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At his three pediatric offices on Cape Cod, it’s not uncommon for Dr. Leif Norenberg to meet a 12-year-old patient who smokes marijuana or a teenage girl who cuts her arms.
“Years ago, I didn’t know what to do. I’d ask patients, ‘Are you anxious, are you depressed?’ I saw they were cutting and I’d say ‘Oh my gosh, what do we do?’” recalled Norenberg. “I didn’t know what to do, so we’d refer them to a counselor and they might or might not go.”
These days, there’s a clinical social worker on his team. She’s available during regular office visits to help children and youth manage everything from anxiety to drug use. Ideally, she nips the problem in the bud, but there’s also a larger goal: to identify — and treat — the early signs of addiction.
“There’s a link between untreated mental health and addictive disease,” said Catie Dotolo, the social worker embedded in Norenberg’s pediatric practice. “If a young child struggled with anxiety and didn’t learn skills or tools to navigate those feelings, eventually that child could find reprieve in substance. They could use, they could drink, and, suddenly, their symptoms aren’t so bad.”
I'd ask patients, 'Are you anxious, are you depressed?' I saw they were cutting and I'd say 'Oh my gosh, what do we do?' I didn't know what to do, so we'd refer them to a counselor and they might or might not go.
Dotolo’s work in the pediatric practice is part of a pilot project run by Gosnold on Cape Cod, a detox and addiction treatment center. Founder Ray Tamasi says most people show up at Gosnold when their addiction escalates to the point of crisis. Why not, he asks, treat addiction like heart disease or childhood asthma and, instead, take a more proactive approach?
“Think about how we treat other conditions. We try to identify early, we screen people and identify or stratify the risk,” said Tamasi. “We know there are risk factors that make people more likely to develop substance abuse disorders. We don’t do a lot about that early on."
Yet Dotolo says conditions like depression and anxiety are remarkably common. “More than 70 percent of the children that I interface with can identify the emotion of anxiety. Not all have anxiety disorders, but there is a lot of pressure today on children," she said.
When there’s a significant mental health or substance use issue, Dotolo will refer children and families to outside help. She deals with what, at least on the surface, might be considered the small stuff.
For instance, a teenage boy smoking pot.
Dotolo connected WGBH News with a 16-year-old patient who is now a junior at a Cape Cod high school. The boy, who did not want to be identified, started smoking marijuana in eighth grade. He says it was a mix of curiosity and peer pressure that led him to try to the drug, but says he continued to use it because it eased his anxiety about school.
“Eighth grade, I don’t know why, but it was kind of a stressful for me. I guess [the marijuana] got rid of the stress, in a way,” he said.
The boy’s mother, who also asked not to be identified, says it was clear that her son was worried about his marijuana use. Unsure what else to do, she brought him to the pediatrician’s office, where he connected with Dotolo.
“Had that not happened immediately on the spot, I think we would have probably said, ‘Oh, it’s an aberration, it’s typical peer pressure. It’s everywhere, no big deal,'" she said. "I think she helped him put it in perspective and helped him think about [how] it is out there, and your choices make a difference in what you do with your life," she said.
There should be a nationwide push for this. The world isn't getting any less weird or less stressful.
The boy said his time with Dotolo made a lasting impression, helping him prioritize his well-being and better understand his emotions.
“I didn’t get what was going on, why I was feeling that way,” said the boy. “She helped me pinpoint what was really the problem and the issue.”
Leif Norenberg, the pediatrician, says having Dotolo in his office is not a magic bullet. There are still children dealing with mental health and addiction issues. But in the two years since Dotolo joined his team, he’s seen a positive impact.
“We’ve taken kids who were not talking to parents, not going to activities, were floundering in school,” said Norenberg. "And all of a sudden, they’re back to normal or as close to normal as any of us can be.”
Dotolo’s work is funded through a grant. Scaling this project may be difficult because insurance companies typically reimburse medical care and behavioral care separately. There’s no mechanism to pay for this kind of integrated care.
“There should be a nationwide push for this,” said Norenberg. “The world isn’t getting any less weird or less stressful.”