New addiction society guidance on medetomidine’s brutal withdrawal

Clinicians first noticed medetomidine in the Philadelphia drug supply during the spring of 2024. There was a cluster of overdoses one weekend, leaving patients more sedated and with lower heart rates than normal after receiving the reversal medication naloxone. 

It raised some red flags, but amid a constantly changing drug supply, not many. None of the patients died, and most went home from the hospital the same day. It wasn’t until autumn, when patients started coming in with excruciating withdrawal symptoms, that doctors knew something had dangerously shifted. 

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STAT+: Across the U.S., homegrown experiments aim to save kids from their phones

MILWAUKEE — Kat Zilka sat on the floor of her living room, beside a glowing Christmas tree and a pile of essays, and felt like weeping. It was late in 2022, and she had asked her 12th grade digital journalism students to reflect on their relationships to devices. 

“The things they were writing were deeply disturbing,” she said. 

Teenagers quietly enduring online abuse, using their phones all night without their parents’ knowledge, or trapped in a cycle of deleting and redownloading social media. Their words made real what Zilka had been observing for years — how the light in students’ eyes was dimmer, especially since Covid — and revealed the astonishing magnitude of the problem.

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Psychosocial Correlates of AI Chatbot Use for Emotional Support Among Young Adults: Cross-Sectional Study

<strong>Background:</strong> Generative AI chatbots are increasingly used for mental health–related purposes, yet little is known about the factors associated with such use or AI chatbot dependence. <strong>Objective:</strong> This study examined factors associated with young adults’ use of AI chatbots for emotional self-disclosure and mental health–related support, as well as the associations between AI chatbot use and dependence. <strong>Methods:</strong> A cross-sectional online survey of individuals aged 18 to 29 years was conducted in Japan. Self-report measures assessed psychosocial factors (self-esteem and loneliness), mental health symptoms (anxiety and depression), AI chatbot use (emotional self-disclosure and mental health–related support), and AI chatbot dependence (emotional dependence and social anxiety–related dependence). <strong>Results:</strong> Of 820 participants, 381 (46.5%) reported using AI chatbots for emotional self-disclosure at least once in the past month, including 65 (7.9%) who reported doing so every day or almost every day. In addition, 336 (41%) reported using AI chatbots for mental health–related support, including 53 (6.5%) who reported doing so every day or almost every day. Anxiety and depressive symptoms were combined into a composite measure of mental health symptoms because they are highly correlated. Multivariable logistic regression showed that greater mental health symptom severity, but not self-esteem or loneliness, was associated with both emotional self-disclosure (odds ratio [OR] 2.23, 95% CI 1.85-2.69; <i>P</i>&lt;.001) and mental health–related support (OR 2.42, 95% CI 2.01-2.94; <i>P</i>&lt;.001). Among emotional self-disclosure users (n=381), the frequency of emotional self-disclosure was positively associated with emotional dependence (β=0.334; <i>P</i>&lt;.001) and social anxiety–related dependence (β=0.307; <i>P</i>&lt;.001). Path analyses indicated that a model specifying psychosocial factors and mental health symptoms as antecedent variables to AI chatbot use and dependence fit the data better than an alternative model specifying AI chatbot use and dependence as the antecedent variables (comparative fit index [CFI]=0.994 vs 0.583; root mean square error of approximation [RMSEA]=0.033 vs 0.293). In this model, lower self-esteem and greater loneliness were associated with more severe mental health symptoms, which, in turn, were associated with greater AI chatbot dependence, primarily through direct pathways and, to a lesser extent, through more frequent emotional self-disclosure. Among emotional self-disclosure users, loneliness was the only significant psychosocial correlate of emotional dependence (<i>F</i><sub>1,369</sub>=7.78; <i>P</i>=.006). <strong>Conclusions:</strong> Emotional engagement with AI chatbots was common in this sample of young adults in Japan. Findings suggest that young adults experiencing mental health symptoms may be more likely to use AI chatbots for emotional self-disclosure and mental health–related support, while loneliness may be particularly relevant to emotional dependence among users. These findings highlight the need to understand AI chatbot use not only as a technological behavior but also as part of young adults’ broader emotional and help-seeking landscape.

What Is Sextortion?

Andy, a 16-year-old high school junior in New York City, received a message from a girl he didn’t know on Snapchat. She was cute, blonde, a freshman at the University of Wisconsin, and her greeting was Midwestern nice. He barely paused before responding. They chatted on the platform for a few days before she asked him to send a nude photo of himself. Andy didn’t know what to do, so he texted his closest friends for advice. They told him to find a nude photo of a stranger online and send that, so he did. And that’s when everything changed.

The person posing as a college girl threatened to share the photo everywhere online and claim it was him — unless Andy sent a $100 gift card. Scared, he went to the drug store and sent it right away. But the threats didn’t stop, and the messages got more frequent and intense. The person texting revealed that they were an adult overseas, not a college student, and would be tortured if they didn’t succeed in getting Andy to send more money. The amounts increased to $300 at a time, and he scrambled to do it, using his parents’ credit card. Over the course of a week, he racked up a bill of nearly $2,000.

This is just one example of sextortion, the use of explicit content to threaten someone with exposure if they don’t do what is demanded. One large U.S. survey found that approximately 5 percent of middle and high school students have been victims of sextortion, while about 3 percent admitted to targeting others. The National Center for Missing and Exploited Children (NCMEC) notes that they have seen a dramatic increase of cases reported to their CyberTipline, in particular from teenage boys.

Definition of sextortion

Sextortion is a form of exploitation where a child is threatened or blackmailed, most commonly with the possible public sharing of nude or sexual images of the child, by someone who demands additional sexual images or money.

A teen can be sextorted by a someone they know — often someone they are dating or used to date. But the perpetrator also can be an adult stranger pretending to be a teen to lure kids.   

With strangers, the interaction starts off innocuously enough: a friendly text or message online, often from someone who appears to be a similar age as the child and usually of another gender. That might be on video games such as Roblox or Minecraft for younger kids or Discord servers for teens. They may share connections in common on the platform because they’ve reached out to the child’s friends as well, so even though they’re a stranger, they don’t seem like one. “What’s tricky is who kids will describe as a friend versus a stranger is different than for adults,” says Megan Ice, PhD, a psychologist at the Child Mind Institute. “A kid may feel like they know this person” who they just met online and texted a few times.

The predator will establish a friendship or romantic relationship, then they may propose “I’ll show you mine if you show me yours” to ask for a nude photo. Or they will secretly record a video or live chat to get explicit content. In the era of generative AI and “nudify” apps, a kid doesn’t even have to provide a nude — they can use regular photos of a child to create sexual images for blackmailing purposes.

There is also sadistic sextortion, a newer but growing form of sextortion where the child is forced to do dangerous and disturbing things like torture pets or hurt themselves and write their name in blood on the wall, all performed on camera. A global network called 764 has targeted children and adolescents with sadistic sextortion, and the FBI has posted warnings about the group.

The pressure to comply is intense — the texts might come every few seconds, dozens of messages an hour and progressively faster, to create a sense of urgency. The blackmailer might have a package delivered or send the police to a child’s house on a false report (known as “swatting”) to show they know where they live, so the threat of retribution feels very real. The fear, shame, and hopelessness have led some kids to die by suicide after being sextorted.

Why teens are at risk for sextortion

While all age groups are at risk for sextortion, teens are often targeted because they are particularly vulnerable. During adolescence, changes in the brain can lead teens to feel social rewards intensely, so they care a lot about what others think of them, Dr. Ice says.  And that makes them more likely to underestimate the risks of doing something that feels good in the moment.

“Adolescents are exploring their identity, they’re exploring their sexuality,” says Justin Patchin, PhD, a professor of criminal justice at the University of Wisconsin–Eau Claire, who studies sextortion. Their prefrontal cortex is still developing, so short-term rewards are prioritized over long-term consequences. That means “they’re more vulnerable to acting impulsively and sharing explicit images with somebody that they’re interested in.”

“The other reason high school students make a particularly good target is because if a 16-year-old girl sends a topless picture to somebody online, they’ve now created and distributed child pornography, which is a crime. Whereas if an 18-year-old girl does that, it’s not a crime,” Dr. Patchin says. Blackmailers may tell teens who send sexual images or other explicit content that they’ve broken the law and could be prosecuted, which makes the extortion even more effective.

“I teach criminal justice, and sexting is the only behavior that I can think of where teens are treated more harshly by the system than adults,” Dr. Patchin says.

Teen groups at higher risk for sextortion

Research shows that LGBTQ+ kids are more at risk for sextortion. They often find community online, and it’s common for them to have friendships with people that they haven’t met in person.

Kids with autism, ADHD, or mental health issues such as social anxiety may also be particularly at risk. “Neurodiverse kids may develop strong friendships in online communities related to niche interests, making them vulnerable to predators who take advantage of the lack of supervision in these spaces,” Dr. Ice says. She is especially concerned about autistic kids, who may not question the intentions behind other members’ communications, and kids with ADHD, whose struggles with impulsivity may mean they act quickly when responding to a request.

“Kids who are hiding behavior from adults” — such as kids with eating disorders or who self-harm — tend to be very active in online communities like Reddit, Dr. Ice says. Predators will commonly target those communities to find the kids who are most vulnerable and then work to build relationships with them.

How to prevent sextortion

Parents can’t prevent sextortion from happening, but they can talk to their kids to make them aware of it — and advise them to speak up immediately if something happens. “I tell parents if there’s an incident in the news, if you see an article that you’re reading online, that’s a good prompt to have that conversation with your kid and say, ‘Hey, look at this story,’” Dr. Patchin says. “You can ask them, ‘Has anything like this happened to you? If it does, please come talk to me. We’ll deal with it together.’”

You can discuss the risks of sexting, Dr. Patchin says: “If that image does get online somewhere and a bunch of people see it, what kind of potential consequences there might be. And in an extreme, terrible situation, maybe it could be a crime if a prosecutor or a police officer wants to pursue it.”

It’s also important to be aware of common tactics and tell kids about them. For example, predators often move the conversation to messaging apps disguised to look like a clock or calculator app, but when you click on it, you have to enter a password. That can help them avoid detection, because mainstream apps often have content filters. Private messaging apps also make it harder for law enforcement to track and prosecute them.    

“Kids need to be educated, because there are people online who will take advantage of them not knowing what is safe,” Dr. Ice says. “Just like you would take certain safety precautions when you’re walking down the street, you need to take safety precautions online.”

While you want kids to understand the risks of engaging in these behaviors, you want to emphasize they should come to you for help no matter what. “You want to make clear that if they tell you, they will not lose access to their phone or all the things that keep them connected to their friends,” Dr. Ice says. “I think that fear is what keeps it secret a lot of the time.”

NCMEC has useful resources about sextortion, including an interactive activity for teens, noescaperoom.org.  

Signs of sextortion

Many signs of sextortion are similar to those of depression or even addiction, particularly online gambling. For example, a child might show sudden changes in eating or sleeping habits, uncharacteristic changes in behavior or routine, or engage in more secretive online behavior. Kids might become either distant or clingy because they are stressed out and afraid to tell you what is going on. According to NCMEC, other signs might include:

  • Receipt of anonymous gifts (physical or digital)
  • Law enforcement being called to your home under false pretenses
  • Random occurrences at your address, such as unexpected deliveries

Signs of sadistic sextortion might include:

  • Scarring on the thighs or forearms, especially if the scars form a pattern
  • Sudden interest in collecting tools including drills, screwdrivers, hammers, blow torches, or large knives with no clear purpose
  • Family pets or other animals being harmed or dying under suspicious circumstances

What to do if someone is blackmailing your child

If your child tells you they are being sextorted, “you want to avoid shaming and blaming — of yourself or the child,” Dr. Ice says,  because these are professional scammers who know what works. “Let them know they did the right thing to tell you, and you can help them.” Don’t pay the blackmailer more money because it rarely makes them stop. Here are some steps you can take:

  • Report the account on the platform where the interaction occurred.
  • Block the person, but don’t delete your child’s profile or messages — they can be helpful to track the person and stop the blackmailing.
  • Go to the police station to report the sextortion. You can also report the incident to the CyberTipline, run by NCMEC, which can connect you with legal, emotional, and other supports.
  • Use NCMEC’s Take It Down, which helps youth remove online nude, partially nude, or sexually explicit photos and videos taken before they were 18.

When Andy finally told his mom Jackie about the sextortion — about a week after that first message — it was nearly 11pm, but his dad took him to the police station to report it. The police said that they were the fourth family to come in that day about sextortion and reassured them that the perpetrators would not come after them. “Hearing that was the biggest relief,” Jackie said. “Once we wiped his phone and computer, it was over.”  

Frequently Asked Questions

What is sextortion?

Sextortion is a form of exploitation in which someone threatens to share a nude or sexual images unless the person comply with demands, typically for money, more explicit content, or other harmful actions. Kids are often targeted, and the perpetrator may be someone the child knows or a stranger who has built trust online by pretending to be a peer.

How can you get rid of blackmailers?

Experts advise not paying the blackmailer, because paying rarely makes the demands stop and often leads to requests for more money. Instead, report the account on the platform, block the person, save the messages as evidence, and contact law enforcement. If your child is being targeted, the National Center for Missing and Exploited Children has useful resources.

What should you do if someone is blackmailing you with nudes?

If someone is threatening you with intimate images, tell a trusted adult right away and remember that you are not alone. Report and block the offender, keep copies of messages and other evidence, and make a police report. If the images or videos were taken before you turned 18, the National Center for Missing and Exploited Children has a service called Take It Down to help you remove them from the internet.

The post What Is Sextortion? appeared first on Child Mind Institute.

Renewing a Commitment to Collaboration

Ottawa ON, November 10, 2026 — The Canadian Centre on Substance Use and Addiction and the Mental Health Commission of Canada   signed a renewed memorandum of understanding on November 9, 2026, issuing the following joint statement:

“The Canadian Centre on Substance Use and Addiction (CCSA) and the Mental Health Commission of Canada (the Commission) have renewed their memorandum of understanding, reaffirming a long-standing commitment to working together to improve mental health and substance use health outcomes for people in Canada. Through this collaboration, both organizations can leverage expertise and networks to bring about meaningful change and improve wellness for individuals and their communities.

While our organizations have collaborated for many years, both with and without a formal agreement, this renewed MOU reflects our shared belief that the challenges facing people in Canada are best addressed through partnership.

Mental health and substance use health are deeply interconnected. Many people experience challenges in these areas together, and they require coordinated, person-centred approaches that recognize the complexity of people’s lives. By bringing together our respective expertise, CCSA and the Commission can strengthen knowledge exchange, inform policy discussions, support innovation, and advance practical solutions that better serve people and communities across Canada.

Our collaboration already extends across a range of initiatives. Most recently, the CCSA and the Commission partnered to develop Canada’s first guidance for the responsible use of artificial intelligence in mental health and substance use health. This work is helping establish practical criteria grounded in trust and explainability, human-centred care, equity, and data governance, demonstrating how our organizations can work together to address emerging opportunities and challenges in health care.

This renewed agreement is not simply about formalizing a partnership. It is about affirming our continued commitment to collaboration, recognizing that meaningful progress happens when organizations work together toward shared goals.

We look forward to building on our partnership in the years ahead.”

About CCSA
CCSA was created by Parliament to provide national leadership to address substance use in Canada. A trusted counsel, we provide national guidance to decision makers by harnessing the power of research, curating knowledge and bringing together diverse perspectives.

CCSA activities and products are made possible through a financial contribution from Health Canada. The views of CCSA do not necessarily represent the views of Health Canada.

About the Commission
The Mental Health Commission of Canada is a pan-Canadian, not-for-profit organization that connects evidence, knowledge, and lived experience to provide actionable insights and solutions that advance mental health and improve lives. Guided by our vision of “Strong Evidence. Strong Solutions. Strong Mental Health.” We deliver on our mission by enabling collective action, informing solutions and decision-making, transforming knowledge and building capacity.  

Media contacts
Mélissa Joseph, Strategic Communications Advisor 
Canadian Centre on Substance Use and Addiction
613‑235‑4048 x 364|mjoseph@ccsa.ca

and

Debra Yearwood, Director, Marketing and Communications
Mental Health Commission of Canada
613-402-9080
mediaphone@mentalhealthcommission.ca

The post Renewing a Commitment to Collaboration appeared first on Mental Health Commission of Canada.

Maladaptive state allocation: an orexin-based framework linking sleep disturbance, chronic pain, and substance use disorder

Sleep disturbance, chronic pain, and substance use disorders are highly prevalent conditions that frequently co-occur and exacerbate one another. Although traditionally studied as distinct clinical entities, growing evidence suggests they share common neurobiological mechanisms. Among these, the orexin (OX; also known as hypocretin) system has emerged as a critical regulator of arousal, motivation, stress responsiveness, and nociception, positioning it as a potential contributor to interactions among sleep, pain, and addiction. In this review, we propose that OX may function as a state-integration network that coordinates behavioral responses to competing physiological and environmental demands. Through widespread projections to brainstem, thalamic, limbic, and mesolimbic circuits, OX transmission dynamically regulates vigilance, salience attribution, pain modulation, and reward-seeking behavior. Under physiological conditions, these actions promote adaptive behavioral prioritization. However, chronic dysregulation of OX transmission may result in maladaptive state allocation characterized by persistent hyperarousal, amplified pain-related salience, and excessive motivational value assigned to drug-associated cues. We synthesize experimental evidence implicating OX-dependent circuits in the pathophysiology of sleep disturbance, chronic pain, and substance use disorder and introduce a conceptual triad model linking these conditions. Within this framework, we propose that sleep loss may increase pain sensitivity and craving, chronic pain may disrupt sleep and promote substance use, and repeated drug exposure may further destabilize sleep and pain regulation, creating a self-reinforcing cycle. Finally, we discuss individual factors that may influence vulnerability to triadic comorbidity and highlight emerging therapeutic approaches targeting the OX system.

10 Hz repetitive transcranial magnetic stimulation for nitrous oxide dependence: a case report

Nitrous oxide (N2O) abuse has emerged as an increasingly serious public health concern, yet effective interventions for N2O dependence remain lacking. We report on a 21-year-old woman with N2O dependence who, after 6 months of repeated N2O inhalation, developed gait instability, limb numbness and tremors, accompanied by delusions and auditory hallucinations. During her first hospitalization, she was treated with antipsychotics and vitamin B12; however, she relapsed to N2O use shortly after discharge and was readmitted. Upon her second admission, she received 10 sessions of 10 Hz repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex. Her craving for N2O began to decline after the third session and continued to improve after the sixth, with dependence largely resolved by the end of the treatment course. No adverse events, such as headache or tinnitus, and no significant withdrawal symptoms were observed during treatment. The patient was followed up 3 times after discharge and had maintained abstinence from N2O for 3 months (12 weeks) since her last use, remaining emotionally stable and resuming normal daily life and work. To our knowledge, this is the first reported case of high-frequency rTMS for N2O dependence. Our findings suggest that rTMS may reduce craving in the short term in these patients, offering a promising therapeutic approach to this escalating public health problem.

The nonlinear relationship between symptoms of internet addiction and depressive symptoms: an empirical study among Chinese university students

ObjectTo examine the nonlinear dose-response association between IA and depressive symptoms, while also exploring potential variations in this association across demographic subgroups.MethodsA cross-sectional study was administered to Chinese university students. Internet addiction (IA) was assessed using an 8-item standardized diagnostic instrument. Depressive symptoms were evaluated utilizing the Center for Epidemiologic Studies Depression Scale (CES-D). Restricted cubic spline (RCS) regression was employed to detect nonlinear relationships and identify inflection points. Multivariable logistic regression and Cochran-Mantel-Haenszel stratified analyses, controlling for potential confounders, were conducted to assess symptom-specific correlates and examine subgroup differences.ResultsA nonlinear association was observed between IA scores and depressive symptoms (p < 0.005), characterized by inflection points at scores of 4 and 7. Higher odds of depressive symptoms were seen at scores exceeding 4, demonstrating a pronounced increase beyond 7, and lower odds below 4. Analysis of specific IA symptoms revealed: Preoccupation was significantly correlated with higher odds of depressive symptoms (OR = 2.60, p<0.05); deception was associated with elevated odds of depressive symptoms (OR = 1.51, p < 0.05); whereas needing more time online exhibited an association with lower odds of depressive symptoms (OR = 0.63, p < 0.05). Each unit increase in IA score was associated with 31% higher overall odds of depressive symptoms (OR = 1.31, p < 0.05). This association persisted following covariate adjustment, demonstrating a robust and independent correlational association. The positive association remained consistent across nearly all demographic and socioeconomic subgroups examined. Boarding school attendance was linked to a stronger IA-depressive-symptom association (p < 0.001). Furthermore, only children exhibited stronger correlational estimates between IA scores and depressive symptoms compared to non-only children (OR = 1.24, p = 0.030).ConclusionThe study indicates a positive correlational link between IA Score and depressive symptoms. RCS regression shows a curved relationship, with turning points at scores 4 and 7. Higher IA Scores correlate with elevated odds of depressive symptoms, making it a potential screening indicator for depressive-symptom risk (correlational only) for college students. Elevated odds are also present with an IA Score below 4. Excessive online activity correlates with higher odds, while prolonged internet use for gratification shows an association with lower odds of depressive symptoms.