Meth's Reach Hits Rural Children Hard
Associated Press, 1/20/2003

HOPKINSVILLE, Ky.— The physical withdrawal from methamphetamine wasn't so bad. It was knowing what she had done to her children, then ages 7 and 10, that made Teresa Cannon cringe in her jail cell. "I forgot about my kids," Cannon says of the four years she spent cooking and smoking meth while her children fended for themselves. "Looking back at the way they had been treated, you hate yourself. I was so ashamed. So ashamed." When Cannon went to jail, her children, now ages 9 and 12, lived with her sister-in-law. Now they're back with their mother. But others aren't so lucky.
    Authorities have seen foster care cases multiply because of the spread of methamphetamine in Kentucky, Indiana and other rural states in recent years. With meth, "the parents are the users and the children are basically the innocent victims," said Larry Marchino, director of the Knox County Office of Family and Children in southern Indiana. Marchino estimates about half the children on the rural farming county's roster of foster kids are there because their parents used, made or sold meth a drug that is often snorted for its rush of euphoria and energy.
    It is the counties with the highest unemployment rates and fewest resources that appear to be most affected, said Glenn Cardwell, director of the Vigo County Office of Family and Children in southern Indiana. Nearly 40 of Vigo County's 180 foster children have parents involved with the drug, costing the county about $150,000 annually. Foster care costs from $16 to $20 per day depending on the age of the child. "Our frustration is that it is taking up a lot of resources that we really don't have," Cardwell said. "We don't have the budget to deal with it. If we deal with additional kids here that means we're shorting kids somewhere else."
    Nationally, the Drug Enforcement Administration reports that children are nearby as the drug is made 20 percent of the time. Earlier this month, an eastern Kentucky man was arrested on child endangerment and drug charges after a working meth lab was allegedly found in his car along with a child. Because of the danger of the household chemicals and the fertilizer anhydrous ammonia both commonly used in the production of the drug children can be more at risk than with most other drugs since it is often made at home.
    In 2001, a 15-month-old boy died in Rossville, Ga., of injuries suffered from a meth lab explosion when a space heater was turned on, authorities said. His parents were charged in the death. Jackie Hofmann, a family case manager in Vigo County, said she has counseled scared children whose parents were injured in a meth lab explosion. "We get more and more reports every day," Hofmann said.
    Parents high on the drug are beyond considering logical problems that may result from their children being around the drug, authorities say. "When someone's addicted to a drug it becomes the most important thing in their life," said Cheyenne Albro, director of the Pennyrile Drug Task Force in western Kentucky. "It takes precedence over sex, their family and jobs, morals, beliefs, and it changes their entire life."
    Cannon met Albro when he kicked down her door one night and arrested her husband. After serving 5 1/2 months in jail, she now assists the Hopkinsville-based drug task force in training law enforcement about the meth-cooking culture. "You'd sell your soul, and I guess you do, really. God. Family. No one matters," Cannon said, describing what a person feels on meth. Cannon said she justified her drug cooking by saying it was to provide for her children after her husband started serving a 10-year sentence on drug charges. "But it wasn't for anybody but me and my habit," Cannon said.
    The side-effects of methamphetamine use can reduce abusers' ability to be good parents, Marchino said. "They're very easily excitable. They can become paranoid on the drug," Marchino said. "Then when they come down from their meth high they can crash out for several hours at a time and basically they're completely out of it."
    In Kentucky, police try to call child protection officials before a drug bust, said Joseph Abel, an official with the seven-county Green River Region of Kentucky's Cabinet for Families and Children. A parent's arrest is "extremely traumatic. Unfortunately, sometimes it can't be handled as sensitively as we like because of the situation," Abel said. "If you have police officers getting ready to arrest the parent, we have to be there in terms of the aftermath." Child protection officials say they try to place children taken from their homes with a relative, but if none is available a child will go into foster care. Cannon cries each time she recalls the day she made pancakes for her son after getting out of jail. "He says, you're a real mommy now," Cannon said.

New Drug Courts Offer Path Away From Jail Cells
Christian Davenport, Washington Post- 1/20/2003

Instead of going to jail, Shannon Gregor has attended a treatment center in Glen Burnie to help overcome her addiction to cocaine.  Once again, Shannon Gregor had ditched her three children and husband and emptied the bank account. She headed for her dealer's house and then to a $120-a-night Baltimore hotel, where she snorted her way through a $1,000 mound of cocaine and then called for more. This, she knew when she woke up bleary-eyed the next day, was the bottom.
    Yet on Thursday, just a few weeks later, she sat in an Anne Arundel County courtroom, looked Judge James M. Dryden in the eye and smiled confidently. She had been drug-free for 59 straight days with the urine tests to prove it. "You're coming up on two months of being clean," Dryden said, leafing through her file. "Two months tomorrow," she said, shoulders back, beaming.
    Dryden couldn't help grinning back at Gregor, the 29-year-old daughter of a police detective who spent a career locking up people just like her. In the drug court, Dryden uses jail only as a last resort. And now the program and others like it have become so popular that several other jurisdictions across the state are considering starting drug courts, which favor treatment and counseling rather than jail time.
    Howard and Baltimore counties, where dockets and jails are swollen with drug offenders, hope to join Anne Arundel, Prince George's and Harford counties and the District and Baltimore city, which all have drug courts. And even though the courts don't come close to solving the country's drug problem, they have become hugely popular with jurisdictions desperate to try anything. There are 850 such courts for juveniles and adults in jurisdictions across the country and 350 more planned, according to the National Association of Drug Court Professionals.
    The movement in Maryland is gaining momentum from Gov. Robert L. Ehrlich Jr. (R), who has vowed to make fighting drug addiction a top priority and pledged in his campaign to create juvenile drug courts across the state. "The drug epidemic makes us bleed every day," he said in his inaugural speech last week. "It must be addressed, and you are going to hear a lot about this problem from our administration."
    It works like this: Nonviolent drug offenders are offered a choice of jail or the court program. If they pick the latter, they meet with case managers who assess their needs and draft a plan of treatment. Some offenders must go to therapy or counseling every day, others once a week. Some receive counseling that helps them find a job or a home or be a better parent or student. If the defendant skips treatment or fails a drug test -- some are scheduled, some random -- the judge can send them to jail or make treatment more rigorous. "In the past, court was like an industry: Come in, get your sentence and go to jail," said Gray Barton, executive director of the Maryland Drug Treatment Court Commission. "But now these judges have a chance to make a difference in some of these people's lives."
    For those who complete the drug court program, the recidivism rate is between 4 percent and 25 percent, compared with 60 to 80 percent for the general prison population, according to Susan P. Weinstein, chief counsel of the drug court association. It is also less expensive than jail, she said.
    While the evidence suggests that drug courts have been successful, their reach is severely limited. Only about 8 percent of all drug offenders enter drug court programs, Weinstein said, mainly because those who commit a violent crime are ineligible. Anne Arundel court officials have been able to persuade only about 500 people to enter the voluntary program since its start in 1997; just 140 have graduated. Meanwhile, drug arrests in the county have jumped from 2,531 in 1996 to 2,711 in 2000, according to a University of Maryland study.
    Howard County Circuit Court Judge Lenore Gelfman has been pushing for the county to open a drug court for more than a year. "With the number of drug cases on the rise, we have to do something," she said. Drug arrests in Howard jumped from 888 in 1996 to 1,223 by 2000, according to the University of Maryland study. About 80 percent of inmates in the Howard County Detention Center have a substance abuse problem. The number of people seeking treatment for heroin went from 210 in 1997 to 383 by 2001. And among high school students included in a survey of the county's schools, 4 percent said they had tried crack cocaine, 11 percent had tried LSD, and 53 percent had five or more servings of alcohol on the same occasion.
    But Gelfman doesn't need the numbers to know there are problems: They show up in her courtroom every day. Her caseload for Friday was no exception: 41 small bags of marijuana found in the spare-tire compartment of a speeding car; a man arrested by an undercover officer on suspicion of selling crack cocaine on Route 1 in Jessup; crack rocks a patrol officer found in a cigarette box. "I think everyone realizes that drug and alcohol addiction is what drives the majority of crime in any community, and certainly that would apply to Howard County," said State's Attorney Timothy J. McCrone.
    For years, Dryden sentenced drug users to jail, only to see them complete their time and return on another drug charge. Participants in the drug court also relapse, but now, Dryden said he can do something about that besides locking them up in a crowded prison. On Thursday, Dryden was confronted with a trying case. "It looks like we had a little bad patch in the road," Dryden said. "Yes, we did," said the defendant, a young man with bleached blond hair, sideburns and a craving for heroin and cocaine he couldn't seem to give up. "You know what this means," Dryden said. The young man did: more intensive treatment -- as much as three hours a day, three days a week -- or a weekend in jail. He preferred jail. Without a car, getting to treatment meant he would have to miss work, potentially costing him his job.
    But Dryden wasn't convinced that jail was the best option. "Maybe you'd rather just do the quick and easy thing instead of showing up every day and having to prove something to someone," he said. "I'm not crazy about going to jail at all," the young man said. "I've never been before in my life." He continued his lament about transportation and vowed: "I'm not going to touch the stuff again. It was very poor judgment. I'm done with it." "Well, you admitted the cocaine use before the urinalysis came back positive," Dryden said. "That's a good sign." So a weekend in jail it was.
    Just a few months before, he imposed the same sentence on Gregor. Her tests had been coming up drug-free -- in part because she would sneak in a water bottle full of urine that she knew was drug-free. But finally she was caught. The first time, Dryden ordered more frequent therapy sessions. The second time, he put her under house arrest and ordered drug tests every other day. The third time, jail. Still, she kept using. Her parents took her children away and threatened to get a court order for custody if she protested. She didn't. Her husband would deposit his paycheck, "and the next day, I'd take out the whole thing," she said. She would stay out sometimes for three days at a time, sleepless, feeding an addiction that was carving canyons in her memory.
    Then last November, she blew through an ounce of cocaine in the Baltimore hotel, snorting lines as thick as her finger for 12 straight hours. The next day, lost in deep depression, she decided to check herself into a clinic. She hasn't touched cocaine since. "You seem happy today, and you look good," Dryden told her as she sat before him Thursday. "It's really nice to see you doing this well." She felt good, she said, confident that she had licked her addiction. Dryden said he was, too. Still, she wasn't there yet. She would have to continue counseling, work on staying clean and then report back to court in three weeks. He had seen too many fail surprise drug tests at the end to let her off just yet.

Counseling Group Helps Children Deal with Loss
Cassandra Spratling, Detroit Free Press- 1/20/2003

Eight children stand in a circle, holding hands: a chain link of little intertwined fingers. "Let's go around and say why you're here," says their therapist Maria Dionisio, the only adult in the chain. "I'm here because my father died," a bespectacled boy begins. "I'm here because my grandma died," says a girl whose head barely reaches the counselor's waist. "I'm here because my twin died," says a pig-tailed girl with eyes bright enough to light up a darkened room. Moments later the children vie for hand puppets to act out dramas drawn from their lives -- children who know more about death and dying than many adults do.
    The children are enrolled in the Family Bereavement Program run by the Children's Center in Detroit, one of the metro area's largest and longest-running efforts to assist children who've lost a loved one. The program offers individual, group and family counseling. In addition, a court liaison helps guide families through legal proceedings. The bereavement program started in 1987 and was aimed at the siblings or children of homicide victims, says program coordinator Rachel Grayson. But over the years it evolved to include any child struggling to cope with the death of a loved one. "My husband was sick. He wasn't murdered. It's still a tragedy," says Katherine Diamond, whose 12-year-old son, Alton Jr., has been in the program since his dad died two years ago.
    The children meet once a week in group sessions divided by age: generally 5- to 9-year-olds in one room and children 10 through 17 in another. The Children's Center, one of many agencies supported by the annual North American International Auto Show's Charity Preview held recently, offers support, guidance and assistance to children and families.
    Dionisio explains why the sessions begin with all the children stating why they are a part of the group. "My intention is to make them feel comfortable," she says. "They know they are not the only one going through a loss. It makes them feel less ostracized. "A lot of times children feel different from other kids because of what they've gone through."
    From a child's point of view, the counseling sessions look like a time to eat pizza, play games and have fun with friends. But they're designed to encourage the children to work through their feelings. "A lot of times when a child has lost a father, a mother or a sibling, they don't know how to express that pain and grief," Grayson says. "Art therapy, drawing, drama, puppetry: They are wonderful ways to work with children who often can't express how they feel with words."
    Ten-year-old Michael Lacey Jr. of Detroit says the games are one of the main reasons he enjoys going to the sessions. The other reason is he can talk about his father's murder with kids and counselors who understand. During a break in one of the games Michael talks timidly, but with clear details about his father's murder on Nov. 20, 1998. "My father was killed," he says. "He went to the corner store to buy some bread. He noticed a gang of guys outside the store, but he ran in, anyway, and ran out. When he came out they were breaking into his car. He said something to them and one guy said something back. My dad tried to run. They shot him. They shot him in the back and the side." Michael was 4 years old.
    In the days and months that followed, Michael was depressed, says his grandmother, Floretta Lacey of Detroit. "He'd just sit around acting like he didn't care about anything," she recalls. "He didn't talk to anybody. He didn't do anything." Going to the center for counseling helps ease the pain. "Every day I come here I can just let it out so I won't be crying as much," he says. "I cried a lot when it happened." He most misses playing Monopoly, Sorry and Playstation with his dad, Michael E. Lacey Sr. "Sometimes we used to play all day," he says. "There shouldn't be any guns." Michael says being in the program lets him know he's not alone. "I don't have my dad, but I have grandfathers and godfathers who help me, too." he says. "And I like all the different activities we do here."

Learning to cope
Children react to death in different ways, center therapists say. Some shut down like Michael did. Some misbehave. Some pretend the death never happened. Eight-year-old Shallante' Crossley refused to accept that her twin brother, Allante', had died. He was run down in June 2001 by a truck that her mother, Gailya Spratt, says was driving too fast through their west side Detroit neighborhood. Shallante' saw the truck strike her brother as he attempted to cross the street. The truck dragged Allante' down the street as Shallante' and others looked on in horror.
    For weeks afterwards, Shallante' had nightmares, her mother says. She refused to go to school and when she did, she wouldn't participate. "They had been in the same class and she couldn't stand being there without him," Spratt explains. Shallante' slept in her brother's pajamas and wore his clothes. "I think she tried to take on his identity," her mother says. "She wrote his name on her school papers." A friend referred the family to the Children's Center. Another sister, Patricia, 9, attends with Shallante'.
    Spratt says she's seen a tremendous improvement in both daughters, particularly in Shallante'. "Her grades are improving," says Spratt, who always wears a photo button of Allante'. "She's focusing more in class and listening. Last year, she didn't do anything. She'd say, 'I don't want to do anything because Lonnie's not doing anything.' " Shallante' says she likes going to the Children's Center because it's a place where she can think about and talk about her twin. "I like to talk about my twin because I can think about him more," she says. "And I get to draw pictures of him. Sometimes it makes mesad. Sometimes it makes me happy. Sometimes it makes me laugh. Like I think about when he brought funny dancing 'Rugrats' into class."

Two generations
About 300 people participate in the bereavement program each year, Grayson says. Funding comes from a variety of sources, including federal government, private insurance and donations. The program is helping two generations in Ida Warfield's family. Warfield, 20, and her 5-year-old daughter, Jay-Shelle. Jay-Shelle was named in part for her cousin, Michelle Warfield. Michelle was killed in 1994 by drive-by shooters, while she, Ida and some other kids sat on the porch of a baby-sitter's home. Michelle was 9; Ida was 12. Though they were niece and aunt, they were more like sisters.
    "I took it hard for a long time," Warfield says. "I just couldn't believe it." She believes Michelle's death led her to have difficulty in school. She dropped out. "I couldn't focus," she recalls. "All I was thinking about was the incident." Attending counseling sessions helped her focus. She now works as a caregiver in a nursing home and plans to return to school.
    When Warfield's mother died in March 2001, she realized her daughter was suffering just as she'd suffered over Michelle's death. Jay-Shelle was very close to her grandmother, Jeanette Warfield, who died of cancer. Ida Warfield enrolled Jay-shelle in the program shortly afterward. "I know it's helping her," Warfield says. "She's doing very well in school and she likes coming here."
    At the end of the 1 1/2-hour group session, play therapists lead the children in a round of dancing and exercising. "Physical activity gives them a break from intense conversation," Dionisio explains. "It lightens things up. It releases some of the anxiety that may build up."

Where to get help
Family Bereavement Program at Children's Center of Wayne County, call 313-832-3555, ext. 1170.
SOSAD (Save Our Sons and Daughters) at 313-361-5200, 9 a.m.-8 p.m. Mon. and Thu, and 9 a.m.-5 p.m. Tue., Wed. and Fri.
Open Arms at 313-921-7983, 8:30 a.m.-4:30 p.m. weekdays.
Sand Castles Grief Support Program of the Hospices of Henry Ford Health System: 313-874-6881. It has sites in Clinton Twp., Detroit, Downriver, Rochester, St. Clair Shores and Southfield. A Plymouth location is scheduled to open this Spring.
Parents of Murdered Children at 248-360-9692 anytime.

Report: Painkillers Over-Prescribed in Eastern Kentucky
Associated Press, 1/20/2003

LEXINGTON, Ky. -- Drugstores, hospitals and other legal drug outlets in eastern Kentucky received more prescription painkillers per capita than anywhere else in the nation from 1998 to 2001, according to a report. Nearly half a ton of narcotics reached six small mountain counties during that span -- the equivalent of three-quarters of a pound for every adult who lives there, according a story Sunday in the Lexington Herald-Leader, which used an analysis of Drug Enforcement Agency data.
    "I can't imagine that Kentucky has any more pain than Detroit has. There's something going on," April Vallerand, an assistant professor at Detroit's Wayne State University who serves on pain advisory panels. Richard Clayton, an addiction expert who heads the University of Kentucky's Center for Prevention Research, said the problem is already out of control. "This may be the first epidemic -- if it is an epidemic -- that started in rural areas," he said.
    Courts and hospitals are overwhelmed. The newspaper found that possession and trafficking charges for all controlled substances jumped 348 percent in eastern Kentucky from 1997 through 2001, while admissions of prescription-drug addicts to residential drug-treatment centers tripled from 1998 to 2001. Eastern Kentucky counties led the nation in per capita narcotics distribution in 1998, 1999 and 2000, the newspaper found. In 2001, the St. Louis area passed Kentucky, driven by large increases in the amount of OxyContin and of morphine, which is widely used to treat pain after surgery.
    St. Louis is home to many oncologists, plus a teaching hospital, which accounts for some of its numbers, said Susan McCann, administrator of the Missouri Bureau of Narcotics and Dangerous Drugs. One Appalachian pain specialist suggested that eastern Kentucky, with its older population, many injured coal miners and high rates of lung cancer, might need large amounts of narcotics to treat legitimate pain sufferers. "An older population with more chronic disease and more chronic pain would, of course, explain at least part of the need for more pain meds," said Dr. Philip Fisher, head of the Huntington, W.Va.-based Appalachian Pain Foundation, a non-profit organization.

Drug Firms Fend Off Discount Initiatives
Alice Dembner, Boston Globe- 1/21/2003

Rosalie Hatch found her own solution to the rising price of prescription drugs last fall. After going without antianxiety pills for months so she could afford food and rent, she found a Canadian pharmacy that would fill her prescriptions for one-third less than the price charged at her Stoughton drugstore. But this week, the company that makes her medicine plans to cut off Canadian suppliers selling to Americans. Hatch fears she will again be unable to afford the drug that prevents her debilitating anxiety attacks. Similarly, the state of Maine thought it had found ways to get affordable drugs to hundreds of thousands of citizens without drug coverage. But the pharmaceutical industry has blocked the two discount initiatives in court. Faced with soaring drug expenses and no federal action to halt the escalation, consumers and states -- led by New Englanders -- are mounting a revolt. So far, the drug industry has countered the moves step for step.
    Tomorrow, the battle shifts to the US Supreme Court for oral arguments on the industry's pivotal challenge to the most expansive drug-price control program in the country. Maine RX would use the state's Medicaid buying power to force drugmakers to give deep discounts to about 325,000 residents without drug coverage. But industry lawyers, who got a court order blocking the Maine program shortly after lawmakers approved it in spring 2000, say it would violate laws governing Medicaid and interstate commerce. Nonetheless, Hawaii just approved a similar program, and Massachusetts and 27 states have filed legal arguments in support of Maine. ''States have stepped into the vacuum,'' said Cheryl Rivers, executive director of the National Legislative Association on Prescription Drug Prices. ''It's like a tidal wave wearing down a retaining wall. The dam is broken if Maine RX is upheld.''
    National spending on prescription drugs topped $140 billion in 2001, growing at twice the rate of other health costs, according to the federal Centers for Medicare and Medicaid Services. Greater use of drugs, price increases, and a shift to newer, more expensive medications all contributed to the rise. For the consumer, the average price of a prescription drug rose 10 percent in 2001, putting the medicines out of reach for some older people and many others without drug coverage. But Congress has deferred action on adding a drug benefit to Medicare, the health insurance program for the elderly, and has shown no interest in price controls. And the new Senate majority leader, Republican Bill Frist of Tennessee, says prescription drug legislation is not his top priority.
    Drugmakers argue that the costs are driven by the expense of developing drugs and any price controls would shut down the pipeline. While the companies support a Medicare drug benefit, they say seniors can already get help through discount programs in 27 states, new discount cards issued by the drugmakers, and charity programs.
    But for many consumers, those programs don't go far enough. An increasing number are turning to Canada, where government controls keep prices much lower, so that drugs made in the United States and shipped to Canada cost Americans less than the same items purchased at the corner drugstore. Canadian pharmacies estimate that Americans spent about $1 billion on prescriptions there last year, in person or via the Internet or mail. Some drug companies are trying to shut off that outlet. Merck, Wyeth, and Lilly all recently warned Canadian wholesalers that sales to Americans violated their contracts. And GlaxoSmithKline told pharmacists and wholesalers last week that starting today, anyone caught selling its products to Americans would be cut off from future supplies. ''We think importing medications in this way puts patients at risk'' through mislabeling or shipping damage, said Glaxo spokeswoman Mary Anne Rhyne.
    But patients such as Rosalie Hatch say their drugs arrive in perfect condition and that cutting off the supply would hurt them more. Hatch suffered badly last fall when she couldn't afford Paxil at the price charged by her local drugstore. Last week, she got a 90-day supply of the Glaxo product from Hometown Meds in Manitoba for $147.84, compared with $74.30 for a 30-day supply locally. ''I don't think it's fair'' to cut off the supply, said Hatch, who is 56 and disabled. ''These pharmacy companies are really trying to rule the world. I think they should lower their prices and make the drugs available for people who can't afford them.''
    Consumers have also banded together to press for changes in drug pricing through class action lawsuits in Boston and across the country. The suits allege the companies fraudulently inflated drug prices and worked to keep cheaper, generic preparations off the market, allegations the companies deny. ''It's a war on many fronts and it's building up to a movement,'' said Susan Sherry, deputy director of Community Catalyst, a Boston-based organization coordinating many of the lawsuits.
    State legislatures have become another front, as lawmakers confront shrinking revenues, growing health care costs, and desperate constituents. So far, Maine has attempted to go the furthest. Under Maine RX, the state sought to force drug companies to lower their prices for the uninsured, threatening to restrict access to their drugs for Medicaid patients or to have state officials set the prices. A federal appeals court upheld the change, but the Pharmaceutical Research and Manufacturers of America took it to the Supreme Court.
    ''Maine RX limits access to drugs by Medicaid patients,'' said Majorie Powell, an attorney for the trade association. ''It's bad public policy and violates the federal Medicaid law by imposing prior authorization [of medications] for cost containment rather than clinical purposes. If people want to go to a price control system, they will get the results that every other country has seen - less research, and government decisions about what drugs you can and can't have.'' Counters Newell Augur, a spokesman for the Maine Department of Human Services, ''It's so ironic that they would claim to argue on behalf of the vulnerable people in the state when the very program they're attacking is meant to help low- and moderate-income folks.''
    With Maine RX tied up in court, Maine went to Plan B, the Healthy Maine program, which expanded the state's Medicaid drug discount of about 25 percent to 225,000 low-income people making too much money to qualify for Medicaid's other benefits. But the pharmaceutical industry shut that program last month, after only 112,000 had enrolled, winning a federal appeals court ruling that the program illegally expanded Medicaid. A similar effort in Vermont was also quashed.
    The industry is also fighting programs in Michigan and Florida, although it has lost in the early rounds. Those programs are negotiating lower prices for Medicaid drugs -- and in Michigan's case, for seniors -- by requiring that doctors seek state authorization to prescribe drugs from companies that don't negotiate. (In Massachusetts, former acting governor Jane Swift vetoed a similar program approved by lawmakers.)
    ''This is still an uphill battle,'' said Peter Shumlin, the former Vermont Senate president, who chairs an alliance of state lawmakers trying different tactics. Massachusetts and eight other states, for example, announced last week that they're developing a nonprofit company to manage drug costs. ''But the simple fact that average citizens realize they need to use their passports to stay healthy is going to raise such a level of frustration that no single court case will stop this effort,'' Shumlin said.

Abuse Specialists Challenge Church Defense Tactic
Michael Paulson, Boston Globe- 1/22/2003

Calling the deposition of therapists ''an act of reabuse,'' 83 mental health professionals from around the nation are denouncing Bishop Richard G. Lennon's decision to allow church lawyers to question counselors treating alleged victims of clergy sexual abuse. The direct challenge to Lennon, led by a New York psychoanalyst who had been hand-picked by US bishops as an expert on sexual abuse, comes as plaintiffs' attorneys and victims increasingly are complaining that Lennon has not made significant changes since assuming the post of administrator of the Archdiocese of Boston upon the resignation of Cardinal Bernard F. Law. The church has taken a series of tough legal steps, including resisting a subpoena from the state attorney general and pressing an argument that the First Amendment protects it from litigation by victims, as Lennon pushes to resolve abuse-related claims by more than 500 people.
    Attorneys for alleged victims say settlement talks, which Lennon promised to intensify, have all but broken down. And some victims say the sense of hope they felt with Lennon's appointment has swiftly ebbed. ''The church's priorities have been very evident - reaching out to parishes, reaching out to its law firms -- but there has yet to be any effort to reach out to the victims as a whole,'' said Olan Horne of Lowell, who said he and other members of a victims' group called Survivors of Joseph Birmingham had placed nearly a dozen phone calls before finally hearing yesterday that Lennon would meet with them.
    The archdiocese has justified its decision to depose therapists by saying that it is standard legal practice and that the church is entitled to defend against parties who choose to press litigation that claims emotional harm. Yesterday, a Lennon spokesman continued to defend the church's legal strategy, but acknowledged that it sometimes conflicts with the church's effort to reach out to victims.
    ''There is a tension between the pastoral work of the Office of Healing and Assistance Ministry and the litigation that's involved,'' said Rev. Christopher J. Coyne. ''You have people that the archdiocese is trying to help on a pastoral level, but these same people are bringing lawsuits against priests, bishops, and the archdiocese, and as long as we remain in litigation, that tension is going to remain.'' Coyne said Lennon has been meeting with victims and their families, but has not had time during his first five weeks as administrator to meet with everyone who is seeking time with him. He said he does not expect the church to rethink the deposition of therapists, which lawyers acknowledge is common when a victim alleges psychological damage.
    ''There hasn't been any reconsideration of whether we should be doing this -- it's part of the legal process the archdiocese and other defendants must go through in order to bring forward a defense against people who are bringing suit,'' he said. ''The archdiocese is committed to mediation and does not want to go through litigation, but if forced to do so, the defendants and the archdiocese will mount the defense anybody else would.''
    Therapists, including faculty members from Boston College, Boston University, Simmons College, and the University of Massachusetts, and a variety of clinicians who work with trauma survivors denounced the move, saying that even if legally permissible it is morally unacceptable. Clinicians, authors, and researchers made up the overwhelming majority of those who signed the letter to Lennon, which was also signed by a handful of abuse victims and non-Catholic clergy. ''While the Archdiocese of Boston has a legal right to pursue the depositions of therapists treating abuse survivors in litigation with the Church, it is crucial for Church officials to remember that these suits have emerged from the sexual abuse of minors by priests and, often, only after years of stonewalling efforts by the hierarchy,'' the letter said. ''We hope that you will reconsider your decision to retraumatize the already broken members of your flock and will choose to pursue a pastoral rather than corporate and counter-litigious path.''
    The letter was spearheaded by Mary Gail Frawley-O'Dea, the executive director of the Trauma Treatment Center at the Manhattan Institute for Psychoanalysis, who was the only therapist invited by the bishops to testify at the June meeting of the US Conference of Catholic Bishops in Dallas. ''I am not a hysteric; I don't think suing is the best way for survivors to go. I have a lot of empathy for the bishops who are trying to make things right, and I don't consider the church my enemy,'' said Frawley-O'Dea, a Chelmsford native who attended Academy of Notre Dame in Tyngsborough and Emmanuel College in Boston. ''But I think that this is very despicable and deceitful. To say `the church loves you' and `we want to help you' and then to invade your treatment is really just wrong. It may be legally OK, but it's wrong.''
    Lawyers handling abuse cases say the therapist depositions are part of a pattern of toughening legal strategy by the archdiocese. Yesterday, victims' attorney Roderick MacLeish Jr. said he and lawyers for the church are not currently discussing settlement. ''Right now, there is no opportunity to have a meaningful dialogue,'' he said. And plaintiffs' attorney Robert A. Sherman said that despite Lennon's public comments, there has been ''zero change'' since Lennon replaced Law. Lennon's statements, Sherman said, ''have certainly not been translated into any action by the archdiocesan lawyers.''
    The archdiocese also continues to wage a fierce legal battle out of public view. The church's lawyers have sought to quash a subpoena issued by a criminal grand jury convened by Attorney General Thomas F. Reilly, according to lawyers who are familiar with the issue. The subpoena demanded that the church produce any correspondence between the archdiocese and the Vatican regarding the sexual misbehavior of priests.
    Victims are increasingly upset. Ann Hagan Webb, a psychologist who signed the letter and who also serves as coordinator of the local chapter of the Survivors Network of those Abused by Priests, said the depositions have damaged the credibility of the church's outreach to victims. ''The whole survivor community is upset about the deposing of therapists, and certainly the therapist community is upset about it,'' Webb said. ''By deposing a therapist they have quickly destroyed a lot of people's trust in the process and have frightened people about whether they should continue to be in therapy.''
    Other therapists who signed the letter expressed similar sentiments. ''This might be legally OK, but it's ethically wrong, and that's what the archdiocese has continued to do -- they always put form ahead of substance and policy ahead of people,'' said Linda T. Sanford, who teaches at the Boston College Graduate School of Social Work. ''People should not have to sacrifice their privacy just because they are looking to be compensated for the pain and suffering they've endured.'' Marcie A. Mitler, a Cambridge counselor who specializes in child sexual abuse, called deposing therapists ''a way of revictimizing someone who has probably taken years and years to tell anybody.''

Study on Twins Supports View of Marijuana As Gateway Drug
Associated Press, 1/22/2003

A study of Australian twins and marijuana bolsters the fiercely debated ''gateway theory'' that pot can lead to harder drugs. The researchers located 311 sets of same-sex twins in which only one twin had smoked marijuana before age 17. Early marijuana smokers were found to be up to five times more likely than their twins to move on to harder drugs. They were about twice as likely to use opiates, which include heroin, and five times more likely to use hallucinogens, which include LSD. Earlier studies on whether marijuana is a gateway drug reached conflicting conclusions. The impasse has complicated the debate over medical marijuana and decriminalization of the drug. The findings suggest that genetics plays a subordinate role in drug use.
    The study appears in today's Journal of the American Medical Association and was funded in part by the National Institutes of Health. It does not answer how marijuana, or cannabis, might lead to harder drugs. ''It is often implicitly assumed that using cannabis changes your brain or makes you crave other drugs,'' said lead researcher Michael Lynskey, ''but there are a number of other potential mechanisms, including access to drugs, willingness to break the law, and likelihood of engaging in risk-taking behavior.'' Lynskey is a senior research fellow at Queensland Institute of Medical Research in Brisbane and a visiting assistant psychiatry professor at Washington University in St. Louis, where some of the research was done. Lynskey and colleagues acknowledged the study has several limitations, including relying on participants' reporting of their own experiences.
    In an accompanying editorial, Denise Kandel of Columbia University's psychiatry department said the study does not explain ''whether or not a true causal link exists'' between marijuana and hard drugs. ''An argument can be made that even identical twins do not share the same environment during adolescence,'' she said.
    Study participants were age 30 on average when they were asked about their teenage drug use. They included 136 sets of identical twins, who share the same genetic makeup. About 46 percent of the early marijuana users reported that they later abused or became dependent on marijuana, and 43 percent had become dependent on alcohol. Cocaine and other stimulants were the most commonly used harder drugs, tried by 48 percent of the early marijuana users, compared with 26 percent of those who didn't try marijuana early. Hallucinogens were the second most common, used by 35 percent of the early marijuana twins versus 18 percent of the others.

Survey: Husbands, Wives Go Opposite Ways
Jim Fitzgerald, Associated Press- 1/21/2003

CHAPPAQUA, N.Y. -- Love and sex are more important to a happy marriage for men in their late 50s and early 60s than at any other time in their lives, a new survey says. Unfortunately for them, that's just when intimacy becomes less important to women. The survey, being published in the February issue of Reader's Digest, found that between the ages of 57 and 64 men become more attentive to their wives while women, finally freed from family responsibilities, find more goals outside of marriage. ''The guys are saying, `Now I get it. I want more intimacy,''' said John Gottman, a marriage expert who analyzed polling data for the magazine. ''And the women are saying, `Sorry, bub, I've already done that. I've got my own goals now.'' A 60-year-old New York woman in the survey said she was finally getting the chance to travel, but her retired husband didn't want to. ''What am I supposed to do? Stay home?'' she asked. ''Life's too short.''
    The nationwide telephone survey was conducted in June for the Chappaqua-based magazine by the Ipsos-NPD research group, which randomly chose 500 married men and 500 married women, but no couples. Questions were designed to determine how happy their marriages were and find out about specific behavior and attitudes. Gottman, who teaches at the University of Washington and is the author of ''The Seven Principles for Making Marriage Work,'' then compared the answers to find the relationship between marital happiness and particular behavior and attitudes. Women in the 57-to-64 age group rated good sex at 46 on a scale of 100 for its importance to a happy marriage. Men rated it 62. For the 44-to-56 age group, the importance of sex got a 66 from women and a 54 from men. The differences smooth out somewhat in later years. The importance of sex drops for men, while they remain highly interested in being in love.
    ''When you're young, you demonstrate love more often with sex,'' said a 77-year-old man from Michigan. ''But when you're a bit older, you find there are many other ways a peck on the back of the neck or a pat on the butt.'' For both sexes, spending time alone together is more important after age 65 than in the first years of marriage. Also, arguments no longer carry the sting they do for younger couples. ''We let off steam and then a few minutes later start talking to each other as if nothing happened,'' said a 73-year-old woman from Connecticut. ''Now that we're older, we don't hold a grudge.''
On the Net: Reader's Digest: http://www.rd.com

Mentally Ill Texas Man Will Seek Clemency
Patty Reinert, Houston Chronicle 1/22/2003

WASHINGTON -- A Texas murderer with paranoid schizophrenia lost his latest bid Tuesday to avoid execution when the U.S. Supreme Court refused to hear his appeal. Without commenting, the high court declined to take up the issue of whether James Colburn, 42, should get a chance to convince a lower court that he should not be executed because he is mentally ill. "We're profoundly disappointed," said Houston attorney Philip Hilder, who along with James Rytting is representing Colburn.
    The decision means the state likely will set a new execution date for Colburn, whose execution by injection was stayed by the Supreme Court in November, just minutes before he was to enter the Huntsville death chamber. Hilder and Rytting said they are considering further appeals. Meanwhile, they will ask Texas Gov. Rick Perry for clemency in an effort to get their client's death sentence commuted to life in prison. "Executing people with mental illness as grave as Mr. Colburn's is barbaric," Rytting said. "This is an opportunity for the state of Texas to demonstrate, and even take the lead, in this critical area of the law and help him." Jane Shepperd, spokeswoman for the Texas Attorney General's Office, declined to comment on the court's decision. Representatives for the governor's office were attending Perry's inauguration Tuesday afternoon and did not return calls seeking comment.
    Colburn was sentenced to death for the June 26, 1994, murder of Peggy Murphy near Conroe. Murphy, 55, was hitchhiking on a street outside Colburn's apartment when she asked him for a glass of water. Colburn invited her into his apartment and attempted to rape her. When she resisted, he choked her until she passed out, then stabbed her in the neck with a steak knife. He then asked a neighbor to call the police and sat down to smoke a cigarette and await their arrival. Colburn confessed later that day, saying he had heard a voice telling him that killing Murphy would send him back to prison, where he would be safe. Colburn, who had suffered from paranoid schizophrenia since the age of 14, had told family members that he had been hearing voices in the days before the killing and was worried he would harm someone in his family. Colburn previously had tried to kill himself and had been in and out of mental hospitals to treat his disorder, which includes symptoms of delusions, hearing voices and feeling persecuted.
    At trial, prosecutors said Colburn told detectives that he did not hear voices specifically commanding him to kill Murphy, but instead acted on a sudden impulse. They also said Colburn was receiving proper medication to control his psychosis. Rytting and Hilder said Colburn was so heavily sedated with antipsychotic drugs that he slept through much of his trial. Even when awake, Rytting said, Colburn was so drowsy he was unable to understand the proceedings or to communicate with lawyers trying to defend him. The jury found Colburn guilty and agreed on a death sentence despite his mental illness.
    Under Texas law, a mentally ill killer can be executed if, as his execution date approaches, he understands the reason for the punishment and the fact that the execution is "imminent." Last fall, as Colburn's execution date was approaching, the Montgomery County court where he was convicted ordered a mental evaluation to determine whether Colburn was competent to be executed. The court appointed two experts suggested by prosecutors, both of whom found Colburn competent. Colburn's lawyers asked the court to pay for an expert of their choosing to challenge the state's experts and they asked for a hearing to present evidence. The court denied both requests.
    On appeal to the U.S. Supreme Court, Colburn's lawyers first tried to argue the bigger issue that executing the mentally ill is "cruel and unusual punishment" banned by the Eighth Amendment to the Constitution. The court, which last year banned executions for the mentally retarded on those grounds, rejected Colburn's plea that it consider extending the ban to spare mentally ill killers. But then, at the very last minute, the justices agreed to halt Colburn's execution so they could consider whether to accept his case and decide the procedural question of when inmates like Colburn should be allowed to make the case that they are incompetent to be executed.
    The first time Colburn's lawyers tried to make that argument, shortly after his conviction, the lower courts said they were too early. The issue was not considered "ripe" for deciding because Colburn's execution was not yet "imminent." Later, the courts said it was too late for Colburn to make the argument because he had failed to raise it earlier. The 5th U.S. Circuit Court of Appeals in New Orleans agreed with that assessment, but other circuits around the country have disagreed in similar cases. Colburn's lawyers urged the Supreme Court to settle the issue, but they were unable to persuade the justices to take the case.

In Texas Drug Court, Success Is Sweet
Thom Marshall, Houston Chronicle- 1/23/2003

The judge told the young woman standing before him she could have a Life Saver and spend half a day doing community service. Or she could leave her Life Saver in that big jar on the bench between them and not work the four hours. Others who preceded her in standing before Judge Bradley Smith at that weekly session of the Fort Bend County Drug Court automatically got Life Savers without having to do community service. But they each had met all the court-ordered obligations and duties without a glitch since the last session. This young woman had been late to one of the meetings she is required to attend under the drug court program. Successful completion of the program results in no criminal record. But if you wash out of it, your case gets turned over to the regular justice system for routine disposition. The idea behind drug courts is that a combination of judicial oversight and supervised treatment works better to reduce drug use and crime than if courts and treatment operate separately.

County slow to get started
The concept has been slow to catch on in Texas. Nationally, there are more than 900 drug courts. Texas has but seven. Two years ago the Legislature ordered three other counties -- including Harris -- to get them going, but our officials have been dragging their heels. Courts administrator Jack Thompson told me on Thursday that a team finally is heading out to California on Monday for a three-day meeting on drug court planning.
    Harris County taxpayers pay far more money than residents of any other region in the state for locking up people over drug crimes. We should be first in line to try anything that might improve our local justice system. (Studies have shown that every public dollar spent on drug courts saves close to $10.)
    The young woman in the drug court spotlight in Richmond offered Judge Smith a good excuse for her tardiness. Smith said that while he sympathizes with anyone who has car trouble, excuses just don't fly in the program. She was late. She must pay. Either give up the Life Saver or take it and do the four hours. If it was just the little piece of candy it appeared to be, the choice would be easy. You can buy an entire package for a few coins at any convenience store. Who would work four hours for only one? But in Smith's drug court a Life Saver is not just candy. It is a symbol of success. Different drug courts use different gimmicks and rewards in their programs. Smith said his operation reflects some of what he learned when helping his own son conquer a marijuana habit. He knows that a group of peers can make a big difference in an individual's recovery efforts.

All share triumphs, shortfalls
When he calls you to approach the bench to discuss your progress, if you have tested drug-free and met all the other requirements, he announces to the others in the courtroom that you are a lifesaver. The others applaud, and you take a Life Saver from the jar. If you mess up and don't make it, you don't just let yourself down, you disappoint the whole group.
    There also is a symbol for that disappointment. If the group isn't 100 percent lifesavers at the end of the session, if even just one out of the entire bunch didn't make it, everyone must drop a dollar in the pot on the way out of the courtroom. That is why it might be worth four hours of community service to someone to take a Life Saver and be a lifesaver. "You can decide," the young woman told Judge Smith. "No," he said, "it's your decision." Learning to weigh the options and make good decisions for yourself is a part of the program.
    It was obvious she didn't want to spend a half day of her weekend on community service work. It was also obvious that she wanted her Life Saver. The judge watched her face and waited. The others in the program watched her back and waited. You could have heard a pin drop. Finally, her hand moved slowly to the jar as she announced her decision. The applause started. She took her Life Saver.

OxyContin Ads to Carry Prominent Warning of Risks
Raja Mishra, Boston Globe Staff- 1/24/2003

The Connecticut-based maker of the often abused painkiller OxyContin yesterday promised all future ads for the drug would include prominent warnings about its addictive potential, a response to blistering federal government criticism that the firm's marketing campaign dangerously downplayed the drug's risks.
    Federal health officials said they will nonetheless continue to investigate the firm's OxyContin marketing campaign, a sign that government officials are concerned that the company's sales effort might be contributing to the national OxyContin crime and addiction wave that has ravaged parts of New England and Appalachia. The criticism came in a rare warning letter sent to the company, Purdue Pharma LP, last week by the US Food and Drug Administration, which accused the company of improperly relegating information on OxyContin's risks to the small-type section of recent ads. The seven-page letter even took aim at a Purdue marketing slogan. ''It is particularly disturbing that your November ad would tout `Life With Relief,' yet fail to warn that patients can die from taking OxyContin,'' said the letter from the 30- member FDA department charged with monitoring drug ads.
    The government criticism echoed complaints in nearly 180 lawsuits nationwide charging Purdue with designing misleading ads that helped addict patients to their drug. Plaintiff's lawyers in those cases said the FDA letter would bolster their cases. ''This will go a long way in the courts,'' said Troy N. Giatras, a Charleston, W. Va. lawyer who heads the Association of Trial Lawyers of America's OxyContin litigation group. ''Coming from the FDA, it will have great weight with judges and juries.'' The FDA reviews the contents of drug advertising under the federal Food, Drug, and Cosmetic Act, which requires ads to contain balanced information about the risks and the benefits. FDA officials occasionally send letters of reprimand for violations; the agency can levy fines as well. A Purdue spokesman said the advertisments in question were the product of an ''honest misunderstanding'' and that company would soon offer FDA officials a detailed formal explanation.
    The episode continues the controversy surrounding Purdue since it began selling OxyContin six years ago -- controversy the firm has fought with increasing vigor in the last two years. It has had 19 civil lawsuits against it dismissed while never losing or even settling a single case. Yesterday the firm announced that it would provide a new supply of OxyContin pills to pharmacies that had been robbed of the drug. In addition, Purdue recently hired former-New York City mayor Rudy Giuliani, now a crime consultant, to assist their efforts in working with police to reduce the number of drugstore holdups. The firm has also spent considerable time and money educating doctors about proper painkiller use, including a recent $3 million gift to Massachusetts General Hospital's pain clinic that will also fund safety courses.
    But the FDA letter marks a new level of government involvement in the OxyContin controversy. The letter said that two of the company's recent ads in the Journal of the American Medical Association ''omit and minimize the serious safety risks associated with OxyContin,'' which worked to ''grossly overstate the safety profile'' of the drug. Failure to change future ads could result in criminal prosecution, the FDA said.
    Purdue spokesman James Heins noted that the company has run 140 previous ads that focused primarily on OxyContin's risks. The company plans to dedicate future ad space to painkiller education, at least in the short term, he said. Future ads for the drug, which has recorded more than $2 billion in sales over the last five years, would prominently feature warnings, he said. Regarding the impact the FDA warning may have on lawsuits, Heins said: ''This situation won't change the merits of the suits that have been brought against the company. It won't automatically make these baseless allegations suddenly legitimate.'' Most of the pending lawsuits predate the ads singled out by the FDA, which ran in October and November of last year. But Purdue critics say that much of the firm's advertising over the last five years was similarly misleading, though no judge has agreed with them to date. Meanwhile, the FDA warned Purdue in its letter that, ''We are continuing to evaluate other aspects of your promotional campaign for OxyContin,'' though an agency spokeswoman refused to provide details on the effort.
    Pain-management specialists praise OxyContin's unique time-release mechanism, which gently dispenses painkilling opioids over long time spans, eliminating the need to constantly take pills. But doctors must carefully wean patients off the drug, and some patients end up addicted. More troubling, many street addicts discovered that crushing the pills would disable the time-release mechanism, creating a rush that rivals heroin. OxyContin abuse began to grow three years ago in rural areas like Maine, West Virginia and Kentucky, eventually spreading to urban areas such as Boston.
    More than 360 Massachusetts people died of narcotic overdoses in 2000, more than triple the number a decade earlier, a spike attributed in part to OxyContin, as well as the increasing availability of heroin. Maine officials reported 161 fatal overdoses last year, four times the 1997 total, a tally also blamed in part on the painkiller. OxyContin thefts have also skyrocketed in Massachusetts. A week ago, a Framingham pharmacy was robbed of OxyContin at gunpoint, the third time in five months. Earlier this month, police arrested a Suffolk County correctional officer for allegedly selling the painkiller, as well as cocaine and marijuana, to inmates. And perhaps the ultimate confirmation of its crime status: a December sweep by Boston police found La Cosa Nostra members allegedly trafficking OxyContin.

Study: Single Parent Children Prone to Psychiatric Illness
Emma Ross, Associated Press- 1/24/2003

LONDON - Children growing up in single-parent families are twice as likely as their counterparts to develop serious psychiatric illnesses and addictions later in life, according to an important new study. Researchers have for years debated whether children from such homes bounce back or whether they are more likely than those whose parents stay together to develop serious emotional problems. Specialists say the latest study, published this week in The Lancet medical journal, is important mainly because of its unprecedented scale and follow-up -- it tracked about 1 million children for a decade, into their mid-20s.
    The question of why and how those children end up with such problems remains unanswered. The study from Sweden's National Board for Health and Welfare in Stockholm suggests that financial hardship may play a role, but other specialists say the research also supports the view that quality of parenting could be a factor.
    The study used the Swedish national registries, which cover almost the entire population and contain extensive socio-economic and health information. Children were considered to be living in a single-parent household if they were living with the same single adult in both the 1985 and 1990 housing census. That could have been the result of divorce, separation, death of a parent, out of wedlock birth, guardianship or other reasons. About 60,000 were living with their mother and about 5,500 with their father. There were 921,257 living with both parents. The children were aged between 6 and 18 at the start of the study, with half already in their teens.
    The scientists found that children with single parents were twice as likely as the others to develop a psychiatric illness such as severe depression or schizophrenia, to kill themselves or attempt suicide, and to develop an alcohol-related disease. Girls were three times more likely to become drug addicts if they lived with a sole parent, and boys were four times more likely.
    The researchers concluded that financial hardship, which they defined as renting rather than owning a home and as being on welfare, made a big difference. However, other specialists questioned the financial influence, saying Swedish single mothers are not poor when compared with those in other countries, and suggested that quality of parenting could also be a factor. ''It makes you think that what you're seeing is just the most dysfunctional families having these problems, rather than the low income. The money is really an indicator of something else,'' said Sara McLanahan, a professor of sociology and public affairs at Princeton University, who was not involved in the study. ''If you really thought that it was the income that makes the difference, you would think that Swedish lone mothers would do a lot better than the British or those in the United States, but they look very similar,'' she said. Other specialists agreed.
    In the last 20 to 30 years, poverty has been greatly reduced everywhere in Europe, but psychiatric problems in children have not, said Dr. Stephen Scott, a child health and behavior researcher at the Institute of Psychiatry in London, who also was not involved in the study. He said that in previous studies, once researchers have adjusted their results to eliminate the influence of bad parenting, any increased risk of emotional problems shrinks markedly. This, he said, indicates it is not so much single parenthood but the quality of parenting that is at issue. ''The kind of people who end up as single parents might not have done well by their kids, even if they hadn't ended up alone. They tend to be more critical in their relationships, more derogatory toward other people,'' Scott said, adding that it is also harder to be a warm, non-critical parent when you're bringing up a child alone. However, he noted that there are plenty of children from single-parent families who don't end up with serious emotional problems. There may also be a genetic element: More irritable people are more likely to become separated, but they are also more likely, whether they are separated or not, to have more irritable children, Scott said.

Privacy of Rape Accusers Clashes With Trial Rights
Adam Liptak, New York Times- 1/26/2003

LAWRENCE, Mass. -- The Women's Resource Center is stocked with toys, children's books and masks. Samantha A. Zellinger, an employee, says they help young victims of sexual abuse feel comfort during counseling. "If their hands are busy," Ms. Zellinger said, "it's easier for them to talk." Whether the center can protect the privacy of those talks, though, is uncertain. It was held in contempt of court this month for refusing to turn over the counseling records of a 16-year-old girl to lawyers for the man she says raped her. The court imposed a fine of $500 for each day it did not comply with its order.
    The defendant's lawyer, Paul Rudof, concedes that he does not know what the records contain. But, Mr. Rudof said, they might exonerate his client. "The question is," he said, "what's more important -- one individual's private communications with a treatment provider being revealed in a limited fashion, or the potential that an innocent person be convicted of a crime where exculpatory evidence could have been available?"
    More than half the states give some protection to rape counseling records. But the laws vary, and courts have struggled to balance an accuser's privacy with a defendant's right to a fair trial. The privilege for rape counseling is far less well established than that protecting communication between lawyers and clients or doctors and patients. How much privacy women get depends on money, Wendy J. Murphy, the center's lawyer, said. "It really depends on whether you are rich or poor," she said. "Rich people go to their doctors. Poor people go to rape crisis centers."
    The immediate question in this case is whether the defendant, Manuel Valverde, 20, is entitled to know how many times his accuser received counseling. Even the prosecutor, Jean Curran, said Mr. Valverde was entitled to that much. Mr. Rudof explained why he wanted the information. "Someone who was truly raped and traumatized in the way this girl claims to have been won't have just ceased going to counseling after a couple of sessions ," he said. "That's inconsistent with true counseling." That assertion outraged Ms. Murphy. "The sexist and speculative nature of this argument aside," she wrote in court papers, "there is simply no logical nexus between a victim's credibility and the number of times she talks to a counselor." She added, "There is no responsible way to generalize about the 'typical reaction' or the behavior of a 'typical' rape victim." Ms. Zellinger has another reason some rape victims might go to counseling only a few times. "Maybe it's so traumatic that they're not willing to face it," she said.
    The $500-a-day fine, imposed by Judge Peter Agnes Jr. of Superior Court on Jan. 2, has been suspended until next week, to give the center time to appeal. The appeals court has not indicated whether it will hear an appeal. Nor have the courts decided how much information Mr. Valverde is entitled to have, though the center has been ordered to deliver the entire file to the courthouse.
    Disputes like this are relatively common. Rape defendants are more likely than other defendants to seek intimate information about their accusers, said Douglas E. Beloof, a professor at Lewis and Clark Law School in Portland, Ore., and the executive director of the National Crime Victim Law Institute. "Dirt matters in sex, and it doesn't matter in armed robbery cases," Professor Beloof said, "because the culture puts the rape victim's character on trial."
    Even states that have some protection for rape counseling records often allow exceptions that make it hard for counseling centers to assure clients that their confidences will never be revealed. "You force any responsible provider to tell victims that if you talk to us, anything and everything you say could be read by a judge and used by the defendant," Professor Beloof said. Ms. Zellinger said that sort of warning would either destroy the counseling relationship or undermine prosecutions. "People would not take the risk of coming in, or they would come in with the knowledge that they would not be prosecuting," she said. "They have to make a choice between going through the prosecution process or the healing process."
    A few states have absolute privileges. Last month, the Utah Supreme Court upheld an absolute statutory privilege that had been challenged by a rapist who said his inability to inspect the victim's statements had violated his constitutional right to a fair trial. Many states, including Massachusetts and Pennsylvania, have tried a variety of approaches. After decisions in those states refusing to recognize a privilege, the number of victims seeking counseling dropped, anonymous calls seeking help increased and the likelihood that victims who received counseling would press charges declined, a 1995 Justice Department report said.
    Roger Witkin, a defense lawyer in Boston, said the debate over the scope of the protection lost sight of the real issue in a criminal trial. "A fair trial requires that they give you every statement the opposing witness ever made, consistent, conflicting, whatever," he said. "Everything should go to the defense lawyer."
    Ms. Zellinger said the center, which has 15 employees, could not afford the fines Judge Agnes imposed. "I have anywhere from 10 to 15 people in my shelter," she said. "Seven hundred dollars can feed them for a month." Ms. Murphy has asked the appeals court to consider an alternative. She gave it the names of 500 women who said they would each serve a day in jail to satisfy the sanction. The list has since grown to 2,000 people. One of them is Gail Burns-Smith, the executive director of Connecticut Sexual Assault Crisis Services. "Can you imagine how much pain you have to be in to pick up the phone and call a hot line because you have no one else to talk to?" she asked. "if we do not take a strong stand and protect victims' confidentiality, they will stop coming to us."
    The grandmother of the girl whose records are the subject of the dispute here is also her guardian. Speaking through a translator, she expressed surprise, confusion and discomfort about Judge Agnes's ruling. "If she is looking for counsel and letting out her feelings to someone," she said of her granddaughter, "she would hope that it would be kept confidential."

Even in the Age of Prozac, Some Still Prefer the Couch
Erica Goode, New York Times- 1/28/2003

Four days a week, Rachel H. takes the subway uptown, waves to the doorman in the large prewar apartment building where her psychoanalyst keeps his office, lies down on a burgundy leather couch and begins to talk. Ms. H., a 33-year-old graduate student, has heard all the jokes. She has listened patiently to friends who tell her she would be better off taking Prozac or trying yoga or leaving New York altogether to escape her obvious "dependency" on her analyst. She has endured teasing and incredulity. "Don't you think that's so last century?" asked one woman.
    Yet Ms. H. is not bothered by this lack of enthusiasm. After spending six years and about $60,000 on analysis, she says, she is less self-destructive, more responsible, more productive and more successful in her work. She has more compassion for others. She understands, in ways that have grown more layered and complex, her own strengths and limits and those of the people close to her.
    In the last quarter century, psychoanalysis has been declared dead many times over. Psychoanalysts, once dominant in psychiatry, now stand on the sidelines of a field where drug treatments and brief forms of talk therapy are the rule. Thanks in large part to Woody Allen, Freud's talking cure has become shorthand for costly self-indulgence with no obvious benefit. And many psychiatrists barely hide their disdain for what they regard as an outmoded approach to treating mental disorders.
    Yet thousands of Americans -- it is not known exactly how many -- continue to seek out psychoanalysis. Like Ms. H., they believe that the arduous, uncertain and often emotionally painful dissection of mental life such treatment entails offers something they can find nowhere else. "Obviously I think it's an incredibly valuable thing that I'm doing. Otherwise, why would I do it?" said Ms. H., who spoke on the condition that her last name not be used out of concerns for her privacy. "You have to see things for what they are, and I think that's essentially all that it's about," she said. "It's about lifting the veil, seeing relationships and seeing yourself, so that you can begin to make choices that will not lock you into an unhappy future and an unhappy life."
    In its heyday in the 1950's and 1960's, psychoanalysis attracted a wide swath of the intellectual elite, along with many middle class patients who, backed by generous health insurance plans, were referred to psychoanalytic treatment as the best psychiatry had to offer. Experiences on the couch, good or bad, provided routine fodder for dinner parties. And the language of classical psychoanalytic theory -- the unconscious, the Oedipus complex, the superego and the id -- became firmly embedded in the culture.
    Yet most psychoanalysts now acknowledge that analysis was practiced far too broadly and that its effectiveness, particularly as a treatment for severe mental illnesses like schizophrenia and manic depression, was greatly oversold. "Many analysts thought that psychoanalysis was the treatment of choice for virtually every mental disorder," said Dr. Kerry J. Sulkowicz, the chairman of the public information committee for the American Psychoanalytic Association, which held its winter meeting in New York last week. "We've learned that that's not the case." Today, pharmacology and focused, short-term psychotherapies predominate in the treatment of mental illness. Psychoanalysts are more cautious about whom they will treat on the couch. And those who seek their help represent a far smaller and more select group.
    According to a survey conducted in 2001 by the psychoanalytic association, analytic patients in the United States are typically well educated, well-off financially, white and 30 to 50 years old. Some are mental health professionals, trying to understand themselves better in order to better help their patients. But business people, artists, writers, academics and others also find their way into analysis.
    Many have tried other forms of talk therapy and have been dissatisfied with the results. Some have taken, or continue to take, antidepressants or other psychiatric drugs and have found that while helpful, the medications have not solved their problems in forming intimate relationships or in avoiding destructive behavior patterns. Still others remain stubbornly committed to the notion that their emotional difficulties are rooted in the unconscious rather than in the ebb and flow of brain chemicals. "I had this really strong conviction that my problems were psychological, and I wanted to deal with them psychologically," said Patrick Cody, 40, a communications consultant in Washington who spent 10 years in analysis, which he sought out after experiencing depression and severe panic attacks.
    In an era of managed care, most patients pay out of their own pockets for their treatment, which typically involves three to five sessions a week, at fees varying from $10 a session at a psychoanalytic training clinic to more than $200 a session at a Park Avenue practice. But time is often a bigger issue than money. "I don't have a problem with patients' affording fees," said Dr. Henry Bachrach, a researcher and analyst at the New York Psychoanalytic Institute. "But I can't get to see them four times a week, because I can't ask them to give up their livelihood."
    Hollywood portrayals to the contrary, studies suggest that few people enter analysis for casual reasons. In a 2002 survey of 342 American analysts conducted by Dr. Norman Doidge, an assistant professor of psychiatry at the University of Toronto, most said that many of their patients in analysis suffered from multiple long-standing psychiatric disorders like anxiety, depression, sexual dysfunction and pervasive personality problems. About 80 percent of the 940 patients reported on in the survey had received other treatment before analysis. Eighteen percent were taking psychiatric medication.
    At the same time, three-quarters of the analysts' patients were steadily employed at the start of analysis, Dr. Doidge found. And they were mentally tough enough to survive the rigors of treatment on the couch -- an experience that bears some similarity to immersion in a sensory deprivation tank and that Dr. Bachrach described as "putting you on the stove and turning up the heat."
    Psychoanalysis itself has undergone profound changes in the last decades. In Argentina, France, Germany, Finland, Canada, especially in Quebec, and other countries, Freud's legacy continues to thrive. Psychoanalysts are held in esteem and patients are plentiful. In some cases, the cost of psychoanalytic treatment is underwritten by national insurance.
    But in the United States, the scientific and economic events that have transformed psychiatry have squeezed psychoanalysts to the margins. Most analysts' caseloads include only a few full-fledged psychoanalytic patients, the rest arriving once or twice a week for less intensive psychotherapy. The American association, the largest of the psychoanalytic organizations, counts roughly 3,500 members, 700 of them in New York. The average age of the association's membership is 62.
    Once rulers, analysts now more often find themselves supplicants, mounting public relations campaigns to improve their image and reaching out to attract more candidates for psychoanalytic training and to forge better relationships with other psychiatric disciplines. This is not always an easy battle, as was evident in the focus groups assembled as part of a "strategic marketing initiative" undertaken by the association in 2000. Asked to describe their psychoanalyst colleagues, the mental health professionals who participated in the groups used adjectives like "arrogant," "elitist," "uninvolved," "cultish" and "insular." The public was no more helpful. Freud's name still rang a bell. But the marketing effort found that the only thing most Americans knew about psychoanalysis was that it took a long time and that it involved a couch. Asked what kind of mental health professional they might look to for treatment, no one mentioned an analyst.
    Still, much of the psychoanalysis derives from an earlier time, when rigid neo-Freudian orthodoxy was the rule. "I think there's been a shift in the last 15 years," said Dr. Robert Galatzer-Levy, an analyst in Chicago. "There was a time that if people deviated from whatever was at that point standard, they risked being thrown out of the analytic community. Now, Dr. Galatzer-Levy said, "the ideas get heard; they get discussed, they get debated, they are often integrated with one another."
    In fact, few analysts these days adhere to a strict Freudian model, though most subscribe to the basic tenets of psychoanalytic theory, including the importance of unconscious fantasies and conflicts, the influence of childhood experiences, the centrality of the relationship with the analyst as a replaying of other important relationships in the patient's life. Most talk to their patients, rather than sitting silently. Many are willing to divulge information about their personal lives; whether they are married, for example. Many exercise eclecticism in treating patients, drawing upon different theoretical perspectives. And many endorse the use of medication, in some cases prescribing it themselves. At one time, analysts were required to have medical degrees. But social workers, psychologists, art therapists and other mental health professionals have now joined the ranks of those who pursue the four years of training or more that becoming a psychoanalyst requires.
    At its best, Dr. Galatzer-Levy said, what analysis has to offer is change that is far deeper than what may be achieved in the 6 to 20 sessions of therapy covered by most insurance plans, change affecting "the way people think and feel about things, the way they act in the world." Some of that change may take place after the last psychoanalytic session has ended. In one of the first tightly controlled studies of the effectiveness of psychoanalytic treatment, Dr. Peter Fonagy, a professor of psychoanalysis at University College London, found that adult patients with borderline personality disorder, given psychoanalytic treatment in a partial hospital setting, showed significantly more improvement than a control group that received no formal psychotherapy. But Dr. Fonagy also found that the patients receiving psychoanalysis continued to improve in the 18 months after the treatment, progress he believes occurs "when you face new problems and you are then able to deal with them in a superior way."
    Patients who have had good experiences in psychoanalysis also describe substantial personal growth. For Mr. Cody of Washington, the fruit of his treatment has been emotional maturity, he said, a lessening of fear, a greater ability to control his emotions, an ability to laugh off criticism where he once would have rankled. In his analysis, Mr. Cody said, there were "periods of great stagnation but also periods of great benefits." "There would suddenly be one session where things popped open," he said. "Every time that happened, I'd say, `That's worth $3,000."'
    Ms. H. said that in the course of her sessions on the couch she had examined every aspect of her life, from her fears of abandonment to her perfectionism to her repetitive dreams of running through city streets to save her brother from an attack by urban guerrillas. She has learned, she said, that "the truth is mutable, the story changes." -- "You might hold your parents responsible for some of your unhappiness and then later on that becomes incredibly unimportant," she said. Yet Mr. Cody and Ms. H., like many others in analysis, have moments of doubt and disillusionment, and lingering questions that may never be fully answered: How much growth would have taken place anyway, with time and life experience? How much of what has been accomplished in 10 years could have been accomplished in 4 or even 2? Dr. Doidge, in his survey, found that the average length of analysis was 5.7 years. In an address to the psychoanalytic association last week, Dr. Owen Renik, a training analyst at the San Francisco Psychoanalytic Institute and Society, said that keeping patients in analysis "for years or even decades" when no improvement was taking place represented an egregious -- and common -- ethical violation by psychoanalysts.
    "Too many analysts keep too many patients too long in treatment -- in the absence of any evidence that it's helping," Dr. Renik said later in a telephone interview. Analysts, he added, often rationalize why they are keeping a patient in treatment, but actually may be delaying the end of the analysis out of a desire for financial gain, an unwillingness to admit defeat or other conscious motives.
    Those whose time on the couch been less than positive could add other breaches to the list: Analysts so psychologically damaged themselves that they make their patients worse, not better. Analysts who allow the transference to become a pseudo love affair that replaces relationships in the real world. Analysts who are unable to admit their mistakes.
    Dr. Bachrach of the New York Psychoanalytic Institute said it was no surprise that analysis could cause damage. "If it can do a lot of good, it can also do a lot of harm," he said. Yet in a world of quick fixes and glib explanations for human behavior, analysis still symbolizes a commitment to complexity and deeper understanding. "It is a question of values," Dr. Bachrach said, "of what you want and what you expect out of life."

Income Gap Is Seen in Abuse Cases
Stephen Smith, Boston Globe- 1/29/2003

One in 10 poor women in Massachusetts said they had been physically or verbally abused by a husband or boyfriend within the previous 12 months, according to a telephone survey released yesterday by the state Department of Public Health. That contrasted sharply with rates of abuse compiled from wealthier women, with only one in 100 saying they had been abused. Public-health specialists and social workers who treat abused women said the disparate levels of abuse reflect the burden poverty places on women -- and how financial stress can ignite anger that explodes in physical violence or brutally harsh words.
    Those specialists fear that the current economic decline may precipitate even more cases of abuse. ''An episode of economic depression, a layoff, can certainly be a triggering period for somebody who's already prone to violent behavior,'' said Nancy Scannell, director of government affairs for Jane Doe Inc., a statewide coalition of 60 community-based groups addressing sexual assault and domestic violence. ''When you're looking at people who are experiencing poverty as a way of life, there are day-to-day stresses that simply don't exist in the lives of people with means.''
    The findings on abuse are part of a larger study on the health of women in Massachusetts that was conducted by interviewing 8,628 women in 2001. The women were asked questions about their well-being, everything from how regularly they get a mammogram to how frequently they eat fruits and vegetables.
    Because the study relies on the respondents being forthcoming about sensitive medical and social issues during a 25-minute telephone survey, analysts warned against drawing definitive conclusions. But in three studies - in 1998, 1999, and 2001 -- the percentage of women with household incomes under $25,000 a year who reported abuse remained constant at about 10 percent. The survey asked women whether they had been physically hurt, sexually abused, or subject to verbal threats that left them frightened for their safety.
    ''These results are not surprising,'' said Dr. Bruce Cohen, a director in the state's Bureau of Health Statistics, Research, and Evaluation. ''They emphasize the need to reach out to people who are less fortunate and in need.'' Specialists also said, however, that wealthier women may understate the extent of violence in their lives. ''We know this is an issue that affects women of all economic and income levels,'' said Tina Nappi, program director at Passageway, a domestic violence intervention program at Brigham and Women's Hospital. ''What I know to be true is that women of higher income levels do experience abuse, but they do not report it as often.'' Because they rely less on social-service agencies for help, wealthier women may not have become accustomed to repeatedly identifying themselves as abuse victims.
    For poor women, escaping abuse can prove an especially formidable task: There's no money for a hotel, no room in a family member's home, no access to an attorney to help seek custody of children. That, abuse counselors said, means that low-income women remain trapped in abusive relationships. By contrast, wealthier women have more options to escape. Their financial standing, however, can also prove to be a barrier to seeking help, with women from higher-income families fearful of sacrificing the status they have achieved.
    The state's new commissioner of public health, Christine C. Ferguson, suggested that researchers in her agency should begin tracking the intersection between economics and violence. ''We might consider taking economic points in time, comparing what happens when economic times are good with when they're not so good,'' Ferguson said.
    Specialists at agencies that work with abused women expressed concern about the consequences of the present economic malaise. Social-service agencies have received reports recently of police departments responding to an increase in domestic-abuse calls. ''Our fear is that the economy does make it a more perilous time for women,'' said Scannell, of Jane Doe Inc. ''It's a pit-in-your stomach sort of place to be.''

Obsessive-Compulsive Patients Confront Fears in Therapy
ABC News, 1/29/2003

Becky, a schoolteacher, is frightened of contamination from cleaning products. Lee, a chiropractor, fears accidentally bumping into things, and can't walk past a mirror without turning back to look again. Danielle, who is terrified of eating with plastic utensils, obsessively washes her hands. Each has been diagnosed with obsessive compulsive disorder, or OCD, an illness that affects as many as 3.3 million adults and about 1 million children every year. It can ruin lives and even drive some people to thoughts of suicide.
    It is also a disorder that is so embarrassing to sufferers that most never seek help. On average, people see three to four doctors and spend at least nine years seeking treatment before they get a correct diagnosis, and even then, it can take even more years to get the right treatment. But Becky, Lee and Danielle — who all wanted their last names withheld — went to McLean Hospital in Belmont, Mass., where the OCD Institute is a last resort for people in the grip of compulsion. "It's sort of the purest form of torture, because these are people that aren't crazy or insane, and yet they're unable to see that ... or unable to stop what they're doing," said Dr. Michael Jenike, who heads the institute. At the clinic, patients learn how to overcome their obsessions by confronting their fears head-on.

People Don’t Understand
It is unclear what causes OCD, but some speculate that it could be hereditary, while others say it may be the result of a chemical imbalance of serotonin, a neurotransmitter linked to mood and depression. But other brain chemicals are almost certainly involved, and stress can be a trigger for it as well. Because of their odd behavior, people with obsessive compulsive disorder are misunderstood, and often miserable about their obsessions. "I never had a normal childhood," said Danielle. "I've been called, lazy, stupid, inconsiderate," Becky said. "Even people who know I have the disorder just don't understand." "I used to scrub each and every finger," Danielle said.
    Jenike started the OCD Institute six years ago. For patients, living at the institute means confronting their fears. Seven days a week, therapists push boundaries, immersing the patients in the things they fear the most. Experts now believe that such "exposure therapy" may be the only way for some patients to overcome the disorder. Pushing anxiety to its limit while resisting the urge to give in to obsessive fears may control OCD.

Facing Fear of Germs
Juan, who has a fear of germs, faced his fear head on when his therapist had him put his hands on the outside of a garbage can. He followed that with an exercise that included lying down on the carpet. "Think of all the garbage that's in there ... all the food ... who knows what else is in there?" the therapist said, as Juan practiced deep breathing. "What's on the floor?" "Dirt, germs, everything," Juan said, with his hands spread out on the carpet. "That's right. Put your hands on your face," the therapist said. "This is hard," Juan said. "Go ahead, you can do it," the therapist said. "Think of all the germs that are now on your face." "That's gross," Juan said. "I know it's gross," the therapist said. "Keep 'em there. Where's your anxiety level?" "Nine," Juan said. "OK. Keep 'em there," the therapist said.
    Throughout their therapy, patients must rate their anxiety on a scale of one to 10. Often, in one sitting, that anxiety can go down dramatically. "Their brain will, what do we call habituate, and get used to the anxiety," Jenike said. "And then they'll realize that they won't die, and nothing terrible will happen."
    A therapist named Denise worked with Danielle on eating with a plastic fork. "I can't," Danielle said "Yes you can, just try," the therapist urged. "Oh God," Danielle said. "I don't feel like Danielle any more. I feel like OCD Danielle. This is hard." Becky, who fears contamination from cleaning products, said that she hopes that she will be able to face her fears after she leaves the clinic to go home. "What I do here is very important, but the most important part is when I go home," Becky said. "It's very scary."

Treating OCD
Eventually, everyone goes home from the OCD institute, where they learned how to live a life free of OCD and free of fear. While experts say it won't work for everyone, it does offer one thing many needed when they arrived here: hope "I just feel so relieved to be a typical person for once," Danielle said.
    In treating OCD, cognitive behavior therapy should be the first line of action, and it can be combined with anti-depression medications, which increase serotonin, ABCNEWS' Dr. Tim Johnson said. But a third of patients are resistant to the usual treatment, a mix of behavioral therapy and antidepressants, Johnson said. Other treatments are also being researched. This fall, some French researchers completely cured some patients of the disorder, using electrical stimulation of the brain — a treatment that is also used for patients with Parkinson's disease.

Both Sides of Same-Sex Marriage Issue Face Off in Connecticut
Susan Haigh, Associated Press- 1/30/2003

HARTFORD, Conn. -- Both sides of the same-sex marriage debate faced off at the state Capitol Wednesday. Holding dueling rallies and news conferences, each group promised a fight in the latest effort in the legislature to extend state marriage laws to gay and lesbian couples. Opponents of same-sex marriage delivered boxes of petitions to legislative leaders and the governor. The Knights of Columbus collected 70,000 signatures from people who want the legislature to enact a DOMA, or Defense of Marriage Act, that would spell out in law that Connecticut only recognizes marriage between men and women. Brian Brown, executive director of the Family Institute of Connecticut, said citizens are worried about the continued effort by some lawmakers to push for same-sex marriage. ''If they continue to move in this direction, they are moving against the will of the people,'' Brown told about 150 supporters, including numerous Catholics from throughout the state.
    Just yards away, at another rally, about 150 advocates of same-sex marriage said they believe a growing number of Connecticut residents are supportive of changing the marriage laws. They gave legislators about 200 letters, many accompanied by photographs, from couples, parents and religious leaders telling their personal stories about how the state's marriage laws are discriminatory and have affected their lives. Some passing motorists honked their horns as the rally-goers held signs that read, ''It's not about tolerance, it's about civil rights,'' and ''100,000 bigots can be wrong.''
    Katy Zapatika, 26, of Waterbury came to the rally with her mother Jane Zapatika. Both women are Catholics. ''I'm a gay person and I expect the right to marry whoever I want to marry,'' Katy Zapatika said. ''The old religious values don't apply as far as I'm concerned anymore. This is not a religious issue. It's a civil rights issue.''
    This marks the third year in a row that proponents have fought for opening the marriage laws to same-gendered couples. Last year, legislators enacted a law that allows any person to legally designate another to make decisions for them, such as health care choices and organ donation. Anne Stanback, president of Love Makes a Family, an organization fighting to change state law, predicted that opening marriage to same-sex couples probably won't happen this year. However, she said some lawmakers appear willing to vote for a civil unions system, similar to the Vermont system, where gay and lesbian couples receive the same legal benefits of marriage without being recognized as ''married.'' ''We are slowly making progress,'' Stanback said. Stanback did not rule out the possibility of a legal challenge, but said proponents prefer working though the legislative process. Challenges are underway in Massachusetts, New Jersey and Indiana, she said.
    Opponents said Connecticut should learn from Vermont and not be surprised by a court challenge. That's why they're fighting to enact the DOMA. A bill has already been submitted. Rabbi Daniel Green of New Haven said he believes allowing gays and lesbians to marry will encourage other minority groups to seek the ability to marry. He questioned how the state could deny a father and son, for example, from marrying, if it granted same-sex couples that right. ''The risks are simply too great,'' he said.
    Peter Wolfgang, a member of the Litchfield Knights of Columbus, called marriage of same-sex couples ''an attack on freedom, justice, peace and the future of the family.'' Petitions written by The Knights of Columbus and supported by Hartford Archbishop Daniel A. Cronin were circulated at Catholic churches across the state in November.

Pataki Offers $80 Million To Fix System for Mentally Ill
Clifford J. Levy, New York Times- 1/30/2003

Gov. George E. Pataki announced a landmark plan yesterday to spend at least $80 million on housing and services for residents of adult homes for the mentally ill in New York. The plan would overhaul and eventually do away with a neglect-ridden system that arose more than a generation ago when New York, like other states, began closing many of its psychiatric hospitals. Mr. Pataki, in an effort to drastically change how the state houses and cares for many of its mentally ill, proposed in his new budget that New York create 2,000 units of housing immediately to begin replacing the homes, and agree to several thousand units more in the coming years. The plan would put New York at the forefront of efforts to address a longstanding crisis in housing for the mentally ill across the nation.
    The privately run adult homes, which are known as board-and-care facilities in some states, have become notorious as poorly regulated repositories for people who have been discharged from psychiatric wards and have nowhere else to go. That has been especially true in New York, where scores of deaths under questionable circumstances have gone uninvestigated, residents have been preyed upon by the homes' operators and doctors, conditions are sometimes filthy, and untrained workers paid minimum wage do much of the supervision. A few of the most troubled homes have grown so large that, despite having inadequately trained personnel, they house nearly as many residents as the state's psychiatric hospitals. The homes shelter 15,000 mentally ill people in the state, most in New York City and nearby suburbs. Yet despite knowing for decades about grievous problems, Albany had never acted to reform the system meaningfully.
    Under Mr. Pataki's initiative, the housing -- some to be built, some that could include private individual apartments-- would be specifically for adult home residents, as well as for the mentally ill homeless and patients discharged from state psychiatric centers, two categories of people who historically have ended up in the homes. In addition a small number of beds would be set aside for mentally ill children. "This is a system that has existed for 30 years, and there are no quick fixes, but these recommendations and the funding that we have put behind them will set the stage for a new system for providing care for the mentally ill," said Robert R. Hinckley, a senior adviser to the governor.
    Mr. Pataki had embraced recommendations to change the system that were issued by a special administration task force in November, but until the release of his budget yesterday, would not detail how much he was willing to spend on them. In an otherwise grim document that reflected the state's dire fiscal condition, the adult home initiative was one of the few that received new financing. In its long-term plan, the administration task force, which was established by Mr. Pataki after a series of articles in The New York Times last April detailed widespread failings in the adult homes, called for the creation of 6,000 housing units so adult home residents could be moved and what remains of the system radically revamped.
    The Democratic majority in the Assembly yesterday called the governor's initial plan inadequate, given the magnitude of the problems at the homes, and said it wanted to spend tens of millions of dollars more. Leaders of several advocacy groups said they were pleased with the plan, noting that they had feared that the governor would use the state's fiscal situation as an excuse to delay new spending for adult homes.
    "There is a lot of promise here, and we hope to build on it in the coming months and years," said Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services, who was a member of the administration task force. "We are just going to have to work extra hard to make sure that these resources actually reach adult home residents."
    Shelly Nortz, deputy policy director for Coalition for the Homeless and a leading expert in Albany on housing for the mentally 'ill, called the plan "the biggest thing that the administration has ever done in the housing area." "And they deserve credit for doing it in this budget climate," she added. The adult homes initiative came as Mr. Pataki presented a separate proposal to continue reducing the size of the state psychiatric system, and use the money from hospital closings to improve local mental-health services. He called for the closing of three small upstate psychiatric hospitals -- in Elmira, Syracuse and Middletown -- this year. And he said he wanted to close the Bronx Psychiatric Center and the Bronx Children's Psychiatric Center in 2005. That proposal, which took mental-health advocates by surprise, would leave the Bronx as the only borough in the city without its own state hospital.
    In addition to a $65 million housing proposal for adult home residents, Mr. Pataki called for the state to spend $8 million more -- which would at least double when matching federal and local Medicaid funds were included -- to undertake short-term improvements in the homes. Nurses and social workers are to conduct special evaluations of residents to determine whether they can be immediately resettled in smaller, better-managed facilities. The state is also to hire nurses and social workers for the homes to improve medication practices and supervision of the residents.
    Assemblyman Richard N. Gottfried, a Manhattan Democrat who is chairman of the Health Committee, attacked the governor's proposal, saying it fell short of what the task force had recommended. Mr. Gottfried said that Mr. Pataki did not set aside money for the full 6,000 units of housing endorsed by the task force, and had only promised to do so. Mr. Gottfried added that the task force called for state spending on short-term measures to reach as much as $50 million annually. Mr. Gottfried said the Democratic majority, which held hearings on the adult homes last year, would fight for more spending. "The governor's proposal is a small fraction of the basic need that almost everyone says is a top priority," he said.