For many depression sufferers, antidepressants such as Prozac have lessened or even eradicated the dispiriting gloom that shrouds their lives. But at least a million Americans have found little or no relief in medication, leading some to believe that escape from depression is not possible. An experimental treatment may help an estimated 20% to 30% of those with severe depression. Called transcranial magnetic stimulation (TMS), it applies short bursts of magnetic energy to a patient's skull, stimulating regions of the brain that regulate moods. "This could be a potent new weapon in our therapeutic arsenal," says Dr. Sarah H. Lisanby, director of the Magnetic Brain Stimulation Laboratory at Columbia University / New York State Psychiatric Institute in New York.
      Developed in 1985, transcranial magnetic stimulation was inspired by electroconvulsive therapy (ECT), in which people are given electric shocks to their brains to induce brief seizures and ease symptoms. Although electroconvulsive therapy can be effective for people suffering from severe and intractable depression, it can cause serious side effects, such as confusion and memory impairment. "We thought that by using a milder and more localized stimulation, we could relieve depression without the memory disturbance," says Dr. David H. Avery, a psychiatrist at the University of Washington School of Medicine in Seattle, who has studied transcranial magnetic stimulation. Since then, techniques have been refined, and new brain scanning tools, such as positron emission topography and magnetic resonance imaging, have enabled scientists to better identify the brain regions that govern our emotions. As a consequence, researchers can aim the magnetic beams with more precision, and they have a better understanding of how much stimulation is needed, says Lisanby.
      In a typical session, a doctor holds a powerful electromagnetic coil, which produces about the same amount of energy as an MRI machine, on the patient's forehead. The device creates a pulsating magnetic field that passes through the skull and seems to stimulate the electrical circuits in the brain. Patients are awake during the procedure, which normally lasts for about 45 minutes. They may feel a light tapping on their head with each pulsation, and some experience mild scalp contractions or headaches. But they don't experience side effects that would prevent them from resuming normal activities immediately after treatment.
      Unlike the magnets sold at health food stores for various purposes, which aren't at all powerful, the stimulators create enough electrical current to prompt nerve cells in the brain to fire. This seems to energize brain areas by stimulating blood flow and spiking levels of mood-enhancing brain chemicals, such as dopamine and serotonin. "What is clear is that TMS triggers changes in brain function," Avery says.
      Tests conducted in the last decade have yielded encouraging results. A 2002 Columbia University analysis of 25 small studies indicated that, overall, TMS patients experienced a 28% reduction in symptoms compared with a 7% reduction in those who received sham treatments. A new trial, which began in early 2004 and will eventually involve 286 patients at 16 centers nationwide, is pivotal, says Lisanby. "We're hopeful that, if positive, these results could lead to TMS being approved for treating depression," she says.
      Transcranial magnetic stimulation may be an effective treatment for other brain disorders. Yale University researchers are using magnets to stimulate speech-processing areas of the brain in an effort to quiet auditory hallucinations associated with schizophrenia. Scientists at the National Institutes of Health in Bethesda, Md., are studying the procedure's effectiveness in reducing epileptic seizures. They're also studying its potential to ease symptoms of Parkinson's disease and to help stroke patients undergoing rehabilitation.

The high-potency marijuana now widely available in cities and some small towns is causing an increasing number of teenagers — and some preteens — to land in drug treatment centers or emergency rooms, recent government statistics suggest. The numbers are not conclusive, experts say, but have renewed scientific interest in and debate about the risks of marijuana use. "The stereotypes of marijuana smoking are way out of date," said Michael Dennis, a research psychologist in Bloomington, Ill. "The kids we see are not only smoking stronger stuff at a younger age but their pattern of use might be three to six blunts — the equivalent of three or four joints each — just for themselves, in a day. That's got nothing to do with what Mom or Dad did in high school. It might as well be a different drug."
      Though overall marijuana use in minors has declined slightly since the mid-1990s, recently released statistics from hospitals and treatment centers suggest that the drug is causing many young users serious problems. Late last year, federal health officials reported that the number of marijuana-related emergency room visits for children age 12 to 17 had more than tripled since 1994, to 7,535 in 2001, the latest year for which figures were available. The most common reason for the visit was an "unexpected reaction" to the drug. "Overdose" was cited in 10% of these cases, "chronic effects" in 6% and "accident or injury" in 4%.
      The latest U.S. Health and Human Services Department data show that marijuana or hashish use is, by far, the most common reason why children age 12 to 17 were placed in licensed public or private treatment centers, accounting for more than 60% of reported cases in 2001. In an analysis published last week, researchers at Columbia University's National Center on Addiction and Substance Abuse calculated that the treatment rate for cannabis dependence or habitual use in youngsters had jumped 142% in the last decade.
      It is too early to tell whether these statistics truly represent a surge in habitual use, experts said. Admission figures could be skewed by changes in the way some states collect data and report it to the federal government. Forced drug treatment is also a way many teens avoid juvenile detention after a drug arrest.
      Most children who smoke marijuana are occasional users, experts said. And there is little evidence that a heavy marijuana user who quits the habit will experience the kind of physical withdrawal symptoms reported by heroin or cocaine users. Because marijuana seized by federal authorities today is about twice as potent as it was in the 1980s, health officials are taking the drug more seriously.
      Although some scientists doubt that marijuana induces real physical dependence, many top drug researchers have concluded otherwise. "There is no question marijuana can be addictive; that argument is over," said Dr. Nora Volkow, director of the National Institute on Drug Abuse. "The most important thing right now is to understand the vulnerability of young, developing brains to these increased concentrations of cannabis."
      More than 50 government-funded studies of cannabis are underway, and Volkow has pledged agency funds to investigate areas related to regular marijuana use. These include:
• Effect of cannabis on the young brain. Doctors have little understanding of how regular marijuana use alters the biological development of the brain. Clinicians who treat heavy users say that the earlier a person starts taking the drug, the more quickly a habit takes hold. "The risk of becoming addicted is far higher for a child in junior high than it is for someone who tries it in high school," said Dennis, a researcher at Chestnut Health Systems, a large behavioral care provider in Bloomington. Regular use can also exacerbate symptoms of attention deficit hyperactivity disorder and trigger latent mental disorders, some doctors believe.
• Medications to help break the habit. In recent years, doctors have had some success treating narcotic addiction with drugs such as buprenorphine, which is used for heroin dependence. They have done very little testing of drugs to ease marijuana craving.
• Genetic susceptibility. In a recent study of 198 young people, doctors in New Zealand found that those who reported enjoying their first-time use of marijuana were more likely to develop a habit later on. The researchers said their findings suggested that some people might be genetically vulnerable to addiction. Volkow is encouraging researchers to isolate genes that may contribute to the vulnerability.
      Research into the addictive qualities of marijuana has always been controversial. In the 1970s, psychiatrists documented flu-like symptoms in heavy cannabis users withdrawing from the drug. But the symptoms were so mild compared with the agony of withdrawal from heroin, cocaine or nicotine that many doctors dismissed the studies as inconsequential. Others charged that government researchers were attempting to demonize what was a mostly harmless drug.
      "But there's stuff out there now that's 10, 20, even 50 times as potent we could get for research in the '70s," said Dr. Reese Jones, a professor of psychiatry at UC San Francisco. "It's like studying the effects of high doses of alcohol using 3.2% beer. Now, marijuana is more analogous to 100-proof vodka. Not every kid's getting that, but the ones who do and come into treatment will get sick when they go off the drug. And when you give them marijuana, they feel better."
      Doctors only vaguely understand how marijuana affects the body. It can act as a stimulant or depressant. It eases pain, as opiates do, but it can also increase anxiety and induce paranoia. Its most psychoactive ingredient, tetrahydrocannabinol, or THC, acts throughout the brain, and the plant contains hundreds of other chemicals whose effects are unknown. Using brain-imaging technology, scientists have shown in recent years that THC is especially active in the cerebellum, which helps regulate movement, and in the frontal cortex, the part of the brain that enables us to make judgments and inhibit impulses. "These findings can help explain how chronic marijuana use causes some behavior changes — such as why intoxication can lead to automobile accidents," said Volkow, who did some of the imaging research.
      Steven Sussman, a professor of preventive medicine at USC, began tracking a group of 339 teenage marijuana smokers in the late 1990s. All the young men and women were heavy users when the study began. Five years later, 42% have quit and 58% still smoke frequently, Sussman reports in a paper due out later this year. The difference between the two groups is partly social: The quitters were more likely to have gotten married than the others and had fewer marijuana-using friends throughout the study. But those who managed to quit also tended to use less than their peers from the beginning. In short, dosage matters. And if frequent marijuana users are getting more THC, doctors say, then it's time old assumptions about the harmlessness of the drug were reexamined.

What do people mean by "forgive and forget?" The older man knew the question, posed by a University of Michigan researcher, was a sticky one. "It means they'll bury the hatchet, but leave the handle sticking out," the older man in the study answered. In other words, people can let go of anger at being wronged. But act like it never happened? People are people, he seemed to say. So the "handle" of each buried axe often remains, a reminder that the memory of the wrong lingers beneath the surface.
      U-M social scientist Neal Krause knew he was hitting paydirt when study subjects used such rich metaphors. They were opening up about a complex matter, forgiveness, that mattered a great deal to them. Krause, in turn, was eager to learn the ways older people really think about forgiveness. In 1997, he was beginning a multimillion-dollar study of religion and health in later life for the National Institute on Aging. Forgiveness, he felt, was a critical issue in later life that he and other researchers little understood.
      The responses from the older man and other Washtenaw County residents guided Krause and others as they wrote reams of questions for a series of national surveys in the multiyear research project, titled "Religion, Aging and Health." The wide-ranging project has brought new understanding of how religious beliefs affect the ways older people navigate the stresses of old age. Now in its seventh year, the study will continue to poll the older people through 2008 about forgiveness and 16 other facets of religion, from prayer to religious doubt.
      Bury the hatchet, and bury it deep, the results so far on forgiveness suggest. Older people who are able to forgive past hurts and wrongs -- from a wayward son, an abusive father, a spouse who squandered savings -- enjoy better mental health than those who can't let go of past offenses. Continued negative feelings about being wronged or having wronged others can contribute to poor health. With more results to come, Krause's large nationwide study of 1,500 people 65 and older already has added insights to the growing scholarly inquiry into links between faith and health.

Forgiveness is complex
The first wave of interviews took place in 2001. On the topic of forgiveness, the results are shedding light on questions that intrigue Krause and colleagues: Does how you forgive matter? What is an apology? Why is it that forgiving right away works better? From the Washtenaw County residents, Krause's team had learned that people vary widely in their thinking about forgiveness. Some said they did not generally forgive people for wrongs, or did so reluctantly. Some felt the wrongdoer needed to earn forgiveness by acts of contrition, such as apologizing or changing their behavior. Others said forgiveness should be given freely, without requiring acts of contrition.
      Based on these insights, the national survey has made several intriguing findings so far, says Krause.
* Subjects who said they forgave, no matter how they did it, enjoyed better mental health. (Mental health was measured through questions about depression, life satisfaction and death anxiety.)
* How you forgive is important. "The more acts of contrition you require someone to perform, the worse your (mental health) outcomes. It comes back to bite you," says Krause.
* Older African Americans are more likely to forgive than older whites. "African-American culture is more group-oriented than white Anglo culture. You'd expect more socially facilitating behavior," Krause says. African Americans and whites, though, shared common ground in how they forgave. African Americans were no more or less likely than whites to require acts of contrition.
      The study also looked at who was more or less likely to require acts of contrition. Those who didn't require acts of contrition were ones who said they felt God had forgiven them for their wrongs, so they felt dutybound to forgive others in the same unconditional way.

Bygones aren't always bygones
The man who talked about the hatchet was one of 129 Washtenaw County residents 65 and older whom Krause's research team asked early in the project to talk about their beliefs and experiences concerning forgiveness. All were self-described Christians; 61 percent were white, 39 percent African Americans. Some hadn't made peace with their past: "I did not forgive my husband, which I regret to this day," said a wife who described her spouse as an alcoholic and a womanizer. Others said forgiving unconditionally allowed them to set the past behind them and get on with life.
      Those conversations inspired Berit Ingersoll-Dayton, a U-M professor of social work who worked with Krause on the early phase of the project. She heard the subjects' voices change when they talked about forgiveness. "It really showed this was an area that was very important to them and, for some, an unresolved area." Krause asked questions in the study to find out whether older people struggled not only to forgive others, but to forgive themselves for wrongs they committed. Self-forgiveness turned out to be a particularly sensitive matter for seniors. Ingersoll-Dayton and Krause have written an article on the topic, currently being reviewed for publication. "They were trying to make sense of the transgressions they committed earlier in life," she says. "Some said, 'I still haven't been able to forgive myself,"' even though they felt they had forgiveness from God. "That," she says, "directed me to think, 'What might we do for older people in our own community?"'
      So she and Ruth Campbell, a U-M social worker and aging expert, offered eight-session forgiveness groups at the U-M Turner Senior Resource Center a few years ago. The idea behind asking older people to talk about their unresolved issues was "to begin to take some of the psychic weight on their shoulders off," Ingersoll-Dayton says. "We actually had people say, 'I feel lighter,' after the group sessions."

Removing one late-life stress
Unresolved hurts and grudges are causes of stress, especially in later life, Krause says. It's a time when people naturally mull over their pasts. Anxieties stemming from blaming others or oneself add to the inevitable stresses older people face: the loss of meaningful work, the deaths of spouses and friends, loneliness and diminished health and mental abilities. The more talked-about stresses of work and raising families come thick and fast earlier in life. But in the so-called golden years, Krause says, "the ones you deal with are hummers." Results so far suggest that those subjects who said they forgave eliminate at least one of these stresses of old age.
      The 1,500 people in the national survey include:
* People who say they are Christians, involved in religious activities at various levels.
* People who say they used to be Christians, but are not now affiliated with any faith.
* A a small number who have never been involved in any religion.
      The study focuses on Christian beliefs in part because Christianity is the predominant faith among Americans, and because of the difficulty of writing questions to cover beliefs of people of other religious backgrounds as well, says Krause. "I wanted to carve off a manageable hunk." As it was, the variations within Christianity were plenty to deal with. "There are whole other modes of forgiveness out there," Krause says, both within and outside religious faiths. "I don't know whether they work. They probably do."

Religion as a human institution
Krause has devoted much of his career to understanding the stresses that go with being older and their effects on mental and physical health. He says he's not an active participant in organized religion himself. But he came to realize that he could not understand how today's older generation deals with stresses unless he studied the role of religion in their lives. "He doesn't have an agenda," says Benjamin Shaw, assistant professor in public health at SUNY Albany and a former graduate student of Krause. Krause, in fact, thinks some researchers go overboard in promoting religion's health benefits. "It's not about living forever or keeping people from being ill," he says.
      He probes what he calls "the underside of religion," too. He's written about the impacts of infighting in congregations. "Human institutions are flawed. Why should religion be any different?" he asks. "This study will really be groundbreaking because the data is so good. This research could get to a deeper understanding of what it is about religion that brings these health benefits," Shaw says. He thinks the results could lead to wiser, more realistic interventions for people struggling in late life, even if they're not religiously inclined.

University Tailors a Program for Autistic Students
Jennifer Bundy, Associated Press- 5/2/2004

HUNTINGTON, W.Va. — Andrew Reinhardt is an 18-year-old college freshman who aspires to study math and physics at the Massachusetts Institute of Technology, yet his mother is afraid to let him cross a busy street by himself. Her fear is justified. Although Reinhardt is academically ready for college — he scored a 27 on the ACT and had a combined SAT score of 1140 — Asperger's Syndrome makes it difficult for him to cope with daily life. He doesn't like crowded rooms. When he goes somewhere, he is single-minded, walking quickly with his head down, body leaning forward as if into a strong wind. He sometimes pays no attention to what's going on around him, heightening his mother's fear of him crossing streets.
      At Marshall University, Reinhardt has trouble taking tests in a classroom because he is irrepressibly distracted by lawnmowers outside and students who may finish before he does. He misplaces things like books and pencils — he can go through dozens of pencils in a semester. And he avoids working on projects with other students because he thinks that they hold him back and do sloppy work.
      He is able to attend college with the help of a program at Marshall's Autism Training Center, which works with autism spectrum disorders like Asperger's, a neurobiological condition characterized by normal intelligence and language development with deficiencies in social and communication skills. Although many colleges have counselors and staff familiar with autism, only Marshall has a program tailored for autistic students. The program serves three of the university's 16,360 students and may eventually accommodate 10.
      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 Barbara Becker-Cottrill, the center's director. "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." It is not special education. Students must meet and maintain the university's academic standards, and they're required to pay, like everyone else, tuition of $1,630 for in-state residents and $4,472 for those living outside West Virginia.
      Reinhardt's goal is to develop an engine that operates faster than the speed of light. "I want to be the next Albert Einstein," he said with an enthusiastic smile. "I come up with all these physics ideas all the time. I know they don't work because I don't have the education behind them. I haven't taken the calculus-based physics yet." He has wanted to go to college since he was in elementary school. But, as he relaxed in the center's lounge, he said: "I probably wouldn't go to college at a place that didn't have a place like this."
      The center offers tutoring, counseling, a quiet space to take exams, and help navigating the bureaucracy and social world of college: how to schedule classes, join clubs, buy books and replace ATM cards that don't work. As proof of the center's success, Reinhardt made the Dean's List with a 3.6 GPA after his first semester. He has been hired as a math tutor this spring.
      There's no way to measure how many college students have forms of autism. 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 Asperger's Syndrome. And no one knows how many people in the general population have autism. Some studies suggest that it might affect at least 40 per 10,000 U.S. children. That's 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," Perner, author of a guide to selecting a college, said in a recent issue of the bimonthly Asperger's Digest. Autistic students often drop out or do not attempt college because they have difficulty with bureaucracy, time management, and taking notes, tests and required classes not in their area of expertise, Perner said.
      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 more programs like Marshall's were needed. "I think they would do much better; there would be a much higher rate of success if this type of program were available," said Shore.
      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, the Marshall program's director. "The problem is, social and daily living issues are interfering."
      The Marshall program was founded two years ago with a $75,000 donation from the family of its first student, Lowell Austin, now a 19-year-old sophomore. The family wanted to honor Austin's uncle, Howard Austin, who spent his career trying to develop cognitive skills in machines. Howard Austin, who died in April 2001, was fascinated that his nephew could have both extremes of human intelligence. The program has been a lifeline for Lowell Austin, who is majoring in sports marketing, participates in clubs and lives in a dorm, without a roommate. "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.



Recovery From Clutter
Lisa Kahn, Newhouse News Service- 5/2/2004

Hey, you with the mismatched socks, brimming trash can and sticky bathroom floor. Does your life feel like a constant search for lost keys? Do you avoid repairmen because of their horrified expression when you open the door? It could be that your pizza-stained pants and unpaid bills are not a sign, of sloth or financial irresponsibility, but a symptom of a serious, progressive disorder that causes great embarrassment and despair to untold thousands. It's called CHAOS (Can't Have Anyone Over Syndrome), and, if you're afflicted, it'll take more than spring cleaning to get your house in order. In fact, some experts say the only cure for hard-core cluttering may be to submit to a Higher Power.
     Take Mike Nelson, author of several books including "Stop Clutter From Wrecking Your Family" (New Page Books, 2004, $15.99). His wisdom, he says, was gleaned through the school of hard knocks. "I had a fiancee who threw me out" because of chronic messiness, he admits.
Realizing that it would take more than a few quick-fix tips to clean up his act, Nelson decided to adapt the 12-Step Program used by Alcoholics Anonymous to address the root of his problems. "Cluttering is a behavior. To change a behavior, you've got to treat the causes, using practical and psychological tools," says Nelson, who lives in Galveston, Texas. Apparently, his techniques worked; he has established a national organization called Clutterless Recovery Groups (www.clutterless.org), which has earned not only praise, but referrals from the therapeutic community.
     "The basic reason people clutter is out of some kind of fear: fear of not being able to make a decision, fear of not knowing something, or the fear of letting others into their lives," he theorizes. "Some people literally use clutter to insulate themselves from the outside world." If cluttering is about control, Nelson reasons, then learning to live a de-cluttered lifestyle is about harnessing that control in a positive way. "It's not about how much or how little stuff you and your kids have, or how neat it is. It's about how you, your spouse and your kids relate to each other and keep material things from coming between you," he says.
     Apparently, such epiphanies abound in the cluttering recovery business. Marla Cilley, a k a The FlyLady (for Finally Loving Yourself) has mentored fellow sufferers via the Internet since 1999 (www.FlyLady.net). She recalls the day that she, too, hit a messy wall of her own making. "My sink was overrun with dishes and I looked like a truck had just run over me," she confesses in her self-help tome, "Sink Reflections" (Bantam Books, 2002, $14.95). Cilley, whose tips for taming disorder are liberally sprinkled with cute catch phrases and touchyfeely spirituality, claims that she has found a way to replace chaos and disorganization with "peace and joy." Her simple program shows readers how to create everyday routines and divide overwhelming chores into "manageable missions." She guarantees that even the worst offenders will be able to greet guests without fear, find their keys and even locate their misplaced kids.
     If all this hoopla over sloppiness strikes you as so much psychobabble, there's a good chance that either A) you've got your life - and your stuff - pretty much under control, or B) you are so overwhelmed by disarray that you can't see how bad things have become. Not sure if you are a true CHAOS sufferer? The FlyLady says you're probably in a clutter crisis if you can answer yes to any of the following:
• You caught the baby eating something that had been on the floor for a couple of days.
• Things perpetually fall off the closet shelf and hit you on the head.
• Your windows are so dirty you can't tell if it's cloudy or sunny outside.
• You tripped over something in the middle of the night and couldn't find your way back to bed.
     Though you might recognize yourself in one or more of these scandalous scenarios, chances are it's a fleeting fall from grace caused by a traumatic event like an illness, a divorce or a job loss. Even happy occasions like marriage or new parenthood can temporarily derail even the most confirmed neatnik, says Nelson. Still, whether you're a truly classifiable clutter-holic or just a short-term slob, admitting you need help getting your life back in order is key, experts agree.
     But if disorganization is your dilemma, how are you supposed to figure out a solution? Both Cilley and Nelson say: Look at the small picture. Recovery from clutter, insists the FlyLady, must come "one baby step at a time." "You have struggled for years with a cluttered home and you are so beaten down," she commiserates. But don't despair. The gateway to your unobstructed path, she says, is a spotless sink. Before your kitchen basin can be soaked, scrubbed and scoured into sparkling submission, the dishes must be washed. Completing such "manageable missions" can deliver a sense of accomplishment that can inspire a clutterer to keep on cleaning, Cilley believes.
     Nelson's proving ground is not the sink, but the sofa. "Concentrate on one square foot of sofa and just clear that space, an item at a time," he advises. "Once the stuff is off that square foot, tell yourself out loud that it is now a sacred area. You can clutter anywhere else, but not there. Keep this up, one square foot at a time, and soon the whole sofa doesn't get cluttered. It's like putting together the pieces of a big jigsaw puzzle."
     Above all, experts agree, learn to let go of unrealistic expectations about how your home should look. "Clutter comes and clutter goes. I still have times when my mental state just rebels against keeping neat," Nelson admits. Or, as Cilley puts it, "When I finally quit beating myself up for what I didn't do and started doing what I could, it became my ticket to FLY."

A Quitter's Dilemma: Hooked on the Cure
Petra Bartosiewicz, New York Times- 5/2/2004

For years it was the same routine: wake up, light a cigarette, inhale deeply and start the day. "I wouldn't even get out of bed without a cigarette," said John Palagonia, 53, of Massapequa, N.Y., who was a two-pack-a-day smoker for more than 20 years. In 1989, Mr. Palagonia, who entertains at children's parties dressed as characters like Barney and Elmo, decided to quit. He turned to Nicorette gum to curb the cravings for a cigarette. The smoke savored between sips of his morning coffee was replaced with a peppery square. On breaks at work, driving his car, after dinner -- all the times he had luxuriated in smoke -- he would pop another piece. "I got to the point that I was having problems with my teeth, and my jaw was killing me," Mr. Palagonia said. He eventually returned to smoking for a short time "to get off the gum." What ended up working for him was counseling, not a hit of nicotine.
      A third of the nation's nearly 50 million smokers attempt to quit each year, according to the American Cancer Society, and that has made smoking-cessation products an $800 million business in the United States alone. The products include gum and patches sold over the counter; pills, inhalers and nasal sprays sold by prescription; and even more exotic products like nicotine-infused lollipops sold on the Internet. Still, addiction to nicotine remains. The medical field has accepted that fact since the mid-80's, when the Food and Drug Administration approved, by prescription, products like gum to give would-be quitters a substitute comparable to cigarettes in price and nicotine content, but without other cigarette toxins.
      Now some scientists and former smokers are voicing misgivings. No one disputes that cigarettes, which are laced with toxic additives like ammonia, pose far graver health risks than nicotine alone, but nicotine is also classified as a poison, and in recent studies it has been shown to break down into a substance that causes abnormal cell growth. In 2001, researchers at Stanford University found that nicotine speeds the growth of malignant tumors by stimulating the formation of the blood vessels that feed them, a process called angiogenesis. Dr. John Cooke, the lead author of the Stanford study, said, "As long as people are using nicotine replacements properly, it's a win for all of us, if we can get people to stop smoking. But, I would urge people not to use it long term."
      For people addicted to nicotine, using the replacement products properly can be difficult. A study financed by GlaxoSmithKline , the pharmaceutical company that manufactures Nicorette and other stop-smoking products, found last November that more than a third of nicotine gum users continued chewing beyond the 12 weeks recommended under F.D.A. guidelines. "We estimate 36.6 percent of current gum users are engaged in persistent use," said Dr. Saul Shiffman, a company consultant and the study's primary author. Though the company says on its Web site that nicotine "may promote lung cancer," it insists its products are safe "when used as directed." Even the companies that make nicotine-replacement products acknowledge problems with treating this particular addiction. Dr. Kenneth Strahs, GlaxoSmithKline's vice president for research and development in smoking control, said, "I wish we could tell you that if you took one piece of our gum it would be enough, but that's not the case. Nicotine addiction is a chronic relapsing condition."
      When the F.D.A. approved over-the-counter sales of Nicorette gum and the NicoDerm CQ patch in 1996, sales of the two products soared. GlaxoSmithKline reported $578 million in global sales of over-the-counter nicotine replacements during 2003, down from $606 million the year before as other companies jockeyed for market position. How effective these products really are remains a debate. Some ex-smokers and smoking-cessation experts oppose using nicotine at all when trying to quit. "It's like the difference between snorting cocaine and freebasing it," said Mr. Palagonia. He has neither smoked nor chewed nicotine gum for a decade now after years of meetings at Nicotine Anonymous, a 12-step program.
     "The trick with getting off cigarettes is to stop delivering the drug," said Joel Spitzer, a smoking-cessation counselor and director of education at WhyQuit.com, an online support and education site that advocates quitting nicotine cold turkey. Mr. Spitzer, who estimates he has counseled 5,000 individuals in stop-smoking clinics he has run in Chicago, says nicotine replacements keep ex-smokers in a protracted state of withdrawal. Denise Henrie, a mother of four from Owasso, Okla., is familiar with that. Ms. Henrie, 43, tried and failed twice to quit smoking, using nicotine gum for more than a year. "You feel a little hopeless," said Ms. Henrie, adding, "I just don't want to be addicted to anything at all." She has slipped back to her pack-and-a-half-a-day habit, but she remains optimistic. A package of Nicorette sits in her kitchen pantry for a third try.
      According to the American Cancer Society, fewer than 5 percent of smokers who attempt to quit each year succeed. Of those who do, the society reported last year, 91 percent quit cold turkey. Some people succeed only after a long struggle. Jeanne Hutchinson, 59, began chewing nicotine gum in 1984, the first year it was available by prescription. "One of the happiest days of my life was when nicotine gum was allowed to be sold over the counter," said Ms. Hutchinson, a social worker in Chicago. But, years later, she was still hooked on the gum. "I felt almost like a drug addict," said Ms. Hutchinson, who estimates the 12 pieces she chewed each day cost her more than $15,000 over the years, without curing her habit. Suffering from a receding gum line and worn molars, she joined WhyQuit last January and managed to stop using nicotine. Still, when she reached into her coat pocket a few months ago and found a long-forgotten piece of gum, it took all her willpower not to pop it into her mouth.
      That may be why analysts say that demand for nicotine-replacement therapies is unlikely to wither anytime soon. "We see it as a market with tremendous potential, but efficacy-starved," said Devesh Gandhi, a research associate at Sanford C. Bernstein, adding that the market -- for "a product that really works, that manages both the addiction and the side effects of the withdrawal" -- is there for the taking.



Unpacking Skinner's Box
Laura Miller, New York Times Book Review- 5/2/2004

It's sad to see an interesting writer go off the rails, but last month that is what seemed to have happened to Lauren Slater. After publishing some genre-twisting memoirs, Slater, a psychologist, wanted to celebrate landmark psychological studies as ''stories -- absorbed, reconfigured, rewritten.'' The result, in her new book, ''Opening Skinner's Box: Great Psychological Experiments of the Twentieth Century,'' is a wayward and powerful blend of science, autobiography and imagination. Writing, for example, about Stanley Milgram's famous investigation at Yale, which revealed students' willingness, under orders, to administer what they believed were painful electric shocks to other people, Slater uses the second person to convey the point of view of one of the obedient torturers, a literary choice that nails her point: we all think we wouldn't turn up the voltage, but Milgram's results showed that 65 percent of us will.
      Slater's maverick approach elicits unexpected emotions and invigorating transits of thought. It has also called forth the wrath of a battalion of psychiatrists and psychologists, and one irate daughter.
      The professionals, spearheaded by Robert L. Spitzer of Columbia University, have sent letters of protest to Slater's publisher, W. W. Norton, containing long lists of errors and ''outright fabrications,'' and have posted some of those letters to the psychiatry-research newsgroup on Yahoo.com. Slater and her publisher contend in turn that she is the target of a campaign to discredit her, not because the mistakes in ''Opening Skinner's Box'' are substantive but because the participants dislike the way she has portrayed psychology and psychologists. Slater's critics present themselves as crusaders for veracity, while she presents herself as a writer being slapped down for showing the messy, human side of the profession. None of the articles written about the controversy so far has quite located the complicated heart of the dispute. As is often the case with Slater, a gifted writer who casts herself as a trickster or provocateur, what's really going on can be devilishly hard to nail down.
     Both sides have cause to gripe. One of the psychologists, Jerome Kagan of Harvard, has said that a scene Slater wrote depicting him as ducking under his desk during their interview is inaccurate. He says he had too quickly scanned a fact-checking e-mail message she sent him to spot and challenge this detail. But during an interview with Slater at her publisher's offices, she showed me the message; she lists among the items to be verified, ''3. that, in demonstrating to me that people do, indeed, have free will, you jumped under your desk. . . .'' Kagan's response -- ''I was trying to demonstrate that when humans have a choice of actions, they can select an act that has never been rewarded in the past'' -- hardly suggests that he failed to notice the item.
      In another example, Elizabeth Loftus, a psychologist and prominent critic of recovered memory theory, writes in a letter to the publisher: ''Slater refers to 'the woman who yelled ''whore'' [at me] in the airport a few years back.' No woman has ever yelled 'whore' at me in an airport.'' Slater is indeed inaccurate here. She has garbled the first line of a 1996 Psychology Today article (linked from Loftus's own Web page) that says, of Loftus, ''She has been called a whore by a prosecutor in a courthouse hallway, assaulted by a passenger on an airplane shouting, 'You're that woman!' '' A sloppy mistake, no question, but this doesn't mean Slater invented the incident out of whole cloth.
      It doesn't help Slater's case that ''Opening Skinner's Box'' has more than its fair share of gaffes, typos, miscast technical terms and misspelled names. ''Each by itself wouldn't necessarily rise to the level of complaint,'' says Loftus, ''but the collection, and in combination with the things done to other people,'' moved her to object and made Slater's critics ''want to look through the book to find every error there is.'' What most seems to have spurred Loftus to action is Slater's attempts to depict her personality: ''I come across as a loon. She portrays me as someone I am not.'' As for Spitzer, his gravest charge is that Slater falsely describes him making a spiteful comment about a scientist whose research he deplores. (Slater insists that Spitzer did make the remark, but she has agreed to remove it from future editions of the book.)
      The heat here arises from how Slater handles not science but people, the ''characters'' who star in the stories she tells. She is not above manipulating her readers, while technically avoiding inaccuracy, if it will make the tale more potent. This recklessness is both the kernel of her talent and her nemesis; she is forever threatening to cross the line. She steps over it in writing about B. F. Skinner's daughter Deborah. Contrary to some earlier reports, Slater doesn't endorse the urban legend that Deborah was raised in one of her father's animal-conditioning boxes. But she does spin a bogus miasma of mystery around Deborah's fate, implying that she is hard to find and possibly unstable, though Deborah herself denies it. Why, then, didn't Slater approach her? Perhaps because, as Deborah's sister told a reporter for The Times of London, it ''might have ruined a good story.''
      Reality seldom conforms to the shapely contours of fiction, and Slater isn't the first journalist (or the last) to want to give it a nudge now and then. Her memoir ''Lying'' overtly toys with the line between memoir and fiction, but experimenting with your own story is a writer's prerogative. The ''Opening Skinner's Box'' controversy looks like a quarrel about facts, but it's really a duel of stories. Slater's subjects are saying, in part, ''How dare you presume to tell the story of us? Now we're going to tell the story of you!'' And another Lauren Slater is conjured by their accounts -- a compulsive liar, an incompetent scholar, ''a little loose inside,'' to use a phrase she unkindly applies to Loftus. A few of the tactics used to create this figure (especially those employed by Slater's critics on the book's Amazon.com page) are as shabby as what Slater herself has been accused of. Others are merely distortions of memory or interpretation -- perhaps, like her own, a bit too obedient to the needs of the story.

From Therapy's Lenny Bruce: Get Over It! Stop Whining!
Dan Hurley, New York Times- 5/4/2004

On a recent Friday evening, nearly 200 people came to the Albert Ellis Institute in Manhattan to watch a master performance — call it stand-up psychotherapy — by a legend. As he has on nearly every Friday night for more than 30 years, Dr. Albert Ellis, the 90-year-old psychologist who invented rational emotive behavioral therapy and wrenched psychotherapy out of the age of Freud and into the age of Dr. Phil, was demonstrating his no-nonsense, confrontational, obscenity-laden technique before a packed house on East 65th Street.
      "Do you know why your family is trying to control you?" he asked a volunteer who joined him at the front of the room. "Because they're out of their minds," he said, adding an unprintable adjective between "their" and "minds." Another volunteer, Kristin Bell, spoke of her sister who had been killed by a drug dealer eight years before. "Why can't you understand that some people are crazy and violent and do all kinds of terrible things?" Dr. Ellis asked. "Until you accept it, you're going to be angry, angry, angry."
      It is Dr. Ellis's conviction that people can always rationally choose to change and that a psychotherapist's job is to nudge them, gently or otherwise, in the right direction. That view has defined his career and has helped usher in an emphasis on quick results over profound insights. Even so, his exhortations to give up anger did not prevent him, less than an hour later, from shouting, "Get out, get out, get out!" when his path out of the room and into the elevator to his penthouse apartment was blocked by the crowd. "I wasn't upset," he insisted later. "I'm just very firm. I was determined to get them the hell out of the way."
      Dr. Ellis has, throughout his life, been firmly determined to let nothing stand in his way, not the critics who have derided him and his methods, not the gastrointestinal infection that nearly killed him last year and resulted in the removal of his colon, not the profound deafness that now forces him to wear headphones and his guests to shout into a microphone. If anything, the controversy surrounding his reputation as a kind of Lenny Bruce of therapy has only increased his influence.
      In July 1982, a review of psychotherapy journals found him to be the most frequently cited author of works published after 1957. That month, he was also ranked as the second most influential psychotherapist in a survey of clinical psychologists, beaten by Carl Rogers, founder of the far gentler school of client-centered psychotherapy. No. 3 was Freud. "I believe he's a major icon of the 20th century and that he did help to open up a whole new era of psychotherapy," said Dr. Aaron T. Beck, an emeritus professor of psychiatry at the University of Pennsylvania and the founder of cognitive therapy, which is also based on rational thinking.
      Dr. David B. Baker, a professor of psychology at the University of Akron and the director of its Archives of the History of American Psychology, said Dr. Ellis's confrontational approach posed a direct challenge to the drawn-out process of Freudian psychoanalysis. "His idea and system of confronting irrational thoughts doesn't give you a lot of time to reflect," Dr. Baker said. "He's going to challenge you, confront you, and be very directive."
      On a recent morning at his institute, Dr. Ellis laid out his principles for 50 visiting psychotherapists who had arrived for a three-day workshop. "All humans are out of their minds," he began, adding another expletive. "They're not only disturbed. They get disturbed about their disturbances." Just because people do not like adversity, they decide that it should not exist, Dr. Ellis complained. "They say, `You disturbed me,' or, `It disturbed me,' or, `My mother disturbed me,' " he said. "They won't accept responsibility for their own disturbance. They refuse to accept the way it is. And then they get depressed about their depression. They rage about their rage. They're screwballs." To counter people's natural tendency toward self-criticism, Dr. Ellis says, "I teach U.S.A., Unconditional Self-Acceptance: You always accept you no matter what you do." Also on his list are Unconditional Other Acceptance ("Nobody is evil, even if they do evil things") and Unconditional Life Acceptance ("You always accept things, no matter how they are").
      Therapists can help people, he said, by giving them what he terms rational coping statements to overcome their irrational self-destructive beliefs. For example, Dr. Ellis said, when preparing to take on a risky challenge, patients should be encouraged to say they would like to do well, but too bad if they don't. In one exercise that Dr. Ellis promotes, patients are encouraged to imagine situations that normally provoke extreme fear, panic or rage. Holding the imaginary situations in their minds, the patients are asked to change the feeling to acceptance. Practiced daily for a month, the exercise can help people change their most deep-seated feelings about situations, he said.
      Unlike Dr. Beck, who subjected his methods and techniques to careful scientific testing, Dr. Ellis's insights have evolved, in great part, from personal experiences. At 19, when he was, by his own estimate, painfully shy of women, he set himself a task. Hanging around a bench in the New York Botanical Garden in the Bronx one summer, he decided that he would speak to every single woman who sat down alone. In one month, he approached 130 women. "Thirty walked away immediately," he said. "I talked with the other 100, for the first time in my life, no matter how anxious I was. Nobody vomited and ran away. Nobody called the cops." In one month, he said, "I completely got over my shyness by thinking differently, feeling differently and, in particular, acting differently." So successful was the transformation that in the 50's and early 60's he built his reputation as a sexologist, writing best-sellers like "Sex Without Guilt" and "Science of Love." There was criticism. But he did not care. "I just kept going and going and going," he said. "Kinsey was much better known. But he wasn't read. They were reading my books."
      With a doctorate in clinical psychology from Columbia and a large psychotherapy practice that specialized in sex and marriage therapy, Dr. Ellis became disgusted with traditional methods after spending — or, as he put it, "wasting" — six years in psychoanalysis. He turned to Greek, Roman and modern philosophers — and his own experience. A result was rational-emotive-behavioral therapy, whose focus, he decided, would be not on excavating childhood, but on confronting the irrational thoughts that lead to self-destructive feelings and behavior. "The trouble with most therapy," Dr. Ellis said, "is that it helps you to feel better. But you don't get better. You have to back it up with action, action, action."
      Among his peers, the reactions were quick — and brutal. "I was hated by practically all psychologists and psychiatrists," he said. "They thought it was superficial and stupid. They resented that I said therapy doesn't have to take years." Yet Dr. Ellis has never stopped saying anyone can change his life, usually without medication.
      Now living on the top floor of the institute that bears his name, Dr. Ellis refuses to give in to the depredations of age. "I'll retire when I'm dead," he said. His health problems, he insisted, were little more than annoyances. "When they said they might have to take my colon out, I told them, `That's too bad if you have to, but what else can we do?' " he said. "I don't think it's terribly unfair. The Buddha said life is suffering. But he forgot to add that for older people, it's much more suffering."
      Married and divorced twice without children, Dr. Ellis was in an open relationship for 37 years that ended a year ago. These days, he works, as he always has, pretty much around the clock. Since nearly dying last year, he has written four more books, sending the total over 70. "While I'm alive," he said, "I want to keep doing what I want to do. See people. Give workshops. Write, and preach the gospel according to St. Albert."

Has the Romance Gone? Was It the Drug?
Anahad O'Connor, New York Times- 5/4/2004

For most people taking antidepressants, the risk of a diminished sex drive may seem like a worthwhile sacrifice for the benefits from the drugs. Up to 70 percent of patients on antidepressants report sexual side effects, yet the number of Americans who take the drugs has ballooned since Prozac was introduced in the late 1980's. Last year, studies show, doctors in the United States wrote 213 million prescriptions for antidepressants.
      But what if the sexual side effects of the drugs, often considered little more than a nuisance, had more serious consequences, impairing not only sexual desire in some people, but also the ability to experience romance? The question, which experts are beginning to ask, was at the center of a talk this weekend at the annual meeting of the American Psychiatric Association in New York. Dr. Helen E. Fisher, an anthropologist at Rutgers, presented findings that suggest, she says, that common antidepressants that tinker with serotonin levels in the brain can also disrupt neural circuits involved in romance and attachment. "We know that there are real sexual problems associated with serotonin-enhancing medications," said Dr. Fisher, author of "Why We Love: The Nature and Chemistry of Romantic Love" (2004). "But when you cripple a person's sexual desire and arousal, you're also jeopardizing their ability to fall in love and to stay in love."
      Dr. Fisher and a colleague, Dr. Anderson J. Thomson Jr., have studied the brains of people in love and pored over research from the last 25 years on the neurological basis of romance. Three brain systems, all interrelated, the researchers say, control lust, attraction and attachment. Each runs on a different set of chemicals. Lust is fueled by androgens and estrogens. Attachment is controlled by oxytocin and vasopressin. And attraction, they say, is driven by high levels of dopamine and norepinephrine, as well as low levels of serotonin. As a result, they say, increasing levels of serotonin with antidepressants can cripple the sex drive but also set off an imbalance among the three systems. Drs. Fisher and Thomson are submitting a scientific paper on the subject for publication this year.
      "There are two lines of evidence on this," Dr. Thomson, a psychiatrist at the University of Virginia, said. "The first is the well-documented frequency of sexual side effects. But when you actually talk to patients who have diminished libido and you ask how it affects them, you discover that it has an enormous impact on their romantic lives."
      Often, the change is subtle. Drs. Fisher and Thomson point to case studies of people who gradually find their emotions blunted and their ability to see attractive features in others lost. The researchers also point to more extreme cases like people who say losing their sex drives caused romantic feelings toward longtime spouses to evaporate suddenly. "Everyone is distinctly different," Dr. Fisher said. "Some people are so securely attached that this isn't going to change things for them. But people should be aware that these drugs dull the emotions, including the positive ones that are central components of romantic love."



Marijuana Abuse Is Up Among U.S. Adults
Associated Press, 5/4/2004

CHICAGO -- Habitual marijuana use increased among U.S. adults over the past decade, particularly among young minorities and baby boomers, government figures show. The prevalence of marijuana abuse or dependence climbed from 1.2 percent of adults in 1991-92 to 1.5 percent in 2001-02, or an estimated 3 million adults 18 and over. That represents an increase of 22 percent, or 800,000 people, according to data from two nationally representative surveys that each queried more than 40,000 adults.
     Among 18- to 29-year-olds, the rate or abuse or dependence remained stable among whites but surged by about 220 percent among black men and women, to 4.5 percent of that population, and by almost 150 percent among Hispanic men, to 4.7 percent. Among all adults ages 45 to 64, the rate increased by 355 percent, to about 0.4 percent of that population.
     The report, published in Wednesday's Journal of the American Medical Association, was led by Dr. Wilson Compton of the National Institute on Drug Abuse, who said the rise in dependence was probably due at least partly to increases in the potency of pot over the past decade. Also, the figures may indicate that baby boomers ``bring their bad habits with them into old age,'' he said.
     The researchers said adults were considered marijuana abusers if repeated use of the drug hurt their ability to function at work, in school or in social situations, or created drug-related legal problems. Drug users were considered dependent if they experienced increased tolerance of marijuana, used it compulsively and continued using it despite drug-related physical or psychological problems. Overall use of the drug -- that is, casual use and habitual use -- remained stable at around 4 percent, or more than 6 million adults.
     ``This study suggests that we need to develop ways to monitor the continued rise in marijuana abuse and dependence and strengthen existing prevention and intervention efforts,'' said Dr. Nora Volkow, the institute's director. Programs that target young black and Hispanic adults are particularly needed, she said. Increases in dependence among young minorities may reflect their growing assimilation into sectors of white society where marijuana use is more accepted, Compton said. Researchers from the National Institute on Alcohol Abuse and Alcoholism contributed to the report.
     On the Net:
JAMA http://jama.ama-assn.org
NIDA: http://www.drugabuse.gov
NIAAA: http://www.niaaa.nih.gov