Camouflaging – Teenagers losing their identities and values

Camouflaging – Teenagers losing their identities and values

A behavior becoming common in teenage and tween girls has been identified by an adolescent psychologist. The behavior that has been identified is called “Camouflaging.” This behavior left unidentified can lead to low self-esteem, depression, cutting etc. It is becoming very common. When I was a guest co-host on the Street Solider Radio Show on KMEL, and the teens were talking about how they change how they dress or their opinions based on their friends. They were describing Camouflaging.

Camouflaging is when an adolescent girl changes how she looks, her opinions or things that she does in order to be accepted by the other girls. The real problem occurs when the girl is changing so much about herself or does it for so long that she forgets or losses track of her real self. Besides changing how she feels, she may forget her chore beliefs and do things she doesn’t believe in.

While this behavior has just been identified in girls and the research appears correct, I believe this behavior applies to boys too.

Many adolescent boys change the way they dress, their beliefs and the way they act to be accepted by their friends. I hear many of these boys telling me in therapy that they feel lost. They tell me they no longer have an idea of who they really are or believe or feel. These boys often turn to alcohol, drugs and cutting. Usually to numb out their lost feeling or to feel something. Often they turn to these in order to forget somethings they have done in order to fit in with their friends.

As a result, many teens start acting like someone they are not just to be accepted. This fear of not being accepted and forgetting their real self because they has been covering their true self up for so long or denying their true feelings for so long can result in boys and girls having low self-esteem and/or feeling depressed.

This low self-esteem and depression can result in such behaviors as cutting, eating disorders, drug use, becoming sexually active etc. Often boys and girls cut just so they can feel as I stated above. The constant denying of their emotions or values can cause boys and girls to lose a sense of their true feelings. Therefore, cutting can occur so boys and girls feel or cope with denying themselves. Denying their feeling or who they are can result in boys and girls feeling very confused. Therefore, they look for behaviors that help them remember who they are and help them identify their true feelings. They also seek behaviors that help them deal with denying their feelings or changing their behaviors. This can trigger eating disorders, drug abuse or other self-destructive behavior. This helps numb out the confusion and disappear of denying their feeling and trying to forget their true self. This can cause feelings of depression and anxiety too.

What should parents look for in their teens? If your son or daughter tries to stop wearing his or her glasses or if he or she all of a sudden changes how he or she dresses or acts these are possible warning signs. Another change could be not doing as well in their classes because they are afraid of looking too smart. Basically, if you see signs indicating that your teenager is trying to deny who they are so they will be accepted by others. It’s more than the common issue of trying to be accepted by friends, they are forgetting themselves and beliefs to fit in.

While it is normal for teenagers to make changes in their attitudes or how they dress, we are talking about something that goes far beyond normal self-expression. We are referring to changes where a teenager is trying to deny who they are because they feel they are unacceptable.

This is what we are talking about. If teenagers are changing their hair or how they dress as a way to express themselves that is normal teenage behavior. However, if teenagers are doing it just to fit in and they end up losing a sense of their true self this is camouflaging.

As I stated, Camouflaging results in depression or low self-esteem because the teenager is forgetting their true self. If they are doing it as a way of trying to experiment with their self expression, the teenager is happy and confident as stated above. This is the main point to understand. Experimenting with their dress and beliefs etc. is normal for teens and helps teenagers identify themselves, however denying or camouflaging their feelings results in teens losing themselves and many behavior problems. This is the main thing for parents to watch for in their adolescents behavior.

If you go onto Yahoo and look up Camouflaging you will find a segment on Good Morning America about Camouflaging. In fact, here is the link to the GMA segment https://gma.yahoo.com/video/parents-worry-tween-teen-camouflaging-122935763.html?soc_src=copy. Also if parents look at the February issue of Teen Vogue, you will find an article about Camouflaging.

Dr Michael Rubino has over 20 years experience working with teenagers and their families. Dr Rubino is considered an expert psychotherapist in the treatment of teens. For more information about Dr Rubino and his private practice visit his website at http://www.rcs-ca.com or http://www.RubinoCounseling.com or his Facebook page at http://www.Facebook.com/drrubino3.

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Helping Teens Start High School in 2019

Helping Teens Start High School in 2019

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 picking on and teasing 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 they want to make a good impression on the other students. At their age image is very important. 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 will 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 may be everyone knew them and they were in the “popular group.” 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. Be sure to encourage them to have faith in themselves 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. All the Freshmen are starting all over just like them, 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. At this time is a good time to establish what your expectations are homework, after school jobs and weekend curfews. 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, 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 were respected, 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. It is even more important today because technology has changed a number of rules. For example, if a girl texts a nude photo to a boy, he is guilty of having child pornography. Yes it was mutually agreed to but they are still under 18 years old so it is a crime. Texting is another area where they can get into trouble. If someone takes a text as a threat they can get into trouble for bullying or assault. As I said, technology has changed the rules and many of us have not been able to keep it. Therefore, 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.

Sadly, one other subject you may want to discuss is school shootings. Develop a plan with your teenager about what they would do if there was a shooting at their school. Also discuss with them what to do if they hear rumors or have concerns about how another student is acting. Finally, discuss how you can help if they are feeling worried or not safe at school. It is sad, but this is the world we live in today. Talking to you teen can help decrease anxiety and help you to maintain open communication with your teenager.

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. Michael Rubino is a psychotherapist who specializes in treating children and teenagers. He has over 20 years experience working with teenagers. To learn more about his private practice in Pleasant or the work he has done over 20 years visit his web site at http://www.RubinoCounseling.com.

Teenagers Spending Summer in Their Room

Teenagers Spending Summer in Their Room

An issue that comes up daily with teenagers in psychotherapy is their bedroom. Many parents tell me that their teenager’s bedroom is like a junk yard. Parents are embarrassed by the bedroom and feel the teenager is being disrespectful. Many parents ask me should they demand that their teenager clean their bedroom. Also many parents ask about is it appropriate if they search their teenager’s bedroom. Also during the summer, but I hear it all year long, parents feel teenagers spend too much time in their room Let’s deal with this one issue at a time.

Parents it is very important to remember to pick and choose your battles. There are a lot of issues you will need to discuss with your teenager. Therefore, it is important to ask, is it worth an argument? Teenagers are at a point in their life where they do need their privacy. They are also at a point where they are trying to find their own identity. Their bedroom is a place they use for part of this process. Also you want your teenager to learn responsibility. Their room is something they can be responsible for.

My recommendation is not to make an issue of their bedroom. You have more important issues such as school, how late your teen wants to stay out, where they want to go and the common issues of alcohol, drugs and sexual activity. Therefore, their bedroom really is a minor issue. In my opinion it is not worth the fight. Arguing about their bedroom, which they view as their private space, can lead to bigger problems with some of the other issues I listed above. Also remember these are only some of the issues you will need to set guidelines and expectations about your teenager’s behavior. This is why I strongly recommend leaving the bedroom alone.

Many parents ask me, “then I should just let them live in a junk yard?” The answer is yes. However, there are some guidelines I do set with teenagers. I tell them that Mom and Dad are not going to clean their room as long as they comply with the following guidelines:

1. The bedroom door must be able to be closed so no one else has to look at the mess.

2. People can walk by the room without smelling anything such as rotting food.

3. There are no ants or bugs going into or coming out of the room.

4. They do not keep dishes in their room so Mom has dishes when she needs them.

5. They are responsible for getting their clothes out of the room and cleaned. They are also responsible for putting away their laundry.

If they do not follow these guidelines, then they are giving Mom and Dad permission to go in and clean the room as they see fit. I ask the teenager and parents to both agree to these guidelines. I also recommend writing down the guidelines. Therefore, two months from now if someone remembers the agreement differently, you have a document you can refer back to which states what everyone agreed to.

Therefore, I recommend to parents if their teenager can agree to these guidelines, let them live in a junkyard. If they forget to get their clothes to the washer then they will be the one wearing dirty clothes. This is helping them to learn responsibility. It also gives them a sense of independence which they need.

I remind teenagers, if you do not want Mom and Dad cleaning their room then they need to abide by the guidelines. I also remind them it is their responsibility to get their clothes to the washer. If they don’t then they will be wearing dirty clothes to school. I also remind them that they cannot stay home from school because they do not have any clean clothes. I am basically telling the teenager that their parents and I feel they are responsible enough to take care of their room. This again helps the teen feel more mature and understand that they have to start assuming more responsibility for theirselves.

Now for the next issue, searching your teenager’s room. I do not think it is something parents should do on a regular basis just because their child is a teenager. As parents you have a responsibility to make sure you are raising a responsible young adult and if they need help, you have an obligation to provide them with the help they need. Therefore, if you have valid reasons to believe your teenager is using drugs or alcohol on a regular basis, then yes search the room. A valid reason would be noticing the smell of marijuana on their clothes or coming from their room. Finding marijuana or alcohol bottles in their backpack or car that they use. Other signs could be changes in their behavior and grades that are associated with drug use. However, before searching the room, I would recommend when your child enters middle school that you discuss with your child about the conditions which would make you search their room. If you feel it is necessary, tell your teen that you will be searching their room. Obviously, you do not tell them a week a head of time so they can hide things. I suggest you calmly inform them when they are home that you will be starting to search their room in a few minutes. It is important you explain the reasons why you are searching their room.

Parents may be concerned about an argument. This may start an argument, but this argument is worth it. Remind your teen about the agreement the two of you had made about searching their room. If you feel your teenager is not mature enough to abide by the agreement and is likely to start a physical fight, then you do not tell them and search it when they are out of the house. Remember you are only searching the room if you feel your teen is having a serious problem and need professional help. As a parent, it is your responsibility to get them help when they need it. You will want to remember this fact because your teenager may be very angry with you. However, it is better to have an angry teenager than a dead teenager. Many of the drugs teens are using today can kill someone very quickly and teenagers are not usually aware of all the risks.

Therefore, in general respect the privacy of your teenager’s bedroom, however, if you notice signs that indicate your teen is having difficulties then search the room.

As for the last issue that becomes most apparent in the summer is parents feel teenagers spend too much time in their bedroom. They hear them staying up late, sleeping until noon and the rest of the time playing games on their laptops and talking with friends using the games. Yes this can be an issue. The best approach is to discuss this issue prior to summer. However, if you did not, it is not too late. Let your teen know you need to talk to them about their room. Do not attack telling them they are spending too much time in their room. They will simply stop listening and the discussion is over. Before talking to them think about what and why you are concerned about the time in their room. One major reason hopefully is you want the opportunity to spend some time with them. Explain your concerns and some possible solutions you have developed. At this point ask your teen how they feel and do they have any solutions. If you have a calm, caring conversation and you are willing to consider all options, you should be able to resolve the issue. Most teens want to hear that their parents care and want to spend time with them. They tend not to admit to these feeling but they are their. Also teens do better when they feel you have listened to their ideas and are not just telling them what to do.

Dr. Michael Rubino has over 20 years experience as a psychotherapist who teats teenagers and children. For more information regarding Dr. Rubino’s work or private practice visit his website at http://www.RubinoCounseling.com or his Facebook page at http://www.Facebook.com/drrubino 3.

Alarming New Facts about Teenagers and Heroin Use

Alarming New Facts about Teenagers and Heroin Use

Many teens die from suicide and drug abuse. Suicide is now the second leading cause of deaths for children 10 to 24 years old. One thing that contributes to teenage suicide is drug use. Specifically, the use of pain killers and heroin. In this article I attempt to describe both issues for parents. It is important for parents to be aware of these issues if we are going to stop them.

ABC 20/20 did a very good show last year about the epidemic of heroin use in the United States. If you did not see it, you can probably find it on YouTube. Parents this is a show you need to see because many teenagers I work with are not afraid or concerned about how dangerous heroin can be. In fact in 2017, the CDC estimated 494,000 people 12 and older used heroin. The minimum age the CDC is citing is 12 years old. Think about that fact there are 12 year old kids using a highly addictive drug such as heroin.

According to ABC 20/20, 129 people die every year from a heroin overdose. A majority of these deaths are teens and people in their twenties. Heroin is used by people in the lower income level and by people who are the wealthiest in the country. It is used by whites, blacks, Hispanics basically every ethnic group. It is also used by males and females. Therefore, for the families in Lafayette, Walnut Creek and Danville who say we don’t have that problem here, yes you do. Also for parents and educators who think that if their child is in a private school so they are less likely to use, you are wrong too. Heroin crosses all ethnic and economic boundaries. The epidemic is so severe some schools are teaching children in the 6th grade how to use Narcan. This drug can reverse an overdose of heroin if administered in time.

Therefore, parents in the Bay Area, you need to pay attention to this issue and these facts. You might be saving the life of your child or someone else you love.

As stated Heroin use to to be a drug of the past but it is now very popular with teens. Heroin is a cheaper alternative to many other drugs. For $10 a teenager can buy a capsule of heroin. This is much cheaper than other drugs.

Heroin is still mainly snorted or injected. Because it is injected teens are exposing themselves to HIV and Hepatitis C. Both are life threatening conditions with no cure. Also many girls who use heroin get pregnant but don’t realize they are pregnant until the 4th or 5th month. The girls stop using but stoping when you are five months pregnant it is too late for the baby. The babies will be born drug addicted and if they live through withdrawals, these children will have on going health issues and learning disabilities. In addition to exposing themselves to diseases most teens use Heroin with other drugs such as alcohol. This makes the probability of overdosing on Heroin even higher. Heroin lowers a persons breathing rate and the drugs they are combining it with lower the breathing rate even more making an accidental over dose more likely. The person’s rate of breathing becomes so low and they die. If your body doesn’t have enough oxygen to keep your brain a live, your brain stops working and so does your heart and all your other organs. The rate of deaths due to a heroin overdose has increased by a factor of 5 from 2010 to 2017 (CDC). This is a shocking and alarming statistic. Remember 12 year old kids are using heroin so many of those deaths are 12 year old kids.

Why is Heroin coming back and very popular with teens? Heroin is very similar to the Opioid based pain killers that teens have been using for years. However, with the cost of pain killers rising on the streets and becoming harder to get due to new prescription laws, heroin is easier to get and cheaper. Also teens tend to like the high better. It is not uncommon for someone to get addicted after using heroin one time. Also with the Opioid epidemic in our country, teens are now more likely to try heroin because it is easier to get and cheaper.

In the last few years heroin use has doubled in teenagers. What teens are at the highest risk? Those who have been using Opioid pain killers, those abusing marijuana and males. Remember it is very common for teens to combine heroin with other drugs and they are unaware of the impact it has on their breathing. They may collapse and not know why and by the time their friends get them to an emergency room it’s too late. Also teens may go to sleep after using and their breathing rate is so shallow they never wake up.

This is a very dangerous drug. If it doesn’t kill when the teen uses it the drug can kill when the teen is an adult if the teen contracts HIV or Hepatitis C. The rate of teens using this drug has doubled and the amount of people dying from an overdose has increased by a factor of 5 since 2010. Again, parents you cannot ignore this issue. Heroin is being used by upper class children and poor children, athletes, and all races. So it is impacting all teens.

The other major issue with this drug is stopping. Someone cannot just go off heroin. People can die from withdraw. However, finding a treatment center that is affordable or with an open space is very difficult. They may have to wait four months to get into a rehab center. This is very dangerous. When someone decides to stop heroin, they need to enter rehab immediately. If they have to wait even 2 days, they may not make it because they cannot stand the withdrawal symptoms.

If we get involved we can hopefully stop teens from using this highly addictive killer. I have attached a link to a handout by the CDC with facts, warning signs and suggestions to help your son if you think he is using heroin. http://www.cdc.gov/vitalsigns/heroin/

http://www.cdc.gov/vitalsigns/heroin/

In addition to these issues, Heroin and drug abuse is linked to teenage suicide. These drugs besides creating a high, create depression. At times a depression so severe that a teenager decides they would be better off dead and they commit suicide. For the age group 10 to 24 years old, suicide has gone from the third leading cause of death to the second leading cause of death now (CDC). Therefore, we need to pay attention to the pain killers and other drugs kids are using. And yes 10 year old kids are using these drugs too.

Many times the teen has decided they want to get clean and stop using the drug. However, as I mentioned above, finding an affordable treatment program with an open bed can be very difficult. Some teenagers may need to wait 2 months. This can be two months two long. The teenager may be so depressed and tired of living the drug life that they decide to kill themselves rather than endure the emotional and physical pain of waiting two months.

Another point is for some teenagers they have to try four or five times in rehab before they are successful. Again most teenagers are usually dealing with severe depression at this point. For them the thought of trying again and not succeeding is to much to tolerate. Therefore, they chose the option of suicide to eliminate their pain.

Finally, I mentioned a number of teenagers can overdose by accident, however it may not be an accident. Many teens know these drugs very well so they know how to stage what will look like an accidental overdose. Therefore, we really don’t know how many teenagers are committing suicide due to being sick and tired of using drugs and living a drug life. Many of the accidental overdosages could really be suicides. There is no way to tell.

What we know is drug use and suicide are at an epidemic rate for teenagers. It is at a point where we need to get aggressive and provide better access to rehabilitation programs and better access to psychotherapy so the depression can be treated. We need a multi-disciplinary approach to this issue and we need to make it easy for teenagers and parents to use it. We also need to remove the negative stigma and judgement, if someone admits they are addicted and need help. Admitting you need help is an essential first step and it is extremely difficult to do to. Therefore, we don’t need people shaming them for taking that step.

Dr. Michael Rubino is a psychotherapist who has been working with teens for over 20 years and he is considered an expert in this field. For more information about Dr. Michael Rubino and his private practice visit his website at http://www.rubinocounseling.com or his Facebook page at http://www.Facebook.com/DrRubino3.

Why Teenagers Should Not Try to be Their Friend’s Therapist

Why Teenagers Should Not Try to be Their Friend’s Therapist

There is an issue I have encountered many times working with teenagers in psychotherapy that is seldom talked about. The issue is teenager’s trying to act as a therapist to the friends or girl/boy friend. There have been many times that a teen will tell me their girlfriend is suicidal and ask me what they should do to help her? Often a teen will ask could they just bring their girlfriend into one of their sessions. They argue since I am helping them, I can help their girlfriend. At this point we need to have a conversation about how therapy works and the situation that they are in at that point.

In terms of me just seeing the girlfriend, I explain I need parental consent because she is under 18 years old. I also explain if she is suicidal the parents should be involved. Sometimes the teen explains their girlfriend is living in an abusive household and the parents would never agree to psychotherapy. In these situations, I provide the suicide crises number and tell the teen to have the girlfriend call the crises line and they will get her help. Some teens will exaggerate a situation just so I will see the girlfriend. Therefore, it may be a normal argument between a teenager and parent that I may be entering. Therefore, I provide the crises line and 911 so the situation can be assessed. If the girl does need help, I don’t want to ruin the chances of her getting psychotherapy by acting too fast. I also need to be careful how I handle the situation with my patient. If he is wanting me to see his girlfriend, I have established a therapeutic relationship and trust with him and I do not want to spoil that bond.

The other part of this situation and the more important part is the teen trying to act like their friend’s psychotherapist. Many teens feel since they have been coming to therapy and making progress, if I give them some advice they can help their friend. I explain that they do not having the training needed to be a therapist. I also point out they are not emotionally ready to be a psychotherapist. Many teens feel a very close bond to their friends and girlfriends because they have shared a lot of very personal information and have been open emotionally. While this may be true, it is not the same as psychotherapy.

Why is it important to discuss this issue? What if a teen tries to be their friend’s therapist and the friend commits suicide. They teen will be emotionally devastated and blame themselves. The parent of the teen who committed suicide may blame the teen too. Maybe they were not handling the situation correctly and the teen might have been saved if they had been hospitalized. However, the teen was never hospitalized because their friend was acting as the therapist. The teen could be in a lot of trouble. I have seen this happen. I have had parents come in for grief therapy because their child committed suicide and their child’s friend was acting as therapist and keeping everything a secret. This is a very sad and tragic situation for all involved.

Any time I have a teen asking me about a friend I explore the situation to determine if they are acting as therapist. If they are I explain to the teen why this is inappropriate. I acknowledge how close they are to their friend and how much they care about their friend. I then point out because they care so much they want to do what is best for their friend. I ask them how they would feel if their friend committed suicide? I point out that they are in a very difficult situation that they are not emotionally prepared for or professionally trained for. We discuss that this doesn’t mean anything negative about them. We discuss how they are expecting too much of themselves. I explain if they really want to help their friend, they will encourage their friend to seek help or they may need to tell someone such as the school counselor or their friend’s parents. Sometimes they say, “but I promised to keep it a secret.” I explain sometimes you may need to break a promise to help someone. I also point out their friend may initially be mad but if they truly care they need to do what is best for their friend.

Teenage suicide is an epidemic. The CDC just moved suicide from the third leading cause of death to the second leading cause of death for teenagers. The situation where friends try to act like the therapist happens more often than people realize. I had a situation occur this week. After explaining the situation to the teen, they spoke to their friend and their friend is now in therapy. This was a good ending. I would estimate 1 out of 3 teens ask me about their friends and are trying to be the therapist to their friend. Besides teens feeling they can handle this situation because they feel so close to their friend, I believe this occurs due to our views on mental health.

Because of the mental health stigma many teens are reluctant to go to therapy. They don’t want to be labeled as “crazy” or “weird.” Furthermore, it is not easy for teens to get therapy. Many psychotherapist prefer not to work with this age group for various reasons. Also many families cannot afford psychotherapy and many insurance companies do not cover psychotherapy. As a result, teenagers tend to turn to each other when they are encountering emotional issues. Research indicates that teens turn to their friend first when they encounter emotional issues. If we want to stop teenagers from acting like psychotherapist and if we want teenagers to get appropriate mental health care, we need to talk to teenagers about why they can’t act as a friend’s therapist and we need to increase access for teenagers to mental health care and remove the mental health stigma.

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

The Drugs Teenagers are Using Now

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.