Category: Substance Use

38 Unconventional Coping Strategies

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

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Image by Daniel Sampaio Donate if you want (Paypal) from Pixabay

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

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

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

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

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

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

Image by Victor Vote from Pixabay

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

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

Current Research

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

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

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

Image by Amanda Oliveira from Pixabay

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

Unconventional Coping Strategies

  1. Crack pistachio nuts
  2. Fold warm towels
  3. Smell your dog (Fun fact: dog paws smell like corn chips!) or watch them sleep
  4. Peel dried glue off your hands
  5. Break glass at the recycling center
  6. Pop bubble wrap
  7. Lie upside down
  8. Watch slime or pimple popping videos on YouTube
  9. Sort and build Lego’s
  10. Write in cursive
  11. Observe fish in an aquarium
  12. Twirl/spin around
  13. Solve math problems (by hand)
  14. Use a voice-changing app (Snapchat works too) to repeat back your worry/critical thoughts in the voice of a silly character OR sing your worries/thoughts aloud to the tune of “Happy Birthday”
  15. Listen to the radio in foreign languages
  16. Chop vegetables
  17. Go for a joy ride (Windows down!)
  18. Watch YouTube videos of cute animals and/or giggling babies
  19. Blow bubbles
  20. Walk barefoot outside
  21. Draw/paint on your skin
  22. Play with (dry) rice
  23. Do (secret) “random acts of kindness”
  24. Play with warm (not hot) candle wax
  25. Watch AMSR videos on YouTube
  26. Shuffle cards
  27. Recite family recipes
  28. Find the nicest smelling flowers at a grocery store
  29. Count things
  30. Use an app to try different hairstyles and/or makeup
  31. People-watch with a good friend and make up stories about everyone you see (Take it to the next level with voiceovers!)
  32. Wash your face mindfully
  33. Buy a karaoke machine and sing your heart out when you’re home alone
  34. On Instagram, watch videos of a hydraulic press smash things, cake decorating, pottery/ceramics throwing, hand lettering, and/or woodwork
  35. Shine tarnished silver
  36. Create a glitter jar and enjoy
  37. Tend to plants
  38. Color in a vulgar coloring book for adults
Image by A_Different_Perspective from Pixabay

Click below for a PDF version of “Unconventional Coping Strategies.” This handout can be printed, copied, and shared without the author’s permission, providing it’s not used for monetary gain.

Unconventional Coping Strategies

  • Cassie Jewell, M.Ed., LPC, LSATP
  • With Lauren Mills, MA, LPC-Intern (Contributor)
  • Lauren Mills, MA, LPC-Intern (Supervised by Mary Ann Satori, LPC-S) is a therapist in Texas and a current resident in counseling.     

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

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

coping strategies

Alcarelle: A Hangover-Free Alternative to Alcohol

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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!

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Alcarelle

Alcarelle, providing liquid courage without the consequences of alcohol: no hangover, no calories, and no harmful impact on your health. Sound too good to be true? Maybe… but maybe not.

Alcarelle is a substance that mimics the effects of alcohol; the Alcarelle website proclaims, “Like alcohol, but better.” Essentially, it’s a synthetic, non-toxic version of alcohol that activates the same neurotransmitters as booze, inducing the “warm fuzzy” feelings of tipsiness. Created by English neuropsychopharmacologist, David Nutt, the active molecule in Alcarelle provides the relaxing and social lubricating qualities of alcohol with none of the associated dangers.

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

According to a 2019 interview in Men’s Health, the Alcarelle effect “plateaus” after three drinks. The implications are that you won’t get hammered or black out 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.    

Image by congerdesign from Pixabay

Bottom line: too much is unknown at this point. Alcarelle may not make it past the testing phase. (Currently, only a prototype of the synthetic molecule exists and funding for the project is limited.)

While I’m hopeful that an alcohol-alternative could advance the treatment of substance use disorders (especially since I believe the ultimate treatment, while yet undiscovered, will be pharmacological), I don’t anticipate Alcarelle being a magical “cure-all.”

DC Area Locals: Ride Free This Holiday Season

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

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Don’t drink and drive! From 10:00 p.m. to 4:00 a.m., use WRAP’s Holiday SoberRide Promo Code (valid 12/20/19-1/1/20) for a free Lyft ride (up to $15).

In Virginia, a first offense DWI can cost up to $2,500 in fines plus court costs. Drunk driving may also result in license suspension and jail time (not to mention death!) #NeverWorthIt

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

5 Effective Self-Care Strategies for Addiction in the Family

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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.

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Image by DanaTentis from Pixabay

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.

In the book Beyond Addiction: How Science and Kindness Help People Change (A Guide for Families), the authors discuss the importance of self-care. This post reviews the authors’ recommended self-care strategies.

(Side note: I strongly recommend reading Beyond Addiction if your loved one has an SUD or if you work in the field. This book will increase your understanding of addiction and teach you how to cope with and positively impact your loved one’s SUD by using a motivational approach. This is one of the best resources I’ve come across, especially for family members/significant others.)

Image by Pexels from Pixabay

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:

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

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

  1. Switch the focus of your thoughts. The possibilities are endless; for you, this could mean reading a magazine, calling a friend, walking the dog, etc. The authors of Beyond Addiction suggested making a list of ideas for changing your thoughts (and keeping it handy).
  2. Switch the focus of your emotions. Steer your emotions in a happier direction by watching corgi puppies on YouTube, reading an inspirational poem, or viewing funny Facebook memes. The writers of Beyond Addiction suggested bookmarking sites in your Internet browser that you know will cheer you up.
  3. Switch the focus of your senses. This could mean taking a hot shower, jumping into a cold pool, holding an ice cube in your hand, walking from a dark room to one that’s brightly lit, looking at bright colors, listening to loud rock music, etc. Also, simply walking away from a distressing situation may help.
  4. Do something generous. Donate to your favorite charity, pass out sandwiches to the homeless, visit a nursing home and spend time with the residents, express genuine thanks to cashier or server, etc. By redirecting attention away from yourself (and directing energy toward positive goals), you’ll feel better. In Beyond Addiction, it’s noted that this skill is especially helpful for individuals who tend to ruminate. Also, it’s important to brainstorm activities that are accessible in the moment (i.e. texting a friend to let them know you’re thinking about them) that don’t take multiple steps (such as volunteering).
Image by congerdesign from Pixabay

Relax

“Body tells mind tells body…” Relaxing your body helps to relax your mind. It also focuses your thoughts on relaxing (instead of your loved one’s addiction). What helps you to relax? Yoga? A hot bath? Mindful meditation? (I recommend doing a mindful body scan; it’s simple and effective, even for the tensest of the tense, i.e. me.)

Soothe Yourself

In Beyond Addiction, self-soothing is described as “making a gentle, comforting appeal to any of your five senses.” A hot beverage. Nature sounds. A cozy blanket. A scenic painting. Essential oils. A cool breeze. A warm compress. A massage. Your favorite song. Find what works for you, make a list, and utilize as needed. Seemingly small 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.)

Image by Free-Photos from Pixabay

Create a Positive Experience

Doctors Foote, Wilkens, and Kosanke refer to this as “making it better,” not in the sense that you’re fixing the problem (or your loved one), but that you’re making the moment better by transforming a negative moment into a positive one. Suggested self-care strategies for creating a positive experience include the following:

  1. Half-smile. Another mind-body technique, half-smiling tricks your brain into feeling happier.
  2. Meditate or pray. As explained in Beyond Addiction, “meditation or pray is another word for – and effective channel to – awareness and acceptance. Either one can open doors to different states of mind and act as an emotional or spiritual salve in trying moments.”
  3. Move. By moving, you’re shifting your focus and releasing energy. Stretch, run, play volleyball, chop wood, move furniture, etc.
  4. Find meaning. The authors of Beyond Addiction wrote, “Suffering can make people more compassionate toward others. Having lived through pain, sometimes people are better able to appreciate moments of peace and joy.” Suffering can also inspire meaningful action. What can you do to find meaning?
  5. Borrow some perspective. How do your problems look from a different viewpoint? Ask a trusted friend. You may find that your perspective is causing more harm than good.

Perspective

Perspective is “an understanding of a situation and your reactions to it that allows you to step back and keep your options open… [it’s] seeing patterns, options, and a path forward” (Beyond Addiction).

When Trish married Dave nearly 20 years ago, he rarely drank: maybe an occasional beer over the weekend or a glass of wine at dinner. After their fist daughter was born, his drinking increased to a few beers most nights. Dave said it helped him relax and manage the stress of being a new parent.

By the time their second daughter was born several years later, his drinking had progressed to a six-pack of beer every evening (and more on weekends). Currently, Dave drinks at least a 12-pack of beer on weeknights; if it’s the weekend, his drinking starts Friday after work and doesn’t stop until late Sunday night.

Dave no longer helps Trish with household chores or yardwork as he did early in their marriage. He rarely dines with the family and won’t assist with the cooking/cleanup; he typically eats in front of the TV. Dave occasionally engages with his daughters, but Trish can’t recall the last time they went on a family outing, and it’s been years since they went on a date.

Dave struggles to get out of bed in the mornings and is frequently late to work; Trish is worried he’ll get fired. They frequently argue about this. Dave is irritable much of the time, or angry. Most nights, he doesn’t move from his armchair (except to get another beer) until he passes out with the television blaring.

Trish is frustrated; she believes Dave is lazy and lacks self-control. When she nags about his drinking, he promises he’ll cut back, but never follows through. Trish thinks he’s not trying hard enough. She can’t understand why he’d choose booze over her and the kids; sometimes she wonders if it’s because she’s not good enough… maybe he would stop if she was thinner or funnier or more interesting?  At times she feels helpless and hopeless and others, mad and resentful; she frequently yells at Dave. She wonders if things are ever going to change.  

Image by Luis Wilker Perelo WilkerNet from Pixabay

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 and 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.)

Image by HannahJoe7 from Pixabay

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.

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

self-care strategies

Book Review: Staying Sober Without God

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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.

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I stumbled upon Staying Sober Without God while searching for secular 12-step literature for a client who identifies as atheist. Jeffrey Munn, the book’s author, is in recovery and also happens to be a licensed mental health practitioner.

Munn wrote the book because as a nonbeliever he felt the 12 steps of AA didn’t fully translate into a workable program for atheists or agnostics. (For example, the traditional version of Step 3 directs the addict to turn his/her will and life over to the care of God as they understand him. If you don’t believe in God, how can you put your life into the care of him? Munn notes that there’s no feasible replacement for a benevolent, all-knowing deity.)

The whole “God thing” frequently turns nonbelievers off from AA/NA. They’re told (by well-meaning believers) to find their own, unique higher power, such as nature or the fellowship itself. (The subtle undertone is that the nonbeliever will eventually come around to accept God as the true higher power.)

In Staying Sober Without God Munn asserts, “There is no one thing that is an adequate replacement for the concept of God.” He adds that you can’t just replace the word “God” with “love” or “wisdom.” It doesn’t make sense. So he developed the Practical 12 Steps and wrote a guide for working them.

Image by congerdesign from Pixabay

The Practical 12 Steps are as follows:

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

The Practical 12 Steps in no way undermine the traditional steps or the spirit of Alcoholics Anonymous. Instead, they’re supplemental; they provide a clearer picture of the steps for the nonbeliever.

Before delving into the steps in Staying Sober Without God, Munn discusses the nature of addiction, recovery, and the role of mental illness (which is mostly left untouched in traditional literature). He addresses the importance of seeking treatment (therapy, medication, etc.) for mental disorders while stressing that a 12-step program (secular or otherwise) is not a substitute for professional help. In following chapters, Munn breaks each step down and provides guidelines for working it.

The last few chapters of the book provide information on relapse and what the steps don’t address. Munn notes that sustainable recovery requires more than just working the steps, attending AA meetings, and taking a sponsor’s advice. For a balanced, substance-free lifestyle, one must also take care of their physical health, practice effective communication, and engage in meaningful leisure activities. Munn briefly discusses these components in the book’s final chapter, “What the Steps Miss.”

Image by xxolaxx from Pixabay

Staying Sober Without God is well-written and easy to read. The author presents information that’s original and in line with current models of addiction treatment, such as behavioral therapy (an evidence-based approach for substance use disorder). Working the Practical 12 Steps parallels behavioral treatments; the steps serve to modify or discontinue unhealthy behaviors (while replacing them with healthy habits). Furthermore, a 12-step network provides support and meaningful human connection (also crucial for recovery).

In my opinion, the traditional 12 Steps reek of the moral model, which viewed addiction as a moral failure or sin. Rooted in religion, this outdated (and false) model asserted that the addict was of weak character and lacked willpower. The moral model has since been replaced with the disease concept, which characterizes addiction as a brain disorder with biological, genetic, and environmental influences.

The Practical 12 Steps are a better fit for what we know about addiction today; Munn focuses on unhealthy behaviors instead of “character defects.” For example, in Step 7, the addict implements healthy habits while addressing unhealthy characteristics. No one has to pray to a supernatural being to ask for shortcomings to be removed.

Image by m storm from Pixabay

The Practical 12 Steps exude empowerment; in contrast, the traditional steps convey helplessness. (The resulting implication? The only way to recover is to have faith that God will heal you.) The practical version of the steps instills hope and inspires the addict to change. Furthermore, the practical steps are more concrete and less vague when compared to the traditional steps. (This makes them easier to work!)

In sum, Munn’s concept of the steps helped me to better understand the 12-step model of recovery; the traditional steps are difficult to conceptualize for a nonbeliever, but Munn found a way to extract the meaning of each step (without altering overall purpose or spirit). I consider the practical steps a modern adaptation of the traditional version.

I recommend reading Staying Sober Without God if you have a substance use disorder (regardless of your religious beliefs) or if you’re a professional/peer specialist who works with individuals with substance use disorders. Munn’s ideas will give you a fresh perspective on 12-step recovery.

For working the practical steps, download the companion workbook here:

📂 STAYING SOBER WITHOUT GOD: WORKBOOK

Note: The workbook is meant to be used in conjunction with Munn’s book. I initially created it for the previously mentioned client as a format for working the practical steps. The workbook is for personal/clinical use only.

Kratom: A Safe Alternative to Heroin?

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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.

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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.

Image by GOKALP ISCAN from Pixabay

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.

Image by Abel Tadesse from Pixabay

Harm-Reduction

Compared to heroin, kratom is less addictive and has milder withdrawal symptoms. Furthermore, the risk of overdose is low. A 2018 literature review indicated that it may have harm-reduction potential for individuals who want to stop using opioids.

Dangerous & Addictive?

According to the CDC, there were 152 kratom-involved deaths between July 2016 and December 2018 (“kratom-involved,” meaning it was a factor). In seven of those deaths, kratom was the only substance found in toxicology tests (although it should be noted that the presence of other substances was not fully ruled out). It’s possible to overdose on kratom, and when combined with other drugs or medications, it can be fatal.

In rare cases, kratom has been linked to liver toxicity, kidney damage, and seizures. In the case of a 32-year-old woman who was using it for opioid withdrawal, it was likely the cause of acute lung injury. Use may also cause cardiac or respiratory arrest.

Image by Simon Orlob from Pixabay

Kratom’s harmful effects are not limited to the body; a 2010 study linked chronic use to alterations in working memory. In 2016, researchers found that kratom use was associated with cognitive impairment. An additional 2016 study supported previous findings that it may affect learning. In 2019, researchers found that high doses were linked to memory deficits. In contrast, a 2018 study indicated that high kratom consumption was not related to long-term cognitive impairment. That same year, researchers found that long-term kratom use did not appear to cause altered brain structures. More research is needed in this area.

Regarding whether or not kratom is addictive, multiple studies have found that regular use leads to dependence, withdrawal symptoms, and cravings. Kratom cessation may also cause psychological withdrawal symptoms, such as anxiety and depression.

Image by StockSnap from Pixabay

Bottom Line

Will kratom step up as the hero of today’s opioid epidemic? Doubtful. And for kratom to be a viable treatment option, more conclusive research is needed. Additionally, researchers must study the safety of long-term use.

While it’s unlikely, kratom use could lead to adverse health effects or cognitive impairment; it could also fatally interact with other substances or medications. Furthermore, long-term use may lead to addiction. In sum, the majority of the literature suggests that kratom is, by no means, safe.

That being said, when compared to shooting heroin, kratom is safe (a safer alternative, at least). And if someone chooses to use it to reduce/stop their opioid use, I’ll view it as harm-reduction. Until we have more answers, I will hold to the harm-reduction view… it has the potential to save lives.

kratom
  • References
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  • 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 Pharmacol, 8, 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 Drugs, 51(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 Rehabilitation, 10, 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 Biology, 21:98– 110. doi: 10.1111/adb.12185

80 Powerful 12-Step Groups for Recovery

(Updated 5/15/21) 12-step recovery groups, while not a substitute for treatment, can play a crucial role in recovery and continued sobriety. AA/NA (and similar) meetings are available all over the world and are open to anyone with a desire to stop using or drinking.

12-step

12-Step Recovery Groups

The following list is comprised of links to both well-known and less-familiar 12-step and similar support groups for recovery.

Support Groups for Addiction

For Families & Others Impacted by Addiction & Mental Illness

Secular Alternatives

Faith-Based Alternatives

Additional Support Groups & Organizations

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!

12-step

Click below for a downloadable PDF version of this post.

12-STEP RECOVERY GROUPS

50 Free Mental Health Worksheets & Handouts

(Updated 1/23/22) This is a list of 50+ mental health worksheets, handouts, forms, and more for mental illness/substance use disorders.

Please repost and share with anyone who might benefit! New resources are added on a regular basis.

Click here for a list of sites with mental health worksheets/handouts and here for for a list of free PDF workbooks, manuals, and self-help guides.

Find additional free mental health worksheets and resources at TherapistAid, GetSelfHelpUK, and Taking the Escalator.

Mental Health Worksheets & Handouts

Group Ideas & Topics

15 Tips for Dealing with Challenges in Group Therapy 🆕
101 Group Topics
Discussion Questions for Multifamily Groups
Discussion Topics for Substance Abuse Groups
Group Check-In Ideas
Questions to Explore Values-Ideas-Beliefs

Group Activities

5-Minute Autobiography
Affirmations Activity
First Impressions

Good for newly formed groups. Each group member writes down their “first impression” of other group members. The facilitator then reviews each “impression,” and group members have the opportunity to share their answers.

Icebreaker Question Cards

Print/cut the cards, fold, and place in a container. Group members take turns drawing the cards and answering the questions.

People Search

Give group members 15-20 minutes to collect signatures. The first person to collect all signatures wins.

Recovery Question Cards

Print/cut the cards, fold, and place in a container to pass around. This activity works best with a working group.

Clinical Film Discussion Questions

Mental Health Handouts

12-Step Recovery Groups
25 Examples of Dialectics
25 Journal Prompts for Self-Discovery
Grief Misconceptions 🆕
Healing Grief 🆕
Journal Prompts (from The Sober Survival Guide)
List of Hobbies
Online Grief Support 🆕
Post-Traumatic Growth
Resources for Suicide Prevention & Recovery 🆕
Uncommon Grief Experiences 🆕
Unconventional Coping Skills
WORKOUT PLANS – Beginner & Intermediate 🆕

Mental Health Worksheets

30-Day Random-Acts-of-Kindness Challenge 🆕
Am I a Good Friend? 🆕
Consequences of Addiction
Daily Affirmations for Self-Love 🆕
Daily Mood Tracker
Leisure-Wellness-Spirituality in Recovery
Letter to Self
Life Areas for Goal Development
Managing Relapse Triggers
My Addiction
My Goals
My Resentments
Relapse Prevention
Relapse Prevention Plan
Resisting Temptation in Recovery 🆕
Self-Care Ideas 🆕
Self-Care Menu 🆕
Self-Discovery Assignment
Self-Esteem Worksheet
Shifting Motivations in Recovery
Sobriety Bucket List
Treatment Planning Worksheet
Wants Vs. Needs
Weekly Food Diary
What Do I Have Control Over? 🆕

Workbooks & Bonus Materials

COPING WITH LOSS Workbook
Staying Sober Without God-Companion Workbook

Daily Self-Inventory for Mental Health Professionals

Free Coloring Pages for Adults

Miscellaneous Printables

20 Check-In Ideas for Therapy
Case Presentation Template
Therapeutic Interventions
Group Supervision Log-Supervisor Version
mental health worksheets

500 Free Printable Workbooks & Manuals for Therapists

(Updated 4/5/22) The following list is comprised of links to over 500 free printable workbooks, manuals, toolkits, and guides that are published online and are free to use with clients and/or for self-help purposes. Some of the manuals, including Individual Resiliency Training and Cognitive Behavioural Therapy for Psychotic Symptoms, are evidence-based.

Please repost this and/or share with anyone you think could benefit from these free printable workbooks and clinical tools!

For free printable workbooks and guides for youth/family, click here. For additional free printable workbooks and resources on a variety of mental health topics, see 200+ Sites with Free Therapy Worksheets & Handouts and 42 Free Therapy Handouts & Worksheets.

Free Printable Workbooks, Manuals, & Self-Help Guides for Mental Health Professionals & Consumers

Disclaimer: Links are provided for informational and educational purposes. I recommend reviewing each resource before using for updated copyright protections that may have changed since it was posted here. When in doubt, contact the author(s).

Substance Use Disorders & Addiction

Free printable workbooks, manuals, toolkits/self-help guides for substance and behavioral (i.e. food, gambling, etc.) addictions and recovery

There are several SAMHSA workbooks listed below; you can find additional free publications on SAMHSA’s website. For fact sheets and brochures, go to the National Institute on Drug Abuse website or the National Institute on Alcohol Abuse and Alcoholism. If you’re looking for 12-step literature, many 12-step organizations post free reading materials, workbooks, and worksheets; don’t forget to check local chapters! (See 12-Step Recovery Groups for a comprehensive list of recovery support group sites.)

Other great places to look for free printable workbooks and resources for addiction include education/advocacy and professional membership organization sites. (Refer to the Resource Links page on this site for an extensive list.)

💜 = Resource for Veterans
🏳️‍🌈 = LGBTQ+ Resource

Anxiety & Mood Disorders

Free printable workbooks and other resources for anxiety (generalized, social phobia/anxiety, panic attacks), depressive and bipolar disorders, and prenatal/postpartum anxiety and depression

For more factsheets, brochures, and booklets, see SAMHSA, National Institute of Mental Health, NHS UK, CMHA, and education/advocacy sites listed on the Resource Links page on this site.

💜 = Resource for Veterans

Anxiety Disorders
Depressive & Bipolar Disorders
Postpartum Anxiety & Depression

Schizophrenia & Psychotic Disorders

A small collection of free printable workbooks, manuals, toolkits, and guides for schizophrenia spectrum and related disorders

Obsessive-Compulsive & Hoarding Disorders

Free printable workbooks, manuals, and guides for obsessive-compulsive, hoarding, and related disorders and issues

Trauma & PTSD

Free printable workbooks, manuals, and guides for trauma (including vicarious trauma) and PTSD

💜 = Resource for Veterans

Eating Disorders

Free printable workbooks and toolkits/guides for anorexia, bulimia, and binge eating disorders

Suicide & Self-Harm

Free printable workbooks and toolkits/guide for suicide prevention and recovery and for non-suicidal self-injury

For additional resources for suicide, see 100+ Resources for Suicide Prevention & Recovery.

Grief & Loss

Free printable workbooks and toolkits/guides for grief and loss

For additional resources for grief and loss, see Grief & Loss: A Comprehensive Resource Guide and 3 Powerful TED Talks on Grief.

Anger

Free printable workbooks, manuals, and guides for coping with anger

For additional anger management tools, see 75 Helpful Anger Management Resources.

Self-Esteem: Free Printable Workbooks & Guides

Healthy Relationships & Communication

For additional related tools, see 50 Free Marriage & Relationship Assessment Tools.

Meditation & Mindfulness

Resiliency, Personal Development, & Wellness

Free Printable Workbooks for Forgiveness
Free Printable Workbooks & Guides for Sleep
Free Printable Workbooks & Guides for Stress

Self-Care

Free printable workbooks, toolkits, and guides for self-care

Nutrition & Exercise

Free printable workbooks, manuals, and guides for diet, physical activity, and health

CBT, DBT, & MI

Note: The free printable workbooks and other resources listed in the following section may also be listed in other sections of this post.

CBT: Free Printable Workbooks & Manuals
DBT: Free Printable Workbooks & Manuals
Motivational Interviewing

Additional Free Printable Workbooks, Manuals, & Self-Help Guides

🔝

free printable PDF workbooks

Please comment with links to additional free printable workbooks and PDF resources for therapy or self-help!

4 Ways to Fight Stigma with Language

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Words have power. They are impactful. They can contribute to stigma and divide humanity. To help fight stigma, change your language.

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stigma

Have you ever been called a bitch? A creep? A whore? An idiot? Maybe someone said you were lazy or worthless or stupid. Words can hurt. Language has power. (Consider the power of your name spoken aloud… you immediately respond by answering or turning your head… the sound commands your attention and response.)

Furthermore, words are impactful… not only for the person being labeled, but for an entire group of people. They contribute to stigma while fueling biases. They divide humanity. Retard. White trash. Crazy. Junkie. N*****. Slut. Spic.

A while back, a colleague made a racial slur in my presence. He seemed unaware, so I gently corrected him; he immediately lashed back, calling me the “PC Police.” Not only did this person perceive the slur as perfectly acceptable, he seemed to have a negative perception of “political correctness.” It was a joke to him: “People need to stop being so sensitive!” (Um, no… maybe people need to stop being degrading to each other!)

Honestly, I have trouble understanding the negativity surrounding political correctness. Why strive for anything other than accuracy? (Especially knowing the power language holds.)

Why Language Matters: 4 Words/Phrases to Stop Saying

If you side against ignorance and want to end the stigma associated with mental illness, change your language. The following words or phrases contribute to stigma:

“Addict”

There are many negative connotations surrounding this word. Similarly, “alcoholic” can be demeaning. A person who is addicted to drugs or alcohol has a medical condition. Instead of calling them an addict (or junkie or tweaker or crackhead), say “individual with a substance use disorder.” Demonstrate the same empathy you would for a person who has cancer or MS or paralysis.

“Schizophrenic”

Don’t label a person who suffers from mental illness. They are more than the disorder they’re afflicted with. Calling someone “schizophrenic” or “borderline” or “bipolar” reduces them to an illness, not a person. It’s dehumanizing.

“Retarded”

True, “mental retardation” used to be the diagnostic terminology for classifying individuals with lower IQs. Today, however, it’s mostly used as an insult. The American Psychiatric Association has eliminated the term as a classification; the correct term is “intellectual disability.”

“Committed suicide”

This phrase suggests that the person who dies by suicide is criminal. Criminals commit crimes. An individual who dies by suicide should not be placed in the same category. Instead, say “died by suicide.” This demonstrates respect for both the individual and their loved ones.

Language has the power to influence and shape the world. You have power. Be a positive influence and choose to fight stigma instead of contributing to the toxicity.

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