Suicide and addiction. Too often, we hear these words in the same breath.

At face value, the connection feels logical. Think of celebrities who die by suicide—often there’s the implication, if not outright fact, of a struggle with substance misuse.

At the most basic level, “what suicidality and addiction share is the desire to escape from pain and distress,” says Michael Groat, Ph.D., director of psychology at Silver Hill Hospital in New Canaan, CT. It’s pain that often draws from a shared landscape of suffering that includes childhood trauma and abuse, economic hardship, chronic physical pain, and mental health issues such as bipolar disorder and depression.

But what exactly is the link? And can suicidality or addiction actually lead to the other?

Not everyone with addiction issues contemplates suicide. And not everyone who contemplates or attempts suicide struggles with addiction. Often, however, the paths converge and feed a loop of misery.

“Someone may turn to an addictive substance or behavior as a way to cope with pain in their life. But addiction then creates its own negative cascade,” says Groat.

A person struggling with addiction may eventually lose their job, their relationships, and their home as their habit takes over their life. As their addiction deepens, the pain they feel may grow stronger. As a result, they may begin to see suicide as their only way to escape.

“If you talk to people who have reached the point of considering suicide, many don’t actually want to die. They want relief from their suffering,” Groat says.

STATISTICS ———————————–

Hard Facts About Substance Use Disorder and Suicide

Under the distorting and disinhibiting influence of addictive substances, people in their most desperate hours may then be more likely to take impulsive action. Indeed, acute alcohol intoxication is present in 30% to 40% of suicide attempts, according to the Substance Abuse and Mental Health Services Administration, and opioids are present in about 20% of people who die by suicide.

Next to depression and other mood disorders, substance use disorder is the top risk factor for suicide, according to SAMHSA. People who abuse alcohol and/or drugs attempt suicide six times more often than those in the general population.

While all substance use disorders are associated with heightened suicide risk, alcohol and opioid abuse are clear standouts, increasing a person’s likelihood of dying by suicide by 10 and 14 times, respectively, per a 2018 study published in American Journal of Psychiatry Residents’ Journal. Male deaths by suicide outnumber female by almost four to one generally, says SAMHSA.

Gambling, Sex Compulsion, and Suicide Risk

It’s not just addiction to substances that’s at issue. Addictive behaviors are strongly associated with suicide, too.

“A lot of people don’t think of problem gambling as an addiction because a person isn’t using a substance. But the effects of gambling addiction can be devastating,” says Shane W. Kraus, Ph.D., assistant professor of psychology at the University of Nevada, Las Vegas. Among those who seek treatment for problem gaming, as much as 30% report having made suicide attempts.

Even stronger links have been found between suicide and compulsive shopping and compulsive sexual behavior. Problem gaming, such as playing video games online, is a likely cause of suicidality as well, but more research is needed to be certain.

“People often drink excessively or use drugs to escape their problems. Addictive behaviors also provide a kind of distraction,” says Groat. “When you win while gambling or buy something new, it delivers that excitement, that needed hit of dopamine. In the short term, you don’t have to think about your issues. You don’t have to deal with your unhappiness. But over time, behavioral addictions make problems worse.”

Addiction, Mental Illness and Suicide

People have increasingly accepted evidence showing that mental illness is a disorder of the brain, not a personal frailty.

Addiction—specifically substance use disorder—falls under the umbrella of mental illness. As with other psychiatric disorders, a person’s risk of developing an addiction can be influenced by their genes, their own physical makeup, and their environment.

“Unfortunately, some people still believe addiction has to do with people’s moral failings. That’s why there’s still so much stigma around it and why a lot of people don’t seek help,” says Kraus.

Now consider these realities about the dangerous and common collision of addiction with other mental health disorders:

• 90% of people who die by suicide have one or more psychiatric disorders. Risk is highest among patients with mood disorders like bipolar, depression, schizophrenia, and substance use disorders.
• People with psychiatric disorders are also at much higher risk of addiction. Among people with a mood disorder, 32% are found to also have a substance use disorder. In the absence of effective treatment or before an illness is even identified, many self-medicate, “often turning to substances or engaging in activities like gambling as a way to find relief from their negative feelings,” says Groat.
• When mood disorder and substance use disorder coexist (called “comorbidity”), the risk for suicide escalates considerably. For instance, men with both depression and alcohol use disorder have the highest long-term risk of suicide of all groups, around 16%.

Other Risk Factors for Addiction and Suicide

Not everyone who struggles with addiction and becomes suicidal starts out with a diagnosable mental health issue.

For example, “a lot of young people might begin using drugs or gaming intensively as a way to cope with feeling lonely, sad, or anxious,” says Groat.

Poverty and abuse can also lead a basically healthy person to seek escape through addictive behaviors. Peer pressure, easy access to addictive substances, and exposure to family members with addiction issues can raise a person’s risk of turning to drugs, alcohol, and addictive behaviors, too.

Many people are able to dip into potentially destructive coping behaviors and eventually move past them. Or they avoid them all together.

“There are plenty of high-achieving people who come from a history of trauma and pain,” says Groat.

There are also people who get by with low-level substance use or compulsive behavioral disorders that detract from their life but don’t reach crisis levels. Think of functional alcohol misusers, who nip into the bottle throughout the day yet still manage to keep a job. Or a long-time gambler who might have had a nicer house or paid for his kids’ college had he not blown so much on craps.

But others may be more vulnerable and find it harder to control their use or behavior, probably by some combination of genetic vulnerability and environmental factors.

“They then get into a spiral that creates its own problems. And people who didn’t start out with a mental health issue may end up with one because of their addiction,” Groat says.

If left untreated and allowed to spiral, that combination of addiction and comorbid mental illness can then lead a person to a desperate point. And in many cases, that point can be thinking about or attempting suicide.

TREATMENT ———————————–

The Challenge of Finding Treatment for Suicidality and Addiction

Considering how closely linked addiction and suicide are, one might assume that treatment options are plentiful.

To some extent, that’s true for people who have suicidal ideation and are also struggling with behavioral addictions like gambling. Guided by a licensed practitioner, talk therapies like cognitive behavioral therapy can teach skills to reduce urges and help people replace unhealthy thoughts with positive or adaptive ones.

While there are currently no FDA-approved medications that specifically target addictive behaviors, emerging research has shown that some drugs can effectively reduce addictive urges. There are also peer-led support groups and treatment programs that specifically target behavioral addictions.

The same cannot be said, however, for suicidality and substance use disorder, despite how commonly these two issues co-occur.

Certainly, there are places and professionals that treat patients who are at risk of suicide. And there are counselors, peer-led support groups, and rehab facilities that deal with substance use disorder, increasingly with the help of medications that ease recovery by blocking cravings and eliminating withdrawal symptoms.

But people struggling with both suicidality and substance dependence too often find themselves “in a murky gray area,” says Groat.

Someone may be referred to a mental health provider for their suicidal ideation and to a substance abuse counselor to address their addiction. This may work in some cases, but often care can be fragmented and patients receive mixed messages and conflicting advice from their different providers.

What’s more, some mental health specialists and facilities require potentially suicidal individuals to first deal with their substance dependence before coming on as patients. But many inpatient and outpatient rehab facilities will not take patients who are actively suicidal.

The tragic result: Families trying to help loved ones with alcohol or drug and suicidal ideations may not know where to turn at their most desperate time.

“It’s a huge limitation of the mental health field and a symptom of our broken mental health care system,” says Groat.

What You Can Do ———————————–

The Best Approach to Co-Occurring Suicidality and Addiction

This doesn’t mean help can’t be found. It just means you have to know how and where to look for a facility or specialist that treats dual diagnoses or provides what’s called “co-occurring care.”

If matters aren’t immediately life threatening, you can see a primary care provider, emphasize that addiction and suicidality are both at issue, and ask for a referral to a place or person that provides co-occurring care.

If you don’t have or want to see a physician, call the National Suicide & Crisis Lifeline at 988, describe what’s going on, and ask for a referral to a place or specialist who can treat dual diagnoses.

Whichever way you go and whatever possibilities you find, “you need to ask questions,” says Groat. Ask what their experience is with comorbid suicidality and addiction. Ask if they take a dual approach to treatment and what that approach entails.

“There unfortunately isn’t a way that I know of to quickly identify who is most likely to provide this kind of care. But I find that many therapists who specialize in suicidal ideation are also used to working with people who have substance use issues,” says Groat. “I also find that a lot of people and places that treat bipolar disorder are accustomed to treating substance abuse and suicidality because both are relatively common among people with BPD.”

Psychology Today’s website has a directory of therapists who specialize in bipolar disorder, as well as directory of therapists who specialize in suicidal ideation. There’s also a directory of licensed therapists who specialize in substance use disorder. All can provide helpful leads.

It may take some effort to find it, but there is support out there that can help you deal with the vicious cycle of addiction and suicidality.

“If you are able to find someone who can listen and understand how bad you feel … a therapist who ‘gets’ you and doesn’t judge you for your addiction … and effective medication … it can change the course of your life,” says Groat.

If you or someone you care about is in immediate crisis and is actively planning to hurt themselves or attempt suicide, call 988, go to an emergency room, or call 911.

Notes: This article was originally published July 7, 2023 and most recently updated July 24, 2023.

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Massachusetts is ranked #8 in the rate of drug-related deaths that occurred in 2019, reports the CDC. That year, the state had 32.1 drug-related deaths for every 100,000 residents. Heroin is the top illicit drug of use in Boston and the entire state. Plus, it has contributed to thousands of overdose deaths in recent years.

Here’s a closer look at the scope of drug abuse in Boston and Massachusetts, and information about drug rehab treatments that can help you experience a long-lasting recovery.

Boston and Massachusetts Drug Addiction Statistics

• In 2017, heroin represented nearly 57% of all admissions to drug rehab centers in Boston, reports the Massachusetts Department of Public Health.
• In 2017, 4.5% of admissions to drug rehab centers in Boston were for crack or cocaine, 3% were for marijuana, 2.4% were for opioids other than heroin, and 2.1% were for sedatives and hypnotics.
• The city of Boston reports that an estimated 11.3% of people living in Boston are suffering from some form of substance abuse.
• In 2012, nearly one in 10 of all visits to Boston hospital emergency departments were related to substance abuse.
• Heroin is the top drug of choice for people who live in Boston and abuse drugs.
• In 2013, an estimated 42% of public high school students in Boston reported having used marijuana at least once in their lifetime, reports the Boston Public Health Commission.
• In 2013, there were approximately 28.3 admissions to drug rehab centers in Boston for every 1,000 residents aged 12 and older.
• The state of Massachusetts reports that the number of opioid-related deaths in the state has increased 450% over the last 16 years.
• Between 2013 and 2014, an estimated 3% of Massachusetts residents aged 12 years and older met the criteria for drug abuse or dependence.
• In 2018, an estimated 88% of drug overdose deaths involved at least one opioid, reports the National Institute on Drug Abuse (NIDA).
• In 2018, there were 475 heroin-related deaths and 331 deaths related to prescription opioids in Massachusetts.
• In 2018, more than 90% of opioid-related deaths in Massachusetts involved synthetic opioids such as fentanyl.
• In 2018, doctors in Massachusetts wrote an estimated 35.3 opioid prescriptions for every 100 people.
• In 2017, there were an estimated 13.7 babies born with neonatal abstinence syndrome in Massachusetts for every 1,000 hospital births.
• In 2017, an estimated 25.5% of male HIV cases and 30.2% of female HIV cases in Massachusetts were caused by injection drug use.
• There are an estimated 38,100 people in Massachusetts living with hepatitis C caused by injection drug use.
• The NIDA reports that the number of unintentional drug overdoses reported in Boston hospitals increased by 40% between 2010 and 2012 — most of which were related to heroin.

Treatments for Drug Addiction in Massachusetts

Drug use disorders are typically treated using a combination of intervention, family coaching, behavioral therapy and life tools at Baystate Recovery.

The goal of behavioral therapy is to teach patients how to cope with stress and other triggers of drug use, and to change harmful behaviors that may be contributing to their addiction. Relapse prevention training, cognitive-behavioral therapy, and 12-step facilitation therapy are some of the many evidence-based behavioral therapies used at drug rehab.

The post Recent Drug Addiction Statistics for Boston and Massachusetts appeared first on My Blog.

Cutting down on your drinking? Set SMART goals and practice refusing drinks now.

• Someone can set a SMART goal about their drinking to imbibe less.
• It helps to make sure one knows how much booze is in each drink one has.
• One doesn’t have to offer an excuse to reduce or stop drinking, but it helps to be prepared with responses.

It is officially summer! Many of us are finally enjoying some downtime in the sun at cookouts, sporting events, or weekend getaways.

Dry January has long come and gone, but you may have decided to cut back or even stop your alcohol use for a bit longer. If so, you are not alone! More and more people are drinking less alcohol for a variety of reasons. Drinking less can improve one’s physical health in many ways, such as reducing cancer risk, avoiding “empty calories,” and reducing the toxins your body is exposed to on a daily basis. While actively drinking less used to be closely linked to having alcohol-related problems, it is clear that there are any number of reasons that someone may want to reduce drinking in the here and now.

Getting started with SMART goals

So, you may have decided you want to drink less. As a first step, it is helpful to define what that means for you. Having a specific, measurable, attainable, relevant, and time-specific (SMART) goal can help you on this path. For instance, considering how much you want to drink, when, in what context, and for how long can help you clarify what “cutting back” means to you.

When considering how much, think about how much you want to drink in a week versus in a sitting. This could look like setting a goal to drink no more than four drinks in a week and no more than two drinks in a sitting. There is no one-size fits all approach, but a helpful starting point can be low-risk drinking guidelines issued by your local health authority. For example, you can view the guidelines for Canada and the United States using the provided links.

Tips for counting your drinks

When sticking to these limits, it is important to know “What is a drink?” While it is natural to count by the glass, bottle, or can, the actual alcohol content of beverages varies widely. A “standard drink” is an agreed-upon way of measuring one drink based on the amount of alcohol in the beverage. One standard drink is whatever size beverage leads to 0.6 fluid ounces or 14 grams of pure alcohol. For instance, a 12-oz can or bottle of regular beer (5 percent) is one standard drink. But 12 ounces of strong craft beer (9 percent) is nearly two standard drinks! This can give you a sense of how much booze is in your go-to beverages to help you keep count of your drinks.

Simple ways to say “no” to a drink without saying it.

Even though you may have decided you want to drink less, it can still be difficult at first to refuse drinks offered by friends and family. Here are some ideas of how you can say “no” to a drink that is offered to you without using the word “no”:

1. “Thanks, I already have a drink.” Bring your own non-alcoholic drink of choice and perhaps even some extra to share! There are more and more non-alcoholic drinks coming to market, which provides a number of options to partake in drinking-centric festivities without alcohol.
2. “Thanks, but I am good for now.” Express appreciation, but indicate that you do not really feel like a drink right now.
3. “I would love to have a [insert non-alcoholic drink] instead.” Ask for another option that they likely have on hand.
4. “I decided not to drink today because [insert reason], but thanks for offering.” Express appreciation and provide a reason. Reasons are not necessary, but if it is someone that is close to you and you want to share why—go for it! Common reasons are for health, well-being, later plans for activities or driving, or just wanting to fully live in the moment.

You can do this!

These options provide some ideas of how to refuse a drink without saying “no” outright. Remember, you don’t need to explain your reasons for not drinking. The key is to keep it simple and polite. Most people will understand and respect your choice! The more you practice refusing drinks, the easier it will become.

The post 4 Ways to Say “No” to Alcohol Without Saying It appeared first on My Blog.

If there’s one consistent truth in behavioral health treatment, it’s that one size does not fit all. Cookie-cutter treatment often doesn’t work, even if an accurate diagnosis has been made and standard-of-care interventions are applied.

In the case of major depressive disorder, for example, numerous options are available. In terms of pharmacotherapy, there are many medication treatments all with different mechanisms of action. Drug classes include selective serotonin reuptake inhibitors, norepinephrine-dopamine reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and more. But not all patients with a diagnosis of depression will respond to all of these treatment options.

The truth is we are all different. Heterogeneity within a diagnostic group is the rule, not the exception. And, as a field, we are still in the early stages of trying to figure out what treatment is best for the patient.

In the real world, prescribers, like psychiatrists, often have to try several medicines, before finding the best one for a particular patient. Sometimes it takes weeks or months before we get an answer to the question of which medication is best for that individual. It’s an often-frustrating process of trial and error.

Therapists also struggle with a similar situation. Often trained in several modalities, we will often pick and choose from our various skill sets, trialing one kind of intervention, and then another, until finding the one that fits the person’s needs in front of us. Meanwhile, the patient’s life continues to unravel. Wouldn’t we all be better off if we better knew how to match treatments to a patient’s individual needs off the bat?

How Things Work Today: Where Your Behavioral Health Provider Is Coming From

When mental health practitioners first evaluate patients in their offices, we may spend the first session, or several, to identify any underlying diagnoses, based on the diagnostic bible, otherwise known as the Diagnostic and Statistical Manual. One of the primary reasons we do this is to inform our recommendations and treatment plan.

A diagnosis gives us a treatment direction. Once we know the diagnosis, we have an idea about the next steps; our training has taught us about the standard of care, and we already know the first-line treatments. If we don’t know, we can go to the literature to identify the treatments that are most likely to work best for this diagnosis.

Results from clinical trials, especially large, double-blind, randomized controlled trials, are the foundations of a psychiatrist’s decision-making about treatment. A typical study of this type takes a large group of people with a single diagnosis—say, major depressive disorder—and randomizes them to active treatment or placebo.

The patients are followed over time. Measurements of the patient’s clinical status, after weeks of treatment, are compiled and analyzed to answer the following question: Does the active treatment get people better faster than the placebo, and if so is it a statistically significant difference?

If so, then several more studies, in different populations, need to be done. If several studies show the medication to be effective, the field adopts that medicine or psychotherapy as a recommended standard of care intervention.

But, unfortunately, not all treatments work for all people. There is significant variability within each diagnosis, based on metabolism, brain chemistry and function, genetics, comorbidity, and any number of other factors. The fact is that individual patients respond differently than the populations in the drug studies do.

Many medicines have been studied and found, on the whole, to be effective within the categories of addictions, anxiety disorders, major depressive disorder, bipolar disorder, and psychotic disorders, to name just a few. Numerous psychotherapies, also growing in number, are also evidence-based within each diagnostic category.

So, in the face of numerous treatment options to choose from, providers don’t have much information on which one might be best for the patient. Sometimes they’ll go with experience, familiarity, and intuition. Occasionally, there is guidance from the literature about how to match treatment to the individual. But often times it’s just a guessing game.

To avoid the time-consuming and in some cases life-threatening trial and error process, where we pick treatments based on intuition and personal experience, we need better ways to know ahead of time what the individual in front of us needs most.

The Importance of Defining Subtypes to Inform Treatment

“Precision medicine” and “personalized medicine” have been high-priority research agendas for over a decade. These terms refer to medical care designed to optimize efficiency or therapeutic benefit for particular groups of patients and involve using genetic or other biomarker information to make treatment decisions. This is especially important as more and more treatment options are coming out.

Research to define subgroups within diagnostic categories, with the end goal to increase the efficiency and effectiveness of treatment, is a major focus of behavioral health research. Genetics, radiologic imaging measures, demographic information, blood tests (such as hormone levels), cognitive function, and behavioral traits are examples of markers that can be utilized to define these subgroups. Examples of disorders being studied using these methods include post-traumatic stress disorder, mood disorder, psychotic disorders (like schizophrenia), substance use disorders, and other addictions.

The more researchers explore the validity of subgroups, the closer we will come to being able to identify which medication is best for the individual patient in front of us—treatment matching—thereby improving the outcomes of patients and the efficacy of existing treatments, potentially saving lives.

The Future

Research in this area of behavioral health and addictions is still in its early phases. For major depressive disorder, there are some early signs of useable tools. Some facilities and providers are, for example, encouraging patients to do genetic testing to identify the medications to avoid, and the ones that are most likely to work with minimal side effects.

Some experts express concerns that these expensive tests are not yet ready for prime-time, because it is still not established whether they actually improve patient outcomes—i.e. that testing helps patients get better any faster. Yet other studies (many, it must be said, funded by the companies that produce these testing kits) have reported that they do have clinical benefits and cause overall cost savings. However, more research needs to be done to find affordable, accessible, and accurate ways for behavioral health providers to individualize treatment with medications.

In addictions—which will be the focus of my next four articles—there are some signs of affordable, accessible markers that can be deployed now. Although the work is preliminary, these potentially useful markers are not costly, and if clinicians are to have this information in mind when making decisions, it is unlikely to cause harm.

Conclusion

In this age of a ballooning number of treatment options, researchers have been working hard to identify the best ways to subtype people within a diagnostic category in order to pick the best medication.

A textbook, or several, could be written about sub-typing in behavioral health disorders to guide pharmaco- and psycho-therapeutic treatment for mental health and addictive disorders. I don’t have the space to cover it all.

Therefore, in the next group of articles, I’ll limit my review of the literature to three groups of clinical diagnoses: alcohol use disorders, other substance use disorders, and the debated topic of food addiction. I’ll also do an additional article on the promise of sub-tying using an addictions neuroscience framework. I’ll primarily be focusing on sub-typing to guide medication treatment rather than choosing between psychotherapeutic modalities.

That said, there is a growing (exciting) literature focused on treatment matching in psychotherapy, too, and in a few places (like in the article about the neuroscience-based sub-typing paradigm, and in the article about alcohol use disorders), I’ll occasionally reference treatment-matching in psychotherapy too.

The post Narrowing Down The Choices: What Treatment Is Best for Me? appeared first on My Blog.

Self-soothing is defined as an individual’s efforts or capacity to calm themselves while in a state of emotional distress (Wright, 2009). It is a key aspect of well-being as it helps us stay regulated and calm (take the well-being quiz here to learn more about your well-being).

We learn many of our self-soothing patterns when we are babies. It is believed that when we are soothed by caregivers, we internalize this soothing and learn how to do it for ourselves (Wright, 2009). So there are a variety of ways that we might not develop this skill and end up having difficulty self-soothing as adults. Improving our self-soothing skills as adults requires self-insight, the development of self-soothing skills, and the ability to effectively use these skills to return to an emotional baseline.

Here are some specific self-soothing techniques that may help:

1. Listen to Relaxing Music.

Research has shown that relaxing music reduces cortisol, an important stress hormone (Khalfa et al., 2003). If you’re feeling agitated or unable to settle down, calming music might just help change the mood, enabling you to breathe deeper, refocus your thoughts, and nudge negative emotions into remission.

2. Take Some Deep Breaths.

A key part of self-soothing often involves deactivating the sympathetic nervous system. We can do this by activating the parasympathetic nervous system. The parasympathetic nervous system helps stop our fight-or-flight responses and return us to a calm state.

We can easily activate the parasympathetic nervous system by taking a few long, deep breaths. One easy breathing strategy to remember is box breathing. Box breathing involves breathing in for a count of four, holding for a count of four, breathing out for a count of four, and then holding for a count of four. Repeat this box breathing method for a few rounds until you start to feel calmer.

4. Try the “Butterfly Hug.”

EMDR is a therapeutic technique used to help people process trauma. One EMDR technique is the Butterfly Hug. The Butterfly Hug is not considered to be a self-soothing technique in itself, but rather a technique for processing distressing emotions and material often left from trauma. Soothing is what is thought to occur after processing this material. So this technique is not to be used while experiencing negative emotions, but rather it is to help you work through negative baggage that may be causing heightened distress in general.

5. Do Pleasant Activities.

In Dialectical Behavior Therapy (DBT), it is suggested that engaging in pleasant activities is a good way to self-soothe (Linehan, 1993). Indeed, regularly doing an activity we enjoy can help us feel more content, and doing this activity when we’re stressed may make us feel better. Some of my favorite pleasant activities are gardening, spending time with friends, and doing arts and crafts. What pleasant activities help you feel better?

In Sum

When we’re feeling upset, it can sometimes be hard to self-soothe. But by using some self-soothing techniques, we actually do have a lot of control over how we feel.

Adapted from an article on self-soothing published by The Berkeley Well-Being Institute.

References

Jarero, I., & Artigas, L. (2016). Instruction for the Butterfly Hug Method.

​Khalfa, S., BELLA, S. D., Roy, M., Peretz, I., & Lupien, S. J. (2003). Effects of relaxing music on salivary cortisol level after psychological stress. Annals of the New York Academy of Sciences, 999(1), 374-376.

​Linehan, M. M. (1993). Skills training manual for treating borderline personality disorder. Guilford press.

Wright, J. (2009). Self‐Soothing—A recursive intrapsychic and relational process: The contribution of the Bowen theory to the process of self‐soothing. Australian and New Zealand Journal of Family Therapy, 30(1), 29-41.

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Written by Rowan Lynam

In a stunning 3-minute PSA for the Dove Self-Esteem Project, Dove examines the cost of toxic beauty standards on the mental health of developing minds. The video emphasizes the cascading and long-term consequences children exposed to certain content can form, including developing life-threatening eating disorders.

Mary’s Story

In the ad, we follow Mary, the central focus of the piece, from early childhood to her young teens. We see her go from the uninterrupted joy of her young life to something hyper-fixated and solemn. It begins when she receives her first smartphone, which the PSA draws attention to.

From there, Mary is sucked into the endless stream of beauty and body content online. Not far from her 13^th birthday, she is shown writing in a journal covered in rainbow stickers and “keep out” stickers, outlining her weight-loss goals and her plan to go on WeightWatchers for Adolescents. She plans a detailed workout routine and develops a fixation on her eating habits. We see her standing in front of the mirror, examining her still-developing body from the side to see how thin she is. Then, we see a self-recorded video of her weighing herself and then turning the camera back to see her painfully childish face.

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“I had an issue and a problem that needed to be fixed,” the Heels actor said in a candid video over the weekend

Alexander Ludwig is celebrating five years of sobriety.

The Heels actor, 30, marked the milestone in a video posted on social media Sunday.

“It’s pretty crazy to me that five years ago to the day, I was so lost, so confused and so scared about where my life would go,” Alexander said. “All I knew was that I had an issue and a problem that needed to be fixed.”

“I’ve lost a lot of friends to this disease, so many people didn’t make it and I don’t really know why, because there’s so many reasons why that should have been me and not them,” he continued. “I don’t want to make this video as, like, congratulatory to myself — it’s really just for anybody that needs to see this.”

Alexander also gave a glimpse at the road he has traveled in his post — and offered hope for those who are sharing his journey.

“If you’re struggling, be brave enough to ask for help and take it from me, there really is hope at the end of the road, there really is a light at the end of the tunnel. It’s actually staggering to me how much has changed in my life since I got out until now,” he said.

“It’s amazing what can happen when you decide to love yourself and commit to loving yourself and to growing every day as a human being as opposed to satiating these impulses we all have,” Alexander added.

The Canadian actor and rising country musician, who has been married to wife Lauren Ludwig since January 2021, also shared that his five-year sobriety “birthday” is on the same day as the three-year anniversary of his first date with his wife. “I’d say it’s pretty serendipitous,” Alexander wrote about the coinciding dates.

The Hunger Games alum’s candid post came about as he and his wife prepare to welcome their first baby — a girl — this spring.

Back in February, Alexander and Lauren shared that they were expecting a child in May, after suffering three miscarriages.

“It’s been a long road, and we wanted to wait until things were looking promising this time around,” Alexander wrote alongside a photograph of himself cradling his wife’s baby bump.

“Thank you guys for all of the support. We couldn’t be more grateful. ,” he added.

The post Alexander Ludwig Celebrates Being 5 Years Sober with Emotional Post: ‘I Had an Issue’ appeared first on My Blog.

Spring Hill Recovery Center

Millions of people drink (namely beer) on St. Patrick’s Day every year, which began as a day to celebrate the patron saint of Ireland, St. Patrick. People in recovery from drug or alcohol addiction can pursue sobriety by participating in non-alcohol-related activities and getting outside support.

St. Patrick’s Day is one of the biggest drinking holidays of the year. While it’s intended to be a celebration of St. Patrick, a patron saint of Ireland, it’s morphed over time into a day largely centered on drinking beer and spirits.

If you or someone you love are in recovery from drug or alcohol addiction over the festive holiday, you may need to take certain precautions to avoid relapse.

Fortunately, you can enjoy the holiday sober. Here, we’ll discuss the prevalence of drinking on St. Patrick’s Day in the U.S. and provide tips on how to remain sober and focused on recovery.

Why People Drink On St. Patrick’s Day

St. Patrick’s Day falls during the season of Christian Lent, a 40-day season of fasting to prepare for Easter.

Every year on March 17th, Christians began gathering to celebrate the anniversary of St. Patrick’s death in the year 461 AD.

On this day, the restrictions of Lent were lifted and people celebrated by drinking alcohol, eating meat, dancing, and more. This is what spurred the consumption of alcohol on St. Patrick’s Day, a tradition that’s continued to this day.

In America, many people have dubbed Boston as hosting the first St. Patrick’s Day celebration in 1737 when Irish immigrants gathered to celebrate.

From there, non-Irish Americans began to adopt the practices of the holiday, making it into what it is today.

The Scope Of Drinking On St. Patrick’s Day

St. Patrick’s Day is the third most popular day for drinking in the U.S., next to drinking on New Year’s Eve and Mardi Gras, the most popular drinking holiday.

However, it’s the most popular day for drinking beer. According to one survey, there’s a 174% increase in beer sales on St. Patrick’s Day compared to the rest of the year, and a 153% increase in the sale of spirits.

The survey also found that:

• the average number of drinks consumed on St. Patrick’s Day is 4.2
• more than 13 million pints of Guinness beer are consumed on the holiday
• 32% of men binge drink on St. Patrick’s Day

Staying Sober In Addiction Recovery Over St. Patrick’s Day

With so many people donning green clothes and accessories to head out to the bars for a night of alcohol-focused merriment, it can be difficult to get through the day without seeing people drinking.

Social media makes seeing these scenes more accessible than ever, as people post pictures and videos of parties with drinking on apps like Instagram and TikTok.

Though the culture of drinking can be all-consuming, it doesn’t have to be. Whether you plan to spend the holiday in or go out with friends, you can stay safe and focused on recovery.

Here’s how you or your loved one can stay sober this St. Patrick’s Day:

• Find people you trust: If you choose to go out and celebrate with friends on St. Patrick’s Day, choose people who know your recovery journey and can help to keep you accountable.
• Learn about the tradition: If you are a practicing Christian or simply want to know more about the roots of the holiday, spend time learning about the history of St. Patrick’s Day and connect with the traditional aspects of the celebration.
• Go to a parade: You can enjoy the family-friendly aspects of St. Patrick’s Day like a parade, celebrating the day without needing to drink.
• Enjoy Irish foods: Traditionally, St. Patrick’s Day was celebrated with ham and cabbage; however, Irish Americans began a tradition of corned beef and cabbage in the 1700s. Invite friends over and make a traditional St. Patrick’s Day meal together.
• Create a plan: Make a plan for how to handle triggers or difficult situations involving alcohol if you decide to go out. You might choose one person who is aware of this plan and can help you to exit quietly if need be.

Find Alcohol And Drug Addiction Treatment In Massachusetts

Our addiction treatment specialists recognize the difficulty of staying sober on major drinking holidays in the U.S. such as St. Patrick’s Day.

To keep yourself or a loved one safe and on track with recovery, consider reaching out to us to learn about our treatment programs.

We offer a range of programs, including access to drug and alcohol detox in Massachusetts, outpatient treatment, inpatient rehab, and more. Call us today to learn more about your options.

The post The Culture Of Drinking On St. Patrick’s Day And Staying Sober In Recovery appeared first on My Blog.

I direct one of the largest addiction research centers in the country, and I study substance use in adolescence. Here’s what every parent needs to know about adolescent substance use:

1. Adolescence is the time when most kids initiate substance use.

It’s when they establish regular patterns of use, that many start to experience consequences. About 15 percent of the population will meet the criteria for a substance use disorder at some point in their lives, meaning that substance use is causing significant harmful consequences. The average age of onset for problems is in the early 20s, so most problems start in adolescence. That’s why we focus so much substance use prevention programming on teens.

2. Adolescents have brains that are wired for risk-taking.

This is a result of the fact that the brain doesn’t develop evenly. The part of the brain that is highly attuned to experiencing reward is fully developed in adolescence. That’s a product of evolution—if our brains didn’t respond positively to food, social interactions, and sex, as a species, we wouldn’t survive very long. Those things make us feel good, and we seek out more of them.

But as we all know, too much of a good thing can lead to trouble. The part of our brain that helps us weigh the consequences of our actions and think about long-term implications isn’t fully developed until the mid-20s. So, teenagers are like race cars without fully functional brakes. Using drugs is a novel experience that adolescent brains crave—and then drugs hijack the reward system by producing feel-good effects. It’s a big part of the reason why most adolescent substance use is risky adolescent substance use. Teens don’t have a glass of wine with dinner; if one drink is good, their reward-primed brains tell them, five drinks must be better! Of course, there is a lot of individual variability in this trait, but developmentally, teenage brains are at a high point for risk-taking.

3. The drugs available to kids today are more dangerous than in the past.

Vaping has risen tremendously in popularity, with one in four youths reporting that they have vaped. Vapes come in fun flavors and are easy to hide; most youth (and parents) do not realize that a single vape can contain as much nicotine as a pack of cigarettes.

Cannabis use is on the rise as most states have legalized marijuana for either medicinal or recreational purposes. Up to 11 percent of youth report using cannabis daily. This is the drug most of us who study adolescent substance use are most worried about presently.

The marijuana available today is nearly 10 times stronger than the marijuana that was available in the 70s, 80s, 90s, and up through the 2000s. Early research is showing potent adverse effects on memory and motivation in kids who use them regularly. The level of THC, the psychoactive ingredient in marijuana, was about 3 percent until the early 2000s; it is now close to 25 percent in the marijuana available today, and up to 90 percent in edibles like gummies! Many parents are unaware of just how different and dangerous this drug is compared to how they remember marijuana. Parents, think of it this way: If marijuana use in your youth was the equivalent of having a beer when your kids use marijuana, it’s more like drinking a liter of vodka.

Fentanyl, a powerful synthetic opioid which can be produced far more cheaply than other opioids, has flooded the drug market as a result of the opioid epidemic. It is the top cause of accidental overdoses, which have grown exponentially over the past several years. The concern now is that it’s not only opioids that are laced with fentanyl; it’s other drugs as well. Increasingly, cocaine, ecstasy, and other street drugs also contain fentanyl, leading to accidental overdoses in youth who experiment.

4. Alcohol remains the most widely used drug in youth.

It is the most available drug, so it continues to be the one most kids use recklessly, leading to injuries, fights, unwanted sexual behavior and assaults, accidents, and death. Well-meaning parents have asked me if, due to the increasing availability of more dangerous drugs, they should instead encourage their child to take the “least-worse” path and stick to alcohol.

There are two reasons this isn’t a good idea. First, it assumes that all kids will use alcohol or other drugs, which is not the case. We don’t want to inadvertently normalize substance use in our kids. Many youth choose not to drink. Rates of alcohol use have fallen steadily over the past decade, with national data showing that only 55 percent of high school seniors report using alcohol in the past year.

Secondly, there is no evidence that when youth use alcohol it deters them from using other drugs. In fact, the opposite is true. Youth who use alcohol are more likely to try other drugs as well. When the novelty of alcohol wears off (remember they have sensation-seeking brains!), they move on to trying other drugs.

5. Parents can make a difference.

Parents, don’t despair! There are actions you can take to reduce the likelihood your teen will initiate substance use or use in risky ways.

• Monitor your kids. Know who they are with, where they are going, what they are up to. Remove easy access to alcohol in your house. Parental monitoring is the number-one thing that research shows reduces substance use in teens. Kids can’t use alcohol and other drugs if they don’t have access. You can make it harder for them to get access. Remember, their brains aren’t in a place to help them make the best choices; you have to make up the difference.
• Talk to your kids about alcohol and other drugs. Ask your child questions about substance use in their school and among their friends. Ask what they think about using alcohol or other drugs. Use this as an opportunity to have a conversation about substance use. Be clear about the rules and expectations in your house, and—this part is key—outline and implement consequences if they are broken. It’s normal for teens to push boundaries, and the unfun part of being a parent is that we have to serve as the referees. But unfortunately, this isn’t a game; your child’s life is at stake.

References

Nicotine vaping now one of the top forms of substance use among teens. (2022). University of Michigan News.

Marijuana and hallucinogen use among young adults reached all time-high in 2021. (2022). National Institute on Drug Abuse.

Synthetic Opioid Overdose Data | Drug Overdose. (2021). Centers for Disease Control and Prevention.

Miech, R. A., Johnston, L. D., Patrick, M. E., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2023). Monitoring the Future National Survey Results on Drug Use, 1975–2022: Secondary School Students. Ann Arbor: Institute for Social Research, The University of Michigan.

Parents & Educators. (2020). National Institute on Drug Abuse.

The post Teen Substance Use appeared first on My Blog.

At ten years old, I considered I, Robot a scary movie. To this day, it lives on as a flashbulb memory in my mind—loss of control and existential threat don’t sit well with me. A similar uneasiness took hold when I recently read the news: ChatGPT can handle questions on the US medical licensing exam (USMLE).¹ Great, I thought. Now, I not only need to fear robotic sentience but also paid almost half a million for medical school for no reason. And, with Microsoft announcing a ten billion investment in ChatGPT maker, OpenAI, and Google unveiling its version, Bard, the future looms large and inevitable.² Now, as I prepare to match into psychiatry, I can’t help but wonder if ChatGPT could do my future job.

The app-based chatbot released in December immediately popularized generative AI. Generative AI analyzes patterns in written words from across the web, forming complex mathematical and computational formulations, to produce human-like text. With its dizzying number of potential uses and user amassment, generative AI platforms could be instrumental in providing psychiatric care– especially given the stark supply and demand issues.

Today, 21% of US adults reported experiencing a mental illness, and one in ten youth report mental illness severely impacting their life. Yet, only one mental healthcare professional currently exists for every 350 people.³ Trained on clinical data, generative AI could aid in psychiatric diagnosis, medication management, and psychotherapy. The technology could act as a patient-facing chatbot or back-end assistant that provides the physician with insights garnered from its large language model (LLM) processing capabilities. But at what cost?

Generative AI Could Improve Patient Health, Autonomy, and Equity

For a hospital or clinic to safely integrate generative AI, a certified mental healthcare professional would need to provide oversight, in a hybrid care model, with all data falling under HIPAA’s jurisdiction. First, ChatGPT could help analyze patients’ linguistic and communication patterns to improve physicians’ diagnostic accuracy and identification of patients in crisis. For instance, ChatGPT could pick up on verbal subtleties that emerged before a patient’s past manic episodes. ChatGPT could also make pharmacological and interventional treatments more effective by analyzing patients’ language patterns to discern early signs of treatment responses. In conversation, it could quantify how much less a patient may perseverate or exhibit negative cognitive distortions. These conversational statistics, which hold mental status exam clues, could be analyzed and trended in real time. When presented in conjunction with the clinician’s findings, this process may protect against human error to improve diagnostic accuracy and enhance proactive treatment adjustments.

ChatGPT could also provide psychiatrists with the most up-to-date and relevant research on treatment options to address a patient’s particular symptoms (not just their broad diagnosis) and individualized care. Such individualization is integral in psychiatry given the existence of multiple options in each medication class (e.g., second-generation antipsychotics or SSRIs) and numerous overlapping symptoms within DSM-5 diagnoses.

In terms of generative AI’s use in psychotherapy, data shows a mounting exodus of psychiatrists from this realm: 50% of psychiatrists today report they do no psychotherapy.⁴ As many modalities of psychotherapy have become manualized (i.e., performed according to specific administration guidelines that maximize the probability of the intervention being conducted consistently across settings, therapists, and clients), studies show that the average psychiatrist does not offer a substantial comparative advantage in overall outcomes compared to less costly therapy practitioners. As supply and demand forces edge psychiatrists out of therapy, ChatGPT could be key in the search for cheaper alternatives.

If ChatGPT were to help craft therapeutic responses, it may be most beneficial in assisting therapists with manualized therapies that leverage specific tools. ChatGPT’s absent humanity is at the crux of its limited ability to autonomously provide psychotherapy. In the words of the psychiatrist, Phil Stutz, the common denominator of the human experience is pain, uncertainty, and constant work– none of which ChatGPT has felt. These universal elements add authenticity to a human therapist’s words. When they say, “I understand… I care about you… I want you to feel safe,” their verbal and non-verbal communication convey true empathy and emotional support derived from parallel lived experiences.

Countless studies show that the transcendent factor for the efficacy of all psychotherapy is the strength of the therapeutic alliance built through attunement, non-verbal gestures, and positive regard.⁵ Here, ChaptGPT falls short. The chatbot also wasn’t caring for a patient in their darkest times for years, even decades. A longitudinal and storied therapist-patient relationship builds an incomparable alliance.

To overcome ChatGPT’s lack of human experience and long-term rapport, ChatGPT may be best suited for therapy modalities that are minimally dependent on emotional/supportive statements (e.g., supportive psychotherapy or motivational interviewing) or the interpersonal relationship between patient and therapist (e.g., psychodynamic psychotherapy). Generative AI could primarily assist in manual-based treatment modalities like cognitive behavioral therapy or interpersonal therapy, where ready-made tools can be taught and applied. Ultimately, IRB-approved research will be needed to understand a chatbot’s ability to develop a therapeutic alliance and execute certain psychotherapy modalities.

In addition to clinical benefits, ChatGPT could improve patient empowerment. Bettering patients’ autonomy and dignity is crucial in psychiatric care: psychiatry has a history of coercive institutionalization and involuntary admission/treatment can make patients feel devalued or diminish their sense of agency.⁶ Despite significant progress, mental illness is still highly stigmatized. More than half of people with mental illness don’t receive care, citing stigma as the main barrier.⁷ Thus, accessing behavioral healthcare virtually, on one’s own terms/time, may empower patients. ChatGPT’s ability to democratize the source of medical information is may also deconstruct the (historically paternalistic) medical hierarchy and center patients in their mental health treatment. In addition, ChapGPT’s analysis of speech and language patterns may more accurately identify – and not circumvent – patients’ concerns (e.g., medication side effects that the physician may consider relatively minor) to optimize shared decision-making.

Finally, ChatGPT could not only benefit individual patient care but also the entire behavioral healthcare system. ChatGPT could help distribute mental health resources more equitably by reducing costs and increasing access to alleviate mental health disparities. Due to its high cost (and often insufficient coverage by Medicaid and Medicare) and lengthy wait times, substantial equity issues exist in accessing psychotherapy. ChaptGPT would save psychiatrists time (e.g., through aided telepsychiatry responses and automation of administrative tasks, such as routine patient progress tracking via screening tools (e.g., PHQ-9 or Y-BOCS)) and allow clinicians to care for more patients at a lower cost.

(Here is an independent example of how ChatGPT can write an informative blog that was prompted to write about “Mental Health and substance abuse in New York” – J. Riley)

Mental health and substance abuse are two interconnected issues that continue to plague many people in New York City. According to the New York State Office of Alcoholism and Substance Abuse Services, about 1.9 million New Yorkers struggle with a substance use disorder, and many of them also suffer from co-occurring mental health conditions. In this blog post, we will explore the impact of mental health and substance abuse in New York and the resources available to those who need help.

The Impact of Mental Health and Substance Abuse in New York
Mental health and substance abuse are often intertwined. Substance abuse can lead to the development of mental health disorders, and vice versa. In New York, many people struggling with mental health issues turn to drugs or alcohol as a way to cope with their symptoms. Unfortunately, this can exacerbate their condition and lead to addiction.

Substance abuse can have a devastating impact on individuals, families, and communities. It can lead to health problems, financial instability, relationship issues, and legal problems. In New York City, substance abuse is a leading cause of overdose deaths. In 2020, there were 2,317 overdose deaths in New York City, an increase of 25% from the previous year.

The pandemic has also exacerbated mental health and substance abuse issues in New York. Many people are struggling with isolation, financial stress, and other challenges, which can trigger or worsen mental health conditions and substance abuse. According to a survey conducted by the New York City Department of Health and Mental Hygiene, 53% of New Yorkers reported symptoms of anxiety or depression in September 2020, up from 29% in 2018.
Resources Available for Mental Health and Substance Abuse in New York

Fortunately, there are resources available for people struggling with mental health and substance abuse in New York. The state has a network of treatment providers, including hospitals, clinics, and community-based organizations, that offer a range of services, including detoxification, counseling, medication-assisted treatment, and peer support.

The New York State Office of Addiction Services and Supports (OASAS) operates a 24/7 toll-free helpline, 1-877-8-HOPENY, where individuals can get information about substance abuse treatment and referrals to local providers. OASAS also offers an online directory of treatment providers in New York.
The New York City Department of Health and Mental Hygiene operates a range of mental health programs and services, including crisis intervention, outpatient treatment, and mobile treatment teams. The NYC Well program provides free and confidential mental health support and referrals 24/7 through phone, text, and chat.

In addition to these resources, there are also many community-based organizations that provide support and services to people struggling with mental health and substance abuse in New York. For example, the Partnership for Drug-Free Kids offers resources and support to families affected by substance abuse, and the National Alliance on Mental Illness (NAMI) provides education, advocacy, and support for individuals and families affected by mental illness.

Conclusion
Mental health and substance abuse are complex issues that require a comprehensive approach to address. In New York, there are many resources available to individuals and families struggling with these challenges, including treatment providers, helplines, and community-based organizations. If you or someone you know is struggling with mental health or substance abuse, don’t hesitate to reach out for help. There is hope, and recovery is possible.

Generative AI’s Legal/Ethical Pandora’s Box and Therapeutic Limitations

The potential for ChatGPT to cause harm in psychiatric care would be largely dependent on the level of oversight by certified healthcare professionals. A collaborative approach could be a slippery slope with a healthcare system focused on efficiency and cost. Increasing generative AI’s autonomy and therapeutic responsibilities at the behest of substantial profits could erode critical behavioral healthcare infrastructure.

ChatGPT may not be as sensitive nor perceptive to communication signals by patients (i.e., tone, inflection, prosody, fluency, and non-verbals) to pick up on subtle markers of physical/sexual/emotional abuse or crisis (e.g., suicidality, homicidal tendencies, mania, or malignant catatonia). The inability to identify such queues and ask questions to discern if the patient or others in their life are safe could lead to catastrophic outcomes and a legal deluge; in many states, ChatGPT would become a mandated reporter (e.g., for abuse) with legally binding responsibilities.

Gaming the Chatbot?

Generative AI also has enormous implications for involuntary admission and treatment. Predicting which patients are high-risk and not good candidates for AI-assisted care is not straightforward. Perhaps most scarily, patients may learn to game AI in a way they couldn’t a real provider. For instance, a patient may know what to say to avoid hospitalization when suicidal. Patient risk assessment requires a thorough, moment-to-moment physical and mental status exam as well as a longitudinal knowledge of the individual. ChatGPT may not only miss crucial nuances but also incorrectly influence the thinking of the physiatrist reviewer. For instance, if an EKG machine’s reading differs from a doctor’s manual analysis, the doctor often second-guesses themself even when the machine is wrong– humans tend to defer to technology. Altogether, the malpractice concerns for misdiagnosis are staggering if AI evaluations are incorporated into safety assessments and involuntary admission. Patients could claim that generative AI got it wrong, leading to their unlawful admission.

ChatGPT may also jeopardize informed consent. ChatGPT is programmed to present information with a confident, highly factual tone, which could lead patients to miscalibrate evidence in their decision-making. Further, informed consent and feeling authentically supported by a chatbot therapist may be mutually incompatible. Was it the psychiatrist or ChatGPT who wrote the virtual therapeutic response? And, if both were involved, what did the co-construction process look like?

In addition to potential individual patient harm, ChatGPT’s implementation could negatively transform the behavioral healthcare landscape. It is entirely possible that ChatGPT is overhyped and not that effective compared to a practitioner. If chatbot-assisted care is less efficacious, its implementation could exacerbate mental health disparities by offering less effective treatment to low-income, rural, and adolescent patients. For instance, people may assume that adolescents facing the greatest shortage in mental health providers prefer chat-based psychiatric care due to their generation’s technological savviness. Paradoxically, recent studies have found that younger age groups are less likely to use digital mental health interventions and report a low preference for online mental healthcare compared to face-face treatment.⁸

The overestimation of this market fix would create further harm as funding is diverted from more evidence-based alternatives. The availability of ChatGPT may also reduce incentives for real people to offer care in medically underserved communities (even less pay, more competition) and further reduce the quality of available services. Touting this shiny new option could distract from the political, systems-based work needed to fix disparities, such as improving access to and financing psychotherapy for medically underserved communities. Altogether, more research is needed to determine which patient population, if any, ChatGPT may be most effective before we pour resources into it.

Finally, disseminating ChatGPT would require a private company, such as OpenAI or Google, to handle sensitive, HIPAA-protected data. Psychiatric notes are extremely personal, with psychotherapy notes having additional protections compared to other clinical documentation.⁹ Control over this data and its processing could lead to harm in that it could be stolen in a data breach. Transforming generative AI into an accurate clinical assistant will require training generative AI’s LLM on clinical data (not just general internet information like ChatGPT). Such training will need access to past notes and mass data collection, processing, and storage– substantially increasing the risk of mishandling high-stake information.

Ultimately, physicians’ egos or fears of extinction should not hinder their ability to help patients. Medicine can join, research, regulate, and symbiotically work with generative AI companies, or we can stick our heads in the sand and hope Will Smith will save us from the robots.

References

1. USMLE Program Discusses ChatGPT | USMLE. (n.d.). Retrieved March 1, 2023, from https://www.usmle.org/usmle-program-discusses-chatgpt

2. Google Announces Bard, Its Rival To Microsoft-Backed ChatGPT. (n.d.). Retrieved March 1, 2023, from https://www.forbes.com/sites/qai/2023/02/08/google-announces-bard-its-rival-to-microsoft-backed-chatgpt/?sh=2388e5043791

3. NIMH, Mental Illness. (n.d.). Retrieved March 1, 2023, from https://www.nimh.nih.gov/health/statistics/mental-illness

4. Trends in Outpatient Psychotherapy Provision by U.S. Psychiatrists: 1996–2016 | American Journal of Psychiatry. (n.d.). Retrieved March 1, 2023, from https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2021.21040338

5. Alliance: A common factor of psychotherapy modeled by structural theory—PMC. (n.d.). Retrieved March 1, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404724/

6. Understanding psychiatric institutionalization: A conceptual review—PMC. (n.d.). Retrieved March 1, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3702490/

7. Psychiatry.org—Stigma, Prejudice and Discrimination Against People with Mental Illness. (n.d.). Retrieved March 1, 2023, from https://www.psychiatry.org/patients-families/stigma-and-discrimination

8. Evidence on Digital Mental Health Interventions for Adolescents and Young People: Systematic Overview—PMC. (n.d.). Retrieved March 1, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120421/

9. 2088-Does HIPAA provide extra protections for mental health information compared with other health information? | HHS.gov. (n.d.). Retrieved March 1, 2023, from https://www.hhs.gov/hipaa/for-professionals/faq/2088/does-hipaa-provide-extra-protections-mental-health-information-compared-other-health.html

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