2013-05-18T18:52:16-04:00 Dr. Ronald Ricker and Dr. Venus Nicolino http://www.huffingtonpost.com/author/index.php?author=dr-ronald-ricker-and-dr-venus-nicolino Copyright 2008, HuffingtonPost.com, Inc. HuffingtonPost Blogger Feed for Dr. Ronald Ricker and Dr. Venus Nicolino Good old fashioned elbow grease. tag:www.huffingtonpost.com,2011:/theblog//3.852893 2011-05-20T08:34:00-04:00 2011-07-20T05:12:01-04:00

Dr. Ronald Ricker and Dr. Venus Nicolino http://www.huffingtonpost.com/dr-ronald-ricker-and-dr-venus-nicolino/ New York Times article, "Talk Doesn't Pay, So Psychiatry Turns to Drug Therapy," written by Gardiner Harris, the sad truth of what was once a noble profession, psychiatry, now a shambles of its former self, is accurately described. Mr. Harris used his interviews with psychiatrist Donald Levin, M.D. and his wife, Laura Levin, M.S.W., and their practice in Philadelphia to describe, in considerable detail, the "new" psychiatry.

Dr. Levin was trained during the "old" days when psychotherapy and knowing one's patients were the cornerstones of the practice of psychiatry. The 50-minute psychotherapy hour was the rule. Dr. Levin, as he and his wife freely discuss, has seen the light -- the new, economic light -- which now rules his and many psychiatric practices. By 2005, only 11 percent of psychiatrists practiced any kind of psychotherapy, now called "talk therapy." This percentage has undoubtedly shrunk since then; psychotherapy and the 50-minute hour are psychiatry's equivalent of high button shoes. Not talking earns a great deal more than talking.

The Times article reports that in the old days, Mr. Harris "knew his patients' inner lives better than he knew his wife's; now, he often cannot remember their names." In the same old days, "his goal was to help his patients become happy and fulfilled; now, it is just to keep them functional."

Dr. Levin has found the transition difficult. He now resists the urge to help his patients manage their lives better. "I had to train myself not to get too interested in their problems," he told the Times, "and not to get sidetracked trying to be a semi-therapist." Dr. Levin expressed some astonishment that his patients admire him as much as they do. "The sad thing is that I'm very important to them, but I barely know them," he said. "I feel shame about that, but that's probably because I was trained in a different era."

Dr. Levin has had to give up his old ways for the new. There are a number of reasons for the "new" ways. When he returned to his solo, private practice after a 15-year stint in a clinical hospital practice group, Dr. Levin found that the fees that insurance companies would pay for "talk therapy" were just too low. He could have accepted less money and provided time to patients even when insurers did not pay sufficiently, but, he told The New York Times, "I want to retire with the lifestyle that my wife and I have been living for the last 40 years. Nobody wants to go backwards, moneywise, in their career. Would you?"

"I miss the mystery and intrigue of psychotherapy," he said. "Now I feel like a good Volkswagen mechanic." He went on: "I'm good at it ... but there's not a lot to master in medications. It's like '2001: A Space Odyssey,' where you had Hal the supercomputer juxtaposed with the ape with the bone. I feel like I'm the ape with the bone now." He cleverly compares Hal to psychotherapy and the monkey/bone to himself and the "not much to master" medications.

As the New York Times article states, "Dr. Levin's initial efforts to get insurers to reimburse him and persuade his clients to make their co-payments were less than successful. His office assistants were so sympathetic to his tearful patients that they often failed to collect." In 2004, Laura Levin, M.S.W., a licensed talk therapist, took over the business end of the practice. With admirable zeal, "Ms. Levin created accounting systems, bought two powerful computers, licensed a computer scheduling program from a nearby hospital and hired independent contractors to haggle with insurers and call patients to remind them of appointments." She also imposed a variety of extra fees on patients: $50 for a missed appointment, $25 for a faxed prescription refill and $10 extra for a missed co-payment and who knows how much for writing or calling in a prescription.

Dr. Levin's practice is based on the approximately 11- to 12-minute "hour," seeing 40 patients each day for approximately 11 minutes each. The remaining four minutes allow for social niceties, ushering a patient in and out, offering them the chair, and getting the next chart, all of which adds up to 15 minutes.

Ms. Levin candidly says, "This is about volume ... and if we spend two minutes extra or five minutes extra with every one of 40 patients a day, that means we're here two hours longer every day. And we just can't do it."

Before we feel sorry for the economic plight of the Levins, searching desperately to maintain their lifestyle and send donations, let us examine the math. Insurance companies pay approximately $100 per 15-minute "drug" visit. Private patients pay more. Dr. Levin, by his own accounting, sees 40 patients a day, which at $100 a visit comes to a total of $4,000 per day. Then there is the co-pay. That amount of co-pay ranges up to approximately $50 and averages $40. To the $4,000 per day, therefore, one must add $1,600, the total rising to $5,600 per day. Then, one must add other income from charges made directly to the patients by Ms. Levin, for such things as missed appointments and faxing, calling or writing prescriptions, averaging, let us say, $30 per appointment. These charges add another $1,200 per day -- raising the grand total income to $6,800 a day. Assuming a five-day work week, this totals $34,000 a week, roughly $170,000 a month, and $1,620,000 per year (allowing for one month off for vacations, holidays, etc., assuming he takes them and works five days a week. If he works six days a week, increase all the numbers by 20 percent. If he takes fewer vacations and holidays, you do the math). By his own statement, he needs to maintain his lifestyle and can't go back on that.

Dr. Ricker, a physician, psychiatrist and psychoanalyst working in Los Angeles, Calif., operates the "old" way, treating patients with psychotherapy/psychoanalysis. As Dr. Levin would put it, Dr. Ricker is Hal. He makes 11 percent as much as Dr. Levin, which he still considers a princely sum. Psychotherapy sessions last one hour. Drug evaluations take one to two hours. Drug management meetings are usually 30 minutes to one hour. He works approximately 47 hours a week. His 11 percent also includes his wife/business partner/office manager/secretary, a masters graduate of Columbia University. They also run a non-profit treatment center for disturbed adolescents. He doesn't get paid for that, which would probably cause Ms. Levin apoplexy, because psychiatry is a "volume" thing and he manages to not just "waste" two to four minutes per patient but an entire day each week on his project. Add in those eight hours and he works 55 hours per week.

The tidbits we offer about Dr. Ricker are not at all for the sake of demonstrating his saintly virtues (to some, this might be evidence of foolishness) but to offer a point of comparison.

Psychopharmacology is not a "not much to know" field of medicine. It is a "we don't know enough" field and therefore requires all we can do for its improvement. To ride the misguided waves of insurance companies' seeming largesse makes all of us poorer for it. We pay in both obvious and not-so-obvious ways. We all pay more for our medical insurance, psychiatric care, prescriptions, deductibles, co-pays, etc., the costs of which continue to skyrocket. But, far worse than that, we all pay the ever-increasing price of systematically declining and increasingly inferior psychiatric care. If one really believes that psychopharmacology is a "not much to know" field of medicine, a new job is definitely in order. ]]> tag:www.huffingtonpost.com,2011:/theblog//3.828811 2011-03-01T15:30:09-05:00 2011-05-25T18:35:25-04:00

Dr. Ronald Ricker and Dr. Venus Nicolino http://www.huffingtonpost.com/dr-ronald-ricker-and-dr-venus-nicolino/
By way of example, Dr. Ricker was recently visited by a 24 year old young man who had just spent two weeks as a psychiatric inpatient in a very well known University Teaching Hospital in Los Angeles. He had been discharged the previous day.

Upon entering the office, the patient was stiff, clumsy, and absent of any apparent emotion or other emotive affect. His speech was flat and monotone. There were the usual greetings.

Then, immediately, the patient began reciting a pharmaceutical laundry list of the medications he'd been given at the Hospital, including very large amounts of two major anti-psychotic drugs, an unnamed anti-depressant and a very large amount of a drug called Neurontin.

"Have you been taking these long?"

"Two days", he said. Considering the mammoth dosages of drugs coursing through his veins, he was lucky to be walking or even speaking at all (Did he drive to this appointment all jacked up on pills?)

"You had a Doctor at the Hospital?"

"Yeah", he said.

"Did you two spend time together, trying to understand what needed to be set right inside you?"

"I never met him", was the response.

"Did you have a therapist?"

"Yeah, I did."

"Did you two spend time together, trying to understand what needed to be set right inside you?"

"I met her once. She was nice."

"How did you get these medicines?"

"I went to a conference," he said.

"They decided there?"

"I don't know."

"Did anyone talk to you about these medications? What they do, possible problems, side effects, stuff like that?"

"No. A nurse just brought them to me and asked me to take them. I slept for a whole day."

After only a few minutes into the scheduled hour-long session, he wanted to leave. Another appointment was made for a few days later. He left and never returned.

Another Doctor found to be working with the same patient was contacted, and asked if something had bothered the patient during his visit with Dr. Ricker. "Yeah, he could tell you wanted to talk. He only wanted someone to give him his pills."

Another case of a Doctor mistaken for a drug dealer. So it goes. Dr. Ricker pressed his colleague. "What's with the 5000 mg. of Neurontin?"

He answered with the tone of one explaining why the sky is blue to a toddler. "Don't you know? The drug of choice for anxiety disorders is Neurontin."

Actually, that's an off label use that's very likely ineffective and dangerous. But hey, what's a few dead folks here and there when there's cash coming in? Have a steak on Pfizer.

The Resident in charge of the ward where the patient had been knew nothing about this man's life, family or any other aspect of his personal history. He added, that a drug regimen like that was "Standard for cases like him."

In other words, it's standard procedure to pill-stuff a patient like a foie gras goose, often without knowing anything about the patient and the patient knowing nothing about the drugs. The only way Hippocrates could smile on this would be would be if he were blindly intoxicated.

Is this what the science and art of psychotherapy and psychiatry has been reduced to? Don't talk, don't question, don't get to know the patient. The Doctor's role is to be the last part of the conveyor belt leading from the pharmaceutical plant to the patient's mouth. Any kinks in the line will result in the worst-case scenario for all involved: Loss of Profit.]]> tag:www.huffingtonpost.com,2010:/theblog//3.786905 2010-11-29T19:35:16-05:00 2011-05-25T18:15:22-04:00

Dr. Ronald Ricker and Dr. Venus Nicolino http://www.huffingtonpost.com/dr-ronald-ricker-and-dr-venus-nicolino/
The most important part is never to put nurturing feelings of anger or hatred before nurturing the kids. Sadly, this is often not the case.

Many divorces are maelstroms of explosive rage, mutual recrimination, and even emotional or physical abuse. A couple that at once saw themselves growing old together can barely stand the thought of one more night in the same house. Love and devotion have fermented irreversibly into loathing and resentment, a terrifying transformation for a child to witness.

For the children it's as if an unfixable crack has opened in reality, devouring everything they know, leaving behind only confusion and despair. Don't kid yourself into thinking there's any way to not put the kids "in the middle". They are and will be in the middle for the rest of their lives, by the very nature of the situation. What can be affected is whether the middle is a place of pain and turmoil, or a neutral ground, a sanctuary of calm, the one place where the weapons are put away and decency and empathy can exist.

The only way to facilitate a neutral and calming middle is to agree that children come before the anger, the resentment, and the who-did-what-to-who. Dragging your kids into the battle crosses the line from simply being a person with a failed marriage to being a failed parent. It's not their fight and is tragically hateful to make them pick up the banner for either of you.

Agreeing that kids come first is just that, an agreement--an agreement that must come from the divorcing parents. And just that one single agreement can serve as a singular, vestigial, shared interest: the good of the children. Regardless of the circumstances of divorce, set them aside to figure out how to get your kids through this. Or must the kids come in a close second to self-righteousness?

Communication, the Holy Grail of our children's salvation from divorce, with a soon-to-be or current ex-spouse can be problematic, frustrating, and often next-to-impossible. The whole point of the divorce was to disconnect from an emotional circuit that was not functioning. Why continue to expect something that's proved itself unworkable to work?

Yet, we will have to fight and conquer the very demons that have torn us apart. Our anger and exasperation may have become such familiar companions that we're not sure how to be us without them anymore? At some point our yelling has become yelling for yelling's sake. We may not still be husband and wife, but we are forever Mom and Dad

We must talk. Peacefully. As Adults. Privately? Or with an agreed upon advocate for our children and us, be they a friend, relative, counselor, etc. We must agree that we love our kids and want to hurt them as little as possible. It may be the dawning of a new era for the parents, but for the kids it's the End of Days.

Courts and lawyers are most often useless and often destructive in this, the most important and delicate and saddest result of divorce. The guide for this enormous task will not come from any judge, attorney, or decree. If anything, your children may register in a litigator's mind as one other item to be won, along with the house, the car, the antique silverware received as a wedding gift. The only genuine and worthwhile solace and guidance for our children will come from the parents, and them alone. It is your God given duty to guide your children through this nightmare.

You must put aside your own self-interest and pledge to each other, "I promise never to do anything to hurt our children or to keep them from you. I will never speak ill of you in their presence. I will not blame you to them or around them. I will respect you and your family".

What's closer to your heart? Your anger, your hurt feelings, your need to be right, your need to win...or your kids? The answer should be self-evident, the question utterly unnecessary.]]> tag:www.huffingtonpost.com,2010:/theblog//3.764883 2010-10-19T17:41:55-04:00 2011-05-25T18:05:23-04:00

Dr. Ronald Ricker and Dr. Venus Nicolino http://www.huffingtonpost.com/dr-ronald-ricker-and-dr-venus-nicolino/
In one swipe of his pen all special services to virtually all disabled children, in the past present and future, were gone. In doing so, he also violated Federal Law protecting this group of students being denied services they require to receive and benefit from public education.

California is a seething cauldron of misguided activities and expenditures, but this veto has to lead the parade. Further, the state already runs huge budgetary deficits. Last year and the preceding year, $20 billion and this year $12 billion, no one believing this latter figure. It's not that $132 million is pocket change, but compared to the California Budget ($86.6 billion), it is nothing. It's barely 0.16 percent. Hence, on the backs of our special needs children, a pathetic and hardly worthwhile attempt to save State Money is being carried out.

California is famous for lows. This veto has to be the lowest the State has ever sunk to.

Contact Governor Schwarzenegger and tell him what you think. Also Gubantorial Candidate Jerry Brown and Meg Whitman.
]]> tag:www.huffingtonpost.com,2010:/theblog//3.680488 2010-09-08T16:00:00-04:00 2011-11-17T09:02:45-05:00

Dr. Ronald Ricker and Dr. Venus Nicolino http://www.huffingtonpost.com/dr-ronald-ricker-and-dr-venus-nicolino/
Memorialized in 1966 by the Rolling Stones' "Mothers Little Helpers," it was at that time that our society took the first steps at becoming "Pill Crazy." Valium and Librium and Quaaludes were "Mother's Little Helpers. The first drugs to enter the stage. If you couldn't stand Johnny, your friends, your husband, in-laws, etc, tranquilizers smoothed you out, made you tranquil. Not surprisingly, in the 70s, the consumption of these tranquilizers, once discovered and available, skyrocketed. Anxiety was the popular diagnosis. Antidepressants were beginning to raise their heads as well. Their popularity at that time, however, was muted by the fact that they didn't work well, and also sported many side effects, some of which were very annoying and occasionally dangerous. And, no one knew what was just around the corner.

Prozac

Prozac was first marketed in 1987. It was a totally new type of antidepressant, which seemed to work and had far less side effects. What had been a stream of tranquilizers became a tsunami of Prozac's and tranquilizers. Other 'Prozac's' entered the scene--Zoloft, Celexa, Paxil and Luvox, all vying to take part of Prozac's market share. Promotion of these drugs by drug manufacturers exploded. Where there had been a surge in the diagnosis of anxiety, now the diagnosis of the decade was 'depression.' Housewives by the droves needed and demanded antidepressants and even more tranquilizers. If one was good, two must be better. The pill craze was on.

Diagnoses started to morph. The more the diagnoses, the more opportunities to sell drugs. Anxiety became anxiety neurosis, panic disorder, panic attacks, etc. 'Depression,' as a diagnosis, was of course and remains very popular. However, many patients don't and didn't like that diagnosis--perhaps it sounded too much like a disease. So a new depression explanation and diagnosis emerged--'chemical imbalance,' which sounded more sheik and less like a disease and, of course, yielded more customers.

Not far behind 'chemical imbalance' came 'mood disorder,' a special type of depression, also called bipolar disorder. There are people who actually have a bipolar disorder and require numerous special medications for treatment. These medications, mood stabilizers, antidepressants, and second generation antipsychotics are far more dangerous medications than Prozac and tranquilizers. Further, there are also many people who are said to have 'bipolar disorder' who don't. Often these patients are those who were said to be depressed yet don't get better with standard antidepressants. They get all the special and dangerous medications (the number of which is multiplying geometrically) and have the additional advantage of being able to excuse pretty much anything they do as a result of their 'mood disorder.'

This pretty well takes us through the '90s. But here come our children. How did our children get sucked into all this? Our pill craze was and is a huge part. Parents and physicians often subscribe to this theory, that there is a pill for everything. Mommy says Johnnie is depressed, doctor agrees, Johnnie doesn't. Guess who wins? Certainly not Johnny. Guess what Johnnie gets? A pill, usually an SSRI, which he may end up taking for a long time. Assuming Johnnie takes three years of SSRI therapy, his diagnosis is changed 25 percent of the time, usually to the much more serious diagnosis, bipolar disorder. His medications are changed to a much more serious and dangerous types. If Johnny takes an SSRI for six years the chances of his diagnosis changing to bipolar increases to 50 percent. So do his meds.

There's yet another and newer mine field for Johnnie to negotiate, new in the last two decades. Let's say Johnnie fidgets in his seat, doesn't listen to the teacher, hates to read, and talks to his neighbor all the time. Guess what. Johnnie is diagnosed with ADHD (attention deficit hyperactivity disorder) and given another serious type of drug, a stimulant--usually Ritalin or a form of speed (one example being Adderall). Did you know that Adderall is 100 percent speed? We know speed kills but give it to our children. Think about that. Speed kills and we give speed to our children, masked as Adderall. Astounding.

Johnnie has climbed the pill craze ladder, as did his parents, but with a kicker---he takes stimulants. The effects on Johnnie of his powerful medicines far exceed the effects of those same medicines on his parents. Why? Johnnie is a child. He often takes antidepressants, anti-anxiety agents, mood stabilizers, antipsychotics and stimulants. To climb the pill craze ladder, it took Johnnie's parents 40 years. Johnnie did it in 10. Maybe Johnnie's brother can do it in five.

How does Johnny escape the pill crazed society? Education of parents may be very useful. Reading, studying, talking to friends, to doctors, to teachers, etc. Parents should learn as much as they can about their children. Notice their moods. Talk to them. Get them therapy if they need it. Drugs are only a very, very last resort.

The most useful education comes from us looking at ourselves. I mean everyone looking at themselves, carefully. I and most of my friends lived through the 70s and 80s and 90s and 2000s. Most of us had no medications, no treatments, no diagnoses. We certainly weren't perfect. Yet amazingly, most of us have done and are doing just fine. How are you doing?]]> tag:www.huffingtonpost.com,2010:/theblog//3.665838 2010-09-01T07:00:00-04:00 2011-11-17T09:02:45-05:00

Dr. Ronald Ricker and Dr. Venus Nicolino http://www.huffingtonpost.com/dr-ronald-ricker-and-dr-venus-nicolino/
Furthermore, it is now clear that often we are diagnosing ordinary childhood and adolescent behavior as mental disorders (Wait, children are supposed to be bursting with energy? It's normal for a teenager to be moody and aloof?). This diagnosing is not only based on this idea of "chemical imbalances," but also a general and pervasive notion that every non-acceptable behavior is due to a mental illness. And last, but certainly not least, the prescribing of these medications by doctors is based on the disinformation provided them by the FDA, drug manufactures and often fraudulent studies, all in the name of making money, on the backs of our children.

In a recent lecture, respected journalist, writer and Nobel Prize Nominee, Robert Whitaker (PBS, Boston, June 15, 2010) highlighted not only the appallingly unscientific methodology used in the development, prescription and use of psychotropic drugs in school-aged children, but also how hopelessly corrupt and failed the systems that should be regulating the safety of medicines are in this country.

Unfortunately, many drug companies exist for one reason: to make money. As such, the people who run these companies have developed a worldview bereft of any more notion of ethics or morality than British Petroleum. Some drug companies' success is not based on a drug's usefulness or the safety of its products, but whether it makes money. The path to more money is simple: find new uses for their old drugs, invent new drugs and find new markets for both new and old drugs. Unfortunately, children are today's newest market.

The FDA requires a "Successful Drug Trial" to approve new medications. "Trial" is often a misnomer, as the word implies some notion of impartiality and unknown outcome. These "trials" often are more like kangaroo courts. In one "trial," in this case to prove the usefulness of Prozac, corruption and dishonesty were the rule. Children who responded to placebos were removed from the data, as were negative responders to the actual drug. This meant that the only children who were left in the study group were so-called "positive responders." And, even then, the researchers and doctors, whose "research" funding was provided by the makers of Prozac, were the very ones to decide which subjects, if any, actually did respond "positively" to the drug. This, of course, is a massive conflict of interest. The doctors, researchers and drug companies all want the same thing -- FDA approval and to make more money.

In a 2004 article published in perhaps the most prestigious British medical journal, Lancet, said the trial studies used to provide proof of the usefulness of anti-depressant drugs in children, were "nothing but fraudulent." Following that assessment, all anti-depressants but Prozac were banned in the UK for use on children. (The fact that Prozac was not banned was based on very dubious, some say dishonest, research as documented above).

The true damage caused by the use of anti-depressant drugs like Paxil, Zoloft, Prozac, etc. (AKA of SSRI's: Selective serotonin reuptake inhibitors) by school-aged children is only found by legitimate, longer studies, like those that continued from 17 months to six years. In one study, 25 percent of children who had been on SSRI's for three years were re-diagnosed with the much more serious disorder of Bi-polar disease. This number increased to 50 percent after six years of SSRI use. Long-term use of new anti-psychotics may lead to even greater problems than the initial disease. Diabetes, morbid obesity and early death have all been linked to the use of these drugs. And, as written by us in a previous blog both short and long term use of stimulant drugs such as Adderall), have numerous serious side effects.

What should be a major concern, especially for parents, is the ever-widening definition of what constitutes a childhood mental disorder, a "chemical imbalance" and what, if any, drugs should even be considered to treat these "imbalances." They should also be very concerned about whether these drugs even work (most don't), and, even more importantly, the long-term outcome of the use of these drugs.]]> tag:www.huffingtonpost.com,2010:/theblog//3.700491 2010-08-31T13:02:09-04:00 2011-05-25T17:30:22-04:00

Dr. Ronald Ricker and Dr. Venus Nicolino http://www.huffingtonpost.com/dr-ronald-ricker-and-dr-venus-nicolino/
Today, there are vastly more single parent families. Fathers, for the most part are totally absent. Child abuse has increased immensely. The proportion of children in the foster care system has increased dramatically. Ordinary familial roles have deteriorated dramatically. Violence, anger, and acting out are the rule rather than the exception in many families. There are very poor boundaries in relationship to others, especially authority and institutions representing authority such as the police and schools. Daily social conformity often seems a thing of the past. Running the streets, gang involvement, drug use, and teenage pregnancy are rampant. The misguided parental involvement and lack of appropriate modeling and structure undermines children's and adolescents' self-esteem, motivation, and ambition, creating apathy and hopelessness. The school drop-out rate in one very large urban community is estimated at 80%.


Remedies in the schools for these problems, in the past and present, but for a few wonderful and involved teachers and administrators and a few imaginative programs (e.g. charter schools), amount to a chasm of nothing. The education of many adolescents literally doesn't happen. The school graduation rate in this same community is approximately 20%. Behavioral and emotional needs are either ignored or dealt with superficially, if at all, or left to others, such as the parents and police. Frequent suspensions, transfers from one school to another are popular 'remedies'. Out of sight, out of mind. The strength of families, no matter how strong or weak, is rarely encouraged or used in schools. Efforts to involve, teach and strengthen families, teaching them their key role in their adolescent's success in school, are virtually absent. Teaching families the necessity of maintaining appropriate in-home standards and rules, emphasizing respect for authority and proper socialization skills are usually ignored. Promoting the direct involvement of families in schools such as volunteering, classroom assistance, monitoring and promoting the emotional and behavioral development of their adolescent is virtually a non-event.

The Linden Center, a nonprofit Los Angeles based program, is an example of a program that attempts to deal with these problems. Linden Center believes that Respect is the cornerstone of its program, without which there is little or no hope for positive development. Its fundamental values and beliefs are that self-worth, the development of meaningful interpersonal relationships, academic and vocational success are predicated upon structure, predictability, and high expectations.

The Linden Center integrates emotional support with behavioral standards and academics. It creates structured behavioral, emotional, and academic processes and experiences that repeatedly clarify appropriate roles, reinforce appropriate behaviors, set consistent limits, and provide learning experiences that are individually tailored so as to be reachable and master-able. Career training is also provided so that students' strengths become valuable assets in society and to themselves.

The level of behavioral and emotional problems present in Linden Center children is immense. Many, if not all of Linden Centers' students require assistance with serious emotional difficulties, including anxiety disorders, depression, suicide attempts, hearing voices, hallucinations, etc. To that end Linden Center provides mental health treatment with its staff of seven psychotherapists and one psychiatrist. This area is both one of the greatest challenges and successes at Linden Center.

Family involvement is a crucial part of an adolescent's success. Meetings, open-houses, and parental involvement with their adolescent's emotional and behavioral problems is a great strength at Linden Center. Many of Linden Center's families are very poor. To that end Linden Center has created a program to offer financial help to their families, linked to the school attendance of their students. If a family's adolescent attendance is 100% during a month, for example, the family receives a stipend of $50. This program encourages parents to motivate their children to attend school and helps families with at least some of their day-to-day needs.

Linden Center's success rate is very high. The most prominent successes are related to the often dramatic improvement of its students' emotional and behavioral problems and level of academic functioning. A typical student entering Linden Center is behaviorally out of control, very often violent, severely emotionally ill and academically far behind. Stories of dramatic improvement in these areas are legion and are far too many to count.

The success of Linden Center graduates varies widely. Many are highly successful. A sampling of this group includes four-year college graduates (one from UCLA), community college attendees and graduates, successful professionals, members of the armed services, policemen, and successful family members with wives/husbands and children. One student went to and graduated from culinary school, one joined the Army, one became an EMT, and one a manger of a large university cafeteria. One girl, having graduated from college, wrote an opera. Of other college graduates, one became a social worker, one a teacher of English in Japan, and one a successful mortgage broker.

There are some students, sadly, who have done poorly or very poorly. A number live on welfare. Some have become pregnant and live on welfare. Some have been convicted of crimes. Three students have been killed. Two of these were innocent victims of gang violence. The third was killed during the commission of a crime by the police.

Nonprofit programs like the Linden Center are rapidly closing due to the cutbacks in state funding and decreases in private donations. Despite massive attempts at fund raising, raising enough money to operate Linden Center is and remains a monumental problem.

Writer's Post Script: The United States sends resources and money all over the world, often ignoring disastrous problems at home. We must remember the needs of those of us at home, those of us living in the United States. The Linden Center is but one example of programs striving to help our children and adolescents. There are many others. Sadly, most are near financial extinction.

More information about The Linden Center can be obtained at info@thelindencenter.com

]]> tag:www.huffingtonpost.com,2010:/theblog//3.619549 2010-06-21T14:48:11-04:00 2011-11-17T09:02:45-05:00

Dr. Ronald Ricker and Dr. Venus Nicolino http://www.huffingtonpost.com/dr-ronald-ricker-and-dr-venus-nicolino/
Adderall has the dubious distinction of being the latest addition to the rogue's gallery of lawful drugs that have made the transition to the black market. In recent years, abuse of Adderall and its imitators has increased by nearly 200 percent. Calling it an "upper" is like calling a hydrogen bomb a grenade. It is made of pure amphetamine, it's already picked up its share of street monikers: Speed, Beans, Black Beauties, Christmas Trees, and Double Trouble, amongst others.

What are the pluses in this wonder-drug? In ordinary people it often but not always offers increased concentration. It also keeps people awake for more studying and lots more partying. It often offers a sense of euphoria and happiness and a lot better and more frequent sex, all fun at parties.

Between the glut of pop-psychology theories (often fraudulent) and the never-ending blitz of promotion by Big Pharma, people now believe they can diagnose themselves with something like ADHD as easily as ascertaining if they have a head cold and believe they have the ability to determine the correct medication for their condition. Sometimes they're grandiosely right. Most of the time, however, they're wrong on both counts. Even more of the time, diagnosis is irrelevant. The relevant question is where's the "connection?" Sadly, that's where many of us physicians fit in. We certainly don't intend to, but often serve as the 'connection'. Then, of course, there are those 'patients' and doctors that inhabit the bottom of the barrel: lying 'patients' and immoral doctors. Scripts can and are sold, for lots of money. Never mind the human cost, there's money to be made and drugs to be copped. Take that prescription to the pharmacy. Or, take your money to a nearby local University. You'll pay $30 to $40 dollars per pill for a very small amount of Adderall, usually sold to you by a student. Sales are usually student to student although the numbers of genuine drug dealers are growing rapidly in numbers, bringing with them all the problems of low-life, criminal drug dealers. Dealers recognize good business opportunities. Imagining little Johnny, having just finished Geography 1A, dealing with a real dealer chills the mind.

Illicit Adderall is taken in many ways. Most obviously, a pill can be swallowed. Pills can also be chewed, ground up and snorted, and ground up and injected (the most dangerous way of administration, by far). And then there's 'Stuffing'. This is accomplished by 'stuffing' Adderall in any orifice with a mucous membrane (anus, vagina, penis, mouth, etc.). Shooting gets the most immediate and strongest effect. Snorting is second, chewing third, and stuffing fourth. What 'stuffing' lacks in immediate 'oomph' and the loss of whatever dignity the person may retain, is made up by the length of effect and allows for the greatest amount of Adderall to be used at one time. The anus and vagina are big places and can hold a great deal of Adderall.

Sadly, there's no free lunch.

1) Side effects are numerous. Some are minor, some serious, and some very serious. Most users have no clue as to negative side effects and usually don't care. Ignorance, we suppose, is bliss. The most important and most negative side-effect is the Overdose. Overdose with Adderall is nasty. Results include Cardiac and/or pulmonary arrest, death, severe and lasting mental effects/defects. Which one happens to you is a matter of chance. If you're in an Emergency Room and still alive your chances are relatively good. If you overdose at your apartment and are alone, the chance of your living is slim. If you Over Dose at a party, maybe a Frat Party, you've probably bought it. Drunken, high Frat boys are not known for their medical skills or even a modicum of clear thinking. Minor side effects include anxiety, and transient depression. More serious effects include heart palpitations, elevation of blood pressure, Tourette's syndrome, seizures, stroke, and psychotic episodes or plain old psychosis.

2) Adderall is very, very addictive. Along with the 'fun' of physical and psychological damage, this drug opens the awful Pandora's Box of addiction, with all its' sadness, pain and misery. Adderall not only opens this Box, but also resides within. It is a 'gateway' drug, often leading to other fun drugs like cocaine, heroin, E, etc.

3) The Law. The sale, possession and use of Adderall for illegitimate purposes is a felony. The Drug Enforcement Administration and police are getting better and better at catching end users. Jail, fines and a criminal record are doled out more and more frequently.

4) There are the "grown-up" ramifications, those real-life, practical consequences that aren't even on the radar of the average college kid. For example, life and health insurance: If one lies about a diagnosis, such as ADHD, they still have the diagnosis on their medical records. Health Insurance companies do not have a reputation for being the most empathetic or understanding of institutions, and that's not just towards those who are actually sick. "I have ADHD (lying or not), and I take Adderall" are very good, probably, certain reasons for turn down. Arrests usually aren't flattering criteria for getting a job. Anybody know about Google? Police records are as easy to find as Adderall on campus. More and more employers search prospective employees backgrounds.

Can one live without Adderall?

As far as the fun, this seems to come with the package (you're the package). There's already a place producing more than enough chemicals on its own to make you horny and rowdy: your own body. And, at least, those are free and legal.

The first six pack of 40's is on us.]]>