ScienceDaily (Nov. 21, 2007) — Eating disorders in the U.S. among ethnic groups were thought to be rare, but recent studies have shown that many cultures are now exposed to the thin beauty ideal. As a result, experts expect to see an increase in eating disorder symptoms among ethnic groups. It is also suspected that eating disorders and weight control behaviors may be increasing among adolescent boys. Although research has shown that eating disorders begin during adolescence, few epidemiological studies have been conducted with teens and those that have examined weight control practices among adolescents are too varied to be able to discern trends.
A new study, one of the first to examine trends in adolescent weight control behaviors over a 10-year period, found that the prevalence of these behaviors in male adolescents significantly increased, while black females appear to resist pressure to pursue thinness.
Led by Y. May Chao of Wesleyan University in Middletown, CT, researchers examined data from nationally representative samples of high school students from 1995 to 2005. The data was available via the Youth Risk Behavior Surveillance System (YRBSS), a survey conducted every two years since 1991 by the Centers for Disease Control and Prevention to assess the prevalence of health-risk behaviors among teens.
The results showed that the prevalence of dieting and diet product use among female adolescents significantly increased between 1995 and 2005 and as did the prevalence of all weight control behaviors (including dieting, diet product use, purging, exercise and vigorous exercise) among males. The data suggested that black female adolescents are the least likely to practice weight control, while white female adolescents are the most likely. Among males, white adolescents are the least likely to practice weight control and Hispanic adolescents are the most likely. The authors suggest that Hispanics may be more motivated to control their weight due to the higher prevalence of overweight among these young men.
The increase in weight control behaviors among males indicates that the social pressure for men to achieve unrealistic body ideals is growing, putting young males at an increased risk of body dissatisfaction and developing an eating disorder, according to the authors. "Considering that males have negative attitudes toward treatment-seeking and are less likely than females to seek treatment, efforts should be made to increase awareness of eating disorder symptomatology in male adolescents, and future prevention efforts should target male as well as female adolescents," they state.
The study reported the 10-year trends but also showed that some behaviors fluctuated during this period. The authors suggest that some practices, such as dieting, may be sensitive to changes in certain aspects of culture, such as fashion and topics of media focus, or seasonal variations, since it was not known at what time of year the YRBSS was administered.
Surprisingly, unlike previous studies, the current study did not find that ethnic differences in weight control behavior are decreasing. The authors suggest that black women tend to have more flexible concepts of beauty, which may make them less vulnerable to social pressure. However, this may put them at increased risk for becoming overweight, given the current environment of super-sized portions of nutritionally deficient foods.
The authors conclude, "Males, especially ethnic minority males, are under studied in this field, and this study provides key information about the prevalence of weight control practices in a large, diverse sample of male adolescents and raises important questions about the factors contributing to the ethnic difference in weight control practices among male adolescents."
The study was published online in the International Journal of Eating Disorders.
Friday, December 28, 2007
Thursday, December 27, 2007
High school seniors who drink alcohol to cope with anger or other problems already show a risky pattern of alcohol use that could continue later in life, a study reports.
More than three-quarters of seniors say they have experimented with alcohol, so the findings may not help prevent alcohol use in high school, says researcher Lori Palen of Pennsylvania State University. But such research might help identify high-risk teens before they develop a severe problem, says Zili Sloboda of the international Society for Prevention Research.
The findings in the December issue of the journal Prevention Science raise important questions for parents, especially during the holidays, Sloboda says. Some believe teen drinking is OK with adult supervision. But parents may not realize the teen brain is not fully developed and is especially vulnerable to alcohol's effects, she says.
Palen and her colleagues studied 1,877 high school seniors nationwide; 32% said they drank mostly for the thrill of it, and 15% said they used alcohol to relax. Another 36% said they drank just to experiment. Teens might experiment with all kinds of things, including alcohol, but they're not necessarily developing worrisome habits such as daytime drinking, Palen says.
A smaller group, 18%, said they drank for multiple reasons, including an inability to deal with frustration or anger. This group did show problematic behavior around alcohol: They were more likely to get drunk during the day, possibly during school hours. They also said they got drunk frequently; many had started to drink by sixth grade.
"There are a number of kids who start using alcohol early and use alcohol to deal with psychological problems," Sloboda says. Such teens might not listen to prevention messages that stress the dangers of alcohol. But these same kids might stop risky drinking habits or stop drinking altogether if taught more effective ways to handle frustrations, she says.
source: USA Today
Wednesday, December 26, 2007
According to court officials, there are 24 juveniles enrolled in the Knox County Juvenile Drug Court Program for various drug-related crimes. This represents the highest level of participation at any one time since the program’s inception.
Created by Juvenile Judge James M. Ronk in March 2001, the drug court program was designed to specifically address the intervention needs of the growing body of Knox County teens exhibiting addictive or potentially addictive drug-related behavior.
“Throughout the time I’ve been judge, there have been teen drinking parties and smoking marijuana,” said Ronk. “[At the time], I wasn’t happy with our response. We were looking around for evidence-based programs that offered the opportunity for more effective interventions.”
That same year, the Ohio Supreme Court established its own office to assist local communities in establishing drug court programs. The first drug court program entered Ohio in 1995; today there are 28 juvenile courts throughout the state and nearly 2,000 programs nationwide.
According to officials from Coshocton County, their juvenile drug court program has graduated 22 youths since its inception in December 2002. There are three youths currently enrolled. Dan Wallace, court program administrator for Morrow County, said that Morrow’s juvenile program began in April 2001 and has processed approximately 100 teens since then, with 14 currently enrolled.
“It’s the best thing we’ve found to help combat recidivism,” said Wallace.
The Knox County program accepts youths ages 14 to 18 and was designed, according to a mission statement, “for those juveniles who have been involved in criminal activity and are identified as having a significant drug and alcohol problem.”
Melissa Body, adolescent program coordinator for the Knox County Freedom Center and liaison to the drug court program, called the high number of youths in the program an identification issue.
“It’s not so much that [it’s more of a problem],” said Body. “It’s that we’re identifying kids more. We really try to intervene before there’s a big problem. We choose kids that we feel have potential and they’re headed down the wrong path.”
The court proceedings are unlike any other program in the judicial system. To enroll a child in the program, parents are required to co-sign a contract. Juvenile Magistrate Jeffrey C. Williams said it’s a way to hold parents accountable for their children’s behavior.
“If [we determine] the parent is not actively participating in the child’s recovery, he or she could be held in contempt,” said Williams. “We’ve had parents show up for [weekly] court intoxicated before. Once, it happened twice, and he was found in immediate contempt and went to jail.”
“Parents are required to set a standard in their home. Drugs or alcohol present hinders their recovery from their addiction. Kids have asked for their parents to be [drug] screened, too,” said Program Administrator Angie Webb.
Williams said parents usually end up getting the help they need after watching their child’s progress through the program.
Drug Court Probation Officer Misty Jenkins said the court program is an intensive probation intervention.
“It’s not just sanctions but rewards [for good behavior],” she said. “We’ve found that five positive rewards to one negative sanction is the ratio when [the child’s] behavior begins to change.”
Participants are required to undergo individual and group counseling, home inspections, routine court hearings, 150 hours of community service, scheduled exercise regiments, monthly family activities and a variety of other conditions that vary from child to child.
“It’s based on the idea that these families are not always educated in how to interact with each other,” said Webb. “We teach about them about doing other things than are drug related.”
Webb added that the scheduled family activities include picnics, planting trees, an annual chili cook-off, basketball and soup kitchens. Without a doubt, she said, the favorite this year was pumpkin carving.
“I don’t think any of these kids have ever carved a pumpkin,” said Webb.
Sanctions are handed down for any number of offenses, including missing school, missing a random drug test, missing a scheduled solo or family activity or violating curfews. A sanction could be anything from writing essays to an evening in Podville, forced bike riding, house arrest, community service or detention.
As far as rewards go, well-behaved candidates receive “drug court bucks” to be reimbursed later in the program for extra privileges or prizes. According to one court official, volunteers from the community have donated prizes such as sports equipment or movie tickets on which youths can redeem their bucks.
Williams said sanctions are catered to the individual.
“We try to take a holistic approach to the kids,” said Williams. “We look at the whole kid, the whole family.”
At a recent weekly drug court hearing, one 16-year-old boy who had been missing school was warned by the judge that each day he missed would result in one day’s detention and he would have his guitar taken away.
The nine-month program consists of four separate phases, each varying in the intensity level of supervision. A new enrollee is required to attend court once per week, but by the final phase may only need to show up once per month. Throughout the nine months, all enrollees are subjected to drug and alcohol testing several times per week.
“We’re always looking for a new viable alcohol monitor,” said Jenkins. “We found the ankle bracelet was ineffective. Now we have breathalyzers installed on their home telephones and we can actually see a picture of them breathing into the tube. We try to be as vigilant as we can be.”
Jenkins added that they are now able to track the real-time whereabouts of any child through the GPS chips installed in their cell phones.
Body said that in the early days of the program, youths were usually admitted to the program for repeated probation violations related to alcohol and marijuana.
“In the last six months, [prescription drug abuse] has become more of a problem, even with kids already in the program,” she said.
Recent studies conducted by several universities and the Department of Justice have shown that adolescents who successfully complete the program are less likely to commit future crimes and are more likely to stay clean over the years. A DOJ study conducted in Pennsylvania concluded that drug court graduates had a rearrest rate of 5.4 percent, versus a 21.5 percent rearrest rate among the control group. A Southern Methodist University study concluded that for every dollar spent on a drug court, $9.43 in tax dollar savings were realized over a 40-month period.
Special Agent Rich Isaacson of the Drug Enforcement Agency said his agency was in favor of the court program.
“We’re not going to just arrest our way out of the drug problem,” said Isaacson. “We need to look at it from a holistic approach.”
“Overall, I’m happy with the program,” said Ronk. “I’m convinced we’re having a positive impact on these kids. By definition, kids make mistakes. We hopefully plant some seeds that eventually come to fruition. That’s true with about everything we do.”
Webb said the level of success was relative.
“Any time you’re dealing with juveniles you have to judge success differently,” she said.
“When a parent and kid sit down and look at you and say ‘My kid wouldn’t be alive today if it weren’t for you,’ we call that a success,” said Jenkins. “In the long term, it’s also a real bargain for our community. We give the kids that period of time to give their brain a chance to develop normally as opposed to substance abuse.”
“I wish we could expand to take on kids who are at lesser risk [of addiction],” Ronk added. “Like every other agency, we’re limited by financial and human resources. We hope to add another probation officer soon so we can positively impact even more kids.”
For Jenkins, her definition of success is simple.
“I don’t have a dead kid yet,” she said.
source: Mount Vernon News
Sunday, December 23, 2007
This is a very difficult time for many teens and young adults. The holidays are supposed to be a time of joy and celebration. Unfortunately, that isn't true for many out there in the world and it can be a very lonely time. If you feel alone and need some help, if you just need to vent or need a friend. We invite you to join us at our teen forum where someone will be there to listen.
You don't have to be alone during the holidays! A new year is coming and maybe, just maybe this will be YOUR year!
Happy Holidays to all of you reading!
Posted by C.King, M.Ed. at 7:32 AM
Saturday, December 22, 2007
HARTFORD - Gov. M. Jodi Rell is reminding parents and teens that it is illegal for anyone under 21 to drink alcohol and any adult to allow parties where underage drinking is occurring.
This reminder comes on the heels of the governor proclaiming the month Drunk and Drugged Driving Prevention Month in Connecticut.
As Connecticut youth face the temptations and pressures of the punchbowl-spiked holidays, two new studies find that teenagers and young adults who binge drink are at increased risk of developing chronic health problems later in life.
"We continue to see the tragic consequences of our youth drinking too much, too soon," said Gov. Rell, co-chairwoman of The Governor's Prevention Partnership.
"Adults need to draw the line against underage drinking, not just for the holidays, but year round. The more we learn of its detrimental effects, the clearer it is that reducing underage drinking should be viewed by all as a public health priority."
In addition to the evolving body of evidence on the detrimental effects of alcohol on still developing brains, new research highlights the long term physical effects of binge drinking on teenagers and young adults.
Youth who binge drink are more likely to develop heart disease, high blood pressure and diabetes as they get older than those who drink moderately or start drinking at a later age. The higher risk was found to remain even if the binge drinking is curtailed later on.
Teenagers who binge drink are also more than twice as likely to become alcoholics by the time they reach 30 than non-binge drinkers.
These findings complement recent studies showing that drinking under the age of 21 can permanently impair the brain, causing memory and attention loss.
"As adults we need to change the way we think of underage drinking, and we need to examine the cues we give to adolescents," said Jill Spineti, president of The Governor's Prevention Partnership.
"Underage drinking, especially the turbo party culture that encourages teens to drink too much, too fast, is only as inevitable as we allow it to be. Parents are the leading influence in the decisions their children make."
The Governor's Prevention Partnership offers tips for parents this holiday weekend and for the upcoming New Year's weekend.
1. Don't relax your rules just because it's the holiday season. Kids still need limits and close monitoring. Expectations may need to be renegotiated or reiterated for college students returning home.
2. If your child attends a party, make sure alcohol will not be served and that partygoers will be properly supervised. Be available to provide a ride home if something unexpected happens.
3. If you leave for a night of celebration, be aware that unsupervised kids are at risk for alcohol use. Set up a reliable method for checking up on your child's whereabouts and activities.
4. If you host adult parties in your home and plan to serve alcohol, keep a clear head so that you can supervise any teens who may be present. Set a good example: drink responsibly and don't allow intoxicated guests to drive. Make sure any alcohol in your home is not accessible to your children.
5. Keep kids away from adult parties where there's a risk of witnessing guests overindulging. If appropriate and feasible, send your kids to another safe, supervised setting while your adult party is going on.
6. Be a good role model. Show your kids that you know your own limits, always designate a driver and never let someone drive away from your home intoxicated.
State surveys underscore that Connecticut youth are both drinking and driving impaired at troubling levels.
Nearly half (45 percent) of students in Connecticut's public high schools report having drunk alcohol at least once in the prior month, according to the 2005 Connecticut School Health Survey.
Overall, 28 percent of high school students and 40 percent of seniors reported binge drinking: consuming five or more drinks within a couple of hours, within the past 30 days.
The survey also found that white high school students are nearly twice as likely as their black classmates to binge drink: 31 percent to 18 percent.
The study found that two in 10 Connecticut high school students, more than 19,000, report having recently driven a vehicle while drinking alcohol.
By the time they reach senior year, 34 percent students report having driven under the influence of alcohol.
The incidence of college students driving under the influence of alcohol and or drugs rose 18 percent between 2001 and 2004, according to the State Epidemiological Workgroup.
The Governor's Prevention Partnership is a not-for-profit collaboration of state and business leaders providing prevention resources in schools and communities to keep Connecticut youth safe, successful and drug-free.
Those seeking information about prevention initiative may call Celine Provini, program director at 860-523-8042 or visit www.preventionworksct.org.
Thursday, December 20, 2007
Adolescent drug abuse is of growing concern in America. Children are experimenting with drugs at very young ages. One of the most common drugs that the youth is abusing is alcohol. Surveys show that children as young as twelve years old have experience drinking. These children report that their adolescent drug abuse was induced by peer pressure from classmates, relatives and curiosity. They claim that alcohol use makes them feel like an adult although they need help purchasing the beverage.
Adolescent drug abuse is of concern because the younger a person is when they first start using the drug, the more likely they are for building tolerances and becoming dependent on the drug. Adolescent drug abuse in particular can effect a young girls menstruation and fertility and young boys sex drive. Also alcohol has other implications on sex because females tend to lower their inhibitions, thus making them vulnerable to unwanted sexual advances. Young men under the influence of alcohol tend to become aggressive. Unwanted pregnancies and date rapes are associated with adolescent drug abuse. The chronic effects of alcoholism are liver cirrhosis, Korsakoff Syndrome and possibly bladder cancer.
One atmosphere that encourages large amounts of adolescent drug abuse is colleges and universities. Alcohol tends to be a college undergraduates drug of choice. They have the highest incidence of alcohol abuse and binge drinking of any age group in The United States. This primarily because sororities and fraternities historically support this type of behavior. Adolescent drug abuse in college is not an indication that one will abuse alcohol or any drug later in life. In fact, most drug addicts and alcoholics are not college graduates.
Adolescent drug abuse has many negative side effects and can promote negative behaviors. Therefore, parents and teachers should educate children early about the risk factors of alcoholism and other drugs.
Wednesday, December 19, 2007
College binge drinking has been on the public health radar for years, but new research sheds light on the extent of the problem on campuses today -- especially "pre-partying," participating in heavy, rapid drinking before attending a real party where the drinking continues.
Three-quarters of college drinkers say they "pre-party," and about 45 percent of all drinking events involve a pre-party.
That is according to a study in the December "Journal of American College Health", which features 16 articles rounding up recent research and recommendations.
About 85 percent of the 227 students who participated in the study were considered drinkers; findings are representative of all U.S. students, researchers say.
The study was led by Joseph LaBrie, assistant professor of psychology and director of an alcohol awareness program at Loyola Marymount University in Los Angeles. Students ages 18 to 25 were surveyed about their drinking habits over a one-month period. Among findings:
# Men reported 523 drinking events in the past month; 45 percent involved pre-parties. Women reported 654 drinking events, and 55 percent pre-partied. Both men and women reported heavy episodic drinking during 68 percent of events.
# On pre-partying days, men consumed about eight drinks on average and women consumed about six. On days when students went to parties but did not pre-party, men consumed an average of six drinks and women consumed about four.
# Of all drinking events involving pre-partying, 80 percent involved additional drinking afterward.
LaBrie says pre-partying is just now coming on the radar of administrators, although it has been a well-known behavior among students for some time. Most pre-partying is done in dorm rooms of underage students, he says.
"It's a judgment question. Pre-partying raises blood alcohol levels and impairs students' judgment, and then they continue drinking."
Hangovers, fights and sexual assaults also are more likely to occur on nights when students pre-party, according to the study. Nearly 600,000 injuries and 700,000 assaults result from excessive drinking each year, says the National Institute of Alcohol Abuse and Alcoholism.
LaBrie says pre-partying should be addressed in prevention and intervention tactics on campuses.
Several journal articles recommend that policies focus on promoting responsible drinking and harm-reduction strategies, rather than trying to prohibit drinking.
One study, by Larry Hembroff of Michigan State University's office of survey research, examined a program that sends cards to students nearing their 21st birthdays. The cards encourage students to drink responsibly and are signed by the parents of a student who died from alcohol poisoning.
Of students who received the card, 74 percent of those surveyed saved part of the card, 12 percent say they drank less because of it, and 98 percent said the university should continue sending the cards.
"We can't just stay the course. When something doesn't work we have to try something new," says Reginald Fennel, executive editor of the journal.
source: USA Today
Monday, December 17, 2007
The holiday season is upon us, and Christmas parties and New Year's celebrations are just around the corner. Unfortunately, the holiday season also is often soaked in alcohol, sometimes with tragic endings.
The best way to keep minors from illegally buying and drinking alcohol is not to lecture them about the evils of drinking or force them to watch grisly films of drunken-driving wrecks.
Those approaches have their place, but research confirms that the best defense against underage drinking is a good offense — increased enforcement of minimum-age purchase and minor-in-possession laws.
We support the upcoming — and unannounced — crackdown on underage drinking by undercover officers who will accompany people posing as underage customers looking to get a drink at local bars.
While officers are at it, they should also focus attention on adults who drink at bars and then get in their cars to drive while intoxicated.
While the holiday crackdown is not the result of any complaints or increase in underage drinking, Pensacola Police Department officials said they typically pay more attention to underage drinking during the holidays and summer when there are a lot of graduation parties.
Like underage drinking, drunken driving is a national crisis and an avoidable tragedy waiting to happen. The 1,719 DUI arrests made in Escambia and Santa Rosa counties alone last year are enough reasons to warrant aggressive crackdowns and enforcement.
Even though the legal drinking age is 21 in all 50 states, too many adults, including parents, view underage drinking as a rite of passage — and do nothing to stop it.
This is a dangerous approach. Studies show that children who drink are at greater risk of becoming alcoholics later in life, and are more likely to drive while drunk and cause harm to themselves and others.
To protect minors and discourage underage drinking, state lawmakers should consider legislation that would impose civil liability and tougher penalties on those who sell or provide alcoholic beverages to underage drinkers, as well as those who own or control premises on which underage drinking takes place. The law would include retailers and bars/restaurants that illegally sell or provide alcohol to underage people.
But laws and police undercover stings will not solve the problem. We must focus special attention on illegal underage drinking and do our part to prevent drunken driving.
This requires a community effort. It means involvement of parents, aunts, uncles, siblings, cousins, friends and neighbors. It also means the participation of educators, legislators, law enforcement and establishments that sell and serve alcohol.
The holiday season should be a time to safely have fun with family and friends.
Let us not revisit the holiday tragedies of recent years in which innocent lives were needlessly lost. Don't become an "enabler" by allowing underage children to drink. Remember, the life you save could be the life of someone you know.
source: Pensacola News Journal
Sunday, December 16, 2007
There's no place like home. But Michael Brown, 17, believes he has found the next best thing.
Drinking heavily by age 12, Michael saw his life spiraling out of control. As a teen, he faced charges of vandalism, theft, and breaking and entering. He'd seen the inside of a courtroom too many times.
The Department of Children's Services stepped in and decided what Michael really needed was a home-like environment that would encourage balance, structure, nurturing and love. In August 2007, Michael went to live in My Friend's House.
My Friend's House is a residential group home operated by Williamson County Youth that began its operation in 1988. It currently houses seven boys ages 13-17. My Friend's House is a comprehensive treatment program that fosters self-esteem and confidence and encourages teens to achieve their highest potential. The ultimate goal and purpose of My Friend's House is to reunite young people with their families.
"I feel safe here, and it's a great feeling to know people here are rooting for me to succeed," Michael said. "It truly has become my home away from home."
Michael attends programs and classes such as conflict resolution, family dynamics, anger management and alcohol and drug abuse group therapy.
"I made some really bad decisions," Michael said. "But living at My Friend's House has taught me to accept responsibility for my own actions and that I am in control of my life and my destiny."
My Friend's House Executive Director Patty Martinez has seen many positive changes in Michael.
"He stopped blaming others. He is assuming leadership roles. He has a great attitude and long-range goals," she said. "He can and will make it happen."
source: The Tennessean.comBy PATRICIA BRAZZELL
For The Tennessean
Thursday, December 13, 2007
Washington, Dec 13 : Two new studies have helped explain why teens exposed to foetal alcohol are at high risk for heavy drinking and perpetuating a family cycle of .
This happens because pre-natal alcohol exposure shapes sensory preference which means young people whose mothers drank when pregnant might be more likely to because, in the womb, their developing senses came to prefer its taste and smell.
Researchers with the Developmental Ethanol Research Center conducted a study on mice and found that because the developing nervous system adapts to whatever mothers eat and drink, young rats exposed to alcohol (ethanol) in the womb drank significantly more alcohol than non-exposed rats.
Led by Steven Youngentob, PhD, the research team observed that a biologically instilled preference for alcohol's taste and smell can make young people much more likely to abuse alcohol, especially in light of social pressures, risk-taking tendencies and alcohol's addicting qualities.
These more subtle consequences of foetal alcohol exposure come on top of the potential for Fetal Alcohol Syndrome, which leads to profound neurodevelopmental problems including mental retardation.
In one study, infantile rats exposed to alcohol (ethanol) in the womb drank significantly more of it in youth but not in adulthood. They were the offspring of dams, or mother rats, from one of three experimental groups: ethanol-exposed via the mother's diet at levels simulating moderate to heavy drinking; pair-matched controls that ate the same amounts as ethanol exposed-dams to control for any effect of under-nutrition; and controls that ate freely.
The offspring were examined after 15 days of birth, still infants, or 90 days of birth, fully mature. Adult rats chose to drink ethanol or non-ethanol solutions, both from bottles. Rat pups were presented with ethanol solutions through tubes implanted in their cheeks; they could either swallow to accept, or reject it by shaking their heads, licking the chamber walls or floor, or letting it drip out.
The ethanol-exposed animals drank significantly more ethanol than both groups of control animals. The researchers cite their finding as evidence for ethanol preference resulting from maternal use or abuse of ethanol during pregnancy.
The researchers put forth the idea that when the developing nervous system senses ethanol in amniotic fluid, it adapts without awareness of which chemicals will help or hurt the organism. It could be alcohol; it could be carrot juice; the adaptation is the same. Given the former, the olfactory system of a developing foetus becomes attuned to ethanol's chemosensory attributes. It 'likes' the taste and smell, two big factors in the flavour of alcohol.
However, Youngentob further suggested that if the nervous system has no further experience with the drug by adulthood, ethanol loses its chemosensory allure.
The related study found strong evidence of the role of the olfactory system. As in the other study, the researchers exposed the rats to ethanol by giving it to pregnant mothers. Control mothers just ate chow, and the offspring were tested either at 15 or 90 days after birth.
When exposed to ethanol odour, the prenatally exposed young rats sniffed it significantly more than control rats. To heighten ethanol's sensory impact, the odour-responsive cells in their nasal passages also became tuned. This altered odour response predicted the sniffing response of the animals. Again, these effects faded by adulthood, the rat equivalent of 30 to 40 human years.
"From a clinical perspective, an enhanced preference for ethanol odour may be an important contributor to the risk for an enhanced postnatal avidity for the drug," the researchers said.
The findings are published in the December issue of Behavioural Neuroscience.
Tuesday, December 11, 2007
By Donna Leinwand, USA TODAY
Emergency rooms and schools across the nation are reporting that waves of youths are overdosing on non-prescription cough and cold medicines that are widely available in drugstores and supermarkets.
The dozens of overdoses in the past two years — including at least five deaths in which the abuse of over-the-counter medicines was a factor — reflect how medicines such as Robitussin and Coricidin are becoming more popular as recreational drugs for kids as young as 12, police and doctors say.
The incidents represent a dangerous turn from past decades, when some youths would guzzle cough syrup to try to get a buzz from alcohol and codeine, authorities say. Most cough and cold medicines no longer contain alcohol, and those with codeine, an addictive opiate, are available only by prescription. But more than 120 over-the-counter medicines include dextromethorphan, or DXM, a cough suppressant that when taken in heavy doses can produce hallucinations and a loss of motor control, much as PCP does.
Kids don't have to drink entire bottles of goopy cough syrup to go "Robotripping" or "Dexing." Pills such as Coricidin HBP Cough & Cold tablets — known as "Triple C's" — offer far more potent doses of DXM with less hassle. Youths can buy the medicines easily, then go to Web sites to learn how much someone of their weight should take to get high.
Whether in cough syrup or pills, DXM costs just a few dollars, is "easy to get ... and there's a lot of information about how to get high on it on the Internet," says Charles Nozicka, medical director of pediatric emergency medicine at St. Alexius Medical Center in Hoffman Estates, Ill., west of Chicago. He says that he began seeing DXM overdoses among teens three or four years ago, and that lately he has seen as many as four cases a week.
Authorities say DXM overdoses typically occur in clusters, as word of the drug spreads in a community's middle schools and high schools. This fall, parents and school officials in Naples, Fla., who had known little about DXM were shocked when several kids in their early teens suddenly passed out in class after overdosing on the drug.
At Pine Ridge Middle School in Naples in September, a 13-year-old girl brought about 80 Coricidin pills to campus one day and gave some to six friends, authorities there say. Each of the friends took at least five pills — the recommended dosage for adults is no more than one pill every six hours — and soon the school was in chaos. Two students lost consciousness in their first-period classes; they and one other overdosed youth were treated at a local hospital.
The girl who distributed the pills thought it would be "fun to feel messed up and act ... drunk," says Cpl. Joseph Scott of the sheriff's office in Collier County, which is in southwestern Florida on the Gulf Coast.
Another round of overdoses occurred on Nov. 6 at Immokalee High School, which also is in Collier County. A 15-year-old girl and two of her friends took five Coricidin pills each before school. By 10:45 a.m., the girl "couldn't remember her own name," Scott says. When paramedics could not stabilize her heartbeat, they called for a helicopter to take her to a hospital. Authorities learned later that she had obtained the pills from a boy who had taken them from his home. The girl's friends did not have to be hospitalized.
Scott says that many parents in Collier County were shaken by the idea that youths could buy large amounts of such a potentially dangerous drug at a local store, and then consume the drug, without breaking any laws. "It's something people aren't really informed about yet. The parents we've dealt with so far are pretty much in shock," Scott says. "It seems right now it's mostly the younger kids" who are taking DXM.
Scott says his office is compiling information packets about DXM that will be distributed to local pharmacies and schools.
Elsewhere, growing concerns about DXM have led some drugstores to restrict access to cough and cold medicines.
After two teenage girls and two 20-year-old men in Merrill, Wis., overdosed on medicines containing DXM this year, some drugstores in the city of about 10,000 people 160 miles north of Madison began to stow such remedies behind their counters. At the Aurora Pharmacy, customers now must request Coricidin tablets, and they aren't allowed to buy several boxes at once. Pharmacist Jim Becker says he wants the drug "where we can keep an eye on it."
Drug manufacturers say they sympathize with concerns about drug abuse, but they have resisted efforts to restrict consumers' access to Coricidin, Robitussin and other remedies containing DXM.
"The vast majority of people take them responsibly," says Fran Sullivan, spokesman for Wyeth Consumer Healthcare in Madison, N.J., which makes Robitussin products. "As a medicine, it works hands-down, so we want people to be able to use it if they need it."
Aware that teens might be tempted to abuse its newest DXM product, anti-cough gel-tabs, Wyeth made its packaging large enough so that it is difficult to stash in a backpack or pocket, Sullivan says. The company advertises on TV shows geared to adults, he says.
"We've noticed that the abuse comes and goes in waves," he says. "It gets really popular in a small area for a short period of time and then it dies out. Teens end up in the emergency room, it makes the local newspaper, and the area goes on alert."
Schering-Plough, which makes Coricidin, is working with the Partnership for a Drug-Free America to create an educational Web site on DXM, company spokeswoman Mary-Fran Faraji says. Company representatives also are meeting with pharmacists, parents, schools and retailers to discuss ways to prevent drug abuse.
But Faraji says Schering-Plough doesn't plan to eliminate DXM from its non-prescription cough and cold medicines. She notes that most of the potential alternatives to DXM as a cough suppressant are opiates that carry more potential for abuse. "Reformulating our product is not going to make the abuse issue go away," Faraji says. "Our product is safe and effective when used as directed."
DXM approved decades ago
DXM, a synthetic drug that chemically is similar to morphine, was approved by the Food and Drug Administration as a cough suppressant in 1954. Drug manufacturers began putting it in cough syrups in the 1970s as a replacement for codeine.
DXM is sold legally without a prescription because it does not make users high when taken in small doses. The recommended dose, about one-sixth to one-third of an ounce of an extra-strength cough syrup, contains 15 to 30 milligrams of DXM, according to the National Institute on Drug Abuse. At doses of 4 or more ounces of cough syrup, DXM produces effects similar to those of PCP or the anesthetic ketamine, the institute says. DXM can produce hallucinations, depressed breathing, elevated blood pressure and an irregular heartbeat. Overdoses can cause seizures, comas and death.
It can be particularly dangerous when taken with other drugs.
Lee Cantrell, interim director of the California Poison Control System's San Diego division, says that Robitussin and some other cough and cold remedies containing DXM have additional ingredients that can be fatal to abusers if taken in huge doses. For example, antihistamines, which often are combined with DXM in cough and cold remedies, can be toxic and cause respiratory distress, Cantrell says. He says cough medicine abuse emerged as a problem in California about three years ago.
During what officials called a "mini-outbreak" of DXM overdoses in New Jersey two months ago, a 15-year-old boy had to be treated for acetaminophen poisoning after he drank two bottles of Robitussin and took some Coricidin. Acetaminophen is a pain reliever/fever reducer that, over time, can cause liver damage if taken in large doses.
The federal government does not keep statistics on DXM abuse, but drug specialists say anecdotal evidence suggests that its use does not approach that of methamphetamine or the club drug Ecstasy. DXM abusers, drug specialists say, typically are young teens who are seeking a cheap alternative to drugs that are more expensive and more difficult to get.
Still, "what we see in the emergency department is probably the tip of the iceberg," Nozicka says of DXM abuse in his community near Chicago. "There's probably a lot more going on, but most (overdose cases) don't end up in the emergency room."
Some drug counselors and doctors say young adults have begun using DXM with alcohol, Ecstasy and other drugs.
DXM "looks innocuous enough, but if you take enough of it, it can cause serious problems," says Ed Bottei, medical director of the Iowa Statewide Poison Control Center in Sioux City. A 22-year-old college student in Ames, Iowa, died of a DXM overdose in October 2002. "Even though it's an over-the-counter medicine, it can still hurt you," Bottei says.
Authorities who have been more focused on illegal drugs often have been surprised by sudden outbreaks of DXM overdoses.
After a series of overdoses in the Detroit area in August, the U.S. Drug Enforcement Administration issued an alert that warned parents, schools and local communities about an "escalation" in DXM abuse.
The alert cited a "disturbing increase" of overdoses in the Grosse Point area, near Detroit.
DEA special agent David Jacobson, spokesman for the agency's Detroit office, says that federal drug enforcement analysts usually can forecast regional trends in drug use, based on geographic patterns. But "Robotripping" came out of nowhere, he says.
"Law enforcement hadn't heard about it, but all the kids had," Jacobson says. As he and others in the community asked around, they found that DXM abuse "was not only out there, but it was out there more than we thought."
Internet fuels trend
Like others who monitor DXM abuse, Jacobson says the Internet has fueled the trend.
"Now (DXM cases) pop up everywhere," he says. "If one kid is doing it anywhere, kids here will know about it."
At Michigan State University in East Lansing, the student health center is planning to include a question about DXM abuse on its next student health survey in the spring, says Dennis Martell, the university's interim coordinator for health education.
"We want to be proactive in identifying the problem before it becomes the rage," he says.
Meanwhile, as word of DXM spreads among teens and young adults, pharmacies are reporting more thefts of cough and cold medicines, as well as suspicious purchases.
Victor Vercammen, a pharmacist who works in a drugstore north of Chicago, says he recently watched two young men try to buy six packages of Coricidin. As the clerk rang up the purchase, Vercammen confronted the pair.
"I could tell as the conversation went on that they planned to misuse it, so I asked if they realized that it could cause a seizure, that it could be fatal," says Vercammen, a spokesman for the Illinois Pharmacists Association. "My hope was that educating them at least gets them to think about it. The popular conception is that because it's over-the-counter, it's safer."
Monday, December 10, 2007
1. What is self harm?
Medically the term self harm means to deliberately harm or injure oneself through any behaviour that causes detriment to your health, like over-eating or smoking. A more appropriate term to use is that of self injury or deliberate self harm.
In common conversation, the terms self harm and self injury are often used interchangeably.
2. Who self harms?
Young people have the highest rate of self harm, with approximately three teenagers (13-19) harming every hour in the UK. One in ten people have harmed by the age of sixteen. It is thought to be the second highest reason for Hospital Accident and Emergency admissions (with the top being 'accidents'). Figures suggest that four times more girls harm than boys.
Although these statistics are very up to date, it is very difficult to get a true figure as research definitions of self harm vary. Also the level of taboo around the subject is so high that most are very secret about it, and this normally omits them from any research.
3. How do people self harm?
There are countless ways that someone may self harm, with the most common being cutting, used by over two thirds of those who self harm.
Here are just a few examples: cutting, burning, punching, head banging, hair pulling (Trichotillomania), poisoning to cause discomfort or damage, insertion of foreign objects, excessive nail biting, scratching, bone breaking, gnawing at flesh, picking wounds, tying ligatures around the neck etc, medication abuse, alcohol abuse, illegal drug use, smoking - some are socially acceptable. starvation, binge-eating, vomiting. This list is endless - it's important to be aware that someone who stops self injuring may replace their harming behaviour with a different type.
4. Why do people self harm?
People often harm themselves because they can find no other way to relieve a feeling of being overwhelmed by intense emotions.
These emotions commonly fall into five groups:
Anger and frustration : Feeling so wound up and annoyed that you want to scream and shout. (in this case animals would claw at themselves).
Low self esteem (punishment) : Feeling so undervalued and low that you want to harm and feel you may even deserve it.
Dissociation : Feeling so overwhelmed by everything going on around, they want to escape or distract themselves by making a louder metaphorical noise.
Control and focus : Feeling that so much is out of your control that the only thing that you can control is the harm you inflict on yourself.
Self nurture : Feeling unreal and needing to harm to know you exist, or to help yourself heal.
Normally someone who is self harming will be able to identify at least one of these, if not more, as a reason for their behaviour.
5. Why do people continue self harming?
Once someone has found a way of coping, that both works and brings relief, it is a very daunting prospect to try relinquishing that way of coping in favour of another.
When someone cuts themselves, they send a rush of endorphins through the body, that travel to the wound sight to help heal it. The experience of this is described as being similar to being walked up on from behind and startled, and then taking a sudden intake of breath to recover from the fright: the relief of that breath feels similar to the buzz felt by harmers. This feeling is addictive and is considered as a chemical addiction, underlining why it can be difficult to stop harming.
6. How do you know if someone is self harming?
The short answer is you might not: it is a very secretive thing, and often purposefully hidden from others. A person is three times more likely to harm if they feel they lack emotional support, so those who are isolated, or feel isolated, may be more likely to harm. Those who find coping with the strains of life very difficult may also self harm.
7. What immediate risks are associated with self harming?
Someone who self harm's is a hundred times more likely to commit suicide, whether accidental or not. In other words, there is a risk of death, even though that is not the intention of the harming action.
Infection of wounds is also a significant risk. The cleanliness of implements used in cutting is a significant factor in whether infection occurs, as is treatment of wounds. Proper medical treatment for cuts and burns etc will give better healing prospects and reduced risk from infection.
8. What long term risks are associated with self harming?
If a person harms regularly over a period of time they are likely to weaken their body, depleting the essentials needed to maintain themselves. For example, the body's ability to clot blood may be reduced, immune systems could weaken and pulled hair may not grow back. These are but a few examples of many potential long-term effects on health. However the body is also surprisingly resilient, and is not impossible to have just scars as a indication of times spent harming.
9. What alternatives are there to self harming?
As a direct alternative to self harm, holding ice cubes in a hand and trying to crush them, has the same result, but without any long term physical effects. Another alternative can be having an elastic band on a wrist that is pinged onto the skin to give a short spurt of pain and a small rush - this however does need to be done in moderation, as overdoing it can bruise. One other form is to pluck hairs on legs or arms as a technique for weaning off cutting.
A lot of harming is done impulsively - so encouraging someone to wait five minutes each time they want to harm can help the urge to pass. If the person has identified the emotional groups they are harming out of, it can be very beneficial to explore different ways of expressing those feelings.
10. What support is available?
It is very important for a self harmer to have consistent emotional support, where they can feel safe and respected. In terms of professional support an initial visit to a doctor will often lead to a referral to relevant mental health support in the local area. In Luton CAMH (Child and Adolescent Mental Health Unit) is a long established and effective NHS resource, with access to a wide range of support, from counseling to art therapy.
If you or someone you know has issues with self-harm aka "cutting" please have the join us at Sober Teens You will meet people from all over the world just like you and you will get the support you need!
Friday, December 7, 2007
Methamphetamine is a powerfully addictive stimulant that dramatically affects the central nervous system.
Methamphetamine is commonly known as speed, meth, chalk, Christina or Tina. In its smoked form it is often referred to as ice, crystal, crank, and glass. It is a white, odorless, bitter-tasting crystalline powder that easily dissolves in water or alcohol.
The drug is made easily in clandestine laboratories with relatively inexpensive over-the-counter ingredients. These factors combine to make methamphetamine a drug with high potential for widespread abuse.
Methamphetamine's chemical structure is similar to that of amphetamine, but it has more pronounced effects on the central nervous system. Like amphetamine, it causes increased activity, decreased appetite, and a general sense of well-being.
The effects of methamphetamine can last 6 to 8 hours. After the initial "rush" or "flash," there is typically a state of high agitation that in some individuals can lead to violent behavior.
Methamphetamine users can be identified by:
Signs of agitation
Loss of appetite
Increased physical activity levels
High blood pressure
Shortness of breath
Nausea and vomiting
Occasional episodes of sudden and violent behavior
Visual and auditory hallucinations
Bouts of insomnia.
A tendency to compulsively clean and groom and repetitively sort and disassemble objects, such as cars and other mechanical devices
Thursday, December 6, 2007
There are many reasons why high school seniors choose to drink alcohol: experimentation, to get a thrill or maybe in an attempt to unwind. But the most dangerous motivation is a combination of those plus the desire to escape from problems and deal with anger and frustration.
According to new research, teens with multiple reasons to drink including reasons related to coping with problems are most likely to display the heaviest and most dangerous drinking behaviors.
Researchers from Penn State collected data from 1,877 students taken from the annual national Monitoring the Future survey in 2004. “Students who had multiple reasons to drink including reasons related to coping, were also more likely to begin drinking at an earlier age, more likely to be drunk in the past year and more likely to drink before 4:00 pm, compared to students who drank to experiment with alcohol, to experience the thrill of drinking or just to relax,” Penn State researcher Donna Coffman, Ph.D., was quoted saying.
According to study authors, more than three-quarters of high school seniors have tried alcohol or are drinking regularly, so it’s too late to tell them not to drink. They say it’s important to figure out why a teenager is drinking because drinking patters that develop during adolescence are likely to continue into adulthood.
Wednesday, December 5, 2007
Studies have shown that teenage girls are using drugs and alcohol with increasing frequency. What has contributed to this rise and why are girls more vulnerable?
A National Survey of Drug Use and Health in 2004 showed that girls began smoking marijuana earlier than boys. Besides increased substance abuse, studies also show that more teen girls are absuing tobacco and alcohol.
According to the Department of Health and Human Services, “girls ages 12 to 17 now match boys in illegal drug and alcohol use and have actually surpassed boys in smoking cigarettes and misusing prescription drugs.”
In 2006, the Office of National Drug Control Policy (ONDCP) reported that "1.6 million girls reported having at least one major depressive episode in 2004." The number one drug of choice for girls since 2003? Marijuana, which can bring on symptoms of depression, ranks highest. Prescription pills, diet pills to pain killers also fill out the list of common drugs used among girls.
The increase in substance abuse among young women is especially dangerous because of the more serious health issues associated with female users. The female physiology is substantially different; women tend to develop alcohol-related health problems far faster than young men do, reports the American Medical Association.
These alcohol-related issues can include: brain damage, cancer, cardiac complications as well as mental disorders. Teen girls who drink alcohol regularly will also likely experience a disruption of growth and puberty. This disruption can result in serious, depressive symptoms which add to the general stress of trying to fit in with peers.
A study by the Department of Human Services showed that one in six girls became sexually active after consuming alcohol. According to the Office of National Drug Control Policy, teen girls who binge drink are 63% more likely to also become teen mothers. In the same study, one in four girls were reported to have driven under the influence or had gotten in a car with someone who had been drinking.
No family is immune from conflict, family problems arise when tensions run high and studies show teen girls are “more sensitive to conflict[s]” (ONDCP) in the family, so a social support system is vital for teens. A mentor, or confidant that is a positive role model as well as social groups like church organizations, Boys and Girls Clubs or the YMCA, are all good choices when creating a positive social circle.
Source: http://substanceabuse.suite101.com © Andrea Okrentowich
Jan 28, 2007
Tuesday, December 4, 2007
Specific brain changes occur in women who are anorexic, even after they have recovered from the disorder, say researchers.
Researchers at the University of Pittsburgh School of Medicine studied the differences in brain function between 13 women who had suffered from anorexia and 13 healthy women who had never had the disorder. The recovered anorexics had maintained a healthy weight for one year and had normal menstrual periods.
They wanted to find out why women with the psychiatric condition have a high level of anxiety and whether there is a physical cause for the heightened emotional response.
Their findings are published in the December issue of the American Journal of Psychiatry.
Researchers administered tests to both groups of women.
The first involved guessing whether a hidden number on a playing card (obscured by a flashing question mark on a computer screen) was higher or lower than five. Correct guesses were rewarded with $2 and incorrect guesses resulted in a $1 payout by the participant.
At the same time, MRI images were taken of the participants' brains — focusing specifically on areas associated with emotions and planning.
"During the game, brain regions lit up in different ways for women who formerly had anorexia compared to healthy controls. While the brain region for emotional responses showed strong differences for winning and losing in healthy women, women with a past history of anorexia showed little difference between winning and losing," said Angela Wagner, a researcher at the University of Pittsburgh School of Medicine and the study's lead author.
"For anorexics, then, perhaps is it difficult to appreciate immediate pleasure if it does not feel much different from a negative experience."
The MRIs also revealed that in women who had formerly been anorexic, the regions of the brain that link actions to outcomes were more active than in healthy women, indicating anorexic women were more preoccupied with perfectionism and doing things right, according to the researchers.
"They tended to try and find strategies within the game, and were concerned about making mistakes," said Kaye.
Anorexia is one of several eating disorders that strikes mainly girls or women, although boys or men can also be affected. The disease involves a distorted image of one's body that leads to an obsessive fear of gaining weight, weight loss and malnutrition.
According to the Public Health Agency of Canada, approximately 0.5 per cent to four per cent of women will develop anorexia nervosa during their lifetimes.
source: Canadian Broadcasting Corporation, cbc.ca
Monday, December 3, 2007
Alicia Garcia has heard stories about high school students keeping alcohol in their lockers and drinking during school hours. And she knows alcohol is more available to her 17-year-old daughter than when she was that age.
"They're getting to that age where they're influenced by their friends. I grew up in Mexico. It wasn't an issue when I was younger," Garcia said. "It's important to learn how to communicate and avoid this."
That's why Garcia and her daughter, Melissa Rocha, were among about three dozen people who attended a Saturday event called Parent Involvement: A Solution to Underage Drinking at the Hilton Hotel in Salt Lake City. It was the first of a series of mini-conferences geared toward ethnic communities to educate parents and youth about the consequences of underage drinking and to offer solutions and ways to prevent it. The first conference was for the Hispanic Latino community.
"The message we had about underage drinking wasn't getting out to the ethnic communities," said Jesse Soriano, interim director for the State Office of Ethnic Affairs.
The conference wasn't just about minors and alcohol. There were also workshops on teenage pregnancy and gateway drugs.
"Underage drinking leads to other things like violence, crime, teenage pregnancy," Soriano said. "Alcohol is the root problem."
The workshop for parents was in Spanish; teens heard the message in their own workshop in English. Marcela Lopez and Teresa Mora, of Communidades Unidas, gave parents statistics and talked about how alcohol can affect the brain of drinkers under the age of 21.
Forty percent of kids who drink before age 15 will be alcohol-dependent, according to ParentsEmpowered.org. Sixty-seven percent of those kids will also try other illicit drugs.
Underage drinking can hinder the development of the brain's prefrontal area (responsible for good judgment and impulse control) and the hippocampus (involved in learning and memory).
"It's a serious problem, but the good news is parents are the No. 1 reason why kids don't drink," said Art Brown, president of the Utah chapter of Mothers Against Drunk Driving (MADD). "Adults can stop this. Parents need to be engaged."
Roderic Land, of Planned Parenthood, gave teens hypothetical situations about alcohol and talked about how alcohol impairs judgment and affects behavior.
"It gave us another perspective," said Brania Gutierrez, a student at Copper Hills High. "The peer pressure is everywhere. People ditch school and go drink. I learned about setting my limits."
Doug Murakami, alcohol education director for the Department of Alcoholic Beverage control, said tailoring the conferences to certain communities with native speakers who interact with kids and parents should be more effective.
"We're in our second year in this campaign and last year, we just basically did PSAs on Spanish radio and other media outlets," Murakami said. "But we realized that the way to change behavior is to reach out to the communities. We wanted more of a grass-roots approach."
source: Salt Lake Tribune
Saturday, December 1, 2007
Friday, November 30, 2007 - 11:34 posted by BlogMeister
Anxiety, Addiction and Depression Treatments
Parental Behaviors May Affect Eating Disorder Risk
Early life experiences, especially with in terms of parents' actions toward their children, can affect the development of eating disorders, according to an Australian study published in the International Journal of Eating Disorders. The researchers examined the childhood experiences of girls with eating disorders and depression, finding evidence that parents' comments, expectations, and the amount of control they exert over their daughters can contribute to the development of anorexia, bulimia or depression.
The researchers, led by Dr. Tracy D. Wade of Flinders University, gathered information on early life experiences from a total of 622 female twins. They compared the experiences of 170 girls who had anorexia, bulimia, or depression to the experiences of girls without these disorders. They also studied 226 twin pairs in which one twin had an eating disorder or depression and the other did not. Their results indicate that parents' actions can affect a daughter's chances of developing an eating disorder or depression. Girls with eating disorders were more likely to have parents who commented on their appearance and eating habits, and they were also more likely to have received less care from their fathers. Family conflict also had an effect and was associated with anorexia, bulimia, and depression. High parental expectations put girls at risk for bulimia and depression, although this connection was strongest for girls with bulimia. The researchers also found that girls who reported having an overprotective or controlling father were more likely to have anorexia.
The results of this study provide more information on the factors that lead to eating disorders and depression, and with a greater knowledge of this information, physicians and therapists can better tailor the treatment options to fit a patient's needs. A girl with anorexia may feel a lack of control in her life possibly related to an overprotective father, while a girl with bulimia may have an incorrect perception of her parents' expectations for her. Working together, a girl's family and doctor can help her to address the underlying factors that may have contributed to her eating disorder or other mental illness.