By Jana Wu, LCSW, LADC, ICAADC, CASAC
In my fifteen years of clinical practice within the realms of mental health and substance use treatment, I have observed a recurring pattern that demands urgent scrutiny. As I approach the age of 50, I find myself increasingly troubled by a professional and personal inquiry: Why is the medical and social response to women’s distress consistently focused on immediate relief rather than comprehensive understanding?
This question has gained renewed urgency through my clinical work with women navigating the complexities of midlife. Recently, a specific substance—kratom—has emerged as a focal point in the stories of women who are struggling to maintain the precarious balance of modern life. They are not looking for a "high"; they are looking for a way to keep going.
The Chronology of Convenience: A Historical Perspective
The medicalization of women’s discomfort is not a modern phenomenon, nor is it exclusive to the current pharmaceutical landscape. To understand why women turn to substances like kratom, we must examine the long-standing societal preference for "quieting" female distress.
In the 19th century, the medical establishment relied on vague, catch-all diagnoses such as "hysteria" and "neurasthenia" to categorize a broad spectrum of symptoms: anxiety, fatigue, insomnia, irritability, and chronic pain. These diagnoses were rarely about curing the underlying ailment; they were, in practice, methods of managing women whose symptoms threatened the stability of their domestic and social roles.
By the mid-20th century, the methodology shifted from diagnosis to chemical intervention. The era of sedatives gave way to the "tranquilizer boom." In 1963, the introduction of Valium (diazepam) marked a turning point. Within years, it became the most widely prescribed medication in the United States. Its ubiquity was such that it permeated pop culture, most notably in the Rolling Stones’ 1966 hit, "Mother’s Little Helper." The song served as a stark social commentary on the millions of women relying on prescription pills to navigate the exhausting, repetitive demands of motherhood and domestic life.
Nearly 60 years later, the specific drugs have evolved, but the underlying dynamic remains stagnant. Whether it is a 1960s tranquilizer or a 2020s botanical supplement, the pressure to maintain a facade of seamless productivity persists.
The Midlife Crucible: Why Now?
The women I see in my practice—ranging from their late 30s to their 60s—are often at the height of their responsibilities. They are the "sandwich generation," managing the professional pressures of their peak earning years while simultaneously navigating the emotional and physical demands of raising children and caring for aging parents.
For many, this period is complicated by perimenopause and menopause. These hormonal transitions can trigger or exacerbate anxiety, sleep disruption, and mood instability. When a woman in this demographic experiences these symptoms, she is often met with a healthcare system that is better equipped to treat the symptom than to investigate the source.
If a woman suddenly finds she cannot sleep or experiences debilitating panic, the current system often offers a quick chemical fix. However, relief is not a long-term treatment plan. When we prioritize the immediate suppression of symptoms, we lose the opportunity to explore the complex intersection of hormonal shifts, psychological stressors, and environmental triggers.
Kratom: The "Natural" Alternative to Pharmaceutical Dependence
It is within this gap—the space between "I need help" and "I don’t want to be over-medicated"—that kratom has found a foothold. Kratom (Mitragyna speciosa), a tropical tree native to Southeast Asia, is increasingly utilized by women who perceive it as a natural, traditional alternative to the pharmaceutical system.
Many of my clients report that they discovered kratom while searching for a way to manage pain or anxiety without the side effects—or the stigma—associated with benzodiazepines or opioids. They describe it as a tool for energy and focus, allowing them to "keep up" with the relentless pace of their daily lives.
However, the perception of "natural" is dangerous when conflated with "risk-free." Unlike FDA-approved medications, kratom products in the United States operate in a regulatory gray area. There is no standardized potency, no quality control, and no consistency in manufacturing. A consumer may purchase a product today that is vastly different in alkaloid concentration from what they purchased last month, leading to unpredictable physiological outcomes.
Supporting Data and Clinical Concerns
From a substance use treatment perspective, the primary concern is the lack of awareness regarding poly-substance interaction. I frequently encounter individuals who use kratom in conjunction with alcohol, prescribed benzodiazepines, or other opioids.
When these substances are combined, the risk profile increases exponentially. Kratom’s potential for sedation, when mixed with other depressants, can lead to severe complications, including:
- Respiratory Depression: The slowing of breathing to dangerous levels.
- Excessive Sedation: A dangerous loss of motor control and cognitive function.
- Dependence and Withdrawal: Many users report physical reliance on kratom, with withdrawal symptoms that mimic traditional opioid cessation, including restlessness, muscle aches, and severe anxiety.
We do not talk about these risks enough. Because kratom is sold in smoke shops and gas stations, the public perception is that it is a benign herbal supplement. This accessibility masks the clinical reality of a substance that can, and does, lead to substance use disorders.
Implications for Future Care: Whose Discomfort Are We Treating?
The central challenge for clinicians today is to deconstruct the "relief-first" model. We must ask ourselves: Whose discomfort are we actually treating? Is the medical intervention designed for the patient’s long-term health, or is it designed to make the patient’s distress less visible to society?
We are currently failing women by offering them a binary choice: either endure the agony of unchecked anxiety or sign up for indefinite reliance on a substance—whether that substance is a prescribed pill or an unregulated botanical.
A New Framework for Clinical Practice
To address this, we must adopt a more holistic, patient-centered approach:
- Clinical Curiosity: When a woman presents with anxiety, providers must resist the urge to provide immediate chemical relief. We must dedicate the time to understand the "life surrounding the symptom."
- Hormonal Awareness: Given the prevalence of midlife transitions, clinicians should integrate endocrine health into mental health screenings.
- Risk Communication: Professionals must be transparent about the dangers of kratom and the risks of poly-substance use, moving past the "natural vs. synthetic" narrative.
- Long-Term Strategy: We must prioritize evidence-based psychotherapy, lifestyle intervention, and integrated health over the "pill-per-symptom" model.
Conclusion: Breaking the Cycle
The story of the woman seeking relief is a story as old as medicine itself. It begins with a woman who is struggling, a provider who is overwhelmed, and a desire to make the pain disappear. But the real work—the work that leads to actual healing—begins when we stop trying to make the distress disappear and start trying to understand why it arrived.
As clinicians and researchers continue to study kratom and the broader spectrum of substance use, we must listen to the women using these substances. Their stories are not just about addiction or anxiety; they are stories about the modern, relentless demand for perfection and the profound exhaustion that follows.
Until we address the systemic pressures that make "relief" seem like the only option, women will continue to look for their own solutions. Our responsibility is to ensure that those solutions are safe, informed, and part of a genuine path to recovery rather than another chapter in a history of temporary, and often harmful, masking.
About the Author
Jana Wu, LCSW, LADC, ICAADC, CASAC, is a clinician at Mountainside Treatment Center specializing in PTSD, anxiety, depression, and co-occurring disorders. A nationally recognized expert on kratom, she founded the country’s first clinician-led kratom support group and has presented on kratom and emerging substances to professional audiences nationwide. Her expertise has been featured in The Wall Street Journal, Rolling Stone, and on NBC News and iHeartRadio. She was a founder of the Addictions Committee of the Connecticut chapter of the National Association of Social Workers.
