DOCUMENT PESUME CG 003 015 ED 024 967 By- Mlles, Stanley F. (Statement on Recent Research on LSD,Marihuana, and Other DangerousDrugs.] National Association of Student PersonnelAdministration, Detroit, Mich. Spons Agency-National Inst. of MentalHealth (DHEW), Bethesda,Md Pub Date (671 Note-tip Price MF-$0.25 HC-$0.65 Values, *Narcotics,*Psychological Descriptors- *Lysergic Acid Diethylamide,Mental Health, Middle Class Studies, *Research Projects Mental Health is continuingsupport of severalstudies The National Institute of the designed to measure trends inthe use of hallucinogens.Indications are that psychological and birthdefect damage fromchronic LSD use evidence for persisting units of is minimal. Though they are acontinuing problem,admissions to psychiatric "bad trips" are declining.About five percent ofthose college students persons with psychiatric polled admitted usingLSD. While a minorityof these users suffer severe there is a decline inadmissions to collegehealth services problems from drug abuse, hand, of students with LSD reactions.Marihuana use amongstudents is, on the other Of immediate concern isthe potential effectof any reality-distorting on the rise. To understand agent on the futurepsychological developmentof the adolescent user. abuse, it is necessary tolook beyond specificagents to the the problem of drug alienated yough reject underlying causes ofstudents reliance ondrugs. Today's being irrelevant andseek to alter their ownworld society and its institutions as development of new through drug use. Suchsocietal relectionmakes urgent the approaches to bridge the generationgap. (CJ) U.S. DEPARTMENT Of HEALTH, EDUCATION &WELFARE OFFICE Of EDUCATION

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PERSON OR ORGANIZATION ORIGINATING IT.POINTS OF VIEW OR OPINIONS

STATED DO NOT NECESSARILY REPRESENTOFFICIAL OFFICE Of EDUCATION POSITION OR POLICY.

STATEMENT

BY

STANLEY F. YOLLES, M.D. DIRECTOR, NATIONAL INSTITUTE OF MENTAL HEALTH PUBLIC HEALTH SERVICE U.S. DEPARTMENT OF HEALTH, EDUCATION, ANDWELFARE

BEFORE THE

SUBCOMMITTEE ON JUVENILE DELINQUENCY

OF THE

COMMITTEE ON THE JUDICIARY, U.S. SENATE

ON

RECENT RESEARCH ON LSD, MARIHUANA, AND OTHER DANGEROUS DRUGS

(Reproduced by the NASPA Drug Education Project) 4

Mr. Chairman: Public Health Service to I am happy to appeartoday in behalf of the marihuana, and otherdangerous drugs, discuss recentresearch on LSD, supported by the NationalInstitute of MentalHealth. elucidating the nature and There has beenconsiderable progress in efforts have enabled us to extent of the LSDproblem. Intensive research and long-term implicationsof obtain a betterunderstaniing of the short- psychologic and biologiceffects. LSD use, particularlyin regard to its NIMH, or utilizingLSD The scope of researcheither funded by the of activity from surveysand from the NIMH supplies, coversa wide range and experimentalpsycho- epidemiologic studiesthrough basic biochemical supporting a total of 58 pharmacologic research. Currently the NIMH is million in FY 1968for research studies and will haveexpended over $3.4 This represents an in the area of LSDand relatedhallucinogenic agents. the level of supportin FY increase of 20 projectsand $1.7 million over 1966. regarding the extent During early 1967 there wasconsiderable concern particularly in lightof reports of the LSD problemin the United States, rapid rate.NIMH is that the number of users wasincreasing at a very the extent and continuing to supportseveral studiesdesigned to measure Preliminary findingsfrom trends of LSD andother hallucinogenic use. in the past year asignificant these studies indicatethat we have witnessed decline in LSD use inthe United States. with this decline. I am sure thatthere are a number offactors associated indicate that a keyfactor in explainingthis decline Our evidence would information based on has been the availabilityof factual scientific LSD can cause severepsychotic reactions research findingswhich suggest that only in the cellsof the user but and may causechromosomal changes not also, for women, in herchildren.

CONFERENCE ON TOXICEFFECTS OF LSD

of the country'sleading Five months ago, the NIMHconvened a meeting then availableregarding the research experts toevaluate the information toxic effects of LSD. for the record. I would like to submit asummary reportof this conference I would like to The final report of theproceedings is beingcompleteC discuss briefly some ofthe highlights ofthis conference. for indicated that withseveral exceptionsthe evidence The discussion administration is minimal. persistAng.psychologic damagefrom chronic LSD (when not on LSD)showed One exception is theobservation that chronic users This suggests thepossibility uniformly lower thresholds toauditory stimuli. the chronic LSD user evenwhen that sensory overload maybe a problem for this drug. In other words,these persons are more he is not ingesting between low sensitive to soundsand might havedifficulty in discriminating and high intensitysounds. -2-

Several workers havedescribed the phenomenon ofrecurring hallucinogenic In same instances experience wlthout recurrentingestion of the drug. paranoid episodes, at users of LSD withouttaking the drug have recurrent The significance and extent times accompanied byvivid hallucinations. of these reactions are not asyet fully known. psychiatric units of persons Though a continuingproblem, admissions to Dr. "Uliam Frosch,who reported with so-called"bad trips" are declining. ',lir ,,oions to Belleque in 1966 that there was arapidly rising rate of ouch rate for such Hospital in New York City, nowinforms us that the admission cases at his hospitalhas declined. concern aboutpossible Some investigators inthe past year had expressed psychoses related outbreaks of new forms of acuteand/or chronic organic pres2nt at the meeting to hallucinogenic drug use. The consensus of those However, was that thereis not sufficientevidence to justify this concern. modification of the usualtherapy for acutehallucinogen caused psychoses of terminating the acutepsychotic is indicated. The results in terms reactions are in mostinstances good.

CHROMOSOME DAMAGE

focused on the relation- Considerable public attentionhas recently been particularly ship between LSD andchromosome damage. These reports are damage with leukemia- alarming because of theassociation of chromosomal chromosomal changes noted type syndromes andbirth defects. The types of in survivors of theHiroshima in sane LSD users havealso been observed of ionizing radiation, attmic blast and other personsexposed to high doses leukemia-type all of whom have anincreased likelihoodof developing syndromes. possible attributable toLSD The initial reportof chromosome damage School of Medicine by Dr. Maimon Cohen of theUniversity of Buffalo hallucinogenic sparked a flurry ofresearch activity aroundthe effects of the offspring of exposed drugs on chromosomes invivo and in vitro and upon human and animal subjects. investigators engaged in The NIMH is currentlysupplying LSD to 20 Cohen referred to theproduc- research of this type. The initial report of in human white bloodcells (lymphocytes) tion of chromosomal abnormalities LSD was not present cultured with LSD. These changes werenot observed when been observed when such in the medium (althoughsimilar changes have now cultures have been madewith thorazine, aepirinand caffeine). by Drs. Irwin Dr. Cohen's findings wereconfirmed nearly immediately They additionally and Egozcue of theUniversity of OregonSchool of Medicine. circulating lymphocytesof several reported chromosomalabnormalities in the "hippies" in the Portland area. Dr. Herman Liscoof Harvard University had been exposed topsilocybin, has reported identicalchanges in persons who another hallucinogen.

Similar human in vivo reportsabout LSD were madeby Drs. Cohen, confirmed by Frosch and Hirshhorn. Their findings, however, were not several investigators atthe University of California, byDr. David Hungerford of the Cancer ResearchInstitute in Philadelphia or byDr. Albert Kurland's group at SpringGrove State Hospital. In the several studies where chromosomes were examinedbefore and after LSD administrationin man, the Irwin and Cohen findingscould not be replicated.

If LSD does in fact causechromosomal abnormalities in man,the significance can only belearned over time. Similar changes occur after certain viral illnesses;but in these conditions theeffects are short- Long term and are notassociated with serious pathological consequences. lasting chromosomal damageof this type has, however, beenreported in persons exposed toatomic radiation and other individualsconsidered highly vulnerable to leukemia. In considering the leukemiacausing potential of LSD we mustconsider that longitudinal studies inidentified individuals a_e mandatory to determinewhether such changes arelong-term have any and a prelude to leukemia.Short-term chromosomal changes may not pathological significance.

BIRTH DEFECTS

Observations of chromosomalabnormalities also led to severalstudies to determine theeffects cf LSD on offspringin several animal species. In the mouse and the hamster,when LSD was administeredearly in pregnancy, there was a significantincrease in the number of spontaneousabortions and birth defects. Contradictory reports have appearedabout such findings is impossible to generalize in the rat. Experts in this field tell us that it from one species to another withregard to drug effects uponthe fetus. Thalidomide, for example, failedin several animal studies topresent birth defects across species lines althoughit did produce birthdefects in man.

There have been a number of newspaperarticles which have attempted to relate LSD to reported birth defects.One report in the New York Timesof February 10 quotes Dr. William Froschof New York Universitydescribing one child with retardedmental development. This investigator pointed out that there was no directevidence that the drug was toblame. :"..tere has been one report from the Universityof Iowa which was reported in LANCET and purported to show that anoffspring who had been exposed to the drug during the mother's45th day of pregnancy showedfindings similar to that of Thalidomide exposedinfants. Dr. Hirshhorn has reported chromosomal breaks in 50 percentof infants exposed to LSD inutero. There have been two reports ofencephalocele, an unusual defect inwhich the brain herniated through anincompletely fused skull infetuses had been exposed to LSD early in the pregnancyand then were spontaneously aborted.

Evidence that hallucinogenic drugs can causebirth defects in exposed humans is at best presumptive atthis time. Reports from animal studies and in utero chromosomal investigationssuggest a possible linkbetween some of the birthdefects reported and maternal ingestionof LSD. These investigators themselves would be thefirst to argue that theirfindings are not definitiveand that a reasoned and deliberate responseis indicated. -4-

At this time ourinformation about the biologichazards of LSD and other hallucinogenic drugs mustbe considered imcomplete. Howevp.r, in light of the preliminaryfindings, one should add to theusual uunings about LSD use particularemphasis on the possiblehazards for women in the childbearing ages.

Additionally, the advisory committee wasstrongly supportive of mechanism of action continuing, refining andintegrating research into the because of its abuse, and the biological andpsychological effects of LSD, its unique nature, andits pcossible therapeuticpotential.

SURVEYS OF LSD USE INCOLLEGES

I would now like to turn to adiscussion of findings fromseveral college surveys of LSD usein college populations. Five percent of the individual colleges students polled admitted tousing LSD with a range among likely to have also usedmarihuana of 2-9 percent. LSD users are much more Conversely, as well as otherdrugs such as amphetamineand barbiturates. marihuana also use LSD. only a small percentageof those who have used of the sample LSD users tended to be"experimenters" with only 30 percent "serious" LSD users. of the student drug We now have some dataabout the characteristics better than average, user. The academic standing ofthe occasional user was while the heavily involveddrug users had lowerthan average scholastic of student grades. There is a relativelysmall group, perhaps 3-4 percent question of "just being drug users, for whomtaking drugs is no longer a complicated and severe in," but whose problem ofdrug abuse represents a number of admissions to psychiatric problem. There is a decline in the college health services ofstudents with psychoticreactions secondary to LSD use parallelingthe decrease at Bellevuenoted earlier.

ONGOING RESEARCH

usefulness of LSD Research continues on thepossible therapeutic We particularly in the treatment ofalcoholism and psychoneurosis. currently have 12 studies and arespending this year over$1 million in this area. there are and I would I have already indicatedwhat research results in this now like todescribe briefly some of theother research going on area and what we arehoping to find out. conducted which are There are currently a totalof 93 studies being drug ar..1 using LSD supplied by thisInstitute. All requests for this reviewed by a joint FDA-NIMHcommittee to establishthe soundness of research designed and to guaranteethat all necessary precautions are elucidating the observed. A large number of thesestudies are devoted to mchanism of action of LSD. This agent has beenof great interest to neuropharmacologists and others ttudying the central nervoussystem because its actions appear to be relatedto the levels of serotoninand perhaps to catecholamine levels in thebrain (serotonin andcatecholamines are naturally trans- occurring substances which appearto play a keyrole in the biochemical actions of the brain. and 24% in Sixty percent of studies arein animals, 16% in humans tissue culture studies are isolated tissues.Most of the animal and Recent reports devoted to elucidatingthe mechanisms of actionof LSD. suggest that LSD may exert by Dr. George Agahanjianand Dr. Daniel Freedman the very area of themidbrain subtle chemicaland/or electrical effects on This is particularly which is believedresponsible for phase IR.E.M. sleep. in individuals who intriguing in view of reportsof temporary psychosis Additionally, many are specificallydeprived of this type ofsleep. psychotropic drugs specificallyinhibit this phase ofthe sleep cycle. hallucinogenic drugs. Other investigators arestudying the metabolism of Research is also proceeding onthe effects of LSD uponbrain protein understand the metabolism and nucleic acidsynthesis in ordbr to better all correlated biochemical basis of learningand memory. These studies are learning studies in variousanimal species. It is clear with behavioral and broad that LSD is an extremelyvaluable research toolwhich has opened up without vistas for basic researchthat would be impossibleto develop its ready availability tothe research community. of LSD Human studies aredesigned to test thetherapeutic potential resistant psychiatric in alcoholism, psychoneurosisand other treatment behavioral and subjectiveeffects conditions. Additionally, LSD has some derived from animalstudies. As a tool tostudy in man which carinot be mechanisms, LSD and perception, sensory integrationand basic emotional available for human other hallucinogenic drugsshould continue to be pharmacological studies.

MARIHUANA

The official nameof I shall now turn tothe subject ofmarihuana. knowledge about the the drug is cannabis. Basic research to uncover has been severely pharmacology and psysiologicalactivity of cannabis legitimate sources of a hampered by the lack ofavailability of adequate that has been donehas standardized natural product. The little research supplied utilized marihuana seizedby the Federal Bureauof Narcotics and relatively old and hadlost to researchers. Unfortunately this material was much of its original potency.

PROBLEMS OF RESEARCH

is the lack of a A key problem in the fieldof research on cannabis For results of scientificinvestigation to bereproducible, standard product. constituents and potency researchers must have availableagents whose chemical There is tremendousvariability in black marketcannabis. art: identical. materials, Seized materials may beadulterated with otherplant or chemical We know that the or maybemixtures of difEerent varietiesof cannabis. and where it is grown. potency of cannabisvaries according to its age to be the develop- Unitl recently the onlysolution to this problem appears standardized variety of cannabis. ment of a specialfacility for growing a studies While this project stillhas high priority tofacilitate scientific tetrahydrocannabinols, of natural cannabisthe recent synthesisof a number of shows great promise in the chemically activeconstituents of cannabis, expediting research inthe field.

The synthesis of thetetrahydrocannabinols and theirincreasing availability for research purposesnow makes itpossible for us finally biochemical, genetic, and to perform thevitally needed pharmacologic, about the code of behavioral resParch necessaryto answer our questions over the action and toxicity ofcannabis. While there have been reports associated with year fromforeign countries aboutirreversible psychoses this and other marihuana use, in recent yearsresponsible scientists in the validity of these countries have raisedconsiderable question about done on For instance, manyof these foreign studies were conclusions. from our own research chronic institutionalized persons. We are well aware it is extremely oninstitutionalized schizophrenicsthat after several years the effects of the difficult, if not impossible,to distinguish between Additionally, these disease and the effectsof institutionalization. chronic physical diseases, foreign studies havedealt with populations with delineate which malnutrition, etc. whichmake it extremely difficult to factors. symptoms are due tochronic marihuana useand which are due to other

PROPOSED RESEARCH

supplies of synthetic With the impendingavailability of adequate priority to an tetrahydrocannabinol we havedeveloped and have given high elucidate a number ofbasic facts. intensive systematicplan of research to of long-rangetoxicity in These studies will rangefrom the investigation controlled human studies. animals through biochemical :search and carefully social and psychological Additionally, we willexpan0 n our currentprogram of begun negotiations to investigations of marihuana u3ers. We have already the "marihuana psychosis perform studies in theseforeign countries where syndrome" has been described.

studies of marihuanawill cost approximately$5.25 We estimate that knowledge do million over the nextthree years. Though major gaps in our already given us some answers. exist, data from ongoingand past research have

SURVEYS OF MARIHUANA USE INHIGH SCHOOLS ANDCOLLEGES

indicate that approximately Surveys of high schooland college drug use reported some experience with 20 percent of the collegestudents questioned high school and college marihuana. It is estimated thatabout two million Generally more men students have had someexperience with marihuana. having ever used involvement. Of those who reported students reported "once or twice" marihuana, 65 percenthad used it less thanten times with that fully 50 percentof the commonest response. It is of great interest This finding may be those whojlaye tried_marihuana_experiened.no effects. (1) the agent may nothave been potent, a functionof at least four factors, (3) the expectation (2) frequently effects are seenonly after repeated use, experiences, (4) the social of the user has asignificant effect on what he setting in which usetakes place has an effect onthe response. _7-

Under NIMH contract support a surveyinstrument for moreaccurately populations assessing the prevalenceof drug abuse in highschool and college successful pilot studies withthis has been developed. On the basis of is pending review by the instrument a grant proposalfor a five-year study National Advisory MentalHealth Council at itsmeeting next month. the decreasing use of Our evidence wouldindicate that in contrast to LSD, use of marihuanahas been increasing. there were 200 million users The United Nationsestimates that in 1950 In the of marihuana in the world,mainly in India and inNorth Africa. extent of the problem. United States, we are notquite sure of the exact but it is much morelikely Estimates az high as 20million have been made, have used it at least that in the neighborhoodof 4 to 5 million persons once.

EFFECTS OF CANNABIS

toxicity of marihuana. Little can be added toprevious reports on the of It is considered to be amild hallucinogen, takenby the usual route mild euphoria and smoking, iccasionally byingestion. It may induce a suggestibility and a faultyperception, really an lead to heightened In exaggerated notion ofthinking more clearly,profoundly and creatively. of the eyes, addition, it is known to causereddening of the membranes drowsiness, and rapid heartbeat, muscularincoordination, unsteadiness, distortion of time and spaceperception. it may also produce In acute intoxication,especially when ingested, paranoid reactions andtransient visual hallucinations,pronounced anxiety, lessen inhibitions psychoses lasting 4 to 6hours. It generally tends to motivations, and creates for the user afalse reality based onhis wants, his similar to LSD but itseffects are not or the set. In this respect it is as potent. of space and time The muscular incoordinationand the distortion potentially hazardous perception commonlyassociated with marihuana use are _nee the drugadversely affects one's abilityto drive an automobile or perform other skilled tanks. effects of marihuana We still do not knowenough about the long-term that there are serious use. As in the case of tobacco,it is possible apparent through care- consequences of chronic usewhich will only become ful longitudinal studies.

One needs to be particularlyconcerned about the potentialeffect of psychological development of the a realitydistorting agent on the future adolescent user We know that normaladolescence is a time of great psychological turmoil.Patterns of coping withreality develr7ed during the teenage period aresignificant in determiningadult behavior. Persistent use of an agentwhich serves to ward offreality during this critical development period islikely to compromise seriouslythe future ability of the individual tomake an adequate adjustment to acomplex society. _8-

While we have no data to indicate that marihuana can affect chromosomes, this possibility is being investigated.

PREVENTION AND EDUCATION

Prevention and education efforts in the area of hallucinogenic agents have a high priority for the NIEH. Efforts in this and other areas related to research are coordinated with the FDA through a mechanism by which the Chief of the FDA's Division of Drug Studies and Statistics has a joint appointment in the NIMH Center for Studies of Narcotic and Drug Abuse.

I would like to point out that prevention and education efforts aimed at the student population demand extremely careful preparation and imple- mentation. Even high school students are extremely sophisticated about drugs. We are constantly impressed at speaking appearances before high school and college audiences about:

1. The extent of accurate knowledge mixed with misinformation about all drugs, not just LSD and marihuana, but barbiturates, amphetamines, etc; and

2. The suspicion with which students approach information supplied by "official sources."

"Scare" techniques are not only ineffectual, but are even detrimental to conveying needed information about the hazards of drug abuse.With the present incidence of marihuana use, many students have either experienced or observed first-hand the effects of this drug,They know that psychoses or other grave consequences are not an inevitable concomitant of smoking one marihuana cigarette.

It is clear that to be effective, a preventive educational effort must be carefully tailored to specific population groups and must be based on the best educational and scientific footing. The decrease in LSD use is, at least in part, I would suggest, a function of the degree to which users will respond to scientific evidence of potential danger.

Let me give you one example of how we have implemented this approach. In September 1966, the National Association of Student Personnel Administra- tors joined with FDA, NIMH and the Treasury Department in planning a program to provide student personnel and other college administrators with up-to- date, accurate information which would help them understand and cope with student drug use. Subsequently, FDA funded a contract to implement these plans. Under the direction of Dr. Helen H. Nowlis, Professor of Psychology and former Dean of Students at the University of Rochester, the National Association of Student Personnel Administrators' Drug Education Project was developed. In February and March 1967, over 1400 persons participated in seven regional conferences for the purpose of acquiring and exchanging information about the problems of drug abuse on the campus.

The continuing demand for consulting services for professional groups and colleges planning drug education programs led to a continuation of tfe project on a part-time basis. I am sure that Dr. Nowlis, who I under- stand will also appear before the Committee, can provide a detailed discus- -.9-. sion of this project. materials as part of its The NIMH is nowdeveloping a variety of Films for television aswell as small groups,film education efforts. with leading strips, pamphlets, etc., arebeing prepared. We have consulted well as educators so that our experts in thecommunications industry as sound. materials will beinstructive, effectiveand scientifically

ALIENATION

to point out thatin trying Mr. Chairman, Ithink that it is critical of drug abuse, one mustlook to understandscientifically the problem problems of such agents asLSD, marihuana,amphetamines beyond the specific of widespread drug use and barbiturates to someof the underlying causes From aspirin tosleeping and abuse. We live in adrug-oriented culture. Americans, of all ages, are pills, from tranquilizersto "the pill," numbers than everbefore. ingesting drugs in greatervariety and greater drug abuse, I think that if we areto get to the rootof this problem of prepared to investigateand identify theunderlying problems we must be with drugs. which lead people tochoose to distort orward off reality view drug abusein the One way of conceptualizingthe problem is to the broader contextof the natureand extent of student population in in school casualities" of the educationalsystem. Through our interest and alcoholism, wehave and college mentalhealth, Suicide prevention, of our brightestand become increasingly awarethat a fair percentage "succeeding" in their encounterwith the most competentyouth are not higher educational system. "alienation" in describingthe Behavioral scientists usethe term term "don't trust cross-generational diseaseepitomized by the youth-coined characterIzed as: "rebellion without anyone over30." Alienation has been refusal of what is without rejection without a program . . . a a cause. . . a vision of whatshould be." by Greek Lapse, communication betweengenerations were noted manifested in over 2,000 years ago,and more recently were philosoph, 1920's and the American society by the so-called"lost generation" of the problem of "silent generation" of the1950's. However, the currant alienation in the United States iswider, deeper, and morediffuse than and the poor, at any previous time in ourhistory. It affects the rich the college student and theschool drop-out, the urban andthe rural both young and old, besetby aliena- youngster. The number of persons, tion is far greater thanthat ever seen in anyprevious generation. relevance of major Because many alienatedyoungsters question the unable to learn societal values andinstitutions, they find themselves available to them. from the variousopportunities that presently are "To ask one of the youngsters, as As Freedman andBrotman point out. . . action?' elicits a scornful answer: one of theauthors did, 4There's the 'There's only action if youhave a high.' The implication is clear, what is meaningful is thesubjective state. If an undrugged state is defective, myopic, why notalter perception throughdrugs and create a -10- new 'reality?' Some youngsters who feel helpless toaccommodate to or change an unacceptable world,consciously choose to alter their own. . . Their most frequent statement isthat life is a 'drag.' It lacks meaning for there is no engagement; thefuture is unknown but certainlyhorrible. Since you cannot alter theworld or determine the direction inwhich it will go, you must alter yourstate of consciousness andperception, that is, see the world andexperience the world through a'high.' Any alteration is acceptable, and thus,the barbiturate user candescribe to you the joys of a 'drowsy high"and the amphetamineuser will talk about the'high' he gets on benzedrine - andlikewise for the LSD, marihuana, andheroin abuser. All that is important is inone's subjective state.Perceptions and beliefs of the square wor d or thenon-drug world are superficial,distorted, mean- " This rejection of many goals of the society, the unwillingness ingless. . to model themselves on anystable adult leaders and theinability to acquire the necessary attitudes andskills for responsible adult behavior,make urgent the developmentof new and innovative approaches tobridge the intergenerational gap.

If this is not done,there are serious dangers thatlarge proportions towards of current and future generations willreach adulthood embittered other the larger society, unequipped to take onparental, vocational and behavior. citizen roles, and involved in someform of socially deviant

I would propose that if we are everto solve the problemof drug abuse, it is critical for us tofocus on and try to solvethe root causes of alienation.