Kratom use is treatable through the same levels of care used for other substances, and the starting point is a clinical assessment rather than a decision made at home. Two compounds in the plant, mitragynine and 7-hydroxymitragynine, act on opioid receptors in the brain [1]. That is why the clinical approach often borrows from opioid care.
Federal health agencies are direct about the gaps. Kratom may have the potential to be addictive, and people who use it regularly may have withdrawal symptoms if they stop [1]. Research in people is limited and still in early stages [1]. This page sets out when treatment helps, what an assessment covers, whether detox comes first, what residential and step-down care involve, which therapies have evidence behind them, where medication fits, why a second diagnosis changes the plan, and how the bill works. Background on the substance itself sits on our page about kratom.
When kratom use becomes something treatment can help with
The useful question is not how much someone uses. It is what the use is costing them and whether stopping has become hard.
Certain patterns come up again and again. Using more often, or for longer, than intended. Taking it to head off withdrawal symptoms rather than for any effect. Repeated attempts to stop that end the same way. Hiding the spending. Choosing it over things that used to matter.
Physical signs matter too. Regular users may experience withdrawal symptoms when they stop [1]. Reported side effects range from mild ones such as nausea, constipation, dizziness and drowsiness to rare but serious ones, including seizures, high blood pressure and liver problems [1]. If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental health crisis, call or text 988.
A further risk is what is in the product. Harmful contaminants, including heavy metals and disease-causing bacteria, have been found in some kratom products [1]. That is not a reason for panic, but it does mean the person may not know what they have been taking.
If several of those apply, an assessment is the sensible next step. Our withdrawal symptoms page covers what stopping tends to involve, our guide to how to get into rehab sets out how that first call runs, and our directory of our facilities shows which campus sits in which state.
Assessment: what a clinician looks for before recommending a level of care
An assessment is a structured conversation, not a test to pass. It takes an hour or so, and its output is a recommended level of care.
Clinicians work through five areas. How much, how often and for how long. What happens when the person stops, and whether they have had severe withdrawal before. Other substances, especially alcohol, benzodiazepines and prescription opioids. Physical health, with liver function a particular question for kratom because serious liver problems have been reported with long-term use of large doses [1]. And mental health, because a second condition changes the plan.
Two more practical areas get covered: what home looks like, and what support exists around the person.
Federal protocol builds screening for other mental and physical conditions into the evaluation stage of detox itself, which is where the medical picture gets established [3]. Our levels of care page explains what each recommendation means in practice.
Does kratom need medical detox first?
Sometimes, and the honest answer is that it depends on the person rather than on the substance alone. Stopping without supervision should not be assumed to be safe, particularly where other substances are in the picture.
Because kratom acts on opioid receptors [1], clinicians often reason about it the way they reason about opioids. Federal guidance says that unlike alcohol and sedative withdrawal, uncomplicated opioid withdrawal is not life-threatening [4]. It also says that for opioid withdrawal, as for alcohol and sedative-hypnotic withdrawal, hospitalization or some form of 24-hour medical care is generally the preferred setting [4].
The combination cases are the ones to take seriously. Where alcohol or benzodiazepines are also being used, withdrawal can be dangerous on its own, with seizures and delirium among the risks [4].
Detox has limits. Federal protocol defines it as evaluation, stabilization and fostering entry into treatment, and states that detoxification is not substance abuse treatment and rehabilitation [3]. Our medical detox page covers the process.
If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental health crisis, call or text 988.
Where kratom treatment happens in Florida
The Recovery Village Umatilla, in Umatilla, Florida, runs medical detox, inpatient treatment for substance abuse, inpatient rehab for mental health, partial hospitalization, outpatient care and aftercare planning. A clinical assessment always comes first, and it sets the level of care.
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The Recovery Village Umatilla is part of our family of treatment centers. See The Recovery Village Umatilla campus.
Residential treatment for kratom use, and who it suits
Residential care means living on site while in treatment. Federal reporting describes it as organized clinical service in a 24-hour setting outside a hospital, for people who are medically stable but need structure around them [2].
It suits four situations in particular. Repeated attempts to stop at home that have not held. A home where the substance is easy to get hold of. A second diagnosis that needs attention at the same time. And a history of severe withdrawal.
Days are scheduled rather than open. Programs typically build a week out of group therapy, individual sessions, medical review and structured evening time, though the shape differs by campus and by level of care, so ask for the current timetable at admission. The point of the structure is that decisions get easier when there are fewer of them.
Our inpatient rehab page describes the setting, and what the rehab process is like walks through a stay end to end.
PHP and IOP for kratom use
Partial hospitalization and intensive outpatient care are the step-down levels. Federal reporting groups them and describes them as ranging from counseling and education through to clinically intensive programming [2]; it is partial hospitalization specifically that the same source describes as a step-down option after residential treatment [2].
Partial hospitalization is the heavier of the two. Clinical hours occupy most of the day, and the person sleeps at home or in supported housing. It suits someone who no longer needs overnight supervision but would not hold a lighter schedule.
Intensive outpatient runs fewer hours across fewer days, which makes work or study possible alongside it. Our Umatilla campus runs medical detox, inpatient treatment for substance abuse, inpatient rehab for mental health, partial hospitalization, outpatient care and aftercare planning, and admissions will confirm which step-down levels are running there and at the nearest campuses.
Plain outpatient care is described as suitable either as a first level for a mild to moderate substance use disorder, or as continuing care after something more intensive [2]. Our outpatient rehab page sets out the difference.
Therapies with the strongest evidence for this substance
There is no therapy studied specifically for kratom in any depth, because research in people is at an early stage [1]. What clinicians use instead are the approaches with evidence across substance use disorders generally.
Federal reporting says cognitive behavioral therapy may be the most researched and evaluated of all the therapies for substance use disorders [2]. Its premise is that substance use disorders develop partly from maladaptive behavior patterns and dysfunctional thoughts, and treatment works on modifying those and building coping skills [2]. It is a short-term approach, usually involving 12 to 24 weekly individual sessions [2]. People with a substance use disorder and a co-occurring mental disorder who received it had significantly better outcomes than those who did not [2]. Our page on cognitive behavioral therapy explains the method.
Contingency management gives tangible rewards for positive behavior change and has been found effective in treating substance use disorders, with results reproduced across alcohol, opioid and methamphetamine use disorders [2].
Motivational enhancement therapy uses motivational interviewing to help someone resolve their own uncertainty about stopping [2]. It is often the opening move when a person is ambivalent.
Group counseling is standard in most programs, but federal guidance says it should primarily be used alongside individual counseling rather than instead of it [2]. Our types of therapy page covers the rest.
Medication options, where they exist
There is no medication approved specifically for kratom use disorder, and kratom itself has not been approved as safe and effective for any medical purpose [1].
That does not mean medication plays no part. Where a person also has an opioid use disorder, or where withdrawal is severe, a prescriber may use medications established for those situations. That decision belongs to a clinician who has taken a full history, and it is made in the room rather than from a web page. Our medication assisted treatment page explains how those options are used.
Some people have turned to kratom itself to manage opioid withdrawal and cravings. Researchers are studying whether it helps, but it has not been shown to be safe and effective for that or any other medical use [1].
Two practical points. Tell the assessing clinician about every product being taken, including supplements. And expect liver function to be checked, because serious liver problems have been reported with long-term use of large amounts [1].
Co-occurring mental health conditions and why they change the plan
A second diagnosis changes the level of care, the therapy and the order of work. An assessment will ask about anxiety, depression, trauma and chronic pain, among other things — not because anyone can tell you which of them is most common alongside kratom, but because any of them changes what the plan has to do.
Treating one and ignoring the other rarely holds. The evidence for cognitive behavioral therapy in people with both a substance use disorder and a co-occurring mental disorder is one of the clearer findings in the federal review [2].
Chronic pain deserves its own mention. Where pain is what someone was managing, removing the kratom without a pain plan leaves the original problem untouched, and that is a predictable route back — so say on the first call whether pain is part of the picture.
This is also why the evaluation stage screens for other mental and physical conditions before anything else happens [3]. A plan that names both problems is the one worth having.
Paying for kratom treatment and verifying benefits
Treatment for kratom use is billed as substance use disorder treatment, like any other. There is no separate category and no separate rate.
Federal parity law shapes what a plan may do. Copays, coinsurance and limits such as a visit cap cannot be more restrictive for substance use benefits than the rules applied to substantially all medical and surgical benefits in the same class [5]. Limits that apply only to substance use benefits are prohibited [5]. Parity has a scope worth knowing. It applies to non-federal governmental plans with more than 50 employees, to private employer group plans with more than 50 employees, and to individual-market coverage. Small-employer group plans are generally outside it, although non-grandfathered small-group and individual plans must cover mental health and substance use disorder services as an essential health benefit under the Affordable Care Act [5].
Verification is a call the program makes to your plan. What comes back is a benefits picture: the covered levels of care, your deductible position, your share of the cost, and whether prior authorization is needed. Detox and the program after it are usually authorized separately, so approval for one is not approval for the other.
Our pages on insurance coverage for rehab and what rehab costs cover the mechanics, and how long rehab takes covers the other half of the bill.
Frequently Asked Questions
Do I need inpatient treatment for kratom use? Not always. An assessment decides it, weighing how severe the withdrawal has been, what else is being used, physical health and what home is like. Residential care tends to suit people whose attempts to stop at home have not held, or who have a second diagnosis. Where risk is lower, partial hospitalization or outpatient care may be the recommendation instead.
Is there a medication for kratom addiction? No medication is approved specifically for kratom use disorder, and kratom has not been shown to be safe and effective for any medical use. Where an opioid use disorder is also present, or withdrawal is severe, a prescriber may use medications established for those situations. That is a clinical decision made after a full history, not something to arrange in advance.
How long does kratom treatment take? It depends on the level of care and on what else is going on. Detox runs days rather than weeks. Treatment afterward runs from weeks to months. Cognitive behavioral therapy is described as a short-term approach usually involving 12 to 24 weekly individual sessions. No honest figure exists before an assessment, and aftercare continues well past the formal program.
Will insurance cover it? Usually, because this is billed as substance use disorder treatment like any other. Federal parity law limits how much more restrictive a plan may be for substance use benefits than for medical and surgical benefits in the same class. Detox and the program that follows are normally authorized separately, so ask the program to verify both before admission.
What happens on the first call? Someone asks what has been happening, for how long, what else is being taken, and what the medical history looks like. Nothing is diagnosed on that call. It ends with either a booked clinical assessment or a clear reason why something else fits better. Benefits verification usually runs alongside it, and a family member may make the call.
Sources
- National Center for Complementary and Integrative Health. Kratom: What You Need To Know. National Institutes of Health. https://www.nccih.nih.gov/health/kratom
- Office of the Surgeon General. (2016). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health — Chapter 4: Early Intervention, Treatment, and Management of Substance Use Disorders. U.S. Department of Health and Human Services. https://www.ncbi.nlm.nih.gov/books/NBK424859/
- Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment, Chapter 1: Overview, Essential Concepts, and Definitions in Detoxification. Treatment Improvement Protocol (TIP) Series, No. 45. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64119/
- Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment, Chapter 4: Physical Detoxification Services for Withdrawal From Specific Substances. Treatment Improvement Protocol (TIP) Series, No. 45. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64116/
- Centers for Medicare & Medicaid Services. The Mental Health Parity and Addiction Equity Act (MHPAEA). CMS.gov. https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity
This page is for general information and is not medical advice. Only a licensed clinician who knows your history can tell you what is right for you. If you or someone you know is in immediate danger, call 911. For free, confidential support 24/7, call or text 988.
Author
Chief Medical Officer,
The Recovery Village
