Hi everyone! I have been active here for a little over a year now and can hardly express how absolutely blown away I have been with how creative, thoughtful, and compassionate the people of this community have been to me during my time here — especially when I was suffering from a mental health crisis awhile back. I have read each and every card I have ever gotten from this subreddit multiple times over and still find it difficult to express how profoundly touched I have been by the messages of so many empathetic people. I have also written back to many kind users with my own letter responses and have ultimately had an extremely positive experience in this little corner of the internet.
With that all being said, I would really love to propose a writing prompt that I am very passionate about: cats!
To anyone interested; I would love nothing more than to receive cards filled with information about yours or someone you knows kitty(s). I have included some questions below to provide a basic outline as a way to best get to know your furry friend(s):

1. ^{what are your cat(s} name(s)?)
2. ^{how old is/are your cat(s}?)
3. ^{what breed(s} of cat(s) are they?)
4. ^{how did you come into contact with your cat(s}? I.e. came from a shelter, abandoned on the side of the road, from a breeder, etc.)
5. ^{how have they impacted your life? (from both the good and the bad})
6. ^{what type of personality do they have?}
7. ^{what are some positive and negative quirks and behaviors you've witnessed them do?}
8. ^{depict even the most mundane interactions you have had with your cat(s} that you still remember to this day.)
9. ^{include any fun additional stories you’d like to share about your cat(s}.)
10. ^{this last one is just a personal request and please disregard it if you do not have the means to do so - but I would absolutely love to have a printed picture of your kitty cat or cats! It would help to provide a face to their names and personalities. (plus I just love to see people's cats as well haha})

If you've made it this far, thank you for taking the time to read out my solicitation and I hope some of the users here consider my request.

Hey y'all. I just got back from being out of town for two days. I leave my cat alone with an auto feeder and water fountain, and returned to a litter box with two days worth of normal poop. However, shortly after I got back, my cat peed in the litter box and continued to sit there for an alarming amount of time doing nothing afterwards. She then returned to the litter box later and squatted for a while but did nothing. Never seen this behavior before. This morning I saw her pee again, lingering around a bit but not as long. She hasn't pooped since I got back but it's only been a few hours. I have her on wet food in case she's constipated and she is very happy about that. Normal play/energy levels, constantly purring, not hiding, does not seem to be in pain. When do I go to the vet?
Species: cat
Age: 7
Sex/Neuter status: f/spayed
Breed: Domestic shorthair
Body weight: 14lbs
History: no medical issues thus far
Clinical signs: above!
Duration: 1 day
Your general location: NYC

So out of the blue my gf asked for a break, we have been dating for 4 months but been very good friends for more than a year. I asked her if she would prefer to break up and assured her that I wouldnt get mad or anything like that and that we'd still be friends either way but she told me the thought never crossed her mind. She also told me that the break didnt have anything to do with me and that she just needed space because of family related issues.
I'd have liked to discuss more what the break meant for us and what the rules were but she wasnt interested in talking, she told me that her mental energy was totally drained and that she coulnd't talk anymore, so I respected her wishes and gave her space, went no contact and even left the discord servers on which we were together to gave her as much space as possible and let her have intimate space with her friends without me.
After some days she was the one that reached out to me, like nothing had happened, and we had a casual conversation, no mention about the break on her part, so I assumed that things were kind of normal again between us. Still, I decided to still give her some space for the rest of the day so to not be too pushy in case she still needed a little more space.
Then, the night of that day she deleted our mentions of each other and relationship status on social media without any warning (only on his public account, not the private one). I got mad, but only because she didnt communicate with me, If she wants to break up thats fine, I even offered her to do so, but doing it this way seemed like she wanted to break up while trying to avoid to confront me or talk about it with me and worse of it, she is leaving me still waiting for her, which I felt was very unrespectful. Not only that, but a similar situation arised in the past in which I communicated, very respectufully, that I was a little hurt by his behavior and she not only didnt answer, apologize or even acknolewdge the message, she practically ghosted me for about a month and a half. Granted we werent dating yet back then but we were very close friends.
I know it's only social media shit and usually I wouldnt take it to heart (it was just some pics, matching photos and references to each other on the bio) but this is not the first time I have felt disrespected in this relationship (she sometimes disappears for days, which I have always respected because I assume she needs alone time when she does, sometimes his friends had been rude towards me and she has never defended me, we may make plans she wont show up to), 'till this moment I have tried to be understanding and brush those things off because of her social anxiety and because usually trying to talk to her about it hasn't worked, so I usually try to adapt to her needs because I honestly just love the girl, but this time I felt like I had to speak up for once.
So I told her that I thought it was impolite of her to do that, and that I'd appreciate If she was more open in respect to what she really wanted to do. Just that. I didnt cruse her, got mad or anything, juts told her that I thought his actions were impolite. And then she LITERALLY laughed at me, at which I answered that I was sorry If I came off as rude but that I thought it was not necessary to get in that mood, and then she just snapped, started cursing at me and just got extremely rude in general.
Im just so confused right now. Maybe I shouldnt have said anything but she was the one that reached out to me after I gave her plenty space, she was the one that refused to break up and I think that I have rightful reason to be annoyed by his hot and cold attitude and lack of communication. Thoughts?
For what is worth I find extremely unlikely that she is cheating and she has always struggled with severe mental health issues and family problems (severe depression and aforementioned social anxiety)
TL;DR! My gf asked for a sudden break but said she didnt want to break up, that it wasnt myf ault I agreed. She suddendly reappered again as If nothing happened, things seemed normal but then she deleted most things related to me on social media, I was left confused and when I asked her about it she snapped.

Vision is the gateway to the world around us, and finding the perfect optician who can enhance it is no small feat. In the bustling city of Chandigarh, where fashion meets precision, a selection of top-notch opticians awaits, ready to revolutionize your eyewear experience. From visionary expertise to a dazzling array of frames and lenses, these opticians are committed to illuminating your world with clarity and style. Come with us as we embark on a journey to explore the best opticians in Chandigarh, where vision meets innovation and where finding your ideal eyewear becomes an unforgettable experience.
While it is essential to consult with an eye care professional for specific recommendations, here are some of the qualities to look for when searching for the best opticians.

1. Professional Expertise

One of the key factors of a great optician is their professional expertise. The best opticians are equipped with a team of experienced and highly skilled optometrists who have extensive knowledge about various eye conditions, vision correction techniques, and the latest advancements in the field. They should be able to conduct comprehensive eye exams, accurately diagnose vision problems, and provide personalized solutions based on individual needs.

1. State-of-the-Art Facilities

Opticians with state-of-the-art facilities are more likely to provide high-quality eye care services. Advanced equipment and technology not only ensure accurate measurements but also aid in the detection of any underlying eye conditions. The opticians in Chandigarh invest in modern equipment and regularly update their facilities to offer the best possible care to their patients.

1. Wide Range of Eyewear

Opticians should offer a diverse range of eyewear products to cater to different preferences and budgets. Whether it's designer frames, prescription glasses, contact lenses, or sunglasses, opticians should have a wide selection to choose from. Additionally, they should have knowledgeable staff who can assist customers in finding the perfect frames that suit their face shape, style, and vision requirements.

1. Quality Customer Service

Opticians who prioritize customer service are likely to create a positive and satisfying experience for their clients. The best opticians should have friendly and knowledgeable staff who can address customer queries, offer personalized recommendations, and provide assistance throughout the eyewear selection process. Prompt after-sales service and support are also important for customer satisfaction.

1. Transparent Pricing

Transparent pricing is an essential aspect of choosing the best opticians. Customers must have a clear understanding of the cost of various eye care services, eye exams, and eyewear products. The opticians should provide detailed information about pricing, including any additional charges or discounts. They should also offer a range of options to suit different budget requirements.
6. Positive Reviews and Reputation
Customer reviews and reputation can provide valuable insights into the quality of service provided by opticians. The opticians often have positive reviews and recommendations from satisfied customers. Online platforms, social media, and word-of-mouth are good sources to gauge the reputation of opticians in the city.

1. Comprehensive Eye Care Services

Opticians who offer a comprehensive range of eye care services are advantageous for individuals with different eye care needs. The best opticians in Chandigarh should not only provide vision tests and eyewear products but also offer services such as contact lens fitting, eye disease management, and specialized treatments like orthokeratology or low vision aids.

1. Convenient Location and Timings

Accessibility and convenience play a vital role in choosing the best optician. Opticians located in easily accessible areas with ample parking facilities make it convenient for customers to visit. Moreover, opticians with flexible timings, including evenings and weekends, accommodate individuals with busy schedules.

Specialities And Commitment To Look For:

Vision Care Experts

Vision Care Experts is a renowned optician in Chandigarh, offering comprehensive eye care services to individuals of all ages. With a team of highly skilled optometrists and ophthalmologists, they provide personalized vision assessments and accurate prescriptions.

EyeCare Clinic

EyeCare Clinic is a trusted name in Chandigarh, known for its exceptional eye care services and commitment to patient satisfaction. The clinic offers a comprehensive range of services, making them a preferred choice among the residents.

Vision Plus Opticals

Vision Plus Opticals is a trusted optician in Chandigarh, known for its quality products and reliable services. With a commitment to customer satisfaction, they offer the following notable features:

• Comprehensive Eye Examinations: Vision Plus Opticals provides thorough eye examinations using advanced technology to assess visual health and detect any underlying conditions accurately.
• Prompt and Efficient Service: Vision Plus Opticals is known for its quick turnaround time, ensuring that customers receive their eyewear in a timely manner.

Wrapping Up

In the vibrant city of Chandigarh, where visual clarity meets style, the best opticians stand tall, ready to transform your vision and enhance your eyewear experience. Vision Care Experts, EyeWear Trends, EyeCare Clinic, and Vision Plus Opticals have established themselves as leaders in the field, offering cutting-edge technology, personalized solutions, and a diverse range of eyewear options. In conclusion, when searching for the best opticians in Chandigarh, Negi Opticals stands tall as a shining example of excellence in eye care. Their commitment to customer satisfaction, combined with a diverse selection of eyewear options and a team of experienced professionals, sets them apart from the rest.

Are you tired of sleepless nights and increasing stress levels? Look no further as we introduce you to the unique solution you've been searching for. Experience the groundbreaking BiOptimizers Magnesium Breakthrough, an advanced dietary supplement that will improve your sleep quality and help alleviate stress.

What is BiOptimizers Magnesium Breakthrough?

BiOptimizers Magnesium Breakthrough is a natural magnesium supplement developed by the renowned company, Bioptimizers. Known for their commitment to enhancing people's lives through nutritional supplements, Bioptimizers collaborates with top-notch companies to create 100% natural, safe, and effective formulas that promote optimal health.
The formula of BiOptimizers Magnesium Breakthrough results from extensive research and trials. It combines a unique blend of ingredients, incorporating all seven primary forms of magnesium required for various bodily processes. This comprehensive mix of premium magnesium types is vital for maintaining optimal health.
Unlike other supplements on the market, BiOptimizers Magnesium Breakthrough stands out by offering the benefits of all the elemental magnesium forms. This addresses the risks associated with magnesium deficiency and ensures that the body receives a complete range of magnesium, reducing the likelihood of defects and related health issues.
The formula has gained significant attention and received positive reviews from individuals who have experienced its benefits. Bioptimizers Magnesium Breakthrough is worth considering if you're searching for a high-quality magnesium supplement.

How does BiOptimizers Magnesium Breakthrough work?

Magnesium plays a crucial role in maintaining good health and well-being. Understanding the significance of magnesium, BiOptimizers has developed the Magnesium Breakthrough formula to ensure our bodies never run out of this essential mineral.
Research indicates that 80% of people do not obtain enough magnesium through their diets, affecting all forms of magnesium. Many supplements on the market need to be better absorbed or contain limited quantities and types of magnesium.
In contrast, BiOptimizers Magnesium Breakthrough incorporates seven distinct forms of magnesium, each contributing to various bodily functions.
1. Highly Absorbable Magnesium Form: The blend includes a highly absorbable form of magnesium, ensuring efficient utilization once it enters the body.
2. Multifaceted Support: The seven diverse forms of magnesium support the body and its functions. They bolster tissues and muscles while addressing issues like insomnia. This is due to magnesium's positive influence on neurotransmitters and stress response. Moreover, it enhances the production of GABA, a critical factor in regulating calmness.
3. Optimal Magnesium Levels: The formula effectively supports health and well-being by promoting absorption and maintaining optimal magnesium levels.
4. Health Benefits and Risk Reduction: Consistent use of this formula offers numerous health benefits and diminishes the risk of conditions associated with magnesium deficiency.

BiOptimizers Ingredients

BiOptimizers' breakthrough formula incorporates all seven basic forms of magnesium to ensure effectiveness. Here's a list of the different magnesium forms present in the formula:

1. Magnesium Chelate: Crucial for maintaining muscle health, enhancing function, reducing recovery time, and promoting muscle growth.
2. Magnesium Citrate: Supports metabolic activity, aiding in metabolism and promoting the health of blood vessels.
3. Magnesium Bisglycinate: Beneficial for improving muscle health and maintaining muscle relaxation responses.
4. Magnesium Malate: Among the most bioavailable forms of magnesium found naturally, commonly sourced from fruits, offering overall health benefits and supporting well-being.
5. Magnesium Sucrosomial: Enhances energy production, strengthens the immune system, and contributes to maintaining healthy bones.
6. Magnesium Taurate: Essential for cardiovascular health, providing vascular protection and playing an important role in the body.
7. Magnesium Orotate: Crucial for overall health, supporting heart health, regulating functions, improving metabolic processes, boosting energy production and physical performance, and enhancing recovery after physical activities.

BiOptimizers Benefits

The BiOptimizers Magnesium Breakthrough formula actively supports various functions in the body, offering the following benefits:

1. Reduces Stress and Anxiety: Regulates the production of crucial neurotransmitters, actively decreasing stress and anxiety.
2. Promotes Calmness: Enhances the production of GABA, a key element in maintaining a peaceful state.
3. Boosts the Immune System: Safeguards overall health and well-being by strengthening the immune system.
4. Supports Cardiovascular Health: Mitigates the risk of health issues associated with magnesium deficiency, actively supporting cardiovascular health.
5. Strengthens Bones: Contributes to the overall health and vitality of bones.
6. Optimizes Muscle Health: Maintains and optimizes muscle health, ensuring proper functioning.
7. Enhances Metabolism: Aids in the efficient utilization of energy by boosting metabolism.
8. Increases Strength and Endurance: Supports muscle building and physical performance and increases strength and endurance.
9. High Bioavailability: Facilitates effective formula absorption due to its high bioavailability.

What is the Recommended Dosage?

Each bottle of the BiOptimizers Magnesium Breakthrough formula contains 60 capsules of premium, highly bioavailable magnesium forms.
Taking 2-3 capsules daily is recommended to optimize bodily functions and promote overall health.
Use the magnesium formula consistently for a minimum of three to six months for optimal results. This will ensure you experience the comprehensive benefits of magnesium.

Are there any Side Effects?

Consuming BiOptimizers Magnesium Breakthrough daily does not cause any side effects. It is entirely safe for long-term use. The formula is derived from natural forms of magnesium that have undergone scientific testing and clinical validation to ensure their safety.
Unlike artificial magnesium medications and supplements that can disrupt your digestive system, BiOptimizers Magnesium Breakthrough is a true breakthrough. The range of benefits offered by this product includes better sleep, digestion, metabolism, brain functioning, nervous system, skin, and hair health. You can confidently use this supplement without concerns for as long as you desire.
Rest assured that BiOptimizers Magnesium Breakthrough is designed to be safe and supportive of your overall well-being.

Who can Benefit from BiOptimizers Magnesium Breakthrough?

Magnesium is a crucial mineral for everyone's well-being. Unfortunately, many individuals do not obtain sufficient amounts of magnesium from their diets, leading to brain function, digestion, sleep disturbances, and irritability.
BiOptimizers Magnesium Breakthrough was created to address these problems by providing seven primary forms of magnesium for the body to perform optimally.
The formula is recommended for adults who experience:

• High levels of stress
• Sleep disturbances
• Magnesium deficiencies
• Digestive problems
• Cognitive issues
• Other ailments

To facilitate faster recovery and cellular healing, BiOptimizers Magnesium Breakthrough surpasses any other remedies you may have tried.
However, it is essential to note that this product is intended for adult use only. Individuals under the age of 18 should refrain from consuming it.
Click the link BiOptimizers Magnesium Breakthrough!

Species:Cat
Age:11
Sex/Neuter status: Neutered male
Breed:Domestic shorthair
Body weight:17
History:Has never had any prior health issues other than worms and giardia when I got him as an 8 week old kitten. Last night he was up on a cabinet (one of his usual nap spots) and I think he misjudged the jump down and he landed on a candlestick on my table that has some pokey bits (not sharp but they do stick out).
Clinical signs: He has a 1/4 inch long, shallow/surface level cut on the outer side of his paw pad and there is a smaller than dime sized patch of fur missing above it on his paw. He is bearing weight on the paw, jumping up and down onto couch/bed/counters (though I am trying to stop him to get him to rest but I live in a studio so it's hard to keep him anywhere he can't jump, even in the bathroom there are counters he can jump onto), sleeping, cuddling and purring like normal, eating/drinking/using litter normally, stretching (he likes to lay with all 4 legs straight out and has been doing that), and generally seems totally like himself except for a limp and the cut. Within an hour of the incident he had gone to sleep in his usual spot on my pillow and slept his usual amount of time. Did not cry when it happened or since then. He is letting me touch his paw to clean the cut (have been handling wearing disposable latex gloves to clean gently with soap and water). He is limping and walking a little slowly, has not been licking the cut or really paying attention to it.
Duration: 13 hours
Your general location: New York City
Links to test results, X-rays, vet reports etc:

Looking for jobs in biostats or public health analysis. I've revised my resume pretty frequently and over the past two weeks have tried to better tailor to job descriptions.
https://preview.redd.it/q9xzzuwcjz2b1.jpg?width=612&format=pjpg&auto=webp&s=c01cf2dc77b98e2630ba01c10384362169be5c3e

My step kids 11&8 are staying with us for two weeks while BM goes on vacation with her boyfriend. She is missing SD11 elementary school graduation and it’s making me so mad bc she missed her kindergarten graduation to go to a rave festival. They will be with us during the last week of school so I have to drive them to school as well as driving my husband to work. It’s a half hour drive to my husbands work and their school and we already spend hundreds in gas a month and taking them to school is even more. I’m also on food stamps and we only get it for me and my husband (BM lies to DSHS to get food stamps for the kids so we can’t claim them) and with the regular routine me and my husband already skip meals so we have more food for when they come over. I feel like asking her for 100$ just to cover the extra gas and food isn’t unreasonable. Especially since she waited to tell us until a few weeks before that she was leaving and had the kids tell us that we were taking them, didn’t even ask.BM just baby trapped her boyfriend who is very wealthy and they live with practically no expenses bc they live with his dad. She doesn’t buy or do anything for the kids so it isn’t like she doesn’t have 100 to spare for the kids. If I was healthy enough to work and make things comfortable I would but I can’t and I have a toddler (who I get WIC for but it’s just baby food so I can’t exactly buy everyone food with that like I can food stamps) I just don’t understand what the harm is in asking via text so we have a record of her saying no, or on the off chance she says yes we can hold her to her word when she leaves. This woman has never taken her kids on her trips that she goes on. She even went to disney land without them and told them she wouldn’t ever take them. She fights letting my husband see them, even threatening to lie to the police, but when she wants to go rave or go to Mexico or just abandon them for months(which she did when she was living in her car with her ex) she just expects us to drop everything and cater to that, which of course we do bc we love the kids and if they stayed with her family they’d be abused per usual. She is a HCBM and she drives me nuts. She also refused to give me the phone numbers of the kids friends parents to invite them to a graduation party for SD11 that my mom and I are doing. I had to just print invitations with my number on them hoping she didn’t tell the parents to say no. This is all bull shit. I wish my husband would take her to court already and end her power trip. She’s a neglectful, abusive mother and these kids don’t deserve it. They deserve to be home with us. I’m sick of digging their over grown nails out of their fingers and toes bc she doesn’t help them clip them. Sick of emergency rooms and walk in clinics bc they haven’t been to the doctor in years. I’m sick of them coming over with mats in their hair and stinking to high heaven bc they haven’t showered since the last time they were here. I’m sick of the behavior problems bc of her. I’m sick of all of it I just wish we had them so they had a good stable home instead of bouncing around BM family’s houses being abandoned. I know we aren’t perfect but we are a hell of a lot better than her.
This morphed into a rant so I guess I’m done.
Edit: after writing this I realized how silly the doc thing was so after calling and searching for good times the kids have doc apps! I can’t change the apps or take them with my husband concerning or being there but I finally found a day we have them and can get apps! I just scheduled them at the doc office attached to the walk in clinic we take them to!! Thank y’all!

Hi Reddit! I wrote two posts earlier this year about an alarming number of coworkers having psychotic breaks at or explicitly because of my workplace. I initially was here for a reality check and reassurance that this is not normal. then, this March, I wrote an update after being very explicitly targeted at work by management after speaking up about multiple safety violations. I was navigating my supervisor being one of the many who had seemingly lost it, and the stress that was leading me to break down. I had many people send me DMs to make sure I was ok, and I am appreciative. For this reason, I figured I would give you all another update.
I wanted to first provide some additional context. I was in a position where I oversaw safety protocols. I also had been at that job for a long time and knew staff at most sites. That is how I knew so many people were not okay. Thats also how I knew about staff getting sent to psych wards for emotional breakdowns at work. There were very clear correlations between staff having mental breakdowns, covid and, later, city policy changes.
I have been on leave since the day after I wrote that post. Since then, I know of at least five staff members who have been assaulted by clients - a consequence of policies which trigger clients mixed with skeletal staffing. One coworker got a concussion after a client assaulted them and management never reached out. I know of another coworker who noticed the signs of a mental breakdown and, fortunately, left before it got too bad.
I had launched a safety investigation and was subject to some pretty awful things from management during that time. I was also experiencing weekly violations of accommodations for a psychical disability- technically, I was “allowed” to say no when I did not have the support required, but then I could not complete my job. I had been speaking up and was hit with unexpected disciplinary action for “inappropriate use of email” after I started emailing HR about these violations and cancelling work events because I knew accommodations wouldn’t be met / explaining why I was canceling (my supervisor was usually unresponsive). I had an infection for the last two weeks due to yet another violation (or at least exacerbated by that) and was on a heavy course of steroid treatment. I believe that steroids might have been my breaking point - they triggered hypomania.
I was having severe panic attacks daily for a long time afterwards. I was blacking out. I don’t remember most of April. I do know that I took my pets to the ER multiple times that following week because I was terrified they were dying (they weren’t. Literally nothing was wrong). I cried a lot. I spoke to lawyers. I called the disability company. I did not my period bc of the stress. I was just generally unwell.
Things have slowly gotten better. I am working closely w my own mental health team for PTSD. I probably have a new job in the works, and I was finally able to get approval to sign up for my LCSW (a major concern was that my clinical supervisor was so clearly unwell & had retaliated after I did the whole code of ethics thing and spoke privately to him. His situation is pretty acute - I know about substance misuse due to inappropriate self disclosure, and I witnessed some alarming things that are likely related that I will not mention here. I was worried he wouldn’t sign off if any additional paperwork was needed. The state had already taken 6 months to process my application, and they had already requested additional paperwork from him. With every week I stayed, the situation got significantly worse). I am currently studying - its been hard because I am still having panic attacks and get triggered reading the code of ethics. But I am significantly more grounded.
I was really disheartened when people accused me of being the psychotic one and making things up. I do not have a psychotic disorder. But, even if i did, that would not necessarily discount my experience. I left before I snapped. Not all my coworkers are privileged enough to be able to leave without a plan in place. Its just reddit, I know. But I also hope that social workers understand that it’s possible for work conditions to really become that dangerous. I am expecting my agency to be highlighted in the news at some point for these violations, but social work is one of many pink collar industries where things are really, really bad.
I do have the option of filing lawsuits regarding ADA. But, right now, I just want to rest and move forward. The idea of taking a new social job makes me feel physically ill, but I need the insurance. I just want to be okay. I have changed so much since shit went down. I am a significantly angrier person with very little patience. I am really careful to never blow at another person, so I have been self isolating.
Thank you to everyone who provided support. To anyone reading - if you ever think your workplace is unsafe, trust your gut. These places will gaslight the hell out of you. You will have yourself thinking you are lucky for extra vacation days or whatever.
Be safe out there <3

Hey-Oh! So, I see some form of this question multiple times per day in various skin and personal care subs: How do I deal with my hyperpigmentation? I also asked myself this question a few years ago. See, I'm prone to freckles and a little melasma and I set out to figure out a way to solve it with years of research, trial and error, testing, talking to dermatologists and professionals, and scouring every medical article I could get my hands on. I wanted to share my findings and research since this is a common concern, especially among people in their 30s. This started as a small post about my routine and ballooned into a massive book about hyperpigmentation. I hope it's helpful!
DISCLAIMERS:

• I use the term "brightening" instead of "lightening" which is a subtle distinction. None of the ingredients or methods I recommend bleach your skin as "lightening" would suggest, but they can reduce the appearance of hyperpigmentation. "Brightening" tends to be a confusing term in skincare, but for the purposes of this post, I use it as a descriptor for anything that helps prevent or reduce melanin in hyperpigmented skin.
• I will use the term "hyperpigmentation" ad nauseam as a catch-all term for excess pigmentation in the skin including freckles, melasma, PIH and dark spots. This does not encompass moles which are different. This is also different from redness, which is a whole other post.
• Speaking about hyperpigmentation requires some sensitivity to very real issues around it including cultural implications. This post is not intended to moralize hyperpigmentation nor is it intended to alienate the normal melaninization of skin across various tones. Hyperpigmentation refers to excess melanin production on the skin in the form of spots that are darker than the surrounding skin. It's not bad or wrong, nor does it speak to anyone not "doing a good enough job" of taking care of themselves.
• I do repeat myself a few times in here but that is for people who are skipping around the article. I want to be as thorough as possible even if you're jumping to the parts of the post you need.
• I do run an online dermatology practice and skin care consultancy, but in order to protect the integrity of my advice, I do not promote my business, I don't give direct medical advice, I don't link to any products/websites, and I don't have any products I've formulated myself to promote.

This is going to get long because I wanted to cover everything re:hyperpigmentation. But for your reading pleasure and ease, I have divided this post up so you can get whatever information you need:
Table of Contents

1. Types of Hyperpigmentation
2. What Causes Hyperpigmentation?
3. How To Treat Hyperpigmentation Part 1: The Ingredients
4. How to Treat Hyperpigmentation Part 2: The Routine and Recommendations
5. Body Hyperpigmentation
6. Nuclear Options

Let's get to it!

Types of Hyperpigmentation

Hyperpigmentation refers to excess melanin production in the skin, but it can actually take a couple different forms. Knowing the type of hyperpigmentation you're experiencing is key to understanding if and how it can be treated.
Freckles: Freckles are incredibly common, especially for people with lighter skin tones. They are small, brown or reddish-brown dots often clustered on the skin. They develop on the surface and are not raised bumps. Freckles can appear anywhere on the body but are common on the face. Freckles are permanent, but the color, contrast and severity can vary and be tempered.
Melasma: Melasma appears as dark patches or splotches around the face, though usually found on the forehead, upper lip, and high on the cheeks. Melasma forms deeper in the skin and appears more amorphous than freckles, moles, or age spots. It can create a “muddy” appearance and is very common among pregnant and postpartum women due to hormonal factors. But it can literally happen to anyone and anywhere on the body.
Post-Inflammatory Hyperpigmentation (PIH): Post-inflammatory hyperpigmentation (PIH) occurs when damaged skin forms melanin during the healing process leaving dark spots. This is common after acne, injuries, eczema, burns, and other trauma to the skin. Exposure to UV rays during healing can make PIH worse. Post-inflammatory erythema (PIE) is similar, but leaves pink or red marks on the skin as a result of damage to the capillaries from injury or inflammation. Basically, when skin is compromised by injury, as part of the immune response cells will begin to generate melanin in an attempt to prevent further damage from UV exposure, so what will happen is the wound/legion/blemish will heal but the pigmented skin remains.
Age Spots: This is kind of a forgotten form of hyperpigmentation. Sun spots, also referred to as liver spots, and solar lentigines are large spots/patches of dark skin with distinct borders. They vary in color from light brown to almost black. They develop on the surface of the skin usually later in life, but reflect damage that often occurred from improper sun protection at a younger age. They can appear on the face, neck, chest, hands, and arms, usually on areas that had UV exposure. For many people, they can begin to appear in your 30s or 40s.

What Causes Hyperpigmentation?

There are a number of factors that can contribute to the formation of hyperpigmentation. Generally, it forms as the result of a combination of genetic and environmental influences. Everyone is unique, but these are some of the most common causes of hyperpigmentation and dark spots:
Genetics can play a role in the development of hyperpigmentation and dark spots in several ways:

• Melanin production: Melanin is the pigment that provides color to our skin, hair, and eyes. The amount of melanin produced and distributed in the skin is largely determined by genetics. People with a greater genetic predisposition to melanin production in their skin are more likely to experience hyperpigmentation and dark spots as a result of sun exposure, hormonal changes, and other factors. People with darker skin are also more prone to melanin production in the form of hyperpigmentation.
• Genetic anomalies: Certain genetic anomalies, such as oculocutaneous albinism, can affect melanin production and distribution in the skin, leading to an increased risk of hyperpigmentation and dark spots.
• Family history: If you have a family history of hyperpigmentation or dark spots, you may be more likely to develop these conditions yourself.
• Enzymes and genes: The enzymes that control melanin production and distribution are regulated by specific genes. Variations in these genes can impact melanin production, leading to an increased risk of hyperpigmentation and dark spots.

Sun (UV) Exposure. In addition to genetic determination of melanin production, UV exposure is the leading environmental cause of hyperpigmentation and the formation of dark spots. Melanin is the pigment that provides color to our skin, hair, and eyes. It acts as a natural sunscreen (but don't treat it like natural sunscreen!!! This isn't the point of the exercise), absorbing UV radiation to protect the skin from damage.
When the skin is exposed to UV radiation, the melanocytes (cells that produce melanin) in the skin go into overdrive, producing more melanin to protect the skin from further damage. This increased melanin production can result in dark spots or areas of hyperpigmentation on the skin.
Hormones. In addition to genetic determination of melanin production, hormones and hormonal sensitivity is a leading internal cause of hyperpigmentation and the formation of dark spots.
One of the most well-known examples of hormonal hyperpigmentation is melasma, a condition characterized by dark, amorphous patches on the face, particularly on the cheeks, forehead, nose, and upper lip. Melasma is often associated with hormonal changes, such as those that occur during pregnancy, hormonal therapy, or birth control pill use. The hormonal changes can stimulate an increase in melanin production, resulting in dark spots or areas of hyperpigmentation. This can happen irrespective of UV exposure, though the sun does exacerbate it.
Hormones can also affect melanin production by altering the skin's metabolism and pigmentation pathways. For example, high levels of cortisol, a hormone produced by the adrenal glands during stress, can trigger an increase in melanin production, resulting in hyperpigmentation.
Inflammation, Injury & Trauma to the skin can result in hyperpigmentation by triggering an increase in melanin production. When the skin is inflamed or injured, it triggers a response from the body's immune system, which can stimulate an increase in melanin production as a protective measure.
For example, acne breakouts or other skin injuries can result in post-inflammatory hyperpigmentation (PIH), which is characterized by dark spots or areas of discoloration on the skin. The dark spots are a result of an increase in melanin production in the affected area, which occurs in response to the inflammation or injury. In addition to acne and other skin injuries, other conditions that can result in PIH include eczema, psoriasis, and insect bites.
Medication Side Effects. Certain medications can cause hyperpigmentation on the skin. Medications that can cause hyperpigmentation include:

• Tetracycline antibiotics: Tetracycline antibiotics, such as doxycycline and minocycline, can cause discoloration of the skin and teeth when taken in high doses or for an extended period of time.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as ibuprofen and naproxen, can cause hyperpigmentation in some individuals, especially if taken in high doses or for an extended period of time.
• Chemotherapy drugs: Certain chemotherapy drugs, such as doxorubicin and daunorubicin, can cause hyperpigmentation, especially in areas of the skin that have been exposed to the sun.
• Hormonal medications: Hormonal medications, such as birth control pills and estrogen replacements, can cause hyperpigmentation in some individuals, especially if they are taken for an extended period of time.
• Antimalarial drugs: Antimalarial drugs, such as chloroquine and hydroxychloroquine, can cause hyperpigmentation in some individuals, especially if taken in high doses or for an extended period of time.
• Isotretinoin aka accutane when taken for acne can cause hyperpigmentation due to the increase of cell turnover and exposing delicate new skin cells to UV rays before they have shored up.

If using these medications is necessary for your livelihood, it is not recommended to stop their use without the recommendation of your doctor.

How To Treat Hyperpigmentation Part 1: The Ingredients

When looking for skin care products to treat and prevent hyperpigmentation and dark spots, it's important to look for ingredients that can help encourage cell turnover, curb melanin production, and block harmful UV rays. A lot of these things overlap with treatments for other conditions like acne and general anti-aging, but I've noted ones that specifically work on the mechanisms controlling melanin production. Now, this is an extensive list, but I know it doesn't have everything. I've included the ingredients that had the most compelling evidence and/or worked the best for me or people at my practice. But it's also not necessarily a shopping list. You don't have to have all of these things to treat hyperpigmentation, but I'll get to that in the routine portion. This is more to be used as a tool that can help you diversify your routine if you find one ingredient or another doesn't work for you. And it can help you determine if a product targets hyperpigmentation based on its ingredients. There's lot's of options. Some of the key ingredients to look for include:
Retinoids that increases cell turnover. Retinoids like tretinoin, adapalene, retinol et al, can help treat hyperpigmentation by promoting the turnover of skin cells and increasing cell growth, which can help fade dark spots and improve overall skin tone by replacing pigmented skin cells at the surface. While retinoids are extremely effective, they do have some caveats. First, they can be sensitizing to a lot of users, but this can be tempered by using different form functions, different application methods, or different concentrations. Second, because it's constantly turning over skin exposing delicate new skin cells to the elements, it can actually worsen hyperpigmentation if you're not vigilant about sun protection and avoidance. Tretinoin and other retinoids are firewalled behind a prescription in some countries and may be more difficult to obtain. But retinol/al is available in OTC forms.
SPF represents a class of many ingredients designed to protect the skin from UV rays and the damage that occurs from exposure. UV exposure is one of the biggest causes of fine hyperpigmentation and wrinkles so adequate protection is essential. I know I'm not winning any science awards for this declaration, but a lot of people who struggle with hyperpigmentation aren't adequately protecting themselves from the sun. But you also have to be kind of realistic. Even with perfect protection and avoidance, sometimes your hyperpigmentation will still flare. This happens during the summer for a lot of people and something even I grapple with. The key is to do your best and SPF actually works well with numerous other ingredients (like the ones listed below) to help solve that problem.
Arbutin is a Tyrosinase Inhibitor that blocks melanin production. Arbutin, or the synthesized version called alpha arbutin, is a favorite brightening ingredient because it's a slow-release derivative of hydroquinone that inhibits melanin production. This results in both healing and prevention of dark spots, especially when paired with topical acids. It metabolizes on the skin into hydroquinone which is super effective for hyperpigmentation while being a less controversial and hard-to-come-by ingredient than pure hydroquinone. More on hydroquinone in part 6.
Tranexamic acid is another Tyrosinase Inhibitor. This was first used in wound care and it was found to have profound effects on hyperpigmentation. Although it's an acid, it's not a chemical exfoliant, kinda like how hyaluronic acid is not a chemical exfoliant. The exact mechanism by which tranexamic acid works to reduce hyperpigmentation is not fully understood, but it is believed to work by reducing inflammation by blocking plasmin which contributes to melanin production when unchecked. It is particularly effective in treating melasma and one of my personal favorite ingredients.
Kojic Acid is another Tyrosinase Inhibitor. Kojic acid is a natural skin brightener that is derived from various fungi. Kojic acid can also help to exfoliate because it's a slight chemical exfoliant, which can remove dead skin cells that contribute to hyperpigmentation and improve overall appearance. But it does both things: block melanin production and turn skin cells over.
Azelaic Acid has a lot of things going for it that can help with hyperpigmentation. It's an anti-inflammatory and antiseptic that disrupts melanin production. Azelaic acid works by inhibiting the production of melanin in the skin like those other tyrosinase inhibitors. In addition, azelaic acid also has anti-inflammatory and antibacterial properties, which help to improve the overall health and appearance of the skin by reducing melanin production as a result of injury or inflammation. It's also an anti-acne ingredient that can address the root cause of PIH by reducing acne on the skin. It's pretty awesome and available in OTC and prescription strengths.
Niacinamide is another one that directly and indirectly addresses hyperpigmentation. It's a skin soother that decreases inflammation and it naturally reduces sebum production which can curb acne which can curb PIH. It actually took me a little while to figure out that this was another solid hyperpigmentation treatment for these reasons because I used to look at it as being more of an acne treatment. Niacinamide is a form of vitamin B3 that works by inhibiting the transfer of pigment within the skin, which can help to reduce the appearance of dark spots and uneven skin tone. So while it doesn't block tyrosinase, it prevents transfer of pigmented skin cells to the surface.
Vitamin C aka L-ascorbic acid is an antioxidant that fights free radical damage. It treats and prevents hyperpigmentation in three ways. First, it reduces free radical damage from UV exposure which helps increase the effectiveness of SPF when worn together. Second, it is also a tyrosinase inhibitor that blocks melanin production. And finally, vitamin C encourages skin cell turnover. The key is finding a nice stable version of it.
Glycolic and Lactic Acid. Since this list is getting long I am going to group these together. Glycolic Acid is a water-soluble alpha hydroxy acid that penetrates into the pores to treat pigmentation by providing general exfoliation and resurfacing of the skin. The result is improvements in dark spots, texture and other signs of aging. Lactic Acid is also an AHA but with a slightly larger molecular size than glycolic acid so it doesn't penetrate as deep and acts more as a surface exfoliant. As a result it provides more gentle exfoliation to buff away surface pigmentation with an added benefit of acting as a humectant to seal moisture into the skin.
Licorice Extract is a plant extract that inhibits melanin production. Licorice root extract contains a compound called glabridin, which has been shown to have skin brightening effects as, you guessed it, a tyrosinase inhibitor. In addition, licorice root extract also has anti-inflammatory properties, which can help to reduce redness and inflammation associated with hyperpigmentation. I'm seeing more and more of this pop up in skin care.
Soy Proteins are another plant extract that inhibits melanin production. They contain compounds known as isoflavones, which have been shown to help reduce the amount of melanin produced by melanocytes in the skin. Additionally, soy proteins have antioxidant properties that can help to protect the skin from damage caused by free radicals, which can contribute to hyperpigmentation.

How To Treat Hyperpigmentation Part 2: The Routine and Recommendations

This is adapted from numerous comments, posts and DMs I've written on the topic and also comprises a large portion of my own personal routine and routines we recommend to patients. This is a generalist routine meaning it targets all the forms of hyperpigmentation I've mentioned; freckles, melasma, PIH, and age spots though it can be tweaked to address these individually more specifically. This is really my jumping off point for people to get a good idea of what they can achieve as a baseline with OTC ingredients before fine tuning or enlisting the help of a dermatologist. For a lot of people, this is enough to fully resolve, but even if it gets you part of the way there, this should give you a good idea of reactivity.
A few caveats:

• Freckles cannot ever be 100% eradicated. You can however reduce their appearance and prevent them from getting darker. It's important to have realistic goals and understand that sometimes our genetics will overrule any routine we have.
• This routine and any hyperpigmentation routine will not address moles. Moles are a totally different thing that can only be eradicated through removal by a medical practitioner. Moles can be raised or not, but no amount of topicals will get rid of them.
• Melasma is a beast. Sometimes it can be treated with OTC topicals, sometimes it requires prescription strength topicals like hydroquinone, sometimes you need in-office procedures like fractal lasers or IPL. Again, this routine is a jumping off point to see what you can accomplish at home before going down that road (and more on that at the bottom in part 6).
• You'll notice I don't mention products with all the ingredients I listed above. This is because the more you put on your face, the greater your risk of causing irritation. Again, you can adjust and tweak by switching out products with these ingredients or add/subtract as it suits your personal needs.
• If you're struggling with hyperpigmentation while pregnant or breastfeeding, these recommendations may need to be paused.

Alright, let's get to it!
AM routine -- The Goal: Heal, Protect, and Prevent. In order of application following a lukewarm water rinse:

• Azelaic acid
• Alpha Arbutin
• Vitamin C serum
• Moisturizer
• SPF

The combo of C+AZ+AA+SPF is an absolute powerhouse for healing existing hyperpigmentation and preventing new hyperpigmentation from forming. It makes your SPF more effective, it inhibits the production of melanin from UV exposure (not your natural melanin production though), and it speeds cell turnover with dual antioxidant action and gentle chemical exfoliation. The result is brighter skin in a few months of consistent use.
For Azelaic Acid, this is the ingredient for serious treatment. It's considered one of the most effective ways to reverse melasma aka serious hyperpigmentation short of hydroquinone -- which is both controversial and hard to get. It brings a little bit of exfoliation to the table in addition to inhibiting UV melanin production, but it also has a slight antiseptic property which can help with acne. Paula's choice Azelaic Acid Booster is the only one I've really tried after sampling the Ordinary's in-store and not liking the texture. I get about 6 months out of a tube and a little bit goes a long way.
For Alpha Arbutin, the Ordinary's formulation is pretty solid. I prefer the Ordinary's AA 2% + HA as opposed to their AA 2% + Ascorbic Acid 8% as I don't believe the quality and stability of their Ascorbic Acid (Vitamin C) is great. That's why I opt for a separate Vitamin C serum step. But the AA + HA also has a little bit of lactic acid in it which provides some gentle exfoliation and encourages AA deeper into the skin where it's more effective. Lactic acid is mild enough that it's safe for use in a morning routine, but you still want to protect with SPF. There are a couple AA products floating around but I think TO's product is probably the best, most straightforward one. Alpha Arbutin metabolizes into hydroquinone on the skin so is basically one of the best OTC pigment correctors you can get.
For Vitamin C, the gold standard really is Skinceuticals CE Ferulic. This is stupid expensive though so I’m going to suggest Timeless Vitamin C. I like that it comes in an airless pump that prevents oxidation over time. Vitamin C is an antioxidant that increases the rate of skin cell turnover bringing forward new, skin cells while simultaneously improving the effects of SPF. It's a great foundation for a fix.
These ingredients can be layered on one right after the other then topped with your moisturizer (I like a basic one like cetaphil daily lotion), then topped with your SPF. The SPF I would recommend is Canmake UV mermaid gel in clear as this will not leave a white cast on your skin and it’s generally a very elegant SPF. It's SPF 50 which means it gives really good protection, but there are numerous SPFs you can try. I personally like anything from La Roche Posay, any Neutrogena SPF that's not formulated with ethylhexylglycerin, Supergoop Unseen Sunscreen, Biore Aqua Rich (another Japanese brand), Trader Joe's SPF if you can get your hands on it, and EltaMD.
Of all the products I’ve tried that could act as a stand-in for vitamin c, azelaic acid, and alpha arbutin, there’s one Japanese serum from Hada Labo called “whitening lotion” which has had the biggest impact on my hyperpigmentation in a single product of anything I’ve tried. This might be a little too effective though, I actually find that it washed me out within the first 2 weeks of twice daily use, so now I only use it in the morning. And I’m not a fan of the translation… which is a direct but mistranslation. It’s not a bleaching lotion, it also relies on a form of vitamin C and tranexamic acid to brighten skin. But it's a really interesting to try if you wanted a simplified morning routine in which case I would apply this, then your moisturizer, then your SPF.
PM routine -- The Goal: Renew and Reveal. In order of application:

• Cleanse
• Buffer
• Tranexamic acid and exfoliant OR retinoid**
• Moisturize

To cleanse, I have a really basic recommendation that will remove your SPF, makeup, and any grime/sebum from your day. Start with Cetaphil gentle cleanser. This is a gentle, hydrating cleanser that will break up your SPF really effectively. Massage in and rinse. Then apply a foaming cleanser, I recommend Cetaphil daily cleanser which foams. This will sweep away anything that’s left and give you a good foundation for the rest of your routine. While this doesn't directly help hyperpigmentation specifically, it's a critical step especially for people who are acne>PIH prone. It also gives you a nice clean slate to apply the rest of your skincare. I've tried dozens of cleansers but always come back to these two as good basic options.
For your Buffer this is an important step that can be done prior to using a chemical exfoliant or retinoid: applying an occlusive that will block the active from more sensitive skin. I recommend buffering around your eyes and nostrils with La Roche Posay Cicaplast balm because it kind of doubles as a nice eye cream, but this can also be done with basic vaseline or aquaphor for a more budget-friendly option.
For Tranexamic Acid, my holy grail TXA product, La Roche Posay Glycolic B5 is actually a multipurpose serum that combines ingredients to treat hyperpigmentation with chemical exfoliants. It contains two hyperpigmentation heavy hitters -- Tranexamic acid and Kojic Acid which are great for melasma -- and two exfoliants -- Glycolic Acid and Lipo-Hydroxy Acid (LHA) which is like fancy salicylic acid -- so it both reveals new skin cells that are less prone to pigmenting from UV exposure while sloughing away your old skin cells. You can use this 2 or 3 nights per week. On off nights, just cleanse and moisturize.
For a Retinoid if you can get prescription tretinoin, this is going to be the best bet. Your doctor will advise you on the concentration. More on that in part 6. It will help speed up the rate of cell turnover bringing new, unpigmented skin cells to the surface faster. Some other OTC options include differin (which is rated more for acne but uses the same mechanism for cell turnover so it's also effective in this use case) and retinols. Now, I haven't tried every retinol on the market but I have two that I stand by: SkinCeuticals retinol and L'Oreal retinol serum. The SkinCeuticals is, in my opinion, the closest to RX tretinoin in terms of efficacy, but it's a little pricey. The L'Oreal also does a really good job and is a little more affordable. It's currently my go-to OTC on the days I'm not using my RX retinoid tazarotene. You can use this 2 or 3 nights per week. On off nights, just cleanse and moisturize.
** My recommendations for tranexamic acid and retinoids CANNOT be used in the same night. You'll nuke your skin. And for most people, both aren't necessary, you can get away with using one or the other. If I had a preference, I would say use the TXA serum instead of a retinoid, but if you can build up a tolerance to using them both without damaging your barrier, they work really well together. So, proceed with caution. If you want to use both, use them on alternate nights and give yourself a night or two without either to let your skin recover. For me personally, I do retinoids on Sundays, and Wednesdays, chemical exfoliants on Mondays and Thursdays, and I let my skin rest (cleanse, moisturize, squalene oil) on Tuesdays, Fridays, and Saturdays.
On top of whichever active you choose, apply your moisturizer. You can use the same one you use in your morning routine, the Cetaphil daily lotion as it’s nice and light. I also like La Roche Posay Toleraine double repair for a ceramide-based cream alternative if you want something richer. You do not want to "slug" over actives. This advice gets mixed in a lot. Slugging refers to applying an occlusive layer over your skincare such as vaseline, aquaphor, oils like squalene oil, or healing balms like La Roche Posay Cicaplast balm. While this can be done on hydration nights, it should not be done on nights when you're using chemical exfoliants or retinoids as this may make them too effective causing irritation and breakouts.

Body Hyperpigmentation

Ok, I need everyone to be a grownup for two seconds. These products and methods (both from the prior section and this section) should NOT be used on your genitals. First, you can cause serious irritation or infection by applying active skincare to your genitals. Second, it's really not going to do anything to change the pigmentation of the skin there. The skin on your genitals is different than your body and facial skin and it pigments in different ways for different reasons so it's not going to respond to topicals the same way the rest of your body does. Don't even try it.
To be perfectly clear, these are the areas you should not be applying skincare: labia majora, labia minora, vaginal entrance or vagina, clitoral hood, perineum, anus, intergluteal cleft aka inside your butt crack, penis, or scrotum. And I say this as someone who chaffed the precipice of her "intergluteal cleft" in an unfortunate crunches-in-the-wrong-gym-shorts accident leaving me with some deeply incriminating hyperpigmentation and earning me the nickname "skid mark" from my ever loving boyfriend. It faded after a year but you can still send prayers.
These are areas you can apply skincare but do so with absolute caution and at your own risk: bikini line, mons pubis, inner thigh up to the groin fold, butt cheeks.
Ok, now that we've got the disclaimers out of the way, let's move forward. Hyperpigmentation can also occur on body skin for the same reason it appears on the face, but it can also be triggered by friction. And because body skin is different from facial skin, it requires a slightly different approach. This is my recommendation for both hyperpigmentation and KP (Keratosis pilaris) because they rely on the same mechanism for treatment: chemical exfoliation.
In the case of body hyperpigmentation, I recommend a two prong approach: a body wash in the shower and a topical treatment to be used after. Oh, and SPF again if there are areas that are exposed to the sun, and I have a holy grail SPF recommendation for this.
Now you may have noticed in my facial skin recommendation that I did not mention CeraVe as a treatment brand. I have posted numerous takedowns of CeraVe on other threads so I won't rehash them here suffice it to say that it's no longer a brand I can in good faith recommend since it's acquisition by L'Oreal. This is often the brand that's considered when treating KP on the body, but I don't believe their formulations and ingredient quality works for everyone.
For the body wash, I recommend Neutrogena body clear with Salicylic acid. This is an exfoliating body wash that will help clear away dead skin cells on the surface allowing new ones to come through. To be effective, you want it to sit on your skin for a little while. I recommend lathering it up and applying it after turning off your shower faucet and letting it sit for 2 or 3 minutes. This is when I like to knock out shower emails. Then rinse away.
On towel dried skin after your shower, apply AmLactin Bumps Be Gone. Again, this is formulated for KP but the reason I like it is because it contains lactic acid which will also give the assist on brightening hyperpigmented body skin. The wash and this should be effective, but you might also want to mix in a few drops of the alpha arbutin serum I recommended for your facial routine, maybe three drops per application area (each leg, each arm, chest, etc). I generally don't encourage facial products on the body because it's not an economical use for them, and also because body skin is a little more resilient and doesn't need skincare that's formulated for more sensitive facial skin. The AA serum from the Ordinary is very affordable however and is a good hyperpigmentation generalist.
Another one that I mentioned in the facial hyperpigmentation portion that can work well on the body is the Hada Labo whitening lotion. Again, this is formulated around tranexamic acid which is very effective for hyperpigmentation and a little bit if this stuff goes a long way. I buy it in bulk from Japanese Importers though it's also available on Amazon for a slightly higher price. If you find yourself in Asia, stock up on it. I use this specifically for fading tan lines that happen (even with diligent/neurotic SPF use) around my fitness watch and the straps of my workout tops that I run in.
You also want to wear SPF on areas that are exposed to the sun to prevent pigmentation from occurring. The one I absolutely love that’s not your 90’s banana boat is Aveeno Protect + Hydrate lotion with SPF 60. This is a great SPF for a lot of reasons: it finishes like a lotion instead of a sunscreen, it dries down totally clear, and it has a pleasant, slight sweet scent. On a scale of 1-10 with 1 being bare skin, 10 being banana boat slathered on by your mom in 1997, and regular body lotion being a 2, I give Aveeno Protect + Hydrate a 2.5 in terms of texture and feel-finish. I use it as my daily lotion on my neck, arms, shoulders, and chest. If you're more active you might need a heavier hitter here like a sport sunscreen.

Nuclear Options

In general, I recommend trying OTC topical solutions for any skin concern before heading down the in-office procedure route. Part of this is because you can usually put a good dent in what you're struggling with by using OTC topicals, making in-office procedures and RX treatments easier and more effective. Part of it is so you have a good maintenance routine in place to use after the fact to preserve the results of your in-office procedure which can sometimes be costly. Lastly, while some procedures can solve the immediate problem completely, topical skincare can be really effective at treating other adjacent conditions like redness, acne, and fine lines.
Side note: I haven't listed every possible compounded medication because there are a lot, and many compounded meds are formulated to tackle multiple issues like acne and hyperpigmentation. I also tend to favor single note skin care (aka, products with very few ingredients) as this allows you to combine or remove certain actives and gives you a better sense of reactivity.
For tougher-to-treat hyperpigmentation such as melasma, if your topical routine doesn't totally clear the problem in 6 to 8 months, a visit to the dermatologist might be helpful. Here are the heavier-hitting procedures and topicals that can go the extra mile after you've exhausted other options.
Medical Grade Peels: Medical grade chemical peels can be done by dermatologists. Trichloroacetic acid (TCA) or phenol peels may be done for cases of severe hyperpigmentation, but high concentration BHA or AHA peels are also commonly used. I do these twice a year. Because of the strength of the acids used, these must be done by a medical professional with careful followup.
***IPL Therapy and Laser Therapy may not work for everyone and in some cases may exacerbate hyperpigmentation so you really want to work with dermatologists with a lot of experience in treating cases similar to yours to determine if these interventions are appropriate for you.
IPL Treatment: Intense Pulsed Light (IPL) therapy can treat hyperpigmentation by targeting the melanin in the skin with a broad spectrum of light wavelengths, heating and breaking the melanin down. IPL is particularly effective for treating sun damage and age spots, as well as other forms of hyperpigmentation. The treatment is relatively non-invasive, with minimal downtime, making it a popular option. This is also a great treatment for the redness associated with enlarged blood vessels (often confused for broken capillaries) on the surface of the skin which can also appear alongside hyperpigmentation. There isn't any clinical evidence to support at-home IPL devices being effective in the same way. That doesn't mean it's not possible, it's just not studied enough to be certain. Most at-home IPL devices do not operate in effective wavelengths the way professional grade ones do.
Laser Therapy: Fractional and CO2 lasers can be used to treat a range of hyperpigmentation issues, including sun damage, age spots, and melasma. The treatment works by removing the top layers of skin, which contain the excess pigmentation, revealing fresh, healthy skin cells underneath. The lasers also stimulate the production of collagen, which helps to improve skin texture and reduce the appearance of fine lines and wrinkles.
Hydroquinone: This isn't an in-office procedure like the aforementioned treatments, but it is firewalled behind a prescription meaning you can only access hydroquinone in effective concentrations by working with a doctor. This is a somewhat new development at least in the US following some covid-era rejiggering of prescription clearances. HDQ is controversial because it's a skin bleaching agent which has some cultural implications in places where light skin is favored over natural pigmentation. HDQ technically works the same way other OTC tyrosinase inhibitors do (in fact arbutin actually metabolizes into HDQ when applied to the skin), pure HDQ happens to be the most powerful version of them. It lightens any skin it touches, not just hyperpigmented skin in higher concentrations which can make it tough to use. This effect isn't as profound in the other tyrosinase inhibitors I mentioned making them much easier to use over HDQ which, in high concentrations, must be dotted on the skin in only hyperpigmented areas. So HDQ is really reserved for intervention in extreme or OTC treatment-resistance cases.
Tretinoin and Prescription Retinoids: This is going to be dependent on what part of the world you're in, but in a lot of countries, tretinoin and its counterparts like tazarotene are only available through prescription. I mentioned retinoids in the routine so if you're able to get your hands on a prescription from a doctor, it may be more effective than OTC retinols. Most doctors will prescribe a retinoid over hydroquinone, so this is usually easier to procure and can be quite effective on its own as a hyperpigmentation treatment. OTC differin is the only retinoid available over-the-counter (in the US) which can also be used for hyperpigmentation.
Prescription Azelaic Acid: This is another one that's available in lower concentrations over-the-counter (which can still be quite effective) but there are prescription strength grades of azelaic acid. This is usually reserved for rosacea treatment as it tends to target redness and flushing, or as an acne treatment because of its antiseptic properties, but it can also be an effective hyperpigmentation treatment for its tyrosinase-inhibiting ability.
If you made it this far, congratulations! I hope this information is helpful. While it is extensive and based on massive amount of research, experience, experimentation and work with professionals, it may not be perfect and it may not be suitable for everyone. Feel free to offer any constructive criticism or ask any questions in comments. I am always open to expanding my understanding.

I'm a therapist in Florida and one of my specialties is Ketamine Assisted Psychotherapy. I have been wanting to write this post with the hopes of it finding at least a few ears that will find it beneficial.
As excited as I am about the benefits of psychedelics making their way into mental health spaces to give real relief for hurting people, watching the beliefs around this drug is undermining not only the impact it has on the patients who approach it with hope, but escalates risk of physical harm and risk of addiction.
There is a lot that science doesn't know about the brain and how it works. The intricacies of the space that holds our thoughts, our consciousness, controls the functioning of our body and frames who we are individually with our personality, insights, perspective etc is a code that has yet to be unlocked.
When something is out of sorts with our body, there are numerous ways to check what is wrong..blood work, imaging scans, visual observation... but this isn't as clear when it impacts our mental health.
Poor mental health isn't about how our brain operates. In the field, when we look at brain operating issues (i.e. dementia, TBI, cognitive disorders, psychosis), we know this does impact mood and we know the reason. The physical brain is not working right. Even if we don't know why the brain is zigging instead of zagging, we know it is a brain matter issue.
However, all of the other diagnosis that people live with (i.e. mood disorders like depression and anxiety, PTSD, personality disorders, phobias, compulsive disorders)...the brain is hurting in those un-examinable ways. In the ways that identify how we think, perceive life, examine and understand our environment and ourselves. These spaces are impacted by not just want is happening in our physical body but by the experiences we have in our day to day life.
Our brain is an amazing computer, constantly synthesizing everything around us. It takes in every bit of information from our environment and our experiences and helps us create an identity. It uses these things to help us develop an identity, anticipate and plan for our days and our future. It helps us learn about and mitigate danger to our body and our heart. As a species that is intricately social, it observes and interprets information from the humans around us. ALL OF THIS helps us identify a schema, a frame of reference for looking at and being in this thing called life.
For efficiency, our brain looks for patterns and develops millions of rules to live by so we can avoid discomfort. The same brain that realizes that most of us don't go around clashing patterns on our clothes also learns that dealing with a manipulative family member might be problematic. It learns about grief and loss, it learns about love and friendship. It learns about passions and interests and drive...or it learns about hopelessness and feeling trapped and victimized. We all experience good things in life and bad things in life...and our brain learns and creates "thought grooves" and perspectives.
Ideally, we have a lot of both.... but what if the good and bad experiences in life are out of balance?
Sometimes, people create patterns on how they view the experiences of life and create protective, healthy habits. This is most likely to happen when we've had good examples that teach us how to take bad situations an learn from them.
However, what about when we haven't had the best examples? What if we didn't see how to handle those "feel bad" emotions....loss, guilt, sadness, confusion. What if we were traumatized by one, two, five, more painful situations that didn't break our body by hit our heart? What if we experienced sever pain by 1000 cuts...and there wasn't space to heal?
What grooves do the brain create then? How does this impact how we see the world...and ourselves in it?
THESE are the seeds and origins of many of our responses that we have come to identify as mental health issues. It is unmeasureable but it the symptoms are there....everything from brain fog, pessimism, hyper or hyposomina, unexplained pain, fidgeting, short temper, social anxiety, pessimism, worrying, compulsive behaviors.... Our brain has developed its habits and our body connects with that groove.
Then you go to therapy and you learn why these things are happening... you get your diagnoses... Major Depressive Disorder, PTSD, OCD etc... and you learn WHY you have the symptoms. Because your intelligent, you start to understand...
BUT then you go home and all those good ideas and strategies for living a better life are hard to implement... coping skills, setting boundaries, self discipline, healthy habits. You know their good for you... you know they could help... but.... the groove
AND THIS is the crux and power of neuroplasticity. Something starts to happen in medicine space that may allow you to shift your perspective... not what you know intellectually, but it softens the groove that your brain has built so you can implement a new habit or a new way of thinking.
Journaling or taking a walk or starting a garden doesn't seem like such a difficult thing to do. (All of which make the mind and body feel good.)
Something clicks inside that doesn't just let you understand that you can tell your friend "no" when they call you for help AGAIN even though you're tired, but that saying "no" is ok and if your friend loves you, it will really be ok.
You re-evaluate that traumatic incident that happened to you... not because it wasn't painful... but you can not only understand why it wasn't your fault, but you can accept the reasons why it wasn't.
THIS is neuroplasticity.
THIS is what is being wasted when you aren't actively working on shifting how you see life and yourself. The bumb of a good mood is not the goal of medicine space of psychadelics... if that is your goal, then you might as well find a easier addiction. Because ALL addiction is the avoidance of what is painful in exchange for feeling good now.
But if you want to get better, then giving the brain a way to see the world...and yourself... differently. THIS is what causes long term change.
Please don't waste that opportunity!

Unsurprisingly black men and boys were the most likely to be killed by police use of force. Though women of other races were much likely to be killed by police use of force compared to white women, the sheer number of men of all races killed by police is dramatically higher than women of all races. A white man or Asian man have an exponentially higher risk of being killed by a police officer than a black women (despite the common narrative of this being only a race issue).
The following is gathered from my own thoughts in applying some social science thinking briefly as to why this happens.I have read a lot of about this type of research in particular (strain theory especially), have an anthropology degree, master degree in public health, and work in public health, so I'm not just BSing.
The issue of extrajudicial police killings in the United States is both equally a racial and gender issue; targeting all men over all women, but especially black men. On a structural/sociological/criminological level this is in part due to the men are more likely to live a criminogenic lifestyle compared to women, causing more interactions and worst interactions with law enforcement.
While multifactorial, following criminology/sociology theory this is largely due to structures In society that cause men, especially young men, especially black men to have a crimogenic lifestyle. It's situations that me are forced into that are conducive to criminal or crime-adjacent behavior rather than there own choices. The social determines of health, in particular the concept of Built Environment is a the realm of which this mostly happens.

Good morning!
I was wondering if others had any tips on how to get a therapist through Kaiser?
I was suggested MyStrength as Kaiser's new telehealth system by the behavior health scheduler, and I love that. I love having it all in one spot and not having to leave my apartment, however, when I click the link to schedule an appointment, both on my computer and my phone I get a blank screen? I am currently trying again, but I keep getting new error messages saying that the connection is not secure/has been hacked. I just spoke with Kaiser on the phone and they had no idea what I was talking about regarding MyStrength as a thing that exists.
Anyone have any tips or similar experiences? I love this and would love to make it work.
Alternatively, anyone in the DC area have any luck getting a therapist through Kaiser?

Hello,
So I recently went to my local clinic on Sunday for a gnarly ear infection. She said I had both outer and inner ear infection and I was prescribed 20mg prednisone, 875mg amoxicillin, and neomycin ear drops.
Problem started on Friday with an itchy ear which turned into excruciating pain on Saturday. Seriously, it was up there on the pain level of IUD insertion. Anyway, I went to the doctor and on yesterday(Monday) I finally felt some relief from the pain.
Today, I’m experiencing mild/moderate pain, decrease in swelling, but I still have the feeling of my ear being clogged. I woke up this morning with some pain but it seems to have subsided for the most part once the medication kicked in.
I also have health anxiety and OCD in relation to it, so I just want to make sure this healing process is going as it should!
For reference 26F, 250 lbs Other medical conditions: hyperthyroid
Thanks so much!

WILDLIFE by nickel
​
Story 1- Stone and Grass
Chapter 2- Behaviors
​
Emergency rooms were trained to be ready for any arrivals at any time of the day or night, but the strange cases that were arriving had the nurse practitioners baffled. Three had arrived at a little past 2am, and a further single was arriving presently. The ambulance had pulled away seconds after they'd carefully unloaded their unconscious cargo at the emergency entrance and were wheeling them inside, keeping an eye out for any changes. The lead of the two, a fox named Maxwell Forscythe, was handing over the paperwork for the patient and pre-planning the routes for the trauma center room to park them in.
"Student, male, early 20s, comatose, irregularities in BP and bodily temperature, is that all that could be gleaned on the ride over?" asked the nurse on duty. Maxwell's partner nodded. "We checked him as much as we could without disrobing him, not a scratch, just low core temp and a weakened pulse for someone his age, possible arhythmia maybe?" "No way to be sure 'til he's seen by the staff, and have the cardiologist have a look. Wheel him into Obs G202, it should be open." "Should be, Paul?" asked Maxwell. Paul looked up, half-awake. "It's open, okay? This place is going a little bananas after the previous patients, y'know."He grimaced at him and signaled his partner so they could move the gurney. The ward was a bit of distance, but there was no immediate danger as of yet. His partner, a human woman named Grisholm, was peering closely at the inert body. "See anything?" "Look, I'm not saying we need to check the patient's neck again, but this feels--" "Good grief, Griz, we already looked, he hasn't been sucked off by a vampire." Her face went very pink. "That's not what its called, it's 'drained'! and it can be anywhere, sure, but the neck or the leg, I mean... this is exactly how it goes, unless the person is just ripped to pieces." The fox sighed, using his mag-badge to open the double doors ahead. "Well, I'm pretty sure this guy wasn't ripped to pieces, but vampires, Griz? In Canada?" "The world is a mighty strange place sometimes, and small places are just where shit like this tends to go down. I'm just saying we should keep our eyes open today, that's all." "Just in case our friend here rises in the night to suck someone else off, yeah?" he teased, knowing exactly how to needle his friend. Grisholm was at a lack for words, just making half-syllables in protest as they reached the elevator. "I read that book you lent me, y'know, I see why you like this stuff so much." Grisholm looked deflated until she caught Max's eyes, one of which was winked with a grin. "It's alright, Griz... I do it too." Her friend looked a little placated, helping to push the patient into the lift and pressing the next floor button. "Let's just not rule it out yet, okay? Now, come on, game-face time, the day's already started."
​
Hours later, after an alarm deep in the Deckard Forest Range's only unnatural home had gone off and Kari had finished washing and getting dressed, the message was finally reported over the news, which she was watching on her phone with apt attention, her pupils widened in curiosity while automatically eating her breakfast.
"Hospital authorities are preparing a statement at this time, but have denied these mysterious cases as any sign for panic over unproven conditions, Jeremy?" Jeremy Cole was the on-site reporter, who the feed switched to, the hospital in the background full of activity from police standing watch, to people showing up to mill around as they often do. "That's right, Grace, the only details being released in surety, so far, point to the victims being discovered within our local favorite, Mt. Loyal University. They began arriving as early as 2 this morning, and the scenes have been under careful scrutiny. Whether or not these are scattered cases of extreme fatigue, or the beginnings of another infection sweeping the country is still no one's guess to make. Jeremy Cole, reporting live in Calgary, BCB News." "Thank you, Cole, we intend to keep this story updated as the facts are confirmed. Follow the progress on Flitter at--" Kari backed out of the video feed, thinking on the details that took place in the classroom yesterday, and of her gruff teacher. 'He wouldn't just succumb to weariness just like that, he would've gone to the teacher's lounge and caught a nap like he does,' she thought, getting up to pace a little, 'which means it was a sneak attack, practically untraceable, and enacted on the state of being for-" Her eyes widened again as she came to a stop, putting together some details towards a possible answer. Who was a restless-looking passerby that was headed in the direction of chemicals, many of which can be used to trigger invisible manners of attack? Who was passing the scene of the incident and looking particularly smug about something? Who smelled of sharp ethanol that could've been a fumigation bomb scent? "It was HIM!" she squawked suddenly, looking around as if a timebomb had just begun to countdown, hurrying over to get her shoes and jacket on, along with the standard wallet-phone-keys trifecta being pocketed. If anything, classes would be off or postponed during this weirdness, but she'd call on the drive over just to make sure. 'He's either here to steal some expensive artifacts, or... looking for someone, and either way doesn't look good.' She thought as she got onto the road to town, rolling her window down to catch the fresh, cold air of the morning.
The small lifeform had been moving around through the garden all day before heading towards a number of weird smells nearby. A long soil path led to a burnished wooden door, which the creature easily walked under. Within was a rainbow of enticing scents, and its sensors went wild probing all over the place to find small specks of food to chew up. Gradually, it found its way up to a huge, breathing creature of some kind, heaped in a pile in the corner of the chamber. The climb all over its body was an interesting journey for the intruder, but when it stepped onto an expanse lighter gray, the giant tensed up and awoke, turning its colossal head to slowly open huge eyes like golden boulders. It froze under this monstrous gaze, trying to look uninteresting, but a huge pair of digits picked it up, and its fate was sealed as it waited for the end.
"Hey, no visitors at this hour." said Tom, licking the small beetle off his finger to munch it up and lay back down, trying to let the blessed sleep come back, but he'd looked at his phone and seen the time, too late now. With a long exhale, he got up and began looking for a clean shirt, coming up empty except for the shirt he had on, so the day's errand was clear. "Well, thank god the plants don't have any clothes to take care of, I gotta feed them and see to their good health already." he said brightly, secretly picturing what the main garden would look like with the garden-life all sporting tiny sweaters and hats with a grin. A large knapsack was full of his clothes, the shirt and Jacket from yesterday were on, his shoes were worn, and he was carefully out back into the world, locking the Door behind him with the finesse of a safecracker. He put on some earbuds and began walking towards the main street, knowing he'd seen a laundromat there the day before. It felt like a good day to get something done; the weather was the pleasant side of chilly on the cloudless day, and folks seemed to be out walking the main street. Tom was in a rather good mood, also knowing of the beers in the knapsack to help the early afternoon chore along. And so, there he was 20 minutes later at 24 Laveuse, beginning the large load of laundry and setting back on the plastic seats, moving his tail so he didn't squash it. The place was a little empty and the small fenced area on one side of the parking lot made for good hiding, so he stepped outside to carefully get down to libations to pass the time. Traffic came and went like it usually did, one car taking the nearby right turn kind of harshly but otherwise nothing else of notice. There was a wandering guy with the air of a bum about him, sort of haunting the crossroads, and Tom privately hoped he would carry on before attracting police. Strangely enough, another short parade of cars was going thru the town, looking like a gangsta's funeral procession. Tom stared vacantly until they were gone, and he was starting to wonder just what this town's deal was. It was at this moment that the hands emerged silently from behind and seized his arms tightly, hauling him back with sudden urgency before he could panic properly. "What the fuck?! You wanna... god, wha-?" he barked, only to be hauled back harder into the side alley by the building, and out of sight. "Careful, dammit, there's a beverage here-" The tall can was smacked out of his hand. "Hey! what's your damage, guy?" Tom demanded as he was turned around roughly, only to meet those same blue eyes and red hair from yesterday. "Oh, wait, it's you fro--" Kari got her best threat display face on and poked a claw to the underside of his chin, which managed to inescapably encourage his silence."Now, answers, spill 'em, what were you really up to yesterday?" she now demanded. "I don't know what you're talking about, I was just looking for my friend to return a phone charger." "You didn't say that." "You didn't ask." he replied mildly, averting his gaze in a condescending manner. Kari growled in her throat and tightened her grip on his shoulders. "Watch it, wise-ass. Did you see or hear anything before the disturbance yesterday?" "What disturbance, I was already on my way when people found him." Her face went almost sideways in an accusative scowl. "Don't play dumb, I saw your ass drifting thru that crowd, and you saw me looking at you, captain salute." Tom's face contorted in regret. "You saw that, huh." "Yeah, I did." she grunted before slamming him roughly to the wall and releasing him. Tom looked as angry as he could without looking confrontational; something about her strength and methods did not point to a fight with any outcome but a grievous loss on his side. "Alright," he said, stepping back one step to opt for a cigarette from his fresh pack and turning from her to light it, "So I was near the scene, what else have you got?" Her angered look softened a micrometer and she took a few steps, mostly to get away from the rich smoke. "The guy from yesterday, the unconscious one? He was a good man, good teacher, and now his life might be in danger. You were at least in the hallway over there, did you see or hear anything that'd help out with finding the culprit?" "Help out?" he said, plucking the cig from his lips, "Look, Ms. Conrad, I-" "Conniff." "Whatever! I was just passing thru and it just felt like you got stuck having to deal with the cops, alright? It was rude to snark you, I apologize, I thought you were just in trouble or something. Apart from my friend, there wasn't really anybody on that side of the building that wasn't behind doors." Kari looked him over, trying to get a read on his intentions, and he seemed to notice this with disdain. "What's your deal anyways, apple-polisher, you some sort of local hero or something?" Tom continued, dragging on the smoke while shooting her a look. She frowned this time, an expression without anger that was a different face entirely. "He's a friend of mine, one of the few I have. You would do the same if it was someone you cared about, wouldn't you?" Tom almost answered honestly, but he was too mad to focus on polite truths. "No, I wouldn't, and I don't think you would either." he snapped, "I'm a pragmatist, number one's the only thing I came into this world worried with, and it's the only number I'll need." "Wow, okay, I thought you were just a sneaky guy before, but now I can see you're just an asshole." "And so are you, Ms. Confit, and I can't stand people that pretend to care." "Who's pretending? Frankly, *I* can't stand little shits like you who think their lousy life is free license to take everybody down with them." Tom was really mad now, and was almost considering lighting the fire in this fulminating argument, but he just sneered and flicked his cigarette ahead, stepping bitterly on it as he left. "You don't have anything I need, nor do I have anything you need, we're even. Now leave me alone, will you?" Kari wanted to kick his ass so badly in that fury-soaked moment. "I don't think anyone needs anything you've got, Mr. Blackberry, least of all YOU.. and it's CONNIFF, you son of a bitch!" she snarled at the retreating raccoon. "Actually, I can think of something I need from someone." he said, turning suddenly. "Yeah, and what's that, a chemical shower?" "No, you owe me a beer, kitty cat!" They were easily half a foot from each other now, staring daggers into daggers. The snow leopard spat harshly on the ground and left in a weaponized huff, tail twitching madly behind her. Tom felt the heat in his ears still peaking. "I better not see you again, or it'll be too soon!" he called after her, "And I smell bad because of my dirty laundry I carried, not because- well, I meant to put this shirt in with.. ohhhh, god DAMMIT!" and he kicked at the wall of the building before stomping back to check his clothes. "Bitch..." he muttered, trying to leave the incident behind.

When I stopped calling myself an "addict", I stopped acting like an "addict". It was the most empowering and life-saving move I ever made. As a clinician, the first thing I do with my clients is help them to develop a robust positive identity and make sure they understand they are not an "addict" first and foremost.
Here's an excerpt from an important article (link at bottom) that illustrates why the term "addict" is on its' way out the door in the medical and clinical communities:
"Why calling someone an addict is harmful
“Drug and alcohol addiction was historically considered a moral failing, demonstrating a weakness of character,” explains Dictionary.com Lexicographer Heather Bonikowski. “This disparaging connotation persists in the nouns addict and alcoholic, in spite of our evolving modern understanding of the problem.”
Bonikowski specifically notes alcoholic for reason. She led the implementation of our changes to addict in parallel with revisions to the sometimes offensive noun alcoholic, which we now define as “a person with alcoholism or alcohol use disorder; a person addicted to intoxicating drinks.”
From disparaging slang and informal expressions to technical terms, English has many words for people who—while they may not have alcohol use disorder, another new entry in our dictionary—are habitual drinkers of alcohol. Words used for these people, like lush or dipsomaniac, have been historically glossed using the noun alcoholic; we revised our definitions of these terms to be in line with whole-person language.
Using words like addict to refer to people has become increasingly stigmatizing, Jess Keefe, a Senior Editor with Shatterproof, tells Dictionary.com. Shatterproof is a national nonprofit focused on educating the public on the disease of addiction.
“There’s a lot of disdain for the people we call addicts,” Keefe says, “It’s the only medical condition where you’re criminalized for what your body does.”
That’s what the noun addict has come to connote to most English speakers: “criminal,” “problem.” And to the people who are facing addiction, hearing themselves described as nothing more than an addict can be extremely dehumanizing.
“You start to believe it; you start to internalize it,” Keefe says. “If people don’t believe they can get better, they won’t.”
Changing societal perception of substance-use disorders means changing the language surrounding the topic of addiction, and as the updates to Dictionary.com show, that’s happening.
How doctors helped drive dictionary changes
Providing insight into the complex nature of addiction, Bonikowski explains: “Addiction is the complicated result of genetic predisposition intersecting with dysfunctional behavior, neurochemical modification, environmental factors, and social influences. Many major medical associations treat addiction as a disease, in part because it is a chronic condition that is demonstrably present in a person’s neurophysiology.”
Dictionary.com’s updates reflect the change in language surrounding addiction has been led in large part by medical practitioners. In 2013, the American Psychiatric Association published its Diagnostic and Statistical Manual of Mental Disorders(DSM–5) with new language that removed the words abuse and dependence in relation to addictive (and often illegal) substances.
In 2017, the director of the federal Office of National Drug Control Policy directed all federal agencies to adjust both internal and external communications to language that adheres to the DSM-5. Organizations from the American Medical Association to the American Society of Addiction Medicine have made similar calls to their membership to adopt non-stigmatizing language for all communications (written and spoken) about addiction"
https://www.dictionary.com/e/whats-wrong-with-the-word-addict-video/

I was diagnosed with autism 14 dec 2021 by the nhs and they referred me for an adhd appointment. Was told likely 3 year wait so been waiting since
A mental health nurse I see helped me with a right to choose form for psychiatry UK and according to nhs app my GP received it on 2nd March 2023
I asked for a follow up last week and they said they would chase it because whichever gp is dealing with it hasn’t yet. Is this normal? Still waiting after 12 weeks for them to refer me with right to choose?
Honestly debating sucking it up and going with adhd 360 privately because my life is becoming unbearable and I don’t know if I can cope with the waiting. And then more waiting for medication / titration too. I know there’s a bit of a stigma with the documentary already but tbh I get barely anything through the GP anyway and never have. I already got accepted through the adhd 360 screening a few months ago when I signed up