{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T07:44:16Z","timestamp":1785397456112,"version":"3.56.0"},"reference-count":21,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["DIGITAL HEALTH"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:p>As direct-to-consumer ketamine prescriptions obtained via telehealth in the United States, along with psychedelic support, proliferate, some patients are turning to general-purpose chatbots as de facto \u201ctherapists\u201d in unmonitored settings. These AI-guided altered-state sessions carry significant ethical, clinical, and legal risks. Current AI tools are not licensed professionals, lack consistent reliability, and cannot provide emergency support. Combined with mind-altering drugs, their unpredictability can precipitate harm rather than relieve distress. The convergence of these innovations (psychedelic therapeutics and generative AI) creates an unregulated frontier in mental health care. Traditional safeguards in psychedelic therapy rely on \u201cset and setting,\u201d a supportive mindset and environment guided by trained humans. When that role is replaced by AI, both are fundamentally disrupted. Clinicians should recognize that patients are already experimenting with AI in this way, often without disclosure or oversight. When screening for psychedelic use or discussing at-home treatment, providers should anticipate the risks of inadequate monitoring, unsafe crisis response, and blurred therapeutic boundaries with AI chatbots. Even if clinicians do not endorse or recommend AI tools, they may bear responsibility once patient use is known. Providers should therefore counsel patients about these dangers, document safety discussions, and routinely ask about AI use as part of risk assessment.<\/jats:p>","DOI":"10.1177\/20552076261429341","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T12:39:58Z","timestamp":1774355998000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["When the therapist hallucinates: AI, psychedelics, and the risks of unsupervised digital mental health care"],"prefix":"10.1177","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9917-4590","authenticated-orcid":false,"given":"Michael R","family":"MacIntyre","sequence":"first","affiliation":[{"name":"University of California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"Chatbots Can Go Into a Delusional Spiral. Here\u2019s How It Happens. - The New York Times [Internet] https:\/\/www.nytimes.com\/2025\/08\/08\/technology\/ai-chatbots-delusions-chatgpt.html ([cited 2025 Oct 15])."},{"key":"e_1_3_3_3_2","unstructured":"People Are Using AI Chatbots to Guide Their Psychedelic Trips | WIRED [Internet] https:\/\/www.wired.com\/story\/people-are-using-ai-chatbots-to-guide-their-psychedelic-trips\/ ([cited 2025 Oct 15])."},{"key":"e_1_3_3_4_2","unstructured":"Telehealth startups prescribing ketamine at home stir concern [Internet] https:\/\/www.statnews.com\/2022\/11\/03\/ketamine-online-mindbloom-wondermed-health\/ ([cited 2025 Oct 15])."},{"key":"e_1_3_3_5_2","unstructured":"FDA warns patients and health care providers about potential risks associated with compounded ketamine products including oral formulations for the treatment of psychiatric disorders | FDA [Internet] https:\/\/www.fda.gov\/drugs\/human-drug-compounding\/fda-warns-patients-and-health-care-providers-about-potential-risks-associated-compounded-ketamine ([cited 2025 Oct 15])."},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1038\/s44184-024-00097-4"},{"key":"e_1_3_3_7_2","unstructured":"People are using AI to \u2018sit\u2019 with them while they trip on psychedelics | MIT Technology Review [Internet] https:\/\/www.technologyreview.com\/2025\/07\/01\/1119513\/ai-sit-trip-psychedelics\/ ([cited 2025 Oct 15])."},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2023.115466"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40596-024-02043-0"},{"key":"e_1_3_3_10_2","first-page":"477","article-title":"Legal and ethics concerns of psilocybin as medicine","volume":"52","author":"Schonholz SM","unstructured":"Schonholz SM, Appel JM, Bursztajn HJ, et al. Legal and ethics concerns of psilocybin as medicine. J Am Acad Psychiatry Law [Internet] 2024 Dec 1 [cited 2025 Oct 15]; 52: 477\u2013485, https:\/\/pubmed.ncbi.nlm.nih.gov\/39562046\/.","journal-title":"J Am Acad Psychiatry Law [Internet]"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1145\/3571730"},{"key":"e_1_3_3_12_2","doi-asserted-by":"crossref","unstructured":"Bender EM Koller A. Climbing towards NLU: on Meaning Form and Understanding in the Age of Data. Proceedings of the annual meeting of the association for computational linguistics [Internet]. 2020 [cited 2025 Oct 15];5185\u201398 https:\/\/aclanthology.org\/2020.acl-main.463\/.","DOI":"10.18653\/v1\/2020.acl-main.463"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/2050324516683325"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcbs.2019.11.004"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1038\/npp.2017.84"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291724002496"},{"key":"e_1_3_3_17_2","unstructured":"Many teens are turning to AI chatbots for friendship and emotional support [Internet] https:\/\/www.apa.org\/monitor\/2025\/10\/technology-youth-friendships ([cited 2025 Oct 15])."},{"key":"e_1_3_3_18_2","unstructured":"OpenAI Says It\u2019s Hired a Forensic Psychiatrist as Its Users Keep Sliding Into Mental Health Crises [Internet] https:\/\/futurism.com\/openai-forensic-psychiatrist ([cited 2025 Oct 15])."},{"key":"e_1_3_3_19_2","unstructured":"Zinberg NE. Drug set and setting the basis for controlled intoxicant use."},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-024-02800-5"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2025.1528253"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1002\/bsl.2647"}],"container-title":["DIGITAL HEALTH"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20552076261429341","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/20552076261429341","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20552076261429341","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T17:56:15Z","timestamp":1777398975000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/20552076261429341"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":21,"alternative-id":["10.1177\/20552076261429341"],"URL":"https:\/\/doi.org\/10.1177\/20552076261429341","relation":{},"ISSN":["2055-2076","2055-2076"],"issn-type":[{"value":"2055-2076","type":"print"},{"value":"2055-2076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]},"article-number":"20552076261429341"}}