Noteworthy News Articles on Mental Health Topics, September 9-17, 2000

Family Court Decision Sparks Debate on Behavior-Modifying Drugs
Lynn Brezosky, Associated Press, 9/9/2000

BERNE, N.Y.--Kyle Carroll was past his twos and still not talking. Or rather, he was speaking, but in a language that seemed all his own. It was the first hint Jill and Michael Carroll had that something was different about their son. In kindergarten, it became clear Kyle wasn't about to focus in the classroom. A pediatrician diagnosed Kyle with Attention Deficit Hyperactivity Disorder and prescribed a trial run of Ritalin.
    That trial has lasted three years now, in the Carroll's view long enough. But at the end of a torturous yearlong battle with the Berne-Knox-Westerlo school district, they learned they don't have the choice of stopping it, despite their arguments the drug is wiping out sectors of their son's personality and turning him into a sickly, staring, insomniac.
    Under a consent order signed by Albany County Family Court Judge Gerald Maney in May, the couple must continue administering medications prescribed by a physician meeting court approval. That means unless they find a doctor who recommends taking their child off medication, and they haven't yet, they must continue giving Kyle Ritalin or risk losing him on grounds of neglect.
    What makes the order landmark is that Ritalin is a different kind of medicine, part of an emerging class of pills that treat behavior rather than disease. The Carroll's case is believed to be the first in which the state has mandated a chemical change in personality in a child who's not deemed homicidal or suicidal. It raises a national question whose decision is it to administer behavior-modifying drugs? To Dr. Peter Breggin, consultant in a class-action suit accusing the American Psychiatric Association (APA) of conspiring with Novartis (the pharmaceutical company that makes Ritalin) to sell as much of the drug as possible the ruling speaks of the loss of the most basic of constitutional rights, of mind control, of Big Brother. Only now, he says, Big Brother is Big Business. And by introducing youths to the notion there are biological defects in their brains and capitalizing on the idea of a quick-fix cure, Breggin says, the drug companies are no better than the cigarette manufacturers now paying out millions for encouraging addiction to their product.
    On the flip side is the possibility raised by Ritalin's many defendants that millions of children are part of the first generation of humans to have a medicine that allows them to focus and succeed, both in the classroom and the schoolyard, the microcosms of the professional world and society. Stimulant medications can then seem as progressive as insulin or penicillin.
    Yet even the staunchest proponents of stimulant medications such as Ritalin, the APA is one proponent, express surprise at Maney's ruling. ''It's an unusual case up there,'' said Dr. Richard Harding, professor of clinical sociology and pediatrics at the University of South Carolina and president-elect of the APA. Ideally, Harding said, the decision will be made jointly between parents and doctors, never forced.
    Breggin, author of several books on the subject, crusades against psychotropic drugs as a whole, and calls Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder ''a fabrication.'' ''The diagnosis is if the kid squirms in his chair, interrupts, is sloppy a list of things that annoy teachers and make it hard to teach,'' he said. There's no real diagnostic evidence of ADD, he says, none of the different colored brain clusters one sees in cases of Alzheimer's Disease or strokes. Jeffrey Schaler, a psychologist who teaches at American University's School of Public Affairs, agrees. ''There's no deficiency that Ritalin is fixing,'' he says, ''what it's doing is changing a behavior so the child complies with expectations and behaviors expected of him. You drug the child and get him to comply by drugging.''
    Albany County Family Court, Schaler says, has invaded the Carroll's privacy. Beyond that, he sees the decision as a fearsome precedent, an entry into a new gray area socially, with consequences no one can even guess at.    ''Psychologists and psychiatrists are going back over history saying just about every great person, every person who had some great contribution to society had some sort of mental problem. If you gave all those people drugs would that have stopped?'' Shaler asks. Schaler, however, thinks it's wrong to blame the companies, who are simply making a product, rather than the mindset of ''thou shalt not have any difficulty in your life.''   ''The bottom line is studying's hard work,'' he says. ''The bottom line is you just have to focus and discipline yourself.''
    It's an argument Jordan Lippman, a 22-year-old student at Union College in Schenectady, has grown tired of.   Until 11th grade, when he was diagnosed with dyslexia and ADD and prescribed a cocktail of the stimulant Adderall and the anti-depressant Welbutrin, Lippman was miserable. ''I always knew I was different because I was always in detention for forgetting my pens, forgetting my assignments,'' he says. ''I knew I was intelligent, yet it didn't correspond to anything. I knew the material but I couldn't make it translate into anything like good grades.''  Lippman's parents were well-off enough to send him to a private high school near their home in Tenafly, N.J., where he received plenty of one-on-one attention.
    On the strength of a personal interview and an award-winning senior year project on Attention Deficit Disorder (the success he says started his momentum), he was accepted to Union College, a highly selective private college in Schenectady. When a test was pulled away from him before he could finish it, Lippman realized he wasn't cutting it. He has since built a support group for students with ADD and ADHD, and lobbied deans and the college president. In effect, he has changed the campus climate for those with ADD.
    His peers have been the hardest to convince. In a written debate with Lippman that played out in the campus newspaper, Concordiensis, a former suite mate wrote ''one of the aspects of Union that makes it a desirable college, is that not everyone can attend here. If a student cannot keep up with his or her peers in the classroom, perhaps Union is not the ideal college for him or her.'' Lippman replied in part, ''you know that I work just as hard, and three to four times as long as most other students here at Union. My strengths are abstract verbal reasoning, but it is extremely difficult for me to do the initial processing of written language.''
    He says ADD is misnamed because it's not an attention disorder but rather a control disorder, in which the part of the brain that organizes and plans isn't working. He says his medication combined with self-awareness and awareness on the part of the college has helped him succeed. Lippman is now completing an internship with the New York City-based International Dyslexic Association, boasting a 3.676 finish for the last term, and meeting with editors from the Princeton Review to modify listings of services for the disabled listed by colleges. He's impressed faculty and developed mentors, including Dr. Rudy Nydegger, a clinical psychologist who teaches management and psychology at the college.
    In his own practice, Nydegger advocates a therapy that frequently includes writing prescriptions for stimulant medications. ''I don't look at solving problems by throwing drugs at them, but if we can get those kids calmed down and focused then we can help them learn techniques for managing their behavior,'' he says. And he for one is convinced ADD and ADHD have long existed. ''We called it other things,'' he says. ''We called kids stupid, underachievers.''

Family Loses Argument Against Drug
Lynn Brezosky, Associated Press, 9/9/2000

BERNE, N.Y.--The school nurse called during Kyle Carroll's first week of second grade last September. Wasn't Kyle going to be taking his Ritalin? No, Jill Carroll said, he made it through the summer without the drug and did just fine. She and her husband Michael were holding out, hoping the Ritalin days were over. On Sept. 15, the Carrolls say they got another call. Kyle was in the office and the district was threatening to expel him unless the medicating resumed.
    Superintendent Steven Schrade, who wasn't with the approximately 1,200-student school district when all this happened, denies the threat and now says the whole situation with Kyle ''was from well-intentioned people and just snowballed.'' Confidentiality reasons, Schrade said, prevented him from being able to discuss the case or the battle of wills the Carrolls say took place between Kyle and his teacher. ''I think there are a number of other factors that we can't talk about,'' he said. ''Believe me, Ritalin wasn't the only reason that the family ended up in Family Court.''
    Meetings would follow, with the Carrolls on one side of the table and a team including guidance counselors and special education specialists on the other.   ''I just started throwing things at them, why Kyle shouldn't be on Ritalin,'' said Michael Carroll, a construction worker. ''They just kept throwing things back at me, why he had to be. They didn't let me finish a sentence. They were comparing Ritalin to insulin. It has nothing to do with that. (Without insulin) the child dies. Without Ritalin you've just got to give a lot more time.''
    The law requires that school employees report instances of neglect to child protective agencies. In Kyle's case, someone at the school equated the failure to medicate Kyle with the unexplained bruises or signs of malnutrition that prompt other calls. The Family Court case, and court order mandating the Carrolls continue giving Kyle medications prescribed by a physician, followed. ''The case as I see it is educational neglect,'' said Pamela J. Joern, the law guardian appointed to the case. ''Your child has a diagnosis, it interferes with his education, a recommendation is made. It is not followed by the parents. It continues to interfere with his education. The parents take no steps to address the problem. It's not a pro-Ritalin decision; it's not an anti-Ritalin decision. A parent failed to ensure their child was able to receive an education.''
    Psychiatrist Susan Abbott of Port Jefferson, Long Island, defends this, saying Kyle probably was better able to learn when medicated. ''If unmedicated, you certainly won't learn as much as well, you won't achieve the same grades, you may not be able to follow your aspirations, attend your college of choice,'' she said. ''When the kids in the neighborhood don't play with you and you fall farther and farther behind...that's sad.''
    On Ritalin, the Carrolls say, Kyle is a zombie. He barely eats or sleeps; Michael says he senses him laying awake in his bedroom long into the night. When the parents came to school to view the children's pipe-cleaner bug projects, all the other children ran around excitedly. Kyle sat at his desk, staring off into space. ''We'd rather have him hyperactive than 'duh...,''' said Jill, who works as a store clerk. Side effects like Kyle's are often attributed to Ritalin; the drug has also been associated with stunted growth and irregular heart beat, and is named in at least one death.
    The Carrolls, who have three other children in addition to 8-year-old Kyle, feel the school would rather drug Kyle than take time with him. Said Abbott, ''I think in a world where each child can have their own teacher that would work. But in a class where teachers spend 33 percent of the time on one child with ADHD... you kind of have to think of the real world here.''

Report Calls For Two-Tiered Child Protective Investigations
Associated Press, 9/10/2000

ALBANY, N.Y.--An advocacy group for poor families says state child protection agents investigate families too often and should offer help more. The State Communities Aid Association report differs from other critiques by drawing attention to cases that are investigated but not substantiated. Two-thirds of nearly 145,500 claims in 1998 were determined to be unfounded, the report said.
    ''Nine-one-one gets hundreds, thousands, millions of calls. They don't send a cop out every time,'' said the report's author and the group's president, Karen Schimke. Of the reports that are substantiated, an estimated 40 percent are closed the same day, suggesting that families that needed ongoing help didn't receive it, the report says. The report called for Child Protection Services to prioritize cases through a two-tiered system, sending investigators to the most potentially dangerous ones instead of conducting lengthy investigations into every abuse or neglect complaint.  The less threatening arm of the system would work best if it used workers from community agencies instead of child-protection offices, said Richard Wexler, executive director of the National Coalition for Child Protection Reform.
    A two-tiered system, said Marno Batterson, a senior associate with the Center for the Study of Social Policy, is ''a step in the right direction. It's not foolproof.'' Batterson headed the child-protection system in Iowa and helped get a law passed in 1997 to switch its focus from investigating to helping families. The push for the change came from a widely publicized case in which the state put a mother on its child-abuse registry because her mentally impaired son had wandered from the house while she put another child to bed. Now the new system is under scrutiny because a 2-year-old girl whose case was under investigation was beaten to death in January. ''The public expects perfection, and it's not achievable,'' Batterson said. ''We're taking a look at it, and we welcome anything that might help us provide better service to the children and families of New York,'' said Bill Van Slyke, spokesman for the Office of Children and Family Services, which oversees Child Protection Services.

Ecstasy Additives Trouble Activists
Amber Bollman, Boston Globe- 9/11/2000

Law enforcement authorities and antidrug activists are warning that new and dangerous additives are being mixed into one of the most popular drugs sold and used in the city's nightclubs. Law enforcement officials say many makers of ecstasy, eager to cut costs and meet the demand for the euphoria-inducing drug among high school and college students, are lacing the pills with cheaper and more dangerous substances. ''You are becoming less and less likely to get what you think you're getting,'' said Mariellen Burns, a Boston Police Department spokeswoman.  Boston police are combating the popularity of the illegal drug by sending undercover officers into nightclubs to nab dealers. ''This drug is often marketed specifically to people of that age'' range, Burns said. Of particular concern, authorities said, is the use of PMA, a chemical recently blamed for the death of an 18-year-old woman in Illinois.
    When ingested, PMA causes sharp increases in body temperature. It also prevents blood from clotting and causes internal bleeding. ''You essentially bleed to death from the inside,'' said Emily Romano of the New England chapter of DanceSafe, a national group that promotes health and safety in nightclubs. While no hard data are available, anecdotal evidence from police and antidrug groups suggests that ecstasy pills laced with a variety of additives are infiltrating dance clubs in Boston in growing numbers. Besides PMA, other common additives include amphetamines, Valium, and even caffeine.
    According to the Drug Enforcement Administration, ecstasy use increased 500 percent in the United States from 1993 to 1998. During that period, emergency room visits nationwide resulting from the use of ecstasy skyrocketed, from 68 to 1,100. Massachusetts officials said the number of samples of ecstasy pills that arrived at the state's drug analysis lab rose from 20 in 1997 to 342 last year.
    In recent weeks, Romano said she has spoken to several young people who have taken what they believed to be pure ecstasy and experienced symptoms of much more harmful substitutes. ''I hear these kids talking about really terrible hallucinations and convulsions, which are not things you experience with ecstasy,'' Romano said. ''There has been a definite scare, especially because of deaths and injuries that have happened in other parts of country.''
    Chris, a 20-year-old college student living in Boston, says he used to use ecstasy every weekend, but a bad experience scared him off the drug permanently. Last November at a party, he took a pill that turned out to be mostly ketamine, an anesthetic used in animal tranquilizers. Although Chris swallowed only one pill, his friends crushed and snorted several. Like most varieties of ecstasy, the pills Chris and his friends took were stamped with a logo, in this case a green triangle. ''I just felt really bad, but they started seeing all kinds of crazy things and seriously thought they were dying,'' Chris said. ''They were messed up for a long time, and they couldn't really sleep for like three days. That pretty much ended it for me.''
    Danny, a 19-year-old who lives in Miami, said, ''With ecstasy, you never know what's in it, but it seems now like more and more people are ending up with bad pills.'' Like others interviewed for this report who said they used ecstasy, Danny spoke only on the condition that his last name not be used. Ecstasy pills typically cost less than $1 to make but sell for between $20 and $40.
    According to DanceSafe, which encourages ecstasy users to have their pills tested and posts the lab results on its Web site, green-triangle stamped pills from New York, Seattle, Philadelphia, and Los Angeles have been found to contain DXM, another common additive that is found in many over-the-counter cough suppressants. Aja, a 20-year-old from St. Louis studying at a Boston college who has been using ecstasy for almost three years, has experienced vomiting, convulsions, and uncontrollable jaw clenching after unknowingly taking ecstasy pills that contained DXM and methamphetamines. DanceSafe, which operates testing tables inside some West Coast nightclubs, has launched a local campaign urging clubgoers to purchase kits to test ecstasy pills. While the pills can often be bought inside clubs, users often take them at home before heading out for the night. The kits cost about $25 and are available online.
    Ecstasy users build a tolerance for the drug very quickly, and must often take several pills over the course of the night to maintain their high. Romano is encouraging users to take only one pill, to minimize the effects of potentially contaminated drugs. Burns, however, said there is no such thing as responsible ecstasy use. The drug, she said, is easy to conceal, and in the darkness of a nightclub or party, anything could be passed off as ecstasy. ''These people have no idea what they are doing,'' Burns said. ''Anyone who thinks they are safe is incredibly naive, because there are no safe ways to do these drugs.''
    Though ecstasy has not been proven to be physically addictive, Burns said many users become addicted to ''the state of mind and the escapism.'' Aja, who says she has cut back her use to every other weekend, went through a period in which she used the drug three times each week, sometimes taking as many as 15 pills a night. ''It's definitely a waste of brain cells and money, too, to be taking so many,'' she said. Aja has since purchased a testing kit, but admits that she doesn't always use it. Danny also tries to test most of his pills and buys them from dealers he trusts. Chris said he generally only took pills that he had seen other friends try without suffering severe side effects. ''Someone always has to be the guinea pig, but it usually wasn't me,'' he said. But, he added, most ecstasy users don't worry enough about contamination. He is particularly concerned about students arriving in Boston to start college. ''I really worry about these freshmen because you know there are going to be a ton of them rolling, and they don't know anything about the drug at all,'' Chris said. ''People really need to smarten up.''

DAs Differ Over Jailing Kids Charged As Adults
Carol Kreck, Denver Post- 9/11/2000

In Denver, 16-year-old Abraham Madrid spends 22 hours a day in a 6-by-9 cold-water cell at Denver County Jail. He and five other boys go to school two hours a day, two days a week. They are let out for recreation 45 minutes a day. The floor is strewn with trash and food tossed from cells. Their neighbors are adults moved into that section of the jail as punishment because they caused problems in other buildings. "Some (adults) are in for murder and it's kind of scary," said Abraham, who is charged as an adult for aggravated robbery. "You have to get to know them." It's a different story in Boulder where 14 year-old John Christopher Engel is charged as an adult for the murder of his mother and grandmother. When John Christopher isn't being evaluated for mental illness, he's at the Platte Valley Youth Services Center in Greeley. He spends his days in school, not in a cell.
    District attorneys statewide have the power to put juveniles charged as adults in jails for adults and that makes Colorado unique nationally, said attorney James Bell with the Youth Law Center in San Francisco, which successfully sued Denver's Gilliam Youth Services Center for crowding in 1994. "In other states, kids stay in juvenile hall until (their trials) are over," Bell said. The idea is, "just because you're charged, doesn't mean that you're guilty," Bell said. While they're presumed innocent, they should be receiving services for juveniles required by law - education, for example, he said.
    But Denver District Attorney Bill Ritter said youths charged as adults tend to have committed violent crimes and don't belong at Gilliam. "In choosing between jail and housing them at Gilliam with kids who may have committed status offenses (truants, for example), I choose city jail. The appropriate place to detain a juvenile charged as as adult is an adult facility," Ritter said. According to Colorado law, juveniles charged as adults will be held at an adult jail, "unless the district attorney and defense counsel agree otherwise." Because juvenile defense counsel would always want their clients in juvenile facilities, that gives prosectors sole discretion in deciding where youths will await trial. The result: some places, like Boulder, don't put their juveniles in adult facilities, but others, like Denver, do.
    Some 200 kids on the Front Range were charged as adults and had spent time in adult jails from July 1, 1999, to June 30 of this year, according to Susan Davis of the state Division of Criminal Justice. Numbers weren't yet available from the Western Slope. Housing juveniles with adults is a bad idea for many reasons, said Clarke Watson, who intervenes for kids and families in the justice system. "They don't like children" "The staff doesn't know how to work with children, they don't like children and (the facility) was not designed to accommodate children," Watson said.
    That is not such a big problem in places like Arapahoe and El Paso counties where the jails have facilities for young people, said Simon Mole, director of intake for the Colorado chapter of the American Civil Liberties Union. But in places like Denver that have no special place to put juveniles, it is a different story. "I do think most kids charged as adults tend to be in isolated conditions because jails have nowhere else to put them," Mole said.
    Denver prosecutor Bonnie Benedetti said Denver may have made an exception for a child charged as an adult several years ago because the youth was very small, but that exception was before her arrival at the district attorney's office where she prosecutes juveniles. "We think they are serious kids and a danger to others," Benedetti said. "Danger wouldn't be my concern," said Vel Garner who directs Gilliam Youth Services Center. "If there were large numbers, I would have concerns." At the time of this interview, Garner said she could have taken all seven youths who were then at Denver County jail. The week before, she wouldn't have had room. Charges rare in Boulder
    Boulder prosecutor Phil Miller said juveniles are rarely charged as adults in Boulder. When they are, they're still sent to Platte Valley Youth Services Center. If they become a problem at Platte Valley, they're sent to the Arapahoe County jail, which has a facility for young people. Many of the state's jails are in even worse shape than Denver's, said Mole, who gets complaints from jails all over the state. Mole said allowing juveniles awaiting trial to be exposed to adult prisoners is bad, but protecting them by isolation also is damaging.
    "I have inspected a couple of jails where juveniles are housed, and it does concern me that (juveniles) are almost always in 23-hour lockdown - solitary confinement for their protection," Mole said. "It's the kids they put in segregation," not adult predators, Mole said. "Segregation is the new word for solitary. There's punitive segregation and administrative segregation. "Physically, it's still solitary confinement in a small cell." While the state-run juvenile detention system must adhere to certain standards, conditions in county jails vary wildly. Mole receives complaints about charges for medical treatment, medications withheld, guards trigger-happy with pepper spray, temperatures so cold that water freezes in cells, water pressure so low that prisoners have to lick it up, waste going down one toilet and coming up another.
    Denver's problems stem from severe overcrowding in an antiquated facility. On the day he was interviewed, new corrections chief Fred Oliva said he had 2,015 prisoners in a facility designed for 1,350. "We try to keep (juveniles) as safe as possible, but there are other adults in that facility, and sight and sound (separation from adults) is not something we can do," he said. The area where kids and problem adults are housed consists of three rows of cells directly on top of each other, juveniles occupying part of the bottom row. When the juveniles wait to be taken anywhere in a group, they often chat with adult prisoners in their cells. They're also exposed to adult prisoners who are trusted with prison jobs.
    Abraham said a boy in the cell next to his got in a fight with an adult prisoner, a trusty who was passing out laundry. "He grabbed Armando by the wrist and pushed him against the wall. Armando got all scared and started hitting him back." "The guard said Armando was the aggressor," Oliva said. "I believe the guard." Confinement takes toll
    Perhaps the most frustrating aspect of being a kid in an adult jail is being in that cell 22 hours a day, Abraham said. Kids on the lowest tier have to breathe the stink of spoiled milk and other refuse poured out from the tiers of adults above them. "At first it was frustrating being in there, 22 hours a day," he said. Now, he tries to stay calm and think about his case. He draws, he reads, "I write a letter to my mom or something." He calls his grandmother once a day. Abraham has been in jail for four months and his next court date is scheduled for the middle of this month.
    Kids don't want to be there and most sheriffs don't want them there either, said Betty Marler, director of the Division of Youth Corrections. "I don't know any sheriff who likes having a kid in an adult jail," Marler said. "They would much prefer to have a kid in a juvenile facility." Marler recalled when Penny Brown, now director of Mountview Youth Services Center, ran the Adams County jail. She had a 16-year old charged as an adult and called Marler to help her get him out of there. Brown told Marler conditions in the adult jail were driving the teen crazy; she was visiting him in his cell and playing board games with him to keep him sane. Some lie about age
    Boulder sheriff George Epp said the rare occasions he has juveniles are when they lie about their age, claiming to be 18 or 19 when they're actually 16 or 17. "We ship them out as soon as we find out. "Generally, you want to separate them from adult prisoners, first to protect them so they're not assaulted," he said. "And there's a long-standing, well-founded belief that many kids who commit crimes as juveniles grow out of it. If we were to house them with adult criminals, that would reduce their chances of growing out of their criminality."

Volunteers Sought to Help Rising Number of Suspected Abused Kids
Brian Ballou, Detroit Free Press- 9/12/2000

The room's colorful decor is designed to make a child feel at ease, as are the playroom trappings -- coloring books, stuffed animals and games. The room is equipped with another feature -- a large one-way mirror. Behind that mirror, prosecutors, child protective services workers, police and medical officials assemble to listen to conversations between forensic social workers and children believed to have been sexually or physically abused. Older children are interviewed in another room with a more grown-up setting.
    The rooms at the Care House in Pontiac are the first stop for all children taken from suspected abusive households in Oakland County, according to officials with the Child Abuse and Neglect Council of Oakland County. Three years ago, about 400 children between the ages of 3 and 16 were interviewed by the council, which works out of the one-story Care House. Now, the caseload is at an all-time high with more than 600. Administrators expect the number to grow and are seeking volunteers.
    Today, the council is hosting Volunteers Call for Action Day, a recruiting drive, from 10 a.m.-8 p.m. at the Care House. There are 25 volunteers, and the council needs about 40, said executive director Judith Hoeffler. Volunteers need to be at least 18.  "We don't know whether the increase in the caseload means that there are more cases of abuse or whether public awareness has caused many people to come forth that wouldn't have in the past," Hoeffler said. "Whatever the reason, we need more volunteers here to help the children." Trained experts handle the two-hour interview, while the volunteers welcome the children, play with them and provide family support. Kim Gusse, director of intervention and training, said, "A good volunteer is someone who works well with children and is compassionate."
    The independent council has had a contract with Oakland County since it opened in 1989. It is paid $125 per interview, up to $80,000 a year. Operating costs are $800,000 a year, half of which is raised through fund-raisers and private donations. The remaining is paid by grants. In 1999, the Oakland County Children Protective Services hot line received about 8,000 calls, 80 percent of which led to an investigation, said program specialist Peggy Tiemann. The number of calls has remained steady over the last two years, but more calls are being investigated, she said. The 24-hour Oakland County Child Protective Services number is 248-975-5010. Care House is at 44765 Woodward in Pontiac.

You May Get Hooked Within Days of First Cigarette, Study Shows
Emma Ross, Associated Press- 9/12/2000

LONDON -- Scientists have confirmed a suspicion held by some smokers but never proven: It could take just a few cigarettes to become addicted. Some 12- and 13-year-olds showed evidence of addiction within days of their first cigarette, according to research reported this week in the British Medical Association journal Tobacco Control.  "There's been a suspicion that many people become addicted very quickly, but this is really the first hard evidence that we've had that this occurs," said Dr. Richard Hurt, director of the Nicotine Dependency Unit at the Mayo Clinic.
    Experts have tried for years to determine how long people have to smoke before becoming addicted, and "the best answer to date had been one to two years," said Hurt, who was not involved in the study. He said the findings will help scientists better understand the biology of nicotine addiction and lend more plausibility to the idea that some people may be more genetically susceptible to it than others.
    "The really important implication of this study is that we have to warn kids that you can't just fool around with cigarettes or experiment with cigarettes for a few weeks and then give it up," said Dr. Joseph DiFranza, who lead the research at the University of Massachusetts. "If you fool around with cigarettes for a few weeks, you may be addicted for life." The study, conducted in 1998, followed 681 12- to 13-year-olds in central Massachusetts for a year and tracked their smoking habits.   The researchers did not label any of them addicted because the standard definition of nicotine dependence assumes addiction cannot happen without prolonged heavy smoking. The scientists simply recorded symptoms that indicate addiction. These include cravings, needing more to get the same buzz, withdrawal symptoms when not smoking, feeling addicted to tobacco and loss of control over the number of cigarettes smoked or the duration of smoking.
    Ninety-five of the youths said they had started smoking occasionally -- at least one cigarette a month -- during the study. The scientists found that 60, or 63 percent, had one or more symptoms of addiction. A quarter of those with symptoms got them within two weeks of starting to smoke and several said their symptoms began within a few days.  Sixty-two percent said they had their first symptom before they began smoking every day, or that the symptoms made them start smoking daily. The researchers found that the symptoms began soon after the teens started smoking.
    The assumption that smokers become addicted only after smoking a lot of cigarettes over a long period of time came from observations that some people can smoke five cigarettes a day for many years and not become addicted, the study noted. However, it has never been proven that daily smoking is necessary for addiction to begin, the study added. The scientists suggested there may be three types of smokers: Those who become addicted very quickly, those who get hooked gradually after more regular smoking and those who can smoke lightly or pick up and drop the habit without becoming addicted. It is also possible that adolescents could be more sensitive to nicotine and that addiction may take longer in people who start smoking at a later age, they added.

Seventh Death Linked to Outpatient Opiate Detoxification
Linda A. Johnson, Associated Press- 9/13/2000

TRENTON, N.J. (AP) - A seventh patient death has been linked to two Camden County doctors facing loss of their medical licenses over their controversial method of detoxifying drug addicts within hours. The disclosure comes as Drs. Lance Gooberman and David Bradway were about to face a long series of hearings starting this week at which state regulators could pull their medical licenses, assess large fines or take other action. The hearings have been postponed until January so their new attorney can prepare his case.
    Gooberman and Bradway both are charged with gross and repeated malpractice, negligence, incompetence and professional misconduct. ''Not true,'' their lawyer, John S. Sitzler of Mount Holly, said Wednesday. ''We maintain they followed proper medical procedures, that the deaths were unrelated to the procedure. We intend to prove that.''  The doctors say they have successfully helped more than 2,300 people addicted to heroin and other opiate drugs get them out of their system and start on the path to recovery. The patients were sedated with anesthetic drugs in the doctors' Merchantville office, injected with medications to accelerate and ease withdrawal symptoms over just a few hours, then sent home with a relative or friend the same evening.
    For many addicts afraid of enduring two to seven days of horrible withdrawal symptoms - nausea, vomiting, fever and chills, pain and anxiety - or unable to miss work for that long, the speedy procedure Gooberman once advertised on billboards seemed like their only hope. State regulators and some addiction specialists disagree, calling the method unsafe. ''This procedure, as it was being practiced by Drs. Gooberman and Bradway, was a danger to the people who were being treated,'' Mark Herr, director of the state Division of Consumer Affairs, said Wednesday. ''There are no shortage of treatments that are cutting edge. We just want to make sure those cutting-edge treatments aren't cutting off life.''
    The two doctors have been barred since last Oct. 13 from performing the procedure, known as ultrarapid opiate detoxification, outside a hospital. At least one other addiction specialist in New Jersey oversees a similar procedure in a hospital, performed by an anesthesiologist and with patients monitored at least overnight. The state calls the procedure experimental, but it is performed in some other states and in several foreign countries. While the seven deaths among the doctors' patients have attracted considerable attention, only 0.3 percent of their patients died from 1994 through last fall. ''Tell me what medical procedure you know that has such a low mortality rate,'' Sitzler said, adding that many other medical procedures involving anesthesia are performed in outpatient clinics with patients sent home soon after awakening.
    The death most recently disclosed, that of a 30-year-old man, occurred on May 26, 1999, three days after he underwent the procedure. Five other men and one woman, ranging in age from 20 to 50, died anywhere from 6 1/2 hours to nearly three days after the procedure. Herr's office says dozens of other patients needed hospitalization afterward. Gooberman said autopsy reports showed two of the patients who died had taken cocaine shortly after their treatment. ''The autopsy reports have all shown that (the seven patients) had prior heart disease that was undetectable,'' Gooberman said. Sitzler said the doctors' patients were all evaluated beforehand as carefully as they would have been in a hospital and were properly informed of all known risks.
    Gooberman said he initially performed the procedure in a hospital and had patients put in intensive care beds because they are on breathing machines while sedated. But after some of his patients, at the hospital and eager for treatment, were bumped because critical patients needed that bed, he spent a year searching for a hospital where he could avoid that problem. When none agreed, he started doing the procedure in his office, which he said has all the patient-monitoring and emergency equipment in a hospital intensive care unit. The state, however, said Gooberman was wrong to have a certified nurse anesthetist, rather than an anesthesiologist, help perform the procedure. The Division of Consumer Affairs' 11-page complaint against the doctors also alleges they gave inadequate aftercare and didn't know enough about the effects of a drug pellet they implanted in the patients' stomachs to prevent them from getting high if they took opiate drugs after the procedure.

Reauthorization of Domestic Violence Act is at Risk
   Juliet Eilperin, Washington Post- 9/13/2000

The congressional gridlock that has stalled such high-profile issues as gun control and prescription drug coverage is poised to claim a more unlikely target: the Violence Against Women Act. The landmark legislation, enacted in 1994, has been widely praised as one of the most effective vehicles for combating domestic violence. But the bill reauthorizing the act has become enmeshed in fierce turf battles on Capitol Hill, and the law will expire at the end of the month unless it comes to the House floor for a vote.
    Although the act enjoys broad bipartisan support--the judiciary committees on both sides of the Capitol have approved it--House GOP leaders have shown little enthusiasm for pushing the bill when they're struggling to dispatch with more pressing legislative priorities before heading home to campaign for reelection. Supporters of the bill remain optimistic it will make it into law this year but are anxious that the ongoing turmoil in Washington could scuttle it. "Time's a wasting," said Sen. Joseph R. Biden Jr. (D-Del.), the bill's original author. "The Republican leadership controls this whole thing. If the Republican leadership doesn't pull the trigger, this thing's done."
    Democrats raised the issue yesterday in a meeting with GOP leaders and the president and sent a letter to House Speaker J. Dennis Hastert (R-Ill.) demanding a vote. House Minority Leader Richard A. Gephardt (D-Mo.) said yesterday he had visited a recently opened battered women's shelter in his district Sunday that was partially funded by the act: It had 25 beds that were filled in one day. "This is an epidemic problem in this country, and we need to put the federal government behind this effort," Gephardt said. Some Republicans have questioned the cost of the revised bill--the House version would allocate $3.8 billion over the next five years, while the Senate would provide $3.2 billion--but most of their objections concern jurisdictional issues. After the bill was put on a legislative fast track in the Senate, Budget Committee Chairman Pete V. Domenici (R-N.M.) put a hold on the measure, arguing that it infringed on his authority because it authorized spending over a five-year period. The House Education and the Workforce Committee, for its part, wants to weigh in on two of the bill's major programs that fall under its domain. And the House Commerce Committee reserves the right to sign off on public health programs.
    Kevin Talley, chief of staff for the Education and the Workforce Committee, said his staff had tried to broker a compromise with Rep. Constance A. Morella (R-Md.), who authored the House version of the bill. "She hasn't been willing to do that," Talley said. But Morella is appealing directly to Hastert and is planning to hand-deliver a letter to him today from the roughly 50 Republican sponsors of the bill calling on him to bring it up for a vote. House Judiciary Committee Chairman Henry J. Hyde (R-Ill.) and crime subcommittee Chairman Bill McCollum (R-Fla.)--who has been touting his work on behalf of domestic violence victims as part of his Senate bid--sent a letter to Hastert last week calling for a vote.
    Over the past five years, the law has allocated $1.6 billion to state and local programs, including a national toll-free hot line for victims of violence, funding for special police units focused on sex crimes, and civil and legal assistance grants so women can obtain restraining orders and other legal remedies. Some of the law's measures are modest: Police officers in San Francisco now carry cards with the names of shelters that they can hand out when responding to a domestic violence call. Others are broader: The hot line has logged more than half a million calls since its inception and now averages 13,000 calls a month.
    The new bill would expand the reach of the program, funding transitional housing for women and children and providing support for specific groups, including the elderly, the disabled and American Indians. In May, the Supreme Court struck down a civil rights provision in the act that gave women the right to sue their attackers for monetary damages if they could show that the crimes had been motivated by gender bias. But supporters say that was only a small part of the overall law.
    Even if authorization expires Sept. 30, Congress could still choose to appropriate federal funds annually for specific domestic violence programs. But women's advocates fear that many initiatives would fall through the cracks and that communities would have less of an opportunity to coordinate their efforts. "The idea behind VAWA was to create a system that got everybody together to solve the problem of sexual assault and domestic violence in communities," said Juley Fulcher, public policy director of the National Coalition Against Domestic Violence. "It comes down to how many shelter beds do we have. How many attorneys do we have to take on these cases? How many police officers do we have on the street?"

Anger Experts Say There's More to Knight's Tirades Than Just Venting
Anne Reuter, Ann Arbor News- 9/13/200

Bobby Knight made headlines this week when his history of angry tirades cost him his job as Indiana University basketball coach. After he grabbed a student and upbraided him for addressing him as "Knight", the school's president, Myles Brand, fired Knight for "a pattern of unacceptable behavior." Knight, known for his notorious temper, couldn't control himself, news accounts read.
    A forthright, volatile man who can't control his impulses? A skilled manipulator who used anger as a tool to get what he wanted for years but arrogantly went one step too far? A man whose deeper emotional issues have led him to habitually rage about things that others let roll off their backs? Or a man who didn't recognize the tough-coach culture he had created needed to change? How to make sense of Knight's behavior depends on whom you ask.
    We talked with local experts familiar with people who get angry, often, the way Knight does, and who suffer consequences that land them in court, get them in trouble at work or in relationships. Knight's habitual in-your-face expletives and shoves, his stubborn persistence despite criticism, form a pattern psychologists, psychiatrists and other counselors say they see every day. Without firsthand knowledge, these professionals couldn't supply definitive explanations of Knight's anger. But they offered some myth-defying insights about anger-prone people. Each questions a lot of popular beliefs about anger: that it's an explosive force that is nigh impossible to control, that people need to "vent," (but not by stuffing a garbage can as Knight once did), or that a few hours in anger management class will transform a chronically angry person.

Anger as a Tool
"Anger can be a very motivating, positive emotion, and (yet) people can use it in violent, devastating ways," said David Garvin, a counselor who deals with men involved in domestic abuse cases. The key word is use: Garvin has come to believe that habitually angry mates, bosses and coaches don't really lose their tempers, but use them very deliberately as a tool to control others. Garvin see Knight as unusual only because he managed to have his behavior condoned for so long. As a skilled manipulator, the combative coach doesn't need anger management classes, Garvin said. "He's the one who's the expert. Teaching him how to manage his anger is like teaching Michael Jordan how to dribble."
    Garvin puts angry men on a hard road of self-examination in a year-long program, "Alternatives to Domestic Aggression," run by Catholic Social Services in Ann Arbor, MI. He doesn't buy the argument that a boss's or coach's problem is that his anger gets the best of him. "It's not his anger, it's arrogance," he said. Knight, he said, "needs to deal with his arrogance and learn to control it and his (sense of) privilege."

Looking for Anger's Roots
Denis Walsh is an Ann Arbor psychiatrist and psychoanalyst on the consulting staff at St. Joseph Mercy Hospital. He's dealt with aggressive personalities as a forensic psychiatrist and a consultant on workplace violence. Walsh's professional training leads him to look beneath outward actions for deeper reasons for a person's behavior. People vary in their capacity to tolerate internal feelings such as anxiety, humiliation or shame. "Anger can stem from feelings of humiliation," he said. "A boss who is a bully somewhere is obviously frightened."
    Walsh suspects there's an underlying emotional problem that causes Knight's behavior, but "He's unlikely to want to find that out." Walsh agreed that Knight uses his anger deliberately as a way to control others at times, but that's not to say he's always in control. "He's manipulative, sure, but it's the 10 percent of the iceberg that's above water," he said. Tough coaches, like army drill sergeants, have traditionally felt society approves of their actions. "There's an underlying belief in our culture, "This is the way you make men," Walsh said. They often see a verbal or physical put-down as beneficial, both to an offending team member and the team. "Bobby Knight feels he's doing these people a favor," Walsh said. "He has a genuine interest in these kids."

Cultures Condone Anger
The idea that Knight's personality led to his firing is popular right now, but business psychologist Palmer Morrel-Sanders prefers another explanation, based on his insights into corporate culture. "We face this problem everyday in the workplace. People who do the beautiful work, but their behavior is deplorable." Said Morrel-Samuels, whose Chelsea-based firm, Employee Motivation and Performance Assessment, advises large corporations on improving employee motivation and performance.
    "Grabbing someone by the arm is not appropriate, but it is understandable as part of a corporate culture that encourages intimidation, directness and strength," he said. He argued that coaches build their own cultures in college athletic departments just the way Ford or GM executives do. Morrel-Samuels has dealt with companies where a boss's verbal invective to and about employees has lowered employee morale and increased error rates. "What Mr. Knight is doing with his team is what many executive are doing with their team. They just don't lay on hands," he said
    He says an organization allows such behavior because the team wins or quarterly profits are good. "I maintain it's possible to get the performance without the behavior," he said. "The very best long-term performance is achieved by people who are ethical, who do behave well and who do not humiliate employees." If Knight lands another college coaching job, Morrel-Samuels said he will have to conform to an altered set of ground rules, written outside the team culture he created. "There will be safeguards we won't hear about," he said. "Otherwise the legal liabilities (from potential injury) are too much for an administrator to deal with."

Researchers Say Genetic Susceptibility Makes It Harder for Some Heroin Addicts to Quit
Melissa Schorr, ABC News- 9/14/2000

Boston--Heroin users with a genetic variation that prevents them from kicking the habit may need to try alternative treatments — even including taking small sustained doses of the drug, researchers report today. The scientists, led by Dr. Ernest Noble, a psychiatrist at Neuropsychiatric Institute and Hospital at the University of California Los Angeles, report their results in the forthcoming issue of Neuropsychiatric Genetics. In the report, they say they have linked a previously identified "pleasure-seeking gene" to heroin users unable to get through addiction treatment successfully. Researchers followed 95 heroin patients who entered a rehab program using methadone, a drug treatment that helps some, but not all, heroin addicts kick the habit. Of the patients in this study, 54 successfully completed treatment, but 22 dropped out and 19 fared poorly.

Rehab Dropouts Had Gene
The researchers found the drug addicts who failed this program were four times more likely to have the pleasure-seeking gene. Specifically, of the patients studied, 22 percent of those who failed the program and 42 percent of those who had a poor outcome had the genetic variation, compared to only 9 percent of the patients who successfully completed treatment. And before entering the program, those with the gene had used, on average, twice as much heroin as those without it.
    "Heroin users who have this genetic variation may suffer from a more virulent form of the addiction that is less amenable to the standard course of treatment," says Noble, a former director of the National Institute on Alcohol Abuse and Alcoholism. "I don’t think these patients can get off drugs — if they don’t use heroin, they’ll use other things." The gene is present in about 30 percent of the population, and may predict a tendency toward addiction in general. "If you have a certain form of this gene, you are more susceptible to substance abuse problems," says Noble. Previous studies have linked the gene, called DRD2, with similar addictions such as alcoholism, smoking and overeating. Those who have this variation of the gene have fewer receptors for the pleasure-giving brain chemical dopamine, researchers say. These people may need to more aggressively pursue activities that will stimulate their few receptors to pleasure levels equal to others. "These people don’t feel normal pleasure in life," Noble says, "The only time they feel like they’re living is when they take these substances."

Alternative Therapies Needed?
In light of this and other work, researchers at the National Institute on Drug Abuse have approved several trials trying alternative treatment methods for patients with these genes, he says. "We haven’t found the best treatment for them yet," Noble admits. "But once we identify these people, maybe we can set up better treatment for them."
In one study, patients receive a much higher dose of methadone than is typical, which seems to help keep heroin users in treatment longer. And in one controversial form of treatment, patients with severe addictions even receive small daily doses of purified heroin to satisfy their need for stimulation. The treatments have already been tried overseas, but are still in the early stages here in the United States, Noble says.

Corrections Chief Challenges Criticism to Sex Offender System
John P. McAlpin, Associated Press- 9/15/2000

TRENTON, N.J. -- A day after a Senate investigator said no working system alerts prosecutors when sex offenders are released from prison, the top corrections officer claimed his department does just that in nearly ever case. New computer systems are being tested and revamped review procedures are in place, all to insure prosecutors have enough time to begin Megan's Law notifications, Corrections Commissioner Jack Terhune said Friday. Since a convicted rapist was mistakenly released in March, no sex offender ordered confined to a state hospital after serving a sentence has been freed, Terhune said. Corrections officials meet state laws requiring notice in the majority of other cases, he said. ''We believe we are close to 100 percent compliant,'' Terhune said.
    Raymond Alves was freed in March after serving less than half of a 47-year sentence for the rape of a teen in Fair Lawn and the assault of a Clifton teen. Prosecutors in Bergen and Passaic counties said they would have tried to block the release had they been alerted, as state law requires. Once freed, Alves took off on a 12-day cross-country bus trip before being arrested and charged with violating sections of Megan's Law. Sex offender notification rules require convicts to provide a valid address and to register with local authorities.
    Before the Senate Judiciary Committee in March, Terhune admitted his department made mistakes before releasing Alves. At the time, he promised changes. The committee then hired former U.S. Attorney Michael Chertoff to investigate the department's procedures. At a hearing Thursday, Chertoff told the panel county prosecutors often reported they were not notified as required by law. In many cases, sex offenders were on the street before prosecutors were told and police had time to verify addresses. State law requires notification 90 days before a scheduled release. ''We are well on the way to fixing it,'' Terhune said.
    For the first time, the Corrections Department and the state Parole Board are sharing detailed information on when inmates are scheduled for possible release, Terhune said. Corrections administrators now begin reviewing an inmate's records six months before a possible release. Since April, inmates who will qualify for Megan's Law when released are tracked once they begin serving a sentence, Terhune said. All prisons are now using the same forms and procedure, Terhune said.
    Complicating the process are inmates who are ordered released by the courts before scheduled parole eligibility dates, Terhune said. The notification process is also hampered by an inability to accurately fix a release date, he said. Inmates are granted various credits, all of which are flexible and change the ultimate release date. That release date is the time when corrections officials plan to begin a review of a sex offender, Terhune said. Sometimes that review begins and the release date is moved up several months, he said. Terhune could not offer any specific number of inmates that fall into such categories.
    The commission also would not comment specifically on the numbers offered by Chertoff of inmates who were released before the 90-day notice. ''The numbers don't mean much until you look at the names,'' he said.  His department has responded to questions from Chertoff and that internal review is now being examined by the attorney general's office, Terhune said.

Board Clears Psychiatrist, But Criminal Case Remains
Mitchell Zuckoff, Boston Globe- 9/15/2000

Eighteen months after accusing a Fall River psychiatrist of improperly prescribing drugs to patients and branding him an imminent threat to public health, the state board that regulates doctors reversed itself this week and dropped all charges against him. But the troubles are not over for Dr. Kennard C. Kobrin.  Yesterday, a board official suggested that Kobrin might still lose his medical license if convicted of criminal charges against him. ''There is still the pending criminal case,'' said Pamela G. Wood, the medical board's deputy director and general counsel. ''As with any physician, the board follows those actions carefully as well, and we'll wait to see how that turns out.''
    The Board of Registration in Medicine voted unanimously Wednesday to end its attempt to strip Kobrin's license. The vote came one month after a magistrate issued a 67-page ruling that squarely backed Kobrin's treatment methods and rejected the board's case as unfounded. ''These false charges have haunted me for nearly two years, but I always knew that the truth would vindicate me,'' Kobrin, 61, said yesterday in a statement.
    Kobrin still faces an 82-count criminal indictment on charges he defrauded the Medicaid system, illegally prescribed drugs, and engineered a kickback scheme involving referrals to other mental health providers. Those criminal allegations, filed in late 1998 by the attorney general's office, triggered the medical board's action. In March 1999, the board sought an emergency license suspension based on its contention that Kobrin posed a threat to public safety and bore indirect responsibility for the deaths of 13 patients. The board said his practice was grossly substandard because he was motivated by profit to over-prescribe Valium-like drugs called benzodiazepines to patients who were substance abusers.
    The criminal charges have yet to be tested in court, but the medical board's case began crumbling almost as soon as it was filed. First, Magistrate Kimberly A. Fletcher rejected the board's attempt to summarily suspend Kobrin's license pending a full hearing, saying it had provided no proof that Kobrin was a danger to the public. The setback prompted the board to drop its most sweeping charge: that Kobrin provided ''pervasive substandard care and illegal prescribing in his practice as a whole.''
    The board pressed ahead by focusing on the dead patients, hoping Fletcher would support a license removal after hearing all the evidence. To the contrary, Fletcher's ruling last month endorsed Kobrin's defense that his treatment methods were appropriate and well within accepted standards for prescriptions and patient supervision. Fletcher was especially critical of the experts hired by the medical board to make its case, saying one gave sworn testimony that was unfounded, and another offered an opinion about medical records he had not seen or could not read. Fletcher also said there were ''gross inadequacies'' in statistics the board tried to use to prove Kobrin over-prescribed drugs.  Moreover, it was revealed during the hearings that, of the 13 supposedly dead patients upon whom the medical board built its case, one had been counted twice and two others are still alive.
    Wood, the deputy director, said she could not comment on the merits of the case, but rejected suggestions that the outcome reflected poorly upon the board. ''I don't think it's an issue of credibility,'' Wood said. ''The magistrate is the one who takes the evidence and holds the hearings, and sometimes the magistrate and the board will differ. This is one of those cases.''  Kobrin's lawyer, Robert A. Griffith of Boston, said the medical board's decision to drop its charges ''will have a direct impact on the pending criminal charges against Dr. Kobrin.'' He said the criminal case is based on the same patients and prescriptions that were at issue in the board's effort to lift Kobrin's license. ''When the criminal allegations are exposed to the light of day, those too will be proven totally false,'' Griffith said. But a spokesman for Attorney General Thomas F. Reilly said prosecutors will vigorously pursue the criminal charges. ''Our case is separate from what the board considered, and we're moving forward,'' said spokesman Stephen Bilafer. He said no trial date has been set.
    Kobrin and his defenders have maintained that he has been the target of more than a decade of investigations and allegations as a result of a landmark 1984 case in which Kobrin successfully fought prosecutors' efforts to force him to release patient records. The case led to new privacy protections for Medicaid patients. Authorities deny any link between that ruling and the cases against Kobrin. Over the past 22 years, Kobrin built a private practice that at its peak treated some 400 patients, a majority of them substance abusers on Medicaid. His treatment approach is based largely on drug therapy, including the use of medications thought to diminish anxiety disorders among addicts.

Fight Over Ritalin is Heading to Court:
Company Accused of Conspiring to Create Diagnosis
Toni Locy, USA Today- 9/15/2000

The emotional debate over whether kids are placed unnecessarily on Ritalin, the medication used to treat hyperactivity, is headed to the courts. In lawsuits filed in California and New Jersey this week, Novartis Pharmaceuticals is accused of conspiring with the American Psychiatric Association and others to create a ''novel medical diagnosis'' of attention deficit hyperactivity disorder (ADHD) and then cashing in on the fear it caused among parents. ''I am not saying it doesn't exist,'' Richard Scruggs, one of the lawyers bringing the suit, said Thursday. ''I am saying the definition is inappropriately broad. Under (those) criteria, there's not a child in America that's not ADHD. And everybody makes money on the diagnosis: the shrinks, the drug company and the schools.''  Novartis and the APA deny the allegations. In a statement, Novartis says the charges are ''unfounded and preposterous.''
    The lawsuits have caused a furor in the medical and scientific communities, where ADHD is considered a major childhood health issue. They also have created a buzz in the legal world because some lawyers involved are veterans of the successful litigation against tobacco companies. ''The turning point in the tobacco litigation was when we showed the tobacco companies were targeting children,'' says Donald Hildre, another of the lawyers filing the lawsuit. ''And I believe that is going to be the turning point here.''
    Jules Asher, a spokesman for the National Institute of Mental Health, says there is no question ADHD exists, and that Ritalin is an effective treatment. But, he says, no one knows what effect the stimulant has on children who take it for many years. Nor, he says, does anyone know how the drug affects very young children. Peter Jensen, director of the Center for the Advancement of Children's Mental Health at Columbia University, says studies are underway to find answers to both questions. Last year, Jensen reported his findings in the largest-ever study on ADHD children ages 7 and older. He concluded the condition is under-diagnosed, contrary to the lawsuits' premise. ''It's flabbergasting that someone could concoct this argument and keep a straight face,'' he says.
    Ritalin has been manufactured since the mid-1950s. Attention deficit disorder (ADD) became an accepted medical diagnosis in 1980. The diagnosis was modified and ADHD became official in 1987. Since then, there has been an explosion in Ritalin prescriptions for kids, fueled mainly by general practitioners and pediatricians. In 1995, physicians wrote 6 million Ritalin prescriptions for children and adolescents. Although some kids might fidget and talk too much, Scruggs says, that doesn't mean they have ADHD. ''It's a real injustice to have these kids think they are diseased.''

Institutions Not Typically Known for Their Alternative Approaches Are Using Therapies
Denise Hamilton, Los Angeles Times- 9/16/2000

Every weekday morning at 8:45, a handful of people stroll into a group therapy room in Santa Monica for a unique court-sanctioned treatment. They are lawyers and housewives, gangbangers and construction workers with one thing in common--each has been convicted of a nonviolent drug offense. Inside, they dab at their ears with alcohol swabs, pour themselves a cup of herbal tea and settle back into comfy lounge chairs. For the next hour, they will listen to meditative music while a licensed acupuncturist inserts five thin, stainless-steel needles into each ear. "We have found acupuncture to be effective in the detox part of drug court treatment," says Los Angeles Superior Court Judge Laurence Rubin, who oversees Santa Monica's drug court program for nonviolent and first-time offenders. "It was important enough that they wrote acupuncture into the program and got government funding for it."
    In a measure of how accepted such treatments have become, alternative therapies can be found today in the most unusual and unexpected of settings nationwide, including many institutions run by bureaucrats more known for red tape than innovation. The range of therapies includes yoga classes in juvenile halls and probation camps; meditation classes in prisons; massage at hospices, domestic abuse shelters and facilities for homeless women; and acupuncture for incarcerated prisoners as well as drug addicts. The therapies' low cost and potential for spiritual growth have helped them gain ground in such settings, where it is thought that they may offer something especially valuable to those who are imprisoned, mentally ill, homeless or struggling with personal demons. As society grasps for solutions to these troubling problems, the use of alternative therapies is expected to spread further.
    That has certainly been the case with acupuncture, originated thousands of years ago by the Chinese and already far from an isolated experiment in New Age medicine. One of the most common of the so-called alternative therapies, it is used in more than 600 drug rehabilitation programs and is a key treatment in drug courts nationwide, according to Dr. Bryan Frank, president of the American Academy of Medical Acupuncture, an association with 2,000 physician members who use acupuncture in their practices. It's a core part of the one-year detoxification and recovery program run by the Clare Foundation, a private, nonprofit drug and alcohol treatment center. The foundation contracts with Los Angeles County courts to provide services for those convicted of drug offenses in Santa Monica, Culver City, Beverly Hills and Malibu.
    Although acupuncture has been offered sporadically as part of drug court programs for several years, medical and legal experts have found it so helpful in relaxing patients and reducing cravings for drugs that the therapy has been incorporated officially into the one-year detox and maintenance program for all patients who want it--and most do.
About 80% of those who go through the one-year drug court programs have no further contact with the criminal justice system, Rubin says. By contrast, he points out, 60% of those who are incarcerated for drug offenses commit another crime within two years.
    Of course, it's impossible to break down how much of that success stems from acupuncture and how much is due to the drug court program itself, which instead of incarceration puts offenders through detox and then one full year of group and individual counseling, 12-step programs, drug testing, acupuncture and court appearances. If they're still clean by then, criminal charges against them are dropped. But medical and legal experts say there's no doubt that acupuncture helps.
    "Acupuncture is not a treatment in itself, but it seems to help in relaxing people and reducing their cravings," says Bob Mimura, executive director of the countywide Criminal Justice Coordination Committee, an advisory body to the Los Angeles County Board of Supervisors. "It's a little out of the ordinary for us," Mimura admits of the widespread use of acupuncture in L.A. County's 11 community drug courts, which have served 900 people since 1994. "In the justice community, it's very difficult for them to look at new approaches like drug court. But there's growing support for this program."
    The use of acupuncture in drug rehabilitation was pioneered in the United States by Dr. Michael Smith, who runs a renowned substance abuse recovery program at Lincoln Medical Center in New York. In 1974, Smith read about a Hong Kong doctor who was using acupuncture to treat addicts in Asia and adapted that research at his own clinic.
Smith says that much remains unknown about exactly how acupuncture affects cravings. Some scientists have linked the treatment to the release of the body's natural painkillers, which might help reduce cravings. It may also relax patients by stimulating the vagus nerve that runs through the ear. "When you work in the field, you realize how agitated and disruptive people are, and acupuncture helps people feel more comfortable, balanced, at ease with their own thoughts," Smith says.
    His anecdotal comments are buttressed by a report published last month by researchers at Yale University. They found that acupuncture may help ease cravings in people addicted to cocaine, which, because of its highly addictive nature, is one of the most difficult drugs to kick. That report, in the August issue of Archives of Internal Medicine, found that 53.8% of patients who had acupuncture treatments five times a week tested negative for cocaine at the end of the eight-week study period. In contrast, 23.5% of patients who were given an ersatz acupuncture treatment and 9.1% of patients who only watched relaxation videos tested negative for cocaine. Among acupuncture's benefits, experts say, are its low cost and lack of side effects, which means it can be used on a broader population, including pregnant women.

A Human Connection through Massage
Another alternative therapy that has come into vogue at prisons, homeless shelters and other institutions is therapeutic massage. While acupuncture addresses specific physical problems, massage helps overall emotional balance. "Safe, healthy touch is important for everyone, but perhaps especially so for those suffering from neglect, abuse or serious illnesses like cancer," says Karen Menehan, editor of the Santa Cruz-based Massage magazine. "For those people, massage provides the human connection that allows for feelings of comfort and relaxation to occur--feelings that might not otherwise happen much, or ever, in their day-to-day lives." Massage therapists can be found at the scene of emergencies, working on search-and-rescue teams, among firefighters, police and volunteers, and in more unusual cases, working on cancer patients in Louisiana; premature infants in Miami; abused and homeless kids in St. Louis; and veterans suffering from post-traumatic stress syndrome in Palm Beach, Fla.
    In Cleveland, a volunteer group of licensed massage therapists called Charlie's Angels gives free massages each month at hospices, psychiatric institutions, Ronald McDonald Houses for parents of children with long-term and terminal illnesses, and battered women's shelters. There are usually lines of people waiting for the 15-minute massages, says Charlotte Versagi, the group's spokeswoman. The volunteers reap their own rewards, she says, recalling a visit to a psychiatric institution. "These are people who have been on medication for years and they are not normally touched," Versagi says. "One gentleman would only rock and moan, and a therapist was able to get him down from his wheelchair onto a mat. After she started massaging him, he actually uncurled his body and stopped humming and banging his head. The staff was shocked." What accounts for the change? "There are physiological bases for what massage does," Versagi says. "It reduces blood pressure, it takes stress out of the muscle. It increases endorphins."
    In Portland, Ore., licensed massage therapist Diane Foster organizes a group of female colleagues who give massages at Rosehaven, a facility for homeless women. "If you're on the street, you really don't get any nurturing touch at all; the only reason someone would want to touch you is to get something from you," Foster says. "The other day, I put my hands on this woman's back and it was so stiff, so I asked her, 'Where did you sleep last night?' and she said, 'I didn't, I was laying on a concrete park bench,' and that's exactly what her back felt like--a piece of cement." Petria Malone, Rosehaven's volunteer coordinator, says that many of the center's clients have to keep their guard up to survive. Massage gives them a safe way to relax. "A lot of our women have been abused and touched in inappropriate ways, and the touch provided by massage therapy is very healing. Women return time and again saying they just need that touch to reduce stress in their lives," she says. That was the case with Frances De Angelo, who dropped in at Rosehaven one recent day for a massage. "All our shoulders really ache from carrying bags and such, and I feel so good when I have a massage. I'm able to close my eyes and relax. It will last a good 1 1/2 to two weeks, and then it's time for another one. I've told several of the other ladies about it."

Yoga Classes in Juvenile Hall
With many alternative therapies, it's hard to quantify the benefits. But medical and psychiatric professionals say over and over that such treatment promotes a general sense of well-being and focuses the individual, all of which are crucial to those suffering hardships--especially those in institutional settings. This is the case in Los Angeles County's vast juvenile justice system, where there are waiting lists at juvenile hall and probation camps to get into the yoga classes that serve up to 500 youths each week.
    "Yoga provides an all-encompassing physical, spiritual and mental training system that really challenges these kids," says Karen Moran, a mental health caseworker and probation officer at Camp Fred Miller for juvenile offenders in Malibu, which houses youths convicted of crimes including murder and assault. "At first they all think it's going to be something for wusses, then they find they can barely do it. But they get so relaxed, they get to a place they've never gotten before, except through drugs," Moran says.
    The yoga classes are the brainchild of Mark Stephens, a management consultant with the Los Angeles County Juvenile Court schools and dedicated yoga practitioner who started the Yoga Inside Foundation two years ago to introduce the Eastern practice to juvenile offenders and inner-city schoolchildren. "Yoga provides a safe, nurturing environment for allowing someone to tune in to their own bodies, develop an awareness of themselves and confront the problems in their lives," Stephens says. The nonprofit foundation provides a $25 to $50 a class stipend for teachers who lead classes in inner-city schools and juvenile facilities. Stephens concedes that is a lot less than the $200 per class these teachers could earn at Westside yoga studios, but says his program ties into the concept of "karma yoga," in which practitioners are urged to bring the principles and values of yoga to the community, especially the disadvantaged.
    The success of the Yoga Inside Foundation can be seen in its expansion, from a $14,000 operating budget in 1999 to a projected $125,000 next year. All the staff, including Stephens, are volunteers. But spreading the gospel of yoga, and seeing it touch young bodies and minds motivates them. Says Diane Carpentieri, a yoga instructor who also teaches a weekly one-hour class at MacLaren Children's Center in El Monte: "A lot of the kids have no idea what yoga is to begin with. But they start doing it, and realize that their mind is connected to their body, and they like the way that makes them feel. It unleashes something spiritual in them." John Robbins, the administrator at the children's shelter, agrees. "It's not the cure-all in terms of all of a sudden you've got a changed child," he says. "But it allows them the space to get inside their heads and be a little more introspective, and that's valuable to them."

Suicide Epidemic Ravages Native Youth on Northern Ontario Reserves
Detroit Free Press, 9/16/2000

TORONTO (AP) -- A youth suicide epidemic is once again ravaging northern Ontario's native communities, with one of the worst hit reporting almost nightly attempts by teen-agers as young as 13 and 14. Twenty young people have died on reserves across the province's north this year, Jim Morris, a health adviser to Nishnawbe-Aski Nation, the region's top native political organization, said Friday.
    The problem is most serious on the Pikangikum First Nation, a community about 186 miles northeast of Winnipeg, which made national headlines when it was rocked by a wave of suicides and attempts in the summer of 1994. The six suicides among teenagers since January in Pikangikum are only "the tip of the iceberg," Chief Peter Quill said in an interview Friday during a break from an emergency meeting of chiefs and crisis workers in his troubled community.
    Morris said the latest spate of deaths shows an alarming new trend. "They're getting younger," he said, and more young girls are now committing suicide, including a group of Pikangikum youths who recently hanged themselves after sniffing gasoline. Northern Ontario has the highest suicide rate in Canada, at three times the national average, Morris said, and Pikangikum, Webequie and Kingfisher First Nation have experienced a string of epidemics since the early 1990s.

After Sons' Suicides, a Father Withdraws in Grief
Sheba R. Wheeler, Denver Post Staff Writer - 9/17/2000

Les Franklin returns from his home office with his glasses perched atop his bald head, vigorously rubbing tears from his eyes. Before he can sit down in the kitchen of his Denver home, the phone rings again. "Marianne, you've gotta get these phones," Franklin tells his wife. "I just can't talk about Jamon's death anymore." After his youngest son killed himself 10 years ago, Franklin created a foundation to prevent youth suicide. He gave hundreds of lectures, telling again and again how painful it was to see Shaka, 16, dying from a self-inflicted gunshot wound. But the public may never see that side of Les Franklin again.
    After the recent death of his 31-year-old son, Jamon, also to suicide, he has been reluctant to share his pain. The Franklins have scarcely been seen out of their house since they discovered Jamon Franklin's body Aug. 15.  "The first time I spoke was at Shaka's funeral, and I never stopped," said Franklin, 61. "But it's just too emotionally draining for me now. It triggers thoughts and images in my mind that I just can't forget. All I think about is bad stuff, now."
    Franklin will remain the chairman and executive director of the Shaka Franklin Foundation for Youth in Denver, which seeks to offer teenagers life-affirming artistic and recreational activities. But the former IBM executive will no longer participate in the foundation's day-to-day suicide prevention efforts. "He's done what he can with the prevention end of it," Marianne Franklin said. "Maybe it's time for someone else to take up the reins."
    To escape painful memories, the Franklins are selling their huge 17-year-old house that Les Franklin built in southeast Denver. The couple has occupied just the kitchen and a bedroom for the past month. Every other room has been stripped, and the furnishings donated to the foundation's two youth development centers in Denver.   The happy months Franklin spent dreaming and designing the house with his two sons cannot get rid of the ghosts that haunt this home.
    Shaka shot himself while in a bedroom Marianne Franklin later converted into a business office as the foundation's headquarters. Years later, but just 25 feet away, the Franklins found Jamon's body in a restored Cadillac in the garage. He had killed himself inhaling carbon monoxide fumes. Marianne refuses to drive her car into the garage. Les can't bear the thought that he slept one night in the house not knowing that his son lay dead below. "I'm beaten and I'm angry," Marianne Franklin said. "I don't like having to try and live with something like this."
    She and Franklin's closest friends said they worry the most about Franklin's words of death and hopelessness. It sometimes seems that his own hold on life is tenuous. "I don't know if I want to live," Franklin said. "You live for your children, for creating a legacy and building a family. I don't have a future left." Ken Crichlow shudders inwardly, fearing that Franklin may do himself harm. Crichlow, a foundation board member, has visited the Franklins every day since Jamon Franklin's death. Although Les Franklin shares few of his thoughts, Crichlow is determined to be there when he does. While Marianne seems to be holding up as best she can, her husband is consumed with anger over Jamon's suicide, Crichlow said.
    Shaka was a teenager, too young to have the skills to cope with everyday troubles, according to Franklin. The Thomas Jefferson High School student was despondent over a season-ending football injury and his birth mother's terminal cancer. But Jamon Franklin was an adult who had not only worked with the foundation but had promised his father that he would never take his own life.  "(Les) was just starting to get back to himself and distance himself from the pain of Shaka's death," Crichlow said. "He was upbeat, positive and back to his joking self. He was the Les we all knew before. Then this happened."
    Crichlow and Marianne Franklin gain solace in the happiness Les Franklin has shown each time he dons his beloved hockey skates and plays with the youngsters of the foundation. Strength flows back into Franklin's voice when he speaks about the foundation's ambitious plans. The nearly $500,000 operation is raising $10 million to expand the youth centers and build an ice rink and 240-acre mountain retreat for urban kids. He is pushing for charities and corporations to donate funds to make his vision a reality. "I just want to see it happen for the kids," Les Franklin said.