is a research analyst at the Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.

Special Report Chairperson: Tony P. George, MD, FRCPC

In the United States, cannabis is a Schedule I drug. However, legislative matters have effectively allowed each state to manage legalized recreational cannabis. This patchwork has led to disparities in state versus federal regulations regarding recreational 

 that, coupled with myths about its psychological benefits, increase confusion for our patients. This article will summarize changes in cannabis legislation and provide an update for psychiatrists on the evidence both for and against its clinical utility.

Recovery-Based Approaches and Forward-Thinking Policy: Implications for Addiction Care

Ashley E. Kivlichan; Darby J.E. Lowe, MSc; Tony P. George, MD, FRCPC

Nonabstinent Recovery From Alcohol Use Disorder

Cassandra L. Boness, PhD; Alena Kuhlemeier, PhD; Katie Witkiewitz, PhD

Dual Diagnosis: Double the Stigma, Double the Trouble

Darby J.E. Lowe, MSc; Emily Simpkin, RN; Tony P. George, MD, FRCPC

Eighteen states (and Washington, DC, and Guam) have adopted legalized recreational cannabis use, and 37 (plus DC, Guam, Puerto Rico, and the US Virgin Islands) have approved medicinal use. While this patchwork leads to disparities in medical care and arrests across states, it allows for comparisons in mental health trends related to legalization. Longitudinal analysis of 505,796 respondents found an increased diagnosis of cannabis use disorder (CUD) in individuals aged 12 to 17 years (2.2% to 2.7%) and 26 years and over (0.9% to 1.2%) after legalization, which was not mirrored in states where it remains illegal.

 However, there was no increase in CUD prevalence for respondents aged 18 to 25 years.

Evidently, for consumers to make informed choices and to reduce potential harms, legalization alone may be risky and should be coupled with increases in evidence-based education and access to treatment, especially for at-risk groups such as adolescents and individuals with mental illnesses.

CUD refers to continuous excessive use, characterized by a loss of control, psychological and social impairments, and risky behavior. The prevalence of CUD (ages 12+) is around 2.9% in the United States,

 with males having rates twice that of than females.

 However, in psychiatric patient samples, CUD prevalence reaches ~25%.

 Individuals with mental illnesses and other SUDs may be more susceptible to CUD because of shared genetic and environmental factors increasing vulnerability,

 or because of overuse in an effort to manage symptoms (ie, coping with negative affect).

 There is the popular perception that cannabis is an effective tool in managing anxiety, mood, and eating disorders, but evidence to support self-medication is minimal.

 in cannabis are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is known to produce the characteristic “high” from inhalation of cannabis because of its high-affinity for cannabinoid type 1 (CB1) receptors in the mesolimbic dopamine system; CBD antagonizes these effects, but the exact mechanism is unclear.

The acute effects of THC intoxication, including at higher doses, are outlined in the 

. Cannabis misuse is associated with first-episode psychosis, longer psychotic episodes, more positive symptoms, and poorer psychosocial functioning in individuals with schizophrenia.

 Such effects directly correlate with THC dose and potency; evidence suggests a dose-dependent relationship between cannabis use and schizophrenia that cannot be explained by use of other psychoactive substances.

 Similarly, in bipolar disorder, cannabis use is associated with earlier onset of depressive, manic, and psychotic episodes and more frequent suicide attempts,

 with high THC as the culprit. Moreover, longitudinal studies on bipolar disorder show lower rates of treatment adherence and greater symptom severity, particularly mania and psychosis, in bipolar cannabis users.

Less clear is the interaction between THC and depression. While cannabis prevalence in depression is high,

 longitudinal studies have provided modest evidence on whether 

 Infrequent use may not be related to depression, whereas heavy use is more likely to increase symptoms.

 Similarly, evidence on cannabis as a risk factor for anxiety disorders is modest, with some prospective studies showing greater risk of developing anxiety disorders and more anxious symptoms in cannabis users,

 while others have failed to replicate such findings.

 These inconsistencies might be explained by genetic differences

 or the dose-dependent nature of THC intoxication, with low doses eliciting feelings of relaxation and euphoria, while higher doses result in dysphoria, panic, and paranoia. Moreover, extensive exposure to THC over time may paradoxically increase anxiety via changes in allostatic load.

 Despite claims that cannabis helps reduce depression and anxiety, we found no controlled clinical trials suggesting its effectiveness. In fact, in a recent study of 28 days of cannabis abstinence in people with 

, there was a significant improvement in depressive and anxiety symptoms, sleep problems, and anhedonia with extended cannabis abstinence, which argues against self-medication of mood symptoms by cannabis use.

 Conversely, CBD does not produce intoxication. Rather, it has been shown to antagonize CB1 and CB2 receptors, thus opposing effects of THC. Preclinical models suggest a range of potential therapeutic benefits of CBD as a function of antipsychotic, neuroprotective, anxiolytic, and sedating properties.

 For example, animal models suggest that 

 might produce antidepressant effects via serotonergic neurotransmission, in particular activation of 5-HT1A receptors.

Preliminary evidence in human studies is similarly encouraging: CBD may produce antianxiety and antidepressant effects.

 Interestingly, increased doses are not associated with dysphoria or anxiety as is found with increased THC doses. One study found that administration of CBD produced functional changes in anxiety-related limbic and paralimbic cortical areas that were further associated with a reduction in state anxiety.

 Moreover, there is evidence that CBD 200 to 1500 mg daily may alleviate psychotic symptoms through inhibition of anandamide metabolism and reduce cognitive impairments through CB1 and CB2 receptor agonism in schizophrenia.

One case study even found improvements in symptoms of 

where the individual had previously failed to respond to olanzapine, clozapine, or haloperidol.

 Even where findings are null, CBD is well tolerated and does not worsen symptoms.

 Thus, emerging evidence on anxiolytic, antipsychotic, and antidepressive effects of CBD is promising. Of note, there are a number of drug interactions between CBD and common psychiatric medications that need to be considered when prescribing CBD.

In addition, some studies have found support for the use of CBD in treating cannabis-related issues. Specifically, CBD at 40 to 100 mg daily has been shown to improve cannabis withdrawal symptoms,

 which may help participants avoid using to alleviate withdrawal. Other open-label studies have found that CBD increased rates of abstinence and reduced the amount of cannabis used by participants.

Unfortunately, trends observed in concentrations of THC and CBD in cannabis in licit and illicit markets have seen the former increasing from an average of 4% to as high as 25% to 30%, and the latter decreasing from 0.28% to less than 0.15% (1995-2014).

 This imbalance precludes the opposing effects of CBD on THC intoxication, increasing the risk of experiencing harms associated with 

Cannabis Legalization and the Opioid Toxicity Crisis

The rapidly increasing rates of opioid-related poisonings has galvanized health care providers, advocates, and governments to find solutions to overprescription of 

 and the toxicity of the illicit opioid market (eg, carfentanil). It has been proposed that legalization of cannabis may play a role in curbing the opioid crisis.

A few studies have attempted to answer this question. Initially, Bachhuber et al

 suggested that in states with medical cannabis laws, rates of fatal opioid overdoses were reduced after implementation of these laws. However, more recent studies have suggested the opposite

 and that frequency of cannabis use, in fact, correlates with the severity of opioid use disorder.

 These studies, although methodologically sound, are not entirely sufficient to answer the question of whether cannabis legalization may curb the opioid crisis—a broad and somewhat vague claim. Examining a few scenarios will help highlight the importance of defining the potential role of cannabis legalization in reducing opioid overdoses.

, prescription of high-dose opioids long term may increase the risk of developing opioid use disorder

 that may in turn result in transition to use of illicit opioids (eg, heroin, fentanyl).

 In these cases, prescribing cannabis for pain management may, in fact, reduce the chances of introduction to and dependency on opioids.

It has also been suggested that recreational cannabis use may act as a “gateway drug” that encourages transition to use of other drugs, such as opioids. In states where cannabis remains illegal, 1 potential mechanism of this transition (if it occurs) is introduction to the illicit market, criminal networks, and potentially the judicial system if one were arrested. In this instance, legalization of cannabis means individuals could access regulated amounts without having to go through illicit sources.

However, for individuals who already have an 

 that has arisen from a complex array of biological, psychological, and social circumstances, legalization of cannabis may not affect their use of opioids. Rather, as suggested by Olfson et al,

 we may see that individuals continue to use opioids alone or with cannabis and thus would likely benefit more from a specific and targeted opioid use disorder intervention.

As such, well-controlled longitudinal studies are needed to adequately investigate the clinical and public health relationships between cannabis use and opioid toxicity.

While there remains a dearth of clinical research on the benefits of cannabis, particularly in individuals with mental illnesses, the evidence suggests they are likely outweighed by the harms of (high-THC) cannabis. However, the question is no longer should cannabis be legalized? The question is how can we effectively promote evidence-based public health messaging around cannabis, regulate available supplies to achieve an appropriate balance of THC and CBD, and increase access to CUD treatment?

is a research analyst at the Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada. 

 is an associate professor of psychiatry at Harvard Medical School, and director of addiction psychiatry at Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts.

is professor of psychiatry, Temerty Faculty of Medicine, at the University of Toronto, and senior physician-scientist at CAMH in Toronto, Ontario, Canada. He is currently deputy editor and incoming coprincipal editor of Neuropsychopharmacology (NPP).

Acknowledgements: This work was funded in part by NIH grant R21-DA-043949 to Dr George.

1. Cerdá M, Mauro C, Hamilton A, et al. 

Association between recreational marijuana legalization in the United States and changes in marijuana use and cannabis use disorder from 2008 to 2016.

US epidemiology of cannabis use and associated problems.

A systematic review and meta-analysis of sex differences in cannabis use disorder amongst people with comorbid mental illness.

4. Lowe DJE, Sasiadek JD, Coles AS, George TP. 

Diversity of molecular targets and signaling pathways for CBD.

6. D’Souza DC, Pearlson GD, Selloni A, et al. A review of cannabis and cannabinoids in schizophrenia and psychotic disorders. 

7. Polkosnik GL, Sorkhou N, George TP. Effects of cannabis use on psychotic and mood symptoms: a systematic review. 

8. van Rossum I, Boomsma M, Tenback D, et al; EMBLEM Advisory Board. 

Does cannabis use affect treatment outcome in bipolar disorder? A longitudinal analysis.

Association of cannabis use in adolescence and risk of depression, anxiety, and suicidality in young adulthood: a systematic review and meta-analysis.

 Exploring the association between cannabis use and depression.

11. Otten R, Huizink AC, Monshouwer K, et al. 

Cannabis use and symptoms of anxiety in adolescence and the moderating effect of the serotonin transporter gene.

12. Lucatch A, Kloiber S, Meyer J, et al. Effects of extended cannabis abstinence in major depressive disorder. 

The therapeutic role of cannabidiol in mental health: a systematic review.

14. Silote GP, Sartim A, Sales A, et al. 

Emerging evidence for the antidepressant effect of cannabidiol and the underlying molecular mechanisms.

15. Zieba J, Sinclair D, Sebree T, et al. 

Cannabidiol (CBD) reduces anxiety-related behavior in mice via an FMRP-independent mechanism.

16. Crippa JA, Derenusson GN, Ferrari TB, et al. 

Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: a preliminary report.

17. Leweke FM, Mueller JK, Lange B, et al. 

Role of the endocannabinoid system in the pathophysiology of schizophrenia: implications for pharmacological intervention.

The effects of cannabidiol (CBD) on cognition and symptoms in outpatients with chronic schizophrenia a randomized placebo controlled trial.

19. Hill KP, Gold MS, Nemeroff CB, et al. 

Risks and benefits of cannabis and cannabinoids in psychiatry.

20. ElSohly MA, Mehmedic Z, Foster S, et al. 

Changes in cannabis potency over the last 2 decades (1995-2014): analysis of current data in the United States.

21. Bachhuber MA, Saloner B, Cunningham CO, Barry CL. 

Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010.

Association of state policies allowing medical cannabis for opioid use disorder with dispensary marketing for this indication.

23. Olfson M, Wall MM, Liu SM, Blanco C. 

Cannabis use and risk of prescription opioid use disorder in the United States.

24. Hoffman KA, Ponce Terashima J, McCarty D. 

Opioid use disorder and treatment: challenges and opportunities.

25. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Phillips JK, Ford MA, Bonnie RJ, et al, eds. 

Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use.

 National Academies Press (US); 2017. ❒

Articles

What's the latest update on cannabis legislation and its clinical utility?

Cannabis Legalization: What Psychiatrists Need to Know

Richard Berlin, MD, shares Naomi Shihab Nye's poem "

has been writing a poem about his experience of being a doctor every month for the past 24 years in

in a column called “Poetry of the Times.” He is instructor in psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts. His latest book is

Videos

"Poetry calls us to pause. There is so much we overlook, while the abundance around us continues to shimmer, on its own."

Making a Fist

The NCCHC Foundation will award scholarships for students and correctional health professionals who have three or less years of experience in the field to attend the NCCHC 

Correctional Mental Health Care Conference

, taking place August 1-2 in Denver. Completed applications are due no later than 12 pm (CDT) on May 27, 2022. Awardees will be notified by July 5, 2022.

The Scholarships will cover the full price of conference registration, a value of $425, plus travel and hotel expenses. Gifts are made possible by Centurion Health, Corizon Health, and other generous donors to the NCCHC Foundation.

Apply for a scholarship for the NCCHC Correctional Mental Health Care Conference!

NCCHC Foundation Offers Scholarships for the NCCHC Correctional Mental Health Care Conference

Dr Pies is Professor Emeritus of Psychiatry and Lecturer on Bioethics and Humanities, SUNY Upstate Medical University; Clinical Professor of Psychiatry, Tufts University School of Medicine; and Editor in Chief Emeritus of 

 (2007-2010). Dr Pies is the author of several books. A collection of his works can be found on

The horrific mass school shooting in Uvalde, Texas, is the deadliest such shooting at an American school in nearly a decade.

 A mass shooting is frequently defined as a single attack in a public place, in which 4 or more victims were killed. Sadly, there are few reasons to believe that the frequency of such tragedies will decline anytime soon. On the contrary, unless a wide range of contributing factors change, there are compelling reasons to expect more mass shootings in the US, some of which will target schools.

The reasons for this rather gloomy prediction are detailed below. It is not my intent to dissect the specific details of the Uvalde shooting or to speculate on the psychology or motives of the shooter; but rather, to provide a framework for understanding why the US seems caught in an endless, repeating loop of gun-related carnage.

1. There is an almost inexhaustible supply of marginalized, emotionally disturbed, rage-filled young men in this country

Since 1982, at least 123 mass shootings have been carried out in the US by male shooters, versus 3 by females.

 I will say more about the gender issue and its cultural roots presently. According to psychology professor 

, most of the perpetrators of K-12 shootings are under the age of 18.

And while there is no single psychological or demographic profile that can proactively identify likely school shooters, there are some general features school shooters tend to share, such as profound feelings of rejection and a history of having been bullied. Many shooters also display a fascination with guns and/or a preoccupation with violence.

There is no credible, clinically-based evidence that mass shooters, as a group, are psychotic or delusional when carrying out their violence.

 Furthermore, blaming “mental illness” for school shootings stigmatizes those with clinically-diagnosed psychiatric disorders, who are rarely violent when adequately treated.

 That said, Kowalski and her colleagues found that more than half of K-12 shooters had a history of “psychological problems” of various sorts.

2. Handguns are easily obtainable in the US, and are often poorly-secured by family members. 

Though the Uvalde shooter apparently used a rifle,Kowalski found that handguns were used in over 91% of the K-12 shootings, and almost half of the shooters stole the gun from a family member.

 According to Daniel Flannery, a professor at Case Western Reserve University and the director of the Begun Center for Violence Prevention Research and Education, “It’s way easier to get a handgun than it is to do just about anything else in this country…our background check is woefully inadequate.”

 Furthermore, more than half of gun owners do not safely store all their guns, according to a survey of 1444 US gun owners conducted by researchers at the Johns Hopkins Bloomberg School of Public Health.

3. Violent acts, including mass shootings, are on the rise nationwide, possibly related to the pandemic and its attendant socioeconomic dislocations.

Recent data from cities across the US show a trend of increased violent crimes as the COVID-19 pandemic has lingered on, though the numbers vary from city to city.

 Moreover, a cross-sectional study showed large increases in mass shootings with the start of the COVID-19 pandemic, “…consistent with the notion that mass shootings, an extreme form of violence, may be influenced by social and economic factors.”

 While acknowledging that such correlations do not necessarily represent causation, the recurrent and largely unpredictable surges of COVID-19 infection, coupled with their adverse socioeconomic repercussions, probably represent a risk factor for more mass shootings.

4. Psychological distress is increasing among teens and adolescents, and there is a shortage of mental health support for this age group.

In December 2021, the United States surgeon general, Vivek Murthy, MD, warned that young people are facing devastating mental health effects as a result of generational challenges, including the coronavirus pandemic. Dr Murthy’s report noted significant increases in self-reported depression and anxiety in younger age groups, along with more emergency room visits for mental health issues.

 Murthy observed that, “Young people are bombarded with messages through the media and popular culture that erode their sense of self-worth—telling them they are not good-looking enough, popular enough, smart enough or rich enough [and]…that comes as progress on legitimate, and distressing, issues like climate change, income inequality, racial injustice, the opioid epidemic and gun violence feels too slow.”

 While it is not clear that these trends will have a direct effect on the likelihood of school shootings, we need to recall Dr Kowalski’s finding that most perpetrators of K-12 shootings are under the age of 18.

 Unfortunately, obtaining professional help for this troubled age group has become increasingly difficult in the US, and shortages of mental health workers have only been worsened by the pandemic.

5. Media attention may encourage the copycat effect.

After mass shootings, the general media are often fixated on the shooter’s motives, family background, signs of mental disturbance, social media postings, etc. Almost inevitably, this lurid coverage is linked to the shooter’s name and face. Unfortunately, there is reason to believe that this sort of sensational publicity may encourage copy-cat killers, bent on outdoing the previous shooter.

 To the tens of thousands of disaffected, rejected, and bullied young men who imbibe this sort of cultural glorification, the temptation to “make history” by violent and vengeful means may prove irresistible. Alas, I see no sign that the media are becoming more restrained in their publicity of these horrific events—and this does not bode well for the future.

Though it is easy to give in to despair, there are ways, as a society, that we can reduce the frequency and lethality of mass shootings. As my colleague, James L. Knoll IV, MD, and I argued in a previous article,

“While solid, evidence-based methods of preventing mass shootings are still lacking, we believe that progress will come through work on a number of fronts. First, better reporting of ominous behaviors and careful use of extreme risk protection orders may avert at least some mass shootings. Second, the use of Threat Assessment and Management (TAM) teams in our schools may also help preempt planned attacks. TAM teams are interdisciplinary groups of professionals that include law enforcement, mental health providers, and other security stakeholders, collaborating in a structured effort to accurately assess and mitigate the risk of violence.”

Beyond these remedies, I believe that we Americans, as a society, need to do some serious introspection. That begins by asking ourselves some serious questions, like: what must we do to reduce the likelihood that troubled adolescents with violent intentions will get hold of unsecured firearms? What resources are required to address the mental health needs of younger populations? And what must we do to counteract the allure and glamor of these unspeakably violent deeds?

1. Kornfeld M, Iati M, Knowles H, et al. Biden says Second Amendment ‘not absolute’ as more details of school shooting emerge. 

https://www.washingtonpost.com/nation/2022/05/25/texas-school-shooting-uvalde-victims-live-updates/

2. Statista Research Department. Mass shootings in the U.S.: shooters by gender, as of May 2022. May 25, 2022. Accessed May 26, 2022. 

https://www.statista.com/statistics/476445/mass-shootings-in-the-us-by-shooter-s-gender/

3. Kowalski RM. School shootings: What we know about them, and what we can do to prevent them. Brookings. January 26, 2022. May 26, 2022. 

https://www.brookings.edu/blog/brown-center-chalkboard/2022/01/26/school-shootings-what-we-know-about-them-and-what-we-can-do-to-prevent-them/

Mass murder: causes, classification, and prevention. 

6. Shapiro E, Andreano C. The type of gun used in most US homicides is not an AR-15. ABC News. October 26, 2021. Accessed May 26, 2022. 

https://abcnews.go.com/US/type-gun-us-homicides-ar-15/story?id=78689504

7. Survey: more than half of U.S. gun owners do not safely store their guns. Johns Hopkins Bloomberg School of Public Health. February 22, 2018. Accessed May 26, 2022. 

https://publichealth.jhu.edu/2018/survey-more-than-half-of-u-s-gun-owners-do-not-safely-store-their-guns

8. Beals M. How violent crime has gone up since the pandemic. 

. February 15, 2022.Accessed May 26, 2022. 

https://thehill.com/policy/national-security/594291-how-violent-crime-has-gone-up-since-the-pandemic/

Mass shootings in the US during the COVID-19 pandemic.

10. Richtel M. Surgeon General warns of youth mental health crisis. 

 December 7, 2021. Accessed May 26, 2022. 

https://www.nytimes.com/2021/12/07/science/pandemic-adolescents-depression-anxiety.html

11. Axelson D. Addressing the youth mental health crisis with coordinated systems of care. 

https://www.psychiatrictimes.com/view/addressing-the-youth-mental-health-crisis-with-coordinated-systems-of-care

Reducing media-induced mass killings: lessons from suicide prevention. 

13. Pies RW. After Las Vegas, the danger of copy-cat killers. 

http://www.psychiatrictimes.com/trauma-and-violence/after-las-vegas-danger-copy-cat-killers

14. Knoll JL IV, Pies RW. Moving beyond “motives” in mass shootings. 

. January 14, 2019. Accessed May 26, 2022. 

https://www.psychiatrictimes.com/view/moving-beyond-motives-mass-shootings

Kowalski RM, Leary M, Hendley T, et al. 

K-12, college/university, and mass shootings: similarities and differences

Unless there are substantive societal changes at many levels, the answer may be yes.

Is the Plague of Mass School Shootings in the US Here to Stay?

The majority of adults worldwide drink alcohol,

 and most individuals drink alcohol without developing problems related to alcohol use.

 Yet, epidemiological data in the United States suggest as many as 13.9% of individuals meet criteria for a current 

 (AUD) and approximately one-third (29.1%) meet lifetime criteria.

 Globally, alcohol use contributes to 5% of the total disease burden and is associated with tremendous social and economic costs.

AUD is defined by the DSM-5 as clinically significant impairment or distress, resulting from endorsing at least 2 of 11 symptoms in the past 12 months.

 The 11 symptoms are intended to fall into 4 symptom clusters (

The DSM-5 also provides a definition of remission from AUD based on the length of time that symptoms are no longer present. Early remission is defined as greater than 3 months and less than 12 months of endorsing no symptoms of AUD, apart from craving. Sustained remission is defined as 12 months or more of endorsing no symptoms of AUD, apart from craving. Craving is excluded from definitions of remission, given that craving could persist long after remission of other AUD symptoms is achieved.

Although AUD is often described as a chronic and relapsing condition, remission from AUD is achievable. In fact, most people with AUD enter remission even without treatment.

 This natural recovery process is the most common pathway to AUD resolution.

 As noted previously, it is important to highlight that many people drink alcohol without developing problems,

 and those who drink less have lower morbidity and mortality.

Samantha Johnstone, BA; Kevin P. Hill, MD, MHS; and Tony P. George, MD, FRCPC

As early as the 1700s, AUD recovery was defined by complete and total abstinence from alcohol use, and this view persisted until the 1900s.

 Although in some spaces, such as Alcoholics Anonymous, total abstinence is still considered a required aspect of recovery, current definitions have shifted toward a focus on the importance of overall functioning and general well-being with or without abstinence.

 Recovery from AUD includes broader domains of well-being, quality of life, social environment, and health functioning, with subdomains of cognitive and emotional functioning, purpose in life, engagement in valued activities, social network support, cultural connections, reductions in harmful use, and ecological and contextual features that support health (

Domains and Subdomains in Definitions of Recovery from AUD

"Limiting definitions of recovery to abstinence and the absence of AUD symptoms fail to capture the multidimensional and heterogeneous pathways to recovery that research has shown to exist among both treatment-seeking and population samples."

Cannabis Legalization: What Psychiatrists Need to Know

Making a Fist

NCCHC Foundation Offers Scholarships for the NCCHC Correctional Mental Health Care Conference

Is the Plague of Mass School Shootings in the US Here to Stay?

Nonabstinent Recovery From Alcohol Use Disorder

Simple Tasks

Honoring Heritage Months: Jewish American & Asian American and Pacific Islander

Enough

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Substance Misuse in College Students