Critics Unjustly Criticize Electroconvulsive Therapy
Daniel Maixner & David Knesper, Ann Arbor News- 2/19/2004

In recent weeks the Ann Arbor News has published two articles regarding electroconvulsive therapy (ECT). One was published on Jan. 1 and appeared in the editorial section. There, Larry Allen objected strongly to court-ordered ECT. The other was a syndicated article from the Los Angeles Times, which ran Dec. 17, that was opposed to the use of ECT as a treatment for any psychiatric illness. At this time, we want to educate the public about the paramount importance of ECT for the treatment of serious mental illness.
     Our perspective is clear. We are physicians caring for people with some of the most serious and treatment-resistant forms of mental illness: depression, bipolar disorder, and schizophrenia are examples. What is not clear in Allen's piece is his affiliation. Allen's article does mention that he is the Michigan director of the Citizen's Commission on Human Rights, but it does not indicate that his group was formed by the Church of Scientology in 1969 and that both groups have a history of antagonism toward ECT and psychiatry's biological approaches to treatment. On its Web site, CCHR features an exhibit titled "Psychiatry Kills"; this exhibit is front and center in its Los Angeles headquarters. CCHR publishes material stating "Electroconvulsive Therapy - Pain and Fraud in the Name of Therapy."
     Readers need to be aware that anti-psychiatry groups exist and that their advocates do not necessarily disclose their biases. ECT is not (even if court-ordered in rare cases) a cruel procedure used by conniving physicians conspiring with the legal system to harm patients. We also do not use ECT for "bad behavior," as insinuated by Allen.
     What exactly is ECT? A brief electrical pulse is applied (usually two to three times a week for a total of six to 12 treatments) to the scalp, inducing a brief seizure while the patient is under anesthesia. ECT reverses the course of severe mental illness. ECT is not violent or dramatic as portrayed often in movies and popular culture. Patients are asleep and relaxed.
     Like any medical procedure, ECT does have certain risks. For example, there may be memory deficits during the treatment period, and there is a variable loss of memory for recent (two-to-six months before treatment) past events. In rare cases, patients have amnesia for memories that go back farther than a few months. For many people, memory is already impaired due to severe depression. When the depression improves so does memory.
     The risk of death is also cited often by opponents as a major risk with ECT; however, the scientific literature documents that ECT is extremely safe. The University of Michigan Medical Center and most major academic medical centers administer ECT for Food and Drug Administration (FDA)-approved purposes. Tens of thousands of people each year receive ECT safely, including the elderly and patients with serious medical problems. ECT is so safe that it is now largely administered on an outpatient basis.
Patients benefit from ECT because it stops and reverses what otherwise would be a protracted mental illness episode. Scientific evidence finds that the longer someone experiences a severe episode of depression, mania, or psychosis, the more likely that the illness may be resistant to treatment and/or become chronic and incapacitating.
     Who receives ECT? Each year, about 100,000 people in the U.S. receive ECT. The majority of cases are patients with severe and disabling depression. This type of depression has not responded to antidepressant medications or psychotherapy, has persisted often for many months or years, has wreaked havoc in that person's life, and decimated families. Others may be so severely depressed, psychotic, or manic that they shut down totally. They stop eating, become unresponsive, and are at risk for death. In the most severe medical situations, the person is so confused and incompetent that a family member must serve as legal guardian and consent to ECT when it is medically necessary.
     In rare cases, physicians will ask the probate court to order treatment. The Michigan Mental Health Code allows this specifically. Although Allen highlighted two cases in the last four years where court-ordered ECT was vacated by an appeals process, those decisions are unrelated to the medical appropriateness of the recommendation for ECT. When a person is judged to be a danger to himself or herself or to others, and suffers from a severe mental illness, the Michigan Mental Health Code allows the probate court to order the administration of medications or ECT A pure Libertarian viewpoint would find court-ordered treatment of any kind to be an atrocity. But these same libertarians are also advocating letting people suffer, and allowing people to commit suicide even though their illnesses would respond to and improve with readily available medical
treatments. If a family has a loved one who is so delirious and disorganized that he or she refuses life-saving antibiotics, the family would surely insist that their bacteria-ravaged loved one receive antibiotics. The same consideration must be given to someone who has a brain illness.
     ECT has been used for 65 years, and the reason ECT does not disappear is because it works. Patients recover from severe illness. ECT saves lives and drives symptoms of mental illness into remission. For a very few critics, ECT is a punishment for misbehavior and a negative means to force behavior changes. This is ridiculous. If the general public could see the dramatic improvements in people's lives that we witness everyday, its stigmatized view of ECT would evaporate.

Daniel F. Maixner is director of the ECT Program and David J. Knesper is director of the Hospital and Community Psychiatry Section in the Department of Psychiatry at the University of Michigan.

Livingston County Mental Health Services Demand Growing
Lisa Carolin, Ann Arbor News- 2/20/2004

When Angus "Mac" Miller came to work for Community Mental Health in Livingston County in 1977, the population of the county was 65,000. Today the population has more than doubled and growth has turned the county substantially more suburban than rural. Miller also has seen the services his agency provides mushroom along with his budget. "In 1977, we had 20 employees, a $1.5 million budget, and we provided outpatient services primarily," says Miller. "Now we have 200 employees and a budget in excess of $16 million. We do outpatient care, case management, residential services, psychiatric hospitalizations, and manage the majority of Medicaid-funded mental health services. The demand is higher, our services are broader, and the finances are more complex."
     "Before John F. Kennedy was president, private mental health care facilities were just for people with money. Everyone else went to state facilities, and the length of stay was measured in years."
Miller says that in 1987, a full management concept was adopted in the county, which meant accepting responsibility for Livingston County clients anywhere in the state system. Mental health services became more available in the communities where people lived. People were able to move out of state hospitals and back into their communities. Mental health patients now live more independently. Some get medication services at their homes, and others with developmental disabilities can live in group homes that specialize in adult foster care. There is a facility called the Clubhouse in Fowlerville where disabled people can build employment skills and engage in social activities. "We now provide more support in the community," says Miller. "The key is that you have to carry through with good support services and good housing."
     Why the increase in the number of people diagnosed with developmental disabilities? Miller said that more people and many more children are diagnosed now because health professionals are better at identifying disabilities and there's not as much stigma so more people come forward and seek help. He says treatment comes after a problem has occurred and a condition has been diagnosed. "We try to provide prevention services," says Miller. " A child's success in school can predict criminal behavior. We need to intervene early in childhood whether it's with the family setting or the child himself."
     Miller says that the Parent-Infant Program has met with a lot of success. Families are referred to the program by doctors and social workers. Problems range from post-partum depression and problems in the bonding process to profound emotional development problems of the child.
Miller was almost born into his profession. Both of his parents were social workers who worked in state hospitals. He also had a great-uncle who was a patient at the state hospital in Pontiac. He received a bachelor's degree in psychology from Kalamazoo College and a master's degree in social work from the University of Michigan. From 1973-77, Miller worked at Kalamazoo State Hospital on and off as a psychologist and social worker. "The job was rewarding and challenging and discouraging," says Miller. "There were adults at the hospital who had been there for 15 years and had burned all their bridges. The hospital was their life, and it was difficult to be helpful. The adolescents in the children's unit were remarkable. They had profound problems but were open to intervention. I wanted to work with people who were still in the community and had family, friends and assets."
     One of the most rewarding parts of his job is having people who were in state hospitals now working in Livingston County. Miller began working for Community Mental Health in Livingston County in 1977 as an outpatient therapist for adults and kids. He also married his Iranian-born wife, Mandana, that year. The two met at U-M's School of Social Work. Mandana ran a shelter home for the county and now owns Heirloom Oriental Rugs in Brighton.
     In 1982, Miller became the program director supervising outpatient services and emergency services. He was hired by the Community Mental Health Board as executive director in 1986. The board is made up of 12 members, including at least three who have been consumers of mental health services themselves or who have a family member who has.
     Probate Judge Susan L. Reck, a former CMH board member, says Miller has been instrumental in starting the county's human services collaborative body and "getting agreements among agencies that result in pooled funding" which has improved the lives of people living in the county. Miller wants to see society less focused on repair and more focused on preventive maintenance. He says that too often people identify the illness more than the person. "Part of my passion for community mental health relates to the fact that there should be a life for everybody in this community, and Livingston County should embrace all of its residents and help them to find a meaningful life."
     Jeanette Freeland, administrative analyst at the Family Independence Agency, has worked with Miller and CMH for many years. "He is a remarkable man, an absolute delight to work with, and he has a rare combination of qualities. He is incredibly optimistic but very practical and attuned to good business practices. He can find a strength or a positive in just about any situation. His mantra is to always assume positive intent."
     Community Mental Health Services of Livingston County is at 2280 E. Grand River Ave., in the county's east complex in Genoa Township. Visit or call the center at (517) 546-4126. Starting this week, a family and community training series is being offered for 10 weekly sessions on Wednesdays from 6 p.m.-7:30 p.m. at the CMH building. There is no cost and the purpose is to provide education and support to families who are struggling to deal with mental illness.

Illinois Mental Health Experts Wary of Losing Center
Karen Mellen & Stanley Ziemba, Chicago Tribune- 2/20/2004

A day after the governor announced plans to close the state mental health center in Tinley Park, officials said they have just begun planning how to move patients out of the 140-bed facility. Advocates for the mentally ill, who have long complained that the stigma of the illness makes mental health services the stepchild of the health-care system, said Thursday they are concerned that the move by Gov. Rod Blagojevich will strain an already stretched system.
      Others said they will reserve judgment until they see what the Department of Human Services suggests will take the place of Tinley Park Mental Health Center. According to the governor's plan, the center would receive $23.8 million to operate during fiscal 2005 and then close in mid-2005. "The danger here is, we've had state closings where no money was transferred into the community," said Frank Anselmo, head of Community Behavioral Health Care Association, a Springfield-based trade association for community providers. "If it's done poorly, it turns into tragedy. If it's done properly, it's something everybody can support."
      About one-third of the patients at the Tinley Park center have been there more than a year. One patient has lived there more than 30 years. Patients requiring lengthy stays would be transferred to other state hospitals, officials said. The average stay for patients discharged in 2003 was 22 days, and mental health experts say new drugs to treat depression, bipolar disorder and other conditions mean more people can live in the community.
      To that end, patients could be offered counseling, crisis intervention, affordable housing and other support services, said Tracey Scruggs, spokeswoman for the Department of Human Services. She could not provide a plan or the cost, saying that state officials would reach out to providers and advocacy groups before deciding anything. Part of the arrangements could include contracting with local hospitals to provide in-patient care for the mostly indigent state patients, Scruggs said.
      But John Rowley, vice president of the south-suburban branch of National Alliance for the Mentally Ill, said there already is a shortage of psychiatric hospital beds in the area. Having a hospital devoted to patients with mental illnesses was a great resource for many, from police officers who would pick someone up to local hospitals with no psychiatric units. "There has to be a place for people to go," Rowley said.
      Suzanne Andriukaitis, executive director of NAMI of Greater Chicago, said she was frustrated because the governor made a decision on closing the facility with no plan for how to ensure patients will receive care. She said without support services, there could be other costs to society from people who do not receive adequate treatment. "I'd like to go down to the governor and say, `Do you know what you're doing here, buddy? You're going to have to spend a lot more money on public services, police, fire, jails, prison,'" she said.
      The Tinley Park center has about 300 employees. State officials said the employees would be offered transfers. The hospital's capacity has been shrinking almost from its beginning. It was originally designed to be the state's main geriatric psychiatric institution, but the $35 million, 3,000-bed giant officials planned never materialized. When the center opened in 1958 on the northwest corner of Harlem Avenue and 183rd Street, it had 480 beds. By the early 1990s, as more community-based services and agencies were established, the number of patients was halved to about 250. In 1982 the state scrapped plans to house up to 150 criminally insane patients at the center because of "strong community opposition."
      When the state began closing some mental health institutions in 1997, Tinley Park officials began eyeing the hospital land near the Harlem Avenue interchange with Interstate Highway 80 and the Tinley Park Convention Center, which is considered a prime spot. In 1999 the village acquired 54 acres of state land on the west end of the hospital site in exchange for about $1 million worth of discounts on water and sewer fees at the mental health center. The village used the land to expand the parking lot for the Tinley Park Metra Station and for a new library.
      In the last two years, the village has approached the state several times about selling a large chunk of the land to ease state budget woes, Mayor Edward Zabrocki said. The village, he said, envisions commercial and residential development there. "We're looking at this as a positive step by the governor," Zabrocki said. "If this recommendation flies, it will definitely enhance that corner and the entire area. Development would also produce more tax dollars for our community and the state."

Researcher Says Children Need a Pat on the Back
Daniela Lamas, Knight Ridder News Service- 2/20/2004

Imagine going though the day without touch, without a casual hug, pat on the shoulder or even a handshake. This would be lonely. It might even be harmful, particularly for children. A growing body of research suggests that American children and adolescents are dangerously touch-deprived.
"It's a very serious problem. If monkeys are deprived of touch, they kill each other," said Tiffany Field, who directs the University of Miami's Touch Research Institute. The institute's studies have shown touch can reduce pain and stress hormones, alleviate symptoms of depression and help premature infants gain weight, among other benefits.
     But psychologists and school counselors say that, particularly with today's pervasive sexual abuse accusations, there are significant barriers to a large-scale shift in how Americans view touch.
"I think parents really need to make sure kids are getting some touch, a back rub before they go to bed or while they're doing their homework," Field said. "Even for adolescents -- they love their heads being rubbed, their backs being rubbed. It doesn't have to be anything more."
     One repercussion of the lack of human touch could be increased aggression, Field says.
Anthropological studies have documented that primitive cultures with less affectionate touch are more violent than geographically close cultures with more touching. With this premise, Field traveled to France, which has one of the lowest rates of adolescent male homicide. She observed preschool children on playgrounds with their parents and friends both in France and in Miami, and found that U.S. children touched less and were more aggressive. The preschoolers in Miami grabbed toys from their peers twice as often as the French children and quarreled more than seven times as much, while their parents touched them three times less frequently.
     And while this study doesn't prove that lack of touch increases aggression, Field said, monkey studies suggest one possible way this link might work. Monkeys who have been deprived of touch have shown a drop in the level of serotonin, she wrote. Their levels of cortisol increase, which makes them more agitated and aggressive. At the same time, massage therapy has been shown to lower the level of cortisol and increase the level of serotonin -- hence, a relationship between increased touch and decreased aggression. Field has studied teacher touching in classrooms, and she found that the amount of touching decreased as the children grew from infant to toddler to preschool age while the childrens' aggressive behaviors increased.

Addiction Medication Has a Slow Start in the U.S.
Daniel Costello, Los Angeles Times- 2/20/2004

An addiction medication heralded as a breakthrough because doctors can dispense it in their offices has failed so far to generate much enthusiasm among the nation's doctors. The tepid reaction to buprenorphine has disappointed some doctors and patient advocates who believe that the drug has the potential to coax reluctant addicts into treatment. The drug received federal approval more than a year ago.
      Buprenorphine is an opiate substitute and can be used by people addicted to heroin, prescription painkillers such as Vicodin and OxyContin, and other opiates. It is the first of the addiction medications doctors could begin dispensing in their offices during the next few years. Prescription medications for alcohol and cocaine addicts are under development or are being reviewed by the Food and Drug Administration.
      According to the National Institute for Drug Abuse, there are more than 1 million opiate addicts in the United States and that number is rising. Some of the reasons include the large number of Americans, from baby boomers to the elderly, who are getting hooked on medication for chronic pain, as well as a growing and illegal trade of narcotics on the Internet. "We're seeing less interest than we expected, especially among primary care physicians," says Robert Lubran, director of the division of pharmacologic therapies at the U.S. Department of Health and Human Services.
      Only a few thousand addicts across the country are using buprenorphine, according to estimates, a much smaller number than expected before the drug's approval. By comparison, France introduced the drug in 1995 and within four years had more than 60,000 patients. One major reason is that France's public health system is paying for the medication. Although a few U.S. insurers cover the drug's $250-a-month cost, most private insurers and state Medicaid programs for the poor, including California's Medi-Cal program, are not paying for buprenorphine. In California, the number of doctors who have signed up for the federal training required before they can dispense the drug also is fewer than anticipated: about 200 physicians.
      Last summer, a Boston University School of Public Health survey of doctors who have undergone federal training found that many physicians are facing hurdles in trying to dispense the drug. Anara Guard, the researcher who oversaw the survey, says many doctors reported that they couldn't get local pharmacies to stock buprenorphine, because the stores didn't feel there was a big enough demand or because they were apprehensive about having addicts as customers.
      Many doctors also said they were troubled by the idea of dispensing a narcotic to addicts and did not feel they had the resources in their offices to deal with patients who might be prone to volatile behavior. Doctors had been barred from dispensing narcotics to addicts since Congress enacted the Harrison Narcotic Law in 1914. Legislation passed by Congress in 2000 eased those rules. Another problem, some doctors said, is that federal health officials have set unreasonable limits on how many buprenorphine patients each doctor can treat. The current statute limits physicians practicing solo or in small or larger groups from treating more than 30 patients at one time. The result is that single practitioners and large-scale medical plans have the same limitations on the maximum number of patients who can be treated. Kaiser Permanente, one of California's largest health providers, with 7 million members statewide, says it has not started dispensing the drug because the 30-patient limit would make it impractical.
      Sen. Orrin G. Hatch (R-Utah) recently introduced a bill in Congress to exempt large group practices and academic medical centers from the limit. "The regulations around this drug are too cumbersome," says Dr. Judith Martin, an Oakland family physician who recently began treating two patients with buprenorphine. She says she is "extremely pleased" with the results so far. Some large medical providers and members of Congress are lobbying the health department to update the regulation. A spokesman for the drug's manufacturer, Reckitt Benckiser Inc., says sales are "lower than some original estimates" but that the company expects the numbers to increase rapidly over the next year.
      Research shows buprenorphine is safer than other medications such as methadone. Buprenorphine appears to lead to fewer overdoses, a major concern with any opiate or opiate substitute, and patients appear to experience fewer relapses. Buprenorphine is given on a short-term basis in detox centers or, more often, it's used as a maintenance medication. The orange-colored pill is taken daily by letting it dissolve under the patient's tongue. Unlike methadone, buprenorphine does not produce a sense of being high. Because of that, experts say the drug has a lower chance of being illegally sold on the street, which happens with many treatment medications.
      Still, the drug is not for everyone. It may not work with hard-core addicts who need a more potent medication to stave off severe withdrawal. And some primary care doctors unused to treating addicts say buprenorphine patients present unexpected challenges. Dr. Art Van Zee, of St. Charles, Va., a small Appalachian town that Van Zee says has been "destroyed" by OxyContin abuse, says he recently stopped writing 30-day prescriptions to new patients and now insists they stop by his clinic every day. Several addicts, he says, stopped taking the medication for weeks at a time when on their own. Van Zee remains hopeful about the drug's potential. "This is no magic bullet,'' he says, "but I am starting to believe it's better than anything else we've got."
      Lubran, of the Department of Health and Human Services, says the federal government will be heavily promoting buprenorphine during the next year by sponsoring more than 40 information sessions for doctors across the country. This spring, the department is sponsoring its first buprenorphine workshop in California for primary care doctors as part of the American Academy of Family Physicians annual conference in San Francisco.

Grain Allergy a Risk Factor for Schizophrenia, Study Says
Reuters News Service, 2/20/2004

LONDON -- Schizophrenia could be linked to an allergy to gluten, a protein found in wheat and other grains, scientists said Friday. Gluten intolerance, known as celiac disease, can erupt at any age but mostly affects people between 30 and 45, often causing weight loss, diarrhea and fatigue.
"A history of celiac disease is a risk factor for schizophrenia," the researchers wrote in an article for the British Medical Journal. The scientists recommended a gluten-free diet to treat celiac disease and said some clinical trials had shown that cutting out cereals also alleviated symptoms of schizophrenia.
      The study, a collaboration between Johns Hopkins medical institutions and Denmark's Aarhus Universities and Aarhus Psychiatric Hospital, tested 7,997 schizophrenic patients in a Danish psychiatric unit. The scientists stressed that the result reflected only a small proportion of cases since both diseases were rare. Last year, a study found a link between parental age and schizophrenia. Drug use has also been cited as a potential trigger for the mental illness.

British Journal Regrets Vaccine-Autism Link Study
Associated Press, 2/21/2004

LONDON - A leading medical journal said Saturday it should not have published a controversial 1998 study that claimed a link between childhood vaccinations and autism. The editor of the Lancet, Dr. Richard Horton, said Dr. Andrew Wakefield and a team of British scientists who conducted the study on the triple measles-mumps-rubella (MMR) vaccine didn't reveal that they were being paid by a legal aid service looking into whether families could sue over the immunizations. Horton called it a "fatal conflict of interest."
     Wakefield's study suggested that the MMR vaccine could put children at risk of autism a developmental disorder often arising in the first few years of life and inflammatory bowel disease.
The paper has since been discredited on scientific grounds, but some parents have clung to the findings and health officials say that vaccinations have fallen dangerously low since its publication.
Allegations to be published in The Sunday Times say Wakefield and his team at the Royal Free Hospital were being paid by the Legal Services Commission, a legal aid service which was considering whether families could sue over children believed damaged by the MMR injection.
"In my view, if we had known the conflict of interest Dr. Wakefield had in this work, I think that would have strongly affected the peer reviewers about the credibility of this work, and in my judgment it would have been rejected," Horton told the British Broadcasting Corp. Wakefield defended his study in a statement to the editors of The Lancet. "The clinical and pathological findings in these children stand as reported," he said. "My colleagues and I have acted at all times in the best medical interests of these children and will continue to do so." The Legal Services Commission could not be reached for comment.
     The allegations have led to calls for a public inquiry. Health Secretary John Reid said the General Medical Council, the health industry's watchdog, plans to mount an investigation "as a matter of urgency." Evan Harris, a lawmaker with the opposition Liberal Democrat party and a member of Parliament's science and technology committee, also called for an independent inquiry "given the importance attached to the work of the Royal Free Hospital group by the media in the MMR debate."

Lilly Warns of Zyprexa Risk for Elderly
Associated Pres, 2/21/2004

INDIANAPOLIS - Eli Lilly and Co. said it had warned doctors and psychiatrists that elderly patients suffering from dementia face a higher risk of stroke if they use the company's top-selling drug, the anti-psychotic Zyprexa. Lilly made the warning in a letter sent nationwide on Jan. 15 based on findings from recent clinical trials of Zyprexa, Lilly spokesman Dan Collins said Friday. The U.S. Food and Drug Administration did not require the warning, he said. "We felt it was important to be proactive in communicating this information about the increased risk of stroke in elderly patients with dementia-related psychoses," Collins said.
     That category of patients accounts for about 2 percent of total Zyprexa sales, he said. Clinical trials conducted to investigate whether to seek an FDA-approved indication for Zyprexa to treat that category of patients found those taking Zyprexa were more likely to suffer a stroke than those taking a placebo, Collins said. The Zyprexa patients also had a higher risk of death from all causes than those using a placebo.
     Zyprexa is not approved for use in elderly patients with dementia, although some doctors do use the drug on a so-called "off-label" basis to help such patients get through episodes of dementia.
Because of the test findings, Lilly will not seek FDA approval for a Zyprexa indication to treat older patients with dementia, Collins said.
     Introduced in 1996, Zyprexa now accounts for about a third of overall sales at Indianapolis-based Lilly, with Zyprexa sales last year reaching $4.3 billion Recently, the drug has come under competitive pressure because of the emergence of newer rivals Geodon and Abilify. Zyprexa also is undergoing a patent challenge. Lilly and generic companies that want to introduce generic knockoffs of Zyprexa concluded a three-week bench trial in Indianapolis last week, and a federal judge is expected to issue a ruling in coming months. Industry analysts have said they expect Lilly to prevail.
On Friday, Lilly shares closed down 18 cents at $72.47 on the New York Stock Exchange.
On the Net: Eli Lilly and Co. www.lilly.com

Gambling Addiction Nearly Tore a Family Apart
Sam Skolnik, Seattle Post-Intelligencer- 2/23/2004

DES MOINES -- Before he stepped into the Emerald Queen Casino in the summer of 2000, Eli Bunch had gambled only a few times. Briefly in Las Vegas in the late 1970s, when he lost about $20. Once, on a Caribbean cruise a few years back, netting $50 -- "enough to do a lot of laundry," he said. So Bunch, a former top manager at a prominent local company, didn't think twice about taking a brief, diversionary trip to "the boat," the casino on the Blair Waterway in Tacoma run by the Puyallup Tribe. He won $300 that day playing electronic slot machines. Days later, Bunch stopped in again. He hit it big, winning $3,000 from a $20 investment. "I stood there handing hundreds to my wife, and I was saying, 'All you've gotta do is go, and they give you money,' " said Bunch, 50.
     Those wins triggered the most devastating period in Eli's and Jody Bunch's lives. Within three months, Eli Bunch had lost his initial $3,000 winnings, and $3,000 more. He lost an additional $50,000 over the next six months. He took money out of his retirement fund and other investments. The tally through June 20, 2003 -- the day he quit gambling -- came to about $250,000. Because of a consuming dependence on slot machines, blackjack and other games of chance, he spent his savings, separated from his wife and nearly lost his house before he stopped. Along the way, Bunch briefly moved in with his elderly parents and "nearly destroyed" ties with his two grown daughters.
In April, Bunch said, he and his employer -- a company where he had built a 28-year career -- mutually agreed that he would leave, because of a number of issues related to his gambling. "Gambling became more important to me than my career, than relationships -- every relationship I had that was important," Eli said. He even stole his wife's credit card to quickly gin up gambling money.
     Jody and Eli Bunch, who is now a defense industry consultant, still live together. But they are legally separated. "In my head, we are married," said Jody Bunch, 50, a secretary for a construction management firm. "The legal separation, that's a financial protection, and I'm not willing to undo that." Jody Bunch said that in a fruitless effort to try to change her husband's habits, she would set deadlines for Eli to return home from his gambling binges before she locked him out by setting the burglar alarm. After those late-night deadlines came and went, Jody said, "I would set the alarm and leave a note on the front door saying, 'It's on,' and he didn't care. He would just sleep in his car until morning."
     At first, she found it difficult to understand the power of gambling. "I never used to believe in this whole 'addiction culture,' " she said. "I thought, 'Yeah, right, give me a break.' But, oh my goodness, I've learned a lot. It's incredible the hold gambling gets on you." Eli Bunch says he is recovering. He attends Gamblers Anonymous meetings, although not as regularly as both he and his wife say he should. And the couple has attended joint therapy for people with gambling problems and their spouses. "It's like a grand chase, like you're a race-car driver," Eli Bunch said. "But you just don't ever want to get out of the car -- whether you're ahead or behind."

To Get Help
Several resources are available for people who believe they have a gambling problem or know someone who does:
Gamblers Anonymous: 206-361-8413, or toll-free at 877-727-5050. www.gamblersanonymous.org
Gam-Anon, for family and friends of problem gamblers: toll-free at 877-727-5050. www.gam-anon.org

University Program Helps Autistic Students
Associated Press, 2/23/2004

HUNTINGTON, W.Va. -- Lowell Austin and his uncle, Howard, had a special bond. The man with the doctoral degree in artificial intelligence from the Massachusetts Institute of Technology and the boy with Asperger's Syndrome played ball together and roughhoused like friends. Lowell is advanced in some areas and far behind his peers on others -- hallmarks of his autism spectrum disorder that is characterized by normal intelligence and language skills, but marked deficiencies in social and communication abilities.
     When Howard Austin died in April 2001, his family wanted to create a memorial and turned to Marshall University. The family's only connection to Marshall was they had heard about its Autism Training Center and that it was in West Virginia. Howard Austin and his siblings grew up in Athens, Mercer County. With a $50,000 contribution, the family asked the center to create a program that could serve as a national model to help people with autism attend college. The family would later add $25,000. ``Marshall had all the parts of the puzzle,'' said Lowell's mother, Linda Austin. ``They just hadn't put it all together.''
     Although Lowell would become the program's first student, his father said the donation was made with no strings attached. ``There was no quid pro quo,'' said Larry Austin, an Alexandria, Va., lawyer and banker. ``We were happy when he was accepted, but it was not preordained. ``We wanted them to have the freedom to design the program as they saw fit,'' he said.
     What's been created since the 2002-03 school year is a program where Lowell and the two other students with Asperger's Syndrome are supported, not coddled. They are required to meet and maintain the university's academic standards. ``If I didn't have the support, I wouldn't have been where I am right now,'' said Lowell, a 19-year-old sophomore majoring in sports marketing.
No one knows how many college students have Asperger's Syndrome. Many go undiagnosed or are simply perceived as ``a little bit strange,'' said Lars Perner, an assistant professor of marketing at San Diego State University who has the disorder.
     And no one knows how many people in the general population have autism. Some studies suggest it might affect at least 40 per 10,000 U.S. children. That is 10 times higher than estimates a decade ago, which many scientists think reflects better diagnosis. The exact cause is unknown, although both genetics and environmental factors are suspected of playing a role. ``Some of these students might be able to get into college because of fairly strong academic credentials and a reasonable academic showing. That may not mean they will be able to stay in college,'' said Perner, author of a guide to selecting a college in a recent issue of ``Asperger's Digest.''
     As researchers learn more about autism and public school services for autism improve, more autistic students are graduating from high school academically prepared for college, said Kim Ramsey, who directs Marshall's program. ``The problem is, social and daily living issues are interfering.'' Marshall's program offers tutoring, individual counseling, a space to take tests away from distractions, help navigating the bureaucracy and social world of college and a lounge to hang out. Once students learn how to manage college life, they can use those skills to obtain and keep jobs. ``We see ourselves as safety net,'' Ramsey said.
     Lowell was the program's only student its first year. His experience was such a success that two more students were admitted this year: Andrew Reinhardt, 18, of Beckley and David Fair, 23, of Weirton. Lowell and Andrew are now excelling. David is having a more difficult time because, as he admits, he never studies.
     Stephen Shore, who is finishing his doctoral degree in special education at Boston University and has been diagnosed with ``atypical development with strong autistic tendencies,'' said there is a need for programs like Marshall's. ``In some ways, looking back on things, I realize now I made a lot of my own accommodations,'' said Shore, author of ``Beyond the Wall: Personal Experiences with Autism and Asperger Syndrome.'' He asked for extensions on tests, shared notes and bought notes from note taking services. People with autism spectrum disorders ``have been going to school for years on their own. ``I think they would do much better, there would be a much higher rate of success if this type of program were available. It is a needed thing,'' Shore said.
     Marshall's program may expand up to 10 students, but it will remain small by choice. The goal is not for all students with autism to attend Marshall, but for the program to become a model for other colleges, said center Director Barbara Becker-Cottrill. ``The true goal is for students to have the ability to attend the university of their choice. Our work will be working with other universities on how to establish a program such as this on their own campuses.'' Marshall may begin doing that as early as this fall, she said.
     The program has been a lifeline for Lowell, his family says. ``I have seen such a growth in him, his confidence, his ability to face a situation, ... his conversational skills,'' said his aunt, Ellen Austin Friend of Athens. He participates in clubs. He is the equipment manager for Marshall's football team. He lives in a dorm, without a roommate. ``Without the help, I wouldn't have made it to college,'' Lowell said. ``I wouldn't have lived like a normal student.''

Domestic Abuse Gets Attention of Washington Lawmakers
Jennifer Lloyd, Seattle Post-Intelligencer- 2/23/2004

OLYMPIA -- Bills dealing with domestic violence -- including measures spurred by the murder-suicide involving Tacoma police Chief David Brame -- are moving through the Legislature. The Senate endorsed two bills focusing on domestic-violence issues, while the House passed seven bills. Two companion measures stemming from Brame's fatal shooting in April of his wife, Crystal, are top priorities. House Bill 2392 and its twin, Senate Bill 6161, would require law enforcement agencies to adopt a model statewide policy or an individual policy for responding to allegations of domestic violence by their employees. The Washington Association of Sheriffs and Police Chiefs, along with representatives from law enforcement agencies and victims' rights organizations, would develop the model policy by Dec. 1. Agencies would have to adopt procedures by June 1, 2005, and train every employee on the domestic-violence protocol by June 30, 2006. The bills' sponsors, Rep. Pat Lantz, D-Gig Harbor, and Sen. Debbie Regala, D-Tacoma, represent districts at the epicenter of the Brame tragedy.
      "For me, there has been a degree of satisfaction that I took action and a positive step to make amends for what happened in the parking lot of my grocery store last April," said Lantz, a member of the state's Task Force on Officer-Involved Domestic Violence. "It is definitely a pioneering effort. No other state has adopted statewide minimum standards."
     On Thursday, the House Committee for Juvenile Justice and Family Law heard testimony on the Senate bill, a result of concern over the Brame incident. According to testimony Thursday, law enforcement agencies should have a clear policy for handling domestic-violence allegations against officers so that victims know what to expect during a police investigation.
     "In my case it was two whole months before they contacted me. That's a whole lot of time to wonder if they're investigating it, how they're investigating it, without talking to me," Heidi Collins testified. Her husband, an officer with an Eastside department, was charged last July with assaulting her. He returned to work in January after receiving a "stipulated order of continuance," not a guilty verdict, for a fourth-degree assault charge in King County District Court. He must undergo domestic-violence treatment. "This bill will eliminate a lot of the stress that comes from not knowing what is going to happen next, when or if anything is going to happen at all," Collins said.
     According to the 2002 Statewide Domestic Violence Comparison Report from the Washington Association of Sheriffs and Police Chiefs, 13.6 percent of all offenses were domestic-violence related. King County reported more than 11,000 domestic-violence offenses that year. A lobbyist for the Washington Council of Police and Sheriffs agreed that police departments should have a policy for dealing with domestic violence in their ranks. "We think it's important that all of our guilds have domestic violence policies," said Lee Reaves, spokesman for the council's more than 4,700 members.
     Both bills unanimously passed their houses of origin. Also on Thursday, the Senate Judiciary Committee heard testimony for another House bill regarding domestic violence. House Bill 2398 would require that the courts notify the victim at least five days before any hearing on changes in a protection order against an offender.
     Rep. Dave Upthegrove, D-Des Moines, sponsored the bill after the Washington State Coalition Against Domestic Violence brought to his attention several cases in which victims were not notified of protection-order changes. "We had one case where the petitioner had not known that her order had been changed and had allowed the abuser to come to the home to pick up his things," said Grace Huang, the coalition's public policy coordinator.
     The coalition discovered 12 cases in which the petitioner did not receive notice that his or her protection order had changed. Each year, the courts in Washington file about 18,000 protection orders and modify about 3,000 of those orders, according to Huang. "The goal of the legislation is to make sure the victims know when a protection order is being changed or modified," said Upthegrove. "Current law doesn't have tight enough requirements on serving notice."
     Committee members raised concerns over the amount of money required to enact this legislation. The estimated cost is $170,000 to city and county governments through 2009. "I think it's a great idea, but it's a huge fiscal impact on local governments at this time," said Sen. Mary Margaret Haugen, D-Camano Island. Judiciary Committee members will continue debating this issue next week.
Other domestic-violence related bills this session:
**House Bill 2397 and Senate Bill 6384 would allow courts to impose a penalty up to $100 on someone convicted of a domestic-violence crime. The penalties would help pay for domestic-violence programs.
**House Bill 1949 would allow the court, during a protection-order hearing, to require the accused to give temporary financial assistance to the alleged victim.
**Police officers would be prohibited from bringing a weapon into a court if the officer is there as a party in a harassment or domestic violence case by House Bill 2473.
**House Bill 2481 would tack $10 onto marriage-license fees for domestic-violence prevention programs.
**Victims of domestic violence, sexual assault or stalking will be able to terminate housing rental agreements without paying future months' rent if House Bill 1645 passes. Victims would still be obligated to pay rent for the month they break the rental agreement.



Meth Lab Plague Spreading
Fox Butterfield, New York Times- 2/23/2004

BOONE, N.C., Feb. 20 — Sandra Rupert, a counselor at an elementary school in this town tucked high up in the Blue Ridge Mountains, wondered last year about two sisters who were second and third graders. They had headaches, colds and coughs virtually every day. Sheriff Mark Shook found the explanation when he raided the children's home and discovered their mother and her boyfriend were cooking methamphetamine in the attic, next to where the girls slept. The girls were suffering from the toxic fumes emitted by the methamphetamine cooking, said Chad Slagle, a social worker with the Watauga County Child Protective Services Unit. They were removed immediately from the house and taken away from their mother. They had to leave without taking any of their clothes or toys, Mr. Slagle said, for fear of further contamination.
      The girls are among the young victims as methamphetamine has crossed the Mississippi and moved to the East Coast in the past few years. According to the Drug Enforcement Administration, small methamphetamine laboratories, known as mom and pop labs, are now being found in every state in the East. What makes the spread particularly worrisome is new evidence that children living in homes with laboratories face a health threat as hazardous as those who actually use the drug.
      A study released in January by the National Jewish Medical and Research Center in Denver, which specializes in respiratory illnesses, found that poisonous chemicals released in the methamphetamine cooking process spread throughout buildings where the cooking was being done. "The study showed that the chemicals are everywhere in the house and that children living in houses with meth labs might as well be taking the drug directly," said Michele Leonhart, the acting deputy administrator of the D.E.A., which helped finance the research.
      Last year, 8,000 illegal methamphetamine laboratories were seized nationwide, and 3,300 children were found in them, according to D.E.A. figures. In addition, 48 children were burned or injured and one was killed when methamphetamine laboratories caught on fire or exploded, as they sometimes do, the agency's statistics show. In Tennessee, which has the worst methamphetamine problem in the Southeast, 697 children were removed from their parents' custody and placed in foster homes over the past 18 months because they were living in places with methamphetamine laboratories, said Carla Aaron, a spokeswoman for the Tennessee Department of Children's Services. About the same number were placed with relatives who were not cooking methamphetamine, Ms. Aaron said.
      Here in Boone, a town of 22,000 in western North Carolina near the Tennessee border, 41 illegal methamphetamine laboratories have been seized in the past two years, and 17 children have been placed in foster homes or with other relatives, said Mr. Slagle, the social worker. "We had heard about meth for years, but it was always a West Coast problem," Mr. Slagle said. "So we were completely surprised when it hit us here."
      It is hard to compare the impact of different drugs. But given the harm methamphetamine does to children and the large amount of toxic waste cooking it creates — five pounds for every pound of methamphetamine — some law enforcement officials are now comparing the problem to the crack cocaine epidemic in the nation's big cities in the 1980's. "Meth makes crack look like child's play, both in terms of what it does to the body and how hard it is to get off," said Capt. Richard P. Nuzzo of the New York State Police. Mr. Nuzzo is a member of the New York State Contaminated Crime Scene Emergency Response Team, which deals with methamphetamine. The authorities in New York State found their first methamphetamine laboratory only in 1999, Captain Nuzzo said. By last year the number had climbed to 73, mostly upstate.
      Methamphetamine is an artificial stimulant that releases high levels of the neurotransmitter dopamine into the brain, producing euphoria and great energy, often lasting up to 12 hours. But it also leads to paranoia, delusions and memory loss, and over a period of time to physical decay like rotting teeth. There is debate among experts about how treatable methamphetamine addiction is. But most specialists believe it is one of the hardest to treat, requiring that a patient stay in treatment for up to two years.
      Cooking methamphetamine is an extremely toxic process, said Dr. Andrew Mason, a forensic toxicologist who lives in Boone. There are two common methods used in the mom and pop laboratories, and they both produce dangerous gasses and leave hazardous waste, Dr. Mason said. One method combines red phosphorous, usually taken from the strips on matchboxes; pseudoephedrine, from cold tablets; and iodine. The other method, more common in farming country, involves anhydrous ammonia, a liquid fertilizer, cooked with pseudoephedrine and lithium, taken from car batteries. "One out of every five labs is discovered because of an explosion," Dr. Mason said. "That alone ought to tell you something. If you heat the ingredients too high, they spontaneously burst into flame."
      Last Monday, a laboratory was discovered when it blew up in a house down a hollow in the mountains just outside Boone. The man doing the cooking had third-degree burns, Sheriff Shook said. The red phosphorous method produces phosphine gas, which can be lethal, Dr. Mason said. The ammonia method can produce a cloud of ammonia gas, which is also extremely dangerous, he said. Last year, six members of the volunteer fire department in Deep Gap, a neighboring town, were injured when they put out a fire in a trailer where, unknown to them, there was a methamphetamine laboratory. One of the men, Darien South, 31, had his lungs burned so badly that he went into respiratory arrest for four days. Mr. South said that as a result of his injuries, he had lost his job as a truck driver for Coca-Cola and had so much difficulty breathing that he had trouble performing his other job, as a preacher in a Baptist church.
      Sheriff Shook said he believed methamphetamine first came into his county via truck drivers from Tennessee, who for a price taught local people how to cook it. The local authorities have improvised their response. Mr. Slagle said that in his first case, he was investigating a family for domestic violence when Sheriff Shook told him the parents had a laboratory he was going to raid. "We were completely ignorant about the dangers, and when we took the kids, we let them keep their clothes and stuffed animals, contaminating our vehicles and contaminating the children further," Mr. Slagle said.
      By September last year, the county had worked out a rigorous protocol. In a raid, the sheriff's deputies found methamphetamine and its residue all over a house where the father was cooking, so Mr. Slagle made the man's 15- and 16-year-old sons take off their clothes and gave them new clothing. They were then taken to the emergency room in the Boone hospital where a nurse dressed in a "moon suit" decontaminated them, scrubbing them down with a special solution and large brushes, "like a car wash," Mr. Slagle said.
      One problem Sheriff Shook faces is that North Carolina's current penalties for manufacturing methamphetamine are light, the same as for growing one marijuana plant. A first-time offender faces a maximum sentence of six to eight months in jail and can get out on bond for as little as $1,000. "So they can be back cooking before we finish the paperwork," Sheriff Shook said.
      That was what happened in the case of the two sisters. Their mother and her boyfriend were charged, but were released on bail, and the grandmother, who was given custody of the girls, secretly let them go back to their mother. In January, the methamphetamine laboratory apparently started a fire behind the house. When sheriff's deputies arrived, they found jars with chemical residue from cooking methamphetamine in the kitchen sink along with the family's dishes. The county will now move to terminate the mother's parental rights and put the girls in a foster home, Mr. Slagle said. Ms. Rupert, the school counselor, said, "The sad thing is that these girls lost everything." After they were taken away the first time, people volunteered to give them new toys and clothes. This time, they had to leave those new possessions in the house. They too were contaminated.