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Behavioral Health FAQ's

SUBSTANCE USE DISORDERS: ALCOHOL & DRUG ADDICTION / MENTAL HEALTH PROBLEMS & MENTAL ILLNESS / Suicide / CO-OCCURRING DISORDERS OR CO-MORBIDITY / problem gambling

SUBSTANCE USE DISORDERS: ALCOHOL & DRUG ADDICTION

man looking at ocean

Q: What are addictions?
A: Addictions are compulsions to use and abuse things to an excessive and destructive extent. People most often become addicted to alcohol, drugs, sex, gambling and food. These compulsions are very powerful and produce a life-threatening and self-perpetuating process that can end in disability or death for the sufferer, as well as cause family members and loved ones pain and suffering. Addictions can produce major life consequences, such as loss of a job and financial trouble, worsening of negative personality traits, loss of other interests, and repetitive relapsing, possibly ending in death

Q: What is alcohol and/or drug addiction?
A: Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use despite harmful consequences to the individual who is addicted and to those around them. Addiction is a brain disease because the abuse of alcohol/drugs leads to changes in the structure and function of the brain. Although it is true that for most people the initial decision to take drugs is voluntary, over time the changes in the brain caused by repeated abuse can affect a person’s self control and ability to make sound decisions, and at the same time send intense impulses to take drugs or drink alcohol. These changes in the brain are what make it so challenging for a person who is addicted to stop abusing alcohol/drugs.

Q: What is the difference between addiction and abuse?
A: Drug or alcohol addiction is a diagnosable disease characterized by several factors including a strong craving for drugs/alcohol, continued use despite harm or personal injury, the inability to limit drug use/drinking, physical illness when using stops, and the need to increase the amount used in order to feel the effects.

Abuse is a pattern of drug use/drinking that result in harm to one’s health, interpersonal relationships or ability to work. Certain manifestations of abuse include failure to fulfill responsibilities at work, school or home; using/drinking in dangerous situations such as while driving; legal problems associated with drug/alcohol use, and continued use despite problems that are caused or worsened by drug use/drinking. Abuse can lead to addiction.

Q: Is alcoholism or drug addiction a disease?
A: Yes, alcoholism and drug addiction are diseases. The craving for alcohol or a drug can be as strong as the need for food or water.  Persons dependent on alcohol or drugs will continue to use despite serious family, health, or legal problems. Like many other diseases, alcoholism and drug addiction are chronic, meaning that it lasts a person's lifetime; it usually follows a predictable course; and it has symptoms.

Q: Can alcoholism and drug addiction be cured?
A: No, there is no cure for these diseases at this time. However, alcohol and drug dependence can be treated successfully. While there is no “single” or “right” path to recovery, most people benefit from  clinical treatment services, including medication as appropriate;  peer and self-help support groups; faith-based approaches; non-clinical services such as linkage to and coordination among a variety of social services and community resources; or a combination of these and other methods.

Q: Why do some people become addicted, while others do not?
A: No single factor can predict whether or not a person will become addicted to drugs or alcohol. Risk for addiction is influenced by a person’s biology, social environment, and age or stage of development. The more risk factors an individual has, the greater the chance that drinking alcohol or taking drugs can lead to addiction.

Q: What is a substance use disorder?
A: The phrase substance use disorder refers to conditions arising from the abuse of alcohol and/or psychoactive drugs. Substance use, like many human behaviors, occurs along a broad continuum from no use to extremely heavy use. The continuum includes substance use, substance abuse, and substance dependence or addiction.

Q: How do I know if I have a substance abuse problem?
A: Drug/alcohol use is a problem if it causes trouble in your relationships, in school, in social activities, or in how you think and feel. If you are concerned that either you or someone in your family might have a substance problem, consult your personal physician.

Q: How do I know if someone else is addicted to alcohol/drugs?
A: If a person is compulsively seeking and using alcohol/drugs despite negative consequences, such as loss of job, debt, physical problems brought on by drug abuse, or family problems, then he or she may be addicted. Seek professional help to determine if this is the case and, if so, work to get that person into the appropriate treatment.

Q: Does treatment really work?
A: Yes, research shows that the success rates for addiction treatment are equal to the success rates for other chronic illnesses such as diabetes, hypertension and asthma. Approximately 40 – 60% of individuals who complete chemical dependency treatment and attend self help groups (such as Alcoholics Anonymous) are likely to remain abstinent from alcohol or other drugs.

Q: Is addiction to alcohol and other drugs more prevalent in certain groups of individuals?
A: No, anyone may become addicted to alcohol and/or other drugs. Addictions affect people of all ages, all income groups, all ethnicities, all religious groups, urban and rural, male and female. No one is immune to an addiction.

Q: What happens to your brain when you take drugs?
A: Drugs are chemicals that tap into the brain’s communication system and disrupt the way nerve cells normally send, receive, and process information. Researchers have found that using drugs (or alcohol) for a long time changes the brain in important, long-lasting ways. It is as if a switch in the brain turned on at some point. This point is different for every person, but when this switch turns on, the person crosses an invisible line and becomes dependent on the substance. People who start using drugs or alcohol early in life run a greater risk of crossing this line and becoming dependent. These changes in the brain remain long after a person stops using drugs or drinking alcohol.

Q: What are the physical signs of abuse or addiction?
A: The physical signs of abuse or addiction can vary depending on the person and the drug being abused. For example, someone who abuses marijuana may have a chronic cough or worsening of asthmatic symptoms. Each drug has short-term and long-term physical effects. Stimulants like cocaine increase heart rate and blood pressure, whereas opiates like heroin may slow the heart rate and reduce respiration. In addition, in some cases a person may experience withdrawal symptoms from a physical need for the substance upon stopping use. These symptoms vary as well, but may include nausea, sweating, shakiness, and extreme anxiety.

Q: What are the symptoms of Substance Use Disorders?
A: One of the most important signs of substance addiction or dependence is continued use of drugs or alcohol despite experiencing the serious negative consequences of heavy drug or alcohol use. Often, a person will blame other people or circumstances for his or her problems instead of realizing that the difficulties result from use of drugs or alcohol. These false beliefs are called denial, and denial is part of the illness.

Other important symptoms of substance use disorders include:

  • Tolerance—A person will need increasingly larger amounts of alcohol or drugs to get high.
  • Craving—A person will feel a strong need, desire, or urge to use alcohol or drugs, will use alcohol or a drug despite negative consequences, and will feel anxious and irritable if he or she can’t use them. Craving is a primary symptom of addiction.
  • Loss of control—A person often will drink more alcohol or take more drugs than he or she meant to, or may use alcohol or drugs at a time or place he or she had not planned. A person also may try to reduce or stop drinking or using drugs many times, but may fail.
  • Physical Dependence or Withdrawal Symptoms—in some cases when alcohol or drug use is stopped, a person may experience withdrawal symptoms from a physical need for the substance. Withdrawal symptoms differ depending on the drug, but they may include nausea, sweating, shakiness, and extreme anxiety. The person may try to relieve these symptoms by taking either more of the same or a similar substance.

 

Q: What is withdrawal? How long does it last?
A: Withdrawal is the variety of symptoms that occur after use of some addictive drugs is reduced or stopped. Length of withdrawal and symptoms vary with the type of drug. For example, physical symptoms of heroin withdrawal may include: restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, and cold flashes. These physical symptoms may last for several days, but the general depression or dysphoria (opposite of euphoria) that often accompanies heroin withdrawal may last for weeks. In many cases withdrawal can be easily treated with medications to ease the symptoms, but treating withdrawal is not the same as treating addiction.

Q: What is detoxification, or "detox"?
A: Detoxification is the process of allowing the body to rid itself of a drug while managing the symptoms of withdrawal. It is sometimes the first step in a drug treatment program and should be followed by treatment with a behavioral-based therapy and/or a medication, if available. Detox alone with no follow-up is not treatment.

Q: Does alcohol affect older people differently?
A: Alcohol's effects do vary with age. Slower reaction times, problems with hearing and seeing, and a lower tolerance to alcohol's effects put older people at higher risk for falls, car crashes, and other types of injuries that may result from drinking. Older people also tend to take more medicines than younger people. Mixing alcohol with over-the-counter or prescription medications can be very dangerous, even fatal. In addition, alcohol can make many of the medical conditions common in older people, including high blood pressure and ulcers, more serious. Physical changes associated with aging can make older people feel "high" even after drinking only small amounts of alcohol.

toddler holding mother

Q: Does alcohol affect women differently?
A: Yes, alcohol affects women differently than men. Women become more impaired than men do after drinking the same amount of alcohol, even when differences in body weight are taken into account. This is because women's bodies have less water than men's bodies. Because alcohol mixes with body water, a given amount of alcohol becomes more highly concentrated in a woman's body than in a man's. In addition, chronic alcohol abuse takes a heavier physical toll on women than on men. Alcohol dependence and related medical problems, such as brain, heart, and liver damage, progress more rapidly in women than in men.

Q: If a pregnant woman abuses drugs, does it affect the fetus?
A: Many substances including alcohol, nicotine, and other drugs of abuse can have negative effects on the developing fetus because they are transferred to the fetus across the placenta. For example, nicotine has been connected with premature birth and low birth weight as has the use of cocaine. Whether a baby's health problems, if caused by a drug, will continue as the child grows, is not always known. Research does show that children born to mothers who used marijuana regularly during pregnancy may have trouble concentrating, even when older. Our research continues to produce insights on the effects of drug abuse on the fetus.

Q: Is it safe to drink alcohol during pregnancy?
A: Any pregnant woman who drinks alcohol is at risk of having a child with an FASD, regardless of her education, income, or ethnicity. Pregnant women and women planning to get pregnant should not drink. Pregnant women who are drinking should stop at once to reduce the risk of harming their fetus. Alcohol can harm a fetus at any time, even before a woman knows she’s pregnant. Women who are nursing also should not drink. Alcohol can pass through breast milk to the baby. No amount of alcohol is safe during pregnancy or nursing.

 “Fetal alcohol spectrum disorders” (FASD) is an umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. These effects may include physical, mental, behavioral, and/or learning disabilities with lifelong implications. The term FASD is not intended for use as a clinical diagnosis. It refers to conditions such as fetal alcohol syndrome (FAS), alcohol-related neuro-developmental disorder (ARND), and alcohol-related birth defects (ARBD).

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MENTAL HEALTH PROBLEMS & MENTAL ILLNESS

sitting on bench

Q: What is mental illness?
A: Mental illnesses are biologically based brain disorders. They cannot be overcome through willpower and are not related to a person's character or intelligence. They are medical conditions that disrupt a person’s thinking, feeling, mood, daily functioning and ability to relate to others. People affected can be of any age, race, religion or income.

Q: Are mental health problems different than mental illnesses?

A: Yes. A mental health problem is the term used to describe signs and symptoms of insufficient intensity or duration to meet the criteria for any mental disorder. Almost everyone has experienced mental health problems in which the distress one feels matches some of the signs and symptoms of mental disorders. Mental illness is the term that refers collectively to all diagnosable mental disorders. Mental disorders are health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.

Q: What are the symptoms of mental illness?
A: Mental illness comes in a variety of forms and is accompanied by a number of related symptoms. Symptoms vary depending on the type and severity of the condition. Some general symptoms that may suggest a mental disorder include:

  • Confused thinking
  • Long-lasting sadness or irritability
  • Extreme highs and lows in mood
  • Excessive fear, worrying or anxiety
  • Social withdrawal
  • Dramatic changes in eating or sleeping habits
  • Strong feelings of anger
  • Delusions or hallucinations (seeing or hearing things that are not really there)
  • Increasing inability to cope with daily problems and activities
  • Thoughts of suicide
  • Denial of obvious problems
  • Many unexplained physical problems
  • Abuse of drugs and/or alcohol

Q: How can I help a loved one who may be suffering from a mental illness?
A: Discuss the issue with your primary care physician, or in the case of a child, your pediatrician. Your physician may perform a physical evaluation to determine whether any physical problems may be the cause or contributor to the mental or emotional problem. The physician can be helpful by providing the names of psychiatrists appropriate to consult.

Q: Who is susceptible to mental illness?
A: Anyone may be susceptible to a mental illness. Psychiatric problems affect people of all ages, all income groups, all ethnicities, all religious groups, urban and rural, male and female. No one is immune to a mental illness

Q: Isn’t mental illness a rare disorder?
A: Mental Disorders affect one-quarter of all Americans. On any given day one out of every 4 people you pass may be experiencing a mental illness. By this count more than 2 million of Ohio’s 11 Million citizens experience some form of mental disorder including 200,000 children.

Q: Is mental illness is the same as mental retardation?
A: These are different conditions. Mental retardation is characterized by limitations in intellectual functioning and difficulties with certain daily living skills. In contrast, people with mental illnesses—health conditions that cause changes in a person's thinking, mood, and behavior—have varied intellectual functioning, just like the general population.

Q: Is mental illness brought on by a weakness of character?
A: Mental illnesses are a product of the interaction of biological, psychological, and social factors. Social influences, like the loss of a loved one or a job, can also contribute to the development of various mental health problems.

skateboar child

Q: What should I do if I am concerned about mental, behavioral, or emotional symptoms in my child?
A: Talk to your child’s doctor or health care provider. Ask questions and learn everything you can about the behavior or symptoms that worry you. If your child is in school ask the teacher if your child has been showing worrisome changes in behavior. Share this with your child’s doctor or health care provider. Keep in mind that every child is different. Even normal development, such as when children develop language, motor, and social skills, varies from child to child. Ask if your child needs further evaluation by a specialist with experience in child behavioral problems. Specialists may include psychiatrists, psychologists, social workers, psychiatric nurses, and behavioral therapists. Educators may also help evaluate your child.

Q: How do I know if my child’s problems are serious?
A:  Not every problem is serious. In fact, many everyday stresses can cause changes in your child’s behavior. For example, the birth of a sibling may cause a child to temporarily act much younger than he or she is. It is important to be able to tell the difference between typical behavior changes and those associated with more serious problems. Pay special attention to behaviors that include:

  • Problems across a variety of settings, such as at school, at home, or with peers
  • Changes in appetite or sleep
  • Social withdrawal, or fearful behavior toward things your child normally is not afraid of
  • Returning to behaviors more common in younger children, such as bed-wetting, for a long time
  • Signs of being upset, such as sadness or tearfulness
  • Signs of self-destructive behavior, such as head-banging, or a tendency to get hurt often
  • Repeated thoughts of death


Q: Can children experience mental illnesses or are their actions are just products of bad parenting?

A: A report from the President's New Freedom Commission on Mental Health showed that in any given year five to nine percent of children experience serious emotional disturbances. Just like adult mental illnesses, these are clinically diagnosable health conditions that are a product of the interaction of biological, psychological, and social factors.

Q: Does mental illness cause people to be violent and unpredictable?
A: The vast majority of people with mental health conditions are no more violent than anyone else. Instead, the Surgeon General has reported that people with mental illnesses are 10 times more likely to be the victims of violence and crime.

Q: If mental illness is a disease, why can’t you just take a pill to control it?
A: Treatment varies depending on the individual. A lot of people work with therapists, counselors, friends, psychologists, psychiatrists, nurses, and social workers during the recovery process. They also use self-help strategies and community supports. Often they combine these with some of the most advanced medications available.

Q: Can people with mental illnesses recover?
A: Studies show that treatment works, most people with mental illnesses get better, and many recover completely. Science has greatly expanded our understanding and treatment of severe mental illnesses. Newer classes of medications can better treat individuals with far fewer side effects. There are more treatments, services, psychosocial interventions, and community support systems than ever before, and more are in the works.

Q: What is Recovery?
A: Recovery from mental illness isn’t the same as a cure. Instead, recovery means regaining control over your life. It means leading a useful, satisfying life even though symptoms may reoccur. Recovery is a process, beginning with diagnosis and eventually moving into successful management of your illness. Successful recovery involves learning about your illness and the treatments available, empowering yourself through the support of peers and family members, and finally moving to a point where you take action to manage your own illness by helping others.

Q: What are psychotropic medications?
A: Psychotropic medications are substances that affect brain chemicals related to mood and behavior. These medications are often used in the treatment of mental illnesses in conjunction with clinical treatment services and a range of non-clinical interventions and support services.  In recent years, research has been conducted to understand the benefits and risks of using psychotropic medications in children. Still, more needs to be learned about the effects of these medications on a developing mind and body, especially in children under six years of age. As with any medications, the risks and benefits should be discussed with your doctor.

Q: Is depression in older adults just part of aging?
older adult maleA: Depressive disorder is not a normal part of aging. Emotional experiences of sadness, grief, response to loss, and temporary “blue” moods are normal. Persistent depression that interferes significantly with ability to function is not. Depression, one of the conditions most commonly associated with suicide in older adults, is a widely under-recognized and under-treated medical illness. It can and should be treated when it occurs at the same time as other medical illnesses. Untreated depression can delay recovery or worsen the outcome of these other illnesses.

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SUICIDE

Q: Who May Be Suicidal?
A: Suicidal behavior is found in all segments of the population in America. While some groups of the population show a higher rate of suicidal behavior, it is well to remember that no group is safe. Suicidal risk is higher in adolescents, middle aged white men, and the elderly. Males are more prone than are females. Whites are more likely to commit suicide than African Americans. A number of demographics can be cited regarding group risk. In the end however, suicide is a singular event completed by an individual. Prevention of suicidal behavior begins at that level.

Q: What are the risk factors for suicide?
A: Research shows that risk factors for suicide include:

  • Depression and other mental disorders, or a substance-abuse disorder (often in combination with other mental disorders). More than 90 percent of people who die by suicide have these risk factors.
  • Prior suicide attempt
  • Family history of mental disorder or substance abuse
  • Family history of suicide
  • Family violence, including physical or sexual abuse
  • Firearms in the home ( the method used in more than half of suicides)
  • Incarceration
  • Exposure to the suicidal behavior of others, such as family members, peers, or media figures

However, suicide and suicidal behavior are not normal responses to stress; many people have these risk factors, but are not suicidal. Research also shows that the risk for suicide is associated with changes in brain chemicals called neurotransmitters, including serotonin. Decreased levels of serotonin have been found in people with depression, impulsive disorders, and a history of suicide attempts, and in the brains of suicide victims.

Q: What should you do if someone tells you they are thinking about suicide?
A: If someone tells you they are thinking about suicide, you should take their distress seriously, listen non-judgmentally, and help them get to a professional for evaluation and treatment. Talking about the issues involved in a person's depression or asking whether the person is suicidal will not lead to the suicidal act. It may help him/her to step back.

People consider suicide when they are hopeless and unable to see alternative solutions to problems. Suicidal behavior is most often related to a mental disorder (depression) or to alcohol or other substance abuse. Suicidal behavior is also more likely to occur when people experience stressful events (major losses, incarceration). If someone is in imminent danger of harming himself or herself, do not leave the person alone. You may need to take emergency steps to get help, such as calling 911. When someone is in a suicidal crisis, it is important to limit access to firearms or other lethal means of committing suicide.

Q: How would I know if someone I care about was contemplating about suicide?
A: Often suicidal people will give warning signs, consciously or unconsciously, indicating that they need help and often in the hope that they will be rescued. These usually occur in clusters, so often several warning signs will be apparent. The presence of one or more of these warning signs should not be taken as a guarantee that the person is suicidal. The only way to know for sure is to ask them. In other cases, a suicidal person may not want to be rescued, and may avoid giving warning signs. Typical warning signs which are often exhibited by people who are feeling suicidal include:

  • Withdrawing from friends and family
  • Depression, broadly speaking; not necessarily a diagnosable mental illness such as clinical depression, but indicated by signs such as:
    • Loss of interest in usual activities
    • Showing signs of sadness, hopelessness, irritability
    • Changes in appetite, weight, behavior, level of activity or sleep patterns
    • Loss of energy
    • Making negative comments about self
    • Recurring suicidal thoughts or fantasies
    • Sudden change from extreme depression to being “at peace
  • Talking, Writing or Hinting about suicide
  • Previous attempts
  • Feelings of hopelessness and helplessness
  • Purposefully putting personal affairs in order, such as giving away possessions; sudden intense interest in personal wills or life insurance; or “clearing the air” over personal incidents from the past


This list is not definitive: some people may show no signs yet still feel suicidal, others may show many signs yet be coping; the only way to know for sure is to ask. In conjunction with the risk factors listed above, this list is intended to help people identify others who may be in need of support.

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CO-OCCURRING DISORDERS OR CO-MORBIDITY (also referred to as “dual diagnosis”)

Q: What Is Co-morbidity?
A: “Co-morbidity” is a term used to describe two or more disorders or illnesses occurring in the same person. They can occur at the same time or one after the other. Co-morbidity also implies interactions between the illnesses that can worsen the course of both.

Q: Are Alcohol Dependency and Drug Addiction Mental Illnesses?
A: Yes, addiction or dependency changes the brain in fundamental ways, disturbing a person’s normal hi­erarchy of needs and desires and substituting new priorities con­nected with procuring and using the drug. The resulting compulsive behaviors that weaken the ability to control impulses, despite the consequences, are similar to hall­marks of other mental illnesses.

Q: How Common Are Co-morbid Drug Addiction and Other Mental Illnesses?
A: Many people who are addicted to drugs are also diagnosed with other mental disorders and vice versa. For example, compared with the general population, people addicted to drugs are roughly twice as likely to suffer from mood and anxiety disorders, with the reverse also true.

Q: Why Do These Disorders Often Co-occur?
A: Although drug use disorders commonly occur with other mental illnesses, this does not mean that one caused the other, even if one appeared first. In fact, establishing causality or even directionality (i.e., which came first) can be difficult. However, research suggests the following possibilities for their co-occurrence:

  • Drug abuse may bring about symptoms of another mental illness. Increased risk of psychosis in some marijuana users suggests this possibility.
  • Mental disorders can lead to drug abuse, possibly as a means of “self-medication.” Patients suffering from anxiety or depression may rely on alcohol, tobacco, and other drugs to temporarily alleviate their symptoms.  
  • These disorders could also be caused by common risk factors, such as—
    Overlapping genetic vulnerabilities. Common genetic factors may make a person susceptible to both addiction and other mental disorders or to having a greater risk of a second disorder once the first appears.
    Overlapping environmental triggers. Stress, trauma (such as physical or sexual abuse), and early exposure to drugs are common factors that can lead to addiction and other mental illnesses.
    Involvement of similar brain regions. Brain systems that respond to reward and stress, for example, are affected by drugs of abuse and may show abnormalities in patients who have certain mental disorders.  
    Drug use disorders and other mental illnesses are developmental disorders. That means they often begin in the teen years or even younger—periods when the brain experiences dramatic developmental changes. Early exposure to drugs of abuse may change the brain in ways that increase the risk for mental disorders.

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PROBLEM GAMBLING

q: What is problem gambling?
A: Problem gambling includes all gambling behavior patterns that compromise, disrupt or damage personal, family or vocational pursuits. The essential features are increasing preoccupation with gambling, a need to bet more money more frequently, restlessness or irritability when attempting to stop, "chasing" losses, and loss of control manifested by continuation of the gambling behavior in spite of mounting, serious, negative consequences. In extreme cases, problem gambling can result in financial ruin, legal problems, loss of career and family, or even suicide.

Q: Isn't problem gambling just a financial problem?
A: No. Problem gambling is an emotional problem that has financial consequences. If you pay all of a problem gambler's debts, the person will still be a problem gambler. The real problem is that they have an uncontrollable obsession with gambling.

Q: Can you be a problem gambler if you don't gamble every day?
A: The frequency of a person's gambling does not determine whether or not they have a gambling problem. Even though the problem gambler may only go on periodic gambling binges, the emotional and financial consequences will still be evident in the gambler's life, including the effects on the family.

Q: How much money do you have to lose before gambling becomes a problem?
A: The amount of money lost or won does not determine when gambling becomes a problem. Gambling becomes a problem when it causes a negative impact on any area of the individual's life.

Q: How can a person be addicted to something that isn't a substance?
A: Although no substance is ingested, the problem gambler gets the same effect from gambling as someone else might get from taking a tranquilizer or having a drink. The gambling alters the person's mood and the gambler keeps repeating the behavior attempting to achieve that same effect. But just as tolerance develops to drugs or alcohol, the gambler finds that it takes more and more of the gambling experience to achieve the same emotional effect as before. This creates an increased craving for the activity and the gambler finds they have less and less ability to resist as the craving grows in intensity and frequency.

SOURCEs:
Substance Abuse & Mental Health Services Administration (SAMHSA);
National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH), a component of the U.S. Department of Health and Human Services (DHHS); National Council on Problem Gambling;
National Institute of Mental Health (NIMH), part of the National Institutes of Health (NIH), a component of the U.S. Department of Health and Human Services (DHHS); Ohio Suicide Prevention Foundation

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