Pondering what goes unspoken

As I write this, I am at an international conference in which the primary topic is dual disorders–meaning the  not so infrequent clinical situation in which someone is suffering from both a mental health and addictions problem at the same time. The medical field understands dual or co-occurring disorders to be harder to treat than when there is one disorder. Adolescents with co-occurring mental health and addictions, have an even harder time in school then if they had one disorder, have more problems functioning and take longer to get better. To be frank, I think a lot of psychiatrists don’t like to ask about the addictions part of the problem because they are not sure what to do about it. For the patient or client, there is often shame or discomfort about sharing information about their addiction, or they are just not ready or sure how to. So, addictions and dual disorders remain unspoken between doctor and patient. Here are 5 things we can do about that:

  1. Your pediatrician or primary care doctor should be screening for substance use or other risk behaviors regularly. 
  2. All child and adolescents psychiatrists should assess for both mental health symptoms and substance use disorders in their first sessions with adolescents and older children and continue to monitor and offer information.
  3. The doctor should ask about substance use without judgement, asking the patient about both what they find positive and negative about using drugs or drinking. Knowing both sides, negative and positive, helps with discerning motivation for change and brings to light the ambivalence we can all have about change.
  4. Ideally, treatment offered should address both disorders in an integrated fashion (both together).
  5. All of us should remember that both psychiatric disorders and addictions are both treatable, and people often do get better. It can take a while to see change and often only after a series of attempts, lapses and relapses but recovery is possible.

If we can talk about it then we can work on it. 

Secrets of a Latina Child Psychiatrist

Child psychiatrists are physicians trained in child development, pediatric mental health disorders, talk therapy and medical care for children and adolescents suffering from a range of mental health problems: depression, anxiety, psychosis, neurodevelopment disorders such as Autism Spectrum Disorders. There are not enough child and adolescent psychiatrists to serve all of the needs of the US population of pediatric patients with psychiatric disorders. However, mental health and behavioral disorders are among the most prevalent and disabling health problems faced by young people. As a Latina, bilingual psychiatrist I also am one of a few child psychiatrists in the country who can serve Spanish speaking children and families. But to be honest, I wish we had more child and adolescent psychiatrists in the country to serve all of the young people who need care. I also believe that child psychiatrists should not have their practice limited to providing pharmacological treatments (medication), as is the trend, but given the opportunity to offer integrated care (therapy, family and other interventions that may also include medications if needed)  for helping children and adolescents.

I want to welcome you to this blog. I hope you visit frequently. I hope to offer you some helpful information that I share with you from my experience as a practicing child psychiatrist who has worked in diverse settings and with many families for over 15 years.  Families, youth and medical providers often have many questions about  mental illness or behavioral health problems in children. I can’t offer you specific medical advise but I hope we can enter in a dialogue about the challenges, and opportunities for better addressing the needs of our children especially the most vulnerable.


Dr. Lisa