Search for tag: "behavioral health"

Parents often wonder if their baby is lazy. I have parents use that term all the time. If their child isn't doing everything they think they're supposed to be doing, the parent labels their child as lazy.

For example, I have parents telling me a lot that their 12-month-old is lazy because they're not walking. Your child isn't lazy. Walking can start any time from 9 months until 18 months.

Parents will tell me their child is lazy because they want to be fed. If your child is under 18 months old and still learning how to use utensils, that's not lazy. They're just still learning. If they're 4 and they want you to feed them, that's not laziness. It's them being manipulating and trying to get you to do what they want.

Parents will also ask me about why their child isn't talking. They think that their 18-month-old should be saying sentences and instead only says about five words. Well, the biggest language explosion happens between 18 months and 3 years old. By 18 months, they should be saying four words, in addition to mama and dada. Boys tend to talk later than girls too. Not sure why, but that tends to be what I see. Girls tend to be more social. Boys tend to develop their motor skills faster.

I get the opposite too. Some parents think their children are developing completely normally when, in fact, they're behind on motor or speech milestones. This is one reason we do the autism screening at 18 and 24 months, to catch those kids that are behind and determine: Is this expressive speech delay? Are there not enough opportunities for motor development? Is there a concern for autism? Does the child have a different diagnosis that requires evaluation by specialists?

Now, I'll end with this as a heads-up. There was a recent article published in the "Journal of Pediatrics" outlining about how developmental guidelines for the first five years of life needed updating, and the Centers for Disease Control just adopted these new guidelines.

It will take a little while for everyone to catch up with these new guidelines when pediatricians do their screening evaluations at well-child visits. But we have a general good idea of where your child should be. As pediatricians, we are really good at figuring out if your child is on track developmentally, or if they need to see a specialist for a speech or motor developmental delay.

If you are concerned about a specific developmental issue with your child, be sure to discuss it with your child's pediatrician.

Dr. Gellner: Technology for teens can be a good thing, but it can also cause a lot of new problems. Since smartphones came out, there's been a big increase in emotional issues in teens. Is this a coincidence? I'll discuss teens and technology on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering The Healthy Kid Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: A new study by psychologists has many of us concerned. It says that the happiness, self-esteem, and life satisfaction of teens has been significantly impacted by the use of social media. Until 2011, it seems teen happiness was on the rise as it had been for a few decades. But from 2012 to 2016, there was a sharp decline. By 2013, 37% of teens had a smartphone, and by 2016, 73% of teens had one.

It seems that teens who spend more time on electronic communication through social media, texting, and video games are less happy with their lives and had lower self-esteem. Ask any teen that has a Facebook or Instagram account and they will tell you that everyone else has a better life than they do. They see their friends post things and they think, "My friend is so pretty. My friend gets to do so much cool stuff. Everyone looks like they're having the best day ever all the time." If you think about it, even us adults, we're guilty of thinking the same things.

Previous generations of teens had magazines that gave unrealistic views of body size, success, beauty, but now teens are bombarded every waking moment, it seems, by images of impossible standards. With social media, teens can post what they want on their feeds showing only the best pictures of themselves having the best experiences while hiding the struggles of everyday life. With as much time as teens spend on their phones, it's no wonder that they think that others have it better. Not only are they seeing their friends do all these fabulous things, their friends, and even strangers, can comment on pictures and videos they post. Those who comment can build them up by saying how awesome something is or they can be critical.

Posts can be shared too, which then expands the number of people seeing what is posted. Kids don't always realize that when they post something, it's out there forever and out there for anyone to comment on. That's often how cyber bullying starts, with a single post. That leads to negative texts, which can lead to being bullied at school, which triggers anxiety and depression, and sadly, can even lead to suicide.

As parents, one thing you can do to help your teen is to make sure you are included in their social network. That way, you can see what others are saying about your child and you can report any cases of cyber bullying to the appropriate authorities. Be involved in your child's online life, whether they want you to be or not, because it could really save their life.

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Interviewer: Lately, it seems like your child has been a little down and depressed, but it might not be actual depression. Pediatrician, Dr. Cindy Gellner, tell us about Seasonal Affective Disorder and kids.

Dr. Gellner: It's a seasonal type of depression that we see when it's wintertime and daylights get shorter. It's most common in older teens and young adults, and more often affects girls. Symptoms include those of normal depression, but they seem to only happen in the wintertime and get better during the spring. These can include feelings of hopelessness, sleeping more than usual, having a hard time completing assignments, and not really motivated for school. They can even be less social than before.

Take them to their pediatrician. This is a brain chemistry issue, not a behavior problem. Increased light exposure helps, so try taking a walk in the daylight. Talk with a counselor, and spend extra time with your child.

updated: November 26, 2020
originally published: December 29, 2017

Dr. Gellner: Unless you've been living under a rock, you probably know what a fidget spinner is. You may have one or have bought your child one. Places that sell these toys are marketing them as tools to help with ADHD, anxiety, and PTSD. But is that true? I'll give you the true spin on these spinners today, on The Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kids Zone with Dr. Cindy Gellner, on The Scope.

Dr. Gellner: Yes, I caved and bought my boys fidget spinners, and they promptly were lost, broken, replaced, and fought over. But do they really help with fidgeting?

Reviews of the toys online say that they're effective in helping with anxiety, ADHD, autism, PTSD, and other mental health issues. And for someone looking for answers on how to get their child to calm the wiggles down, fidget spinners can seem like a great idea and for as low as $5.

Well, there's no hard evidence to suggest fidget spinners can help with focus. There haven't been any scientific studies on these toys, specifically. A lot of parents want something, anything that can help their child stop fidgeting, even if their child hasn't been diagnosed with ADHD. Kids all try to get their parents to buy them because their friends have them, so there's peer pressure as well. It's the cool thing to have right now.

However, these spinners may actually cause problems. Kids may find themselves focusing more on the toy than the lesson at hand if they're taken to school. Actually, a lot of schools have already banned kids from bringing fidget spinners to class, which is a good thing if you've ever heard the whirring noise they make.

For kids who do have ADHD or other behavior concerns, there may be additional problems. These kids seem to be obsessed with spinners inside and outside of school. Their world revolves around the toy, and if it gets lost or broken, you're going to have an outburst on your hands. Kids with ADHD tend to have impulse control issues, and losing a fidget spinner can lead to a meltdown.

Instead of looking for a quick fix when it comes to focus problems, parents and teachers should work together to develop a plan for any student who has behavior concerns. This plan should be well-structured, with tasks broken into manageable pieces, limited distractions, and clear expectations for behavior.

Parents may also want to consider seeking help from their pediatrician. Most kids who have true ADHD are being managed by medications, which can really help a child reach their full potential in school by helping balance their brain chemistry.

Don't expect a fidget spinner to be a miracle cure for your child's ADHD. Also, parents should know that these toys break easily and can become choking hazards for younger siblings if the bearings fall out. One should be prepared to be annoyed for the whirring sound as well. Even the silent ones aren't silent.

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Interviewer: How to help your young child after a traumatic event. We'll talk about what you can do next on The Scope.

Announcer: Health tips, medical news, research and more for a happier, healthier life from University of Utah Health Sciences. This is the Scope.

Interviewer: Dr. Katherine Rosenblum is the director of the infant and early childhood clinic at the University of Michigan. When scary things happen to young children, we're talking about infants, toddlers preschoolers, what can you do to help them through that? Is this something that a lot of parents don't recognize first of all?

Dr. Rosenblum: I think it's something that people often overlook because we think young kids are really little, maybe it won't affect them so much, maybe they won't remember things that happened, and also because it's hard for them to tell us what they're thinking and feeling if they don't have the words for it yet. But in fact little kids are affected by scary things that happen in the environment or that happen to them. So we often think about how young kids actually do experience trauma or stress and what we want people to be thinking about is how we can help them to manage those feelings. I think how we can help them cope.

Interviewer: How do you define trauma or stress to that age group?

Dr. Rosenblum: Little kids deal with little stresses all the time. For example, starting at a new school, Mom or Dad is going to work and we have to adapt to separations. It's hard but kids can learn to manage that. It's a stress and it helps them learn I can manage little stresses.

Trauma, in contrast, is something that's so big that actually it overwhelms the individual's ability to cope effectively, and especially for little kids. When they're faced with something that is traumatic or really, really distressing, then what they need is a lot of help to be able to figure out how to recover from that and to be able to recover from that. It really requires additional support from outside.

Interviewer: So are we talking about emotional trauma exclusively or physical trauma as well?

Dr. Rosenblum: Actually, it can be a whole range of things. One of the most common traumatic experiences for young kids is accidents. They get injured or hurt. And that can be really scary and overwhelming and parents might see that after an accident they're afraid, they're more fearful, they're more clingy, that sort of thing, dog bites, things that can happen in the environment.

Interviewer: Falling off of a play set maybe even.

Dr. Rosenblum: Absolutely right. If it was really a scary experience, maybe they had a broken arm, or they had to have some sort of a medical procedure, those things can be really distressing. But with support they can really recover from that.

Big traumas are things that are just told really overwhelming to to the child. It might be witnessing someone being seriously hurt or injured, or really scary events that happen in the community. Those are things that we really think of as true traumas. They overwhelm that young child's sense of, "I can I can cope." It really creates a sense of intense fear or threat, danger.

Interviewer: Seems like we're talking about a wide range of things like from separation anxiety because a parent is going to work versus a traumatic accident. Are they all kind of dealt with the same way or do they require different strategies?

Dr. Rosenblum: The one thing that's sort of common across all of those things for young kids and the number one thing that young kids need when they're managing things that are challenging is the support and help of their primary caregivers, what we think of as their attachment figures, their parents. Young kids are totally dependent on their caregivers to help them navigate life's challenges, and whether those challenges are small or big they're turning to their primary caregivers for help with coping.

Interviewer: I'm sensing here as a parent a little bit of a struggle because on one hand, I don't want to over . . . because a little bit of stress and that sort of thing's good so I don't want to maybe overprotect or over . . . I mean how do you decide how much?

Dr. Rosenblum: It's really important to on one level follow your child's cues. So your child is going to be showing you, :I need you in some way," and parents have an intuitive sort of sense often of, "When my child needs me, I'm going to go to them and help them." Doesn't mean that you're going to prevent them from having to face challenges. Normative things like going to school, that's really important and you're helping them learn how to balance. But when young kids are experiencing something that a parent knows is really really stressful, then I think it's actually really important for the parents to sort of say, "Hey I'm here. I'm here with you. You're safe right now. I'm going to take care of you. I'm going to protect you"

Interviewer: And what does that interaction look like? Say a child falls off of a play set. You can tell the over the next couple of days there is a big fear there. My dad was a rancher. He'd say, "You get bucked off the horse you get back on". Is that the approach you take or is there a better approach?

Dr. Rosenblum: Let me sort of step back and share something with you that's sort of interesting. We often have people who sort of say, "Hey, I'm worried about spoiling my child. If my child is crying and I pick them up, is that going to spoil them?" What we actually know from the research is that when kids express feelings like being afraid or sad and they have parents who pretty consistently and reliably go to them and help them with those experiences, they actually end up as they get older being more able to cope with life's punches if you will, the hard things that come in life. They can sort of bounce back get up and do things better on their own as well.

So I think two things. One, we want kids to be able to try to sort of manage small things on their own. If your dad saw you sort of fall down and bump your knee, it might be totally appropriate to take a moment, sort of look and say, "Hey, wait a second, is he really hurt? Is he really distressed or is he going to be able to sort of bounce back from this on his own?" That's totally appropriate. But if he sees that you're really crying, that you're really hurt, and you're looking up, that's a time where we really hope a parent is going to say, "Hey buddy. You know I'm here for you. I've got your back. Come here and let me help you."

Interviewer: With an adult I might validate somebody's feelings a bit. "I totally understand why that was a scary experience." Do you do the same thing with kids?

Dr. Rosenblum: Absolutely. "That was really scary. But you know what? I'm here. I'm going to help you and you're going to be okay." Little kids really like to know that someone's there, someone's got their back, someone's going to scoop them up, give them a hug and then help them be able to sort of do that bounce, get back into normal daily routines and experiences. That's another piece that's really important here. I think the other part of your question was, "I don't want to over react." I don't think it's overreacting to really be asking how is my child managing, am I seeing . . . If something scary, something really big happens, use your child as your guide. Look at your child's behavior. Is your child looking more fearful, having trouble sleeping, a little bit more clingy? If all of those things are true then that's a time to give a little bit more. But if your child seems to be doing okay, all right, be a watchful observer. Use your child to help you determine what your child needs.

Interviewer: Would there be a point where you'd visit a counselor?

Dr. Rosenblum: Absolutely. So if your child is continuing to persist in showing more clinginess, looks very fearful, can't sort of do the normal routines, seems really distressed or you're just really concerned about them, trust your gut, talk to the primary and pediatricians are a great resource. They can help you sort out is this something that we can sort of wait and see and sort of watch and wonder? Or is this something where it might actually be helpful to get some extra help?

Interviewer: Do you have a resource if a parent's listening right now on their like, "This is great. I'd like to learn more"?

Dr. Rosenblum: There's a really wonderful website called the National Child Traumatic Stress Network and they have a website, NCTSN.org, and that provides wonderful resources for parents, for teachers of young kids about how to help kids manage really scary or big things. For smaller sort of things, the more every day sorts of occurrences, there are a number of resources that are available as well. The American Academy of Pediatrics has a website dedicated for parents and there's also a wonderful resource called Zerotothree.org. Again, lots of resources to help parents navigate life's challenges with young kids.

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Interviewer: Using Imodium to treat opioid withdrawals: a bad idea. We'll find out more about this disturbing trend next on The Scope.

Announcer: This is "From the Frontlines" with emergency room physician Doctor Troy Madsen on The Scope. On The Scope.

Interviewer: Doctor Troy Madsen is an emergency room physician at University of Utah Health Care and he said he'd seen a couple instances where people are using Imodium, which is an anti-diarrhea medication, as a way of trying to treat their withdrawal symptoms from opioids. I find this hard to believe. What's going on?

Dr. Madsen: Yeah. So this is really interesting. So as you may know, there's an opioid epidemic in our country and the Centers for Disease Control has acknowledged this and said we have so many people who are using opioids now. So prescription opioids, things like Percocet, Norco, Oxycodone are using that for to get high. Essentially what they may consider it legal high because they're getting a prescription or it's a prescription medication they're buying from someone.

So then, these individuals may then be saying to themselves, "I really can't be doing this. I need to get off this medication." So they're finding things on the Internet that discuss using Imodium or loperamide is the generic name and using that to sort of detox, taking that as a bridge to give yourself some of the same effects as the opioids give you while allowing your body to adapt and adjust and then gradually get off the medication.

Interviewer: So, first of all, bad idea trying to self-treat an addiction like that?

Dr. Madsen: Absolutely, not a great idea. But the reason they're doing this is because it's probably been out there for years and then I think it's just gained steam with some people posting things on the Internet about this. But Imodium or loperamide is actually an opioid. It doesn't give you the same high as things like Oxycodone, but it has kind of the same effects, acts on some of the same receptors in the body.

That's why it help with diarrhea because if you've ever heard of someone who says, "Hey, taking all these Percocets and I can't have a bowel movement. It constipates me." Well, that's kind of how this stuff works for diarrhea. Same kind of idea. It slows down the bowels but also then acts on somebody's same receptors in the body that opioids act on that people are using for highs.

Interviewer: Yeah. So self-treating bad but, above and beyond that, Imodium causes other problems that you see then?

Dr. Madsen: It does. And the big thing we're seeing is some of these people are just taking such incredibly high doses that it's been putting their heart into these arrhythmias, these abnormal heart rhythms that are life-threatening. And that's where we see it in the ER. I've seen cases of people coming in who are in just these crazy heart rhythms, these life-threatening heart rhythms and it's because they're taking large doses of Imodium and then that is triggering this heart rhythm.

And really, it's the kind of heart rhythm where you've got to shock their heart to get them out of it, get them on medication, do something for it or their hearts just not going to keep working and they're going to die from this.

Interviewer: That doesn't sound much better.

Dr. Madsen: It doesn't. It's not a great thing to do.

Interviewer: It doesn't sound like a great solution to the original problem.

Dr. Madsen: Yeah, there's not. There are much better solutions to opioid addiction and to getting off that. It's a sort of thing where you've come into the ER, we will often get people into in-patient detox programs. We can also prescribe medications that can help with this. So I would not recommend taking Imodium or loperamide. Again, that's the generic name for it. I would not recommend taking that to treat an opioid addiction because of the threat of these abnormal heart rhythms.

And this really comes up because there was actually just a study published or report in one of the big emergency medicine journals talking about increasing cases of this and increasing calls to poison centers for people who are taking more and more of these medications to try and treat opioid addictions and then are having very bad effects from this.

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Dr. Gellner: Face it. There are times we all let our tempers flare. But if your teen is more angry than you think they should be, it's time to put the fire out. I'll discuss ways to tame their tempers on today's Scope. I'm Dr. Cindy Gellner. Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Dr. Gellner: Your teen walks into the room and you can see it happen: they're volcano ready to erupt. It's true. All those hormones you hear so much about can indeed cause mood swings and confused emotions. Teens are under more stress today than ever as well.

They might be also one of those kids who really feel emotions intensely. But no matter what pushes their buttons, one thing is certain, there are times that they are going to blow a fuse. Anger is a normal emotion and there's nothing wrong with feeling mad. What counts is how they handle it.

Anger can be a really powerful emotion. So teaching teens how to manage it is sometimes a challenge. It takes plenty of self-awareness and self-control to manage those angry feelings. And these skills take time to develop. Little kids aren't very aware of what they feel. They just act it out in their behavior. That's why you see them having tantrums when they're mad.

But teens have the mental ability to be self-aware. They also have the ability for self-control, although they don't' know how to use it. Teens, or anyone, really, when they get angry, there's also another emotion that's the real reason for the strong emotion, such as hurt, guilt or frustration.

Help your teen figure out what else is going on. This is a great time to open up a discussion about feelings since teens usually won't open up on any day ending in "Y" unless they're forced to.

So there are five steps as a parent that you can tell your teen about that will help them manage their temper. First, have them identify the real problem. Did you just tell them no because they wanted to go out with friends and you said they need to clean their room? What are they really mad at? You, because you're being unfair? No. They're mad because they have to clean their room.

Then, help them think of potential solutions. This is where that self-control pause button comes in. Have them stop and think about the reaction, but don't just react out of anger. Ask them three things that they could do. They could yell at you and throw a fit. They could clean their room and then ask if they can go out or they can sneak out and run to their friend's house as fast as possible.

Third, they need to consider the consequences on each of these choices. Yelling at you will probably get them grounded. Cleaning their room takes work and they may miss out on some fun, but you'll probably let them hang out with their friends and then the bonus is they get to clean room. Sneaking out really ends well. When you do catch them, look out.

Next, have them pick a choice that they actually act on. By the time they've really thought this through, chances are you won't be yelled at and they haven't run away yet if they're still they're talking to you. So cleaning the room and getting to the fun is the best choice for all.

Finally, after they've made their choice and, hopefully, cleaned their room, then have them think about all that just happened. Did they feel they made the right choice? What did they learn about the decision-making process? Can they make the same positive choices on their own? Be sure to praise them for thinking things through before acting. Sure, these five steps sound like a piece of cake when you put them out there and everyone is calm. The real test comes when your teen is in full hothead mode.

Make sure your teen knows that there are other ways to manage their anger too. Lots of research had shown that exercise is a great way to improve your mood and decrease negative feelings because it raises endorphins, those happy hormones in our brains.

Listen to music. Have them wear headphones if their musical styles clash with your own. Writing, whether poetry, song lyrics in a journal or in a letter that they plan to rip the shreds and throw away, writing helps release intense feelings so they don't stand inside. Same with doodling. That's why adult coloring books are so popular right now. Some teens find that meditation and deep breathing helps.

Sometimes, anger is a sign that more is going on. Sometimes, it's a sign of depression. Sometimes, it's a sign that there is too much stress in your teen's life and they may be overscheduled or pushing themselves too hard.

Again, anger is a really strong emotion. It can feel overwhelming at times. Helping your teen learn how to deal with strong emotions without losing control is part of becoming more mature. It takes a little effort, a little practice and a little patience, but your teen can learn how to douse the flames and chill out with help and support from you.

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Dr. Gellner: It's a disturbing trend, teens cutting themselves. Why? And how can you help your child, if they are a cutter. I'm Dr. Cindy Gellner and we'll discuss this on today's Scope.

Announcer: Keep your kids healthy and happy. You are now entering The Healthy Kid Zone, with Dr. Cindy Gellner, on The Scope.

Dr. Gellner: Cutting isn't new. But, this form of self injury has been more openly discussed lately. If you haven't heard about cutting, chances are pretty good, that your teen has and might even know someone who does it. It can be hard to understand why a teen would deliberately cut themselves. But parents who are aware of this problem, can really help. That's why we're talking about it today.

Many parents don't really understand what cutting is. It's when a person uses a sharp object to make marks, cuts, or scratches on their body, on purpose. Teens usually cut themselves on their forearms, thighs, or belly. Somewhere they can hide with clothing. They might use a razor blade, knife, scissors, a metal tab from a soda can, the end of a paperclip, anything that can injure the skin. And there is a sense of shame and secrecy that often goes along with cutting. So most teens make up excuses on how they were hurt if someone sees the marks.

Most people who cut are girls. But guys do it too. And it usually starts during the teen years. The bottom line is that cutting is a sign of a deeper, emotional issue. And if you want to help your teen, you'll need to figure out, what those issues are. The cutting often begins as an impulse. "So and so mentioned it feels good, so maybe I should try it." A teen might give in to peer pressure to try cutting as a way to seem cool, popular, or avoid being bullied by other teens.

Regardless of the reasons, cutting isn't a healthy way to deal with the extreme emotions, or pressures, that come with the teenage years. For some, cutting helps them deal with feelings that seem too intense to endure. From the normal teenage heartbreaks, to rejections from friends, dramatic situations, or even the pressure to be perfect. Deep grief can be overwhelming for some.

Cutting can be a way of testing whether they can still feel physical pain. Others describe cutting, as a way of waking up from emotional numbness. Many teens discover that once they start, they can't stop. There is a sense of control and relief to see and know where this specific pain is coming from. And a sense of soothing when it stops. It seems to give them a sort of stress relief, from deep painful emotions, or even a high. Endorphins are feel good hormones released during intense physical exertion. But, they can be released during an injury.

Unfortunately, cutting is a behavior that tends to reinforce itself. Many teens say they feel addicted to the behavior. Whenever tension builds, the brain craves relief and drives the self injuring teen to seek relief by cutting again. Some would like to stop but don't know how, or feel they can't. Other teens don't want to stop the cutting, it just feels that good.

Cutting is often linked to other mental health conditions. Like obsessive compulsive disorder, depression, or bipolar. Other teens struggle with personality traits that attract them to dangerous excitement of risky behavior, or self destructive acts. Some are prone to dramatic ways of getting reassurance that they are loved and cared about. Many teens cut for a long time before anyone else knows. It can take courage and trust, to reach out.

If confronted by the cutting, teens can respond in different ways depending partly on the teen, and partly how they are approached by it. Some might deny the cutting, while others might admit to it. But say it's not really a problem. Some might get angry and reject any help. But many teens are relieved that someone knows, cares, and wants to help.

Like quitting any habit, cutting can be difficult to stop. And a teen might not succeed at first. It takes determination, courage, strength, as well as support from others, who understand and care, to break this powerful desire to harm themselves. If you find that your child is cutting, please talk to your pediatrician or other mental health provider. Getting to the bottom of the cause of the cutting may take some time. But your child is worth it.

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Announcer: Health tips, medical news, research, and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: You may have heard recently of a drug called Naloxone. What it does is it reverses opioid-based overdoses. So if you have an opioid-based pain pill or if somebody has a drug overdose that's based on opioids, it can actually reverse it and save their lives. Dr. Jennifer Plumb is one of the founders of UtahNaloxone.org, is also in pediatric emergency medicine here at University of Utah Healthcare, and Sam Plumb is the program's manager at UtahNaloxone.org.

I wanted to ask you both, why is this important to you? I've gone to the website. I see that you've put a lot of work into it. I see on my Facebook feed a lot of times you're trying to increase awareness. Dr. Plumb, why?

Dr. Plumb: We are in this position, I think, at a position of passion, but also at a position of a true desire that we can bring awareness to the epidemic that's gripping our state with opioid overdoses. We are fourth in the nation, which is a distinction that certainly nobody wants. We're not talking about it a whole lot, and I think that there are a lot of people out there who have at-risk family members.

We unfortunately lost our brother in 1996 to a heroin overdose, and since that time the situation has just gotten worse and worse. Naloxone was not legal to have in the home setting when Andy died, and it is legal now. So I think that we both feel very passionately that if one family can be spared what we went through, it's all worth it.

Interviewer: It would've saved his life you believe?

Dr. Plumb: Absolutely, I believe it would've saved his life. It would've saved his life.

Interviewer: So when you say we have opioid-based overdoses, are you talking about pain pill overdoses, intentional, accidental? I mean, what are we talking about here, people abusing?

Dr. Plumb: When the figures all come out, the Health Department puts them together and the CDC also puts them together, and they do look at all of those categories. They look at intentional or suicides. They look at accidental or poisonings. We are seeing in this state that we have continued accidental overdose increases. So what do these look like from an opioid perspective? Most of these poisonings and overdose deaths in Utah are from opioid substances.

There are some others, cocaine, methamphetamine, alcohol, that can also kill people, and unfortunately does kill people. But the majority are from the opioid-based substances. Of those, the majority probably still is prescribed pain medications. So the pain pills, OxyContins, Percocets, codeines, these medications that we all have heard about in different incarnations in our lives, but heroin is another big one.

The CDC just this year basically released data and released recommendations calling it an epidemic. It's truly an epidemic what's happening. Since 2000, I believe, we're almost up 400% for heroin overdoses nationwide. It's everywhere.

Interviewer: Not a problem here, though, right? Not in Utah.

Dr. Plumb: You certainly wouldn't think so.

Interviewer: But it is.

Dr. Plumb: It absolutely is. It's really challenging, because I get that people don't want to talk about it. There's a lot of stigma around it. But to me, it really is just another medical problem, a critical one and one that will kill someone if it's not dealt with, and if we don't get people help. But we don't talk about it. You're exactly right. It doesn't exist if we don't talk about it. We don't see billboards about it. We don't see PSAs. We need to. We need to start encouraging conversations surrounding these substances so other families don't go through what we have gone through.

Interviewer: Sam, you're also involved in UtahNaloxone.org. You're the program's manager, and I understand you do a lot of outreach to people that have a drug addiction problem. Talk about that a little bit, and how Naloxone can change things.

Sam: Well, I think it could potentially have a drug addiction problem. When you're doing community street outreach, you're dealing with a population that they obviously aren't in a good place. If they themselves aren't active users, they could know people who are at risk of an overdose, for instance. So the idea is these are people that are typically missed by other realms of the medical field.

They don't typically go to the doctor. They don't have access to the pharmacy. They don't often have insurance. So for that reason, these people are most at risk for having an overdose and not having the access to Naloxone, which can save them.

Interviewer: You actually make these available to those at-risk individuals.

Sam: Yes. We go out to different areas, and you start to have an understanding of more at-risk areas of the city. For instance, I know Pioneer Park is one that people typically think of. The Road Home, places where there are typically going to be people that are living outside or don't have the means to often take care of themselves, or provide themselves the shelter. We will go out and we will educate each and every person that gets a kit so that they know everything that they need to do should they witness an overdose, or should they themselves have an overdose.

Then, we distribute the kits, and we've really had a great response for that matter from that group of people, and they're very willing to be honest about it. If you ask them if they're using, they will tell you frankly, "Yes, I am." When you tell them that you're willing to help them, to say that they're gracious is an understatement.

Interviewer: I'm going to be cynical here for a moment and say, what do you say to individuals that would say, "Well, they have a drug addiction, that's their own problem?"

Sam: I mean, that is probably what we hear the most frequently about that population. But these are people that do not have the typical resources that even somebody of no means may have, for instance family, support, friends, a place to stay, any type of income. Without some type of help, that doesn't mean that they should just die as a result. For these people, you can't recover if you're dead. So Naloxone gives them that chance to actually recover from a potentially fatal overdose, and then also have the opportunity to seek some type of treatment or go into recovery.

It's really surprising, and I think that if you have a doctor or an EMS responder, they revive you, well that person is just doing their job. But if you have a friend, or a mother, a father, actually revive you, I think that that has more of an impact on your future usage as well.

Dr. Plumb: We've seen that too. We've seen firsthand, as well as anecdotal reports from other states. But we've seen firsthand, if someone is revived by their mom, and they wake up and their mom is begging them not to die, there's a different lightbulb that goes off. There is a realization that, "Wow. Somebody really wants me to be alive. I need to be here for myself. I need to be here for them. My life does matter to them." It's been reported in the literature too that actually bystander-administered Naloxone is a much more powerful tool to get people to have that realization that their rock bottom has come.

Interviewer: So that very much near death experience is actually the thing that will help turn them around and perhaps get them unaddicted, or more willing to seek treatment?

Dr. Plumb: On a healthier path, basically.

Interviewer: Yeah.

Dr. Plumb: Just to have that realization that, "Wow. I actually need to be here. Someone else sees that I need to be here, not just someone whose job it was to save me. Someone else made the conscious decision to save my life. They're not medical. They just care about me."

Sam: It also is very important to mention that the experience of having Naloxone administered to you, especially if you are an active user, an addict, it is something that is terribly painful. It kicks them into instant withdrawals. Some of the people that we've spoken to have said, "I'd rather be tazed or shot before I get that Naloxone again." You're like, "Well, would you rather be dead?" "No. Well, if I'm going to die, then yes you can give it to me." But other than that, I mean, it's a terribly painful experience. So it's not something that people would use or to . . .

Interviewer: Yeah. Because I was going to ask, I was going to say, now I've got my safety net so, woo, party's on. Right?

Dr. Plumb: Your parachute, kind of. We hear people say, "Oh, you're providing a parachute to people," and that's just not the reality.

Sam: Because if you think about it too, these people who are active users, number one, nobody wants to overdose, nobody wants to be an addict, and beyond that they don't want to waste their last fix. So if you give them Naloxone and they've overdosed, they've just lost their last high. So it's another way to think about it.

Dr. Plumb: Yeah. We do get questions about that, though. "Well, aren't you just enabling use? Aren't you just enabling riskier use? Aren't you just basically telling people you're okay with this choice that they make?" The reality of it is, no, we're not. What we're telling them is, "Hey, listen. We want you to get to a healthier place. We want you to get to a place where your life is not so encompassed by your addiction. But we can't get you there and you can't get yourself there if you're not alive." Naloxone will get you basically breathing again if you've overdosed. That's all it does.

Interviewer: So I know that you're an advocate for having the conversation. It's not just for people that are homeless or at The Road Home. There are plenty of other people that have drug addictions, that have families and live in homes. What would you say to a person that's in that situation that's listening?

Dr. Plumb: Well, I think probably the best way to speak to them would be to provide some examples of folks that have reached out to us. Sam and I can both give you examples of different conversations that we've had with people. I think one of the most powerful ones for me thus far, since we have embarked on this, has come from a mom who desperately reached out to us to get Naloxone. She had asked multiple providers, her physician, other physicians, emergency department physicians, addiction physicians.

She'd asked for a prescription for Naloxone for her son, who was a heroin addict, and at the time he was clean. We all know that one of the times that you're most at risk of overdosing is when you've had a period of sobriety. So your body is not at all accustomed to opiates, even as short as a period of three days and you go back to using what you used before, and you can overdose. So this mom reached out to us and in desperation said, "Can you please help me get Naloxone?"

She came up to Primary Children's and met with me. I educated her on how to use that. I was willing to write her a prescription. She was so uncomfortable getting it from the pharmacy that I ended up just giving her a free kit, which we have the ability to do. She didn't want that on her record. She didn't want that anywhere in the medical record.

Despite the fact that it's completely legal, insurance companies cover it, that it's been done for two decades now in the U.S., she had that stigmatization worry. She got the kit, and within a week she had to use it to save her son. I mean, it gives me chills even now thinking about it, because whether it was her motherly sixth sense or her experiences from the past, but she knew, and she almost didn't have that opportunity to save her son's life. Sam took a call today from a gentleman . . .

Sam: He has some type of chronic back disorder and he's in tremendous pain, and surprisingly he told me that his prescription for pain relief is morphine. He's receiving six doses of morphine throughout one single day of 60 milligrams each dose. Typically, 100 milligrams is something where you start to think of somebody as very high risk, or is a very high dosage, and he's taking 360 milligrams a day.

He's bedridden, he can't work, but he made the effort to call out to get Naloxone, because he said, "I fear for my life with the amount of medication that I am being prescribed, and I worry that my doctor may prescribe more. I want my family to be able to save me if I overdose."

This is a similar story that we hear from other people as well. These aren't just people that are down on their luck. These are people who are taking their medication as prescribed.

Dr. Plumb: And are still just at risk, because at the bottom line, end of the day, these are risky substances. It isn't about a risky person. It isn't about a moral character judgment. It's about these are risky substances, and they are everywhere in our society. I think all of us should take a little thought about, "Do I have these in my home? Do I have these in my home for a legitimate reason, or what may be an illegitimate reason?"

It doesn't matter to me. If they're in the home, they don't discriminate. They can absolutely cause an overdose and a death, and being prepared is really just not only smart, but it's appropriate. It's not asking for anything wrong by asking to be able to keep yourself or the people that you love alive.

Interviewer: It's like having a fire extinguisher or a first-aid kit, or an EpiPen, or an inhaler, or any of those things that you would use.

Dr. Plumb: Absolutely. Although, interestingly, an EpiPen which is absolutely vital for people who have anaphylaxis or allergic reactions to things, an EpiPen can actually hurt you. It's epinephrine, adrenaline. That can cause heart arrhythmias. That can actually hurt you. Naloxone can't hurt you. So I mean, even a level beyond it, I absolutely advocate for EpiPens and think they should be everywhere we know where they should be, but Naloxone is even safer. But it is very much the same thinking, that if there were to be that worst case scenario, you'd be prepared.

Sam: I think that's something that is particularly salient here in Utah, because we have our own culture here and it is a very stigmatized issue, whether it's an opioid pain medication or if it's an illicit substance. But we do hear from people that call us to talk about Naloxone after it's too late. Oftentimes in Utah, unfortunately, the conversation starts too late, when somebody has already been lost and there's nothing that can be done. So given how simple it is and how safe it is, it just makes complete sense to have it.

Interviewer: That's right. This can be that conversation.

Dr. Plumb: Right. Absolutely.

Interviewer: Right?

Dr. Plumb: Think about it.

Interviewer: This is the conversation and now go out and get . . . So do you just, prescription from your physician?

Dr. Plumb: Yeah. Your physician can absolutely prescribe it there. It's 100% legal for them to do so. Some physicians are a little uncomfortable with it, and I think that this will come in time. The law is pretty fresh still. I think physicians will become more comfortable with it.

But if you do run into a conversation where your physician states they're not comfortable, reach out to us. I can absolutely call in a prescription statewide, and we have done so from St. George to Brigham City and Wendover to Vernal, statewide. It's absolutely legal for me to call in a prescription for anyone who's either at risk of an overdose or at risk of witnessing an overdose.

Sam: For more information or to view our training videos, or even for other resources such as treatment and medication-assisted treatment, we have all of that listed at www.UtahNaloxone.org.

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Interviewer: How to treat addiction based on what we understand about the neuroscience of addiction. That's next on The Scope.

Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Eric Garland is a clinical researcher and practicing licensed psychotherapist at the University of Utah. Neuroscience is looking at a new way of thinking about addiction which then would guide how we would treat addiction. Give me a little background, how the school of thought in neuroscience treats addiction right now or thinks about addiction.

Eric: Sure. So there's really a way of understanding addiction that has emerged out of the past couple of decades, and there's been a lot of research and time and energy put into understanding this problem, and what we're coming to realize is that addiction is really a process of normal learning gone awry. The same processes in the brain that facilitate normal learning get hijacked by drugs of abuse.

Normally when we learn things, when we have an experience and the experience is rewarding, this tells the brain to do this thing again. And so we learn that that activity or that experience is valuable. We get some sort of pleasure or reward out of it.

In everyday life that might be good relationships with people that we care about, doing activities and hobbies that we love. It might be something simple like enjoying the pleasure of a tasty, healthy meal or a beautiful sunset or the snow on the mountains, but as a person becomes addicted, the effects of addictive drugs on the dopamine system in the brain cause changes in this normal learning pattern such that what was once rewarding becomes less rewarding and the brain becomes more and more dependent on drugs to receive the same amount of pleasure and reward.

Even drug use itself in the beginning is highly stimulating and rewarding to the brain. It produces a surge of dopamine release. But over time, the drug itself produces less reward and drug use becomes more and more of an automatic habit. People start to use drugs on automatic pilot without getting any pleasure out of it. It's just like any other habit we have that we do. The more you do it, the easier it becomes, the more automatic it becomes, the less you have to think about it, and that habit starts to become triggered by cues. For example, if you're an alcoholic driving past the bar or driving past a liquor store, or if you're a smoker and you smoke in social situations.

Interviewer: Or just even driving. I've known smokers that I could predict when they pull a cigarette out based on where we were in a trip.

Eric: Exactly.

Interviewer: By the time we hit the stop sign at the end of the street, a cigarette is going to be out. By the time we hit here, another cigarette's going to be out.

Eric: Exactly.

Interviewer: So wow, okay.

Eric: And they may not even intend to be smoking it. They may not even realize that they're smoking it. A lot of smokers have the experience of sort of looking down and seeing that half their cigarette's gone up and they don't even remember smoking it. It just becomes an automatic habit. It doesn't even give them pleasure anymore.

Interviewer: And then worse yet, the other things that didn't give them pleasure, don't give them pleasure anymore.

Eric: That's right.

Interviewer: So what do you do with that point? How do you break this cycle?

Eric: Right, and so the cycle, it gets worse because the things that used to give them pleasure are no longer giving them pleasure and the drug isn't giving them pleasure. The person is in a deficit. They're in a negative mood state and that really drives them to take higher and higher doses of the drug just to feel okay. And there's the addictive cycle right before you.

Interviewer: So how do you solve that?

Eric: Well, if this is the problem then it seems that we need treatments that can do two things. One, they can help a person become aware of the automatic habit of addiction, to become aware of when cues are triggering this automatic habit so that the person can begin to exercise some self-control over the automatic habit.

And then two, we need treatments that can help people to find a way to enjoy pleasure in life again, to teach the brain to relearn how to feel a sense of pleasure and reward from everyday activities that used to bring them pleasure.

Interviewer: And what are some of those things that you can do to start discovering pleasure in life again?

Eric: Yeah, so that is where a technique called mindfulness comes into play because mindfulness is really, although it's based on some ancient techniques for training the mind, we're coming to realize now with neuroscience that this approach actually strengthens both of those processes, both self-control over automatic habits as well as increasing attentional focus that might enhance the experience of reward.

Interviewer: Let me jump back for a second. So this is just one way of looking at addiction, what you've described to me. How sure are we that this is the way it is? I mean, how have they figured out this much?

Eric: There've been multiple millions of dollars invested by the National Institutes of Health, specifically the National Institute on Drug Abuse and the National Institute on Alcoholism devoted to this topic. These studies range from studies with animals, studies with humans and even studies down to the cellular level to understand how neurons communicate to each other and how drugs actually affect neurotransmission.

One simple way that this has been shown to be the case is by putting people in a brain scanner and watching how their brains respond when they're shown drug-related cues on a screen, for example, pictures of cigarettes, and showing activations in brain circuits in the reward center of the brain, and as addiction progresses seeing activations in the dorsal striatum which is the part of the brain that's involved in habit responses, and conversely seeing the opposite effects with regard to naturally rewarding queues.

So if you put somebody in a brain scanner and this person has developed addiction and you show them, for example, cues of smiling babies or beautiful sunsets or couples holding hands, the brain responds less sensitively to those cues.

Interviewer: It seems like some people are more prone to addiction. With this way of thinking, why would that be, or is that a false statement to begin with?

Eric: No, there's quite a bit of research looking into, for example, the genetic factors that predispose somebody to addiction, but in the line of discussion that we're talking about, people vary to the extent to which they're naturally sensitive to rewards. They vary to the extent to which they seek out novelty, they're sensation-seeking is the term, and they also vary to the extent to which they can control their impulses. Some people are just better naturally at stopping themselves and exerting self-control than others.

But my interest as a therapist is how people can train those capacities so that no matter where you start from, you can train your mind to strengthen self-control and strengthen your ability to experience pleasure in everyday life.

Interviewer: Are there any resources that if somebody wanted to learn more on their own that you could steer them towards?

Eric: There are a number of practitioners in the community that are practicing mindfulness-based therapies and there are also a number of providers in the community that are practicing other evidence-based treatments for addiction like motivational interviewing and cognitive behavioral therapy.

Interviewer: How is this way of treating being approached right now by the rest of the addiction community, people that don't subscribe to this philosophy?

Eric: This is a really hot topic right now in the addiction research field in terms of the importance of reward, the importance of sensitivity to natural reward as a predictor of addiction-related problems, but the idea that we could actually improve this capacity in somebody who is addicted and has lost the ability to feel pleasure in everyday life, this is a brand new thing. So it's a pretty hot topic and controversial.

Interviewer: Yeah, and not only overcoming addiction but actually maybe even be happier than they were ever before.

Eric: Exactly. It has a lot of applications to other issues, too, like depression or chronic pain and just improving the healthy response in life.

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