Can we use ChatGPT for Mental Health and Substance Use Education? Examining Its Quality and Potential Harms

Background The use of generative artificial intelligence, more specifically large language models (LLMs), is proliferating, and as such, it is vital to consider both the value and potential harms of its use in medical education. Their efficiency in a variety of writing styles makes LLMs, such as ChatGPT, attractive for tailoring educational materials. However, this technology can feature biases and misinformation, which can be particularly harmful in medical education settings, such as mental health and substance use education. This viewpoint investigates if ChatGPT is sufficient for 2 common health education functions in the field of mental health and substance use: (1) answering users’ direct queries and (2) aiding in the development of quality consumer educational health materials. Objective This viewpoint includes a case study to provide insight into the accessibility, biases, and quality of ChatGPT’s query responses and educational health materials. We aim to provide guidance for the general public and health educators wishing to utilize LLMs. Methods We collected real world queries from 2 large-scale mental health and substance use portals and engineered a variety of prompts to use on GPT-4 Pro with the Bing BETA internet browsing plug-in. The outputs were evaluated with tools from the Sydney Health Literacy Lab to determine the accessibility, the adherence to Mindframe communication guidelines to identify biases, and author assessments on quality, including tailoring to audiences, duty of care disclaimers, and evidence-based internet references. Results GPT-4’s outputs had good face validity, but upon detailed analysis were substandard in comparison to expert-developed materials. Without engineered prompting, the reading level, adherence to communication guidelines, and use of evidence-based websites were poor. Therefore, all outputs still required cautious human editing and oversight. Conclusions GPT-4 is currently not reliable enough for direct-consumer queries, but educators and researchers can use it for creating educational materials with caution. Materials created with LLMs should disclose the use of generative artificial intelligence and be evaluated on their efficacy with the target audience.

It's important that you look after yourself and your baby in other ways during your pregnancy and after the birth.
Prenatal and postnatal care appointments are vital for any pregnancy and will need to be attended regularly to ensure you are healthy and that your baby is safe and growing well.
Regardless of whether you stop using crystal methamphetamine or continue to use the drug during pregnancy, it's important that you inform your GP or obstetrician of your crystal methamphetamine use.They will be able to give you advice on any additional steps you may need to take to support the health of you and your baby.For example, you might need nutritional supplements if your appetite has been affected by your crystal methamphetamine use.

WHAT ELSE CAN I DO TO LOOK AFTER MYSELF AND MY BABY THROUGH PREGNANCY?
No.There is no level of crystal methamphetamine use that is safe during breastfeeding.This is because crystal methamphetamine can be released into breast milk and cause problems for your child's health and development.It's recommended that mothers don't breastfeed for at least 48 hours (2 days) after using crystal methamphetamine.Your GP or obstetrician can provide further advice on how to limit any risk to your baby.

IS IT SAFE FOR ME TO USE CRYSTAL METHAMPHETAMINE WHILE BREASTFEEDING? I WANT TO STOP USING CRYSTAL METHAMPHETAMINE, BUT I NEED HELP. WHERE CAN I GO TO FOR SUPPORT?
Several services throughout Australia can provide support to those experiencing problems with crystal methamphetamine and other drugs.Although it can be difficult to seek help, the sooner you reach out for support, the better.
Your GP or obstetrician can be a good starting point -they can discuss your concerns with you and provide referrals to other services that you might need.For free and confidential advice about alcohol and other drugs, you can also call the National Alcohol and Other Drug Hotline on 1800 250 015.
For links to more alcohol and other drug services in Australia, visit our When and Where to Get Help page.

WHAT ARE CO-OCCURRING CONDITIONS ('COMORBIDITY')?
'Comorbidity' occurs when a person experiences two or more medical conditions at the same time.There are many different types of comorbidity that people can experience.This factsheet focuses on the type of comorbidity where someone experiences both a substance use disorder (e.g.crystal methamphetamine 'ice' dependence) and a mental health disorder (e.g.anxiety, depression, psychosis) at the same time.Another term used for this is 'co-occurring substance use and mental health disorders'. 1 To learn more a about the mental health problems that can happen when someone is using ice please visit the mental health effects of ice page.

HOW DO THEY DEVELOP?
There are several reasons why substance use and mental health disorders might occur together.The important thing to remember is that, once established, these conditions often interact in ways that maintain one another.This can make it hard for people to recover if they are not able to access treatment for both problems.

ONE CONDITION MAY DIRECTLY CAUSE THE OTHER
Someone may become dependent on alcohol and/or other drugs (like ice) because they use them to help cope with mental health symptoms.
Alternatively, someone's use of alcohol and/or other drugs may impair the way their brain functions, leading to poor mental health.

ONE CONDITION MAY INDIRECTLY CAUSE THE OTHER
Poor mental health may cause life difficulties that lead someone to use alcohol and/or other drugs.For example, the experience of mental health problems may limit someone's ability to study or work.Someone in this position may start using alcohol or drugs to manage the stress of not being able to study or work how they would like to.
In the opposite direction, using alcohol and/or other drugs may limit someone's ability to study or work.The stress of not being able to study or work how they would like to, may then impair their mental health.

BOTH CONDITIONS MAY BE CAUSED BY SOMETHING ELSE
Sometimes two conditions can be caused by a shared biological, psychological, social or environmental risk factor.A shared risk factor is something about a person or their circumstances that increases their risk of experiencing each of the conditions.

HOW COMMON ARE THEY?
Substance use disorders and mental health disorders are both common in Australia.National population estimates indicate that one in two Australians will develop a substance use, anxiety or mood disorder (e.g.depression) in their lifetime, and one in five meet criteria for a substance use, anxiety or mood disorder annually.
The co-occurrence of substance use disorders and mental health disorders is also common.
individuals with a substance use disorder also have at least one co-occurring anxiety or mood disorder.

DO THEY AFFECT TREATMENT?
Research into whether people who have a co-occurring mental health condition respond differently to alcohol and other drug treatment is mixed.
On balance, the evidence indicates that having co-occurring conditions is not an insurmountable barrier to treating people with alcohol and other drug use disorders, however some clients with co-occurring mental health disorders may require additional treatment.People experiencing co-occurring substance use and mental health issues should discuss this with their local doctor, alcohol and other drug counsellor or mental health professional to ensure both areas of concern are addressed in treatment.
For more information about treatment and support services available visit the get help page.

REFERENCES:
Information in this fact sheet has been adapted from the Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings (3rd edition).The full Guidelines can be accessed here.A full list of references is available here.
Adapted from the Comorbidity Guidelines.See the key source list below for more information.