Noteworthy News Articles on Mental Health Topics, October 1-10, 2006



Move Over, Dr. Phil, Freud Is Back
Abby Ellin, New York Times- 10/1/2006

Deborah and Steve’s relationship is in crisis, and as guests on “The Dr. Keith Ablow Show,” the latest TV program dedicated to healing the masses, they are sharing it with the world. The biggest problem is Steve’s proclivity for bashing in windows and walls, which terrifies his wife and kids. Dr. Ablow, a forensic psychiatrist, informs Steve that he will lose his family if he doesn’t control his rage. Steve chokes up. He can’t speak.
      That would be the point where Dr. Phil, on his own talk show, would start finger-pointing and lecturing about what Steve needs to do to change his life. Instead, Dr. Ablow, 44, whose head is as smooth as a Magic 8 Ball and whose eyes are intense but kind, moves from the leather armchair to the coffee table, and leans into a clearly miserable Steve; picture Robin Williams and Matt Damon in “Good Will Hunting.” (“It’s not your fault. It’s not your fault.” Cue tears.) “What are you feeling?” he asks Steve, who looks like he’s about to explode. “What are you feeling?” Dr. Ablow pushes and prods. By the end of the segment, he has recommended that the couple get counseling for at least a year. The show will pay for it. The work has just begun. Cut to commercial.
     Somewhere between Woody Allen’s Soon-Yi surprise and Dr. Melfi’s failure to slay Tony Soprano’s sociopathic demons, therapists of the old-fashioned, “lie back on the couch and tell me about your childhood” school began to fall out of fashion. Unhappy childhood? Boo-hoo. Parents ignored you? Get over it! But now Dr. Ablow has found his way to daytime television, trying to bring therapy back to the childhood-rooted philosophy where he thinks it belongs.
      “The Dr. Keith Ablow Show,” which in New York is shown weekdays at 10 a.m. on Channel 5, is the latest program meant to help people resolve their problems in 42-minute segments. But unlike his TV competitor Dr. Phil McGraw, who dispenses advice with almost militaristic fervor, Dr. Ablow points patients and guests to the past. What happened when they were 5? How does that affect the way they live today? “If Phil were to talk to a man who’s not doing well as a father, he’d likely tell that person there are certain rules to which good fathers subscribe and that the man is failing to subscribe to certain of those which he ought to,” Dr. Ablow said. “I’d ask that father to tell me about his own father. It’s very difficult to figure out how to be an excellent father until you’ve experienced all the sadness you’ve experienced with your own.”
     It was Dr. Ablow’s own bullied childhood, he said, that brought him to Freudian psychiatry. But he took a circuitous route to television: private practice; author of 12 books, including one psychoanalyzing Scott Peterson, the convicted killer, whom he never met (getting him into hot water with some of his peers); expert witness at murder trials; appearances on “Larry King Live,” Court TV and “The Oprah Winfrey Show.” (Dr. Ablow said Oprah Winfrey invited him to take Dr. Phil’s place on her show, after Dr. Phil got his own program. A spokeswoman for Ms. Winfrey could not verify the offer.)
     Dr. Ablow has been married to his wife, Debbie, for 11 years and they have two young children. He divides his time between New York, where he tapes the show, and a suburb north of Boston. His profession has changed over the years, with many therapists these days focusing on behavior — Dr. Phil, emblematically, is a cognitive behavioral therapist — rather than root causes.
     With managed care and the development of new medications, the trend has been away from spending months, even years, exploring problems of the past. “Psychiatry became a neurobiological science, all about drugs and brains, and less about the mind,” said Dr. David I. Joseph, a psychiatrist in Baltimore. “It certainly was less about psychoanalytic thinking, that you needed to understand the past and the unconscious.”
     In some ways, Dr. Ablow is an unlikely advocate for the old ways. He is the unorthodox shrink, far from the bearded, bespectacled, disembodied voice on the couch that has been the butt of so many New Yorker cartoons. He has met patients in their homes, at restaurants, at the track (his fee is anywhere from $50 to $500 a session). Patients have been encouraged to wake him at 3 a.m. if they have an especially disturbing nightmare. (“My wife couldn’t stand that,” he says.) Dr. Ablow said he does prescribe medication when necessary, and he does issue behavioral strategies that he thinks will help people with their compulsions. At his heart, though, he said, he’s a “life story listener.”
     His methods don’t please everyone. Meeting patients outside the office is usually a no-no. “Most psychiatrists feel that boundaries are very important, and most patients feel that boundaries are very important,” said Dr. Dinah Miller, a psychiatrist in Baltimore who knows Dr. Ablow but disagrees with his methods. “This is not the usual, and most psychiatrists wouldn’t feel comfortable eating or running with their patients.”
     And though “Inside the Mind of Scott Peterson” landed him on the best-seller list, it also infuriated Dr. David Rosmarin, a Boston psychiatrist who filed a complaint that is pending with the Massachusetts Psychiatric Society. He objected to Dr. Ablow’s label of Mr. Peterson as a sociopath without having treated him, thus violating the so-called Goldwater Rule, which refers to offering opinions on people you have not examined. In an interview, Dr. Rosmarin said the rules are clear and anyone can find them on the American Psychiatric Association Web site. Dr. Ablow calls the rule self-serving and says it stems from fear of litigation. “I believe the goal of educating the public about dangerous people will always trump the concerns of the guild on whether they can protect their assets,” he said.
     He has other criticisms for psychiatry, blaming it for the onslaught of pop psychology and the move away from deep psychological work. “Organized psychiatry has failed to assert itself,” he said. “The fact that psychiatry students can complete their training without having had a single therapy session is another force that’s aligned in favor of the behavioral approach.”
     Dr. Ablow’s past is in Marblehead, Mass. The son of a shoe salesman and a teacher, he was raised in an upper-middle-class home that was protective and “therefore made me wonder how strong I was in reality,” he said. From the first to sixth grades he was bullied, he said. He said he had two options: “I could hate the people who were chasing me around, or I could try to understand them. I ultimately wanted to understand them. All bullies have been injured by others.” One day, he said, he hopes to have his bullies on the show. “I still have emotions about it. These things don’t die easily.”
     In 1991, a friend’s murder and a brief breakup with Debbie landed him in therapy. He said he stayed for about two years. He learned that he was stronger than he thought he was, he said, and that he was still too dependent on his parents for approval. “I learned that the past really does constrain what you can do in the present until you look at it.”
     Dr. Ablow said his career twist into talk television was accidental. (Would Freud see it that way?) In Los Angeles with his agent to pitch a dramatic series inspired by his practice, he met with Lisa Hackner, the senior vice president for development at Telepictures, and told her that he believed that when you faced the truth in your life, “when you found the courage to do so, you became much more powerful.” They soon had a deal.
     Whether the world needs yet more soul-baring before a live studio audience is uncertain. Since the show made its debut on Sept. 11, ratings have been low, according to Mediaweek, an industry publication. Some psychiatrists worry that rather than rescuing the profession, Dr. Ablow will hurt it. “He’s attempting to convey complexity in a medium that’s not designed to do that,” said Dr. Glen O. Gabbard, professor of psychiatry and director of the Baylor Psychiatry Clinic at Baylor College of Medicine in Houston, and author of “The Psychology of the Sopranos.” “The very essence of psychotherapy is shades of gray, ambiguities and ambivalence. None of these things lend themselves to being simplified in a way that’s digestible to a typical TV audience.” Dr. Phil, though, said he welcomes the company. “The more people that are distributing usable information through accessible means, the better off we all will be," he said in an e-mail message.
     As to whether television merely exploits people like Steve? “Self-disclosure is a paper tiger,” Dr. Ablow said. “You strengthen yourself when you say the things you’re afraid to say in front of other people, and the more people the better.” He pauses. Who knows? The question might make a good show one day.



A Danger to Others, Including Doctors
Elissa Ely, M.D., New York Times- 10/3/2006

The prison psychiatrist had described the patient as unrepentant, explosive, satisfied with his crime and “extremely physically fit.” According to the prison record, his conviction was for assault and battery with intent to kill; he had attacked his ex-wife with a machete.

He himself said his sentence was for “mayhem,” and he denied any substance use, even though the unforgiving record also said he had been a cocaine dealer.

Three days out of prison, full of historical inconsistencies, he showed up at the walk-in clinic for an evaluation. We had the record, but had never met him before.

The graduate student on duty was prepared to take a thorough history. She started with early childhood development. She was very responsible, and I could see by the blank papers on her clipboard that she was planning to include all relevant dates: his first steps, language acquisition, toilet training difficulties. She wanted to know him from birth onward.

He interrupted her at age 11 months. He said that housing, medication and a job were his rights as a citizen; he had been discharged to a shelter, and homelessness infuriated him.

“I should have had a key to an apartment when I walked out the prison door,” he said.

Most of all, he needed money, he said, and if we couldn’t arrange emergency financing, he planned to get it by any means possible.

“Do you have a deadline for this?” the student asked, writing carefully.

“Tomorrow,” he said.

“Do you know what you would do to get it?”

He shrugged.

“You would hurt someone?”

He nodded.

We had no authority to send him back to prison. We could only send him to a psychiatric emergency room. This was not the right place for him. He did not have a mental illness. He was extremely physically fit and unrepentant, not hallucinating or suicidal.

But he needed to be someplace other than in a vulnerable community. Committing him for further evaluation was the best we could do. Security was called, and while the student continued to take her early childhood history, an ambulance arrived with a stretcher and restraints. He did not resist.

“You supposed to help me,” he said, looking directly at us. I felt he might be taking a mental picture for future use.

I called the emergency room, and spoke to a weary voice that no one could blame for its lack of enthusiasm. I said he was on his way, and described his history of violence, substance use and prison sentence. I quoted the vague but certain threats he had just made — in the presence of a psychiatrist, no less — and our conviction that he would act on them. He was an acute risk to others. Exactly which others I could not say.

There was silence on the phone. “Is the man psychotic?” the voice asked.

“No,” I said.

“Did he assault anyone?”

“No,” I said. “Not yet.”

Prevention was the point. The act in question had not happened, but it was just a matter of time. The best predictor of future violence is past violence. His sense of future purpose had been chilling.

No one wants a man like this, without psychosis or clear-cut violent behavior, in an emergency room. It means a long night and a large headache. The voice was skeptical.

“Doesn’t sound hospitalizable,” it said.

I argued, though I would have said the same thing if I had been in that position.

Early the next morning, I called back. A different weary voice answered.

“We sent him home,” the voice said.

“But he doesn’t have a home,” I said.

The voice said: “There was no psychiatric illness. We gave him a cab voucher, and he left on his own. He said he’d follow up with you.”

He planned to hurt someone and had given fair warning. We knew it would happen. In his unrepentant mind, there was no reason not to. Sincerely, I hoped he would not follow up with me.

Researchers used a seven-item questionnaire to determine whether people felt a need to spend money, whether they were aware that their spending behavior was aberrant, whether they bought things to improve their mood and whether their buying habits had led to financial problems.

They followed up with three questions designed to determine the degree of loss of control: How often have you just wanted to buy things and did not care what you bought? How often have you bought something and when you got home were not sure why you bought it? How often have you gone on a buying spree and just could not stop?

A statistical analysis of the results found that 5.5 percent of men and 6.0 percent of women could be classified as compulsive shoppers — that is, people whose uncontrolled urges to spend money lead to serious negative consequences.

Compulsive buying, sometimes called compulsive or addictive shopping, is not a recognized psychiatric diagnosis, but it is now being considered for inclusion in the next edition of the Diagnostic and Statistical Manual of Mental Disorders.

Dr. Lorrin Koran, the study’s lead author and emeritus professor of psychiatry at Stanford, said compulsive buyers commonly suffer from other psychiatric disorders.

“Many of those who come in for treatment suffer from depression, anxiety disorders and other impulse control disorders like pathological gambling and binge eating,” Dr. Koran said.

The results of the study were published Sunday in The American Journal of Psychiatry. Two of the paper’s five authors report a financial relationship with several pharmaceutical companies.

An editorial published with the paper notes that the recognition of such a condition as a mental illness would be controversial and that some would criticize it as creating a trivial disorder in order to “medicalize” a moral issue or to invent a reason to sell more drugs.

But the editorial also points out that the same sorts of objections were raised about diagnoses like social anxiety disorder and attention deficit hyperactivity disorder, now widely considered common and treatable illnesses. (I and one author of the editorial, Dr. Eric Hollander, are the co-authors of the book “Coping With Social Anxiety”).

Behavioral addictions and impulse control problems, the editorialists write, can be considered from various perspectives — medical, moral, ethical, religious — and they vary widely in severity. But at their most serious, behavioral disorders can be seriously debilitating.

“Compulsive buying, like pathological gambling, may lead to bankruptcy, divorce, loss of employment and even suicide attempts,” Dr. Koran said.

The authors acknowledge that their results are based only on a telephone survey, which is subject to various biases, and that without a structured clinical interview, an accurate diagnosis is not possible. And the sample included a greater percentage of people over 55 than are in the general population, and a substantially higher percentage of women.

They note that a structured and validated diagnostic interview administered to a large and representative sample of the population will still be required to determine exactly how many people suffer from the illness, and establish with certainty which if any treatments are clearly effective.

Still, Dr. Koran said, “the survey shows, surprisingly, that men and women are equally or nearly equally likely to suffer from this disorder, and that a troubling proportion of the population appear to be engaging in financially destructive behavior.

“My hope,” he continued, “is that people who think they have this disorder will seek help because available studies suggest that psychotherapy or medications help many compulsive buyers to stop.”

Researchers interviewed 591 adolescents ages 12 to 17 about their drug and alcohol use and then questioned at least one parent of each about what he or she thought the children were using. The analysis appears in the October issue of Alcoholism: Clinical and Experimental Research.

Parents consistently said they believed that their children were using substances less frequently than the children reported. Alcohol use was most common, with 54.4 percent of the teenagers reporting having consumed at least one drink in their lifetimes, and 23.6 percent saying they had been intoxicated. But only 30.5 percent of parents believed that their children had ever had a drink, and only 8.1 percent said their children had ever been drunk.

While 44 percent of the adolescents reported smoking cigarettes, only 27 percent of their parents knew they smoked.

Almost 23 percent of the adolescents admitted to using marijuana, while only 13.2 percent of their parents were aware of it.

With drugs other than marijuana, the results were similar: 8.5 percent of teenagers said they had used other drugs, while 3.1 percent of parents knew it.

“Parents of 12- and 13-year-olds had the lowest rates of knowledge,” said Dr. Laura J. Bierut, the senior author of the study and an associate professor of psychiatry at Washington University in St. Louis. “That’s worrisome, because there is good evidence that the younger you start to use substances, the more likely you are to develop addiction.”

“Children are not telling you about their drug use,” Dr. Bierut added. “You have to ask. Kids have access to drugs, they use them, and most parents are clueless.”

Foley Acquaintances Question Alcoholism
Associated Press, 10/3/2006

WEST PALM BEACH, Fla. -- When disgraced former Rep. Mark Foley announced he was entering rehab for treatment of alcoholism and ''other behavioral problems,'' some of those who have known him for years were shocked and suspicious.

Some friends and acquaintances said they rarely saw him drink.

A former colleague, Rep. Peter King, R-N.Y., said on Fox News Channel: ''I don't buy this at all. I think this is a phony defense. The fact is, I think he's responsible for what he did here and I think it's a gimmick.''

Foley abruptly resigned from Congress after being accused of sending lurid Internet messages to teenage boys who served as pages on Capitol Hill. The FBI and Florida law enforcement officials are investigating whether the Florida Republican violated any laws.

''Mark acknowledges that he is an alcoholic and as many alcoholics does not publicly display his consumption,'' Foley's attorney and longtime friend David Roth said.

Some longtime acquaintances said they cannot reconcile Foley's public and private lives, including the lurid communications and the claimed drinking problem.

''I have never seen Mark inebriated in public,'' said Robin Bernstein, who has known Foley for 25 years. ''I mean, he was a social drinker like most of us at cocktail parties with a glass of wine, but Mark was always ... the consummate gentleman.''

''The best thing he can do now is get help for the problem he hid from many of us. The man I knew was certainly an honorable man,'' Bernstein said.

Longtime friend and Palm Beach socialite Petra Levin said she knew Foley had a drinking problem. ''You know, a lot of people who have drinking problems, you mainly do not see them in public, and that's why it becomes a problem,'' she said.

Dr. Lauren Williams, a psychiatrist who specializes in addiction at the University of Miami's Miller School of Medicine, said many alcoholics hide their drinking, especially when they are in positions of power.

''It really permeates the person's life at different stages, and until something drastic happens, they don't own up and say, `I have a problem,''' Williams said.

It is certainly not new for public figures to blame alcoholism or addiction for misdeeds. Mel Gibson blamed alcohol for his anti-Semitic tirade during a drunken driving arrest in California.

Rep. Patrick Kennedy, D-R.I., checked himself into the Mayo Clinic for addiction to prescription pain drugs after a nighttime car crash near the Capitol that he claimed not to remember. Rep. Bob Ney, R-Ohio, began treatment for alcohol dependency after admitting he improperly accepted tens of thousands of dollars worth of trips, meals and sports tickets in the Jack Abramoff lobbying scandal.

While Foley's attorney said the congressman never had ''inappropriate sexual contact with a minor,'' that may not matter, said Kendall Coffey, a former U.S. attorney in Florida.

He said Foley could face criminal charges under state or federal laws for ''grooming'' minors for sexual contact.

''There are going to be experts who look at these e-mails and say those are the unmistakable fingerprints of a predator, but others will call them fantasies. It's a question of intent,'' the former prosecutor said.



Older Beats Out Newer In Psychiatric Drugs Study
Shankar Vendantam, Washington Post, 10/3/2006

Schizophrenia patients do as well, or perhaps even better, on older psychiatric drugs compared with newer and far costlier medications, according to a study published Monday that overturns conventional wisdom about anti-psychotic drugs, which cost the United States $10 billion a year.

The results are causing consternation. The researchers who conducted the trial were so certain they would find exactly the opposite that they went back to make sure the research data had not been recorded backward.

The study, funded by the British government, is the first to compare treatment results from a broad range of older anti-psychotic drugs against newer ones. The study was requested by Britain's National Health Service to determine whether the newer drugs - which can cost 10 times as much as the older ones - are worth the difference in price.

There has been a surge in prescriptions of the newer anti-psychotic drugs in recent years, including among children.

The study, published in the Archives of General Psychiatry, is likely to add to a growing debate about prescribing patterns of anti-psychotic drugs. A U.S. government study last year found that one of the older drugs did as well as newer ones

Yesterday, in an editorial accompanying the British study, the lead researcher in the U.S. trial asked how an entire medical field could have been misled into thinking that the expensive drugs, such as Zyprexa, Risperdal and Seroquel, were much better.

"The claims of superiority for the [newer drugs] were greatly exaggerated," wrote Columbia University psychiatrist Jeffrey Lieberman. "This may have been encouraged by an overly expectant community of clinicians and patients eager to believe in the power of new medications. At the same time, the aggressive marketing of these drugs may have contributed to this enhanced perception of their effectiveness in the absence of empirical information."

Peter Jones, a psychiatrist at the University of Cambridge in England who led the study, searched yesterday for the right word to describe what had happened to his colleagues. "'Duped' is not right," he said. "We were beguiled."

One drugmaker immediately questioned the findings. Carole Puls, a spokeswoman for Eli Lilly and Co., which makes Zyprexa, said it was problematic to compare large groups of medications because there are differences between the drugs in each class. Individual patients need different medication options, she said.

Janssen Pharmaceutica, which makes Risperdal, and AstraZeneca, which makes Seroquel, did not respond to requests for comment.

Schizophrenia is a serious mental disorder that is believed to affect about one in 100 adults. It is characterized by psychotic symptoms such as hallucinations and delusions and negative symptoms such as social withdrawal.

Especially over the past decade, older antipsychotics such as Haldol have been widely criticized for triggering uncontrolled body movements, even as the new "atypical" antipsychotics were hailed for causing fewer side effects. Recently, however, concern has grown that antipsychotics in general, and some of the newer drugs in particular, may be causing metabolic side effects.

The new study randomly assigned 227 schizophrenia patients to two groups -- one received a newer antipsychotic, the other an older drug. The patients were evaluated for more than a year by experts who did not know which drug was being taken.

While the researchers had expected a difference of five points on a quality-of-life scale -- showing the newer drugs were better -- the study found that patients' quality of life was slightly better when they took the older drugs. Jones said a conservative interpretation of the data suggested that there is no difference, "so the notion you would pay 10 times as much would be difficult to justify."

"Why were we so convinced?" he asked, referring to the widespread opinion among psychiatrists that the new drugs were worth the great difference in cost. "I think pharmaceutical companies did a great job in selling their products. That is certainly one issue.

"It became almost a moral issue on whether you would prescribe these dirty old drugs," he added. "It became the 'my son' phenomenon. What would you prescribe for your son?"

In retrospect, Jones and others said, there were hints going back many years. In 2003, Robert Rosenheck, a psychiatrist at the Department of Veterans Affairs, found there was no difference between Haldol and Zyprexa -- after patients taking Haldol were treated to prevent the movement side effects.

Last year, the U.S. government trial found that an older drug called perphenazine did about as well as the newer medications. Still, the belief in the newer drugs was so ingrained that many psychiatrists insisted that the results could not be extrapolated to other old drugs, said Rosenheck, who helped conduct that study.

Darrel Regier, who directs research at the American Psychiatric Association, cautioned against drawing broad conclusions after the new study and said that "a thoughtful and prolonged process " is needed before treatment guidelines are changed. Not all the drugs used in the British study were available in the United States, he said, and with many of the newer medications reaching the end of their patent lives, he predicted that questions of cost would fade away.

Jones and Rosenheck said the problem with many drug company studies that seemed to show that new drugs are better is that they focused on short-term results -- a symptom or side effect -- rather than the big picture: how patients fare long-term.

"The story of these newer antipsychotic drugs is a story that reveals an institutional gap," Rosenheck said. "It should not have needed 10 years to get three government studies."

Jones said the studies also illustrate the importance of trusting data, rather than judgment. He drew an analogy with his hobby of walking.

"Sometimes the compass tells you go straight in front of you, but you somehow know it is wrong and that north is behind you," he said. "I have learned to follow the compass."



CDC Finances Study Into Causes of Autism
Associated Press, 10/6/2006

ATLANTA -- The largest federal study to date into the causes of autism was announced Friday -- a multi-state investigation that will involve 2,700 young children.

The U.S. Centers for Disease Control and Prevention and five other research centers will study the youngsters over five years. The research is designed to ferret out any genetic and environmental factors that may contribute to autism.

''The CDC hasn't funded a study like this (before),'' said Diana Schendel, the CDC lead health scientist who is overseeing the Georgia research.

But some parents of autistic children say the CDC -- which promotes childhood vaccinations -- is not interested in fully exploring vaccinations as a potential cause.

''We don't want the CDC to do anything. We don't trust them,'' said Wendy Fournier, president of the National Autism Association.

Autism is a complex disorder usually not diagnosed in children until after age 3. Symptoms can include repetitive behaviors such as head-banging, avoiding physical or eye contact with others, and communicating with gestures rather than words.

In 2000, Congress directed federal health officials to increase research into autism. The law prompted a series of CDC studies, including prevalence research released in May that found 300,000 U.S. children have been diagnosed with autism.

The new study will recruit 900 children diagnosed with autism, 900 with undefined or other developmental problems, and 900 randomly selected youngsters.

Those studied will be ages 2 to 5, in part because health records and memories will be more complete, Schendel said.

That decision will limit the study's ability to assess the past impact of vaccinations that contain the mercury-based preservative thimerosal, she acknowledged. Since 2001, thimerosal has been removed from shots recommended for young children.

Fournier's group suspects that ingredient is a leading cause of the disorder, although past research suggests it is not.

Researchers will examine the medical records of the children and their parents, and will take cheek swabs and blood and hair samples, Schendel said.

The CDC awarded the other participating institutions $5.9 million for the study. They are the Kaiser Foundation Research Institute in California, the Colorado Department of Public Health and Environment, Johns Hopkins University in Maryland, the University of North Carolina at Chapel Hill and the University of Pennsylvania.

Until Friday's announcement, the largest federal study to focus specifically on autism's causes was research sponsored by the National Institute of Environmental Health Sciences, looking at 1,000 California children ages 2 to 5. That study is still in progress.

The new use for Risperdal is to treat irritability associated with autistic disorder, including temper tantrums, deliberate self-injury and aggression in children and adolescents, ages 5 to 16.

The approval is the first for the use of a drug to treat behaviors associated with autism in children, the Food and Drug Administration said.

Risperdal, first approved by the FDA in 1993, has been used to treat schizophrenia and bipolar disorder in adults.

The anti-psychotic drug is not a cure for autism, nor does it treat the condition itself, but it may provide relief for some children, according to Johnson & Johnson.

Autism is a complex developmental disability. It typically appears during a child's first three years of life, and it affects communication, social interaction and creative or imaginative play.

"This approval should benefit many autistic children as well as their parents and other caregivers," said Dr. Steven Galson, director of the FDA's Center for Drug Evaluation and Research.

Two eight-week trials involving 156 children between the ages of 5 and 16 showed that those given Risperdal achieved significantly improved scores for certain behavioral symptoms of autism compared to those given dummy pills, the FDA said.

In 2005, the FDA declined to expand its approval of Risperdal, also known as risperidone, to include autism.

The most common side effects of Risperdal include drowsiness, constipation, fatigue and weight gain.

On the Net: Food and Drug Administration: http://www.fda.gov/

Everything is relative in “Shadow,” and everything is about relatives. Its major players include Ms. Smiley and her sister, Christine Kotulski (known as Tina here), both scarred by their mother’s illness. The women’s father, cousin, nieces and nephews weigh in on the experience of growing up — and putting up — with the delusions and complications of schizophrenia. All are articulate and full of feeling.

But the film’s star is its subject: Millie Smiley, a beautiful, battle-worn woman whose ease before her daughter’s camera gives “Shadow” grace and honesty. A true heroine, the elder Ms. Smiley undergoes a transformation, metamorphosing from a minimally functioning mental patient into a loving grandmother. For all their tribulations, the Smileys have something to smile about.

When Millie Smiley first appears on camera, she is a patient in an Illinois state mental hospital and so detached from reality that she thinks she is there because she has run out of money. As we get to know her, through her talk about “noise pollution” and a suicide attempt (“blood everywhere”), we also meet, via home movies, her younger self, a gorgeous blonde who fell apart after her first daughter was born.

“I said, ‘My God, what am I dealing with here?’ ” remembers her former husband, Alan, who left his wife and daughters so he could “survive.”

A simplistic approach would cast this man as a villain, but “Shadow” sees shades of gray. Mr. Smiley was an absent but caring father, and in the end he and his second wife welcome Millie Smiley into their family.

The villain of “Shadow” is the vast and anonymous system that shuttles this woman from one psychiatrist to another without continuity of care or consistency in medications. Health care is an easy target, and “Shadow” is stronger when it’s not tilting at institutional windmills.

At one point, Ms. Smiley and Ms. Kotulski argue about the ethics of lying to their mother. While Ms. Smiley waxes on about a “crisis of conscience,” Ms. Kotulski turns pragmatic. Suddenly their mother’s paranoia seems justified. The scene is more disturbing than any contrived controversy on reality television.

By film’s end, Millie Smiley is making a life for herself: limited by our standards, wondrous by hers. Beaming over things most of us take for granted — a grandchild’s craft, “delicious” fast food — she is an object lesson in resilience and gratitude. “Shadow” is a valentine to her, and a heartening one.

Wisconsin Researchers Puzzle Over Why ADHD Drugs Work
Bonnie Kath, Chicago Tribune- 10/8/2006

For more than 50 years, stimulants such as Ritalin have been prescribed for the treatment of attention-deficit-hyperactivity disorder. In all that time, scientists have never understood why stimulants would help people suffering from this debilitating combination of impulsiveness, hyperactivity and inability to pay attention.

This is because doctors prescribe low doses, but scientists typically have studied the effects of high doses, according to Craig Berridge, professor of psychology at the University of Wisconsin at Madison.

"We know a lot about what these drugs are doing at high doses," he explained. High doses stimulate physical activity, impair focused attention and are addictive. And it would make sense that "they are going to act the same, just to a lesser intensity, at low doses . . . but they act fundamentally differently."

Berridge and a team of researchers were intrigued enough by this paradox to study it. They determined a dosage range for rats that would be equivalent to doses prescribed for ADHD patients, then tested the rats' sustained attention and working memory.

"In both tasks, at these low doses but not at higher doses, methylphenidate, or Ritalin, improved performance in our experimental animals similar to that seen in humans," he said.

With the dosage established, they monitored three areas of the brain--the prefrontal cortex, responsible for working memory and attention span; the nucleus accumbens, associated with addiction and physical activity; and the medial septum, linked to wakefulness--in order to measure the release of chemicals called neurotransmitters, which trigger activity.

They found that low doses of Ritalin have a significant effect on neurotransmitter release in the area associated with attention and working memory but not much effect in the areas related to addiction, physical activity and wakefulness.

Berridge's group now is studying the electrical activity of neurons, "trying to better understand what these drugs are doing to the neural code that supports higher-level cognition. ... We believe that if we know how these drugs work, that may tell us something important about the medical aspects of ADHD, about what is wrong biologically that produces these behavioral symptoms."

When They Say Alcohol Made Me Do It
Alan Feuer, New York Times- 10/8/2006

It's no secret that alcohol is often used as a balm for human frailty to cover the pain that comes with rage or guilt or grief.

But what about alcohol treatment programs? Can they be used as a sort of salve as well?

When Representative Mark Foley announced last week he was entering a rehabilitation clinic after being confronted by ABC News with sexually explicit messages he sent to teenage pages, he joined a growing list of public figures who blamed the bottle for their sins and misbehavior. At the height of a Washington sex scandal, Mr. Foley focused on his drinking, which may or may not have been the most pressing issue on his plate.

Mel Gibson underwent something similar last summer when he declared he was taking “necessary steps” to combat his alcoholism after an anti-Semitic rant against a Los Angeles sheriff’s deputy during a drunken-driving stop in Malibu. Last month, Representative Bob Ney of Ohio said his drinking, in part, was behind his taking of free meals and an all-expense-paid golf trip to Scotland from the lobbyist Jack Abramoff. Declarations like these, in which nefarious activity is linked to — even pinned on — alcohol use, have been debated of late by the professionals who treat substance abuse.

Some expressed concern that high-profile personalities were entering treatment just to cleanse their image, contributing to a creeping skepticism about alcohol treatment. Others said that the greater concern was not that too many people — including the rich and famous who may not need it — were getting treatment but that too few people who genuinely need it still don’t.

John Schwarzlose, president of the Betty Ford Center in Southern California, said that substance-abuse treatment had gained a certain cachet.

“At different times in the last 30 years it’s certainly been to your advantage to say, ‘I went to treatment,’ ” he said. “I worry people do it for that reason sometimes, to revive a career.”

To Mr. Schwarzlose, this phenomenon may, in fact, point to another challenge.

“It’s a warning signal to the addiction-treatment field that you better be doing good assessment, that you’re treating people who are clinically appropriate,” he said. “If someone is trying to ‘hide’ or find sanctuary, hopefully addiction places are not going to take them in.”

For Ed Diehl, president of Seabrook House, an in-patient center in South Jersey, public perception is crucial. “We worry that the larger public will begin to become cynical as people say, ‘Oh, I’m in trouble, I’ll enter an alcohol treatment facility,’ ” he said. “My concern is someone gets caught cheating on their taxes and says, ‘Oh my God, I must have been out of my mind drinking.’ ”

Bear in mind, Mr. Diehl said, that it is almost always a crisis — whether it’s a drunken-driving arrest or a sex scandal — that motivates people to seek treatment, which is often to the good.

Terry Allen, who directs the Hanley Center, a 95-bed drug and alcohol treatment facility in West Palm Beach, Fla., said most people don’t check into treatment centers unless they actually want help.

“The reality is we seldom question people’s motivations because not many people seek rehabilitative services that don’t need them,” he said.

Nonetheless, Mr. Allen said he believed it was common practice in public relations to play on people’s emotions by “attributing bad behavior to addiction.”

Some public relations executives do not disagree.

“Never underestimate the power of ‘I’m sorry’ and the ability of people to forget,” said Sean Cassidy, president of Dan Klores Communications.

There is a caveat, he said. The tactic will only get a story off the front pages for a while. To wrest the full potential from the public relations cure, it does help, he said, to be sincere.

To Howard Rubenstein, the estimable New York public relations executive, the I’m-an-alcoholic declaration is hopelessly played out.

“So many celebrities have used rehab as a fig leaf lately to cover over their abhorrent actions,” Mr. Rubenstein said, “and as a result it’s become routine and lacks credibility.”

“I think it ought to be banned as an excuse,” he said.

An Analyst Questions the Self-Perpetuating Side of Therapy
Benedict Carey, New York Times- 10/10/2006

As a young boy growing up in the Bronx, Owen Renik saw his mother struggle with depression, watched helplessly as she deteriorated from a muscle-wasting disease, and spent months living with relatives because she was unable to care for him. From that powerlessness grew a desire to become a doctor. By the time Dr. Renik was out of college and had worked for a time driving a taxi in New York — an immersion course in brief counseling while dodging traffic — it was clear what kind of doctor he would be.

He fell hard for Freud, and as a successful psychoanalyst who was also a prolific writer and engaging speaker, he rose quickly in the psychoanalytic establishment. He has held high office in the American Psychoanalytic Association and at the field’s premier journal, The Psychoanalytic Quarterly, where he served as editor in chief for about a decade. As an insider, he has questioned the techniques and affectations of analysis in an attempt, he says, to spare the science of psychoanalysis from those who would make it a monastic ritual, a priesthood.

His book “Practical Psychoanalysis for Therapists and Patients,” released last month, is meant to give therapists, their clients and anyone interested in therapy a sense of how to navigate the chutes and ladders of treatment, what to expect from therapy and how to know when it’s time to stop. Dr. Renik, 64, has a private practice in San Francisco and is a training and supervising analyst at the San Francisco Psychoanalytic Institute and Society.

Q. Why do you think the profession of psychoanalysis needs corrective advice now?

A. The profession is in a great decline, and I predict the decline will continue. The reason for it, and the reason a corrective is needed now, is that although psychoanalysis began in a spirit of open-ended inquiry, with an orientation above all to be helpful to the patient, it took on a self-perpetuating guild mentality that was its ruin. The possibility is still open to reverse the decline, but it will be necessary to escape the clutches of an establishment that, unhappily, has increasingly gotten away from the original scientific enterprise.

Q. You place great emphasis in the book on symptom relief as the central measure of the effectiveness of therapy. Shouldn’t that be obvious?

A. Not necessarily. There is a tendency among psychoanalysts to pursue self-awareness as a goal in itself, rather than a means to an end. Originally, the idea was that the self-understanding that arose as a result of psychoanalysis was unique and impressive and valid because it afforded relief from symptoms that were otherwise impossible to treat.

If you don’t require that self-awareness be validated by symptom relief, there are two destructive consequences. The first is scientific. You have no independent variable to track; you set up a circular situation in which it’s the analyst’s theory that determines what is found in analysis. Many critics of psychoanalysis have recognized this.

But an equally important consequence is that you relieve the analyst of any accountability. The process can go on forever, and there are all kinds of temptations to extend it, including the therapist’s vanity, his inability to admit failure, his narcissism — and nobody likes lost income. The therapy then becomes an esoteric practice of proselytizing, rather than a discipline, and the proof of that is everywhere in the world, where fewer and fewer people go to analysis at all. If the therapy worked, people would be going.

Q. How long should you have to wait before expecting to see positive changes in your life?

A. I have no precise and general answer, but there should be evidence very quickly of some progress. This idea that you have to wait around a long time for the fruit to drop from the tree is nonsense. If you don’t see progress soon, you should move on. If you don’t get better quickly with the next person, fine; you may conclude that the process will take a little longer than you expected. But nothing all that much is lost. Hanging around forever and ever with the same person has a much greater nonrefundable cost.

Q. You challenge the traditional analytic notion that the therapist should be a neutral guide. Why?

A. I think there is a tendency to confuse a nonjudgmental attitude with the psychoanalytic concept of neutrality. But none of us can help having a personal take on any issue a patient is discussing, and there is no way for us to think about any issue — let alone intervene — without that being influenced by our own very personal psychology.

Therefore, the only thing that happens when we aspire to relative neutrality is that we encourage the analyst and the patient to create a fiction of impersonal contribution. That makes the influence of the analyst’s personal assumptions all the more powerful, because they’re exempted from review, they go underground.

Q. Doesn’t psychoanalysis find that some patients deliberately sabotage themselves because, consciously or not, they don’t really want to get better?

A. Yes, and this is a species of patient blaming. It means the analyst hasn’t understood what the patient’s misguided motivations are. Everybody is trying to cut himself the best deal possible, and if it looks like somebody is trying to do himself in, it’s only because he is trying to escape greater harm by doing so. One example from the book was rather ironic: the patient was continually attacking me, verbally, knowing that his accusations would be discredited. This preserved his wishful thinking that nothing was as it seemed and that his mother was more loving and supportive than he experienced her as being. Discovering this proved to be a turning point in the therapy.

Q. If psychoanalysis is to be more practical in the ways you suggest — providing quick symptom relief, discarding the fiction of therapist neutrality, encouraging more patient collaboration in treatment — is it still psychoanalysis?

A. Yes, I think it is. There are any number of traditional concepts that remain very useful, perhaps the most familiar being unconscious motivation. The effort to reveal such motives when they’re important remains. Another principle unique to psychoanalysis is paying close attention to the treatment relationship itself, and its role in the cure.

But the point is that technique should never define a science. Psychoanalysis doesn’t mean lying on a couch, it doesn’t mean coming in five times a week, and it doesn’t even mean free association. It means applying concepts scientifically to better understand patients.

Q. When is it time to stop therapy?

A. You should have a criterion for judging whether the outcome is satisfactory, which leaves you free to judge by trial and error. If the treatment seems sufficient, you stop. You can always resume the therapy when and if there’s a need. What might also happen along the way, you might become aware of other things that then you define as symptoms, and you want to address those. Let’s say you have trouble dating, for example. We discover when we look into it that you have trouble asserting yourself, and that applies in a number of areas, including your work life. So we go on, until you are able to make progress there. If you’re not having symptom trouble after that, there’s no reason to keep analyzing stuff. That’s it. You’re done.

University, Group Create Autism Registry
Associated Press, 10/10/2006

JEFFERSON CITY, Mo. -- Missouri officials said Tuesday they hope to create a model for other states to work with a new national registry for families dealing with autism.

A University of Missouri-Columbia center dedicated to studying autism is pairing with the Kennedy Krieger Institute in Baltimore. That group is developing a national online registry for parents of children with autism. The university and the state Mental Health Department are creating a state-level registry that will link to the national one.

''We don't clearly understand what services are out there, what services are benefiting people, and where there are gaps in service,'' said Janet Farmer, director of the university's Thompson Center for Autism and Neurodevelopmental Disorders.

Autism is a complex disorder, characterized by a wide range of behaviors, sometimes anti-social, including insistence on sameness, difficulty communicating and an inability to socialize. The Mental Health Department said it serves about 3,400 people with autism but estimated that about 30,000 in Missouri could have the disorder.

The idea behind the registry is twofold. First, it should help researchers learn more about people with autism, their backgrounds, medical history and what treatments have worked or failed. The creators also hope it can help researchers easily find potential subjects who match their criteria.

Those families could soon have a new resource to learn more about the condition, connect with others in their situation, and volunteer for a research project.

''Subject recruitment is one thing that's slowing down research in autism,'' said Paul Law, who is spearheading the Interactive Autism Network national project.

In addition, it should give families a place to learn about new developments and tell researchers what problems are pressing and where their focus should be.

''What parents think they need to better understand and what researchers are going after are not always in alignment,'' Law said.

Some families have begun providing information on a pilot basis, and the Kennedy Krieger Institute is tweaking the system based on their experience, Law said. He expects the registry to launch nationwide later this year.

Farmer said she expects Missouri's version to be up and running early next year.

On the Net:
Thompson Center: http://thompsoncenter.missouri.edu
Kennedy Krieger: http://www.kennedykrieger.org

Grieving Children to Get a Place of Their Own Soon
Jo Mathis, Ann Arbor News- 10/10/2006

Sheila Morrison-Patrias' daughters were just 2 and 4 years old when her husband, Rod, died of leukemia 15 years ago today.

For the first three years, neither girl showed much reaction to the loss.

"In first grade, Stacia (her older daughter) pleaded with me not to tell her teacher or any of her classmates that she didn't have a dad,'' said Morrison-Patrias, of Chelsea. "She didn't want anybody to know she was different. And if someone brought up her dad when I was around, she would ask them not to talk about him because it would make me cry.''

When she was in second grade, Stacia began to cry a lot herself, releasing her pent-up emotions.

That's when the family discovered Ele's Place, a nonprofit center in Lansing designed to help grieving children and their families cope with the death or life-threatening illness of a parent, sibling or other loved one through peer support groups.

Now, Morrison-Patrias, who remarried in 1997, is helping form an Ann Arbor chapter of Ele's Place. The plan is to open the program in the spring, preferably in a westside Ann Arbor location not yet found.

She got the idea about a year ago when she met a grieving family in Chelsea for whom a drive to Lansing was too far.

"It was like the light bulb went off: We need an Ele's Place!'' said Morrison-Patrias, who lived in Jackson when she and her daughters attended the program in Lansing, and now lives in Chelsea.

Morrison-Patrias' daughter, Leah Morrison, 17, a senior at Chelsea High School, thinks a local Ele's Place will be a great resource because so many kids are dealing with a loss.

In fact, she said, two fellow teammates on her basketball team of 12 girls have also lost fathers. Another friend from church has lost her mother. "I definitely can relate to the things she goes through,'' she said. "I feel comfortable talking to her. We understand each other.''

Rod Morrison was 38 when he died just six weeks after his diagnosis. He had been principal of Manchester High School for six years prior to becoming superintendent of Olivet Community Schools for the year before his death.

At his funeral was Chelsea High School Principal Ron Mead, who is also excited about a local Ele's Place. He can speak from experience about grief and trauma. On Dec. 16, 1993, Chelsea High School science teacher Stephen Leith, 51, shot and killed Superintendent Joe Piasecki and wounded Mead and English teacher and union steward Phil Jones.

"Joe Piasecki had a daughter who was a sophomore in our school at that point in time, and I think it's safe to say she still struggles,'' said Mead, who realizes how close his children came to being in the same position. "She's an adult now, holds down a job, lives out of state, and so on. But it's had a permanent impact, and it would have been great if she had had a resource like this at that time.''

He said children who grieve feel isolated about that part of their lives and rarely talk about it at school because other students have no idea how to talk back to them about it.

"That's something Ele's Place can really overcome,'' he said. "At least once a week, they've got this group of kids and a trained volunteer helping them so they can wrestle with their thoughts. Otherwise, this is going to be all bottled up inside them. And sooner or later it's going to cause some problems.''

Mead said a few years ago, a student lost her father between her freshman and sophomore years.

"She was bubbly, always smiling, upbeat, real positive,'' he said. "And I kid you not: I never saw her smile during her entire sophomore year. She was still a great kid, but she was hurting, and it was obvious in every thing she did.''

Ele's Place Executive Director Laurie Baumer said Morrison-Patrias and her volunteers have been dedicated to their task.

"This group just blew our socks off,'' said Baumer. "They worked so hard the first six months and are continuing to work really hard connecting with more people, volunteering on the project, fund-raising, looking for a site.''

In Lansing, Ele's Place relies heavily on Michigan State University college students, as well as retirees and others. Ele's Place staff is helping with the Ann Arbor chapter now, but eventually local volunteers will be trained to lead groups.

Mead said that when Morrison-Patrias first asked him to be involved in Ele's Place, he asked his counselors how many students they knew who had lost a parent. The next day, he had a list of about 20 names, and he knew some names that weren't on the list.

Mead said some people have a misconception about a high school guidance counselor's duties, assuming they should counsel grieving kids.

"They're really guidance personnel more than anything else,'' he said. "They'll do some initial intake, and a certain amount of counseling. But when students have a serious need, our job is to refer them outside the school to the appropriate professional help.''

Grief counseling is something for which resources are lacking, he said.

"We have a lot of people we can send them to for drugs and alcohol issues, but this is a different ball game,'' he said. "(Ele's Place) is a phenomenal thing, and would benefit every child in this situation.''



Tragedy Binds Pair of Texas Mothers
Associated Press, 10/10/2006

DALLAS - Two Texas women who killed their young children in cases that drew nationwide attention have formed a friendship at a state hospital, a newspaper has reported. Andrea Yates, who drowned her five children in a bathtub, and Dena Schlosser, whose baby died after she severed the girl's arms with a kitchen knife, became roommates at the Maple unit of the North Texas State Hospital after each was found not guilty by reason of insanity.
     "We talk about our past, we talk about our memories, our, fun memories, the things that our kids did," Schlosser told The Dallas Morning News. With the support of her family, Schlosser agreed to be interviewed several times by phone. Yates did not want to come to the phone. But her ex-husband Rusty Yates, who regularly visits her at the hospital in Vernon, 174 miles northwest of Dallas, said Schlosser has become a friend. "Hopefully, they can help each other through the long recovery process," he said.  The two women probably will be in the state's care for years, staying at Vernon or another hospital until their doctors and judges agree they can be released.
     Conversations between the women often revolve around their young daughters--Mary Yates was 6 months old and Maggie Schlosser was 10 months old when they died. Schlosser's parents, Connie and Mick Macaulay of Canada, said their daughter once tearfully called after: talking with Yates. "They'd. talked a lot about Mary and Maggie," said Mick Macaulay, a mental health counselor. "They were feeling guilty, remorseful and sad."
     Schlosser, 37, was already at the hospital when Yates, 42, arrived this summer. Yates drowned her children at her family home in suburban Houston in 2001 and Schlosser cut off her daughter's arms in her family home in suburban Dallas in 2004. The women have much in common. Both were married, stay-at-home moms, who followed out-of-the mainstream religious leaders. Both suffered from postpartum depression and psychosis after the birth of their daughters. Yates, who had been a nurse, believed when she drowned her five children - Mary, 2-year-old Luke, 3-year-old Paul, 5-yearold John and 7-year-old Noah - that she was protecting them from Satan. Schlosser, who has a degree in psychology, wanted to offer her baby to God.
     While Schlosser has no distinct memories of what she calls "the tragedy," she knows she killed Maggie. During her trial, psychiatrists said that in her delusional mind, she believed God wanted her to cut off' the baby's arms. "I had delusions. that were going on that I didn't understand, but I believed them. I thought I was doing the right thing," she said. Schlosser eventually hopes to reconcile with her surviving daughters. The girls, now 8 and 11, live with their father, who has filed for divorce.
     She's written her daughters a letter a week since her arrest, telling the girls how much she loves and misses them. But she's waiting to mail them until the girls are ready to read them. .
She also knows they aren't ready to see her yet. "I'm willing to wait. I'll wait as long, I'll wait for the rest of my life," she said. "I love them dearly. My. kids are my world, and they always will be."
Yates has no living children but will one day be buried with her children, a right she won in the divorce.

Addiction Treatment, Novel but Unproven
Shari Roan, Los Angeles Times- 10/10/2006

The drug treatment first raised eyebrows several months ago with its provocative marketing campaign. Featuring deceased comedian Chris Farley and the message "It wasn't all his fault," the billboard, radio and Internet advertisements were a bold departure from the often understated ads used to market addiction treatment.

But since then, it's been the therapy itself, known as Prometa, that has caught the attention of the public and the medical community alike, drawing both anecdotal reports of success and sharp criticism. The philosophy of Hythiam, the small Santa Monica company that developed the treatment, is that drug addiction is a brain-based disorder that cannot be overcome by willpower alone. That belief isn't unusual, but the company maintains that three specific medications — used in a certain sequence and dosage — can treat brain dysfunction and break addictions to alcohol, cocaine and methamphetamine.

Doctors using Prometa "have never seen anything this dramatic," says Terren Peizer, Hythiam's chairman and chief executive. "This is changing the way we approach this disease."

The drugs aren't approved for addiction treatment, and the company makes doctors who use their method sign a disclosure agreement promising not to divulge details. The company also charges up to $15,000 for the two to five outpatient visits that form the core of the treatment.

Critics point out that no randomized studies pitting Prometa against standard treatment or a placebo have been done to show that the method is safe, or useful, in helping addicts achieve sobriety.

"Controlled studies where participants have paid similar amounts of money and have equally high expectations of treatment have not been completed or published," says Dr. Lori D. Karan, a researcher in the Drug Dependence Research Laboratory at UC San Francisco. She suggests there is a high likelihood of a strong placebo effect.

Prometa's secrecy and lack of a track record worry doctors. "They are using a procedure that has yet to be proven effective, charging an inordinate amount of money and making promises they are not able to keep," says Dr. Rick Chavez, medical director of the Pain Institute in Redondo Beach. He says some of his patients tried the Prometa approach and relapsed.

Hythiam officials and proponents of Prometa say critics are worrying needlessly. Not only are no promises made, they say, more than 1,000 of people in the United States have safely undergone the treatment. They say word-of-mouth reports show it works where most other treatments have failed.

An outpatient treatment
Peizer launched Hythiam three years ago after searching worldwide for a better way to treat drug addictions. Although he has no background in addiction treatment, Peizer was looking for an investment opportunity and was intrigued by the idea that addictions could be treated with medications. Before starting Hythiam, he directed several other science or biotechnology companies.

Prometa is based on research by a Spanish doctor who believed that medications that control the gabaminergic system of the brain could help break addictions. The treatment involves administration of an intravenous medicine, flumazenil, and two oral drugs, gabapentin and hydroxyzine, in an outpatient setting. The patient also receives vitamins and minerals and is urged to begin traditional psychosocial counseling and group support meetings to augment recovery.

The medications, which are approved by the Food and Drug Administration for treating other disorders but not drug addiction, are aimed at quieting cravings and improving mental clarity, Peizer says.

Hythiam has applied for a patent to protect its unique use of the three medications and the specific dosing regimen. The company licenses the protocol to addiction treatment centers or doctors for a fee and, so far, has about 45 licensees nationwide, Peizer says.

Peizer points to data compiled by several doctors using the protocol that show it works. Data from a drug court (a specialized court designed to handle cases involving offenders who abuse substances) in Pierce County, Wash., showed that 98% of methamphetamine and cocaine addicts achieved clean urine screening tests for three months after the Prometa treatment provided by Hythiam. That data was presented in June at the National Assn. of Drug Court Professionals' annual conference.

Another 12-week nonrandomized study by Research Across America, a clinical research company, on methamphetamine-dependent patients showed that 80% of patients "experienced a significant clinical benefit" with the medication alone (without behavioral therapy). The benefit was defined as decreased cravings, reduction in methamphetamine use and staying in treatment. The study, which was also undertaken and paid for at the request of Hythiam, was presented in June at the annual meeting of the College on Problems of Drug Dependence.

"You have different populations in different regions of the United States all showing the same result," Peizer says. People like the treatment, he says, because it jump-starts the recovery process and can be accomplished on an outpatient basis. "You don't have the added stress of being away from your friends, family, community and workplace," he says. "You don't have the stigma" of hospitalization.