Addiction, Overstimulation, and Performance in Sports Psychiatry

Addiction, Overstimulation, and Performance in Sports Psychiatry

In this episode of MD Newsline, Dr. Justin Morales, Addiction Psychiatry Fellow at Mass General Brigham Harvard Medical System, explores how our understanding of addiction has evolved from a simple reward-pathway model to a comprehensive biopsychosocial framework. Dr. Morales discusses substance use disorders alongside emerging behavioral addictions such as social media overuse, gaming, and binge behaviors. He explains how dopamine signaling, reward-based learning, and executive function circuits influence compulsivity and craving—and why modern overstimulation may blur the line between habit and addiction. The conversation also examines cannabis potency trends, co-occurring psychiatric conditions, sports psychiatry, and emerging neuromodulation treatments for addiction. Episode Highlights: The Biopsychosocial Model of Addiction Dr. Morales outlines the shift from a narrow neurochemical model to a holistic framework incorporating biology, psychology, and social environment. Treatment may involve medication, therapy, and social interventions working together rather than in isolation. Substance vs. Behavioral Addictions While behavioral addictions like social media overuse are not formally classified the same way as substance use disorders in DSM-5, clinicians can adapt similar criteria—such as functional impairment, compulsivity, and high-risk behaviors—to assess severity. Cannabis Potency and Psychiatric Risk Modern cannabis products are significantly more potent than in prior decades. Dr. Morales highlights growing concerns about high-THC exposure potentially contributing to psychosis and mood destabilization. Co-Occurring Mood Disorders Over half of individuals with substance use disorders have a co-occurring psychiatric condition. Dr. Morales discusses common treatment pitfalls—such as addressing depression without addressing substance use—and emphasizes integrated care. Digital Overstimulation and Dopamine Social media and gaming platforms leverage reward-based learning similar to substances. The brain adapts to chronic overstimulation, which may lead to reduced baseline motivation and mood flattening. Dopamine Detox: Myth or Medicine? Although strong research evidence is limited, reducing overstimulation may help the brain recalibrate toward homeostasis and improve natural reward sensitivity. Integrated Treatment for Multiple Addictions Dr. Morales explains how clinicians may treat different substances pharmacologically while addressing underlying psychological drivers—such as avoidance or emotional numbing—through unified therapy strategies. Sports Psychiatry and Identity Athletes face unique pressures tied to performance, injury, career transitions, and identity fusion. Substance use and mood disorders may emerge during times of injury or role changes. Youth Sports and Escalating Pressure With increasing financial and performance stakes at younger ages, adolescent athletes face heightened mental health risk before full neurodevelopment. Neuromodulation in Addiction Emerging treatments—including transcranial magnetic stimulation (TMS), deep brain stimulation (DBS), and vagus nerve stimulation (VNS)—target brain circuits involved in executive function and craving, particularly the prefrontal cortex. Executive Function and Craving Addiction involves planning, coordination, and decision-making processes—not simply impulsivity. Targeting prefrontal control circuits may influence compulsive behaviors and substance-seeking. Collaborative Care Model Effective addiction and sports psychiatry care requires collaboration among psychiatrists, psychologists, social workers, trainers, coaches, and family members to identify behavioral changes early and provide coordinated support. Key Takeaway Addiction in the modern era extends beyond substances to include digital and behavioral reinforcers embedded in everyday life. A biopsychosocial framework—combined with integrated treatment, executive function support, and collaborative care—offers the most effective approach for addressing substance use disorders and behavioral addictions alike. Resources: Website: https://mdnewsline.com/ [https://mdnewsline.com/] Newsletter: https://mdnewsline.com/subscribe/ [https://mdnewsline.com/subscribe/] Contact with Dr. Justin Morales: Here [https://www.linkedin.com/in/psychdrjm/]

AI, HER2-Low, and the Future of Precision Oncology

In this episode of MD Newsline, Dr Frederick Howard, breast oncologist at the University of Chicago and leader of a research group focused on AI-driven biomarker development, explores the rapidly evolving role of artificial intelligence in breast cancer care. Dr. Howard provides a comprehensive overview of how AI is being integrated into oncology—from radiographic imaging and digital pathology to clinical decision support and language models. He discusses both the promise and the practical challenges of deploying AI tools in real-world workflows, including validation standards, regulatory guardrails, and ethical considerations. The conversation also dives into emerging applications such as AI-based HER2 quantification, recurrence risk prediction from H&E slides, and the potential for multimodal models to transform precision medicine. Episode Highlights: AI in Radiology and Mammography Dr. Howard explains the evolution from early computer-aided detection systems to modern deep learning algorithms trained on millions of mammograms. He discusses emerging AI-driven breast cancer risk prediction tools derived directly from imaging and how they may enhance early detection strategies. Digital Pathology and Biomarker Development AI tools are increasingly capable of quantifying immunohistochemistry and identifying features beyond human visual interpretation. Dr. Howard highlights research presented at major oncology meetings demonstrating improved concordance in HER2-low classification and improved reproducibility in biomarker scoring. Predicting Recurrence Risk Without Genomic Testing One of the most promising areas involves AI models trained on H&E slides to predict recurrence risk—potentially matching or exceeding established genomic assays such as Oncotype DX and MammaPrint. Dr. Howard discusses the validation challenges required before these tools can replace or complement genomic testing in clinical practice. HER2-Low Classification and Antibody-Drug Conjugates The discussion explores limitations of traditional HER2 immunohistochemistry, especially at the lower end of expression. AI-based quantitative approaches may improve patient stratification for HER2-directed antibody-drug conjugates, though questions remain about predictive thresholds and biological mechanisms. Language Models in Oncology Practice Dr. Howard examines the growing use of large language models for literature review, documentation support, and clinical trial matching. He emphasizes the need for HIPAA-compliant systems, clinician oversight, and standardized evaluation frameworks to ensure safe and responsible deployment. Ethics, Governance, and Over-Reliance From data privacy to clinical accountability, the episode addresses the ethical considerations surrounding AI in cancer care. Dr. Howard cautions against over-reliance on AI systems and underscores the importance of maintaining clinician expertise and critical thinking. The Future: Multimodal AI and Precision Medicine Looking ahead, Dr. Howard envisions a future where digital pathology, genomics, imaging, and clinical data converge into multimodal AI systems capable of delivering truly personalized treatment recommendations. He stresses that large-scale data sharing and collaboration will be essential to realizing this potential. Key Takeaway Artificial intelligence is no longer theoretical in oncology—it is actively shaping diagnostics, risk stratification, and treatment selection in breast cancer. However, rigorous validation, ethical governance, and thoughtful integration into clinical workflows are critical to ensuring that AI enhances—rather than replaces—expert clinical judgment. Resources: Website: https://mdnewsline.com/ [https://mdnewsline.com/] Newsletter: https://mdnewsline.com/subscribe/ [https://mdnewsline.com/subscribe/] Contact with Dr. Frederick Howard: Here [https://www.uchicagomedicine.org/find-a-physician/physician/frederick-howard]

Late-Stage Breast Cancer Diagnosis Among Black Women in the Mid-South

In this episode of MD Newsline, Dr. Janeane N. Anderson, Assistant Professor at the University of Tennessee Health Science Center and breast cancer researcher, shares insights from the ACCESS Study—an innovative qualitative research initiative focused on understanding why Black women in the Mid-South region are disproportionately diagnosed with advanced-stage breast cancer. Dr. Anderson discusses structural barriers, community-based recruitment strategies, and the importance of centering lived experiences in oncology research. She also highlights the critical need for equitable research participation, race- and gender-concordant research teams, and stronger clinician engagement to improve outcomes for underserved populations. Episode Highlights: Understanding Advanced-Stage Breast Cancer in the Mid-South Dr. Anderson explains how the Mississippi Delta region represents a "cancer hotspot," with higher rates of late-stage diagnoses and mortality among Black women. She explores how structural vulnerability, transportation challenges, cultural norms, and fragmented healthcare systems contribute to disparities. The ACCESS Study: A Community-Centered Research Design The ACCESS Study is a three-year qualitative investigation examining socio-ecological factors that increase the likelihood of de novo metastatic breast cancer diagnoses among Black women. Dr. Anderson outlines her multi-method approach, including: · In-depth interviews with photo elicitation · Ethnographic "go-alongs" in participants' neighborhoods · Observations during clinic visits · Interviews with regional clinicians This immersive methodology allows researchers to understand not just clinical outcomes, but the lived realities shaping patient journeys. Barriers to Recruitment and Participation Recruiting women with metastatic breast cancer presents unique challenges. Dr. Anderson discusses barriers such as: · Health status and treatment burden · Caregiving responsibilities · Transportation and rural geography · Income instability and housing challenges · Research mistrust rooted in sociohistorical and contemporary inequities She emphasizes that participation barriers are often structural—not a lack of interest. Recruitment Strategies That Worked Dr. Anderson highlights the importance of race- and gender-concordant research teams, which foster trust and cultural understanding. Additional effective strategies included: · Leveraging electronic health records for efficient identification · Community-based outreach in churches, libraries, salons, and local organizations · Multiple consent touchpoints to address concerns and build rapport Her key message to clinicians: Ask. Many eligible patients are interested in research—but are never invited. Moving Beyond Accrual Metrics Dr. Anderson argues that equitable research should not be measured by numbers alone. Individual stories—"n of 1" experiences—reveal intersectional traumas and systemic barriers that large datasets may overlook. She advocates for qualitative methodologies to better understand the "why" behind disparities. Sexual Health and Survivorship At the San Antonio Breast Cancer Symposium, Dr. Anderson also noted the need for greater focus on oncosexology. Sexual health remains one of the most unmet needs in breast cancer survivorship, impacting quality of life, adherence, and overall well-being. Key Takeaway Dr. Anderson underscores that addressing disparities in advanced breast cancer requires more than clinical innovation. It demands community engagement, culturally concordant research teams, clinician advocacy, and methodologies that center the lived experiences of Black women. True equity begins with listening—and asking. Resource Website: https://mdnewsline.com/ [https://mdnewsline.com/] Newsletter: https://mdnewsline.com/subscribe/ [https://mdnewsline.com/subscribe/] Contact with Dr. Janeane N. Anderson: Here [https://www.uthsc.edu/faculty/profile/?netid=jande163]

Understanding Cancer Disparities, Mistrust, and Access to Care

In this episode of MD Newsline, Dr. Jordonna Brown, a medical oncologist at Kings County Hospital in New York City, shares her frontline experience caring for patients in a safety-net hospital setting. Speaking from the San Antonio Breast Cancer Symposium (SABCS), Dr. Brown discusses cancer disparities, late-stage presentation, mistrust in the healthcare system, and the evolving landscape of breast cancer treatment. She offers a candid look at the social determinants of health shaping patient outcomes—from delayed screening and misconceptions about chemotherapy to barriers in long-term adherence and clinical trial participation. Episode Highlights: Late-Stage Presentation and Screening Gaps Dr. Brown highlights a concerning trend: many patients present with advanced-stage breast cancer due to missed routine mammograms. Barriers include misconceptions about radiation exposure, fear of pain, religious beliefs, and lack of awareness about updated screening guidelines starting at age 40. Mistrust and Chemotherapy Misconceptions One of the most persistent challenges is distrust in the medical system. Patients often fear that chemotherapy may be more harmful than beneficial. Dr. Brown emphasizes the importance of patient-centered communication, empathy, and transparent education to build trust and empower informed decisions. Younger Patients and Aggressive Disease Breast and colon cancers are increasingly diagnosed in younger populations. In women under 40, breast cancer often demonstrates more aggressive tumor biology. Younger patients also face unique psychosocial challenges, including body image concerns, fertility considerations, career disruptions, and adherence to long-term maintenance therapy. Socioeconomic Barriers and Access to Care Financial instability, employment loss, transportation issues, and food insecurity can significantly impact adherence and long-term outcomes. Dr. Brown discusses how institutional support—such as social services, transportation programs, counseling, and food banks—helps mitigate these barriers. Clinical Trials and Underrepresentation Dr. Brown notes persistent skepticism around clinical trials among underrepresented communities. She underscores the need for improved education, emphasizing that today's standard treatments are the result of prior clinical trials—and that participation advances care for future generations. Emerging Therapies and Personalized Medicine At SABCS, Dr. Brown was encouraged by advances in early-stage hormone-positive breast cancer, including new selective estrogen receptor degraders (SERDs) such as giredestrant, which may offer improved tolerability compared to traditional endocrine therapies. She also discusses the growing role of artificial intelligence in shaping cancer care and the importance of ensuring diverse data representation in AI-driven tools. Mental Health and Survivorship The emotional and social impact of a cancer diagnosis often extends beyond treatment. Family dynamics, job security, and mental health are frequently under-addressed areas. Dr. Brown advocates for integrated palliative care, psychotherapy services, and survivorship groups to support patients holistically. Key Takeaway Addressing breast cancer disparities requires more than medical innovation—it demands trust-building, education, equitable access, and culturally sensitive communication. By partnering with patients, improving representation in clinical research, and strengthening community-based support systems, clinicians can meaningfully improve outcomes across diverse populations. Resources: Website: https://mdnewsline.com/ [https://mdnewsline.com/] Newsletter: https://mdnewsline.com/subscribe/ [https://mdnewsline.com/subscribe/] Contact with Dr. Jordonna Brown: Here [https://health.usnews.com/doctors/jordonna-brown-3437931]

Inflammation and Resistance in MDS & AML: Targeting the JAK-STAT Axis

In this episode of MD Newsline, Dr. Theodoros Karantanos, Assistant Professor of Medical Oncology at the Johns Hopkins University Sidney Kimmel Cancer Center, discusses the emerging role of inflammatory signaling in high-risk myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). Dr. Karantanos shares insights from his laboratory research exploring how inflammatory pathways—particularly interferon gamma and JAK-STAT signaling—contribute to treatment resistance, including resistance to venetoclax. He also highlights the impact of TP53 mutations, bone marrow microenvironment dynamics, and post-translational modifications in shaping disease progression and therapeutic response. Episode Highlights: Inflammatory Signaling and Venetoclax Resistance High-risk MDS and AML frequently demonstrate upregulation of inflammatory pathways. Dr. Karantanos explains how interferon gamma signaling activates the JAK-STAT cascade (JAK1/2, STAT1/3/5), leading to transcriptional programs associated with resistance to venetoclax and chemotherapy. The Role of TP53 in Driving Inflammation Loss of TP53 function not only impairs apoptosis but may intrinsically upregulate interferon gamma signaling within leukemic cells. This cell-intrinsic inflammatory activation may partially explain why TP53-mutated MDS and AML remain particularly difficult to treat. Post-Translational Modifications as Resistance Drivers Phosphorylation and ubiquitination play central roles in regulating inflammatory cascades. Dr. Karantanos emphasizes that proteomic and phospho-signature analyses are essential, as RNA expression alone cannot fully capture pathway activation under therapeutic pressure. Bone Marrow Microenvironment and Cytokine Crosstalk The bone marrow niche—including fibroblasts, adipocytes, endothelial cells, and immune subsets—contributes to resistance through cytokine secretion (e.g., IL-1β, TNF-α) and drug metabolism. These interactions reshape therapeutic exposure and promote survival of malignant clones. Monocytic Leukemias and Inflammatory Activation Monocytic AML subtypes (M4/M5) appear particularly enriched in inflammatory signaling, including interferon gamma and TNF-α activation. These subsets may represent high-priority targets for inflammation-modulating strategies. Targeting Inflammatory Pathways: Translational Strategies Potential therapeutic approaches include IRAK1/IRAK4 inhibitors, JAK pathway modulation, and antibody-drug conjugates targeting downstream interferon-regulated surface proteins such as CCRL2 and ICAM-1. Combination and triplet regimens may offer future improvements over venetoclax-based standards. Single-Cell and Spatial Transcriptomics Dr. Karantanos highlights the importance of computational biology, single-cell RNA sequencing, and spatial transcriptomics in deciphering the complex inflammatory networks within the bone marrow microenvironment. These technologies are critical for identifying actionable nodes and refining patient stratification. Key Takeaway Inflammatory signaling is not merely a bystander in myeloid neoplasms—it is a central driver of disease evolution and therapeutic resistance. Integrating inflammatory biomarkers, post-translational pathway profiling, and microenvironmental analysis may unlock new precision strategies for high-risk MDS and AML, particularly in TP53-mutated and monocytic subtypes where unmet need remains greatest. Resources: Website: https://mdnewsline.com/ [https://mdnewsline.com/] Newsletter: https://mdnewsline.com/subscribe/ [https://mdnewsline.com/subscribe/] Contact With Dr. Theodoros Karantanos: Here [https://profiles.hopkinsmedicine.org/provider/theodoros-karantanos/2707273]