Intimate Acquaintances Hurt Women More Often
Detroit Free Press, 2/24/2003

WASHINGTON -- Current or former spouses, boyfriends and other intimate partners were to blame for one-fifth of the nonfatal violence in 2001 against females age 12 and older, the government reported Sunday. "Such crimes, intimate partner violence, primarily involve female victims," Callie Marie Rennison, a statistician with the Bureau of Justice Statistics, said in the report.
    Aggravated and simple assault were the most common of the 588,490 violent acts recorded against females by intimate partners, according to the Justice Department agency. Those 502,690 included threats, attempted attacks and attacks without weapons that largely resulted in minor injuries. There were more than 44,000 robberies and nearly 42,000 rapes against women and girls by intimate acquaintances. In contrast, there were 103,220 nonfatal violent offenses committed by spouses, girlfriends or boyfriends against males that year -- about 3 percent of the total such crimes against men. Even though women and girls are victims of violence by intimate partners more frequently than men, the total number of such acts has fallen by almost 50 percent in recent years. In 1993, there were more than 1.1 million such crimes against females and almost 163,000 against men.
    The report also included FBI murder statistics for 2000, the most recent year available. It found that 1,247 women and 440 men were killed by intimate partners that year, which continues a decline that began in 1976. That year, 1,600 women and 1,357 men were killed by an intimate acquaintance. Still, 33 percent of all killings of women in 2000 were at the hands of an intimate partner, compared with just 4 percent of male murder victims, the statistics show.

Florida Court Awards Custody to Transsexual Dad
ABC News, 2/24/2003

C L E A R W A T E R, Fla.— A transgender father who was born a woman and won custody of his two children last week, in what is being called the first ruling of its kind, says that the children's best interests were the real issue in the case. Clearwater Circuit Judge Gerard O'Brien ruled on Friday that Michael Kantaras, who underwent a sex change operation 17 years ago, is legally a man, and the best parent for his two children. The judge awarded him custody of Mathew, 13, and Irina, 11, and granted "liberal visitation rights" to their mother. "I could say I was surprised," Kantaras said on ABC News' Good Morning America today. "The children were very happy and very relieved because they know now that they can have a loving relationship with both their mother and their father," he said.

Defining Transsexualism
The transgender case is the first in Florida courts and the first ruling of its kind nationally that addresses the custody issue for transgender parents, said Karen Doering, one of Michael Kantaras' lawyers and a staff attorney for the National Center for Lesbian Rights. "The court was really able, for the first time ever, to make a full and fair assessment of when is a man a man and when is a woman a woman, so this will truly be precedent setting," Doering said.
    Doering added that the court was really able to understand the condition known as transsexualism because medical testimony was a huge part of the case. "We were able to bring in three of the leading experts in the nation on the diagnosis and treatment of transsexualism," Doering said. "It's a condition where in their mind a transsexual person is one gender, but they are actually born into the body of another gender."
    Three expert witnesses testified that people like Kantaras are defined as males in the medical community because they do not have female reproductive organs or female hormones. Doering said the experts helped demonstrate that a transsexual person can live a very healthy life once they complete a two-year sex reassignment as Kantaras did. Michael Kantaras, a 43-year-old bakery manager, had a sex change operation in Texas in 1986 and legally changed his name from Margo to Michael. In 1989, he married Linda Kantaras, who knew of the sex change.

Legally a Woman
After they married, Michael adopted Linda's now-13-year-old son, Mathew, from a previous relationship. During the marriage, Linda bore now-11-year-old Irina through artificial insemination with sperm from Michael's brother. The children have been living with their father for the past six months. But the children's mother, Linda Kantaras, argued that Michael had no right to custody because he was legally a woman. Florida law bans same-sex marriages and bars homosexuals from adopting children.
    Kantaras said the outcome marks a huge victory for transgendered people, but he says that he always considered that part of the case as a secondary factor. "I focused mainly on what was in the best interest of our children, and that was my priority throughout the four and a half years of this trial," Kantaras said. Linda Kantaras and her lawyer could not be reached for comment, despite repeated attempts, but have previously had said they would appeal if they lost.
    The often-bitter child custody battle began when Michael Kantaras left his wife for her best friend. O'Brien awarded him temporary custody of the children last year, saying Linda violated a court order to refrain from using Michael's sex change to turn the children against him. He said he was also concerned about Linda's anger problems. Linda, a substitute teacher, retained visitation rights to the children.
    Three expert witnesses testified that people such as Michael Kantaras are defined as males in the medical community because they do not have female reproductive organs or produce female hormones. "The marriage law of Florida clearly provides that marriage shall take place between one man and one woman. It does not provide when such status of being a man or woman shall be determined," O'Brien wrote.

Study: Tobacco, Alcohol, Drugs Kill 7 Million a Year
Reuters News Service- 2/25/2003

CANBERRA, Australia — Tobacco, alcohol and illicit drugs prematurely kill about 7 million people worldwide each year and the number is rising, according to a study released in Australia on Tuesday. Professor Juergen Rehm, director of Switzerland's Addiction Research Institute, said in the Australian capital Canberra the global burden of disease resulting from smoking, drinking and taking drugs was huge.
    "One reason for this is increased worldwide exposure to these substances, especially in the highly populated emerging economies of Southeast Asia and China," Rehm told Reuters before presenting his study to an international drug-research symposium in Perth. "Another is that the relative share of diseases associated with substance abuse, such as chronic disease, accidents and injuries, as well as HIV and hepatitis, are predicted to increase."
    Rehm said tobacco, alcohol and illicit drugs were responsible for about 8.9 percent of the total global burden of disease in the year 2000, with his study building on some research he conducted for the World Health Organization last year. He said tobacco was the number one killer addiction in 2000, responsible for 4.9 million deaths or 71 percent of the total drug-related deaths -- a jump of more than one million since 1990. The rise was most marked in developing nations although most smoking-related diseases were found in industrialized countries. About 1.8 million deaths were attributable to the use of alcohol, about 26 percent of all drug-related deaths, with the proportion greatest in the Americas and Europe. Russia's alcohol problem was particularly pronounced. Illicit drugs caused about 223,000 deaths, or three percent of all drug-related deaths.
    "The most surprising finding from this research is that alcohol has become the number one risk factor in developing countries with emerging economies like China and Thailand over the past decade, above tobacco," Rehm said. Rehm said although the outlook seemed bleak, he hoped his research could be used by governments to formulate policies to combat the preventable deaths and disease. He said increasing taxes on alcohol and tobacco had proved to be a more effective way to reduce drinking and smoking, and resulting disease, than treatment or health care intervention.

Mental Illness Among Blacks in Spotlight
Ellen Barry, Boston Globe- 2/25/2003

Two of the city's most violent crimes of the last year - LaVeta Jackson's murder of her two children and the shooting of two police officers, allegedly by Jermaine Berry - point to a dangerous disconnect between African-American families and the mental health system, said speakers at a forum last night at the Codman Square Health Center in Dorchester.
    On one side, there is a deep suspicion of doctors who spout psychiatric jargon and have the power to strip a person of civil rights. On the other is a health system that puts an increasingly heavy burden on mentally ill people and their families to seek out and coordinate services themselves.
    And in between, said the Rev. Eugene Rivers, is a culture of shame that prevents black people from talking openly about mental illnesses. Two months ago, during the tense days after the police officers' shooting, Rivers lashed out at state agencies for not supplying the 20-year-old Berry with proper treatment for schizophrenia. But at a forum on violence and mental health in the black community last night, Rivers shifted responsibility to families who have too long approached psychiatric illnesses as an embarrassing secret. ''Talking about mental health in the black community is like talking about incest,'' Rivers said. ''That's the bigger problem, not the Department of Mental Health.''
    Citing the two examples, speakers discussed reasons why illness could go untreated and deteriorate into crime. Jacqueline Rivers, a founder of the National Ten-Point Leadership Foundation, speculated that side effects of anti-psychotic medications prompted Jackson to stop taking them, leading to a downward spiral that ended last July when she slit the throats of her children, who were 3 and 6. Jackson had suffered from delusions for years, but the family caring for her in Boston knew little about her illness.
    In the audience, trembling with emotion, was Michele Slade, who came home that day to find her niece and nephew dead. Slade said she discovered only after the children were dead and Jackson had been shot to death by police that Jackson had taken antipsychotic medicine. She stood, though, to tell the audience that nothing she learned about the illness could bring her to forgive the crime. Another woman in the audience of about 70 people, Emma Johnson, raised her hand to ask a Department of Mental Health representative her question: ''Chemical imbalance - is that a part of depression?'' As the state official launched into a discussion of endorphins, Johnson said that as far as she knows, ''chemical imbalance'' runs in her family.
    One clinician who works with African-American families said he frequently finds himself battling long-held beliefs - and a suspicion of psychiatry that developed ''for good reason.'' Another obstacle, said social worker Larry Higginbottom, is an assumption that serious mental illness can be resolved by rest and quiet: ''This is more than just a breakdown, brother,'' Higginbottom said he tells clients. ''They're having hallucinations.''
    At the forum last night, audience members complained of patterns they have seen as their acquaintances received state services. One man said that the mental health of youths in juvenile detention is not thoroughly examined, but they are simply asked whether they suffer from mental illness and left alone if they say they do not. Another man said that a lack of insurance is a reason for poor mental health treatment in black neighborhoods. Cliff Robinson, an area director for the Department of Mental Health, had little good news: Cuts to the mental health budget have forced the agency to reduce the amount of free treatment available in the community, he said.
    Boston Police Superintendent Paul Joyce, who is in charge of special operations and the Youth Violence Strike Force, said community support will become more crucial as a large wave of prisoners, many with mental illnesses, are released from state prisons. Joyce, who oversees use of force for the police review board, said recent police shootings of mentally ill citizens represent the worst-case scenario. ''That's not where we want to be as a city,'' he said. ''What happens in those situations, the officers will carry for their whole careers. Sometimes it ends their careers.''

Teens Are Rarely Screened for Suicidality
Carol Vinzant, Washington Post- 2/25/2003

By the time they reach high school, most American students have been screened, probed and protected from a wide range of ailments: amblyopia and hearing problems, scoliosis and tuberculosis, mumps and head lice, flat feet and language delays, measles and myopia. But these programs very rarely screen for one of the most deadly and devastating threats teenagers face: the desire to kill themselves.
    "We'd like to see screening" for depression and risk of suicide "become more commonplace, a routine part" of high schools' student health programs, says David Shaffer, director of the division of child and adolescent psychiatry at Columbia University in New York. "We want it to become part of the culture." Shaffer is developer of the Columbia TeenScreen Program, a sequence of tests and interviews designed to sift through a large group of teens and identify the few kids at high risk for depression and suicide. Along with the mental health advocacy group Positive Action for Teen Health (PATH), TeenScreen has launched an ambitious plan to screen -- and, as required, direct to treatment -- every teen in America.
    Each year, around 8 percent of teens report an attempt to commit suicide in the past year, and about 1,600 succeed, according to the U.S. Centers for Disease Control and Prevention. For ages 10 to 24, suicide is the third-leading cause of death, following auto accidents and homicides.
    TeenScreen's approach to the problem is different from most other suicide prevention techniques in that it does not seek to educate, destigmatize or provide hot lines for troubled kids, arguing that these methods have been proven ineffective or even harmful. TeenScreen seeks only to identify the youth at highest risk and get them the treatment they need, leaving the others as undisturbed as possible.
    While the screen-and-treat approach is gaining support and momentum in the field, it remains controversial. John Kalafat, a professor of psychology at Rutgers University and president of the American Association of Suicidology, has researched in-school educational and awareness programs and determined that many of them do indeed succeed in getting at-risk teens counseling or medical care. And he sees shortcomings in screening programs, including the fact that exams' need to be conducted regularly to be fully effective and a research record not significantly better than other programs'. TeenScreen "is a good program," Kalafat says, "but why present it as, 'We do this because the others aren't good'?"
    Laurie Flynn, PATH's national director and former executive director of NAMI, a national mental health advocacy group, is well aware of how devastating teen depression can be for families. Her teenage daughter attempted suicide 16 years ago but was able to get help and is okay today, she says. "Since we know we can identify kids at risk for suicide and we know we can help, how can we turn away from this?" she asks. "We're talking about saving lives here. And reducing disability. And reducing suffering."

An Illness, Not a Gesture
As part of its campaign to spread the screening program nationally, Columbia and PATH conducted a survey on teen depression and suicide in December of parents in Washington, New York, Florida and Ohio. A large majority of parents, the survey found, thought other parents would miss the warning signs -- but that they themselves would be able to see them. Nearly nine out of 10 thought themselves able to do so. This conflicts sharply with Shaffer's research into completed suicides. After conducting investigations into 120 teenage suicides over a two-year period, he and his colleagues discovered that 90 percent had a diagnosable mental disorder that had gone undetected. More than half had significant symptoms for more than two years. This does not necessarily mean the parents were inattentive; it's partly the nature of the teenage beast. "Teenagers go to great pains to hide emotional distress from their parents," Shaffer says.
    Shaffer's research found that the risk factors for suicide included a mood disorder (usually depression); past suicide attempts; and alcohol and drug abuse. Family conflict and stress at home were less important factors. Of the various factors, mental illness, particularly depression, is key, Shaffer says. "Suicide only happens to people with a mental illness," he says.
    The TeenScreen system consists of four parts: After receiving parental permission, all kids in a class or group take a simple, 10- to 15-minute written questionnaire asking if they've thought about or attempted suicide, feel depressed or use drugs or alcohol. A sample question: "In the past month, how much of a problem have you had with feeling unhappy or sad?" Responses range from "1, No Problem," to "5, Very Bad Problem." One question asks if the teen has ever considered killing himself or herself. Many who respond "yes" later report that they had simply never been asked this before.
    Between 40 and 50 percent of the whole group is usually directed to go to the next stage, a 45-minute computerized test designed to further distinguish those at risk from typically moody teens. The computer interrogator -- it speaks in a voice, through headphones -- provokes more honest reporting from kids than an adult questioner would, TeenScreen says. About 20 to 25 percent of those who take this test are flagged for in-person interviews with a mental health professional, who can distinguish teens who are suffering from appropriate situational distress (their parent's divorce, say) from those with more serious underlying psychological disorders. Those who are so diagnosed are sent on for counseling or therapy, with the coordination efforts of PATH.
    So far, more than 10,000 students have gone through the program; 10 to 15 percent have been referred for treatment. Pilot programs are running in 66 communities, and the group is offering to expand its efforts to 400 more communities. Columbia provides training and software free, but communities and schools need to provide staff and commit to screening at least 500 kids.
    The screenings have uncovered a wide swath of mental suffering that had gone undetected by parents and undeterred by all the well-meaning programs they had put in place. Less than one-third of those suffering from major depression, about one-quarter of those contemplating suicide and only half of those who had made a previous suicide attempt were under professional care (again belying the survey data showing parents believe they can detect mental illness in their children).

Other Approaches
For decades parents and professionals have grappled with the rising rate of teen suicide and developed a variety of strategies. Since the 1980s communities responded by starting suicide hot lines and offering suicide awareness and education programs at high schools. While begun with good intentions, Shaffer says, they were not all backed by substantial research. Not only have many not been proven effective, Shaffer says, some may actually hurt.
    The National Institute of Mental Health essentially concurs. In a 2000 report, it wrote: "Many of these programs are designed to reduce the stigma of talking about suicide and encourage distressed youth to seek help. Of the programs that were evaluated, none has proven to be effective. In fact, some programs have had unintended negative effects by making at-risk youth more distressed and less likely to seek help. By describing suicide and its risk factors, some curricula may have the unintended effect of suggesting that suicide is an option for many young people who have some of the risk factors and in that sense 'normalize' it -- just the opposite message intended."
    Kalafat has gathered and published research in professional journals that shows some educational programs' effectiveness, though he acknowledges that differences in program quality are problematic. He says there is no evidence that clearly shows screening results in fewer suicides than educational interventions. "It's the same old argument, that somehow kids are more likely to commit suicide because we talk openly about it," he says. Similar arguments are used against introducing drug and sex education in the schools.
    People who work in suicide intervention programs described as ineffective by screening activists report they can see the results themselves. "We're out here on the front lines," says Fred Davis, president and executive director of Parents Against Teen Suicide Inc., which conducts educational programs and interventions mainly in North Carolina. He says his group has helped get 25,000 people into the mental health care system and has gone out to intervene in 2,000 potential suicides, only one of which resulted in a death. "You can't tell me this doesn't work."
    Both camps agree that program quality varies widely, and that more research is needed to determine what works best. All parties seem to agree that, aside from the question of how suicide prevention is handled, teens need better education about mental health, especially depression. Getting high-risk kids into treatment -- medication, along with family counseling or therapy to reshape their destructive thinking patterns -- can help with a range of concerns, including social and learning problems. The screens can help identify other psychiatric conditions, ranging from drug and alcohol abuse to eating disorders, all of which require or benefit from therapeutic intervention.
    Meanwhile, to support the national effort, PATH is doing what advocates do in Washington: lining up legislation (Rep. Rosa DeLauro (D-Conn.) last year introduced the Children's Mental Health Screening and Prevention Act of 2002, which would create 10 federally funded demonstration screening projects); briefing congressional staff; working the executive branch (to get on the radar screen of the President's New Freedom Commission on Mental Health, created last year to study the nation's mental health delivery system); and pushing their survey to gain media visibility.
    There are also efforts to get school systems onboard with screening, partly by convincing them that undiagnosed depression and other psychological conditions can "get in the way of their learning objectives," Shaffer said. The group last year began working on a strategy with Rep. Patrick Kennedy (D-R.I.) based on the idea that early intervention in psychological problems can reduce special education costs later on.
    TeenScreen leaders find that resistance still comes from some parents, who object to having their child interviewed on such personal topics. Parents usually have to sign a consent form to permit their child to take the test, and often only 50 to 70 percent do (sometimes it's far lower). Sometimes PATH will add incentives like movie rental coupons for those who return screening forms. Another tactic is to require action from parents -- a denial-of-permission slip -- to forbid the testing. When this is done, only about 10 percent actively object. "When most parents figure out this is all about helping their children," says Flynn, "they are fine with it."

California Releases Molester Who Had Been in Mental Hospital
Kim Curtis, Associated Press- 2/25/2003

SAN JOSE, Calif. -- A man convicted of molesting at least nine young boys in three states is ready for release from a mental hospital, a judge ruled. But California officials still need to figure out where he should go next. Santa Clara County Superior Court Judge Robert Baines said Monday that Brian DeVries is now ready for outpatient treatment under close supervision.
    DeVries, 44, has spent more than five years at Atascadero State Hospital under the state's violent sexual predator law. The law allows such criminals to be locked up indefinitely after their sentences are completed, if they are considered a threat to society. In 2001, DeVries also voluntarily underwent surgical castration. During a brief court hearing, Baines said DeVries ''has met his burden and is eligible for supervision and treatment in the community.'' DeVries did not attend.
    If a satisfactory treatment program for DeVries is located, he would be the first California offender to be freed after completing the post-sentencing treatment program under the violent sexual predator law. The Department of Mental Health now is supposed to find a treatment provider and a place for DeVries to live, and to come up with a plan to monitor his day-to-day activities. A letter from DMH to the judge last week called the search a ''daunting process.'' But DeVries' lawyer, Brian Matthews, thinks department officials are dragging their feet. ''I don't think they want anybody out. When does that turn into a constitutional problem?'' he said outside court.
    DeVries was charged with molesting the 5-year-old son of landlord in New Hampshire in 1978. While on probation, he sexually assaulted at least three other boys ages 8, 10 and 12. He molested four more boys in Florida and an 8-year-old boy in San Jose. He finished serving his last prison sentence in 1997 and has been at Atascadero ever since.
    In Contra Costa County, officials also are having trouble finding a treatment provider for Cary Verse, a 32-year-old convicted rapist who was granted his petition for community release on Jan. 24. Lawyers in that case are expected back in court next month. Another sex offender, Marin County rapist Patrick Ghilotti, was deemed eligible for release in October 2001, but turned down his outpatient treatment program, saying it was too restrictive. The state is fighting his release in court, and Ghilotti remains at Atascadero.
    While a handful of sexually violent predators have been released from Atascadero, mostly on legal technicalities, no one has gone through the treatment program and ''graduated'' into supervised community release.

A Call for Action on Problem Drinking
Thomas H. Maugh II, Los Angeles Times- 2/26/2003

Teenagers account for nearly 20% of the alcohol consumed in the United States every year, while excessive drinking by adults accounts for another 30%, according to a study to be issued today. "If half of all alcohol consumption is a product of misuse and abuse, we have a real problem on our hands," said epidemiologist Susan E. Foster of the National Center on Addiction and Substance Abuse at Columbia University, who led the study in today's Journal of the American Medical Assn. "The implications are that the alcohol industry has an economic interest in both, and that interest is at odds with public health," she said.
    The industry responded quickly, contending that the study has serious flaws in its methodology and that Foster's estimate of teenage drinking is nearly double that reported by the government. An industry spokesman also questioned the study's definition of abuse -- anyone consuming more than two drinks a day. "Illegal underage drinking and alcohol abuse in any amount is a serious problem, but Foster does no one any good by repeatedly playing fast and loose with the data," said Dr. Peter H. Cressy, president and chief executive of the Distilled Spirits Council.
    Regardless of the exact figures, underage drinking "is a real problem that we need to address correctively, in the family and in the community," said Dr. Ting-Kai Li, director of the National Institute on Alcohol Abuse and Alcoholism. "Is this something new? No, it is not. Is it increasing? I don't know. "I think it doesn't matter whether it is increasing or decreasing. It is an important problem that we must address."
    Foster and her colleagues released a similar report a year ago that said underage drinking accounted for 25% of alcohol consumption. She said Tuesday in an interview that the group had erred in that study, overestimating underage drinking because youths were overrepresented in the federal surveys it relied on. "We've spent the better part of a year getting it right and we are now confident of our findings," she said. Foster also said the team's new estimates were very conservative. The surveys that supplied the data did not include high school dropouts, young people in the military, the homeless and the institutionalized, groups that are known to exhibit heavy alcohol consumption.
    Drinking among teenagers is a severe problem, not only because it is illegal, but also because it can damage the brain, interfering with mental and social development. Individuals who begin drinking before age 15 are four times as likely to become alcoholics as those who wait until they are adults, studies have shown.
    Three former U.S. surgeons general -- Drs. Julius Richmond, Antonia Novello and David Satcher -- joined with the Columbia researchers Tuesday in a nationwide call for action by the alcohol industry, parents and the public health community. Among other actions, they called on the industry to endow an independent foundation to curb underage drinking, as well as excessive drinking by adults; include information about the dangers of underage and excessive drinking on labels, as is now done for cigarettes; and include the nutritional content of products, including calories, on the labels.
    On the Net:
JAMA: http://jama.ama-assn.org
National Center on Addiction and Substance Abuse: http://casacolumbia.org
Distilled Spirits Council of the United States: http://www.discus.org

Internet Sites Offer a Different Kind of Help for Kicking Tobacco
Anne Rueter, Ann Arbor News- 2/26/2003

Some smokers want to quit, but can't imagine soul-searching with a bunch of other would-be quitters about their complicated relationship with tobacco. Others like the idea of group sessions, but don't have the time. Many may find their best bet lies on the Internet. There's a plethora of smoking cessation aids out there -- individual counseling in person or by phone, six-week group sessions with a counselor, nicotine patches and gum, to name a few. But for some people, it's hard to beat the Web's convenience and all-hours availability, plus another advantage: Quitting -- or failing to -- happens in private.
    Online quit-smoking aids are as effective as face-to-face group talk sessions and individual counseling, proponents say. HMOs and employers like Web-based programs because they reach a lot more people at a lot less expense, says Ted Dacko, CEO for HealthMedia, an Ann Arbor firm that markets a quit-smoking program to corporations, universities and pharmaceutical firms. A lot of help for quitters online is free. Some programs charge a membership fee. In some cases, users need a logon from a health-care plan or an employer to gain access.
    HealthMedia Inc., founded by University of Michigan health-care researcher Victor Strecher, has refined its "Breathe" smoking cessation aid over the last five years. UNISYS Corp. and Johnson & Johnson are among the HealthMedia clients offering the aid as part of benefit package. The University of Michigan recently began offering Breathe Advantage, the firm's quit-smoking aid plus its related aids for weight control and stress-management, to students and staff. U-M has announced that starting next fall, it will no longer offer students dormitory rooms where smoking is permitted.
    Although the university has no figures on how many students are participating in Breathe, online methods are a natural fit for an age group that has grown up using the Internet, says Carol Tucker, a health-education coordinator at the U-M University Health Service. Breathe Advantage users complete a detailed questionnaire that allows the program to tailor its suggestions to the individual, says Dacko. The program tries to help a smoker learn his or her main reasons for smoking and key triggers for lighting up. "We simulate the counseling process without having the counselor present," Dacko says. He believes the program, developed by doctors, psychologists, registered dietitians, exercise physiologists, and behavioral scientists, appeals to would-be quitters who are pressed for time and want to make their attempt in private.
    Breathe refrains from sending frequent reminders. After the initial session, it sends newsletters at key stages when a smoker is likely to relapse. A person receives five communications over a period of about a month. (For one smoker's experience using an online aid, see related story.) But smokers can find plenty of sympathetic company online if they want it. "To be able to sit in your own home and scream and yell and cry and laugh with others that are going through the same thing was a modern-day miracle," wrote one ex-smoker at whyquit.com, where people with aliases like MareBear and ElBob post messages titled "My Mind is out to get me!" "Life is very good," "Stress, Stress, STRESS!!!" and "Stinky Wallpaper: What can I do???"
    Another site, quitnet.com, directly appeals to smokers who want supporters to cheer them on. A snuffed-out cigarette points to the motto, "Quit All Together." The site, which charges a membership fee, lets smokers create a quit plan, pose questions to counselors and get advice and commiseration in several support forums, where thousands of postings occur each day.
    Many sites offer advice and support for free. Among them are the American Lung Association's Freedom From Smoking program (www.lungusa.org/ffs) with step-by-step modules to help smokers quit, message boards and stress-reduction and exercise tips. Smokers will find 225 pages of advice, e-mail counseling and support groups at www.quitsmokingsupport.com, a site claiming it has helped millions of smokers quit since 1993.
    Smokers vary in what works best for them, be it face-to-face counseling, midnight visits to online chat rooms or a jolting list of lung-disease statistics. Tucker of University Health Service sees online aids as one of a whole array of tools available to smokers who want to quit. Most people try to quit several times before they're successful, so having a lot of options is a good thing, she says. Smokers who use an online program without interacting with others may miss a key ingredient to many people's success: "There's tremendous support for quitters," Tucker says.

Cigarettes Bind Journalist to Longtime Smoking Habit
Courtney Ceronsky, Ann Arbor News- 2/26/2003

I expected quitting the second time to be easier than it had been when I initially tried to give up cigarettes. After all, I learned so much from my first attempt:
* Life goes on without cigarettes (who knew the depression that accompanies quitting would feel like a mournful break-up with a longtime lover?.)
* I could do it. I'd go smoke-free for up to a week at a time when I first tried to quit. Besides, I'm not a heavy smoker. I was averaging about five smokes on a good day, a half pack on a bad one.
    That's why I agreed to give healthmedia.com a try. I tried to quit late last summer when the latest tobacco tax increase hiked cigarette prices up to about four bucks a pack. As a 29th birthday present to myself, I made an appointment with my doctor and got a prescription for Zyban, another name for the anti-depressant Wellbutrin, which is supposed to take the edge off nicotine withdrawal. (I ended up quitting the drug prematurely, mistaking, I later realized, the unexpected symptoms of withdrawal - sleeplessness, nausea, constipation, disorientation, in addition to the anticipated crankiness - for side effects of the drug.)
    I was totally gung-ho, at first. I signed up to do weight training three days a week and power walked for up to an hour at a time on the other days. I even started doing my grocery shopping at Whole Foods Market. I was determined to have a healthy new lifestyle, and I refused to gain any weight.
    Well, that plan didn't last very long. I'm not exaggerating when I say I started to feel like a crackhead looking to score my next hit. Wherever I went, I scoped out the smokers in case any emergency should happen and I really needed a cigarette. And it didn't help that most of the women in my family smoke so I could easily steal a drag here or a cigarette there.
    I hit rock bottom one rainy night when I just wanted one cigarette and my only option was to buy a pack. I sat in my car parked in front of the tobacco store I used to frequent, tearfully watching the man who sold me cigarettes make small talk with his more loyal customers. I missed his friendly chatter, the smell of his store, and most of all, unwrapping a new pack of Benson and Hedges Lights and lighting one up. But I couldn't bring myself to do it, I didn't buy a pack that day.
    I noticed my clothes were fitting a bit more snugly and occasional snacking became constant grazing. I really didn't want to add to the 20 or so pounds I originally wanted to lose, especially with the holidays just around the corner. So that was my rationale when I bought a pack the day before Thanksgiving. I didn't plan to start smoking again full time, but the holidays did me in. By Christmas, I was back up to about a half pack a day and weighed about 7 pounds more than I did before I tried to quit. It was the worst of both worlds.
    A couple of weeks into the new year, I agreed to check out healthmedia.com. The three different aspects of the program appealed to me. The Web site treats smoking cessation as a process, beginning with "Relax," a segment devoted to stress management before you quit. I will be going back to review that area -- I foolishly thought I had that part under control the second time around. The next leg of the program is "Breathe," which deals with techniques and motivations for quitting. The final part of the program is "Balance" for weight issues after quitting. Unfortunately, I didn't get that far.
    As soon as I got my access code, I logged on to the Web site and plunged right into the questionnaire. I spent about 20 minutes looking inward, confessing my fears and weaknesses related to giving up cigarettes. My "tailored guide" was available immediately. I needed to consider my menstrual cycle and avoid major, stressful projects when I set my quit date. I picked a support person, my boyfriend, an ex-smoker, to receive occasional e-mail messages from healthmedia.com to help me quit (A bit of advice -- don't pick someone you live with to be your support person. As "supportive" as he or she intends to be, chances are that someone may also up the stress level enough to trigger a craving.) After I quit, the program told me, I needed to stay away from smokers for a least two weeks, until I became strong enough to resist temptation.
    I arrogantly set my quit date for the end of January with no regard for the time of the month, or the surprise retirement party my sister and I were planning for our dad. I was also to begin volunteering for bingo at the American Legion -- hardly a smoke-free environment. Let's see, I was totally smoke-free for a whole weekend.
    According to healthmedia.com, the key is this: "Being motivated to quit smoking means having a reason that is compelling enough to push your desire to quit beyond your desire to smoke." After my sister called me at work to tell me the room we reserved for my dad's party was double-booked, my first thought was to smoke. When she called back and said, never mind, the woman who was setting up our party had us down for the wrong date, I thought, "I need a cigarette." I actually bought a pack when I found out our party planner quit a week before the event. Of course, the party worked out fine, and would have regardless of whether I smoked or not, but obviously, at that point, my reason to quit wasn't more compelling than my desire to smoke.
    I haven't given up hope though. This program isn't a miracle solution for a psychological and physical addiction. It does, however, offer common-sense advice about staying motivated and exploring alternatives to smoking, from calculating the time and expense involved with the habit (a half pack a day costs about $730 a year and at 7 minutes per cigarette eats up about 15 days annually) to deep breathing techniques and suggestions such as going for a walk after dinner rather than lighting up.
    My last newsletter -- the program e-mails participants four in all -- offered a "quick tip" that involves writing affirmations on note cards, such as "I choose not to smoke today regardless of any situation" to read in the morning and throughout the day as a reminder. Of course, none of it works unless you apply it, and gradually, I'm getting to the point where I'm ready to do that, again. I have access to healthmedia.com until mid-August and I'm in the process of going back over the "Relax" section of the program (this also requires a support person and my boyfriend received an e-mail telling him to be more helpful because I'm especially prone to stress right now - I love it!). I'll work my way back to "Breathe," and move on to "Balance" (or convert my closet to all elastic waistbands). I'm assuming the saying "the third time's a charm" wouldn't be a cliche unless it rang a little bit true.

SE Michigan Drug Deaths Jump 50% From 1996 to 2001
Associated Press, 2/27/2003

DETROIT -- The number of drug-related deaths in southeast Michigan jumped about 50 percent between 1996 and 2001, according to a report. In 2001, 729 people died of drug overdoses, longtime abuse or suicide in the Detroit area, according to the report released Wednesday by the Substance Abuse and Mental Health Services Administration. That was up from 493 such deaths six years earlier, The Detroit News reported. It capped a five-year upward trend, the report said.
    "One life lost to drugs is one too many," said agency administrator Charles Curie. "Effective prevention and treatment programs are key to helping reduce the needless loss of life that results from abuse of drugs." The agency is working with states and local drug treatment providers to build treatment capacity and to implement the most effective treatment services, he said.
    The nationwide study included four southeast Michigan counties: Wayne, Oakland, Macomb and St. Clair. According to the study, heroin and prescription drugs figured heavily in the increase. Deaths related to prescription painkillers more than doubled in the six year period, from 176 to 354. They figured into more deaths than any other drug in 2001. Heroin-related deaths also jumped from 149 to 285. The Detroit area saw more deaths related to multiple drugs than any of the other cities studied. Marijuana also figured into more deaths in Detroit than anywhere else.
    The statistics were not surprising to Chad Audi of Detroit Rescue Mission Ministries. Its homeless shelters are hosting more people battling drug addictions, he said. "There's more junk in the streets," said Audi, who is visiting Washington this week to ask Michigan lawmakers for more money for the group's drug treatment programs. He says it currently receive $3.5 million to treat substance abuse and needs twice as much to adequately handle the problem.
    On the Net: Substance Abuse and Mental Health Services Administration, http://www.samhsa.gov

Attention Deficit Disorder for Adults
Valerie Reitman, Los Angeles Times- 2/10/2003

Difficulty concentrating? Getting along with your spouse? Weaning yourself from the Internet or that computer game to get your work done? Or thinking about all those things you have to do instead of focusing on what you're reading right now? Pharmaceutical giant Eli Lilly & Co. thinks its new blue, gold and white pills might help. The Indianapolis drug maker has been heavily marketing the drug Strattera, also known as atomoxetine, for attention deficit/hyperactivity disorder. It's the first drug approved for ADHD in adults as well as children, and a surprising number of adults -- including doctors, lawyers and chief executives -- may benefit.
    The roll-out includes Lilly-sponsored informational sessions with psychiatrists and physicians nationwide to educate them about the condition and, of course, encourage them to prescribe the drug. And it promises to draw attention to a syndrome that is largely undiagnosed, but possibly endemic, in adults. In fact, the drug could do for ADHD what Prozac, another Lilly drug introduced in the late 1980s, did to highlight an epidemic of low-grade depression across the country.
    The new spotlight on ADHD, however, also promises to dredge up skepticism about whether such a syndrome actually exists and whether society -- which has come to expect chemical relief for everything from anxiety to sexual dysfunction -- is simply looking for a quick fix to smooth out personality quirks and discipline problems and improve concentration. Critics charge that society has tilted too far toward helping people who say they have ADHD. Patients under treatment can get extra time to take their college entrance and professional boards and win protection from being fired -- even if they're disorganized or can't complete projects on time -- under the Americans With Disabilities Act. Meanwhile, Lilly and many psychiatrists claim that as many as 4% of American adults -- about 8 million people in the U.S. -- suffer from ADHD.
    Adults whom psychiatrists say have ADHD might charitably be described as "organizationally challenged." They have lightning-short attention spans and perhaps a propensity to engage their mouths before their brains. They might fidget and daydream much of the day and find boring and passive activities particularly challenging. Few people like to balance their checkbooks, but those with ADHD just can't seem to make themselves do it.

Equal-opportunity disability
Though they might be good at conceptualizing ideas and adept at socializing, when it comes to the details, they often just can't execute until the last minute, if at all, says Dr. David Feifel, director of the Adult ADHD Clinic at UC San Diego School of Medicine. Though there are many criminals and chronic job-hoppers who are said to suffer from it, ADHD is an equal-opportunity disability, according to several psychiatrists interviewed for this article. Patients include every sex, race, age and socioeconomic status, and surprisingly many successful professionals, such as chief executives, doctors and lawyers. (Despite its name, it doesn't necessarily involve hyperactivity, a symptom often seen in young boys with the diagnosis, but that often isn't present in girls or adults.) "They are people who ... have the No. 1 qualifying factor: underachievement," says Dr. David Comings, director of medical genetics at City of Hope National Medical Center in Duarte. "They are not as successful as their motivation, efforts, intellects and abilities would seem to indicate."
    Some people compensate by gravitating toward professions that are less detail-oriented, provide constant variety, and require short bursts of attention rather than sustained day-in-and-day-out concentration and organization. For instance, if they become doctors, they might choose to work in an emergency room -- where constant activity provides plenty of stimulation and isn't boring -- rather than doing cancer research. Others cope by surrounding themselves with efficient secretaries, assistants and spouses, or simply work or study longer to compensate for their lack of concentration.
    Lew Mills, a San Francisco psychotherapist who works with ADHD patients, says he was 40 when he realized he'd had the disorder since childhood. He might have three projects going on a certain day, he says, and might do one and forget the other two. "It feels like there are always a lot of balls in the air and I'm trying to catch as many as I can."
    But the ADHD diagnosis in both children and adults itself is controversial. After all, couldn't most of us be more successful? Don't we all have personality traits that make some of us more detail-oriented and organized and others perhaps more gregarious and better at envisioning the big picture? With life becoming so much more complex, with so many distractions, many people feel more overwhelmed than ever and may be prone to seeking chemical relief.
    Some doctors dismiss ADHD as a concoction of drug makers out to make money. "ADHD is the paradigm of the way the pharmaceutical industry has influenced the way we think," says Dr. Lawrence Diller, a behavioral pediatrician in Walnut Creek and author of "Running on Ritalin." "Suddenly, everybody's got panic and phobic disorders," Diller adds. "It's an astonishing phenomenon -- when we have this much money, everybody's going to have something."
    These days, the number of children taking Ritalin and related stimulants for ADHD has surged. Drug makers sold about $1.3 billion worth of the stimulants last year, according to Datamonitor Healthcare PLC, a health care intelligence and consulting firm Concurs fellow skeptic Dr. Peter Breggin, a psychiatrist and author of "Toxic Psychiatry" and several other books: "Any of us who are creative and interesting, we're all diagnosable with a lot of things. It's become a farce." Breggin scoffs at the criteria for ADHD outlined in the American Psychiatric Assn.'s diagnostic manual. They include failing to give close attention to details or making careless mistakes; difficulty sustaining attention in tasks or play; not seeming to listen when spoken to directly; not following through on instructions and failing to finish schoolwork, chores, or duties in the workplace. "Any ordinary person knows this is nonsense," Breggin says.
    Both Diller and Breggin think society has gone overboard in administering drugs to allegedly hyperactive children, who are taking Ritalin and its sister stimulants, Adderall and Concerta. They believe that Strattera could become a fad with adults as more people hear about it and identify with it. Resnick, who runs an ADHD clinic at Randolph-Macon College in Ashland, Va., agrees that Ritalin has become a quick fix for many who don't need it. "The scary part is that mostly parents come in and say 'Johnny got a C in chemistry, so he must need Ritalin.' " But he and most other doctors these days accept that the condition does exist. Whether those with it should take drugs to alleviate their symptoms involves determining how much of an impairment it is in the patient's life -- whether they have learned to cope or whether it is wreaking havoc with their lives, work and relationships.

'Not just a bad hair day'
Dr. Lenard Adler, a psychiatrist who teaches at New York University and directs its ADHD program, says patients who seek treatment are often in their 40s. Frequently, since the disorder appears to be hereditary, they recognize the same symptoms in themselves when their child is diagnosed.
    "It's not just a bad hair day," says Dr. Timothy Wilens, a clinical researcher at Massachusetts General Hospital who has run clinical trials and done consulting for Lilly. "It must be chronic.... Everyone has walked into a room and wondered, why did I do this? It might happen once or twice a month.... For someone with ADHD, it might happen 10 or 20 times a day." Often, there are other compounding problems such as depression or bipolar disorder.
    In the past, even if they recognized and accepted it in adults, physicians may have been reluctant to prescribe stimulants, which are strictly controlled to prevent abuse. Students use them to improve concentration and consequently their grades. In many states including California, regulators must be informed of who is given them; prescriptions have to be written out by the doctor, they cannot be called into the pharmacy; and doctors cannot hand out samples.
    Strattera, however, is not a controlled substance and will be much easier for physicians to prescribe. Some patients who've taken Strattera in Lilly's clinical trials say it does help. About 60% reported dramatic improvements in concentration and impulsiveness control, Lilly says. Side effects tended to be few in adults -- loss of appetite, nausea, dizziness and some decrease in sexual function in men.
    Lilly says Strattera reduces ADHD symptoms by blocking or slowing reabsorption of norepinephrine, a brain chemical, or "neurotransmitter" considered important in regulating attention, impulsivity and activity levels. This keeps more norepinephrine at work in small gaps between neurons in the brain, which helps pass impulses from one neuron to another. Feifel says some patients find it "phenomenal" while others found it not so effective compared to stimulants.
    Victor, a 24-year-old from Chula Vista who asked that his last name not be revealed, says Strattera helped improve his focus when he took it as part of the clinical trials. In high school and before dropping out of college, he had to reread material over and over for it to sink in and had difficulty completing a book. It took a while for the drug to kick in, but slowly, he realized he was much more focused. He could finish books and get through even the driest material without getting distracted. It helped him successfully complete Emergency Medical Technician training, and now he's working in a hospital and continuing his education. He says, "I stopped interrupting -- I could listen and take things in."