mental-health

Substance Addiction: A Disease, Not a Matter of Free Will

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by Zijun Zhou, July 27, 2025

In the 21st century, social technology and cultural advances have brought new challenges. One of the most serious is drug addiction, now a major public health and social issue. The latest statistics from the Addiction Group (2024) show that nearly 50 million Americans suffer from a substance addiction or substance use disorder (SUD) each year, but less than 10% receive appropriate treatment. Further, more than 70% of alcohol-dependent people have never sought professional help. Addiction is also deeply intertwined with broader mental health challenges, including a significantly elevated risk for suicidality. While not all of the 13 million adults and 3.4 million adolescents in the United States affected by suicidal thoughts each year necessarily have a diagnosed substance use disorder, research robustly demonstrates that individuals with SUDs face a substantially increased risk of suicide mortality (Sugue, 2024). For example, a large case-control study conducted across eight integrated healthcare systems in the United States found that all categories of substance use disorders, including alcohol, tobacco, and other drug use disorders, were significantly associated with an increased risk of suicide mortality, even after controlling for comorbid mental health and physical health conditions. This methodological rigor is critical, as it provides strong evidence that Substance Use Disorder is not merely an epiphenomenon or symptom of other psychiatric conditions, but rather a powerful and independent driver of suicide risk. This finding offers a solid evidentiary foundation for the article’s central thesis: that addiction is itself a primary pathological process. The study emphasized that the risk is particularly pronounced for individuals with multiple substance use disorders, and that women face a relatively higher risk compared to men (Lynch et al., 2020). This strong association further underscores that substance use disorders likely contribute significantly to suicide risk, particularly among individuals experiencing suicidal ideation and broader mental health crises. Such findings emphasize the importance of addressing addiction as a critical public health concern.

Despite the mounting scientific evidence, a consensus on the nature of addiction remains elusive in both academic and public spheres. A landmark event in this debate occurred in 2014, when the esteemed journal Nature published an editorial, Animal farm, which claimed that the view of addiction as a brain disease was not particularly controversial, at least among scientists (Animal Farm, 2014). This assertion, however, provoked a swift and strong backlash, culminating in a letter signed by 94 international addiction scholars who contested this one-dimensional portrayal. They argued that substance abuse cannot be divorced from its social, psychological, cultural, political, legal and environmental contexts: it is not simply a consequence of brain malfunction. This public debate highlights the complexity of the issue. Therefore, this article’s support for the disease model is not intended to dismiss these vital critiques. Rather, it is to argue that, while fully acknowledging the importance of these psychosocial and environmental factors, the neuroadaptive changes that occur in the brain during addiction are so profound, pathological, and dysfunctional that the disease framework remains the most robust scientific model for understanding its compulsive nature and for guiding effective intervention.

Addiction is a chronic disease characterized by drug seeking and use that is compulsive or difficult to control despite harmful consequences (National Institute on Drug Abuse, 2018). Unlike the traditional concept of addiction as a weakness of will or an individual’s choice, the occurrence and development of addiction are driven by complex neurobiological mechanisms. These neurobiological mechanisms fundamentally undermine voluntary control by profoundly restructuring the brain’s reward system. This restructuring pathologically heightens the motivational value of the drug while diminishing the perceived value of natural rewards. As a result, the individual experiences intense, cue-driven cravings that can overwhelm rational thought. This is compounded by severe disturbances in emotion and stress regulation that create a deeply negative affective state during abstinence, driving a powerful compulsive need to use the drug to escape from this distress. These issues are further exacerbated by significant impairments in executive function, which compromise the prefrontal cortex’s ability to control impulses and weigh long-term consequences, weakening the brain’s inhibitory control system against relapse. The clinical manifestations of addiction are usually accompanied by tolerance and withdrawal symptoms, and its essence is continuous and repeated drug seeking and use. Tolerance and withdrawal symptoms may be present, and the essential elements include continuous and repeated drug seeking at the cost of normal rewards. It is not the result of one’s own choice.

Critics often argue that addiction is not a real disease because they believe that the brain is designed to change throughout life naturally. They support this by pointing out that the growth stages of children and adolescents and learning throughout adulthood are based on similar changes in the cerebral cortex and limbic system (Lewis, 2017). However, this view ignores the changes in brain structure and function that addiction demonstrably causes, which form the core basis for defining it as a disease. These extensive alterations exemplify an abnormal state affecting brain structure and function, accompanied by clear behavioral symptoms, consistent with established medical criteria for a disease (National Cancer Institute, 2011). Indeed, addiction manifests precisely through such pathological changes. For example, a defining feature of drug abuse is the pathological ‘hijacking’ of the brain’s natural reward system and emotional regulation circuits. This hijacking itself represents a fundamental disruption of normal brain function, an abnormal state directly initiated when all addictive drugs drastically increase dopamine release in key brain regions. Dopamine is the central neurotransmitter of the brain’s reward system and is primarily responsible for regulating feelings of pleasure, motivation, and reinforcement learning. However, a drug-induced surge in dopamine is not a physiological adaptation like normal learning, but rather an extreme and abnormal neurochemical event that profoundly alters neural circuits. In addictive behaviors, drugs cause a sharp rise in dopamine levels in key regions such as the nucleus accumbens and the striatum by stimulating dopamine neurons. This abnormal dopamine release alters neural circuits deep in the brain from the ventral tegmental area (VTA) to the nucleus accumbens. Further, it extends to regions such as the limbic system and orbitofrontal cortex (Leshner, 1997). Together, these regions regulate emotions, decision-making, and impulse control. Unlike the gradual changes of natural learning, this overwhelming, drug-induced flood of dopamine fundamentally corrupts the brain’s decision-making architecture, which is a hallmark of a disease state.

While these changes begin with the limbic system, the effects of addiction extend further to higher-order regulatory regions. The ventromedial prefrontal cortex (VMPC) in drug addicts exhibits significant functional impairments.The behavior of people with an addiction is highly similar to that of patients with VMPC damage: both groups often deny or are unaware of their problems (Bechara, 2005). Moreover, when faced with a choice that offers an immediate reward, they tend to ignore the possible long-term negative consequences, including the loss of their job, family, or even reputation. VMPC damage usually includes the medial parts of Brodmann Area (BA) 25, lower 24, 32, 11, 12, and 10. Although patients may retain normal intelligence, memory, and other cognitive functions, they show significant deficits in emotional and social behavior and long-term decision-making abilities, which is highly consistent with the characteristics of drug addiction (Bechara, 2005). Compared with non-addicts, drug addicts (such as cocaine-dependent individuals) have significantly lower resting-state functional connectivity (RSFC) between the frontal hemispheres. This change is particularly pronounced in areas related to the dorsal attention network, including bilateral prefrontal, medial prefrontal, and posterior parietal regions (Kelly et al., 2011). This weakening of RSFC reflects the persistent impairments in executive function, attention control, and behavioral regulation in people with an addiction. This not only makes them more prone to relapse in the face of environmental cues (for example, encountering people who used to take drugs together, going to places associated with past drug use, or seeing items and equipment related to drugs), but also weakens motivation for long-term goals and impulse control (Mennis et al., 2016).This phenomenon reveals that addiction is not only a functional abnormality of a single neural circuit but also the result of impaired collaboration among multiple brain regions.

From a neurobiological perspective, the development of addiction can be divided into three recurring stages: Binge and Intoxication, Withdrawal and Negative Affect, and Preoccupation and Anticipation. This cyclical model, driven by profound neural adaptations within specific neural circuits, clearly reveals the progressive pathophysiological process of addiction as a chronic, relapsing brain disease, rather than a simple issue of willpower or choice. Each stage involves the activation of specific neurobiological circuits and is accompanied by clinical and behavioral characteristics (Koob & Volkow, 2016; Volkow, Koob, & McLellan, 2022). Exploring each of these stages in turn reveals how the disease progresses and systematically hijacks the brain’s circuitry.

During the Binge and Intoxication stage, addictive substances significantly increase dopamine levels by triggering their release in the brain’s reward circuitry. This process bypasses natural reward mechanisms, directly stimulating dopamine transmission in key regions such as the nucleus accumbens and prefrontal cortex, resulting in reward effects from drug use that far exceed those of natural stimuli (Kalivas & O’Brien, 2008). This direct and overwhelming stimulation of the reward pathway represents an initial pathological transformation and an early manifestation of the disease state of addiction, as it disrupts the brain’s normal regulatory processes, disproportionately amplifying the incentive value of drugs. Dopamine signaling not only reinforces the immediate response to drugs but also links drug use to specific environmental cues through conditioned learning. As usage frequency increases, dopamine cells gradually become less responsive to the reward but more sensitive to cues predicting the reward, thereby intensifying drug cravings (Koob & Volkow, 2016). This neural adaptation marks a pathological hijacking, reflecting addiction as a disease where patients’ behavior is increasingly driven by external cues rather than autonomous choice. This neural adaptation marks a pathological hijacking, reflecting addiction as a disease where patients’ behavior is increasingly driven by external cues rather than autonomous choice, thereby setting the stage for the painful withdrawal of the second act.

The Withdrawal and Negative Affect stage is characterized by a critical shift from reward-system dominance to the recruitment of brain stress and antireward systems. This transition is initiated by counteradaptive mechanisms, specifically the opponent process, a neurobiological response that counteracts the drug’s initial rewarding effects. In addition, this process becomes dysregulated; it fails to return to its homeostatic baseline and instead establishes a new, pathological state known as allostasis (Koob & Le Moal, 2008). This allostatic state represents a chronic deviation of the brain’s reward set point, sustained by the extended amygdala’s overactivation of the antireward system (Koob & Le Moal, 2008). The hyperactivity of this system, mediated by neurotransmitters like corticotropin-releasing factor, is responsible for the profound negative emotional states of withdrawal, such as anxiety and irritability (Volkow, Koob, & McLellan, 2022). Consequently, the motivation for drug use is fundamentally altered. It shifts from a volitional act to seek pleasure to a compulsive behavior driven by the need to temporarily alleviate this persistent, aversive internal state (Koob & Volkow, 2016). This shift from choice to compulsion is a core pathological feature of the disease. At this juncture, the motivation for drug use has fundamentally shifted from chasing pleasure to escaping pain—a critical turning point that marks the transition from voluntary use to compulsion.

Regarding the Preoccupation and Anticipation stage, its core feature is dysfunction in the prefrontal cortex and its associated circuits. This stage is primarily associated with significant impairment in executive function, including reduced impulse control, self-regulation, and decision-making abilities. Due to abnormal regulation of dopamine and glutamate signaling in the prefrontal cortex, addicts struggle to resist impulses when exposed to drug-related cues. Additionally, prolonged drug use has led to significant neuroplastic changes in the brain. These changes are concentrated at the molecular level, such as the accumulation of deltaFosB and brain-derived neurotrophic factor (BDNF). These molecular-level changes not only reinforce compulsive drug-taking behavior but also significantly increase the risk of relapse (Kalivas & O’Brien, 2008). Research has shown that short-term withdrawal (e.g., 12 hours) significantly increases an individual’s reactivity to cues, accompanied by enhanced activation of the medial prefrontal cortex (mPFC) and orbitofrontal cortex (OFC). This change is associated with intense craving and withdrawal symptoms (Goldstein & Volkow, 2011; Volkow, Koob & McLellan, 2022). The effects of long-term abstinence on prefrontal cortex activity highlight the complexity of neuroadaptive changes in addiction. While some studies suggest reduced activity in certain prefrontal regions during prolonged abstinence, possibly due to adaptive behavioral strategies, the overarching pattern remains one of significant dysfunction. Such complexity underscores the difficulty addicts face in resisting drug-related cues, reinforcing the importance of understanding impaired cortical function in the chronic relapse cycle of addiction. Due to impaired executive function in the prefrontal cortex, addicts often struggle with decision-making to inhibit drug use, leading to a vicious cycle of repeated drug use. This significant functional impairment of the prefrontal cortex, including imbalances in neurochemical signaling and persistent molecular-level adaptive changes, constitutes the core pathological manifestation of addiction as a chronic brain disease. A key example of such a change is the accumulation of the protein deltaFosB, which acts as a long-lasting molecular switch that structurally rewires neural circuits to reinforce compulsive drug-seeking (Nestler et al., 2001). It directly undermines an individual’s ability to engage in rational assessment, inhibit inappropriate impulses, and maintain long-term goals, rendering self-control exceptionally challenging at the physiological level, thereby contributing to the chronic nature of the disease and its high relapse rate. At this point, the brain’s accelerator (the craving system) is stuck on full throttle, while the brakes (executive function) have failed, trapping the individual in a cycle of relapse that is physiologically difficult to escape.

The profound impact of environmental and social factors on the neurobiologically vulnerable individual—as underscored by the disease model of addiction—is vividly illustrated by the case of Vietnam War veterans. Vietnam War veterans experienced widespread heroin addiction due to the high levels of stress and availability of drugs in the war environment. However, after returning home, many were able to quit relatively successfully due to the disappearance of the war environment and related cues (Leshner, 1997). This case powerfully demonstrates the significant influence of social and environmental factors on addiction, highlighting the need for holistic treatment strategies that address not only neurobiology but also the psychological context in which addiction occurs.

While the end of the war created a positive environmental shift for many, more recently, the COVID-19 pandemic provided a stark counterexample of how social upheaval can catastrophically worsen the addiction crisis. In the wake of the pandemic, U.S. drug overdose deaths surged dramatically, increasing by over 30% in 2020 and surpassing 106,000 in 2021, with opioid-related fatalities showing the most significant rise (Tanz et al., 2022; Spencer et al., 2022). This trend was starkly illustrated at the state level; in New York, a recent report by the New York State Office of the State Comptroller (OSC) found that the increase in opioid overdose deaths in New York between 2019 and 2021 was approximately 68% (OSC, 2022). A perfect storm of factors drove this crisis. On one hand, the pandemic created a widespread mental health crisis, increasing feelings of anxiety, loneliness, and despair, which fueled the demand for substances. On the other hand, lockdowns and social distancing measures severely disrupted access to treatment and recovery support services, leaving vulnerable individuals isolated (Hulsey et al., 2020). This was compounded by an increasingly toxic illicit drug supply, where lethal synthetic opioids like fentanyl became more prevalent (Melamed et al., 2022). This modern-day example powerfully underscores the complex interplay between the neurobiological disease of addiction and large-scale environmental stressors. These cases powerfully illustrate a central tenet of the modern disease model: the neurobiological vulnerabilities established by the disease process are dramatically amplified or mitigated by the external environment. A purely neurobiological focus, therefore, is insufficient. A truly comprehensive strategy must be bimodal, simultaneously targeting the internal pathophysiology of the brain and the external social context of the individual.

Viewing addiction as a disease shapes healthcare policies, treatment approaches, and social attitudes, directly influencing societal outcomes. This disease-oriented perspective provides a clear scientific basis for developing effective treatment protocols, reducing stigma towards individuals with addiction, and guiding evidence-based policy-making. For instance, it supports legislative changes such as improved insurance coverage for addiction treatment and shifts from punitive measures toward rehabilitation. Economically, addiction imposes significant burdens on society; the annual social cost of tobacco, alcohol, and illicit drug abuse in the United States reaches approximately $700 billion (Volkow et al., 2022). This figure is projected to rise due to the ongoing opioid crisis, with opioid-related disorders and overdoses alone accounting for around $1.5 trillion in losses in 2020, including healthcare expenditures, lost productivity, and criminal justice expenses (Lines, 2024). Additionally, over 25% of arrests in the United States involve drug-related offenses (Lines, 2024). Addressing addiction comprehensively as a public health issue, then, is both economically and socially essential.

From a policy and legislative perspective, treating addiction as a disease has driven changes in healthcare and insurance systems. For example, the Mental Health and Substance Abuse Equity Act (MHPAEA) requires that substance abuse treatment be covered under the same insurance as general healthcare services. The implementation of this law has significantly improved patients’ access to treatment. Although there has been a slight increase in spending on substance abuse treatment per insured person, the impact on overall healthcare costs has been relatively small, demonstrating the economic viability and social value of insurance policies with equality at their core (Busch et al., 2014). Moreover, treating addiction is less costly and more effective than incarcerating addicts. Leaders in the police and justice sectors are increasingly recognizing that sending addicts to prison only perpetuates social problems, while directing resources to treatment and rehabilitation services can improve public safety (Williams, 2015). Despite its existence, enforcement has been challenging, leading to persistent coverage disparities. Federal agencies issued final rules in September 2024 to strengthen enforcement (U.S. Department of Labor, EBSA, 2024), but these new rules were immediately challenged by industry lawsuits, ultimately leading the agencies to suspend enforcement in May 2025 pending review (APASI, 2025). This policy uncertainty highlights the ongoing challenges of translating scientific consensus into stable and effective societal responses. Nevertheless, the view of addiction as a disease remains the fundamental driver for promoting fairer insurance coverage and shifting from punitive to rehabilitative criminal justice reforms.

Moreover, considering addiction as a disease may also reduce social stigma, so that more addicts can actively seek help rather than refusing treatment out of shame or fear. Currently, more than 70% of alcohol-dependent people have never sought professional help, and views of addiction as a moral failure or a weakness of the will undoubtedly exacerbate this phenomenon. In contrast, defining addiction as a disease can lead society to invest more resources in treatment, rehabilitation, and prevention services, rather than simply punitive policies. For example, the Patient Protection and Affordable Care Act (ACA) has promoted the inclusion of substance abuse services in basic health benefits, which has greatly improved the accessibility of addiction treatment, further illustrating the important guiding significance of the disease definition for public policy.

Viewing addiction as a disease provides the essential foundation for critical policy and social reforms. Such a perspective underscores the value of evidence-based treatment strategies over punitive approaches, which not only reduces stigma and encourages more individuals to seek necessary care but also promotes public safety by breaking the cycle of addiction-related crime. Ultimately, addressing addiction as a chronic disease rather than a moral failing allows for a more compassionate, effective, and economically sustainable societal response.

In summary, neurobiological evidence clearly indicates that addiction is a brain disease rather than a simple lack of willpower. Addictive substances create lasting changes in brain circuits, disrupting neurotransmitter regulation (e.g., dopamine) and impairing critical functions controlled by areas such as the prefrontal cortex. These persistent physiological alterations undermine self-control, rational decision-making, and the proper assessment of natural versus drug-induced rewards. However, this biological model is not deterministic; as the experiences of Vietnam veterans demonstrate, environmental context and social support are powerful modulators of these neurobiological vulnerabilities. The cyclical and relapsing nature of addiction underscores its chronicity and complexity. Just like other chronic diseases, a short-term cure is a relatively rare outcome; instead, relapses are more common. Recognizing addiction as a disease, one that involves a complex interplay of biology and environment, thus fosters deeper understanding and enables society to respond with greater empathy and effectiveness.

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A Psychological Approach to Understanding and Addressing the Implications of Discrimination

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By Aviram Nessim, May 12, 2025


“Our future survival is predicated upon our ability to relate within equality.” 

– Audre Lorde

Discrimination, in both its overt and covert forms, has been shown to negatively impact individuals and society alike. Beyond its immediate effects, such as increased stress and negative emotions, discrimination affects physical and mental health, reduces productivity, and deepens systemic inequalities. These effects are also often internalized by individuals and can ripple outward to affect entire communities, weakening social cohesion and reducing trust between and within communities (Heiserman & Simpson, 2023; Lei et al., 2021; Yeh & Tung, 2021). The primary objective of this essay is to examine how discrimination affects human psychology and contributes to a less cohesive society. A secondary objective is to propose evidence-based solutions that may help in resolving this issue.

It is first essential to clarify the definition of discrimination and address how it most commonly appears in society, particularly given the term’s frequent misuse and oversimplification (Feagin & Eckberg, 1980). The American Psychological Association (2025) defines discrimination as “the unjust and differential treatment of the members of different age, gender, racial, ethnic, religious, national, ability, identity, sexual orientation, socioeconomic, and other groups at the individual level.” In everyday life, discrimination most frequently arises in interpersonal settings, particularly in workplaces, and disproportionately affects people of color, women, and individuals from lower socioeconomic backgrounds (Murphy et al., 2018; Perry et al., 2013).

From a psychological standpoint, the effects of discrimination can be devastating for both the mind and body. It has been linked to increased rates of depression, disease, economic and social marginalization, and psychological distress (Brown et al., 2000). Krieger (1999) illustrates how perceiving racial discrimination can trigger a physiological stress response: fear and anger activate the “fight-or-flight” response, mobilize lipids and glucose to increase energy supplies, heighten sensory vigilance, and produce transient elevations in blood pressure. When this response becomes chronic, it can lead to sustained hypertension and other long-term health consequences. This stressful reaction serves as one way that discrimination provokes a general state of distress. Beyond physical effects, chronic discrimination can also reduce motivation, diminish overall well-being, and, even worse, lead to complete social withdrawal (Williams et al., 2019). Finding ways to create inclusion and a sense of belonging, then, becomes of utmost necessity, as a fair and inclusive society will only benefit us all. 

One solution to this problem comes through strategically debiasing establishments in a way that both majority and minority individuals feel included. Inclusion is psychologically vital, as research shows that feeling included increases one’s self-esteem, confidence, and sense of self-worth (Boeldt, 2017; Brouge, 2023). One effective approach is perspective-taking, in which individuals from different backgrounds are encouraged to understand one another’s experiences. This can include viewing the world from multiple lenses, practicing active listening, and expressing empathy. Perspective-taking has been shown to reduce stereotype threat among stigmatized groups and decrease in-group favoritism, likely by signaling that the same situation can be perceived and experienced in different ways (Galinsky & Moskowitz, 2000). 

At the organizational level, one effective strategy involves promoting norms of group-based respect, including actively acknowledging, accepting, and valuing differences between and within groups, which has been shown to increase perceived inclusion (Jansen et al., 2015). These effects are amplified when the majority group members who are motivated to be non-prejudiced take an active role in creating inclusive environments (Murphy et al., 2018). Another important strategy involves educating people about the sources of discrimination and identifying structural inequalities in policies and workplace procedures. By doing so, both approaches have been shown to broaden people’s understanding of the factors that contribute to prejudice. For example, Son Hing et al. (2002) found that individuals with aversive racist attitudes, once made aware of their biases, were more willing to support policies designed to address systemic discrimination and promote equality.

Today, America is more racially and ethnically diverse than ever before. With this growing diversity comes a greater need to mutually respect, cooperate with, and include everyone at both the individual and organizational levels. Failing to do so risks exacerbating social divisions and perpetuating cycles of unsupported, unhappy, and unproductive individuals. However, by choosing to respect and include, we have an incredible opportunity to let our diversity become one of our greatest collective strengths.

Works Cited

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Heiserman, N., & Simpson, B. (2023). Discrimination reduces work effort of those who are disadvantaged and those who are advantaged by it. Nature Human Behaviour, 7(12), 1890–1898. https://doi.org/10.1038/s41562-023-01703-9 

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America’s Youth Suicide Crisis: How An Unprecedented Epidemic Spiraled Out of Control

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by Vignesh Subramanian, May 15, 2024

In 2023, the Centers for Disease Control and Prevention (CDC) published up-to-date data on suicide rates among American youth that stunned public health and medical professionals nationwide. The federal report, issued in June, found that the overall suicide rate among U.S. youth ages 10 to 24 had surged 62% over the prior two decades (2001-2021), after decades of prior decline (Curtin & Garnett, 2023). On average, 11 young Americans died by suicide out of every 100,000 each year during this period; for children ages 10-14, the suicide rate had tripled from 2007-2018 (from 0.9 to 2.9 people per 100,000); for adolescents ages 15-19, it rose 57% from 2009-2017 (from 7.5 to 11.8 people per 100,000); and for young adults ages 20-24, it rose 63% over the entire period (from 11.9 people in 2001 to 19.4 in 2021 per 100,000). The findings painted a stark picture of a nation in the throes of a full-fledged crisis, with millions of its young people suffering in silence and thousands compelled by circumstance to take their own lives. 

Yet this grim milestone was seen by many as preceded by years of warning signs. Well before the COVID-19 pandemic, CDC reports noted that suicide rates among U.S. youth ages 10-24 had jumped 57.4% from 2007-2018 (rising from less than 7 deaths per 100,000 to nearly 11), with even such states as New York, New Jersey, and Massachusetts – widely viewed as having strong safety nets for at-risk youth – seeing increases in youth suicide rates ranging from 40% to 60% over that single decade (Curtin, 2020). The issue notably remained pervasive for young Americans of all ages. Between 2007 and 2019, the suicide rate among pre-teens ages 8 to 12 surged a disturbing 166% (Penfold, 2021), with 8.4% of children as young as nine and ten years old reporting suicidal thoughts and 1.3% even making attempts (Janiri et al., 2020). From 2018-2019, 18.8% of adolescents ages 12-17 seriously considered attempting suicide, with 15.7% making a suicide plan, 8.9% attempting suicide at least once, and 2.5% making an attempt that required medical treatment (Ivey-Stephenson et al., 2020), corresponding to around 1.24 million medically attended suicide attempts by American teenagers nationwide. This data came on the heels of separate studies finding that suicide rates more than doubled in the preceding decade (from approximately 2 deaths per 100,000 people in 2008 to 5 per 100,000 in 2018) for adolescents as young as thirteen and fourteen years old (Levine et al., 2023). And since 2019, emerging American adults ages 18-25 have demonstrated the highest prevalence of both serious suicidal thoughts (11.8% in 2019, rising to 13.6% by 2022) and suicide attempts made (1.8% in 2019, rising to 2.7% by 2021 before dropping to 2.1% by 2022) among adults across all age groups (National Institute of Mental Health, 2024; Richesson et al., 2022; Keating & Rudd-Arieta, 2021).

In 2023, the Centers for Disease Control and Prevention (CDC) published up-to-date data on suicide rates among American youth that stunned public health and medical professionals nationwide. The federal report, issued in June, found that the overall suicide rate among U.S. youth ages 10 to 24 had surged 62% over the prior two decades (2001-2021), after decades of prior decline (Curtin & Garnett, 2023). On average, 11 young Americans died by suicide out of every 100,000 each year during this period; for children ages 10-14, the suicide rate had tripled from 2007-2018 (from 0.9 to 2.9 people per 100,000); for adolescents ages 15-19, it rose 57% from 2009-2017 (from 7.5 to 11.8 people per 100,000); and for young adults ages 20-24, it rose 63% over the entire period (from 11.9 people in 2001 to 19.4 in 2021 per 100,000). The findings painted a stark picture of a nation in the throes of a full-fledged crisis, with millions of its young people suffering in silence and thousands compelled by circumstance to take their own lives. 

Yet this grim milestone was seen by many as preceded by years of warning signs. Well before the COVID-19 pandemic, CDC reports noted that suicide rates among U.S. youth ages 10-24 had jumped 57.4% from 2007-2018 (rising from less than 7 deaths per 100,000 to nearly 11), with even such states as New York, New Jersey, and Massachusetts – widely viewed as having strong safety nets for at-risk youth – seeing increases in youth suicide rates ranging from 40% to 60% over that single decade (Curtin, 2020). The issue notably remained pervasive for young Americans of all ages. Between 2007 and 2019, the suicide rate among pre-teens ages 8 to 12 surged a disturbing 166% (Penfold, 2021), with 8.4% of children as young as nine and ten years old reporting suicidal thoughts and 1.3% even making attempts (Janiri et al., 2020). From 2018-2019, 18.8% of adolescents ages 12-17 seriously considered attempting suicide, with 15.7% making a suicide plan, 8.9% attempting suicide at least once, and 2.5% making an attempt that required medical treatment (Ivey-Stephenson et al., 2020), corresponding to around 1.24 million medically attended suicide attempts by American teenagers nationwide. This data came on the heels of separate studies finding that suicide rates more than doubled in the preceding decade (from approximately 2 deaths per 100,000 people in 2008 to 5 per 100,000 in 2018) for adolescents as young as thirteen and fourteen years old (Levine et al., 2023). And since 2019, emerging American adults ages 18-25 have demonstrated the highest prevalence of both serious suicidal thoughts (11.8% in 2019, rising to 13.6% by 2022) and suicide attempts made (1.8% in 2019, rising to 2.7% by 2021 before dropping to 2.1% by 2022) among adults across all age groups (National Institute of Mental Health, 2024; Richesson et al., 2022; Keating & Rudd-Arieta, 2021).

Surges in suicidal ideation and attempts among young Americans subsequently contributed to sharp increases in long-running trends of associated emergency department (ED) visits and hospitalizations. From 2011-2020, pediatric ED visits by children, adolescents, and young adults ages 6-24 nearly doubled nationwide (from 4.8 million visits, or 7.7% of all pediatric ED visits, to 7.5 million, or 13.1% of all visits), even as the overall number of pediatric ED visits for all causes decreased (Bommersbach et al., 2023). This spike in visits included a five-fold increase in the number of pediatric ED visits for suicide-related symptoms (from 0.9% of all visits in 2011 to 4.2% in 2020), which now make up an average of 5% of all visits by this age group. This alarming trend has been substantiated by other large national studies examining related healthcare data. Analyses of insurance claims for 24.5 million youths ages 1-21 found that mental health-related inpatient hospital admissions surged 61% among this population between 2016-2021, alongside a 45% increase in mental health-related ED visits and a 74% increase in ED visits for suicidal ideation, attempts, and self-harm by 2022, with the increases being most pronounced for adolescents and young adults (Clarify Health Institute, 2022; Clarify Health Institute, 2023). A review of 4.8 million pediatric hospitalizations from 2009-2019 at U.S. acute care hospitals revealed that a diagnosis of suicide or self-injury made up 64% of all mental health-related hospitalizations (Arakelyan et al., 2023). Other studies have found that all mental-related pediatric ED visits among youths ages 3-17 rose 8% annually from October 2015 to February 2020 (compared to an average increase of just 1.5% for visits for other reasons) (Cushing et al., 2022), with 13% of all patients revisiting within 6 months, and that from 2019-2020 – the last full year before the pandemic – the overall number of behavioral health cases for youth under 18 increased 30%, with pediatric ED cases of suicide attempts and self-injury in particular having jumped 50% (Children’s Hospital Association, 2023). 

It was this already escalating crisis that proceeded to become severely exacerbated by the pandemic: in 2021, the first full year of the pandemic in the United States, the national suicide rate among youths 10-24 years old returned to 2018 highs after two years of moderate declines (Stone et al, 2023; Curtin et al., 2022). The stressful impacts of the period were acutely felt by young Americans of varied educational levels. The CDC found that 22% of U.S. high school students – including roughly a third (30%) of female students (Gaylor et al., 2023) – had seriously considered suicide the previous year, with 18% making a plan and 10% attempting at least once (drastically up from 16%, 13%, and 8% a decade prior, respectively) (CDC, 2023b). Separate reports also noted that three months into the pandemic, roughly a quarter (25.5%) of young people ages 18-24 – the largest age demographic on college campuses – had seriously considered suicide in the prior 30 days (Czeisler et al., 2020), and a Healthy Minds Survey found that 15% of U.S. college students surveyed during the 2021-2022 school year had seriously considered suicide, the highest rate in the survey’s 15-year history (Eisenberg et al., 2023). The CDC further found that beginning in April 2020 – shortly after the start of the pandemic in the United States – and proceeding through October of that same year, the proportion of mental health emergency-related visits among all pediatric ED visits surged 24% for children ages 5 to 11 and 31% for those ages 12 to 17 relative to 2019 levels (Leeb et al., 2020). In the second full year of the pandemic (from March 2021 to February 2022), pediatric mental health-related ED visits for youths ages 5-17 collectively jumped another 7%; the percentage of their ED visits resulting in psychiatric inpatient admission rose 8%; and the mean length of their stay increased 4%, with youth in both years of the pandemic more likely to spend two or more nights experiencing prolonged boarding (Overhage et al., 2023). 

Overall, amid the pandemic, U.S. youth and young adults ages 10-24 began to represent 15% of all suicides nationally, and demonstrated exorbitantly high rates of ED visits for mental health emergencies and self-harm in particular, with 354.4 such visits per 100,000 members of this population in 2020 (compared to 128.9 visits per 100,000 people for middle-aged adults) (CDC, 2023a). Adolescent girls were noted to be at particularly high risk, with the proportion of ED visits for suicide attempts among those ages 12-17 jumping 50.6% from February-March 2019 to February-March 2021 (compared to just a 3.7% increase for boys and young men of the same ages) (Yard et al., 2021). Girls and young women ages 10-24 overall demonstrated a 43.6% increase in visits for suicidal ideation over the past two decades (Overhage et al., 2023), as well as an associated ED visit rate in 2021 measuring roughly double that of boys and young men (though the latter themselves consistently report some of the largest increases in suicide rates, including an 8% increase among those ages 15-24 in the same year) (CDC, 2023a; Curtin et al., 2022). Even more stark disparities in suicide rates have been discovered among other marginalized groups – with over a quarter of LGBTQ+ youths reporting attempting suicide in 2021, a significantly higher rate than that of their peers (Jones et al., 2022); higher percentages of American Indian and Alaska Native (AI/AN) youths experiencing suicidality than any other race or ethnicity that same year; Latina adolescents consistently being twice as likely to attempt suicide than their peers of the same race (Ivey-Stephenson et al., 2020); Black youths experiencing the largest percentage increases in suicides among any racial group in recent years (Stone et al., 2023); and Asian American/Pacific Islander (AAPI) adolescents and young adults being the only racial group to have suicide rank as their leading cause of death (CDC, 2018) – that merit an entirely separate article beyond the limitations of this paper.

For several years, U.S. lawmakers have demonstrated a propensity to pin the blame for the country’s youth suicide crisis entirely on the pandemic – despite such claims not covering the full story (Warner & Zhang, 2022). It is clear that this crisis had already reached epidemic proportions by the time COVID-19 took hold in early 2020. Yet even if this myopic view of its origins is genuinely held by those in elected office, it has failed to translate into substantive policy reforms that might address the widespread and life-threatening struggles with mental health currently faced by millions of young Americans. Nearly two full years into the pandemic (in October 2021), the American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association joined together to issue the unprecedented declaration of a national state of emergency in children’s mental health (AAP et al., 2021). The declaration took into account “dramatic increases” in rates of pediatric suicidality and ED visits for mental health emergencies, and called upon “policymakers at all levels of government and advocates for children and adolescents to join us” in working to institute a series of reforms, including securing sustainable funding for mental health screenings, establishing suicide prevention programs and risk assessments in schools and primary care, and addressing acute care needs in hospital settings by expanding access to adequate numbers of beds, step-down programs from inpatient units, and short-stay stabilization units, among other measures (Hua et al., 2024). Less than two months later, the U.S. Surgeon General echoed these calls, issuing an advisory highlighting the scope of the youth mental health crisis and outlining recommendations for governments and private healthcare organizations to collaborate to support children’s emotional and social well-being (Office of the U.S. Surgeon General, 2021), and roughly a year later, the AAP and over 130 other healthcare organizations explicitly called upon the Biden administration to declare a federal national emergency in children’s mental health (AAP et al., 2022). Yet despite these high-profile calls to action, no comprehensive federal legislation has been passed to support crisis identification, prevention, and intervention services for youth in either community or hospital settings (Roubein & Beard, 2022), and President Biden has yet to declare a national emergency in youth mental health, neglecting an opportunity to mobilize the full leverage and resources of the federal government to address the crisis.

At the state and local levels, attempts to contend with the youth suicide crisis have hardly fared better. As of June 2023, while half of all U.S. states and D.C. have enacted laws over the past decade that uniformly require their K-12 schools and school districts to adopt suicide prevention and intervention policies and guidelines outlining how staff should respond to students exhibiting suicidal ideation, 25 states have still not done so, according to the American Foundation for Suicide Prevention (AFSP, 2023). Furthermore, while 13 states uniformly require K-12 school personnel to be annually trained in such prevention and intervention protocols, a plurality of states (24, plus D.C.) do not mandate such training to occur every year – raising the risk that recall of key protocols may be poor in an emergency – and another 13 states do not require training at all. 22 states also uniformly require schools to develop curricula for student education in either suicide awareness and prevention and/or mental health more generally, but a majority (28, plus D.C.) continue not to do so. Statewide policy is even less consistent at the collegiate level, with 22 states having enacted laws uniformly requiring colleges and universities to adopt various specified suicide prevention policies – ranging from printing hotline numbers on student ID cards and publicizing student mental health resource information to adopting institutional awareness programs or prevention and intervention strategies – while the majority of states (28, plus D.C.) lacked any laws establishing a uniform standard of preparedness for higher education institutions as of December 2022 (AFSP, 2022). The resulting patchwork of policies, fragmented across thousands of campuses and communities, fails to offer a comprehensive response to the nationwide youth suicide crisis that transcends their outskirts and borders. Meanwhile, conflicting guidelines on the ages at which youths are recommended to be screened early in childhood for suicide risk (the AAP recommends those ages 12 and up be universally screened annually, with those ages 8-11 screened when clinically indicated, while the U.S. Preventive Services Task Force argues there is insufficient evidence to justify screening any asymptomatic youths for suicide risk) continue to confuse localities and providers seeking to address the root causes of such ideation (Jenco, 2022). Hospitals and inpatient facilities are also becoming overwhelmed by surging numbers of suicidal young adults, adolescents, and increasingly younger-aged children who arrive in EDs already at their crisis point (Richtel & Flanagan, 2022), with no end to this epidemic in sight as of yet.

Today, suicide is the third leading cause of death among young Americans ages 15-24 and the second leading cause of death among those ages 10-14. The United States loses far more of its young people to suicide than any other developed nation each year, with the total number of lives lost representing a disproportionately large segment of its youth population (Doran & Kinchin, 2020). For every young person lost to suicide, roughly 1,000 others are estimated to be considering and struggling with the idea of attempting (National Alliance on Mental Illness, 2024) – but every one of these suicides is preventable. Despite having an abundance of options with which to act, the nation’s leaders have collectively and inexcusably allowed this crisis to spiral out of control, and in so doing, have left millions of vulnerable children, adolescents, and young adults at risk. We must act swiftly and decisively to change course, advancing reforms that will reshape national policy to confront these harsh clinical realities – and ultimately save lives. 

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  35. Richtel, M. & Flanagan, A. (2022). Hundreds of suicidal teens sleep in emergency rooms. Every night. The New York Times. https://www.nytimes.com/2022/05/08/health/emergency-rooms-teen-mental-health.html 
  36. Roubein, R. & Beard, M. (2022). Congress is working on legislation to address children’s mental health crisis. The Washington Post. www.washingtonpost.com/politics/2022/06/01/congress-is-working-legislation-address-children-mental-health-crisis/ 
  37. Stone, D. M., Mack, K. A., & Qualters, J. (2023). Notes from the field: Recent changes in suicide rates, by race and ethnicity and age group — United States, 2021. Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, 72(6), 160-162. DOI: 10.15585/mmwr.mm7206a4 
  38. Warner, J. & Zhang, J. (2022). ‘We have essentially turned a blind eye to our own children for decades’: Why we need to stop politicizing children’s mental health. The Washington Post Magazine. https://www.washingtonpost.com/magazine/2022/03/21/childrens-mental-health-crisis-politicization/ 
  39. Yard, E., Radhakrishnan, L., Ballesteros, M. F., Sheppard, M., Gates, A., Stein, Z., Hartnett, K., Kite-Powell, A., Rodgers, L., Adjemian, J., Ehlman, D. C., Holland, K., Idaikkadar, N., Ivey-Stephenson, A., Martinez, P., Law, R., & Stone, D. M. (2021). Emergency department visits for suspected suicide attempts among persons aged 12–25 years before and during the COVID-19 pandemic — United States, January 2019–May 2021. Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, 70(24), 888-894. DOI: 10.15585/mmwr.mm7024e1 

The Possible Anti-depressant Effects of Magic Mushrooms

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By Maisha Pathan, March 9, 2024

Depression is a debilitating condition that affects up to 17.8% of American adults as of
2023 (Witters). Although there are countless treatment options in the form of antidepressants,
and therapy, sometimes, these treatments may still not be enough to provide relief for those
suffering from depression. Shrooms, also known as magic mushrooms may be an emerging
answer to those seeking an alternative. This unorthodox form of treatment called
psilocybin-assisted therapy (PAT) is gaining popularity, and the results are significant enough to
be brought to the public’s attention. In PAT, the patient is given a dose of the psychedelic
psilocybin, also known as magic mushrooms, in a controlled setting while their assigned
therapist stands by to monitor the experience. Despite its low toxicity and even being safer than
nicotine and aspirin, the stigma surrounding psychedelics causes people to hesitate even
considering this as an option, on top of which it’s still a controlled substance by the government
(Lowe et al. 20). However, research obtained from clinical trials shows that in a controlled
environment and administered by a trusted professional psilocybin has a powerful impact on
depressive symptoms, and many participants report improvement in their condition after their
sessions. For the people struggling with treatment-resistant depression, severe depression, or
anyone who finds that medication and therapy aren’t helping them: psilocybin-assisted therapy
could be a viable option for treating depression and should be offered alongside therapy and
medication.


Historically, psilocybin mushrooms have been in use for centuries, prominently in the
Aztec empire around the 15th century. The substance was referred to as “god’s flesh” in Nahuatl
and used in religious and healing rituals (Nichols 679). However, it wasn’t until 1957, when
Albert Hoffman a chemist who (also created LSD) isolated psilocybin from a Mesoamerican
psilocybin mushroom, and published its effects, that magic mushrooms entered modern
American society (Nichols 680) . Although the substance was then used in psychedelic therapy,
it became popularized for its recreational use during the 60’s aided by the hippie movement,
until the USA passed the Comprehensive Drug Abuse Prevention and Control Act of 1970,
which marked it as an illicit drug along with LSD and other psychedelics. Despite these
restrictions, psilocybin continued to be used recreationally by citizens and has been gaining
more traction in media.


Major depressive disorder is a serious depressive disorder that can have a lasting impact
on the brain. This damage essentially rewires the brain which can keep the person in their
depressive state for a prolonged amount of time. The compounds that makeup psilocybin can
sometimes reverse, or rewire, the damage depression does to the brain. According to an article
published by Healthline, a medical information website, depression can shrink regions of the
brain governing memory (hippocampus), emotion (amygdala), and cognitive functions
(prefrontal cortices). As a result of shrinking, function in these brain regions such as emotional
regulation and interest, memory, and concentration are also diminished (“5 Ways Depression
Can Physically Affect the Brain”). Psilocybin, specifically psilocin comes into play here due to
its role as a subtype of serotonin receptor. It activates a serotonin receptor called the 5-HT2A
which increases serotonin levels similar to SSRIs (2-Minute Neuroscience: Psilocybin, 0:16). In
a study conducted by researchers at Weill Cornell Medicine, an fMRI was used to show how the
activation of the 5-HT2A serotonin receptor by psilocin affected the brain landscape. The results showed that on psilocin, the brain lowered energy barriers between different regional
connections in the brain which allowed regions of the brain that were typically not stimulated to
be activated. Due to the flattening of the brain’s energy landscape, new connections could be
made between different brain regions, enabling neuroplasticity and promoting neurogenesis,
which is generation of new neurons. This opens up space that allows the brain to rewire itself,
and if the psilocybin is taken in a clinical setting such as in a PAT session, old patterns of
thinking can be replaced with new, expansive thought patterns which can reverse the effects of
depression on the brain by fostering new connections (Kuceyeski).


The structure of PAT is what makes it so successful and extremely safe in treating
depression. It’s is controlled by doctors and therapists in a clinical setting and is spread
throughout three stages: a preparatory stage, an administration stage, and an integration stage
(Schuitmaker 2). Each stage of PAT plays a significant role in how effective the treatment will
be for the patient while maintaining the environment in a controlled setting.


In the preparatory stage, participants attend several psychotherapy sessions to set their
goals and intentions for their experience. This creates the set and setting. Although individuals’
experiences on psilocybin vary from person to person an important factor to the experience is set
and setting. An article analyzing PAT in medicine by Cureus, a peer-reviewed medical journal,
explains that set refers to a patient’s goals and intentions for their psilocybin experience and is
discussed with their therapist so that it could be used to guide the individual and keep them on
track. The setting refers to the patient’s mental, physical, and emotional state prior to and during
the treatment. Attending these preparatory therapy sessions helps the therapist assess when and
where treatment should take place (Ziff et al. 7).


Once the patient is prepared, the next stage is “administration” which the Yale Manual for
Psilocybin-Assisted Therapy of Depression details. Typically, on the day of administration, the
patient is taken to a homey, welcoming room, where they lie down on the couch, put on
headphones, run a musical playlist, and wear a blindfold. The dose of psilocybin provided can
vary but typically is less than 1 gram and based on what the participant can handle. The music,
lying down, and blindfold work together to create a relaxing environment where the patient can
feel safe. They know that if they need any support they have their therapist right there next to
them. These measures create a controlled environment for the patient, minimizing possible
adverse reactions like anxiety or paranoia which can lead to nausea or vomiting. Once the patient
is settled and has consumed their psilocybin dose, the drug slowly takes effect, guiding them on a
journey into the depths of their mind. The therapist only guides the patient when needed based on
the goals and intentions set in the preparatory sessions, and otherwise does not interfere with the
psilocybin trip (Guss et al. 45-50).


The day after administration takes us to the third stage, “integration.” Integration
consists of several sessions through the following weeks during which the therapist asks the
patient about their experience, what they saw, felt, learned, what they’d like to take away from
their experience, and how to integrate that into their lives (Guss et al. 51-60). Although all three
stages of psilocybin-assisted therapy are equally as important, integration ensures that the
positive experiences are incorporated into the patient’s life and have a lasting effect while the
negative experiences if any are worked through. This structuring makes the therapeutic
administration of psilocybin safe and maximizes the benefits the substance can provide a
patient.

The effectiveness of psilocybin-assisted therapy as a treatment is evident in a number of studies.
In an article published by Johns Hopkins Medicine, the efficiency of using psilocybin to treat
major depression is explored through two studies conducted under their Psychiatry and
Behavioral Sciences department. The results found from both studies showed that using
psychedelic therapy by giving each participant a dose of psilocybin followed by psychotherapy
significantly reduced the symptoms of depression in both studies. Half of the participants in the
first study entered remission from depression at the end of the four-week follow-up. In the
second study, participants with a long history of depression on antidepressants were provided two
doses of psilocybin in a few weeks. They took a GRID-Hamilton Depression Rating Scale before
and after. The results showed that 67% of the participants showed a reduction in their symptoms
after a week, and four weeks after treatment, 54% of participants in the study were in remission
(“Psychedelic Treatment with Psilocybin Relieves Major Depression, Study Shows”). In another
study conducted by the Psychiatric University Hospital of Zurich, 52 participants suffering from
major depressive disorder were treated with psilocybin-assisted therapy. Half of them were given
psilocybin while the other half, 26 individuals were given a placebo. The results showed that
psilocybin significantly decreased depressive symptoms in those who had it, more than those
who received a placebo along with their therapy sessions. By the end of the study 14 out of 26,
met the criteria for remission from depression on the Montgomery–Åsberg Depression Rating
scale. In comparison to the placebo group in which the treatment was technically seven required
therapy sessions, 4 out of 26 met the criteria for remission demonstrating that psilocybin was the
driving force for the symptom reductions (Rotz 7-10).


In one clinical PAT trial conducted by NYU School of Medicine, the participants were four
cancer patients struggling with depression and anxiety. At the end of their participation which
spanned 26 weeks, each patient demonstrated a significant reduction in their depressive
symptoms which resulted from the experiences they had during their trips.
Many people suffering from depression who participated in psilocybin-assisted therapy
clinical studies report having positive experiences that aided in reducing their depressive
symptoms. Chrissy, a 50-year-old female with stage 4 breast cancer stated “[The psilocybin
experience] brought my beliefs to life, made them real, something tangible and true – it made my
beliefs more than something to think about, really something to lean on and look forward to,”
(Malone et a. 4). Although Chrissy knew that she was still going to pass, she was able to accept
and even look forward to the time she had left. In a separate trial by the Faculty of Medicine at
Al-Hikma University, ten participants struggling with depression were treated their with
psilocybin-assisted therapy. During an integration session with their therapist, a young adult
known as Participant 1 stated, “My whole thought pattern changed. I was so relieved. My head
had never been clearer. I was so happy the day after cried to my trip buddy about how I could see
again…. I was on three different anti-depressants, valium, and sleeping pills. This stopped within
2 weeks of my first dose,” (Hisham et al. 3). Many other participants from the same study
reported the experience was mind-expanding, and gave them a more positive outlook in life. The
experiences of the participants in this particular study are consistent with the neuroplasticity
effect psilocybin can have on the brain which allows it to create new connections and eradicate
old, negative thought patterns.


Psilocybin-assisted therapy has proven to be a worthwhile treatment venture for many of the
patients who participated in treatment for their depressive disorders. It’s important to note that psilocybin in this case is being used for treatment, not for recreation or self-exploration and
because it is being used for treatment by entrusted clinics it poses a relatively low risk, if at all to
those who receive it. However, that is not to say that this should be an option for everyone.
Studies have shown that people who are genetically predisposed to psychotic disorders such as
Schizophrenia can be triggered if exposed to any psychedelic substances such as psilocybin, in
the case where if they hadn’t been exposed to the substance they would not have developed any
form of psychosis (Ziff et al. 8). This is however, managed under psilocybin-assisted therapy as
before being able to receive it, all patients must undergo medical health screening to ensure it
will be an appropriate option for them. Many of the clinical studies on PAT usually begin with a
large pool of participants, which is slowly trickled down to a very small number via medical
health screening. The doses of psilocybin provided by these clinics are also quite moderate, and
typically less than even 1 gram which is the starting dose for recreational users. Years of research
and studies have gone on to show that psilocybin-assisted therapy can bring profound
improvement to depressive symptoms, especially for those who have exhausted all other options
such as medications and therapy. Age, health, and environment are all factors to consider when it
comes to PAT and it should be offered based on a mutual decision between the patient and their
mental healthcare provider. Although psilocybin-assisted therapy is not currently offered as an
official treatment and can only be accessed by participating in clinical trials, this may change
soon. In 2018, the FDA granted psilocybin-assisted therapy “break-through therapy” status
which means they will prioritize reviewing it soon for approval meaning it could soon be widely
offered for treatment (Coleman). For those struggling with depression who haven’t found relief
from any of the current treatment options, or are interested in trying psilocybin-assisted therapy,
this may be good news. Still, as in all cases, it’s important to do your own research to determine
whether this is the right option for you.

Bibliography

  1. Alshaikhli, Hisham, et al. “Effectiveness of Psilocybin on Depression: A Qualitative Study.”
    Electronic Journal of General Medicine, vol. 18, no. 3, Apr. 2021, p. em296,
    https://doi.org/10.29333/ejgm/10862.
  2. Coleman, Theara, and The Week US last updated. “The Legal State of Psychedelic Therapy in
    the US.” The week, 25 June 2023,
    theweek.com/drugs/1024449/the-state-of-psychedelic-therapy-in-the-us. Accessed 26
    Oct. 2023.
  3. Guss, Jeffrey, et al. “The Yale Manual for Psilocybin-Assisted Therapy of Depression (Using
    Acceptance and Commitment Therapy as a Therapeutic Frame).” Yale Manual for
    Psilocybin-Assisted Therapy of Depression , Aug. 2020,
    https://doi.org/10.31234/osf.io/u6v9y. Accessed 4 Nov. 2021.
  4. Kuceyeski, Dr. Amy. “Psychedelic Drugs Flatten the Brain’s Dynamic Landscape.” WCM
    Newsroom, Weill Cornell Medicine, 2022,
    news.weill.cornell.edu/news/2022/10/psychedelic-drugs-flatten-the-brain%E2%80%99s
    dynamic-landscape    .
  5. Lowe, Henry, et al. “The Therapeutic Potential of Psilocybin.” Molecules, vol. 26, no. 10, Jan. 2021, p. 2948, https://doi.org/10.3390/molecules26102948.
  6. Malone, Tara C., et al. “Individual Experiences in Four Cancer Patients Following Psilocybin-Assisted Psychotherapy.” Frontiers in Pharmacology, vol. 9, 2018, p. 335252, https://doi.org/10.3389/fphar.2018.00256. Accessed 26 Oct. 2023.
  7. Nichols, David E. “Psilocybin: From Ancient Magic to Modern Medicine.” The Journal of Antibiotics, vol. 73, no. 10, May 2020, pp. 679–86, https://doi.org/10.1038/s41429-020-0311-8.
  8. Neuroscientifically Challenged. “2-Minute Neuroscience: Psilocybin.” YouTube, YouTube Video, 5 May 2020, www.youtube.com/watch?v=XBEas8MGzd0.
  9. Rotz, Robin, et al. “Single-Dose Psilocybin-Assisted Therapy in Major Depressive Disorder: A Placebo-Controlled, Double-Blind, Randomised Clinical Trial.” EClinicalMedicine, vol. 56, Feb. 2023, p. 101809, https://doi.org/10.1016/j.eclinm.2022.101809.
  10. Schuitmaker, Nicole. “Psilocybin-Assisted Therapy: A Scoping Review of Participants’ and Facilitators’ Experiences in Qualitative Studies.” Research, Society and Development, vol. 12, no. 9, Sept. 2023, p. e12312943308–e12312943308, https://doi.org/10.33448/rsd-v12i9.43308. Accessed 26 Oct. 2023.
  11. Witters, Dan. “U.S. Depression Rates Reach New Highs.” Gallup.com, 17 May 2023, news.gallup.com/poll/505745/depression-rates-reach-new-highs.aspx#:~:text=In%202023%2C%2029.0%25%20of%20Americans. Accessed 19 Aug. 2023.
  12. Ziff, Shawn, et al. “Analysis of Psilocybin-Assisted Therapy in Medicine: A Narrative Review.” Cureus, vol. 14, no. 2, Feb. 2022, https://doi.org/10.7759/cureus.21944.
  13. “Psychedelic Treatment with Psilocybin Relieves Major Depression, Study Shows.” Www.hopkinsmedicine.org, 4 Nov. 2020, www.hopkinsmedicine.org/news/newsroom/news-releases/2020/11/psychedelic-treatment-with-psilocybin-relieves-major-depression-study-shows#:~:text=In%20a%20small%20study%20of. Accessed 26 Oct. 2023.
  14. “5 Ways Depression Can Physically Affect the Brain.” Healthline, 24 Oct. 2018, www.healthline.com/health/depression-physical-effects-on-the-brain#reversing-the-effects. Accessed 26 Oct. 2023.

Healthcare’s Youngest Victims: Inequality in Pediatric Healthcare and How We Can Fix It

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 by Cameron Takmil, February 24, 2024

Millions of children visit the emergency room every year with cuts, bruises, and a myriad of other diagnoses. Many are turned away from necessary treatments for seemingly nothing except one thing – race. While seemingly trivial, disparities across racial and ethnic lines persist, underscoring a critical need for systemic reform. Recent research spearheaded by experts at Northwestern revealed that healthcare inequities are widespread, affecting non-white minorities profoundly in pediatric care. 

The most concerning disparity was in pain management. When comparing kids of color to their white counterparts, they were not given proper medication at the same rate (Godoy 2024). 

These disparities manifest in other ways, including but not limited to diagnostic imaging, surgical complications, emergency care wait times, and treatment for developmental disabilities. Children of color often get the short end of the stick in these circumstances, receiving less than optimal care. UCLA researchers determined that white pediatric patients were more likely to receive sepsis treatment, compared to their black counterparts who also were less likely to be given full diagnostic testing through automated sepsis-alert systems (Li et. al 2022).

Premature infants of color tend to have increased rates of morbidities with regard to bronchopulmonary dysplasia, intraventricular hemorrhage, and necrotizing enterocolitis (Fanta et. al 2021). Those same infants generally had a lower birth weight, were born more prematurely, and had a higher mortality rate compared to white infants.

Differences lie not only in physical health, as mental health has seen its fair share of disparities amongst pediatric patients. Post-diagnosis, Latino and Black children receive medication and treatment at a lesser rate than White children (Fanta et. al 2021). Underdiagnosed and undertreated, patients of color were less likely to be evaluated on evidence-based mental health care and be given the correct medication all in all.

These inequalities persist despite the families having insurance, pointing towards the idea that these disparities are caused by other factors (Godoy 2024). Nevertheless, Hispanic and Black populations were much less likely to be uninsured, which is another hindrance in access to ubiquitous healthcare (Zhang et. al 2019).

The source of these inequalities stems from decades-long structural racism. Race-based residential segregation, institutional racism, and concentrated poverty have led and in many cases today, continues to worsen quality of housing, safety, and healthcare access and quality. A Harvard study found that in nearly all of the largest urban areas in the United States, two-thirds of non-Hispanic Black children and more than half of Hispanic children lived in areas graded as low- or very low opportunity (Slopen, Heard-Garris 2021). On the other hand, fewer than 1 in 5 Asian or White children live in low- or very low opportunity neighborhoods, clearly more affluent than their minority counterparts.

Government programs that have kept many afloat are slowly falling to the wayside, exposing vulnerable populations to even worse conditions. The Special Supplemental Nutrition Program for Women, Infants and Children, or WIC, served nearly half of the U.S’s infant population, and over six million children overall (Center for Health Journalism 2024). WIC has been able to improve birth metrics such as birth weight, preterm birth, and infant mortality rates. Despite being seemingly essential, the refusal by Congress to adjust its budget has put close to a million Americans at risk of losing their benefits.

These disadvantages extend into overall health as “toxic stress” – a term used by researchers at the Dana-Farber Cancer Institute – leads to negative consequences in physical and psychological health. Their study discovered that adversity during childhood was associated with poorer neurocognitive, neonatal, and cardiovascular health (Umaretiya et. al 2022). Due to red-lining – residential segregation policy in the 20th century – environmental risk is increased in more impoverished areas, posing a risk of safety and exposure to its residents (Samuelson 2024). Pediatric patients of color who live in these areas with higher density of housing code violations are more likely to be admitted and return to the ED due to asthma and related complications  (Fanta et. al 2021). 

If that was not enough to overcome, this prejudice has been baked into society with false, harmful, and misleading stereotypes, which many internalize, whether consciously or subconsciously. Minority parents, especially Hispanic parents, frequently report that healthcare providers do not dedicate sufficient time to understand their child’s needs, respect their parenting expertise, or align with their child-rearing preferences (Flores 2005). These same populations also reported that topics such as community violence, household smoking, alcohol usage, issues paying for the child’s basic needs, and spouse/partner support were discussed more frequently than white parents.

These sentiments extend far beyond healthcare, as anti-minority beliefs have come to the forefront in the past years. According to a recent national survey, “51% of whites think that blacks are prone to violence, whereas only 16% of whites think that whites are prone to violence” (Flores 2005). In the doctor’s office, we see much of the same, as the prevalence in which community violence was discussed quadrupled and tripled for Hispanic and Black patients respectively. Similar trends were found with regard to substance use, even in families where average income exceeded $75,000 (Flores 2005). 

This gap in communication and understanding only exacerbates the feeling of marginalization and can lead to decreased satisfaction with care and impaired patient-provider communication. These same minority populations have been reported to have higher levels of distrust of their provider, mainly due to implicit and explicit discrimination (Umaretiya et. al 2022). Such interactions might not only perpetuate discrimination but also detract from providers’ ability to educate, inform, and aid these patients.

It is not all hopeless, though, as there is a pathway for solutions to reduce the gap between patients of color and white patients. Addressing and solving disparities in pediatric healthcare is a multifaceted challenge that demands an in-depth and multidisciplinary approach. The strategies to promote health equity in pediatrics can be categorized into three levels: individual, institutional, and structural as demonstrated in research (Fanta et. al 2021). 

At the individual level, healthcare professionals can make up ground by engaging in continuous professional development focused on understanding and mitigating the impact of interpersonal racism, discrimination, and bias on pediatric health inequities (Fanta et. al 2021). It is crucial to educate providers on not only their explicit biases, but more importantly their implicit biases that they might not be aware of. Through this, a mindset of cultural humility and openness, being other-oriented, and recognizing the impact of power dynamics on building trusting relationships with patients and their families can be cultivated. 

These shortcomings of healthcare are not only the responsibility of the providers to ameliorate, as the onus is on institutions to invoke change themselves. Diversifying the workforce can enhance the relatability and effectiveness of the patient-provider relationship (Fanta et. al 2021). This could help patients feel more comfortable with providers who might be more apt to understand their plight. 

In a broader sense, addressing structural disparities requires moving outside of the healthcare system and advocating for policy reform aimed at eliminating inequities in critical social determinants of health. These determinants include healthcare access and quality, economic stability, education, neighborhood and built environment, and social and community context (Fanta et. al 2021). A study from Dana-Farber notes that adopting universal and systematic social determinants of health – coined as SDOH in their paper – screening within pediatric care can identify key areas where interventions can be most effective (Umaretiya et. al 2022). Identifying the specific root causes on a patient-to-patient basis will allow for much more optimized solutions.

Something as simple as integrating SDOH screens into each visit, within national pediatric protocols, can help identify mechanisms driving disparities and opportunities for intervention (Jindal et. al 2024). Developing multilevel health equity interventions that address identified pathways, such as access to care, patient-health-care-system interaction, and the impact of toxic stress, is crucial (Umaretiya et. al 2022).

It will be imperative to focus on improving the various systems that lead to poorer healthcare outcomes for pediatric patients of color. Efforts to dismantle the underlying racism that perpetuates pediatric racial and ethnic health inequities must focus on policies within multiple interdependent systems. This includes challenging housing policies that sustain poor housing, limiting access to resources like high-quality education and healthcare, and increasing exposure to environmental risk factors (Jindal et. al 2024). Enhancing family resilience through evidence-based psychosocial interventions can also play a role in mitigating the effects of toxic stress (Umaretiya et. al 2022).

To effectively reduce and solve disparities in pediatric healthcare, a concerted effort from all stakeholders—healthcare providers, institutions, policymakers, and communities—is required. This involves addressing not only the immediate healthcare needs of children but also the broader structural and social determinants of health that contribute to disparities. By implementing these strategies at the individual, institutional, and structural levels, we can move closer to achieving health equity in pediatrics, ensuring that all children have the opportunity to thrive and reach their full health potential.

Bibliography

  1. Godoy, M. (2024, January 18). Kids of color get worse health care across the board in the U.S., research finds. NPR. https://www.Godoy.org/sections/health-shots/2024/01/18/1225270442/health-inequities-pediatrics-kids-of-color-disparities
  2. Li, E., Ng, A. P., Williamson, C. G., Tran, Z., Federman, M. D., & Benharash, P. (2022). Assessment of Racial and Ethnic Disparities in Outcomes of Pediatric Hospitalizations for sepsis Across the United States. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2022.4396 
  3. Fanta, M., Ladzekpo, D., & Unaka, N. (2021). Racism and pediatric health outcomes. Current Problems in Pediatric and Adolescent Health Care, 51(10), 101087. https://doi.org/10.1016/j.cppeds.2021.101087 
  4. Zhang, X., Carabello, M., Hill, T., He, K., Friese, C. R., & Mahajan, P. (2019). Racial and Ethnic Disparities in Emergency Department Care and Health Outcomes Among Children in the United States. Frontiers in Pediatrics, 7. https://doi.org/10.3389/fped.2019.00525 
  5. Slopen, N., & Heard-Garris, N. (2021). Structural Racism and Pediatric Health—A Call for Research to Confront the Origins of Racial Disparities in Health. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2021.3594 
  6. The Health Divide: Pediatric care is worse for kids of color; federal nutrition program faces worrying shortfall | USC Center for Health Journalism. (n.d.). Centerforhealthjournalism.org. Retrieved February 10, 2024, from https://centerforhealthjournalism.org/our-work/insights/health-divide-pediatric-care-worse-kids-color-federal-nutrition-program-faces 
  7. Puja J. Umaretiya, Robert J. Vinci, Kira Bona; A Structural Racism Framework to Guide Health Equity Interventions in Pediatric Oncology. Pediatrics May 2022; 149 (5): e2021054634. 10.1542/peds.2021-054634, https://publications.aap.org/pediatrics/article/149/5/e2021054634/186711/A-Structural-Racism-Framework-to-Guide-Health
  8. Pediatric care for non-white children is universally worse across U.S. (n.d.). News.northwestern.edu. Retrieved February 10, 2024, from https://news.northwestern.edu/stories/2024/01/pediatric-care-for-non-white-children-is-universally-worse-across-u-s/ 
  9. Glenn Flores, Lynn Olson, Sandra C. Tomany-Korman; Racial and Ethnic Disparities in Early Childhood Health and Health Care. Pediatrics February 2005; 115 (2): e183–e193. 10.1542/peds.2004-1474 https://publications.aap.org/pediatrics/article/115/2/e183/67379/Racial-and-Ethnic-Disparities-in-Early-Childhood 
  10. Jindal, M., Barnert, E., Chomilo, N., Gilpin Clark, S., Cohen, A., Crookes, D. M., Kershaw, K. N., Kozhimannil, K. B., Mistry, K. B., Shlafer, R. J., Slopen, N., Suglia, S. F., Nguemeni Tiako, M. J., & Heard-Garris, N. (2024). Policy solutions to eliminate racial and ethnic child health disparities in the USA. The Lancet. Child & Adolescent Health, 8(2), 159–174. https://doi.org/10.1016/S2352-4642(23)00262-6