Ryther - Healthy Children, Stronger Families

DXM is a dangerous new drug that teenagers are abusing found in common household cold medicines. Below is an interview with Kelliegh Kinst BA, CDP, Assistant Program Supervisor at Ryther’s Inpatient Substance Abuse program for teen boys. Parents and school administrators may be surprised about what they learn.

Where does DXM come from and what does it do?

DXM (Dextaramorphine) is added into cold medicines for suppressing a cough. Coricidin, Robitussen DM and Mucinex are the cold medications that reportedly have the highest concentration of DXM. Teenagers use DXM by swallowing higher than recommended amounts. In the past decade it has increasingly been consumed by teenagers to produce a feeling of intoxication similar to alcohol and ecstasy (MDMA).  In very high doses DXM can produce hallucinations and dissociation similar to PCP or Ketamine, (Inaba and Cohen, 2007). The impact that DXM use has on a teenage life is profoundly negative. The temporary high may be desirable, but in the long run, their lives are suppressed from the quick pull of this readily available new drug.

Why do kids start to abuse DXM?

I recently interviewed a client named “Steve” at Ryther’s Inpatient Substance Abuse program about the dangers of DXM abuse. I was astounded by what I learned.

Apparently, the cold medications are being stolen by teens so much more often than bought that the manufacturers have decreased their distribution of the products. Steve said, “Because it’s so readily available, it’s really hard to quit. I get triggered to use whenever I go into a Walgreens or a Safeway because it’s right there, waiting for me to put it in my pocket.” As a result, Steve feels that DXM has the potential to “ruin lives almost as fast as heroine.”

The real danger is that though the drug is widely used, there is a stigma against it in teenage social circles. Teenagers do not share that they’re using DXM because it’s seen as pathetic by experienced drug users—Steve compared it to a thief “stealing scrap metal.” When they don’t admit it to their friends, they don’t learn how to use it “safely.” They’re experimenting alone with doses way beyond what they need to get high. Without asking questions on how to use the drug “safely,” overdoses are occurring at a rampant rate.

Steve reported having this experience the first time he tried it: “I found out I had taken 3 times the amount that I needed to get high. I only discovered this after the fact, in my outpatient treatment class from a kid who shared about his own DXM use.”

What are the signs that a teenager is abusing DXM?

From: Inaba and Cohen, 2007

- Nausea
- Vomiting
- Blurred vision
- Bloodshot eyes
- Fever
- Diarrhea
- Urinary retention
- Sweating
- Dilated pupils
- Shallow respiration

What can parents do?

If you suspect that your child is using DXM, getting them an Alcohol and Other Drug assessment will determine if they are and what type of treatment they may need. Talking to your kids about the dangers of alcohol and other drug use may produce eye rolls and “OMG” Facebook posts, but it will also show them that you are invested. Turning to alcohol and other drugs as a result of peer pressure often stems from teenagers feeling invalidated or insecure. With regular check-ins and sound parental guidance, your teenager will have the assurance that they are cared for and loved. Which in turn can decrease the likelihood of them feeling  the need to seek fulfillment from alcohol and other drugs.

Things to keep in mind:

- This drug can be found in anyone’s medicine cabinet and is often stolen instead of purchased. Therefore, a lack of financial difficulties does not rule out the possibility of your child using the drug.

- Kids most at risk are ones who are isolated or kids who are already experienced with drugs as they will turn to DXM if they do not have access to their D.O.C. or, “Drug of Choice.”

- Other street names for this drug are: “CCC,” “tussin,” “orange crush,” and “dex.” (Inaba and Cohen, 2007)

Inaba, Darryl and Cohen, William, (2007), Uppers Downers All Arounders, Physical and Mental Effects of Psychoactive Drugs, Sixth Edition, CNS Publications, Inc. Medford, Oregon

A skill you can teach your child today for better tomorrows

How can parents help a child learn to cope with big feelings or a frustrating situation? Well, it takes practice and a plan. And that’s what SODA is. The acronym stands for “Stop, Options, Decide, Act.” The basic steps you can teach your children are listed below. With practice, children can learn self-regulation and problem solving skills. In Ryther’s Sub-Acute Residential program in the cottages, we ask children ages 6-13 to use their SODA skills when they are making everyday choices or faced with a problem.

S.O.D.A. Skills:

1. 1. STOP when a problem is presented
2. 2. Think about their OPTIONS
3. 3. DECIDE on the better option
4. 4. ACT on that option

So what does SODA look like in action?

Tiffany and Zach both want to play together, but they want to play different games and can’t agree. At this point, we teach children to stop before things escalate into a larger problem. Take a step back. Maybe take some deep breaths. Become calm before acting or speaking.

Next, we suggest that they think about their options to solve the problem. We might prompt by saying, “You can compromise and play two games or not play with each other at all.”

Once Tiffany and Zach decide on the option that’s best for them, they then act on that option. You as a parent can commend this behavior.

How do you get the kids to buy in to the program?

We combine the SODA program with an incentive reward program. It’s fairly simple and can be used at home. Each time children demonstrate SODA skills, they get a sticker to place on their chart. When they fill up the chart, they show that they are beginning to master the skills, and staff can reward them with a small toy from the “prize box.” For some kids Pokémon cards are a real motivator and, for others, a half hour later bedtime works.

Start Slow…

When kids first start using SODA, it’s best to guide them through each step. Help them discover options and present only two at a time. Too many options may cause confusion and provoke other issues. The more that children use SODA skills, the more options they’ll discover on their own and the more instinctive and routine using these skills will become. (It could be helpful for adults too!) You’ll have helped them learn a valuable skill.

Contributed by Kristine Joy Culala, BSW, Sub-Acute Care Counselor

An interview with Colin Powers, Supervisor of Cottage A in Ryther’s Sub-Acute Inpatient program, on Gotcha! moments: spontaneous messages of positive reinforcement.

At Ryther, why is it so important to catch kids doing something right?

Our kids have had multiple failed placements and multiple moves. More often than not, they assume that the moves were their fault, the abuse was their fault, and they start to internalize that they’re “bad” kids. It’s important to change this mindset and start teaching them that they are not to blame for everything, and that they do in fact have reasons to feel successful.

How do Gotcha! moments work in the cottage?

The best Gotcha! moments come unexpectedly when a staff tells a child, “I think you had a great day. You should be proud of yourself.” An immediate reward might be given to them, or a message of affirmation might be left on their door overnight so it’s the first thing they see when they wake up. Sometimes it’s just a note that says, “We’re really glad we’re getting to know you.”

What tips do you have for parents who want to try this type of positive reinforcement at home with their own kids?

Spontaneity is the key. It’s easy to catch your child doing something wrong. But if you think about it, it’s just as easy to catch them doing something right. Recognize them, praise them, and tell them what it is specifically that they did that was commendable.

How do tweens or teens respond to this?

It can work with this age group too. Sometimes, a special privilege might be the best reward when they get caught doing something right. It could be getting to stay up later, receiving one-on-one time or a special treat. It is also effective for them when they receive detailed feedback from parents, which serves to help them identify their own strengths. “Thanks for reading to your little brother. You know, we have a lot of little kid books, maybe we should go get you some young adult books this weekend.”

Thoughts involved in “wrong thinking” are called “thinking errors.” We all make “thinking errors” every now and then (justifying, blaming, lying and excuse making) so that we don’t have to feel too bad when we make a mistake that causes some degree of harm. Ryther takes careful steps to recognize them in our children and teenagers to decrease the chances of hurting others and empower them to take responsibility for their actions.

Of the many types of thinking errors, one comes to mind on President’s Day: lying. Remember the story of George Washington and the cherry tree? Young George received a hatchet and went hacking about in the family garden, ultimately chopping the bark of a cherry tree enough so that it died. When his father discovered that the cherry tree had been chopped, he became enraged and directly questioned his son. George considered potential responses for several moments and said, “I cannot tell a lie, father, you know I cannot tell a lie! I did cut it with my little hatchet.”The anger drained from his father’s face and he said, “My son, that you should not be afraid to tell the truth is more to me than a thousand trees!”

What a gift George’s father gave to him when he showed that he valued the truth more than he valued a prized possession? How did he muster the emotional strength to do that?

Why do Children & Teenagers Lie?

Whether you’re working with kids or raising kids, you must consider the problem of lying within the context that a child has learned to lie. Some kids lie because it’s a natural part of being young (forging a doctor’s note to skip high school classes). Others lie because they have learned that their parents, teachers, and other adults are uncomfortable with the truth (consider teens who are afraid to tell their parents they’re gay for fear of not being accepted). Some kids lie to protect themselves and others, maybe fearful of further abuse, of feeling shame or embarrassment, or of the consequences from an angry parent.

At Ryther, we teach children that lying about wrong behavior is worse than the behavior itself. We do this by maintaining a calm, neutral stance in response to disclosures and discoveries. We hold groups in which kids learn about how different “thinking errors” such as lying apply to different situations and engage them in role playing to identify where a person is using errors to justify their behaviors. Individually, our staff are trained to recognize and point out “thinking errors” when kids use them, then prompt them to describe their thought process and put into words the thoughts and feelings they had when they made a mistake.

Tools for Parents

Of all the thinking errors, lying is the most difficult to verify. Kids can lie by telling partial truths, by denying or giving false information and by faking agreement with something. As adults, we might suspect a lie is being told but not have the evidence that this is so. In this case, it is most helpful to state your suspicions and the evidence that backs them up. Don’t ask questions like, “Did you take the money out of my wallet?” This opens up the opportunity for more lies. Rather, state, “Some money is missing from my wallet, and I saw you near my purse this morning. I am wondering if you know where my money went.” It’s important not to be accusatory, as this breeds resistance and conflict. Remain calm and don’t get angry. Focus on your own feelings and how the act you think your child has committed has affected something important. Offer the opportunity for your child to talk to you about the problem later, and if you say you won’t be mad when the truth is told, follow through with that promise. However, don’t avoid giving a consequence for wrong behavior. If you know for sure that a lie has been told, give your child the opportunity to tell the truth within a set amount of time, and let him or her know that consequences for the behavior will be more severe if the truth does not come out.

Like George’s father, as parents and caregivers we should show our children that we value the truth more than the loss of possessions or harm that is caused by mistakes they make. We should also be talking with our children about the importance of telling the truth when a lie protects someone who should experience consequences for wrong behavior that hurts others. Perhaps most importantly, we should recognize that kids often communicate through their behavior, and lying is a behavior kids use to meet a need to feel worthy, successful and good. Find ways to help meet this need in your child every day, and you should be able to notice a gradual elimination of a child’s need to cover up the truth. Dealing with lying in children and teens is not an easy process, but a patient, thoughtful approach on the part of a parent will make it easier for all.

Contributed by Ryther Therapist Lindsey Beaky, MA, LMHCA

If you’re concerned about your child and would like to seek professional help, please call 206.517.0234 or visit this page.

An interview with Dr. Elina Durchman, Psychiatrist at Ryther.

How can parents tell when their child needs professional help?

There is no easy answer for that, but anytime a parent is concerned about their child, they should seek professional advice. When there is a behavior or mood change, parents should seek professional help. The most common symptoms are acting out in a school setting or daycare. Very young children who don’t know how to verbalize their feelings can be aggressive at daycare or preschool. This can be a warning sign that something is going on. Parents should check with their child’s teacher to see how their child is acting in the classroom and compare this to their home environment. There is often a difference between home life and school. Kids can be very calm and happy in the home environment, but very fearful at school.

Why might a child become anxious or defiant regarding school?

Children may become defiant at school because they don’t understand their teacher or what the teacher is saying, which is very difficult for children to deal with and also difficult to explain to their parents. Sometimes, a child has a learning disability that hasn’t been recognized or diagnosed, and it’s very difficult for the kids to explain that they have a learning disability. Parents often think the kids are just defiant and don’t do their homework, and in this situation school can become a stressor for the child. For example, we know that ADHD is a developmental problem that we can measure in the brain, and if it’s severe enough the child may need to be on medication. It seems unfair to require a kid with ADHD to struggle in school when a medication  exists that can help them improve their school experience.

What are the most common psychiatric issues that you address?

The most common struggles that kids have are with anxiety, depression and, of course, ADHD. I also work with some teens in the co-occurring program that addresses both mental health and substance abuse issues. There are other mood disorders to be evaluated. These include bi-polar disorder, or other disorders on the psychotic spectrum. There are also children who have stressors in the family because of parents separating and other home issues. These are often triggers for anxiety, mood disorders like depression and other psychiatric issues.

It is important to note that many people are predisposed to depression, anxiety or other mental conditions. When a traumatic event happens, this can trigger an episode of these pre-existing conditions. However, if children receive mental health treatment, they will often have the tools they need later in life to successfully deal with these events.

What are some common stressors among young children?

 A stressor might be that kids don’t know how to express their unhappiness or that they want something, or don’t like something. So the most common way the kids show these feelings is to act out, by having a temper tantrum or something similar. I often spend time explaining these behaviors to the parents. The parents sometimes don’t understand why the kids are acting this way, and kids are unable to explain to their parents in any other way except by acting out. A child might get diagnosed with something like Oppositional Defiance Disorder because they don’t want to go to school or to soccer practice. So they throw a huge tantrum, but often the tantrum isn’t about soccer practice at all but rather some source of anxiety or fear related to that particular activity. These conditions cause anxiety and fear for the kids. Think of a young child being fearful and not knowing how to explain to their parents that they don’t want to go to a certain place. Often their only response is to fight back.

A lot of people (parents) don’t recognize these behaviors or know where these behaviors come from, and they are often times very grateful and happy when the situation is explained to them.

If you have concerns or questions, you may call Ryther at 206.517.0234 or visit our website for information or to make an appointment with one of Ryther’s psychiatrists.

Dr. Elina Durchman