Caught in the weeds: The impact of cannabis on mental health
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
Mental Health and the Environment of Connection
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.
Am I shopping too much?
|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 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1805733/#B1
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 Psychology, 7(914). https://doi.org/10.3389/fpsyg.2016.00914
Günüç, S., & Doğan Keskin, A. (2016). Online Shopping Addiction: Symptoms, Causes and Effects. Addicta: The Turkish Journal on Addictions, 3(3). https://doi.org/10.15805/addicta.2016.3.0104
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 Addiction, 17. https://doi.org/10.1007/s11469-018-9883-y
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 Psychology, 7(1). https://doi.org/10.1080/23311908.2020.1800924
Recent advances in the neuroscience of youth’s brain development and screen time exposure
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 (www.healthychildren.org/MediaUsePlan) 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.
- 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.
- 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.
- 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
Managing Suicidality During Isolation
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 take5tosavelives.org or bethe1to.com 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 www.mhanational.org/find-support-groups
Lindner Center of HOPE 513-536-HOPE
Danielle J. Johnson, MD, FAPA Lindner Center of HOPE, Chief Medical Officer
Substance Use and Stress
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
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.
Social Media and Technology and the Impact on Mental Health
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.
“In the News” – Dr. Cummings and patient discuss youth mental illness warning signs with Local 12’s Liz Bonis.
Trevor Steinhauser’s struggle with mental illness began at an early age, but thanks to receiving early help and support for his symptoms, Trevor is feeling better and is now four years sober.
Trevor and Tracy Cummings, MD, Medical Director of Inpatient and Partial Hospital Program Services at Lindner Center of HOPE, spoke with Local 12’s Liz Bonis about mental illness warning signs to watch for in children, such as anxiety and panic attacks.
Trevor credits the Lindner Center of HOPE for helping him overcome his own issues with mental illness and substance abuse. By employing a team approach and giving him a voice in his own treatment, Trevor says the Center was the first to help him learn coping skills for lifelong problems, such as depression and anxiety.
According to Dr. Cummings, behaviors that lead to addiction often present in a person’s youth.
“The reality is that, in any given year, one in five of us are experiencing mental illness. About half of those cases started before age 14, so a lot of people have been having symptoms for a long time. They’ve just figured out ways to either adapt to those or not talk about those,” Dr. Cummings said.
Lindner Center of HOPE has a comprehensive program that treats both substance abuse and co-occurring mental health disorders. Learn more about our Intensive Outpatient program here.
Watch the full story from Trevor and Dr. Cummings’ sit down with Liz Bonis interview on local12.com
New Treatments Available to Help People with Drug Addictions
The statistics surrounding addiction are shocking and the impact is devastating.
In 2017, 70,000 people[i] in the U.S. died from drug overdoses – the highest number in history. Hamilton County accounted for 570 of those deaths[ii]. The City of Cincinnati alone saw a 79% increase in overdose deaths from 2014 to 2017.
The region, including Kentucky and Indiana, continues to be hit especially hard by the opioid epidemic. Overdose death rates[iii] here are among the highest in the country. As a result, children in our communities experience parental loss rates that nearly double the national average.
For someone with addiction, sobriety can be a long and painful process. As addiction becomes better understood as a mental illness[iv], new approaches are being implemented to help people maintain long-term recovery.
Lindner Center of HOPE recently unveiled a new 10-day, in-patient substance use disorder detox and evaluation program that increases our community’s capacity for treatment, and employs the latest proven methods.
The approach includes a comprehensive evaluation for each person, and each visit is uniquely designed to meet that person’s needs. Upon completion of the program, patients receive an individualized plan-of-action to increase the odds of continued sobriety.
“Our expert addictions team found that a one-size-fits-all treatment approach doesn’t work for sobriety,” said Paul E. Keck, MD, president and CEO of Lindner Center of HOPE. “Each individual must have a personalized path to success. That’s what this program is designed to do.”
Treating the Whole Patient
According to the Substance Abuse and Mental Health Services Administration[v], 80 percent of people who have a substance use disorder also have a mental illness. So a personalized approach to recovery is vital.
Program participants first complete detoxification with close medical supervision. The in-patient portion of the program includes about nine hours of daily programming. The patient also participates in an additional 10 hours of internal addiction programming and access to community support groups.
While completing the inpatient portion, patients stay in Lindner Center’s Sibcy House – a one-of-a-kind facility dedicated to individualized, compassionate comprehensive care. Each patient resides in a private room, complete with a full bath. The program includes:
- Sessions with a psychiatrist, social work and addictions therapist
- Testing determined by an addictions therapist
- Coaching sessions with a chemical dependency specialist
- Patients also participate in additional programming tailored to their individual needs.
For more information about the program, visit Lindner Center of HOPE’s website or call 513/449-8415.
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Lindner Center of HOPE treats most substance and behavioral addictions. Plans may include medication-assisted treatment, therapy or support groups, and screenings for underlying issues like depression and anxiety.
About Lindner Center of HOPE
Lindner Center of HOPE, located in Mason, OH, is a comprehensive mental health center providing patient-centered, scientifically advanced care for individuals suffering with mental illness. Learn more at LindnerCenterofHope.org.
[i] WKRC. (2018, November 30). Acting Attorney General addresses the opioid epidemic during Cincinnati visit. https://local12.com/news/local/acting-attorney-general-to-address-the-opioid-epidemic-during-cincinnati-visit
[ii] WCPO Staff. (2018, July 30). Staggering numbers in Cincinnati’s opioid crisis, but health officials see progress. https://www.wcpo.com/news/local-news/hamilton-county/cincinnati/staggering-numbers-in-cincinnati-s-opioid-crisis-but-health-officials-see-progress
[iii] Demio, T. (2018, Aug. 3). Children here experience parental loss at higher rate than national average
[iv] National Institute of Mental Health. (2016, May). Substance Abuse and Mental Health. https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health/index.shtml
[v] Substance Abuse and Mental Health Services Administration. (2019, Jan. 30). Mental Health and Substance Abuse Disorders. https://www.samhsa.gov/find-help/disorders
Screenagers: Overcoming internet and gaming addictions
A New Way to Balance Digital Usage
It’s a concern for parents across the country.
Teenagers are consumed by countless digital distractions. Smart phones, gaming consoles, or any number of devices connected to the Internet compete for their attention.
Concerns over growing and habitual media use are nothing new, but the broad availability of portable devices seem to have “leveled up” the problem. Now, more children are becoming addicted to online content and gaming.
Popular video games like Fortnite are played by more than 200 million people. Some teens spend as much as 12 hours or more[i] a day playing online, while others spend the same amount of time engaged in social networks. This obsession can affect health as well as school and work performance.
But how do you know when a habit has crossed over into an addiction? And what do you do when it is clear your son or daughter is addicted?
For children who show signs of internet addiction, a recent study[iv] suggests each child needs to be evaluated in context of their own unique situation. Personality traits, type of game(s) played, life situations and cultural expectations can all explain excessive gaming. For example, if the habit is used to replace real-life social interactions or escape from life traumas and stress, an Internet or gaming addiction may be in play.
“Today’s society is dependent upon technology, mobile devices, social media, and the Internet,” says Dr. Chris J. Tuell, clinical director of addiction services at Lindner Center of HOPE. “However, when dependence crosses over to an addiction, it’s time to take steps to regain control.”
Several habitual behaviors can indicate Internet and gaming addiction. “The three C’s of addiction also apply to Internet addiction,” says Dr. Tuell. “If someone exhibits a loss of control, a compulsion/obsession to be online, irritability when offline, or continues to use technology despite negative consequences, they may be suffering from Internet addiction.”
The Reboot Program
To combat Internet and gaming addiction, and provide a resource for families who need help, Lindner Center of HOPE has introduced a new program called “Reboot.” The first two weeks of the Reboot program involve a comprehensive assessment of the teenager to draft a course of treatment. The second two weeks focus on developing better habits with technology.
“For those struggling with self-control, this program helps them re-center their lives and avoid additional complications,” said Dr. Tuell.
According to Mental Health America[v], the nation’s leading non-profit mental health advocacy organization, children with Internet addiction often struggle with other mental health problems like alcohol and substance use, depression, and/or aggression.
Addiction experts at Lindner Center of HOPE assess if patients are suffering from one or more co-occurring disorders, like depression. Identifying underlying mental health conditions helps to personalize treatment plans for each “Reboot” patient – increasing their odds of winning the battle with internet and gaming addiction.
In addition to internet and gaming addictions, Lindner Center of HOPE treats most substance and behavioral addictions, including heroin, morphine, hydrocodone, oxycodone, amphetamine, methamphetamine, LSD, alcohol, cocaine, marijuana and tobacco, gambling and pornography. Plans may include medication-assisted treatment, therapy or support groups, and screenings for underlying issues like depression and anxiety.
About Lindner Center of HOPE
Lindner Center of HOPE, located in Mason, OH, is a comprehensive mental health center providing patient-centered, scientifically advanced care for individuals suffering with mental illness. Learn more at LindnerCenterofHope.org.
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[i] Feely, J. & Palmeri, C. (2018, Nov. 27). Fortnite Addiction Is Forcing Kids Into Video-Game Rehab. https://www.bloomberg.com/news/articles/2018-11-27/fortnite-addiction-prompts-parents-to-turn-to-video-game-rehab
[ii] Cash, H., Rae, C. D., Steel, A. H., & Winkler, A. (2012). Internet Addiction: A Brief Summary of Research and Practice. Current psychiatry reviews, 8(4), 292-298. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480687/
[iii] Price, L. & Snider, M. (2018, June 19). Video game addiction is a mental health disorder, WHO says, but some health experts don’t agree. https://www.cincinnati.com/story/tech/nation-now/2018/06/18/gaming-disorder-who-classifies-video-game-addiction-health-disorder/709574002/
[iv] Kuss D. J. (2013). Internet gaming addiction: current perspectives. Psychology research and behavior management, 6, 125-37. doi:10.2147/PRBM.S39476 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832462/
[v] Mental Health America. Risky Business: Internet Addiction. http://www.mentalhealthamerica.net/conditions/risky-business-internet-addiction