Noteworthy News Articles on Mental Health Topics, October 1-5, 2001

Behavior Techniques Included in Treatment of Attention Deficit Disorder
Lindsey Tanner, Associated Press- 10/1/2001

CHICAGO --The American Academy of Pediatrics issued its first guidelines for treating attention deficit/hyperactivity disorder, suggesting that stimulant drugs may be most effective but that behavior techniques should also be used. The guidelines for children aged 6 to 12 follow the academy's first-ever recommendations for diagnosing the disorder, published last year. The academy said the guidelines are needed because ADHD is the most common neurobehavioral disorder in childhood and because pediatricians often are the first medical professionals who encounter afflicted children. ''This is such a common problem in pediatric practice that doctors are very much asking for guidance in how to do this better,'' said Dr. James Perrin, a Harvard Medical School pediatrics professor and co-chair of the subcommittee that created the guidelines.
    The guidelines appear in the October issue of Pediatrics, the academy's medical journal, which is released Monday.  Between 4 percent and 12 percent of school-age children or as many as 3.8 million youngsters, most of them boys are believed to have ADHD. Symptoms may include short attention span, impulsive behavior, and difficulty focusing and sitting still. Symptoms must occur in two settings home and school, for example for an accurate diagnosis.  The new guidelines, created from a research review and in consultation with child psychiatrists and psychologists, suggest pediatricians are well-equipped to treat most cases. Dr. Donald Brown, a Chicago pediatrician with ADHD patients, said the guidelines will be ''quite helpful for us, for a condition as nebulous ... as ADHD.'' He said he often recommends behavioral treatment first.
    Evidence favoring the use of medication specifically stimulants such as methylphenidate, sold as Ritalin, or amphetamines is stronger than evidence on behavior therapy, the guidelines say. Symptoms improve in at least 80 percent of children on stimulants, and medication should be switched if it isn't working. Too high a dose, however, can make children appear dull, the guidelines say.  Drugs should be used with behavioral techniques, including time-outs for impulsive behavior like hitting. The guidelines also call for rewarding children when they complete tasks, such as homework. For some children, behavior techniques alone may work, Perrin said.
    Critics say many doctors and teachers turn to Ritalin as an easy fix, and that its long-term effects are uncertain. But the guidelines say treatment should begin only after a diagnosis is certain, and after doctors, parents and teachers have discussed appropriate treatment goals. They also say stimulants are generally safe and side effects such as decreased appetite, jitteriness and stomach aches are usually mild and short-lived.
    While some worry that stimulants could stunt or delay a child's growth, a study that followed patients into adulthood ''found no significant impairment of height attained,'' the guidelines say. Dr. Bennett Leventhal, director of child and adolescent psychiatry at the University of Chicago, said most children don't need lifelong drug treatment and about half can stop taking medication in early adolescence.
    On the Net: Pediatrics: http://www.aap.org

Terrorism Tied to Jump in Pain Problems
Avram Goldstein, Washington Post- 10/1/2001

Tens of thousands of people whose chronic physical pain is usually kept in check have suffered setbacks since the terrorist attacks on New York and Washington, according to pain management specialists across the nation. Those who regularly treat pain say that since Sept. 11 they have been inundated with complaints of worsening pain from patients who suffer from cancer, back problems, arthritis, diabetic neuropathy, chronic headaches and other ailments.
    At Washington Hospital Center, pain management specialists said complaints about flare-ups have been five times greater than usual. In Houston, specialists reported that pain complaints from cancer patients are up 33 percent, and in Buffalo, they have doubled. The widespread reaction, they said, was clearly triggered by stress over the attacks, fear of more terrorism and concern for what the future will bring their children. "A lot have been stable for years on their medication, but after [the attacks], we are getting flooded with phone calls saying that their pain has gotten quite out of control," said Lee Ann Rhodes, the medical director of pain management at Washington Hospital Center. "Patients who normally are happy that their pain is under control are coming in in tears."
    The phenomenon was evident in the first week after the attacks. At George Washington University Hospital, physicians said complaints about pain and other symptoms of chronic ailments climbed abruptly. "The medicine department was swamped with . . . patients with rheumatoid arthritis, pain, asthma," said James L. Griffith, associate chairman of the psychiatry department. All kinds of chronic medical disorders were aggravated, he said.
    Physicians said stress levels across the country have increased as Americans fret over the risks of bioterrorism, the ailing economy, grief for those who died and anger at the attackers. Moreover, they said, the suffering has been amplified by insomnia, as millions of Americans stay glued to televisions into the wee hours or simply lose sleep to worry. They go through their days on less rest, and doctors said sleep deprivation intensifies the perception of pain.
    Peter Staats, chief of pain medicine at Johns Hopkins University in Baltimore, said the reaction leaves no doubt about the strength of the mind-body connection. "Pain more than any other area of medicine has the mind and the body interlinked," Staats said. "When patients are in an emotional state of anxiety and anger, there is symptomatic magnification. It doesn't mean they don't hurt. But pain involves emotions," and physicians must understand that and not automatically prescribe more painkillers.
    Estimates of the number of Americans who suffer chronic pain range from 45 million to 100 million. Many are treated with drugs, but specialists also provide counseling, biofeedback and other relaxation techniques to help patients diminish discomfort. But anger and angst can cut through such efforts without a patient's awareness, said David Borenstein, a rheumatologist and clinical professor of medicine at George Washington University. He said the many patients who have perceived more pain were unaware that their bodies were reacting to world events. "When you tell people this is a natural response to a loss and stress, I think many have come to understand it and don't necessarily require additional medicines," he said. "Those more on the edge have needed more."
    Judy Denny, 55, of the District, has had chronic pain in her right leg since she emerged from failed back surgery as a paraplegic four years ago. The pain has mostly been controlled with the help of her physician, Rhodes. But the past two weeks have not gone well for Denny, who said she has felt anguish for the attack victims and fear for what the future will bring her two teenage children. After speaking with Rhodes, she said, she realized why she was in greater pain. "I never, ever put it together before, but I have been having particular problems with my right leg in the last weeks," she said. "There are earthquakes in other countries that kill thousands of people, and we don't see that as a major thing in our lives, but when it's the Twin Towers, it really gets to you."
    Roberta Hagen, a Bethesda nurse who has suffered from chronic back pain for 10 years, said her pain skyrocketed the day of the attack when her family was worrying about a nephew who worked in the World Trade Center. Even after learning that he was alive, she said, her symptoms did not ease. "It was absolutely miserable," she said. "Obtaining information about my nephew helped, but then there was a secondary effect of sympathy for the rest of the folks who didn't survive. . . . Normally, you think you have such good control, and then you find with these outside stressors [that] you lose that and the condition just goes out of control."
    Physicians across the country who treat cancer patients for pain report the same phenomenon. Jessie Leak, an associate professor of anesthesiology at M.D. Anderson Cancer Center at the University of Texas in Houston, described the problem as endemic and said complaints to her office have risen 33 percent. Most of M.D. Anderson's patients come long distances, so the complaint volumes there are representative of the nation, Leak said. "This extraordinary event is beyond anything we normally deal with," she said. "They are experiencing a tremendous sense of displacement and anxiety about this event added to their cancer and pain."
    Mark J. Lema, chairman of anesthesiology at the State University of New York at Buffalo, said clinic traffic at the Roswell Park Cancer Institute there has doubled in recent days because of pain complaints, and he said those complaints stem from the stress of Sept. 11 and the worry that there will be other attacks. "Everyone's been worried," Lema said. "People are tense because they are waiting for the other shoe to drop."

Major Depression Shrinks Brain, Study Finds
Lauran Neergaard, Associated Press- 10/1/2001

WASHINGTON -- Major depression makes an important part of the brain actually shrink. Stress seems to be a suspect, but no one knows how to stop or reverse the atrophy. Now a new study of primates' brains says a European anti-depressant seems to counter the shrinkage -- raising calls for more research to see if other medications might help people. German researchers tested a new anti-depressant sold in Europe called tianeptine.
    Major, long-term depression can cause a brain region, the hippocampus, to permanently shrink, up to nearly 20 percent. The hippocampus is important for learning and memory, so that may explain why memory loss often accompanies depression. Nobody knows exactly why atrophy occurs: Neurons may die or shrink, or ones that should have been born to replenish the region may not be. Whichever, it does seem linked to a stress hormone called cortisol, because about half of seriously depressed patients secrete too much cortisol.
    To see if tianeptine could help, neurobiologist Eberhard Fuchs and colleagues at the German Primate Center tested tree shrews, who exhibit a classic model for human depression when exposed to social stress. The shrews experienced excess cortisol, decreased brain chemicals important for healthy cells, a 33 percent decrease in new cell growth and a 7 percent decline in hippocampal volume. But ones that were given oral tianeptine saw their brain chemical concentrations return to normal, cell growth restart and the hippocampus return to its pre-depression size.

Mental Health Groups Seek Parity in Health Insurance
David Fisher, Seattle Post-Intelligencer- 10/1/2001

Kylee Qualls was 15 when her mood swings started to steepen. Lyrical, electric highs would be followed by devastating lows. People around her chalked it up to adolescence. A phase. Eight months into her episodes, she landed in the hospital after three days without sleep -- another manic high. Doctors finally diagnosed her with bipolar disorder. Today, at 29, Qualls remains stable with the help of prescribed lithium. She's a mental-health worker herself, a professional woman with a college degree. But it was only about a year ago that she summoned the courage to tell friends and the public that she has a mental-health disorder.
    Despite improvements in treatments, in drugs and in medical understanding, she and other advocates say, people who suffer from mental-health problems still feel plagued by a cloud of public misunderstanding and stigma. In fact, the fear of insanity is still rooted deeply enough -- both in people who experience it, and in the people around them -- that it prevents thousands from seeking treatment and prevents too many families from coming to grips with what it will do to their lives, advocates say.
    About 355 people, including mental-health counselors, people who suffer from mental illnesses and their relatives turned out in Seward Park yesterday for a 5K run/walk. The first local event of its kind, "Move for Mental Health" is an attempt to bring local mental-health problems and the people who suffer from them out of the shadows, said Eleanor Owen, executive director of Washington Advocates for the Mentally Ill, whose son has had schizophrenia for 26 years. "Mental illness is not a disease of the soul," said Shirley Havenga, executive director of Community Psychiatric Clinic, the event's other sponsor. "It's a disease of the brain."
    Given the numbers, it could seem curious that awareness raising is necessary. Mental illnesses affect one out of every four families in America, according to the National Alliance for the Mentally Ill. More than 300,000 people in Washington state suffer from one or more of a wide variety of disorders, ranging from depression and schizophrenia to Alzheimer's disease and childhood behavioral disorders, according to the state Division of Mental Health. Nationwide, the figure is 54 million. Still, mental-health sufferers face a collection of problems that, their advocates say, are at least partially rooted in misunderstanding.
    U.S. Rep. Jim McDermott, D-Seattle, a trained psychiatrist, walked the event yesterday to spotlight the push this fall for a "full-parity" mental-health insurance bill. Currently, private insurers can deny or limit drug prescriptions and treatment visits for mental-health patients, although many need continual care to maintain stability. Full parity would require coverage similar to the benefits the sufferers of long-term physical diseases, like diabetes, receive. Services have improved greatly in the past 30 years, said Havenga, whose Seattle non-profit provides everything from direct medical services to case management. The clinic also provides 300 units of housing in the Puget Sound area, saving many from homelessness.
    Started by eight local families with mentally ill relatives, Washington Alliance for the Mentally Ill today is the largest mental-health support group in the nation. It specializes in helping families adjust. Still, the strains of working with mental-health problems are largely personal. Wendy Priest, a Seattle teacher, watched her son slowly withdraw from the world four years ago at age 17 as his burgeoning schizophrenia took hold. "It's like getting blown off your feet," Priest said. "It takes awhile to find your equilibrium again. Your biggest support is the people who have been there, because it's not the kind of thing you study until it happens to you."
    Those are the kinds of interconnections and education Move for Mental Health organizers are trying to encourage by at least lessening some of the fear and mystery that surrounds mental illness, Havenga said. Ron, one of the event's organizers and a 52-year-old sufferer of bipolar disorder, asked to keep his last name out of the paper. "This is good," he said. "But most of the people here are already believers. The next step is to get people who don't know anything about it to come and participate."

Hairdressers Enlisted to Spot Domestic Violence
San Francisco Chronicle, 10/2/2001

SAN FRANCISCO -- San Francisco District Attorney Terence Hallinan announced yesterday a new program aimed at training hairdressers to spot the signs of domestic violence and refer their clients to those who can help. The San Francisco Hairdresser Project -- announced as part of October's Domestic Violence Awareness Month -- is being modeled on a similar program that the Women's Center of Southeastern Connecticut began in 1999.
    It is the first program of its kind on the West Coast, Hallinan said. Hairdressers who participate in the project will be asked to go through a two-hour training session in identifying signs of abuse. They will be provided with a list of community agencies to which they can refer clients. "Hairdressers are uniquely situated to discover bruising and other signs of physical and emotional abuse suffered by their clients," Hallinan said at a press conference.

Mercury-Autism Debate Left Open
Thomas H. Maugh, II, Los Angeles Times- 10/2/2001

There is no evidence to either prove or reject the theory that mercury in childhood vaccines has lead to autism and other developmental disorders, but the theory is "biologically plausible," a government panel said Monday. Thimerosol, a mercury compound, is no longer used in new vaccines for children although some may remain in stock in clinics and pharmacies. Until last year the compound was widely used as a preservative to prevent bacterial contamination in some vaccines. Parents of autistic children and their advocates have been pointing to the use of the compound as a possible cause of an increase in autism cases. But the Institute of Medicine report, commissioned by federal agencies, found no convincing evidence to support their fears. But neither did it find any evidence to reject the those fears outright. The report called for more research to settle the issue.
    "It should be reassuring to parents that we can find no evidence linking thimerosol to any neurological disorder," said Dr. Marie McCormick of the Harvard School of Public Health, who headed the committee that drafted the report. "If a vaccine without thimerosol is available, it should be used. However, if that vaccine is not available, it is far better to be vaccinated with a thimerosol-containing vaccine than not to be vaccinated. The risks of not being vaccinated are certain, while those of vaccines are . . . theoretical." Thimerosol was never used in the measles-mumps-rubella vaccine, which has been viewed by parents as the major villain in the surge of autism cases. Its primary uses were in vaccines for hepatitis B, hemophilus influenza B, meningitis and diphtheria-pertussis-tetanus. All are now available in thimerosol-free formulations.
    Parent advocates reacted favorably to the new report. "They are taking a very strong position compared to other Institute of Medicine reports," said Portia Iversen, a co-founder of Cure Autism Now. "I just wish they had gone one step further and asked for a recall of all mercury-containing vaccines." That sentiment was echoed by Sallie Bernard of the nonprofit Safe Minds. "We believe that no child should get any mercury-containing vaccines," she said.  But Dr. Louis Cooper of Columbia University, president-elect of the American Academy of Pediatrics, said parents should not be concerned. "No one knows the magnitude of the stocks [of thimerosol-containing vaccines], but my sense of it is that the numbers are likely to be quite small."
    In 1999, federal and private agencies recommended that the preservative no longer be used in children's vaccines, and that recommendation was widely adopted by the middle of last year. The principal ingredient of thimerosol is ethylmercury, a chemical cousin of the methylmercury found in mercury-contaminated fish. Ethylmercury was used in multidose vials of vaccines to prevent contamination by bacteria when a syringe needle is injected into the vial repeatedly. Most children's vaccines now come in single-dose vials and no preservative is required. The mercury compound is still used in some vaccines for adults, including the influenza vaccine, as well as in some over-the-counter products, such as nose drops. But most physicians have never considered that a problem. "The issue is really the amount of ethylmercury per body weight, and the dose in an adult is much smaller" than in a child, McCormick said.
    The report is available on the Internet at http://www.nap.edu

Coping With Workaholics at Home and Office
A Book Review of "Chained to the Desk"
John Lagone, New York Times- October 2, 2001

"Chained to the Desk: A Guidebook for Workaholics, Their Partners and Children and the Clinicians Who Treat Them" by Dr. Bryan E. Robinson, New York University Press, $16.95.
   Every so often, most of us put in longer hours on the job to the detriment of family relationships and our own need for relaxation. But does this constitute workaholism? This interesting guidebook's author, a professor at the University of North Carolina and a psychotherapist, reassures us that it does not, that there is a vast difference between being a hard worker and a workaholic.
    "A workaholic," Mr. Robinson Writes, "is not the single mom who works two jobs to pay mounting bills. Neither is it the tax accountant who works extra-long hours on weekdays and weekends until April 15th rolls around." So what constitutes a true workaholic? Simply put, one has to be driven by deeper internal needs rather than by external needs that require work to satisfy "an inner psychological hunger." Workaholics, Dr. Robinson says, tend to be separatists, preferring to work alone and focused on the details of their work, to which their egos are attached.
    In contrast, he explains, healthy workers can see the bigger picture and work cooperatively with others toward common goals. They enjoy their work, while workaholics often create or look for work to do, even during social activities or leisure times.
    Real workaholics, Dr. Robinson adds, will not try new challenges unless they can excel immediately and often are lonely people with a fax machine as a best friend. They tend to show up at work before anyone, are the last to leave and are often contemptuous of people who maintain an even pace in their work routines.
    The book examines the effects of workaholism on the spouses and children of workaholics, offers advice on coping with a workaholic boss and suggests ways to perform "optimally instead of workaholically" and how to delegate work. Not surprisingly, there is Workaholics Anonymous, founded in 1983. Its 12 steps, which mirror those of Alcoholics Anonymous, are supplemented by "tools of recovery" specific to workaholics. The bottom line, as Dr. Robinson sees it: "If friends or loved ones have accused you of neglect because of your work or if you have abused work to escape from intimacy or social relationships, you might want to take a closer look."

Drinking's Long-Term Toll on the Brain
New York Times- October 2, 2001

Elderly people who drink alcohol heavily appear to have more brain shrinkage, or atrophy, than those who drink lightly or not at all. Moderate drinkers seem to have overall healthier brains than nondrinkers, according to a report in the journal Stroke. The lead author, Dr. Kenneth JU. Mukamal of Beth Isreal Deaconess Medical Center in Boston, and his colleagues studied 3,660 men and women over 65 who had brain M.R.I.'s taken from 1992 to 1994.
    The researchers found that the more elderly people drank, the more their brains atrophied, and that process can cause problems like diminished hand strength and difficulty rising from a chair. But the heaviest drinkers, those who consumed 15 or more drinks a week, were also 41 percent less likely than abstainers to have had so-called silent strokes--small strokes that are not noticed when they occur but that can interfere with a range of everyday tasks. The researchers say they found significantly fewer silent strokes among light drinkers, who had one to six drinks a week, than among people who abstained. On the other hand, the light drinkers did have more brain atrophy than abstainers but less than heavy drinkers. The researchers also said one study was no basis to change one's alcohol consumption habits.

Rational and Irrational Fears Combine in Terrorism's Wake
Erica Goode, New York Times- October 2, 2001

The familiar became strange, the ordinary perilous. On September 11th, Americans entered a new and frightening geography, where the continents of safety and danger seemed forever shifted. Is it safe to fly? Will terrorists wage germ warfare? Where is the line between reasonable precaution and panic?
    Jittery, uncertain and assuming the worst, many people have answered these questions by forswearing air travel, purchasing gas masks and radiation detectors, placing frantic calls to pediatricians demanding vaccinations against exotic diseases or rushing out to fill prescriptions for Cipro, an antibiotic most experts consider an unnecessary defense against anthrax.
    Psychologists who study how people perceive potential hazards say such responses are not surprising, given the intense emotions inspired by the terrorist attacks. "People are particularly vulnerable to this sort of thing when they're in a state of high anxiety, fear for their own well-being and have a great deal of uncertainty about the future," said Dr. Daniel Gilbert, a professor of psychology at Harvard. "We don't like that feeling". Dr. Gilbert said. "We want to do something about it. And, at the moment, there isn't anything particular we can do, so we buy a gas mask and put an American decal on our car and take trains instead of airplanes." But, he added, "I'll be very surprised if five years from now even one life was saved by these efforts."
   Still, many psychologists said avoiding flying might be perfectly reasonable if someone is going to spend the entire flight in white-knuckled terror. And though experts say gas masks will offer dubious protection in a chemical attack, if buying them helps calm people down, it can do no harm. "The feelings may be irrational, but once you have the feelings, the behavior is perfectly rational," said Dr. George Lowenstein, a professor of economics and psychology at Carnegie Mellon University. "It doesn't make sense to take a risk just because it's rational, if it's going to make you miserable. The rational thing is to do what makes you comfortable."
    The public's fears may be heightened, he and other experts said, by the sense that the government failed to predict or prevent the September 11th attacks, making people less trusting of the reassurances offered by the authorities, who have said that biological attacks are unlikely and, with vastly heightened security, air travel is safe. Checkpoints on highways, closed parking structures at airports, flyovers by military aircraft and other security measures, they added, while reassuring many people, may for others increase anxiety by providing a constant reminder of danger. In fact, the threats now uppermost in may people's minds, Dr. Lowenstein and other psychologists said, are examples of the kinds of risks that people find most frightening.
    "All the buttons are being pushed here," said Dr. Paul Slovic, a professor of psychology at the University of Oregon and the author of "The Perception of Risk." Threats posed by terrorism, he said, "are horrific to contemplate, seem relatively uncontrollable and are catastrophic." He and other researchers have found that risks that evoke vivid images, that are seen as involuntary, that are unfamiliar or that kill many people at once are often perceived as more threatening that risks that are voluntary, familiar and less extreme in their effects. For example, in studies, people rank threats like plane crashes and nuclear accidents higher than dangers like smoking or car accidents, which actually cause many more deaths each year.
   This fact is a source of endless frustration to some scientists, who cannot understand why people panic over almost undetectable quantities of pesticides on vegetables but happily devour charcoal-broiled hamburgers and steak, which contain known carcinogens formed in grilling. And, when asked to rank the relative dangers of a variety of potential hazards, scientific experts routinely give lower ratings to things like nuclear power and pesticides than do laypeople, researchers have found.
    "Everything in some sense is dangerous, in some concentration and some place, and usually not in others," said Dr. James Collman, a chemistry professor at Stanford and the author of  "Naturally Dangerous: Surprising Facts About Food, Health and the Environment." He said his daughter called him after the terrorist attacks to ask if she should buy a gas mask. "I told her not to panic," he said. "I thought it was sort of a statistically silly thing to do, and were there ever any toxic gases out there, whatever mask she had might or might not be effective anyway."
    Yet psychologists say the average person's responses make sense if one realizes that human beings are not the cool, rational evaluators that economists and other social scientists once assumed them to be. Rather, the human brain reacts to danger through the activation of two systems, one an instant, emotional response, the other a higher level, more deliberate reaction. The emotional response to risk, Dr. Lowenstein said, is deeply rooted in evolution and shared with most other animals. But rationality--including the ability to base decisions about risk on statistical likelihood--is unique to humans. Yet the two responses, he said often come into conflict "just as the experts clash with the laypeople."
    "People often even within themselves don't believe that a risk is objectively that great, and yet they have feelings that contradict their cognitive evaluations," Dr. Lowenstein said. For example, he said, "The objective risk of driving for four or five hours at high speeds still has got to be way higher than the risk of flying." Yet Dr. Lowenstein added that a group of his colleagues, all academic experts on risk assessment, chose to drive rather than fly to a conference after the terrorist attacks. "If you ask them which is objectively more dangerous, they would probably say that driving is," Dr. Lowenstein said. And though his colleagues cited potential airport delays, he said he suspected fear might have also played into their decision.
    President Bush and other policy makers in Washington, Dr. Lowenstein said, must contend with a similar struggle between reason and emotion in shaping their response to the attacks. "A lot of what's going on is this battle where the emotions are pushing us to respond in a way that would give us quick release but would have all sorts of long-term consequences," Dr. Lowenstein said. In fact, studies show that once awakened, fear and other emotions heighten people's reactions to other potential hazards. In one study, for example, students shown sad films perceived a variety of risks as more threatening than students who saw emotionally neutral films.
    Fear can also spread from person to person, resulting in wild rumors and panic. One example often cited by sociologists who study collective behavior is the so-called Seattle windshield pitting epidemic, which occurred in 1954, a time when cold war fears ran high and the United States was testing the hydrogen bomb. That year, tiny holes in car windshields were noticed in Bellingham, Washington, north of Seattle. A week later, similar pitting was seen by residents of towns south of Bellingham, Soon, people in Seattle and all over the state were reporting mysterious damage to their windshields. Many speculated that fallout from the H-bomb tests was the cause. Others blamed cosmic rays from the sun. At the height of the panic, the mayor of Seattle even called President Dwight D. Eisenhower for help. But eventually, a more mundane explanation revealed itself: In the usual course of events, people did not examine their windshields that closely. The holes, pits and dings turned out to be a result of normal wear and tear, which few had noticed until it was drawn to their attention.
    The antidote to such fears, psychologists say, is straightforward information from trustworthy sources. "Trustworthiness has two elements," said Dr. Baruch Fischhoff, a psychologist in Carnegie Mellon's department of social and decision sciences. "One is honesty and the other is competence." Attempts by authorities to use persuasion often fall flat, Dr. Fischhoff said, because "if people feel they have to peel away the agenda of the communicator in order to understand the content of the message, that's debilitating." "Give me the facts in a comprehensible way, and leave it to me to decide what's right for me," he said.
    Yet what psychologists can say with some certainty is that, if no further attacks occur in the near future, people's fears are likely to fade quickly--even faster than the fearful themselves would predict. Studies suggest, Dr. Gilbert said, that "people underestimate their resilience and adaptiveness." "We have remarkable psychological and physiological mechanisms to adapt to change," he said. "I guarantee you that in six months whatever New Yorkers are feeling will seem pretty normal to them even if it is not exactly what they were feeling before."

Massachusetts Mentally Ill, Activists Press for More Funds
Rebecca Duran, Boston Globe- 10/3/2001

Hoping to bring their message directly to legislators, 500 people with mental illnesses and their advocates marched on the State House yesterday, asking for nearly $300 million for housing and other services. ''I don't want to be seen as a social problem anymore. I want to be seen as a health concern,'' said organizer Moe Armstrong, a member of the board of directors of the National Alliance for the Mentally Ill in Washington, D.C.
    A lack of funding for mental health programs in recent years has created an overload of cases and left inadequate resources to meet the needs of thousands of patients on wait lists for treatment, according to organizers. ''People with mental illness and mental disabilities can prosper with proper mental health support,'' said Tobias Fisher, executive director of the alliance in Massachusetts, which is hoping for $288 million in next year's state budget for adult mental health, statewide homeless services, and child and family mental health programs.
    Flanked by Democratic state Senator Sue Tucker of Andover, Democratic Representative David Sullivan of Fall River, and Boston Mayor Thomas M. Menino, participants yelled, ''Hey hey, ho ho, stigma and ignorance have got to go!'' as they began their march around the Common to the State House.  ''We think in government that if we send you a $300 check, that's going to solve your problems,'' said Menino, referring to President Bush's recent tax cut. ''But just think if we had all those $300 checks to build more housing in America - all types of housing.'' Carla Van Loon , assistant programming director for the Crossroads Clubhouse in Hopedale, said patients paying three-quarters of their income in rent were unlikely to overcome their problems.
    ''Without decent affordable housing, people can't get out of the public system,'' she said. And low pay for human service workers creates unreasonably high employee turnover at her clinic. ''It pays better to work at Burger King or McDonald's than it does to work with people,'' she said. Lauri Leeds, a social worker in Weymouth, said she's discouraged by the government's lack of interest in those with mental illness. ''Our job is to serve people,'' Leeds said. ''The lack of funding makes us feel disempowered.''

Vermont's First Methadone Clinic to Open
David Gram, Associated Press, 10/3/2001

MONTPELIER, Vt. -- A Burlington-based mental health services group said Tuesday it wants to open Vermont's first methadone clinic, but the question of where to put the clinic was already raising controversy. The Howard Center for Human Services plans to open a clinic in January and within three months expects to serve 40 patients. The Burlington-area clinic would be the first in Vermont, and would open two years after the Legislature first passed a law allowing such clinics in Vermont.
    Methadone is a synthetic narcotic that can stop a heroin addict's craving for heroin without producing a high. Many drug abuse counseling professionals say methadone treatment is the best approach to ending heroin addiction. Jane Kitchel, secretary of the Agency of Human Services, said more than 340 people in Vermont would likely seek methadone treatment in the state if it became available. More than a third live in Chittenden County, she said.
    Howard issued a statement saying it did not have a location for the clinic, but Executive Director Todd Centybear made it clear he hopes to find space on the campus of Burlington's hospital, Fletcher Allen Health Care. Centybear said he thought the hospital-run University Health Center, which houses several physician groups, would be an ideal place to open a clinic. He noted that a research program on a drug used as an alternative to methadone already is being conducted out of that facility. ''They have security there. As far as location is concerned, you can't get much better,'' Centybear said.
    Fletcher Allen spokesman Mike Noble said there had been ''very preliminary'' talks between the hospital and the Howard Center, but the two were a long way from reaching any agreement. He noted Fletcher Allen is currently undergoing a major expansion and, with many services displaced because of the construction. ''We don't have any space up here,'' Noble said. ''Every square foot we have is engaged in support for the project under way. We have three modular buildings on the site right now.''
    State government is behind Howard's proposal, so long as a good location can be found, said Kitchel. When opening methadone clinics was first discussed, Gov. Howard Dean was emphatic that any such clinic should be housed in an existing hospital. A 2000 law contained that provision, but it was changed earlier this year to allow up to five clinics to open outside hospitals. Kitchel said the Howard clinic would be opened under the auspices of a hospital under contract with the Vermont State Hospital in Waterbury. She said state officials' primary concern now was to find a location acceptable to its surrounding community.
    Two Burlington sites have been discussed but are now deemed remote possibilities, both Kitchel and Centybear said. Those were the Act One drug and alcohol rehabilitation center on Pearl Street, which is run by a Howard affiliate, and a Howard facility on Flynn Avenue. The first was deemed too close to the Church Street Marketplace, Burlington's premier commercial area. The Flynn Avenue location was seen as too close to a school and nearby homes. Burlington Mayor Peter Clavelle said he would support a methadone clinic, but insisted that it be located at the hospital. ''I think people seeking methadone treatment are sick and the hospital's the place to treat sick people,'' Clavelle said.

Wayne County Mental Health Director to Leave Post
Kim Kozlowski, Detroit News- 10/3/2001

DETROIT -- The executive director of the Detroit-Wayne County Community Mental Health Agency has announced that she plans to leave when her contract expires in January, following three years of intense restructuring of the agency. Altha J. Stewart's tenure will end during a crucial time in the state's history of mental health services. For the first time, community mental health agencies are preparing to demonstrate to the state that they can provide services -- otherwise, the state may consider privatization. Stewart has helped Wayne County, with a $560-million mental health budget, get ready for the new assessment of agencies, according to Cassandra Smith Gray, assistant executive for Wayne County Health and Community Services.
    Smith Gray characterized Stewart's departure as a "devastating loss" to the county. "We've come a long way, and I mean a long way," she said. "She is going to be a tough act to follow." Hailed as a stellar psychiatrist and administrator with a national reputation, Stewart said it was time to leave her post at the state's largest mental health agency, which also serves people with developmental disabilities and substance abuse problems. "Sometimes in change, you need something or someone," Stewart said. "But once you're on the road to adapting to change, that person or thing can move on." Stewart moved from her home in Philadelphia and began her post in February 1999 after a national search. When her two-year contract expired, she requested that her next contract only last for one year. She declined to reveal her plans for the future.

Terror Attack Increases Pain & Sleep Symptoms
Melinda T. Willis, ABC News- 10/3/2001

The terrorist attacks of Sept. 11 have added to the chronic pain of people already suffering debilitating illness, put people at increased risk of heart attack and deprived people of much-needed sleep. When four airplanes were hijacked and crashed into the World Trade Center, the Pentagon and in rural Pennsylvania, the stress of it all was just the beginning of the agony for some. And while there are no concrete numbers, specialists say chronic pain sufferers may have a harder time controlling their symptoms in the wake of the terrorist attacks.
    "Stress makes pain worse," says Dr. Norman Marcus, director of the Norman Marcus Pain Institute in New York City. Stress has been shown to aggravate pain related to migraines, cancer, symptoms of irritable bowel syndrome, and fibromyalgia. Anxiety, uncertainty, sadness and anger can all take their toll even on bodies free of chronic pain, experts say. Dr. Lee Ann Rhodes, medical director of Pain Management at Washington Hospital Center, says it's typical for her practice to get about two calls a day concerning pain. She got 10 calls within 24 hours of the attack, and six to eight calls per day over the next couple of days, she says. Chronic pain is often managed with pain medication, and can be of concern to patients who think they're losing their efficacy. But Dr. Melvin C. Gitlin, director of the Pain Management Center at Tulane University Hospital and Clinic, says, that when the pain is brought on by traumatic events, "We can provide reassurance and education of patients that there is a reason for the worsening of their symptoms."

Depriving the Sleep Deprived
Still more people appear to be losing sleep. "Physicians are reporting that there are more people that are having sleep difficulty since Sept. 11," says James Walsh, president of the National Sleep Foundation. He says physicians appear to be writing more prescriptions for sleeping pills than usual. "Whenever you have stress in your life, particularly at a traumatic level, sleep disturbance is very common," says Walsh. Walsh says that someone who loses sleep day after day not only is tired, but can find it hard to concentrate as well because memory becomes a problem. Walsh adds, "Falling asleep in dangerous or ill-advised situations [like while driving] becomes a risk."   "The effects of sleep loss are cumulative and many of us operate with a sleep debt already," adds Walsh. "When we have the added sleep loss because of anxiety, then people will start having problems."

Stress and the Heart
Previous studies have established links between mental stress and cardiovascular events, as well. Depression, anxiety and anger have been shown to trigger heart attacks and these powerful emotions are common in the wake of disasters, especially for those already at risk of heart attack.  In anticipation of such harmful stress, Dr. Lori Mosca, director of Preventive Cardiology at New York-Presbyterian Hospital, established a post-disaster heart attack prevention program in midtown Manhattan shortly after the attacks.  "We have seen significant elevations in blood pressure, shortness of breath and chest pain, which are typically seen in the wake of natural disasters," says Mosca. "We are seeing what we might have expected." And while, the data is not firm, she expects the risk of heart attack related to trauma to persist for up to six months following the event, not just in Manhattan, but elsewhere, as well. She says people report they are drinking more, exercising less because they are watching TV, and that they are stressed and depressed, all of which may lead to weight loss, or overeating for comfort, which can contribute to weight gain — behaviors that can have potentially harmful long-term impact on the heart.

Stress Elimination Tips
-To help solve physical problems related to stress, doctors recommend the following:
-Talk to a physician to address the cause of your stress.
-To help with sleep, stay alert during the day, and talk to your physician about ways of getting rest at night.
-Avoid harmful behaviors like smoking or excessive drinking.
-Maintain positive behaviors like exercise. Even getting up to walk to the TV instead of just using the remote control can help.
-Continue taking prescribed medications.

Actress Drops Her Dieting Obsession
ABC News, 10/3/2001

N E W Y O R K— After years of trying to keep pace with her skinny co-stars, TV actress Courtney Thorne-Smith decided it was time to stop dropping pounds, and instead lose her obsession with weight loss. A longtime television series actress, Thorne-Smith is now starring with Jim Belushi in the new ABC comedy According to Jim, where she plays Belushi's wife, a sophisticated counterpart to his character's all-American guy persona.
    The actress is best known for her roles on two hit shows on the Fox network, Ally McBeal and Melrose Place.  While acting on those dramas, Thorne-Smith, 33, said she was dieting relentlessly. To stay skinny, she would eat only small meals of salad and fruit, which added up to about 1,000 calories a day. Then she would exercise obsessively, burning about 700 calories day by running. "I felt terrible," Thorne-Smith said on Good Morning America. I was exhausted: 300 calories don't give you a lot of energy," she said.
    Thorne-Smith was not fat by any measure. The recommended weight for a woman her size (5 feet 6 inches tall, with a medium frame) ranges from 130 pounds to 144 pounds. She maintained her weight at about 120 pounds, but she wanted to lose 10 more. No one told her she had to lose weight, but ever since the actress got a role in her second television series in 1988, the short-run sitcom Day by Day, she felt she needed to stay very thin. The pressure to be Hollywood-thin intensified as soon as she landed the role of Alison Parker on Melrose Place in 1992. She worked alongside slim co-star Heather Locklear and other ultra-thin actresses. When she moved onto Ally McBeal, she had to share scenes with Calista Flockhart, one of the skinniest actresses in Hollywood.
    In preparation for her character's almost-nude scene on Ally McBeal, Thorne-Smith ate only fruit for a whole week. At one point she had lost 15 pounds, and went to a nutritionist, explaining that she was exhausted and was not sure why. The nutritionist said she was starving herself and exercising too much. Then Thorne-Smith came across an article about Hollywood actresses who seemed too thin. Her name was in it and she was struck by the prospect of becoming a role model for young girls. "I thought, I hate the thought of a 12, 13 or 14 year-old girl seeing a picture of me and thinking she'll do what I did," she said.
    The actress said she started eating well and exercising to be fit. But when she didn't feel thin enough, she ate even less and exercised even more. Thorne-Smith feared that other young women would get on the same unhealthy cycle when looking at so many pictures of ultra-thin women. At that point, she realized she needed to step back from her work, and allow herself the freedom to eat. Thorne-Smith now eats five small meals a day, a healthy diet consisting of mostly lean protein, vegetables and fruit. She works out daily, completing about 90 minutes a day of cardiovascular exercise, along with yoga and weightlifting. She is also putting energy into another creative pursuit. She writes about exercise and healthy living as a contributing editor for Self magazine.

Jan. 7 Trial Date Is Set for Andrea Yates
Houston Chronicle, 10/3/2001

A Harris County district judge on Wednesday set a Jan. 7 trial date for Andrea Pia Yates, accused of drowning her five children in a bathtub. Last month, a jury found the 37-year-old Clear Lake mother competent to stand trial on capital murder charges.   Yates, who is in the psychiatric unit of the Harris County Jail, has pleaded not guilty by reason of insanity.  If the trial jury finds that Yates had a severe mental disorder and did not know right from wrong when the crime was committed, she will be declared legally insane. At that point, she could be either committed to a state mental hospital or freed, depending on the judge's decision. If found guilty, she could be executed. Yates is being tried in the 230th State District Court before state District Judge Belinda Hill.

Mom Testifies in Shooting of Schizophrenic Daughter
Ed Asher, Houston Chronicle- 10/3/2001

The mother of a schizophrenic woman who was fatally shot by a Houston police officer says police could have used nonlethal tactics to subdue her daughter and disarm her of an 8-inch butcher knife. "I felt something else could have been done rather than have her shot to death," Sue Seymour testified Wednesday in a wrongful death lawsuit against the city of Houston. Her daughter, Sheryl Seymour, was killed Jan. 20, 1999. "I just felt like one or two of them (police) could have done something, they could have thrown something at her. I still think someone could have gotten behind her and done something to help her. "They didn't have to shoot her." Police have said an officer fired a single shot at Sheryl Seymour, 40, only after she raised the knife and charged at them.
    In the lawsuit, Sue Seymour alleges the officer violated her daughter's civil rights. The suit seeks an unspecified amount in compensatory damages for mental anguish suffered by the parents. They are leaving the amount up to the jury. They also are seeking legal fees. Seymour's family has said she was mentally unbalanced and seeking help the day she was killed. The family contends police could have used measures short of deadly force to defuse the encounter.
    The case raised questions about how police deal with mental health situations. Mental health experts said the case was an indication that officers are poorly trained to deal with the mentally ill and called for better training. What was particularly disturbing, critics said, was that Seymour was 5 feet tall, weighed 100 pounds and was not carrying a gun. A police spokesman said because of the ongoing litigation, he could not comment on whether the case resulted in changes of policy.
    However, in the summer following the incident, the Houston Police Department teamed with the Mental Health Association of Greater Houston to create the Crisis Intervention Team, a pilot program involving 60 officers specially trained to handle mentally ill suspects. The CIT program became permanent last year and includes more than 500 patrol officers or about 20 percent of the department's more than 5,000 officers.
    The night she was shot, Seymour called 911 demanding an ambulance to take her to a psychiatric facility. When she opened the door, she advanced on paramedics and three police officers with a knife. Efforts to persuade her to put the knife down were unsuccessful. Police say patrolman J.G. Lopez fired, hitting her in the right shoulder, only after she raised the knife and ran at them.
    In other testimony Wednesday, Sue Seymour said her daughter did not begin showing signs of problems until she was 13 or 14. "She seemed to be like a regular child until she was around a teen-ager. When she went into junior high school, she changed a lot. She was very hard to manage," Seymour said. Sheryl Seymour began seeing a psychiatrist after she began experiencing deep depression, her mother said. She married in 1986, but the marriage lasted only a few years, she said. "She became more and more difficult for him to manage, she was just very mean," Sue Seymour said. "She was very angry and we didn't know what to do about it."
    In 1981, a police officer in a club noticed that Sheryl Seymour had a gun in her purse and arrested her. The charges eventually were dropped when it became clear she needed psychiatric attention. During her incarceration, a complete psychological examination was done and she was diagnosed with schizophrenia. The mother also testified that it was not unusual for her daughter to call an ambulance when she felt a psychotic episode coming on. In the nine years before her death, she did so at least 12 times. "They would come and try to calm her down and she wouldn't have to go to the hospital," she said.
    Sue Seymour learned of her daughter's death when her ex-husband called her that morning. "He said he couldn't talk, he couldn't say it. I asked if it was about Sheryl and he said yes. "I said, `Is she dead?' And he said yes."  On cross-examination, she agreed that her daughter got angry when she had been drinking and that she thinks her daughter had been drinking that night. The trial resumes today in the courtroom of U.S. District Judge David Hittner.

OxyContin Ravages Poor Areas in the East
Elizabeth Mehren, Los Angeles Times- 10/4/2001

MACHIAS, Maine -- The Reid boys had bright futures mapped out. Brett, 19, loved animals. He was supposed to be the veterinarian. Jesse, a year older and a born litigator, would be the family lawyer. But now, these handsome small-town brothers are prescription drug addicts, serving jail time. The two have been caught in an alarming wave of addiction triggered largely by the abuse of OxyContin, a prescription painkiller that produces a powerful, heroin-quality high. More than a year ago this tenacious synthetic opiate began ravaging poor, rural parts of New England and Appalachia, earning the nickname "hillbilly heroin." Increasingly, its abuse is spreading to urban areas along the Eastern Seaboard. Since April, more than 100 Boston-area pharmacies have been robbed of OxyContin. The robbers demand nothing else: not even cash, just OxyContin. Federal officials say OxyContin abuse has not yet hit California because heroin remains cheap and plentiful. But in remote areas, OxyContin swept in because it is easier to get than heroin.
    Perhaps nowhere is the prescription drug problem as bad as here in Washington County, on the northeasternmost tip of the United States, the first spot in America to see the sun rise each day. Prosecutions for crimes involving OxyContin have gone up more than tenfold here since 1998, a state attorney said. In five years, county residents seeking treatment for prescription drug addiction increased by the same sharp number. Injection is a common way to abuse this drug, and in Washington County, the rate of hepatitis C--generally transmitted by shared needles--is twice that of the rest of the state. Officials say that among the county's 35,000 residents, there are certainly 1,000 addicts and possibly many more. Maine is a poor state, and officials lack resources needed to establish the exact number of prescription drug addicts. Washington County Sheriff Joe Tibbetts, a sturdy man with scant occasion for hyperbole, said 60% of his inmates go through prescription drug withdrawal. Ask around the county, Tibbetts said, and almost anyone will know someone who is hooked on OxyContin or another prescription drug. "We've gone far beyond a problem, far beyond a crisis," Tibbetts said. "We're in the epidemic stage."
    Hugging the Canadian border, Washington County is about the size of Rhode Island, 500 square miles. It has limited employment possibilities and little in the way of diversion. Most people are poor, and almost all are white. They say prescription narcotics offer an escape from bleak, boring lives. Synthetic opiates such as Dilaudid, Ritalin and Percocet are easy to score and quick to provide a euphoric rush. But abusers say "Oxy," as the drug is known on the streets, gives the finest high of all. Crime is surging along with the drug explosion, said state prosecutor Matt Erickson, who has jurisdiction over Washington County. Prescription narcotics are involved in thefts, robberies and shoplifting--not to mention drunk driving, assault and domestic abuse, Erickson said.
    "Once you are addicted to these opiates, you will do anything to get that fix," said former U.S. Atty. Jay McCloskey, who notified the drug manufacturer, Purdue-Pharma, of the problem in Maine. "You will steal and you will deal," said McCloskey, who later joined the company as a consultant. The social toll is immeasurable. Families in Washington County are falling apart. Health and law enforcement systems are stretched to their limits. And prescription drug abuse is rife in the workplace. In the last 18 to 24 months, said McCloskey, "I believe it has become the greatest criminal problem and possibly the greatest social problem facing Maine."
    In Machias, Sheriff Tibbetts said he has watched schoolkids hold a finger to one nostril, pretending to snort OxyContin, just like mom or dad. He has seen mothers split a Ritalin tablet: half goes to her child, half gets sold on the street. "Then the mother goes back to the doctor and says, 'You've got to double the dose because it's not working,' " said Tibbetts, whose own 23-year-old daughter is addicted to prescription drugs.
    First approved in 1995, OxyContin has soared in popularity for managing severe pain for victims of cancer and other serious illnesses. According to federal government statistics, the annual number of OxyContin prescriptions has jumped from about 300,000 in 1996 to close to 6 million. The drug generated more than $1 billion in sales last year for its privately held manufacturer, Purdue-Pharma of Stamford, Conn. Doctors must follow strict guidelines to prescribe OxyContin and similar controlled substances. Purdue-Pharma even has introduced tamper-proof prescription pads for Maine physicians. But addicts find a way around such constrictions.
    In pill form, OxyContin gradually releases oxycodone, an opiate found in many painkillers, over a 12-hour period. The slow release reduces both the risk of a rush and the opportunity for addiction. Addicts cancel that out by crushing the pill, then snorting or injecting it. Because the drug is legal--and indeed, aggressively marketed--many abusers are surprised by the speed and intensity of the addiction. OxyContin tablets are color-coded according to dosage, ranging from 10 milligrams to 80 milligrams. Purdue-Pharma recently suspended shipment of the 160-milligram dosage. In a pharmacy, a 10-milligram pill costs less than $2. The 20-milligram costs under $3. On the street, OxyContin of any dosage inflates to at least $1 per milligram. Initially, abusers say, a high will last for hours. But as they build tolerance, they crave more.
    OxyContin has been linked to more than 100 deaths, according to the U.S. Food and Drug Administration, which recently strengthened the warnings on the drug and called on doctors to restrict its use. Until state officials brought the abuse issue to the manufacturer's attention, Purdue-Pharma spokesman Jim Heins said the company was unaware of the problem. Maine, said Heins, was "the first state to hit our radar screen." But the abuse problems are not limited to the Northeast. Lawsuits filed against Purdue-Pharma by the states of West Virginia and Virginia contend that forceful marketing of OxyContin has contributed to its widespread abuse in their states. Maine is considering similar action. Heins called the lawsuits "baseless, an unfortunate distraction." He said the company has launched education programs to train New England doctors to recognize "diversion and abuse." He also said company scientists are trying to produce an abuse-proof OxyContin formula. OxyContin, Heins said, "sort of is the lightning rod for this [abuse] issue, unfortunately for us."
    Isolated and economically depressed, Washington County is marked by a series of watery inlets and fields that each summer bear blueberries. Hand-picking the berries traditionally was guaranteed work here. But now, growers say local laborers are unreliable, so immigrants from Mexico and Nova Scotia are brought in to work the fields. Lumbering and fishing also are labor staples here. Many of those jobs go begging too. "We have a county with a lot of impaired people, and that's not a recipe for good economic health," said state Sen. Jill Goldthwait. "People don't show up for job interviews, or they get hired and don't show up for work."
    At the Sunrise County Economic Development Agency, executive director Diane Tilton said a local employer recently complained about workers shooting up with prescription drugs on the job. When Tilton suggested mandatory drug testing, she said the employer replied, "If I did that, half my people would be fired." Serving up fresh blueberry pie at Helen's, this town's most popular restaurant, owner Gary Hanscom said, "I have never, ever had trouble getting help here--until now." His own 27-year-old son is hooked on OxyContin, unable, or unwilling, to work, Hanscom said. And "three of my waitresses, prettiest things you ever saw--everything going for them, husbands, kids, you name it--well, two of them are in the hospital right now, in withdrawal. The third one, I don't know where she is." Long before prescription drugs took hold, alcohol abuse was widespread here. Towns are scattered, often more accessible by boat than by car. There is no mall, no movie megaplex, no mini-golf course. As a whole, the county displays what Tilton politely calls "low educational attainment."
    At the County Jail, 20-year-old Jesse Reid grew dreamy as he recalled his first encounter with OxyContin: "It was like nothing I had ever experienced before in my life. It seemed like this great, big euphoria. I was on top of the world. I just kept taking it. Now I know more people who are using it than not using it." Reid sold other drugs to support his OxyContin habit. He spent time in rehab, but his insurance benefits ran out. He stayed clean for a month, "if that," before OxyContin lured him back. "What this drug is doing to peoples' lives is ruining them. People are spending their kids' college money. They're stealing. They're holding up people in their own families. Old people are doing it. Young people are doing it. Basically, everybody here is doing it," he said.
    In an area like Washington County, said state prosecutor Erickson, enforcing the laws on prescription drug abuse poses special difficulties. "If you have probable cause to think somebody has 30 bags of heroin and they are dealing it, you can get a search warrant. If you have probable cause to believe that somebody has 30 OxyContin tablets and they are selling them out of their house, it would be hard to get a warrant. The only case that's really prosecutable is where you have some cooperative defendant go in wearing a wire, and make a purchase." In a county where "everybody knows each other and is fiercely loyal," that cooperative defendant would be hard to locate, Erickson said.
    Besides, law enforcement in rural Maine is definitely small-scale. Most towns have no police department, making Sheriff Tibbetts the primary constabulary. Just a few months ago, Tibbetts said, a local car dealer donated a 1984 station wagon for the department's sole drug officer. "Until then," Tibbetts said, "we were fighting the war with a bicycle." The battle may be outpacing the foot soldiers, Tilton said. "It used to be you had people in County Jail that were drunk, sleeping it off. Now they've got people vomiting in the jail, flipping out and crying, and mothers slipping the drugs into them just to alleviate their misery. This is a whole new level."
    Everywhere in Washington County, the need for treatment is a persistent theme. Many people do not know where to get help, or how. The state's two drug treatment facilities have waiting lists. Out-of-state rehabilitation is too expensive for most. "What we need more than anything else is rehabilitation," Tibbetts said. "A 6-by-10 cell with a doctor coming out every once in a while, that's just hell. And you know, these people don't want to be addicts. They're very nice people."
    In the nearby hamlet of Lubec, Jane Hallett said depression drove her to a $200- to $300-a-day prescription drug habit that wiped out a generous family inheritance. Moving from Percocet to Ritalin to OxyContin, Hallett plowed through land, a business and other assets valued at about $300,000 in just a few years. "I sold my washer and dryer for two pills one day," she said. "I sold fuel for a pill. I went through cars, trucks, china, silver, diamonds. I've gone to jail because I stole every checkbook my sister had." Hallett, "39--but I feel 140," said the prevalence of prescription drug abuse in Washington County seems to feed upon itself. "You've got a small, close-knit community. One person's using. Soon everyone's using. That's just the way it is," she said.
    In another part of the county, the mother of two prescription drug abusers saw firsthand just how far her sons would go. The mother asked that her name not be used. But she talked freely about finding a syringe and other drug paraphernalia when she put one son's laundry away. She talked about installing a lock on her bedroom door to keep her boys from stealing from her. Then, while she was at work, the youths brought a ladder to her second-floor window and went in to grab whatever they could sell. "Being a mother, I didn't want to even believe that my kids could get involved in stuff like that," she said. "I thought they were rebellious and moody, like any teenager. I thought, you know, this too shall pass."
    Tibbetts has designated one lieutenant, Mike Riggs, to work full time tracking down prescription drug problems. Riggs said he worries that a drug plague in a remote part of northeastern Maine is easy to dismiss. He gets weary, trying to explain just how bad it is here. "I'll tell you who owns this problem," Riggs said. "We all own this problem. Every one of us." Driving along a rough, pitted road, Riggs said: "Education, treatment and enforcement is going to be the answer. The money is there to spend. It's just a question of how you want to spend it. You can build more prisons, buy more cops--well, that's fine. Seems as if you treated the addiction problems, it would be much wiser."
    Riggs paused to point out a rickety trailer where he said a dealer was living. He gestured toward a shingled house with bright blue trim: another dealer. Teachers sell prescription drugs to students, he said. Deals go down in front of the hardware store. Not long ago, while an elderly woman was at her husband's funeral, relatives rifled her medicine cabinet and made off with her dead husband's OxyContin tablets. "Hopefully, something will come to pass," Riggs said. "Because what is happening right now is very sad. Very sad."

Time Release Drugs to Treat Attention Deficit Problems
Alexa Pozniak, ABC News- 10/4/2001

Children with Attention Deficit Hyperactivity Disorder can be disruptive and troublesome, especially in school. "They usually can't sit still, they may blurt out answers, poke other children with their pencil, and no matter how smart they are, they'll usually have trouble keeping track of their homework assignments and following verbal instructions," says Dr. Henry Holcomb, associate professor of psychiatry at the University of Maryland. To treat these symptoms until now, children have had to take three-to-four pills each day, usually the drug Ritalin. At least one of the doses had to come during school. But a new class of timed-release medications may change that for many kids. Ritalin LA, the newest, by the companies Novartis and Celgene, is on its way. This week it received a letter of approval from the Food and Drug Administration, the first step in the approval process.
    With the older drugs, children faced a range of obstacles, having to not only remember to take the drugs at specified times, but also face the embarrassment of having their friends know why they were going to the principal or nurse's office. Furthermore, "because of cutbacks, many school systems don't have school nurses anymore to give it out," notes Dr. Glen Eliot, Director of the Children's Center at the University of California, San Francisco. Another benefit of timed release Ritalin is that "There wouldn't be the peaks and valleys associated with other forms of the drug," says Dr. Eugene Bresin, director of Child and Adolescent Psychiatry Training at Massachusetts General Hospital. "These peaks and valleys create a rocky period of time in the classroom. So they have a more steady level in their system."
    Still, once-a-day dosages aren't for everyone. "Sometimes it provides extremely high amounts of medicine, constantly, which is too much for some people," says Holcomb. " And then when it stops working, the termination effects are powerful. "Some people have bad responses from going from a very high amount of medicine to a very low amount of medicine, so they're going from a state of being highly productive and focused to a state of exhaustion and inability to focus. An awful lot of people would need an additional dose of medication in the afternoon." Elliot says the most important things these drugs provide are options. "Overall, it's substantively more than just a marketing ploy. It gives parents, children, and physicians some real choices not previously available."

Parents and Experts Disagree on Medicating Kids
ABC News- 8/9/2001

Each year, the drug Ritalin is currently being prescribed to an estimated 4 million American schoolchildren diagnosed with attention deficit disorder/attention deficit hyperactivity disorder. But some parents feel that schools and medical professionals are labeling kids too quickly with ADD/ADHD and then prescribing Ritalin. The matter is now before the courts in a class-action lawsuit. Lawyers for the plaintiffs allege that Novartis, the makers of Ritalin, over-promoted the diagnosis of ADD/ADHD to boost drug sales and that the company failed to adequately warn the public of Ritalin's impact on children's cardiovascular and nervous systems. The company denies the allegations. Joining us today for an online chat was Dr. Peter Breggin, a medical consultant to the plaintiffs in the lawsuit and the author of Talking Back to Ritalin and Reclaiming Our Children: The Healing Solution for a Nation in Crisis.
Moderator: Welcome Dr. Peter Breggin.
Breggin:  Hello. This is my very first online chat, so it's an inauguration for me and anyone who's listening. I'm Peter R. Breggin, MD. I am a psychiatrist in private practice in Bethesda MD where I've been located since I left the National Institute of Mental Health in 1968.
Moderator: How exactly is ADD/ADHD diagnosed?
Breggin:  The diagnostic manual created by the American Psychiatric Association is the basis for the diagnosis. It divides ADHD into 3 different aspects. One is hyperactivity, another is impulsivity, and a third is inattention. If you actually look at the criteria under these categories, it's a list of behaviors that annoy teachers or disrupt classrooms.
    For example, under hyperactivity, the first criteria is "often fidgets with hands or feet or squirms in seat." Under impulsivity, the first criteria "often blurts out answers before questions have been completed," which to me means he could do well on Jeopardy. And the third, inattention, has for it's first criteria, "often fails to give close attention to details or makes careless mistakes." Clearly this is not a biological disorder, but a list of behaviors that put children in conflict with adults. Even if the evaluator does many different tests lasting many hours, the diagnosis still comes back to these "fake" criteria. I call them "fake" because they really reflect conflicts between parents and children and teachers and children.
Jarod Cooper from proxy.lucent.com: Has there been any research done on the effect that Ritalin may have on adults who were medicated with as children?
Breggin:  Ritalin and other stimulants suppress growth of all origins of the body by disrupting growth-hormone cycles and that is likely to have a lasting effect. And animal studies show that amphetamines such as Adderall and Dexedrine cause brain-cell death and that Ritalin causes permanent brain disfunction at regular clinical doses. There are very few long-term studies. One good study from the University of California School of Education by Nadine Lambert followed children given Ritalin and other stimulants and found increased cocaine and nicotine abuse in young adulthood. Some children develop tics and on rare occasion they become permanent. Some develop severe mental disorders such as depression and obsessive-compulsive disorder, and it can take time to recover. Some of the school shooters such as P.J. Solomon of Conyers GA were taking Ritalin, and clearly his acts have a lasting effect on the rest of his life.
Moderator: In your estimation, how many children are actually afflicted with ADD/ADHD and in need of treatment? How do your numbers compare to the number of kids being medicated?
Breggin:  I do not believe that ADHD is a valid diagnosis. And I believe that medicating children is not the way to handle our conflicts with them as parents and teachers. However, even by the standards of most ADHD advocates, our children are heavily overmedicated. A recent study out of Duke University showed that more than 7% of children were receiving stimulants. Another study out of Virginia showed that 10% of children were receiving stimulants in school, and probably a greater number if you included children medicated before coming to school. In addition, a study in the Journal of the American Medical Association (JAMA) has shown a 3-fold increase in Ritalin subscriptions to toddlers, ages 2 to 4, and hardly anyone thinks that's justified.
    So by almost any standard, we are far overmedicating our children. The International Narcotics Control Board of the World Health Organization (WHO) has warned that the US has an epidemic of excessive Ritalin prescription, and emphasizes that stimulants are highly addictive. The US Drug Enforcement Administration (DEA) has also warned that Ritalin is excessively prescribed and is being abused by children and young adults. They have emphasized that Ritalin is not as safe a drug as advocates claim. In Talking Back to Ritalin, I document the many adverse affects from stimulant-caused mental disorders to growth suppression, heart problems and addiction.
Moderator: Is Ritalin the most widely prescribed drug for ADD/ADHD?
Breggin:  For many years Ritalin has been by far the most widely-prescribed drug, sometimes in its generic form, methylphenidate. It is now being replaced by Adderall, which is a form of amphetamine. We have even more animal research showing permanent brain damage from amphetamines than from Ritalin, a drug that is classified as amphetamine-like. Now there's a new product coming out which is basically a one-a-day dose of Ritalin. That will be even more dangerous because it encourages the quick fix mentality. Also, when a drug acts for a longer period of time, it's more dangerous because if it has a harmful effect, it can't be quickly cleared out of the body.
Betty from ee.missouri.edu: What are the FDA and NIH stipulations for including children in drug trials?
Breggin:  The FDA has approved Ritalin for use in children 6 years and older. The NIMH is currently planning to do studies involving hundreds of 2-4 year-old children. I believe that this is child abuse and should not be allowed. I urge conscientious individuals to write to their congressmen and senators and to the director of NIMH protesting giving these drugs to young children. Basically the government is doing the drug companies' dirty work by trying to prove that it is good to give these drugs to little tiny children.
A. McDonald: I have a friend who successfully treated her child's ADD with the Dr. Feingold Diet. How much research is being done to explore a link between ADD and the increased amount of preservatives and other things in our food?
Breggin:  There's no scientific evidence that children diagnosed with ADHD have a physical disorder. Therefore, I believe it is faulty to try treating it as if it's caused by a food allergy, too much sugar, or additives. Certainly, a good diet of healthy food will improve a child's quality of life, but it's a mistake to equate that with treating this fraudulent disorder. However, in order to impose a Feingold Diet requires paying a great deal of attention to your child, including all of your child's daily activities inside and outside the home. It requires a rigorous program of discipline for you and your child. I believe this is why these fad solutions actually end up helping parents and children in regard to the child learning self-control.
eb@expressvisa.com from z064001102.hou-tx.dsl.cnc.net: What sort of effect does Ritalin have on the cardiovascular system?
Breggin:  Ritalin, Adderall, and all stimulants cause cardiovascular problems and on occasion cardiac arrest. Stimulants disrupt the rhythm of the heart. Animal studies show they weaken heart muscle. Addicts who abuse stimulants can develop severe cardiac disease. Children develop hypertension. Scientists in the black community where hypertension is a particular problem have warned about exposing African-American children to these drugs. Finally, we have had recent reports of sudden death from Ritalin. And I'm a medical expert in one of them.
Moderator: If you don't believe in the use of medications, what are alternatives are available for parents?
Breggin:  I discuss alternatives in great length in two of my recent books, Talking Back to Ritalin (1998) and Reclaiming Our Children (2000). In addition, in my book Your Drug May be Your Problem (1999), my co-author David Cohen and I have a chapter on how to withdraw children from stimulant drugs. In deciding what to do with your child's problems, you first of all need to find out what they really are. Diagnosing doesn't help. You need to find out if your child is undisciplined at home and/or at school, if your child feels anxious or distressed at home or school. If the problem is largely at home, where your child is out of control or very upset, then there's very good news. You as a parent, if you improve your parenting skills, will invariably be able to improve your child's self-control and conduct. The power is in our hands as parents, not in the child's brain. There are many good books and workshops available on parenting.
    If the problem is in school but not at home, you have a more complicated situation. Schools can be very unresponsive to the needs of children. You should explain to the school that you do not favor medication, that there are many doctors who are against giving stimulants to children, and that you want to work with the school in engaging your child's interests and imagination. You should explain to the school that you will obtain any necessary psychological evaluation privately, and that you don't want the school evaluating your child except with tests given routinely to all children. Furthermore, a change of teachers or schools often completely solves a child's school problem.
    Do not accept blaming your child's brain; instead, insist that the school work with you to find ways to solve your child's education problems. And finally, if your child is out of control in class, you need to visit the classroom and spend time there, both to observe your child and to invest the classroom with your authority. Very likely your child is undisciplined at home, and if you get good advice on how to handle that problem, it will carry over into school.
Matt L. from inf.uiowa.edu: When a physician is diagnosing ADD/ADHD, should a complete evaluation by a pediatric psychologist be routine?
Breggin:  Hold on to your hat, because I'm going to say something that may be hair-raising! You should not have your child evaluated by medical specialists of any kind for emotional or psychological problems unless you can be certain that they don't believe in psychiatric drugs. To take your child to any medical doctor with even a hint of a behavioral problem, nowadays the vast majority of time will result in a knee-jerk prescription of stimulant medication. The more experienced and specialized the physician or mental-health specialist holds themselves out to be, the more likely they are professionally and financially invested in making the ADHD diagnosis and in prescribing drugs. Before seeking professional help, screen people by phone to make sure that they will help you in regard to the kind of parenting and teaching your child is receiving, and that they favor psychological and educational approaches, rather than medical ones.
Michael from techdata.com: Does ADD/ADHD go away as a child gets older?
Breggin:  Since ADHD is not a valid disorder, it is not possible to give a scientific response to the question. However, in general, if a child is distressed and in conflict with the adults in his/her life, it is important to help that child before these problems continue into adulthood. However, doctors have no scientific basis for frightening parents by telling them that their children will have a "bad outcome" in adulthood if they are not medicated. In fact, studies that show a "bad outcome" for children diagnosed with ADHD were conducted on children who were given stimulants at a research clinic. Therefore, the correct conclusion is that taking stimulants as a child may lead to a "bad outcome" in adulthood.
Dr. Peter Friedrichs from netwurx.net:  Is it possible many of these children have nervous system dysfunction that when corrected, they can resume a more normal behavior?
Breggin:  No, there is no evidence that children routinely diagnosed with ADHD have any neurological disorder. Many of them, in fact, seem to be superior in terms of their physical or mental endowment, and that is precisely what gets them into trouble. When on rare occasion there is a neurological problem such as a head injury, the diagnosis is head injury rather than ADHD, and most certainly the neurologically impaired child should not have additional brain dysfunction imposed through stimulant drugs. Medical doctors have for a hundred years tried to claim that behavioral problems in children are biological and genetic because as medical doctors that's the only way we can be in charge of the field. But in those hundred years, we have never proven that any of the behavioral problems that children have are biological in nature.
Moderator: Dr. Breggin do you have any final thoughts to share?
Breggin:  America is the first society to ever turn to the mass drugging of its children as a solution to the conflicts that inevitably arise between the generations. It is difficult to be a child. Childhood is filled with frustration, disappointment, abuse and trauma. It is difficult to be a parent, especially in this modern age where parents are often raising children on their own or while working. It is difficult to be a teacher in large, overcrowded classrooms that lack teaching assistants and volunteers and that lack the kind of exciting technologies that capture the attention of children.
    But in facing the difficulties of parenting and teaching, we must not in our frustration falsely blame the brains of children in order to exonerate ourselves of responsibility. Instead, we must redouble our efforts to become the kind of parents and teachers that our children need, and we must use our influence to improve family life and school life in America. By contrast, when we tell a child that the child has ADHD, a biochemical imbalance, cross-wired in his/her brain, a genetic defect, or some other fabricated biological dysfunction, we saddle that child with an identity that will burden that individual for the rest of his/her life.
    We disempower children by telling them that they can't control themselves or can't learn; we disempower ourselves as adults by saying we can't reach any particular child, and we actually end up in our frustration damaging the brains of our children to make them more docile and more manageable. That is all we can accomplish with the drugs —crushing the spontaneity of our children. Instead we should take responsibility for empowering our children to live as full lives as possible with an intact brain. If you have further questions, please turn to my website www.breggin.com. The website describes our national organization, the International Center for the Study of Psychiatry and Psychology, which is holding it's annual conference in New York City at the Roosevelt Hotel 22-24 September.

Counselors See the World Trade Center Through the Mind of a Child
Kathryn Masterson, Associated Press- 10/5/2001

GREENWICH, Conn. -- In the minds of the children, the buildings broke. The planes they saw on television kept hitting again and again. And there's a reasonable explanation why a parent hasn't come home. ''My Daddy's going to be coming back, but there aren't enough taxis,'' a 6-year-old told his class in New Canaan. ''Once there are enough taxis, he's coming home.''
    Those are the kinds of stories and explanations that the Den for Grieving Kids has begun to hear as the nonprofit counseling organization starts to work with families and children whose lives have been torn apart by the World Trade Center tragedy. Serving the wealthy Fairfield County towns of Greenwich, New Canaan, Darien and Stamford, the Den for Grieving Kids is well-positioned to help. Thousands of Fairfield County residents commute into New York. Of 60 Connecticut residents confirmed dead or missing in the Trade Center disaster, 50 are from Fairfield County. And many had children who must come to terms with something many adults are still struggling to understand. ''The longing of children, the waiting in which they have no concept of time,'' said Lorenzo Colon Munroe, director of the Den for Grieving Kids.
    The Den has helped children who lost parents, siblings or friends to homicide, suicide, accidents and AIDS. Working with the children affected by the Trade Center attack will be the greatest challenge the organization has ever faced, Munroe said. The Den has been visiting schools and talking to teachers to try to understand how children see the tragedy.
    One little girl told a social worker, ''And they did it over and over and over again.'' She had watched the attacks on television. The day after the attacks, when Robert Higley II was missing from the Trade Center, his 4-year-old daughter, Amanda, told her mother, Vycki, she did not want to go to preschool. She was afraid the other children were going to laugh because she didn't have a daddy. That thought soon passed, and Amanda went back to school. Her mother tried to keep a routine for her daughter as they waited for news. Robert Higley worked on the 92nd floor for Aon Risk Management Services. Co-workers who escaped said he was on his way out but went back up to help others. For the first several days after the attack, Ms. Higley answered Amanda's questions Where is Daddy? Why aren't we picking him up at the train station? by simply saying, ''Daddy is missing.'' By the first weekend, the family told Amanda that her father had died and gone to heaven. That was when Amanda first cried, her mother said.
    A year and a half ago, Ms. Higley's sister Elizabeth died of kidney failure at 29. Ms. Higley believes her sister's death may have helped Amanda understand her father's. ''She realizes Daddy's in heaven with Aunt Beth,'' Ms. Higley said. Ms. Higley, who is expecting another daughter next month, said she is grateful Amanda is only 4 young enough to believe unquestioningly in haloed angels and a cloud-filled heaven, too young to know what happened to the Trade Center. ''She won't know the horror until I'm ready to tell her the horror,'' Amanda's mother said. ''I can keep her sheltered.''
    The Den for Grieving Kids, which offers its services at no cost and runs several programs for 40 families, is starting a separate group for the families of Trade Center victims. ''The most important thing we do is, we listen to people's scary stories and we don't run away,'' Munroe said. Many of the families may have trouble getting past their grief because of the uncertainty of ever finding a body. And grieving in private may prove almost impossible. ''They might as well be wearing a big letter WTC 9-11,'' Munroe said. At the Den, families will be able to come together several times a month to have dinner, talk with counselors and play. The families and the counselors will explain death to children who do not understand. ''We will sit with the children who still wonder if Daddy's going to come home when there's enough taxis,'' Munroe said