How to Help Someone Who has a Mental Health Issue During the Holidays

How to Help Someone Who has a Mental Health Issue During the Holidays

For many people the Holidays can be a stressful time. For some people there is the stress of not having enough money. For others, they lost a loved one this year and this is the first Holiday without their loved one. For others, there are family issues that make this a difficult time of the year. Finally, for people with mental health issues, the Holidays can be a very difficult time.

For people with mental health issues the Holidays can be difficult for many reasons. They may be dealing with family issues, financial issues or not feeling happy. Not feeling happy can be difficult because everyone is supposed to be happy during the Holidays. At least this is what we are told by society. Also some people with mental health issues may find the Holidays difficult because their condition is not stabilized yet or the Holidays can be a trigger for their mental health issues. I see this with the patients I work with who are Bipolar or patients who are dealing with eating disorders. Just to name a couple of mental health issues that are triggered by the Holidays.

People who are suffering with mental health issues that are triggered by the Holidays need support and understanding. You cannot just tell them to pull it together or to take a pill. It is not that easy for them. If it was, they would automatically take those steps on their own to solve the situation.

There are some things that people with mental health issues can do that may help them. Dr. Pooky Knightsman, who deals with her own mental health issues, describes some of these options in her video. I have included a link to it so you can watch it. If you have a loved one who has mental health issues, please watch this video and may be you and suggest some of these ideas to your loved one. If they work that would be fantastic for the person coping with mental health issues. If they do not work, please understand the person is not having issues on purpose. If you love them you need to be patient and understanding and help them through this difficult time. Here is the link to Dr. Knightsman YouTube video https://youtu.be/ch5JLIYyPtU.

Dr. Michael Rubino is a psychotherapist with 20 years experience treating children and teenagers many of them are Bipolar. For more information regarding Dr. Rubino’s work or his private practice visit his website http://www.RubinoCounseling.com.

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Political Issues that Prevent Suicidal Teenagers from being Treated

Political Issues that Prevent Suicidal Teenagers from being Treated

Suicide is at an epidemic rate in the United States. According to the CDC it is the third leading cause of death for children between the ages of 10 to 18 years old. Using a gun in the third most common method of suicide in the United States. For boys it is the most common way to attempt suicide (CDC). For many people this may not be surprising. However, it is time that we seriously try to prevent children from attempting suicide and eliminate this epidemic.

The problem with eliminating this epidemic is the access to mental health care and the stigma society places on mental health care. As a psychotherapist who treats suicidal teenagers, I have run into numerous difficulties with insurance companies when I have a suicidal teenager or child. Many insurance companies will only allow the child to be seen once a week. If the child is acutely suicidal, they usually need to be seen twice a week. Many parents can barely afford their copayments and cannot pay for an additional session on their own. This places a great deal of stress on the parents and places the child in danger.

Some people will say the teen should then be hospitalized. This is not an easy answer either. There are not many pediatric or adolescent inpatient psychiatric units in our area. I have had numerous situations where a child or teen may spend over 48 hours in an emergency room because there are no inpatient beds at any of the psychiatric units. In fact, one Thanksgiving I had a mother page me and I had never seen her son before. He was suicidal, but the hospital said they had no beds and gave her my number to call and told her she had to leave the hospital.

If a teenager is hospitalized, often they are only allowed to stay 72 hours and then discharged home. They have to be discharged because the insurance will not authorize more time. It doesn’t matter what the psychiatrist on the inpatient unit recommends. The insurance makes their own decision based on the treatment guidelines. Again this places the child in danger and creates a great deal of stress on the family. Often parents give up and accept the insurance companies decisions. It is too much dealing with a child who wants to die and getting the run around by your health insurance that you have been paying high premiums to for years. Additionally, many times the child or teen is discharged back into my care but I am never notified by the insurance company or hospital and the insurance company does not want my opinion, but they discharge the teen to me for psychotherapy treatment and to monitor.

In addition to the access to mental health care there is the negative stigma associated with it. Many parents wait a few weeks before bringing their teenager to be assessed for suicidal thoughts. They do not wait because they are bad parents, they wait due to the shame. If there child is diagnosed as depressed they are afraid about how people will react to their child and them. In fact, if a child is out of school due to being hospitalized for being suicidal, we instruct the school administrators to tell the staff the teen was out due to appendicitis or a death in the family. They are afraid if teachers or students find out the teen was suicidal that people will think the teen is crazy and not want to associate with the teenager. This may sound bizarre, but it’s true. Most patients schedule their psychotherapy appointments at times when no one will notice they are gone and try to come into the office without anyone seeing them. Our society has a very strong negative stigma about mental health. Many people with mental health issues have difficulty making friends, finding jobs or just being treated as a normal person, if others know they have mental health issues. This stigma is causing many people not to seek help. As a result, many teens due commit suicide because they kept their feelings a secret. They did not want to be labeled a “freak.” However, this stigma is ruining the lives of many children and teenagers and destroying numerous families.

Mental health care is no different from physical health care. No one is ashamed of being diabetic so why should a teen have to be ashamed of having depression? We must demand that insurance companies treat physical and mental health care the same. Additionally, our society needs to treat them the same and not be afraid of someone who is depressed or embarrassed if you are diagnosed with depression.

Finally, the last issue I want to address is the method many teenagers use. Many teenage boys use guns because they believe no one can stop them and it is guaranteed to work. However, this is a myth. Guns have a strong kick to them when fired and often move slightly. Many teenage boys try to commit suicide with a gun and instead of committing suicide, they shot their face off. Instead of dying they end up in ICU in worse condition having to undergo numerous surgeries and being scared for life. This is one reason why we need sane gun laws. We have laws about how old you have to be to drive or smoke. We also have laws mandating that we must where seat belts. We have these laws because research has shown they make us safer. These laws have not restricted our freedom so sane gun laws will not restrain our freedom.

The ABC News show 20/20 did a story about a young man who was depressed and finally attempted suicide with a gun. It goes into all the difficulties he faced when the gun moved. He was fortunate because he was eligible for one of the first face transplants. However, this story shows the destruction that occurs when they use a gun as their method of suicide and it fails. Please watch and see what this young man and his family must undergo. While watching the after effects of this failed suicide attempt, think about how senseless it is the millions of teens and families undergo this situation when it could have been prevented if they were not ashamed and had easy access to mental health care. Please watch this show, 26-year-old’s incredible face transplant journey: ‘I see me’ – ABC News – https://abcn.ws/2OLXuL5 via @ABC.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating teenagers and children. He is an expert at treating suicidal children and teenagers. For more information about his work or private practice or if there is an issue you would like him to address visit his website http://www.RubinoCounseling.com or his Facebook page http://www.Facebook.com/drrubino3.

Parents Cannot Be Their Teenager’s Best Friend

Parents Cannot Be Their Teenager’s Best Friend

Many parents worry because their teenager talk more to their friends than to them. Often many parents feel like a failure because their teenager is spending more time with friends than them. This subject is one I hear daily in my office. Parents are concerned that if their teen is spending too much time with friends, then if their teen is involved with drugs or other issues, they will find out too late. Unfortunately, many parents tell me they have decided that, “”I am going to be my teenager’s best friend” as a way prevent these problems.

Wrong!! You do not want to be your teen’s friend. You need to be your teen’s parent. Your teen has enough friends. Your teen doesn’t need another friend, they need a parent. They need someone to educate them about life and how to make decisions.

Remember, as a parent it is your responsibility to help guide your teen to be successful as an adult and in life as a productive member of society. This means at times you will have to set firm boundaries, educate them about life and sometimes tell your teen no. It is important to remember being a parent is not a popularity contest. You must set appropriate limits for your teen which means at times they will be mad at you. It is okay if they are mad at you. This is part of the process a teenager experiences as they are maturing into an adult.

Despite what they say, most teens want and like boundaries. At times they can be very helpful to your teen. They may be faced with a great deal of peer pressure to do something that they do not want to do and they can use you as the excuse why they cannot do it. Some may say this is immature because the teen is using their parent as an excuse, but we put our teens in a very, very difficult world so I think they are allowed some extra help now and then.

Another reason why should you not be your teen’s friend because your word and rules will mean nothing to your teen, if you are their friend. A friend is defined as a close associate. In other words, teenagers see their friends as equals. Now think about what this implies, if you are equals, you are on the same level as your teen. Therefore, they think they know as much as you do and since you are equals they can choose to follow your rules or ignore them as they see fit.

I run into this problem daily in my office. A parent will say “we have always been best friends, I talk to my teen and their friends about everything and we have good times together hanging out. I don’t understand why they disregard my authority as their parent.”

The answer is simple: you eliminated your authority as the parent and made yourself an equal as a friend. If you want your teen to respect your authority as the parent, you must remain the parent and not be the friend.

Consider the decisions these teens have to make every day. They are faced with issues regarding alcohol, drugs, sex, gangs and decisions about careers in their future. Teens live in a very difficult and complex world today. They need parents to help set appropriate boundaries and guide them so they make the best choices for themselves and avoid a great deal of trouble. You can only do this as a parent. Remember, as a parent you are not in a popularity contest. You have a responsibility to help guide your teen. If you want to help them survive high school then be the parent and make the tough, unpopular decisions that are in your child’s best interest. This will help your teen to respect you and the rules you made earlier you can enforce. If you set yourself as friend and equal, your teen loses respect for you, your advice and your rules. You find yourself powerless and you leave your teen on their own to decide what is appropriate behavior.

This is a difficult time for you and your teenager, but if you maintain your role as parent and your teen maintains their role as child you both will survive high school easier. Of course there will be difficult moments, but nowhere near as difficult if you blur the relationship boundaries.

Dr Michael Rubino has over 20 years experience working with teenagers and their parents. He is well respected in the community. To learn more about his work or private practice, visit his website at http://www.rcs-ca.com. You can also email him from this website, if you have questions.

Sleep is Important to Children’s Mental Health

Sleep is Important to Children’s Mental Health

School is back in session and the Holidays are upon us and we are no longer on daylight savings time. The excitement of the Holidays, days off from school and changing the clocks may disrupt the sleep pattern of many elementary, middle school and high school students. Many children and especially teenagers will have activities where they need to stay up later. This can disrupt their sleep pattern and they may be getting less sleep during the Holidays. Sleep is very important for children and teenagers. In fact, research shows that sleep has a big impact on our mental health and physical health. Research has shown that sleep deprivation can cause a person to suffer a psychotic break or if the depreciation is really severe it can even result in a person’s death. I recently received some very good information regarding sleep and mental health. It was provided by Jenny Thompson who is associated with http://www.bettermattressreviews.com. I think it is valuable information for everyone so I have provided it below.

Mental health and sleep are closely related. Sleep problems frequently accompany mental illness, and can even be the first warning sign of a disorder. In turn, lack of sleep worsens mental health symptoms, creating a vicious cycle.

Mental illness is common, with almost 20 percent of Americans suffering from at least one mental health disorder. While only 10 to 18 percent of the general population experience sleep issues, as many as 50 to 80 percent of people with mental illness have trouble sleeping.

Mental health disorders are the largest cause of insomnia. 40 percent of insomniacs and over 46.5 percent of hypersomnias have a comorbid mental health disorder. On the other hand, only 16.4 percent of people have a mental health disorder without any kind of sleep issues.

Sleep problems are closely correlated with ADHD, anxiety disorders, bipolar disorder, depression, and schizophrenia. Below we’ll review how sleep affects several mental health disorders, and provide tips for getting better sleep.

Schizophrenia and sleep

Schizophrenia affects 1 percent of people, or 3 million Americans. Onset often occurs in late adolescence or the early 20s. Individuals with schizophrenia suffer from psychoses such as delusions and hallucinations, and experience difficulty focusing their thoughts and expressing themselves.

Up to 80 percent of people with schizophrenia have sleep problems, including:

Irregular sleeping hours. They may fall asleep anytime during the day or night rather than during the typical overnight sleep period of most people. They may have consistently delayed melatonin release that shifts their sleep pattern later than normal, slowly shift their circadian rhythm later and later each day, or follow no consistent sleep-wake patterns at all.

Irregular sleep quantity. They may get too much (hypersomnia) or too little (insomnia) sleep, as a result of medication side effects, fear or anxiety due to hallucinations (which may cause them to sleep more to escape, or conversely to be afraid of nightmares), or the irregular sleep hours cited above.

Sleep apnea. Individuals with sleep apnea literally stop breathing during the night, due to blocked airways or a miscommunication between the brain and the breathing muscles.

Less refreshing sleep overall. Due to the issues described above, people with schizophrenia experience less refreshing sleep overall because they have trouble getting sufficient amounts of REM sleep.

For many people with schizophrenia, an onset of sleep problems can be a warning sign that psychosis is starting or returning.

A 2012 study of mice found that abnormalities in the SNAP-25 gene are linked to schizophrenia as well as disrupted sleep-wake cycle, suggesting that resolving sleep issues may less or resolve schizophrenia symptoms.

Anxiety disorders and sleep

Generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, social phobias, and PTSD are all associated with having anxious thoughts while trying to fall asleep at night and related insomnia.

Source: The National Academies Press

Panic episodes may waken an individual with panic disorder from sleep, thus disrupting their overall sleep quality. Likewise, individuals with PTSD are prone to vivid re-experiencing traumatic nightmares which heighten their bedtime anxiety and also cause interrupted sleep.

Individuals with mood and anxiety disorders may be prescribed various medications such as antidepressants and mood stabilizers which can further interfere with sleep.

Insomnia not only accompanies anxiety; it can cause it. When individuals experience chronic sleep deprivation, it disrupts their serotonin and gamma-Aminobutyric acid neurotransmitter levels, which can result in anxiety. One study found that having insomnia increased one’s risk to have yet another mood or anxiety disorder one year later.

Depression and sleep

Insomnia is one of the biggest risk factors for depression. Lack of sleep worsens mood, and the effect is even worse for individuals with a mood disorder. Depressed people with sleep issues have a higher risk of suicide than depressed individuals without sleep problems.

Treatment is also complicated. While antidepressants boost mood and alertness to help treat depression, that same alertness makes the insomnia persist – and not addressing the insomnia can make individuals less responsive to treatment. But certain prescription drugs for insomnia, like Rozerem, may worsen depression. The key is to find a treatment plan that helps both issues, but not at the expense of either.

Depression and sleep issues are bidirectional. That means the problems of one can worsen the other. The good news is, that also means the improvement of one often fixes the other. For example, 35 million Americans suffer from mild depression (dysthymia). For many, their comorbid insomnia goes away once they begin taking antidepressants.

Bipolar disorder and sleep

Bipolar disorder affects 3 percent of Americans, or 6 million adults. In addition to severe changes in mood, behavior, and energy levels, individuals with bipolar disorder may also experience the following sleep problems:

Insomnia, or difficulty falling or staying asleep

Hypersomnia, or oversleeping, especially during depressive episodes

General sleeplessness, where individuals feel fine even when they’ve had significantly less sleep, although this abnormal sleeping pattern eventually catches up with them

Delayed sleep phase syndrome, where the individual has a delayed circadian rhythm, causing them to naturally start to fall asleep or wake up later than others and experience excessive daytime sleepiness as a result

Irregular sleep-wake patterns from manic episodes and related hyperactivity at night

REM sleep issues like vivid nightmares

Sleep apnea affects one-third of individuals with bipolar disorder, resulting in less restful sleep overall and excessive daytime sleepiness

For individuals with bipolar disorders, different sleep issues may arise depending on when they are in a manic or depressive state.

In fact, for 75 percent of individuals with bipolar disorder, sleep problems are one of the biggest warning signs that they are about to experience a manic episode. For example, sleep loss from chronic sleep deprivation or even a night of jet lag can induce a manic episode. Manic periods are so arousing that individuals can go for days without sleep, or sleep drastically less amounts than usual and not feel tired. However, that lack of sleep makes its mark in other ways, as they’ll still experience the other symptoms of sleep deprivation felt by everyone, including increased irritability, trouble focusing, reduce judgment, depressed mood.

As they enter depressive episodes, bipolar people may experience insomnia or hypersomnia, both extremes which cause further imbalances in mood and increased anxiety.

In between manic and depressive episodes, individuals with bipolar disorder experience poorer quality sleep, occasional insomnia, and interrupted sleep.

Sleep tips for individuals with mental health disorders

There are various psychotherapies that treat mental illness, sleep therapies for sleep problems, and other behavioral changes that can help individuals with mental health disorders sleep better at night.

1. Practice good sleep hygiene.

It all starts with good sleep habits. Good sleep hygiene includes keeping the bedroom cool, dark, and quiet, and limiting stimulating activity before bed, such as watching television, using the computer, or engaging in heavy exercise. Heavy meals, as well as alcohol, drugs, and caffeine, should be avoided in the early evening and late night hours.

2. Be careful with napping.

For individuals with excessive daytime sleepiness, power naps of 20 minutes can help give a sense of refreshment. However, naps longer than 20 minutes should be avoided as they can contribute to insomnia later that night.

3. Try sleep therapy.

There are various psychotherapy options that assist individuals with mental health disorders. There are also many specific therapies designed to treat comorbid sleep problems.

Cognitive behavioral therapy (CBT) has proven very effective for treating insomnia. CBT first helps the patient recognize their harmful or disruptive thought patterns and habits. Then, they learn to replace them with positive thoughts and better ways to cope so they can calm anxieties surrounding sleep as well as the rest of their lives. One study in particular found that six 20-minute sessions of CBT resulted in a nearly 50 percent decrease in insomnia, 20 percent decrease in depression and anxiety, and 25 percent decrease in paranoid thoughts, and 30 percent decrease in hallucinations.

Sometimes taught as part of CBT, meditation and deep breathing exercises can soothe anxious thoughts and help relax the body for sleep. You can find audio files of guided meditation and relaxation exercises on the MIT Medical website.

Sleep restriction therapy involves setting a strict bedtime and waketime, and only staying in bed for that allotted amount of time, regardless of how much sleep the individual actually enjoys. Eventually the body gets used to the new sleep-wake cycle and begins to sleep and wake at the proposed appropriate time. A small 2013 study found that sleep restriction therapy improved sleep and reduced symptoms of insomnia for patients with bipolar disorder.

Chronotherapy works similarly by gradually adjusting the bedtime and waketime. It’s a newer therapy and the research is still bearing out.

Bright light therapy helps reset a person’s circadian cycle and make them feel more awake in the morning. Exercising outside in the morning in areas of bright sunlight can provide a similar effect.

4. Explore natural remedies.

Melatonin supplements help kickstart melatonin production in the brain. These can be helpful for insomnia or anyone who has difficulty falling asleep due to a period of mania or delayed sleep-phase syndrome. Valerian root can also help induce sleep. Both melatonin supplements and valerian root are widely available at pharmacies.

5. Keep a sleep diary.

If you’re concerned you may have a comorbid sleep disorder, a sleep diary can help you track your sleep habits. Note when you fell asleep and when you woke up, the total amount of time you were asleep, and anything abnormal that happened during your sleep, such as nightmares or snoring. If you find you’re not getting enough sleep, you can meet with a sleep specialist for a diagnosis and share your diary with them.

You may also want to consult a mental health professional for an evaluation and/or your primary care physician.

Dr. Rubino has over 20 years experience as a psychotherapist treating children and teenagers. Many children and teenagers have undiagnosed sleep problems. For more information regarding Dr. Rubino’s work or private practice visit his websites http://www.rcs-ca.com or http://www.RubinoCounseling.com or visit his Facebook page http://www.Facebook.com/drrubino3.

How To Cope with the Holidays after A Divorce

How To Cope with the Holidays after A Divorce

The Holiday season is usually a difficult and stressful time for many families. Everyone trying to make plans and trying to see grandparents and other family members. It can be especially difficult for divorce families. After a divorce the issues often become even more stressful.

One thing that parents need to remember is that they decided on the divorce the children did not. I often hear arguments about parents want their time or wanting to continue their family’s holiday traditions. However, they often ignore what the children want to do.

Many times a divorce may be finalized, but the parents are not done fighting with each other. Therefore, the use the Holidays as a reason to continue to argue or try to hurt each other. What they forget is they are really hurting their children more than each other.

Based on dealing with families who are divorced, I would make the following recommendations to parents. First, parents need to remember that Holidays are more about the children and family not their divorce. Next they need to develop a plan together regarding the Holidays. The first step is for the parents to talk together about what the children seem to enjoy the most about each Holiday. Also parents should also ask the children what they enjoy most about the Holidays.

After you have this information then sit down civilly and see how you can allow the children to do what they enjoy most about the Holidays. Another thing to remember is the children should not be forced to choose between Mom and Dad. Come up with a plan where the children have equal time with both parents. Also they should have equal time with grandparents, cousins and other Extended family from Mom and Dad’s side.

The other thing is don’t turn the Holidays into a competition. Gifts should not be used to influence the children. You should discuss with each other what your children want and what you plan to get the children. When you were married you discussed what to get them so even after the divorce you can coparent and discuss what is realistic and what is not.

Finally, remember the Holidays are a time to get together as a family and enjoy each other. Therefore, for the sake of your children put your divorce aside and decide how this can be a happy family time for everyone. If you can do things together, that would be the ideal situation. If you can’t then being kind to each other and making the Holiday season fun for the children is the goal for you as parents. Stated another way, the children should still feel like they have one family during the Holidays not two. Maybe things are being done a little differently because of the divorce but they still have a mother and father.

If you achieve this goal, it will make you feel better too. A divorce should not wreck your lives. Obviously, your lives will change after a divorce but you can still be a family.

Dr. Michael Rubino has over 20 years experience as a psychotherapist working with children/teenagers and families. For more information about Dr. Rubino’s work or private practice visit his website at http://www.rcs-ca.com or Facebook page http://www.Facebook.com/drrubino3.

The Holiday Season and Finals a Stressful Time for Teenagers

The Holiday Season and Finals a Stressful Time for Teenagers

The end of the Fall semester is around the corner and it is a time of year that students panic because it’s Finals time. Your teenagers are probably very stressed or getting stressed. There is a lot going on right now. Seniors are trying to complete college applications, seniors and juniors are worried about grades because these grades will impact which colleges they can go to. In addition, there is time off for Thanksgiving and Christmas so many teenagers are focusing on spending time with their friends. However, they also need to allow for time with their families too.

As I stated besides finals, teenagers are having to balance between friends and family. In addition to spending time with friends there are the parties that occur over Thanksgiving and Christmas break. Besides having to balance time between family and friends, they still have to keep the homework current and study for finals or complete semester projects.

In many classes the final may be worth fifty percent of the students grade. The final grade in a class is very important. This grade will be part of their overall GPA which can affect what colleges Juniors can apply to and their ability to get scholarships. Also for seniors these are the grades colleges will be using to determine who they accept or reject. Seniors know they need a decent Fall semester GPA to have a chance of being accepted by a college.

As you can see there is a great deal of pressure on high school students during this time of year. Also since the competition to get into colleges has increased and the competition for scholarships have increased so has the stress on high school students.

Many students will do what ever they need to in order to survive this time of year. This includes using alcohol or weed to help them relax or sleep. They will also take friends ADHD medication, use cocaine, or start taking caffeine pills or start drinking a great deal of coffee or energy drinks so they can stay awake and study. They don’t realize how much caffeine those energized drinks contain. Also the combination of weed to sleep and caffeine to stay awake can cause mood changes, psychosis and even death.

Most teens want to do things on there on so they will tell you everything is fine and they have it covered. They think it is fine because of the substances they are using. Remember a teenagers prefrontal lobes are not fully developed yet. Therefore, they only focus on the here and now and not on the future. They also do not always think about the long term consequences about some of the things they are using.

If your teenager is getting anger very easily or crying easily this is a sign that something is going on. If you notice a change in their eating habits such as going from eating a lot to eating nothing, this is another sign. Also if you notice a change in their sleep pattern such as awake all night and falling asleep at odd times this is also a sign.

What do you do if you notice anything that is making you worry, you should sit down and talk to your teenager. Explain you know there is a lot of stress right now and point out the changes you have noticed and what you are concerned about. Reinforce you are not having this conversation because you are mad or they are in trouble, you are having this conversation because you love them. If they are using things or doing things because they think it will help them study, let them know you are there to help. Explain some of the dangers associated with what they are doing. Remind them no grade is worth their life.

One thing you may want to do, is say to your teenager you know the end of the semester is a stressful time. Ask them if they need any help studying or help organizing their time. Let them know if there is any way you can help, you are there to help. Remind them, all they need to do is ask you for help and you will help.

Hopefully they will listen to you and confide in you. If they continue to deny everything, then go to any local pharmacy and buy a drug testing kit. Explain you are only doing this for their safety and they are not in trouble. They may be afraid or embarrassed to tell you. They may feel like a failure in your eyes. As their parent they really need your love and support right now not a lecture. Again remember when you were in high school and how difficult it was to tell your parents certain things. Good luck.

Dr. Michael Rubino specializes in working with teens and has over 20 years experience and his work is nationally recognized. To find out more about Dr. Michael Rubino visit his website at http://www.RubinoCounseling.com or his Facebook page at Facebook.com/Drrubino3