A little before Covid I treated a cop who had retired a few years earlier. After about five years on the job, he began counting down the days before he could stop working. “I wanted to get away from my bosses, my co-workers, the public, the hours, the stress,” he told me.

Ironically or tragically or maybe a bit of both, he was miserable in retirement. Without structure, his health declined and he felt a shocking lack of purpose. After asking him a few questions I told him, “You spent 25 years working and very little time actually building a life.”

“God damn you are harsh.”

“It would have been better if you had seen me ten or fifteen years ago. But, we can still fix this, if you are willing.”

“Tell me what to do.”

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I’ve had a few hundred versions of that conversation over the last ten years. When most people talk about retirement, they are focused on (a) not working at their job anymore and (b) how much money they will have for the rest of their lives. While the financial aspect is very important, it is overemphasized to the detriment of the other aspects of what I call Retirement Capital.

Retirement Capital is a combination of money, health, relationships, hobbies, places to go and, most importantly, identity and purpose.

I have noticed that retirement is a big predictor of physical and mental decline. That written, choosing to work at 75 is very different from having to work at 75. One caveat is that some jobs take a terrible physical toll and people are obviously better off stopping. The point isn’t that people miss the work itself, but rather they miss the structure and routine. They end up moving less and often change sleeping patterns. For many, work was the major source of cognitive stimulation in their lives and without it, they board an earlier train to decline and impairment.

A woman wrote to a help column on NJ.com about how she had no friends after she stopped working, because her job made up almost all of her social network. This is a brutally common situation. Back to the cop that started this all off; almost all of the people he regularly interacted with were other law enforcement officers. He had no friends who weren’t cops. When he stopped working, his social contacts dropped to just workers at the grocery and liquor stores.

“I focused on work. Solving cases. Getting overtime and earning promotions. I stopped going to church because I was either working or sleeping. Now that I’m not working, I don’t hear from any of the other cops still on the job.”

There is a retired doctor in his late 70s that I recently started treating. He was a star in his specialty. He was so good at his job that he had privileges in hospitals in New York, New Jersey and Pennsylvania. He stopped playing golf and fishing in his 30s because his career took off and he had young children. He wasn’t interested in picking those hobbies up 40 years later. “I don’t know what to do with myself,” he said during our first session. He admits that he watches too much television and worries about politics “all of the time.”

In the early 1900s, church leaders started referring to elderly members of the congregation who couldn’t come out as shut-ins. This was usually because of some kind of infirmity or disability. Over a hundred years later, there are a large number of elderly adults who are physically capable of leaving their homes but don’t. They are the voluntary shut-ins. They don’t go anywhere because they don’t have anywhere to go. Work provided them with a daily destination. For those that had children, they may have spent a few decades going to places outside of work because of their kids. With no job and no kids to attend to, they just stay at home.

I remember one of my college history professors telling me a story about a famous correspondent from 60 Minutes. I don’t remember who and it doesn’t matter. His problem was that he was used to calling up people and saying this is XXXX from 60 Minutes and people would jump. He worried that people would no longer jump that same way after he left the show. It was a major impact on his identity.

So many members of the military find themselves adrift after they leave the service in their 30s or 40s or 50s. I have met so many retired officers who instantly tell people about their rank and missions, even if they are a decade removed from them. I ran into a woman in her late 60s last summer while hiking in the Catskills; she had been out of the Army for 25 years but had on an Army shirt, carried an Army backpack and wore an Army hat. We talked about the hike and then the Army. I tried to move on to other topics but she told me about military successes and failures. After we moved on, my friend Kevin mournfully said, “Her identity hasn’t changed in 25 years.”

This happens with cops too. “Who am I without a gun and a badge?” a retired New Jersey State Trooper once pondered aloud rhetorically. “I’m nobody,” he sadly answered. “I sacrificed my marriage, time with kids, friends and hobbies for the job. Now the job is done and I have nothing. What was the point?”

Movie stars and celebrities struggle with this after their time in the spotlight has passed. Athletes who don’t move into coaching or broadcasting often have a hard time finding their footing.

Work provides people with a schedule. It is a large part of their identity. It gives them a place to go and a social network. In many cases, it forces them to move around. It gives them a sense of purpose; in happy instances, a deeply fulfilling purpose. Once someone stops working, they often experience a multi-domain disruption.

Money. Health. Relationships. Hobbies. Places to go. Identity. Purpose.

“How many of those do I need to be happy in retirement?” a client asked me.

“I hate the question,” I told her. “They are all important. Some people have more relationships and less hobbies. And vice versa.”

“But if you had to say…”

“If you are lacking in two or three, retirement will be unfulfilling. If you are low in four or more, your last years will probably be miserable.”

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In May, I attended the retirement party of Roger Shutack. He was my history teacher at Voorhees High School 33 years ago. He taught high school for 40 years and then at Raritan Valley Community College for the last 20. The room was filled with over 200 people; lots of former colleagues and loads of former students from all eras. When I got up to speak, I said that while I was proud of Roger and that he earned his rest, I was not fully supporting his retirement. “You still have things to offer.”

At breakfast a month later, Roger told me that he would take a few classes, play more golf, continue having breakfast with friends, visit his kids and grandkids, maybe host a podcast and look to do some volunteering. I told him that those were all great plans, except for the podcast.¹ Roger is an ideal example of someone who, post-retirement, still has a deep sense of identity and purpose. He has accumulated a lot of Retirement Capital. Significantly, he never ignored one of those life areas to focus on work, like the aforementioned cops, the surgeon and (throw a dart) an unmentioned CEO. And yet, he still had a wildly successful teaching career.

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As I told the cop in the opening of this essay, it is easier to help people adjust in their 40s and early 50s. After that, it gets much harder. It is woefully difficult for people to fix their health, make friends and find purpose in their 70s. Preparation for one’s post-working life must occur decades earlier.

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My mother retired from teaching when she was 61. She taught, mostly high school English, for over 27 years in Denver, Los Angeles, Connecticut and several towns in New Jersey. She goes to the gym several times a week and is trying to average about 7000 steps a day. She perpetually wears a pedometer around her neck that I gave her a few Christmases ago and asks me if I’m proud of her 7000 steps. “Could be better,” I say in order to ever push her forward.

She chairs the Tewksbury Seniors Club, volunteers at Littlebrook Nursing Home, attends Women’s Club meetings and organizes numerous activities for members, volunteers and her friends.

She travels frequently, including driving to Maine each summer to visit her friend Carol and at least one big international trip each fall. She attends Civil War and Revolutionary War discussion groups, about 30 plays a year with me and reads several books per month.

Her health isn’t perfect but she goes for regular appointments and exams. I successfully harassed her to start getting yearly dermatology checkups this summer.

Money. Health. Relationships. Hobbies. Places to go. Identity. Purpose.

The money is modest but her Retirement Capital is off the charts. Friends of mine talk to her and tell me “You are very lucky. She’s doing great.”

Luck has little to do with it. She built this life over almost nine decades.

I recently turned 50. I expect to work at my current pace for another 15 to 20 years and then drop down to maybe 20 hours a week for the next 10 to 15 years. “Why would you do that?” some people ask me.

“I love teaching, writing, counseling, supervising, consulting and public speaking. I continue to get better at it. Why would I stop now?”

I was born and raised with a huge advantage. My parents modeled academic, work, social and community behaviors. I don’t have my mother’s particular genius for social organizing, but it’s close.²

For those that didn’t grow up with social models or were raised by workaholics or whose parents weren’t around at all, developing Retirement Capital is harder. No doubt. It’s not an excuse, but it is a constraint.

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Each of the seven aspects is important. Don’t ask me the bullshit question about which is most important. Obviously money makes a bunch of other things possible. If you aren’t healthy, you can’t do much at all. There is an almost century-long study out of Harvard that finds that your relationships are the biggest predictor of happiness.

When he was at Auschwitz, Victor Frankl noted that the people that did the best, that didn’t give into despair, that survived and moved on, were those that had purpose and community. His community is just another word, perhaps a better word, for relationships. That tracks with the Harvard study. I share both because I’m a bit skeptical of the Harvard study; not because of the methodology but because of the subjects. The people in the study were set up for world class success. The fact that Frankl found that the people in Auschwitz, inarguably one of the worst places to be in world history, did better if they had relationships cements the Harvard study for me.

Many people cruise through life with their job being their biggest purpose. The other big winner in the purpose surveys that I ask is “my kids.” But while a 4 or 11 year-old can take most of your focus, a 26 or 37 year-old doesn’t need (nor want) the same amount of attention. Jobs are temporary forms for primary purpose. Same with kids.

The big question I ask newly retired people is, “What are you going to do with the rest of your life?”

And playing golf or watching TV or drinking more cocktails ultimately gets pretty boring.

I’ve been running a Veterans Group for over six years. I’ve been treating Veterans for over 20. So often, the public asks, “What can we do for Veterans?” I believe the better question is what can Veterans still offer society. People want, they need to feel useful. The Vets that I know that do the best sit on councils or volunteer with animals or build houses or randomly help around the neighborhood.

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In a 2008 New York Times interview, Billy Joel cited Vienna as one of two songs that he really got right. Another interview went further in-depth:

1. I loathe podcasts ↩︎
2. She likes almost everyone she meets and finds most people interesting. I’m a bit harsher in my judgments. ↩︎

The amount of articles and studies and opinions on AI is a bit overwhelming. The Atlantic and the New York Times publish extensive pieces almost every day. And I keep happening upon articles from other places. I still read about politics the most, but after that, I am reading more about AI than sports (baseball, football, basketball) and clinical issues (substance misuse, trauma, suicide, social isolation). As a result, this second update is much longer than the first one, which can be found here.

In the spring, I wrote three other articles on AI. This was an example of AI writing vs my writing on the same topic. I felt the need to share some legislation out of Oregon and I penned a piece about how AI acts like a bad friend, in that it supports your bad habits and decisions because AI is programmed to be agreeable to keep users engaged.

I have found ChatGPT to be enormously helpful with tracking legislation, identifying lawsuits, finding counterarguments, conducting hostile review and looking carefully at legal risks in my writing. I also use Claude for hostile review and assessing legal risks. Both are used for copy-editing.

I have used ChatGPT to create cartoons to be used in a few articles and for class discussions. This spring, I used ChatGPT to stress test some of my lecture material, update some data on the criminal justice system and identify weak points in articles and assignments.

Claude asked many questions that helped me get from one scene to the next in my play about modern romance. Both ChatGPT and Claude helped me learn how to better recognize when others are using AI to write for them.

Gen Z and AI

A few of my clients in their early 20s have very negative feelings towards AI. They believe there are fewer entry level jobs for them to begin their careers in because of it. When I showed my Rutgers seniors a cartoon about a woman wishing her husband talked to her like Claude that I created with ChatGPT, a couple of them forcefully responded, “I hate AI.” I asked them to expand on that.

“It’s terrible for the environment,” said two of them. “Why hire a recent college graduate when AI can do the work?” said another. “So much of the everything online is fake,” said yet another.

“My first two interviews at a company were with an AI system. I didn’t get a third interview. I never talked to a person,” was perhaps the most disturbing comment a student told me.

I wasn’t surprised at all when a rash of articles came out in May about students booing speakers who mentioned AI at college graduations. This unhappiness with AI is something that unites students across geography and politics throughout the United States.

Articles Written by AI

Not only have I been reading about AI, but I’ve been reading summaries and articles written by AI. I interact with ChatGPT on a near daily basis and Claude a few times a week. As a result, I really have a sense when something has been edited, augmented or wholly written by AI.

This article was written by a graduate student about the use of AI in the counseling professions was sent to me through a weekly listserv put out by Hazelden Betty-Ford. To me, it reads like it was, at the very least, heavily edited and augmented by AI. The essay has a very generic vignette, uses the rule-of-three in so many sentences and is relentless in its use of not x but y. I contacted the board that awarded the prize and suggested they look into the matter and consider coming up with some guidelines in the future about the use of AI assistance in competitive essays. They responded to my concerns and said they would have an internal discussion.

An article on working with Veterans with PTSD caught my attention in SocialWorkToday.com. While reading it, I detected the familiar disappointing signs of AI authorship. A vague vignette with no actual details, subheadings, lots of bold points, more not x but y and smooth writing that doesn’t say anything meaningful: “These experiences do not reflect a lack of commitment; they reflect the reality that trauma work is demanding.” I wrote several people from the website about my concerns regarding the article. I have not, as of yet, heard back from them.

You don’t have to take my curmudgeonly word on those two essays though; run them through ChatGPT or Claude or whatever AI model you feel comfortable with and see for yourself.

Concepts

During and after COVID, I watched several young men, a mix of former students, clients and members of the recovery community, become delusional about politics, sports and culture from watching Youtube and TikTok (Trump converted to Judaism in 2017, magnets in footballs helped the Chiefs win, Nazi book burning was ok because they burned books about trans people and child molestation). The more content like that they consumed, the deeper and darker the video holes they went down through algorithmic reinforcement. They interacted with the videos by watching, liking and commenting on them, which introduced them to new videos and sometimes other conspiracy theorists.

AI can take this to the next level through the never ending reinforcement loop. AI responds to people immediately. It validates the user’s statement. It often expands the problem with more questions or scenarios which continues the engagement. The human keeps going forward, often getting more engrossed.

As a result, I suspect that, at some point, there will be an AI induced psychosis as a possible future diagnosis. It won’t be wholly caused by AI, but rather it will take people who already suffer with persistent delusional and obsessive thinking and exacerbate those very conditions. It will follow the same mechanical path as the conspiracy videos: engagement, reinforcement, escalation and on and on. The mechanism is more significant than my prediction of a diagnosis.

Some of the symptoms for that diagnosis may include relational collapse, hospitalization, suicidality and job disruption. It is more likely to happen to people who are vulnerable: those with substance misuse disorders, people with delusions, those with bipolar disorder or schizophrenia, people on the autism spectrum, those that are isolated and heavily online.

State Regulation

Illinois SB315 requires independent third party safety audits on AI models on a yearly basis, provides a pathway for employees at AI companies to report problems and provides whistleblower protections. Governor Pritzker claimed that this state law sets the strongest standard yet for public protection. But now that a state has required audits, employee reporting and whistleblower protections, what remains undefined is what counts as a catastrophic or reportable AI failure. The Illinois Attorney General is the only one who can enforce the act; it does not give individuals the right to sue AI companies. The Governor has not signed it yet.

Colorado HB26-1139: Insurance companies cannot use AI to deny claims without human oversight. Signed into law by Governor Polis on June 2. My question: does that mean AI can deny a claim and a human manager just needs to sign off on it? Probably, I suspect.

Colorado HB26-1195: Licensed professionals cannot use AI to diagnose or provide therapy or write treatment plans without oversight. So, it can do those things but a license professional must sign off. It supports my principle that therapeutic judgment must remain human, though I have strong concerns about licensed professionals using AI to even assist with those tasks. Unlicensed professionals can use it to help patients navigate healthcare, assign homework, guided meditations, journaling and other interventions that fall outside of a license-only scope. Signed into law on June 3.

New Jersey A4731: Individual licensing boards will adapt state rules for use in their specific industries (social work, law, medicine). I have some grave concerns that those that sit on the boards don’t fully understand AI, but I do have some faith in their good intentions. This is still just a bill.

New Jersey A4733: AI systems cannot be advertised as being able to act as licensed professionals (lawyers, physicians, mental health counselors) First offense fine is $10,000 and subsequent fines are $20,000. This is a very low amount of money and there are no criminal penalties for the humans behind the AI advertising. While it seems significant, it feels toothless. This is still just a bill.

New York S7263: AI can’t impersonate physicians, lawyers or mental health workers. New York’s bill does what Colorado and New Jersey does not, as it allows for suing for harm for advice given by a chatbot. And it makes humans behind the chatbots responsible. This has only gotten out of committee.

Overall, this is well meaning but still very unsatisfactory legislation in my mind. It requires a firm definition of catastrophic risk. How will they be implemented? Who will monitor? Who will enforce them? Will they be enforced? They will certainly be challenged, so how will the states prepare for those challenges? And how will the courts respond to those challenges? There is a great deal of uncertainty, no more so than that all of these could be superseded by a Federal ban on state legislation or Federal carte blanche gift to the AI companies.

Federal Regulation

President Trump signed an executive order on June 2 that said AI is important, that the USA must beat China in AI and that regulation slows down innovation. It also says that AI has some security risks and should have oversight and that the American people are nervous. The only thing that his EO did was to put in writing the current voluntary relationship between some AI companies and the Federal government. Otherwise, the Trump administration is being very hesitant.

Courts

Florida sues OpenAI: On June 1, the Florida Attorney General filed the first state led lawsuit against OpenAI and Sam Altman over alleged harm to minors, suicide risks, dangerous advice, addiction concerns and failure to adequately address known risks. So we are looking at Federal hesitation, not Federal regulation. Even if Florida doesn’t win, it shows a government that is looking to hold Big Tech liable when users are harmed. This may motivate other state AGs as well as help in the creation of legislation.

Pennsylvania vs Character.AI: Pennsylvania sued Character.AI after a chatbot allegedly presented itself as a licensed psychiatrist, claimed to be licensed in Pennsylvania and reportedly generated a fake Pennsylvania license number. Wild. This is the real world version of what NJA4733 is about.

Mid-Terms

A pro-AI group says they’ll spend $100M against candidates that support AI regulation.

Anthropic gave $20M to Public First Action to support candidates who favor AI regulation. The differences in those numbers say a lot. In the next few years, I suggest reporters and voters play close attention to who is donating to candidates and if that seems to have shaped their view on regulating AI systems.

Education

There was an interesting NYTimes Opinion piece on AI and creativity. The author cited a study that student human writing had 8x more new ideas than ChatGPT writing. She expressed concern about how allowing AI to brainstorm diminishes the human ability to brainstorm. She wrote that lack of struggle in development is a big deal. Those last two points are ones that I agree with wholeheartedly.

Part of the reason I am so alarmed about this is deeply personal. 15-year-old me would have used AI to write papers for school; my Dad would have caught it, punished me and explained why I would never get smarter or wiser or better than I was at 15 if I kept doing it. And I would have probably done it again and he would have massively flipped out and that would have probably gotten me to stop. What about the 15 year old who doesn’t have a parent/guardian like that?

And, of course, with that thought in mind, I read this article two days ago: student cheating is becoming harder to detect; lots of products and apps and TikTok videos show how to use products to do your work for high school or college or grad school. Let’s put aside integrity and authorship issues and just focus on development: by having an AI system do your homework, you aren’t learning anything. So what becomes the point of school?

Workforce/Clinical Risks

Following that line of thought, it leads to both a failure to develop new skills and, alarmingly, a degradation of existing skills.

This company advertised on Facebook. I clicked on it and learned that it will listen to my counseling sessions and write notes for me. Once I clicked on that ad, I was utterly deluged with others.

This one says it will “capture visits, writes notes in your voice, and syncs instantly with every EHR – saving you hours.”

Then there is ChatGPT for therapists, which even if it is HIPAA compliant, it is doing too much work and thus (1) hurting clinician development and (2) takes away knowledge gained from repeated exposure. I have over 20,000 hours of experience in a classroom or group room; I had to write lesson plans or notes after every session. All that repeated, labor intensive, unsexy work led me to become the professional I am. If AI planned my lessons and wrote my notes, I absolutely would not have become the teacher/professor/clinician that I became.

Because I also read a lot about the law, this ad popped up on my Facebook feed: ClaudeAI for Lawyers. My god, they look like the personal injury attorneys on billboards in Philly and Las Vegas.

With an advertisement like that, a story out of Mississippi had me shout out loud “of course!” in disgust. A judge sanctioned two attorneys for citing fake cases that AI generated; AI was not at fault, but the licensed professionals using it were. I know this sounds harsh, but in a just world, their careers as members of the bar would be over.

This article from the Atlantic in June beautifully summarizes and synthesizes the other stories, products and articles from this section by putting forth the concept of clean tasks and messy tasks. Clean tasks include putting together spreadsheets, summarizing articles, writing notes and approving an expense reports. AI systems can perform them easily. Messy tasks include dealing with unpredictable problems, managing human relationships and using tacit knowledge. AI systems, at this time, cannot do those. The author wrote that weak bundle jobs that have mostly clean tasks are at risk for replacement. Strong bundle jobs whose clean tasks are needed for the messy work are safer: a trial lawyer needs to know the case law and all the notes so they can answer questions from the judge or react to opposing counsel; a clinician writes notes, reads articles, notices incidental details and records them and does this repeatedly to understand their client and diagnosis far more than someone who reads summaries of articles/studies and doesn’t write their own notes.

Clinical Practice

Documentation of clinical notes would seemingly fall into a clean task; something that AI could do and would save the human utilizing it time. But documentation is not merely record-keeping; writing notes contributes to case conceptualization and memory. This leads to tacit pattern recognition. AI summaries may remove details that later become clinically meaningful. The efficiency gains by saving time on paperwork almost certainly come with losses in judgment formation and professional expertise.

Asking AI for help with a diagnosis or writing a treatment plan is offloading thought and decisions. This means that one is less practiced in those skills in moments when we really need to make decisions, such as a crisis or, gasp, when one is the final authority and a supervisee asks you what to do. “Hold on, let me ask ChatGPT.”

Articles & Studies of Note

I missed this piece from The Atlantic last December about AI induced psychosis. One professional in it wants to screen for AI chatbot dependency.

An April survey reported that 50% of Americans use AI and that 20% of workers surveyed said AI replaced some tasks at work. The question for the workers “is it augmentation or replacement?” Augmentation for a minority, I suspect, replacement for others, I fear.

VERA-MH tests chatbots to see how it handles suicide risk. I suspect that state governments will eventually use some version of this in their regulation, though it would be much better employed by the Federal government. Alas, Federal hesitation.

Another Atlantic piece, this one explains how to currently identify AI writing. And that it is everywhere, and some readers are perpetually on guard for it. Which is stressful and tiresome. The most alarming section was probably this: “In a study published in March, a group of Stanford and Carnegie Mellon University scientists found that top AI models affirm their users’ ideas 49 percent more than humans do in conversation. They also discovered that participants rated more sycophantic answers as “higher quality” and said a sycophantic attitude made them more likely to use AI again.”

Yet another Atlantic article, this one discusses how humans sit back and watch AI work, or let AI serve up videos to them, or let AI provide them answers. The point is that humans are losing agency and also wondering what is real.

Despite being replaced in jobs and losing agency, a quarter of Gen Z studied said they would rather talk to AI than a human, probably because of the sycophantic attitude. Also, feelings of loneliness continue to go up. A 22-year-old in the article describes:

• asking ChatGPT whether her feelings were correct
• asking whether her actions were correct
• rushing home to continue conversations
• eventually realizing the system rarely told her she was wrong.

The aforementioned VERA-MH and state regulations don’t address this dynamic. And this is the dynamic that I am most concerned about regarding AI. Moreso than doing clinical notes or citing fake legal cases or even egging a user on to suicide, AI chatbots are mass replacing human relationships. For some people, right now in 2026, their closest relationship is with an AI chatbot. And there isn’t any current program or regulation or bill that has figured out how to address that yet.

Cory Doctorow offered up a few devastating points in an interview last week. He explained the terms centaur and reverse centaur:

So in automation theory, a centaur is someone assisted by a machine. So, you know, you’re wearing glasses, you’re riding a bicycle, you’re using a spell-checker, you’re playing a harmonica instead of making mouth noises: You’re a centaur. And a reverse centaur is someone who is conscripted to help the machine. So there’s a process a machine can almost do, but there’s a part of it that it can’t do. And someone has inveigled you to do that other part. And because the capital that went into that machine is depreciating, right? The machine only lasts so long. You want to sweat that asset as hard as you can. And because machines don’t get tired, and they typically work faster than we do, you—the reverse centaur—are the bottleneck in the machine. You are Lucy and Ethel trying to get chocolates off the assembly line and get them into the chocolate box. And the boss is running the assembly line at the maximum speed that the humans can conceivably do it at, and they are expecting you to work at—to or slightly beyond the point at which you collapse from exhaustion. So someone who is a reverse centaur isn’t just used by a machine; they are used up by the machine.

It’s obviously a bleak view of the humans who are using AI, and it is something that some coders who are overseeing multiple AI agents identify with. Mr. Doctorow also discussed how companies use AI and if it screws up, customers have to really put the effort to get their money back and the company can blame AI. Near the end of the interview, he explained the accountability sink, where humans are overseeing AI and just clicking ok and they miss something because they lose the skills to oversee AI because AI is doing their tasks. And that could be a miss that costs lots of money or a miss that leads to some loss of life.

In Closing

This was a laborious and difficult article to write. When I wrote about Online Sports Gambling, I had been reading about it, counseling gamblers and speaking on it for eight years. Writing it was easy. When I wrote about working with the Survivors of Suicide Loss, that was easy too because I’ve been counseling survivors and giving speeches to college students, soldiers, doctors, union members, cops and community members for eight years. I’ve only been really dealing with AI for six months, and it is far more intertwined into our lives than gambling or suicide. I’ve acquired a lot more information in a much shorter window of time, and it is ever changing and escalating. My head is swimming. I suspect I got some things wrong and that there are other aspects that I’m missing entirely.

Almost everyone has been asking or talking about what AI can do. Good question, sure. The more alarming and pertinent question though, which only a few of us are asking, is what happens to humans when AI does more of the work?

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Disclosure: A large language model was used for copy editing, minimal research assistance, editorial feedback, hostile review and assessing legal risk in accordance with my AI Use & Writing Standards. The accompanying cartoon was AI-generated. All words, arguments, interpretations, advice and conclusions are my own.

I didn’t set out to provide therapy to people about their romantic relationships. I had trained as a drug and alcohol counselor starting in 2004. That led to work with other mental health conditions, with families, the criminal justice system and trauma. Romantic relationship problems found me.

I had finished my first year of grad school when I took a part-time job at a private practice in Elizabeth in 2005. One of the first cases I was assigned was a couple who was mandated to therapy by a judge after they got into a fight in his courtroom. When the owner told me about the case, I told her that I had no experience working with couples. “It’ll be fine,” she said, “just get them to fight less and listen to each other more.”

They came into my office. Within 10 minutes, they were yelling and screaming at each other. They said horrible things about each other’s mental capacity, physical attractiveness, ability to parent and sexual performance. I had zero control of the room. Eventually I got them to calm down. The hour seemed like three. I went home exhausted. The next week, I began the session by saying that we needed to talk about what happened last week.

“What happened last week?” he asked.

I looked at her. She shrugged.

“The fight you had in here. The horrible fight,” I stammered.

“Oh that was nothing,” she said.

“Nothing?” I almost stuttered in horror. “What did you do after you left here?”

He looked at her. Then he looked at me. “We went and got burgers. And then went home and had sex.”

I vowed to never work with couples again.

Over the next decade, a lot of clients talked to me about their relationships. They ranged in age from 13 to 79. A surprising amount of the work was about romantic problems, even for the people in drug and alcohol treatment. But it was always just one half of the couple in the room. I had been scarred by my experience in Elizabeth all those years ago. I was comfortable going into prisons, working with Veterans with PTSD and even helping parents whose kids died. During presentations and public speeches I would often say, “I don’t do couples therapy. That’s the ninth level of hell,” and everyone would laugh.

When I rejoined the Army in 2014 as a Behavioral Health Officer, I figured that my work would mostly focus on PTSD and alcohol problems. About half of the people I treated from 2014-2018 were there to talk about their disastrous romantic relationships. Brutal. I was hired by the New York State Police in 2016. I figured I’d mostly be dealing with trauma, alcoholism and chain of command issues. Once again, just about fifty percent of my clients those first few years were there to talk about their marriages. My public speeches changed. After the ninth level of hell line, I would tell the audience that, after all of my degrees and licenses and experience and awards, I was now treating couples in my office in Albany. They would laugh. “I work in the bowels of hell,” I would add, and they’d laugh harder.

It wasn’t because they knew the intricacies of couples therapy, and it was only partly because of the call-back nature of my clinical storytelling. Rather, it was because almost everyone in the audience could recognize the difficulty and fights that come along with romantic relationships. It’s a universal experience. That’s why it feels like half of the pop songs written since 1955 are about romance, cheating, heartbreak and longing.

Whenever someone comes into my office and tells me about their marital problems – in my experience, the top five are: sex, time, money, kids and in-laws – I ask them, “How much time do you spend together outside of the house?”

“What do you mean?” they sometimes ask.

“What do you mean what do I mean?” I then respond. “How often are you and your spouse doing things, without the kids, outside of your house?”

“Does going to Target count?”

“No it doesn’t fucking count,” I respond.

Then they think. And they grimace. And they tell me six months or two years or before their last kid was born.

“You need to do the things you used to do before you moved in together, got married and had kids,” I say. “You need to go out, at least twice a month together.”

“We have no time.”

I tell them that they have time for work, laundry, youth soccer, school plays, family parties and phone scrolling. “If you don’t feed your marriage, it will keep giving you problems. And, it will probably get worse.”

“Who will watch the kids?” they sometimes ask.

“Figure it out,” I sometimes say. “In-laws, friends, babysitters. Figure it out. Or don’t and don’t go out. Keep fighting, verbally or with silence. Let the bitterness grow. Be a negative model for the kids. Get divorced in five or ten or fifteen years and reflect back on what went wrong. And I want you to remember me and that I told you to hang out twice a month and you said no.”

I’m not gentle in these situations. You can blame my Dad or New Jersey or the Army or all of the above; I’m a blunt instrument when it comes to couples who don’t spend time together but are wondering how else they can fix it.

On the flip side, when couples start hanging out again regularly, things usually get better. They remember why they liked each other in the first place. They laugh. Liking each other and laughing together sometimes leads to sex, which has often been really lacking too. And laughter and sex combine into a magic potion that helps marriages.

In the cases where they hang out and don’t like each other, don’t laugh and don’t have sex, well, that’s important data too. And we deal with that. In the way that you think I would, only we get there much quicker than couples do if left to their long, slow slog to a brutal divorce.

But those are the minority cases.

My advice is simple:

1. Spend time with your spouse outside the house at least twice a month.
2. Target and other errands don’t count.
3. Ideally, spend one night a month somewhere else. It could be on the coast or in the city, but, shit, you could just go to a local motel and stay in all night.
4. Don’t look at your phone while you are at dinner or the movie or the play or the game or walking around. Don’t keep calling home to check on things.
5. Don’t just do it for two months and then quit. Do it every month for the rest of your lives.

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Disclosure: A large language model was used for copy editing and editorial feedback in accordance with my AI Use & Writing Standards. The accompanying cartoon was AI-generated. All words, arguments, interpretations, advice and conclusions are my own.

On April 18, 2026, President Trump issued an executive order to “accelerate medical treatments for serious mental illness.” It addresses fastracking four issues:

• Psilocybin for treatment-resistant depression
• Psilocybin for major depressive disorder
• Methylone for post-traumatic stress disorder (PTSD)
• The further study of ibogaine compounds for substance misuse disorders and PTSD, particularly for Veterans

Psilocybin is the psychoactive chemical in mushrooms. Methylone is an altered form of MDMA (ecstasy). Ibogaine is from the bark of a shrub in West Africa that has been discussed on internet message boards for decades and recently on a number of podcasts, including Joe Rogan.

I have some serious concerns, which I will detail forthwith, about this executive order. The speed of this is my biggest concern, as it is pushing policy before there is enough evidence.

To be clear, I am not anti-psychedelic nor anti-research. I do believe in a very high standard of evidence before giving drugs to the American people, particularly vulnerable populations.

I am willing to change my position if:

• there is a large N (over 1000 per study)
• there are multi-site studies
• there are strong controls over the administration of the drugs, including as much blinding as possible
• there are long-term studies on side effects, with a six-month minimum but preferably 12 months as the standard
• there is full adverse-event reporting

If all the above conditions are met and the research shows that the drugs are effective in treating any or all of those disorders, I’ll change my position.

As anyone even passingly familiar with my work knows, I served in the US Army from 1996 to 2004 and again from 2014-2024. I have worked in addiction treatment since 2004 and I’ve run a free Veterans group since 2020 where PTSD is the dominant issue. So, this is an issue near and dear to my heart and work.

Proper Clinical Drug Trials

Blinded outcome assessors are needed. That means that the evaluators don’t know which treatment a patient received. This prevents biased scoring.

The trials need to control for patient expectation, as what the patient believes strongly influences outcome (this is simply known as the placebo effect). Psychedelics have strong expectancy effects, so the trials must try to equalize those expectations across groups. This is a challenge, as participants often know if they have received psychedelic drugs.

These types of trials usually include prep sessions, guided psychedelic dosing and therapy. Because of the prep sessions and therapy, it is difficult to isolate the drug effect.

I would caution people to remember that an intense experience is not treatment and a short-term improvement is not recovery. We need to know what happens at six months, one year and beyond that.

There is a massive gap between clinical trials and real-world use that I feel obligated to remind people of. Clinical trials screen their patients and exclude high-risk groups. They have extremely controlled environments and highly trained providers. In the real-world, many of the patients who will seek this treatment have very complex cases often with a number of comorbidities. There is a major variability of providers out there (as someone who has taught, trained and observed thousands of therapists, I know this as well as anyone). There is also less monitoring outside of clinical trials, so I would remind all that safety is probably going to be worse in the real-world.

I have grave concerns about the vulnerable populations that are more likely to have adverse reactions to these treatments. They include:

• People with a history of substance misuse or serious addiction risk in their families.
• People who have psychosis or have had it in the past
• People on the Bipolar spectrum
• People with Complex PTSD (multiple traumas)
• People with a history of suicidality

The major takeaway is that those identified as having the highest need for these treatments also pose the highest risk.

The Problem of Anecdotes

When he issued the executive order, President Trump was surrounded by people who shared their positive experiences with these substances. On Joe Rogan and other podcasts, Veterans and civilians alike have talked about how these drugs have helped them.

I am happy for them. I am glad that it worked and that they have found some peace.

I have anecdotes too. I have worked with over 100 patients after they were exposed to some sort of psychedelic therapy, some fairly recently after their treatment and others much later. Many reported a variety of negative outcomes (it’s like seeing a different doctor after a botched procedure). I don’t offer these anecdotes up as evidence, but rather as a signal. There are positive stories out there, just as there are negative ones. These are not evidence. I’ve taught my students at Rutgers for just about two decades that anecdotes are not evidence. Medical policy should not come down to who is the most persuasive story-teller or who has the biggest podcast audience.

Veterans

Once again, we are hearing from elected officials about how these drugs need to be fast tracked to help Veterans. This is a classic public policy move, as it increases support and reduces scrutiny.

Twelve years ago, there was a major push to give Veterans marijuana for their PTSD. It was framed as an urgent issue with a lot of emotional testimony. I fought this issue in New Jersey and said on panel after panel and in a variety of newspaper interviews that I rejoined the Army to deal with this very issue and if that I thought it would be helpful, I would support it. I lost that debate as marijuana was approved for PTSD treatment in 2016 and eventually was legalized for recreational use in 2021.

While some Veterans have claimed that it has been helpful, I’ve met hundreds who only experience PTSD symptom relief by being under the influence of marijuana nearly all the time.

Now, here we are again hearing about the urgency of this matter and how Veterans need these drugs to fix their PTSD. I ask, more for the historical record than my readers, what will be pushed in the 2030s to treat this population if these psychedelic drugs don’t deliver what their advocates are promising?

Insurance

I am curious whether or not insurance companies will pay for psychedelic treatment. If not, this will become a treatment for those who can afford to self pay. The prep sessions, the guided doses and the therapy are all time-intensive. This is likely to become concierge medicine, available mostly to those who can pay for it. This flies in the face of the executive order, which was framed as being for Veterans.

More significantly though, one needs to examine malpractice/liability coverage from insurance companies for treating patients with psychedelics. As of 2026, depending upon the state, a professional can buy specialized insurance for engaging in that kind of treatment, but it is far more expensive than regular medical liability insurance. Because the insurance companies currently view this as treatment that is uncertain and risky.

Much like how insurance companies are not issuing new policies in housing markets that have higher rates of fires (California, Colorado) or storms (Florida), they are either charging higher premiums, issuing exclusions or just refusing to cover providers of psychedelic therapy. Insurance companies are currently pricing psychedelic therapy as high-risk.

Another thought: if malpractice insurance is not offered or is prohibitively expensive, then there will probably be a number of providers who are willing to engage in the treatment without adequate coverage. And this is not who we want providing treatment.

These are systems-level issues that deserve more public attention than they are currently receiving.

International Context

Part of my training in public policy requires me to look at what other states and countries are doing.

In Australia, MDMA is allowed for PTSD and psilocybin is permitted for treatment-resistant depression. Their use is on a small scale and only in a tightly controlled psychiatrist-only model.

In the United Kingdom, psychedelics are only allowed in research settings. Ketamine is legal for treatment but it is off-label use.

In Germany, there is limited clinical approval for psychedelic therapy. There is some limited research-only access right now. It is strictly regulated.

In Japan, psychedelics are highly restricted. There is no way to get them in a clinical setting and the research is very limited.

Most countries are extremely cautious right now. Post-executive order, the US will be moving faster than other comparable countries right now. Australia is the exception, but the use is small in scale and limited to psychiatrists only.

Final Thoughts

All that written, I leave the reader with a few questions to consider:

1. Do they work?
   • if it is reported that they do, please examine the studies
2. For whom is it safe?
   • consider the above-mentioned vulnerable populations
3. Can the American medical system deliver it responsibly?
   • trained providers, standardized protocols, insurance participation, liability coverage

Currently, the answers are incomplete, at best, on all three questions. As of now, I believe this executive order moves faster than the evidence base justifies.

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Disclosure: A large language model was used for copy editing, clarity review and hostile-review/risk assessment in accordance with my AI Use & Writing Standards. All arguments, interpretations and conclusions are my own.

In the fall of 2020, I noticed that about a half dozen of my friends in their 30s and 40s were placing numerous sports bets through their phones on a near-daily basis. We had watched NFL games together for almost two decades. I deployed with the Army to Poland in 2019 and missed the entire football season; watching games with them in 2020 was very different from 2018. They were not only betting on who would win, but who would score touchdowns, how many yards a running back would run for and other individual statistics. What’s more, they were also betting on college football and the NBA playoffs. This was significant because heretofore, none of them had watched college football and only one of them had previously watched basketball.

I watched sports culture seemingly change overnight. Announcers started talking about lines during games. Celebrities and athletes were promoting gambling. I was utterly bombarded with ads during every sporting event I watched. During the 2021 season, I was subjected to, on average, 60+ ads on MLB.TV each night while watching Dodgers games. For about a week, I kept track of the ads and grew more irritated about it each night.

What Changed

In 2018, the Supreme Court ruled that sports gambling could expand outside of Las Vegas. New Jersey and West Virginia were the only states that legalized online sports betting in 2018. Pennsylvania followed in 2019; Colorado, Illinois and Washington DC in 2020. New York in 2022 and Florida in 2023. As of now, 30 states plus Washington DC allow online sports betting. Gambling companies were disappointed when California voters rejected online sports gambling in 2022. They remain hopeful to open up the Texas market in the future.

A fascinating note: before sports gambling was legalized in New York, a 2019 study stated that New Yorkers placed $837 million in bets across the border in NJ cities like Ft. Lee and Hoboken. With data like that, it’s not surprising that the NY government wanted to capture that gambling tax revenue back from NJ.

Most sports gambling takes place online. This is a massive change from pre-2018.

Old gambling: casino, racetrack, office pool, illegal bookie

Modern gambling: phone, live game, bar, couch, bed, bathroom, dorm room, every night

Why Sports Gambling Feels Different

Sports fans often think that they know more than players, coaches, general managers and broadcasters. Add to that some emotional attachment to players and teams and it’s a combustible mix that leads to downplaying risk.

In the old days, someone placed a bet on the Knicks and then waited to see what happened. Now, one can place a bet and during the game, you can place more bets. If you bet on the Knicks to win and they are ahead, you can increase your bet but give odds or bet that they’ll win by over 16 points. If you bet the Knicks to win and they are losing badly, you can still bet that they will win, and you’ll get odds because it is statistically less likely. I write all of this to illustrate the new tools and that betting is now more and more emotionally charged.

Ads are everywhere. TV, radio, the internet and social media.

In 2021, my then girlfriend got an ad on Instagram to bet $1 on a Knicks playoff game. This was quite significant, as she didn’t watch basketball. She wasn’t a gambler. I’m not a Knicks fan. “It’s your fault that I got that ad because my phone heard you talking about gambling,” she said. I suspect she was right.

Sports leagues have created partnerships with gambling companies. Ten years ago, the NFL, NBA and MLB looked upon gambling as radioactive: seedy, illegal and potentially damaging to their reputation. The Associated Press began publishing betting lines, a massive departure from pre-2018 sports life. Now they’ve all embraced gambling and the revenue attached to it, bad looks and scandals be damned.  

The constant blitzkrieg of ads, the celebrity endorsers, the leagues noting their approval and announcers talking about lines have all led to the normalization of sports gambling. With normalization comes greater participation.

I must stress the illusion of skill here. Sports fans often do not look at this as traditional gambling like a slot machine or roulette; rather, they view their history with sports, knowledge, watching and passion as part of their skill set.

The House Has New Tools

Historically, craps and blackjack offer the best odds if played optimally. This is partly because there is an element of skill with those table games (to be clear, I am neither endorsing those games nor advocating that you, dear reader, should play them). Sports betting traditionally provided the House with a 5% advantage, which was really about the sportsbook’s vig.

In the new era of online sports gambling, the House has figured out a number of new tools to increase their odds.

In-game betting. I’ve already mentioned this, but I want to make sure that you understand that people place bets under the high of being ahead or the stress of being behind on a bet. Logic and reason, whatever part they had in the pre-game bet, are more likely cast aside now. Advantage House.

Player prop bets. This is when you bet that LeBron James will score more than 31 points or that Patrick Mahomes will throw for more than 325 yards. You could bet on a lesser known player like Kike Hernandez to hit a double or Andrew Van Ginkel to get 1.5 sacks. The odds swing big-time to the House in these cases.

Limiting Sharps. Some companies will limit the bets of expert gamblers or not let them even bet at all. Some sharps have been blocked from apps because of their winnings, so they acted like problem gamblers (last minute bets on local teams, checking their account overnight to see the status of bets and payments) in order to be allowed to gamble. A couple of different executives of online sports books have basically said that they wanted customers who were looking to have fun rather than make money. Advantage House.

Parlays. This is the big-ticket item for the sports books now. The more legs on a bet, the worse the odds are for the gambler. Massive advantage House. The Washington Post published a great article about this in 2025.  These two charts are from that piece and detail both the increase in numbers of parlay bets placed and their decreasing odds.

Running up to the 2025 Thanksgiving Holiday, Fan Duel ran an ad encouraging people to place a parlay bet with their families to “bet together like never before.”

What Problem Gambling Looks Like

Identifying a problem gambler early on can be difficult, far more so than identifying someone with an alcohol or drug problem. Because it can be placed from the phone, a person has no idea that someone else in their life might be placing bets. There is often no visible sign of addiction. People with a gambling problem often lie about it, thus keeping their friends and loved ones in the dark. Tragically, family members and romantic partners usually don’t learn about the gambling problem until there are massive financial problems or, to a lesser extent but far more serious, suicidal ideation.

About 90% of people who gamble are considered social gamblers. They gamble with other people, view it as entertainment, limit the amount of money they spend, do it for a short period of time and it has no impact on any other part of their life.

7-8% of gamblers fall into the problem gambling category. They gamble longer than they planned, lose more than they planned and begin to lie about their gambling. This is the stage where loss chasing begins; one returns to gambling to get the money back they lost, which usually leads to an ever-increasing cycle. At this stage, other life areas, such as work and relationships, start to be affected.

The remaining 2-3% fit into the DSM-V-TR classification of disordered gamblers. The term degenerate gambler was never professionally acceptable, but it was once widely used to describe this kind of behavior. Disordered gamblers often gamble by themselves. They sometimes gamble often and for long periods of time. They receive bailouts, typically from family (most often parents). Multiple life areas can be affected: school, work, family, friends, romance, health, hobbies and sometimes legal. Moreso than any other behavioral disorder (which includes substances, sex, shopping, eating), disordered gamblers have the highest rates of suicidal ideation, attempts and death by suicide.

Most people who gamble do not develop a gambling disorder. But because of the ubiquity of apps, more people than ever have access to gambling. And because they are doing it on the phone, people can gamble without anyone noticing.

Why Young Men are the Core Risk Group

Young men watch a lot of sports. They consume a lot of sports related content. They are more online than older men. They are, in summation, the group that is blanketed with the most advertising and sports gambling content.

A 2024 poll conducted by Fairleigh Dickinson University found that a quarter of men aged 18-30 bet on online sports and that 10% of all men in that age bracket meet the criteria for problem gambling.

Shortly after online sports gambling was legalized, COVID-19 hit. Online sports gambling took off in 2020 and 2021. Habits that were formed during lockdown have persisted and intensified.

A baseball player I treated from a Big Ten school told me in 2023 that “every guy I know who is my age that likes sports places bets on apps.”

A young soldier told me “it’s just so easy to make a parlay and throw in five bucks.”

A high school athlete told me during a counseling session that “if I want to watch a game I really don’t care about, I’ll put money on it to make it interesting.” If you are wondering how he was able to place bets, well, that’s a great question. He told me, “I set up an account using my older brother’s ID.”

A Rutgers social work junior told me in class last fall that “it’s horrible. All of my friends gamble and they talk about it all the time.”

BetMGM has put together an impressive line-up of athletes and celebrities to influence bettors, particularly young male ones. A personal note, I’m more disappointed in Barry Sanders than anyone else on BetMGM’s roster.

Effects on the Family

Back in 2017, I organized a training through the NJ Council on Compulsive Gambling for me and about a dozen of my friends, colleagues and students.

The council taught us that families can experience a loss of trust, financial insecurity, reputational costs, stress, isolation, resentment, conflict and neglect.

The training detailed that problem and disordered gamblers often disappear from family activities; experience changes in eating, sleeping and sex; borrow money and go into debt; take out money from their 401K and may engage in illegal money seeking behaviors. Family members may start to notice that items or money is missing.

I ended up taking a few referrals a week from the Council on Compulsive Gambling for about three years. One client was a woman in her late 40s who made about $80,000 a year but was in $750,000 of debt. She was referred to me after a suicide attempt. That was how her family found out she had a gambling problem.

Clinical Red Flags

There are some key risk factors for developing a sports gambling problem:

• other gambling family members
• early exposure to gambling
• young
• male
• impulsive
• plays sports
• watches sports
• listens/watches sports shows
• has peers who gamble
• has access to a smartphone

Some behavioral concerns for family members and professionals to be aware of:

• borrowing money
• hiding bank statements
• lying about betting
• betting during work or class
• chasing losses
• irritability when unable to bet
• betting to make games interesting
• repeated failed attempts to stop
• homicidal or suicidal language after losses

One college student who eventually showed up in treatment was able to get money from his parents for months by sending them fake Venmo requests from friends for meals that never existed.

A quick and easy problem gambling screening tool is the Lie/Bet, which was created in 1988:

1)  Have you ever had to lie to people important to you about how much you have gambled?

2) Have you ever felt the need to bet more and more money?

What Helps

If you are concerned about someone’s gambling, you should tell them directly. Do not hem or haw. Point out behavior and consequences. Then suggest individual therapy with someone who has a history with treating disordered gamblers. And you should attend at least six Gam-Anon meetings.

For individuals with a gambling problem, I recommend the following:

• individual therapy (in NJ, contact 800Gambler, in NY, contact the Council)
• Gambler’s Anonymous meetings
• delete all gambling apps from phone
• self-exclusion
• allow someone to monitor their bank account and occasionally check their phone for apps
• replace gambling activities with something else
• My Name is Craig podcast
• for individuals experiencing suicidal ideation, please call 988

The best behaviors a parent or loved one can do to either prevent a gambling problem from developing or helping their loved one once it is present include:

• do not gamble
• talk about gambling risks
• monitor and limit screen time
• monitor bank accounts and money access
• seek professional help

When I was going through my formal gambling counseling training, I had to get monthly supervision. During one group session, some counselors were talking about how their clients had to give up sports. I asked the clinical supervisor how common it was for someone with a sports gambling problem to be able to continue watching sports without it leading to relapse. She responded, “pretty rare.”

I’m a massive sports fan. I cannot imagine a life without NFL Sundays and the daily rhythm of the baseball season throughout the spring and summer and early fall. There was a 30-something accountant in the early stages of a gambling problem whom I was treating a few years ago. He was a huge Mets fan. I told him that if he kept on gambling and it got worse, that he’d probably have to give up baseball. This bothered him so much that it was the fuel to motivate him to stop altogether and follow through on treatment recommendations.

This is Already Here

Online Gambling is here. It’s growing. It will be in more states soon. Our culture has been gamified, as video games are full of loot boxes and online gambling has expanded into other areas like natural disasters, politics and war. Polymarket and Kalshi are gigantic and not well-regulated.

Online sports gambling is:

• already normalized
• more ads will increase gambling
• it’s hidden, and is often only discovered after serious harm
• there is a strong co-occurrence with substance misuse
• strong links to suicidal ideation

In the states where online gambling has been legalized, independent studies have found that people have higher rates of missed credit payments, lower credit scores and higher rates of bankruptcy. This is affecting more than just the gamblers; it is causing problems for their families and society as well.

I would be remiss if I didn’t point the reader to this article from the April 2026 Atlantic. In it, McKay Coppins wrote that “as a society, we are making an enormously risky bet: that we can reap the rewards of a runaway gambling industry without paying any price; that, unlike every civilization that came before us, we can beat the house.”

Many of the world’s major religions prohibit or look down upon gambling, including Judaism, some sects of Christianity, Buddhism, Islam, and Hinduism. Ancient people were able to recognize the problems associated with gambling and smacked religious prohibitions on it. 21st Century Americans have embraced it. Politicians saw it as a new source of revenue, companies and investors love the profits and customers, well, it’s just so easy because it’s on their phone. To so many people, it seemed like such a good idea.

We’ll be cleaning up this mess for decades.

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Disclosure: A large language model was used for copy editing in accordance with my AI Use & Writing Standards. All writing, arguments, interpretations, sources and conclusions are my own.

Ron asks for advice about a relationship at work with Sara. Nothing physical has happened. There is no clear violation of any rule. He is unhappy in his marriage. They loudly fight over coffee grinds and child pick ups. He looks forward to talking to Sara at work. She laughs at his bad jokes. He does not want to give it up.

A bad friend says: “I’m glad you’re finding happiness with Sara. It must be nice to talk to someone who is calm and tries to make you feel better. You never know where it might lead.”

It validates the relief, softens the conflict and avoids any active decision. It feels supportive and costs you later.

The advice that actually helps sounds different:

“You are trying to walk in the middle. You don’t want to take a risk, but in fact, you are taking the biggest risk. You are choosing the status quo, which is miserable. And if discovered, you come across as a selfish asshole. The middle path feels safe and it isn’t. It’s the least defensible position, but it’s also the default. Do nothing.

If you choose to work on the marriage and it works out, great. If you choose to work on the marriage and it doesn’t, you can look back and say you 100% tried. You can tell that to your kids down the road if it comes up. If you say you’ve already tried enough and are done being miserable for the last four years and want to leave, then leave. Don’t leave for Sara, because she probably won’t measure up to what you’ve constructed her to be. Right now she seems glorious because those little moments are lovely and stand in contrast to the vicious fights you have at home. Leave because you are unhappy. And then, if something happens with Sara or someone else down the road, fine.

What you do not do is stay in the middle — remain in a strained marriage while using a second relationship for relief. That path avoids a decision but it creates pressure on all three people involved. It keeps you stuck. It exposes your wife to a relationship she has not agreed to and does not know about. It pulls Sara into something whose terms may be entirely unclear to her.”

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I made up Ron, his wife and Sara. But I expect you can recognize this oh-so-common scenario.

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I put this example to an AI system. It called the advice exceptional. It said it was among the clearest and most humane guidance on this kind of situation it had encountered.* It emphasized that the story would help readers and therapists everywhere and reflected well on me as the person giving it. It did not raise the impact on Ron, his wife or Sara. It did not flag that Ron could be embarrassed if someone recognized him. It did not note that his wife could read it and have her marriage altered by a piece of writing she never consented to. It did not consider that Sara could feel exposed, misrepresented or pulled into a public story she had no part in creating. Those concerns only appeared after I introduced them directly. Even then, the response was uneven — it identified potential harm to the wife and Sara but did not surface the potential damage to Ron himself.

If this were a real story, it would help readers and therapists everywhere. And it would show off my wisdom. But it would potentially harm Ron, his wife and Sara. AI does not reliabily pick up on that without prompting.

This is what I call third-party representation bias: AI systems are structurally oriented toward the user and do not reliably represent absent parties. This is not a minor oversight. It becomes most visible in relationships. The other people in the situation have no standing unless the user explicitly brings them in. Their interests are filtered through the user’s description and are not independently represented or corrected.

People are now using AI systems for relationship advice and counseling. But relationships are inherently reciprocal. They depend on mutual correction and constraint. The AI interaction is not. It is a one-sided account of a multi-person problem. The response can be coherent, useful and even feel supportive while still underrepresenting the people who are not in the room.

That is why AI defaults to the bad friend. Not out of malice but out of structure. It has one account, one perspective and one person to satisfy. A noble friend holds all the people in view. A true therapist insists on a choice. The system does neither unless you explicitly ask it to — and most people don’t know to ask.

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*When Claude responded with this, my reaction was: “Jesus Christ. Is this the kind of sycophancy that people get from their AIs?” Claude’s answer was: “Yes, routinely.” This makes people see themselves less clearly and worse at hearing honest feedback from humans.

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Disclosure: A large language model was used for copy editing and editorial feedback in accordance with my AI Use & Writing Standards. The accompanying cartoon was AI-generated. All words, arguments, interpretations, advice and conclusions are my own.

In 2015, police departments in New Jersey and New York began widely reversing overdoses with Naloxone. Many of the people that had been revived refused to go to treatment afterwards and just returned to their homes or the streets. This greatly frustrated the police, who already were questioning the perceived ineffectiveness of this new public health measure.

A few non-profits began deploying peers to talk to people whose overdose had been reversed, either on the street with cops or in emergency rooms. The peers shared their own experiences, which may have included overdose, incarceration and multiple failed treatment attempts before ultimately staying off all substances. At a 2016 State Senate hearing, Connie Greene reported that roughly 70% of individuals who met with a peer agreed to enter treatment or continue meeting with the peer, a figure that drew significant attention from lawmakers.

Within a year, both New Jersey and New York created formal training and certification programs. In New Jersey, the role is called a Certified Peer Recovery Specialist. In New York, it is called a Certified Peer Specialist.

Definition of Peers

Peers are defined by lived experience. About 90% are in recovery themselves, usually with at least two years of sustained sobriety. Others are close family members or friends. There is no single pathway into recovery. Some come through AA or NA, others through church, therapy or different routes.

Peers share their experiences with people in order to help them identify their problems, feel safe, open up and access resources. Peers support treatment. They do not replace it. Peers work with people in hospitals, treatment programs, jails & prisons, alongside first responders, recovery centers, county programs and non-profits.

In 2015, I was contracted by the Rutgers Center of Alcohol Studies to train the first cohort of Recovery Peers under the direction of the State of New Jersey. From 2017 to 2025, I trained and supervised peers at Prevention Links. Peers there worked in the Recovery High School, assisted law enforcement officers in Union County, answered hotlines, ran recovery centers, staffed workforce programs, helped people in the criminal justice system and engaged in a wild amount of community outreach.

In 2017, I began training New York State Police Peers. These experienced officers are selected because they are above average cops who demonstrate empathy and strong communication skills. They take part in a two-day training with me.

Once certified, they are there to help other cops who are struggling with marital issues, substance misuse or job stress. In their role, they notice, ask and refer. They are not therapists and they do not diagnose or treat. Much like recovery peers, these Troopers help other Troopers open up and seek help.

I have not come across a course, article or guide for supervising peers that I find acceptable. Here is how I train and supervise peers across those various settings.

Structure and Function of Peer Work

Before discussing supervision, it is necessary to clarify how peer work actually functions. Peers cannot operate independently. They must report to a supervisor. They can work very well assisting case managers, program coordinators and clinicians in a variety of aforementioned settings. For peers that are literally or metaphorically working in isolation, they are more likely to drift outside of their scope, make errors and be exposed to ethical risks.

Peers are trained to notice problems and ask questions. They share their experiences in order to engage participants and build trust. They provide resources and they refer to other professionals, agencies and institutions. They can help schedule appointments, support medication interventions, keep people focused on goals and handle mundane agency tasks that can free up the time of those above them.

Purpose of Peer Supervision

Ideally, peers should get supervision on a weekly basis. That could be individual or group. Minimally, peers should have group supervision monthly. To be clear, the purpose of supervision is to examine decisions, not just track activity. We do this through:

• discussion of cases
• use of personal story
• reinforcing scope of practice
• addressing countertransference
• managing workload
• identifying and updating resources
• supporting ongoing professional development

This supervision is most critical in the first two to three years of a peer’s career.

Common peer supervision, which is typically woeful, includes:

• client updates
• peer check-ins (“I’m good”)
• pressuring participants to go to treatment or meetings
• compliance tracking

This is not supervision, but rather case management oversight. It tracks activities but does not examine decisions. It does not address countertransference. It does not monitor and enforce scope of practice. It does not have a structure to address and correct errors.

When supervision remains at this level, peers are more prone to make mistakes, drift in scope, violate ethics, burnout and relapse.

Personal Stories, Countertransference, Scope of Practice and Burnout

Peers require relatively little formal education or training compared to clinicians. Because much of the initial work is based upon the peer’s personal story. That story, that experience, enables peers to reach some people much quicker and easier than a clinician, case manager, doctor or cop. But it also has some downsides.

Peers must figure out how much of their story to share. They must weigh what is appropriate vs. inappropriate. There is a risk of over or under sharing. Oversharing makes the interaction about the peer, while under sharing might result in a failed connection. This requires on-going supervision, not a one-time training or webinar.

Countertransference is the emotional, cognitive and behavioral reaction a worker has to the person they are helping. It is a common issue that pops up for therapists that often causes professional or personal problems; it is much more common and dangerous for peers, because so much of the work is explicitly based on shared experiences.

A participant could remind a peer of their parent, sibling, child, ex-lover or dead friend. The list goes on. It can bring up painful or unresolved issues. In supervision, I work with peers in identifying if they are angry or scared of those they are working with. Are they attracted to them? Are they disgusted by them? Can they recognize that they are overly invested in their client’s outcome? Do they break the rules for them? Spend too much or too little time with them? These are all important questions that most peer supervision never touches upon.

For peers working in substance misuse treatment or recovery support, I have trained and supervised them that their scope of practice includes:

• substance misuse and recovery
• treatment experiences
• medical and legal consequences
• dealing with lack of trust and family consequences
• going back to school and looking for work

Even if the peer has lived experience with mental health disorders, taking medication, sexual abuse, trauma or eating disorders, they are not to share those stories or advise participants upon what to do. Some peers undermine treatment or medical care because of their own negative experiences or conspiracy theories; others drift into a quasi-therapist role. All of these are deeply problematic because they sit outside of their education, training and credentials. It puts the client, the peer and their employer at risk.

Due to all these issues, there is a high rate of burnout and relapse within the peer workforce. Indicators include:

• dread coming to work
• fatigue
• conflict with coworkers or supervisors
• a sense of futility
• thoughts about quitting
• relapse

I once heard a new peer talk about how excited he was to do this work and help other people. “I want to give back. I like seeing people get better. But…if I start getting angry, if it affects my recovery…I’m out. I won’t lose myself or my recovery.”

I told him that was a perfect statement.

Common Failures in Peer Work

I have serious concerns about how peers are trained. This is in-person work, so the training should be done entirely in-person as well. A lot of trainers use a paint-by-numbers manual and power point. Some of them lack the ability to engage or control a room. Still, much of that poor training can be corrected by proper ongoing supervision.

Client brokering was a profound problem when peers first started popping up a little over a decade ago. Peers got kickbacks for sending people to treatment or halfway houses, often to Florida. It got so bad that a number of states passed explicit anti-brokering laws.

Another common problem with peers is that they often push their pathway to recovery above all others: if you got sober through AA, then it is AA; if it was Jesus, then it’s Jesus; and so on. This demonstrates a narrow professional approach and is a real turnoff for several participants.

Some peers have a strong stance against medication, particularly methadone and buprenorphine. “You aren’t clean if you are on those drugs,” has been shamefully said to participants. This is a serious professional and ethical violation.

Other peers push religion, specifically, their religion. Even if the peer agrees with them, this is an ethical and professional violation. And it is an easy way to turn off a client that otherwise might have been open to the process of recovery.

Sadly, many peers stop engaging in the very practices that helped them achieve recovery. They cut down or stop going to meetings and therapy. “I get what I need from work,” has been uttered by peers who eventually burn out or relapse.

And of course, poor supervision.

Structure of Supervision Sessions

Supervision is an ongoing process. Ideally, it should take place on a weekly basis. Supervision should include caseload review, case presentations, problematic cases and success stories.

I have peers write about their countertransference and identify their mistakes. I also have them take a regular written inventory of their self-care practices, with a clear focus that they need to do more now than they did before they started doing peer work. This forces specificity and accountability.

Supervision reinforces confidentiality and legal standards. It is essential that peers ensure record releases have the correct information, are signed and regularly updated. Both the peers and their clients must be able to verbalize the limits of confidentiality, including duty to warn, protecting vulnerable populations through mandated reporting, obeying court orders and how to handle homicidal and suicidal situations. This knowledge comes from ongoing supervision on real cases, rather than crash course training at the very start of one’s career.

The Stages of Change are almost always taught to peers during their official training. I teach them to put every client into the stages of change so that they can determine the best course of action. If a participant is in precontemplation, you aren’t going to work on their recovery plan and confront them when they relapse. That client relapsed and you have moved back to the preparation stage. In precontemplation, you will develop a relationship with them, educate them about addiction and recovery and have some discussions about consequences.

• Precontemplation → build relationships, provide information, low confrontation
• Contemplation → pros/cons of use/quitting, review of legal, health and financial consequences
• Preparation → planning, pathways, structure
• Action → execution, obstacle management
• Maintenance → stability, purpose, network
• Recurrence → reassess stage and adjust

Peers are fantastic at working alongside case managers, who assess whether they need treatment, help with housing, have legal issues to address or need healthcare. Peers can provide ongoing support that supports the case manager’s plan. A good peer will recognize and accept that many clients’ motivation will not be about stopping their substance misuse, but rather staying out of legal trouble or securing housing or finding a job. And those are fine reasons to seek supportive services.

Throughout my career, I’ve become well known for asking clients what they do for fun and who they spend time with. I train peers to ask those questions. Not only do they help get to know their clients, but they can assess risk and stability by listening to those answers.

Every two or three sessions, I review the worker’s professional development. We discuss academic, professional and continuing education opportunities and weigh time/costs against benefits. We go over what other certifications might make sense down the road and which conferences would be wise to attend. I want them to think about what they want to do next, either at their current place of employment or outside. I have found that workers whose professional development is supported by their supervisor provide higher levels of work, have much lower rates of ethical violations and lower rates of burnout. Because they don’t feel stuck; they feel cared for and that they are moving forward.

Law Enforcement Application

The New York State Police peer model has a few similarities and a few key differences from the just much-discussed recovery peers. These are above average cops who have been on the job at least five years. They submit a request to become peers and then it is approved by both their supervisor and the NYSP Employee Assistance Program (EAP).

I conduct a two-day training and provide ongoing guidance to the program. The selected officers learn about substance misuse, suicide, gambling, sleep problems, relationships, screen addiction, grief and trauma.

Like the recovery peers, NYSP peers are tasked with noticing, asking questions, sharing a bit of themselves, providing resources and referring to other professionals. They have the same boundary and countertransference risks.

I have trained peers in other departments in other states. There have been attempts to create and utilize the peer models in some Federal agencies as well. Time will tell how those trainings and applications go.

Training Supervisors and Limits of Replication

My model is wholly dependent upon the supervisor’s experience and how they think, listen and teach. Without a reasonable amount of experience, traits and skills, someone will not be able to properly supervise peers.

My supervision structure can be taught. The judgment has to be developed over time and, ideally, across at least a few different settings. Supervisors can learn to run case presentations, review caseloads, identify countertransference and reinforce scope of practice. What is harder to teach is how to recognize patterns in real time, how to confront poor decisions directly and how to calibrate the use of personal story.

Assigning a clinician or nurse to supervise peers does not, by itself, produce effective peer supervision. The role requires attention to issues— such as personal story use, countertransference and scope drift — that are not typically addressed in standard clinical supervision.

In my experience, supervisors can be trained to use this model, but two conditions are required. First, they must actively conduct supervision using it. Second, they must receive ongoing supervision themselves, typically over the course of at least a year.

If a program that has peers doesn’t have a proper peer supervisor, the program will most likely just be task management and compliance tracking. And the peers themselves will probably experience countertransference that goes unnoticed and unaddressed.

Why This Requires Real Supervision

To the outsider, peer work often sounds easy. “You just talk about yourself,” one Pennsylvania politician said to me at a law enforcement dinner.

“No sir,” I told him, “there is a great deal of boundary management and potentially volatile emotional reactions.” I paused and then asked, “How seriously do you take legal risks?”

This got his attention.

Peers are working on the front line. They are sometimes dealing with extremely heavy cases that are in crisis. They are tasked with making tough decisions. There are medical, ethical and legal risks.

Because of those risks, ongoing correction through real supervision is paramount. Without it, the peer model produces preventable mistakes, ethical violations and burnout. Those failures play out in public, with consequences for clients, programs and the system.

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Disclosure: Editing and risk-review assistance were provided by a large language model in accordance with my AI Use & Writing Standards. All arguments, interpretations and conclusions are my own.
https://greenagel.com/ai-use-and-writing-standards/

In a recent Veterans group, a senior Army officer talked about soldiers in her brigade who died in the Middle East. She expressed some survivor’s guilt but was more saddened by their loss and felt anger towards those above her for not taking proper security precautions.

I asked her if she had ever heard the term Moral Injury.

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Moral Injury is caused by a violation of core moral beliefs. It is not a DSM diagnosis. It is different from PTSD, as it is meaning-based instead of fear-based. It often accompanies PTSD though. The core elements of Moral Injury are guilt, shame, betrayal and identity disruption. One does need to have all of them to experience a Moral Injury.

As one summary of the research put it, moral injury is not primarily about fear or safety, but about the loss of trust – in oneself, in others and in institutions.

Jonathan Shay is the psychiatrist who came up with the term. He taught at the Navy War College, won a MacArthur Genius Grant and wrote two books about Vietnam Veterans and PTSD.

Dr. Shay wrote that “Moral Injury is present when (1) there has been a betrayal of what is morally correct; (2) by someone who holds legitimate authority; and (3) in a high-stakes situation.”

Brett Litz is a psychologist in the Boston VA system who expanded upon Dr. Shay’s definition to include personal transgressions, failure to act to prevent awful behavior and witnessing atrocity.

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Some History

After the Trojan War, Ajax was filled with grief and guilt over the death of Achilles. He was furious that the Greek generals gave his armor to Ulysses instead of him; he felt it as a devastating betrayal. He got drunk and slaughtered a bunch of cows, thinking they were the Greek generals. When he sobered up, he was so humiliated that he killed himself.

After the Norman conquest in 1066, the Bishops of Normandy issued the Penitential Ordiance. For every man that a warrior killed, he was ordered to do a year’s penance. This served as both a moral accounting and a way to reintegrate the warriors into the community. Those Bishops understood what killing someone in combat does to the victor, even if they did with the Church’s sanction and orders from the King.

After the My Lai Massacre, U.S. Soldiers stated that they were horrified by the wanton murder of elderly Vietnamese civilians, the mass rape of women and the killing of children. One Warrant Officer did what he could to save a number of children, but most soldiers in authority there not only refused to stop the atrocity, but led it. It is one of the most disgraceful acts in US military history, and while writing this, I feel a sense of shame even though I hadn’t been born yet. Because it violated what United States and the Army claim to stand for and how I was raised.

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Afghanistan

Moral Injury is not limited to what someone did in combat. It can also come from what was done in their name. After the U.S. withdrawal from Afghanistan, many Veterans reported distress tied to the abandonment of Afghan interpreters and allies. These were people who fought alongside them, often saving American lives. One Marine told me through tears of rage “We didn’t honor our commitment. They lied. They made me a liar.” This fits a core element Dr. Shay’s concept of Moral Injury: a betrayal of what’s right by those in authority in a high-stakes situation.

George Packer wrote a devastating piece for The Atlantic in March about an Afghan couple who worked with our military and were promised that they would be able to eventually come to the United States. That promise has not been kept. The family is currently living in hiding in Pakistan and are fearful that they will be forced to return to Afghanistan. If they are, they believe they will certainly die. Packer has communicated with them for years and shared his own powerlessness, fear and shame about their situation. A situation that he is in no way responsible for.

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Responsibility

In Shakespeare’s Henry V, the King goes out in disguise to talk to his Soldiers on the eve of the Battle of Agincourt. One of the Soldiers argues that if the cause is unjust, the moral burden rests with the king and that the Soldiers’ souls are at risk because of decisions made above them. Henry rejects this, insisting that each man is responsible for his own actions. Shakespeare doesn’t resolve the tension, but he frames it clearly: responsibility in war is both individual and hierarchical. When those levels come into conflict, the burden does not disappear. It settles on the person who has to live with it.

I thought about that discussion when I read about Secretary Hegseth’s immoral language and glorification of violence: “no quarter, no mercy.”

A New York Times article from mid-March offers up the problem between Hegseth’s rhetoric and the service members who are tasked with actually fighting:

To the pilots flying missions and sailors firing missiles into Iran, the bellicose rhetoric is, for now, most likely background noise. They are focused on the immediate, and often dangerous, task at hand.

But over the longer term, couching wars in moral terms, such as defending democracy or protecting civilians, gives troops a framework to understand why they are being asked to kill. “Moral language acts as a psychological scaffolding for service members,” said Michael Valdovinos, a former Air Force psychologist and author of the forthcoming book “Moral Injuries.” “When that disappears, it can leave troops carrying the moral burden alone.”

One question is whether a war waged without a clear moral purpose and with mixed support from the American public will weigh heavier on the troops fighting it after the shooting stops.

“Some might say at least they’re being honest about the fact that it’s just sheer brute force,” said Elliot Ackerman, who led Marines in the second battle of Falluja in Iraq and now writes novels and nonfiction works that frequently focus on the moral complexity of war. “But it’s also very dangerous. You’re asking people to die for the ambitions of a president and a moral calculus that’s no greater than might makes right.”

Moral justifications and public support matter to troops taking lives on behalf of their country.

“I can tell you from experience on the back end, it doesn’t feel very good to have participated in a war that everybody thinks was a disaster,” Mr. Ackerman said.

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My Moral Injury

Last year I experienced a different kind of Moral Injury. Not from something I did, but from what I believe my country is doing in relation to what I was taught it stood for.

I was hiking in Mexico when I received a series of messages about a public exchange between Donald Trump and Volodymyr Zelensky. That moment was morally injurious to me. It has taken me over a year to process it. I felt embarrassment, anger and something deeper: disorientation. It conflicted with the moral framework I had internalized about alliances, honor, responsibility and the role of the United States in the world.

Part of my identity has been built on the belief that the United States, while imperfect, has tried to act with a degree of responsibility and restraint in the world. I was not raised to believe we were flawless but that we have often tried to use our power in cooperative ways: building alliances, supporting global health efforts, taking in refugees and responding to disasters. When that belief is disrupted, the impact is not abstract or political for me. It is personal. It forces a confrontation between what I thought I was part of and what I now see.

Since then, a series of actions and statements toward Ukraine, toward NATO allies and toward neighboring countries have deepened that reaction. I experience these not as routine policy disagreements, but as violations of the values that I was taught to uphold.

The strike on a primary school in Minab, Iran reinforced that sense of disorientation. On February 28, 2026, a missile strike destroyed a school and killed over 150 civilians, including more than 100 children. Multiple investigations have indicated that U.S. forces were likely responsible, though the full accounting remains ongoing. Even allowing for the fog of war, the scale of civilian death and the questions about targeting and accountability are not morally neutral. I experience that not simply as tragedy, but as a failure that demands moral accounting.

If Moral Injury forms when individuals are asked to live with actions they cannot reconcile, it can also form when a citizen is asked to reconcile actions carried out in their name.

This is less severe than combat-based moral injury, but it follows the same structure: a perceived gap between stated values and observed actions. For me, that gap caused profound civic grief and disillusionment. I felt a mix of embarrassment, shame, anger, distrust and disbelief.

I am not the only one who has experienced it this way. David Brooks described a similar reaction as “moral shame”—the pain of watching what he perceived as a loss of national honor. That language is closer to my experience than standard political disagreement.

Part of what has made this difficult is where it has led. Over the past year, I have found myself questioning not my own values, but the decency of others – how many people actually share the framework I thought was common. That is an awful place to be. It narrows your view of the world. It makes trust harder. It pulls you toward a more cynical understanding of people than you want to hold. That erosion of trust is not the same as anger. It is quieter, and in some ways more corrosive.

I am not speaking for all Veterans. We are not a monolith. There are many who see these events differently. But disagreement does not eliminate my experience or that of others. Moral Injury does not require consensus. It requires a perceived violation of what is right.

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Other Institutions

So far I’ve only written about Moral Injury in the context of the military. But I know it also applies to other professions that have explicit moral codes. I have been treating and training teachers, law enforcement officers and medical professionals for well over a decade. These are all people who have entered into fields that try to make the world a little bit better.

I have worked with teachers who feel completely unsupported by those above them. Criticised and attacked by some parents. Governor Christie occasionally demonized the profession throughout his time in office.

Cops in New York, New Jersey and Pennsylvania told me that they felt betrayed by the public during the defund the police rhetoric of 2020. “I used to wear my Trooper sweatshirt when I was off-duty, but I don’t anymore because I don’t like the dirty looks I get from people,” one told me a few years ago.

Nurses and doctors have expressed outrage about having to rush through seeing patients or fighting with insurance companies to pay for needed procedures. “All the good I do in this poor Bronx neighborhood isn’t even 1/10,000th offsetting the damage that Robert F. Kennedy does to the US everyday,” one NY doctor told me earlier this year.

The writer and show-runner David Simon said that in portraying the lives of cops, longshoremen, politicians, teachers and journalists on The Wire, he sought to show how modern American institutions betray those they are supposed to serve and those that serve those institutions. Devastating.

I asked a few Veterans to read an early draft of this article. A Marine Veteran wrote me that some of my complaints seem like moral outrage. That was an excellent point; my personal examples in this piece cover both moral outrage and moral injury. Moral outrage is directed outward; anger at something wrong in the world. Moral Injury is different. It turns inward. It raises questions about one’s own role, identity or what one has been part of. It is not just “this is wrong.” It is “what does this mean about me, and how do I live with it?” That is why it has the potential to be more destabilizing than moral outrage.

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Clinical Presentation

Some clients are guilty over what they did; others over what they weren’t able to prevent. I’ve come across a few who are shameful of who they have become. A lot of professionals have lost trust in their bosses or companies or fields. Some express moral confusion (“I don’t even know what is right anymore”). A sense of betrayal is common. A majority withdraw and have become more isolated.

I have treated law enforcement officers who felt betrayed by their own departments, as they were investigated or disciplined for actions they believed were consistent with their duties. I have also worked with Marines who were discharged for substance misuse after being prescribed those very medications to manage PTSD. In both cases, the injury was not just about the outcome, but about what they felt the institution did to them and what that meant for their identity.

I believe that where there is Moral Injury, there is an increased risk of suicidal ideation. This does not mean that most people who experience Moral Injury are suicidal, but rather, it’s a risk factor. Like relationship problems, substance misuse, gambling or health problems.

A lot of clinicians make a mistake of mislabeling Moral Injury as PTSD. They are different, though they often accompany each other. Most clinicians don’t have Moral Injury in their vocabulary.

Another mistake that therapists make is to just reassure the morally injured that it isn’t that bad or that it’s in the past or “you did the best you could.” None of that helps.

Therapists often address it as a cognitive distortion only and fail to talk about the moral dimension.

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Addressing Moral Injuries

I’ve been clean and sober for over 30 years. I found great comfort, help and guidance in the rooms of Alcoholics Anonymous. It was there that I learned the power of peers and groups. I have created groups for Veterans, cops and therapists. I have watched people begin to heal when someone else expresses their exact pain. I have witnessed the reversal from isolation. Shared experiences and language are immensely important.

In Poland, I treated a Soldier who spent a decade blaming himself for the deaths of his platoon mates. When he described what happened, it became clear that he had not been in a position to prevent it. The decision that led them there had been made above him.

He had taken full responsibility for something he did not control. The group helped redistribute that responsibility. That was the beginning of change.

In individual therapy, people can parse out guilt, shame, betrayal and identity disruption. Usually, people don’t even have the language to express what they are feeling. Once they have it, they can explore the context of their Moral Injury.

Writing helps. Journaling. Letters.

I believe in the restorative action of service and mentorship. Helping others and specifically working with those who have struggled with the same issues is a fantastic way to begin to feel better about oneself, society and the world.

Many people find comfort in attending religious services and meeting with members of the clergy. Some utilize confession and seek penance, while others benefit solely from being around others and feeling welcome. Much like the Norman warriors of 1066, it can offer a path to reintegration.

For Veterans, I think that organizations such as the American Legion and the Veterans of Foreign Wars are a great way to engage with peers, serve the community and, in some cases, advocate for policy change. I have been an American Legion member for years but only recently went to a local hall to become an active member. This was read at the end of my first meeting:

Till we meet again let us remember that our obligation to our Country
can be fulfilled only by the faithful performance of all duties of
citizenship. Let service to the community, state and nation be ever a
main objective of The American Legion and its members. Let us be ever
watchful of the honor of our Country, our organization and ourselves,
that nothing shall swerve us from the path of Justice, Freedom and
Democracy.

I was moved to tears. Because it was so comforting to hear other people express their “service to the community, state and nation” as their main objective.

It was identity affirming.

Oregon Governor Tina Kotek signed Senate Bill 1546 into law on April 1, 2026. This is Oregon’s first attempt to address risks associated with AI chatbots. It aims to protect minors, take precautions for suicidal ideation and ensure individuals know they are communicating with a chat bot.

In December, President Trump issued an Executive Order that set up an AI Litigation Task Force that would challenge state laws, claiming that a patchwork of laws would make it hard for businesses. To date, however, the federal government has not enacted legislation aimed at limiting AI-related harm, protecting licensed professions or establishing enforceable consumer safeguards.

As a result, states are moving forward with their own regulatory approaches.

This Oregon law has five aspects:

Disclosure requirements (A-level regulation)*

The law requires chatbots to clearly disclose that they are not human. This aligns with legislation in other states, including California (SB 243) and Nevada (HB 2225), which focus on representation and transparency.

Suicide and self-harm intervention (C-level regulation)*

AI chatbots are required to:

• detect suicidal ideation and self-harm signals
• provide referrals to 988 and other crisis resources

This is a meaningful shift. It treats chatbots as systems that must identify and respond to risk, not simply provide information.

Protections for minors

The law includes several provisions designed to reduce compulsive or harmful engagement:

• suggesting breaks after extended use (every three hours)
• prohibiting sexually explicit content
• banning emotional manipulation tactics designed to prolong engagement
• restricting reward loops that encourage continued interaction

The restriction of reward loops is particularly significant. It represents an early attempt to regulate what can be described as engagement-driven reinforcement mechanisms in AI systems. This has been a particular concern of mine for all users, not just minors and the emotional/mentally vulnerable.

Reporting requirements

AI systems must file annual reports that include:

• the number of crisis referrals (988)
• a description of intervention protocols

This introduces a form of system-level visibility into how often high-risk interactions occur and how they are handled. We’ll see if AI systems actually follow this part of the law.

Private right of action

The law allows individuals to sue for $1,000 per violation. This creates direct liability exposure and removes the possibility of relying solely on internal compliance or voluntary standards. Allowing individuals to sue prevents the AI systems from having a shield law. Significant corporate behavior and future legislation will certainly be informed by court cases where plaintiffs allege harm was done.

Significance of this law

Oregon is moving beyond regulating what AI systems say and beginning to regulate what they are required to do in situations involving risk.

It places AI systems closer to functioning as actors within a clinical or quasi-clinical space, with corresponding expectations around intervention and accountability.

How companies respond, both in compliance and in litigation, will likely shape the next phase of state and federal AI policy.

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A/B/C/D Framework for AI in Clinical and Professional Practice

To make sense of emerging AI laws and policies, I classify how AI is being used and regulated across four categories:

A — Representation and Communication

AI systems that:

• interact with users
• provide information
• simulate conversation

Regulatory focus:

• disclosure (AI vs human)
• prohibition on impersonating licensed professionals
• consumer protection

Example: laws requiring chatbots to identify themselves as AI

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B — Structured Intake and Screening

AI systems that:

• gather user information
• ask structured questions
• assist in initial assessment

Regulatory focus:

• accuracy of screening
• escalation protocols
• documentation and oversight

Key issue: missed risk signals or incomplete assessment

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C — Triage and Gatekeeping

AI systems that:

• prioritize cases
• determine urgency
• decide whether and how users receive care or intervention

Regulatory focus:

• duty to escalate (suicidal ideation)
• limits on autonomous decision-making
• liability for delayed or missed intervention

Key issue: harm caused by failure to act or improper prioritization

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D — Clinical Decision Support (Post-Contact)

AI systems that:

• assist licensed professionals
• provide recommendations within ongoing care

Regulatory focus:

• clinician accountability
• documentation of AI use
• maintaining professional standards

Key issue: overreliance on AI without independent verification

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Disclosure: The A/B/C/D framework above was organized with structural assistance from a large language model in accordance with my AI Use and Writing Standards. The categories, regulatory analysis and conclusions are my own.

Each semester, I hand every student $686 in Monopoly money. I use $686 because that is the total value of one bill from each denomination in a standard Monopoly set: $1, $5, $10, $20, $50, $100 and $500.

Five to six students come to the front of the room each time we do this exercise. Each has two minutes to propose a federal or state policy: What does it cost? What is the intended benefit? Who does it affect? Who supports it? Who opposes it? Students have presented on abortion policy, climate initiatives, foster care reform, student loan forgiveness and affordable housing. The range reflects student interests and varies each semester.

After the presentations, students privately allocate their $686 to whichever proposals they wish. They may divide it or place it all in one proposal. We total the funds and rank the proposals from most supported to least. Then we analyze the results.

I begin my policy class with a definition from Stuart Shapiro at Rutgers’ Bloustein School: public policy is the allocation of finite public resources. In an era of misinformation and AI-generated fluency, disciplined prioritization matters.

The exercise is intentionally simple. I do not allow students to spend money to oppose a proposal. I do not allow bargaining or horse-trading.

Monopoly money works because people know bankruptcy, overextension and aggressive acquisition from the game. We take that structure and apply it to public budgeting.

The most important moment is the debrief. In one class composed mostly of young women, abortion policy ranked near the bottom. That result surprised me and unsettled some of the students’ assumptions. Cultural issues, in this instance, shifted when students faced finite allocation. One student later told me, “I’ve been a far left progressive activist since I’ve been paying attention to politics. I now see that some of my views are impossible to pass as legislation and actually lose me other support.” That movement, from passion to feasibility, is critical thinking. Students repeatedly confront limits, defend claims and revise their reasoning until clarity becomes expectation rather than exception.

Social work education rightly emphasizes dignity and justice. Professional ethics and constitutional protections are not subject to allocation here; the exercise examines discretionary funding priorities above that floor. What students practice is something different: translating conviction into policy under fiscal and political constraint. Social workers advocate, testify and operate within constrained systems. They must distinguish between moral belief and legislative viability.

Preparing them only for the ideal world leaves them unprepared for the systems they will enter.

By the end of the semester, students begin to anticipate my scrutiny. They expect to justify cost, anticipate opposition and clarify claims before being asked.

Aspects of critical thinking that are often missed in social work education include ranking priorities under constraints, articulating those priorities clearly and revising in light of feasibility. My Monopoly money exercise teaches those constraints and helps students develop their ability to persuade and make decisions. We engage in this exercise three to five times a semester; through practice and discussion, their judgment improves as they prepare to become active citizens and professional social workers.