Self-Care Strategies When Your Loved One Has an Addiction

Self-care is not a luxury; it’s necessary for survival when your loved one has a substance use disorder. By taking care of yourself, you gain the energy and patience to cope with your problems. Self-care promotes wellness and emotional intelligence; it puts you in a better space to interact with your loved one. Strategies include developing/building resilience, practicing distress tolerance, keeping perspective, and recognizing/managing your triggers.

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

When your loved one has a substance use disorder (SUD), it can be overwhelming, distressing, and all-consuming. When we’re stressed, we forget to practice basic self-care, which in turn makes us even less equipped to cope with the emotional chaos addiction generates.  

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

Based on the premise that your actions affect your loved one’s motivation, taking care of yourself is not only modeling healthy behaviors, it’s putting you in a better space to interact with your loved one. Chronic stress and worry make it difficult to practice self-care. Self-care may even seem selfish. However, by taking care of yourself and thus reducing suffering, you gain the energy and patience to cope with your problems (and feel better too). Furthermore, you reduce the level of pain and tension in your relationships with others, including your loved one with a SUD. Self-care strategies include developing/building resilience, practicing distress tolerance, keeping perspective, and recognizing/managing your triggers. Therapy and/or support groups are additional options.

“An empty lantern provides no light. Self-care is the fuel that allows your light to shine brightly.”

Unknown

Resilience

The definition of resilience is “the capacity to recover quickly from difficulties” (Oxford Dictionary). Doctors Foote, Wilkens, and Kosanke wrote that having resilience is a way to “systematically reduce your vulnerability to bad moods, lost tempers, and meltdowns.” While you cannot “mood-proof” yourself entirely, resilience helps when facing life’s challenges, setbacks, and disappointments. To maintain resilience, one must practice at least the most basic self care practices, which are as follows:

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

Self-care is not something you can push in to the future. Don’t wait until you have more time or fewer obligations. Self-care is not a luxury; it’s a necessity. The authors of Beyond Addiction pointed out that self-care is something you have control over when other parts of your life are out of control. If you find it challenging to implement self-care practices, tap into your motivations, problem-solve, get support, and most of all, be patient and kind with yourself.

“Taking care of yourself is the most powerful way to begin to take care of others.”

Bryant McGill

Distress Tolerance

On tolerance, Doctors Foote, Wilkens, and Kosanke suggested that it is “acceptance over time, and it is a cornerstone of self-care.” Tolerance is not an inherent characteristic; it is a skill. And like most skills, it requires practice. However, it’s wholly worth the effort as it reduces suffering. By not tolerating the things you cannot change (such as a loved one’s SUD), you’re fighting reality and adding to the anguish.

Techniques for distress tolerance include distracting yourself, relaxing, self-soothing, taking a break, and creating positive experiences. (The following skills are also taught in dialectical behavior therapy (DBT), an evidence-based practice that combines cognitive behavioral therapy techniques and mindfulness. For additional resources, visit The Linehan Institute or Behavioral Tech.)    

Distract Yourself

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

Relax

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

Soothe Yourself

In Beyond Addiction, self-soothing is described as “making a gentle, comforting appeal to any of your five senses.” A hot beverage. Nature sounds. A cozy blanket. A scenic painting. Essential oils. A cool breeze. A warm compress. A massage. Your favorite song. Find what works for you, make a list, and utilize as needed. Seemingly small techniques can make a big difference in your life by creating comfort and reducing out-of-control emotions.

Take A Break

“Taking a break” doesn’t mean giving up; it’s a timeout for when you’re emotionally exhausted. Learn to recognize when you need to step away from a situation or from your own thoughts. Find a way to shift your focus to something pleasant (i.e. a romantic movie, a nature walk, a day trip to the beach, playing golf for a few hours, traveling to a different country, etc.)

Create a Positive Experience

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

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

Perspective

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

When Trish married Dave nearly 20 years ago, he rarely drank: maybe an occasional beer over the weekend or a glass of wine at dinner. After their fist daughter was born, his drinking increased to a few beers most nights. Dave said it helped him relax and manage the stress of being a new parent. By the time their second daughter was born several years later, his drinking had progressed to a six-pack of beer every evening (and more on weekends). Currently, Dave drinks at least a 12-pack of beer on weeknights; if it’s the weekend, his drinking starts Friday after work and doesn’t stop until late Sunday night.

Dave no longer helps Trish with household chores or yardwork as he did early in their marriage. He rarely dines with the family and won’t assist with the cooking/cleanup; he typically eats in front of the TV. Dave occasionally engages with his daughters, but Trish can’t recall the last time they went on a family outing, and it’s been years since they went on a date. Dave struggles to get out of bed in the mornings and is frequently late to work; Trish is worried he’ll get fired. They frequently argue about this. Dave is irritable much of the time, or angry. Most nights, he doesn’t move from his armchair (except to get another beer) until he passes out with the television blaring.

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

A different perspective would be to recognize that Dave has an alcohol use disorder. He feels ill most of the time, which affects his mood, energy level, and motivation. He wants to cut back, but fails when he tries, which leads to guilt and shame. To feel better, he drinks. It’s a self-destructive cycle. If Trish understood this, she could learn to not take his drinking personally or question herself. Her current reactions, nagging and yelling, only increase defensiveness and harm Dave’s sense of self-worth. Alternative options for Trish might include learning more about addiction and the reasons Dave drinks, bolstering his confidence, and/or creating a supportive and loving environment to enhance motivation.

Triggers

In recovery language, a “trigger” is anything (person, place, or thing) that prompts a person with SUD to drink or use; it activates certain parts of the brain associated with use. For instance, seeing a commercial for beer could be triggering for a person with an alcohol use disorder.

You have triggers too. For example, if your loved one is in recovery for heroin, and you notice that a bottle of opioid painkillers is missing from the medicine cabinet, it could trigger a flood of emotions: fear, that your loved one relapsed; sadness, when you remember the agony addiction brings; hopelessness, that they’ll never recover. It’s crucial to recognize what triggers you and have a plan to cope when it happens.

Therapy and Support Groups

Lastly, therapy and/or support groups can be a valuable addition to your self-care regime. Seeing a therapist can strengthen your resilience and distress tolerance skills. Therapy may provide an additional avenue for perspective. (Side note: A good therapist is supportive and will provide you with tools for effective problem-solving and communication, coping with grief and loss, building self-esteem, making difficult choices, managing stress, overcoming obstacles, improving social skills/emotional intelligence, and better understanding yourself. A good therapist empowers you. A bad therapist, on the other hand, will offer advice and/or tell you what to do, disempowering you.)

Regarding support groups, there are many options for family members, friends, and significant others with a loved one who has a SUD, including Al-Anon, Nar-Anon, and Families Anonymous. Support groups provide the opportunity to share in a safe space and to receive feedback, suggestions, and/or encouragement from others who relate.


“I have come to believe that caring for myself is not self indulgent. Caring for myself is an act of survival.”

Audre Lorde

In sum, self-care is not optional; it’s essential for surviving the addiction of a loved one. Self-care enhances both overall wellness and your ability to help your loved one; in order words, take responsibility for your health and happiness by taking care of yourself.

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

Book Review: Staying Sober Without God

Munn wrote this book because, as a nonbeliever, he felt the 12 steps of AA didn’t fully translate into a workable program for atheists or agnostics. This inspired him to develop the Practical 12 Steps.

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

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

I stumbled upon Staying Sober Without God while searching for secular 12-step literature for a client who identifies as atheist. Jeffrey Munn, the book’s author, is in recovery and also happens to be a licensed mental health practitioner. Munn wrote the book because, as a nonbeliever, he felt the 12 steps of AA didn’t fully translate into a workable program for atheists or agnostics. (For example, the traditional version of Step 3 directs the addict to turn his/her will and life over to the care of God as they understand him. If you don’t believe in God, how can you put your life into the care of him? Munn notes that there’s no feasible replacement for a benevolent, all-knowing deity.)

The whole “God thing” frequently turns nonbelievers off from AA/NA. They’re told (by well-meaning believers) to find their own, unique higher power, such as nature or the fellowship itself. (The subtle undertone is that the nonbeliever will eventually come around to accept God as the true higher power.) Munn writes, “There is no one thing that is an adequate replacement for the concept of God.” He adds that you can’t just replace the word “God” with “love” or “wisdom.” It doesn’t make sense. So he developed the Practical 12 Steps and wrote a guide for working them.

The Practical 12 Steps are as follows:

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

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


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

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

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

In my opinion, the traditional 12 Steps reek of the moral model, which viewed addiction as a moral failure or sin. Rooted in religion, this outdated (and false) model asserted that the addict was of weak character and lacked willpower. The moral model has since been replaced with the disease concept, which characterizes addiction as a brain disorder with biological, genetic, and environmental influences. The Practical 12 Steps are a better fit for what we know about addiction today; Munn focuses on unhealthy behaviors instead of “character defects.” For example, in Step 7, the addict implements healthy habits while addressing unhealthy characteristics. No one has to pray to a supernatural being to ask for shortcomings to be removed.

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


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

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


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

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

List of Hobbies

Discover your next greatest hobby with this diverse list of assorted leisure activities, which range from beekeeping to Kombucha brewing to knife throwing to ghost hunting.

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

I developed this list (with the help of Wikipedia, and Google, of course) as part of a project I was working on and thought it would be worth sharing.

Hobby Categories

Animals & Nature | Arts & Crafts | Collections | Cooking & Baking | Entertainment | Home Improvement & DIY | Literature, Music, & Dance | Outdoor & Adventure | Self-Improvement & Social | Sports | Travel | Miscellaneous

Read and be inspired!

Animals & Nature

  • Attend pet shows (or horse shows)
  • Beekeeping
  • Berry or apple picking
  • Bird watching
  • Butterfly garden (Visit one or create your own!)
  • Butterfly watching
  • Be a plant parent; nurture and care for indoor plants
  • Composting
  • Dog training
  • Dog walking
  • Fossil hunting
  • Grow and tend to a fruit tree
  • Grow an indoor herb garden
  • Grow plants from seedlings (and plant outside when in-season)
  • Hang humming bird feeders and then sit back and enjoy the company!
  • Horseback riding
  • Become an expert at identifying various plants
  • Mushroom hunting
  • Nature walks
  • Adopt a pet
  • Pet fostering
  • Pet sitting
  • Plant a flower bed
  • Go on a swamp tour
  • Tend to a vegetable garden
  • Topiary
  • Visit a farm
  • Visit an aquarium
  • Go to zoos and/or nature centers
  • Watch wildlife on Animal Planet
  • Go whale watching

Arts & Crafts

  • Drawing
  • Candle making
  • Collages – Use whatever materials you desire!
  • Coloring
  • Crocheting
  • Design your own greeting cards or stationary
  • Flower arranging
  • Glassblowing
  • Jewelry making
  • Knitting
  • Lettering/calligraphy
  • Mixed media art
  • Mosaic making
  • Origami
  • Painting (watercolor, oils, acrylics, etc.)
  • Paper crafts (including paper mache)
  • Photography
  • Pressed flower craft
  • Pottery
  • Quilting
  • Scrapbooking
  • Sculpting
  • Sewing
  • Sketching
  • Soap making
  • Weaving
  • Wood carving

Collections

  • Action figures
  • Antiques
  • Autographs
  • Barbies
  • Books (classics, signed copies, etc.)
  • Christmas tree ornaments
  • Comics
  • Fun socks
  • Hot sauce from around the world
  • Movie or music memorabilia
  • Obsolete tech (i.e. outdated cell phones, tape players, etc.)
  • Original artwork
  • Plates
  • Purses, shoes, and other accessories
  • Recipes
  • Records
  • Retro video games
  • Rocks and/or crystals
  • Shells
  • Souvenirs
  • Sports memorabilia
  • Stickers
  • Ticket stubs
  • Toys
  • Vases
  • Vintage items

Cooking & Baking

  • Braising
  • Bread making
  • Cake decorating
  • Canning
  • Cheese making
  • Coffee roasting
  • Cookie decorating
  • Grilling and BBQ
  • Hosting dinner parties
  • Kombucha brewing
  • Learn ethnic and regional recipes
  • Learn recipes from cooking shows
  • Make “fun foods” for kids
  • Make homemade ice cream
  • Make jam or jelly
  • Make your own beef (or vegan!) jerky
  • Participate in competitive food festivals (or just go and enjoy the food!)
  • Pasta making
  • Pastry and confection making
  • Pickling
  • Pie making
  • Raw diet meals
  • Recreate menu items from your favorite restaurants
  • Reduced fat cooking
  • Sautéing
  • Slow cooker meals
  • Smoothie making
  • Soup, sauce, and stock making
  • Sushi making
  • Take a cooking class
  • Tea brewing
  • Try new recipes on a regular basis
  • Use an air fryer
  • Use a dehydrator
  • Use Pinterest for inspiration
  • Vegan cooking
  • Watch Food Network for inspiration

Entertainment

  • Attend movies, operas, plays, and musicals
  • Bingo
  • Board games and/or party games
  • Card games
  • Chess
  • Strategy games
  • Dine out at new restaurants
  • Escape rooms
  • Gaming
  • Go to museums
  • Go to poetry slams or open mic nights
  • Jigsaw puzzles
  • Karaoke
  • Murder mystery shows
  • Read entertainment/celebrity magazines
  • See your favorite bands/artists perform live
  • Standup comedy
  • Theme parks
  • Watch your favorite Netflix series, but make sure you become overly invested (borderline obsessed) with the story line and characters in order for this to qualify as a legit hobby

Home Improvement & DIY

  • Add a backsplash to your kitchen
  • Bathroom remodel
  • Build a shed
  • Build furniture
  • Design a meditation room, home office, “man cave,” or “she shed”
  • DIY headboard
  • Fireplace makeover
  • Hanging shelves
  • Home organization
  • Install smart home technology
  • Kitchen remodel
  • Paint an accent wall or update your entire home
  • Paint old cabinets
  • Redecorate a room
  • Stencil or wallpaper
  • Update a closet
  • Update furniture
  • Update lighting
  • Use chalk paint or metallic spray paint

Literature, Music, & Dance

  • Acting
  • Attend art galleries
  • Attend literary fests
  • Ballroom dancing
  • Belly dancing
  • Blogging/guest blogging
  • Break dancing
  • Editing
  • Go to book signings
  • Go to the library
  • Join a book club (either in-person or online, i.e. Goodreads)
  • Listen to music
  • Play/learn an instrument
  • Puppeteering
  • Rapping
  • Reading
  • Sell your art on etsy.com
  • Singing
  • Song-writing
  • Submit articles/opinion pieces/essays to magazines and newspapers
  • Swing dancing
  • Take a dance class (swing, hip hop, ballroom, etc.)
  • Take a drama or improv class
  • Take voice lessons
  • Wikipedia editing
  • Write a book
  • Write poetry
  • Write short stories

Outdoor & Adventure

  • Backpacking
  • Boating
  • Bungee jumping
  • Camping
  • Canoeing
  • Caving
  • Fishing
  • Geocaching
  • Go-Karting
  • Hiking
  • Hot air ballooning
  • Kayaking
  • Laser tag
  • Mountain biking
  • Mountain climbing
  • Paintball
  • Parasailing
  • Rocking climbing
  • Sailing
  • Scuba diving
  • Skiing
  • Skydiving
  • Snowboarding
  • Snorkeling
  • Waterskiing
  • White water rafting
  • Wilderness survival

Self-Improvement & Social

  • Advocate
  • Attend support groups/meetings
  • Attend workshops
  • Bullet journaling
  • Daily positive affirmations and/or self-reflection
  • Join a club
  • Join a gym
  • Join a Meetup group
  • Join a political campaign
  • Journaling
  • Keep a gratitude journal
  • Listen to podcasts
  • Make a vision board and update it regularly
  • Meditation
  • Read research
  • Read self-improvement books
  • Social media
  • Stretching
  • Take a class (i.e. self-defense, a foreign language, etc.)
  • Use a habit tracker app
  • Volunteer
  • Watch documentaries
  • Watch inspirational Ted Talks
  • Wear a fitness tracker
  • Yoga

Sports

  • Archery
  • Badminton 
  • Baseball
  • Basketball
  • Biking
  • Body building
  • Bowling
  • Boxing
  • Cricket
  • Darts
  • Disc golf/frisbee
  • Fencing
  • Football/flag football
  • Golf
  • Gymnastics
  • Hockey
  • Ice skating
  • Jogging/running
  • Knife throwing
  • Lacrosse
  • Martial arts
  • Poker
  • Racquetball
  • Racing
  • Riding a unicycle
  • Roller derby
  • Rugby
  • Skateboarding
  • Soccer
  • Surfing/body boarding
  • Swimming
  • Table football
  • Table tennis
  • Tennis
  • Thai Chi
  • Volleyball
  • Weight training
  • Wrestling

Travel

  • Alaskan cruise
  • All-inclusive resorts
  • Beach vacations
  • Caribbean cruise
  • Cross country train trip
  • Explore your home town and other nearby place as though you’re a tourist
  • Guided group tours
  • Mediterranean cruise
  • Road trip
  • See the Northern Lights
  • Travel to all the continents in the world
  • Travel to all the states in America
  • Trip to Las Vegas
  • Visit the Grand Canyon
  • Visit the New Seven Wonders of the World
  • Visit the Seven Ancient Wonders of the World
  • Go on city walking tours

Miscellaneous Hobbies

  • Astrology/astronomy
  • Billiards
  • Couponing
  • Creating DIY home products
  • Fantasy sports
  • Genealogy
  • Ghost hunting
  • Hair styling/braiding
  • Hula hooping
  • Juggling
  • Keeping up with the latest fashions
  • Kite flying
  • Learning magic tricks
  • Makeup application
  • Metal detecting
  • Model building
  • People watching
  • Storage unit auctions
  • Sunbathing
  • Yard sale shopping/thrifting

Note: The Wikipedia webpage, “List of Hobbies” (https://en.wikipedia.org/wiki/List_of_hobbies), was utilized as a reference for this list.

Kratom: A Safe Alternative to Heroin?

Kratom is a tropical tree native to Southeast Asia. It’s becoming increasingly popular in the United States. It’s used for pain relief, mood enhancement, and to manage opioid withdrawal symptoms or reduce/stop opioid use. This post explores the use of kratom as a potential treatment for opioid use disorder.

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

Kratom (mitragyna speciosa) is a tropical tree native to Southeast Asia and, like coffee, is part of the Rubiaceae plant family. Ingesting kratom leaves produces a high. Taken in small amounts, kratom leads to stimulant-like effects (i.e. increased energy and focus – stronger than caffeine, less intense than cocaine). When taken in larger doses, the high is similar to that of an opioid (euphoria, drowsiness, “pinned” pupils, dry mouth, sweating, nausea, constipation, etc.) Kratom is unique in that it produces both stimulant and opioid-like effects.

Note: “Opioid” is the term used for any drug that binds to the opioid receptors in the brain. An “opiate,” on the other hand, is a naturally occurring chemical found in the poppy plant, such as morphine or codeine. All opiates are opioids.

In the United States, kratom users cite pain relief as a primary motive for use. Kratom, an opioid agonist, works by binding to opioid receptors in the brain. It can be effective for both acute and chronic pain. Others report using kratom for energy, increased focus, lower levels of anxiety, to reduce/stop the use of opioids, to reduce symptoms of PTSD or depression, and to elevate mood.

Kratom is legal in Virginia; it’s sold at vape or “head” shops as a loose powder or in capsules. (Alternatively, kratom can be purchased online.) Packaging is typically labeled “botanical sample only; not for human consumption.” The extremely bitter powder can be sprinkled over food or brewed into a tea. It’s easily swallowed in capsule form.

What does kratom mean for the opioid epidemic in America? Will kratom one day play a key role in the treatment of opioid use disorders? Or will it fall into the “harm reduction” category? Is it a natural pain medication, a safe alternative to highly addictive opioid pain killers?

Or, will we find that kratom, like heroin, is habit-forming and deadly? Currently, the research is mixed.

An Alternative to Opioid Drugs

The results of a 2019 survey published in Drug and Alcohol Dependence revealed that 90% of respondents found kratom effective for relieving pain, reducing opioid use, and easing withdrawal symptoms.  

In 2011, researchers discovered that kratom alleviated morphine withdrawal symptoms. A more recent study indicated that kratom may reduce morphine use.

Earlier this year, researchers found that kratom use was associated with significant decreases in the occurrence and severity of opioid adverse effects; kratom lessened the discomfort of opioid withdrawal. Multiple studies have substantiated these findings, suggesting that kratom is a useful medication for opioid addiction and withdrawal.

Interestingly, in 2007, it was found that kratom reduced alcohol withdrawal behaviors. More recently, researchers discovered that kratom decreased alcohol use; this suggests that kratom may help those with alcohol use disorders (AUD) in addition to opioid addiction.

Harm-Reduction

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

Dangerous and Addictive?

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

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

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

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

Bottom Line

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

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

That being said, when compared to shooting heroin, kratom is safe (a safer alternative, at least). And if someone chooses to use kratom to reduce/stop their opioid use, I won’t lecture about the “dangers” of kratom. Until we have more answers, I will hold to the view that kratom is a harm-reduction measure… and it has the potential to save lives.


References

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Burke, D., Shearer, A., & Van Cott, A. (2019). Two cases of provoked seizure associated with kratom ingestion. Neurology, 92(15), 4.5-030.

Coe, M.A., Pillitteri,J.L, Sembower, M.A., Gerlach, K.K., & Henningfield, J.E. (2019). Kratom as a substitute for opioids: Results from an online survey. Drug and Alcohol Dependence, 202, 24-32. ISSN 0376-8716, https://doi.org/10.1016/j.drugalcdep.2019.05.005

Eggleston, W., Stoppacher, R., Suen, K., Marraffa, J. M., & Nelson, L. S. (2019). Kratom use and toxicities in the United States. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy.

Gutridge, A.M., Robins, M.T., Cassell, R.J., Uprety, R., Mores, K.L., Ko, M.J., Pasternak, G.W., Majumdar, S., & van Rijn, R.M. (2019), Therapeutic potential of g-protein-biased kratom-derived and synthetic carfentanil-amide opioids for alcohol use disorder. The FASEB Journal, 33:1, 498.3-498.3.

Halpenny, G.M. (2017). Mitragyna speciosa: Balancing potential medical benefits and abuse. ACS Medicinal Chemistry Letters, 8(9), 897-899. DOI: 10.1021/acsmedchemlett.7b00298

Hassan, Z., Muzaimi, M., Navaratnam, V., Yusoff, N.H.M., Suhaimi, F.W., Vadivelu, R., Vicknasingam, B.K., Amato, D., von Hörsten, S., Ismail, N.I.W., Jayabalan, N., Hazim, A.I., Mansor, S.M., & Müller, C.P. (2013). From kratom to mitragynine and its derivatives: Physiological and behavioural effects related to use, abuse, and addiction. Neuroscience & Biobehavioral Reviews, 37:2,138-151, ISSN 0149-7634. https://doi.org/10.1016/j.neubiorev.2012.11.012

Hassan, Z., Suhaimi, F., Dringenberg, H. C., & Muller, C. P. (2016). Impaired water maze learning and hippocampal long-term potentiation after mitragynine (kratom) treatment in rats. Front. Cell. Neurosci. Conference Abstract: 14th Meeting of the Asian-Pacific Society for Neurochemistry. doi: 10.3389/conf. fncel (Vol. 58).

Hassan, Z., Suhaimi, F. W., Ramanathan, S., Ling, K. H., Effendy, M. A., Müller, C. P., & Dringenberg, H. C. (2019). Mitragynine (kratom) impairs spatial learning and hippocampal synaptic transmission in rats. Journal of Psychopharmacology, 0269881119844186.

Hemby, S. E., McIntosh, S., Leon, F., Cutler, S. J., & McCurdy, C. R. (2018). Abuse liability and therapeutic potential of the mitragyna speciosa (kratom) alkaloids mitragynine and 7‐hydroxymitragynine.  Addiction Biologyhttps://doi.org/10.1111/adb.12639

Hughes, R. L. (2019). Fatal combination of mitragynine and quetiapine–a case report with discussion of a potential herb-drug interaction. Forensic Science, Medicine and Pathology15(1), 110-113.

Jaliawala, H. A., Abdo, T., & Carlile, P. V. (2018). Kratom: A potential cause of acute respiratory distress syndrome. DRUG INDUCED LUNG DISEASE: CASE REPORTS, A6604-A6604, American Thoracic Society.

Khor, B.S., Amar Jamil, M.F., Adenan, M.I., & Chong Shu-Chien, A. (2011). Mitragynine attenuates withdrawal syndrome in morphine-withdrawn zebrafish. PLOS ONE 6(12):e28340, https://doi.org/10.1371/journal.pone.0028340

Kumarnsit, E., Keawpradub, N., & Nuankaew, W. (2007). Effect of mitragyna speciosa aqueous extract on ethanol withdrawal symptoms in mice. Fitoterapia, 78:3, 182-185. ISSN 0367-326X, https://doi.org/10.1016/j.fitote.2006.11.012

Meepong, R., & Sooksawate, T. (2019). Mitragynine reduced morphine-induced conditioned place preference and withdrawal in rodents. Thai Journal of Pharmecutical Sciences, 43:1, 21-29.

NIDA. (2019, April 8). Kratom. Retrieved from https://www.drugabuse.gov/publications/drugfacts/kratom on 2019, July 19

Olsen, E.O., O’Donnell, J., Mattson, C.L., Schier, J.G., & Wilson, N. (2019). Notes from the field: Unintentional drug overdose deaths with kratom detected – 27 states. MMWR Morb Mortal Wkl Rep, 68:326-327.

Palasamudram Shekar, S., Rojas, E.E., D’Angelo, C.C., Gillenwater, S.R., & Martinez Galvis, N.P. (2019). Legally lethal kratom: A herbal supplement with overdose potential. Journal of Psychoactive Drugs51(1), 28-30.

Raffa, R.B., Pergolizzi, J.V., Taylor, R., & Ossipov, M.H (2018). Nature’s first “atypical opioids”: Kratom and mitragynines. J Clin Pharm Ther, 43: 437– 441. https://doi.org/10.1111/jcpt.12676

Sakaran, R., Othman, F., Jantan, I., Thent, Z. C., & Das, S. (2014). An insight into the effect of mitragyna speciosa korth extract on various systems of the body. Global J Pharmacol8, 340-346.

Saref, A., Suraya, S., Singh, D., Grundmann, O., Narayanan, S., Swogger, M.T., Prozialeck, W.C., Boyer, E., Chear, N.J.Y., & Balasingam, V. (2019). Self-reported prevalence and severity of opioid and kratom (mitragyna speciosa korth) side effects. Journal of Ethnopharmacology, 238, 111876. ISSN 0378-8741, https://doi.org/10.1016/j.jep.2019.111876

Singh, D., Chye, Y., Suo, C., Yücel, M., Grundmann, O., Ahmad, M. Z., … & Mϋller, C. Brain magnetic resonance imaging of regular kratom (mitragyna speciosa korth) users: A preliminary study.

Singh, D., Müller, C.P., & Vicknasingam, B.K. (2014). Kratom (mitragyna speciosa) dependence, withdrawal symptoms and craving in regular users. Drug and Alcohol Dependence, 139, 132-137. ISSN 0376-8716, https://doi.org/10.1016/j.drugalcdep.2014.03.017

Singh, D., Narayanan, S., Müller, C.P., Swogger, M.T., Rahim, A.A., Abdullah, M.F.I.L.B., & Vicknasingam, B.K. (2018). Severity of kratom (mitragyna speciosa korth) psychological withdrawal symptoms. Journal of Psychoactive Drugs, 50:5, 445-450. DOI: 10.1080/02791072.2018.1511879

Singh, D., Narayanan, S., Müller, C. P., Vicknasingam, B., Yücel, M., Ho, E. T. W., … & Mansor, S. M. (2019). Long-term cognitive effects of kratom (mitragyna speciosa korth) use. Journal of Psychoactive Drugs51(1), 19-27.

Swogger, M.T., & Walsh, Z. (2018). Kratom use and mental health: A systematic review. Drug and Alcohol Dependence, 183, 134-140. ISSN 0376-8716, https://doi.org/10.1016/j.drugalcdep.2017.10.012

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Yusoff, N. H. M., Suhaimi, F. W., Vadivelu, R. K., Hassan, Z., Rümler, A., Rotter, A., Amato, D., Dringenberg, H. C., Mansor, S. M., Navaratnam, V., & Müller, C. P. ( 2016). Abuse potential and adverse cognitive effects of mitragynine (kratom). Addiction Biology21:98– 110. doi: 10.1111/adb.12185

From Survival to Endurance to Fulfillment: How I Found Meaning in Life

“I gave up on having a future. And I was strangely okay with it.”

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

Without delving too deep into my past, I will tell you that my late teens and early to mid 20’s were not the best of times. They were dark. Lonely. Depressing. I was living a life of chaos and hopelessness. At one point, I didn’t think I was going to survive; I gave up on having a future. And I was strangely okay with it.

My turning point was a spiritual awakening of sorts. A near-death experience led to a realization that I didn’t want to die; and it was either die or change my life. I picked change.

What helped me to live again (and ultimately find fulfillment)? You might guess family or a relationship or God. But at the time, I wasn’t close with my family, I didn’t have any significant relationships/friendships, and God wasn’t a part of my life. It was the following that helped me become the person I am today:

A Therapist

Having not a single shred of self-esteem, I went to see a counselor. She created a safe space and then uplifted me, making me feel worthwhile. She normalized what I was going through; I felt less alone. She affirmed me for positive choices I made. She initiated the mending of my fragile self. I gradually gained confidence, not only in myself, but in the idea that I could live a better life.

My Dog

She loved me unconditionally… and she depended on me fully. If I died, she would think I purposely left her. I couldn’t bear the idea; I wouldn’t do that to her. She played a huge role in my recovery. I sometimes think she saved me.

My Potential

I’ve always known I have potential. I’m smart and creative. I’m motivated and driven. But that potential died somewhere along the way in young adulthood. In moments of clarity, I mourned my lost potential. I wanted to be better and to do better with my life. I was meant, maybe not for great things, but for better things than living out of my car, broke and friendless. When I decided to live, my potential reawakened; it became a driving force – a bright, glowing beacon that revitalized and inspired me.

“You have to forgive yourself.”

Self-Forgiveness

I couldn’t bear to tell my therapist about some of the things I’d done. I was ashamed; late at night, lying in bed, I would think about past events. I’d feel sick to my stomach – then, an unpleasant head rush heart racing not able to get enough air… (That’s the feeling of shame seeping from your mind into your being.) My therapist didn’t push me to share; instead, she said, “You have to forgive yourself.” It became my mantra, quietly uttered in the dark. I would repeat, “I forgive myself, I forgive myself, I forgive myself…” until I internalized it. (That being said, it didn’t happen overnight… it took weeks, months, years. But all was set in motion with that one simple statement.)

Education

I went back to school and was able to fully immerse myself in my studies. As a naturally curious person, learning is a sort of fuel for me. The more I learn, the thirstier I become. My classes provided me with not only knowledge, but with a spark that generated purpose.

Passion

While in school, I discovered a new passion; I fell in love with research. (#nerd) I thrived in my research/statistics class; my undergraduate study was even published in a national journal. It felt good to be passionate about something again; it stirred up (from the dust) long-forgotten loves, like reading and writing – passions I thought I’d left behind in childhood.

A Meaningful Career

After finishing college and starting graduate school, I became a counselor… and found meaning in helping others. My first job in the field was tough, heart-breaking at times, and deeply fulfilling. It solidified what my education had started to shape – I no longer needed to survive or endure life; I found my purpose for living.

Professional Development for Mental Health Practitioners

20 professional development ideas for counselors, social workers, and other mental health clinicians

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

Professional development encompasses all activities that provide or strengthen professional knowledge/skills. Ongoing professional development is a requirement for mental health practitioners in order to maintain competency and for keeping up-to-date on the latest research and evidence-based practices in an ever-changing field.

Listed below are several ideas for counselor professional development.

1 Find a mentor (and meet with them at least once a month).

2 Sign up for relevant e-mail lists. A few I find the most helpful/informative: Brain & Behavior Foundation, National Institute of Mental Health, and SAMHSA.

3 Become a member of a professional organization (i.e. American Counseling Association).

4 Keep up-to-date on the latest research. If you are a member of a professional organization, take advantage of your member benefits; you likely have access to a professional journal. You can also browse sites like ScienceDaily or use an app like Researcher.

5 Facilitate professional trainings or manage a booth at a conference.

6 Read counseling and psychology books (such as On Being a Therapist by Kottler or Mindsight by Siegel).

7 Practice awareness. Know your values, limitations, and personal biases.

8 Become familiar with local resources in your community.

9 Volunteer.

10 Join a professional counseling forum and participate in discussions. The ACA has several. You could also go the reddit route (i.e. r/psychotherapy).

11 Review your professional code of ethics on a regular basis. (Link to the ACA Code.)

12 Attend webinars, trainings, and conferences. Stay informed by subscribing to email lists, participating in professional forums, and searching Eventbrite for local events; search “mental health.” PESI is another source, but the seminars can be costly.

13 Network/consult.

14 Subscribe to psychology magazines like Psychology Today or Psychotherapy Networker.

15 Further your education by taking classes or earning a certificate.

16 Pick a different counseling skill to strengthen each week. (You can even use flashcards to pick a new skill or simply review!)

17 Write an article or book (or book review!)

18 Take free online courses.

19 Listen to podcasts (like Therapy Chat or Counselor Toolbox).

20 Practice self-care on a regular basis to prevent burnout. Why is self-care included in a post on professional development? Because self-care is crucial for counselor wellness; a counselor experiencing burnout puts his/her clients at risk.

Feed Your Mood: The Link Between Diet and Mental Health

What foods are associated with increased psychiatric symptoms? What should you eat if you want to boost your mood? Learn what researchers have found when it comes to diet and mental well-being.

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

You may have heard of the “food-mood connection.” Research indicates that our food choices greatly impact not only physical health, but mental well-being. Some foods seem to boost mood and reduce psychiatric symptoms while others are linked to depression and anxiety.

Mood Thugs

Sugar negatively impacts mood and slows memory and learning. High-sugar diets are associated with smaller brain volume. Furthermore, sugar will make you less alert and more tired. A recent study found that the idea of a “sugar rush” is myth.

Sugar is not the only villain; fat can be just as harmful. One study found that a high-fat diet may lead to symptoms of depression and anxiety. Furthermore, trans fat may lead to poor memory function.

If you have bipolar disorder, avoid processed meats such as jerky, hot dogs, etc. Researchers found that nitrates in processed meats are associated with mania.

Mood Champions

A diet high in fiber and vegetables (with limited added sugar) has been linked to improved mood and a reduction in depressive symptoms. Interestingly, women seem to benefit more than men, and the effect is even greater when exercise is added. A vegan or plant-based diet is associated with lower levels of depression, anxiety, and stress.

Fruits and vegetables are good for mood, but raw fruits and veggies are better. A raw diet is associated with higher levels of mental wellbeing and lower levels of psychiatric symptoms. According to a recent study, the top raw foods associated with mental wellness are apples, bananas, berries, carrots, citrus fruits, cucumbers, grapefruit, kiwi, lettuce, and dark, leafy greens.

So how many servings of fruit/veggies should you eat per day for optimal mental health? At least 8, according to one study that found happiness benefits were evident for each portion for up to 8 servings per day.

What nutrients should you include in your diet for improved mental health? Research indicates the following are important for mental wellbeing:  Omega-3 fatty acids (fish, flaxseed, walnuts), phospholipids (egg yolk, soybeans), niacin (liver, avocado, brown rice), folate (legumes, beets, broccoli), vitamin B6 (chickpeas, tuna), and vitamin B12 (sardines, fortified nutritional yeast).

In sum, skip the fast food and soda; head to the salad bar instead to feed your mood and your belly!


References

Bonnie Beezhold, Cynthia Radnitz, Amy Rinne & Julie DiMatteo (2015) Vegans report less stress and anxiety than omnivores, Nutritional Neuroscience, 18:7, 289-296, DOI: 10.1179/1476830514Y.0000000164

Boston University. (2017, April 20). Is soda bad for your brain? (And is diet soda worse?): Both sugary, diet drinks correlated with accelerated brain aging. ScienceDaily. Retrieved from www.sciencedaily.com/releases/2017/04/170420162254.htm

Johns Hopkins Medicine. (2018, July 18). Beef jerky and other processed meats associated with manic episodes. ScienceDaily. Retrieved from www.sciencedaily.com/releases/2018/07/180718082225.htm

Knüppel, A., Shipley, M. J., Llewellyn, C. H., & Brunner, E. J. (2017). Sugar intake from sweet food and beverages, common mental disorder and depression: prospective findings from the Whitehall II study. Scientific reports7(1), 6287. doi:10.1038/s41598-017-05649-7

Lim SY, Kim EJ, Kim A, Lee HJ, Choi HJ, Yang SJ.   Nutritional Factors Affecting Mental Health.   Clin Nutr Res. 2016 Jul;5(3):143-152. https://doi.org/10.7762/cnr.2016.5.3.143

University of California, Los Angeles. (2012, May 15). This is your brain on sugar: Study shows high-fructose diet sabotages learning, memory. ScienceDaily. Retrieved from www.sciencedaily.com/releases/2012/05/120515150938.htm

University of California, San Diego Health Sciences. (2015, June 17). Dietary trans fat linked to worse memory. ScienceDaily. Retrieved from www.sciencedaily.com/releases/2015/06/150617144237.htm

University of Manchester. (2019, February 5). Healthy diet can ease symptoms of depression. ScienceDaily. Retrieved from www.sciencedaily.com/releases/2019/02/190205090511.htm

University of Otago. (2018, April 16). Raw fruit and vegetables provide better mental health outcomes. ScienceDaily. Retrieved from www.sciencedaily.com/releases/2018/04/180416101403.htm

University of Warwick. (2016, July 10). Fruit and veggies give you the feel-good factor. ScienceDaily. Retrieved from www.sciencedaily.com/releases/2016/07/160710094239.htm

University of Warwick. (2019, April 4). No such thing as ‘sugar rush’! Sugar worsens mood rather than improving it. ScienceDaily. Retrieved from www.sciencedaily.com/releases/2019/04/190404104345.htm

Wiley. (2015, October 19). High-fat diet may cause changes in brain that lead to anxiety, depression. ScienceDaily. Retrieved from http://www.sciencedaily.com/releases/2015/10/151019123204.htm