Kratom addiction: signs, symptoms, withdrawal, and treatment

Kratom addiction is defined by an obsessive need to use the psychoactive substance kratom, which contains alkaloids that have effects similar to those of opioids like morphine. Kratom is advertised as a dietary supplement, but because it resembles opioids, there are worries about its potential for addiction. 

The signs and symptoms of kratom addiction include small pupils, tremors, sweating, sleep disturbances, irritability, mood swings, nausea and vomiting, failure to quit despite numerous attempts, heightened risk-taking, and loss of interest in formerly valued activities. 

The symptoms of kratom withdrawal are jerky movements, runny nose, watery eyes, sweating, muscle aches, tremors, nausea, vomiting, abdominal cramps, irritability, mood swings, anxiety, and insomnia. 

The treatment options available for kratom addiction include detoxification, behavioral therapies, medications, and holistic approaches.

Is Kratom addictive?

Yes, kratom is addictive. In fact, according to a study by Hassan et al., published in the 2013 issue of Neuroscience and Biobehavioral Reviews, kratom, scientifically known as Mitragyna speciosa, possesses properties akin to those of a stimulant and a narcotic. Both of them have the potential to be abused. 

Historical documentation exists that substantiates the methodical application and possible misuse of M. speciosa preparations, and more recently, of mitragynine, which is the purified active constituent of kratom.

Moreover, a 2011 case report by Sergey V. Sheleg and Gregory B. Collins published in the Journal of Addiction Medicine described a 44-year-old male patient who had abused alcohol in the past and became addicted to kratom. 

He started taking kratom for his persistent stomach pain and gradually worked his way up to six dropper squeezers every four to six hours. He had been using kratom continuously for the past year. He was then unable to quit taking kratom, and if he cut back on the dosage, he started to have the usual withdrawal symptoms associated with opiates, such as cramping stomach pain, sweating, and diarrhea. 

The case report further demonstrated that kratom’s main alkaloid, mitragynine, is a partial opioid agonist and chemically similar to tryptamine-based psychedelics, such as psilocybin or LSD.

How long does it take to get addicted to Kratom?

It takes over six months of use to get addicted to kratom, as indicated in a 2014 study by Singh et al., published in the journal Drug and Alcohol Dependence, where over the course of six months of use, more than half of the 293 regular kratom users developed severe kratom dependence issues, while 45% developed moderate kratom dependence.

A significant craving for kratom was reported by almost 23% of regular users; those who drank three or more glasses a day were more likely to have a higher craving. The study’s findings further revealed that regular kratom usage is linked to the onset of withdrawal symptoms, drug dependency, and cravings, all of which worsen with continued use.

It is important to note that the amount of time it takes for kratom addiction to develop varies greatly from person to person. It is influenced by a number of factors including dosage, frequency of usage, individual susceptibility, and mode of intake.

What is Kratom addiction?

Kratom addiction refers to the compulsive and problematic dependence on a psychoactive substance derived from the leaves of the Mitragyna speciosa tree. This herbal supplement, often marketed as a dietary product, contains various alkaloids, with mitragynine and 7-hydroxymitragynine being the primary ones.

Through binding to opioid receptors in the brain, these alkaloids elicit effects comparable to those of morphine and various other opioids. The term “opioid-like” serves to emphasize the manner in which kratom influences the central nervous system (CNS). Despite being considered a herbal supplement and occasionally promoted for its natural origins, the risk of developing dependence on kratom raises concerns.

How common is Kratom addiction?

Kratom addiction is exceedingly common. In fact, in 2021, 1.7 million people, or 0.6 percent of those 12 years of age or older, reported using kratom in the previous year, according to results from the 2021 National Survey on Drug Use and Health published by the Substance Abuse and Mental Health Services Administration in December 2022. 

In comparison to young adults aged 18 to 25 (0.8 percent or 284,000 individuals) and adults aged 26 or older (0.6 percent or 1.4 million individuals), the proportion was comparatively lower among adolescents aged 12 to 17 (0.2 percent or 45,000 individuals).

What are the signs and symptoms of Kratom addiction?

The signs and symptoms of kratom addiction include a variety of physical, psychological, and behavioral markers connected with the compulsive use of this psychoactive substance. The signs and symptoms of kratom addiction are listed below.

• Small pupils: Individuals experiencing kratom addiction exhibit constricted pupils, a physiological response linked to the opioid-like effects of kratom’s active compounds. This is a symptom that appears when using kratom and is representative of the drug’s effects on the central nervous system.
• Tremors: People who use large or modest amounts of kratom suffer from tremors. According to a study by Afzal et al., published in the January 2020 issue of Cureus, tremors in the face and extremities develop with modest doses of kratom; tremors in general result from long-term use and during withdrawal. 
• Sweating: Excessive sweating is one physical manifestation of kratom addiction. This symptom is more pronounced during withdrawal phases, reflecting the body’s response to the absence of the substance and the challenges of adjusting to decreased kratom intake.
• Sleep disturbances: Addiction to kratom disrupts normal sleep patterns, causing difficulties in falling asleep or staying asleep. Sleep disturbances exacerbate the negative effects of kratom addiction on an individual’s well-being by contributing to general physical and mental health difficulties.
• Irritability: 1,807 kratom exposures were reported to U.S. poison control centers between 2011 and 2017, with a notable spike in reports from 2016 to 2017, according to a 2019 study by Post et al., published in Clinical Toxicology. 86.1% of exposures involving just kratom had one or more clinical effects. Agitation/irritability was the most frequent side effect (22.9%).
• Mood swings: The interaction of kratom with the brain’s neurotransmitter systems lead to fluctuations in neurotransmitter levels, contributing to changes in mood. Additionally, the development of tolerance and dependence associated with kratom addiction further amplifies mood swings as individuals experience variations in the presence of the substance in their system. 
• Nausea and vomiting: Using too much kratom causes gastrointestinal distress, which includes nausea and vomiting. These physical symptoms contribute to a general feeling of discomfort and are present during periods of acute kratom intoxication or withdrawal.
• Failure to quit despite numerous attempts: The chronic inability to stop taking a substance despite repeated attempts to do so is one of the hallmarks of addiction. Individuals grappling with kratom addiction find it challenging to break free from its grip, experiencing relapses even after recognizing the negative consequences of their use.
• Heightened risk-taking: Engaging in activities with potential negative consequences are indicative of the altered risk perception associated with kratom addiction. One example of this is polysubstance use. A 2019 study by Schimmel et al., published in the Annals of Emergency Medicine found that in the previous 12 months, 37.7% of those who used kratom also used prescription opioids nonmedically, 17.8% used illicit opioids, 54.8% used another illicit substance, and 72.6% used cannabis. Kratom users reported high rates of other drug use and high Drug Abuse Screening Test (DAST-10) scores, putting them at a higher risk of polysubstance problems.
• Loss of interest in formerly valued activities: Individuals affected by kratom addiction gradually lose interest in social and recreational activities they once enjoyed. This withdrawal from previously cherished pursuits is a common behavioral sign of addiction, reflecting the prioritization of substance use over other aspects of life.

What are the side effects of Kratom addiction?

The side effects of kratom addiction involve the negative and unwanted outcomes linked to the repeated and obsessive use of this stimulant. The most common side effects of kratom addiction are listed below. 

• Constipation: Constipation is one of the negative effects of kratom addiction, which is marked by irregular bowel motions and trouble passing stool. Due to its effects on the digestive tract, kratom reduces intestinal motility, which causes constipation and its accompanying discomfort. This side effect leads to general gastrointestinal distress, impairing the regularity of bowel motions in people who are addicted to kratom.
• Dizziness: This adverse reaction is frequently linked to the drug’s effects on blood circulation and pressure. The alkaloids in kratom alter blood flow and vasodilation, which causes periods of lightheadedness. Individuals experiencing this side effect feel lightheaded or unsteady.
• Loss of appetite: Alterations in appetite result from kratom’s influence on neurotransmitter systems involved in regulating hunger and satiety. Individuals addicted to kratom find themselves less inclined to eat regularly, exacerbating the nutritional impact of this side effect.
• Itching: A 2011 study by Kapp et al., published in the Journal of Medical Toxicology described a young man who experienced intrahepatic cholestasis after consuming kratom. One of the patient’s major symptoms was pruritus (itching), which appeared along with jaundice when the kratom intake was stopped. In addition, the patient experienced restlessness and insomnia that started soon after they stopped taking kratom powder; while the pruritus undoubtedly played a role in these symptoms, it’s possible that these symptoms were indicative of drug dependence and withdrawal.
• Hyperpigmentation: High doses of kratom used over time may cause hyperpigmentation, especially in areas that are exposed to the sun, according to a 2022 study titled, “Kratom as a novel cause of photodistributed hyperpigmentation” published in the JAAD Case Reports. The paper further stated that due to its adrenergic, dopaminergic, and serotonergic properties, mitragynine, the bioactive component of kratom, may increase melanocyte-stimulating peptides and cause hyperpigmentation.

What are the risk factors for Kratom addiction?

Risk factors for kratom addiction describe a set of conditions, characteristics, or circumstances that increase the likelihood of individuals developing dependence on kratom. The risk factors for kratom addiction are listed below. 

• Genetic predisposition: An individual’s susceptibility to addiction is influenced by genetic factors, and responses to kratom are impacted by variations in genes associated with neurotransmitter function or substance metabolism. According to a 2023 new release from the National Institute on Drug Abuse titled, “New NIH study reveals shared genetic markers underlying substance use disorders,” in a 2023 study headed by Washington University in St. Louis researchers, over a million people’s genetic data were evaluated by scientists. This is one of the largest studies of its sort. The research discovered specific genes that are typically inherited in persons with addiction issues, independent of the substance used. 
• Previous substance use disorders: Addiction to kratom is more likely to occur in people with a history of substance use disorders, particularly those involving opioids or other psychoactive substances. A person’s susceptibility to developing a kratom dependence is heightened by the neurobiological changes linked to past substance abuse.
• Co-occurring mental health conditions: Mental health problems like anxiety or depression make it much more likely that someone will become addicted to kratom. As per a 2020 study by Garcia-Romeu et al., published in Drug and Alcohol Dependence which included 2,798 kratom users, found that the substance was predominantly utilized to alleviate anxiety (67%) and depression (65%). These people use kratom as a form of self-medication to help ease the symptoms of mental distress. However, this way of coping leads to addiction, which makes one’s mental health problems worse.
• Social factors: Isolation and a lack of strong social support networks are two social factors that contribute to the risk of kratom addiction. Individuals experiencing loneliness or social disconnection are more prone to seeking solace in substances like kratom. Lack of a supportive social environment makes it harder to develop healthier ways to deal with stress, which makes people more likely to use kratom as a way to escape.
• Environmental influences: Regular exposure to environments where kratom use is prevalent serves as a risk factor. Peer influence, cultural acceptance, or easy accessibility to kratom in certain settings contribute to its initiation and continuous use. Social norms that support kratom use are likely to normalize its use and encourage the development of addiction in those who are vulnerable to it.

Why is using Kratom addictive?

Using kratom is addictive due to its active alkaloids, particularly mitragynine and 7-hydroxymitragynine, which interact with opioid receptors in the brain. These receptors are part of the same system that responds to opioids like morphine. 

Dopamine is one of the neurotransmitters released when these receptors are stimulated; dopamine is linked to reward and pleasure. Over time, consistent use of kratom results in the development of tolerance, where higher doses are needed to achieve the same effects, and dependence, where individuals experience withdrawal symptoms upon discontinuation. 

The addictive potential of kratom is exacerbated by the neurological changes induced by prolonged use and the reinforcing nature of the pleasurable effects. Moreover, the misconception that kratom is a harmless and lawful substitute unintentionally fosters its improper utilization. This is because individuals grossly underestimate the hazards linked to its addictive properties.

What are the complications of Kratom addiction?

The complications of kratom addiction include gastrointestinal issues such as constipation, potential cardiovascular effects, nutritional deficiencies, liver toxicity, and depressive symptoms. 

Physically, individuals experience gastrointestinal issues such as constipation, as well as potential cardiovascular effects due to alterations in blood pressure and circulation. Prolonged use leads to nutritional deficiencies and weight loss due to a loss of appetite. Liver toxicity has been reported in certain cases.

For instance, according to a drug record titled, “Kratom” from the website LiverTox: Clinical and Research Information on Drug-Induced Liver Injury last updated in April 2020 by the National Institute of Diabetes and Digestive and Kidney Diseases, rare cases of acute liver damage have been linked to long-term recreational kratom use. When using kratom powder or tablets regularly, the injury usually appears one to eight weeks later. The symptoms include nausea, fatigue, dark urine, pruritus, and jaundice.

Psychologically, complications include mood disturbances, ranging from irritability to depressive symptoms, often linked to kratom’s impact on neurotransmitter systems. Socially, individuals face strained relationships and a decline in occupational or academic performance as kratom use takes precedence. Moreover, the risk of overdose is a significant concern, as the potency of kratom products vary widely.

What are the symptoms of Kratom withdrawal?

The symptoms of kratom withdrawal include jerky movements, runny nose, watery eyes, sweating, muscle aches, tremors, nausea, vomiting, abdominal cramps, irritability, mood swings, anxiety, and insomnia.

In a study by Singh et al., published in the June 2014 issue of Drug and Alcohol Dependence, in 64% of regular users, withdrawal symptoms from kratom lasted one to three days. They persisted longer than three days in 36% of cases. Those who drank more than three glasses of kratom per day were more likely to experience severe substance withdrawal symptoms during discontinuation than those who drank fewer than three glasses per day.

What are the available treatments for Kratom addiction?

Available treatments for kratom addiction include a variety of therapeutic approaches aimed at addressing the complexities of reliance on this psychoactive chemical. The available treatments for kratom addiction are listed below.

• Detoxification: Detoxification, often the initial phase of kratom addiction treatment, involves gradually tapering down the dosage to manage withdrawal symptoms. The goal is to safely eliminate kratom from the body while providing support to manage withdrawal discomfort. Detoxification alone is not sufficient for long-term recovery but serves as a critical first step before engaging in comprehensive treatment strategies.
• Behavioral therapies: Behavioral therapies, such as cognitive behavioral therapy (CBT) and contingency management (CM), are commonly employed to address kratom addiction. These therapies prioritize the alteration of maladaptive behaviors, the identification of substance use triggers, and the development of coping mechanisms. Particularly, CBT assists addicts in identifying and altering erroneous thought patterns, thereby promoting long-term recovery.
• Medications: To manage kratom withdrawal symptoms, medications are occasionally used. For instance, in a 2022 case report by Broyan et al., published in the journal Substance Abuse, individuals were given buprenorphine/naloxone and exhibited a substantial decrease in kratom use while on the medication. According to the study, buprenorphine/naloxone can be a successful therapeutic option for kratom use disorder (KUD). However, greater sample size study is required to confirm these findings. Another study from the March 2021 issue of Frontiers in Psychiatry titled, “Case Report: Treatment of Kratom Use Disorder With a Classical Tricyclic Antidepressant” found that a 44-year-old man who suffered withdrawal symptoms and increased anxiety after using kratom did not react to tramadol or a variety of antidepressants. Within a month of commencing a classical tricyclic antidepressant, clomipramine, his symptoms had vanished and he was able to resume normal living.
• Holistic approaches: Integration of holistic treatments, such as yoga, meditation, and mindfulness techniques, is undertaken to attend to the holistic well-being of individuals undergoing recovery from kratom addiction. With a holistic approach to recovery, these practices endeavor to foster relaxation, diminish tension, and augment self-awareness. Along with traditional treatments, holistic approaches give people a wide range of tools to deal with both the physical and mental parts of addiction.

When is Kratom addiction counseling necessary?

Kratom addiction counseling becomes necessary when individuals exhibit signs of dependence or compulsive use of the substance, indicating a potential struggle with addiction. If someone experiences difficulties in controlling their kratom use, shows signs of tolerance (requiring higher doses for the same effects), or attempts to quit but faces persistent challenges, counseling becomes essential. 

Additionally, it’s imperative to seek professional therapy when kratom use starts to interfere with day-to-day activities, relationships, employment, or mental health. Counseling is advantageous in such situations because it offers individuals a structured and supportive setting in which they investigate the fundamental factors contributing to their addiction, cultivate adaptive coping mechanisms, and strive towards a lasting recovery.

The objective is to tackle not solely the immediate issues associated with kratom consumption, but also the psychological and social elements that underpin the addiction. This encourages long-term positive development and general well-being.