BRADFORD, Vt. -- A new drug addiction treatment program that opens this week is designed to fill critical gaps in the options now available. Health Commissioner Paul Jarris says Valley Vista, a former nursing home perched on a hill outside the village of Bradford, will offer the longest and most intense treatment regimen, and specializes in rehabilitating two under-served populations: women and adolescents. Half the 80 beds at Valley Vista will be reserved for women and 18 in a new wing are for youths. More of the beds may be set aside for women in the future. The first admissions will be women.
      Vermont is experiencing an epidemic of heroin use, Jarris said, with dealers targeting young women. A 2003 survey of 78 women in prison found 83 percent had used drugs more than five times and 51 percent also admitted to alcohol problems. Programs for young users have not existed up to now. "We have had to go out-of-state," Jarris said. Gov. Jim Douglas announced a plan to recruit a residential treatment provider to Vermont shortly after taking office in 2003. Valley Vista is the result.
      The state had been relying out-of-state residential programs for Vermonters with the most persistent addictions. Officials predict an in-state program will yield better results for many patients. Jarris explained that out-of-state programs have fewer links to local drug and alcohol counselors, mental health centers and support groups such as Narcotics Anonymous -- all services that people trying to kick drug habits need when they return home.
      Linking patients to local services will be integral to treatment at Valley Vista, according to Rick DiStefano, chief operating officer. He expects many patients will need group counseling three or more times a week when they first leave the facility. The availability of these services will determine the length of time patients stay, he said. "Folks who return to more rural areas, where less out-patient intensive care is available, we'll keep them a little longer."
      DiStefano and partner Jack Duffy developed Valley Vista after years of working at Conifer Park, a 225-bed drug rehabilitation center in Glenville, N.Y., where many Vermonters have been sent to try to overcome their addictions. "The patients we saw coming from Vermont were more opiate-involved than patients from anywhere else in New England," said DiStefano, a nationally certified chemical dependency counselor who worked 18 years at Conifer. He said the treatment program at Valley Vista has been designed for complicated cases involving simultaneous addictions to opiates, painkillers and alcohol. Treatment begins with medically monitored detoxification -- for those still using drugs or alcohol. Patients in withdrawal won't be isolated from other clients further along in their recovery, DiStefano said. "You will begin your rehabilitation on Day 1 as you can tolerate it."

New Therapy on Depression Finds Phone Is Effective
Benedict Carey, New York Times- 8/25/2004

Debates about the safety and effectiveness of treatments for depression miss a basic reality about the disease: most people affected by it do not seek help at all, and those who do commonly neglect to complete counseling or drug regimens recommended by doctors. For at least a third of the people who try them, treatments of any kind fall short, surveys show. But improving success rates may be a matter of picking up the phone, according to a report today in the Journal of the American Medical Association. In a large-scale, 18-month study, doctors in Seattle found that they could significantly increase recovery rates for patients taking antidepressants by providing several 30- to 40-minute counseling sessions over the phone.
      In previous studies, researchers showed that phone calls from nurses or other clinic staff members providing emotional support could help people trying to quit smoking, stay on medication or shake low moods. The Seattle study is the first to test the effect of a standardized form of counseling, cognitive behavior therapy, delivered entirely over the phone. "It's thrilling to see these kinds of results," said Dr. Jeanne Miranda, a professor of psychiatry at the University of California, Los Angeles, who was not involved in the study. "I do this kind of therapy in person, and it is often very hard getting some people to come in; they want the help but are just too busy to find time in their schedule, and on the phone they can do it on their time."
      It is not clear from the study whether phone counseling will be equally helpful for everyone with depression. The Seattle researchers focused on patients who sought treatment and were motivated enough to begin taking drugs. Dr. Jürgen Unützer, a psychiatrist at the University of Washington who was not involved in the study, said that only about a quarter of all Americans suffering from the illness try drug therapy each year. The rest do not, because of lack of awareness, access or interest, psychiatrists say, and many people with depression are wary of taking mood-altering drugs.
      But because 40 percent of the people who begin antidepressant therapy quit within the first month, doctors should consider the telephone a powerful ally, said the study's lead author, Dr. Gregory E. Simon, a psychiatrist at the Group Health Cooperative, a 500,000-member health plan in Washington. "This represents an important change in the way we approach treatment," Dr. Simon said, "not only using the phone, but being persistent, proactive, reaching out to people and finding them where they are. Depression is defined by discouragement; very often they're not going to come to you."
      The researchers followed 600 men and women receiving antidepressant treatment at Group Health clinics. The patients were randomly assigned to one of three treatment plans: usual care, in which they were instructed simply to follow their prescription; telephone management, in which they received two phone calls and a mailer with advice and support for continuing the prescription; and phone therapy, in which trained counselors provided up to eight sessions of advice on how to combat the negative thinking and inertia that fuel depression. Participants in the last group also had workbooks that reinforced the phone therapy, and counselors encouraged them to do homework between sessions. "One thing we had them do was to list their 10 most common negative thoughts, and then when they had one, to write it down, 'O.K., that was Thought No. 3,'" Dr. Simon said. "This is a way of practicing stepping back from those thoughts and seeing their effect." By the end of the study, 80 percent of those who had received phone therapy said their depression was "much improved," compared with 55 percent of those who were given usual care. Of those who received encouragement by phone but not explicit therapy, 66 percent said they were "much improved."
      The researchers do not know what component of the phone therapy made it effective or whether the increased attention itself made patients feel better. But for therapists trying to treat patients who are overwhelmed or hard to reach-single parents, low-income people. for example -- the study may provide an alternative to in-person care.
      In rural areas, where stigma can be a barrier to treatment, it is nearly impossible to visit a therapist discreetly, Dr. Miranda of U.C.L.A. said. "I was working in rural Idaho, where there's really only one mental health worker, and everyone knows where that person works and what their car looks like," she said. "By working on the phone, you can catch people at home and they have some privacy."

Paxil Maker Settles
Brooke A. Masters, Washington Post- 8/27/2004

NEW YORK -- Drugmaker GlaxoSmithKline agreed Thursday to settle charges that it hid and misrepresented unfavorable data about the effectiveness and safety of its top-selling anti-depressant Paxil for children and adolescents, agreeing to post all clinical trial data on its drugs by the end of 2005.
      The settlement with New York Attorney General Eliot L. Spitzer also includes a $2.5 million payment to the state of New York. It puts the British-based firm at the forefront of a burgeoning debate about whether pharmaceutical manufacturers should be required to tell doctors and the public when new research shows their drugs in a negative light. Currently companies are required to share information about newly discovered risks and side effects only with regulators, though the editors of leading medical journals and the American Medical Association called in June for that to change.
      Spitzer drew national attention to the debate that same month by filing civil fraud charges against Glaxo, citing a 1998 e-mail in which company officials discussed the Paxil studies and the need to "effectively manage the dissemination of these data in order to minimize any potential negative commercial impact." Within two weeks, Glaxo had put the Paxil data on its Web site and promised to create a public registry of studies of its other drugs.
      Glaxo spokeswoman Nancy Pekarek said the company continues to believe it did nothing wrong. She said Glaxo had been working on the registry idea for months before Spitzer's lawsuit. Under the settlement, new studies will be added to the registry within 10 months after their completion. "This is what we were looking for when we announced the case," Spitzer said of the settlement. "We hope this represents a sea change in the way pharmaceutical companies handle marketing," he said in an interview. "Doctors will not now have to rely on what the pharmaceutical representatives say about the studies of the drugs. If the other companies follow this model, something dramatic will have changed."
      Two other big drug companies, Johnson & Johnson and Forest Laboratories, have said they also have been contacted by Spitzer's office about their test data and marketing practices, and Eli Lilly, the maker of the antidepressant Prozac, promised last month that it would create a public registry for its drug-testing data. "We are pleased that the Attorney General believes the Clinical Trial Register we have been developing will provide useful information to the medical and scientific community," Mark Werner, Glaxo's chief U.S. lawyer, said in a statement.

Illinois Drug Court to Be Studied
William Presecky, Chicago Tribune- 8/27/2004

Because of its success, Kane County's Drug Rehabilitation Court will be analyzed next year in a national study aimed at pinpointing what makes such programs effective alternatives to jail. Michael C. Daly, director of the county's 4-year-old rehabilitation program, said Kane's will be one of 30 drug courts nationwide that the U.S. Department of Justice has selected for review beginning Jan. 1.
The Washington-based Urban Institute, a non-profit urban research organization, has been commissioned to do the yearlong study, Daly said. Nationwide there are about 1,000 drug rehabilitation courts like Kane's that provide an alternative to incarceration for non-violent defendants whose behavior is linked to drug use, he said.
      In Kane, Presiding Judge James Doyle, who founded the drug court, maintains close supervision of each person in the program. Every participant is required to have a job, make weekly court appearances, participate in treatment and be tested for drug use three times a week. "Testing is a key component," said Daly, noting that it is the aim of the federally sponsored study "to identify what components make drug courts work."
      Every participant in Kane's program must remain in it for at least two years and dismissal is contingent on each being drug-free for a minimum of a year. Daly said that after-care support is provided as an option to people who successfully complete the program. The next "graduation" from the program is set for Oct. 8, he said. Since it was begun in August 2000, participation in Kane's program has grown steadily. There are 855 participants currently, Daly said. The federally funded study comes as Kane officials continue to evaluate the fast-growing county's long-term jail needs with an eye toward building a major detention facility near the county judicial center in St. Charles.
      Increased knowledge about the effectiveness of jail diversion programs such as drug rehabilitation court, electronic home monitoring and the use of global positioning systems to track accused and convicted sex offenders will be critical in assessing future construction needs, said Karen McConnaughay (R-St. Charles), chairwoman of the County Board's Corrections and Rehabilitation Committee.
      Kane is one of 50 jurisdictions nationwide, and one of four in Illinois, to receive a $84,000 federal grant last year to track accused and convicted sex offenders using GPS technology. "We've had five people on since March and we haven't had a violation yet," said James Mueller, director of court services.

Scientists May Use Drugs to Stop Addiction
Associated Press, 8/29/2004

NEW YORK -- Can Prozac help you kick cocaine? Can Ritalin? How about a blood pressure pill or medicine for muscle spasms? If you're an alcoholic, could you get help staying sober by taking an anti-nausea drug used by cancer patients? Scientists are exploring those questions right now. In fact, in the field of addiction medicine, one of the hottest sources of new drugs is ... old drugs. Despite years of research, there is no drug approved in the United States for treating cocaine dependence. To find such a treatment, the National Institute on Drug Abuse is sponsoring human studies of 21 medicines already on the market for something else. That's about two-thirds of all the potential cocaine drugs being tested in people, says Frank Vocci, director of NIDA's pharmacotherapy division. Over at the National Institute on Alcohol Abuse and Alcoholism, nearly all the potential alcoholism drugs tested in people under institute sponsorship over the past 10 years were previously approved for some other use, says Raye Litten, co-leader of the institute's medications development team. While the strategy is hardly new, ``it's been going on maybe just a bit below the radar screen'' for most of the public, Vocci said.
      It can certainly work. In 1997, for example, the government approved a stop-smoking pill called Zyban, which was in fact the older antidepressant Wellbutrin. To be sure, experts haven't given up on developing new drugs. Most NIAAA-funded drug studies for alcoholism that are in early stage testing -- not yet tried on people -- are brand-new drugs, Litten said. But the notion of examining current drugs for addiction-breaking potential holds several advantages. It's a lot cheaper to get federal approval for a new use of an old drug than to bring a completely new medicine to market. And experience with an existing drug gives an idea of its safety and dose range for possible anti-addiction effects, Vocci said.
      He and others caution that people who happen to have medications on hand that show promise in such studies shouldn't give them to friends and family with addiction problems. That must be left to professionals. Experts also say that even effective anti-addiction medicines usually can't work by themselves, but must be used along with non-drug therapy.
      The most straightforward approach to testing an existing drug is to follow its approved purpose, but in a different way. For example, some scientists are studying how to prolong the effects of naltrexone, now usually given as a daily pill for treating dependence on alcohol or opiates like heroin and morphine. Dr. David Gastfriend of Massachusetts General Hospital and Harvard Medical School and other researchers recently reported that specially formulated naltrexone helped alcoholic men cut down on their drinking for a month when they received the drug as a shot in the buttocks.
      Why is a monthly visit to a doctor better than just taking a pill every day? ``The pill requires a daily awareness that this is a dangerous disease and a rational decision to take the pill,'' Gastfriend said. ``The problem with this illness is that on any given day, a person can feel, `No, it would be better if I could drink.' So you take the pill the first day and you have to make 29 more decisions'' the rest of the month. ``But if you received an injection the first day, those 29 decisions have already been made,'' said Gastfriend, a paid consultant to Alkermes Inc., which is developing the formulation he studied, called Vivitrex.
      More striking than just reformulating a drug is finding a new and apparently unrelated use for it. Here, scientists are guided by emerging knowledge about how addiction hijacks the brain. Addicts apparently suffer from a combination of unusually strong desire for a drug and a weak inhibition against using it, Vocci said. ``These people essentially have a revved-up engine and thin brake pads,'' he said.
      In the brain, scientists have found that cocaine produces euphoria by stimulating nerve circuits that communicate with a substance called dopamine. So they've looked for medications that can affect the activity of this dopamine system. One is a decades-old old drug called baclofen (pronounced BAK-loe-fen), used to treat spasms, cramps and muscle tightness in people with multiple sclerosis or spinal problems. Steven Shoptaw, a researcher at the University of California, Los Angeles, recently published a preliminary, federally funded study that suggested it can cut cocaine use in addicts. A much larger study is now under way to confirm that, but for now the drug looks promising, Shoptaw said. Other drugs that work in a similar way and that are being tested in cocaine addicts include the anti-seizure medications tiagabine, topiramate and a drug sold overseas as Vigabatrin.
      Cocaine withdrawal symptoms might be eased by boosting the brain's depleted dopamine levels. So scientists are studying dopamine-boosting drugs like Ritalin, used for attention deficit hyperactivity disorder, and amantadine, used for flu and Parkinson's disease. But addiction is complicated enough to involve many brain circuits, which in turn provide many targets for anti-addiction drugs. Inderal, a blood-pressure medicine, may reduce cocaine craving during early abstinence by interfering with the actions of another brain substance, norepinephrine. The antidepressants Prozac and Effexor, which boost levels of yet another brain chemical called serotonin, are also under study in cocaine dependence. Then there's ondansetron (pronounced on-DAN-se-tron), which is normally used to prevent nausea and vomiting after cancer chemotherapy or surgery. Scientists are studying it for both cocaine and alcohol abuse, again for its action in the serotonin circuitry.
      It might seem logical that a single drug could help in multiple kinds of addiction, but even that situation can come with a twist. Consider Antabuse, the anti-alcohol drug that works by making users sick if they drink alcohol. Scientists recently found, unexpectedly, that Antabuse also helps cocaine-dependent people cut back on cocaine, though not by making them sick. Just how it does that isn't clear, says researcher Dr. Thomas Kosten of Yale University. Antabuse hampers the normal breakdown of cocaine by the body, and boosts dopamine levels while reducing norepinephrine levels, he said. The net effect may be to reduce both withdrawal symptoms and desire to seek cocaine, he said.
      Shoptaw thinks that within the next five years, some drug will win approval for treating cocaine dependence. Baclofen, topiramate and Antabuse lead his list of candidates. Each may find a use in a different phase of cocaine dependence, such as getting off the drug or staying off, he said. And addiction specialists are eagerly looking beyond today's medicine cabinet toward a drug that isn't approved for anything in the United States yet. Rimonabant blazed into the headlines in March when researchers reported evidence that it might help people battle both cigarette smoking and obesity. But why stop there?
      Rimonabant blocks the brain's docking sites for its own marijuana-like substances, part of the ``cannabinoid'' system that might play a role in addictions beyond food and nicotine, says Dr. Herbert Kleber of Columbia University. Once the drug is approved for either smoking or obesity, he expects researchers will jump in and test it for things like heroin and cocaine. And the strategy of squeezing new uses of out existing drugs may score another success.

No Man Is a Crystal Meth User Unto Himself
Frank Owen, New York Times- 8/29/2004

Bobby Darnell, a 34-year-old Texan who has lived in New York since 1996, does not fit the stereotype of a club drug user. For six years, he was an administrator for nonprofit groups, and he has sung in the New York City Gay Men's Chorus since 1998. "The chorus is mostly people from small towns, not club kids or fashion people," Mr. Darnell said. "That's sort of what attracted me to it." But four years ago he began casually exploring the club scene and tried crystal meth, the street version of the powerful stimulant methamphetamine, for the first time. After he lost a job to cutbacks in 2001 and found himself at home with nothing to do but look for work, he began to spend long hours on the Internet, and fell into a pattern of casual sexual encounters that sometimes included crystal meth, which intensifies sexual drive and lowers inhibitions. "I never did it for days and days at a time, just for a couple of days every two or three weeks," Mr. Darnell said. It took a long time for him to recognize that he had a problem. But by then, he had driven away all his old friends. "I would cancel things, and then people just stopped calling after a while. Everyone in New York is so busy, it's very easy for someone to disappear." Eventually Mr. Darnell was hospitalized. Only his connection with members of the chorus pulled him back from the brink. "There was one older gentleman," he said, "who would just come and hold my hand all day during those first couple of weeks" as he drifted in and out of consciousness.
      Stories like Mr. Darnell's have become increasingly common as crystal meth has spread beyond New York's gay club culture to a wider cross section of gay men, especially young ones. The drug, which can be sniffed as a powder, smoked in crystalline shards or dissolved in water and injected, is considered just as addictive as crack cocaine. It is blamed for a host of problems, ruining its users' health, robbing them of their jobs and sometimes driving them to mental illness, suicide or death by overdose. But its effects go well beyond the wreckage of individual lives, creating a ripple effect in the larger social world of gay men in the city. Long used by blue-collar Americans as an endurance enhancer and a recreational drug, crystal meth first became popular in gay dance clubs in New York in the mid- to late 90's, having migrated east from the gay scenes in Los Angeles, San Francisco and Honolulu. But in the last three or four years, its use here has grown enormously.
      Mr. Darnell, who has pulled his life together and is now working as a receptionist, said four or five other chorus members had started experimenting with the drug around the same time he did. "One by one these people wouldn't be dancing anymore, one by one they would lose their jobs, one by one they wouldn't be at rehearsal anymore," he said.
      Many men say they have lost friendships or romantic relationships to crystal meth, and many who don't use it keep their distance adamantly from those who do. The rift is apparent on Web sites and in chat rooms where men advertise for romantic or sex partners, often using coded references like "PNP" (for "party and play," meaning drugs with sex) or "No PNP," "chem friendly" or "absolutely no tweakers" (a reference to people strung out on the drug).
      Crystal meth "turns people into antisocial zombies," said Trip Zanetis, 23, a nightclub publicist who said he hates what it is doing to his social world. "It makes people hostile and delusional. The vibe is much more negative and colder than in the past, thanks to this drug." As Max Wixom, 26, a theatrical publicist and production designer, put it, "Even the way gay men look at each other is different." "In 1996, when I first arrived in New York and started going out, you could easily get to know people," Mr. Wixom said. "It felt like a community or a brotherhood." But with the rise of crystal meth, he said, gay night life has turned "more predatory and dehumanized."
      Dr. Steven Lee, a New York psychiatrist who specializes in treating crystal meth addicts, said there is now "a much harder edge in New York gay clubs than in the past." This change, he said, is largely because of the drug: in addition to its sexual and stimulant effects, crystal meth promotes aggression. "Some of my patients talk about how they feel on crystal meth as akin to being robots programmed with the sole purpose of doing more crystal and having more sex," Dr. Lee said. The drug also causes paranoia in regular users, and can eventually lead to psychotic episodes.
      Gay Men's Health Crisis, founded in the 1980's to help people with AIDS, said that two years ago, it received very few hot line calls related to crystal meth, but that it now gets about five a day. Fewer than half the new clients in its drug counseling program reported crystal meth use as their main drug problem three years ago; this year the figure is 80 percent. Crystal Meth Anonymous, a support and recovery group, began operating in New York five years ago with one meeting a week, which was never attended by more than six people, said Raul M., one of the group's early members. Now there are 23 meetings, some attracting crowds of more than 100. "In the last year we've almost doubled in membership," he said. "We expect to add new meetings later this year, but we're running out of venues." A 2003 study by researchers at Hunter College found that about 20 percent of gay men in New York had tried crystal meth, and that about half that number had used it in the three months preceding the study.
      John Lee, 24, a graduate of Dartmouth and a research analyst at a hedge fund company, said the drug is causing strange behavior in his own social circle. Although he said he never uses crystal meth and only occasionally goes out clubbing, several friends — college-educated and middle class — go dancing and use it almost every weekend. "They're constantly irritated, and it affects the way they relate to other people, but they don't realize it," Mr. Lee said. One Filipino friend frequently gets into fights with people he imagines are making fun of his accent. "He'll scream at them and start shoving them," Mr. Lee said. "He thinks it's racism, but it's strictly his paranoia."
      It is in New York's gay club world — where, according to a recent study by the Center for H.I.V./AIDS Educational Studies and Training in New York, 62 percent of those who use any club drugs reported "significant and frequent use" of crystal meth — that the social effects have been most strongly felt. Aficionados of the scene say dance clubs have become sterile environments filled with monotonous music and detached dancers. "I've been in this business for 25 years, and I've seen four or five different sets of people come and go," said John Blair, a longtime party promoter who owns the Chelsea bar XL and is a co-owner of Avalon (the former Limelight), where he gives regular Sunday night parties. "Each group of people goes through a similar experience with different music and different drugs," Mr. Blair said. "But crystal is by far the worst drug I've ever seen happen to night life. It not only takes over people's lives, but it really negates what the whole scene is supposed to be about."
      In fact, the rise in crystal meth use has hurt the club industry in New York, particularly the big-box clubs famous for after-hours dance marathons — some gay, some mixed — that start at 2 or 3 a.m. and often continue until 7 or 8 the following evening. Drug crackdowns by the police on the clubs Sound Factory in March and Exit last year were at least partly due to such parties. And as people become heavier users, they are moving away from the club scene, becoming increasingly reclusive and focused on Internet sex liaisons — and, in some cases, on just maintaining their drug habits. Mr. Darnell, the Gay Men's Chorus member, said that after he lost his job in 2001, he barely left his apartment, which became a nightmarish mess. A neighbor of his in Hell's Kitchen, who was also using crystal meth and had also become a shut-in, allowed his electricity to be shut off and his cats to bear litter after litter.
      Dan Carlson, a founder of an anticrystal-meth organization called the H.I.V. Forum NYC, said one club promoter recently offered to help with the group's work. "I said, `Great, but what's in it for you?' " Mr. Carlson said. "And he's, like, `This Internet stuff is killing my business.' " Mr. Carlson is one of a small but growing number of vocal crystal-meth opponents, many of them former users themselves. He started the H.I.V. Forum NYC last July with Dr. Bruce Kellerhouse, a psychologist, after they became angry at the news that H.I.V. infections had jumped 18 percent nationwide among gay and bisexual men since 1999 — an increase that he and others involved in H.I.V. prevention blame largely on crystal meth, which has been associated with high rates of unprotected sex. (As yet, there is no firm scientific data showing conclusively that crystal meth is behind the rise, but anecdotal evidence from doctors in New York suggests that the drug plays a role in anywhere from 50 to 75 percent of new H.I.V. cases in the city.) "For many years," Mr. Carlson said, "crystal has built this reputation as being glamorous, being fun. Anyone who's edgy is doing crystal meth. And if you're not, you're not cool — you're not part of the `in' crowd, not part of the scene."
      Last month, the H.I.V. Forum NYC held a public meeting at the Fashion Institute of Technology that drew 300 people — doctors, drag queens, city officials, clubbers, law enforcement officers, recovering addicts — and was led by John Cameron Mitchell, the director, writer and star of the film "Hedwig and the Angry Inch." The discussion featured personal testimony from audience members and panelists about the negative impact that crystal meth has had on the gay world.
      The H.I.V. Forum also started an advertising campaign in June, to coincide with the annual Gay Pride celebration. The latest ads, displayed on phone booths in Chelsea, feature a buff young man clad only in briefs, looking at a computer screen and sucking on a glass crystal-meth pipe filled with smoke. The caption begins, "Another night on the A List?" and the tagline says, "Crystal meth: Nothing to be proud of." The ad campaign appeared a few months after a veteran AIDS activist and H.I.V. Forum member named Peter Staley spent $6,000 of his own money to put up posters on phone booths in Chelsea saying: "Huge Sale! Buy crystal, get H.I.V. free!"
      But not everyone approves of such measures. In the May issue of the gay magazine Genre, a writer who calls himself Diabolique criticized people like Mr. Staley as "nanny nelly liberal activists" and accused them of helping spur a continuing police crackdown on gay night life. "It combines the worst aspects of over-the-top antidrug hysteria with the best of `get press at any cost' 80's-era AIDS activism," Diabolique wrote. "The ads don't work on drug-taking hedonists, they work on riling up the news media, public health and law enforcement officials." "There's a total split in the gay community about this issue," Diabolique said in an interview. "Most gay men I know thought the `Buy crystal, get H.I.V.' ads were ridiculous." "Crystal meth is a problem," he said. "It's the worst drug problem I've seen in all my years of clubbing. But hysterical antidrug, antisex propaganda does nothing to solve that problem."
      The editor in chief of Genre, Bill Henning, said he regards the things that organizations like H.I.V. Forum say as mainly puritanical propaganda. "It's great they're bringing attention to it, but they're not reaching the people they need to reach with all this finger-wagging," he said. "It's the same sort of antisex, antidrug argument that's been going on in the gay community for years." But John Blair, the party promoter, said the message may be getting through. The closings of most after-hours parties, the advertising campaigns and the personal horror stories about the drug are beginning to have an effect, he said. "Thank god for G.M.H.C. and the H.I.V. Forum," he said. "In the last year, things have started to turn around. Using crystal is not something you brag about anymore. There's a growing stigma against it, especially among the younger set. As people get more and more information, they realize the harm it's doing, not just to users but to the community as a whole."




Methadone Use on the Rise in Oregon
Associated Press, 8/30/2004

MEDFORD, Ore.-- For nearly 50 years, under carefully controlled circumstances, methadone has helped heroin addicts weather the pain of withdrawal. But in the 1990s, the drug began to be prescribed by the Oregon Health Plan to treat pain in general, giving the drug an unexpected boost. Now, doctors say they have lost control of the drug, which they believe is being abused. In 2002, methadone killed 103 Oregonians -- two more than heroin -- making it the state's most lethal drug.
      Use of the drug has seen a dramatic spike. In Southern Oregon, for instance, methadone use grew more than threefold over the last three years, according to data compiled by the federal Drug Enforcement Administration. In January 2001, Jackson and Josephine county pharmacies sold about 1,000 grams of methadone per month. By midsummer 2003, they were selling 3,500 grams a month.
      Lisa Taylor of Eagle Point lost her brother to methadone last spring. She knew something wasn't right when they talked on the phone the night before he died. ``He sounded funny,'' she says. ``I thought he was intoxicated.'' The next day she got a call from her brother's landlord who said ``You need to come here real quick.'' Jackson County sheriff's deputies found Taylor's body and a prescription bottle for 60 methadone tablets, filled just two days earlier. Only five pills were left in the bottle. ``Folks are feeling better after they take one,'' says Tim Pike, a Jackson County sheriff's detective and a deputy medical examiner. ``And they think, 'If one made me feel better, two or three will make me feel even better. For people who are not used to it, a couple could be lethal.''
      Methadone was discovered during World War II when German scientists were looking for a substitute for morphine, which was in short supply. Like morphine and other opiates, methadone works as a pain killer, too. Unlike those other drugs, it produces very little euphoria, or ``rush,'' at the dosage that controls pain. That makes it an ideal drug for people trying to lead normal lives despite pain that never goes away.
      Unfortunately, methadone will make people feel good if they take larger quantities, says Steve Brummett, who manages Jackson County's methadone treatment program. ``Two to four hours after taking it orally, people report a sense of well being,'' Brummett says, ``and then it tapers down over time.''
      Methadone's long ``half-life'' in the body makes it a dangerous recreational drug, says Dr. Robert Trujillo, an anesthesiologist who oversees the pain clinic at Providence Medford Medical Center. Long after the pleasant feeling fades, methadone remains in the bloodstream. ``That's where people get in trouble,'' Trujillo says. Now, a decade after making it one of the pain killers of choice on the Oregon Health Plan, doctors in Oregon are finding themselves stuck in the middle, says Trujillo.
      The state monitors how many opiates they prescribe but also encourages them to treat chronic pain aggressively. ``A person who knows how to play the system knows exactly the right things to say'' to get methadone, Trujillo said. ``I've been fooled,'' says anesthesiologist Dr. Erich Weber. ``I've definitely been fooled.'' ``There are people who are extraordinarily good at duping doctors,'' says Jim Kronenberg, a spokesman for the Oregon Medical Association. ``Those are the 'doctor shoppers' who end up with five or six sources for the same drug.''

Study: Heart Scares May Not Stop Smokers
Associated Press, 8/30/2004

MUNICH, Germany-- More than half of European smokers who suffer a heart attack, bypass surgery or other serious heart problems are still smoking a year later, despite anti-smoking campaigns and doctors' advice to stop, a new study found. Experts said the findings, presented Monday at Europe's largest medical conference, indicate that smoking cessation efforts are failing many of the most vulnerable victims. ``We are disappointed because people are not stopping smoking, but how effectively are they advised to give up smoking?'' said Dr. Jaakko Tuomilehto, a public health expert at the National Public Health Institute in Helsinki, Finland.
      Programs to help smokers kick the habit don't exist in many cardiovascular clinics, and doctors have just been telling patients to stop smoking, which is not enough, said Tuomilehto, who was not involved with the research. ``It is an addictive state, and these poor people are not receiving the right treatment. They would like to stop, but they need better help,'' he said.
      Experts at the American Heart Association say the situation among U.S. smokers isn't much different. Neither the government nor health insurance companies in the United States pay for drugs or programs aimed at helping people quit smoking, both of which help, said Dr. Rose Marie Robertson, chief science and medical officer at the American Heart Association. All that is left is for doctors to advise their patients to quit. ``If a doctor says it, versus a doctor not saying it, it is better. You might double the quit rate, but it isn't enough,'' said Robertson, who was not involved with the study.
      The research, led by scientists at Erasmus University in Rotterdam, the Netherlands, involved 5,551 people in 15 European countries who suffered a heart attack or who underwent either open heart surgery to bypass clogged arteries or balloon angioplasty, where a tube is threaded through the blood vessels to a blockage and a balloon is inflated to squash the plaque against the walls of the artery. About a year and a half later, they were interviewed about their smoking and given a carbon monoxide breath test to verify their answers. About 40 percent of the patients were smoking before they had their heart scare. About 52 percent of those people continued to smoke after they had recovered.
      When a similar study was conducted in 1996, 40 percent of smokers continued the habit after their heart trouble. However, the difference between these two studies was not statistically meaningful, so experts conclude there has probably not been much change in the proportion of people quitting smoking after the illness. The smoking continued despite the fact that 88 percent of smokers in the study were advised to stop. ``Preventive cardiology regarding smoking cessation has not been improved since 1996,'' the study concluded. ``A considerable and increasing proportion of patients with coronary heart disease continues smoking, despite advice from their physicians to quit,'' the study said, adding that there is a need for better smoking cessation programs.
     Studies have shown that nicotine replacement therapy, drugs that help curb the craving, and government policies such as smoking bans in public places, high taxes on tobacco and restrictions on cigarette advertising can substantially improve the chances of people kicking the habit.
      The World Health Organization last year signed a global treaty aimed at curbing smoking and the millions of deaths it causes around the world. The treaty includes a ban on tobacco advertising and other restrictions, but countries are only now starting to implement it. About 30 percent of European adults smoke. Rates are particularly high in Eastern Europe and rising sharply in the developing world. In the United States, about 23 percent of adults are smokers.

The Nicotine Patch Didn't Work? You May Not Have Used It Enough
Mary Duenwald, New York Times- 8/31/2004

Smokers who try to give up cigarettes can double their chances of success by using patches, gum, lozenges, inhalers or nasal sprays containing nicotine. Yet 3 in 4 people who use these products do not end up quitting, in part because they use them too little or for too short a time. If anything, smokers should consider using nicotine replacement even more aggressively than the package instructions recommend, recent research suggests. Studies have found that using gum or a nasal spray along with a patch works better than using either product alone, and that it is beneficial to use products even after slipping back into smoking.
      Nicotine replacement therapy has been around since 1984, when the Food and Drug Administration approved Nicorette gum as a prescription medicine. The patch followed in 1992, and both smoking cessation aids have been sold without a prescription since 1996. Nicotine lozenges are now also sold over-the-counter. Inhalers and nasal sprays are available by prescription.
      Nicotine replacement products are meant to be used for three to six months, more heavily at the beginning when nicotine dependence is at its most intense. Patch users usually start with the 21-milligram dose, then switch after two weeks to a 14-milligram patch. Seven-milligram patches are also available.
      Some people cut patches in half, to get smaller doses. This is probably safe, but a cut patch may not provide a predictable dose, said Dr. Michael C. Fiore, director of the tobacco research and intervention center at the University of Wisconsin Medical School. A patch can also be safely worn into a sauna or a hot tub. "Heat dilates your blood vessels, so you might get a little more nicotine absorption," Dr. Fiore said, but it would still amount to less than a person gets from smoking.
      It's probably a good idea, however, to remove the patch before having an M.R.I. scan. A recent article in The American Journal of Nursing reported the case of a construction worker who suffered a second-degree burn on his arm during an M.R.I. The foil backing of his nicotine patch became a conductor for the energy generated by the scanner's magnets.
      Gum and lozenge users are usually told to begin by chewing a two-milligram piece every one to two hours, having an extra piece when they feel a strong craving. After six weeks, the recommended dosage drops to one piece every two to four hours, and three weeks later falls to one every four to eight hours. The idea is to ensure that the body has a continuous supply of nicotine. But many people use gum and lozenges only when they feel a strong craving for a cigarette, said Dr. Saul Shiffman, a professor of psychology at the University of Pittsburgh who has conducted many studies of nicotine replacement therapy and is a consultant to GlaxoSmithKline, a makers of patches, gum and lozenges.
      Many would-be nonsmokers also stop nicotine therapy after a couple of weeks, Dr. Shiffman said. Price is a factor: most therapies cost $3 a day. But some people also dislike the peppery nicotine taste of gum or lozenges, which mint or orange flavoring does little to disguise. And many people stop early because they don't want to ingest any more nicotine. "People are unreasonably afraid of nicotine," Dr. Shiffman said. "The majority of smokers believe that nicotine causes cancer and is a big player in the harm caused by cigarettes." In fact, carbon monoxide, tar and the countless toxic particles in cigarette smoke are what promote illness. Although smokers may become dependent on nicotine, it does not appear to raise the risk of cancer, lung disease or heart disease.
      Early reports that people who smoked cigarettes while wearing a patch stood an increased risk of heart attack proved unfounded years ago. In fact, sticking with the patch even during a brief lapse may increase the odds of quitting. In a study not yet published, Dr. Shiffman found that people who continued to wear the patch even after smoking a cigarette or two had more than double the chance of avoiding a total relapse.
      When nicotine gum and patches first became available over the counter, some experts expressed concern that people might use them far longer than recommended. But at least one survey suggests that fewer than 5 to 8 percent of gum users continue longer than a year and 5 to 10 percent of patch wearers do, said Dr. John Hughes, a professor of psychiatry at the University of Vermont. He added that only a small percentage of these long-term users are dependent on nicotine. "But it is like caffeine addiction," Dr. Hughes said. "The only harm is that you're having to pay for it."
      Continuing treatment longer than necessary may be particularly beneficial for some women, said Dr. Antonio Cepeda-Benito, an associate professor of psychology at Texas A&M University, who recently reviewed 21 controlled trials of nicotine replacement therapy and found that women were more likely than men to relapse a year after starting nicotine replacement therapy.
      Another recent study found that smokers who were white, had low to moderate dependence on cigarettes and were not obese responded better to patches, while people who were members of minorities, were heavily dependent on cigarettes or were obese did better with a nasal spray. Dr. Caryn Lerman, a professor of psychiatry at the Abramson Cancer Center of the University of Pennsylvania, who led the study, said the spray provided a more sensory experience, which could be more rewarding for some people. "We'd like to be able to identify the treatment most likely to work for individual smokers," Dr. Lerman said.

Youth Finds Refuge in Therapy As She Looks for a Way Out of Drugs
Laura Potts, Detroit Free Press- 8/31/2004

The second time, she swallowed a handful of pills. Each incident landed 15-year-old Amber Kauten in a psychiatric hospital this summer, where the Shelby Township girl said she finally got the kind of help she was craving. "When I was in the mental hospital, I felt like the other kids understood me," said Amber, a wide-eyed brunette with a soft smile. "I just like to go there so I can think. I just feel like I need someone to talk to whenever."
      When you're 15, lots of things can get you down. But for Amber and millions of other youngsters like her, the sadness, anxiety, irritability, violent mood swings and feelings of isolation are more than just a passing phase. They're symptoms of mental illness. Amber takes Concerta, which is prescribed for Attention Deficit Hyperactive Disorder, and Lexapro for depression.
      In the United States, the Surgeon General estimated about 21 percent of 9- to 17-year-olds have a diagnosable mental disorder, but a report released in June by George Washington University said up to 80 percent of those children go without care. "When families are identifying that a young person has a problem and seeks to get help, it's hard to find, sometimes impossible to find," said Sharon Peters, president and CEO of the advocacy group Michigan's Children. "Basically, we just don't have enough of those services to meet the kind of needs out there." What's needed is early intervention -- such as peer-to-peer support groups or therapy with a child psychologist -- but treatment options are woefully lacking, Peters and other advocates say. Still, early intervention could prevent crisis situations like the one Amber found herself in.

Signs of trouble
There were plenty of signs that Amber was in need of help before she was hospitalized. Running away, using drugs and dating a man more than a decade older, Amber "just kind of ran and did what she wanted," said her mother, Michelle Kauten, 36. She would haul Amber home and set rules, but she felt helpless and didn't understand how her daughter went from being "a perfect little girl" to a violent, disobedient teen. Like many parents, she didn't know where to turn.
      Patrick Barrie, who oversees mental health services at the Michigan Department of Community Health, acknowledges the need for more services. But he said his agency -- which funds the local mental health service providers -- has been cash-strapped, the victim of federal and state budget cuts. His agency estimates 545,000 Michigan children had a mental disorder in 2002. In that year, his department served more than 28,000 children age 17 and under who had diagnosed mental illnesses, and another 1,192 children with developmental disabilities and mental disorders.Medicaid provided another 25,000 Michigan children with short-term help in 2002.
      Other public entities, such as schools and the juvenile justice system, also provide some mental health care for children, but there is no central clearinghouse for determining how many Michigan children are getting help. In fact, Michigan's mental health system is a stupefying confluence of government agencies, schools, and public and private health-care systems, all with varying qualification standards and funding mechanisms. They do, however, share one common theme: a severe lack of money. "The money crunch has affected everyone, but it's especially true for children's services," said Mark McWilliams, director of education advocacy for Michigan Protection and Advocacy Service . Based in Lansing, the organization is a federally mandated watchdog group that advocates for people with disabilities. And it's an issue facing children's mental health systems nationwide. In 2002, nearly two-thirds of states cut mental health services, according to the National Mental Health Association.
      Provider shortages, low payment rates and the budget reductions plaguing the mental health system add up to fewer services that are harder to access, advocates say. Because funding for mental health services in Michigan has remained flat since at least 1998, it "starts to create an atmosphere of scarcity where everybody's more concerned with their financial stability, and it starts to create restrictions on care," Barrie said. "Agencies are less optimistic about the future, so they plan more conservatively for the future," Barrie said.
      That means local community mental health authorities and other agencies have stricter standards for accessing care and are providing less of things such as therapy, said Malisa Pearson, staff development and community education coordinator for the Association for Children's Mental Health, a nonprofit advocacy group based in East Lansing. "Kids that five years ago would have automatically been eligible for county mental health services are being turned away because they aren't so bad that they are significantly impaired to the point that they're really struggling," Pearson said. "If you're not really severe, you don't meet the criteria to get services at all. So then the families get really desperate." In other words, children who are suicidal, breaking the law or otherwise posing a threat may be hospitalized or locked up, but often nothing exists to help them at the first signs of a problem.
      Sorting out how to access services can be a daunting task, especially for people like Kauten, a single mom trying to raise two children and keep a job in the midst of Amber's outbursts, rule-breaking and disappearances. Schools sometimes provide a gateway to the mental health system, though parents have complained that school officials are reluctant to evaluate students, perhaps because of the high cost of providing special education and ancillary services, such as counseling. According to a 2003 U.S. Department of Education study, the average cost of educating a child with learning disabilities in special education was $4,100 and $7,700 for an emotionally disturbed child. That's in addition to Michigan's regular per-pupil funding of nearly $7,000.
      Advocates say school officials often hesitate to stigmatize children by labeling them as mentally ill, or may assume that other public and private mental health systems will step in. More likely, though, children's mental health needs are met by the child welfare or juvenile justice system, if only in a limited capacity. "There's often a dispute between who's going to provide what kind of services," said McWilliams. "There's a real challenge to helping those kids in the juvenile justice or court system get back into the community-- and if they don't, they're headed to the correctional system," he said. "For society it's a very expensive and wasteful thing, and you're wasting the potential of a kid's life." That's something that Amber and her mom fear.

Downward spiral
After about three years of emotional turmoil, Amber's self-destructive behavior put her where many other mentally disturbed children end up: in the custody of the police. When Amber first started exhibiting problems, her mom didn't know where to turn. At 12, Amber confessed to using marijuana, but her mom believed her when she said she'd stopped. In fact, Amber said, she was eventually smoking so much -- hours every day -- that she stopped feeling like she was getting high. "I'd just get depressed and then I'd turn to drugs," she said. "It felt good. But once I started coming down, everything would start to hit you again."
      A neighbor introduced Amber to huffing Freon and taught her how to steal it from air conditioning units around their mobile home park. The high, she said, would only last a few minutes, so they would collect garbage bags of the gas and spend hours inhaling it. High one afternoon, after about 25 hits, she passed out, struck her head and had to be taken to the hospital, where she was treated for a concussion. "It didn't stop me," she said.
      At 14, frustrated with her mother's rules and drawn to kids she now admits were bad influences, Amber ran away for several days. When she voluntarily went home, her mom called the Shelby Township police, who charged her with incorrigibility. Amber was placed with an aunt, and the charge was later dropped. According to Shelby Township Police Sgt. Kenneth Underwood, if a child is generally disobediant -- breaking curfew, running away, getting physically abusive -- parents can call police and they can file incorrigibility charges. The matter then goes to juvenile court, where a judge rules on dismissal, probation or sends the youth to a detention facility depending on the seriousness of the charge.
      But when Amber returned to her mom's house last September, she continued to do drugs, ignored her curfew and ran wild. She also started dating a 26-year-old man, despite her mother's insistence that she stop seeing him. One day a few months ago when the man showed up at her home, Michelle Kauten called the police, who charged the man with contributing to the delinquency of a minor and again charged Amber with incorrigibility. Amber's father, who is divorced from Michelle and lives a few miles away, also came to the home to speak with Amber. She said she was furious with him and "told the police I wanted to go to the hospital because I wanted to kill my dad." They took her to Harbor Oaks Hospital, a juvenile mental health facility in New Baltimore, where she spent five days dealing with her anger.
      But just two weeks after she returned home, Amber's boyfriend brought her food from Taco Bell. While Michelle called Amber's father, Amber slipped into her bedroom and took eight to 10 sleeping pills. "I just took pills so I could go to the hospital to get away from my dad. I just thought I'd get drowsy," Amber said. But, realizing she'd gone too far, she told her mom, who called an ambulance. "I could feel myself dying," said Amber, who had her stomach pumped before she was taken to another psychiatric hospital, Havenwyck, in Auburn Hills.

Insurance trouble
That's when the mental-health funding crisis hit home for the Kautens. Amber has private insurance coverage through her mom's job at Ford Motor Co., but like most insurance, its mental-health coverage is limited. For each of Amber's psychiatric hospital stays, she was covered for five days. And though her doctor wants her to receive more intensive therapy, it would not be covered.
      The U.S. Census Bureau reports that nearly 70 percent of children in the United States are privately insured, but they're out of luck once they reach their coverage limit. One therapy session, for instance, can cost more than $100, and residential treatment facilities, with 24-hour care, can cost in excess of $250,000 a year. According to the Bazelon Center for Mental Health Law, a Washington, D.C., advocacy organization for people with mental disabilities, 94 percent of health maintenance plans and 96 percent of other plans have restrictions on mental health benefits.
      Families at a certain income level can qualify for Medicaid -- which covers about 68 percent of Michigan children receiving mental health services -- and some federal programs exist for children who are uninsured or underinsured. But increasingly, children whose parents are not insured and don't qualify for Medicaid or other public help are creating a growing segment that advocates call "the gap population." "If you're not Medicaid-eligible and you don't have private insurance, you're really in a bad spot now. Those are the kids that are going to get the least, regardless of what they need," Pearson said. "Even the ones that are getting through the door are getting less and less." Barrie said the statute on mental health care "directs us toward children with the most severe disorders when we don't have enough money to cover everybody." It's a struggle, he said, and he laments that more preventative services can't be available.
      Experts say early intervention is best when children start to display mental or emotional disorders, which will only grow worse if they're not appropriately addressed. Behaviors can turn more destructive, and the frustration of being misunderstood, mistreated or cast aside can contribute to school and career failure, alienation, substance abuse and, in some cases, suicide, which is the third-leading cause of death among teens and young adults, according to the Centers for Disease Control. "Childhood is such an important time to intervene," Barrie said. "Childhood is a time when there's a great capacity to make modification before some of those" disorders "have hardened into patterns."
      According to a landmark 1999 Surgeon General's report, about half of children with a mental disorder are impaired mildly, while the other half are significantly impaired; of those, one in 20 is considered severely impaired. Most commonly diagnosed are anxiety disorders, such as post-traumatic stress disorder, but children also can have the same disorders as adults, including bipolar disorder, schizophrenia and chronic depression. But because children can't always communicate what they're feeling or why they lash out, become introverted or sulk, it can be difficult to distinguish between normal childhood behaviors and more serious mental health issues. Parents, fearing blame, also may be reluctant to have their children labeled mentally ill, or may regard mental illness as something that only affects adults.
      Pearson is frustrated by what she sees as a system that's "all reactive, crisis-driven." "It is one of the only systems that we don't see as being worthwhile to be a prevention model. There are very good treatment models that work, and people can be productive members of society," she said, citing training for families of children with behavioral difficulties, and respite care to occasionally give parents and kids a break from one another. "This is just as important as any other disability that we give credence to," Pearson said. "We have to make an investment in these children and families because it's good for us as a community."

'I don't want to be some druggie'
Amber said that, ideally, a 24-hour crisis center would exist for times when she feels she could erupt or be tempted back to drugs. Through her hospital stays and counseling, she said she's learned coping mechanisms for both, but -- just a few weeks since her last hospitalization -- she worries that sometimes they won't be enough. "When I'm mad, I can't be at home because I don't trust myself. Sometimes, I get so angry that I feel like I could wreck this whole house," she said. As for the marijuana and other substances, Amber concedes, "Sometimes, I miss drugs." But, she says, she wants to stay clean. "I don't want to be some druggie because I have high goals for myself," said the soon-to-be sophomore, who wants to go to college and become a lawyer. "I have so many leadership qualities, but I just follow and I don't know why. I'm smart, but I do dumb things. I feel like I still need to change more."

Kids' Mental Health Needs Lost in Scrambled System
Laura Potts, Detroit Free Press- 8/31/2004

"There are many children who could benefit from mental health interventions who don't get it in a timely and appropriate manner," said Patrick Barrie, who oversees mental health services at the Michigan Department of Community Health. But with no single entry route into the system, pervasive budget woes and insufficient insurance coverage, hundreds of Michigan children instead end up in detention facilities or as wards of the state. Thousands of others receive inadequate or no mental health care. Access to services is confusing, and eligibility requirements often discourage early intervention, meaning it often takes a crisis to get help.
      The Michigan Department of Community Health (DCH) estimates that 545,000 of the 2.5 million children in Michigan in 2002 had a mental disorder, the most recent year for which data are available. Among children ages 9-17, the state estimated that between 66,000 and 120,000 have a serious emotional disturbance, which can include severe anxiety and schizophrenia. Barrie and other DCH officials concede that they don't have an exact count of how many children in Michigan have mental disorders, but they base their estimates on national mental illness prevalence rates and state statistics of how many children have accessed services.
      The DCH, through county agencies, provides things such as therapy and case management to more than 28,000 children age 17 and younger who have been diagnosed with mental illnesses, and 1,192 others with developmental disabilities and mental disorders. An additional 25,000 children get short-term help from Medicaid, the federally funded program providing medical care for poor people and people with disabilities.
      But children with mental disorders also land in juvenile detention facilities, the foster care system, or receive some services through the public school system. No one tracks how many children get mental health services through these other means, nor is there a way to know how many parents pay for private help. But with treatment costing tens of thousands of dollars a year, children with enduring mental illness usually end up getting public assistance. "There are a variety of systems dealing with children, and it creates the possibility of none of them doing as much as they could for these kids. When the other one doesn't step in, as often happens, then nobody's doing anything for these kids," said Elizabeth Bauer, a member of the Michigan State Board of Education who also serves on the Michigan Mental Health Commission, appointed by Gov. Jennifer Granholm.
      All the dozens of mental health experts interviewed for this series agree that state and federal funding in the past five years has remained, at best, stagnant, while demands on the system have grown. DCH officials said funding for children's mental health care has been flat since 1998. In that year, the department spent about $2,569 for each Michigan child with a mental illness; in 2003, it was $4,167 -- a negligible amount when one therapy session can cost more than $100, and residential treatment facilities typically cost in excess of $250,000 a year.
      The total DCH budget for children's services in 1998 was $111.7 million, and $122.5 million in 2003, said Judy Webb, director for DCH's division of quality management and planning. "We've seen a reduction in the numbers of people served, but an increase in the amount spent per person," Webb said. "We've been using our limited dollars for treating the more severely impaired population." Moreover, prevention programs for the state's children have been slashed. In 1999, DCH spent $11.3 million on prevention, but just $3.1 million in 2003. With funding shortages elsewhere, "prevention sort of goes on the back burner," Webb said.
      The Family Independence Agency does not track how many children receive its mental health care, said FIA spokeswoman Maureen Sorbet. But she said, "Lots of our children, especially in juvenile justice and foster care, certainly receive those services," such as therapy with a psychologist or psychiatrist.
      Meanwhile, state-run psychiatric hospitals for adolescents have dwindled from six in the late 1980s and early 1990s to just one today -- Hawthorne Center in Northville, which has about 90 beds for long-term, institutional care. Experts pushed for more community-based services to end the warehousing of mentally ill children, but shuttering hospitals also was a cost-cutting measure. The DCH said those saved dollars went toward programs that help children get family counseling and other services while living at home, but experts say that didn't happen.
      Instead, many children who act out while awaiting placement in a health-care facility end up in juvenile detention, experts say. "Incarceration not only sends a negative message about the child's worth, it has horrible consequences. Kids with mental illness or emotional disorders in these settings are very vulnerable to physical and sexual assaults, worsening of symptoms, and the suicide numbers are four times more than the general population of teens," said Susan McParland, executive director of the Michigan Association for Children with Emotional Disorders.
      In some cases, parents who feel they have no other options are giving their children up, either by petitioning themselves on neglect charges or making their children wards of the court. Custody relinquishment to obtain mental health services for children is illegal. But according to a 2003 report by the U.S. General Accounting Office, at least 12,700 American families have done so, including at least 160 children in Oakland County and 400 in Wayne County. Advocates believe the numbers are much higher.
      The state is aware of the problems facing children who are mentally ill. Since January, the governor's commission has been taking suggestions and discussing ways of improving care. The 33-member commission is meeting Sept. 20 to discuss a list of recommendations, which will be presented to Granholm by month's end. Advocates applaud the efforts as a start but say a national effort is needed to save children from further mental distress, interrupted family life and juvenile detention. "The access to services for children with mental or emotional disorders ranges from bad to worse in this country. It's tearing families apart," said Christopher Burley, deputy director of communications for the Bazelon Center for Mental Health Law, a Washington, D.C.-based advocacy organization for people with mental disabilities. "Every day that policy-makers fail to act on this is another night that 2,000 kids across this country are going to bed in juvenile detention facilities because they can't find mental health services in the community."

Depression, Anxiety Linger for Caregivers
Jamie Talan, Newsday- 8/25/2004

The conventional wisdom that a caregiver's emotional burden is lightened when the ailing relative enters a longterm care facility may have been a misconception, a new study suggests. Caretakers continue to suffer from depression and anxiety long after the daily demands of caring for the loved one have ceased, according to University of Pittsburgh researchers who followed more than 1,000 families. They report their findings -- characterized as the first study to examine the emotional effects of caring for family members with progressive dementia -- in the Journal of the American Medical Association.
     Earlier studies have shown that caregivers are at increased risk of illnesses, presumably because of unabated stress and paying less attention to their own medical needs. There had been a presumption that home caregiving generated the biggest emotional and physical burden, one that was presumed lifted when caregiving was turned over to professionals.
     Richard Schulz, a professor of psychiatry at the University of Pittsburgh School of Medicine, and his colleagues found that almost half the caregivers registered signs of depression after relinquishing a loved one to a long-term care setting. The study also found that daily nursing home visits appear to add emotional weight. "Until now, professionals haven't thought about how to help this caregiver population," Schulz said in a telephone interview. Many are left with guilt that they have broken promises to a loved one and have less control over their daily care, he said. "These symptoms shouldn't be ignored. Caregivers would benefit from treatment."
     During the four-year study, which tracked 1,222 caregivers, 180 people were placed in nursing homes. The patients had an average age of 80, caregivers averaged 63. Blacks were found less likely to institutionalize their loved ones. Spouse caregivers reported more depression and anxiety than did children or other family caregivers. "Of course you become depressed," said Harriet Block of Floral Park, N.Y, whose husband of 60 years has had Alzheimer's since 1995, Cy Block, 85, who played for the Chicago Cubs, appearing in the team's last World Series engagement in 1945, lived at home until last year. Block said she held her life together by forging friendships and keeping busy. "Alzheimer's affects everyone around the person," she said.
     Max Nichols, a writer who lives in Manhattan, said he managed to escape depression when his wife, Mickey, developed Alzheimer's by building a strong family support network. She was 57, working as a music therapist, when signs of the mind-robbing illness appeared. She lived at home for the next six years. "We kept her very busy," said Nichols, who said they were married for 44 years and raised their family in Oklahoma. "She volunteered every day for years into her illness. We worked at keeping her feeling good about herself." Ultimately, a fall led to her move into a nursing home. Nichols, who is finishing a book on his family's experience, said he and their children took turns at the nursing home, feeding, cleaning and putting her to bed at night. He said concentrating on his wife's needs helped keep depression at bay.
     Researchers said the study found that those who said they did not find solace in caregiving were more likely to opt for nursing home placement sooner than those who said they reaped some emotional benefit from caregiving.