Key Points

  • A commentary published in JAMA Psychiatry warns that the mental status examination, psychiatry’s primary diagnostic tool, was designed around hearing patients and can misread American Sign Language patterns and listening fatigue as psychiatric symptoms, leading to diagnostic errors in deaf and hard-of-hearing people.
  • Clinicians unfamiliar with ASL may read ordinary facial grammar as flat or unusual affect; the authors recommend asking whether someone is “trying to signal or communicate with you” rather than asking about hearing voices.
  • A Swedish registry study of 4.2 million people found that a substance use disorder raises the risk of a suicidal event roughly 16-fold, and the risk remains about 6 times higher even after accounting for co-occurring psychiatric illness.
  • The combination of an alcohol use disorder and a drug use disorder carried the highest adjusted suicide risk in the study, a pattern Dr. Sylvie Stacy says reflects a specific neurobiological vulnerability she sees regularly in clinical practice.
  • Past-month cannabis use among U.S. adults 50 and older rose from about 4.5% two decades ago to 12.9% in 2022 and 2023, while the share meeting criteria for cannabis use disorder more than doubled over the same period.
  • Cannabis use disorder is treatable without residential care in most cases; cognitive behavioral therapy, motivational enhancement therapy, and contingency management have the strongest evidence base, and no FDA-approved medication currently exists.

Addiction News Weekly Episode 1.20

In This Episode:

Episode Transcript

Welcome to Addiction News Weekly by Rehab.com, where we break down the biggest stories in addiction, recovery, and public health this week. Psychiatrists argue that the standard mental health evaluation can misread deaf and hard-of-hearing patients, new research on why dual diagnosis care is a safety feature rather than an upgrade, and cannabis use disorder is climbing among adults over 50 in a pattern that families tend to miss. Let’s get right into it.

When the Mental Status Exam Misreads Deaf and Hard-of-Hearing Patients

We start with what happens in the first appointment. A commentary published September 23 in JAMA Psychiatry, led by Dr. Jessica Williams of Washington University School of Medicine, argues that the field’s main diagnostic tool, the mental status examination, was built around hearing patients.1,2 More than 70 million people in the United States live with some form of hearing loss, and hearing loss itself is linked to higher rates of depression, anxiety, and psychosis.

The argument is that clinicians who do not understand signed languages can mistake normal communication for symptoms. In American Sign Language, facial expression carries grammar as well as emotion, so a clinician who does not know that can read ordinary signing as flat or unusual affect, and a question about hearing voices may simply not apply. Asking whether anyone is trying to signal or communicate with the person is more clinically useful.

For hard-of-hearing patients, the mismatches look different. The constant effort to hear produces listening fatigue, which can present as irritability or trouble concentrating. The authors also name something they call the deaf nod, where a patient signals understanding they do not have because asking again is embarrassing. That is how treatment instructions may get missed.

Their recommendations are practical: regular check-ins and teach-back, where the patient explains back what they understood, and in-person interpreters over video services. If you or a family member has hearing loss, ask before choosing care. Does the program provide qualified interpreters or live captioning? Will it be the same interpreter each visit? Does the clinician use teach-back? How clearly a program answers those questions tells you whether communication access is built into the treatment or handled only when something goes wrong.

Why Dual Diagnosis Care Is a Safety Feature, Not an Upgrade

Our second story is about why dual diagnosis care matters. Researchers used 47 years of Swedish national records covering 4.2 million people, publishing in Molecular Psychiatry.3 They found that a substance use disorder raised the risk of a suicidal event roughly 16-fold, and that after adjusting for co-occurring psychiatric illness, which accounts for much of that, the risk remained about six times higher.

Here is Rehab.com medical officer Dr. Sylvie Stacy:

When I look at population registry data, especially of this scale, my focus goes to distinguishing between an epidemiologic risk ratio and an individual patient’s actual prognosis. I often remind patients that a broad population multiplier describes a cohort-level probability. Inherited risk means higher likelihood, not a fixed outcome. In my own practice, I have seen plenty of patients with extensive family histories who never go on to develop either an addiction or suicidal behavior.

Thinking about the methods here, I do appreciate the familial co-aggregation design that the authors used. By comparing biological relatives across varying degrees of relatedness, including identical twins and full siblings and cousins, the data show that shared genetic factors partly drive the co-occurrence of substance use disorders and suicidal behavior. When I do an initial clinical intake with a patient, I treat a family history of addiction or mood disorders as actionable baseline data. Having that background helps me structure an appropriate safety monitoring plan from the beginning.

This paper also highlights a pattern that matches what I see in my clinic. Patients diagnosed with both an alcohol use disorder and a drug use disorder showed the highest adjusted risk, even after the authors controlled for separate psychiatric illnesses. I have had many appointments where someone tells me about their drinking but minimizes their sedative or stimulant use. That specific combination carries a high neurobiological vulnerability. I always try to get the full picture of a person’s substance use.

Finally, the study showed that psychiatric comorbidities accounted for about 60% of the unadjusted risk attenuation. Major depression, bipolar disorder, and ADHD all heavily mediate those outcomes. Managing addiction while ignoring a mood disorder leaves the primary driver intact. We need to look for medical and psychiatric teams that work together to tackle both issues.

If suicidal thinking is present right now, call or text 988 in the United States. Support is available at any time.

Cannabis Use Disorder Is Climbing Among Adults Over 50

Our last story is about a pattern families tend to miss. A national study published in the journal Addiction, supported by the National Institute on Drug Abuse, found that past-month cannabis use among U.S. adults aged 50 and older rose from about 4.5% two decades ago to 12.9% in 2022 and 2023.4,5 Over that same period, the share meeting criteria for cannabis use disorder more than doubled, from 0.6% to 1.5%. That is still a small share of the age group, but the authors note the rise outpaced what availability alone would predict.

Much of the use is for pain, sleep, or anxiety, sometimes in place of a prescription. That carries specific risks at this age because older adults metabolize drugs more slowly, often take multiple prescriptions, and are more prone to falls, confusion, and drug interactions.

The signs of cannabis use disorder are easy to dismiss as habits: using more than intended, trying to cut back and not managing it, cravings, continuing despite problems with memory, motivation, or relationships. Tolerance and withdrawal count as well, and cannabis withdrawal, while not medically dangerous the way alcohol or benzodiazepine withdrawal can be, still brings irritability, disrupted sleep, and reduced appetite. That is a large part of why daily users struggle to stop, especially if the use started as a way to manage pain.

If you are wondering about a parent, the relevant questions are the ones that apply to any substance. Is the use daily? Is the amount climbing? Have they tried to stop and been unable to? If those raise concern, a conversation with their physician and a full medication review is a reasonable first step. Cannabis use disorder is treatable; most people do not need residential care for it, and the evidence supports cognitive behavioral therapy, motivational enhancement therapy, and contingency management. There is still no FDA-approved medication, so therapy leads. Specialized programs for older adults can account for polypharmacy considerations and age-specific health factors that general programs may overlook.

Conclusion

Three stories in the same opening in each. An evaluation that cannot see how someone communicates. A family history nobody asked about. A daily habit that looks like a personality. None of those are failures of treatment, they are things that get missed before treatment even starts.

If you or someone you love is looking for treatment, Rehab.com lists thousands of verified centers across the country, and free, confidential support is available anytime through the SAMHSA National Helpline at 1-800-662-4357. And if you are in crisis, you can call or text 988 at any time.

Those are the top stories in the news. For more, visit Rehab.com. We will be back next week. I’m Kay, and thank you for listening.

You Might Also Like

  1. Dual Diagnosis: Understanding Drug Addiction and Mental Health: Core guide to co-occurring substance use and psychiatric disorders, directly relevant to the suicide risk data and integrated treatment discussion in this episode.
  2. Addiction Treatment and Rehab for Seniors: Covers age-specific risks, polypharmacy considerations, and treatment options for older adults, essential context for the cannabis-over-50 story.
  3. Marijuana Abuse and Addiction: Overview of cannabis use disorder, signs, withdrawal, and treatment options referenced in this episode.
  4. Mental Health and Addiction: Hub for co-occurring mental health and substance use resources, including depression, bipolar disorder, and ADHD, the conditions Dr. Stacy identifies as heavily mediating suicide risk.

Sources in This Episode

  1. Williams J, Shapiro L, Petersen KH. Deaf and hard-of-hearing competency in psychiatric practice. JAMA Psychiatry. Published online September 23, 2026. https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2854370. Accessed October 13, 2026.
  2. Psychiatric Times Editors. The importance of improving deaf and hard-of-hearing competency in psychiatric practice. Psychiatric Times. Published September 30, 2026. https://www.psychiatrictimes.com/view/the-importance-of-improving-deaf-and-hard-of-hearing-competency-in-psychiatric-practice. Accessed October 13, 2026.
  3. Newswise. One in nine older adults who use cannabis meet criteria for cannabis use disorder. Published September 28, 2026. https://www.newswise.com/articles/one-in-nine-older-adults-who-use-cannabis-meet-criteria-for-cannabis-use-disorder. Accessed October 13, 2026.
Dr. Sylvie Stacy Written By: Dr. Sylvie Stacy MD, MPH Chief Medical Officer
Sylvie Stacy, MD, MPH, Medical Officer at Rehab.com, is a board-certified addiction medicine specialist with over a decade of experience treating individuals with addictions in diverse clinical settings including residential treatment programs, detox centers, outpatient clinics, and correctional facilities.