Noteworthy News Articles, August 11-25, 2000

Noteworthy News Articles on Mental Health Topics, August 11-25, 2000

Arrest Trips up 'Moderate Drinking' Crusader's Cause
Candace Heckman, Seattle Post-Intelligencer- 8/11/2000

ELLENSBURG -- For years, Audrey Kishline thought she and other recovering alcoholics could learn to drink responsibly. Her belief was so strong that she helped found a nationwide movement called Moderation Management, and became the movement's marquee speaker. Today, the Woodinville woman will be sentenced in Kittitas County court on two counts of vehicular homicide -- deaths resulting from her drunken driving. Four months ago, the 43-year-old alcoholic drove down the wrong side of Interstate 90 near Cle Elum, plowing through traffic and crashing her pickup head-on into a car driven by Richard "Danny" Davis, 38, of Yakima County. In the car with Davis was his daughter LaSchell, 12. Both were killed. More than an hour later, doctors found that Kishline had three times the legal limit of alcohol in her bloodstream. She was headed for Spokane, though she still cannot say why.
    Detractors of the Moderation Management movement immediately began to criticize Kishline for what they called her moral failure -- and for duping alcoholics into thinking they could drink again. For decades, Alcoholics Anonymous and other organizations have said only total abstinence would do. Yet as their founder prepares to enter prison, Moderation Management followers are keeping the movement alive. While suffering the tragedy of Kishline's relapse, they say they continue to believe in her. In fact, they say they respect her for pleading guilty to her crimes, and note that accepting responsibility for their own actions is the first rule of their organization. The fourth rule is never to drink before driving.
    Moderation Management, commonly called MM, was ushered into the mainstream media five years ago as "a common sense" solution to heavy drinking. With individual meetings in 15 states, the organization is spreading quickly through support groups on the Internet. There are no reliable membership numbers, however. Kishline declined comment for this story, citing an agreement between Washington prosecutors and the Davis family aimed at preventing her from capturing media attention. But in the past, the housewife and mother of two has described herself as a recovering alcoholic who rebelled against that label. Traditional 12-step treatment programs such as AA are based on the belief that alcoholism is a disease that cannot be cured -- and that once someone becomes an alcoholic, he or she will always be an alcoholic even if he or she never again drinks. That stigma, Kishline reasoned, becomes an enormous weight and deterrent for people to seek help. Kishline in 1994 wrote that after undergoing abstinence-based treatment, she was disgraced and demoralized, and was compelled to return to alcohol. She describes discovering that she could teach herself to drink moderately -- not chronically, as alcoholics do. As recently as 20 years ago, researchers and noted psychologists were proposing moderation as a healthy habit.
    Kishline, who has no formal training in the field, took the work of these people and wrote it into a self-help format without the medical jargon. Though her ideas were not original, media attention to her book made her the spokeswoman for a controversial, rapidly growing movement. Never accepted in the established alcohol treatment community, the group shone among the general public, attracting many drinkers for whom abstinence treatment had already failed. While still promoting the movement, in January Kishline logged on to the Moderation Management Internet news group to announce that she could no longer sustain moderate drinking and that she would leave her organization to join several abstinence-based 12-step recovery programs. The announcement was a shock, said MM board member Marc Kern. During the ensuing debate and angst within the network, some people dropped out while the publicity attracted newcomers as well.
    Two months later, Kishline failed sobriety altogether. State troopers at the crash scene found her unconscious. A partially empty bottle of vodka and a container of the prescription anxiety drug Alprazolam were found in her truck. Supporters have argued that Kishline's failure was because of abstinence-based treatment, not moderation. According to the National Institutes of Health, there are far more problem drinkers in the United States than chronic drinkers who are severely dependent on alcohol and need to quit. MM proponents say traditional abstinence-based programs that do not consider moderation as an achievable goal are themselves a form of denial. They maintain that a majority of problem drinkers can on their own learn to drink less, while some need guidance -- a book, a support group or professional help.
    But Kern, a Los Angeles-based psychologist, said that for most people with real alcohol problems, moderation is not viable. In a sense, MM worked for Kishline, he said, because working through her own methods helped her learn she has a more serious problem. Many members who routinely attend MM meetings end up choosing total abstinence, he said. "Because it is a very rational, gentle forum, they find that this forum is better to talk about their alcohol problems than other methods," Kern said.
    MM critics say it is impossible to predict when a person "crosses the line" into alcoholism, though. Because of that, they contend that abstinence is the safest course of recovery -- and some blame Kishline for leading drunks to believe they could safely drink. In a sharply worded critique in June, Stacia Murphy, president of the National Council on Alcoholism and Drug Dependence, said Kishline's denial of her alcoholism has contributed to the progression of the disease for thousands of Americans and their families. Like programs fashioned after Alcoholics Anonymous, Moderation Management stresses certain steps and rules, though it omits the highly spiritual aspects of AA and other organizations. For example, MM-ers must first abstain for 30 days in order to clear their system and lower their tolerance. But they need not put their lives "into the hands of God," as many 12-step programs ask. Kishline in her book also lists drinking guidelines that differ for men and women of various weights. Typically, the group allows three drinks per day for women and four for men. By comparison, the U.S. Department of Agriculture in new dietary guidelines released in May defines moderate drinking as one drink a day for women, two for men. Teetotalers argue that MM's liberal guidelines were attracting drunks looking for an excuse to leave AA -- concern shared even by psychologists who actively support the organization, Kern said. Stanford University psychologists, at the invitation of the group, have studied the program. Their results are due later this year.
    In various media accounts after the death of the Davises, Kishline is reported to have denounced Moderation Management and its members for denying their alcoholism. But her close associates say she made no such statement and still believes in the principles of moderate drinking. After pleading guilty June 29, Kishline apologized -- admitting that nothing she says or does could reverse the destruction she caused. "I am giving this statement in a public forum because I pray that my story can touch at least one other alcoholic," Kishline said in Kittitas County Superior Court. "When I failed at moderation and then failed at abstinence, I was too full of embarrassment and shame to seek help."
    Her confession has done little to still the debate over Moderation Management. A little more than a week later, 36 noted professionals in the alcohol abuse treatment field issued a statement supporting both moderation and abstinence-based approaches as equally viable answers to problem drinking. Many more treatment professionals, however, continue to advocate abstinence as the only path to recovery. Kern added that the debate, sparked by "a horrible, horrible, horrible tragedy," has been helpful. It put the discussion of recovery methods back on the table in a big way, forcing people to look into the "gray area" of alcohol abuse. Kishline faces a sentence of 41 months to life in prison, although the Kittitas County prosecutor is expected to ask for 54 months in custody, followed by two years of community supervision that would include a locking device on her car's ignition.

No Appeal in Prozac Robbery Case
Associated Press, 8/11/2000

NEW HAVEN, Conn. (AP) A Wallingford man who robbed a bank and businesses while under a drug- and alcohol-induced mania received a 10-year suspended sentence Friday. Christopher DeAngelo, 30, also got five years of probation. He was returned to Whiting Forensic Institute after his sentencing in New Haven Superior Court. A Milford judge already had committed DeAngelo to Whiting for up to 10 years for robbing a bank in Derby, even though he was found innocent by reason of insanity.
His lawyer, John R. Williams, said he will not appeal the decision to commit DeAngelo to Whiting, a maximum-security psychiatric hospital in Middletown. ''I feel the judge acted within the broad discretion which the law gives to him, and it's highly probable that his ruling would be affirmed if appealed,'' Williams said Thursday. DeAngelo was found innocent by reason of insanity in February of robbing the First Union Bank in Derby in 1997.
Judge Richard Arnold ruled DeAngelo fell into a manic state from taking Prozac and Xanax and by drinking alcohol. The Prozac was prescribed to control his obsessive-compulsive disorder and Xanax to ease anxiety. In June, Arnold ruled that DeAngelo could suffer further episodes of violence without appropriate treatment and committed him to Whiting. DeAngelo later pleaded guilty in New Haven Superior Court to three robbery charges from armed holdups at a bank and two businesses in Wallingford.

Audit: Mental Health Services Not Checking Background of All Employees
Detroit Free Press, 8/11/2000

LANSING, Mich. (AP) -- More than 100 people contracted by the state to work in the mental health industry between 1998 and 1999 were convicted of a felony, according to a state audit released Friday. Eight of the 11 contractors hired by the Central Michigan Community Mental Health Services to provide residential or in-home care services employed 117 felons convicted of 188 felonies, according to the audit conducted from 1996 to 1999. Those contractors also employed 23 people on probation or parole, the audit said.
    State auditors were unable to determine whether employees who had been convicted of a felony, on probation or parole had direct contact with consumers. Agency officials said employees convicted of felonies relating to violent crimes or sexual misconduct are generally not allowed to have contact with consumers of the agency. Three contractors hired to provide in-home services employed 79 felons who had been convicted of 126 felonies, the audit said. Three of the six residential facilities investigated by state auditors were not conducting criminal background checks of all their employees, the audit said. The three other vendors completed the reviews when the employees were hired, auditors said. Contractors who did not complete the checks said that they did not realize the reviews were required, auditors said.
    While potential employees can indicate a felony conviction on applications, facility officials did not make additional inquiries, the audit said. Although the Central Michigan Community Mental Health Services did not check the background of its workers before or during their employment, state auditors determined that none of the employees directly hired by the agency were convicted of a felony or on probation or parole. A felon could not be prohibited from working for Central Michigan Community Mental Health Services. Central Michigan Community Mental Health Services is funded by the state Department of Community Health. Geralyn Lasher, a spokeswoman for the department, said she had not seen the audit and could not comment on it.
    "By obtaining criminal background checks and monitoring contract employees with a felony background, (the agency) could better ensure that its consumers are receiving services in a safe environment," state auditors said in their report. While the agency accepted the auditors' recommendation, officials said there is no requirement forcing them to conduct criminal background checks.

Crusader Gets 4-1/2 Years in DUI Deaths
Candace Heckman, Seattle Post-Intelligencer- 8/12/2000

ELLENSBURG -- As tearful family members watched, a nationally known advocate of moderate drinking was sentenced yesterday to 4-1/2 years in prison for killing two people in a drunken-driving crash last spring. Audrey Kishline founded a national movement promoting moderate drinking as an alternative to abstinence for recovering alcoholics and other drinkers. At her sentencing for vehicular homicide yesterday, relatives of the victims said they eventually may forgive Kishline. But they decried her sentence as too lenient and vowed to push for tougher laws. "This was a senseless crime and it makes me very angry," said Debbie Davis, whose brother Richard Daniel Davis was killed Mar. 25 along with his daughter, Lashell. "When they were hit, they never had a chance." Kittitas County Superior Court Judge Michael Cooper agreed the sentence he handed down -- the maximum possible in the case -- was too light. He said he would have punished Kishline more if he could.
    Kishline, 43, a Woodinville author, founded the Moderation Management organization seven years ago, promoting the idea that problem drinkers can drink safely if they follow certain guidelines. Four months ago, the recovering alcoholic broke her own rules. She barreled in her pickup truck the wrong way on westbound Interstate 90, slicing through traffic near Cle Elum for more than a mile. She smashed into a Dodge, killing driver Davis and his daughter. Kishline said she was so drunk that evening that she blacked out and cannot remember anything. "But I do know that I did this," she told the judge yesterday. "Whether I remember or not, whether I could conceive of this or not, I know the family suffers intolerable grief because of me."
    Cooper said the criminal justice system is "totally inadequate" to handle drunken-driving deaths. He encouraged the victims' family and friends to lobby for tougher drunken- driving penalties. "The way society values life is tragic," Cooper said, stressing that people are too tolerant of drinking and driving. When family and friends told the judge about themselves and the two people lost, some words were barely audible over the clicking of news cameras. During occasional moments of silence, Kishline's and the victims' families broke into tears.
    Later, in a hallway jammed with news media, Debbie Davis said that lobbying for harsher penalties would become her family's crusade. In the first half of this year, 72 of the 190 fatal crashes in Washington involved drunken drivers, according to the state Traffic Safety Commission. William Davis, Richard's brother, said he is mystified by the national controversy over drinking and safety spawned by Kishline's case. "Why should it be such a controversial issue?" he said. "All I see is a woman who couldn't face up to her problems." Davis added that his late brother, being a deeply religious man, likely would have forgiven Kishline eventually as his family now must try to do. No one defended Kishline in court yesterday. Her mother, Christa Hoven, flew in from New Jersey to ask leniency "not for her, but on behalf of her children," who will be without a mother. "We all feel that what is happening is justice and she has to go to jail," said Kishline's sister Tina Conn.

Psychiatric Hospitals Use Threats to Get Discharges
Associated Press, 8/13/2000

BOSTON--Psychiatric hospitals in the state are filing questionable child abandonment charges against some parents that could cost them custody of their children, according to a published report. The hospitals make the claims when they want to discharge a patient even though the patient's parents may claim their children are too sick or dangerous to be discharged. Parents say they are so intimidated by hospitals that they take home sick and dangerous children only to have them readmitted a few days later. ''These parents are not abandoning their kids, they are struggling to get them what they need to stay alive,'' Lynne Rachlis, a child advocate told The Boston Globe.
    Hospitals said they rarely use abandonment charges, called 51A abuse or neglect petitions, unless there is no alternative. ''The hospitals are not using the 51A as a tool for premature discharges,'' said David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems. ''We file 51A's when there is a situation where we suspect abuse or neglect. We don't file it to threaten or pressure parents.''
    But state agencies are concerned enough to warn hospitals against using such action. The state Mental Health Department, which licenses psychiatric hospitals, said it plans to put hospitals on notice that coercion should play no part in discharges. ''It's not appropriate for hospitals to file or threaten to file a 51A because a family is not feeling safe,'' commissioner Marylou Sudders said. The abandonment charges are rarely sustained, said Social Services department spokeswoman Carol Yelverton.
    Hospital officials said there aren't any financial incentives to file a 51A, but acknowledge a severe shortage in beds for psychiatric patients. There are no statewide figures for the number of abandonment charges filed by psychiatric hospitals. But the Westwood-Pembroke Health System, which runs three psychiatric hospitals in the state, said it files abandonment charges in 1 percent of its discharges, or about 14 times a year. ''We're trying to do what's right for the patient,'' said Westwood-Pembroke chief executive Kenneth A. Davis. ''The hospital isn't the villain here. In a handful of cases when we reach an impasse in discharge planning, we're left with no other alternative than to involve the Department of Social Services.''
    Filing abandonment petitions is becoming a problem nationwide because ''the mental health system is inadequate,'' according to Mary Gilbert of the Bazelon Center for Mental Health Law in Washington, D.C. ''The parents can't have the children home without support services, and the community-based services aren't available,'' she said. Paula Riga of Lowell tried for 10 years to get her son, Jacob, mental health care after he tried to commit suicide and threatened his siblings. But doctors said Jacob, 17, could go home last week even though Riga saw little change in his behavior and feared for herself and four other children. An outpatient therapist said Jacob needed more treatment, but hospital officials at Westwood-Pembroke's Westward Lodge facility filed abandonment charges. The Social Services Department dismissed the hospital's allegations of neglect and Jacob is back at the hospital. ''I'm not abandoning him,'' Riga said. ''I'm just refusing to take him out of a safe place. I can't manage him anymore without help.''

Researchers Close in on Genetic Sources for Schizophrenia
Ann Schrader, Denver Post- 8/13/2000

Schizophrenia is a cruel disease, striking usually as a person is leaving the cocoon of adolescence for the world of independence. For 28 years, Dr. Robert Freedman has studied the biological basis of schizophrenia and has treated patients' delusions, disorganized thoughts and withdrawal. Freedman, a psychiatry professor at the University of Colorado Health Sciences Center and Denver Veterans Affairs Medical Center, headed a team that published a 1997 paper on a genetic link to schizophrenia.
    Quite by accident about four years ago, the team stumbled onto a nicotine connection to schizophrenia on a single chromosome, chromosome 15. The researchers found that the alpha-7 nicotinic receptor, which stimulates the brain's filtering mechanism, is connected to schizophrenics' tendency to become heavy smokers. Smoking, it seems, gives many schizophrenics the brief ability to calm their thoughts, something that has been known for years. About six areas in the human genome are believed to be involved with schizophrenia, It took Freedman's team about five years to find the alpha-7 nicotinic receptor.
    Taking schizophrenics' propensity to smoke heavily as a clue, a huge piece of DNA, a sequence of genes on chromosome 15, was isolated for study. In the early 1990s, it wasn't only a case of looking for a needle in a haystack. The research was asking: "What are the needles in the haystack?" said Sherry Leonard, a molecular biologist in CU's Center for Neuroscience and Schizophrenia. In the past four years, Freedman and Leonard have been looking at possible genetic changes in DNA sequences. Using a blood sample or skin cells, they look for differences between patients along chromosome 15. If a difference is found, they look on the map to check the location of the gene that may be involved in the disease. "Once you know the chromosome location you're interested in, you look for a change in the way the gene works that causes it to malfunction and causes illness," Freedman said.
    The human genome map helps Freedman and Leonard to identify chromosome areas that might be involved in the inheritance of schizophrenia and bipolar disorder. So far, six areas in the genome have been linked with schizophrenia, with the CU group identifying one of the areas. DNA sequences published as the human genome was mapped have greatly sped up Freedman's work. "Our first genome scan took us three years to run. Now we can run it in a couple of months," he said. The work is incredibly complex, requiring researchers to shift through thousands of base pairs, weak chemical bonds between the bases between each cell's two twisting strands of DNA. The alpha-7 nicotinic receptor involves duplication of the genes and involves about 1.5 million base pairs. "We look at them 300 to 500 at a time," Freedman said. Of about 200,000 that have examined, about 50,000 base pairs were born in Freedman's lab.
    The next step is looking at gene regulators and "what turns them on and off," Leonard said. A device that measures gene expression in postmortem brain tissue was purchased last year with a $200,000 VA grant. Freedman's work draws on about 300 people with schizophrenia or close family members with the schizophrenia gene and about 200 people without the schizophrenia gene as a control group. Patients receiving clinical treatment frequently provide samples for the lab work. The lab reports back information that someday will be able to help patients, such as drugs designed to negate the genetic abnormality.

Hinckley Psychologist Alleges Retribution
Bill Miller, Washington Post- 8/13/2000

    A psychologist at St. Elizabeths Hospital alleges she was transferred and punished after recommending that presidential assailant John W. Hinckley Jr. be permitted to leave the grounds for unsupervised visits with his parents. "My career was fine, no problems--until I wrote the recommendation in 1996," said Susan Lerner, a 15-year employee who said she has clashed with officials at the psychiatric hospital ever since. "Had it been any other patient, this never would have happened." She has recently sued in U.S. District Court, naming the D.C. government, the D.C. Commission on Mental Health Services and three administrators from St. Elizabeths Hospital as defendants. D.C. officials declined to discuss the allegations in her suit. "We're planning to file a motion to dismiss the complaint," said Arabella W. Teal, the District's principal deputy corporation counsel. Because the matter is pending, she said she would not "get into the ins and outs of what the allegations are."
    Hinckley's case has drawn enormous attention to St. Elizabeths since 1982, when he was brought there after a jury found him not guilty by reason of insanity in the 1981 shootings of President Ronald Reagan and three others. Over the years, there have been conflicting demands surrounding treatment. Federal prosecutors have opposed the loosening of restrictions; those who treat Hinckley have said his major depression and psychotic disorder have been in remission for years. Lerner, 53, who headed Hinckley's treatment team, signed the June 1996 report in which numerous mental health professionals unanimously urged Hinckley's conditional release for 12 hours a month to visit his parents. But a hospital review board that had the final say rejected the recommendation. Then Hinckley's attorneys asked a judge in U.S. District Court to permit the unsupervised visits. Senior Judge June L. Green turned down the request after a hearing in June 1997, concluding that Hinckley remained dangerous.
    Meanwhile, Lerner said, her career took a turbulent turn. Her performance evaluation went down. She was transferred to a job with fewer opportunities to have an effect on patients. And now, the hospital is trying to fire her, according to the lawsuit. In one of her many disputes with the hospital, the suit says, her license as a psychologist is threatened. Lerner, of Germantown, alleges in the suit that job-related stress has rendered her unable to work. Although she was diagnosed in 1982 with multiple sclerosis, she said she had managed her symptoms until officials "pushed me over the edge." She has been off work since February, first on sick leave, then on administrative leave without pay. A neurologist said her symptoms are likely to become permanent, Lerner said. Her work problems took place against a backdrop of family difficulties. Her son, Scott, suffered for years from a bipolar mental illness and AIDS and twice made statements that drew the attention of the Secret Service. In 1991, while undergoing hospital treatment after an attempted suicide, he said: "If they don't find a cure for AIDS. I'm going to kill the president." Three years later, he made a threatening comment about Chelsea Clinton during an argument with his therapist. Secret Service investigators interviewed him but did not push for criminal charges. In both investigations, they found no reason to believe he was a threat, Lerner said.
    According to Lerner's lawsuit, St. Elizabeths officials attempted to keep her off the witness stand at Hinckley's 1997 hearing by raising her son's past. The suit quotes the former director of forensic in-patient services, Elizabeth Teegarden, as saying the Hinckley matter was "a very political case." Teegarden allegedly told Lerner that prosecutors had contacted the hospital and that they intended to discredit her testimony by making her son's medical records public. The implication, Lerner said, was that her son's illness biased her in favor of Hinckley's parents. "They were blackmailing me; that was clear," Lerner said. "If I testified, then my son's life would have been an open book in court. And because of who it was about, the media would be there and it would be out." At the urging of her son, Lerner said, she decided to testify anyway, although it turned out that neither side put her on the stand. Hinckley's attorney relied on the written recommendation of the treatment team. Prosecutors countered with testimony from Raymond F. Patterson, then an independent psychiatrist, who said Hinckley had a history of masking symptoms.
    Even though she did not testify, Lerner said, her supervisors acted against her. "All of a sudden, my performance evaluation went down," she said. "Until then, for 12 years, I had an outstanding evaluation." Her supervisor downgraded her, saying he disagreed with her recommendation about Hinckley, she said. Lerner said that her supervisors "were very angry. They started to watch what time I came in, what time I left, when I went to lunch. This never happened before." In spring 1998, Lerner told a reporter for the New Yorker magazine about alleged attempts by the hospital to keep her from testifying on Hinckley's behalf. Her comments appeared in the magazine a year later as part of a broader story, titled "Strange Love," that examined Hinckley's relationship with his girlfriend, a former mental patient named Leslie deVeau. After the story appeared, Lerner said, her problems at work intensified.
    Patterson, the psychiatrist who testified against letting Hinckley out, had become the hospital's administrator in charge of forensic services. He asked a committee to investigate whether Lerner's published comments violated ethical standards. The panel ultimately said it could not conclude that she had violated ethical standards but recommended she be admonished for not getting clearance for her talk with the news media. Patterson, she said, ordered another panel to reinvestigate. The ethics investigation has put her license to practice psychology at risk, she said. She also was moved in June 1999 from her job as a clinical administrator to a position in the psychology department--a move that she protested. She said she was told it was for "the good of the hospital." And she got into trouble over a paid leave she received to attend a series of professional seminars. She missed a two-day seminar in January 1999 because of her son's AIDS-related illness; after weeks in intensive care, he died in February 1999. Lerner said she made a mistake in paperwork and wound up getting paid for the two days, and administrators later tried to fire her. "I had never, ever, in my career, wherever I worked, had a disciplinary action against me. Nothing," she said, contending that she offered to adjust her leave time. She said the hospital has not acted on its plans to dismiss her. Her transfer is the subject of a grievance procedure. The ethics investigation is ongoing. Lerner said she has not worked lately because of her multiple sclerosis and alleges that the hospital's actions aggravated her symptoms.
    In addition to the D.C. government, the defendants named in the suit are Patterson and supervisors Joseph Henneberry and Ritzia A. George. Lerner seeks at least $6 million in damages. Lerner's attorney, Lynne Bernabei, said she is hinging the civil suit on allegations that the D.C. government's actions interfered with Lerner's rights to free speech and that they violated the D.C. Whistleblower Act of 1998. The suit claims that hospital officials attempted to "illegally suppress relevant testimony" at the 1997 Hinckley hearing and attempted to force Lerner out because she publicly discussed what happened.
    As for Hinckley, he remains at St. Elizabeths with no unsupervised visits. In a turnabout, hospital officials last spring recommended that he be permitted to visit his parents without an escort. But a court hearing was canceled when the hospital withdrew its recommendation in June, after prosecutors said Hinckley still appeared obsessed with violence. Hinckley occasionally leaves St. Elizabeths, but only on short day trips with hospital staff. Last year, he won a court fight to go on those outings.

Study: Acupuncture Cuts Cocaine Cravings Counseling, Recovery Programs Also Advised
Donna Leinwand, USA Today- 8/14/2000

WASHINGTON -- The ancient Chinese therapy of acupuncture can help cocaine addicts control their cravings when it is combined with more modern treatments, says a new study in the Archives of Internal Medicine. In the study of 82 addicts, one group received eight weeks of treatment in which an acupuncturist inserted needles into four specific points on the outer ear where stimulation is believed to have a therapeutic effect. Another group received acupuncture to points on the ear that are not thought to have any treatment effect. A control group watched relaxation videos. Slightly more than half the addicts who received the specific acupuncture tested free of cocaine in the last week of treatment, compared with 23.5% of the other acupuncture group and 9% of the group that watched the tape.
    Participants were addicted to cocaine and heroin. In addition to the acupuncture, they received counseling and methadone for heroin addiction. About a third of those enrolled in the study dropped out before completing treatment. ''This is not a definitive study, but it is a well done clinical trial that says (acupuncture) is a treatment approach that ought to be considered seriously,'' says Alan Leshner, director of the National Institute on Drug Abuse, which funded the study. Leshner says acupuncture should be combined with other therapies, such as psychological counseling.
    Hundreds of drug treatment centers have used acupuncture since the 1970s to help ease withdrawal symptoms and cravings, with anecdotal reports of success. ''These findings need to be replicated in future studies,'' says Arthur Margolin, principal investigator for the study and a research scientist at Yale University School of Medicine in New Haven, Conn. Most clinical trials aimed at measuring acupuncture's effects in drug treatment have been inconclusive.
    At Lincoln Hospital Recovery Center in the Bronx, N.Y., patients can receive acupuncture combined with counseling and attend a 12-step recovery program such as Narcotics Anonymous, says Michael Smith, a psychiatrist who directs the center. Lincoln began using acupuncture in 1973, after Smith read about the therapy's effect on drug addicts after surgery. ''Acupuncture is a real help in reducing cravings,'' Smith says. ''It's a valuable component within the program.''

Therapists Accused in 'Rebirthing' Death Due in Court
Steve Gutterman, Associated Press, 8/15/2000

GOLDEN, Colo. (AP) It was therapy meant to re-create a birth. Instead, it is accused of leading to a 10-year-old's death. Wrapped in a flannel blanket meant to represent the womb, Candace Newmaker, 10, cried again and again that she couldn't breathe as therapists pushed against her with pillows. They wanted her to fight her way out and become ''reborn,'' investigators say. About 30 minutes later, therapists unwrapped the blanket; Candace was no longer breathing and was lying in vomit, according to the sheriff's department. She died of asphyxiation a day later at a Denver hospital.
    On Tuesday, four people, including therapists Connell Watkins, 53, and Julie Ponder, 39, face preliminary hearings on child abuse charges as a result of the April 18 ''rebirthing session.'' The session was supposed to help Candace overcome ''reactive attachment disorder,'' in which children resist forming loving relationships and become unmanageable and violent. Also charged and facing preliminary hearings are Jack McDaniel, 47, an intern at Watkins' home-based therapy center in Evergreen, and Watkins' business manager, Brita St. Clair, 41. Candace's adoptive mother, Jeane Newmaker, 46, faces a hearing next month.
    ''I believe these people were trying to help this child and not injure her,'' said David Savitz, McDaniel's lawyer. ''I don't believe it rises to the level of a criminal offense. Savitz said that if McDaniel is arraigned, he will plead innocent. None of the other defense attorneys involved in the case would comment. Prosecutors, too, declined comment, but the prosecution's case is outlined in an affidavit filed when Ponder, who allegedly led the session, was arrested. The affidavit alleges that a videotape of the therapy session shows Candace frequently complaining of breathing difficulties and saying that she feared for her life. The affidavit says the therapists ignored Candace's pleas, and that one of them told the girl, ''You want to die? OK, then die. Go ahead, die right now.''
    Evergreen has become an unofficial center for therapists specializing in attachment disorder since the now-retired Foster Cline started developing treatment methods in the mountain town two decades ago. But other area therapists have said they were shocked to hear that Watkins used the rebirthing therapy. They said they had never before heard of rebirthing therapy used in children or in cases of attachment disorder. Court documents say Newmaker, a nurse practitioner from Durham, N.C., hired Watkins to treat Candace for two weeks for $7,000. She had been seeking help for her daughter's problems since adopting the girl in 1996. Watkins and her three associates were charged with knowing or reckless child abuse resulting in death. They face up to 48 years in prison if convicted. Newmaker was charged with criminally negligent child abuse resulting in death, which carries a maximum sentence of 12 years.

UNH Study Urges Controlling Parental Anger
Associated Press, 8/15/2000

DURHAM, N.H.--Reducing ''psychological aggression'' toward children may help prevent some mental illnesses, according to a pair of University of New Hampshire sociologists. Shouting or threatening to spank are the most common forms of aggression found in a survey of 991 parents during a one-year period, by Murray Straus and Carolyn Field. More severe forms, such as cursing, threatening to kick the child out of the house or calling him or her dumb or lazy, occur less often and are more common tactics used to control or correct teen-age behavior.
    The findings of Straus, sociology professor and co-director of the UNH Family Research Laboratory, were prepared for Tuesday's annual meeting of the American Sociological Association in Washington, D.C. ''Psychological Aggression by American Parents: National Data on Prevalence, Chronicity and Severity,'' indicates that 90 percent of parents use psychological aggression by the time their children had reached age 2; by age 5, the figure is 98 percent; the rates continue in the 90 percentile from ages 6 to 17. ''Even infants are not immune from being yelled at by angered parents. Despite this near universality, psychological aggression by parents has not been investigated as part of the family system,'' he said.
    ''It is the focus of attention only if it is chronic and severe enough to be considered a form of deviance, and investigated by scholars concerned with child abuse rather than by those concerned with normal families,'' he added. The rates of psychological aggression are a minimum estimate because not all parents are willing to disclose such information, Straus said. Still others may have forgotten a number of instances, and only five examples of aggression are used in the survey. The study found that screaming or yelling at child is the most common form of psychological aggression at 75 percent. Just over half of those surveyed, 53.6 percent, had used threats of spanking. About one-quarter had sworn at or cursed their children in the past year, while 17 percent had called them derogatory names.
    The most severe example of psychological aggression, threatening to kick a child out of the house, is the least prevalent, at 6 percent. The child's age, however, is a major factor, and 18 percent of parents with teen-age children report using that threat. Straus and Field were careful not to label this common parental behavior as psychological abuse. ''To be legally classified as abuse requires exceeding a level of severity and chronicity that results in harm to a child,'' Straus said.
    The report also said avoiding discipline increases the probability of the child being well behaved and well adjusted. ''Parents can and should criticize misbehavior,'' Straus said, ''but by criticizing the behavior, not the child as a person.'' The report said the younger the parent, the more likely he or she is to use psychological aggression and the higher one's socio-economic status, the less likely he or she is to do so. In previous research, Straus found a similar pattern of almost universal psychological aggression between intimate partners. ''We suggest that such tolerance and prevalence of this behavior between adult partners happens because these same adults learned from their parents that psychological aggression is acceptable,'' he said.

Seeing Pessimism's Place in a Smiley-Faced World
Erica Goode, New York Times, 8/15/2000

Dr. Barbara Held has had just about enough of accentuating the positive and eliminating the negative. She does not want to cheer up, look on the bright side or let a smile be her umbrella. And she is not planning to put a smiley face sticker on her car bumper any time soon. In fact, Dr. Held views such activities as rather worrisome. She is one of a small band of psychologists who believe their profession--and indeed America as a whole--has succumbed to an ethos of unrelenting positivity. This "Tyranny of the positive attitude," as Dr. Held sees it, prescribes cheerfulness and optimism as a formula for success, resilience and good health, and equates negativity with failure, vulnerability and general unhealthiness.
    Positive thinking is a staple of self-help books, popular music and Sunday sermons. And in recent years, it has also found a home in the positive psychology movement, which was founded to correct what its leaders, including Dr. Martin Seligman, a professor of psychology at the University of Pennsylvania and a former president of the American Psychological Association, saw as the field's overly narrow focus on mental illness and human failing. But Dr. Held and like-minded colleagues, who gathered last week at the psychological association's annual meetings in Washington for a symposium titled "The (Overlooked) Virtues of Negativity," feel that bliss can be taken too far. While positive thinking has its advantages, they argue, a little whining now and then is not such a bad thing. Pessimism, in some circumstances, may have its place. And the unrelieved pressure to be upbeat, they assert, may gloss over individual needs and differences, and may make some people feel worse instead of better. "I'm worried that we're not making space for people to feel bad," said Dr. Held, a clinical psychologist at Bowdoin College in Brunswick, Me., and the author of "Stop Smiling, Start Kvetching." "Life is very hard," Dr. Held said. "If you're having a hard time with something, it can make it harder to cope if you feel pressure to act O.K. when you're not.
A large body of experimental work has elaborated on the pulses of optimism and positive thinking, which appear to have beneficial effects on performance, social adjustment and some aspects of health. But at least some research supports the notion that in some cases, it may be more useful to see the glass as half empty. Dr. Julie Norem, a social psychologist at Wellesley College, for example, has studied "defensive pessimism," a coping strategy that involves setting unrealistically low expectations, then mentally playing out all the possible outcomes of a given situation. For instance, Dr. Norem explained, a defensive pessimist is likely to approach a coming public speaking engagement with mounting anxiety. But rather than giving herself a pep talk or using positive imagery to calm herself down, the defensive pessimist will picture herself tripping over the microphone cord, dropping her notes and dissolving into a fit of coughing. Yet this anxious reverie will also include plans for avoiding such humiliation, like wearing low heeled shoes or having a glass of water on the lectern. "This mental rehearsal tends to make defensive pessimists feel less anxious, and so they actually perform better," Dr. Norem said.
    In laboratory experiments, the psychologist and her colleagues have found, defensive pessimists indeed perform as well on tasks as "strategic optimists," who are less anxious, tend to set high expectations for their own performance and avoid thinking about all the things that could go wrong. But the performance of each group suffers when it is impeded from engaging in its preferred strategies. In one study, for example, defensive pessimists and strategic optimists participated in a dart throwing exercise. The subjects were randomly assigned to prepare for the task in one of three ways. In one, they engaged in "coping imagery," imagining something going wrong and taking steps to fix it, a strategy close to the natural approach of defensive pessimists. In the second, the subjects practiced "mastery," imagining a flawless performance. In the third, the participants engaged in a relaxation exercise, distracting themselves from the pending dart throwing by imagining a peaceful scene, perhaps a beach. Defensive pessimists, the researchers found, did well in the game when they prepared using imagery that mimicked their preferred coping style. But their performance declined when they imagined performing perfectly and they did even worse when asked to act like optimists, distracting themselves with relaxing images. Strategic optimists, in contrast, performed best after the relaxation exercise and worse then they imagined things going wrong.
    Other researchers have investigated the benefits of griping (high for those who do it infrequently, lower for for frequent complainers) and extent of pessimism in different cultures. (Asian-Americans, one study found, are more pessimistic than Caucasian-Americans, and are more likely to use pessimism as a way of coping.) Work by Dr. James Pennebaker, a professor of psychology at the University of Texas at Austin, also underlines the positive role of what some might call "constructive negativity." Obsessively ruminating about how miserable life is, studies show, can have a harmful effect on health. But in a series of studies, Dr. Pennebaker and his colleagues asked subjects to focus on stressful or disturbing life events in a structured way, writing essays about the most traumatic experience of their lives, for example. The subjects; health improved on a variety of measures, and this improvement persisted for up to four months after the studies were over.
    Dr. Pennebaker said he was happy to be considered part of the positive psychology movement but that "a lot depends on what we mean by positive psychology." "There's some reasonably compelling evidence to suggest that when people are falsely peppy and upbeat and chipper, it's not very healthy," he said. And, he added, little data supports the idea that a positive attitude enhances health--something he pointed out repeatedly several years ago when his wife developed breast cancer, and people kept telling her, 'You just need to be positive all the time.'"
In fact, Dr. Pennebaker added, a 1989 study he published with Dr. David Watson, now at the University of Iowa, indicates that even nervous, unhappy people, prone to chronic complaining, appear to be nor more unhealthy than their buoyant peers. Subjects in the study who scored high on measures of nervousness, apprehension, irritability and oversensitivity were more likely to complain about physical symptoms. But they were no more likely to visit the doctor, develop high blood pressure or die. "It's not bad to be nervous and it's not bad to be angry," Dr. Watson said in an interview. "We have these emotions because they serve useful functions for us."
    The participants in last week's symposium emphasized that they hoped to temper, not to disparage the field's interest in positive things. "I"m not saying it's good to let people wallow in the negative," said Dr. Arthur Beaujhart, a humanistic psychologist at California State University at Dominguez Hills. "I see this as a healthy corrective, or an expanding of the positive psychology movement." But psychologists identified with that movement say that positive psychology already makes clear that at times, optimism is neither appropriate nor beneficial. Dr. Seligman, a founder of positive psychology, expressed amusement that a positive focus could stir controversy. "I"m all for negative psychology," he said. "I spent 35 years of my life doing it. It seems to me that there's no danger that people are going to be working exclusively on the positive. I think most of psychology has been about going from minus 8 to minus 5."

Judge Throws Out Connecticut's Lawsuit Against HMO
Associated Press, 8/16/2000

HARTFORD, Conn.-- A U.S. District Court judge has thrown out Connecticut's lawsuit against the state's largest HMO. The lawsuit, filed in December, alleged Physicians Health Services pressured patients to use company-preferred drugs, even when the medicine their doctor prescribed was safer and more effective. It also accused the company of using price, not quality, to determine which drugs to cover. In his ruling Tuesday, U.S. District Court Judge Stefan R. Underhill said that the lawsuit appears to raise ''very legitimate and serious concerns'' but the state has no legal standing to bring the action.
''I said at the outset there were formidable hurdles and this ruling in a way is not a complete surprise,'' said Blumenthal, in Los Angeles attending the Democratic National Convention. ''But we believe that the hurdles, the obstacles legal and otherwise, can be overcome and in the end we will change the way this industry does business.'' He said he plans to appeal. The U.S. Supreme Court in June ruled that HMOs cannot be sued simply because they use financial incentives to hold down medical costs. Allowing such lawsuits, the court ruled, would undermine the very reason Congress passed the ERISA statute in 1974 facilitating the creation of HMOs. ''This is not tobacco. The tobacco industry is not regulated the same way health plans are,'' said Joseph J. Kempf Jr., a lawyer for PHS. ''I think ERISA has very strong protections and I think ERISA severely limits lawyers' ability to attack the health plans.''
In a 28-page ruling, Underhill said that, regardless of the merits of the case, the state of Connecticut is barred from suing HMOs under the federal statute that governs the management of employee-benefit plans. ''Congress carefully limited the persons authorized to being an ERISA civil enforcement action, and any such plaintiff must be either a 'participant, beneficiary or fiduciary,''' Underhill wrote. ''The state does not meet any of these statutory requirements.'' Blumenthal called Underhill's interpretation of ERISA ''hyper-technical.'' Officials at PHS said they were pleased with the decision and confident Underhill's ruling will be upheld by the higher court. Issues of legal standing aside, Kempf said Blumenthal's case would not have prevailed on the merits. Of the eight plaintiffs named in the lawsuit, Kempf said seven ultimately got the medication they wanted; the eighth did not pursue an appeal.

Rebirthing Victim, 10, Had Nightmares of Being Murdered
Kieran Nicholson. Denver Post- 8/16/2000

Ten-year-old Candace Newmaker, the girl who died after a "rebirthing" session in Evergreen went awry, had dreams that she was going to be murdered, including one the night before the infamous session, according to court testimony. Candace had been thrown out of a second-story window by her natural mother before being adopted by Jeane Newmaker in 1996, and that caused the nightmares, according to testimony from Diane Obbema, an investigator with the Jefferson County Sheriff's Office crimes-against-children unit. "She had nightmares about being murdered," Obbema said. "She thought she was going to die after she fell out the second-story window." Obbema said the girl's natural mother was "abusive and neglective." In April, Jeane Newmaker, 46, brought Candace to Evergreen from their home in North Carolina to undergo an intensive two-week therapy program with hopes of curing the girl's "attachment disorder" to her adoptive mom, according to David Savitz, a defense attorney.
    Therapists Connell Watkins, 53, and Julie Ponder, 40; business manager Brita St. Clair, 41; and intern Jack McDaniel, 47, all face the charge of knowing or reckless child abuse resulting in death. Savitz represents Jack McDaniel. Jeane Newmaker, of Durham, N.C., faces a hearing Sept. 6 on a lesser felony charge, criminal-negligence child abuse resulting in death. Candace Newmaker was being treated at Watkins' home, but Ponder was acting as the lead therapist during the April 18 rebirthing session because she was more experienced in that particular therapy, having gone through it herself more than once, said Obbema.
    The two-week rebirthing session, and other earlier sessions, were videotaped. Obbema testified that Watkins told her: "The video is going to hang us." And Ponder, according to Obbema, told a deputy at the scene: "It's my fault . . . I had no idea she stopped breathing." Ponder was in charge of monitoring the girl's breathing, Obbema testified. During Tuesday's preliminary hearing before County Judge Charles Hoppin, defense attorneys Savitz and Michael Steinberg, who represents St. Clair, tried to establish a lesser degree of responsibility by their clients. While cross-examining Obbema, Steinberg stated that St. Clair had expressed reservations about the rebirthing procedure, but was assured by Ponder and Watkins that it was a "perfectly safe technique."
    Parts of Obbema's testimony were based on the tape, which was not shown at the hearing. The television program "Inside Edition" requested a copy of the video on Aug. 1, but Hoppin denied the request. On Tuesday, as evidence was introduced, defense attorney Craig Truman, who represents Watkins, requested that the items, including the two-page autopsy on Candace, be sealed. The preliminary hearing was continued until 1:30 p.m. Thursday, when Hoppin will determine if the defendants should be bound over for trial.

Michigan Gets a D in Post-Abuse Care
Mary Anne George, Detroit Free Press, 8/16/2000

Michigan needs to enact more laws to improve the health care system's response to victims of domestic violence, according to a study by the Family Violence Prevention Fund released Tuesday. The study by the San Francisco-based advocacy group evaluated state laws governing the training of health care providers, the screening for abuse, the reporting of injuries, protocols for dealing with domestic violence and the protection of victims from insurance discrimination. Michigan was one of 34 states that received a grade of D. Pennsylvania was the only state to receive an A. California, Maryland, New Hampshire, New York and Washington received B's. Colorado received an F.
    Lisa James, project manager for the study, said researchers looked only at laws governing health care and domestic violence. "Health care providers see many more women who are victims of domestic violence than police or domestic-violence shelters," James said Tuesday. "They may be the first and only people to provide victims with information, support and resources." The need for medical screening for victims is vital, according to James.
    Thirty-one percent of women report being sexually or physically abused at some point in their life by a husband or boyfriend, and 37 percent who seek treatment in the emergency room for violence-related injuries were abused by an intimate partner, according to data compiled by the group and the U.S. Department of Justice. Debi Cain, executive director of the state's Domestic Violence Prevention and Treatment Board, said there are many efforts to help health care providers identify and assist victims. "Michigan has been a national leader in passing laws regarding law enforcement's response to domestic violence," Cain said. "But we can do more."
    Among the reasons Michigan got a low grade: The state doesn't have laws mandating training in screening and identifying domestic violence for health care providers. Only 11 states have such laws, according to the study. The state also has no law mandating that providers screen patients for domestic abuse. Only four states have such laws.

Predator's Supervised Release is Proposed
David Fisher, Seattle Post-Intelligencer- 8/16/2000

EVERETT -- Mitch Gaff is a sexual predator. He likes to stalk women, humiliate them and rape them. No one denies that. But his doctors at the Special Commitment Center at McNeil Island say he is ready to return to society, albeit with 24-hour guards and many treatment requirements. Snohomish County prosecutors have taken Gaff to trial in an attempt to keep him locked up in the high-security center, where people who are labeled dangerous sexual predators are sent for indefinite terms of treatment after their normal prison terms end. In the decade since a landmark state law created the Special Commitment Center its counselors have never recommended a release. Until now. Gaff's case marks the first courtroom test of a positive release recommendation.
    Gaff has completed more than eight years of therapy to learn how to control his deviant, violent urges, Dr. Vincent Gollogly, a clinical psychologist and the center's director, testified Tuesday. That doesn't mean the 42-year-old rapist is cured, Gollogly told an eight-man, four-woman jury. It just means that a team of doctors and social workers, including outside psychiatrists from Western State Hospital, have determined that he probably will be able to control himself with monitoring and treatment. That would include 24-hour supervision by security guards, a home equipped with electronic monitoring and security system, visits to a probation officer, alcohol and drug counseling and sex offender therapy. If Gaff is released, those restrictions could be eased later if a Superior Court judge approves changes, Gollogly said, but would likely always include monitoring. Actuarial tests, designed to identify personality characteristics that lead to reoffending, indicate that Gaff has a 55 percent chance of reoffending within seven years without treatment and a 65 percent chance of reoffending within 10 years, Gollogly said. But he said he believes Gaff's therapy have given him the ability to "modulate" his behavior, dropping the risk of reoffending to "less than 50 percent."
    In a clear, quiet voice, Gaff recounted his rapes and attacks on the witness stand, one by one. In his first attack, he said, he raped a woman who fell asleep at a party. "Why?" Deputy Prosecutor Paul Stern asked. "Because I wanted to," Gaff replied. Stern led him through a description of seven rapes and at least two thwarted attacks, all on strangers, over a period of six years. Finally, in 1984, while he was on probation for another attack, Gaff stalked a 16-year-old girl who bought flowers from a shop where he worked. He bound and gagged the girl and her 14-year-old sister in their Everett home, then raped and sodomized them. He tried to strangle the 14-year-old to death with a hair-dryer cord, then attacked her sister with a knife when she intervened. The attack ended when the 14-year-old ran into the street to scream for help.
    Gaff said he has "gained a lot" from his treatment. "I've integrated more. I've gotten stronger." Later, with Gollogly on the stand, Stern noted that one psychologist's tests indicated that Gaff has a psychopathic personality, and could manipulate his counselors into a favorable review. Gollogly said the state Department of Social and Health Services, which runs the Special Commitment Center program, is surveying state-owned properties where Gaff and other soon-to-be-released offenders might be housed, but no location has yet been determined. The state estimates it will cost $150,000 a year to provide "least restrictive alternative" housing.

Anti-Nausea Cancer Treatment Shows Promise for Alcoholics
Lindsey Tanner, Associated Press- 8/22/2000

Chicago--A drug used to fight nausea in cancer patients can help the most difficult-to-treat alcoholics significantly reduce their drinking, research suggests. Success with the drug ondansetron comes amid a growing search for new medications to help treat a disease that affects some 14 million Americans. In the past half-century, just two drugs have been approved to treat alcoholism, though studies on a number of others are under way. Researchers from the University of Texas Health Science Center in San Antonio reported preliminary results with ondansetron in Wednesday’s, Journal of the American Medical Association.
Ondansetron worked in patients with early-onset alcoholism, who represent about 3.5 million of the nation’s alcoholics, said Dr. Bankole Johnson, a psychiatrist who led the study. These alcoholics, who develop problem drinking at or before age 25, are believed to have a biological predisposition toward alcoholism. They often respond poorly to counseling, exhibit anti-social behavior and have a high relapse rate.
An imbalance between two chemical messengers in the brain, serotonin and dopamine, is believed to create a craving for alcohol in early-onset alcoholics, Johnson said. Ondansetron’s ability to regulate the serotonin-dopamine interaction may explain why it was effective only in such alcoholics, he said.
The study involved 271 alcoholics who were given ondansetron twice daily or a dummy pill for 11 weeks. Weekly behavioral therapy also was included. Three different doses were tested, with the middle dose proving most effective. Alcoholics on that dose had an average of about 1½ drinks daily compared with nearly 3½ drinks daily for the placebo group. They also abstained from drinking for an average of about 70 percent of the study days, compared with 50 percent for the placebo group. The findings could lead to better ways to treat alcoholism and to tailor treatment to specific types of alcoholics, Dr. Henry Kranzler of the University of Connecticut wrote in a JAMA editorial. Glaxo Wellcome Inc. makes ondansetron. The National Institute on Alcohol Abuse and Alcoholism funded the study.

Sex-Offenders' Facility Gains
Kieran Nicholson, Denver Post- 8/23/2000

JEFFERSON COUNTY - Despite the impassioned pleas of dozens of Pine area residents, county commissioners agreed Tuesday to move forward with a proposal to build a facility there for juvenile sex offenders. Opponents of the plan, some of whom had to watch part of the proceedings on closed-circuit TV because the hearing room was so packed, stormed from the hearing in disgust. "This decision was made in eight minutes after seven hours of testimony," said Stan Foxx, spokesman of Help Our Mountain Environment, or HOME, a grassroots organization against the planned center. "The short time (deliberating) suggests that the performance put on by the county commissioners was just that, a show."
   More than 300 opponents, many spilling into the hallways of the county building, jammed into the hearing room Tuesday morning, asking the board to scrap the plan or at least slow down the process to involve a wider range of residents and experts. The issue has been contentious in the Pine area since the proposal was revealed in mid-July, on the heels of the devastating Hi Meadow fire and local flooding. Security guards even frisked people for weapons as they entered the hearing room. In the end, county officials said they had to move forward but would keep other sites in mind and would explore the idea of the state getting involved. "I'm not convinced that this is the best solution or the best site," said Commissioner Michelle Lawrence, just before the three-member board voted unanimously to go on with the process. "However, we must keep our options open. The state should take the lead in this matter."
    Before the board's decision, state Rep. John Witwer, R-Evergreen, testified on behalf of HOME and other opponents, offering to craft legislation that could take the hotly contested facility out of Jefferson County's hands. Witwer said he believes such a facility would be warmly accepted in Brush or perhaps in a sparsely populated county. Witwer said he would work on legislation for the next session with Sen. John Evans, R-Parker. Both represent Jefferson County's mountain community. Perhaps the state Department of Human Services "will take the load off the counties," However, county officials say one of the reasons the facility is planned within Jefferson County is to allow easy access to family members who would be involved in the treatment of the offenders.
    In an unusual measure for public hearings, security guards were stationed outside the main hearing room to check for weapons in response to death threats aimed at County Administrator Ron Holliday. He is spearheading the county's effort to build a 60-bed residential treatment center that could be expanded to 100 beds. Some opponents told commissioners the size of the facility would have a negative impact on the kids being treated there, as well as the surrounding community.
    "First, there is little if any dispute that the most effective treatment environment for juvenile offenders is in a home or homelike setting," said Donald Smith, a retired Colorado Court of Appeals judge who also served as chief judge of the 18th Judicial District. Smith, who lives in Buffalo Creek and was on a judicial committee that drafted the Colorado Children's Code in the late 1960s, said he believes the county is more concerned with "securely warehousing these children instead of helping to rehabilitate them." Holliday said that the center would use a series of cottages, with no more than 12 kids in each cottage. "Housing and treating kids in small group cottage settings" within the facility would create an acceptable treatment environment, he said.
    Under state law, the county is responsible for placing offenders into court-ordered treatment programs. It's currently responsible for 45 kids. County officials plan to have the proposed residential treatment facility running by February 2002, when a county ordinance limiting the number of sex offenders to one per group home goes into effect. Opponents also questioned the impacts the facility would have on the mountain community, including its effect on water and property values, and safety of nearby residents. Kay Smith, a Pine Junction resident and licensed clinical social worker, citing a report on sexual offenders' propensities to start fires, is worried that another Hi Meadow fire could be started. That fire in June burned 10,000 acres in the area. "In my opinion, the facility is a powder keg waiting to explode," she said.

Just Say--Yes? Survey Finds Some Parents Introduce Teenagers to Drugs
Ephrat Livni, ABC News- 8/24/2000

NEW YORK--One in five drug abusers in some treatment programs in the United States received their first taste of these illegal substances from their parents, usually before the age of 18, a new survey says. The survey found that drug treatment candidates at 70 Phoenix House drug treatment programs in the United States are 19 times more likely to have been introduced to illicit drugs by a family member than a professional drug dealer, according to Penn, Schoen and Berland Associates, the national research firm in New York that conducted the study.
Twenty percent obtained the drugs from the parents, and of these 6 percent even used heroin with them. "These findings should disturb everyone involved in preventing drug use among kids," says Dr. Mitchell S. Rosenthal, a psychiatrist and president of Phoenix House. Rosenthal believes the findings of the survey reveal that too many parents in America view teenage drug use as little more than a right of passage.

Not a Representative Population
The study does not apply to the general population of drug users, however. "It’s important to realize that these are kids who have already gotten in serious trouble with drugs," says Alyse Booth, spokeswoman for the National Center for Addiction and Substance Abuse at Columbia University, in New York City, commenting on the study. " I don’t think 20 percent of parents across the country are smoking dope with their kids," she says, yet added, "a large majority of baby boomers did use illegal drugs and are more likely to have a benign attitude [to their kids using them]." The survey noted similar levels of parent-teen drug sharing among whites, blacks and Hispanics, as well as among urban and suburban residents.
"In this survey we met the neighborhood pusher and he is a lot like us," Phoenix House’s Dr. Rosenthal stated.
Stephen Higgins, a professor of psychiatry and psychology at the University of Vermont in Burlington, says addiction professionals have known for some time that most people are introduced to drug use by friends and relatives and not by a professional pusher. But he says this may be the first formal study that attempts to quantify that phenomenon. According to the study, 36 percent of respondents were introduced to drugs by a neighborhood friend, 29 percent by a school friend and 19 percent by relatives. Family members who introduced youngsters to drugs include siblings, parents, uncles, aunts, cousins and spouses. Of those who used drugs with their parents, 76 percent used marijuana, 19 percent used crack, 16 percent used cocaine and 6 percent used heroin.

Prevention Starts Where?
"The study poses significant questions about drug prevention and education campaigns — which call parents ‘the anti-drug’ and urge them to talk to their children about drugs — in many households where parents do not embrace anti-drug values," according to a statement issued by Phoenix House. Other addiction experts also questioned the value of anti-drug tactics in light of the survey. For children who are exposed to drugs at home, school or national drug prevention campaigns become "totally worthless," says Dr. Peter Rogers, a pediatrics and addictions specialist at Children’s Hospital in Columbus, Ohio, who also serves on the substance abuse committee of the American Academy of Pedriatics. He called the survey’s findings "shocking... even after working in substance abuse for fifteen years."
"The message that is very clear here is that parents can have an impact on their kids," says Columbia’s Booth. She believes parents are unaware of the extent of their influence — both positive and negative — on children. Parents have to send a very clear message to their kids about not using drugs and those parents who use illegal drugs, such as marijuana, are likely conveying very mixed messages. "Family systems are powerful forces in shaping the attitudes and behaviors of our children," agrees Scott F. Basinger, chair of the Substance Abuse Assistance Council at Baylor College of Medicine, in Houston, Texas. "This information suggests the problem is not ‘out there’ but ‘in here.’" He says the survey suggests more efforts and resources should focus on families and education rather than in support of law enforcement effort attempts to stop dealers, adding, "I hope the Office of National Drug Control Policy considers this survey data."
The survey, funded by Phoenix House, looked at a random sample of 528 current residents at Phoenix House drug treatment programs in New York, California, Florida and Texas. Residents responded to 80 questions about their drug history and their views on substance abuse treatment and policy issues. Phoenix House is a private, non-profit substance abuse treatment, prevention and education program, serving 5,000 adult and adolescents in eight states.

Getting Off Antidepressants: Withdrawal Side Effects of SSRIs Emerging
Rebecca Raphael, ABC News- 8/25/2000

As bad as her panic attacks were, 27-year-old Melissa Hall says that going off the medication she originally took as treatment was also a nightmare. Although she followed a doctor’s advice and tapered off the Paxil, she says she experienced severe dizziness, nausea and electric shock sensations, which left her virtually incapacitated. "I didn’t work for two months," she says. "I just laid on my couch waiting for the dizziness and nausea and everything to go away." When doctors didn’t have answers for her, Melissa turned to the Internet, where she found hundreds of postings by people experiencing similar symptoms as they discontinued Paxil, reassuring her that she was not alone. As patients like Melissa attempt to discontinue use of various antidepressants, some experts worry they are not getting enough information about how to deal with potential withdrawal side effects.
Millions of people, perhaps as many as 10 percent of the American population, have taken serotonin boosters, which are often used to treat depression, panic disorder and compulsive behavior. Many of them have no problem discontinuing use, but others experience side effects of varying degrees. "Some of them seem to have more withdrawal side effects than others," says Thomas Moore, a health policy analyst at George Washington University. Despite anecdotal reports, there have been very few studies, and experts can’t say how many people may experience some form of withdrawal. "We see withdrawal symptoms that can be so severe," says Dr. Joseph Glenmullen, a clinical instructor in psychiatry at Harvard Medical School and author of Prozac Backlash, "that patients feel held hostage to the antidepressant."

Washing Out of the Body
Shari Loback was prescribed Paxil for chronic headaches by her neurologist, who she says never warned her about problems associated with getting off the drug. "I was so dizzy and sick, and sometimes I would get out of bed and I would just collapse because I couldn’t get up," Loback says. Other patients report experiencing balance problems, flu-like symptoms, hallucinations, blurred vision, irritability, tingling sensations, vivid dreams, nervousness and melancholy.
    While SSRIs work similarly, by adjusting the amount of serotonin in the brain, they each have a different half-life, which is the amount of time the drug stays in the body. The SSRIs with shorter half-lives, such as Paxil, wash out of the body most quickly and can cause a jolt to the nervous system. In contrast, Prozac, which has a longer half-life, remains in the system longer, so withdrawal effects may be less disruptive. "Prozac is less likely to cause acute withdrawal," says Dr. Robert Hedaya, psychopharmacologist and author of The Antidepressant Survival Guide. "Withdrawal symptoms take longer to hit, but that doesn’t mean you won’t experience them in four or five weeks."
    Compounding the problem, some experts say, is that many patients who go off the drug mistake withdrawal symptoms for a return of the original symptoms they were using the drug to treat. It is then very common for patients to restart the medication. "This is chasing one’s tail by medicating withdrawal side effects," says Dr. Glenmullen, which often results in needlessly prolonging exposure to the drug. The product insert for Paxil warns that "abrupt discontinuation may lead to symptoms such as dizziness, sensory disturbances, agitation or anxiety, nausea and sweating, and also mentions "withdrawal syndrome" as a rare adverse event.
    "What we have seen in terms of the anecdotal reports is that it happens very rarely," says Dr. David Wheadon, vice president of regulatory affairs at SmithKline Beecham, the maker of Paxil, referring to withdrawal side effects. After growing concern about these withdrawal symptoms, drug companies renamed these phenomena "antidepressant discontinuation syndrome," avoiding the negative connotations of the word "withdrawal." Wheadon says these symptoms only occur in about two out of every 1,000 patients who discontinue the medication in what he calls an "appropriate" way. Even then, he says, the symptoms are mild and short-lived. While Melissa Hall was ultimately able to get off the antidepressant, she says her experience was far from mild or short-lived. "Even though I had found people on the Internet that were going through the same thing," she says, "no one knew how long it was going to take."

As You go Off an Antidepressant….
Work closely with a doctor. Think of your doctor as your partner in healing, suggests Hedaya. Don’t go off medication without medical supervision.
Taper the medication. Experts agree that the best way to avoid withdawal side effects is to wean off the medication. By reducing the dosage in small increments, the brain can gradually adjust to the change in chemical balance and slowly adapt to living without the drug. For some people, experts say, this process may take up to a year.
Get psychotherapy. While drugs can often cover up problems, therapy can help uncover and address the underlying causes. Cognitive behavioral treatment, for example, can work to change maladaptive behavior, bring out stifled emotions and provide you with the tools for dealing with future issues. In fact, extensive clinical research has shown that for some conditions, psychotherapy is superior to medication in the long run.
Time it right. It is best to go off medication, Hedaya suggests, when the factors that may have led to depression or a panic attack, for example, were resolved or at least under your control. It may be beneficial to go off medication when not undergoing a major life change or enduring stress.
Exercise. Study after study provides strong evidence that exercise plays a major role in lifting mood, boosting energy, improving immune function, reducing stress, anxiety and insomnia, increasing sex drive and elevating self-esteem.
Eat a healthy, balanced diet. Consider consulting a nutritionist who can suggest foods that will positively impact mood, energy level or help treat (or at least not worsen) any other conditions.
Find a "centering practice." Dr. Richard Mackenzie of Childrens Hospital Los Angeles recommends a "centering practice" such as yoga or meditation to get in touch with your inner compass, find equilibrium, reduce stress, stabilize mood swings and relax.
Get your hormone systems tested. "Everybody should make sure they have a very thorough evaluation of their nutritional status, hormones, minerals, vitamins and immune system," says Hedaya, "to enhance possibilities of reducing dosage or going off medicine." Hormone imbalances like an underactive thyroid or deficiencies of amino acids and minerals, for example, can rob you of energy, sexual vitality and feelings of well-being and are easily treated.
Consider vitamin supplements. Hedaya reports success in patients coming off Efexor, for example, by taking 25-50 mg. of Vitamin B6 daily. He notes, however, that excessive doses on a prolonged basis can be toxic.
Turn to friends and family. "These are people who have been in a patient’s life far longer than a therapist," says Glenmullen, "and will continue to be there long after therapy is complete." Glenmullen also suggests making use of community resources such as church or support groups.