Short Title

CHRONIC HEAVY USE OF CANNABIS: PSYCHOLOGICAL EFFECTS '-

Ph.D. PSYCHOLOGY

CHRONIC HEAVY USE OF CANNABIS SATIVA:

PSYCHOLOGICAL EFFECTS

Marilyn Bowman

Abstract

The psychological effects of chronic heavy use of Cannabis Sativa (marijuana) were studied in a population of normal adult males with a history of heavy daily use for ten years. Three groups of objective·psychological tests were used to compare these subjects with a control group matched for age, sex, social class, alcohol use, intelligence, education and 'modernity'. The first group of tests were concerned with physiological, sensory and perceptual-motor functions; group two tests measured concept-formation and abstracting abilities, and the third group of tests measured memory functioning. An initial study demonstrated that there were no indica- tions of user-impairment on the se measures. A replication of the study using an improved single-blind design confirmed the findings of the original study. It is suggested that this drug does not lead to mental

impairment comparable to that found typical of alcohol or

cocaine-abusing subjects. CHRONIC HEAVY USE OF CANNABIS SATIVA:

PSYCHOLOGICAL EFFECTS

by

Mari1yn Laura Bowman

A thesis submitted to the Facu1ty of Graduate Studies and Research in partial fu1fi11ment of the requirements for the degree of Doctor of Phi1osophy.

Department of Psycho1ogy McGi11 University March, 1972 Montreal, Canada

® Marilyn Laura Bowman 10/72 ACKNOWLEDGEMENTS

I wish to thank Dr. R. O. Pihl for advice and encourage­ ment throughout the course of my research. In addition, I thank my Jamaican friends Ronald Watts and Jennifer Lynn, without whose help this study could not have been done. A modest grant from the American Psychological Association is also gratefully acknowledged. Joe Vanagas and Laurel Ward are thanked for their helpful technical assistance. TABLE OF CONTENTS 1 Page INTRODUCT ION 1 History and Incidence of Use 1 The Chemistry and Pharmacology 3 Studies of Immediate Effects in AnimaIs 6 Studies of Chronic Effects in AnimaIs 13 Reports and Studies of Immediate Effects in Humans 17 Reports and Studies of Chronic Effects in Humans 29 Studies of Cannabis Users 37 Some Basic Issues in Human Drug Research 44

THE PRESENT INVESTIGATION 48 Subjects 48

Measures 53 Study I -- Method 71

Results 74 Discussion 80

Study II Method 89 Results 90 Discussion 96

DISCUSSION 103

SŒ-1MARY 121

REFERENCES 122

APPENDICES l

INTRODUCTION

History and Incidence of Use Marijuana preparations are the most widely used illicit

drugs in the world, having an estimated 200 to 300 million

consumers (Mechou1am, 1970). Until quite recent1y the vast

majority of users were found in Oriental and African cultures. This pattern is now shifting and in western techno1ogica1

societies there has been a major increase in the number of

users. This increase appears to represent an ongoing trend and has brought the use of the drug under renewed scrutiny by governmental and hea1th authorities who have long maintained

strict sanctions against its use.

One of the basic unresolved issues concerning the drug

is the extent and manner in which prolonged regular use might

change the user, either in terms of inte1lectual performance

or in terms of persona1ity and social functioning o This

thesis will attempt to answer some of the questions relating

to inte1lectua1 performance changes with chronic heavy use of

the drug.

Initial1y the incidence rates and patterns of use of the

drug will be described in order to place the issue into its

current social contexte A description of the drug in terms

of its chemistry, its active e1ements and genera1 potency will

fo11ow. These findings will be used 1ater in the study to

provide a background against which data from the investigation

may be evaluated. 2

In order to describe the dimensions of the use of the drug in western societies it is interesting to review some of the studies of the incidence of use found in Britain, the

United States, and Canada.

In Britain Bewley (1966) drew attention to the changing

incidence rates reflected in the statistics describing Can­ nabis offenses; these ranged from a figure of 100 in 1945 to

more than 800 by 1964.

North American studies have used sophisticated survey

techniques in attempting to establish incidence rates. Man­

heimer, Me1linger and Balter (1969), in such a study among

San Francisco adults which specifically excluded students,

found that 13% of his sample had used the drug at least once,

with certain age groups demonstrating significantly higher

rates than that: men aged 18-24 had a 50% incidence rate.

In general a consistently high incidence rate has been found

among young adult men. Studies of soldiers in Vietnam have

found usage rates around 30% (Sapol & Roffman, 1969; Colback,

1971), which is a rate typically found also in studies of

civilian co1lege men. The Preliminary Report of the National

Commission on Marijuana and Drug Abuse (to the United States

Governrnent) estimated that 24 million Americans have tried the

drug at least once, while 8.3 million appear to be fairly

steady consurners (Shafer, 1972).

In Canada, a study of the figureô of the Division of

Narcotics Control for cannabis-related cha~ges, shows the 3 fo11owing trend: In 1962 there were 24 cases; in 1969 this figure had risen to 5,157 (Addiction Research Foundation, 1969). Individua1 surveys re1ating to incidence of use in schoo1s and co11eges across Canada give figures ranging from

5.9% to 24% in 1969 (LeDain, 1970); figures for use by adu1ts on the who1e have not yet been satisfactori1y estab1ished.

If current rates of experimenting with the drug continue one author predicts that within six years aIl students in metro­ po1itan Toronto schoo1s will have tried the drug (Smart,

Fejer, & White, 1971). Thus British and Canadian studies revea1 an increasing use of the drug, whi1e the American studies have shown rela­ tive rates of use in the genera1 population which are now quite high. The 1ega1 sanctions against the drug are coming underincreasing attack and the three governments described above have each been stimu1ated to review the evidence con­ cerning the effects of its use. (In Britain the Wootton

Committee, the American Committee noted above, and in Canada, the LeDain Commission.) The data to be provided in this in­ vestigation represent a contribution of direct relevance to

the concerns of these committees, and to the general public.

The Chemistry and Pharmaco1ogy

One of the reasons for the dearth of information con­

cerning effects of the drug has been an extreme1y 1imited

scientific 1itcrature. This 1ack of investigations had had

two main roots. First1y, 1ega1 strictures concerning pos­

session have been enforced against scientific investigators 4

in the same manner as against potentia1 consumers, thus the drug was not rea11y accessible for research purposes until quite recent1y. Second1y, unti1 eight years ago the actua1

chemistry and pharmaco1ogica1 activity of the cannabinoids were 1arge1y unknown and thus the question of dosage uncon­ tro11ed.

Previous1y, attempts made to extract and identify the main active compounds in marijuana had resu1ted in the des­ cription of cannabino1 (CBN), cannabidio1 (CBD) and tetra­ hydrocannabino1 (THC) as the major ingredients of interest (Adams, 1940). Adams suggested that THC was the principal active ingredient, a1though he was unab1e to describe its chemica1 structure (a task he had accomp1ished for CBN and CBD). In addition he noted the effects of the passage of time on these agents, in particu1ar the transforming of CBD to THC and then to CBN. This sequence has been recent1y confirmed and described in detai1 (Gr1ic, 1968). It appears that the resin in green plants is main1y CBD acid which changes to CBD as ripening progresses, then to ~8THC and A9THC when the plant is mature.

In the past decade considerable work has been done to confirm, describe and synthesize THC in its various isomers (Gershon, 1970) and as a resu1t of the se studies there has deve10ped a minor 'controversy concerning whether .D8THC or D.9THC is the principal active THC isomer ( Taylor, Lenard, & Schvo, 1965; Garriott, Forney, Hughes, & Richards, 1968). In an important study (Isbe11, Gorodetsky, Jasinski, C1aussen, 5

Spulak, & Korte, 1967) it was demonstrated that a synthetic

Â9THC used by human subjects in both oral and smoked pre­

parations~ produced those subjective effects typical of mari­

juana. However a number of investigators have shown that

~THC appears to convert to ~8THC with ageing of the plant,

with exposure to acids or with combustion or high temperatures

(Lerner & Jeffert, 1968; Bfron, 1967). On this basis it is

claimed that ~8 could weIl be the actual active ingredient

within the body under either oral or smoked routes of admini­

stration. In spite of this issue Â9THC is commonly recognized

. as the principal psycho active isomer and is the element most

commonly used to describe the potencies of various prepara­

tions of marijuana used in contemporary studies.

As a result of newly gained freedom to study the drug

and increasing knowledge of its chemical identity, studies

have attempted to describe the nature of its action within

the body, i.e., the pharmacology of the drug.

It has been frequently noted that a higher level of mari­

juana activity is experienced from smoking than from oral

ingestion of equivalent doses (Isbell, et al., 1967; Mechoulam,

1970). This has been explained as being due to the conversion

of inactive THC acids into ~9THC with the heat of combustion.

Once in the body it has not been clearly established whether

the psychoactivity is caused by ~9THC, ~8THC or metabolites

created within the body. The frequent report that no effects

are experienced the first time the drug is used, would support 6 the hypothesis that metabolites are the actual active ingre­ dients. Once within the body, immediate effects in man

following inhalation begin within minutes and are 1arge1y

dissipated within three hours. Oral administration begins to

affect subjects between one and two hours post-drug, with

effects continuing up to eight hours (Weil, Zinberg, & Nelson,

1968; Waskow, 01sson, Sa1zman, & Katz, 1970). Both animal and hum an studies are now proliferating as

investigators begin to delineate the effects of the drug upon

physio10gica1 and psycho10gica1 parameters. Much of the work

with humans has been based on findings coming out of animal

investigations, both concerning immediate and chronic effects.

For this reason a truncated review of the animal 1iterature

will be made, with an emphasis on those findings which repre­

sent a fair1y consistent agreement among investigators.

Studies of Immediate Effects in AnimaIs

A number of studies have been concerned with the immediate

effects of the drug upon various species of anima1s. The

first broad group of functions under this description to be

reviewed here will be basic physiologica1 responses. Para­

meters of interest will inc1ude heart rate, respiration, body

temperature, b100d pressure, and cortical activity.

An extract of pure natura1 ~9THC was administered intra­

venous1y to anaesthetized rats in an attempt to de1ineate

effects on heart rate, respiration, and body temperature

(Mi1zoff, Brown, Forney, & Stone, 1971). The surprising finding 7

of depressed heart rate, while confirming the report of one other animal investigator (Miras, 1965), is at variance with another report (Jaffe, 1970) and with an array of human results (Siler, Sheep, Bates, Clark, Sook, & Smith, 1933; Lowe, 1944; Isbell et al., 1967; Hollister, Richards, & Gillespie, 1968; Weil et al., 1968). No control group was used in the Milzoff study, however, and it is possible that heart rate was respon­ ding to the effects of the anaesthetic used in the procedure. The force of heart contraction has been shown to be reduced in direct proportion to dosage (Manno, Manno, Kilsheimer, & Forney, 1970). There is a general consensus that respira­ tion rate becomes depressed under influence of the drug (Miras, 1965; Garriott et al., 1968; Milzoff et al., 1971), although variable, dose-related effects were found by one investigator (Bose, Vijaijvarguja, Saifi, & Bhagevat, 1963). Blood pres­ sure dropped for a short time in response to THC, and to a group of THC-related synthetic preparations in a study by Garriott et al., (1968). The effect on body temperatures appears to be a cooling one, as shown in a number of studies using preparations of the drug ranging from hashish extracts (Garattini, 1965), to multimetabolite THC (Miras, 1965), to extracts of pure natural ~9THC (Milzoff et al., 1971; Holtzman, Lovell, Jaffe, & Freedman, 1969). Thus it is clear that the drug causes sorne changes in the basic physiological functioning of animaIs, sorne of which have been shown to be directly related to dosage levels. 8

Early studies of a synthetic THC derivative (DMHP) on the reticular formation had demonstrated a depressant or seda­ tive activity directly comparable to that of two barbiturates

(Boyd & Merritt, 1966). In the course of their studies on pain,

Bicher and Mechoulam (1968) however, found that cortical acti- vity increased and arousal threshold dropped as a result of

48 or 69THC. Hockman, Perrin, & Kalant (1971) found that

~9THC produced electroencephalographic changes iri rats corres­ ponding in significance to the three dosage levels which they administered. In the higher dosages the EEG patterns resembled those believed typical of hallucinatory activity (hypersynchrony), although there was significant variability between subjects. A number of investigators have concluded that both frontal areas

and the midbrain arousal system are affected by.the drug, and the most consistent EEG response has been found to be one of

increasing synchronization (Boyd & Merritt, 1966; Bose, et al.,

1963; Bicher & Mechoulam, 1968). Thus cortical changes in the

direction of increasing tranquillization of the animal repre­

sent a fairly consistent finding. From a range of behavioral

studies however, it appears that sedation is not the only type

of response, and that stimulation also occurs as a common

response to the drug. Consequently it is difficult to assign the drug to one psychopharmacological category.

Degree of ataxia, and activity level have been two commonly

used indices in the group of studies done in the attempt to

resolve this issue.

Ataxia is reported as a major behaviora1 response in dogs 9

to a marijuana extract (Loewe, 1944), to pure THC (Garriott

et al., 1968; Ho1tzman et al., 1969), to three synthetic THC

isomers (Grunfeld & Edery, 1969) and in rats to a pure natural

~9THC (Phillips et al., 1971). Whether or not the ataxia is

related to depressant or stimu1atory activity of the drug is,

however, not clear. Several investigators have noted a general

decrease in motor activity immediate1y fo1lowing the adminis­

tration of the drug in various preparations. As an alcohol

extract (Bose et al., 1963), as a hashish extract injected

into rats and mice (Garattini, 1965), as a natural THC in-

jected into mice (Garriott, 1967; Garriott, King, Forney, &

Hughes, 1967; Ho1tzman et al., 1969) and as a pure Â8 and

~9THC (Grunfe1d & Edery, 1969) this effect has been confirmed.

To complicate this consensus however, Garriott et al., (1967)

reported an increase in spontaneous activity following the

initial depression in mice injected with natural or synthe-

tic THC, and a contrary sequence has been reported by other

authors (Carlini & Kramer, 1965; Scheckel, Boff, Dahlen, &

Smart, 1968). They found initial stimulation regularly followed

by depressed activity levels and even catalepsy with high dosages.

In attempting to sort out these confusing findings a

number of studies have combined the cannabinoid with other drugs

of known depressant or stimulatory activity. Potentiation of

the effect of either would lead to a clearer basis for classi­

fying the main cannabis effect. Thus it has been shown that the

sleeping-time induced by barbiturates can be significantly en­

hanced by the administration of various marijuana extracts 10

(Loewe, 1944; Bose et al., 1963; Miras, 1965; Garattini et al., 1965), and with prepared pure natura1 and synthetic

THCt s (Garriott et al., 1967, 1968). Phi11ips, Brown, &

Forney (1971) found a similarly potentiating effect when a water-suspension of natural h9THC was administered with ethy1 alcohol; the ethanol-induced immobility was further enhanced by the THC. Thus in enhancing the sedative effects of known sedatives, the depressant aspect of cannabis is confirmed.

However, studies in which various amphetamines are combined with versions of cannabis have shown an effect paradoxica1 to these depressant findings. Loewe (1944) found that a mari­ juana extract combined with benzedrine greatly increased dog ataxia and later studies with purer versions of THC found that the activity which amphetamines induced, was significantly pro­ longed by the THC (Dagirmanjian & Boyd, 1962; Garriott et al.,

1967).

Studies of the response to pain as a measure of the effect of cannabis have shed one final contradictory 1ight on this topic. Throughout history the drug has been known for its ana1- gesic effects, however Stuart (1963) dismissed these as being too slight to be of therapeutic interest. The work of Car1ini

and Kramer (1965), Phillips et al. (1971), and Holtzman et

al. (1969) further attacks the notion of analgesic effects

from cannabis. AlI reported an increased sensitivity to

tactile or auditory stimulation in which strong vocalizations accompanied any sur.h sensations being perceived by the rat.

This would seem to indicate a 10wer thresho1d of pain tolerance. Il

In contrast to these findings, Bicher and Mechoulam (1968) demonstrated significant analgesic properties for both~8 and 49THC in mice and rabbits using shock to the sciatic nerve as the pain stimulus, and using cortical and blood pres­ sure changes as the index of pain. They have found these analgesic effects directly comparable to those of morphine in potency, although the mode of action appears to differ at the cortical level.

Thus it appears that the drug asserts both depressant and excitatory effects upon the nervous system possibly in a specifie sequence which more detailed observations would clarify. As an aspect of general arousal and sensory thres­ hold levels, studies of pain have likewise provided contra­ dictory information which may lead to a consensus if closer

attention could be di~3cted to the sequence of the responses

noted. Studies of the effect of the drug on more complex

behaviors have included both social behaviors such as ag­

gression and dominance, and learned skills such as rope­

climbing and visual-discrimination.

Isolation-induced aggression in mice is suppressed by

injections of extracts from natural marijuana (Santos, Sampaio, Fernandes, & Carlini, 1966; Salustiano, 1966; Carlini, 1968). Confirmation of a reduction in aggressiveness as an

immediate effect of drug administration was noted by Siegel

and Poole (1969) in a study of a mouse community, where a tem­

porary disruption in the community's dominance hierarchy was

also found. 12

In studying changes on rope-climbing, Carlini and Kramer

(1965) administered an alcohol extract of natural cannabis to rats, and found an initial impairment which disappeared after repeated exposures to the drug. This temporary disruption of a learned skill has been found in monkeys on tasks of memory and visual discrimination following the administration of either 8THC or 9THC (Scheckel, et al., 1968). In pigeons the disruption'has been noted to be only a temporary suppres­ sion of the visual discrimination response, which is quickly

returned to normal levels following administration of high

doses of cannabis extracts (Siegel, 1969).

Finally, immediate performance on a maze-learning trial by

rats injected with an alcohol extract of natural cannabis minutes

before the trial, resulted in enhanced performance as a tempor­

ary response. With the passage of time depression set in and

impairment was demonstrated (Carlini & Kramer, 1965).

Thus aggressiveness appears to be reduced as a general

immediate response to the drug. Changes in the performance of

learned skills tend to involve a temporary disruption or sup­

ression of the behavior, with graduaI recovery to nondrug levels

although the report of temporary enhancement found by Carlini

appears in contradiction to this general finding. Further

studies of learning are necessary before the exact nature and

sequence of these changes can be considered established.

In concluding this review of the animal literature on

immediate effects of the drug, it is clear there are many 13 unanswered contradictions in the findings. In part this is due to the fact that only in 1964 was the exact chemical structure of THC known, and even later than that (1968), synthesized. Because of this, many investigators worked with extracts of the natural substance which varied widely in composition and subsequently in effects until fairly re­ cent times.

Studies of Chronic Effects in Animals

The literature on the effects of chronic administration of the drug also suffers from this handicap which in many cases makes direct comparisons of contradictory findings quite difficult.

Overall, there have been few studies of the effects of chronic use of the drug in animals, and even fewer of these effects in humans. In the animal studies a main concern has been directed to the issue of tolerance, a topic once con­ sidered to be linked intimately with the concept of physical dependence upon a drug. In the animal studies with marijuana modestly consistent findings concerning tolerance have ac­ crued. Tolerance. Tolerance to the effects of the drug has

been demonstrated by a number of investigators, yet there is a general reluctance in the North American 'iterature to

accept this finding (Gershon, 1970; Grinspoon, 1971). Car­

lini (1968) discovered that in spite of initial signs of 14 impaired rope-climbing, rats given daily interperitoneal in­ jections of an alcohol extract of natural cannabis began to improve, and eventually performed as weIl as controls. Sup­ port for this finding has been shown in studies reported by

McMi11an, Harris, Frankenheim, & Kennedy, (1970) and McMi11an, Harris, Turk, & Kennedy (1970). Pigeons given high dai1y doses of THC were measured on a conditioned response (key­ pecking for food) which initially showed impairment as a drug effect. Within one week, however, the original response was

recovered, and in some birds, improved beyond predrug levels.

Once to1erance was established, increasing dosages of the drug

could be administered with no further apparent changes in

performance on the task. These studies also demonstrated that

to1erance to Â9THC meant the establishment of cross-tolerance to 68THC as weIl. Other studies of cross-tolerance have shown

that rats made tolerant to ~9THC or a cannabis extract remain

sensitive to mescaline or LSD-25 (Silva, Carlini, Claussen, &

Korre, 1968). This kind of investigation appears to be quite

rare, probably in reflection of the resistence of investiga­

tors to the general notion of tolerance effects with this

drug. This topic is of great relevance to human studies which

have similarly displayed sorne ambivalence in investigating the

phenornenon.

Physiological effects. Physiological studies have shown

that with chronic administration, the drug is stored in various

tissues and may lead to changes in these tissues over a period

of tirne. 15

Miras (1965) injected radioactive THC into rats and found the substance in the liver, lungs, and brain. It rapidly dis­ appeared from the blood following administration, going to tissue sites and to excreta within thirty minutes post­

injection. Lung tissue was similarly found to be a main site

of THC concentration in an inhalation study with rats using

49THC (Ho, Fritchie, Kralik, Englert, McIsaac, & Idanpaan, 1970).

Less agreement is found concerning brain changes with the drug. Luthra, Rosenkrantz, Muhilly, Thompson, & Braude (1971) found significant decreases in protein, RNA and ACHE with daily

injections of very high dosages of THC for periods of one and

three months. In contrast, Carlini and Carlini (1965) found

no changes in RNA, but increased DNA in their study of the effects

of a cannabis extract on brain chemistry. DNA changes, if con­

firmed, might help to explain the changes in short-term memory

shortly to be described as immediate effects of the drug in

humans.

The drug rapidly disappears from body fluids and can be

identified in excreta only if it has been made radioactive. For

this reason identification of a chronic hum an or animal user is

not yet possible with any rapid or convenient biochemical pro­

cedure, although one investigator has reported a technique for

identifying a Metabolite in urine following an oral dose of the drug (Milsson, Agurell, Nilsson, Ohlsson, Sandberg, & Wah1quist, 1970) . Behavioral changes have been reported in several studies as

the result of prolonged administration of the drug. These have

affected functions ranging from appetites, to social behavior

and learning rate. 16

Appetites for both food and sex appear to be diminished with prolonged use of cannabis derivatives (Miras, 1965; Abel & Schiff, 1969; Carlini, 1968; Phillips, Brown, Martz, Hubbard, & Forney, 1971). Aggression, initially reduced by administration of the drug as an immediate effect, eventually returned to normal levels in animaIs in whom aggression was induced through the use of isolation (Carlini & Masur, 1969, with an injected cannabis extract). Learning, possibly enhanced as an immediate drug effect as described earlier, has been shown to become impaired when the drug is administered for long periods of time (Orsingher & Fulginiti, 1970). These reports are aIl of great interest in terms of possible relevance to human behavior as they correspond to both intellectual and personality factors which have long been of concerne The animal studies showing appetite changes re­ present a consistent fin ding by several different groups of investigators and are perhaps the most likely to be confirmed in human studies. The changes in aggression and learning, however, represent much more isolated pieces of research and do not provide as broad a basis for extrapolating hypotheses to hum an subjects.

The problem of developing analogies to human subjects from animal data is an especially vexing one in the studies on cannabis, because many of the contradictory findings have been due to species differences within the animal studies. Findings true of rats and mice have often been at variance 17 with re1ated investigations in rabbits and dogs. For this reason animal research on1y pro vides a background of ideas and facts on which human studies might be based, and studies in humans might easi1y provide data quite contrary to simi1ar investigations in rats.

In view of this it is necessary to study the findings of studies using human subjects as we11, in attempting to

discover what effects might be predicted as a resu1t of

chronic human use of the drug. It will be necessary to study

findings of the immediate effects, as continua1 use may 1ead

to the establishment of permanent changes corresponding to

the temporary changes of intoxication.

Fina11y, a review of studies into the effects of chronic

use in humans will provide a usefu1 guide and context for the

investigation then to be reported.

Reports of Immediate Effects in Humans

The confusion that exists concerning immediate effects

of the drug in humans has certain1y been fostered by anecdota1

materia1 written over the 1ast century and a ha1f. Literary

reports by Gautier, Baudelaire and Ludlow (Grinspoon, 1971),

and more recent1y by Ginsberg (1966) have described subjective

experiences in extravagant language and with frequentIy contra­

dictory reports. This 1iterary materia1 will not be reviewed.

A slight1y more objective body of 1iterature on immediate

effects derives from the observations of public hea1th officiaIs

and medica1 practitioners. Two areas of consistent controversy 18 have arisen from these observations. Changes in aggressive behavior, and the major disruption of normal personality functioning have both been claimed to result from use of the drug. These claims have been vigorously examined and rejected in studies using case report data, incidence rates, and clinical observation.

Charges that aggression and criminal activity were sti­ mulated by marijuana were common in older literature of the

U. S. Federal Bureau of Narcotics (Anslinger, 1945). Despite frequent repeats of the charges in the mass media, scientific investigations into the subjecT. have persistently refuted the connection (Siler et al., 1933; Phalen, 1943, 1945; Bromberg & Rogers, 1946; Williams, Himmelsback, Winkler, Ruble, & Lloyd, 1946; Moraes Andrade, 1964). Even with consistent conclusions however, these investigations fail to me et criteria of scien­ tific respectability in that they have lacked control groups and much of the data was old anecdotal material.

A much more vociferous case has been made on the basis of medical observations, for the role of the drug in precipitating

psychosis in normal individuals (Dhunjibhov, 1930; Allentuck,

1944; Asuni, 1964; Keeler, 1967, 1968; Keeler, ReifIer, & Liptzin, 1968; Perna, 1969; Klee, 1969; Grossman, 1969; Spencer,

1970). Early reports were reviewed in detail by Murphy (lQ~3)

who concluded that the incidence of psycho sis among the marijuana­

using population appeared to be below that which would be expected

in the general population. Mo~e recent studies of the data (Smith

& Mehl, 1970; Weil, 1970; Bialos, 1970; Grinspoon, 1970) have ,-

19 described one major personality disruption with the drug as an acute anxiety attack in a frightened naive subject. Toxic psychoses of a few hours to a few days duration have been noted following very high oral doses, but confirmation of long-term functional psychosis in a previously normal person has not been demonstrated to be a result of marijuana use.

Rather this condition appears to be related to previous hal­ lucinogenic drug use and pre-existing personality disorders.

In 1967 the weaknesses and contradictions in the reports based or" such data began to be challenged by more rigorous scientific methodologies. The recently achieved chemical knowledge, aided by renewed government~l concern, resulted in a new experimental attack on the topic by investigators in­ terested in a wide range of possible effects.

These studies of the immediate effects on three main types of psychological factors will be examined. Basic physiological, sensory and perceptual-motor, and cognitive­ memory changes represent the major areas which experimental studies have shown to respond to the effects of marijuana when objective measures have been applied.

Studies of Immediate Effects in Humans

Physiological. Physiological changes as a response to the administration of the drug have been reported by a number of investigators. The most consistent finding is that of increased heart rate (Allentuck, 1944; Williams et al., 1946;

Isbell et al., 1967; Hollister et al., 1968; Weil et al., 20

1968; Crancer, Dille, Delay, Wallace, & Haykin, 1969; Manno,

Kiplinger, Haine, Bennett, & Forney, 1970; Waskow et al., 1970;

Jones & Stone, 1970; Dornbush, Fink, & Freedman, 1971). This

response has been shown to be dose-dependent (Kiplinger, Manno,

Rodda, Haine, & Forney, 1971) and is considered to be a satis­

factory index for the verification of marijuana intoxication

(Isbell et al., 1967). Blood pressure changes are not as clearly

established, with Siler et al. (1933) finding no significant

changes, Allentuck & Bowman (1944) slight increases, but with most current investigations finding slight decreases when pure

~9THC is the preparation (Isbell et al., 1967; Hollister et al.,

1968; Waskowet al., 1970). Body temperature was reported as

rising as an effect of the drug in the early study of Williams

et al. (1946), but more recent investigators have found no sig­

nificant changes (Isbell et al., 1967; Hollister et al., 1968),

and there is little confirmation of the hypothermia noted in

the animal studies described previously.

No change has been found in respiration rate (Isbell et

al., 1967; Weil et al., 1968). Munch (1966), and popular anti­

drug literature reviewing the effects of cannabis, describes

dilation of the pupils as a major immediate effect, but clinical

studies have flatly contradicted this report (Isbell et al.,

1967; Weil et al., 1968). Conjunctival injection, however, has

been repeatedly noted as a str'iking immediate response to cannabis' smoking (Allentuck & Bowman, 1944; Isbell et al.,

1967; Weil et al., 1968; Hollister et al., 1968; Manno et al.,

1970; Waskowet al., 1970). 21

Blood glucose (BG) levels have been studied in an effort to explain the increased appetite for food commonly reported by users; the findings have been varied. Allentuck & Bowman

(1944) found decreases in BG levels, while most investigators

find no change (Isbell et al., 1967; Hollister et al., 1968;

Weil et al., 1968; Manno et al., 1970; Dornbush et al., 1971).

Actual appetite was reported as enhanced by the drug in early

studies (Siler et al., 1933; Williams et al., 1946), but a more

recent and rigorous study has been unable to confirm any con­

sistent change in appetite (Hollister, 1971). Sleep time was

reported to increase under a one-month trial with free access

to the drug (Williams et al., 1946). Of more recent studies

there is one report finding an increase in REM sleep time

(Rickles, Kales, & Hanley, 1970), and another report claiming

a tendency to decrease REM sleep time (Pivik, Zarcone, Holli­

ster, & Dement, 1969).

EEG studies of immediate marijuana effects have been mini­

mal, with one report of no significant alterations under doses

of up to the quite high level of 52.5 mg of A9THC (Jones &

Stone, 1970). Another report which initially found no sig­

nificant differences, was re-analyzed and discovered to show

a slight increase in alpha waves (Rodin & Domino, 1970) which

contrasts with a much earlier report of decreased alpha (Wikler & Lloyd, 1945). These slight changes are not typical of those found when there is an ongoing degenerative process

in the central nervous system. If alpha is enhanced, this

change rather describes a temporary tranquillizing effect

which may have long-term implications as weIl. 22

Metabolic studies in humans have shown that the drug

(~9THC) is metabolized completely within the body, and that excretion takes place over a number of days. Most of the meta­ bolic waste products are disposed of in urine and faeces within three days, but traces can be discovered up to one week post­ drug (Lemberger, Silberstein, Axelrod, & Kopin, 1970). The Most dramatic physiological changes in response to the drug then, are heart rate and conjunctival injection with other indices providing disputed or minimal measures of change.

Sensory and perceptual effects. Studies of effects upon sensation and perceptual motor skills have shown moderate con­ sensus as to an interaction between dose levels and task com­ plexity in determining degree of impairment caused by the drug.

A study which was part of the Mayor's Committee Studies in New York (1944) found no change in olfactory thresholds, taste discrimination, or on three different measures of tactile sensation (Williams et al., 1946). Another investigation at this time found no change on auditory acuity or visual dis­ crimination (Morrow, 1944), and this pattern of no significant

changes has been repeatedly found in more recent studies of

sensory threshold (Clark & Nakashima, 1968; Caldwell, Myers, Domino, & Mavriam, 1969; Caldwell, Myers, & Domino, 1970;

Hollister & Gilles~ie, 1970; Jones & Stone, 1970; Rodin, Domino, & Porzak, 1970). Two exceptions to this general finding were

a report of impaired auditory acuity with pro1onged use

(Williams et al., 1946), and a study in which, at very high 23 dosages, an initial heightening of auditory and visual acuity was noted, followed by significant impairment (Isbell et al.,

1967). The explanation for these contradictions probably lies

in the differences in route of administration, dosage levels,

and measurement techniques used in the studies, and no conclusion

as to the major effects of marijuana on sensory thresholds can

yet be sa id to be established.

Effects of the drug upon speech include increased fre­

quency (Williams et al., 1946), a shift in content to more

visual imagery and concern with the present (Weil et al., 1968),

and difficulties with serial coordination in the presentation

of thoughts (Melges, Tinklenberg, Hollister, & Gillespie, 1970).

The latter are believed to represent changes in memory function­

ing. On the basis of their observations, Weil et al. (1968)

remained convinced that further changes were occurring in speech

style and content but these evaded analysis by any conventional

technique for describing speech. Subjective reports by us ers

contradict Williams' finding of increased frequency, noting

instead an introverted retreat from talking (Tart, 1970). The

Most consistent findings of effects on speech thus appear to

relate to subtle changes of content and organization of thoughts.

The extent to which these temporary shifts might become per­

manent with chronic use has not been demonstrated.

Despite an early report that time estimation is not sig­

nificantly changed (Morrow, 1944), MOSt investigators since

then have found fairly consistent over-estimations on this type

of measure (Williams et' al.,' 1946; Isbell et al., 1967; Weil 24 et al., 1968; Clark et al., 1970). Hollister et al. (1970) found some over-estimation but noted a high degree of varia­ bility among the subjects. Melges, Tinklenberg, Hollister, &

Gillespie (1971) were more interested in a subject's sense of himself in time, and used subjective reports to discover an enhanced interest in the present, rather than in the past or future.

Psychomotor effects. From the earliest studies to the present day there have been consistent reports of slight im­ pairment on some psychomotor tasks. Gross motor performance appears to be unaffected (Williams et al., 1946), fine simple psychomotor tasks are slightly impaired (Halpern, 1944; Morrow,

1944; Williams et al., 1946; Weil et al., 1968; Hollister &

Gillespie, 1970; Manno et al., 1970, 1971; Rodin et al., 1970;

Kiplinger et al., 1971), and complex psychomotor tasks are moderately adversely affected (Morrow, 1944). Crancer, Dille, Delay, Wallace, & Haykin (1969) compared cannabis effects to those of alcohol on a simulated driving task and found the alcohol

group to be more impaired; however it appears that the dosages of the two drugs used in this study were not equivalent (Kalant,

1969) and the subjects (not double-blind), were biased in favor

of marijuana. Two further points are of interest in summing up

the literature on psychomotor effects. Firstly there have been

repeated findings that chronic us ers perform better "under the

influence" than do naive users (Halpern, 1944; Williams et al.,

1946; Weil et al., 1968). Secondly, dose-dependent impairment 25 levels are still not a completely consistent finding. Kip­ linger et al. (1971) and Manno (1970) reported dose-dependent effects in sorne studies and not in others (Manno, Kiplinger,

Sholtz, & Forney, 1971). However, it is safe to say that in moderate doses (for example typical 'social' doses), the drug appears to slightly impair fine complex psychomotor perfor­ mance (e.g., hand steadiness, pursuit rotor, Bender Gestalt) in infrequent or naive users. If the dose is sufficiently high, impairment is clearly demonstrated.

Cognitive effects. Halpern's early work for the Mayor's

Committee (1944) gave as a general finding that impairment

was more consistently the case on 'complex mental processes'

than on simple processes. Unfortunately this study, as with

others of that era and situation, (Allentuck, 1944; Morrow,

1966)can be criticized on a number of methodological issues

which detract from the strength of the arguments. These

include the very biased nature of the subjects (imprisoned

criminals in a welfare hospital), the lack of double-blind

assessment procedures, and the lack of a placebo condition.

A more contemporary investigation of complex cognitive

performance, without really succeeding in improving the re­

search design, subject selection or reportage, describes simi­

lar findings. Clark, Hughes, & Nakashima (1970), with six sub­

jects, found impaired performance on the Iowa Silent Reading

test, a test of reading speed and accuracy. Other studies of

cognition have directed their attention to the efficiency of 26

1earning new materia1 as an index of the drug effect.

A1though 10w doses did not change Digit Symbo1 (learning) performance, Halpern (1944) found that high doses did resu1t in diminishing increments in the task, and another task, the

Kohs B10ck Design, was impaired by high drug 1eve1s. Simi-

1ar1y, Williams et al. (1946) reported comprehension and ana1ytic

thinking to be impaired. In a much more recent study using

"normal" heavy users, Jones and Stone (1970) and Ho11ister and

Gillespie (1970) found a 10w moderate oral dose of marijuana

extract 1ed to no significant change on either the Digit

Symbo1 task or on the Rod-and-Frame test of perceptua1-cognitive

differentiation. These inconc1usive reports 1ead to an exami­

nation of attention and concentration as aspects of cognitive

performance which under1ie many of the more comp1ex tasks

described in the preceding two sections.

Attention and concentration. Impaired concentration \\las

noted by Williams et al. (1946) a1though they didn't identify

the index upon which this was based. More recent1y, Me1ges et

al. (1970) used an e1aborate measure of sustained attention

combined with memory and ca1cu1ation aspects, the Goal Directed

Seria1 Alteration task (GDSA), and found dosage-dependent im­

pairment. On a simple task of sustained attention alone (seria1

subtraction of sevens), no significant decrement had been noted. Fina11y, Meyer, Pillard, Shapiro, & Mirin (1971) found casua1 users of the drug to be significant1y impaired on the Continuous

Performance Test (thought to be a measure of attention, ,-

27

Mirsky [1964J), although this was not true of heavy (daily)

users whose errors did not significantly differ from a con­

trol condition. Weil et al. (1968) had found no significant

differences on this task, even with a distraction condition,

however, Manno et al. (1970, 1971) found significant impair­

ment when a group of very complex cognitive tasks were pre­

sented under conditions in which delayed auditory feedback

intruded distracting sounds of the subjects' responses, and

Kiplinger (1971) has demonstrated that the impairment found

on these tasks was dose-dependent.

This group of findings on tests intimately related to

memory competence, leads us to now review the findings con­

cerning memory functioning as a behavior demonstrating an

immediate response to the drug.

Memory effects. On tasks involving simple, short-term

memory there have been mixed findings, with Digits Forward

and Reverse the frequent index. Halpern (1944) found only

the Digits Reverse impaired, Melges et al. (1970) found both

impaired, while Waskow et al. (1970) found neither affected.

Dornbush et al. (1971) used a related alphabet-recall task to

find impairment only with high doses of the smoked drug.

Tinklenberg et al. (1970) found Digits Forward impaired as a

short-terrn effect which disappeared by three and one-half

hours, while up to that tirne, Digits Reversed showed a steady

decrement, using an oral extract version of the drug. 28

In studying more complex tasks impairment is a more consistent finding. A visual task was poorly remembered by

Halpern's (1944) subjects. Clark et al. (1968), in a con­ fusingly presented, designed and analyzed study, found learning

(memory) rates impaired on a very neat digit-code memory task which measured rates to achieve criterion level of performance.

A similar digit-coding task was used by Weil et al. (1968) to disco ver that chronic users actually improved their performance on the task, in contrast to the impairment which naive users showed. Tinkienberg et al. (1970) added an extra complication to the Digits Forward task (rearranging in seriaI order), and found significant impairment. On a group of memory tasks from the Wechsier Memory Scale, Waskow et al. (1970) found only one task impaired (seriaI addition), while four others re­ mained at control levels. Only one worker has set out to clarify the origin of the memory dysfunction; Abel (1970, 1971) in a series of studies showed that information was being satisfactorily "put in" to the users, using a series of re­ calI and recognition tasks concerning auditory verbal material.

Rehearsai of materiais in short-term memory, however, appeared to be impaired and "storage" in long-term memory was thus not

achieved.

In summation, it could be stated that the more careful

studies show dose-related impairment on more complex and more

long-term memory tasks. 29

In summation of the findings concerning the immediate effects of the use of marijuana, it has been found that a simple task and a low dosage might easily show no change on either psychomotor, conceptual or memory functions, but high doses will certainly affect complex tasks related to any of these. Thus impairment will generally be noted as a function of greater task complexity, and higher dosage levels. Of tangential interest is the frequent report that heavy regular users do not consistently demonstrate impairment under drug conditions, in contrast to the performance of naive or in­ frequent users.

Reports of Chronic Effects in Humans

Studies of chronic changes developed as a result of pro­ longed marijuana use have relied very heavily on anecdotal and case-report evidence. Oriental and African descriptions have provided much of the material used by orthodox public groups in western cultures as justification for the warnings against the drug. For example, the AMA Council on Mental

Health (1968) warned that cannabis was a dangerous drug and as such was a problem of public health. An editorial in the

British Medical Journal (1967) was somewhat more cautious.

It decried the appeals for a more permissive attitude to the

drug, but acknowledged the purely speculative nature of des­

criptions of the effects of prolonged use. Kalant and Kalant

(1968) studied the evidence thoroughly and concluded that

while the non-American studies of the Chopras (1965), Benabud 30

(1957), and Moraes Andrade (1964) were the most thorough to date, they aIl suffered from the 1ack of a matched control group of non-users. For this reason they conc1uded that the "information current1y avai1ab1e (about chronic effects is) not near1y as complete or as conclusive as information about the acute effects." Observations of specific effects attributed to chronic use will be described in a sequence inc1uding physio10gica1, cognitive, and persona1ity changes. Reports of physio10gica1 effects. Freedman and Rockmore (1946) cou1d find no evidence of genera1 physica1 impairment, but a number of authors have suggested that chronic respiratory disease may resu1t from chronic smoking (Chopra & Chopra, 1965; Wa1dman, 1970). Ka1ant .and Ka1ant (1968) point out that it may be due to smoke components not re1ated to the psycho active cannabis materia1s, but this point has not been studied. A microscopic study of smokers' 1ung tissue fai1ed to find differences of any significance (Mann, 1970). One of the main concerns in the past has been to determine whether or not c1assic "addiction" (physica1 dependence) deve10ps with the drug. A mass of reports disputes this notion (Adams, 1940; Si1er et al., 1933; A11entuck, 1944; Williams et al., 1946; Moraes Andrade, 1964; Chopra & Chopra, 1965; Ka1ant & Ka1ant, 1968; Grinspoon, 1971). One curious exception is Fraser's (1949) report of nine cases which showed signs of mental i11- ness fo110wing withdrawa1 of the drug. Rather than supporting 31 the notion of physical dependence as Fraser suggests, this

raises the interesting possibility that subjects were self­

medicating with it for relief of ongoing emotional problems.

Reports of cognitive effects. Deterioration of cognitive

functions has been ascribed to chronic use by a number of

authors. Dulling of the intellect (Schultes, 1969), brain

lesions (Munch, 1966), and mental deterioration similar to

that found in chronic deteriorated alcoholics (Leonard, 1969)

have aIl been attributed to long-term use of the drug. Other

authors have disagreed: the India Hemp Commission of 1894

(1969), Siler (1933), Phal en (1945), and Eddy in the WHO re­

port (1966) aIl claim there is no evidence for this charge.

Siler and Phalen found that an explanation for the idea of

mental deterioration in the Panama soldiers was easily found

when they discovered that Most of the us ers were very poor,

very maladjusted and showed a high percent age of mental de­

ficiency. Thus, conditions which explained reasons for using

the drug were taken as descriptions of its effects, a not un­

common confusion throughout the literature. A major problem

however, resides in the fact that none of the claims or

counter claims have been based on controlled studies using

objective measurements. In the closest attempt to study the

problem in a more experimental manner, Williams et al (1946)

described some mental and personality changes he observed

over a period of one month in which a population of chronic

users were provided with free access to a synthetic analogue 32 of THC. Unfortunately he did not have a control group in this study, and the period of confinement and drug use studied was very short, so his findings are a shaky base upon which to base any final judgement.

Similarly, Siler (1933) provided free access to marijuana cigarettes to user subjects for a brief six days of confine­ ment. Unfortunately this period was not long enough to establish the existence or otherwise of dependence or psycho­ logical changes, and the lack of objective measures or a control group further mars the usefulness of his report.

Thus no adequate study has yet determined the validity of the idea that mental deterioration is a result of chronic use of the drug in spite of the continuing claims to this

effect.

Reports of personality effects. Similarly, claims of

personality deterioration have been made on the observations

of western users (Bromberg, 1968; Leonard, 1969; Chapple,

1966; Eddy, 1966; Kolansky & Moore, 1971; McGlothlin & West,

1968; Mirin et al., 1971). The most recent descriptions have

emphasized a personal lethargy or "amotivational syndrome Il as

gradually developing over a period of prolonged use of the

drug. The India Hemp Commission findings are not support ive

of this idca, but as this commission did not rollow rigorous

scicntific procedures the point is not yct adequately establishcd.

Psychological dependence (as opposed to physiological),

has been proposed by a number of authors (Bromberg, 1968; 33

Chopra & Chopra, 1965). Unfortunately this term can refer to anything from the desire to read a morning newspaper or to wear clothing in public places (intense but trivial) to a desire to consume an expensive drug frequently (which may be intense and far from trivial). Archibald et al. (1969) have discussed the difficulties with automatically assigning danger to any habit which demonstrates psychological dependence.

Of further relevance, it is equally defensible to assume de­ pendence-seeking as a reason for use of the drug rather than as an effect resulting from its use.

Whatever the implications, there is a moderate consensus in the literature that the use of the drug provides psycho­ logical satisfaction often leading to its habituaI use.

This group of observat~ons and opinions has been des­ cribed separately from the actual studies of chronic use in order to dramatize the contrast between what is commonly

assumed about the drug, and the actual known facts. The

following section presents findings from studies in which

some attempts were made to find mat ching control populations

and reasonably objective measures, in describing the effects

of chronic use.

Studies of Chronic Effects in Humans

Physiological. Tolerance to the effects with regular

prolonged use, or habituation, refers to the condition in

which a subject is able to consume greater amounts of a

drug with experience, and in which the effects experienced are 34 typical of those earlier associated with smaller doses. An interesting feature of the literature over the past five years has been a steady reference to 'reverse tolerance' or increased sensitivity to the drug, in which successively smaller doses are required by the experienced user to achieve the de­ sired effects (Weil et al., 1968; Weil & Zinberg, 1969; Hol­ lister, 1970; Grinspoon, 1971). Researchers have been very determined to abolish the misconception about physical depen­

dence with which tolerance is normally associated. As a.result

a great deal of evidence has been ignored which shows that tolerance normally associated with physical dependence does

indeed appear to develop. Halpern (1944), Williams et al.

(1946), Weil et al. (1968), Smith & Mehl (1970, Jones et al.

(1971) and Meyer et al. (1971) aIl have found that casual users

are significantly more impaired under the drug condition than

are experienced users. In spite of this, the subjective re­

ports of users claiming reverse tolerance have been believed

to the extent that elaborate biochemical theories have been

developed to try and account for these reports (Lemberger et

al., 1970 Mechoulam, 1970; Hollister, 1970). Smith & Mehl

(1970 ), however, have proposed three stages of differing toler­

ance to the drug which appear to account quite nicely for the

controversial data. Initially there is little sensitivity to

the drug; with infrequent but continuing use a heightened sensi­

tivity develops (reverse tolerance), but with frequent con­ tinuing use, insensitivity or tolerance m larger doses does 35 become established. This theory certainly agrees with fin­ dings from the animal literature concerning long-term tolerance, and matches observations coming from hum an situations where very heavy use is common (Cho~ra & Chopra, 1965; Smith & Mehl,

1970).

Only little has been done to study cross-tolerance effects with other drugs, probably as a result of the bias noted above.

Isbell and Jasinsky (1969) found no cross-tolerance to LSD-25 and concluded that the psychomimetic effects of the two drugs must be mediated by different mechanisms in the body.

One final study will conclude this discussion of studies of the physiological effects of chronic use. Campbell, Evans,

Thompson, & Williams (1971) reported significant cerebral atr.ophy in ten young men presenting a variety of neurological complaints.

This 'study' was widely reported in the news media, much to the detriment of scientific truth. Examination of the cases shows a magnificent range of pathologies ranging from mental retar­ dation and diagnosed schizophrenia, to long-standing epilep­ sies, aIl pre-dating the onset of cannabis use. In addition to these problems most of the subjects had histories of

extensive multiple drug use, typica11y starting with heavy

amphetamine use at age 14 and including up to 25-30 LSD 'trips'.

The control group is virtual1y unidentified other than the

note that the control subjects were of a simi1ar age. Despite

this relevant historical data, the observed differences in

brain ventricular measurements were attributed to the effects of cannabis use. Cognitive and personality effects. Examination of the effects of chronic marijuana use on thinking and memory has been almost exclusively confined to the anecdotal, subjective and case-study material reported earlier. Actual studies in which chronic users have been compared with naive or infre­ quent users on cognitive tasks have been mainly confided to elucidation of changes under intoxication with the drug, as immediate effects. Similarly, there have been no adequate controlled studies of personality changes resultant from chronic marijuana use. Reports have been a mixture of obser­ vation, subjective claims, or descriptions of the observed personality characteristics of highly deviant user groups.

This lack of objective evidence concerning chronic

effects on cognitive or personality functioning is quite re­ markable, and has been steadily noted in official reports

reviewing data concerning marijuana. The British Medical

Journal (1967) acknowledged a need for the study of prolonged

use, as did the American "Task Force Report" on Narcotics and

Drug Abuse (1967). Similarly, shortly before Weil's ground­

breaking study of immediate effects in 1968, an editorial in

Science (while condemning the drug), called for an evaluation

of its long-term effects. Kalant (1968) in her very detailed

review of the classic marijuana literature, introduces her

work with the comment that there is still "far too little

information regarding ••• questions related to chronic use ••• , JI ,-

37 pointing out that the wide range of existing reports on chronic effects aIl suffer from a lack of suitably matched control populations of non-users. Hollister (1970) in reviewing three years of active research in immediate effects, chemistry and pharmacology, concludes uThe crucial clinical experiments in regard to the social questions about marijuana, such as the possible deleterious effects from chronic use, cannot be answered by laboratory experiments. These must be settled by close observation made on those who experiment on themselves." Finally, Canada's LeDain Commission, in its

Interim Report (1970), also noted that UThe existing evidence provides no clear guidance for predicting what will be the long-term effects of cannabis use. fI As two priority tasks, it saw studies conccrncd \'Iith the long-term effects on per­

sonality and on mental capacity. The study soon to be des­

cribed has addressed itself to the issue of long-term-use

effects on mental capacity.

Studies of Cannabis Users

In view of the paucity of reliable evidence concerning

actual psychological changes associated with chronic use, it

is interesting to examine studies which have attempted to

describe characteristics of users. These studies of person­

ality have not made the leap in logic necessary to describe

their findings as being direct results of cannabis use. In­

stead, they have usually assumed an interaction effect to·be

operating, in which personal reasons for drug seeking, and specific drug effects are on1y two of Many relevant factors in the persona1ity findings.

An ear1y report (Halpern, 1944) used a wide range of psycho1ogica1 tests to compare twenty-seven users with eighteen non-users; it conc1uded that users were more introverted and passive, i11 at ease socia11y, and uninterested in being normally productive. Unfortunate1y, the subjects were se1ected from a highly deviant group (prison hospital inmates) in which criteria for matching the users and controls were not made explicit. Not aIl tests were given to a11 subjects, and the actual test re1iabi1ities are cloudy, thus the differences noted are difficult to eva1uate.

A study done of soldier us ers in the Panama-Canal Zone reported by Phalen (1943) conc1uded that users smoked marijuana out of boredom and curiosity; de1inquent behaviors which had been attributed to the effects of the drug by officers, were

rather demonstrated to be the result of alcohol abuse. A

seven-month study of thirty-five psychiatrical1y hospitalized

soldiers who were marijuana "addicts," described these patients

as suffering from multiple problems (Marcovitz & Myers, 1944).

Poor socio-economic backgrounds, and a very high incidence of

severe headaches for which the smoke was claimed to be anal­

gesic, were specific features of this population, not aIl of which

can be claimed to be results of marijuana use. Freedman & Rockman

(1946) studied 310 soldier-users suffering "army-maladjust-

ment" and found three-quarters complaining of major physical 39 disorders. One-half of these were found to be legitimate

(and one-half of these were severe headache). As a group these men had low skills, a low promotion rate, and a high degree of dissatisfaction, aIl of which appeared to be re- lated to their poor socio-economic backgrounds and which were considered to provide reasons for their drug use. An-

other group of 60 soldier-users in psychiatric care was

studied, with similar findings concerning poor family back­

ground, poor work history and psychopathic characteristics;

the drug was described as being used largely to enhance self

esteem (Charen & Perelman, 1946). These early groups of users

were thus typically lower-class and suffered from a multitude

of problems which are frequently associated with that circum­

stance. This pattern of user-characteristics has recently been

shifting to middle and upper-middle class young people and adults

in western countries. A report coming at the height of this

shift in the mid-sixties characterized users as people with

personality deficits and incipient or existing psychotic

disorders; they were described as sick and in need of insti­

tutionalization where they could receive the psychotherapy and

lengthy guidance which they required (Watt, 1965). Since 'chis

dramatic but quite loosely referenced statement, studies have

continued which have attempted to delineate more precisely the characteristics of users. Robins & Murphy (1967) did a

study of mainly black men from a specific grade-school class

in the 1940's, describing the incidence of drug use among ,-

40 other characteristics. Once the very high proportion of heavy alcohol users was removed from this study, the main difference between marijuana users and non-users was in amount of public welfare received in the past five years.

This might weIl relate to personality changes earlier ascribed to the drug (apathy, the amotivational syndrome), but this more precise cause and effect relationship was not claimed in this study.

Other contemporary studies have been concerned with at­ titudes, psychiatric characteristics, and psychological test personality profiles. King (1970), defining a user as an individual who has smoked marijuana on one or more occasions,

found that users and non-users could not be distinguished in terms of their College Entrance Examination Boards or in terms

of their grade point average at graduation. However, on an

attitude questionnaire the users appeared to have more

"liberal" ideas toward sex, drug and alcohol use, and external

authority. The relevance of this study to questions of

chronic use is, however, virtually nonexistant in view of the

very broad definition of "user." A rather vague rating-scale

was used by Zinberg and Weil (1970) to compare chronic users,

moderate users and non-users; the general conclusion was

that chronic users were considerably more neurotic (hysteric)

than the other two groups. It is not clear that the rating

was done single-blind, and the reliability of the rating­

scale is not established, much less its validity, thus the ,-

41 report is of 1imited impact.

More rigorous measurement indices were used by Hogan,

Mankin, Conway, and Fox (1970) and Bri11, Crumpton, & Grayson

(1971) in attempting to de1ineate persona1ity characteristics of users. Hogan used th~ ~a1ifornia Persona1ity Inventory in addition to a biographica1 questionnaire and some specifica1ly constructed scales (such as Uempathyu). Frequent users demon­ strated a 1evel of moral deve10pment simi1ar to that of non­

users, but disp1ayed quite a different persona1ity uprofi1e"

from non-users on the CPI, characterized by high empathy,

f1exibi1ity, narcissism, capacity for se1f-aggrandizement and

social status. The 'moral deve10pment' findings are in contrast

to those of Bril1 and co11eagues, who found heavy users to

score significant1y high1y on the MMPI sca1e of "psychopathic

deviant. u To McG10th1in's charge that continuing use of the

drug leads to an Uamotivationa1u syndrome (McG10thin & West,

1968), the Bri11 study reported no evidence of impaired goal

orientation. Infrequent users were similar to non-users and

to those who had experimented with the drug and stopped; these

groups were co1lective1y distinct from the heavy users on

measures of stimu1us-seeking and incidence of other drug use

(exc1uding a1coho1). From this scanty literature it is not

possible to c1aim any striking personality characteristic for

users, a1though a general wi1lingness to seek satisfactions

in the face of genera1 prohibitions might be inferred from

the Bri11 and Hogan data. 42

Such expectancy effects seem to have played a major role in the studies of cannabis. For example, the idea that personality characteristics contribute toward drug use in general has long been noted and has provided part of the basis for the idea that marijuana use leads to heroin use.

If there is an taddictive personalityt it could be expected that such a progression would represent a common finding, even if the use of heroin is not considered to be a direct drug effect caused by the use of marijuana. It is equally possible however, that personality characteristics do not represent the only reason for drug use. It may weIl be that other, more societally-based factors also contribute to the expectancy the user has toward the effects of his drug, and may be very relevant in understanding why a user might seek certain drugs and not others.

For example, North American users often emphasize the private inner experiences which are achieved under marijuana intoxication. They report enhanced awareness of sensory stimuli, interesting changes of thinking (Tart, 1970; Haines &

Green, 1970), new insights and personal harmony (Mirin et al.,

1971), and tranquility (Malcolm et al., 1969, Haines & Green,

1970).

In other cultures less introspective reasons are often

given. In India (Chopra & Chopra, 1965) and Jamaica, the drug

is used to combat hunger or fatigue, and as a stimulant to

religious discussion (Prince, 1969). In comparing these

diverse reasons for use of the drug it may be possible to 43 distinguish those reasons which might correlate most highly with other or multiple drug use. For example, the seeking of expanded consciousness--a leisurely and somewhat self­

indulgent behavior, might lead the seeker to experiment with

a wide range of possible chemicals in the course of the

search. This may describe a large segment of the heavily­

using North American population. In contrast, where the

drug is used as a daily aid to enduring ongoing problems

such as hunger and fatigue and the drug use doesn't repre-

sent a casual hobby or personal search, more specifie, res­

tricted drug use might be expected. Finally, where the drug

is believed to have divine characteristics related directly

to a body of dogma, it could be anticipated that the trial

of other drugs might be specifically abhorrent (e.g., peyote

in the Native American Church, marijuana in the Rastafari

Brethern of Jamaica). In this view, therefore, the progression

to heroin use would represent the operation of specifie ex­

pectancies only slightly related to the actual effects of the

drug; the lack of progression to other drug use similarly

represents the operation of other expectancies. That is, it

is the expectancies which guide the user to seek or not to

seek other drugs, not the actual drug effect. The role of

expectancy effects in the drug experience, both in terms of

describing reasons for use and effects found, is considered

to be of major importance in studying both immediate and

chronic changes ascribed to marijuana use. This has been 44 a contributing factor to Many of the contradictory findings noted in the. human literature reviewed. It is one of a num­ ber of issues relevant to the problem of describing the effects of chronic use.

Basic Issues in RUffian Drug Research

Although Most of the studies reviewed were granted reason­ able validity unless their errors were unusually gross, negligence on a number of points persistently appears which detracts from the strength of Many of the reported findings.

These include inadequate descriptions of the drug, unreliable measurement techniques, inappropriate subjects, faulty de­ sign, and indifference to expectancy effects.

The drug. Studies frequently identify the drug in an inadequate manner (Abel, 1970, 1971; Clark & Nakashima,

1968). Its composition should be made explicit, especially when it May be 'street' marijuana which has a fairly high rate of fraud (29%, :t

The measures. Studies in which highly objective mea­ surement techniques are used as dependent measures, often use the highly unreliable self-report of their subjects as the independent variable. That this May be a dangerously misleading practise is shown clearly by the work of Jones 45

(197la, 1971b). His study showed placebo response to a well­ designed placebo cigarette to be very high, with experienced heavy users responding positively to the placebo even more than the infrequent users, thus destroying the illusion of

expertise and drug-familiarity which experienced users often

cherish about themselves. This study stresses the importance

of using measuresmuch more objective than subject self­

report as to the degree of drug response.

The subjects. In studies of the immediate effects a

common problem until now has been an indiscriminate mixing

of infrequent users and experienced users as generic "users."

In view of the consistent after-the-fact findings that these

two groups perform quite differently on most tasks (cf. toler­

ance) it would seem desirable to actually design studies with

this finding incorporated from the beginning.

In "studies" of long-term use and users, the subjects

have mainly been highly deviant minorities who therefore

reflect a vast range of social and personal problems. Pri­

soners and psychiatric patients have provided the data for

nearly aIl of the studies in this area (Morrow, 1944;

Allentuck, 1944; Halpern, 1944; Williams et al., 1946; Siler

et al., 1933; Charen & Perelman, 1946; Waskow et al., 1970), and in most studies haven't ev en been compared against a matched but

non-using control group. This results in highly biased and un­

generalizable findings and is at least partly responsible for

the almost total lack of useful information in the two large 46 areas of concern regarding chronic use--personality and cog­ nitive changes. Furthermore, the frequent use by chronic marijuana users, of a wide range of other drugs, has added further damage to the credibility of the findings.

The design. Another difficulty concerns the establish­ ment of "blindness" in the study. In a typical laboratory study the design should be double-blind, but because of pharmacologie al problems relating to extraction procedures, many studies (e.g., Weil et al., 1968) have used placebo preparations which were easily identifiable by the subjects.

Their responses therefore could have been quite consciously

oriented to the real drug. In 1968 this was excusable; it

no longer is as sever al techniques have now been established

for excellent non-active versions of natural marijuana, and

the Caldwell et al. (1970) and Dornbush et al. (1971) studies

using alfalfa and oregano respectively as placebo, are quite

unforgiveable at this point in time.

Expectancy effects. A final group of difficulties stem

from the operation of setting and expectancy effects. Fol­

lowing the work of Schadner and Singer (Schachter, 1964; Schachter & Singer, 1967) a host of workers have issued

continuing caution as to the role pIayed by subject expec­

tancies concerning his eventual experience, and by the changes

that can result merely from setting variables (group, aione,

laboratory, natural field, etc.). The placebo effect is

part of this as weIl. That research designs continue to ,-

47 denigrate or ignore these factors however, may be seen from the continuing pleas for care (Evans, 1967; Jones, 1971a,

1971b; Lennard et al., 1971). 48

THE PRESENT INVESTIGATION

This study was designed as an attempt to establish the performance levels of very heavy chronic users of marijuana in comparison with a matched group of non-users, on a number of psychological tests. It was thus a cross-sectional, natur­ alistic study in that the subjects had already performed the experimental manipulation upon themselves, and it was there­ fore not possible to include accurate data concerning the subjects' pre-experimental performance. The basic concern was to discover if impaired mental functioning could be considered a characteristic typically and specifically associated with chronic heavy use of the drug. Measures were to be concerned with what could be broadly described as "mental deterioration,1I with specific functions chosen for examination on the basis of their relevance to the previously outlined findings; special interest was thus placed on sensory, perceptual-motor, con­ ceptual and memory functions. The rationa~in choosing each specific measure is outlined in a section to follow.

Subjects

Because of the problems outlined earlier regarding the highly deviant subject population of chronic users in nearly

aIl studies to date, it was felt essential to go to a culture

where use of the drug is so widespread as to be a majority

rather than a minority, behavior. The island of Jamaica fits this requirement. 49

Further, subjects were not to be an institutiona1ized minority of the genera1 population, but citizens living nor­ ma11y in the community. In view of the difference in responses between infrequent regu1ar users and heavy regu1ar users, the criterion for accepting a user was estab1ished as 'at 1east ten years of regu1ar use,' with dai1y use to be the contem­ porary criterion. This provided a genuine1y chronic popula­ tion in contrast to Many North American and British studies which have defined chronicity in far 1ighter terms (e.g., 3 years of regu1ar [undefined] use, Campbell et al., 1971).

Furthermore, Jamaican users of the drug are not multiple drug

users as has often been the case in other studies of chronic

"marijuanatt users. The one other drug in common use in the

is1and is a1coho1; subjects in the present study were to be

virtua11y non-users of a1coho1. The above criteria for selec­

tion of user subjects cou1d a11 be met within Jamaica.

Marijuana (or ganja, as it is loca11y known) has been

cu1tivated on the is1and for approximate1y one hundred and

fifty years, having been introduced by indentured servants

brought over to Jamaica from India fo11owing the emancipation

of slaves in the British Empire in 1838. Cu1tivation of the

plant is extreme1y widespread (a1though i11ega1) and the in­

cidence of ganja use in the general population is correspon­

ding1y high. In spite of this the drug has not rea11y been

considered a public hea1th prob1em, and does not appear as such

in any of the compilations of Caribbean social and economic 50 literature (Wilgus, 1965; Sable, 1967; Comitas, 1968). Only one work has briefly dealt with it as an aspect of Jamaican police work (Lepinske, 1955). In terms of land cultivation no exact figures are offi­ cially available in spite of frequent reports in the daily press concerning intercepted export attempts relating to quantities measured in the tons. Estimates concerning the in­ cidence of use, however, are available (Prince, 1971). Using a sampling technique with some potential for bias, his findings showed heavy use (daily or several times daily) in the general population, to include 46% of adult males, with an additional

6% of occasional users bringing the total to 52%; rates for women were lower. (This predominance of men is typical of marijuana use throughout the world, including the technologi­ cal societies [Soueif, 1967; Malcolm, 1969; Manheimer, 1969;

Haines, 1970J.) Even allowing for some sampling error, this figure demonstrates the widespread incidence of use.

Ganja use is more prevalent among the poor as it is less expensive than any of the forms of alcohol, thus MoSt subjects

in this study were from the 'lower' class. As financial status

of people rises in Jamaica, incidence of alcohol use and al­

coholism similarly rises (Beaubrun, 1968).

In addition to meeting detailed criteria for matching

experimental and control subjects, the users had to meet further

criteria relating to history, frequency and recency of ganja

use. They were to be tested at least four hours post-drug. ,-

51

Clearly the drug was still in their bodies (Lemberger et aL, 1970) but not in· such quantities as to classify the subjects as under its psychoactive effects. A number of studies have shown that by four hours post-drug, aIl measurable psychoactive effects from smoking it have been lost (Allentuck, 1944; Hal­ pern, 1944; Weil et al., 1968; Manno et al., 1971), thus there was no attempt made to require prolonged abstinence prior to testing. The intention was to test a chronic user in his typical non-high condition. As the drug is customarily smoked at three to four-hour intervals throughout the day it was quite practical to use this criterion for recency. The specific indices used to match user and control subjects in­ cluded age, intelligence, modernity of thinking, alcohol use, years of education, and social class. The measures used in

each case are outlined.

a) Intelligence. Hebb has noted that even with signi­

ficant brain damage (for example large surgical excisions),

many patients continue to maintain pr.e-operative global scores

on standard intelligence tests (Hebb, 1945). This finding has

continued to hold concerning overall Wechsler scores (Taylor,

1969), but it has been shown that some types of subtests main­

tain their score levels better than others (Wechsler, 1944;

Reitan, 1966). It was therefore decided to use a type of

scale known to resist change related to brain damage; in this

case, an "informationll type of scale was chosen as the basic

intelligence measure. This would be used to determine the level 52 of general knowledge available to the subject, and would serve

as the basis for mat ching user and control groups. Negrete

and Murphy (1967) adapted the Kent E-G-Y scale (Kent, 1946) in

a similar attempt to assess the basic knowledge of their coca­

leaf chewing subjects in Argentina, and in order to eliminate

the mentally deficient from their study. Upon investigation

it appeared that with minor changes the Kent was also very

suitable for use in the present study. Scale D was used, with

item 10 changed from ItHow many stripes in the flag'?u to "How

many weeks are there in a year'?u The maximum possible score

on the test is 36; subjects had to attain 15 or better as a

criterion for selection.

b) Modernity-Traditionality. It was anticipated that

subjects would be derived from a variety of sub-cultures

varying from the deeply rural and isolated, to the inner-city

westernized. In view of this it was felt wise to have some

index of degree of modernity or traditionality represented by

the two groups of subjects. Greater urban experience could

easily create a different level of general sophistication which

might be reflected in certain test performances. The '~odernity

Scale" of Smith and Inkeles (Biesheuval, 1969) seemed ideal for

this purpose, having been used in a range of cultures including

Argentina, Chile, India, Pakistan, Israel, Nigeria, and the Kentucky Appalachians. The standard version is addressed to

adult males and was in aIl respects suitable for use in the

study. Administration and scoring were done in the standard 53 manner. c) Alcohol use. Estimates of their typical daily, weekly or monthly alcohol consumption were obtained from sub­ jects. Use was then rated for purposes of establishing over­ aIl group rates and comparisons. Beer, stout and wine were regarded as equivalent beverages. It was hoped to avoid rum-users entirely.

d) Education. No absolute criteria were established as

either maximal or minimal amounts, rather, years of schooling were recorded directly. It was hoped that the groups would

be found to be similar on. this index, as it could be used as

one of the control measures. It was not anticipated that

subjects with a great Many years of education would be found

in either group.

e) Social class. As suhjects were to he matched in

terms of social class, a simple classification system was used

to determine a subject's level. This system was adapted from

Kruijer (1969); the categories are presented in Table 2.

Using this classification, Kruijer finds the lower class to

constitute 60-75% of the Jamaican population • .,' Selection of Measures

In addition to meeting criteria of relevance to the

question being investigated, certain other requirements had to be met by aIl measures being considered for the study, in

order to be suitable to the population. For example, it was

not possible to use material involving written words at aIl, 54

Table 1

Alcohol Use Scale

Amount Rating

None 0 l - 4 drinks per month l 2 - 3 drinks per week 2 4 - 6 drinks per week 3 1 - 2 drinks per day 4 3 + drinks per day 5

Table 2

Social-Class Rating in Terms of Employment

Class Employment Rating

Upper professional, business owner 5 Middle teaching, white collar 4 Lower skilled trades 3 casual sales, farming 2 unskilled trades, fishing l Indigent 0 55 in the anticipation of a high degree of illiteracy among subjects. What auditory-verbal material was considered had to be culturally appropriate. Further, as the study was going to be mobile, conducted in a wide range of environments including those with no electricity, electrical equipment had to be minimized. Any equipment that was considered indis­ pensable had to be adapted to a self-contained power source.

These criteria eliminated the bulk of such possible tests

as Pursuit meters, delayed auditory feedback, and continuous

performance tests. Heavy equipment such as the Rod-and-Frame,

Purdue Pegboard, or the Halstead-Reitan Tactual Performance

and Category Test, was similarly impossible to considere

Tests involving the use of pitch-dark rooms (e.g., for phi

phenomena) also had to be eliminated from consideration.

As subjects were volunteers with little experience with

sustained attention to school-type tasks it was considered

unwise to plan to have a very lengthy, time-consuming or

overly frustrating test battery. In practical terms then, the

group of measures had to be literacy-free, highly portable,

power-line independent, and preferably not too lengthy or

frustrating.,

In addition there were limiting factors of culture af­

fecting the choice of measures. In view of the fact that the

experimental situation concerned comparisons within one cul­

ture, the standard concerns and problems in making cross­

cultural comparisons of raw test data were not an issue. That 56

is, both the experimental group and control group were to be

Jamaican, and comparison with outside normS or criteria were not intended to be made; the study was designed to provide

data within one society. The findings however, were to be

generalized to other societies. In order to legitimize this

process of generalization it was necessary to concentrate on

measuring those aspects of psychological functioning least

culture-bound as far as present evidence is available.

Holtzman (1968) has reviewed the findings to date

achieved in the young science of cross-cultural psychology.

Physiological and sensory variables reportedly show no marked

differences between cultures. Perceptual judgements are

known to be affected in cultures of extreme perceptual con­

ditions (e.g., Arctic wastelands, dense tropical jungle),

but in less extreme conditions perceptual functions do not

show significant cultural variation. Cognitive functioning

measured with largely non-verbal tests has shown cross­

cultural comparability although the effects of culture begin

to intrude in terms of emphasizing some skills and not others.

Personality variables however are clearly subject to cultural

influences, and Gordon and Kikuchi (1966) have described in

detail the kinds of errors that can result from inadequate

cross-cultural validation of American personality tests and concepts.

The present study thus concentrated on variables relevent

to the marijuana questions, but avoided those measures in 57 which cu1tura1 factors p1aced c1ear1y 1imiting or distorting inf1uences. As Most of these cu1tura1 inf1uences are found in the area of persona1ity assessment, the investigation did not pursue this avenue of interest, and no forma1 tests of persona1ity were used. In the questionnaire which fo11owed the test session some attempt was made to touch upon some of the more pressing persona1ity issues re1evant to chronic mari­ juana use (e.g., the 'amotivationa1 syndrome'), through in­ dices such as emp1oyment, genera1 attitudina1 questions, and through the posing of hypothetica1 situations.

Tests of physio1ogica1, sensory, and perceptua1 motofunc­ tioning. The first group of tests attempted to describe sub­ jects' performance on a variety of tasks concerned with physio1ogica1, sensory, and perceptua1-motor factors. Measures inc1uded pu1se rate, the tapping test, the pin-pricking test, reaction time, and time estimation.

a) Pu1se rate. Tranqui11ization has been described as

an immediate effect of the drug in EEG studies which have shown

increased a1pha wave activity. The question cou1d be raised therefore that repeated tranqui11izing episodes might exert

a more permanent effect on the centra1 nervous system, in

which arousa1 1eve1 might be 1owered. One measure of this

possib1e effect was pu1se rate. An opposite hypothesis cou1d be deve10ped from the data which consistent1y report increased pu1se as an acute effect.

Possib1y, chronic episodic spurring of the heart rate might 58 result in a permanently heightened level. A final reason for measuring pulse rate was as verification of the subject's claim to not be under the acute influence of the drug. Thus an initial pulse reading was obtained.

Another use was hypothesized for a later pulse measure­ ment taken as a measure of response to a stressful situation.

Would the general tranquilizing effect of the drug le ad to an

arousal response different in degree from that obtained with

a non-user. In order to answer this question the second

pulse reading was taken following completion of the mildly

stressful and attention-arousing Reaction Time test.

b) Fine psychomotor speed. In view of the reports that

gross motor performance remains virtually unaffected under

moderate doses as an immediate effect of cannabis .intoxication,

no specific measure of this was included. However, fine

psychomotor performance does tend to become impaired and such

a test was sought for this study. In a study of the results

of prolonged use of alcohol this type of measure has also been

found useful in detecting a deficit in brain function (Fitz­

hugh, Fitzhugh, & Reitan, 1960, 1965). The Finger Oscillation, or Tapping Test, of Halstead

(1947) seemed a suitable measure. It has a lengthy history

of use in precisely this type of investigation and has con­

sistently proven its validity as an index of certain types of

impaired brain functioning (Vega, 1969). The Reitan rules

for presentation of 10-second trials were used. The scores 59 essentially describe the speed with which the task is performed.

c) Fine psychomotor accuracy. A further test of this type of performance, but one which required a much finer de­ gree of accuracy, was the pin-pricking test from the Lincoln­

Oseretsky Tests of Motor Development (Oseretsky, 1946). In this test the subject is required to press a pin through an

irregular series of fine holes bored through a wooden template.

The score is simply the number completed within a 45-second

trial. This time limit was long enough to spread out the

distribution of performances without allowing any subject to

complete the task.

d) Reaction time. Clark and Nakashima (1968), Hollister

(1970), and Dornbush et al. (1971), found reaction time to be

impaired following use of the drug. A portable reaction

timer with its own power supply was built for this purpose.

The subject was asked to depress a key upon the appearance

of a light. The stimulus was presented ten times and the

score represented the best five responses of the ten trials.

e) Time estimation. Many investigators have found dis­

tortions in time perception as a result of immediate use of

the drug, mainly in the direction of overestimation (Clark & Nakashima, 1970; Hollister & Gillespie, 1970; Jones & Stone,

1970, Dornbush et al., 1971). It was felt that a test re­ quiring identification of "n" seconds or minutes would be

unrealistic in the less time-conscious culture of po or Jamaica,

but that estimations in terms of the time of day might be ,-

60

possib1~. The task as finally used consisted of informing the subject of the exact c10ck time at the beginning of testing, then asking his estimate of the time at the con­ clusion. Ca1culations of his performance included absolute error, base, and relative error.

Tests of Concept Formation, Cognitive Style, Abstracting

Abi1iJcy.

a) Concept formation. The performance on tasks involving abstracting abi1ity or Itimmediate adapting ability" (Reed &

Reitan, 1963) has been shown to be related to the functioning of the frontal cortex (Halstead, 1947) especia1ly the dorso-

1atera1 aspect (Mi1ner, 1963). Many different tests have been designed to test this general concept inc1uding the

Go1dstein-Scheerer tests, the Wisconsin Card Sorting Test

(Grant & Berg, 1948) and the Halstead-Reitan Category Test

(Halstead, 1947). In a number of studies with alcoho1ics of average intelligence it has been repeatedly demonstrated that

abstracting and concept formation on such tasks has been im­

paired in comparison,with normal controls or with known brain­

damaged patients (Fitzhugh et al., 1960, 1965; .Jones & Parson, 1971). This impairment appears to ref1ect the actual

cortical damage known to be associated with prolonged alcohol

use (Courville, 1955, Haug, 1968). In a group of coca-leaf chewers Negrete and Murphy similarly found this ability im­

paired on three different measures, in comparison with a con­

trol group (1967). Doehring & Reitan (1962) noted that the 61

Category Test for this ability appeared to show impairment equally from right or left hemisphore damage.

In view of the consistent finding in the studies on cognitive changes immediately post-marijuana, it might be an­ ticipated that the moderate impairment found at that time might be reflected in a permanent impairment with prolonged

drug use. Three measures of this ability were thus included

in this study, as indices of deterioration of those cognitive

abilities basic to most intellectual functioning: abstracting,

sorting and generation of rules.

The Kohs Block Design is a subtest of the WAIS with es­

tablished reliability. It has been used in other cross­

cultural work (Berry, 1966; Dawson, 1967), and has been one

of the tests considered sensitive to nbrain damage" in a

number of studies (Negrete & Murphy, 1967; Fitzhugh et al.,

1960, 1965). A slightly shortened version of it was adminis­

tered in the standard way and the raw scores were used as the

index of performance.

The Wisconsin Card Sorting Test has been shown to be

particularly sensitive to frontal lobe damage (Milner, 1963;

Taylor, 1969). Certain alterations were made in its adminis­

tration (shortening, more detailed instructions) in order to

improve ease of administration with the particular population being studied. Scores obtained were (1) total errors, (2)

number of items required to complete sets one and two.

(Other derived scores were shown to correlate very highly with 62 these two basic measures and were thus not included in the findings later reported.)

The Embedded Figures Test (Witkin et a"l" 1$4,1962) requires the subject to develop or abstract a concept from a visually­ presented simple stimulus, then to be able to maintain and identify this concept in a more complex and distracting visual stimulus. Thus the task uses perceptual skills, and more abstract cognitive skills which have been described as

"cognitive style". '1his dimension has spawned a number of tests including the Embedded Figures test and the Rod-and­

Frame test. The dimension has been used as a measure in studies of the immediate effects of the drug (Hollister &

Gillespie, 1970; Jones & Stone, 1970--both using the Rod­

and-Frame version, and Harman et al., 1966, using the EFT).

In a brief note Dinnerstein (1968) predicts that EFT scores

should change in the direction of field-dependence as a re­

suIt of the effects of marijuana in view of the metabolic

changes caused by the drug and assumed to be related to field

dependence (an increase in cholinergic activity in relation

to adrenergic). A prediction of change in the opposite

direction can be derived from the work of Harman (1966), who

reports that psychedelic agents lead to an increase in field

independence as measured on the EFT. Wheth"er either of these

contradictory effects might hold true for extended marijuana

use was not predictable, but clearly of interest. ,-

The EFT has béen used in other cross-cultural psychologi­ cal investigations, in a simplified version (Berry, 1966;

Dawson, 1967a, 1967b; Wober, 1967) and this practise was followed in the present study. The children's version of the test was used; cards D4-P2 were given as practise-teaching items, then the sets D3-E2, Dl-El, D8-H12, D7-H14, D6-P3 were administered as the test items. The scores used were (1)

Mean time on rights, (2) rating including rights and time performance.

Tests of Memory. As described in the earlier literature review of immediate effects, memory appears to be adversely affected by the use of marijuana. Memory furthermore is a skill known to be affected by organic brain damage, especially damage to the mesial portions of the temporal lobes (Milner,

1967). For this reason investigation was indicated into the possibility that prolonged use of the drug does in fact affect those brain regions in a more permanent way.

Because of the Many aspects in which memory is demon­

strated a fairly detailed study was made of this particular function.

Following Keppel (1965), short-term tasks were those

defined as involving a time-lapse of up to 20 seconds or so.

Deficit in short-term memory upon use of marijuana has been

demonstrated in a number of studies described earlier (Abel,

1970, 1971; Clark et al., 1970; Dornbush et al.~ 1971).

For the present study this function was further broken down 64 into more discrete e1ements.

In genera~ performance on verba1-auditory tests of short­ term memory appears to be a function of the 1eft (dominant) temporal lobe (Mi1ner, 1962, 1967; Shankwei1er, 1967), and genera1 verbal impairment is often used as an index of brain dysfunction (Smart, 1965).

In view of this, a paired-associate test was adapted from the Wechs1er Memory Sca1e Form 1 (Wechs1er, 1945). The on1y changes were the substitution of stone, fish, wind, banana,

and ackee, for the original words iron, grocery, inch, app1e,

and cabbage. The first and third substitutions were done to minimize articulation prob1ems and substitutions were made

from Osgood's (1969) list of cu1turally neutra1 words. The

remaining substitutions were made in order to make the words

more culturally familiar. Meaningful rather than nonsense

words were used in order to keep the task within the level

of difficulty which could be expected of these subjects

(Bevan & Steger, 1971). The score used was the total correct

on trial three. (Other derived scores were found to correlate

very highly with this index and thus were not included as

separate findings.)

Performance on the Digits Forward and Digits Reversed

subtest of the WAIS, has been an index of deficit in many

studies of immediate marijuana effects, and this aspect of

memory was considered to be of possible relevance to more

chronic damage. The test was administered and scored in the

standard manner. 65

Non-verbal tests are generally related to the functioning of the right, non-dominant hemisphere (Milner, 1962). Fol­ lowing Melges' (1970) and Tinklenberg's (1970) reports of difficulties in executing sequences (in their studies, com- plex sequences involving computational skills in addition to attention and memory), a non-arithmetic index of this ability was included in this study. The Knox Cube test of the Arthur Point Scale (Arthur, 1944) presents the subject with an auditory-visual sequence which must be remembered and duplicated by him. Functioning on this type of immediate recall has been shown to be affected by prolonged cocaine use (Negrete & Murphy, 1967). The test was administered and scored in the standard manner, then a second form was administered in which a 5-second delay (non-

interference) preceeded the subject's response.

Performance on tests of non-verbal auditory short-term

memory has been related to the functioning of the right (non­

dominant) hemisphere (Milner, 1962, Shankweiler, 1966). For this study, the Harris Rhythm task was used. A similar test (the Seashore Rhythm Test) has found impairment in

the performances of alcoholics (Fitzhugh et al., 1960, 1965). In the Harris Test the subject repeats a tapped rhythm pat-

tern immediately after its presentation by the examiner. The

score is simply the number of correct responses. Both verbal and non-verbal long-term memory skills have

been shown to be sensitive to brain dysfunction when they are

measured over a longer time gap. Milne~ (1967) has shown how 66 a delay of approximately 45 minutes on paired-associate tasks is particu1ar1y diagnostic of 1eft temporal lobe dysfunctiono

Thus the paired-associates task was repeated following a group of interspersed tests, an interva1 of approximately 40 minutes. Simi1arly, Taylor (1969) has reported that delayed reca11 of the Rey Osterreith Comp1ex Figure is particularly sensitive to right temporal lobe dysfunction, and this task was also repeated in a manner identical to that for the paired-associates. This particular test involves an initia1 presentation of the complex geometrical figure for direct copying, following which tasks are interspersed until the request for free recall is made. Scoring was according to the standard procedure. The typica1 delay involved approxi­ mate1y 30 minutes.

The final test battery thus inc1uded the following measures:

(1) Tests for mat ching user and control subjects

(a) The Kent E-G-Y Test, Scale D (information-

intelligence)

(b) The Modernity-Traditiona1ity Scale

(c) Alcoho1 rating sca1e

(d) Employment rating scale.

(2) Tests of physiological, sensory, and perceptual­

motor performance

(a) Pulse rate (arousal level)

(b) Tapping Test (fine psychomotor speed)

(c) Pin-Pricking (fine psychomotor speed and accuracy) 67

(d) Reaction time

(e) Time Estimation

(3) Tests of concept formation, abstracting ability, cognitive style (a) Kohs Block Design

(b) Wisconsin Card-Sorting Test

(c) Embedded Figures Test

(4) Tests of Memory (a) Paired-Associates (verbal auditory short-term memory)

(b) Digits Forward and Reverse (numerical auditory sm)

(c) Knox Cubes Test (visual auditory sequencing STM)

(d) Harris Rhythm Test (auditory non-verbal STM) LTM) (e) Paired-Associates, Delayed (verbal auditory

(f) Rey-Osterreith Complex Figure Delayed (visual- spatial Lm)

(g) Knox Cubes Test, Delay (visual auditory sequencing) used in This completes the description of the test battery are found in this study. The forms used to record test data and Study 110 Appendix land Appendix 2, sorted aS to Study l parts In addition to these tests, a questionnaire of three was devised. 68

Part 1. Basic Screening Questionnaire. This was the

initial screening device and was used to rate the suitabi1ity of potentia1 subjects in terms of age, medica1 status, employ­ ment, a1coho1 and marijuana history and recency of use. The

Kent index of intelligence was incorporated into this. (See

Appendices 3 and 4 for the two versions of the screening ques­

tions used in the two studies to be reported.)

Part II. Main Questionnaire. It was thought useful to

have a range of social and demographic information about

subjects in view of possible group differences which might

be affecting the test performances of subjects quite

separate1y from the defined independent variable of chronic

marijuana use. Thus information in this part of the ques­

tionnaire concerned measures of literacy, sources of rein­

forcement (adapted from Caute1a & Kastenbaum, 1967), diet

(Back, 1961), and general hea1th history. The Modernity

sca1e was inc1uded in this section as it was not directly used

as a screening device. Re1igious be1ief, crimina1 history,

degree of future time perspective (Shybut, 1968; Smart, 1968)

preference for delayed gratification (K1ineberg, 1968) need

achievement (Mische1, 1961a, 1961b), and severity of child­

hood training were a11 tapped as possible sources of user­

control differences. Questions concerning sleep and 1eisure

habits, opinion concerning marijuana, contemporary living

arrangements, income, assets and support of dependents were

a11 considered relevant. A note was made of grooming é.\nd ,-

69 musculature, if either were out of the ordinary. Appendices

5 and 6 contain the versions of this questionnaire used in the original and replication studies.

Part III. Users only questionnaire. This was designed to elicit facts, opinions and attitudes concerning the sub­ jectst experience with marijuana. Slight additions were made at the time of the second study in order to consider effects of the drug on sexual behavior, and the possibility of "flashbacks." A flashback is a sudden recurrence of the

subjective drug effects at a time when the drug has not

actually been taken. Keeler (1968) and others have reported

on psychiatrie patients who have described flashbacks associ­

ated with marijuana use, but the point is hotly debated by

others (Smith & Mehl, 1970).

The general data on use and on basic social-demographic

characteristics were modelled roughly after the survey done

by Soueif (1967) in Egypt. The progression from general

questions to increasingly intimate was not entirely followed

but the most sensitive questions were reserved for the latter

part of the interview. (See Appendices 7 and 8.)

Study I

Method: Subjects. Subjects were Jamaican men living

normally in the community. They were chosen according to

the following criteria: Age 20-45; Kent Scores 15-36;

Alcohol use very low; Absence of severe head in jury, diabetes,

epilepsy; Normal vision and hearing; Social class 10w; 70

Education, limited. Additional criteria had to be met by ganja users: Recency of use, four hours or more; Frequency of use, daily once or more; History of use, ten years or more regular use. There was no attempt made to eliminate subjects on the

basis of criminal or psychiatric histories; rather this in­

formation was considered to be of interest and was routinely

obtained in the questionnaire.

The subjects were sought in both rural and urban areas,

covering aspects of the island ranging from Sandy Bay,

Tryall, Montego Bay and Dutch Hill, to Kingston and Bull Bay.

Obtaining subjects would have been entirely impossible

without the help of Jamaican friends. The typical procedure

involved driving out in the morning to seek someone whose

name and "useft characteristics were already known from con­

versations with other subjects or acquaintances. Upon finding

the man and chatting briefly, the nature of the study would

be explained and testing (almost invariably) would begin.

In no case was the subject's self-description concerning ganja

and alcohol use taken as the sole evidence. Corroboration of

his status typically involved one or two others. Sometimes

a whole group of casual users would recommend a particular

subject as being a "true herbsman" with no alcohol use at

aIl. It frequently happened that one subject would lead to

another and a whole network of users or controls would unfold

over a period of days. This first study included a high 71 proportion of rural people in both groups, but especially in the control group. A small, sober community of farmers deep in the interior was located, and 70% of this control group was obtained in that region. It was feared that this might unduly weigh the control group in the direction of "tra­ ditionality" and unsophistication, but this was not revealed to be the case on the index of modernity.

Method: Procedure. The specific subject selection pro­ cedure followed the brief introduction to a potential subject.

A rapid conversational assessment was made to confirm the level of alcohol and ganja use which had been claimed by the

informants for the subject. This questionning had to be done

carefully in order to prevent the subject from learning the

exact nature of our criteria. If he appeared to meet the

necessary requirements, and was agreeable to spending approxi­

mately one and one-half hours doing the assessment, testing

then began.

The first stage in the formaI assessment of the subject

involved administering the Basic Screening Questionnaire.

If he continued to meet aIl criteria in this more formal

questionning, administration of the test battery was begun.

Three potential user-subjects were dropped at this stage be­

cause of significant alcohol use, and one control subject was

dropped because of age.

The final test battery now began, using the following

sequence of tests: Pulse 1; Tapping; Paired Associates; Rey ,-

72

Design-copy; Wisconsin Card Sorting; Reaction Time; Pulse 2;

Kohs Blocks; Digit Span; Knox Cubes, Knox Cubes-delay con­ dition; Paired Associates-delayed recall; Rey Figure-delayed recall. Following completion of this, the remainder of the questionnaire (part II, Main) was done. Finally, the us ers al one were given the additional users questionnaire (part III).

As can be understood the entire procedure took place in the house, yard, or other territory of the subject. Locations

included deserted churches, stream-sides, riverbanks, hill­

sides, and communal smoking huts. Attempts were made to

achieve privacy but this was frequently impossible and occas­

ionally undesirable. That is, it was sometimes the best

decision in diplomatic terms, to allow the wife and neighbors

of a subject to stand around and watch the entire proceedings

in order to maintain goodwill and prevent the possibility of

unpleasant suspicions arising. Unfortunately this yielding

to the demands of diplomacy sometimes lost potential sub­

jects as they learned many of the tasks while watching. A

strict manner had to be maintained vis-à-vis these ohservers

in order to ensure that no helpful whispers would he offered

to the subject as a result of the observers enthusi~c and

detailed following of the testing.

In the case of users, the onlookers had to be cautioned

against smoking (ganja) at the testing location in order to 73 avoid subject and tester becoming high from referred smoke in the room. Users themse1ves had to have not smoked for the previous four hours; their evidence was checked against co11eagues' and pulse measure was used as corroboration.

Rejection of testing was given by on1y one potentia11y good subject. A control at first agreed to it with interest, but was flatly forbidden to do it by his wife. In spite of my invitation to her to watch the entire procedure she refused to alter her order. Villagers 1ater exp1ained that she was a very jealous woman and that had probab1y been the source of her hostility. Thus in this study the experimenter both sought, screened, tested and interviewed subjects. Data collection for Study I was carried out between August 2, 1971 and September 10, 1971.

Results: Matching User and Control Groups. Twenty-six

subjects were obtained; sixteen users and ten contro1s.

On the social-demographic indices used for matching

users and controls, no significant differences were found using a multivariate ana1ysis of variance [F(5,20) = 0.9189, p < 0.4891]. See Table 3 for the univariate F statistics. Data showing the means and standard deviations for the two

groups on aIl measures May be found in Appendix 9. From

Table 3 it is c1ear that the groups were very closely matched in terms of the specifie socia1-demographic variables which

were intended to serve as indices for matching users and

contro1s. 74

Table 3

Socia1-Demographic Comparisons

Univariate Significance Variable F(l,24) Level

Age 0.1195 0.7327 Kent 0.0051 0.9435 Modernity 0.0356 0.8521 A1coho1 Use 1.2023 0.2838 Education 1.9718 0.1731

It will be reca11ed that matching was a1so hoped for on a socia1-c1ass measure described ear1ier. In fact, 93% of the users and 90% of the contro1s fe11 within the lower c1ass, with one midd1e-c1ass subject of lower-c1ass origins in each group.

Test Resu1ts. On the tasks comparing the user and control subjects on measures of physio1ogica1, sensory and perceptua1-motor functioning, there were no overa11 signifi- cant differences between the groups [F(4,21) = 0.4640,

p ~ 0.7614J. The univariate F statistics may be found in

Table 4.

The tests of.concept formation and abstracting ability

were used to compare the groups, and no significant dif-

ferences were found overa11 [F(5,20) = 1.4711, p ~ 0.2433J. The univariate F statistics (Table 5) show the Kohs B10cks 75 as being closest to demonstrating differences between the groups. Examination of the raw mean score data shows this difference to be in favor of the users.

Table 4

Sensory and Perceptua1 Motor Comparison

Univariate Significance Variable F(1,24) Leve1

Tapping 0.2822 0.6002 Reaction Time 1.5855 0.2201 Pulse-Initial 0.0104 0.9197 Pulse-Arousal 0.0694 0.7945

Table 5

Concept Formation Comparison

Univariate Significance Variable F(1,24) Leve1

Kohs Blocks 2.9890 0.0967 EFT Mean Rights Time 2.4494 0.1307 EFT Rated 0.0803 0.7793 Wisconsin Cards Errors 0.2483 0.6230 Wisconsin Cards Set 1 + 2 Items 0.0417 0.8399 76

There were no overal1 significant differences between of the the chronic ganja users and the controls on any 0.1993J. measures of memory used [F(8,17) = 1.5935, p <

Once again, the two tests coming closest to demonstrating Delay Con­ group differences (Digits Forward, Knox Cubes, the users dition) were describing differences in favor of

(see Table 6 for the univariate F statistics).

Table 6

Memory Comparisons

Univariate Significance Variable F(1,24) Level

Digits Forward 3.6556 0.0679 Digits Reversed 0.9991 0.3275 Knox Original 0.1234 0.7285 Knox Delay 3.1801 0.0872 Paired Associates Trial 3 1.8837 0.1826 Paired Associates Delay 1.8279 0.1890 Rey-Osterreith Copy 0.9488 0.3398 Rey-Osterreith Delay 0.0028 0.9581

done A study of the correlations between measures was the in order to eliminate overly-repetitive tests from which analysis. The correlation matrices between measures Appendix 10. remained fo11owing this analysis may be found in represent It can be seen that the tests used in the study

reasonably independent measures. 77

Questionnaire Results. Detailed results of the ques­ tionnaire may be seen in Appendix Il.

On the basic screening questionnaire figures concerning the subjects' age, social-class, alcohol use and Kent score have already been reported. The only other data of relevance from this portion of the questionnaire is the description of the ganja users' history with the drug. This shows the mean number of years of use to be 16.6, median 17 years of use, and range 6-31 years, with modes at 10 years and 19 years.

In reviewing the main questionnaire it is apparent that there was a.slight difference in literacy levels favoring the control group; this difference was also reflected in the years of education describing the two groups but was not sig­

nificant when tested, as noted earlier. The next difference

of interest is in the number of subjects charged by the

police for crime. Sixty-three percent of the users have

been charged, in contrast to 0% of the controls.

A tendency for the users to sleep less than the controls

was found. In another realm it appeared that users preferred

to spend their leisure time in the company of other people

(as opposed to being alone) considerably more than the con­

troIs (87% to 50%). Finally, ganja users were significantly more likely to

have had ganja-using male relations (father, uncles) than

were the control subjects (43% to 0%).

Of interest in the users-only questionnaire is the age 78 at first use of ganja (mean 12.5 years old, mode and median

12 years, range 9-21). The majority of users began because of the influence of their friends or fami1y. The majority of users took the drug both in spliff and pipe forms (50%) while the largest number of the remaining users smokedonly spliffs (43%). (A spliff is a large cigar-like object; the pipe is typically a water-pipe.) Effects on appetite are described interestingly in that while 86% report enhanced ap­ petite, 14% describe a paradoxical effect in which a hungry man who has no food may obtain re1ease from his hunger pangs

by smoking the tweed'. Subjects approved of children beginning to smoke the drug by approximately age 7, and felt that ganja tea cou1d be given to babies from the earliest

age. A large majority (81%) of the user-subjects use ganja

as a medication. Colds, stomach-ache and asthma are typi­

ca1ly singled out as suitab1e for ganja treatment.

Users unanimously regarded rum as a dangerous and harm­

fuI substance and usua1ly provided vivid anecdotes illus­

trating this opinion. They were similar1y unanimous in

reporting no incidents of violent or unusual behavior as

resulting from their own use of the drug. Fina1ly, a

majority of users take.the drug as a stimulant when they

must complete a particularly heavy, physically demanding job.

They feel the drug gives them extra strength and dexterity,

and helps clarify their mind, thus a110wing them to give the

job a1l the attention it requires. '-

79

Analysis of the Drug. A group of samp1es of typical smoking material were taken from three subjects, and sent for analysis to the Canadian Food and Drug Directorate. In collecting these samples no particu1ar attempts were made to get special batches, rather, sma11 amounts were simply taken from whatever supplies the subjects had on hand. The re- sults from this analysis May be seen in Table 7.

Table 7

*Analysis of Jamaica Cannabis by the

Food and Drug Directorate, Canada.

Sample % % % % Number CBD .d8THC 69THC CBN

l (a) 0.73 0.53 3.22 2.23 (b) 0.55 0.33 2.37 1.77 (c) 0.65 0.53 2.66 2.00

2 (a) 0.64 0.14 7.55 1.14 (b) 0.64 0.22 6.74 1.29

(c) 0.65 0.17 5.44 0 0 90

3 (a) 1.52 0.84 13.64 2.54 (b) 1.35 0.68 13.61 2.71 (c) 0.67 0.39 6.82 1.32

*Material supp1ied by subjects.

It can be seen that the values for Â9THC content are

exceptiona11y high; aIl samp1es from subjects two and three gave values in excess of the 4-5%.19THC content d escrib e d

as typical for hashish (Mechou1am, 1970). 80

Discussion--Study I The tests used in this study have revea1ed a striking

1ack of differences in performance between chronic marijuana

users and control subjects. Before accepting this finding as

va1id, it wou1d seem usefu1 to examine the study for possible

sources of error.

1) Literacy: In view of the slight differences between

users and contro1s on the measure of 1iteracy (69% to 80%

1iterate respective1y), the data was ana1yzed strict1y in

terms of this dimension. Even though the tests had been ori­

gina11y chosen to be suitab1e for i11iterates, it was still

possible that the measures might sort subjects in such a way

asto prejudice the performance of the i11iterates.

Ana1ysis of the socia1-demographic variables used to

match the groups showed definite differences overa11 between

1iterates and i11iterates using a mu1tivariate ana1ysis of

variance [F(5,20) = 5.3311, p ~ 0.0029J. Table 8 shows the

individua1 measures' responsiveness to the 1iteracy of the

subjects. In this table it can be seen that 1iteracy is

c1ear1y a factor in the achievement of a high score on the

Kent index of genera1 intelligence, and tends to be corre1ated

with years of education. As there was no significant dif­

ference between user and control groups on Kent scores, how­

ever, or on years of education, the 1iteracy differences

between the two groups were apparent1y not sufficient to create

a prob1em in the ana1ysis of the test data for users and con­

tro1s. 81

Table 8

Social-Demographic Variables and Literacy-Study I

Variable Univariate Significance F~1324l Level Age 0.2034 0.6561 Kent 15.9817 0.0006 Modernity 0.0022 0.9630 Alcohol 1.8798 0.1831 Education 3.3925 0.0779

Analysis of the sensory and perceptual-motor tasks in terms of sensitivity to the literacy of the subjects found no overall differences between groups [F(4,2l) = 0.7566,

~ 0.5650]. Table 9 shows the univariate F statistics for

the various measures.

Table 9 Literacy Effects on Sensory and Perceptual Motor Tests

Variable Univariate Significance F(1,24) Level

Tapping 0.0837 0.7749 Reaction Time 2.0378 0.1664 Pulse-Initial 0.0228 0.8814 Pulse-Arousal 0.1307 0.7209

Similarly, analysis of the concept formation tests shows

no overall difference on these measures between literate and 82 i11iterate subjects [F(8,17) = 2.6507, ~ 0.0434]. See Table 10 for the univariate statistics; there is, however, a significant tendency for 1iterates to make fewer errors on the Wisconsin Card Sorting Task. Neverthe1e~s these 1iteracy differences have not been large enough to prejudice the per- formance of users as a group, on this test.

Table 10

Literacy Effects on Concept Formation Tests

Variable Univariate Significance F(1,24) Leve1

KOHS b10cks 2.0264 0.1675 EFT -M 0.0002 0.9876 EFT - Rated 0.0372 0.8487 WISC. - Errors 9.4261 0.0053 * WISC. - 1 + 2 0.2181 0.6448

Fina11y, mu1tivariate ana1ysis of the memory tests shows that overal1, performance was not re1ated to literacy [F(11,14) = 1.1140, p < 0.4173]. See Table 11 for the univariate F statistics which however, show a significant tendency for 1iterates to perform better on the Paired-

Associates tas), especia11y on the original presentation.

As the differel ~e in 1iteracy favors the control group, and as users and contr JI groups performed equa11y weIl on the Paired-

Associates task, it can be seen that the literate users are performing weIl enough to overcome the handicap presented by the i11iterates in the group, on this measure. Table Il

Literacy Effects on Memory Tests

Variable Univariate Significance F(1,24) Leve1

Digits - F 0.4789 0.4956 Digits - R 0.0063 0.9373 Knox 1.8582 0.1855 Knox - de1ay 0.3813 0.5428 Paired A. Il.5604 0.0024* Paired A.-de1ay 7.7523 0.0103* Rey 1.0621 0.3131 Rey - de1ay 3.8529 0.0614

2) Re1igiosity: In order to avoid heavy a1coho1 users it became necessary in both user and control samp1es to seek a certain number of subjects from groups known for their non- use of a1coho1. Among users this condition was met by members of the Rastafarian movement (Prince, 1969); among contro1s this condition was met by people loca11y referred to as

"Christians". The 'Rastas' made up 61% of the user group, whi1e aIl contro1s were 'Christians'. Whi1e convictions concerning a specific re1igious dogma May weIl represent cu1- tura1 and persona1ity differences between the individua1s in

these two groups, it is not easi1y possible to c1aim that

'Christianity' wou1d uniform1y lower scores on the measures

used in this study, nor that Rastafarian be1iefs necessari1y

wou1d compensate for mental impairment as measured on these '-

84 tests. The role that personality and social factors may have contributed to the subjects' religious belief is complex, but if any trend can be claimed it is that the Christian ap­ peared to be somewhat better off. This was true in terms of housing, general standard of living, and educational achieve­ ment even though it did not show up on the rough measure of social class obtained. Thus, any differences between the users and controls in terms of religious belief and its social correlates, were to the disadvantage of the Rastafarians rather than the Christians. In this context the lack of im­ pairment in the users cannot be easily ascribed to either their religious convictions nor to the other societal correlates of their religious beliefs.

3) General Subject Response: Motivational differences between the groups might possibly affect their performances on these tasks. Throughout the study the marked interest and persistence of subjects in both groups was a surprising and

pleasant finding. Rapport was easily established and subjects

applied themselves with great discipline even when the tasks

were clearly giving them trouble.

Among users, experiences with 'pilot' subjects'showed

that offer of payment was detrimental to the subject's moti­

vation. That is, their interest in the study of ganja was

keen and genuine, and typically resulted'in a positive en­

thusiasm for the tasks. 85

Among the controls, payment was routinely offered, in view of their less personal interest, and frequent disapproval of ganja use. Control subjects were however, quite interested in the study itself, and perhaps hoped their efforts would help to prove the dangers of the drug. Whatever the sources, motivational differences were not obvious between the groups during the testing situations.

4} The Drug: Another possible reason for the lack of differences might lie in the characteristics of the drug used.

Data were presented earlier which showed the samples obtained to be very high in ~9THC content. The government chemist

(Ellington, 1971) has provided other corroborative data con- cerning the potency of Jamaican ganja. His office has been analyzing ganja materials for sorne years now in cooperation with the law enforcement agencies on the island. (Possession is illegal and penalties are severe.) He has provided these data at my request. (See Table l2.)

Table 12

*Analysis of Jamaican Ganja--Government Chemist, Jamaica

Material 69THC Cannabinol Cannabidiol % % % 1. dried leaves 1.2 0.2 0.2 2. largely fruiting tops 5.5 0.6 0.6 3. usual smoking material 2.8 0.3 0.3

* Material supplied through police seizures 86

The possession of "dried leavesll is not considered an offense in Jamaica as this material is presumed to be so weak as to be ineffectual (also perhaps its use is so widespread as ta be uncontrollable). This view of potency is interesting to con- trast with that typical of contemporary North American human research on the immediate effects of the drug. In these studies effective doses for inhalation commonly involve 1%

THe (approximate1y 3 mg.), with a range from 2-10 mg. As a further comparison, values for Mexican marijuana have been reported as ranging from .8-1.4% THe, with an average value of

1.2% (Lerner & Zeffert, 1968). Values of 4.6% THe are des­ cribed as leading to "mind-rocking depersonalization" in the

North American literature (Lerner, 1969). Thus, the Mean value of 6.9% THe found for the randomly gathered ganja used by -the subjects in this study (range of values 2.37%-13.64%) represents a drug of impressive potency. Another worker has found THe values for Jamaican ganja of up to 14% (Yawney,

1972).

The smoking method used in Jamaica varies somewhat from common North American practise in that the material is available

in such large quantities for such small costs that the sub­

stance is srnoked more 'generously'. That is, Jamaican smokers

do not hoard every tiny butt in order to extract the last pos­

sible essence; sirnilarly smoke is not 'stacked' into the lungs

with the choking system used by North Americans and is freely

exhaled through the nostrils. Despite the difference in ,-

87 smoking methods however, it is c1ear that users do obtain the effects which the drug is known for, as conjunctira1 injec­ tion and rapid heart beat occur quick1y and routine1y.

It may be usefu1 to convert the mean amount per week found typica1 of users in this study (5.86 oz.) into equiva-

1encies described in terms of tobacco cigarettes. A standard tobacco cigarette weighs one gram; at this rate the users in this study consume the equiva1ent of 22.6 ganja cigarettes per day. Lest this sound exaggerated or even impossible, the mode of use must be described. The typica1 sp1iff ranges in size from 2-5 grams. A typica1 chi11um or pipe uses 7 grams (1/4 oz.), and some even use one-ha1f an ounce. Thus the subject who uses slight1y under one ounce per day (22.6 gm., mean for this study) can achieve this by

smoking 4-11 sp1iffs, or three pipefuls, both c1ear1y feasib1e habits. One subject who c1aimed to smoke up to one pound per

day on occasion (he was the local ganja distributor), was

frequent1y observed smoking pipefu1 after pipefu1 (flchain­

smoking") over periods of up to five hours with on1y moderate

effects noticeab1e. In genera1 these Jamaica dose-1eve1s may

be compared to those used by Charen's (1946) chronic users

(4-6 cigarettes dai1y), the Mayor's Committee's (1944) users

(6-10 cigarettes dai1y), and McG1oth1in's (1968) hippies (6-

10 cigarettes dai1y).

From the data presented it does not appear that the po­

tency or the quantity of the drug consumed by these subjects 88 is to be taken lightly. These men were very heavy consumers and had been so for Most of their lives. If cognitive im­ pairment of any significance is generated by the chronic use of this drug it would seem that these subjects are ideal candi­ dates for the demonstration of this effect. 5) Design: Another possible source of bias in the reported findings is based in the design of the study. As noted earlier, it was not possible to use a double-blind design. 'User' subjects clearly were aware of their status as drug users, and controls were similarly aware of their non-using status. In view of the detailed questions concerning drug and alcohol use it was not possible to deceive potential

subjects as to our area of concern or the reasons for seeking them out. Had we attempted such a deceit the suspicions of

aIl subjects would have been aroused as the drug is illegal

and its use, however widespread, is private. Thus there

could be no deception to subjects and no 'double-blind' design.

In terms of ~ingle-blind' however, as noted earlier, the ex­

perimenter handled aIl aspects of this study, from subject­

seeking to screening, testing and interviewing, thus allowing

the possibility of experimenter bias. If there were any

conscious hopes for specific findings, this bias could only

be described as highly ambivalent: on one hand a hope for

clear-cut group differences in order to have statistical sig­

nificance and scientific respectability, on the other hand a

vague concern that the drug be not too harmful in view of the millions of people that use it regularly. In any event, the lack of differences posed a problem Which might weIl derive from this design looseness. It was therefore decided to attempt a replication of the study using a hired research assistant who would do the testing 'blind' or who would pro­ vide subjects to the experimenter for blind testing. The second field trip for data collection lasted from December

4, 1971 until January 9, 1972.

Method--Study II

Subjects: Subject selection criteria were identical to those described in Study I, and subjects were obtained in

a manner similar to that of the first study. This time, how­

ever, aIl subjects were located within the various ghetto

areas of the city of Kingston. Individual informants ranged

from employers, maids, and gardeners, to friendly strangers.

In addition, the informaI aid of several social agencies was

enlisted.

Procedure: Fo~ing the introduction to the subject and

the conversational confirmation of his "subject" characteris­

tics (i.e., the validation of an informant's information),

the Basic Screening Questionnaire was completed if the subject

expressed interest in participating in the study. Following

this the subject was tested. After completion of the test

battery, either tester finished off the final questionnaire,

including the Users-Only questions when appropriate. 90

Both the tests and the questionnaires were revised slightly for this study, chiefly by the addition of a few items. Three tasks were added to the test battery: the

Pin-Pricking test, the Harris Rhythm test, and the Time

Estimation task. Questions concerning actual employment status, number of children and dependents, and sexual effects of the drug were among those added to the questionnaire.

Results--Study II

Twenty-eight subjects were obtained; fourteen were us ers and fourteen were controls. Four referred users were not tested (one was too old, the other three failed to meet future appointments). Five referred controls were not tested (one was too old, two failed to meet the intelligence criterion

and one drank too much alcohol).

Because both experimenter and research assistant al­ ternated as tester in this study, an initial analysis was

made of the test scores in terms of tester. On this basis

the Harris Rhythm test was dropped from aIl analyses. This

test is in fact a highly tester-dependent task unless pre­

sented on tape; this was not done and the results were not

reliable. The remaining tests were independent of tester­

based variation.

Matching the Groups: On the social-demographic vari­

ables used to match the users and controls, no overall dif­

ferences were found using a multivariate analysis of variance

[F(5,22) = 1.7837, p ~ 0.1579). Table 13 shows the univariate ,-

91

F statistics, in which it appears there is a slight age dif- ference between the groups. When this is examined the group

m eans sho w that users are slightly older. See Appendix

12 for specific group means and standard deviations on the test measures.

Table 13

Social-Demographic Comparisons

Variable Univariate Significance F(1,26) Level

Age 3.8237 0.0614 Kent 0.5469 0.4663 !-lodernity 0.0769 0.7838 Alcohol use 1. 2871 0.2670 Years of educa- tion 1.8760 0.1826

Test Results: Significant overall differences between

users and contro1s were not found on the tests of sensory and perceptua1 motor performance [F(8,19) = 0.5658, p < 0.7928). See Table 14 for the univariate F statistics, none of which

showed significant differences between the groups. ,-

92

Table 14

Sensory and Perceptua1-Motor Tests

Variable Univariate Significance F(1,26) Leve1

Tapping 0.0540 0.8181 Reaction Time 1.8031 0.1910 Pins 0.0029 0.9576 Pulse - Initial 0.5961 0.4471 Pulse - Arousa1 0.2646 0.6114 Time Est. Errors 0.4093 0.5280 Time Est. Base 0.0255 0.8745 Time Est. Relative 0.1081 0.7450

On measures of abstracting abi1ity and concept formation there were no overa11 significant differences between the

groups [F(5,22) = 0.4344, p ~ 0.8197J. See Table 15 for the univariate F statistics, none of which showed differences

between users and contro1s.

Table 15

Concept Formation Tests

Variable Univariate Significance F(1,26) Leve1

KOHS 1.5442 0.2251 EFT - M 0.0286 0.8670 EFT - Rated 0.0019 0.9655 Wisconsin - Errors 0.6866 0.4151 Wisconsin - Items 1+2 0.6249 0.4364 93

The memory tests similarly showed no overall differences between the groups [F{8,19) = 0.3365, p < 0.9408J; the uni- variate analysis of variance also confirmed this finding con­

cerning the individual measures (see Table 16).

Table 16

Memory Tests

Variable Univariate Significance F{1,26) Level

Digits - Forward 0.1884 .0.6679 Digits - Reversed 0.0257 0.8738 Knox 0.1214 0.7304 Knox - Delay 0.0251 0.8753 Paired Ass. - 3 0.9337 0.3429 Paired Ass. - Delay 0.6514 0.4270 Rey - 0 0.2342 0.6325 Rey - Delay 0.1314 0.7200

See Appendix 13 for the correlation matrices describing

the relationships among the test variables; it may be seen

that the tests are providing relatively independent measures.

Table 17 summarizes overall probabilities and corres-

ponding chi-square statistics computed according to Winer

(1962), for the findings of the two independent studies.

The combined probabilities indicate that chronic users of the

drug show no significant impairment on any aspects of mental

functioning measured by these tests. 94

Table 17

Overa11 Probabi1ities--Study I and Study II

2 Variable x4 Significance Leve1

Age 6.20 0.18 Kent 1.64 0.80 Modernity 0.81 0.94 A1coho1 5.16 0.27 Education 6.91 0.14 Tapping 1.42 0.84 Reaction Time 6.34 0.18 Pulse I 1.78 0.78 Pulse II 1.44 0.84 Kohs 7.65 0.11 EFT - M 4.36 0.36 EFT - Rated 0.57 0.97 WISC. - E 2.70 0.61 WISC. - 1+2 2.01 0.73 Digits F 6.19 0.18 Digits - R 2.50 0.64 Knox 1.26 0.87 Knox - Delay 5.15 0.27 Paired Ass. 5.54 0.24 Paired Ass. - Delay 5.03 0.28 Rey 3.07 0.55 Rey - Delay 0.74 0.95

Q~estLonnaire ResuLts: See Appendix 14 for a detai1ed description of the questionnaire responses; the high1ights will be brief1y noted here. 95

The basic screening questionnaire showed a higher rate of employment for controls than for users (79% to 58%). Ganja users reported a history of ganja use of 21 years (mean),

with a mean of 13 years of heavy use. This distinction be­

tween "use" and "heavy use" was not made in the first study.

On the main questionnaire the controls once again were

discovered to have a somewhat higher rate of functional

literacy (71% to 57%). In another repeated finding, users

were charged for more crimes than controls (69% to 14%), with

the user rate dropping to 23% when ganja-related charges were

separated out. Simi1arly users tended to report less sleep

than control subjects, and preferred to spend their 1eisure

time in the company of others (92%) rather than a1one, in

contrast to the controls (50%). These findings were consis­

tent with those of the original study. In a further rep1i­

cation of results it was found that the majority of ganja

users (69%) had male relatives who were also users in con­

trast to the controls, where this was true of only 29% of

the subjects.

The final, users-only questionnaire, also repeated many

of the significant findings of the original study. Most sub­

jects (57%) started to use ganja because of the influence of

their friends. Continuing use was described as due to the

help ganja provided to meditation, thinking and knowledge

(71%), with on1y a small group (14%) smoking it merely for

the thrill of being high. In terms of mean weekly consumption 96 this group of users averaged 6.3 oz., with the median and mode at 3.5 oz. The number of users describing the para­ doxical effect on appetite described in the first study dropped, but the existence of this idea was nevertheless

again demonstrated.

It was fe1t acceptable for children to start smoking by

age 10, and for the tea to be used by babies, as found in Study 1. Similarly a high proportion of subjects (86%) used

ganja as a medicament. Not one subject had ever used any

other psycho active drug other than a1cohol. In response to

the query concerning the role of ganja in sexual behavior

71% disputed the suggestion that it had effects of any kind,

while 29% felt that it enhanced sexual pleasure. (These

subjects happened to be very sexually active.) The idea of

"f1ashbacks" met only puzzlement; the phenomenon appeared to

be completely alien and unknown. Finally, a majority of the

users reported they smoked ganja as a stimulant when they

had a particular1y heavy and fatiguing job to perform, pro­

viding exp1anations for this similar to those reported in

the original study.

Discussion--Study II

Once again the objective test measures have shown a

striking lack of differences between the two groups. Indeed,

rather than describe the findings as a lack of differences,

it would be more apt to describe the two groups as being

remarkably simi1ar. 97

A brief check on sorne of the possible confounding factors contributing to this finding will be made, parallelling that done following the first study.

The Sub.iects:

1) Literacy. Again, the control subjects have a some­ what higher literacy rate than the users (71% to 57%) and this difference (although not significant) is also noted in the years of education (5.2 to 3.6, favoring the controls).

It thus becomes relevant to examine the effects of literacy on the measures used in this second study.

On the social-demographic measures we find that literacy does affect this group of variables overa11 [F(5,22) = 7.5882,

p ~ 0.0003J. Specifical1y, the univariate F statistics show that the Kent information-intelligence scores, and years of

education, are re1ated to the subjects' 1iteracy, as in

Study l (see Table 18). Users might be anticipated to show

somewhat lower scores on these measures; in fact they did not

perform significant1y worse on the Kent, nor were the edu-

cationa1 differences between the experimental groups, signi-

ficant.

Table 18

Social-Demographie Variables and Literacy

Variable Univariate Significance F(1,26) Level

Age 1.3443 0.2569 Kent 6.4567 0.0174 * Modernity ].1104 0.3017 Alcohol Use 0.8198 0.3736 Education 21.3488 0.0001 ir 98

Examining effects on the tests of sensory and perceptual- motor performance we find that there is no overall significant difference relating to the literacy of subJects [F(8,19) = 0.5615, p < 0.7960J. Theunivariate F statistics, found in Table 19 individually confirm this overall finding.

Table 19

Sensory, Perceptual-Motor Skills and Literacy

Variable Univariate Significance F(1,26) Level

.. Tapping 2.8560 0.1030 Reaction Time 0.4660 0.5009 Pins 3.2619 0.0825 Pulse - 1 0.0436 0.8363 Pulse - 2 0.1320 0.7194 Time Est. - E 0.0707 0.7925 Time Est. - B 0.1870 0.6690 Time Est. - R 0.6287 0.4351

Among the concept formation tasks (see Table 20), the

Kohs Block Design cornes closest to being responsive to

literacy using the univariate analysis of variance. When

the mean scores of users and controls are checked however,

the slight difference that is found favors the users, al-

though they are slightly more illiterate. Using a multi-

variate analysis of variance this literacy difference does

not have overall significance for concept formation tasks

however [F(8,19) = 1.5496; p ~ 0.2058J, and the original

data analysis is not affected. 99

Table 20

Concept Formation and Literacy

Variable Univariate Significance F(l,26) Level

Kohs 4.1667 0.0515 EFT - M 3.8112 0.0618 EFT - Rated 0.6165 0.4395 WISC. - Errors 2,1366 0.1559 WISC. - 1+2 0.0005 0.9816

The ana1ysis of 1iteracy effects on the memory tests shows that the 1ess 1iterate users have a disadvantage on these measures. Three of the tests are biased in favor of literates, and over a11 the memory tasks the differences be- tween literates and illiterates are also significant

[F(12,15) = 3.2740, p ~ 0.0165J. When this finding is com- pared to the actua1 resu1ts of users and controls on these measures, the 1ack of differences found suggests once again that the literacy handicap of the users was not sufficient to affect the group scores on the memOrY tests. (See Table 21.)

Over aIl these measures there were tendencies for 1iterate subjects to outperform illiterates on four indices. However, in spite of a 10wer literacy rate, the users performance as a group did not differ significantly from the controls. This suggests that the literacy differences between the two groups were not significant enough to affect the test scores being studied. Possible interaction effects between tester, literacy and group membership could not he analyzed as some of the cells contained too few observations. 100

Table 21

Memory and Literacy

Variable Univariate Significance F(1,26) Level

Digits - F 0.3943 0.5356 Digits - R 7.5147 0.0110 -* Knox 5.0857 0.0328 Knox - Delay 4.0230 0.0554 Paired Associates 4.4469 0.0448 Paired Ass. - Delay 8.8974 0.0062 * Rey 17.7550 0.0003 * Rey - Delay 1.8907 0.1809

2) Religion. In view of the religiously biased sampling

in the original study an attempt was made to make the groups more comparable in the replication study and this was in fact

achieved. Fifty per cent of the users were Rastafarian, and

50% of the controls were 'Christian', while the remaining

half of each group professed no particularly strong attach-

ment to any religious group. Thus this factor as a possible

source of bias in the groups has been reduced in importance.

3) Motivation. Nearly aIl subjects in both groups received

the promise (fulfilled) of payment in return for their co-

operation. These subjects were nearly aIl living in inner

city sIums or shanty areas, and their general standard of living appeared worse than that of the subjects in the

original study although in cash terms this was notnecessarily

true. The response of most subjects under these circumstances 101 cou1d be described as p1easant and cooperative, but more money-oriented than in t:le original study. The f1avor of great enthusiasm shown by the ear1ier group of subjects was 1ess rare1y encountered, but once at work on the task subjects disp1ayed good 1eve1s of attention and persistence.

As the slums of Kingston have deve10ped certain revo1u­ tionary groups with anti-co1onia1ist, Black Power ideo1ogy, there was some concern that the experimenter wou1d encounter difficu1ties. In fact on1y one potentia1 subject refused on this basis. He was a Rastafarian and exp1ained his dis­ approva1 of the project in most sophisticated terms; he and his brethern were tired of supp1ying "M. Sc. and Ph.D. thesis materia1" to foreigners who had no interest in actua11y he1ping the Rastas with their prob1ems. He thus beautifu11y expressed the point made by Ke1man (1967) in his cautioning psycho1ogists to recognize that academic co1onia1ism is be­ coming increasing1y resented as an exploitation of the socio­ cultural heritage of deve10ping nations. Rejection on the basis of this attitude was on1y encountered once in the course of the two studies.

Design: The rep1ication study was attempted specifica11y

in order to estab1ish sing1e-b1ind testing. This objective

was achieved in perhaps 40% of the cases. Two practica1 dif­ ficu1ties prevented the more efficient execution of this plan.

1) The seeking-out of subjects was very diff.icu1t,

consequent1y the combined energies and resources of both 102 experimenter and assistant were frequently necessary, th us destroying the 'blind' before the subject was even located.

2) In cases in,~chthe difficulty had been successfully by-passed, the distinctive physical appearance of the users and the controls was sometimes enough to a1low for identi­ fication on a purely visual basis. As a further hazard, both kinds of subjects were interested enough in the topic to con­ tinually interject discussions of it into the testing session.

These betrayed both their biases and their group membership.

Perfect single-blind testing could only have been achieved

if subjects' hair and clothing were standardized, and if they

were not allowed to speak du ring testing. This condition

was not in our power to establish, and attempts to do so

would have been disastrous for data collection.

The attitude of the research assistant was a mitigating

factor against any possible effect of unconscious pro-drug

bias on the part of the experimenter. The assistant was an

upper-middle class Jamaican woman with no personal experience

with the drug, and with a general attitudetoward it of dis­

approval mixed with curiosity. 103

DISCUSSION

This thesis has presented strong evidence that 'mental deterioration' as commonly defined, does not appear to characterize those persons who have used cannabis sativa heavily and for long periods of timeo The temporary altera­ tions of sensory and perceptual-motor skills commonly found when a user is under the immediate influence of the drug, do not appear to create any comparable permanent changes with chronic use. Similarly, the impairment on concept formation tasks known to be associated with intoxication by the drug, and with slow degenerative brain processes initiated by other drugs such as cocaine and alcohol, do es not appear to create any comparable changes in chronic marijuana users. Finally the disruptions of memory associated with heavy chronic alcohol use and with acute marijuana intoxication, are shown not to lead ta any significant chronic memory disruptions in heavy regular users of marijuana.

These findings are at variance with a number of des­ criptions in the literature on chronic effects of marijuana use (Munch, 1966; Leonard, 1969; Mussen & O'Neill, 1969;

Schultes, 1969; Grollman & Grollman, 1970). In these reports mental deterioration ascribed to brain lesions, or described as similar to the degeneration found in chronic alcoholics has been attributed to chronic cannabis use.

In view of the contradictions between these reports and the present findings, possible errors in the selection of 104 subjects and the execution of the research were investigated.

It appears that the groups were chosen and matched fairly.

If there was any basic disadvantage in the test situation it

appeared to have been directed against illiterates. In both

studies this should have acted to the detriment of the per­

formance of the users as they were represented by a some­

what higher proportion of illiterates than were the controls.

However, as the users' performance equalled that of the con­

troIs these differences in literacy levels were apparently

not large enough to affect the findings.

The design of the study was loose originally in terms of

allowing for possible experimenter bias to affect test scores.

The replication study managed to partially improve on this,

however there still may be sorne distortions due to this

factor. Not considered in the earlier discussions, were

issues relating to the measures used, and the general reasons

underlying the choice of these.

The main rationale behind the choice of measures in these

studies rested upon two lines of evidence: 1) Reports that a

particular function as measured by a particular test, showed

impairment as an effect of intoxication with cannabis; 2)

Reports that a particular function as measured by a particular

test showed impairment as a result of a) the chronic use of

another psychoactive drug (e.g., cocaine, alcohol) or b) a

known condition of brain dysfunction.

It was necessary to use these indirect sources of tests 105 in view of the 1itera11y non-existent nature of other sound studies of chronic users. The minor stream of reports of chronic use and chronic users has 1arge1y consisted of 1ists of subjective observations, from which quite contrary findings have issued. These have not provided any particu1ar1y fruit­ fu1 notions upon which to choose precise measures for the present study. It was fe1t therefore, that the most satisfac­ tory procedure was to use the rationa1e out1ined above.

These sources provided at 1east sorne solid evidence to sup­ port the usefu1ness of the indices.

Another exp1anation which might account for the 1ack of findings between the groups however, lies in the possibi1ity that a very subt1e group of brain functions do change with chronic use of the drug, but that no one has as yet identi­ fied them sufficient1y to provoke deeper investigation. The present study cou1d not accommodate undefined variables. How­ e~in another variation of this idea, the disinc1ination of this study to investigate persona1ity changes in chronic

us ers might have resulted in abandoning one 1ine of research

which might have found significant differences between the

users and contro1s. The decision to restrict the investi­

gation to inte11ectua1 and perceptua1 ski11s was based on a number of factors described ear1ier. In addition to the generic difficu1ties in the assessment of persona1ity within

our culture, e1aborate validation of persona1ity concepts

and tests in the Jamaican culture wou1d have been necessary 106 before even beginning the actual research into marijuana

effects. This kind of project was far beyond the scope of the current investigation.

Therefore, in terms of the kinds of mental changes due

to the habitual use of this drug which are commonly proposed

in the literature, the tests which have been used in this

study appear to have been appropriately chosen. Further this

study investigated those kinds of mental impairment believed

to be responsible for the test performance changes hypothe­

sized by other authors. That is, it is suggested that the

findings of this study are valid in that the mental functions

responding to the drug were accurately identified, and the

tests to measure these were correctly chosen.

If these findings are accepted as valid in spite of the

conflicting reports from other studies, it is necessary to

look for the sources of the discrepancies. There are two

possible explanations for these.

The first explanation relates to the source of data

underlying the belief in the dangers of this drug. Most

Western authors have relied heavily upon descriptions of

chronic use derived from other cultures and countries with

longer experience with the drug. There have been two basic

problems with the data thus obtained. In many of these

cultures marijuana is used in combination with other drugs.

For example in South Africa it is commonly used in conjunction

with sweet wine, and in India and Afganistan, with opium. 107

These other drugs may be 1arge1y responsib1e for the mental changes attributed to the nlarijuana. Second1y, in neg1ecting to study cannabis users in comparison with a c10sely matched control group, these studies have been unab1e to prove that any of the observed effects have been the result of the action of the drug. Impoverished circumstances, pqor nutrition and poor health (aIl frequent1y noted), may have been the cause of the drug use rather than its effect; in any event a cor­ relation between cannabis use and mental du11ness cannot be

claimed to have been demonstrated until adequate comparisons

are made with an appropriate control group. Further a longi­ tudinal study would be required in order to prove any such

correlation to ref1ect a causal relationship. In terms of

these two difficu1ties, the unique nature of the findings of

the present study are made more explicable.

A second interpretation of these findings relates to the

importance and operation of expectancy effects among cannabis

users. The manner in which these effects cou1d relate to

performance on objective test measures is complex. First it

should be understood that Jamaican users do not regard ganja

as a hindrance to either thinking or working. In view of the

evidence that heavy North Anterican users can compensate for

some of the behavioral effects of the drug in ways Which a1ign

performance with expectancies (Weil, 1968; Smith & Meh1, 1970),

it is equally possible that the chronic Jamaican user's

expectancy of improved mental functioning in fact contributes 108 to the lack of impairment found in the present study. That is, their expectations of enhanced memory, enhanced strength and dexterity May be a strong predictor of test performances which wouid contrast strongly with the expectancies and performances of North American users. Severai Jamaican users explained that they first tried the drug as an aid to studying for school examinations on the advice of oider friends. Its effects were found to be helpful, and its use was therefore continued. In contrast, while North American us ers May feel that creativity is enhanced by the drug, memory improvement is certainly not stressed as a typical effect. The publicity given to experimentai findings which stress impairment May further foster expectations of memory difficulties when these are consistently expected and dis­ played, the expectations of the experimenters aiso begin to be involved, in terms of determining the focus of studies.

In this way a tremendous potential for artifact can gradually be developed. Before turning from the test results to an examination

of the questionnaire results this concept of experimenter

expectancy effects is interesting to consider in the light of

information coming out of some casual observations made

during this study which were quite independent of either test

or questionnaire data. These observations concern the concept

of the development of tolerance to cannabis. Comments made

earlier in this text describe the casual dismissai of the 109 ide a of tolerance with prolonged cannabis use, as a common feature of many review articles and books (Gershon, 1970;

Grinspoon, 1971). It was suggested that the traditional linkage of tolerance with the notion of physical dependence had resulted in a blanket rejection of the duo in relation to cannabis use. On the basis of direct observations of the

Jamaican chronic users, it would appear that major behavioral tolerance effects do occur. Subjects were observed smoking massive quantities over prolonged periods of time, yet con­ tinuing to move, work and talk remarkably normally. Subjects whose three-hour-previous spliff disqualified them from im­ mediate testing, were amazed at the suggestion that it could still be affecting them. They would vigorously object, and explain that "one little spliff" didn't have any effect at

aIl on them in the first place, so how could it be affecting them three hours later. Constant examples of tolerance were

presented throughout the three months of the studies. For

this reason it is suggested that the little-regarded findings

of Smith and Mehl (1970) and Jones and Stone (1970) be more

carefully examined. They are very likely sound bases on which

to found experimental investigations into behavioral tolerance

effects arising with the chronic use of this drug by humans.

In preparation for now looking at the questionnaire data,

it may be useful to attempt to assess the degree of reliability

which can be expected of this self-report data. 110

In any questionnaire system the respondent is free to lie, and the brief instrument used in this study to accom­ pany the more objective measures provided no exception to such a freedom. On many items lying or distorting would serve no obvious purpose (e.g., what do you plan to do in the future', and many other similar 'what if •••,' items). Items relating to personal data however might easily be distorted for various reasons. Exaggeration of alcohol or ganja use might fulfiU a desire to appear manly (although there is no

Jamaican equivalent to Itmachismolt ), and denial of medical problems may also r.elate to this type of feeling. Not aIl such pitfalls can be avoided but there are several ways of discovering or minimizing them. Soueif (1967) in his ex­ cellent survey, returned to his respondents sorne weeks later to repeat certain items in order to obtain an index of reli­

ability. This was not possible in the present study because

of practical problems, so another system of precaution was

used. As described in the section on 'obtaining subjects', we

typically knew about a subject from several other informants

before we actually found him. The informants were asked if

they knew men with certain characteristics (alcohol use,

ganja use and age were usually specif~ed), and if the infor­

mant and his friends concurred on certain names these would be sought as potential subjects. In view of the general lack

of privacy found in Jamaicanlower-class life, habits of

alcohol and ganga use were well-known by a man's peers within ,-

111 each small district. Thus information which the subject would provide would be considered against the data given by the in­ formants. These men often accompanied the experimenter in the search for the subject, giving helpful directions and asking questions concerning the study. If contradictions in data occurred, the whole group of men would decide on the most accurate response. Certainly for example, the figures given for quantity of ganja use appeared to correlate with the mode and amount of use actually observed of the subject.

Although this multiple-informant system is still not a measure of laboratory preci~ion it is considerably more relia­ ble than single-informant evidence. For this reason it is felt that the data provided in the questionnaire is reasonably dependable.

In examining the actual data provided by the question­ naire, it was found that there were some specific differences between the users and controls on behaviors which may have been caused by chronic use of the drug. Both current employ­ ment status, and criminal history demonstrated these major differences between the groups.

Current employment status was not obtained in the ori­ ginal study thus no data are available for it, but in Study

II the users had an unemployment rate of 42% in comparison with the controls' rate of 21%. Both of these very high figures must be viewed in the context of Jamaica's overall unemployment rate of 23% (Buxton, 1971), of which a dis- 112 proportionately high fraction is found in the less skilled lower class. These differences May relate to the 'amoti­ vational syndrome' referred to earlier, but very possibly relate more to the religious belief system which separates the two groups. That is, the Rastafarians tend to regard employment in a very different manner from "Christians."

The Ras Tafari have as their major concern, a return to their

'homeland', Ethiopia, where they feel they will no longer be harassed by evil white exploiters or black 'Babylon'. They

are less likely to stick with a job which they feel is ex­

ploitative or demeaning to their self-dignity, as their belief system supports this value far more than the value of material

achievement. The Christians on the other hand, are part of the Pro­

testant ethic in which hard work and a steady job are highly

valued. They do not typically discuss employment as exploi­

tation, and tend to value material success more than the

Rastafarians. A final factor May also be relevant to this difference; because of their unusual hair and clothing styles

there is often prejudice against hiring Rastafarians similar

to that directed against hippies in North America. The

middle-class employers are distrustful of this unusual ap­

pearance. Many of the users explained that employers often tried to pay them less for a job than other workers would

receive, safe in the knowledge that Rastas had a harder time

in finding employment and might accept bad conditions out of

necessity. 113

the In view of these factors it can be understood that factors high rate of unemployment among users may reflect of the other than a personality change caused by the effects and cultural drug. It is suggested that religious belief, phenomenon. factors are major factors contributing to this ganja The greater incidence of criminal charges among use are users (even when those directly related to ganja might be con­ removed) is another interesting phenomenon which however, be sidered as an effect of the drug. It can also vs. related to the different ideologies of the Rastafarians

ft a stern Old T esta­ the "Christians • The Rastafarians take believe the ment view of righteousness and punishment, and most proper response to any attack is a prompt counterattack; assault. The of the criminal charges were in fact related to New Testament "Christians" however operate more in terms of a and thus fear of eternal punishment if they behave badly, even in display behaviors more commonly regarded as passive, in this the face of provocation. The role of ganja therefore It has not been higher crime level is not easy to estab1ish. types of possible to learn the actual base rates for these the meaning crime in the Jamaican lower class population, so Nevertheless to be applied to our data is further obscured. more than it is apparent that the criminal rate reflects

simply drug effects. the In these two examples of major differences between belief groups, the role of social attitudes and personal 114 systems has been indicated as of importance in addition to the purely pharmacological effects of ganja. In another group of questionnaire findings it was similarly found that genuine drug effects were mingled with religious belief and prevalent social attitudes; these findings were those concerning the

use of the drug for medicinal purposes.

Both control and user subjects reported using ganja for the relief and cure of a number of conditions including colds,

stomach ache and asthma. In addition to accepting it as a

medication however, users have an extensive folklore ela­

borating on its pharmacological properties. For example it

is believed that ganja and penicillin are mutually antagon­

istic. Thus if a ganja smoker has to go for a penicillin

shot he believes he must stop smoking the 'herb' two days in

advance, or the penicillin will not work; it will be over­

whelmed by the strength of the ganja. Another common belief

is that ganja ashes will help heal an open skin wound.

Sorne of these uses appear to be based upon genuine phar­

macologicalcharacteristics of the drug as shown in the

studies for example, of Lynch and Zitterell (1970). A series

of studies demonstrated that certain cannabis derivatives

showed anti-bacterial action of impressive calibre when com­

pared with known anti-bacterial agents such as penicilline

Further, the cannabis preparations were useful against

penicillin-resistant bacteria. Dilution of the preparations

with such body-fluids aS blood resulted in a major (50%)

loss in efficacy, and for this reason the authors suggested 115 it might be more feasibly used in topical preparations rather than as a systemic agent. The Jamaicans, as described, do use it topically. Other research has demonstrated that its anti-bacterial activity is effective against both gram­ positive and tuberculosis bacteria (Kabelik et al., 1960).

In India it is one of the staple components of Medications used by the village doctors. There, it is suggested that unless equally cheap and effective alternative medicines are made available, the use of cannabis in medicines should be continued in spite of the general sanctions against smoking it (Dwarakanath, 1965). It can be seen then that some of the Jamaican uses of the drug relate to genuine pharmacological effects. It would be of great interest to learn if penicillin and cannabis anti-bacterial effects are mutually antagonistic as suggested by these subjects, or if this is merely one of the blind alleys arising from this folk Medicine.

In terms of general physical condition the Jamaican users ranged from average to superb. They uniformly reported health histories in which they had "never been sick" in terms of requiring the care of a doctor or hospital. It seems at least a possibility that the steady use of the drug has pro­ vided a kind of anti-bacterial preventative Medication similar to that provided by the routine administration of strep­ tomycin common in commercial animal-rearing. This would also be a very interesting idea for pharmacological research. In ,-

116

that a similar vein, Prince et al. (1972) have proposed ganja may have provided Jamaicans with a Itbenevolent to alternativett to alcohol which has contributed directly Jamaica in lower rates of alcohol-related mental illness in not have comparison with other Caribbean islands which do de­ the plant. Such conditions as chronic brain syndrome, of lerium tremens and alcoholic hallucinosis are examples rates are these illnesses for which the Jamaican incidence

lower. Throughout much of this discussion of the Jamaicans' effects with use of ganja as medicine the interplay of drug of the role belief systems has been noted. The importance of this of beliefs or expectancies in relation to the effects provided by drug is further explored in studying other data

the questionnaires.

Jamaican users consider ganja to be a pure natural of herbal gift from God, and do not regard their consumption con­ it as "drug use" at aIl. In examining the long-held to other tention that use of marijuana causes or is conducive data drug use (Abe1son, 1968; Paton, 1968), the Jamaican

concerning use and expectancy effects are of considerable access to interest. The north coast of Jamaica provides through the LSD and other North American psycho active drugs they search activity of hippies bringing in their wares as study for an island paradise. The subjects of the original to drug-use were main1y from this region, and they responded ,-

117 questions with a rather puritan i cal horror at the thought

lt of using Itdrugs • Study II subjects from Kingston wou1d have access to opium and cocaine if they were interested, but do not use these drugs. (The cocaine passes through en route from South America to the United States, and the opium is used by the local Chine se population.) That is, not on1y did the Jamaican ganja users not use other drugs, they had a specifie distaste for the idea of using "chemica1s" in order to achieve intoxication or insight. Thus if there is

any cause and effect re1ationship operating between cannabis

and other drug use, this must be ana1yzed in terms of per­

sona1 and social factors rather than as an inherent drug

effect of cannabis.

Sexual functioning did not appear to fit the description

provided by Mann (1968) in the Journal of Reproduction

and Ferti1ity, in which uchronic intoxication with hemp

narcotics soon 1eads to 10ss of potency and often ends in

sexua1 inversion". Although most subjects (86%) did not use

the drug to specifical1y enhance sexual p1easure or per­

formance (in contrast to popu1ar be1ief), user subjects who

reported that their favorite 1eisure activity was "p1aying

with my girl" or "romance", had gigg1ing women and chi1dren

listening nearby to confirm the success of this activity.

(Tangentia11y, users had an average of 2.6 children in com­

parison with 1.8 for contro1s, probab1y ref1ecting religious

be1ief. Users tended to regard birth control as evil, 118 exp1aining that God wished man to have chi1dren fias sands of the sean). In terms of sexua1 behavior there is no expec­ tation of diminished performance and no suggestion of this as a possible effect was ever advanced; again it is suggested that changes in sexua1ity probab1y invo1ve expectancy effects of users rather than particu1ar drug effects.

In contrast to the apathy and fl amotivationa1 syndrome" described as typica1 of chronic users in North America

(Bromberg, 1968; McG10thlin & West, 1968), Jamaican users often specifica11y smoke ganja to provide energy and strength

in order to accomp1ish particu1ar1y heavy tasks, and the

drug is regarded as a stimulant for this purpose (61% of the users). This finding agrees with Chopra & Chopra (1965) who

reported the drug is used to ward off fatigue in India.

Once again social expectancies appear to be operating strong1y,

in addition to what must be only moderate drug effects, in the

demonstration of such diametrica11y opposed behaviors.

Appetite for food is another area in which the common

North American report of increased hunger or increased

appreciation and desire for food, is be1ied by much more

comp1ex reports from Jamaican chronic users. They say 'If

a man has no appetite but he must eat to preserve his hea1th,

'herbs' (ganja) will act as a good tonic to his appetite.

If however, he is hungry and has no food to eat, a good smoke

will take away his interest in food'. Thus once again ex­

pectancy effects appear to override the basic drug effect. 119

Certainly from the literature on appetite and blood glucose levels, it is not clear why North American self-reports of increased appetite should be regarded as veridical evidence of drug effects.

Similarly, reports concerning analgesic properties pre­ sent paradoxical evidence. The tea or smoke is commonly used to relieve stomach ache, but it is felt that use of it will

increase the pain of headache. These reports do nothing to clear up the confusion concerning pain which was reported

earlier in the review of animal literature (Bicher & Mechoulam,

1968 versus Holtzman et al., 1969). It would appear that

further research could easily separate out the purely

pharmacological analgesic activity and resolve this paradox,

for expectancy effects on this topic could be manipulated in

either human or animal laboratory studies.

Questions concerning the phenomenon of "flashbacks"

described in the North American psychiatric literature

(Keeler et al., 1968) brought only puzzled responses from

our subjects as reported earlier. It was clear this experience

was a possibility none of them had ever entertained much less

experienced. Repetitively, it appears that expectancy op er­

ates to create this experience in those who have reported it.

The major role assigned to expectancy concerning this parti­

cular Itdrug effectif agrees with the findings of clinicians

who have worked with large numbers of marijuana us ers (Smith

& Mehl, 1970) and is contradicted only by the occasional 120 reports of c1inicians who have had psychiatric patients re­ porting this phenomenon.

It is apparent that a wide range of effects of this drug are inf1uenced by the expectations of the users, and that

North American subjects frequent1y describe effects quite contrary to those reported by the Jamaican subjects. A1though this has been acknow1edged to a certain degree in the 1itera­ ture, in view of some of the more dramatic contrasts reviewed here it is probable that there are still many.other effects attributed to the drug which are in fact expectancy effects based within the users, rather than within the action of the drug.

In conc1uding, this discussion has suggested that the lack of mental impairment on psycho1ogica1 testsfuund in this study of heavy cannabis users, is a va1id finding. The e1imination of users of other drugs, and the selection of a carefu11y matched control group are be1ieved to account for these resu1ts which are in contrast with Many other reports.

In both test and questionnaire findings there was evi­ dence to support the idea that expectancies play a major ro1e in the kinds of effects found with the drug, Many of which may be cu1tura11y loaded. 121

SUMMARY

The research described in this thesis was designed to investigate the effects of chronic heavy consumption of cannabis sativa (marijuana) upon sensory, perceptual-motor, cognitive and memory functions. Two studies were carried out in which independent samples of subjects were obtained among normal adult Jamaican males. The experimental and control subjects were matched on a number of variables and objective psychological tests were used. The design was cross-sectional. The first stu1y showed that heavy chronic users of the

drug demonstrated no impairment on any of the measures used.

Possible reasons for this negative finding were reviewed and

a replication study was carried out in which the methodology

was made more rigorous in order to put greater control over

possible sources of error in the original findings. The

replication study confirmed the results of the original study

strongly and consistently.

Questionnaire data were obtained in each study and

examined for possible explanations of the findings.

Topics and research strategies for further investigation

were identified in the test, questionnaire, and observa­

tional findings.

It was concluded that the present investigation does

not support the idea of mental deterioration as a drug effect

in subjects who are heavy regular consumers of marijuana. ,-

122

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and non-users. Nature, 1970, 226, 119-123. APPENDIX 1

Psychological Test Record-Study I ,-

Subject No. PULSE l 15 sec --- TAPPING Left hand 10 sec Right hand

PAIRED ASSOCIATES l metal - stone rose - flower baby - cries baby - cries obey - wind obey - wind danger - dark north - south north - south north - south ackee - pencil school - f ish school - fish up - down rose - flower rose - flower fruit - banana ackee - pencil up - down school - fish up - down obey - wind metal - stone fruit - banana fruit - banana danger - dark danger - dark a ckee - pene il baby - cries metal - stone

FIRST RECALL 2ND RECALL 3RD RECALL Easy Hard Easy Hard Easy Hard north ackee obey fruit baby fruit obey metal baby rose school metal baby up danger up rose school ackee obey rose metal fruit nor't!.h school danger ackee danger north up

TOTALS TOTALS TOTALS

REY DESIGN l (attached) WISCONSIN CARD SORTING (attached) EMBEDDED FIGURES TlME: lA 2B 3C 4D REACTION TIME l 2 3 4 5 PULSE II 15 sec KOHS BLOCKS Practise 1: 2-4 Practise II: 2-4 card 1: 0-4 Card 2: 0-4 Card 3: 0-4 card 4: 0-4 Card 5: 0-4 BACKWARD SCORE DIGITS FORWARD SCORE DIGITS 2 3 2-4- 5-8-2- 2 6-9-4- 3 5-8- 4 6-2-9- 3 6-4-3-9- 3 7-2-8-6- 4 4-1-5- 5 3-2-7-9- 4 4-2-7-3-1- 4 7-5-8-3-6- 5 4-9-6-8- 6 1-5-2-8-6- 5 6-1-9-4-7-3- 5 3-9-2-4-8-7- 6 6-1-8-4-3- 7 5-3-9-4-1-8- 6 5-9-1-7-4-2-8- 6 4-1-7-9-3-8-6- 7 7-2-4-8-5-6- 8 8-1-2-9-3-6-5- 7 5-8-1-9-2-6-4-7- 7 3-8-2-9-5-1-7-4- 8 4-7-3-9-1-2-8-

KNOX CUBE TEST WITH 5 SEC DELAY

1-4 1-4- 2-3 2-3 1-2-4 1-2-4 1-3-4 3-4-1 2-1-4 1-3-2-4 3-4-1 2-4-3-1 1-4-3-2 1-3-2-4-3 1-4-2-3 1-4-2-3-4-1 1-3-2-4 2-4-3-1 1-3-1-2-4 1-3-2-4-3 1-4-3-2-4 1-4-2-3-4-1 1-3-2-4-1--3 4-1-3-4-2-1-4

PAlRED ASSOCIATES II

ackee baby meta1 school up rose obey fruit danger north TOTALS EASY HARD

REY FIGURE II (attached) PICTURE STORY CARD ,-

APPENDIX 2

Psychological Test Record-Study II ,-

TIME OF DAY -----(Tell Subject) Subject NO. PULSE 1 15 sec ----- TAPPING Left hand 10 sec Right hand

PAIRED ASSOCIATES l meta1 - stone rose - f10wer baby - cries baby - cries obey - wind obey - wind danger - dark north - south north - south north - south ackee - penci1 s choo1 - f ish schoo1 - fish up - down rose - f10wer rose - f10wer fruit - banana ackee - penci1 up - down schoo1 - fish up - down obey - wind meta1 - stone fruit - banana fruit - banana danger - dark danger - dark ackee - penci1 baby - cries meta1 - stone FIRST RECALL 2ND RECALL 3RD RECALL Easy Hard Easy Hard Easy Hard north ackee obey fruit baby fruit obey meta1 baby rose schoo1 meta1 baby up danger up rose schoo1 ackee obey rose meta1 fruilt north schoo1 danger ackee danger north up TOTALS TOTALS TOTALS

REY DESIGN l (attached) WISCONSIN CA RD SORTING (attached) EMBEDDED FIGURES TIME: 1 2 3 4 5 REACTION TlME 1 2 3 4 5 PULSE II 15 sec KOHS BLOCKS Practise 1: 2-4 Practise II: 2-4 card 1: 0-4 card 2: 0-4 Card 3: 0-4 card 4: 0-4 Card 5: 0-4

DIGITS FORWARD SCORE DIGITS BACKWARD SCORE 5-8-2- 3 2-4- 2 6-9-4- 3 5-8- 2 6-4-3-9- 4 6-2-9- 3 7-2-8-6- 4 4-1-5- 3 4-2-7-3-1- 5 3-2-7-9- 4 7-5-8-3-6- 5 4-9-6-8- 4 6-1-9-4-7-3- 6 1-5-2-8-6- 5 3-9-2-4-8-7- 6 6-1-8-4-3- 5 5-9-1-7-4-2-8- 7 5-3-9-4-1-8- 6 4-1-7-9-3-8-6- 7 7-2-4-8-5-6- 6 5-8-1-9-2-6-4-7- 8 8-1-2-9-3-6-5- 7 3-8-2-9-5-1-7-4- 8 4-7-3-9-1-2-8- 7 ,-

5 sec KNOX CUBE TEST WITH 5 SEC DELAY HARRIS RHYTHM TEST delay

1-4 1-4- xxx 2-3 2-3 xx xx 1-2-4 1-2-4 x xx 1-3-4 3-4-1 x x x 2-1-4 1-3-2-4 xxxx-- 3-4-1 2-4-3-1 x xxx 1-4-3-2 1-3-2-4-3 xx-- x x 1-4-2-3 1-4-2-3-4-1 xx- xx- xx 1-3-2-4 4-1-3-4-2-1-4 xx xxx 2-4-3-1 x--- x x x 1-3-1-2-4 x xxxx 1-3-2-4-3 xxxxx 1-4-3-2-4 xx x xx 1-4-2-3-4-1 xxxx xx 1-3-2-4-1-3 x x x xx 4-1-3-4-2-1-4 xx xxx x x xxxx xx xx x x xx PAIRED ASSOCIATES II xxx--- x xx x x --xx xxx- xx ackee x-- xx xx x xx baby metal school up rOEe obey fruit danger north TOTALS EASY HARD

REY FIGURE II (attached) PICTURE STORY CARD

Time Test ended Subject's estimate ,-

APPENDIX 3

Basic Screening Questionnaire-Study l

BI. Do you want $1.00 now or will you wait unti1 ____ when l can give you $3.00? a) now $1.00 b) 1ater $3.00 B2. Identity - name and village in code B3. How old are you? B4. Is your hearing aIl right? a) yes; b) no B5. Vision - ask to read chart a) row 7-8; b) row 4-6; c) rOl'i 1-3 on1y B6 Have you ever had a very bad injury to your head? a) no; b) yes B7. Do you ever have fits or convulsions? a) no; b) yes B8. Do you have to take any medicine regu1ar1y? a) no; b) yes B9. What kind of work do you do? BIO. Do you drink rum or other 1iquor? a) no; b) yes - what kind B11. If yes - how often a) dai1y; b) one or twice/week; c) once or twice/month; d) very rare1y? B12. Do you use ganga a) no; b) yes? B13. If yes - how often do you use it a) dai1y or severa1 times dai1y; b) severa1 times each week c) 2-3 times /month; d) once a month or 1ess? B14. If user - when did you 1ast smoke ganga a) within 1ast 7 hours; b) 8-16 hrs. ago; c) 17-24 hrs. ago? B14a. If user - For how many years have you been using it a) 1-5 years; b) 6-10 years; c) more than 10 years ? BIS. What are houses made of? B16. What is sand used for? B17. If the f1ag f10ats to the south, what direction is the wind coming from? B18. Tell me the names of sorne fishes. B19. At what time of day is yOUl~ shadow the shortest? B20. Give me the names of some large cities. B21. Why does the moon look 1arger than the stars? B22. What metal is attracted by a magnet? B23. If your shadow points to the north east where is the sun? B24. How many weeks are there in a year? ,-

APPENDIX 4

Basic Screening Questionnaire-Study II Subject No.

BASIC

B2. Identity B3. Age B4. Hearing normal? BS. Eyesight normal? B6. Bad injury to head? B7. Fits or convulsions? B8. Any medicine every day? B9. Kind of work

Employed now?

BIO. Drink rum or other liquor? Bil. How often and how much?

B12. Use c.s?

B13. How often?

How much/day?

B14. Used c.s. within last four hours? Most recent use

B14A. For how many years been using? Using heavily?

KENT BIS. What are houses made of? (1 pt. ea. up to 4) B16. What is sand used for? (Making glass - 4; mixing with concrete - 3; other - 1) B17. If the flag f10ats to the south, what direction is the wind coming from? (north - 3 pts., other - 0) B18. Tell me the names of some fishes (1 pt. ea. up to 4) B19. At what time of day is your shadow the shortest (noon - 3, other - 0) B20. Tell me the names of sorne large cities (1 pt. ea. up to 4) B2l. Why does the moon look larger than the stars? (near objects look bigger - 4; it i5 nearer - 3, it is lower down - 2) B22. What metal is attracted by a magnet? (iron - 4; steel - 2; other - 0) B23. If your shadow points to the north-east where is the sun? (SW - 4; other - 0) B24. How many weeks are there in a year? (52 - 2; other - 0) APPENDIX S

Main Questionnaire-Study l

Ml. Can you write your name - Show me. a) legible writing or printing; b) can't M2. Can you write this number (tt27") If yes, show me a) correct; b) illegible or can't M3. Can you read this sentence (show card with sentence) a) perfect; b) sorne difficulties; c) major dif­ ficulties or can't M4. How many years of schooling have you had? years MS. If you could have anything at aIl, tell me four things you would like to have M6. Tell me what you had to eat yesterday -­ M7. What have you eaten today -- M8. Do you eat enough good food to feel healthy most of the time? a) yes; b) no; c) other M9. When was the last time you had meat? a) today; b) yester­ day; c) within the past week; d) longer than one week ago MIO. When was the last time you had fish- (as above a) b) c) d) MIl. When was the last time you had chicken- (as above •• ) Ml2. Have you ever been severely sick? a) no; b) yes M13. If yes, what was wrong? M14. Were you ever in hospital for a long time? a) no; b) yes MIS. If yes, what was wrong? M16. Have you ever given much thought to sorne public problem such as the elections to the extent that you really wanted to do something about it? a) frequently; b) a few times; c) never M17. If schooling was freely available, how much school do you think your sons should have? (Years ____ ) M18. Two 12-year-old boys stopped during their work in the cane fields. They were trying to think of a way to cut the cane with less work. The father of one boy said "That is a good thing to think about - tell me your ideas about how to change our ways of cutting canett. The father of the other boy said ItThe way to cut cane is the way we have always done it. Talk about change will waste time and not help. It Which father said the wiser words? a) the first; b) the 2nd M19. What should qualify a man to hold a high position? a) high family background; b) devotion to the old ways; c) popularity; d) education and special knowledge M20. What is the most important thing to help Jamaica to be a good country? a) hard work of the ~eople; b) good government planning; c) God's help; d) good luck M21. Doctors and scientists in many universities study such things as what makes a baby a boy or girl, and how a seed turns into a plant. What do you think of such studies? a) aIl good, very interesting and important; b) sorne good; c) aIl somewhat harmful; d) aIl very harmful M22. Sorne people say it' is good for a man and his woman to limit the number of children they will have so they can take better care of the children they already have. Others say this is wrong. What do you think? a) limit; b) this is wrong M23. Which kinds of news are you most interested in? a) world events - in other countries; b} Jamaican news; c) news from your village or parish; d} sports and racing news; d} religious news M24. If you meet a person who cornes from a country thousands of miles away, can you understand his ways of thinking? a) yes, I think so; b} no M25. Do you think a man can be truly ~ood without having any religion at aIl? a} yes; b) no M26. Are you a religious person? a) yes - attend services every week or more; b) yes - but don't attend regu­ larly; c) no M27. Have you ever been charged by the police for a crime? a} never; b) yes, 1-3 times; c) yes, 4 or more times M28. If yes, What was the nature of the charge? M29. Did you have to go to gaol? a) yes; b) no M30. Look into the future and tell me four things that you think might happen to you. M31. When do you think 1; 2; 3; 4 will happen? M32. If you could gct a large gift by waiting awhile, or get a small gift immcdiately~ which would you do? a} wait for the large; b) take the small now M33. If you could be anything you wanted what would you be ••• What kind of person would you like to be? a} (if he gives any occupation); b) (If he wishes for importance, status but no specifie job); c) (if he wishes for personal qualities, e.g., nice,good) M34. How much do you think the men in this are a use ganga? a) the same as you; b) more than you; c} less than you M35. Grooming a) yes; b) no M36. How would you describe your sleep patterns? a) have a lot of trouble sleeping; b) restful sleep, regularly; c) other M37. Do you think you sleep more or less than other men? a) more; b} less; c} same M38. What do you like to do when you're not working? a) (Any activity with friends); b) (Any lone activity); c) describe M39. Do you think the use of ganja should be legalized? a) yes; b) no; c) uncertain M40. What do you think the long-term effects of ganja are? a} helpful; b) harmful; c) mixed good and bad; d) other M4l. How strict was your mother with you when you were a child? a) very strict, lots of punishment; b) quite strict; c) not too strict; d) other M42. l'm thinking of something, l'm thinking very hard about something (Close eyes). Do you agree or disagree with it? a) agree; b) disagree M43. Did your mother and father live together while you were growing up? a) together; b) father left before age 6; c) father left between 6-14~ d) father came and went at irregular intervals; e} other M44. Did your father or uncles or other male relative use ganja? a) yes; b) no; c) dontt know M45. Who do you live with now? a) legal wife; b) girlfriend­ no children; c) girlfriend-mother of your children; d) mother; e) other M46. How much money do you usually earn in one week? M47. Is your work very hard physically? a) yes; b) not too; c) other M48. If user, does ganja make your work easier? a) yes; b) no ,-

APPENDIX 6

Main Questionnaire-Study II '-

Subject No.

HAIN l

: Hl. Write name of villa e '. H2. Read "27" H3. Read THE BANANAS ARE READY FOR MARKET H4. Years of school

HS. If you could have anything at aIl, tell me 4 things you would like to have.

M6. What ate yesterday H7. What ate today M8. Eat enough good food to feel healthy most of the time? H9. When last ate meat fish chicken H12. Ever been very sick M13. What?

H14. Ever in hospital for long? M1S. What?

MaD M16. Ever thought about a public problem (schools, elections) so much that you really wanted to do something about it yourself?

H17. If school was free, how much school would you like your sons to have?

M18. !WO l2-yr.-old boys stopped during their work in the cane fields. They were trying to think of a way to cut the cane with less work. The father of one boy said "That is a good thing to think about - tell me your ideas about how to change our ways of cutting cane". The father of the other boy said "The way to cut cane is the way we have always done it. Talk about change will waste time and not help". Which father said the wiser words?

H19. What should qualify a man to hold a high position?

M20. What is the most important thing to help Jamaica to be a good country?

M21. Doctors and scientists in many universities study such things as "what makes a baby a boy or girl, and how a seed turns into a plant". What do you think of such studies?

M22. Sorne people say it is good for a man and his woman to limit the number of children they have, so they can take better care of the children they already have. Others say this is wrong. What do you think?

M23. Which kinds of news are you most interested in? HAIN Il

M24. If you meet a person who cornes from a country thousands of miles away, can you under­ stand his ways of thinking? M25. Do you think a man can be truly good without having any religion at aIl?

M26. Are you a religious person? M27. Have you ever been charged by the police for a crime? M28. If YES - what was the charge

M29. Did you have to go to gaol? M30. Look into the future and tell me four things,that you think might happen to you: 1. when 2. when 3. when 4. when M32. If you could get a large gift by waiting awhile, or get a small gift immediately, which would you prefer? M33. If you could be anything you wanted, what would you be •••••• what kind of person would you like to be?

M34. Do the men in this area use c.s. very much

M35. Grooming Musculature M36. Restful sleep? M37. Sleep more or less than others? M38. Preferred leisure activities M39. Should ganja use be legalized? M40. What are the long term e-fects of using ganja?

M4l. How strict was your mother with you when you were a child?

M43. Did your father and mother live together while you were growing up?

M44. Father or uncles use?

M45. Who do you live with?

M46. How much money earn in a good week? bad week?

M47. Is work physically demanding?

M48. Users - ? use to make easier?

M49. Own any land? buildings? vehicles? other (boats ••• )

M50. Have any children? Number?

How many of them are you taking care of steadily? APPENDIX 7

Users On1y Questionnaire-Study I

U1. How old were you when you first started using ganja? a} 5-10 years old; b} 10-15 yrs. old; c} 15-20 yrs. old; d} other U2. What was the main reason you first started smoking ganja? a} to kcep in with my friends; b} to feel good/high; c} curiosity; d} to look 1ike a "rea1 man"; d} for sexua1 excitement; f} other U3. Why did you continue to use g after you had first tried it? (Don't give suggestions) a} became a habit--felt I needed it; b} he1ps ease prob1ems of dai1y 1ife; c} enjoy being hi~h; d} makes me enjoy being with friends more; e) other U4. How do you usua11y take g? a} smoke in sp1iff; b} smoke pipe; c} tea; d} other US. How much do you norma11y use at one time? a} sp1iffs __ ; b} p.pe __ U6. How much does g use cost you each week? U7. Does g affect your appetite? a} yes, want to eat more, enjoy food more; b} yes, 10se interest in food; c} no; d) other u8. Do you usua11y use it a10ne or with other people? a) a1onc; b) with Eami1y; c) with male friends; d) with Eriends of both sexes; e) other

Continue a genera1 discussion of use covering such topics as:

U9. Do you think ganja can be harmful to people? U10. Do you think women shou1d use it? Young chi1dren? How young? U11. Have you ever used it (e.g., in tea) because you were sick and you thought it might help your sickness? U12. If you had the choice which wou1d you prefer to take-­ ganja or rum (or any alcoho1}S U13. Do you use ganja main1y because it costs less money? U14. Have you ever heard that drinking a lot of rum can be harmfu1 to your body? U15. Have you ever done anything unusua1 (e.g., violent, crimina1 etc.) whi1e under the influence of ganja? APPENDIX 8

Users Only Questionnaire-Study II USERS ONLY

U1. Age at first use U2. Main reason first time used

U3. Reason continue using

U4. Method of use

U5. Amount normally taken in one day

U6. Cost/week U7. Effect on appetite

U8. Use alone or with others? sex?

U9. Can it be harmful?

UIO. At what age should a child start smoking?

drinking tea?

Ull. Ever used as medicine?

For?

U12. Prefer c.s. or a1cohol?

U13. ls rum harmful to your body?

U14. Ever done anything unusual under the influence?

U15. Ever used drugs?

U16. Women

U17. Flashbacks? APPENDIX 9

Means and Standard Deviations-Study I

CONTROLS USERS S.D. Variable Mean S.D. Mean

Age 30.0 6.5 29.0 7.5 Kent score 24.1 5.8 24.3 4.8 15.8 1.8 15.9 1.8 Modernity 1.6 A1coho1 use 1.1 1.2 1.7 Years of education 8.4 3.5 6.5 3.2

Tapping 233.8 37.6 243.0 45.8 Reaction time 14.8 6.0 17.0 4.3 Pulse-initial 70.0 2.5 70.4 3.3 Pu1se-arousa1 68.8 3.0 70.4 2.9

Kohs b10cks 9.6 5.7 12.6 3.2 EFT-mean rts 13.9 14.0 7.8 5.3 EFT rated 12.4 4.1 12.8 3.3 26.6 9.5 24.5 11.0 Wisconsin-errors 1.0 Wisconsin-set 4.1 1.0 4.2 1+2 items

Digits forward 5.6 0.7 6.4 1.2 Digits reversed 3.1 0.7 3.4 0.9 Knox original 9.5 2.6 9.1 2.7 Knox delay 4.4 1.2 5.3 1.5 Paired Ass-Tr.3 6.2 2.1 7.3 1.9 Paired Ass-De1ay 5.3 3.1 6.6 1.9 Rey-O-orig. 30.9 7.1 32.9 3.9 Rey-O-de1ay 18.7 8.9 18.9 7.7 APPENDIX 10 Correlations Between Variables-Study l

1. Social-L~mographic Variables

Age 1 Kent ~loderni ty Alcohol Education Age 1.0000 1 Kent -0.0011 ! 1.0000 Modernity -0.2664; 0.3838 1.0000 . Alcohol -0.3395 i -0.2900 0.0462 1.0000 Education -0.3996 i 0.3077 0.4893 0.1148 1.0000 1

2. Sènsory and Perceptua1-MOtor Variables

lTapping React. Pulse 1 Pulse 2

Tapping 1.0000 Reaction T. 0.1019 1.0000 Pu1se-1 0.2574 -0.3817 1.0000 Pulse-2 0.1234 -0.2963 0.8916 1.0000

3. Concept Formation Variables

Kohs EFf-M EFT-R Wisc. E Wisc.1+2 1 Kohs 111.0000 EFf-M . 0.0874 1.0000 ,EFf-Rated 0.5463 0.3138 1.0000 Wisc.Errors ,-0.4761 i 0.1225 -0.3332 1.0000 Wisc. 1+2 rO.4680 1 0.1887 -0.1817 0.6404 1.0000

4. Memory Variables

DIG-F DIG-R Knox Knox-D P.A. 3 P.A. D REY REY-D Digits-F 1.0000 Digits-R , O. 2444 1. 0000 1 Knox 1 0.3784 0.5754 1.0000 1 Knox-Del. 1 0.4234 0.4025 0.6294 1. 0000 1 P.A. -Tr.3 i 0.1452 i 0.1883 0.3551 0.2647 ; 1.0000 . P.A.-Del. i 0.0761 1 0.3136 0.3253 0.2660 0.8206! 1.0000

Rey 0.1399 i 0.4546 0.7013 0.3662 1: 0.3594 1; 0.3162 1.0000 iReY - De1. 1 0.3436 1 0.4366 0.5931 0.2556 0.3393 0.3151 0.6271 1.0000 ,-

APPENDIX Il

Questionnaire Resu1ts-Study I

Question Number Item Content Users Contro1s

B. 1. This was omitted because of the impracticabi1ity of promising a rendez-vous 2. Identity 3. Age (described ear1ier) means 29.0 30.0 4.-8. Medical history--a11 unsuitab1e e1iminated--in fact on1y one was lost for this. 9. Type of emp10yment Upper c1ass (5) Kruijer sca1e (1969) Middle c1ass (4) 6% 10% Lower c1ass (3) 43% 80% (2) 50% 10% Indigent (0) o o 10.-11. A1coho1 Consurnption None Sca1e o 18% 30% 1-4/month 1 44% 50% 2-3/week 2 12% 10% 4-6/week 3 o o 1-2/dai1y 4 18% 10% 3+ dai1y 5 6% o 12. Ganja user? 100% o 13. Frequency of ganja use. dai1y + 100% 14. Recency of ganja use--Testing was de1ayed unti1 4 hrs. post-use 14A. Years of steady ganja use. Mean 16.6 yrs. Range 6 31 yrs. Median 17 yrs. Modes 10 yrs.19 yrs. 15.-24. Kent sca1e 24.3 24.1

M.1.-3. Literacy 69% 80% 4. Years of education 6.5 yrs. 8.4 yrs. 5. Sources of Reinforcement a) Concrete and specific, e. g. , house 75% 60% b) Abstract but earth1y, e. g. , inter- persona1 18% 5% c) Abstract, theo1ogica1, e. g. , sa1vation 8% 35% 6. -11. No significant differences cou1d be detected in dietary habits 12.-15. No subjects reported significant disease or hospita1ization 16.-25. Modernity Sca1e 26. Consider self to be a re1igious person 93% 100% Appendix 11 continued

Question Number Item Content Users Contro1s

27. 28. Have been charged by the police for crime 63% 0% 29. Went to gao1 for the crime 6% o 30. Future orientation 1) Real 44% 10% 2) unrea1, non­ specific 56% 90% 31. Time extension cou1d not be ca1cu1ated because of the high 'unrea1ity' or the responses. 32. Prefer a de1ayed large reward 43% 40% 33. Need achievement-occupationa1 orien- tation 37% 30% 34. An uninformative item 35. A11 subjects' grooming was adequate 36. Easy to have restfu1 sleep 93% 80% 37. Sleep amount compared to others 1) more 13% 40% 2) 1ess 31% 10% 38. Socia1ization in 1eisure time 1) a10ne most1y 13% 50% 2) with others 87% 50% 39. Ganja shou1d be 1ega1ized? --yes 87% o 40. Opinion of ganja 1) he1pfu1 50% o 2) harmfu1 7% 80% 3) mixed 43% 20% 41. Very strict mother when a chi1d 86% 80% 42. Item abandoned because of embarrass­ ment (mine) 43. Fami1y intact during youth 43% 60% raised by grandparent 13% 10% 44. Male relatives use ganja --yes 43% o 45< Current accommodation a10ne 19% o with dependellts 43% 50% with parent(s) 25% 50% with peers 13% o 46. Income: dropped because suspicion of unre1iabi1ity 47. Work is very hard physica11y 48. Use ganja to make heavy work easy 68% yes Appendix 11 continued

Question Number Item Content Users Controls

Part III: Users Questionnaire

1. Age at first use of ganja - mean 12.5 yrs. Range 9-21, mode & med. 12 yrs. 2. Reason for first use - to keep in with friends 56% - curiosity 25% - to meditate (re1igious) 14% - to fee1 high 7% 3. Reason for continuing use - it he1ps ease the prob1ems of daily 1ife 37% - it brings insight and wisdom 37% - enjoy being high 25% 4. Normal methud of use - sp1iff & pipe 50% - sp1iff a10ne 43% - pipe al one 7% 5. Quantity norma1ly used - mean/week 5.86 oz. - median & mode 3.5 oz /week - range .4-31.5 oz. 6. Cost per week - mean $8.80 - range 0-$50.00, median $6.00 7. Effect on appetite - enhance 86% - paradoxica1 14% 8. Use and socia1ization - with both sexes 50% - with men only 31% - a10ne main1y 19% 9. Dup1icates M40, abandoned 10. Age a young chi1d cou1d start smoking 6.9 yrs. range 2 wks- cou1d have tea babies 15 yrs. 11. Ever used as a medication - yes 81% 12. Prefer ganja to rum - unanimous 13. Insu1ting question - dropped 14. Is rum harmfu1 to the body - unanimous yes 15. Done something unusua1 under ganja in- fluence, e.g., violent none - one funny story to1d APPENDIX 12

Means and Standard Deviations-Study II

CONTROLS USERS Variable Mean S.D. Mean S.Do

Age 28.4 7.8 . 34.0 7.3 Kent 22.6 2.1 23.5 4.1 Modernity 17.6 1.8 17.7 0.7 A1coho1 use 1.4 1.4 2.1 1.8 Education 5.2 2.9 3.6 3.1

Tapping 232.1 42.6 236.1 48.3 Reaction time 22.5 7.4 19.4 4.2 Pins 54.9 12.3 55.2 15.6 Pulse-initial 73.2 1.6 17.4 3.8 Pu1se-arousa1 71.~ 2.0 17.2 3.6 Time est. l 21.7 20.5 17.1 17.7 Time est. base 88.1 30.8 86.1 35.4 Time est. rel. 22.8 18.4 25.4 23.4

Kohs 8.1 5.5 10.6 4.9 EFT - mr 12.7 7.2 13.1 7.9 EFT - rated 12.8 3.8 12.7 4.8 Wisconsin-errors 24.8 7.9 27.2 7.6 Wiscon. items 1+2 28.1 5.4 29.9 6.4

Digits - for. 6.0 1.3 6.2 1.3 Digits - rev. 3.3 1.0 3.3 1.3 Knox 8.1 2.2 8.5 3.1 Knox de1ay 4.5 1.2 4.4 1.1 Pair. asse tr.3 6.6 2.0 5.7 3.0 P.A. de1ay 5.8 2.4 4.9 3.2 Rey 33.2 3.4 32.5 3.6 Rey de1ay 16.1 7.8 17.1 6.1 APPENDIX 13 Correlations Between Variab1es-Study II

1. Social-Demographie Variables Age Kent Mod. Alcoh. Educ. Age 1. 0000 Kent 0.1315 1.0000 Moùernity 0.4028 -0.0556 1.0000 A1coho1 -0.2792 -0.1206 -0.0774 1.0000 Education 0.2029 0.2280 -0.0013 -0.2260 1. 0000

2. Sensory, Perceptua1-t-.'lotor Variables

Tapp. R.T. Pins Pulse 1 Pulse 2 1 Time E Time B Time R

Tapping 1.0000 1

Reaction T. -0.1093 1 1.0000 Pins 0.2712 11-0.5490 1.0000 Pulse 1 -0.1067 1-0.0901 0.0252 1.0000 i Pulse 2 -0.0046 i 0.1952 0.0875 0.6856 1.0000 il Time E. 0.3042 1 0.0041 -0.1169 -0.1652 -0.1914 ! 1.0000 Time B. 0.3793 1 0.0704 -0.1647 0.4622 0.2974 0.4366 1.0000 Time Rel. 0.2467 i-0.0663 0.1894 -0.3629 -0.1288 0.6522 -0.0779 1. 0000

3. Concept Formation Variables

Kohs EFT-R Wise. -E Wise. 1+2 ! 1 EFT-M 1

Kohs 1.0000 \ EFT-M 0.2149 1. 0000 EFT-R 0.2182 ,-0.0973 1.0000 Wise. Errors -0.1124 1 0.1205 -0.2706 1.0000 Wise. 1+2 0.2023 0.2024 -0.0109 0.5431 1.0000

4. Memory Variables

1 DIG-F DIG-R 1 Knox Knox-D P.A. -3 P.A.-D. Rey Rey-D

Digits-F 1.0000 1 Digits-R 0.1982 1. 0000 1, Knox 0.1575 0.5169 1.0000 Knox-Del. 0.0424 0.5167 0.5236 1. 0000 1, P.A. -3 -0.0248 0.3578 i 0.4335 0.2439 1.0000 P.A. Del. 0.0547 0.4092 1 0.3378 0.4012 0.8918 1.0000 Rey 1. 0.3930 0.5400 0.3951 0.2989 0.4371 0.5164 1. 0000 Rey-Del. -0.0892 0.0622 1 0.1410 0.0108 0.4195 0.4104 0.3291 1.0000 :, .' APPENDIX 14 Questionnaire Resu1ts-Study II

Part I. Basic Screening Information

Question Number Item Content Users Contro1s

B. 1. Omitted 2. Identity 3. Age 34.0 28.4 4.-8. Medical history; aIl unsuitab1e e1iminated 9. Emp10yment -Upper cl. (5) o o -Middle cl. (4) o o -Lower c1.-ski11ed (3) 72% 79% -semiski11ed (2) 7% 14% -unski11ed (1) 21% 7% -indigent (0) o o Current1y emp1oyed-yes 58% 79% 10.-11. A1coho1 consumption - none (0) 29% 36% -1-4/mo. (1) 14% 29% -2-3/wk (2) 21% 14% -4-6/wk (3) 7% 7% -1-2/day (4) 14% 14% -3 +/day (5) 14% o 12. Ganja use 100% o 13. Frequency of ganga use - dai1y+ 100% 14. Recency of ganja use (4 hrs.+) 100% 14A• Years of steady ganja use (mean) 21.1 yrs. Years of heavy dai1y use (Mean) 13 yrs. 15.-24. The Kent Sca1e 23.5 22.6 ,.-

~ Appendix 14 continued

Part II. Main Questionnaire

Question Number Item Content Users Contro1s

M.1-3. Literacy tests 1iteracy 57% 71% 4. Years of education 3.6 yrs. 5.2 yrs. 5. Sources of reinforcement 1) concrete & specifie 71% 76% 2) abstract but earthy, e.g., interpersona1 10% 11% 3) abstract, theo1ogica1 19% 13% 6.-11. Diet - groups equa11y protein-shy 12.-15 •. Hea1th history - nothing serious reported 16.-25. Modernity Sca1e - reported e1sewhere 26. Consider self to be re1igious 79% 79% 27.-29. Have been charged by the police for a crime (If ganja charges e1iminated) 23% 14% Went to gao1 for the crime 38% o 30. Future orientation 1) Real 21% 29% 2) Unrea1 79% 71% 31. Time extension - cou1dn't be ca1cu1ated because of the 'unrea1ity' of the responses 32. Prefer de1ayed reward 46% 71% 33. Need achievement - occupationa1 orientation 38% 57% 34. Not used 35. Grooming was adequate in aIl. Mus­ culature normal 36. Easy to have restfu1 sleep 93% 100% 37. Sleep amount compared to others 1) more 31% 36% 2) 1ess 38% 14% 38. Social habits in 1eisure time 1) a10ne most1y 8% 50% 2) with others 92% 50% 39. Ganja shou1d be 1ega1ized? yes 77% 14% 40. Opinion of ganja 1) he1pfu1 77% 14% 2) harmfu1 0% 57% 3) mixed 23% 29% 41. Very strict mother when a chi1d 46% 93% 42. Item dropped 43. Fami1y intact during youth 46% 64% 44. Male relatives use ganja 69% 29% 45. Current accommodation 1) live a10ne 29% 29% 2) live with dependents 43% 43% 3) live with peers 14% 14% 4) live with mother 14% 14% Appendix 14 continued

Question Number Item Content Users Controls

M. 46. Dropped 47. Work is very hard physica11y 48. See Users - Part III 49. Property ownership house/land 23% 29% vehicle 16% 21% 50. Number of chi1dren me an 2.6 1.8 dependents supporting - mean 2.3 2.3 Appendix 14 continued

ParL III. Users on1y Questionnaire

Question Number Item Content

U. 1. Age at first use of ganga Mean 12.8 2. Main reason for first use 1) To keep in with friends, relations 57% 2) To he1p thinking, schoo1, meditation 29% 3) Casua1 curiosity 14% 3. Reason for continuing use 1) he1ps know1edge, meditation 71% 2) enjoy the kick 14% 3) don't find it harmfu1 14% 4. Preferred method of use sp1iff & pipe 36% - pipe a10ne 42% - sp1iff qn1y 21% 5. Quantity norma11y used - mean ounces per week 6.3 median & mode/week 3.5 oz. - range .8 - 28. 6. Cost per week for ganja $4.75 7. Effect on appetite - 10se it 14% - enhanced 43% - parad xica1 7% 8. Social patterns of use - with both sexes 43% - with men on1y 57% - a10ne mainly o 9. Dup1icate of M40 10. Age a chi1d cou1d start smoking ganja 10 yrs. cou1d start drinking ganja tea 6.4 mo. Il. Have used it as a medication 86% 12. Prefer ganja to a1coho1 - unanimous 13. Dropped ! . 14. Done something unusua1 under ganja influence, e.g., violent none Many commented how it caIrns them (36%) 15. Ever used other drugs - "cocaine, acid" none 16. Does it enhance sex yes 29% Disagree, never used it that way, don't know 71% 17. Ever experienced f1ashbacks (described) none M.48 Use ganja to make heavy work easier 54%