Lindner Center of HOPE’s Premiere Assessment Residential Programs have a private entrance to welcome patients and families. Both programs operate as private-pay programs.

If you or a loved one is suffering from mental illness or addiction, contact us for information on our residential treatment programs for mental health in adults.

One in four individuals are living with a mental illness, according to the 2012 National Survey on Drug Use and Health: Mental Health Findings1 conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA). It is a leading health problem in the United States, with approximately 61.5 million adults, or one in four, experiencing a mental illness in a given year.

Among adolescents, the same study found an estimated 20 percent of teens ages 13 to 18, and 13 percent of youth ages 8 to 15, experience a severe mental disorder in a given year.

Another major public health problem, according to the National Institute on Drug Abuse, is drug and alcohol abuse. The Closing the Addiction Treatment Gap (CATG) initiative2, created by the Open Society Institute, reports that 23.5 million Americans, or one in every 10 individuals over the age of 12, are addicted to drugs and/or alcohol.

The statistics bring to the forefront the importance of residential mental health facilities focused on comprehensive assessment and intensive treatment in a residential setting, as one effective tool in treating mental health conditions and addiction, including non-substance addictions like gambling.

But for most people, recognizing a mental illness or an addiction, finding the best help to treat it, and knowing what to expect from a residential treatment center can be an uncertain road without the proper guidance.

Click here for more information.

Anyone born between 1946 and 1964 is a part of the Baby Boomer Generation. This generation is often defined as people born during the post–World War II baby boom, consisting of approximately of 76 million Americans. During the 1950s, 8% of the population was over the age of 65. By 2019, this number grew to 16.5%. By 2050, 22% of the US population will be over the age of 65 (over 1 out of 5). There will be 3.7 million centurions in the United States by 2050. So what does this have to do with substance use? Here are the facts: Most baby boomers in their younger years, smoked more marijuana and did more illicit drugs than any other generation. Many baby boomers indulged in early substance use, but as they reach middle age and retirement, many have continued to abuse alcohol and drugs, are getting arrested for drug offenses, and dying from drug overdoses.

Many older adults, now approaching retirement, were exposed to older peers and the events of the times, who were proud participants in a counter-culture movement. This anti-war, anti-establishment, and pro-experimentation with drugs, appeared to contribute to a more accepting view of the use of substances. The class of 1979 reported the highest level of drug use (over 50%), of any high school graduating class, before or since. For many Boomers, the use of alcohol, cannabis and other substances has continued through the years. With the aging of any generation, there are changes in health and one’s environment. With Boomer kids no longer around the house, the Boomer begins to lean more on old behaviors of the past, as a means of coping with physical, emotional, and mental concerns. With these concerns, come higher risk, and the possible onset of addiction.

Aging Boomers have a higher rate of accidental overdose than 18-45 year-olds. More members of this generation are dying from accidental overdoses than car accidents, the influenza or pneumonia. While the misuse of prescription medication is a major concern, 36% of Boomer admissions to drug treatment centers are for heroin abuse, 22% for crack cocaine, 12% for opioid painkillers, and 10% for methamphetamines. Over 10% of 50 to 64 year-olds are using illicit drugs. Despite these drugs, alcohol continues to be the most abused substance. For older adults, the proliferation for drug and alcohol use is based on their formative years. With continued use of substances, or rediscovering mind-altering substances, older adult bodies will be unable to handle or metabolize alcohol or drugs as he or she once did. Research studies indicate that if an older adult continues with this behavior, he or she will become one of the 5.7 million Americans over the age of 50, who will require substance abuse treatment.

Another significant factor, contributing to this boom with Boomers, is the massive focus on chronic pain in the U.S. and the subsequent spike in opioid prescriptions. Americans take more prescription painkillers than any other country. The U.S. contains about 4.4% of the world’s population, but is responsible for consuming over 80% of the world’s opioid use. Women of all ages, especially older women are drinking alcohol more often and using more drugs than ever before. According to the National Survey on Drug Use and Health, the rate of binge drinking among older women has increased from 6.3% to 9.1%. Rates of female Boomers abusing alcohol and developing dependency have doubled.

As any generation becomes older, the realities of aging begin to settle in. The combination of loneliness, isolation, chronic health conditions, depression and excess free-time may be leading older adults to abuse drugs and alcohol at higher rates. The total number is expected to reach 15 million by 2030. A Duke University study surveyed 11,000 people over the age of 50, and found a correlation between being separated, divorced or widowed and binge drinking.

What about mental health? One in four adults currently struggles with mental illness. Older adults are more likely to have experienced the traumatic loss of a partner, a close friend, and/or a family member. Loss can also come in the form of retirement, and how the very identity of what defined a person for so many years is now gone. The daily existence of boredom and a lack of structure become problematic. When these factors combine with the likelihood that many older adults use alcohol and experimented with drugs as teenagers and young adults, the result is a population vulnerable substance abuse.

There is help.

If you feel that you are struggling with mental health issues and/or substance use, there is help. The majority of individuals with a substance use issue, 84%, also have a co-occurring mental health issue. For many, sobriety is not enough. An individual may need to see a therapist to resolved past issues, find healthier ways of coping, examine their distorted thinking which perpetuating the unhealthy behavior. Most importantly, substance abuse is not about an issue of character, morality, weakness or bad behavior. Mental health and wellness is deserved for all, especially with My Generation (cue music – The Who).

By: Chris Tuell, EdD, LPCC-S, LICDC-CS
Lindner Center of HOPE, Clinical Director of Addiction Services

By: Jennifer B. Wilcox, PsyD
Staff Psychologist, OCD and Anxiety Disorders Program





What is compulsive hoarding?

Hoarding Disorder is a psychiatric illness and is considered to be a subtype of Obsessive-Compulsive and Related Disorders. The Diagnostic and Statistical Manual of Mental Disorders – 5th Edition (DSM-5) defines Hoarding Disorder (HD) as:

Persistent difficulty discarding or parting with possessions, regardless of their actual value. This difficulty is due to a perceived need to save the items and to the distress associated with discarding them.

The difficulty of discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use.

The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).

The hoarding is not attributable to another medical condition and is not better explained by another mental disorder.







How is compulsive hoarding different from normal clutter or collections?

It is not uncommon for people to acquire a few extra possessions from time to time, resulting in occasional clutter. However, while normal clutter or collecting doesn’t usually interfere with a person’s daily functioning, compulsive hoarding often does. Compulsive hoarding also differs from normal clutter or collecting as it tends to become unmanageable, overwhelming, and causes significant distress or family discord. Though collections usually bring people joy and fill them with pride, hoarding often comes with shame and embarrassment.

Why do people hoard things?

Compulsive hoarding is thought to result from a combination of factors including genetics, environmental factors, life experiences, and learned behaviors. The reason one person hoards may not be the same as the reason someone else hoards. Some people who hoard are compulsive shoppers and acquire more things than they need or have room to accommodate. Others may have difficulty categorizing or making decisions about what to do with particular items. Sometimes they can’t remember what they own or where it is, leading to the purchase of duplicate items. Other times people hold on to possessions for emotional or sentimental reasons or get anxious when they discard things. Some people believe that the hoarded items may be useful someday and keep the items despite not needing them currently. The level of insight a person has about their struggles in these areas can vary widely from completely absent insight to good insight.

What types of things do people hoard?

The types of items a person hoards vary based on factors such as the reason they are hoarding and how severe their hoarding issues have become. Some commonly hoarded items include books, newspapers, magazines, boxes, bottles, clothes, food, items purchased in bulk, collectibles or vintage items, furniture, animals, or digital media.

How many people suffer from Hoarding Disorder and who does it affect?

While the exact prevalence of people who suffer from Hoarding Disorder is not certain, it is estimated that it affects approximately 2.5% of the general population. Studies have shown that prevalence rates in men and women are nearly equal and appear to be consistent across developed countries. Most studies report onset between 15 and 19 years of age and show a chronic course over the lifespan.

What is the treatment for Hoarding Disorder?

Hoarding Disorder is treated using Cognitive-Behavioral Therapy (CBT), a type of therapy that allows someone to work with a therapist to shift their thinking patterns and change their behavioral patterns to healthier ones. Randomized controlled trials have shown this to be an effective treatment for hoarding. While the data on the efficacy of medication for Hoarding Disorder is limited, there is some evidence to support the use of medication in the treatment of this disorder. For those hoarders who have limited insight, a Motivational Interviewing (MI) approach can help to foster their motivation and confidence. Finally, working on skills that improve the hoarder’s ability to maintain attention and focus, categorize items, and decision-making can be beneficial in treating Hoarding Disorder.

What can I do to help a loved one who seems to have issues with compulsive hoarding?

It is generally not recommended for family and friends to discard hoarded items without the hoarder’s permission. This can be extremely distressing for a compulsive hoarder and tends to make them upset, anxious, or angry. Instead, it is recommended that friends and family talk to their loved ones about their concerns and help them to seek professional treatment. Additional resources are available at the International Obsessive-Compulsive Disorder Foundation (IOCDF) and the Anxiety and Depression Association of America (ADAA).


American Psychiatric Association, 2013. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. American Psychiatric Association Publishing, Arlington, VA.

Treatment of Hoarding Disorder

Postlethwaite, A., Kellett, S., Mataix-Cols, D., 2019. Prevalence of Hoarding Disorder: A systematic review and meta-analysis. Journal of Affective Disorders 256, 309-316.

Christine Collins, MD, Lindner Center of Hope

By: Christine Collins, MD, Lindner Center of HOPE Addiction Psychiatrist




Legalization of cannabis is rapidly expanding across the world. To date, 17 states (and DC) in the US have legalized marijuana for all uses, and another 19 states have legalized it for medical purposes only. The media tends to portray cannabis and its constituents, as safe, natural items that have potential to provide benefit. As medical marijuana dispensaries and CBD stores seem to be popping up all over, it is important for us to recognize the impact of cannabis on mental health and how it may affect vulnerable populations, such as young people. Clinicians and patients alike should be aware of the current state of scientific evidence and possible risks posed by cannabis use.

Cannabis is a complex plant composed of hundreds of compounds including THC (9delta-tetrahydrocannabinol, the main psychoactive component) and CBD (cannabidiol, purported to offer many health benefits). There are currently several medications approved by the FDA that are cannabis-related: dronabinol and nabilone (synthetic THC containing meds used for chemotherapy-related nausea and for appetite/weight gain in HIV patients), and recently-approved Epidolex (cannabis derived which contains CBD used for the treatment of rare childhood seizure disorders, Dravet syndrome and Lennox-Gastaut syndrome). These were extensively studied and underwent the typical FDA process for approval as effective and safe medications for these purposes. Other uses of cannabis are largely unregulated.

Using “medical” marijuana varies by state and is a much different process from taking an FDA approved medication which has been rigorously studied. Since it is designated DEA schedule I by the federal government, large scale studies on cannabis have been limited in the US. The current scientific evidence on cannabis remains mostly observational data and animal studies, rather than the gold-standard randomized controlled trials in humans. There is an ongoing need for well-designed research in this area to better understand the possible therapeutic benefits and safety profile of cannabis and to differentiate the effects of its constituents. Current evidence suggests that cannabis may help chronic pain, nerve pain, and spasticity in certain patients. There is limited and inconsistent evidence that CBD in particular may have benefit in treatment-resistant anxiety, social anxiety, and insomnia. However, other studies show that whole-plant cannabis worsens existing anxiety and mood. Notably, there IS consistent evidence that cannabis increases the risk for developing a psychotic disorder in vulnerable individuals and exacerbates psychotic symptoms. Cannabis use in anyone with a history of an addictive disorder may trigger another cross addiction or contribute to someone falling back to an old addiction.

Safety considerations must be taken into account regarding cannabis. Today’s whole-plant cannabis is generally more potent (higher levels of THC) than it was historically. How it is consumed also plays an important role—vaping allows for a higher percentage of THC to be absorbed quicker and therefore may be more likely to trigger adverse mental health reactions such as anxiety and paranoia. Edibles can cause problems for users who expect a quicker onset of action leading to higher levels of consumption to achieve a desired effect. Interactions with other medications do occur. For instance, certain psychiatric meds may alter the breakdown and elimination of THC and CBD, and vice versa.

What may be the area of greatest concern is the impact of increasing cannabis acceptance and legalization on young people. A recent study demonstrated that earlier use of all substances including cannabis was associated with increased risk for developing a substance use disorder later in life.  Cannabis use has been shown to have adverse effects on IQ and executive functioning. Moreover, younger onset of marijuana use is associated with lower overall neurocognitive functioning. Youth who engage in marijuana use, also report taking part in other risky behaviors such as using other substances like nicotine and alcohol, and driving after marijuana use. As such, there is grave concern that cannabis use in this age group could lead to significant problems.

While ongoing high-quality research is needed in this area, current available evidence does NOT show consistent benefit for cannabis (including CBD products) on mental health symptoms and it may instead exacerbate symptoms. Patients should be encouraged to use caution and to have open conversations with their mental health and medical providers about cannabis use in order to understand how this may impact their mental health. Clinicians should be aware of the risks of cannabis use particularly for adolescents and should help prevent use in this specific population.


Dharmapuri, S, Miller, K, & Klein, JD. Marijuana and the pediatric population. Pediatrics. 2020; 146(2)279-289

Hill, K. Medical marijuana for treatment of chronic pain and other medical and psychiatric problems, a clinical review. JAMA. 2015; 313(24) 2474-2482

Levinsohn, E & Hill, K. Clinical uses of cannabis and cannabinoids in the United States. Journal of the Neurological Sciences. 2020; 116717

Whiting et al. Cannabinoids for medical use: A systematic review and meta-analysis. JAMA. 2015; 313(24) 2456-2473


By Chris J. Tuell, EdD, LPCC-S, LICDC-CS
Lindner Center of HOPE, Clinical Director of Addiction Services; Assistant Professor, Department of Psychiatry & Behavioral Neuroscience
University of Cincinnati College of Medicine

At the end of the Vietnam War in 1975, 1 out of 5 soldiers (20%), returning to the United States from Southeast Asia, was addicted to heroin. It was estimated that approximately 100,000 American soldiers would be returning home, addicted to this destructive drug. Experts projected a drug epidemic, which would destroy countless lives and communities. It never happened.

Once soldiers returned home to families, friends and communities, the destructive nature of a hardcore drug, like heroin, failed to materialize. In fact, 95% of the soldiers who were once addicted to heroin, stopped using the drug almost immediately once they returned home.

For many years, our understanding of addiction was based on early research conducted in the first half of the 20th century. These studies involved rats and consisted of placing a rat in a solitary cage, providing the rat with a choice of water: plain water or water laced with cocaine or heroin. The study found that all the rats preferred the drug-laced water to the plain water. All the rats overdosed on the drug. The majority of the rats died in the study. This became our model of addiction for many years. The accepted belief became, if you are exposed to a drug, you will become addicted, and you may overdose and die.

Several years later, this original study was replicated, but with a significant difference. Researcher Bruce Alexander from the University of Vancouver, created, what was referred to as: a “rat park.” This park consisted of tunnels, multiple levels, toys, and other rat companions. Similar to the original study, all rats were given the same choice of water: plain water or water laced with heroin or cocaine. In Alexander’s study, rats preferred the plain water. Rates of overdose and death to the rats were significantly lower when compared to the initial study. How do we explain this difference in results? Perhaps, it is about the cage. Perhaps, it is about the environment.

Upon their return home, the soldiers from Vietnam who were struggling with a heroin addiction were able to re-connect with loved ones and community. A change in environment allowed for a change in connection, resulting in health, wellness and sobriety. Likewise, the environment of the rat in a solitary cage, as compared to the environment of the rat park, provided the rat with a “connection” with other rats, an environment which allowed the rat…to be a rat.

Individuals, who experience issues of mental illness and/or substance use disorders, have a natural tendency to withdraw and isolate from others. Depression, anxiety and addiction, greatly affect an individual’s ability to connect with others, let alone with one’s environment. This past year we have seen the devastating impact of COVID-19. We know that in order to maintain health and wellness, we need to maintain social distance and disconnect from one another. For now, this has and continues to be, what we need to do. It remains challenging for many of us to continue to avoid contact with loved ones and friends. We are separated from the very individuals who love us, support us, and are our sources of connection.

We have seen the rise of mental health issues during the past year. Nearly 20 percent of COVID-19 patients have developed a mental health issue (i.e., depression, anxiety) within three months of their diagnosis. During the past year, 4 in 10 adults in the U.S. have reported symptoms of anxiety or depression. Within the general population, rates of mental health issues and substance use have significantly increased across the board. In addition, the disconnection that we have witnessed has fragmented our society in general by harboring increased levels of fear, anger and animosity towards one another.

Hope on the horizon

Once “herd immunity” is achieved, the importance of re-connecting with one another becomes vital and essential to our health and mental wellness. We are social beings and need connection with one another. History has shown that the mental health impact of disasters outlasts the physical impact, suggesting today’s elevated mental health needs will continue well beyond the coronavirus outbreak.  Like the moth that needs to struggle out of the cocoon in order to develop the strength that it needs to survive in the world, we too are developing the strength that we need from the struggles we have endured.  Re-connecting with one another is an answer.  It gives us strength and it gives us hope.


By Jessica Kraft, APRN, PMHNP-BC, Psychiatric Mental-Health Nurse Practitioner, Lindner Center of HOPE

Everyone needs to shop from time to time, but at what point does shopping become a problem? And is this a diagnosis? Compulsive buying disorder (CBD) is a mental health condition characterized by “excessive, impulsive, and uncontrollable purchase of products in spite of severe psychological, social, occupational and financial consequences”. While this diagnosis is not found in the DSM-V, shopping addiction was described and discussed clinically in the early 20th century by Bleuler and Kraepelin (Black, 2007). There is still much to be learned about the causes of CBD or shopping addiction, but several factors thought to be contributing include materialism, social anxiety, a general lack of social support, loneliness, or trauma history (Harnish, Bridges, Gump, & Carson, 2018). It is not uncommon for those with CBD to also struggle with anxiety disorders, mood disorders, substance use disorders, eating disorders, or disorders of impulse control.

Most consumers of goods take value and usefulness into consideration when making a decision about a

purchase and emotion is not often involved in the decision. This has also been referred to as “utilitarian shopping”, where someone only shops when they need something. Those who struggle with CBD more often make purchases in order to improve their mood, cope with stress, gain social approval, or improve their self-esteem. This has been referred to as “hedonic shopping” where the primary purpose of shopping is for entertainment, distraction, or pleasure. Research has shown that CBD has relation to reward sensitivity and the mesolimbic dopamine reward circuit in the brain (Günüç & Doğan Keskin, 2016). Over time this behavior becomes reinforced and can create a pattern similar to those seen with behavioral addictions like gambling, sexual addiction, or internet addiction (Granero et al., 2016).

Some might think that during a global pandemic with economic uncertainty people would be less likely to spend and work towards curbing unhealthy shopping impulses. For some who struggle with CBD, this isn’t necessarily the case. With the emphasis and ease of online ordering and curbside pick-up options combined with the increased stress that many are feeling related to the pandemic, coping with shopping addiction has been more challenging for some. This year credit and debit card use increased by 79% in May compared to April in New Zealand. As shops reopened in Australia over the summer there were “Christmas size crowds”. A recent study in the UK showed that those with underlying mental health conditions (primarily depression and anxiety) were more likely to resort to “panic buying” or compulsive buying in response to the pandemic (Jaspal, Lopes, & Lopes, 2020). Considering that loneliness is a contributing factor to compulsive buying as well as the need to cope with stress it really isn’t very surprising that the pandemic has exacerbated these unhealthy buying behaviors in those who struggle with CBD.

What are the symptoms of CBD?

  • Urges to make a purchase are strong and the act of purchasing creates a “high” feeling
  • Preoccupation with shopping or planning purchases
  • Making a trip to the store and purchasing more items than originally intended
  • Most purchases made are unnecessary items
  • Debt, maxed out credit cards, or spending beyond one’s means
  • Hiding purchased items from family members or friends due to guilt
  • Feeling unable to stop oneself from shopping or making unnecessary purchases

What can you do to decrease urges to shop?

  • Seek professional help. While there are few evidence-based treatments for CBD there has been interest and anecdotal success with antidepressants (SSRIs),  cognitive behavioral therapy (CBT), and habit reversal training (HRT)
  • Join a support group or surround yourself with understanding and supportive people
  • When feeling the urge to purchase something make yourself wait a minimum of 24-hours
  • Declutter your space, organize, and get a better idea of what you have and what you love
  • Identify and avoid triggering situations – for example, unsubscribe from e-mails from your favorite stores if this has led you to make unnecessary and impulsive purchases in the past
  • Be mindful of who you follow on social media and how this influences your shopping behaviors
  • When looking at an advertisement ask yourself what they are trying to sell you and how this makes you feel about yourself. For instance, does this company benefit financially from you feeling badly about yourself or wanting a different lifestyle?



Black, D. W. (2007). A review of compulsive buying disorder. World Psychiatry, 6(1), 14-18. Retrieved from

Granero, R., Fernández-Aranda, F., Mestre-Bach, G., Steward, T., Baño, M., del Pino-Gutiérrez, A., … Jiménez-Murcia, S. (2016). Compulsive Buying Behavior: Clinical Comparison with Other Behavioral Addictions. Frontiers in Psychology7(914).

Günüç, S., & Doğan Keskin, A. (2016). Online Shopping Addiction: Symptoms, Causes and Effects. Addicta: The Turkish Journal on Addictions3(3).

Harnish, R. J., Bridges, K. R., Gump, J. T., & Carson, A. E. (2018). The Maladaptive Pursuit of Consumption: the Impact of Materialism, Pain of Paying, Social Anxiety, Social Support, and Loneliness on Compulsive Buying. International Journal of Mental Health and Addiction17.

‌Jaspal, R., Lopes, B., & Lopes, P. (2020). Predicting social distancing and compulsive buying behaviours in response to COVID-19 in a United Kingdom sample. Cogent Psychology7(1).

Screen time recommendations vary by the child’s age. Presently, the American Academy of Pediatrics (AAP) recommends that for children younger than 18 months of age, the use of screen media other than video-chatting should mostly be discouraged. For children 2 to 5 years of age screens are acceptable for no more than one hour per day thus allowing them ample time to engage in other activities promoting growth. For older children, current guidelines encourage proactive development of an individualized Family Media Use Plan ( that takes in consideration the particular child’s maturation and needs. This article will focus on a few recent neurobiological findings addressing the effects of excessive screen time exposure on the growing brain in youth to help us be better informed as parents, educators and healthcare workers.

Preschoolers – if the content is educational, that’s all that matters, not how it is presented, right? Wrong! 

In a 2019 study by Cincinnati Children’s Hospital researchers documented associations between higher screen use and lower measures of brain structure and skills in preschool-aged children. The team examined the screen time habits and cognitive skills of 47 children, 3 to 5 years of age and conducted brain scans on each child.  Prior to the scans, the kids took a cognitive test and the parents filled out a questionnaire regarding their child’s screen time habits. The final score, called the ScreenQ score, was based on a number of criteria focusing on AAP recommendations, including whether the child was exposed to screens before 18 months of age, if they had a television in their room, and how much time they spend in front of screens. Scores ranged from zero to 26 and the higher scores represented less of an adherence to general screen time recommendations from the AAP. It was observed that higher ScreenQ scores were associated with lower brain white matter integrity, poorer expressive language and poorer cognitive skills suggesting that excessive time in front of a screen, even if the content is considered educational, might decrease cognitive skills in preschoolers. (1)

Elementary School Age and tweens -Reading is all good, right? Wrong!

A 2018 study from Cincinnati Children’s Hospital explored the time spent using screen-based media versus reading an actual book on the functional connectivity of the reading-related brain regions in children aged 8-12. Time spent on screens might be linked to impaired shifts in brain connectivity, while reading a book is linked to more beneficial neurobiological changes. The researchers had families rate how much time their children spent on various screens and how much time they spent reading actual books. The children’s brains were scanned, to assess how regions involved in language were connected, and it turned out that screen time was linked to poorer connectivity in areas that govern language and cognitive control. Reading a physical book, on the other hand, was linked to better connectivity in these regions. These findings underscore the importance of children reading real books to support healthy brain development and literacy and to consider limiting excessive screen time, even if some of the content presented through screens might be related to reading and considered educational. (2)

Tweens- screens are all bad, right? Wrong!

A 2019 study published in NeuroImage explored the effect of screen media activity on structural brain changes and how this might affect specific behaviors in 9-11 year olds. Structural scans of the brains of 4277 participants were correlated to screen activity like watching television, playing video games, or using social media. Some finding were expected, like individuals with significant exposure to activities engaging the visual system (watching TV or video) showing structural patterns suggestive of greater maturation in the visual system (i.e., thinner cortex). Some structural brain changes related to increased screen exposure were associated with more psychological issues and poorer performance on cognitive tests, while other latent variables did not show such relationship. The authors summarized that it remains difficult to conclude that brain structural characteristics related to screen media activity have uniformly negative consequences. Moreover, while some media activity associated brain structural changes were related to poorer cognitive performance, others were related to better cognitive performance suggesting that screen media activity can not be simplified as overarchingly “bad for the brain or for brain related functioning”.

Regardless of the age group discussed, one strategy to mitigate the potential risks associated with excessive exposure to screens is to ensure that the child has an overall well balanced and healthy lifestyle. This includes reinforcing proper eating and sleeping habits adequate for the age of the child, sufficient and diverse physical activity and providing plenty of opportunities for not screen related social interactions. Establishing a flexible family matrix of screen rated “rules” which dynamically adapts to the growing child would ensure that parents and educators factor in screen time exposure as one of the determinants when raising a healthy kid.

  1. John S. Hutton, Jonathan Dudley, Tzipi Horowitz-Kraus, Tom DeWitt, Scott K. Holland.
    Associations Between Screen-Based Media Use and Brain White Matter Integrity in
    Preschool-Aged Children. JAMA Pediatrics, 2019.
  2. Horowitz-Kraus T, Hutton JS. Brain connectivity in children is increased by the time they spend reading books and decreased by the length of exposure to screen-based media. Acta Paediatr. 2018;107(4):685-693.
  3. Paulus MP, Squeglia LM, Bagot K, et al. Screen media activity and brain structure in youth:
    Evidence for diverse structural correlation networks from the ABCD study. Neuroimage. 2019;

Anna Guerdjikova, PHD, LISW, CCRC
Director of Administrative Services, Harold C. Schott Foundation Eating Disorders Program, Lindner Center of HOPE, University of Cincinnati, Department of Psychiatry, Research Assistant Professor

In the United States, suicide is the 10th leading cause of death.  The rate increased 33% from 1999 through 2017 according to the Centers for Disease Control and Prevention.  The American Foundation for Suicide Prevention states that “suicide most often occurs when stressors and health issues converge to create an experience of hopelessness and despair.” For some, the COVID-19 pandemic could create this experience. The pandemic has produced a condition that has increased many of the risk factors for suicide: feelings of depression and anxiety, increased alcohol and substance use, serious physical health conditions, unemployment, financial crisis, illness or death of a loved one, isolation, and decreased access to care.

Social distancing and isolating at home have limited access to coping skills and reduced suicide protective factors. People no longer have in person contact with behavioral health providers, there is decreased connectedness to support systems, and no access to gyms, art studios, massage therapy, beauty salons, barbers, etc.  With fewer physical and creative outlets, healing therapies, and self-care that improves self-esteem, people can feel lost. They also no longer have physical access to places of worship where the social connection was as important as the message or music.  It important to remember that we need to maintain physical distancing rather than social distancing – it is necessary to maintain physical separation to not contract the virus but other ways of maintaining social connections are still very important.

Another risk factor that staying at home can bring is closer proximity to abusers. Children of abusive parents who are no longer in school are now with their abusers all day and adults with abusive partners are also with their abusers more often. Adverse childhood experiences are associated with 2 to 3 times more suicide attempts later in life and victims of intimate partner violence are twice as likely to attempt suicide.

Staying at home also increases access to lethal means so it is imperative to either remove guns from the home or ensure they are locked securely and reduce access to other lethal means (such as large amounts of extra medications, excess amounts of alcohol, ropes/cords) in the home for people who are high risk for suicide.  For homes with large amounts of prescription medications due to multiple health conditions, a medication safe is recommended.

For people with loved ones who have risk factors for suicide, it is important to know the warning signs. Warning signs include talk of: killing themselves, feeling hopeless, having no reason to live, being a burden, feeling trapped, and unbearable pain; behavior: increase use of alcohol and drugs, looking for a way to end their lives (including internet searches), withdrawing from activities, isolation from family and friends, too much or too little sleep, saying goodbye to people, giving away possessions, aggression, and fatigue; and mood: depression, anxiety, loss of interest, irritability, humiliation/shame, agitation/anger, and relief/sudden improvement.  If you notice these warning signs, it is important to ask a person directly if they are having thoughts of suicide and if they are, get them help by contacting their mental health providers, calling a crisis line, taking them to an emergency department, or calling 911. Visit or to learn how to talk to your loved ones about suicide. Due to COVID-19, people have tried to avoid emergency departments and hospitals but if someone you love is unsafe do not hesitate to get them the help they need.

What are ways to increase coping skills and protective factors in our current climate? Take advantage of telephone or video appointments offered by your mental health providers. If you do not already have mental health providers, now is a good time to seek treatment – practices are still accepting new patients and insurances are covering telephone and video appointments. To reduce worry and fear, limit media consumption about COVID-19. Stick to a routine, stay physically active, get outside with appropriate physical distancing, get enough sleep, limit alcohol, and eat healthy. If you feel you have a problem with alcohol, substances, overeating, or other addictive behaviors – there are online support groups. Connect with loved ones by phone, social media apps, video apps, or writing. Consider safe altruistic ways to connect with others – making masks, running errands for vulnerable loved ones, donations, etc.

How can you get help?  Crisis Text Line: text HOME to 741741, they can also be messaged on Facebook messenger.

National Suicide Prevention Lifeline 1-800-273-8255

YouthLine answered by trained teen peer support from 4 pm – 10 pm and by adults from NSPL during other hours 877-968-8491 or text teen2teen to 839863

Childhelp National Child Abuse Hotline text or call 1-800-422-4453

National Domestic Violence Hotline 1-800-799-7233 or text LOVEIS to 22522

Mental Health America Support Group Directory

Lindner Center of HOPE 513-536-HOPE


Danielle J. Johnson, MD, FAPA Lindner Center of HOPE, Chief Medical Officer

Chris Tuell Ed.D., LPCC-S, LICDC-CS, Clinical Director of Addiction Services

As feelings of anxiety, depression, or sheer boredom mount due to the growing pandemic of the coronavirus, the desire to turn to drugs and alcohol as a coping mechanism could become more problematic. Experts warn against self-medicating during these stressful times for a multitude of reasons. For many people who struggle with mental illness and/or substance use disorders, there is an unfortunate tendency to withdraw or isolate from others. So when we are told to practice social distancing, remain in our homes, isolate from one another, this can feed into a further deepening of an individual’s struggles and isolation with depression, anxiety, trauma or loss.

According to SAMHSA, (Substance Abuse Mental Health Services Administration), 84% of individuals who experience a substance use disorder, also experience a co-occurring mental health issue as well. During times of stress, many of us seek relief, in any way we can find it. The use of substances is not a healthy way of coping. Substance use is frequently used as a means to escape or numb-out from life’s problems. Substance use will often exacerbate a previous existing problem, making it worse.

In cities across the country, people are increasingly living under “shelter-in-place” or lockdown mandates that have closed businesses, limited social gatherings, and urged self-quarantine. These added stressors have resulted in increased levels of alcohol consumption. According to the Republic National Distributing Company, a wine and spirits distribution company, sales of spirits jumped by 50% for the week ending March 21, 2020. Nationally, the overall increase for the week according to Nielsen data, saw a 55% spike in alcohol sales.

Each of us experiences stress from time to time. However, recent events of the past few months have been unprecedented. Stress can feel overwhelming. There are different types of stress – all of which carry physical and mental health risks. A stressor may be a one-time or short-term occurrence, or it can happen repeatedly over a long time. Some people may cope with stress more effectively and recover from stressful events more quickly than others. Unfortunately for some, substance use becomes an unhealthy way to self-medicate one’s stress, mood and/or anxiety.

Coping with the impact of chronic stress can be challenging. Because the source of long-term stress is more constant than acute stress, the body never receives a clear signal to return to normal functioning. With chronic stress, those same lifesaving reactions in the body can disturb the immune, digestive, cardiovascular, sleep, and reproductive systems. Some people may experience mainly digestive symptoms, while others may have headaches, sleeplessness, sadness, anger, or irritability. Over time, continued strain on the body from stress may contribute to serious health problems, such as heart disease, high blood pressure, diabetes, and other illnesses, including mental health issues such as depression or anxiety. For some, substance abuse only adds insult to injury.

When does one’s consumption of a substance (i.e., alcohol, drugs, gambling, Internet, gaming) become
problematic? Addictive behaviors consists of the following three behavioral questions (The Three C’s).
• Is there a loss of Control? (I am unable to manage the behavior.)
• Is the behavior Compulsive? (I cannot stop doing the behavior.)
• Do I continue to engage in the behavior, despite the negative Consequences?

Coping with life stressors by the use of alcohol or any other substance, is a bad idea. If you take practical
steps to manage your stress, you may reduce the risk of negative mental and physical health effects. Rather
than reaching for that adult beverage, below are tips that may be helpful in coping with stress:

Be observant. Recognize the signs of your body’s response to stress, such as increased alcohol and other
substance use, difficulty sleeping, , being easily angered, feeling depressed, and having low energy.

Talk to a health professional. Don’t wait for your health care provider to ask about your stress. Start the
conversation and get proper health care for existing or new health problems. Effective treatments can help
if your stress is affecting your relationships or ability to work.

Get regular exercise. Just 30 minutes per day of walking can help boost your mood and improve your

Pursue calming activities. Explore relaxation or wellness programs which may incorporate meditation,
imagery, muscle relaxation, or breathing exercises. Schedule regular times for these and other healthy and
relaxing activities.

Set goals and priorities. Decide what must get done now and what can wait. Learn to say “no” to new
tasks if you start to feel like you are taking on too much. Try to be mindful of what you have accomplished at
the end of the day, not what you have been unable to do.

Stay connected. Even though this may be a challenge, given our current social distancing, we need to remain
connected with one another. You are not alone. Keep in touch with people who can provide emotional
support and practical help. To reduce stress, ask for help from friends, family, and community or religious
organizations. Many community support groups (AA, NA, GA, SMART Recovery) are available online. Stay
healthy, stay connected.

By Jen Milau, APRN, PMHNP-BC
Lindner Center of HOPE,
Psychiatric Mental-Health Nurse Practitioner

 There’s no denying it: the advent of social media has changed the way we connect with one another. In some ways, these programs have offered an opportunity to locate and reconnect with lost friends or family members – a phenomenon that was not even fathomable until recent decades. However, this near-immediate accessibility of information, coupled with the rapid growth of social media sources, has not been accompanied by a “user guide” or an algorithm for appropriate and healthy incorporation into our daily lives. Instead, the technology has been thrust upon us as a society, and we have been left with the task of “figuring it out as we go.” In the field of psychiatry and mental health, we are seeing the repercussions of this in a number of unexpected ways, and those who have been hit the hardest are among our most vulnerable – children, adolescents, and young adults.

As a clinician working primarily with this population, I have been struck by the stark and abrupt increase in suicidality and mental health concerns within the last five years. According to the Centers for Disease Control, in 2017, suicide stood as a leading cause of death for individuals aged 10-34, second only to accidental injury. Just this year, the American Psychiatric Association (APA) published data Continued from page 1 which cites that “more U.S. adolescents and young adults in the late 2010s (vs. the mid-2000s) experienced serious psychological distress, major depression, and suicidal thoughts, and more attempted suicide and took their own lives… These trends are weak or nonexistent among adults 26 years old and over, suggesting a generational shift in mood disorders and suicide-related outcomes rather than an overall increase across all ages.” The specific data presented within this report reflect a 40-122% increase (depending on specific age range) in suicidality and psychological/mood disturbances among individuals age 12-25. So the question stands: why have young people been so disproportionately affected?

The answer to this is complex, and certainly not yet fully understood. It is important to first consider what we know: Adolescence is a period of significant neurochemical and biological transformation. With these physiological changes comes the development of a sense of identity – a process fueled by social interactions, sexual exploration, experimentation with interests, exposure to information, and individual expression. These facets of development have not changed by any means. Rather, the way in which today’s youth is exposed to these experiences has shifted from primarily organic, physical, human interactions to online exchanges through a variety of social media and communication apps available with a simple tap of a finger. Since this happens behind a screen, kids are not faced with the immediate implications of their words or actions, as they do not witness the non-verbal cues accompanying a person’s response, and do not experience the inevitable feeling of anxiety that goes along with confrontation or conflict in a real-time situation. They have the opportunity to carefully calculate their responses over time, or blatantly ignore a person with whom they do not want to interact, rather than being placed into a situation that requires problem-solving and relational abilities in the immediate moment. This has led to a generation of individuals who have largely avoided natural social responses; in turn, we are seeing a serious rise in the prevalence of social anxiety and kids who are devoid of many vital interpersonal skills.

Additionally, within the world of social media, we are offered the opportunity to customize our “online identities” to mirror whichever characteristics we choose to share with others. Due to our human need for acceptance and attention, this usually results in the meticulous formation of an “ideal self” – one which typically is not reflective of our inherently flawed (and beautifully unique) personalities and instead represents a false utopian identity used to highlight those traits of ourselves and our lives that we feel may be most desirable to others. As this practice becomes typical of an entire society, we begin to unconsciously accept these “pseudo-selves” as reality, leading to the habit of comparing our actual lives to those that are portrayed on the internet. This can result in significant issues with self-esteem, increased self-doubt, shame, body image concerns, and social isolation – problems which, for an individual predisposed to mental illness, could trigger a major mood episode or exacerbation of anxiety symptoms.

Further, the immediate accessibility of information to which we have become accustomed has unfortunately led to an expectation for instant feedback and gratification that is simply not applicable to most real-life scenarios. Studies suggest that the neurochemical response to “likes” on a post or picture actually mirror that which is experienced with illicit drug use or other behavioral addictions. This, then, leads to further desire to obtain more likes, and the consequent sense of disappointment and desperation when posts do not receive the attention that we were expecting.

When we view these ideas in the context of an adolescent who is developmentally tasked with the goal of exploring and forming a sense of self while also battling the physical and emotional implications of rapid growth and hormone changes, this becomes extraordinarily problematic. Many patients that I see describe feelings of worthlessness and hopelessness due to their perception that they are not as “successful” as others they see online. For a child who has endured trauma, the ability to form harmful connections with ill-intentioned adults is too readily accessible, leading to exploitation and further exacerbation of trauma-related symptoms. Children with attention issues are experiencing insomnia due to being constantly stimulated by their devices into the nights, resulting in reduced academic performance and mood dysregulation. And most importantly – families are not connecting in the ways that are imperative for fostering well-adjusted and cognitively flexible young adults.

This being said – there is certainly hope for change moving forward. As we adapt to the presence of technology within our lives, we are learning more and more about the importance of moderation in regards to screen time and devices. As a clinician, I preach to my patients and their parents about the risks of social media and unlimited time with technology and encourage open conversations regarding limits and expectations for its use. I challenge parents to model what it looks like to balance screen time and “real” time, and recommend the implementation of rules for all members of the family, not just children or adolescents. By increasing the number of organic experiences and social interactions that our children have, we are preparing them to be able to adjust to the unexpected, unpredictable twists and turns.