Panic Attacks and School

Panic Attacks and School

In our society people do not discuss mental health and it is something people feel embarrassed about. They also feel shame if they have mental health issues or if they go to a psychotherapist. However, school and college are starting very soon and school can trigger emotional issues for many adolescents.

While we have this negative stigma about mental health, teenagers worry about it a great deal. Especially since 1 out of 5 teenagers deal with mental health issue. As a psychotherapist who treats teenagers, I see a large number of teens for panic attacks especially boys. I believe teenage boys are more prone to anxiety attacks because of the stereotype that boys don’t cry and they see emotions as weak. However, in our society men do cry and have emotional problems. Emotions are not a sign of weakness for men and boys. The documentary, “The Mask You Live In,” address this issue that men and boys face. I recently read an article by the basketball player, Kevin Love, which addresses this issue and explains how it impacts men and boys. I have included what he wrote so you can understand what men and boys face in our society.

On November 5th, right after halftime against the Hawks, I had a panic attack.

It came out of nowhere. I’d never had one before. I didn’t even know if they were real. But it was real — as real as a broken hand or a sprained ankle. Since that day, almost everything about the way I think about my mental health has changed.

“I DID ONE SEEMINGLY LITTLE THING THAT TURNED OUT TO BE A BIG THING.”

Kevin Love discusses his decision to seek help after suffering from a panic attack. (0:54)

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I’ve never been comfortable sharing much about myself. I turned 29 in September and for pretty much 29 years of my life I have been protective about anything and everything in my inner life. I was comfortable talking about basketball — but that came natural. It was much harder to share personal stuff, and looking back now I know I could have really benefited from having someone to talk to over the years. But I didn’t share — not to my family, not to my best friends, not in public. Today, I’ve realized I need to change that. I want to share some of my thoughts about my panic attack and what’s happened since. If you’re suffering silently like I was, then you know how it can feel like nobody really gets it. Partly, I want to do it for me, but mostly, I want to do it because people don’t talk about mental health enough. And men and boys are probably the farthest behind.

I know it from experience. Growing up, you figure out really quickly how a boy is supposed to act. You learn what it takes to “be a man.” It’s like a playbook: Be strong. Don’t talk about your feelings. Get through it on your own. So for 29 years of my life, I followed that playbook. And look, I’m probably not telling you anything new here. These values about men and toughness are so ordinary that they’re everywhere … and invisible at the same time, surrounding us like air or water. They’re a lot like depression or anxiety in that way.

So for 29 years, I thought about mental health as someone else’s problem. Sure, I knew on some level that some people benefited from asking for help or opening up. I just never thought it was for me. To me, it was form of weakness that could derail my success in sports or make me seem weird or different.

PHOTO BY CHRISTIAN PETERSEN/GETTY IMAGES

Then came the panic attack.

It happened during a game.

It was November 5th, two months and three days after I turned 29. We were at home against the Hawks — 10th game of the season. A perfect storm of things was about to collide. I was stressed about issues I’d been having with my family. I wasn’t sleeping well. On the court, I think the expectations for the season, combined with our 4–5 start, were weighing on me.

I knew something was wrong almost right after tip-off.

I was winded within the first few possessions. That was strange. And my game was just off. I played 15 minutes of the first half and made one basket and two free throws.

After halftime, it all hit the fan. Coach Lue called a timeout in the third quarter. When I got to the bench, I felt my heart racing faster than usual. Then I was having trouble catching my breath. It’s hard to describe, but everything was spinning, like my brain was trying to climb out of my head. The air felt thick and heavy. My mouth was like chalk. I remember our assistant coach yelling something about a defensive set. I nodded, but I didn’t hear much of what he said. By that point, I was freaking out. When I got up to walk out of the huddle, I knew I couldn’t reenter the game — like, literally couldn’t do it physically.

Coach Lue came up to me. I think he could sense something was wrong. I blurted something like, “I’ll be right back,” and I ran back to the locker room. I was running from room to room, like I was looking for something I couldn’t find. Really I was just hoping my heart would stop racing. It was like my body was trying to say to me, You’re about to die. I ended up on the floor in the training room, lying on my back, trying to get enough air to breathe.

The next part was a blur. Someone from the Cavs accompanied me to the Cleveland Clinic. They ran a bunch of tests. Everything seemed to check out, which was a relief. But I remember leaving the hospital thinking, Wait … then what the hell just happened?

PHOTO BY JED JACOBSOHN/THE PLAYERS’ TRIBUNE

I was back for our next game against the Bucks two days later. We won, and I had 32. I remember how relieved I was to be back on the court and feeling more like myself. But I distinctly remember being more relieved than anything that nobody had found out why I had left the game against Atlanta. A few people in the organization knew, sure, but most people didn’t and no one had written about it.

A few more days passed. Things were going great on the court, but something was weighing on me.

Why was I so concerned with people finding out?

It was a wake-up call, that moment. I’d thought the hardest part was over after I had the panic attack. It was the opposite. Now I was left wondering why it happened — and why I didn’t want to talk about it.

Call it a stigma or call it fear or insecurity — you can call it a number of things — but what I was worried about wasn’t just my own inner struggles but how difficult it was to talk about them. I didn’t want people to perceive me as somehow less reliable as a teammate, and it all went back to the playbook I’d learned growing up.

This was new territory for me, and it was pretty confusing. But I was certain about one thing: I couldn’t bury what had happened and try to move forward. As much as part of me wanted to, I couldn’t allow myself to dismiss the panic attack and everything underneath it. I didn’t want to have to deal with everything sometime in the future, when it might be worse. I knew that much.

So I did one seemingly little thing that turned out to be a big thing. The Cavs helped me find a therapist, and I set up an appointment. I gotta stop right here and just say: I’m the last person who’d have thought I’d be seeing a therapist. I remember when I was two or three years into the league, a friend asked me why NBA players didn’t see therapists. I scoffed at the idea. No way any of us is gonna talk to someone. I was 20 or 21 years old, and I’d grown up around basketball. And on basketball teams? Nobody talked about what they were struggling with on the inside. I remember thinking, What are my problems? I’m healthy. I play basketball for a living. What do I have to worry about? I’d never heard of any pro athlete talking about mental health, and I didn’t want to be the only one. I didn’t want to look weak. Honestly, I just didn’t think I needed it. It’s like the playbook said — figure it out on your own, like everyone else around me always had.

PHOTO BY JEFF HAYNES/NBAE/GETTY IMAGES

But it’s kind of strange when you think about it. In the NBA, you have trained professionals to fine-tune your life in so many areas. Coaches, trainers and nutritionists have had a presence in my life for years. But none of those people could help me in the way I needed when I was lying on the floor struggling to breathe.

Still, I went to my first appointment with the therapist with some skepticism. I had one foot out the door. But he surprised me. For one thing, basketball wasn’t the main focus. He had a sense that the NBA wasn’t the main reason I was there that day, which turned out to be refreshing. Instead, we talked about a range of non-basketball things, and I realized how many issues come from places that you may not realize until you really look into them. I think it’s easy to assume we know ourselves, but once you peel back the layers it’s amazing how much there is to still discover.

A message from Kevin Love’s Grandma

“HAPPY BIRTHDAY, KEVIN.”

Kevin’s grandmother records a greeting for his 25th birthday in 2013. (0:33)

Since then, we’ve met up whenever I was back in town, probably a few times each month. One of the biggest breakthroughs happened one day in December when we got to talking about my Grandma Carol. She was the pillar of our family. Growing up, she lived with us, and in a lot of ways she was like another parent to me and my brother and sister. She was the woman who had a shrine to each of her grandkids in her room — pictures, awards, letters pinned up on the wall. And she was someone with simple values that I admired. It was funny, I once gave her a random pair of new Nikes, and she was so blown away that she called me to say thank you a handful of times over the year that followed.

When I made the NBA, she was getting older, and I didn’t see her as often as I used to. During my sixth year with the T-Wolves, Grandma Carol made plans to visit me in Minnesota for Thanksgiving. Then right before the trip, she was hospitalized for an issue with her arteries. She had to cancel her trip. Then her condition got worse quickly, and she fell into a coma. A few days later, she was gone.

I was devastated for a long time. But I hadn’t really ever talked about it. Telling a stranger about my grandma made me see how much pain it was still causing me. Digging into it, I realized that what hurt most was not being able to say a proper goodbye. I’d never had a chance to really grieve, and I felt terrible that I hadn’t been in better touch with her in her last years. But I had buried those emotions since her passing and said to myself, I have to focus on basketball. I’ll deal with it later. Be a man.

The reason I’m telling you about my grandma isn’t really even about her. I still miss her a ton and I’m probably still grieving in a way, but I wanted to share that story because of how eye-opening it was to talk about it. In the short time I’ve been meeting with the therapist, I’ve seen the power of saying things out loud in a setting like that. And it’s not some magical process. It’s terrifying and awkward and hard, at least in my experience so far. I know you don’t just get rid of problems by talking about them, but I’ve learned that over time maybe you can better understand them and make them more manageable. Look, I’m not saying, Everyone go see a therapist. The biggest lesson for me since November wasn’t about a therapist — it was about confronting the fact that I needed help.

PHOTO BY BRANDON DILL/AP IMAGES

One of the reasons I wanted to write this comes from reading DeMar’s comments last week about depression. I’ve played against DeMar for years, but I never could’ve guessed that he was struggling with anything. It really makes you think about how we are all walking around with experiences and struggles — all kinds of things — and we sometimes think we’re the only ones going through them. The reality is that we probably have a lot in common with what our friends and colleagues and neighbors are dealing with. So I’m not saying everyone should share all their deepest secrets — not everything should be public and it’s every person’s choice. But creating a better environment for talking about mental health … that’s where we need to get to.

Because just by sharing what he shared, DeMar probably helped some people — and maybe a lot more people than we know — feel like they aren’t crazy or weird to be struggling with depression. His comments helped take some power away from that stigma, and I think that’s where the hope is.

I want to make it clear that I don’t have things figured out about all of this. I’m just starting to do the hard work of getting to know myself. For 29 years, I avoided that. Now, I’m trying to be truthful with myself. I’m trying to be good to the people in my life. I’m trying to face the uncomfortable stuff in life while also enjoying, and being grateful for, the good stuff. I’m trying to embrace it all, the good, bad and ugly.

I want to end with something I’m trying to remind myself about these days: Everyone is going through something that we can’t see.

I want to write that again: Everyone is going through something that we can’t see.

The thing is, because we can’t see it, we don’t know who’s going through what and we don’t know when and we don’t always know why. Mental health is an invisible thing, but it touches all of us at some point or another. It’s part of life. Like DeMar said, “You never know what that person is going through.”

Mental health isn’t just an athlete thing. What you do for a living doesn’t have to define who you are. This is an everyone thing. No matter what our circumstances, we’re all carrying around things that hurt — and they can hurt us if we keep them buried inside. Not talking about our inner lives robs us of really getting to know ourselves and robs us of the chance to reach out to others in need. So if you’re reading this and you’re having a hard time, no matter how big or small it seems to you, I want to remind you that you’re not weird or different for sharing what you’re going through.

Just the opposite. It could be the most important thing you do. It was for me.

Dr. Michael Rubino is a psychotherapist with over 20 years of experience treating teenagers and children. For more information about Dr. Rubino’s work or private practice visit his website www.RubinoCounseling.com or follow him on Twitter @RubinoTherapy.

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The Impact of Domestic Violence on Children

The Impact of Domestic Violence on Children

Hear how domestic violence impacts children as they grow up. Some learn lessons how not to act but unfortunately many learn to repeat it. We need to educate boys and girls about domestic violence if we want to end it https://www.linkedin.com/feed/update/urn:li:activity:6433836921314689024

A New School Year and New Drugs

A New School Year and New Drugs

Over the next few weeks, students will be starting high school and middle school. Many parents are concerned about the challenges their children will experience in these environments. A common one is peer pressure and drugs. As a psychotherapist who treats teenagers, I hear about what is going on with teenagers and what they are doing. I have been hearing from many teens about new designer drugs they are taking. Many people assume teenagers are primarily using marijuana. However, teenagers are looking for new drugs and ways to modify how they use marijuana. These new drugs can be very dangerous, even deadly. However, many teenagers are not aware of the dangers and risks they are taking.

As summer ends many teens will want to get in one more party. As school resumes for many teenagers this means partying with old and new friends. Drugs are often part of these parties. One major problem facing teens is the fact that many Emergency Room physicians cannot keep up with all the new drugs teenagers are using. Therefore, if a teenager ends up in the Emergency Room due to overdosing or having a bad reaction to one of these new drugs, a teenager may die before an Emergency Room physician determines what the teenager took and how to treat it. The show The Good Doctor recently had an episode which addressed this issue. The teen had used, Molly, not a new drug but because there were so many options, the teenager almost died before they could determine how to treat him.

Recently I read an article by Angela Chen. The article discusses these new dangerous drugs and how deadly these drugs can be. I have included her article below so parents can be aware of the dangers facing their teenagers. Hopefully, parents will also take this opportunity to discuss this issue with their teenagers.

On a July day a little over a year ago, over 30 people collapsed on a street in Brooklyn. They lay on the ground, vomiting down their shirts, twitching and blank-faced. Some, half-naked, made jerking movements with their arms, eyes rolled back. Others groaned and clutched onto fire hydrants to try to stay upright. Witnesses said the scene was like The Walking Dead. Headlines claimed that people had turned into “zombies,” while police said that the 33 affected were lucky to be alive.

All had smoked an “herbal incense” product called AK-47 24 Karat Gold. Eighteen people were sent to the hospital by ambulance. The situation had all the signs of a drug overdose, and so doctors ordered the usual tests: blood count, urine analysis, heart rate monitoring.

The first patient tested was a 28-year-old man who was slow to respond, but otherwise showed few clear signs of trauma. Heart sounds: normal. Blood count: normal. His lungs were clear and there were no major neurological problems, no excessive sweating or skin lesions. He tested negative for opiates, cocaine, amphetamines. Nothing came up.

The case went to the Department of Homeland Security and the Drug Enforcement Agency. They knew who to call to get a second opinion. They packed blood and urine samples on dry ice and shipped them to a small lab 3,000 miles away in San Francisco, run by toxicologist Roy Gerona. If anyone in the country could figure out what was in 24 Karat Gold, it would be him.

Forty years ago, drugs had easy names: cocaine, meth, heroin. Today, the names can read like an ingredients list for a chemistry class: 5F-AMB, PX-2, MDMB-CHMINACA. Today’s designer drugs are made by synthesizing chemicals and hoping they give you a high that’s strong enough to be worth it, but not strong enough to send you to the hospital.

Designer drugs are volatile. If you tweak just one molecule, you can get an entirely differently substance, one you hadn’t bargained for. They’re also easy to get. There’s no shortage of “research chemicals” vendors on the dark web are willing to sell. And they’re growing more popular. These so-called “novel psychoactive substances” entered the mainstream in 2009. That year, according to the United Nations Office on Drug and Crime, there were about 100 of these substances reported; six years later, there were nearly 500. Because designer drugs don’t show up on traditional drug tests, they’re hard to track and identify. It’s a public health problem that requires a special set of skills to handle.

One of the most prominent categories of designer drugs are those intended to mimic marijuana, called synthetic cannabinoids. Marijuana, or cannabis, is widely considered one of the safest drugs, but synthetic cannabinoids are some of the most dangerous synthetic drugs. The Global Drug Survey (GDS) found that last year, for the fourth year running, the risk of seeking emergency medical treatment was higher after using synthetic weed than for any other drug.

When you smoke a regular joint, a chemical called tetrahydrocannabinol (THC) travels through your blood. It binds with receptors called CB1 and CB2. Because of the structure, there’s “kind of a limit on how stoned you can get,” says Adam Winstock, a London-based psychiatrist who administers the GDS. If you’re smoking a popular cannabinoid like K2 Spice, a chemical travels through your blood, but this time, it’s not THC. It’s something else that also binds with CB1 and CB2 — but unlike with regular weed, we don’t know exactly how these chemicals bind, especially when they’re illicit drugs from the black market. This mystery makes synthetic marijuana likely to lead to “much more extreme responses,” like seizures and psychosis, according to Winstock.

Synthetic cannabinoids originated in a quest to create a better pain medication. A Clemson University chemist named John W. Huffman synthesized hundreds of compounds in an attempt to find a better painkiller, but often created incredibly psychoactive substances with no medicinal properties at all. When he published the results of these compounds — called JWH compounds, after his initials — he made the information available to be copied.

There are more than 300 JWH compounds alone, and around 2004, labs in China began studying old research papers, synthesizing the compounds and distributing them as “herbal incense” products. K2 Spice itself — often partly based off the JWH-018 compound — started in China, became popular in Germany around 2008, and entered the US around 2009.

Labs can also turn to the expired patents — patents that are rich fodder, even if (or perhaps because) there was a good reason said drugs never made it to market. It’s nearly impossible to figure out how to shut down the overseas labs producing these drugs. As soon as you ban one substance, the labs move on to another.

Gerona, a toxicologist with gray hair styled in an undercut, was the one who received the biological samples from the DEA. From a small lab in the Medical Sciences Building at the University of California, San Francisco, Gerona says he and his team are playing a “cat and mouse game” with illicit international drug manufacturers. When an overdose happens, Gerona’s team tries to identify the drug in question — often synthetic substances no one has seen before. But the lab goes one further: Gerona’s lab attempts to identify and classify these substances before the mass overdoses even happen.

Inside, the lab is meticulously neat: rows of spotless tables are covered in bottles with orange rubber caps, all labeled with orange duct tape, and small gray centrifuges. A window overlooking a courtyard has molecular structures scribbled over it in pink and green marker. Near the door sits an enormous freezer, filled with thousands of brightly colored, frost-covered boxes of drug samples kept at -112 degrees Fahrenheit.

Gerona launched his toxicology lab in 2010, in partnership with the San Francisco Poison Control Center. The date wasn’t a coincidence; he says that 2010 was the year that a designer drug called “bath salts” began flooding the market. “Bath salts” is a blanket term for a group of designer drugs made from stimulants; they create a euphoric high like MDMA, sometimes with hallucinations thrown in. The drugs usually come in powdered and capsule form, and can cause freak-outs that were well-documented on YouTube at the time. The most famous of these was a viral story of a 31-year-old Miami resident attacking and then eating a homeless man. (Scientists dispute the drugs’ role.)

For users and the DEA, the spike in bath salts use was a nightmare. For Gerona, the increased interest in designer drugs led to more work and more samples from around the country. Eventually, the lab caught the notice of both Michael Schwartz, a toxicologist at the Centers for Disease Control and Prevention, and DEA pharmacologist Jordan Trecki. A collaboration between Gerona’s lab and the DEA was formed. (Neither the DEA nor the CDC responded to repeated requests for comment.)

The first step in doing an analysis at Gerona’s lab is getting the sample — urine, blood or, rarely, a tiny bit of drug itself — shipped over on dry ice. In traditional drug testing, you check to see if the sample matches any of the known substances: marijuana, heroin, cocaine, and so on. They match, or they don’t. Designer drugs, almost by definition, are made of chemical combinations we haven’t seen before. They almost never match traditional databases, and the chemists often don’t know what they’re looking for. So Gerona’s lab gathers as much information about the substance as possible.

A tiny vial of the biological sample — usually plasma, the colorless part of blood — goes into a bulky, printer-like machine. That machine is called a liquid chromatography mass spectrometer, and very crudely put, it separates out all the different parts of the plasma by mass. (Think of it like an extremely sensitive centrifuge.) That process makes it easier to identify chemicals, and the mass spectrometer then spits out the different measurements in a computer chart with peaks and valleys called a chromatogram.

Then, says Axel Adams, a graduate student in Gerona’s lab, you turn to the so-called “prophetic library.”

“ RESEARCHES LOOK FOR POSTS ABOUT DRUGS ON SUBREDDITS LIKE R/RESEARCHCHEMICALS

Gerona’s “prophetic library,” about three years in the making, is a detailed catalog of already synthesized variants that his team believes is going to be the next big street drug. The library was made possible with the help of Samuel Banister, a synthetic chemist at Stanford University. Banister synthesizes variants of popular street drugs and takes down their chemical information to create “reference standards.” Synthesizing can take anywhere from a few days to a couple of weeks; the lab now has almost 150 variants on file. It’s a side job for Banister, but at one point, he says, “I was pumping out five to 10 a week.” The final products look like white crystalline solids and are kept in drawers in the lab, ready for when a case like AK-47 24 Karat Gold comes along.

In addition, lab members spend hours each week on drug forums, researching trends. It’s more of an art than a science. Researches look for posts about drugs on subreddits like r/researchchemicals. They reference surveys like the Global Drug Survey and survey “trip reports” from experiential documentation sites like Erowid and PsychonautWiki.

They look for terms like synthetic pot, K2, Spice, and sometimes, scientific terms like “cannabinoids,” or a specific popular class of cannabinoids, like “FUBINACA” or “JWH compounds.” Often, the posts themselves will include the name of the chemical. Gerona has ordered drugs off the dark web. In one case, the invoice billed him for “cosmetics,” and the package included lipstick, fake eyelashes, and tabs labeled “powder.” The “powder,” unsurprisingly, turned out to be drugs. But most of the time, the drugs in the powder were not the drug that was ordered.

“ THE INVOICE BILLED HIM FOR “COSMETICS,” AND THE PACKAGE INCLUDED LIPSTICK, FAKE EYELASHES, AND TABS LABELED “POWDER”

If there is a match because the compound is already in the library, finding the right variant is “only going to take 15 minutes,” says Gerona. “Otherwise, it could take a week, or it could not be solved.”

Adams checked the results of a blood sample tied to AK-47 24 Karat Gold against the prophetic library. The computer pulled up a chart that indicated a line — jagged, up and down — that shows the mass of the components of AK-47 24 Karat Gold, versus the same information for AMB-FUBINACA.

Drugs don’t pass through the body untouched. Once they’re ingested, the body processes the compounds. So by the time they’re in the blood or urine, it’s not exactly the same compound as the drug that was ingested. It’s hard enough to find a reference standard for the original compound; it’s even more difficult to find a reference standard for the possible variants. In the case of AMB-FUBINACA, the chemical in the biological sample from Brooklyn wasn’t the parent compound. It was a derivative. Luckily, Banister had already synthesized that variant, too.

The peaks and valleys of the two lines of AK-47 24 Karat Gold and AMB-FUBINACA matched up precisely. It took the team only seven days to identify the substance in the Brooklyn case — and most of that time was spent waiting for the sample to get there.

Gerona’s lab has worked on cases across the country, from New York City to Sacramento to Colorado. The number of cases varies. Sometimes, they’ll get 15 to 25 samples a month. One Mississippi case involving synthetic cannabinoids resulted in over 400 samples. The average turnaround on results is about six months, says Adams. That’s not good enough for Gerona.

And it’s not likely that the problem will go away. Marijuana legalization advocates claim that people will stop with the synthetic stuff once the real thing is okay. But that’s not true in the experience of Andrew Monte, a clinical toxicologist at the University of Colorado School of Medicine who collaborates with Gerona’s lab. Recreational marijuana is legal in Colorado, but he sees patients who are on these synthetic compounds anyway. Monte’s team has surveyed people who come into the ER and even set up at music festivals to ask attendees questions. Synthetic drug users are “taking it for a different reason, to get a different high,” Monte says. “They’re really looking for something different than what pot gives, the same way you might choose cocaine over pot or meth over pot.”

“ ONE MISSISSIPPI CASE INVOLVING SYNTHETIC CANNABINOIDS RESULTED IN OVER 400 SAMPLES

To help address this problem, in 2016 Gerona started a new research consortium called P SCAN, or the Psychoactive Surveillance Consortium and Analysis Network. (Yes, the double entendre is intended.) They’re working with about 10 poison control centers in places like Kansas and Colorado. They’ve had more than 100 cases referred to them and are writing up case reports and manuscripts. (The 24 Karat Gold case was published by the New England Journal of Medicine.)

P SCAN will continue to do the surveillance work Gerona has been doing for years, but also create a database of clinical data connected to the specific synthetic drugs they track and discover. Think of it like a medical version of Erowid. This way, the next time there’s an outbreak like the one in Brooklyn, investigators and researchers can look at specific physical indicators (heart rate, respiratory information, neurological information, and more) and say, “Ah, this matches the symptoms of AMB-FUBINACA” — all without shipping samples across the country.

But even with P SCAN and the prophetic library, the task is huge. “The identity of a lab needs to constantly expand and rework in order for it to stay relevant,” says Gerona.

Gerona is a biochemist by training. Before launching his lab, he didn’t know anything about Spice, or AK-47 Gold, or the dark net. But now, Gerona says, “I have no other choice but to really learn about it, so that I am relevant and retain my relevance in the field.” He’s hoping to work with people in technology to automate this “market research” to glean new insights and make the prediction process even faster. “It would be so great if we could predict the drugs coming in with more accuracy, instead of after people are hurt,” he says.

Weeding out designer drugs is a Sisyphean task, Gerona admits. It may be impossible to shut down the overseas labs, but he wants to have even better methods for predicting what’s going to get big and then, instantly identifying the substances. He compares the endless drug variations to nature: the cold virus is still around because it changes all the time. HIV has never been cured because it continues mutating. “In a sense, they’re reinventing themselves all the time, so reinvention is key to persistence. As long as you’re reinventing yourself, you can persist.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating teenagers. He treats teenagers with drug issues and has seen many end up in the Emergency Room because teenagers think they are the experts. For more information about Dr. Rubino’s work or his private practice visit his website www.RubinoCounseling.com or his Facebook page http://www.Facebook.com/Drrubino3.

What Parents Need to Know About ADHD and Schools

What Parents Need to Know About ADHD and Schools

School is starting very soon and many parents are worrying about the upcoming school year. They are concerned will there be the same struggles with homework and will the teacher be reporting that their child does not pay attention in class and my have attention hyperactivity disorder (ADHD). I hear this very often from parents and do many assessments on children to determine if a child has ADHD. Yes ADHD is a really disorder, but too many teachers and schools rush to the conclusion that a child has ADHD and needs medication.

According to statistics by the American Psychological Association, five percent of children in the United States have ADHD. It is also more common in males and it does tend to run in families. However, not every child who has ADHD requires medication. Many children can be treated with psychotherapy and behavior modification. Therefore, if your child is diagnosed with ADHD do not rush to medicate your child. There are different subtypes of ADHD and different severities of the diagnosis.

If you child does have ADHD, they are entitled to accommodations such as extra time taking a test. This would be covered by a 504 plan. However, if your child has severe ADHD and needs resource assistance too, they are entitled to an Individual Educational Plan (IEP). Many schools may tell parents ADHD does not qualify for an IEP. This is not true. The severity of the ADHD determines if a child needs an IEP. They would qualify under the categories of Emotional Disturbance or Other Health Impairments.

If you feel your child may have ADHD or their school suggests the idea, make sure you have your child appropriately assessed by a professional who specializes in ADHD. In the past schools would often diagnosis children with ADHD. Schools are no longer supposed to make this diagnosis. If they feel a child might have ADHD, they are supposed to have your child evaluated. Many parents take their child to their pediatrician, however, many pediatricians are not trained in diagnosing ADHD. I would suggest having your child evaluated by a mental health clinician trained in working with children and in assessing for ADHD.

As I stated above, if you are going to have your child evaluated for ADHD, make sure you take your child to a mental health clinician who specializes in children and in doing assessments. The assessment for ADHD is not very difficult and an appropriate evaluation by an appropriate mental health clinician should cost around $250 depending on where you live. I have seen some parents who have spent thousands of dollars getting CT scans, MRIs and PET scans. You do not need an expensive scan of your child’s brian to diagnosis ADHD.

The DSM V, the diagnostic manual that mental health clinicians use, list the criteria needed for the diagnosis. I am including a link to the Center for Disease Control which list the criteria for the diagnosis and other information about ADHD, http://www.cdc.gov/ncbddd/adhd/diagnosis.html. Typically the diagnosis can be made by a clinician interviewing the parents, having a play session or two with the child and observing the child at school or consulting with the teachers. However, remember if you are going to have your child evaluated for ADHD, you want a mental health clinician who specializes in treating children and assessing children for ADHD. Your child’s pedestrian should be able to refer you to someone or if you call your insurance they will probably have referrals.

Before you rush to have your child assessed, remember some basic facts. Most children between the ages of two to five are very active. They also have very short attention spans. Sometimes you need to give a child some time to mature especially if you have a boy. Remember boys mature slower than girls and tend to be more active than girls. It is important to keep these facts in mind when you are wondering if your child has ADHD.

Now if you child is more hyperactive than other kids his age or his attention span is shorter than most kids his age, there might be an issue. Also if there is a strong family history of ADHD in the family such as his father had ADHD as a child and paternal and maternal uncles all had ADHD as children, there might be an issue. Also if your child was born premature or there were complications during the pregnancy or child birth, there might be an issue. Premature babies or babies with a difficult pregnancy or birth are more likely to have ADHD and learning disabilities.

Bottom line, if someone suggests that your child has ADHD don’t rush to the pedestrian seeking medication. Compare your child’s behavior to other children and consider the risk factors. If your child doesn’t have many risk factors for ADHD maybe wait six months and reassess the situation. The most important thing to remember is if you decide to have your child assessed for ADHD, make sure you go to a mental health clinician who specializes in children and ADHD. You want a mental health clinician who specializes in treating children with ADHD and assessing children for ADHD. Also remember you do not need any expensive scans like a CT scan. There are other treatment options besides medication, so do not rush to medicate your child either. Consider all the treatment options.

Dr. Michael Rubino specializes in treating children and assessing children. He has over 20 years experience treating and assessing children and teenagers. For more information about Dr. Michael Rubino’s work visit his website at www.rcs-ca.com or his Facebook page http://www.Facebook.com/Drrubino3

The iGen Generation and The Struggles they face

The iGen Generation and The Struggles they face

I have noticed for several years how teenagers who have grown up with Smartphones have different problems the past teens I have seen in psychotherapy.

The teens who have always have had Smartphones report feeling more anxious, lonely and depressed. They also are more likely to engage in cutting and other self-mutilating behaviors. Finally, they are more likely to report suicidal feelings. I have noticed they go no where without their phones and can become violent if you take their phones away.

Many parents have noticed the same issues and asked me how they can address these issues. The problem is we don’t have an answer to this question. The iGen generation is the first generation to grow up with Smartphones and instant access to almost everything. We do not have the research to tell us how these teens will be impacted.

However, Dr. Jean Twenge did a study and her results are scary. They show 1 out of 5 iGen teens have mental health issues and the suicide rate for this generation has increased by 200%. This is shocking.

I have included a link to a presentation she did so parents can understand this problem better and some options they have to help their teenager. iGen: The Smartphone Generation | Jean Twenge | TEDxLagunaBlancaSchool https://youtu.be/UA8kZZS_bzc via @YouTube

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating teenagers. For more information about his work visit his website http://www.RubinoCounseling.com.

Preparing Your Teenager for High School

Preparing Your Teenager for High School

In about six weeks a number of students will be starting their first year in high school. Parents this is a good time to think back to your first day of high school and how you felt and what you were expecting. This can help you relate to some of the feelings your teenager is having and help you when you talk to them about starting high school. Hopefully this article will be able to provide some tips to make it an easy transition for your teenager and for you.

One common stressor for many teenagers are the stories they have heard about how seniors pick on and tease the freshman students. Another common fear for freshman is that they are going to get lost on the campus and not be able to find their classrooms. Your teenagers are at a point in their life where their image and reputation are very important to them. Therefore the idea of being teased by the seniors or getting lost on the campus can be very stressful and also create a great deal of anxiety for a student starting high school.

As parents, you can talk to your teenagers about your first days days at high school and reassure them that the stories they hear about Freshmen being targets for the seniors are greatly exaggerated. Also you can try to go with them over to the school before it starts and walk around the campus so they can get use to where everything is at their new school. Another thing you can do is remind them that everyone makes mistakes so if they do get lost the first day it is not a big deal. Remind them there will be a lot of other kids starting their first day of school too and there will be other kids getting lost. This is also another opportunity to continue to establish an open relationship with your teenager. The more you talk with each other you increase the likelihood that they feel comfortable coming and talking to you about issues they will have while in high school.

Another issue facing some students is starting all over. In middle school they may have been very popular and everyone knew them. Now no one knows them and they need to start all over. This may be frightening to them, but remind them there will be many times in life when they will need to start as the new person. Also remind them, if they were able to do it in middle school, they can do it in high school too. However, encourage them to have faith and be patient because it won’t happen over night. Now for many students middle school was a nightmare. They may be looking forward to starting over. Again remind them if they have the desire to try they can do it, but also to be patient because it may not happen as quickly as they like.

Also before school actually starts is a very good time to establish what your expectations are regarding grades and after school activities and hanging out with friends. Furthermore, before school actually starts is a very good time to establish what your expectations are for your teenager regarding grades, homework, after school activities. If you establish an understanding between yourself and your teenager before these situations arise you can save yourself a lot of time arguing with your teenager. However as you establish these guidelines you want to have a conversation with your teenager about these issues. Remember your teenager is starting to enter the adult world, if you simply just tell them these are the rules no matter what they will feel that you are being unfair and they will try to find a way around your rules. If you have a discussion with them about the rules they will feel that their opinions are being respected and they are more likely to feel that the rules are fair and are more likely to follow the rules. It is also a good idea to write a contract with all the things you agreed to. If you write the agreements down and there is a misunderstanding you simply need to refer back to the contract. Also this is another opportunity for you to establish a relationship with your teenager where they feel comfortable enough to come to you and discuss any problems they may be having. You are also role modeling to them how to have an adult discussion and how to negotiate fairly and respectfully with other their people.

Of course you also want to take this opportunity to discuss with your teenager the fact that they are going to be faced with making decisions about alcohol, drugs and sex. This is a good time to provide them with the education they will need in order to cope with these situations. Remind them that information they may receive from their friends may not always be accurate. Furthermore, encourage them that at any time if they have any questions or concerns regarding these matters or any other matters you are always there to listen and to talk with them.

One thing to remember is acronym HALT. I teach this often with anger management, but it helps with communication too.

H – hunger

A – anger

L – lonely

T – tired

If either one of you are having these feelings, it is generally not a good time to have a discussion. Also if either one of you is feeling like this and you may not be listening to each other. Therefore, if either one of you are having these feelings or don’t feel like talking, then it’s better to postpone the conversation until you are both ready to talk.

Lastly, remind them that they are starting a brand-new phase in their life and it is normal to feel anxious and stress. Also remind them that these feelings are normal in the beginning but they usually quickly disappear after they have started school.

A few things you can do on the first day of classes to help with any anxiety are you can get up in the morning with them and have breakfast with them before they go to school. You can also put a note of encouragement in their backpack that they will find when they are at school and this can help reassure them and remind them how much support they have at home. Finally, you can arrange to be at home when when they get home from their first day of high school so you can talk about it with them. Also plan to have a family dinner to discuss everyone’s first day of school and offer encouragement where needed. These are just a few ideas to help with the transition process.

Dr. Rubino has a private practice in Pleasant Hill and specializes in working with teens. To find out more about the work he has done over 20 years visit his web site at http://www.RubinoCounseling.com.

Fair Fighting Rules When Teens Act Dispectfully

Fair Fighting Rules When Teens Act Dispectfully

I just posted an article about how parents can avoid power struggles with their teenagers especially when the teenagers answer in a disrespectful manner. In addition to power struggles, disrespectful behavior can result in arguing. Therefore, this post regarding fair fighting in conjunction with the one one disrespectful behavior should be helpful to parents.

We must remember that a teenager’s brain is not fully developed. The prefrontal cortex is still developing in teenagers. This part of the brain is responsible for reasoning and other executive functions. Therefore, while teenagers look mature enough to have a reasonable conversation, their brains may not be mature enough therefore they are more likely to argue. However, an argument is not always bad. There are ways to have a healthy argument and ways to have destructive, hurtful arguments. Most of us never learned how the have a healthy, reasonable disagreement.

Many people feel that a disagreement or fight is always a bad thing for a relationship. However, this is not true. If you handle a disagreement or argument fairly, it can be a very healthy thing for a relationship. It can help you overcome past miscommunications or help you to resolve a problem.

As I stated above, parents who are dealing with teenagers need to remember that for teenagers their Frontal Lobes in their brains are still developing. Therefore, they cannot always reason like adults and often have difficulties having fair disagreements. I have included a list by TherapyAid.com which explains fair fighting rules.

Yes this might sound odd, but you can have a disagreement that is fair. You do not always need to use insults or not listen to each other. By using these rules, you and your teenager may be able to resolve an issue or at least come to an understanding without saying things that will hurt one another.

Parents what I suggest is that you sit down with these rules with your teenager and discuss that you would like to start to using these rules in your family. Take the time and go over each rule so you both understand the rules. Also make a copy for yourself to keep, your teen to keep and a copy to put on the refrigerator to remind everyone. Remember, these rules will be a change for both of you so don’t be surprised if it takes you some time to get use to these rules and use them on a regular basis. Change usually never occurs over night.

While these rules are beneficial for parents and teenagers, these rules are also useful for couples. Very few people in our society were brought up learning how to clearly communicate. Just look at how many arguments occur due to miscommunication if you need proof. For couples I would recommend the same steps as parents and teens. First sit down and go over the rules so you both have the same understanding of the rules and keep a copy for yourselves. The next time you have a disagreement practice using these rules. Keep practicing until you become comfortable using these rules.

Fair Fighting Rules

1. Before you begin, ask yourself why you feel upset.

Are you truly angry because your partner left the mustard on the counter? Or are you upset because you feel like you’re doing an uneven share of the housework, and this is just one more piece of evidence? Take time to think about your own feelings before starting an argument.

2. Discuss one issue at a time.

“You shouldn’t be spending so much money without talking to me” can quickly turn into “You don’t care about our family”. Now you need to resolve two problems instead of one. Plus, when an argument starts to get off topic, it can easily become about everything a person has ever done wrong. We’ve all done a lot wrong, so this can be especially cumbersome.

3. No degrading language.

Discuss the issue, not the person. No put-downs, swearing, or name-calling. Degrading language is an attempt to express negative feelings while making sure your partner feels just as bad. This will just lead to more character attacks while the original issue is forgotten.

4. Express your feelings with words and take responsibility for them.

“I feel angry.” “I feel hurt when you ignore my phone calls.” “I feel scared when you yell.” These are good ways to express how you feel. Starting with “I” is a good technique to help you take responsibility for your feelings (no, you can’t say whatever you want as long as it starts with “I”).

5. Take turns talking.

This can be tough, but be careful not to interrupt. If this rule is difficult to follow, try setting a timer allowing 1 minute for each person to speak without interruption. Don’t spend your partner’s minute thinking about what you want to say. Listen!

6. No stonewalling.

Sometimes, the easiest way to respond to an argument is to retreat into your shell and refuse to speak. This refusal to communicate is called stonewalling. You might feel better temporarily, but the original issue will remain unresolved and your partner will feel more upset. If you absolutely cannot go on, tell your partner you need to take a time-out. Agree to resume the discussion later.

7. No yelling.

Sometimes arguments are “won” by being the loudest, but the problem only gets worse.

8. Take a time-out if things get too heated.

In a perfect world we would all follow these rules 100% of the time, but it just doesn’t work like that. If an argument starts to become personal or heated, take a time-out. Agree on a time to come back and discuss the problem after everyone has cooled down.

9. Attempt to come to a compromise or an understanding.

There isn’t always a perfect answer to an argument. Life is just too messy for that. Do your best to come to a compromise (this will mean some give and take from both sides). If you can’t come to a compromise, merely understanding can help soothe negative feelings.

Again, this might seem simple to some people, but communication problems are one of the biggest problems I encounter as a psychotherapist. We simply don’t educate children about clear communication, which creates problems when these children become adults and try to talk with each other. So don’t be embarrassed or assume you do not need help in this area. Simply read the rules and try them in your life and see what happens.

Dr. Michael Rubino is a psychotherapist with over 20 years experience and he specializes in treating teenagers, children and families. For more information regarding his work or private practice visit his website at www.rubinocounseling.com or his Facebook page at www.facebook.com/Drrubino3 or follow him on Twitter @RubinoFamily.