Noteworthy News Articles on Mental Health Topics, June 22-26, 2006



Jury Selected in Second Yates Trial
Peggy O'Hare, Houston Chronicle- 6/22/2006

A jury of eight men and seven women was selected today to hear the second trial of Andrea Yates, who has pleaded innocent by reason of insanity in the drowning deaths of her children five years ago this week. The 15-member panel includes three alternates, who will be released before deliberations in the capital murder trial begin.
     Not a single person among the 120 panelists summoned to a courtroom today where attorneys will choose a new jury for the retrial of Andrea Yates was unfamiliar with her infamous case. Every citizen in the group, which filled the courtroom nearly to capacity, said they had heard of or had some knowledge of the Clear Lake area mother drowning her five children five years ago. However, state District Judge Belinda Hill told the panelists, such knowledge does not disqualify them from serving on the jury. Rather, she emphasized, the 120 people must ask themselves if they can set aside what they previously learned about the case so they can give Yates a fair and impartial trial.  Yates' new capital murder trial is set to begin at 9:30 a.m. Monday. Hill told the panelists she hopes a jury will be chosen for those proceedings later today.
      Yates, 41, is in the courtroom with her attorneys for the jury selection process. At the beginning of this morning's session, Hill introduced the attorneys to the audience, then introduced Yates as "the accused.'' Like her attorneys, Yates stood up from her chair, faced the audience and nodded politely. "Good morning,'' the crowd said in unison to her.
     Yates' new trial is expected to last anywhere from a month to perhaps five and a half weeks - an announcement that prompted many panelists to shake their heads and sigh audibly. She has once again pleaded not guilty by reason of insanity. A new trial was scheduled when an appeals court threw out Yates' capital murder conviction last year for three of her children's deaths. The appeals court remanded the case because of concerns that a forensic psychiatrist's erroneous testimony might have swayed the jury during Yates' first trial in 2002. Dr. Park Dietz, who served as the state's mental health expert during the first trial four years ago, told the jury that an episode of the NBC drama Law & Order - which depicted a mother being acquitted by reason of insanity after drowning her children in a bathtub - had aired shortly before Yates killed her five children on June 20, 2001. Prosecutors said that Yates was an avid viewer of the program. After Yates was convicted, but before she was sentenced to life in prison, attorneys and the jury learned that no such episode of Law & Order existed.
     The panelists summoned for today's jury selection process included at least two attorneys and at least two physicians. All 120 people had to fill out jury questionnaires earlier this week before reporting to the courtroom. About one-fourth of the crowd - 37 people - told Hill they had already reached a conclusion on Yates' guilt or innocence based on pre-trial publicity that would influence their finding of a verdict. "What I'm saying is, my mind is not 100 percent made up, but I have some very strong feelings about the case,'' one of the panelists told Hill.
     Several people also made clear they don't agree with Texas law on the insanity defense, which requires a defendant to prove she did not know her conduct was wrong at the time of the crime because a severe mental disease or defect. "What if you totally disagree with that concept?'' one panelist asked. "Whether you agree with the law or not, that's the definition,'' Hill told him. Hill stopped another man immediately when he referenced the Yates case specifically. "We're being asked to forget that five people-'' the man said before he was interrupted. "Let me stop you right there. We're not discussing any specifics about this case,'' Hill told him. The man then tempered his comments to the law itself. ``I personally have a fundamental issue with this law,'' he responded to the judge. Another 17 panelists said they believe a person who killed their children is legally insane, no matter what evidence is presented. One panelist asked what happens to a defendant found not guilty by reason of insanity. Hill said the law prohibits her and the attorneys from answering that question.
     Hill informed the panel that a death sentence will not be considered for Yates during her new trial. That's because the jury in Yates' first trial rejected that option. "From the questionnaires, we know that some of you have concerns about the death penalty. Let me tell you from the outset, the death penalty is not an option in this case,'' Hill told the crowd. Attorneys on both sides of the case will each have two hours to speak to the panel later this afternoon. Typically, each side is allowed 10 strikes to remove a person from the panel, but attorneys have indicated they may ask for more.



In Politics, a More Upbeat Mood About Depression
Neely Tucker, Washington Post- 6/23/2006

A politician with clinical depression? What kind, the staggering bipolar variety? The fluttering veils of gray known as dysthymia? He's on medication? Is it a mild dosage of Prozac, a few milligrams of Zoloft? Heavyweight dosages of lithium? Twenty, thirty years ago, it wouldn't have mattered. Any open admission of an illness associated with asylums would have been the kiss of political death. It was "One Flew Over the Cuckoo's Nest" territory. Ask Tom Eagleton. But much has changed about the stigma around mental illness, mood disorders and their role in American politics since Eagleton was dumped from the vice presidential spot on the 1972 ballot after it was learned he had undergone electroconvulsive therapy. Back then, they said it was for "nervous exhaustion."
      Montgomery County Executive Doug Duncan's announcement yesterday that he was dropping out of the Maryland governor's race because of clinical depression startled observers, but mainly because the 50-year-old Duncan had been in public office for more than a dozen years with little indication of depressive behavior. He said yesterday that his family has a history of depression, but he did not elaborate on details of his condition or treatment. He said he had begun medication on Monday.
     It made for dramatic politics, changing the shape of an election. But too much has changed for it to be a political obituary. Call it a political asterisk. "Without knowing more about him, his illness or the medication, it's just impossible to say what should happen next," says Bob Boorstin, who held several senior positions in the Clinton administration while on medication for bipolar illness. "There's been a sea change in public attitudes toward politicians with depression, but that doesn't necessarily mean it's the right thing for a particular person to continue in public life."
     Jennifer Duffy, editor of the Cook Political Report, said perhaps the only sign that things might not have been well in the Duncan camp was that his campaign had not been as aggressive as many had expected. "I kept waiting for him to shift this thing in high gear," she said yesterday. "They started with some ads, but that's not really him, his energy. I'm going to say that this diagnosis explains some of that." Still, she said, that did not mean that it necessarily cast a larger shadow. "Depression is one of these issues that can be dealt with. You have to sort of figure it out, the whys and the treatment, and then you can be okay. . . . I don't think it disqualifies him from future public office, if that's what he wants."      
     Depression has always been with us, of course, whether in the contemplative quiet hours after midnight or in the bright light of the campaign trail. Politicians from Lincoln to Churchill functioned with extraordinary capability despite medical conditions that might today be classified as clinical depression. The difference was that mental illness was not then a topic of public discussion. In 1972, in Eagleton's case, the admission of the illness seemed to equate it with personal weakness or a character flaw. Such perceptions could not stand the weight of scrutiny, and presidential candidate George McGovern dropped him immediately. (Eagleton, years later, said he harbored no bitterness and, had the roles been reversed, would likely have done the same thing.)
     In the intervening years, politics and the art of openly managing medical infirmities changed. Lawton Chiles retired from the U.S. Senate. He later acknowledged that he was suffering from depression, but Florida voters elected him to two terms as governor after he said he was treating the condition with Prozac. Rep. Patrick Kennedy told Rhode Island voters he suffered bipolar depression but was on medication. They returned him to office with 67 percent of the vote. There are ads for antidepressants on television and in the glossy magazines. There are little orange prescription bottles in family medicine cabinets. So many people take antidepressants that a book titled "Prozac Nation" became a national bestseller a decade ago. Still, familiarity with an illness does not diminish the need for medication, or minimize the severity of the disease. Mental illness can kill. "I would not want an untreated depressive to be an airline pilot, a CIA agent or a bartender," says Boorstin.
     In 2002, an advocacy group called the Depression and Bipolar Support Alliance released a poll that showed that 24 percent of all Americans would not vote for a political candidate with a mood disorder. An equal percentage said they "might not vote" for such a candidate. Sue Bergeson, president of the Chicago-based advocacy group, said yesterday that it is likely those poll numbers would be lower now, as more people learn more about the illness. People understand that not everyone with a heart condition should be the vice president of the United States, but they also acknowledge Dick Cheney seems to handle it with the right medication and treatment, she points out. "The pressure of holding office is intense, and whether heart disease or depression, it's going to be hard" for candidates with any sort of infirmity to manage both the job and the condition, she said. "It's not always good for people with terribly disabling diseases to hold these offices, but many do a wonderful job anyway. Where would we be without Lincoln? Without Churchill? The point is, it's an individual issue."

Social Isolation Growing in U.S., Study Says
Shankar Vedantam, Washington Post- 6/23/2006

Americans are far more socially isolated today than they were two decades ago, and a sharply growing number of people say they have no one in whom they can confide, according to a comprehensive new evaluation of the decline of social ties in the United States. A quarter of Americans say they have no one with whom they can discuss personal troubles, more than double the number who were similarly isolated in 1985. Overall, the number of people Americans have in their closest circle of confidants has dropped from around three to about two.
      The comprehensive new study paints a sobering picture of an increasingly fragmented America, where intimate social ties -- once seen as an integral part of daily life and associated with a host of psychological and civic benefits -- are shrinking or nonexistent. In bad times, far more people appear to suffer alone. "That image of people on roofs after Katrina resonates with me, because those people did not know someone with a car," said Lynn Smith-Lovin, a Duke University sociologist who helped conduct the study. "There really is less of a safety net of close friends and confidants."
     If close social relationships support people in the same way that beams hold up buildings, more and more Americans appear to be dependent on a single beam. Compared with 1985, nearly 50 percent more people in 2004 reported that their spouse is the only person they can confide in. But if people face trouble in that relationship, or if a spouse falls sick, that means these people have no one to turn to for help, Smith-Lovin said. "We know these close ties are what people depend on in bad times," she said. "We're not saying people are completely isolated. They may have 600 friends on Facebook.com [a popular networking Web site] and e-mail 25 people a day, but they are not discussing matters that are personally important." The new research is based on a high-quality random survey of nearly 1,500 Americans. Telephone surveys miss people who are not home, but the General Social Survey, funded by the National Science Foundation, has a high response rate and conducts detailed face-to-face interviews, in which respondents are pressed to confirm they mean what they say.
     Whereas nearly three-quarters of people in 1985 reported they had a friend in whom they could confide, only half in 2004 said they could count on such support. The number of people who said they counted a neighbor as a confidant dropped by more than half, from about 19 percent to about 8 percent. The results, being published today in the American Sociological Review, took researchers by surprise because they had not expected to see such a steep decline in close social ties.
     Smith-Lovin said increased professional responsibilities, including working two or more jobs to make ends meet, and long commutes leave many people too exhausted to seek social -- as well as family -- connections: "Maybe sitting around watching 'Desperate Housewives' . . . is what counts for family interaction."
     Robert D. Putnam, a professor of public policy at Harvard and the author of "Bowling Alone," a book about increasing social isolation in the United States, said the new study supports what he has been saying for years to skeptical audiences in the academy. "For most of the 20th century, Americans were becoming more connected with family and friends, and there was more giving of blood and money, and all of those trend lines turn sharply in the middle '60s and have gone in the other direction ever since," he said. Americans go on 60 percent fewer picnics today and families eat dinner together 40 percent less often compared with 1965, he said. They are less likely to meet at clubs or go bowling in groups. Putnam has estimated that every 10-minute increase in commutes makes it 10 percent less likely that people will establish and maintain close social ties. Television is a big part of the problem, he contends. Whereas 5 percent of U.S. households in 1950 owned television sets, 95 percent did a decade later.
     But University of Toronto sociologist Barry Wellman questioned whether the study's focus on intimate ties means that social ties in general are fraying. He said people's overall ties are actually growing, compared with previous decades, thanks in part to the Internet. Wellman has calculated that the average person today has about 250 ties with friends and relatives. Wellman praised the quality of the new study and said its results are surprising, but he said it does not address how core ties change in the context of other relationships. "I don't see this as the end of the world but part of a larger puzzle," he said. "My guess is people only have so much energy, and right now they are switching around a number of networks. . . . We are getting a division of labor in relationships. Some people give emotional aid, some people give financial aid."
     Putnam and Smith-Lovin said Americans may be well advised to consciously build more relationships. But they also said social institutions and social-policy makers need to pay more attention. "The current structure of workplace regulations assumes everyone works from 9 to 5, five days a week," Putnam said. "If we gave people much more flexibility in their work life, they would use that time to spend more time with their aging mom or best friend."

Study Links Air Pollutants With Autism
Marla Cone, Los Angeles Times- 6/23/2006

Children with autism disorders in the San Francisco Bay Area were 50% more likely to be born in neighborhoods with high amounts of several toxic air contaminants, particularly mercury, according to a first-of-its-kind study by the California Department of Health Services. The new findings, which surprised the researchers, suggest that a mother's exposure to industrial air pollutants while pregnant might increase her child's risk of autism, a neurological condition increasingly diagnosed in the last 10 years. But the scientists cautioned that the link they found in the Bay Area is uncertain and that more definitive evidence would be needed before concluding that mercury or any other pollutant could trigger autism.
      Gayle Windham, the study's lead researcher and senior epidemiologist in the department's environmental health investigations branch, called it "a single small study" and "a first look" at whether toxic pollutants play a role in the neurological disorder, which is often marked by poor verbal and communication skills and withdrawal from social interaction.
     Scientists have long wondered if the surge in diagnoses is due, in part, to environmental causes. Some of the increase comes from growing doctor and parent awareness, but experts say that cannot explain all of it. "Clearly this suggests that there may be correlations between autism onset and environmental exposures, especially as it relates to metal exposures," said Isaac Pessah, a toxicologist who heads UC Davis' Center for Children's Environmental Health and Disease Prevention. Pessah, who was not involved in the study, is also a researcher at the university's MIND (Medical Investigation of Neurodevelopmental Disorders) Institute, which studies autism. "It would be prudent to reserve judgment until we see if this study can be replicated and whether it's of general significance" by looking for the same link outside the Bay Area, he said.
     About 300,000 U.S. children have been diagnosed with autism and often need special education. The study compared 284 children from six Bay Area counties who were diagnosed as having so-called autism spectrum disorders — which include a less-severe syndrome called Asperger's — with 657 children from the same counties without the disorders. All were born in 1994.
     The scientists reviewed data for 19 hazardous air pollutants that are known or suspected neurotoxins: chemicals that have a toxic effect on the brain. They found that the children with the autism disorders were 50% more likely than the non-autistic children to be born in areas with higher estimated levels of three metals and two chlorinated solvents: mercury, cadmium, nickel, trichloroethylene and vinyl chloride. No significant link was found with 14 other solvents and metals, including compounds such as lead, benzene and chromium.
     The national autism rate is six children per 1,000, so a 50% increase would elevate that rate to nine per 1,000. The biggest increase came with heavy metals including mercury, a pollutant from power plants, factories and mines that can disrupt brain development.
      The Bay Area was chosen for the study because extensive data are readily available there because of a federally funded program to count and track autistic children. The region's toxic air pollution is considered typical for urban areas. San Francisco County had the highest estimated levels of metals and solvents, including mercury, and Marin County had the lowest of those studied. But the researchers did not compare autism prevalence by county.
     In their report, published online Wednesday in the journal Environmental Health Perspectives, the authors said their research "suggests that living in areas with higher ambient levels of hazardous air pollutants, particularly metals and chlorinated solvents, during pregnancy or early childhood, may be associated with a moderately increased risk of autism. These findings illuminate the need for further scientific investigation, as they are biologically plausible but preliminary and require confirmation."
     The study is the first to look for a connection between autism among children and levels of hazardous air pollutants at birth. Last year, scientists who compared volumes of industrial mercury emissions in Texas with autism in schoolchildren reported a similar link. Autism is believed to start in the womb, early in pregnancy, when the brain develops. Genetic factors determine who is susceptible, but experts theorize that environmental factors contribute. The new study found that mercury was the "most significant correlation with autism," Pessah said, "but every family may not be affected the same way because of their genetic makeup."
     Many parents of autistic children blame vaccines that contained a type of mercury called thimerosal. Expert reviews have found no link between vaccines and autism, but some scientists do not consider them definitive. No assumptions about vaccines can be made on the basis of the air pollution study. "Mercury in the air is a different type than in vaccines," Windham said.
     The new study examined elemental mercury, which is released into the air from coal-burning power plants, chlorine factories and gold mines. It spreads globally and builds up in food chains, particularly in oceans. Levels of mercury are increasing in many parts of the world, largely from power plants in China and India. The researchers had not expected to be able to discern a relationship between autism and the air pollution data. The five metals and solvents are common industrial pollutants, but air is only one source of exposure, because they also contaminate water and food.
     Some experts say that if there is a link between mercury and autism, it most likely comes from fish consumption, the main route of mercury exposure. A 20-year, ongoing study in Denmark's Faroe Islands has shown that children have slightly reduced intelligence when mothers consumed excessive mercury in seafood.
     The largest limitation or uncertainty in the Bay Area study is that the pollution data did not come from measurements of compounds to which the mothers were actually exposed. Instead, they were based on estimates calculated by the U.S. Environmental Protection Agency using computer modeling of industrial emissions. Windham said that "there could be other explanations" for the link they found. For example, it could be that women who live in the worst-polluted areas also smoke more or eat more contaminated seafood. The scientists did not track down the mothers to compare lifestyles. Researchers at Johns Hopkins University's School of Public Health are conducting a similar study in the Baltimore area to see if they replicate the findings.

Guilty Ex-Mayor Rues His Gambling Addiction
Alaine Griffin, Hartford Courant- 6/23/2006

While bill collectors were knocking on the doors of clients Stephen T. Gionfriddo defrauded, the former Middletown politician and lawyer was living the life of a high-stakes gambler, losing nearly $400,000 at casino slots and poker tables since 2001. "I got into something that ate me up," an emotional Gionfriddo, 55, said Thursday after pleading guilty to wire and mail fraud charges in U.S. District Court in Hartford. "I made mistakes. Now, I'm going to try and help the people that I hurt."
     Gionfriddo's lawyer, Richard R. Brown of Hartford, said Gionfriddo's gambling addiction is "the root of the problem" that brought Gionfriddo to court, where the former Middletown mayor waived indictment and entered his guilty pleas before U.S. District Judge Christopher F. Droney. Prosecutors charge that Gionfriddo embezzled $638,138 in client funds. He disputes that number, saying the amount is greater than $400,000 and less than $1 million. Gionfriddo's gambling addiction is so bad, Brown said, Gionfriddo "banned himself" from the casinos, adding his name to a list casinos keep of people who voluntarily agree to be cited for trespassing if they show up.
     Assistant U.S. Attorney Nora R. Dannehy said Gionfriddo and an unidentified family member began frequenting the Mohegan Sun casino in 2000 "with some regularity," soaking the slots with money and spending hours at the poker tables. Between 2001 and 2005, casino records show Gionfriddo lost $391,762, Dannehy said. At one point, Gionfriddo was juggling 10 credit cards with an amassed debt of about $250,000, most of which was cash advances needed to cover gambling expenses, Dannehy said.
     That's when Gionfriddo "began to steal client funds" to cover his debts, Dannehy said, sometimes pocketing the proceeds from a real estate closing or a settlement award. The people he allegedly wronged include neighbors, friends, and his mother, father and brother. "He would misrepresent the status of his cases and used the money to cover his own expenses," Dannehy said. The mail and wire fraud charges stem from Gionfriddo's use of a telephone and the mail in commission of the crimes.
     A complaint from a Middletown couple, Jason and Tara Connelly, led to the suspension of Gionfriddo's law license last July. The couple claimed Gionfriddo shifted $98,000 from the sale of their house into a personal account. Gionfriddo reportedly continued paying the mortgage and had access to the cash for 18 months. With the Connellys' complaint came a flurry of similar stories from Gionfriddo's clients. A trustee was then appointed to examine Gionfriddo's bank accounts and case files. State police began a probe that was eventually taken over by the FBI.
     Middlesex State's Attorney Timothy J. Liston said Thursday there is no pending state investigation into Gionfriddo's actions and that any information state police received in connection with the investigation was turned over to federal investigators. State authorities are seeking to make sure Gionfriddo never practices law again.
     Gionfriddo began practicing law in 1976, focusing on real estate, probate, criminal, and negligence cases. His prominence in the legal community propelled the lifelong local resident into politics, serving on the Middletown City Council for 14 years. Gionfriddo reached his highest office in 1993 when he became mayor after then-Mayor Sebastian Garafalo stepped down. He served in the post for roughly half a year. Gionfriddo also held key positions on the economic development commission and planning and zoning board. Last November, Gionfriddo did not seek re-election, ending more than two decades of service on the city council. He had been the council's highest ranking Republican.
     Gionfriddo has the option of voluntarily giving up his law license forever and agreeing never to apply for reinstatement, said Patricia King of the state disciplinary counsel's office, which pursues evidence of wrongdoing against lawyers. If he fails to do that, King said, she would ask a Superior Court judge to permanently disbar Gionfriddo. There are a total of 18 grievances filed with the Statewide Grievance Committee against Gionfriddo and about a dozen lawsuits against him in Superior Court, seeking money damages. Some of Gionfriddo's former clients who lost money have filed claims for restitution with the state's client security fund. The government says the victims are owed $847,638, which may include expenses they incurred during the investigation.
     Gionfriddo, who was released Thursday after posting a $25,000 bond, will be sentenced Sept. 8. He has agreed not to appeal any prison sentence of up to four years and three months and to make mandatory restitution to the victims. Each fraud count he faces carries a maximum penalty of 20 years in prison and a $250,000 fine. Gionfriddo said he is enrolled in a state-sponsored gambling addiction counseling program. Brown said although he's not sure Gionfriddo will be able to repay all of his former clients, Gionfriddo told him "he's going to spend the rest of his life trying to make whole every single client whose trust he broke."
     For Karen Grenier, 43, it may be too late. Neither she nor her sister, Yvonne, was receptive to the smiles Gionfriddo flashed them in the courtroom Thursday. "He just ruined her financially," Yvonne Grenier, 47, of Middletown, said about her sister, whose money from the sale of her home - about $130,000 - Gionfriddo deposited but ended up never paying off the mortgage. Karen Grenier now faces a series of lawsuits and has filed for bankruptcy. For months, Yvonne Grenier said her sister lived in fear of nonstop calls from the mortgage company, which did not understand her situation, knocks on her door from judicial marshals serving lawsuits, and potential landlords who were aware of her financial woes and refused to let her rent apartments. Karen Grenier struggled with all of this shortly after the death of her husband, Yvonne Grenier said. "We came today just to get a feeling of some sort of justice," Yvonne Grenier, 47, said. "I think he was taking advantage of his status in town, not only his legal power but his supposed prestige as a politician. The real lesson in all of this is what the little person has to do to fight someone with that kind of power."



An Anti-Addiction Pill?
Benoit Denizet-Lewis, New York Times Magazine- 6/25/2006

Last month, the Picower Institute for Learning and Memory at the Massachusetts Institute of Technology was host to a conference about addiction for a small, invitation-only crowd of neuroscientists, clinicians and public policy makers. It was an unusual gathering. Addiction conferences are usually sober affairs, but M.I.T. offered a lavish cocktail reception (with an open bar, no less). More important, the conference was a celebration of the new ways scientists and addiction researchers are conceptualizing, and seeking to treat, addiction. While many in the treatment field have long called addiction a "disease," they've used the word in vague and metaphorical ways, meaning everything from a disease of the mind to a disease of the spirit. Many assumed that an addict suffers from a brain-chemistry problem, but scientists had not been able to peer into our heads to begin to prove it.

Now they can, using advances in brain-imaging technology. And they tend to agree on what they see, although not necessarily on how to fix it: addiction — whether to alcohol, to drugs or even to behaviors like gambling — appears to be a complicated disorder affecting brain processes responsible for motivation, decision making, pleasure seeking, inhibitory control and the way we learn and consolidate information and experiences. This new research, in turn, is fueling a vast effort by scientists and pharmaceutical companies to develop medications and vaccines to treat addiction. The National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism are studying, or financing studies on, more than 200 addiction medications.

The search for pharmacology to treat addiction is not new. The history of addiction treatment in America is rife with supposed miracle medications and "cures," most of which turned out to be useless. But there are a handful of drugs — some developed in the mid-1900's, others in the last decade or so — that are being used to help addicts quit. For heroin addiction, there's methadone and buprenorphine, both of which bind to and activate opioid receptors in the brain. Each essentially substitutes for heroin by activating the same brain receptors as the drug, but many addiction doctors prefer buprenorphine, which the Food and Drug Administration approved in 2002, because it causes less of a high and less dependence.

For alcohol, Antabuse, which makes people physically ill if they drink, has been on the market since 1948, although it isn't widely used. Addiction scientists are more hopeful about another anti-alcoholism drug, naltrexone, which was originally developed to treat opioid addiction but was approved for the treatment of alcoholism in 1994. Studies have found it can help some alcoholics abstain from or cut down on their drinking, and two pharmaceutical companies recently teamed up to produce Vivitrol, a long-acting, injectable form of naltrexone, which the F.D.A. approved in April. Some hope Vivitrol will sidestep a huge challenge facing those seeking pharmacological solutions for addiction: unless they're getting high from it, most addicts aren't model medicine takers. (Vivitrol requires a monthly shot from a doctor.)

None of the medications currently approved to treat addiction are perfect, and in many ways they are the products of some of our earlier advances in neuroscience. In the last few years, though, scientists say they've learned a staggering amount about how addiction affects the brain, and neuroscientists and other addiction researchers are eagerly testing and developing a new generation of anti-addiction medications.

"In 5 or 10 years, we will be treating addiction very differently," predicts Nora Volkow, a psychiatrist and the director of the institute on drug abuse, who attended the M.I.T. conference and presented a lecture, "Addiction: The Neurobiology of Free Will Gone Awry," in an intense and rapid-fire speaking style. (Besides being a leading American thinker about addiction, Volkow is the great-granddaughter of Leon Trotsky.) What Volkow means is that in a decade or so, we may actually start treating addiction effectively. Addiction is one of the nation's biggest public health problems, costing $524 billion (including lost wages and costs to the public health care and criminal justice systems) each year. The majority of the estimated 20 million alcoholics and drug addicts in America (and millions more compulsive gamblers, overeaters and sex addicts, if you accept an expanded understanding of addiction) never get help. Those who do often relapse repeatedly, sometimes returning to treatment centers 5, 10 or 15 times (if they don't die first). And many of those who "recover" simply trade one addiction for another — addicts call this dance "switching seats on the Titanic."

For much of the past two decades, Volkow and other neuroscientists exploring the physiological basis of addiction have tried to explain it by studying the brain chemical dopamine, which functions as a neurotransmitter, sending signals between cells in the brain. Dopamine affects a variety of critical functions, including learning, memory, movement, emotional response and feelings of pleasure and pain.

Dopamine was originally thought to serve as a kind of pleasure signal in the brain, telling us when something feels good or rewarding. But scientists now believe that dopamine is more a predictor of salience — that is, it tells us, and then helps us to remember, what we should focus on. When you see a person you are strongly attracted to, scientists can now see a spike of dopamine in your brain. If you are hungry and smell a food you like, dopamine also increases. But even unpleasant experiences — like physical pain or the fear of an intruder in the house — can cause a dopamine spike. (Some hypothesize that different dopamine receptor cells are responsible for firing during rewarding or aversive situations.)

Drugs, particularly cocaine and methamphetamines, cause a large increase in the amount of dopamine secreted and pooling between brain cells, leading to feelings of euphoria. With regular, repeated "addictive" drug use, though, the brain eventually responds by reducing its normal release of dopamine. Studies also show a simultaneous decrease in the number of dopamine receptors created. That, in turn, makes the brain's reward system less likely to respond to behaviors (romance, a good meal, the company of friends) that produce a normal dopamine surge. The addicted brain essentially becomes pathologically selective, dependent on bigger and bigger blasts of, say, cocaine to feel rewarded.

Perhaps most fascinating to addiction researchers is how an increase in dopamine creates a craving — and an expectation of a reward. In a study published earlier this month in The Journal of Neuroscience, Volkow used a brain scan to look at the dopamine releases in 18 cocaine addicts while they watched two videos: one of nature scenes, the other of people using cocaine. Volkow found that dopamine increased while the addicts watched the cocaine video and that the severity of the increase matched their self-reported level of craving for the drug. "For these people, their lives and experience had taught them that when they see others using cocaine, they're probably about to get rewarded with drugs, too," Volkow told me. "So even though they consciously knew that they weren't going to get cocaine after watching the video, their brains had learned to expect the reward."

Scientists posit that cue-induced dopamine spikes and craving essentially overpower the brain's well-meaning frontal cortex, which is responsible for planning and decision making. The institute on drug abuse is currently financing studies of medications that could potentially blunt that process, interfering with the release of dopamine when an addict sees a conditioned cue.

Dopamine also travels to the parts of the brain responsible for solidifying memory, like the amygdala, which learns and stores emotional memories (including the high of drugs). Some researchers hypothesize that through a combination of medicine and behavioral therapy, addicts could "unlearn" these powerful memories and associations, making them less likely to relapse when they see a cue. "Potentially, you could put an addict in a virtual-reality situation where you show them videotapes of friends they used to use drugs with, or whatever their strongest triggers are," Eric Nestler, a neuroscientist and addiction specialist at the University of Texas Southwestern Medical Center, told me earlier this month. "But now, the cue isn't associated with any kind of rewarding response. So then you can give a medication, which we're making progress on developing, that enhances memory formation. Essentially, you'd be teaching them something new — that a line of white powder means nothing special."

Dopamine may also make some people more vulnerable to addiction. Recent studies in both animals and humans have indicated that those with low levels of dopamine D2 receptors, which regulate the release of dopamine in the brain, are more likely to find the experience of taking drugs pleasurable. Some researchers, like Volkow, suggest that people with fewer D2 receptors experience a less intense reward signal, causing them to overindulge in order to feel satisfied.

In one experiment, Volkow increased the level of dopamine D2 receptors in rats that had low levels. After the increase, the rats significantly curtailed their intake of alcohol, which they had eagerly gulped down before. Unfortunately, we don't yet know how to safely increase the number of dopamine D2 receptors in humans.

In fact, we don't yet know how to do much when it comes to dopamine and addiction. Understanding how the neurotransmitter works may help us to understand addiction better, but it hasn't led to any effective medications, the ultimate goal of many researchers. Because addiction seems to disrupt so many different brain regions, neuroscientists are now casting a wider net in their pursuit of effective medications. For some, the new frontier involves the brain's two major "workhorse" neurotransmitters: GABA and glutamate.

Getting the Brain's Brakes to Work
Walter Ling, a neurologist and the director of the Integrated Substance Abuse Programs at U.C.L.A., likes to explain complex brain processes using simple metaphors. GABA, he says, is to a brain what a braking system is to a car. "The brain works by inhibition," he told me recently. "At some point you realize that your car is a great car not because of its engine but because it has a great braking system. GABA is the brakes. If your brakes don't work well, you crash."

GABA (gamma-aminobutyric acid) is the brain's major inhibitory transmitter, and its role, in essence, is to keep glutamate, the main excitatory transmitter, from overwhelming us. In the extreme, too much glutamate can cause a seizure and too much GABA can put us in a coma. Researchers are particularly interested in the brain's critical balance of GABA and glutamate — some hypothesize that addictive craving is the result of too much glutamate or too little GABA. "We've been able to measure GABA in living brains for some time, but measuring glutamate in living human brains has just become feasible in the last few months," says Frank Vocci, the director of the division on pharmacotherapies and medical consequences at the institute on drug abuse. "What's been shown is that people with alcohol and cocaine problems have less GABA in their brains, and we do know that medications that increase GABA have shown some efficacy in treating addiction." (Vocci says that it isn't yet clear whether the absence of GABA is a cause of addiction or a result.) The seizure medication topiramate, for example, works on both GABA and glutamate and has helped some alcoholics in initial trials quit or cut back on their drinking. The muscle relaxant baclofen, which essentially mimics the effects of GABA, may also help some cocaine addicts quit. Both are being tested further by the institute.

Hythiam, a Los Angeles-based health care services management company that made national news in the spring when it plastered Chris Farley's face — with the words "It Wasn't All His Fault" — on a series of Los Angeles billboards, is particularly interested in GABA's role in addiction. The company is aggressively marketing its Prometa protocol for cocaine, alcohol and methamphetamine addiction, which involves therapy and medications, both oral and intravenously injected, not usually used to treat addiction: flumazenil, approved by the F.D.A. to treat overdoses of Valium and Xanax, and gabapentin, approved to relieve neuropathic pain. While no double-blind placebo studies have tested Prometa's effectiveness (two are under way), addiction-medicine doctors around the country who have administered the protocol report encouraging results. Prometa appears to reduce anxiety and craving by enhancing the brain's GABA receptors, says David Smith, the former president of the American Society of Addiction Medicine and now the director for medical affairs at Hythiam and the head of a Prometa treatment center in Los Angeles. Sanjay Sabnani, Hythiam's senior vice president for strategic development, says: "It's all hypothesis at this point, because we haven't sliced open anyone's brain yet, but it seems that normalizing the GABA receptor takes away the craving and anxiety that one would typically experience in the absence of the drug. And it doesn't appear to be happening because of will power, love, God, discipline, family support or anything else. It seems to be happening because the protocol resets a faulty mechanism in the brain." Yet, several addiction scientists told me they were skeptical that Prometa works, and some criticized Hythiam for promoting it before it has been rigorously tested.

The Prescription Model
Hythiam was among a handful of companies publicizing their anti-addiction medications last month at the American Society of Addiction Medicine conference in San Diego. Several were armed with charts, graphs and clinical-study results (particularly the ones that found their medications most effective), and their eager young marketing and sales teams talked about doing for addiction what the pharmaceutical industry did for depression: medicalizing it, and destigmatizing it in the process.

They know it won't be easy. A series of recent surveys sponsored by the National Council on Alcoholism and Drug Dependence and by Faces and Voices of Recovery, a recovery advocacy group, found that half the public called addiction a personal weakness. Among those who did see addiction as a disease, most put it in a special category of diseases that people get by making poor choices. In a 2004 poll of the general public, two-thirds said they believed that a stigma — usually defined as a thing that disgraces a person or injures one's reputation — exists for people in recovery from addiction.

The pharmaceutical companies came to San Diego to argue that addiction is a chronic and recurring disease like diabetes or hypertension — and no one, they say, tells a diabetic to try to tough it out without insulin. They don't discount the importance of environment in inducing addictive behavior or psychosocial interventions as part of the recovery process; in fact, most stress therapy as an essential adjunct to their products. But they insist that medications will stabilize addicts and make the deeper therapeutic and spiritual work more effective.

In the exhibition hall, the prime booth location near the entrance belonged to Alkermes and Cephalon, the two pharmaceutical companies producing and marketing Vivitrol, the recently approved, injectable form of naltrexone, prescribed for alcoholics. Alkermes and Cephalon are initially focusing on doctors who specialize in addiction, but they plan eventually to market the drug directly to primary care physicians, most of whom are used to sending their addicted patients to treatment centers and groups like Alcoholics Anonymous. "It would require a complete paradigm shift," Doug Neale, a product director at Cephalon, told me, "but we'd like to see the day when a patient who is struggling with alcoholism can walk into their primary care doctor's office, say, 'Doc, I'm drinking too much and can't seem to stop,' and the doctor will have a handful of options for medications that he could prescribe."

But Ling, the U.C.L.A. researcher, cautions that we still have a way to go before we can effectively treat most addicts medically. "In general, we have a pretty good handle on dealing with opioid addiction," he says. But "if you look at the various studies of alcohol-abuse drugs, the results are mixed at best," he continues, adding: "These kinds of mixed findings mean that the drug maybe works for some people, but it's not working all that great. And we're still far off from having a handle on treating people addicted to stimulants like cocaine and methamphetamine."

A Higher Power Versus Medicine
John Schwarzlose, the president of the Betty Ford Center, says he isn't convinced that treating alcoholics and drug addicts with more drugs — particularly if they aren't proved effective — is a good idea. He points out that millions of addicts around the world have recovered without the help of medication. "We're open to medications that will actually work, but the fact is that today 12-step treatment is still the best treatment there is," he told me. "Nothing even comes close. And until something does, we like to try to keep most of our patients as drug-free as possible."

Many addiction treatment centers share that view, which made for a strange scene in the exhibition hall at the society of addiction medicine conference. The treatment centers, most of which advocate a behavioral and spiritual solution to addiction, promoted their centers right next to pharmaceutical companies boasting novel medical solutions. "Why can't these two camps come together?" Smith, the medical director of Hythiam, said as he sat in front of the company's booth. "They need to come together. In medicine, if something isn't working, you try something new. In addiction, if someone goes to treatment and fails, for years we've just sent them back again and again and expected different results. That's insanity. And we're starting to realize that. The field of addiction treatment is changing right before our eyes, and it's only going to continue to change. Advances in neuroscience and pharmacology will change everything."

Those changes could lead to addiction vaccines. Several are already in development. The British company Xenova Group Plc has created what it says are effective vaccines for cocaine and nicotine addiction (NABI Biopharmaceuticals in Florida has also developed a nicotine vaccine). The vaccines, which the institute on drug abuse and others are testing, work by producing antibodies to a specific drug, binding to the drug when it enters the bloodstream and keeping it from entering the brain. An effective vaccine won't stop craving or treat any underlying pathology (making it an inadequate solution, some say), but it will make it nearly impossible for an addict to get high on that particular substance.

And if it is combined with medications that could blunt craving, some addiction specialists believe that we'll stop using the word "treat" and start using the word "cure." Matthew Torrington, an addiction-medicine doctor in Los Angeles who works with Smith at his Prometa center, attended the society's conference and told me that he believes we can essentially eliminate addiction in America.

"With the scientific advances we're making in understanding how the human brain works," he says, "there's no reason we can't eradicate addiction in the next 20 or 30 years. We can do it by fixing the part of the brain that turns on you during drug addiction and encourages you to kill yourself against your will. I think addiction is the most beatable of all the major problems we face. And I think we will."

The Stress Culture
It's not the first time a doctor has predicted the end of addiction. In his book "Slaying the Dragon: The History of Addiction Treatment and Recovery in America," William L. White recounts how in the 1800's, countless "medications" like Knights' Tonics for Inebriates promised to remove "the craving for a stimulant that those who have been addicted to the use of ardent spirits know so well." In the 1905 Sears, Roebuck & Company catalog, a person struggling with opium or morphine addiction could buy a bottled "cure" for 69 cents.

Most of these miracle potions were promoted as a result of important scientific and medical breakthroughs. Science, it seems, has always been just about to save us from addiction. "But it has never lived up to its promise," says Bruce Alexander, emeritus professor of psychology at Simon Fraser University in British Columbia, "and I don't believe the science will live up to its promise now, either. Addiction doesn't demand a scientific solution."

Alexander is among a vocal group of addiction researchers who argue that focusing on a pill to treat addicts fails to address the primary cause of becoming and staying hooked: our unhappy, disconnected lives. Beginning in the late 1970's, Alexander and his team of researchers at Simon Fraser set out to study the role of our environment on addictive behavior. Until that point, most scientists studying addiction put rats in small, individual cages and watched as they eagerly guzzled drug-laced solutions and ignored water and food, sometimes dying in the process. This phenomenon was noted — first by researchers, then drug czars, then parents trying to keep their children off drugs — as proof of the inherently addictive quality of drugs and of the inevitable addiction of any human who used them. This was false, of course. Most people who use drugs don't become addicted.

So what made all those lab rats lose their minds? Bruce Alexander and his research team had a rather simple hypothesis: The rats had awful lives. They were stressed, lonely, bored and looking to self-medicate. To prove it, Alexander created a lab-rat heaven he called Rat Park. The 200-square-foot residence featured bright balls and tin cans to play with, painted creeks and trees to look at and plenty of room for mating and socializing.

Alexander took 16 lucky rats and plopped them into Rat Park, where they were offered water or a sweet, morphine-based cocktail (rats love sweets). Alexander offered the same two drinks to the control group of rats he left isolated in cages. The results? The rat-parkers were apparently having too much fun to bother with artificial highs, because they hardly touched the morphine solution, no matter how sweet Alexander and his colleagues made it. The isolated and arguably depressed rats, on the other hand, eagerly got high, drinking more than a dozen times the amount of the morphine solution as the rats in paradise.

When I spoke with Alexander recently, he predicted that unless we undergo a "cultural renaissance" and all start living in a human version of his rat park (which he conceded isn't likely), we won't be eradicating addiction anytime soon. While Volkow of the institute on drug abuse doesn't agree with Alexander that developing addiction medications is a fruitless enterprise, she does say that a positive and nurturing environment, particularly during childhood and adolescence, is a strong protector against addiction. Volkow says that addicts are more likely to have been unnecessarily stressed during childhood (from neglect; emotional, physical or sexual abuse; or poverty) and that they're less able to deal with stress as adults.

Studies show that animals who are stressed during early development are more likely to self-administer drugs later in life and that living in an enriched environment — one with a minimal amount of strain and anxiety, like Rat Park — appears to protect animals from developing addictive behavior.

And remember the dopamine D2 receptors that some hypothesize may protect us from abusing drugs? There is evidence that our environment can affect those, too. In 2003, researchers at the Wake Forest School of Medicine measured the levels of dopamine D2 receptors of 20 macaque monkeys while they were housed in isolation. They then assigned the monkeys to social groups of four monkeys each, letting natural social hierarchies develop. Three months later, they tested the levels of D2 receptors again.

The dominant monkeys — who, the theory goes, were much less stressed and anxious than the subordinate ones — had 20 percent higher D2 receptor function, while the submissive ones were unchanged. The monkeys were then taught how to self-administer cocaine by pressing a lever, with researchers finding that the dominant monkeys took significantly less cocaine than the subordinate ones.

Interestingly, though, when the animals that seemed to be protected from addiction were given cocaine repeatedly, the number of their D2 receptors eventually went down, and they then became addicted. The moral of the monkey story, Volkow says, is that environment — if good or bad enough — can sometimes trump genetics and biology.

"Some people may be naturally better protected against addiction than others," Volkow says, "but that's not enough to keep someone from becoming addicted. The same thing is true for those who are genetically predisposed. We know from twin and family studies that about 50 percent of a person's vulnerability to addiction is genetic. But if you're never exposed to illegal drugs, or if you grow up and live in an environment without trauma and too many stressors, you probably won't become addicted."

If It's Not One Addiction, It's Another
What Volkow and other researchers can't yet explain is why we choose one particular manifestation of addiction over another. Why do some of us become addicted to cocaine, while others are hooked on alcohol or cigarettes? Researchers hypothesize that environmental availability and genetic predisposition both play a part, but they don't know for sure.

Further complicating the question is that many people are addicted to more than one thing. Howard Shaffer, director of the division on addictions at the Cambridge Health Alliance, an affiliate of Harvard Medical School, suggests a "syndrome model" of addiction: each outwardly unique manifestation of addiction is actually part of the same underlying disorder. Shaffer's syndrome model argues that behavioral addictions (like gambling, sex and eating) can be just as powerful as an addiction to heroin or crystal meth, and his belief is gaining acceptance among neuroscientists and addiction researchers, many of whom used to dismiss this idea as a product of an American culture that's addicted to calling everything an addiction.

But by studying the brain's reward and pleasure systems, researchers are discovering that drugs and powerfully rewarding behaviors like gambling and sex affect it in similar ways. Neurologists at the University Medical Center Hamburg-Eppendorf in Germany, for example, found that pathological gamblers, like drug addicts, have a sluggish reward system that doesn't react normally to pleasing stimuli. The scientists used an M.R.I. scanner to compare the brain responses of 12 gambling addicts and 12 nonaddicted people to a card-guessing game. Subjects were told to pick a playing card, and if the card turned out to be red, they won a euro.

The game activated the ventral striatum, an important part of the brain's reward system. Those nonaddicts who picked a winning card had increased blood flow to the striatum, but the gambling addicts who picked the right card had much less of it (their reward system was less active). It was as if their brains, which were accustomed to powerful rewards, were saying, "You call this silly prize a reward?" The same kind of indifference to basic rewards has been seen in the ventral striatum of cocaine addicts.

"People addicted to gambling and drugs look a lot alike," Shaffer told me when I visited him in his office in March. "Gamblers have to increase their bets to get the same level of excitement, just like someone addicted to drugs who has to keep using more to get an effect. When addicted gamblers cut back, they experience withdrawal symptoms that look like stimulant withdrawal. They get depressed, they're irritable and they have trouble sleeping. And if they gamble again, they can make the symptoms go away for the short run."

While Shaffer focuses much of his recent behavioral addiction research on gamblers, Volkow studies overeaters and also finds many similarities to drug addicts and alcoholics — including the fact that obese subjects have lower levels of dopamine D2 receptors than those who eat normally. "Because we know that many people are addicted to more than one thing and that many people switch addictions," she told me at the M.I.T. conference, "in my own research I'm mostly interested in developing medications that could work across a variety of addictions."

An Addict's Perspective
What do addicts think about all this focus on their brains? William C. Moyers, a recovery advocate (and the son of the journalist Bill Moyers) who for 12 years has been free of crack and alcohol, was invited to speak at the M.I.T. conference. In a room full of scientists and addiction researchers obsessed with the intricacies of the human brain, Moyers read a lecture that reminded them that treating addiction might be even more complicated than they thought.

"I have an illness with origins in the brain. . .but I also suffered with the other component of this illness," he told the gathered researchers and scientists, some of whom dutifully took notes. "I was born with what I like to call a hole in my soul.. . .A pain that came from the reality that I just wasn't good enough. That I wasn't deserving enough. That you weren't paying attention to me all the time. That maybe you didn't like me enough."

The conference room was as quiet as it had been all day. "For us addicts," he continued, "recovery is more than just taking a pill or maybe getting a shot.. . .Recovery is also about the spirit, about dealing with that hole in the soul."

Prenatal Effect Hinted for Some Gay Men
Associated Press, 6/26/2006

WASHINGTON -- Men who have several older brothers have an increased chance of being gay -- whether they were raised together or not -- a finding researchers say adds weight to the idea that sexual orientation is based in biology.

The increase was seen in men with older brothers from the same mother, but not those who had stepbrothers or adopted brothers who were older.

''It's likely to be a prenatal effect,'' said Anthony F. Bogaert of Brock University in St. Catharines, Canada, who did the research. ''This and other studies suggest that there is probably a biological basis'' for homosexuality.

Bogaert studied four groups of Canadian men, a total of 944 people, analyzing the number of brothers and sisters each had, whether or not they lived with those siblings and whether the siblings were related by blood or adopted.

His findings are reported in a paper appearing in Tuesday's issue of Proceedings of the National Academy of Sciences.

S. Marc Breedlove, a professor in the neuroscience and psychology department of Michigan State University, said the finding ''absolutely'' confirms a physical basis.

''Anybody's first guess would have been that the older brothers were having an effect socially, but this data doesn't support that,'' Breedlove said in a telephone interview.

The only link between the brothers is the mother and so the effect has to be through the mother, especially since stepbrothers didn't have the effect, said Breedlove, who was not part of the research.

Tim Dailey, a senior fellow at the conservative Center for Marriage and Family Studies disagreed.

''We don't believe that there's any biological basis for homosexuality,'' Dailey said. ''We feel the causes are complex but are deeply rooted in early childhood development.''

There have been a number of attempts to establish a physical basis ''and in every case the alleged findings have been severely challenged and questioned,'' he said.

''If it is indeed genetically based it is difficult to see how it could have survived in the gene pool over a period of time,'' Dailey added.

Bogaert said the increase can be detected with one older brother and becomes stronger with three or four or more.

But, he added, this needs to be looked at in context of the overall rate of homosexuality in men, which he suggested is about 3 percent. With several older brothers the rate may increase from 3 percent to 5 percent, he said, but that still means 95 percent of men with several older brothers are heterosexual.

The effect of birth order on male homosexuality has been reported previously but Bogaert's work is the first designed to rule out social or environmental effects.

Bogaert said he concluded the effect was biological by comparing men with biological brothers to those with brothers to whom they were not biologically related.

The increase in the likelihood of being gay was seen only in those whose brothers had the same mothers, whether they were raised together or not, he said.

Men raised with several older step- or adopted brothers do not have an increased chance of being gay.

''So what that means is that the environment a person is raised in really makes not much difference,'' he said.

What makes a difference, he said, is having older brothers who shared the same womb and gestational experience, suggesting the difference is because of ''some sort of prenatal factor.''

One possibility, he suggests, is a maternal immune response to succeeding male fetuses. The mother may react to a male fetus as foreign, but not to a female fetus because the mother is also female.

It might be like the maternal immune response that can occur when a mother has Rh-negative blood but her fetus has Rh-positive blood. Without treatment, the mother can develop antibodies that may attack the fetus during future pregnancies.

Whether that's what is happening remains to be seen, but it is a provocative hypothesis, said a commentary by Breedlove, David A. Puts and Cynthia L. Jordan, all of Michigan State.

The research was funded by the Social Sciences and Humanities Research Council of Canada.

On the Net: PNAS: http://www.pnas.org

Nicotine Fight Aims at Brain Receptors
Carey Goldberg, Boston Globe- 6/27/2006

Smokers are about to get some radically different methods to help them quit, based in large part on scientists' progress in attacking nicotine addiction where it happens: in the smoker's brain.

Last week, patients in a clinical trial at Massachusetts General Hospital received their first doses of an experimental vaccine that keeps most nicotine from entering the brain. By late summer, Pfizer expects to begin selling a new pill that partially blocks a receptor -- a type of on-off switch -- in the brain that seems to be the central culprit in smoking addiction.

Also on its way, researchers say, is an experimental drug that targets receptors first discovered in research on marijuana and the ``munchies." By damping down areas of the brain involved in craving, this drug may help smokers quit without gaining much weight, initial studies suggest.

For the first time in 10 years, ``we have completely new approaches for smoking cessation," and there is hope that the new drugs, because they better target the brain's addiction response, could prove more effective than current treatments," said Dr. Nancy Rigotti, director of Mass. General's Tobacco Research and Treatment Center. She cautioned, though, that none of the new treatments ``is a magic bullet."

New tools to help quit smoking are desperately needed, federal health authorities say. Among the 44 million Americans who smoke, about 70 percent would like to quit and 40 percent really try. But in a given year, fewer than 5 percent of would-be quitters actually succeed, a National Institutes of Health panel said last week.

Current drug treatments are moderately effective, on average doubling the success rate of smokers trying to quit compared with those who attempt to break their addiction without any pharmaceutical assistance, said Rigotti.

The arsenal for quitters includes various types of counseling, nicotine replacement in forms ranging from patches to lozenges to inhalers, and Zyban, an antidepressant found to help smokers kick the habit.

None of these has helped Tim Campbell, 44, of Ipswich. Despite endless urging from his wife and six children, and a half-dozen attempts to quit that have included Zyban, nicotine gum, the patch, and hypnosis, he just cannot beat his pack-a-day habit. In 30 years of smoking, the longest he has ever stayed away from cigarettes was about a month. Cigarettes are the first thing on his mind every morning; he smoked even during a cancer walk with his sister.

``I do want to quit, but I can't," Campbell said.

With the rate of relapse still so abysmal, researchers have been struggling to develop radically new approaches.

In the field, ``Vaccine therapy is really the newest kid on the block," said Dr. Victor Reus, a professor of psychiatry at the University of California at San Francisco, who is overseeing a small clinical trial of the ``NicVax" vaccine like the one at Mass. General. Scientists have been trying for a generation to try to harness the body's immune system to fight addiction, but those efforts are only now beginning to pay off, with at least three companies developing anti-nicotine vaccines.

Reus said drugs of abuse -- such as nicotine or cocaine -- are made of small molecules that easily slip across the ``blood-brain barrier," which is essentially a filter meant to protect the brain from potentially damaging substances. With the vaccine, patients develop antibodies to nicotine, so that when they smoke, the antibodies attach to the nicotine and make the resulting molecule too big to pass into the brain. The result: Smoking stops being pleasurable.

Jurors Hear Yates' Chilling Call to 911
Dale Lezon & Peggy O'Hare, Houston Chronicle- 6/26/2006

Andrea Pia Yates sat quietly this morning, staring at the defense table while jurors in her capital murder trial heard details of how she systematically drowned her five children in a bathtub five years ago.

As the trial got under way, jurors listened to a recording of the 911 call Yates placed, and also heard from the first Houston police officer who arrived at the home that day.

The sounds of Yates' heavy breathing on the phone filled the courtroom as prosecutors played a recording of the 911 call,  made at 9:48 a.m. on June 20, 2001. Yates spoke calmly to the 911 operator, but would not say why she needed police.

"Hi. Uh - I need a police officer at home,'' she told the operator. After being asked why, she said only, "I just need them to come ... I just need a police officer.''

Yates said she was alone. When the operator asked if her husband was standing beside her, Yates responded sharply, "No.''

"You sure you're alone?'' the operator asked.

"No, my kids are here,'' Yates finally said.

"How old are your children?'' the operator asked.

"They're 7, 5, 3, 2 and 6 months,'' Yates said in a flat voice.

The operator who took the call, Dorene Stubblefield, told the jury this morning that she felt that Yates understood what she was saying, even though she wouldn't answer some questions.

The first Houston police officer to arrive at the home at 942 Beachcomber told jurors that Yates' hair and clothes were dripping wet when she answered his knock at the door.

"I asked her why she needed the police. She just responded that, 'I just killed my kids,''' Officer David L. Knapp recalled. "She was very wide-eyed, kind of like in an excited state.''

Yates then led Knapp to a bedroom. The carpet in the hallway was so wet that it made squishing sounds as they walked on it, he recalled.

Knapp said he also noticed two sets of wet footprints - an adult's and a child's - covering the tile floor in the living room.

In the bedroom, Knapp discovered four of the children's bodies on a bed, covered by a sheet. He recalled seeing a white, frothy substance coming from three of the victims' noses and mouths, indicating their lungs had burst.

As he inspected the bodies, Knapp said, Yates stood behind him in the bedroom doorway and said nothing.

A fifth child - 7-year-old Noah - would eventually be found, face-down in the filthy, brown water of the bathtub, where all of the children had died.

After the gruesome discovery, Knapp told Yates to sit on a love seat in the living room while he called for help. "She had no problem following those instructions,'' Knapp said.

Yates eventually handed over her driver's license and later signed a consent form allowing officers to search her residence, jurors were told.

The children's father, Russell - who has since divorced Andrea Yates - and his mother, Dora Yates, arrived at the home within minutes of the first police officers, but were not allowed inside, Knapp said.

Russell Yates stood outside, near the windows of the children's bedrooms, calling out the children's names, Knapp said.

The father then walked to a set of French doors in the back of the house, crying and distraught, and asked Andrea Yates through the doors, "Why did you do this?'' Knapp told the jury.

When Russell Yates, overcome by emotion, fell to the ground, his mother tried to comfort him, Knapp recalled. "She was distraught and was also trying to help him at the same time,'' the officer said.

Earlier in the day, defense attorney George Parnham told jurors that Yates has a documented history of severe psychosis.

He said that history included a three-week stay at a mental-health facility a few months earlier and being prescribed strong anti-psychotic drugs.

A few months before the June 20, 2001 drownings, a doctor "for some inexplicable reason" took Yates off the medication and counseled her to have "happy thoughts," Parnham said.

"But for Andrea Yates being taken off anti-psychotic medication, those children would be alive today," he said.

The scene in the courtroom included dozens of news reporters and local residents who listened intently as attorneys for both sides spoke.

Yates' head was bowed as she listened to the prosecutors, and she seemed to slump farther down as Harris County Assistant District Attorney Kaylynn Williford described how Yates held each child under water and how they fought to live.

When Parnham spoke, she raised her head at times and watched him.

Earlier in the morning, the parking lot across Franklin Avenue from the Harris County Criminal Justice Center held several RV-sized television trucks as media outlets from around the nation prepared to cover the trial.

Swarms of news photographers and cameras swirled around people entering the courthouse with cartons of files for the trial about 8 a.m. When defense attorneys arrived moments later, they were mobbed by the cameras, as well.

As early as 7:45 a.m., about two dozen spectators had lined up in the hallway outside the courtroom on the 20th floor. Among them were Russell Yates, and her mother, Karin Kennedy.

Mental-health experts as well as curious onlookers also waited in line for the first-come, first-served seating imposed by state District Judge Belinda Hill.

Moments before the public was ushered in, at least a dozen news reporters jockeyed for good seats in the back row, where Hill had allotted them one seat per media outlet.

When court staff members saw Kennedy in line, they escorted her into the court offices an hour before the trial began. They later made sure she had a seat.

Russell Yates filed into the courtroom with other spectators about a half-hour before the trial began, but he has been subpoenaed to be a witness and was not allowed to remain in the room.

 Before he left, bailiffs escorted Andrea Yates into the courtroom from a holding cell, but she and her ex-husband did not appear to look at each other. She wore a light-green dress and  wire-frame glasses.

Prosecutor Joe Owmby read the charges against Yates, who is on trial for three of her children's deaths. When Hill asked Yates how she pleaded, she replied in a soft voice, "Not guilty.''

Prosecutors often choose not to charge a defendant accused of killing several people with all the deaths, so that, if they fail to win a conviction, they can prosecute the person on the remaining deaths.

But initial studies showed promise, he said, and there's ``a lot of interest, not just for nicotine vaccines but for cocaine and methamphetamine vaccines, which are also being investigated right now."

There is certainly interest among smokers. Rigotti and Reus both said that as soon as they put out word that their clinical trials were starting, they were swamped with hundreds of would-be patients for the two-dozen spots. Rigotti said she is still seeking patients with vascular disease for a safety trial of another smoking-cessation drug, the new Pfizer pill called Chantix.

Chantix, which received US Food and Drug Administration's approval last month, stems from decades of research into how addictive drugs act inside the brain.

With time, it became ever clearer that a particular receptor in the brain with the cumbersome name of the ``alpha-four-beta-two nicotinic receptor subtype," was absolutely central to nicotine addiction, to the point that mice engineered to lack it cannot become addicted. When the receptor was restored in experiments, the mice returned to normal levels of addiction.

A number of experimental drugs now target this receptor, said Dr. Marina Picciotto, a Yale associate professor of psychiatry involved in scientific work on the receptor but not in the drug's development.

Based on the research, she said, companies decided, ``Let's try to tweak it [the receptor] in a way that will allow us to get smokers to have some stimulation of that receptor without having the addiction." With that limited stimulation, the thinking goes, smokers would not go through withdrawal.

Chantix, the drug Pfizer developed, might be compared to a 40-watt bulb that replaces the flickering 100-watt bulb that is nicotine, said Jotham W. Coe, Pfizer's main inventor of the drug or, as he puts it, the chief ``molecular carpenter and architect."

Nicotine, like other drugs, causes a sudden surge of dopamine, a brain chemical associated with pleasure and reward, but the surge quickly gives way to plummeting dopamine levels, which makes smokers feel bad and crave another cigarette. ``Chantix is like a 40-watt bulb that stays on all the time," he said. ``Chantix really is a shield from the vicious cycle of nicotine addiction."

In initial studies, one in five smokers who used Chantix for 12 weeks remained tobacco-free after one year, Pfizer says.

The drug has been approved for up to six months, and its main side effect is mild nausea, Rigotti said. Yet another drug worth watching, she said, is Rimonabant, which was developed to fight obesity but is also being tested for smoking cessation. Its maker, Sanofi-Aventis, has applied to the FDA for approval, for both obesity and smoking. The drug's brand name would be Acomplia.

Research into how marijuana works in the brain yielded discovery of the ``endocannabinoid system," which appears to be involved with feelings of reward and satiety, Rigotti said. Rimonabant acts to block that system, and in initial reports of its results, one of its great appeals is that the people who use it to stop smoking tend to gain very little weight, she said.

Still more research is being done. Dr. Nora Volkow, director of the National Institute on Drug Abuse, predicts that within five years, enough will be known about the genetics of addiction that it will be possible to test children and determine which are at particular genetic risk of becoming addicted to cigarettes or other drugs. Then -- and this is speculation at this point -- the question could arise of whether such children should be vaccinated against nicotine, or whether some other method might prevent them from getting hooked.

Ultimately, researchers said, it seems likely that smokers who want to quit will be offered a menu of various aids, from nicotine replacement to stop the withdrawal symptoms to -- perhaps -- the vaccine to prevent relapse and other drugs to stem cravings.