Monday, June 30, 2008

Ed Carter died yesterday, 06/29/08

Ed Carter, a retired Addictions Specialist with New York State Office Of Alcholism and Substance Abuse Services, died yesterday at hospice in Buffalo, NY from esophageal cancer.

Ed was a great friend to GCASA as our OASAS contract manager. He helped us build our current building for administration and Batavia Clinic, and our Atwater Community Residence.

Ed will be missed as a friend and as a great, all around human being.

Click on image to enlarge for easier reading.

Monday, June 23, 2008

Sarah Edwards to be Gambling Specialist and Charlene Grimm to be Substance Abuse Counselor in Batavia Clinic

Today, John Bennett, GCASA's Director of Treatment, announced some important staff changes in the Batavia Clinic. Here is John's announcment:

I pleased to announce that Sarah Edwards has accepted the position of gambling specialist. Sarah has been working in the women's program with Norma Miller for the past two years and also developed the nicotine services in Genesee County. She just recently sat for her CASAC in June 2008 and is enrolled in the counselor education master program at Brockport for the fall semester. Sarah has strong program development skills and I am sure she will do a great job developing GCASA's gambling addictions services. Please congratulate her when you see her.

I am also pleased to announce that Charlene Grimm has accepted the position of clinic counselor vacated by Sarah Edwards. Charlene has been working as the substance abuse specialist in the collocation demonstration project. She has been working in Livingston county and has been a key player in the implementation of the this program. Previously Charlene worked three years for stepping stone in Rochester NY in their outpatient program.. She is a CASAC-T and is currently working on her masters in counseling through St John fisher. Please congratulate her when you see her.

GCASA is looking for a substance abuse counselor to work with child protective service personnel

GCASA is looking for a substance abuse counselor to work with child protective service personnel. Contact John Bennett at 585-815-1849 or Kim Corcoran at 585-815-1801.

Click on the image to enlarge for easier reading.


Thursday, June 19, 2008

Error in announcement for law enforcement dinner

There is an error in the announcement about the law enforcement dinner tommorrow night, June 20, 2008. The dinner will be at the Batavia Party House on Rt. 5 east of Batavia, NOT at Bohn's. The social gathering begins at 6:30 PM and the dinner begins at 7:00 PM.

Sorry for any confusion.

Hope to see you there.

Wednesday, June 18, 2008

Law enforcement recognition dinner, Friday, June 20, 2008 at Bohn's in Batavia

Click on image to enlarge for easier reading.



For more information click here.

2008 Stop DWI winning posters

All the 2008 Stop DWI poster contest winning posters are now up on the GCASA web site for both Orleans and Genesee County. To go to the links for the posters click here.

Here is the third place winner in the K - 3 category in Orleans County by Brennan Callara from Oak Orchard Elementary.

GCASA Cares web traffic

In the first two weeks of GCASA Cares web log's existence, it has had 111 unique visitors for 194 visits with 460 page views.

We would appreciate your sharing the existence of the blog with colleagues, family, and friends. You can email articles or send them GCASA Cares URL -> http://gcasacares.blogspot.com

Thanks for helping us spread the word.

Increase in cigarette tax leads to more quit attempts by New York smokers

Increasing the cigarette tax is a huge success in that it has given many New York State smokers incentive to make a quit attempt. This is a good thing for their health and for our society.

As a public health strategy, decreasing access to toxic substances by increasing their costs, decreases the prevalence of substance abusing behaviors and improves the health of a community.

All OASAS licensed facilites must be tobacco free by July 24, 2008. GCASA went tobacco free on April 1, 2008. In the last 2 months, 99% of clients,and visitors, and 100% of staff have been in compliance. This is a tremendous change in making our community healthier and drug free. Thanks to everyone for all your efforts and sacrifices.

This article is from Monday, June 16, 2008, Daily News. Click on the image to enlarge it for easier reading.

Prescription drugs kill far more people than street drugs

An article in the New York Times on June 14, 2008 states that a recent study by the Florida Medical Examiners found that the number of people killed by presciption drugs was three times the number killed by street drugs. Here is a snippet from the times article:

From “Scarface” to “Miami Vice,” Florida’s drug problem has been portrayed as the story of a single narcotic: cocaine. But for Floridians, prescription drugs are increasingly a far more lethal habit.

An analysis of autopsies in 2007 released this week by the Florida Medical Examiners Commission found that the rate of deaths caused by prescription drugs was three times the rate of deaths caused by all illicit drugs combined.

Law enforcement officials said that the shift toward prescription-
drug abuse, which began here about eight years ago, showed no sign of letting up and that the state must do more to control it.

“You have health care providers involved, you have doctor shoppers, and then there are crimes like robbing drug shipments,” said Jeff Beasley, a drug intelligence inspector for the Florida Department of Law Enforcement, which co-sponsored the study. “There is a multitude of ways to get these drugs, and that’s what makes things complicated.”

The report’s findings track with similar studies by the federal Drug Enforcement Administration, which has found that roughly seven million Americans are abusing prescription drugs. If accurate, that would be an increase of 80 percent in six years and more than the total abusing cocaine, heroin, hallucinogens, Ecstasy and inhalants.

The Florida report analyzed 168,900 deaths statewide. Cocaine, heroin and all methamphetamines caused 989 deaths, it found, while legal opioids — strong painkillers in brand-name drugs like Vicodin and OxyContin — caused 2,328.

It is ironic that with all the money the United States has spent on "the war on drugs" over the last 4o years, the biggest killers are perfectly legal in the U.S.: tobacco, alcohol, and prescription drugs. The number of deaths caused by "legal drugs" is far greater than what are caused by illegal drugs. About 600,000 people a year are killed by tobacco, alcohol, and prescription drugs as compared to 30,000 by street drugs.

Here at GCASA we work to reduce the demand for legal and illegal drugs by giving people accurate information and helping them to make healthy choices. We have seen a huge increase in our treatment of people addicted to opiates to the extent that we have developed a whole new opiate addiction treatment program. For more information you can ask any GCASA counselor or call John Bennett, GCASA's Director of Treatment, at 585-815-1849, or Maryann Bowman, GCASA's Director of Prevention, at 585-815-1877 or email John at jbennett@gcasa.org, or Maryann at mbowman@gcasa.org.. You can reach me, David Markham, Executive Director, at 585-815-1800 or dmarkham@gcasa.org.



Video lasts 2:31 minutes

Tuesday, June 17, 2008

DePaul to withdraw from providing addiction services. RFQ issued by Monroe County

DePaul Addiction services will be closing their inpatient beds in mid-August. Monroe County has contracted with Coordinated Care Services, Inc. (CCSI) to issue an RFQ (Request For Qualifications) to providers who might want to operate the inpatient rehabilitation, detox, outpatient clinic, community residences, and supportive living programs. GCASA is considering submitting an application to operate the outpatient clinic, community residences, and supportive living programs.

The RFQ states that Monroe County substance abuse programs will be given preferred provider status, but regional and other providers' applications will also be considered. Should GCASA apply? Leave your comments or send them to me at dmarkham@gcasa.org.

Click on image to enlarge for easier reading.

Wednesday, June 11, 2008

Kevin Neu, M.S.W., GCASA substance abuse counselor in Albion, NY is missed

Kevin Neu, M.S.W., a substance abuse counselor at GCASA in GCASA's Albion office died suddenly on May 21, 2008 after working a full shift the day before until 9:00 PM.

Kevin was well liked and respected by his clients, his colleagues, and his referral agents and collaborative partners in the community.

Kevin left a full case load and a sense of shock among those who respected and loved him. He was 58 years old and had worked at GCASA almost 3 years.

This is the second death of a GCASA staff member while employed at GCASA in the last 3 years. We still grieve the loss of Mary Brady, RN, who worked at GCASA well over 10 years.

Here is part of obituary in the Rochester Democrat and Chronicle:

Neu, Kevin T.Greece, NY: On May 21, 2008. He is survived by his mother, Catherine Neu; son, Dr. Kristoffer (Sharda) Neu; 2 daughters, Amber Landschoot and Dawn (Brion) Swanson; brother, James (Denise); 2 grandchildren, Fox and Max; several nieces & nephews.

You can read the whole obituary by clicking here.

Batavia gets a new police chief - Randy Baker

Batavia got a new police chief yesterday, 06/10/08, Chief Randy Baker. Randy has been a big help to GCASA staff as a youth officer, and helping with compliance checks. I attended the Genesee County Criminal Justice Advisory Committee (CJAC) this morning and was pleased to see that Chief Baker was there representing the Batavia Police Department.

Congratulations to Chief Baker and the people of Batavia and Genesee County for having such a high caliber individual as a Chief of Police.

Click on image to enlarge for easier reading.

New York State Nurses Association help nurses with substance abuse problems


The New York State Nurses Association has a EAP for nurses called SPAN. SPAN is an acronym for Statewide Peer Assistance For Nurses.

There are several peer assistance for nurses support groups in Western New York State. The regional coordinator is Paula Calleri, RN, MS, CARN. You can reach Paula at 1-800-724-6976 x355.

GCASA successfully provides treatment services for a number of health care professionals. Referrals to services such as SPAN are facilitated by GCASA counselors, but only with the consent of the client and permission to release information.

To find out more about SPAN click here.

Here is a Q&A from the Sping, 2008, SPAN newsletter.

Click on image to enlarge for easier reading.

Tuesday, June 10, 2008

Older adult smokers quit when cost of cigarettes go up - not just kids.


Taxes on cigarettes went up $1.25 per pack last week in New York State for a total tax of $2.75 the highest of any state in the nation. There is public health research evidence that when prices of cigarettes go up the prevalence of smoking goes down.

It has been thought that younger people are more sensitive to the price increases and quit, but now there is further evidence that adults are sensitive as well especially adults less well educated and poorer.

The study was reported in the July, 2008 issue of the Journal of Health Economics. Here is the abtract:

While recent evidence casts some doubt, it is generally accepted that the price sensitivity of smoking varies inversely with age. We investigate the responsiveness of older adult smoking using variation from recent historically large cigarette tax increases in the United States. Using data from the Behavioral Risk Factor Surveillance System from 2000 to 2005, we find consistent evidence that higher taxes reduced smoking participation by older adults, especially those who are less educated and live in low-income households. Our findings run contrary to existing evidence which suggests that cessation behavior by older adults is not sensitive to price. Since a large literature suggests smoking cessation even later in life reduces morbidity and increases longevity, our findings may represent substantial gains in health among tax-induced quitters.

Pre-Trial Release Program in Genesee County saves county taxpayers almost 4 million dollars per year.


Genesee Justice, currently under the direction of Ed Minardo, has a long history of restorative justice and pre-trial release programs. One of the most important is called the RUS program. RUS is an acromym for Released Under Supervision. People who meet certain criteria are released prior to trial to be supervised by Genesee Justice.


It costs $86.00 per day to keep a male in jail in Genesee County. Genesee County does not have jail facilities for females so they are usually incarcerated in Orleans County for per diem rate of $70.00 per day after a base annual fee of $15,000.00.



As of 02/27/08 Genesee Justice was monitoring 129 defendants (101 males and 28 females.) If these defendents would have been incarcerated it would have cost Genesee county taxpayers $8,686.00 per day for the males, and $1,960.00 per day for the females.



The RUS program saves Genesee County Taxpayers $3,885,790.00.



As of 02/27/08, this caseload of defendants was supervised by one case manager costing $32,000.00 in salary plus fringe benefits.



For more information about the Genesee Justice Pre-trial release program, you can contact Ed Minardo at 585-344-2550 x2465

Effective rural practice


GCASA serves primarily two rural counties, Genesee and Orleans between two major metropolitan areas in Western New York State, Rochester and Buffalo. There was and interesting article in the Families In Society journal in April - June, 2007, Vo. 88, #2, entitled Social Workers' Suggestions for Effective Rural Practice by Joanne Riebshleger.

Here are some of the interesting ideas in the article.

There is a sense of a "rural divide", that is there is "The City" and then there is the country. Here at GCASA students from Buffalo don't want an internship in Batavia or Albion because "it's way out there" when in reality we are only 35 minutes from downtown Rochester and downtown Buffalo.

There are higher rates of poverty and scarcer formal resources but people tend to help each other out more in informal networks.

There is a slower pace of community and change. People are a little more "set in their ways."

Everything is connected and everybody tends to know everybody or "know of" everybody. This makes it a little more difficult to create professional boundaries and to avoid dual relationships.

Professional relationships tend to be "closer" and "more personal" which can make the access to service easier and sometimes more psychologically intimidating. Because of the closeness of relationships, we often see people who can afford it, commute from the community for service while poorer people, who do not have that option, must deal with the perceived shame of asking for services in their own community jeopardizing their anonymity.

There is a greater geographical span to access services and transportation is often a problem. Often professionals feel a bit more isolated because there is not so much collegial support close by.

There is an "insider group" status given to professionals who have local connections. Without that it is more difficult for "outsiders" to obtain trust and credibility.

There is a stigma attached to rural people and practice as not being as current, up to date, or as good as what is available in the city. "I'm just a country boy." "I'm not as smart as those professionals in the big city." is a common feeling and perception. Services delivered in cities are perceived as being higher quality and more expert.

Advocating for social justice in rural areas may be more difficult because of local politics and local norms and attitudes which are perpetuated by community gatekeepers who have a vested interest in the status quo and who distrust outsiders who they perceive as "coming in and trying to change things."

Working in rural communities can be very rewarding as well as challenging. Rural communities while "more political" in some ways also are less bureaucratic so it is easier to meet and develop relationships with key community leaders. In some ways in rural communities problems are easier to solve because the human dimension is on a smaller scale.

If you would like a copy of the article, email me at dmarkham@gcasa.org and I will send one to you.

Underage drinking in LeRoy. Police are proactive.


Click on image for easier reading.

5th Annual Skate Jam in Medina NY on June 7th huge success


The fifth annual skate jam and community garage sale in Medina, NY last Saturday, June 7, 2008 was a huge success. Here is what Pat Crowley, GCASA's Assistant Director of Prevention in Orleans County had to say about it:

We had 250 parents, and youth attend this year- it was awesome. I looked over the surveys briefly that were filled out ( 164 youth, 37 adults )- thought it was interesting where they all came from- Alden, Lockport, Albion, Jeddo, Middleport, Basom, Batavia, Lyndonville, Holley, Kuckville, Rochester, Barker, Amherst, Knowlesville, Santa Rosa, Ca.; Huntsville, Ala.; St. Robert, Missouri; Florida and Medina.

To read the article in the Medina Register on June 8, 2008 click here.

292.89 Cannabis Intoxication means being stoned

Cannabis intoxication means "being stoned." DSM-IV TR diagnostic criteria for 292.89, Cannabis Intoxication, is described.

Video lasts 5:40

Monday, June 9, 2008

Teens benefit from AA and NA study finds


Reuters HealthDay reported on June 4, 2008 on a study which will appear in the August, 2008 issue of the journal, Alcoholism: Clinical and Experimental Research which found that teens who go to AA and NA meetings do better after discharge from inpatient rehab programs. Here is part of what the article says:

Alcoholics Anonymous and Narcotics Anonymous offer benefits to adolescents, even if they eventually stop attending meetings, says a study that included 160 teens enrolled at two treatment centers in California.

The teens, with an average age 16, stayed from four to six weeks at the centers, which were focused on abstinence and used a 12-step model. The teens were reassessed at six months, and one, two, four, six, and eight years after they left the centers.

"We found that most of the youth attended at least some AA/NA meetings post-treatment," John F. Kelly, associate director of the MGH-Harvard Center for Addiction Medicine at Massachusetts General Hospital, said in a prepared statement.

"Those patients with severe addiction problems and those who believed they could not use alcohol/drugs in moderation attended the most. The NA and AA focus on abstinence/recovery probably resonates better with these more severely dependent individuals who also typically need ongoing support," said Kelly, who's also an assistant professor in psychiatry at Harvard Medical School.

While many of the study participants eventually stopped going to AA/NA meetings, they seemed to benefit from their time with the organizations.

"We found that patients who attended more AA and/or NA meetings in the first six months post-treatment had better longer term outcomes, but this early participation effect did not last forever -- it weakened over time," Kelly said.

"The best outcomes achieved into young adulthood were for those patients who continued to go to AA and/or NA. In terms of a real-world recovery metric, we found that for each AA/NA meeting that a youth attended, they gained a subsequent two days of abstinence, independent of all other factors that were also associated with a better outcome."

Kelly noted that even a little exposure to AA/NA can go a long way.

Smoking in the movies influences teens to smoke

Smoking in the movies. Video lasts 1:33

GCASA has openings for Chemical Dependency Counselors

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Zero Tolerance for under age 21 DWI positively influences college students decisions to drink and drive


There has been a lot of criticism of the legal drinking age being 21 with a desire to lower it back to 18. The only problem is that from a public health perspective the drinking age of 21 saves thousands of lives. Here at GCASA we have a "Support 21" club which promotes the law of 21 being the legal drinking age.

I will post further information on this blog dealing with the 21 drinking age issue. Here is an abtract of a study in a recent Health Economics issue which found that the Zero tolerance laws for DWI for people under 21 definitely influence college students decisions to drink and drive positively.

Zero tolerance laws make it illegal per se for anyone under age 21 to drive with any measurable amount of blood alcohol. Although a link has been established between zero tolerance laws and lower motor vehicle fatalities, research has not produced strong evidence on how zero tolerance laws influence individual alcohol use and drinking and driving behaviors. Using a unique data set and a difference-in-difference-in-difference-type research design, we are able to analyze a number of pathways through which zero tolerance laws can work among an important underage population, college students. We find that zero tolerance laws reduce drinking and driving among college students. Further analysis of our detailed alcohol use measures suggests that zero tolerance laws are particularly effective at reducing the probability of driving after drinking for those who reported drinking away from home.

Video lasts 2:41

GCASA's Royal Employer Services


GCASA has an Employee Assistance Program called Royal Employer Services. It's largest contracts include the County government employees in Genesee, Orleans, and Wyoming counties as well as Genesee Community College and the ARCs of Orleans and Genesee Counties. Royal also has numerous commercial contracts with companies such as Chapin Manufacturing, Hodgins Engraving, Liberty Pumps, Orcon Industries, and PW Minor and Sons just to name a few.

Royal has excellent EAP counselors including John Bennett who also is the Royal Employer Services Director, Kathy Hodgins, Tammy Leach, Liz Riter, Norma Miller, and Kelly Carlie.

Today I recieved from Leslie Pfalzer, the EAP coordinator, the first issue of the EAP staff newsletter labled July 2008, Issue 1. It is very well done and informative. If you are a profesional counselor and would like to have a copy notify Leslie at 585-815-1820 or email her at lpfalzer@gcasa.org

To learn more about Royal Employer Services click here.

Sunday, June 8, 2008

The pain of alcoholism in the family

This is a post recently posted on the Cyber Recovery Fellowship. I don't think it is much different than what GCASA's counselors deal with regularly.

I don't know if this is strictly for people with an addiction, but I guess you can consider me with an addiction. I don't drink, do drugs but I am a child of two past and current alcholics as well as a sister of an alcholic. I am currently in Alanon and counsling for co-dependency, being in a marriage where my husband is addicted to pills and of course my brother.

I have taken my brother in my home with the knowledge of his past , DUI's, Jail, hit and runs. He was clean of alchol and I was so happy to finally have my older brother being able to expierance that relationship is something I will never regret. I did waike up everyday with fear of losing him, losing the brother I always wanted and finally had to alchol again.

The other day I noticed a personality change, he became my dad, then he was standing next to me and I could smell a faint smell of beer. I was putting stuff together for a yard sale and I went in the room he has been sleeping to grap some things then I noticed the famous duffel bag, where he would always sneak beers into my moms house. I looked in it and found empty beer bottles and cans, then today I noticed outside some beer caps on my patio.

He has no where else to go, he has burned all of his bridges with anyone close to him. I have not approached him at this point because I need to do the right thing.

Prior to him staying with me I told him that if he is to drink he can not stay here, I have a 5 year old daughter who senses everything around her and she I have to put her best interest first being her mother.

I guess I am torn between giving him a second warning since I already gave him a warning prior to drinking or to I have to stand my ground and follow the clear boundries that I already set?

My brother is 36 years old, no health insurance so rehab is not an option ---- which he has done a few times already. I don't want him to feel unloved because I love him dearly but I can't let him take advantage (if that is the word) of me .

Please , anyone help me. He has no job because he lost his last from alcohol and him being a felon he has difficulty getting one. I am the only working one in the household and it isn't enough to cover the bills as is, so while he has been staying here it has been without cost, he has been spending the loose change around the house on the beers.

What do I do, where will he go, what should I say?


If you are a counselor, or a friend, what would you say to this women?

Video about alcoholic Barbie and co-dependent Ken lasts about 4:46

Saturday, June 7, 2008

Long term use of marijuana causes significant brain injury


Reuters Health Day reported on June 2, 2008 on a study which appears in the June, 2008 issue of the Archives of General Psychiatry which was done in Australia which found that there are serious long term negative effects of marijuana use on the brain. Here is part of the what the Reuters article says:

MONDAY, June 2 (HealthDay News) -- People who use marijuana for a long time can develop abnormalities in their brains, Australian researchers report.

Although growing literature suggests that long-term marijuana use is associated with a wide range of adverse health consequences, many people believe it is relatively harmless and should be legalized, the researchers noted.

"However, this study shows long-term, heavy cannabis use causes significant brain injury, memory loss, difficulties learning new information, and psychotic symptoms, such as delusions of persecution [paranoia], delusions of mind-reading, and bizarre social behaviors in even non-vulnerable users," said lead researcher Murat Yucel, from the ORYGEN Research Centre and the Neuropsychiatry Centre at the University of Melbourne.

This new evidence plays an important role in further understanding the effects of marijuana and its impact on brain functioning, Yucel said. "The study is the first to show that long-term cannabis use can adversely affect all users, not just those in the high-risk categories such as the young, or those susceptible to mental illness, as previously thought," he said.

The report was published in the June issue of the Archives of General Psychiatry.


Video lasts 3:36

Internet addict with early signs of withdrawal

Internet addict with early signs of withdrawal. Video lasts 56 seconds.

Friday, June 6, 2008

Canoeing and kayaking while drunk can lead to death


Canoeing and kayaking while drunk leads to death. Here is part of the Reuters HealthDay article from May 21, 2008 referring to a CDC (Center For Disease Control) study.

Canoeists and kayakers who want to enjoy the water while staying safe should wear lifejackets, get some training, and stay away from alcohol, suggest health officials with the Centers for Disease Control and Prevention (CDC).

Among the 38 people who died while participating in paddle sports in Maine between 2000 and 2007, more than two-thirds weren't wearing lifejackets and 5 (of 31 tested) had blood alcohol levels above the legal limit for boating and driving in the state, Dr. Jon Eric Tongren of the CDC and colleagues found.


I remember reading years ago about the number of people who drown because they are swimming while drunk. Part of the explanation is that intoxicated people become disoriented when under water and can't tell up (the surface) from down (the bottom.)

Smoking and drinking hasten onset of Pancreatic Cancer


Smoking and drinking, especially beer, hastens the onset of pancreatic cancer according to a Reuters HealthDay article published on May 21, 2008 based on a study reported at the Digestive Disease 2008 conference in San Diego in May. Here is part of what the Reuters article says:

Heavy smoking and drinking, especially beer, may hasten the onset of pancreatic cancer, according to researchers who presented their data Tuesday at the Digestive Disease Week 2008 conference in San Diego.

Beer appears to exert a stronger influence than hard liquor or wine in lowering the age of onset of pancreatic cancer, said researcher Dr. Michelle A. Anderson, assistant professor of medicine at the University of Michigan.

Anderson and her colleagues evaluated patients from The Pancreatic Cancer Collaborative Registry, a multi-center, international patient registry, looking at whether the patients drank or smoked, and if so, how much and what type of liquor.

They evaluated the smoking and drinking (or abstinence) patterns of 453 patients in all, about equal numbers of men and women.

Patients who smoked did tend to develop pancreatic disease at a younger age and there were dose-related effects, Anderson said. Heavy smokers (such as those who have smoked more than a pack a day for 40 years, or more than two packs for 20 years) presented with pancreatic cancer an average of seven years before nonsmokers.

The average age of onset of pancreatic cancer is between 70 to 80, experts noted.

Heavy drinkers, defined as having more than three daily drinks, presented with pancreatic cancer 10 years younger than those who did not drink.

Comparing beer, wine and hard liquor, the team found that beer lowered the age of developing pancreatic cancer most, Anderson said. When she compared beer drinkers to non-beer drinkers, the effect was statistically significant; however, when she considered other variables that may affect cancer onset, the effect disappeared.

Cigarette smoking is already a well-known risk factor for pancreatic cancer. Heavy alcohol intake may induce chronic inflammatory changes that are also linked with cancer, Anderson said.

The combination of chronic smoking plus drinking had no stronger effect on pancreatic risk than either habit alone, the researchers found.

Decisons and attempts to quit smoking often cascades through social networks

The National Insititute of Health, NIH, issued a press release on May 21, 2008, about as study published in the May 22, 2008 issue of the New England Journal of Medicine which found that the decision and attempt to quit smoking often cascades through social networks. Here is part of what is written in the NIH press release:

When smokers kick the habit, odds are they are not alone in making the move. Instead, the decision to quit smoking often cascades through social networks, with entire clusters of spouses, friends, siblings and co-workers giving up the habit roughly in tandem, according to a new study supported in part by the National Institutes of Health (NIH).

Researchers analyzing changes in smoking behavior over the past three decades within a large social network found smokers quit in groups and not as isolated individuals. Those who continued to smoke also formed clusters that, over time, shifted from the center of the social network, where social connections are more numerous, to the periphery of the group. The report, appearing in the May 22, 2008, New England Journal of Medicine and funded primarily by the National Institute on Aging (NIA), part of the NIH, could play a role in developing clinical and public health interventions to reduce and prevent smoking. The smoking analysis was also supported by the Robert Wood Johnson Foundation.


A little further down in the press release it says:

The researchers found the closer the relationship between contacts, the greater the influence when one person quit smoking. For example:

When a husband or wife quit, it decreased the chance of their spouse smoking by 67 percent.

When a sibling quit, it reduced the chance of smoking by 25 percent among their brothers and sisters.

A friend quitting decreased the chance of smoking by 36 percent among their friends.

In small firms, a co-worker quitting could decrease smoking among peers by 34 percent. In larger firms, the influence was insignificant.

Neighbors did not seem to be influenced by each other’s smoking habits.

"Interestingly, geography did not appear to play a role because smoking behaviors spread between contacts living miles apart and in separate households," said Christakis. "Rather, the closeness of the relationship in the network was key to the spread of smoking behaviors."


It makes me wonder if we could take advantage of this dynamic at GCASA in our outpatient programs and/or residential programs, if we asked clients to find "buddies" to quit with?

Wendy, I wish you wouldn't smoke weed. When you smoke I miss my friend.

Video lasts 32 seconds.

Thursday, June 5, 2008

Teen gambling

This is an informative and entertaining video about Teen Gambling. It lasts 9:45 and is worth watching. It is made by middle school age kids for middle school age kids although I am 62 and enjoyed it.

Bob Goodsell is retiring from Genesee County Department of Social Services

Bob Goodsell who has been the Director of Financial Services at Genesee County Department of Social Services forever is retiring and there is a retirement party in his honor on Wednesday, June 25th, at 5:30 PM at Bohn's restaurant in Batavia.

Bob is a great guy, a dedicated professional, and one of those people in County government who is conscientious, dedicated, hard working, creative, personable, honest, dependable, and is a blessing to work with.

We at GCASA will miss him greatly and wish him well in his retirement. It has been an honor and a privledge and a joy to work with him over the years.

Here is the flier announcing his retirement party.

Click on the image to enlarge it for easier reading.

Smoking kills in more way than one in Genesee County, NY

We are all familiar with the unsual ways that smoking kills such as lung cancer, heart disease, and less well recognized and acknowledged is through accidental fires. One such smoking related fire killed a 17 year old high school student in Genesee County, NY.

Click on image to enlarge for easier reading.




Video lasts 1:32 minutes.

Liklihood of being physically assaulted is related to amount of liquor sold in neighborhood


Reuthers Health Day reported on May 20, 2008, on a study reported in PLoS Medicine, May 2008, which found that the number of physical assaults in a neighborhood is correlated to the amount of liquor sold in local liquor stores.

This is not a new Public Health finding. Other studies have demonstated the number of negative occurances of alcohol related problems such as DWI, assaults, property damange, disorderly conduct, rape, accidental injury is directly related to the number of alcohol retail outlets per square mile.

ABC boards and local zoning laws should take this into account when they issue alcohol permits.

Also, Happy Hours, 2 for one night, and ladies night at bars which encourage binge drinking, increase the liklihood of negative activity.

From a public health perspective as well as a criminal justice perspective decreasing access to disinhibiting substances such as alcohol which increases impulsivity , poor judgement, and disregulated emotional expression goes along way in increasing the safety, orderliness, and quality of life in a community.

Here is part of what was written in the Health Day article:

The more alcohol sold at a person's local liquor store on a given day, the more likely he or she is to be hospitalized as the result of a serious assault on the following day, Canadian researchers have observed.

In an interview with Reuters Health, Dr. Joel G. Ray of the University of Toronto, who led the study, noted that while critics have said the findings are "nothing new" or "self-evident," the problem of booze-related brawling remains common, with potentially devastating consequences, and is not being addressed. "I do really think we need to look at (alcohol abuse) as something as serious as the illicit drugs we now ban," he said.

People are known to be more likely to commit violent acts when they have been drinking, and there's also new evidence that alcohol boosts a person's risk of being the victim of violence as well, Ray and his team point out in the Public Library of Science journal PLoS Medicine.

Gambling Addict To Loan Shark - Take my life please! Just shoot me!

Video on gambling addiction. Lasts 1:32 mintues

GCASA needs school based student screening and referral services providers to work in schools

GCASA's prevention program has contracts with schools in Genesee and Orleans Counties to provide a substance abuse prevention educators in the schools to provide substance abuse screening and referral services.

People filling these positions need to be good with troubled kids, their parents, and work well in a complex organization like a school.

People filling these positions need to be self directed, have excellent interpersonal and communication skills, and know how substance abuse affects individuals, groups, families, and school performance. They also will need to become familiar with community resources.

GCASA recognizes that people in these positions have a very unique skill set and we are developing a career ladder for Student Screening and Referral Services providers.

If you, yourself are interested in exploring this career or know someone who is please contact, Maryann Bowman, GCASA's Director Of Prevention at 585-815-1877, mbowman@gcasa.org, and/or Kim Corcoran, GCASA's Director of Human Resources at 585-815-1801, kcorcoran@gcasa.org. Please spread the word. There are a couple of positions available.
Here is the job posting. Click on the image to enlarge it for easier reading.

Quitting smoking lowers womens risk of heart disease 47%


Reuters HealthDay published a report on May 13, 2007 on an article in the May 7, 2008 issue of the Journal of the American Medical Association, JAMA, which found that women who quit smoking have a 47% lower risk of dying from heart disease within 5 years than women who continue to smoke. Here is part of what the article says:

New research shows that women who quit smoking have a 47 percent lower risk of dying from coronary heart disease within five years of extinguishing their last cigarette.

The risks of dying from other conditions also decline after quitting, although the time frame varies depending on the disease.

"The harms of smoking are reversible and can decline to the level of nonsmokers," said study author Stacey Kenfield, whose report is in the May 7 issue of the Journal of the American Medical Association. "For some conditions like chronic obstructive pulmonary disease, it can take more than 20 years, but there is a rapid reduction for others."

"It's never too early to stop, and it's never too late to stop," added Kenfield, who is a postdoctoral research fellow in the department of epidemiology at the Harvard School of Public Health in Boston.

Smoking is still the leading preventable cause of death in the United States. Not only does tobacco smoke cause lung cancer, it is also implicated in heart disease, other cancers and respiratory diseases.


At GCASA we have Nicotine specialists in both clinics in Batavia and Albion as well as all our clinical staff are trained to assess stages of readiness of clients and if ready, to help them with smoking cessation. It is no exaggeration to say that these efforts are saving lives and research such as the study referenced in this article proves it.

Wednesday, June 4, 2008

Smoking Kills

Video lasts 30 seconds.

8th annual GCASA awards dinner nominations welcomed

It is time to consider and nominate a person and/or organization you think deserving of community wide recognition for improving the quality of life in Genesee and Orleans counties.

Here is the front page of the nomination form. click to enlarge the image.



Here's for form to fill in and submit to Pam LaGrou, Director of Communications and Development, GCASA, 430 East Main Street, Batavia, NY 14020.

Click on image to enlarge it.



Here are the past award recipients in 2006 and 2007.

Genesee County Drug Free Communities Coalition met on 06/03/08 with over 100 people in attendance

The Genesee County Drug Free Communities coalition had a great meeting yesterday mornning (Tuesday, June 3, 2008) at Bohn's Restaurant in Batavia, NY. There were over 100 people there including 30 - 40 high school students from various high schools in Genesee County.

Paul Mrozek, a reporter for The Daily News, was there and wrote a great article for The Daily News which appeared in today's issue, 06/04/08.

Click on image to enlarge it for easier reading.

Jamie Beedham, GCASA Gambling Prevention Specialist writes article in 06/04/08 Daily News

Click on image to enlarge for easier reading.

There's No Wrong Way To Talk To Your Kids About Drugs

This video is pretty good. It's worth watching. Leave your comments. It lasts 32 seconds.

Clinical case of substance abusing 25 year old male with bipolar and ADHD

Here is an interesting case of a 25 year old male with substance abusing behavior and bipolar disorder and ADHD.

Adam is a 25-year-old, single, white man who is referred after dropping out of college subsequent to being arrested for making fake college IDs. In addition to this, his parents report that he has taken money from them for college when, in fact, he was not attending classes.

Adam moved back home with his parents 1 year ago; since then, he has had angry outbursts and has destroyed some household property. His parents report that he has written bad checks, has a history of chronic lying, has years of substance abuse, and has severe mood swings with violent outbursts. The psychiatrist interviews Adam privately, and then speaks with Adam's mother for historical confirmation. His father is interviewed at a later session for corroborating information.

Clinical Note


A clinician's initial reaction to this presentation may be one of trepidation. The parents complain about and the patient acknowledges substantial substance abuse, antisocial behavior, academic delinquency, and violent mood swings. It is incumbent upon the clinician to avoid premature conclusions and follow a thoughtful structured diagnostic interview in order to parse out symptoms and diagnostic disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria, longitudinal course, and family psychiatric history.

To read full report click here.

Teens don't need a drug dealer to get high

PSA Video lasts 30 seconds.

2008 Orleans County Drug Free Poster Contest Grand Prize Winner

To view other winning posters click here.

June 7th, 5th annual Skate Jam - Medina, NY


Changes in psychiatric patients' thoughts about quitting smoking during a smoke-free hospitalization




A recent study reported in the journal, Nicotine and Tobacco Research, found that psychiatric patients in a smoke free inpatient unit were more likely after discharge to think that they could quit smoking successfully.

This study may have implications for us at GCASA when we receive clients from Stutzman and Norris and/or other smoke free rehab facilities (and maybe jail) who have been smoke free. Admission to our outpatient clinic for aftercare treatment may be a golden time to develop long term cessation goals with these clients if, as the study suggests, their expectancy of successful smoking cessation has increased due to their experience of their smoke free inpatient stay.

Here is abstract of the study:


Though exempted from national bans of tobacco smoking in hospitals, some psychiatric facilities have voluntarily gone 100% smoke free with little reported difficulty in clinical management. The impact of smoking restrictions on psychiatric patients' thoughts about quitting smoking, however, is not known. This study investigates changes in thoughts about quitting smoking for patients hospitalized in a smoke-free psychiatric inpatient facility. Participants were 100 smokers recruited from a university-based adult inpatient psychiatry unit. The present study focused on participants' reported desire to quit smoking, their expectancy of success and anticipated difficulty with quitting, and their smoking abstinence goal. Assessments were conducted at hospital intake and shortly before hospital discharge. Follow-up assessments were conducted by phone at 1 week, 1 month, and 3 months posthospitalization to measure smoking behavior. Although no cessation treatment was provided in this observational study, from admission to discharge, participants reported an increased expectancy of success with quitting and a decreased expectancy of difficulty with staying quit. They also were more likely to endorse a smoking-related goal. Psychiatric diagnosis was not related to thoughts about abstinence. Furthermore, participants' thoughts about abstinence at discharge were significantly related to their subsequent smoking behavior. Hospitalization in a smoke-free environment is associated with increases in patients' expectancies about quitting and staying smoke free.



Problem gambling is not a game

Problem gambling is not a game. Video lasts 30 seconds.

Tuesday, June 3, 2008

DWI Victim Impact Panel Recognition Dinner


The DWI Victim Impact Panel Recognition Dinner will be held at the Batavia Party House on Friday, June 20, 2008 at 6:30 PM. Awards will be given to various law enforcement personnel who have done an outstanding job in enforcing DWI laws and keeping our community safe. Also, DWI victims will be honored.


Tickets are $20.00. Please call Mike Laycock at GCASA for more information at 585-815-1874 or email Mike at mlaycock@gcasa.org.


Click on the image to enlarge it.


A sign of how far the disease of alcoholism has progressed.........

Click on the image to enlarge it.



GCASA to provide problem gambling treatment services in Orleans County

GCASA gets license and $3,000.00 to provide problems gambling treatment services in Orleans County.

Click on image to read approval letter.

July 9 is Drug Free Communities night at Batavia Muckdogs


July 9th, 2008 will be Drug Free Communities night at the Batavia Muckdogs. Baseballs will be given out to the first 500 people admitted into the park. There will be games and prizes and plenty of Drug Free Communities promotional materials.


July 9 is a Wednesday night. Game time is 7:05 PM. We hope to see you there.

Genesee County Drug Free Poster Contest Grand Prize Winner


Here is the 2008 grand prize winner of the Drug Free poster contest. It was submitted by Peter Miano from Genesee Valley BOCES. The poster has been made into a T-Shirt and will also be made into a billboard.

To see the other posters go to the GCASA web site.

GCASA 2007 annual report now available


The GCASA 2007 annual report is now available. It was first distributed at the 2008 GCASA annual meeting last May 28, 2008.

If you would like a copy contact Pam LaGrou, GCASA's Director of Communications and Development, at 585-815-1803 or plagrou@gcasa.org.


Monday, June 2, 2008

About 2.1% of adolescents 14 - 21 have problems with gambling


Reuter's HealthDay reported on May 12,2008, on a study which appears in the June, 2008 issue of the Journal of Gambling Studies done by researchers Research Institute on Addictions in Buffalo, NY.


The researchers did a phone survey of 2,300 people between the ages of 14 and 21. They found that 2.1% were problem gamblers. There were far more males than female adolescent problem gamblers.
Based on 2000 census numbers there were about 3548 people in Genesee County between 14 and 21, and 2550 in Orleans County. With a 2.1% problem gambling prevalence rate, that would mean that there are 75 young people in Genesee County, and 54 young people in Orleans County with gambling problems.

Here is part of what the Reuter's article says:
An estimated 750,000 American teens and young adults are problem gamblers
according to researchers at the University at Buffalo's Research Institute on
Addictions.

Problem gambling is defined as gambling associated with three or more negative consequences, such as gambling more than you intended or stealing money to gamble.

The national telephone survey of almost 2,300 respondents, ages 14 to 21, found that 2.1 percent were problem gamblers, which works out to a nationwide total of about 750,000 young problem gamblers, the researchers said.

They also found that 11 percent of respondents gambled twice a week or more -- considered frequent gambling -- and that 68 percent of respondents said they'd gambled at least once in the past year.

The findings of the survey, conducted from August 2005 through January 2007, are
available online and were expected to be published in the June 2008 issue of the
Journal of Gambling Studies.

"In a society where young people are increasingly exposed to gambling influences, there is cause for concern," principal investigator John W. Welte said in a prepared statement.

"As might be expected, all statistically significant results showed that greater
gambling involvement is associated with aging into an adult status. In fact,
gambling may be associated with the transition into adulthood," said Welte, a
senior research scientist at the Research Institute on Addictions.

The study found that gambling increased with major life changes such as getting a
job, leaving school, living independently from parents, and marriage. Young
people who worked full-time were more likely to gamble, those who weren't in
school were more likely to gamble frequently (twice a week or more), and those
who lived independently were more likely to gamble and to be problem gamblers.

"As far as gender, it seems likely that females' gambling involvement
tends to emerge in adulthood, while male involvement can be high in adolescence.
We found identical problem gambling rates for adult males and young males (4
percent). We found adult females' gambling rates were much higher (3 percent)
than that of young females (less than one-tenth of a percent). In other words,
problem gambling is almost non-existent among female adolescents and young
adults," Welte said.

GCASA Summerfest 2008


GCASA's 3rd annual summerfest will be held on Saturday, July 26, 2008, at St. Anthony's church hall and parking lot on Liberty Street in Batavia, NY.

Atwater Community Residence and Supportive Living clients and alumni will be meeting at 10:00 AM followed by brunch. At 12:00 PM there will be a Chicken Barbeque, music, dancing, children's games, vendors open to the public from 12:00 - 3:00 PM.

Plan on coming to hang out and celebrate recovery.

NY State to have highest state and city cigarette taxes in the nation effective June 3, 2008


Effective Tuesday, June 3, New York State will have the highest state and city cigarette taxes in the nation. New York State Health Commissioner Richard F. Daines and New York City Health Commissioner Thomas R. Frieden will make a major public health announcement on the impact of the tax hike at a press conference on Tuesday, June 3, at 11 a.m. at the Children's Museum of Manhattan.

New York State tax on cigarettes is going up $1.25 from the current $1.50 per pack to $2.75.

It is estimated that 140,000 adults in New York will quit smoking as a result of the increase in price, and 250,000 young people will not get addicted to nicotine as a result of the increase in price.

WHO: NYS Health Commissioner Richard F. Daines, M.D., and NYC Health Commissioner Thomas R. Frieden, M.D., M.P.H.

WHAT: New York's two top docs make major public health announcement in connection with $1.25 per pack increase in state cigarette tax, which takes effect June 3.

WHERE: Children's Museum of Manhattan, 212 West 83rd Street, New York, NY

WHEN: Tuesday, June 3, at 11 a.m.

Note: Media planning to attend are requested to RSVP by contacting Diane Mathis at 518-817-6198 or emailing dmm10@health.state.ny.us

GCASA has been tobacco free since April 1, 2008


OASAS has promulgated regulations that say that all OASAS licensed programs must be tobacco free by July 24, 2008. While GCASA has been smoke free since October of 2003, GCASA implemented its tobacco free policy on April 1, 2008. Here is a copy of the letter that was sent to all GCASA referral agents:

GCASA

February 1, 2008

Dear Clinic Referral Agent

As you probably know tobacco kills more Americans every year than alcohol or street drugs. 430,000 Americans die from tobacco. 100,000 Americans die from Alcohol, and 30,000 Americans die from street drugs.

Bill W. and Dr. Bob, the founders of Alcoholics Anonymous, even though they both became sober, died from tobacco.

For reasons we don’t understand completely, people who struggle with substance abuse disorders and major psychiatric disorders use tobacco 4 times the rates of people without these disorders. We, at GCASA, are well aware that most of our clients struggle with tobacco addiction as well as problems with other drugs. Since 2003 GCASA has offered services to people who suffer from tobacco addiction.

In 2007, New York State Office of Alcoholism and Substance Abuse (OASAS) developed new regulations which mandate that all of its licensed programs be tobacco free by 07/28/08. It is our intention at GCASA to go tobacco free by April 1, 2008.

Tobacco free means that no tobacco products or paraphernalia (lighters, clothing with tobacco product logos) can be brought onto or kept on GCASA grounds, or in GCASA facilities, and vehicles. Also, the smell of tobacco about a person’s body is not acceptable.

As of April 1, 2008 we expect clients to abide by our tobacco free policy and not bring tobacco, and/or tobacco paraphernalia onto GCASA property and/or into our facilities and vehicles. We know that tobacco addiction is a very difficult addiction for people to break and GCASA’s staff is prepared to assist anyone who desires to maintain their abstinence from tobacco through counseling, support, nicotine replacement therapy, etc.

We appreciate your attention, understanding, and assistance in helping us implement our new tobacco free policy and in creating a climate conducive to people pursuing their sobriety and recovery.

If you have any questions or concerns about this policy, feel free to discuss them with John Bennett, the Treatment Program Director, any of our Outpatient Services staff, and/or myself.

Very truly yours,


David G. Markham, L.C.S.W.
Executive Director
GCASA

8th annual GCASA awards dinner


The 8th annual GCASA awards dinner will be held this year on Saturday, October 18, 2008 in the Forum at Genesee Community College.

Nominations for awards are now being accepted and will be accepted until July 2, 2008.

You can submit nominations to Pam LaGrou, plagrou@gcasa.org or call Pam at 585-815-1803 for more information.

Sunday, June 1, 2008

Legislation introduced in Massachusetts to lower the BAC to .02 for DWI

An article appeared in the Boston Herald on March 17, 2008 and appears on Prof. David Hanson's web site which states that legislation has been introduced in Massachusetts to lower the legal BAC to .02. Here is part of Hanson's web site says:

Massachusetts would lower its maximum legal BAC for driving from the current .08 down to .02 if state senator James Fagan’s proposed legislation becomes law. The act would essentially prohibit the consumption of any alcoholic beverage before driving.

It's about time. I wish this legislation could be passed in New York State. We would all be a lot safer on our highways. About 600 people are killed a year from DWI in New York, and about 17,000 in the United States.

Teen gambling in New York State

Teen gambling in Brooklyn and Long Island. Video lasts 2:55.

Teen Substance Abuse TV report in Indianna

Teen substance abuse report on Channel 13 in Indiana. Video lasts 3:12.

Not all victims of DWI crashes are killed.

Not all victims of DWI crashes are killed. Jacqueline Saburido was 20 when a car she was riding in was crashed into by a drunk driver.



Jacqui Saburido on Oprah in 2003. Video lasts 7:16 and is well worth watching.

Prom and graduation season

1/3 of the 1,700 kids, aged 18 - 24 killed each year from accidental injuries (including motor vehicle crashes), homicide and suicide occur during prom and graduation season.


Because of this heightened concern and awareness I have been asked to give some presentations at some of the local high schools. I have three scheduled this year, and the last two days I have given two, and next week I will do the third. These presentations are given to high school assemblies of seniors,  and in some cases seniors and juniors, about DWI and making "good choices". This has been less than satisfying for me for a whole bunch of reasons. However I have been given an opportunity to review some of the data and I thought I would share some of it here because I think it is instructive in many ways of the kind of society we are living in.


1 in 3 12th graders report, on survey, that they have binge drank (5 or more drinks on a single occasion) in the last two weeks. This data is pretty consistent in Genesee County,NY, New York State  as a whole, and across the country.


Goofing on the 150 or so juniors and seniors I talked with this morning, I asked them to raise their hands if they had binge drank in the last two weeks. Surprisingly about twenty hands went up and one kid shouted out laughing, "Yeah, I got wasted!!!", the kids around him laughed.


I asked them why they think so many kids binge drink and they shouted, "Because it's fun."


I guess it is to a point. BUT.............................................................


90% of the estimated college rapes per year (97,000) occur when the victim, perpetrator, or both are intoxicated. I live in a college town and I remember a few years ago seeing an article in the college newspaper reporting that 11 rapes had been reported to campus security that year. I was startled. Is that high, low, under reported? I thought rape was a serious felony crime and rapists, if convicted, go to prison. Are college student rapes on a college campus reported to campus security handled differently? Is this a different type of crime?


25% of sexually active college students , or about 400,000 college students between the ages of 18 - 24 per year, report having unprotected sex per year while under the influence. Studies have found that 20- 25% of young women are infected with a STD like chlamydia and/or gonorrhea without knowing it.


11% of college students report perpetrating property damage while intoxicated.


25% of college students report symptoms of academic failure ( missing classes, late papers, doing poorly on exams) because of alcohol.


Vomit_2 Living in the downtown area of a college town in Brockport, NY, on Saturday morning when I walk the two blocks from my house to my office to see clients, I have to walk around the piles of vomit on the village sidewalks. Last week I could actually see the elbow macaroni and beans from Jimmy Z's garbage plate in the vomit. There were three piles on the corner of King Street and Main Street. This is a common occurrence. I pointed out to the kids this morning that alcohol is poison and your body tries to reject it and if the body cannot, alcohol poisoning leads to coma and death.


Alcohol is readily accepted in our society and glamorized in commercials and advertisements constantly. Is it any wonder that "getting wasted" and "to party" have become synonymous?


After my two kids were killed in a drunk driving crash, perhaps I am over sensitive, but the tragedies and heartache caused by alcohol, it seems to me, far outweigh its benefits and pleasure especially when used to excess as the youth in our society seem to do in significant numbers.


Here is my daughter Brigid in her Irish dancing dress before a performance when she was 5 about a week before she was killed.


Brigid Kathleen Markham


04/11/87 – 03/10/93


Brigid_2


Here is my son Ryan in his Irish dancing outfit before a performance about a week before he was killed .


Ryan John Patrick Markham


05/09/84 – 03/10/93


Ryan_2


Here is the 18 Wheeler tractor trailer that smashed into the car driven by my wife and with four of my children in it. It was the driver's third DWI.


Car_crash   


This is me, a tired old man, talking about it after 15 years. Had they not been killed at age 5 and 8, Brigid would be 21 today, and Ryan would be 24. I miss them terribly. They were great kids and would have been outstanding adults. Our world is poorer for not having them in it.


Dave_tan_coat