PARC IS MOVING...

PARC is now an integrated part of my new website and can be reached directly via this link. Please visit me there and tell me what you think---

CO-OCCURRING DISORDERS IN TEENS: Bipolar Disorder--The Great Imitator

Angry outbursts, erratic sleep patterns, sudden mood swings, and changes in personality. If you’re a parent of a teenager, these behaviors can be the status quo—actually, we often take these behaviors for granted. When teens are in trouble, when they are struggling to cope with issues that are too difficult for them to handle, drinking or getting high makes these behaviors worse often to the point of frightening us.

Symptoms of addiction often mimic other behaviors and make it hard to figure out exactly what’s going on in kids who are getting high. We know that kids (and adults) get high to help manage the difficult emotions associated with life’s challenges. And we know that adolescence presents them (and us!) with unique challenges.

Your parental instinct that something is wrong is often correct, but understanding the difference in the root causes of their erratic behavior will help you decide what course to take with your child.

Sometimes the issues are normal external pressures, like arguments with friends, academic expectations, real or perceived rejections by others.

Sometimes the issues are internal, relating to your child’s coping style, temperament, or ability to tolerate frustration. When bipolar disorder is present, however, the internal issues are also related to your child’s brain functioning.

HOW ADDICTION SYMPTOMS CAN MIMIC BIPOLAR DISORDER

It’s important to understand that bipolar disorder is a medical condition of the brain. The person experiences extreme highs (mania) and extreme lows (depression). When I explain below more about what bipolar disorder is, you’ll see how easily it can be misdiagnosed in children and teens as major depression, attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder.

During a manic episode, a person’s mood is noticeably euphoric, irritable, or aggressive. It is common for a person who is manic to think that nothing is wrong with their behavior even though it is extremely distressing to family and friends.

During a depressive episode, a person may feel sad or lose interest in previously enjoyable activities. When severe, thoughts of suicide may be present. Someone with bipolar disorder can experience a variety of mood patterns, such as having mostly episodes of mania or mostly episodes of depression. Another person may cycle rapidly between the two. It is also possible for someone to remain symptom-free for extended periods of time.

BIPOLAR DISORDER AND CHILDREN

Another important thing to know is that bipolar disorder looks different in children and teens than it does in adults. When children or teens have bipolar disorder, they have mood swings with extreme ups and downs. When they are up, they have brief, intense outbursts or feel irritable or extremely happy (mania) several times almost every day. They have a lot of energy and a high activity level. When they are down, they feel depressed and sad.

Children more often experience several severe mood swings in a single day versus the sustained and clearly defined manic episodes that adults have. These intense moods quickly change from one extreme to another without a clear reason. Some children may briefly return to a normal mood between extremes.

Many children change continuously between mania and depression, sometimes several times in the same day. Sometimes children with bipolar disorder have symptoms of both mania and depression at the same time, often showing itself as agitation or extreme irritability.

But because of the “normal” ups and downs of adolescents or for children with sensitive temperaments, times of mania or depression may be less obvious in children and teens than in adults. It’s often difficult to sort out what exactly is going on.

Normal ups and downs of adolescence are exaggerated greatly when kids are drinking or getting high. As with adults, children will resort to getting high in an attempt to feel “normal” or balance out the “feeling crazy” that bipolar contributes to. That’s why when substance abuse is in the picture things get even more confusing.

The good news is that bipolar disorder can be effectively treated usually with a proper combination of medication and counseling. Getting a thorough evaluation by a professional who is experienced with mental illness and addictions is your best bet in determining what course of action to take.

As always, education and support are the best antidotes to the fear and helplessness we feel as parents when our children are suffering from bipolar disorder.

Other excellent resources to learn about bipolar disorder and get support are the Depression and Bipolar Support Alliance and the Child and Adolescent Bipolar Foundation has a great site especially for kids.

HAPPY MOTHER'S DAY! CELEBRATE WITH MOM'S NITE OUT

In celebration of the great jobs moms do, The Partnership at Drugfree.org is promoting 'National Mom's Nite Out' to give moms a well-deserved night off and celebrate who they are besides being a mom--a girlfriend, a friend and a woman.

Locally, there's a fun nite planned here on Philadelphia's Main Line to give moms a chance to strut their stuff at a fashion show and silent auction.

Taking time out for yourself to re-energize and let off steam is crucial to effective coping with addiction in the family. Make sure you don't just wait for Mother's Day!!

WHAT ARE CO-OCCURRING DISORDERS?

Please note: This is the first in a series of blog posts that will address the relationship between addiction and associated mental health problems. I'm starting with a general overview here and will add posts that will be more specific, focusing more on specific mental health issues as they relate to children and the family.

Comments, suggestions, and questions are always welcome and will help me develop and tailor the blog to your interests/needs.

Addiction doesn't happen in a vacuum.

Sometimes we take for granted what our brains are for. We are not robots--our brain controls everything that we do, from monitoring breathing and heart rate to deciding whether to eat a cheesesteak with or without fried onions or reaching for a salad instead.

We know that drug, alcohol, and other addictions are complex problems that involve the interaction among many variables:

• Biological, such as heredity or genetic makeup
• Environmental, such as family, school pressures.
• Social, or interactions and relationships with others
• Emotional, or feelings such as anxiety, depression, anger.

It's the emotional variables that underly and contribute to the symptoms we most often associate with co-occurring disorders and compromise our mental health. I've previously written here before about the interaction between addiction and mental health, but what I want to focus on now is what happens when an addicted person's emotional issues become prominent and seem to take on a life of their own.

'Co-occurring disorder' is a fancy term for mental health problems that occur alongside the addiction, when a person's ability to manage their emotional world becomes a problem in itself. The main types of co-occurring disorders are:

• Anxiety problems: panic attacks, phobias, generalized anxiety, obsessive-compulsive disorder
• Post-Traumatic Stress disorder (PTSD)
• Depression problems: Major depression and Bipolar Disorder
• Attention Deficit Hyperactivity Disorder (ADHD)

The first three listed above sometime start prior to the addiction, when the person turns to drugs (marijuana, cocaine, opiates, etc.), alcohol, or other compulsive behaviors (overeating, gambling, shopping, video gaming, etc.) to help manage their difficult emotions better. Choosing drugs, alcohol or compulsive behaviors helps to escape the painful and/or scary feelings by numbing, avoiding, or disconnecting from feelings altogether. Our emotions are often warning signs that something is wrong. Just like ignoring warning light on your car's dashboard can become a serious mechanical problem, not paying attention to our emotions can lead to coping-with-life problems.

ADHD, on the other hand is related to addiction and emotional well-being in a different way than the emotions described so far. ADHD is a neurobiological, or brain-based disorder, that contributes to increased impulsivity in behavior and emotional expression. Impulsivity often contributes to low frustration tolerance and anger management problems.

Sometimes, when a person becomes sober and lets go of their longstanding coping mechanisms, anxiety, depression, and ADHD problems become revealed and will need specific attention in addition to traditional addiction counseling and relapse prevention approaches.

It's estimated that 60% of people with a drug and alcohol problem also have a co-occurring mental illness. Symptoms of addiction--mood and personality changes, sleep and appetite disturbance, irritability and impatience--often mimic co-occurring disorders. Symptoms of depression are often expressed differently in children and adolescents, so that can complicate things even more.

Research suggests that the best treatment approach is one where both addiction and mental health issues are addressed at the same time. Finding a therapist skilled in treating both addictions and mental illness is crucial if there is any uncertainty of mental health problems.

Don't be afraid to ask a potential therapist if she/he has experience with co-occurring disorders, if you're at all unsure about your child or family member's situation. It will greatly increase the likelihood of getting the comprehensive treatment that's needed.

"COLLEGE IS A PART OF LIFE; IT'S NOT APART FROM LIFE"

Getting a college degree is an impressive accomplishment that any person can be proud of.

Unfortunately, the faulty expectations that are part of the "mystique" of college life--"These will be the best years of your life!"--undermine the success of many kids' adjustment to college, leaving behind a long line of depressed, anxious, alcohol- and drug-abusing kids.

Many kids hit a wall when they get to college, mostly because they're not prepared for what are the normal challenges of this phase of life that college presents. Yes, it's normal-- no, there's nothing wrong with you!--if you struggle with establishing a life separate from your parents, family, lifelong friends and supports.

Confronting brand new academic, financial, and social pressures that the college experience brings is hard enough for any child, let alone with those with acknowledged learning and/or emotional problems. "Changes of scenery" and "getting away from mom and dad" are not part of a good plan for kids already struggling to manage their anxiety, depression, and/ADHD.

A recent Huffington Post article by Meg Schneider points out that, yes, going away to college offers the possibility of growth and positive change, but it's naive to believe that old challenges can just be erased.

Meg offers many excellent realistic suggestions for embracing the opportunities offered in college that will improve the chances of a successful college experience. Her main message is one of normalizing the college experience, and I love how she describes it: "College is a part of life. It's not apart from life". Perfectly stated.

If your child is unhappy at college, it's crucial to have him/her ask for help. It doesn't mean that there's something wrong with him or her. Getting that diploma may involve a few detours or pit stops along the way, including a few at a counselor's office. It's a normal part of the journey to that impressive graduation milestone.

I'M NOW ON FACEBOOK AND PART OF THE 21st CENTURY

I've finally joined the 21st century and started a Facebook page. It's still early in the century so in that sense at least I'm not that far behind.

I've been hesitant to do it because of what we know about the potential problems associated with social media and my concerns about the ability to maintain the privacy and boundaries needed for a safe and respectful site for any visitors. These concerns are balanced by my wish to be more accessible to the community but feeling somewhat limited by the constraints of my website and this blog.

What I realize now is that the spontaneity and openness of Facebook that I initially feared as a potential problem can be harnessed (I'm hoping!) to my need for more a fluid and dynamic relationship with the community. My comfort level with social media has grown exponentially in the past year, somewhat paralleling the exponential growth of the power of Internet technology.

Throughout history, changes in communications technology (for example, printing press, radio, television, etc.) are initially met with much fear and skepticism. Marshall McLuhan coined the phrase "the medium is the message" in the 1960's to cleverly demonstrate that the content of the message itself is often not as important as how the message is transmitted by a technology. In other words, the Internet technology itself (Facebook, Twitter) that is being used to communicate the message is transforming our lifestyle, attitudes, and behaviors in ways that are more important than the actual messages that are being sent over the Internet.

So, I'm looking forward to learning more about using social media as tools in my work and personal life, but keeping mindful of the problems associated with Internet addiction and the damaging consequences associated with Internet use if we're not careful.

Let me know what you think, and I look forward to seeing you on Facebook!

'NOT MY KID': THE ENABLING TRAP

An article in the Ambler Gazette last weekend about parents in Blue Bell, PA acquitted of charges of hindering a police investigation of their young adult son reflects the potential trap of enabling that many parents face when their children brush up against possible consequences from their substance abuse.

Please note: I’m not intending in any way to make a judgment about these parents, but I’d like to use their situation to identify a common issue among parents who are worried about their children’s drug and alcohol use.

Enabling occurs when you begin to lose your way and get confused about how to protect your children’s safety. You desperately want to believe your kids are telling the truth and therefore can be easily convinced that everything is okay, often telling yourself, 'Not my kid'.

Parents who are aware of their teenage children abusing drugs and alcohol are very familiar with enabling. When children are showing problems associated with getting high, a dramatic shift in the family often occurs.

The ‘not my kid’ mindset is a set up. The addict becomes an expert at manipulating and deflecting responsibility onto others and takes advantage of your love and protection to selfishly get what she wants without regard for the consequences or impact on others.

The whole family begins to react in unhealthy ways to accommodate the addict’s behaviors, because confronting them directly creates messy, often embarrassing conflicts.

Out of love, concern, shame, and fear, you become uncertain about how to best intervene. Living with a child with a drug and alcohol problem is like being in the back seat of your car as you are driven around by your inexperienced, untested young driver—the daily out-of-control, often terrifying feelings become unbearable at times.

The world of the enabler is like a yoyo, jerked back and forth across the line between being over involved trying to protect and cover up for your child, to being so angry, scared, and helpless that you want to give up. You swing back and forth between looking the other way and wanting to stalk your child’s every move.

Intervening can feel daunting. Here are some guidelines to make it easier:

• Educate yourselves by arming yourself with facts about drugs and alcohol to be credible when talking to your kids.
• Learn more about the dynamics of enabling.
• Confront your denial: Parent's instincts about a problem are usually correct. Avoiding and ignoring the problem makes you part of the problem.
• Take care of yourself by getting support:

-- Reaching out for help is a way for you to take care of yourself. Start by sharing concerns with spouses, partners, and trusted friends to help feeling less ashamed, overwhelmed, and helpless.

-- Community programs like Al-Anon and Nar-Anon can be lifelines for families struggling to regain balance in their lives.

-- Online communities such Parenting the Addict Child are excellent resources for those who aren’t comfortable with groups or 12-step programs.