Alcohol Detection Locks Kept Drunks From Driving
Patrick Walters, Associated Press, 1/11/2003

PHILADELPHIA -- Breath-alcohol detectors installed in the cars of convicted drunken drivers prevented them from driving under the influence more than 10,000 times in the first year of Pennsylvania's Ignition Interlock Law, according to a study. Drivers must pass a breath test before the system will allow them to start their vehicles, and they must periodically test themselves throughout their drives. Their blood-alcohol level must be below 0.025 percent less than a quarter of the legal limit to keep the car running. After three lockouts, the driver must pay to have the car taken to a certified service center in order to have the system reset.
    Under Pennsylvania's law, drivers whose licenses have been suspended for two years may get the licenses back after one year if they agree to have the interlock device installed in their vehicle. From Oct. 1, 2001, to Sept. 30, 2002, 1,855 of the 18,600 eligible DUI offenders chose that option, according to the report by the Pennsylvania DUI Association, which was contracted to evaluate the system. The interlocks' internal logs showed the devices kept those drivers from driving drunk 10,142 times, the report said.
    Pennsylvania is one of the first states to complete a comprehensive evaluation of its ignition interlock program, and other states may soon look to Pennsylvania as an example. Jason King, a spokesman for the American Association of Motor Vehicle Administrators, said he wasn't aware of other figures demonstrating the effectiveness of the devices. It has sometimes been difficult to track the success of ignition interlock programs, said Dr. James Frank, a psychologist in the office of research and technology with the National Highway Traffic Safety Administration. ''The information that comes back to us is very anecdotal,'' he said.
    Pennsylvania started its program in 2000, and participants started using the devices in October 2001, said Dave Holt, assistant manager of the Pennsylvania Department of Transportation's alcohol highway safety administration. Holt said he hopes the program will be made mandatory after a one-year suspension. The main complaints about the program so far have involved drivers having to figure out how to get the machine to work, said Anthony Tassoni, a spokesman for the Pennsylvania DUI Association. ''There's an extremely large learning curve,'' Tassoni said. There are five types of approved ignition interlock devices, with some requiring the driver to just inhale or exhale, while some require the driver to exhale while humming.
    Forty other states and the District of Columbia have some form of ignition interlock law, according to Mothers Against Drunk Driving. New Mexico's ignition interlock law went into effect Jan. 1, so transportation officials there said they are just starting to work out their system and they're keeping an eye on what Pennsylvania is doing. ''We're going back to change the law to have some fixes,'' said Virginia Jaramillo, chief of the traffic safety bureau of the New Mexico State Highway and Transportation. ''I'll probably be calling them to see how it worked for them.''
    On the Net:
Pennsylvania Driving Under the Influence Association: http://www.padui.org
Pennsylvania Department of Transportation: http://www.dot.state.pa.us/
Mothers Against Drunk Driving: http://www.madd.org
American Association of Motor Vehicle Administrators: http://aamva.org

Michigan Drunk Driving Law May Change
Amy F. Bailey, Associated Press- 1/11/2003

LANSING-- Facing the loss of $9.5 million in federal highway funding, state lawmakers are considering a bill to lower the legal level for drunken driving in Michigan. Lawmakers must lower the drunken driving standard from 0.10 percent blood alcohol content to 0.08 percent by Oct. 1, 2008 to avoid losing 2 percent of its federal funding next year. The loss of federal money would increase by 2 percent each year a state fails to enact a 0.08 percent standard until 2007, when it levels off at 8 percent. States must adopt a 0.08 percent standard by Oct. 1, 2007 to recover the funds they lost over the last The penalties were included in the federal transportation budget approved by Congress in 2000.
    State Rep. Jerry Kratz, R-Grass Lake, introduced a bill this week that would lower Michigan's drunken driving standard to 0.08 percent. "The federal government is putting the pressure on us," he said Friday. "We certainly don't want to lose any transportation funds in a year when we are facing a $2 billion a year deficit." Lawmakers didn't take up similar legislation in previous legislative sessions. Former Republican House Speaker Charles Perricone, R-Kalamazoo Township, said the measure violated states rights.
    House Speaker Rick Johnson, R-LeRoy, isn't planning to consider the bill at the beginning of the new two-year session, but he doesn't want to jeopardize federal funding, spokeswoman Emily Gerkin said. Gov. Jennifer Granholm, a Democrat, supports reducing the standard to 0.08 percent.
    "At this point it does look like it's inevitable," said, Bill Zaagman, a lobbyist for the Michigan Restaurant Association, which has opposed the change partly because it doesn't target the problem drinkers. After three drinks over two hours, a 140-pound person would likely haven blood alcohol content of between 0.05 percent and 0.09 percent, Zaagman said. A 220-pound person would be in that range after three to five drinks over two hours, he said Thirty-four states, have already enacted the 0.08 percent standard, according to the National Conference of State Legislatures. Even without the lower standard in Michigan, the total number of alcohol and/or drug-involved deaths in the state dropped 2.5 percent in 2001, according to state data. Michigan has seen a nearly 21 percent reduction in such deaths over the last decade, the state said.
    The current penalties for drunken driving at 0.10 percent blood alcohol content and impaired driving at 0.08 percent are nearly identical, said Lance Cook, of the Michigan State Police. The maximum sentence for impaired driving is 93 days in jail, 45 days of community service and a $300 fine, Cook said. The maximum penalty for drunken driving is 93 days in jail, 45 days of community service and a $500 fine, he said
    Jenny Lozano, director of the Wayne County chapter of Mothers Against Drunken Driving, said people who have a 0.08 blood alcohol content are too impaired to drive. "People don't really realize that even a lower BAC still impairs how you are behind the wheel," she said. "Your judgment, even though it may not be completely off, is off enough to make a difference."

New Jersey Closing 18-Bed Psychiatric Unit
Associated Press, 1/11/2003

LIVINGSTON, N.J. -- St. Barnabas Medical Center plans to close its 18-bed psychiatric unit next month, citing a low number of patients and changes in Medicare reimbursement that led to the hospital being paid less for services provided. Hospital officials said patients still being treated as of the Feb. 1 effective date will remain until they are discharged. The sixth-floor unit is being assessed for other uses, including a sleep disorders center or space for neurological studies.
    Ronald Del Mauro, the hospital's chief executive officer, told The Star-Ledger of Newark the restructuring would allow St. Barnabas to enhance psychiatric services at two affiliates, Beth Israel Hospital in Newark and Clara Maass Medical Center in Belleville. Beth Israel has a 45-bed unit, while Clara Maass' unit has 20 beds.
    Richard Sostowski, senior attending psychiatrist at St. Barnabas, said the hospital's unit traditionally has drawn patients from Newark and the Oranges. Sostowski conceded residents in suburban Essex County will have to adjust, traveling farther for care. But he said the change will turn out all right if St. Barnabas takes the opportunity to make psychiatric programs at Beth Israel and Clara Maass ''centers of excellence.'' The hospital's nurses union objected to the announcement, calling it shocking that a major medical facility would eliminate a such crucial service.

Survey: 1,200 Priests Accused of Abusing Children
Laurie Goodstein, New York Times- 1/12/2003

The sexual abuse crisis that engulfed the Roman Catholic Church in the last 12 months has now spread to nearly every American diocese and involves more than 1,200 priests, most of whose careers straddle a sharp divide in church history and seminary training. These priests are known to have abused more than 4,000 minors over the last six decades, according to an extensive New York Times survey of documented cases of sexual abuse by priests through Dec. 31, 2002.
    The survey, the most complete compilation of data on the problem available, contains the names and histories of 1,205 accused priests. It counted 4,268 people who have claimed publicly or in lawsuits to have been abused by priests, though experts say there are surely many more who have remained silent. The survey provides a statistical framework for viewing the sexual abuse crisis against the modern history of the American Catholic Church. It found, for example, that most priests accused of abuse were ordained between the 1950's and the 1970's, a period of upheaval in the church, when men trained in the traditional authoritarian seminary system were sent out to serve in a rapidly changing church and social culture.
    Most of the abuse occurred in the 1970's and 1980's, the survey found. The number of priests accused of abuse declined sharply by the 1990's. But the data show that priests secretly violated vulnerable youth long before the first victims sued the church and went public in 1984 in Louisiana. Some offenses date from the 1930's. "This has been going on for decades, probably centuries," said Richard K O'Connor, a former Dominican priest who says he was one of 10 boys sexually assaulted by three priests in a South Bronx parish in 1940, when he was 10. "It's just that all of a sudden, they got caught."
    The survey also shows how pervasive the abuse has been. Using information from court records, news reports, church documents and interviews, the survey found accusations of abuses in all but 16 of the 177 Latin Rite dioceses in the United States. Every region was seriously affected, with 206 accused priests in the West, 246 in the South, 335 in the Midwest and 434 in the Northeast. (Some priests were counted more than once if they abused in more than one region.) The crisis reached not only big cities like Boston and Los Angeles but smaller ones like Louisville, Ky., with 27 priests accused, and St. Cloud, Minn., with 9.
    The scandal has set off an intense debate within the church over what caused it and what can resolve it. Many Catholic conservatives blame the reforms of the Second Vatican Council and the social upheaval of the 1960's for removing priestly inhibitions on sexuality and dissent. Liberals tend to find the root causes in what they call the church's repressive approach to sex, including priestly celibacy, and its deeply ingrained culture of secrecy.
    Mr. O'Conuor said that his parents wrote a letter complaining to the senior pastor, and even threatened to hire a lawyer. But he said he knew of 10 other boys who had been similarly attacked and whose mothers had learned of the molestations but said nothing. He says the women, devout Catholics, refused to confront the priests. "In the 40's and 50's, when you were talking to a priest, it was like you were talking to Jesus Christ himself," Mr. O'Connor said. One day, the three priests disappeared from the South Bronx parish, Mr. O'Connor said. His parents later learned that their letter had eventually made its way to Cardinal Francis Spellman of New York, who sent the three priests, all now dead, to work in parishes upstate.

Loosening the Roman Collar
By the mid-1980's young priests emerged from their near-cloistered seminaries and stood blinking at a world changing around them. There were simultaneous cultural revolutions inside and outside the church. The Second Vatican Council, which ended in 1985, suddenly lowered barriers between the church and modern society, and between the clergy and laypeople. The liturgy went from Latin to English, the altar was turned around and priests faced the people at Mass for the first time in centuries. Lay people took on leadership roles. Priests and nuns joined the antiwar movement and the civil rights struggle, rubbing elbows with Protestants and Jews, college students and feminists. Priests who had had strict curfews in the rectories where they lived with their fellow priests were suddenly free to come and go. They bought cars, were invited to meetings and marches, moved about without their collars.
    Father Silva, ordained in 1965 in San Francisco, said: "All of a sudden, father is expected to be close to the folks, and so he takes off his cassock, he takes off the Roman collar and puts on a sport shirt, and he's assigned to work with the teenagers. Here you are developmentally somewhere between age 13 and 16, never having ever looked at your own sexuality, never having asked the question, gay or straight? -- you didn't even know the words," Father Silva said. "And so you find yourself with the teen club, and father is taking the students on a ski trip overnight. If he is emotionally still a teenager, very inappropriate things can happen." In fact, it was customary for new priests then to be assigned to supervise the teen club or the altar boys, church experts said. Parishes in those days had full complements of three or more priests, and the priest with the least seniority was often given the job with the least status -- working with youngsters.
    Dr. Mary Gail Frawley-O'Dea, executive director of the Trauma Treatment Center of the Manhattan Institute for Psychoanalysis and a sexual abuse expert who addressed. the Catholic bishops at their Dallas meeting last year, said of priests: "They were thrown into the company of young men who were having adolescences very different than they had -- dating, masturbating, having buddies. The priest saw himself as an age mate of the youth, and better yet, as leader of the pack. At some point, all those human needs for closeness, including touch, just burst."
    The Times study found that 4 of 5 victims of priests were' male. That is nearly the opposite of those victimized by nonpriests, nearly two-thirds of whom are female, several experts in sexual abuse said. The experts offered several possible explanations: that priests simply had more unfettered access to boys; that priests who had had their first sexual encounters in seminaries were more likely to be attracted to boys; that a high percentage of priests were gay; that women and girls hesitated to report such abuse for fear they would be accused of inviting the attention.
    Over all, 256 priests were reported to have abused minors in the 1960's. There were 537 in the 1970's and 510 in the 1980's, before a drop to 211 in the 1990's. The numbers do not prove that the upheaval in the church and society in the 1960s or 70's caused the abuse, but experts who reviewed The Times's research said it was important to consider the historical context in which the scandal occurred. The church was jolted by two earthquakes in the 1960's. Vatican II was the first, and Humanae Vitae, the papal encyclical upholding the church's condemnation of artificial birth control in 1968, was the second.
    Amid surging use of the birth control pill, many priests say it fell on them to promulgate a teaching they could not agree with. And many said the controversy removed their inhibitions about criticizing or even disregarding church teachings on sexuality. "People were beginning to decide that the church couldn't make the rules anymore," Mr. Dinter said.
    At the same time, many healthier priests were jumping ship. Beginning in 1967 and for the next 10 years, priests abandoned their vocation in droves. About 525 left in 1968, 675 in 1970 and 575 in 1973 -- at the height, more than 1 percent of the American priesthood annually, according to figures supplied by the Center for Applied Research in the Apostolate at Georgetown University. Many left disillusioned that Vatican II had not eased the rigid episcopal hierarchy or the rules on celibacy, and many left to marry. Those left behind included a greater percentage of priests who were theologically conservative, gay or maladjusted, a trend that the bishops had apparently begun to note. In 1971, they commissioned a study by Dr. Eugene Kennedy, a psychologist at Loyola University of America and a former priest, and Dr. Victor Heckler, the principal investigator. Their report, "The American Priest: Psychological Investigations," found that 57 percent of priests were psychologically "underdeveloped."

Sinners In Therapy
By the 1970's and 1980's, when abuse was reaching a peak, church leaders were still doing little to confront it effectively. As they had for centuries, bishops and priests regarded priests who molested not as criminals but merely sinners. "If a priest was having sex with a boy it meant he was weak and gave in," Mr. Dinter said. "It meant he should go to confession and not be weak again."
    Even a serial offender like John J. Geoghan, a defrocked priest who was convicted of abuse last year in Boston, was repeatedly given a pass by his bishops and his peers. He has been accused of molesting more than 130 children over 30 years in a half-dozen parishes. "If you read his record, seminary rectors were wondering about him," Dr. Kennedy said. "But the culture of the priesthood was very supportive, so a fellow got a lot of cover just. for wearing a Roman collar."
    By the 1970's, some bishops had begun referring priests to therapists, but most of the therapists were priests, or working at church-related treatment centers, Dr. Frawley-O'Dea said. Bishops who turned to outside clinicians sometimes disregarded the advice they were given. Dr. Stayton recalls that in the early 1970's, a bishop asked him to have precisely six sessions with a priest who was molesting children. After the six meetings, Dr. Stayton said: "They transferred him to a high school someplace outside of his diocese, and they didn't ask me. I never had to make a report, I just had to turn in a bill. I would never have recommended that he go to a high school."
    The Times study found that half of the priests accused of abuse had more than one victim, and one-third had three or more. In the rest of the cases, only one victim has come to light. But there have been many cases in which an accused priest insisted he had only one victim, and more came forward later. Experts in sexual disorders say that the high percentage of priests with multiple victims suggests that the church was dealing with a cohort of offenders who were not easily stopped.
    Dr. David Finkelhor, director of the Crimes Against Children Research Center at the University of New Hampshire, said, "The more victims you have, the higher chance of reoffending." Sixteen percent of the priests accused of abuse had five or more victims, which may be an indication, said Dr. Finkelhor, that these were "compulsive child molesters -- those who actually have a preference for juvenile victims. That's their primary sexual orientation."
    By the mid-1980's, the warning had been sounded. The Rev. Gilbert Gauthe, a Louisiana priest who molested as many as 100 boys, was sentenced to 20 years in prison. Two priests and a lawyer who defended the church in that case produced a report predicting that sexual abuse by priests could eventually cost the church in the United States more than $1 billion. The report was never distributed to the bishops.

A Scandal's Unwritten Chapter
The Times's research confirms a point that the nation's Catholic bishops made as the scandal escalated last year: most of the abuse cases are old. Of the accused priests, 211 abused in the 1990's, and 36 since 2000. The bishops say the abuse declined because they began to address the problem in the mid-1980's. In 1992 the bishops' conference issued five recommendations, which included removing an accused priest from ministry for evaluation and treatment, and reporting cases to law enforcement. Seminaries were overhauled, in part, in recognition that they were producing unhealthy priests. By the late 1980's, many Catholic seminaries and dioceses began psychological screening of candidates for the priesthood, said Sister Katerina Schuth, a sociologist at St. Paul's Seminary at the University of St. Thomas. Human sexuality, was added to seminary curriculums soon after 1992, when Pope John Paul II called for the church to pay attention to the "human formation" of priests said Sister Schuth. Studies show that more seminarians and priests now identify themselves as homosexual than in previous generations, and with the openness has come more candid discussion in seminaries of celibacy and chastity, she said.
    The decline in priest cases in the 1990's parallels a 40 percent decline in the sexual abuse of children generally, Dr. Finkelhor said. There are many reasons, he said: more offenders are incarcerated for longer periods; children are more closely supervised; and there is more awareness about identifying and reporting sexual abuse. But many say that the real reason for the decline may be simply that the victims of the 1990's have not surfaced yet. "You will see some kind of a bubble in 2005, when the people who were abused in the 1990's come forward," said Dr. FrawleyO'Dea, who has treated many abuse victims. "It takes a lot of survivors until their mid-20's, when they have accumulated enough life experience, to know they were messed up." But there could be another explanation for the 1990's decline: the church is still covering up cases. Despite the pressure on bishops over the last year to reveal the extent of the abuse, some refused to release the number of accusations or the names of the accused priests.

Many Nuns Sexually Abused, Study Finds
Betsy Taylor, Associated Press, 1/12/2003

ST. LOUIS - Authors of a study that estimated about 40 percent of US Catholic nuns had experienced some form of sexual trauma say they have been overwhelmed with calls from victims and requests for more information since the findings were reported in a newspaper. The 1996 survey had appeared only in two religious journals, Review for Religious and Review of Religious Research, before the St. Louis Post-Dispatch wrote about it on its front page last week.
    Researchers at Saint Louis University said their findings weren't widely publicized at the request of the Leadership Conference of Women Religious, a Catholic religious women's organization. Several orders of nuns helped to fund the nationwide study of about 1,100 nuns. Leadership director Sister Carole Shinnick wrote in an opinion-editorial piece that the conference discouraged publicity because it feared the results would be sensationalized, not as ''some cover-up.'' The piece has not been published but was issued as a statement. She wrote that nuns had services in place to help abused nuns before the study, and that the information had reached members of religious congregations and those who worked with them at the time it was completed.
    John T. Chibnall, a research psychologist who co-authored the study, said the abuse of nuns needs to be addressed. ''The abusers were priests. They were nuns. They were lay people. They were family members,'' Chibnall said. ''I don't think this can be ignored any more,'' he said. ''Even if one woman who has experienced sexual abuse has the courage to come forward and seek help, it will make a difference.''
    The survey estimated that about 40 percent of Catholic nuns in the United States have experienced either childhood sexual abuse, sexual exploitation, work sexual harassment, abuse within their community or another form of sexually traumatic experience. Chibnall said the findings show nuns as a group experienced less childhood sexual abuse and the same amount of adult sexual abuse as the public.

Back to Normal, And It's Terrifying
Karen Durbin, New York Times- 1/12/2003

The way movies portray mental illness is positively bipolar, oscillating between comedy ("One Flew Over the Cuckoo's Nest") and Grand Guignol ("The Snakepit"). When they do better, as in "Pollock" or "A Beautiful Mind," it's rare enough to be a surprise. At the center of a Danish film called "Kira's Reason: A Love Story," is a performance by a young actress named Stine Stengade of extraordinary subtlety and power that may also be one of the most accurate portrayals of mental Illness to come along in years. Ms. Stengade, who is 30, plays a woman returning to the husband and small sons she adores after an extended stay in a psychiatric hospital. Upon seeing her children in the back seat of the family car, she presses her face to the window and reduces them to giggles with goofy expressions and rude noises. But turning to get in, she freezes, just long enough for us to feel her fear of the daunting, desirable world most of us take for granted. Made with the intimate minimalism of Denmark's Dogma 95 film movement, "Kira's Reason" uses a troubled but passionate marriage to explore the shifting line between consensual reality and the sometimes eloquent dissent of madness.
    This is the first leading filth role for Ms. Stengade, who has done mostly theater. "The movie purposely doesn't specify her illness," she said by telephone from Copenhagen, where she lives with the film's 39-year-old director, Ole Christian Madsen. Nevertheless, she prepared for the part by reading up on bipolar disorder, also known as manic depression, and spending time in a local psychiatric hospital with women who were about to go home. Although a few scenes call for Ms. Stengade to behave in grotesque, even painfully comic ways, she mostly plays Kira in a state of acute loneliness, with hyper-intelligent eyes that see both too much and too little. She's a stranger in a strange land, and her passport keeps expiring.

Are Headaches Triggered by Medicine?
ABC News, 1/12/2003

Americans spend some $3 billion a year on over-the-counter headache remedies. But many experts believe some headaches — so-called rebound headaches — are actually caused by the very same medicines people are taking to stop them. Dr. Fred Sheftell, one of the world's most-respected headache doctors, is upset that the labels on over-the-counter headache remedies offer absolutely no warning about rebound. "There's nothing that I know of where any of these products say anything about the genesis of rebound headaches and chronic daily headache. … I'd like to see that."

A Vicious Cycle
Here's how experts think rebound starts. Normally, when you take a pain reliever for an occasional headache, the medicine turns off pain receptors in the brain. But in a person prone to headaches — especially migraine headaches — pain relievers taken more than two to three days a week on a regular basis can make the pain receptors more sensitive than usual. Consequently, as soon as the medicine wears off, these hyper-sensitive receptors turn on to produce a new headache. That leads the headache sufferer to take more medicine, which, in turn, leads to more headaches — a truly vicious cycle. Before long, most rebound patients are taking headache medicine every single day.
    This vicious cycle nearly killed Eric Peterson, a 26-year-old veterinary student. But what will shock you is how little medicine it took to get him in trouble. Peterson's problems started in high school with migraine headaches that hit him a couple of times a week. "I think I started with an ibuprofen type. I wasn't finding a tremendous amount of relief with that. And tried Excedrin — found that controlled things nicely for me," Peterson said.

Daily Habit Can Trigger Serious Health Problems
Initially, Peterson was able to manage his headaches by taking two Excedrin just two to three times a week. But that was enough to lead to rebound headaches. Soon, Eric was taking the pain relievers every day, which was very bad for both his head ... and his stomach. Peterson's health problems became painfully clear last summer at a Chicago Cubs game. "We were walking up the stands to find our seats and I became very dizzy and light-headed and nearly passed out," he said.
    Years of taking Excedrin had eaten away at Peterson's stomach lining. He was sitting in the stands slowly bleeding to death. Just four hours later Eric wound up in a hospital emergency room. Doctors were able to save his life, but they told him he could no longer take over-the-counter pain killers. This was frightening news for Peterson, who had become so reliant on the pain relievers, he was more concerned about he was going to manage his headaches than he was about the damage to his stomach. "I didn't know how I was going to cope from day to day without having to be able to take that medication," he said.

Stop the Medicine, Stop the Pain?
Duane Soderquist, 25 years ago, was in a situation very similar to Peterson's. Soderquist said, "I think I had seven free headache days in 10 years." It was Soderquist's case that caught the attention of Dr. Joel Saper, a neurologist and founder of the Michigan Head-Pain Neurological Institute in Ann Arbor. A pioneer in the treatment of rebound headaches, Saper said it was Soderquist who first opened his eyes to the fact that over-the-counter medications could imprison a brain in rebound headaches.
    Soderquist had seen 20 doctors for his excruciating daily headaches. At that time, no one realized that his headaches were a result of the hyper-sensitive pain receptors in his brain turned on by the handfuls of over-the-counter medication he was taking every single day. Soderquist said he was taking about 50 tablets a day. Saper hospitalized Soderquist, taking him off the medication. "I thought I was gonna die for three days," Soderquist said. But then an amazing thing happened. Once the medication had cleared from Soderquist's system, his headaches stopped — for the first time in 10 years. Saper said, "That's when I learned the power and the potency of the rebound effect. And the need to take people off those medicines." Today, Soderquist is virtually headache-free and enormously grateful to Dr. Saper. "The day I left and went home after not having a headache — there at the hospital, the last day — it was just like somebody took a house off my back," Soderquist said.
    Nearly 90 percent of the patients at Dr. Saper's headache clinic are diagnosed with rebound headaches. And each one takes the same first step: Stop the medicine. Eric Peterson was actually able to detox at home. But he admits it was brutal. "For probably about three days I just had intolerable headaches. … It was probably the most miserable three days of my life," he said. But the payoff was worth it — Eric is finally free from daily rebound headaches. And he's managing his occasional migraines with preventive medications and newer treatments like biofeedback.

Can You Get Hooked?
So, do these cases mean you could get hooked on the over-the-counter pain medicines you're taking? It's important to remember that if you're taking these medicines for other problems, like arthritis, it's usually OK. Rebound headache can be triggered by the overuse of a wide variety of over-the-counter and prescription medications. But if you're starting to take medicines more frequently for headaches — be careful. Also remember that migraines are the kind of headache most likely to lead to rebound. Dr. Saper said it's most important that frequent headache sufferers consult a physician. "If you're using this medication more than two or three days per week on a regular basis," Dr. Saper said, "talk to your doctor about the possibility of rebound headache."

Beating the Family Demons
ABC News, 1/12/2003

Mariel Hemingway never knew her famous grandfather. But Stephen Crisman, Mariel's husband of 18 years, says she carries the family traits. But along with those family traits came a legacy of family trauma. Ernest Hemingway, the hard-drinking, Nobel Prize-winning writer shot himself just months before Mariel was born in 1961. Her grandfather's death was just one in a string of tragedies that would haunt the legendary family.
    In a Ketchum, Idaho cemetery Ernest is surrounded by other Hemingways who lost their lives to alcoholism, illness, and sadness. It's not a place where Mariel feels comfortable or visits often. While some may view these family tragedies as a sort of "Hemingway curse," Mariel doesn't view it that way. "I don't think of it that way but I know that I'm gonna keep it at bay by taking care of myself physically, mentally and emotionally," she told 20/20's Deborah Roberts. At 41, Mariel is clearly a survivor. She says yoga and meditation have saved her — bringing serenity to a life threatened by demons. Yoga is a key part of her new memoir called Finding My Balance. "I use the yoga postures to say this is how I observe my pain from my past. I'm not gonna hold onto my past," she said.
    It all started well enough in Sun Valley where her father Jack, Ernest's eldest son fell in love with a striking woman everyone called Puck. The couple soon had two daughters, but the love affair had soured. By the time Mariel came along she says it was clear that her parents were in a loveless marriage. They were living in separate rooms and fighting a lot, she said. Alcohol played a big role in the couple's troubles. Mariel recalled, "My father and my mother drank every night. … They would call it wine time. … I know that after one glass of wine, they were smiles, after two, there were getting cranky. After three, stuff was happening. The bottle of wine and you know glasses were hitting the walls." Those episodes had a lasting impact on Mariel, who now says she's "very frightened of alcohol personally" and doesn't drink.
    Mariel's homelife spun out of control as her two rebellious sisters experimented with alcohol and drugs. Her sister Muffet's drug use, she says, led to mental illness. "Muffet was so extraordinary. She was a tremendous free spirit as a kid, but then she would have just these flashes of like almost crazy behavior. Not almost crazy, it was quite nutty behavior," Mariel said. Her parents would eventually learn that Muffet was suffering from manic depression, which was later diagnosed and treated. Then there was Mariel's sister Margaux, who was seven years older than Mariel. She was a beautiful fashion model, but she was also troubled and rebellious, Mariel recalled.
    Her parents were vicious toward each other, but Mariel desperately loved them both, and was shattered when her father delivered some serious news. When she was just 12 years old her father told her that her mother had cancer and was unlikely to live more than a few more months. Mariel said, "I became so religious, I prayed and prayed, would get on my hands and knees and I said I'll do anything to keep my mother alive. … Because as crazy as she was, she was my best friend. I mean I loved her." Mariel became the primary care-giver, a big responsibility for a child, but she says it made her feel loved and close to her mother, who eventually grew stronger.

Mariel's Emerging Stardom
In the meantime, Margaux had left home and become a jet-setting fashion model, hoping to become a movie star. Cast in a new film, Lipstick, she suggested that Mariel play her kid sister. It was an unexpected turning point. Margaux's performance was panned, but Mariel emerged a star. Director Woody Allen cast the sheltered Mariel in his film Manhattan as his teenage lover. She says it was her first "real" kiss.
    The role snagged her an Academy Award nomination and a bona fide movie career. She was next cast in the starring role as an Olympic caliber athlete in the film Personal Best. Mariel said the role had a downside in that people began to see her as a tomboy. "I wanted people to think that I was a woman," she said. So when a lead as a sexy Playboy model in a film called Star 80 came up, she fought for the part — and got it.
    Mariel got breast implants around that time, but says she didn't get them for the film. "I did it for me. I didn't want to be thought of as a tomboy. I didn't want to be thought of as this kind of butch girl," she said. She's now had the implants removed, saying, "It's not me. It was never me. It's kind of the antithesis of who I am. I'm a real natural person."
    Mariel is dedicated to being the healthy Hemingway. She eats organic foods and even owns a yoga studio in Ketchum. The spiritual focus of yoga helps with what she calls an addictive personality. Her most serious problem, she says, was an intense caffeine habit. But she licked that problem thanks to a strong will and a solid happy family life.

Margaux's Tragic Death
Then, in 1996 Mariel was hit with another devastating shock. Thirty-five years to the day after her grandfather's suicide, her sister Margaux, who'd lost her shining career to drugs and alcohol was found dead. "It was horrible. It was so shocking," because, Mariel said, "Margaux was doing better than she'd been doing in years." Margaux Hemingway's death was eventually declared a suicide — a ruling Mariel refuses to believe. "My sister died because she had epilepsy from all the drugs and alcohol that she had indulged in, in the past. … It wasn't an overdose of drugs. She did not commit suicide." Mariel said she feels certain Margaux's death was not a suicide because, she said, "I know my sister. … She was very — outspoken and outgoing and she would not have committed suicide without a note."
    Loss was a clear part of Mariel's life. Her father died in December 2000, and just two days after her dad's death, her husband, Stephen, was diagnosed with cancer. "I had a melanoma in my head the size of Detroit," and was given a diagnosis that was usually fatal, he said. Mariel charged forward finding the best doctors and care for her husband. Stephen is now cancer free.

Another Hemingway in Paris
Mariel is also embracing the positive legacy left by her grandfather. Recently, she was in Paris scouting locations to film A Moveable Feast, Ernest Hemingway's memoir about his early life in Europe. She plans to direct it. "That is the Hemingway people like to remember It's perfect! It's a perfect story. It's a love story — and it's my family! It's my mother, it's my grandmother, and my grandfather."
    What's important now is family, not her acting career. Mariel's focus is creating a healthy home for teenage daughters, Dree and Langley, something she never had. Dree said, "She's a cool mom. I've just been able to talk to and tell my mom whatever I'm feeling, and — it's kind of like we're best friends but we're like — mother and daughter."
    For many people, family dysfunction just continues. It becomes a cycle. But this Hemingway has chosen another path. She said, "My path was to figure out why we came from so much dysfunction and illness and, and say no more. My parents didn't choose to pass it on to me. But they did, and I'm saying no! My kids are going to have problems in their lives — I want them to be their problems — not mine."

Michigan Police Can't Find 1,313 Sex Offenders
Associated Press, 1/13/2003

EAST LANSING, Mich. -- Michigan law enforcement agencies do not know how to find 1,313 rapists, child molesters, pornographers and other sex offenders who have moved without reporting new addresses. The missing sex offenders no longer live at the address they listed on the state's 31,045-name Sex Offender Registry. Their failure to file a change of address within 10 days is a felony that carries up to four years in prison.
    Also, about 2,100 other sex offenders failed to confirm their addresses with a local police agency in the past year, The Detroit News said Monday. Police do not know whether they have moved. Failure to report is a misdemeanor with a penalty of up to 93 days in jail. State police maintain the list but do not track whether the missing sex offenders are wanted for new crimes. State and local police say they lack the money and staffing to look for them in an organized fashion.
    The failure to track the sex offenders puts the public at risk, said Hedy Nuriel, head of HAVEN, a Pontiac shelter for victims of sex abuse and domestic assaults. "We see women stalked all the time," she said. "It's horrendous. Victims' rights laws need to be addressed. They were written to keep people safe."
    Oakland County Sheriff Michael Bouchard helped draft the registry law when he served in the state Senate. He said he is troubled that so many sex offenders have disappeared. "The ones who are ignoring the law are the most important people to find," Bouchard said. "Why don't they want to be found?" This month, Bouchard ordered a sweep of his county to confirm that all 978 sex offenders living there are properly registered. "We hoped each community would try to make a commitment, since we put the list in their hands," he said. "What's a better priority than protecting our children and women?"
    In some other communities, police say they can barely keep up with the basic duty of patrolling the streets. "There aren't too many police departments right now -- especially with the cuts in state revenue sharing -- with resources to devote to just checking on those on the (sex offender) list," said Macomb County Sheriff Mark Hackel. He said Macomb County has some 10,000 open warrants for suspects wanted for other crimes. Those take precedence over tracking down missing sex offenders who already have served their time but may be on parole or probation.
    The state now is taking a new head-count of sex offenders. Under the law, all 31,045 sex offenders on the registry must report to local police between Jan. 1 and Wednesday. Local police, in turn, forward the information to the State Police. "There is no statewide organized effort, but post commanders are encouraged to have troopers go out, when they have a slow time, to check on certain individuals to make sure they are where they are supposed to be," said state police spokesman Mike Prince.
    Charlotte Marshall, a civilian state police employee who compiles the registry, said about 82 percent of those on the offender list, excluding those locked up for their crimes, are complying with the law. Those who were convicted of felony sex offenses have to report four times a year. Misdemeanor offenders, such as those convicted of child pornography possession or indecent exposure, must report once a year.
    On the Net: Michigan's sex offender registry, http://www.mipsor.state.mi.us/

 

Texas Psychologists Will Push to Prescribe
Todd Ackerman, Houston Chronicle- 1/13/2003

Psychologists and psychiatrists may seem indistinguishable in many ways, but there's always been one obvious difference: the ability to prescribe drugs. Psychologists, the ones without the authority, hope to end that longtime separation in Texas in 2003. Emboldened by New Mexico's decision last year to allow psychologists to prescribe, the Texas Psychological Association plans to push hard in the Legislature for similar authority.
    "The time is right," says Deanna Yates, president-elect of the association. "There's a huge need for providers of psychotropic medication that isn't being met by psychologists. Enabling patients to receive medication without having to see both a psychologist and psychiatrist makes great sense, which is why it's just a matter of time before other states fall in line behind New Mexico."
    The psychologists' push, evidence that the treatment of mental illness has swung away from Freudian psychotherapy to medications that alter brain function, is expected to capture attention in many state legislatures this year. Already, the prospect is raising competence and turf issues: Would psychologists make fatal mistakes? How many patients would psychiatrists lose?
    The outcome, say observers, may hinge less on medicine and more on powerful lobbies and access issues involving a state's rural territory. The possibility has psychiatrists marshaling forces for a battle. In Texas and nationwide, their leaders are rallying the troops to "stop this plague from spreading across the nation." "Allowing psychologists to prescribe medications in Texas would be a high-risk experiment and a prescription for disaster," Dr. Martha Leatherman, chairwoman of the Texas Society of Psychiatric Physicians' government affairs committee, recently told a committee of the Texas Legislature. "A medical degree is required to properly diagnose psychiatric illness and prescribe medications safely and effectively."
    Among Texas health issues, it is the skirmish between psychologists and psychiatrists that could most dramatically change the status quo in Texas, increasing the number of patients receiving drugs such as Prozac and Zoloft and widening the rift between the two specialties. It could end lengthy waiting periods to see psychiatrists -- or bring tragic results. The idea isn't new. Since the late 1980s, psychologists in 14 states have attempted to gain prescriptive authority. But New Mexico became the first state to take action when a law offering Ph.D. psychologists the same prescribing power as M.D. psychiatrists took effect July 1. The law gives the authority to psychologists who have completed a special training program in psychopharmacology, medicine and supervised prescribing.
    Its passage has encouraged at least 12 states to plan legislation this year and many more to plot future legislation. But Dr. Bryan Liang, a University of Houston lawyer and medical doctor, says not to expect such legislation to spread through the country like wildfire. "It'll vary state by state," said Liang, who also has a Ph.D. in health policy. "It'll be most popular in states with tremendous rural populations, where legislators will have the hardest time ignoring horror stories about patients without nearby psychiatrists. It'll be least popular in states without that much rural population and with strong medical lobbies."
    New Mexico's law, based on a Defense Department pilot program that trained 10 psychologists to write prescriptions from 1991 to 1997, was touted as a solution to problems involving rural access. Psychologists there say their patients often have to drive for an hour to see the nearest psychiatrist.
    The numbers are less than clear in Texas, where Liang expects psychologists to make a formidable assault. The state boasts large swaths of rural territory and significantly more psychologists (3,600) than psychiatrists (2,193). But most of the population lives in urban areas, and psychiatrists are located in 15 more counties than are psychologists.
    Even without a law allowing them to prescribe, more than 150 Texas psychologists already have gone through a training program like New Mexico's. The training, initially in California but now based at Texas A&M University, includes 450 hours (about two years) of courses in biochemistry, physiology and pharmacology as well as a roughly two-year internship in which psychologists are supervised prescribing drugs in practice. Candidates must then pass a national board exam given by the American Psychological Association.
    Texas Psychological Association officials have been planning for the past five years to push a bill to extend prescriptive powers to psychologists, but made a strategic decision to wait until significant numbers had been trained. A bill was introduced in the 2001 Legislature, but it wasn't promoted and never made it out of committee. No bill has yet been filed this year. "I think we can pass this, this year," said David White, the association's executive director. "Psychiatrists are making a turf battle out of this and acting like doctors are the only ones who can prescribe drugs, but we already have nonphysician medical personnel -- nurse practitioners, physician assistants, optometrists, dentists and podiatrists -- who've been granted prescription-writing privileges."
    It's unclear how much business psychologists would take away from psychiatrists. After all, 80 percent of psychotropic, or mood- or mind-altering, prescriptions are written by nonpsychiatrists -- primary-care physicians and other MDs. And if psychologists gain authority to prescribe psychotropic drugs, which are among the most dangerous of medications, their insurance premiums -- and hence their fees -- would escalate as well. Nevertheless, each side accuses the other of trying to make money at the expense of what's best for patients, and both sides tell anecdotes of the other side's failings. Psychologists boast of primary-care physicians who call them for advice on psychotropic drugs because they're not up to speed on them. And psychiatrists tell of psychologists who miss patients' potentially fatal conditions because they don't have the proper medical background.
    But few psychiatrists seem inclined to accept compromise. Warning that psychotropic medicines affect not only the brain but all organs and systems of the body, they argue that extending prescriptive powers to psychologists will harm patients. "High-quality and cost-effective treatment for patients with mental illnesses is best provided by collaboration between psychologists and medical professionals," said Julianne Abadie, spokeswoman for the American Psychiatric Association. "Psychologists have always had a clear path to prescribing privileges: medical school."

Masters of Denial
Jeffrey Kluger, Time Magazine- 1/12/2003

It has got so psychologist Lawrence Josephs can tell right away which patients are likely to fire him. The narcissists may be the worst. These are the ones who are there in the first place only because their spouse would not quit hectoring them to show more interest in the marriage, and the people at work just didn't seem to give them the credit or attention they deserve. Often, they stay only long enough to decide that what they really need is to leave the marriage and quit the job. After that, they sack the shrink. "They come in under duress," says Josephs, a psychology professor at Adelphi University in Garden City, N.Y. "But they don't commit. What they really want is to have everything on their own terms. "If it's any comfort to Josephs, he's not alone in having such trouble managing narcissists " It's not just the narcissists giving therapists such problems.
    Narcissism is one of 10 conditions under the diagnostic heading of personality disorders (PD), and by most accounts, narcissists are among psychology's toughest nuts to crack. Talk therapy often doesn't touch them; drug therapy may do just as little. Researchers know why. Common mental conditions, such as anxiety disorders, eating disorders and depression, can be thought of as a pathological rind wrapped around an intact core. Peel the skin away through talk therapy or melt it away with drugs, and the problem may abate. Personality disorders, by contrast, are marbleized through the entire temperament. Narcissists may be self-absorbed, but they believe they jolly well have a right to be.
    Histrionic personalities may make too much of things, but how else can they be heard? It's hard enough to persuade most people to see a therapist, harder still when the patient denies there's a problem at all. "People rarely come in with a self-diagnosed personality disorder," says Josephs. "Friends and family push them into it." These days they have more reason than ever to push. As families increasingly fragment and as societal pressures grow, experts say they are seeing more cases of personality disorder than ever. As much as 9% of the population is thought to suffer from some kind of personality disorder, and as many as 20% of all mental-health hospitalizations may be the result of such conditions.
    Epidemiologists have not done a very good job of comparing these figures with those of earlier years, but many doctors report anecdotally that their PD caseload is indeed on the rise. "The more severe ones are increasing," says Josephs, "especially among people who grew up in homes with divorce or drug and alcohol problems." As this happens, more and more researchers are looking for new ways to treat the conditions, exploring both genetic and environmental roots, seeking both therapeutic and chemical cures. And well they might.
    "The social costs of personality disorders are huge," says Dr. John Gunderson, director of the Personality Disorders Service at McLean Hospital in Belmont, Mass. "These people are involved in so many of society's ills, divorce, child abuse, violence. The problem is tremendous." While solutions are elusive, the pathological arc of PDs is predictable. They tend to show up after age 18, striking men and women equally "though gender may influence which of the 10 disorders a person develops. The disorders are grouped into three subcategories, and of these, the so-called dramatic cluster "borderline, antisocial, narcissistic and histrionic disorders" is the best known.
    It's the borderlines who cause doctors, to say nothing of families, the most headaches. People with borderline-personality disorder form exceedingly volatile relationships, whipsawing between idealizing family and friends and dismissing them as worthless or hateful. They are intensely afraid of being abandoned but react so savagely when a loved one disappoints them that abandonment is often just what they get. Prod these people into therapy, and the same dynamic unfolds there. "At one point, you're their closest friend, and two weeks later, you're the enemy," says Norman Clemens, a psychology professor at Case Western Reserve University in Cleveland.
    Histrionic and narcissistic personalities use drama or self-absorption in much the same way" pushing away family and exasperating therapists. People with antisocial personalities raise the stakes higher, exhibiting aggressiveness, lack of conscience and indifference to the law, often folding criminal behavior into their pathology.
    Less dramatic but just as stubborn is the so-called anxious cluster, including the straightforwardly named dependent personality, the socially withdrawn avoidant personality and the rigid and rule-bound obsessive-compulsive personality (a different diagnosis entirely from obsessive-compulsive disorder, an anxiety condition.
    The third group "actually called the odd cluster" includes the paranoid, schizotypal and schizoid personalities. Paranoid sounds like just what it is. Schizotypals and schizoids both have problems forming relationships and interpreting social cues; schizotypals may also suffer delusions. "Schizoids are lone wolves," says Clemens. "Schizotypals skate along the edge of real schizophrenia."
    Before scientists can figure out how to treat these conditions, they must first figure out what's behind them. Few researchers doubt that when disorders are so woven into temperament, some of what causes them is written into genes.  A Norwegian study published in 2000 examined identical and fraternal twins and found that matched pairs, with their matched genetic blueprints, were more likely to share personality disorders than unmatched pairs. The borderline personality had an estimated 69% level of heritability. This confirms the observations of doctors in the field who notice higher rates of personality disorders among descendants of PD sufferers. "There are almost certainly multiple genes involved in predisposing people to PDs," says Gunderson.
    But genes aren't everything. Therapists who work with narcissists often uncover childhood abuse or some other trauma leading to low self-esteem or even self-loathing" just the kind of emotional hole that pathological grandiosity would be designed to fill. Borderline-personality disorder affects more women than men, and some research has shown that up to 70% of borderline women were sexually or physically abused at some point in their lives. It's hard to hang that kind of mistreatment on the genes.
    Poorly handled bipolar disorder or learning disabilities may also evolve into personality disorders. Dr. Larry Siever, professor of psychiatry at Mt. Sinai School of Medicine in New York City, believes that some of the rise in PDs may be linked to the loss of natural support groups, as individuals in an increasingly mobile culture migrate farther and farther from home. "In the past," he says, "we lived close to our extended families in highly structured communities. People could take care of their own and rein them in." Whatever the specific roots of the conditions, once those environmental and genetic die are cast, is that it for the disordered personality? The short, bleak answer is often yes, at least as long as PD patients resist acknowledging the problem.
    Anxiety disorders such as phobias are generally referred to as ego-dystonic illnesses: the sufferer acknowledges the problem and wants to do something about it. Personality disorders are ego syntonic: individuals believe that the drama, self-absorption and other traits that characterize their condition are reasonable responses to the way the world is treating them. That's a hard patient to heal, but there is hope, and some of it starts in the pharmaceutical lab.
    Researchers are finding that antipsychotics can help alleviate paranoid, schizoid and schizotypal symptoms. A variety of drugs, including mood stabilizers, such as lithium and Depakote; anticonvulsants like Tegretol; and ssri's, may help control the impulsive element of the dramatic disorders. And while antidepressant and antianxiety medications do little to rejigger something as fundamental as personality, doctors find that if they prescribe the drugs to relieve the stress that comes with living so disordered a life, some motivated patients may then take on the harder work of talk therapy. For those who do, the options are growing.
    Analytic therapy, which explores past traumas, can uncover the deeply rooted conflicts behind the conditions. More immediate results can be gained through cognitive and behavioral therapy, which teach coping skills.  A new treatment known as dialectical behavior therapy, developed by clinical psychologist Marsha Linehan of the University of Washington, can teach borderlines to recognize the situations that trigger explosive feelings, helping them squelch a reaction before it erupts. "The first thing we teach is to get control of the behavior," says Linehan. "After that, we work on feeling better."
    When patients commit to some form of therapy, even the doctors can be surprised. A study conducted by Gunderson and colleagues at Harvard, Yale, Columbia and Brown looked at borderline, avoidant, obsessive-compulsive and schizotypal patients and found that, after two years of treatments, including medication, psychotherapy, DBT or group and family therapy, they showed a 40% improvement. "That's big news," says Gunderson. "Nobody would have thought we'd get better than 15%." Forty percent, however, still leaves 60% suffering, and researchers hope to tip that balance the other way.
    At Mt. Sinai, Siever is looking deeper into what makes people neurologically susceptible to PDs, studying the structure and function of the brain itself in order to determine which areas misfire in the course of the disorders as well as the role played by such neurotransmitters as serotonin and dopamine. Others are studying such possible causes as high levels of stress hormones in the womb or even poor nutrition during brain development. Understanding the biochemistry should make it easier to develop medications. Until then, it will mostly be up to patients to deny the lie that the disorder tells "that there's really nothing wrong with them" and make the therapeutic commitment necessary to fix things. "Nobody totally changes," says Josephs. "But anyone can become more flexible and resilient. Anyone can make progress." That alone is already a better prognosis than most patients have had.

More Mentally Ill Behind Bars
Associated Press, 1/13/2003

DETROIT - The number of mentally ill people being locked up in Michigan jails and prisons is increasing, leading to a heightened risk of inmate suicide. Frustrated administrators say they lack the money, personnel and expertise to evaluate or treat such inmates. "We weren't designed to deal with mental health issues. We weren't intended to deal with the mentally ill," said Terrence Jungel, executive director of the Michigan Sheriffs Association. But treatment behind bars, not in clinical settings, is all that is available for many mentally ill lawbreakers.
    Michigan has closed 10 state mental hospitals in the past decade. According to a Sunday report in a Detroit newspaper, 23 percent -- or 11,598 -- of new state prison inmates in 2002 reported past mental health problems. That's an increase from 19 percent -- or 6,169 -- in 1990. Nationally, the number of mentally ill persons behind bars is almost five times the number of patients in state mental hospitals, according to the U.S. Justice Department.
    "We have a failing mental health system," said Dr. Elliot Luby, a clinical professor of psychiatry and law at Wayne State University. "The effects are felt at county jails. They don't have the funds, hospitals here have been closing and there are very few acute care facilities. So the hospital settings then become the prisons." The influx of mentally ill inmates means jail administrators are facing problems similar to those of mental health professionals -- including preventing suicides.
    Suicide is. the third-leading cause of death in prisons and the leading cause of death in jails nationwide, according to the Justice Department. Suicides are relatively uncommon, however, in Michigan's state prisons, which now house nearly 50,000 inmates. The Department of Corrections has recorded 45 suicides since 1995. Similar figures for jails are not available in a central database. In Wayne County, eight inmates have killed themselves since 1999 and six Macomb County inmates took their lives between July 2000 and last April, the newspaper said. In November, Oakland County recorded its first jail suicide in more than a decade, that of a schizophrenic 19-year-old who hanged himself with a sheet.
    The Michigan Corrections Department has detailed policies for overseeing prisoners who may be suicidal and for administering prescriptions. The department also inspects jails to make sure they have written policies covering inmate care, but its oversight powers are limited. Its inspection reports go to sheriffs and county commissioners, who must decide how to address any deficiencies -- and how to pay for solutions.
    The Michigan Sheriffs Association is working to help its members deal more effectively and safely with the mentally ill inmates in their jails. Two training sessions will be held May 29-30, executive director Jungel said. "We're looking for better ways of diverting the mentally ill from county jails to treatment programs," Jungel said. "One of the problems is that there is really limited availability of regional treatment programs. "It's a community problem that needs to be dealt with on a community-wide basis."
    Gov. Jennifer Granholm sympathizes with the sheriffs' plight, but the state's own budget woes would limit its ability to respond, spokeswoman Mary Detloff said. "The governor feels jails are not the place for us to keep the mentally ill," Dettloff said. "We've received a lot of information from mental health advocacy groups who want us to take a look at this."

Private Agencies Help Collect Child Support
Liz Cobbs, Ann Arbor News- 1/13/2002

Nancy Fox tried for nearly 10 years to collect child support from her ex-husband, who moved out of state two years after their 1989 divorce. Fox received child support in 1990, but the payments stopped the following year. Since then, Fox said, she went at least twice a year to Washtenaw County's Friend of the Court office in downtown Ann Arbor, hoping that something could be done. "I kept going back to the Friend of the Court because I felt there was hope," said the 47-year-old Ypsilanti Township resident. "They always told me they were trying. They were always doing something, but nothing ever happened." That was until late 1999 when on the advice of a friend, Fox contacted a private child support collection agency, called Supportkids. By January 2000, the Austin, Texas-based agency had located Fox's ex-husband, discovered he had just settled a lawsuit and, from those proceeds, collected $11,500 in back child support for her now 13-year-old son.
    Fox is among a growing number of custodial parents who are turning to private collection agencies as an alternative to the state-operated Friend of the Court system, an agency of the Circuit Court's family division that enforces court orders relating to child custody, child support and parenting time. The movement has not gone unnoticed by Michigan lawmakers, who approved legislation, effective in March, that allows the state to hire private agencies to track down delinquent parents and collect unpaid child support. The bill was included in an 11-bill package lawmakers approved last fall in response to calls from then Gov. John Engler and Michigan Supreme Court Chief Justice Maura Corrigan to improve the state's child support system. Some of the legislation took effect Dec. 1, including a provision that allows parents to opt out of Friend of the Court if they can settle custody, visitation and child support issues on their own. That option is already available in Washtenaw County.
    In addition, newly elected state Attorney General Mike Cox recently announced he was setting up a new child support collections division that would aggressively track down deadbeat parents. Cox campaigned on the child support enforcement issue and said that he could relate to custodial parents' frustration, since he had raised his 19-year-old daughter without child support from her mother.
    Private agencies say they are not trying to replace state programs, just helping those parents the states cannot help. "We complement the work government agencies do because we can handle cases they cannot," said Vanessa Diaz, vice president of Supportkids. "Private agencies are not the solution, they're only a part of the solution. It's going to take cooperation by government agencies working with private agencies to collect the billions of dollars of child support owed in the country." Supportkids, founded in 1991 by Casey Hoffman, a former assistant attorney general in charge of the Texas child support enforcement program, handles cases where there are arrearages in the court-ordered child support. Unlike government agencies, Diaz said case workers at private agencies have a lighter case load and more time and resources to work on cases, including the tough interstate cases in which a parent has left the state without providing forwarding information.
    One thing private agencies don't have is the power to bring delinquent parents into court once they're located, Washtenaw County Friend of the Court Judah Garber said. In addition, Garber said, agencies also charge a large percentage fee for their work. The 20 to 35 percent fee that agencies charge is contingent upon whether they can collect the child support owed.
    Fox said Supportkids told her up front that it would take out 34 percent of whatever it collected. "I thought, 'Well, having some child support money is better than having none at all,"' she said. What Fox didn't expect was for the Friend of the Court to step in and have the money routed through its office. "They started charging me a fee but they hadn't done any work," Fox said.
    Garber said he cannot talk about specific cases like Fox's, but did say that state law requires that child support collections come to the Friend of the Court, whether the agency finds the missing parent or not, and not through a third party. In addition, administrative fees and surcharges are established by a state statute. He said the agency or a parent can get a court order to redirect the money from the Friend of the Court. Washtenaw County's Friend of the Court charges a $3.75 per month administrative fee on open accounts, Garber said. Legislation passed in 1996 established an 8-percent surcharge on arrearages.
    Fox suggests that state agencies like the Friend of the Court begin working with private agencies to help custodial parents, but keep the focus on getting money for the child. "Friend of the Court is trying to move other agencies out of the picture and trying to do the job all by themselves," Fox said. "They need to open up more and let these organizations work with them."

Study: Depression Causes Brittle Bones
John McKenzie, ABC News- 1/13/2003

Someone suffering from depression might experience bouts of insomnia, loss of appetite, and overall lethargy. It can also trigger less obvious problems. Growing evidence suggests that depression, one of the most common diseases of the brain, is so powerful it can actually erode bones in the body.
    Cindy Uhl, a lab technician in Rochester, Minn., was one of those people determined to stay healthy. She exercised regularly, ate well, and routinely took vitamin and mineral supplements. Then one day two years ago, walking to work, she slipped and fell. Her wrist was shattered. "It looked like I had gone through a car windshield from the way the bones had been damaged," she said.
    During the operation, doctors discovered why Uhl had remarkably brittle bones. At only 46, she had advanced osteoporosis. "Usually a woman that age can sustain a fall and put their wrist out and catch themselves and not have any problem," said her physician, Dr. Lorraine Fitzpatrick of the Mayo Clinic. "But she had this very bad fracture. "Cindy had the bones that were the equivalent of someone who's 15 to 20 years older than she was," said Fitzpatrick. One likely explanation, doctors said, was that Uhl had suffered from a bout of depression years earlier.
    Dr. Philip Gold, chief of the Clinical Neuroendocrinology branch at the National Institute of Mental Health, is conducting pioneering research on the effects of depression on bone density. "If you are a pre-menopausal woman and you've had major depression you have a 25 to 30 percent chance of having lost significant amounts of bone and are at much higher risk of fracture," said Gold. "The general physician and people in the general population would be very surprised to find out there is such a significant risk of osteoporosis in patients with depression."

Brain Controls Hormones, Causing Bone Loss
Depression is like a severe and prolonged state of stress. It causes blood pressure and the heart rate to increase. It also causes the brain to produce dangerously high levels of hormones. "The brain really controls the hormones in the bloodstream," explained Gold. "The brain speaks to the body through hormones, and that is how the brain induces bone loss and other medical problems in patients who are depressed."
    And it doesn't take much. Research suggests a depression that lasts only a few months can trigger significant bone loss. There's preliminary evidence it can have the same effect in men. "The men who are depressed really seem to lose bone even more rapidly and to a greater extent than the women," said Gold. But since bone density in men is greater to begin with, fewer men are likely to lose enough to have actual bone fractures.

Women at Higher Risk of Breaking Bones
For women, doctors say, the situation is much more alarming. Researchers at the National Institutes of Health estimate that at least 400,000 women in the United States, women in their 30s and 40s, already have brittle bones as a result of depression and don't even know it. "Depression is an under-recognized risk factor for osteoporosis," said Dr. Fitzpatrick of the Mayo Clinic. "It just doesn't seem to be on anyone's radar screen." The good news, say doctors, is that osteoporosis can be easily diagnosed with bone mineral density scans, and readily treated with medications that not only stop bone loss, but actually grow new bone.

Prescription Drug Lawsuit Expected to Proceed
Alice Dembner, Boston Globe- 1/14/2003

A national consumer lawsuit seeking to force a reduction in the prices of many prescription drugs probably will be allowed to move forward, a federal judge in Boston indicated yesterday, despite complaints from drugmakers that their industry is being put on trial. However, Judge Patti B. Saris indicated she will probably narrow the scope of the case.
    The Boston lawsuit, consolidated from more than 20 cases filed by individuals, unions, and consumer groups across the country since fall 2001, alleges that the nation's major pharmaceutical companies fraudulently inflated the prices of drugs paid by consumers and the government, violating consumer protection and racketeering laws. The suit seeks to recover hundreds of millions of dollars paid by consumers and to end the alleged manipulation of prices.
    Yesterday, in a courtroom packed with nearly 100 observers, industry representatives urged Saris to dismiss the lawsuit, arguing that the court had no jurisdiction over their pricing policies and that those policies were not illegal or part of an organized criminal racket. Referring to the sweeping scope of the case, GlaxoSmithKline attorney Mark Lynch said, ''You have virtually the entire pharmaceutical industry before you. ... The plaintiffs have proposed investigating the prices of thousands of drugs.''
    Attorneys for consumer groups, ranging from Health Care for All in Boston to the Gray Panthers of Sacramento, Calif., suggested the court needed to enforce laws protecting the public from deceptive pricing. They allege some elderly consumers might have paid hundreds of dollars each year in inflated costs through insurance copayments.
    After nearly three hours of testimony, Saris indicated she was unlikely to throw the case out, but would probably pare it down. ''I can't be the supervisor of the entire pharmaceutical industry,'' she said. ''If we get past this triage point, we're going to have to start pruning.'' Her ruling on how much, if any, of the case will proceed is not expected for three months. Saris said she believed the court had jurisdiction, but she was ''deeply troubled'' by some of the consumer allegations that the drug companies and doctors engaged in an organized criminal enterprise as defined under the Racketeering and Corrupt Organizations Act.
    The suit is the latest attempt to challenge a system under which companies report a high ''sticker'' price for drugs, while selling them at a deep discount to doctors, hospitals, and pharmacy management companies. Consumers and the government -- through Medicare -- end up paying close to the sticker price, providing the doctors and others with a profit. The suit alleges that 21 drug companies engaged in this practice and marketed the profit to doctors to encourage them to prescribe their drugs. The sticker price, called the average wholesale price, can be as much as 20,000 percent more than the actual average price, according to the lawsuit, although markups of 50 percent to 500 percent are more common. The lawsuit also cited pricing information culled from other lawsuits, including the Boston US attorney's criminal and civil case against TAP Pharmaceutical Products, which resulted in a record $885 million settlement for the government in fall 2001.
    Lynch, the lead attorney for the industry, argued that there was no deception because everyone knew the average wholesale price was ''a term of art'' and included a markup, and that Congress had sanctioned the practice in 1997 by turning down a Clinton administration attempt to change it. ''The plaintiffs would have you make the losing side in Congress the winning side,'' said Lynch. But Thomas Sobol, arguing for the consumers, said the court has the duty to enforce the law, which calls for an average wholesale price and not some made-up number. His colleague, Steve Berman, argued that doctors and drug companies participated in racketeering, and said that they ''worked together at trade associations to halt any investigation'' of the pricing.

More Kids Receiving Psychiatric Drugs
Shankar Vedantam, Washington Post- 1/14/2003

The number of American children being treated with psychiatric drugs has grown sharply in the past 15 years, tripling from 1987 to 1996 and showing no sign of slowing, researchers said yesterday. A newly published study, the most comprehensive to date, found that by 1996, more than 6 percent of children were taking drugs such as Prozac, Ritalin and Risperdal, and the researchers said the trajectory continued to rise through 2000.
    While the increase may partly reflect better diagnosis of mental illness in children, the authors said they fear that cost-saving techniques by insurance companies, marketing by the pharmaceutical industry and increased demands on parents and doctors may be driving the increase. "There are fewer options other than medication," said Michael Jellinek, chief of child psychiatry at Massachusetts General Hospital, who reviewed the new study.
    Insurers have increased their profits by decreasing the use of psychotherapy, which is more expensive than drugs in the short run, he said. "The insurance system gave an incentive for medications and a disincentive for therapy." The insurance industry disputes that interpretation, suggesting instead that more children are getting drugs because more effective medicines have been developed. Most psychiatrists say that a combination of psychotherapy and medication often provides the best treatment.
    The new research found steep increases in the use of most classes of medicines, including antipsychotic drugs. Such powerful medications, normally meant to treat schizophrenia, were increasingly being prescribed to children on Medicaid, said the study's lead author, Julie Zito -- possibly as a way to restrain difficult children. "Other than zonking you, we don't know that behavioral management by drug control is the way to learn to behave properly," said Zito, a researcher at the University of Maryland in Baltimore. "If we are using drugs to control behavior, that doesn't change the underlying problem if someone doesn't know how to get along with their peers."
    Zito's study evaluated 900,000 children on Medicaid in a Midwest state, a mid-Atlantic state and in a private HMO in the Northwest. Zito said the large study made it likely that the data are representative of the nation's population. A re-evaluation of one of the health plans in 2000 found that the increase had continued, she added.
    "The medicine may help the symptoms but not address issues of self-esteem, interpersonal relationships and family relationships -- all of which are part of recovery," said Jellinek, who analyzed Zito's study. In obsessive-compulsive disorder, for example, he said, "you can get a lot of benefit from behavioral treatments. If someone is getting medicines for OCD, I would like to see them be given a trial of behavioral therapy to see if that helps them and maybe decrease the medication." Both Zito's study and Jellinek's analysis were published in the most recent issue of the Archives of Pediatrics and Adolescent Medicine.
    Susan Pisano, vice president of communications at the American Association of Health Plans, whose members provide managed care to about 160 million people, said the study did not address the quality of care the children received. "The research doesn't say, 'There is a greater use of drugs and that's having a deleterious effect on children,' " she said. "It just says there is a greater use of drugs." Pisano said more analysis was needed to answer the quality question.
    Zito agreed that her study could not determine whether the trend represented a growing awareness of mental illness or was evidence of over-medication and mistreatment. That is because she tracked medication records, not individual children. Without comprehensive studies that tracked the outcome of medication treatment of children, she and Jellinek said, it was difficult to say whether the children were getting the right treatment. Noting that children are being medicated at almost the same rate as adults, Zito pointed out that few safety studies of the drugs have been done in children. Pharmaceutical companies largely do studies on adults to get new medicines approved or to show that one drug is superior to another.
    Jellinek, who is also a professor of psychiatry at Harvard University, said insurance companies should be required to share data about the number of children getting comprehensive treatment in addition to those getting only medicine. Without such information, policymakers cannot independently evaluate whether the treatment is appropriate, he said.
    Pamela Greenberg, executive director of the American Managed Behavioral Healthcare Association, which represents companies that cover mental health services to about 110 million Americans, said criticizing the insurance industry for the trend is wrong. "I don't believe providers are saying, 'We will just provide a medication because that's going to be the highest profit margin for me,' " she said. Besides raising ethical issues, she said, inadequate treatment could result in a child continuing to be sick. "A sick patient from the economic standpoint still costs you money and could end up in the hospital." Greenberg said the industry might be willing to make some of its internal information public, so long as it was to a national authority that could properly interpret the data.
    David Fassler, a psychiatrist at the University of Vermont at Burlington who has testified on children's mental health issues on Capitol Hill for the American Psychiatric Association, said parents should push for comprehensive evaluations of children who develop psychiatric symptoms. Such evaluations, he said, may entail several sessions with professionals, reviewing a child's developmental history and school records, analyzing the child's functioning at school and with friends and family, and having mental health professionals spend time with children and families. "You can't do that evaluation in a 5-10 minute office visit," he said. "The reality of contemporary pediatric practice makes it difficult to devote the time necessary to do a full and comprehensive evaluation."

Finding the Best Teen Drug-Treatment Programs
ABC News, 1/14/2003

When Marty Kehn found out his teenage son was on drugs, it was as though a stranger had moved into their suburban home, and he wasn't sure how to help. "Life with Spencer while he was using was life without the Spencer I know and love," the father said. "Instead of family weekends, dinners and water skiing, there were calls from police, searching his room for clues to what was going on, only to find things that were stolen … another morning in court."
    Spencer Kehn, now 16, tried out a series of drug-treatment programs before meeting success, and has now been drug-free for one year. But finding a program that worked entailed a lot of trial and error. "The first program was unsuited for Spencer because it did not involve his family," said Barbara Kehn, Spencer's mother. "We then got him into a residential program which had after-care. So he has continued to learn and he's gotten a network of non-using friends."
    More than 1 million American teenagers need treatment for substance abuse, but only one in 10 is actually undergoing treatment, according to the National Household Survey on Drug Abuse. Parents who do seek treatment are often faced with an assortment of programs and need to know which work best. Today, a nonprofit group called Drug Strategies is releasing a first-ever comprehensive guide to teen drug treatments.

Getting Into a Teen’s World
Mathea Falco, the president of Drug Strategies, said parents who want help for their teens should look for some very specific things. "A good program should use a nationally recognized assessment interview to determine a teen's drug use, their psychiatric history, their family and school situation," Falco told ABCNEWS' Good Morning America. "More than half the teens in drug-treatment programs have psychiatric problems that also need to be addressed. And these should be found in a screening."
    The programs with the best track records should also use a comprehensive treatment approach, meaning they address factors other than drug use. "Effective programs address the full reality of the teen's world, from school to family to peer pressure to juvenile court, where many teens are referred to treatment," Falco said. "It can't just look at curtailing substance abuse." In addition, family members should be involved in the treatment process, in areas such as counseling, group meetings and drug education. "Some programs even have caseworkers who come to your home," Falco said.

Avoiding Relapse
Parents should also ask programs what their retention rate is, since three out of four teens in drug treatment drop out of their programs before finishing. Most teens fail to finish a 90-day program, Falco said. Finally, a good treatment program has continuing care that stretches on, even after the teen has bidden the program itself goodbye. Three in four teens relapse in the first three months after treatment programs. "Successful programs link teens to community services that can help them, things like 12-step programs, psychiatric services, remedial education," Falco said. Residential facilities that are live-in and have around the clock supervision can cost around $15,000 a month. Most outpatient programs, which provide treatment one to three times a week, cost about $800 a month. In some cases, treatment is covered by insurance.

The Turning Point for Spencer
Spencer Kehn said that he started using marijuana and alcohol when he was 13 and tried other drugs as well. At first, his parents thought that he was turning around on his own, but then he would get into more trouble at school, or with the police. Spencer ran away from his first treatment program, which didn't involve the family at all, and his parents then sent him to a lockdown-type facility. When he was ready to leave that program — which was not successful — he called his parents and got a surprise.
    "They told me they didn't want me at home," Spencer said. "That made me realize the effect I was having on everyone, it wasn't just about me. So I thought I would at least give treatment a shot." Next he tried an outpatient program, but was disorderly and got kicked out. He then attended a residential program that offered follow-up treatment, and has been drug-free for a year.
    Marty Kehn said that struggling with Spencer's addiction was tough, but ultimately brought the family closer. "Trust your instincts, even if it goes against what you want to believe about your child," he said. "We have learned so much about ourselves and human behavior. We have also become much closer as a family."

Finding Teen Treatment Centers
In Treating Teens: A Guide to Adolescent Drug Programs , Drug Strategies offers a list of hotline numbers to help parents find teen substance abuse treatment centers in each state. Here is the list for the Midwest.
Illinois: 312-814-2300
Indiana: www.in.gov/fssa/shape/providers.asp
Michigan: 888-736-0253
Minnesota: 651-582-1832
Ohio: 614-466-3445
Wisconsin: 608-266-2717