Noteworthy News Articles on Mental Health Topics, December 28-31, 2005

Depression Device Said to Gain Acceptance
Associated Press, 12/28/2005

HOUSTON -- A tiny implantable device that aims to treat depression patients has started gaining some acceptance months after the federal government approved its use, the manufacturer said. The Vagus Nerve Stimulator delivers mild electrical pulses every 5 minutes to the vagus nerve, which carries information to parts of the brain that control mood, sleep and other functions.
      An increasing number of psychiatrists and surgeons were receiving training to use the stimulator devised by Houston-based Cyberonics. More than 2,000 psychiatrists and 250 surgeons were trained for the therapy during the quarter that ended Oct. 28, said chief executive and president Robert ''Skip'' Cummins. ''I think it has started out a bit slowly. But the average psychiatrist, I think, is excited to have something that is a new possible treatment,'' said Dr. Thomas Schwartz, assistant professor of psychiatry at SUNY Upstate Medical University in Syracuse, N.Y, one of 20 sites that participated in study of the device.
     More insurance companies were agreeing to reimburse patients for the cost of the device. By early December, 62 insurance providers had agreed to pay for costs associated with the therapy. The U.S. Food and Drug Administration approved the Vagus Nerve Stimulator in July to treat severely depressed adults who haven't responded to at least four treatment regimens. Those are signs that Cyberonics' device is making inroads. But it could take at least two years before the medical community and insurance companies accept Cyberonics' device, said Thom Gunderson, an analyst with Piper Jaffray in Minneapolis.
     Insurance companies have agreed to reimburse patients who use the device only a case-by-case basis and haven't included coverage for the therapy into their policies. And some psychiatrists continue questioning whether the device is effective. ''I'm just really skeptical,'' said Dr. Christopher Merkl, a Houston psychiatrist who has received marketing material from Cyberonics. ''I haven't been impressed with the literature on this.''
     Cyberonics lost $22 million on revenue of $29 million for the quarter that ended Oct. 28. Costs associated with launching the device accounted for some of the loss, Cummins said.



For Some, Kicking Meth Habit Pays
Charles Ornstein, Chicago Tribune- 12/28/2005

SAN FRANCISCO -- For more than two decades, Robert Bowers stole money, jewelry, identities, even silverware, to feed his methamphetamine addiction. He landed in prison, rehab and Skid Row hotels. That was until earlier this year, when the government paid Bowers to quit. A little-heralded program run by San Francisco's Public Health Department over the last year has given meth users rewards worth as much as $40 per week to stay off drugs. And, in a break from traditional approaches, participants receive no counseling or lectures, even if they test positive for meth use.
      Their end of the bargain is simple: Show up at a clinic three times a week, urinate in a cup and collect their reward--a voucher--if they test drug-free. "Here I am getting clean, I feel better and I'm getting something for it," said Bowers, 42, who says he hasn't used meth since early February and has put more than 45 pounds on his formerly 128-pound frame. "That means something."
     Although just a pilot program, the San Francisco venture is the latest in a string of experiments and studies over the years to point in the same intriguing, if controversial, direction: Addicts respond remarkably well to material rewards, even little ones. "You're using the exact same technique that parents use with their children every day," said Nancy Petry, a researcher at the University of Connecticut School of Medicine. "It's behavior modification and behavior shaping."
     The findings could be especially significant in California, where methamphetamine use is surging. It has surpassed alcohol and heroin as the drug of choice among people seeking treatment. The drug increases arousal and reduces inhibitions, sometimes leading to violence, child neglect and serious health problems such as malnutrition and heart failure among chronic users.
     In essence, the voucher approach replaces one reward with another--the high of drugs such as meth with the mental boost of grocery money, a gift certificate or a rent subsidy. Given the power of addiction, as shown by many addicts' desperate and self-destructive acts, the trade-off might seem insufficient. But for some reason, researchers say, it works.
     Since November 2004, 159 participants have enrolled in the 12-week San Francisco program. So far, about 38 percent of those eligible have completed their stint. Although the success of drug programs is hard to gauge and not systematically tracked, experts said the San Francisco program's numbers are comparable to or better than those of other publicly funded outpatient treatment options.
     What makes the program most noteworthy is that it is simpler than conventional treatment--less time-consuming and substantially less costly, proponents say. Because there are waiting lists for drug rehabilitation in many parts of the country, including San Francisco, such programs also broaden options for treatment. The benefits go beyond stemming drug addiction, extending to prevention of sexually transmitted diseases, said Dr. Jeffrey Klausner, San Francisco's director of STD control. Research shows that meth is associated with risky sexual behavior.
     Earlier this year, UCLA researchers published one of the first studies to challenge the idea that vouchers had to be paired with another treatment to work. Over 16 weeks, meth users who received vouchers tested negative for drug use 83 percent of the time, compared with 75 percent for those receiving therapy alone. "Clearly, it wasn't the money," said Steven Shoptaw, a UCLA researcher. "It was the fact that somebody recognized them."

 

Hormone Under Study May Help Shyness
Carey Goldberg, Boston Globe- 12/28/2005

Imagine yourself cuddled up in a warm embrace, protected, beloved, at peace with the world. Now imagine you could put that feeling in a bottle of nasal spray and sniff it when, say, you had to give a speech or go to a party full of strangers. ''It could be like social Viagra," said Andreas Meyer-Lindenberg, an investigator at the National Institute of Mental Health. He was talking about oxytocin, a hormone long known for its effects in the human body; it helps spur labor contractions, breastfeeding, and orgasm. It has also long figured in research on bonding in animals, including landmark findings that it encourages monogamy and parental love in rodents.
      Researchers now report that they can boost oxytocin in the human brain using a nasal spray. And when they do, trust seems to rise and social fear seems to abate, raising the possibility that oxytocin-based drugs might eventually help people with mental illnesses that involve exaggerated fear of others, from crippling shyness to autism and schizophrenia.
     This month, Meyer-Lindenberg and others reported in The Journal of Neuroscience that when young men snorted oxytocin -- allowing it to cross the blood-brain barrier -- brain scans showed that fear centers became less responsive to threatening faces. And this summer, the journal Nature published research showing that when subjects played a game that hinged on trust, those who had snorted oxytocin were much likelier to trust other players than those who had not.
     The two studies fit nicely together and with other recent research, said Thomas Insel, director of the National Institute of Mental Health and one of the pioneers in research on oxytocin and rodent bonding. For example, he said, brain scans suggest that the fear centers in the brains of autistic people are hypersensitive in social situations, so perhaps oxytocin could help quiet them. ''I think one take-home from this is that it would be worth a try," he said.
     Oxytocin research has been reaching the kind of critical mass that all but guarantees that pharmaceutical companies will be seeking to develop oxytocin-based drugs, said Robert Ring, a neuroscientist and oxytocin researcher at Wyeth Pharmaceuticals in Princeton, N.J. Ring reported at last month's Society for Neuroscience conference that oxytocin or a similar molecule reduced anxiety in mice subjected to a variety of stressful situations, such as standing on an open, elevated platform. ''These results suggest that the development of oxytocin-like drugs may offer a novel way to treat anxiety disorders in humans," he said. Oxytocin ''has been shown to reduce anxiety, to increase pain thresholds, and to lower levels of stress hormones. It is truly one of the body's most amazing molecules." He declined to say whether Wyeth was developing an oxytocin-like drug but noted that oxytocin in the form used in the recent experiments was far from ideal: People tend to prefer a pill to a spray, and the effects of the spray are short-lived. On the other hand, he said, most panic attacks and phobias involve acute situations, so a quick, short-acting substance may be useful.
     The synthetic oxytocin used in the experiments has been around so long that it is available as a generic drug. It is no longer sold in the United States, though European women still use it to boost breastfeeding, said Paul Zak, one of the authors of the trust paper in Nature.
     The dose needed to produce effects on trust was large -- subjects took about three teaspoonsful up their noses. But it appears to be quite safe, said Zak, who is director of the center for Neuroeconomic Studies at Claremont Graduate University in California. The biggest side effect is that perhaps 20 percent of the men who take it get erections, he said, and, of course, pregnant women would want to avoid it because it could trigger contractions.
     Zak agreed that oxytocin seems to hold promise for psychiatric patients but argued that it might be best to harness the brain's own oxytocin -- through methods like petting animals -- or to use an oxytocin-like drug in conjunction with therapy to retrain a patient's oxytocin responses. It may not be wise to raise base-line oxytocin levels, he said, because it might make a person too gullible and a ''target for predation."
     On that score, a body spray on the market called ''Liquid Trust," is advertised as containing oxytocin that will induce unconscious trust in all who encounter you. But Zak said it's ''totally bogus," because sniffing oxytocin from someone's shirt collar will not get enough of the hormone to the brain. It's also available without a prescription -- unlike the real stuff -- he said, and overpriced: ''Liquid Trust" costs $49.95 for a two-month supply, while Zak and his colleagues made their inhalers for about $5 each.
     The new work on oxytocin is spurring other warnings. Some researchers note that it may have potential as a date-rape drug, since oxytocin is involved both in trust and in sexual arousal. In Nature, the prominent neuroscientist and author Antonio Damasio spun an imaginary scenario in which politicians sprayed the crowds at political rallies with oxytocin to inspire trust. But he countered that current methods in marketing and political persuasion probably already manipulate natural oxytocin levels anyway.
     For now, researchers are much more interested in the potential good that oxytocin can do. Some speculate that oxytocin might be able to help new mothers who have trouble bonding with their babies or orphans whose psychic scars from neglect make it hard for them to love adoptive parents.
     Markus Heinrichs, one of Zak's Swiss collaborators on the Nature letter, is already testing oxytocin on patients with social phobias, including one study that combines the hormone spray with cognitive behavioral therapy. Results should be in next spring, he said in an e-mail from the University of Zurich. Meyer-Lindenberg said that he and others were preparing to try oxytocin on autistic people. ''We've never had even an inkling of a drug that might be able to treat a core symptom of autism," he said, ''so there's at least a hope that might be possible."



About 1 in 10 US Teens Face Major Depression
Susan Heavey, Reuters- 12/29/2005

WASHINGTON -- Nearly one in 10 American teenagers experienced major depression last year and fewer than half were treated, according to government statistics released on Thursday that doctors say confirm the problem is still overlooked among young people. Overall, 9 percent of teenagers, or 2.2 million, were depressed, with older teens more at risk than their younger peers, said the Substance Abuse and Mental Health Services Administration, or SAMHSA. About 12 percent of youths aged 16 or 17 faced severe depression in 2004, compared with about 5 percent of those 12 or 13 years old. Among those aged 14 or 15, 9 percent experienced a major episode. "These new data serve as a wake-up call to parents. Mental health is a critical part of the overall health and well-being of their children," said SAMHSA Administrator Charles Curie.
      Major depression was considered a period of at least two weeks that included a loss of interest, depressed mood and at least four other symptoms such as a change in sleeping, eating or concentration. Doctors said the findings showed more needed to be done to help teenagers early on, but were not surprising. "The real tragedy, as the report notes, is that there are still so many young people who aren't receiving the appropriate and effective treatment they need and deserve," Dr. David Fassler, a psychiatry professor at the University of Vermont, said in an e-mail to Reuters.
     Dr. Bennett Leventhal, a professor of child and adolescent psychology at the University of Illinois in Chicago, said the number of depressed teens had hovered at about 10 percent for 15 to 20 years. "Despite the fact that it's common and has a huge impact on children and their lives, we're not addressing this very serious illness," he told Reuters. Adding to treatment difficulties, said Leventhal, were a limited number of specialized caregivers, insurance issues and difficulty among parents and teachers in noticing the symptoms.
     Treatment for depression among teenagers became a controversial issue when a U.S. Food and Drug Administration scientist concluded in early 2004 that anti-depressants posed a suicide risk in youth. Another university-sponsored study showed a similar link. The FDA has since required drug manufacturers to disclose the possible risk on labels for anti-depressants. Some experts, including doctors, worried the warning would lead to fewer youths receiving treatment.
     Thursday's findings, part of the agency's annual National Survey on Drug Use and Health, also showed very depressed adolescents aged 12 to 17 were twice as likely to engage in substance abuse than those who were not depressed. About 28 percent of depressed teens used alcohol, while nearly 23 percent smoked cigarettes and about 21 percent used drugs. Among those who did not report a major episode, about 17 percent drank alcohol, about 11 percent smoked, and about 10 percent used drugs. The report surveyed 70,000 people in the United States aged 12 and older.

For 3 Sons, It Was the Only Way: Turning Father In for Bank Robbery
Monica Davey, New York Times- 12/29/2005

CHICAGO -- The three brothers quickly gathered in their small town's empty fire station to compare notes on the photographs they had happened across on the Internet. In horror, the three agreed that the older man in the dust mask, dark glasses and golf shirt in the surveillance photos of a string of bank robberies across downstate Illinois looked an awful lot like their father, William A. Ginglen, a former marine, once president of the local junior chamber of commerce, a member of both the Moose and Elks lodges, even an auxiliary town police officer. In case there was any lingering hope of doubt, the gun perched on the bank counter in one picture was a nickel-plated .45, a cherished gift one of the brothers, Garrett Ginglen, had presented to his dad a few years back; another image revealed the waiting getaway car: the Ginglen family's black Mercury Cougar.
      So, the three brothers walked out of the fire station, feeling as though "the whole world was spinning," and did the only thing they felt they could. They turned in their own father, who will be sentenced on Thursday to what is nearly certain to amount to a life sentence in prison for the 64-year-old. "There was never a question among us about what to do," said Garrett Ginglen, 41, who said he had nonetheless vomited into a waste paper basket when he first glimpsed the surveillance photos. "In a way, he's responsible for his own capture," said Clay Ginglen, 36, another of the brothers. "He actually raised us to do exactly what we did."
     Growing up in Lewistown, 200 miles southwest of Chicago, the three boys - Garrett, Clay and Jared - looked up to their father the way many in the town of 2,500 people did, two of the brothers recalled in telephone interviews this week. For years, William Ginglen was known as a respected neighbor, his lawyer, Ron Hamm, said, working as an industrial engineer and supervisor at companies like International Harvester, attending the Illinois Street Christian Church since age 5, and serving on a neighboring community's volunteer fire department, its village board, and as chairman of Lewistown's zoning board of appeals. His moral compass was uncomplicated, his sons said: "What's right's right and what's wrong's wrong." He told them once that if they ever messed up, they had better hope the law got there before he did. "I wanted to be just like him," Garrett Ginglen said.
     But in recent years, William Ginglen, by then a husband of more than four decades and a grandfather, fell on hard times. He changed jobs and struggled to find steady work that suited his background. He said he had gotten a job collecting receipts for video poker along a route around downstate Illinois. Money seemed tight at home, but his sons said they noticed few other signs of turmoil. At about the same time, in late 2003 and 2004, local sheriffs began reporting a puzzling rash of bank robberies in some unlikely places - relatively safe little Illinois towns like DeLand, Tallula, Versailles and Kenney.
     The nearly unprecedented wave set off worry among the region's small banks. They created new rules and installed new security systems, but the crimes continued. Then on July 12, 2004, the robber hit his seventh spot - the Bank of Kenney - for a second time, said Sheriff Roger Massey of DeWitt County, and new camera equipment netted clear images of the robber. Sheriff Massey, whose office had no crime-fighting Web site at the time, rushed to get an Internet site built just for the new bank robber images. A few days after the pictures were posted, Sheriff Massey said, the Ginglen brothers -- a music teacher, a police officer and a company's project manager on safety issues - happened upon the images.
     After the brothers' meeting at the Lewistown firehouse (where two of them are volunteers), they went to their father's house to confront him. He was not home, but they saw the very clothes the bank robber had worn in the pictures, they said, and called the authorities immediately. Also found in the house were the elder Mr. Ginglen's lengthy, meticulously kept writings. Sheriff Massey described the works, typed into a computer, as a diary of Mr. Ginglen's day-by-day descent into adultery with a girlfriend who lived in Champaign, into drug use and drug parties, into gruesome financial strain and, ultimately, into bank robbery. "It turned out that he was leading a secret life, a double life," Sheriff Massey said. "The bizarre part was that he wrote it all down. He was the most documented person I've ever seen. If he spent $5.98 on lunch, he wrote it down. And every time he bought cocaine or had sex, he documented it all."
     Mr. Ginglen, who was arrested on Aug 20, 2004, the day after his sons called the authorities, has since pleaded guilty to armed robbery and firearms charges, accused of netting more than $50,000. Efforts to reach him by telephone in the Christian County Jail failed this week, but he faces at least 32 years in prison when he is sentenced on Thursday in Springfield. "I can only say that this is conduct that is something that one would never expect based on his character and history and background," Mr. Hamm, his lawyer, said. Mr. Hamm said he intends to appeal the case based on questions about the government's use of evidence, including the writings, which Mr. Ginglen earlier told The Chicago Tribune were merely a "fictionalized" outline for a book he was working on. Gina Burton, who works in Mr. Hamm's office, said Mr. Ginglen was still working on a book from jail. He has sent her pages of handwritten notes to type up on her computer, she said. The latest chapter, she said, was called, "Turning Your Father In."
     For now, relations between the father and his sons remain chilly. "I wouldn't say he's angry with his sons," Mr. Hamm said. "He raised them to be law abiding." Garrett Ginglen said he has not spoken to his father since he was arrested. "The thing is, we turned him in for robbing banks," he said, "but then we saw his journal. I'm really mad for what he did to my mother." "I really miss the guy that was my dad," he went on. "I'm not sure about this bank robber guy." Clay Ginglen, meanwhile, has spoken to his father on the telephone four or five times. The quick talks have touched on grandchildren and work, he said, nothing more. He is busy on Thursday, he said, and will not attend his father's sentencing.
     Rarely does the tug between doing the right thing and sparing a loved one carry such weighty consequences, but Clay Ginglen said he and his brothers have reluctantly agreed to speak publicly about what they did in case anyone else faces such an ugly choice. "We don't regret this at all," he said. "We would do the same thing again."



A Fatal Lapse for Victim of Torment
Paul Pringle & Hector Becerra, Los Angeles Times- 12/30/2005

Before it killed him, the beating that Chadwick Shane Cochran suffered in a Los Angeles jail may have brought back terrifying memories. The attack last month was not the first time the system failed to protect the mentally ill man while he was in custody, according to a civil rights lawsuit. Four years ago, the suit alleged, Georgia prison guards choked and karate-chopped Cochran after he was pulled from a class for mentally ill inmates and vomited on an officer's shoe.
     In the suit, the Southern Center for Human Rights accused prison officials of abusing and failing to protect Cochran and several other mentally ill prisoners. The center dropped the suit in January after the prison changed a number of its practices without admitting wrongdoing. By then, however, Cochran had left Georgia and returned to a life of drug abuse and petty crime, as he struggled with depression and paranoia. He was making frequent trips to state hospitals, but the treatment never seemed to help, his relatives say. "I loved him so much, and it's so wrong he had to be killed that way!" Cochran's mother, JoAnn Moye, wailed as she sat on the living room floor of her Macon, Ga., home, gazing at photos of her son. "It just hurts me so to know he was beat like that!"
     In the weeks since his death, Moye and others who loved Cochran have looked back, trying to make sense of how this tormented but sweet man, an amateur rock drummer raised by a strict Baptist minister, could wind up dead so far away and in such brutal circumstances. They say Cochran had never been a threat to anyone, only to himself, and he was often afraid.
     In the end, it was his paranoia, possibly triggered by a methamphetamine binge, that landed him at Men's Central Jail in Los Angeles, where he was killed. A woman who had befriended him had lent him a gun — to make him feel safer. When sheriff's deputies came to his home after a report that he was behaving strangely and carrying a gun, they took him in. Three weeks later, two inmates, apparently in the mistaken belief that Cochran was an informant, pummeled and stomped him for up to 30 minutes, sheriff's officials say. The inmates have been charged with murder and torture.
     Sheriff Lee Baca said later that Cochran, 35, had been moved from the cellblock for mentally ill inmates into the general population after he told medical evaluators that he had mental problems, but "not to the level where he couldn't function," and he was not on medication. An investigation is continuing. The killing was the eighth in the jail in two years. "This is a guy who would have had a shot if he were taken care of in the mental health system rather than get caught up in the criminal justice system," said Lisa Kung, director of the Southern Center for Human Rights.

Early Signs of Trouble
Those who knew him best say Cochran's problems started in childhood, when he showed symptoms of attention deficit disorder and perhaps deeper troubles. Even as a preschooler, his parents say, Shane seemed bothered by something they couldn't understand. He would awake in the middle of the night and walk quietly into their room. "He would just stand there and say, 'I'm scared, I'm just scared,' " said his father, Michael Cochran, who has filed a wrongful-death lawsuit against Baca and Los Angeles County. The dead man's young daughter is also a plaintiff in the suit.
     Cochran rebelled early against his domineering father, whose ministry took the family around the South and Midwest. Michael Cochran didn't allow his children to listen to pop music, go to movie theaters, attend dances, or patronize restaurants and stores that sold alcohol. But Michael Lance Cochran, Shane's older brother, said the two of them sneaked around to watch music videos and wrestling broadcasts. He said he preferred to think of Shane not as mentally ill, but rather "mentally hurt." "We've been depressed our whole lives," he said. "He was a good guy with a good heart."
     Shane's father said his son "didn't want to be under my authority." So he punished him. "I paddled his butt, yes I did, and it was black and blue," he said. Moye contends that, on one occasion, she saw her husband tie the boy's hands to a basement pipe and strike him with a board, yelling "demons out!" in an exorcism of sorts. The father, who has since left the ministry, denies that he tied his son or staged an exorcism. He said that he gave him only a harsh spanking. "I wish I had never done it," he said, adding that he had apologized to his son years later and that Shane had apologized for his drug use and crimes.
     Both he and Moye said they sought help for their young son. When he was about 12, they took him to a psychologist, until Shane refused to cooperate, his father said. He was placed in a Christian wilderness school, then a foster home at age 14. Cochran's foster mother, Barbara Lookenott of Mansfield, Ohio, remembers him well. His five-month stay with Lookenott and her husband, Randy, was a "cooling-off period" for the boy and his parents, she said. "He didn't want to mind you," Lookenott said. She recalled once taking him to the hospital after he broke his arm playing football. As soon as he was back in her car, he ripped the cast off, she said. "That's the kind of kid he was," she said.
     But he was also an endearing, good-looking boy who loved to jump from bed to bed in the furniture store where her husband worked, and who smothered everything he ate in ketchup, Lookenott said. She recalled that he had the habit of drinking cough syrup, lots of it. He would insist he needed it for a cold, and his parents would oblige him during their visits, she said. In hindsight, Lookenott said, she wonders if the cough syrup was the boy's first attempt to ease his inner pain with a drug. Cochran's parents said they don't recall his taking the medication.

Good at Getting Caught
Shortly after he left the foster home, Cochran's own home broke apart. He lived mostly with his mother and her grandmother in Georgia after his parents' rancorous divorce. Moye said her son began using marijuana at 18 and later crack. He also started dabbling in small-time crime. He had learned to play drums and was arrested for stealing music equipment from a church. His main skill as an outlaw seemed to be getting caught. He earned his high school equivalency diploma at a boot camp for low-level offenders. In the meantime, he met the young woman who would become the mother of his daughter, Skyler. They were together for several years but never married.
     Those years were not without upheaval. Cochran repeatedly checked himself into hospitals, his mother said. "Maybe 30 or 40 times," she said. And there were more detours to jail. Now and then, especially when incarcerated, he would take a razor or knife to his wrists, his parents said. "He couldn't stand to be confined," Moye said. Both parents said they took their son to drug treatment sessions. Michael Cochran said he bailed him out of jail numerous times, then adopted a tough-love approach and refused his pleas for money because it would be spent on drugs.
     Shane Cochran's relationship with Skyler's mother ended, and she married another man. Cochran's parents said he was rarely allowed to see his daughter. Once, in the company of Moye, he tried to force a visit, and got into an altercation with his ex-girlfriend's husband. Cochran and Moye were arrested. He had begun using crystal meth, Moye said, to kick a crack addiction.
     His crimes became more bizarre. A newspaper reported that he was arrested when police officers saw him walking down the street in shorts and sunglasses carrying some sort of religious text. The paper said he apparently had stolen the shorts, sunglasses and book from a home he burglarized. He also made himself a cheese sandwich in the house and took a shower.
     After another stint in a Georgia jail and more failed attempts at treatment, Cochran left Macon for Arizona. "He thought he could get to run from everything," Moye said. "He'd be down on his knees, praying, 'God, please help me! God, please help me! I don't want Satan to take my life!' " In June 2004, Moye put him on a bus to Las Vegas. It was the last time she saw him.

Good and Bad Sides
Later that summer, Cochran turned up in Phoenix, where he quickly ingratiated himself with people who saw his tender side, his awkward eagerness to please. They gave him work, places to stay and walking-around money. June Carter and her husband, Carl, were amused that he called himself a Southern "good ol' boy," and that he carried a photo of himself sitting in a 1969 Dodge Charger that had been painted to resemble the General Lee car from "The Dukes of Hazzard." And they were touched by his underlying loneliness. "He did need friends and people to talk to," said June Carter, who met him while he was painting a house next door. She and her husband took a liking to Cochran, treating him to dinner at Hometown Buffet and giving him clothes, toiletries and cigarettes. They tried, without success, to fix him up on dates.
     Others saw his less-agreeable side. Ray Grdn said he quickly spotted him for a "tweaker" — a crystal meth addict — after his brother hired Cochran to paint a house Grdn owned. Grdn called the Phoenix police after learning that Cochran was staying in a guest house on his property without permission. They arrested Cochran on suspicion of trespassing.
     Cochran's behavior became stranger and stranger. Charles Wright, who also hired him to paint his house, said Cochran would yell that there were people outside, people out to get him. After some of these spells, Wright said, Cochran would check into a hospital. It became too much for Wright, who ordered Cochran out of the house. "It's a scary world he was in," Wright said.

'I Told Him I Loved Him'
Cochran's parents continued to hear from their son during 2004 and 2005. Michael Cochran said he talked to him in August about his resolve to stay clean, and his hopes to be home for Christmas. "I told him I loved him," Michael Cochran said. Moye said she spoke to her son regularly, until a week before he ended up in Men's Central Jail. She said they had made plans for her to fly out to take him back to Macon on Nov. 3.
     He was staying with Gloria Rowe, who had encountered him outside a grocery store, standing in the rain. "Wringing wet, no jacket," said Rowe, 79. She put him up in a decrepit trailer behind her Covina Hills house, as she had with other down-and-out young men. "I love being around the young folks, seeing them have fun," she said. Rowe said she bought Cochran clothes and shoes and fed him. She learned later that he had been stealing her tools and other property to sell on the street, presumably to buy meth. Rowe found syringes in the trailer after he had left. She said that explained why he had been so jumpy, unable to sit still. "And he was always, always scared," she said. Rowe gave him a revolver for protection.
     On a Sunday morning in October, 10 days after he moved onto the property, he told Rowe's neighbor, Yolanda Nickoley, that someone had broken into the trailer. He then spotted a drum set near her garage and brightened, his fear lifting, Nickoley said. The drums belonged to her 17-year-old son, Travis King, and Cochran said he would like to come by and jam with him. Sometime after midnight, Travis heard banging on the walls and knocking on the front door. He went downstairs and found a bedraggled Cochran standing at the doorway. Cochran had Rowe's gun in his hand, and he pleaded with the teenager to come out and help him, because somebody was after him, Travis said. To reassure him, Travis said, Cochran tossed the gun into some bushes. When Travis stepped outside, Cochran hugged him. Travis asked Cochran what he was high on, and Cochran told him speed, the teenager recalled.
     The two chatted for three hours about rock 'n' roll, and Travis started playing the guitar, with the volume turned down. Cochran began to sing, and they toyed with some lyrics. At one point, Travis said, Cochran looked through him and exclaimed, "Shut up, shut up, Bill! See, he thinks it sounds cool!" There was no one there. "He was like, 'The demons are out because I'm in a weakened state,' " King said. He said he had to encourage Cochran to leave and went back to bed, but then heard more banging outside. It was Cochran again. He pulled the gun from the bushes, pointed it at him with a smile and yelled, "Ha!" Travis said. The teenager was not afraid, but insisted that Cochran give him the gun, Travis said. Cochran did so reluctantly, expressing fear of his unseen foes.
     Travis' parents came out to investigate and ordered Cochran to leave. When their son told them about the gun, they called sheriff's deputies. Within hours, Cochran was arrested on charges of being a felon in possession of a firearm and taken to jail for what turned out to be the final time.

Gut-Wrenching News
Shane's younger brother Adam Cochran got a vague phone message while he was driving in Florida with his wife and her father. He used his cellphone to call the number on the voicemail. The number rang to the Los Angeles County coroner's office. Adam knew instantly that it was about his brother. "I pulled over and threw up," he said. Back in Macon, Moye had to be hospitalized after getting the news. "I just went nuts," she said.
     No sheriff's deputy was present to stop the assault on Cochran at Men's Central Jail, but a Macon deputy did attend his funeral in Georgia — to keep the peace between the parents, who were driven even further apart by Shane's death. At the close of the ceremony, Moye hyperventilated and an ambulance came. She was given oxygen after she was escorted away from Cochran's coffin, which remained closed because of the damage to his face. "I won't see him until I die, and I really want to see him," she said about a week later, sobbing over the photos and a Bible in which her son had inscribed a tribute to her a year and a half ago.
     Her face glistening with tears, she pulled out a poem Shane had written:
It's never easy looking forward through the rain
Traveling backwards with my friend called pain
Torn and tattered from this road called life
Scarred by memories that cut like a knife.



Hinckley Can Leave D.C. Area for First Time
Karlyn Barker & Susan Levine, Washington Post- 11/30/2005

A federal judge yesterday granted presidential assailant John W. Hinckley Jr.'s request to leave a psychiatric hospital in the District to make several overnight visits to his parents at their home near Williamsburg. The visits will be the most freedom Hinckley has had since his arrest in 1981 for shooting President Ronald Reagan, press secretary James S. Brady, and two law enforcement officers. He has been held at St. Elizabeths Hospital in Southeast Washington since 1982, when he was found not guilty by reason of insanity.
      Hinckley, 50, will be allowed to make three three-night visits to his parents' house in a gated luxury community. After a hospital assessment of the outings, Hinckley would be permitted four more visits of four nights each. The trips are the latest steps that Hinckley's attorneys hope will lead to his outright release from the mental hospital. "This is wonderful news," said Barry Wm. Levine, the Hinckleys' attorney. "John is going home. His fate is in his own hands."
     U.S. District Judge Paul L. Friedman set numerous restrictions on what he called Hinckley's "limited conditional release." The hospital must submit a detailed itinerary at least two weeks ahead of the visits, and the government will be alerted to the plans. The Secret Service will continue to monitor Hinckley, as it has in recent years when he left the hospital. "He is not permitted to leave one or both parents' supervision at any time during the course of the conditional release" except when the hospital allows him short trips in the community, Friedman ruled. The time spent away from his parents' supervision will be limited to 90 minutes.
     Hinckley's parents, John and Jo Ann, are to call the hospital at least once a day during the visits and immediately alert authorities to any problems. Hinckley must return to St. Elizabeths, the judge ordered, "if there are any signs of decompensation or deterioration" in his mental condition "no matter how slight." His parents must provide the hospital with written feedback after every stay. Hinckley must meet with a psychiatrist in the Williamsburg area at least once a visit. His treatment team at St. Elizabeths must interview him and his parents after each outing and provide a report to the court.
     Hinckley has been winning more privileges in recent years, building on what doctors have characterized as a successful series of outings. With hospital supervision, he has taken more than 200 day trips to bowling alleys, shopping centers and other local places. He also joined his family in the past two years on more than a dozen unsupervised excursions in the Washington area, including at least eight overnight visits. This is the first time he will be permitted to travel outside the region.
     In an extensive opinion, Friedman cited testimony from doctors, who agreed at a hearing in September that Hinckley was ready for the visits. The doctors noted that Hinckley's mental illnesses -- a psychotic disorder and major depression -- have been in full remission for at least 11 years. He takes the drug Risperdal daily to prevent a relapse of his psychotic disorder.
     Even though Hinckley's doctors agreed that he has responded well to the loosening of his restrictions, prosecutors have been wary, saying at court hearings that Hinckley has masked symptoms in the past and that he could pose a danger. The federal government had opposed Hinckley's requests to visit Williamsburg, a three-hour drive from Washington. Justice Department attorneys repeatedly raised concerns about whether he is capable of having normal relations with women. Hinckley has told his doctors that he wants more freedom so he can meet women and maybe find a wife.
      It was Hinckley's "delusional" obsession with actress Jodie Foster that led him to try to assassinate Reagan. In addition to Reagan and Brady, the gunfire March 30, 1981, wounded D.C. police officer Thomas K. Delahanty and Secret Service agent Timothy McCarthy. A year ago, the judge declined to loosen restrictions on Hinckley, saying he had questions about his relationship with Leslie deVeau, a former mental patient who was Hinckley's girlfriend for much of the past two decades. Hinckley has since broken up with her, but prosecutors have questioned Hinckley's interactions with other women, especially hospital staff, saying he appears to misread their intentions.
     Friedman's ruling yesterday stopped short of giving Hinckley broader freedoms envisioned by his defense team and the hospital. Hinckley's attorneys had hoped for longer visits, up to seven nights, outside the area. The hospital had suggested Hinckley could embark on other activities during the extended stays with his family, such as seeking a driver's license, looking for employment or getting vocational training, but Friedman said that was premature. The judge said Hinckley was ready, however, to walk unescorted around his parents' neighborhood for stretches of up to 90 minutes. And he said gardening, shopping and cooking could be suitable activities during the stays.
     Levine said the family didn't oppose the court's "excess of caution" but hoped the initial visit could be planned immediately and take place quickly. "It's all about acclimating to life outside of a structured environment," he said. Channing Phillips of the U.S. attorney's office said, "We will need time to review and digest the opinion before deciding what steps to take, if any."

 

Internet Creates New Group of Sexual Addicts
Marianne Szegedy-Maszak, Los Angeles Times- 12/30/2005

For many people, a peek at an "adult" site offers merely a titillating glimpse into an illicit world. For others, a peek becomes a moment of respite, a brief vacation from the demands of the real world. Then it becomes a habit. Soon, it is a compulsion that occupies hours and hours every day, shattering careers, marriages and lives. The addictive nature of cruising the Internet and the obsessive allure of pornography combine to take over their existence. And although many who become addicted have had a history of acting out sexually with prostitutes, phone sex or pornographic magazines and movies, others are pulled in from outside such an orbit.
     The Internet, more than any other type of mass medium, seems to be creating a new group of people engaged in compulsive sexual behavior, say psychologists and clinicians. The accessibility, anonymity and affordability — what one researcher calls the "triple A engine" — are reeling in people who would otherwise have never engaged in such behavior.
     "I tried to figure out why it was that these images, or why it was that seeing this act, was so powerful, and I haven't been able to," says Phil, a married 28-year-old in Washington state. Like others interviewed for this story, he agreed only to the use of his first name. "But the obsession just ruled, and once I got into that world, it just took over." Phil's story — with infinite variations but the same grisly narrative — is repeated by many whose lives are consumed by cyber porn. Whether gay or straight, married or single, those interviewed describe the intense feelings of guilt and excitement when entering this intoxicating universe, far away from the less thrilling one in which they live.
     "As cyber sex has become more and more of a problem, what has shifted for me is the realization that many people who were into cyber sex didn't fit the classic profile of sex addicts," says Patrick Carnes, author of "In the Shadows of the Net: Breaking Free of Compulsive Online Sexual Behavior." He has spent 30 years studying and establishing sex addiction as a field of psychological dysfunction. "For most people this is not an issue," says John Bancroft, the former director of the Kinsey Institute for Research in Sex, Gender and Reproduction. "But others have always had a problem keeping any kind of sexual stimuli under control and they have never had opportunities to go over the top as they do now."
     Sex addiction is not recognized as a legitimate psychiatric disorder. But psychologists, psychiatrists and other clinicians are reporting increasing numbers of cases in which men — and researchers estimate that about 72% of visitors to pornographic sites are men — are showing all the signs of having an addictive disorder. They spend hours a day cruising the Net for explicit sexual sites. They become utterly dependent on the stimulus, making normal life — especially intimate life — no longer possible. When the material isn't there, they become obsessively preoccupied with it. And they ultimately crave even more time on the Web with even more graphic, lurid or outrageous stimuli.
     It's the Internet's potential for escalation that has created such an increase in compulsive sexual behavior, says Rob Weiss, clinical director of the Sexual Recovery Institute in Los Angeles, an outpatient treatment center for people with sexual behavior problems. In the past, someone could buy videos or magazines, each with a clear beginning, middle and end. "But now you can sit in the den and it never ends," he says. "There is a much better opportunity for someone with addictive tendencies to just get lost."
     Some people who are lured into this world begin to act out in their three-dimensional existence, visiting prostitutes, for example, or engaging in phone sex. But most do not. The Internet offers an endless variety of stimulation, but it also leads to what psychologists refer to as a "dissociated state." Staring at the screen, feeling increasingly stimulated, clicking the mouse, all become almost a form of hypnosis, a state impossible to sustain in the real world. Typically only a real crisis — a lost job, a confrontation by a spouse, police at the door because illegal pornography has been downloaded — can lead the addict to treatment. An assortment of 12-step programs have emerged to support recovery, and psychotherapists are reporting a surge in their practices of people seeking some way to rid themselves of this problem.

The strain of addiction
Night after night he sat at the computer, eyes scratchy with fatigue, back aching and tense, his right hand sometimes cramping from clicking the mouse from site to site to site. Phil considers himself a sex addict. When he was most out of control, he would wake up, kiss his wife goodbye, go to an adult bookstore and watch a movie while masturbating. Then, at work and when completing his undergraduate degree, he would check in at various Internet sites and try to recapture the images he saw in the film. Most evenings he would visit nearly 200 pornographic sites and masturbate two or three times. Some of the sites were chat rooms and he conversed with young women he fantasized were teenage girls and suspected were older men pretending they were teenage girls.
     He flirted with women, or girls, on the sites, looked at pictures, watched pornographic video streaming — and found that the novel variations of what could be considered a pretty basic act were seemingly endless. After all, more than 4.2 million websites and more than 372 million pages are devoted to pornography, according to the Internet security service Internet Filter Review. Even if he had maintained this rate of consumption, it would have taken him almost two and half years to see everything. But he could never see everything, because the pornographic universe, more rapaciously than Einstein's universe, is constantly expanding. Industry figures estimate that about 200 new sex-related sites are added each day. "You keep yourself in a state of arousal for anywhere from half an hour to two or three hours," Phil says. "It's degrading and humiliating and very, very frustrating and confusing. A lot of it is based on the need to escape and get away from everything."
      Those interviewed who are attempting to kick their Internet pornographic habit describe feelings of dissociation, and the way that the graphic sexual images on the Web intrude in their daily lives. Given the range of erotica they are exposed to, their own intimate lives pale in comparison, as partners, spouses and girlfriends recede in importance.
     If there is one psychological element that unites them, clinicians who work with these addicts say, it is a basic fear of real intimacy. And for many, the sexual and illicit charge they receive from cruising the Internet is a way to cope with depression or anxiety that rules the rest of their lives. Web porn becomes a kind of self-administered shock therapy. Among clinicians, they are seen as suffering from "problematic online sexual behavior." They range in age from pre-pubertal to geriatric.
     In one study of 9,265 general Internet users, about 6% scored in a way that suggested cyber sex compulsivity, while an additional 10% of the entire sample was considered "at risk." That research, conducted in 2000 by Al Cooper, a psychologist at Stanford University, was published in the journal Sexual Addiction and Compulsivity. Extrapolating from this research, experts estimate that Internet sex has taken over the lives of possibly 8.9 million people in this country. They do not fit any neat or coherent profile.
     In his early book on sex addiction, "Don't Call It Love: Recovery From Sexual Addiction," Carnes described sex addicts as people who shared a number of characteristics. Overwhelmingly, they had a history of emotional, physical or sexual abuse in their childhoods. They often had suicidal thoughts or feelings and strong feelings of loneliness, and most came from families where there was abuse of drugs or alcohol. Not so for the person addicted to cyber sex. Many are men, but women are increasingly showing up at 12-step programs, addicted less to graphic sex but much more to Internet "relationships" and Internet dating.

The brain's response
Masters and Johnson, the eminent duo of sex research, divided the human sexual response into four distinct phases: excitement, plateau, orgasm and resolution. Though these phases differ for each individual, it is generally understood that most people with both a healthy libido and a satisfying intimate relationship fully experience all of them. Perhaps not reliably, perhaps not all the time, but frequently enough to maintain a certain emotional and sexual equilibrium.
     These behavioral phases, neuroscientists have learned, are generated by an exquisite interplay between two competing systems in the brain: the excitatory system and the inhibitory system. Experts in the human sexual response, like former Kinsey Institute director John Bancroft, caution that at this point "we can only speculate and conceptualize how the brain functions in an inhibitory way." Nonetheless, when there is sexual dysfunction, when someone is uninterested in sex — called a sexual anorexic by some clinicians — or obsessively masturbating, it is safe to say that either the inhibitory system or the excitatory system is out of whack.
     The final ingredient in the inner workings of our sexual responses is what sex researchers call an arousal template. As individual as a fingerprint, an arousal template is, Carnes writes, "the total constellation of thoughts, images, behaviors, sounds, smells, sights fantasies and objects that arouse us sexually." The template can be as elaborate as an opera or as innocent as a particular perfume, but the images and feelings that it contains set in motion all the other elements of our sexual responses. But with the variety and intensity of images, the Internet can throw this arousal template and all that follows into chaos. "It can tap into an arousal template or fetish behavior that we don't even know we have," says David Delmonico, a professor of psychology at Duquesne University and co-director of Internet Behavior Consulting. The counseling group helps people who have problems controlling their use of the Internet, such as preteens addicted to instant messaging and adults unable to control cyber sex.
     On the Internet, fairly standard pornography can lead very quickly into the darker world of teenagers or even younger children. "A lot of guys will say that they didn't start with the teen stuff or the little kid stuff," Delmonico says. "But it became more and more enticing for reasons that they simply were unable to explain." Bondage sites and bestiality sites. Diapering sites and foot fetish sites. Young teens, hermaphrodites, dirty socks and excessively large organs. Anyone cruising the Internet can find more and more vehicles for arousal. "People build up a tolerance, it doesn't give them the same high that it did before," Carnes says. So the process from excitement to resolution is thwarted. They need more to get excited and, for those who are compulsively hooked on cyber sex, the gratification of resolution never occurs.
     Drew is nearly 40 years old, a married father who lives in Virginia. He is also a recovering sex addict who says he has been helped by Sexual Compulsives Anonymous. When he went online, he says, he was seeking escape from the tedium of daily life, from the depression that haunted him for as long as he could remember.
     In one of the few studies of sexual compulsivity, published in 2004 in the Journal of Sex Research, a small sample of 31 self-identified sex addicts received questionnaires and were interviewed, then compared with an age-matched control group. Although a symptom of depression for most people is decreased interest in sex, the study found that for a small number, including those who consider themselves sex addicts, their interest in sex increased with their depression. In another study, published in 2003 in the Archives of Sexual Behavior, 9.4% of those who saw themselves as sex addicts reported increased interest in sex when depressed and more than 20% were more interested in sex when they were anxious. In addition, 45% of the self-identified sex addicts described feeling dissociated from their activities, an experience that was often repeated anecdotally. The findings, though preliminary, have led some clinicians to augment their treatment of sexual compulsion with treatment for depression. And given the fact that one of the side effects of many antidepressants is decreased libido, some clinicians have found that antidepressant medication can also help.
     When the emotions overwhelmed Drew, he would click on an Internet icon on his desktop and seek out teenage girls. "When you are out there and in chat rooms or discussion boards and others are all discussing this as not a big deal, it lowers your resistance to it," he says. "So you are more open to doing other things."
     In fact, so desensitized have people become to explicit sexual images from the Internet, that many law enforcement officials or forensic psychologists specializing in sex offender programs have reported that the Internet has created a new dilemma in the field. Phallometric testing had long been a reliable way to measure arousal patterns among sex offenders by showing them erotic images of varying degrees. But the images no longer have the power to arouse because the offenders are so desensitized by the far more graphic and lurid images that are available on the Internet. "One of the most stunning clinical shifts I have seen is how quickly cyber sex exploration alters arousal," Carnes says.

Intimate disconnect
Like many behavioral addictions — eating disorders, gambling — cyber sex obsession does not occur in a vacuum. The partner or spouse of someone who is obsessed with Internet sex suffers immeasurable humiliation and anguish.
     Phil's wife was shattered by his fascination with the world of online pornography. Initially she thought that his enthrallment with pornography and Internet sex was simply the experimentation of a young and healthy man. But over the years she felt her own self-esteem shrivel as she realized that she could never compete with the Internet. "I always felt like I was some doll, acting out his fantasies but without any real connection between the two of us," she says.
     Weiss of L.A.'s Sexual Recovery Institute says that treatment for people who are sexual compulsives must also include treating an unhealthy relationship. "A healthy partner would say, 'I'm not sitting around here while you are doing that, I am outta here.' " But instead, many of these partners, in textbook versions of codependence, shield their children from their father's activities "by making sure they ring the bell when coming home, so daddy knows we are here and will stop masturbating in front of the computer," Weiss says.

Therapy and support
As Internet sex problems have increased, so have treatments. An alphabet soup of 12-step programs — Sex Addicts Anonymous, Codependents of Sex Addicts, Sexual Compulsives Anonymous — have sprung up to meet the exploding needs. Some preach complete abstinence unless in a married relationship, others chart areas of acceptable and unacceptable behavior.
     Clinicians have turned to cognitive behavior therapy, as well as drugs, because there is a long established link between aberrant sexual behavior and depression, anxiety and other emotional disorders. "We look at our clients who are sex addicts like it is an eating disorder," says Weiss. "Sexual recovery is not not having sex. It is about healthy sexuality and staying within those boundaries."
     Four years ago, Phil's wife threatened to leave if he did not get his behavior under control. She then took him to a meeting of Sexual Compulsives Anonymous. He looked around the room and heard stories that made him shudder, both because those who recited them seemed to be such losers, and because he recognized himself. They are now struggling to pull their lives back together as a couple, going to 12-step meetings of Codependents of Sex Addicts and Sexual Compulsives Anonymous. Phil cannot access the computer at home, and the television is locked and only his wife has the key. They go to meetings frequently and struggle to claim a normal intimate life. Phil has recently been diagnosed as suffering from bipolar disorder, and acknowledges having struggled with depression, like so many who act out sexually. Phil's marriage is the most powerful incentive to change that exists. " If I lose my wife, I won't have anything left to live for," he says, his voice thick with emotion. "My hope is just to make it through the day. Hour to hour. Minute to minute. It's 9 o'clock in the morning and I haven't acted out. There was a time when I would have acted three or four times already. So that gives me hope." Because of his wife, Phil is one of the very lucky ones. For those who lack such a sustaining or intimate connection, hope will forever compete with a click of a mouse.

Where to turn for support:
A number of resources and support groups are available for people who believe that they or their partners might be addicted to cyber sex. Although support groups and 12-step programs are the treatments of choice, there are fundamental differences between their basic philosophies. S-Anon and Sex Addicts Anonymous believe that the only way to recover is through sexual abstinence and an exclusive marital relationship. But these programs often do not feel manageable for people who are unmarried or gay. Other groups, such as Sexual Recovery and Sexual Compulsives Anonymous, contend that recovery needs to be structured by integrating normal and healthy sexual activity into daily life.

Here are some of the main support groups:
•  Codependents (or Co-Addicts) of Sex Addicts (COSA): http://www.cosa-recovery.org.•  ; Counseling Affiliates Sexual Addiction Treatment Program, including tests: http://www.sexaddictionhelp.com .
•  Recovering Couples Anonymous: http://www.recovering-couples.org .
•  S-Anon: (800) 210-8141, (615) 833-3152 or http://www.sanon.org .
•  Sex Addicts Anonymous: (800) 477-8191, (713) 869-4902 or http://www.sexaa.org .
•  Sex and Love Addicts Anonymous, for those who are also involved in compulsive emotional relationships online: http://www.slaafws.org .
•  Sexual addiction resources, by Patrick Carnes: http://www.sexhelp.com .
•  Sexual Compulsives Anonymous: (310) 859-5585 or http://www.sca-recovery.org .
•  Sexual Recovery Institute, Los Angeles: (310) 360-0130 or http://www.sexualrecovery.com .
•  Sexual Recovery Anonymous, www.sexualrecovery.org.

How to know if you need help:
A number of tests are available on the Web to determine if you have a problem with sex addiction or Internet sex addiction. A positive answer to one of these three basic questions suggests that someone has a sex addiction, according to the Society for the Advancement of Sexual Health:
•  Do I have a sense that I have lost control over my specific sexual behavior?
•  Am I experiencing significant consequences because of my specific out-of-control sexual behavior?
•  Do I feel like I am constantly thinking about my specific out-of-control sexual behavior, even when I don't want to?
Questions about Internet sex addiction can be found at http://www.sexhelp.com or http://www.sexaddictionhelp.com .
In his book, "In the Shadows of the Net," Patrick Carnes writes that a positive answer to any of the statements below could indicate a problem. Have you ever done any of the following:
•  Kept sexual activity on the Internet a secret from family members.
•  Carried out sexual activities on the Net at work.
•  Frequently found yourself erasing your computer history files in an effort to conceal your activity on the Net.
•  Felt ashamed at the thought that someone you love might discover your Internet use.
•  Found that your time on the Net takes away from or prevents you from doing other tasks and activities.
•  Found yourself in a kind of online trance or time warp during which the hours just slipped by.
•  Frequently visited chat rooms that are focused on sexual conversation.
•  Looked forward to your sexual activities on the Net and felt frustrated and anxious when you couldn't get on when you planned.
•  Found yourself masturbating while on the Net.
•  Had sexual chat room friends who became more important than the family and friends in your life.
•  Regularly visited porn sites.
•  Downloaded pornography from a newsgroup on more than one occasion.
•  Had favorite porn sites.
•  Visited fetish porn sites on more than one occasion.
•  Viewed child pornography online.
•  Taken part in the CUseeMe sexual video rooms.

 

Anti-Anxiety Drug to Help Stuttering Being Tested
Stephen Heuser, Boston Globe- 12/31/2005

A few years ago, doctors testing an experimental anxiety pill noticed something odd in a 26-year-old woman trying the drug: Her severe lifelong stutter was going away.

Soon after she stopped taking the pills, her stutter returned.

The drug, pagoclone, eventually failed as an anxiety medicine, but a Lexington company is trying to revive it as the first-ever medication aimed at helping people who stutter. In a test on 120 patients across the country, Indevus Pharmaceuticals Inc. hopes to show that the drug's effect on the woman was more than an intriguing surprise.

If the drug succeeds -- a process that would take years, even if the first test goes well -- it would mark a major shift in how stuttering is treated, and validate a growing amount of research suggesting medical causes for a disorder long seen as emotional.

''For years we thought [stuttering] was brought about by bad parenting, or that the individuals are too nervous," said Gerald Maguire, a psychiatrist and researcher into stuttering at the University of California at Irvine who is testing pagoclone on eight patients. ''But we're learning now, especially in the last 10 years, that there are specific brain regions that aren't functioning well in people who stutter."

Stuttering affects 3 million people in the United States, but has been slow to receive the serious medical attention given to brain disorders such as depression or schizophrenia. Speech therapy and devices designed to alleviate stuttering are rarely covered by health insurance. The disorder is even a staple of low comedy, from Porky Pig to former Howard Stern sidekick Stuttering John.

For severe victims, however, stuttering is a dramatic neurological interruption that blocks words with the abruptness of a CD player skipping. Some have so much trouble just articulating their names that their faces distort and their arms flail.

''Many people pick their jobs, or choose their careers, based on their perceived ability to communicate," said Michael Blomgren, a speech researcher at the University of Utah who also stutters. ''When I was young I dreamed of becoming a pilot, but the reality is pilots need to communicate in a split-second way with the control tower, and that just wasn't an option for me."

Like many people who stutter, Blomgren enrolled in intensive speech therapy and essentially re-learned how to talk.

Others use a device based on a technique called ''altered auditory feedback," which requires them to wear an expensive earpiece that replays their speech.

The idea of drug therapy for stuttering is relatively new. Although doctors don't understand why, certain psychiatric drugs seem to help alleviate stuttering. Maguire, the California researcher who himself stutters, has been taking an antipsychotic called Zyprexa since 1997. ''If I weren't on it, this conversation would be taking hours," he said.

But such drugs have serious limitations. Their side effects, including weight gain and sexual dysfunction, can be more debilitating than the original disorder. And their effect on stuttering has not been extensively tested.

Pagoclone, the experimental pill from Indevus, started its life in the 1990s as a potential psychiatric drug. It was licensed to the pharmaceutical giant Pfizer Inc., which tested its effects on both panic and anxiety with mixed results. It had few side effects, but tests didn't show clear improvements either. Pfizer killed the program in 2002, sending Indevus stock into a tailspin.

Indevus officials, however, were intrigued by a striking and unanticipated effect on test patients: Two of them suddenly stopped stuttering.

''It really made us believe that it's worth investing the money to do a proper trial," said Jim Shipley, the company's vice president for medical affairs.

Indevus re-acquired the rights to pagoclone, took out a fresh patent based on its possible use as a treatment for stuttering, and launched a new clinical trial designed to show whether it can help a broader population. They have enrolled about half of the 120 patients they hope to test, and expect to have results by the middle of 2006.

Indevus warns that even if the trial succeeds, a larger trial will need to follow, and approval wouldn't come for at least three years.

But even if the drug ultimately fails, stuttering researchers believe the effort is worthwhile. ''We may have stumbled across the panacea, and if it is, fantastic," said Maguire. ''But at least it's going to give us significant insight into the mechanisms of stuttering."

Pagoclone is believed to boost the effects of a brain chemical called GABA, which may indirectly inhibit the release of another chemical, dopamine, which dampens brain function. Studies done by Maguire and others have shown that stutterers' brains have too much dopamine in certain areas, preventing them from functioning properly. Measuring pagoclone's effect on brain chemistry against its effect on stuttering will help researchers determine whether a link exists.

New brain-scanning technologies have offered other clues. Blomgren found that when stutterers speak, both sides of the brain tend to light up with activity, whereas in fluent speakers one side naturally dominates. To him, it suggested the two sides were fighting for control, and words were getting caught in the middle.

''Essentially, there were too many cooks in the kitchen," Blomgren said. ''We know it's an oversimplification, but we know a part of this definition holds true."

Treatment from such discoveries is still years away. For now, people who stutter have recourse only to a handful of devices and psychiatric drugs that haven't been specifically approved for stuttering.

The best-known device, the SpeechEasy, fits inside the ear and replays the speaker's voice with a slight delay and pitch shift.

Some users report little effect -- Blomgren said the SpeechEasy made his stuttering worse -- but others have reported dramatic improvement, and it was featured on ''Oprah" as a ''medical miracle."

Beth McNeill, an East Bridgewater speech therapist who has stuttered severely since a bout of encephalitis at age 10, bought one of the devices in August.

Before she started using it, ''two percent of my words were fluent," McNeill said, ''and now I can basically stand up and read a report and talk fluently 85 percent of the time."

With little clinical research to prove its effectiveness, SpeechEasy isn't covered by most insurance plans, so patients like McNeill have to pay the full cost of $4,000 to $5,000. Manufacturer Janus Development Group has sold only 5,500 units since it was introduced in 2001, according to a company spokesman, but says more tests are underway that may encourage more insurers to pick up the tab.

Indevus hopes to avoid similar problems with pagoclone, which will only be approved by federal regulators if clinical evidence shows clear benefits and low risks. But it will still face hurdles, not least of which is that it must be prescribed by a doctor. Currently, stuttering is nearly always treated by therapists.

Shipley, the Indevus vice president, compares the situation with that faced by antidepressant manufacturers about two decades ago, when few people thought depression could be treated with a drug.

''It's a challenge," he said of pagoclone's development, ''but it's been an interesting challenge."