The Drugs Teenagers are Using Now

High school students are out of school for the next two months for Summer Break. They are looking forward to spending time with their friends at school and those returning from college. This usually means a lot of late nights and parties. 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.

Summer break is only two months so many teens want to get in as many parties as they can. During summer break 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 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 http://www.RubinoCounseling.com or his Facebook page http://www.Facebook.com/Drrubino3.

Why Boys Feel Emotionally Isolated

We know the traditional male stereotype is unhealthy for men & boys. I have many parents bring their teenage boys in for therapy due to depression. I have also heard many boys tell me they feel empty and numb. They tell me they can’t describe how they feel.

If I ask if they ever cry, they look shocked. Boys are not allowed to cry. While they can’t tell me how they feel they can tell me all the rules about acting like a man. They also discuss how they don’t really talk with their friends. They say they joke around with their guy friends. As a result, they never know how anyone is feeling and they feel lonely at times.

Here is another article discussing how living by the stereotype leads to a feeling of isolation for teens. This increase the odds of drugs, fighting & early sexual activity https://www.theatlantic.com/family/archive/2018/06/imagining-a-better-boyhood/562232/

Why Cities are Banning E-cigarettes

San Francisco bans e-cigarette sales due Tobacco companies target teens with flavored nicotine and no health data from the FDA. Tobacco companies say they are safe but no research data to prove it. San Francisco passes ban on e-cigarette sales, a US first

https://www.cnn.com/2019/06/25/health/san-francisco-e-cigarette-ban-sales-bn/index.html

Common Mistakes Teenagers Make on Social Media

In today’s world texting has become a very common way for people to communicate with each other. If I go to a baseball game or the theater, I see adults texting the entire time. I have even seen people fired via text. While it is becoming very common with adults, it is even more common with teenagers. The teenagers I see for psychotherapy text all the time. It appears that texting is now the preferred way that teenagers communicate with each other. If you remove their cellphones and they cannot text, many teens become very upset and I have seen many become violent.

While technology is advancing at a fast pace, our laws and ethics are having a difficult time keeping up with the latest advances. However, when laws are passed or ethical standards set, many teenagers and adults are not aware of the new laws. This is creating a tremendous problem for teenagers and their families. I have worked with many teenagers who are struggling with an issue due to texting and they had no idea they were doing anything inappropriate.

First, it is important to note that any time you post something, tweet or text, it is on the internet forever. This is why many celebrities have won very large monetary judgements against people who have posted false or embarrassing material. You can remove it from the site it was posted to, but it still can found on other sites. Therefore, if a teenager post something, they need to think about the fact that it will be out there forever and anyone can see it. This may lead to embarrassing situations.

Let’s consider the most common problems that teenagers encounter. The first one is texting sexually explicit photographs to their boyfriend/girlfriend. At the time they think it is no big deal. However, high school romances typically do not last. If one of the individuals feels hurt, they can post that sexually explicit picture all over the Internet. It can be sent to their families and friends. In fact, their entire school could see it. This would be extremely embarrassing. Even if the person who posted the picture is punished, the picture is still out there and the damage is done.

Additionally, teenagers fail to think about the fact that they are under 18 years old. Therefore, they could be violating child pornography laws by sending the picture or by receiving it and having a copy on their cellphone. In fact, Congress is trying to pass stricter laws regarding teenagers texting sexually explicit picture. Therefore, besides being very embarrassed, the teenagers involved might find themselves facing legal charges for violating child pornography laws.

The second major issue is harassment. Friends get mad at each other or often one teenager is singled out and they become the object of numerous texts telling them they are ugly, no one likes them etc. These texts can be sent so often and by some many other teenagers that the teen who is the target commits suicide. There are numerous examples of this and a common one is accusing a teenager of being gay. This is not harmless teenage game playing. This harassment can be vicious. They are also cases where the teenagers sending these texts have been charged with stalking or more serious charges if the teenager committed suicide.

When this occurs, the teenagers are shocked. They think they were just teasing another kid and it was harmless. They have no idea what this teenager is already dealing with in their life or what it can be like to have numerous classmates texting you every day all day long. It is not harmless teasing, but because technology has increased so quickly it is not the same teasing that use to occur at school. We have not had enough time to think about this point.

A surprising issue is that texting is an excellent way for schools or police to arrest teenagers for dealing drugs, buying or using drugs. I have worked with many teenagers from numerous schools where the school catches someone using or selling marijuana on school grounds. The school then checks the student’s cellphone and looks at the text history. The school then starts calling in the student’s on the text history and asking about drug use or selling. One teenager getting caught at school can result in ten teenagers being expelled. The teenagers are usually in shock. First, they never thought they were doing anything wrong and they never thought a text could get them in trouble. However, it can and it does. I have seen many teenagers for psychotherapy because of a text found by the school.

Finally, texting and posting can destroy a high school student’s plans for the future. Many colleges now look online when a student applies to their college. If they feel the teen is not someone they want representing their University due to their social media post, they will not be admitted to the University. It can also impact a teen even if a University accepts them. Harvard University once again told a student they had accepted that their admissions to Harvard had been revoked due to racist social media they found posted by the teen. Harvard did this two years ago to ten students. The lesson is think before you post because it could change your entire life.

Parents, we see adults getting into trouble due to texts they have sent, what makes us think that teenagers can’t get into trouble too? Remember they are not grown adult yet, so their ability to think logically as an adult is not fully developed. Even if it was, technology is moving so fast that adults are getting into trouble due to texting.

Therefore, we cannot expect teenagers to be able to sort all of this out on their own. Talk to your teen about texting, you may need to monitor their texting. There are apps that can help teenagers identify texts that may be inappropriate. Bottom line teenagers need to support and guidance from their parents regarding the ever evolving technology that we are facing. If we cannot keep up with the ethical issues, how can a teenager?

Dr. Michael Rubino is a psychotherapist with 20 years of experience working with children and teenagers. He also treats Internet addiction. For more information on Dr. Rubino’s work or his private practice visit his website at http://www.RubinoCounseling.com or his Facebook page at http://www.Facebook.com/drrubino3. Dr. Rubino also offers a summer workshop for teenage boys to help them understand how to be a responsible teenager and avoid trouble with school, friends or the police. Please contact him for more information.

Fourth of July Activities and Teenage Injuries

The 4th of July weekend is around the corner and many teenagers will be involved in various activities. It’s a popular weekend for teenagers to be out drinking and also swimming with friends. Most people assume these are every day activities and everyone will have a good time.

However, this is not reality. Every year 5,000 teenagers are killed in motor vehicle accidents and 400,000 are injured (CDC statistics). These injures may range from cuts and bruises to someone being paralyzed.

Also regarding swimming, there are 3,500 accidental drowning every year. And out of these drownings 1 out of 5 are teenagers (CDC statistics). This is the number who die. It doesn’t include brain injuries due to lack of oxygen to the brain or breaking a neck by diving. A broken neck can result in death, paralysis or being in a Halo Brace for 6 months. Again this is an activity we assume is safe and nothing would happen swimming in a friend’s pool.

With the Fourth of July weekend coming up, there are going to be a lot of parties and drinking. There are also going to be a lot of drunk driving accidents, drownings and accidental overdosing. You have no way to know if you or your family might be one of the unlucky families this weekend. It could be your teen who is killed or it could be you. Therefore, talk to your teens about their plans and about safety.

You never know what is going to happen in life. Especially given everything that is happening all over the world. And if you look at the above statistics, you never know when or if something is going to happen.

A mother experienced this fact when her son committed suicide. Suicide is the third leading cause of death for teenagers. After that she wrote the following poem to her son. She also encouraged all parents of teenagers to remember to say “I love you,” to your teenager. You may not get another chance.

I Love You

How could you?

They asked you,

How could you?

But you could not answer

As you were not here.

Why would you?

They asked you,

Why would you?

But their questions fell onto

The world’s deafest ears.

I loved you!

They told you,

I loved you.

But they told you too late,

Through their tears.

I’ll miss you,

They told you,

I’ll miss you.

And in death now

They hold you more dear.

The point is don’t take the risk. Since you never know what may happen and many teens feel that their parents don’t care, take the opportunity while you have it to express your feelings. Don’t spend the rest of your life regretting I never told him I loved him or wondering if that would have made the difference.

Dr. Rubino is a psychotherapist is Pleasant Hill who specializes in treating children and teenagers. He has over 20 years of working with teens. To find out more about his work or to contact him visit his website at http://www.RubinoCounseling.com.

Summer Activities and Teenage Concussions

It is summer time and school is out. Many children are engaged in summer activities such as swimming, water skiing and diving. Others are preparing for next year’s football season and cheerleaders are preparing too. While we use to assume these activities were safe, we now know they can be dangerous.

Many parents of high school athletes are aware of the dangers of concussions. Even one concussion can cause permanent damage according to recent research studies. However, there is another condition that parents need to be aware of when their child plays sports. This disorder is CTE. CTE is Chronic Traumatic Encephalopathy (CTE) it is a progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma, including symptomatic concussions as well as asymptomatic subconcussive hits to the head.

Our brain sits in our skull surrounded by fluid. Therefore, any time anyone hits their head or their head is jarred around, the brain moves in this fluid hitting the front and back of your skull or the sides of the skull depending on what direction the force came from. When the brain hits the skull it can cause bruising and microscopic tears of very fine nerve fibers. Nerve fibers that are too small to be seen on an MRI or a CT scan.

Physicians have known that CTE effects boxers for many years, however, it was just recently that evidence showed that football players are at risk too. This was the main focus of the movie, Concussion, starring Will Smith. The NFL did everything they could to stop the filming of this movie. The movie shows how CTE results in the patient becoming severely depressed and psychotic. Many of the patients with CTE commit suicide. Also many CTE patients were football players.

Why is this important for parents to know? It is important because CTE is caused by chronic head injuries. Head injuries that date back to when a teenager was playing high school sports. Therefore, it is important for parents to ensure that their teenager’s school is using the latest safety gear, especially for the head, and to take any head injuries seriously. There is no way to tell what will happen when these teenagers become adults.

For many years, football and schools have reported that they are developing helmets that protect the head better. However, these safer helmets are not being used in high schools or professional football. Schools and professional football are monitoring players closer after a head injury, but still little to nothing is being done to protect the brain prior to an injury.

As an adolescent psychotherapist who has been practicing for over 20 years, I am seeing more evidence of this every year. Every year I am seeing more teens with Post Concussion Syndrome. This disorder may occur after a concussion and can be associated with headaches, mood swings and memory difficulties. The teenagers who experiences this Syndrome becomes very frustrated because they are aware of the changes in their mind and because no one can say how long the symptoms will continue. In fact, no one can guarantee that the symptoms will disappear.

This becomes very frustrating to the teenager and their parents. Some teenagers are so overwhelmed that they start self-medicating with drugs and alcohol. Anything that they think might help. Others become so depressed because they fear that the symptoms are permanent that they become suicidal and may attempt suicide.

For many years these head injuries in teenagers were down played because there was not enough evidence to indicate that teenagers could be impacted by head injuries. Well the research clearly indicates that teenagers can suffer long term results from a single concussion. Additionally, this can create symptoms that are overwhelming for the teenager and their family. Imagine being a parent and you see your child suffering with Post Concussion Syndrome and there is nothing you can do to stop it. Parents also become depressed and nervous that their child may never recover.

Everyone’s brain is different and so is the recovery process. This means we have no way of knowing how many Concussions or head traumas it takes before CTE is started in someone. It also means we have no way to determine how long it will take for someone to recover from a concussion or if they will have permanent impairments. We only can tell after it occurs not before.

We do know that patients recovering from Post Concussion Syndrome or dealing with CTE can benefit from psychotherapy. Often this option is not given to teenagers because again many people believe teenagers are very unlikely to suffer with these issues. However, if you look at the research it indicates that teenagers can and do suffer from Post Concussion Syndrome and teenage head injuries can cause CTE.

As a psychotherapist who treats teenagers with head injuries, I strongly encourage every parent to watch the movie, Concussion. Also before your child starts playing any competitive sports, such as football or soccer, go online and research head injuries and signs and symptoms of concussions. Also if you teenager does sustain a head injury while playing sports or just playing have them evaluated. You never know how severe a head injury is by just looking at someone. A few years ago an actress fell in the snow and her friends said to go to the doctor she said she was fine. Two hours later she was dead. When she fell she caused her brain to bleed and she died.

The lesson from this story is as your teens go swimming, camping, climbing, suffering etc., over the summer monitor if they have a head injury. It can happen as easily as two kids hitting their heads together while wrestling and playing. If you notice any changes or your teen is complaining of not feeling well have them examined by a physician. Also keep track of how many head injuries they have sustained over time. If they get a concussion by diving maybe they need to take it easy for the rest of the summer.

Above all, use your best judgement as a parent. Do not be afraid to ask for a CT scan or an MRI if your child suffers any type of head injury. If your teenager does sustain a concussion and you notice a personality change or memory issues do not hesitate to seek psychotherapy for your child and for yourselves. Also don’t hesitate to talk to your teenagers high school. If the teenager is having problems concentrating after a head injury, the school may need to provide them with accommodations until the child recovers.

This can be an overwhelming and frightening topic to consider but the more you educate yourself, the easier it will be to manage. If you have additional questions regarding the personality changes or neuropsychological changes with head injuries, please feel free to contact me.

Dr. Michael Rubino has been treating children and teenagers for over 20 years. He also has training in neuropsychology. For more information about Dr. Rubino’s work or private practice visit his website at http://www.RubinoCounseling.com or his website that deals with accommodations at school http://www.LucasCenter.org or his Facebook page http://www.Facebook.com/drrubino3

Every Parent Makes Mistakes

This weekend we celebrate Father’s Day and last month we celebrated Mother’s Day. These days are set aside to provide us time to tell are parents how much they helped us as children and how much they mean to us. However, not everyone feels this way about their parents. Some people have a parent who abandoned them and others have parents who were physically and emotionally abusive. Therefore, Father’s Day and Mother’s Day are not happy days for many people because they had parents but their parents were not there for them. As a result, many people are angry and hurt by their parents and don’t want to celebrate their relationship with their father or mother.

While this is true that many parents were far from perfect parents, at times there are reasons why parents acted the way they did as a parent. I do not say this to excuse their behavior and parenting style because they are responsible for how they decided to act and parent. I say this to help people, who had abusive parents or parents who were not emotionally available, understand why their parents acted the way that they did. Many people who had less than perfect parents tend to blame themselves for their parents actions. This often results in people carrying around hurt, anger and shame that they do not need to. Also they tend to make excuses for their parents behavior because they are afraid what other people will think of them not their parents. They feel people will assume they must have been terrible kids to raise so their parents actions were justified. This only adds to their hurt, anger and shame.

The truth is many parents abandoned their children or are physically and emotionally abusive because their parents were the same way, but worse. They had no role models showing them how responsible parents should act. Also our society provides little assistance or education to new parents. Therefore, they are left on their own to figure out how to act as a parent. This is a difficult task and then when you add the pressures from work and paying bills some parents cannot tolerate the stress. They use whatever is easiest for them which is usually using the same techniques that their parents used.

As a psychotherapist when I work with a patient or a teen, I do a family history. I find out from the adult what life was like when they grew up and what life was like when their grandparents grew up. If I’m working with a teen who is dealing with substance abuse or physical or emotional abuse at home, I find the pattern in the family history. Typically, the pattern goes back to the great grandparents if people can remember that far back. This means we are dealing with a problem that has been going on for over four generations and being transmitted from generation to generation.

How can this happen? It can happen very simply. In the early 1900s very, very few people believed in psychotherapy. In the 1950s people still did not believe in it except for “really crazy” people who were locked up in hospitals. This stigma still continues to this day. When people call to schedule a psychotherapy appointment for their teenager, many ask if they come to therapy will it prevent their teenager from being accepted to colleges or getting jobs in the future. If a teenager contracts a sexually transmitted disease, these questions are not asked. In fact, many middle schools give condoms to sixth graders. Our priorities are off if we don’t worry about a sixth grader’s future when we give them a condom, but we worry about their future if they go to psychotherapy to improve their lives.

Therefore, the main point is that our society to this day still places a negative stigma on psychotherapy and getting help. Therefore, many parents in the 1950s had no help when they became parents. Children do not come with instructions and there were few parenting classes at that time. Therefore, few parents knew what to do as a parent and there were few resources available to help parents who were overwhelmed.

Bottom line, your mother or father may not have been perfect and may have mad a lot of terrible mistakes, but they did the best they could at the time with what they knew. I have found this many times when I have interviewed the parents and sometimes the grandparents of a teen I’m seeing in psychotherapy. They admit they made mistakes, but they did not know what else to do at the time.

Therefore, for those of you who had abusive or neglectful parents, you are entitled to your feelings, but try to understand they did the best they could do. Maybe you can’t forgive them, but don’t blame yourself or feel ashamed. You did nothing to create the situation and there was no way you could have made it better. For teenagers today, again you did not create the problem and the problems have nothing to do with you as a person. Also you cannot change your parents. You can try to understand that they did their best in the past, however, now that you are in therapy they have an option to improve the situation. They can begin their own psychotherapy and address their own issues.

Decade after decade we are seeing the same parenting issues being passed down from generation to generation. We need to stop this pattern. We must remove the stigma associated with psychotherapy and the stigma associated with needing assistance with problems. No child comes with a parenting guide when they are born. As a result, parents will and do make mistakes. Instead of making them feel ashamed and embarrassed, we need to provide parents with options for seeking help such as more parenting classes. We need classes which focus on raising a toddler and other for adolescents. Also for parents who were abused themselves they need individual and group psychotherapy. Why do we keep repeating these mistakes and allowing the cycle of abuse to be transmitted to another generation.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating children, teenagers and their families. For more information regarding his work or private practice visit his website http://www.RubinoCounsling.com or his Facebook page http://www.Facebook.com/drrubino3

Children Need a Dad too

We have all heard very often how important a mother is to a child especially a young child. While this is true Dads are just as important to children and young children. I say Dad because any man can father a child, but it takes work to be a Dad to a child.

Because of the stereotype we have about men in our culture, Dads are often not considered to be important in children’s lives. We tend to focus on mothers and what they provide children. Also because men tend to work a lot and have a tendency not to express emotions, many people assume Dads are usually not emotionally available to children.

However, if we look at the stereotype it also demonstrates why Dads are important. Dads are the male role models to their sons. Dads teach their sons how to treat women, their wives and their children. They teach their sons how a man is supposed to act in relationships and react to people in general.

Dads are also role models for their daughters. Their daughters see how their Dads treat their Moms. This is the first example girls have of how they should be treated in an intimate relationship. If their Dad is verbally and physically abusive, they will most likely expect their boyfriend or husband to treat them that way. Additionally, if girls are exposed to a Dad who is verbally, emotionally or physically abusive, they are more likely to have low self-esteem as adults and be bullied as a child. Boys also are more likely to suffer from low self-esteem and be bullies, if their Dad is verbally, emotionally or physically abusive.

Additionally, boys tend to look for validation from their Dads that they are doing a good job developing into an adult man. If their Dad is not emotionally available, many boys interpret this as they are a failure to their Dad and they become hurt and angry. Since men and boys tend to have difficulties expressing their emotions, because men don’t express sadness or similar emotions, they tend to express these emotions as anger. In other words, boys and men tend to project their pain onto others.

If we change our mind set and see how valuable a Dad is to kids then may be Dads can start meeting the emotional needs of their children and families. However, this requires men to stop living up to the stereotype society has about how men are supposed to act. Since men tend to focus on the stereotype about male behavior, they tend to pass this stereotype on to their sons.

I have a friend who was able to ignore the male stereotype and write a wonderful poem to his son. He wanted his son never to doubt how he felt about him and he wanted to make sure he shared it with his son. What a tremendous gift he gave to his son! Also what a fantastic role model he is being to his son about how to be a Dad.

I asked for his permission to print it here and he graciously said yes. I hope other Dads will read this and share a gift like this with their son or daughter. Also I hope it helps to eliminate the false stereotypes we have about Dads.

I never want this to go unsaid, about my son,

So here in this poem, for all to hear

There are no words to express how much you mean to me,

with a smile upon my face, and warm feelings in my heart, I must declare!

A son like you, always polite and full of joy,I thought could never be.

Since the day you were born, I just knew you were like a mini me,

from your first breath I knew,

God sent me a blessing- and that was you.

For this I thank him every day,

You are the true definition of a son, in every way.

Your kindness and caring with love for all,

you give my life meaning, for us to share.

Becoming your father has shown me a new sense of being.

I want you to know that you were the purpose of my life,

Turning everything I ‘am – into a happy place.

Always remember that I know how much you care,

I can tell by the bond that we share.

For a son like you there could be no other,

And whether we are together or apart,

Please do not ever forget-

You will always have a piece of my heart.

This is a fantastic example of a Dad!

Dr. Michael Rubino is a psychotherapist with 20 years experience working with children & teens. He is an expert in this area of treatment. For more information about his work or private practice visit his website at http://www.rcs-ca.com, http://www.RubinoCounseling.com or follow him on Facebook http://www.Facebook.com/drrubino3 or on Twitter @RubinoTherapy.

Teens Ask Please Accept Me For Who I Am

Being a teenager in today’s world is very difficult. Teenagers face expectations regarding needing to make money to be a success. They face stereotypes about how boys must act if they want to be men and girls face stereotypes about how they must act to be considered women. I hear teens tell me everyday how overwhelmed and confused they are trying to fit into all the necessary stereotypes. They feel overwhelmed because at times they are not sure how to act and confused because at times they don’t agree with the stereotype. If they don’t, they are not sure what to do. This is a lot of pressure for a 13 year old child to be trying to cope with on a daily basis. It’s no surprise that many teens turn to drugs as a way to cope. It is also not a surprise that Cutting is at epidemic rates for teens and suicide is now the second leading cause of death for teens (CDC)

Now what if you don’t fit into the stereotypes? What if you suffer from depression? If you have a learning disability? Or if you are homosexual or bisexual? What do these teenagers do? This is how they were born and they cannot change that fact. Many of these teens will struggle trying to fit the stereotypes and also try desperately to hide from friends and family that they do not fit the teenage stereotypes. Some are lucky and parents or a teacher intervene helping them to get the help they need. Many are not so lucky and often choose suicide. Teenagers who are homosexual or questioning their sexuality are five times more likely than the average teen to think about and attempt suicide (CDC). These are very scary and sad facts.

The CDC found one in five teenagers are dealing with mental health issues such as depression, anxiety or stress. Many may think about psychotherapy but quickly block that option. Only “crazy people” need psychotherapy. If they had to go to therapy they are really a “loser.” For teenagers who are willing to try therapy, they often cannot find a therapist who treats teenagers or their family cannot afford it. Also for many cultures such as Latin or Asian, they believe that personal issues need to be resolved within the family and you would never share intimate family issues with strangers. Therefore, for these teens psychotherapy is not an option.

However, as a psychotherapist who specializes in treating teenagers, I hear daily from teens that all they want is to be accepted for who they are and they don’t want to have to always hide. The teen with depression or the learning disabilities wants to be considered just as important as the star quarterback on the football team. They want this from their school, their friends, society and finally from their families. Is this too much to ask for?

These teenagers are not stealing or doing anything to be ashamed of, they are being themselves just the way they were born. Why can’t they be accepted and celebrated? The answer is they can! It is something I teach them in every session we have together. There are organizations such as Alive and Free in San Francisco and Challenge Day in the San Francisco Bay Area who work with teens and society so these teens can feel accepted being themselves.

Another organization addressing this issue is called Born This Way. It was started by Lady Gaga and her organization works with teens and society so all teens feel accepted for who they are just the way they were born. Lady Gaga explains the mission of her foundation this way, “Safety, skills, and opportunity. Number one, I want everyone to feel safe in their community: school, home, whatever city you live in. Two: developing the skills that are needed to be a loving, accepting, and tolerant person, and to also inject that sentiment into all the people around you, being a supportive human being. And the third is opportunity. I believe once you feel safe in your environment and you acquire the skills to be a loving and accepting person, the opportunities for you are endless to become a great functioning human in society.”

For people who do better by hearing something or seeing it, I have included a link to a YouTube video where Lady Gaga explains Born This Way, https://youtu.be/

The concept really is very simple. Why can’t we accept children and teenagers just the way they were born. Every person is unique and everyone has talents to contribute to the world. So why do we pressure boys into the stereotype the must have big muscles and play sports to be a man? Why do we tell girls that boys are smarter and if someone touches them in a way they do not like it is their fault because of the clothes they are wearing. This is insane!

If we do away with the stereotypes and focus on teenagers liking their own personalities and bodies, we would have less cutting, suicide and drug use. We would also have many more teenagers who are happy and successful at life. Being happy is a successful life not a big bank account. Therefore, let’s get started on helping teens. We need people to support more organizations like the ones I named above. If we do we can eliminate the stereotypes and stigma of not fitting a stereotype. We also need to make psychotherapy more accessible to all teenagers and remove the negative stigma associated with mental health care. Now some people may think what I am proposing is impossible and just a dream. However, you are seeing more groups like the ones I mentioned open every year. We are seeing teenagers and parents being attracted to them. It is possible to improve the lives of children and teenagers. It may need to start with a dream. Dreams do come true look at what Walt Disney created with his dream.

Dr. Michael Rubino is a psychotherapist with over 20 years experience working with children and teenagers. He is on the nations advisory board for Alive and Free. For more information about his work and private practice visit his website http://www.RubinoCounseling.com or his Facebook page http://www.Facebook.com/drrubino3 or on Twitter @RubinoTherapy.

Eating Disorders Impact Boys Too

Eating disorders and body image issues are a major problems for teenagers. Despite what most people may think, these issues impact girls and boys. Most people assume eating disorders only impact girls, but they impact boys too. Boys worry about their abdominal muscles having the “six pack” look and how strong they are compared to other boys. Also for some sports such as wrestling they must make a certain weight to compete. Therefore, they worry about their weight. So eating disorders impact boys too.

Looking at the prevalence of eating disorders in teens can be very difficult. Some break the statistics down to diagnoses such as anorexia. While some focus on under eating, teenagers who over eat can also have an eating disorder. Another classification is unhealthy eating that many teens engage in. Some may skip meals or some may consume to many calories to make weight for their sport and then go days without eating. Therefore, eating disorders can take many shapes and forms. Overall, it is estimated that eating disorders impact 5% of female teenagers and 1% of male teens (NIMH). However, the number for males is considered to be under reported. This assumption exists due to the belief many have that eating disorders only impacts girls. Therefore, there is an assumption that the 1% for boys is an underestimate due to under reporting. Working with adolescents I am sure the 1% is incorrect. I hear many teenage boys complain about their bodies or needing to make weight for their sport. I also hear things they do such as only drinking water a week before a weigh in or loading up on protein drinking before working out. What they report may not fit the picture of anorexia we have, but it definitely is not healthy and is involved with body image. This is a major factor in all eating disorders whether it be anorexia or over eating.

One reason I’m addressing this subject is as I stated above most people assume that eating disorders do not impact boys. Eating disorders impact boys and teens from every economic level, ethnicity and religion. They are an equal opportunity disorder. Another reason I’m addressing this issue is suicide is the number one mental health issue killing teenagers in our country. Eating disorders are the second leading mental health issue killing teenagers. It is estimated that every 62 minutes someone dies from an eating disorders (NIMH). The death may occur after someone has received treatment and is considered in recovery. Eating disorders take such a toll on teenage bodies they may die even though they are considered to be recovered. The singer Karen Carpenter is a prime example. She struggled with an eating disorder for years and struggled with treatment too. However, she finally reached a point where she was considered recovered from her eating disorder and started to resume her life. Unfortunately, she died suddenly one day from a heart attack. The toll the eating disorder put on her body weakened her heart severely. So severely that it caused her to have a heart attack even though she was in recovery.

This is a very sad story and fact. We can avoid these issues by early diagnosis and treatment. We also must realize that eating disorders impact boys too. If we do not we are not addressing the entire problem. We need to address how our society look at men’s bodies and women’s bodies and the expectations we place on both genders. No one can live up to the female and male stereotypes we have created. In order to change these stereotypes we need to start with teenagers and provide them with enough self-esteem to reject the stereotypes.

As I stated early treatment is necessary. To have early treatment we must have early diagnosis. I have included a link to a video by Dr. Pooky Knightsmith which discusses the ten common warning signs of an eating disorder in teens and children, please watch this video https://youtu.be/nKwbE8mP_PA.

If your teen or child displays any of these warning or signs or if you feel your teen maybe struggling with an eating issue, make an appointment with an adolescent psychotherapist who specializes in adolescents and eating disorders. Do not feel ashamed or embarrassed. A mental health issue is no different than a physical health issue. We only believe their is a difference due to the stigma we have created. However, keeping this stigma is endangering the lives of many teens so help your teen and ignore the stigma. Help them deal with their health issue.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating teenagers and children. He also treats teens including boys with eating disorders. For my information about his work and private practice visit his website http://www.RubinoCounseling.com or his Facebook page http://www.facebook.com/drrubino3.

Dr Michael Rubinio

Understanding Your Teenager

Month: June 2019