Kratom and CBT
Is it a miracle remedy? An addictive opiate? None of the above? With growing popularity and access in the US market, Kratom has found itself at the center of debate in a country caught in the throes of an opiate epidemic.
READ ON TO HAVE YOUR PRESSING QUESTIONS ANSWERED CONCERNING WHAT KRATOM IS, WHETHER OR NOT IT IS LEGAL, PROS AND CONS, AND MORE.
WHAT IS KRATOM?
Kratom is an herbal supplement in the coffee family. Though it binds to opiate receptors in the brain, it is not an opiate. Instead, proponents argue, it interacts with these receptors in a way more akin to coffee, chocolate, and exercise than the opiates making national headlines.
Native to Southeast Asia, Kratom has been growing in popularity in the United States in recent years. Proponents claim it provides increased energy and relief from chronic pain, depression, anxiety, and more—without the dangerous side effects, euphoric high, or addictive qualities that make opiates so dangerous. Kratom can be taken as a powder, steeped in tea, or put into capsules.
IS KRATOM LEGAL IN THE US?
Kratom is currently legal in 44 states. The remaining six (Indiana, Tennessee, Wisconsin, Vermont, Arkansas, and Alabama) classify it as a controlled substance. On a national level, legal access to Kratom is currently being debated and decided.
The legal fight began when dietary supplement companies applied for “Old Dietary Ingredient” status, which would allow suppliers to sell Kratom without restrictions. In response, the FDA, which has been historically opposed to natural or alternative remedies, urged the DEA to issue an emergency scheduling alert. The Telegraph notes that this alert is “an action taken when dangerous drugs have hit the streets, deaths have occurred, and the public’s safety is at risk.”
The DEA’s failure to substantiate the claim that Kratom was indeed endangering public safety or causing deaths led to public outcry. Once the US Congress applied pressure, the DEA was forced to withdraw the alert and open a temporary public comment period. They received over 10,000 comments before the comment period ended in December of 2016.
The DEA also requested an expedited scientific and medical review from the FDA. The results of that review and ultimate decision could take months, especially with a new administration in the US. The American Kratom Association is leading the fight to keep Kratom legal and accessible to Americans as the nation waits on the FDA and DEA to move closer to a decision.
WHAT ARE THE ADVANTAGES OF KRATOM?
Proponents of Kratom argue that the supplement is a safer alternative to opioids that can be used to treat chronic pain, drug addiction, and more.
For example, Edward W. Boyer, MD, PHD, a professor of emergency medicine at the University of Massachusetts Medical School told WebMD of a case where a man successfully treated his opioid withdrawal with Kratom.
He explained, “Most people with opioid withdrawal have abdominal pain, diarrhea, dysphoria. This guy really only had a runny nose, and that is pretty remarkable. I’m not willing to say [Kratom] is great for everyone. I’m just ready to say that is pretty interesting, and it should probably be studied more in a controlled way.”
WHAT ARE THE DANGERS OF KRATOM?
Opponents warn that users should be hesitant to view this as a miracle cure. The DEA reports that Kratom is addictive, with painful and dangerous withdrawal symptoms. Several southeastern Asian countries have outlawed it due to these concerns.
Proponents disagree, arguing that any cases of negative side effects or addiction are due to coexisting conditions or drug abuse—not Kratom use alone. Further research is needed before we can know for sure.
In fact, the real danger may be in the lack of knowledge and regulation. There is no official drug label based on scientific studies that can make the user aware of the risks or how it may interact with other drugs.
IS KRATOM A SAFE ALTERNATIVE TO OPIATES?
Until further studies are completed, it is difficult to know if Kratom is a safe alternative to opiates. Proponents say yes. Opponents say no. If you or a loved one is addicted to opiates, know that is never safe to self-medicate or wean oneself off of opiates by switching to Kratom. Opiate withdrawal without medical supervision is often painful and dangerous.
The basic concept of cognitive behavioral therapy (CBT) is that our perceptions are far more impactful to how we process our responses than the reality of the experience itself. Our interpretations, responses, thoughts and emotions directly affect, on a profound level, how we approach, react and handle the events of our lives. Over time we become conditioned to respond to our experiences in a habitual way.
CBT helps patients re-educate themselves through a variety of techniques that help change habitual ways of thinking, feeling, perceiving, and reacting to events. In this way, people learn to replace distorted or false thinking with a more realistic (and frequently accurate) approach.
Research into cognitive processes which involve our belief systems, (i.e. recurrent thoughts, assumptions, fantasies, etc.) revealed how these processes play an essential role in mental, emotional, and substance abuse disorders. It showed that people have the potential to control their response to their environment to a large extent.
CBT is collaborative and goal-oriented. The patient and therapist consider and decide together on the appropriate treatment goals, the type and timing of skills training, the nature of outside practice tasks, and so on. Not only does this foster the development of a good working relationship and avoid an overly passive stance by the therapist, but it also assures that treatment will be most useful and relevant to the patient.
Cognitive Behavioral Therapy:
BASIC PRINCIPLES OF CBT
LEARNED BEHAVIOR
CBT is based on social learning theory. It is assumed that an important factor in how individuals begin to use and abuse substances is that they learn to do so. The several ways individuals may learn to use drugs include modeling, operant conditioning, and classical conditioning.
Modeling
People learn new skills by watching others and then trying it themselves. For example, children learn language by listening to and copying their parents. The same may be true for many substance abusers. By seeing their parents use alcohol, individuals may learn to cope with problems by drinking. Teenagers often begin smoking after watching their friends use cigarettes.
Operant Conditioning
Laboratory animals will work to obtain the same substances that many humans abuse (cocaine, opiates, and alcohol) because they find exposure to the substance pleasurable, that is, reinforcing.
Classical Conditioning
Pavlov demonstrated that, over time, repeated pairings of one stimulus (e.g., a bell ringing) with another (e.g., the presentation of food) could elicit a reliable response (e.g., a dog salivating). Over time, substance abuse may become paired with particular places (bars, places to buy drugs), particular people (drug-using associates, dealers), times of day or week (after work, weekends), emotional states (lonely, bored), and so on. Eventually, exposure to those cues alone is sufficient to elicit very intense cravings or urges that are often followed by abuse.
FUNCTIONAL ANALYSIS
The first step in CBT is helping patients recognize why they are abusing and determining what they need to do to either avoid or cope with whatever triggers their use. This requires a careful analysis of the circumstances of each episode and the skills and resources available to patients. These issues can often be assessed in the first few sessions through an open-ended exploration of the patients’ substance abuse history, their view of what brought them to treatment and their goals for achieving success in recovery.
In identifying patients’ determinants of drug abuse, it may be helpful for clinicians to focus their inquiries to cover at least five general domains:
Social: With whom do they spend most of their time? With whom do they use drugs? Do they have relationships with those individuals that do not involve substance abuse? Do they live with someone who is a substance abuser? How has their social network changed since drug abuse began or escalated?
Environmental: What are the particular environmental cues for their drug abuse (e.g., money, alcohol use, particular times of the day, certain neighborhoods)? What is the level of their day-to-day exposure to these cues? Can some of these cues be easily avoided?
Emotional: Research has shown that feeling states commonly precede substance abuse or craving. These include both negative (depression, anxiety, boredom, anger) and positive (excitement, joy) affect states. Because many patients initially have difficulty linking particular emotional states to their substance abuse (or do so, but only at a surface level), affective antecedents of substance abuse typically are more difficult to identify in the initial stages of treatment.
Cognitive: Particular sets of thought or cognition frequently precede abuse (I need to escape, I can’t deal with this, I can deal with this if…and so on). These thoughts are often charged and have a sense of urgency.
Physical: Desire for relief from uncomfortable physical states such as withdrawal has been implicated as a frequent antecedent of drug abuse. While controversy surrounding the nature of physical withdrawal symptoms from substance dependence continues, anecdotally, abusers frequently report particular physical sensations as precursors to substance abuse (e.g., tingling in their stomachs, fatigue or difficulty concentrating)
CBT for substance use disorders captures a broad range of behavioral treatments including those targeting learning processes, motivational barriers to improvement, and a variety of other issues. Overall, these interventions have demonstrated efficacy and may be combined with each other therapeutic modalities to provide more robust outcomes.
