Dr. Henry Paul, MD

Psychiatrist, Author and Educator

DABBING – WHY PARENTS NEED TO WORRY!

February 8th, 2016

I came across this article yesterday on dabbing. I hadn’t heard of it before, so I was curious. Dabbing is a new method of smoking pot that gets you the quickest, long-lasting high with just one inhale. That’s right – one drag from a pipe or vaping pen can give the effect of smoking many joints.

On the website, Parents Opposed to Pot (POPPOT), they say that “Dabbing is to marijuana as crack is to cocaine.” They go on to say that the addiction from dabbing can be immediate, and once you do it “is nearly impossible to get unhooked.”

So how are “Dabs” made? According to the POPPOT website, “Dabbers take a tiny bit of butane hash oil, BHO – hardened or buttery, and quickly light it up in a small compartment.” The site explains how the THC is extracted from the plant using butane gas and some type of glass tube. THC is what causes a high. By extracting the THC into an oil (hash oil is known for giving a quick and lasting high) or buttery wax that hardens, you can then break it into tiny pieces that give a high that will last all day.

In states like Colorado where pot is legal, parents are fearful that legalization of the drug is why it is now showing up in middle school. We don’t have studies to confirm this, but I think the parents are right to assume this.

NJ.com reported in an article in September 2015, “According to a 2014 study by the National Institute on Drug Abuse, cigarette smoking by teens is down, but marijuana use has held its own and nearly 45% of the over 41,000 teens polled for the study reported that they’d smoked pot by the time they reached 12th grade, with an alarming number beginning as early as eighth grade.”

Angelo Valente, Executive Director of the Millburn-based Partnership for a Drug-Free New Jersey told NJ.com, “Kids are starting with pot younger and younger and middle school is a pivotal age for experimentation with pot, alcohol, and tobacco, especially when middle and high schools are located on the same campus.”

What I can say to parents is to know what dabbing is, know the signs and symptoms of drug use to watch for with your kids, and seek advice from a professional when you have concerns. Why should parents worry? Dabbing is new, it’s dangerous, it’s highly addictive, and it can result in injury and death.

LINKS
Kids exposed to marijuana at a younger age, experts say — NJ.com
What is “Dabbing” and Why Parents Need to Worry

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

KEEPING THE MIND OF COLLEGE ATHLETES HEALTHY

January 21st, 2016

The National Collegiate Athletic Association released last week new guidelines on dealing with the mental health of college athletes, an issue that remains a top concern for the association’s chief medical officer, Brian Hainline.

“Concussions may be the elephant in the room, but mental health is really, I think, going to be a game changer for the NCAA,” he said. “My hope is that mental health is going to become as accessible to every student-athlete as an ankle sprain, and the NCAA is going to take a leadership role in telling the rest of the United States of America how to move away from the pathetic way it handles mental health. And it is pathetic.”

Hainline spoke on Thursday at the NCAA’s annual meeting where he emphasized the importance of mental health. Earlier this month, the NCAA’s Sports Science Institute released a new set of guidelines directing institutions on how to manage the mental health issues surrounding college athletics. Behavior on and off the field are all part of the overall well-being of an athlete.

The new guidelines outline four best practices for the mental health care for college athletes and 24 different mental health agencies weighed in and helped to create the strategies.

The guidelines suggest that colleges implement procedures and clear action plans for dealing with mental health issues including a push for annual mental health screenings for athletes, evaluation of athletes by licensed practitioners and education that will help athletes to recognize symptoms of mental health disorders. The guidelines also address substance abuse and aggressive and risky behaviors that according to a study by the American College Health Association’s National College Health Assessment, says that athletes demonstrate more aggressive behavior and risky behavior than non-athletes.
I think the study and the new guidelines are a vital step in the right direction.

LINKS
Mental Health of College Athletes

CHEERLEADING: FEWER INJURIES BUT MORE SEVERE

December 17th, 2015

Interesting study out last week that says that cheerleading is a less dangerous sport for teens. The report does note that even though there are fewer accidents those that do happen tend to be more severe and more likely to result in concussions.

According to Reuters, “On average, cheerleading typically has less than one injury for every 1,000 minutes of participation time, meaning there’s no more than one accident every 17 hours, the study found.”

According to the report the only sports that are safer are track and field and swimming. The injury rates are obviously much higher for football and surprisingly high for girls’ soccer.

It is a very difficult decision that parents have to make when deciding whether or not to let their child participate in sports, particularly ones that are deemed dangerous. On one hand, children need to get exercise and it is good character building for young people to participate in team sports. On the other hand, when faced with the news about concussions and death it is not surprising that parents are fearful for their children’s safety when playing a sport like football. Look, even if you’re not a football fan, you can’t turn on the television without hearing something about the ongoing controversy over concussions and football.

The debate has been raging in this country for years now about the lack of exercise and the growing waistline of our young Americans. So how do parents decide where to draw the line? I think that you have to take into account that so many sports, like track and field, baseball, swimming and cheerleading are important because they get kids active, they build self-esteem and they teach comradery and teamwork.

I recommend that if parents have concerns that they discuss them with their pediatrician, the school and their children. Here are some alternatives to team sports that I recommend to help keep your child active.

Sports that are off the playing field such as skiing, swimming, Tae Kwon do, running, kick-boxing, resistance/weight training, etc. are very good for exercising. These days with extreme sports kids are finding where they “fit in” so take an interest in what they’re interested in and encourage them to pursue it.
Encourage exercise at the local gym. Suggest that they go with their friends. Encourage them to embrace exercise as a lifestyle change that they will have for a lifetime.
Outdoor sports such as kayaking, bike riding and hiking are also good alternatives. They can also be done in groups to encourage comradery.

Please send me your thoughts on exercise.

LINKS
Cheerleading Among the Safest Sports
Sitting Around Isn’t Good for Anyone’s Health

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

THE FINAL SHOT – MENTAL ILLNESS

December 11th, 2015

A USA TODAY story out yesterday said, “At a time of heightened concern over police shootings, a new report estimates that people with mental illness are 16 times more likely than others to be killed by police.”

Why is this? The problem is a lack of treatment for those with mental illness, and I also think a lack of training of law enforcement to recognize it. Mental illness is still something that carries a stigma. People, in general, don’t want to talk about it. For years now, the main thing driving the conversation about mental health has been the mass shootings. People are arguing that mental illness is the reason behind the mass shootings.

Now, a new study out from the Virginia-based Treatment Advocacy Center is saying that about one-in-four fatal police encounters involve someone with mental illness. This study is moving beyond saying that not just those who decide to shoot others in a mass shooting have some mental illness, but that many victims of shooting by law enforcement may also have mental health issues that made them do something illegal that got them killed.

I agree, and this is why we need more dialogue and more solutions on how to help those with mental illness. There are over 8 million people in the United States who have a mental disorder that can alter their thinking and perception of the world around them. From paranoid syndromes to fear, loneliness and anger there are plenty of emotions, disturbances of judgement and other issues that are associated with mental illness that can cause a person to act out or sometimes simply not understand laws or social constructs. And, the disorders themselves ranging from bipolar disorder to schizophrenia to various personality and substance abuse disorders that increase vulnerability often go undiagnosed. For many, even if they are diagnosed, some just stop taking their medications and other forms of treatment.

So what’s the answer? Well, I think that Mayor de Blasio and #ThriveNYC is a start. I believe that having a dialogue and trying to develop programs that can help those suffering from mental illness is a good place to start. Look, people with mental illness are no more violent than others. A better understanding by all will help many to seek and get the help they need. America has to embrace this conversation before change can ever really take hold.

Join me on Facebook and let’s have a conversation about this. Ideas and change come from collaborative thinking and open discussion.

LINKS
“I Called the Police for Help, Not to Kill My Son”
Groups call on Congress to reform mental health system

THRIVE NYC PREPARES TO ROLL-OUT IN CITY TROUBLED WITH MENTAL HEALTH ISSUES

November 20th, 2015

Next month New York City is preparing to roll-out ThriveNYC, a new mental health initiative that Mayor Bill de Blasio says will help to prevent and treat mental health disorders among the city’s 8.4 million residents.

According to a report released earlier this month by the city’s Department of Mental Hygiene, at least one in five adults in NYC suffer from depression, substance abuse, suicidal thoughts or other psychological disorders. This report says that nearly 20 percent of New Yorker’s suffer each year with a mental health disorder and that, “at any given time over half a million adult New Yorkers are estimated to have depression, yet less than 40% report receiving care for it.”

The official website of the City of New York lists these sobering statistics from the report:

At least one in five adult New Yorkers is likely to experience a mental health disorder in any given year.
8% of NYC public high school students report attempting suicide.
Consequences of substance misuse are among the leading causes of premature death in every neighborhood in New York City. Each year, 1,800 deaths and upwards of 70,000 emergency room visits among adults aged 18 to 64 can be attributed to alcohol use.
73,000 New York City public high school students report feeling sad or hopeless each month.
Approximately 8% of adult New Yorkers experience symptoms of depression each year.
Major depressive disorder is the single greatest source of disability in NYC. At any given time over half a million adult New Yorkers are estimated to have depression, yet less than 40% report receiving care for it.
There are $14 billion in estimated annual productivity losses in New York City tied to depression and substance misuse.
Unintentional drug overdose deaths outnumber both homicide and motor vehicle fatalities.
The stigma of mental illness has been found to have serious negative effects on hope and an individual’s sense of self-esteem. Stigma also increases the severity of psychiatric symptoms and decreases treatment adherence.

Kudos to the Mayor and his team for recognizing this problem and doing something about it. Providing services is not going to be so easy in a city the size of New York City. With funding cutbacks to mental health agencies, reorganization and mergers of major hospitals, a shortage of beds and practitioners, and a lack of substance abuse preventative and rehab programs mental health officials face quite a conundrum. Other challenges include overcoming the stigma of mental illness, cultural issues, “income inequality,” and homelessness. I will be watching closely as this program rolls-out. I applaud the Mayor for tackling this!

Links:
Reuters
The New York Daily News
Crain’s New York Business

YOU ARE GETTING SLEEPY, VERY SLEEPY….THE DANGERS OF HYPNOSIS

October 20th, 2015

Recently a court in Florida sided with the families of three students who died after their principal hypnotized them. The principal who was hypnotizing the students to help them deal with such things as test anxiety, trouble concentrating and dealing with pain held no license to practice therapeutic hypnosis. He had been told several times by the district’s school board that he was not to hypnotize students.

The former principal admitted to hypnotizing more than 75 students, staff and others between 2006 and 2011. Among those who were hypnotized, three of those students died in 2011; two from suicide and one was in a fatal car accident after apparently self-hypnotizing to deal with pain from a toothache, a technique the principal had taught the teenager to overcome pain during football games.

In general, hypnosis is usually a benign experience, but there are risks. In this case, I suspect that the posthypnotic effects of suggestion were in play.

Hypnosis is defined in the GOOGLE dictionary as the induction of a state of consciousness in which a person apparently loses the power of voluntary action and is highly responsive to suggestion or direction. Its use in therapy, typically to recover suppressed memories or to allow modification of behavior by suggestion, has been revived but is still controversial.

Hypnosis by a trained professional, who is aware of the possible side effects, is generally safe. Licensed professionals are trained to anticipate, minimize, recognize and treat the occurrence and severity of the side effects. Side effects and complications of hypnosis can include unexpected feelings, unexpected trance-like state, delusional thinking, depression, suicidal thoughts, a crisis of identity, impaired memory and changes in personality. Physical side effects include nausea, dizziness and insomnia.

Hypnosis that is conducted by a trained therapist or health care professional is considered a safe, complementary and alternative medicine treatment. Studies as early as 2005 suggested that hypnotists can strongly influence the behavior of their subjects. I believe that hypnosis does work for certain habit disorders, addictions such as smoking, and possibly compulsions. Hypnosis should only be done by licensed and experienced people, and under no circumstance should anyone, including a high school principal, be doing it.

Parents of student killed in hypnosis scandal speak out
Board OKs settlement over principal who hypnotized students

WHO IS KIDDING WHO? FLAVORED TOBACCO IS LURING KIDS TO SMOKE

October 8th, 2015

“Youth who use multiple tobacco products are at higher risk for developing nicotine dependence and might be more likely to continue using tobacco into adulthood.” Center for Disease Control CDC

Last week the CDC announced its findings in a new study that looked at flavored tobacco and its influence on teens and smoking. The problem for this age group is the growing usage and the misguided perception that e-cigarettes and other tobacco products are safe alternatives to cigarette smoking. I want to be clear – they’re not!

The CDC says that electronic cigarettes, or e-cigarettes, are battery-powered devices that provide doses of nicotine and other additives to the user in an aerosol.

This new CDC study looked at flavored tobacco and its propensity for enticing young people to smoke. Guess what? Teens and middle schoolers think that because it tastes better or because it is an e-cigarette that it is safer. The CDC says nearly a quarter of high school students and more than 7 percent of middle-schoolers have used some tobacco product.

In a report to NBC News, CDC Director Tom Frieden, M.D., M.P.H. said, “Flavored tobacco products are enticing a new generation of America’s youth into nicotine addiction, condemning many of them to tobacco-related disease and early death.”

“The increased use of e-cigarettes by teens is deeply troubling,” said Frieden in a recent CDC press release. “Nicotine is a highly addictive drug. Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes.”

The Food and Drug Administration (FDA)outlawed the use of flavored cigarettes, other than menthol. E-cigarettes don’t fall under the same regulations. E-cigarettes not marketed for therapeutic purposes are currently unregulated by the FDA. What’s concerning to me and should be of concern to parents as well is that because e-cigarettes are new there is still a lot we don’t know. What I do know is that any product that has tobacco in it is not safe for anyone, especially children. Now more than ever it is important to talk to your kids about the dangers of smoking. Check out the links below with more information about tobacco use and children.

Flavored Tobacco Lures Kids, CDC Says

CDC reveals “alarming” news about teen e-cigarette use

Tobacco Use Among Middle and High School Students — United States, 2011–2014

Youth and Tobacco Use

VICTIMS OF CHILDHOOD BULLYING & THE IMPACT ON THEM AS ADULTS

August 24th, 2015

I have counseled plenty of children over the years who have been the victims of childhood bullying. Now, a new study says that childhood bullying has effects that last long into adulthood. I came across an article this week in MedicalNewsToday.com that says, “Research is now attempting to understand why victims of childhood bullying are at risk of poorer outcomes in adulthood, not only for psychological health, but also physical health, cognitive functioning and quality of life.”

Bullying comes in many forms, but intimidation, teasing and the threat of violence are often involved. The article in MedicalNewsToday.com references studies by the US Department of Health & Human Services (DHHS) that said that the most common types of bullying are verbal and social:

Name calling – 44.2% of cases
Teasing – 43.3%
Spreading rumors or lies – 36.3%
Pushing or shoving – 32.4%
Hitting, slapping or kicking – 29.2%
Leaving out – 28.5%
Threatening – 27.4%
Stealing belongings – 27.3%
Sexual comments or gestures – 23.7%
Email or blogging – 9.9%

In children, it has been shown that persistent bullying can lead to depression and anxiety. These disorders are often why parents finally call me. The bullying itself may go away with intervention from parents and school administrators, but the scars are deep and can last a lifetime.

In a study in the UK in 2014, “researchers found, at age 50, participants who had been bullied when they were children were more likely to be in poorer physical and psychological health and have worse cognitive functioning than people who had not been bullied.”

The study also said that “Victims of bullying were also found to be more likely to be unemployed, earn less and have lower educational levels than people who had not been bullied. They were also less likely to be in a relationship or have good social support. People who had been bullied were more likely to report lower quality of life and life satisfaction than their peers who had not been bullied.”

In working with children of bullying, I find that many of these kids suffer from severe anxiety with features of post-traumatic stress disorder (PTSD), depression and often, suicidal ideation. These children may find that they will need to seek counseling for an extended period to learn to handle their anxiety and depression. Psychotherapy is the treatment of choice and, in some cases, medication is necessary. These children also may find that they will need to seek counseling throughout their life to learn to handle their anxiety and depression. For many, lifestyle changes and talking about their childhood experiences with bullying will help. Sadly in some cases medication will be necessary. The sooner a child begins to deal with their bullying the better the outcome.

PROBLEMS IN SCHOOL? ONE OF THE TOP REASONS PARENTS CALL ME

July 16th, 2015

“Under the Individuals with Disabilities Act, or IDEA, public school districts nationwide are required to provide a free and appropriate public education to all students diagnosed with a disability. The mandate requires schools to identify students who may have learning impairments, and to develop a plan to educate them appropriately at no extra cost to parents.” Public Schools Delay or Deny Special Education Services for Most Vulnerable Students (NBC News)

Schooling and education are a major focus of adolescence and are one of the most frequent reasons that parents call me for a psychiatric consultation for their children. Teenagers spend most of their time during the day at school. It is easy to understand why problems at school then become such a major focus for parents – not to mention the anxiety that the teen is feeling. It is also easy to understand that problems in school are often an indicator of problems elsewhere, and it is important that parents be able to differentiate the two. As with athletics in some families, school performance becomes a major focus of parents’ anxieties, ambitions, and vicarious living. Also, they may project problems in their lives on their children’s performance.

It is normal for teenagers to experience some problems at school that are not particularly serious, especially during what are called the transition years, moving from middle school to junior high school or from high school to high school. It’s unusual to find teenagers who don’t experience some degree of stress at these times. But when school problems persist long past these transitions and become more deeply entrenched, there is a problem.

Here are some simple things to do if you suspect problems at school:

Contact your teenager’s guidance counselor and set-up a meeting. If there is a specific clas, that seems troubling for your teenager you should contact that teacher and ask to meet. You may want to set-up this meeting to include the guidance counselor.
Often an undiagnosed learning disability may be the underlying factor. Learning disorders can have a serious impact on a teen’s performance and their self-esteem. Many of you have most likely heard the terms ADHD (Attention Deficit Hyperactivity Disorder), ADD (Attention Deficit Disorder), PTSD (Post-traumatic Stress Disorder), OCD (Obsessive Compulsive Disorder), ODD (Oppositional Defiant Disorder), Spectrum Disorder (including Autism), and many more.

Special education is part of the public school system in the United States, and its function is to make sure that children who are diagnosed with learning disorders or medical conditions that affect learning get the services they need. Navigating the waters of the special education system can often be complicated for parents. There are both Federal and State mandates that affect special education services. Key players in making sure that your child gets the proper services include the child’s pediatrician and/or psychiatrist, the school CSE (Committee on Special Education), the school’s guidance office and teachers, and you. Sadly, there are schools who will fight or delay the services. In that case, you may need to hire an attorney or seek out a special education advocate.
Here are some resources to help you understand the rights of children with disabilities.

Robin’s blog. She was the mother Jarrod in the NBC story.

The Disability Rights Education and Defense Fund (DREDF), founded in 1979, is a leading national civil rights law and policy center directed by individuals with disabilities and parents who have children with disabilities.

SHOULD I WORRY ABOUT THE MUSIC MY TEEN LISTENS TO?

March 30th, 2015

“Music lyrics have undergone dramatic changes since the introduction of rock music more than 40 years ago. This is an issue of vital interest and concern for parents and pediatricians.” American Academy of Pediatrics

As an adolescent psychiatrist for over thirty years, I have been asked over-and-over about the influence that music has on teenagers. The concerns that parents have about today’s music are very real. Parents worry about the suggestive nature of the lyrics and the influence it will have on their children. Even worse, parents are scared that the music might be harming their children.

For the most part, listening to music is a healthy, relaxing and very natural thing. Teenagers listen to music for a host of reasons. For many of them music is at the center of their lives socially and culturally and listening to music is important to fitting in.

I think music reveals a lot about a person and can be a window to one’s soul. It can help quieter teenagers to express themselves, and it can express emotions that tempestuous adolescents may not be able to voice.

It is difficult for parents to hear songs about drugs, nirvana, suicide, gangs, racism, sexism, and sex. It is scary to think that your child is taking those lyrics to heart. Teenagers experiment with different types of music, and often much of it is just a phase. Remember, the songs that you listened to in high school that your parents thought were suggestive? Most likely your parents weren’t happy when you were listening and singing those lyrics either.

As with many other trends, the music phase will pass without any lasting damage. Music only becomes a concern when your teenager is manifesting other emotional difficulties and is using music-listening to get away from problems, to substitute for real-life activities, or to accompany a depressive withdrawal. In these cases, the music is giving your teenager a message about depression, severe social problems, drug use, and even suicide plans and parents must intervene. Parents should not turn off the music. Instead, learn about the music. Today you can find the lyrics to almost any song on the Internet, so GOOGLE the artist and the song. That is the best way to assess the lyrics. Then have a discussion about it with your son or daughter. You will get a glimpse of what is bothering your teenager and then, if necessary, you can seek required help. Click here for recommendations from Common Sense Media to help you talk with your teenager about the music they are choosing to listen to.

Disclaimer
This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.