A new app helps doctors know when a patient is “med seeking.” Image courtesy of Ambro at FreeDigitalPhotos.net
It’s still in its early phases of testing, but one Toronto Emergency Room has put ER doctors on the path to reducing prescriptions given to “med seeking” patients.
A fair number of patients who go to see a doctor fake pain or illness in order to obtain a prescription for certain drugs. These can often include opiates such as oxycontin, benzodiazepines such as Valium or Xanax, and other drugs. It can be extremely challenging for a doctor to know when someone is faking or telling the truth if there are no specific tests to help them make their determination.
My sister is a nurse on a hospital inpatient unit. She tells me some patients are constantly asking for medication for this or that. They are often asked to rate their pain on a scale of 1-5 and they claim to be a 5 so they can have stronger medicine. They sometimes become combative, rude and irate when they are told they need to wait longer. She says it can be a real challenge to know when a painkiller isn’t working because the patient already has an addiction to painkillers, and therefore has a tolerance to the drug, and when it isn’t working because the patient is truly in extreme pain.
One way that patients “med seek” in the ER is to fake alcohol withdrawals. According to http://www.ideastream.org/news/npr/344232232, Valium is often given for alcohol withdrawals. I worked on a detoxification unit at a hospital for a few years before going into private practice, and I remember this was often the case. Someone who has an addiction to benzodiazepines will often go to great lengths to use again. Occasionally these people go to the emergency room and fake a tremor in their hands. They claim to be sobering up from alcohol dependence.
Sobering up from alcohol dependence can be very dangerous depending on the level of use. If the use was consistent and high in volume, a person will experience uncomfortable withdrawal symptoms. Some of these are irritability, anxiety, nausea, headache, sweating, fast heart rate, confusion and tremors. In extreme cases a person can get delirium tremens (DTs), which can include hallucinations and seizures. Sometimes DTs cause death.
When a patient shows up in the emergency room claiming to suffer from alcohol withdrawals, the doctor has to determine whether these are real or fake. They then have to decide what to prescribe. It can be a very challenging decision.
It turns out though, that truly faking hand tremors is almost impossible if the doctor knows exactly what to look for. There is now an app being tested that helps doctors create a score. A high score means it’s most likely from alcohol. A low score means it’s most likely malingering (faking illness for some gain). Most malingerers faking alcohol withdrawal tremors are looking for a benzodiazepine.
Coming from someone who sits in therapy with people struggling with addiction on a regular basis, this app is a great thing! One of the best ways to get through an addiction is for access to the drug of choice to be restricted as much as possible. This is especially true during the early days of sobriety when the ability to resist temptation is still low. It is why those of us who work in this field always advise family members to stop giving any kind of money to someone with a drug problem; if you can’t pay for it, it’s harder to get it, which means it’s harder to use it.
Helping teens grow and families improve connection,
Marijuana is everywhere. If your teenager isn’t using it, they know at least five other adolescents who are. Teenagers have a very lackadaisical attitude towards the drug. They generally don’t think much about the physical health consequences of inhaling smoke/vape into the lungs, or the mental health consequences of using a drug that fosters dependence and indifference.
Here’s the thing with abusing weed. Teens can usually still function at a fairly decent level. If they were using heroin, methamphetamine, or cocaine, it is obvious that something is amiss. The effects with cannabis are more subtle. When a teenager is abusing marijuana, they seem off, but as a parent you might not be able to pinpoint why. There is a change in their motivation, but that could just be that they’re tired of school. It’s not so clear that you immediately think “drugs.”
With teenagers who regularly abuse marijuana, there are symptoms that really demonstrate why cannabis use can be a problem. Their grades drop. They lose interest in spending time with certain friends. They stop wanting to play sports. They lie to you more often. They seem uninterested in things that used to be exciting. They don’t react with anxiety to things that should make them anxious, such as you being mad at them. They suddenly become more concerned with money, and yet don’t seem to have much of it. They also might gain weight. Despite all this, the majority of teenagers who are consistently abusing marijuana don’t think there are any negative effects from the drug.
If you suspect your teenager is using, one of the best tools at your disposal is the over-the-counter drug panel. It is pretty easy to administer. Your teenager can fake it out with certain products they can purchase on the internet, at a smoke shop or get from their friends. However, if you surprise them with the test, it will most likely give you real results. Teens who are drug tested on a regular basis by their parents, at random, tend to quit using altogether. If they don’t quit, they often dramatically reduce their use. Once a few months go by, most of them tell me things like, “I feel the cobwebs clearing,” or “I think more quickly now,” or “I didn’t even realize how much it was affecting me.”
Help your teenager stay drug free. You’ll help them avoid depression, anxiety, bad friends, low motivation in school, and frustration in their relationship with you. If you yourself use marijuana from time to time, please understand that your teenager almost certainly knows it, and assumes that means you approve them using it too.
Helping teens grow and families improve connection,
Every week in my counseling office, I sit across the room from at least one Orange County teenager who is struggling with codependency. They do not usually realize this is their struggle. Their parents call me because their child is feeling a lot of anxiety, or has been having a hard time in their friendships. Sometimes the teen has been feeling depressed, or is acting out. Many, many times the call comes because parents are fed up with their child’s association with a certain group of kids, and this has caused some big arguments in the house.
This is a common enough problem that if you are my client and you are reading this, you might think I am telling your story. Well, in a sense I might be; this is true because codependency in teenagers is very common, and very challenging to work with.
First of all, what is codependency, and what does it mean when a teenager is codependent? Codependent behavior is when you cannot let go of someone who needs to make a change in their life. You feel valued by “helping” someone who actually does not want help. Let me explain this better with the most common scenario I see. I work with a lot of teenage girls who are dating a boy that uses/experiments with drugs. The girl hates this and tells her boyfriend to stop using. The boyfriend makes all kinds of promises, and the girl feels important. The girl believes the relationship is saving the boyfriend from spiraling downward into harder, more addictive drugs. She knows it is not good for her to date someone like this, but she feels value because she thinks he loves her enough to stop. She says things to me such as, “I can’t break-up with him because then he’d really fall apart.” (Just so we’re clear, I used the example of the girl being codependent, but boys are often codependent too.)
Friendships can have the same elements of codependency as dating relationships. A great number of teens I work with know they ought to make better friends. However, they often hold two beliefs preventing this. The first one is that the “better” people would not want to befriend them. The second (the codependent belief) is that their friends would do worse things if they were not around to keep them in check.
So, now that you know what codependency is, and what it can look like in teenagers, when is it time to end a relationship?
1. When your teen comes home upset on a regular basis. Adolescents are often moody, so I am referring to extra moody.
2. When you notice your teenager is clinging to a friend who only calls them back when nobody else is available.
3. If your teenager has been giving a lot of money to a friend.
4. If your teen is consistently asking you how to help a certain person, and you’re not sure it’s a good idea.
5. If your teen begins to lie in order to cover for a friend.
6. I’m sorry that I even have to write this one down, but it comes up more than you’d think. If your teenager starts asking you to lie to a friend’s parents to cover for that friend.
7. If you find out your teenager has been picking up their friend from unusual situations.
8. If your teen’s friends have spent the night and you didn’t even know they were coming over (This doesn’t mean your kid is codependent, it’s just a caution flag.)
9. If your teen is dating someone and all their friends stop coming around.
10. If you have a strong feeling of dislike for the person your teen is dating, and their friends agree with you.
Codependency in teenagers is common, but destructive. It raises levels of anxiety for your teen, and it can leave them feeling down. As a parent, this is very painful to watch. Codependency is difficult, but can be helped. Often this takes a parent being really firm, or it takes some good counseling.
Helping teens grow and families improve connection,
Why is it that most people who party as teens don’t end up with an alcohol abuse problem? How come an unlucky few end up as alcoholics? Researchers have been experimenting on rats and have found what they believe is a solid link to the human brain in this case.
Check out this quick article. I thought it was fascinating: https://www.medicalnewstoday.com/articles/322271.php
Helping teens grow and families improve connection,
Lauren Goodman, MS, MFT
Some people’s brains lead them to seek out alcohol once they’ve tried it. Credit: Wikimedia/free-images.com
Yes, your teenager knows someone hooked on vaping. Yes, your teenager has been offered a vape, probably multiple times. Yes, people are vaping at school. No, it’s not simply fruit flavored water vapor. Yes, they can easily access “pods” even though they are underage. Yes, it is highly addictive and is a exponentially growing problem.
Helping teens grow and families improve connection,
Codependence is emotionally, financially, physically and spiritually exhausting.
Codependence, also known as co-addiction, can wreck havoc on a person’s life. It is best explained through a hypothetical example:
Karen is a 30 year old woman who has struggled for years with addiction to crystal meth. She first tried it when she was 20. She began to use more and more frequently until she was crashing on “friends'” couches instead of having a home, lost her job, and sometimes went a few days without affording food. Throughout this period of time she stayed in contact with her mom.
Karen’s mom, Jane, was naturally worried sick about her daughter. Sometimes Karen would move back in with Jane. Jane always made Karen promise not to use anymore, but would never stick with her rules. She justified allowing Karen to use methamphetamine in the house because, ‘At least then I know where she is and I know she’s safe.’ She paid for seven rehabs for Karen. At some point Jane had to take a second mortgage on her home to try and pay for another rehab. Jane also would give Karen money when she saw that Karen was hungry. She paid for Karen’s cell phone bill, ‘so I don’t lose track of her.’ Essentially Jane’s addiction became trying to help Karen get healthy.
On the surface Jane sounds like a loving mom going to any length to help her daughter. Indeed Jane’s actions are motivated by a combination of love and fear. The problem though is that Jane is helping Karen continue to use drugs, and has completely destroyed her own financial future. Every time Jane gives Karen money, pays for her cell phone, or allows her to move home when she is not clean and sober, it frees up what little money Karen gets to buy more meth. Although Jane does not directly give Karen money to buy meth, she does indirectly. Also, Karen has not really shown any signs that she wants to get better. Despite this, Jane has spent hundreds of thousands of dollars to try and fix this. Jane has paid for rehabs (these are typically quite expensive), cell phone, money for food, etc. Jane now has an extra large mortgage, which will financially burden her into retirement.
Like many people who struggle with co-addiction, Jane’s entire identity is wrapped up in trying to convince her daughter to get better. Karen’s addiction did not have to ruin Jane’s life too. While Karen’s addiction would have always been a source of pain and deep disappointment for Jane, both she and Karen would have been better off if Jane held firm and healthy boundaries.
As a therapist who focuses on treatment of addiction in families, helping to disentangle the web of codependency is one of the main things I do. And, actually, when the codependent family member or friend changes their behavior to a healthier position, oftentimes the addict decides to get better. If the story of Karen and Jane feels a little too close to home, firstly, my heart hurts for you. Secondly, the stronger you get, the more you are helping the addict you love to recover.
Helping teens grow and families improve connection,
Hello, I’m Lauren! If you notice your teen struggling, you might be feeling helpless, hopeless, frustrated or concerned as a parent. Try to remember, there is hope. I want to help your adolescent feel better. My hope is for them to enjoy their life again. I want them to feel confident they can handle whatever situations arise.
