Teens Abusing Cough and Cold Remedies
Anand Vaishnav, Boston Globe- 2/1/2003

At least 20 students in Brookline and Newton have been treated for what officials fear is a disturbing craze creeping into local high schools: getting high on name-brand, over-the-counter cough and cold medications. After years of looking out for students who abuse alcohol or illegal drugs, educators in some schools are now confronting teens who misuse substances sitting on store shelves -- specifically, the cough syrup Robitussin and the cough and cold pills Coricidin HBP.
   Doctors say both medicines can give users a mellow, slow, sometimes foggy feeling similar to PCP and can quickly become addictive. And in some cases, teen-agers who have ingested a whole bottle of Robitussin or eight or more pills of Coricidin to get high have shown up in emergency rooms. ''It's rampant,'' said Dr. Michael W. Shannon, acting chief of emergency medicine at Children's Hospital in Boston, where some of the teens have been treated. ''Look at who's taking it. These are kids who are unable to buy alcohol, unable to buy cigarettes ... and now you've got something that you know is in many households. It's cheap, it's legal, it's easy to obtain, and nobody questions you if you have it in your backpack.''
   Abuse of over-the-counter medicines isn't limited to Coricidin and Robitussin, but doctors and pharmacists trace the appeal of those two medications to a drug called dextromethorphan, or DXM. Found in at least 135 medicines, it is structurally related to PCP, Shannon said. Those who ingest eight or more pills of Coricidin, for example, or four or more ounces of Robitussin feel disoriented and can often hallucinate. Coricidin also is an antihistamine, adding to the mellow feeling users get if they take excess amounts. ''People call it brain fuzz,'' Shannon said. ''They can't process as quickly. They hear questions, but they can't put together words for an appropriate response. For many, as you can imagine, that's just very unpleasant -- to be someone who might be a bright, articulate kid and all of a sudden be someplace where you've lost a lot of your faculties.''
   In 2002, the poison control center serving Massachusetts and Rhode Island recorded 1,048 calls for misuse of DXM, up from 870 the year before, said Dr. Michele Burns, the center's medical director. Burns, also an emergency-room doctor at Children's Hospital, said treatment of those who overdose requires ''liquid decontamination'' of their stomachs, and that they are able to leave after four to six hours. Pediatricians have had their eye on this trend for many years. But high school officials typically watch out more aggressively for illegal substances such as marijuana and alcohol.
   At Brookline High School, counselors and health officials have encountered about 10 students since May who had taken the cold medicines to get high -- including two whom the school sent to the hospital -- and have become alarmed enough to help launch a student-led effort to curtail the trend. Brookline school and town officials also have asked local stores to monitor who buys the medications or to place them behind pharmacists' counters. ''I think it's becoming more prevalent, and parents don't know anything about it,'' said Brookline High junior Pascale Boucicaut, who said she once saw a friend drink almost an entire bottle of Robitussin. ''It seems really gross.'' Brookline High School Headmaster Robert Weintraub has notified parents of the trend in a newsletter, and the concern has surfaced during parent meetings.
   In Newton, parents and teachers in the past 18 months have dealt with about 10 high schoolers who exhibited warning signs associated with taking too much of the medicines- - clumsiness, sluggishness, a slowness that resembles intoxication. Some were habitual users, and all sought treatment, said Rich Catrambone, a prevention and intervention counselor at Newton South High School, one of Newton's two public high schools. So great is the concern in Newton that school health officials inserted a question on abuse of over-the-counter cold medicines into an annual survey administered to middle- and high school students. ''It's a highly dangerous phenomenon,'' Catrambone said. ''It's something that kids have caught onto and used because of the availability of it. It is something that I think pharmacists or grocery stores need to watch very closely in terms of seeing kids coming in and buying large quantities of this stuff.''
   Regular users say controlled use of DXM provides relaxation and clarity. Through websites and e-mails, entire communities of users discuss the dangers of addiction to DXM and ways to use it more safely -- not before driving, for example -- or how much to consume at one time. A 16-year-old Vermont teenager reached through such a website said he ingests Robitussin once or twice a month. The youth, who did not want to be named, said he does not use Coricidin because it contains an antihistamine and he fears the drug combination. He said he enjoys the high associated with DXM, although he cut back when he realized he was consuming too much. ''The effects range from euphoria to mild hallucinations. You're more open, and there's slight memory loss ... '' the teenager said in a telephone interview. ''DXM alone is relatively harmless if used in moderation. If you use it too often, it can start to get dangerous.''
   The nation's poison control centers reported receiving more than 14,400 calls last year about intentional misuse of over-the-counter and prescription cold medicines, according to the American Association of Poison Control Centers. While the number of such centers reporting data varies every year, the figure is still the highest in a decade in which the number of such calls fluctuated. Police departments from Oregon to New Hampshire have picked up students outside school who overdosed on the medications. In Texas, lawmakers have proposed legislation to make the drugs harder to buy by requiring customers to ask store employees for assistance. But some pharmacists worry that such tactics could inconvenience those who consume medicines with DXM safely, and may not necessarily deter students determined to get high.
   Carmelo Cinqueonce, executive vice president of the Massachusetts Pharmacists Association, said asking stores to be more vigilant of students repeatedly buying the drugs at their stores is better than moving the drugs behind the pharmacists' counter, which could deter legitimate consumers and hurt sales. ''Education would be first and foremost,'' Cinqueonce said. ''If there's awareness out there that this is occurring, it'll certainly raise the red flag, whether it be the pharmacists in the back or the cashiers in the front.'' Michael DeAngelis, a spokesman for the CVS Pharmacy chain, which has 550 stores in New England, said there is no corporate policy to rearrange the products' display, but managers can regulate them how they see fit. Spokesmen for Schering-Plough Health Care Products, makers of Coricidin, and Wyeth Consumer Healthcare, makers of Robitussin, said they've warned of the dangers of abusing their products through the Council for Family Health's website. They also say they will work with communities or schools that contact them asking for help.
   At Brookline High School, students known as peer educators are taking matters into their own hands. The students plan to create a website outlining the consequences of abuse and have addressed incoming freshmen about those and other drugs. ''It's an easy substance to obtain, and it's so cheap and so harmful,'' said Lars Margolis, a junior. ''We're trying to work to combat this before it gets really big.''

Boston College Gay, Straight Alliance Approved
Jenna Russell, Boston Globe, 2/2/2003

In an unprecedented gesture of acknowledgment to its gay students, Boston College will grant official recognition to a proposed gay-straight student alliance, after months of pushing by the student government and the campus newspaper. Student body president Adam Baker said he was notified of the decision Friday in a letter from the Rev. William Leahy, the president of the Catholic university. The move, which is likely to anger some conservative alumni, followed a series of impassioned editorials in the student newspaper last fall and months of talks between Leahy and student leaders. ''It's pretty amazing to see that people can stand up for what they believe in, fight for civil rights, and see something accomplished not just in their lifetime, but in a few months' time,'' said Peter Marino, a senior and the director of gay and bisexual issues for BC's student government.
    The school's well-established group for gay and bisexual students, known as the LGBC, has applied for official recognition three times since its creation almost 30 years ago, and has been rejected each time. University officials have accommodated the group, allowing it office space on campus, but say that they cannot endorse it because its mission conflicts with the teachings of the Catholic Church. Frustrated with the refusals, and with language in the school's federally mandated notice of nondiscrimination, which treats sexual orientation differently than race and religion, student leaders stepped up pressure on administrators last spring.
    Over the summer, the Princeton Review's annual college guide ranked BC second in the nation for intolerance to gays. The ranking angered students, who called it unfair but worried about the damage to BC's national reputation, which has much improved in recent years. The proposal for the gay-straight alliance was presented as a kind of test case to push the administration forward, said Baker, who acknowledged that the project probably would have been abandoned if Leahy had denied recognition to the alliance. To maximize its chances of success, the proposal emphasized Jesuit ideas and morals, he said, ''caring for the whole person, making sure everyone is part of the community.'' ''Recognition was the main focus,'' Baker said. ''We thought it was very important to have a recognized group because it makes the group much more visible. It will receive funding, it will be listed on the website for student organizations -- it's very important for students looking at choosing Boston College.''
    Some details of the group's structure and mission still need to be worked out before the recognition will be final, Baker said. As part of the agreement with Leahy, the alliance will offer support and education, but will steer clear of advocating for policy changes. The group's name is likely to be the Alliance, excluding any reference to sexuality, a decision described as mutual by students and school officials. ''This is a support group; the LGBC is an advocacy group,'' said BC spokesman Jack Dunn, who described the role of the new alliance as ''supportive rather than divisive.'' The number of gay students at the school is not known, but meetings of the LGBC, short for Lesbian Gay Bisexual Community, are regularly attended by 20 to 30 students at BC.
    Not everyone was pleased by the decision. Sophomore Ryan Connors, opinion editor for the Catholic newspaper on campus, voiced disappointment, pointing to a ''slippery slope'' that could lead to more shifts in position. He said he sees little difference between the proposed alliance and the LGBC. Both groups fulfill the Catholic mission of compassion but fail to address the church's teaching that homosexual acts are immoral, he said. ''It's not enough to emphasize compassion and be silent on the other parts,'' he said. ''This was the last thing the school had held strong on, that the faithful Catholic community could be happy about, and the fact that he's given in on this point is upsetting.''
    According to Dunn, a dozen of the nation's 28 Jesuit Catholic colleges and universities have officially recognized gay-straight alliances. At the College of the Holy Cross in Worcester, the Association of Bisexual, Gay and Lesbian Students, known as ABIGAIL, was established in the mid-1990s, spokeswoman Kathy McNamara said. It has been controversial only among some of the Catholic school's alumni, she said. Dunn said he doesn't expect protest from BC's 130,000 alumni, a majority of whom are Catholic. He said he has not received any calls from concerned graduates since campus debate on the topic heated up last fall. ''I think they'll be understanding that it's an appropriate step ... respectful of church teaching,'' he said.
    Retired math teacher and school principal Roger T. Connor, a 1952 graduate, said the group's recognition doesn't offend him, but the 75-year-old expects many alumni will object, and may hold back donations. ''The traditionally minded alumni will probably be much opposed, especially in my age group,'' said Connor, of Milton, a director of the Boston College Alumni Association. But other alumni may become more connected to the school as a result, said Marino, who hopes that one role of the alliance will be to reach out to gay alumni. A gay alumni network existed for much of the 1990s, but was disbanded because of a lack of cooperation from BC, its former leader told the student paper. ''There are a lot of gay alums who feel disconnected, who want to be a part of the community but don't feel wanted,'' said Marino.

Love At Goon Park: Harry Harlow & the Science of Affection
Barbara Smuts, New York Times Book Review- 2/2/2003

While studying wild baboons in Kenya, I once stumbled upon an infant baboon huddled in the corner of a cage at the local research station. A colleague had rescued him after his mother was strangled by a poacher's snare. Although he was kept in a warm, dry spot and fed milk from an eyedropper, within a few hours his eyes had glazed over; he was cold to the touch and seemed barely alive. We concluded he was beyond help. Reluctant to let him die alone, I took his tiny body to bed with me. A few hours later I was awakened by a bright-eyed infant bouncing on my stomach. My colleague pronounced a miracle. "No," Harry Harlow would have said, "he just needed a little contact comfort."
    The phrase "contact comfort" was made famous through Harlow's experiments with baby rhesus monkeys at the University of Wisconsin in the 1950's and 60's. In her well-researched account of Harlow's life and work, "Love at Goon Park," Deborah Blum describes how Harlow removed newborn infants from their mothers and housed them with surrogate mothers, some made of terry cloth and some of wire. When exposed to a moving toy or a strange room, babies with cloth mothers rushed to them, buried their faces in the soft fabric and relaxed. Their peers, with only wire mothers, shook in terror against the wall. Left alone for months with only wire mothers, they pined away, staring at the world with lifeless eyes, like my orphaned baboon.
    The series of Harlow's experiments that followed revolutionized psychology in the middle of the 20th century. Until then, as Blum vividly documents, the dominant thinking in psychology was very different. An extreme position, made popular by psychologists, like John Watson, held that young children should never be caressed, held or physically comforted by parents. Watson and later behaviorists like B. F. Skinner claimed that a baby reaching for Mom is simply reflecting an association between Mom and food. Early psychologists said that mothers who responded warmly to a baby's cries would produce excessively dependent adults, unable to function in American society. Despite the absence of supporting evidence, this view profoundly influenced not only parental behavior but national institutions like orphanages, which minimized contact between caregivers and children, and hospitals, which denied parents the opportunity to comfort their sick and frightened children.
    When Harlow began his monkey experiments, a few sensitive researchers, like the British psychiatrist John Bowlby, had challenged behaviorist dogma. But because they based their claims mainly on anecdotal evidence, mainstream psychology, aspiring to be a "hard science" like physics, rejected them. Harlow's genius, Blum says, was to recognize the importance of using a humanlike animal to document thoroughly the positive effects of love and the devastation wrought by its absence. Harlow demolished behaviorism's claim that infant attachment depends on food. Given a choice between a wire mother that dispensed milk and a milk-free cloth mother, baby monkeys overwhelmingly preferred the cloth mothers. He found that monkeys living with their mothers thrived physically, while those deprived of maternal succor withered away and often died, like untouched children in orphanages. He showed that to develop social confidence, young monkeys need peers to play with. Babies deprived of either mothers or peers became forever unable to connect with others. He also discovered that infant monkeys are terribly vulnerable to loss. Infants raised by mothers but later separated from them for months became listless and lost interest in other monkeys. If that didn't convince skeptics, Harlow went farther, placing baby monkeys alone in a vertical chamber called the "pit of despair"; they emerged months later with all the signs of full-blown depression.
    To learn how to heal people deprived of adequate love, Harlow's team experimented with many ways to help these monkeys recover from the trauma inflicted on them. Eventually they discovered that the wounded souls, if paired with a very young female monkey, could be slowly coaxed back into connection with others. Harlow characterized the trajectory of his research as "love created, love destroyed, love regained." That is an equally apt description of his personal life, which Blum skillfully weaves into this history of his science. A loner in childhood, Harlow began his career as an iconoclast, mostly ignored by his colleagues at Wisconsin. Unfazed, he built a laboratory from scrap lumber and inspired a cadre of talented students, including his first wife, Clara Mears. (The lab's address was 600 N. Park, Madison, Wis., but the careless handwriting of so many of its researchers led everyone to call it Goon Park; thus Blum's title.) Intensely driven by curiosity and a desire to prove the behaviorists wrong, Harlow was a workaholic who rarely spent time with his family. After Clara left him, taking their children, intense loneliness drove him to drink for the rest of his life.
    "It was during those ... sleep deprived, alcohol-inspired days," Blum writes, "that Harry Harlow first started thinking about the nature of love." He married again fathered two more children, worked like a maniac, lost his wife to cancer, suffered from depression relieved only slightly by electroshock therapy and created his infamous isolated-monkey model of depression. Blum presents the puzzle of a man who legitimated a science of love while failing those who most loved him, and the paradox of work that made baby monkeys suffer in order to sensitize people to the needs of children. Was his research justifiable? Blum focused on such questions in a previous book, "The Monkey Wars," based on newspaper reporting that won her a Pulitzer Prize in 1992. Here she addresses them only briefly, saying we can honor Harlow's insights without approving of his experiments.
    This neat conclusion would be easier to accept if Harlow's incontrovertible findings had produced a moratorium on using baby monkeys to investigate maternal deprivation and infant depression. Sadly, such work remains all too common. Blum's book left me wondering how Harry Harlow, a man 30 years ahead of his time, who consistently defied scientific convention, would view such research if he were alive today.

Texas School Is Sued Over a Gay-Straight Club
Steven Greenhouse, New York Times- 2/2/2003

KLEIN, Tex., Jan. 29 - Last October, Maria Dukler, a 17-year-old honor student, and 16 other students at Klein High School asked the principal for permission to form a GayStraight Alliance, saying 'it would promote tolerance. In the months since then, neither the principal nor the school district in this affluent suburb north of Houston has given the students permission to form the club. Convinced that the school district is deliberately delaying a decision to prevent the club from being formed, Ms. Dukler and the American Civil Liberties Union have sued the Klein Independent School District in Federal District Court in Houston, asking the court to order school officials to approve the club. The lawsuit accuses the district of violating Ms. Dukler's First Amendment rights and the Equal Access Act, a federal law that bars schools from discriminating against clubs based on the content of their speech. The suit was filed soon after the A.C.L.U. sued Boyd. County High School in Kentucky, asking it to reinstate the Gay-Straight Alliance after the superintendent closed all clubs in the school. His decision to allow the club had set off large protests.
    More than 1,200 Gay-Straight Alliances operate in high schools across the nation, but here in conservative Harris County, some parents say they fear that a club in Klein High would promote homosexual sex. Ms. Dukler, who is on the varsity tennis team and on Klein High's state championship math team, denied that the club would promote sex. "The club will be to talk about tolerance, to teach tolerance," she said. "It will try to make our school a little bit safer, try to make it bearable to walk down the hallway."
    One day in December, she said, three boys sneaked up on her. "One shoved me into a wall of lockers, and the other two called me a dyke and a faggot. My leg was really bruised. There's verbal abuse everywhere." Her father, Malcolm Dukler, strongly supports her effort to start the club, saying, "The issue is the safety of our child."
    David Feldman, the school district's lawyer, criticized the A.C.L.U. for filing the lawsuit, saying, "Klein hasn't violated anything yet because no decision has been made on the club's application." Mr. Feldman said the district would announce a decision soon. He does not know, he said, whether the club will be approved. He said the public's feelings would not control the decision. Lizbeth Johnson, the district's assistant superintendent for community relations, said many clubs, not just the Gay-Straight Alliance, were waiting for approval. "We've heard from more parents on this Issue than on some other clubs," Ms. Johnson said. "We're getting responses both positive and negative."
    District officials said the high school's principal, Pat Huff, would not comment, but Mr. Huff told The Houston Chronicle earlier in January that he gave the Gay-Straight Alliance application to the superintendent "because of the controversial nature of the club" and because of the district's conservative population. Mr. Huff said: "We're a little different than some of the other high schools maybe in the inner city that have allowed the club to go forward. It would be a different issue out here. I have to always be thinking about the people, our constituency."
    David George, who is Ms. Dukler's lawyer and the president of the A.C.L.U.'s Houston chapter, said the school district appeared to be trying to suppress an unpopular club. "The law doesn't say just because the average citizen of the school district is uncomfortable you get to ban it," Mr. George said. "The Equal Access Act is clear that students are allowed to have clubs, regardless of the viewpoint of the speech used. Klein High School is simply violating federal law."
    While waiting for the court's decision, Ms. Dukler goes on with her life as a high school junior, studying for exams, playing in tennis matches and looking at colleges. She said she was heartened that 200 students had signed a petition supporting the club. Roughly 3,700 students attend Klein High. "I've spoken to people at other schools, and they told me there was harassment before the G.S.A. started," she said. "But when it got going and working, when these people spread the message about tolerance, a lot of the harassment stopped."

Study: Ritalin Use Seen to Vary by Area
Associated Press, 2/3/2003

CHICAGO -- Prescription rates for Ritalin and similar attention deficit disorder drugs, which are both widely praised and widely maligned, vary dramatically across the nation, new research indicates. While the prevalence of attention deficit disorder is not thought to vary greatly by region, a study released today found that treatment rates ranged from 1.6 percent of children's prescriptions examined in Washington, D.C., to 6.5 percent of children's prescriptions in Louisiana. Significantly higher rates were found in the South and Midwest than in the West. Overall, about 4 percent of prescriptions examined for children ages 5 to 14 in 1999 were for stimulants including Ritalin.
    The study, appearing in February's issue of Pediatrics, was done by researchers at Express Scripts Inc., a Missouri-based pharmacy benefits management company. The researchers reviewed a nationally representative sample of company prescription claims for 178,800 children throughout 1999. The claims were for all types of medication.
    Lead researcher Emily Cox and colleagues said that while they did not determine if higher prescription rates represented overuse or if lower rates represented underuse, ''both may be occurring.'' The variations should be examined ''to reduce the risk to children from unnecessary drug therapy as well as the negative health and emotional consequences to children with untreated medical conditions,'' the researchers said. Critics of excessive use of such drugs, including some doctors, have worried that the drugs sometimes are promoted by schools and others as a ''quick fix'' without other appropriate treatment. Advertising of the drugs, physician practice styles, parents' and teachers' values, and anti-Ritalin campaigns may have contributed to the varying drug use rates, the researchers said.
    Methylphenidate, the drug more widely known by the brand name Ritalin, was the most common stimulant prescribed. Others were dexedrine and other amphetamines. Stimulant use was found to be more prevalent among white children and those from higher-income families. Cox said the higher rates probably are representative of the nation's commercially insured population. The study did not look at Medicaid claims.
    The American Academy of Pediatrics guidelines for treating attention deficit hyperactivity disorder cite data suggesting the disorder affects 4 percent to 12 percent of school-age children, or as many as 3.8 million youngsters, most of them boys. Academy guidelines, issued in 2001, recommend stimulants and behavioral therapy for treating ADHD. It says that stimulants are generally safe and side effects are usually short-lived.

At 18, Mental Patients Face Perilous Change
Ellen Barry, Boston Globe- 2/3/2003

When their daughter turned 18, Bill and Susan Louisignau gave her a charm bracelet and a pizza party. Susan Louisignau looked on uneasily as her daughter passed the invisible line into legal adulthood. Along with the gifts, the girl had come into the rights accorded every adult in Massachusetts: to stop taking her psychiatric medication, to keep her treatment secret from her parents, and to quit treatment altogether.
    Ten days later, their daughter, who has bipolar disorder, came home from school so manic that she threatened to burn herself alive in the family car. Over the next two years, she was hospitalized 11 times, at a cost to the state that her mother estimated at half a million dollars. It may not have been clear at the pizza party, but now Louisignau understands that the girl had moved, without support, into a territory beyond her control. ''When you turn 18, if you have this kind of diagnosis, you cannot be given carte blanche,'' said Louisignau, a real estate appraiser who lives in Greenfield. ''I think that's where the breakdown comes in the law. You're all of a sudden telling a population that they're entitled to all the rights of adulthood.''
    In a mental health system with plenty of weak points, analysts are increasingly focusing on the period around a person's 18th birthday -- a juncture where, they say, patients often take a disastrous turn toward homelessness, criminal behavior, and a revolving-door cycle of crisis, hospitalization, and release. Beginning on their 18th birthdays, patients lose access to a broad array of state services, including mental-health case workers, day programs, and monitoring at schools or by probation officers. The changes come just as they are granted adult rights -- including the right to decline medical treatment and to keep medical information from even their immediate family. Many do not qualify for adult services, and those who do often find them unappealing.
    The disruptive changes that accompany an 18th birthday came up this year in two violent criminal cases. Jason Potter, 21, who allegedly stabbed his mother and stepfather to death in September, had decided when he turned 18 to stop taking his antipsychotic medication, his father said. And 20-year-old Jermaine Berry, a schizophrenic who allegedly shot two police officers Jan. 1, had been monitored by the Department of Youth Services until his 18th birthday.
    For state services to terminate abruptly during the danger zone of late adolescence ends up incurring a great cost later on, as young people wind up in jails or hospitals, said a researcher at UMass Memorial Medical Center. And yet that's the way many programs are designed. ''If you could get them to age 25,'' most would have passed the danger zone, said Maryann Davis, who has become a national authority on late-adolescent youth. ''It simply is an inopportune time to pull services.''
    The cutoff dates come one by one during high-risk years. At 17, a young person can be prosecuted as an adult. At 18, he or she gets the right to refuse treatment and DYS monitoring can end. At 19, juvenile services from the Department of Mental Health end. Gradually, data have been building to support what many social service professionals have believed for years -- that young people who ''age out'' of juvenile mental health services often spin off on disastrous paths:
    One-third to one-half of adolescents receiving mental health services do not continue to do so as adults, according to Davis. This is largely because adult mental health services are geared toward severe mental illnesses like schizophrenia and bipolar disorder, which have traditionally been diagnosed after adolescence. Eligibility for children's services does not require such severe diagnoses, and many children with emotional disturbances are accepted.
    Children treated for mental illness are frequently arrested, prompting a ''cost shift to corrections,'' said Davis, coauthor of ''Transition to Adulthood: A Resource for Assisting Young People with Emotional or Behavioral Difficulties.'' The average age of service termination is 17, and for those who are arrested the peak time of arrest is between the ages of 18 and 20, according to a study by Davis of 131 juvenile DMH clients. Among that group, 64 percent were arrested and arraigned before their 25th birthday, more for nuisance crimes than violent crimes. Almost half were charged as adults.
    Many mentally ill young people end up homeless. Almost half of 323 homeless people ages 18 to 24 surveyed on one night this year had been treated in a psychiatric hospital, according to a census by the Massachusetts Housing and Shelter Alliance. One in 10 had spent time in a DMH facility, and 61 percent had taken psychiatric medication. ''It really does suggest that we need to be thinking differently'' about the transition from child services to adult services, said Joan Mikula, assistant commissioner for child-adolescent services at the Department of Mental Health.
    A year-and-a-half ago, at the pressing of consumer advocates, DMH helped fund a survey of young adults who had ''aged out'' of juvenile mental health services. In a report released this winter, the research firm Consumer Quality Initiatives found that many complained of a traumatic loss of personal support and no independent living skills training. Many young people find adult services unappealing, said Jonathan Delman, the firm's executive director. ''They see people who are stuck. They see the ravages of side effects of medication. They see age,'' said Delman, who suffers from bipolar disorder. ''They're in a position where thay can think, `I can make it, maybe.' . . . You can't imagine what it's like to be in a day program or a clubhouse and being with people who you think you might become.''
    Delman's recommendations revolve around creating services that could be more appealing to young people, such as peer mentoring services, in which teenagers would be paired with older peers who had already been through the transition out of child services. Other programs in place, like Super Employable People in Quincy, coach young people on job interviews, socialization, cooking, and budgeting skills -- training that ''can be fun, and also maintain a sense of self-respect,'' said Katie Payson, the program's director.
    What is not likely to change, said Mikula of DMH, are the state and federal laws that grant young people the right to refuse treatment and medication at the age of 18. For some parents, those laws remain the central problem, giving their children veto rights just at the time in their lives when they most resist authority. If her daughter had been forced to move into a supervised group home, Louisiagnau said, the 11 emergency hospitalizations would not have taken place. ''It doesn't make any difference right now how many programs we have,'' she said. ''The law has got to change.''
    Even for parents who would not alter the laws, the transition can be jarring, even frightening. One night last fall, a case manager from the Department of Mental Health came to John and Carol Willett's home carrying a sheaf of release forms for their son, Michael, who had turned 18 a week before. Michael had been treated by a psychiatrist since he was 14, when his obsessive hand-washing became a problem, and was eventually diagnosed with schizoaffective disorder. As Michael's parents stood by, the case manager informed him that unless he signed the forms he no longer needed to inform them of any of his treatment decisions. ''I didn't know what to make of it all,'' said Michael Willett, who immediately signed the release forms because, he said, ''I want my parents to be informed.'' But since then, it has gradually dawned on his parents how completely they could be shut out of their son's medical treatment. ''Right now, if he goes psychotic I can't do anything,'' said his mother. ''That scares me silly.''

More in College Seek Help For Psychological Problems
Erica Goode, New York Times- 2/3/2003

A study of college students seeking psychological counseling has found that their emotional difficulties are far more complex and more severe than those seen in the past. From 1989 to 2001, the percentage of students treated for depression doubled. So did the percentage of suicidal students, according to the study, conducted at the counseling center at Kansas State University. More than twice the percentage of students were taking some type of psychiatric medication even though the absolute number of students seen by the center remained stable.
    Problems related to stress, anxiety, learning disabilities like attention deficit disorder, family issues, grief and sexual assault also rose. The study also found accompanying increases in more traditional college complaints like trouble in separating from parents, romantic relationships or the choice of careers.
    "What we're seeing is people with multiple problems, and some of those are significantly more serious," said Dr. Sherry A. Benton, the assistant director of training at the counseling center in Manhattan, Kan., and the lead author of the report, which appears today in the journal Professional Psychology: Research and Practice. The study was based on forms filled out by therapists after treating more than 13,000 students seen at the center between 1989 and 2001. Mental health professionals at other college counseling services said the study, the largest of its kind and the first to look at specific categories of problems, confirmed their impressions that students are now struggling with more serious forms of distress.
    In a 2002 national survey, more than 80 percent of 274 directors of counseling centers said they thought the number of students with severe psychological disorders had increased over the previous five years. What lies behind the increase is not clear. A greater awareness of mental illness and the easing of the stigma attached to seeking psychiatric help may play a role. But experts also cite the pressures on students to succeed academically and the breakdown of family support systems as factors. "People just don't seem to have the resources to draw upon emotionally to the degree that they used to," said Dr. Robert Portnoy, the director of counseling and psychological services at the University of Nebraska. "What would once have been a difficult patch for someone in the past is now a full-blown crisis."
    Doris Bertocci, a social worker at Columbia University's counseling center, said about the Kansas State study, "If anything, the conclusion understates the gravity of the problem." Columbia last year reported a 40 percent increase in the use of the counseling center since the 1994-95 academic year and has nearly doubled its staff, extended its hours and set up offices in dormitories. A spokeswoman said the number of students using the center had risen further in the last year. Other colleges have registered similar growth in demand. Ms. Bertocci said many clients coming to the center suffered from depression, manic depression, panic attacks and eating disorders or were dealing with family issues, including physical or sexual abuse. Some, she said; were "chronically suicidal." "Our impression," she added, "has been that by the time students get to Columbia, many of them have had their emotional needs neglected by a lack of access to adequate mental health services."
    In the Kansas State study, the percentages of students with eating disorders, chronic mental disorders or who abused drugs or alcohol was not significantly higher in 2001 than in 1989. The percentage of students dealing with sexual or physical abuse from childhood increased sharply in the mid-1990's but then declined.
    The prevalence of psychiatric problems on campus and the question of how much responsibility colleges have for the mental health of their students received wide attention two years ago, after highly publicized suicides at several institutions, including the Massachusetts Institute of Technology. Many campuses have had sharp increases in psychiatric hospitalizations. For example, Dr. Portnoy said 15 to 20 students at Nebraska were now hospitalized each semester, up from 3 or 4 a decade ago. In the vast majority of those cases, he said, suicidal thoughts or actions precipitate the hospitalization. In the 2002 national survey, the counseling service directors reported a total of 116 suicides at 55 colleges. Only 20 of those students, the survey respondents said, had been seen by college counseling centers before the suicides.
    Dr. Benton, at Kansas State, said addressing the needs of suicidal students was one of the most taxing responsibilities that counseling center staff members have. In 2002, she said, her center dealt with 96 students who were contemplating suicide or had made suicidal gestures or attempts. "The amount of time and energy and resources that it takes is unbelievably high," Dr. Benton said. "I've had a mother say about her occasionally suicidal son, 'I'm counting on you to keep him alive.' That's a lot of pressure." Ms. Bertocci, of Columbia, said that many of the students she sees require antidepressants or other psychiatric medication but cannot afford to pay for it and do not have insurance to cover the cost. Dr. Benton said that only about 30 percent of the students at Kansas State had health insurance. About 15 percent of college counseling centers charge students for individual counseling sessions.
    Lindsay Gangwish, 23, saw a counselor at the University of Nebraska counseling center once a week during her four years at the university. She paid $20 per session for the first 25 sessions, she said, then $45 per session after that. Ms. Gangwish, who graduated in December, said she sought counseling in her freshman year after having panic attacks and mood swings. Eventually, bipolar disorder was diagnosed. She said the illness runs in her family. But she added that the pressures of college had contributed to her difficulties. "There's a lot of stress," she said. "You hear a lot of people talking about the stress."

Finding Happiness: Cajole Your Brain to the Left
Daniel Goleman, New York Times- 2/4/2003

All too many years ago, while I was still a psychology graduate student, I ran an experiment to assess how well meditation might work as an antidote to stress. My professors were skeptical, my measures were weak, and my subjects were mainly college sophomores. Not surprisingly, my results were inconclusive. But today I feel vindicated.
    To be sure, over the years there have been scores of studies that have looked at meditation, some suggesting its powers to alleviate the adverse effects of stress. But only last month did what I see as a definitive study confirm my once-shaky hypothesis; by revealing the brain mechanism that may account for meditation's singular ability to soothe. The data has emerged as one of many experimental fruits of an unlikely research collaboration: the Dalai Lama, the Tibetan religious and political leader in exile, and some of top psychologists and neuroscientists from the United States. The scientists met with the Dalai Lama for five days in Dharamsala, India, in March 2000, to discuss how people might better control their destructive emotions.
    One of my personal heroes in this rapprochement between modern science and ancient wisdom is Dr. Richard Davidson, director of the Laboratory for Affective Neuroscience at the University of Wisconsin. Dr. Davidson, in recent research using functional M.R.I. and advanced EEG analysis, has identified an index for the brain's set point for moods.
    The functional M.R.I. images reveal that when people are emotionally distressed -- anxious, angry, depressed--the most active sites in the brain are circuitry converging on the amygdala, part of the brain's emotional centers, and the right prefrontal cortex, a brain region important for the hyper-vigilance typical of people under stress. By contrast, when people are in positive moods -- upbeat, enthusiastic and energized -- those sites are quiet, with the heightened activity in the left prefrontal cortex.
    Indeed, Dr. Davidson has discovered what he believes is a quick way to index a person's typical mood range, by reading the baseline levels of activity in these right and left prefrontal areas. That ratio predicts daily moods with surprising accuracy. The more the ratio tilts to the right, the more unhappy or distressed a person tends to be, while the more activity to the left, the more happy and enthusiastic. By taking readings on hundreds of people, Dr. Davidson has established a bell curve distribution, with most people in the middle, having a mix o f good and bad moods. Those relatively few people who are farthest to the right are most likely to have a clinical depression or anxiety disorder over the course of their lives. For those lucky few farthest to the left, troubling moods are rare and recovery from them is rapid.
    This may explain other kinds of data suggesting a biologically determined set point for our, emotional range. One finding, for instance, shows that both for people lucky enough to win a lottery and those unlucky souls who become paraplegic from an accident, by a year or so after the events their daily moods are about the same as before the momentous occurrences, indicating that the emotional set point changes little, if at all.
    By chance, Dr. Davidson had the opportunity to test the left-right ratio on a senior Tibetan lama, who turned out to have the most extreme value to the left of the 175 people measured to that point. Dr. Davidson reported that remarkable finding during the meeting between the Dalai Lama and the scientists in India. But the finding, while intriguing, raised more questions than it answered. Was it just a quirk, or a trait common among those who become monks? Or was there something about the training of lamas -- the Tibetan Buddhist equivalent of a priest or spiritual teacher -- that might nudge a set point into the range for perpetual happiness? And if so, the Dalai Lama wondered, can it be taken out of the religious context to be shared for the benefit of all?
    A tentative answer to that last question has come from a study that Dr. Davidson did in collaboration with Dr. Jon KabatZinn, founder of the Mindfulness-Based Stress Reduction Clinic at the University of Massachusetts Medical School in Worcester. That clinic teaches mindfulness to patients with chronic diseases of all kinds, to help them better handle their symptoms. In an article accepted for publication in the peer-reviewed journal Psychosomatic Medicine, Drs. Davidson and Kabat-Zinn report the effects of training in mindfulness meditation, a method extracted from its Buddhist origins and now widely taught to patients in hospitals and clinics throughout the United States and many other countries.
    Dr. Kabat-Zinn taught mindfulness to workers in a high-pressure biotech business for roughly three hours a week over two months. A comparison group of volunteers from the company received the training later, though they, like the participants, were tested before and after training by Dr. Davidson and his colleagues. The results bode well for beginners, who will never put in the training time routine for lamas. Before the mindfulness training, the workers were on average tipped toward the right in the ratio for the emotional set point. At the same time, they complained of feeling highly stressed. After the training, however, on average their emotions ratio shifted leftward, toward the positive zone. Simultaneously, their moods improved; they reported feeling engaged again in their work, more energized and less anxious. In short, the results suggest that the emotion set point can shift, given the proper training. In mindfulness, people learn to monitor their moods and thoughts and drop those that might spin them toward distress. Dr. Davidson hypothesizes that it may strengthen an array of neurons in the left prefrontal cortex that inhibits the messages from the amygdala that drive disturbing emotions.
    Another benefit for the workers, Dr. Davidson reported, was that mindfulness seemed to improve the robustness of their immune systems, as gauged by the amount of flu antibodies in their blood after receiving a flu shot. According to Dr. Davidson, other studies suggest that if people in two experimental groups are exposed to the flu virus, those who have learned the mindfulness technique will experience less severe symptoms. The greater the leftward shift in the emotional set point, the larger the increase in the immune measure. The mindfulness training focuses on learning to monitor the continuing sensations and thoughts more closely, both in sitting meditation and in activities like yoga exercises. Now, with the Dalai Lama's blessing, a trickle of highly trained lamas have come to be studied. All of them have spent at least three years in solitary meditative retreat. That amount of practice puts them in a range found among masters of other domains, like Olympic divers and concert violinists.
    What difference such intense mind training may make for human abilities has been suggested by preliminary findings from other laboratories. Some of the more tantalizing data come from the work of another scientist, Dr. Paul Ekman, director of the Human Interaction Laboratory at the University of California at San Francisco, which studies the facial expression of emotions. Dr. Ekman also participated in the five days of dialogue with the Dalai Lama. Dr. Ekman has developed a measure of how well a person can read another's moods as telegraphed in rapid, slight changes in facial muscles. As Dr. Ekman describes in "Emotions Revealed," to be published by Times Books in April, these micro-expressions -- ultra-rapid facial actions, some lasting as little as one twentieth of a second -- lay bare our most naked feelings. We are not aware we are making them; they cross our faces spontaneously and involuntarily, and so reveal for those who can read them our emotion of the moment, utterly uncensored.
    Perhaps luckily, there is a catch: almost no one can read these moments. Though Dr. Ekman's book explains how people can learn to detect these expressions in just hours with proper training, his testing shows that most people-- including judges, the police and psychotherapists -- are ordinarily no better at reading micro-expressions than someone making random guesses. Yet when Dr. Ekman brought into the laboratory two Tibetan practitioners, one scored perfectly on reading three of six emotions tested for, and the other scored perfectly on four. And an American teacher of Buddhist meditation got a perfect score on all six, considered quite rare. Normally, a random guess will produce one correct answer in six.
    Such findings, along with urgings from the Dalai Lama, inspired Dr. Ekman to design a program called "Cultivating Emotional Balance," which combines methods extracted from Buddhism, like mindfulness, with synergistic training from modern psychology, like reading micro-expressions, and. seeks to help people better manage their emotions and relationships. A pilot of the project began last month with elementary school teachers in the San Francisco Bay area, under the direction of Dr. Margaret Kemeny, a professor of behavioral medicine at University of California at San Francisco . She hopes to replicate Dr. Davidson's immune system findings on mindfulness, as well as adding other measures of emotional and social skill, in a controlled trial with 120 nurses and teachers.
    Finally, the scientific momentum of these initial forays has intrigued other investigators. Under the auspices of the Mind and Life Institute, which organizes the series of continuing meetings between the Dalai Lama and scientists, there will be a round at the Massachusetts Institute of Technology on Sept. 13 and 14. This time the Dalai Lama will meet with an expanded group of researchers to discuss further research possibilities. Though open to the public, half the seats will be reserved for graduate students and academic researchers.  More information is at www.InvestigatingTheMind.org

A New Choice for Treating ADHD
Matt McMillen, Washington Post- 2/4/2003

The calls started coming several months ago: When will it be here? When will you have it? For some parents the wait seemed interminable. They kept the phones ringing until the release date finally arrived. This may sound like the launch of the new Harry Potter book. It's not. But if research and clinical trials prove correct, the newly released drug Strattera, the object of the callers' questions, will help many children with attention-deficit hyperactivity disorder (ADHD) concentrate while they read that soon-to-be bestseller. "Parents called and begged to put their kids on it," says Larry B. Silver, a clinical professor of psychiatry at Georgetown University Medical Center who specializes in treating ADHD.

Why the excitement?
Strattera, which hit pharmacy shelves Jan. 14, is the first new type of medication for treating ADHD that the Food and Drug Administration (FDA) has approved since 1975. Developed by Eli Lilly and Co., it is also the only non-stimulant approved to treat the disorder. Though stimulants have proven effective for managing the disorder's symptoms, not everyone responds well to them. Some don't respond at all; others have serious side effects, such as a difficult "rebound" effect, when symptoms return in force between doses or at the end of the day during which symptoms return at a greater level. And Strattera, unlike most stimulants, is taken only once a day. These factors make it a much-welcomed option for many doctors, parents and patients. "In medicine," says Joseph Biederman, a professor of psychiatry at Harvard, "we are always looking for alternatives."
    ADHD affects an estimated 3 to 7 percent of school-age children, and it often continues into adulthood. The disorder is marked by an inability to concentrate, overly impulsive behavior and, frequently though not always, physical hyperactivity. Untreated, ADHD can wreak havoc at school, at work and in social lives. Behind the wheel of a car, the distraction that is a hallmark of the disorder can be deadly.
    Fortunately, the disorder is highly treatable. Stimulants, such as Ritalin and Dexedrine, have been used to treat ADHD for half a century. These drugs are often the first line of treatment after the disorder is diagnosed, and they work for perhaps 70 percent of those who take them. But what about the others? In some cases, stimulants have little or no effect, while in some others, the side effects outweigh the benefits. In searching for alternatives, researchers have looked at, and doctors have prescribed, a variety of other drugs. Clonidine, a blood pressure medication, has shown some effectiveness, as has the antidepressant buproprion, marketed as Wellbutrin. Of the various alternatives, an older class of antidepressants known as tricyclics held the most promise; but possible side effects included damage to the heart, making prescribing it for children unacceptable.
    In the mid-1990s, while Harvard's Biederman was exploring tricyclics as a treatment for ADHD, Lilly researchers were testing Strattera (then known as tomoxetine, now called atomoxetine) as an antidepressant. But studies showed the drug to be ineffective against depression, and the company halted testing and development. "In the normal course of events," says David Michelson, medical director of Lilly's Strattera project, "it would have died there." But staff psychiatrist John Heiligenstein speculated that atomoxetine had potential for treating ADHD. To him, the drug appeared to work in much the same way as the tricyclics but without the potentially harmful side effects. Michelson says Heiligenstein, an ADHD specialist, "worked very hard to get the company to do pilot work." (Lilly, citing a need to protect its creative process, declined to make Heiligenstein available for an interview.)
    The first studies Heiligenstein conducted were done with Biederman and Thomas Spencer, an associate professor of psychiatry at Harvard, in 1996. According to Michelson, they were "done under the gun before the last lots of the drug expired. The results looked good, so that opened some eyes." That study, which was conducted on adults, was published in 1998. It would take four more years and more than 4,000 child and adult test subjects to bring the drug to pharmacy shelves.

Now, How to Use It?
Spencer recalls that when results of the first test were presented to Lilly, "no one knew how to set the dose or how long it lasted or how safe it would be for kids." Researchers now know the answers to many questions regarding Strattera's efficacy and safety. (For example, Biederman says the safety data on the drug are among "the largest in pediatrics.") But they still can't say precisely how it works. This is not surprising, given that much about ADHD itself remains a mystery. Research suggests that the symptoms of the disorder result, at least in part, from malfunctioning of the brain's neurotransmitters, or chemical messengers, including dopamine and norepinephrine. Stimulant medications at the proper dosage appear to normalize dopamine levels. Strattera, according to Timothy Wilens, an associate professor of psychiatry at Harvard who works with Biederman and Spencer, "goes after norepinephrine." But as Lilly's own press release acknowledges, "it's not known precisely how Strattera reduces ADHD symptoms."
    Treatment of ADHD is further complicated by the fact that the disorder can affect different people in different ways. For some, ADHD causes hyperactivity. For others, inattention is the primary indicator. This points to the possibility that different areas of the brain are affected in different people. This in turn could explain why certain medications work for some people but not others. When prescribing drugs for ADHD, "we use trial and error based on probability," says Silver. Different medications at different doses are prescribed until the best drug at the best amount is found. This can take months, and success is never guaranteed.
    While the researchers who studied Strattera are excited to see it become widely available, they caution that it is not a miracle drug that will replace stimulants in the treatment of ADHD. They also stress the need to find and stay with whatever medication works best. "Stimulants are unequivocally highly effective," says Biederman. "It would be a terrible mistake to change treatments if a patient is doing well." Current research can only suggest that Strattera and stimulants such as Ritalin are equally effective in countering the symptoms of ADHD. "The data," says Biederman, who worked on one study that compared the Strattera with Ritalin, "is not there to show definitively" how they match up.
    Wilens, author of "Straight Talk about Psychiatric Medication for Kids" (Guilford Publications, 1998), has seen a nearly equal reduction in symptoms for patients taking either drug; Strattera, he notes, seems "slightly less effective than methylphenidate (Ritalin)." Practitioners like Georgetown's Silver and Washington-based psychiatrist Nora Galil currently prescribe Strattera only for patients for whom stimulants are ineffective or intolerable. Within a week of the new drug's release, Galil, who assisted in the study of Strattera, was writing two to three prescriptions a day for the new drug, mostly for patients who had tried stimulants. She is cautiously optimistic about Strattera's becoming a first-line treatment for ADHD.
    Larry Sasich, a pharmacist and researcher with Public Citizen's Health Research Group, offers a warning to those who might get too enthused about Strattera. His group recommends that people wait for seven years after approval before trying any new drug "unless there is clear proof that it is more effective" for them than drugs currently available. Laws governing the development and approval of new drugs, he explains, require that they prove to be more effective than a placebo but do not require that they be any safer or more effective than older medications -- leading, he feels, to a marketplace crowded with "endless alternatives . . . . With each new drug you use, the cost of health care goes up."
    A CVS spokesman said a 30-day supply of Strattera costs $105, compared with $98 for 30 days' worth of Concerta, a once-a-day stimulant whose active ingredient is the same as Ritalin's. A month's standard dose of Ritalin costs $83 at CVS; a generic version of the drug costs half that half that. Adderall, a stimulant taken twice a day, is priced at $120, with the timed-release form of the drug costing $188. Until there is strong evidence that Strattera is more effective than stimulants or that it works for people who don't respond well to stimulants, Sasich recommends a wait-and-see approach: "Lilly," he says, "has submitted nothing to indicate that Strattera is superior to other medications."
    One advantage Strattera has over stimulants is that it is not a controlled substance, which means that prescriptions can be refilled over the phone. That appeals to many people; it may help patients stay on the medication. According to Wilens, studies have shown that people have stopped taking stimulant medication, which require a written prescription for each refill, due to the inconvenience. For people taking Strattera, he says, that problem is lessened "because there is an ease of use."
    Like all medications prescribed for the disorder, however, Strattera comes with a laundry list of side effects. For children, these include decreased appetite, nausea, vomiting and tiredness. Adults can also experience sexual side effects, dry mouth and sleeping problems. According to Wilens, these side effects, which are similar to those of stimulants, seem to diminish with time. And, with more study, more will be learned about the long-term effectiveness of Strattera.
    The immediate goal, Galil says, is to find a treatment that works, whether it is Strattera or one of the stimulants. "I tell parents, 'You don't have much time. Your kids are developing now.' "

Report Mixed on Drinking, Strokes
Reuters News Service, 2/5/2003

CHICAGO -- Two alcoholic drinks a day may reduce the risk of the most common kind of stroke by nearly 30 percent, but downing five drinks or more daily raises the risk by about 70 percent, according to a study published yesterday. The findings, from Tulane University School of Public Health and Tropical Medicine in New Orleans, were based on an analysis of 35 previously published studies that appeared between 1966 and 2002.
    ''Our study strongly suggests that reducing alcohol consumption in heavy drinkers should be an important approach to prevention of stroke in the general population,'' said the report published in this week's Journal of the American Medical Association. ''It also suggests that moderate alcohol consumption reduces risk of ischemic stroke. However, the implications of these findings should be examined cautiously,'' it added. ''Any advice regarding the consumption of alcohol should be tailored to the individual patient's risks and potential benefits.'' An ischemic stroke occurs when a blood clot interrupts blood supply to part of the brain. Such events account for about 80 percent of all strokes. The rest are hemorrhagic strokes, caused when a blood vessel in the brain bursts.
    The researchers said combining data from the existing studies showed that people who consumed more than 60 grams of alcohol per day -- roughly five or more drinks -- had a 64 percent increased risk of suffering any kind of stroke compared with people who did not drink at all. Their risk of an ischemic stroke was 69 percent higher and the risk of a hemorrhagic stroke about 50 percent greater, it said. On the other hand, consumption of less than 12 grams of alcohol daily -- one drink -- reduced the risk of ischemic stroke by 20 percent and from 12 to 24 grams daily -- one to two drinks -- was associated with a reduced risk of 28 percent compared with nondrinkers, the study said. While a considerable body of research has already linked heavy drinking to an increased risk of stroke, less is known about why there might be a protective effect with moderate consumption, the authors said.

 County Executive Fires Two Michigan Community Mental Health Officials
Associated Press, 2/5/2003

DETROIT -- Wayne County Executive Robert Ficano has fired two officials of the Detroit-Wayne County Community Mental Health Authority, which serves 75,000 people and spends $530 million a year. Ficano removed finance director William Miller and his assistant, Maria Norfolk, on Friday. On Tuesday Ficano challenged the board's extension of interim director Patricia Kukula's contract last week. He said the action re-established her salary at $166,000 defies his order that all appointees' pay be cut by 14 percent.
    Ficano, who took office in January after longtime county leader Ed McNamara did not seek re-election, has raised questions about large expenditures for consultants. The former sheriff said the mental health agency will run a deficit of at least $4 million and that several contractors doing business with the agency have gone unpaid, The Detroit News reported. Ficano has hired the accounting firm of Plante & Moran to audit the mental health agency and other county departments. "We have a lot of concerns that things are still being done the old way," Ficano said Tuesday, referring to investigations and controversies over Wayne County contracting practices under McNamara. "We want to send the message that this isn't going to be tolerated and we're going to be responsible to the taxpayers." Board chairman Mohamed Okdie accused Ficano of trying to take control of the board, the Detroit Free Press said.

Making Divorce Less Painful for Parents and Their Kids
Amanda Vogt, Chicago Tribune- 2/5/2003

After her parents got divorced, Celina Bondie, 15, dreaded visits with her dad. Inevitably when he picked her up, the sight of her mother set him off, and the shouting that followed attracted the attention of neighbors and police. "There would be a scene, and people stared. ... It got to where I just didn't want to see him," Bondie said. After two years of "scenes," protection orders and corrosive court battles, a Cook County judge assigned a battle-weary Bondie and her family to Apna Ghar, a social services agency in Chicago's Uptown neighborhood that provides monitored visitation exchanges, a relatively simple idea that advocates say could help fend off family tragedies. At Apna Ghar, Bondie's mother drops her off 15 minutes before her father is scheduled to arrive, then waits in a separate room to make sure the exchange takes place. Her father picks up Bondie without seeing his former wife, and social workers get a regular chance to keep an eye on all three of them.
    Family advocates and many judges are pushing for more monitored exchange sites in Illinois, which has only eight. They say that the simple act of keeping the parents apart reduces conflict and eases a child's fear. Perhaps more importantly, trained professionals can observe troubled parents and children for early signs of problems.
    On Dec. 15, the body of Joshua Gleeson, 3, was found floating in the Des Plaines River near Channahon, and the body of his sister, Ashley, 5, was recovered the next day. Their father, Patrick Gleeson, 48, is charged in their shooting deaths, which allegedly took place during a court-ordered visit. Gleeson issued a statement saying that his custody battle and visitation disputes with the children's mother made him depressed. He suggested the children were now better off. On Oct. 1, Mary Elizabeth Brunson-Waller, 3, was shot to death by her father outside his home in unincorporated Lemont. Mary Elizabeth's parents were entangled in a custody dispute, and authorities said John Brunson believed he was about to lose visitation privileges when he killed his daughter as she slept in her car seat.

Warning signs
Though Mary Elizabeth's parents met at a local police station for exchanges, some advocates believe that if trained observers had been present, they might have recognized warning signs. "A trained clinician might have recognized the signs," said Brenda Thompson, director of E.M. Branch & Associates, a new exchange site in Evergreen Park. "At least there would have been no contact between the parents and therefore no fuel for the fire."
    Cook County has two monitored exchange sites. There also are sites in Will and DuPage Counties, two in St. Clair County, one in McLean County and one in Peoria County. Nationally, there are a smattering of programs in Michigan, Kansas, Florida and California. There aren't more sites because of the cost, said Family Court Judge Scott Drazewski of the 11th Judicial Circuit Court in Bloomington. "There are no psychiatrists behind the counter at McDonald's, but it costs nothing to exchange children there," he said. Depending on the amount of federal funding, state assistance, donated services and the number of hours they operate, centers cost between $40,000 and $150,000 a year to run, officials said.
    In June 2000, Illinois enacted the Neutral Site Custody Exchange Funding Act, which authorizes any county with a population between 100,000 and 1 million to establish an exchange site paid for by passing an ordinance charging a $1 to $8 fee on civil case filings, officials said. DuPage, Will, St. Clair and Peoria Counties assess such fees, officials said. Although Cook County is home to one of the largest circuit courts in the country, it has no publicly funded monitored exchange program. Limited monitored exchange services are provided by two private agencies, both of which have long waiting lists, officials said.
    "There's just not enough grant money to go around, and there is no tax support for these services at the county or state level," said Marjorie Johnson, project coordinator for the Chicago Department of Human Services' family support division. Judge Moshe Jacobius, who presides over Cook County Circuit Court's domestic relations division, admits he and his colleagues would love to recommend monitored exchange programs to troubled families more often, but they can't overburden private facilities such as Apna Ghar. "We definitely have a need for more exchange services," he said.

Protecting the children
Those services carry a price, but so does exposing children to parental conflict, experts point out. Numerous studies show such strife leads to depression in children and poor performance in school, said Patrick Tolan, director of the Institute for Juvenile Research at the University of Illinois at Chicago.
    Divorce court judges like the program because it allows them to grant visitation to non-custodial parents while watching out for the best interests of the child, said Billy Lee Dunford-Jackson of the Reno, Nev.-based National Council of Juvenile and Family Court Judges. "Judges don't want to say no to visitation with Dad, but they don't want to wake up the next morning and read in the paper about a visitation gone tragically wrong," Dunford-Jackson said. Monitored exchange programs can help authorities enforce cooling-off periods for parents, said Will County Divorce Court Judge Karla Goody. She has seen a marked decline in protection-order violations since Will County started its program last year.
    Joe and Amy Myatt, whose contentious divorce led them to the DuPage County Family Center in Wheaton, have experienced the positives of being monitored. Joe Myatt said the program's structure gave him room to reflect on how his anger about the divorce was affecting his children: "I have a much calmer head now, and I just want to see my kids." Amy Myatt said, "Before, every time Joe would come to the house, the police would end up involved. My daughter used to cling to me and cry before a visit. Now the stress is completely gone." But the children may be the best endorsement for the program. "At first, I didn't want to be here," Celina Bondie said of Apna Ghar, which means "our home" in Hindi-Urdu. "But they listen to you here. ... Now I feel 100 percent more comfortable, and being with my dad is a better experience."

NFL Footballer Finds It No Snap to Cope With Depression
Janice Billingsley, ABC News- 2/5/2003

On the eve of the biggest game of his life, pro football player Barret Robbins apparently suffered an emotional meltdown. The 6-foot, 3-inch, 320-pound lineman, who has a history of depression and bipolar disorder, had apparently stopped taking his medication. In published reports, he had once described his struggle with mental illness as "a battle within your head. It's not an easy thing to deal with."
    How common is a decision like Robbins' to stop taking necessary medication at just the wrong time? Too common, say mental health professionals, adding that much remains to be learned about bipolar disorder, a disease that affects an estimated 2 million American adults. "This is the fourth National Football League player with bipolar disorder who this has happened to," says Xavier Amador, a Columbia University psychologist and author of I'm Not Sick, I Don't Need Help, a book about bi-polar disorder. "These players get medication but don't get psychotherapy and education to help them get more understanding of their illness," says Amador, who has worked with other pro football players with bi-polar disorder.
    Another obstacle confronting many people with the disease, he adds, is that they don't think they're ill. This means they'll take drugs until they feel better, and then they stop, which is most likely what happened to Robbins, Amador says. "Non-compliance with drug therapy is a big issue, especially for people with bi-polar disorder, because with medication it's not just not feeling depressed, but also not feeling so high," says Matthew Silvan, a psychology professor at Columbia University.
    Bi-polar disorder is characterized by intense mood swings, from feeling worthless and depressed to feeling irrationally powerful and competent, Silvan says. And the pleasure of the high feeling is often "sufficiently enticing that people don't want to give it up," so they give up their medication instead, Silvan says. That decision can lead to devastating consequences.
    According to a report in the San Francisco Chronicle, a man who claimed he was among a group with Robbins the day before the Super Bowl said the player became despondent and suicidal after drinking heavily. "He was crying and totally depressed about his life and the pressure he was under," said Cartier Dise, the owner of a car customizing business popular with some Raiders players. "This guy was messed up. All he could think about was his family, his two daughters. He was talking about killing himself, saying he was disappointing people and he had a lot of people to support financially and he was letting them all down," the Chronicle quoted Dise as saying. Silvan says, "This is just speculation, but if you are depressed and see yourself as worthless, you might find the presence of millions of people staring at you too much."
    Bob Carolla is a spokesman for the National Alliance for the Mentally Ill. He also has bi-polar disorder. "Stress, pressure and anxiety can aggravate the underlying illness of bi-polar disorder," Carolla says. Those with the illness can respond to stress in several ways, he says. People with bipolar disorder must take a virtual cocktail of different medications, including mood stabilizers, anti-depressants and drugs that treat the side effects of those drugs. Under stress, however, remembering to take all the pills in the proper doses at the proper times of day can seem an insurmountable task, Carolla says. "People can get frustrated and the temptation is to say, 'To hell with it,' and stop the medicine. Or they just lose track and may skip dosages," he says. What they need, he says, is the people around them to know about their illness and be alert to the symptoms. That way they can help if the patient stops his or her medication, becomes restless, or acts in inappropriate ways.
    More understanding of the disease is also crucial, Amador says. "Bi-polar disorder is a lifelong illness, rather than just a brief episode of illness, which is a hard pill to swallow," he says. "People need psychotherapy." A description of the various medications available for treatment of mental illness can be found at the National Institute of Mental Health at www.nimh.gov/publicat/bipolar.cfm

Study: Addicted Girls Need Specialized Treatment
Associated Press, 2/5/2003

WASHINGTON—Young girls and women are more easily addicted to drugs and alcohol, have different reasons than boys for abusing substances and may need single-sex treatment programs to beat back their addictions, according to a study released Wednesday. "They get hooked faster, they get hooked using lesser amounts of alcohol and drugs and cocaine, and they suffer the consequences faster and more severely," said Joseph A. Califano Jr., chairman of the National Center on Addiction and Substance Abuse at Columbia University, which conducted the survey of girls and young women over three years. "With some exceptions the substance abuse prevention programs have really been designed with a unisex, one-size-fits-both-sexes mentality," Califano said. "We now know that girls are different than boys let's recognize it and let's help them."
    The study, based on a nationwide survey of females age 8 to 22, found the gender gap is narrowing between boys and girls who smoke, drink and use drugs. Approximately 45 percent of high school girls drink alcohol, compared with 49 percent of boys, and girls outpace boys in the use of prescription drugs, the study found.
    While boys often experiment with cigarettes, alcohol and drugs in a search for thrills or heightened social status, girls are motivated by a desire to reduce stress or alleviate depression, the study found. Girls are also more likely to abuse substances if they reached puberty early, had eating disorders or were ever physically or sexually abused, researchers said. Their likelihood of using cigarettes, alcohol or drugs also increases when they move to a new community, or advance from middle school to high school or from high school to college.
    Califano said more treatment centers need to give female recovering addicts "a chance to be with just women," adding that substance abusers who were victims of physical abuse may not respond well to a group with men. Some traditional confrontational methods of beating addiction may also be the wrong approach for women, researchers found. Califano said facilities like the Betty Ford Center, which now has separate treatment programs for men and women, may be the model for future success. "We have not put together prevention programs that go to the things that influence girls and influence young women," Califano said. "Women have paid a fearful price for this failure."
    The study recommends that parents, educators and doctors do more preventive work with girls who fall into the various risk categories. It also faults alcohol and tobacco companies for promoting their products by linking them to glamorous models, and calls for a ban on alcohol advertising on television and cigarette and alcohol advertising in magazines with large numbers of young readers.

$1.3 Billion for Abuse Victims Is Going Unspent
Shannon McCaffrey, Detroit Free Press- 2/6/2003

WASHINGTON -- Services for battered women, rape victims and abused children face budget cuts even though more than $1.3 billion sits in a fund the federal government created to help pay for such assistance. Advocates for abuse victims say the crime victims fund -- stocked not with taxpayer dollars but with penalties and fees that criminals pay -- is hoarding the badly needed cash. Although the fund contains more than $1.3 billion, shelters are bracing for staff layoffs. Those at counseling centers worry they soon will have to put child-abuse victims on waiting lists.
    In Anniston, Ala., where three slayings in the past six months were related to domestic violence, the expected cut of about $20,000 is likely to slice another employee from the Second Chance shelter's staff of 13. "We'll probably survive this, barely," said Kimberly Lumpkin, the shelter's executive director. "But anything more and we're going to have to look at shutting down." Lumpkin is weighing whether to continue staffing the 18-bed shelter 24 hours a day. Reducing hours would mean that women who needed help in the middle of the night might have no place to go and could affect the safety of the women at the shelter, she said. Some women must drive almost two hours to reach Second Chance from rural areas. Shutting the shelter would make help virtually inaccessible for those women, she said. "What's so frustrating is that the money is there gathering dust in Washington," Lumpkin said. "What do you say when you have to shut the door to a woman who has finally gotten up the nerve to leave her husband?"
    Adam Spector, a spokesman for the Justice Department's Office of Justice Programs, said that although the money to the agencies that provide the services was decreasing, more money than ever was being spent to help victims. "It's not as if money is being taken away from victims. It's just available in different ways," Spector said.
    The cap on the amount that can be spent from the victims' fund each year is scheduled to rise in fiscal year 2003. But the USA Patriot Act -- which Congress passed after the Sept. 11, 2001, terrorist attacks -- shifted more of the fund's money to compensate victims directly for things such as medical bills and funerals. With $50 million also earmarked for a reserve fund for victims of future terrorist attacks and other money siphoned off for victims programs at the FBI and federal prosecutor's offices, the remaining cash is spread thinner.
    The fund was created in 1984 so that fines and penalties criminals paid could help the victims of their crimes. In the late 1990s, enormous fines from several large antitrust cases pumped up the fund. In fiscal year 2000 alone, it collected almost $1 billion. That same year, Congress capped the amount that could be distributed to the states annually, because legislators said they worried that without a limit the available money would fluctuate wildly year to year.
    The cap rises every year, and President George W. Bush proposed a $75-million increase to $625 million for fiscal year 2003. But with more money flowing to other needs, that will still mean a cut of $50 million to $60 million to the 6,100 victims services organization that depend on the fund. Congress will determine the final figure as it negotiates a spending bill. But neither the House nor the Senate versions of the bill increased the cap enough to spare cuts in victims services.
    The smaller check from Washington comes at a particularly tough time. States that also fund the programs are reeling from severe budget cuts. In Texas, state leaders are recommending a $4-million cut in victims services on top of the $3.7-million cut in federal funding for victims, according to the Texas Council on Family Violence. And private donations are down because of the flagging economy.

Survey: States Losing Track of Sex Offenders
Kim Curtis, Associated Press- 2/6/2003

S A N F R A N C I S C O — In a startling new survey, a child advocacy group found that states across the country have lost track of tens of thousands of rapists, child molesters and other sex offenders who are supposed to be registered in Megan's Law databases. Prompted by an Associated Press investigation that revealed California had lost track of at least 33,000 sex offenders, Parents for Megan's Law contacted all 50 states by telephone to ask about the accuracy of their registries. It found that states on average were unable to account for 24 percent of sex offenders supposed to be in the databases. And 19 states, including Texas and New York, said they were unable to track how many sex offenders were failing to register, or simply did not know.
    Federal law requires the addresses of convicted sex offenders to be verified at least once a year. But the survey found that up-to-date addresses for more than 77,000 sex offenders are missing from the databases of 32 states. And in the other 18 states and the District of Columbia, which are responsible for 133,705 offenders, thousands of the ex-convicts may have disappeared. "They're implementing Megan's Law, then turning their backs on it," said Laura Ahearn, executive director of the nonprofit agency in New York. "They need the technology and the staff to track down their sex offenders."

Many States Had Just Rough Estimates
All states responded to the group's survey, but only 32 were able to provide failure rates. Many of these said they have never audited their sex offender registries and provided only rough estimates of their accuracy. The survey, which the group plans to release Friday, relied on the word of officials in each state, unlike The AP's analysis in California, which was based on a CD-ROM of data taken directly from the registry. The survey said Oklahoma and Tennessee had the highest rates of noncompliance, both at 50 percent. A Tennessee official disputed this, and Oklahoma's Corrections Department spokesman, Brian Johnson, said the figure was just his best guess. "I don't have any specific actual information in terms of the level of noncompliance," he said. "We've not done a study of that that I'm aware of."
    The databases are supposed to help the public and police monitor sex offenders by keeping track of their home and work addresses and other personal details. Adults can search the database at sheriffs' offices or police departments, assuming the information is kept up to date as required.

Not Enough Staff
All states have versions of the law named for 7-year-old Megan Kanka, a New Jersey girl who was raped and killed by a child molester who had moved in across the street. But many states admit they don't know whether the databases are accurate — and they have little staff to do the work.
    In Oklahoma, Johnson's department mails address verification forms each year to 5,415 sex offenders, who are required to update and return them. But no one monitors how many of forms come back and how many don't. Johnson said he spends about a third of his time on sex offender registration. One full-time worker has the rest of the responsibility.
    The advocacy group said Tennessee's Bureau of Investigation told it half of the state's 6,300 sex offenders were out of compliance with the law. But a spokeswoman for the agency, Jeanne Broadwell, said 37 percent of 5,812 offenders were missing. She couldn't explain the discrepancy. The agency receives most of its updates from local law enforcement by mail, Broadwell said, and it usually takes about six more weeks to put it into the Megan's Law database.

Florida Compliance Rate Praised
Among the states with the best compliance rates is Florida, where state officials told the group only 4.7 percent of 27,689 offenders have failed to update their addresses. Florida's Department of Law Enforcement sends letters out each year and has a full-time staff of 11 to keep close track of those that come back. Offenders who don't respond often get a visit from police, spokeswoman Mary Coffee said. "We send a notification to law enforcement that says, 'Here's the guys who didn't report.' Certain agencies have entire units who follow-up on these folks," Coffee said.
    Several state agencies, including the department that issues driver's licenses and state identification cards, which sex offenders in Florida are required to keep, have direct electronic access to the database. "We have legislative and technology help that helps us do our best keeping track of these folks," Coffee said.
    Ahearn said she was surprised that some populous states reported very different results. For example, Massachusetts told the group it had lost track of 44 percent of its 18,000 offenders, while Illinois said it lost just 14 percent of its 17,087.
    After The AP's story about the California database, state and federal lawmakers, advocates for crime victims and police demanded efforts to improve Megan's Law databases. But with California and other states facing big budget deficits, more money will be hard to find. Johnson, the Oklahoma official, also said he doubts the databases will ever provide more than a false sense of security. "There's three reasons to have a sex offender registry," he said. "One is public protection, the second is it supports law enforcement investigations and it might prevent future acts of criminal behavior. I'm not aware of any research that says any of those things are accomplished."