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Parental Strategies - Doc's Corner

Each week, one of our community partners, Dr. Moe Gelbart generously volunteers his time to provide information for our community related to wellness. Dr. Gelbart is the Executive Director of Thelma McMillen Center in Torrance. Check out his latest edition of "Doc's Corner".

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DOC’S CORNER

4/18/19

 

ANXIETY IN CHILDREN AND TEENS PART I

 

Anxiety is the most common and prevalent mental health issue that adults, teens, and children experience.  The good news is that it is a very treatable problem, with high levels of success in overcoming it.  Since everyone experiences anxiety at times, understanding the difference between “normal” anxious feelings, and how that differs from the continuum of the disorder of anxiety is important.  In the next few columns, I will address what anxiety looks like in it’s different forms, when it qualifies as a “disorder”, what the signs and symptoms are, and what are some of the coping strategies.

As stated, everyone experiences some forms of anxiety at some times in their lives.  It is a sense of worry, fear, nervousness, concern.  The anxiety cycle is part of our survival mechanism.  In the classical fight or flight response, which has been with us since man walked the earth, a threat is perceived (like a tiger in the jungle) and the body goes into automatic survival response, including heart pumping, blood racing to the interior, sweating, muscle tensing, all designed to prepare the body to deal with the stress, that is fight, or flee.  When the threat (the tiger) is gone, the body comes back to normal.  Without this autonomic ability, we would not have survived.  However, as our brains developed, we have come to a place where we do not need an actual threat, but can create one in our mind.  We worry, anticipate, catastrophize, all without an actual threat.  Our bodies go through the fight or flight response.  What we go through, and what our children go through, is what I call a case of the “what ifs”….what if I am not popular enough, not pretty enough, not smart enough….what if I fail the exam, don’t make the team, don’t get into college, get bullied, and so on.  The list is infinite and endless.  The result is that we perceive a threat, our bodies react, we become aware of our physical symptoms, they concern us, which leads to deepening the perception that something is wrong, and we spiral down the tunnel of anxiety.  Anxiety can be mild, moderate or intense.  Some anxiety may even be beneficial, and help one prepare properly for a task by making us feel prepared, alert, focused, and ready to take on a problem.  When anxiety becomes too overwhelming and powerful, it interferes with our ability to perform and do our best, and in it’s most intense form becomes paralyzing and disabling.  When feelings and thoughts of anxiety become so overwhelming that they become obsessive, and prevent us from achieving things, or we find relief in avoidance of important things, we can consider the problem more serious and begin to look at anxiety disorders.  The common thread to these are that the anxiety occurs too often, is too intense, is out of proportion to the reality of the situation, and impacts daily activities and feeling of well-being.   There are six main types of anxiety disorders classified by the American Psychological Association:

Generalized Anxiety Disorder: With this common disorder, people worry constantly and chronically about many things.  Children can worry about family, school, health, social media, the future, etc. They always think of the worst that could happen, what we call catastrophizing.  Generalized anxiety is often accompanied by physical symptoms, including headaches, stomach aches, pain, nausea, and can lead children to avoid activities, or even not go to school.

Obsessive-Compulsive Disorder (OCD.  This anxiety is one in which a person has unwanted thoughts or images (obsessions) which they attempt to cope with by performing repetitive or ritualized actions (compulsions).  An example would be that one feared germs were everywhere (obsessive thought) which would lead to ritual cleaning and handwashing (compulsions).

Phobias. Phobias are intense fears of things which are either not dangerous, or the level of fear is much over exaggerated compared to the threat.  Common phobias are fears of heights, animals, flying, public speaking.  Reactions and coping mechanisms usually involve avoidance of the perceived threat.

Social Anxiety Disorder.  This is more than casual shyness, and involves intense fear over social interactions.  The results are withdrawal, isolation, lack of involvement in activities, and constant fear of being judged.

Panic Attacks.  These are among the most disabling forms of anxiety.  A person experiences a sudden terror, which can include severe physical symptoms and intense fears of passing out, dying, “going crazy”.  The coping mechanism is fleeing from the situation, which provides some measure of relief, but actually increases the strength of the phobia.

Post Truamatic Stress Disorder (PTSD).  This anxiety is the result of a traumatic and terrifying past experience, resulting in continual replay of the event, nightmares, flashbacks, and a sense of dread and fear.

 

The common thread with anxiety disorders is the anxiety is a result of thinking.  Thoughts can become unrealistic, and tend towards all or none, black-white thinking.  The thinking leads to feelings of anxiety and fear, and cause physical symptoms which are experienced as fearful and anxious, which then intensify\ies the cycle of thinking.  Those suffering from anxiety are hesitant to let anyone know, as they fear being judged or misunderstood.  Often when they do share their concerns, they are minimized by others who perceive them as unrealistic fears, or common concerns that should not produce so much distress.  This intensifies the anxiety.  In the next column, we’ll look at the cause of anxiety, and how to recognize it in your children.

 

Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.

 

Moe Gelbart, Ph.D.

Executive Director, Thelma McMillen Center

 
DOC’S CORNER
4/11/19
VIDEO GAMES: ADDICTION, OBSESSION, OR A BAD HABIT
Amongst parents I work with, one of the most consistent complaints and concerns revolve around screen time, video games, and the battle over the cellphone. Like much that technology has to offer, there are benefits and consequences of progress. I compare it to nuclear power, which when used properly, it can light up a city, and when used inappropriately, can blow up a city. The power of the smartphone is astounding. It seems hard to believe, but the handheld device our children have today is more powerful than all of NASA’s combined computing power in 1969 when they put a man on the moon. What is it that is so appealing, and hooks children’s attention? I am most struck by the appeal to any age child. Even a 5 month old infant is instantly drawn to a screen, and is fascinated to manipulate it. Whether intentional or not, the developers have created a crisis for countless children and families.
One level of appeal is certainly neurological. As other columns have pointed out, the brain develops in a pattern that during the teenage years, high energy, low effort activities are neurologically appealing. Engaging in such activities is pleasurable, and is accompanied by neurotransmitter release of dopamine, the “pleasure hormone” in the brain. Teens, as well as adults, seek out this pleasurable feeling in their activities, though adults have developed more logic and judgment to mediate the desires. For many teens, the pleasure they feel engaging in screen time and video games cannot be matched by most other activities, and with this reinforcement, they continue to seek it out. Another factor is that gaming and screen time is never ending, and insatiable, unlike many other activities which have a beginning, middle, and finally a closure. As a simple example, eating a delicious piece of cake produces a dopamine pleasure experience, but when the cake is finished, the experience is finished. This is never the case with video gaming, and the opportunity for reinforcement is always there. As Dr. Nora Volkow, Director of the National Institute on Drug Abuse states, “pulling the plug in the middle of a video game is a bit like yanking a half-eaten doughnut out of someone’s hand”, leading to the resistance parents experience.
While there may be some controversy as to whether video games can lead to a true addiction (it is not an official psychological disorder), there is no doubt that children become obsessed with their screen time, and battle any attempt to curb it. There is also no doubt that too much screen time has negative consequences. Here are some of the concerning signs a parent should look for:
· More than the number of hours one plays, it is more important to examine how gaming is interfering with social relationships, school performance, mood, and “normal” development of usual skills.
· Does the child sacrifice activities, such as sports, clubs, to play computer games. If he continues to spend time in spite of negative consequences, there is a problem.
· Effect on grades is always a significant sign of a problem. I have worked with students who have been admitted to the top universities, who then spend all their time gaming and have to leave school.
· Excessive screen time may be a coping mechanism for dealing with depression, anxiety, or low self esteem.
· Too much time in front of a screen leads to a sedentary lifestyle, and increases health concerns including weight gain.
· Concentration and attention can be effected, and children who spend too much time on video games can become less interested in reading.
· Many of today’s video games are focused on violence and aggression, and there is belief that engaging in these games increases aggressive tendencies.
The American Academy of Pediatrics has guidelines on screen time for children, which includes
· No hand held devices or video games until 13 years old.
· Introduce cell phones, IPads, at 13, allowing up to 2 hours a day of use, and 30 minutes a day of non violent video games.
I would recommend the following for dealing with excessive video and screen time
· Familiarize yourself with the expert guidelines. While they may seem extreme, they are enforceable is you are consistent and start early.
· Avoid the temptation to use screen time as an “electronic babysitter”. Yes, your child will be quiet, and well behaved, and you will be able to get things done, but you may be developing a pattern you will not be able to break.
· Have clear and consistent boundaries about game play, and make sure both parent are on the same page and enforcing the limits.
· The earlier in life you are clear and set rules, the more likely your children will comply. Having said that, it is never too late to implement strong guidelines – just be prepared for a bit of a battle.
· If your child continues to use despite significant negative consequences, consider seeking out professional help from a mental health professional who specializes in teens, and understands addiction.
Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.
Moe Gelbart, Ph.D.
Executive Director, Thelma McMillen Center
 
DOC’S CORNER
3/21/19
SUPPORT VS. ENABLING: WHEN WE PROTECT TOO MUCH
We all love our children. We all want to do what is best for them, protect them, help them to succeed, and insure that nothing bad happens to them. We need to find a balance, however, between support and enabling. Many parents ask me what the difference is, especially when I am working with teens (or adults) who are experiencing problems with drugs or alcohol. The basic difference is that support is a “two-way street”, while enabling is a “one-way street”. When we support our children, there is an unwritten contract that each of us has a responsibility to perform, and that as long as one person does what they have agreed to, the other will respond in kind. For example, you may tell your teen “as long as you don’t use drugs or alcohol, we will provide you with a vehicle to drive”. If they demonstrate compliance, then they get to drive. If, however, they experiment and use, and we give them second and third chances, or are unable or unwilling to put up with their upset and anger, and continue to let them drive, we are enabling them. In other words, our behavior is actually strengthening the behavior which we want to avoid. In previous articles, I have written about the value of limits, consequences, and follow through, and enabling is not enforcing limits, and not following through with consequences. Some parents are determined to provide too much support. We have all heard the term “helicopter parenting”, which describes parents who hover over their children, and are over focused on them, often taking too much responsibility for their successes or failures. Newer terms include “lawnmower parent”, and “bulldozer parent”. Such behavior generally emanates from a good, caring, loving place, though it may be fueled by one’s own unfulfilled dreams and regrets, and living one’s life through their children. The helicopter parent is so concerned that their child will not find their own way that they intervene in things like teacher selection, playing time in sports, closely monitoring school work and over-assisting in projects, selecting children’s friends for them. We have come to a place in our society that we are afraid to let our children feel disappointment, uncertainty, and failure. In reality, these are often important life lessons, and help children grow, and gain self-esteem. Of course, our role as parents is to protect our children from danger, and severe consequences, but over protection can have negative impact. When we do too much for our children, the message we may be sending to them is that they are not capable of achieving those things themselves. Although the results may be positive, in regards to things like grades, their self-esteem does not improve and grow. In order for self-esteem and self-confidence to improve, one must benefit from the results of their efforts, and take pride in their achievements. Otherwise, results not earned can often lead to what is called “the imposter syndrome”, which follows people well into their adulthood and careers. I have worked with many successful adults, CEOs of
companies, who fear internally that they will be found out as incompetent. In addition to decreased confidence and self-esteem, overprotecting your children decreases the development of their own coping skills, and their ability to deal with negative outcomes, and often increases anxiety. The other major consequence is a sense of entitlement, and developing a belief that things will always be taken care of. The reality is that the world will not treat them like their parents do, the world will not enable them. Their teachers, their bosses, the local police officer will not be ok with them not holding up their end of the bargain.
What are some things you can do to stop overprotecting and enabling your children, and to put your helicopter down?
* Redefine the notion of failure. It is a word I try and help parents not use. Instead, I encourage them to look at behavior as successive approximations to the mark. Each time you miss the mark, you are provided with new, good information to improve your next attempt.
* Understand limits, consequences, and follow through, and hold your children accountable.
* Recognize that difficulties and roadblocks are building blocks to growth, strength, and independence. Overcoming obstacles may be painful, but are great learning tools.
* Know that you cannot protect them from disappointment, and that not being successful at everything can actually be a benefit. Help them learn to understand that they do not need to be perfect. Like the saying goes: “Perfect is the enemy of good”.
* Accept, and help them accept, the notion that things will not always work out. Help them take (safe) risks.
Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.
Moe Gelbart, Ph.D.
Executive Director, Thelma McMillen Center
 
DOC’S CORNER
3/14/19
MARIJUANA: NOT AS HARMLESS AS YOU MIGHT THINK
I have written about marijuana use and myths in previous columns. Because of changes in attitudes in our present society, as well as changes in law, there is a concern that marijuana will become commonly accepted and thought to be harmless. I believe this is an extremely dangerous position to take, especially for teenagers. In general, marijuana is potentially very harmful for teens, as is any drug or alcohol. I have discussed in the past the details of the developing teenage brain, how it is constantly being shaped until the mid 20s, how fragile and vulnerable it is to drugs and alcohol, and how the pleasure centers can become totally focused on substance use and ignore other forms of positive reinforcement. This can lead to dependency in the worst case, or to poor decision making leading to unintended negative consequences. In the 15 years we have had an Adolescent Treatment Program at the Thelma McMillen Center, marijuana use among teens has been the most consistent problem, and among the most difficult to treat. The internet has made kids “experts” in marijuana, although they only seek to confirm their positive views. They can argue the benefits of marijuana, the health benefits (not accurate), the fact that it is natural, the belief that people smoked it in the 60’s with no ill effects, the belief that it is safer than alcohol, and on and on. The legalization in many states, including California, has only strengthened their resolve that it is safe and beneficial, and the belief that physicians can prescribe it for medical use further strengthens their resolve, and makes it more difficult to convince them otherwise. The medical use of marijuana is highly misunderstood and over-exaggerated, and people spinning signs outside of shops or delivering marijuana is not medical marijuana as advertised, nor does spending $50 for a medical marijuana card make it legitimate, even if a physician’s name is attached to it. The rise of cannabis related products, some over the counter, and endorsement by celebrities and athletes further tantalize the teenager into believing marijuana is harmless. There are, however, serious risks.
To begin with, it is the THC (Tetrahydrocannabinol) in marijuana that provides the euphoric feeling. Interestingly, true medical marijuana consists of cannabidiol (CBD), which does not get one high, and is not appealing to teens. Today’s marijuana has incredibly high concentration of THC levels, sometimes ranging from 40 to 80 percent THC. For relative comparison, top shelf marijuana found in shops contains about 20 percent THC, and marijuana smoked in the 60”s was less than 10 percent THC. Marijuana concentrates with high THC levels are known as oil, wax, honey oil, budder, butane, dabs, black glass, and errl. It is ingested by smoking, and infusing in food or drinks. Vaping has become an increasingly popular method of use, as it is
smokeless, odorless, and easy to hide. It is also a method to provide high THC concentrated marijuana.
Recent studies have shown that the use of high concentrated marijuana has led to very significant psychological and physical issues and problems. We know that marijuana can cause paranoia, anxiety, panic attacks, and hallucinations. There has been a dramatic rise in emergency department visits related to the drug, for physical issues like elevated heart rate and blood pressure, as well as cannabis induced psychosis (CIP). Teens who use marijuana increase their chances of developing a mental disorder by 4-12 times. Regular use of marijuana is related to the development of psychotic disorders such as schizophrenia, bipolar disorder, or PTSD. We have treated kids who have vaped high concentrate marijuana one time, and wound up in the emergency room in critical condition. Studies published in JAMA Psychiatry journal show that cannabis use during adolescence is associated with an increased risk of developing depression or suicidal behavior in young adulthood, even in teens with no depressive symptoms prior to starting use.
As is often the case, the most important tool a parent can have is knowledge. Newer studies examining the effects of high concentrate THC marijuana are indicating many more physical and psychological problems than was previously recognized. It is important to dispel the myths that teens believe in regards to the safety of the drug, and to have a firm stance and belief in trying to curb it’s use among adolescents. At the Thelma McMillen Center, we started out treating dependency issues, but quickly realized that just as important a contribution we could make was to very early intervention. Many parents I have worked with, whose children are in long term treatment programs wish they had taken a stance as soon as they learned their child was experimenting with marijuana.
Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.
Moe Gelbart, Ph.D.
Executive Director, Thelma McMillen Center
 
 

DOC’S CORNER

3/7/19

 

ADVICE TO PARENTS: IT’S NOT ALL YOUR FAULT

 

I’ve been in practicing as a psychologist for 42 years. When I first started my career, I worked extensively with children, adolescents, and families. I remember seeing troubled children enter treatment, and often saw extreme dysfunction in the family system. Things seemed to make sense. Children were experiencing problems as a result of experiences they had within their families. That realization only lasted a short while, however. I remember, very early in my career, a young girl was going through severely difficult emotional problems, combined with significant drug abuse. Her parents and family were wonderful, smart, supportive, communicative, concerned, and did everything they could for her, and provided all the professional help they could. In spite of their positive parenting, the young woman was quite troubled. And to make matters worse, the parents blamed themselves, felt guilty, felt they didn’t do enough, and felt fully responsible for their daughter’s problems. I have been struck ever since how willing parents are to take blame for their children’s problems. If their child is depressed, anxious, using drugs or alcohol, in trouble with the law, doing poorly in school, or some other problem, parents are quick to blame themselves, and question what did they do wrong. Interestingly, I have never met a parent who has taken responsibility for their child’s successes. Never do they proclaim “my child is an all-American athlete” or “my child became CEO of XYZ” all “because of me”. It is only when things don’t go well that they feel responsible. The truth is, parents DO have a major role/responsibility in their children’s development and well-being, but by no means are they fully in control of the outcome. When I work with parents on learning to “be kind to themselves”, I help them recognize that in addition to factors at home, children are influenced by peers, teachers, magazines, movies, television, music, rock stars, celebrities, and more. In addition, they come into this world with a genetic makeup, and a unique personality. If there are mental health issues or addiction issues in their genetic background/history, they will be more prone to those kind of problems than their peers. If children experience adverse childhood events, or trauma, often outside of parental control, their chances of having mental health or substance abuse issues are greatly increased. Of course, there is social media, quickly becoming one of the strongest influences in the issues that effect your children, and one of the major contributors to stress, depression, anxiety, and drug/alcohol abuse. I compare social media to nuclear power: used properly, it can light up a city, but used incorrectly, it can blow up a city,

So as not to be mistaken, parents have a critical, crucial, and overwhelming role in the well-being of their children. I am only expressing that all problems are not a result of parental mistakes, and even the best parenting cannot prevent children from experiencing problems.

The most powerful parental second guessing I have worked with is the number of parents I have seen who have lost a child to drug issues. Clearly, nothing could be more painful. Every parent I have seen have wracked themselves thinking “could I have done more”, or “I should have done more” or “did I enable too much”. Everyone I have personally worked with had spent years doing everything they could for their child. I cannot ease their pain and their loss, but I work hard to relieve them of the guilt they feel, and remind them that they are not in control of what happens to their children, and we never know how things would have turned out if they had acted differently.

Parents have a role, but they are not fully responsible, for what difficulties their children experience. As parents, we need to work on our parenting, and learn how to communicate effectively, provide unconditional love, strengthen self-esteem, provide appropriate boundaries and consequences, and much, much more. At the same time, parents need to engage in self-care, pursue their own interests and friendships, and learn how to experience joy and meaning in their lives, and not have all of their own self-meaning revolve around their children’s successes or failures.

 

Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.

 

Moe Gelbart, Ph.D.

Executive Director, Thelma McMillen Center

 

 

 

DOC’S CORNER

2/28/19

 

EATING DISORDERS PART III: SIGNS, SYMPTOMS, AND ADVICE FOR PARENTS

 

The incidence of eating disorders among teens is rapidly increasing, and the dangerous and harmful effects of suffering from these problems are among the most significant risks our teens face. In the past few columns, I have identified the various forms eating disorders take, the data in regards to them, and some of the factors which are the root causes for developing such a devastating problem. In this article, I will focus on how to recognize the problem in your teen, what are some of the signs and symptoms, and where to turn for assistance.

 

Emotional and Behavioral Symptoms. The most obvious, and primary symptom your teen will initially exhibit is obsessive concern with their weight and food intake, and great attention to weight loss, dieting, and over control of what foods they will eat. They will begin to eliminate foods they are willing to eat, be uncomfortable eating around others, will skip meals, will eat very little of what is offered to them, and will be clued in to all the dieting fads, often experimenting with one after another. They may become obsessed with the health value of various foods. It is important to remember that eating disorders are really about the obsession of weight and food, and the behaviors related to food intake are the behavioral manifestations of those obsessions. They will constantly monitor their weight, and have extreme concern with their body size and shape, often checking themselves out frequently in the mirror. Their comments about themselves will be extremely negative, and they will magnify even the slightest impairment. Their mood may change, and they will become increasingly sad, depressed, anxious, ashamed, and sink into feelings of very low self-esteem. They tend to isolate, and no longer want to be around friends that they used to see. They will counter your expressions of concerns by convincing you that they are actually being healthy in their approach. As the problems progress, they may skip meals, or you may notice that they have discarded their food when you are not looking. They very well may make frequent trips to the bathroom. They may take up an obsession with exercise as a form of “health” or weight control, fearing about even missing one day. As parents, we can be seduced, at first, thinking our children are going down a healthy road of exercising, eating healthy, and taking care of themselves. However, the quality of their choices, and the obsessive nature of their thoughts should be clues that something may be amiss.

 

 

Physical Symptoms. Weight loss, and/or weight fluctuations will be the most noticeable signs you will see from your child. They will suffer abdominal pains, stomach cramps, menstrual

irregularities, and feelings of fullness or bloated. Binging and purging will result in dental problems, cuts and calluses on the hands/fingers, both related to excessive vomiting. They will experience dry skin and hair, brittle nails, thinning hair, and muscle weakness. They can become dizzy and have fainting spells, and are frequently fatigued. They will experience sleep problems, dark circles under the eyes, and poor wound healing. As the problems progress, the physical symptoms become worse, and certainly frighten most parents. The effects of eating disorders appear extremely dangerous, because they are extremely dangerous.

 

Steps to Take. If you suspect your child is developing an eating disorder, it is essential to lovingly confront them with what you are observing, to let them know how concerned and fearful you are for their well being, and to get them qualified help as soon as possible. A visit with a pediatrician, especially one that is knowledgeable in eating disorders, is mandatory. Lab results can confirm concerns and help determine how progressed the problem is. It is also essential to consult with a mental health professional who has expertise in eating disorders. Do not hesitate to question someone’s experience and qualifications. An experienced clinician will have a team of specialists they consult with, including dieticians, psychiatrists, physicians, and treatment programs when necessary. If your child’s problems are in the early stages, they will benefit from uncovering the underlying issues related to their problem. If the eating disorder has progressed significantly, they will likely need a team approach to care. At that stage, the most important aspect is that they be medically followed and monitored.

As always, information is the key. The more you know, the more you can try to either prevent a problem, or recognize it in its early stages. It is important to take the matter very seriously – eating disorders are not just a phase, are not just a harmless choice.

 

 

Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.

 

Moe Gelbart, Ph.D.

Executive Director, Thelma McMillen Center

 

 

 

2/21/19

 

EATING DISORDERS PART II: CAUSES, RISK FACTORS

 

In my last column, I presented data on how prevalent eating disorders are among teens, and what the different eating disorder diagnoses are. It will be helpful to understand what are the causes and risk factors associated with eating disorders, and what are some of the signs and symptoms to look for. As with all mental health issues, the more knowledge parents have, the more likely they are to take preventive measures, as well as recognize problems in their early stages. Naturally, early prevention and intervention reduce potential harm significantly.

 

Risk Factors: Risk factors for eating disorders fall into biological, social, and psychological categories. Genetics play a role, and if a teen has a close relative with a diagnosed eating disorder, their risk for developing such a problem is greater. In the same vein, if there is a family history of significant mental health issues, such as depression, anxiety, or addiction, it may predispose the teen for developing an eating disorder. Psychologically, the trait of perfectionism is a leading cause for ED. When teens experience unrealistic high expectations, and are faced with prospect of needing to control the outcome of things, they often transfer those unrealistic expectations to trying to control their food intake or appearance. Along with perfectionism comes the need to control, and trying to control results when one does not have control of all the factors leads to frustration, anxiety, and a distorted attempt to control certain things like food intake and body weight. Body image dissatisfaction and distortion is a significant factor in unhealthy use of food to achieve unrealistic results. Social risk factors are numerous, and grow daily with teen’s devotion to social media. The internet is filled with messages to teens regarding “the ideal body”, often unrealistic and unattainable. A Stanford study found that 96% of young eating disorder patients admitted they learned about purging and weight-loss methods from the Internet. There are extremely dangerous websites for teen girls, Pro-Ana (for pro anorexia) and Pro-Mia (for pro bulimia), which provide “thinspiration” for girls, accompanied by photos of bony-thin fashion models, along with advice about losing weight, being thin, attracting male attention, and other destructive suggestions. As an example, here are the “Thin Commandments” from one of the websites:

1. If you aren't thin you aren't attractive.

2. Being thin is more important than being healthy.

3. You must buy clothes, style your hair, take laxatives, starve yourself, do anything to make

yourself look thinner.

4. Thou shall not eat without feeling guilty.

5. Thou shall not eat fattening food without punishing oneself afterwards.

6. Thou shall count calories and restrict intake accordingly.

7. What the scale says is the most important thing.

8. Losing weight is good/gaining weight is bad.

9. You can never be too thin.

10. Being thin and not eating are signs of true willpower and success

 

Powerful, and painful messages, aimed at vulnerable teenagers.

 

Another risk factor, closely associated with social media, is bullying and cyber bullying. 60% of teens with eating disorders reported that bullying contributed to the development of their problem. The anxieties faced by teens as they post pictures of themselves on line, fearful of how others will respond, is so overwhelming that they often will take hundreds of photos before they are willing to post the perfect one. Once a teen forms a negative body image, they may strive in unhealthy ways to achieve what the media portrays as the ideal body.

 

There are more subtle societal factors, such as constant bombardment in the media of photo-shopped perfect figures among teen celebrities, and advertisements designed to manipulate purchases to make one look “better”. The attitude that parents demonstrate towards weight plays a significant role in how a teenager feels about themselves physically. While most of us as parents understand the need to avoid direct criticism of our children’s weight or eating habits, we are conflicted about trying to help them feel and stay healthy while at the same time maintaining their self-acceptance and self-care. Very well meaning parents will ask their child “do you think you really need to eat that piece of cake”, not knowing that it may have a devastating effect on the self-image. There are also powerful messages parents give off without realizing it. I believe this is especially true when the fathers of young girls are unaware of the impact of their comments about another person’s appearance. Remarking on the beauty or body of someone on TV, at the beach, or somewhere else, either positively or negatively, will be absorbed by their teenage daughter, and often lead to unrealistic self-expectations.

Interestingly, most experts agree that ultimately eating disorders are not really about wanting to be thin, but rather, expressions of underlying issues of anxiety, depression, and trauma. Controlling food intake is a way of managing internal pain, emotional discomfort, and trying to control. Although the vehicle for the problem is food - restricting, purging, etc,- the main issue is of control, and obsession of thought. The teen with eating disorder is constantly thinking about their body and their weight, and what they are eating. It becomes a round the clock obsession which greatly impairs normal functioning.

 

In our next column, I will address the signs and symptoms, what to look for, and what steps to take if you are concerned about your teen and eating disorders.

 

 

Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.

 

Moe Gelbart, Ph.D.

Executive Director, Thelma McMillen Center

 

 

2/7/19

 

EATING DISORDERS: BASIC DEFINITIONS

Among the most frightening, and dangerous mental health issues teens struggle with are eating disorders. The problem is wide spread, and I hope to be able to share the basic facts, statistics, causes, and strategies for coping in this and future articles. The different types of eating disorders include Anorexia, Bulimia, Restrictive Food Intake Disorder, Orthorexia and Binge Eating.

Facts: The incidence of eating disorders is generally growing, and disproportionately affects teenagers. While most prevalent in ages 12 to 25, children younger than 12 are at danger, especially due to health issues that can be caused by refusing to eat at such a young age. Following are some alarming facts:

* 40-60% of elementary school girls (6-12) are concerned about their weight.

* In High School, 44% of females and 15% of males have attempted to lose weight

* 15% of female teens have disordered eating

* 81% of 10 year olds are afraid of being fat

* 9% of 9 year olds have vomited to lose weight

* Cases of anorexia nervosa among girls 15-19 have increased every decade since 1930

* The incidence of bulimia in women has tripled since the 90’s

* Every 62 minutes at least one person dies as a result of an eating disorder.

* The mortality rate of those that suffer from anorexia is 12 times higher than the death rate for all other causes of death

Types of Eating Disorders: In general, eating disorders constitute an unrealistic and all-consuming fear related to weight gain and the desire to be thin. They are fueled by early trauma, personality issues, psychological factors, genetic components, and very much driven by social media. The causal factors will be addressed in detail in later columns.

Anorexia. There are two main types of anorexia, both characterized by fear of weight gain and abnormal eating patterns. In the restrictive type, the teen aggressively limits food and caloric intake, effectively starving the body of the nutrition and calories needed. They feel an intense fear of gaining weight or becoming fat, and are blind to the seriousness of their weight loss. Their body self -image drives their self-worth and self-confidence. The other type of anorexia is the binge/purge type, in which they purge after they eat, causing an additional set of health problems. A teen may have an atypical anorexia, where they may be overly concerned with weight and food intake, but may not be severely underweight.

Bulimia. The most common form of bulimia is the binge and purge type, whereby the teen eats a large amount of food in a short time, with an accompanying sense of lack of control

around their eating. They then compensate for their behavior, and intense fear of gaining weight by things like excessive exercise, use of laxatives or diuretics, periods of fasting, and most commonly self-induced vomiting.

Binge Eating Disorder. This problem is different from bulimia in that the teen does not compensate for their binge eating. It is characterized by a sense of uncontrollable excessive eating, followed by feelings of shame and guilt. Criteria for the disorder is the behavior occurring at least once a week for a period of three months. The compulsion to eat often results in the teen eating in secret and eating when they do not feel hungry.

Avoidant Restrictive Food Intake Disorder (ARFID). With ARFID, the teen begins to limit his/her range of preferred foods, which become less and less and narrower over time. It usually results in dramatic weight loss. They become obsessively picky eaters, though they are not driven by body image fears of fears of gaining weight.

Orthorexia. This problem is similar to, and has elements of ARFID. The teen develops an unrealistic and compulsive concern about the health of food ingredients, and eat only limited and narrow food groups that they deem as healthy or “pure”. The teen will cut out an increasing number of food groups, and the thought of food selection will be obsessively considered throughout the day.

 

As I mentioned, there is much more to learn about signs, symptoms, causes, and therapeutic approaches, hopefully to be covered in the columns to come. In the meantime, the most important thing for a parent is to be aware of their child’s thinking and behavior surrounding food and body image, and to get them help if there is any concern. Food restrictions and purging carry extremely dangerous physical consequences, and if one has concern, they should seek out knowledgeable pediatricians and/or mental health professionals.

 

 

Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.

 

Moe Gelbart, Ph.D.

Executive Director, Thelma McMillen Center

 

 

1/31/19

  

SELF INJURY, SELF HARM, AND CUTTING AMONG TEENS.

 

As we all know, teens encounter a variety of stressors in their lives, and develop both healthy and unhealthy ways to cope with their internal difficulties. Among the most alarming coping mechanism that parents can discover is that their child is engaging in self-injury. The behaviors are primarily cutting on oneself, but can include burning, interfering with wound healing (picking at wounds), inserting objects into the skin, punching or hitting oneself, certain forms of hair pulling. It can occur in a very rare, and minimal way, or it can be so severe as to draw blood.

 

How prevalent is this problem? It is alarming to know that cutting is on the rise among teenagers. It is also alarming to realize that those who begin cutting as teens will likely continue in their adult years, without proper treatment. The statistics are difficult to capture, as much of cutting among teens goes unnoticed and unreported. Some figures include:

 

* Each year, 1 in 5 females and 1 in 7 males engage in self injury

* 90% of adults who cut began as adolescents

* Almost 50% of those who cut have been victims of sexual abuse

* Cutting begins early, often at around 14

* 2 million cases are reported annually

* 70% of teens who have engaged in self injury behavior have made at least one suicide attempt

* Perhaps as many as 1/3 of adolescents have experimented with cutting

 

Why do teens cut? Teens generally cut as a reaction to stress and feelings of helplessness. When internal emotions feel too overwhelming, cutting can provide some distorted sense of relief. 55% of self-injurers said they wanted to get their mind off their problems. 45% said it helped them relieve tensions and stressors. Some people cut on themselves because of a sense of low confidence and self-esteem, and feel the need to punish themselves. Many teens report a sense of emotional numbness, and cutting provides a way to feel, and release feelings. For others, there are friends and websites who encourage the behavior. Cutting also occurs with other emotional difficulties, including eating disorders, depression, anxiety, and substance abuse. Some experts believe that forms of piercings and tattooing are self injury and self harm. Cutting can be anything from light scratches in times of great distress, to daily cuts so deep they draw blood. Cutters generally cut on their wrists, upper arms, inner thighs, and stomachs.

 

What should parents do? If you suspect or know that your child has a problem, it is important to communicate with them, and to seek professional help. Be aware that the cutting is a symptom of underlying problems, and just getting them to stop cutting is not enough. They

need help finding the source of the emotional pain, and gain healthy tools for coping. It is also important for a professional to help determine if the cutting is a precursor of suicidal ideation and intent. Try to avoid judging, criticizing, or attacking the behavior, and recognize that it comes from a troubled emotional place. Try not to be panicked, repulsed, or shocked – learning that your child is engaging in this is a time for acceptance, love, and assistance.

 

Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.

 

Moe Gelbart, Ph.D.

Executive Director, Thelma McMillen Center

 

________________________________________________________________________

 

1/24/19

 

MYTHS CONCERNING MARIJUANA USE FOR TEENAGERS

 

 

The legalization of marijuana (MJ) in California has taken a difficult situation, and complicated it, especially for teenagers. At the Thelma McMillen center, working with teens to consider their marijuana difficulties is among the most difficult thing we experience. Many teens are what I call “Nobel Prize” winners in MJ, that is they research it, and seemingly know everything about it, and can argue one out of any position designed to point out the harm in use. Of course, they only focus on google hits that confirm their already entrenched beliefs, and reject others out of hand. When confronted with the need to stop using, they endorse things like: it’s natural, an herb, found in nature; the generation of the 60’s/70’s (their parents) used it with no problem; it has medicinal value; it is not addicting, and, most recently….IT IS LEGAL!

 

Let’s explore some of the myths. Much of this information is found in the book Reefer Sanity, Seven Great Myths About Marijuana, by Kevin A. Sabet, PhD.

 

Myth 1: Marijuana is harmless, and non addictive. The reality is MJ is addicting. 1 in 6 teens will experience significant dependency on or abuse of MJ. The developing teenage brain is susceptible to significant psychological craving and addiction of MJ. Using criteria of progressive use, inability to stop, and experiencing negative consequences , marijuana is considered an addictive substance. In addition, the potency of today’s MJ is 5-10 times stronger than it was when popularized in the 60’s, leading to a host of serious problems. We see emergency admissions double due to cannabis related problems. Methods of use, like edibles and vaping, combined with higher THC levels, lead to increases in episodes of depression, anxiety, panic attacks, psychosis, and schizophrenia. There are also negative health effects – MJ is carcinogenic – and negative impacts on productivity, learning, grades, and overall drive and ambition.

 

Myth 2: Marijuana is medically beneficial. There are medical benefits to MJ, but they are very specific to particular problems, and not the panacea that is advertised by those who endorse use. Very simply put, the medicinal benefits from MJ come primarily from cannabinoid properties, while it is the Tetrahydrocannabinol (THC) which produces the euphoric feelings of getting high. Although teens may complain of anxiety, insomnia, pain or other vague issues that they medicate with MJ, they are really seeking the high of the THC, and would reject a medicinal form of MJ that did not include that.

 

Myth 3: Everyone uses Marijuana. Although your child may tell you this, they are only minimally correct. While almost half of high school seniors have tried MJ, 20% of seniors, 15%

 

of 10th graders, and 7% of 8th graders report monthly use of MJ. While those figures are way too much, it is not true that “everyone” uses.

Myth 4: If it were bad for you, it wouldn’t be legal and physicians wouldn’t prescribe it. The legalization of MJ has given some teens validation of their belief that MJ is safe, and not a problem to use recreationally. I believe the jury is still out as to the negative effects of legalizing MJ.

 

There are reports from other states and countries that legalizing MJ has led to an increase in use among teenagers. There are more issues related to traffic accidents. It is very difficult to determine when one is driving under the influence, and what the safe level of MJ in the system is. Even more complicating is that MJ is stored in the fat cells, and remains in the system 30-60 days. As for physician prescriptions, there are very strict rules for when a physician should dispense MJ (in fact, it is , technically, a federal crime to do so). Most of the dispensaries “dispense” without the appropriate criteria and use.

 

In summary, as society struggles with the moral and political complications of whether or not to make marijuana legal, it is important as parents to know that it is a very harmful substance for our teenagers, particularly in light of brain development issues and that negative consequences will impact them for a long time.

 

Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.

 

Moe Gelbart, Ph.D.

Executive Director, Thelma McMillen Center

 

_____________________________________________________________________________

 

1/17/19

 

TEENAGERS IN LOVE

 

In a few weeks, it will be Valentine’s Day. Our children, even our little elementary schoolers, will be drawing hearts and sending love wishes to those around them. As parents we will delight in how cute all this is. But for some teenagers, the “love” connection goes way beyond February 14th, causing pause and concern for parents. What can a parent expect, and how should they deal with the news that their teenager is “in love”? Adolescence, as we know, is a vulnerable time. It is a time when developmentally and biologically, teen brains are creating new hormones, emotions, drives, desires for individuation, and good decision making often lags behind emotional drives. It is a time when many teens experience their “first love”. As a parent, knowing how to deal with your child, how to guide them, and what limits to set can be very confusing and conflict producing.

 

As adults, most of us have gone through romantic feelings and relationships and breakups, and we have a more informed perspective, but helping our children navigate through this experience can be difficult. As with most emotional issues, there are no easy answers or clear cut directions or rules. Thinking about the issue, communicating with your spouse/significant other, and being on the same page and having a game plan can help greatly. Here are some areas to ponder over.

 

1. At what age should teens be allowed to date? This requires you to have a definition of dating, and what you can tolerate at certain ages versus others. Criteria of spending time alone together, or identifying as boyfriend/girlfriend should be considered. How much control do you actually have, and what are the risks of trying to exercise too much control? I personally do not believe that a teen is emotionally ready for real dating until they are at least 16, and probably a bit older. More important, is having a discussion about what dating means and is, and understanding your child’s emotional readiness.

 

2. How much control should you exercise? It is well known that the more parents try and control their children’s emotional relationships with others, the more likely they are to experience resistance and push their children towards the very thing they would like to avoid. Think Romeo and Juliette. At the same time, parents cannot just sit back and totally allow their children to head down a painful path. Like most issues, the key is communication, and developing an open, validating, respectful ability to discuss issues. It is much easier to set limits and boundaries after one validates feelings.

 

3. How is the relationship influencing life and decision making? It is important to keep close tabs on your “in love” child, and make sure they are maintaining their goals and directions. Grades, extra-curricular activities, and time with friends should not be negatively affected. If things that were important begin to slide, parents need to step in as soon as possible, and help with understanding and planning. Make sure that being in a relationship does not overwhelm other areas of their life.

 

4. Have an honest talk with your teen about sex. They need to know about short term gratification and long term consequences. They need to understand about safeguarding their reputation, internet and social media issues, disease and unwanted pregnancy, and how they can misperceive the meaning of certain actions. If possible, it is beneficial to talk to the parents of your child’s partner, and encourage them to have similar conversations.

 

5. Try and understand what is motivating their relationship. On some level, this is the most difficult of all, not just for teenagers, but for adults as well. Quite often, we are unaware of what needs are being met in a relationship, and whether these are healthy or unhealthy needs. If one feels insecure, if one feels abandoned by a parent, if one sees themselves as a people pleaser and rescuer, if one is co-dependent, if one experiences low self-esteem, a love relationship can artificially soothe those needs. However, that would not be the basis of a healthy relationship. Help your teen understand what a healthy relationship is, and how in a mutually satisfying relationship, each is allowed to be a strong individual and help make the other person achieve more of their potential.

 

6. Be particularly aware if your teen is in a relationship with an addictive person. As stated, such a relationship is born out of motives one is not aware of, but such a relationship could be very painful. Particularly vulnerable are children whose parents have a drug or alcohol problems. Statistics indicate that such children are highly likely to be drawn to a person with a substance abuse issue, often trying to unconsciously fix past issues through present relationship. The results are usually very troubling.

 

7. Don’t put all your hopes in geography. I have worked with many parents who feel that all will be fixed once their son/daughter go off to college, and the relationship runs its course due to distance. Many times this is the case, but often it is not. I have seen teens change their college plans, in order to be near their boyfriend/girlfriend, often at great personal expense. I have worked with parents who felt relieved when their daughter went away to college, and got away from the unmotivated directionless boyfriend, only to find out that he was moving to the city she was in to be with her.

 

There are many more things to consider, and this just grazes the tip of the iceberg. As with most issues with your teens, the antidote is communication, and having the ability to talk, trust, respect, and be honest. Remember, this is an area we all have personal experience in that we can draw upon.

 

Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.

 

Moe Gelbart, Ph.D.

Executive Director, Thelma McMillen Center

 

 

 ____________________________________________________________________

 

DOC’S CORNER

12/13/2018

 

NEW YEARS RESOLUTIONS FOR PARENTS

Happy 2019, and welcome back to school. As it is traditional to reflect on goals, visions, and desired changes, and to make New Years Resolutions, I offer these suggestions for New Year’s Resolutions for parents:

1. Examine your priorities. Most of us put our families as our number one priority, but when we look at how we spend our time, quality time with our children is often lacking. This is especially true for working parents. Be sure to carve out positive time that your children enjoy spending with you, that has no particular accomplishment or goals attached, and that your children experience as pleasurable. You can start with something as simple as having one meal together as a family every week.

2. Catch them doing something right. We spend a great deal of our time setting boundaries, disciplining, and having consequences for behaviors we want to minimize, but it is more important to notice, recognize, and acknowledge positive behaviors. This is important even if the behaviors are only partially in the direction of the desired behavior. Changes are much more likely to occur, and more powerful, when accompanied by positive reinforcement. It is believed that children hear 17 negative comments for every point of encouragement or praise. Help raise your child’s self-esteem and self-worth with positive statements.

3. Model the behavior you would like to see in your child. Monitor your own screen time and cell phone use. Create cell phone free time each day. Limit TV time, and replace it with reading. Review your nutrition and exercise plans. As I have written in previous columns, your children will be more likely to do what you do, not what you say.

4. Ask less questions. By this, I do not mean to talk less, or inquire less. Questions often leave the subject of the questions feeling like they are under attack, or are being interrogated. They get defensive because they do not know what the motivation behind the questioning is. You can achieve a better connection if you express your own feelings, and wait for a response. For example, instead of saying “where were you last night?” you can replace it with “ I didn’t know where you were last night, and that made me really concerned and worried”. Most likely you will get a response, with much less anger and irritation.

5. Listen more. Be willing to listen with what therapists refer to as “the third ear”. In addition to the content of what your child is saying, try to understand the feelings behind their communications, and work hard at validating their feelings. Remember, their feelings are based on their perceptions, experiences, and world views, and are

always a result of how they see things. Being able to reflect on that for them will strengthen the communication, and make it easier for you to help guide them.

6. Carve out time for yourself. Parenting is a tough job, and takes a great deal of devotion and energy. I have heard from many parents who feel taken for granted by those in their family. Make sure your schedule includes time and activities which are solely for your benefit and self-care. Don’t sacrifice things that make you feel good and help energize you. In addition, make sure you and your spouse/partner have time together that is not devoted to family issues.

7. Reduce how over protective you are. While it is your role to provide limits, boundaries, and safety in your children’s lives, they need to make mistakes in order to grow, and learn from them. Don’t feel like you have to shield them from all pain. A poor grade, a painful relationship, a rejection, etc., can be beneficial, and lead to improved choices if handled correctly. I have worked with many parents who, lovingly, have tried to protect their children from all negative experiences, only for those children to go off to college and not have developed an adequate base to take care of their own needs.

8. Manage your expectations. Try to find the balance between encouragement, and having meaningful goals and plans, and making sure that you are understanding your child’s needs and desires. College admission is a good example of this. While we might want to wear a sweatshirt with an Ivy League school name on it, so we feel proud and accomplished, that may not be the best for your child. When it comes to grades, remember, by definition, 50% of the group is below the mean – everyone cannot be in the top 10%. Help your child value themselves for who they are, not necessarily for what they accomplish.

9. Have the courage to set limits and boundaries. I have written about the importance of limits/boundaries, consequences, and follow through. Work hard at being clear and consistent. Your child will seemingly rebel, but will be grateful and feel cared for and safe

10. Remember to reflect on being grateful. Before going to bed each night, reflect on the things, big and small, that you have to be grateful for. Research shows that a short, regular gratitude reflection has many powerful positive benefits.

 

Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.

 

Moe Gelbart, Ph.D.

Executive Director, Thelma McMillen Center

DOC’S CORNER

12/13/2018

 

UNDERSTANDING AND PREVENTING ADOLESCENT SUICIDE: PART II. In last week’s column, I presented warning signs and risk factors related to Teen suicide. This is, obviously, a very serious topic. Today, we’ll look at some of the things parents can do to make a difference, and to minimize the risks.

1. Knowledge is the first step. Knowing warning signs and risk factors is essential. Issues of depression and anxiety need to be taken very seriously. Warning signs do not mean your child will attempt to harm themselves, but should not be ignored. Their feelings need to be taken seriously, and not dismissed as a passing thoughts or need for attention.

2. Communication with your child is essential. Interacting positively, including compliments, positive feedback are preventive tools. Even if they are not talking about problems, stress, fears, anxieties, you should pay close attention, and be aware of the stresses and difficulties they may be going through – eg, breakups, school problems, bullying, medical problems, peer pressure – and talk to them about how they are feeling. Avoid grilling them, and listen to how they feel. Active listening from a concerned, caring parent will make the child feel understood and cared for, and feel like they are not alone in their distress.

3. Take all threats seriously. The first level of suicidal thought is called “ideation”. At this stage, teens may just be contemplating harming themselves as a way of coping with their problems. It is important to listen non-judgmentally, and provide love and support. Do not tell them that “they don’t mean it” or that it is “crazy or ridiculous”. Let them know how much you care about them, that you will help them find solutions to their issues, and that most problematic things are temporary. It is also important to seek professional help right away. You can contact your pediatrician or school counselor for a referral to a licensed mental health provider who specializes in adolescents.

4. Share your feelings with them. Let them know that it is normal to have fears, depression, and sadness, and that sharing these thoughts and feelings often help provide a different, and more positive perspective. Options can reduce a sense of hopelessness.

5. Appropriately monitor your child’s whereabouts, and social media communications. Teens frequently utilize social media to express their concerns and thoughts. Be aware of their friends, coaches and communicate regularly with other parents in the community. Very often, children will tell parents about what their friends are thinking or doing.

6. Drugs and alcohol are serious issues, and related to self-harm. All and any use is risky use, and should be addressed. You may not be able to prevent your child from experimenting, but I believe it is essential that they know where you stand, and that you maintain a zero tolerance attitude.

7. If you keep guns at home, store them safely, and consider removing them if you are aware of a pending crisis. Suicide from firearms among youth topped a 12 year high in 2013, with most of the deaths involving a gun belonging to a family member. These deaths may have been prevented if a gun was not available.

8. Help lower any stigma associated with getting mental health treatment. Let them know that it is a positive step, and does not mean they are “crazy”. Help them understand the value of therapy, and medication if needed. Let them know that getting help is a process, and is not accomplished immediately. Assist them in not being too hard on themselves, or not having unrealistic demands or expectations.

9. Encourage your child not to isolate themselves. If you have concern, or if they have verbalized thoughts of self-harm, do not leave them alone until you have had an evaluation by a professional. Follow the professional’s recommendations and guidelines.

For those parents who have to deal with suicidal feelings with their teens, it is incredibly frightening. Knowing what to look for, and taking proper actions, is the best thing one can do to avoid a tragic outcome.

Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.

 

Moe Gelbart, Ph.D.

Executive Director, Thelma McMillen Center

 

DOC’S CORNER

12/6/2018

 

UNDERSTANDING AND PREVENTING ADOLESCENT SUICIDE: PART I. Adolescent suicide has become a national health crisis. Although it is difficult to talk about, and most of us would like to act like it doesn’t exist, knowing some of the causes, risk factors, and ways to get help can save tremendous distress, and even lives. The Center for Disease Control (CDC) reports that it is the second leading cause of death among youth, ages 15-19. In 2016, 2,061 adolescent suicide deaths were reported, accounting for 18% of all reported deaths in this age group. Males are much more likely to die by suicide, by almost three times as much as females. While females have higher incidence of suicidal ideation and behavior, males are more likely to carry out the acts. Almost 20% of teenagers have contemplated suicide in the last year. The causes and risk factors of suicidal thoughts and behaviors are a combination of biological, psychological, and environmental factors. Mental health issues are clearly related to such thoughts. 20% of youth have a significant mental health issue, including depression and bipolar disorder which are most commonly associated with suicidal threat. Other psychological disorders are also related, including anxiety, conduct disorders, substance abuse, post traumatic stress, and eating disorders. When these problems are combined with external circumstances for teens, they often feel overwhelmed. Interpersonal losses, disciplinary problems, school failures, conflicts with peers, and bullying can lead to a sense of hopelessness. Adverse Childhood Events (ACE) and significant and serious family issues, like physical and sexual abuse, are high risk factors. Children who have gender identity or sexual identity conflicts are at high risk, with LBGT adolescents having the highest rates of suicidal ideation. Suicide is a relatively rare event, and difficult to predict, but there are some warning signs. As listed by the American Psychological Association, these include::

1. Talking about dying or suicide. Any mention of such thoughts should always be taken seriously, and evaluated.

2. Recent Loss. Including death, divorce, separation, break up.

3. Change in personality: withdrawn, anxious, irritable, indecisive, apathetic. These can be indicators of problems other than suicidal thinking.

4. Change in Behavior: can’t concentrate, perform routine tasks

5. Change in sleep patterns: insomnia, too much sleep

6. Fear of Losing Control: acting in erratic or self harming ways

7. Low self esteem: feeling worthless, shame, guilty, self hatred

8. No hope for the future: sense of hopelessness and no ability to see things getting better.

9. Inability to experience pleasure: especially from events which used to be fun

10. Giving away prized possessions

11. Prior suicide attempts

12. Increased drug or alcohol use

13. Preoccupation with Death and dying.

I know that the issue is overwhelming and daunting. Knowing the risk factors and recognizing warning signs can definitely reduce acting out. In the next article, Part II, I will discuss preventive measures parents can take, as well as specific actions to take if you have concerns. The most important is to take all verbalizations or signs as very serious, and to immediately seek professional, therapeutic evaluation and help. Thinking that these thoughts will pass is not a good strategy. Proper assessment and treatment is essential. If you have concerns, do not be afraid to talk to your children, and ask them how they feel. Parents sometimes think that bringing up these issues can put thoughts in their children’s heads – instead, it is a message and assurance that someone cares, and will give them the opportunity to talk about their problems.

 

Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.

 

Moe Gelbart, Ph.D.

Executive Director, Thelma McMillen Center

 

 

DOC’S CORNER

11/29/18

 

THE IMPORTANCE OF VALIDATING FEELINGS. Every parent knows the value of communication with their children. It is probably the most sought after goal, and desire. A recent article in the Wall Street Journal cited research indicating that when communication breaks down, the mental health of adolescents suffer. The article quotes that “teens who disclose their daily activities and inner feelings to a parent tend to have lower levels of anxiety and depression and are less likely to engage in risky behaviors”. While seemingly obvious, why is it that the barriers to communication are often great? One study asked teenagers “who would you most like to talk to about problems” and the overwhelming majority answered an understanding adult. However, when asked “ who DO you talk to about problems”, the majority answered a friend/another teen. In essence, they are getting most of their input and advice from friends who have similar experiences, rather than parents who have their best interest at heart, combined with extensive life experience. The reason for this is that teenagers often do not feel heard, and feel adults talk at them, rather than to them. The most important skill/factor to reverse this trend is learning how to validate feelings. This is the cornerstone for good communication, not only with your children. First, we have to understand that feelings are never incorrect. When your child says they are sad, angry, hurt, you can’t say “no you’re not”. Feelings are always the result of thinking. What our thoughts tell us, create and lead to our feelings. While our feelings are always correct, our thinking may be distorted, based on wrong information, or exaggerated. It is essential to learn to validate feelings. What that means is to listen carefully, hear what your child is feeling, and let them know you understand the feeling, based on what they are telling you. For example, if they come home and say they are really angry at their teacher, and you ask why, and they say they were not treated fairly, you have to be able to put yourself in their shoes, and validate their feeling experience. You might say “if you think you were not treated fairly, I could understand why you are angry”. This is not agreeing with their perception, but understanding that how they feel is correct based on their perception. When you validate their feeling, they feel heard, and you have built a bridge of communication with them which allows you to begin to understand, or question, their thinking. With their feelings validated, they will be much more willing to look at other possibilities. If the thinking can change, eg, you come to an understanding that they were treated strictly, but not unfairly by the teacher in our example, their feelings will change. Changing thinking changes feelings. That is one of the primary goals of counseling – to challenge and change thinking which may be leading to negative feelings. The reverse of validating feelings is called invalidating feelings. As parents, we do this unknowingly, usually with good intent. If you want to insure that your child will not want to share and open up with you, make them feel like you think their feelings are incorrect. This is often done caringly, and

with good intent, but the results are a shutdown in communication. In our example, a parent would say “you shouldn’t be angry at your teacher – I’m sure he wasn’t being unfair”. The child experiences this being told they are wrong, and although they may not say so, will begin to shut down. The most direct invalidation is “you shouldn’t feel that way”.

 

As stated, learning how to validate feelings is one of the most essential skills to good communication. It is complex, and not easy. You must work at listening, at trying to hear the feelings which are being communicated (sometimes indirectly), and then make it clear that you understand, and respect (not necessarily agree with) the perspective and point of view. When you are able to validate your child’s feelings, you may be surprised that they are much more willing to open up to you.

 

Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.

 

Moe Gelbart, Ph.D.

Executive Director, Thelma McMillen Center

DOC’S CORNER

 

 

11/8/18

 

PARENTAL STRATEGIES: TO TEST OR NOT TO TEST, THAT IS THE QUESTION. THOUGHTS ON DRUG TESTING YOUR TEENS

 

Parental concern about drug use is almost universal, and the topic of whether or not to drug test one’s own child is a consuming dilemma. Parents major concerns regarding drug testing include lack of knowledge about what is available, what to do if the tests are positive, and most importantly, how does drug testing interfere with the relationship, and the strong desire to maintain trust. The other concern I hear most often is what should the timing of drug testing be, ie, is it done after one suspects a problem, or is it a preventative measure? Although opinions vary, I believe drug testing is a valuable tool for many reasons. Urine drug testing kits are readily available in your pharmacy, or on the internet. Most of these test for a panel of drugs, including alcohol, marijuana, opiates, benzodiazepenes, cocaine. Many of the synthetic and club drugs will not show up, and require sophisticated, and expensive testing. I recommend testing because it goes a long way to removing questions or doubts, and if test results are negative, a parent can much more easily dispense with their suspicions, and probing questions. One of the main benefits of drug testing is that it provides a reasonable and built in excuse for your child to refuse temptation or peer pressure to use, and saying “no, I can’t, my parents will test me when I get home” is clearly understood. If framed in a positive manner, ie, “I just want to do this so we can get this concern out of the way and not be bothered by it”, most kids will not protest too much. If a request produces great anger, resentment, and refusal, that may be a sign that there is something to hide.

 

When should one consider testing? The clearest answer is if there is concern or suspicion of use, obviously. It is a much more difficult decision if one is trying to use it as a precaution or preventative measure. If you have a good relationship with your child, if they talk to you about the pressures of use in the community, then you can discuss the issue with them. Letting them know that your relationship, trust, and communication is of utmost importance, allow them to have a voice in the decision. When there is any suspicion or concern, drug testing is a good tool.

 

If you decide to test, there are some important considerations. Testing should be random, and not announced. It can and should be linked to those times that you are especially concerned. Know that some substances, like alcohol, cocaine, meth clear the system relatively rapidly, within 1-3 days, while marijuana, which is stored in the fat cells, will stay in the system and continue to test positively for 30-60 days. You need to have a strategy for positive test results –

what will you do? Having this in place will lessen anger and battles that may result. Finally, be aware that results of drug testing can be inaccurate. There are a small percentage of false positives, or substances which may trigger a positive test that are not drug related. The percentages of these are small, but they do exist. More significant issues involve tampering with tests. If your child is having a problem, then the desire to hide it from you will be great. Teenagers have vast availability of resources aiding them in covering up their use, including ingesting substances, diluting, or even using someone else’s urine. When you are dealing with this level of deception, then it is best to consult a professional and decide upon a course of assistance. Please know that the Thelma McMillen Center provides free drug testing for teens, and if results are positive, provide resources to parents.

 

In summary, I believe drug testing is a useful tool to both lower anxiety among parents, provide a built in excuse for teens, and ultimately to build trusting relationships.

 

Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.

 

Moe Gelbart, Ph.D.

Executive Director, Thelma McMillen Center

 

 

DOC’S CORNER

11/1/18

 

UNINTENDED NEGATIVE CONSEQUENCES

 

When the topic of teen drug or alcohol use comes up, many parents do not pay close attention. The majority feel that their children do not have major issues. When there is a presentation or lecture, they do not feel the need to attend, thinking it does not apply to them. For those where there is an issue, concerns around shame and embarrassment and not wanting to publicly air problems prevents them for seeking help. Compared to most medical problems, substance abuse is endured in silence, and when one needs assistance, there is reluctance to go to a friend, neighbor, or physician, and ask for a good referral. The reality is, the vast majority of your children will not develop an addiction problem. Only about 7% will fall into the most severe category of use in their lifetime. While that may bring some measure of relief, at the Thelma McMillen Center we have learned that the real danger for most is what we call “unintended negative consequences”. Any use by a child or teenager exposes them to significant risks. I use the analogy that using is like walking through a mine field, and accidentally stepping on a mine will a major negative impact. The following are the major unintended negative consequences that teens encounter, with any degree of use:

School Problems. For teens who experiment with alcohol and drugs, their school performance often suffers. Some drugs, like marijuana, have significant impact on memory and concentration. While impact may only be a grade or two, such impact has effect on college admission and future. Their friends and activities could change. The vicious cycle then turns towards low self-esteem, anxiety, and depression. These consequences are often a result of experimental use, and do not require full blown addiction.

Legal Problems. Using substances or alcohol is illegal. The consequences for even a single use can be significant. Being ticketed, or even arrested for a substance related issue will follow the child for a long time. Certain legal actions can effect the ability to gain college admission, or to qualify for financial scholarship or assistance. I worked with a law school graduate who was ticketed for alcohol as a teen, and had to defend himself to the moral character committee in order to be admitted to the bar. These are not problems of addiction, but of experimentation.

Sexual Issues. The use of drugs and alcohol correlate with higher incidences of sexual experimentation. Substance use reduces judgment and good decision making, and can result in sexually transmitted disease, unwanted pregnancy, and accusations of sexual assault. (did anyone watch the Supreme Court confirmation hearings). I have worked with teens who have been accused of sexual assault, and have undergone severe legal and financial consequences. These were not kids who were addicted, but just experimenting.

Accidents. Over the last twenty years, life expectancy has increased for all ages except 15-24. The three leading causes of death are accident, suicide, and homicide, all linked to drug and alcohol use. Although only 17% of the population, 15-24 year olds are involved in 48% of the fatal accidents. I have worked with many kids who have injured or killed others while under the influence of drugs or alcohol, and have undergone significant consequences. The majority of them were not addicted, but just experimenting.

 

I write to you about unintended negative consequences not to frighten you, but to make you aware of things that could happen without your child having a drug or alcohol problem. It is essential to have a belief and philosophy when it comes to substance use, and to make sure you effectively communicate that to your children. While you will not be able to fully control their behavior, clear messages from you could make a difference. The goal is to delay experimentation. In our program, we have recognized the need to work with early intervention as much as with abuse and addiction. The research indicates that the sooner one intervenes, the less the likelihood to develop an addiction.

 

Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.

 

Moe Gelbart, Ph.D.

Executive Director, Thelma McMillen Center

 

 

DOC’S CORNER

10/25/18

 

A NEW EPIDEMIC: THE BASICS OF VAPING

 

As if we didn’t have enough to worry about, there is a new major problem targeting teenagers: VAPING. The Food and Drug Administrations (FDA) has declared youth vaping an epidemic, and is trying to ratchet up the control of these devices and substances to teenagers. Vaping has become the most popular tobacco product among teenagers, with nearly 12 percent of high school students, (almost 2 million) and 3 percent of middle schoolers (500,000) admitting to using the devices in the last 30 days. Of greater concern is the incredible growth daily of the number of kids trying it. While cigarette smoking is decreasing among teenagers, vaping is on the rise, as kids falsely perceive it to be safer than smoking tobacco. In this week’s column, I will cover some of the basics that parents should know about, and in future columns will address the allure for teens, the neurological and psychological basis for using, the consequences, and what can be done.

According to the Partnership for Drug Free Kids, “Vapes and e-cigarettes are battery operated devices that people use to inhale an aerosol, which typically (though not always) contains nicotine along with flavorings or other chemicals.” Vapes come in an array of styles, looking like cigarettes, pipes, and everyday objects like flash drives, pens, inhalers, and other objects. As popularity and use increases, manufacturers go to great lengths to assist teens in hiding the devices and deceiving adults around them, like putting them in hooded sweatshirts with the teens smoking through the seemingly harmless cord. These are strange manners of administration created by the vaping companies, considering they strongly declare that vaping is for adults only – sure! E-cigarettes are known by many different names, including e-cigs, hookahs, mods, vape pens, JUULs, jeweling, and electronic nicotine delivery systems (ENDS). The devices work by placing a liquid cartridge into a battery powered heating element, which atomizes the solution, and is breathed in by a mouthpiece. Although the liquids are often flavored, the vaping is usually odorless and smokeless, and generally undetectable. The liquids are also often flavored and packaged to give the appearance of something fun and harmless. Unfortunately, that is where the problem starts. Most vaping products that teens use have high levels of nicotine. According to the manufacturer of JUUL, the most popular device, a single JUUL pod contains as much nicotine as a pack of 20 regular cigarettes! The younger kids start using a vaping/nicotine product, the higher the chances for addiction to nicotine, and the stronger the addiction. 40% of kids who vaped started using tobacco products, compared to 10% of youth that did not smoke at all. That is just the beginning. Teens who begin to vape are twice as likely to move on to marijuana products as those who do not vape, with marijuana in the form of hash oil, wax, and other potent THC products. Nicotine and THC are extremely

dangerous and damaging to the vulnerable, developing teen brain. Again, that is just the beginning. There are a host of severe medical, psychological, and developmental problems which arise out of vaping. I will cover these in future articles in detail.

Knowledge is the first step in battling this epidemic. It is, literally, happening right under our noses. Although our kids believe, and want us to believe, that vaping is harmless, that is far from the truth. They are being manipulated by big business, who are motivated by huge profits, both now and in the future. What teens perceive as harmless actually has severe, and long term negative consequences.

 

Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.

 

Moe Gelbart, Ph.D.

Executive Director, Thelma McMillen Center

 

 

DOC’S CORNER

10/18/18

 

MYTHS RELATED TO TEEN DRUG AND ALCOHOL USE

At a recent parent support group that I run, the topic of children lying about vaping and drug use came up. At the first experience, parents were greatly saddened, concerned that they could no longer trust their children, and feeling a certain sense of innocence slip by. It was an experience that, not surprisingly, was commonly shared by most. The group came to understand not to take such truth challenged communications personally. When it comes to behaviors teens know they should not engage in, ie, alcohol use, drug use, vaping, excessive gaming, etc, they will not tell the truth. It is important for parents to understand, accept, and expect this, and to remain vigilant to warning signs. Being told what we want to believe feeds our denial needs, and temporarily calms our anxiety, but it is not good in the long run.

For starters, for example, you find marijuana or vaping device in their drawers, or back pack. What is the first thing your child will say to you? “it’s not mine!”. This is a reflexive response, rooted in their DNA, that all kids say. Mark this down: IT IS ALWAYS THEIRS. They are never carrying someone else’s drugs or paraphernalia. When you walk into their room, and catch them smoking marijuana, or vaping, what is the first thing they will say to you? FIRST TIME! It’s the first time I ever used, and you caught me. Of course, when you catch them again, sometime later, you will probably hear: “Oh no! The second time I ever used, and you caught me again”. Of course, almost all the time, this is not true.

What are some of the myths they would like us to believe? Among the most common are;

1. It’s only beer. The reality is that a 12 ounce can of beer, a 6 ounce glass of wine, and a 1 ounce shot of liquor, all have the same amount of alcohol/ethanol content, so that drinking six beers is the alcohol equivalent of 6 shots of vodka.

2. Everyone drinks and uses. It may feel that way, but the reality is that not all teenagers drink alcohol or use drugs. In fact, the data in the South Bay shows that 4% of 7th graders, 25% of 9th graders, and 42% of 11th graders reported using alcohol or drugs in the past 30 days. (interestingly, for 9th and 11th graders, our data is higher than the state averages). In regards to marijuana use, the data shows that 13% of 9th graders and 27% of 11th graders in the South Bay reported using marijuana in the past 30 days. To a child who is experimenting, it may feel like everyone is because they often spend their time with others who are similarly experimenting, but the truth is that not everyone uses.

3. It’s only marijuana. Teens who experiment with marijuana become “experts” in what they perceive as the harmlessness of the substance. They study the internet, and find articles to confirm their biases. I constantly hear things like, “it’s a natural herb and harmless”; “everyone used it in the 60’s and nothing happened”; “it’s not addicting”;

“it’s legal, so it can’t be bad for you”. These are myths. The reality is that marijuana is very dangerous, very harmful, and especially so on the young, developing teenage brain. It interferes with concentration, memory, drive, and motivation. The potency of marijuana today, that is the THC levels, is significantly higher than it was years ago, and therefore more damaging. There are methods which make the potency even greater. (I will go more in depth in a future column on marijuana and the problems related). In our treatment program, for both adults and teens, we see that marijuana is both addicting, and leads to other drug use as well. The notion that it is a harmless, natural substance is a myth.

Knowing the myths surrounding teen age substance use is a major tool in increasing awareness, and being prepared for early intervention when needed.

 

Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.

 

Moe Gelbart, Ph.D.

Executive Director, Thelma McMillen Center

 

 

DOC’S CORNER

10/11/18

 

PARENTAL STRATEGIES FOR HELPING TEENS IN TODAY’S PRESSURE COOKER:  PART IV – PICKING YOUR BATTLES, THE A-B-C METHOD

 

There is the inevitable, seemingly never ending struggle between children and teens trying to establish their own identity, and live by their own rules, and we parents trying to teach them, guide them, and protect them from dangerous behaviors and actions.  Sometimes it feels to both sides like there are rules for everything, nothing is acceptable, and there is a constant tug of war regarding rules and expectations.  To cope with this, and ultimately achieve better relationships and results, I advise parents to adopt what I call the “A-B-C” method.  The core principle is to understand that all behaviors are not equal, and for parents to be able to distinguish between essential and non-essential issues.  I suggest dividing the issues with your teenagers into A, B, and C categories.  “A” category issues are essential, and non-negotiable.  It is important to note that for each of these categories, there are no hard and fast rules as to what is to be included – each set of parents decide what fits for them.  The most important issue is that both parents be on the same page, or the result will be massive splitting.  “A” category issues are things like taking drugs or drinking, attending school, not being verbally or physically abusive, and behaviors which are absolutely unacceptable.  The child needs to know that these behaviors and rules are non-negotiable, and parents will do whatever it takes to insure compliance.  Most parents can identify “A” issues relatively easily.  “C” issues are things your child does, that you don’t like or agree with, but that you can live with.  Again, it is each parent’s personal decision as to what constitutes a “C” item, but it is things like the color or length of their hair, how well they clean their room, how they spend some of their time.  My recommendations regarding “C” issues are to let your child know how you feel, but let them make their own choices.  This is an important step in them developing their self-identity and to independence.  Finally, “B” issues are those areas where parents express their desires and expectations, children express their points of view, preferences, and choices, and there is an attempt at negotiation, bargaining, and compromise.  “B” issues can be things like curfew times, attending events or parties, screen time on cell phones or devices.  The goal on “B” issues is to try and arrive at compromise and understanding, learning to give and take, and both points of view receiving respect and validation.  Although not a hard and fast rule, you should try and achieve a balance between A-B-and C behaviors, perhaps close to a third for each.  When caught in a battle, you can ask yourself, “is this A, B, or C” and act accordingly.  The problem for many parents, and children, is when everything begins to  be an “A”, ie, how you clean your room becomes as much of a battle as whether you try drugs, and the child then begins to tune everything out, and hears everything as an absolute demand.  These children experience and perceive their parents as trying to control all aspects of their life, and a common reaction is to rebel against everything. 

 

Think about your own situations, and try and place rules/expectations into A-B-C buckets.  I think you will find a much more pleasant response from your children.  I am impressed that parents with whom I have presented this to have taken it to heart, remembered if for years, and found it works extremely well.

 

Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.

 

Moe Gelbart, Ph.D.

Executive Director, Thelma McMillen Center

 

DOC’S CORNER

9/26/2018

 

PARENTAL STRATEGIES FOR HELPING TEENS IN TODAY’S PRESSURE COOKER: PART II – SETTING LIMITS

 

Here is a secret. Kids love limits and boundaries. You would never know it from their behavior, and their reactions to limits. It is in their developmental DNA to push against boundaries and rules and limits, and in doing so it is how they come to understand themselves and the world around them better, and how they grow emotionally. While they will rebel against most of the limits you set, limits actually provide a safety net for them to explore their environment. They know how far they can go, and know if they cross those lines, they will be taken care of. Those who grow up with little or no limits, experience fear and uncertainty, which leads to anxiety and the need to predict the future and plan for all possible outcomes. Growing up with inadequate limits develops distrust in one’s ability to live in the present and develop good coping skills.

 

Limits by themselves are not enough. Parents need to develop limits, consequences, and follow through. All three aspects need to be present. Limits without consequences or follow through are the proverbial “bark without bite”. Limits need to be set clearly and objectively, and understood by the child. As much as possible, they should be set out in advance of behaviors, and not reactive to issues and events which come up. Naturally, all behavior is not always predictable. We will use an ongoing example for demonstration. A curfew limit could be “you need to be home by 10 PM”. The child needs to understand it is not 10:05 or 10:10, but 10. Consequences should be explained in advance, and not as a reaction to an event. I believe it is important for consequences to be related to the offense, and not random. If curfew is the issue, the consequences need to be related to privileges for staying out, and not unrelated issues. It is very important to not have consequences of removing things which are positive for the child’s development. In our curfew example, the consequence could be something like “if you come home after 10, you won’t be able to go out next weekend”. The consequences should be meaningful enough to change behavior, and should BE DISCUSSED IN ADVANCE. Children will learn they have choices, which have consequences and have a right to make those choices. This approach enables parents to diffuse their anger over broken limits. Imagine, instead of getting angry at your child for coming home late, you said “ I respect your right to have an extra 10 minutes out today, knowing that as a result you will not be going out next weekend”. The final piece, and most critical piece, is follow through. You must think clearly about the consequences you set, and be certain you are able/willing to act on them. If you do not, if you soften, then your child will learn to not trust your words, and internally ignore your limits. We have all seen rambunctious 2 year olds in shopping carts in the grocery store

throwing items. The parent screams “if you don’t stop, I’m never taking you shopping again”. Even at 2, the child smirks internally, knows this is not true, and their willingness to listen is eroded slightly. Before you set consequences, make sure it is something you will see through.

This process – LIMITS/CONSEQUENCES/FOLLOW THROUGH is essential in raising children who will feel secure and safe in a stressful world.

Next week, I will discuss Delayed Gratification.

Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.

 

Moe Gelbart, Ph.D.

Executive Director, Thelma McMillen Center

 

DOC’S CORNER

9/4/18

 

As parents, we are all concerned about the dangers of drug and alcohol use. Given all that is known, all the publicity, all the problems that teenagers are aware of, one wonders, Why do teens use? The reasons, of course, are complex, and there is no single answer. The unique development of the teenage brain sheds some light. We now know that it takes about 25 years for the brain to fully develop and mature. During the teen years, the pathways for physical coordination, sensory processing, motivation, and emotions have been well formed. However, the prefrontal cortex, which controls judgment, is not yet fully in place. This leaves teenagers as highly emotional, preferring lots of physical activity, and seeking high excitement and low effort tasks (any of your kids enjoy video games, for example). With judgment not fully formed, teens like high risk behaviors that stimulate them, and often do not think of safety or long term consequences, rendering the teenage years as quite vulnerable. That leaves the door wide open for experimentation with mind altering substances.

 

Teens experiment with drugs and alcohol because it is fun (at least at first) and because it makes them feel good. In a later column, I’ll address the biochemistry of what makes them feel pleasure. Substance use is also used to deal with unpleasant feelings. Almost 60% of kids self- medicate issues concerning depression, anxiety, ADHD, bipolar, learning disabilities, and other psychological concerns. By numbing and distracting their feelings, they may experience temporary relief. However, as we know, the problems are not solved, but exacerbated by this tactic. Peer pressure, and peer acceptance is another factor for teens beginning to use. Striving for acceptance, or wanting to avoid being singled out, can often be a powerful influence, and wanting to be part of what is perceived as “the in crowd” can push someone to action. Today’s teenagers are experiencing a great amount of pressure, via social media and high expectations to achieve, and they often turn to drugs or alcohol as a way to relieve that pressure. For those who perceive themselves as falling short of expectations, in school performance, athletic performance, or other extra-curricular activities, substance use is often attempted to deal with feelings of low self-esteem. Alcohol and drug use can also be a misguided attempt to cope with life traumas, including loss, abuse, illness, and other serious family issues. Finally, there is a genetic component to substance use problems. If there is a family history of drug or alcohol dependence, teens must learn that their brains may be wired differently than others, and need to be even more cautious about the desire to experiment. Often knowing the risk factors is the first step to increasing awareness and developing a plan for recognizing and dealing with difficulties.

Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.

 

Moe Gelbart, Ph.D.

Executive Director, Thelma McMillen Center