CAPC Marshfield

CAPC Marshfield is a revolutionary mental health clinic. We are actively engaged in the training of new therapists and nurse practitioners.  Under the supervision of therapist Jolene Nowak,  Psychiatrist Dr. Jenna Moravec, and Mental Health Nurse Practitioner Shelley Strojni, we train social workers, Licensed Professional Counselors, and Marriage and Family therapists from several Wisconsin schools, including the University of Wisconsin system.  We also supervise Advanced Practice Nurse Practitioner Students and Medical students and Residents from the Medical College of Wisconsin, Central Wisconsin Campus.  You can be assured of receiving high-quality care from clinicians practicing at the highest standards of ethics and the most current scientific evidence.

Our clinicians utilize treatment interventions that have been given the highest rating from SAMSHA,  the Substance Abuse and Mental Health Services Administration, including Theraplay. We also utilize  Acceptance and Commitment Therapy, Family Based Therapy, Trust-Based Relationship Intervention, Modular Based Family Therapy, and the Nurtured Heart approach, Mindfulness-Based Cognitive Behavioral Therapy, Trauma-Focused CBT, EMDR,  Experiential and Metaphor Therapy.  Our clinicians are also in the process of becoming trained as providers of Mentalizing Based Therapy.

Youth Crime: Incarceration is too costly

The long-term cost of incarcerating the nation’s youth is between $8 and  $21 billion, according to a report out Tuesday. The Justice Policy Institute’s “Sticker Shock: Calculating the Full Price Tag for Youth Incarceration” says Florida’s base cost is $55,000 dollars per juvenile per year. From there, the number increases. According to the Justice Police Institute’s executive director, Marc Schindler, the total cost of detaining juveniles is about more than running juvenile detention centers. It also includes lost future earnings, tax payments from confined youth, future reliance of formerly confined youth on public assistance. Previous studies suggest that kids locked up for minor crimes might go down a worse path;  the incarceration of youth increases the likelihood that they will commit new offenses, and this Justice Policy study considers the costs of those harmed by these new offenses.

Juvenile Detention: Its costs go beyond the costs of running the detention facility.

Juvenile Detention: Its costs go beyond the costs of running the detention facility.


FACTSHEET: The tip of the iceberg: What taxpayers pay to incarcerate youth Sticker Shock: Calculating the Full Price Tag for Youth Incarceration

Marijuana Affects the Brain, Even with Minimal Use

Marijuana is the most commonly used illicit drug in the United States.  A new study reveals that Mariuana affects the brain, even with minimal use.

Marijuana use is  associated with problems with motivation, attention, learning, and memory. Animal studies have shown that  marijuana’s active ingredient, Δ9-tetrahydrocannabinol,  produces structural changes in the nucleus accumbens. However, less is known about how low to moderate marijuana use affects brain structure in people, particularly in teens and young adults.

Researchers used magnetic resonance imaging (MRI) to compare the brains  people 18-25 years old who reported smoking marijuana at least once per week with those with little to no history of marijuana use. Imaging data revealed significant brain differences between non users of marijuana and minimal users of marijuana.

Persons who were dependent on marijuana were excluded from the study. The size and shape of the amygdala (which is responsible for regulation of emotions)  and the nucleus accumbens  (which is responsible for motivation and reward processing) was different in casual or minimal users of marijuana compared to those who have not used.  The scientists found that the more the marijuana users reported consuming, the greater the abnormalities in the nucleus accumbens and amygdala. The shape and density of both of these regions also differed between marijuana users and non-users. The study was published April 16 in The Journal of Neuroscience.

The findings suggest that marijuana affects the brain, even with minimal use. “This study suggests that even light to moderate recreational marijuana use can cause changes in brain anatomy,” said Carl Lupica, PhD, who studies drug addiction at the National Institute on Drug Abuse, and was not involved with this study. “These observations are particularly interesting because previous studies have focused primarily on the brains of heavy marijuana smokers, and have largely ignored the brains of casual users.”


ADHD has neurobiological origin, study confirms

A study carried out on mice has just confirmed the neurobiological origin of attention-deficit hyperactivity disorder (ADHD), a syndrome whose causes are poorly understood. Researchers have identified that hyper stimulation of the superior colliculus causes behaviors similar to those of some patients who suffer from ADHD. They report that norepinephrine accumulates in the affected area, confirming that this neurotransmitter plays a role in attention disorders.

ADHD affects between 4-8% of children. It manifests mainly through disturbed attention and verbal and motor impulsiveness, sometimes accompanied by hyperactivity. About 60% of these children still show symptoms in adulthood. No cure exists at this time.

Effective treatments include psychostimulants and neurofeedback. Persistent controversy surrounding the neurobiological origin of this disorder has hindered the development of new treatments.

The study in Strasbourg investigated the behavior of transgenic mice having developmental defects in the superior colliculus. This structure, located in the midbrain, is a sensory hub involved in controlling attention and visual and spatial orientation. The mice studied were characterized by duplicated neuron projections between the superior colliculus and the retina. This anomaly causes visual hyperstimulation and excess norepinephrine in the superior colliculus. The effects of the neurotransmitter norepinephrine which vary from species to species, are still poorly understood. However, we do know that this norepinephrine imbalance is associated with significant behavioral changes in mice carrying the genetic mutation. By studying them, researchers have observed a loss of inhibition: for example mice hesitate less to penetrate a hostile environment. They have difficulties in understanding relevant information and demonstrate a form of impulsiveness. These symptoms remind us of adult patients suffering from one of the forms of ADHD.

Currently, the fundamental work on ADHD uses mainly animal models obtained by mutations that disturb dopamine production and transmission pathways. In mice with a malformed superior colliculus, these pathways are intact. The changes occur elsewhere in the neural networks of the midbrain. By broadening the classic boundary used to research its causes, using these new models would allow a more global approach to ADHD to be developed. Characterizing the effects of norepinephrine on the superior colliculus more precisely could open the way to innovative therapeutic strategies.

Journal Reference:
Chantal Mathis, Elise Savier, Jean-Bastien Bott, Daniel Clesse, Nicholas Bevins, Dominique Sage-Ciocca, Karin Geiger, Anaïs Gillet, Alexis Laux-Biehlmann, Yannick Goumon, Adrien Lacaud, Vincent Lelièvre, Christian Kelche, Jean-Christophe Cassel, Frank W. Pfrieger, Michael Reber. Defective response inhibition and collicular noradrenaline enrichment in mice with duplicated retinotopic map in the superior colliculus. Brain Structure and Function, 2014; DOI: 10.1007/s00429-014-0745-5
Brain Structure and Function.

Eating Disorders 101-Managing Serious Mental Illness In Schools

Eating Disorders 101 – Managing Serious Mental Illness in Schools was presented at the 2014 Wisconsin Association of School Nurses Spring Conference
on April 10, 2014
Jenna Saul, MD, DFAACAP – Owner and Medical Director, Child & Adolescent Psychiatry Consulting and Horses Treat

Robyn Hussa Farrell, MFA, E-RYT – Founder & CEO, Mental Fitness, Inc.

Dawn Radsek, RN–Froedert Hospital

Eating Disorders 101 – Managing Serious Mental Illness in Schools is a Train-the-Trainer program for school nurses. Participants
will be introduced to this national evidence-based program for school nurses to lead eating disorders and obesity awareness and prevention trainings in their district. The presentation will include a program overview, 15 minute documentary film, time for questions and discussion with a certified eating disorder specialist and national program director.


This program was funded by a grant from the American Academy of Child  & Adolescent Psychiatry

Parenting the Whole Child: A Holistic Child Psychiatrist Offers Practical Wisdom on Behavior, Brain Health, Nutrition, Exercise, Family Life, Peer Relationships, School Life, Trauma, Medication, and More

My rating was a 5 out of 5 stars

This book is a definitive guide for parents who want to help their children grow to be resilient, optimistic and adaptive. For children whose parents are struggling, the book can be beacon of hope, a road map to helping their children become adaptive and reach their full potential. Dr. Shannon is a voice of hope who acknowledges that while mental health problems exist the labels given no longer have to be thought of as static, restrictive or permanent constructs.  Shannon integrates knowledge of  how the brain  can change with recommendations for nurturing strengths to promote health and wholeness. Dr. Shannon applies scientific research from Neuro-development, Psychology and Nutritional Science with an understanding of Positive Psychology, research in learning, family dynamics, and social development to provide parents with a clear, integrated, and holistic understanding of how to promote a child’s healthy mental, social and emotional well-being.  While Shannon’s book emphasizes a holistic approach, it remains practical and real-life; it does not suggest that one must live their lives in a biome  to provide a nurturing, positive, healthy environment for a child to thrive. Every one of us can parent for Wholeness.

Click here and it will bring you to Good Read for a better look at the book.

Eating Disorders and Addiction, Which Comes First?

Eating Disorders And Addiction 

The eating disorder sufferer, whether female or male will often have a complex array of symptoms. Sometimes they will fit neatly into the Anorexic or Bulimic spectrum, and other times may exhibit symptoms of both, or have other complicated patterns of beliefs about food and their weight. Recent studies over the last decade, on both small and large scale show that as many as fifty percent of all eating disorder sufferers may be likely to have some form of problem with substance abuse or drug addiction too.

The link between eating disorder and substance abuse

When someone is suffering from an eating disorder their symptoms will be such that no matter how hard they try, what they see in the mirror is never good enough, they may view themselves as holding too much weight and whatever the scales say, they will be lying. In a person who is addicted to drugs or other substances, they may feel that they have no control over the stress in their lives or that they simply cannot cope with every day challenges. By taking whatever their substance of choice is, they perceive, albeit wrongly, that it gives them a sense of calm and ease and so they feel more able to cope. The coping mechanism of someone with anorexia, bulimia or EDNOS is similar by nature, the sufferer using either restriction of food or binge eating as a way to cope with their mental troubles. Thus in some cases, the sufferer may turn to substances as a way of trying to deal with their frustrations. It is believed that the condition is more likely to affect people who suffer with bulimia rather than anorexia, though not totally exclusively.

Which comes first?

It’s also important to examine the way in which either condition develops. In some sufferers the eating disorder will present itself first, with the onset of substance abuse following. In such cases, the sufferer may begin to experiment with drugs as a way of firstly suppressing the appetite, secondly as a way of keeping themselves going for long periods of time without eating and thirdly as a way of keeping anxiety and any psychological distress to a minimum. In other cases, the reverse might happen – the sufferer of a drug addiction finding that when they start to withdraw from substances that their appetite and hunger signals become confused which can then lead on to problems with food and either restrictive eating or binging developing.

Eating disorders as an addiction

It’s true to say that in many cases an eating disorder is an addiction in itself. In cases of anorexia and bulimia the sufferer will become addicted to trying to control their weight and try to control what they consume on a daily basis. Sufferers will be affected entirely by genetics, what they see in their immediate environment, how friends and family behave around food and perhaps any traumas or difficulties they have experienced in their lives. All this will create grounding for the development of eating problems and the potential for an issue with drugs or other substances to develop. However, in situations like these it is important to remember that they can be overcome.

Repairing and recovering

It is completely possible to make a recovery from both eating disorders and substance abuse. Finding drug addiction help in Maryland or any other state across the country is something that is incredibly important, alongside treatment for issues with food. Anyone who suffers from both addiction and an eating disorder is fighting two different challenges of dependence, first with food and secondly with the substances. Therapy and inpatient care can go a long way in helping the sufferer understand why they are engaging in certain behaviors and aid them in coming to terms with withdrawal and recovery from both conditions. The first and most important step is for the sufferer to admit they have problems. Once they have been honest and opened up, then the path to wellness can begin in earnest. Sufferers more often than not will find that occasional relapses occur, but it is important to understand that this is entirely normal and all part of the recovery process as a whole. There is nothing to feel afraid or ashamed of in opening up and talking about such issues, being honest and open is a sign of strength and one of wanting to fight and regain health and sufferers must always try and keep this uppermost in their thoughts whilst in recovery.


Written by Lisa Grant

New National Study Reveals 12 Year Olds More Likely to Use Potentially Deadly Inhalants than Cigarettes or Marijuana

Today, the Substance Abuse and Mental Health Services Administration (SAMHSA) in conjunction with the 18th annual National Inhalants & Poisons Awareness Week released a survey that indicates that more 12 year olds have used potentially deadly inhalants than cigarettes or marijuana, perceiving it to be “Safer”.

The need to increase awareness of this public health risk among physicians, parents and others is critical.
They may sniff refrigerant from air conditioning units, aerosol computer cleaners, glue, air fresheners, hair sprays, nail polish, paint solvents, degreasers, gasoline, or lighter fluids, with the intention of getting high.  These substances are readily available, inexpensive, and easily hidden where they were found, in garages and household cabinets.

Most youth believe that huffing is “safer” than using  illegal substances, and are unaware of its deadly potential. Most parents are not aware that use of inhalants can cause “Sudden Sniffing Death” – immediate death due to cardiac arrest – or lead to addiction and other health risks.

SAMHSA data from the 2006-2008 National Surveys on Drug Use and Health show a rate of lifetime inhalant use among 12 year olds of 6.9 percent, compared to a rate of 5.1 percent for nonmedical use of prescription type drugs; a rate of 1.4 percent for marijuana; a rate of 0.7 percent for use of hallucinogens; and a 0.1 rate for cocaine use.

“Parents must wake up to the reality that their child might try huffing and the consequences could be devastating,” said SAMHSA Administrator Pamela S. Hyde, J.D.  “That’s why SAMHSA is leading the way to get information out to healthcare providers, kids, parents and everyone in the community so that our children hear a consistent message about the dangers of huffing.”

“Young people and their parents are key audiences for this important public information campaign about the clear and present dangers associated with inhalant abuse,” said Gil Kerlikowske, Director of National Drug Control Policy. “With data showing that young people often don’t perceive the great risk of abusing inhalants, we must redouble our efforts to inform adolescents of the dangers and to encourage parents to be more vigilant in protecting their children from inhalants often present in common household products.”

It is possible to die from trying inhalants even once.  ‘Sudden Sniffing Death’ causes the heart to beat rapidly, which can result in cardiac arrest.

Tourette Syndrome: Histamine May Play a Role

Researchers under  Dr. Matthew State, an associate professor of child psychiatry, psychiatry and genetics at Yale University School of Medicine. have been studying the genome of  a family in which the father and all eight of his children have Tourette Syndrome  and have identified a mutation on the HDC gene that encodes the enzyme L-histidine decarboxylase, which is involved in regulating levels of the neurotransmitter histamine in the central nervous system.

This research provides clues to treating Tourettes Disorder, a neurological disorder that can cause debilitating, involuntary motor and verbal tics.

While the variant itself is likely very rare — meaning most people with Tourette syndrome don’t have the precise mutation — what’s known about the gene’s function in the body hints at new treatments, researchers explained.

Previous research in mice has shown that manipulating brain levels of histamine by decreasing activity of HDC makes mice more likely to have repetitive behaviors, such as biting, rearing and chewing, which may be similar to tics in humans.

Drugs that increase the release of histamine in the brain, but don’t affect histamine levels in other parts of the body, are in the latter stages of development. Previous research has shown that when given to mice, these drugs decrease the repetitive behaviors. It’s possible those drugs could also help people with Tourette syndrome.

Genetics may point to the function of the gene, which points to what kind of mechanisms might be involved in the disorder.

The study is published in the New England Journal of Medicine.

Tourette syndrome tends to run in families. The disorder usually emerges in childhood and, for some, improves in adulthood. Although the causes of the syndrome are unknown, previous research suggests abnormalities in certain brain regions and in the neurotransmitters dopamine, serotonin and norepinephrine may play a role.

Children who see doctors for Tourette syndrome often have other disorders as well, including depression, attention-deficit/hyperactivity disorder, obsessive-compulsive disorder or learning disabilities.

Many cases of Tourette syndrome are mild and improve over time. But severe cases can be debilitating — socially and physically — and current treatment options are limited.

In addition to behavioral intervention, first-line medications include antidepressants and anti-anxiety medication. More severe symptoms of the syndrome can be treated with antipsychotic medications such as risperidone (Risperdal) or neuroleptic medications, such as haloperidol (Haldol), but long-term side effects can be serious.

The mutation identified in this family may be unique to them, but suggests the likelihood that functional differences in the  HDC gene or in the histamine biochemical pathway would play a role in other families affected by Tourettes.

SOURCES: Matthew State, M.D., Ph.D., associate professor, child psychiatry, psychiatry and genetics, Yale University School of Medicine, New Haven, Conn.; Francis J. McMahon, M.D., chief, Genetic Basis of Mood and Anxiety Disorders, National Institute of Mental Health, Bethesda, Md.; May 5, 2010, New England Journal of Medicine, online

American Soldiers in Afghanistan: Suicide Deaths Nearly Equal Combat Deaths

  • There were 197 Army suicides in 2008, according to the Army’s numbers. The total includes active- and non-active-duty soldiers.
  • Last year, the number was 245.
  • This year, through May, it’s already 163.

The Army has instituted many programs to counsel and train soldiers  with a goal of suicide prevention. Several of them have failed. Often, as soldiers transitioned from one assignment to another, the new station was unaware of past mental health issues.


Source: U.S. military branches (2001-09) and Centers for Disease Control and Prevention (latest figures through 2006)