Noteworthy News Articles on Mental Health Topics, July 20-25, 2008



Me and My Girls
David Carr, New York Times Magazine- 7/20/2008

Where does a junkie’s time go? Mostly in 15-minute increments, like a bug-eyed Tarzan, swinging from hit to hit. For months on end in 1988, I sat inside a house in north Minneapolis, doing coke and listening to Tracy Chapman’s “Fast Car” and finding my own pathetic resonance in the lyrics. “Any place is better,” she sang. “Starting from zero, got nothing to lose.”
      After shooting or smoking a large dose, there would be the tweaking and a vigil at the front window, pulling up the corner of the blinds to look for the squads I was always convinced were on their way. All day. All night. A frantic kind of boring. End-stage addiction is mostly about waiting for the police, or someone, to come and bury you in your shame.
     After a while I noticed that the blinds on the upper duplex kitty-corner from the house were doing the same thing. The light would leak through a corner and disappear. I began to think of the rise and fall of their blinds and mine as a kind of Morse code, sent back and forth across the street in winking increments that said the same thing over and over. W-e a-r-e g-e-t-t-i-n-g h-i-g-h t-o-o. They rarely came out, and neither did I, so we never discussed our shared hobby.
     I was lonely, but not alone. The house belonged to Anna, my girlfriend and dope dealer, who had two kids of her own and newborn twins by me. One night, Anna was out somewhere, and I was there with the kids. I had a new pipe, clean screens, a fresh blowtorch and the kids were asleep. It was just me and Barley, a corgi mix I’d had since college. When I was alone and tweaking with Barley, I’d ask her random questions. Barley didn’t talk back per se, but I heard answers staring into her large brown eyes. Am I a lunatic? Yes. When am I going to cut this stuff out? Apparently never. Does God see me right now? Yes. God sees everything, including the blind.
     Trapped in drug-induced paranoia, I began to think of the police as God’s emissaries, arriving not to seek vengeance but a cease-fire, a truce that would put me up against a wall of well-deserved consequences, and the noncombatants, the children, out of harm’s way. On this night — it was near the end — every hit sent out an alarm along my vibrating synapses. If the cops were coming — Any. Minute. Now. — I should be sitting out in front of the house. That way I could tell them that yes, there were drugs and paraphernalia in the house, but no guns. And there were four blameless children. They could put the bracelets on me, and, head bowed, I would solemnly lead them to the drugs, to the needles, to the pipes, to what was left of the money. And then some sweet-faced matrons would magically appear and scoop up those babies and take them to that safe, happy place. I had it all planned out.
     I took another hit, and Barley and I walked out and sat on the steps. My eyes, my heart, the veins in my forehead, pulsed against the stillness of the night. And then they came. Six unmarked cars riding in formation with lights off, no cherries, just like I pictured. It’s on. A mix of uniforms and plainclothes got out, and in the weak light of the street, I could see long guns held at 45-degree angles. I was oddly proud that I was on the steps, that I now stood between my children and the dark fruits of the life I had chosen. I had made the right move after endless wrong ones. And then they turned and went to the house across the street.
     Much yelling. “Facedown! Hug the carpet! No sudden movements!” A guy dropped out of the second-floor window in just gym shorts, but they were waiting. More yelling and then quiet. I went back inside the house and watched the rest of it play out through the corner of the blind. Their work done, the cops loaded several cuffed people into a van. I let go of the blind and got back down to business. It wasn’t my turn.
     Twenty years later, now sober and back for a look at my past, I sat outside that house on Oliver Avenue on a hot summer day in a rental car, staring long and hard to make sense of what had and had not happened there. The neighborhood had turned over from white to black, but it was pretty much the same. Nice lawns, lots of kids, no evidence of the mayhem that had gone on inside. Sitting there in a suit with a nice job in a city far away and those twins on their way to college, I almost would have thought I’d made it up. But I don’t think I did. While I sat there giving my past the once over, someone lifted up the corner of the blind in the living-room window. It was time to go.

On the face of it, I am no more qualified to take my own inventory than the addict with the fetid dreads who spare-changes people on the subway while singing “Stand by Me.” Ask him how he ended up sweating people for quarters, and he may have an answer, but he doesn’t really know and probably couldn’t bear it if he did.
     To be an addict is to be something of a cognitive acrobat. You spread versions of yourself around, giving each person the truth he or she needs — you need, actually — to keep them at a remove. Let’s stipulate that I do not have a good memory, having recklessly sautéed my brain in fistfuls of pharmaceutical spices. Beyond impairment, there may be no more unreliable narrator than an addict. Recovered or not, I am someone who used my mouth to constantly create one more opportunity to get high.
     Here is what I deserved: hepatitis C, federal prison time, H.I.V., a cold park bench, an early, addled death. Here is what I got: the smart, pretty wife, the three lovely children, the job that impresses. Here is what I remember about how That Guy became This Guy: not much. But my version of events is worth knowing, if for no other reason than I was there.
     I was born a middle kid in a family of seven children into a John Cheever novel set on the border of Hopkins and Minnetonka, suburbs on the western edge of Minneapolis. It was a suburban idyll where any mayhem was hidden in the rear rooms of large split-level houses. My home was a good one; my parents were kind; no one slipped me a Mickey, and if they had, I would have grabbed it with both hands and asked for another. It is baked into my nature.
     Let’s skip high school. I graduated and traveled out West, hopping a bus of the so-called Rainbow Family, and on the ensuing ride, they gifted me with peyote, a profound sense of life’s psychedelic possibilities and a tenacious case of the crabs. I came back to Minneapolis and took crummy jobs, including working at a hydraulic-tube assembly plant where my boss was a dwarf who took Dolly Parton’s breasts as his central religious icons. I eventually enrolled in two land-grant universities where I had many friends, very little money and what Pavlov called “the blind force of the subcortex.” I subsisted on Pop-Tarts and Mountain Dew, along with LSD, peyote, pot, mushrooms, mescaline, amphetamines, quaaludes, valium, opium, hash and liquor of all kinds. Total garbage head.
     On my 21st birthday, a dealer who dropped his money on Dom Pérignon at the fancy restaurant where I worked palmed me a cigarette tin and told me to open it in the bathroom. I did the powder inside and it was a Helen Keller hand-under-the-water moment. Lordy, I can finally see! My endorphins made a Proustian leap at this new opportunity, hugging it and feeling all its splendid corners. Every addict is formed in the crucible of the memory of that first hit. Even as the available endorphins attenuate, the memory is right there. By 1985, I tried freebasing coke and its more prosaic sibling, crack.
     “Crackhead” is an embarrassing line item to have on a résumé. If meth tweakers had not come along and made a grab for the crown — meth makes you crazy and toothless — crackheads would be at the bottom of the junkie org chart. In the beginning, smokable cocaine fills you with childlike wonder, a feeling that the carnival had come to town and chosen your cranium as the venue for its next show. There is only one thing that appeals after a hit of crack, and it is not a brisk walk around the block to clear one’s head. Most people who sample it get a sense of its lurid ambush and walk away.
     Many years later, my pal Donald sat in a cabin in Newport, Minn., staring into a video camera I had brought and recalling the crackhead version of me. “As good friends as we were, as much as I loved you, you weren’t you. I wasn’t talking to my friend David; I was talking to a wild man. You were a creature. I was afraid.”
     If the subject of careers or majors came up, I told people I was a journalist, with only that uttered noun as evidence. But then I caught a real, actual story for the local weekly and the fever to go with it. I was a dog on a meat bone when it came to stories; I could type — and sometimes write — as fast as the next guy, and I had an insatiable need to know more. My work got noticed, and some of the more unfortunate aspects of the guy who produced it were overlooked. I got jobs, nailed investigative targets and won a few awards.
     During the day, I took the slipperiness of public officials personally — my moral dudgeon is freighted with irony in retrospect — and displayed significant promise as a reporter. But as time wore on, I combined a life of early promise as a writer with dark nights full of half-baked gangsters and full-blown addiction. I became a dealer for the creative community in Minneapolis, selling coke to colleagues, comedians and club kids. I was a frantic fan of the amazing Minneapolis music scene at the time — Soul Asylum, the Replacements, Prince — but the only thing I played with any regularity was drug-addled fool. I moved grams, eight balls, ounces, quarter pounds — no one trusted me with a kilo for more than a few minutes. Every day I would wake up to a catalog of my misbegotten life — jobs, money, girlfriends and family were all subject to the ineluctable entropy of the junkie lifestyle. There were signs early on that the center would not hold. In the mid-’80s, I was working on a running story about a suspect who had been accidentally shot dead while he was being taken into custody by the police department’s decoy unit. In the middle of the reporting, my phone rang, and one of the cops from the decoy unit was on the line. “You know, I’ve been asking around, and your life is not without blemish,” I remember him saying. “You better watch your step.” For weeks afterward, I would drive somewhere and see the van from the decoy unit in my rearview.
     Some of my running buddies went to prison, but I was more of a misdemeanant, spending hours — and every once in a while, days — in various county jails. I lived by this credo: moderation in all things, especially moderation. My duplicity around women was towering and chronic. I conned and manipulated myself into their beds and then treated them like human jewelry, something to be worn for effect. And when I was called to account, I sometimes responded with violence.
     One night in 1986, I was at a party for Phil, my longtime coke connection who was going away to federal prison. I met Anna, who had better coke than Phil and soon developed a fondness for me. She was selling serious amounts of coke and allowed me to pretend I was her partner. We were an appalling mix, metastasized by her unlimited supply. In less than a year, I lost my job, and she lost her business.
     It would have ended there, but on April 15, 1988, Anna had twin girls. My daughters. Our remaining friends had begged us, quite reasonably, to abort them. Pals began to boycott our house because it had become such a grim, near-scientific tableau of addiction’s progression. Eventually we both went to treatment, and our kids went into foster care. I sobered up; Anna did, too, until she didn’t; and I obtained physical custody of the twins, Erin and Meagan. As a power trio, we worked our way off welfare. I married somebody grand, we had a baby and professionally, one thing led to another, and I ended up working at The New York Times. I have lived most of the last two decades showered by those promises that recovery delivers, with luck, industry and fate guiding me to a life beyond all expectation.

But was it really all thus? When memory is called to answer, it often answers back with deception. How is it that almost every warm bar stool contains a hero, a star of his own epic, who is the sum of his amazing stories? If I said I was a fat thug who beat up women and sold bad coke, would you like my story? What if instead I wrote that I was a recovered addict who obtained sole custody of my twin girls, got us off welfare and raised them by myself, even though I had a little touch of cancer? Now we’re talking. Both are equally true, but as a member of a self-interpreting species, one that fights to keep disharmony at a remove, I’m inclined to mention my tenderhearted attentions as a single parent before I get around to the fact that I hit their mother when we were together. We tell ourselves that we lie to protect others, but the self usually comes out looking damn good in the process.
      The arc of the addict, warm and familiar as a Hallmark movie with only the details pivoting, is especially tidy in the recollection:
I had a beer with friends.
I shot dope into my neck.
I got in trouble.
I saw the error of my ways.
I found Jesus or 12 steps or bhakti yoga.
Now everything is new again.
     In the convention of the recovery narrative, readers will want to scan past the tick-tock, looking for the yucky part so that they can feel better about themselves. (Here’s a taste: When I got to detox for what I thought was the last time, they took one look at my arms and brought me a tub filled with lukewarm water and Dreft detergent to soak my scabrous, pus-filled track marks. They dropped pills into my mouth from several inches away as if feeding a baby bird, and even the wet-brain drunks wouldn’t come near me. See how that works?) Today I am a genuine, often pleasant person, I do solid work for a reputable organization and have, over the breadth of time, proved to be an attentive father and husband. But drugs, it seems to me, do not conjure demons; they reveal them. So how to reconcile my past with my current circumstance? Which, you might ask, of my two selves did I make up?
     As a veteran journalist, I decided to report the story. For two years on and off, I pulled medical and legal documents and engaged in a series of interviews with people I used to run with. By turns, it became a kind of journalistic ghost dancing, trying to conjure spirits past, including mine.
     Some people I interviewed wanted me to say I was sorry — I am, and I did. Some people wanted me to say that I remembered — I did, and I did not. And some people wanted me to say it was all a mistake — it was, and it was not. It felt less like journalism than archeology, a job that required shovels and axes, hacking my way into dark, little-used passages and feeling my way around. It would prove to be an enlightening and sickening enterprise, a new frontier in the annals of self-involvement. I would show up at the doorsteps of people I had not seen in two decades and ask them to explain myself to me.

In drug-gangster movies, the kingpin is always some guy with a pock-marked face who has goombahs on his flanks on the way into the restaurant, sits with his back against the wall and always gets the big piece of chicken. But the most successful person I did business with was just a touch over five feet, cute, with a full head of dyed blond hair, a little mouth and a fondness for maniacs in matters of the heart, if not business.
      When I met Anna, I was more or less living with Doolie, a woman I adored. I began stepping out on her because Anna was in high effect, moving what she said was a kilo a month from straight-up Colombian sources through a series of reliable associates who were also her pals. She worked dead drops in storage spots, safe-deposit boxes and mules to keep her at a remove from the nuts and bolts of the drug enterprise. When the piles of money were too big to hand-count, she used a digital scale to weigh piles of 20s. She had two kids in a nice house in north Minneapolis; the serious dope business was done elsewhere.
     On our first date, we mowed through my eight ball of indifferent coke. She sent me to a safe under the carpet of her steps, and I beheld a pressed kilo of pure cocaine. Decades later, we were talking outside a hotel in Tucson. She still had no trouble recalling the dimensions of a kilo of coke. “It was about as big as a book, about this big,” she said, framing the air with her hands. “It still had the snake seals; I mean, it was right from the Medellín cartel.”
     It had been 10 years since we had even seen each other. Of all the trips I had taken in pursuit of the past, this was one in which a common truth was unlikely to emerge. We each need to find a place to put our time together that does not leave either of us immobilized with shame. I ended up with our kids, but the moral ground curiously rests with her. I hit her, for one thing. And whatever she did, she did out of a kind of love. My instincts were far more mercenary. In her version, everything was going swimmingly until I came along, and then I seduced her into smoking cocaine. In my version, I lumbered into her life, succumbed to abundant blandishments and descended into a violent, destructive mania.
     For a time, we were both riding high. I had a budding reputation as a reporter, and she was one of the most respectable sources of serious weight in the city. Anna introduced me around to her pals as her trusted associates, but they all knew precisely what I represented: the guy who would ruin a good thing. Certainly she got a primer from her adjacency to me, observing that the difference between snorting and smoking coke was vast. “We fought for about six months about it, and then I joined you,” she remembered. She tipped over almost immediately. By the spring of 1988, six months after we had gotten together, her business was in disarray, I had lost my job and then, oh, yeah, she was pregnant. Together Anna and I drew many lines in the sand and then stepped across them, usually with me leading the way.
     When Anna’s water broke in her living room on Oliver Avenue, I had just handed her a crack pipe. (Anna, by the way, swears such a thing never took place. I have my memories, and she has hers.) She had just entered her third trimester. Were we in the midst of giving birth or participating in a kind of neonatal homicide? The water beneath her became a puddle of implication. Now look what we did.

“Man, them are little babies, where’d you get ’em?”The kid, about 8, saw me coming out of the hospital with a twin in each arm in May of 1988. I was speechless. How could a child this small, this unknowing, tell at a glance that these children had landed on me from a very great distance? They had been patients in the neonatal intensive-care unit for a month. Born at 2.5 and 2.9 pounds, and each just over 15 inches, Meagan and Erin arrived two and a half months premature. According to medical records, which I requested almost 20 years after the fact, Erin “cried spontaneously, but each time her crying stopped, her heart rate decreased and her respiratory effort became poor. She was intubated in the delivery room. . . . ” Meagan “had umbilical, artery and venous catheters placed on 4/16/88 for blood pressure and arterial blood-gas monitoring and for delivery of emergency medications.” Once the jaundice of their early birth wore off, they were small pink spots surrounded by an array of tubes and machines, the organic part of the apparatus. As I stared at them in my addled state on visits to the hospital, my mind wandered to bath time, something I had heard that you did with babies. What would we use, a teacup?
      Once we got the girls home, the heart and respiration monitors seemed specifically designed to terrorize us. One of them would shift positions or spit up a bit, and the alarms would go off. Recently, I went to see a pal, Chris, now a professor of creative writing in New Orleans, who watched the unfurling disaster back then. “One winter night, you called me late and said, ‘We’re out of diapers, we don’t have diapers,’ and you thought somebody was watching the house,” he recalled. “You guys were paranoid and getting high, and you said, ‘I think the cops are watching the house; I can’t leave,’ and so I went to the convenience store, got some diapers, drove over, with diapers and milk or something.”
     Chris did what he could, but other friends thought of calling the authorities. A document I found in the twins’ medical files suggested they were already on the case: “The parents have appeared to be open about their drug use. They have stated their intention to attend A.A. meetings and provide a chemically free environment for their children. This may be difficult without intervention considering the long reported history of drug use,” said a letter dated April 22, 1988, from the medical team to Child Protective Services of Hennepin County.

I remember driving to a dark spot between the streetlights at the rounded-off corner of West 32nd and Garfield. Right here, I thought. This would be fine. The Nova, a junker with a bad paint job my brother bought me out of pity, shuddered to a stop, and I saw two sleeping children in the rearview, the fringe of their hoods emerging in outline against the backseat as my eyes adjusted to the light. Teeny, tiny, itty-bitty, the girls were swallowed by the snowsuits. We should not have been there. But I was fresh out. I had nothing. I called Kenny.
      Anna was out, and I could not bear to leave them home, but I was equally unable to stay put. So here we were, one big, happy family, parked outside the dope house. Then came the junkie math. If I went inside the house, I could get what I needed in 5 minutes, 10 minutes tops. The twins would sleep, dreaming their little baby dreams where their dad is a nice man, where the car rides end at a playground.
     The people inside would be busy, working mostly in pairs. Serious coke shooting is something best done together. The objective is to walk right up to the edge of an overdose without actually dying. The technique was to push the plunger in slow but large. One would be pushing, watching as the other listened to the interior sound of blood and nerves brought to a boil. Are you good? Yes. No. . . . Just, um . . . ah . . . that’s perfect.
     Kenny’s lip-licking coke rap was more ornate, somehow more satisfying, than that of most of the dealers I worked with. His worldview was all black helicopters and white noise — the whispering, unseen others who would one day come for us. It kept me on my toes.
     But tonight I had company. I certainly couldn’t bring the twins in. Even in the gang I ran with, coming through the doors of the dope house swinging two occupied baby buckets was not done. Sitting there in the gloom of the front seat, the car making settling noises against the chill, I decided that my teeny twin girls would be safe, that God would look after them while I did not. I got out, locked the door and walked away. Inside, a transformation — almost a kidnapping — got under way. The guilty father was replaced by a junkie, no different from the others sitting there. Time passed, one thing begot another and eventually I was thrown clear.
     Leaving, I remember that. Out the metal door and then out the front door with its three bolts onto the porch and the hollow sound of my boots on the wood floor. A pause. How long had it been, really? Hours, not minutes. I walked toward the darkened car with drugs in my pocket and a cold dread in all corners of my being. I cracked the front door, reached around, unlocked the back and leaned in. I could see their breath. God had looked after the twins, and by proxy me, but I realized at that moment that I was in the midst of a transgression He could not easily forgive. I made a decision never to be that man again.
     In Minneapolis 19 years later, I stood on the spot outside Kenny’s where I parked that night. The car was, according to my brother Jim, a Chevy Nova. He sent me the title: ’79 Chevy Nova with 89,950 miles on it, plate number NHS091. Thinking back through all those years, I remember standing by the car, I remember looking back in. I remember the math. And I remember the snowsuits.
     But that’s where the plot thickens and the facts collide. Erin and Meagan were born on April 15, 1988. Whenever I felt compelled to explain myself and the cold facts of our history, that night outside Kenny’s was the necessary moment. In the story as I recited it, that horrible night occurred very soon after they were born. I thought I quickly entered treatment because even though I had been an unreliable employee, a conniving friend and a duplicitous husband, nothing in my upbringing allowed me to proceed as a bad father. The twins were then whisked into temporary foster care soon after their birth. After that, it’s a Joseph Campbell monomyth in which our hero embraces his road of trials, begins to attain a new Self and hotfoots it back to the normal world.
     Nice story if you can live it. If the girls were born in April, and I went into treatment a few months afterward, as I have always said, where did the snowsuits come from? Minnesota is cold, but not that cold. When I was talking to my brother about the make of the car and mentioned the snowsuits, he said: “That’s easy. You didn’t go to treatment until sometime in December, like eight months after they were born.”
     He’s almost right. I did not enter Eden House, a six-month inpatient treatment program in Minneapolis, until Nov. 25, 1988. So the presence of snowsuits on a cold November night were undoubtedly real. That part about me straightening out right after they were born? A myth, but not the kind Joseph Campbell had in mind.

Sometime soon after that night at Kenny’s — the week before Thanksgiving 1988, as I would later find out — I became convinced that something brutal and unspeakable was about to land on all of us, including the kids. At our house, it all was needles, blood, babies and piles of dirty clothes. High or not, it was hellish to behold.
      I called my parents and said that if they took the kids, I would go to detox and Anna would go to treatment. “You told us that there were no adults in the house, that it was a dangerous place for children to be,” my dad recalled as I talked to him on his deck overlooking Lake Minnetonka in the summer of 2006.
     Did I say goodbye to the girls? I can’t remember, and neither can my dad. And then I left. Having benchmarked a new kind of bottom, I needed gas and a boost of coke, so I stopped at the station just up the street from their house. I was out of my mind with grief and loss, and when I pulled out of the station, I gunned the engine to leave behind what I had just done. I got pulled over a few blocks away for driving recklessly and thrown in the back of the squad car. When we got to the brightly lit station, the cop who pulled me over stared at the welter of needle marks on my arms. He went out to his car and came back red-faced, tapping a bindle of coke into the palm of his hand. “I found this under my backseat,” he said. “You put it there.” “I can’t help you with that, officer,” I said as politely as I could manage.
     They eventually kicked me loose. It took me a few more days to get to detox, a nice suburban facility near my parents’ house. Detoxes are really human aquariums, a place where large, Librium-infused humans bob here and there, watched by the staff through thick plate glass in case one of them freaks out or starts flopping around. My job, as it turned out, was to settle my arms up to my biceps in a large tub of Dreft detergent, a nice low-tech way of disinfecting my track marks without involving a lot of hands-on work by the staff. I had become a white-trash untouchable.
     A few days later, my parents had Thanksgiving dinner, and I came straight from detox. My babies were there. After dinner, my parents spoke to me quietly, off to the side. They had spoken to my older brother, John, a guy who worked in leadership for the Catholic Church, and he had wired up temporary foster care through Catholic Charities. Erin and Meagan would be placed with a family while I went “to deal with things.” It was decided that I would follow my detox with an intensive six-month rehab program at Eden House, a last-chance facility in downtown Minneapolis.
     So that was it. Only it wasn’t. When I was in New Orleans talking to Chris about that time, he reminded me that the night before I went in to Eden House, I had to go back at it one more time. “You had called me and wanted me to pick you up some rocks, because you were going in the next day, and you wanted to get high one more time. And I did. I think it was the only time I’d been to your parents’ house, but we were in your basement or first floor, the bedroom down there. I had to open up the car door for you because your hands were all swollen up, your arms were all bruised up from — ” Um, shooting coke? “Yeah, I think it was kind of a moment for me,” he said.

By my recollection, when the twins went into temporary foster care, I handed them to some faceless county bureaucrat. Besieged by unseen forces within, the father, with the gentle encouragement of his parents, admits that he is worthless and that strangers must step unto the breach and pry the children from his hands. Never happened, at least not that way.
      When I called Pat and Zelda, Erin and Meagan’s temporary foster parents, in the summer of 2007, they explained there was no faceless bureaucrat, that my mother and I had dropped them off just before I went to Eden House. They loved those babies from the minute they saw them. Their father? Not so much.
Zelda: “You were very serious, very somber, and it felt kind of belligerent, like you really weren’t interested, like you really didn’t want to talk to us much, but we were a necessary evil. This was a good place to put the girls. You were that way and — ”
Pat interrupted. “And you were high.”
Zelda: “You were a bit disheveled.”
David: “Disheveled and high.”
Zelda: “Yes.”
Pat: “And you fell on the floor.”
David: “In what way?”
Pat: “You just kind of lost your balance and fell on the floor, and I remember thinking that if one of the babies was there, the baby would have suffered some pretty severe injury.” Pat had his doubts about ever seeing me again.
Pat: “I remember thinking, this will never work . . . you were so far out of it. I just thought that this was a way of exiting the scene.”

Eden House was a long-term therapeutic community, the kind of place that brimmed with slogans. This was the main one: “The answer to life is learning to live.” This is the point where the knowing author laughs along with his readers about his time among the aphorisms, how he was once so gullible and needy that he drank deeply of such weak and fruity Kool-Aid. That’s some other story. Slogans saved my life. All of them — the dumb ones, the imperatives, the shameless, witless ones. I lustily chanted some of those slogans and lived by others. There is nothing romantic about being a crackhead and a drunk — low-bottom addiction is its own burlesque that needs no snarky annotation. Unless a person is willing to be terminally, frantically earnest, all hope is lost.
      All the assets I had — an ability to verbalize, intellectualize and filibuster — got no play at Eden House. In at least a few other treatment centers, I was often seen as baby Jesus, a counselor’s pet who knew all the jargon and right buttons to push. At Eden House, I was seen as a fool, and a pretty soft one at that. It wasn’t Abu Ghraib, but it wasn’t the treatment place with the elliptical machine and a staff nutritionist, either.The chronicity of addiction is really a kind of fatalism writ large. If an addict knows in his heart he is going to use someday, why not today? But if a thin reed of hope appears, the possibility that it will not always be so, things change. You live another day and then get up and do it again. Hope is oxygen to someone who is suffocating on despair.
     The implications of a misstep arrived every weekend. My parents would come by with the twins after having picked them up from the foster-care family and set them down to crawl around in the visiting room. I can remember one of the female counselors — Beth, maybe — coming in and marveling at Erin and Meagan and asking no one in particular whom they belonged to. It took me just a second to realize the answer. “That would be me.”
     My counselor at the time was Marion, a large black man who affected mirrored sunglasses and an air of mystery. Three months into treatment, I had arranged all of the necessary passes to go to my sister’s wedding. The Friday night before the event, Marion called me into the office and told me if I went to the wedding, I should not bother coming back. I was livid, and my family suggested that I should walk away from this arbitrary place. I remember going down to Marion’s office later to tell him off, but then I stayed and did not go to the wedding. What had he said to me that changed my mind?
     Marion pulled up on a motorcycle at a coffee shop in south Minneapolis in July of 2006 with the mirrored shades still firmly in place. I told Marion that I remembered going down to his office to tell him where he could put his “therapeutic no.” What had he said? He remembered what I did not. “You were on the verge, and I told you, ‘Well, why don’t you just get those two girls high too?’ ”
     When I got out of Eden House after six months, I moved into a sober house and began taking care of the kids here and there. Anna and I were no longer together, but she had sobered up as well, so the children had been returned to her. But while I was going to recovery meetings and doing my little freelance writing assignments, Anna began struggling.
     One day in the summer of 1989, I showed up at her house and the twins were wet, hungry and wailing. We went to the nearby 7-Eleven on Penn and Dowling Avenues in north Minneapolis. I waited until the spot right in front of the door opened up, and I went and quickly bought diapers, milk, new bottles and some bananas. While I changed them, they ate the bananas and drank the milk with an animal intensity. I decided not to take them back, not knowing what it meant other than the fact that I would need my own place, more clothes and more money.

If I am a good person now and an able father, I must have been the easy choice as custodial parent back in the day. In this formulation, when I started pursuing custody, I was just a beefier version of Mother Teresa, all selflessness and calm, and Anna was a nasty basket case. Eighteen years after the case was decided, I went to see Barbara, the attorney who helped me obtain custody of my daughters.
      These many years later, Barbara hesitated when I ran that story and then told a different one. “You looked unwell,” she said. “You weighed close to 300 pounds. It was in the winter, and you had on a very heavy coat, but it obviously didn’t fit you; it was raggedy. If I had seen you on the street, I would have thought you were homeless, because you were very rough. Your hygiene was bad; your eyes were rheumy.”
     But even so, I was a man about my business, right? “I wasn’t used to having clients look like you. I didn’t do criminal; I represented banks and mortgage companies, and so to have you come in and want custody of two little babies, um, I struggled with whether or not that was even a realistic goal that we should consider. . . . I couldn’t tell if you were following along well enough to understand the impact of what this would mean to your life.”
      So other than being addled from an unspeakable habit, a little smelly and a touch on the amazingly obese scale, I was good to go. Ready to star in one of those car commercials where the kids crack wise in the backseat while the dad says something sage and knowing into the rearview. Except I didn’t have a car. And the kids did not legally belong to me. I had never married their mother or established my paternity. I had no insurance, and I had not paid taxes in several years. Although Anna has always given me abundant credit for doing a good job with our twins, she is quick to remind me that I stole them in the first place. A part of me was convinced she was right. Revisiting the issue with Barbara, I talked about how we managed to persuade Anna to take a drug test when she moved back from Texas, where she had been staying with her mom. We made visitation conditional on a clean result, and she came up positive for cocaine and pot. I remembered this as a clever linchpin in our legal strategy, but Barbara reminded me that Anna had failed that test over and over and that she moved in with a dope dealer when she got to town. How she missed appointments to see the kids, missed court dates, switched lawyers and eventually agreed to a settlement that gave me physical custody of the girls.
     History suggests that things turned out as they should have, but Anna’s suggestion that I was not the obvious choice as the twins’ custodial parent found significant traction when I went back and looked at the record. I had won a tallest-midget contest with Anna, nothing more. Each of us had a history of relapse, and mine was far more extensive. The lie that I told myself — that I was made entirely new by my decision to lay off drugs — kept doubt at bay. If I really examined my fitness in all of its dimensions, I would have been paralyzed. It was a fairy tale that kept me alive and allowed me to make it come true. Everything good and true about my life started on the day the twins became mine.

When a woman, any woman, has issues with substances, has kids out of wedlock and ends up struggling as a single parent, she is identified by many names: slut, loser, welfare mom, burden on society. Take those same circumstances and array them over a man, and he becomes a crown prince. See him doing that dad thing and, with a flick of the wrist, the mom thing too! Why is it that the same series of overt acts committed by a male becomes somehow ennobled?
      I’m not saying that raising children, especially by yourself, is a trip to Turks and Caicos, but single parenting is as old as reproduction. Families declare themselves in all sorts of versions, and ours happened to be two adorable toddlers stapled to 250 pounds of large, white male. Still, people who knew our circumstance marveled at its idiosyncrasy. And people who knew me before the twins wondered all the more.
     I had no idea what I was doing, but children teach you how to care for them. Leave the house without an extra diaper, and they will have some brutal, smelly event at a McDonald’s. Let them wheedle their way into your bed so you can get some rest, and you will be fighting them off every single night of their young lives. Gradually, slowly, the three of us developed a routine at bedtime, with baths, prayers and stories — stuff I had been brought up on or seen on TV.
     As we spent more time together, they began to know me, and I came to adore them — madly, deeply, truly. We developed other rituals. When it came time to actually turn out the light, I would sing a song of my own making.
To the tune of nothing in particular, but very up-tempo:
“Oh, I’ve got the nicest girls in town,
I’ve got the nicest girls in town.
They are so nice, they are so sweet,
I love them twice, they can’t be beat.”
And then, a real strong Broadway finish, with every note held and punished (apologies to Ethel Merman).
“Oh. I’ve. Got. The. Nicest. Girrrrrrrls.
Innnnnnn.
Townnnnnnn.”
     It was a huge hit in our crummy little upper duplex, but if that all sounds like some after-school special, with the fat ex-junkie dad singing to his misbegotten daughters, well, it is what it is.

I always thought that people who spent endless amounts of time drilling into their personal histories are fundamentally unhappy in their lives, and I’m not. I’m ecstatic in my own dark, morbid way and subscribe to a theory of the past that allows the future to unfold: We all did the best we could.
      Even with the trope of reporting, my addiction narrative arrives at some very common lessons. Too much of a bad thing is bad. If you don’t sleep and eat but drink and drug instead, you will lose jobs, spouses and dignity. And while the lessons of the recovery story are important, they are even more prosaic. Once I stopped doing narcotics and alcohol, I landed good jobs, remarried, had a baby and, of course, learned to love myself.
     Junkies and drunks frequently end up putting a megaphone to their own pratfalls in the form of memoir because they need to believe that all of the time they spent with their lips wrapped around glass, whether is was a bottle of vodka or a crack pipe, actually meant something. That impulse suggests that I don’t regret the past — it brought me here to this nice, happy place — but I’d also like to squeeze something more from it. And so I have.
     Two years of reporting and a lot of awkward conversations later, I realized that in reductive psychoanalytic terms, I had achieved a measure of integration, not just between That Guy and This Guy but between my past and my present. Carl Jung suggested that until we embrace both our masculine and feminine sides, we can’t be made whole. For all the testosterone I have deployed in my affairs, I experienced salvation in expressing common maternal behavior. You are always told to recover for yourself, but reproduction has an enormously simplifying effect on life: Are you willing to destroy others, including little babies, in order to feed the monster within?
     Not in my case, but it was a much closer call than I would like to admit. I now inhabit a life I don’t deserve, but we all walk this earth feeling we are frauds. The trick is to be grateful and hope the caper doesn’t end any time soon.

David Carr is a culture reporter and the media columnist for The New York Times. His book, “The Night of the Gun,” from which this article is adapted, will be published in August.

This One’s for Daddy
THE PRINCE OF FROGTOWN
By Rick Bragg.
255 pp. Alfred A. Knopf. $24.

Christopher Dickey, New York Times Book Review- 7/20/2008

The dirt-poor man of the South — the much-caricatured hillbilly, the redneck, the malicious drinker of mean moonshine, proud to the point of self-destruction, brave to the verge of madness, who’d fight you as soon as look at you but cherishes an atavistic sense of decency and fairness, even chivalry — that man has long been a puzzlement to much of the rest of America and, often as not, to himself. And one man like that, whose people were like that, was Rick Bragg’s father, Charles. “The Prince of Frogtown” is his story, and theirs.
      Bragg has been looking for his old man for a long time, although he didn’t always know that. In his best-selling 1997 memoir, “All Over but the Shoutin’,” he told the story of his mother and her love and courage raising three kids on welfare and the wages she could get picking cotton or cleaning houses in east Alabama. In “Ava’s Man,” the next book Bragg wrote about his family, he told of his mother’s father but not of his own. “I sawed my family tree off at the fork,” Bragg writes here, “and made myself a man with half a history.”
     Bragg, a Pulitzer Prize-winning journalist, couldn’t begin to get his daddy into focus and thought that he didn’t want to try after all he’d seen his momma endure: “Against his darkness her light was even brighter, as she just absorbed his cruelties till she could not take them into herself anymore.” So like many reporters who know how to use a pen as a sword and a notebook as a shield, he reduced his father to a literary device in the book about his momma. “He became nothing more than the sledge I used to pound out her story of unconditional love.” And by the time Bragg was in his 40s he’d convinced himself that his father had become “no more than a question I answered at book signings in nice-sounding clichés.”  But Bragg was still hunting for his father, and the memories of the man who drank himself to death with a vengeance in 1975 hunted him, too, as such memories do. “My boy,” Willie Morris told him, “there is no place you can go he will not be.”
     As Bragg tells the story here, what made him open up his mind to his father was the sudden appearance in his own life of a 10-year-old stepson. The kid seemed to Bragg to have been coddled and cuddled too much, and in the early pages of the book “the boy,” as he is called, looks suspiciously like another literary device. He is the antithesis of the boy Bragg remembers himself being in a world that for better or worse, mainly worse, was dominated by the ways of Bragg’s reckless daddy.
     Compared with the hardscrabble mountain and mill-town tale of the father, the soft-edged suburban narrative of the stepson and Bragg’s relationship with him feels gooey and romanticized. But eventually it balances the account of Charles Bragg’s life, leavens it and lightens it. There are some very funny passages about Rick and the boy, especially toward the end of the book when Charles’s ineluctable decline and death become almost too painful to contemplate. “My father was already waking with the shakes when I was born,” Bragg writes at one point. And then several pages later: “His death was so certain it was like it already happened.”
     The deadly fatalism not just of his father, but of his people and of the whole pre-Sun-Belt South is deeply familiar to Bragg and beautifully evoked by his musical prose. He writes of ancestors who, at night, “beat Irish drums, tooted tin whistles and plucked dulcimers as they danced across dirt floors, and sang in lilting, tragic voice of lost homes, lost love and lost wars,” setting the scene for the story of a man whose great lost cause was himself. Bragg has an unflinching eye for the telling details of rural poverty and the terrible mixing of social monotony and industrial danger that marked those living in the company houses of a Southern mill town. Looked down on by everybody around them, they lived in “Frogtown,” near a creek crawling with snakes and flowing with pestilence.
     “They absorbed degradation at work, and took it out on each other when the hated whistle blew,” Bragg writes. “But in this community of violence and suffering were some of the finest people who have ever lived, who scraped a few handfuls of flour into a brown paper bag, house by house, until a full bag could be delivered to a family whose provider was sick, shot, cut or hurt in the machines. The choking dust took a lot of them, and some just never got over the fact that they left their mist-shrouded mountains for this, and died sorry. But they met their quotas and punched their time cards and went home to sleep under quilts dyed with roots and berries, a people neither town nor country, but something in between.”
     Charles Bragg’s tragedy was that he had the sense to want out, and even to get out, but he couldn’t stay away. He was a marine during the Korean War but came back to be at home, to show off, to fall in love. And then the drinking got real bad. And worse. Charles tried to get away one more time, taking his wife and boys to Dallas, where he found a good job, steady pay and a nice house. But Rick’s mother would not trust her husband to make good. She wanted the security, such as it was, of the welfare check she’d gotten used to in his long absences. She went back home to the mill town and to her mother and took the kids.
     Eventually Charles followed, too. But he was broken by then, and it seemed as if every encounter with his family was a spectacle of crazy-drunk cruelty: “One night he staggered into the house and greeted my mother with a big smile. He was missing his front teeth. The thing she had loved about him most was his white, perfect teeth, and he had gotten them pulled, for meanness.” And there was the time he brought his sons a fine dog, then brought it back days later mangled and dying from fighting in a pit. Bragg’s hatred burned so intense that for the longest time, for almost 40 years, he would not remember what happened one night when his father saved his life.
     There are moments when you think Bragg will tell you that despite everything he loved his father, but he never does say it quite. He is even surprised when his mother, after all these years, says she really did love the man. What Bragg tells us is something he inferred from a pair of loaded dice among the few possessions his father left him, a message of sorts: “Rig the game if you can, ’cause luck is a bitch for a poor man; and don’t worry what people think, because once it’s all over the people who love you will make you what they want you to be, and the people who don’t love you will, too.”
     Charles Bragg will remain a puzzlement. But Rick Bragg has made of the dark shadow in his life a figure of flesh and blood, passion and tragedy, and a father, at last, whose memory he can live with. And that is no small thing for any man to do.

Christopher Dickey, Newsweek magazine’s Paris bureau chief, is the author of “Summer of Deliverance: A Memoir of Father and Son.”



Rise In Autisum Diagnoses Makes Parents Aware, Wary
Kathleen O'Brien, Newhouse News Service- 7/21/2008

Sandra Devlin cradles her newborn daughter, Delilah, with the same devotion she lavished on her four older children. "De-li-lah," she coos in a singsong voice, holding the 4-month-old baby close to her face. As she did with her other kids, she hopes to elicit a smile, a laugh or a gurgle of recognition. It's a time-honored mother's gesture — but one that now comes with a twist: This time, Devlin is also checking for autism.
      Every generation of parents has a worry unique to its era. In the '40s, the specter of polio made mothers frantic about any trip to the neighborhood swimming pool. The '80s brought the sense that every child risked abduction, his photo ending up on the side of a milk carton. For today's parents, that fear is autism. "In my office, that's the big elephant in the room. They'll ask about something else, but what they're really asking is, 'He doesn't have autism, does he?' It is the question for this generation," said Ari Brown, a Texas pediatrician and spokeswoman for the American Academy of Pediatrics.
     With autism spectrum disorders now diagnosed in 1 out of 150 children nationally, rare is the parent who isn't aware of autism. And with that awareness can come a new wariness of vaccines, which a vocal minority of autism activists blame for the jump in cases. Pediatricians report seeing more parents question, delay or even shun altogether the traditional round of childhood immunizations.
     Such worries never crossed the mind of Devlin, of Denville, N.J., with her first two children, now 19 and 13. Autism arrived on her radar screen for the next two kids, now 9 and 3. With Delilah, born 11 weeks prematurely, that concern is front and center. "I never did that with my older kids," she said of her new habit of checking for eye contact from Delilah. "But now I'm looking specifically for autism."
     Pediatricians say this worry has its benefits: Parents are more aware of crucial child-development milestones and as a result, they are quicker to pick up on lags. That may mean some cases of autism — maddeningly difficult to catch in the youngest toddlers — are diagnosed earlier. "If you have a child who doesn't talk, I think in other generations they would've said, 'Oh, he's a late bloomer.' It wasn't a big deal," said Mary Jean Wick, a mother of five in Denville. "Now it's definitely a fear for this age of parent."
     However, it can make some parents see autism behind every bush. "Thirteen years ago, parents wouldn't be able to answer the question, 'How does your child play?'" Brown said of her early years in practice. "Now you hear, 'Oh my God, my child lines up his trains. Does he have autism?' There are these extreme parents who think every little thing is autism. I have to say to them, 'Sometimes kids can be quirky.'"
     Autism spectrum disorders are developmental disabilities marked by an impairment of social interaction combined with communication problems and restricted or repetitive behaviors and interests. The spectrum encompasses a wide variety of thinking and learning abilities, from gifted to severely challenged. While its prevalence has soared in recent years, experts are unsure whether more cases are occurring or simply more cases are being diagnosed.
     Some parents will single out one small trait or habit of their children as a "symptom" of an autism spectrum disorder, said Michael Segarra, president of the New Jersey chapter of the American Academy of Pediatrics. When a parent voices concern that a child plays with only one toy, for instance, Segarra will ask a checklist of questions about the child's social interaction. This helps the parent see the big picture. Some parents accept their pediatrician's reassurances. Others don't — leading to more referrals to specialists.
     Apprehension about autism shows up most dramatically with the issue of child immunizations, which some parents view as a culprit in the recent rise in autism. A major study released last year in the New England Journal of Medicine shows no association between long-term neurological and psychological problems and early exposure to thimerasol — which contains mercury — in shots. (Use of thimerasol in routine vaccines was stopped in 2001.)
     However, that has not reassured everyone. A poll of parents of autistic children showed 54 percent believe autism is caused by vaccination shots, according to Harvey Bennett, director of Child Neurology and Development Medicine at Goryeb Children's Hospital in Morristown, N.J. At a recent talk before a group of family physicians, he called that finding worrisome and "astounding."
     Pediatricians report more parents are delaying shots, asking they be spaced out or refusing them altogether. "They don't listen to me. They don't believe a word I say," said Naomi Grobstein, a pediatrician with the Family Health Center of Montclair, N.J. "They say, 'He's not ready!' or 'He's too young!'" She reminds parents of the lethal risk posed by diseases like measles, diphtheria and tetanus. "It's easy to believe these shots aren't necessary, because we don't see these diseases anymore," she said. "I ask them, 'What if your child is the one who spreads measles around?'"
     Complicating the picture are celebrities who either blame or suspect vaccines, such as actress Jenny McCarthy and radio talk show host Don Imus. Doctors complain the celebrities get an unquestioning ride in the media.
     Wick, the mother of five children ages 1 to 11, said she has worried about immunizations, but decided to get her kids vaccinated. "I can see that there are people who just panic," she said. "But maybe that's something in the culture, that we just want to control everything." It's important to address that anxiety, said Brown, the Texas pediatrician who is also author of "Baby 411," an advice book. "If there is something that is keeping you up at night with worry, then you need to go to the pediatrician to check it out," she said. "That peace of mind is worth the co-pay."



Violence Is Common Among The Young
Brittany Johnson, Washington Post- 7/21/2008

Almost half of undergraduates say they have experienced emotional, physical or sexual violence stemming from personal relationships before or during college, according to a new study. Although students said most incidents of emotional and physical abuse were committed by partners, some acts of sexual violence involved friends, acquaintances and strangers. The study did not look at violence by family members. Most relationship violence occurs before students step on campus, the study found.
      The research, published in the July issue of the Archives of Pediatrics & Adolescent Medicine, was based on a survey of 910 students (390 male, 520 female) ages 17 to 22 from three campuses: a nonresidential community college, a mid-size Catholic university and a large Ivy League university. Students at each school reported similar experience with relationship violence despite the schools' differing racial and socioeconomic mixes.
     Although violence in general may be more prevalent among lower-income groups, relationship violence "crosses socioeconomic levels, race and gender, and is prevalent across ages," said lead researcher Christine Forke, a registered nurse at Children's Hospital of Philadelphia.
     Students participating in the survey were asked if they had experienced physical violence, defined as pushing, grabbing, hitting, choking or slapping; emotional violence, defined as being made to feel bad about oneself or isolated from family and friends, or having a partner act in a possessive manner; or sexual violence, defined as being coerced, pressured or forced into having sexual contact.
     Amir Afkhami, an instructor of psychiatry and behavioral sciences at George Washington University, called the findings fascinating, but he questioned whether the self-reporting understated the problem. Overall, 44 percent of students reported experiencing at least one type of relationship violence, 42 percent as a victim and 17 percent as a perpetrator. Fifteen percent of females in the study reported being victims of sexual violence. Afkhami said he thought that figure was low. Based on his clinical experience, he said, "at least one-third to one-fourth of women students have experienced some type of forced sexual contact."
     Although most students who said they had been the victims of violence were female (more than 50 percent), 22 percent of male students also said they had been victimized. Charles Wibbelsman, director of Kaiser Permanente's teen clinic in San Francisco, said he was surprised the male response was so large. He said the lack of male-friendly support services reinforces the culture of silence among male victims. "As pediatricians, we ask our female patients, 'Are you dating someone? Has there been any violence? Have you been a victim of date rape or physical harm on a date?' But how often do we ask a guy? A lot of that information just isn't sought out," said Wibbelsman, a member of the American Academy of Pediatrics Committee on Adolescence. Afkhami also expressed surprise at the percentage of men identifying themselves as victims of violence.
     During college, male students reported committing a higher rate (2.6 percent) of sexual violence than women (1 percent); female students reported committing a higher rate (7.3 percent) of physical violence than men (1.8 percent). Forke acknowledged that perpetrators and victims may have under-reported incidents because of denial, fear of reprisal or shame.
     Perpetrators mostly identified their sexual victims as partners; victims were more likely to identify their attackers as acquaintances. Forke said the difference reflects various coping mechanisms. Victims, she said, want to distance themselves from the people who hurt them, thinking, "How could someone who loves me do this to me?," while perpetrators want to excuse themselves of wrongdoing, reasoning, "This is my partner; we do this all the time." Wibbelsman said people let their guards down as they get closer, and this vulnerability can open the door to abuse.
     Transitioning into college life, away from family and established support systems, can also increase a student's dependence on unhealthy relationships, Forke said. Based on their finding that most violence occurs before college, Forke and Wibbelsman recommend that counseling on healthy relationships and domestic violence begin in middle school, so young people can learn to distinguish positive from negative behaviors just as they are starting to experience them. "The earlier you are in the cycle [of violence], the longer it's likely to continue," Forke said.
     Many of those who experience such violence also report such health problems as low self-esteem, suicidality, substance abuse or further physical or sexual abuse later in life, according to the Centers for Disease Control and Prevention. "If your child doesn't know what a healthy relationship is when they go out into the world, it can be detrimental to them," Forke said.
     Wibbelsman, who described the results as eye-opening, said that most research has been done on youths up to age 18 and that pediatricians are beginning to realize that more should be done to understand "the forgotten population" of young adults. "We need to look at young adults as an at-risk population," he said.



Russia Scorns Methadone for Heroin Addiction
Michael Schwirtz, New York Times- 7/22/2008

MOSCOW — The conference seemed innocuous enough: a Moscow hotel, slide shows and several dozen doctors and specialists gathered to discuss how to treat heroin addiction. But then members of a Kremlin youth group called the Young Guard arrived, crowding the hotel’s entrance and denouncing the participants as criminals and paid agents of the West. The focus of their outrage was methadone, a drug prescribed by doctors around the world to wean addicts from heroin. A synthetic form of opium, methadone is central to a therapy endorsed by the United Nations and 55 countries, including the United States. But not Russia. Though heroin abuse is widely linked to the country’s H.I.V. epidemic and the spread of criminality, the issue of methadone treatment is all but taboo here.
      Methadone, typically taken by mouth in liquid form, blocks addicts’ cravings for heroin by binding to the brain’s opioid receptors. Methadone has critics in many countries, who argue that it replaces one form of opiate addiction with another; in Russia even talking about it can provoke legal sanction. “There is no possibility to have a normal discussion about this issue,” said Dr. Vladimir D. Mendelevich, director of the Institute for Research Into Psychological Health, in Kazan, 500 miles east of Moscow.
     After the conference in February, which Dr. Mendelevich helped organize, Moscow’s legislature began an inquiry into whether he had engaged in “drug propaganda,” and it called on prosecutors to open a case against him, he said. Several years ago, prosecutors filed administrative charges against him after he posted reports on methadone treatment to his Web site. The charges were eventually dropped, but he was forced to take down the site. “If I revive it,” he said, “another case of narco-propaganda will be opened, and there would likely be some kind of verdict.”
     While Dr. Mendelevich struggles with his opponents, Russia continues to suffer a steady increase in intravenous drug use. Drug addiction was nearly unheard of until the Soviet Union fell. But as borders opened and the economy collapsed, illicit narcotics gushed in. Estimates on the number of drug addicts in Russia range from three million to six million. Most use intravenous drugs like heroin and other opium-based narcotics that largely originate in Afghanistan and easily flow across the country’s porous southern borders. The epidemic has put added strain on Russia’s struggling health care system and has posed a serious challenge to law enforcement.
     Intravenous drug use is also the leading cause of H.I.V. and AIDS in Russia. It accounted for about 66 percent of new cases in 2006, and the epidemic continues to grow, though not as quickly as in the past, according to the United Nations’ AIDS agency. The Russian government estimated that as of 2007 more than 400,000 people were living with H.I.V., out of a population of about 142 million. (The United Nations’ estimate from 2005 was 940,000; by comparison, 1.2 million Americans, out of a total of 300 million, were living with H.I.V.)
     Many international experts say methadone treatment is critical to controlling the epidemic. Coupled with needle exchange (already in use in some Russian cities), the therapy could “largely stop the spread of H.I.V. among injecting drug users,” Peter Piot, the executive director of Unaids, the United Nations agency, said in May. Without methadone, he said, the epidemic is not likely to be stopped. “I may be wrong, but I don’t see it happening.”
     Russia’s health establishment is not impressed. At the same AIDS conference, Dr. Gennady G. Onishchenko, the country’s chief sanitary doctor, the equivalent of surgeon general, said health officials “are not convinced that this is effective,” and added, “There is little optimism for legalizing methadone therapy in the near future.”
     Dr. Onishchenko declined to be interviewed on this issue, as did Dr. Nikolai N. Ivanets, Russia’s top narcotics specialist. Dr. Ivanets, an aggressive opponent of methadone, who gave opening remarks at Dr. Mendelevich’s conference, attacked the professional credentials of the conference participants and singled out Dr. Mendelevich for special scorn. “Everyone has become so annoyed with methadone, with the exception of a few groups of people who call themselves specialists,” Dr. Ivanets said at the conference. “This is a group of dissenters.”
     Methadone opponents in Russia say the therapy entraps patients in lifelong addiction; others accuse Western countries of pushing the treatment on Russia for commercial gain. There are also fears that methadone could seep into the black market, given the high level of corruption at many Russian clinics.
     Russia’s own treatment methods, though not perfect, they argue, sufficiently address the needs of addicts. Then there are the pro-Kremlin youths from groups like Young Guard — the youth wing of the dominant United Russia party — whom the government routinely mobilizes to harass high-profile dissenters. At their demonstration outside the methadone conference, protesters held placards and waved flags, calling methadone “a dead end.”
     But some Russian specialists, along with current and former addicts, have begun to challenge the official line. “Scientific arguments, evidence-based data, are not convincing them,” said Evgeny M. Krupitsky, the head of a laboratory that conducts research on drug addiction at St. Petersburg State Pavlov Medical University. Russian methodology regarding opiate addiction “is not evidence-based,” but relies on “subjective opinions of major leaders in this field.” Though not every addict would benefit from methadone substitution therapy, more than 60 percent of Russian users would, Dr. Krupitsky said.
     Many researchers on both sides of the methadone debate agree that only a small fraction of the heroin users in Russia seek treatment at detoxification centers and that most who do — some say more than 90 percent — relapse into drug use shortly after leaving. At such clinics, doctors encourage immediate abstinence from drug use, rather than the gradual process that methadone substitution therapy entails. Patients are often given sedatives and painkillers to cope with withdrawal symptoms. Many are then released after a month or two with the expectation that they will remain clean. They rarely do.
     “You only have a chance to stay sober for one month,” said Masha A. Ovchinnikova, a former heroin addict from St. Petersburg, who said she quit largely with willpower (and anti-withdrawal drugs provided by “contacts”), while friends remained mired in addiction or died. “If you go on detox once and then twice and then three times, you realize that it doesn’t work for you,” Ms. Ovchinnikova said. “You don’t want to ask for help from the medical system; you don’t believe in it.”
     Supporters of methadone treatment or other opiate substitution therapies argue that if properly administered by medical professionals, the treatment method breaks addicts’ dependence on illegal narcotics, acting as a surrogate to ease withdrawal symptoms, while decreasing the risk of overdose, criminality and H.I.V. transmission. “I am for any scientific, medical approach to treatment,” said Albert Y. Zaripov, a former heroin addict who counsels users in Kazan. He began shooting heroin more than a decade ago with a group of 10 friends. Four are in jail, another four remain chained to their addictions, and two died. He alone quit, but after he had contracted H.I.V. “If there is another treatment besides substitution therapy, there’s no problem,” he said. “But I haven’t heard of anything else that has helped or that is more effective.”


Compulsive Shopping: Is It a Disorder?
Melissa Healy, Los Angeles Times- 7/22/2008

There is little doubt that compulsive shopping can cause severe impairment and distress -- two key criteria for formal recognition as a mental disorder. But the rest remains up for grabs: Is compulsive shopping a biologically driven disease of the brain, a learned habit run amok, an addiction in its own right, or a symptom of the other dysfunctions -- most notably depression -- that so often accompany it? Where is the line between avid shopping (a norm widely observed in the United States) and compulsive shopping? And how, if this is an illness, is it best treated?

      Compulsive buying is not currently recognized as a disorder by the mental health profession's guidebook, the Diagnostic and Statistical Manual of Mental Disorders, generally called the DSM. That may change soon, as psychiatrists draft the next version of the DSM, due out sometime after 2010.
     In anticipation, researchers and academic practitioners are exploring and debating what the cause of such a condition might be, how widespread it is, and how best to diagnose, characterize and treat it. A decision to adopt compulsive shopping as a diagnosis would require most private and public health insurers to cover its treatment, spur new research on the phenomenon and very likely escalate what is now a modest search by pharmaceutical companies for drugs that could curb its symptoms.
     It would also raise ethical issues about the nature of "behavioral addictions" -- a controversial catch-all term that includes Internet addiction, hypersexuality and compulsive gambling. Preliminary evidence suggests that these "behavioral addictions" involve malfunctions in many of the same brain circuits -- those involved in arousal and reward-seeking behavior, deferral of gratification and repetition of actions that result in harm. All are expected to be considered for inclusion in the coming DSM.

Ties to other problems
While experts debate how compulsive buying is related to psychiatric disorders, there is little doubt that they often go hand in hand. Psychiatrist Timothy Fong, director of UCLA's Impulse Control Disorders Clinic, says that probably 40% to 50% of patients in treatment at the clinic have a major psychiatric disorder accompanying their out-of-control buying behavior. A French study published in 1997 found that of 119 patients hospitalized for depression, almost 32% would meet proposed standards for the diagnosis of compulsive shopping. A pair of 1994 studies found that among subjects who met proposed standards for compulsive shopping, roughly two-thirds also could be diagnosed with anxiety, substance abuse or mood disorders, impulse-control disorders such as kleptomania or pyromania, or with disorders marked by obsessive-compulsive behaviors. "What's unclear," especially where depression is present, "is which came first," says Fong.
     Equally unclear is how to treat a condition with such seemingly varied and uncertain origins. Psychotherapy appears to help, and treating other psychological problems with medication and therapy is widely viewed as essential. Preliminary studies have found that antidepressants that increase the availability of the neurochemical serotonin in the brain can ease shopping compulsion. And naltrexone, a drug that blunts the inebriating effects of alcohol, has shown modest effectiveness in curbing the urge to shop.
      But Dr. Lorrin Koran, a professor of psychiatry (emeritus) at Stanford, stressed that in many cases, these medications have been scarcely more effective than placebos. That fact suggests that for many compulsive shoppers, awareness of the problem, encouragement from others and personal motivation might be as powerful as any drugs. "Even though we don't have conclusive proof that one treatment or another works better than another, we do know that people tend to get better if they seek treatment," says Koran. Much of the cognitive behavioral therapy that has shown promise has focused shoppers on "changing the self-talk" -- the things a compulsive shopper tells himself or herself to justify a trip to the store or a purchase -- and finding other ways to react to sadness, anger or frustration.

Sadness and spending
That sadness may spur excess spending was neatly demonstrated in an experiment conducted by researchers at Harvard, Stanford, Carnegie Mellon and the University of Pittsburgh and published in the June issue of Psychological Science. Thirty-three subjects were offered $10 to participate in a study and divided into two groups: one that listened to a sad story and wrote an introspective essay about it and another that listened to an emotionally neutral story, then detailed their day's activities.
     Afterward, subjects in each group were offered the chance to buy a sporty insulated water bottle using some of their $10 payment, and asked to state the price they would be willing to pay to buy it. The difference -- by all appearances dictated solely by differing emotional states -- was startling: Subjects in the sad-story group were prepared to pay almost four times as much to acquire the snappy water bottle as those who had entered the market in a neutral emotional state.
     In short, misery appears to make people less miserly, not more, the authors concluded -- especially when the miserable were very focused on their feelings of sadness. Sad consumers, they suggested, are likely to think less of themselves, and thus may be more motivated to boost their self-image with a pricey purchase.



Unlocking Motive Is Key to Conquering Compulsive Shopping
Melissa Healy, Los Angeles Times- 7/22/2008

Los Angeles psychotherapist Eileen Gallo, author of "The Financially Intelligent Parent," has led many shopping-addicted patients into the light. The road to solvency, she says, starts with a journey of self-discovery. When shopping begins to cause marital discord, missed appointments and financial woes, Gallo says, "it's time to take a look inside and find out the motivation for the behavior. Some shop just to fill themselves up, and of course it doesn't last long."
     Once such consumers recognize their motives for shopping, a bit of mindfulness can be a powerful thing, Gallo says "They certainly can take their own pulse when they're thinking about shopping, have a self-dialogue," Gallo says. "They can ask themselves: 'How am I feeling now? Am I angry, depressed, lonely? How will I feel when it's time to pay for it? Can it wait?' "
     These are questions that Denise Hinds, a 51-year-old Woodland Hills resident, is asking herself more often these days. With nine bins of clothes in storage and a closet jammed with clothes -- many with price tags still attached -- Hinds acknowledges, "I have racked up a good amount of debt buying things I didn't need."
     Recently divorced and trying to set a new financial course in life, Hinds says she's trying to be more mindful of what she buys -- and why. "When I wasn't happy, I was disappearing a lot to the mall," Hinds says. "It's a diversion, a distraction, another way of not dealing with your problems. At home, everything may be crappy: The baseboards need replacing and the bathroom needs cleaning. But you go to a place where everything is new, nicely lit and you can space out."
     When she was sad, Hinds says, she would tell herself she needed to take care of herself, that she needed a treat. "Part of it is that you're trying to fulfill some need -- I deserve this." Part of it, she adds, is that "composing outfits" is a hobby that makes her happy. It's a mood-elevating respite from stress, sadness and boredom. Though Hinds is trying to replace those lost hours at the mall with books, friends and hiking with her dog, she still finds she needs a fix of "mall air" now and again.
     After a hiatus of about two weeks, Hinds recently drove to the mall. She needed a few things at Target, but parked her car at the other end of the complex so she could walk through and check out the midsummer sales. She brought along her recyclable tote bag, which made her feel more virtuous about shopping. In the parking lot after that recent foray, she was still savoring the pleasure of finding a fetching purple shrug, a pair of sandals on sale and a few new summer tops that, she said, laughing, she "just couldn't live without." The little sweater, she said, was a particularly satisfying catch. "I thought of that in my bag and I felt happy." But even as she did so, a shadow of sadness seemed to darken her celebratory moment. "It's fun. But it doesn't last," Hinds says with a sudden sigh. "You can fill yourself up but you still want more."



A.D.H.D. Increasingly Common in Older Kids, CDC Says
Associated Press, 7/23/2008

ATLANTA -- More older children are being diagnosed with attention deficit hyperactivity disorder while the rate is holding steady for children under 12, according to a government report released Wednesday. Some experts called the finding surprising, noting that most childhood diagnoses traditionally occur by age 11.
      The study didn't investigate why the increase in one age group was so much higher than the other. It found the percentage of older children diagnosed with ADHD has been rising by 4 percent each year. Some experts say the increase may reflect that doctors are increasingly considering the possibility of ADHD in older kids who have concentration problems -- a trend that coincides with the marketing of ADHD medications to teens and adults.
     The finding may also reflect the misuse of Ritalin and other ADHD medications in that age group as study aides and recreational stimulants, some experts speculated. ''There are people out there being treated for ADHD that probably don't meet the diagnostic criteria,'' said Scott Kollins, director of Duke University Medical Center's ADHD Program.
     Attention deficit hyperactivity disorder -- characterized by impulsiveness, hyperactivity and inability to focus attention -- is a behavioral and learning problem that usually appears in children by age 7. The problem often is identified in school, and most children are diagnosed by age 11. The Centers for Disease Control and Prevention estimates that more than 4.4 million U.S. children have been diagnosed with ADHD by medical professionals.
     The new study draws its results from an annual survey of 35,000 to 40,000 U.S. households, in which government researchers go door-to-door to conduct interviews. In households with children, parents are asked if a doctor or health professional had ever told them that their child had ADHD or attention deficit disorder (ADD).
     The study's findings cover 1997 through 2006. In each of those years, nearly 50 million children fell into the 6-to-17 age range, the study estimates. Roughly 4 million of them were given an ADHD or ADD diagnosis, the study estimates. For children ages 6 through 11, the proportion hovered around 7 percent during those years. But for children 12 through 17, it rose from just under 7 percent to nearly 10 percent. That increase wasn't seen in previous government estimates, said Patricia Pastor, a CDC health statistician and the study's lead author.
     It may reflect a growing understanding that a child -- especially an older kid -- can have ADHD without being disruptively impulsive or hyperactive, said Jeff Epstein, director of the ADHD center at Cincinnati Children's Hospital Medical Center. Another factor may be that ADHD is sometimes diagnosed when adolescents are being checked for other conditions, such as depression, said Dr. Mohammad Ghaziuddin, director of the University of Michigan's ADHD and autism program.
     Meanwhile, the use of ADHD medications has been increasing. According to the CDC, doctor's visits for children under 15 where methylphenidate -- also known as Ritalin -- was prescribed or given went from 1.9 million in 1993 to 3.2 million in 2005. The marketing of newer ADHD drugs like Aderall XR and Strattera to adults and older kids is pushing up use, experts said. ''I think the industry does drive a lot of it,'' said Kollins of Duke, referring to pharmaceutical marketing.
     On the Net: The CDC report: http://www.cdc.gov/nchs