Tuesday, April 8, 2025

By Don Sapatkin

Plus: The American Psychological Association makes concessions to Trump pressure on DEI. Exposure to wildfire smoke is associated with more frequent mental health emergencies. 

But first: The superiority of monogamy is a myth, The Journal of Sex Research reports: non-monogamous people are just as happy with their relationships and sex lives.

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Some good news: protesting may benefit your mental health!

As draining as recent weeks have been to watch – and experience – the energy on Saturday was universally positive, the mood upbeat and celebratory. The spirit reminded me of the (many, many) anti-Vietnam War protests I joined in junior high and high school – the music and connections with strangers. While anger and hurt may have compelled many to come out over the weekend, there’s also evidence that coming together to resist can help: Studies of student protesters, Black Lives Matter participants and LGBTQ+ activists have found that protesting can improve their mental well-being.

Kate Woodsome, a journalist who explores the ties between mental health and democracy in her  Substack newsletter, wrote a smart report from Saturday’s rally in Washington, D.C. about how collective resistance, including protest, can build resilience.

Before, during and after a protest, she writes, it’s important to pay attention to what you’re feeling and how your environment affects it, and then “adjust” to take care of yourself and others. “When we’re frayed, so are our relationships,” she says. People have felt overwhelmed and helpless these past couple months, she adds, and Saturday was a way to regain agency and boost morale: “Threats to one’s well-being can activate the “tend-and-befriend” stress response, especially in women, boosting oxytocin and reducing cortisol. So engaging in collective resistance like protests can reduce anxiety and nurture collective resilience.”

To me, Woodsome’s most incisive comments come at the end of an accompanying video she recorded on her way to the D.C. rally. The people around her are finding strength in kindred causes, she says, recalling that she saw a similar collective energy from those at the Trump inauguration. “What’s fascinating is that whether you’re for or against something, when you bond together with others, there is a particular strength and resilience that can come from it.” Her grace note: “Find your cause and work towards it. Hopefully it is not impinging on others’ rights in the process.” 

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San Francisco’s new centrist mayor scales back on a liberal city’s harm-reduction policies

One of the biggest successes of the harm reduction movement in the U.S. might be needle exchanges, pioneered in part by activists in 1980s San Francisco. Underground groups swapped used needles for clean ones, no questions asked, helping slow the spread of HIV amongst injection drug users, many of whom had the virus, and who otherwise frequently shared needles. It worked, and similar schemes have been a key part of controlling the disease since, despite fierce opposition from conservatives. Needle exchange sites have taken on other functions, too, by serving as neutral places where long-time addicts, many of them homeless, can come for health care. As that trusting relationship builds over months, staff can try to convince them to get treatment.

Few cities are as open-minded about harm reduction as San Francisco. City-funded nonprofits have for years handed out smoking supplies like foil (for heating fentanyl, heroin, cocaine and methamphetamine), straws (for inhaling or snorting the heated vapors) and pipes, largely in hopes of getting users into treatment and housing, but also because smoking is believed to be safer than injecting. They may also give out clean needles.

Times are a’changing. Daniel Lurie, the centrist new mayor who campaigned on a law enforcement-friendly platform of reducing crime and fentanyl use last week announced a rollback of what he deems overly loose harm reduction policies, the New York Times reports. “We’ve lost our way,” Lurie said as he walked around the city’s Tenderloin neighborhood, kneeling beside people who appeared to be unconscious or openly using drugs while ignoring the city officials who looked on. “We are no longer going to sit by and allow people to kill themselves on the streets.”

Under the new policy, effective April 30, city-funded nonprofits and other contractors will be required to proactively “provide counseling to motivate participants to enter treatment in all interactions that include the distribution of safer use supplies.” And: “Programs must ensure that they can rapidly link participants to treatment as soon as a participant is ready.” Safer smoking supplies can no longer be distributed on sidewalks or other public spaces, instead moving to buildings like those that house clinics. Syringes and safe-injection supplies are an exception, and can still be given out on sidewalks and in parks.

The opioid overdose reversal drug naloxone, widely distributed by programs working to make drug use safer, will still be encouraged. And Lurie, who keeps naloxone in his city-provided Chevrolet Tahoe, said he still believes in the value of sensible harm reduction. The city plans to add more shelter and treatment beds, but released no details – Lurie acknowledged in his announcement that the city does not currently have enough to meet needs. 

The nonprofit providers that will be affected by the policy change have argued that they do not have enough funding or staffing to adhere to the robust counseling requirements. And the head of the San Francisco AIDS Foundation, said making it harder to obtain foil, pipes and straws might push people toward injecting fentanyl instead, which is more likely to lead to fatal overdoses and skin infections.

Gina Fromer, CEO of Glide Foundation, told the San Francisco Chronicle that for organizations like hers to make real progress helping people, “we need the resources that will lead people to recovery and stability, and the city has to hold up its end of the bargain on that.” Glide should still be able to distribute smoking supplies from its parking lot in the Tenderloin.

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Offering addiction services to patients who are hospitalized boosts the odds they’ll get treated

People with opioid use disorder are frequently admitted to hospitals, often for medical conditions unrelated to narcotics. Yet very few of them begin treatment while hospitalized. In a new study, some patients with OUD were randomly assigned to a hospital-based addiction consultation service regardless of why they were admitted – in other words, not necessarily due to an overdose. Patients who received those consultations were roughly twice as likely to begin effective medication-assisted treatment before discharge, and also significantly more likely to continue that treatment afterward, compared to the group that received usual care. 

“Usual care” practices differed among the three academic medical centers where the randomized controlled trial was conducted but could involve a less-intensive, less-coordinated effort to offer care for patients with the disorder, if that care occurred at all. 

The conclusion – that it’s productive to offer treatment when patients are already in the hospital – seems obvious, and has for years. This study backs that assumption up with additional evidence: “Patients can begin treatment for their addiction at the same time their other illnesses are being addressed,” Allison Ober, lead author of the study published in JAMA Internal Medicine and a senior policy researcher at RAND, a nonprofit research organization, said in a press release. The consultation model in the study involved an addiction medicine specialist, a care manager and follow-up telephone calls for the month after release.

The opportunity to begin treatment could be particularly important for patients who have trouble accessing medications to treat the disorder because of unstable housing, costs, and other social determinants of health. Most of the study’s 325 adult participants were low-income, more than half had been without a home in the past year, and 50% were unemployed. 

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Whither hotlines after DOGE?

Here’s a tidbit of apparent good news: Many workers involved with overseeing the national 988 crisis and suicide hotline appear to have been spared from cuts decimating the surrounding Substance Abuse and Mental Health Services Administration (SAMHSA), Stat reports. The hotline, which has routed roughly 15 million calls, texts and chats to trained crisis workers since its mid-2022 launch, also connects to the Veterans Crisis Line.

Other hotlines were not so lucky. Among those losing staff are the Maternal Mental Health Hotline, which offers free professional counseling to pregnant and postpartum women and has received more than 54,000 calls since launching in 2022. It’s unclear what will happen to the national network of quit-smoking lines after the CDC’s Office on Smoking and Health was gutted – HHS firings hit the people overseeing contracts with states and running quit lines in languages including Spanish, Korean, and Cantonese, according to Stat.

It’s worth bearing in mind that Stat’s report that “many” SAMHSA workers assigned to 988 were spared only refers to the firings of 10,000 announced two weeks ago. KTTC/NBC10 in Rochester, Minn. and other local news outlets ran stories about cuts made more than a month ago, and one 988 communications worker posted that a quarter of her team had been terminated. Also unknown: the impact of HHS Secretary Robert F. Kennedy Jr.’s plans to merge SAMHSA, the Health Resources and Services Administration (which operates the Maternal Mental Health Hotline), and several other agencies into his new Administration for a Healthy America. 

Other threats loom as well: The 988 suicide hotline is overseen by the federal government, but is operated almost entirely by the states –  and some of the nearly $12 billion in grants to states that were cut with no warning (a federal judge has issued a temporary hold) had been used to pay for local operations.  A Wisconsin “warmline” staffed by non-clinical certified peer specialists, for example, shut its doors on Saturday due to a grant cancellation. 

Other Trump/Musk/DOGE headlines: JAMA News: “Guaranteed Pandemonium” as HHS Secretary Slashes Federal Health Workforce; The Atlantic:  RFK Jr.’s 18th-Century Idea About Mental Health; and ‘I Am Going Through Hell’: Job Loss, Mental Health, and the Fate of Federal Workers, in KFF Health News.

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In other news…

The American Psychological Association has suspended its requirement that accredited postgraduate programs show a commitment to diversity in recruitment and hiring, the New York Times reports. The changes are part of a wave of concessions from private sector organizations that fear investigations stemming from President Trump’s executive order attacking diversity, equity and inclusion policies. The APA is the chief accrediting body for professional training in psychology, and the only one recognized by the U.S. Department of Education. It accredits around 1,300 training programs, including doctoral internships and postdoctoral residencies. Trump has specifically targeted accrediting bodies, recently taking aim at the American Bar Association.

But the APA’s capitulation is particularly noteworthy. Psychologists are disproportionately white and female, and the association has made combating racism a central focus of its work in recent years. An APA accreditation official told the Times that its Commission on Accreditation’s March 13 vote to suspend the diversity requirement was driven by a large number of inquiries from programs worried about threats from the Trump administration. Legal counsel instructed many of them to cease diversity-related activities, but leaders were concerned that doing so could jeopardize their accreditations. But Trump’s Department of Justice may be looking for more: “Suspension is a welcome development, but it is not nearly enough,” a DOJ spokesman said.

Exposure to wildfire smoke in particular is linked with more mental health ER visits, according to a Harvard press release on faculty research. The analysis, in JAMA Network Open, examined medical records for 86,668 California emergency department visits, all for mental health conditions, during the severe 2020 wildfire season. It found that recent exposure to wildfire-specific fine particulate matter (PM2.5) was associated with a significant increase in mental health-related ED visits, particularly for young children, racial and ethnic minority groups, and women. 

“Our study suggests that – in addition to the trauma a wildfire can induce – smoke itself may play a direct role in worsening mental health conditions like depression, anxiety, and mood disorders,” corresponding author Kari Nadeau says in the press release. The study is described as the first of its kind. I wrote three months ago about a different kind of study, also a first, that linked long-term exposure to wildfire smoke with increased risk of dementia.

If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

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