Category: schizophrenia

Life with a schizoaffective teen

Life with a schizoaffective teen

I have first-hand experience raising a child with schizoaffective disorder.  Up until my child’s onset of the disorder in the ‘tweens’, I never thought I had much patience or backbone.   But one’s character strengthens with trials, and I learned I was patient and stronger inside than I thought.  Parenting my child entirely changed my life’s direction.

Farther down this post are practical tips and advice for raising your child.

My Story:  Schizoaffective teens have both schizophrenic symptoms (thoughts disconnected from reality) and affective symptoms (unstable emotions and moods).  What an unfair combination to sabotage one’s brain.   My child had to persevere through intense feelings, excruciating anxiety, and thoughts that rarely touched on facts.  How could anyone maintain any semblance of normalcy during this?   The mental effort of holding herself together must have been exhausting.

My child was often exasperated with me, as other teens can be with their parents:  “Mom, you don’t understand; it’s like the TV’s on, the radio’s on, music is streaming, you’re talking to me, and I’m trying to read a book, and I can’t not think about every single thing.”  Right, I did not understand.  I sounded like she was processing 10,000 inputs at once.  The mental overload must be why she acted crazy sometimes.

Hallucinations feel real when you’re in them

My child had a slow early onset of hallucinatory experiences beginning about 11 or 12, and she was able to hide it until 14. She considered the hallucinations and voices normal and became accustomed to them.  Eventually, she noticed that others didn’t see or hear the same things:  the rhinoceros walking by; the sky turning green; words writing themselves on a blackboard.  She took this proof of being special, magical, a traveler on the metaphysical plane.  She had attitude and felt superior to others; she felt she had special powers.

I have never had hallucinations, but imagine they are like dreaming wide awake. My child’s audio hallucinations included something out of Monty Python:  two loudly arguing British ladies, with thick Cockney accents, relentlessly criticizing each other’s cooking and husbands.  She said this only occurred in math class, and complained it was impossible to hear what the teacher said.  Even today, during summers when she is happy, she seems to be hearing jokes throughout the day.  Our family witnesses outbursts of laughter and giggling for no apparent reason. Humor is contagious, and we all cheer up when this happens.

My child’s visual hallucinations took fascinating forms:  stairs looked like a cascading waterfall; a living room chair continually rotated in space instead of standing still; moving objects left trails in space, like a series of images seen with a strobe light.

She awoke one morning and described her life as a powerful queen for 1000 years, and talked about it in extraordinary detail.  She had an uncanny air of confidence and royal privilege in the telling.


My child is the bipolar type of schizoaffective person.  While depressive types don’t have the highs or excessive agitation,  they still suffer with anxiety and paranoia.  When she was in a down cycle, she darkened her room and slept in a pile of bed-clothes on the floor.  She avoided things with negative symbolic meaning, such as certain people, certain streets, or certain names.   For some reason, sunflowers and Christmas were upsetting.  During depressive phases, she talked about suicide, or “caught” other disorders such as anorexia and PTSD.  I was often accused of abuse and endured many hurtful words.

Haunted by anxiety and paranoia

Anxiety and panic were torturous, and I wished I could have spared her from the pain.  She would obsess on a past emotional hurt and become horribly upset for hours, days, weeks at a time. (In my stress and ignorance back then, I yelled at my child unaware of how hard this impacted her mental health.)  I have apologized a zillion times.

My child continues to obsess on ancient hurts, now well into adulthood.  Any traumatizing experience can become a theme in the life story of a schizoaffective person.   They will refer to it and make connections to it for the rest of their lives.  Major obsessions with my child are about money (having money, people stealing money, having no control over money).   It’s common for her to interpret any event as the turning point when everything started to go downhill, “That’s when you took all my money, “That’s when you ruined my life.”

Paranoia is ever-present.  It’s the very nature of schizophrenia spectrum disorders to find something to be paranoid about.  The point is that a parent to must avoid talking them out of their paranoia.  It will never work, and both of you become frustrated and upset with each other.  The emotional drain on your child can also cause intense irritability.  I had to learn to “de-escalate” my child, don a quiet and patient demeanor, affirm her feelings, show empathy, and change the subject (“redirect”).  The other problem with paranoia is that it creates intense resistance to psychiatric treatment–as if others are trying to control their mind.  There’s more about building trust below, the kind of trust you’ll need to help them accept mental health treatment.

Stalkers of famous people often have schizoaffective disorder

She did some reading and told me that people with schizoaffective disorder often believe they are connected to a celebrity’s life as lovers or confidantes, and some will stalk that person.  John Hinckley is a famous example of this.  He believed he was the boyfriend of actress Jodie Foster in her role in the film, “Taxi Driver.” In this film, her boyfriend attempts to assassinate a president to impress her.  Hinckley then did the same, and attempted to assassinate then-President Ronald Reagan.  In prison, Hinckley was diagnosed with schizoaffective disorder.  The Beatles musician, John Lennon, was killed by Mark David Chapman.  Mark believed that he, himself, was John Lennon, and that the real John Lennon was impersonating him–Chapman is another person with schizoaffective disorder.

As an adult, my daughter told me that parents should pay attention to their schizoaffective child’s obsessions. An obsession might be considered harmless, such as obsessing on winning a lottery, or dangerous, such a wanting to stalk or harm someone because they your child is obsessed with them.

Partial complex seizures can simulate symptoms of schizoaffective disorder

Partial complex seizures of the left temporal lobe (temporal lobe epilepsy) cause, enhance, or simulate symptoms of schizoaffective disorder.  If your child has not had an EEG (electroencephalogram), request one.  If there is seizure activity, it can be easily treated by anticonvulsant medication.  My child did indeed have this seizure type in the left temporal lobe.  The medication removed some of her symptoms, such as seeing auras around people and moving patterns on surfaces.  (See an abbreviated article with an explanation at the end of this post.)

Lessons I learned

  • Don’t challenge your child’s beliefs about their experiences, even if you think they are strange, focus instead on keeping your child functional: taking medications, attending school if possible, engaging in safe activities, and managing their personal care.  You will be better able to support appropriate and safe thinking if they trust you, and aren’t afraid you will argue with them.
  • Believe and act on any references to suicide or destructive plans—this may be manipulation, but don’t take the chance.   If you believe your child is being manipulative or overly dramatic, ask them respectfully to stop.  Yes, just ask.
  • Allow your child to talk comfortably about their hallucinatory experiences.  You want to know what they are experiencing.  Is a voice or image tormenting your child, like telling them to hurt themselves or others?  My daughter was lucky in a way.  Her main hallucination seemed to me like a boyfriend who gave her support and made jokes to make her laugh.  (I think many of the jokes were about me.)
  • “Inoculate” your child from cruel voices or messages–teach them to deny the power of the voice(s) and not take them seriously.  Example:  “I know you can’t stop voice(s) from bullying you, but I encourage you to resist or ignore them or fight back.  No one has power over you.”  She was very upset once because her ‘boyfriend’ yelled at her.  I told her to tell him, “Stop it and leave me alone! Don’t talk to me that way!”  She did (somehow), and it apparently worked.  The voice vanished for a couple of days (as if he was sulking?), but returned and apologized later.

Things you can do

  • Low stress is a priority. Create a low-key environment in the home, and limit stressful sensory input (people bickering, harsh music, intensely emotional movies or reading).
  • Allow your child to avoid over-stimulation–crowds or energized spaces with too many things happening (parties, malls, sports events or activities, slumber parties, or whatever they say it is).
  • Don’t argue with them if something they say doesn’t make sense to you.  Listen attentively and avoid offering your opinions.  Let me repeat, don’t reason with someone who is inherently irrational.  Ensure they are safe, comfortable, and appropriate, and spend quality time listening like you would any other child.
  • Help them avoid anxiety-causing things or places.  Go out of your way.  Make a point of driving down a different road, or bringing them home from an event early, even if it’s inconvenient.  This is respectful and humane because they are agonizing about something  you don’t experience.  You need their trust so they will listen to you and accept support that can protect them from their own mind.
  • Help them avoid dangerous obsessions–Some examples of dangerous obsessions for a schizoaffective person are extremists and extremist messages of any stripe, books about negative occult practices, suicide, extreme religious beliefs, and anything that threatens the safety of themselves or others.
  • Ask your child what they need to calm down or settle.  If they want to be in a dark room with the windows covered with foil, fine.  If they want to listen to loud music through headphones, fine.  Just watch.  It will be obvious if it settles them, or helps them focus and become clear-headed.
  • Allow your child to be weird at home as long as they adhere to basic rules.  “I respect your freedom to be who you want to be, but you must take showers and wear clean clothes.  Hygiene is the family policy.  This rule won’t change, but I am happy to help you with this if you want.”  No reasoning or justification, just a simple statement of the rules everyone follows.
  • Provide your child with a journal or large surface upon which to write or draw.  This has several benefits.  Writing and drawing help them process and organize their thoughts.  It also helps you understand their head space, and if their thoughts reflect normal adolescents or are veering off into paranoia or potentially destructive obsessions.

You can ask for, and expect, respectful behavior

It is possible to ask your schizoaffective teen to stop disrespectful or harmful, inappropriate behavior, and it is possible to set a boundary if done in a respectful considerate tone of voice without justifying yourself.

Example of something I said to my daughter during a particularly dark period:  “I’m leaving the house and I’ll be gone about 2 hours.  Do not try to commit suicide, stay right here in your room and be calm.  I’ll bring you a snack when I get home.”  She groaned “oooh kaay”.  Note that this gave her a reason to wait until I came home.

Outcomes are poor with schizoaffective people, but statistics say they have a better long-term prognosis than those experiencing schizophrenia (see “Outlook for schizoaffective disorder and schizophrenia”).  Perhaps it’s because their emotional awareness gives them the ability to form friendships and relationships, and talk about feelings (unlike those suffering with ‘pure’ schizophrenia).  See article at the end of this post, “Social Interaction Increases Survival by 50%.”

You are in this for the long haul.  You will experience a roller coaster ride of emotions.  Pace yourself as if in a marathon.  There may be multiple crises  and hospitalizations, but these may space farther apart over time with treatment and family support, and you’ll have respite.  Your child will settle into stable, repeated patterns unique to them, and you’ll learn which triggers to avoid, and to ignore what isn’t important.  You’ll also learn how to bring them back into positive states of mind, and set up a healthy environment where they choose to stay.  Have hope.  I lived this, and can attest to it.

–Margaret

Please add your own story or comment.  Your observations help others.  Read about other parents’ experiences, which may help you better understand your situation.

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Complex Partial Seizures Present Diagnostic Challenge  (summary)
Richard Restak, M.D. | Psychiatric Times, September 1, 1995

Temporal lobe epilepsy (TLE), is now more commonly called complex partial seizure disorder. It may involve gross disorders of thought and emotion, and patients with temporal lobe epilepsy frequently come to the attention of psychiatrists.

A Dr. Jackson observed in the late 1800’s that seizures originating in the medial temporal lobe often result in a “dreamy state” involving vivid memory-like hallucinations sometimes accompanied by déjà vu or jamais vu (interpreting frequently encountered people, places or events as unfamiliar). Jackson wrote of “highly elaborated mental states, sometimes called intellectual aura,” involving “dreams mixing up with present thoughts,” a “double consciousness” and a “feeling of being somewhere else.” While the “dreamy state” can occur in isolation, it is often accompanied by fear and a peculiar form of abdominal discomfort associated with loss of contact with surroundings, and automatisms involving the mouth and GI tract (licking, lip-smacking, grunting and other sounds).

– – – – – – –

Social Interaction Increases Survival by 50%

Psychiatric Times. July 30, 2010

Theoretical models have suggested that social relationships influence health through stress reduction and by more direct protective effects that promote healthy behavior. A recent study confirms this concept.  Findings from a meta-analysis published in PLoS Medicine indicate that social interaction is a key to living longer. Julianne Holt-Lunstadt, PhD of Brigham Young University and colleagues analyzed data from 148 published studies (1979 through 2006) that comprised more than 300,000 individuals who had been followed for an average of 7.5 years. Not all the interactions in the reports were positive, yet the researchers found that the benefits of social contact are comparable to quitting smoking, and exceed those of losing weight or increasing physical activity.

Results of studies that showed increased rates of mortality in infants in custodial care who lacked human contact were the impetus for changes in social and medical practice and policy. Once the changes were in place, there was a significant decrease in mortality rates. Holt-Lundstadt and colleagues conclude that similar benefits would be seen in the health outcomes of adults: “Social relationship-based interventions represent a major opportunity to enhance not only the quality of life but also of survival.”


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Marijuana and psychosis in teens

Marijuana and psychosis in teens

Underside of a normal brain. Filled-in volume identifies areas where there is blood flow.
Underside of 16 year old’s brain after 2 years’ marijuana use, with voids where there is no blood flow.

It’s a myth that marijuana is safe.  While it has proven benefits for certain physical ailments, the drug’s effect on adolescents, especially those with psychiatric vulnerabilities, can lead to psychosis and debilitating long-term cognitive impairment. Research on the effects of marijuana on the human brain has been taking place internationally for a couple of decades.  Studies show marijuana has a more negative effect on the brain than is generally understood.  Even though it is from a plant source, it is a psychoactive drug with dangerous side-effects the same as any synthetic psychoactive drug.

Just because marijuana is plant-based does not mean it is safe.  Its use and dosage should be guided by a doctor.

One researcher discovered that both mentally ill and normal adult test subjects experienced negative mental health side-effects.  He wrote, “When THC (tetrahydrocannabinol) was administered in one trial, it caused both patients and controls to experience transient increases in cognitive impairments and schizophrenia-like… symptoms.”

Marijuana legalization has deeply concerned pediatric psychiatrists and other providers specializing in child, adolescent, and young adult mental health treatment.  Up until the their early 20’s, young brains undergo radical changes as part of normal development.  Neurons are “pruned” to reduce their number (yes indeed, one can have too much gray matter to function as an adult). Pruning occurs more rapidly in teenagers–think about it, a lot of nonsensical teenage behavior can be explained by this.  The THC in marijuana, the part responsible for the high, interferes with the normal pruning process.

Numerous research summaries are appended below, and the dangers to adolescents are shown time and again.  I find this statement extraordinarily sad:

“Increasing levels of cannabis use at ages 14-21 resulted in lower levels of degree attainment by age 25, lower income at age 25, higher levels of welfare dependence, higher unemployment, lower levels of relationship satisfaction, and lower levels of life satisfaction.” 

I worked with adolescents in residential care and in the juvenile justice system who regularly used marijuana when they could.  A young man on my caseload grew noticeably depressed after he started smoking regularly, and his anxiety and paranoia increased.  He said that smoking helped him feel better, but he couldn’t observe what I and other social workers observed over time. Smoking marijuana, ironically, was briefly relieving him of its own side-effects.

When marijuana is ‘medical,’ a medical professional determines a safe adequate dose.
And when it is ‘recreational,’ there is no such limit… no one even realizes there should be.

  A note on medical marijuana – The plant Cannabis sativa has two substances of interest:

  1. cannabidiol (CBD) – the molecule considered safe for a variety of treatments and approved by the American Medical Association;
  2. tetrahydrocannabinol (THC) – the molecule responsible for the high and the one that can produce psychotic symptoms.

Please share this information with other parents and peruse the research below.   Everyone needs to know that the same warnings parents teach their kids about alcohol and illegal street drugs also apply to marijuana.  It may not be possible to totally prevent your troubled child from using, especially in states where it is legal, but you can do what you can.  We can’t ignore this anymore.

–Margaret

 


Proof cannabis DOES lead teenagers to harder drugs
Daily Mail, London U.K., June 7, 2017

“The study of the lives of more than 5,000 teenagers produced the first resounding evidence that cannabis is a gateway to cocaine, amphetamines, hallucinogens and heroin.” Read the full story  “Teenagers who regularly smoke cannabis are 26 times more likely to turn to other drugs by the age of 21.  It also discovered that teenage cannabis smokers are 37 times more likely to be hooked on nicotine and three times more likely to be problem drinkers than non-users of the drug.”


Legal cannabis laws impact teen use
The Geisel School of Medicine at Dartmouth, NH, June 27, 2017

‘A new study has found that adolescents living in medical marijuana states with a plethora of dispensaries are more likely to have tried new methods of cannabis use, such as edibles and vaping, at a younger age than those living in states with fewer dispensaries. ” …As cannabis legalization rapidly evolves, in both medical and recreational usage, understanding the laws’ effect on young people is crucial because this group is particularly vulnerable to the adverse effects of marijuana and possesses an inherent elevated risk of developing a cannabis disorder.


Marijuana Can Permanently Lower IQ in Teens
Duke University and King College (London), August 2012

Teens who regularly smoke marijuana are putting themselves at risk of permanently damaging their intelligence as adults, and are also significantly more likely to have attention and memory problems later in life, than their peers who abstained, according to a new study conducted by Duke University and London’s King’s College. This study is among the first to distinguish between cognitive problems the person might have had before using marijuana, and those that were caused by the drug..

The research found that adults who started smoking pot as teenagers and used it heavily, but quit as adults, did not regain their full mental powers. In fact, “persistent users” who started as teenagers suffered a drop of eight IQ points at the age of 38, compared to when they were 13.  Researchers noted that many young people see marijuana as a safer alternative to tobacco. A recent “Monitoring the Future” study found that, for the first time, more American high school students are using marijuana than tobacco. Lead researcher Madeline Meier, a post-doctoral researcher at Duke University, said, “Marijuana is not harmless, particularly for adolescents.”


Risks of increasingly potent Cannabis: The joint effects of potency and frequency
Joseph M. Pierre, MD; Current Psychiatry. 2017 February;16(2):14-20

Cannabis at a young age (age <15 to 18) increases the risk of developing a psychotic disorder.  The accumulated evidence to date is strong enough to view the psychotic potential of Cannabis as a significant public health concern, especially a high-potency Cannabis (HPC) form of hash oil known as Cannabis “wax” or “dabs” that contains as much as 90% THC. Preliminary anecdotal evidence supports the plausibility of hyper-concentrated forms being more psycho-toxic than less potent forms.  Of great concern when it comes to teens, HPC comes in very appealing forms (baked goods, candy, and drinks).  Full article here.


“Woody Harrelson quit; What happens to your body after a stoner quits smoking weed.”
Expect the following if you child attempts to quit or quits marijuana, and give them lots of love and support!  Dr. Stuart Gitlow and Dr. Joseph Garbely explain what happens to them.  Read the full article here.

  • They miss and crave it at first
  • They get anxious
  • They feel feelings again
  • It’s going to be uncomfortable for months, even a year

Marijuana Use Linked with Poor Depression Recovery
Journal of Affective Disorders; ePub 2017 Feb 13; Bahorik, et al

Marijuana use is common and associated with poor recovery among psychiatry outpatients with depression a recent study found. Researchers evaluated 307 psychiatry outpatients with depression, and past-month marijuana use for a substance use intervention trial. They found:

  • Marijuana use worsened depression and anxiety symptoms; it also led to poorer mental health functioning.
  • Medical marijuana (26.8%; n=33) was associated with poorer physical health functioning.

Keeping Teenagers Safe In Vehicles:  Alcohol use is down but marijuana use is up
O’Malley, P. & Johnson, American Journal of Public Health. Nov. 2013, Vol 103, No. 11.

Driving accidents remain the number one cause of mortality among American teenagers. Alcohol use is often involved, and more recently, distracted driving as a result of cell phones is a contributor. A recent analysis has found that drinking and driving has decreased among teenagers, but using marijuana and driving has increased.”  In this longitudinal study, a sample of 22,000 12th grade students from high schools across the country were questioned over a ten-year period, from 2001-2011. They showed an increase over the 10-year period in either being the driver or passenger of a driver who had just used marijuana. Specifically, 28% reported doing so within the past two weeks.  Marijuana use can impact drivers as much as alcohol.


Early Marijuana Use Heightens Psychosis Risk in Young Adults (summary)
John McGrath MD, Rosa Alati MD Archives of General Psychiatry, published online March 1, 2010,
MedscapeCME: Psychiatry and Mental Health

“Early cannabis use increases the risk of psychosis in young adults,” reports lead investigator John McGrath, MD, of Queensland Centre for Mental Health Research in Brisbane, Australia.  “Apart from having an increased risk of having a disorder like schizophrenia, the longer the young adults reported since their first cannabis use, the more likely they were to report isolated symptoms of psychosis.”

Investigators assessed 3801 study participants at ages 18-23 years, identifying first marijuana use and three psychosis-related outcomes:  non-affective disease, hallucinations, and the Peters et al Delusions Inventory Score.  “Psychotic disorders are common and typically affect 1 or 2 people of every 100” Dr. McGrath said, “…(I) was surprised that the results were so strong and so consistent…  We need to think about prevention.”

Results mirror those of another study conducted by Michael Compton MD, published in the American Journal of Psychiatry (November 2009), where investigators looked at 109 patients in a psychiatric unit and found that daily marijuana and tobacco use was common.  Of those who abused cannabis, almost 88% were classified as weekly or daily users before the onset of psychosis.

Emma Barkus, PhD, from the University of Wollongong in New South Wales, Australia, says other studies suggest that those who are engaging in risk behaviors about the age of 14 years are more likely to persist as they get older, adding further support to the role of cannabis use in predicting earlier psychoses.


Evidence Accumulates for Links Between Marijuana and Psychosis (summary)
Michael T. Compton, MD, MPH – Assistant Professor, Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, Georgia, 2008

Cannabis is the most abused illicit substance in the general US population, and the most abused illegal drug among individuals with schizophrenia.This literature reviewed studies that examined (1) associations between cannabis use and clinical manifestations of psychosis, and (2) the biologic plausibility of the observed links.

The initiation of cannabis use among those with psychotic disorders often precedes the onset of psychosis by several years.Cannabis use in adolescence is increasingly recognized as an independent risk factor for psychosis and schizophrenia.  Progression to daily cannabis use was associated with age at onset.

Study evidence also supported biological links between cannabis use and psychosis.  In the brains of heavy users, interactions with specific cannabinoid receptors are distributed in brain regions implicated in schizophrenia.  Other studies report elevated levels of endogenous cannabinoids in the blood and cerebrospinal fluid of patients with schizophrenia.  When THC (tetrahydrocannabinol) was administered in one trial, it caused both patients and controls to experience transient increases in cognitive impairments and schizophrenia-like positive and negative symptoms.


Chronic toxicology of cannabis.  (summary)
Reece, Albert Stuart; Clinical Toxicology (Philadelphia, PA.)   vol. 47  issue 6, Jul  2009 . Medical School, University of Queensland, Highgate Hill, Brisbane, QLD, Australia.

 Findings: There is evidence of psychiatric, respiratory, cardiovascular, and bone toxicity associated with chronic cannabis use.  Cannabis is implicated:

  • In major long-term psychiatric conditions including depression, anxiety, psychosis, bipolar disorder;
  • Respiratory conditions include reduced lung density, lung cysts, and chronic bronchitis;
  • elevated rates of myocardial infarction and cardiac arrythmias;
  • linked to cancers at eight sites, including children after in utero maternal exposure.

Marijuana Use, Withdrawal, and Craving in Adolescents (summary)
Kevin M. Gray, MD, Assistant Professor in the youth division of the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina in Charleston.

Findings in the literature survey:  Initiation of marijuana use typically occurs during adolescence.  Recent data indicate that in the United States, 42% of high school seniors have tried marijuana; 18% have used it in the past 30 days; and 5% use it daily.  Among adolescents aged 12 to 17, 3.6% met criteria for cannabis use disorder (abuse or dependence) and 2% met criteria for cannabis dependence.

More than half (51%) of adolescents reported that marijuana is fairly or very easy to obtain.  Ironically, this ready availability may be a “reverse gateway” from marijuana use to cigarette use to nicotine dependence.  Earlier initiation is associated with problem-related marijuana use: “hard” drug use, poly-drug use, and academic failure.  Using marijuana once per week or more during adolescence is associated with a 7-fold increase in the rate of daily marijuana use in young adulthood.  Cannabis dependence increases the risk factors for impaired driving and delinquent behavior.  Chronic use is associated with impaired immune function, respiratory illnesses, cognitive problems, and motivational impairment. 

There is a debate whether marijuana use begins as “self-medication” for psychiatric disorders, or whether habitual marijuana use can predispose some individuals to psychiatric symptoms.

Social anxiety disorder in adolescence is associated with 6.5-times greater odds of subsequent cannabis dependence, and vice versa, frequent marijuana use during adolescence appears to increase the risk of subsequent development of anxiety and depressive disorders.  The prevalence of cannabis abuse is 2 to 3 times greater among adolescents who have major depression.  Also linked in both directions: conduct disorder predicts marijuana and other substance use, while early-onset marijuana use predicts conduct disorder.

Five treatment regimes were studied: motivational enhancement/cognitive-behavioral therapy (MET/CBT), family education and therapy intervention, a community reinforcement approach, and multidimensional family therapy.  All resulted in positive but modest outcomes, with MET/CBT and community reinforcement treatments being most cost-effective.

Emerging evidence indicates rewards for marijuana abstinence may be positive.  Multi-systemic therapy, an intensive approach that incorporates individual, family, and community components, has demonstrated effectiveness among delinquent adolescents.

Withdrawal: Marijuana withdrawal symptoms are a constellation of emotional, behavioral, and physical symptoms that include anger and aggression, anxiety, decreased appetite and weight loss, irritability, restlessness, and sleep difficulty, which result specifically from withdrawal of marijuana’s psychoactive ingredient, THC.  Less frequent but sometimes present symptoms are depressed mood, stomach pain and physical discomfort, shakiness, and sweating.  Onset of withdrawal symptoms typically occurs within 24 hours of cessation of THC, and symptoms may last days to approximately 1 to 2 weeks.

Craving: Patients’ craving of marijuana is evidenced after presenting them with cues associated with marijuana (e.g. sight or smell of the substance, films of drug-taking locations, and drug-related paraphernalia).   Exposure to cues leads to robust increases in craving, along with modest increases in perspiration and heart rate.  Cue reactivity can predict drug relapse.

Craving and withdrawal symptoms interfere with successful cessation of use and sustained abstinence.  In addition, medications are often used to target withdrawal from substances, such as benzodiazepines for alcohol dependence and clonidine and buprenorphine for opioid dependence. These medications could be combined with psychosocial interventions, or developed to complement concurrent psychosocial treatments.


Legalization of Marijuana: Potential Impact on Youth (summary)
Alain Joffe, MD, MPH, W. Samuel Yancy, MD the Committee on Substance Abuse and Committee on Adolescence – PEDIATRICS Vol. 113 No. 6 June 2004, pp. e632-e638

Scientists have demonstrated that the emotional stress caused by withdrawal from marijuana is linked to the same brain chemical that has been linked to anxiety and stress during opiate, alcohol, and cocaine withdrawal.  THC stimulates the same neurochemical process that reinforces dependence on other addictive drugs.  Current, well known, scientific information about marijuana shows the cognitive, behavioral,and somatic consequences of acute and long-term use, which include negative effects on short-term memory, concentration, attention span, motivation, and problem solving.  These clearly interfere with learning, and have adverse effects on coordination, judgment, reaction time, and tracking ability.  http://pediatrics.aappublications.org/cgi/content/full/113/6/e632


The Past, Present, and Future of Medical Marijuana in the United States (summary)
By John Thomas, JD, LLM, MPH, Professor of advanced law and medicine, civil procedure, and commercial law at the Quinnipiac University College of Law, Hamdon, Connecticut, January 6, 2010

Cannabidiol (CBD) is considered safe and has a variety of positive benefits, and this component should be legalized.  However, the other narcotic component in marijuana, tetrahydrocannabinol (THC), is responsible for the high, and too much may not be a good thing because it can produce psychotic symptoms in people.


 Medical Marijuana:  The Institute of Medicine Report (summary)
Ronald Pies, MD, Editor in Chief – Psychiatric Times. Vol. 27 No. 2 , January 6, 2010
Marijuana is not a completely benign substance. It is a powerful drug with a variety of effects.  However, except for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other prescription medications. Cannabinoids can induce acute transient psychotic symptoms or an acute psychosis in some individuals… (but it is unclear) what makes some individuals vulnerable to cannabinoid-related psychosis.  There is a pressing need for more high-quality research in the area of medical marijuana and cannabinoid use.

 Link Between Cannabis Use and Psychosis Onset at a Younger Age (summary)
Ana Gonzales MD, Santiago Apostol Hospital in Vitoria, Spain, Journal of Clinical Psychiatry. August 2008

Researchers found a strong and independent link between cannabis use and the onset of psychosis at a younger age, regardless of gender or the use of other drugs.  The link is related to the amount of cannabis used.  “The clinical importance of this finding is potentially high,” Dr. Gonzalez-Pinto given that cannabis use is extremely prevalent among young people… estimates of the attributable risk suggest that the use of cannabis accounts for about 10 percent of cases of psychosis.”The findings showed a significant gradual reduction in the age at which psychosis began that correlated with an increased dependence on cannabis. Compared with nonusers, age at onset was reduced by 7, 8.5, and 12 years among users, abusers, and dependents, respectively, the researchers report.

Cannabis use and later life outcomes. (summary)
Fergusson DM, Boden JM, Addiction;  Pages: 969-76;  Volume(Issue): 103(6), June 2008

A longitudinal study of a New Zealand birth cohort tracked subjects to age 25 years.  Cannabis use at from ages 14-25 was measured by:  university degree attainment to age 25; income at age 25, welfare dependence during the period 21-25 years, unemployment 21-25 years, relationship quality, and life satisfaction.  Other indices were measured to adjust for confounding factors:  childhood socio-economic disadvantage, family adversity, childhood and early adolescent behavioral adjustment and cognitive ability, and adolescent and young adult mental health and substance use.The findings were statistically significant.  Increasing levels of cannabis use at ages 14-21 resulted in lower levels of degree attainment by age 25, lower income at age 25, higher levels of welfare dependence, higher unemployment, lower levels of relationship satisfaction, and lower levels of life satisfaction.


Doctors:  Pot Triggers Psychotic Symptoms (summary)
May 1, 2007
Aetna Intelihealth – Mental Health

 LONDON — New findings show physical evidence of the drug’s damaging influence on the human brain.  In some people, it triggers temporary psychotic symptoms including hallucinations and paranoid delusions. Two of the active ingredients of cannabis: cannabidiol (CBD) made people more relaxed.  But second ingredient: tetrahydrocannabinol (THC) in small doses produced temporary psychotic symptoms in people, including hallucinations and paranoid delusions. According to Dr. Philip McGuire, a professor of psychiatry at King’s College, London, THC interfered with activity in the inferior frontal cortex, a region of the brain associated with paranoia. “THC is switching off (a chemical) regulator,” McGuire said, “effectively unleashing the paranoia usually kept under control by the frontal cortex.”In another study, Dr. Deepak Cyril D’Souza, an associate professor at Yale University School of Medicine, and colleagues tested THC on 150 healthy volunteers and 13 people with stable schizophrenia. Nearly half of the healthy subjects experienced psychotic symptoms when given the drug.  Unfortunately, the results for the schizophrenic subjects was so much worse that researchers scrapped adding additional schizophrenic subjects to the study.  The negative impact was so pronounced that it would have been unethical to test it on more schizophrenic people.”One of the great puzzles is why people with schizophrenia keep taking the stuff when it makes the paranoia worse,” said Dr. Robin Murray, a professor of psychiatry at King’s College in UK.  She theorized that schizophrenics may mistakenly judge the drug’s pleasurable effects as outweighing any negatives. 

Stigma is prejudice, and harmful to children

Stigma is prejudice, and harmful to children

Stigma victimizes the victims

“Misconceptions based on perception rather than fact have been shown to be devastating to children’s emotional and social well-being.”
–Dr. Bernice Pescosolido

Stigma, blame, judgment… It only takes a few individuals to harm a child or family with their words, but it takes a whole society to allow it.  In this article, I’m going to present recent research on the negative stereotyping of families and children with mental disorders, and share stories from families I know.  I hope readers will be empowered to speak out against this form of prejudice and mobilized into changing our society’s attitudes.

Puckette(c)2007

Stigma takes many forms.

The most common scenario of stigma is when you are seen as a bad parent, perhaps even an abusive one, or your child is seen as stupid, spoiled, attention-getting, or manipulative.  Another form of stigma is having others show disrespect to parents who seek help from the mental health profession.  Psychologists are “flakes,” and families  who see them are “wackos.”  “Where’s your faith?”, some say, or “why don’t you quit making excuses for your child and give them real consequences?”

One of the more destructive forms of stigma is the condemnation parents receive when they “drug their child to fix them.”  Too many believe drugs turn children into “zombies” (see research study below).  Because of the stigma of treatment, I’ve seen many parents try every alternative treatment possible to help their child, only to have their child struggle year after year in school, fall farther behind their peers, make no progress in therapy, and other setbacks that medicines can prevent.  These parents cling to the belief that they are doing the right thing, yet some children really need medicines, and the drugs don’t turn them into zombies.  [In today’s treatment approaches, drugs are always considered a piece of the treatment puzzle, never the complete answer.]

 

A mother’s story about her experience with stigmatization:

This mother lost her best friend of 20 years because the friend got tired of hearing the mom talk about her very troubled 10-year-old son.  In frustration, the friend wrote her a letter saying the mom was neurotic, and that she should quit trying to control her son, that her son’s behavior was a cry for help.  The friend said she needed to set her son free and get help for her emotional problems, and that she wasn’t going to “enable” this mom anymore by being her friend.  The mom was stunned and hurt by the letter.  She intellectualized that she didn’t need a friend like this, but her heart was nonetheless broken by the betrayal.  The son turned out to have brain damage from a genetic disorder and it was getting worse.

It’s hard enough to be reminded over and over again how our children don’t fit in, and how we may never  have the same joys as parents of mentally healthy children.


Ideas for what you can do when you’re blamed and judged.

First, resist defending yourself; it can attract more unwanted attention and disagreement.  You don’t have the time or emotional energy to explain or teach someone who will challenge everything you say.  Do everything you can to avoid people like this—many have had to cut off some family members and friends, and even their clergy or religious communities.

My story:  when my child was diagnosed with a serious mental disorder, I stood up in front of my church congregation, explained what was happening, and asked for prayers for my family.  At the end of that service, people started avoiding me.  There were no more hello’s.  There wasn’t even eye contact.  The abrupt isolation from people I knew was devastating and I stopped attending.  What did I say?  Why did this happen?  I thought if my child had a ‘socially acceptable’ cancer others would know what to do or say to ease the isolation and grief.

Second, actively seek supportive people who just listen.  You need as large as possible a network of compassionate people around you.  You may be surprised how many people have a loved one with a mental or emotional disorder, and how many are willing to help because they completely understand what you’re going through.

Third, politely and assertively say thanks but no thanks.  Try something like this:  “Thanks for showing interest, but we are getting the help we need from doctors we trust.” Or simply, “please don’t offer me advice I didn’t ask for.”  No apologies.

It’s hard enough to be reminded over and over again how our children don’t fit in, and how we may never get have the same joys as parents of mentally healthy children.

–Margaret


Public Perceptions Harsh of Kids, Mental Health (excerpt)

May 1, 2007   (USA TODAY)

Though the subject has been analyzed in adults, until now there has been limited research illuminating how the public perceives children with mental disorders such as depression and attention deficit disorders, according to experts from Indiana University, the University of Virginia and Columbia University.  The findings are published in the May 2007 issue of Psychiatric Services.

The study, based on in-person interviews with more than 1,300 adults, indicates that people are highly skeptical about the use of psychiatric medications in children.  Results also show that Americans believe children with depression are more prone to violence and that if a child receives help for a mental disorder, rejection at school is likely.

“The results show that people believe children will be affected negatively if they receive treatment for mental health problems,” says study author Bernice Pescosolido, director of the Indiana Consortium for Mental Health Services Research, in Bloomington.  “Nothing could be further from the truth.  These misconceptions are a serious impediment to the welfare of these children.

According to the study:

  • Those interviewed believed that doctors over-medicate children with depression and ADHD and that drugs have long-term harm on a child’s development.  More than half believed that psychiatric medications “turn kids into zombies.”
  • Respondents thought children with depression would be dangerous to others; 31% believed children with ADHD would pose a danger.
  • Respondents said rejection at school is likely if a child goes for treatment, and 43% believe that the stigma associated with seeking treatment would follow them into adulthood.

Pescosolido and her colleagues say such stigma surrounding mental illness — misconceptions based on perception rather than fact — have been shown to be devastating to children’s emotional and social well-being.

Population studies show that, at any point in time, 10% to 15% of children and adolescents have some symptoms of depression.  About 4 million children, or 6.5%, have been diagnosed with ADHD, only 2% less than the number of children with asthma.

“People really need to understand that these are not rare conditions,” says Patricia Quinn, a developmental pediatrician in Washington, D.C.

To banish the stigma linked to mental health problems in children, the public has to get past labels and misconceptions, Pescosolido says.   Normalizing these conditions would help too, Quinn says.  “We need to view depression and ADHD like we do allergies,” she says. “They are very treatable.”

Call 911 – Make a crisis plan for your troubled child

Call 911 – Make a crisis plan for your troubled child

Don’t let your family become emotionally battered when your troubled child or teen goes through one crisis after another.  It’s the last thing your family needs—more stress and exhaustion!  Since your main job as a parent or caregiver is to reduce stress, you must manage the inevitable emergencies in a way that quickly settles down your family, as well as get help for your child.  Are you prepared to head off a crisis when you see one coming?  Does your family have a crisis plan for when (not if) your troubled child has a mental health emergency that puts everyone or everything in danger?

Never be afraid to call 911 when there’s a danger of harm. You will NOT be bothering them!

I got my crisis plan idea from the “red alert” scenes on Star Trek, when red lights flash and an alarm sounds, and crew members drop everything and run to their stations with clear instructions for protecting the ship.

 

Think of your family as crew members that pull together when someone sounds the Red Alert because your child is becoming dangerously out of control.  Each family member should know ahead of time what to do and have an assigned role, and each should know they will be backed up by the rest of the family.  This will be tremendously reassuring to everyone.  Together, you can manage through a crisis, reduce the dangers, and ensure everyone is cared for afterwards.

 

Have a crisis plan for the home, the workplace, and the school

…and start by asking questions.  Here are some examples:

 

o        Who goes out and physically searches for a runaway?  This person should be able to bring the child back to school or home without mutual endangerment, and they should know how to work with police or community members.

 

o        Who gets on the phone and calls key people for help?  Who do they call, the police or a neighbor or a relative?  Does your town or city have a crisis response team for kids?  Some do.

 

o        Who should be appointed to communicate with the child?  This should be a family member or friend that the child trusts more than the others.

 

o       Can a sibling leave to stay at someone else’s house until things cool down at home?  Which house?  An escape plan for a sibling can protect them and help them manage their own stress.

 

o       Who should step in and break up a fight?  And what specifically should they do or say each time to calm the situation?  Believe it or not, your troubled child can often tell you what works best and what makes things worse.  Listen to them.  It doesn’t have to sound rational to you if it works to calm them down quickly.

 

o       How should a time-out work?  Who counts to 10, or who can leave the house and go out for a walk?  Where can someone run to feel safe and be left alone for a while?

 

o       What should teachers or co-workers do to calm down a situation and get their classroom or office back to normal as quickly as possible? 

 

Experiences and evidence has shown that a rapid cooling down of emotions and rapid reduction of stress hormones in the brain supports resilience—the ability to bounce back in a tough situation.  Your entire family needs resilience, not just your troubled child.  A simple crisis plan makes all the difference.

The Troubled Teen Industry – A warning about boarding schools and outdoor camps

The Troubled Teen Industry – A warning about boarding schools and outdoor camps

This is a troubled teen in a military-style camp, not an adult military recruit who’s there by choice.

There is a troubled teen industry out there—boarding schools, outdoor programs, and “boot camps” that are not licensed, not certified, and not experienced with youth with disorders.  Maybe you’ve seen the ads that promise to improve your teen’s behavior in the back of some magazines.  They promise that their program will “fix” your child.  They promise that your teen will learn important lessons about respect and about following your rules.  There are quotes from satisfied parents about how the program saved their teen’s life, but you can’t contact them.  The ads claim that staff are highly trained, strict, and caring.  The location is usually too far to check out easily, an airline flight away from home, often in a rural area.  The cost is outlandish.  To help with payment, the program provides financial advice to parents about getting loans and 2nd mortgages.

It’s a red flag if they –>promise<– to ‘correct’ your child.

You’re a desperate parent and you’ll do anything you can to stop the craziness and get a break.  You tell yourself it must be a nice place, especially if it advertises a religious approach*, even though you haven’t seen it in person.  The representative on the phone seems to know exactly how you feel and what your teen needs.  If you’re desperate, you may not think to ask if the organization is a legitimate behavioral health treatment facility.  Many are not!

*Claiming a religious affiliation is no guarantee of a genuine, effective faith-based program.

 What to ask:

 

What is the training and licensure of staff?  You want to know if they have therapists with MSW degrees, registered nurses, psychiatrists or doctors, and if a professional is available on site 24/7.  Mental health programs are about treatment and stability through medication or therapy, and positive activities with lots of emotional support.  Safety must be paramount.  Staff must be aware of the types of things that can go wrong and how crises should be handled.

 

Does the camp or school have a business license in their state?  Are staff licensed to practice behavioral health?  Do they have grievance procedures?

 

Is the camp or school accredited as a treatment facility, and by whom?  Does it have mental health agency oversight?  Are emergency services (hospital, law enforcement) a phone call away?  If your child’s mental health is a concern, read “What to know about psychiatric residential treatment.”

 

punish boy in boarding school
It’s understandable if you’ve “had enough!” and want your child punished, but excessive punishment does not work.  (Quote of camp counselor, “If I can’t make a kid puke or piss in his pants on his first day, I’m not doing my job.”)

Can you call and talk to your child when you request?  Can you visit?  Can your child call you when they request it?  Some of these programs limit or disallow parental contact. Why? According to a testimonial at a children’s mental health conference, a young man was used as slave labor at a camp. The staff kept communicating to his mother that he was misbehaving, that he hated her and didn’t want to talk, and that they recommended he stay another 6 months.  In this way, they drew out his stay for 3 years.

I’ve heard personal testimony from parents and troubled young people whose condition was worsened by the camp or school, or who felt betrayed by their families.  On rare occasions, children have died at the hands of young, untrained staff who thought they were just disciplining the child.  Other stories included teens being offered drugs by staff or other campers, or sexual relationships with staff or campers.

 

Check out the article below.  The problems in the “troubled teen industry” are significant enough such that an advocacy group has formed to change state laws to protect youth.


 

Unlicensed residential programs: The next challenge in protecting youth. –excerpt-

By Friedman, Robert M.; Pinto, Allison; Behar, Lenore; Bush, Nicki; Chirolla, Amberly; Epstein, Monica; Green, Amy; Hawkins, Pamela; Huff, Barbara; Huffine, Charles; Mohr, Wanda; Seltzer, Tammy; Vaughn, Christine; Whitehead, Kathryn; Young, Christina Kloker

American Journal of Orthopsychiatry. Vol 76(3), Jul 2006, 295-303.

 

According to this article, many private residential facilities are neither licensed as mental health programs nor accredited by respected national accrediting organizations.  The Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (A START) is a multi-disciplinary group of mental health professionals and advocates that formed in response to rising concerns about reports from youth, families, and journalists describing mistreatment in the unregulated programs.  There is a range of mistreatment and abuse experienced by youth and families, including harsh discipline, inappropriate seclusion and restraint, substandard psychotherapeutic interventions, medical and nutritional neglect, rights violations and death.

Spirituality and mental health, some research

Spirituality and mental health, some research

Scientists worldwide have been studying the effect of religion and spirituality on mental health and addiction recovery in children, teens, and adults.  Below are research findings that show religion and spirituality improve adult and adolescent mental health, including recovery from mental crises and substance abuse, when the spiritual approach carries messages of love, kindness, tolerance, and moral responsibility.  But when religion had a punitive or unforgiving message to those with mental or substance abuse disorders, the results were disheartening: a worsening of psychotic symptoms; inability to sustain recovery from substance abuse; and physical abuse.

If you look at the dates of some of these studies, you’ll see that researchers have been measuring of the value of spirituality for mental health and addiction for ~30 years, and results have consistently shown statistically significant positive benefits.

Below are summaries research reports–clinical writing that can be difficult to wade through if you’re not a mental health geek, so key findings and conclusions are highlighted in brown to make it easier to scan.

–Margaret

A second article in this blog documents both positive and negative effects of parents’ experiences in a religious community, Faith can help, & harm, a family’s mental health.


God Imagery and Treatment Outcomes Examined
Currier JM, Foster JD, Abernathy AD, et al. God imagery and affective outcomes in a spiritually integrative inpatient program. [Published online ahead of print May 5, 2017]. Psychiatry Res. doi:10.1016/j.psychres.2017.05.003.

Patients’ ability to derive comfort from their religious faith and/or spirituality emerged as a salient mediating pathway between their God imagery at the start of treatment and positive affect at discharge, a recent study found. Drawing on a combination of qualitative and quantitative information with a religiously heterogeneous sample of 241 adults who completed a spiritually-integrative inpatient program over a 2-year period, researchers tested direct and indirect associations between imagery of how God views oneself, religious comforts and strains, and affective outcomes.

Findings  —  Analyses revealed that patients generally experienced reductions in negative emotion in God imagery over the course of their admissions.


When God Is Part of Therapy
Tara Parker Pope, March 2011, New York Times

Faith-based therapy is growing in popularity, reports Psychology Today, as more patients look for counselors who can discuss their problems and goals from a religious frame of reference.

Studies show that people prefer counselors who share their religious beliefs and support, rather than challenge, their faith. Religious people often complain that secular therapists see their faith as a problem or a symptom, rather than as a conviction to be respected and incorporated into the therapeutic dialogue, a concern that is especially pronounced among the elderly and twenty-somethings. According to a nationwide survey by the American Association of Pastoral Counselors (AAPC), 83 percent of Americans believe their spiritual faith and religious beliefs are closely tied to their state of mental and emotional health. Three-fourths say it’s important for them to see a professional counselor who integrates their values and beliefs into the counseling process.

The problem for many patients in therapy is that many patients are far more religious than their therapists.

Nearly three-fourths of Americans say their whole approach to life is based on religion. But only 32 percent of psychiatrists, 33 percent of clinical psychologists and 46 percent of clinical social workers feel the same. The majority of traditional counselor training programs have no courses dealing with spiritual matters.


“[Spirituality] enables neurotic conflicts typical for adolescence to be more easily overcome.”

The influence of religious moral beliefs on adolescents’ mental stability.
Pajević I, Hasanović M, Delić A., : Psychiatry Danub. 2007 Sep;19(3):173-83

University Clinical Centre Tuzla, Trnovac b.b, 75 000 Tuzla, Bosnia & Herzegovina. zikjri@bih.net.ba.
This study included 240 mentally and physically healthy male and female adolescents attending a high school, who were divided into groups equalized by gender (male and female), age (younger 15, older 18 years); school achievement (very good, average student); behaviour (excellent, average); family structure (complete family with satisfactory family relations), and level of exposure to psycho-social stress (they were not exposed to specific traumatizing events).  Subjects were assessed with regard to the level of belief in some basic ethical principles that arise from religious moral values.

Conclusions — A higher index of religious moral beliefs in adolescents enables better control of impulses, providing better mental health stability.  It enables neurotic conflicts typical for adolescence to be more easily overcome.  It also causes healthier reactions to external stimuli.  A higher index of religious moral beliefs of young people provides a healthier and more efficient mechanism of anger control and aggression control.  It enables transformation of that psychical energy into neutral energy which supports the growth and development of personality, which is expressed through socially acceptable behaviour.  In this way, it helps growth, development and socialization of the personality, leading to the improvement in mental health.


Religion, Stress, and Mental Health in Adolescence: Findings from Add Health
Nooney, J. G. 2008-10-23 from http://www.allacademic.com/meta/p106431_index.html

A growing body of multidisciplinary research documents the associations between religious involvement and mental health outcomes, yet the causal mechanisms linking them are not well understood.  Ellison and his colleagues (2001) tested the life stress paradigm linking religious involvement to adult well-being and distress.  This study looked at adolescents, a particularly understudied group in religious research. Analysis of data from the National Longitudinal Study of Adolescent Health (Add Health) reveals that religious effects on adolescent mental health are complex.  While religious involvement did not appear to prevent the occurrence of stressors or buffer their impact, some support was found for the hypothesis that religion facilitates coping by enhancing social and psychological resources.


Study Links Religion and Mental Health
David H. Rosmarin and Kenneth Pargament, Bowling Green State University, Ohio, (IsraelNN.com) 2008

A series of research studies – known as the JPSYCH program – reveals that traditional religious beliefs and practices are protective against anxiety and depression among Jews.  The research indicates that frequency of prayer, synagogue attendance, and religious study, and positive beliefs about the Divine are associated with markedly decreased levels of anxiety and with higher levels of happiness.  “In this day and age, there is a lot to worry about,” Rosmarin notes, “and the practice of religion may help people to maintain equanimity and perspective.”


The Once-Forgotten Factor in Psychiatry: Research Findings on Religious Commitment and Mental Health (excerpt)
David B. Larson, M.D., M.S.P.H., Susan S. Larson, M.A.T., and Harold G. Koenig, M.D., M.H.Sc., Psychiatric Times.  Vol. 17 No. 10, October 1, 2000

“The data from many of the studies conducted to date are both sufficiently robust and tantalizing to warrant continued and expanded clinical investigations.”

Treatment of Drug Abuse

  • The lack of religious/spiritual commitment stands out as a risk factor for drug abuse, according to past reviews of published studies.  Benson (1992) reviewed nearly 40 studies documenting that people with stronger religious commitment are less likely to become involved in substance abuse.
  • Gorsuch and Butler (1976) found that lack of religious commitment was a predictor of drug abuse.  The researchers wrote:  “Whenever religion is used in analysis, it predicts those who have not used an illicit drug regardless of whether the religious variable is defined in terms of membership, active participation, religious upbringing or the meaningfulness of religion as viewed by the person himself.”
  • Lorch and Hughes (1985), as cited by the National Institute for Healthcare Research (1999), surveyed almost 14,000 youths and found that the analysis of six measures of religious commitment and eight measures of substance abuse revealed religious commitment was linked with less drug abuse.  The measure of “importance of religion” was the best predictor in indicating lack of substance abuse.  The authors stated, “This implies that the controls operating here are deeply internalized values and norms rather than fear or peer pressure.”
  • Developing and drawing upon spiritual resources can also make a difference in improving drug treatment.  For instance, 45% of participants in a religious treatment program for opium addiction were still drug-free one year later, compared to only 5% of participants in a nonreligious public health service hospital treatment program-a nine-fold difference(Desmond and Maddux, 1981).
  • Confirming other studies showing reduced depression and substance abuse, a study of 1,900 female twins found significantly lower rates of major depression, smoking and alcohol abuse among those who were more religious (Kendler et al., 1997).  Since these twins had similar genetic makeup, the potential effects of nurture versus nature stood out more clearly.

“lack of religious commitment was a predictor of drug abuse”

Treatment of Alcohol Abuse

  • Religious/spiritual commitment predicts fewer problems with alcohol (Hardesty and Kirby, 1995).  People lacking a strong religious commitment are more at risk to abuse alcohol (Gartner et al., 1991).  Religious involvement tends to be low among people diagnosed for substance abuse treatment (Brizer, 1993).
  • A study of the religious lives of alcoholics found that 89% of alcoholics had lost interest in religion during their teen-age years, whereas 48% among the community control group had increased interest in religion, and 32% had remained unchanged (Larson and Wilson, 1980).
  • A relationship between religious or spiritual commitment and the non-use or moderate use of alcohol has been documented.  Amoateng and Bahr (1986) reported that, whether or not a religious tradition specifically proscribes alcohol use, those who are active in a religious group consumed substantially less alcohol than those who are not active.
  • Religion or spirituality is also often a strong force in [addiction] recovery.  Alcoholics Anonymous (AA) invokes a Higher Power to help alcoholics recover from addiction.  Those who participate in AA are more likely to remain abstinent after inpatient or outpatient treatmen t(Montgomery et al., 1995).

“…adolescents [who were] frequent church-goers with high spiritual support had the lowest scores on the Beck Depression Inventory.”

Suicide Prevention – Surging suicide rates plague the United States, especially among adolescents.  One in seven deaths among those 15 to 19 years of age results from suicide.

  • One study of 525 adolescents found that religious commitment significantly reduced risk of suicide (Stein et al., 1992).
  • A study of adolescents found that frequent church-goers with high spiritual support had the lowest scores on the Beck Depression Inventory (Wright et al., 1993).  High school students of either gender who attended church infrequently and had low spiritual support had the highest rates of depression, often at clinically significant levels.
  • How significantly might religious commitment prevent suicide?  One early large-scale study found that people who did not attend church were four times more likely to kill themselves than were frequent church-goers (Comstock and Partridge, 1972).  Stack (1983) found rates of church attendance predicted suicide rates more effectively than any other evaluated factor, including unemployment.  He proposed several ways in which religion might help prevent suicide, including enhancing self-esteem through a belief that one is loved by God and improving moral accountability, which reduces the appeal of potentially self-destructive behavior.
  • Many psychiatric inpatients indicate that spiritual/religious beliefs and practices help them to cope. Lindgren and Coursey (1995) reported 83% of psychiatric patients felt that spiritual belief had a positive impact on their illness through the comfort it provided and the feelings of being cared for and not being alone it engendered.

Potential Harmful Effects

Psychiatry still needs more research and clearer hypotheses in differentiating between the supportive use of religion/spirituality in finding hope, meaning, and a sense of being valued and loved versus harmful beliefs that may manipulate or condemn.”

  • Alcoholics often report negative experiences with religion and hold concepts of God that are punitive, rather than loving and forgiving (Gorsuch, 1993).
  • Bowman (1989).  In assessing multiple personality disorder, children in rigid religious families, whose harsh parenting practices border on abuse, harbor negative images of God.  Josephson (1993). Individual psychopathology is linked with families whose enmeshment, rigidity and emotional harshness were supported by enlisting spiritual precepts.
  • Sheehan and Kroll (1990).  Of 52 seriously mentally ill hospitalized patients diagnosed with major depression, schizophrenia, manic episode, personality disorder and anxiety disorder, almost one-fourth of [psychiatric patients] believed their sinful thoughts or acts may have contributed to the development of their illness.  Without the psychiatrist inquiring about potential religious concerns, these beliefs would remain unaddressed, potentially hindering treatment until discovered and resolved.  Collaboration with hospital chaplains or clergy may help in some of these instances of spiritual problems or distress.

Conclusion

Religious/spiritual commitment may enhance recovery from depression, serious mental or physical illness, and substance abuse; help curtail suicide; and reduce health risks.  More longitudinal research with better multidimensional measures will help further clarify the roles of these factors and how they are beneficial or harmful.

–Margaret

How to work with police once you’ve called 911.

How to work with police once you’ve called 911.

 

Q: Should I call 911?  I’ve been told I should call the police or mental health hotline when there’s a crisis, but how do I know when it’s a real crisis?


A:  If your child is doing something dangerous to him or herself, or others (including a pet), or property, and if you can’t manage it or stop it, call.  “Dangerous” means threatening, harmful, or abusive.  Emergency 911 dispatchers, police, and mental health crisis workers all encourage anyone to call, anytime.  You will not bother them.  I once visited a 911 facility and got a chance to ask to speak with the staff and this was their message.  They described the many ways they can respond when a child or teen “blows out,” runs, or becomes suicidal.

 


Once you call the police:

Advice from the Federation of Families for Children’s Mental Health (www.ffcmh.org).

  

1.   Remain as calm as you possibly can.

 

2.   Provide only facts as quickly and clearly as possible.

EXAMPLE:  I am calling from [address].  My 13-year-old son is threatening to cut his sister.  He has [diagnosis] and may be off his medication and under the influence of alcohol.  There are 4 of us in the house: my mother, my son and daughter, and myself.

 

3.   Identify weapons in the vicinity or in your child’s possession and alert the dispatcher

 

4.   Be specific about what type of police assistance you are asking for.

EXAMPLE:  We want to protect ourselves and get my son to the emergency room for a psychiatric evaluation, but cannot do that by ourselves.  Please send help.

 

5.   Answer any questions the dispatcher asks.  Do not take offense when you are asked to repeat information.  This is done to double-check details and better assist you.

 

6.   Offer information to the dispatcher about how an officer can help your child calm down.

 

7.   Tell the dispatcher any addition information you can about what might cause you child’s behavior to become more dangerous—suggest actions the officer should avoid.

EXAMPLE:  Please don’t tell him to stand still.  He cannot hold his body still until he calms.  If you can get him to walk with you, he can listen and respond better.  He is terrified of being handcuffed.  Please tell him what he needs to do to avoid being handcuffed.

 

REMEMBER:  Your primary role in this situation is to be a good communicator.  Your ability to remain calm and provide factual details is critical the outcome of this situation.” 

– – – – – – –

 

What is your local police force like?  Call the non-emergency line and check, ask questions about how police typically respond to situations where a child or teenager is diagnosed with a mental disorder and out of control.

 

In many parents’ experiences, including mine, the police were very helpful.  Others have had poor experiences.  Some said their child calmed down and appeared normal once the police arrived, and they felt the police assumed they were exaggerating.  Some said the police only aggravated the crisis, and in a very few cases, the encounter lead to tragedy.

In 2007, I attended the national conference of the Federation of Families in Washington DC, and learned from the President of the National Association of Chiefs of Police, Ronald C. Ruecker, that the NACP has made a commitment to promote police training in crisis response to children with mental disorders, including information about the disorders and their manifestations.