Noteworthy News Articles on Mental Health Topics, July 5-10, 2001

Drinking Among Teens Rampant
Will Lester, Associated Press- 7/5/2001

WASHINGTON— A 15-year-old Ohio boy speaks of friends jailed for drinking and driving. A 17-year-old from Tennessee talks of classmates who use the school bathroom to get an early start on drinking. And a 20-year-old college student from Maryland says a priority her freshman year was to track down a fake ID.  Teen drinking remains widespread in this country despite an intensive campaign to reduce it over the last two decades. Two thirds of Americans — both teens and adults — favor the legal drinking age of 21, according to an Associated Press poll conducted by ICR of Media, Pa.   After dropping significantly in the 1980s, when the legal drinking age was raised to 21 in all 50 states, the amount of teen drinking has settled in at a rate many consider too high and a continuing health hazard.  School officials and drug abuse experts are now looking for ways to regain lost momentum in their efforts to curb a problem associated with 2,273 traffic fatalities among those ages 15 to 20 in 1999, the most recent statistics available.
    Fake IDs and underage drinking have been in the news since the 19-year-old twin daughters of President Bush, Jenna and Barbara, had a brush with the law. The sisters were cited by police after their visit May 29 to a Mexican restaurant in Austin. Two weeks earlier, Jenna Bush had pleaded no contest to underage drinking and was ordered to receive alcohol counseling and perform community service. The average age that teens start drinking dropped from about 18 in the mid 1960s to about 16 in the late 1990s, research suggests. Those who start drinking younger are more likely to become alcohol dependent.
    ``We need to re-evaluate what we're doing and do something different now,'' said Mark Weber, a spokesman for the Substance Abuse and Mental Health Services Administration. Options include tougher enforcement, community education and promotions to tell students drinking is less rampant than they might think.
    In a 1999 survey, about half of all high school students had consumed alcohol in the past month. Drinking levels grow higher for older teens. The legal drinking age had reached 21 nationwide by 1988 — spurred by a 1984 federal law that tied federal highway dollars to compliance by the states. Research suggests the amount of teen drinking dropped by about 13 percent after states raised the drinking age. The number of alcohol-related traffic deaths of those between 15 and 20 dropped by almost half in the decade after the drinking age was changed, according to the National Institute on Alcohol Abuse and Alcoholism.
    ``It's clear that the move in the age to 21 is the most successful effort that we've had in the last couple of decades to reduce drinking and alcohol,'' said University of Minnesota researcher Alexander Wagenaar. Dwight Heath, an anthropologist at Brown University in Providence, R.I., counters that Europeans are right to expose people to drinking at a younger age and demystify alcohol. The drinking age in the United States ranged from 18 to 21 in the years after Prohibition ended in 1933. Some states had lowered the drinking age to 18 by the early 1970s, but that trend was soon reversed with a major goal of reducing traffic fatalities.
    David Ponte, a 15-year-old from Cleveland, supports the higher drinking age after having several friends jailed for drinking and driving. While two-thirds of Americans supported the 21-year-old legal drinking age, even more in the AP poll wanted tougher enforcement of the laws. The survey of 1,008 adults and 514 teens was taken June 6-10. It had error margins of plus or minus 3 percentage points for adults and 4 percentage points for teens.
    Both students and school officials say teen drinking remains very popular in high school.  ``Most of them have easy access to alcohol in their homes, their friends' homes and fake IDs,'' said Ted Feinberg, a veteran school psychologist. ``By the time they get to college, it's nothing new,'' said Brian McDowell, a 17-year-old from Memphis. For Mara Conheim, a 20-year-old student at the University of Maryland, ``freshman year was all about finding a fake ID.'' Another Maryland student, 21-year-old Brent Robbins, said older students often lend IDs to younger classmates. Gary Paleva, director of the college's office of judicial programs, says the college does all it can to prohibit drinking, but ``sometimes parents have lost control before students get here.'' Both teachers and counselors question the effects of their efforts. ``There are all kinds of signs up around our school. We have little workshops and seminars,'' said Detroit high school teacher Cassandra Jerrido. ``But drinking is caused more by peer pressure. I don't see any of our efforts working.''
On the Net:
—National Highway Traffic Safety Administration — http://www.nhtsa.gov
—National Institute on Alcohol Abuse and Alcoholism — http://www.niaaa.nih.gov
—Substance Abuse and Mental Health Services Administration — http://www.samhsa.gov

Women Face Unique Challenges When They Quit Smoking
Robin Eisner, ABC News- 7/5/2001

A variety of gender-specific factors make it difficult for women to quit, according to Dr. Kenneth Perkins, professor of psychiatry at the University of Pittsburgh Medical School. They include:
*Nicotine replacement therapy may not be as effective for women.
*Women smokers are more fearful than men of gaining weight.
*A woman's menstrual cycle may affect withdrawal symptoms.
*Husbands may be less supportive to women trying to quit than wives are of husbands.
    Half of all people (including women) who have ever smoked have quit — not necessarily after the first time they tried — but eventually, according to Dr. Michele Bloch, medical officer in the Tobacco Control Research Branch of the National Cancer Institute. While 90 percent of women (and men) try to quit without help from professionals, the success rate can triple when they get some sort of counseling or medical intervention. Without help, only 5 percent to 10 percent of people will stop smoking for a year. With help, the rate goes up to 20 percent to 30 percent. Some data suggest women may have more difficulty quitting than men, according to David Wetter, associate professor of behavioral science at the University of Texas' M.D. Anderson Cancer Center in Houston.
    The most effective methods to quit smoking include behavioral change, counseling/social support and drug treatment, such as nicotine replacement and the antidepressant buproprion, according to a U.S. surgeon general's report issued last June after extensive research. Counseling and social support can include asking a family member or friend to be there for you when you feel an urge to smoke, calling state telephone quit lines (several states offer counseling services on the phone to help people quit), joining groups or seeing a health-care professional or smoking cessation specialist for more intensive therapy.
    What is important in the behavioral aspect of quitting is planning and preparing, says Glen Morgan, program director of the Tobacco Control Research Branch in the NCI's Behavioral Research Program. About a month before quitting, a smoker should monitor how many cigarettes she smokes and the times and circumstances that lead to the behavior, such as being on the phone, when angry or at a bar. Then she can begin to understand the triggers for smoking, Morgan says. Research suggests that a woman's emotional state may influence her smoking more than a man's, so women should pay attention to their feelings when trying to cut back. Slowly, a woman can begin to reduce her smoking under trigger circumstances and replace cigarettes with other activities, such as cooking, exercise or even knitting, he says.
    During this preparatory time, the woman should also start planning what she will do when she has stopped smoking and has cravings. Some people may want to buy a special candy for those times or take a long walk, he says.  "All this preparation makes it easier when the day comes to throw out the cigarettes and ashtrays and stop completely," Morgan says. But women should not be discouraged if they relapse after the big quit day. Each time a woman quits, she can learn about what pushed her to start again. If it's alcohol, perhaps she needs to stay away from bars for a while or have a contract with a friend to take away her cigarette, Morgan says.
    Research seems to show that women may benefit more than men by taking buproprion to help them quit, says Dr. Michael Fiore, chairman of the panel that issued the surgeon general's report. Fiore is also professor of medicine at the University of Wisconsin Medical School in Madison. The drug, he says, may help address the higher rate of depression women experience when they try to quit.
    Although women are concerned about gaining weight when they quit, the NCI's Bloch says dieting is not recommended. Instead of dieting, which can be stressful, women should try to exercise. Women need to reassess what makes them attractive should they gain the average five pounds to 10 pounds that often show up during quitting, Bloch suggests. "Nicer teeth and cleaner hair are benefits of not smoking," Bloch says. "After a woman successfully stops smoking, she can then lose the extra weight."
    A key time to reach women about quitting smoking is when they are trying to get pregnant, experts say. Women may be more motivated to stop at this time because of the damage smoking can do to the developing fetus and the impact secondhand smoke has on children. Women who are thinking about getting pregnant or who are pregnant should tell their doctors if they are using nicotine patches or gums, which are available without a prescription, because as with other drugs, doctors should be kept in the loop about what medications the women is taking, says Dr. Richard Hurt, director of the Mayo Clinic Nicotine Dependence Clinic. Although manufacturers tell pregnant women to seek medical attention when taking these products, Hurt has performed research with pregnant women in their third trimester who used the patch and found the nicotine had no effect on the developing fetus.
    Pregnant women, however, may not be apt to tell their doctors about their smoking or quitting behavior, Bloch says, because there is a lot of shame associated with pregnancy and smoking. She warns doctors should not be judgmental and try to help women quit. "We still have a long way to go to understand the gender differences when it comes to quitting smoking," says Bloch. "But we have some clues now."

Russia's Poisonous Nectar
David Filipov, Boston Globe- 7/6/2001

UGLICH, Russia - With the peculiar expression of reverence and dread that Russians reserve for their national beverage, Vladimir Shabalin raised an ancient crystal shot glass of vodka. And then he put it down without drinking.  Shabalin is the director of the Vodka Library, a stunning homage to Russia's obsession with its favorite libation. The ''books'' in this library are thousands of shimmering bottles of vodka, crystal-clear representatives of the many epochs and varieties of the spirit, all encased like rare artifacts in thick glass. The exhibit has a dual message: Vodka is not just something to celebrate, but also something to understand and fear.
    ''Vodka has never done anything good, but without it, Russia would not exist,'' Shabalin said. Shabalin is acutely aware that vodka is not only Russia's liquid pride and joy, but also one of its most fearsome killers. Russian health and police officials estimate that alcohol abuse was a factor in half of the 350,000 accidental deaths in Russia last year. One study suggested that two out of three Russian men are inebriated when they die.
    Visitors to the Vodka Library, 200 miles north of Moscow in the ancient Volga River town of Uglich, can request a ''taste test'' of the local brands. But it comes with a somber lecture from Shabalin on the virtues of responsible drinking and the perils of succumbing to ''the green snake,'' the Russian euphemism for alcoholism.
    Given the devastation that drinking has caused in Russia, it might seem strange that Uglich authorities have chosen to erect a monument to vodka on the leafy square outside the Vodka Library. But that is the plan. Sculptor Ernst Neizvestny, famous for having crafted the headstone on the grave of former Soviet leader Nikita Khrushchev and well-known for his drinking binges (which got him thrown out of the Soviet-era Artists' Union), has agreed to take on the job. During a visit to Uglich, Neizvestny explained the need for a monument by quoting an ancient Russian expression: ''In Russia we have happy drinking, without which we would not exist.''
    A walk through the library's main exhibit retraces Russia's bittersweet romance with vodka. Visitors can pore over century-old czarist brands, drably labeled Soviet-era bottles, and the legions of counterfeits that sprang up after the Soviet period. Displayed next to the bottles are artifacts of various eras, such as currency and distilling equipment. Young women in bright traditional garb direct visitors to the well-stocked shop near the exit, where Uglich vodka can be purchased for the road.
    Uglich was chosen for the library because it was the home of Pyotr Arseneyevich Smirnov, founder of the legendary Smirnoff brand. After a brief period of prosperity in the 19th century, the family immigrated to France and sold the brand to a businessman, who changed the spelling of the name. But Smirnovs are still local heroes in these parts. There is another museum in Myshkin, a 40-minute drive from Uglich, dedicated to the Smirnov family.
    In the effort to caution against the evils of abuse as well as venerate the national drink, Shabalin has a doctor give tours of the Vodka Library that feature real-life exhibits such as the preserved livers of patients who died of cirrhosis (''Many people have quit drinking after visiting our museum,'' Shabalin said.) Reproductions of czarist and Soviet anti-alcohol posters on the walls detail the efforts of previous generations of Russian leaders to combat alcohol abuse.
    Shabalin tries to educate anyone of the 6,000 annual visitors to his library who will listen on how to drink vodka properly. Half a shot glass per sitting is the norm for women, two shot glasses for men, he said, as he invited three guests to imbibe classic Uglich vodka from a murky green bottle. Vodka should be sipped, not tossed back in one gulp, as many Russians like it. And it should be accompanied by a snack, such as pickles, herring, or black bread.  And, of course, the vodka must be Russian. ''We tell children, `Don't drink vodka - but if you have to, drink domestically produced vodka,''' Shabalin said.
    Because Russian laws forbid drivers even the slightest taste of alcohol, Shabalin's guests, who traveled to Uglich by car, were forced to go away dry. That did not keep him from trying to persuade them to have a sip. As he explained, traditional drinking etiquette requires that the host get the guests drunk, egging them on with such exhortations as ''you can't stand on one leg'' (after the first shot) and ''God loves a trinity'' (after the second). And so on.
    It is hard to say when vodka became a Russian national pastime. One theory has it that Russia's leaders are responsible for making people dependent on demon vodka. In the 16th century, Ivan the Terrible forced its sale at state-run inns, while levying taxes that made the production and sale of beer and mead unprofitable. Subsequent czars retained the monopoly on vodka, except for a brief period, 1863 to 1896, during which noble families, like the Smirnovs, were also allowed to produce and sell the drink. The Soviet government kept the monopoly; vodka sales provided 25 percent of the USSR's budget.
    ''It is a myth that drunkenness is a national characteristic of the Russian soul,'' said Grigory Zaigrayev, a senior analyst on alcohol abuse issues for the Russian police, in a recent interview. ''The culture of unrestrained drinking was forced upon the people by the tough alcohol policies of the state.'' Former Soviet leader Mikhail Gorbachev tried to curtail drinking by cutting vodka production, but that just drove up demand for moonshine. Boris Yeltsin, the former president, ended the monopoly but also relaxed licensing requirements, which led to a proliferation of underground distilleries.
    Death by acute alcohol poisoning has risen each year. Last year it jumped to 34,000 from 29,900 in 1999, according to Russia's State Statistics Committee. So far this year, the rate is 10 percent higher than in 2000. Alcohol may have played a role in as many as 25 percent of the 2.2 million deaths in Russia last year, said Irina Demina, vice president of the Russian health society.
    Despite those grim statistics, alcohol consumption is at a record high of nearly 15 quarts of pure alcohol per person per year, up from about 11 quarts 25 years ago. ''Russians are becoming even more of a drinking nation,'' Demina said in a recent interview. It is hard to say how the trend can be stopped. Zaigrayev argues that Russia's harsh post-Soviet economic realities have driven people to drink more because, at $1 to $5 per bottle, vodka is one pleasure they can still afford.
    Shabalin believes a culture of drinking does not mean that Russians have to be a nation of drunks. With better information, he said, Russians could learn to drink properly. ''To say that vodka is the same as alcoholism is like saying love is the same as venereal disease,'' Shabalin said. Prodded, he added that he often exceeds the norm of two shot glasses. ''Vodka is evil,'' he shrugged. ''But what can you do?''

Washtenaw County Sex Offenders Lax in Registering
Susan L. Oppat, Ann Arbor News, 7/6/2991

State police are planning to crack down on convicted sex offenders in Washtenaw County who are widely ignoring a law that requires them to keep the state informed of their whereabouts. Felony sex offenders must report four times a year but 201 of the nearly 350 Washtenaw County residents who were supposed to verify their addresses with the police last January failed to show up.
    State Trooper/Investigator Scott Singleton of the Ypsilanti Post intends to change that. After July 15, when the current registration period ends, Singleton will go knocking on doors, looking for convicted sex offenders who failed to verify their address on the public registry. He'll be armed with a warrant. And when he can prove to other police departments his method works, Singleton says he's going to be knocking on their doors, too, asking them to help by charging offenders who don't verify addresses in their jurisdictions.
    Since Jan. 1, 2000, anyone convicted of a felony sex offense, or the high-court misdemeanor of fourth-degree criminal sexual conduct, has been required to appear at the local police or sheriff's department, or Michigan State Police post, during the first 15 days of January, April, July and October, to verify their addresses. Persons convicted of other misdemeanor sex offenses must verify their addresses every Jan. 1-15. They are required to show proof of address - even if they haven't moved. Anyone who fails to show up can be charged with a 90-day misdemeanor. Anyone who has moved and not notified the registry within 10 days can be charged with a four-year felony. Multiple convictions boost the penalty. Offenders remain on the list for 25 years or life, depending on the conviction. Juvenile offenders register confidentially, then go on the public list on their 18th birthdays.
    Singleton was not initially thrilled with the assignment from Lt. Beth Moranty, commander of the Ypsilanti Post. But then he thought about it some more. "What if I had kids, and an offender was living next door? There is a high rate of recidivism (among pedophiles)," he said. "I'd want to know, and people have a right to know. But if the list isn't accurate, they're not going to know."
    So on July 16, Singleton will run the state computer list, to see who was supposed to register in the county, but didn't. Then he'll gather other troopers, and knock on doors across the county. Anyone who didn't verify will be charged, he said. Singleton has met with county Assistant Prosecutor Rolland Sizemore III to streamline the paperwork required to seek a warrant. After he works the bugs out of the first cases, Singleton will approach other departments around the county, and ask them to join the effort in their jurisdictions. With enough prosecutions, he believes, offenders will begin to register and verify their addresses, and the work load will drop. Singleton said the departments he's contacted so far have been receptive.
    Ann Arbor Police Detective Lt. James Tieman said the department does assign an investigator to verify the address of each new registration, but does not have the manpower to verify every address of every person on the registry in the city. Tieman was not aware of Singleton's plan, but was pleased to hear it.  As of last Friday, 84 people were registered in Ann Arbor Zip codes, but those codes extend into township jurisdictions. The Washtenaw County Sheriff's Department covers Ypsilanti and Superior townships which, with the city of Ypsilanti and a portion of Pittsfield Township, have the largest number of registered offenders.
    Sheriff's Commander Anderson Brown Jr. said he hadn't heard about the state police program, either. But if two-thirds of the people on the list aren't complying with verification requirements, he said, " it's time to knock on some doors." Saline police already do, twice a year. Chief Paul Bunten said if the few offenders there don't verify, "we knock on the door." Only one offender has so far failed to verify, he said, and there were special circumstances. But if others do it, he said, "I'm not afraid to charge them." As for Singleton, "once we start knocking on doors, we'll know who's not living where he's supposed to be living. And we'll be checking every three months. We may not be perfect the first time, but every time we do it, we'll get more proficient."
    The public can check the registry by Zip Code or name on the Internet, at: http://www.mipsor.state.mi.us

Boy's Death Puts the Spotlight on Boot Camps for Troubled Youngsters
Alisa Blackwood, Associated Press- 7/7/2001

PHOENIX -- The death of a 14-year-old boy this week at an Arizona desert boot camp for delinquents is just the latest episode in the troubled history of these grueling programs. Boot camps use military discipline to try to turn rebellious youngsters' lives around. But over the past decade, as the popularity of such camps has grown, so have abuse allegations, lawsuits and deaths. Many such camps are state-run, and the youngsters are sent there by the courts under close supervision. But there are an untold number of other such camps around the country like the one in Arizona that are privately run, and are for unruly teen-agers sent there by their parents. And these private boot camps are often subject to little or no regulation. ''It's a situation that lends itself to abusive conditions,'' said R. Dean Wright, a professor of sociology at Drake University in Des Moines, Iowa. ''Any time you have someone use lock and key, the person who has the lock and key has the power to abuse, and they often do.''
    Anthony Haynes died Sunday while attending a five-week boot camp 40 miles west of Phoenix operated by the America's Buffalo Soldiers Re-enactors Association, where the regimen includes forced marches, wearing black uniforms in triple digit temperatures, in-your-face discipline and a daily diet limited to an apple, a carrot and a bowl of beans. The youngsters were supervised by 17- and 18-year-olds, and there were no medical personnel on hand, Sheriff Joe Arpaio said. Unidentified former drill instructors at the camp told The Arizona Republic that youths were kicked and forced to swallow mud. At least one person who attended the camp said that a counselor stomped on his chest and poured mud down his throat. On the day Haynes died, the mercury climbed as high as 114 degrees. The teen-ager's mother, Melanie Hudson, who paid $2,000 to send the boy to the camp after he slashed her tires and was caught shoplifting, said she was told her son had vomited mud before he died.
    Authorities removed about 50 youngsters from the camp Monday and returned them to their parents.  The sheriff's department is investigating the boy's death and the abuse allegations. Authorities were awaiting autopsy results Friday. The organization that runs the camp referred calls to a lawyer who did not return messages.   ''There obviously should be some sort of oversight,'' Maricopa County Attorney Rick Romley said Friday. ''I mean, we even regulate day-care centers. There should be some type of oversight, and perhaps this case will be the one that prompts some action in the Legislature.''
    In South Dakota in July 1999, 14-year-old Gina Score died after a forced run at a girls boot camp operated by the state. Two staff members were acquitted on child abuse charges in the death and other alleged problems, including making girls run in shackles until their ankles bled. In 1998, 16-year-old Nicholaus Contreraz died at the privately run Arizona Boys Ranch boot camp. Charges of murder, manslaughter or child abuse against six staff members at the camp were dropped by prosecutors. There have been at least three other deaths at boot camps in the past decade and numerous abuse allegations across the country.
    The first juvenile boot camp opened in Orleans Parish, La., in 1985 and led the way for others modeled on prison boot camps for adults. Many parents praise the camps and the positive changes they say they have seen in their children. Peggy Sevier's son was sent to the state-funded Pinellas County Boot Camp in Clearwater, Fla., after he was convicted of assault and battery at 17. Officials said the four-month program is closely monitored by the state.  ''Since the boot camp, I think he thinks about things before he actually does them. He seems to have a little bit more respect. He's changed,'' Sevier said. ''It's an eye-opener.''
    However, a 1998 study by the Koch Crime Institute, a nonprofit research center, found that juvenile boot camps around the United States are no better than traditional methods at deterring crime. The recidivism rates for graduates of juvenile boot camps was between 64 percent and 75 percent, compared with 63 percent to 71 percent for traditional programs for juveniles.
    Wright said parents often send their children to the camps unaware of the potential for abuse. In Arizona, for instance, the law regulating juvenile facilities specifically excludes private camps that do not run year-round. The camp where Haynes died ran for five weeks. ''Many parents are just simply exasperated,'' Wright said. ''So many parents feel they have no control over their child and they want something that's going to work.'' Haynes' father, Gettis Haynes Jr., said he wishes he had known more about the camp before sending his son there. ''I'd advise anyone who would send their kid to a boot camp to investigate it as deep as they can before they ever do anything like we've done,'' he said.
    On the Net:
America's Buffalo Soldiers Re-enactors Association at http://www.thebuffalosoldiers.com
Koch Crime Institute: http://www.kci.org

Vermont Abuse Protection Program Begins
Associated Press, 7/6/2001

MONTPELIER, Vt. -- A new Vermont initiative may offer at least some help to domestic abuse victims who are still under siege. Aimed at residents who have been the targets of domestic abuse, sexual assault and stalking, the Safe at Home program is designed to protect victims by offering them a secret address. As of this week, victims who request it will be able to receive their mail at an address maintained by the Vermont secretary of state's office.  The mail will then be forwarded to participants at their concealed residence as part of a plan to help keep abusers from learning their whereabouts.
    Karen McGauley, who is coordinating the program, said she expects it to be an important part of the effort to keep victims the vast majority of whom are women and children as safe as possible. If a person needs the confidentiality of their address, they can apply, McGauley said. But she cautioned that the program is not foolproof, nor will it address all of a victim's security issues. She will still need to take such other precautions as maintaining an unpublished telephone number and being careful about whom she gives personal information to. ''I really need to make that point. It's not going to fix all the possible circumstances where (victims) need assistance. But it's one less place where they can find the person,'' McGauley said.
    Safe at Home can work only if victims get a new address. They have to be relocated, and there can be no government record of them with this address. She said she knows of about 10 people who are set to sign up, and estimated that number may expand to 30 or 40 by year's end. For now, at least, the project is a one-woman show with McGauley planning to sort the mail herself according to household, then remail it to the participants. She was hired last October to get the program up and running by Jan. 1 this year. But that schedule hit a snag when Vermont police officials argued that they might need to get in contact with victims, and wanted to be allowed to know where they were living.
    But others worried about cases where the aggressor in domestic abuse situations was a police officer. The main law that created the program went into effect last year. But before the program could start, Vermont Secretary of State Deborah Markowitz decided an additional piece of legislation was necessary to clarify the access question. That bill became law six weeks ago and gave police the right to find out participants' home addresses for a list of legitimate law enforcement duties including: the execution and enforcement of court orders; service of criminal and civil paperwork; screening for criminal justice employment; and the investigation of participants who are suspected, charged or convicted of criminal offenses or juvenile delinquencies. Markowitz said that the law also provides that her office can review requests by agencies and determine if they are appropriate. ''I insisted on a paper trail: who? and why? We want to make sure that law enforcement has some legitimate need. We're really pleased to be getting started,'' Markowitz said.

Retirees Wooed by Casinos Seen as Vulnerable to Addiction
Rene Sanchez, Washington Post- 7/8/2001

PALM DESERT, Calif. -- The last time casino promoters approached the Joslyn Senior Center with coupons for the elderly, director Michael Barnard greeted them with a new rule: He would only accept discounts for meals, not gambling. Local casinos also have offered to send buses to and from the center once a week. Barnard has said no thanks. And just a few weeks ago, for the first time, the center hosted a seminar filled with tales of retirees who squandered their savings on slot machines. "This issue is coming to the forefront," Barnard said, "so we're getting more aggressive."
    Across the desert West, and in other retirement havens and casino capitals around the country, senior care providers and community groups have begun taking tougher stands against a problem they say is becoming ever more serious: elderly gambling addiction. Some are urging casinos, which relentlessly court retirees, to back off. Others are waging new campaigns to warn seniors of the perils of excessive gambling. And all are worried that they are only at the beginning of what could be a difficult struggle as the giant baby-boom generation grays and casinos keep opening.
    In California, where the elderly population is expected to double to nearly 7 million in the next two decades, counselors on problem gambling are touring the many retirement communities here in the Coachella Valley with films and lectures on gambling addiction. Tribal casinos are expanding to the point that soon California may have more slot machines than any state except Nevada. In Arizona, where tribal casinos also are flourishing, a nonprofit group on problem gambling is meeting with leaders of senior centers. The group also is asking centers to put place mats on their lunch tables containing tips on responsible gambling. In New Jersey, where buses unload thousands of retirees every day on the casino strip in Atlantic City, groups are going to churches and other civic gatherings to tell adult children of elderly gamblers about the dangers the pastime poses to their parents. And in Florida last month, specialists in problem gambling came from across the country to begin developing a think tank devoted to examining elderly addiction.
    "We used to focus only on addictions to alcohol or medication, but now we're looking closely at gambling," said Michelle Rainier, a director of the Office on Aging in California's Riverside County, which held its first conference on the issue this spring. "But it's going to be hard to intervene and slow this down. There's a lot of denial out there among seniors."
    Few doubt that the elderly are gambling in growing numbers. A national survey of senior citizens two years ago found that about half of them had gambled "recently." That figure, according to the National Gambling Impact Study Commission, is twice as high as it was a generation ago, when hardly any states had any form of legalized gambling. Today, nearly every state does. Researchers also say the nationwide surge in gambling over the past two decades is more apparent among retirees than any other age group. Most of them do not end up wrecking their lives from the habit.
    But in Arizona last year, about 40 percent of the calls to a hot line for problem gamblers came from senior citizens, nearly twice as many as two years earlier. "It gets higher every year," said Paula Burns, director of the Arizona Council on Compulsive Gambling. "Most of them are lonesome," said Barbara, 69, a retiree from San Diego who would not give her last name because she is recovering from a serious gambling problem. "Going to a casino is a way to be around people. It usually just starts off as a social thing, but then they start throwing a few quarters in the slots, and then more, and then some of them really get hooked. You can see it in their eyes. They get desperate to win. It's easy to get caught up in. And the excuse is that they are not hurting anyone but themselves."
    Meanwhile, casinos are trying harder than ever to attract retirees: Some are dispatching buses to senior centers or vans to trailer parks -- and timing their offers for free rides to coincide with the arrival of monthly Social Security checks. Some are staging midday entertainment to suit elderly tastes. Casinos also are using direct mailings to entice seniors with stipends to play slot machines or offering discounts for food, drinks or lodging. In some instances, the more customers gamble, the better the bargains. The gaming industry defends most of the overtures and contends that the majority of seniors who come to casinos view the outing more as an inexpensive opportunity to socialize than an attempt to win jackpots. Industry leaders also say they are taking significant steps to promote responsible gambling.
    At the new Agua Caliente Casino in nearby Rancho Mirage, staff members are being trained to look out for elderly customers gambling to extremes. Brochures on problem gambling are stacked next to cash-advance windows, and hot line numbers for addiction counseling are posted near the casino's 1,000 slot machines. The casino's marketing director, Trey Jordan, also said that it only mails promotions to affluent seniors who live in the Coachella Valley. "There probably are casinos trying to grind all the money they can out of them," he said. "But we do everything we can to have them play responsibly."
    Advocates for the elderly say more must be done. Their emerging counterattack looks much like the presentation that Tom Tucker, a leader of the California Council on Problem Gambling, brought here to the Joslyn Senior Center earlier this summer. It was his latest stop in a nine-city tour of the Coachella Valley, where the number of residents at least 65 years old grew by 47 percent in the last decade. The region, 130 miles east of Los Angeles, is a desert landscape of palm trees, golf courses and roadside restaurants offering early-bird specials. In the winter, retirees from across the country swarm here to bask in balmy weather. In the scorching summers, many retreat to the air-conditioned comfort of local casinos. Once a month, in a new project financed by Riverside County, Tucker visits a senior center to deliver the same urgent message. He is careful not to condemn gambling, but stresses that many retirees are turning to the habit to escape loneliness or pain and instead are falling into financial ruin. The elderly are a group especially vulnerable to gambling addiction, Tucker said, for two simple reasons: "They have time and money."
    At one point during his seminar, Tucker flipped off the lights in a small conference room and showed a video titled "Game Over." It featured retirees speaking with anguish about how gambling had taken over their lives. "I had too much leisure time." "I felt like it had become my machine." "I was in total denial until one day I couldn't meet my bills." On the narratives went. Tucker's audience listened intently. But only a few elderly residents had come to the session, despite the offer of a free lunch. One was Madelyne Sklar, a retiree who said she visits local casinos a few times a month and does not bet or lose much money. "But I am noticing more people around here who seem to have a problem," Sklar said. "I have friends who go to the casinos all the time. Some people have nothing better to do. I came out to this because I think a lot of people really need a better idea of what the difference is between gambling that is okay and gambling that is too much."
    The trouble that Tucker has getting retirees to attend some seminars is not uncommon. Across the country, similar groups say that many senior citizens are reluctant to admit they have a problem or are not comfortable in self-help sessions. Some groups are trying to lure retirees to seminars on gambling addiction by promoting them vaguely as workshops on health. "They have made it this far making their own decisions, so you have to be careful about telling them what they should or shouldn't do," said Barnard, of the Joslyn Senior Center. And since many senior centers make day trips to casinos a staple of their activities, it is not easy to reverse course and disparage gambling.
    "Casinos are very attractive to senior centers," said Burns, of the Arizona council. "It's easy programming -- you don't have to plan anything." For many retirees, there is no better way to spend a day. As they gamble in greater numbers, stigmas once associated with the habit fade. And to many senior citizens, casinos are safe, clean places that lavish them with attention. One recent weekday at the Agua Caliente Casino, retirees lined nearly every row of slot machines looking entranced by the spectacle of blinking lights, ringing bells and jingling coins.
    Gambling counselors say seniors with addiction problems often develop them after retirement, when other social outlets are harder to find. "Our society is not prepared for so many elderly people living longer and healthier with more money," said Terry Elman, a director of the Council on Compulsive Gambling in New Jersey. "The solutions are not very far along."

Vermont's Heavy Prescription Use Seen Linked to Addiction
Associated Press, 7/8/2001

RUTLAND, Vt. -- Vermonters are heavy users of prescription drugs compared to most other Americans, and officials fear that lots of drugs available legally can contribute to illegal distribution as well. According to recent statistics compiled by the federal Drug Enforcement Administration, Vermont ranks second in the nation for per capita consumption of Ritalin, used to treat attention deficit disorder in children. That's one of the drugs that's been targeted in numerous pharmacy break-ins in recent years.
    Vermont's consumption of Ritalin is more than five times greater than Hawaiis, the lowest. Vermont ranks fifth in the nation for per capita consumption of morphine, another frequent target of pharmacy burlars, and seventh for per capita consumption of medical cocaine, which can be used during surgery as an anesthetic. And Vermont is 14th in the nation for consumption of oxycodone, an opiate derivative used as a painkiller. Consumption of that drug in Vermont is about six times greater than in Illinois, which ranked the lowest.
    The statistics ranked all 50 states in order of grams consumed per 100,000 people between 1997 and 2000, according to Vermont State Police Capt. Steve Miller, head of the Vermont Drug Task Force. Morphine and medical cocaine are not commonly prescribed but are used in hospitals as aids in surgery, he said. But Ritalin and oxycodone-based painkillers, like Vicodan, Percocet and OxyContin, are prescribed to patients. And officials said the wide availability of those drugs, which can be addictive, could lead to an increase in cases of drug abuse. ''It's not surprising that as the availability has increased, more winds up in the streets,'' said Jeff McKee, the director of treatment for Rutland Mental Health Services, an organization that provides drug counseling. ''We have seen, in the last few years, the increased use of Ritalin and OxyContin as street drugs.''
    McKee said teenagers now are abusing a wider range of drugs than in the past. He said it is not uncommon to see teenage clients who have recreationally used Ritalin, which when snorted gives the user a cocaine-like high, or OxyContin, which has an effect similar to heroin when snorted or injected.
    But tracking cases of prescription drug abuse is difficult, Miller said. And so is determining why Vermont ranks so high for consumption of these drugs. ''We either have a lot of sick people, or we have doctors over-prescribing these drugs, or we have a lot of cases of abuse out there,'' he said. ''It could be any one of the three.'' Vermont lacks a prescription monitoring program, which some states have, to track who is getting the drugs and how much they are getting. ''The only way we can find out if an individual has visited 10 pharmacies in the same day to get the same drug is to go to each one of those pharmacies,'' he said. ''And that is next to impossible.''

Vermont Panel to Examine Links Between Addictions
Associated Press, 7/8/2001

MONTPELIER, Vt. -- The comedian George Carlin once spoofed the notion that marijuana leads to harder drugs by saying ''mother's milk leads to everything.'' But a new state commission aims to take seriously the idea that an individual's addictive behaviors often are not limited to one substance, and that efforts to combat addiction need to be better coordinated. ''You seldom find a heroin user who hasn't smoked marijuana,'' said Rep. Thomas Koch, R-Barre Town. ''You seldom find marijuana smoker who hasn't smoked tobacco.''
    The chairman of the House Health and Welfare Committee came up with the idea of a commission on tobacco, alcohol and substance abuse addiction, which is expected to spend the better part of the summer and fall reviewing the state's existing system of substance abuse prevention. ''We have a major problem that needs attention,'' Koch said. ''We really need to take a comprehensive look at the substance abuse spectrum. ... What were saying is these things are all related.''
    The idea for the 16-member commission came after the House Appropriations Committee was considering using some of the roughly $24 million in tobacco settlement funds the state receives annually to pay for substance abuse programs other than those relating to tobacco, Koch said. The bulk of the funds go toward health care and tobacco prevention while the rest has been placed in a trust fund with the hope of creating a sustainable revenue source in future years, said Jennifer Wallace-Brodeur of the Campaign for Tobacco Free Kids.
    Wallace-Brodeur said that while some consolidation and coordination might be in order, there were many respects where tobacco use prevention and education diverged from programs aimed at other, harder drugs such as heroin.  ''I think we have to be careful of lumping this together where it's not appropriate,'' she said. ''If the research supports combining efforts in some elements of the program, we should be looking at that, but we have to keep in mind a large part of our effort is helping people quit tobacco. It doesn't make sense to combine treatment or combine prevention messages in advertising.''

Children Trapped By Mental Illness
Carey Goldberg, New York Times- 7/9/2001

BOSTON--The 16-year-old had needed help, no question. She was taking rides from strangers, she was acting suicidal. Finally, she ended up in a psychiatric hospital, where her mother says the staff effectively saved her life, stabilized her, worked on her bipolar disorder. But once in the girl could not get out. Not for months after the staff thought she was ready to go. No matter how she cried. She had joined the ranks of thousands of mentally ill children and teenagers in the country who, doctors, advocates and officials say, are trapped in psychiatric hospitals and in other institutions for lack of treatment programs outside. The problem is so widespread that it has prompted recent lawsuits demanding more outpatient treatment in states from New York to Idaho to California. And experts say it is only one of the more visible indicators of a broader, deeper problem, yawning gaps in the treatment of mental illness among the nation's children.
    Five to 10 percent of American children have serious mental health disorders, federal officials say. About 60 to 70 percent who have mental health disorders do not get the treatment they need, said Gary De Carolis, chief of the child, adolescent and family branch of the federal Center for Mental Health Services. But a Surgeon General's report released in January offered an even higher estimate, 80 percent.
    Experts say it is unclear how many children are not only undertreated but actually trapped in the mental health system, victims in large part of poor record-keeping and differences in the process from state to state. The National Mental Health Association is working to quantify "unmet need" in 13 states and is struggling with variances in data collection and systems, said Maril Olson, the association's director of child welfare. "I don't know of any states that would say, 'We are doing really great,"' Ms. Olson said. "Every state would say 'We don't have enough funding, we don't have enough services.'"
    Here in Massachusetts, advocates and doctors have been documenting several aspects of what they call the "stuck kid" problem. There are the children who must wait for hours in emergency rooms while in full-blown psychiatric crises. There are the "boarder kids," children stuck for days or weeks or in extreme cases, months in pediatric wards because there is no place for them in a psychiatric ward or hospital. There are the "wait-listed kids," waiting months for outpatient therapy or case management And there are the "stuck kids" themselves, usually about 100 of them at any time in the state, according to official figures, who are ready for discharge from psychiatric hospitals but cannot leave for lack of outside treatment programs.
    Dr. Josh Sharfstein, a Massachusetts pediatrician who has documented the state's "stuck kid" problem among children cared for by the child welfare system here, found that from last October to March, stuck patients spent 15,796 days - or more than 43 years - of unnecessary time in hospitals, 33 percent longer than in the previous six months. "The systems to take care of the most severely mentally ill kids are completely broken," Dr. Sharfstein said. "If you have a heart ailment in Massachusetts, you're going to get excellent care, but if you're a child with mental illness you could have the best insurance and wind up spending three days in the emergency room
    Massachusetts has more psychiatrists and social workers per person than any other state and is second in the number of psychologists, said the state's mental health commissioner, Marylou Sudders. "Stuck kids" are a high priority for the whole administration, Ms. Sudders said, and the state added $10 million to its mental health budget of $584.6 million last year to deal with the problem. And yet it persists. Ms. Sudders attributed the problem to an overall crisis in mental health treatment, and she cited these other factors: a staffing shortage so severe that the state can actually operate only 8 of 10 beds for mentally ill children it has the money for; a shortage in psychiatric wards; and a boomlet in the state's adolescent population. Whether caused by demographics or other societal shifts, a sharp rise in juvenile psychiatric emergencies has been reported in many states, including Connecticut and New York.
    Mental health advocates also mention the effect of managed care on mentally ill children. Private managed care, experts say, tends to reduce. coverage for mental health and parents often wait too long before seeking help. In some states, managed care programs for children covered by public money have so cut the amount of treatment received that state governments have abandoned the programs. Whatever the causes, the gaps in the system compound the pain of parents who are coping with their children's illnesses, and often, experts say, exacerbate the illnesses themselves.
    "If a child has appendicitis or a diabetic condition, you're going to get them in to the hospital that day," said Pamela Sepe, a registered nurse and a mother of four, including a 14 year-old son who has bipolar disorder and obsessive-compulsive disorder. "It's just so sad, because they have an illness too, but it just affects a different area" When her son had a recent crisis and began flying out of control, Ms. Sepe took him to the emergency room, as his doctor had instructed her, only to be told after nine hours of waiting that there were no psychiatric adolescent beds anywhere in the state for him. She had to take him home.
    Most children and teenagers stuck in psychiatric, hospitals tend to be wards of the state, many unable to return home. But Ms. Sudders said the problem extended to children covered by private insurance. When the children covered by public money got stuck in psychiatric hospitals, parents and say, that backs-up the whole system.   "All along the system there is a bottlenecking or a logjam." Said Lisa Lambert, assistant director of the Parent/Professional Advocacy League, which advocates for mentally ill children. "It's all connected." The stuck patients also burden the psychiatric hospitals, taking up beds needed by others while the hospitals lose money because the state does not usually pay full rates when a patient's stay is no longer considered clinically necessary.
    For all the problem's complexity, there seems to be a consensus about the solution: more mental health services must be provided in communities, so that mentally ill children could live at home while still receiving intensive treatment and oversight by professionals. The federal Center for Mental Health Services has been giving tens of millions of dollars in grants each year to encourage such programs for several years, and they now exist in 67 communities, Mr. De Carolis said. The programs bring together all the agencies that normally deal with mentally ill children -- including the juvenile justice system and child welfare offices -- to make them collaborate rather than try to stick each other with the bills for a child's care. They generally create interagency teams and strive for "wraparound" treatment -- wrapping the services around the child instead of making the child negotiate a maze of agencies. They often include staff members who can spend extensive time in the child's home, and respite care when parents are at wit's end. The programs have already proved themselves, Mr. De Carolis said, cutting hospitalizations and delinquency, and saving money. But they often meet some resistance. A therapist used to 50 minute hours, he said, might balk when told to go into schools and homes and act as part of the community; so might the director of a 140-bed treatment center when the emphasis shifts to intensive at-home services.
    Lawsuits around the country on behalf of children stuck in the system generally demand -- and have often received -- more of such wraparound services. In May, a federal judge in Los Angeles ruled in favor of the plaintiffs, who represented more than 100 children in the state's mental hospitals and thousands in other locked facilities, in a class action lawsuit demanding wrap-around services. In New York, a class action lawsuit on behalf of hundreds of children that suit says are stuck in institutions is expected to soon. At any time, the state has a waiting list of about 200 children who need residential treatment, the plaintiffs. say, and has failed to create enough community services for them.
    With waits of 6 to 12 months, "Children are really suffering," said Nancy Rosenbloom, staff lawyer at the Legal Aid Society, which is bringing the suit. "There are children at home getting no services; children in foster care not getting mental health services; children in the hospital who don't need to be in the hospital and children in jails and prison are there because judges feel they need some kind of residential care. In Massachusetts, the threat of a similar suit has been brewing; the state has been negotiating with patients' advocates, who sent notice of their intent to sue a month ago.
    Compared with other states "Massachusetts has tons of group homes," said Steven Schwartz, executive director of the Center for Public Representation, which would bring the suit. "We have more hospital beds than most states. What don't have is a home based support that allows people to leave hospitals for home. That's why, we have the problem of stuck kids." And the real number of stuck children in Massachusetts alone is probably in the thousands, Mr. Schwartz said, if those stuck in state hospitals and other facilities, not only private hospitals, are counted.
    As for the 16-year-old girl with the bipolar disorder, she needlessly spent about four months in the hospital crying to her mother on phone, "You've got to get me out of here !" She finally did get out of the hospital last week, but not to go to a residential treatment program. She simply went home, despite her mother's misgivings. "I finally had to get her out myself," her mother said, "She would still have been there."

Progress Made at Sex Predator Center, Monitor Finds
Sam Skolnik, Seattle Post-Intelligencer- 7/10/2001

TACOMA -- The court-appointed monitor assigned to gauge conditions at the state's Special Commitment Center for sexually violent predators said yesterday that it had made "significant progress" in treating its 140 residents. Special Master Dr. Janice Marques, testifying on the first of what likely will be several days in U.S. District Court, said the lack of a halfway house for those released from the center was "the most important piece of unfinished business." The plan for a halfway house, passed into state law three weeks ago after several attempts, calls for temporary and permanent housing for prisoners freed from the center, so that they can be slowly acclimated back into society. Since the center's founding in 1990, the government has civilly committed to it chronic rapists, child molesters and other sexually violent predators -- people deemed not sufficiently treated and a danger to society -- after their prison terms have expired.
    In 1994, Tacoma-based U.S. District Judge William Dwyer agreed with complaints of inadequate treatment by center inmates and issued an injunction against the program. Dwyer has threatened to fine the center up to $3 million unless it made several improvements to its treatment programs. The center must not be strictly punitive -- like a second prison term -- and must not be indefinite, he ruled.
    If anything, the center should be fined more money, said John Phillips, an attorney for the sex offenders. He said the state was warned to have a halfway house up and running by yesterday's hearing. Phillips said the plan for the McNeil Island halfway house, the temporary version of which will be open in October, would fail to provide a "continuum of care" for released inmates. "In short, it isn't here yet, and when it arrives it will too little and too limited," he said yesterday.
    In her testimony, Marques slapped the center for still failing to meet certain standards regarding treatment, pinpointing flaws in training, resident monitoring and oversight, among other things. But overall, the psychologist said she is satisfied that the center has been moving in the right direction. "I'm not displeased," Marques said afterward. "I'd say there has been significant progress."
    Lawyers for the state said the center has improved substantially, and that the threat of fines should be lifted. Further, they submitted that they had tried to find a site for a halfway house on mainland Washington, but that "hysteria and NIMBY-ism" -- the "not in my back yard" syndrome -- in several cities denied them the chance to place the house in a "normal" residential location. While not ideal, placing halfway houses on sparsely populated McNeil Island -- where the commitment center is located -- "really is a big advance," Senior Assistant Attorney General Lucy Isaki said. U.S. Magistrate John Weinberg is presiding over the hearing instead of Dwyer, who is ill. He will make his recommendation to Dwyer, who in turn will rule later this summer.

A Ravaged Musical Prodigy At a Crossroads With Drugs
Amy Waldman, New York Times- 7/10/2001

The judge in State Supreme Court in Manhattan stared sternly through her glasses at the defendant, whose body trembled. "You have been around this planet for along time, and you've been using drugs for a fairly substantial amount of time as well," she said. "What I want is for you to go and get some help with this problem." She was giving Gil Scott-Heron a choice. He could go into a lengthy drug rehabilitation program. Or he could go to state prison.
    Mr. Scott-Heron, the musician, writer, spoken-word poet and activist whose politically pointed lyrics in the 1970's helped give rise to rap, reached a crossroads on July 2. After years of reports about his drug use, and after 10 days in jail, the gaunt 52-year-old pleaded guilty to felony possession of cocaine, and agreed to face either a treatment program or prison in September. In return, Mr. Scott-Heron, the onetime prodigy whose albums full of anthems about race and economics, love and addiction, have found fans across several generations, was allowed to leave the country for a European tour that was already supposed to be under way.
    That moment of courtroom reckoning has inspired dismay among friends who see him as a victim of punitive drug laws, hope among others who want him to get help, but little surprise. Mr. Scott-Heron has always denied having a drug habit, and continues to do so, adamantly. "Most of the people who comment, I've never smoked a joint with," he said. But friends, relatives, fans and professional associates have concluded differently. Cocaine, they believe, particularly crack cocaine, has had him in its grip for years.
    His body, if nothing else, would seem to give him away. His cheeks are sunken, many of his teeth gone, his physique emaciated, his deep, rumbling voice sometimes slurring into unintelligibility. A reviewer described him as "a raggedy old man." A fan wrote on the Internet last week: "Life, and the elements within, has beat the brother down pretty bad, as many of you who have seen him perform recently will attest."
    Mr. Scott-Heron is certainly not the only famous person to battle addiction, or even the best known. His case, like that of Robert Downey Jr. or Darryl Strawberry, shows how fame adds an excruciating public cast to private disintegration, but also how it can insulate a person against the worst consequences of his habit. Drug user or not, Mr. Scott-Heron is still a profitable commodity to many people, whether promoters, publishers or bandmates, who know that to confront him about his drug use could mean losing his favor.
    Mr. Scott-Heron said in an interview last week: "The people who have the most access to me -- people who I've played music with for 20 years -- the fact, that they're still around, either they have the I.Q. of a plant or I don't have a problem." He had pleaded guilty, he said, only because he had to keep his tour commitments: "I had to say what I had to say to go where I needed to go."
    When Mr. Scott-Heron began his career with an explosive brilliance, there was no hint that a judge would be deciding his fate 30 years on. Born in Chicago, raised in Tennessee and New York, he won a scholarship through his writing to the prestigious Fieldston School in the Bronx. He went on to Lincoln University in Pennsylvania and at 19, wrote his first novel. At 21, he released his first album, which included the iconic "The Revolution Will Not Be Televised." He was, wrote Nat Hentoff, the music critic, a "protean phenomenon.
    He set angrily political poems about black pain and what he regarded as American hypocrisy to funk. He wrote of the race into space in "Whitey on the Moon":

A rat done bit my sister Nell.
(with Whitey on the moon)
Her face and arms began to swell.
(and Whitey's on the moon)
I can't pay no doctor bill.
(but Whitey's on the moon) ...

    He penned lyrics about Watergate, illegal immigrants, and, in one of his biggest hits, "Johannesburg," apartheid. He rapped about Ronald Reagan in "Re-Ron-." And he empathetically addressed addiction's cost and chokehold. "You keep sayin' kick it, quit it, kick it quit it! God, did you ever try to turn your sick soul inside out so that the world could watch you die?" he wrote in "Home Is Where the Hatred Is." People said hearing his music changed their lives. In 1975, he was the first artist signed to the Arista label, where he made 11 albums. He was seen as a legend in the making.
    Today, although rappers like Chuck D of Public Enemy cite his early work as a major influence, he is seen as someone who did not make it as far as his talent merited. Many artists become less productive or reliable over time even without drugs, and many struggle with record labels, as Mr. Scott-Heron has. (He was abruptly dropped by Arista in 1985.)
    But it seems likely that drugs also squandered some of his promise. Since 1984 he has produced only one new studio album, the 1994 "spirits." He has continued to tour regularly, and sell out often, but also has earned a reputation among fans and promoters for failing to show up for performances. And he has been arrested on drug charges in England, Canada and Australia as well as New York. "Has anyone seen Gil Scott-Heron?" one fan wrote on the Internet after Mr. Scott-Heron did not appear for a performance. Another fan wrote, "This happens a lot when Gil is supposed to play," adding, "Go and see him before it's too late."
    Still, Mr. Scott-Heron has maintained enough function, including writing a nonfiction manuscript that he says is 800 pages, to cite it as evidence that he is not a regular drug user. "It's hard to have a habit when you're working all the time," he said in an interview at the apartment where he has been living in a drug-infested part of Harlem. Prickly when the subject of drugs arises, he is otherwise charming and funny. An avid sports fan, he said of the Mets, "I think they're having a worse year than I am."
    To his younger half brother, Denis Heron, that ability to get by is the problem. "I guess we were hoping he would hit bottom, and we could jump in," Mr. Heron said. "But he's a survivor. He's learned how to hover right above crashing." The challenge that Mr. Scott-Heron's situation has posed for his family, friends and the criminal justice system is if, and how, to force help on someone who not only does not want it, but denies he needs it. I sort of lost interest," said Mr. Heron, who barely sees his brother anymore, adding that he saw nothing to do, "short of grabbing him and throwing him in a room and saying one of us isn't walking out until we're both sober."
    In the end, Justice Carol Berkman of State Supreme Court,did resort to coercion, threatening prison to force treatment. "He didn't want to do this, he had to be pushed," said Mr. Scott-Heron's Legal Aid lawyer, Robert Kitson. "He had to be put in jail and threatened with the end of his tour before he went into rehab."
    Outside the courtroom, the person pushing the hardest has been Mr. Scott-Heron's former girlfriend Monique de Latour. She has confronted his bandmates for their failure to act. She has urged promoters not to book him, saying that supplying him with cash supported his habit. She has pressed prosecutors to put him in treatment. And last Monday, she faxed Justice Berkman a letter arguing for rehabilitation, not prison. Many of Mr. Scott-Heron's friends see her as a woman scorned venting her fury. They say she is trying to ruin his life, and that she has betrayed him by publicly discussing his drug use and helping ensnare him in the criminal justice system. "Everyone knows about his problem," said Barry Roberts, the manager of Mr. Scott-Heron's sometime musical partner, Brian Jackson. "But calling the police on him does not get him help."
    Ms. de Latour is "vicious and malicious," said Alistair Abrahams, Mr. Scott-Heron's manager in Europe, who was busy last week trying to reassemble the pieces of a tour. Mr. Scott-Heron said he had not seen Ms. de Latour in 18 months, and called her a "very unhappy woman." Ms. de Latour, an artist whom Mr. Scott-Heron met in Australia in 1995, is undeterred. "If they want to blame me, that's fine, if it's going to get Gil some help," she said. His bandmates "think he needs to be on stage, whatever it takes," she said. "My point is, he may drop dead next week, and then you won't have anyone to be on stages."
    His bandmates talk not about drugs, but about Mr. Scott-Heron's generosity. Larry McDonald, who plays in Mr. Scott-Heron's band, Amnesia Express, said, "No matter how people perceive someone with problems like this, he is one of the nicest people I've ever been around, and probably the closest I've come to working with true genius."
    Mr. Scott-Heron's case poses a question: does friendship means helping someone to live as they wish or forcing them to live as they should? Some friends see drug use as a personal choice. "I think someone should be free to do to themselves what they wish," said Jamie Byng, the publisher of Canongate Books, which is reissuing Mr. Scott-Heron's novels and poems in the United States. He blamed "the absurd war on drugs" for Mr. Scott-Heron's plight. Mr. Scott-Heron's lawyer agreed, pointing out that his client now has a felony on his record for possessing 1.2 grams of cocaine.
    Mr. Byng did say that he has so worried over Mr. Scott-Heron's health over the years that he feared getting a call saying he was dead. But, he and others said, it was not their problem to solve. "I didn't realize that playing God was something I was supposed to do," said Larry Gold, the owner of S.O.B.'s, the club in Manhattan where Mr. Scott-Heron often plays.
    Some argue there has always been a connection between drugs and art. And some wonder how sobriety would affect him. It is hard to assess Mr. Scott-Heron's creativity now, because so little of it has been made public of late. The success of an 18-to-24-month rehabilitation program, the length the judge suggested, is hard to predict. Long-term treatment is considered the most effective, but coerced treatment has yielded mixed results. Last week, Mr. Scott-Heron, overjoyed to be free, and free to tour, seemed unconcerned. In September, he said, he would try to persuade the judge that she had been wrong about his history. If not, he would agree to her conditions -- whether rehab or prison. Asked if he had ever been in a program before, he replied, "I was on 'Saturday Night Live."'

Sister's Mental Illness Made her Father a Victim
Pamela Butler, Grand Rapids Press- 7/8/2001

At the end of my victim's statement for my sister's sentencing, I played a message she left on our answering machine in the fall of 1999. She was yelling at me for hanging up on her. She finished with "you don't have to be my sister anymore, goodbye!" I thanked her face-to-face at her sentencing for releasing me from that impossible job. Nothing with Susie was ever easy. Our Dad's death, by her hand, brought our relationship to a tragic end. My husband and I live in Traverse City. My visits to Grand Rapids were during the day, and my sister slept during the day and was awake at night. Most of my contact with her in recent years was by phone. Our three-hour phone calls would leave me exhausted and scared. History was repeating itself. Our mother was bipolar, and I know how manic sounds. By the content of our conversations, it was easy to see Susie's personal life was spiraling downward.

Looking for help
My sister needed help. I started looking for help by talking with anyone I could think of who knew the mental-health system. This is what I was told: First, an adult with a severe mental illness is to seek help themselves. But often, the nature of their illness prevents them from seeing they need help. Susie would explain her symptoms by telling me, "I am just depressed" or "I am just angry" or "I am just lonely." She felt she was fine and the rest of the world was mentally ill. We were to change, and accept her as she was. I believe Susie enjoyed the power her illness gave her to control others. Even her threats of suicide were another form of control. The second in line to seek help is the person with the closest contact, preferably living under the same roof. In our situation, this person was incapacitated by fear. My sister's partner was so worn down by Susie's physical and verbal abuse she was unable to take the necessary steps.
    If the first two steps don't happen, you wait for imminent danger. This is Russian roulette with your loved one's life at risk. Susie was on a "hunger strike." She had lost half her body weight in a year. We also knew she was threatening suicide and was abusive to her partner. Susie kept a loaded gun hanging by her bed. If you're lucky and no one dies before you can show imminent danger, you can get an involuntary commitment order. Only when Susie was arrested for holding a gun on her partner and calling 911 herself to have her partner removed from their house, did we get that opportunity. She was transferred from jail to Forest View Psychiatric Hospital.

The patient's rights
Even when there is court-ordered hospitalization in place, patients have the right to sign themselves in on a voluntary basis instead. Our hopes were dashed. She was only there a week, when Dad was informed she would be released soon. Susie had never been hospitalized before. She was obviously a danger to herself and others. There wasn't enough time to even get her medications regulated. She told her treatment team she was just depressed over our mother's recent death. Her family knew better. We thought we would be able to speak about our concerns at a scheduled hospital hearing. Susie deferred her hearing.
    I've been told that these hearings are considered expensive and a lot of trouble for the hospital and for an overloaded court system. Now, as I look at the hours spent on this case, the cost of my sister's jail and prison time, the bad publicity for Forest View, a big step backwards in the battle against the stigma connected with mental illness, three psychological evaluations for Susie in jail, and the emotional toll it has taken on my family, my guess is it would have been less trouble and less expensive to have had full disclosure at a hospital hearing back in December 1999.
    After a short hospital stay, a Band Aid on an open wound, the patient is released with a promise to follow-up with treatment. My sister, who always used the word "defiant" to describe herself, promised to comply. Susie was at Forest View two weeks and two extra days on a suicide watch. I will never know if a longer stay would have made a difference in my sister's mental health or saved my father's life.

Afraid of his daughter
I do know that my father was shamed into taking his adult, abusive daughter into his home. He told her treatment team he was afraid of her. He was told his choices were take Susie in, or she would be out on the street in December. I left messages on her caseworker's machine knowing he was the one responsible for finding a suitable placement for her, that Dad's home was not suitable. Dad was 83 years old with multiple health problems. Mother had just died before Thanksgiving, and for years he had been caring for her. I was begging for my father's life on an answering machine.
    With Susie in Dad's home, we were back to square one. The pattern of behavior Susie had with her partner, she repeated with our dad. She was isolating him, depriving him of sleep, abusing him. He would not leave her. My sister had him convinced she would kill herself if he abandoned her. Everything that we told the staff at Forest View would happen, did happen. Waiting for imminent danger this time was deadly. Over the past two years, I've heard the expression, "the pendulum has swung to far in the other direction" over and over referring to the state of mental-health care today. My sister was able to systematically destroy a 23-year relationship with her partner, a relationship with me and my family, her father's life and her life. The only thing protected until now was her right to stay mentally ill.

The voice of the families
I believe something so basic might have made a difference for my family. The families of the mentally ill should have an equal voice. When we talk of patterns of violent behavior, please listen. With my sister, there were "red flags" everywhere. Her treatment teams, while at Forest View and after her release, were informed of her abusive ways. My hope is the people involved in my sister's treatment remember Robert Courtright and the pain they caused him and those who loved him by placing a time bomb in his home. It is too late for my family, but there are many more families like ours. Please make some changes when violent behavior is part of the equation. Families have knowledge that would be helpful in treatment, and they need some help dealing with their family member on a daily basis. We are not the enemy. Mental illness is.
    I also believe that those who are mentally ill and violent should lose their right to defer the hospital hearing. An impartial judge should decide the length of a patient's hospital stay based on the evidence presented. At that time, the court should have the option of ordering a psychological evaluation. My sister refused an evaluation. How do you treat someone effectively without that information? All you have to do is read a newspaper, watch television or count the mentally ill "re-institutionalized" in our prisons to know something is broken and needs fixing. The pendulum needs to be stopped. Let it rest in the middle.

California HMO to Reward Doctors for Patient Satisfaction
Brian Rooney, ABC News- 7/10/2001

L O S A N G E L E S— In what may herald a major shift in health care, Blue Cross of California announced today that it would stop rewarding doctors for cutting costs, and instead give them bonuses based on patient satisfaction. With 2.2 million members and 20,000 doctors, Blue Cross is one of the largest health maintenance organizations in the nation to have taken such a step.
    Under the new system, Blue Cross will survey patients about their physicians, asking questions such as whether they had all the care they needed and whether they liked the doctor's manner. The doctors will receive bonuses of up to 10 percent based on the surveys. Blue Cross will also grade the doctors on whether they give preventive care and whether they are successful in persuading patients to stop smoking. The HMO believes the system will lead to happier doctors and patients. "Physicians working with managed care are more satisfied when their rewards are linked to quality, rather than cost containment," said Michael Bellman, a Blue Cross vice president. "And there is also work to suggest that satisfied physicians have satisfied patients."
    Under the traditional system of managed care, doctors who order fewer tests, deny some procedures or even limit patient visits, receive a bonus for saving money. Critics say such bonuses encourage doctors to skimp on patient care. Some advocates of health-care reform portrayed Blue Cross' move as an admission that offering bonuses for cutting costs was a bad system. "This validates what we've been saying about HMO abuses," said Sen. Edward Kennedy. "We welcome the fact that one HMO takes this action."
    Blue Cross officials acknowledge they had enough dissatisfied patients to warrant changing the way they do business with doctors. But they hope this will be healthy for their own bottom line as well. "We believe that if you promote improving the quality of the care that's being delivered and improving patient outcomes, that will result in cost-effective care," said Dr. Robert Crocker, a senior vice president of Blue Cross.  Despite the new incentive to please patients, Blue Cross has not changed the flat fee system by which it pays doctors, a system critics say will still encourage doctors to skimp on care. "They're still prepaying doctors to provide care. The less often you come, the less sick that you are, the more money the doctor makes. So there's still a very big incentive to keep costs down, which means providing you less care," said David Feinberg, author of Don't Let Your HMO Kill You.

Study: Childhood Stress Could Impair Cognitive Abilities
Will Dunham, ABC News- 7/10/2001

Neglect and abuse during early childhood can cause memory loss and impaired cognitive abilities later in life by boosting the production of a hormone that harms the brain's learning and memory center, scientists said Monday. In an experiment involving laboratory rats, researchers at the University of California at Irvine's College of Medicine showed that these stress-related dysfunctions were caused by a brain hormone called corticotropin-releasing hormone (CRH). Until now, scientists had assumed that steroid stress hormones produced by the adrenal glands were responsible.  Dr. Tallie Baram, who led the study, said pinpointing the mechanism at work could lead to new types of treatments for stress-related damage to the brain. The study appears in the Proceedings of the National Academy of Sciences.
    The researchers studied what happened in the brains of rats in an attempt to gain a better understanding of how stress in early childhood, including emotional neglect and abuse, produces enduring negative consequences in people. "It's been shown in children and infants and also in animal models that chronic, early-life stress leads to a decline in cognitive function, particularly cognitive function that's related to the part of the brain called the hippocampus," Baram said in an interview. "That part of the brain is responsible for learning and memory. What's been really not clear is how that happens."
    Baram's team used a single injection of CRH, a hormone that regulates the nervous system's responses to stress, to mimic early-life stress in rats that were about two weeks old. The rats given the injection experienced significant brain cell death — a loss of between one-tenth and one-fifth of the cells in a section of the hippocampus associated with stress-related damage. Rats injected with the hormone were less able to perform spatial memory and object-recognition tests later in life than rats that did not receive the injections. While the injections were given only once early in life, cell death in the hippocampus and memory problems worsened with age, the study found.
    "What we are finding is that not only are we killing cells in the hippocampus, but there's also reorganization — new connections to the existing cells that make them more vulnerable," Baram said. "We create, if you will, a vicious cycle in which stress early in life can have very persistent effects throughout life." The researchers ruled out steroid stress hormones — whose levels shoot up during stressful events — as responsible for the cell death. They said rats that had been altered to prevent them from producing these adrenal hormones still showed the memory loss and cell death produced by the CRH injection. Baram said if scientists can find a method to block the impact of CRH on the brain, it would be possible to create new ways to prevent cognitive impairment later in life when treating certain human stress-related disorders.

Doctors Keep Own Depression Hidden
Patricia Wen, Boston Globe - 7/10/2001

The leaders of their profession have tried for years to convince the public that mental illness is nothing to be ashamed about. But some psychiatrists go to extremes to hide their own treatment for depression, including prescribing Prozac or other drugs for themselves. A recent study in Michigan showed that four out of every 10 psychiatrists said they would consider self-prescribing to treat minor or moderate depression, largely to minimize records of their condition. About 16 percent said they had self-prescribed drugs for depression in the past, though such actions are widely regarded as a professional no-no, and, in some cases, a breach of state medical licensing laws.
    ''Psychiatrists, like all other people, don't want mental illness to come up as an issue in their lives. They don't want people to know about it.'' said Dr. Richard Balon of Wayne State University in Detroit, co-author of the survey, which was presented at the annual meeting of the American Psychiatric Association. The stigma attached to mental illness was underscored in late June when drug maker Eli Lilly and Company inadvertently released the e-mail addresses of 600 people taking the antidepressant Prozac. The mistake - a result of a mass e-mail to people taking Prozac on which all the addresses were listed - provoked outrage among both patients and civil libertarians over the violation of privacy.
    Balon's study, released in May, provides the first statistical data to back up what has been known anecdotally for years in the psychiatric community, and it triggered calls for more professional training on the issue. Several local psychiatrists say they have known of colleagues who have self-prescribed pills, grabbed samples, or relied on physician friends to get drugs in order to keep their mental illness from medical or insurance records.
    The practice of self-prescribing underscores just how powerful and enduring is the stigma over mental illness, even as society is awash in news accounts of how common the condition is. Well-known Americans such as Tipper Gore, television journalist Mike Wallace, and actor Drew Carey have gone public with their battles over depression, yet that doesn't stop the widespread belief that anyone with a record of mental illness will face discrimination in jobs or insurance. The Michigan data echo previous studies that have shown that self-prescribing is common among many physicians from their earliest years in practice. A 1998 study found that half of all resident physicians in four medical schools reported self-prescribing everything from antibiotics to sleeping pills to antidepressants, sometimes from the sample closets.
    Dr. Jason Christie, a co-author of the study, said many harried physicians are driven by convenience, and giving oneself penicillin is not the same as Prozac. ''The truth is, few people worry if you get a little asthma medicine or antibiotics for yourself. That's not regarded as a big deal,'' said Christie, a pulmonary specialist at the University of Pennsylvania School of Medicine. ''But where's the line? Is it antidepressant medicine?''
    Dr. Edward Khantzian, a psychiatrist in Haverhill and Belmont, said he has personally known a half-dozen physicians who self-prescribed some kind of antidepressant or antianxiety drug to treat a mental disorder. In the case of psychiatrists suffering from depression, the need for confidentiality drives most of the self-prescriptions. In the Michigan study, which focuses on the anonymous responses of 567 physician members of the Michigan Psychiatric Society, about 60 percent said their willingness to self-prescribe was to avoid a permanent insurance record. The study did not specify other reasons, but some psychiatrists speculate the reasons have largely to do with convenience.
    In Massachusetts, doctors risk an inquiry into their medical license if they expose patients' medical or psychiatric conditions. In applications, they are asked if they have any medical condition they believe impairs their ability to practice medicine. Some psychiatrists choose traveling far away to protect their privacy. One New England psychiatrist drives three hours to get treatment in a place where the therapist is unknown, said Betsy Mahoney, project director of the medical information privacy project at the Civil Liberties Union in Maine.
    ''I'd like to think we psychiatrists understand all the issues and see ourselves as role models,'' said Dr. David Osser, president of the Massachusetts Psychiatric Society. ''If we had some kind of mental difficulty, we could show how people can cope successfully with this disorder on a high level. But I don't see clear evidence of this. Psychiatrists are still worried that people will perceive them as less functional if they have a mental disorder.''
    As a result, psychiatrists may also fear the potential loss of referrals, say some mental health specialists. While few would discriminate against a cardiologist revealing heart disease - perhaps even thinking it enhances their practice - some patients may fear that a psychiatrist dealing with even a mild depression cannot focus as well on the patient's emotional issues. ''It's perverse,'' Mahoney said. ''But psychiatrists are in one of the few medical specialties where you are discriminated against if you have the disorder you treat.''
    Medical associations also advise physicians against treating friends and relatives, believing it's difficult to be medically objective in these cases as well as when treating oneself. The Michigan study showed that 46 percent of psychiatrists would treat a friend or relative for mild or moderate depression. Psychiatrist Kim Rawlins of Brookline said she thinks some psychiatrists may treat friends or relatives out of compassion, knowing that is the only way the troubled person will feel comfortable enough to get treatment. It is not, she said, always driven by confidentiality issues.
    In some cases, physicians can legally prescribe medication for themselves. The federal government allows each state to decide what medications can be self-prescribed. In Massachusetts, a physician is prohibited from self-prescribing any drugs listed in schedules 2 through 4, which generally describe the addictive narcotic-type drugs. They also include antianxiety drugs, such as Valium and Xanax. Most antidepressants including Prozac, are considered non-addictive and doctors can legally self-prescribe them, though they are advised not to, said Nancy Achin Sullivan, executive director of the Board of Registration of Medicine in Massachusetts.
    Records show that, of the 68 doctors disciplined since January 2000, seven of them, or 10 percent, had prescription-related violations, mostly having to do with addictive substances. Several psychiatrists say the problem of self-prescribing illustrates the need for mental health care providers to be vigilant about the vulnerability of the psychiatric profession. ''It surprises me the large percentage of psychiatrists who have departed from what has been drummed into us from our medical school training,'' said Dr. Charles Welch, psychiatrist and president-elect of the Massachusetts Medical Society. ''Any doctor who treats himself has a fool for a doctor.''