Often when we think about teens smoking weed, we think of scenes like That Seventies Show, with kids enjoying the giddy side effects and having fun. There is another side to marijuana use though, and it isn’t often talked about in the media. Cannabinoid Hyperemesis Syndrome (CHS) is a condition that is brought on by using high potency THC over a long period of time. The syndrome causes severe nausea and vomiting, and often occurs within 1-5 years of chronic use.

The medical community is slow to acknowledge how rapidly this condition is becoming more and more common. Look on-line and you’ll find established medical centers using words like “rare” and “only after long periods of daily use.” However, what is happening in my practice is I am seeing prodromal phase of this condition with an increasing frequency.

People who suffer from this condition experience three phases of the illness: the Prodromal phase, the Hyperemetic phase, and the Recovery phase. The Prodromal phase is the stage in which symptoms of abdominal pain and nausea are uncomfortable and occur mostly in the morning. Ironically, those suffering in the early phase of the illness often use marijuana to try to curb the nausea, as it is known to abate nausea in many people who are suffering from ill effects of other conditions. Unfortunately, this use establishes a pattern of worsening symptoms. In the Hyperemetic phase, the abdominal pain and nausea become productive and manifest in repeated bouts of intense cyclical vomiting. During this time, the desire to eat and drink diminishes, causing weight loss and dehydration. Taking hot showers and baths help alleviate the symptoms temporarily, but if marijuana use continues, symptoms continue to worsen. The Recovery Phase occurs when marijuana use has stopped and is out of the system. It is then possible for the person to eat and drink normally. It may feel like normal life has finally resumed, this can last for many months, unless the person uses marijuana, at which point the symptoms can re-emerge and set the cycle into effect all over again.

It does seem like a strange reality that the very substance often used for alleviating nausea can cause this type of illness for some chronic pot users. Apparently, the difference lies in the area of the body being stimulated by marijuana use. People who get relief from nausea through marijuana use experience this relief due to the impact of the substance on the areas of the brain that effect nausea. For CHS sufferers, they are experiencing the impact of marijuana use on their digestive tract. Early on in marijuana use, brain receptors are more sensitive to THCs effects;  high levels of THC marijuana usage decreases the brain’s sensitivity to the THC effects, and this can result in greater sensitivity to the digestive effects of the substance (nausea and vomiting). And todays marijuana industry is selling legally and illegally THC strengths upwards of 50% - 90% THC.

Parents of teens who use marijuana frequently may notice digestive issues emerging in their kids. Having an awareness of CHS and the stages of the illness can help parents and kids monitor these symptoms and determine if the digestive upset is being caused by marijuana use or some other cause.

Teens are skeptical of parental input regarding marijuana use, particularly if they already know that their parents are not in agreement with their usage. Information about CHS can be shared with teens as a possible medical issue brought about by marijuana use. Informing them of symptoms to look out for (abdominal pain, nausea, vomiting) and offering to arrange a medical consult may empower them to look into the condition on their own or start to observe any trends related to their usage patterns. Initially, teens who are struggling with some of the symptoms may resist the idea that it could be CHS, since the only way to reverse the symptoms is to cease all use of marijuana. As with many other areas of parenting a teen, engaging in a power struggle about it is futile. Sharing information and expressing your care and concern may show your teen that, while you love them and want them to be healthy, you also understand that they need to come to terms with the possibility that their physical health is being impacted by marijuana use, and how disappointing that must feel for them. It can be challenging to strike a balance between trying to help them “fix” the problem and encouraging them to take a look at the facts and determine it for themselves; especially since we know that their prefrontal cortex is still developing process and they actually DO need our help to make decisions and think critically! Showing teens that their thoughts and opinions are important and encouraging them to consider their digestive symptoms and whether they could be related to marijuana use is a non-confrontational way to have the conversation and encourage self-reflection.

Many teens may under report their THC use to their doctor, and with child consent laws being what they are in many states (as low as 14) you as their parent may be in the dark about the level of information your child is providing their doctors. That said, as a proactive parent, it is worth sharing your concerns to your child’s doctor about the possibility of CHS, particularly as it is still not a commonly known condition, particularly in the prodromal phase. Don’t be afraid to bring this up to the care team. Often having a doctor support the possible diagnosis and share details with your teen directly can be impactful.

Lastly, the only definitive test for CHS is to stop smoking weed altogether. While on the one hand you might think, “great! Easy fix! My kid will get better immediately, “ the truths is these higher concentrations of THC are incredibly addictive, and take more than willpower to overcome. This is why so many of my clients end up needing residential care to help them to stop. Once they begin to see and feel healthy again, they have taken the most important first step to stem a very serious medical condition, not to mention the positive impact on drug-free brain development. It is a rough road, but there is hope and help.

Sometimes when people think of Obsessive Compulsive Disorder (OCD) they have a narrow view of what the condition involves. The average person may jump to the stereotypical excessive-handwashing version of OCD, or the person who obsessively checks the stove to make sure they turned off the burner. These are examples of how OCD can show up in people’s lives, but it doesn’t tell the whole story. 

Anyone who has this anxiety-based condition or has a loved one with OCD can attest to the varying ways it can present itself in thought, feeling and behavior. The hallmark of an OCD diagnosis is the presence of two components; obsessive thoughts that are distressing and repetitious, and compulsive urges to engage in behavior to reduce the stress. It’s not exactly a picnic in the park for teens with this condition, but it is manageable with the right type of treatment.

Obsessive Compulsive Disorder responds well to Cognitive Behavioral Therapy (CBT) because it helps teens dissect thoughts and feelings, while identifying ways to disrupt the urge to engage in the behaviors that can take up so much time and energy. Often the key to breaking up with OCD is learning how to tolerate the strong urges to act on distressing thought without giving in. 

​For teens who are struggling with this, it may sound impossible; the urge to engage in certain behaviors to reduce stress is powerful, but this is the avenue toward freedom. Think of it like a workout, or a training session for your thoughts and feelings. No one starts out running a 5K on their first day out jogging or benching 300 pounds their first visit to the gym. It’s all about learning the techniques and skills that can help you become an OCD Jedi Master. 

Cognitive Behavioral Therapy also helps teens sort out some of the underlying anxieties that drive OCD. Learning about triggers is a helpful way to recognize when symptoms may become more intense. Covid-19 may be a trigger for people who struggle with fears surrounding viruses or infectious illness, for example. For some this may manifest in excessive hand washing, overuse of hand sanitizer or other behaviors to reduce stress. 

It is important to remember that the compulsive behaviors of OCD are well beyond the range of typical precaution. Compulsive behaviors are time-consuming and/or disruptive to daily life. CBT can help teens determine where behaviors make the leap into being excessive or disruptive and then work on building tolerance to the distressing thoughts. Teens in treatment can learn to use coping strategies to manage thoughts and urges rather than giving in to them. Medications can also be useful for teens struggling with OCD, but it is crucial to engage in the therapeutic aspect of the work to build skills for managing it. Often CBT is sufficient, and no medications are needed.  

​Parents of kids with OCD are often flummoxed about how to help. The best thing a parent can do is offer empathy, support, and gentle reminders of coping skills when anxiety triggers are mounting. Remember that teens who are struggling with OCD are distressed by their thoughts and that is what drives the compulsive behaviors. It may be tempting to try to convince them that their thoughts are illogical or baseless, but this approach is likely to cause even more stress, which could increase symptoms. 

​Remember, your teen will build tolerance for varying thoughts and levels of distress in therapy and will learn to trust their minds with uncomfortable thoughts. Managing OCD is about learning how to keep perspective and recognize that thoughts are “only thoughts” and do not require excessive attention or action. When people with OCD learn to allow thoughts to enter and exit the mind like a passing breeze, it can alleviate a lot of stress and often symptoms begin to subside. Even when anxiety is causing some thoughts to get stuck, treatment can help teens recognize the familiar pattern and use skills learned in counseling to get through a difficult moment without giving in to a compulsive urge. 

Parents can also do some research to learn more about OCD and the ways it can affect teens. There are a variety of great resources available, including the McLean Hospital site and Peace of Mind. Both sites are helpful for parents to learn more about OCD and varying treatment methods. Teens will enjoy BeyondOCD.org Just for Teens site. 

Regardless of where you are on your journey with OCD, and whether you are a parent or a teen with the condition, relief is possible. When you use CBT tools and practice strategies, you can manage OCD and enjoy your life.

Often even the most emotionally reticent teens connect with holiday wonder. It is, indeed, the most wonderful time of the year (or it is supposed to be, according to the song and the hyper-energetic festivity).

The holidays are likely to look far different this year, with Covid lurking around. Many of us are changing our plans and scaling back holiday gatherings, postponing trips to see family and friends, all in the name of safe social distancing practices. These are the wise choices we are making to keep ourselves and our loved ones safe, but that doesn’t make it fun.

Even if your teen isn’t saying it openly, the shift in traditional festivities is likely impacting them emotionally. Teens who are already prone to depression and anxiety may feel the affect of these changes with greater depth but may not have the ability to articulate it.

If you are worried about your teen’s emotional health this holiday season, here are some things to pay attention to that may indicate internal struggle.

Sometimes anxiety and depressive symptoms aren’t outwardly noticeable and can impact your teen. A depressed or anxious teen might also be experiencing:

Ask any group of parents about their fears for their teenager and you will get a zillion different responses. There are plenty of things to worry about when it comes to teens (we earn these gray hairs, afterall). Out of the long list of issues parents worry about, substance abuse is certainly in the top five. Some parents may worry a lot about their teen’s drug and alcohol use, while others tend to think about substance use as a rite of passage, and as a result may be less concerned about it. Regardless of where we stand on the topic, it can be  helpful to understand more about substance use so we can be proactive and compassionate with kids who may be struggling.

Ten million people between the ages of 12 and 29 need treatment for substance abuse. Understanding drug and alcohol use patterns in teens is important because most people who later struggle with addiction start at a young age, some as young as 12 or 13 years old.

The graphic above shows varying types of street drugs teens typically abuse, but the number one substance teens access is alcohol. One study shows that an alarming 4.3 million youth report binge drinking within the past month.

Often, we feel at a loss as to how to protect our kids from the detrimental effects of substances. We hear stories about teen overdose deaths, sexual assaults that are committed during intoxication, car accidents, legal involvement and so on.