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.

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!

POSTSCRIPT  

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 me.....at least as much sense as any drug use story I know of.    

 

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. 


 

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.

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.