The Holidays and Special Need Children

The Holidays and Special Need Children

The Holidays are here and many people expect it to be a great family time and a great deal of fun for the kids. However, this is not true for every family or child. The Holidays can be a very difficult time for a child who has Autism or is on the Autistic spectrum or have other types of Cognitive Disabilities. The noise and having a lot of people being around can be upsetting to them. Also many children on the spectrum are use to a certain daily routine. The festivities of the Holidays can disrupt their routine and upset them.

The Holidays, as I said above, are supposed to be a happy time. Therefore, when parents, who have a child on the autistic spectrum, see their child getting upset or agitated, it is difficult for them. Additionally, many parents who have children on the spectrum worry about how other people will react or judge their child.

All of this worry for the parents and change for the kids can make the Holidays a stressful time for autistic children. I did read a very good article by Lori Lite which has good ideas for parents to use during the Holidays. These ideas can help make the Holidays a happy time for your child and for your family. I would suggest trying these ideas and not worrying how other people may or may not judge your child. Being Autistic is nothing to be ashamed about. I treat many autistic children and they are usually very caring, smart children. We need to change our views regarding autism. It is a medical condition like diabetes or being blind. We make accommodations for children with these issues so we can make accommodations for a child with Autism. Therefore, try some of these ideas to help you and your child enjoy the Holidays.

Get Ready: Social stories, books, and movies can be a big help in preparing your child emotionally for holidays. Comfortable clothing and small dose exposures to holiday sounds can help physically. Think ahead with an eye for anxiety causing issues. If wrapping paper too loud? Use easy open bags or just decorate with a bow. Are the electronic bears with bells at Grandma’s house going to cause sensory overload? Ask her to unplug them before you get there. Let friends and family know about triggers ahead of time. If your child doesn’t like to be hugged suggest a handshake or just a wave. Your friends, family, and special needs children will be glad you did.

Prepare Your Children For Gatherings: Eliminate unnecessary anxiety associated with getting together with family members you rarely see by looking through photos of relatives prior to your event. Play memory games matching names to faces. This will help your children feel more comfortable with people they may not have seen in a while. Aunt Mary won’t seem quite so scary when she bends down to greet your child.

Use Relaxation Techniques: Incorporate deep breathing or other coping strategies into your day. Let your children see you use techniques when you are feeling stressed. Encourage them to use relaxation techniques on a daily basis. Breathing, visualizing, and positive thinking are powerful tools.

Incorporate Positive Statements Into Your Dinner: This is empowering and reflective. Each person at the table can state an attribute of their own that they are thankful for. For example, “I am thankful that I am creative.” Feeling stressed? Try, “I am thankful that I am calm.” Your special needs child can prepare ahead with a drawing or sign language if they want to participate without speaking.

Don’t Rush: It’s simple; none of us are very good at rushing in a relaxed way. The two just do not go together. It is impossible for children or teens to rush without getting angry. Make sure you leave enough time to enjoy the journey and avoid meltdowns. Children with special needs should be given notice of transitions.

Write Things Down: Getting the constant chatter and lists out of your head decreases stress and anxiety. Kids love making lists. Give them a clipboard or dry erase board. Help your child make a list of what they want to do for the holiday. It might be helping decorate or what to pack for self-care relaxation bag. This will help you relax and help your children feel involved. Encourage them to add happy words like laugh or draw a smile face on their list.

Schedule Downtime: Don’t overbook your children. It’s important to use holiday time for relaxation. Try staying in pajamas till noon. Pop your favorite popcorn and watch a movie when you wake up. You’ll be surprised how an hour or two of relaxation can rejuvenate your children’s bodies, minds, and spirits.

Shopping: Avoid taking your children shopping on the busiest shopping days of the year. The chaos, noise of large crowds, and long lines will definitely add stress to your life. If your child is absolutely known to meltdown during shopping you can select a few gifts and bring them home. Set up a shopping experience in your home for your child. The whole family can participate. Have a checkout counter and a gift-wrapping table.

Be Flexible: Relax your expectations and definitions of what a fun experience is for your children. Most of us do not need the full blown exhausting experience of holidays to reflect that we had a good time. A few positive minutes is worth a lifetime of memories!

Let The Children Participate: Let your children do one thing for the holiday that makes them feel proud. Kids can collect acorns or place a few jingle bells into a bowl for a beautiful stress free centerpiece.  Children can fold the napkins or put the forks out. Let them draw a special picture to place on your guest’s chair. Be prepared to accept their participation as perfect and wonderful. Restrain for correcting or straightening out the napkins and enjoy the holidays with your special needs child!

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating children and teenagers. Many of these children and teens are on the Autistic Spectrum. For more information regarding Dr. Rubino’s work or private practice visit his website http://www.RubinoCounseling.com or Facebook http://www.Facebook.com/drrubino3

Teenagers Abusing ADHD Medication

Teenagers Abusing ADHD Medication

As a psychotherapist, who specializes in treating teenagers, I often hear parents concerns about their teenager using marijuana or alcohol. Besides the concern that their teenager may be using there is also the concern about their teenager becoming addicted to alcohol or marijuana. In addition to marijuana and alcohol, parents are concerned about their teenagers using other drugs such as, methamphetamine or heroin. While there is an epidemic of methamphetamine, heroin and opioid addiction in our Country, there is another drug parents need to be concerned about.

Methamphetamine is a very popular drugs with teens because it is easy to get and there are a number of ways to use it. Also many teenagers like the effect that they receive from methamphetamines. They get an adrenal rush and can stay up for days at times. Therefore, it makes it easier for them to get all their work done and study for tests. Many teenagers are involved with numerous school activities, trying to maintain a good grade point average and want to spend time with their friends. They often find out that they don’t have enough energy to keep up with their schedule. The boost they receive from the methamphetamine helps them keep up their schedule and to complete all their school assignments. However, buying methamphetamines can be a dangerous thing to do and if they are caught with methamphetamines, they are in a lot of trouble.

Many teenagers do not want to run the risk of being caught with or buying methamphetamines. Therefore, teenagers have found away around the risk, medications for Attention Deficit Hyperactivity Disorder (ADHD). Most medications for ADHD such as Ritalin or Concerta are stimulant based. In other words, they contain a form of methamphetamine. Therefore, if a high school student who does not have ADHD takes Concerta, they experience the same effect as if they took methamphetamine such as cocaine. They get a burst of energy and can stay up all night so they can finish their work.

During mid terms and finals (which are occurring now), I hear many teenagers talk about taking Concerta or other ADHD drugs so they have the energy to study and complete all their assignments while still spending time with friends. Some teenagers will complain to their parents they have noticed they have problem paying attention in class and concentrating on their homework. They hope their parents will think maybe they may have ADHD and need medication. If they are successful, their parents will take them to the physician so they can get a prescription for ADHD medication. On the other hand, teenagers who are suppose to be taking medication for ADHD often sell their medication. They can sell it very easily to friends at school and they can make good money too. Many of these teenagers feel they don’t need their medication so they are happy to sell it.

The buying and selling of ADHD medications on high school campuses is a daily occurrence. Most research studies indicate it starts in 8th grade and continues in high school. Many teenagers rely on ADHD medications to help them when they feel they are falling behind in school. Many teenagers see no problem using the ADHD medications because they were prescribed by a doctor. However, they were not prescribed to them. Therefore, the dosage they are taking may be too much for their body. If this is the case, one negative side effect is a very rapid heart rate which can damage the heart muscle. Also I have seen teenagers combine these medications with energy drinks which have very large amounts of caffeine. I have had teenagers report they felt like their heart was going to come out of the chest because it was beating so fast. In addition, they also report not being able to sleep for days because they are “wired”.

This is a major danger when teenagers use ADHD medications to stay awake. They can become wired the same way as if they used cocaine or smoked methamphetamines. Also taking these ADHD medications opens the door to teenagers experimenting with such drugs as cocaine. They like the effect of the ADHD medication and wonder how other drugs may feel or they may not be able to get their ADHD medication any longer so they start experimenting. In fact, research indicates that teenagers who abuse ADHD medication are more likely to use methamphetamines or heroin.

In addition to opening the door to other drugs, they are risking their health and life. If they heart rate is racing and their blood pressure is rising they can induce a heart attack. Also parents may notice there is something wrong, but if they do not know their teenager has been taking ADHD medication, there is no way for a parent to tell a physician. Therefore, the teenager may not get the medical help they need in time. In addition to the physical symptoms, using too much methamphetamine can cause psychotic symptoms and the teenager may need to be hospitalized. The bottom line is just because the ADHD medication came from a pharmacy does not make it safe for everyone. I have included a link for parents which discusses the dangers and symptoms that parents need to be aware of regarding teenagers abusing ADHD medications https://drugabuse.com/library/adderall-abuse/#effects-of-adderall-abuse.

Hopefully, parents can take this information and discuss the situation with their teenagers. Encourage them that if they are feeling overwhelmed by school and life to talk to you not to turn to a drug. A drug will never solve the problem and more likely create more problems. Also let your teenager know all you expect is the best they can do naturally. You do not expect perfection.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating teenagers and children. He is a founding member of the National Advisory board for the Alive and Free program. For more information regarding Dr. Rubino’s work or private practice visit his website http://www.RubinoCounseling.com or his Facebook page http://www.Facebook.com/drrubino3.

Helping Parents with IEP terms

Helping Parents with IEP terms

The school year is starting and so are IEP meetings. An IEP refers to an Individualized Educational Plan that the parents and school agree upon. This plan is a legal agreement which states the school environment and accommodations a child needs in order to benefit from their education. Unfortunately not all schools tell parents about all of their rights they have at their child’s IEP meetings (Individualized Educational Plan). Also they do not fully explain all the terms. This creates a great deal of confusion and anxiety for parents. Typically any time I write an article regarding IEPs, I receive emails from parents across the country asking if they are being treated fairly in their IEP meetings.

A common term that is used at IEP meetings is Least Restrictive Environment. At times this term is used to deny a child services. Parents may be asking about Resource Assistance or a Special Day Class and the school may say the Resource Room is not an option because it is not the least restrictive environment. They may insist that the child be placed in a general educational classroom. In other words, the typical classroom people think about when they think of a classroom. However, placing a child in a general education classroom or school is not always the least restrictive environment. Also schools and at times parents may worry about how much inclusion their child will be receiving with the proposed IEP.

Inclusion refers to providing children, who need special educational services, access to the general educational atmosphere and students. However, this is not always the least restrictive environment for your child. The least restrictive environment is the environment in which your child will benefit the most from their education. This may not always be a general education classroom. Remember, least restrictive refers to the environment where your child has the least amount of difficulties learning so they can benefit fully from their education. Therefore, a Special Educational Classroom may be the least restrictive environment for your child depending on their educational needs. If they will benefit more from their education in a Special Day Classroom then that is the least restrictive environment for your child.

This can be a confusing term to understand especially since most people have been lead to believe that inclusion is the same thing as the least restrictive environment. I have included a link to a video which further explains this term. I strongly recommend you watch it so you have a clear understanding of what least restrictive environment refers to and what inclusion refers to https://youtu.be/I7HFRF8y288.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating children and teenagers in Special Education. He often assists parents with IEPs and school accommodations. For more information about Dr. Rubino’s work or private practice visit his websites http://www.RubinoCounseling.com or http://www.LucasCenter.org.

Fourth of July Activities and Teenage Injuries

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.

Memorial Day A Day We Need to Look at Our Actions

Memorial Day A Day We Need to Look at Our Actions

It’s Memorial Day weekend and it’s also the beginning of graduations too. For many teenagers this means parties, hanging out with friends and staying out late. It’s a popular weekend to celebrate by drinking and some head for the beaches or swimming pools depending on the area you live in. 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 by breaking their back. Concussions are very common and can have life long effects on someone.

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. These injuries can occur in car accidents too.

With it being the Memorial Day weekend and the beginning of graduations and graduation parties, 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 your teenager 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.

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 now the second leading cause of death for teenagers (CDC). 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.

Also the ironic part to this weekend is it really a time to honor the men and women who have served in the military. To remember all those soldiers who have been killed, injured for life or coping with Post Traumatic Stress Disorder or a Traumatic Brain Injury, so we can benefit from a democracy that allows us the freedom to live our lives how we want to live life. So we can go to church if we want and express our opinions without having to fear for our lives.

However, over time we have forgotten the meaning of today. Therefore, we do not value what we have and take chances with our lives we do not need to take. We also forget the veterans who are paralyzed or trying to cope with PTSD and reliving the war they were in daily. This also has a major impact on veteran’s families too. Another fact we forget.

May be if we take a few minutes to remember the true meaning of this weekend, we will value life more and be less likely to take senseless chances such as driving drunk. We may also remember the veterans who are still struggling with their injuries today and ensure they get the help they need and deserve. Many do not and as a result the suicide rate for veterans is very high compared to the general population. There are few treatment option for them too. A very sad fact when they provided us with the freedom we enjoy daily.

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, his private practice or to contact him visit his website at http://www.RubinoCounseling.com or his Facebook page http://www.Facebook.com/drrubino3.

Issues related to Teenage Concussions

Issues related to Teenage Concussions

Many high school students look forward to participating in high school sports and other physical activities as part of their high school experience. While school may be ending for the year, many athletes will be practicing over the summer for next years games. Football is one example of a sport where the players practice the entire summer in order to be ready for the next school year’s season. Typically most people look at the fun and the positive experience these activities provide for students. However, high school athletes do get hurt, sometimes seriously. High school athletes do suffer broken arms and legs, but they also suffer concussions, traumatic brain injuries and spinal cord injuries. Parents are now learning that “basic” concussions in teenagers are more common than people think and can create more problems that people think. A concussion can cause physical impairment such as not being able to walk or emotional issues such as a teenager suddenly having anger problems or depression. Unfortunately, this year we had example of these issues, when a wrestler from College Park High School suffered a spinal cord injury and was paralyzed.

As a result of these head injuries, many teenagers develop Post Concussion Syndrome after a concussion. Teenagers can have violent mood swings, difficulties concentrating and with memory. This can cause problems at school and with family and friends. I have seen teenagers who get so depressed by these changes that they become suicidal. Post Concussion Syndrome can last a year and often physicians do not warn parents or teenagers about this syndrome. This makes matters worse because they feel like they are crazy because they don’t understand why they have the symptoms. Also these symptoms can create problems at school that the student may need accommodations for in order for the student to understand the classes.

We have been hearing more and more about concussion in professional sports in recent years. We have also seen professional athletes walk away from their careers because they are not willing to risk the after effects of multiple concussions. A fact that some in professional sports do not want to be publicized. Will Smith stared in a movie regarding a professional football player and how his life significantly changed after several concussions. The National Football League tried to stop this movie from being made and shown, but they lost.

However, we do have examples. Mohammad Ali is the most notable example of how multiple concussions can change a person and leave them disabled. Also a news anchor for ABC News documented how his life changed after receiving a traumatic brain injury while covering the war in Afghanistan.

Concussions, Traumatic Brain Injuries and Spinal Cord Injuries also occur in teenagers. Teen athletes such as football players routinely suffer concussions, traumatic brain injuries or spinal cord injuries. Many of these athletes suffer permanent brain damage such as difficulty remembering things or emotional issues such as mood swings. Also a number of high school athletes do die from concussions every year.

A research study from Boston University released shows that boys who play football before the age of 12 years old are more likely to have memory problems and problems making decisions as adults. This study also shows that boys who play football before age 12 are three times more likely to develop clinical depression as an adult. The study suggests the reason this occurs is because around the age of 12, a child’s brain is undergoing a great deal of development at this age. Robert Stern, one of the authors of the study, explained that “the brain is going through this incredible time of growth between the years of 10 and 12, and if you subject that developing brain to repetitive head impacts, it may cause problems later in life.”

Another MRI study, by the Wakes Forest School of Medicine, showed that boys between the ages of 8 years old to 13 years old who played even just one season of football showed signs of diminished brain function.

High school athletes are not the only teenagers at risk for concussions or other serious injuries. Teens in general are at risk because teens are willing to engage in risky behavior such as jumping off something or racing cars. Many teens feel they are safe. They hear about these issues but think it would never happen to them. However we never know who it will happen to. Therefore, parents you need to educate and monitor your teenager’s behavior. If you have a teen athlete, you may need to make the decision to stop them from playing a sport if they have suffered a couple concussions. This is not easy but you must think of their lives after high school.

Also boys are not the only ones at risk for concussions. Girls are at risk for concussions and other serious injuries. In fact, some studies show that cheerleaders are at a higher risk of getting a concussion than football players. Cheerleaders do not use helmets and have no head protection. Also many people assume a child needs to be knocked out in order to sustain a concussion. This is not true. You can sustain a concussion without losing consciousness. So football players are not the only one at risks. Any high school athlete is at risk – boy or girl. Anything that causes a jarring of the head can cause a concussion. Our brain sits in fluid in our skull. Therefore any jarring force can cause the brain to hit the side of the skull and cause a concussion. This is why all high school athletes are at risk for concussions.

I have included a link to a YouTube video where a physician describes the basic information about what happens to a brain during a concussion and the process of recovery from a concussion. This is a must see for any parent https://youtu.be/zCCD52Pty4A.

In addition to this video I have included a fact sheet from the CDC regarding information about concussions for you to review http://www.cdc.gov/headsup/pdfs/schools/tbi_factsheets_parents-508-a.pdf.

I have also included this link from the CDC which helps parents, coaches and schools https://www.cdc.gov/headsup/.

Parents need to talk to their teenagers’ school and coaches regarding making sure that they use the latest safety equipment for their sport. Parents may even want to research what the latest safety equipment so if your teen’s school is not using the latest safety equipment, you can inform the school. The ultimate goal is we want high school sports to be fun and safe for high school students.

Dr. Michael Rubino has over 20 years experience working with teenagers and their families. For more information on Dr. Rubino’s work or private practice, where he treats Post Concussion Syndrome, please visit his website at http://www.RubinoCounseling.com or follow him on Twitter @RubinoTherapy.

Facts about Teenage Mental Health Care in the United States

Facts about Teenage Mental Health Care in the United States

The week is dedicated to children’s mental health care. As a psychotherapist who specializes in treating teenagers, I have seen how teenagers and their parents do not receive the access to the mental health care they deserve. Hopefully this article will explain what teenagers and their parents currently deal with and the changes that we need.

We often hear parents complain that their teenager is driving them crazy or a teenager complaining how unfair their parents are to live with on a daily basis. However, there are another set of complaints that get ignored on a routine basis. The complaints that get ignored are parents begging for mental health care for their teen or a teen crying out for help by cutting themselves or running away.

Many of us assume that if a parent wants mental health care help for their teen or if a teen needs help, all either one of them has to do is ask for help. Unfortunately, this is not how our world works.

It is very common for parents to ask everyone they can think of for help for their teenager and the only answer they get is, “I am sorry we cannot help you or your child.”

It is also not uncommon for teens to ask for help by admitting to someone that they are feeling suicidal and the teen is told stop being so dramatic or “sorry there is nothing we can do for you, but try calling this number.”

Some of you may assume that I must be exaggerating, but I am not. I have had many parents beg me to see their child because no one has any appointments or they don’t deal with teen issues. When I interview the parents, they have been every where asking for help, but no one has offered any help or referred them to someone else because they don’t deal with their child’s issues.

For example, one Thanksgiving I had a mother have my answering service page me and she was begging me for help because her teen was suicidal. I was referred her to the mother by the County hospital because the County hospital said they had no room for her son. When speaking to the mother it was obvious the teenager needed to be hospitalized. When I asked her why her son was not in the hospital, she again told me the County hospital gave her my telephone number because they had no more beds for suicidal teenagers. No one in the system cared what she was dealing with and how concerned she was about her son.

Again, some people might believe this is an isolated case. Sadly this is not an isolated case. I specialize in treating suicidal and bipolar teens. There have been a number of times I have sent a suicidal teen by ambulance from my office to the County hospital only to have the teen released in less than an hour because the hospital had no beds. I had one person on the Psychiatric Crises Unit tell me on the telephone unless the person had a shotgun in their mouth not to send them to the Hospital because they had no beds for suicidal teens.

Now, some of you may assume the situation would be different if the teen had private insurance because I have been referring to the County Hospital. If you are thinking having private insurance would make a difference, you are wrong. I have had many private insurance companies deny my request to authorize additional therapy sessions for a suicidal teenager. When I remind the insurance that the teen is suicidal and needs therapy to prevent them from acting on their feeling, they often say to refer them to a community counseling center. When I remind them that most non-profit counseling centers have closed due to the economy they simply say sorry they have exhausted their benefits and they will no longer cover their treatment.

This puts the therapist in a difficult position. Do you just discharge the teen or do you continue to treat the teen for a low fee or for free? When 1 out of 5 teens have a psychological condition that needs treatment, what do you do when treatment is denied or there are no treatment options? Also, when you examine the results further you find that teens who need therapy but fail to receive it are more likely to get involved with drugs, crime, are more likely to drop out of school, more likely to get pregnant or father a child and that child is more likely to become a foster child. These teens are also more likely to end up on probation, homeless and on welfare.

As a society we do not place much emphasis on mental health care. Mental health care programs are always some of the first programs cut when the budget is cutback. In fact if you look at the recent cut backs due to the Congress not balancing the budget, mental health programs were some of the first programs to be cut.

I find it very interesting that Contra Costa County had enough money to build a new Juvenile Hall, which is three times the size of the old Juvenile Hall, but there was not enough money to fund a large number of mental health services which had to be cut.

We often look at teens who are acting out and blame their parents. We ask why don’t they get their child the help they need? What stops them from helping their teenager? Why is the teen always getting involved with drugs or not going to school? The answer could be because the teen needs mental health care and the parents have been and continue to try to get their teen help but their is no help. The teen may be acting out because they are tired of asking for help and being in pain so they start looking for the easiest way out of pain.

If we want our teenagers to grow up to become productive members of society then we need to provide them with the mental health care they need. If we want parents to be responsible parents then we need to provide parents options for how to get their teens help when they ask for it.

What can we do? We can write our Congressmen and Senators and demand that they fund community mental health centers. We need more mental health clinics. We don’t need an useless wall on the Southern border.

We can also demand that private insurance companies be required to offer teenagers and their families adequate mental health benefits based on what professional therapists are recommending. The professional treating the child knows what the child needs not some clerical worker with a Bachelors degree who is answering phone calls at the insurance company.

In short, if we want our teenagers to survive their teen years we all need to act together and demand that our children receive the treatment they need and deserve. Private insurance companies make huge profits and drive the cost of health care up based on how they do business. If we don’t start to speak up for our kids, they will never receive the care they need. Look at your next pay stub and look at how much you pay for health insurance and compare that to the benefits you receive.

Dr. Michael Rubino has over 20 years experience treating children and teenagers. If you would like more information about his work or private practice visit his website at http://www.RubinoCounseling.com.

How to Have A Safe Super Bowel Party

How to Have A Safe Super Bowel Party

This weekend people will be watching the playoffs to see who will plain in the Super Bowl. As I stated in my previous article for many it is a day to party and have fun, but it is also the day when the most domestic violence occurs. This statistic is for adults and teenagers. So, how do you have a safe, fun Super Bowl Sunday? You need to develop a plan that reduces stress and too much drinking.

First, remember that it is just a day and just a football game. Therefore, if everything is not perfect such as you don’t have all the food you wanted or things are not arranged how you wanted, do not stress over it. You can still enjoy the game without a lot food or alcohol. Also if everything is not arranged perfectly, you can still enjoy the game. In other words, do not stress and argue over minor details.

If you are going to have small children around, set up a separate room with food and activities for them. Many children under 10 years old will lose interest in the game and if there is nothing else for them to do, they will want attention and distract people from the game. Therefore, set up another room where they can watch other television shows and have games to play. This way they are not bored and they can enjoy themselves.

People drinking too much is a common problem during Super Bowl parties. Therefore, when your friends arrive, tell them you care about them and their safety. Therefore, you want everyone to put their car keys in the basket as they enter. This way if someone accidentally has too much to drink, you can give them a ride home. This way if someone has too much to drink, you don’t have to argue about them driving if they are not safe to drive. This can help avoid an argument and a possible physical fight.

Also watch how much alcohol you are serving. If you are serving alcohol, serve food too. The food helps to absorb the alcohol and decreases the likelihood that someone will drink too much. Also towards the end of the game stop serving alcohol and switch to sodas. If someone has had too much to drink, this gives them a chance for their body to process the alcohol they consumed so they can lower their blood alcohol level.

Another good idea is to set rules for your party. Announce to your guests that you want everyone to have a good time and no arguing or fighting. Therefore, cheering for their team or favorite player is fine, but you do not want any name calling nor is there to be any insulting other people at the party. Also good nature teasing is fine but no swearing and if someone asks you to stop the joking, respect their request. Bottom line, state that regardless of who wins or loses, you expect everyone to act like adults and to treat each other respectfully so it is a fun day for everyone.

It would also be helpful to remember the acronym HALT:

H – hungry

A – angry

L – lonely

T – tired, too much alcohol

If you notice someone expressing these emotions or drinking too much, this is a situation which could result in an argument or violence. Therefore, if you notice a potential violent situation, try talking to the person to see what is bothering them. If you notice a couple arguing try having one person step outside with you for a time out so they can calm down. You may want to let them know that they seem slightly upset and you are just checking-in to see if there is a problem and if you can help. Instead of ignoring the situation try to offer some help so people can calm down. This can help a great deal.

At the end of your party, if someone is not sober enough to drive, offer to drive them home. Remember all the car keys are in a basket so you do not have to argue to get the car keys. Remind them that you are only offering to drive because you care about them. You do not want to see them arrested for driving under the influence, you do not want to see them get into a car accident and you definitely do not want to see them kill someone else or themselves in a car accident.

If you notice a couple who appear to be arguing, offer to allow one person to stay for a while and you will drive them home later. Giving them a chance to calm down could help avoid a domestic violent incident. If after a little while the person at your house or the person who went home tells you they do not feel safe around the other person right now – listen to them! Offer to let the person stay at your house for the night. You do not want to assign blame to anyone. Simply state that they seem to be having a stressful day and instead of them both staying in the same house that night and arguing all night and arguing in front of the children is not a good idea. It is okay if they need to take a break for the night and talk about it tomorrow. You are providing them and the children with a safe environment and hopefully avoiding a domestic violent incident. Many people are afraid to step in and offer help when they see a potential domestic violent situation. However, if more people offered to help and did not shame the family, the incidence of domestic violence could decrease and more people may be willing to seek help.

If you are a couple who are having incidents with domestic violence, discuss the issue before the day. Hopefully, the two of you are in psychotherapy and can discuss the issue in a therapy session. Discussing a potential problem with a therapist or even a friend prior to the event can be very helpful. If you are not in therapy and afraid to talk to a friend and do not feel safe call the following number for help: The National Domestic Hotline 1-800-799-SAFE (7233). Someone will answer 24 hours a day, 356 days a year. Do not be embarrassed to call. If you need help, please reach out and ask for it before someone gets seriously injured or killed.

Hopefully these suggestions help and you can enjoy the game in a fun peaceful environment.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating teenagers and he is certified to assess and treat domestic violence. If you want additional information regarding Dr. Rubino’s work or his private practice visit his websites http://www.rcs-ca.com, http://www.RubinoCounseling.com or his Facebook page http://www.Facebook.com/drrubino3.

Facts About High School Sports and Concussions

Facts About High School Sports and Concussions

Many high school students look forward to participating in high school sports and other physical activities as part of their high school experience. While school may be ending for the year, many athletes will be practicing over the summer for next years games. Football is one example of a sport where the players practice the entire summer in order to be ready for the next school year’s season. Typically most people look at the fun and the positive experience these activities provide for students. However, high school athletes do get hurt, sometimes seriously. High school athletes do suffer broken arms and legs, but they also suffer concussions, traumatic brain injuries and spinal cord injuries. Parents are now learning that “basic” concussions in teenagers are more common than people think and can create more problems that people think. A concussion can cause physical impairment such as not being able to walk or emotional issues such as a teenager suddenly having anger problems or depression. Unfortunately, this year we had example of these issues, when a wrestler from College Park High School suffered a spinal cord injury and was paralyzed.

As a result of these head injuries, many teenagers develop Post Concussion Syndrome after a concussion. Teenagers can have violent mood swings, difficulties concentrating and with memory. This can cause problems at school and with family and friends. I have seen teenagers who get so depressed by these changes that they become suicidal. Post Concussion Syndrome can last a year and often physicians do not warn parents or teenagers about this syndrome. This makes matters worse because they feel like they are crazy because they don’t understand why they have the symptoms. Also these symptoms can create problems at school that the student may need accommodations for in order for the student to understand the classes.

We have been hearing more and more about concussion in professional sports in recent years. We have also seen professional athletes walk away from their careers because they are not willing to risk the after effects of multiple concussions. A fact that some in professional sports do not want to be publicized. Will Smith stared in a movie regarding a professional football player and how his life significantly changed after several concussions. The National Football League tried to stop this movie from being made and shown, but they lost.

However, we do have examples. Mohammad Ali is the most notable example of how multiple concussions can change a person and leave them disabled. Also a news anchor for ABC News documented how his life changed after receiving a traumatic brain injury while covering the war in Afghanistan.

Concussions, Traumatic Brain Injuries and Spinal Cord Injuries also occur in teenagers. Teen athletes such as football players routinely suffer concussions, traumatic brain injuries or spinal cord injuries. Many of these athletes suffer permanent brain damage such as difficulty remembering things or emotional issues such as mood swings. Also a number of high school athletes do die from concussions every year.

A research study from Boston University released shows that boys who play football before the age of 12 years old are more likely to have memory problems and problems making decisions as adults. This study also shows that boys who play football before age 12 are three times more likely to develop clinical depression as an adult. The study suggests the reason this occurs is because around the age of 12, a child’s brain is undergoing a great deal of development at this age. Robert Stern, one of the authors of the study, explained that “the brain is going through this incredible time of growth between the years of 10 and 12, and if you subject that developing brain to repetitive head impacts, it may cause problems later in life.”

Another MRI study, by the Wakes Forest School of Medicine, showed that boys between the ages of 8 years old to 13 years old who played even just one season of football showed signs of diminished brain function.

High school athletes are not the only teenagers at risk for concussions or other serious injuries. Teens in general are at risk because teens are willing to engage in risky behavior such as jumping off something or racing cars. Many teens feel they are safe. They hear about these issues but think it would never happen to them. However we never know who it will happen to. Therefore, parents you need to educate and monitor your teenager’s behavior. If you have a teen athlete, you may need to make the decision to stop them from playing a sport if they have suffered a couple concussions. This is not easy but you must think of their lives after high school.

Also boys are not the only ones at risk for concussions. Girls are at risk for concussions and other serious injuries. In fact, some studies show that cheerleaders are at a higher risk of getting a concussion than football players. Cheerleaders do not use helmets and have no head protection. Also many people assume a child needs to be knocked out in order to sustain a concussion. This is not true. You can sustain a concussion without losing consciousness. So football players are not the only one at risks. Any high school athlete is at risk – boy or girl. Anything that causes a jarring of the head can cause a concussion. Our brain sits in fluid in our skull. Therefore any jarring force can cause the brain to hit the side of the skull and cause a concussion. This is why all high school athletes are at risk for concussions.

I have included a link to a YouTube video where a physician describes the basic information about what happens to a brain during a concussion and the process of recovery from a concussion. This is a must see for any parent https://youtu.be/zCCD52Pty4A.

In addition to this video I have included a fact sheet from the CDC regarding information about concussions for you to review http://www.cdc.gov/headsup/pdfs/schools/tbi_factsheets_parents-508-a.pdf.

I have also included this link from the CDC which helps parents, coaches and schools https://www.cdc.gov/headsup/.

Parents need to talk to their teenagers’ school and coaches regarding making sure that they use the latest safety equipment for their sport. Parents may even want to research what the latest safety equipment so if your teen’s school is not using the latest safety equipment, you can inform the school. The ultimate goal is we want high school sports to be fun and safe for high school students.

Dr. Michael Rubino has over 20 years experience working with teenagers and their families. For more information on Dr. Rubino’s work or private practice, where he treats Post Concussion Syndrome, please visit his website at www.RubinoCounseling.com or follow him on Twitter @RubinoTherapy.

New Drugs Teenagers are Using

New Drugs Teenagers are Using

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.

Spring Break is occurring and summer break is around the corner and for many teenagers this means partying and using drugs. One major issue is many Emergency Room physicians cannot keep up with all the new drugs. Therefore, if a teenager ends up in the Emergency Room due to overdosing or having a bad reaction to one of these new drugs, a teenager may die before an Emergency Room physician determines what the teenager took and how to treat it. The show The Good Doctor recently had an episode which addressed this issue. The teen had used, Molly, not a new drug but because there were so many options, the teenager almost died before they could determine how to treat him.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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