Latest Drug Provides a Risk of an Epidemic in the Gay Club Scene
Andrew Jacobs, New York Times- 1/29/2002

Some know it as crystal. Others refer to it as Tina, a campy abbreviation of its other name, Christina. But among the habitues of New York's frenetic gay club scene, the extraordinarily powerful stimulant commonly known as crystal meth is earning a new nickname: the Evil One. Once largely confined to California, the Midwest and the Southwest, where it has upended the lives of gay men and a constituency of truckers, bikers and housewives, methamphetamine is increasingly becoming a conspicuous part of New York's clubbing landscape and a major worry for health care workers.
    In New York, the drug, which gives its users a seductive rush of power, confidence and energy that can last for days, is still mostly confined to gay men. But law enforcement officials and drug abuse counselors fear that it could follow in the footsteps of Ecstasy and cocaine, widely used party drugs that gained cachet among gay club-hoppers but later spread well beyond their world. "If it took off, it would be a disaster," said Bridget G. Brennan, special narcotics prosecutor in New York. "We are watching it very closely."
    Prized as aphrodisiac and long-lasting stimulant, methamphetamine can be snorted, inhaled, swallowed or injected. Many experts say it is more addictive and toxic than heroin, crack or cocaine. It is also alluringly inexpensive: just one lung full of smoke, the equivalent of a few dollars' worth, can spark a night of euphoria. But one toke, most users discover quickly, is never enough. "The first time I tried crystal I knew I was in love," said Eric Martin, 50, a behavioral researcher from Queens who injected crystal for several years but is now sober. "The second time I tried it, I knew I was in trouble. Wicked is the only word I can think of to describe it."
    The drug is particularly popular as an energy jolt for club-goers who sometimes spend 10 hours on the dance floor. But what begins as a recreational pursuit can rapidly become all-consuming. Jobs, friends and lovers fall by the wayside. HIV positive men neglect life-sustaining drug regimens. Food, sleep and safe-sex practices become distractions. Over time, insomnia can lead to hallucinations and, with regular use, a psychotic state that mental health experts say is indistinguishable from paranoid schizophrenia.
    There are no official statistics gauging the drug's spread in New York, but one telling measure can be found in a classroom at an old school in Greenwich Village. Three years ago, when Mr. Martin started the city's first Crystal Meth Anonymous meeting, at the Lesbian and Gay Community Service Center on West 13th Street, it had three regular attendees. Now there are four meetings around the city every week, each drawing 30 to 50 people. "It was just a matter of time before it arrived here," said Michael P. Dentato, executive director of Body Positive, an organization that serves people infected with HIV. "Now we're on the cusp of an epidemic."
    Two weeks ago, more than 100 health care providers, researchers and drug counselors gathered at New York University for a conference to try to assess the drug's prevalence here. A recent study by the Center for HIV/AIDS Educational Studies and Training found that more than half of gay men in New York who admitted using alcohol or drugs had tried crystal meth in the previous year. By comparison, a 1998 survey conducted at bars and clubs by the center found that 10 percent of gay men said they had tried it. Dr. Perry N. Halkitis, a New York University psychologist who authored both studies, said he believed that crystal meth would continue to spread unless public health officials and gay leaders started publicizing the drug's destructive side.
    Also known as crank, ice, speed or blue-collar cocaine, methamphetamines have been popular since the 1960's, when bikers and truckers in the West used the drug to stay awake. Easy to produce and cheaper than most narcotics, it gained wider appeal in the 1980's and 1990's, first with working-class men in the rural heartland and later, with well-heeled gays in San Francisco and Los Angeles. These days, the drug is made in clandestine labs in Mexico and California, or on isolated farms in states like Missouri or Iowa. Recipes are on the Internet; essential ingredients like anhydrous ammonia and red phosphorus are available at farm-supply stores. According to law enforcement officials, crystal meth is sold in the New York area by a handful of gay men who buy it from friends on the West Coast, with much of it arriving by express mail. For now, they say, it is a low-key enterprise supplying people who largely know one another. Investigators have made a few arrests, though seizures have been relatively small.
    A more complex and powerful descendant of amphetamine, methamphetamine swamps the brain with dopamine, a chemical that regulates pleasure, motivation, attention and movement. Those who have sampled the flaky off-white substance describe a high both subtle and irresistibly empowering. Self-confidence soars, melancholy is banished, and users say they feel invincible. Sexual desire is also heightened to extreme levels, many gay say, leading to behavior that is both excessive and dangerous. "It makes any situation more pleasant, and gives you incredible stamina and energy," said Rick Whitaker, 33, a writer who details his addiction in an autobiography, "Assuming the Position." Unlike other drugs, he and others say, it can be integrated into daily life, at least in the beginning. Productivity improves. Even housework is enjoyable. With the appetite suppressed, losing weight is effortless. The shy and awkward suddenly feel charming.
    "It is the perfect drug for a gay man in New York," said John, a 45-year-old publishing executive, who declined to give his last name, and who started a 12-step meeting in his apartment in 1998 when few had even heard of the drug. "It makes you feel brave, powerful, and for people dealing with HIV, it helps you overcome your fears." But after the high comes the crash. Mr. Whitaker recalled running out of crystal after a 36-hour drug marathon and contemplating suicide.
    Researchers say there are other dangers, too. Because a user's blood pressure is elevated for up to 72 hours, the risk of small-scale strokes or heart attacks increases tenfold. The drug is also extremely toxic to the brain. Dr. Nora Volkow, a psychiatrist at Brookhaven National Laboratory, has found brain damage among frequent users that resembles an early stage of Parkinson's disease. Although some recovery occurs with abstinence, many of the subjects in her study had impaired verbal and motor skills and degradation to areas of the brain associated with feelings of euphoria. "People are taking it to feel good, but they're actually destroying their ability to feel pleasure," she said. "It's like selling your soul to the devil." Public health officials say the drug is particularly dangerous for HIV positive men, who often begin ignoring their complex schedule of medications. Dr. Antonio E. Urbina, an internist at St. Vincent's Manhattan Hospital, said missing even a few doses can open the door to increased viral replication and even mutations that resist the existing AIDS drugs. He and other medical professionals say they fear that the drug will help spawn these so-called super viruses and , over time, encourage their spread to others high on crystal.
    Eric Martin and other meth users say they expect their meetings to grow more crowded. More than 40 people, showed up for the meeting last Tuesday night, "Suicide Tuesday," as Mr. Martin calls it, the day when a weekend of partying comes to a crashing end. After John gave an account of his destructive dance with crystal, a dozen other men, identified by first names only, took turns announcing their tentative triumphs. Then Craig raised his hand. Jittery and gaunt, he described a weekend lost in drugs and unsafe sex. The worst part, he said, was lying to his mother. "I feel like I'm trapped in a downward spiral and I don't know how to get out," he said. Many winced, or looked at their feet. Everyone seemed to understand what he was going through, but in the end, there was nothing anyone could say.

New Drug for Attention Deficit Disorder Tested
Jamie Talan, Newsday- 1/29/2002

Scientists have developed and are testing the first non-stimulant medication for attention deficit disorder. Results from a new study, published in the journal Pediatrics, suggest that the medicine reduces inattention and impulsivity.  In the study of the drug, atomoxetine, half of 298 children received it and half received a placebo dose for eight weeks. Three dosage levels were tested.
    Physicians have "been waiting for a medicine like this," said Dr. Lenard Adler, associate professor of clinical psychiatry and neurology at New York University School of Medicine. Prescription ADD medicines -- the amphetamines Dexedrine and Adderall, and the methylphenidate drugs Ritalin, Focaline, Metadate and Concerta -- are stimulants and considered Schedule II controlled substances because of the potential for abuse in the wrong hands.
    The stimulant medications target two brain chemicals: dopamine and norepinephrine, but primarily dopamine. These chemicals play important roles in attention and impulse control, behaviors that are regulated by the brain's frontal lobes. Dr. David Michelson and a team of scientists at Eli Lilly and Co., in developing a non-stimulant medication, set their sights on norepinephrine. Atomoxetine blocks the norepinephrine transporter, which means that the chemical can remain inside the cell longer.
    A major side effect of the new drug is decreased appetite, which is also a problem with Ritalin and other methylphenidate drugs. But, so far, other side effects associated with the older drugs -- tics, or movement disorders, anxiety and obsessive-compulsive symptoms -- haven't shown up, according to Michelson. The study's findings have been submitted to the Food and Drug Administration. If approved, it would also be the first ADD medicine approved to treat adult ADD. Adler said tests in adults with ADD showed that those receiving the drug were better able to focus and organize. Children in the study, conducted at 13 sites, ranged in age from 8 to 18. The medicine is also being tested for Tourette syndrome, a tic disorder.

Research Indicates Light Treatment Helps Depression
Hilary Waldman, Hartford Courant- 1/30/2002

Whoever thought that a daily bath of bright fluorescent light would take its place alongside the pill bottle and the therapist's couch as an accepted and effective treatment for winter depression? Then again, who 20 years ago would have imagined that the blues that sometimes creep in as the mercury dips and the days darken would take a place alongside phobia and anxiety in the psychiatric field's phone book-thick manual of common disorders?
    Now, as light therapy for seasonal affective disorder, or SAD, has matured into a mainstream treatment for a very mainstream malady, researchers are finding evidence that light may also have a place in treating more chronic, year-round depression. A small study published late last year by researchers at Wesleyan University in Middletown, Conn., and Columbia University in New York found that an hour-long bath of bright light worked as well as antidepressant medications in half of the patients studied. The researchers also found that treatment with high-density negative ions was equally effective. The negative ions--charged particles of oxygen--are blown through a high-powered air purifier.
    "The startling thing about chronic depression is it is [resistant] to treatment," said Michael Terman, director of the winter depression program at Columbia Presbyterian Medical Center in Manhattan. "If light is a factor, at least we can treat it easily." Terman and Namni Goel, an assistant professor of psychology at Wesleyan, are trying to recruit 60 chronically depressed people in Connecticut and New York to participate in a controlled trial comparing the effectiveness of bright light, high-density negative ions and low-density negative ions in elevating spirits.
    Ellen, a 37-year-old Connecticut woman, enrolled in Goel's first study about a year ago, in part because she was nursing her newborn son and did not want to return to the antidepressants that had helped her for several years. "The thing the light box did for me that the antidepressants didn't was I found myself being super-energized," said Ellen, who asked that her last name not be published. Subsequently, she tried the high-density negative ions, which also controlled her depression. But she preferred the light. After the study period, Ellen returned to the antidepressant medication Zoloft; her insurance covers the drug but not the $200 to $400 cost of a standard light box.
    Although some insurers do cover the treatment, Terman and Goel said they hoped that their research, paid for by the National Institutes of Mental Health, might convince more companies that bright light therapy could be cost-effective. Light, they said, might allow chronically depressed patients to take less medication, even if it does not eliminate the need for drugs. In Europe, light and antidepressive medications are already being used in tandem to treat depressed patients in psychiatric hospitals, Terman said.
    How light affects mood remains something of a mystery, although some clues are beginning to emerge. The best guess is that something--perhaps a change in melatonin secretion--knocks the body's biological clock out of whack, causing depression. Melatonin is a hormone that regulates sleep and waking. "The notion is that when various circadian rhythms get out of sync it causes the onset of depressive symptoms," Terman said. He is investigating the promise of bright-light therapy in alleviating jet lag for travelers. And with Dr. Neill Epperson, an assistant professor of psychiatry and obstetrics and gynecology at the Yale University School of Medicine in New Haven, Terman is testing bright light in treating depression during pregnancy.

Connecticut Counseling Program Helps Youths Stay Out of Trouble
Associated Press, 1/30/2002

HARTFORD, Conn. -- Juvenile offenders who received services under a new, comprehensive counseling program were half as likely to commit more crimes than those who received traditional services, a study done for the state has found. The study, done by a Maryland consultant for the state Department of Children and Families, tracked youths who received multisystemic therapy, which targets a variety of problems relating to family, school and peers.  While traditional services have focused on one problem at a time, such as drug abuse or behavioral problems, multisystemic therapy takes a big picture approach, state officials said. Therapists are available to families 24 hours a day, seven days a week for up to six months.
    DCF Commissioner Kristine Ragaglia said the study's findings prove that increasing community-based programs is the best way to help at-risk youths. ''This provides us an opportunity to get in there and start dealing with issues in a holistic way,'' Ragaglia said. ''We're not only working with these kids, we're working with their parents, siblings and friends.''  DCF began providing multisystemic therapy, or MST, in 1999, making Connecticut the first state in New England to use the program. The state's program serves up to 300 youths a year. About half the states in the country use MST.   Youths who received MST in Connecticut had a recidivism rate of 18 percent one year later, compared with a rate of 36 percent who juveniles who did not get the counseling, the study found. The therapy not only is effective, but it saves the state money, Ragaglia said.
    Connecticut spends about $1.7 million a year to house troubled youths in secure residential treatment programs. For every dollar spent on MST, taxpayers save $13.45 in juvenile housing expenses and costs that go to victims of juvenile crime, Ragaglia said. Some of the state's worst juvenile offenders have been receiving MST. To get into the program, youths must have served time at least once in Long Lane School or the new Connecticut Juvenile Training School, four to six months remaining on parole, a mild to moderate substance abuse problem and a family willing to cooperate with therapy.
    MST therapists counsel parents during the difficult period when juveniles return home after spending time in a residential treatment program. ''Kids succeed in residential because there is structure,'' said Susan Lashar, program director at Community Solutions Inc. of Bloomfield, one of the agencies under contract with the Department of Children and Families to provide MST services. ''They know what the rules are and what the consequences are. We try to recreate that in the home so they succeed.''
    Donna, a parent from central Connecticut, had trouble raising her daughter, Nina, who was a veteran juvenile offender by the time she was 16. They agreed to discuss MST only if their real names were not used. Family therapist Kim Monahan taught Donna to not back down to her family rules and make Nina realize there were consequences and rewards for every behavior. ''I've never done that,'' Donna told The Hartford Courant. ''I've always made threats but never followed through. Kim helped me by teaching me not to give in.'' Monahan also made sure Nina stayed in school and stayed away from bad friends. Nina said she hated Monahan in the beginning, but eventually became her friend. ''The program helped me with other parts of my life,'' Nina said. ''If it weren't for MST, I'd just be another statistic.''
    But the program has some critics.  Martha Stone, director of the Center for Children's Advocacy at the University of Connecticut's School of Law in Hartford, said she supports the concept of MST, but there are some problems. ''I've seen a lot of inconsistencies in its delivery,'' Stone said. ''Program providers need to be held accountable. There are still a few kinks to work out.''

Obsessive Attitude Toward Appearance Can Lead to Eating Disorders
Judi Sheppard Missett, Detroit News- 1/30/2002

Body image has taken on an alarming importance in girls of increasingly younger age. The tendency to judge one's worth by outer appearance is beginning as young as age 8 and is fueled by an unprecedented access to media images that reflect unrealistic ideals. Unfortunately, girls are focusing on weight, diet and clothing size before they even complete puberty. And when you consider that girls gain an average of 40 pounds between the ages of 8 and 14, an overly zealous awareness of weight may set the stage for an emotionally difficult time.
    To complicate matters, one expert believes that attractive young women are even more vulnerable to the dark side of body image issues, and eating disorders, in particular. "Perhaps the connection stems partly from the fact that pretty little girls are often told they're pretty, while less pretty girls are praised for their abilities," notes Caroline Davis, Ph.D., a professor of health psychology at York University in Toronto. Davis has done several studies that show a link between attractiveness and eating disorders.
    One innovative program designed to combat the trend has been launched by the Harvard Eating Disorders Center in Boston. The eight-week program, developed by Harvard's Catherine Steiner-Adair and Lisa Sjostrom, targets preadolescent girls with the goal of exacting positive changes in body image. One of the strategies is to ask young girls what women they admire, with one restriction: no models or celebrities. Inevitably, they discover that they appreciate traits quite unrelated to appearance, such as personality and strength of character.
    What can adults do to help young women develop positive body images and a strong sense of self-worth?
* Praise efforts and accomplishments that have nothing to do with appearance. For example, the tenacity with which they approached learning a sport or studying for an exam. Or the way they helped a friend or family member with a task or project. Recognize other talents -- artistic, domestic and athletic, as well.
* Don't obsess about weight or appearance yourself. Children copy the behaviors and attitudes of the adults around them: parents, grandparents, teachers, coaches. If a conversation is narrowing in on weight or clothing size, steer it toward healthy eating habits and the importance of regular physical activity instead. Make the emphasis on overall health rather than appearance.
* Help the young women in your life develop a positive inner voice. Women tend to be overly critical of themselves, according to Susan Nolen-Heksema, Ph.D., a professor in the department of psychology at the University of Michigan in Ann Arbor. Teach them how to constructively assess themselves and their efforts without being destructive. The tone should be, "Here's what I did right, but here's how can I do better," rather than "I totally blew it. I never do anything right."
* Exercise is a great way to boost body image and self-esteem, especially when the focus is on the amazing things your body can do and how great it makes you feel. The following exercise uses a resistance ball to improve posture. Begin by sitting on the ball in your normal posture. Just try to steady yourself and get familiar with the feeling of sitting on the unstable surface. Next, sit up on your "sit bones" and lengthen your spine, visualizing it stretching tall. Relax your shoulders down and back, and lift your head high without tilting your chin upward or jutting it forward.  Think of hanging from a string that is attached to the top of your head, almost like a marionette puppet. Have a friend check to see if you are properly aligned, with your head level, and ears, shoulders and hip bones all in a vertical line. Now try to maintain this alignment as you move slightly in various directions on the ball: forward, side-to-side etc.

Washington D.C. Area Moves To Help Mentally Ill
Jo Becker and Dana Hedgpeth, Washington Post- 1/30/2002

Prompted by a wave of clinic closings that has left mentally ill patients with dwindling options for treatment, Maryland officials and Montgomery County Executive Douglas M. Duncan yesterday announced plans to jointly spend $1 million over the next year to try to shore up the local system. Officials called it the state's most comprehensive effort to date to help a large local government and clinics confront the mental health care crisis. "We want to make sure that everyone with mental illness has access to the mental health services they need," said Duncan (D).
    But several people who treat or advocate for the mentally ill said the partnership offers only a temporary fix to a state system desperately in need of an overhaul. "The money will help us make it through this fiscal year, but then who knows?" said Craig Knoll, executive director of Threshold Services, which plans to close its two Montgomery clinics by April 8, leaving 500 patients to find services elsewhere. Critics also say there is very little, if any, new money going into the effort: The state's share will come from a reallocation of money earmarked for Montgomery, and the county is looking to shift dollars from other programs to pay for at least some of the initiative.
    Yesterday's announcement by Duncan represented a retreat from his long-held policy that the county should not pay for the state's mental health care responsibilities. Duncan said that under the plan, the state is "still the big player." Georges C. Benjamin, secretary of the Maryland Department of Health and Mental Hygiene, characterized the effort as a "partnership which allows us to make a good system even better by providing an additional safety net."  But Montgomery County Council member Blair G. Ewing (D-At Large), who successfully pushed for a task force to study the issue, said Benjamin "is fooling us." "It's a lousy system, it's a failing system, and it's only going to get better with fundamental reform," Ewing said.
    About 74,000 patients are imperiled as Maryland outpatient clinics close or refuse to accept uninsured or underinsured clients. In Montgomery, four clinics closed after the county's largest provider -- CPC Health Inc. -- went bankrupt last year. Eight more are struggling, three of which plan to shut down soon. The problem: Medicaid rates the state pays providers to treat the poor are so low that even the best-run clinics will lose at least 15 cents on every dollar, a state study found. The state compounds the problem, providers complain, by paying late. The difficulties worsen when the federal government is responsible for the bill: Medicare, the program that provides coverage to the elderly and those with disabling mental illnesses, reimburses only 50 percent of treatment costs. The state no longer picks up the difference for most patients. In 1997, the state launched an ambitious plan to reduce Medicaid costs by moving to a managed care system and to use the savings to treat more uninsured people. But the state greatly underestimated demand, and the system was soon overwhelmed.
    The plan announced yesterday does not address Medicaid rates, and Benjamin said the state has no plan to do so. He said providers are strapped mainly because of Medicare rates, over which the state has no control. But Evelyn Burton, vice chairman of the local chapter of the National Alliance for the Mentally Ill, said that unless the state uses its authority to raise Medicaid rates, the initiative "is like a one-year patch." The $1 million will cover some administrative costs for providers who treat underinsured and Medicare clients, help clients of failed clinics find new therapists and expand the county's outreach efforts. The state will also train clinics to better operate within a managed care environment.
    A private study, commissioned by Duncan after the County Council gave clinics $870,000 during the last year, suggested that some were partly to blame for their financial woes. The $50,000 study found that clinics often lack good management tools and have high turnover, making it difficult to improve business practices. Clinics have failed to adjust their assessment of what constitutes adequate care to meet the criteria of the programs paying the bills, the study found. A lack of emphasis on billing means that many clinics do not receive the reimbursements to which they are entitled. The county said it will keep a tight rein on clinics that accept the money. "It's an extremely effective use of resources, because people will be held accountable for the manner in which they deliver services," said Jeff Carswell, a vice president at Affiliated Sante Group, which loses about $50,000 a month on its five clinics in Maryland. But the financial support won't prevent clinics from closing, providers said. Lynne Myers is a vice president for Montgomery General Hospital, which closed its Silver Spring clinic this week. "It wouldn't have stopped our operating losses," she said, "because we couldn't pull in enough revenues to provide care for these patients."

Mentally Ill Will Be Hurt By Va. Cuts, Advocates Say
William Branigin, Washington Post- 1/30/2002

Advocates for Virginia's mentally disabled warned yesterday that more than 13,000 people with mental illness, retardation or substance abuse problems stand to lose treatment, drugs and other assistance next year if the state goes ahead with a series of proposed funding cuts. The advocates called on Gov. Mark R. Warner (D) and the General Assembly not to make more than $25 million in proposed cuts in community-based services over the next two fiscal years. The cuts represent a false economy, they warned, because many mentally disabled people who are denied services in their own communities could end up in the state's mental institutions or jails -- at an even greater cost to taxpayers.
    "These proposed cuts represent a major retreat in the state's commitment to its citizens with mental disabilities," said Ray Burmester, a co-chairman of the Coalition for Mentally Disabled Citizens of Virginia. "Not only do waiting lists grow longer, but many disabled citizens currently receiving services will lose them." The cuts are part of the new governor's efforts to address a budget shortfall of more than $3 billion between now and 2004. They come after what local mental health officials say has been a spike in demands for services after the Sept. 11 terrorist attacks. "There's no way of knowing whether 100 percent of [the increase] is attributable to September 11, but we can reasonably infer that a fair piece of it is," said Gary Axelson, manager of the Fairfax-Falls Church Community Services Board's mobile crisis units.
    Since assuming office this month, Warner has proposed deeper cuts in community mental health services than his predecessor, James S. Gilmore III (R). Gilmore's budget called for a 2 percent cut this fiscal year, followed by an additional 4 percent trim in fiscal 2003. Warner has proposed cutting the current year's $170 million budget by about 3 percent, or $5.1 million. The fiscal 2003 budget would drop by $11.9 million, with a deeper cut of $13.6 million in the next fiscal year.
    During a previous budget crunch a decade ago, Virginia was able to make up lost state mental health funding with federal money, so that people did not actually lose services they were already receiving. Now that option is no longer available, and the impact on the state's most vulnerable population is likely to be much greater, advocates said. "Localities have never, ever in the history of Virginia seen these people lose services before," said Mary Ann Bergeron, executive director of the Virginia Association of Community Services Boards in Richmond. "I don't know how we're going to do it. . . . There's going to be an awful lot of pain."
    Among those worried about the cuts is Nancy Rome, whose mentally ill son spent years in jails and mental institutions before Loudoun County officials found a place for him in a small group home last year. "If these services weren't available for him, I don't know what I'd do," she said. Even without mental health treatment locally in group homes, Rome said, "we're paying for it somewhere. If these people have nowhere to go, they'll end up possibly back in jail. Then who's paying for that?" Services provided in communities include crisis intervention to prevent mentally ill people from attempting suicide or harming others, emergency help for people who are unable to care for themselves, psychotropic medications for the uninsured, day programs and residential services for those with severe problems and continuing case management.
    Including the $5 million in reductions scheduled to take effect next month and extend through June, about $30.5 million in state funding for community services is to be cut over the next 2 1/2 years, Bergeron said. "This is the money that preserves the safety net in Virginia, and it's already very thin," she said. "This will shred the safety net."
    According to the Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services, the Fairfax-Falls Church Community Services Board stands to lose more than $766,000 in state funding next year, forcing it to drop at least 268 clients, most of them people with mental illness. Arlington risks losing $331,000, Prince William County $301,000, Alexandria $264,000 and Loudoun County $131,000 in 2003.
    In Maryland, mental health care has been underfunded for several years, leaving the state mental health department facing a $20 million deficit this year. Lawmakers meeting in Annapolis have vowed to sort out the shortfall and face mounting pressure from providers. In addition to forcing community services boards to drop existing clients, the Virginia cuts would leave no way to pare down waiting lists or deal with family emergencies involving the mentally retarded, the coalition's Burmester said. He said more than 1,000 people with mental retardation are on a waiting list for "urgent care" under Medicaid in Virginia. "The impact on families will be devastating," he said. "Not only will the waiting list grow, but the hundreds of emergency situations that occur each year will not be addressed. It takes state funds to meet these crisis situations, and Virginia has left localities holding the bag."

Expert: Makeup of Yates Jury May Hint at Defense Strategy
Carol Christian, Houston Chronicle- 1/30/2002

The selection of eight women to hear Andrea Pia Yates' capital murder trial suggests that Yates' lawyers may try to implicate her husband, a prominent jury expert said Wednesday. "I think this is a clear signal that the defense is locking and loading on the husband," said Robert Hirschhorn, a Dallas-area lawyer who has been a jury consultant on many high-profile cases.
    The selection of three female alternates Wednesday ended 3 1/2 weeks of jury selection for the trial of the Clear Lake mother who confessed to drowning her five children in the family bathtub June 20. Yates' attorneys, George Parnham and Wendell Odom, joined with prosecutors Joe Owmby and Kaylynn Williford in accepting the alternates as backup for the eight women and four men already selected. The jury is composed of 11 Anglos and one Hispanic; the alternates are two Anglos and one black. "Only four men (on the jury) says they're going to be spending a bunch of time bashing this husband," Hirschhorn said. "Men don't like to hear about another man being bashed. It's not a subject many men open up to."
    "Women will be far more critical of her conduct than men," said Robert Gordon, founder and director of the Wilmington Institute of Trial Sciences, which has offices in Houston and Arlington. "Even though a woman understands the frustration of being the primary caretaker, all women will reject the idea of destroying their young," said Gordon, a lawyer who holds a doctorate in psychology and has studied juries for 25 years. "To destroy your young is contrary to biology and psychology and evolution."
    Stacy Schreiber, a psychologist and director of the Institute of Trial Sciences, agreed that a jury of mostly women could favor the prosecution. "I'm concerned that, because it's a lot of women, the defense will take it for granted that they will relate," said Schreiber, who advises defense lawyers in criminal trials. "But I think women are a lot harsher on other women. If any of what Mrs. Yates has gone through is within their own experiences, they may compare and contrast ... None of them is on trial for violent crimes." Schreiber said that having two women on the jury with bachelor's degrees in psychology could be detrimental to the defense. Undergraduate courses don't cover much abnormal psychology or mental illness, she said. "People with a psych background of mostly surface stuff may think they know more than they do," she said.
    Hirschhorn noted that none of the jurors has a large family, which he believes favors the prosecution. "Couples with one child tend to center their whole universe around that child," he said. "It's hard to believe that anybody could do anything bad to such a precious being. There's a big difference between couples with one kid and lots of kids."  Gordon and Schreiber predicted that Yates will be convicted but not sentenced to death. "I believe the jury will not want to see her be found not guilty because it doesn't seem right or just with reference to the catastrophic conduct she engaged in to murder her children," Gordon said. "It also seemed to be premeditated."
    Schreiber noted that the jury also includes two military veterans, an engineer, energy technician, lab technician and a plant operator -- careers that require people to see things in black and white, rather than in shades of gray. "Those individuals who think in the abstract may be able to consider the evidence, apply it to the question and acquit her," Schreiber said. "However, the majority of jurors -- and very likely the leaders on the panel -- are more likely to reject anything but the criteria for acquittal provided for within the jury charge."
    To prove that Yates is not guilty by reason of insanity, the defense has the burden to show she had a severe mental disease or defect at the time and did not know her conduct was wrong. For the insanity defense to work, Hirschhorn said, Parnham and Odom must make jurors empathize with Yates. They must paint a picture of a woman driven crazy not by her children, Hirschhorn said, but by her controlling husband. A traditional insanity defense based on a thick medical record would make it easier for jurors to dismiss her claim, he said. "Here's the question," Hirschhorn said. "What was so bad in that house that drove her to this outrageous conduct? If the defense says it was because she was depressed, she's going to lose. If they make it come alive with what it was like to live with him, then the jury might see a much different picture."    Testimony is scheduled to begin Feb. 18 and is expected to last about two weeks, the attorneys told state District Judge Belinda Hill on Wednesday. Attorneys had said earlier they expected testimony to last three to four weeks.

Xanax Called ‘Highly Addicting’
ABC News, 1/30/2002

The president's 24-year-old niece, Noelle Bush, faces a prescription fraud charge after allegedly trying to buy the anti-anxiety drug Xanax without a doctor's prescription. Noelle Bush, Florida Gov. Jeb Bush's only daughter, was released from jail Tuesday, one day after after she was arrested at a Tallahassee pharmacy drive-through window while trying to pick up Xanax without a doctor's prescription. Gov. Bush issued a statement after his daughter's arrest that read, in part: "This is a very serious problem. Unfortunately, substance abuse is an issue confronting many families across our nation."
    Dr. Mitchell Rosenthal, founder of the Phoenix House drug treatment program, says the governor's statement rings true. "There is a huge number of people in America, 4 million people, who are using prescription drugs, painkillers, stimulants and sedatives," Rosenthal said on ABCNEWS' Good Morning America. "This is four times as many people who are using heroin. It is a very serious problem."
    The Tallahassee pharmacist, Carlos Zimmerman, told police he had received two messages on the store's voicemail from someone identifying herself as "Dr. Noel Scidmore." The caller left a detailed prescription for Xanax for Noelle Bush. Zimmerman called the doctor's answering service to confirm the prescription, and a colleague of Dr. Scidmore responded to Zimmerman's call. "Dr. Wickstrom called me back indicating that Dr. Scidmore is moving and isn't really practicing now, and said it was a fake and to bust her," Zimmerman said in a statement to police.
    Candy Tsourounis, assistant clinical professor at the University of California at San Francisco's School of Pharmacy, said the issue of prescription drug fraud is nothing new. "Often a doctor's prescription pad is stolen and the person in need has someone write out the prescription as if it were real," she said. "Other people attempt to phone in a prescription to a pharmacy, impersonating a nurse or physician. Unless the person doing the impersonating is really clever, most people would suspect something," she said.
    Xanax, the brand name of the drug Alprazolam — which is in a class of drugs called benzodiazepines — was approved by the Federal Drug Administration for treating anxiety in 1981. According to Llyod Wells, vice president of the child and psychiatry department of the Mayo Clinic, it is a "highly addicting drug" if used regularly. Though some people can become addicted in a short period of time — a couple of weeks — most people would have to be taking it over a long period of time," he said. "But I do think doctors are explaining the risk of Xanax addiction with their patients." According to doctors at the FDA, the risk of dependence and its severity is greater in patients treated with high doses — more than 4 milligrams a day — for more than eight to 12 weeks. Wells said people should talk to their physician if they feel they are becoming dependent on the drug. There are many other treatments available to people who suffer from anxiety, he said.
    In his statement, Gov. Bush said: "Columba [Bush's wife] and I are deeply saddened over an incident that occurred last night involving our daughter Noelle." Noelle Bush told police she did not call the pharmacy pretending to be a doctor, and that the prescription had been obtained lawfully about a week earlier. Police said she admitted that the contact number left on the voicemail was that of her second home phone line. She will be arraigned Thursday on the prescription fraud charge. Noelle Bush, who has two brothers, graduated from Tallahassee Community College and attended Florida State University during the 2000-2001 academic year. The university's registrar told The Associated Press she is not registered there this year. The Bush family had said previously, after Jeb Bush's unsuccessful 1994 campaign for Florida's governorship, that one of their children struggled with a drug problem. They did not say whether it was Noelle or one of her brothers.

Budget Cuts Could Cost Maine's Mentally Ill
Associated Press, 1/31/2002

PORTLAND, Maine -- A reduction in state funding for the Amistad social club could be disastrous for hundreds of mentally ill Maine residents, club leaders warn. Some will end up in jail, others in the hospital and still more homeless, officials at the Portland club say. They are upset over a plan that would cut funding to Maine social clubs by 17 percent because of the state's projected $248 million budget shortfall.
    The proposal by the Department of Behavioral and Developmental Services would mean an annual loss of about $53,000 for the Amistad. That could result in fewer programs, staff cuts and shorter hours. ''By cutting funding, you're cutting your own hand off,'' says Shawn Potter, who sits on Amistad's board of directors. ''People who don't come here and see each other are going to end up in the hospital.'' The state's 13 social clubs would all receive reduced funding under the budget plan being considered by lawmakers. The Portland Coalition would have to reduce hours so steeply it might be forced to close, according to its executive director.
    The proposed cuts have drawn sharp criticism, especially in light of their timing. Maine is currently working to reduce its number of mentally-ill jail inmates, which is disproportionately high by national standards. And the state is trying to prove in court that it has established an adequate community-based system of care for adults with mental illness.
    Last Thursday, members of social clubs around Maine converged on the State House to share their fears with lawmakers. Dozens of Amistad members have written letters, describing how the club has bettered their lives, to protest the proposed cuts. Operators of the club, visited by 325 people each month, say their funding has not increased for more than six years, and they can barely pay fix costs like rent. If the club scales back its days of operation, members would lose the continuity of service they need, says Amistad's executive director Karl Vertz.
    But Lynn Duby, commissioner of the Department of Behavioral and Developmental Services, says social clubs are not being treated unfairly. Agencies that serving the mentally retarded would lose almost $1.3 million. Social clubs, by comparison, would lose $200,000 from a $1.2 million budget. It is not clear whether that money would be restored if the state's budget situation improves.
    The mentally-ill members of Amistad feel the proposed funding cuts are a short-term fix that will cause greater long-term problems. Shawn Powell says he dreads Sundays, currently the only day Amistad is not open. He sleeps in late, won't leave his apartment and becomes depressed, while other members roam the streets and shoplift.   ''We need each other,'' he says.

Treatment Focus on Anger Could Help Curb 'Road Rage'
Louis Jacobson, Washington Post- 1/31/2002

Over the past few years, Americans have expressed growing alarm at "road rage" assaults perpetrated by angry drives against other motorists. But for every incident of criminality, there may be hundreds of cases of frustrated drivers lashing out in more limited ways, such as cursing or yelling. As commuting patterns grow longer and longer, tendencies toward "angry driving" are attracting increasing attention from researchers. "Our reading of the literature is that aggressive driving may be as large a risk factor for accidents as driving under the influence of alcohol," said Edward B. Blanchard, a psychology professor at State University of New York at Albany. "It's a problem that really needs to be addressed."
    The study of driving anger is relatively new. Not only is there no officially recognized mental health disorder that covers driving anger, but no recognized disorder includes anger as the primary determinant. But Jerry Deffenbacher, who teaches at Colorado State University, is one of a number of psychologists who believe that more attention is needed. Deffenbacher argues that even run-of-the-mill angry drivers can make life difficult for others, as well as themselves. "When people commute for an hour a day, just think about how much blood pressure is being raised, how many teeth are being gnashed, how many interpersonal relationships are being damaged," Deffenbacher said. "It's the wear and tear, the sandpaper on the soul. As a therapist, that's what I'm worried about." Deffenbacher began studying angry drivers in the late 1980s, several years before a widely publicized American Automobile Association study made road rage a commonly understood phenomenon. Deffenbacher published his first paper on the subject in 1994 and continues to expand his lines of inquiry.
    Conceptually, he distinguished angry drivers from aggressive drivers. "Aggressive driving is behavior that puts someone at risk--but you could be a rapid lane changer who is as happy as a clam," Deffenbacher said. By contrast, angry drivers tend to express emotional reactions through cursing and shouting, but they generally don't respond in ways that endanger the safety of their fellow motorists. Deffenbacher devised a questionnaire to gauge the driving habits of his students at Colorado State. Some of the measures he designed determined how angry his subjects got while behind the wheel. Others categorized how those drivers reacted to frustrating situations on the road. Once Defenbacher had used the questionnaire to determine the angriest and least angry drivers in the group, he gave members of those top and bottom groups a diary to record their actual driving experiences.
    The diaries demonstrated that the differences between high- and low-scorers were paralleled by the subjects' behavior. High-anger drivers in the study reported 2.7 times as many angry incidents as the low-anger drivers did. Over the course of a 300-driving-day year, that would mean that the high-anger drivers would become angry 729 times, compared with only 270 times for the low-anger drivers. In addition, the diaries showed that high-anger drivers tended to become more intensely angry. High-anger drivers rated the intensity of their angry outbursts as 60 on a scale of 1 to 100. Low-anger drivers, by contrast, experienced outbursts that averaged only 27.
    Then Deffenbacher took his research a step further. He brought in high- and low-anger drivers to use a video game simulator in his laboratory. The simulator offered Deffenbacher's subjects three situations: a country road with no traffic; a three-lane urban highway with slow-moving traffic; and a twisting, rural road in which the driver is stuck behind a slow-moving vehicle. While drivers in both groups reacted calmly to the easy country drive, the high-anger drivers were likelier to become angry in the two more frustrating situations. Moreover, the high-anger drivers drove in ways that were more likely to cause accidents. They followed more closely behind the cars in front of them, and they experienced "crashes" at twice the rate of low-anger drivers.
    So if high-anger drivers are more likely to cause havoc, Deffenbacher asked, why are they the way they are? The answer isn't clear. Deffenbacher does know that it doesn't have to do with gender: Men and women displayed roughly similar patterns of behavior. Also spending a lot of time behind the wheel is not a factor, because high- and low-anger subjects reported driving roughly the same number of trips and miles.
    Deffenbacher has made progress in treating angry drivers. Partially funded by the Centers for Disease Control and Prevention, he subjected small groups of high-anger drivers to eight weekly sessions in which they learned coping techniques and exercises that promote relaxation and attitude adjustment. After five studies, he said, "I think a tentative and optimistic answer is yes, we can help angry drivers.

Demons in Barbara Eden's Family
ABC News, 1/31/2002

If Barbara Eden found a magic bottle with a genie inside, or if the I Dream of Jeannie star could really just blink her eyes to make almost anything happen, perhaps she would turn back time. Last June, Eden's only child died of a heroin overdose, and the world discovered that she had been keeping a heartbreaking secret. She talked to Connie Chung about the tragedy she could not blink away.
    Though I Dream of Jeannie only ran on network TV for five years, from 1965-1970, the show has been re-running almost continually ever since. Eden almost gave up the role because she had wanted to start a family. After being married for seven years to TV actor Michael Ansara, she learned she was pregnant on the very day the pilot for I Dream of Jeannie sold. She told the producer, and instead of replacing her, the network agreed to shoot around her pregnancy. For the first 13 episodes, they hid her pregnancy with props and veils. In August 1965, while the series was on hiatus, her son Matthew was born. Though Eden wanted to keep extending her family, her second pregnancy was a stillbirth, which she had to actually carry full term, even though the fetus was dead. Eden said she never considered going to therapy, which she now realizes was a mistake, since she never really grieved for her lost child. She continued working, and ultimately broke down. Her marriage unraveled and she divorced, which was when her son Matthew, then about 9 or 10, started using drugs. When Matthew was about 12, Eden remarried and moved to Chicago. She planned to bring her son with her, but Matthew wanted to stay in Los Angeles, and she said her ex-husband threatened to sue for custody. So for the next six years, Matthew lived with his father, while Eden became a commuter mom who saw her child usually every three weeks.
    In 1983, she divorced again and moved back to Los Angeles to find that her son was a moody and withdrawn teenager. "He wasn't the happy warm boy that I'd known," she said. Like many parents, she didn't recognize the signs that Matthew was fighting a drug addiction. "We didn't know any better," she said. She finally learned the horrible truth when Matthew was 19 — and had been using drugs for nearly a decade. She and Matthew's father forced their son into rehab. It was the beginning of a 16-year battle. Eden said Matthew was in and out of rehab seven or eight times, when she finally resorted to tough love. "He was told he did not have a home with me if he was going to use drugs, he had to leave," she said. "And he left! His father and I were frantic. We were looking for him everywhere. We didn't know where he was … He was sleeping on the streets." Matthew's bouts of homelessness tested his mother's resolve. "I would always bring him food," she said. "I wanted to see my son, but I didn't trust him."
    By the time he was 31, Eden said, Matthew was staying sober longer and longer. He became a dedicated body builder, bulking up, shaving his head and getting movie roles. He also fell in love. "His life was on an even track," said Eden. "He had a lovely, lovely girl he was engaged to and they were going to get married in another month."
    But Matthew had found a new temptation in the world of bodybuilding: He started injecting steroids. Then, last July, he drove into a gas station where a security camera picked up his truck at about 6:30 p.m. Two and-a-half hours later, he was found slumped over his steering wheel. "Apparently he had taken a hit of heroin and he hadn't had it in quite a while, I guess," said Eden. "It killed him. It stopped his heart." In Matthew's truck, investigators found small amounts of heroin, marijuana, anabolic steroids and a syringe. Eden had been optimistic about her son, she said, "because he was making progress … he was winning the war."
    Though he lost the war, Eden is determined not to lose hers. She is now dedicated to helping parents who may find themselves in a similar situation. "I think we have come to a point in our lives now where we have to give up a little bit of that privacy with our children," she said, pointing out that parents may need to get nosy and more involved if they suspect anything. "You get in those drawers. You find out what's going on."
    Is Your Child Using Drugs? How to Find Out According to the Partnership for a Drug-Free America, if your child exhibits one or more of the following behaviors or moods, drugs may have become a part of his or her life.
• She's withdrawn, depressed, tired or careless about her personal grooming.
• He's hostile, uncooperative and frequently breaks curfews.
• Her relationships with family members have deteriorated.
• He's hanging around with a new group of friends.
• Her grades have slipped and her school attendance is irregular.
• He's lost interest in hobbies, sports and other favorite activities.
• Her eating and sleeping patterns have changed; she's up at night and sleeps during the day.
• He has a hard time concentrating.
• Her eyes are red-rimmed and her nose is runny — but she doesn't have allergies or a cold.
• Household money has been disappearing.
• You have found any of the following in your home: pipes, rolling papers, small medicine bottles, eye drops, butane lighters, homemade pipes or bongs (pipes that use water as a filter) made from soda cans or plastic beverage containers.
    Some of these indicators can be caused by emotional problems or physical illness. Discuss the possibility with your child's doctor and, if necessary, take him in for a physical exam. If illness is not the problem, it's time to choose a course of action.

Rethinking The Rules of Parenting
John Stossel, ABC News- 1/31/2002

Any parent knows how frustrating it can be when children just don't listen: when they refuse to get dressed, or throw a tantrum when told it's time for bed. But parenting instructor Mac Bledsoe has a radical idea: disobedience is not always bad. He believes it can be turned around to teach a child to think for himself. "Obedience as a tool for discipline is really, really dangerous," Bledsoe told 20/20's John Stossel in an interview airing Friday night. "It does not teach children to think for themselves, and it teaches them to listen to an outside voice to find out how to act."  Bledsoe believes parents should aim to teach their children how to make decisions for themselves, so they can act responsibly when left alone, and become more independent when they get older .

Watching With Hidden Cameras
Like other parents before them, Kristin and Joe Marquez believed that obedience is a crucial value to instill in a child. So when their 5-year-old, Joseph, would act up by refusing to take a bath or go to bed, they would insist, provoking long tantrums. They tried timeouts and mild spanking, but nothing worked. When they spoke to 20/20, they were getting desperate, and beginning to doubt whether they were good parents. "Every other word out of my mouth is, 'Don't do that, stop doing that, play nice.' It's always something negative," Kristin said. The couple, who both worked full-time, allowed 20/20 to place hidden cameras in their home. The cameras caught some of their frustration, with Joe at one point telling his son, "God darn it. Why is it so hard for you to do what I ask?"

Making Their Own Choices
20/20 introduced the Marquezes to Mac Bledsoe, who tours the country giving parenting seminars. Bledsoe does not have a degree in child psychology and has not written a book, but says he has expertise in parenting from 29 years of teaching and coaching high school football. He is also a parent himself, with two successful sons, one who is starting a business and another, Drew Bledsoe, who is quarterback for the New England Patriots. Bledsoe has a video series called "Parenting with Dignity" and a Web site sponsored by his football-playing son's foundation.

After talking to the Marquezes and watching tapes of them interacting with Joseph and his 3-year-old sister, Victoria, Bledsoe had some advice. First, he said, the Marquezes should allow Joseph to make some of his own decisions, easy ones where safety is not an issue. "Let him choose and experience the consequences," Bledsoe said.  As an example, one hot summer's day Joseph had wanted to wear long pants, but his mother told him to wear shorts. Bledsoe suggested that next time she try letting Joseph have his own way. Perhaps he would be sweaty in long pants, he said, but he'd learn from his own mistake.

Focusing on the Positive
Another strategy Bledsoe suggested was for the Marquezes to focus on what they wanted Joseph to do, rather than tell him what he should not do. If you tell someone, "don't think about elephants," it's elephants that they'll think about. In the supermarket, when Joseph wanted a toy, his mother had told him, "You're not getting a toy, Joe. I'm telling you right now." But once she told Joseph he could not have a toy, all of the boy's thoughts were focused on the toy, Bledsoe said. He suggested she shift his attention by saying instead: "That's a cool toy. Let's put it back and go find the popcorn" — replacing the image in his head of getting a toy with the image of finding the popcorn. Acknowledging that there are times when a child must obey, Bledsoe said parents should give clear instructions and, if the child does not obey, let him feel the consequences.

Practice Sessions
Another strategy Bledsoe suggested is practice sessions: "rehearsing" a problematic process ahead of time, so parents and children can go over away from the anger or frustration of the moment. He suggested the Marquezes sit the children down one day before dinnertime and say, "OK, kids, tonight we're going to practice — before we have dinner, we're going to practice appropriate dinner behavior." To avert Joseph's dressing tantrums, Bledsoe advised Joe to have a session with his son the night before, and to pick out what he would wear the next day.

Learning For Themselves
Bledsoe said the aim should always be to teach children to think for themselves, so that when they are away from their parents, they can make the right decisions. Bledsoe said that the willfulness and independence in a child like Joseph could actually pay dividends later — for instance, he might be more likely to resist peer pressure to use drugs when he became a teenager.

After the Marquezes met Bledsoe, they started putting his advice into action, allowing Joseph to make more of his own decisions, and telling him what they wanted him to do instead of always saying no. Two months later, they said, they found parenting less of a struggle and more of a pleasure. Kristin said trips to the grocery store have actually become fun after she took Bledsoe's advice to involve the children in the process, like letting Joseph make the grocery list. Joe and Joseph have practiced the dressing routine the night before and have seen an improvement. "There's no arguments in the morning about what he's going to wear because he's involved in picking it out," Joe said.