Parents, Shopping for Discipline, Turn to Tough Schools Abroad
Tim Weiner, New York Times- 5/10/2003

ENSENADA, Mexico - Ryan Fraidenburgh was 14 when he was brought here shackled, kicking and screaming. Two men carrying handcuffs and leg irons came for him at his mother's home in Sacramento, Calif., shoved him into a van and bound him hand and foot. They drove him 12 hours south, over the Mexican border, into a high-walled compound near here called Casa by the Sea. "It was nighttime," Ryan recalled. "I look around and I see kids sleeping on cement. I was really, really scared. The big honcho, Mauricio, said, 'You don't speak English here.' I didn't know how to speak Spanish." Ryan quickly learned the rules: stay silent, be compliant, don't look up, don't look out the window, don't speak unless spoken to. The punishments for breaking the rules included solitary confinement, lying on the floor in a small room, nose to the ground, often for days on end.
    Ryan was not a criminal. He was only skipping school, his parents said in telephone interviews. But in August 2000, they said, in the middle of a bitter divorce and custody battle, they decided to send him away to Casa by the Sea, which calls itself a "specialty boarding school" for behavior modification. Like hundreds of other parents, the Fraidenburghs made their choice largely on the basis of a glossy brochure and a call to a toll-free number in Utah. They came to regret their choice.
    The idea of sending a child to such a program in Mexico was unheard of a decade ago. But in the United States behavior-modification programs and boarding schools for troubled youths have faced increasing legal and licensing challenges over the past few years. More and more are moving abroad -- some to Mexico, Central America. or the. Caribbean -- where they operate largely under the regulation radar and where some employ minimum-wage custodians more than teachers or therapists, say government officials, education consultants and clinical psychologists.
    The behavior-modification business is booming at Casa by the Sea, on Mexico's Pacific Coast, the largest of 11 affiliated programs with roughly 2,200 youths, about half of them in Mexico, Costa Rica and Jamaica. The programs are run by a small group of businessmen based in St. George, Utah, under the banner of the World Wide Association of Specialty Programs and Schools, or Wwasps, and Teen Help, the program's main marketing arm.
    Over the past seven years, local governments and State Department officials have investigated Wwasps-affiliated programs in Mexico, the Czech Republic and Samoa on charges of physical abuse and immigration violations. The Mexican program, in Cancun, and the Czech program closed, and their owners left those countries saying they feared unjust charges. The Samoan program cut its affiliation with Wwasps.    
    Ken Kay, the president of Wwasps, would not allow a reporter to visit Casa by the Sea; Dace Goulding, the program's director, declined to answer any questions. But Mr. Kay, responding to inquiries in writing from his office in. Utah, said no charge of abuse had ever been proven against any of the programs in any court. "We are about getting families back together," he said in a written statement. "We are not for everyone, and there are very few but vociferous critics of not just us but any youth intervention." He described many of the program's critics as parents who feel they have been "manipulated, brainwashed or duped" or who are battling through divorce and taking their anger out "by making us look terrible."
    In telephone interviews, eight teenagers who were formerly in Casa by the Sea described a system in which the youths try to ascend six "levels" through a system of rewards and punishments, including being sent to "R and R," a small, bare isolation room, often for days on end. Discipline, not education, was the rule, they said. For Laura Hamel, 17, of Vienna, Va., who counts herself as a success story, it was a slow two-year ascent to graduation in March. She said she was demoted from Level 3 -- back to Level 1 after giving a weeping, lonely friend a hug and a kiss on the cheek at Thanksgiving. Affection of that kind is forbidden.
    A youth who rises to Levels 4, 5 and 6 can become a "junior staff member" and "participate in the discipline process" against lower-level youths, Casa's contract with parents says. "The authority is in your hands," said Ryan Pink, 19, of El Paso, who reached Level 5 at Casa. "You can discipline kids. The younger kids -- they were constantly being restrained, being punished, put in R and R for four or five days. Nose to the wall. Or nose to the ground. And at night you sleep in the hallways."
    Many parents and youths say the behavior-management system of discipline and punishment scares youths into sobriety obedience. Others -- parents and youths formerly enrolled, education experts, government authorities and a former Wwasps program director -- say the programs profit from struggling parents unable to handle their depressed, delinquent, defiant or drug- abusing children.
    The financial success of Casa by the Sea is evident. Its enrollment has nearly tripled, from about 200 youths when it opened in 1998 to more than 570 today, almost all American teenagers. Already among the biggest programs of its kind outside the United States, Casa by the Sea has just spun off another program for those 18 and over.
    Tuition and fees at Casa by the Sea ran about $30,000 a year, half of what some United States-based programs cost. Its staff members "do not need and may not necessarily have" teaching credentials, Casa's contract with parents plainly states. Lon Woodbury, publisher of Woodbury Reports, which rates schools and programs for troubled teenagers inside and outside the United States, said one reason that American programs have moved abroad is "to avoid the laws and regulations of the States." He added, "They can hire minimum-wage staff and still charge stateside prices."
    Profit margins and growth within the programs run by Wwasps appear solid. Teen Help, the affiliation's main marketing arm, was the single biggest corporate campaign contributor in the state of Utah in the 2002 election cycle, donating $215,290 to Republican campaigns, according to online federal election records posted in March. Mr. Kay, the Wwasps president, said that the proof of the programs' success is the way in which "behavior of students generally changes drastically." The organization's internal surveys, he said, proved that "more than 98 percent of the schools' parents are completely satisfied." He wrote, "No wonder these are the fastest growing schools of their kind in the world!! "
    The overseas "specialty boarding school" industry is growing so fast that United States consular officials in overseas embassies say they have no idea how many such programs exist. "No authorities in Mexico control these institutions," said Elisa Ledesma, a lawyer at the American Consulate in Tijuana. Consular officers demanded and received access to several such programs in Mexico, one official said, after they "heard horror stories from parents."
    The consular officers have the power, under the Vienna Convention, to visit overseas programs to check on the well-being of American citizens under 18. In January, after several such visits, the State Department issued a notice on "behavior modification facilities" in Mexico, Costa Rica and Jamaica. The programs may "isolate the children in relatively remote sites" and restrict their contact with the outside world, it said.
    At least seven programs in Utah, Montana, South Carolina and New York are Wwasps affiliates, according to the organization's Web site; at least three have faced legal challenges. Utah state officials say they are reviewing the license of the flagship Wwasps program, Cross Creek Manor, and that a second program, Majestic Ranch, is operating without a proper license. Six weeks ago, according to the state attorney general's office in Utah, a director of Majestic Ranch entered into a court agreement to have no unsupervised contact with children after he was charged with misdemeanor child abuse. Attorneys for both programs contest the licensing challenges. South Carolina officials have fined a third Wwasps program, Carolina Springs Academy, $5,000 for operating without a license.
    While some dissatisfied parents have sued Wwasps and its programs, the contract that parents sign with Casa by the Sea sets high hurdles for them. It states plainly that the program "does not accept responsibility for services written in sales materials or brochures" or promises made by "staff or public relations personnel" and that any dispute between a parent and the program must be settled in a Mexican court, not in the United States.
    The Wwasps programs market themselves under a multitude of interlinked Web sites. Their sales personnel offer thousands of dollars in incentives to adults who recruit new youths or host Web sites advertising the programs. Some parents said in interviews that they enrolled their children in programs they had never visited after browsing Web sites, brochures and videotapes depicting happy children in a wholesome setting.  "I sent him there sight unseen," said Patti Reddoch, of Sweeny, Tex., who considered Dundee Ranch for her son, Edmund Brumaghin, now 17, but chose Casa by the Sea instead. "The music he was listening to started getting darker and he was getting more into the drugs, and that's when I decided I needed to do something. "So I went on the Internet and started searching around and found the Wwasp program. I contacted them and made the arrangements, and that's pretty much it. It didn't take me any time at all." Mrs. Reddoch, speaking by telephone, said she then hired an "escort service" familiar with Casa by the Sea to handcuff and transport her son away at 5 am. one Sunday last September. That morning, her son cursed her bitterly, but now his attitude is changing, she said. "I am very pleased with the school," said Ms. Reddoch, who said she visited Casa by the Sea once, for a weekend, last January. "I've started putting out brochures for referrals. I would recommend Casa to anyone."
    Reality may differ from the brochures, however. "Everyone has a shaved head," Michael Zieghelboim, who was formerly enrolled at Casa by the Sea, said in a telephone interview. "They walk around like zombies. Most of the staff have no training." "Casa by the Sea was the scariest thing that ever happened to me," siad Mr. Zieghelboim, who now lives with his father in El Salvador. He said that despite falling behind in his education at Casa by the Sea -- at 17, he is now in the 10th grade -- he rates himself a success. "If I had never gone there, I'd probably still be doing cocaine," he said.
    This kind of tough discipline is an attraction for many exasperated parents. The program runs "a very tight ship," said Virginia Day, of Redmond, Wash., who sent her son, Gabriel, 15, to the program in July. "The staff that works most closely with the kids are not necessarily professionals, and I know that this is an issue," said Ms. Day, who called herself a very satisfied customer. "This is not a school that specializes in a therapeutic component." Carol Maxym, an educational consultant in Maryland, said: "What they are looking for at Casa is compliance. Compliance is easy, if you break the kid down enough. And compliance is cheap." She added, "The parents often don't realize what's going on."
    Youths and staff at other overseas Wwasps programs have described harsh conditions. One was Aaron Kravig, now 19. He said he contracted scabies, untreated for six months, ate meals of watery porridge and fish entrails, and was schooled almost solely with "emotional growth" videos at Tranquility Bay, the Wwasps-affiliated program in Jamaica, according to a transcript of sworn testimony he gave last year at a Virginia state court hearing.
    In Costa Rica, Ms. Knight, the former director of the Wwasps-affiliated Academy at Dundee Ranch, resigned in August after sending a letter to the national minister of child welfare calling for the program to be shut down. The letter said the program was "hiring unqualified, untrained, staff" and providing "the bare minimum of food and living essentials." It said the program "takes financial advantage of parents in crisis, and puts teens in physical and emotional risk,"
    The speed with which some parents choose an overseas behavioral-modification program for their children baffles some educational consultants. "I find it incredible that parents would send their kids off to some place they've heard about on the Internet," Mr. Woodbury said. Ms. Maxym, author of "Teens in Turmoil A Path to Change for parents, Adolescents and their Families" (Viking Penguin, 2000) said, "I find it interesting that parents will spend less time finding a school for their child than buying a new car."
    Ryan Fraidenburgh's father, Bob, an aerospace engineering executive, said he had only glanced at Casa by the Sea's "brochures that looked like Club Med." He said he removed Ryan from the program by himself in January 2001 after deciding he had been too hasty. "We made a huge mistake," he said. "Until the day I die I'll regret that." Ryan's mother, Carolyn, said "We were expecting treatment, not a minimum-wage person to watch over your kid like he was an animal in a cage."

One School That Relies On Therapy
BAHIA DE KINO, Mexico - Joe Quaglio, a 17-year-old from the suburbs who acts like he grew up in the ghetto, is standing in front of his peers, 15 teenage boys, throwing his old life away. Newspaper clippings about old friends, one shot in a drug deal, one serving 30 years in jail, flutter out of his hands and into the trash. Out goes an old journal. Out go the Chuck Taylor sneakers and an old gang bandana. His fellow students embrace him. This ritual takes him one step toward graduating from one of the only schools in the world that would have had him: Positive Impact, on. the shores of the Sea of Cortes, a long way from the culture and conflicts of the United States.
    While bigger institutions like Casa by the Sea offer behavior-modification programs, there are other schools with a different approach toward teenagers in trouble. One of the best, in the opinion of several educational consultants in the United States whose profession is matching teenagers and parents with such schools, is Positive Impact. A four-year-old school with 60 boys, 60 miles from the nearest city, Hermosillo, Mexico, the school relies on individual and group therapy, not behavior modification. The mood is one of cooperation, not control. Staff members have undergraduate and graduate degrees in fields like psychological counseling and education. Almost all the boys here are from well-to-do families -- they have to be, because tuition at Positive Impact runs close to $60,000 a year. Many of the boys say they started drinking and taking drugs at 12.
    Hughes Pope, an intelligent, friendly, calm 17-year-old from Greenland, N.H., said he started smoking and selling marijuana in the eighth grade five years ago and hit bottom when he stole his father's prescription pain pills. "My parents were at a loss as to what to do with me, and I knew I was driving a wedge between them," he said, gazing out to sea. "It was a never-ending battle. My plan was to wear my parents down to where they didn't care anymore."
    Then, last year, an escort service - two big men, hired by his parents - took him from: his home into a nineweek wilderness camp in Utah called Second Nature. After that experience sobered him, he arrived at Positive Impact. "There has never been any abuse here,'' he said. "People back home thought I was going to come back a therapeutic zombie. But there are clear-cut expectations here. People are focused. You learn to live." After a year at Positive impact, he and his teachers said, he is headed home; without formally graduating from the program, to a different high school in New Hampshire and later, he expects, a small liberal arts, college. The alternative, he said, would have been prison or worse.
    Not all the students are success stories, and not all will be, said the school's director, John Andersen. About a third graduate from the program. There are no long-term studies showing how these teenagers will fare as adults. But Joe Quaglio -- Q, to his friends says he is coming 'out of a hard, ugly cocoon. He used to live in a state of rage, he said, adding, "Jail or death were my only two options." His friends and teachers say they think he now has a chance to make it.

Abuse Survivor Starts Program to Help Kids
Alan Bernstein, Houston Chronicle- 5/10/2003

Among the eye-popping tattoos that cover much of Anthony Calleo's body, one on his stomach shows two swallows holding a banner. The banner, encircling his navel, says, "Save me from hell" in Latin. "It's pretty self-explanatory," he said. Every college student's graduation is bound to involve a story of perseverance and personal growth. But Calleo's graduation today from the University of St. Thomas with a major in theology and philosophy caps a story that includes sexual abuse, drug abuse and crime.
    After he emerged from that purgatory, Calleo, 23, co-founded an after-school center in the working-class neighborhoods just north of downtown Houston. The idea behind the Stop Abuse Forever Center, now a year old and run completely by teens and young adults, is that no more kids should have to endure what he did.  Calleo's tattoos and his side career in pizza delivery color the story even more.
    The center faces Jefferson Davis High School. Sitting in his office, surrounded by objects such as a pair of skateboards, a piñata, a tambourine and a set of children's drawings, the intense young man unfolded his tale.  While living with his mother in northwest Houston, he was sexually abused multiple times by a male neighbor a few years older than he. In fear, he did not report the assaults. "I always knew 'it happened' instead of thinking it happened to me," he said, jabbing at a desk handle. "It was like something happening to somebody on TV."
    The psychological damage was done. "You lose a sense of self-control, a sense of self-worth, and you are scared all the time. Some people fold, some people become distrustful and deceitful, some people become real violent." Calleo said it was the latter two for him. From age 13 to 16, he said, he was a brawling, burglarizing, lying, amphetamine-abusing, hard-drinking stain on himself and the city. He said he often deserved to be arrested and never was, that he thought about killing himself and obviously didn't proceed.  He said his mother, Cynthia Calleo, supported him with love and used unemployment benefits to pay for his enrollment in a private middle school.
    Calleo is deeply devoted to Catholicism now, but he said his turning point at 16 was anything but spiritual.  He developed respiratory and digestive diseases. "I woke up one time from all these amphetamines," he said. "I remember not knowing where I was. I was just dead. It wrecked me, and I just came to and said, `What the hell are you doing?' " Calleo said he decided at that moment to avoid death "more out of spite and hate than out of a new appreciation for living." He embraced the Straight Edge movement, a strident culture rooted in a strain of punk music that preaches against alcohol, drugs, tobacco and, sometimes, animal products.  At St. Thomas High School around the same time, a theology teacher inspired Calleo to think about ethical and political issues and to see a connection between Catholic teachings and the anti-establishment message of punk rock songs. At the University of St. Thomas, Calleo and roommate Mark Valdez came up with the idea for the center, known as SAFE.
    With about 30 steady volunteers and donations from a variety of private sources, they run the center at a two-story building rented from a church. Kids, mostly 11- to 14-year-olds, come there for tutoring, computer classes, dance instruction, movie nights, pizza parties and other activities. They pay 25 cents a day for the services. Calleo said he and the staff keep an eye on a nearby stretch of sidewalk where preteens take their after-school disputes. "We break up a lot of fights," he said. And through Community in Schools Houston, a dropout prevention program, Calleo meets with students at their schools in the neighborhood, counseling them about the tripwires of adolescence.
    Calleo said he and Valdez hope to earn a salary for their SAFE Center work someday. For now Calleo delivers pizzas. In the fall, he will start pursuing a master's degree in social work at the University of Houston. He wants to get a doctorate in theology eventually, then "teach at a university and write books and stuff." Along the way, he quotes theologians and authors and talks about "matrices of different subcontexts" in his life.
    His left arm is covered with tattooed scenes and characters from one of his favorite movies, The Nightmare Before Christmas. His right arm is festooned with fanciful versions of sailor tattoos: sea creatures and an anchor. Calleo said the tattoos are merely artistic statements that he acquired after leaving drugs and crime behind. Saying that they aren't connected to his work with children, he refused to have the tattoos photographed. But some of the tattoos have deeper meaning. Calleo said there are angels on his legs, reflecting his religious devotion. He said he withstood a lot of pain to the get the birds applied to his abdomen. And so, after all, they are a relevant symbol. Like his story, one of pain and grace.

A Dozen Doctors in Appalachia Arrested for Painkiller Prescriptions
Roger Alford, Associated Press- 5/11/2003

PIKEVILLE, Ky. -- More than a dozen Appalachian doctors, many of them recruited to work in the medically underserved region, have been taken away from their patients in handcuffs for allegedly supplying drug addicts with powerful narcotics. In eastern Kentucky alone, seven small-town doctors are in prison or on their way for illegally prescribing drugs like the painkiller OxyContin. At least six others have been arrested in the hills of West Virginia, Virginia, and southern Ohio.
    Advocates for the mountain region say that while the loss of so many doctors leaves a void, in these circumstances, the departures can only improve medical care. ''As badly as we need more physicians, we certainly don't need the type that will violate their oaths and do much more harm than good,'' said Ewell Balltrip, executive director of the Kentucky Appalachian Commission.
    Federal and state law enforcement agencies began cracking down on wayward physicians in Appalachia in 2000, after OxyContin, intended for cancer patients and others suffering from severe pain, began showing up in large quantities on the black market. The first eastern Kentucky physician snared in the crackdown Dr. Ali Sawaf, 61, of Harlan had turned to illegally prescribing OxyContin and other painkillers after he lost his $250,000-a-year job at a regional clinic. Assistant U.S. Attorney Roger West said at the time that Sawaf handed out prescriptions almost as quickly as he could write them. The latest physician to plead guilty, Dr. David Procter, 52, of South Shore, traded pain killers for sex. He admitted to a federal judge that he had sexual relations with two female patients after they became hooked on the drugs.
    Most of the doctors caught in the past two years had been recruited to the region to help care for rural residents, said Assistant U.S. Attorney Pat Molloy. ''They may not have stepped over the line before they got here, but clearly they were corruptible,'' Molloy said. Legitimate doctors have nothing to fear when they appropriately prescribe medications, Molloy said. The doctors who have been prosecuted, he said, were flagrant violators.
    The problem is not confined to Appalachia. A Florida doctor was convicted of manslaughter in the OxyContin overdose deaths of four patients. A Connecticut physician, nicknamed ''Dr. Feelgood'' by police for the prescriptions he wrote for OxyContin and other pain killers, was convicted last year on multiple counts. Authorities blame the abuse of OxyContin for scores of overdose deaths in the Appalachian region and beyond. If taken properly, the drug is released slowly into the body. But abusers circumvent the time-release by crushing the pills and inhaling or injecting the powder to get the same kind of euphoric high that heroin brings.
    Larry Bailey of Grayson said he believes his son would still be alive if unscrupulous doctors had not been so willing to feed his addiction. At first, Paul Bailey, 35, had a legitimate need for medication to ease severe back pain. But the last time he visited Dr. Rodolfo Santos of South Shore, he left with prescriptions for painkillers, tranquilizers and muscle relaxants. It was a combination of those pills that claimed his life.
    Santos was convicted last month of overprescribing drugs. Larry Bailey had been in the courtroom during Santos' trial. ''Being angry doesn't solve anything,'' Larry Bailey said. ''But I was thrilled to see him being put out of business.' The jury recommended that Santos, who was recruited to work in eastern Kentucky, serve 16 years in prison. He could be eligible for parole in a little more than three years. Procter, the physician who owned the clinic where Santos worked, pleaded guilty in April to one count of conspiracy and two counts of illegally prescribing controlled substances, and faces 10 to 12 years in prison.
    In an effort to get more doctors into rural Appalachia, area leaders got a medical school established in 1997. As of this month, the Pikeville College School of Osteopathic Medicine will have graduated 168 doctors.  The new doctors will immediately begin to narrow the physician-to-patient ratio, easily replacing the physicians who have been sent to prison, said Dr. John Strosnider, dean of the college. Strosnider said he has no doubt that, as a result of the crackdown, legitimate physicians are more careful about prescribing OxyContin and other potent pain killers. ''They're leery that patients may be trying to fool them,'' Strosnider said.

Drug Court Effectiveness Still up for Debate
Associated Press, 5/11/2003

PORTLAND, Maine -- It's been 20 months since Maine set up its drug court, an innovative drug treatment program designed to cut off crime at its roots. But so far, only 31 have successfully completed the treatment. Another 61 failed to live by the rules and were expelled before graduation.  Advocates for the Maine Adult Drug Treatment Court program say it's too soon to say what those numbers mean or if they mean anything at all. They say that drug court clients are all addicts with long criminal histories, and that relapses should be expected. And the program is too new, they add, to product statistically meaningful results.  But the disappointing early returns have some top officials questioning whether the program can succeed in its present form, and asking if it's living up to its promise. ''In most of these cases, people are doing the time they were going to do anyway,'' Cumberland County District Attorney Stephanie Anderson said. ''There are some red flags here.''
    Drug court gives drug offenders a simple deal: Complete a rigorous yearlong drug-treatment program, or go to prison and serve a long sentence. Clients must attend at least five meetings of a 12-Step program each week, abide by a curfew, submit to surprise urinalysis tests at least twice a week and do volunteer work or go to school if they aren't employed. Each week, all drug court defendants appear before a judge. If they fail in any way, they are instantly punished, often by a quick trip back to jail. The drug court has six sites around the state, and it now handles fewer than 200 cases. Most people who apply are not admitted, and almost twice as many are expelled as graduate.
    John Babbitt, 32, is among those who failed and succeeded. Babbitt was arrested for dealing heroin at the age of 19 and received a mostly suspended, 25-year prison sentence. He was released on probation, which he constantly violated, and was sent back to serve more and more of his sentence, eventually doing eight years in prison. Drug court at first appeared to work, and Babbitt seemed free from a heroin habit that had controlled him since he was a teenager. A year ago, he became one of the program's first graduates. But three months later, a staggering, bleary-eyed Babbitt caught the eye of a clerk at the Cumberland Farms convenience store in Windham, who called police. Babbitt tested positive for methadone and other drugs and was sent back to prison for two months. Today, Babbitt is married and trying to rebuild his life. He has stayed clear of trouble with the law, but has decided to control his drug problem with methadone maintenance instead of the abstinence he learned in drug court. ''I slipped. It happens in recovery,'' Babbitt said. ''If I didn't have drug court I probably wouldn't have recovered as well as I did.'' For Lisa Nash, a probation officer for 16 years, even Babbitt's case doesn't make her lose hope. ''Sometimes I get discouraged with the failures, but then I think, this kid still has a shot,'' Nash said. ''A year of being clean is still an accomplishment.''
    In Cumberland County, four of the first nine drug court graduates have violated their probation and ended up back in prison. In York County, three of the first eight graduates failed to stay out of trouble after completing the program, and Penobscot County reports three of its 13 drug court graduates did not stay sober. In Androscoggin, Oxford and Washington counties, drug court officials report no relapses among graduates.

Michigan Beds for Mentally Ill to Drop to Under 1,000
Sara Scott, Ann Arbor News- 5/11/2003

LANSING -- Gov. Jennifer Granholm is closing one of the few remaining state psychiatric hospitals, even as advocates argue that there are not enough long-term-care beds for the mentally ill. It's a tricky situation for a new governor who has pledged to protect Michigan's most vulnerable populations and simultaneously balance the state's bleeding budget. The state expects to earn $64.6 million by closing and selling the 250-bed Northville Psychiatric Hospital, which sits on a 453-acre campus in northwest Wayne County. The last 80-some patients are expected to be moved out by the end of May, and the facility will officially close in July. That leaves three state psychiatric hospitals for adults: Caro in the Thumb, Walter Reuther in Westland and Kalamazoo Psychiatric Hospital in Kalamazoo. Hawthorne in Northville is a psychiatric hospital for children.
    Once Northville closes, there will be 981 beds left at state hospitals. Advocates say the state needs at least several hundred more. "It puts pressure on a system that just isn't ready for it," said Mark Reinstein, executive director of the Mental Health Association of Michigan. "We understand the challenges she's faced with But this is not the answer."
    Closing Northville was actually former Gov. John Engler's idea, announcing plans just over a year ago to sell Northville. At the time, state officials said the closure wouldn't happen for three years. Advocates had hoped Granholm, who took office in January, would postpone the closure. But Granholm officials said they decided to push forward for several reasons, including budget trouble and staff shortages. Engler's budget crunchers had already factored closure savings into the budget, so given the state's $1.7 billion deficit, there was no money to keep it open. On top of that, about 700 employees at the state's psychiatric hospitals opted to take early retirement last year. "When that happens you really have to start talking about consolidating," said Patrick Barrie, the director of state mental health services.  Another key factor is that Granholm and her administrators are strong proponents of deinstitutionalization, said Janet Olszewski, director of the Community Health Department, which oversees mental health services.  "We believe that people, generally speaking, should be served in their communities instead of in state hospitals," Olszewski said.
    Michigan began closing psychiatric hospitals and mainstreaming the mentally ill into their local communities in 1972, as part of a national trend. Over the next three decades, state officials reduced the number of mentally ill in state hospitals from 17,000 to fewer than 1,000 once Northville closes. Local CMHs also contract with area hospitals for another 3,000 beds.
    But advocates for the mentally ill -- most of whom strongly support the concept of deinstitutionalization -- say the state has gone too far. Many of the mentally ill ended up in jails or prisons because they did not get adequate support or structure, Reinstein said. Two years ago, a coalition of advocacy organizations issued a report calling for at least an additional 400 long-term care beds. Closing Northville will only compound the problem, advocates say.
    "We haven't seen it yet, but any time a facility closes (it puts pressure on the community health programs)," said Dan Russell, director of the Genesee County Community Mental Health. "And a lot of times the funds don't always follow that person into the community." That has been a key issue for the mentally ill and their advocates. While they support the concept of deinstitutionalization, they've maintained that the state's motives were more about saving money than doing right by the mentally ill. Last year there were 197,894 mentally ill people receiving services through CMHs statewide. The state spends about $1.6 billion on Community Mental Health programs. In Genesee County, the CMH contracts with several community hospitals to care for patients who need inpatient care. "There are many weekends when it's difficult to find a bed," Russell said.
    Still it is a difficult situation for many advocates who would very much like to see the state close Northville, which is outdated and in many ways a disturbing reminder of the past. "The state has always said it was going to close Northville and we're all for that," said Elmer Cerano, the executive director of the Michigan Protection & Advocacy Service Inc., which advocates for the mentally ill. "But the plan was to have a better option for them."
    All states are struggling with how to develop a community-based system that provides enough structure and support, Barrie said. "We want to make sure that to the extent possible, people can live in their community, live in their homes, carry out their lives, but with the adequate supports," Olszewski said. "But we also understand that sometimes, for some people, that's not going to be possible."

Life Skills Program Meets Mental Illness Needs
Tracy Davis, Ann Arbor News- 5/11/2003

A group of adults is gathered around a conference table on a Thursday morning, workbooks in front of them. Today's assignment: Learning about their illnesses, understanding symptoms and side-effects of medication, and how to control them. The group is taking part in Life Skills, a program at the University of Michigan designed to help people with mental illnesses learn how to cope with various aspects of life.
    The topics might seem elementary: nutrition, exercise, time management, budgeting, tracking medication side-effects, socializing, basic problem-solving, expressing feelings, developing assertiveness and awareness of personal space. But many people -- even those who don't have to deal with a mental illness -- struggle with these issues. And for those with mental illnesses, devoting time and attention to those basics can be even harder. It's critical knowledge to help keep them from getting into a crisis, mental health professionals say.
    For example, a bipolar client might attend a family gathering with better skills to deal with confrontations. Those tools could ultimately help prevent him from spiraling into a stress-induced crisis, going off his medication or eventually being hospitalized. With the tools the program gives them to adjust to and deal with different situations, the students are better equipped to handle life's curve balls.
    The program's success and growth has drawn statewide attention and is beginning to attract interest from health care providers outside of Michigan. As providers struggle to meet the basic needs of the mentally ill in increasingly underfunded programs, Life Skills has gotten the attention of those who recognize its potential for preventing crises in people for whom there are fewer and fewer resources.
    Life Skills began at the University of Michigan Hospital in the late 1980s when Nancy Mann, a nurse in the psychiatry department, saw a need to teach schizophrenic patients how to deal with everyday situations after they were discharged from the hospital. "There were a lot of places doing bits and pieces of the program," said Mann. "There wasn't anything that actually covered anything in organized sequence. We were trying different approaches, and it suddenly hit us that to have clients work together in a group setting might work better. "Being in a class setting and being with their peers, they were able to exchange more ideas, to talk about what worked and what didn't work for them. As the groups progressed, you could see them come together as a class, as a unit to figure out a problem. That was really important to them."
    The program remained in-house for years. But as hospital stays got shorter, there was not enough time to teach the classes to patients before they were discharged. The program was shelved. In 1998, Mann and a fellow nurse, Bill Borem, started teaching the class on an outpatient basis. Today, they're up to 10 classes a week in group homes and drop-in classes in Ann Arbor, Detroit, Ypsilanti, Adrian and Holly. Students include people with a variety of diagnoses, such as bipolar disorder, manic depression, severe depression, schizophrenia and post-traumatic stress syndrome. And the basic skills the classes teach have had a lasting impact. Some students keep repeating the 20-class series. "They get something new out of it every time," Borem said.
    Successes by the students are obvious, Mann said. One of her favorite stories was a man who wanted to get a high school diploma. During a class on goal setting, he pulled a piece of paper from his pocket. It was information on how to take the GED test. Together, the class brainstormed ways to help him prepare for the test. "I will always remember that day he pulled out that crumpled paper," Mann said. "He was able to reach out to his support system who could help him work on some of that stuff." Greg Buchrestean of Ypsilanti Township, who goes to Thursday meetings periodically, said he enjoys not only the skills he learned, but the friends he has made. When Buchrestean, who has a bipolar disorder diagnosis, was so excited about a trip to Florida that he packed a month in advance, others understood why. "I've made a lot of good friends," said Buchrestean, a constantly smiling and outspoken member of the group.
    And for students in group homes or institutions, teaching them ways to feel they have more control over their environment is critical, program teachers say. "For so many people we see, they don't have a lot of options," Mann said. "Some don't have the option of living with family. They also may not be able to pick who they're living with. Every single person wants to feel like they have some control over their environment. If we can teach them to get that into their home situation ... it helps them feel safer in their home environment."
    Life Skills is getting calls from all over the state with requests from communities and group homes. But because the program is grant-funded to pay the salaries of Borem and Mann while they are teaching, and a couple of other staffers, traveling long distances to teach the class isn't feasible at the moment. Robert Johnson, a social worker and marketing director of the program, said the next step is a "train-the-trainer program." The group hopes to instruct health care professionals around the state and eventually, the nation, how to teach the life skills program.
    "The problem is there aren't very many programs out there to do this," said Mona Goldman, a research investigator in the U-M psychiatry department who has been evaluating the effectiveness of the program. "This one has a couple of advantages. First of all, it's very flexible. It's been used a variety of settings." And it can help classes in which students are very highly functioning, or those who are not functioning very well, she said. Also, the one-hour, once-a-week class format works well for most students. "By having that relationship (with students) for 20 weeks, we can connect with them," Borem said. "I think we're having contact with all of the clients that they're not getting elsewhere."
    Program leaders hope to expand Life Skills into other parts of the Midwest. As quickly as it is growing, they expect it could be available nationwide in five to 10 years, if they can get enough funding to train other health care workers. "You can't deinstitutionalize people and put them on the street and not fund community programs," Borem said. "It's a serious situation facing all of the communities in the country."

Studies Help Police Follow California Meth Culture
Akilah Johnson, Los Angeles Times- 5/12/2003

Many small-time methamphetamine users will be standing at their stoves Tuesday, cooking up their weekly stash of the drug. A new report by Southern California narcotics experts finds that many addicts opt to cook a personal supply of the white crystalline stimulant — a cheap and highly addictive substitute for cocaine — on Tuesdays or Wednesdays, in the middle of the night. Why those two days? Because by Monday, many addicts have used up their supply. They wait until late at night to mix up a new batch because, the later the hour, the less chance they'll get caught.
    The report was one of two studies recently conducted by the Inland Narcotics Clearing House, a branch of the Office of National Drug Policy Control that is made up of a consortium of local and federal law enforcement agencies. The findings provide a stark, often disturbing profile of methamphetamine users and suppliers in Riverside and San Bernardino counties, the region's hotspot for methamphetamine manufacturing. The studies also tracked how quickly people across Southern California are learning to manufacture the drug, and the way these "cooks" get around tough restrictions on the over-the-counter ingredients used to make meth. Riverside County sheriff's sergeant and clearinghouse spokesman Rod Crisp said the studies "help our officers on the street understand the trends and what they're up against."
    The first study, called the Hammer Report, provided an annual review of meth lab seizures during 2002. The second report was based on a survey of 200 admitted methamphetamine addicts at rehabilitation facilities throughout the two counties. A lack of information regarding the local meth problem, authorities say, prompted the survey.
    Law enforcement officials say the methamphetamine trade has two distinct and vastly different sources: the stove-top cooks, who tend to be addicts scrounging to feed their own habit; and "super labs," high-tech and well-funded clandestine manufacturers run by Mexican drug-trafficking organizations. The latter can produce millions in profits. Stove-top cooks make meth to use, not sell. And though they only produce about 20% of the nation's meth, they are the most abundant, said Will Glasby, spokesman for the Drug Enforcement Agency.
    Local authorities say the surveys have given them a better idea of who these stove-top cooks are: middle-aged, blue-collar white males living in suburban areas. Contrary to popular belief, most stove-top cooks do not learn to make meth by searching the Web or by reading a book. Nearly 60% of those surveyed said a friend or companion showed them how.
    The study estimates that between 1999 and 2001, more than 250,000 people in Riverside, San Bernardino, Los Angeles and Orange counties learned to cook methamphetamine — also known as speed or crank. One of the study's most startling revelations is how state and federal restrictions on the sale of methamphetamine's ingredients, such as over-the-counter decongestants and a variety of industrial cleaning solutions, have spawned a new breed of junkie known as the "dirt baron."
    To overcome the challenge of getting what's needed, the report says, some users have taken to combing isolated parts of the desert looking for leftovers dumped in the dirt by large-scale meth lab cooks. Once such a location is discovered, dirt barons dig up the soil, which often contains toxic byproducts produced in the meth-making process. According to the report, they then "transport it home to extract any residual meth that may be left in the dirt." Nearly 65% of those surveyed said they know someone who has or have themselves gone to such extraordinary lengths to get high. But the dirt barons, desperate for meth's long-lasting high, are still better off than some, authorities say. There are others who use their own urine, Crisp said. These "tinkle tweakers," as police call them, store their urine in bottles so they can reprocess it to extract methamphetamine.
    But stove-top lab seizures account for the majority of the nation's meth busts. Close to 95% of the country's more than 7,000 lab seizures last year were these mom-and-pop operations, Glasby said. "You have a huge number of these small labs, but they're not producing large quantities," he said, adding that most stove-top labs produce less than 10% of what a super lab turns out. "They're not doing it to get rich. They're doing it to get high."
    Unlike the stove-top cook, super labs crank out large quantities of meth and distribute it across the country. Southern California's Inland Empire has more super labs than most places, authorities say. Nearly 400 methamphetamine labs were uncovered in the region last year, according to the Hammer Report. Twenty-two were large-scale labs capable of manufacturing more than 17 tons of crystal meth a year with a street value of $160 million. This is probably just a fraction of the labs in operation. Authorities say that for every lab they find, there could be five more they don't detect. Super lab cooks, authorities say, can make 10 pounds of methamphetamine or more a night, a year's supply for a stove-top cook.
    Many sophisticated labs, says the Hammer Report, are located along freeways and railways that link Inland regions to the rest of the country. That way, it says, the finished product can be shipped out easily and quickly. Most of the methamphetamine seized around the country comes from this area, said Jose Martinez, a spokesman in the DEA's Los Angeles division. "It's got the dubious honor of supplying methamphetamine to the rest of the country," he said.

Schools Failing Disabled Kids, Advocates Say
Dean Schabner, ABC News- 5/14/2003

How does a boy, once a member of gifted programs, descend through a series of disciplinary actions and suspensions, ultimately to be barred from school entirely by the age of 14? His parents say it was because of his emerging learning disability, and rather than deal with his problems, they say his school system, like many school systems across the country, simply tossed him aside.
    The boy, identified as K.S.G. to protect his identity, is one of eight learning-disabled students who are part of a class-action lawsuit filed recently against the New York City Department of Education. It's a case that education experts and advocates for children with disabilities say is emblematic of a disturbing trend that is becoming endemic across the country as schools grapple with funding cuts, understaffing and increased pressure from the federal No Child Left Behind program to raise overall performance levels. "New York City schools and districts regularly engage in a practice of excluding disabled children from school and denying them educational services to which they are entitled," alleges the suit filed by a group called Advocates for Children in U.S. District Court in New York. A spokesman for the New York City Department of Education declined to comment on the suit.
    In K.S.G.'s case, the suit says, he began his schooling in a program for gifted students, but when his performance started to slip and he developed disciplinary problems, he was repeatedly suspended and transferred from school to school. In just the past year, he missed more than 50 days of classes. Instead of having him evaluated to try to find the reason for his problems — as required by the federal Individuals with Disabilities Education Act, or IDEA, as it's called — his family says school officials have tried to ban him from school altogether. His family says that if his school had him evaluated, they would have recognized that he suffers from severe brain trauma and attention deficit/hyperactivity disorder, as he has since been diagnosed by the New York University Child Study Center, and could have provided him with the program required by federal law. Instead, at 14 years old he is barred from school, awaiting a hearing to try to get him back in.
    "Disabled children miss weeks, months or years of school or they are moved without due process to 'alternative' schools or suspension centers where they are warehoused without legally adequate instruction," the Advocates for Children complaint says. "These practices violate the principles underlying the federal laws that were created to protect disabled children."

To Jail or the Streets
Advocates and researchers say the failure to provide educations for children with disabilities does more than harm a few kids. They say it exacts a high toll on society at large, even if removing some troubled students from class helps other children remain undistracted and focused. There are more than 6.5 million students with disabilities in the nation's schools, and about half of them have learning disabilities, according to Jim Bradshaw of the U.S. Department of Education. He said that over the last decade the number has been rising, but that the increase has been in line with the increase in overall student population.
    Researchers and advocates point to studies, including two finished recently, that find higher percentages of children with learning disabilities in the juvenile justice system than in the general population. They say that if schools were doing what federal law requires in terms of providing individual attention, they would not fall behind their peers and develop the frustration and anger that can lead kids to act up and create problems.
    Once kids with learning disabilities find themselves in the juvenile justice system, there is little chance for them to get their education back on track and get started out in life on the right foot, researchers and advocates say. "The schools end up getting rid of kids, discarding them," said Dan Mears, a senior research associate at the Washington, D.C.-based Urban Institute and co-author of the study "Addressing the Needs of Youth with Disabilities in the Juvenile Justice System: The Status of Evidence-Based Research." "Then there are two places they can go: into the justice system or out on the streets," he said.

‘They Basically Unravel’
According to Mears' study, children and youth with disabilities have become increasingly overrepresented in the juvenile justice system as a direct result of discipline problems caused by their disability. The National Center on Education, Disability and Juvenile Justice has found the same thing, as have the Civil Rights Project at Harvard University, Children and Adults with Attention Deficit/Hyperactivity Disorder, and Advocates for Children. "Once they can't read and can't do math at the level of their classmates, when they do math and read at a second-grade level and they're 15 or 16, they basically unravel," said Elisa Hyman, director of Advocates for Children.
    An educator who runs the largest special education program in Vermont said there are other factors that contribute to children acting up, but that frustration with a lack of academic progress play a role. "I think it's reasonable to imagine that if an adolescent has fallen behind, they'd get to a point where they might not buy into the whole education thing as a positive thing for them," said Richard Smith, director of special education at the Orleans Essex North Supervisory Union.

A Dead End?
Ira Hughes, a 20-year-old New York City man, is another case of what can go wrong, but also of how it can be made right. He said he wanted to stay in school, but when he realized he was going to be in 10th grade for a third time, it stopped making sense, and he dropped out two years ago. Hughes has severe dyslexia that the school he was attending seemed unable to deal with, he said. He had not had a teacher working with him one-on-one since junior high school, which was when his disability was finally diagnosed, and felt he had not made academic progress since then. "It was like a dead-end thing," he said. "I felt like if it was three years, it could be four years or five years. It wouldn't matter." So he dropped out, rather than beat his head against a wall that wasn't moving. Hughes, who works as a security guard, is currently attending a GED program where he works one-on-one with a teacher who is helping him overcome his dyslexia, and he is on course to get his diploma. The classes are being paid for by the New York City Department of Education, he said, "Kind of like, 'We owe you.' "
    Hughes, some children's advocates would say, is lucky. Not just because now he is getting the help — at taxpayer expense — that he didn't get in school. But also because his frustration at not getting the kind of attention he felt he needed to help him learn did not lead to disciplinary problems that could have landed him in the courts, with little or no chance at an education.

A Complex Problem
While researchers believe they understand the price society pays for not educating the learning-disabled, the causes of the problem are too complex for pointing fingers in any one direction, Mears and other researchers say. Special-education students are supposed to spend most of their time in a mainstream classroom, with short one-on-one sessions with a specially trained teacher to deal with the student's particular problem, educators who ABCNEWS spoke to said.
IDEA, enacted nearly three decades ago, requires that once students are diagnosed with a learning disability, their school has to develop an individual education plan that can be re-evaluated every year. Such programs are extremely expensive, though, and as school districts are forced by funding cuts to reduce staff, regular classroom teachers can find themselves forced to deal more and more with students they are not trained to handle, said Dick Riley, spokesman for the United Federation of Teachers. That can take time away from other kids. In some cases, inadequate funding means that schools do not have sufficient facilities or personnel to implement the programs required by federal law, Mears said.

‘Wait and Fail’
Sometimes the programs work perfectly, but another difficulty for teachers and schools is simply recognizing when a child has a problem, which is why Smith said his district has implemented a program to identify children who need special education programs at an early age, trying to avoid the "wait and fail model," when schools wait until children are already performing at a drastically lower level than where their ability would indicate they should be.
    "The reality is that by high school they may already be at a crisis point where they're going to be really hard to change," he said. "We think it's better to start when they're young, when we can make a positive change before they get to that crisis point. Research shows that even by the end of first grade their performance already has an impact on their opinion of themselves." However, many teachers are not properly trained to recognize the warning signs of learning disabilities, so a child may already have fallen far behind others in the same age group, Mears said.
    There is also federal pressure. The mandatory testing used to measure a school's progress under No Child Left Behind can create pressure on administrators to get rid of children who are disciplinary problems, no matter why the child is acting up, and zero-tolerance policies give teachers and administrators no room for leniency if there are extenuating circumstances, said Peter Leone, a University of Maryland professor in the Department of Special Education and the director of the National Center on Education, Disability and Juvenile Justice. "If you run a school and you are told you're going to be judged on how kids do on these standardized tests, you're going to want your school to do as well as possible," Leone said. "There's no incentive in too many cases to keep the learning-disabled kids in schools."

Let Teachers Teach
Of particular concern to groups like the Maryland-based Children and Adults with Attention Deficit/Hyperactivity Disorder, or CHADD, are proposed federal laws that they fear would inhibit teachers who suspect that a child might have a learning disability from suggesting to parents that they have the youngster evaluated. One is the Child Medication Safety Act of 2003, which would bar school officials from requiring learning-disabled children to get medication as a condition for being allowed in school. "As a condition of receiving funds under any program or activity administered by the Secretary of Education, each State shall develop and implement policies and procedures prohibiting school personnel from requiring a child to obtain a prescription for a controlled substance in schedule II under section 202(c) of the Controlled Substances Act as a condition of attending school or receiving services," the House bill, HR 1170, says in part.
    They fear that the potential for schools to lose federal funding will lead instructors to avoid the issue of learning disabilities altogether. "It's really absurd, because if a teacher is not the person who can raise those concerns, if a teacher is not the person with the mandate to raise concerns about a student's learning, who is? They're the experts, aren't they?" said one teacher with 15 years experience in special education who asked not to be identified. "That said, I'm horrified when I hear teachers say 'That kid needs to be medicated,' though I've seen so many kids with attention deficit who do so much better when they get the medication they need," the teacher said. "I've seen so many kids who want to be good students and are bright kids but can't screw themselves down to the chair without medication."
    Another concern is a proposed revision of IDEA, called the Improving Education Results for Children with Disabilities Act of 2003. The measure would revise the requirement that a student who has been diagnosed with a learning disability be re-evaluated every year to requiring new evaluations only every three years, among other provisions such as making it easier to remove learning-disabled students in some circumstances.
    Proponents of the measures say they would give parents greater control, and allow teachers to focus better on the classroom. According to a statement released by Rep. John Boehner, R-Ohio, the chairman of the House Committee on Education and the Workforce, regarding the IDEA revision, HR1350, is that the changes will lead to "reducing the number of students who are misidentified or overrepresented in special education" and allow teachers "to teach, not fill out paperwork."

A Success Story
Advocates fear that if it becomes harder under law to deal with children in special education, more will fall through the cracks. Evelyn Green, an administrator with the Chicago public schools' Office of Early Childhood Development and the president of CHADD, said she has seen such "discarded" children among the gangs on the streets of Chicago. "What's really clear is that some of these kids, particularly the leaders, are really bright, but a lot of them are angry and frustrated," Green said. "It's evident having a conversation with them that they are very bright, but maybe they can't read because they're dyslexic. The frustration with their learning disability leads to them acting out, taking it out on society."
    She said her own son could have gone that way, because of his attention deficit disorder. "I think about the number of times that he got in trouble directly as a result of his AD/HD," she said. "If he hadn't had the protections in place, I hate to think where he might be. He's graduating with honors with a college scholarship. I know that wouldn't have happened without a positive behavior plan."

Kids at Risk
Mears' study, based on examination of data from numerous sources, including individual districts as well as from city- and statewide studies, found that children who have been diagnosed with learning disabilities make up roughly 20 percent of the population in the juvenile justice system, while they are just 10 percent of the overall population.
    The National Center on Education, Disability and Juvenile Justice solicited information from departments of education, juvenile courts and detention centers and, from the responses, estimated that at least 34 percent of the children in the juvenile justice system had been enrolled in special education at some point in their school. "Actually, we think that's low," said Leone, the NCEDJJ director. "A handful of states said that more than half the kids in long-term juvenile detention had been enrolled in special education. We don't think that's an aberration."
    The disparity in the numbers may be due in part to inaccuracies in record keeping, or failure of the youngster's family or school to report on the child's education history. "I think it's a problem that we're becoming more and more aware of," Leone said. "I think there's a growing awareness in a larger community."

Drug Study Promising for Heavy Drinkers
Shankar Vedantam, Washington Post- 5/15/2003

A drug with a novel mechanism of action reduced the craving for alcohol among heavy drinkers and may help alcoholics quit or seriously reduce their drinking, researchers reported yesterday. The medicine, topiramate, which is marketed to control seizures, was found to be effective in a trial with 150 volunteers conducted at the University of Texas at San Antonio, said lead investigator Bankole Johnson, a psychiatrist. "We think it's very significant," he said in an interview. In a comparison of those taking the drug with those receiving placebo pills and behavioral counseling, the drug "is four times better in terms of heavy drinking and eight times better in terms of complete abstinence."
    The Food and Drug Administration has not approved the medicine, which appears to affect the brain's ability to experience the pleasure of drinking and to reduce the craving for alcohol, for treating alcoholism. The study would have to be replicated in larger groups before doctors could recommend it. Still, federal researchers and others agreed that it could open a new front in the treatment of alcohol abuse, which afflicts about 14 million Americans -- one in every 13 adults. Alcohol abusers are defined as men who have five or more drinks per day and women who have four or more drinks each day.
    Unlike traditional alcohol abuse studies, which usually examine the effectiveness of medicines and psychological interventions in keeping alcoholics from drinking at all, Johnson's study involved volunteers who were active heavy drinkers. The results were published in the Lancet medical journal. "The results were very promising," said Raye Litten, chief of the Treatment Research Branch at the National Institute on Alcohol Abuse and Alcoholism. Large studies are underway to measure the effects of combining other medications with a range of psychosocial therapies. Topiramate may be especially effective in easing the symptoms of withdrawal, said Robert Swift, an alcohol abuse researcher at Brown University.
    Doctors believe that most alcoholics require treatment with multiple approaches, including other medicines and psychological or religious techniques, to quit drinking and stay sober. Since many alcoholics go back to the bottle, doctors have come to mark victory against alcohol abuse in modest terms -- keeping people sober for periods of time rather than expecting them to quit permanently. "Alcoholism is not a homogenous disease, so there is no magic bullet out there to treat" it, Litten said. "There is a biological component and a psychological component and a cultural component and a social component, and they vary from individual to individual."
    Two medicines are approved to treat alcohol abuse -- disulfiram, sold under the trade name Antabuse, makes drinkers feel sick if they drink, while the better known naltrexone, sold as ReVia or Depade, appears to reduce the pleasure in drinking, Swift said.
    Johnson pointed out that all the patients taking topiramate in his study -- even those still drinking -- were no longer consuming dangerous amounts of alcohol. "We are able to get practically everybody drinking close to nothing, and the ones who are still drinking are not drinking as much," he said. The study measured the effectiveness of topiramate -- which is sold under the brand name Topamax -- among 150 heavy drinkers. Half received the medicine and low-intensity counseling, while the other half received placebo pills and the same counseling. The average person in the topiramate group was drinking 9.59 drinks a day upon beginning the study, compared with 8.85 drinks a day in the placebo group. Participants were asked to keep track of how much they drank, and even before they began taking medication their consumption dropped dramatically -- an indication of the role social factors play in alcohol abuse. By the end of the three-month trial, patients taking topiramate were down to 1.5 drinks a day, while those taking the placebo were down to 3.36 drinks a day. Johnson said 13 or 14 patients in the topiramate group quit entirely and stayed sober, while only two from the placebo group stopped drinking altogether.
    Topiramate is sold in the United States by Ortho-McNeil Pharmaceutical of Raritan, N.J., which provided the pills and some funding. Most of the funding came from Johnson's own department. The researcher said he owns no stock in the company and would not financially benefit if the FDA approved the medicine for treating alcohol abuse. Stephanie Scott, a spokeswoman for the company, said, "Right now, all we can say is the results are promising and would warrant some future investigation. We are not actively pursuing an indication for alcoholism for this compound."
   Johnson's study did not report any severe side effects, but a recent study of topiramate in epileptics, conducted by Kimford J. Meador, chairman of the Neurology Department at Georgetown University Medical Center, found that some experienced severe side effects unless they started at low doses and built up gradually.

A Smoother Life for People Who Stutter
Martin Miller, Los Angeles Times- 5/15/2003

Ordering dinner may not sound like much of a triumph, but it is when you stutter like Kevin Murphy. For most of his life, the 19-year-old college student had avoided public speaking and talking to strangers. The embarrassment caused by the few excruciating seconds of stammering over a syllable, word or phrase was simply too much to bear. Because of it, Murphy's parents always had ordered his meals when eating out. But on this particular night a couple of years ago at a hometown restaurant, Murphy, still in high school at the time, surprised his father by ordering dinners for the two of them. He marks this moment, shortly after an intensive month-long speech program, as a beginning. "I told my dad I wanted to make up for all those times he had ordered for me," said Murphy, now a business student at Idaho State University.
    Stuttering is a communication disorder, with speech disruptions that typically strike at the beginning of a word or sentence. The condition can range from mild (a syllable or word is occasionally repeated) to severe (a five-word sentence can take a minute or longer). About 1% of the population suffers from the condition in some form, with adult male stutterers outnumbering their female counterparts by a ratio of 4 to 1, according to the National Stuttering Association.
    The disorder is as old as spoken language, researchers say. Depicted in Egyptian hieroglyphics and written about by Hippocrates, its long history has fueled many misconceptions, some of which still exist. Among the most damaging is that stuttering's roots are psychological and can be blamed upon stupidity, nervousness or a mental illness. Instead, researchers believe stuttering has multiple causes, probably involving brain chemistry, genetics and environmental factors. Anxiety and tension can compound the problem, quickly creating a vicious cycle that destroys the ability to speak. Non-stutterers can unwittingly contribute to the dynamic by either finishing sentences or offering up unsolicited advice like: "Relax" or "Slow down." "There's no cure," said J. Scott Yaruss, a National Stuttering Association board member and co-director of the Stuttering Center of Western Pennsylvania. "But every person who stutters can learn to speak more effectively, more smoothly and with less effort. There really should be nothing a stutterer can't do."
    Murphy was about 3 years old when his parents noticed his talking troubles or, as researchers call them, speech "dysfluencies." But as is frequently the case, pediatricians weren't overly concerned. After all, an estimated 5% of children experience some developmental stuttering between the ages of 2 and 6. In more than three-quarters of these cases, the children outgrow it. "It's totally normal for a child to go through a period where they stutter," said Yaruss, an associate professor of communication science and disorders at the University of Pittsburgh. But, he added, if parents are worried or, more important, the child seems to be, an appointment with a speech therapist is recommended. If a child enters a speech therapy program before the age of 7, the condition can often be eliminated, Yaruss said. "Families are often told to wait and see if their child's stutter goes away," he said. "But this is too big a risk for the child, because if we wait too long, the opportunity for a complete full recovery can be lost."
    Murphy, however, saw about a dozen doctors and speech therapists over more than a decade. Often the therapies included avoiding certain words or sounds that might trigger stuttering or altering the speed of their speech. Like many stutterers, Murphy found these strategies usually worked only temporarily. And, despite all his treatments, he was still considered a severe stutterer, leading him to shy away from speaking in class and to avoid friendships with non-stutterers. "When you're going to school — whether it's elementary or high school — you never want to be the different one in the crowd," said Murphy. "I never really had a problem with teasing, but it was still pretty tough at times."
    Drug therapies were and still are available, but Murphy opted against them. The drugs have been shown to improve the condition in only about half the cases. Also, the powerful medications, similar to the ones used to treat schizophrenia and depression, can have serious side effects.
    Three years ago, Murphy joined the National Stuttering Association, and a couple of speech pathologists in the group suggested he try a new intensive speech therapy program at Eastern Washington University in Cheney. Unlike many traditional programs that emphasize conquering the condition or modifying speech to become more socially acceptable, this one urged stutterers to embrace and accept their condition. The month-long program, called the Successful Stuttering Management Program, costs about $1,500. In individual and classroom sessions, students are instructed to deal with their difficulty without shame and to stop avoiding words that can exacerbate stuttering. (Some people, for instance, might stumble over "V" sounds and thus avoid using words that begin with "V.") The goal is to help stutterers communicate more effectively, not to stamp out stuttering. "It's really one of the few programs in the country that takes such a broad-case approach," said Yaruss. "The key is it doesn't focus on just creating fluency, but overcoming fears and feeling better about the fact you stutter. It's hard work, much harder than learning a small trick."
    Murphy found the program's off-campus instruction to be most helpful for his everyday life. In these scenarios, students are pushed into what they consider to be the most challenging speaking situations: conducting on-the-street surveys and phone calls to strangers. "At first listeners didn't know what was going on, whether I was doing a survey or making a phone call," said Murphy. "But as soon as the people realized that it just takes me a bit longer for me to get my message across, things would improve." "I would usually say, 'I stutter so it takes me a little longer," added Murphy. "That helped out because I would be more at ease, and then I'd know the listener was more at ease too."
    After the program, Murphy stopped turning away from potentially stressful speaking situations such as asking for directions from strangers. He recently addressed a group of 500 people at last year's NSA convention in Anaheim. The confidence he has gained has also made it easier to forge friendships with non-stutterers. The efforts had their ups and downs, but through practice, his speech has steadily improved. "I wasn't the same stutterer I was when I came out of the program," he said. "I was significantly better, but again it's not something you can fix in a month. You need to work on it every day -- and I do."

Grief Over Spouse's Death Can Give Way to a New Sense of Fulfillment
Benedict Carey, Los Angeles Times- 5/15/2003

Some people follow their spouses right through to the next world, dying mere hours or days after their beloved. It is sometimes suggested that the cause of death was a broken heart. But while many people view widowhood as the start of a prolonged period of grieving and suffering, socials scientists are finding that, more often than not, just the opposite is true. Men and women who lose a spouse not only survive the loss but usually resume satisfying lives, researchers find. "You do feel like you're dying yourself, at first," said Helen Kane, 83, of Downey, who lost her husband, Austin, four years ago to cancer. "It kind of comes as a surprise when you don't."
    In studies during the last few years, researchers have found that many widows and widowers show no signs of mental anguish or need for counseling. Some recently widowed men and women actually report being more satisfied with their lives than peers whose spouses are alive. And now social scientists are beginning to understand exactly how so many of them discover a renewed sense of self-assurance, after losing their spouses. "We focused for so long on the negatives of widowhood that we weren't able to acknowledge that there might be something good to say about it," said Deborah Carr, a sociologist at Rutgers University in New Brunswick, N.J., who presented the new research on life satisfaction at a recent aging conference. "It is amazing to me that in some cases married women reported lower satisfaction with their lives than those who'd lost a spouse just six months before," Carr said.
    The new findings on widowhood spring from an analysis of in-depth interviews with 1,532 Detroit-area seniors conducted in the 1980s and 1990s, as part of a University of Michigan project called Changing Lives of Older Couples, or CLOC. During the investigation, 319 of the participants were widowed. For the first time, researchers had enough information to compare people's lives before and after a spouse's death, rather than relying on memories. Analyzing the interviews and surveys, they find that personality traits and marital relations can help predict one's experience of widowhood, and provide clues to how people manage its aftermath of loss and uncertainty.
    For even when it's long expected, after all, the death of a spouse is an emotional earthquake that psychologists rate as one of life's most distressing events. Kane said she was "in real, physical, aching pain for about a year" after her husband died. When Jim Shoop's wife died seven years ago, his days became "all blackness." As you grow older, said the 80-year-old Downey resident, "you find that your spouse is much closer to you than ever before, when both of you were working and raising kids. You're always together with this person, and then one day they're gone."
    About a quarter of the Michigan widows and widowers reported serious depression after their spouses died. But George Bonanno, a psychologist at Columbia University in New York who studies grief and recovery, recently compared the interview responses more closely and found that nearly half of these people were depressed before their spouses died. "Losing a spouse undoubtedly exacerbates the depression in many cases," Bonanno said, "but it didn't cause it in these people."
    Among those who did experience depression just after being widowed, Bonanno found high levels of a specific personality trait: an anxious neediness. In surveys taken before their spouses died, these husbands and wives tended to agree with statements such as, "I imagine the worst if a loved one doesn't arrive on time," and "People sometimes don't realize how easily they can hurt me." While such people are in the minority, they tend to be highly sensitive to being betrayed and have a preoccupation or fear of being abandoned, Bonanno said, adding that these people often require counseling.
    By far the most common experience of grieving is what psychologists call the resilient pattern, an acceptance of death that gives way to recovery of energy and interest in beginning a new life. Sometimes this process can drag on for a year or more, complicated by squabbles over an estate, or lack thereof. But most often it happens within the first year after the death.
    After her husband of 34 years, Judah, died of a viral infection last September, Alice Graubart, 57, a Chicago social worker, had nightmares almost every night. "I was reliving the circumstances of his death a lot — the hospital scenes, the way he looked. It was awful," she said. After three months, however, the anguish finally broke, the nightmares faded and a sense of normality returned. "It's a new normal," she said. "He's not here, but I feel like myself again."
    One reason older adults recover more quickly is they've had more life experience, psychiatrists say. By age 60, most have had at least one parent, friend or family member die; they've had scares about high blood pressure, high cholesterol, polyps or cysts and lived through the midlife reckoning with their own mortality. "After a certain age, widowhood is not unexpected, it's almost a developmental milestone of late life, neither surprising nor abnormal," said Dr. Gary Kennedy, past president of the American Association for Geriatric Psychiatry. "This is not to say that it can't be devastating. But provided the person had a good marriage, there's a lot to be built upon."
    Yet it's doing for oneself that helps people climb out of their misery, according to Carr, the Rutgers sociologist. In a new study of dependence and widowhood based on the Michigan data, Carr found that men who relied on their wives for tasks such as cooking, laundry and housework tend to report high levels of satisfaction when widowed. Some widowers find another woman to help look after them; but others find surprising pleasure in the small chores of daily living once done by their spouses. After coming to terms with the death of his wife, Claire, 14 years ago, Wilbur Yonan, 78, of Long Beach, discovered grocery shopping. "It's something I like to do now. I get a charge out of it, though I'm not sure most widowed men feel that way," said Yonan, who's now remarried.
    Women who relied on their husbands for emotional support likewise reported high levels of life satisfaction in widowhood, the research suggests. Many of these women were in stifling relationships to start with, explains Carr, and probably were lacking in self-confidence while married. After losing a spouse, they find strength in simply living and providing for themselves, something they'd thought unimaginable before.
    But there's more to the adjustment than simply escaping the manipulations of a demanding spouse. In almost any long marriage, Carr argues, there are parts of our personality that are put on hold or fall into the background of the relationship. "At some level in a long marriage, people forget about an aspect of themselves, something that wasn't fostered by their partner," she said. "In a sense you can lose some private part of yourself in a marriage that can now be rediscovered when you're alone. Sometimes you need a shock to make you see those things, and make a real change in your life."
    Helen Kane rarely had to visit the post office, bank or cleaners because her husband took care of those chores during their marriage. "I would think nothing of saying, 'Oh, stop and get stamps', or, 'Go ahead and drop this off at the bank,' and that was that," she said. "I really never made those trips myself." Since he died, she has little choice.
    A hospice volunteer who also counsels other widows, Kane said one of the first tests of a newly widowed person's emotional resilience comes in April — tax month. "For people who never had to worry about the finances, it's a very big deal to get that done, because you can't concentrate very well after this person has left you, and it's very hard to close out a year when you've got a death in it."
    Over time, the oddest thing for many widows and widowers may be that the initial shock and grief soften, the waves of sadness no longer crash on every anniversary, and what was once such a painful and persistent event drops gradually into the past. It's as if the emotional chemistry has altered, which, psychologists now say, is normal. For many years, said Columbia University's Bonanno, the common belief among mental health experts was that people who didn't continually grieve after the death of a spouse were unfeeling or in denial about unresolved issues. "But now we can say that this is the how human-beings handle the loss of the most important person in their lives," he said. "They grieve and move on."

Parent of 12-Year-Old Suicide Lobby for Insurance Law
Michael Hill, Associated Press- 5/17/2003

ROTTERDAM, N.Y. -- Timothy O'Clair's short, troubled life was marked by depression, sudden rages and finally, the 12-year-old hanging himself in his closet. Tom and Donna O'Clair tried to treat their youngest son's mental illness as best they could. But they repeatedly bumped up against limits in their insurance coverage. Psychiatric visits were parceled out. Timothy's institutional stays could be frustratingly brief. Getting enough help for Timothy could be a struggle.
    In a sense, the O'Clairs are still fighting for Timothy two years after his death. Tom and Donna are lobbyists for expanded mental health coverage. Between parenting and their day jobs Tom is a mechanic, Donna a nurse's aide they shoehorn in talks to lawmakers, TV cameras and public audiences. Churning up painful memories of their lost boy is worth it, they decided, if they can help secure passage in New York of ''Timothy's Law.'' ''This is all therapy for us,'' Tom explained. ''I mean, we're dealing with Timothy's loss daily anyway. To deal with his loss and to feel his loss and not do anything about it is beyond me.''
    Timothy was born in 1988 and raised in brick home with a big grassy yard near Schenectady in upstate New York. The third of three boys, his parents describe a boy who fished, chipped golf balls and skinned his knees. Pictures in Timothy's memory album show a rail-thin boy with dark hair getting on the school bus, smiling on the beach, mugging for the camera and then, jarringly, lying in his coffin with a crown of daisies.
    Timothy's slide from typical to troubled started becoming apparent in third grade. He would become easily frustrated and quick to anger. The episodes were like dark clouds in a sunny sky. A look or a laugh could set him off. He kicked his mother's shins black and blue, threw rags in the furnace and threatened to kill himself. Once, he scrambled up a tree with a rope around his neck. Why are you so mad, his parents would ask him.  I don't know, he would say. ''He has these feelings and sometimes he can't describe them,'' Tom said. ''He can't tell us where they come from. He just has them.''
    The O'Clairs sought psychiatric help early on. Therapy. Medication. Institutional stays. Timothy was eventually diagnosed with attention deficit hyperactivity disorder, depression and oppositional defiance disorder. The O'Clairs say Timothy received good care; the problem was getting enough of it. The family's insurance plan through Tom's employer, the Thruway Authority, limited mental health coverage to 20 days outpatient care and 30 days inpatient, common in New York state. Tom said they had to spread out Timothy's treatment so he wouldn't use up his 20 visits in three months ''and then Boom! nothing for the rest of the year.'' Copays for repeat care ratcheted up from $10 to $35. Coupled with the cost of uncovered care, the family's money was getting sucked up. As Timothy's condition worsened, the family could not afford the care they thought he needed.
    The answer was a bitter pill they avoided as long as possible. They arranged for full insurance coverage, but it meant placing Timothy in foster care so he would be eligible for Medicaid. ''That was the hardest thing I had to do,'' Donna said. ''I fought with that idea.'' Foster care could be a bumpy ride but a break came in the summer of 2000. Timothy improved markedly over seven months at the Northeast Parent Child Society.
    Timothy came home Jan. 30, 2001. He killed himself six weeks later. The final decline was so rapid it caught the O'Clairs by surprise. Tom was working his second job that night. Donna was grocery shopping with their middle son. Timothy was home with his oldest brother. Timothy smashed his little league trophies in one final rage, tied a bathrobe sash around his neck and hanged himself in his closet. It was his ''safe place,'' Tom said.
    The O'Clairs transitioned from private grief to public lobbying about 18 months later. Tom did volunteer work at Samaritans Suicide Prevention Center, which led to a proposition from mental health advocates: Would the O'Clairs lend Timothy's name to a bill before the state Legislature? The bill would mandate mental health services be covered at the same level as physical ailments such as cancer or diabetes.
    The benefit to mental health advocates is clear. J. David Seay of the state chapter of the National Alliance for the Mentally Ill notes that lending a child's name to a bill personalizes policy issues in a way reasoned speeches cannot. Bill naming became popular after Megan's Law in the '90s and continues today. The national Amber Alert for abducted children signed into law this year, for instance, was named for a slain Texas girl.
    The O'Clairs get something out of it too. Lobbying for Timothy's Law is a way to face their pain head on. They believe Timothy could have been helped by the law, and now others could be helped in his memory.  As they spend spare hours spreading Timothy's story, Donna pins a button with a picture of Timothy to her blouse. Tom has his son's smiling face tattooed on his burly upper arm. ''Everyone has his 15 minutes of fame,'' Tom said, ''and Timothy is not going to miss out on his.''
    Tom does most of the talking during interviews, reciting talking points from memory. Equitable insurance would cost premium holders only $1.26 extra a month, he says, and 81 percent of New Yorkers polled favor it. Legislative support is harder to gauge. The Democratic-led Assembly approved a similar bill last year, but a bill has yet to be introduced in the Republican-run state Senate. The insurance industry has opposed the expanded coverage. Leslie Moran of the New York Health Plan Association said the group fears Timothy's Law would add close to $210 million annually in new costs to the system, potentially increasing the number of uninsured.
    Mental health advocates believe the O'Clair's story and their energy is bringing the bill closer to passage. In a two-day tour of upstate cities this month, the pair crunched in visits to Binghamton, Syracuse and Rochester in a single day the day Timothy would have turned 15. ''It's like we're still giving him a gift on his birthday,'' Tom said.
    On the Net: http://www.timothyslaw.org