Noteworthy News Articles on Mental Health Topics, December 5-11, 2005

High Court to Probe Ariz. Insanity Defense
Associated Press, 12/5/2005

WASHINGTON -- The Supreme Court agreed Monday to consider whether a teen convicted of killing an Arizona police officer had a fair chance to argue that he was insane, renewing debate about insanity defenses. Justices over the past decade have repeatedly declined to consider cases involving insanity claims. In a surprise, the court said it would take up the case of Eric Michael Clark, who has been diagnosed with paranoid schizophrenia. He was a 17-year-old high school student when he shot Officer Jeff Moritz during a traffic stop in Flagstaff, Ariz., on June 21, 2000.
      There was evidence that Clark believed his town had been taken over by aliens and that he was being held captive and tortured before the killing. His lawyer, David Goldberg, told justices that the state insanity law is unconstitutional because it restricts what evidence can be introduced at trial. ''This court has never directly addressed this issue of national importance,'' Goldberg said.
     Arizona changed its laws after John Hinckley's acquittal by reason of insanity in the March 1981 shooting of President Reagan and three others outside a Washington hotel. Arizona assistant attorney general Michael O'Toole said in a filing that ''even if the states are required to provide an insanity defense to criminal defendants, this court's prior decisions make clear that no one particular test is required.''
     In 1994, the court let stand Montana's abolition of insanity as an affirmative defense for criminal defendants. But then three years ago justices refused to review a Nevada Supreme Court decision that defendants have a right to use insanity defenses. At issue in the Arizona case is the use of evidence in contesting whether a defendant was so mentally ill that he or she did not know the crime was wrong. Clark was sentenced to 25 years to life in prison in the officer's death. Arguments in his case will be held next spring. The case is Clark v. Arizona, 05-5966.
     On the Net: Supreme Court: http://www.supremecourtus.gov/



Doctor's Case Highlights Gap in Drug System
Scott Allen, Boston Globe- 12/5/2005

By the time Dr. Michael Brown was arrested in August in a Jaguar that police say was loaded with cash, prescription drugs, and a jumble of patient records, his reputation for liberally dispensing painkillers had earned him a nickname in law enforcement circles: Dr. Feel Good. Police had identified at least eight suspected drug addicts or dealers among Brown's patients, according to a state investigator's report, and a mothers' group had picketed his Cape Cod office last summer, accusing him of addicting young people to the highly potent drug OxyContin.
      Yet, the state office that tracks doctors' prescriptions of highly addictive drugs did not notify police or medical regulators while Brown, for more than a year before his arrest, was emerging as the single biggest prescriber of OxyContin in Massachusetts. The Prescription Monitoring Program's records show that Brown, an internist working alone in Sandwich, prescribed about 1.7 percent of the OxyContin prescribed in the state in 2004. The 144,435 tablets of the narcotic he prescribed in the first six months of this year led the state's doctors by a wide margin.
     Though monitors collect information on more than 2 million prescriptions for addictive drugs each year, they rarely release information about individual doctors unless police or regulators request it -- and then only if a panel of doctors and pharmacists agrees that release of information will not unfairly raise suspicions.
     Nancy Achin Audesse, director of the Board of Registration in Medicine, said senior staff in the physician-licensing agency can't recall ever receiving a tip about potential overprescribing by a doctor from the Drug Monitoring Program. ''The correct way to identify an allegedly misprescribing doctor is not by mothers walking outside the doors," she said, adding that state agencies ''need to do a better job of sharing information."
     Brown has pleaded not guilty to one count of illegal possession with intent to sell the painkiller Norco and 12 counts of illegal drug possession. The drugs in his car -- mostly medicines for asthma, allergies, and erectile dysfunction -- were merely sample packs that drug companies supply to physicians, he has said. His lawyer Russell Redgate denied that Brown improperly prescribed or sold narcotics, saying critics such as the protesters at his office last summer are spreading baseless rumors.
     Brown's license to practice medicine was suspended within three days of his arrest, but the cochairman of the Legislature's OxyContin Commission, Representative Peter Koutoujian, believes the board could have acted much earlier if it had been notified of Brown's OxyContin prescribing pattern.
     Koutoujian, a Watertown Democrat, believes the case shows how Massachusetts is falling behind in the battle against one of the fastest-growing kinds of drug abuse: More than 9 million Americans take prescription drugs for nonmedical purposes, sometimes with fatal results. Other states have created readily accessible databases that allow law enforcement officials and licensing agencies to quickly check doctors' prescribing habits and find drug-addicted patients who ''doctor shop" by approaching multiple doctors for narcotics.
      'When the drug monitoring program started in 1992, it was one of the first in the nation and ahead of its time . . . but other states have caught up and surpassed Massachusetts," said Koutoujian. He said his panel is expected to recommend that investigators and regulators get greater access to prescribing records of physicians when it reports early next year on prescription drug abuse.
     Doctors who support the current monitoring program say the state needs to be cautious about releasing prescribing information to investigators because dispensing large volumes of narcotics, by itself, is a poor indicator that doctors are doing anything wrong. Doctors who run pain management clinics, they point out, would normally prescribe many pain relievers, and over-zealous investigators could discourage them from adequately treating their patients. ''If there are 100 doctors in Massachusetts all prescribing over some number of OxyContin dosages, there's no evidence those physicians are any more likely to be" overprescribing drugs than other doctors, said Paul Dreyer, director of the division of health care quality in the Department of Public Health, which runs the monitoring program.
     Brown's prescribing of pain relievers first came to the attention of law enforcement officials in the mid-1990s, but they had difficulty accumulating enough evidence to charge him with a crime. The Board of Registration, meanwhile, received at least two complaints alleging Brown knowingly prescribed painkillers for drug addicts in the late 1990s, according to board records. One patient wrote in 1999 that ''Dr. Brown is known among a whole realm of people and friends for prescribing [narcotics] . . . to satisfy our addiction." But, in each case, the complaint came from a drug addict and Brown denied the accusations. Unable to resolve the contradictory versions, the board entered documents in Brown's file to note the charges had been made.
     Redgate said the history of fruitless investigations only proves his client is not a drug trafficker. ''I've seen in print that the [Drug Enforcement Administration] has been investigating Dr. Brown for 10 years. If true, that's a sterling recommendation" for Brown's innocence, said Redgate. Brown is free with no bail, he said. But members of a family support group called Learn2Cope said that Brown's name came up repeatedly at meetings as the doctor who prescribed narcotics to addicted family members. Marilyn, who asked that her last name not be used to protect her 23-year-old son's identity, said he repeatedly went to Brown when the son became addicted to painkillers following nose surgery. ''He along with many of his addict friends would frequent Dr. Brown's office and would pay between $120 and $150 cash for an OxyContin prescription" that her son would then fill at a drugstore, she said. However, she never went to police with her accusation. Earlier this year, a pharmacist on Cape Cod told an investigator from the Board of Registration that she had been suspicious of Brown's practices for eight years, noting that his patients tended to stay on the same dose of OxyContin with no sign Brown was trying to wean them off the medicine, according to a board investigator's report on Brown.
     Board officials, for reasons that haven't been made public, asked the drug monitors for information on Brown in mid-2003, but, at the time, Brown did not rank among the top 100 prescribers of OxyContin. However, that soon changed as Brown began ''ramping up" his prescriptions of narcotics including OxyContin, according to Dreyer. By 2004, Brown was in the top 10 of OxyContin prescribers, and he ranked number one for the first half of 2005, Dreyer said. He confirmed that the drug monitors didn't alert the Board of Registration or police to the trend, but he felt they did not need to because the board had already asked about Brown once in the past. ''If they want to know more about him, they can ask us," he said.
     During the investigation, an informant allowed police to videotape Brown as the doctor repurchased a bag of the narcotic Norco that he had originally prescribed to the informant. The informant told police that Brown regularly prescribed drugs for him and then bought them back. On Aug. 22, police arrested Brown in his car. They found 12 different prescription drugs, more than $60,000 in cash, and X-rays and MRIs in the trunk. Three days later, his medical license was suspended, but by then, board documents show, grave questions about Brown's medical practice were surfacing: In the fall of 2004, he allegedly diagnosed one elderly woman's lung cancer as a rib injury that required pain relievers, rejecting her daughter's suggestion of a second opinion. ''Specialist, schmecialist," Brown told the daughter, according to a report by the Board of Registration. Peter Sundelin, another attorney for Brown, said the report contains ''substantial inaccuracies," though he declined to elaborate. Koutoujian, of the OxyContin Commission, said the case underscores the need to modernize the drug monitoring program along the lines of other states.
     In Kentucky, which allows authorized people to directly access its computerized drug-monitoring program, doctors are among its main supporters, say program officials. Robert Benvenuti, inspector general of the Kentucky Cabinet for Health and Family Services, said 85 percent of system users are doctors, mainly checking on their patients' prescription history to keep from falling prey to doctor-shoppers. The system, nicknamed KASPER, also saves investigators time they once spent calling individual drug stores, reducing the average duration of doctor-shopping investigations from 156 days to 16. But Kentucky's system isn't cheap. The state spent $1.4 million to create the computer network, and a dozen employees spend at least part of their time working with KASPER. Massachusetts, by contrast, has only one employee who works primarily on prescription monitoring, and he has other duties as well. Dreyer said the state hopes to add software next year that will allow officials to track ''doctor shopping" patients.

Therapies: A Dose of Dolphins for Moderate Depression
Eric Nagourney, New York Times- 12/6/2005

Researchers working in Honduras have taken an unusual approach to treating mild to moderate depression: they teamed their patients up with dolphins. To test unconfirmed reports that dolphins could help people with learning disabilities and mental health problems, the researchers offered 10 patients a regimen of surf, sun, sand and dolphins, said Dr. Michael A. Reveley, a professor of psychiatry at the University of Leicester in England and the senior author of the study. To try to draw a valid comparison, another group got the same regimen, minus the dolphins.
      The study found that the patients who took part in the program that let them spend time with bottlenose dolphins for two weeks enjoyed relief from their symptoms. Patients in the control group, who spent quality time in the sun and the water, without the dolphins, did not experience the same benefit, the researchers found. The research took place at a marine science institute in Honduras, and the findings were reported in BMJ, the British medical journal.
     The patients in the dolphin group were taught about the animals' behavior and water safety. When they were rescreened for depression at the end of two weeks, they scored better than they had on arrival. Based on their own reports three months later, nine of the patients reported lasting improvement.
     Dolphin therapy offers some obvious advantages over drug therapy. "No side effects were noted," the researchers wrote, "although accidental injuries may occur." While the approach is hardly suited to widespread application, the findings shows the importance of maintaining a strong connection to nature, the researchers said. Some conservationists, however, frown on swim-with-dolphin programs, contending they are stressful to the animals.

 

Meth's Impact Reaches Child Protection
Associated Press, 12/6/2005

ANOKA, Minn. -- For a premature baby delivered by a woman addicted to methamphetamine, little Logan Meir was coming along pretty well. Doctors treating his underdeveloped palate had removed the tracheal tube he was breathing through and had sewn up the hole. If all went well, he would be ready for adoption in just a few days. ''The doctors say he will never run a marathon or climb a mountain, but otherwise he should be normal,'' his social worker, Libbie Pelletier, told Anoka County Judge Jenny Walker Jasper.
      Like most of the cases Walker Jasper handled that day, Logan's highlighted yet another consequence of the meth epidemic: The drug has become a huge issue in child protection cases anywhere the drug has invaded. ''There is no drug better suited to making horrible decisions about your children than methamphetamine, which keeps you awake for days and then when you crash it's like the sleep of a coma, during which you have no idea what's happening with those kids,'' said Roger Munns, spokesman for the Iowa Department of Human Services.
     A survey released in July by the National Association of Counties said 40 percent of child welfare officials in 13 states reported increased out-of-home placements because of meth in the past year. In Minnesota, some judges say as much as 80 percent of their child protection caseload is meth-related. On a recent day in Walker Jasper's courtroom, all but a handful of the 30 child protection cases on her docket involved meth. ''It's pervasive around the country,'' said Laura Birkmeyer, chair of the National Alliance for Drug Endangered Children and executive assistant U.S. attorney for San Diego. ''Every state that is seeing a large increase in methamphetamine manufacturing is seeing the concomitant problem of drug-endangered children.''
     Even where child protection caseloads aren't growing, officials say, the proportion that involve meth is often on the rise, and those cases are among the most difficult to handle. Meth fuels domestic violence, and kids can get caught in the middle. They also fall victim to criminals and predators who hang out with drug-using parents. ''Those guys can be pretty mean and violent,'' said Ann Stackpool-Gunderson, supervisor in charge of child protection for Isanti County. ''Kids will come to school with bruises. We've had calls to law enforcement from older children -- teens wanting to protect their youngest siblings.'' In some cases, people carry out the dangerous process of making methamphetamine in homes where children are present, exposing kids to toxic and explosive chemicals as well as the drug itself.
     Between cases, Walker Jasper said that Logan's mother, Michelle Sydow, once was doing well in her struggle against addiction. She'd moved to northern Minnesota to get treatment. She got her teeth fixed -- a common side-effect of meth abuse is a disastrous collapse in dental health known as meth mouth. ''She looked like a million bucks,'' Walker Jasper said. Sydow should have stayed up north, but she moved back to the Twin Cities metro area, fell in with her old friends and started using again, the judge said. Logan was born at 27 weeks -- roughly 10 weeks premature -- with meth in his system, she said.
     Sydow didn't appear for the hearing on Logan, now 2. But she was in Walker Jasper's courtroom later that day to fight the county's efforts to terminate her parental rights to her daughters, ages 12 and 6, who are in foster care. The mother's attorney acknowledged to Walker Jasper that her client had slipped, but said she had a job and a home and would be returning to treatment. The 12-year-old sat in the courtroom, with her own attorney by her side, but mother and daughter kept their distance. They exchanged uneasy glances but did not speak as they left after the judge set a pretrial hearing date for January. ''She's really disappointed in her mom -- and she should be,'' Walker Jasper said afterward.

 

FDA Strengthens Warning on Paxil
Associated Press, 12/8/2005

WASHINGTON -- The Food and Drug Administration is strengthening its warning that the antidepressant Paxil may be associated with birth defects, citing a new study that found increased risk of fetuses developing heart defects. The FDA asked manufacturer GlaxoSmithKline to reclassify the drug, which goes by the generic name paroxetine, as a ''Category D'' drug for pregnant women. The classification means that studies in pregnant women have shown a risk to the fetus. However, the FDA said, the benefits of the drug may outweight the risk to the fetus.
      Two studies of pregnant women taking Paxil during their first trimester have shown their babies have heart defects one and a half to two times a greater rate than the norm, the FDA said. The agency announced the strengthened warning Thursday. It issued a previous warning in September. The FDA is advising doctors not to prescribe Paxil to women in their first three months of pregnancy or people who are planning to become pregnant, unless there are no other options.

 

Compulsive Eating Support Groups on Rise
Associated Press, 12/8/2005

ALBANY, N.Y. -- Grabbing a handful of cookies off the plate, stealing a roommate's food, overeating while home alone. These could be signs of compulsive overeating. In the United States, the nation's fixation on weight is only making the disorder more prevalent, experts say. The number of support groups for people whose lives are controlled by food has grown sharply in recent years.
     J im M., a member of Food Addicts in Recovery Anonymous in Saginaw, Mich., tells a typical story. ''I didn't have that switch that says, 'You've had enough.' I just always wanted more and more and more,'' said the former college football player, who like other 12-step program members wouldn't allow the use of his full name. Jim's obsession was so great he constantly broke off social engagements to eat giant piles of food in the privacy of his home. ''I just always made food my priority,'' he said.
      Since 1998, the number of support groups hosted by Food Addicts has grown from about 20 to 300 nationwide. Overeaters Anonymous, founded in 1960, now has more than 4,300 meetings in the country.
     David Levitsky, a professor of psychology and nutrition at Cornell University, said compulsive overeating is becoming more widespread in part because the country has a growing obsession with weight loss. Dieters make a religion of calorie-counting, starving themselves until their bodies rebel with a binge. That sets off an ensnaring cycle of guilt, dieting and binge-eating, he said. ''More people nationally are going on diets. And there's always going to be a certain fallout of people who can't define when enough is enough,'' he said.
     Binge-eating disorder is more prevalent than anorexia or bulimia, according to the National Association of Anorexia and Associated Disorders. A study by the American Psychiatric Association in 2000 suggested between 0.7 percent and 4 percent of the population suffered from the disorder, but researchers believe the actual figure is much higher, said Annie Hayashi, spokeswoman for NAAAD.
     Even thin people and those of average weight can be possessed by binge eating, said Susan L., who chairs the group Food Addicts. ''Not all overeaters are obese, and not all obese people are overeaters,'' she said. The only uniting characteristic is an overwhelming preoccupation with food, she said.
     The behavior of compulsive overeaters is distinct from the average person who might indulge in normal ''emotional eating'' -- like curling up with a carton of ice cream after a breakup or taking comfort in macaroni-and-cheese on a blue day. Those in the throes of a binge feel they cannot stop and they eat until they are physically uncomfortable, according to Overeaters Anonymous.
     Still, health experts say diagnosis can be tricky in a nation where two-thirds of the population is overweight and food is so linked with the psyche. Among the warning signs, noted by Mario Rago, a board member for the anorexia and related disorders group:
--Cruising from store to store to hoard tubs of ice cream and bags of cookies to consume in a single sitting.
--Racking up debt from buying food.
--Letting food take precedence over personal relationships and work.
     Ultimately, compulsive eating is isolating, and that was the tip-off to Anne B., a web designer in San Mateo, Calif. Nobody seemed to suspect she had a problem. Her weight fluctuated, but she was never obese. Slowly, she withdrew from friends and co-workers until she found herself alone. After joining Food Addicts nine years ago, the 31-year-old has finally came to terms with her disorder. She weighs her food now to make sure she's eating an appropriate amount.
     For Michigan resident Jim M., coming to terms with compulsive eating has brought changes that go beyond the 200 pounds he's lost. He says he now goes to his annual college football reunions and no longer avoids social situations to hide and eat. ''If somebody asks me to do something, I don't make excuses anymore. I go,'' he said. ''Now I realize going to a restaurant is not about the food. It's about being with your friends and having a good time.''
     On the Net:
American Dietetic Association, www.eatright.org
National Association for Anorexia and Associated Disorders, www.anad.org
Overeaters Anonymous, www.oa.org
Food Addicts in Recovery Anonymous, www.foodaddicts.org

 

Flight Passenger Was Mentally Ill, Police Say
Sara Kehaulani Goo, Washington Post- 12/8/2005

The American Airlines passenger killed by air marshals at Miami International Airport on Wednesday suffered from bipolar disorder, according to investigators, raising new questions about how much training sky marshals receive in dealing with travelers with mental illnesses. Rigoberto Alpizar, a 44-year-old Costa Rica native and U.S. citizen, was shot multiple times by air marshals after he allegedly claimed to have a bomb in a backpack strapped to his chest, local and federal officials said. The Federal Air Marshal Service said Alpizar repeatedly ignored the marshals' orders to get down on the ground and they took appropriate lethal action because they considered him a threat.
      After the shooting, police found no evidence of explosives in Alpizar's backpack or in his checked luggage, which was exploded by police on the tarmac as a precaution. "All indications are that this was a textbook situation," said air marshal spokesman David Adams, whose agency is reviewing the incident. "We will also supply results to our training division to see if there's any training changes that need to be made."
     Bipolar disorder, also known as manic-depressive disorder, is a mental illness that causes extreme mood swings alternating between euphoria and depression. Left untreated, it can affect rational thinking and can lead to delusions and suicidal behavior.
     The image of Alpizar as a potential terrorist threat didn't seem to square with neighbor and family accounts of the Home Depot Inc. employee who lived with his wife on a small street teeming with children in a quiet Orlando suburb. Several neighbors said Alpizar and his wife, Anne Buechner, were friendly and involved in occasional block parties. "He's a very gentle man, very nice," said Jennifer Tatro, a neighbor who lives on the same street in Maitland, Fla. "I never had an uncomfortable moment with him."
     Yesterday afternoon, a woman who identified herself as Alpizar's sister-in-law, Jeanne Jentsch, gave a statement to reporters gathered in front of the Alpizar-Buechner home, saying Alpizar "was a loving, gentle and caring husband, brother and friend." She said Alpizar was born in Costa Rica and became a "proud American citizen several years ago."
     Federal officials have not released the names of the two air marshals involved but said they both were based in the Miami field office and joined the agency in 2002. One of the marshals speaks Spanish and formerly worked for the U.S. Border Patrol while the other had worked for the U.S. Customs Service as an officer.
     Several passengers aboard the Boeing 757 in Miami said that Alpizar's wife ran after him when he rushed to the front of the aircraft and was confronted by the air marshals. Two passengers, according to media reports, said they heard Alpizar's wife say that he was "sick" or "bipolar" and that he had not taken his medication. Yesterday, Miami-Dade County Police Department investigators said they had interviewed Buechner and that "she advised that Mr. Alpizar had been diagnosed with bipolar disorder."
     Lydia Lewis, president of the Depression and Bipolar Support Alliance, a Chicago nonprofit group, said police departments have been increasingly trained to work with mental heath experts in dealing with suspects who are mentally ill. Still, she said, "In this case, it was a terrible tragedy and I'm not certain all the training in the world . . . would have changed this case." Experts said that police increasingly incorporate mental health training and, in some cases, experts as part of certain units to learn more effective ways of responding to mentally ill people who are not receiving treatment. The air marshals said their training includes a number of different role-playing scenarios involving violent or disruptive passengers as well as hijackers, but a spokesman said he could not say definitively whether the training included how to work with someone who appears to be mentally ill. "They get trained in all different situations -- not any particular characteristics," Adams said. "A lot of characteristics blend in together" that involve a passenger who is not in a normal state of mind, such as someone who is intoxicated or someone who is mentally ill and has not taken medication, he said. "But air marshals have to react to a situation. When an individual says they have a bomb in the bag, you don't know what someone's mental state is."
     Dr. Robert Phillips, an adjunct professor of psychiatry and law at the University of Maryland, said it is too difficult in this case to determine whether the marshals acted correctly because the facts are not clear. "Generally, law enforcement is aware that from time to time [mentally ill] individuals need to be handled differently," Phillips said. "There are also circumstances where that can't occur" because of the situation, he said.
     Many organizations, including the Air Line Pilots Association and members of Congress, expressed support for the air marshal program yesterday and said the officers acted appropriately. But one anti-gun organization that fought the arming of airline pilots said the incident raises questions about whether the traveling public is sacrificing safety in the name of security with more guns on aircraft. "There needs to be a serious investigation," said Kristen Rand, legislative director at the Violence Policy Center. "It seems this man didn't have a bomb and probably wasn't a threat. People think if you put a gun on an airplane it's going to solve the problem. In this situation, it's created problems."

 

Eli Lilly Seeks FDA Approval for Cymbalta
Associated Press, 12/9/2005

INDIANAPOLIS -- Drug Eli Lilly and Co. said Friday that it has filed with the Food and Drug Administration to have its antidepressant Cymbalta approved for the treatment of generalized anxiety disorder. The company said that it will use data from two clinical trials to support the application.
      Generalized anxiety disorder is a condition lasting for at least six months characterized by exaggerated worry or chronic anxiety and irritability, and may include physical symptoms like muscle tension, restlessness and insomnia.
     Cymbalta was approved by the FDA in August 2004 for the treatment of major depression, and in September 2004 for the treatments of diabetic nerve pain. Other antidepressants approved for generalized anxiety disorder include Forest Labs' Lexapro, Wyeth's Effexor, and GlaxoSmithKline's Paxil.

 

Study Links Caffeine Addiction, Family Alcoholism
Jonathan Bor, Baltimore Sun- 12/9/2005

BALTIMORE — Most pregnant women have little trouble kicking caffeine once their doctors warn them that the common stimulant found in coffee, tea, cola, chocolate and other foods could endanger their babies' health. But researchers have found a group that does have trouble: women with a family history of alcohol abuse. "It's not just an academic issue," said Dr. Roland R. Griffiths, a professor of psychiatry and neuroscience at the Johns Hopkins School of Medicine whose earlier research established caffeine as an addictive substance. "These are people who want to quit, should quit and can't quit."
     Griffiths, whose study appears in this month's American Journal of Psychiatry, said the finding suggested that alcoholism and caffeine addictions shared a common genetic factor. It also suggests that pregnant women may need extra help avoiding caffeine if they have a family history of alcohol abuse. For them, the standard warnings may not be enough.
      In the study, researchers tracked 44 pregnant women seeking care at a suburban Baltimore obstetrics practice. Though most of the women had little trouble kicking caffeine, seven of the women couldn't quit or significantly cut back — and all of those women had a family history of alcohol abuse. No woman in the study was an alcoholic. A family history was defined as having at least one parent or sibling who was.
      Women who consume caffeine while pregnant run a higher risk of miscarriage and stunted fetal growth. The U.S. Food and Drug Administration and its counterparts in Canada and Britain recommend avoiding caffeine during pregnancy. The women who couldn't quit caffeine said they were thwarted by withdrawal symptoms, caffeine cravings and difficulty carrying out daily activities.
     Dace S. Svikis, a coauthor of the study, said these women also reported higher rates of past cigarette smoking and problematic alcohol use. "This suggests that caffeine dependence may be a useful marker for risk of dependence on other drugs of abuse," she said.
     In the 1994 study that established caffeine as an addictive substance, Griffiths found that caffeine had the essential properties of an addictive drug. Some who consume caffeine regularly suffer headaches, nausea and other symptoms when they try to cut back. They may also need increasing doses to achieve the same level of alertness, and may repeatedly fail in their attempts to quit.


Katrina's Emotional Damage Lingers
Ceci Connolly, Washington Post- 12/9/2005

NEW ORLEANS -- "I've been thinking the last couple days the best thing to do is die." The man, speaking on a dull monotone, was slumped in a chair inside the steamy convention center here, waiting to see a doctor. He didn't want to come to the makeshift hospital, but a friend insisted. "I'd hardly had a drink in years," said the man. "Right after the hurricane hit, I just started drinking. If I stop drinking, the pain becomes so great it's unbearable."
      In these months after Hurricane Katrina, it is not hard to find people like David, a quirky, debonair, fragile artiste who asked that his last name not be published. They can be seen walking on deserted streets with glazed eyes. In grocery stores and offices, they inexplicably break into tears. Police officers confess to counselors that they are fighting more with spouses and yelling at their kids. Many turn up at local hospitals searching for a neat explanation for pain the likes of which they have never felt before.
     Every disaster has its second wave, the emotional scars that linger after the initial blow. But the impact from Katrina -- which displaced nearly 2 million people, eradicated entire neighborhoods, separated families and reopened racial wounds -- is far beyond what mental health experts in this country have ever confronted, they say. In the extreme cases -- and there have been many -- they have hanged themselves, overdosed and put guns to their heads. The number of suicides in neighboring Jefferson Parish is more than double what it was in the fall of 2004. In the first days of the crisis, coroner Robert Treuting saw five suicides in three days. In the two months since, there have been 11, compared with five a year ago. Two New Orleans police officers have taken their lives, and at least one more has attempted suicide. "It's like living in the Twilight Zone," said Candace Cutrone, who as assistant coroner for mental health in Orleans Parish has the overwhelming task of evaluating psychiatric cases for local hospitals. "The whole world changed overnight."
     Orleans Parish coroner Frank Minyard said he does not have statistics for the city, because many deaths -- including nine by gunshot -- remain a mystery. He knows of at least one woman who killed herself recently. New Orleans emergency personnel have responded to at least six suicides and nearly two dozen suicide attempts since Katrina. The tightly knit community of Academy of the Sacred Heart, the Rosary, is coping with two suicides, headmaster Timothy M. Burns said. Shortly before Thanksgiving, a woman with young children took her life. Last week, the father of a Sacred Heart student was buried.
     And with so few medical services available in the region and the slow pace of rebuilding, experts expect the psychological toll to grow far worse. "I think the whole city's grieving," said Alvin M. Rouchell, chairman of the psychiatry department at the Oschner Clinic Foundation in neighboring Jefferson Parish. "I've seen a lot of post-traumatic stress disorder. People who had emotional disorders before the hurricane have a worsening of conditions, and some people for the first time are having panic attacks, depression, PTSD." Calls to a national suicide-prevention hotline skyrocketed from the typical 100 to 150 a day to more than 900 in the immediate aftermath of Katrina before leveling off to about 210 a day now, said Charles G. Curie, administrator of the federal Substance Abuse and Mental Health Services Administration.
     In a clinical survey of Orleans and Jefferson parishes, the Centers for Disease Control and Prevention found that 45 percent of the residents were experiencing "significant distress or dysfunction" and 25 percent had an even "higher degree of dysfunction," said Dori Reissman of the CDC. Nearly half of those interviewed reported feeling isolated, and a quarter believe at least one family member needs counseling. On Wednesday, the Bush administration plans to distribute public service announcements to 11,000 media outlets advertising a confidential toll-free number for individuals or family members who may have been psychologically impacted by the storm and its aftermath.
     For the professionals on the ground here, David's tale is all too familiar. "New Orleans is a very special place where people exist on very thin circumstances," he said haltingly. "I was one of those people." During the first week, from a relative's home in Texas, he watched televised images of his beloved New Orleans descend into a dark, violent wasteland. "I said, 'My God, who destroyed my city?' " he recalled. "I went into shock." On a recent day, as David's wait to see a physician stretched past two hours, he paced in and out of the still-hot Louisiana sun, dragging on a Marlboro he bummed off another patient. He is both dapper and disheveled -- his wide-brimmed hat and polished shoes odd accoutrements to his soiled shirt and heavy wool trousers. "I'm one of those people who just got hit real hard. I'm very scared," he said, his voice barely audible, his face hidden beneath the hat. "I'm scared because I don't have any identity anymore."
      He drew sustenance -- financial, emotional, intellectual and spiritual support -- from all that this historic, jazz-loving, slightly down-and-out melting pot of a city had to offer. Everything familiar -- his favorite clubs, Charity Hospital, funky shops, fellow artists and paying customers -- is gone. A borderline alcoholic who took anti-anxiety medication, David, now nearing 60, fears that his landlord is about to evict him and that he has run out of family and friends to lean on. The combination of sadness, guilt and despair has prompted him to consider suicide. "Being here right now, this exact moment, is one of the most painful moments of my life," he said.
     David went to the tent complex inside the convention center because the MASH-style unit here is his only real option. Of the 534 psychiatric beds in the metropolitan area, the region is down to fewer than 80, said Charles Hart, manager of the behavior medicine center affiliated with West Jefferson Medical Center. And for those lucky enough to be placed inpatient, "discharge is a real problem because there's no place to send anyone" for ongoing outpatient care, he said.
     Susan-Anne Henry, a psychiatric nurse practitioner at East Jefferson General Hospital, called 21 facilities in search of a bed for one severely ill patient. "The reason I stopped at 21 was I ran out of facilities to call," she said. Yet keeping psychotic patients in the emergency department creates a backlog and often exacerbates her patients' condition. She was recently forced to keep one patient in the ER for 37 hours. "The next day, when I returned, he was worse," she said.
      So deep and widespread is the emotional damage that Cheryll Bowers Stephens, head of the Louisiana Office of Mental Health, likens Katrina's impact to the trauma of war. The military presence -- tanks on city streets, soldiers in camouflage, the constant din of helicopters overhead and armed checkpoints -- over a prolonged period of time made Katrina "a different type of disaster than we have seen previously," she said.
      Therapists are especially concerned about first responders and colleagues who witnessed so much suffering firsthand. Many police officers report nightmares, family tensions and having "short fuses," said Howard J. Osofsky, chairman of the psychiatry department at the Louisiana State University School of Medicine. Riding in an elevator recently, someone asked what day of the week it was, prompting a response from one officer that Osofsky will never forget. "He said, 'I know what day it is. Every day is the same day; it's the day after the hurricane.' " Osofsky's great fear is that as more residents return to nothing -- no home, no car, no job -- nothing except a life insurance policy, they will opt for a "rational suicide," he said. "In their minds, the question is whether they are better off dead or trying to take care of their families."
     David asks himself similar questions every day. "I'm tired. I'm so weak. I don't have any strength, and I don't have any will," he said. "Being here is kind of like being in prison.

 

Psychiatry Ponders Whether Extreme Bias Can Be an Illness
Shankar Vedantam, Washington Post- 12/10/2005

The 48-year-old man turned down a job because he feared that a co-worker would be gay. He was upset that gay culture was becoming mainstream and blamed most of his personal, professional and emotional problems on the gay and lesbian movement. These fixations preoccupied him every day. Articles in magazines about gays made him agitated. He confessed that his fears had left him socially isolated and unemployed for years: A recovering alcoholic, the man even avoided 12-step meetings out of fear he might encounter a gay person. "He had a fixed delusion about the world," said Sondra E. Solomon, a psychologist at the University of Vermont who treated the man for two years. "He felt under attack, he felt threatened."
      Mental health practitioners say they regularly confront extreme forms of racism, homophobia and other prejudice in the course of therapy, and that some patients are disabled by these beliefs. As doctors increasingly weigh the effects of race and culture on mental illness, some are asking whether pathological bias ought to be an official psychiatric diagnosis.
     Advocates have circulated draft guidelines and have begun to conduct systematic studies. While the proposal is gaining traction, it is still in the early stages of being considered by the professionals who decide on new diagnoses. If it succeeds, it could have huge ramifications on clinical practice, employment disputes and the criminal justice system. Perpetrators of hate crimes could become candidates for treatment, and physicians would become arbiters of how to distinguish "ordinary prejudice" from pathological bias.
     Several experts said they are unsure whether bias can be pathological. Solomon, for instance, is uncomfortable with the idea. But they agreed that psychiatry has been inattentive to the effects of prejudice on mental health and illness. "Has anyone done a word search for 'racism' in DSM-IV? It doesn't exist," said Carl C. Bell, a Chicago psychiatrist, referring to psychiatry's manual of mental disorders. "Has anyone asked, 'If you have paranoia, do you project your hostility toward other groups?' The answer is 'Hell, no!' "
     The proposed guidelines that California psychologist Edward Dunbar created describe people whose daily functioning is paralyzed by persistent fears and worries about other groups. The guidelines have not been endorsed by the American Psychiatric Association, which publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM); advocates are mostly seeking support for systematic study.
     Darrel A. Regier, director of research at the psychiatric association, said he supports research into whether pathological bias is a disorder. But he said the jury is out on whether a diagnostic classification would add anything useful, given that clinicians already know about disorders in which people rigidly hold onto false beliefs. "If you are going to put racism into the next edition of DSM, you would have enormous criticism," Regier said. Critics would ask, " 'Are you pathologizing all of life?' You better be prepared to defend that classification." "I think it's absurd," said Sally Satel, a psychiatrist and the author of "PC, M.D.: How Political Correctness Is Corrupting Medicine." Satel said the diagnosis would allow hate-crime perpetrators to evade responsibility by claiming they suffered from a mental illness. "You could use it as a defense."
     Psychiatrists who advocate a new diagnosis, such as Gary Belkin, deputy chief of psychiatry at New York's Bellevue Hospital, said social norms play a central role in how all psychiatric disorders are defined. Pedophilia is considered a disorder by psychiatrists, Belkin noted, but that does not keep child molesters from being prosecuted. "Psychiatrists who are uneasy with including something like this in the Diagnostic and Statistical Manual need to get used to the fact that the whole manual reflects social context," said Belkin, who is planning to launch a study on pathological bias among patients at his hospital. "That is true of depression on down. Pathological bias is no more or less scientific than major depression."
     Advocates for the new diagnosis also say most candidates for treatment, such as the man Solomon treated, are not criminals or violent offenders. Rather, they are like the young woman in Los Angeles who thought Jews were diseased and would infect her -- she carried out compulsive cleansing rituals and hit her head to drive away her obsessions. She realized she needed help but was afraid her therapist would be Jewish, said Dunbar, a Los Angeles psychologist who has amassed several case studies and treated several dozen patients for racial paranoia and other forms of what he considers pathological bias.
     Another patient was a waiter so hostile to black people that he flung plates on the table when he served black patrons and got fired from multiple jobs. A third patient was a Vietnam War veteran who was so fearful of Asians that he avoided social situations where he might meet them, Dunbar said. "When I see someone who won't see a physician because they're Jewish, or who can't sit in a restaurant because there are Asians, or feels threatened by homosexuals in the workplace, the party line in mental health says, 'This is not our problem,' " the psychologist said. "If it's not our problem, whose problem is it?"
     Opponents say making pathological bias a diagnosis raises the specter of social engineering -- brainwashing individuals who do not fit society's norms. But Dunbar and others say patients with disabling levels of prejudice should be treated for the same reason as are patients with any other disorder: They would feel, live and function better. "They are delusional," said Alvin F. Poussaint, a professor of psychiatry at Harvard Medical School, who has long advocated such a diagnosis. "They imagine people are going to do all kinds of bad things and hurt them, and feel they have to do something to protect themselves. "When they reach that stage, they are very impaired," he said. "They can't work and function; they can't hold a job. They would benefit from treatment of some type, particularly medication."
     Doctors who treat inmates at the California State Prison outside Sacramento concur: They have diagnosed some forms of racist hatred among inmates and administered antipsychotic drugs. "We treat racism and homophobia as delusional disorders," said Shama Chaiken, who later became a divisional chief psychologist for the California Department of Corrections, at a meeting of the American Psychiatric Association. "Treatment with antipsychotics does work to reduce these prejudices."
     Amid a profusion of recent studies into the nature of prejudice, researchers have found that biases are very common. Almost everyone harbors what might be termed "ordinary prejudice," the research indicates. Anthony Greenwald, a psychologist at the University of Washington in Seattle, and Mahzarin R. Banaji, a psychologist at Harvard, developed tests for such biases. By measuring the speed with which people make mental associations, the psychologists found that biases affect even those who actively resist them. "When things are more strongly paired in our minds, we can respond to them more quickly," Banaji said. "Large numbers of Americans cannot as swiftly make the association between 'black' and 'good' as they can between 'white' and 'good.' "
     Similarly, psychologist Margo Monteith at the University of Kentucky in Lexington found that people can have prejudices against groups they know nothing about. She administered a test in which volunteers, under time pressure, had to associate a series of words with either "America" or a fictitious country she called "Marisat." Volunteers more easily associated Marisat with such words as "poison," "death" and "evil," while associating America with "sunrise," "paradise" and "loyal." "A large part of our self-esteem derives from our group membership," Monteith said. "To the extent we can feel better about our group relative to other groups, we can feel good about ourselves. It's likely a built-in mechanism."
     If biases are so common, many doctors ask, can racism really be a mental illness? "I don't think racism is a mental illness, and that's because 100 percent of people are racist," said Paul J. Fink, a former president of the American Psychiatric Association. "If you have a diagnostic category that fits 100 percent of people, it's not a diagnostic category." But Poussaint said there is a difference between ordinary prejudice and pathological bias -- the same distinction that psychiatrists make between sadness and depression. All people experience sadness, anxiety and fear, but extreme, disabling forms of these emotions are called disorders.
     While people with ordinary prejudice try very hard to conceal their biases, Solomon said, her homophobic patient had no embarrassment about his attitude toward gays. Dunbar said people with pathological prejudice often lack filtering capabilities. As a result, he said, they face problems at work and home. "Everyone is inculcated with stereotypes and biases with cultural issues, but some individuals not only hold beliefs that are very rigid, but they are part of a psychological problem," Dunbar said. The psychologist said he has helped such patients with talk therapy, which encourages patients to question the basis for their beliefs, and by steering them toward medications such as antipsychotics. The woman with the bias against Jews did not overcome her prejudice, Dunbar said, but she learned to control her fear response in social settings. The patient with hostility against African Americans realized his beliefs were "stupid."
     Solomon discovered she was most effective dealing with the homophobic man when she was nonjudgmental. When he claimed there were more gays and lesbians than ever before, she presented him with data showing there was no such shift. At those times, she reported in a case study, the patient would say, "I know, I know." He would recognize that he was not being logical, but then get angry and return to the same patterns of obsession. Solomon did not identify the man because of patient confidentiality.
     Standing in the central yard of the maximum-security California State Prison with inmates exercising around her, Chaiken explained how she distinguished pathological bias from ordinary prejudice: A prisoner who belonged to a gang with racist views might express such views to fit in with his gang, but if he continues "yelling racial slurs, assaulting others when it's clear there is no benefit" after he leaves the gang, the behavior was no longer "adaptive." Prison officials declined to identify inmates who had been treated, or make them available for interviews.
     Chicago psychiatrist Bell said he has not made up his mind on whether bias can be pathological. But in proposing a research agenda for the next edition of psychiatry's DSM of mental disorders, Bell and researchers from the Mayo Clinic, McGill University, the University of California at Los Angeles and other academic institutions wrote: "Clinical experience informs us that racism may be a manifestation of a delusional process, a consequence of anxiety, or a feature of an individual's personality dynamics." The psychiatrists said their profession has neglected the issue: "One solution would be to encourage research that seeks to delineate the validity and reliability of racism as a symptom and to investigate the possibility of including it in some diagnostic criteria sets in future editions of DSM."

 

The Siren Song of Sex With Boys
Kate Zernike, New York Times- 12/11/2005

When Sandra Beth Geisel, a former Catholic schoolteacher, was sentenced to six months in jail last month for having sex with a 16-year-old student, she received sympathy from a surprising source. The judge, Stephen Herrick of Albany County Court in New York, told her she had "crossed the line" into "totally unacceptable" behavior. But, he added, the teenager was a victim in only the strictly legal sense. "He was certainly not victimized by you in any other sense of the word," the judge said. The prosecutor and a lawyer for the boy's family called the judge's comments outrageous. But is it possible that the 16-year-old wasn't really harmed?
      The last few months have produced a spate of cases where women are prosecuted for having sex with boys: Debra LaFave of Florida, another teacher, faces trial for sleeping with a 14-year-old student; Lisa Lynette Clark of Georgia was impregnated by her son's 15-year-old friend, whom she married a day before she was arrested; Silvia Johnson of Colorado was sentenced to 30 years for having sex with teenagers and providing drugs and alcohol.
     Certainly no one doubts that a teacher who has sex with her students should lose her job. Or that a 37-year-old mother should not find herself pregnant by her son's 15-year-old friend. Or that a 41-year-old mother who provides sex, drugs and alcohol to teenagers so she can be cool among her daughter's friends is troubled. But when the women face prison, questions are raised about where to set the age of consent. And because many of those named as victims refused to testify against the women in what they said were consensual relationships, not everyone agrees that the cases involve child abuse.
     "We need to untangle the moral issues from the psychological issues from the legal issues," said Carol Tavris, the author of "The Mismeasure of Women" and a social psychologist. "That's the knot." She added: "You may not like something, but does that mean it should be illegal? If we have laws that are based on moral notions and developmental notions that are outdated, do we need to change the laws?"
     Though it might seem that way from the headlines, women having sex with teenage boys is not new. A federal Department of Education study called "Educator Sexual Misconduct," released last year, found that 40 percent of the educators who had been reported for sexual misconduct with students were women.
     Charol Shakeshaft, the author of the study and a professor of education at Hofstra University, said that even when the woman is not a teacher, the relationships are not healthy. "A 16-year-old is just not fully developed," she said. "Male brains tend to develop the part that can make decisions about whether it is a wise thing to do later."
     Prosecutions of women have been rising slightly in the last several years, said David Finkelhor, director of the Crimes Against Children Research Center at the University of New Hampshire. Mr. Finkelhor says he believes that the scandal involving sexual abuse by priests called more attention to cases with teachers and other authority figures. But the cases also reflect a decline in the double standard applied to men and women, brought on, he said, by increasing numbers of female prosecutors and police officers who may not buy into the traditional notion that a boy who has sex with an older woman just got lucky. But several studies have raised questions about whether the recent cases should be filed under child sex abuse.
     The most controversial study was published in 1998 in Psychological Bulletin. The article, a statistical re-analysis of 59 studies of college students who said they were sexually abused in childhood, concluded that the effects of such abuse "were neither pervasive nor typically intense, and that men reacted much less negatively than women." The researchers questioned the practice, common in many studies, of lumping all sexual abuse together. They contended that treating all types equally presented problems that, they wrote, "are perhaps most apparent when contrasting cases such as the repeated rape of a 5-year-old girl by her father and the willing sexual involvement of a mature 15-year-old adolescent boy with an unrelated adult." In the first case, serious harm may result, the article said, but the second case "may represent only a violation of social norms with no implication for personal harm." They suggested substituting the term "adult adolescent sex" for child abuse in some cases where the sex was consensual. "Abuse implies harm in a scientific usage, and the term should not be in use if there is consent and no evidence of harm," said Bruce Rind, an author of the study and a psychology professor at Temple University.
     This view could prove a hard sell, politically and legally. The article in Psychological Bulletin was roundly criticized by prominent conservatives and denounced in Congress, as was the judge in Ms. Geisel's case. In 2003, Bruce Gaeta, a New Jersey judge, was reprimanded by the state's highest court for characterizing an encounter between a 43-year-old female teacher and a 13-year-old boy who had been a student as "just something between two people that clicked beyond the teacher-student relationship."
     Pamela Rogers Turner, a Tennessee teacher, was sentenced in August to nine months in jail for sex with a 13-year-old boy. Thirteen? Professor Rind and others agree that that is too low to set the age of consent, making 12 truly out of bounds -- the age of Vili Fualaau when he began having sex with the most infamous of the teachers in sex scandals, Mary Kay Letourneau. (The fact that a decade later the two are married and even registered for china at Macy's has not changed anyone's mind.) But Professor Rind and others point out that Canada and about half of Europe have set the age of consent at 14 after recommendations by national commissions. To set it much higher, as most states do, they say, ignores the research, and the hormones.
     Even those who argue for more protection of children agree that the laws in this country can be arbitrary. In Ms. Geisel's case, she was caught first with a 17-year-old student, but because he was of legal age, she was charged only after his 16-year-old friend came forward and said they had taken turns having sex. Can a few months make such a difference? "I'm torn, I don't know," Professor Shakeshaft said. "Teachers are always wrong. And it would be my belief that people aren't formed by 16. On the other hand, my mother married my father at 16 and they were married 65 years." Professor Finkelhor agrees that there is variability among cases and teenagers but says it's better to err on the side of safety.



`I'm on a Binge. I Just Can't Stop.'
Alex Rodriguezb, Chicago Tribune- 12/11/2005

VYPOLZOVO, Russia -- On a recent morning in this small swatch of log cabins and collective farms along the Volga River, Stanislav Morzhukhin began his day the way he begins most days -- swilling moonshine made from solvent-strength spirits and allergy medicine. By midafternoon, the 34-year-old repairman knew he couldn't work. He could barely stand. He jabbed his finger toward three empty bottles on the floor, as if to damn them for ruining his life. His words tumbled out in fragments, but the desperation in his voice rang clear. "I don't know how to stop. Teach me how to stop," Morzhukhin pleaded to a visitor as his wife, Elena, glowered at him from across their kitchen table. "I go on a binge for two weeks, go to work, then go back on a binge. I'm tired of my life now. This isn't living, it's existing."
     In Vypolzovo and thousands of ramshackle villages like it across Russia's heartland, the salve for empty pocketbooks and gloom-filled futures comes in a bottle of hooch--everything from homemade vodka to windshield de-icer. Fifteen years of post-Soviet capitalism has left rural Russia straggling far behind. Russians in collective farms across the country's 11 time zones could count on a safety net of free housing and health care--and on regular paychecks--during the Soviet era. In today's Russia, the same villagers live day-to-day, shivering through stretches of winter without heat, cringing at the sight of their children in tattered school clothes. "Those who don't have cattle or a job, they drink," says Artem Norbekov, 29, unemployed and wobbly from an afternoon of drinking diluted solvent. "We're not to blame for drinking--those who are in charge of our jobs are to blame."
     Alcoholism poses as much of a national health crisis in Russia today as it did during the Soviet Union's early 1980s, when up to two of every five men were considered alcoholics. Today alcohol plays a role in the deaths of nearly a third of all Russians, says Alexander Nemtsov, director of the Moscow Psychiatry Institute and one of the country's leading experts on alcoholism. Alcohol poisoning kills an estimated 40,000 Russians each year, compared with just 400 Americans annually. Alcohol abuse is believed to be one of the driving forces behind Russia's shrinking population, which now stands at 143 million and is projected to plummet to 80 million by 2050. The average life expectancy for a Russian woman now is 72--but for Russian men it has dropped to 58. "Solving Russia's alcoholism problem isn't the easiest way to solve its demographic crisis," said Nemtsov, "but it's the best way."
     The Kremlin has a history of ignoring the problem. When it has tried to act, the results have not been impressive. Mikhail Gorbachev's ill-fated anti-alcohol campaign slashed the hours that vodka could be sold and scaled back production; the measures infuriated Russians and fueled a booming black market. The Russian government nearly caused a revolt when it raised taxes on vodka by 40 percent in 2000. More recently, President Vladimir Putin has turned his attention to beer, signing into law last week a ban on beer drinking in public places.

Illegal production blamed
Health experts say government efforts should target the counterfeit alcohol market, which is wreaking havoc on Russia's working class. Occasional stings aimed at uncovering illegal alcohol production aren't enough, the experts say--authorities need to clamp down on corrupt officials who look the other way for a price. "The main problem is the availability of cheap counterfeit alcohol, and the corruption associated with it," Nemtsov said. "That's the root of the evil, and so far, authorities haven't done anything about it."
     The toxic brew Morzhukhin is hooked on is called Gamyrka and is sold by dealers who work door-to-door. A 16-ounce bottle of Gamyrka costs about 60 cents. The toll it takes on villages such as Vypolzovo is incalculable. Vypolzovo's dairy farm employs about 50 people. More than half are alcoholics, says the farm's director, Nikolai Ustinov. Many routinely show up to work drunk, and some drink at work. Firing them would slash his workforce, so Ustinov sends them home if they are too drunk. He also has sent a few workers to the regional capital, Yaroslavl, to be "coded," a kind of treatment that relies on a regimen of powerful drugs and counseling to scare the alcoholic into staying sober. Its effects don't last. Morzhukhin has been coded eight times. "I think our productivity would increase threefold if everyone weren't so drunk here," says Ustinov, a barrel-chested Russian bundled up in a winter coat in an office with no heat. "These workers are a burden, but we don't want to ruin their lives, so we try to help them. It's the only way they can earn money."
     Villages that surround Ustinov's farm long ago lost any sense of community. In Manylovo, population 70, what once was the village church is now a half-destroyed, red-bricked husk of a building. Villagers stagger down snow-packed roads, drunk by midday. Standing on a village lane with her coat open on a frigid afternoon, Ludmilla Kulikova bobs her head and insists she is perfectly fit to work her shift in the dairy stables at Ustinov's farm later that evening. She has had several rounds of what many villagers in Manylovo drink: a spirit called Russian North, diluted with water. Ostensibly sold as bath foam, Russian North, the label on an 8-ounce bottle states, is more than 90 percent ethyl alcohol. "If they sell it, why not drink it?" Kulikova says. "It's cheaper than vodka, so we buy it." Years of hard drinking are etched in Kulikova's 47-year-old face: ruddy, bloated cheeks, gray teeth, deep lines furrowed underneath leaden eyes. She began drinking heavily at 19 and never stopped. "I'm on a binge for six months already," Kulikova says resignedly. "I just can't stop."

It comes down to money
At Manylovo's only store, a small cabin with the sign "Day to Day Goods," Irina Yefimova keeps an ample supply of vodka, wine and beer stocked on shelves. But it is bottles of Russian North that she regularly sells out of. "I would prefer not to sell it, but I have to," Yefimova says. "I never include this stuff in the order we send to our suppliers, but my boss does. He only cares about the money." As Yefimova explains, Kulikova's 25-year-old daughter, Irina Smirnova, stops in. Her husband, Nikolai, was drinking with friends and sent her out to buy more Russian North. "About half of the village drinks this stuff," Smirnova said. "I used to drink it when my friends brought it, but we stopped drinking this after people started dying."

 

Police Tackle Domestic Violence
Trady Gordon Fox, Hartford Courant- 12/11/2005

NORWICH -- Six-year-old Colby Brand clutched a portable phone and boasted to visitors that he knows how to dial 911. His mother, Dawn Brand, said he still has nightmares about the time her former boyfriend broke into their apartment and was waiting when they walked up the stairs. Colby likes to have the telephone nearby now, but he feels even safer knowing that Rob and Pete will stop by. That's what he calls Norwich Officers Robert J. Faulise Jr. and Peter G. Petrides, members of the department's Domestic Violence Patrol, who visit regularly to make sure that Colby and Dawn Brand are OK.
     The patrols -- part of a pilot program funded by the state -- are changing the way that some police departments handle domestic violence cases, and proponents would like to see the approach spread statewide. The Norwich, Danbury and Berlin police departments each received three-year, $50,000 grants to pay for extra officers and a civilian advocate. Under the program, which began in January, the teams regularly visit victims of domestic violence after an arrest has been made to prevent other assaults. One municipality was chosen from the eastern, central and western regions of the state for the program.
     The pilot program has won the support of Chief State's Attorney Christopher Morano and Superior Court Judge Michael A. Mack, deputy chief court administrator. Mack is an outspoken advocate for victims of domestic violence. Earlier this year in Idaho, Mack's stepdaughter and her two young children were fatally shot by her husband, who then killed himself. "I love this program," said Morano, who has also bolstered his department's resources and increased staff training to address the issue.
     Along with recent high-profile cases, including a state trooper who shot and killed his former girlfriend before turning the gun on himself, at least 20 women and several children were killed last year in domestic violence incidents in Connecticut. "It really begged for us to do something different," said Norwich Police Chief Louis J. Fusaro Sr.
     Mack is encouraging as many police departments as possible to try to work the program or a similar one into their budgets. "If, in fact, we could see our way to fund this type of thing," Mack said, "we would avoid a lot of problems going forward."  Linda Blozie, public affairs director for the Connecticut Coalition Against Domestic Violence, which helped fund the program, said there is less chance for violence to escalate if police are checking on the victim.
      In Norwich, the officers have found that gaining the trust of a woman who has been emotionally and physically abused takes tenacity and patience. At the beginning of each shift, Faulise, Petrides and victim's advocate Jamie L. Spotten have "story time," where they look over cases and discuss which victims to visit. Traditionally, police make an arrest and then move on to the next case. For this program, they have all gone through special training to help victims, and have learned to be conscious of their body language. "There's no manual for this," Faulise said. "We kind of invent it as we go."
     On a recent frigid night, the two officers and Spotten rapped on the Brands' door and were welcomed into her small, tidy apartment smelling of scented Christmas candles. Dawn Brand invited the three to sit around her kitchen table, a lit candle in the center. They high-fived Colby and sat down to chat with his mother. "It's been very quiet since the last time he was arrested," Brand said warily of her former boyfriend, who has been arrested three times. Faulise told Brand that they would continue to visit her, through his court cases, and through her visits to the women's center. "You guys are a big help, especially not having family here," she said.
     Initially, Brand was not a big fan of the police department. She was arrested in one of the incidents. But after working with the domestic violence patrol team, her case was dropped and now she likes having the police to stop by. "It feels good to have support," she said. "You have backup."
     Support was just what Lou Anne Rennie needed after her husband, Jared Rennie, beat her last month, not long after he was charged with murder in the bludgeoning death of a Norwich man. Jared Rennie had been released after posting bail on the murder charge at the time of the assault. "Today was my first day at the women's center," Rennie told the team after they stopped by for a visit last week. "I came to the realization that throughout all the time it was happening, I brushed it under the rug. Now I'm not bouncing back and I need help." She has had all the locks changed, and even though her husband, whom she is divorcing, was jailed after beating her, she is still afraid. "I haven't been able to shake it," she told the officers. "It's real tough." She knows that she and her two children will need counseling after the assault. Her son heard her screaming for help during the attack. "We're going to keep coming back," Faulise told her. "We're going to be there for you."