Noteworthy News Articles on Mental Health Topics, July 1-7, 2007 A study released a little over a week ago, which found that eldest children end up, on average, with slightly higher I.Q.’s than younger siblings, was a reminder that the fight for self-definition starts much earlier than freshman year. Families, whatever the relative intelligence of their members, often treat the firstborn as if he or she were the most academic, and the younger siblings fill in other niches: the wild one, the flirt. These imposed caricatures, in combination with the other labels that accumulate from the sandbox through adolescence, can seem over time like a miserable entourage of identities that can be silenced only with hours of therapy. But there’s another way to see these alternate identities: as challenges that can sharpen psychological skills. In a country where reinvention is considered a birthright, many people seem to treat old identities the way Houdini treated padlocked boxes: something to wriggle free from, before being dragged down. And psychological research suggests that this ability can be a sign of mental resilience, of taking control of your own story rather than being trapped by it. The late-night bull sessions in college or at backyard barbecues are at some level like out-of-body experiences, allowing a re-coloring of past experience to connect with new acquaintances. Psychological studies suggest that seeing past labels from a distance — explaining them, analyzing them, mocking them — not only reduces the sting of the memory but can also reinforce the sense that you have changed, have grown up and out of those old clothes. A more obvious outlet to expand identity — and one that’s available to those who have not or cannot escape the family and community where they’re known and labeled — is the Internet. Admittedly, a lot of the role-playing on the Internet can have a deviant quality. But researchers have found that many people who play life-simulation games, for example, set up the kind of families they would like to have had, even script alternate versions of their own role in the family or in a peer group. Thus the quiet one becomes more forceful, the screw-up more careful, the flake single-minded. The act of seeing your own story, and playing out other versions of it, marks the beginnings of self-definition, and is central to what happens in good psychotherapy. Decades ago the psychologist Erik Erikson conceived of middle age as a stage of life defined by a tension between stagnation and generativity — a healthy sense of guiding and nourishing the next generation, of helping the community. IN a series of studies, the Northwestern psychologist Dan P. McAdams has found that adults in their 40s and 50s whose lives show this generous quality — who often volunteer, who have a sense of accomplishment — tell very similar stories about how they came to be who they are. Whether they grew up in rural poverty or with views of Central Park, they told their life stories as series of redemptive lessons. When they failed a grade, they found a wonderful tutor, and later made the honor roll; when fired from a good job, they were forced to start their own business. This similarity in narrative constructions most likely reflects some agency, a willful reshaping and re-imagining of the past that informs the present. These are people who, whether pegged as nerds or rebels or plodders, have taken control of the stories that form their identities. In conversation, people are often willing to hand out thumbnail descriptions of themselves: “I’m kind of a hermit.” Or a talker, a practical joker, a striver, a snob, a morning person. But they are more likely to wince when someone else describes them so authoritatively. Maybe that’s because they have come too far, shaken off enough old labels already. Like escape artists with a lifetime’s experience slipping through chains, they don’t want or need any additional work. Because while most people can leave their family niches, schoolyard nicknames and high school reputations behind, they don’t ever entirely forget them. And that’s one reason why I.Q., that most loaded label of them all, is such a sore point for so many. It’s too narrow a test, and too arbitrary — especially when differences are slight, as they were in the recent study — to mean the difference between Ms. Studious, and Mr. Screw-Up, to further cloud identities that are already difficult enough to build.
''That's a big lag,'' especially combined with the fact that only 24 percent of alcoholics reported receiving any treatment at all, said study co-author Bridget Grant of the National Institute on Alcohol Abuse and Alcoholism. The treatment rate for alcoholics was slightly less than the rate found a decade earlier. The study did not look at reasons for the decline, but other research has revealed a belief among doctors and the public that treatment doesn't work. However, Dr. Mark Willenbring, director of the institute's Division of Treatment and Recovery Research, said evidence indicates that substance-abuse treatment is more effective than treatments for many medical disorders. Three common approaches to treating alcoholism are 12-step programs, cognitive behavioral therapy and motivational enhancement therapy. Medications such as Antabuse, naltrexone and Campral also can help in combination with counseling, he said. ''The important thing is to engage with treatment and stick with it,'' Willenbring said. About 42 percent of men and about 19 percent of women reported a history of either alcohol abuse or alcoholism during their lives. Whites and Native Americans were more likely than other ethnic groups to report drinking problems. Alcohol abuse was defined as drinking-related failure to fulfill major obligations at work, school or home; social or legal problems; and drinking in hazardous situations. Alcoholism was characterized by compulsive drinking; preoccupation with drinking; and tolerance to alcohol or withdrawal symptoms. The definitions were based on the American Psychiatric Association's diagnostic manual. Treatment, in the study's definition, could have been by a doctor or another health professional, in a 12-step program, at a crisis center or through an employee-assistance program. The study, appearing in Monday's Archives of General Psychiatry, was based on a new analysis of the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. The survey involved more than 43,000 face-to-face interviews with a representative sample of Americans, ages 18 and older. A previous report on the same data found that 4.7 percent of adults reported alcohol abuse in 2001-2002, and 3.8 percent reported alcoholism. The new analysis was the first to report on the prevalence of alcohol problems over a lifetime. The study was funded by the New York State Psychiatric Institute and the National Institute on Alcohol Abuse and Alcoholism, a division of the National Institutes of Health. On the Net: The ‘Big Dreams’ Are the Threads of Our Lives Rebecca Cathcart, New York Times- 7/3/2007 It wasn’t a surprise. He had been given a diagnosis of terminal cancer the year before. But it was a jolt to my system — one switch, pulled down with a thump, the power fading and the conveyor belt coming to a stop. My memories from that week are a jumble of misfiled pieces. But at the end of the second week, I had a dream that remains crisp and vivid in my mind. I sat up in bed and saw my father across the room. His figure was full and healthy and framed by the yellow light that glowed in the stairwell outside my door. He was grinning, green eyes on me, and listening to sounds from the dining room below, the clinking of plates and the voices of my extended family laughing and sharing memories of him. He raised his dark eyebrows and laughed with them. “Back to life” or “visitation” dreams, as they are known among dream specialists and psychologists, are vivid and memorable dreams of the dead. They are a particularly potent form of what Carl Jung called “big dreams,” the emotionally vibrant ones we remember for the rest of our lives. Big dreams are once again on the minds of psychologists as part of a larger trend toward studying dreams as meaningful representations of our concerns and emotions. “Big dreams are transformative,” Roger Knudson, director of the Ph.D. program in clinical psychology at Miami University of Ohio, said in a telephone interview. The dreaming imagination does not just harvest images from remembered experience, he said. It has a “poetic creativity” that connects the dots and “deforms the given,” turning scattered memories and emotions into vivid, experiential vignettes that can help us to reflect on our lives. Grief itself is transformative. It is a process of disassembly. The bereaved must let go of the selves they were, as well as the loved ones they have lost. The dreams we have while grieving are an important part of that process. “Our dreams have to do with how we internalize the people we love,” said Pamela McCarthy, director of counseling services at Smith College. “You learn to look within for the loved one and the particular function that person played in your life, such as caretaking or guidance in the case of a parent. This becomes part of a function that you can provide for yourself.” Cultural narratives in regions like Vietnam and North and South America assign special importance to such dreams and consider them actual encounters with the spirits of lost loved ones. “This notion is so widely shared by traditions all across the globe that some scholars have gone so far as to argue that religion itself actually originated in dream experience,” Kelly Bulkeley, past president of the Association for the Study of Dreams, wrote in his book “Transforming Dreams: Learning Spiritual Lessons From the Dreams You Never Forget” (2000). Current dream study has its epic narrative in the life and dreams of the pseudonymous Ed, a widower who recorded 22 years of dreams about Mary, his deceased wife. Ed made his journal available to G. William Domhoff, a psychology professor at the University of California, Santa Cruz, a leading dream theorist. Dr. Domhoff and Adam Schneider, his research assistant, categorized the 143 dreams and cross-referenced them with Ed’s waking reflections on his wife, their marriage and her death from ovarian cancer on June 15, 1980. In a path-breaking study in 2004, Dr. Domhoff asserted that Ed’s dreams could not be the nonsensical noise of a restless brain stem. They represented the currents of loss, love and confusion in Ed’s waking life. Ed and Mary’s love began on a seaside boardwalk in 1947. They wed a year later, when Ed was 25 and Mary 22. In his more comforting dreams, Mary appears young and radiant as she did that day, with dark hair and bewitching eyes. In Ed’s dreams, his companionship with Mary and her withdrawal during an arduous illness are recurrent themes. Sometimes, his mind weaves these threads together to poignant effect, as when Ed finds himself standing across the street from where Mary sits in a car, unable to cross over. Other times, they form jumbled, comic events. Ed and Mary are lost in a city. They see Jerry Seinfeld and ask him for directions. Soon, Ed realizes that Mary has left with Mr. Seinfeld. He broods behind a building and begins to sink in quicksand. Almost 20 years after Mary’s death, Ed dreams he is walking down a hallway in their old apartment. It leads to Mary’s hospital room, where she lies, gaunt and still. Her head, according to Ed’s journal, is “hanging over the top edge of the bed.” Her hair is sparse, as it was after chemotherapy. “I sit on the bed,” he writes, “and cradle her in my arms.” Such composite images and sudden scene changes, Dr. Domhoff conceded, may be the brain’s effort to make sense of random neuron fire. But they are more likely to be symbolic of Ed’s emotional struggle. Dreams, Dr. Domhoff wrote, are the “embodiment of thoughts” from our waking lives. Deirdre Barrett, assistant professor of psychology at the Harvard Medical School and editor in chief of the journal Dreaming, wrote the first significant study on dreams of the dead. She collected dream reports from two sample groups totaling 245 people at the University of North Carolina, Chapel Hill, and found 77 such dreams. Her findings were published in the 1992 issue of Omega: The Journal of Death and Dying. The type and intensity of these dreams, Dr. Barrett wrote, corresponded to phases of her subjects’ waking grief. She arranged the dreams in four categories based not only on common content, but also on concurrent stages of grieving. The most common was “back to life” dreams, which made up 39 percent of the dreams of the dead in Dr. Barrett’s sample. In such dreams, subjects were surprised or frightened by the appearance of a deceased loved one. Dr. Barrett theorized that these early dreams corresponded to the confusion and denial of early stages of grief. Dr. Domhoff is not willing to link dreams so closely to stages of waking grief. But, he said in an e-mail message, Ed’s dreams did dissipate in intensity and frequency over time. Dreams that occur during rapid eye movement, or REM, cycles are the most memorable and emotionally powerful, said John Antrobus, a retired professor of psychology and sleep research at the City College of New York who founded the sleep laboratory there in 1965. The dreams have power because brain activity during REM is most similar to that of a waking state. The emotional responses to REM dream content, therefore, are most like the responses during waking cognition. In REM, the amygdala, the lima-bean-size gland at the base of the skull responsible for emotions, and the hippocampus, the tissue curled up under the temples that enables memory, are active. The two organs, along with areas in the frontal and prefrontal lobes near the forehead that enable attention and coordination, work simultaneously in producing dreams. “You have an image of a lost loved one, and along come all kinds of emotions you’ve tied up with them,” Dr. Antrobus said. “Their image comes up, and all parts of the brain associated with the loss get activated, as well in REM sleep, because they’re part of our survival system.” In a study last year, Dr. Antrobus and City College graduate students linked the body’s circadian cycle and the singular level of brain activity in REM to the high emotionality of REM dreams. Core body temperature rises gradually from its nadir in the middle of the night during slow-wave sleep, the least active brain state. As morning nears, subcortical brain activity tied to the circadian cycle increases. When these cycles coincide in the last and longest REM phase, the study found, the mind produces its most dramatic dreams. “The brain is waking up,” Dr. Antrobus said in an interview. “It starts waking up long before you are fully awake.” Dreams during this active period are more likely to be highly memorable, vivid, and experiential, what Dr. Antrobus calls “superdreams.” “That’s what people talk about,” he said. “That’s what they’re usually remembering. That’s what these ‘big dreams’ are.” He added that the four or five phases of REM in a normal night’s sleep might include similar dream content. Just as the image of a lost loved one stimulates parts of the brain associated with loss, the content of dreams early in the sleep cycle could set the tone for that night’s dream experiences. Our memories upon waking, therefore, may be our recollection of a night’s cumulative dream content. Apart from an effort to understand the physiology behind the content of dreams, what do we do with big dreams? If we ignore them, said Dr. Knudson of Miami University of Ohio, “we discount our most valuable resource in understanding ourselves.” America is not a country with a ritualistic approach to grief. Many employers offer as few as three days off after a family member’s death. Dreams of the dead keep alive our connections to lost loved ones. “Big dreams, those dreams that stop you dead in your tracks, are for precisely that purpose,” said Dr. Knudson, whose father died three years ago. “They pull us out of our headlong rush forward. They yank us back down from our schedule books and our jobs. He continued, “I don’t want to get over my father. That’s not to say that I want to suffer on a daily basis or that I don’t want to understand that he is dead. But I look forward to dreams in which my father will come again. What does it mean to ‘get over’ it? I think that is crazy.” UConn Project Helps Pot Addicts Kathleen Megan, Hartford Courant- 7/3/2007 When police discovered marijuana in his pocket almost three decades ago, they did the kid a "favor." Rather than arrest him, they brought the 15-year-old home to his father for only a talking-to. High school teachers repeated the favor when they knew he was stoned or saw him smoking a joint outside the school, giving him only verbal warnings. Though he was young at the time, the lessons weren't lost on Jim, who is now 42 and living in the Farmington Valley area and asked that his real name not be used. Too often, the attitude about pot is, "It's only pot," said Jim, and it's thought not to be particularly harmful or addictive. "But I'm here to say that's a lie." As a grown-up, Jim's habit continued, and he lost jobs because of dirty urines but always managed to find a new job. Finally, earlier this year, he reached a point where he couldn't stand the habit any longer: the sneakiness, the cost, the risk of firing or arrest. He feared he'd lose his wife and that his three children would be ashamed of him. That was when he found out about the University of Connecticut Health Center's research project designed specifically to help longtime marijuana users kick the habit. Jim, who had managed to stop drinking when it became a problem, found that quitting marijuana was much harder and that the habit had a huge negative impact on his life. Ron Kadden, a psychologist at UConn and the study leader, said that in previous trials, he and his staff have been successful in helping longtime heavy pot smokers cut back on their usage, but not in getting them to quit completely. This current research project, which consists of nine individual weekly sessions with a counselor and follow-up visits, is aimed at testing various strategies to determine which ones are most successful at getting participants to stop entirely. While other drugs - such as opiates, cocaine and alcohol - may be more physically addicting, Kadden said it appears that marijuana is more addictive psychologically. "They just depend on it," Kadden said of the chronic user. "There is a feeling that you can't function adequately without it." "People are willing to cut down but not willing to get off altogether," he said. "They are having trouble at work, trouble with their families; they are not getting promotions, not thinking as clearly as they would like to. They are not socializing with family and friends because they are so busy getting marijuana or being high. ... There is a feeling of depression and anxiousness when they are not using. ... There is a lot of pre-occupation with it. It's murder to quit." For Jim, marijuana had become a constant every day. Jim, who works second shift, said he'd toke a little first thing in the morning to help him with the chore of getting his three children off to school; then he'd have a little more to help him relax through the morning; then more as he was getting ready for work; another hit during work; and more to relax when he got home in the evening. "It got to the point where high was normal; not being high was abnormal," said Jim. "You didn't feel right unless you were stoned. It became kind of a maintenance thing, maybe not a lot each time, but enough to maintain that feeling of highness." If he didn't have it, he felt as if he was "crawling inside" his own skin and became extremely irritable. He was spending $60 to $120 a week to maintain that steady high. He feared he would get caught again and lose his job, while he also felt like a hypocrite talking to his children. "I'd sit and tell my kid all the dangers, all the bad things about drugs, and here I am doing it," said Jim. "My self-esteem was at an all-time low." Sarah, who also comes from a Farmington Valley town and asked that her name not be used, is a divorced mother of three children, who had also struggled with addiction to alcohol and to other drugs. But in recent years, it was marijuana that she used regularly. "I had to be high to work; I had to be high at lunch. I had to be high to get through the evening and all the many, many activities my kids are in: Cub Scouts, Boy Scouts, soccer. That was my way of being able to go sit and do everything better. "I would like the feeling. I always felt I could function better when I was high," she said. She was also meticulous about making sure that no one knew she was high, always brushing her teeth after smoking. But she also feared her habit would be discovered. "My kids are getting older. I didn't want them to see things. ... I didn't want them to be ashamed of me." Both Jim and Sarah participated in what was a pilot project earlier this year for the current research that Kadden is conducting. The participants were put on one of three slightly varying treatment programs, though both Jim and Sarah had the same treatment plan. Their plan emphasized the development of coping skills to help them quit their habits and provided them with incentives - prizes - for practicing those coping skills at home. Jim said he found it very helpful to work on identifying those behaviors that triggered the desire to use and on developing coping strategies. The hardest part of quitting for him was dealing with the sleeplessness he suffered without pot. However, he said, that only lasted for about two weeks. Meanwhile, he had to deal with his irritability. "Without pot, I didn't have much patience," he said. "It would be like: Oh, I just snapped at that kid for no reason." The training helped him realize that the uncomfortable feelings and the urge to smoke would pass if he just relaxed, counted to 10 or diverted himself in some other way. "Instead of sitting there feeling sorry for yourself," he said he learned to "do something else, wash the dishes, take a walk. I'd say to myself: Stop that. Don't think that way. Look what you're doing to yourself." Along the way, he qualified for prizes such as gift certificates for gasoline and for local stores. Now, he said, he feels as if a big weight as been lifted from his shoulders. "No drug ever gave me this feeling of confidence. That this is doable. You can be drug-free. ... It's very empowering." Kadden said it is encouraging that both Jim and Sarah have been abstinent for several months, but with substance abuse, "there is no such thing as cured." If either have a setback, they can call the program and talk to a counselor and if necessary get a referral for longer-term help. "We'll have to see how they do over a longer period of time," said Kadden. "Talk to me in terms of years and then I'll be impressed, ... but they've got to start here. These are potential successes." Sarah said the treatment helped her learn to deal with the little things that used to make her anxious and nervous and send her running for pot to relax. She also said her determination to have clean urines was a big motivator for her. The prizes also helped: She ended up with a clock radio, a DVD player, a set of tools, a compact disc player, golf balls and other items. But mainly she said it was her own determination to quit. "I didn't want to be 60 years old, still trying to figure out how to get off pot," she said. Arrest Highlights Rx Drug Abuse Associated Press, 7/5/2007 CHICAGO -- Drug abuse experts say the arrest of Al Gore's son underscores the growing problem of prescription drug abuse among America's youth. College students use the stimulant Adderall, an attention deficit drug, to get a speedy high or pull all-nighters The other drugs police say they found in Al Gore III's possession -- marijuana, Xanax, Valium and Vicodin -- also are campus favorites, experts say. ''Al Gore's son is just like everyone else's,'' said Dr. Donald Misch, director of health services at Northwestern University in Evanston. ''The only thing missing was the No. 1 abused drug, which is alcohol.'' Students commonly pair pills with beer and cigarettes, experts say. They trade tips about the effects of prescription drugs on networking sites like Facebook and trade pills they've stolen from home medicine cabinets, ordered on the Internet or taken from friends with legitimate prescriptions. Prescription drug abuse among 18- to 25-year-olds rose 17 percent from 2002 to 2005, according to the White House drug policy office. In 2004 and again in 2005, there were more new abusers of prescription drugs than new users of any illicit drug. Young people mistakenly believe prescription drugs are safer than street drugs, doctors say. But accidental prescription drug deaths are rising and students who abuse pills are more likely to drive fast, binge-drink and engage in other dangerous behaviors. The White House plans a national advertising campaign aimed at getting parents to clean out their medicine cabinets and lock up any prescription drugs they need, said deputy drug czar Scott Burns. ''We found in focus groups of young people across the country that in large measure they're getting the drugs from their own medicine cabinets and the Internet,'' Burns said. Some Web pharmacies deliver ordered drugs without legitimate prescriptions, but other sites steal credit card information and never fill orders, Burns said. Nearly 60 percent of Americans who report abusing prescription drugs say they get them from friends or family, according to the 2006 National Survey on Drug Use and Health, the largest survey on substance abuse in the country with about 70,000 participants. According to another survey, the 2005 National Survey on Drug Use and Health, there are 14.6 million current marijuana users and 6.4 million prescription drug abusers, with most prescription drug abusers using painkillers such as Vicodin. Cocaine ranked third, with 2.4 million current users. The same survey found the annual average number of new abusers of prescription pain relievers was 2.4 million, edging out the 2.1 million new users of marijuana. Al Gore III, 24, was driving about 100 mph on the San Diego Freeway when he was pulled over Wednesday. He was arrested for illegally possessing marijuana and prescription drugs. While a student at Harvard University he was arrested in 2003 for marijuana possession. Former Vice President Al Gore said Thursday his son is getting treatment. The drugs police say they found when they searched the young Gore's car are commonly found on campus, according to experts. Vicodin, a brand name for acetaminophen and hydrocodone, is a painkiller that works by attaching to opioid receptors in the brain; it can be addictive and can bring on a feeling of euphoria when abused. Xanax (alprazolam) and Valium (diazepam) are both used to treat anxiety and can cause withdrawal symptoms when stopped suddenly; they produce feelings of relaxation or drowsiness. Adderall (dextroamphetamine and amphetamine) is used to treat attention deficit hyperactivity disorder and can cause sudden death or serious heart problems, especially if misused. Students crush and snort it to get a fast rush or swallow the pills to stay awake for a late night of studying. Abuse of Adderall and other prescription stimulants is more common on college campuses than among young adults not attending college, experts say. A study published in the medical journal Addiction in 2005 found that rates of abuse of prescription stimulants including Adderall were higher at northeastern colleges and schools with more competitive admission standards. About 4 percent of college students in that study reported non-medical use of prescription stimulants in the past year. Al Gore III's arrest may raise awareness among parents, Misch said. ''This is an opportunity for people to understand this is happening in your household,'' he said. ''These are your kids. The drug dealers they're going to are their doctors, their parents and their friends.'' On the Net: Office of National Drug Control Policy: www.whitehousedrugpolicy.gov How to find treatment: http://dasis3.samhsa.gov/ With Rise in Autism, Programs Strained Carey Goldberg, Boston Globe- 7/5/2007 A decade ago, it took a few months to get a child into Melmark New England, a special school largely for children with autism. Now, the wait can be five years. Boston-area parents, worried their child may be autistic, routinely face delays as long as nine months to confirm the diagnosis -- even though current wisdom holds that treatment should begin as early as possible. And LADDERS, a Wellesley autism clinic, has all but closed its doors to new patients: "We're backed up well over a year here, and other clinics are struggling the same way," said Dr. Margaret Bauman, its director. Statewide, the number of schoolchildren diagnosed with autism has nearly doubled over the last five years, from 4,080 to 7,521, according to soon-to-be-published data from the Department of Education. Massachusetts provides some of the best care in the nation for children with autism, but the increase is straining the system and forcing parents to fight harder than ever to get help. "Many people who haven't had the experience assume the hardest part is hearing your child has autism," said Ann Guay of Bedford, whose 12-year-old son, Brian, has the disorder. "But I think the greater challenge is trying to obtain the services you know your child desperately needs." Nationwide, federal health authorities say that about one in every 150 children now has some form of autism, a sharp increase over past estimates. The rates vary from state to state for unclear reasons; Massachusetts has now reached a total of 1 in every 130 schoolchildren. Advocates for children with autism point out that because autism tends to affect four times as many boys as girls, it appears that already more than 1 percent of Massachusetts school boys are "on the spectrum," which ranges from severe disability to lesser problems with communication and social interaction. Some debate lingers about whether the sharp rise in autism rates is real or simply reflects better detection, but for those in the autism world the question is moot: Whatever the reason, the reality is that more children need their services. "Autism programs are faced with enormous needs and no one feels like we have enough programs to meet the up-and-coming numbers of children," said Rita Gardner, executive director of Melmark, in Andover, which serves children in its school, in their homes, and in public schools. "I would argue that this is one of our biggest public health crises in this country." To keep pace, school systems and state agencies are rushing to open more programs, train more teachers, and hire more therapists to help autistic children. The Legislature is recognizing the need: Starting in fiscal year 2006, it gave the state Division on Autism its own line item in the budget, and in the pending budget, allocates $3.2 million to the division, up from $3 million in the last fiscal year.The Legislature also passed a law in 2005 to maximize federal reimbursement for autism services, which often include intensive one-on-one therapy at home for children as young as 1. But the whole system is visibly straining at the seams, from overworked clinic staffers and vacancies that go unfilled for months, to parents so desperate for help that they pick up stakes and move to towns whose school systems are reputed to have good autism programs. "People will naturally do anything for their kids, so one of the forms of intervention is 'real estate therapy,' " said Rafael Castro, an autism specialist at Children's Evaluation Center in Newton. He has seen families migrate to towns such as Marlborough, Acton, and Lexington that have built good autism programs, he said. A few years ago, when state public health authorities began providing autism services to children under 3, they expected about 500 children to enroll. At last count, they are serving more than 1,100. The 7,500 schoolchildren diagnosed with autism make up less than 5 percent of the 163,000 Massachusetts schoolchildren who receive special-education services. But at Massachusetts Advocates for Children, a nonprofit that helps children with special needs, autism has become a dominant concern. "I'd estimate that approximately a quarter to one-third of our intake calls are now from parents with children on the autism spectrum who are struggling to obtain appropriate educational services for their kids," said Julia Landau, director of the nonprofit's Autism Special-Education Legal Support Center. She and Guay, a former lawyer who volunteers there, say some of the greatest challenges face children from low-income families who must overcome barriers of language or of a culture that imposes such a stigma on autism that they try to keep the disability hidden. Psychologist Karen Levine, clinical director of autism at Cambridge Health Alliance, said autism clinics try to prioritize the youngest children and those who have yet to receive a solid diagnosis, seeing them within a month so they can begin receiving help as soon as possible. Bauman, of LADDERS, which is affiliated with Massachusetts General Hospital, noted that her clinic also squeezes in such cases. Mounting research has demonstrated that intensive early intervention with children on the autism spectrum can bring significant benefits. But the intensity of the therapy needed -- small children may receive up to 30 hours a week from the state -- can place heavy burdens on all concerned. Levine said she knows of many families embroiled in battles with their school systems for more services. Often, she said, the schools see the families as pushy, and the families see the schools as withholding. "Actually," she said, "it's a maxed-out system and legitimate needs." Christina Hernandez, Newsday- 7/5/2007 MELVILLE, N.Y. — The vast majority of adult Americans who abuse alcohol never seek treatment, according to a new government public health survey. The survey, the first of its kind by the National Institute on Alcohol Abuse and Alcoholism in 10 years, presents a full picture of alcohol disorders in the country. The survey, which breaks down rates of alcohol abuse by age, race, socioeconomic group and other factors, also found that 30.3% of adults have abused alcohol or suffered from alcoholism at some point in their lives. One of the more striking findings from the interviews was the low numbers of people who seek treatment for alcohol disorders. Only 24% of those who suffer from alcoholism ever seek treatment. This rate was slightly higher a decade ago. And of those who do seek help, the average age is 32.1 — 10 years following the typical onset of alcoholism for those in the study. As for alcohol abusers — those whose excessive drinking leads to personal and professional problems — just 7% seek treatment, with an average lag time of eight years between the onset of abuse and treatment. The stigma surrounding alcohol abuse stops many from admitting the problem and seeking help, said Barbara Keller, director of the Suffolk Coalition to Prevent Alcohol and Drug Dependency on Long Island. "Because there is tremendous denial, it's just very painful to do the intervention that's needed," she said. The National Epidemiologic Survey on Alcohol and Related Conditions was compiled from approximately 43,000 random interviews with people 18 and older in 2001 and 2002. Of men surveyed, 42% had an alcohol disorder in their lifetime, compared with 19.5% of women. Alcoholism is much more prevalent among men, whites, American Indians, and younger and unmarried adults, the survey found. Over a lifetime, single and married men had virtually identical rates of alcohol abuse and alcoholism, about 31%. Alcohol abuse and alcoholism rates were more prevalent at higher income levels. Of those making less than $20,000 a year, rates of alcohol disorders were 23.9%. For earners of $70,000 and above, the rate was 41.4%. Right to Fresh Air Sought for Psychiatric Patients Felicia Mello, Boston Globe- 7/7/2007 It is not much -- just a 6-foot-by-12-foot space with a few chairs, a barbecue, and pots of basil and pink flowers. But to 47-year-old Gigi Alley, the garden she has built on the porch of her Medford home symbolizes everything she did not have during seven weeks of constant confinement in a psychiatric unit at Cambridge Hospital. "Even in times of real distress, I can find moments of calm just by listening to the wind blow in the trees and seeing squirrels," said Alley, who suffers from depression and multiple personality disorder. That is the idea behind a bill pending in the Legislature that would require psychiatric hospitals to provide patients like Alley with a right long enjoyed by prison inmates: daily access to the outdoors. Dubbed the Fresh Air Bill and sponsored by Senator Patricia Jehlen , a Democrat from Somerville, and Representative Frank Smizik , a Democrat of Brookline, the legislation has met with opposition from medical centers and raised questions about the proper balance between patients' autonomy and doctors' clinical judgment. "It's not that we're against fresh air, it's that we cannot guarantee safety," said David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, which represents the majority of the state's private psychiatric institutions. "Many patients are in the hospital because they are dangerous to themselves and to others." State law already requires all public mental hospitals to provide an enclosed alfresco area for residents to roam. But the law does not apply to the state's 64 private facilities, which range from high-rise, acute-care units in congested urban areas to a working farm in Western Massachusetts where people with severe mental disabilities shovel hay and make cheese. Consumers of mental health services and their advocates packed a hearing late last month before the Joint Committee on Mental Health and Substance Abuse, which is considering the bill, to make their case that sequestering patients indoors amounts to discrimination. It will be months before the bill reaches the floor of the Legislature -- if it ever does. "I think in a way this is one of the last frontiers of the civil rights movement," Jonathan Dosick, founder of the Coalition for Fresh Air Rights, said in an interview afterward. "Psychiatric patients in the larger picture are not being treated with decency and humanity. In our laws, prison inmates are guaranteed time outside per day, and then to have this population of people who are often labeled as violent and unstable and don't enjoy this right really angers a lot of people," he said. Proponents and critics of the bill differ on how many hospitals would be affected. Matteodo says only two of the hospitals in his group completely ban fresh air breaks. But many allow them infrequently, only when enough staff is available, or for patients who behave well, smoke, or stay for long periods. Advocates say such restrictions can make it all but impossible for residents to get outside. "I have talked to parents who are getting calls from an adult child in a psychiatric unit who is told they cannot go outside because they don't smoke," said Dori Hutchinson , director of services for the Boston University Center for Psychiatric Rehabilitation. "Their child takes up smoking just to be able to go outside. To me that's outrageous." Mary Milgrom, senior director of nursing at Cambridge Hospital, where Alley stayed, said the hospital works to provide patients with fresh air on a case-by-case basis and is currently reviewing its policies. While few researchers have explored whether being outdoors speeds recovery, many mental health professionals see the idea as common sense -- especially practitioners of ecopsychology, a budding field that examines how the natural environment influences human behavior. "People without psychiatric conditions seem to cope better and feel more hopeful when they have access to even a small amount of landscaping," Frances Kuo , an ecopsychologist at the University of Illinois at Urbana-Champaign, wrote in a letter to the committee. "Why, then, should people in a more vulnerable state be subjected to an often barren, institutional setting?" A century ago, wealthy eccentrics flocked to sanatoriums in the countryside to recover from stress, while poor patients spent years on state farms where they got plenty of exercise even as the government exploited their labor. In recent years, however, advances in medication and shrinking insurance payments have led to shorter hospital stays, usually indoors in urban environments. With an average length of stay of nine days, some private hospitals argue, fresh air becomes less of an issue. Administrators worry they will have to construct costly outdoor courtyards for patients, or else parade them through the hospital to reach the street, potentially endangering them and the public. "We would never want in the name of fresh air to jeopardize a life," said Dr. John Herman , director of clinical services for the psychiatry department at Massachusetts General Hospital. Those arguments do not convince patients like Alley, who called the unit where she stayed from February to April as insular as a space station. Even the window blinds were kept closed at all times, she said. Returning to the outside world was so jarring, she said, that every sound grated on her nerves. "It's easy to feel freakish and different when you're locked inside," she said. "If I had been ableto go out, it would have made me feel less disconnected."
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