The New High School Drugs

The New High School Drugs

High school students are out of school for the next two weeks for Winter 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.

Winter break is only two weeks so many teens will want to get in as many parties as they can. During winter 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.

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Helping a Teenager Grieve a Death

Helping a Teenager Grieve a Death

It is the Holiday Season and many people are grieving for loved ones who past away during this past year. Also many people are dealing with a recent death due to a motor vehicle accident possible as a result of someone drinking while driving. Our society does not deal with death in a healthy manner. Therefore, many people do not know what to do for or what to say to someone who is grieving. Many patients have asked me about what to do in these situations. While doing research regarding grief for patients, I found this information from the grief center. I think it is very good information and very easy to understand. Therefore, I will present the information in three sections.

The 10 Best and 10 Worst Things to Say to Someone in Grief

Sheryl Sandberg’s post on Facebook gave us much insight into how those in grief feel about the responses of others to loss. Many of us have said “The Best” and “The Worst.” We meant no harm, in fact the opposite. We were trying to comfort. A grieving person may say one of the worst ones about themselves and it’s OK. It may make sense for a member of the clergy to say, “He is in a better place” when someone comes to them for guidance. Where as an acquaintance saying it may not feel good.

You would also not want to say to someone, you are in the stages of grief. In our work, On Grief and Grieving, Elisabeth Kubler-Ross and I share that the stages were never meant to tuck messy emotions into neat packages. While some of these things to say have been helpful to some people, the way in which they are often said has the exact opposite effect than what was originally intended.

The Best Things to Say to Someone in Grief

1. I am so sorry for your loss.

2. I wish I had the right words, just know I care.

3. I don’t know how you feel, but I am here to help in anyway I can.

4. You and your loved one will be in my thoughts and prayers.

5. My favorite memory of your loved one is…

6. I am always just a phone call away

7. Give a hug instead of saying something

8. We all need help at times like this, I am here for you

9. I am usually up early or late, if you need anything

10. Saying nothing, just be with the person

The Worst Things to Say to Someone in Grief

1. At least she lived a long life, many people die young

2. He is in a better place

3. She brought this on herself

4. There is a reason for everything

5. Aren’t you over him yet, he has been dead for awhile now

6. You can have another child still

7. She was such a good person God wanted her to be with him

8. I know how you feel

9. She did what she came here to do and it was her time to go

10. Be strong

Best & Worst Traits of people just trying to help

When in the position of wanting to help a friend or loved one in grief, often times our first desire is to try to “fix” the situation, when in all actuality our good intentions can lead to nothing but more grief. Knowing the right thing to say is only half of the responsibility of being a supportive emotional caregiver. We have comprised two lists which examine both the GOOD and the NOT SO GOOD traits of people just trying to help.

The Best Traits

Supportive, but not trying to fix it

About feelings

Non active, not telling anyone what to do

Admitting can’t make it better

Not asking for something or someone to change feelings

Recognize loss

Not time limited

The Worst Traits

They want to fix the loss

They are about our discomfort

They are directive in nature

They rationalize or try to explain loss/li>

They may be judgmental

May minimize the loss

Put a timeline on loss

The above information is meant to be used as a guideline. Everyone goes through the grieving process in their own way. It is very important to understand that point. It is also important to remember while the above is a guideline, the most important thing is your intent. So if you say a worse thing but you said it out of love the person will understand. The guideline will hopefully make you more comfortable to offer support to your grieving loved one or friend. Because someone who is grieving need people to talk to without people feeling awkward. Also everyone is around immediately after the death and through the funeral services. Most people then go back to their normal lives. However, those who were really close to the person are still grieving and trying to figure out how to proceed with life. So don’t forget the person who is grieving can use emotional support for the first year especially. Therefore, do not forget to call, send a card or stop by occasionally. Especially around the holidays and birthdays.

Dr. Michael Rubino has over 20 years experience as a psychotherapist treating adolescents, children and their families. For more information regarding Dr. Rubino visit his website http://www.RubinoCounseling.com or his Facebook page http://www.Facebook.com/drrubino3 or follow him on Twitter @RubinoTherapy

Parents Cannot Be Their Teenager’s Best Friend

Parents Cannot Be Their Teenager’s Best Friend

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

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

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

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

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

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

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

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

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

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

Why Are We Ashamed about Mental Health?

Why Are We Ashamed about Mental Health?

When people hear about mental health they often think about people sleeping in the street or eating out of garbage cans. However, this is not the reality. Mental health issues are the same as physical health issues. They need to be treated. Diabetes is caused by a chemical imbalance, the chemical being insulin. Depression is caused by a chemical imbalance. The amount of serotonin is off for a person dealing with depression. Therefore why should we treat them differently?

This stigma does result in people succeeding at Suicide and it can destroy families because someone does not seek mental health care. If they commit suicide, this impacts the entire family. The shooting in Thousand Oaks is an example of what can happen when people don’t receive mental health care. The mother said she had been afraid of her son for a long time and tried to seek help. The mother lived for years in fear of her son and now she has to live with the fact that her son murdered 12 people and injured many more. All because of the negative stigma associated with mental health care and the lack of mental health care.

I have included a link to a video by Heads Together where a husband and wife discusses how the stigma associated with mental health impacted their family. https://www.facebook.com/201404780244288/posts/671244049927023/

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

Facts about Bullying at School

Facts about Bullying at School

Many kids, despite what they say, really enjoy school. They like seeing their friends, their teachers and learning. However, some kids are not as excited and even worried about going to school. Many of these kids have been bullied and they are afraid of being bullied again. October is National Bully Awareness month and these article will provide you with information you need to protect your child from being bullied. Hopefully, we may even be able to stop bullying.

Often when a child is being bullied they do not say anything to their parents until the bullying is really bad. They are afraid, especially boys, that you will see them as weak. They are also afraid that you will be disappointed in them for not defending themselves. Parents you have not said anything or done anything to create this feeling in your child. Our society teaches children these messages, especially boys. Children receive these messages from television, music, video games about being strong and defending yourself. This is what the documentary “The Mask You Live In”, is trying to address. It is on Netflix and it might be helpful if you watch it.

It is very important to take bullying very seriously these days. It is no longer just one kid calling another kid names. The bullying today occurs at school and may include threats of being killed and it goes beyond school. Now bullies can continue their bullying via text messages, emails, Facebook, Twitter, Instagram and Snapchat. So the bullying becomes non-stop. It can really make someone feel worthless and that they would be better off dead. We have an example of this from a 13 year old boy, on the east coast, who committed suicide because he could not tolerate the bullying any longer. The boy committed suicide to escape the bullying. He is not the first child to commit suicide due to bullying. One 15 year old girl committed suicide due to bullying and she left a note to be placed in her obituary. In the note she asked kids to be kind to each other. Some kids are turning to drugs and alcohol to numb the pain and we are seeing a significant number of accidental overdosages resulting in teenagers’ deaths. We assume they were accidents, they could also be suicides staged to look like accidents.

Bullying is not just an elementary school issue. It occurs in High School and College too. Remember a few years back a college student committed suicide because his roommate secretly filmed him in his dorm room with another guy having sex. When the tape was posted on the college’s email for others to see, the boy was so ashamed because he had not made it publicly known that he was gay. He did not know what to do and ended up committing suicide.

As the rates for bullying, suicide and drug use increase with kids in middle school and now beginning in Elementary school, we must take this issue seriously. I know it is now a very serious problem in Elementary schools because the third leading cause of death for 10 year old children is suicide according to the CDC statistics.

Also a common problem I see elementary children for in psychotherapy is bullying. Many of these children are embarrassed because they feel they should be able to stop the bullying. They are also embarrassed and often don’t want me to tell their parents because they believe they must of done something to deserve being bullied. I explain to them they do not deserve it and they should not have to stop it on their own. I also explain that their parents would want to know so they can help them. I need to emphasize that Mom and Dad won’t blame you or be ashamed of you. It is amazing to see how relaxed these children become when I tell them this about their parents.

What should a parent do? One thing is parents should watch for the following warning signs that your child is a victim of a bully:

Avoiding activities they used to enjoy

Loss of friends or avoiding social situations

Problems sleeping

Complaining of stomachaches or headaches

Loss of appetite

Declining grades

Missing or damaged clothing or belongings

Self-destructive behaviors like running away from home

If you notice any of these or just have a sense something is wrong then talk to your child. However, when you talk to your child reassure them they did nothing wrong, there is nothing wrong with them and you are not upset or disappointed with them. Try to develop a game plan of how you are going to deal with it together and ask how you can be supportive. Also ask your child to promise you if they feel really sad like they want to hurt themselves that they will talk to you before they do anything. You may think this is ridiculous, but I use a no suicide contract with many children that I work with and they honor it. The contract lets them you know that you care about them.

The other thing you can do as a parent is go to your child’s school and ask what is the school’s policy on bullying. You can also ask how the school watches for bullying, how is the policy enforced and what is being done to prevent bullying. You may ask the school to contact or you can volunteer to contact a group such as Challenge Day. This is an international organization that addresses bullying and they are located in Concord. I have seen their work and it is fantastic and kids love it.

Another thing you can do as a parent is start talking to your child about bullying on an occasional basis. This gives you a chance to let them know it’s not their fault and to develop a plan of action if it does occur. You should also discuss drugs and alcohol at the same time. I work with kids all day long and at times I am still shocked at how young kids are when they are starting to get involved with drugs and alcohol.

Keeping an open line of communication with your child is very important if you want them to come to you. Research still indicates that children are more likely to turn to their friends when they have a problem. This is good that they have this emotional support, but their friends don’t have the answers or solutions that they need. Remember it is best to speak to your child when you are in a calm environment and no one else, such as brothers or sisters, are around. Also remember the word HALT. It stands for:

Hungry

Angry

Lonely

Tired

If you sense your child is experiencing any of these feelings it is not a good time to talk. When you talk with your child you want it to be productive and for your child to feel like they are not being judged. Therefore, sometimes it is better to put off a conversation so you don’t end up in an argument. This is more likely to close the line of communication with your child.

I have mentioned several times that being bullied is not their fault. What I have seen from working with children who are bullies, abusive men and reviewing the research is that bullies really have very low self-esteem. In fact many times they lack a sense of themselves. The only way the feel important or alive is by putting someone else down. They do this because they are afraid the other kids might be able to figure out how lousy they feel about themselves. It is often said the best defense is a good offense. They hope that by acting like the big guy on campus that other people will see them as the big guy and they are able to keep their secret. Kids usually do this because it was done to them too.

Therefore, we need to remember the bully is usually a kid who has been abused too and is crying out for help. If we are going to stop the problem of bullying we need programs to help the bullies too. They are only repeating what they have been taught.

One last comment, I saw a school install a “buddy bench.” If anyone had been bullied, having a bad day, feeling lonely, all they had to do was sit on the buddy bench. Another student or teacher would then go over and ask how they could help. There was no shame associated if you sat on the buddy bench. It was presented as a brave choice. The school was using it as part of their program to stop bullying at school. This fantastic idea came from a 10 year old student. Children often have fantastic answers and we need to listen.

Dr. Michael Rubino specializes in working with children and teenagers. He has over 20 years experience working with children and teens especially those who are victims of trauma. For more information about Dr. Rubino’s work or private practice visit his website at http://www.rubinocounseling.com or his Facebook page at Facebook.com/drrubino3.

Helping Children Cope Emotionally with The Current Bomb Threats

Helping Children Cope Emotionally with The Current Bomb Threats

This week children have been hearing about how bombs were delivered in the mail to former Presidents Obama and Clinton and others as well. In addition to hearing about this incident of domestic terrorism, they have also been hearing about school shootings such as the school shooting in Parkland, Florida where 17 students were killed. Additionally, in June of this year, students heard how someone had threatened to go Valley View Middle School and kill at least 30 students. So students who were use to these school shootings occurring typically thousands of miles away from us, now could happen in our area based on the threat made on 6/5/18. This made many students very anxious that the horrific events they have been hearing about could actually happen here and to them. Now this week they are hearing someone is mailing bombs and for people to be aware of their surroundings because we don’t know if it is over or will more bombs be mailed. Also they are hearing that a bomb was mailed to a Congresswoman in California. When you combine these recent events with the number of school shootings which have occurred and it’s no surprise that children are anxious about their safety and their parents safety. and today there was another school shooting. I have been seeing more and more children and teenagers who are complaining of anxiety and depression. Many of these children and teenagers are also afraid to go to school too. I have also been seeing more children and teenagers being placed on home/hospital for school. This means a teacher comes to the house once a week instead of the child or teenager going to school because they are too afraid of being shot at school. This is an alarming trend.

I have also been hearing more teenagers talking about needing to carry a knife with them for their own safety. They tell me you never know when someone might try to attack you. These are not juvenile delinquents or gang members, these are average teenagers. They come from healthy families and are doing well in school and not involved in drugs. This need they feel to protect themselves is an alarming trend. However, the teenagers are saying they do not feel safe at school and now the incident with the bombs in the mail is exacerbating their anxiety significantly.

However, if you take a step back and look at what these children have seen over their lives it makes sense. Most of these children and teenagers were very young on 9/11, or were not even born yet, when the United States was attacked. Since 9/11 they have also seen two wars and heard on the nightly news about numerous terrorist alerts or attacks around the world and here in the United States. They also hear how the TSA are putting tighter security on travelers and places such as Disneyland are increasing security due to concerns about terrorism.

And now, children and teenagers are hearing how numerous bombs were mailed to people yesterday. These also are hearing that we do not know who did it and there is a strong possibility that there are more bombs out there and one of the bombs may explode and kill people.

Teenagers and parents have been asking Congress for sane gun laws so they can go to school safety. However, their requests have been ignored and school shootings continue. Therefore, many children and teenagers do not feel safe at school. Furthermore, the President is blaming the bombing situation on the press and not doing anything to stop it. In fact, the Time Warner building in New York City is being evacuated again tonight due to a suspicious backpack. Families were at restaurants having dinner and had to immediately evacuate. This current bomb threat only serves to add to the anxiety that children and teenagers are feeling. They do not feel safe at school, restaurants and are anxious about what may be in the mail. Is their mother or father going to go to work and be killed by a bomb that was delivered to the building they work in.

In addition to terrorism and bombs, we need to remember this is the first generation growing up with mass shootings. According to ABC News from 2000 to 2015 there have been 140 mass shootings and since January 1, 2016, there have been more mass shootings than the previous 15 years combined. According to the statistics on mass shootings every day 36 people are killed in the United States by a gun. This does not include suicides. For the group we are discussing, suicide is the third leading cause of death for children between 10 and 18 years old and using a gun is one of the most popular methods of suicide. Also because of school shootings, students have seen increased security on their school campuses. Many campuses have metal detectors that students have to pass through as the enter the campus and there are police officers assigned to school sites due to the fear of violence.

Now, in addition to these facts stated above, think about what these children see on the news nightly and the video games they play daily. Anytime there is a shootings incident in the United States, or any where in the world, there is pretty much 24 hour news coverage of the event for days. Now with the bombs that are being mailed, children are hearing that we have no answers and that there are more bombs out there and one may explode and kill people. The evacuation of the Time Warner building in New York City again tonight supports this fact that there are more bombs and we do not have the situation under control. Furthermore, if we look at the video games these kids are playing most have to do with killing and death. And since computer graphics have significantly improved, many of these games look very realistic. Therefore, the video games children and teens are playing are adding to their anxiety or worse desensitizing children and teens to violence and death.

As a psychotherapist, I am hearing children in the fourth and fifth grades telling me they are worried about our election results. They have heard what the President has said and they are afraid about other countries attacking us or that the President may start a war. Also Hispanic children who are legal citizens are afraid that they will be deported. This is a great deal for a nine or ten year old child to worry about.

Looking at all of this it begins to make sense why I am seeing more depressed and anxious teenagers who fear for their lives. These teenagers are being traumatized by daily events occurring in our country. They may not be experiencing the trauma personally but they are experiencing vicarious trauma. With all of the pictures on television and news reports and realistic video games these teenagers are playing, they are being traumatized vicariously. We have never had a generation of children grow up with the amount of trauma that these children are growing up with in the world. Even children growing up during World War II didn’t experience this amount of trauma. We didn’t have instant access to news nor did we have the graphic videos being shown by the news media.

The question now becomes, what do we do? Well we can not change the world unfortunately. However, we can monitor how much exposure our children are receiving to information about the current bombing situation and mass shootings when they occur. We can monitor the video games they are playing and limit access to games that focus on violence and killing. We can demand that the Congress pass gun control laws that make sense. No one needs an assault weapon to hunt a deer. We can also listen to what our children are saying and talk to them about their concerns. We can explain that at Dad’s office or Mom’s office, they are taking extra precautions to make sure their mail is safe. When a mass shooting occurs we can ask them how they are feeling, ask if they have any concerns and reassure them that you are there as their parents to protect them. Also try to become active by looking at sites by the Red Cross. Making a donation helps children to feel there is something they can do instead of just being a victim.

Finally, if you start to notice a change of attitude in your child that you are concerned about have your child assessed by a psychotherapist who specializes in treating children dealing with trauma. I have included a link to an article by the American Association of Child and Adolescent Psychiatry which describes what parents can do http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Talking-To-Children-About-Terrorism-And-War-087.aspx. There is nothing to be ashamed of if a child needs therapy. We are exposing children to situations that most adults have problems dealing with themselves. You may find it very upsetting to talk to your child about these incidents. For these reasons and many more, if you feel your teenager has been traumatized vicariously make an appointment with a psychotherapist who specializes in treating teenagers and victims of trauma. Our kids have had to deal with a lot. We can help make it easier for them growing up in this time by providing the help they need.

Dr. Michael Rubino has over 20 years experience treating children and teenagers and is an expert treating victims of trauma and also performs Critical Incident Debriefing. For more information about his work or private practice visit his website at http://www.RubinoCounseling.com or his Facebook page at http://www.Facebook.com/drrubino3.