Noteworthy News Articles on Mental Health Topics, April 15-18, 2001

Gay Alliance Taking Hold in Schools
Scott S. Greenberger, Boston Globe- 4/15/2001

David, a sophomore at Newton South High School, was puzzled by his reaction to an older boy he met at summer camp. It was only after he returned home, he said, that the reality ''just kind of kicked me in the head.'' He had a crush on him. ''There was something about him that turned me on,'' said David, 16. ''I don't know why.'' David was scared to talk to his family and friends about his feelings, but he found a sympathetic ear at school: Newton South's ''gay-straight alliance.'' Today, David, who has a girlfriend, considers himself bisexual. But he hasn't been romantically interested in any boy other than the one at camp. Because he doesn't want to have sex before he is married, it would be difficult for him to act on such feelings even if he had them. ''I'm hoping to have a wife who says, `Sure, why not?''' he said. ''You know what I mean? Just experiment.''
    Eight years ago, Massachusetts became the first state in the country to help pay for gay-straight alliances in high schools. At the time, they were seen as an antidote to the alarming number of suicides and suicide attempts among gay and lesbian students. Today, an idea born in Massachusetts has spread to more than 800 schools in 47 states. The number of groups has more than tripled in the last three years, according to the Gay, Lesbian and Straight Education Network, a New York group that helps students start alliances.
    But as the groups have multiplied, they have become more than just a safe harbor for students who know they are gay or lesbian, according to a Globe survey of Massachusetts schools. They've also become a place for teens who are unsure about their sexuality to explore it - and that troubles some educators and parents. Some of them argue that gay-straight alliances encourage teens to tackle sexual issues, or even identify themselves as gay, before they are ready. Others question whether schools can, or should, help guide students through what can be a labyrinthine journey to sexual maturity.
    Mary Bullwinkle, a Newton mother of three, says she isn't anti-homosexual, and she doesn't object to scientific lessons on sexual matters. What makes her uncomfortable, she said, is when schools ''start exploring the sexuality part of it, the feelings, the right way to go.'' ''I don't want to tell anybody how to live. But I don't want anybody to tell me how to live either -- or my children,'' Bullwinkle said. But Michael Kozuch, a history teacher at Newton South High School who advises the gay-straight alliance there, says the group ''helps students to find their own answers, rather than saying, `This is the right way.''' ''This stuff is there anyway - most kids are dealing with this issue from elementary school on,'' Kozuch said. ''By the time they get to high school, they are already needing a venue, some avenue to try to understand what's going on with them.''

A growing phenomenon
Sitting cross-legged on a classroom floor, the students in Newton South's gay-straight alliance look and sound like the French Club or the prom committee as they sip from juice boxes and argue about whether they really need a president. One girl has dyed orange hair, but another wears a conservative sweater and a gold cross around her neck. The word ''gay'' is hardly mentioned. The word ''sex'' doesn't come up at all. Across town at Newton North High School, the scene is similar: After a quick rundown of upcoming events - a gay and lesbian dance at the Congregational Church in Needham, a screening of ''Boys Don't Cry'' - about a dozen students in that school's gay-straight alliance spent much of a recent lunch meeting talking about their junior theses on McCarthyism and clipper ships.
    Only a decade ago, such gay-straight alliances would have been unthinkable at all but a handful of American high schools. Now, at many schools, they're unremarkable. Kevin Jennings, who heads the Gay, Lesbian and Straight Education Network, was a teacher at Concord Academy when the first gay-straight alliance was founded there in 1989. In 1991, Newton South became the first public school with an alliance. Jennings says he's amazed at how fast the groups have spread -- and where they've spread -- in the intervening decade. ''If you told me at Concord Academy 11 years ago that I'd be standing in the snow talking to a girl who started a GSA at a school in suburban Anchorage, I'd say that hell had frozen over,'' said Jennings.
    Kozuch, who is gay, remembers what things were like at his Mount Laurel, N.J., high school in the mid-1980s.  ''There wasn't even a thought that this sort of organization could exist,'' said Kozuch, who knew he was gay from the time he was a young boy but was too afraid to tell anyone at school -- or his fundamentalist Christian family.  ''I was able to pass for a long time, but it's not a good experience,'' he said. ''You feel like you're acting 24 hours a day, and that creates a lot of tension within yourself.''
    That tension, studies suggest, can lead to tragedy: An alarmingly high percentage of gay and bisexual high school students have attempted suicide or made suicide gestures, according to a Massachusetts Department of Public Health report that will be released next month. Statistics such as that one spurred the creation of the Governor's Commission on Gay and Lesbian Youth in 1992 and the passage of the ''Safe Schools Act,'' which explicitly bans discrimination against gay and lesbian students, a year later.
    Since the 1993-94 school year, Massachusetts has helped pay for gay-straight alliances at schools that want them - the only state that does so. This year, the Department of Education handed out a total of $285,725, in grants of between $500 and $3,000, to 156 schools. ''It's not about promoting homosexuality or any other such thing. The purpose of this program is to provide a safe environment,'' said Polly Bixby, a physical education teacher who supervises the gay-straight alliance at Mahar Regional High School in Orange.

Roles questioned
Gay rights advocates hail Massachusetts as a model for the nation. But others question whether schools are the right place for them, and teachers the right people to lead them. The Massachusetts Department of Education doesn't require that faculty advisers for gay-straight alliances be school psychologists or guidance counselors, and many of them are regular classroom teachers.
    ''Having been an educator for close to 40 years now, my feeling is that there are a lot of things I know pretty well. But I'm not a psychologist or a social worker. I'm not all things to all people,'' said Quincy Superintendent Eugene Creedon. Creedon said he doesn't want teens struggling with their sexual identity to ''flounder,'' but he worries about schools ''doing more harm than good.'' He has backed broad anti-discrimination groups in his district, but not gay-straight alliances. ''I think the ordinary classroom teacher is not trained to deal with it,'' he said. And it's not just a matter of training. ''Some of these issues are private issues, and it's not our job as school people to be the only agency or organization that needs to be concerned,'' he said. ''There are other organizations in the community that probably have more legitimacy than we do.''
    While Creedon said his opposition is based on educational concerns, he acknowledged that much of the resistance to gay-straight alliances in general comes from people who believe, often for religious reasons, that homosexuality is wrong. But for other parents, it's not a matter of the morality of homosexuality, but whether sexual issues should be discussed in school. ''Families have different ideas about sexuality, and how they want their children to feel about it or react to it,'' said Bullwinkle, the Newton parent. ''I think schools don't take that into consideration. I think they push their own views, not what an individual family may feel about it.''
    Bullwinkle belongs to Newton Parents for Moderation, a group criticized in some quarters for being antigay. But Bullwinkle says that members of the group aren't all on the same page when it comes to homosexuality, and she doesn't have moral objections to it. Some of the uneasiness about the alliances is rooted in the idea that they encourage -- though perhaps only implicitly -- teenagers with raging hormones to experiment sexually.
    Rachel, a junior at Newton South, says she had some questions about her sexuality when she joined that school's gay-straight alliance, but her main motivation was her disgust with the anti-homosexual slurs she heard at summer camp. As the school year went on, however, the questions about her own sexuality grew more intense. A crush on a girlfriend made Rachel ''more and more sure I wasn't completely straight.'' Now Rachel, who has a boyfriend, considers herself bisexual. ''I think I would have come to the realization. I don't think I would have been as comfortable if I hadn't been in the GSA,'' she said.
    Dr. Larry Stone, a Texas psychiatrist who is past president of the American Academy of Child and Adolescent Psychiatrists, says gay-straight alliances may be the only place for many troubled teens to turn. But he wonders whether the groups might lead some of them to identify themselves as gay, lesbian, or bisexual when they haven't yet sorted out their sexuality. ''One thing we know about adolescents is that as a group they tend to feel alienated, they tend to feel isolated,'' he said. ''As a result, they're very prone to pick up whatever is being espoused by a group, and I think we have to be aware of that.''
    Dr. David Fassler, a Burlington, Vt., psychiatrist who works with teens, agrees - to a point. ''All kids explore and experiment sexually as part of their normal development, and their sexual behavior may be with members of the same or the opposite sex,'' he said. ''The experimentation in itself doesn't determine someone's sexual orientation.''  But Fassler rejects the idea that the groups encourage students to identify themselves as gay. And no matter what a student is, Fassler said, a gay-straight alliance can be a comfort. ''I think it's important for schools to do everything they can to support these kids during the high school years.''

"Columbine Effect': Fear Over Reality
Kevin Simpson, Denver Post- 4/15/2001

In 1999, the year the word Columbine became synonymous with school violence, the chances of a child being killed on campus were 1 in 2 million. The following year, harrowing headlines about subsequent shootings fueled a national preoccupation with an apparent epidemic of violence in the classroom. The odds in 2000? One in 3 million. The Justice Policy Institute, a Washington, D.C.-based criminal justice think-tank, offers those numbers to support its contention that facts about school violence - that it's actually declining - have been swimming against an overwhelming current of media coverage and public opinion.  Many facets of life in America have been pulled into Columbine's powerful slipstream during the two years since the suicidal attack by two high school boys who killed 13 and injured 23. Police procedure, school policy, the Internet, academia, the gun debate - all have been fundamentally affected by the event and its myriad aftershocks.
    One school administrator calls it simply "the Columbine effect": Police now respond more aggressively to school shootings. Courts in some states have mandated information sharing between schools and law enforcement, leading to close coalitions with local police that some hail as potentially lifesaving, but others see as uneasy alliances that threaten student freedoms. Schools have stepped up basic programs for bully-proofing and conflict resolution, although, in many cases, improved safety has come with the side effects of zero tolerance and a more repressive environment.
    Cyberspace served as an outlet for the Columbine shooters' rants and ultimately a vehicle for copycat threats and even Web sites lionizing the killers. Now it has come under closer scrutiny by Internet watchdogs, industries and lawmakers as they re-examine thorny free-speech issues around such unfettered communication. Echoes of Columbine also resound through the language; the word itself has achieved almost generic status in the nation's lexicon, connoting a specific brand of school violence. And almost two years ago, the American Dialect Society recognized the phrase "trench coat mafia" -- the clique initially identified with the Columbine shooters -- among its "Brand New" entries, in the same breath as "Pokemania."
    Fallout from the shootings still pervades academia, as college applicants ruminate on its meanings in their essays on entrance exams. "It's a lens through which they can express who they are, how they see the world differently," says Evan Forster, president of EssaySolutions, a New York company that coaches students. "That's what a lot of these kids are writing about." Columbine remains a fulcrum for change. "The tenor of discussion was underway before Columbine," says Jason Ziedenberg, senior researcher at the Justice Policy Institute. "There was a context for Columbine to happen in - the latest in a series of school shootings. But Columbine took what was happening and amplified it. "Exponentially."
    Copycats abound. Within a few weeks of the April 1999 violence, at least 3,000 similar bomb threats poured in - about five times the usual number, according to the National School Safety Center in Westlake Village, Calif.  That summer, during a meeting of about 250 suburban school superintendents, someone asked how many had experienced bomb threats the previous spring. Houston recalls that every hand shot into the air. In such a climate of fear, did administrators have any choice but to crack down, install metal detectors, formulate crisis plans, work more closely with police, pour money into violence prevention? In recent months, more school violence -- and some plans that were defused before they could be acted upon -- reinforced the perception of schools as danger zones. "Sadly, schools are a bit more repressive than even before, and less tolerant because the second-guessing is just too significant," Houston says. "As an administrator, you can't afford to have that on your head: "I ignored it and, by golly, it's another Klebold and Harris.'"
    For years, the conventional metaphor for American schools was assembly-line education -- the factory, Houston says. Now it is the prison -- with guards called teachers, a warden called a principal, metal detectors, uniforms, cops euphemistically called "school resource officers," close collaboration with law enforcement and the courts.  Houston backed some of those measures, even at the expense of student liberties, in the immediate aftermath of Columbine. But two years later, he's uncomfortable with the decidedly adult response to adolescents. "There's a certain mismatch with zero tolerance, moving to adult court, a lot of measures that are just punishment," Houston says. "There's an attitude of, "We're just going to get the little bastards before they do something to us.' "Long before Columbine, I thought America was afraid of its children. All Columbine did was magnify the fear."   Despite statistics from the U.S. Centers for Disease Control and Prevention, the Bureau of Justice Statistics and the National Center for Education Statistics showing declines in juvenile violence during the '90s, public opinion polls describe an epidemic. In one survey, a majority of Americans believed not only that youth crime is on the rise, but that a shooting was at least "somewhat likely" in their school.
    The Justice Policy Institute report details legislative initiatives and policy responses such as anti-bullying programs, improved mental health services, conflict mediation and anger management. But the study also notes that roughly two-thirds of state legislatures have eroded confidentiality provisions regarding juvenile crime, and several states require communication between schools and law enforcement regarding kids who may have committed crimes.  Zero-tolerance policies, metal detectors and video cameras, profiling that seeks to identify dangerous kids before they go off - all of these have found a place in the classroom. The report suggests that some measures taken in reaction to highly publicized cases of school violence may be overly restrictive and more likely to "turn our schools into appendages of the courts" than enhance safety and education.
    Jean Johnson of Public Agenda, a public-opinion research organization in New York, points to a Gallup poll that asked the question: Thinking about your oldest child, when he or she is at school, do you fear for his or her physical safety? In the summer of 1998, only 37 percent said yes. The day after Columbine, that number spiked to 55 percent before plummeting to 26 percent last summer. This spring, amid reports of several copycat attacks, the figure jumped back up to 45 percent.
    The media, Ziedenberg says, have provided Columbine with context. The voracious hunger for content to feed 24-hour news channels, talk-radio airwaves, Internet Web sites and newspapers resulted in idiosyncratic spasms of violence being strung together, sometimes with the thinnest of threads. "It's the way our nation looks at crime now - we'll connect them," Ziedenberg says. "You can tell people there's a 1 in 3 million chance (of being killed at school) until you're blue in the face. They've got the image of the kid sitting down in front of the school crying with a bloody face."
    Several states are enacting measures on school safety. When news of Columbine hit, Ron Stephens was advising about 400 people on how to mark the first anniversary of the day a 14-year-old student shot and killed a science teacher and wounded two others in Edinboro, Pa. "We threw away our notes and did a heart-to-heart debriefing," says Stephens, executive director of the National School Safety Center.   For Stephens, Edinboro has particular resonance with respect to Columbine. The shooter had robbed two students at gunpoint in the school parking lot the night before -- and neither victim had reported the incident to the school or police. If they had, Stephens believes, the Edinboro shootings never would have happened. At Columbine, both shooters had been on probation for a van break-in, and one was reportedly under investigation concerning bomb-making allegations. But school authorities were either unaware or decided not to take action. "I have often used that incident as a teachable moment for students when they're considering whether to break the code of silence," he says.
    Stephens now helps train 3,800 federally funded officers earmarked for schools, but notes that many states are enacting school safety measures. Michigan passed a law, post-Columbine, calling for mandatory 180-day expulsions of students sixth-grade and older who make threats against other students or staffers. In Texas, police must tell schools of a student arrest within 24 hours - and inform them in writing within seven days. Similar laws have been enacted in California, Virginia and Indiana. "A number of states now say, "Look, we want to make certain school officials are informed when Charlie Manson Jr. is in school,'" Stephens says.
    `Two states, Colorado and Oregon, passed laws that closed the so-called "gun-show loophole" that allowed some firearm sales without a background check - including some weapons used at Columbine. But while those measures passed by wide margins, virtually no gun legislation has made its way through Congress. "I would have expected a lot more would have happened by now," says Michael Barnes, a former U.S. congressman and now president of the Center to Prevent Handgun Violence. "When voters are given the chance to express opinions, as they did in Colorado and Oregon, they do so by very large numbers. But politicians don't seem ready to follow." The more conservative political climate in Washington has prompted gun-control efforts to be redirected to the state level, where the push is on in 20 states to persuade attorneys general to issue gun regulations in the name of product safety.
    Meanwhile, a measure to close the gun-show loophole on a national level will be reintroduced in the U.S. Senate later this month. Last year's effort squeaked through the Senate but stalled in the House. Barnes said Columbine will remain a flashpoint in the debate. "The very word evokes the tragedy of children dying because of our nation's failure to get serious about gun violence," Barnes says. "We lose a Columbine of young people every day in America to gun violence, on average. But when they all fall in one tragic incident like that, it draws attention in a way nothing else can."
    There are more hate-mongering Web sites today than when Columbine's suicidal shooters, Dylan Klebold and Eric Harris, surfed the 'Net -- in fact, some of the newer sites were inspired by Harris and Klebold. But there are also more parents who understand that the Internet is not a babysitter. For all the concerns about downloadable bomb instructions or Satanic music sites or murderous video games, Columbine has instilled equal concern over what computers can't provide. Human contact.
    "No parent can ever say again, "We didn't know,'" says Rabbi Abraham Cooper, associate dean of the Simon Wiesenthal Center in Los Angeles, which monitors Web sites and technology's impact on society. "Dylan and Eric used the digital world to create and control their reality. They had no connection to real life." The center's report on "Digital Hate" was published 19 days before the Columbine massacre, and it wasn't a popular message among those who looked upon the Internet as the ultimate melding of free speech and unfettered distribution.
    After Columbine, things changed. Debate has intensified over just how free Internet communication should be. Filtering software has emerged as a parental tool to shield kids from certain material, and online chat has been taken seriously as a means for communicating threats. "Technology itself is neutral," Cooper says. "People have to figure out a way to empower kids to make good decisions, to draw their own lines."

Growing Number of Older Drug Addicts Spawns Unusual Treatment Center
Elizabeth Lesure, Associated Press- 4/15/2001

NEW YORK -- In his 60s, Ramon Loper spent the last few years of his musical career desperately feeding a heroin addiction. He rushed from gig to gig, getting cash and getting high. ''And then,'' he says, ''I broke my hip. Thank God!'' The members of the group session erupt with laughter. A chorus of ''Thank God!'' rings out. Loper is a client in the ElderCare program at Odyssey House one of the few residential drug treatment programs in the country specifically designed to treat the growing population of older substance abusers. Everyone here understands how a broken hip can be a blessing in breaking the cycle of drug abuse.
    From a well-kept brick building in East Harlem, the 50-bed Odyssey House treats recovering addicts of all ages. But the building's fourth floor is reserved for ElderCare, which accepts only people age 55 and older. These are people who typically feel uncomfortable being candid and confronting their problems in most treatment programs, where participants are usually 18 to 44 years old and sometimes younger. Odyssey staff say the close peer relationships allow older people many of whom have had addictions for decades to finally recover. Residents typically stay in the program for 12 months or more, living in same-sex suites with several other clients. ''You put peers together and you allow them to live together, to support one another, to grow together, to share their stories, their pain, their hopes,'' said Peter Provet, the president of Odyssey House. The publicly funded Odyssey House, founded in 1967, is widely known for a program that allows recovering mothers to live with their children while in treatment. The ElderCare program was founded in 1997, when staffers began to see a small but increasing number of older adults seeking treatment.
    Manuela Bookman, 58, is recovering from a 35-year cocaine addiction. The courts referred her to ElderCare after she was arrested on a drug-dealing charge. ''When I was first offered the program, the first thing that came to my mind was 'I can't deal with all these young kids. They're disrespectful,''' Bookman said. ''They told me, 'No, you're only going to be with people your age, people who can identify with you.' It sounded OK to me.'' Provet said the program started with a few beds grouped together on the fourth floor. Now, there are always several people on a waiting list to get in.
    The number of older adults being treated for substance abuse in the country is small 1.6 percent of the more than one million substance abuse clients in the nation but has grown steadily over the last decade, according to Leah Young, a spokeswoman for the Center for Substance Abuse Treatment, a federal agency. The center reports that in 1991, 8,206 clients over the age of 65 were in substance abuse treatment in the United States. By 1998, the number had nearly doubled to 16,247. Young said older adults are more likely to abuse alcohol or prescription drugs, but a persistent number is addicted to ''hard'' drugs like cocaine or heroin.
    ''The abuse of illicit drugs in the country has been growing, and you would assume that most of these people will stop before they get to that point,'' said Herbert Kleber, director of Columbia University's Center on Addiction and Substance Abuse. ''But as you increase the total number, some will end up staying on (drugs) into their older years.'' Take Bertie Alston, 58. ''Aren't drugs a young person's game?'' an Odyssey House counselor asked. ''Yes, but I started as a young person,'' replied Alston, who has spent 36 years addicted to heroin.
    Although the federal government doesn't track exactly how many treatment centers nationwide are geared specifically for older adults, Young said there are very few. One, the Hanley-Hazelden Center in West Palm Beach, Fla., is a 16-bed facility for mostly alcohol and prescription drug abusers. Carol Colleran, director of older adult services at Hanley-Hazelden, said thousands have gone through its 30-day program, but addiction in older adults remains a largely undiscussed problem. ''People shy away from talking about it,'' Colleran said. ''It's really difficult to put a nice little gray-haired grandma in the same sentence that you're talking about alcoholism or drug abuse.''
    Colleran said treatment for older adults is less confrontational than therapy for younger people, and that older people who did not grow up in what she calls the ''self-help'' era have more trouble talking about their feelings. ''People of this generation were not raised to air their dirty laundry,'' Colleran said. Provet said treatment in the Odyssey House program addresses life-stage questions like ''What have I done in my life?'' and ''What mistakes have I made, and how can I correct those mistakes?'' But the program succeeds, he said, because residents are able share their life experiences and empathize with one another.
    In a late March treatment session, Julius Small, a recovering alcoholic, told the group he had recently celebrated a birthday. ''I made 70 on the second day of this month,'' he says. The room erupts with applause. It is this kind of support, Provet says, that allows older people to recover. ''We firmly believe that these folks that come to us after suffering for many, many years of their lives can make good,'' Provet said. ''We do not want, in any way, to write off our elders.''
    More than 100 people have completed the ElderCare program at Odyssey House since 1997. Before a resident leaves, he or she creates an ''after-care plan'' that includes plans for housing, identifies a support network, and works toward independence and financial stability. When he leaves, Loper said, he would like to counsel other former addicts. Bookman says she will help take care of her grandchildren so her daughter can complete a college degree. ''I finally am able to look at myself in the mirror and see a human being,'' Bookman says, ''instead of what I was looking at before.''

New York State's Anti-Smoking Telephone Service Buzzing
Michael Gormley, Associated Press, 4/15/2001

ALBANY, N.Y.--The number of calls to the state's help line to quit smoking has increased 10 fold since a slick television campaign began, state officials said. ''The whole focus is to get smokers to stop smoking and one of the ways to do that is to provide information,'' state Health Department spokesman John Signor said. He said 8,200 calls were received last month, upping the average to 3,000 calls monthly since the TV campaign began in November.
    From 9 a.m. to 5:30 p.m. Monday through Friday not only are recorded messages available on Quitline, but trained personnel answer questions about smoking cessation programs. Specialists at the toll-free Quitline (1-888-609-6292) operated at the state's Roswell Park Cancer Institute in Buffalo will also return calls for people who leave messages off-hours. ''These skilled professionals are dedicated and committed to ensuring New Yorkers have the knowledge and assistance they need to quit smoking,'' said state Health Commissioner Dr. Antonia Novello.
    Quitline is part of a $60.5 million anti-smoking campaign which is being funded through court settlements with tobacco companies. The state will get half of the $25 billion due to the state, New York City will get nearly 27 percent and counties outside the city will share the rest. It's a big program, at least on paper, critics say. ''Quitline and the TV ads are really just a small piece of what the state is supposed to be doing to curb tobacco use,'' said Blair Horner of the New York Public Interest Research Group. ''The state has received roughly a $1.5 billion form the tobacco settlement and raised another half-billion dollars in the cigarette tax ... the state has spent a ton of money and has done very little.'' Some of the tobacco money is to go to fund the new Family Health Plus medical insurance program for the working poor, which is still awaiting federal approval.  While supporting Quitline, Horner said that even if the current rate of calls continues, only 36,000 people will call not all of whom will quit smoking. He estimated more than 4 million people smoke in the state. As for the Pataki administration campaign, ''I wouldn't even call it a major battle,'' said Horner, who suspects much of the tobacco money was put into reserves or to fund tax cuts. ''It's more like a skirmish.''
    Health Commissioner Novello counters that. ''Our statewide media campaign targeting adults and cessation is paying big dividends for New Yorkers,'' she said. ''Not only are we sending a clear message not to smoke, we are also providing significant information and proven cessation methods.'' That campaign includes TV public service announcements featuring supermodel Christy Turlington talking about how her father died of lung cancer and her own success in quitting; a dramatization of a grandfather who quit for his granddaughter's first birthday; and three spots featuring a man identified as ''Rick,'' whose wife died of lung cancer in her mid 40s. The next TV blitz will battle youth smoking. ''Thanks to this campaign, we're going to see fewer smokers in New York state,'' Signor said. ''We're convinced of that.''
    Jack Burns isn't. As manager of the Smokers Paradise cigarette shop in Troy, Burns said customers don't show angst over quitting. Most don't even want to. ''I think they made their decision,'' he said. He said he never hears a word about the state's anti-smoking efforts. The reductions in cigarette sales touted by state officials is more likely smokers turning to the Internet and other states to avoid New York's high cigarette taxes, he said. ''I think it's a cute commercial, but people don't think about it ... It's a mental thing. If you don't want to quit, it's not going happen,'' said Burns, who quit smoking 17 years ago.
    On the Net: http://www.health.state.ny.us

Study: The Unexpected Lights Up Pleasure Centers in the Brain
By Amy Malick, ABC News- 4/16/2001

BOSTON--Apparently the brain's pleasure centers are more "turned on" when we experience unpredictable pleasant things, compared to expected pleasant events, according to new pictures of the brain responding to surprises. Emory University and Baylor College of Medicine researchers used Magnetic Resonance Imaging brain scans to measure changes in human brain activity in response to a sequence of pleasurable stimuli. They used a computer-controlled device to squirt fruit juice or water into the mouths of 25 research participants. The patterns of the squirting were either predictable or unpredictable.
    The researchers found that the MRI scans showed a brain area called the nucleus accumbens to be much more active when the subjects received unpredictable patterns of juice and water. The findings are published in the April 15 issue of the Journal of Neuroscience. The nucleus accumbens is one of the 'pleasure centers' in the brain, areas that are excited when we experience rewarding stimuli. Previous studies have shown this center is very active when people take addictive drugs such as cocaine and heroin, and when they anticipate receiving money.
    The scientists found the amount of activity within the nucleus accumbens was not related to the subject's personal preferences for either juice or water. "This means that the brain finds unexpected pleasure more rewarding that expected ones, and it may have little to do with what people say they like," said Dr. Gregory Berns, assistant professor of biomedical engineering at Emory and Dr. Read Montague, associate professor of neuroscience at Baylor, the authors of the study.
    So, we may subconsciously desire the unpredictable experience over the experience that we consciously believe we prefer. In the future, scientists will be looking to uncover how anticipation and environmental cues may come into play in determining how "predictable" a stimulus is. What about those people who seem to hate surprises? Do their pleasure centers also light up when faced with the unexpected pleasant stimulus? "Well, we don't have the answer to that yet," said Berns, "but we did clearly see our study subjects had a wide range of activation in their nucleus accumbens" which may be reflective of their personalities.

Animal Anesthetic Latest Craze Among Drug Users
Associated Press, 4/16/2001

GRAND RAPIDS, Mich. -- An animal anesthetic most commonly used by veterinarians to tranquilize cats is one of the trendiest drugs now found at dance clubs and rave parties, narcotics officers say. Possession of the drug Ketamine is a felony punishable by up to five years in prison. The long-term effects on humans of the drug, variously known by the street names "K," "Special K" and "Cat Valium," are unknown but overdoses can be fatal. Western Michigan authorities have linked dozens of reported veterinary hospital break-ins during the past year to young people trying to steal the drug for a quick high or a hefty profit on the street. "It's kind of a new fad," said Kent County Sheriff's Detective Jeff McAlary, who is investigating several recent break-ins.
    It is what Andrew Charles Avery was looking for when authorities say he recently broke into two Kent County veterinary clinics. The 19-year-old Cedar Springs man is lodged at the Kent County Jail, charged with breaking and entering. He faces up to 10 years in prison if convicted. Avery also is accused of stealing Ketamine from animal hospitals in Montcalm and Benzie counties. Detectives believe he is part of a group of about 10 young people who have broken into clinics from Barry County to Traverse City in the past four months. Many of those thefts remain under investigation. More arrests are likely, police said.
    Selling Ketamine illegally can be lucrative. The small bottles that veterinarians buy for about $10 sell on the street for about $80, police told The Grand Rapids Press for a story Monday. If the drug is injected, each bottle contains enough for three to five hits. The liquid also can be baked, crystallizing it into a white powder that can be snorted, and sells for $150 a gram. A chemical cousin to PCP, Ketamine hooks its human users with a quick and hazy high. Users report feeling pleasantly disassociated from their bodies for 30 to 60 minutes. But when they "come down," depression can set in quickly until they get their next fix.
    Because users often cannot remember their actions while they were high, Ketamine has been grouped with "date-rape" drugs such as GHB and Rohypnol, or "roofies." Dr. Bernard Eisenga, medical director for the DeVos Children's Hospital Regional Poison Center, said Ketamine is nothing with which to play. "It's probably more of a problem with these kids if they use it chronically," Eisenga said, adding he does not know what long-term effects the drug could have on the human brain.
    Ketamine was developed in 1965 by the University of Michigan as a general anesthetic for humans and animals. It was widely used to treat the wounded during the Vietnam War. Many doctors later began phasing out its use after patients reported hallucinations. It now is used sparingly on humans in this country, although widely used on small animals. That turned veterinary hospitals into targets when Ketamine abuse found a foothold in West Michigan about 18 months ago. In the past year, more than a dozen clinics in Kent County have reported break-ins, including sites in Kentwood, Wyoming, Walker and Sparta. In Ottawa County, hospitals in Hudsonville, Georgetown Township, Grand Haven and Holland have been hit. Allegan County saw a twist to the trend last year. Three people were arrested on felony drug charges for ordering Ketamine over the Internet from a supplier in China.

GlaxoSmithKline Gets Paxil Expanded Label
Reuters News Service, 4/16/2001

NEW YORK -- British drug maker GlaxoSmithKline, PLC said on Monday it received U.S. regulatory clearance to market its top-selling antidepressant Paxil as a treatment for generalized anxiety disorder. GlaxoSmithKline said generalized anxiety disorder affects more than 10 million Americans and is characterized by excessive anxiety and worrying about a number of events or activities. The U.S. Food and Drug Administration granted the expanded label. The company said two studies with a total of 897 patients showed that Paxil reduced anxiety symptoms by nearly 60 percent. Paxil has been sold for nearly 10 years for depression and a number of anxiety disorders, including obsessive compulsive disorder, panic disorder and social anxiety disorder. Sales of the drug under the brand names Paxil and Seroxat were about $2.4 billion in 2000, according to health data firm IMS Health Inc.

Treatment Revolution
Larry Tye, Boston Globe, 4/17/2001

When Kevin Rooney checked into a psychiatric ward for the first time, he got the best medication available - ''truth serum'' to make him confess the real reasons for his breakdown. He also got the most modern therapy known to his doctors - six strapping orderlies who stuck a rubber bit in his mouth so he wouldn't swallow his tongue, then shocked him with so much voltage that he was nearly thrown from the table. That was half a century ago, when mental hospitals were known as loony bins, patients like Rooney checked in but often didn't check out, and the number of people in state-run asylums in Massachusetts reached its all-time peak of more than 23,000.
    Today, seven of the 11 state hospitals from 1950 have closed, their buildings boarded up, converted or leveled altogether. Had the number of asylum patients kept pace with the state population, there would be more than 32,000 now. Instead, there are slightly more than 1,000, the majority of whom will spend less than a year in an institution.  The story of that change represents one of the most inspiring medical breakthroughs of the last 50 years. Today most mental patients are living in the community, functioning substantially better than people did in the asylum. The shift has been possible partly because doctors began to recognize that conditions such as schizophrenia and depression have a biological basis and can be treated with drugs. Even more, it has been possible because of a change in attitude about mental illness: With one in five adult Americans suffering a major mental illness, it has become clear that the community, rather than the nuthouse of old, is the best place for them to get better. ''This is nothing short of a transformation,'' said Danna Mauch, who has followed the changes during more than 30 years working in private and public mental health systems in New England. ''Most are clearly better off; there are few who dispute that.''
    That is not the tale advocates typically tell of mental health in Massachusetts or the nation, as they hammer the system's manifest shortcomings. Thousands are waiting for group homes and other residential services, which generate backups everywhere from psychiatric hospitals to homeless shelters. And too many former mental patients still wander the streets from the South End to Springfield, convinced they are Jesus Christ or Madame Curie. But such shortfalls notwithstanding, the progress made in treating mental illness has been revolutionary. More than 75 interviews by the Globe in recent weeks - with health professionals and patients, in hospitals, at group homes and on the street - suggest that the mental health system finally has found a series of solutions, even if it lacks the cash to fully implement them.
    Nowhere has the revolution proceeded further, faster, than in New England. Governors may have had money in mind when they shuttered mental asylums, but a network of quarter- and halfway houses, overnight shelters and daytime clubhouses has quietly been erected in neighborhoods across the region to replace them. And insurers may still treat mental maladies as less important than physiological ones, but a law that took effect in Massachusetts on Jan. 1 aims to close the gap. ''In the past, the gaps in our system have been more qualitative. The right medicine, treatments, and community health programs simply were not there. Now we have those things,'' says Philip Mangano, head of the Massachusetts Housing and Shelter Alliance, an umbrella group representing 200 programs. ''The gap now is quantitative, with not enough of those good things out there.''
    Kevin Rooney has experienced firsthand the uneven but inexorable march towards answers, enduring four stays in private and public psychiatric wards, 40 sessions of shock therapy and endless trials and errors with often unforgiving drugs. Today, he is what he terms a ''success story'' - living on his own in Natick, getting counseling, participating in group programs and taking medicine to control his manic-depressive illness. ''There are new drugs all the time, more therapy groups are formed all the time,'' he said. ''Mental illness is accepted more today as an illness rather than a crazy person who should be kept upstairs in the attic.''

Back to the snake pit
To understand that transformation, it helps to revisit the 1950s, when the attic and asylum formed the core of the mental health system. The reasons people checked in to state psychiatric hospitals back then, or were committed, varied wildly. Some were clearly psychotic and needed institutional care. Others were addicted to drugs or drink, were inordinately promiscuous or displayed other behavior that relatives or the community saw as antisocial. Most didn't have much money, and after World War II there was an influx of shell-shocked veterans. Those asylums often had their own chickens and cows, vegetable gardens and everything else needed to survive. A sentimentalist might see them as self-sustaining communities where residents worked as they healed. But critics came to see them as ''snake pits'' designed to segregate patients from society. The good news was that the hospitals offered anyone who needed it food, shelter and treatment; the bad was that much of their day was spent rocking in front of a TV, with depressingly little treatment or hope of getting out soon.
    Things started to change in the 1950s. Massachusetts, which in 1662 had opened America's first almshouse and in 1833 built the first state-run asylum, began moving away from the model of the public mental hospital. The discovery of psychotropic drugs such as Thorazine had reduced or eliminated the wildest delusions associated with schizophrenia and other disorders. There also was an evolving alliance between fiscal conservatives worried about the expense of asylums and civil libertarians concerned that they restricted patients too much and helped too little.
    The notion that people would be better off in the community than in a big institution wasn't new: In the early 1800s, enlightened caretakers talked of reintegrating patients into the community. Not until the 1950s, however, was such talk widely acted on, causing the population at state hospitals to drop from 23,560 in 1953 to less than 20,000 by 1960. It continued to fall through the 1960s and 1970s, reaching 2,676 by 1980.
    One problem loomed, however. Although Bay State governors were eager to close the asylums, they hadn't figured out where the former residents would go. Some seemingly didn't care. Others thought the new medications would let people go back home or that other treatment and housing alternatives would evolve. The result was that many former mental patients ended up on the streets, homeless and without medicine to fend off their demons. For Bostonians, grungy panhandlers waiting outside the Park Street T station became the face of mental illness.
    ''We all felt that getting people out of the hospital was a wonderful idea, but we thought it could never work unless there were appropriate places for them to live,'' said Dr. Bruce Cohen, president of the not-for-profit McLean Hospital in Belmont, which has mirrored changes in the state-run system by substantially trimming inpatient services and expanding outpatient and residential ones. ''We felt frustrated that the appropriate places for them to live weren't implemented at the same time.''

Dinner at a group home
Luckily the story does not end there, although few have followed its twists and turns since. State officials have spent the last 20 years filling in the gaps for the thousands of mental patients who would otherwise have been in state asylums. Any attempt to understand where they went has to start in group homes, the cornerstone of community-based mental health.
    In the old days, a halfway house was just what it sounds like, a stopover between the hospital and community, and it came in just one flavor. Today there is a potpourri of approaches, from urban settings like South Boston to outlying ones like Winchendon. Residents stay a year or less in some, permanently at a few others. Some are staffed around the clock; in others, residents work during the day and cook, clean and otherwise care for themselves at home, with counselors coming mainly in emergencies. Many have special restrictions, accepting only men or women, or limited to Asians, Latinos, people who were homeless, or those with drug and alcohol addictions. In 1950, there were no mental patients in group homes or comparable settings in Massachusetts. Today there are 6,237.
    A late afternoon visit to a group home in Jamaica Plain finds some residents helping cook dinner, one playing the piano, while others sit and talk about their day. After years of going in and out of mental hospitals, Delois Howell said she cherishes the support and freedom of her current home. Still, she explained, ''big Satan'' still haunts her every so often, ''and I have to go upstairs and lay down then.'' The goal these days is for as many of the mentally ill as possible to live on their own - and 3,502 already are, in some sort of subsidized housing, with case managers checking in on them.
    Anthony Ferrara is one of them. He started hearing voices when he was 13, telling him to steal a car, and he wielded a screwdriver against a policeman who stopped him. That landed him in a juvenile psych ward, then an adult one. ''I'd sit there like a zombie all day. All I wanted was to go to bed and sleep,'' Ferrara, now 37, recalls. ''In the hospital, when it was time to eat, a buzzer rang. When it was time to sleep, a buzzer rang. When it was time to shower, they told you.'' Ferrara now makes those decisions on his own in his apartment in Dorchester, where he is considered a poster child for today's community-centered mental health system. He graduated from a highly structured group home to one where he had more responsibility, then to independent living. He also graduated from the old generation of anti-psychotic drugs like Haldol to newer ones like Zyprexa that keep him more alert. On the older drugs, ''I had no sense of direction or time. I lost a lot of years,'' he said. ''Now I'm aware, my illness is stabilized, I function like an average person.''
    Not everyone is lucky enough to make it to a group home or out on their own, or to last there if they do. Those who can afford it can get private treatment and accommodations. For the rest, there are other options. One is to check into a full-service facility such as Cambridge Hospital, which has its own state-of-the-art psychiatric emergency room and more than 100 psychiatric beds. Insurers generally allow patients to remain only about two weeks, hoping whatever crisis they experienced stabilizes and they can return to outpatient treatment, or that they can find a bed at a state mental hospital for longer-term care. There are 2,360 beds available in private psychiatric hospitals in Massachusetts today, about twice what there were 25 years ago.
    The state also still runs four of its own mental hospitals, along with inpatient units at five mental health centers and two public health hospitals. While some are at the same sites, those facilities don't have much in common with the asylums of the 1950s. It's not just that they are smaller. There also are fewer locked wards, less use of restraints and more freedom to roam the campus. Some people now stay as little as 90 days, most are out after several years and nearly all are getting medication, group counseling and job training.
    ''I wasn't getting out of bed before I came here. I was sleeping all day,'' said Kerry Larke, a 26-year-old from Marshfield who arrived at Westborough State Hospital in July with a diagnosis of bipolar depression and now is ready to move to a community residence. In the hospital, she said, ''they force us out of the house, but that's good for me. What has helped is partly the medicine, it's partly the support I get from a staff who are interested in my life, it's partly having peers who care about me.''
    State hospitals today are part of a continuum - a place for people who at least temporarily require intensive supervision, but who are being prepared to make their way to group homes or back with their families. To make that point, hospitals feature ''quarter-way houses'' - group homes on the grounds that ready residents like Larke for similar settings outside.
    What about the other tens of thousands who left the asylums of the 1950s, or who would have been there if they had been living then? Some 7,000 of them live on their own, or with family or friends, but get support from state programs. Clubhouses like Center Club near North Station offer meals and job training, a place to spend the day and a way to help in the kitchen or on the computer. There are crisis-response units at places like Cambridge Hospital that bring help directly to people's homes. Outpatient clinics and day hospitals, social clubs and an array of other programs, meanwhile, try to fill perpetually forming fractures in the system.
    Marie Duggan, who has been getting care for 50 years, said it's not even a close call comparing her group home in South Boston with the mental hospitals she used to be in. ''The hospital made me worse,'' said Duggan, who is 62 and still sees specters that speak in comic striplike blocks of copy. ''Here I can go shopping, and for coffee, and to Brigham's for a sandwich. I'd much rather be here.''

The mentally ill in jail
That does not mean there are no gaps remaining in the safety net. There are. Big ones. The most visible are on the streets, where statewide there are an estimated 2,000 homeless people with severe and persistent mental illness. Some go in to shelters such as the Pine Street Inn, but many are too sick - or too distrustful - to accept a bed and a meal. One stop on a recent night by the Boston-based Health Care for the Homeless suggests the problem's dimensions: Workers offer clothing, food and basic treatment to an elderly black woman named Stella lying on a bench in South Station. But she insists she doesn't need it because she is an heir to the Rockefeller fortune. Prisons are another place the mentally ill turn up in disproportionate numbers. One study suggests that at least 1,600 inmates at state and county facilities suffer from major depression, bipolar disorder or schizophrenia, while others suggest there could be many more.
    The Department of Mental Health compiles its own lists of those it wants to help, but can't right now. They show 13,385 adults waiting for a case manager to review their problems, 229 needing help with a job, and more than 3,000 waiting for group homes or somewhere else to live. Some on the residential waiting list are homeless. Others are in hospitals or other highly supervised settings, ready to leave but without a home to go to, which creates a backup for those waiting to be admitted to a state hospital, private psychiatric facility and at every other tier of this intertwined network.
    The lists may be faceless, but they include Kristen Hall, a 26-year-old from Wilmington with blue eyes and freckles. She checked into Westborough State 27 months ago after trying to kill herself while suffering from depression that she said was ''like imagining the worst feeling you can ever have, then multiplying that by a million.'' In many ways, Hall embodies all the uplifting changes in mental health: The hospital helped stabilize her depression with drugs, relieved her substance abuse with therapy, got her used to working again by baking at the on-site Classic Cafe and prepared her for independent living. Little of this was conceivable, despite good intentions, 50 years ago. But Hall was ready to leave nine months ago, and there are no openings for her at either a group home or a government-subsidized apartment. The state has allocated incrementally more money every year to help with housing, but it is not enough to keep pace with the increased need and eliminate the backlog. Hall doesn't follow the budget debates, but she can tell you precisely how long she has been ready to go and what it feels like having to stay. ''It's very frustrating,'' she said as she finished lunch in the recreation room. ''This is a good place to be if you need help, but it's not a way of life to be living here.''

Illinois Bill Aims to Move Mental Patients
Joe Biesk, Chicago Tribune- 4/17/2001

SPRINGFIELD -- With an eye on saving the state millions of dollars a year, Illinois lawmakers are pushing legislation to bring the state in line with a U.S. Supreme Court ruling designed to give mentally ill patients and substance abusers better care. In a bipartisan effort, state Rep. Lou Lang (D-Skokie) and Sen. Tom Walsh (R-La Grange Park) have crafted legislation aimed at moving 250 patients into small residential settings and out of nursing homes and state mental institutions. The goal is to expand the program, called "Choices," over four years to help 1,000 patients.
    But opponents in the nursing home industry maintain the legislation should be defeated because instead of saving money the state would actually lose it. At issue is the 1999 Olmstead decision in a case out of Georgia in which the high court ruled that states should, whenever possible, place people with mental illnesses or disabilities into community settings, such as supervised apartments or group homes. In essence, the ruling means that Illinois and other states should offer mentally ill patients and substance abusers the same type of state-funded care reserved for people with developmental disabilities. The case arose when lawyers for two mentally retarded women sued Georgia, charging the state violated the Americans with Disabilities Act and should have provided treatment for them in a community setting rather than confining them to a state institution. Georgia Human Resources Commissioner Tommy Olmstead argued the state could not afford additional community settings.
    In Illinois, Gov. George Ryan's administration has opposed the Lang-Walsh legislation and backed a bill calling only for further study of the issue. Lang contends such a response is inadequate. "These are real people, suffering real problems, and ignoring it doesn't make it go away," charged Lang, who heads the House Mental Health & Patient Abuse Committee.
    Linda Renee Baker, secretary of the Department of Human Services, said the Olmstead decision leaves states with a variety of choices in how to deal with the mentally ill, developmentally disabled and substance abusers. In the 1970s, the state started emptying large institutions and hospitals for mentally ill patients by placing them in Medicaid-funded nursing homes. But the federal government ruled in 1981 that Medicaid would no longer pay for nursing homes where 50 percent or more of the beds were filled with psychiatric patients.
    The House this month passed the Lang-Walsh bill on a 115-0 vote, but the nursing home industry is hoping to stop it in the Senate by arguing that it would increase state costs. "This bill will cost potentially a lot of money. It will be in the millions," said Terry Sullivan, executive director of the Illinois Council on Long Term Care. But Frank Anselmo, chief executive officer for the Community Behavioral Healthcare Association, said the plan could save the state at least $3.3 million in its first full year.
    The state now spends roughly $7.5 million a year on nursing homes for the same number of mentally ill patients the proposed program would take in its first year. Under the proposal, the state's share would be only $4.2 million, and federal Medicaid reimbursements and Social Security would cover $4 million. Once the program expands to 1,000 people, the state would pay about $16 million a year, compared with the $30 million it spends now, Anselmo said. He estimated nearly 12,500 people in Illinois nursing homes are diagnosed with mental illnesses and eventually could be evaluated for Choices, meaning the program has the potential to grow several times over. Ideally, he said, the program could grow to about 2,500 over 10 to 12 years and, over that period, potentially could save the state more than $100 million.

'Rebirthing' Therapist Had to 'Get Tough'
Kieran Nicholson, Denver Post- 4/17/2001

GOLDEN - A stoic Connell Watkins testified Monday that she was determined to break 10-year-old Candace Newmaker of manipulative ways and make the girl compliant. Watkins said, "I thought we needed to be tough if she was going to come through." Watkins and fellow therapist Julie Ponder are on trial, charged with child abuse resulting in death, after Candace died last April during a "rebirthing" session gone awry at Watkins' Evergreen office.  Candace had been brought to Colorado by her adoptive mother, Jeane Newmaker, to be treated for an attachment disorder. Watkins and Ponder discovered Candace unconscious and not breathing after she had been wrapped in a sheet for approximately 70 minutes as part of her therapy. During the trial, now in its third week, jurors have watched videotaped sessions conducted by Watkins, Ponder and others.
    Watkins testified for about four hours Monday. At times, defense attorney Craig Truman recounted several portions of taped therapies, asking Watkins to explain certain situations. He asked why she told Candace, "Your mom is too worn out to go home with you. Got it!" Watkins answered, "Because it was true." He then asked Watkins to explain why she sometimes tagged the phrase, "Got it!" to the end of questions. Watkins said it was a technique used to gauge whether Candace was being "cooperative" or "resistive."
    While on the stand, Watkins showed little, if any, emotion. She did not cry as she recalled the fourth-grader from Durham, N.C. During one session, Watkins told Candace, "You act pretty stupid." Watkins said the comment was "in reference to something she was doing." "She was a bright kid acting stupid." At another point, Watkins said to Candace, "You're a liar and you lie all the time." Watkins said she based the statement, in part, on what Jeane Newmaker had said about Candace and on reports by North Carolina therapists. "I wanted to be right in her face about it," Watkins said. "I (wasn't) worried about her self-esteem because she already thought she was fine."
    Watkins described Newmaker as an "amazing" mother who did everything in her power to satisfy an unappreciative child. Candace was uncooperative every morning when Newmaker took her to school and acted out by stealing and lying, among other inappropriate behaviors, Watkins said. "She was certainly mean to her mother," Watkins said. Watkins said Candace's non-compliance extended to her therapy sessions here. "She kind of just goes through the motions," she said. "She was just being Candace." Truman asked why Watkins had called Candace a "twerp."  Watkins said that it was a term of "endearment" that she uses for her own grandson. She said it was part of the overall design to let Candace know who was in charge. "Honey, you are the kid and I'm the adult and things are going to go my way."

Los Angeles County Braces for Impact of Drug Law
Matt Lait, Los Angeles Times- 4/17/2001

As Los Angeles County officials prepare for the July 1 implementation of a new law that dramatically changes the way drug offenders are treated by the courts, two matters have become abundantly clear: They need more time and they need more money. "It's a monumental undertaking," said Los Angeles County Public Defender Michael P. Judge, who serves on local and statewide planning groups gearing up for the changes required under Proposition 36, which was passed by voters in November. "Even after the deadline, it's going to be a work in progress. It could take years before all the issues are eventually settled."
    Proposition 36, which 61% of voters favored, would shift many drug offenders--including those convicted of possessing, using or transporting drugs for personal use--from prisons to probation and treatment programs. The reorientation could be profound because one in three of the state's 162,000 prisoners is serving time for a drug-related crime. For the last five months, county officials throughout the state have scrambled to figure out how to identify, monitor and treat the tens of thousands of drug offenders who will qualify for services under the new law.
    Nearly every part of the criminal justice system will be affected by the proposition's demands. Eventually, 30 existing Los Angeles County judges will be trained and designated to handle Proposition 36 drug offender cases. Probation officers, who monitor about 65,000 probationers in the county, are preparing to absorb up to 14,000 additional cases. In the county, officials estimate that the courts will divert up to 20,000 additional drug offenders each year into treatment programs. One of the biggest problems bedeviling county officials is finding enough qualified drug treatment providers to meet the expected need. County officials say they are trying to certify new providers, while asking the existing 300 providers to expand their reach.
    Another challenge, they say, is making do with the limited funding that is supposed to cover the costs of implementing Proposition 36. Under a statewide allocation formula, Los Angeles is receiving $15.7 million of the $60 million in start-up funds to create the infrastructure needed to administer the new law's provisions. In July, the county is expected to get about $31 million of the state's $120 million in annual operating funds for the measure.
To county officials, that's not enough. Judge, the county public defender, said the county will receive about 26% of the money, but accounts for nearly 40% of the drug offenders who are in state prison. A contingent of county officials is negotiating with state representatives to get a larger share of the money. "It's clear to us that Los Angeles did not get a proportionate share of the funds," Judge said.
    Another potential financial problem is the new law's restriction against using any Proposition 36 money on drug testing for offenders enrolled in treatment programs. By most accounts, drug testing plays a vital role in treatment programs because it identifies addicts who relapse while providing positive reinforcement for those who remain sober. "We believe testing is critical to a successful treatment program," said Los Angeles County Superior Court Judge Michael A. Tynan, who serves on a local task force grappling with the ramifications of the new law.
    Tynan said judges, probation officials and treatment counselors feel so strongly about the need for drug testing that they are drafting state legislation that would augment the Proposition 36 funds with money for such testing.
Drug testing is a key component of the county's current "Drug Court" treatment program, which Tynan said will serve as the model for Los Angeles' compliance with the new law. Under the Drug Court program, defendants are closely monitored by Superior Court judges and commissioners to ensure that they stick with their treatment. More than 70% of the defendants who successfully graduate from the Drug Court program remain sober years after their treatment, officials said.
    During one recent Drug Court graduation, the defendants who completed the treatment course spoke of their gratitude for being given an option other than incarceration. "It saved my life," said Luis Ruiz, a 32-year-old construction worker. "In fact, before [Drug Court] I wasn't really living, I had no life. I was just existing one day to the next." Ruiz and the 20 other graduates of the East Los Angeles Drug Court program had been addicted to drugs for a total of 277 years. Over that time, they said, they crushed hundreds of relationships, wasted thousands of dollars and ruined untold dreams.
    In theory, Proposition 36 would give thousands of other drug defendants a similar opportunity to turn their lives around. Whether they will actually get it is something judges, attorneys, health officials and many others are waiting to see. "It's definitely a different approach to the war on drugs," Tynan said. "This is going to be a challenge; we're dealing with a lot of unknowns and a lot of uncertainties."
    One question for Los Angeles County is whether the relatively small Drug Court model will be as successful on a larger scale, given the complications judges, probation officers and other court officials. "You never feel like you're fully prepared," said David Davies, a spokesman for the county probation office. "The county started early on this. We've had amazing cooperation in the process so far. We've put together a plan that on the surface is doable. We'll see if it works."
    As for prosecutors and defense attorneys, there are myriad issues that they expect will have to be resolved by the courts in the months or years ahead. Those matters stem largely from different interpretations of the language of Proposition 36, which is vague on such issues as what constitutes a "drug-related" probation violation and at what point a troublesome defendant is removed from a treatment program and sent to jail. A plan outlining how the proposition will be implemented is expected to go to the county Board of Supervisors within a month. To keep the public informed of the ongoing plans, the Los Angeles County Department of Health Services has posted updates of the county's progress on its Web site: http://www.lapublichealth.org.

St. John's Wort Ineffective, Large Study Finds
Shankar Vedantam, Washington Post- 4/18/2001

St. John's wort, the popular herbal remedy, is useless for alleviating severe depression, according to the first large study to evaluate it in the United States. The study, which tested the herb for eight weeks among 200 patients whose depression made it hard for them to get out of bed in the morning or look after their children, found the supplement was no better than a placebo. The research casts doubt on the effectiveness of St. John's wort, which has been marketed as a safe and effective alternative to prescription antidepressants. About 30 previous studies found the herbal supplement effective for depression, mostly in mild to moderate cases.
    Richard Shelton, the lead author of the new research, said the fact that none of the previous studies had produced negative findings suggested that the work may have been poorly designed or suffered from the bias of scientists eager to prove a pet hypothesis. "It could indicate that St. John's wort is the most effective treatment that has ever been discovered, or people have not published negative studies, or third, that there is something wrong with the data," said Shelton, a psychiatrist at Vanderbilt University in Nashville. "I don't want to accuse investigators of cheating, but there may have been systematic errors."
    Far from settling what has long been a matter of dispute, the new study is likely to spur greater controversy between practitioners of mainstream and alternative medicine. As more Americans try alternative remedies, scientists are struggling to evaluate natural and herbal cures with the rigor and rules of conventional medicine. This controversy is part of that endeavor. Supporters of herbal medicines pointed out that Shelton's study examined only patients with serious depression -- it did not address the effectiveness of the herb against milder depression. Shelton agreed.
    One of the authors of a study that last year found St. John's wort useful suggested that far from proving the herb useless, an unintentional bias against it may have tipped the new study against the supplement. "You have a host of literature on the other side that you cannot dismiss," said Ronald Brenner, chairman of psychiatry at St. John's Episcopal Hospital in New York City and professor of clinical psychiatry at State University of New York downstate in Brooklyn, who found St. John's wort useful in treating mild to moderate depression. "There is no study that is unflawed. If there are flaws in the other studies, there are flaws here, too."
    Brenner's study, which was one of just a few studies of St. John's wort conducted in the United States, lasted six weeks and tested the herb among 30 patients. He found it was as effective as the conventional antidepressant Zoloft. Shelton's study tested St. John's wort against placebo pills. Brenner and other St. John's wort supporters said that in most depression studies, 30 percent to 40 percent of patients report getting better while taking inert pills. There was a lower response rate in Shelton's study, which could mean that researchers subtly communicated to patients that neither the herb nor the placebo would work, or that the particular group of patients studied would not have responded to any treatment, they said. "It's possible that everyone happened to be people who wouldn't have responded to any treatment," Shelton said. But "that's unlikely."
     In interviews, Shelton and Brenner agreed that one potential problem with both of their studies was that neither had three groups of patients -- one taking St. John's wort, one taking a standard antidepressant and one on a placebo.   Both said they would regard as definitive a study that is nearing completion. Jointly sponsored by the National Institute of Mental Health and the National Center for Complementary and Alternative Medicine, it will be the largest and most comprehensive study of St. John's wort. The study will evaluate the herbal supplement in treating major depression.
    The latest study, which was published in today's Journal of the American Medical Association, was supported by a grant from the pharmaceutical company Pfizer Inc., which makes Zoloft as well as St. John's wort extract. The American Psychiatric Association called the work rigorous and sophisticated. "What this shows is if you have got a major depression and have got it for some time, it is not a good idea to rely on this herb," said Lloyd Sederer, director of the association's division of clinical services. The effectiveness of the supplement against milder depression was still open, he said, although the new study raised questions about that, too. As for patients using St. John's wort, Sederer said, "If you are feeling better and you are not having side effects, that's a good thing. But I would be sure to tell your doctor about it so that your doctor knows what other active chemical you are taking and your doctor understands this is a disorder you are suffering from."
    It is not clear how the scientific tussle will affect consumption of St. John's wort. Sales of the herb are on the decline -- down from $310 million in 1998 to $195 million last year, according to Grant Ferrier, editor of the Nutrition Business Journal in San Diego. Mark Blumenthal, founder of the American Botanical Council, a nonprofit group that aims to educate people about medicinal herbs, speculated that the reduced sales were caused by recent reports of problems with herbal supplements and findings that St. John's wort could interfere with AIDS medicines, cardiac drugs and oral contraceptives.

Therapist Says Girl Was Never in Danger
Kieran Nicholson, Denver Post- 4/18/2001

GOLDEN - Candace Newmaker had plenty of air to breathe during her rebirthing session last April, therapist Connell Watkins testified Tuesday. The 10-year-old was never in harm's way, she said. "It could look to the superficial observer of the tape that she couldn't breathe," said Watkins. But "I knew she could." And toward the end of the session, Watkins said, she believed Candace was sleeping. Candace suffocated during the 70-minute "rebirthing" session in Watkins' Evergreen office. "She was so relaxed," Watkins said. "She was breathing but not moving around."
    Watkins testified Tuesday in Jefferson County District Court, where she and therapist Julie Ponder are standing trial on charges of child abuse resulting in death. The trial is in its third week. In eight hours of testimony Tuesday, Watkins showed no remorse. On Tuesday, parts of the videotaped "rebirthing" session were shown to jurors for a second time.  At a late point in the therapy session, Watkins motions to Ponder to check on the girl. Describing the tape, Watkins said she didn't want Candace to hear that they were checking on her. "We don't want her to know we are worrying about her breathing," she testified. "She (Candace) is going to manipulate it." During parts of her testimony on Monday and Tuesday, Watkins alternated between past and present tense when taking about Candace. Watkins told the jury that Ponder found everything to be OK. "She (Candace) didn't get much sleep last night so maybe she is taking a nap," Watkins told the jury. "Maybe she decided to wait it out by taking a nap."
    As part of the rebirthing, Candace was wrapped in a cotton sheet from head to toe, lying in fetal position. She was surrounded by pillows, with four adults leaning into them. Candace was told to work her way out of the sheet in order to be reborn to Jeane Newmaker, her adoptive mother. Candace was undergoing therapy in Evergreen in part because she wasn't bonding with her mother, said Watkins.
    On Tuesday, the tape was stopped several times and Watkins' defense attorney, Craig Truman, asked her questions about how the session unfolded. Before Candace was wrapped in the sheet, Watkins, using a pointer as Truman started and stopped the tape, showed the jury that the girl yawned eight times while receiving instructions on the rebirthing session. She also pointed out "air pockets" along the seam of the sheet.
    Once the session starts, Candace screams to be let out. She repeatedly tells the therapists that she can't breathe; that she has "pooped" and wet herself; and that she is going to die. "She is just saying that to get out of the exercise," said Watkins. "I think she wanted us to think she was dying." Watkins said she knew Candace hadn't soiled her pants because she couldn't smell it. "I'm not at all real worried about what is going on here," said Watkins, illustrating the tape. "I look relaxed. This is no problem."
    About 30 minutes into the session, Candace stops crying out for air and pleading to be released. She is whimpering and occasionally gasping. The therapists and two associates, Brita St. Clair and Jack McDaniel, reposition themselves over the pillows. Ponder wrenches the top of the sheet tighter and asks for another pillow to be put on the pile. "She was having a hard time maintaining position and holding the sheet," said Watkins. "Holding the sheet gets way tiring." They encourage Candace to move forward and she says, "No." "She says very clear - "No' - which tells us she is fine," said Watkins. "We had no reason right then to be concerned."
    Watkins said Tuesday that experience in about five previous "rebirthing" sessions led her to believe that Candace was getting enough air. "I knew there was oxygen from the wraps before. I knew if she was willing to get out she could," said Watkins. "I knew she could pop right out of there and she decided not to." Later still, Watkins says she knows Candace is fine because she can hear her breathing. Classical music plays in the background. Watkins tells St. Clair and McDaniel to take a break and the pair leaves. Watkins helps Ponder push Candace across the floor to reposition the girl. She feels Candace's leg and comments on it, but the girl doesn't reply.
    Ponder and Watkins lean into the pillows and engage in chit-chat, in part about homes in the Evergreen area. It's about an hour into the taped session. The idle talk was to "give Candace the appearance that we are not worried when she is going to come out," said Watkins. For about 20 minutes, Watkins still believed the girl was sleeping, she said. A short time later, the pair unwrapped her. They found Candace unconscious and not breathing. Watkins' testimony continues today.

Maryland Mental Hospital Loses Bid to Live
Jo Becker & Dana Hedgpeth, Washington Post- 4/18/2001

A last-ditch attempt to save one of the area's oldest private mental hospitals failed yesterday when the Montgomery County Council narrowly voted against a $3 million bailout designed to keep Chestnut Lodge from closing its doors.  CPC Health Inc., which filed for bankruptcy in October after accumulating $11 million in debt, runs the 132-bed mental hospital. The company's assets are to be auctioned off Monday. The psychiatric hospital is nationally recognized for inpatient, outpatient and assisted-living programs that have served about 3,000 patients a year. The Lodge, as it is called by patients, sits on a lush, 20-acre tract about a mile from the Rockville Metro station and is known for allowing patients longer stays than most. It is set to close April 27.
    Council President Blair G. Ewing's $3 million grant proposal would have helped Kalyna Bullard, a lawyer who once worked for Chestnut Lodge and is married to the hospital founder's great-grandson. Bullard had bid $6.2 million to run CPC's hospital, assisted-living and residential treatment programs and its school for adolescents. But last week, one of her financial backers, Mickey Simmons, a former Lodge patient who runs a metals recycling business in Utah, backed out of his $2.2 million donation. Bullard said yesterday that Simmons cited the lack of local and state financial support and that he called official apathy the "kiss of death" for the 91-year-old hospital.
    State lawmakers approved a budget last week that included $30 million to address mounting problems with the state's faltering mental health system. But Gov. Parris N. Glendening (D) denied a request for emergency funding for Chestnut Lodge. His spokesman said that the state was committed to helping relocate patients but that Glendening viewed any effort to spend more money on the bankrupt facility as futile. Bullard's was the only one of 12 bids that would have kept the CPC programs intact and Chestnut Lodge running, thus meeting the proposed grant's requirements. But council members were uncomfortable about steering money to one particular bidder and voted 5 to 4 against the proposal. "We would literally be intervening in a bankruptcy proceeding," said council member Nancy Dacek (R-Upcounty). "It looks like we are doing something for one particular group, which is troubling to me." Ewing (D-At Large) contradicted Dacek, saying that any of the bidders could take advantage of the offer, provided they continued to offer the same kind of care as CPC.
    The hospital was founded in 1910 by Ernest L. Bullard, a surgeon who had run a state mental hospital in Wisconsin. He bought the Woodlawn Hotel, Rockville's most elegant summer resort, and turned it into a sanitarium for alcoholics and people with nervous disorders. Its campus was considered a serene location in the suburbs for dignitaries and wealthy people to go for psychiatric treatment. Many of its staff members did extensive work in psychoanalysis and in treating schizophrenia. They included Frieda Fromm-Reichmann, a refugee from the Nazis and a gifted therapist known for her work with schizophrenics, who joined the Lodge's staff in the 1930s. Doctors trained at Chestnut Lodge helped start the National Institute of Mental Health and have run some of the country's most prestigious psychiatric hospitals. The hospital also became famous as the setting for "I Never Promised You a Rose Garden," the l964 bestseller by Joanna Greenburg, and for the filming of "Lilith," starring Warren Beatty. The Bullard family ran the hospital until 1996, when it was sold to CPC, a nonprofit company.
    Two other mental health care providers submitted bids to the bankruptcy court for CPC's assets: Sheppard Pratt, of Baltimore, and Adventist HealthCare, of Rockville. But neither wants to run the Lodge, and both offer shorter-term care to their patients. Developers also have submitted bids in the hope of turning the campus into an upscale housing development, and a private Bethesda school wants the land for its students.
    Chestnut Lodge was criticized by some mental health industry experts for offering long, costly stays to patients at a time when state assistance has been cut and Medicaid and Medicare reimbursements are dropping. Most of CPC's patients have been transferred to other providers; about 30 remain at Chestnut Lodge. Ewing, former hospital employees and mental health care advocates said yesterday that they were concerned that CPC's patients will not get the same quality of care elsewhere. But some council members said the advocates were trying to save a hospital that cannot operate in today's climate. "I think there's a reason that there's only one Chestnut Lodge left," said council member Steven A. Silverman (D-At Large).

Eating Disorders Hidden No More
Steve Rom, Ann Arbor News- 4/18/2001

Lauren Ann Victor stood before an audience of University of Michigan students recently and re-enacted a scene she used to perform nightly, while alone in her bedroom. "You disgust me ... You're so fat and ugly and stupid," Victor began, as she glared at her reflection in a full-length mirror. "You hurt everyone around you ... You are weak and can't even lose weight ... You don't deserve to live, you fat pig." This poignant moment took place at a show sponsored by the U-M student group SPEAK, which stands for Students, Promotion, Education, Awareness, Knowledge. SPEAK promotes awareness of eating disorders, which affect 5 million to 10 million girls and women in this country, statistics provided by U-M Counseling and Psychological Services show.
    A pamphlet distributed by Counseling and Psychological Services estimates that "as many as three of four college-aged women and one of 10 college-aged men struggle with disordered eating attitudes and patterns." However, Dr. Sheryl Kurze, with U-M Heath Services, said those estimates encompass a spectrum of problems, ranging from full-blown eating disorders to simple unhappiness with one's physical appearance. "It's really difficult to answer exactly how widespread the problem of eating disorders is, from the standpoint that there are so many definitions," Kurze said.
    Victor, a co-president of SPEAK, suffered from anorexia, an intense and irrational fear of body fat and weight gain that leads to self-starvation, and bulimia, cycles of binge-eating and purging. "Standing in front of that mirror and saying those things now is hard for me to do, because I don't feel that way anymore," said Victor, who last week celebrated the three-year anniversary of her recovery. Victor said she wouldn't have believed three years ago that she could put the disorder behind her. "It makes me feel incredibly proud." After a "lifetime" of being overweight, Victor said she became anorexic at age 16 and suffered from the disease until her freshman year at U-M, when in her residence-hall bathroom one evening, she began spitting up blood. She was taken to the hospital and diagnosed with kidney failure. At the time, she weighed 87 pounds. Her pulse had slowed to 35 beats per minute, about half a normal heart rate. "(My recovery) reminds me that there is still more work to be done, and there is a reason why this happened," Victor said.
    Victor and co-president Kristiana Kaufmann took over leadership of SPEAK in September, when the former president fell into relapse. At the time, SPEAK had been nearly disbanded, but it has grown to about 80 members and survives with limited funding - between $250 and $500 a semester - from Michigan Student Assembly. The group holds support meetings once a week at the Michigan Union during the fall and winter semesters. "Sometimes, those who come to the meetings just want help getting through the day," Victor said. "They have totally lost touch with life." "It's such a therapeutic thing to meet other people who are going through the same thing as you," said Kaufmann, who formerly suffered from binge-eating and compulsive exercising and dieting. Victor and Kaufmann are both graduating this month but will stick around next school year, they say, to help underclassmen in SPEAK continue the program. "There were a few different times (when I was a freshman) that I do wish there had been something on campus that could help me," Victor said. "There weren't any posters or anything."  Kurze said it's important for those who seek help from groups like SPEAK to remember they're getting peer support but not treatment. Vicki Hays, Ph.D., a counseling psychologist from Counseling and Psychological Services, agreed that's an important distinction. "You need to see a nutritionist and psychologist and get evaluated," Hays said.
    The recent program called SPEAK-Out was the first of its kind for SPEAK in that it welcomed those who aren't struggling with eating disorders to hear testimonials from those who are. It was the first time many SPEAK members had talked publicly about their problems. Victor, who often guest-lectures on eating disorders in U-M classes, praised the speakers' courage. "It's such a private thing," she said. "You will never hear people like (actors) Calista Flockhart or Jennifer Aniston, who obviously have eating disorders, come out and say, 'Yeah, I have this problem.' So for them to do that when they're still in the throes of it, that was definitely a big success." The testimonials brought tears to her eyes. "I don't (usually) cry, but I was just so proud of everybody."

A New Tool to Resist the Pull of Cocaine
New York Times, 4/17/2001

Hope for cocaine addicts may come from a seemingly unlikely source: a drug long used to treat high blood pressure. Researchers have found that the drug, propranolol, seems to help some addicts stay in treatment when the pull of cocaine is especially strong. The dropout rate for such programs can otherwise be very high.
    The report appeared in the April issue of Drug and Alcohol Dependence, and was prepared by researchers from the University of Pennsylvania and the Department of Veterans Affairs Medical Center in Philadelphia. The findings were based on a study of 108 cocaine addicts over an eight-week period.
    Propranolol appears to ease withdrawal symptoms by diminishing the anxiety-causing effects of adrenaline. Addicts going through withdrawal are often more sensitive to adrenaline, the researchers said. The lead researcher, Dr. Kyle Kampman of the university's medical school, previously found that the drug amantadine, which is used to treat Parkinson's disease, also appears to help cocaine addicts. The study is now being conducted to determine how the two drugs work together.