A million Britons live with the hell of Obsessive Compulsive Disorder

Nadine Stewart was convinced she was going to die. Just ten minutes after setting off for a pop concert with her sister, she felt a tingling sensation in her arms and pain in her chest.

‘I knew I was having a heart attack,’ says Nadine, 41, a customer services adviser from Morecambe, Lancashire. ‘I begged my sister to take me to A&E: I ran in and screamed that I was having a heart attack.

‘They put me on a monitor and my heart was fine — what I had suffered was a panic attack. I have no idea to this day what caused it, but it terrified the life out of me.’ 

Nadine Stewart has to do everything nine times or fears her husband will die

But worse was to come. ‘Afterwards, I developed a fear that if I didn’t do something nine times, something terrible would happen to me, my husband Paul or a member of my family.’ says Nadine. 

‘If I made a drink I had to stir it nine times. If I locked the door I had to check it nine times and if I used a cloth to wipe a surface I’d have to wipe it nine times. I don’t know why it was nine. I realised I was being utterly irrational. But every time I tried to curb it — such as only stirring my drink three times — I’d begin to panic.'

 ‘If I didn’t do these things nine times, I’d imagine Paul and me veering off the motorway in our car and see his injured face in the aftermath.’

Nadine had Obsessive Compulsive Disorder (OCD), recognised by the World Health Organisation as one of the top ten most disabling disorders in terms of its effect on quality of life. 

Last month both the British actress Emily Blunt and the MP Charles Walker revealed they suffered from it, with Walker admitting he had to do everything in multiples of four — and felt the need to wash his hands hundreds of times a day. 

 Who knew?
Surveys estimate that fewer than
10 per cent of those suffering OCD are currently receiving treatment.

They are not alone. Around a million people in the UK are thought to be undergoing treatment for OCD, the majority of them women. Women are twice as likely as men to develop anxiety disorders such as OCD — and high-achieving perfectionists are particularly at risk. 

‘There are two parts to OCD, the obsession and the compulsion,’ explains Joel Rose, of charity OCD Action. ‘The obsession is a thought that pops into your head, about harm coming to someone you love or you causing harm to someone.'

‘Everyone has these thoughts but most of us ignore them and get on with our lives. Someone with OCD will develop a compulsive ritual as a reaction to them. It can be continually washing their hands or something invisible like repeating the same phrase over and over in their heads.'

‘The time spent on these compulsions lengthens with time. A severe OCD sufferer might spend six or seven hours a day washing their hands in the hope nothing terrible happens to their children.’

The cause of the condition is not known, though a stressful event in someone’s life may trigger an underlying problem. 

Nadine has never pinpointed the root of her troubles — though they began in the year she started a new job, moved house and got engaged. ‘I had no reason to feel anxious,’ she said, ‘though I suppose there was a lot of change.

‘I became scared of choking to death so I stopped eating and lost three stone in less than three months. I couldn’t leave the house without Paul, and even then it would take me three hours to pluck up the courage.’

Someone who can empathise with Nadine is Jeni Scott, 31, who’s had OCD for three years. 
It began when her father had a heart attack and her mother was diagnosed with cancer, soon after Jeni left university. 

‘I became obsessed with doing things in order,’ says Jeni, a tutor from Newport, Wales. ‘I started making lists but it had everything on it such as “get up, have shower, make a cup of tea” and if I didn’t stick to it I would punish myself by denying myself a treat.

Actress Emily Blunt, star of Five Year Engagement, has revealed she suffers from OCD

‘I developed a phobia of being in the rain in the wrong clothes and had to take a backpack with spare bra, pants, coat, shoes and umbrella everywhere with me. I’d carry antibacterial gel in my bag and use it every ten minutes. I’ve still no idea why I did it, I just found it helped me.’ 

Aisha Faisal, from Reading, Berkshire, also suffers from OCD — and it’s getting worse. ‘I developed it in my teens when my mother fell ill and I had to clean the house,’ the 26-year-old says. ‘Now I’m obsessed with everything being super-clean. I wash my hands 14 or 15 times a day, I shower for an hour at a time and wash the shower head and bath thoroughly before I step in. 

‘If someone touches me, I cringe. My neighbour touched my scarf to tell me it was pretty and I had to have a shower and put all my clothes in the wash.’ Aisha, who has three children under four, admits her obsession extended to giving birth. 

‘Each time I had Caesarean sections — the thought of having a natural birth makes me feel physically sick.’ She made the surgeons assure her everything had been scrubbed thoroughly before each operation. Understandably, her OCD worries the rest of her family. ‘My husband Ali finds it very hard to see me like this. I won’t let him touch me when he comes in from work: he has to shower and put on clean clothes before he can hug me.'

‘With three young children, being clean is impossible and I bathe them twice a day in the winter and sometimes four times a day in the summer if they’re hot and sticky.’

As a result of her obsession her own hands are red raw and she suffers from eczema. ‘I have been to the GP but it’s very difficult to treat. I know I must do something soon, because my eldest daughter, who is four, is picking up on my behaviour and I feel very guilty about that.'

‘The other day she came in from the garden and said she was dirty so needed to get out of her clothes and I washed her and cleaned her thoroughly. My husband can’t believe our electricity bill because the washing machine is on constantly.’

While Aisha is still in the grip of OCD, Jeni and Nadine have overcome the condition. According to the NHS, the two recognised forms of treatment are Cognitive Behaviour Therapy (CBT), which helped Jeni, and anti-depressants. 

But Nadine used another therapy called The Linden Method — a two-day workshop costs £995 — when she reached her lowest point early last year.

‘I was unable to work, leave the house or answer the phone,’ she says. ‘My vision became blurry, my hands would spasm and I’d get pains like rheumatism. I began to think: “What’s the point in living?” yet I was too scared to kill myself.’

The Linden Method — which has also helped OCD sufferers Jemma and Jodie Kidd — works by convincing the sufferer’s sub-conscious that they are safe. 

‘I’m a different person,’ says Nadine. ‘I can leave the house, I’m applying for jobs, taking up hobbies and it’s transformed my relationship with Paul. 

‘He says it’s like having a wife in a wheelchair who can walk again. Except I feel I can not only walk, I can fly.’

How the warnings on bottles of alcohol could look if the UK Faculty of Public Health’s proposal is taken up

How the warnings on bottles of alcohol could look if the UK Faculty of Public Health’s proposal is taken up. Photograph: GNM imaging

Bottles of beer, wine and spirits should carry cigarette-style graphic health warnings to make clear that alcohol is linked to cancer, infertility and violence, doctors are urging.

The UK Faculty of Public Health (FPH) says harmful drinking has become so common that "no nonsense" warnings displayed in a prominent place on alcohol products are needed to overcome widespread public ignorance about the dozens of medical conditions excessive consumption can cause.

Arresting images, such as a liver after years of alcohol-related cirrhosis or a victim of violence, could force drinkers to realise the risks they take with their health, says the FPH, which represents 3,300 public health specialists working in the NHS, local government and academia.

"At the moment when people think about the dangers associated with alcohol they are more likely to think of a city centre disturbance rather than breast cancer, for example, so these health warnings would help educate the public and give them key information before they decide to buy a can or bottle of alcohol", said Professor Mark Bellis, the FPH's spokesman on alcohol who is also the director of the NHS's regional public health observatory in Liverpool, which specialises in drinking and drug-taking, and director of the centre for public health research at Liverpool John Moores University.

"The evidence linking alcohol to over 60 medical conditions is unarguable, so they would need to be factual warnings, not sensational. People don't realise that drink is associated with a whole range of health harms that it increases your risk of, such as injury, a stroke, heart disease, liver disease and many forms of cancer, and don't realise its potential long-term implications for them. This is not the nanny state. This is simply to help the public understand the risks."

The warnings could say things like "Alcohol increases risks of violence and abuse", "Alcohol causes over 15,000 deaths a year in the UK" and "Alcohol increases risks of mouth, throat and other cancers", suggested Bellis. Others could warn that alcohol raises the risk of breast cancer for women, is involved in 25% of deaths of young men aged 16 to 24 and reduces both men's and women's fertility.

Ministers would need to stipulate the size of the warnings on the label of all cans and bottles. "The health messages that are most important for people to see are the ones that drinks manufacturers are least likely to want to put on their products."

Moves by the industry, such as putting the words "drink responsibly" or the website of the industry-backed charity Drinkaware on advertisements, were nowhere near enough given the huge cost to individuals and the NHS from alcohol abuse, Bellis added. Warnings would "help to redress the balance between the need for this information and the bombardment of positive images of alcohol manufacturers we get from their association with big sporting and cultural events like the Olympics and Champions League".

The introduction of text-only warnings on cigarette packets in 1991, followed by picture warnings in 2007, is widely credited with helping reduce the number of smokers to about one in five of the population.

The drinks industry criticised the FPH's plan as disproportionate and unnecessary. "Given that 78% of people drink within the chief medical officer's guidelines [of 21 units a week for men and 14 units for women], it wouldn't be proportionate to have these more graphic warnings," said Henry Ashworth, chief executive of the Portman Group, a drinks industry-funded social responsibility body. "There's no comparison between alcohol and tobacco. The advice with tobacco is don't smoke but with alcohol it's not to exceed three or four units a day."

Already 60% of all cans and bottles of alcohol in the UK carry three types of health information agreed between producers and ministers as part of a pledge that 80% will do so by the end of 2013, he said. These set out official sensible drinking advice, and a warning to pregnant women not to drink at all.

Dr Daniel Poulter MP, a hospital doctor and Conservative member of the Commons health select committee, backed the idea. "At the moment the medical consequences of alcohol abuse, such as its links to fertility and many types of cancer, are underappreciated by the public. We do need to up the game in terms of raising awareness among drinkers both about these risks and about how much they are drinking. Proper labelling is important and having health warnings as part of that would be most welcome", he said.

The British Medical Association, which represents 140,000 of the UK's 200,000 doctors, also endorsed the FPH's call. "We support the use of written health warnings on alcohol products", said Dr Vivienne Nathanson, its director of professional activities. But the wording of warnings was crucial as moderate drinking is harmless but alcohol misuse causes serious ill-health, premature death and violence, she added.

While countries such as France use written warnings to deter alcohol consumption by mothers-to-be, in other places such as Thailand they warn about the increased risk of suicide, family break-up and drink-driving. South Africa plans to follow suit, while the Kenyan government's plan for warnings that would cover 30% of the surface area of alcoholic product containers is being challenged in the country's high court by East African Breweries.

Government action looks unlikely. The Department of Health said it agreed information should be provided to help people make healthy choices. But a spokesman added: "Cigarette-style health warnings are not applicable to alcohol. All levels of smoking are bad for your health, but the same cannot be said for alcohol consumption."

Ministers are working with the industry to encourage greater production of lower-strength drinks, and planned to introduce a minimum unit price, he added.

Ministers who did order the use of labels could face legal challenges from drinks producers and foreign governments under laws regulating trademarks. intellectual copyright and the free movement of goods in the EU, said Philip Pfeffer, a partner specialising in products liability and international trade law at the London solicitors Chadbourne and Parke.

Ted Nugent's drummer flees police in golf cart

Bangor Police Department

Mick Brown's mug shot.

By Gael Fashingbauer Cooper

People are always fleeing police, but usually it's in a vehicle where they have a chance to get away. That wasn't the case for Mick Brown, drummer for Ted Nugent, who tried to make his escape in a golf cart, according to the Bangor, Maine police department.

According to the police department, Brown, 55, reportedly stole a golf cart after a Bangor concert featuring Nugent, Styx and REO Speedwagon at Bangor's waterfront pavilion.

Brown, who was reportedly intoxicated, evaded several people who tried to stop him and somehow picked up two women along the way, the department says on its Facebook page.

"As (officers) attempted to stop Brown, he accelerated past them, past a third officer and when a security officer got close enough to stop him, Brown allegedly shoved the officer," the police reported. "At that point two other security officers physically removed Brown from the cart and placed him on the ground."

Brown was arrested and later released on $4,000 bail, and faces a court date of Aug. 15 for charges of operating under the influence of alcohol, driving to endanger, theft, and assault.

But perhaps the best line from the police report reads, "No damage was reported to the cart although two traffic cones were damaged, one still under the cart, significantly so."

Ted Nugent himself has been in the news lately for his political opinions, most recently for suggesting that the South should have won the Civil War.

Rating films with smoking 'R' will cut smoking onset by teens, experts say

New research from Norris Cotton Cancer Center estimates, for the first time, the impact of an R rating for movie smoking. James Sargent, MD, co-director of the Cancer Control Research Program at Norris Cotton Cancer Center, emphasizes that an R rating for any film showing smoking could substantially reduce smoking onset in U.S. adolescents -- an effect size similar to making all parents maximally authoritative in their parenting, Sargent says. See Also: Health & Medicine Smoking Teen Health Mind & Brain Smoking Addiction Addiction Science & Society Public Health Popular Culture Living Well Reference Laryngitis Bronchitis Lung cancer Emphysema "Smoking is a killer. Its connection to cancer, heart attacks, and chronic lung disease is beyond doubt. Kids start to smoke before they're old enough to think about the risks; after starting they rapidly become addicted and then regret it. Hollywood plays a role by making smoking look really good," says Sargent. "By eliminating smoking in movies marketed to youth, an R rating for smoking would dramatically reduce exposure and lower adolescent smoking by as much as one-fifth." The study, "Influence of Motion Picture Rating on Adolescent Response to Movie Smoking", enrolled a total 6,522 U.S. adolescents in a longitudinal survey conducted at eight-month intervals. Movie smoking exposure (MSE) was estimated from 532 recent hit movies, categorized into three of the ratings brackets used by the Motion Picture Association of America to rate films by content -- G/PG, PG-13, and R. Median MSE from PG-13 movies was approximately three times higher than median MSE from R-rated films but their relation to smoking was essentially the same. The investigators were able to show that adolescent smoking would be reduced by 18 percent if smoking in PG-13 movies was largely eliminated, all else being equal. "The equivalent effect of PG-13-rated and R-rated MSE suggests it is the movie smoking that prompts adolescents to smoke, not other characteristics of R-rated movies or adolescents drawn to them," the study concludes. "We're just asking the movie industry to take smoking as seriously as they take profanity when applying the R rating," comments Sargent, who is also professor of pediatrics at The Geisel School of Medicine at Dartmouth. "The benefit to society in terms of reduced healthcare costs and higher quality of life is almost incalculable." The research was supported by a grant from the National Cancer Institute (grant CA077026) and the American Legacy Foundation. It was funded by the National Institutes of Health.

What Club Drug May Help Depression?

Antidepressants not working for you?Psychotherapy a drag? Supplements no better than a sugar pill?

You might want to check out a drug more popularly known among the club scene and all-night dance parties than for the treatment of depression.

As we reported last month, researchers are taking a second look at ketamine — also known as Special K in the club scene — to help with depression.¹ It appears it has the potential to be faster-acting than traditional antidepressants, which may make it a new treatment option for people who are depressed and are suicidal or in crisis.

Ketamine is already approved for certain medical uses, such as a human anesthetic, but its use is tightly controlled by the U.S. Drug Enforcement Administration because of its potential for abuse. Now a number of pharmaceutical companies are investigating its use in the treatment of depression with active research trials around the world.

 

Bloomberg News has the story:

Ketamine may help patients who don’t respond to conventional antidepressants, such as Cymbalta or Lexapro, which don’t work on about a third of those who try them, says Alana Simorellis, an analyst with Decision Resources Inc. in Waltham, Massachusetts. It may also benefit people who need urgent relief from suicidal tendencies, so long as the drug is given under the supervision of doctors in a hospital, she said.

“There is really no medical intervention for acute suicidality, which is a medical and psychiatric emergency,” said Mount Sinai’s Murrough, who is running a trial to investigate the drug’s potential to prevent suicide. “It’s a huge unmet need.”

Besides Sydney and New York, ketamine is being investigated for depression at sites in Boston, Houston and Miami, as well as Changzhou, China; Grenoble, France; Geneva, Switzerland; and Aberdeen, Scotland, according to data compiled by Bloomberg.

Lisa Monteggia, Ph.D., associate professor of psychiatry at University of Texas, noted, “Ketamine produces a very sharp increase that immediately relieves depression.” Monteggia was the lead author on a study published in last month’s Nature about ketamine’s use for depression.

“Ketamine produces a fast-acting antidepressant effect, and we hope our investigation provides critical information to treat depression effectively sooner.” Current antidepressants can take anywhere from 6 to 8 weeks to become fully effective, and most only relieve some — but not all — symptoms of depression.

But this is hardly new news.

For instance, back in 2007 — 5 years ago — there was a study demonstrating that ketamine relieves depression in hours.²

Of course, the real question will be how to offer a new formulation of ketamine that will allow for more widespread use, while significantly reducing the use of abuse or addition.

If additional research confirms these findings and pharmaceutical companies can crack the abuse issue, ketamine may find a new and more popular use — as a fast-acting antidepressant used to help people where traditional antidepressants have been found ineffective.

Revolutionary new drug Vivitrol offers new life to addicts

Friday is Amanda Gordon's one-year anniversary of being clean from heroin and prescription drugs, a remarkable recovery she never expected to achieve because she had failed so many times before.

But a monthly injection of Vivitrol has accomplished what nothing else did, including nine stints in hospital detox programs.

Her mother, Katherine Gordon, an automotive warranty specialist grateful for her daughter's release from addictions that devastated her only child and her family, goes as far as to call Vivitrol "the closest thing to a miracle I've seen."

The drug, approved in 2010 by the U.S. Food and Drug Administration for treating narcotics addictions in adults 18 and older, is an important advance, changing the world of addiction treatment, many doctors in the field say. Vivitrol, compared with other treatments, they say, is more effective, has no potential for abuse and sale on the street, and can be prescribed by any doctor. The drug is prescribed for addiction to heroin and prescription painkillers such as Vicodin and OxyContin, a rising problem nationally, as well as for alcoholism.

Studies in Russia of 250 heroin patients -- data submitted to gain approval from the FDA -- showed 70% of patients who used Vivitrol for at least six months were clean. But the drug's high cost -- about $1,000 per injection -- remains controversial, as does the notion of using an injection to treat drug abuse instead of focusing more on long-term behavioral changes, as prescribed by 12-step prorgrams.

There also aren't any studies to compare Vivitrol with other drugs and "that's a concern," said Dr. Carl Christensen, medical director for addiction services at the Detroit Medical Center. He said the drug can't be used during pregnancy.

The National Institute of Drug Abuse is continuing research on Vivitrol, as is the company that makes it.

After a slow start reaching doctors, family doctors such as Dr. Raghad Lepley, Amanda Gordon's physician in Highland Township, north of Milford, have started prescribing the injections.

"This is a very new era in addiction treatment," Lepley said.

Finding relief

Gordon, who turns 24 Tuesday, began using heroin and prescription painkillers at 16 when she was an honor roll student at Waterford-Mott High School.

Heroin was her preference, but she crushed up painkillers and snorted them when that's all that was around. "Your whole purpose was to wake up, get some money and go get it," she said.

Once she started on Vivitrol, the urge to use drugs "wasn't there anymore," Gordon said. "I wasn't obsessing over it. I think if any addict could have that obsession lifted for 28 days, they'd see just what a difference it makes."

In contrast to any physician being able to prescribe Vivitrol, doctors need either special training or certification to prescribe other treatment drugs such as methadone or Suboxone. Both are synthetic versions of opioid drugs such as heroin and OxyContin, leading patients to sabotage their recoveries by sometimes abusing them.

Lepley said Gordon "jumped" at the chance to use Vivitrol because "we don't have a lot of options" to treat heroin and painkiller addictions.

Still, Vivitrol brings controversy because of its cost and concerns that no shot can provide the personal commitment to change that alcoholics and drug addicts must address.

Vivitrol costs $1,100 for each injection. Alkermes Inc., the Waltham-Mass.-based manufacturer of the drug, provides financial help for 13 months that reduces the price by half for people with private insurance and cuts co-pays for patients with Medicaid or Medicare to as low as $5 an injection, according to Richard Pops, CEO for Alkermes.

Doctors who use Vivitrol may try to wean people off the drug after a year, though some may need to take the shots for years, the same as other addiction drugs.

Gordon's Blue Cross Blue Shield insurance pays for nearly all the cost of the drug, but not all insurance plans do, one reason top doctors at two major metro Detroit drug rehab programs say they don't routinely prescribe it.

"I don't recommend it" because "it's just cost-prohibitive at this point," said Dr. Philip Gilly, chief of inpatient services at the Henry Ford Health System's Maplegrove Center in West Bloomfield.

Dr. Jeffrey Berger, medical director for the Brighton Center for Recovery, part of the St. John Providence Health System, said he worries also that a shot is "seductive to patients."

"It's the medicalizing of recovery that concerns me," he said. "What I see happening overall is the tendency to think that treatments come in a pill ... and people are not wanting to do the work for a substantial recovery."

Still, he predicted, Vivitrol "changes the whole ballgame."

Costly national problem

More than 1.8 million Americans are addicted to prescription painkillers such as Vicodin and OxyContin, and another 800,000 are addicted to heroin, according to 2010 data -- the latest available -- from the federal Substance Abuse and Mental Health Services Administration. Another 18.2 million have been diagnosed as problem drinkers.

Addiction is a costly national problem because so many addicts fail in recovery and overuse more expensive care in emergency rooms when they overdose or develop drug-related problems.

Drug abuse involving prescription medicines accounted for 1.3 million emergency room visits in 2010. That compares with 1.2 million visits for illegal drugs, 600,000 for alcohol and drugs combined, and 200,000 for underage drinking, according to statistics released this month by the federal Drug Abuse Warning Network, which tracks drug abuse in the U.S.

Rehab stints can cost $15,000 or more for a week's stay, and centers increasingly report seeing patients like Gordon who return more than a half-dozen times.

Dr. R. Corey Waller is an addiction specialist working with a large drug population that floods the Grand Rapids-based Spectrum Health System emergency department. Vivitrol is "exceptionally good" at treating alcoholism and "doubles positive outcomes" for problem drinkers and heroin and painkiller drug abusers, Waller said.

"The difference is night and day," Waller said of Vivitrol, comparing it with other recovery methods, including counseling alone.

The 12-step programs, the cornerstone of Alcoholics Anonymous and others like it, work no more than one quarter of the time, Waller said, referring to figures quoted widely. "Those numbers don't lie," Waller said.

The national resource group 12Step.org referred questions about success rates to an e-mail list of meetings of its sponsors. Those contacted did not respond. Confidentiality is an important component of the programs and many decline news media interviews.

Drugs in the suburbs

Gordon was introduced to the world of hard drugs through a former boyfriend, a drug dealer.

She was hooked in less than three months, she said.

Her parents, now divorced, didn't catch on for several years. "She was white-bread America," said her mother, who has remarried and lives in Commerce Township. "She had a 4.0," her mother said. "She had everything going for her."

She said her daughter played tuba in her school's marching band, symphony orchestra and jazz ensembles for awhile. Gordon's mother now understands how widespread drug use is, affecting the suburbs, as well as core city neighborhoods. "To see this kind of epidemic in Oakland County just floors me. I had no idea," Kathy Gordon said.

Amanda Gordon found that snorting heroin or crushed up painkillers didn't get her high enough. Deathly afraid of needles as a child, her friends talked her into injecting drugs because they said she'd get higher, and need less.

But they had to hold her down, as she sobbed, to inject her the first time, she said.

As her addiction grew, Gordon needed more to get high. When she became skinny and withdrawn, her mother started to suspect a problem, but she thought it was an eating disorder because Gordon still was doing well at school.

Kathy Gordon learned of her daughter's drug use after Amanda Gordon fought with a friend, who in turn told her mom that Gordon was a drug addict.

Kathy Gordon insisted her daughter enter rehab. While in rehab, she took the drug Suboxone, but it didn't work for her.

"It's a choice," Amanda Gordon explained. "I'd say, 'I'm going to get high today,' so I wouldn't take it."

At least three of her friends died of drug overdoses.

More ultimatums came from her parents: Get clean or get out. More rehab stints followed, as did enrollment in a methadone program. There, she met other drug users who sold her heroin, Suboxone or clean urine so she could pass the drug tests required to stay in the program.

"People would sell their pee at the methadone clinics," she said. "They don't watch you. You just go in the bathroom."

Two separate police raids within a year on the Gordon family home, where Amanda Gordon was living with her boyfriend after Kathy Gordon remarried and moved out, led to Amanda Gordon's final awakening.

She said she was disgusted with herself and a habit that grew and grew.

On July 13, 2011, Gordon begged her mother to take her to Lepley, whom she had heard about through a friend at a drug treatment program.

She wanted to try Vivitrol.

Finding a way out

Gordon, savvy from years in drug programs, sabotaged her first Vivitrol shot. She was supposed to be drug-free for seven to 10 days before taking it -- but she wasn't and she lied to Lepley. The combination of Vivitrol and heroin in her system left her curled up in a ball, crying for three days as she weathered painful withdrawal symptoms.

Her mother, who stayed in touch with Lepley and Gordon's friends, did her best to help her daughter soothe the symptoms.

"We got pineapples, strawberries, chocolate dips and Ensure," a liquid nutrition drink, Kathy Gordon recalled.

Somehow Amanda Gordon got through 28 days to her next shot.

Each month, she felt better. She returned to school and got an associate's degree in general studies from Oakland Community College. She dumped the longtime boyfriend and has found happiness in another relationship. She attends weekly Alcoholics Anonymous meetings, which are open to people with all addictions.

She wants to work. She just needs a job.

For now, she busies herself with a new puppy, her boyfriend, working out at a local gym, her job search and occasional talks she gives publicly to people about drug addiction. One in June was to a national organization of court administrators who oversee drug cases.

"I'm happy for the first time in years," she said.

As she planned for her daughter's birthday celebration Tuesday, Kathy Gordon wondered what gift she'd buy her daughter. She might buy her a ring because Amanda Gordon has little jewelry after years of pawning her stuff for drugs, she said in an e-mail.

"The biggest celebration is just going to be having the family together," Kathy Gordon said. "There were so many years that her behavior made it nearly impossible to have family gatherings. She would be late or not show up at all or show up and promptly fall asleep....It was easier just not to plan.

"Today, we have Amanda back, and the monster that impersonated her for so long is gone."

New law allows families to force addicts into treatment

An Ohio law that allows families to force a loved one into addiction treatment has been used only once since it went into effect in March. Though the law is new, it has created debate about whether involuntary treatment will work and if the law is unfair because it is only available to families who can afford to foot the bill. The Cuyahoga County case, which involved a young woman with a severe alcohol abuse problem, is the only one in which an Ohio court has forced an adult into treatment. That case seems to have had a positive outcome with the woman agreeing to continue treatment beyond the court-ordered time frame, said Cuyahoga County Probate Court Magistrate David Mills. The law roughly mirrors a similar measure passed in Kentucky eight years ago after 23-year-old Matthew "Casey" Wethington died of a heroin overdose. Wethington's mother, Charlotte, pushed for change because she felt there were very few tools for family members to help adult addicts who were spiraling out of control. Parents, she said, are desperate to intervene to help their children. "Most parents do not want to see their children incarcerated in order for them to get help for a disease," Wethington said. However, Wethington is perplexed by one important way Ohio's law differs from the one passed in Kentucky. Ohio's law requires family members to sign an up-front agreement that they will pay the total bill for treatment and give the court a deposit for half of the amount. Mills said that the court has gotten many inquiries but that the conversation often ends once the costs, often thousands of dollars, are explained. In the Cuyahoga County case, the woman's family had to deposit $8,000 with the court and agree to pay the total cost of treatment, which could be double that or more. Bill Denihan, chief executive officer of Cuyahoga County's Board of Alcohol, Drug Addiction and Mental Health Services said that while the board supports helping those in need, limiting that to families with means is troublesome. "While we have problems with this, we don't chastise the intent to try and help someone who needs help," Denihan said. "But this is for those that have money. The question we have is what about those who don't have money? How is this fair and equitable?" Wethington said that the Kentucky law places the responsibility for setting up and covering costs of drug and alcohol assessments and treatment on the person asking the court to intervene. But they are not obligated to pay up front and can use insurance or find a free treatment program. Another debate is giving a court the authority to force a person to get treatment they may not want, which could be challenged as a civil rights violation. Historically, laws have existed to involuntarily commit to hospitals people with mental illness who are seen as a danger to themselves or others. Courts and professionals must determine that the danger is pressing. Up to 38 states have some type of law that allows an addict to be temporarily detained, according to a study presented in 2011 to the American Psychiatric Association. But the laws and what they allow vary tremendously, according to published interviews with the study's author, Dr. Debra Pinals, an associate professor of psychiatry at the University of Massachusetts Medical School. In some states police can pick up an addict for a short period of time, others allow for a few days of involuntary hospitalization. In some instances, like Ohio, states allow for longer -- sometimes months -- of involuntary commitment to treatment. State laws also contain a hodgepodge of standards for an addict to be committed, including danger to oneself, grave disability and failure to manage personal affairs. In Ohio, a probate judge or magistrate is supposed to decide whether a person is a danger, with the opinion of a doctor or treatment professional, when possible. But the Ohio Association of County Behavioral Health Authorities chose not to support the law because of concerns about how those decisions would be made and whether they impinged upon civil liberties. Denihan, whose agency is required to provide the probate court with a list of local agencies that have agreed to treat people committed by the court, said the law also runs counter to a central tenet of addiction recovery -- that it be voluntary. "Locking up and forcing people to be treated is challenging," he said, noting that most treatment facilities are not secure. "They have to want to be there." Wethington disagrees. Doctors and treatment providers told her after her son overdosed that he needed to "want" to get better and that he needed to "hit rock bottom" first. "While we were waiting for that, Casey died," she said. "For him, the ultimate bottom was death. I don't want more people dying from addiction." In 2011, 106 people died in Cuyahoga County of unintentional heroin overdoses, a number that has steadily risen since 2003. Addiction, Wethington said, is a disease like others, except that the response to it is partially shaped by the notion that addicts are somehow more responsible for their disease. "Would you be told you shouldn't help or advocate if your child had cancer or diabetes?" she asked. "The goal is to save peoples lives. That is the goal with any disease. But we have to keep people alive for them to recover." Some argue that a person's judgment and decision-making ability can be so clouded by addiction that forcing them at least to detoxify, may help them make a decision to get help. Jessica Berg, Case Western Reserve law and bioethics professor, said that addiction can damage families and finances. But she is curious how "danger" will be interpreted and whether addicts will have the right to argue against the claims of their family members that they are unable to make their own decisions. A great many addicts function for years or decades with their disease, she said. The law gives the addict the right to an attorney. Dr. Stuart Youngner, chair of the Department of Bioethics at Case Western Reserve University, said these types of decisions are being foisted on court systems because of a dysfunctional health care system and the unwillingness of society to have a larger discussion about drug use. Traditionally, he said, involuntary commitments are reserved for very serious situations and are given narrow time frames because our society values freedom to make decisions -- and to be held accountable for them, good or bad. "It is stepping down a slippery slope," he said.

Diabetes drug makes brain cells grow

The widely used diabetes drug metformin comes with a rather unexpected and alluring side effect: it encourages the growth of new neurons in the brain. The study reported in the July 6th issue of Cell Stem Cell, a Cell Press publication, also finds that those neural effects of the drug also make mice smarter. See Also: Health & Medicine Brain Tumor Stem Cells Nervous System Mind & Brain Brain Injury Intelligence Neuroscience Strange Science Reference Neural development Stem cell treatments Diabetes mellitus type 2 Embryonic stem cell The discovery is an important step toward therapies that aim to repair the brain not by introducing new stem cells but rather by spurring those that are already present into action, says the study's lead author Freda Miller of the University of Toronto-affiliated Hospital for Sick Children. The fact that it's a drug that is so widely used and so safe makes the news all that much better. Earlier work by Miller's team highlighted a pathway known as aPKC-CBP for its essential role in telling neural stem cells where and when to differentiate into mature neurons. As it happened, others had found before them that the same pathway is important for the metabolic effects of the drug metformin, but in liver cells. "We put two and two together," Miller says. If metformin activates the CBP pathway in the liver, they thought, maybe it could also do that in neural stem cells of the brain to encourage brain repair. The new evidence lends support to that promising idea in both mouse brains and human cells. Mice taking metformin not only showed an increase in the birth of new neurons, but they were also better able to learn the location of a hidden platform in a standard maze test of spatial learning. While it remains to be seen whether the very popular diabetes drug might already be serving as a brain booster for those who are now taking it, there are already some early hints that it may have cognitive benefits for people with Alzheimer's disease. It had been thought those improvements were the result of better diabetes control, Miller says, but it now appears that metformin may improve Alzheimer's symptoms by enhancing brain repair. Miller says they now hope to test whether metformin might help repair the brains of those who have suffered brain injury due to trauma or radiation therapies for cancer.