CDC: Hanging Most Common in Young Suicides
Associated Press, 6/10/2004

ATLANTA -- Hanging and other forms of suffocation have overtaken guns as the chief means of suicide among American youngsters 10 to 14 years old, the government said Thursday. Researchers from the Centers for Disease Control and Prevention were surprised by the switch and said they first noticed the trend in the early 1990s. By the end of the decade, suffocations had surpassed self-inflected shootings. Health officials said they do not know why the switch occurred and whether it had anything to do with the use of trigger locks, lock boxes and other measures for keeping guns out of youngsters' hands. By contrast, suffocations are often carried out with common household items such as belts, ropes or plastic bags.
     In 1992, there were 96 suicides by suffocation among Americans 10 to 14 years old, the CDC said. That rose to 163 in 2001. Firearm suicides dropped from 172 to 90 during the same period.
Suffocation suicides also rose among teens ages 15 to 19 during the same period (from 333 deaths a year to 551). Firearms remain the most common means of suicide for that group, though the number of deaths from self-inflicted shootings dropped from 1,251 a year to 838, the CDC said.
Overall, the suicide rate for those ages 10 to 19 fell by about a quarter, from 6.2 deaths per 100,000 people in 1992 to 4.6 per 100,000 in 2001, the CDC said.
     On the Net: CDC info: http://www.cdc.gov

Health Insurance Firms Block Parity Bills
Frederic J. Frommer, Associated Press- 6/`0/2004

WASHINGTON -- Aided by House Speaker Dennis Hastert, insurance companies successfully have blocked legislation to make them provide equal coverage for mental and physical illnesses if their policies include both. President Bush endorsed the concept two years ago. Today, supporters of the bill are willing to settle for a scaled-back version they hope Congress will pass in 2004. The original legislation has 69 sponsors in the Senate and 246 sponsors in the House, clear majorities in both chambers. It was named for late Sen. Paul Wellstone, a Minnesota Democrat who championed the issue for years.
     Hastert, however, has declined to schedule a House vote. In the Senate, Republicans blocked an attempt to win passage last fall, on the one-year anniversary of Wellstone's death in a plane crash. "The bottom line is there is still enormous resistance from employers and health plans, and they've been able to turn to allies in the Senate and especially the House," said Andrew Sperling, a lobbyist for the National Alliance for the Mentally Ill.
     Companies such as BlueCross BlueShield Association, United Healthcare Corp. and WellPoint Health Networks have worked to defeat the legislation, in addition to the trade group America's Health Insurance Plans, lobbying reports show. Those groups combined to spend more than $13 million in lobbying last year on issues such as the mental health parity bill.
     The bill would expand a 1996 law prohibiting health plans that offer mental health coverage from setting lower annual and lifetime spending limits for mental treatments than for physical ailments. The proposed legislation also would require equal treatment for co-payments, deductibles and limits on doctor visits.
     Karen Ignagni, chief executive of America's Health Insurance Plans, said employers worried that would drive up health care costs and might cause some to drop mental health coverage altogether.
The Congressional Budget Office has estimated that the legislation would increase health insurance costs slightly less than 1 percent, or roughly $23 billion a year. Ignagni said her group also is concerned about covering every mental health illness, from caffeine addiction to adjustments to adulthood.
     Sponsors of the legislation say they are willing to require only coverage for whatever mental illnesses are already covered by a specific health plan. "The coverage has been scaled back significantly," said Rep. Jim Ramstad, R-Minn., one of the bill's leading supporters. He said Hastert, R-Ill., has been the main obstacle. "I've spoken to him until I'm blue in the face," said Ramstad, a recovering alcoholic. Hastert's office did not return phone messages, but the speaker has expressed concerns in the past that the bill would drive up premiums.
     Paul Dennett, vice president for health policy at the American Benefits Council, which represents primarily Fortune 500 companies, said the scaled-back legislation would be an improvement but not enough to win his group's support. He said employers do not want any expansion of the 1996 law.
In an April 2002 speech to mental health professionals in New Mexico, Bush said the health insurance system must treat mental illness like any other ailments. "Americans with mental illness deserve our understanding and they deserve excellent care," Bush said. "They deserve a health care system that treats their illness with the same urgency as a physical illness." Bush added: "Health plans should not be allowed to apply unfair treatment limitations or financial requirements on mental health benefits."
     Officials with the White House and the Health and Human Services Department did not return phone messages, nor did Senate Majority Leader Bill Frist, R-Tenn. During debate last year, Frist said he supported the legislation, but said it should pass out of the Senate Health, Education, Labor and Pensions Committee before coming to a floor vote. The committee chairman, Sen. Judd Gregg, R-N.H., has told Frist he is fine with the bill going directly to the floor, said Gregg's spokeswoman, Gayle Osterberg. She said Gregg is considering an amendment that would expand mental health benefits without causing people to lose their coverage but declined to elaborate. The Senate sponsor, Sen. Pete Domenici, R-N.M., said Gregg's amendment would require that cost increases not exceed 1 percent. Domenici said he was hopeful for a vote this month.
     On the Net: Information on the bills, S. 486 and H.R. 953, can be found at http://thomas.loc.gov/



Alcohol Abuse Up, but Alcoholism Down
Associated Press, 6/11/2004

WASHINGTON -- Alcohol abuse is up in America -- sharply for most groups -- a government study said Friday. At the same time alcoholism was down. Some 4.65 percent of the adult population reported alcohol abuse in 2001-2002, up from 3.03 percent a decade earlier, the National Institute on Alcohol Abuse and Alcoholism reported. During the same period, the share of the population who were judged to be alcoholics slipped from 4.38 percent to 3.81 percent of people aged 18 and over, the institute said. ``What is surprising, then, is that the prevalence of alcohol abuse increased in the face of slightly declining rates of heavy drinking,'' said the research team led by Bridget F. Grant of the institute, a division of the National Institutes of Health. ``That alcohol abuse seems to be increasing presents intriguing questions,'' she said.
     Alcohol abuse, which increased, is defined as drinking-related failure to fulfill major obligations at work, school or home, interpersonal social or legal problems and drinking in hazardous situations. Alcoholism, which declined, is characterized by compulsive drinking, preoccupation with drinking and tolerance to alcohol.
     Combined, alcohol abuse and alcoholism affected 17.6 million Americans in 2001-2002, up from 13.8 million in 1991-1992. Alcoholism declined over the decade in males, from 6.33 percent to 5.42 percent, and in females from 2.58 percent to 2.32 percent.
     The increase in alcohol abuse was noted across many groups, minorities in particular. ``A group that showed an especially sharp increase was young adult Asian males, a group that has not previously attracted attention as being at elevated risk for alcohol use disorders,'' the researchers said. The rate for Asian males jumped from 1.65 percent to 3.20 percent, with almost all the increase between the ages of 18 and 44. While the overall alcohol abuse rate jumped from 3.03 percent to 4.65 percent, it rose from 3.33 percent to 5.1 percent for whites; climbed from 1.46 percent to 3.29 percent for blacks; declined from 8.14 percent to 5.75 percent for American Indians; rose from 1.08 percent to 2.13 percent for Asians; and climbed from 2.52 percent to 3.97 percent for Latinos.
     By age, overall alcohol abuse rose from 6.54 percent to 6.95 percent for people age 18-29 and from 3.02 percent to 5.95 percent for ages 30-44. For ages 45 to 64 it was up from 1.35 percent to 3.54 percent, and it rose from 0.25 percent to 1.21 percent for those 65 and older. For alcoholism, the rate fell from 4.38 percent to 3.81 percent. For whites it dropped from 4.35 percent to 3.83 percent; it edged down from 3.84 percent to 3.57 percent for blacks; among Indians, it declined from 9.01 percent to 6.35 percent; for Asians it edged upward from 2.26 percent to 2.41 percent; and for Latinos, the rate declined from 5.78 percent to 3.95 percent. The alcoholism rate fell from 9.4 percent to 9.24 percent for those aged 18 to 24; from 4.25 percent to 3.77 percent for ages 25 to 44; from 2.12 percent to 1.89 percent for ages 45 to 64; and from 0.39 percent to 0.24 percent for those 65 and older.
     The study, published in the journal Drug and Alcohol Dependence, is based on interviews with 43,093 people in 2001-2002. The results were compared with a similar study in 1991-1992. On the Net: NIAAA: http://www.niaaa.nih.gov



Few Treatment Options for Problem Gamblers
Associated Press, 6/12/2004

NEW ORLEANS -- Legalized gambling has provided a jackpot of tax dollars for many states, but virtually no money is being funneled to treat the exploding numbers of problem players -- the ones who could lose everything. Louisiana, often thought of as running behind the curve on almost everything, has the nation's only two state-supported residential treatment centers for problem gamblers. Among the other gambling states, only New Jersey chips in -- on a limited basis -- for outpatient treatment. ``If you took the size of the Earth as being the problem and you took a swimming pool in someone's back yard, that's the size of the resources available for compulsive gamblers,'' said Arnie Wexler, former executive director of the Council on Compulsive Gambling of New Jersey.
     Estimates vary widely on how many problem gamblers there are in the United States. A national study authorized by Congress in the late 1990s suggested that up to 6 percent of the adult population has a gambling problem, with about 1 percent being pathological -- or completely out of control. In Louisiana, population 4.4 million, a recent study by the state health department estimated about 74,000 pathological gamblers. No one knows the exact number, Wexler said.
     The state has two residential-type treatment centers -- CORE North in Shreveport and CORE South in New Orleans, with a total of 36 beds -- but that's more than any other gambling state, including Nevada, New Jersey, Illinois, California and Florida. Problem gamblers from those states regularly wind up in Louisiana's centers, but unlike state residents who are treated free, pay $6,000 per month for their stay. ``We are only meeting something in the vicinity of 1 percent of the need,'' said Reece Middleton, head of the Louisiana Association on Compulsive Gambling and co-founder of the Shreveport center which opened in 1999. ``But that's not to say that if we opened 100 beds tomorrow, we'd fill them. People are not real easy to get into treatment.''
     Nationwide, casinos paid about $4 billion in direct gambling taxes in 2002, according to the American Gaming Association, a casino industry trade group. Louisiana's two treatment centers get $2 million a year from state gambling taxes: $500,000 each from the New Orleans land casino, the 14 riverboat casinos, the state lottery and video poker. The state's three Indian casinos, which do not pay state taxes, contribute nothing.
     The explosion of legalized gambling since the early 1990s has doubtlessly fueled the problem, but the number of Gamblers Anonymous meetings shows that the crisis reaches far beyond states with casinos, Wexler said. Sports betting -- legal only in Nevada -- contributes to a big share, he said. ``I'm not going to tell you that availability is the sole problem because you have states like Utah and Hawaii that don't have any legal gambling going on, but you have compulsive gamblers in those states,'' Wexler said.
     Since it opened last year, CORE South has handled 185 clients, said program director Corinne Dumestre. Counselors have seen gamblers who got in trouble with just about every form of wagering imaginable -- illegal sports betting, casinos, video poker, horse racing and Internet casinos. ``You are going to continually have an increasing number of problem gamblers as you increase gaming,'' Dumestre said.
     Those seeking help have limited options. Health insurance coverage generally does not cover treatment. ``There's a Catch 22,'' said Mitch Wallick, who operates the C.A.R.E treatment center, a private facility in Palm Beach, Fla. ``By the time a gambler is ready for treatment and recognizes that, he has no money left.''
     Such is what happened to Jimmy, a San Francisco resident who wound up in the New Orleans center. He said he started looking for help about a year ago -- while embezzling $500 a week from his employer to fuel forays into high-stakes card games at casinos. Both his company's assistance program and his health insurer told him they couldn't help. They didn't recognize it as a problem, said Jimmy, who spoke only on the condition that his real name not be used. By the time Jimmy got into CORE South, he had lost his $65,000 job and separated from his wife and three children. His father loaned him the money to get treatment instead of using up what little was left of his retirement fund.
     Along with the other residents, Jimmy is learning to control his behavior through individual and group therapy, much of it patterned after the 12-step program of Alcoholics Anonymous. ``This program here is a beautiful thing for the state of Louisiana and its people,'' Jimmy said. However, Dumestre said treatment alone, no matter how widely offered, is not enough to handle the problem.
``We need to start our children young and educate them about the dangers of gambling,'' she said. ``We need to educate the senior citizens. And we have to offer these seniors something besides gambling'' for group entertainment.
     Some casino operators are taking steps to limit compulsive gamblers -- at least in their own properties through programs known as ``responsible gaming.'' Las Vegas-based Caesars Entertainment is implementing a systemwide plan at its 19 U.S. casinos to identify problem wagerers -- and discourage them from visiting the casinos by banning special privileges. The company will start by targeting the 8,600 gamblers who have asked to be excluded from casinos in Missouri, Louisiana, Michigan, New Jersey, Indiana and Illinois, plus its own customers who asked to be cut off. ``This is a group of people we will not market to, will not cash checks for, will not allow them to participate in our player rewards program, will not extend them complimentary services, will not allow them to sign markers,'' said Robert Stewart, senior vice president for corporate communications. ``We will not extend any services to them.'' He said his company endorsed the use of gambling taxes by states to treat compulsive gambling. ``We think our responsibility is to govern our own conduct and respond to the way that we market to these people,'' he said. ``We want to be part of the solution for them and not part of the problem.''
     For people like Jimmy, who flew across the country to get help, the crisis requires immediate attention. ``States like California, Nevada and other states where they have lotteries and casinos need programs like this,'' he said. ``Otherwise, it's going to kill a lot of people.''

McSorley's Death Recalls a Life Long Lost
Brian MacQuarrie, Boston Globe- 6/13/2004

The late-night arrival had occurred many times. Patrick McSorley, perhaps the best-known victim of clergy sex abuse in the Boston Archdiocese, had made his way to Alan Brini's North End apartment -- distraught, exhausted, desperate for a place to sleep. His girlfriend, Kristin Carter, had just barred McSorley from her Taunton home, fed up with a drug addiction that had worsened like a gathering hurricane since McSorley received nearly $200,000 in a landmark settlement in 2002.
Now, he was inside Brini's cluttered apartment near Faneuil Hall Marketplace in the early hours of Feb. 22, sobbing as the older man sought to comfort him. "He put his arms around me," recounted Brini, a confidant of McSorley's. "He was crying and said, 'She did it again.' "
     McSorley, 29, sat in a soft black leather chair, his favorite spot in the apartment where Brini shuffled from room to room with the aid of a cane and tended to a serious nerve disorder with powerful drugs that filled his medicine cabinets. All during that night, McSorley placed call after call to Carter, as Brini fell asleep from medication that sometimes blotted out entire days. When Brini woke in the bathroom, nearly 24 hours later, McSorley was lying flat on the bed. "I said, 'Patrick, are you cold?' " Brini, 64, recalled. "I tried to give him artificial respiration, but everything was so hard."
     A 911 call from an emergency transmitter draped around Brini's neck brought police to the apartment. Until that time, Brini said, he continued to try to revive McSorley, refusing to accept his friend's death until he heard an officer remark, "He's A to Z." "In my heart, I knew he was gone, but I didn't want to accept it," Brini said, the tears falling from his eyes and onto his shirt.
     The Suffolk District Attorney's office has labeled McSorley's death, alone and untended, a drug overdose. But among McSorley's family and friends -- among those who watched, stunned, as this unremarkable Hyde Park man suddenly became the telegenic face of the clergy scandal -- the death seemed the sadly predictable destiny of a troubled project kid who found his mission in helping others, but was tragically unable to help himself.
     An unlikely spokesman McSorley burst into the public eye in 2001 with an unexpected intensity that mirrored the widening impact of the clergy sex-abuse scandal. He and 85 other plaintiffs represented by attorney Mitchell Garabedian pursued civil claims against the Boston Archdiocese stemming from their abuse at the hands of the Rev. John J. Geoghan, who was accused of molesting nearly 150 children over three decades.
     But almost alone among the victims, McSorley gravitated to the spotlight with an ease and enthusiasm that belied his roots as the youngest of six children from a poor Boston family that had lurched from dysfunctional homes in Mission Hill to Jamaica Plain to Hyde Park. McSorley attended depositions of Cardinal Bernard Law, sat beside Garabedian at news conference after news conference, and spent many of his days in the company of out-of-town reporters seeking the same insight, over and over, into what had become the biggest scandal ever to shake the Roman Catholic Church in the United States. His mother, Geraldine McSorley, was startled by her son's sudden transformation into an eager, ready source for the media. "I said, 'Patrick, you don't know what you're into there. This'll be something that goes down in the annals of Catholic history,' " she recalled. "He had gone nowhere, gotten nowhere, and done nothing, but then he found himself in the midst of all this social turmoil. My son was like a child the way it went."
     To Garabedian, who did not know McSorley before he walked into the lawyer's State Street office to talk about Geoghan, McSorley was a driven, guileless champion for those victims who could not face the cameras to speak of their anger and shame. "Patrick's legacy can be summed up in one word: courage," Garabedian said. To other survivors of Geoghan's molestation, McSorley was the street-smart articulator of their hunger for delayed justice. "When I saw him on TV speaking out, he made me want to be that person," said Alexa MacPherson, 29, of Dorchester, a victim of clergy sex abuse who befriended McSorley in the last year of his life.
     But to Stacey McSorley Stokes, Patrick's oldest sibling, her brother's role in the limelight was a passion she opposed. "I didn't think it was a good idea, only because of the aftereffects I thought it could have on Patrick," Stokes said. "I was like, 'Pat! Pat? What are you doing, bro?' " Still, she did not fight her brother's penchant for the spotlight. "He had a mission going on, and he was on a roll, and he had an aim and he was going for it," she said. "But after the case was ended, after all was said and done, he had to look at himself, and all that pain came back to him."
     That pain had roots in McSorley's abuse by Geoghan when he was 12 years old. But the trauma of a chaotic family life also appears to have contributed to a dangerously fragile spirit. Troubled family Billy McSorley and Geraldine Payne were little-noticed products of Boston's working class, she from the shadows of Mission Church in Roxbury and he from South Boston. They met as teen-agers and married in 1965, moving to the Mission Hill neighborhood where Payne's world had been dominated by the spires of the nearby church and by the Catholic faith that prompted many of her peers to become priests and nuns. "When you walked away from church, you felt like you were walking on a spring of clouds," said Patrick's mother, now 61. "The church was very important. That was your spirituality right there." Her faith helped Geraldine McSorley weather the rigors of a tumultuous marriage in which her laborer husband bounced from job to job, and brought a ferocious drinking problem into a household that once squatted in a condemned building in Jamaica Plain.
     Strains of mental illness in some family members combined with other problems to break up the McSorleys. Three children were sent to a Catholic foster home; two to state custody. However, most of the family reunited in Jamaica Plain near St. Andrew's Church, where a small, smiling priest named John J. Geoghan imparted a sense of comfort to his blue-collar parishioners and their children at the affiliated Catholic school. Stacey Stokes, Patrick's sister, recalls Geoghan as a reassuring, non-threatening man who seemed imbued with a quiet peace.
     But if the world seemed stable enough at church, the domestic scene had not improved. The McSorleys moved again, this time to subsidized housing in Hyde Park, where Billy McSorley continued to drink heavily. He ended his life one night in 1980 by jumping from a railroad bridge.
Patrick, the youngest, was 6 years old. But the worst was still to come. In 1986, as Stokes walked in the Forest Hills neighborhood, she met Geoghan by chance. The fateful location remains etched in her mind: Walk Hill and Wenham streets. There, she hugged this avuncular reminder of her school days and told him of her father's suicide. "I was so happy to see him because he was such a humble, little man," Stokes said. Geoghan asked where the family lived. The next day, Geoghan offered his condolences in person to Geraldine McSorley and offered to take Patrick, then 12, out for an ice cream.
     For a poor boy, an ice cream spoke of rare luxury. But Patrick unknowingly stepped into the predator's path, one that the priest had trod before. On the drive back to Patrick's house, Geoghan patted the boy's leg, moved his hand to Patrick's genitals, and fondled the stunned child as the priest masturbated himself. After the car stopped, Patrick emerged in numbed disbelief, the ice cream dripping down his hand and forearm as Geoghan warned him not to speak of the incident. "When Patrick walked in the house, I knew something was wrong," Geraldine recalled.
     A double life Patrick eventually told his mother about his encounter with Geoghan, but the shame of the incident and the intimidating authority of a church to which his mother always had deferred combined to keep the episode closely guarded for years. McSorley did not even disclose the incident to his sister until 1999, when Stokes mentioned over dinner that Geoghan, their former parish priest, had been named in sex-abuse complaints reported in the media. McSorley rose from the table, left the room briefly, and returned to tell his story. Nothing was ever the same again. At first reluctant to join the growing number of plaintiffs who said Geoghan had molested them, McSorley took the advice of his sister to join the lawsuits and "validate" what had happened to him.
"He said, 'OK,' just like that," Stokes recalled. "But I didn't expect him to be a spokesman. I didn't expect him to go all out."
     Garabedian said he noticed something special in McSorley, something that would translate well to television, news conferences, and public appearances. "He always spoke from the heart, he always spoke sincerely, and there was a certain genuineness to him that couldn't be defeated," Garabedian said. McSorley also had a street-bred fearlessness, his admirers said, that gave him the confidence to venture before the cameras that other plaintiffs shunned. But if McSorley combined a blue-collar sense of virtue and verve, family and friends said, he also appeared to be the poster boy that could attract attention and sympathy to the case. "He was the young, vulnerable victim," MacPherson said. "He was the handsome boy that's standing up for justice."
     Garabedian played a big role in encouraging McSorley to become the face of the scandal, MacPherson said. But McSorley also relished the spotlight in a cause to which he had become wholeheartedly attached, she added. "I think the only time he felt in control was when he was out there doing that," MacPherson said.
     The idea of "control" was, literally, a concept of night and day with McSorley. During the day, he busied himself with the case and media requests. At night, Stokes said, a frightening world of hard drugs and shadowy friends ruled his life. Cocaine, OxyContin, Percocet, marijuana, and alcohol were frequent means of escape, Carter said, even after she became pregnant with Patrick Jr. six years ago. There also was heroin, which his family and friends agree McSorley abused but which they rarely saw used in their presence.
     The drugs changed McSorley dramatically. Normally caring, breezy, nonjudgmental, and generous, the natural charisma that drew people to McSorley turned dark and ominous. "He became a different person when he did drugs," MacPherson said. Overly self-righteous. Fidgety. Prone to short-tempered outbursts. Stokes said she became concerned about the effect of McSorley's behavior on her two daughters, now 12 and 4. "It was in this kitchen about a year ago," she said recently at her Taunton home. "When he came in, he was ready and reeling," Stokes said of Patrick's startling mood. "I said, 'Wait a minute. What are you on?' " Stokes recalled. "I realized he's going to get himself killed."
     In a June 2003 incident widely reported as a mysterious, accidental plunge into the Neponset River, McSorley actually did try to commit suicide, MacPherson said. Brini, his North End friend, said McSorley had been high on PCP when he fell into the river beside Pope John Paul II Park in Dorchester. Although McSorley denied at a news conference that he had tried to kill himself, MacPherson said McSorley later told her he did not want to leave the river alive. "He wanted the pain to end. He wanted the memories to end," MacPherson said. "He didn't know how to pick up the pieces."
     The legal settlement in September 2002, in which the archdiocese agreed to give $10 million to the 86 plaintiffs, did not ease McSorley's pain. Neither did McSorley's share. If anything, his family and friends agreed, the windfall hastened his death. The money became the fuel that stoked McSorley's worsening drug addiction. "When you think that things would get better, they spiraled out of control for him," Stokes said. At the time of the settlement, McSorley said: "The money is not going to change my life. My heart is always going to be broken because of this." But according to relatives and friends, McSorley spent tens of thousands of dollars on a Caribbean cruise, cottage rentals on Cape Cod, a speedboat, and a new drum set. A fast life had suddenly become faster.
"He knew what he wanted to do with the money -- enjoy it, poor kid," McSorley's mother said. "After the money, he got confused."
     McSorley's aunt, Jane Scarborough of Quincy, said the ready cash could not mask the pain that had been dredged up, relived, and recounted in public. "He said he was sorry he came forward because his life then became screwed up," said Scarborough. She had cared for McSorley for three years after his father died, and even she did not know of the abuse until after he joined the lawsuit.
But the money began to dry up. MacPherson said her friend sometimes would beg for a few dollars to buy a cup of coffee or a pack of cigarettes. Brini estimated he spent $15,000 on McSorley's needs, from hundreds of parking tickets to co-signing for a car loan. "Last summer, he was almost unrecognizable," Carter said. "He was very thin. His eyes just looked different, almost like he didn't have a care, like everything was for the drugs."
     Less than a month after McSorley was pulled from the Neponset River and placed on life support, he was arrested in a Dedham motel and charged with possession of the powerful painkiller fentanyl, marijuana, and drug paraphernalia that included hypodermic needles. The charges were continued without a finding for a year, with the condition McSorley remain clean. After that, according to family and friends, McSorley's habits waned somewhat but remained worrisome.
"He had no friends who were clean," MacPherson said. "His cellphone was ringing off the hook. People knew he had the money or he had something on him." Brini recalled nights when a drug-dazed McSorley would come to the apartment, unable to recognize Brini, swinging appliances around the room and punching gaping holes in the walls. And then there were the sober times, MacPherson said, when McSorley would be painfully sick from drug withdrawal, sitting for hours in waiting rooms at various hospitals with cracked, bleeding feet, pleading for admission to detoxification and rehabilitation units. "I knew he was going to die," Stokes said. "It was only a matter of time."
     Garabedian said he was concerned about McSorley's drug habit and tried to help. At one time, friends said, McSorley received church-paid treatment after Garabedian prodded the archdiocese to help his client. The lawyer, however, said that attributing McSorley's problems solely to drugs and alcohol is a mistake. "It's convenient to blame other sources. The blame really lies with the pedophile priests and their enablers," Garabedian said. "The monsters who created this know who they are: One of them has passed away, and one of them has gotten out of the country." The villains, according to Garabedian, are Geoghan, who was killed in prison last year, and Law, who has been appointed to a ceremonial position in Rome.
     McSorley's mother said she still does not blame Law, asking how the cardinal could be responsible for the day-to-day observation of priests suspected of pedophilia. And Geraldine McSorley believes that Geoghan's death caused her son to question whether the high-profile case was worth another tragedy. "I know it was wrong," McSorley's mother recalled him saying of Geoghan's abuse. "But was it worth a man dying over? Was it worth a man's life?"
     Carter said she misses McSorley terribly, and her 5-year-old son, Patrick Jr., echoes that sentiment in a small apartment where pictures of the smiling family are everywhere. Despite the turmoil and the anxiety, McSorley's absence has left a void in the circle of people who cared for him. The irony of his death -- quickened, his family believes, by his participation in the case -- also has a permanent place in their hearts. "He had no coping skills," Stokes said. "Here he was, fighting for everyone else. But he couldn't even fight for himself."

Psychologists Seek Power to Prescribe
David Kohn, Baltimore Sun- 6/13/2004

BALTIMORE -- Across the United States, psychiatrists and psychologists are engaged in a bruising battle. Two professions normally focused on respecting emotions and listening are instead hurling barbs, accusing each other of caring more about money and turf than patients. A long-smoldering debate ignited last month when Louisiana passed a law allowing psychologists there to write prescriptions. Psychiatrists, who as medical doctors can prescribe, bitterly fought the legislation and said they fear it will generate momentum in other states. Dr. Michelle Riba, president of the American Psychiatric Association, calls the Louisiana law ''really scary," saying undertrained nonphysicians will harm, and perhaps kill, patients. ''Without a doubt, they'll make mistakes," she said.  Psychologists say the ability to prescribe will help them better treat their patients. ''It's just good medical sense," said Jim Quillin, a psychologist who helped lead the fight in Louisiana.
     Two years ago, New Mexico also passed such legislation. But bureaucratic disputes between the state's psychological and medical boards have kept the law from taking effect, so Louisiana psychologists will probably be the first to prescribe medicine, possibly by this summer. This year, seven other states considered, but did not pass, ''RxP" bills, as the measures are known. Louisiana psychologists would have to pass a 400-hour psychopharmacology program to prescribe.
     Psychologists argue that granting prescription privileges will alleviate shortages of psychiatrists. In some rural states, including Louisiana, patients who might need medication wait months to see a psychiatrist. ''When a patient needs to see a psychiatrist, it's usually a fairly immediate need," said Quillin, who has a private practice in Alexandria, La..
     But critics say medical psychologist programs are a drop in the bucket compared with the training doctors must undergo. Dr. Steven S. Sharfstein, president of the Towson, Md.-based Sheppard Pratt Health System, said the psychologists' 400-hour curriculum would cover only five weeks of the typical 80-hours-a-week medical school residency. Psychiatrists also say that many of these programs depend heavily on distance learning, in which students learn by computer and meet through chat rooms.
     Proponents say the Louisiana law includes an effective safeguard against error: Before prescribing a drug, the psychologists must consult with a physician, who can veto the prescription if it seems unnecessary or incorrect. That's not enough, said Sharfstein, who contends that psychologists who want to prescribe ''should go to medical school." But many psychologists say they are at least as capable as primary-care physicians, who now prescribe at least two-thirds of all drugs for mental illness.
     Many psychiatrists accuse psychologists of pursuing the right to prescribe for financial reasons. Because more social workers and licensed professional counselors now offer psychotherapy, psychologists are eager to make themselves more appealing to patients, they say. ''This is mostly a financial issue," said Dr. Patrick O'Neill, head of the Louisiana psychiatrists' group. Russ Newman, of the American Psychological Association, acknowledges that appealing to consumers plays a role, but says psychiatrists are the ones motivated by economics. ''They're trying to protect their market," he said.

My Name Is the Big Book. My Future Is Open.
Felicia R. Lee, New York Times- 6/14/2004

On June 10, 1935, Robert Smith, a physician from Akron, Ohio, took his last drink. He and William Wilson, better known as Dr. Bob and Bill W., had no idea that the date would later mark the beginning of what some consider one of the most important movements in the 20th century: Alcoholics Anonymous. Wilson later wrote an account of their philosophy — that only an alcoholic could help another alcoholic quit drinking — and the lives of other alcoholics that is referred to as the Big Book, the movement's bible.
      Now Sotheby's is planning to auction what it says is Wilson's master copy of the working draft of "Alcoholics Anonymous," the Big Book's disarmingly straightforward official title. Its value has been estimated by the auction house as $300,000 to $500,000. The sale, scheduled for Friday, has created excited speculation among collectors and scholars about who will buy it, and a debate about its value and rightful place.
      Given the enormous impact of a book that in its fourth printing alone has reached more than 19 million people, some believe that Sotheby's is offering a priceless historical document. That status, some argue, means that it should be placed in an archive accessible to scholars and ordinary people rather than on the auction block. "I think these things really belong to the fellowship of A.A.," said Eileen Giuliani, executive director of the Stepping Stones Foundation, which maintains the home and the documents of Wilson and his wife, Lois Wilson, as a museum in Bedford Hills, N.Y. "Documents like this belong in archives."
      Bill Pittman, a historian who has written extensively about the history of A.A., said he, too, was concerned that the manuscript's sale would make it inaccessible to scholars. He said the Sotheby catalog incorrectly stated that Wilson's annotations were among the multitude of annotations on the typewritten manuscript. Mr. Pittman said he viewed the manuscript last year when the owner took it to a rare-book dealer.
      But Selby Kiffer, a senior vice president at Sotheby's, said the manuscript did indeed contain Wilson's annotations. He said experts had spent weeks going through the 161-page manuscript, which contains thousands of annotations by many people. In either case, the absence of Wilson's annotations does not reduce the document's value, said Mr. Pittman, the director of historical information at the Hazelden Foundation in Center City, Minn. Although Wilson was the primary author, there were many drafts and many comments from a wide variety of people involved in the project, he said. The book authorship is stated as "the story of how many thousands of men and women have recovered from alcoholism."
      "It's the most important piece of A.A. history to be sold, ever," said Mr. Pittman, who worked for several years at the A.A. archive in New York City. He said the margin notes and last-minute changes before the master copy went off to the printer provided valuable insights into how the Big Book evolved. Still, he said, he thought the document was overpriced. "I think someone should buy it and give it back to A.A. and let researchers like myself look at it," Mr. Pittman said. "I don't want someone to buy it and sell each individual page." Ms. Giuliani said, she too, thought the manuscript's price put it out of the reach of serious researchers and was out of line with what A.A. material usually cost.
      In many ways the argument about Bill W.'s manuscript is familiar, occurring whenever price tags are attached to valuable historical items. The first edition of "Alcoholics Anonymous" was published in April 1939, and only the personal stories attached to the basic text have changed over the years. The 1938 document being auctioned was consigned to Sotheby's by an A.A. member, Joseph B. (He asked that only the initial of his last name be used.) His aunt was also an A.A. member, who knew Wilson personally, he said, and she gave Mr. B. the manuscript back in 2001. The 1978 inscription on the manuscript is from Wilson's wife, who died in 1988, to a "Barry" (who some historians say is the writer Barry Leach, who wrote a biography of Lois Wilson). Along with the manuscript, Sotheby's is offering a second-edition Big Book that Wilson inscribed in 1958 to "Grace," Mr. B.'s aunt, and four LP albums of A.A. lectures.
      Mr. B. said his efforts to find interest in the document within Alcoholics Anonymous "ran into a lot of brick walls, a lot of dead ends." So, he said, he turned to Sotheby's to establish its provenance and find a buyer. "Not being a rich man, there was some money to be made, but that was not my main reason," Mr. B. said. "It's beyond words for me." As an alcoholic in recovery since 1976, he said that Wilson "saved my life." He found it thrilling, he added, to imagine Wilson cobbling together the Big Book. "I hope it ends up in a proper setting, an academic setting," he continued. "I think Sotheby's can provide that venue."
      Early drafts of the Big Book went out to dozens of people, from alcoholics to psychologists, who sprinkled the margins with their ideas, feelings and experiences. As the manuscript being auctioned by Sotheby's shows, the book was a vigorous exercise in group-think, with a jumble of different handwriting crossing out words, circling phrases, excising passages.
      The first chapter tells Bill W.'s story. Wilson was born in East Dorset, Vt., in 1895 and died of emphysema in 1971. He met Dr. Bob, the co-founder of A.A., during a 1935 business trip to Akron. Desperate for a drink, he contacted a local minister who put him in touch with Dr. Bob, a general practitioner and an alcoholic with a failing practice. The two talked for hours, and the idea of a fellowship of alcoholics helping alcoholics was born. The Big Book was published four years later, but the first sales were slow. It took took off only after a March 1, 1941, article in The Saturday Evening Post about Alcoholics Anonymous and its "freed slaves of drink," as the writer Jack Alexander put it.
      "What really matters for us is the final version of the Big Book,' which helped millions of people to recover," said Judit Santon, the archivist at the General Service Office of A.A. in New York City, home to the largest A.A. archive in the world with half a million pieces of personal correspondence and primary documentation.
      Much of the interest in the manuscript has come from "traditional book and manuscript dealers," Mr. Kiffer of Sotheby's said. As far as anyone knows, he added, the highest price tag for a single A.A.-related item has been for first-edition copies of the Big Book, signed by Wilson, which have gone for as much as $25,000. A thriving market exists for Alcoholics Anonymous items, in the same way that people collect Elvis Presley or Civil War memorabilia, said David C. Lewis, a physician and founder of the Center for Alcohol and Addiction Studies at Brown University. Social historians or any collector of Americana, as well as members of 12-step programs would also find the manuscript intriguing, Dr. Lewis said. "It's basically priceless," he said of the document being sold by Sotheby's. Susan Cheever, the author of "My Name Is Bill" (Simon & Schuster, 2004), a biography of Wilson, agreed. "This is one of the 10 or 20 most important books written in the 20th century, probably the most important nonfiction book," she said. "This guy, with `Dr. Bob,' figured out how to save alcoholics. They changed the way we think about human nature."

Now at Your Drugstore: A Cheap and Dangerous High
Mindy Sink, New York Times- 6/152004

DENVER - Tammy Quist, principal of Fairview High School in Boulder, was not surprised when she learned in April that a student was in a coma after overdosing on an over-the-counter cold medicine. "It's out there, and you know kids do it," Ms. Quist said. "It's cheap, accessible and it's not illegal if kids get caught. And it usually goes unnoticed until a kid takes too much or combines it with something to get a horrible reaction and overdoses."
      Cough and cold medications containing dextromethorphan, or DXM, are becoming increasingly popular among teenagers and young adults looking for a cheap high, experts say. There are no national statistics that track fatalities from cough and cold medications. But reports of overdoses of the drugs have doubled in the last four years, according to the American Association of Poison Control Centers' Toxic Exposure Surveillance System. In 2000, poison-control centers across the country had 2,523 calls about the abuse and misuse of DXM, and 1,623 of those calls involved teenagers. By last year, that total had risen, to 4,382, with 3,271 involving teenagers. These figures, said Dr. Alvin C. Bronstein, medical director for the Rocky Mountain Poison Control Center in Denver, are probably an underestimate. "There is lack of awareness and easy access to these medications," Dr. Bronstein said. "Parents need to be more aware because a box of cough preparation wouldn't look that sinister."
      The problem has caused some drugstores to put cough and cold medications that contain DXM behind the counter, where they are less accessible. Three states -- California, New York and New Jersey -- introduced legislation this year to prohibit sales to minors of products containing DXM, or to restrict the quantities that are sold. The issue of banning bulk sales will be taken up by the American Medical Association at a meeting in Chicago this week. At the same time, some manufacturers have increased the package size of products with DXM to make them harder to shoplift. "We have undertaken a variety of steps to educate parents, teens and schools," said Julie Lux, a spokeswoman for the Schering-Plough Corporation in Berkeley Heights, N.J., which manufactures Coricidin and other products that contain DXM.
      Dextromethorphan is an ingredient in more than 125 nonprescription cough and cold medications, including forms of Robitussin, Coricidin and Vicks. It suppresses coughs by reducing sensitivity in the part of the brain that controls the cough reflex. Officials at the Consumer Healthcare Products Association in Washington, the trade group that represents Schering-Plough and other manufacturers of over-the-counter medications, say dextromethorphan is not an addictive substance and does not produce a chemical dependence.
      Experts say DXM is safe in the 15- to 30-milligram doses recommended for treating coughs or colds. But in the large doses, 100 milligrams or more, typically taken by recreational users, it can cause hallucinations and feelings of unreality. It also carries a risk of high fever, seizures and other serious adverse reactions. Teenagers sometimes refer to dextromethorphan products as Skittles, Red Devils, Robo or Triple C's. The high that the drugs produce is called "robotripping" or "skittling."
      Alex M., a 17-year-old high school student, said DXM gave him a feeling of being outside his body. "I like to use it with meditations," he said. "It's just interesting for self-discovery." He has also used the drugs at parties, where, he said, "It's more something to end the evening." But Alex's experimentation was halted when his father, John, discovered a stash of pure DXM he had purchased online. "We have had long discussions about the side effects," his father said.
      No one is sure what lies behind the recent jump in overdoses from DXM. One theory is that people who abuse it are mixing it, either inadvertently or intentionally, with other drugs, like antidepressants and antihistamines, the interaction increasing the risk of overdose and death. The Internet may also have a role. A quick search on Google brings up dozens of sites describing how to get high on dextromethorphan. "Some of these sites will tell kids exactly how many drops of something they need to take in order to get high," said Ms. Quist, the principal.
      Some experts believe the current enthusiasm for abusing cold and cough medicines will not last. "DXM had some experimentation in the 1960's and it died out," said Dr. Andrea G. Barthwell, deputy director for demand reduction at the Office of National Drug Control Policy. "This seems to be another blip on the radar screen. It's unlikely it will catch on in a significant way."
      Ms. Quist sent a letter to parents outlining the signs of DXM abuse, which include confusion, impaired judgment, blurred vision, dizziness, paranoia, excessive sweating, slurred speech, nausea and vomiting. Most parents, she added, said they were unaware of the problem. In the letter, Ms. Quist recommended that parents keep medications containing the ingredient in places that are not easily accessible and avoid keeping large quantities of such medications in the house.
      The boy who overdosed in April, Ms. Quist said, has emerged from his coma, but she refused to comment further on his condition. Also this spring, a 20-year-old man from Arvada died from a Coricidin overdose. In some cases, overdoses and deaths have occurred when parents or guardians have given cough or cold medications to very small children in inappropriate doses. In May, a Colorado man pleaded guilty to criminally negligent homicide for causing the deaths of his two children after giving them adult cherry-flavored cough and cold medicine. "The labels clearly state how you shouldn't use these products, and that's the first line of defense," said Tom Sanford, a spokesman for Pfizer's consumer health care unit in Morris Plains, N.J. Pfizer makes Benadryl and many other cough and cold medicines. "People need to understand this is serious medicine."

Helping Troubled Youth
John Langone, New York Times- 6/15/2004

The Ups and Downs of Raising a Bipolar Child: A Survival Guide for Parents," by Judith Lederman and Candida Fink, M.D., Fireside/Simon & Schuster, $14.
"Teens Under the Influence: The Truth About Kids, Alcohol and Other Drugs - How to Recognize the Problem and What to Do About It," by Katherine Ketcham and Nicholas A. Pace, M.D., Ballantine, $14.95.
      Children have singular problems, and what troubles them also affects, and sometimes frustrates, parents, friends, teachers and doctors. Some children have fears that breach the bounds of what may be considered normal. Others carry drug experimentation to disastrous addiction. Still others just seem "weird" or "different" or tantrum-throwing playground terrors. These books address some of those woes and outline strategies to rescue troubled youngsters and help the people who deal with them.
      "The Ups and Downs of Raising a Bipolar Child," by the parent of an affected child and a psychiatrist from New York, portrays the anguish of dealing with a child who "doesn't behave like other children" and who is prone to uncontrollable fits of rage. The statistics are troubling. Bipolar disorder may affect as many as a million children in the United States. It is marked by fluctuating mood swings that are often accompanied by other forms of emotional disturbance like eating disorders, severe anxiety, obsessive-compulsive disorders or substance abuse. Bipolar disorder is rooted in heredity, but environmental factors have a role too. The authors write that treatment generally involves combining medication, therapy and the retraining of the parents. "There is seldom a magic pill that by itself solves the problem," they write. "But the right medication mix will take the edge off of some of the more intense moods and, combined with therapy and a low-stress environment, will help a child live a more normal childhood."
      "Teens Under the Influence" covers the mechanisms and effects of alcohol and other drugs, the complex reasons children become addicted, when to seek help and what assistance to seek, how to tell when children are addicted, and how parents can fight back. The book includes candid accounts by adolescents. Some drugs discussed are easy to find and use. Among those are inhalants, rubber cement, airplane glue, shoe polish, paint thinner, lighter fluid, nail polish and even the propellant in aerosol whipped cream. Six percent of fourth graders, and one in five eighth graders, have tried inhalants, the book says. The average age of first use is 12.
      "I'd soak a sock with hairspray," the book quotes one teenager, "put it over my face, and breathe deep. I'd be depressed and then I'd use and I'd feel happy and relieved." Of Ecstasy and other "club" drugs, a 14-year-old girl said, "It was amazing - I could bawl my eyes out, and be happy at the same time." Of prescription drugs, a 17-year-old said: "You want some pills? Just go into your friends' houses and look in the bathrooms."
      A valuable chapter deals with helping parents realize that they should fully cooperate with probation officers, and that they should not bargain with teenagers, make threats or make comments like, "Don't you care about what this is doing to me?" The book has a list of ways for parents to cope, like rescinding driving privileges until the child agrees to obtain help, stopping allowances and not making excuses for the behavior. A mother who followed the advice for her alcoholic daughter said: "I told her she couldn't live in my house any more if she continued to use drugs. I took her house and car keys away. It wasn't easy, but I am convinced my actions and tough love saved her life."