Four Vermont Psychiatrists Honored for Speaking Out
Associated Press, 10/13/2002

BURLINGTON, Vt. -- Four Fletcher Allen Health Care psychiatrists have won a national award for working against a plan to move the hospital's mental health unit despite fears it could cost them their jobs. Drs. Richard Bernstein, Paul Newhouse, Terry Rabinowitz and Scott Waterman will receive the American Psychiatric Association's 2002 Profile in Courage Award at a ceremony in November in Washington, D.C. The award, established in 1996, recognizes American Psychiatric Association members who risk their personal or professional status to take an ethical stand in the name of good of patient care, according to the association.
   The psychiatrists testified in May hearing that health care regulators should not allow Fletcher Allen Health Care to move its mental health ward to Colchester. Former Fletcher Allen Chief Executive Officer William Boettcher had said the psychiatric unit's move was ''not up for negotiation.'' Rabinowitz and other doctors have said they felt their jobs would be at risk if they spoke out against the project.
   Fletcher Allen management proposed in 2001 moving its aging mental health unit from the main medical center in Burlington to the Fanny Allen campus in Colchester. The plan met fierce opposition from legislators, activists and patients. The debate came to a head in May when hospital management asked a panel of regulators to recommend that the state issue Fletcher Allen a permit for the move to Colchester.
   The doctors told regulators the move could put psychiatric patients dangerously far from medical care, stigmatize patients and hurt the hospital and the medical school's ability to recruit faculty and students. Opponents credited the doctors' testimony with tipping the scales. Regulators recommended against Fletcher Allen's plan and the proposal was withdrawn soon after. The hospital has indicated it will build the psychiatric unit on the main campus in Burlington.

Instability Looms For Debt-Heavy Magellan Health
Bill Brubaker and Sabrina Jones, Washington Post- 10/14/2002

Like many psychologists in the Washington area, Rona M. Fields has been closely following the deepening financial troubles of Magellan Health Services Inc., the largest mental health care provider in the United States. Fields said she is concerned that many patients may go untreated if Magellan no longer can pay its bills. The company's debt totals $1 billion. And she is worried about herself. "I'm owed $65,000," she said, for services supposed to be paid by Magellan or the health insurers that hire it to provide mental health services. According to Magellan, it has been paying about 98 percent of its claims on time and Fields is owed no more than $2,500, at least from the company. But billing conflicts with a psychologist are the least of its concerns.
   Magellan, which has helped revolutionize how mental health is paid for and delivered to millions of Americans around the country, has deteriorated financially in a very short time. If it is forced to stop operating, which providers and industry analysts say is a possibility, mental health providers worry that necessary patient care could be disrupted. The Columbia company is making payments on its debt, but officials acknowledge that it will likely be in technical default on its bank agreements in January, in which case banks could demand full repayment. Magellan and its Wall Street advisers are working on a plan that would restructure the company's balance sheet, but as yet have not publicly discussed bankruptcy. The company's stock closed Friday at 4 cents a share in over-the-counter trading, down from more than $11 last November. It was delisted last week from its perch on the New York Stock Exchange because of its low trading price.
   "Magellan's going to go under, and it's going to be a very big disaster for an awful lot of people," Fields said, echoing predictions made by other providers in recent days. But regulatory officials in Maryland, Virginia and the District said last week that Magellan's patients will be treated and that providers will be paid even if the company's problems worsen. "The health insurance companies that contract with Magellan would have the ultimate responsibility to make those payments and provide continuity of care," said Steven B. Larsen, Maryland's insurance commissioner.
   As a third-party administrator, hired by major insurers such as Aetna Inc. and CareFirst Blue Cross Blue Shield, Magellan is not regulated directly by the agencies that oversee the insurance business in Maryland, Virginia and the District. The insurers ultimately are responsible for the actions of their subcontractors, regulators say. Magellan says it covers 2.3 million people with 4,508 providers, including psychiatrists, psychologists and social workers, in these three jurisdictions alone. In addition to health insurers, Magellan has contracts with employers, such as Unisys Corp. and the U.S. Postal Service, to manage employee assistance programs.
   Larsen said he has confirmed with local insurers that they have sufficient reserves to cover any Magellan-related claims. "If Magellan got to the point where it couldn't pay doctor's bills, for example, the HMOs would be required to pay the physicians, and the HMOs would have to take whatever steps are necessary to ensure continuity of care," Larsen said. He quickly added: "This is not to say there might not be disruption if Magellan ran into more severe problems."
   Magellan's chief executive, Daniel S. Messina, declined repeated requests by The Washington Post for an interview over the past week. And company spokeswoman Erin S. Somers declined to address speculation among financial analysts and mental health providers that the company may file for Chapter 11 bankruptcy protection. "We're not at this point going to lay out what the alternatives are," she said.
   Concerns about how Magellan does business are mounting in the provider community, at least in the Washington area. Paul C. Berman, an officer in the Maryland Psychological Association, said he has received increasingly frequent calls and e-mails from therapists who are debating whether to continue seeing Magellan-covered patients. Berman said the fees that managed-care companies such as Magellan pay to psychologists have dropped over the past decade from about $95 a session to $65 a session. Now some providers say they doubt they'll get paid at all if the company files for bankruptcy. "What I'm hearing from folks is, 'I'm nervous I'm not going to get paid. I'm nervous that Magellan is going to go bankrupt and go belly up,' " Berman said. "There are many consumers who have a problem finding providers because more and more providers are dropping out" of managed-care mental health networks.
   James F. Dee, a psychiatrist in Northern Virginia, said he stopped accepting Magellan patients this past summer after years of administrative hassles. "The specific straw that broke my back," he said, was when Magellan customer service representatives told prospective patients he was not part of their network. "Every time we talked to Magellan, they said, 'You're okay,' " Dee said. "Then we find out that we're not okay. And this was repeated too much."
   David G. Epstein, a Towson psychologist, spoke of waiting up to three months to receive payments after being told the company had never received his claims, even those sent by certified mail. Epstein said he has considered leaving Magellan's network but needs the patients. "I have no love lost for Magellan," he said. He added, "If they end up belly up, there is no reason to believe the other companies that jump in will be more efficient."
   Somers said Magellan has had operational problems in the past, but "we're proud of the progress we've made." She said a recent survey commissioned by Magellan showed that 52.5 percent of providers were satisfied with the efficiency and timeliness of the company's claims payments, up from 41.5 percent last year "We want to make it easier for practitioners to do business with us," Somers said. Indeed, keeping a solid base of providers is crucial to Magellan's tenuous relationship with its creditors. If defections increase, hindering its ability to deliver services, the insurers that hire Magellan could decide to do business elsewhere.
  Magellan covers 68 million Americans in all, including 1.2 million in Maryland, 980,000 in Virginia and 145,000 in the District, according to company data. With revenue of $1.76 billion in fiscal 2001, Magellan serves more than 3,000 health plans, businesses, unions and government agencies among its clients.
   Some analysts say Magellan's financial troubles are the result of the company's failure to adequately manage expenses, higher-than-expected health care costs and an increasingly debt-laden balance sheet. Last Tuesday, Standard & Poor's lowered Magellan's credit rating. On Wednesday, Moody's Investors Service also downgraded the company. "The current financing structure they have needs to be addressed. It's saddling the company with too much debt," said Charles Titterton, a Standard & Poor's analyst.
   "The good news is that we have positive cash flow," Magellan spokeswoman Somers said. Magellan had about $34 million in cash on hand at the end of June, $5 million more than it had a year earlier. "We're working in a very expeditious way to address the financial challenges that we face," she said.
   Magellan's troubles could intensify if it loses the contract with Aetna, its largest customer in terms of members, at the end of 2003. Magellan covers "most" of Aetna's 14.4 million members, Somers said. But Aetna is in a cost-cutting mode and may decide to manage its own mental health services, some analysts say. If Aetna doesn't renew that contract, Magellan "would ultimately be forced to file for Chapter 11," David Schmookler, a credit analyst for Miller Tabak Roberts Securities LLC of New York, wrote in a report last month. "In a bankruptcy scenario, we believe Magellan could lose a portion of its public sector contracts, as states are often reluctant to contract with bankrupt health care providers."
   Thomas H. Shinkle, a debt analyst with Imperial Capital LLC of Beverly Hills, Calif., said Magellan may explore several debt reduction techniques such as finding third-party funding. Magellan's debts include $60 million to Aetna, Somers said. Bankruptcy, Shinkle said, could solve the company's debt problems. "Bankruptcy is simply a tool," he said. "To the parties involved, bankruptcy isn't a negative issue, it's an option. It's a normal route."
   Such speculation doesn't comfort the mental health providers at the core of Magellan's business. "Because of psychologists' concerns about payment, it's possible that their consumers will have trouble accessing services," Berman said. "The patients in the end are the ones who lose." At Magellan's headquarters last week, Somers sounded a cautiously upbeat note when asked about company morale. "We've been through some changes," she said. "Folks respond and react to change in differing ways. As an organization, we're very hopeful. We're looking forward to a long-term solution to the challenges that we face."

Study: Light Drinking While Pregnant Can Affect Children
Dan Nephin, Associated Press- 10/16/2002

PITTSBURGH -- Children born to mothers who drink even small amounts of alcohol early in pregnancy are shorter and weigh less at age 14 than children born to mothers who abstain, a study says. The federal government has long said that no amount of alcohol is safe for a pregnant woman to drink. University of Pittsburgh researcher Nancy Day, the study's principal investigator, said her study reinforces that. ''The message should be that women should not drink at all during pregnancy,'' Day said Wednesday.
   The deficiencies found in the study are slight and fall within normal height and weight ranges, Day said, but were still surprising. The differences also were statistically significant, meaning they were not a matter of chance. ''I had actually thought that the growth deficits would go away after puberty,'' said Day, whose research is reported in the October issue of Alcoholism: Clinical and Experimental Research. Day found that even light drinking about 1½ drinks a week had measurable effects on children years later. Children born to women who were light drinkers in their first trimester weighed about 3 pounds less than children born to abstainers and children born to heavy drinkers weighed up to 16 pounds less than children born to abstainers.
   Since 1982, Day has been studying the effects of alcohol on 565 children whose mothers drank, tracking their progress at various ages. At age 14, physical measurements of the children were studied. Day plans to continue tracking the children into early adulthood and will look at alcohol's cognitive effect.
   Dr. Sandra Jacobson, a psychiatrist at Wayne State University in Detroit, said the study was well-controlled and its findings significant. She is conducting a similar study. ''What's interesting here is the women are not alcoholic and not heavy drinkers and you still can detect the effects of alcohol on their children'' so many years after birth, Jacobson said. ''The concern is, did it also affect any of the neurobehavioral development of the child?''
   Throughout the study, women reduced the amount of alcohol that they drank. By the third trimester, only 4 percent of the study participants said they continued to have one or more drinks a day. ''The longer we study light to moderate use of alcohol during pregnancy, the more evidence we find of an impact at these lower levels of consumption,'' said Dr. Louise Floyd of the federal Centers for Disease Control and Prevention.

Meth Labs Flourishing As Drug Easier To Make
Beth Kuhles, Houston Chronicle- 10/17/2002

The illegal drug "speed," also known as methamphetamine, has seen a resurgence over the last several years. But now, the method of manufacturing the drug has changed, and clandestine labs are turning up everywhere. "Name a place," said Lt. Ken Ariola of the Montgomery County Sheriff's Office Special Investigation Unit. "Motels, in the back seat of cars, in ice chests, in the back of a pickup, in motor homes. Wherever you can think of, they are putting them." Since February 2001, the Montgomery County Sheriff's Department has busted about 50 labs. And a recently formed multiagency task force has shut down 36 labs in Harris, Montgomery, Brazoria and Jefferson counties since beginning operations in March. One of the latest labs was discovered in a home-based day-care center in Trinity County, where three small children were present.
   "It is a very addictive drug," said Department of Public Safety Lt. Lee Ann Groves, head of the federally funded Methamphetamine Initiative Group. The eight-member group is composed of officers from the Texas Department of Public Safety, the Harris County Sheriff's Department, the Houston Police Department, the Immigration and Naturalization Service, and the Drug Enforcement Administration. "The recipes are readily available on the Internet. It's out there," she said.
   Methamphetamine was popular in the 1970s and '80s, when it was manufactured in large-scale operations by motorcycle gangs, Groves said. The drug, which sells for $85 to $100 a gram on the streets, can be inhaled, smoked or injected. It produces a speed rush and a euphoric high and allows users to stay awake. The drug remains in the system for one to two days, and the high lasts from one to five hours, depending on the strength of the drug, Ariola said. In fact, his surveillance crews often can pick out users because they are frantically sweeping, washing clothes, cleaning windows or watering lawns at 2 a.m.
   Demand for the drug is on the increase because of the ease of manufacturing it, Ariola said. "Since it is so fast to make, they are not in it for the money," said Groves. "They make enough to use and a little more to sell to get enough money to buy the chemicals." In the 1970s, the process required 18 to 24 hours, specialized chemicals, laboratory equipment and lots of space. But after laws were passed in Texas that required permits for the chemicals and lab equipment, the operations were forced out of state, Ariola said. Now, new chemicals cut down the time and space needed to make the drug. It takes only a few hours and a space the size of a tabletop to make a few ounces, Ariola said. The labs have made a comeback in Texas over the last five or six years. "It has cut the time to a few hours," Ariola said. "They can get materials for it from local entities. ... The problem is the place needed to bring in a clandestine lab. It can be put in the trunk of a car driving down the road. You can have a tabletop and manufacture methamphetamine."
   The two chemicals used in the manufacturing process, red phosphorous and anhydrous ammonia, are readily available. While national registration requirements have been placed on red phosphorous, anhydrous ammonia is commonly used in welding shops and by farmers as fertilizer, Ariola said. The U.S. Drug Enforcement Administration has begun working to convince many stores to voluntarily regulate the sale of one of the main components of methamphetamine -- suphedrine -- which is found in common over-the-counter cold medications. Farmers' associations are trying to develop an additive in fertilizer that would make the anhydrous ammonia ineffective in the drug-making process, said Groves.
   Another danger in the current manufacturing method is that the process is highly toxic and explosive. Officers who process meth labs must wear protective suits with self-contained breathing apparatus and carry air monitoring equipment. Hazardous-materials companies are called to the scene after evidence is gathered to clean up the sites, Groves said. "They produce lots of waste products," said Groves. "They dump it in the water and in bar ditches. ... It gets in the walls of the house or the doors of the cars. If you stay in a motel room, it can be in the sheets. It is a very contaminated environment." A few patrol officers have suffered lung damage after opening and smelling the anhydrous ammonia in suspects' cars. This led the regional task force to provide training to area law enforcement.
   In addition to the local clandestine labs, regional law officers also are combating a supply from Mexico, which is filtering into Houston via California and Dallas. Mexican labs produce large quantities of the drug because of the lack of any regulation on the chemicals needed to manufacture it. "We're hitting it hard; we're just getting started," Groves said. "This problem is not going away because of the availability and ease by which people are able to make it."

Forensic Psychiatrists: Sniper Is Self-Absorbed Loner
Maryann Bennett, ABC News- 10/18/2002

Psychiatrists say the culprit could be a meticulous narcissist who enjoys playing God. As investigators work with inconsistent eyewitness descriptions of the sniper, and the Bush administration considers the possibility that terrorists could be behind the slayings, psychologists say the shooter is likely a narcissist who doesn't experience any empathy for his victims.
   If the suburban shootings turn out to be the work of a non-terrorist serial killer, the shooter is probably a "control killer," said Alexander E. Obolsky, a forensic psychiatrist at the Health and Law Resource in Chicago. Obolsky says the shooter probably spent significant time planning these crimes in order to get an emotional high. "When the sniper is getting ready to shoot, he is playing God," Obolsky said. "He is looking at his target, a woman or a man, and saying 'Am I going to let you live today or will you die today?' That makes him feel good."
   Jeffrery Smalldon, a forensic psychologist who interviewed convicted Ohio sniper Thomas Lee Dillon, and other serial killers, said it's hard for innocent people to understand what makes serial killers tick. Dillon, the deer hunter who went on to shoot and kill five people between 1989 and 1992, seemed to believe he was someone who should be accorded some special significance, Smalldon said. "I think he was very bored with his life," Smalldon said on ABCNEWS' Good Morning America Wednesday. "He was someone who believed that society wasn't really recognizing him in the way he felt certain he deserved to be recognized," Smalldon said.
   Smalldon said Dillon was not crazy by any legal definition. The psychologist said he concluded Dillon had severe personality disorders and was highly narcissistic. Obolsky says the the D.C.-area sniper could have those same disorders. "The person, or persons if the sniper has a partner, is crazy only in the sense that he does not care about people the way typical people do," Obolsky said. "There is another word for it - evil."
   Forensic psychiatrist Dr. Neal Dunsieth, an assistant professor at the University of Cincinnati, says he doesn't think the recent sniper shootings are linked to someone who is emotionally disturbed in any severe way. "The sniper might have some particular personality traits or be predisposed to strange beliefs, but I haven't seen a lot that points to a mental illness," he said Dunsieth says he doesn't believe the Beltway sniper is someone who is lashing out over a recent traumatic event, such as a firing from a job or a break-up. "This doesn't seem like a crime of passion, it's almost like a military operation," he said.
   When it comes to the tarot card, found by police during the investigation of last week's sniper shooting of a 13-year-old schoolboy in Bowie, Md., Dunsieth says it could be interpreted as a message. "The sniper could be trying to say 'I have the ability to change the social order,'" Dunsieth said. Investigators are not sure whether only one or more people - perhaps a shooter with a getaway driver - are involved in the attacks.
   Inconsistent descriptions of the person who killed the latest sniper victim outside a Home Depot store in Virginia Monday night have left investigators unable to come up with a sketch of a suspect. All of the eyewitnesses do agree that the shooter is a man, police said. Obolsky says the man doing the shooting is probably a loner, with no true relationships. "I would be surprised if this man was socially connected in the sense that he has family and work, although it's possible that he is able to blend into his surroundings," Obolsky said.

Number of Detroit Police Arrested for Domestic Violence Drops
Associated Press, 10/18/2002

DETROIT -- From January through July of this year 30 Detroit police officers were arrested on allegations of domestic violence, according to the police department. Then, in July, Chief Jerry Oliver decided to suspend all officers charged with domestic violence, even misdemeanors. Previously, only officers with felony charges were suspended. Since that decision 10 weeks ago only one officer has been arrested. "Now people are thinking about it, and they're thinking about living a different kind of life if they are going to be a police officer," Oliver told the Detroit Free Press for a Friday report. Officers charged with domestic violence misdemeanors are suspended, but remain on the payroll. Felony charges mean suspension without pay.
   But the Detroit Police Officers Association disputes the department's statistics. "Those numbers are tremendously off," said John Barr, sergeant at arms for the union, who estimated that six or seven officers have faced domestic violence charges this year. Barr also disputed the theory that suspensions could deter domestic violence. "That's like saying the death penalty decreases crime," Barr said. "That's pure speculation."
   Jenny Pappariella works for Turning Point, a Mt. Clemens center that works against domestic and sexual violence. She commended Oliver's efforts, but said threatened suspension may not stop abuse. "I definitely don't want to discourage the chief from making a big deal about this; it's a good thing," she said. "I hope it is helping. But usually those who are going to batter don't think or care about consequences." She said it's possible that officers have told spouses or significant others that they face discipline if arrested.

Increase in Autism Baffles Scientists
Sandra Blakeslee, New York Times- 10/18/2002

Trying to account for a drastic rise in childhood autism in recent years, a California study has found that it cannot be explained away by statistical anomalies or by a growing public awareness that might have led more parents to report the disorder.
But the study's, authors, who reported their findings yesterday to the California Legislature, said they were at a loss to explain the reasons for what they called an epidemic of autism, the mysterious brain disorder that affects a person's ability to form relationships and to behave normally in everyday life. "Autism is on the rise in the state, and we still do not know why," said the lead author, Dr. Robert S. Byrd, an epidemiologist and pediatrician at the University of California at Davis. "The results are, without a doubt, sobering."
   As diagnoses of autism have increased throughout the nation, experts and parents have cast about for possible explanations, including genetics, birth injuries and childhood immunizations. The California study found that none of these factors could explain an increase of the magnitude reported there -- more than triple from 1987 to 1998. Dr. Catherine Lord, a professor of psychology and psychiatry at the University of Michigan who is a leading authority on autism, said it was unclear whether the California findings applied to other states. The Federal Center for Disease Control and Prevention is working in 13 states to look at the apparent increase in autism cases, said Dr. Frank DeStefano, an epidemiologist at the agency. So far, there is no reliable count of autism cases nationwide, since criteria and reporting practices vary from state to state.
   The California study was prompted by a 1999 report from the state's Department of Developmental Services, which reported that the number of children with "full spectrum," or profound, autism had increased by 273 percent, to 10,.360 in 1998 from 2,778 in 1987. The study did not deal with milder forms of the disorder like Asperger syndrome. The numbers were surprising, Dr. Byrd said. The traditional estimate was that 4 or 5 children out of 10,000 might develop autism. Instead, it appeared that 10 children in every 10,000 were seriously autistic, meaning they suffered from a brain disorder that left them unable to speak or compulsively performing repetitive motions like flapping their arms or rocking. After the period studied, the number of autistic children continued to rise, to 18,460 cases as of July 2002, according to the California Depart-ment of Developmental Services.
   In response to the study, the legislature directed the MIND Institute, an autism research center at the University of California at Davis, to investigate. "We wondered if the increase was real," Dr. Byrd said. "Maybe we were doing a better job of finding
cases. Maybe there was an increase in awareness of autism. The movie 'Rain Man' was very popular." California has a system of 21 regional centers that diagnose developmental disorders and provide services to children with them. Dr. Byrd and his team mined these centers for data.
   Researchers sent questionnaires to the parents of 684 children with full-spectrum autism or mental retardation. About half were teenagers, born from 1983 to 1985; the others were ages 7 to 9, born a decade later. If the criteria for diagnosing autism had changed in those 10 years or if the definition had broadened, the mystery would be solved, Dr. Byrd said. But the standards used to diagnose full-spectrum autism were the same in both age groups, he said
   Some people suggested that the centers might diagnose autism so families would receive more generous state assistance. But the centers have no incentive to do so, Dr. Byrd said, since they do not receive more state financing for identifying more children with disabilities. The study also considered whether children in the older group were incorrectly classified as mentally retarded, when they were in fact autistic. But the rate of misdiagnosis was about the same in both groups, Dr. Byrd said. Still another possibility -- that large numbers of families with autistic children had moved into California -- was discarded when it turned out that most children in both groups were born in California. A general increase in population accounted for about 10 percent of the rise in autism, Dr. Byrd said. The rest remains a mystery. There also were no significant differences over time in sex, race or parental education. Parents of the older children were more likely to report mental retardation along with autism, but the finding did not ex-plain the rising incidence.
   About a third of parents in both groups reported that their children began to regress around the age of 18 months, Dr. Byrd said. They suddenly lost the ability to say words and stopped making eye contact. Many parents blame measles vaccination, which is given around 18 months; until recently the vaccines contained a mercury-based preservative that some people believe can cause brain damage in young children. The study found no evidence that the vaccine was the culprit, Dr. Byrd said. Nevertheless, more parents of younger children reported constipation and vomiting, which they attributed to complications from the measles vaccine. Wheat allergies were also more frequent. But none of these differences fully explain the increase in autism cases in California, Dr. Byrd said.
   Parents in the study were asked what might have caused their child's autism. Nearly half the parents in both groups said they did not know. A third blamed genetics; smaller numbers cited immunizations, birth injury or environmental factors. "You can't explain an increase of this magnitude on genetics," Dr. Byrd said. Something else is happening. "We know autism has a strong genetic component," said Portia Iverson, a founder of Cure Autism Now, a research and advocacy group in Los Angeles formed by parents of autistic children. "But we don't know what in the environment is interacting with genes to contribute to this huge increase in cases."

New York Restricts Confinements of Mentally Ill
Clifford Levy, New York Times- 10/19/2002

Officials at state psychiatric hospitals in New York ordered social workers this week to stop sending discharged patients to locked units in private nursing homes. The move ends a six-year-old practice that was supposed to help scale back the state's costly psychiatric system but has raised civil rights concerns. The Pataki administration has allowed as many as a dozen nursing homes to keep discharged psychiatric patients locked away in the units, where they are prohibited from going outside on their own, have almost no contact with others and have little ability to contest their confinement.
   The turnabout comes after the United States Justice Department opened a review of the units to determine whether conditions violate federal laws that protect the rights of people who are institutionalized or have disabilities. The department began the review after an article about the units appeared in The New York Times on Oct. 6. The civil rights issue has arisen because residents of the units had not been deemed by the state to be a danger to themselves or to others and therefore did not meet the typical legal standard used to keep someone in a locked hospital psychiatric ward. The units are not regulated as psychiatric facilities, so the residents do not have the protections of people committed to psychiatric wards: the right to a lawyer and to a hearing, to contest having their freedom taken away.
   Gov. George E. Pataki has repeatedly declined to answer most questions about the units, saying only that the decision to establish them was made by health and mental health officials in his administration. His aids have said that the units are properly operated and regulated, and denied that residents are being confined against their will. Officials at several state psychiatric hospitals in the New York City region, however, distributed memos this week saying the hospitals were no longer allowed to release patients to the nursing homes, according to interviews with the officials and an examination of the memos.
   At the Bronx Psychiatric Center, memos were distributed on Wednesday and Thursday outlining the ban, including the .names of 11 nursing homes prohibited from receiving patients. "This protocol shall remain in effect until further notice," one memo said. At the Manhattan Psychiatric Center, which, according to officials, has sent nearly 10 patients to the units in the last two years, workers received the same announcement. "We were told no more discharges to those places," said one worker, who spoke on the condition of anonymity. Roger Klingman, a spokesman for the State Office of Mental Health, which runs the psychiatric hospitals, denied yesterday that any policies had changed and said that the office still believed that the units were appropriate. Asked to explain the memos distributed at the psychiatric hospitals and the statements by workers about the ban, Mr. Klingman declined to comment.
   The units were first set up in 1996 with no public notice, under an arrangement between the administration and Benjamin Landa, a prominent nursing home operator who is also a major contributor to the Pataki campaign. Mr. Landa would not comment on whether he had been notified by the Pataki administration about the ban, which includes the units at the four homes in which he is a partner. "These are important transitional programs which have positive outcomes for patients, and we would welcome any oversight or regulations," Mr. Landa said in a statement. Mr. Landa was appointed by Mr. Pataki to the State Public Health Council; which has declined to regulate the units. Despite repeated requests, the administration has not released documents describing the council's role in the units' creation.
   The units have allowed the administration to save tens of millions of dollars. Albany spends $120,000 annually to treat a patient in a state psychiatric hospital, and the federal government will not cover any of that. But if that person is discharged to a nursing home, the bill typically goes to Medicaid, and half of it is covered by Washington. So a nursing home patient may cost the state roughly $20,000 a year. There are 4,300 beds in the state psychiatric system, down from 9,000 when Mr. Pataki took office in 1995.
   Democrats, including Mr. Patiki's opponent in the governor's race, H. Carl McCall, have denounced the units, contending that residents are being all but imprisoned. Some advocacy groups for the mentally ill said they were upset that the units were created with no input from outside mental health experts. "There are too many question marks about how these units are operating and why they are segregating residents," said Karen Schimke, a former senior Pataki health official who is now president of the Schuyler Center for Analysis and Advocacy in Albany. "They need to take a step back from them."

Schools Often Overlook Bipolar Disorder in Children
Cindy Horswell, Houston Chronicle- 19/29/2002

Three years ago, Helen Smith found her grandson locked in an empty 4-foot-by-4-foot closet, deprived of food. She then learned that the 11-year-old, Paul Daniel Kilgore, was being routinely confined in the so-called "quiet room" at Harlem Elementary in Baytown in response to his bad behavior. Paul Daniel's family put an end to his confinement that day, but the mystery surrounding his erratic conduct continued. It would take two more years and a half-dozen hospital stays before he was finally diagnosed with bipolar disorder -- a brain disorder affecting mood regulation.
   Psychiatrists now believe Paul Daniel is only one of many children and adolescents who are going untreated for the disorder they say is so often misunderstood, mishandled and misdiagnosed. Between 1 percent and 4 percent of adults have been diagnosed as bipolar, and researchers are beginning to think a similar percentage of children and adolescents may also suffer from it.
   Texas schools were barred by state lawmakers in April from keeping students behind locked doors, but they have not been told how they should handle an uncontrollable child who has a disorder such as bipolar. Many area school districts complain that the boundaries aren't clear on the extent to which educational or medical communities should be responsible for helping a bipolar child. The issue has forced school districts to scrap for more funding and training to handle increasing numbers of these children who walk through their doors. "It's been dramatic ... the increase that we are seeing in the diagnosis," said Kay Pickett of the Conroe school district's special education department.
   When Paul Daniel's behavior initially became disruptive, nobody understood why his moods would swing wildly from giddy mischievousness to angry aggression within the same day. School authorities thought he was bent on being a troublemaker, such as when he trashed the files and desk of his counselor, his family said. "I stayed in that closet most of the time," Paul Daniel, now 14, recalled in a recent interview. "There was nothing to do but sleep on the tile floor. I'd get an apple or a half sandwich for lunch. I didn't like it. I was bad all the time then, but I'm not bad anymore."
   Shelley Swedlaw, special education director for Baytown schools, confirmed that the lock has been removed from the closet. However, she said since his teacher is no longer with the district she could not comment further on the use of the room. The boy's mother, Melissa Buchan, decided this past week to begin home-schooling her son.
   For years, the medical community assumed the onset of bipolar disorder (also called manic-depression) came in early adulthood. Authorities now are increasingly convinced that the disorder can begin in childhood. "There is no question that the bipolar disorder is very frequent in children and adolescents and usually missed," said Dr. Robert Hirschfield, head of psychiatry at the University of Texas Medical Branch in Galveston. The diagnosis can often be overlooked because adults usually switch from the manic to depressive phase over a period of months while children can flit back and forth within the same day, authorities said. "In the last few years, more authorities are starting to recognize that the bipolar disorder can exist in children. Just as they have had to recognize children can be depressed, instead of thinking childhood is this idyllic, trouble-free period of life," said Dr. Karen Wagner, who heads UTMB's Mood and Anxiety Center for Children and Adolescents in Nassau Bay.
   The American Academy of Child and Adolescent Psychiatry estimates a third of the 3.4 million children and adolescents in the United States diagnosed with depression may actually be experiencing the early onset of bipolar disorder. Adults diagnosed with serious bipolar symptoms often report first noticing mood swings when they were children, Wagner said.
   DePelchin Children's Center in Houston, which finally diagnosed Paul Daniel as bipolar, provided crisis intervention for 38 children and adolescents diagnosed with the illness last year. Half of those were under age 14. "You must carefully distinguish between children with the illness and those who may be having normal mood swings for their age or be in a home situation that makes them depressed," said Arlene Fisher, DePelchin's director of behavior and health.
   Bipolar symptoms can include lengthy rages or tantrums, pervasive sadness or thoughts of suicide, impulsive or reckless behaviors, trouble sleeping or concentrating, and racing speech and hyperactivity. Researchers are delving into possible causes of the illness, from chemical imbalances to the brain's wiring. Studies indicate a genetic link: If one parent has the disorder, the child has as much as a 30 percent risk of having it. If both parents have the disorder, the risk increases to as much as 70 percent.
   John Moses of Dallas, who a year ago founded Texas Parents of Bipolar Children, believes schools tend to be reluctant to recognize a child with bipolar condition, choosing instead to see the child as "undisciplined." His 11-year-old son, Justin, was not diagnosed until he was hospitalized with the disorder two years ago. By then, his moods were so erratic that he sometimes slept less than three hours a night, had extreme temper tantrums, and experienced giddy moods during which he set fires and hunted lizards with a flashlight while his family was asleep. Justin now takes mood-stabilizing drugs that have allowed him to move from special education to regular classes, his father said. But not everyone is that lucky.
   Ben Davidson of Nassau Bay fell into such a depressed state of hopelessness that he began writing suicidal letters. In March, not long after penning the letters, the 17-year-old hanged himself. His grandmother, Barbara Sewell, who moved from California to care for him after his mother's death from cancer, says she feels "like a complete failure." But she is also angry with the Clear Creek school district for what she called its failure to acknowledge her grandson's bipolar condition. Lynn Slaughter of Clear Creek's special education program said she could not comment on the grandmother's complaints because student privacy rules prevent it. She would say only that each student's problems are handled on an individual basis.
   Beginning in elementary school, Sewell said, her grandson showed signs of an inability to control his emotions. His frustrations escalated to the point that he once threw a desk across a classroom, but he wasn't officially diagnosed with the disorder until 1998, when he threatened his family with a knife. Juvenile authorities sent him to a residential treatment center in Corpus Christi where the diagnosis was finally made. She said Clear Creek never questioned why he was truant during the six months he received classroom instruction and medical help at the center, except to "ask him to return his school books." When released from the center, he registered at Clear Creek again, but the district was not interested in the diagnosis, his grandmother said. He ended up quitting school and eventually took his life.
   An estimated 20 percent of adults and children diagnosed with bipolar disorder will attempt suicide over a five-year period, and others will become substance abusers to "self-medicate," said Wagner with UTMB's mood and anxiety center. She is the lead investigator on a National Institute of Mental Health study looking into the treatment of bipolar children and adolescents.
   In a recent address to Congress about the disorder, fiction writer Danielle Steel said her son began writing in his journal about thoughts of taking his life when he was 11. Eight years later, he did. Steel testified in support of early diagnosis: "It is no longer good enough to diagnose them in their 20s; they are sick long before that."
   Many educators and parents agree that more training is needed to help teachers recognize common symptoms and possible strategies in dealing with the disorder. That's because students are often mainstreamed into regular classes where teachers have no specialized psychological training. "It would be wonderful to get more training, but finding time to do it can be difficult," said Peg Sherwood, director of instructional support services in the Fort Bend school district. Parents think educators particularly need to be trained to recognize the difference between a bipolar child's willful behavior and manifestations of the illness. For instance, Linda Lamb of West University Place would like to see a suspension for "making a terroristic threat" to blow up the high school expunged from the record of her 15-year-old bipolar son. When his career teacher asked him what he wanted to do, he replied, "Blow up a building" -- but only because he had recently seen one being imploded on the news, Lamb said. Pauline Clansy, manager of psychological services for the Houston school district, said she sympathized with Lamb but that privacy rules prevented her from discussing the case.
   Another problem for parents is obtaining residential treatment for extremely ill bipolar children who may need round-the-clock care. The cost runs from $85,000 to $200,000 a year, state officials estimate. "I don't think you should have to have your kids arrested if they are mentally ill, but I resorted to that to get residential care for my son," said Allene Smith of Sheldon. Medicaid and her private insurance would cover only a short hospital stay for stabilization, Smith said.
   "The police did not want to arrest my teenage son because he was sick. But I insisted," she said. Police found a straight razor on him that he had threatened to use on his sister. He was sent to juvenile detention, which then placed him in a residential treatment center. When he was released last year, his mother asked the Sheldon school district to pay for his continued placement at the center, but the district balked. However, schools are required by law to educate all students, which means that if a child cannot be taught in a regular school, districts sometimes pay for residential care that offers educational services. "I hired an attorney and won," she said. "I don't think school districts should have full responsibility for the high cost, but that's the way it ends up."

Betty Ford Reflects on 20 Years of the Betty Ford Center
Claire Shipman, ABC News- 10/20/2002

Twenty years ago this month, there was a revolution in this country in the way we view and treat substance abuse, and it was called the Betty Ford Center. Named, of course, after the former first lady, the center, located in Rancho Mirage, Calif., has become affectionately known as "Camp Betty." The center's goal is treatment without shame. "Somehow, it was all right for men to kind of kick back and sow their wild oats, but as far as women were concerned it was a real stigma," Betty Ford said. "It's really awesome to me to be at our 20th [anniversary]."
   The center is a haven where addicts are addicts, whether they're the former first lady, the guy next door, or the celebrities who seem to frequent the center. The whole world knows Elizabeth Taylor's been to the center twice, and even met her last husband here. Rocker Stevie Nicks checked in after a concert for cocaine addiction. Ozzy Osbourne got clean at Betty Ford. Kelsey Grammer testified about the center to Congress after he got out. "It takes a sense of community and faith to actually overcome this disease," he told the congressmen. Ford is characteristically blunt about the mixed blessings of celebrity clients. "We're happy that they're willing to talk about it, as long as they stay well," she said. "But if they don't stay well, then it's not a big plus for the treatment of this disease."
   In a day when first ladies gave teas and cut ribbons, Ford weighed in about abortion and the Equal Rights Amendment. She shared her breast-cancer diagnosis and mastectomy with the public. She also suffered excruciating pain from a pinched nerve and started to become addicted to painkillers and Valium, something she didn't realize when she was still in the White House. "I never felt I was addicted to them," she said. "That was not something that went through my head." But it did have effects. "It slowed up the way I talked, and it slowed up the way I thought," she said.
   After the White House, her drinking problem developed and her family finally confronted her, she said. "I was very resentful, yes," she said. "I was very angry but we all came together. And my husband, in a very loving way, put his hand around me and he said, 'You know, Mom, we love you too much to let this happen,' and that is what struck home with me."
   Today, her husband continues to stand proudly by her, and raves about her accomplishments. "I'm very honored and proud to be the No. 2 in the Ford family," the former president said. "I'm Betty Ford's husband." But back when his wife had a drinking problem, Ford said, he was "one of the typical enablers." "I would apologize for being late to a party," he said. "I would cancel engagements."
   The Fords noted that the current President Bush talked openly during the presidential campaign about his former drinking, and are "very proud of the fact that he faced up to the problem," Gerald Ford said. "Everybody has their own personal way of handling those things," Betty Ford said of the current president not dwelling on the question of whether he might have been an alcoholic. "We don't all have to do it in the same way."
   At 84, Betty Ford still runs the center, even dropping by on weekends if a patient needs her counsel. "They're distraught and frightened and very sick," she said. "And then weeks later I see them, and they have a smile on their face, they're looking like a million bucks, and they're ready."
   Elizabeth Anderson, 25, was addicted to marijuana and alcohol. She spent a month in the program last May. "Not only do we have Elizabeth back," said her mother, Janice Stutts. "Elizabeth has her life." "Thank you for being such an inspiration to me," Anderson told Ford. "I appreciate that," Ford replied. "Someone was an inspiration to me, so we just pass it along."

Meth Labs Migrating to Cities and Suburbs
Associated Press, 10/21/2002

MELVINDALE, Mich. -- Illegal methamphetamine labs are migrating from rural counties to the state's suburbs and cities, and law enforcement officers are scrambling to block their spread. Officials say meth -- a highly addictive stimulant made from over-the-counter products -- is trickling into the Detroit area and other cities in southeastern Michigan. A lab bust last spring in Melvindale is seen as a wake-up call for Detroit-area officials. "That really got people's attention around here," state police Lt. Tyrone Mitchell told The Detroit News for a Monday story. Statewide, lab seizures have surged from three in 1997 to 91 last year and 153 since January.
   Police, fire, environmental and health officials are receiving special training. A $250,000 grant covers overtime and interagency cooperation. Pharmacists, who sell products used by producers, are being briefed on evidence of the activity. A statewide hot line takes tips about illicit labs. More than 100 state troopers are assigned to a Methamphetamine Investigation Unit. Just five officers were part of the unit when it formed two years ago.
   Detroit-area officials fear that if the migration of meth into urban areas becomes a deluge -- which has occurred in California, Missouri and Indiana -- local communities will confront another form of addiction and a new pattern of drug trafficking that's hard to combat. "It has the potential of changing the entire way we do law enforcement," said Sgt. Michael Lemmon of the Detroit Police Department. "It would be a major new problem, with a whole new set of concerns." Craig Yaldoo, director of the state Office of Drug Control Policy, likened the battle to eradicating weeds: "The goal is to pull at it and weaken its roots in southeastern Michigan so it will not spread to those suburban and urban communities. It has yet to reach the epidemic levels of some states to the west, but we need to take advantage of that and get out in front of this."
   Officials say every pound of meth creates 6 pounds of hazardous waste. Police have informed Department of Environmental Quality officials that dumping of certain materials might provide evidence of a nearby meth lab. Meth causes increased activity, decreased appetite and a general sense of well-being. The effects of meth can last six to eight hours. After the initial "rush," there is typically a state of high agitation that in some individuals can lead to violent or psychotic behavior.

Addiction Fears Rise About Xanax
Ronald Kotulak, Chicago Tribune- 10/21/2002

At the age of 51, a family physician in a midsize southwestern city joined the ranks of an estimated 4 million Americans who are victims of prescription drug abuse. "I took a Xanax pill that my wife had been prescribed to help her sleep, and I felt normal," said the doctor, who asked that his name not be used. "I didn't feel high, I just felt normal. My anxiety was gone. I was calm. It was a wonderful feeling." The doctor's psychiatrist said "great" and prescribed Xanax for him. But it wasn't long before the doctor found he had to up the dose to retain that feeling of normalcy. When his Xanax supply ran low, he turned to alcohol to supplement its calming effect.
   Xanax, a perfectly legal drug, is a member of the sedative-depressant family of pharmaceuticals known as benzodiazepines, and it is widely prescribed for anxiety and panic attacks. The problem with Xanax is that it is too efficient, according to drug abuse therapists. It is the most potent and fastest-acting of the benzodiazepines, properties that can quickly make the brain become dependent on it.
   "Xanax is one of the most problematic addictions that we treat," said Dr. Dan Angres, director of the Rush Behavioral Health treatment network. "For one thing, it is really very highly addicting. It is short-acting so that you eventually need to be dosed rapidly throughout the day. "The other problem with Xanax is that it is very effective," he said. "If people have a panic attack or suffer from anxiety, it will definitely help their symptoms. The problem is that if one is predisposed to addiction, it is a very addicting drug. It's the crack of benzodiazepines."
   Most people who end up abusing prescription drugs become chemically dependent--the drug becomes entwined with the chemistry of their brain--and they suffer painful withdrawal symptoms when they try to stop. Addiction occurs when a person continually seeks to repeat the euphoric effects of a drug regardless of the cost to career, family, friends or life.
   No one really knows how many people are addicted to prescription drugs. The estimated figure of 4 million is only an educated guess, but there is general agreement that the problem is increasing. "Prescription drug abuse is a major health issue in this country," said psychologist Howard Heit, who treats addicted patients in northern Virginia. "It is a hidden epidemic."
   Experts acknowledge the usefulness of psychoactive prescription drugs, but they say that there is little recognition among physicians or the public of their potential for abuse. "We often see the same pattern with prescription drugs," said Dr. Martin Doot, chief of addiction medicine at Lutheran General Hospital in Park Ridge. "They come out, they are heavily marketed and the abuse liability is typically minimized. When Xanax came out, many doctors were sold on the idea that it was not addicting."
   Xanax, like other members of the benzodiazepine family, is prescribed to produce sedation, induce sleep, subdue panic, relieve anxiety and muscle spasms, and prevent seizures. In addition to Xanax, 14 other benzodiazepines are marketed under such names as Librium, Tranxene, Valium, Paxipam, Ativan, Werax and Centrax. The older, slower-acting benzodiazepines are far less likely to cause dependency or addiction. An estimated 80 million prescriptions are written for Xanax annually. Some addicts refer to it as "alcohol in a pill" because of its ability to calm an overwrought brain. It also triggers the release of dopamine in the brain's reward center to produce euphoric feelings that are very similar to those produced by alcohol.
   The manufacturer of Xanax, Pharmacia Corp., is aware of the problem and warns in the package insert that even after relatively short-term use at the prescribed doses, there is some risk of dependence. The company referred calls about dependency to the federal government's National Institute on Drug Abuse and said that Xanax sales figures are considered proprietary.
   The National Institute on Drug Abuse monitors visits to hospital emergency rooms by people who suffer overdoses, bad reactions, withdrawal or other threats to their health from illicit drugs or prescription drugs used for purposes other than medical reasons. In 2001 there were 638,484 emergency room visits for bad reactions to illicit and prescription drugs. Of all the drugs that were abused, 43 percent were prescription medications. Cocaine, marijuana and heroin headed the list of illicit drugs, while narcotic painkillers (OxyContin, Darvon, Vicodin, Dilaudid, Demerol and Lomotil) and Xanax, along with other benzodiazepines were at the top of the prescription drug list.
   Addiction experts say that taking Xanax for more than eight weeks carries a high risk of dependency. "Xanax is one of the most dangerous drugs to come down from, even including heroin," said Kathy Vinson, director of nursing at Holy Family Substance Abuse Alcohol/Drug Treatment Center in Des Plaines. "It can have life-threatening withdrawal symptoms, like seizures."
   Withdrawal symptoms from Xanax mimic those of anxiety and panic. Patients feel they have to take more of the depressant to quell their old disorder, but in fact they are trying to blunt the physical consequences of their new dependence. "About 10 to 20 percent of our patients are addicted to benzodiazepines alone or in combination with other compounds, usually alcohol or illicit drugs," Doot said.
  Although the street use of Xanax is increasing--especially among people who want to enhance the effect of other drugs, or to help them come down from heroin or cocaine--most abusers are patients who were legally prescribed the drug. "We tend to get people who started taking it for insomnia or an anxiety disorder," said Greg Hayner, chief pharmacologist at San Francisco's Haight-Ashbury Free Clinic. "We've had people come in who got it prescribed for stuff like agoraphobia. "They've been given it for legitimate reasons, and the reason we're seeing them sometimes isn't so much because they've been abusing it outright, but they've had a hard time getting off of it," he said.
   But many people who abuse Xanax and other prescription drugs are not seen in detox units or drug treatment programs. They go from doctor to doctor to get new Xanax prescriptions, try to forge prescriptions or scheme with law-breaking doctors or pharmacists to get illegal supplies. Florida Gov. Jeb Bush's daughter, Noelle, who is under treatment for drug abuse, was arrested in January after being accused of trying to obtain Xanax with a forged prescription.
   When Express Scripts, Inc., a managed-care pharmacy, looked at more than 13,000 women 60 and older who were taking benzodiazepines, they found that more than half were taking the drugs improperly. Nearly 60 percent of these women were taking the drugs for four or more months, a length of time that significantly increases the risk of dependence or addiction.
   For the 51-year-old physician reducing the dose of Xanax was physically painful. His anxiety clawed back, he couldn't sleep and a million butterflies seemed to churn in his stomach, disturbing sensations he now recognizes as withdrawal symptoms. He became both chemically dependent on Xanax and psychologically addicted to it. He chased the ever-fleeting "normal" feeling by taking more Xanax and drinking more alcohol. For four years his life descended deeper and deeper into addiction. "That's when I really started doing some suicidal thinking," he said. "Not that I would ever carry it out, but I really began for the first time in my life to have some concrete plans for how I would end my life."
   Several months ago his wife staged a confrontation in the office of his psychiatrist, who by this time knew his patient was out of control. Faced with a breakup of his marriage and the loss of his medical license, he agreed to go into treatment. He consulted an addiction specialist. "He told me that I was an addict, that I'd become addicted to Xanax. Part of that whole thing was my addictive personality, but it was also misprescribing on the part of my psychiatrist." The physician traveled to Des Plaines where he spent a week in Holy Family Hospital's detox unit to clear Xanax from his brain. He spent a week in detox. Safely down from Xanax, he transferred to Rush-Presbyterian-St. Luke's Medical Center where he completed a 9-week program in August. "My anxiety is under much better control," the doctor said. "I'm on no Xanax. I feel no desire to take Xanax ever again. It's a dangerous drug."

Mayor Says DUI Arrest Was Result of ''Foolish Decision''
Associated Press, 10/21/2002

TORRINGTON, Conn. -- Mayor Owen Quinn said he made a ''foolish decision'' to drive home after drinking beer and vodka tonics Friday night, when he was charged with driving under the influence after crashing his city vehicle into a utility pole. Quinn expressed regret about the episode Monday. Police said Quinn's blood-alcohol content was .205, more than twice the legal limit of .08, when he drove his city-issued Ford Explorer into the pole on Migeon Avenue Friday night, The Register Citizen of Torrington reported.
   Quinn said he drank two beers while playing golf at the Torrington Country Club Friday afternoon, then had some vodka tonics in the late afternoon and early evening. Quinn said he realized he was impaired and tried unsuccessfully to call his wife several times. He said he went to the SUV to change out of his golf cleats, then made the ''foolish decision'' to try to drive home.
   Quinn, who suffers from a combination of neck and lower back pains as well as slight arthritis of the hands, also had taken Advil and Legatrin, a nonprescription pain reliever containing Acetaminophen and Diphenhydramine, the newspaper reported. Legatrin's packaging includes a warning that says, ''Avoid alcoholic beverages while taking this product. If you generally consume 3 or more alcohol-containing drinks per day, you should consult your physician for advice on when and how you should take Legatrin.''
   ''It's been a deeply troublesome weekend that I've spent,'' Quinn said. ''I let myself down, and my family. This was a moral violation that I am sorry for.'' Quinn added that he does not think he has an alcohol problem.

For Gay Teens, a Place to Call Home
Patricia Wen, Boston Globe- 10/22/2002

WALTHAM - He seems like a teenager spared some of the superficial agonies of adolescence: His complexion is clear, his body looks full and strong, and his deepening voice rarely cracks. But his transition into adulthood hasn't been easy. The 16-year-old, who is trying to break an addiction to drugs, was arrested on charges of stealing from a liquor store and has had random sexual encounters with older men.
   Now, as one of four residents in New England's first group home for gay, lesbian, transgender, and bisexual youth, he is trying to get his life on track. While many gay teens are rejected by their families, he considers himself lucky to have supportive parents. He said he dreams of the day when he's ready to rejoin them in a suburb of Boston, particularly for lazy summer afternoons in the backyard. ''My dad's cooking at the barbecue grill, my mother's sitting under the sun, and I'm practicing my golf putting,'' said the youth, who asked to remain anonymous. For now, his residence is a stately Federal-style brick home newly dedicated to helping sexual minorities in state custody.
   The program, which opened earlier this month, is the third of its kind in the nation, modeled after programs in Los Angeles and New York. The group home, sponsored by the Home for Little Wanderers, a nonprofit group that helps at-risk children, will eventually serve 12 male and female residents. The teens who qualify to live here are a tiny fraction of those in state custody, but youngsters like them are often the most vulnerable to homelessness and self-destructive behavior.
   One recent study of homeless youth in New York City found that 40 percent of the teens identified themselves as gay, lesbian, bisexual, or transgender. A Massachusetts report found that nearly half of gay, lesbian, and bisexual youth have considered suicide, and nearly 30 percent have attempted suicide. About one in four has been physically threatened with a weapon in school. ''Lots of these teens are depressed, not because they're gay, but because of the reaction to it,'' said Rob Woronoff, director of gay, lesbian, bisexual, and transgender services and peer programs at the Home for Little Wanderers.
   The teenagers who live in the home - three gay males and a transgendered teen who was born male but who identifies as female -- will try to create a new domestic life in a place with strict rules, daily chores, and 24-hour staff supervision. They attend Waltham High School, and return home to help cook meals, clean dishes, fold laundry, and organize the living room. While the teens say they are concerned about how they will fare under the constraints, they say the beauty of their new home is helping them adjust. Their home is set in a bucolic section of town. The backyard has an expansive rolling lawn. The first-floor rooms are used as common space, the second-floor as bedrooms for males, and the third-floor for females. The program's transgendered teen -- who said she was kicked out of her parents' house by her traditional father -- lives on the third floor. ''Once, my dad found me with a dress on, and he was off the wall,'' said the teen, wearing makeup, manicured nails, and a halter top.
   James Palmer, 18, said he was also thrown out of his family's house. He said his parents discovered e-mails he had been exchanging with one of his lovers. When Palmer returned home that day, he said his mother threatened him. ''`You're going to be straight or you're not going to live here anymore,''' Palmer quoted her as saying.
   The teens said they knew they were different as early as third grade. When classmates started to suspect they were gay, the fighting and name-calling began. Several admitted to psychological and substance-abuse problems; all of them smoke cigarettes. For Palmer and the transgendered teen, the deepest pain comes from their families' rejection. Several of the teens said they also felt badly that their problems caused their parents pain.
   Chris Montes, 15, said his parents are trying to understand his new life, but want for him to become independent and emotionally stable. He said he believes his struggles with his sexual orientation are not an issue for his parents, both of whom work in education. ''They are trying to accept me,'' Montes said.
   The group home costs about $72,000 a year per child, roughly the average annual cost of a typical residential placement in the state system, said Michael MacCormack, spokesman for the state Department of Social Services. DSS pays roughly $700,000 a year for the program, with the Home for Little Wanderers contributing about $80,000 a year.
   Shantanette Patrice, director of the program, said the staff also focuses on teaching the teens the skills of everyday living. She said the goal is to have them rejoin their families or a foster family, or live on their own when they are old enough. Staff members teach the youngsters everything from folding laundry to cooking to watering plants, particularly important since neighbors brought by a house-warming gift: a pot of bright yellow chrysanthemums.

Autism Therapy Is Called Effective, but Rare
Laurie Tarkan, New York Times- 10/23/2002

No one has found a cure for autism, the neurological disorder that leads to lifelong impairments in a child's ability to speak, respond to others, share affection and learn. But there is a growing consensus that intensive early intervention is both effective and essential -- the sooner after diagnosis, the better. Early intervention, which involves many hours of therapy with one or more specialists, does not help every autistic child to the same degree. It is best started no later than age 2 or 3, and for reasons that are unclear, it does not help some children at all. But for those who are helped, their parents say, the changes are miraculous.
   Yet the success of early intervention is posing a painful predicament for schools and families -- a predicament made more immediate by a rising tide of diagnoses of autism. Last week, researchers reported that the number of autistic children in California had risen more than six-fold since 1987, and other states and the federal government have also noted sharp increases. By federal law, public schools must provide appropriate education for children with disabilities, starting at age 3. But the treatment is so expensive -- averaging $33,000 a year, according to research published in the journal Behavioral Intervention -- that many families cannot persuade their school districts to pay for it.
   Brian and Juliana Jaynes of Newport News, Va., can testify to that. As a baby, their son, Stefan, developed normally, if not ahead of the curve. By age 2, his vocabulary was well over 100 words. He knew his address and his colors, and he spoke in short sentences. But soon after his second birthday, he started to regress, forgetting the words he once knew. His parents suspected a neurological disorder. A specialist confirmed their suspicions, telling them Stefan was severely autistic and urging them to get intensive therapy for him.
   Instead, school officials placed Stefan in a special education preschool, where, the Jayneses say, he rapidly regressed. (the school district says the placement was appropriate.) After the neurologist told the frantic couple that their son might have to be institutionalized, they removed him from the preschool and began 40 hours a week of behavior therapy at home.
It cost them more than $100,000 over three years. Today, Stefan, 11, attends a school for autistic children and has vastly improved his language, social and self-help skills. He can say some simple sentences and communicate his needs; perhaps most important, he spends more and more time interacting with his family, and less time in his own world. The behavior therapy, his father said, "has brought about an awakening in this little boy's personality that is truly a miracle."
   In recent years, four leading institutions -- the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, the Surgeon General and the National Academy of Sciences -- have called for early intervention, including one-on-one therapy, for children with autism. A panel of experts convened by the academy last year recommended a minimum of 25 hours a week, 12 months a year. But Dr. Catherine Lord, the panel's chairwoman and a psychology professor at the University of Michigan, estimates that fewer than 10 percent of children with autism are getting the recommended level of therapy. "Almost everywhere, schools will say kids are getting services," she said. "But what they're getting varies enormously."
   Because the young nervous system has a great deal of plasticity, many experts believe that early intervention enriches neural growth. Dr. David I. Holmes, president of the Eden Institute, an autism center in Princeton, said, "If you have a child with autism who's not wired correctly, and we allow that to continue without intervention, those neuropathways will become fixed, and it becomes far more difficult to undo that tangled mess." Autistic children lose the ability to learn by observation, something other children do constantly. Behavioral therapy is aimed at teaching these children how to learn. Teaching an autistic child to wave goodbye, for instance, can take 40 hours of repetitive lessons.
   There are several kinds of therapy. The most popular -- the one Stefan Jaynes receives is applied behavioral analysis, in which a therapist asks a child to perform small tasks and then offers feedback to reinforce correct responses. Other programs use sensory integration therapy, based on the theory that autistic children have defects in processing the messages from their five senses; auditory integration therapy, which assumes that some are over-sensitive or under-sensitive to sound or have problems processing sounds; speech therapy; and group programs.
   A growing number of autistic children are treated with drugs. But the drugs are prescribed not for autism itself but for behavior problems that often accompany it: self-injury hyperactivity, aggression, tantrums, anxiety and repetitive behavior. No drug treats the impairment in social and language skills and the inward focus that make up autism's core symptoms.
   "At this stage no one has come up with a truly compelling line of thinking that would lead us to an agent that would alter the course of autism," said Dr. Michael Aman, a professor of psychology and psychiatry at Ohio State University. In a survey he conducted in North Carolina, Dr. Aman found that 23 percent of autistic children ages 3 to 6, and about 46 percent of 7- to 14-year-olds, were given drugs for behavior problems. The drugs often include S.S.R.I.'s (for selective serotonin reuptake inhibitors) for the repetitive and ritualistic behaviors found in autism; antipsychotic drugs, which treat self-injury, aggression and tantrums; and stimulants, for hyperactivity. Many of these drugs have not been well studied in autistic children, experts say; the drugs are prescribed because they are effective against similar symptoms that occur in other disorders.
   The antipsychotic drugs, however, received important support from a study published on Aug. 1 in The New England Journal of Medicine. A new class of so-called atypical antipsychotic drugs was found effective, with fewer serious side effects, in autistic children than the older antipsychotics like haloperidol. Of the children taking the atypical antipsychotic drug, Risperidone, 68 percent showed significant improvement, compared with only 12 percent of those taking placebos. Most experts believe that children will not have to take these medicines for life. Dr. Lawrence Scahill, a child psychiatry professor at Yale and a principal investigator on the Risperidone study, said, "If you can reduce these very challenging behaviors when they occur in a 7- or 8-year-old child, you can bring to bear behavioral and educational treatments that can obviate their use later."
   The federal education law leaves decisions about therapy to professionals and parents. But administrators say parents often demand far more therapy than the experts recommend. "Is the school system going to override teachers, and substitute the teacher's decision with the parent's decision?" asked Bruce Hunter, associate executive director for public policy at the American Association of School Administrators in Arlington, Va.
   The biggest obstacle is budgetary. "When you're looking at limited resources in a school district, sometimes the available resources drive what services schools will propose to offer," said David Egnor, policy director at the Council for Exceptional Children. "It's simply pragmatic." Mr. Hunter added: "The problem all along in special education is that you have a chronic shortage of money that is exacerbated by downturns in the economy, which is when it really gets bad. You get the joy of taking the money from one group of children and spending it on another group."
   Under law, the federal government may reimburse states up to 40 percent of the extra cost of educating a child with a disability. But this year Congress is paying just 17 percent, or 7.5 billion. President Bush has proposed adding $1 billion next year. ''The federal and state governments ought to pay attention to these children who have disabilities and need to be educated and need special treatment, and that costs money," said Representative Dan Burton, Republican of Indiana, who has an autistic grandson. But the chairman of the House Committee on Education and the Work Force, John A. Boehner, Republican of Ohio, opposes full financing of the act until major changes are made. He and others have called for reforms in identifying students with disabilities -- minority students are classified far out of proportion to their numbers -- and in the daunting paperwork for the schools.
   Many experts believe society would pay less in the long run if children received appropriate early intervention. An article in Behavioral Intervention in 1998 found that if 100 children were given early intensive intervention and 40 of them had only partial improvement, the public would save $9.5 million over their school years, ages 3 to 22.
   Most insurance companies do not pay for therapy for developmental disorders like autism, though a few companies offer reimbursement as part of their health benefits. Another obstacle to treatment is a lack of specialists. Public schools have a shortage of more than 12,000 special education teachers, and the number is expected to grow as many teachers retire or leave the field. Advocates say the supply of teachers trained to deal with autism is even shorter, so schools are forced to rely on expensive outside specialists. Even parents who decide to pay for treatment have trouble finding private specialists. Autism schools and private behavioral therapists typically have waiting lists of more than a year. This forces parents to set up their own in-home school and hire teams of people to provide the 20 to 40 hours a week of therapy. Many parents train themselves in the behavioral therapies, and then train college students, whom they can hire for considerably less money than specialists.
   Yet another obstacle to early intervention is delayed diagnosis. Autism is most commonly diagnosed at 20 to 36 months; but experts say the signs often surface earlier. Many families experience delays because pediatricians often dismiss their concerns. The growing awareness of autism may ease that problem. (Autism is now diagnosed in 1 out of 600 children, by most estimates.) But without appropriate therapy, early diagnosis does little but create frustration for parents, as Stefan's mother, Juliana Jaynes, recalled recently. "I had the doctor telling me that every moment counts," she said. "There's that: horrible feeling of time slipping away and nothing being done."

Good and Bad Marriage, Boon & Bane to Health
Sharon Lerner, New York Times- 10/23/2002

In the early 1970's, demographers began to notice a strange pattern in life span data: married people tended to live longer than their single, divorced and widowed counter-parts. The so-called marriage benefit persists today, with married people generally less likely to have surgery and to die from all causes, including stroke, pneumonia and accidents. At its widest, the gap is striking, with middle-aged men in most developed countries about twice as likely to die if they are unmarried.
   Many have argued that the difference in life expectancy is actually because healthier people are more likely to marry. But an emerging group of marriage advocates has put a spotlight on the medical potential of the institution. "Marriage is sort of like a life preserver or a seat belt," argues Dr. Linda Waite, a professor of sociology at the University of Chicago and an author of "The Case for Marriage," published in 2000. "We can put it in exactly the same category as eating a good diet, getting exercise and not smoking."
   But even as marriage is being packaged as a boon to health, there is a new caveat. While people in good, stable partnerships do, on average, have less disease and later death, mounting evidence suggests that those in strained and unhappy relationships tend to fare worse medically. Women seem to bear the brunt of marriage's negative health consequences. In some ways, the physical perils of bad pairings should be obvious, with domestic violence just the most drastic illustration of how romance can lead to bodily havoc.
   At its best, marriage acts as a balm against loneliness and stress, each associated with ill health. The marriage benefit probably extends also to gay couples in committed romantic partnerships and to unmarried heterosexual couples who have been together for years, many researchers agree. But at its worst, marriage can also be a cause of isolation. And, not surprisingly, the tensions and arguments of marriage can often lead to depression, with many studies finding increases in depressive symptoms among those who have reported marital discord compared with those who have not reported such discord.
   Bad marriages can also have some unexpected negative consequences for health. Men and women who reported low-quality marriages had more gum disease and cavities than happily married people. Two studies found marital strain to be linked to ulcers in the stomach and intestine. And people's satisfaction with their relationships appears to alter how they experience pain. Some of these physical effects seem to be direct results of behavior. A supportive partner can help a person stick to restrictive diets and exercise regimens, for instance.
   Perhaps more important, according to Dr. James Coyne, a professor of psychiatry at the University of Pennsylvania, who has studied the effects of marital quality on recovery from congestive heart failure, a good marriage can give a person a reason to stay alive. "Even when your own determination to get better wavers, the commitment to your partner puts you back on track," Dr. Coyne said. In contrast, he said, a bad marriage can be worse than none at all. "Some of these people," he said, "if their spouses said, `breathe for the next half-hour,' they'd try to hold their breaths. It can get that stubborn in a bad marriage."
   That bullheadedness can turn into a matter of life and death, according to Dr. Coyne's study, published last year in The American Journal of Cardiology. It found that the quality of patients' marriages predicted their recoveries as well as the pumping ability of their hearts. Dr. Coyne and his colleagues videotaped couples' arguments in their homes and grouped them according to the negativity of their interactions. Those heart patients who were more negative with their spouses were 1.8 times as likely to die within four years as those who were given less negative ratings. "That's powerful stuff," Dr. Coyne said. "We never expected the effect to be that big."
   Perhaps even more surprising is the evidence that relationship strain can take a direct physiological toll. According to Dr. Janice Kiecolt-Glaser, a professor of psychiatry at Ohio State University, and her husband, Dr. Ronald Glaser, an immunologist, marital arguments cause changes in the endocrine and immune systems. During and after stressful conversations, levels of the hormones epinephrine and cortisol rise and can stay elevated for more than 22 hours afterward. Blood pressure and heart rate also tend to go up with relationship stress.
   A 1998 study showed that women who were unhappy with their marriages experienced increases in blood pressure readings just from thinking about fights they had had with their husbands. And while these biological markers suggest that marital tension can make a person vulnerable to health problems, several researchers have documented that relationship problems affect the actual severity of illnesses. One study of patients with Parkinson's disease documented an association between marital distress and symptoms like eye-blinking. Research on married people with Alzheimer's disease has shown that criticism from a spouse predicted symptoms.
   And, in what may be the oddest study in the field, Dr. Kiecolt-Glaser and Dr. Glaser are now researching how the quality of a marriage affects the body's ability to repair itself. In the continuing study, the scientists admit subjects to a hospital, inflict minor wounds on their arms, and then chart their interactions with their spouses and their progress in healing. As with the overall "marriage benefit," which for women is smaller than for men -- and possibly even nonexistent, according to some researchers -- women are more vulnerable to relationship-related health problems.
   Illustrating the strong negative effect on women, a 15-year study of members of a large health maintenance organization in Oregon found that having unequal decision making power in marriage was associated with a higher risk of death for women, though not for men. In Dr. Coyne's study of congestive heart failure, there was a stronger association between marital discord and death among women. Seven of the eight women with the poorest marital quality died within two years of the first assessment. Studies consistently show that the physiological effects of marital stress are stronger and last longer in women. "We don't know why women are so much more sensitive to negativity or hostility than men," Dr. Kiecolt-Glaser said. Nor do people agree on how to make use of the new data.
   Dr. Waite of the University of Chicago, who is also a board member of the pro-marriage Institute for American Values, suggests that H.M.O.'s should create programs to help people have better marriages. And Dr. Coyne is hoping cardiologists will begin to consider their patients' interpersonal relationships as well as their hearts.
   For Dr. Alex Zautra, a professor of psychology at Arizona State University in Tempe, who has shown an association between criticism from intimate partners and joint pain in women with rheumatoid arthritis, the lesson from this growing literature is not to think of interpersonal ties as either all positive or negative. "In truth, all relationships have both good and bad aspects to them," Dr. Zautra said. The point, he said, is that, in all their complexity, they matter. "At the heart of this is how people's emotions affect their health. People need to start thinking about that."