control. When she nags about his drinking, he promises he’ll cut back, but never follows through. Trish thinks he’s not trying hard enough. She can’t understand why he’d choose booze over her and the kids; sometimes she wonders if it’s because she’s not good enough… maybe he would stop if she was thinner or funnier or more interesting? At times she feels helpless and hopeless and others, mad and resentful; she frequently yells at Dave. She wonders if things are ever going to change.
A different perspective would be to recognize that Dave has an alcohol use disorder. He feels ill most of the time, which affects his mood, energy level, and motivation. He wants to cut back, but fails when he tries, which leads to guilt and shame. To feel better, he drinks. It’s a self-destructive cycle.
If Trish understood this, she could learn to not take his drinking personally or question herself. Her current reactions, nagging and yelling, only increase defensiveness and harm Dave’s sense of self-worth. Alternative options for Trish might include learning more about addiction and the reasons Dave drinks, bolstering his confidence, and/or creating a supportive and loving environment to enhance motivation.
Triggers
In recovery language, a “trigger” is anything (person, place, or thing) that prompts a person with SUD to drink or use; it activates certain parts of the brain associated with use. For instance, seeing a commercial for beer could be triggering for a person with an alcohol use disorder.
You have triggers too. For example, if your loved one is in recovery for heroin, and you notice that a bottle of opioid painkillers is missing from the medicine cabinet, it could trigger a flood of emotions: fear, that your loved one relapsed; sadness, when you remember the agony addiction brings; hopelessness, that they’ll never recover. It’s crucial to recognize what triggers you and have a plan to cope when it happens. Being aware of your triggers is a self-care strategy.
Therapy & Support Groups
Lastly, self-care strategies such as therapy and/or support groups can be a valuable addition to your self-care regime. Seeing a therapist can strengthen your resilience and distress tolerance skills. Therapy may provide an additional avenue for perspective.
(Side note: A good therapist is supportive and will provide you with tools for effective problem-solving and communication, coping with grief and loss, building self-esteem, making difficult choices, managing stress, overcoming obstacles, improving social skills/emotional intelligence, and better understanding yourself. A good therapist empowers you. A bad therapist, on the other hand, will offer advice and/or tell you what to do, disempowering you.)
Regarding support groups, there are many options for family members, friends, and significant others with a loved one who has a SUD, including Al-Anon, Nar-Anon, and Families Anonymous. Support groups provide the opportunity to share in a safe space and to receive feedback, suggestions, and/or encouragement from others who relate.
“I have come to believe that caring for myself is not self indulgent. Caring for myself is an act of survival.”
Audre Lorde
In sum, self-care is not optional; it’s essential for surviving the addiction of a loved one. Self-care enhances both overall wellness and your ability to help your loved one; in order words, take responsibility for your health and happiness by taking care of yourself. Commit to engaging in at least one or two of the self-care strategies you learned about in this post.
Munn wrote this book because, as a nonbeliever, he felt the 12 steps of AA didn’t fully translate into a workable program for atheists or agnostics. This inspired him to develop the Practical 12 Steps.
I stumbled upon Staying Sober Without God while searching for secular 12-step literature for a client who identifies as atheist. Jeffrey Munn, the book’s author, is in recovery and also happens to be a licensed mental health practitioner.
Munn wrote the book because as a nonbeliever he felt the 12 steps of AA didn’t fully translate into a workable program for atheists or agnostics. (For example, the traditional version of Step 3 directs the addict to turn his/her will and life over to the care of God as they understand him. If you don’t believe in God, how can you put your life into the care of him? Munn notes that there’s no feasible replacement for a benevolent, all-knowing deity.)
The whole “God thing” frequently turns nonbelievers off from AA/NA. They’re told (by well-meaning believers) to find their own, unique higher power, such as nature or the fellowship itself. (The subtle undertone is that the nonbeliever will eventually come around to accept God as the true higher power.)
In Staying Sober Without God Munn asserts, “There is no one thing that is an adequate replacement for the concept of God.” He adds that you can’t just replace the word “God” with “love” or “wisdom.” It doesn’t make sense. So he developed the Practical 12 Steps and wrote a guide for working them.
The Practical 12 Steps for staying sober are as follows:
Admitted we were caught in a self-destructive
cycle and currently lacked the tools to stop it
Trusted that a healthy lifestyle was attainable
through social support and consistent self-improvement
Committed to a lifestyle of recovery, focusing
only on what we could control
Made a comprehensive list of our resentments,
fears, and harmful actions
Shared our lists with a trustworthy person
Made a list of our unhealthy character traits
Began cultivating healthy character traits
through consistent positive behavior
Determined that the best way to make amends to
those we had harmed
Made direct amends to such people wherever
possible, except when to do so would cause harm
Practiced daily self-reflection and continued
making amends whenever necessary
We started meditating
Sought to retain our newfound recovery lifestyle
by teaching it to those willing to learn and by surrounding ourselves with
healthy people
The Practical 12 Steps in no way undermine the traditional
steps or the spirit of Alcoholics Anonymous. Instead, they’re supplemental;
they provide a clearer picture of the steps for the nonbeliever.
Before delving into the steps in Staying Sober Without God, Munn discusses the nature of addiction, recovery, and the role of mental illness (which is mostly left untouched in traditional literature). He addresses the importance of seeking treatment (therapy, medication, etc.) for mental disorders while stressing that a 12-step program (secular or otherwise) is not a substitute for professional help. In following chapters, Munn breaks each step down and provides guidelines for working it.
The last few chapters of the book provide information on
relapse and what the steps don’t
address. Munn notes that sustainable recovery requires more than just working
the steps, attending AA meetings, and taking a sponsor’s advice. For a
balanced, substance-free lifestyle, one must also take care of their physical
health, practice effective communication, and engage in meaningful leisure
activities. Munn briefly discusses these components in the book’s final chapter,
“What the Steps Miss.”
Staying Sober Without God is well-written and easy to read. The author presents information that’s original and in line with current models of addiction treatment, such as behavioral therapy (an evidence-based approach for substance use disorder). Working the Practical 12 Steps parallels behavioral treatments; the steps serve to modify or discontinue unhealthy behaviors (while replacing them with healthy habits). Furthermore, a 12-step network provides support and meaningful human connection (also crucial for recovery).
In my opinion, the traditional 12 Steps reek of the moral model, which viewed addiction as a moral failure or sin. Rooted in religion, this outdated (and false) model asserted that the addict was of weak character and lacked willpower. The moral model has since been replaced with the disease concept, which characterizes addiction as a brain disorder with biological, genetic, and environmental influences.
The Practical 12 Steps are a better fit for what we know about addiction today; Munn focuses on unhealthy behaviors instead of “character defects.” For example, in Step 7, the addict implements healthy habits while addressing unhealthy characteristics. No one has to pray to a supernatural being to ask for shortcomings to be removed.
The Practical 12 Steps exude empowerment; in contrast, the
traditional steps convey helplessness. (The resulting implication? The only way
to recover is to have faith that God will heal you.) The practical version of
the steps instills hope and inspires the addict to change. Furthermore, the
practical steps are more concrete and less vague when compared to the
traditional steps. (This makes them easier to work!)
In sum, Munn’s concept of the steps helped me to better understand the 12-step model of recovery; the traditional steps are difficult to conceptualize for a nonbeliever, but Munn found a way to extract the meaning of each step (without altering overall purpose or spirit). I consider the practical steps a modern adaptation of the traditional version.
I recommend reading Staying Sober Without God if you have a substance use disorder (regardless of your religious beliefs) or if you’re a professional/peer specialist who works with individuals with substance use disorders. Munn’s ideas will give you a fresh perspective on 12-step recovery.
For working the practical steps, download the companion workbook here:
Note: The workbook is meant to be used in conjunction with Munn’s book. I initially created it for the previously mentioned client as a format for working the practical steps. The workbook is for personal/clinical use only.
Kratom is a tropical tree native to Southeast Asia. It’s becoming increasingly popular in the United States. It’s used for pain relief, mood enhancement, and to manage opioid withdrawal symptoms or reduce/stop opioid use. This post explores the use of kratom as a potential treatment for opioid use disorder.
Kratom (mitragyna speciosa) is a tropical tree native to Southeast Asia and, like coffee, is part of the Rubiaceae plant family. Ingesting the leaves produces a high. Taken in small amounts, it leads to stimulant-like effects (i.e. increased energy and focus – stronger than caffeine, less intense than cocaine). When taken in larger doses, the high is similar to that of an opioid (euphoria, drowsiness, “pinned” pupils, dry mouth, sweating, nausea, constipation, etc.) Kratom is unique in that it produces both stimulant and opioid-like effects.
Note: “Opioid” is the term used for any drug that binds to the opioid receptors in the brain. An “opiate,” on the other hand, is a naturally occurring chemical found in the poppy plant, such as morphine or codeine. All opiates are opioids.
In the United States, kratom users cite pain relief as a primary motive for use. It’s an opioid agonist, and works by binding to opioid receptors in the brain. It can be effective for both acute and chronic pain. Others report using kratom for energy, increased focus, lower levels of anxiety, to reduce/stop the use of opioids, to reduce symptoms of PTSD or depression, and to elevate mood.
Kratom is legal in Virginia; it’s sold at vape or “head” shops as
a loose powder or in capsules. (Alternatively, kratom can be purchased online.)
Packaging is typically labeled “botanical sample only; not for human
consumption.” The extremely bitter powder can be sprinkled over food or brewed
into a tea. It’s easily swallowed in capsule form.
What does kratom mean for the opioid epidemic in America? Will it one day play a key role in the treatment of opioid use disorders? Or will it fall into the “harm reduction” category? Is it a natural pain medication, a safe alternative to highly addictive opioid pain killers?
Or, will we find that kratom, like heroin, is habit-forming and
deadly? Currently, the research is mixed.
An Alternative
to Opioid Drugs
The results of a 2019 survey published in Drug and Alcohol Dependence revealed that 90% of respondents found kratom
effective for relieving pain, reducing opioid use, and easing withdrawal
symptoms.
In 2011, researchers discovered that kratom alleviated morphine withdrawal symptoms. A more recent study indicated that it may reduce morphine use.
Earlier this year, researchers found that kratom use was associated with significant decreases in the occurrence and severity of opioid adverse effects; it lessened the discomfort of opioid withdrawal. Multiple studies have substantiated these findings, suggesting that it could be a useful medication for opioid addiction and withdrawal.
Interestingly, in 2007, it was found that kratom reduced alcohol withdrawal behaviors. More recently, researchers discovered that it was associated with decreased alcohol use; this suggests that it may help those with alcohol use disorders (AUD) in addition to opioid addiction.
Compared to heroin, kratom is less addictive and has milder withdrawal symptoms. Furthermore, the risk of overdose is low. A 2018 literature review indicated that it may have harm-reduction potential for individuals who want to stop using opioids.
Dangerous & Addictive?
According to the CDC, there were 152 kratom-involved deaths between July 2016 and December 2018 (“kratom-involved,” meaning it was a factor). In seven of those deaths, kratom was the only substance found in toxicology tests (although it should be noted that the presence of other substances was not fully ruled out). It’s possible to overdose on kratom, and when combined with other drugs or medications, it can be fatal.
In rare cases, kratom has been linked to liver toxicity, kidney damage, and seizures. In the case of a 32-year-old woman who was using it for opioid withdrawal, it was likely the cause of acute lung injury. Use may also cause cardiac or respiratory arrest.
Kratom’s harmful effects are not limited to the body; a 2010 study linked chronic use to alterations in working memory. In 2016, researchers found that kratom use was associated with cognitive impairment. An additional 2016 study supported previous findings that it may affect learning. In 2019, researchers found that high doses were linked to memory deficits. In contrast, a 2018 study indicated that high kratom consumption was not related to long-term cognitive impairment. That same year, researchers found that long-term kratom use did not appear to cause altered brain structures. More research is needed in this area.
Regarding whether or not kratom is addictive, multiple studies have found that regular use leads to dependence, withdrawal symptoms, and cravings. Kratom cessation may also cause psychological withdrawal symptoms, such as anxiety and depression.
Will kratom step up as the hero of today’s opioid epidemic? Doubtful. And for kratom to be a viable treatment option, more conclusive research is needed. Additionally, researchers must study the safety of long-term use.
While it’s unlikely, kratom use could lead to adverse health
effects or cognitive impairment; it could also fatally interact with other
substances or medications. Furthermore, long-term use may lead to addiction. In
sum, the majority of the literature suggests that kratom is, by no means, safe.
That being said, when compared to shooting heroin, kratom is safe (a safer alternative, at least). And if someone chooses to use it to reduce/stop their opioid use, I’ll view it as harm-reduction. Until we have more answers, I will hold to the harm-reduction view… it has the potential to save lives.
References
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