Monday, March 19, 2007

Did St Patrick Drink?

I had been thinking about it last week but it really bubbled up this weekend, why do we have a “holiday” with pretty much the sole purpose of drinking?

I went to a local restaurant Saturday for a burger and was amazed that it wasn’t as busy as I would have expected. The waiter’s take was that because they didn’t serve green beer a lot of folks went elsewhere.

What is it about an apparently religious man’s driving the snakes from an island country that promotes public drunkenness? It seems to me that this would be a good target for “holiday repeal”. St Patrick’s Day serves no other purpose. If we really want to model “good” behavior for our children, we really need to stop glamorizing drinking, public drunkenness, and the inference that you have to drink considerable quantities of alcohol to have fun.

(Just a side note: I had a great grandfather how emigrated from Ireland, but he was an Orangeman, so I don't get into "the wearing of the green")

Thursday, March 15, 2007

Parenting and the adolescent brain

I talked with a couple hundred New Trier High School students today about the effects of drugs and alcohol on the adolescent brain.

It is interesting, as I have delved into this topic I better understand why adolescents act and think the way that they do because of the “construction” going on in their brains. But, as a parent, I still often react differently than one with that understanding seemingly ought to.

“What were you thinking when…?” Despite the fact that I know that cognitive control of behavior in an adolescent relies more heavily on the developing prefrontal cortex and that that is easily overwhelmed when the adolescent is “stressed” (stressed in the broadest sense). There is no hippocampal “back-up” as there is in an adult. So, in fact, when “stressed” the adolescent really isn’t thinking it through, there is no “executive processing”.

“Why are you so moody/Why are you in a bad mood?” Despite the fact that I know that the mesocorticolimbic system is still forming causing fluctuations in emotional perception and the ability to solidify assigning emotional value to a thought, action, or attitude. Also, I know that allopregnalone (a hormone released when an individual is “stressed”) works differently in the adolescent brain than in the adult. There are different receptors in the adolescent brain that makes this more excitatory than its calming function in the adult brain (allowing you to pause and reflect on options).

No doubt this dichotomy will persist, but at least with my knowledge (and a bit of help from allopregnalone), I can pause and analyze it somewhat after the fact. I continue to work on narrowing that time, so that that “after the fact” can occur while the discussion is still going on with my teen child and I can bring it into that discussion.

Monday, March 12, 2007

It's not OK

I participated in a discussion recently in a group looking for a rubric, a slogan, a motto, if you will, to use to “push” underage drinking prevention activities in all their permutations. I liked one brought up by someone in the room (thanks Bruce), not necessarily invented by him, but something he felt would be a good choice:

“It’s not OK”

I like it. It’s simple, yet covers a lot of what we will be doing in our efforts to decrease underage drinking.

It’s not OK for parents to buy alcohol for underage kids and/or allow drinking parties for underage kids in their house. It’s not OK for older siblings or friends to provide alcohol for underage drinking. It’s not OK to drink and drive or ride with someone who is drinking and driving. It’s not OK to drink when you are underage. It’s not OK to “target” ads or products at potential underage drinkers. It’s not OK that the number 1 “date rape drug” (alcohol) is so readily available and so under-feared/under-respected.

It’s not OK.

Friday, March 09, 2007


At a meeting of the Lake County Chiefs of Police Association Committee on Underage Drinking meeting yesterday one of the members brought up an HBO series that would begin airing soon.

The series (13 episodes long) is called Addiction. It will begin with its 1st episode next week on the 15th. Interestingly they scheduled it during a time that non-subscribers can watch as well. HBO has also put up a website to supplement the show that seems to contain (I just took a quick look around) a fair amount of good information. It has sections titled: “Understanding Addiction, Adolescent Addiction, Treatment, Aftercare, Stigma and Discrimination”, as well as more show specific information.

The basic premise of the show is:
Over 23.2 million Americans struggle with addiction, yet fewer than 10 percent are getting treatment.

And they are attempting to improve that with the show and website.
The Addiction Project is produced by HBO in partnership with the Robert Wood Johnson Foundation, the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

I wish them success in their endeavor; their success will translate into lives saved. The number of overdose deaths here in Lake County continues an upward trend that has been present for years; we can use all the help we can get.

Wednesday, March 07, 2007

Bad things happen to other people

Zlata Filipovic became a recognized author when her diary covering her experiences during the war in Sarajevo (1991-1993) was published. She wrote a line in another book that caught my eye: “…its human nature to always believe that “bad” things happen to other people, not us.”

I think that thought is what is really going on when we say that kids think “they are invincible”. I don’t think teens (and other folks, for that matter) really think that they are invincible. I think that they know that they can get hurt, or worse, when they do certain things, but they simply think that that “hurt” can only happen to someone else. It won’t happen to me. That pattern seems to fit most incidents and accidents that I see.

That changes the focus of the “intervention” as I see it. While it needs to be a part of the “education” that this stuff and/or action can harm or kill you, the main focus ought to be that it can harm or kill YOU. I think that the thought that bad things always happen to the other guy is why we can’t scare kids straight or into “good” behavior.

We need to figure out a way to overcome that human natural belief and somehow convince teens (and other folks) that the “bad” stuff can happen to them. I think seeing, knowing, talking to, and hearing about kids that these “bad” things have happened to makes an impact. I think presenting in a reasoned and reasonable fashion that believing “it won’t happen to me” doesn’t make it so, can have an impact. I think educating them that the basis for some of their behavior is the belief that “bad” stuff only happens to someone else, can, when repeated over time, have an impact. But I think attempting to scare them into the “knowledge” that they are not invincible, gets you nowhere. Telling them that “this” happens to teens instead of this can happen to YOU misses the mark. It may seem a small difference, but it has got to be personal to get them personally.

Tuesday, March 06, 2007

“everything to live for”

We are often confronted with the statement “My (loved one) could not have died by suicide, they had everything to live for”, when we discuss that manner of death with family and friends.

I came across a bit of information I thought was interesting and that speaks to that point. George Eastman (the Eastman of Eastman Kodak) died by self inflicted gun shot wound in 1932. He was a man described as “a man of power, generosity, and self-determination” and one of the richest men in America at the time. Talk about someone who had “everything to live for”.

However, on closer examination of his life and psyche at the time of his death he was a typical “case” (depression, physical illness, recent losses), but it wasn’t all that obvious at the time. Even someone with “everything to live for” can die by suicide. It does not diminish them in the least, as someone said recently: “they are leaping from their own inferno”.

Monday, March 05, 2007

You don't "get over" grieving in 6 months

Both because I saw it cited in The Chicago Tribune on the 21st and because I am doing some research for a project I am working on, I read a study recently published in JAMA, An Empirical Examination of the Stage Theory of Grief.

I have several “issues” with the study and article, e.g. their mathematically manipulating their data to get a graph that agrees with their hypothesis supporting the stage theory of grief, but more on some of those issues on a later date.

The thing I found most irritating (to say the least) and something I saw pulled from the article in several other publications was their claim that: “those individuals who experience any of the (negative) indicators beyond 6 months postloss would appear to deviate from the normal response to loss”. Never mind that they categorize some responses/emotions to loss of a loved one as “negative” that don’t seem to me to be all that “negative”, the data they present does not support that claim. Certainly, common sense and experience argue against it as well.

Their data show fairly minimal decrease in “yearning” from their 6-12 month to their 12-24 month periods (3.18 on a 1 to 5 scale to 2.64, down from 3.77 in the initial 1-6 month period) and I think one could argue their data does not seem to be a clinically significant change at all across the measurements. Depression goes from 2.29 (again 1 to 5 scale) at 1-6 month, through 2.29 at 6-12 months, to 1.80 at 12-24 months. At no time do any of their indicators go to one (generally “impact felt less than once per month”). They have no “0” in their scales, although in their manipulated data graph it appears that they do.

I just don’t see it; their “measures of grief” do not go away at 6 months. The individual’s continued to experience significant grief symptoms beyond 6 months. Now, before someone jumps on it, I am not saying the folks don’t need help working on their grieving, I am saying that to declare it not “normal” is a disservice and to communicate to “others” that folks should be over it in 6 months is an even worse disservice. People “don’t get over it” in 6 months. It is my contention that you never get over it, but more on that in the future.

Web site finally getting make-over

We are finally making some progress with County IT and our Lake County Coroner Website. It did take a bit of agitation. We now have access to 2 sections (Press Releases and Publications), so we are getting things added and up for viewing (old press releases and our quarterly newsletters, in particular so far). More changes, still under the control and action of IT, will be coming (are promised) over the next few weeks (our designing is done). I look forward to our new look and “news” availability.

Friday, March 02, 2007

Methadone overdose deaths

Just as we are seeing an increase in Methadone-related overdoses, so are many places across the country. While it is often seen as a drug used to replace heroin in addicted individuals, the overdoses we are seeing are related to its increased use as a potent pain medication (as is the case elsewhere as well).

Methadone is being used increasingly in tablet form as a pain med. Like all behavior the reason is “over-determined” or multi-factorial. It is quite effective and had been thought to be less addictive than many other pain meds (not true, but all meds are addictive in some ways and in some people). Another reason is that OxyContin has gotten such a “bad name” that a replacement was needed.

One of the main problems with Methadone is its long half-life (the time required to clear half of the med from the body). The half-life can be up to 60 hours. The problem is that the pain-relief effects diminish prior to it being cleared from the body, so that repeated dosing for pain relief in the face of that slow clearage leads to the development of toxic levels.

The other “problem” with Methadone is that it is usually an incredibly safe med when taken alone, but can quickly becomes deadly when mixed with other meds at higher than “normal” doses. That is, if your Methadone level is a bit on the high side and you take it with a benzodiazepine a bit on the high side and wash it down with a bit too much alcohol, you can wake up dead (as we say in the profession). This can occur even if none of those drugs are in the toxic range by themselves. In particular, the respiratory and cardio- depressant effects of these drugs are additive, if not somewhat geometric, in their cumulative effects.

Methadone may be a good pain med and may be useful in those addicted to heroin, but it can be lethal and we are seeing an increase in its lethal effects.

Thursday, March 01, 2007

Operation STAAT doesn't look so good to me

I had to leave a local community meeting early the other day so I missed a discussion that I would have like to have listened to. In addition to several other programs to decrease underage drinking there was to be a discussion of “Operation STAAT”. Based only on an article in the Chicago Tribune, parts of it seems like a bad idea to me.

Operation STAAT (Stop Teen Alcohol Abuse Together) appears to have a few components according to the article. It encourages neighbors who suspect that there is a party at which underage drinking is taking place to report that to a “hot line”, anonymous calls are allowed. That seems reasonable. It also encourages those neighbors to record and report license plates of the vehicles of the attendees. That seems to have a potential for trouble to me, someone could get hurt if caught writing down the numbers. The program calls for community service for underage drinkers caught offending. That seems reasonable as well.

The part I have the most trouble with is that it requests parents who suspect that their teenagers have been drinking to call the police. The police come to their home and administer a “preliminary breath test” and if positive a juvenile officer meets with the teen and community service hours are set up. If the parents “say” that the teen continues to drink the teen can be charged with underage drinking. If the teen stops drinking, no arrest is made (and no record or other consequences for the teen).

While I am a very strong proponent of being your teen’s parent and not their friend/pal, I think this is wrong-headed. It destroys trust and I think it would get in the way of your (the parent’s) ability to get your teen help and/or treatment. If your teen continues to drink they have a problem probably better handled with counseling than punishment. They would not likely trust you about other problems and issues as well.

Parent; don’t get the police to solve your problems better handled in another way. As they say in the article: We can’t arrest ourselves out of the situation”. You can NOT scare a kid sober.