Kratom is sold as a natural way to ease pain, lift mood, and calm anxiety, but it acts on the same brain system as opioids and can lead to dependence. For people in therapy or recovery, that can quietly undermine the very progress they are working toward.

This post explains what kratom is, how it affects the body and mind, and why it can complicate mental health treatment. The stories below are fictional composites written for illustration, not real people.

What kratom is

Kratom (Mitragyna speciosa) is a tree native to Southeast Asia. Its leaves are sold in the United States as powders, capsules, teas, liquid shots, and concentrated extracts, often at gas stations, smoke shops, and online.

Products are commonly labeled as supplements, which leads many people to assume they are safe or regulated like medication. They are not. Kratom products are not approved by the FDA for treating any condition, strength varies widely from product to product, and legal rules differ by state and have been changing. Being legal to buy does not mean a product is safe to use daily.

How kratom affects the brain and body

The main active compounds in kratom, mitragynine and 7-hydroxymitragynine (7-OH), bind to opioid receptors in the brain. They also affect other chemical messengers involved in mood, alertness, and stress. The effects depend heavily on dose:

Smaller amounts often feel stimulating: more energy, alertness, and talkativeness.
Larger amounts often feel sedating and pain-relieving, with a sense of calm or euphoria similar to opioids.

Common short-term effects include nausea, constipation, dizziness, sweating, itching, dry mouth, and changes in appetite. Some people also report agitation, racing heart, or confusion, especially at higher doses or with concentrated products.

Tolerance, dependence, and withdrawal

With regular use, the body adapts. People often need more kratom to get the same effect, and use can shift from occasional to several times a day.

When use slows or stops, withdrawal can begin. Symptoms are generally described as similar to, though often milder than, opioid withdrawal:

Irritability, anxiety, and low mood
Trouble sleeping
Muscle aches and restless legs
Runny nose, sweating, and stomach upset
Strong cravings

Because these symptoms overlap with anxiety and depression, many people mistake withdrawal for their mental health condition "coming back," and use more kratom to feel better. That cycle is one of the main ways kratom use becomes compulsive.

Other health risks

Dependence is not the only concern. Reports in the medical literature link kratom to:

Liver injury, including cases of jaundice and liver damage
Seizures, particularly at high doses or when combined with other substances
Heart rhythm problems and rapid heartbeat
Dangerous interactions with alcohol, sedatives, opioids, and some prescription medications, which can slow breathing
Contamination, since some products have been found to contain bacteria or heavy metals, and potency is not reliably labeled

Concentrated products and 7-OH-enriched products are of particular concern because they can be far stronger than plain leaf.

How kratom can get in the way of treatment

People turn to kratom for real reasons, such as pain, stress, or trouble coping. But in treatment, it can work against them in several ways:

It can mask symptoms. If kratom is temporarily numbing anxiety or low mood, it is harder to tell what is going on underneath and whether therapy is working.
Withdrawal mimics mental health symptoms. Crashes between doses can look like worsening anxiety, depression, or insomnia.
It can blunt emotional work. Therapy often asks people to feel difficult emotions and practice new coping skills. A substance that dulls or avoids those feelings makes that practice harder.
It can disrupt sleep and energy. Cycles of stimulation and sedation make it harder to show up consistently and to focus in sessions.
It can interact with medication. Kratom may change how prescribed medications work or increase side effects, which can complicate treatment for depression, anxiety, ADHD, or pain.
Secrecy and shame can build. Because kratom is legal and sold as "natural," people often do not mention it, and may feel guilty once they notice they cannot cut back. Hidden use makes it harder to get help.

Stories from treatment

Marcus: pain, depression, and a "natural" substitute

Marcus, 41, started therapy for depression after a workplace injury. Worried about prescription opioids, he had switched to kratom capsules, and over a year and a half his daily amount climbed steadily. When he ran out during a trip, he felt restless, sweaty, and hopeless, and he assumed his depression was getting worse. In reality, a large part of his low mood was tied to the up-and-down cycle of use and withdrawal.

Dana: anxiety that would not improve

Dana, 27, began therapy for social anxiety and made early progress, then stalled. She was drinking kratom tea before work and taking "shots" through the day to feel confident in meetings. Each time she tried to stop, her anxiety spiked, which convinced her she could not handle work without it. Kratom had become a crutch that kept her from learning she could get through those situations on her own.

Terrence: recovery and a gray area

Terrence, 36, had three years of recovery from opioid use disorder. After a stressful job change, he started using kratom, telling himself it was "not an opioid" and so did not count. Within months, he noticed old patterns: hiding use, taking more, and feeling cravings. The shame nearly led him to stop attending his support group, even though connection was exactly what he needed.

Signs kratom may be becoming a problem

Using more, or more often, than you meant to
Feeling anxious, achy, or irritable when a dose wears off
Trying to cut back and not being able to
Hiding use from family, friends, or your care team
Planning your day around when you can take it
Continuing to use despite sleep, health, work, or relationship problems

If this sounds familiar

Having these experiences does not mean you have failed. Kratom is easy to get, widely marketed as harmless, and often taken for understandable reasons.

The most helpful step is to be honest with the people treating you. Tell your therapist and your prescriber exactly what you take and how much, including supplements and "natural" products. If you use kratom daily, talk with a medical professional before stopping suddenly, since withdrawal can be uncomfortable and may need support.

If you or someone you know is struggling with substance use, the SAMHSA National Helpline offers free, confidential support at 1-800-662-4357. If you are in crisis, call or text 988.

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