Reducing Stress Children Experience with Visitation

After a divorce there are still issues to address.  One of the major issues is child custody and visitation, especially exchanges for visitations.  The issues usually are addressed in the divorce settlement and the Court Mediation report.  However, even though the Mediation Agreement attempts to address these issues, there are usually still issues.

I have parents who are divorced come in very often arguing about issues that occur during  visitation exchanges.  A majority of times these issues are addressed by the Mediation Agreement.  However, many parents are still fighting with each other after their divorce is final.  Typically I see this when one or both parents are not ready to let go of each other yet.  Arguing over the visitation exchanges is a way to still keep them in contact with each other.  However, parents do not pay attention to the price the children are paying. By focusing on visitation exchanges this puts the children in the middle of the divorce.

By focusing on visitation and putting the children in the middle of the divorce, I see children who become depressed and anxious.  Often these children start acting out at school and home and their grades start to decline.  Also many of these children often start drinking or using marijuana so they can numb themselves out and ignore their parents' arguments.  Most of these children ask me, why can't they just stop fighting? They are already divorced, what else do they want?

Goldberg Jones is a very good divorce attorney who writes articles regarding issues related to divorce and how these issues impact the children and the family.  He wrote a very good article regarding visitation exchange issues.  I found the suggestions very good and helpful.  I would recommend that divorced parents read these ideas and try them.  Therefore, I have included them in this article for you to review and try.  You have nothing to lose by trying and you could help reduce the stress your children experience with visitation. You may also reduce your stress and frustration and allow yourself to let go of the marriage and move on with your life.

How often visitation issues occur often depends on the custody agreement, parenting plan, and the visitation schedule.  Visitation may be a couple of times a week, once a month, or only around major holidays, but it’s likely going to be a repeating event.  Also how well the parents work together as co-parents and allow the divorce issues to be past issues plays a major role in determining if visitation goes easily or is a source of ongoing arguments.

In the best of times, even if both parents can be civil, custody exchanges will probably still be a little awkward. In less amicable scenarios, prepare for outward hostility that resembles the opening scene in Saving Private Ryan. Pack a helmet and prepare to duck.

In more combative circumstances, it helps to have a strategy in place to keep things civil. That’s easier on everyone, especially the kids. There are ways to cut down the amount of face time and limit the friction. It may never be easy or ideal, but it helps with stress level and peace of mind, for both the parents and the children—no kid wants to watch mom and dad fight.

1. CUSTODY EXCHANGES AT THE BABYSITTER’S

In contentious situations, the more you see your ex, the more potential there is for friction and conflict. Sometimes it’s simply best not to see each other if you can avoid it. There are practical ways to circumvent this. One common approach is to make custody exchanges at a babysitter’s house or at daycare.

One parent drops the kids off and the other parent picks them up. If you schedule it right, the two of you may almost never come face-to-face. Because there are other people involved, you may encounter scheduling hurdles. Clear communication about who is picking up the kids and when is key. But once you iron out the kinks, this strategy helps limit contact and potential fights.

2. CUSTODY EXCHANGES AT SCHOOL

Similar to using daycare to facilitate custody exchanges, you can use your child’s education to the same end. Again, one parent drops the kids off at school in the morning while the other picks them up after. This has the desired effect of not having to see your ex more than is absolutely necessary. It can be useful in situations where parents are prone to fighting.

Like with the child care, you’ll need to arrange this with school administrators. Schools like to know they’re handing kids over to right people. But if there is clear communication between all the involved parties, it’s possible to make these arrangements work.

3. CUSTODY EXCHANGES IN PUBLIC

Many people want to avoid causing a scene in public. If you and your ex can’t handle custody exchanges without fighting, consider meeting in a public place. Choose a neutral spot where neither parent is likely to start a ruckus. If such a place exists. In some situations, nowhere is off limits, but being exposed often encourages both parties to be on their best behavior.

Where depends a great deal on the people involved. Pick a centrally located park. The mall, a restaurant, or a coffee shop where you know the regulars are all options. Extreme cases may call for supervised visitation centers or even a police station. Then again, if you just kind of rub each other the wrong way from time to time, a supermarket parking lot may work fine.

4. INVITE A THIRD PARTY WITNESS

While people are reluctant to fight in public, they’re also often hesitant to start trouble in front of friends or acquaintances. One strategy that can smooth over problematic custody exchanges is bringing along a third party. A mutual friend or even authority figure can help keep the peace, especially if it’s someone who knows both parents.

If there are individuals both of you maintain a relationship with, that might be the ideal fit. This approach often serves to calm down heated emotions. And if things do escalate, having a witness never hurts.

If you do go this route, it’s important to give some thought to who you bring along. If you have a new spouse or significant other, consider the ramifications of their presence. Is that going to touch on a sore spot and ignite lingering resentment? In some situations, it might be best to ride solo instead of risking a potential fight.

5. COMMUNICATE VIA ALTERNATE MEANS

Visitation, overnights, and custody exchanges often become logistical tangles. With football games, school plays, robot camp, and the many other activities children participate in, scheduling gets complicated. Pulling it off requires regular communication. If there are problems in this area, conflict often arises. When it involved kids, some level of contact must exist. Fortunately, there are alternative means of communication.

You may have mutual friends or family members willing to serve as go-betweens. Though it tends to get expensive fast, enlisting a lawyer or mediator is another potential strategy.

Thanks to modern technology, you have more outlets than ever before. If you can’t talk on the phone or in-person, email, texting, instant messaging, and other online options exist. Websites like Our Family Wizard provide shared scheduling services and online tools for co-parenting. There are even numerous smartphone apps for tracking parenting schedules and children’s activities. 6. 

6. PREPARE FOR CUSTODY EXCHANGES AHEAD OF TIME

Preparation in advance of custody exchanges is key. The more prepared you are, the faster and smoother they’ll go. Before your ex picks up the kids, take the time to gather everything they need for this particular stay. Whether it’s a quick overnight or a two-week vacation, make sure to gather the essentials.

Did you pack all of the regular medications they take? Do they have all the school books they need to get their homework done? That report on the solar system isn’t going to write itself. If your daughter has a baseball game, pack the mitt and cleats. If your son can’t sleep without his special stuffed zebra, it needs to make the trip. Knowing you have everything set reduces the amount of time you have to interact with someone you’d rather not see.

Think about what the kids can’t live without and send it with them. Otherwise, you risk a middle-of-the-night call or visit from your ex. If the goal is to limit the amount of contact, that defeats the purpose, doesn’t it?

After a divorce, it may be quite some time before you want to see your ex again, if ever. But when you have kids, that’s not really an option. Custody exchanges can be tough, but it’s something you have to deal with.

For the sake of the kids, for their well-being—as well as your own—it’s important to try to make these encounters as smooth and painless as possible. Have a plan, be efficient, and keep your seething emotions in check for a few minutes. Hopefully, that’s all you’ll need. Taking steps to limit conflict in a custody exchange is healthier for everyone involved.

If you have questions about child custody or parenting plans, feel free to contact Goldberg Jones at his San Diego office.

I think these are all very valid points and important issues to consider and feeling that often occur during and after a divorce.  I often recommend the same approach and encourage parents to consider the same issues in regards to their children and themselves.  Divorce is a very painful experience even when it is handled well and with respect for each other.  However, the truth is most children I see for divorce issues are because their parents are still hurting so they children sense it and take on the family pain trying to solve it.  So please try these ideas.

Dr. Michael Rubino has over 20 years experience treating children and teenagers.  He is an expert in treating children who are involved in a high conflict divorce.  For more information regarding Dr. Michael Rubino or his practice visit his website at www.rcs-ca.com or www.rubinocounseling.com or Facebook page at www.facebook.com/drrubino3. 

Teenagers and Condom Snorting

Teenagers at times can be challenging to deal with because they can be impulsive and they think they have everything figured out.  This may be their opinion, however, it is not the truth and the reason why they need assistance from their parents.  I see this daily in my office when parents bring their teenagers in for psychotherapy.

While some feel that teenagers are driving people crazy on purpose, we need to remember they do not always act the way they do on purpose.  Teenagers bodies and brains are still developing.  This is a very important fact to remember.  The prefrontal cortex of the brain is not fully developed in teenagers.  This part of the brain is responsible for executive functioning.  Executive functioning refers to the ability to reason, assess risk and make judgements.  Therefore, since this part of their brains is not developed they are prone to being impulsive and risk taking.  They never think anything bad will happen to them.

While the idea that teenagers are protected from harm is a nice idea, it is not reality.  Teenagers are hurt daily and even die because of the choices they make.  This is why they need their parents to talk to them about choices and consequences.

This brings us to the latest teenage fad.  The latest fad is condom snorting.  Yes, condom snorting.  They snort the condom up their nose and then try to pull it out of their mouth.  This is very dangerous.  A teenager could choke, it can cause an infection or the teen may be allergic to the latex and cause an allergic reaction.  These are some of the dangers.  Since they are snorting the condom, if an infection occurs it could occur in the nasal cavity which is very close to the brain.  Therefore, an infection in the nasal cavity could progress to the brain.  This could be a deadly situation.

This new fad needs to be taken seriously.  ABC 7 News recently did a story about this new fad.  I have included a link to the news story so parents can get a complete understanding about this new fad http://abc7.com/3296850/ via @abc7.  I encourage anyone who deals with teenagers to watch it so you understand the fad and the risks associated with it.

Parents remember as I stated above, teenagers do not have the mental capacity to adequately assess risks yet.  Their bodies may look like an adult body and at times they may act and talk like adults, but they are not adults yet.  Therefore, they are likely to jump before thinking about consequences.  It is your job as parents to educate them and help them make appropriate choices.

In order to do this, you need to talk with them about choices that they may be facing.  Lecturing does not help.  If you lecture, the teenager tunes you out and doesn’t hear a word you are saying.  If you take the approach that you want to talk with them and have a discussion, they are more likely to listen.  It is very important that you discuss this fad with your teenager so they understand the risks they are taking.  This approach will help you with other issues too.

Dr. Michael Rubino is a psychotherapist with over 20 years experience who specializes in treating teenagers and children.  For more information regarding Dr. Rubino’s work or private practice visit his website www.RubinoCounseling.com or follow him on Twitter @RubinoTherapy.

Coping with A Teenager and Their Cellphone

In today's society many people including teenagers view cell phones as a necessity of life.  However, cellphones are a privilege not a necessity.   We need to remember that fact. 

In a couple of weeks many students will be starting Middle School and moving on to High School.  Many of those students, who do not have cellphones, will be asking for Smartphones.  For those students who have Smartphones many will be asking for better Smartphones. Many teens feel they are entitled smartphones and cannot live without one.

Many people have forgotten that cellphones are privileges especially teens and children in Middle School. This is a common argument I encounter between children and parents. The other argument that is common between parent and children is how much and where the cell phone is being used.  Teens basically accuse parents of child abuse if they say no to a phone or if the parent set limits.  You are not being abusive, you are being a responsible parent.  Remember being a parent is not a popularity contest. You need to do what you feel is best for your child.

Parents if you stop and think about it, why does an 11 year old child need an IPhone 7? They do not need to track mileage or expense accounts nor do they remember their own appointments.  There is really no reason they need a Smartphone.

Smartphones are an area where technology has moved faster than our ethics. If you think about it, IPhones and Smartphones were not around in the year 2000. Now everyone including a majority of teens have an IPhone or Smartphone. In my opinion an adolescent does not need a cellphone until they enter Middle School and at that point all they need is a basic cellphone.  They need a basic phone so they can check-in with you if their plans change or if they feel they are in need of help.

As I stated above, there is no reason that a teenager really needs a Smartphone. They are not taking care of a family nor are they running a business. Therefore, a basic cellphone should be adequate for what they need it for. I understand that given the way our society has changed some parents may find that it is helpful to their family if a child in middle school has a cellphone. This is a decision that every parent needs to make based on their family's situation.

The parent needs to make this decision, not let the child guilt them into buying them a cell phone. If you are divorced and have children, this may be extremely difficult, but the decision about if your child gets a cellphone or not, should be a joint decision by both parents and a decision you both agree on. One parent should not buy a cellphone without consulting the other parent and they should not use it as a weapon in the divorce.

If you decide that your middle school child is mature enough for a cellphone, you should discuss the rules and guidelines about using the phone prior to getting a phone. Some things to discuss are who they give their cell number to, not texting during class and not taking it into the bedroom at night so they can text most of the night. Many kids will text with their friends until 2 or 3 am and then be too tired for school the next day.

Also there should be a discussion about sharing photos. You never know what someone will do with a photo if they get mad with you. Also there needs to be a discussion about the law.  It is not uncommon for teens to send their boyfriend/girlfriend nude photos of themselves.  What they don't understand is they are under the age of 18 years old.  Therefore, if they have a nude picture of their 15 year old girlfriend, they can be charged with possession of child pornography.  Many may say this won't happen to me, but I have had a number of teens in psychotherapy because they were charged with having child pornography.  Also you need to remember, once those pictures are out on the internet, they are out there forever.  There also needs to be a discussion about on-line perpetrators too.  There are many pedophiles on line trying to lure unsuspecting teens into their plans.  Your children need to understand this is a real risk and what to watch for.

Finally, it should be made clear that the phone does not belong to the child — the phone belongs to you the parent. Yes you are giving them the phone to use, but it still belongs to you. If you ask for it back, then the child hands it over no questions asked.  Also if you feel they are using their phone in an inappropriate manner, all you need to do is call your cellphone carrier and request that their phone line be suspended.  It cost you nothing and it is an easy way to control the phone.  When you feel that your child has earned the right to have the cellphone back all you do is call your carrier to reinstate that phone line.

It is very important that you and your teen have an agreement about conditions regarding their cellphone use.  All of these conditions and agreements should be written down in an agreement that you sign and the child signs. You each get a copy of the agreement and one copy is posted on the refrigerator. If there are any disputes about a rule, you simply go back to the agreement and you follow what is written. A written agreement is very important because I have seen parents have conversations, make agreements and then 6 months later there is a disagreement and everyone's memory is slightly different so you have a big fight.

Also given how many adults have gotten into trouble with their Smartphones, if you are going to allow your child to use any kind of cellphone you must discuss the pros and cons so the child does not get into major trouble with the phone.

Below I have included a sample contract that you can use with your child and modify as you need. 

Cellphone Contract

I, child’s name, will not bring my cellphone to the family dinner table.

I will not go over our plan's monthly minutes or text message limits. If I do, I understand that I may be responsible for paying any additional charges or that I may lose my cellphone privileges. 

I understand that I am responsible for knowing where my phone is, and for keeping it in good condition.

I understand that my cellphone may be taken away if I talk back to my parents, I fail to do my chores, or I fail to keep my grades up.

I will obey rules of etiquette regarding cellphones in public places. I will make sure my phone is turned off when I am in church, in restaurants, or quiet settings.

I will obey any rules my school has regarding cellphones, such as turning them off during class, or keeping them on vibrate while riding the school bus.

I promise I will alert my parents when I receive suspicious or alarming phone calls or text messages from people I don't know. I will also alert my parents if I am being harassed by someone via my cellphone. 

I will not use my cellphone to bully another person.

I will send no more than _____ texts per day I understand that having a cellphone can be helpful in a emergency, but I know that I must still practice good judgment and make good choices that will keep me out of trouble or out of danger.

I will not send embarrassing photos of my family or friends to others. In addition, I will not use my phone's camera to take embarrassing photos of others. I understand that having a cell phone is a privilege, and that if I fail to adhere to this contract, my cell phone privilege may be revoked.

Parent Responsibilities I understand that I will make myself available to answer any questions my tween might have about owning a cellphone and using it responsibly.

I will support my child when he or she alerts me to an alarming message or text message that he or she has received. I will alert my child if our cellphone plan changes and impacts the plan's minutes.

I will give my child _______ warning(s) before I take his or her cellphone away 

Signed ______________________________ (Tween) Signed ______________________________ (Parents).  Date ______________________________

Dr. Michael Rubino has been working with middle school and high school students for over 20 years.  He is considered an expert in this field.  Dr. Rubino is one of the founding members of the National Alive & Free Program, a program designed to work with teens. For more information about Dr. Michael Rubino's work and private practice visit his website at www.rcs-ca.com or www.rubinocounseling.com  or follow him on Twitter @RubinoTherapy.

Why Teenagers Result to Camouflaging

A new behavior for teenage and tween girls has been identified by an adolescent psychologist. The behavior that has been identified is called “Camouflaging.” This behavior left unidentified can lead to low self-esteem, depression, cutting etc.

Camouflaging is when an adolescent girl changes how she looks, her opinions or things that she does in order to be accepted by the other girls. The real problem occurs when the girl is changing so much about herself or does it for so long that she forgets or losses track of her real self.

While this behavior has just been identified in girls and what the researcher explains appears correct, I believe this behavior applies to boys too.

Many adolescent boys change the way they dress, their beliefs and the way they act to be accepted by their friends. I hear many of these boys telling me in therapy that they feel lost. They tell me they no longer have an idea of who they really are or believe or feel. These boys often turn to alcohol, drugs and cutting.  Usually to numb out their lost feeling or to feel something.

As a result, many teens start acting like someone they are not just to be accepted. This fear of not being accepted and forgetting their real self because they has been covering their true self up for so long or denying their true feelings for so long can result in boys and girls having low self-esteem and/or feeling depressed.

This low self-esteem and depression can result in such behaviors as cutting, eating disorders, drug use, becoming sexually active etc. Often boys and girls cut just so they can feel as I stated above. The constant denying of their emotions can cause boys and girls to lose a sense of their true feelings. Therefore, cutting can occur so boys and girls feel. Denying their feeling or who they are can result in boys and girls feeling very confused. Therefore, they look for behaviors that help them remember who they are and help them identify their true feelings. They also seek behaviors that help them deal with denying their feelings or changing their behaviors. This can trigger eating disorders, drug abuse or other self-destructive behavior. This helps numb out the confusion and disappear of denying their feeling and trying to forget their true self. This can cause feelings of depression and anxiety too.

What should parents look for in their teens? If your son or daughter tries to stop wearing his or her glasses or if he or she all of a sudden changes how he or she dresses or acts these are possible warning signs. Another change could be not doing as well in their classes because they are afraid of looking too smart.  Basically, if you see signs indicating that your teenager is trying to deny who they are so they will be accepted by others.

While it is normal for teenagers to make changes in their attitudes or how they dress, we are talking about something that goes far beyond normal self-expression.  We are referring to changes where a teenager is trying to deny who they are because they feel they are unacceptable.

This is what we are talking about. If teenagers are changing their hair or how they dress as a way to express themselves that is normal teenage behavior. However, if teenagers are doing it just to fit in and they end up losing a sense of their true self this is camouflaging.

As I stated, Camouflaging results in depression or low self-esteem because the teenager is forgetting their true self. If they are doing it as a way of trying to experiment with their self expression, the teenager is happy and confident as stated above. This is the main point to understand. Experimenting with their dress and beliefs etc. is normal for teens and helps teenagers identify themselves, however denying or camouflaging their feelings results in teens losing themselves and many behavior problems. This is the main thing for parents to watch for in their adolescents behavior.

If you go onto Yahoo and look up Camouflaging you will find a segment on Good Morning America about Camouflaging. In fact, here is the link to the GMA segment https://gma.yahoo.com/video/parents-worry-tween-teen-camouflaging-122935763.html?soc_src=copy. Also if parents look at the February issue of Teen Vogue, you will find an article about Camouflaging.

Dr Michael Rubino has over 20 years experience working with teenagers and their families. Dr Rubino is considered an expert psychotherapist in the treatment of teens. For more information about Dr Rubino and his private practice visit his website at www.rcs-ca.com

New Drugs Teenagers are Using

As a psychotherapist who treats teenagers, I hear about what is going on with teenagers and what they are doing.  I have been hearing from many teens about new designer drugs they are taking.  Many people assume teenagers are primarily using marijuana. However, teenagers are looking for new drugs and ways to modify how they use marijuana.  These new drugs can be very dangerous, even deadly.  However, many teenagers are not aware of the dangers.

Spring Break is occurring and summer break is around the corner and for many teenagers this means partying and using drugs.  One major issue is many Emergency Room physicians cannot keep up with all the new drugs.  Therefore, if a teenager ends up in the Emergency Room due to overdosing or having a bad reaction to one of these new drugs, a teenager may die before an Emergency Room physician determines what the teenager took and how to treat it.  The show The Good Doctor recently had an episode which addressed this issue.  The teen had used, Molly, not a new drug but because there were so many options, the teenager almost died before they could determine how to treat him.

Recently I read an article by Angela Chen.  The article discusses these new dangerous drugs and how deadly these drugs can be.  I have included her article below so parents can be aware of the dangers facing their teenagers.  Hopefully, parents will also take this opportunity to discuss this issue with their teenagers.

On a July day a little over a year ago, over 30 people collapsed on a street in Brooklyn. They lay on the ground, vomiting down their shirts, twitching and blank-faced. Some, half-naked, made jerking movements with their arms, eyes rolled back. Others groaned and clutched onto fire hydrants to try to stay upright. Witnesses said the scene was like The Walking Dead. Headlines claimed that people had turned into “zombies,” while police said that the 33 affected were lucky to be alive.

All had smoked an “herbal incense” product called AK-47 24 Karat Gold. Eighteen people were sent to the hospital by ambulance. The situation had all the signs of a drug overdose, and so doctors ordered the usual tests: blood count, urine analysis, heart rate monitoring.

The first patient tested was a 28-year-old man who was slow to respond, but otherwise showed few clear signs of trauma. Heart sounds: normal. Blood count: normal. His lungs were clear and there were no major neurological problems, no excessive sweating or skin lesions. He tested negative for opiates, cocaine, amphetamines. Nothing came up.

The case went to the Department of Homeland Security and the Drug Enforcement Agency. They knew who to call to get a second opinion. They packed blood and urine samples on dry ice and shipped them to a small lab 3,000 miles away in San Francisco, run by toxicologist Roy Gerona. If anyone in the country could figure out what was in 24 Karat Gold, it would be him.

Forty years ago, drugs had easy names: cocaine, meth, heroin. Today, the names can read like an ingredients list for a chemistry class: 5F-AMB, PX-2, MDMB-CHMINACA. Today’s designer drugs are made by synthesizing chemicals and hoping they give you a high that’s strong enough to be worth it, but not strong enough to send you to the hospital.

Designer drugs are volatile. If you tweak just one molecule, you can get an entirely differently substance, one you hadn’t bargained for. They’re also easy to get. There’s no shortage of “research chemicals” vendors on the dark web are willing to sell. And they’re growing more popular. These so-called “novel psychoactive substances” entered the mainstream in 2009. That year, according to the United Nations Office on Drug and Crime, there were about 100 of these substances reported; six years later, there were nearly 500. Because designer drugs don’t show up on traditional drug tests, they’re hard to track and identify. It’s a public health problem that requires a special set of skills to handle.

One of the most prominent categories of designer drugs are those intended to mimic marijuana, called synthetic cannabinoids. Marijuana, or cannabis, is widely considered one of the safest drugs, but synthetic cannabinoids are some of the most dangerous synthetic drugs. The Global Drug Survey (GDS) found that last year, for the fourth year running, the risk of seeking emergency medical treatment was higher after using synthetic weed than for any other drug.

When you smoke a regular joint, a chemical called tetrahydrocannabinol (THC) travels through your blood. It binds with receptors called CB1 and CB2. Because of the structure, there’s “kind of a limit on how stoned you can get,” says Adam Winstock, a London-based psychiatrist who administers the GDS. If you’re smoking a popular cannabinoid like K2 Spice, a chemical travels through your blood, but this time, it’s not THC. It’s something else that also binds with CB1 and CB2 — but unlike with regular weed, we don’t know exactly how these chemicals bind, especially when they’re illicit drugs from the black market. This mystery makes synthetic marijuana likely to lead to “much more extreme responses,” like seizures and psychosis, according to Winstock.

Synthetic cannabinoids originated in a quest to create a better pain medication. A Clemson University chemist named John W. Huffman synthesized hundreds of compounds in an attempt to find a better painkiller, but often created incredibly psychoactive substances with no medicinal properties at all. When he published the results of these compounds — called JWH compounds, after his initials — he made the information available to be copied.

There are more than 300 JWH compounds alone, and around 2004, labs in China began studying old research papers, synthesizing the compounds and distributing them as “herbal incense” products. K2 Spice itself — often partly based off the JWH-018 compound — started in China, became popular in Germany around 2008, and entered the US around 2009.

Labs can also turn to the expired patents — patents that are rich fodder, even if (or perhaps because) there was a good reason said drugs never made it to market. It’s nearly impossible to figure out how to shut down the overseas labs producing these drugs. As soon as you ban one substance, the labs move on to another.

Gerona, a toxicologist with gray hair styled in an undercut, was the one who received the biological samples from the DEA. From a small lab in the Medical Sciences Building at the University of California, San Francisco, Gerona says he and his team are playing a “cat and mouse game” with illicit international drug manufacturers. When an overdose happens, Gerona’s team tries to identify the drug in question — often synthetic substances no one has seen before. But the lab goes one further: Gerona’s lab attempts to identify and classify these substances before the mass overdoses even happen.

Inside, the lab is meticulously neat: rows of spotless tables are covered in bottles with orange rubber caps, all labeled with orange duct tape, and small gray centrifuges. A window overlooking a courtyard has molecular structures scribbled over it in pink and green marker. Near the door sits an enormous freezer, filled with thousands of brightly colored, frost-covered boxes of drug samples kept at -112 degrees Fahrenheit.

Gerona launched his toxicology lab in 2010, in partnership with the San Francisco Poison Control Center. The date wasn’t a coincidence; he says that 2010 was the year that a designer drug called “bath salts” began flooding the market. “Bath salts” is a blanket term for a group of designer drugs made from stimulants; they create a euphoric high like MDMA, sometimes with hallucinations thrown in. The drugs usually come in powdered and capsule form, and can cause freak-outs that were well-documented on YouTube at the time. The most famous of these was a viral story of a 31-year-old Miami resident attacking and then eating a homeless man. (Scientists dispute the drugs’ role.)

For users and the DEA, the spike in bath salts use was a nightmare. For Gerona, the increased interest in designer drugs led to more work and more samples from around the country. Eventually, the lab caught the notice of both Michael Schwartz, a toxicologist at the Centers for Disease Control and Prevention, and DEA pharmacologist Jordan Trecki. A collaboration between Gerona’s lab and the DEA was formed. (Neither the DEA nor the CDC responded to repeated requests for comment.)

The first step in doing an analysis at Gerona’s lab is getting the sample — urine, blood or, rarely, a tiny bit of drug itself — shipped over on dry ice. In traditional drug testing, you check to see if the sample matches any of the known substances: marijuana, heroin, cocaine, and so on. They match, or they don’t. Designer drugs, almost by definition, are made of chemical combinations we haven’t seen before. They almost never match traditional databases, and the chemists often don’t know what they’re looking for. So Gerona’s lab gathers as much information about the substance as possible.

A tiny vial of the biological sample — usually plasma, the colorless part of blood — goes into a bulky, printer-like machine. That machine is called a liquid chromatography mass spectrometer, and very crudely put, it separates out all the different parts of the plasma by mass. (Think of it like an extremely sensitive centrifuge.) That process makes it easier to identify chemicals, and the mass spectrometer then spits out the different measurements in a computer chart with peaks and valleys called a chromatogram.

Then, says Axel Adams, a graduate student in Gerona’s lab, you turn to the so-called “prophetic library.”

“ RESEARCHES LOOK FOR POSTS ABOUT DRUGS ON SUBREDDITS LIKE R/RESEARCHCHEMICALS

”

Gerona’s “prophetic library,” about three years in the making, is a detailed catalog of already synthesized variants that his team believes is going to be the next big street drug. The library was made possible with the help of Samuel Banister, a synthetic chemist at Stanford University. Banister synthesizes variants of popular street drugs and takes down their chemical information to create “reference standards.” Synthesizing can take anywhere from a few days to a couple of weeks; the lab now has almost 150 variants on file. It’s a side job for Banister, but at one point, he says, “I was pumping out five to 10 a week.” The final products look like white crystalline solids and are kept in drawers in the lab, ready for when a case like AK-47 24 Karat Gold comes along.

In addition, lab members spend hours each week on drug forums, researching trends. It’s more of an art than a science. Researches look for posts about drugs on subreddits like r/researchchemicals. They reference surveys like the Global Drug Survey and survey “trip reports” from experiential documentation sites like Erowid and PsychonautWiki.

They look for terms like synthetic pot, K2, Spice, and sometimes, scientific terms like “cannabinoids,” or a specific popular class of cannabinoids, like “FUBINACA” or “JWH compounds.” Often, the posts themselves will include the name of the chemical. Gerona has ordered drugs off the dark web. In one case, the invoice billed him for “cosmetics,” and the package included lipstick, fake eyelashes, and tabs labeled “powder.” The “powder,” unsurprisingly, turned out to be drugs. But most of the time, the drugs in the powder were not the drug that was ordered.

“ THE INVOICE BILLED HIM FOR “COSMETICS,” AND THE PACKAGE INCLUDED LIPSTICK, FAKE EYELASHES, AND TABS LABELED “POWDER”

”

If there is a match because the compound is already in the library, finding the right variant is “only going to take 15 minutes,” says Gerona. “Otherwise, it could take a week, or it could not be solved.”

Adams checked the results of a blood sample tied to AK-47 24 Karat Gold against the prophetic library. The computer pulled up a chart that indicated a line — jagged, up and down — that shows the mass of the components of AK-47 24 Karat Gold, versus the same information for AMB-FUBINACA.

Drugs don’t pass through the body untouched. Once they’re ingested, the body processes the compounds. So by the time they’re in the blood or urine, it’s not exactly the same compound as the drug that was ingested. It’s hard enough to find a reference standard for the original compound; it’s even more difficult to find a reference standard for the possible variants. In the case of AMB-FUBINACA, the chemical in the biological sample from Brooklyn wasn’t the parent compound. It was a derivative. Luckily, Banister had already synthesized that variant, too.

The peaks and valleys of the two lines of AK-47 24 Karat Gold and AMB-FUBINACA matched up precisely. It took the team only seven days to identify the substance in the Brooklyn case — and most of that time was spent waiting for the sample to get there.

Gerona’s lab has worked on cases across the country, from New York City to Sacramento to Colorado. The number of cases varies. Sometimes, they’ll get 15 to 25 samples a month. One Mississippi case involving synthetic cannabinoids resulted in over 400 samples. The average turnaround on results is about six months, says Adams. That’s not good enough for Gerona.

And it’s not likely that the problem will go away. Marijuana legalization advocates claim that people will stop with the synthetic stuff once the real thing is okay. But that’s not true in the experience of Andrew Monte, a clinical toxicologist at the University of Colorado School of Medicine who collaborates with Gerona’s lab. Recreational marijuana is legal in Colorado, but he sees patients who are on these synthetic compounds anyway. Monte’s team has surveyed people who come into the ER and even set up at music festivals to ask attendees questions. Synthetic drug users are “taking it for a different reason, to get a different high,” Monte says. “They’re really looking for something different than what pot gives, the same way you might choose cocaine over pot or meth over pot.”

“ ONE MISSISSIPPI CASE INVOLVING SYNTHETIC CANNABINOIDS RESULTED IN OVER 400 SAMPLES

”

To help address this problem, in 2016 Gerona started a new research consortium called P SCAN, or the Psychoactive Surveillance Consortium and Analysis Network. (Yes, the double entendre is intended.) They’re working with about 10 poison control centers in places like Kansas and Colorado. They’ve had more than 100 cases referred to them and are writing up case reports and manuscripts. (The 24 Karat Gold case was published by the New England Journal of Medicine.)

P SCAN will continue to do the surveillance work Gerona has been doing for years, but also create a database of clinical data connected to the specific synthetic drugs they track and discover. Think of it like a medical version of Erowid. This way, the next time there’s an outbreak like the one in Brooklyn, investigators and researchers can look at specific physical indicators (heart rate, respiratory information, neurological information, and more) and say, “Ah, this matches the symptoms of AMB-FUBINACA” — all without shipping samples across the country.

But even with P SCAN and the prophetic library, the task is huge. “The identity of a lab needs to constantly expand and rework in order for it to stay relevant,” says Gerona.

Gerona is a biochemist by training. Before launching his lab, he didn’t know anything about Spice, or AK-47 Gold, or the dark net. But now, Gerona says, “I have no other choice but to really learn about it, so that I am relevant and retain my relevance in the field.” He’s hoping to work with people in technology to automate this “market research” to glean new insights and make the prediction process even faster. “It would be so great if we could predict the drugs coming in with more accuracy, instead of after people are hurt,” he says.

Weeding out designer drugs is a Sisyphean task, Gerona admits. It may be impossible to shut down the overseas labs, but he wants to have even better methods for predicting what’s going to get big and then, instantly identifying the substances. He compares the endless drug variations to nature: the cold virus is still around because it changes all the time. HIV has never been cured because it continues mutating. “In a sense, they’re reinventing themselves all the time, so reinvention is key to persistence. As long as you’re reinventing yourself, you can persist.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating teenagers.  He treats teenagers with drug issues and has seen many end up in the Emergency Room because teenagers think they are the experts.  For more information about Dr. Rubino’s work or his private practice visit his website www.RubinoCounseling.com or his Facebook page www.Facebook.com/Drrubino3.

Signs of Teenage Depression

I often have parents ask me what warning signs they need to watch for in their teenagers that may indicate their teen is depressed.  I recently ready an article by Dr. Jerome Yelder, Sr.  He did a very good job of breaking down the basic symptoms adults and teens experience when they are depressed.  I have included the list for parents below so they know what to watch for in their teenagers.

Sleep Problems

Depression can affect your body as well as your mind. Trouble falling or staying asleep is common in people who are depressed. But some may find that they get too much shut-eye.

Chest Pain

It can be a sign of heart, lung, or stomach problems, so see your doctor to rule out those causes. Sometimes, though, it's a symptom of depression.

Depression can also raise your risk of heart disease. Plus, people who've had heart attacks are more likely to be depressed.

Fatigue and Exhaustion

If you feel so tired that you don't have energy for everyday tasks -- even when you sleep or rest a lot -- it may be a sign that you're depressed. Depression and fatigue together tend to make both conditions seem worse.

Aching Muscles and Joints

When you live with ongoing pain it can raise your risk of depression.

Depression may also lead to pain because the two conditions share chemical messengers in the brain. People who are depressed are three times as likely to get regular pain.

Digestive Problems

Our brains and digestive systems are strongly connected, which is why many of us get stomachaches or nausea when we're stressed or worried. Depression can get you in your gut too -- causing nausea, indigestion, diarrhea, or constipation.

Headaches

One study shows that people with major depression are three times more likely to have migraines, and people with migraines are five times more likely to get depressed.

Changes in Appetite or Weight

Some people feel less hungry when they get depressed. Others can't stop eating. The result can be weight gain or loss, along with lack of energy. Depression has been linked to eating disorders like bulimia, anorexia, or binge eating.

Back Pain

When it hurts you there on a regular basis, it may contribute to depression. And people who are depressed may be four times more likely to get intense, disabling neck or back pain.

Agitated and Restless

Sleep problems or other depression symptoms can make you feel this way. Men are more likely than women to be irritable when they're depressed.

Sexual Problems

Hopefully your teenager is not sexually active.  While they may not have the sexual problems adults do, when they are depressed, they may show a lack of interest in dating or relationships and tend to isolate.  They also may feel they are sexually unattractive.

If you're depressed, you might lose your interest in sex. Some prescription drugs that treat depression can also take away your drive and affect performance. Talk to your doctor about your medicine options.

Exercise

Research suggests that if you do it regularly, it releases chemicals in your brain that make you feel good, improve your mood, and reduce your sensitivity to pain. Although physical activity alone won't cure depression, it can help ease it over the long term. If you're depressed, it can sometimes be hard to get the energy to exercise. But try to remember that it can ease fatigue and help you sleep better.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating teenagers and children.  For more information about Dr. Rubino’s work and private practice visit his website www.RubinoCounseling.com or on Twitter @RubinoTherapy