Illegal Methadone Distribution Is Increasing Worry
Associated Press, 10/3/2004

HARTFORD, Vt. -- The recent case of a New Hampshire man charged with illegally providing methadone to three people, one of whom later died of an overdose, points to a worrisome trend: the increasing use of methadone as a street drug. Richard Soucy, 42, faces three counts of dispensing a narcotic, and is being held on $50,000 bail at a jail in Springfield, Vt. According to a Hartford police affidavit, witnesses say he gave methadone pills and "diskettes" on Dec. 2, 2001, to the three people with whom he was sharing a White River Junction motel room. Joyce Letendre of Manchester, Soucy's on-again-off-again girlfriend, was found dead in one of the room's beds the next morning. An autopsy found that Letendre, 37, had died of "acute methadone intoxication." Soucy, formerly of Enfield but more recently of West Stewartstown, N.H., told police that he had his own methadone supply, for which he had a prescription, but that he hadn't shared the drug. The other two people in the room said he had given methadone to all of them, according to the affidavit. Soucy has pleaded not guilty; a status conference in the case is scheduled for Dec. 7.
      Methadone is widely used to treat addiction to opiates such as heroin because it can block the addicted brain's cravings without providing wild highs and withdrawal lows. Daily doses taken over months or years can help an addict return to normalcy in family and work. It is also used for treatment of chronic pain and, increasingly in recent years, as a street drug.
      According to the 2003 report of a study group impaneled by the Center for Substance Abuse Treatment, a division of the U.S. Department of Health and Human Services, the number of "methadone-associated" deaths from 1970 to 2002 was 1,114, but a disproportionate number were in the last few years of that period. There were more such deaths in 2001 than in the years 1990-1999 combined. And total rose sharply again in 2002, to about 200.
      The study group found that increasing abuse of methadone may be tied to more frequent use of take-home, oral prescriptions of a drug that formerly was given in liquid form to recovering heroin addicts at clinics, who were required to drink it there.



Drugs, Alcohol Mixed in With Youth Crime
Siobhan McDonough, Associated Press- 10/6/2004

WASHINGTON -- Nearly four in five young people arrested for juvenile crimes are involved with alcohol or drugs, and few are getting treatment, a study of the juvenile justice system finds. The five-year study by the National Center on Addiction and Substance Abuse at Columbia University said of the 1.9 million arrests of young offenders with substance abuse and addiction problems, only about 68,600 got some form of substance abuse treatment.
      The study of mostly 10- to 17-year-olds found that mental health services are scarce and most education programs for young people in the system fail to meet state standards. "Instead of helping, we are writing off these young Americans," said Joseph A. Califano Jr., chairman of the addiction center. "We are releasing them without attending to their needs for substance abuse treatment and other services, punishing them without providing help to get back on track."
      The study being released Thursday found:
--At least 30 percent of adults in prison for felony crimes were incarcerated as juveniles.
--Ninety-two percent of arrested juveniles who tested positive for drugs, tested positive for marijuana; 14.4 percent for cocaine.
--50 percent to 80 percent of incarcerated juveniles suffer from learning disabilities.
--50 to 75 percent of all incarcerated juveniles have a mental health disorder.
      The study urged a greater emphasis on assessing juveniles' needs and offering substance abuse treatment and other services. Mark Soler, head of the Youth Law Center, an advocacy group in Washington, said the response to children who break the law -- locking them up in a detention facility, the equivalent of a juvenile jail -- is not helping them. "Most of these young people can be safely placed in responsible community programs where they can get treatment," he said. "But when they're locked up behind bars they rarely get that kind of treatment."
      The study of 2000 data examined 2.4 million arrests of minors who ended up in the juvenile justice system; some 1.9 million had been involved with drugs or alcohol. That is defined as using those substances when committing the offense; testing positive for drugs; getting arrested for an alcohol or drug offense; or acknowledging substance abuse and addiction problems.
      On the Net: National Center on Addiction and Substance Abuse at Columbia University: http://www.casacolumbia.org



Household Medicine Abused by Young
Rebecca Dana, Washington Post- 10/8/2004

At CVS pharmacies, you now have to be at least 18 to buy Coricidin Cough & Cold medicine. At Walgreens, there's a three-pack limit on an extra-strength variety of those pills. And at some independently owned drugstores, syrup bottles and blister packs of cough suppressants have vanished from shelves and reappeared behind the counter, near the cigarettes or the prescription drugs. The nation's pharmacy giants are taking precautions in response to a trend that doctors and anti-drug abuse activists say could grow into an epidemic: teenagers and young adults using medicine to get high.
      There are other, darker signs: One morning in May, on a lark, five ninth-graders in Loudoun County swallowed a "cocktail" of Coricidin and the motion-sickness drug Dramamine. Nauseated and loopy, they were rushed to Loudoun Hospital Center, where an emergency room physician explained that the drugs -- considered safe when used as intended -- can be fatal in very large doses.
      From acid to ecstasy, patterns of substance abuse have evolved with the times, and in recent years, illicit use of prescription and over-the-counter drugs has soared among a certain demographic -- mostly suburban, mostly young and mostly middle class, according to researchers. They get the drugs through the Internet, at school and from their parents' medicine cabinets. "We feel this is going to be the next big wave of substance abuse in the country," said Steve Dnistrian, executive vice president of the Partnership for a Drug-Free America. "It's limited to no one prescription drug or over-the-counter drug. It's a new and emerging category we've been watching over the last two years, and we've seen it's going to be a significant problem in the years to come if the data continue to head where they're heading."
      The data, to some, are startling. Prescription drugs are now second only to marijuana as a category of illicit substance abused by teenagers, according to the 2003 National Survey on Drug Use and Health. The number of teenagers calling into poison control centers nationwide about cough medicine abuse has doubled in four years. In a survey of more than 7,000 teenagers by the Partnership for a Drug-Free America, one in five reported taking a prescription painkiller without a doctor's prescription. "Prescription drug use is all over the place," said Chrissy Trotta, a student at George Washington University and the founder of a campus group aimed, in part, at preventing that type of behavior. "Often painkillers, things like Vicodin, are mixed with other drugs. . . . It's a tremendous problem."
      The motivation is often boredom and a sense of rebellion -- not unlike what motivated drug users of their parents' generation, according to interviews with more than a dozen Washington area high school students and an equal number of college students from across the country. Most spoke on the condition of anonymity for fear of repercussions from their parents and their schools.
      Alex Kaplan, 17, a high school senior from Anne Arundel County, said that he has never used prescription or over-the-counter drugs to get high but that abuse of both is prevalent among some of his peers. "When it comes to Robitussin," he said, "it's not like what you would drink if you had a cold, but kids, like, actually drinking half a bottle or 75 percent of the bottle. It just, like, makes you really out of it, I guess. When you're looking at them, it's just kind of creepy looking."At a high school party on a Friday night, you won't always hear: " 'Want to smoke pot?' 'No, let's Robotrip, man,' but you will hear it sometimes," he said.
      The mix of abused medicines has changed. Quaaludes, a type of sedative, are no longer widely available, but today's college students sometimes encounter punch bowls filled with drugs such as the painkiller Percodan at parties, said Andrea Barthwell, deputy director for demand reduction in the Office of National Drug Control Policy. And unlike their parents, young people can go to online pharmacies, where they sometimes can get those drugs. "If you're going out in college, you're going to come across someone who's doing this," said a sophomore at the University of Pennsylvania, who spoke on the condition that he not be identified because of the illicit nature of the activity. "You'll go to frat houses. There'll be kids in a room. You'll just be drinking, and one kid will be like, 'Hey, I got some Xanax,' " a tranquilizer. He added: "When somebody's drunk and they take Xanax, it's a horrible thing to watch. They're completely out of it."
      Dnistrian compares the current surge in the abuse of illicitly obtained prescription medicines to the ecstasy boom of the 1990s or the increase in cocaine use in the 1980s. Some doctors and researchers attribute the trend more to fashion than to the drugs' effects. "We're on the upswing with these prescription drugs, and usage is increasing more for social reasons than for medical ones," said Daniel Z. Lieberman, director of the Clinical Psychiatric Research Center at George Washington University Medical Center. "It's simply the thing to do among high school students who have an intense need to fit in."
      In response, the Bush administration unveiled an anti-drug policy this year that focused on prescription drug abuse. The plan would dedicate nearly $150 million to augment prescription monitoring programs, to train physicians to combat abuse and to establish education programs on the dangers of taking such drugs recreationally. "It's clearly a serious problem that we are working hard to correct," said Michael D. Maves, chief executive of the American Medical Association. "And it's a difficult problem, honestly. Some of this can go on and not be noticed by parents and peers because it doesn't have the same connotation of purchasing and using . . . drugs like heroin. It sometimes doesn't stand out like other things, in terms of truly illegal drugs, but it's no less serious."
      The effect of many abused medications is psychological, Lieberman said, "a very relaxed and mellow high that can be accompanied by a powerful sense of well-being. It's not like cocaine, where you're feeling very energized, where you're able to stay up all night drinking and dancing." But each category of medication has plenty of negative side effects. "Robotripping" -- one of the terms for abusing dextromethorphan, the active ingredient in cough medicines such as Robitussin -- can cause hallucinations, and it's almost always accompanied by the unpleasant symptoms of overdose, such as vomiting, said Rose Ann Soloway, clinical toxicologist at the National Capital Poison Center.
      Linda Simoni-Wastila, a professor in the University of Maryland School of Pharmacy and an expert on youth prescription drug abuse, said perhaps the best way to combat the trend is through improvements in the drugs themselves. This summer, representatives of 20 pharmaceutical companies said they were working on ways to make drugs less addictive and less easily abused. Still, many are unsure about the scope of the problem, let alone the best way to address it. "I've been working in this area for a decade, and I still contend that prescription drug abuse is different from other abuse," Simoni-Wastila said. "The truth is, we really don't know how to prevent it. We don't have specific guidelines on treatment. Right now, it's all very hush-hush."

New Federal Rules Gather Data About Battered Women
James Dao, New York Times- 10/8/2004

WASHINGTON -- Domestic violence groups around the country are protesting new federal rules that require detailed information on tens of thousands of battered women to be collected on centralized computers, potentially making sensitive data accessible to resourceful batterers, they say
Such information has traditionally been kept confidential by domestic violence agencies out of concerns that the identities and locations of the women could be discovered by their abusers. Placing it on centralized computers would make it accessible to a wide range of authorized and potentially unauthorized users, the groups argue. "Once you put this stuff out there, the possibilities are very scary," said Nancy Neylon, executive director of the Ohio Domestic Violence Network. "I don't know that any head count is worth a life."
      But the federal Department of Housing and Urban Development, which developed the rules, says such concerns are overstated. It contends the data bases, which are intended to provide more detailed information about the homeless, can be made secure against unauthorized users. "I don't want to minimize peoples' concerns,'' said Brian Sullivan, a HUD spokesman. "They are real, we share them. But this is already working in parts of the country."
      Such assurances have not satisfied advocacy groups, who are lobbying to have victims of domestic violence exempted from the reporting rules, which took affect Oct. 1. The rules apply to any agencies -- from shelters to food pantries to counselors -- that receive HUD financing and serve the homeless. Victims of domestic violence are counted among the homeless when they seek shelter. Some organizations for domestic violence victims have said they plan to disregard the requirements and will forgo federal financing if ordered to comply. A few groups have also said they have been told they will lose federal money if they do not comply with the rules. HUD officials said there are no plans to withhold money from groups that do not share information, though they could not rule out the possibility of future sanctions. HUD is a major source of grants for homeless and domestic violence programs.
      In Chicago on Thursday, 70 people protested outside HUD's offices downtown, wearing signs that read, "HUD, don't put lives at risk," and "Help me don't track me." One volunteer for a Chicago domestic violence program, Tamme Price, 28, said her former boyfriend repeatedly beat her several years ago, sending her to the hospital twice. He worked for a law enforcement agency and might have had access to the new computerized data base if it had existed then, she said. "I can assure you I would have been much more reluctant to seek the help had this been in place," Ms. Price said.
      It is not clear what kind of access law enforcement officials would have to the new data bases, experts said. Some advocates said the new HUD rules do not prohibit the information -- which includes names, dates of birth, Social Security numbers and some medical information -- from being shared with criminal investigators and other authorities. HUD developed the new system in response to a Congressional mandate to develop a more accurate picture and count of the nation's homeless population. More detailed information will help the government allocate money more efficiently, federal officials argue. It will also help avoid double counting homeless people who might use multiple agencies. Federal officials say the housing department will not have access to the files of specific clients, only to reports that provide aggregate information about the homeless populations in specific regions.
      Domestic violence advocates say the goals of the new system are laudable. But they contend the information can be collected in ways that protect the anonymity of victims. And they argue that placing sensitive personal information on centralized computers will make it possible for information to leak out. "A batterer with access to the system could just punch in a woman's date of birth or Social Security number and find out what programs she is using," said Amy C. Sousa, policy specialist with the Pennsylvania Coalition Against Domestic Violence.
      Cindy Southworth, director of technology with the National Network to End Domestic Violence, said abusers could work for nonprofit groups with access to data bases. Computer hackers might also be able to break into less secure systems, she said. "Unfortunately, these systems won't have C.I.A.-level security," she said. "Nonprofit groups just don't have the money or training for that." Her group estimates that a third of the 1,000 domestic violence programs nationwide receive HUD money and thus are required to follow the new reporting rules. More than 40,000 women seek shelter from those HUD-financed programs each year, while tens of thousands more receive other kinds of services.
      Not all domestic violence groups are protesting the new rules. Michelle Budzek, an administrator with the organization that coordinates homeless services in the Cincinnati area, said concerns about the rules have been exaggerated. She said her group has been collecting information from domestic violence shelters for two years without incident. The system has safeguards that have allowed only a small number of service providers to see the information. Law enforcement agencies cannot review the files without court orders, she said. "This gives us the ability to have a really good handle on where the people are, what their needs are and what are the gaps in services," Ms. Budzek said.

'The Cult of Personality': Are You Normal? Think Again
Sally Satel, New York Times Book Review- 10/10/20042004

The Cult of Personality: How Personality Tests Are Leading Us to Miseducate Our Children, Mismanage Our Companies, and Misunderstand Ourselves.
By Annie Murphy Paul. 302 pp. Free Press. $26.

Psychologists have long tried to capture our personalities. Their efforts thrive today in a testing business, worth $400 million a year, in which some 2,500 tests are on the market. In her engaging book, ''The Cult of Personality,'' Annie Murphy Paul uses research and interviews to expose this sprawling unregulated industry -- a world in which personality tests are used to help answer a range of social questions: which divorcing spouse will be the better parent, who will do well at what job, which student should be admitted to a special program. But as she argues, the tests rarely meet the demands to which they are put. Nonetheless, she writes, their ubiquity ''suggests that they have become our era's favored mode of self-understanding, our most accessible and accepted way of describing human nature.''
      A former senior editor at Psychology Today, Paul is a graceful writer who combines lucid science reporting with colorful biography and intelligent social commentary. She begins the story of personality assessment in America with phrenology, the popular 19th-century practice of measuring bumps (''organs'') on the head to divine various traits. Today phrenology is synonymous with quackery. Its unofficial demise surely came when a practitioner told Mark Twain, who mischievously concealed his identity, that he completely lacked the Organ of Humor. But the search to find ''a key to the knowledge of mankind'' continued. Those were the words of the Swiss psychiatrist Hermann Rorschach, one of the test inventors Paul profiles.
      Rorschach hoped to administer his set of inkblots to everyone, from artists to aborigines, though when he died in 1922 at the age of 37 many European colleagues considered his test contrived and superficial. But the test flourished in America after a German psychologist fleeing the Nazis brought it here.
      It is no surprise that the inkblot -- often called ''a foolproof X-ray of a personality'' -- blossomed in America in the 1930's and 40's. It was a culture bewitched by Freud's theory that our longings, fears and fantasies are largely hidden from awareness. The Rorschach came to be known as a projective technique -- the subject projects his or her anxieties and desires onto ambiguous images -- and it was soon joined by the Thematic Apperception Test (T.A.T.).
      By 1950 the T.A.T. was one of the most frequently used personality tests, and it is still widely taught to psychologists in training. The T.A.T. uses evocative drawings (e.g., a man lying on a bed with another man standing over him; a boy with a violin) to illuminate, in the words of its co-creator Henry Murray, ''the darker, blinder recesses of the psyche.'' Subjects form elaborate stories about the characters in the drawings, but their narratives actually reveal, or so it is believed, subliminal themes that drive their own behavior.
      Today, however, the Rorschach, T.A.T. and other tests are largely discredited as diagnostic devices. They cannot reliably determine a person's ability to relate appropriately to other people, his sexuality or his fantasies, fears and preoccupations. The tests tend to mislabel most normal people as ''sick.'' Conversely, they are poor at detecting psychological defects (with the exception of psychosis). Still, the Rorschach, despite its severe limitations, is used in parole and sentencing hearings to evaluate whether prisoners are prone to violence or likely to commit future crimes, and almost half the psychologists who do child-custody evaluation use it.
      Projective tests were created for psychoanalysis, but another personality measure, the Myers-Briggs Type Indicator, was developed for the workplace. Isabel Myers, a college-educated homemaker, sought to aid the war effort by creating a worker ''sorter'' that would help bosses fit employees to the right jobs. Unfortunately, Paul doesn't provide much information about how the questions in the Myers-Briggs Type Indicator actually work. She does, however, provide ample evidence of its popularity. Eighty-nine of the Fortune 100 companies, including AT&T, Exxon and General Electric, use it ''to identify job applicants whose skills match those of their top performers.'' Beyond the office park, workshops apply Myers-Briggs theory to marriage, spirituality, financial planning, sports and parenthood.
      By far the most popular personality test today is the Minnesota Multiphasic Personality Inventory, created in the 1930's. It is employed chiefly in clinical situations to good benefit, yet Paul highlights its use in government hiring four decades ago and some current class-action suits against businesses giving the test. True, these applications were not legitimate, but they misrepresent the test. Readers would never know, for example, how often it is valuable in selecting among psychiatric diagnoses. Nor would they know that it can identify psychological strengths and weaknesses in patients to help them cope with physical illness and treatment. Or that the test can help detect when a plaintiff is exaggerating symptoms to appear disabled.
      What is the allure of personality tests? They provide ''an unwavering self-conception, a foundation for relating to others, a plan for success and an excuse for failure,'' Paul concludes. But, alas, the virtues of tests that try to assess personality types are illusory: research shows that a single person's scores are unstable, often changing over the course of years, weeks, even hours (a subject may be ''a good intuitive thinker in the afternoon but not in the morning,'' some researchers have noted). And, worse, there is little evidence of the correlation of test scores with school performance, managerial effectiveness, team building or career counseling.
      On a deeper level, enthusiasm for testing may be a particularly American phenomenon. After all, a society that extols freedom and self-determination is one whose citizens have choices. And with choices come anxieties -- about educational options, career paths, even mate selection. Better self-understanding and advice are thus welcome, if not eagerly sought. Besides, what could be more attractive to a society as individualistic as ours than devices that explore and exalt our perceived uniqueness?
      The paradox, Paul is quick to emphasize, is that personality tests ultimately give us a cramped vision of ourselves; instead of opening opportunities, they may confine people by identifying weaknesses that are either not there or that can be overcome. When personality typing is applied to children, Paul writes, it imposes ''limiting labels on young people who are still developing a sense of themselves and their capacities.'' Attempts to fit people into manageable categories end up being the best evidence -- if any were needed -- that we encounter the world in highly idiosyncratic ways.
      Paul is by no means against personality assessment, but she wants appraisals of workers and students to focus on gauging specific abilities. This can be done more effectively, she says, by talking to people, learning details of their past and observing their current behavior. Occasionally, narrowly focused tests can help. On the other hand, the role of tests in custody battles, in particular, is nothing short of malpractice. ''It's not fair to be separated from your family because you saw a wolf instead of a butterfly,'' a divorced father told her. If this book is instrumental in getting personality testing out of the courtroom, Paul will have done a great public service.

Drug Addiction Chief a Study in Contrasts
Maria Recio, Knight Ridder Newspapers- 10/10/2004

ROCKVILLE, Md. -- Nora Volkow is a petite powerhouse. Brilliant, intense, and driven, physician Volkow is a pioneering researcher on brain imaging and the director of the National Institute on Drug Addiction, a part of the National Institutes of Health. Despite her Russian name (pronounced Volkoff), she is one of the highest-ranking Hispanic women in the Bush administration. And that, in turn, makes for a startling contrast with her pedigree -- she is the great-granddaughter of Russian revolutionary Leon Trotsky.
      Born in Mexico City 48 years ago, Volkow grew up in the house where her famous great-grandfather -- exiled by Stalin and welcomed by Mexican artists and politicians -- was killed by a Stalinist assassin. ''I would play with his clothes and his things, even though we weren't supposed to touch anything," Volkow recalled during an interview in her suburban office.
      Volkow's father made the house a museum when the family moved to another house, and Volkow and her three sisters as teenagers would take turns giving weekend tours. Among the many famous visitors was Colombian writer and Nobel laureate Gabriel Garcia Marquez, who sought out Trotsky's house in exile. ''It was an incredible house, so full of history," she said. Volkow never knew Trotsky, who was killed in 1940, and her father, Trotsky's grandson, had suffered so much from Stalin's purges of his family that he would not talk about him. ''My father would not speak about Trotsky," she said. ''My father did not want us to go into politics because his whole family had been destroyed by politics. I learned about him by reading. I always had access to what he wrote -- and I learned on my own."
      ''He's an extraordinary figure," said Volkow of her great-grandfather, whom she refers to simply as ''Trotsky" and who, alongside Lenin, led the Russian Revolution of 1917 and was Stalin's chief rival to succeed Lenin. Volkow sees Trotsky's legacy as that of ''an extraordinary person to try and emulate" for his desire to improve society, but at the same time one she keeps apart out of a need to secure her own identity.
      Volkow has done so by making her own imprint in the world of science. After studying medicine in Mexico, Volkow stopped unannounced at New York University in the early 1980s to learn more about brain imaging on her way, she thought, to getting a doctorate at the Massachusetts Institute of Technology. Instead, fascinated by the new devices that opened the brain to study, she stayed at NYU to pursue a specialty in psychiatry. ''I was fascinated by the brain since I was little," she said.
      In 1987, a study that Volkow had done on the dangers of cocaine to the brain was finally accepted for publication after several years of being refused, and it created a sensation in a society in which many viewed cocaine as a harmless social drug. ''I was the first to document that cocaine was toxic to the brain," said Volkow, who, through brain imaging, showed the chemical changes in the brains of people who are addicted.
      Volkow did pioneering research on the brain's dopamine system in Houston at the University of Texas Medical School from 1984 to 1987 and then moved to Brookhaven National Laboratory in Long Island, N.Y. At Brookhaven, she held senior research positions until being tapped as director of the National Institute on Drug Addiction in 2003.
      At the institute, Volkow helps determine the best use of research dollars to relieve the problem of addiction. As for politics, Volkow has followed her father's advice. She speaks of science and research and her family history, but asked about the irony of working for a conservative Bush administration, she said quickly, ''I'm not appointed by the president." Volkow was appointed by National Institutes of Health Director Elias Zerhouni in 2003

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Experts Urge Close Eye on Depression Drugs
Associated Press, 10/11/2004

CHICAGO (AP) -- Shauna Murphy thinks it's a smart idea to put warning labels on antidepressants. She has good reason. Nine years ago, at age 10, she was put on a particular brand of the medication and, shortly after, tried to kill herself. It's the kind of outcome that has prompted the Food and Drug Administration to begin work on writing ``black box'' warnings -- the strongest caution possible -- for young people who take antidepressants. Some parents have already taken their children off the drugs.
      But even with the troubles they've had, Murphy and her parents are not speaking out against antidepressants. Instead, they are among a number of families, doctors and mental health groups who -- worried the warning labels might stop some people from seeking treatment -- are taking the opportunity to encourage families to get help for young people with depression and other mental health issues. They are particularly focused on teaching parents to monitor their children and figure out which treatment works for a particular child -- whether it be therapy, medication, or both. ``It's a real process and a matter of educating yourself as a parent,'' says Cheryl Murphy, who is Shauna's mom and leader of the southern Nevada chapter of the Depression and Bipolar Support Alliance. She found that it took two years and more than one doctor to find a treatment that helped her daughter. Eventually, Shauna was diagnosed with bipolar disorder, which causes moods to fluctuate between periods of depression and high-energy mania. She now takes an antipsychotic medication. ``The medication I'm on is working quite well,'' says Shauna, who's now 19 and living with her parents in Las Vegas. The Depression and Bipolar Support Alliance, a Chicago-based organization with chapters nationwide, provides monitoring tips on its Web site.
       In response to the warning-label issue, Massachusetts-based Families for Depression Awareness also is working on a ``depression monitoring tool'' that will provide guidelines to help parents and patients track symptoms and medication side-effects. They expect to have it done in the next few months. Mental health experts who specialize in young people agree that monitoring a child on treatment is key, as is doing a thorough evaluation. ``If a child comes in with symptoms A, B and C, the symptoms should, at worst, not get worse -- and, at best, they should start to get better. If not, they're on the wrong medication,'' says Rich Macur Brousil, director of child and adolescent behavioral health at Mt. Sinai Hospital in Chicago. If medication is deemed necessary, he says children should be started on the lowest dose to see how they respond. He and other mental health professionals also strongly recommend that any psychiatric medication be used in combination with counseling -- and frequent visits for follow-up.
      Dr. Bela Sood, who heads the division of adolescent psychiatry at Virginia Commonwealth University, says signs that a medication isn't working might include heightened aggressiveness, unusually bold behavior or a feeling that ``you're crawling out of your skin.'' During an evaluation, she also asks young patients directly if they have thought about suicide. ``There's this myth that if you suggest suicide to a kid that you might turn someone into someone who's considering suicide -- and that's wrong,'' says Sood, who's noted that parents often have no idea their children have considered killing themselves. She and other experts say it is especially important to watch a young person during the first few weeks of treatment -- in part because an antidepressant, for instance, can give someone who is depressed the energy to act upon suicidal thoughts.
      It's a lot for parents to think about. And Toni Embrey, a parent who lives on Chicago's West Side, knows how difficult it can be. She is raising three grandchildren and also has adopted three of her niece's children. Four of the six are on medication of one sort or another -- from stimulants used to treat hyperactivity to antipsychotics and antidepressants. Several of the children go the counseling once a week. ``It can be hard to keep track of it all,'' Embrey says as she spreads the children's pill boxes on her coffee table. ``But I have to look at what it does for them on a daily basis.'' One of her adopted sons, 12-year-old Anthony, says the stimulant he takes has helped keep him calm and out of trouble at school. He also feels like therapy sessions with Macur Brousil at Mt. Sinai have helped him work through his sadness over his biological mother leaving him with Embrey. ``If I talk to Dr. Rich, I get all my anger and stuff out,'' the seventh-grader says.
      Meanwhile, Deborah Gongora, a mom in Victorville, Calif., has found that an antipsychotic has worked well for her 12-year-old daughter, who's bipolar. But her 15-year-old son, who suffers from depression, has done best with therapy and no medication. Says Gongora: ``It really is a case-by-case basis.''
      On the Net:
Depression and Bipolar Support Alliance: http://www.DBSAlliance.org
Families for Depression Awareness: http://www.familyaware.org

British Boarding School Walls Hid Abuse
Sarah Lyall, New York Times- 10/11/2004

LONDON - Tom Perry had not seen his old friend for some 35 years when he called him out of the blue with an urgent question about the boarding school they attended together. "Just as a matter of interest," he asked, "did you like the place?" It was a deliberate provocation. "Hell, Tom, the conversation bowls happily along, and then you ask me a question like that,'' Mr. Perry said his friend protested. But Mr. Perry, a businessman who turned 50 this year, invited him over to continue the conversation. "There's no point in prating about," Mr. Perry said he told his friend. "I must tell you that when I was at Caldicott, I was sexually abused.''
      So began a long process of facing up to the past for Mr. Perry, his friend and at least half a dozen other men who say they were molested by teachers at the Caldicott School, in Buckinghamshire, between 1964 and 1970. But it has been a bumpy and frustrating road. While one of the teachers pleaded guilty to abuse, the case against another, the school's former headmaster, was thrown out of court by a skeptical judge who said the accusations involved events that had happened so long ago that a fair trial was impossible.
      The judge's apparent lack of sympathy, the former students say, is consistent with the general attitude of the British establishment, still disproportionately made up of men of a certain age and class who went to prep schools like Caldicott. Such men may be sympathetic about accusations of sexual misconduct in institutions like the Catholic Church, but acknowledging the abuse that took place at many boarding schools not so long ago is another matter. The subject is often played for laughs, as it was in the movie "Four Weddings and a Funeral," where an obnoxious banker drunkenly recalls being sodomized by an older boy at his former school. "Still," he adds, "taught me a thing or two about life." The common view, many former students say, is that if it happened, you are not expected to whine about it.
      But for many former students, it seems, memories and anger resurface near middle age, when their own children reach boarding school age. The death of parents also liberates some abuse victims from the often-crippling notion that any attack on their old schools would be seen as criticism of the mothers and fathers who sent them there. But in the 1970's, Mr. Perry said nothing. Caldicott was a place where loyalty to the school was emphasized above all else, where a culture of secrecy and shame prevailed and where emotional distress was something to be quelled, not indulged.
      James Foucar, secretary of the Association of Boarding School Survivors, said that when he told his father, in the 1970's, that a teacher was making sexual advances to him, the response was, So what? "My dad's view is, why should you make a fuss - it's commonplace and nobody spoke about it," Mr. Foucar said. "He said that one of his teachers had his hands permanently down my father's shorts, so what was I complaining about?"
      Many traumatized former students say the trouble lies with boarding school in general, never mind the era. But the consensus is that British boarding schools have changed substantially in the last 15 or so years. In the old days, they were unregulated and often run as private idiosyncratic fiefs. Punishments were meted out for the slimmest of reasons, often at the whim of sadistic teachers; and, former students and teachers said, many schools were suffused by a weird undercurrent of sexuality. A surprising number of former boarding school students, for instance, describe how when they lined up en masse, naked, for baths or showers -- always cold, according to the practices of the time -- certain teachers would always seem to materialize, unduly eager to watch. A former student at a school that has closed described rules and behavior that seem bizarre, even Dickensian. Among other things, he said, the headmaster used a billiard cue to beat students, then required them to shake his hand and thank him.
     People his age generally do not want to discuss what happened, or they deflect their discomfort with bluster and black humor, said the former student, now 47 and a businessman, who spoke on condition that he not be identified. "The feeling is, 'Well, we're not nutty as a fruitcake, so it couldn't have done us much harm,' " he said. "But a lot of people of my generation are quite complicated sexually, and I think it comes from their experience at prep school."
      Much of the worst excesses of the past have been swept away by new regulations, starting with the 1989 Children Act, which detailed the state's responsibility to young people. Corporal punishment in private schools was outlawed in 1999. Schools now conduct mandatory background checks on staff members. The number of Childline, a crisis hot line, is posted in school hallways. "The whole punishment system has changed beyond recognition,'' said Adrian Underwood, director of the Boarding Schools Association in Britain. "Now it's inside the normal, civilized norms of society."
      Simon Doggart, the current headmaster of Caldicott, said the school was not what it had once been. "We make children very aware of what their rights are and who they should talk to if they're unhappy," he said. This is little comfort to Tom Perry, who was sent to Caldicott at 8 years old and who says the sexual attentions of Peter Wright, then the headmaster, began when he was 12 and lonely, missing the warmth of family life and craving intimacy and kindness. "My first sexual kiss was from Peter Wright," he said. "My first sexual experiences were with him."
      It was not until decades later that Mr. Perry, racked by depression, sought psychiatric help. He also quickly found a half-dozen other former students who, like him, had lived alone with feelings of shame and complicity all those years. Through his lawyer, Andrew Bright, Mr. Wright declined to be interviewed. In 2003, on the basis of statements by Mr. Perry and four other former students, he was indicted on 13 counts of indecent assaults and three counts of gross indecency with a child. But last year a judge, Roger Connor, stayed the case and set Mr. Wright, then 73, free. "The long delay has clearly made it significantly more difficult for the defendant to put forward his defense," Judge Connor said.
      Though some former teachers have been convicted in similar cases, many judges seem unsympathetic, even hostile, to the issue. In a similar case, former teacher at the Cothill School in Oxfordshire was charged recently with abusing boys in the 1970's. But the judge, Julian Hall, declared this year that "this is the stalest case I have been asked to try" and threw it out. "I think the best thing that should happen to people who behave in this way," Judge Hall told Oxford Crown Court, speaking of the former teacher, Jeremy Malim, "is that they should get a very brisk elbow in the ribs at the time or be rejected."
      Most of the goings-on at Caldicott were known but never spoken about, but a sexual scandal did erupt there in 1973, when a teacher named Martin Carson was caught sodomizing a 12-year-old boy, Alastair Rolfe. The abuse had gone on for a year, and "during that time, virtually everything happened," Mr. Rolfe, now 43, a writer and editor, said in an interview. Spurred by news of the case against Mr. Wright, Mr. Rolfe and others came forward, and Mr. Carson pleaded guilty to sodomy, indecent assault and possessing indecent images of children. In 2003, he was sentenced to two years in prison. He was released after a year. In 1973, there was a rush to cover everything up. Mr. Carson was dismissed and eventually got a job at another school. At home, Mr. Rolfe said, "it was always referred to as 'an incident' like someone tripping over a curbstone." He was sent right back to school and did not discuss the subject again for 30 years when, troubled by issues with his own children, he began seeing a therapist. "I don't want to sound self-pitying," he said, "but I'd probably say it affects all aspects of my life."
      That is also true of Mark Winter, a third man who says he was abused at Caldicott by yet another teacher and who has gone to the police with his accusations. Mr. Winter, 54, a journalist, says he was 11 when the teacher took him into a room and began more than a year of regular abuse. "I wandered, completely traumatized, out of the room," Mr. Winter said in an interview, recalling how he was then spotted by the school matron, a sort of nurse-cum-housekeeper. "She said, 'I know what you've been doing, you dirty boy.' '' Some time later, he confided in a schoolmate. "I told him I was a sexual partner" of the teacher, Mr. Winter said. "He looked at me and said, 'Who wasn't?' ''

FDA Orders Strong Antidepressant Warnings
Associated Press, 10/15/2004

WASHINGTON -- The Food and Drug Administration on Friday ordered that all antidepressants carry ``black box'' warnings that they ``increase the risk of suicidal thinking and behavior'' in children who take them. Patients and their parents will be given medication guides that include the warning with each new prescription or refill.
      Dr. Lester Crawford, acting FDA commissioner, said the agency based its decision on the ``latest and best science.'' ``We continue to believe, however, that these drugs provide significant benefits for pediatric patients when used appropriately,'' he told reporters. ``Antidepressants increase the risk of suicidal thinking and behavior ... in children and adolescents with major depressive disorder and other psychiatric disorders,'' the warning begins. Those risks must be balanced against clinical need, the label indicates in a warning surrounded by a black box, hence the ``black box'' designation. The information guide, available within weeks for patients and their parents, echoes those warnings.
      The FDA's action, which follows to the letter a recommendation of its advisers, was driven by data that showed that on average, 2 percent to 3 percent of children taking antidepressants have increased suicidal thoughts and actions. Independent experts, working with Columbia University, based the finding on a review of data from 24 trials that involved more than 4,400 patients taking antidepressants. They found a greater risk during the first few months of treatment. Crawford said suicides among youths decreased by 25 percent in the last decade, as antidepressant prescriptions to children soared. Children aged 1 to 17 now account for 7 percent of all antidepressant prescriptions.
      Researchers say that although antidepressants were found to slightly increase the risk of suicidal thoughts and behavior in children, the drugs appear to have an even more powerful affect in preventing actual suicide.
      The American Psychiatric Association expressed concern that the agency's actions may lead to fewer antidepressant prescriptions for patients most in need. ``This would put seriously ill patients at grave risk,'' the association said in a statement. Eli Lilly and Co., which manufactures Prozac, the only antidepressant found to be safe and effective for children, echoed the APA's concerns. ``Lilly supports the recent FDA efforts,'' the company said. However, a ``black box warning on antidepressants may have a dangerous effect on appropriate prescribing for patients who urgently need proven treatment options.''
      The FDA said that concern was raised during advisory committee meetings and in its internal discussions. Still, the black box is the best way to ensure patients and doctors discuss the risks and benefits of the drugs. ``We felt that it's one of the most important tools we have to get the message out to people that these drugs shouldn't be used casually,'' said Dr. Sandra Kweder, acting director of the FDA's Office of New Drugs.
      Other drug manufacturers endorsed the FDA's action. ``We agree with the FDA that providing additional information to everyone -- from health care professionals to parents and patients -- is one of the most positive steps that can be taken to advance the diagnoses and treatment of adolescents with depression,'' said Mary Anne Rhyne, a GlaxoSmithKline spokeswoman. Glaxo, the maker of Paxil, settled a lawsuit filed by New York's attorney general by releasing summaries of all its clinical trials. The lawsuit accused the company of not disclosing fully negative information about Paxil's safety record.
      The FDA said parents and physicians will be advised to look for warning signs in children that include worsening depression, agitation, irritability and unusual changes in behavior. Those worrisome signs could come within the first months of starting an antidepressant or if the drug's dosage is changed, higher or lower. Doctors and families are asked to have at least weekly, face-to-face contact with a child taking an antidepressant during the first four weeks of treatment. Biweekly visits would occur for eight more weeks and, as needed, after week 12. The warning notice says caregivers and physicians should be equally as vigilant with adults who take antidepressants.
      Kathleen Bodnar, a grieving mother, expressed the fear that the warning information will go to people receiving the drug but not necessarily to families or others who might best monitor behavior. ``If my daughter were living with me, I could be watching her every single day and notice the difference,'' said Bodnar, whose 21-year-old daughter, Liz Torlakson, killed herself two days after restarting an antidepressant that had been stopped because she had the flu. ``If the doctor waits, even once a week, it's not going to be often enough.''
       Because the FDA chose its most strident alert, the warning must be included in advertising. That means a trend that startled federal advisers -- free samples of antidepressants given to treat other medical conditions -- also must carry warnings. ``These medications were being used outside their indications by physicians who sometimes distributed samples to the families,'' said Dr. Laurence Greenhill, a pediatric psychiatrist in New York. ``In this case, advertising sampling always will have the black box warning on it.''
      The new warnings will be carried by all antidepressants, including Anafranil, Aventyl, Celexa, Cymbalta, Desyrel, Effexor, Elavil, Lexapro, Ludiomil, Luvox, Marplan, Nardil, Norpramin, Pamelor, Parnate, Paxil, Pexeva, Prozac, Remeron, Sarafem, Serzone, Sinequan, Surmontil, Symbyax, Tofranil, Tofranil-PM, Triavil, Vivactil, Wellbutrin, Zoloft and Zyban.



Report: Girls Catching up to Boys in Delinquency
Associated Press, 10/16/2004

NEW BRITAIN, Conn. -- Boys still dominate Connecticut's juvenile justice system but girls are quickly catching up, according to a recently released report. From 1999 to 2003, the number of girls referred to juvenile court in Connecticut increased 49 percent, from 3,530 to 5,258, according to report compiled by Gov.'s Prevention Partnership, a nonprofit public-private alliance. The Connecticut statistics mirror a national trend, according to educators and social service providers many of whom gathered Friday at Central Connecticut State University for a conference on the subject.
      Leigh Jones-Bamman, the author of the report, said the most common denominator among aggressive girls is being a victim or witness to violence. "When violence is witnessed or experienced, it is often normalized," she said. The study also showed that girls are more prone to use other forms of aggression rather than physical confrontation. Those acts include sabotaging friendships or damaging someone's reputation. Girls' aggression in all its forms is overwhelmingly rooted in relationships and the importance of relationships in their lives," the study states.
      Keynote speaker, Lyn Mikel Brown, associate professor of education and women's gender and sexuality studies at Colby College in Maine, showed a scenes from popular television shows, commercials and movies such as "Mean Girls" that depict women and girls verbally abusing each other. She said the prevalence of the theme normalizes the female aggression.
      The study recommends providing time for girls to talk with each other and with adults; adapting peer mediation training to address girls' aggression over relationships; and adapting a bullying prevention curriculum. The report was an outgrowth of five years of work by a Girls and Violence Task Force.