Tag: rights

Reading of the Week: Nudging Sobriety – the New JAMA Psych Paper; Also, Torous & Topol Weigh Generative AI and Wilson on Thick Skin

July 10, 2025 /

From the Editor

Substance work can be lifesaving. But it’s also challenging, as many patients continue to misuse illicit drugs or drop out of care or both. Evidence supports using incentives, including financial ones, to nudge patients toward sobriety. This approach, known as contingency management, includes tools such as vouchers and prizes.

But what forms of nudging work best? And how much of a financial incentive is needed? In a new JAMA Psychiatry paper, Carla J. Rash (of the University of Connecticut) and her co-authors attempt to answer these questions by looking at contingency management. In a systematic review, they drew on 112 protocols from 77 studies, analyzing types of nudges like vouchers (which may be exchangeable for, say, retails items) and prizes (a chance to win things like gift cards) and the amounts of money involved. The authors walk on a familiar path – the literature goes back four decades – but provide a meaningful update. “Based on these findings, weekly incentive magnitude estimates are $128/week for voucher protocols and $55/week for prize-based protocols.” We consider the paper and its implications. 

ChatGPT is the most downloaded app in history with people using it for everything from finding recipes to writing emails. How could generative AI be used for mental health? In a perspectives paper for The Lancet, Drs. John Torous (of Harvard University) and Eric J. Topol (of the Scripps Research Translational Institute) discuss this important and timely topic. “Despite considerable promise, research is still required to establish AI’s benefit and safety for promoting mental health.”

And in the third selection from Academic Psychiatry, Dr. Ariel E. Wilson, a resident of psychiatry at Kaiser Permanente Oakland, writes about patient rights, certifiability, and the weight of making good decisions. The author asks if psychiatrists need to have thick skin. “The challenge in psychiatry lies in finding a balance – creating our own semi-permeable membrane that allows us to protect ourselves from feeling the sting of every emotion we encounter, while also maintaining empathetic and trusting relationships with our patients.”

DG

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Reading of the Week: Alcohol Use Disorder – The NEJM Review; Also, Private Equity & Opioid Treatment and Gee on Refusing Help

January 30, 2025 /

From the Editor

When she was admitted for liver cirrhosis – the last hospitalization in her too-short life – no one visited. In her community, the stigma was great. As she grew more and more ill, I asked if she wanted me to call her family to be at the bedside. She simply smiled and said that they were all busy.

Over the years, I have seen many patients like this woman; we all have. Alcohol misuse is common. What’s the best evidence for screening and treatment? Dr. Paul S. Haber (of the University of Sydney) tries to answer that question with a sparkling review, published in The New England Journal of Medicine. His paper is clearly written and draws from more than sixty references. “Alcohol use disorder is a relapsing and remitting medical and psychological disorder that influences physical health, mental health, and social functioning, and continuing care is recommended.” We consider the review and several key take-aways.

In the second selection, David T. Zhu (of Virginia Commonwealth University) and his co-authors analyze the ownership of opioid treatment programs in the United States, with a particular focus on private equity. The research letter, published in JAMA Psychiatry, drew on government data. “This study found that 29.1% of US opioid treatment programs were owned by private equity firms, exceeding private equity penetration in other sectors of health care (range, 2%-11%).”

And in the third selection, columnist Marcus Gee of The Globe and Mail writes about mental illness and patient rights. He discusses a woman in his neighbourhood who has delusions and refuses shelter in the cold weather, convinced that she will soon be offered keys to a new home. “Surely she deserves better. Surely we can do better.”

DG


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Reading of the Week: The NEJM on “Our Struggle to Care for People with Serious Mental Illness”

November 24, 2016 /

From the Editor

What can we do for those with severe mental illness?

Homelessness: can we do better?

This week, we look at a series of excellent essays that have run on mental illness in The New England Journal of Medicine. They are well written and insightful. We particularly focus on the first of the three essays, which considers treatment and rights.

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