4-20

Today is 4/20, a day when pro-marijuana advocates come out in support of legalization efforts around the US to legalize. I’m a doctor in the state of Texas, and a psychiatrist. I’m in the field of medicine that treats addictions and PTSD. The DSM5 has added Cannabis dependence as a disease classification due to a growing body of research showing that it is possible to get hooked on pot, and simultaneously, evidence shows cannabis may be a viable medical treatment for several mental health disorders.

Meanwhile, the debate over medical marijuana has begun in Texas. Medical cannabis has many uses, many of them that might affect the patients I see every day: PTSD and anxiety disorders can be treated with cannabis. We have other effective treatments for those illnesses, so as a physician, I haven’t been compelled to lobby my legislature for medical legalization of cannabis to treat mental health disorders. 

But then I learned about the research on cannabis oil for childhood seizures from a fellow Texas physician, a pediatrician, who handed me an article and said, “Have you seen these numbers? This is amazing.” It appears cannabis oil can have miraculous effects on some childhood seizure disorders. There are medical journal articles with statistical analyses for the medical professionals, and & videos posted by parents of kids with intractable seizures to demonstrate for anyone who wants to search online and see for yourself. Desperate families of kids with terrible seizure disorders are trying to petition the legislature to offer them hope where there has been none.

Some of the kids who could be helped with medical cannabis have twenty or more seizures every day. The damage to their brains and bodies is unthinkable, and then there’s the toll on the family: the constant monitoring, the sleepless nights, the fear of serious head trauma from the next episode, and the fear of a seizure that can’t be controlled, resulting in an untimely death.

The problem with a debate over medical marijuana is that it can quickly turn into a black and white, simple yes or no, partisan set of arguments. “Drugs are bad.” “Pot is safe.” My view on cannabis is not black or white, for sure.

I don’t want teenagers and young adults smoke recreational marijuana, or use any substance to escape reality. The association between marijuana use and the onset of schizophrenia worries me, and young brains as still forming, making them especially vulnerable to the affects of substance use.

But medical cannabis can save little lives. Children’s lives. So, I hope the Texas legislature legalizes medical marijuana. And I simultaneously hope your teenager (and mine) doesn’t choose to smoke it recreationally.

Hard Choices: When Your Teen Needs Rehab

When is rehab the right choice? Sending a teen away is never fun, never easy. Parents struggle with the same hard questions.

Why can’t she just do a better job of controlling her behavior instead of going to rehab?
    Willpower to overcome unhealthy behavior is difficult for all of us. Even healthy adults fail to follow diets and lifestyle changes. How often do you fail to get to bed on time or exercise regularly? Expecting a teen to ‘will’ herself out of drug addiction is setting her up for a dangerous failure. By the time we are looking at the possibility of rehab, self-control has slipped too far from your teenager’s grasp. She needs help now.

Why rehab? Who needs to go?
    I recommend rehab when a person, teen or adult, has clearly lost control over the use of substances and is unable to regain control. Some individuals experience a feeling of powerlessness and ask for help, but many, especially teens, must be pushed to go into treatment by concerned parents. 
    Rehab stays of 30, 60, or 90 days can remove a teen from a life that’s spiraling out of control. The treatment center will try to keep all the residents substance free and focused on healthy goals. They will be pushed to face their addiction while isolated away from peer groups and pressures to take risks.

Will treatment work?
    Sometimes the result of a rehab stay is complete abstinence from addictive drug use, and other times teens return to drug use later. But even if a teen faces a future relapse, rehab stays may slow the progression of the addiction. 90 days away from escalating dangerous drug use may prevent serious overdose. Breaks from drug use may result in a more manageable illness later. Families usually push for treatment when their teen has lost control, and treatment is a place to contain and control dangerous behavior. 

What if we can’t afford it?
    Substance rehab can be expensive. Some insurance plans help with the cost. Many non-profit agencies allocate funds to aid with addiction treatment. If you’re worried about the cost of care, call your insurance company or research programs that administer or pay for care for the uninsured.

Can we just send him for a couple of weeks?
    Many families consider shorter stays in treatment when funding, or other stressors, make the decision to send a teen to rehab complicated. My recommendation, however, is for parents to commit to the longest-term treatment possible. Changing behavior can take a very long time. If your teen is in trouble, invest now and make the greatest difference in the long run.

Will she hate us if we make this decision?
    This question is a common one. Parents are afraid of the consequences of forcing a teenager into treatment. Your child may be angry, true. To help you decide whether rehab is worth the risk, I encourage you to consider the consequences of your teen not getting the help she needs now. Has she had a dangerous overdose? Is she taking risks that are likely to lead her to serious harm? If the outcome of choosing no treatment sounds scarier than the problems you’ll face if you follow through and make her go, then your teen probably truly needs to go to rehab for her own safety.

Aren’t there outpatient programs where she can get the same treatment and stay at home?
    Yes, and perhaps no. Teens are part of a family and community system. Their peer relationships and their identity in the family are extremely powerful forces. Keeping your teen at home and sending her to school each day, and then to counseling in the evening, does not extract her from her system and help her change in the same dramatic way she might if you pull her away. 
    Outpatient treatment is helpful as a first intervention for milder problems. If your teen had a single alcohol related incident, or was caught with marijuana once at school, outpatient programs are the place to start. But if your teen is exhibiting dangerous behavior or is using regularly, removing her from the system where she operates now is an important part of helping her change risky behavior. 

Won’t he go the rehab and meet a bunch of drug addicted new friends, and end up in worse condition than he started? 
    Parents often imagine that rehab is the worst place for a teen in trouble. While this is a sensible concern, in reality, teens in trouble usually have already built up a circle of troubled friends. However, peer concerns are one more reason to send a teen away from home for treatment, not keep them close to home local programs. If your teen goes to another city for treatment and meets a group of drug addicted peers, those kids won’t be nearby to sell him substances if they relapse after treatment in a far-away community. On the other hand, if your teen attends a program at home, peers from treatment may remain close contacts day to day.

This feels like a pressured decision and we don’t feel ready. Can we wait?
    If your teen is in crisis now, it may be best to act quickly. This is one of the hardest parts of coping with addiction the family. If you’re unsure, talk to professionals or other parents who can guide you. Attend a Parents’ Al-Anon meeting. Tell your story to a parent who has been there. Ask for advice from someone who has made a similar decision for his or her child.

Walking Together With Mental Illness

Gaps in Mental Health Care Fall to Unprepared Families

Mental health prescribers are in short supply and the availability of psychiatric services seems most limited for children. This week I saw a teen just out the hospital and unable to find any child psychiatrist to continue her care. Her parents called every child psychiatry office they could find and could not get an appointment, not even for a 6-month waiting list. Instead they were told, “Sorry,” but that there was nothing available at all.

College campuses are reporting record rates of mental health crises. Counseling centers on campus are unable to provide adequate services for growing numbers of students diagnosed with serious mental illnesses. In the fall semester, I had a student at Texas A & M, a large university with an excellent counseling center, unable to receive any of his care on campus because the system has been flooded with record numbers of students beginning college with major psychiatric diagnoses. Students with simple adjustment issues can meet with an on-campus counselor, but those with serious diagnoses are sent to find treatment on their own and the community psychiatrists are overloaded with too many people already in the system.

Aging baby boomers with declining memory and mood are equally finding it difficult to get the care they need. A seventy-year-old retiree in need of case management and in-home nursing can’t even find a psychiatrist to prescribe her medication.

With such limited resources, families are left to take on much of the burden for managing mentally ill, addicted, or cognitively declining children, siblings, spouses, and parents. Families are responsible for:

1.    Medical care coordination
Finding providers and then making certain they talk to one another falls to families. Families research, call, and beg for care with the few prescribers available. 
2.    Funding for medical care
Despite parity laws, funding for mental health services continues to be a significant burden for families. Many insurance plans fail to cover necessary services, or even when services are covered, it can be impossible to find providers who accept the plan. Families must go outside the plan they pay for and pay cash for private care.
3.    Food, clothing, and shelter
Mental illnesses can rob people of their ability to function and earn income. For some, diminished functioning occurs during a period of crisis, and then when they stabilize, they can return to work or school. Others spend years or even decades unable to work. Families are left to absorb these costs. 
4.    Re-grouping after a crisis to return to function
Families are left to supervise the process of restoring a loved one to functional status. This can be difficult, as families are often uncertain when to support a loved one, when to hold him or her back longer, and when to push him/her to go out into the world and do more.
5.    Monitoring treatment adherence and response 
Many mental illnesses impair insight, resulting in sick individuals denying the importance of medication, therapy, and social services. Family members have to step in and impose care on those who need it, but may not want it.
6.    Advocacy
Family members are left to fight for services they desperately need. 

Training additional mental health clinicians takes years. Until we have more providers to meet to greater need, the burden on families is likely to continue. If you’re a family member supporting a loved one with a psychiatric or psychological illness, join a local organization or group for support. Contact the National Alliance on Mental Illness (NAMI) for support and advocacy organizations in your community.

Parents: Why That ______ Worrying You Isn't So Bad

Fill in the blank above with the thing that’s stressing you out right now about raising your kid. You know, that thing that’s nagging at you. It’s been keeping you up at night with worry. If your child is a toddler, you’re fretting about the temper tantrums, the sleep schedule, or the adjustment to a new baby in the family. Or if you’re parenting a school-aged child, you’re concerned about those reading skills or that social adjustment.

For parents of teens and young adults, it’s the belly button ring, the fender bender, the college essay, or the boyfriend/girlfriend calling after midnight.

Whatever goes in that blank for you, it might feel like the end of the world. It might feel like, “If we don’t work this out, this child won’t be normal.” Or “If my kid goes forth down this path, his/her life is never going to turn out well.”

But you’re probably wrong.

If you’re worrying about your kids, guess what? You’re probably a pretty good parent. Worrying is a sign you take your parenting job seriously. So, good work! As children grow up stage-by-stage, parents are constantly encountering changes in our job descriptions. It’s natural to feel uncertain, even worried. But most of the time, the things we worry about turn out just fine.

Worrying probably won’t help you solve any problems. In fact, it might create a few extra problems for you. Worrying can make parents hover over the crib of a sleeping infant wondering why she’s not falling asleep, and thus inadvertently make it harder for her to sleep naturally. Worrying can take parents up to the elementary school where they argue with teachers over standardized test scores. Or back at home worrying can make parents fuss at kids who feel too tired to review the spelling words one more time before bed. Worrying can make parents hold a college drop out at home until he proves he is a grown up, rather than allowing him to stumble and fall (and learn) on his own out in the world.

In the end, your only goal as a parent is to launch a functional adult.

Functional adults have weathered tantrums, peer problems, failing grades, had tattoos removed, and have driven around in dented cars. When they are young, even the most functional adults make mistakes, and your kid is bound to make a few before leaving home.

Tolerate the mistakes- yours when they are young, and theirs when they are older. Understand the road is bumpy. Courageously relinquish control.