Saturday, October 20, 2012

Why Hasn't My Child Grown Up And Become Independent

Hundreds, if not thousands of adolescents and young adults from the North Shore communities of Highland Park, Lake Forest, Glencoe, Northfield, Winnetka, Glenview, Wilmette and Northbrook continue to require significant parental support well into traditional adulthood ages of 20 to 30.  This support often takes the form of all or almost all ecomonic needs including apartments, cars and spending money. 

Sociologists traditionally define the “transition to adulthood” as marked by five milestones: completing school, leaving home, becoming financially independent, marrying and having a child. In 1960, 77 percent of women and 65 percent of men had, by the time they reached 30, passed all five milestones. Among 30-year-olds in 2000, according to data from the United States Census Bureau, fewer than half of the women and one-third of the men had done so. A Canadian study reported that a typical 30-year-old in 2001 had completed the same number of milestones as a 25-year-old in the early ’70s.

Our urge to protect teenagers from real life – because we don’t think they’re ready yet – has tragically backfired. By insulating them from adult-like work, adult social relationships, and adult consequences, we have only delayed their development. We have made it harder for them to grow up. Maybe even made it impossible to grow up on time.

Basically, we long ago decided that teens ought to be in school, not in the labor force. Education was their future. But the structure of schools is endlessly repetitive. From a Martian’s perspective, high schools look virtually the same as sixth grade. There’s no recognition, in the structure of school, that these are very different people with different capabilities.  Strapped to desks for 13+ years, school becomes both incredibly monotonous, artificial, and cookie-cutter.
We place kids in schools together with hundreds, sometimes thousands, of other kids typically from similar economic and cultural backgrounds. We group them all within a year or so of one another in age. We equip them with similar gadgets, expose them to the same TV shows, lessons, and sports. We ask them all to take almost the exact same courses and do the exact same work and be graded relative to one another. We give them only a handful of ways in which they can meaningfully demonstrate their competencies. And then we’re surprised they have some difficulty establishing a sense of their own individuality.

And we wonder why it’s taking so long for them to mature. The old explanation used to be they needed time for the wave of raging hormones to dissipate (more on this tomorrow). The newer explanation is that their brains simply aren’t developed yet: their prefrontal cortex hasn’t converted from gray matter to white matter, their amygdalas have a surfeit of oxytocin receptors, and their reward centers have a paucity of dopamine receptors. Few can say for sure yet how these anatomical features actually interact and create modern teenagers, but the gist of it is quite simple – until their brains are finished, they’re not ready for real life.

I hear often from parents whose teenagers are disengaged or withdrawn. They have a hard time caring what other kids think, or what society expects of them. They’re having a hard time playing the game of resume-building for a far-off future.

They’re called boomerang children, their m.o. is called failure to launch, and they’re everywhere. We all know them. Many of us have raised them.  Their behavior predates the economic crisis, but I believe they’ve grown in number as the job outlook has become increasingly bleak. Emerging adults choose from a wide variety of lifestyle options, all of which are carefully designed to postpone the onset of adulthood. Society has made it easy for them to do this. Entry level jobs are scarce. The wide acceptance of premarital sex has made postponement of marriage a welcome option, as has birth control and cohabitation. Assisted reproductive technology makes it possible to delay parenthood well into one’s thirties or even forties. 

The impact of emerging adulthood on a society that has been built upon the orderly progression of one generation growing up, getting jobs, starting families, and retiring on pensions supported by the next generation of adults is yet to be felt.  What happens when that cycle is thrown out of whack?
A century ago psychologists made a strong case for the creation of a new stage of human development which we now take for granted.  Acceptance of adolescence as a distinct phase of development required accommodation by the government, our education system, social services, and the law.  Sweeping change is likely to occur should emerging adulthood gain the same level of acceptance. Is emerging adulthood going to be a breakthrough discovery in the field of psychology or is it just a fancy term for self-indulgence?

JEFFREY ARNETT, a psychology professor at Clark University in Worcester, Mass., is leading the movement to view the 20s as a distinct life stage, which he calls “emerging adulthood.” He says what is happening now is analogous to what happened a century ago, when social and economic changes helped create adolescence — a stage we take for granted but one that had to be recognized by psychologists, accepted by society and accommodated by institutions that served the young. Similar changes at the turn of the 21st century have laid the groundwork for another new stage, Arnett says, between the age of 18 and the late 20s. 

Among the cultural changes he points to that have led to “emerging adulthood” are the need for more education to survive in an information-based economy; fewer entry-level jobs even after all that schooling; young people feeling less rush to marry because of the general acceptance of premarital sex, cohabitation and birth control; and young women feeling less rush to have babies given their wide range of career options and their access to assisted reproductive technology if they delay pregnancy beyond their most fertile years.

If society decides to protect these young people or treat them differently from fully grown adults, how can we do this without becoming all the things that grown children resist — controlling, moralizing, paternalistic? Young people spend their lives lumped into age-related clusters — that’s the basis of K-12 schooling — but as they move through their 20s, they diverge. Some 25-year-olds are married homeowners with good jobs and a couple of kids; others are still living with their parents and working at transient jobs, or not working at all. Does that mean we extend some of the protections and special status of adolescence to all people in their 20s? To some of them? Which ones? Decisions like this matter, because failing to protect and support vulnerable young people can lead them down the wrong path at a critical moment, the one that can determine all subsequent paths. But overprotecting and oversupporting them can sometimes make matters worse, turning the “changing timetable of adulthood” into a self-fulfilling prophecy.

The more profound question behind the scholarly intrigue is the one that really captivates parents: whether the prolongation of this unsettled time of life is a good thing or a bad thing. With life spans stretching into the ninth decade, is it better for young people to experiment in their 20s before making choices they’ll have to live with for more than half a century? Or is adulthood now so malleable, with marriage and employment options constantly being reassessed, that young people would be better off just getting started on something, or else they’ll never catch up, consigned to remain always a few steps behind the early bloomers? Is emerging adulthood a rich and varied period for self-discovery, as Arnett says it is? Or is it just another term for self-indulgence?

DURING THE PERIOD he calls emerging adulthood, Arnett says that young men and women are more self-focused than at any other time of life, less certain about the future and yet also more optimistic, no matter what their economic background. This is where the “sense of possibilities” comes in, he says; they have not yet tempered their ideal­istic visions of what awaits. “The dreary, dead-end jobs, the bitter divorces, the disappointing and disrespectful children . . . none of them imagine that this is what the future holds for them,” he wrote. Ask them if they agree with the statement “I am very sure that someday I will get to where I want to be in life,” and 96 percent of them will say yes. But despite elements that are exciting, even exhilarating, about being this age, there is a downside, too: dread, frustration, uncertainty, a sense of not quite understanding the rules of the game. More than positive or negative feelings, what Arnett heard most often was ambivalence — beginning with his finding that 60 percent of his subjects told him they felt like both grown-ups and not-quite-grown-ups.

Cultural expectations might also reinforce the delay. The “changing timetable for adulthood” has, in many ways, become internalized by 20-somethings and their parents alike. Today young people don’t expect to marry until their late 20s, don’t expect to start a family until their 30s, don’t expect to be on track for a rewarding career until much later than their parents were. So they make decisions about their futures that reflect this wider time horizon. Many of them would not be ready to take on the trappings of adulthood any earlier even if the opportunity arose; they haven’t braced themselves for it.

Nor do parents expect their children to grow up right away — and they might not even want them to. Parents might regret having themselves jumped into marriage or a career and hope for more considered choices for their children. Or they might want to hold on to a reassuring connection with their children as the kids leave home. 

If they were “helicopter parents” — a term that describes heavily invested parents who hover over their children, swooping down to take charge and solve problems at a moment’s notice — they might keep hovering and problem-solving long past the time when their children should be solving problems on their own. This might, in a strange way, be part of what keeps their grown children in the limbo between adolescence and adulthood. It can be hard sometimes to tease out to what extent a child doesn’t quite want to grow up and to what extent a parent doesn’t quite want to let go.
Whatever it’s called, the delayed transition has been observed for years. But it can be in fullest flower only when the young person has some other, nontraditional means of support — which would seem to make the delay something of a luxury item. That’s the impression you get reading Arnett’s case histories in his books and articles, or the essays in “20 Something Manifesto,” an anthology edited by a Los Angeles writer named Christine Hassler. “It’s somewhat terrifying,” writes a 25-year-old named Jennifer, “to think about all the things I’m supposed to be doing in order to ‘get somewhere’ successful: ‘Follow your passions, live your dreams, take risks, network with the right people, find mentors, be financially responsible, volunteer, work, think about or go to grad school, fall in love and maintain personal well-being, mental health and nutrition.’ When is there time to just be and enjoy?” Adds a 24-year-old from Virginia: “There is pressure to make decisions that will form the foundation for the rest of your life in your 20s. It’s almost as if having a range of limited options would be easier.” 

This dependence on Mom and Dad also means that during the 20s the rift between rich and poor becomes entrenched. According to data gathered by the Network on Transitions to Adulthood, a research consortium supported by the John D. and Catherine T. MacArthur Foundation, American parents give an average of 10 percent of their income to their 18- to 21-year-old children. This percentage is basically the same no matter the family’s total income, meaning that upper-class kids tend to get more than working-class ones. And wealthier kids have other, less obvious, advantages. When they go to four-year colleges or universities, they get supervised dormitory housing, health care and alumni networks not available at community colleges. And they often get a leg up on their careers by using parents’ contacts to help land an entry-level job — or by using parents as a financial backup when they want to take an interesting internship that doesn’t pay.  

“You get on a pathway, and pathways have momentum,” says Jennifer Lynn Tanner of Rutgers. “In emerging adulthood, if you spend this time exploring and you get yourself on a pathway that really fits you, then there’s going to be this snowball effect of finding the right fit, the right partner, the right job, the right place to live. The less you have at first, the less you’re going to get this positive effect compounded over time. You’re not going to have the same acceleration.”

Even Arnett admits that not every young person goes through a period of “emerging adulthood.” It’s rare in the developing world, he says, where people have to grow up fast, and it’s often skipped in the industrialized world by the people who marry early, by teenage mothers forced to grow up, by young men or women who go straight from high school to whatever job is available without a chance to dabble until they find the perfect fit. Indeed, the majority of humankind would seem to not go through it at all. The fact that emerging adulthood is not universal is one of the strongest arguments against Arnett’s claim that it is a new developmental stage. If emerging adulthood is so important, why is it even possible to skip it? 

The Network on Transitions to Adulthood has been issuing reports about young people since it was formed in 1999 and often ends up recommending more support for 20-somethings. But more of what, exactly? There aren’t institutions set up to serve people in this specific age range; social services from a developmental perspective tend to disappear after adolescence. But it’s possible to envision some that might address the restlessness and mobility that Arnett says are typical at this stage and that might make the experimentation of “emerging adulthood” available to more young people. 

How about expanding programs like City Year, in which 17- to 24-year-olds from diverse backgrounds spend a year mentoring inner-city children in exchange for a stipend, health insurance, child care, cellphone service and a $5,350 education award? Or a federal program in which a government-sponsored savings account is created for every newborn, to be cashed in at age 21 to support a year’s worth of travel, education or volunteer work — a version of the “baby bonds” program that Hillary Clinton mentioned during her 2008 primary campaign? Maybe we can encourage a kind of socially sanctioned “­rumspringa,” the temporary moratorium from social responsibilities some Amish offer their young people to allow them to experiment before settling down. It requires only a bit of ingenuity — as well as some societal forbearance and financial commitment — to think of ways to expand some of the programs that now work so well for the elite, like the Fulbright fellowship or the Peace Corps, to make the chance for temporary service and self-examination available to a wider range of young people.   Public service work for organizations like AmeriCorps, Teach for America or the Peace Corps can be a gateway to a variety of careers, including those outside public service.

THE KIND OF SERVICES that might be created if emerging adulthood is accepted as a life stage can be seen with a visit to Yellowbrick, a residential program in Evanston, Ill., that calls itself the only psychiatric treatment facility for emerging adults. 

When parents are paying the full cost of Yellowbrick’s comprehensive residential program, which comes to $21,000 a month and is not always covered by insurance.  They address it with a concept they call connected autonomy, which they define as knowing when to stand alone and when to accept help.

Patients turn to Yellowbrick with a variety of problems: substance abuse, eating disorders, depression, anxiety or one of the more severe mental illnesses, like schizophrenia or bipolar disorder, that tend to appear in the late teens or early 20s. The demands of imminent independence can worsen mental-health problems or can create new ones for people who have managed up to that point to perform all the expected roles — son or daughter, boyfriend or girlfriend, student, teammate, friend — but get lost when schooling ends and expected roles disappear. That’s what happened to one patient who had done well at a top Ivy League college until the last class of the last semester of his last year, when he finished his final paper and could not bring himself to turn it in.

The Yellowbrick philosophy is that young people must meet these challenges without coddling or rescue. Up to 16 patients at a time are housed in the Yellowbrick residence, a four-story apartment building. They live in the apartments — which are large, sunny and lavishly furnished — in groups of three or four, with staff members always on hand to teach the basics of shopping, cooking, cleaning, scheduling, making commitments and showing up.

For most parents the idea of $21,000 per month is not remotely in the ball park as far as affordability.  Many are already trying to create the development on their own through a more creative combination of monetary support for living, etc.  For the smarter parents, the idea of a consultant makes a great deal of sense and reduces costs over time.  Call us today to see how we can help you get your emerging adult on the road to independence.

Sunday, September 23, 2012

The Reality of Parents Today; Difficulty in Treating Neuro-developmental Disorders.

Writing about the tragedy in Highland Park where a car driven by Carly Rousso hit and killed Jaclyn Santos-Sacramento led me to writing this.  For the past ten years or so I've noticed a detectable increase in the number of cases that have come my way where children, adolescents and young adults have had a history of hard to diagnose or categorize disorders that seemingly have some sort of neuro-developmental origin.  Their histories are full of attempts to treat them for ADHD, Bi-polar Disorders, Anxiety Disorders or other Pervasive Developmental Disorders Not Otherwise Specified.  Some are adopted children whose parental history is either unknown or known and full of drug use stories but many are biological children where no apparent drug use history by either the mother or father is evident.

What I do know is that they show up at my office still looking for an answer.  Their treatment histories are full of information on a variety of medications that have been tried with little to no success.  Common meds include stimulants (Adderall), tranquilizers (Benzodiazepines), various anti-psychotics and anti-epileptics.  Most have developed a history psychoactive substance use and abuse.  Many seem to be hypersensitive to SSRI's and report significant and negative effects when they've been tried.  Some report that small amounts of cocaine seem to make them feel human for once and most call Starbucks or Caribou Coffee their home away from home.

In a nutshell they appear to show a good deal of sensitivity to any substance that alters the biochemistry or neurochemistry of their neurotransmitters and neurotransmission.  All report that their natural physical state is one of discomfort and agitation and all report that various substances whether prescribed or used illicitly remove the discomfort in the exact same way that aspirin removes the pain of a headache.  Unfortunately it is this type of reinforcement paradigm that forms the basis for much of the substance dependence we see today.

For the parents of these kids, even in the best of cases, it's a wild and highly stressful ride.  Just about any impulsive behavior is possible and often becomes a reality.  Even with constant mental health care, nightmare outcomes are possible.  From a treatment point of view there is not much in the way of Evidence Based Treatments. 

Time will tell if growing out of it is a common outcome but until then the parents of these kids live a nightmare and the kids themselves continue to search for a chemical answer that does not contain a downside as far as personal alienation, arrest, dependence and abuse or other negative result.

Friday, September 21, 2012

Carly Rousso Case Not So Clear Cut; Neurotoxins And Huffing

Undisputed facts in this case are that 5-year-old Jaclyn Santos-Sacramento was killed when a vehicle drove onto a sidewalk as she was walking with her mother and two brothers on Central Avenue in Highland Park on Labor Day afternoon. 

The car that hit and caused Jaclyn Santos-Sacramento's death was driven by 18-year old Carly Rousso of Highland Park. 
Rousso has subsequently been charged with one count of reckless homicide and four counts of aggravated driving under the influence of an intoxicating compound.  Basically it's been suggested by law enforcement experts that Rousso was huffing (inhaling a psychoactive substance) while driving and therefore is guilty of reckless homicide.

This case once again highlights for the average person the knowledge that huffing is one of many avenues people use to get high or achieve an altered state of consciousness.  This type of substance use has multiple toxic effects on the body and normally only finds an audience among the most intense and high rate drug abusers.  There are detectable neuropsychological outcomes of this pattern of drug abuse that mimic very closely the outcomes of anyone going under their kitchen sink at home and ingesting the chemicals  found there in an attempt to get high.   Difficulty with attention span and concentration as well as general cognitive decline are among the irreversible outcomes evident with consistent use.  Over time brain atrophy develops in the frontal cortex and these persons are indistinguishable from life long stimulant addicts.  As far as I'm concerned they might as well be just become meth or heroin addicts; the course of their life is on that trajectory and certain death is only 12 months or less away.

But what I really want to talk about is how huffing is gaining a whole new audience among users one would never expect.   I learned about this from firsthand experience when I was called by our Deputy Chief on my way home early one evening and informed one of my ex-clients (52 years old) was just found dead at home in the bathtub with multiple cans of keyboard cleaner on the tub ledge.  The person in question had finally joined AA on a serious level and had been making a meeting a day for the previous 6 months.  What I came to ultimately find was that it was becoming common for AA members of all ages to be huffing but staying clean from alcohol and other more easily detectable substances.  It was suggested by a few friends with 20 plus years of sobriety that the keyboard cleaner was a cheap, non detectable high through drug screens that allowed members to maintain honesty about non alcohol use but still get wasted.

Since that time I've taken to scanning car interiors and desktops for dust off cans; kind of my own system of counting possibilities.  When you've been in the addiction field for 30 years you get somewhat jaded regarding the consistency of substance use.  You see that the more things seem to change, the more they stay the same.  In junior high I remember a few kids used baggies to inhale oven cleaner.  In my first few years of practice I was driving down Willow Rd in Northbrook watching an old acquaintance huffing nitrous oxide while driving his chemical canister truck to hospitals and dentists offices where he refilled their tanks.  Keyboard cleaner abuse doesn't surprise me while people are operating vehicles.  What did surprise me was AA groups know of this current use and how likely it is that some members learn about it at meetings and succumb to it as a way to get high that they think is undetectable and safe.  Wrong again!


It always bothered me about the time of day and location of this tragedy.  Mid afternoon on Central Ave in Highland Park is not a likely location for someone getting high.  Then it occurred to me after writing the above post that The Day By Day Club (an Alano Club) is at 784 Central St Highland Park.  A quick glance at google maps shows the tragedy happened just across and up the street from where Carly would have exited the day by day parking lot. They have 12 step recovery meetings all through the day and at night.  In fact this was the meeting location for my deceased ex-client mentioned above.

It isn't to far of a guess that Carly was using her parents car to attend a meeting which, on Labor Day (holiday meeting schedule).  Getting high before or after a meeting using whats believed to be a non-detectable substance does fit a pattern of use I'm familiar with.  "Yes Mom, I'm just using the car to go to a meeting.  I'll be back right afterwards."

Mr. LaRue, I'd alter that story of yours to include a young girl exiting an AA meeting, inhaling the dust off by mouth in the parking lot at Day by Day, turning on to Central, and upon acceleration, losing control of the car as she headed home just a short drive away.

Carly I'd really think about pleading guilty and paying the debt owed as a result of killing 5 year old Jaclyn Santos-Sacramento who was likely just contemplating a return to or the start of kindergarten the next day.  The likely outcome of getting off on a technicality is a lifetime of repeated living out of an Edgar Allan Poe story.  Take the hit, make amends and move on.   You know that compulsion to use has made your life unmanageable.

And in general this story now makes sense to least as much sense as any drug use story I know of.    

Wednesday, September 19, 2012

Carly Rousso Case Not So Clear Cut; Reasonable Doubt.

Undisputed facts in this case are that 5-year-old Jaclyn Santos-Sacramento was killed when a vehicle drove onto a sidewalk as she was walking with her mother and two brothers on Central Avenue in Highland Park on Labor Day afternoon.  The car that hit and caused Jaclyn Santos-Sacramento's death was driven by 18-year old Carly Rousso of Highland Park.   

There is no denying that this situation is a tragedy for all concerned and that the lives of all involved have been altered.  In the wake of this tragedy emotions have run extremely high as to how it was handled and how blame and responsibility should be determined and what punishments meted out.   

Ken LaRue, the Lake County State's Attorney's Traffic Division chief believes huffing was involved and that "Eighteen-year-old Carly Rousso was driving a Lexus coupe eastbound in Highland Park. Either before she started driving or once she was underway, she grabbed the canister of dusting spray she'd brought along, put it to her nose, pushed down the nozzle and inhaled.  She was instantly filled with a euphoric sensation brought on by a chemical compound in the spray called difluoroethane. Commonly referred to as "huffing," inhaling this compound and others like it causes asphyxiation that users get high from.  "At some point," LaRue said, "she passed out."  She didn't stop the car as it drifted, first across the lanes going in the opposite the direction."

As a Clinician with extensive expertise in alcohol and drug issues as well as a published researcher on the topic I possess an attitude and knowledge which leans heavily toward use of psychoactive substances as a problem.  That being said I believe the tragic incident involving Carly Rousso and the death of Jaclyn Santos-Sacramento is far from clear cut and actually highlights an ongoing problem in law enforcement involving automobile drivers who are under the influence of mood altering substances (psychoactives or psychotropics).  More specifically at what point does having a mood altering substance in your blood stream become a criminal event related to vehicle operation?

Many might mistakenly believe that any substance prescribed by a physician that is found in your blood after a traffic incident acts like a "get out of jail free card."  You were taking it for medical reasons therefore you hold no fault.  Similar to the much joked about "Twinkie Defense", the substance did it, not the person. 

Likewise many believe if a psychoactive substance is found in the blood that a person must of ingested it for reasons of getting high; not true.  Anyone who has ever worked in the printing industry knows there are all sorts of airborne neurotoxins that enter your bloodstream as a normal by product of hard work without proper equipment.  The same can be said for elementary school teachers doing a classroom project with certain magic markers and a large amount of poster board.

Add to this the idea that psychotropics can have unanticipated adverse side effects in minority individuals (ask any African American who has been prescribed anti-psychotics or the older tricyclic antidepressants).  I believe I read where Carly has a Latino background?  And that these adverse reactions can occur at anytime.

Now consider that very little is actually known about the interactions of certain psychotropics and psychoactives.  For instance taking a anti-psychotic with an older antidepressant actually enhances the effect of the tricyclic.  Even St. John's Wort (for depression) can have major unintended side effects with other prescribed psychotropics.  And I haven't even said anything yet about what can happen in a case where there is a documented history (Carly's previous lawsuit) of PTSD erupting in cognitive dysfunction or at least impairment.

For all the above reasons I believe you begin to see the possibility of "Reasonable Doubt."   

So once again I say, there is no denying that this situation is a tragedy for all concerned and that the lives of all involved have been altered and an innocent young girls life has been taken.  In the wake of this tragedy emotions have run extremely high as to how it was handled and how blame and responsibility should be determined and what punishments meted out.  There is however, reasonable doubt and I would not be surprised to see a plea deal that involved no jail time.  The Lake County States Attorney has a very large obstacle to over-come if they are to win a conviction in court.  All Carly Rousso's defense team has to do is to introduce a reasonable doubt. 


Tuesday, September 18, 2012

Carly Rousso Case Not So Clear Cut; Known Evidence Full of Obstacles.

Undisputed facts in this case are that 5-year-old Jaclyn Santos-Sacramento was killed when a vehicle drove onto a sidewalk as she was walking with her mother and two brothers on Central Avenue in Highland Park on Labor Day afternoon.  The car that hit and caused Jaclyn Santos-Sacramento's death was driven by 18-year old Carly Rousso of Highland Park.   

There is no denying that this situation is a tragedy for all concerned and that the lives of all involved have been altered.  In the wake of this tragedy emotions have run extremely high as to how it was handled and how blame and responsibility should be determined and what punishments meted out.   

Ken LaRue, the Lake County State's Attorney's Traffic Division chief believes huffing was involved and that "Eighteen-year-old Carly Rousso was driving a Lexus coupe eastbound in Highland Park. Either before she started driving or once she was underway, she grabbed the canister of dusting spray she'd brought along, put it to her nose, pushed down the nozzle and inhaled.  She was instantly filled with a euphoric sensation brought on by a chemical compound in the spray called difluoroethane. Commonly referred to as "huffing," inhaling this compound and others like it causes asphyxiation that users get high from.  "At some point," LaRue said, "she passed out."  She didn't stop the car as it drifted, first across the lanes going in the opposite the direction."

In a previous post I pointed out that absent any eyewitness accounts or admissions of guilt by Rousso herself, there are at least two problems with determining guilt and handing out punishment in this case.  The first is that unless there is an unimpeachable eye witness or other evidence as to how the difluoroethane entered Rousso's blood, the act of huffing on her part while driving is only speculation.  The second problem is Carly Rousso has a significant history of mental health troubles and diagnosis dating back years.  In fact she was under the treatment of mental health professionals at the time of Jaclyn's tragic death.

To understand how difficult DUI cases can be when substances other than alcohol are present, some pharmacology terms and their definitions have to be introduced.  First lets examine psychotropics versus psychoactives.  Psychotropics are substances (usually in medication form) that are prescribed to treat medical conditions which also produce changes in emotions, cognition's, and/or behavior (mood altering substances).  Psychoactives are also mood altering substances (emotions, cognition's or behavior) but they are not taken upon advice of a physician; they are normally voluntarily introduced into one's bloodstream most often (but not always) in an attempt to "get high."

Whether psychotropic or psychoactive, once introduced into the body these substances are then subject to pharmacokinetics (the bodys effect on the substance).  Pharmacokinetics are concerned with exactly how the body absorbs, distributes, metabolizes and excretes the mood altering substance.  We know a great deal about the pharmacokinetics of alcohol (a psychoactive substance), all medications (psychotropics), some about pot (psychoactive but in some cases psychotropic due to legal changes in some States) and almost nothing about the majority of the hundreds of other psychoactives currently in use illegally or in fashion other than intended.  In a courtroom much can be testified too regarding medications and alcohol; much less can be entered as evidence regarding psychoactives where very little is known about dosages, half life or actual nature of impairment in physical functioning.

Genetics also plays a significant role on Pharmacokinetics.  People of white European backgrounds metabolize psychotropics and psychoactives much differently than do African Americans, Asians or Latino's for example.  Because of this the side effects of psychotropics or psychoactives can be especially hard on minority cultures and normally exceed those side effects for whites of European ancestry.  For those who want to know more about the metabolic issues in minority groups search the P450 Enzyme

What all this sets the stage for is a informed discussion on the nature of the relationship between the difluoroethane that was reportedly found in Carly Rousso's blood after the tragedy, how it may have gotten there and what, if anything, is known about the amount found in her bloodstream and it's effect on behavior.

Sunday, September 16, 2012

Carly Rousso Case Not So Clear Cut; Expect No Jail Time.

Undisputed facts in this case are that 5-year-old Jaclyn Santos-Sacramento was killed when a vehicle drove onto a sidewalk as she was walking with her mother and two brothers on Central Avenue in Highland Park on Labor Day afternoon.

Jaclyn was with her 25-year-old mother and her 4-year-old and 2-year-old brothers, all of whom were also injured when a car jumped the curb on the north side of the 700 block of Central Avenue and plowed into them, according to a news release issued by the Highland Park Police Department.

Five-year-old Jaclyn Santos-Sacramento was taken to Evanston Hospital, where she was pronounced dead at 5 p.m.

The car that hit and caused Jaclyn Santos-Sacramento's death was driven by 18-year old Carly Rousso of Highland Park.

There is no denying that this situation is a tragedy for all concerned and that the lives of all involved have been altered.  In the wake of this tragedy emotions have run extremely high as to how it was handled and how blame and responsibility should be determined and what punishments meted out.

Here's how Ken LaRue, the Lake County State's Attorney's Traffic Division chief, envisions what happened on Central Avenue on Labor Day:

Eighteen-year-old Carly Rousso was driving a Lexus coupe eastbound in Highland Park. Either before she started driving or once she was underway, she grabbed the canister of dusting spray she'd brought along, put it to her nose, pushed down the nozzle and inhaled.  She was instantly filled with a euphoric sensation brought on by a chemical compound in the spray called difluoroethane. Commonly referred to as "huffing," inhaling this compound and others like it causes asphyxiation that users get high from.  "At some point," LaRue said, "she passed out."  She didn't stop the car as it drifted, first across the lanes going in the opposite the direction. Then, towards the sidewalk by Sunset Foods, where Jaclyn Santos-Sacramento was walking with her mother and siblings.

Rousso has subsequently been charged with one count of reckless homicide and four counts of aggravated driving under the influence of an intoxicating compound. 

From the standpoint of legal action there are at least two problems with determining guilt and handing out punishment in this case.  The first is that unless there is an unimpeachable eye witness or other evidence as to how the difluoroethane entered Rousso's blood, the act of huffing on her part while driving is only speculation.  The second problem is Carly Rousso has a significant history of mental health troubles and diagnosis dating back years.  In fact she was under the treatment of mental health professionals at the time of Jaclyn's tragic death.

Carly Rousso's lawyers are free to argue that Carly was using the the canister of dusting spray for it's intended purposes and simply inhaled the substance within that use.  Furthermore they can argue that the PTSD Carly suffered from (or medications used to treat it or the dusting compound itself or even the interaction of the two) caused her to lapse into an altered state of consciousness during which she was unable to control the vehicle.

According to (720 ILCS 5/6-3) (from Ch. 38, par. 6-3)Sec. 6-3. Intoxicated or drugged condition. A person who is in an intoxicated or drugged condition is criminally responsible for conduct unless such condition is involuntarily produced and deprives him of substantial capacity either to appreciate the criminality of his conduct or to conform his conduct to the requirements of law.(Source: P.A. 92-466, eff. 1-1-02.)

While many will no doubt not want to hear about such issues, the fact remains that the case is far from clear cut and there are several mental health issues (involving substance abuse or dependence and PTSD) that will affect the ultimate criminal outcome here. 

Friday, August 17, 2012

Appearance Versus Substance; Hide It Or Light It Up.

There are often great discussions in life that only when we look back do we see how much they mattered.  I had such a discussion with Jean McGrew when he ran district #225 and I was on the board.  The basic issue was whether appearance or substance is the more important element in all things north shore.  While that may seem like an odd sentence, those that live here will either immediately understand or no amount of explanation will help.

Jean's position was firmly that appearance ruled the day and I, of course was a substance fan.  We agreed that having both was preferable but if only one could be had, then we deviated.

I've often seen that same discussion played out in all sorts of area's in life.  A slight derivation on the topic is the phrase "lace curtains" as in all appears tranquil and in it's place from the outside but inside can be quite different.  As you can imagine I see that most days in my work.  Often it takes the form of expensive cars, big home and living paycheck to paycheck.  It can also play out in social position and perceived power.  The made for TV show "Boss" is but one example of this.  All the power in the World, family in ruins.

It's also of interest that when the two worlds of appearance and substance begin to collide how aggressive and controlling behavior can become in trying to right the ship back to appearance and away from substance.  I've said previously the movie "Ordinary People" sheds an extraordinary and insightful light on this topic.  In writing this Blog I've run into it on a few occasions and I expect even more of it, if I do it correctly.  Besides, I have standing in that I grew up here and still work here. 

For example, lets say you've got a person who shows obvious signs of odd behavior, extreme emotion out of context and thinking that appears to have little to do with reality (those who've read previous posts know this as mental illness).  Lets say this person disrupts those around him or her to the point that authorities are asked to manage the situation and do a piss poor job of it.  Apparently what I'm supposed to do is turn a blind eye to the situation and ignore it.  Heaven forbid it's openly discussed or pointed out.  For God's sake don't place a light on it; it doesn't appear as it should.

Today I was on the receiving end of some of that controlling behavior.  My response is the animals have already left the barn so rushing to close the doors is of little help.  I realize those closest to the situation want the nightmare to end but hushing me up won't do that.  History is already written and published in the local papers and the tribune as well.  The best possible end to this story is a change in direction and the mental health system actually working; working on the substance and altering it rather than changing the appearance.

You really have to ask yourself at some point (if you're a substance person) how it comes to be that a governmental body with an approximate budget of $73 Million results to banning people from Village Hall and charging them with misdemeanor telephone harassment instead of getting a good, solid, and contributing family in the community the help they need to deal with an apparent mental health issue.

The next installment of my Blog will spell out, according to known law, how to get the help that's needed.


In honor of an old friend who will be missed I think this passes the test.

Is it the truth?  Yes

Is it fair to all concerned?  I think so if "all" really does mean everyone.

Will it build good will and better friendship?  Not in the beginning but in the long run.

Wednesday, August 15, 2012

Making The Ilinois Mental Health System Work For You

In my previous post I talked about the definition of a mental illness and the fact that thousands in every community are being successfully treated.  The question becomes more difficult when and individual is either unwilling or incapable of accepting the need for treatment.  What can be done then?  And who can do whatever it is that can be done?

Here's the answer. 

(405 ILCS 5/3-701) (from Ch. 91 1/2, par. 3-701)
      Sec. 3-701. (a) Any person 18 years of age or older may execute a petition asserting that another person is subject to involuntary admission on an inpatient basis. The petition shall be prepared pursuant to paragraph (b) of Section 3-601 and shall be filed with the court in the county where the respondent resides or is present.     (b) The court may inquire of the petitioner whether there are reasonable grounds to believe that the facts stated in the petition are true and whether the respondent is subject to involuntary admission. The inquiry may proceed without notice to the respondent only if the petitioner alleges facts showing that an emergency exists such that immediate hospitalization is necessary and the petitioner testifies before the court as to the factual basis for the allegations.     (c) A petition for involuntary admission on an inpatient basis may be combined with or accompanied by a petition for involuntary admission on an outpatient basis under Article VII-A.
(Source: P.A. 96-1399, eff. 7-29-10; 96-1453, eff. 8-20-10.)

So anyone 18 years of age or older can attempt to get someone the mental health help they need.  The petition is normally presented at the emergency room of a hospital where the subject has been taken for help.  Family members can usually get their local ambulance to transport the subject if they know its for a mental health reason and that a petition will accompany the subject to the hospital.

There are however three possible reasons for hospitalization, one or more of which need to be met before hospitalization will occur.  The first two are; 

(1)   A person with mental illness who because of his or her illness is reasonably expected, unless treated on an inpatient basis, to engage in conduct placing such person or another in physical harm or in reasonable expectation of being physically harmed;

(2)   A person with mental illness who because of his or her illness is unable to provide for his or her basic physical needs so as to guard himself or herself from serious harm without the assistance of family or others, unless treated on an inpatient basis; or

These first two reasons had been the law of the land for maybe 25 plus years until a significant change around 2008.  In fact they were in place for so long that many of today's practitioners may not know or understand that a third reason now exists.  The third reason is; 

(3)   A person with mental illness who:
            (i) refuses treatment or is not adhering adequately to prescribed treatment;
            (ii) because of the nature of his or her illness, is unable to understand his or her need for treatment; and
            (iii) if not treated on an inpatient basis, is reasonably expected, based on his or her behavioral history, to suffer mental or emotional deterioration and is reasonably expected, after such deterioration, to meet the criteria of either paragraph (1) or paragraph (2) of this Section.

In determining whether a person meets the criteria specified in paragraph (1), (2), or (3), the court may consider evidence of the person's repeated past pattern of specific behavior and actions related to the person's illness.

So, in essence the three reasons are (1) serious identifiable threat to harm self or others, (2) an inability to care for ones self without significant help and oversight of another to keep one safe or, (3) an identified and untreated mental illness that is expected to deteriorate to the point that either 1 or 2 above would become probable.  Plus, we can now introduce past known mental health issues that are thought to be related to the persons current condition.  No longer are we hand cuffed to the last 72 hour time frame to prove a problem exists.

Reason 3 is a significant change for the positive if people know about it and understand it.  Sadly many people (and professionals) are unaware and simply throw their hands up in the air when faced with a person suffering from a mental illness who does not want treatment of who is failing to comply.

Part 3 of this series will cover obtaining a court order for treatment and a court order for medication use.

Tuesday, August 14, 2012

Untreated Mental Illness; Making The System Work In Illinois

The local newspaper entry read....."___________ was arrested and charged with harassment by telephone after he allegedly called Village Hall and left several extended messages, according to police. Police had warned him in the past to have no further contact with Village Hall unless it was for legitimate purposes."

The above is a common occurrence when Villages have persons thought to suffer from mental health illness living untreated within their community.  I think starting with a definition of mental illness will aid in this discussion.

In Illinois a mental illness is defined as....

(405 ILCS 5/1-129)Sec. 1-129. Mental illness. "Mental illness" means a mental, or emotional disorder that substantially impairs a person's thought, perception of reality, emotional process, judgment, behavior, or ability to cope with the ordinary demands of life, but does not include a developmental disability, dementia or Alzheimer's disease absent psychosis, a substance abuse disorder, or an abnormality manifested only by repeated criminal or otherwise antisocial conduct.

(Source: P.A. 93-573, eff. 8-21-03.)(405 ILCS 5/3-601) (from Ch. 91 1/2, par. 3-601)

So the idea of people with mental illness living within a community shouldn't be news to anyone.  In fact, based on the above definition, there are likely thousands of community members who fall under that definition but who are receiving appropriate treatment and are fully and positively engaged in the process; they are for all practical purposes said to be in remission.

What happens however when an individual meets the above standard but is not fully engaged in treatment or feels they are not in need of treatment?  Practically speaking, as long as they aren't affecting others, they tend to pretty much stay to themselves and suffer more or less in silence.  However, in the example from the newspaper above, sometimes these folks do affect others and in very potentially damaging ways.  What happens then?  And who decides the person needs mental health treatment of some kind?  That'll be the subject of section two of this post later this week.

Monday, August 13, 2012

The Illinois Mental Health System is Broken

"A 77-year-old man is dead and his son is being held at Cook County Jail following a fight the son had with a neighbor at their Northbrook home on Thursday.

Ronald Christensen, 77, of the 1900 block of Thornwood Lane in north suburban Northbrook, was pronounced dead at 8:30 p.m. Saturday at Glenbrook Hospital, according to the Cook County medical examiner’s office.

An autopsy Sunday ruled Christensen died of heart disease and his death was ruled natural, according to the medical examiner’s office.

On Thursday Christensen and his 48-year-old son Ronald M. Christensen, Jr. fell at the home on Thornwood while the elder man was trying to pull his son away from a neighbor who the son had struck in the face, according to police and the medical examiner's office.

Police responded and arrested Ronald Christensen, who was charged with felony aggravated battery." Chicago Tribune

This is a tragedy that could have and should have been avoided.

Getting Help For Mental Illness, Part 1.

Getting Help For Mental Illness, Part 2.

Appearance Versus Substance; Hide It Or Light It Up?

Sunday, August 12, 2012

Police and Firefighter Suicides; Getting Help For First Responders.

Police, Firefighters and Dispatchers can get quality psychological help in the Chicago and suburban Chicago area.  Psychological help for Chicago area Police, Firefighters and Dispatchers is almost always covered by major insurance carriers with very little "out of pocket" expense.

I work as both a police psychologist and as a psychologist to Police Officers, Firefighters and dispatchers.  Sometimes I'm a first responder and sometimes I ride a desk back in the station; it depends on the type of call and if I'm in the station or on the road in a squad when it comes in.  I work inside the system but I am not the system; I am independent from the system.

It is estimated that 12 out of every 100,000 people kill themselves in the USA each year.  Breaking down the statistics further reveals that approximately 18 out of every 100,000 police or firefighters take their life each year.  By way of comparison it estimated that 33 out of every 100,000 military members take their lives and that 36 out of every 100,000 prison and jail inmates takes their lives.

Here in the Chicago and the Northern Illinois suburbs it is hard to reach out to find quality psychological help for first responders.  Most departments have EAP's as a first response to emotional and behavioral issues but concerns remain involving confidentiality and quality.  EAP's work for the department and not the individual first responder and they are often minimally educated and entry level practitioners at best.  Once emotional or behavioral issues rise to the level of supervisory intervention (because help has not been found), the issue of fitness for duty arises and potentially a job is then on the line.

Family's and friends try to reach out and often there is some success.  Most of the police or firefighters in my practice are getting the help they need because of concerned friends or family that did reach out.  No formal interventions, just straight out communications about the concern and a business card of mine or my telephone number.

Roughly half of my first responder clients called me themselves and came by themselves to their first appointment.  The other half had spouses or other family members who wanted help on how to approach the one they cared about.  They sought me out because they knew I was inside the system and know the culture but that I am also outside the system in that I work for my clients and not their employer's.

The choice really is yours.  First Responder, spouse or friend?  Pick up the phone (my direct number is on my website) and call me.  Just what is it you are waiting for?  Things to get worse or the Hail Mary occurrence that makes it all better?  The latter would be great but the former is the norm.

Sunday, August 5, 2012

Police Once Again Put Down an Active Shooter; What We Do Know

"CNN) -- At least seven people, including a gunman shot by a police officer, have been killed in an attack on worshipers at a Sikh temple in the Milwaukee suburb of Oak Creek, Wisconsin, on Sunday, police said.

The wounded officer, a 20-year veteran, was in surgery Sunday afternoon after being shot multiple times, but was expected to survive, Wentlandt said. He was sent to the Sikh Temple of Wisconsin in Oak Creek, south of Milwaukee, after a 911 call about 10:25 a.m. (11:25 a.m. ET)."

What we do know is a 911 call at 1025 hours sent a 20 year veteran officer with tactical experience into harms way.  The officer was first on the scene and engaged the shooter in a gun battle which resulted in the officer being wounded and the shooter dead.  That officer had maybe 60 to 90 seconds between the call and the gun battle with an active shooter.  He risked his life in traffic to get there and then on scene to save the lives of others.

Police and Fire professionals are paid for what they might have to do.  Today Milwaukee residents got a bargain as once again a lone police officer faced off with certain death and stepped up to protect people not even known to him.

It's a tragedy for all concerned but once again a police officer goes down in the line of duty and it gets less coverage so far than any other aspect of the situation.

Friday, August 3, 2012

Group Therapy in The Northbrook, Glenview, Winnetka and Northfield Area

Dr. Conlin is now forming group therapy groups starting this fall in  the Northbrook, Glenview, Winnetka and Northfield area's of northern Illinois.  Participation is open to all and the only exclusionary criteria is current and severe mental illness that is not in remission.
Group therapy provides psychotherapy treatment in a format where there is typically one therapist and six to twelve participants with related problems. A psychologist may recommend group therapy over individual psychotherapy for a variety of reasons. It may be that the group format is better suited for the person or the concern they are dealing with, or that the specific type of treatment has a group therapy component (such as dialectical behavior therapy).

People in group therapy improve not only from the interventions of the therapist, but also from observing others in the group and receiving feedback from group members. The group format, while not providing the one-on-one attention of individual formats, has several advantages.

The advantages of group therapy include:
  • Increased feedback
    Group therapy can provide the patient with feedback from other people. Getting different perspectives is often helpful in promoting growth and change.
  • Modeling
    By seeing how others handle similar problems, the patient can rapidly add new coping methods to his or her behaviors. This is beneficial in that it can give the patient a variety of perspectives on what seem to work and when.
  • Less expensive
    By treating several patients simultaneously, the therapist can reduce the usual fee.
  • Improve social skills
    Since so much of our daily interaction is with other people, many people learn to improve their social skills in group therapy (even though such an issue may not be the focus of the group). The group leader, a therapist, often helps people to learn to communicate more clearly and effectively with one another in the group context. This is inevitably leads to people learning new social skills which they can generalize and use in all of their relationships with others.
Participants can try out new behaviors, role play, and engage with others in not only receiving valuable feedback and insight from other group members, but also in giving it. 

Contact Dr. Conlin today to learn more about our groups starting in September.  Costs are $25 per session and insurance often covers the fee.  Groups are forming for men, women, co-ed grief groups and co-ed adolescent groups.

Thursday, August 2, 2012

The Epic Failure of Colorado University's Behavioral Evaluation and Threat Assessment Team

James Holmes is in custody for allegedly killing 12 people and injuring 58 others when he opened fire in a packed midnight screening of the latest Batman movie, "The Dark Knight Rises" in Aurora Colorado.  Dressed in full riot gear, Holmes allegedly entered from an emergency exit in the front right corner of the theater before releasing something that witnesses identify as tear gas or a smoke bomb. From there, he allegedly sprayed the sold-out theater with a storm of bullets, injuring and killing both adults and children.  Holmes, sporting hair dyed red, reportedly told arresting officers he was "The Joker" in apparent reference to a well known villain in the Batman series.

In a previous post, Someone Knew, I pointed out that the shooter was likely known to be having mental health problems.  Apparently his school did know and and he was in fact the patient of Dr. Lynne Fenton, Head of the Campus Mental Health Service, a founding member and current adviser of the UC Campus Behavioral Evaluation and Threat Assessment team.

According to reports from the Denver post, Dr. Fenton gave the BETA team the name of James Holmes as early as the first week in June, a full month prior to the massacre.  It has been reported that the team took no action and failed to contact local police on the basis that James Homes was in the process of dropping out of school.  If all this turns out to be true, look for beneficial legal action, the result of which will make it more likely that future warnings will be more readily dealt with.

Currently the "Tarasoff Warning" dictates that only where a known target is identified, does a therapist have a duty to warn.  Because the University of Colorado had a mechanism in place to handle threats (their BETA Team) and failed to take any action to do so (rather than simply failing to stop Holmes through their action), they will be held responsible for the killings and Tarasoff will be enlarged.  In fact, I fully expect Holmes to initiate civil action on his own part over CU's failure to prevent the massacre.  He is very likely to prevail and the loss's that CU will ultimately become responsible for will be staggering.

It's one thing to fail to stop an action through error but, it's entirely another to simply fail to act when one has voluntarily taken on the responsibility to do so and has even marketed that ability on ones own website in an attempt to bolster their claims of campus safety.  This is bad for CU and they should be held accountable.  

The legal action will take years but the fall out should result in greater safety for all through an expansion of Tarasoff to include society as a whole to some degree.  

It will also force the mental health system to begin to trust law enforcement, something it should have been doing all along.  If you trust us when the shots start to fly by calling 911, it seems silly that you failed to do so, prior to that point, while James Holmes began collecting weapons and ammunition.  

CU is as guilty as Penn State.  They had a responsibility which they voluntarily chose to take on and instead, they chose to ignore it and pretend it wasn't their job.  Shame on them.  

Sunday, July 29, 2012

U.S. Media is Missing The Point; Our Mental Health System is Broken.

In the early morning hours of 7/20, a mentally ill young man enrolled at The University of Colorado kills 12 (now 13 with a miscarriage) and wounds 52 in an Aurora Colorado movie theater.  

On January 8th of 2011 a shooter killed six people, including Chief U.S. District Court Judge John Roll. The shooting also left 14 others injured, including U.S. Representative Gabrielle Gifford's. He has been indicted on 49 counts by federal grand juries in Arizona.  The mentally ill man charged in the Tucson shooting rampage isn't expected to go to trial in 2012 as he continues to be forcibly medicated to make him psychologically fit to stand trial.

On April 16, 2007, on the campus of Virginia Polytechnic Institute and State University in Blacksburg, Virginia a lone shooter shot and killed 32 people and wounded 17 others in two separate attacks, approximately two hours apart, before committing suicide. The massacre is the deadliest shooting incident by a single gunman in U.S. history.

All these shooters should have been stopped.  They were either current or recently enrolled students known to College officials as posing a danger to themselves or others.  The point here is that not only did someone know of these individuals and their illness's but that each College had threat assessment teams in place to evaluate students for just such actions.  The local Community College where the Arizona shooter previously attended school even went so far as to have the shooter barred from campus as a precaution.

These 3 epic failures of our mental health system in the past 5 years show us how bad things are.  Looking at the past 15 years, the United States has suffered 12 mass shootings that have claimed 262 people, including the Columbine tragedy.  262 innocent people targeted by mentally ill shooters means an average of 17 plus people are killed each year in the USA in mass shootings by known offenders with mental health issues.

Living just outside the boarders of Chicago, as I do, can make one apathetic to the numbers of shooting victims.  And 17 per year seems small by comparison but 17 per year is not small.  262 Victims of mass shootings is an outrage and something we could stop if the mental health system was functional.

In the three cases mentioned above, not only did mental health professionals know about these shooters before they claimed innocent lives but, school threat assessment teams knew as well and failed to stop them.  The U.S. press should be asking more about this issue.