Why is it so hard to quit smoking cigarettes? One reason may be that nicotine acts on the same brain system in humans as heroin and morphine, a new study has found. Earlier studies in animals had found that that nicotine could set off the release of brain chemicals called opioids, which play a role in suppressing pain and causing pleasurable feelings. The new study is the first to establish that the same process occurs in people, the researchers said.
      To prove that opioids were involved, the researchers first had to figure out a way to use positron emission tomography or PET scanners to measure opioid brain activity. They also had to persuade officials at the University of Michigan to waive the no-smoking rules and allow their volunteers to smoke in the hospital's scanner. (They solved the problem by figuring out a way to vent the smoke to the outside.)
      The study, led by David J. Scott, a graduate student, found that smokers appeared to have an increased flow of opioids in the brain all the time. After they smoked a cigarette, there was even more opioid activity in the parts of the brain involved in emotion and desire. The findings were presented last week at a meeting of the Society for Neuroscience.
      Mr. Scott said that he had expected to confirm the nicotine-opioid link, but that it was more pronounced than he had thought. He also said there was no question that the nicotine was responsible, since the volunteers were given both regular cigarettes and nicotine-free ones. "What we're seeing is purely the pharmacological action of the nicotine,'' he said.

New Salvo Is Fired in Mommy Wars
Edward Wyatt, New York Times- 11/2/2004

If any book tempts readers to judge its contents by the cover, it is "Home-Alone America," whose jacket photograph shows Mom leaving for work in her power suit and pumps as Junior clings desperately to her ankle. Any passions left uninflamed might be stirred by the book's subtitle: "The Hidden Toll of Day Care, Behavioral Drugs and Other Parent Substitutes." That seems to label it as another book bashing working mothers, blaming them for the ills of society and condemning them for putting their happiness above that of their children.
      Not so, says Mary Eberstadt, the author of "Home-Alone America," being published this week by Sentinel, an imprint of Penguin Group USA that focuses on conservative viewpoints. "This isn't a finger-pointing book," she said in an interview. "It's not a blaming book. It's an attempt to deliver what I know to be an out-of-the-box examination of a serious social question. That question is, why do kids today have serious problems that their parents' generation and their grandparents' generation did not?"
      Authors on both the left and the right have produced scores of books in recent years that either laud motherhood as the greatest profession or insist that mothers are able to provide substantive role models for their children only by working outside the home. What Mrs. Eberstadt says makes "Home-Alone America" different is that it looks not at mothers or fathers or work or other grown-up concerns; rather, she says, it looks at what is happening to children: obesity, high rates of teen pregnancy and sexually transmitted disease, and the rapidly growing use of psychiatric medications even among very young children. "I'm trying to move the spotlight," she said. "I'm making an honest effort to get the adults off the stage." She also stresses that she does not want to cast blame for those problems on working mothers. "Half the book," she said, "is about what happens when you take Dad out of the house, whether through unwed motherhood or divorce."
      Whether her approach and arguments are truly different or are a more strident version of previous books on parenthood and children is an open question. What is certain is that Sentinel, the publisher, is hoping that "Home-Alone America" draws the kind of attention that often accompanies books published by Regnery, the king of conservative publishers.
      Certainly many experts on parenthood -- not to mention many mothers -- could dispute that a mother's working outside the home is any way comparable to a father's abandonment of the family. "There's no perfect answer to any of these problems," said Dr. Leon Hoffman, director of the Parent-Child Center at the New York Psychoanalytic Society. It is all but impossible to generalize about the causes of behavioral problems and conditions like obesity, Dr. Hoffman said, because of all the variables at play with child, parent and environment.
      "Home-Alone America" certainly presents a stark picture of American youth. Citing sources as varied as "The Maury Povich Show" and the Journal of the American Medical Association, Mrs. Eberstadt documents rapidly rising rates of obesity among children (although she focuses more on those rates than on the actual percentage of children who are seriously overweight). She presents disturbing statistics about the growth in the use of psychiatric drugs to treat attention deficit disorder and hyperactivity. And she includes familiar but still troubling figures on teen pregnancy and the spread of sexually transmitted diseases.
      Mrs. Eberstadt's book attempts to link these problems to absent parents. Obesity, she writes, is in large part the product of a lack of supervision when children return every afternoon to empty homes or are mollified by sugary snacks in day care or at after-school programs. So many children are medicated, she says, because parents spend less time with them, and therefore do not know how children really behave. And while they are unsupervised, teenagers, not surprisingly, are sometimes having sex. "Over the past few decades, more and more children have spent considerably less time in the company of their parents or other relatives, and numerous fundamental measures of their well-being have simultaneously gone into what once would have been judged scandalous decline," Mrs. Eberstadt writes. "It is the argument of this book that the connection between those facts cannot possibly be dismissed as coincidence."
      Other authors who have studied parenting and its effects raise questions about whether the connection that Mrs. Eberstadt makes between these problems and absent parents is quite so clear. Take obesity, for example. "A lot of devoted, around-the-clock parents take their kids regularly to McDonald's," said Ann Crittenden, the author of "The Price of Motherhood: Why the Most Important Job in the World Is Still the Least Valued." If such a link were so clear, she argues, obesity rates should be much lower in families with stay-at-home mothers. And while Ms. Crittenden agreed that the use of psychiatric drugs is too frequent among adolescents and children, she said she has seen little evidence to connect that usage to working parents.
      Mrs. Eberstadt, a Washington-based research fellow for Stanford's Hoover Institution, says she recognizes that many mothers have to work out of economic necessity. "But this is a book for people who have choices," she said. "Any one family might be fine participating in the trends mentioned in the book. But if you step back from that individual family and look at society as a whole, I think you see that some people aren't fine. Some kids in day care do just great. Some kids in day care have problems because of day care. I think we can open an honest conversation about these things."
      A child of divorced parents, Mrs. Eberstadt expressed surprise when it was suggested that readers are likely to wonder about how her own children fare when she is working. She addresses that subject in her book's introduction. "Three of my children are in school all day long and the youngest is on the verge of it," she writes. "I have a part-time paid babysitter who is upstairs while I'm down," where she maintains her home-office, "a husband who often works at home, and older children who also help with the youngest one."
      Again, she added, the book is as much about the effects of divorce as about working mothers. "Some families divorce and the kids turn out fine," she said. "Some families divorce and the kids are miserable and develop serious problems. I'm not generalizing about any individual situation or any particular family. I'm saying step back and look at the scene as a whole."
      To emphasize that fathers are as much the culprits in these trends as mothers, she notes that the back cover of the book features another photo, this one of a father leaving for work, with a child clinging to his ankle. "Maybe for the paperback we can flip the pictures around if that would make people happier," she said. But Mrs. Eberstadt does not apologize, either for the assertions in her book or for the cover photographs. "What this does is grasp the key feature of the book, which is to focus on that child's phenomenological experience," she said of the pictures. "The eminence of what is happening to him at that particular moment, that is the focus that has been missing from this debate. That's why I dwell on the immediate emotional experience of some kids in day care. "In every chapter of the book," she added, "I'm trying to get at the immediate experience of these problems and what they mean for today's kids."

Court Will Rule on Town's Liability in Family Violence
Charles Lane, Washington Post- 11/2/2004

The Supreme Court announced yesterday that it will decide whether victims of domestic violence have a constitutional right to sue local governments that fail to protect them from abusers. Without comment or recorded dissent, the court said it would hear an appeal from a Colorado town accused of refusing to enforce a restraining order against a violent father who eventually killed his three children. The town, Castle Rock, seeks to overturn a federal appeals court ruling that found it liable because it had not given the children's mother adequate notice of its non-enforcement or a chance to plead her case.
      Castle Rock, supported by the International Municipal Lawyers Association and the National League of Cities, contends the Supreme Court must overturn that ruling to prevent a "potentially devastating" flood of lawsuits that "could bankrupt municipal governments . . . given the inevitability of less-than-perfect enforcement." Attorneys for the mother had urged the court to leave the ruling alone, saying that it "reflect[ed] a very fact-specific issue that is unlikely to recur frequently."
      The case is a sequel to one of the most emotion-laden cases in recent Supreme Court history, 1989's DeShaney v. Winnebago County, in which the justices ruled, 6 to 3, that a brain-damaged Wisconsin boy, Joshua DeShaney, and his mother could not sue local authorities who knew that the boy was being beaten by his father but did not stop the beatings. In an opinion by Chief Justice William H. Rehnquist, the court said the constitutional guarantee of due process of law did not "require the State to protect the life, liberty and property of its citizens against invasion by private actors." The ruling prompted the late Justice Harry A. Blackmun to exclaim in dissent: "Poor Joshua!"
      In the case the court agreed to hear yesterday, Castle Rock, Colo. v. Gonzales, No. 04-278, Jessica Gonzales is suing Castle Rock for allegedly failing to enforce a restraining order that barred her estranged husband, Simon Gonzales, from visiting their three children except at specified times. Jessica Gonzales alleges that, when Simon Gonzales abducted the three children from her front yard, she repeatedly asked the police to bring the children back, but they would not act. Simon Gonzales eventually killed the children. He was killed in a gunfight with officers.
      Earlier this year, the Denver-based U.S. Court of Appeals for the 10th Circuit, sitting as a full 11-member panel, ruled that Jessica Gonzales can press a constitutional claim against Castle Rock in federal court. In a 6 to 5 ruling, the appeals court acknowledged that the Supreme Court's ruling in DeShaney bars any claim based on a right to be protected by local authorities. But the 10th Circuit said the restraining order against her husband gave Jessica Gonzales a strong enough expectation of government protection that she had a due-process right at least to be told in advance if the town was not going to enforce it. The case will be argued in March. A decision is expected by July.

Mental Patient Dies in UCLA's Psychiatric ER
Jia-Rui Chong, Los Angeles Times- 11/3/2004

A psychiatric patient died at Harbor-UCLA Medical Center over the weekend after he tried to hang himself in a shower stall, a coroner's spokesman said. The 22-year-old man, who did not have a home address and whose name was being withheld, was taken to the county-run hospital near Torrance on Thursday because he was presenting a danger to himself or others, said David Campbell of the coroner's department. "He was found by hospital staff hanging from a shower fixture," Campbell said. Doctors placed the man on life support. He was pronounced dead on Saturday, Campbell said. The county health department declined to comment on the case, citing privacy concerns.
      "What's important to keep in mind is that psych ERs … take patients there who are being committed involuntarily," said health department spokesman John Wallace. Many such patients "are severely impacted by mental illness and are some of the most difficult patients to treat," he said.
      A male nurse at Harbor-UCLA who was familiar with the case said nurses working in the psychiatric emergency room found the man around midday Thursday, after he had been left alone for about 20 minutes. At the time, two nurses were caring for 12 patients in the psychiatric emergency room, in violation of the state-mandated maximum of four patients per nurse in that ward. "This is a clear indication of not having a safe ratio," the nurse said. In the last few months, more than 160 county nurses, including several who work in Harbor-UCLA's psychiatric emergency room, have refused to take on more patients than state law allows. They have said that doing so would endanger patients.

Study Targets Key to Nicotine Addiction
Associated Press, 11/4/2004

WASHINGTON -- A single molecule may be partly to blame for nicotine's addictive allure, a finding that researchers say could lead to potential therapies to help millions of smokers quit a life-threatening habit. More than 4 million people around the globe -- 440,000 of them Americans -- die from smoking-related causes each year. And, the nicotine-laced smoke damages more than just their lungs.
      The California researchers not only pinpointed a molecule responsible for nicotine addiction, they also created specialized mice to make it easier to search for other molecules impacted by nicotine addiction. The research team started by fiddling with a single gene to create mice that were hypersensitive to nicotine. The genetically engineered mice were tripped up by the tiniest exposure to nicotine -- a concentration 1/50th of the strength of nicotine coursing through a typical smoker's blood. Once hooked, the mice experienced classic signs of nicotine dependence that keep smokers puffing, the research team reports Friday in the journal Science. ``Dependence-related behaviors, including reward, tolerance, and sensitization, occur strongly and at remarkably low nicotine doses'' in the mice, the research team wrote.
      In humans, reward arrives as a pleasant little jolt of dopamine, a calming brain chemical unleashed by nicotine. The body's tolerance for the drug leads to more smoking. Sensitization means not feeling good without a nicotine fix, said Henry Lester, a biology professor at the California Institute of Technology who was among the paper's 10 authors. In mice, researchers saw reward when mice chose nicotine hits over salt, changed body temperatures as evidence of tolerance and more running around among sensitized mice.
      Other researchers praised the study. The findings ``not only provide direct evidence of how nicotine promotes dependence, but also raise fundamental questions about the genetics of addiction,'' researchers at the Centre Medical Universitaire, in Geneva, Switzerland, wrote in a companion piece. If the findings in mice hold true for humans, the work points to a specific target for a new drug to attack, others suggest.
      People become dependent on nicotine when it parks in nerve cell receptors designed for the chemical acetylcholine. Once nicotine fills that space, dopamine is released. By knowing the specific parking place where nicotine can exact a high toll, a drug could be fashioned to fill it. ``The power lies in the ability to be so specific. In being so specific, you can treat the cause without the ramifications of the side effects,'' said Stephen L. Dewey, a Brookhaven National Laboratory scientist who has studied epilepsy drugs to treat nicotine addiction.
      Daniel McGehee, a University of Chicago neurobiologist who has studied a different subset of receptors sensitive to nicotine called it ``a fantastic study'' but cautioned against thinking a drug would deliver benefits without costs. Interfering with how the body experiences the rewards of nicotine could dull other experiences. ``That pathway is not there to promote tobacco use. It's there to promote healthy behaviors that lead to the survival of our species,'' McGehee said. Tampering with it ``may interfere with our ability to find pleasure and joy in normal, healthy things.''
      Lester has been working for years on alpha4, one of a dozen known subunits of nicotine receptor sites. The team learned how to make that protein much more sensitive to nicotine. What wasn't clear was how to manipulate the mice genes. Other researchers had found answers by subtraction, erasing genes. Lester's group worked by addition, making a single amino acid change among the millions of choices present in 30,000 mice genes. ``This is extremely clever because you're looking at it by addition,'' said Dr. L.W. Role, a Columbia University Medical Center professor who studies receptors sensitive to nicotine.
      In the first set of mice, the genetic mutation the researchers made was too pronounced. After the nicotine hits, dopamine levels were so intense the mice died, Lester said. In the Science paper, the researchers fine-tuned those genetic manipulations. ``What we have done is to show that a particular molecule is not only necessary for nicotine addiction, but is sufficient for nicotine addiction,'' he said. ``When the particular alpha receptor is activated by nicotine -- and no other receptors -- that is sufficient to produce some of the effects associated with addiction.'' Because of that, the mice are addicted to nicotine without complicating side effects. ``We can now go on this molecular detective hunt'' Lester said, looking for other molecules changed by nicotine dependence.
      The research was supported by the California Tobacco-Related Disease Research Program, the National Institute on Drug Abuse, the National Institute of Mental Health, the National Institute of Neurological Disorders and Stroke, the Plum Foundation and the W. M. Keck Foundation.
      On the Net: CalTech: http://www.caltech.edu/

New Maine Psychiatric Hospital Running at Capacity
Associated Press, 11/6/2004

AUGUSTA, Maine -- The replacement for the Augusta Mental Health Institute has had to turn away half of eligible patients for the past two months, said Riverview Psychiatric Center Superintendent David Proffitt. If the trend continues for another month, it could violate an agreement signed by state officials last April, Proffitt said. Riverview officials are required to report to the Legislature if more than 30 percent of patients are turned away for three consecutive months.
      Critics have said ever since Riverview Psychiatric Center was proposed in 1999 that the 92-bed hospital would be too small. But Proffitt said the problem is not the size of the hospital. The problem is a lack of community services in place for patients that's causing the hospital to delay the discharge of patients, he said. Because patients can't leave, there's no room for new patients who need intensive treatment, Proffitt said.
      Riverview has 48 beds for civil patients and 44 for those held for violations of criminal law, and it opened with 75 to 78 patients, Proffitt said. During July, 14 percent of eligible patients were turned away and 12.5 percent were rejected in August when the hospital was not at full capacity. Hospital statistics show that nearly 53 percent of eligible patients referred by doctors were turned away in September and more than 54 percent could not be accommodated in October. "We've been having, right now, 100 percent capacity for the last few months," Proffitt said.
      The hospital and much of the state's community mental health system are under the control of a 1990 court order known as the AMHI consent decree. A judge is considering an array of plans to reform the state's community mental health system.

Diagnosing and Responding to Child Abuse
Anne Reuter, Ann Arbor News- 11/7/2004

Elaine Pomeranz smiles frequently, her face animated. She's warm, breezy and keenly observant, all the qualities parents want in a pediatrician. She is one, but her career has taken her to a different zone than a quiet family practice. As medical director of the University of Michigan Hospital Child Protection Team, she pieces together evidence in some of the most baffling, disturbing cases seen at the hospital emergency room and Mott Hospital, the hospital's pediatric wing. They're the infants with suspicious brain and eye hemorrhages whose parents say, "She rolled off the changing table." And the toddlers covered with severe burns, scalded in bath water far too hot. Pomeranz is an articulate advocate for tackling a social problem no one likes to think about: physical abuse of children, particularly infants and toddlers.
      Inflicted head injury is the most common cause of traumatic death among infants, according to a 1998 report in the New England Journal of Medicine. Of the estimated 896,000 children in the United States who were victims of child abuse or neglect in 2002, almost 20 percent were physically abused, according to the National Clearing House on Child Abuse and Neglect.
      The occasional cases Pomeranz sees of suspected "shaken baby syndrome" are hot-button ones for her. She acknowledges she has what amounts to a passion in piecing together these cases of suspected physical abuse. "I don't think you can do this without that," she says. "It's a real burnout otherwise." Married to U-M astronomy professor Joel Bregman, Pomeranz works half-time for the Child Protection Team and half-time in the hospital emergency room, handling pediatric cases. She says very little about what she does to their two sons, 9 and 11. She says being a mother makes it harder to avoid a sense of outrage that people, parents in most cases, can commit physical abuse. But she understands that control snaps when a person can't afford quality child care or a caregiver has to care for an infant all day after working a night shift. "They don't have backup, and they just lose it," she says.

Shaking cases: tragic results
The hospital's Child Protection Team handled about 240 cases last year in which physical abuse was likely involved, says Sue Smith, the team's coordinator. The five-member team evaluates child abuse cases that come through the hospital and an outpatient clinic. It also trains doctors to recognize signs of abuse and offers second opinions and consultations in suspected child abuse cases statewide through a contract with the Michigan Family Independence Agency.
      Cases of shaken babies, mostly infants under 1 year and typically under 3 months, are a small part of the team's case load: about 10 or 12 cases a year, Pomeranz says. But injuries caused when an adult severely shakes an infant, with or without impact against something, are among the most devastating, she argues. (The official term for such injury is "shaking-impact syndrome.") In about 30 percent of cases, the infant dies. Most who survive suffer lasting consequences of brain damage, including retardation, seizures, blindness and cerebral palsy.
      The few parents or caregivers who admit to baby-shaking say the trigger was almost always a baby's prolonged crying, Pomeranz says. "Parents who do this are frustrated, are at their wit's end. They have poor impulse control," she told attendees at a recent meeting of the Washtenaw County Bar Association and the Washtenaw County Medical Society. "Some say, 'I did it many times."'
      U-M neurologist and ophthalmologist Jonathan Trobe, who organized the symposium, frequently looks for the tell-tale signs of retinal bleeding in suspected shaken-baby cases. He describes a common scenario for abuse: An infant's mother goes back to work after three months, leaving her baby in the care of a boyfriend, who may not be the child's father. But he and Pomeranz say shaken babies live in a variety of circumstances. The abusers in some cases are well off and well educated.

Detective work, tough decisions
It's rare to get a true story from parents and other caregivers who have violently shaken a crying infant or angrily doused a screaming toddler in a tub of too-hot water -- often after a blowup over potty training. So when a child with suspicious bruises or burns is brought to the emergency room, a delicate task of sleuthing begins. Using brain and retinal scans, child abuse medical experts identify certain injuries as hallmarks of "shaken baby syndrome," though some trial attorneys hotly contest the validity of such evidence.
      At the symposium, the audience heard about the medical and legal issues raised in the story of 5-week-old Annie, a hypothetical case with details true to real cases local physicians and attorneys have dealt with. Emergency room staff saw Annie first when she was brought in with suspicious bruises on her face. They suspected abuse and called Children's Protective Services, a unit of the Family Independence Agency, as required by state law. CPS investigated and placed Annie in her grandparents' care. Three weeks later the parents, who had moved in with the grandparents, called 911 because Annie had "stiffened." At the ER, brain scans revealed hemorrhaging between her skull and brain. Annie had had a seizure, was in a coma and spent time in the ICU, apparently the victim of violent shaking. Her parents denied any abuse. When she was ready to leave the hospital, she and her older sister were placed in a foster home. The case spelled out for the group how difficult it is, even with officials and doctors alert to abuse, to protect a child in danger from further harm.
      Each abuse case is complex, and people involved in handling these cases are not of one mind on the placement issue. Children's Protective Services has to make difficult custody decisions, both temporary and long term. Should a child continue to live at home with measures like parenting classes and outside monitoring to stem possible further abuse, or be placed in long-term foster care? Parents' emotions can run high when a child is placed in foster care. At the hospital, social workers on the Child Protection Team have the difficult task of preparing parents and trying to defuse tensions when custody is transferred.

Dilemma: How to protect kids
The U-M team sees cases of possible abuse in which it's very hard to determine what has happened. "The ones that keep me awake at night are the ones where I'm not sure," says Pomeranz. "You don't want to separate a child from its parents." But she feels frustrated in other cases when she feels the evidence of physical abuse is clear-cut, but a child continues living with a parent strongly suspected of the abuse or is placed with relatives who may not protect the child from the abuser. Too often, she says, abuse occurs again.
      Pomeranz feels strongly that foster care placements should occur when a child's risk of further injury at home seems likely, even if the perpetrator can't be identified. Quite often abuse cases don't get tried in criminal court, because no one confesses, no witnesses are present at the abuse and many times the victims are too young to talk. "If you don't know if it's mom or dad, don't put the kid back in the home," she says. She feels at odds in this regard with judges who rule on custody, whom she describes as "incredibly reluctant to terminate parental rights." She feels that most children who have been abused are safer in foster care, though she admits "it's not a perfect system."
      Pomeranz calls physical abuse of children "a huge health problem in our country" that doesn't receive the attention and resources that conditions like childhood cancer or AIDS do. She says physical abuse shows no signs of declining, in contrast to child sexual abuse, where the incidence has been dropping, for reasons unknown, in the last decade. "We absolutely as a society pay for it in enormous ways, not just monetarily," she says, when physically abused children grow up to be felons, for instance. "Unless we face this problem and fight it, it's going to continue."

The Election's Over. Are You Still Losing It?
Damien Cave, New York Times- 11/7/2004

Steven Stozney, a psychologist and anger specialist in Washington, began treating patients with political rage problems during the battle over President Bill Clinton's impeachment. After the presidential election on Tuesday, he started receiving calls once again from livid Democrats, including a Kerry campaign staff member who said she was furious with George W. Bush, and was taking it out on her husband. "These political families are collapsing at the finish line," said Dr. Stosny, the author of self-help books like "The Powerful Self." "They just can't take it anymore."
      Both political parties could probably use a little time on the couch just now: therapists say the 2004 campaign was one of the most disturbing, hate-filled contests on record. Voters on the left frequently admitted to fighting for Senator John Kerry's election simply because they wanted "anybody but Bush." Conservatives, on television and on Web sites, regularly impugned Mr. Kerry's patriotism and what they saw as his lack of core beliefs.
      Now, however, might be the time to kiss and make up. After all, medical studies have shown that anger can lead to heart disease. And it's hard to get anything done if you hate the people you work with. Who wants to live in a country filled with road-raging Volvo peaceniks and gay-marriage opponents who think "Will & Grace" recruits people to homosexuality?
      "If we just stay in this negative place, it will take a toll," said Dr. Redford B. Williams, director of the behavioral medicine research center at Duke University. "There's been a trauma here, and if we don't recover — if we continue to ruminate about it — there will be health and social consequences." Dr. Williams, an author of "Lifeskills," a guide to conflict prevention, offered a handful of ways to deal with negative emotion. Hitting a pillow is out; deep breathing is in. Suggestions for redirecting negative emotion toward constructive action — even writing a letter to Congress, as feeble as it may seem — now dominate the therapeutic literature.
      But such solutions may require an epic force of will. For some, the frustration has been building since the 1960's. Fred Siegel, a senior fellow at the Progressive Policy Institute, a centrist research center, said many Democrats were still reeling from the party's losses to Richard M. Nixon and Ronald Reagan. Many felt last week as if they were overdue for a win, after the Clinton impeachment fight, Mr. Bush's victory in 2000 and the rise of Arnold Schwarzenegger. The latest loss, he said, has given Democrats a sense of injustice bordering on the biblical. "This is Jacob and Esau," he said, citing the Old Testament story of the competing sons of Isaac. "Esau's sense of himself as the rightful heir was in some ways legitimate, and yet he didn't get the prize. How is that kind of resentment slaked?"
      The partisan divide tends to make the anger especially intractable. Consider the word "polarization." "It has two definitions," said Jonathan Lear, a professor of social thought at the University of Chicago, "One is the standard idea that both sides of the country have gone out to further extremes. But `polarized' sunglasses let in less of what's outside. Part of polarization is not taking in certain things." This blinding tendency tends to make the anger self-perpetuating. Each side bores in on the other's failures. Emotions are stirred to fever pitch; self-examination is lost.
      No one, apparently, is immune. Peter Wolson, a psychoanalyst in Beverly Hills, Calif., said that several colleagues at a recent conference accused the Bush administration of being intolerant and fascistic while "they themselves were vilifying the Republican Party en masse." "It was irrational black-and-white splitting," he said. "The good and bad guys. For the Democrats the `evildoers' became the Republicans."
      Anger may feel justified and to a degree righteous after a political loss. But consider the health consequences. Several studies have connected anger with an increase in the risk of heart disease. One landmark report that tracked 13,000 patients, published in the journal Circulation in 2000, found that participants with high anger traits were nearly three times more likely to suffer heart attacks or require bypass surgery than those with less. "If any election had the potential to activate this health-damaging tendency," said Dr. Williams of Duke, "this would be it."
      Luckily for the Incredible Hulks in the population, who could explode at any moment with comic-book intensity, there are ways to manage anger. Therapists vary their focus, but all seem to agree on what not to do. Forget throwing darts at a picture of the candidate you loathe, for example, or punching a pillow. Studies show that such violent actions "create a habit of being aggressive," Dr. Stosny said. "You're training your brain to be more offensive." Nor will it do any good to obsess about mistakes made by those outside your control, be they Mr. Kerry or the young voters who failed to turn out as expected. Alcohol, a depressant, will not help either.
      Rather, anger specialists said, Democrats ought to redirect their rage toward constructive action. Phil Towle, a performance coach whose intervention with the warring members of Metallica was the subject of a documentary film this year, said that emotional intensity can be valuable only when correctly focused. "One of the things we did with Metallica was help them understand that they could create music that had the edge but that was motivated by love and passion as opposed to disrespect or hate of each other," Mr. Towle said. "The people who lost or won — both parties really — need to take their energy and find a way to keep the anger alive through passion, through conviction, through belief." A first step: expanding the focus beyond electoral politics. "What you do is write letters to Congress," Mr. Towle said. "You change your own behavior. You change your own environment. You can take any of the issues that you care about and find a way to do something."
      Dr. Williams, in "Lifeskills," describes conversational tactics that can prevent conflicts that lead to outbursts. "The first is speaking clearly in ways that increase the likelihood your message will be heard," he said. "Wrong: `You just want to give a big tax break to your rich friends.' Better: `I'm concerned that giving 40 percent of the tax break to people making over $200,000 per year is unlikely to produce increased spending that we need to help the economy.' " Listening skills, he said, also help defuse ticking tempers. People should keep quiet till the other person finishes, "something Ann Coulter is constitutionally unable to do," he said, after admitting that he is a bit peeved himself about the election. Angry partisans should also appear interested in what those on the other side are saying. "When they finish, tell them what you have heard," he said, and stay open to opposing arguments. "Be prepared — only open to the possibility, you don't have to be changed — to be changed by what you hear."
      This of course assumes that furious Democrats want to talk politics at all. That may not be the case. Matt Aydelott, an academic administrator in Southern California, said he first started to feel the anger rise like bile when Florida's vote total tipped toward Mr. Bush. And by the next afternoon, despair and disbelief had curdled into rage. As he put it in an e-mail message during Mr. Kerry's concession speech, "I can't decide whether to cry or punch somebody in the face."

Vermont Police Trained in Dangers of Methamphetamine
Associated Press, 11/7/2004

RUTLAND, Vt. -- The Vermont State Police and a number of other state agencies are helping put together a training program to let train emergency workers about the dangers of methamphetamine. The drug is cheap, addictive and easy to make from legal ingredients. It also carries with it the dangers of an exploding lab, poisonous gas or chemical contamination from the production process. That's why the liquor control commission, the health department and the police academy are working with the state police to recognize the signs and dangers of methamphetamine labs. "It's an untraditional type program," said John D'Esposito, an investigator with the Vermont Department of Liquor Control, Education, Licensing and Enforcement, at the first training, held last month in Rutland. "This is a first responders safety piece for college security personnel, firefighters, rescue personnel. We should call it 'Be Safe,'" he said.
      The timing and location of the training were prompted by the June arrest of two Arkansas men accused of setting up the first meth lab in the state in years, according to Cynthia Taylor-Patch, training coordinator for the Vermont Criminal Justice Training Council. "A lot of the time these labs are discovered because they explode," Taylor-Patch said. "We haven't had any meth labs discovered in years and now there's been two discovered in Rutland County in the last year."
      Taylor-Patch said the state hoped to prevent problems that have plagued Western states. "It's a huge problem nationally and we've been sort of sheltered here, but we're perfect territory, unfortunately, because we're a rural state," she said.
      Regardless of where training programs go, Detective Michael Smith of the Vermont State Police, said methamphetamine production uses easily available, and potentially dangerous, chemicals. Smith hammered home the dangers inherent in methamphetamine labs with photos of chemical contaminants and exploded buildings at the training, counseling the first responders to resist instincts to go in and help. "All it really takes to make meth is a bowl, a grinder and a heat source," he said, recalling a training class he took where two boxes of Sudafed were transformed into $300 worth of methamphetamines. "It's very easy to make. Anything you need to make meth is legally available.

Canada Suit Seeks Aid for Autism Victims
Clifford Krauss, New York Times- 11/8/2004

VANCOUVER, British Columbia Nov. 6 - Beverley Sharpe wondered what was wrong when her 2-year-old daughter, Allison, did not talk. Something seemed askew when her child would not respond to a rolling ball but would find great pleasure from running her hands repetitively through a bowl of soaking beans. A diagnosis of autism resolved the mystery. But the Sharpes' marriage broke up and Ms. Sharpe was left to pay for Allison's intensive therapy on her own.
      Ms. Sharpe dug in her heels. She refurbished and rented out her garage and rented out several more rooms of her West Vancouver house to pay for the 36 hours of therapy Allison needed every week from four therapists, costing more than $1,400 a month. She also joined a group of parents with autistic children in filing a suit in 1998 seeking public financial aid to meet the children's needs. The case has since wound its way through the British Columbia provincial courts and has reached the Supreme Court of Canada to become one of the most important cases touching social policy to come before the high court in years.
      Provincial governments are now paying for some services for autistic children, but overall Canadian autistic children currently have fewer legal rights than American children with the same neurological disorder. The American children are entitled by federal legislation to receive educational therapy in their public schools, although services are spotty, depending on how well the local district complies.
      But if Ms. Sharpe gets her way, the Canadian rights for the autistic will leapfrog those in America with a health care entitlement that would cost the provinces several billion dollars a year. "This kid will get what she needs if I have to get a second job flipping hamburgers," said Ms. Sharpe, a 43-year-old government meat inspector, speaking of her daughter, who is now 10. "If you need a wheelchair in Canada you get it, if you need radiation you get it, if you are blind we have schools for you, but if you are autistic you get nothing. Why does my kid get nothing?"
      Ms. Sharpe and the other parents involved in the suit contend that they have a constitutional right to have their children's therapy entirely paid for by the government, just as a cancer patient is covered by the Canadian government health insurance system, which serves every citizen. Not to be equally covered, the parents contend, means their autistic children are being discriminated against in violation of the Charter of Rights and Freedoms, Canada's Bill of Rights.
      A decision is expected early next year, and it has the potential to open up a cascade of lawsuits from people with a variety of other disabilities not now covered, including dyslexia. That is why the autism case has stirred resistance from the provincial governments, which say they cannot afford the added burden to a health-care system that is already stretched financially and forcing many people to wait for services. "Demands always exceed resources, and choices have to be made," British Columbia's attorney general, Geoff Plant, said in an interview. "Government is better positioned through science and policy analysis to make these decisions than the courts are."
      Mr. Plant estimated that if all the autistic children in the province received the intensive therapy that parents like Ms. Sharpe say is required to give autistic people a chance to function independently, it would cost British Columbia more than $250 million annually, of a total health budget of $9 billion. He said if all 13,000 children with special needs in the province were similarly entitled, it could cost the province as much as $1.5 billion. "Health care funding would have to be radically reconceived," Mr. Plant concluded.
      The parents of the autistic children contend that intensive early therapy may be expensive, but not as expensive as sending autistic children to group homes, then institutionalizing them for the rest of their lives, as now often happens when they reach adulthood. Estimates of how many people in Canada are autistic vary. But as in the United States, the number of diagnoses of autism here is growing.
      Proponents of more intensive therapy for autistic children have embraced a treatment called Lovaas. It is named after O. Ivar Lovaas, the Norwegian-born psychologist working in the United States in the 1980's who pioneered it. The therapy concentrates on intensive one-on-one behavior-modification training using repetition and rewards.
      Canadian universities lag behind the United States in research and training therapists in this area, advocates for the autistic here say. They add that American parents have been more aggressive in using the courts to expand treatments for the disorder because they are better organized and they are better financed by charitable groups. But Canadian parents are catching up, and there are now more than 20 court cases in this far less litigious society.
      In one case, in the Ontario town of Pickering, parents of a severely autistic child have brought a case before a child-welfare judge accusing their local school board of child abuse for not providing a suitable educational program for their son. In another Ontario case, 29 families are suing the provincial government demanding that it pay for autism therapy beyond the age of 5. This year, the Newfoundland and Labrador Court of Appeal upheld a case involving a 6-year-old child, requiring the provincial government to eliminate waiting time for autism services. Here in British Columbia, a mother is suing the Abbotsford school district in the provincial Supreme Court for preventing a therapist she hired for her 7-year-old son from accompanying him to class. The mother contends that it caused him emotional and physical damage and forced his removal from school.
      Provincial governments are responding to the lawsuits by increasing funding for autism therapy. The British Columbia government in 2001 began offering families with autistic children under age 6 payments of $16,000 a year per child to purchase approved therapies and $5,000 a year for older autistic children. Ontario, the largest province, doubled financing for autism to $66 million this year. But it is the case now before the Supreme Court that has the most potential to lead to sweeping change because Canadians are entitled to reimbursement for most of their health needs.
      "If we can create this national right, every child with autism will have opportunities," said Sabrina Freeman, executive director of Families for Early Autism Treatment of British Columbia, whose daughter, Miki, is autistic. Miki, who is 16 and in the 11th grade, spun around, sang endlessly at the top of her lungs and twirled her feet incessantly as a toddler. Her family could not even take her to a restaurant or a library. After 13 years of Lovaas treatment, however, she is able to play six instruments and takes part in school jazz and concert bands at a fine arts school. Her mother hopes she will someday work in the recording arts field. "These kids are not a write-off," Ms. Freeman said. "Every child with autism has the right to an opportunity. It's their human right."

Scream at Your Own Risk (and Your Children's)
Bonnie Rothman Morris, New York Times- 11/9/2004

The thing about children is that sometimes they misbehave. They disobey. They talk back. They ignore their chores and fight with their siblings. Even the most patient parent can end up hollering. Indeed, yelling at children is so common in American households that most parents view it as an inevitable part of childrearing. But in some cases, researchers say, yelling can become a form of emotional abuse. And children whose parents consistently raise their voices or combine yelling with insults, criticism, ridicule or humiliation may suffer from depression, dips in self-esteem or demonstrate more aggression themselves.
      While physical abuse of children has been widely studied, child development specialists have in recent years begun to focus more attention on emotional abuse, which studies suggest can be equally harmful. In 2002, the American Academy of Pediatrics urged pediatricians to be aware of the risk factors of psychological maltreatment of children. The academy's report, based on numerous studies, said that "a chronic pattern of psychological maltreatment destroys a child's sense of self and personal safety.''
      Almost every parent yells at one time or another. A 2003 study by Dr. Murray A. Straus and Carolyn J. Field, published in The Journal of Marriage and Family, found that 88 percent of the 991 families interviewed reported shouting, yelling or screaming at their children in the previous year. Of the families with 7-year-old children, 98 percent reported having yelled. In another study, not yet published, Dr. George Holden at the University of Texas and his colleagues followed 132 parents and their newborn infants over four years. Thirty-five percent of the parents reported yelling at their children before they were 1. By the time the children were 4, 93 percent said they had.
      Not all children suffer as a result. Researchers say that content and context matter. The tone, what is said and the frequency can mitigate or exacerbate its effects. "The difference comes in how the yelling is used," said Bonnie Harris, a parent educator in Peterborough, N.H., and author of "When Your Kids Push Your Buttons: And What You Can Do About It." "Is it blaming and shaming?" she asked. "If the child is being held responsible for the parent's feelings and behavior, then the yelling can have a deleterious effect. "But not if the parent is just venting without blame, saying, 'I am really angry, I can't stand this anymore,' " Mrs. Harris said. "You have just as much right to your emotions as your children do."
      Researchers are trying to codify the definition of emotional abuse while, at the same time, understanding more about its effects. A study in the July 2001 issue of The American Journal of Psychiatry that compared 49 subjects with depersonalization disorder with 26 emotionally healthy subjects, found that emotional abuse was the most significant predictor of mental illness, more so than sexual and physical abuse.
      Dr. Straus, director of the Family Research Laboratory at the University of New Hampshire, said yelling could set a bad example for children that affects the way they handle social interactions later on. "Yelling sets the tone for family relationships that carry over for dating relationships where you get a lot of psychological aggression," Dr. Straus said.
      Still, in the context of a supportive family environment, raised voices do not necessarily signal trouble, a study published last summer in The Journal of Emotional Abuse says. "Other familial factors (particularly, having an emotionally warm and close relationship with at least one parent) appear to ameliorate the potential negative effects and also, to play a greater role in long-term psychological outcomes than yelling or other forms of aggressive acts," Dr. Anupama Sharma, assistant professor of psychology at Eastern Illinois University and a co-author of the study, said in an e-mail message.
      Some experts even say that yelling can be useful, teaching children about failures in a safe environment. "Children have to understand that we as parents are not perfect and every once in a while we lose it," said Dr. Bennett Leventhal, director of child and adolescent psychiatry at the University of Chicago. "It's far better to understand at home that sometimes people get beyond their limit."
      But as most parents can testify, screaming at children is often not effective. "Yelling overpowers children, it makes them feel frustrated and angry, and what can happen is that after a while kids become immune to being yelled at. They tune it out," said Dr. Myrna B. Shure, a professor of psychology at Drexel University, who conducted a five-year study, financed by the National Institute of Mental Health, of children from kindergarten to fourth grade.
      The yelling can also make parents feel worse. Jen Sayre, a mother of three from Rockingham County, N.H., said she hated yelling at her children. "I feel so sad and out of control when I'm yelling and I'm mad at myself," she said. Mrs. Sayre does not yell often, she said, because she and her husband took workshops with Mrs. Harris to help them be more effective parents. That was four years ago. Today, on the rare occasion that Mrs. Harris raises her voice, a child pipes up and puts her in her place. "My kids will look at me now and say, 'Mommy, this is your issue, you need to work on that," Mrs. Sayre said. "I try everything I can do not to yell, but when I do yell, I apologize."

Patients At St. Elizabeth's 'In Peril,' Report Says
Henri E. Cauvin, Washington Post- 11/9/2004

A watchdog group has found that St. Elizabeths Hospital, the District's psychiatric facility, is seriously understaffed and that "patients' lives are in peril." University Legal Services, a city-designated watchdog agency for people with disabilities, found that many hospital employees, particularly nurses, had to work excessive overtime to make up for the staffing shortage -- even as many wards in the Southeast Washington facility have been crowded. Inadequate staffing, a shortage of resources and a deficient quality assurance program "have resulted in serious injury to patients and staff, as well as several recent patient deaths," the agency said in a newly released report. "Patients' lives are in peril," the report concludes. " . . . The community and the consumers deserve a mental health hospital with a safe, sanitary and therapeutic environment that fosters healing."
      Martha B. Knisley, director of the Department of Mental Health, which oversees St. Elizabeths, said the hospital has been moving aggressively to remedy the crowding and staffing problems. In a letter sent yesterday to University Legal Services, Anne M. Sturtz, the Mental Health Department's general counsel, said the agency had agreed to convene a panel of outside experts to develop a plan to improve St. Elizabeths.
      University Legal Services began examining conditions in spring, when two patient-on-patient attacks brought to light bigger troubles at the aging hospital. Its report comes in the wake of other investigations into care by District and federal officials. A 55-year-old patient was stomped into a coma by another patient, and a few weeks later, a 76-year-old patient was beaten by another patient and died. The Department of Mental Health immediately began examining the violent events, as did the D.C. inspector general's office. In June, the federal Centers for Medicare and Medicaid Services began an audit of the hospital. The inspector general's investigation is continuing but the other probes are done, and the results appear to reflect many concerns cited by University Legal Services.
      Even with the routine overtime, the hospital has not provided minimal staffing in some wards, federal investigators found. A sampling of records by federal investigators found that almost none of the patients had appropriate treatment plans, and a spot-check of wards found that many patients are left to idle away their days, with little constructive activity or interaction.
      Knisley said yesterday that the hospital is making progress. The number of patients, which reached 570 in April, is down to 455, and should be at 400 by July, she said. As part of her department's expanding community care program, many people who would have been admitted are now being cared for as outpatients in neighborhood facilities. "We did have a serious problem in the spring," Knisley said. "Many things have changed since then.
     It was only a couple of years ago that St. Elizabeths emerged from court supervision, and its record since then has drawn criticism from the inspector general and University Legal Services. The death of the patient last spring dramatized the most glaring deficiencies, University Legal Services said in the report, written by staff attorney Robin Thorner and consultant Andrea Procaccino.
      Willie Fraley, 76, was beaten April 21 by fellow patient Jessie Fields, 60, in a dispute over Fraley's habit of hoarding other patients' clothes, according to prosecutors and mental health department investigators. Fraley, whose son said she had been threatened repeatedly by Fields, died a short time later. Hospital staff members told investigators that the woman's son never complained about threats. Fraley died of a heart attack, according to the D.C. medical examiner's office, but the beating was cited as a contributing factor and the death was classified a homicide. Fields is charged with murder, but her competency to stand trial is being evaluated. The Department of Mental Health said that the death was a "tragic accident, not murder" and could not have been prevented, even if the employees on duty that day had been doing their jobs exactly as they were supposed to.
      But what all of the reports make clear is that the employees did not perform as expected. The Department of Mental Health's investigators found that the St. Elizabeths employees on duty in that ward were not monitoring the 21 patients in the day room and did not see the argument as it developed or grew physical. It was not until Fraley had been knocked to the floor and was unconscious that some employees became aware of a problem. The ward's nurse had to be summoned three times and did not give investigators a reason for not responding sooner.
      University Legal Services alleged that poor care contributed to other deaths at the hospital. In two other cases, patients died because the physical therapy they needed was discontinued or never even started, the watchdog group said. Knisley said that she did not have any "final information," but that nothing she had learned so far indicated that the lack of physical therapy caused either death.

Program Aims to Get Drug Users Off Street and out of Jail
Kery Murakami, Seattle Post-Intelligencer- 11/9/2004

The woman slumped on the sidewalk under an ATM in Belltown looked to be in her 40s but was probably a decade younger. She protested vigorously to the six officers standing over her at 5 a.m. that she hadn't been shooting heroin. The syringe at her feet told a different story. When one of the officers pointed it out to her, she dissolved in sobs and moans. "I don't want to go to jail," she said. The unusual collection of Seattle police and state corrections officers listened, almost awkwardly. "I hate this life," she wailed. "I'm so humiliated." Seattle police Officer Tom Burns interrupted in a loud voice -- not out of anger but to be heard over her cries. "Listen!" he said. "We're not going to arrest you."
      The woman's fears may have been understandable considering the circumstances, but she was having a brush with a joint police and Corrections Department program that Seattle Mayor Greg Nickels and state officials want to expand from downtown to the rest of the city by the end of the year. The program's emphasis isn't to throw people behind bars but to push them to take the steps courts have ordered to help them break free from a life of crime.
      Relatively small numbers of people cause a disproportionate amount of trouble, police have found. Trying to break the cycle, officers cruise the streets in a gray van looking for people like the woman at the automated teller machine, whom veteran corrections officer Leslie Mills recognized as someone who's had problems with drugs. The program targets people who are allowed to be out on the streets under certain conditions, such as going to treatment or staying out of known drug areas or, in the case of convicted shoplifters, keeping away from the downtown shopping district.
      Dubbed the "neighborhood corrections initiative" and started seven years ago on an informal basis, the program frequently casts officers in the role of social workers, cajoling past offenders to stick with their court-ordered drug treatment or stay sober. The approach has been applauded by downtown residents tired of drug dealing on street corners. It's also raised concerns that people could be stopped for doing nothing but walking down the street. Often it involves giving people caught violating a court order a choice: clean up or go back to jail.
      The morning officers drove by and recognized the woman by the ATM machine, Mills tapped her name into the computer on her lap. She saw that the woman, who'd been convicted on a drug charge, had been going to treatment as ordered. But she wasn't supposed to be sitting on a sidewalk shooting heroin. Locking her up again would exacerbate overcrowding at the King County Jail and just cost taxpayers money, Mills said. And there was no guarantee a jail stay would help her kick drugs. It was better, Mills said, to prod the woman to get clean.
      Though the idea is not to put people in already overcrowded jails, the officers do take them off the streets, putting them to work cleaning up litter around the city for a day. But by the time the officers met the woman, the van was already filled with others they'd picked up. So the officers left her with the warning -- and took her drugs and needle away. And they let her know that if she wasn't on track the next time they met, they would take her to jail.

Dealing with 'frequent fliers'
Before downtown police and state corrections officers began working together, understaffed corrections officers had a difficult time making sure convicted criminals were taking the steps the courts had ordered. Police officers who encountered the criminals had no idea they weren't supposed to be hanging out on certain corners, or that they'd been blowing off drug counseling. What followed was the revolving door of the same prisoners -- mostly low-level criminals causing a nuisance for neighborhoods -- circling back and forth between jail and the street corners, said Capt. Linda Pierce, commander of the Seattle Police Department's West Precinct, which covers downtown and Belltown.
      Seattle police officers say working with corrections officers has given them another tool to get off the streets people they suspect of committing crimes. They ordinarily cannot detain known dealers they see hanging out on a drug corner, or order them to leave the area, unless they can catch them committing a crime. But if they know that the courts have ordered the person hanging out on the corner not to be there, or that they'd failed their court-required drug test, they could send them off to a work crew, or warn them to leave before they get arrested. The effort is part of Nickels' approach for eliminating drug corners in the city.
    The unit includes veteran downtown officers such as Victor Maes, who's walked or biked the beat downtown for 16 years, or Burns, who patrols downtown by bicycle with his partner, Randy Jokela. (They're known on the streets as Joker and Burns.) Burns knows most past offenders in the area by sight.
      The program makes some nervous, including University of Washington sociology professor Kate Beckett. Beckett staffs a project run by the Washington Defender Association, which is studying the disparity between minorities and whites going to jail. In a broader context, she said, Seattle has been going overboard trying to clean up drug corners. She said a case in point is the city's recent resurrection of SODA, or Stay Out of Drug Areas. Low-level drug offenders sentenced through the county drug court -- which steers people toward drug rehabilitation instead of jail -- are ordered to stay out of these known drug areas. Beckett worries SODA will lead to more people being jailed, because often the dealers live in the drug areas and can't avoid being there. In some cases, people have been arrested for simply waiting for the bus. Beckett said she has no objections if the joint police-corrections program really is designed to help people turn their lives around. But given the push to clean up street corners, she worries overzealous cops will be inclined to put more and more people behind bars.
      An African American woman the police found hanging out on Stewart Street and Sixth Avenue at 4:30 a.m. with a few other people complained that she shouldn't be stopped by the police for being on the street. "Why are you out here?" Mills asked her. "Because I'm a citizen of the United States," she said. When Mills suggested that the woman might not want to hang out with the middle-of-the-night crowd if she wanted to avoid trouble, the woman said, "These are my people. The dregs of society."
      Despite the concerns about personal freedoms, the program has been hailed by downtown residents tired of the open-air drug market. "Our neighborhood is better," said Carol Jordan, who's on the West Precinct's citizen advisory board. "One thing we have now is we can point out the people who are causing chronic problems."
      Mark Dalton, supervisor of the state Department of Social and Health Services' Belltown office, who rode with the officers, compared them to social workers. "They'd see someone who was obviously intoxicated and they'd get right in their face and say, 'You look terrible. What happened?' The person they'd stopped would come back with something lame, and they'd be like, 'I don't want to hear that. I want to hear how you're going to do well.' I was impressed that they gave them choices. 'You can go to jail right now, or we can go to Harborview and see if we can get you into a detox clinic.' They're saving lives literally." City Council members also praise the program. City Councilman Jim Compton, who rode along with the unit a couple of years ago, said: "It's a hell of a good program. They deal with the frequent fliers."

'Get it together'
Riding in the van, Mills said a lot of the people associated with the program have been in law enforcement for a long time and welcomed trying to get to the sources of crime. "Ultimately it's about breaking cycles," she said.
      A few days after the early morning rounds, Joker and Burns were back patrolling Third Avenue and Pike Street on their bicycles. A young man said he was waiting on the corner while his girlfriend shopped "because I don't like shopping." But the officers had noticed him roaming around downtown all day, and a check on his corrections records found he'd violated the terms of his release by failing a drug test. They warned him to leave. He stuck around, so they took him to jail. The man was upset. He'd gotten a job, he said. He'd been checking in with his probation officer every day. Burns said it was true he hadn't seen him doing anything illegal. But hanging out downtown, Burns said, could only lead to trouble. "I could just do nothing and just wait for you to do something and throw in you in jail," Burns told him. "But the only reason I'm on you is I want you to get it together. "Dude, you really have to get it together."