DOCUMENT RESUME ED 054 483 CG 006 613 TITLE Rasource Book for Drug Abuse information. INSTIT TION American A_-3sociation tor Health, Physical Educatiom and Pecreation, washington, D.C.: National Sciance Teachers Association, Washington, D.C. SPONS AGENCY National Inst. of Mental Health (DHEW), Bethesda, Ni. PUB DATE Oct 69 NOTE 123p. AVAILABLE FROM superintendent of Documents, U. S. Government Printing Office, Washington, D.C. 20402 ($1.25)

EDRS P ICE MF-$0.'-)5 HC-$6.59 DESCR1 mORS *Drug Abuse; Drug Addiction; Drug Legislation; Drug Therapy; Educational Programs; *Health Education: Inservice Education; Inservice Programs; *Inservice Teacher Education; Lysergic Acid Diethylamide; Marihuana; Narcotics; *Social Problems; Student School Relationship; Student Teacher Relationship; Teacher Responsibility; Youth; *Youth Problems ABSTRACT The bulk of this book is divided into 3 major sections: (1) teaching about drugs; (2) facts about drugs; and (3) supplementary reports which deal with legal aspects, prevention, drug use-student value correlations, motivation, etc. The section concerned with teaching about drugs provides concrete suggestions for elementary and secondary educators, as well as administrators. Much of the focus is on communication with youth. Facts are presented about marihuana, amphetamines, barbiturates, LSD, and heroin. In addition, there are discUssions about drug dependence, One paper on pharmacologic therapy tor narcotic-dependent persons, and a fact sheet on tederal drug laws. Two shorter sections, which conclude the book, consider the use of films in drug abuse education and, in a somewhat ditterent vein, discuss the essential components of an inservice drug edrcation workshop. An annotated list of movies and a bibliography of selected references are included. (TL) ATTENTION This publication is undergoing revision. The new edition willinclude recently enacted Federal legislation relating to narcotics and dangerousdrugs. Meanwhile, certain sections of this book contain soon to be outdated andtherefore no longer accurate information regarding Federal penaltiesfor the possession and sale of dangerous drugs. The Comprehensive Drug Abuse Prevention and Control Act of1970, passed in October'1970, has revised the Federal laws concerning drugabuse and will serve as a model for similar laws in the States. The new Federal scheduleof penalties, effective May 1, 1970, is summarized in the following.

Marihuana Under the new Federal legislation, possessing or giving awaymarihuana is a misdemeanor instead of a felony, and minimum mandatorypenalties for such offenses are abolished. Ho wever, the penalties remain heavy.Possessing or giving away a small amount of marihuanawith no charge may bring up to 1 year im- prisonment and/or a $5,000 maximum fine. Punishment becomes more severefor a second and subsequent offenses,which are punishable by imprisonment up to 3 years and/or a maximum fine of$10,000. Heavy punishment confronts a person, at least 18 years of age, who distributes or sellsinarihuana, even for a trivial sum, to one who is under 21 years of age. For afirst offense, the penalty is imprisonment for up to .10 years and/or a $30,000 fine which goes up to 15 yearsimprisonment and a $45,000 fine for second or subsequent offenses. If a personis under 21 on a first offense, he may be placed on probation in lieu of sentencingand the official record of his arrest, trial and conviction may be erased aftersatisfactory coinple- tion of probation. Persons involved in a continuing criminal enterpriseface penal- ties of 10 years to life for the first offense, plus a $100,000fine and forfeiture of profits resulting from the enterprise. A second offense will bring20 years to life, and a $200,000 fine. Many State laws are more severe than the Federal law, dealing withmarihuana as if it were a narcotic. Stimulants These drugs are legally available only on a doctor's prescription.Under the new slation, illegal possession is punishable as follows: for a firstoffense, imprison- ment of up to 1 year and/or a maximum $5,000fine. Unlawful distribution or possession with intent to distribute may bring up to 5 years'imprisonment and/or a maximum $15,000 fine and a required2-year special parole term (except that cocaine is subject to stiffer penalties because it is legallyconsidered a narcotic). Involve- ment in a continuing criminal enterprise carries apenalty of from 10 years to life imprisonment, and a maximum $100,000 fine and forfeitureof profits from and interests in the enterprise that is in violation of the Act, if it is afirst offense. For a second 1_,r subsequent offense, penalties aredoubled. A person who is at least 18 who distributes amphetamines illegally to a person under 21 yearsof age is subject to imprisonment and/or fine twice that otherwiseauthorized. Sedatives Like the stimulant drugs, the sedative drugs are available only onprescription. The Comprehensive Drug Abuse Prevention and Control Act of1970 controls abuse of the drugs in two ways. It provides for regulating manufacture,distribution, and possession. Thus, allregistered manufacturers, processors, and their suppliers, wholesale druggists, pharmacists, hospitals, clinics, public healthagencies, and research laboratories must keep accurate records of receipts and outflow. No pre- scription for a Lontrolled drug older than 6 months can be filled, nor can refills be made more than five times in a 6-month period. There are also strong penalties for illegal possession and distribution. The new Federal law replaces old penalties for illegal possession and distribution estab- lished under previous legislation. Illegal possession is punishable as follows: for a first offense, imprisonment of up to 1 year and/or a maximum $5,000 fine. Un- lawful distribution or possession with intent to distribute a barbiturate listed in the five schedules containing drugs with the highest abuse potential may bring up to 5 years' imprisonment and/or a maximum $15,000 fine, and a required 2-year special parole term for a first offense. Involvement in a continuing cAminal enter- prise (large scale trafficking) carries a penalty of from 10 years to life imprison- ment, and a maximum $100,000 fine, and forfeiture of profits from and interests in the enterprise. For second and subsequent offenses penalties are doubled. A per- son who distributesbarbiturates illegally to someone under 21 years of age is sub- ject,ifitis afirstoffense, to imprisonment and/or fine twice that otherwise authorized. LSD For unlawful possession of LSD, under the new le: ition, an offender is sub- ject to a inaximum of 1 year in jail and/or a $5,000 tine. On a first offense for possession, a person under 21 may be placed on probation, with his conviction erased from official criminal records if he meets the requirements of the probation period. Second and subsequent offenses are punishable by 3 years imprisonment and a $10,000 maximum fine. Fo '.. unlawful distribution, and possession with intent to distribute, penalties range up to 5 years and/or a $15,000 maximum fine, with a 2-year special parole term required. For involvement in a continuing criminal enterprise, penalties for a first offense range from 10 years to life, and $100,000 fine and forfeiture of profits from violation of the Act; for a second offense, 20 years to life, and a $200,000 fine and forfeiture as above. Any person at least 18 years of age who distributes LSD to a person under 21 years of age is subject to imprisonment and/or fine twice that otherwise authorized. Narcotics Under the new Federal penalty schedules, illegal possession is punishable as follows: for a first offense, imprisonment of up to 1 year and/or a maximum $5,000 fine. Second and subsequent offenses are punishable by up to 3 years' imprison- ment and/or a maximum fine of $10,000. For unlawful distribution of narcotics in the two schedules of highly dangerous drugs, and for possession with intent to distribute, if a first offense, the penalties are imprisonment up to 15 years and/or $25,000 maximum fine, with a 3-year special parole term required. Second and subsequent commissions of this offense are punishable by imprisonment or fine twice that otherwise authorized, and a spe- cial parole term of 6 years. The penalties are somewhat lower if the drug appears in Schedules HI through V, which include drugs with less abuse potential. A person who is at least 18 and who gives a narcotic to a person under 21 years of age is subject to imprisonment for up to 30 years for a first offense and 45 years for sub- sequent offenses and/or a fine twice that otherwise authorized. Those persons in.- volved in continuing criminal enterprise face imprisonment of 10 years to life, and a $100,000 fine and forfeiture of all profits gained from the enterprise. For a second offense, penalties are set at 20 years to life, a $200,000 fine, and forfeiture of profits. National Clearinghouse for Mental Health Information

RESOURCE BOOK FOR DRUG ABUSE EDUCATION

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Heath Services ate Mental Health Administration National White of Mental Heath Chivy nut Ma/ laid MIS Printed October 1969 Reprinted January 1971

4 The Drug Abuse Education Project of which this publication is a part was performed under contract No. PH 43-68-1471 for the National Institute of Mental Health by the American Association of Health, Physical Education and Recreation, and the National Science Teachers Association of the National Education Association. Marvin R. Levy, Ed.D., was Project Director; Sanford J. Feinglass, Ph.D., Program Coordinator; A. L. Braswell, Ph.D., Science Consultant; Dallas Johnson, M.S., Coordinator of Instructional Materials; and Joseph Fiore lli, Audiovisual Specialist. Margot Davis and La Verne Holt assisted in the prepara- tion of this book and other resource materials and teaching aids emanating from the project. Robert C. Petersen, Ph.D., and Lura S. Jackson, M.S., were Project Officers for NIMH. Advisory Committee to the Project: Richard H. Blum, Ph.D., Director, Psychopharmacology Project, Institute for Study of Human Problems, Stanford University Neil L. Chart, LLB., attorney, lecturer at Boston University School of Law and Tufts University School of Medicine, Boston, Massachusetts Gerald Edwards, Ed.D., Department of Health Education, Ade lphi University, Garden City, New York erome Jaffe, M.D., Assistant Professor, Department of Psychiatry, School of Medicine, University of Chicago, and Director, Drug Abuse Program, Department of Mental Health, State of Illinois Li llard E. Law, Ph.D., Superintendent of Schools, Westfield, New Jersey Helen Nowlis, Ph.D., Professor of Psychology, University of Rochester, and Director, Drug Abuse Education Project, National Association of Student Personnel Administrators Joseph Paige, Ed.D., Urban Education Institute, Detroit, Michigan

PHS Publication No. 1964.

For sale by Um Superintendent. of Docum nts. U.S. Government Printing Office Washington, D.C.. 20402Price $1.25

5 CONTENTS

INTRODUCTION TEACHING ABOUT DRUGS 3 Background Considerations for Drug Program, by Marvin R. Levy,EcI.D. 3 Suggestions for Educators, by Robert C Petersen, Ph.D. 4 Communicating About Drugs, by Helen 'A. Nowlis, Ph.D. 8 Communicating With Youth, by Joseph F. Maloney, Ph.D. 11 The Drug DilemmaA Partial Solution, by Sidney Cohen,M.D. 14 Program Recommendations for Elementary Teachers 18 How Can We Teach Adolescents About Smoking, Drinkingand Drug Abuse, by Godfrey M. Hochbaum, Ph.D. 21 FACTS ABOUT DRUGS 25 uestions and Answers About Marihuana, LSD,Amphetamines, Barbiturates and Heroin (N1MH) 28 Drug Chart 34 What Are Narcotic Drugs? 36 Dependence on Barbiturates and Other Sedative Drugs, American Medical Association 39 Dependence on Amphetamines and Other Stimulant Drugs, American Medical Association 42 Drug Dependence: It, significance and Characteristics, Nathan B. Eddy, M.D. 45 Use, Misuse and Abuse of Amphetamine-Type Drugs, Maurice H. Seevers, M D. 51 Pharmacologic Therapy in Narcotic Dependence, Jerome H. Jaffe,M.D. 54 Tobacco (Nicotine), by Louis Goodman, M.D. and A. Gilman,Ph.D. 57 Fact Sheet on Federal Narcotic and Dangerous Drug Laws 59 Chronology of Federal Drug Laws 61 SUPPLEMENTARY REPORTS ON DRUCf; 63 Legal Aspects of Drug Abuse, by Neil L. Chayet, LL.B. 63 The Marihuana Problem: An Overview, by William H. McGlothlin, Ph.D. and Louis Jolyon West,M.D. 65 Prevention of Drug Abuse, by Stanley F. Yolles, M.D. 68 Drug Use and Student Values, by Kenneth Keniston,Ph.D. 70 Drugs and Personal Values, by Richard H. Blum, Ph.D. 75 Motivations for Student Drug Use, by Richard H.Blum, Ph.D. 79 The Myth of Alienation and Teen-Age Drug Use, by Winfield W. Salisbury, Ph.D. and Frances R. Fertig 83 Predisposition to Alcoholism, by Rev. Stanley T. Helm 87 Glue-Sniffing: A Rehabilitation Approach, by Judge Theodore Rubin and Robert C. Hanson, Ph.D. 89 DRUG FILMS 93 Suggestions on the Use of Films in Drug Education Programs, by David O. Weber and Joseph Fiore lli 93 Annotated Listing of Drug Abuse Films 95 HOW TO PLAN A DRUG ABUSE EDUCATION WORKSHOP, by Sanford J. Feing lass, Ph.D. 99 SELECTED REFERENCES 116 INTRODUCTION

The abuse of dangerous drugs is a growing prob- and NSTA. The seminars included programs for lem across the Nation. The reasons for this are teacher inservice training, presentation by authori- complex and there are no easy solutions. But it is ties on the pharmacological, legal and psychosocial clear that traditional methods of deterrence, involv- aspects of drugs, and evaluation of teaching aids, ing reliance on scare techniques or moral persua- both audiovisual and printed. sion, have not proven effective. A number of materials to assist school systems in The National Institute of Mental Health, the developing sound drug abuse prevention programs Federal agency that has major responsibility for have been prepared under the Drug Abuse Educa- research and educational efforts relating to drugs, tion Project. Some of these are included in this has initiated a broad-based public information and Resource Book. Additional aids that will also be education program to provide facts about drugs. available include guidelines to innovative teaching Among those for whom special materials are being methods in drug abuse education, and filmed lec- prepared are teachers. It is not surprising that teach- tures and presentations. who are being called upon increasingly to -do This Resource Book contains summaries of fac- something" about growing drug use, have been tual information on the major drugs of abuse, and frustrated and troubled about how to go about it. techniques and suggestions that experienced drug It is a task that demands extremely careful prepa- educators have found helpful in communicating ration and implementation. Yet most teachers have with young people who arc thinking about drugs or few resources with which to mount an effective drug have already experimented with them. An effort has abuse prevention program. Useful materials on the been macie to include papers by medical authorities subject have been scarce. Further, where programs and social scientists reflecting a range of views re- have been initiated to combat drug abuse, they have garding drugs. Literature expressing the more con- often been hampered by inadequate or inaccurate servative positions may be found at every hand, and information. Few teachers have the necessary prepa- is ready of access. Thus, materials designed to en- ration for evaluating drug-oriented materials (and hance understanding of the young by the adult a great many words have been spoken and written generation receive emphasis. Without familiarity about drugs that perpetuate myths with varied points of view, including those of the Recognizing the need for materials to help teach- young, a teacher cannot effectively discuss thedrug ers deal more effectively with drug abuse,the problem with young people. NIMH during .1968-69 conducted a project involv- It is hoped that this material will introduce teach- ing the development of teacher training workshops ers to new ways of strengthening communication and resource materials. Under contract with the with students in this area. The goal is the develop- American Association for Health, Physical Educa- ment of skills in the use of drug materialswhich tion, and Recreation and the National Science will enable teachers to open up the kind of dialogue Teachers Association of the National Education and discussion that is a prime requisite in influenc- Association, a two-week pilot work..uop on drug ing youth attitudes. abuse education was held in .Califernia. A section on planning drug abuse education Subsequently, pilot inservice training workshops workshops is included. Most educators, plagued by have been held in many States. Two-day preconven- the problem of how to teach about drugs, have tion seminars in drug abuse education were held in found that the simple expedient of reaching for an conjunction with the annual meetings of AAHPER all-purpose speaker, film or pamphlet, is not the answer. Programs and techniques capable of effec- and also create a new awareness of approaches and tively influencing young people must be attuned to methods of teaching. The guidelines on planning a the complexities and anomalies that characterize worckshop presented here represent a synthesis of today's youth scene. The inservice training work- experiences gained from the workshops conducted shop can provide essential background information, tmder the Drug Abuse Education Project. 1/TEACHING ABOUT DRUGS

BACKGROUND CONSIDERATIONS FOR DRUG PROGRAMS MARVIN R. LEVY, Ed. D., Project Director We are a drug-using society. A large segment of process training is imperative for developing com- our population looks to drugs to alleviate a host of munica tion and awareness skills. physiological, psychological and social discomforts. Parents and the community should be informed Young arid old alike are inundated with commercial of their roles in preparing young people to mature sophisms eulogizing drug products. Within this per- successfully in our culture, by programs that in- suasive cultural milieu, drug abuse is spawned. Edu- crease adult participation, understanding and sup- cation, to be effective, must first recognize the com- port. It is important that the community be con- plex historical, social and psychological setting as a vinced that the school plays but one part in the total powerful stimulus to the use and abuse of drugs. effort. The best deterrent to drug abuse is the individ- The school program for students must begin ual's value system and his assessment of the conse- early. It is no longer appropriate to conceive of quences associated with drug involvement. Decision drug abuse education as a unit or course only at making can be aided when sensitive teacher-pupil the secondary level. Concepts, attitudes and be- relationships based upon mutual understanding, havior are developing during the elementary years integrity, and honesty are established. Exaggeration, and the school cannot ignore this learning oppor- distortion, and sensationalism are propaganda, not tunity. The program should examine societal condi- education, and have no place in the school. tions that promote drug use and abuse. Drugs per se The nature of the problem is such that the school are not the issue; rather, the issue is why people use program must draw together the students, the total them. The program can include the abuse po- school staff and the community. An initial effort tentials of drugs, the meaning of drugs to the must be made with the administrators to insure that individual, pharmacological properties, and legal cogent school policies are promulgated, thereby ramifications. The intent should be upon an exam- enabling the school environment to be relevant to ination of decision-making in such a way that the each student's needs,interests, and aspirations. individual becomes more aware of the factors that School policies should support rather than punish influence his decisions. The program should en- and enlist rather than alienate. Ti.tose who develop compass the principles of group work. Central to school policies must be fully informed regarding the the success of the instructional program is the school nature of drugs, psychosocial motivations, legal con- setting which encourages an acceptance of all chil- siderations, and the content and process of their dren and an understanding of their individual communities' teacher inservice training and student needs which, when frustrated, may lead to drug instructional programs. abuse. Intensive teacher inservice programs are essential. Finally, there must be widespread commitment on In order to present an instructional program which the part of the entire school staff, parents and the does more than dispense facts, those charged with community to create an open environment where teaching need a great deal of preparation. Without boys and girls feel secure, wanted, loved, and free it, few teachers can analyze the facts and nonsense to express their innermost feelings. The school about drugs and come to decisions. Further, group should be this kind of place. SUGGESTIONS FOR EDUCATORS ROBERT C. PETERSEN, Ph.D. Chief, Center for Studies of Narcotic and Drug Abuse, National Institute of Mental Health Drug abuse is many things. It is the heroin user discussionwhich is far more likely to influence injecting his bag of H, the Methedrine user high on young attitudes and behavior than the lectures and "speed," the teen-ager smoking -pot," the 12-year- sermons that have all too often marked the crusade old sniffing model airplane glue. But it is also the against drugs. adult starting his day with an amphetamine for a needed "pick-me-up" and ending it with several Some Concrete Suggestions drinks to "unwind" and a barbiturate to put him to Avoid Panic. Teachers are in a particularly good sleep. position to encourage parents, students, and the The problem of drug abuse reaches deeply into community to remain level-headed about drug our values, aspirations, and fears. It is an emotion- abuse. ally charged area for almost all of us. Drug abuse Drug abuse, like other forms of behavior, may is a serious, growing problem here (and in many have varying causes. For some, it may represent ill- other countries as well) and teachers are increas- advised experimentation; for others it may indicate ingly being called upon to do something. They face serioupsychological problems. If a teacher has the difficuh task of deciding just what and how to reason to believe that one of his students is experi- teach about drugs. encing serious emotional difficulties, consultation Certainly no single article, pamphlet, book or should be sought with the school counselor and a film can enable teachers to be effective. There is conference arranged with the parents with a view much still to be learned about the problem of drug to obtaining professional help for the youngster. abuse and particularly about how to be more effec- Some types of behavior that may be associated with tive in discouraging it. Establishing an atmosphere serious problems include: loss of interest in school conducive to good communication between teacher and social relationships with others, marked altera- and students is of basic importance. This article tion in behavior, deterioration in physical and contains some hints that have proven helpful in personal appearance, and the development of prob- communicating with youngsters who are thinking lems in dealing with school and parents. Since the about drugs or have already experimented with reasons for drug use vary widely, so must the ap- them. It is only a very elementary introduction to proaches to individual students. ways in which teachers can strengthen relationships While the teacher can play a role in referring of trust and understanding with students in this suspected problems to the proper authorities, a highly charged area, and open up dialogue and panic reaction expressed either to the student or to 4 ii a parent can serve only to alienYte the student personal responsibility. It may also help to reduce further and to confuse what should be straight- the adolescent tendency to view drug abuse as an forward, objective, and professional action if the act of rebellion. student needs help. Because the abuse of drugs frequently carries Keep Lines of Communication Open. Encourag- with it heavy legal penalties, it is important that ing an atmosphere in which the student feels free youngstersbe aware of thepossible long-term to confide in parents and teachers and to discuss his results of their behavior. While this should not be concerns is an important first step. Obviously, the the primary emphasis, the legal and social implica- size of present classes often makes personal contact tions over a lifetime should be indicated as two of difficult. At the same time, if the student realizes the essential factors to be taken into consideration that his parents and teachers are making a genuine in any decision to use or not use drugs. Some young effort to understand his point of view, this realiza- people, feeling keenly that certain drug laws are tion is likely to help him in the process of growing unjust, advocate violating them. Thoughtful dis- up. Although it's sometimes difficult, it's important cussion of the implications of such violation and of to avoid being moralistic and judgmental in talking whether the use of drugs is sufficiently important to about drugs and drug users. them to justify such extreme measures may be Many adults, including teachers, feel uncomfort- helpful. able and defensive about discussing drugs with teen- Avoid Creating an Atmosphere of Distrust and agers. This is sometimes due to awareness of our Suspicion. Like many parents, some teachers, anx- own inconsistencies in the use of everyday substances ious to discourage drug abuse, are likely to assume like tobacco and alcohol. Nevertheless, there are that any departure from the preferred styles and good and convincing arguments against the use of customs of the majority is indicative of drug abuse. drugs which can be stated in terms that are per- Youngsters who have tried or are using drugs come suasive to youth. For example, some teen-agers in all sizes and shapes- with short as well as long see the use of drugs as one way of developing hair, and conventional clothes as well as eccentric heightened self-awareness or of enhancing their dress. So do those who don't use drugs. inner freedom. Pointing out the difficulty of achiev- By equating unconventional appearance with ing these goals if they become drug-dependent may drug abuse, we may encourage the very behavior help them realize the fallacy of this viewpoint. we're trying to avoid. At a minimum, the youngster Similarly, if young people are to improve the society islikely tofeel that the conventional world is of which they are critical, they can only do so by completely opposed to any originality or creativity emaining a part of it rather than by chemically that does not fit a common mold and that the price "copping out." of acceptance is complete conformity. While his Avoid "Scare" Techniques. Use of sensational external appearance may conform to the norm, accounts or scare techniques in trying to discourage thereis no assurance that drug abuse will not drug experimentation is usually ineffective because become his private mode of rebellion. the teen-ager's direct knowledge frequently con- Since the problem of teen-age drug abuse em- tradicts them. Teen-agers are demandingand are braces a wider range of substances than those pro- entitled tohonest and accurate answers. Given hibited by law, even an attitude of active suspicion the facts, youngsters often quickly respond. The and continuous surveillance, were that possible, apparent decline in LSD usage, for example, is would not eliminate the problem. It would, how- believed to be related to the well-publicized reports ever, almost certainly destroy the climate of trust of possible adverse psychological and potential bio- and confidence essential to the intergenerational logical hazards. communication thatisdesirable in preventing It is impossible to eliminate or legislate away all abuse. possible substances of abuse. The individual decides Avoid Drug Stereotypes. Many of us, when we for himself whether to use or not to use drugs. think about the drug misuser, immediately think To be effective, prevention ultimately must be based of some more or less vague stereotype of "the on each student's decision not to use drugs because addict." Similarly, we often tend to think of all the they are incompatible with his personal goals. misused drugs as being generally alike. Nothing Emphasizing that no authority, whether school could be further from the truth. Present evidence official or police officer, can make that ultimate suggests that the vast majority of youngsters who decision for him may help the youngster clarify his experiment with marihuana,the most popular

12 illegal drug of abuse, do so on a onetime, experi- our present difficulties with alcohol may be the mental basis. subject of profitable discussion. Another topic which Drugs differ widely in their chemical composition might stimulate good discussions among intelligent and, more important, perhaps, in their effects youngsters and their teachers is the problem of depending upon the personality of the user and the allowing a harmful drug to become popular and circumstances of use. The person who misuses drugs then subsequently making it illegal. It might also may vary from the onetime user experimenting out be productive to discuss some of the originally of curiosity to the chronic, heavy user who is psycho- unsuspected deleterious effects of drugs, such as the logically dependent on a drug. While some types birth defects resulting from use of Thalidomide. of drug misuse may be fairly apparent even to the Use Drug Education Materials as a Springboard untrained observer, other types may be so subtle to Discussion. Even good films, pamphlets, and as to escape the detection of even the expert. other materials need to be made personally relevant Although some drug users go on to the use of to students. This can usually be done best through more potent_ types of drugs, many others do not. discussion. As teachers skilled in classroom discus- just why some users become dependent on particu- sion are well 2ware, much of the art of effective lar drugs and others do notis not very clearly discussion requires that the teacher be a thoughtful understood. It may be related to personality devel- and responsive listener as well as a catalyst. opment, but physiological factors may also play a The arguments (often heated) of the student who role. While a physical dependency on the drug plays advocates use of drugs deserve a hearing and, when some role, psychological dependence appears to be appropriate, a considered rebuttal. Often a teen- more important. Physical dependence on heroin, ager's apparent conviction masks considerable un- for example, can be cured in a relatively short time; certainty aboot the worth of his arguments, which yet the heroin addict has a very difficult time avoid- are frequently offered to test their validity and/or ing using the drug again upon discharge from the honesty of the teacher. Summarily rejecting the treatment. advocate's points may alter his classroom verbal Be Well-Informed Yourself About Drugs. Much behavior but it is unlikely to change his thinking. information is available about the drug problem The most probable result of an arbitrary "put some of it accurate and useful. But unfortunately down- will be to convince the youngster that adult much of what is published tends to be overdrama- objections to drug use are merely prejudices. tized and frequently inaccurate. A student-run discussion on prevention of drug Much of the controversy over the effects of mari- abuse may be even more effective. Teen-agers are huana and its control, for example, results from frequently far more responsive to the mores and overinterpretation or misinterpretation of what values of their own group than they are to the little data are presently available. Drug-use advo- values of the adult world. Former drug abusers cates frequently use the scarcity of scientifically can often be highly effective in communicating with reliable information as a basis for arguing that a student groupthey can "tell it like it is!" marihuana and other drugs are harmless. The ab- Use by teachers and parents of alcohol and sence of complete agreement based on reliable tobacco is of more than casual interest to teen-agers evidence that a substance is harmful does not, of all too often this is the thrust of their argument course, demonstrate its harmlessness. Often, rela- in favor of marihuana. In addition, the problem tively long-term use of a substance is required before of compulsive overeating may be discussed as similar its public health implications are apparent. Ciga- to drug dependence. Habits, such as smoking and rette smoking provides an obvious and apt example. While American experience with marihuana is of drinking and even compulsive overeating, can read- relatively short duration, foreign research studies, ily serve to illustrate the highly persistent nature of though often difficult to interpret, suggest that habitual behavior despite strong rational grounds long-term use of marihuana may be detrimental for change. to the health of the users. As adults we can also serve to demonstrate that A discussion of the implications of various social it is possible to live an involved, truly meaningful policies regarding marihuana and puh:ic health is life without the use of chemical substances to add one approach that may enable you to reach your meaning or excitement. The adult who is himself students. The social problems of adding another "turned on" by life without recourse to drugs is intoxicant of unknown long-range implications to one of the best advertisements for that type of life.

6 13 Alternatives to Drug Use The teen-ager who is unable to find his place in Youngsters who find satisfaction in other activities some orthodox group sometimes turns to drug use are less likely to find regular use of drugs appealing. as a means of finding a kind of group acceptance. Aware of this, the teacher may open up for mdi- The student who is isolated from others or having vidual or classroom discussion ways in which stu- more than the usual difficulties in gaining accept- dents are or can become involved in activities that ance will sometimes respond very well te a special have personal meaning for them. interest shown by one of his teachers. Even whc-a Many young people, while attempting to appear the teacher is unable to solve a problem, he may blase or uninvolved, reel keenly the problems of our serve as a necessary bridge in helping the student contemporary world, and opportunities for active get assistance from some specialized professional involvement, such as work with a political party, source. Particularly for the student with a poor or a program for slum children, might be encour- home situation, a sympathetic teacher can provide aged. While a strong interest in other activities may a model of an understanding adult who has no need not deter a student from experimenting with drugs, to escape into a state of drugged unreality. he is less likely to adopt habitual drug use if he Wherever possible, discussions of drug abuse feels -turned on- by shared and constructive human should be integrated into the general curriculum experiences. rathe: than limited to a specific drug abuse unit or Adolescence is a lonely time for many youngsters. lecture.

14 7 COMMUNICATING ABOUT DRUGS HELEN H. Nowtas, Pif.D., Professor of Psychology, Universityof Rochester

The area of the use and abuse of drugs is a good tive perceptions with a different set of attitudes and example of the role of biases, even among profes- beliefs as a screen. One of the complicating factors sionals. Specialists in each area look at the total is that adult patterns, having persisted for a longer problem and see it primarily from the perspective time, tend to be more elaborate and more firmly of their own theoretical background, major involve- held than those of college students. ment and experience. Thus the medically traintd I would liketo suggest that we talk about see in bold relief the medical aspects of the problem. "marihuana," "LSD," -barbi tura Les,""ampheta. But even within this one point of view, there are mines," "alcohol" and avoid such awkward general differences in emphasis depending on whether one's categories as "narcotic," "drug" or "medicine." Such special interest is research or clinical practice, psy- categories are laden with such a variety of atti- chiatry, psychopharmacology or public health. The tudinal excess baggage that clear communication same can be said about the many other specialists and discussion are virtually impossible. who get into the act: the psychologists, sociologists, The second attitudinal problem which makes anthropologists, enforcement agents, social workers, clear thinking and communication difficult when we ministers and journalists. Each one tends to ask are considering complex issues arises from our tend- different questions and to seek answers in different ency to think in terms of opposing categories, a ways. It reminds one of the proverbial blind men tendency which Charles Osgood calls psychologic. and the elqihant. For example, we tend to label things and people It is no wonder, then, that the layman, the legis- as good or bad. In the process, we may apply the lator, the college administrator, the college student, label to the thing on the basis of what itis not faced with a multitude of points of view, resorts radier than what it is. to selective perception, and chooses that position In the interest of good communication, let us which does the least violence to his own established check some of our excess baggage and not talk about pattern of attitudes and beliefs. But a position "good drugs" and "bad drugs," "safe drugs" and arrived at in this way only leads to further problems "dangerous drugs," even "drug effects." It would be when it must be defended or acted upon in the face difficult to find a single drug which is not potentially of questions or objections from other people who dangerous for some people, under some circum- have arrived at other positions through their selec- stances, at some dose level. A reaction to any drug Based on remarks made at National Association of Student is basically the result of the interaction between Personnel Administrators Drug Education Conference, Wash- an ingested or injected chemical and a physically ington, D.C., November 1966. and psychologically complex individual. Itisa 8 15 function of dose, of pattern and length of use of the the student to make his own decision. On the other drug, of the physiological and psychological condi- hand, if we have already decided what students tion of the individual, of the situation or circum- should do and we feel that the risks in letting them stances under which it is taken, of who administers make their own decisions are too great, we may it, of the expectations of the person who administers selectively use information to explain or justify our it as well as of the person who takes it. In some position. Either approach is defensible and each instances, with the proper circumstances and ex- presents its own problems, but all concerned should pectations, placebosnormal saline solutions, sugar be av ire of which position is being taken. We run or lactose pills -may relieve post-operative pain, into all kinds of problems if we waver from one produce hallucinations, do most anything that a to the other or appear to be operating under one dr ug might do. approach when we are really operating under the One other fact that we should note here is what other. You cannot say, as so many parents do: is .3enerally referred to as "side effects." Virtually "You decideas long as you decide my way." In the every drug has other effects, sometimes harmless, area of the use and abuse of drugs by college stu- sometimes annoying, sometimes harmful. dents, either position presents complex problems. While we are considering terms which should be Second,the communicator must have clearly defined if we are to think and communicate effec- thought through the issues in his own mind. It is tively, we should clarify the terms drug use and probably wise to clearly separate the question of drug user. Much of the confusion that exists in the the dangers or abuse of individual drugs, both reporting and interpreting of statistics and in jour- physical and psychological, from the question of nalistic generalizations has arisen because of lack legality. When a presentation of the untoward of definition of these terms. A large number of the effects of a drug, even the potential untoward so-called drug users have merely used drugs on one effects, is designed to support the illegal status of or a few occasions. In contrast to these there does the drug, battle lines are di-awn on the basis of exist a group for which I would prefer to reserve individual rights vs. arbitrary authority and inva- the term user. Students make a clear distinction sion of privacy, and none of the relevant issues is between those who briefly experiment with a drug open to rational, unemotional consideration. and those for whom use of the drug has at least Third, effective communication has been shown temporarily become an important factor in their to be a function of the prestige of, respect for and lives. The latter they call "heads""pot heads" credibility of the communicator. It has been demon- (marijuana), "acid heads" (LSD), etc. The danger strated that attempts at persuasion based on a high in not distinguishing between the casual experi- fear appealaregenerallyineffective and may menter and the 'head' is that it can lead us to boomerang, especially with subjects of high intel- erroneous generalizations and assumptions both ligence. This type of appeal almost invariably casts about the students and the drugs. Drug user is also doubt on the credibility and motivations of the one of the terms that carries heavy excess baggage. commonicator. An audience which becomes con- As a social psychologist, I would like to talk about cerned with testing credibility will be distracted the dynamics of communication in any educational from the real issues presented in the communication. process. As Lasswell suggested years ago, there are The final factor that should be mentioned with at least three important factors, none of which is respect to the communicator is the fact that if an simple and none of which can be neglected: "Who audience has some knowledge about or attitudes says What to Whom?" toward an issue, all sides of an argument should be It is most important that the communicator be fairly presented. This does not necessarily mean aware of the dynamics of his role, that he be that there should be dramatic confrontation be- eq-uipped with the best current information and tween diametric opposites. It does mean that, as a resources in the area of drug usage and drug effects, minimum, the evidence for opposing views should and that he understand the variety of differences in be fairly presented. Neither does this mean that motivational and attitudinal status of his students. the communicator should not present his own con- First,itis most important for communicators sidered view together with the reasons for it. In about drug use to have made a sincere assessment fact, one of the necessary functions of a teacher of their own goals and motivations. We may define or an administrator is to draw conclusions, take a the issues and present the best and most objective stand, but it should be clear that this stand is taken information as frankly as we can and then trust after careful consideration of all points of view. The second term in our model, the What, needs that some of them turn to drugs in seeking indi- little further comment at this time. I hope I have vidual solutions to or in avoiding problems with kit you with the impression that we have rio nice which our complex society confronts them. Growing neat package to present. In the absence of facts, out of the civil rights and anti-Vietnam involve- there is no need to pretend that we know. We can ments, there are an increasing number who are present hypotheses, trends, hunches as long they are essentially anti-legalistic and feel that any law which labeled as such and presented as tentative, awaiting is stupid or "immoral" should not be obeyed. In the data which will support or refute them. majority of these students thereis more of an The nature of the listener, the Whom in our intellectual commitment than a commitment to model, is a crical factor. A good speaker always action, but they are forced by their position to likes to know something about the type of audience support the right of others to take drugs even he is confronting. So, too, we shoukl keep in mind though they choose not to seek or accept thc oppor- some of the salient characteristics of current stu- tunity themselves, primarily because they have other dents. But here again we must not categorize too strong values and motivations with which drug- generally. There is really no such thing as a typical taking is not consistent. student. Students vary on many parameters. The There is no one answer as to why students are student's decision to use or not to use drugs will interested in and take drugs, particularly the hallu- be based on a variety of motivations and expectan- cinogens. Among those usually listed are curiosity, cies and will differ from individual to individual rebellion, the desire to improve social relations, and group to group. However, there are some to find meaning in life, to be reborn, to experience general characteristics which apply to many students the cosmic, to expand consciousness. It is not pro- in many institutions. Most of them are intelligent, ductive to deny the feelings and moti,.Lions to critical, and quick to question and to detect hy- which these drugs appeal. They exist. . re there pocrisy. These young people have been brought up other ways, legal and less dangerous, to ret,nd to in an age of the pill. Drugs are widely accepted them? Is this not one of the challenges to ech ion as the cure for all ills. It should not be surprising and educators?

I0 17 COMMUNICATION WITH YOUTH josugi F. MALONEY, PH.D., Director, Urban Studies Center, University of Louisville,Louisville, Kentucky Attention, frustration and deep discontent with become exhausted through our efforts to acquire contemporary living patterns are a widespread char- these physical powers, or so "programmed" in pur- acteristic of our times, not of one generation. suit of wealth and a secure freedom from poverty But the discontented young arc quicker than that we have lost sight of our objectives, of our their elders to disown established patterns that offer underlying values. no spiritual food. They are quicker becausethey It's our generation that is hung up on manners are less rooted in the past. and appearancesbecause we have had to struggle Essentially, the young we tend to worry the most to obtain an economic and social statusa sense about are the rebelsthe ones who reject not just of social security. Our self-doubts are what account our life styles, but usus either as hypocrites or for our use of drugs in the form of sedativesin clods. Perhaps they are more conscious of our basic alcoholand in tobacco, which we know are dan- valuesour spiritual principlesthan we are. They gerous and damaging to our health. are sensitive to the seeming contradiction between And we are hung up on race and sexnot the what we preach and what we actually do, how we young. They are less concerned or troubledabout actually live. sex than we. They rightly think us stupid forhaving Last year the Urban Studies Center conducted a done so badly in racial matters. rather extensive study of the so-called generation How many of us ever have two ounces of whiskey gap, with surprisingly broad and intensive coopera- within two hours of driving a car? Was the Kinsey tion from the young adults themselves. The findings Report about our, or today's, young generation? reveal a rejection of our life patterns by the young It's becoming common now to talk about a gen- as being shallow, hypocritical and irrelevant to truly eration gap as a communication gap. I suggest that basic values. the communication gap is mostly one-sided_ I sug- Our generationand the one before ours that gest the young understand us better than we under- shaped our attitudeshas been successfully pre- stand thembetter than they communicate to us. occupied in producing wealth and in making stag- They tune us in and understand our language, but gering progress in the advancement of the physical we do not necessarily understand the words they sciences and mechanical arts. Presumably we did so use or the patterns with which they use words. to acquire the means to better carry ont our under- More, they communicate in a style that we reject as lying spiritual values. But to the young we have outrageous, thoughtlessly rejecting their thoughts Outline of talc made at a pilot workshop of The Drug because they are not presented to us in our style. Abuse Education Project held in Louisville January 1969. Borrow the best of the Beatles' LPsSgt. Pepper's

11 414-854 a - 71 - 2 Lonely Hearts Club Band. Listen toit carefully, tiesand they are right. In formal logic, the weakest but only after you have andied the words, which argument is one based on authority. Our progress arc printed on the album. "She's Leaving Home," in science and technology and the contemporary "Within You, Without You," and "I Get By With corm idiction between alleged principles and action A Little Help From My Friends" showaid our all should lead tile young to question our be- children understandquite an insight into our havior pattern as the ideal model, As teachers, we problems. are successes not in proportion to the conformity They are not politicians, in that they are incapa- of our students to our habits of dress, groomingor ble of inventing and working diligently for a new social action. 1.t, die r, we should assist them in ques- system. They reject witl'out being able to design tioning our behavior in the light of our funda- a well-thought-out substitute. They are not phi- mental principles. Some adults are quite good at losophers because they cannot synthesize a compre- presenting the two different. points of view, This hensive and systematic approach to life. They cer- "translation" was done magnificently in '"f he Grad- tainly don't talk like the politicians we are used to, uate," a high-grossing, but quite subtle movieone and they don't produce logical arguments or rhet- the young understand very well indeed. oric like our honored prose literature, Drugs are a form through which the young can But they are poetical. They do have sharp insights escapefrom us. Let us help the young in their into truth, which they do express very imaginatively searches for a better way to live in accord with our and suggestively, rather than precisely. We made principles. Let us give them love and understanding them poets. We subjected them to the TV, radios with a hope, and a prayer, and a request directed and radio media as the message that has molded at them as well as heaven. Let them do better than their patterns of perception and intellection, The we have done in developing a life that adheres to Saturday morning TV cartoons have exposed them basic spiritual values. If we love them let us love to more mind-expanding fairy talestalking ani- them foe themselvesnot as mirror images of what mals and heroes seen as suchthan we were exposed we think we are. We drive a few to drugs, more to. Bozo the Clown has had more influence on them to despair and fundamental frustration and dis- than our grandparents and parents had time to content. All of them need more of ourselves and read to us. Because we must have a commercial less of our manners. every six minutes or less on TV and every three It's paradoxical, Our use of alcohol, drugs and minutes on the radio, they are accustomed to short, even tobacco are all forms of escape through seda- explosive communications. And the commercials tion. We worry about the young and their use of themselves, the most expensive and professional drugs, which are used for "mind-expansion." We communication form we have devisedare no more can help steer them from their drugs if we stop liv- than 60 seconds. They see fastthey have been ing as if we preferred sedation, We must wake up trained that way before they get to school. They see and live in today's changing world instead of trying things in extremesthe commercial is punchy, and to sleep in the pasteven the immediate past. the interval between commercials is too short to Youth will seek life, Let them find us among the develop complicated arguments or to distinguish living, Thenand only thencan we share life shades of gray. together. They understand our language stylebut reject Presented below, as examples of modern songs, it.Rhetoric is boring. Distinctions are evasions. are some from the Beatles "Sgt. Peppers Lonely We take too long to say littleand much of what Hearts Club Band": we say is trivial. Look at the tremendous intellectual and spiritual "She's Leaving Home" problems teachers must w:.estle with. Ladies may Wednesday morning at five o'clock as the day begins wear evening pants and party pajamas to presi- Silently closing her bedroom door dential inaugural ballsbut they are too risque for Leaving the note that she hoped would say more high schools. If a faculty prohibits slacks for girls She goes downstairx, to the kitchen they will merely confirm the not altogetherun- clutching her handkerchief founded student opinion that the faculty is from Quietly turning the backdoor key another world, a world of the past Stepping outside she is free a past irrelevant She (We gave her most of our lives) to modern life. is leaving (Sacrificed most of our lives) The studentsthe youngreject us as authori- home (We gave her everything money could buy)

12 _rd She's leaving home after living alone And the peoplewho hid themselves For so many years. Bye, Bye behind a wall of illusion Father snores as his wife gets into her never glimpse the truththen it's far dressing gown too latewhen they pass away. Picks up tile letter that's lying there We were talkingabout the love we all Standing alone at the top of the stairs could sharewhen we find it She breaks down and cries to her husband To try our best to hold it therewith Daddy our baby's gone. our love Why would she treat us so thoughtlessly With our lovewe could save the world Flow could she do this to me. if they only knew. She (We never thought of ourselves) Try to realise it's all within yourself is leaving (Never a thought for ourselves) no-one else can make you change home (We struggled hard all our lives to get by) And to see you're really only very small, She's leaving home after living alone and life flows on within you and without For so many years. Bye, Bye you. Friday morning at nine o'clock she is far away We were talkingabout the love that's Waiting to keep the appointment she gone so cold and the people made Who gain the world and lose their soul Meeting a man from the motor trade. they don't knowthey can't see are She (What did we do that was wrong) you one of them? is having (We didn't know it was wrong) When you've seen beyond yourself fun (Fun is the one thing that money can't buy) then you may find peace of mind is Something inside that was always denied waiting there For so many years. Bye, Bye. And the time will come when you see She's leaving home Bye, Bye. we're all one, and life flows on within you and without you, "Within You, Without You" Gan. RUE HA-ISO N We were talkingabout the space Courtesy of Capitol Records, Inc. and Electric & Musical between us all Industries, Ltd.

13 THE DRUG DILEMMA: A PARTIAL SOLUTION SIDNEY COHEN, M.D., Director, Div sion of Narcotic Addiction and Drug Abuse, National Institute of Mental Health The Parents and coping should not be denied any growing One of the great myths of the day is that if a child creature. When help is needed, the parent-child goes wrong, becomes a drughead, for example, this relationship ought to be so open and trusting that must be due to parental failure. If the cause is not it is used for assistance, information, and advice. deprivation or neglect, it must be overprotection or This is just as true for the issue of drug taking as possessiveness. At times it appears that the line for every other problem. Naturally, it would be between insufficient mothering and maternal smoth. best if drug usage could be discussed before the ering is nonexistent. This peculiar notion stems event, but the youngster should feel capable of from the strong lay and professional indoctrination talking about it afterward without fear of excessive with the Freudian tenet that what happens in emotionality or rejection. An open attitude need infancy determines subsequent behavior. not mean acceptance of an act which the parent Unquestionably, substantial numbers of children considers harmful. Approval is withheld, but con- are maltreated, abused, overcontrolled, or spoiled. demnation should not be on an irradonal basis. This does not mean that they are completely Sufficient data are at hand to point out quietly the incapable of overcoming these childhood handicaps. personal, legal, and social hazards. Most often a The individual has some responsibility in such single experience with drugs represents nothing matters. In addition, a large group of quite well- more than the exploratory behavior of youth. If brought-up, characterologically sound children are drug taking becomes habitual, it usually represents turned on to drugs by their associates. It is difficult either a gratification which the young person should to discern how a parent can be blamed for these have been able to derive from daily living or an events_ evasion of life experience due to inability or un- Somewhere between don't care" and overpro- willingness to meet life's day-to-day rebuffs. tection is the parental attitude which best permits Those most attracted to drugs are those who are the child to develop and grow up. He grows by bored, cannot enjoy, or cannot tolerate stress and solving problems, by learning from failure and frustration. The drug fits their emotional discontent defeat as well as from success and reward. This and removes the necessity to plan, to struggle, to opportunity to become resilient by encountering endure. From The D-ug Dilemma by Sidney Cohen, M.D., Copy- The parent who drinks to excess will have an right 1969 by McGraw-Hi11 Ine. Used by permission of impossible task in persuading his son or daughter MeGraw-Hill Book Company. to desist from drug usage. It is true that his act

14 is legal and his child'sis not. Nevertheless, the convincing statement that can be made is your legality of alcoholic intoxication is not a strong way of living. Striving for security, so important argument to a childor anyone else. Harsh and in Limes of hardship and poverty, is an inadequate punitive attitudes makes some children compliant, goal during periods of relative affluence. Those of but many others rebel and become more involved our middle-class children who do not need to strug- in dr.:.gs as an act of defiance. Making obviously gle to obtain food and shelter find such an out- untrue statements about drugs is worse than useless. moded aspiration unacceptable. It is a feeling of Tlw child will tune out those who are patently existentialmeaninglessness whichattracts some trying to frighten him into desisting. people to the drug state. The acquisition of a sense A difficult sit nation occurs when the young person of meaningfulness is the antidote. is part of a group of drug users. Its members rein- Sometimes a young dropout wants to drop back force each other's drug taking. They become au- in after a year or two of the hippie game. The family thorities and can outtalk parents. They may go on relationship ought not to be so embittered that he for some Lime before anything untoward happens. cannot ask for help to find his way back. A line of in such an instance a parent can hardly expect communication should be available to him. his child to abstain unless their relationship has been an unusually good one. What is more likely T he School is that a critical moment will arise when the parent It seems reasonable to insist that usage or traffick- can step in and effectively help his child to stop ing of any illegal drug not be permitted on school using drugs. This moment occurs when someone grounds. Furthermore, psychological dependence in the group is hurt, arrested, or decides to break upon mind-altering psychedelics, stimulants, seda- away from the drug scene for philosophic or per- tives, and intoxicants is contrary to the goals of the sonal reasons. educative process, whether excessive use be on or off The parent has a final responsibility which he campus. If a place of learning is where one's intelli- cannot delegate to the school, the court, or the gence, capabilities, and skills are developed and psychotherapist. However, he may have such feel- enhanced, then habitual displacement of conscious- ings of guilt (sometimes unjustified) when his child ness, reality testing, and reasoning ability is anti- becomes a "head" that he continues to support his thetical to its goals. The frequent use of any drug offspring's deviant way of life. The parent is not can result in impaired performance. Indeed, a single necessarily guilty for a young. t.?.r's character deficit. use of some classes of drugs is associated with a Other people and circumstances have had powerful temporary decrement in psychomotor functioning. impacts on his character formation, too. It does not Of all drug users, only those who indulge in the seem logical to underwrite an undesirable drug psychedelics claim consciousness expansion. From habit. Rather, the attitude should be, I love you and the observations of many who have studied this I will help you, but I won't support you if you issue and from the reports of many who have gone persist in behavior which I believe to be detrimental the psychedelic route for years, chemical conscious- to you. ness expansion is, in the main, a myth. The so-called Should a parent ever report a child's illegal be- revelations and enlightenments are all too often havior to the police or commit him for mental illusory. hospitalization? This question can only be answered If the educator is to learn anything from the on a highly individual basis. If the youngster is current striving for drug-induced perceptual, emo- involved with physically addictive drugs and will tional, and cognitive changes, it is that important not voluntarily seek help, it may become necessary areas of human experience have been neglected by to take over the decision-making responsibility. If our child-rearing and child-teaching practices. Many one's offspring has become a pusher, it may be of those attracted to the drug experience suffer from justifiable to notify the authorities. Certainly, if he anhedonistn, the inability to derive pleasure from has broken with reality and has no insight into his ordinary existence, and alienation, the inability to condition, commitment to a hospital may be the find a meaning within or outside oneself. These are only proper step. Much depends upon his age; if he serious deficits, and in a young person they lead to is a minor, the parental responsibility is greater. serious disorders of behavior or character. From Most of the arguments which youngsters use to childhood through adolescence we are failing (1) to justify their bedrugged episodes are specious. Others provide goals appropriate to our times, (2) to train are partially true, and a few are valid. The most the emotions and the senses, and (3) to set limits.

15 22 Therefore, goallessness, an inability to enjoy, and warned about the teacher's duties in the matter. an attenuated sense of social responsibility predis- It iF to he hoped that it will be possible to listen pose to Chemical escape, chemical hedonism, and the without disclosing, but school regulations may pre- search for chemical enlightenment. vent this. Under such circumstances the student The teacher, in addition to making the educative must be clearly told beforehand. A certified school process as interesting, constructive, and alive as psychologist or psychiatrist has the advantage of possible, can also have a great influence on the being able to keep patients' statements as privileged decision to take or continue to take drugs. He is communications. Referral to such a person will safe- often the confidant when parents are lacking or guard the student. have failed to accept their role. The teacher may be A icpertoire of disciplinary measures with some the first to learn of, or notice, aberrant behavior due built-in flexibility is preferable to rigid, mandatory to drugs. He may be able to persuade his pupil by punishments. The campus supplier of LSD and presenting factual information. Methedrme isnot in the same category as the In schools where the administration believes that youngster who has been persuaded to try a "reefer" no drug activity is present, there may be reluctance and whose negligence has resulted in his detection. to rock the boat by opening up the subject. The Strangely enough, the penalties for both offenses likelihood, though, isthat more drug activity is are equalthey are felonies. Unfortunately, school going on than comes to the awareness of the authori- authorities may have no choice in the matter. They ties. The teacher, as a more neutral person than the are often required to report every breach of dis- parent, can counsel or refer the student to a coun- cipline. It may be well to make students aware that selor. A school counselor may form a group of a felony involves lifelong consequences beyond students involved in drugs. One or more students incarceration. This should not be done as a threat, who have passed through their drug honeymoon but rather as part of setting forth the realistic here- and have come back are very helpful in such and-now risks connected with the misuse of certain si tua Lions. drugs. One element that must be emphasized in all discussions about drugs is that their use is stupid, The Therapist not smart or "in." The regular user even of nonad- All too often the psychotherapist is faced with a dictive drugs is in a state of maturation arrest. The young patient who does not want to be treated, but drug solves his problem; he does not learn to solve who has been forced into the office by anxious problems and endure dissonance in his environ- parents. Little can be done if the patient is not ment. Many drugs leave the student goofy, unable motivated to change. All too often he is at a phase to function. This is hardly a groovy way to exist. of his drug-taking cycle when he is deriving satis- Those drugs which are supposed to expand one's faction, euphoria and release of tension from the consciousness all too often fail to do so, especially chemical he is using. He is feeling no pain; what if one is young and unprepared. more can therapeutic intervention offer? If it hap- The growing brain is more vulnerable to all pens to be one of the psychedelics, he has a feeling chemical agents, and temporary, perhaps even sus- of subjective wisdom far beyond that of the theta- tained harm can result. Permanent harm to the pist. He has a pseudo-philosophic jargon which can brain cells after exposure to large amounts of psy- put many a therapist down. If, somehow, the patient chedelics is a possibility that is now undergoing cannot be motivated to examine himself and his intense study. reasons for overusing drugs, little can be accom- It is in peer groups that drug-taking spreads. The plished. The patient is unlikely to remain in treat- teacher may become aware that one or a few indi- ment, and it is the parents who should be counselled viduals are proselytizing. An epidemic may be about their attitudes at this point. prevented by quick action in such instances. School Sooner or later, after a few bad trips, a psychotic authorities should make the school area a difficult break or disillusion with the drug way of life, the place to obtain or use drugs. It is too much to patient will want out. Perhaps it is merely that he expect that school authorities can be responsible sees the circular, pointless nature of his existence. for activities off the campus. At this moment the skilled therapist who knows The question of confidentiality rarely comes up, something about the nature of the psychedelic but it may. If a student approaches a teacher as a experience can perform a valuable service. It is not friend to discuss his drug problem, he must be a matter of starting anew; the drug experience of the

16 23 past months or years must ba carefully examined able with penalties greater than LSD at this time. to learn as much as possible from it. Thus a bridge Consideration ought to he given to proposals to is built that leads the patient back into an enjoy- place marijuana on the dangerous drug list rather ment of this world and a living of this life in the than under the Narcotics Act as at present. best possible manner. These are the most difficult The mere passage of laws, of course, as a device of patients for they were engulfed in the psyche- to eliminate noxious behavior,isan ineffective delic life because of their unfulfilled needs. They technique. The hope that a decree will abolish have tasted great gratifications in their responsi- undesirable conduct in a democratic society is just bility-free, hedonistic existence. Now the therapist as naive as the expectation that a chemical potion must help them become more responsible, find more will magically change characer. What is needed in significant goals and begin the long hard process of addition to sagacious laws, is public education and psychological maturation. The immaturity which publiccooperationwith the laws. Somehow these caused them to seek the magic pill must be modified. must also be obtained. These are valuable people, often very bright, and with many contributions that they can make. After Puncture of a My th a period of individual therapy a psychotherapeutic A scrutiny of the past suggests that the abuse of group may be at a place where they can find the novel mind-a/tering drugs tends to be cyclic, with a values of the human interaction. rise and a fall which is not clearly perceived except The Legislator from a distance. The preposition that we have experienced periodic surges and declines in drug- The control of the drugs mentioned in this book taking behavior before is no plea for complacency. is necessary, especially for the juvenile. Passing laws An :live effort to teach the individual and society can have a beneficial or a harmful effect depending upon the wisdom of the legislation. With the cur- how to enjoy and endure without euphoriants and rent upsurge of drug misuse especially in those of escapants is essential. Setting the drug-abuse prob- school age, it would seem reasonable to apprehend lem into a historical perspective simply avoids the the supplier of these minors rather than to focus myth that things were never as bad as now. This on catching the juvenile user or possessor. The myth happens to be prevalent among the drug maker, the smuggler, the pusher and the transporter subculture. It betrays a profound and potentially must be found and punished. The penalties for use disastrous ignorance of the history of man. and possession of a drug like marijuana are ex- Cyclic Psychedelics by Dr. Cohen, American Journal of cessive. Marijuana, a weak hallucinogen, is punish- Psychiatry, September 1968.

24 17 PROGRAM RECOMMENDATIONS FORELEMENTARY TEACHERS Recommended by a Team of Kindergarten through is fact and what is non-fact in the drug area. Third-Ginde Educators in Marin County, California For example, they should be aware that: June, 1968 a. The long-range physica, -;nd mental effects of marijuana are not fully understood, al- Introduction though widely varying assertions are made offering extreme points of view. Education that will prepare a child to avoid drug b. Use of illegal drugs is reported by law abuse ina. drug-using culture must begin at an enforcement representativestobe moving early age. It will need to include both process and from ghettos to increasing incidence in affluent content in order to counteract potential drives to societies. drug abuse as well as youthful ignorance about c. Dangerous drug use is the principal reason drugs and their potential effects. for 25% of the arrests of children under fif- Intensive teacher education is essential if teachers teen. It accounts for 16% of the arrests of are to respond to children's questions with certainty those eighteen and older. and assurance, avoiding the exaggeration, distortion 2. CoursesAlthough primary teachers have lim- and sensationalism that nullifies effectiveness of ited occasions to impart specific drug informa- educational efforts. tion to their students, the need seems to be The best deterrent to drug abuse is thought to be increasing. It is therefore recommended that an individual's own value system and his assessment primary teachers take courses in drug infor- of what physical damage might result from drug mation. use. There are a variety of ways to present informa- 3.Reading Teachers are encoUraged to consult tion and instruction in these areas, and the sugges- and keep up with the books and other litera- tions herein are not intended to be exhaustive but ture published concerning drug abuse. While merely to indicate the scope of the subject and to reliable information about drugs currently suggest approaches and a point of view. Teachers used by youth is a little difficult to obtain and will build upon the ideas presented here, applying evaluate, educators must strive to keep abreast their own versatility to them'. of the constantly changing drug scene. 4. AttitudeAbuse of drugs frequently stems Teacher Education from feelings of inability to communicate, to Teachers'informationconcerningdangerous be an integral part of the world. Real personal drugs should include the following: honesty, self-awareness and comfort with emo- 1. FactsTeachers should be informed on what tions are essential to effective communication.

18 Becoming moreprevalentareworkshops development of the whole child through such pre- which lead toward these communication skills. cepts as the following: They are variously called "encounter groups," I.Avoid producing guilt, which acts to reduce 'awareness groups,' or 'sensitivitytraining.' one's sense of personal worth. Encourage free Their purpose is a deep, continuous experi- verbal expres...ion of any emotion. ence with communication. A beginning to the 2. 'Accept emotion. Emotions are real and com- development of communication abilities can pelling. Suggesting alternate ways of handling be obtained through the hook, Between Parent crisis situations is preferable to suppression or and Child, by Haim Ginott. repression of vividly experienced feelings. Dis- Oftentimes the most important and best-remem- cussion of such feelings is advantageous. bered teaching is that which occurs incidentally. 3. Know the child. Efforts made to become per- perhaps involuntarily. In the area of drugs, teachers sonally acquainted with the child will be in- need to be prepared to respond correctly and with valuable. Acquaintance with the parents of naturalness to frequently impromptu questioning. each child helps in this understanding. It is While specific teaching on the drugs most fre- worth keeping in mind that older children quently abused is likely to occur in the primary have complained repeatedly and bitterly that grades only in response to children's specific ques- they experienced a loss of individuality in tions, the teacher needs a good background in the their school experience. intelligent and wise approach to drugs. With it he 4.Encourage choices. The act of making deci- can prepare children to face and absorb the variety sions is something in which children could use of information that will reach them later on. much more practice than they get; opportuni- The approach to teaching about drugs should be ties for affording this are infinite. For example, in terms of understanding of and respect for sub- "Do you want the blue paper or the red stances, not in a scare context. Poison prevention paper?- or -Do you want to do this problem is taught in the primary grades as well as later. or that one?," etc. Such activity is important in Again, without applying scare tactics but by dealing the development of a feeling of individual in facts, a teacher might discuss such things as the worth. overdose of a commonly available substance such 5.Be self-aware. Awareness and acceptance of as aspirin. Actual experiences can be used to explain one's own temperament and style sets a val. the functions of substances. uable example to children.Itis no more Whenever medications are discussed, proper use desirable for the teacher to be depersonalized and the need for direction from a physician in using than for the child. By being himself, the them should be explained. In a context of discussing teacher sets an exampleteaches by precept home safety,the teacher might discuss reasons a great lesson in self-acceptance. medicines should not be left out and available. 6. Know your rights. It is a corollary to #5 to Similarly, class discussion can include the need teach by precept that one can demand one's for ventilation when using glue. own rights in situations. The child cannot take all the teacher's attention, nor all of the Teaching Strategies Relating to Drug Education teacher's time, nor does he really want it though he may try to get it. A teacher will Certain personality characteristics have been ob- help the child by assisting him in finding served in young people who have ahused drugs. limits in his demands on the teacher's time These individuals have generally been described as well as by setting limits on behavior. as showing or having shown problems in communi- 7.Imaginary adventures and excursions. Such cation, passivity and low frustration tolerance, lag activity is useful in developing inner resources in social development, qualities of emptiness and as well as helping children to distinguish be- apathy, to be isolates, poor relationships with peers, tween objective and subjective reality. Such and to be exploitive of adults, impoverished in inner activities (which may be based on actual ex- resources, and desirous of outside stimulation. Fur- perience, musical experience, a picture, etc.) ther, it has been noted repeatedly that the recurring should not be confined only to kindergarten, cry from children is adult failure to accord them but should be enjoyed throughout the primary dignity and to be honest with them. Accordingly, grades. optimum teaching strategies should aim to foster 8.Perceptionbroadly and intensively consid-

19 ered, multi-sensory. Increasing work is being child's development of his own individualism. done in visual perception, but this can be 1 I.Apjreciation of learning. Review with a child greatly expanded and enriched. Experiences in of the things he has learned and of their perceiving and reporting what is seen, heard, possible usefulness or relevance to hislife tasted, smelled or touched and kinesthetic helps to place them in a meaningful and experiences of lifting, pushing, pulling, etc.- favored context, Corollary to this, it might be all these contribute to a sense of selfness. commented thatexplanationstochildren 9.Learning to evaluateThis activity cannot prior to teaching them somethinga unit or be begun too early. Children need to become skill,for examplecan give a child more critics in the present-day world with its on . reason for trying to learn the material than slaught of stimulating experiences. Discussion simply presenting material to be learned be- of TV shows and their accompanying commer- cause the teacher ordains it. cial messages is one method of encouraging 12.Including the student in the evaluation por- evaluations. tion of a parent conference gives him knowl- 10.Role-playing and creative dramathe experi- edge of what is said and opportunity to con- ence of putting oneself in someone else's shoes tribute. This may helptoallaypossible as well as imagining situations helps in the feelings of insecurity or guilt in the child.

20 HOW CAN WE TEACH ADOLESCENTS ABOUT SMOKING, DRINKING AND DRUG ABUSE? GODFREY M. HOCHBAUM, PH.D., U.S. Public Health Service For thousands of years man has found a variety drink because under the influence of alcohol they of means to cope with the drudgeries, pressures, are able to shed inhibitions, uncertainties, or feel- boredom, and fears of every-day life. The need for ings of inferiority and begin to feel free, manly, and such means is an inseparable part of human nature, reckless. The fact that excessive drinking engenders and only the form and use of these means have a variety of health and safety hazards should not changed from one culture era to another. obscure the fact that the drinker may enjoy it and In short, smoking, drinking, or the use of various even temporarily benefit from it in some ways. drugs can under certain conditions serve some con- The nonsmoker or nondrinker often finds these structive, useful, and satisfying purpose. I believe facts difficult to understand and believe. He tends to they can be normal activities and should be ap- see only the negative, unhealthy, dangerous side. proached as such rather than as abnormal or as When he is called upon to teach children about necessarily due to some abnormality in the people such matters, he will tend to present a one-sided using them. picture which conflicts with what many of the The reason we disapprove of them and attempt children think, do, and experience. Indeed, even to control their use is that the benefits, pleasures, educators who may themselves smoke or drink oc- and satisfactions they may yield are outweighed by casionally often focus on the unhealthy and haz- the health hazards they create for the user and in ardous aspects of these habits, in their well-meaning many cases by their threat to a healthy society. zeal to convince children of the risks they are taking According to a number of studies, smokers, in- and of the benefits they can reap from abstention, cluding adolescent smokers, report that cigarettes and disregard or even deny any pleasures or satis- help them to relax, concentrate, tolerate anxiety, factions that may be obtained from them. Such an feel more at ease in awkward situations, and so attitude can obviate any hope of educational suc- forth. Such benefits are reported with such fre- cess, and such an approach backfires easily and quency and consistency that we cannot doubt their often. A person's strongly held beliefs and attitudes validity. Just because these benefits may be psycho- are rarely changed by a one-sided, aggressive attack logical does not diminish their reality or their im- on them. Indeed, as often as not, such an approach portance to the smoker. tends to reinforce the original beliefs and attitudes. We can say the same about drinking. Some boys A more balanced approach, which, instead of attack- Journal of Health, Physical Education and Recreation. ing a person's beliefs, guides him to examine and October 1968. reassess them himself, is more promising. In other

21 2 n-ds, educational efforts should present all sides ing girls and other boys is titillating, desirable, and the argument fairly, give all the known tacts and satisfying. Therefore we actually appeal to values 3ects, and attempt to stimulate the student to which for us are persuasive reasons to drive carefully ty the role of the final arbiterhopefully led by but which for many boys are equally persuasive e educator to do so intelligently and with a sense reasons to do exactly the opposite. Honest puzzle- responsibility for his own weil-being. ment is the response we must expect when we use As long as we harp on the evils and hazards of our own values as arguments with adolescents who Loking. drinking, marihuana, LSD, or sex and do not share and may not even understand these ny the pleasures and satisfactions that some ado- values. cents derive from them, these adolescents will Smoking, the use of alcohol or of hallucinogens, inkand perhaps openly saythat we do not and other similar activities have become symbols ow what we are talking about Our educational of rebellion against established adult standards and orts will seem unreal to them since what we tell authority. It is in the nature of rebellion that dis- ern does not fit reality as they see it and as they approval and repression strengthens and intensifies emselves have experienced it. the movement. Forbidding smoking or prosecuting The same holds true for classroom instruction. a boy for using LSD could easily make these things iless the teacher can present his topicbe it seem even more important and desirable to some toking, excessive use of alcohol, abuse of drugs, adolescents. There are risks involved when we fail or what have youin all of its aspects and to understand the thinking and the attitudes and rnensions, positive and negative, good and bad, values which are characteristic of adolescents. sirable and undesirable, he will lose many of his Scientific facts, no matter how convincing they 'dents. Adolescents, because they are in a period may seem to us, often fail to persuade children. One life where they search out and examine many reason is that facts, even when learned, are viewed tics which adults have come to view as settled, are within the framework of existing motivation, feel- ry sensitive to lack of candor, to incomplete pres- ings, and emotions. Facts that are in accord with tation of facts, and to biased attempts to lead what one already accepts, are accepted; facts that em. They reject quickly, readily, and totally a run counter are frequently rejected, quickly for- urce of instruction, be it a person or presented gotten, or interpreted in such a way that they are nerial, if they doubt its reliability, honesty, and more in line with what one wants them to mean. iceri ty. Thus, to the person who is already motivated to take Visualize a child who is told in school about the some preventive action against a given disease, an d effects of drinking but knows that his mother additional incentive is provided by telling him that s a cocktail ready for his father when he comes on million Americans die every year from the dis- ane, which (as the child may hear often) helps ease because it was not diagnosed early. But the m relax after a hard day's work and be a more person who for one reason or another rejects such easant person to have around. In such a case, the preventive action may reinterpret the same statistics ild has somehow to resolve the conflict between as meaning that many more millions do not contract tat his teacher tells him and what he sees to be this disease, and thereby obtain additional justifica- e facts of the outside world. tion for not taking the action. Another difficulty arises when the teacher at- Clearly, knowledge of facts by itself does not rnpts to affect the child's behavior by appealing necessarily change attitUdes, beliefs, or behavior. motives and standards which are less meaningful Much depends on how and in what context such him than those offered by his peer groups and facts are presented. her influences and which he may neither share This poses a difficult problem, particularly in a: accept. respect to such controversial, emotionally potent For example, in driver education courses, we problems as drinking, smoking-, and the abuse of -ess the hazards of driving at excessive speeds. We drugs. Knowledge gained in the classroom on these gard this emphasis on the risks of such driver subjects is valuable, even essential. But one cannot liavior as a powerful deterrent because we adults rely on this alone if one wants to assure that the lue our health and our lives and usually avoid facts are accepted and applied by the students to posing ourselves unnecessarily to dangers. But their out-of-school behavior. r many adolescent boys, this thrill of taking risks Once we have come to understand the complexity id of thereby proving one's manhood a-nd impress- of the problem, we can turn LO ways of dealing with

29 it more effectively than if we shut our eyes and smoking, drinking, and similar behaviors,these think it is just a question of giving people more influences will be contrary to his normal way of information with the notion that knowledge will thinking. Therefore, education in this area should do the trick. start as early as possibleboth in the home and in I would like to illustrate how one can draw logical the school. and practical implications from our knowledge Thirdly, direct attacks on j:ple's attittules arid about adolescent health behavior. The following habits oftenfail and actua,...y arouse resistance. will not attempt to represent all possible imp;ica- Actually, the harder we attack, the more obstinate amts. It will only illustrate how one might go about and the more extreme these views often become. drawim; such implications. But if influences could be brought to bear on such We have seen that the habits with which we are a person more subtly and without his being con- concerned do provick the adolescent with a variety scious of being "attacked," he will be more receptive. of pleasures and satisfactions and fulfill certain Schools have many opportunities to do just this. needs. Once we acknowledge this fact, it may be Long before formal instruction on smoking or alco- possible to identify other, less hazardous ways by hol or drug abuse is offeredand such courses which adolescents could obtain the same benefits clearly are (or at least are seen by many students to and pleasures_ Here again, one must be cautious be) direct and authoritarian attacksmore subtle not to impose the adult's viewpoint but to stimulate influences could be exerted. and guide adolescents to generate their own ideas For example, physical education courses offer and develop their own means of accomplishing this many opportunities to insert references to the effects e'.1(1. If they invest their own efforts and their own of cigarettes and alcohol on physical fitness and at- creativity, they will be much more likely to follow tractiveness. Other courses could do the same. His- through and to draw their peers into such activities. tory is full of illustrations of battles lost, empires Secondly, we talked about some teenage behavior disintegrated, leaders defeated because of indul- as both a demonstration of being grown-up and an gence in various detrimental health habits. Courses expression of rebellion against adult authority. in biology allow references to the physiological Both of these usually do not really begin to occur effects of nicotine and alcohol. until the early teens. By that time the child is If such educational messages are systematically exposed to a multitude of social influences from his planned with the cooperation of the entire school peer groups. These often influence, stimulate, and staff, attitudes could be created long before adoles- reinforce undesirable health habits and frequently cence which could enable many children to resist prove more powerful than any instruction on smok- temptations they will be exposed to during their ing, drinking, or drug abuse that the school may adolescent years. offer at the same time. We have seen that facts alone are not decisive However, if we began to instill in the child proper factors in changing attitudes or behavior, but they attitudes and values with respect to these habits could be if presented in a context that makes them long before adolescence, we could fortify and help meaningful. For example, statistics offered in the him resist such influences later. Take, for example, classroom on accidents and deaths resulting from tooth brushing. The child learns to brush his teeth driving under the influence of alcohol or the num- long before he understands the health reasons. ber of people dying each year from lung cancer will When he is old enough to learn and understand not have much impact on teenagers. ;n fact, demon- the health reasons, he can easily accept them be- strably it does not even have much effect on us cause they fit in with an already established habit. adults. Highway statistics on how many people In fact, they help to strengthen the habit. In the die during Labor Day weekends on the highway same way I believe that by proper means we can have not led many drivers to drive more carefully. instill in children certain attitudes and ways of But one can observe that drivers, after passing the looking at smoking and drinking when the child scene of a smashed car, slow down. People change is still very young. It can start with using doll play attitudes or behavior very rarely on the basis of in pre-school years, and it can go through all the statistics. They change their attitudes and behavior school years. By the time the child becomes a in response to personal experiences. teenager, there would have developed within him In relation to school health education, visits to an ingrained way of looking at such matters. As hospitals to see cancer patients or having an em- he becomes exposed to other influences toward physema patient visit the classroom may have more

23 30 impact than all the statistics. A teenage boy who was cigarettes, alcohol, marihuana, or what have you. crippled in an accident while driving under the in- Some of these one will find totally and completely fluence of alcohol will he more persuasive than a adamant to any attempt to change their habits and booklet. In short, the more immediate and personal one may have to forget about them. But others may a demonstrationis,the more effective the facts indeed have tried but found it impossible. These themselves will become. boys and girls need and should be provided help There is some evidence that many adolescents with the problem through individual counseling or take up smoking or drinking or drugs, not because perhaps some sort of psychotherapy. they particularly want to or enjoy it, but because We referred earlier to the difficulty of making they consider it a mark of adulthood, or because classroom learning relevant to the outside life so as they believe that it gives them some status among to provide for a carry-over to the latter. One of the thei:. peers or in the eyes of the other sex, or because reasons mentioned is that many childrenand par- other teenagers talk them into it. Many of these ticularly those who represent our most difficult prob- young people may be glad to give it up if they just lem casessee the classroom as a world separate knew how they could do it without losing face in from the real world in which they live. Since this the eyes of their peers or without surrendering some image is hard, perhaps impossible to change,it of these benefits. might be easier to change the situation. One might, These boys and girls would probably be quite re- for example, consider discussion group approaches sponsive to any help teachers can give them. In instead of the more typical lecture approaches of some schools, clubs or other organizations are the classroom and move from the classroom setting formed which do not actually forbid smoking or to more informal settings. What if groups were drinking but deliberately create an atmosphere in assembled in homes of teachers or children, in frater- which such activities are considered childish or nities or dormitories, or in other places which do stupid and are frowned upon. If such organizations not have a school atmosphere? The teacher or other can be made attractive and prestigeful in the eyes experts could function as resource persons while

.of enough students, those who do not choose to the discussions were led by students themselves. In smoke or drink in the first place and those who are fact, the more closely both the physical environment eager to shed such habits can find a congenial peer and the style of instruction maintained in such group which provides them with a good deal of groups resembles situations in which these adoles- social reinforcement. cents usually move and in which they are exposed There are many who do not engage in undesirable to undesirable influences we wish to counteract, the health habits but are on the verge of yielding to more effective the discussions are likely to be. the temptation to try one or another. Psychological Psychosocial research of the last few years has research has shown that during this period of indeci- helped us to understand somewhat better why sion, almost any influence may suffice to swing the adolescents smoke, drink, or abuse drugs. This new decision one way or another. It is this group with understanding has taught us that there are no which medical and other facts may have a decisive simple explanations nor single or simple answers. influence. But if we carefully analyze these problems and Then there are youngsters who really are already search for appropriate implications from the psy- captives to thek habits; they may already have chological and sociological sciences, we can generate become habituated to and acutely dependent on new ideas as to how to cope with the challenge.

24 31 /FACTS ABOUT DRUGS

WHAT IS MARIHUANA?

Marihuana is a drug found in the flowering tops where marihuana is used in religious :-remonies or and leaves of the female Indian hemp plant, canna- as a native medicine. bis saliva. The plant grows in mild climates around the world, especially in Mexico, Africa, India, and How widely is it used in the United State-- the Middle East. It also grows in the United States, The use of marihuana as a'i intoxicating drug where the drug is known by such names as "pot,- was introduced in the United States in 1920. In -tea," -grass,- "weed," and -Mary Jane.- 1937, the Federal Marihuana Tax Act outlawed its The drug is made by crushing or chopping into general use and every state followed with strict small pieces the dried leaves and flowers of the laws and enforcement. In the mid-I960's, authorities plant. This green product is usually rolled and reported a sharp increase in the use of marihuana. smoked in short cigarettes or pipes, or it can be Arrests on marihuana charges have more than dou- eaten mixed with Yood. The cigarettes are com- bled since 1960, according to the President's Com- monly known as "reefers," "joints," and "sticks." mission on Law Enforcement and Administration The smoke from marihuana is harsh and smells 4,f Justice. like burnt rope or dried grasses. Its sweetish odor No one knows the exact extent of marihuana use is easily recognized. in the Unitcd States. Some health authorities be- The strength of the drug differs from place to lieve that 4 to 5 million Americans may have used place, depending on where and how it is grown, the drug at least once in their lives. Other .!stimates how it is prepared for use, and how it is stored. The are as high as 20 million. Research studies ar .. on,!er marihuana available in the United States is much way to determine more precisely just how widely weaker than the kind grown in Asia, Africa, or the the drug is used. Middle East. How does the drug work? What is its use? When smoked, marihuana quickly enters the bloodstream and acts on the brain and nervous Marihuana is one of the least understood of all system. It affects the user's mood and thinking, but natural drugs, although it has been known for medical science still has ,not discovered just how nearly 5,000 years. According to a UN survey, it the drug works in the body, what pathway it takes has been most widely used in Asia and Africa. Very It() the brain, and how it produces its effects. Some early in history, the Chinese used it to relieve pain scientists report that the drug accumulates in the during surgery, and the people of India used it as liver. Because it may cause hallucinations when a medicine. Today it is used mainly for its intoxi- taken in very large doses, it is classed as a mild cating effects and has no known use in modern hall ucinogen. medicine. Traffic in and use of drugs from the cannabis What are its physical effects? plant are now legally restricted in nearly every The long-term physical effects of taking mari- civilized country in the world, including countries huana are not yet known because no one has done

Reprinted from pamphlets produced by the National Institute of Mental HealthNarcotics (PHS pub- lication #1827), LSD (PHS #1828), Marihuana (PHS #1829), The Up and Down Drugs (PHS #1830).

25 the kind of research needed to learn the results of or delusions (beliefs not based in reality). His mood chronic use. The more obvious physical reactions may swing from great joy to extreme anxiety. He include rapid heartbeat, lowering of the body tem- may become deeply depressed, or have feelings of perature, and sometimes reddening of the eyes. uneasiness, panic, or fear. The drug also changes blood sugar 12vels, stimulates the appetite, and dehydrates the body. Users may Is marihuana addicting? get talkative, loud, unsteady, or drowsy and find it Authorities now think in terms of drug "depend- hard to coordinate their movements. ence" rather than -addiction." Marihuana, which is not a narcotic, does not cause physical dependence What are its other effects? as does heroin or other narcotics. This means that The drug's effect on the emotions and senses vary the body does not become dependent on continuing widely, depending on the amount and strength use of the drug. Neither does the body, probably, of the marihuana used. The social setting in which develop a tolerance to the drug, which would make it is taken and what the user expects also influence larger and larger doses necessary to get the same his reaction to the drug. effects. Withdrawal from marihuana does not pro- Usually, when smoked, the drug effect isfelt duce physical sickness. quicklyabout 15 minutes after inhaling the smoke A number of scientists think the drug can cause of the cigarette. Its effects can last from two to four psychological dependence, however, if its users take hours. The range of effects can vary from depres- it regularly. All researchers agree that more knowl- sion to a feeling of excitement. Some users, how- edge of the physical, personal, and social conse- ever, experience no change of mood at all. The quences of marihuana use is needed before more sense of time and distance of many users frequently factual statements can be made. becomes distorted. A minute may seen like an hour. Does it lead to use of narcotics? Something near may seem far away. A 1967 Lexington study of narcotic addicts from How does marihuana affect judgment? city areas showed that more than 80 percent had previously used marihuana. Of the much larger A person using marihuana finds it harder to make number of persons who use marihuana, scientists decisions that require clear thinking, and he finds agree that few go on to use morphine or heroin. No himself more responsive to other people's sugges- direct cause-and-effect link between the use of mari- tions. The drug has an adverse effect on any task huana and narcotics has been found. Researchers that takes good reflexes and thinking. For this point out, however, that a person predisposed to reason it is dangerous to drive while under the in- abuse one drug may be likely to abuse other, fluence of the drug. stronger drugs. Also, users of one illicit drug may be exposed to a variety of them through contacts with What are the latest findings about the drug? drug sellers and other users. Working with man-made tetrahydrocannabinol, one of the active ingredients of marihuana, a lead- What are the laws dealing with marihuana? ing scientist recently found that high dosages of Under federal law, which classifies marihuana as the drug brought on severe reactions in every per- a narcotic, to have, give, or sell marihuana in the son tested. The National Institute of Mental Health United States is a felony. Federal laws and many study also showed that psychotic reactions some- state laws deal with the drug as severely as if it were times occur, for unknown reasons, in some indi- a narcotic. viduals who take smaller amounts. The federal penalty for possessing the drug is 2 to The scientist observed that a dose equal to one 10 years imprisonment for the first offense, 5 to 20 cigarette of the United States type can make the years for the second offense, and 10 to 40 years for smoker feel excited or silly. After an amount equal further offenses. Fines of up to $20,000 for the first to four cigarettes, the user's perceptions change. or subsequent offenses may be imposed. Colors seem brighter, and hearing seems keener. State laws also control the illicit use of these After a dose equal to 10 cigarettes, other reactions drugs. For transfer or sale of the drug, the first set in. The user experiences visual hallucinations offense may bring a 5- to 20-year sentence and a fine (seeing things that are not there), illusions (seeing of up to $20,000; two or more offenses, 10 to 40 years or imagining shapes in objects that are not there) , in prison. If a person over 18 sells to a minor under

26 3 3 18 years of age, he is subject to a fine of up to safe." It is hoped that research now under way may $20,000 and/or 10 to 40 years in prison for the first add to the little currently known about the effects offense, with no suspension of sentence and no pro- of the use of marihuana. bation or parole. Why is so little known about the drug? What are the special risks for- young users? Medical science does not yet know enough about Breaking the laws that deal with marihuana L.an the effects of marihuana use became its active in- have serious effects on the lives of young people. gredienttetrahydrocannabinolwas not available They may find their education interrupted and in pure form until recently. In the summer of their future shadowed or altered by having a police 1966, the chemical, first synthesized by an NIMH- record. A conviction for a felony can complicate supported scientist in Israel, was made available for their lives and plans at Many turns. It can prevent research purposes. Now for the first time researchers a person from being able to enter a profession, such can accurately measure the drug's effects and study as medicine, law, or teaching. It can make it difficult Its short- and long-term action on the body. for him to get a responsible position in business or industry. Special individual evaluation is necessary What research is being done? to obtain a government job. Before a student tries The N-ntionalInstitute of Mental Healthis marihuana, .he should know these facts_ responsible for supporting and conducting research Experts on human growth and development to learn more about marihuana and to present this point out other risks. They say that a more subtle knowledge to the public. result of drug abuse on the young person is its effect The program of the NI MFI Center for Studies of on his personality growth and development. For Narcotic am: Drug Abuse includes surveys of how young people to experiment with drugs at a time people get the drug, how widely students and others when they are going through a period of many use it, and what physical and psychological effects changes in their transition to adulthood is a seri- different amounts and periods of use have upon ously questionable practice. people: With NIMH support, scientists are now -It can be especially disturbing to a young per- studying the special drug qualities of marihuana son who is already having enough of a task getting and its physical effects. adjusted to life and establishing his values," says The NIMH Addiction Research Center in Lex- an NIMH scientist engaged in studies of young ington, Kentucky, is developing studies to discover marihuana users. exactly how marihuana affects memory, perception Another reason for caution is the lack of .cien- (or awareness), mood, and physical movement. tific evidence to support statements being reported Other studies are planned to learn more about the by students that the use of marihuana is -medically drug's long-range effects on the body and mind.

27

411-1-854 0 - - 3 34 AMPHETAMINES AND BARBITURATES,THE UP AND DOWN DRUGS Amphetamines, which first became available for stored in nerve endings) and concentrate it in the medical use in the 1930's, are stimulants to the cen- higher centers of the brain. This speeds up the tral nervous system and are best known for their action of the heart and the metabolic process ability to combat fatigue and sleepiness. They are through which the body converts food into the also sometimes used to curb appetite in medically chemicals it needs. supervised weight-reduction programs. The most commonly used stimulants are amphetamine (Ben- What are the medical uses? zedrine),dextroamphetamine(Dexedrine),and Amphetamines were first used to treat colds, be- methamphetamine (Methedrine). Slang terms for cause they shrink the nasal membranes and can give these drugs include "pep pills,""bennies," and temporary relief for "stuffy" heads. More effective "speed." drugs with fewer side effects are now used for this purpose. Stimulants are now mainly prescribed for How do these drugs affect mood? narcolepsy (overwhelming attacks of sleep) , depres- When properly prescribed by a physician, moder- sion, and weight control. Use of these drugs as ate doses can check fatigue and produce feelings of appetite depressants or for any other purposes is ad- alertness, self-confidence, and well-being. In some visable only under the supervision of a physician, people, this is followed by a letdown feeling or since stimulants can produce unwanted reactions. depression hangover. Heavier doses cause jitteriness, Doctors also prescribe these drugs for fliers, astro- irritability, unclear speech, and tension. People on nauts, and others who can use them as medically very large doses of amphetamines appear with- directed to ward off fatigue during dangerous and drawn, with their emotions dulled. They seem un- prolonged tasks. able to organize their thinking. Are stimulants misused? What are the physical effects? About 20 percent of all medical prescriptions for Stimulant drugs increase the heart rate; raise mood-affecting drugs involve stimulants, according the blood pressure; cause palpitations (throbbing to a national survey. The drug industry produces heart -Ind rapid breathing); dilate the pupils; and enough each year to provide each American with 25 cause dry mouth, sweating, headache, diarrhea, and doses of these drugs. The Food and Drug Adm'in- pallor. They also depress the appetite. istration reports that about half of this supply ewers illegal channels, for nonprescribed use. Black-mar- How do these stimulants work? ket laboratories also produce stimulants, which are Scientists have found that in the body these drugs easily obtained from illegal sources. stimulate the release of norepinephrine (a substance Allkindsof people abuse drugsfrdm the

28 middle-aged businessman or housewife to students, central nervous system. Of the_e, the best known athletes, and truck drivers. Recent government sur- are the barbiturates, made from barbituric acid, veys show that young people are becoming the which was first produced in 18,16. greatest abusers of these drugs. Drivers take them Barbiturates range front the short-acting,fast- to stay awake on long trips, students take them while starting,pentobarbital sodium (Nembutal) and cramming for exams, and athletes take them, al- secobarbital sodium (Seconal) to the long-acting, though sporting associations have banned their use. slow-starting phenobarbital (Luminal), amobarbital Some try them for a temporary kick. Some abusers (Amyta I), and butabarbital (Butisol). The short- reach a point where they need both stimulant and acting preparations are the ones most commonly sedative drugs to get a chemical "up" and a chemi- abused. The slang terms for these include "barbs" cal "down." and "goof balls." The stimulant drugs are generally swallowed as pills, but can be taken in liquid form by injection How widely are they used? into a vein at regular time intervals. This is a dan- Recent surveys show thai, of all the prescriptions gerous practice known among abusers as "speeding." doctors write for mood-affecting drugs, one in four is for a barbiturate. Are these stimulants addicting? Probably an equally large supply ot these drugs is Benzedrine, Dexedrine, and other stimulant drugs obtained illegally, without prescription. do not produce physical dependence as do the nar- cotics. Although the body does not become physi- What are their medical uses? cally dependent on their continued use,it does Doctors prescribe sedatives widely to treat high develop a tolerance to these drugs so that larger blood pressure, epilepsy, and insonmia; to diagnose and larger doses are required to feel the effects. and treat mental illness; and to relax patients be- There is another kind of dependence medical fore and during surgery. Alone or together with authorities note in connection with the abuse of other drugs, they are prescribed for many types of stimulants. They call it psychological dependence, illnesses and conditions. meaning that a practice can become a habit for mental or emotional reasons, with the person get- What are their effects? ting used to and turning to the drug for its effects. Taken in normal, medically supervised doses, barbiturates mildly depress the action of the nerves, How dangerous are stimulant drugs? skeletal muscles, and the heart muscle. They slow These drugs can drive a person to do things be- down the heart rate and breathing, and lower the yond his physical endurance that leave him ex- blood pressure. hausted. Heavy doses may cause a temporary toxic But in higher doses, the effects resemble drunken- psychosis(mental derangement) which requires ness: confusion, slurred speech, and staggering. The hospitalization. This isusually accompanied by ability to think, to concentrate, and to work is im- auditory and visual hallucinations. Abruptly with- paired, and emotional control is weakened. Users drawing the drug from the heavy abuser can result may become irritable, angry, and combative. Finally, in a deep and suicidal depression. they may fall into deep leep. Long-term heavy users of the amphetamines are usually irritable and unstable and, like other heavy Is barbiturate use dangerous? drug users, they show varying degrees of social, Authorities consider the barbiturates highly dan- intellectual, and emotional breakdown. gerous when taken without medical advice and Dangers from injecting "speed" (methampheta- prescription. Because doctors commonly prescribe mine) into the vein include serum hepatitis, ab- these drugs, many people mistakenly consider them scesses, and even death in the case of unaccustomed safe to use freely and as they choose. They are not. high doses. Injection of "speed" causes abnormal Overdose can cause death. heart rates and may result in serious psychotic Barbiturates distort how people see things and states and long-term personality disorders. slow down their reactions and responses. They are an important cause of automobile accidents, espe- What are sedatives? cially when taken together with alcohol. Barbitu- The sedatives belong to a large family of drugs rates tend to heighten the effects of alcohol. manufactured for medical purposes to relax the Users may react to the drug more strongly at

29 one time than at another. They may become con- depressants with intent to sell can bring a fine of fused about how many pills they have taken and die up to $10,000 and a prison sentence of up to five of an accidental overdose. Barbiturates are a leading years. Per.ons over l8 convicted of selling these cause of accidental poison deaths in the United drugs to persons under 21 can be fined $15,000 and States. They are also one of the main means people receive 10 years in jail. Second and subsequent sales use to commit suicide. of these drugs to minors may yield a fine of $20,000 and 15 years in jail. Illegal possession without intent Are barbiturates addicting? to sell can bring a fine of $1,000 and/or imprison- Yes. These drugs are physically addicting. Some ment for one year. State laws also control illicit use experts consider barbiturate addiction more difficult of these drugs. to cure than a narcotic dependency. The body needs increasingly higher doses to feel their effects. li the What research is being done? drug is withdrawn abruptly, the user suffers with- The National Institute ci Mental Health is the drawal sickness with cramps, nausea, delirium, and federal agency primarily responsible for research convulsions, and in some cases, sudden death. There- on drug addiction and ;.buse. It is conducting ex- fore, withdrawal should take place in a hospital tensive animal research to uncover the underlying over a period of several weeks on graduallyreduced dosages. It takes several months for the body to action of the up-and-down drugs and to try to find out how psychologicalorphysical dependence return to normal. develops. It is searching for new drugs and tech- What are the legal controls? niques to treat overuse and dependence on the am- phetamines and the barbiturates. Some investiga- The Bureau of Narcotics and Dangerous Drugs in the Department of Justice regulates stimulant and tors are developing new tests to detect these drugs depressant drugs. Regulations provide for a strict in the body. accounting of all supplies of drugs by the manu- In addition, the NIMH is supporting a number of facturer, distributor, and seller, and restrict the surveys to determine the use of these drugs by var- user to five refills of any one prescription. This ious population groups. Research investigators are means that these drugs can be had legally only trying in particular to learn how young people through a doctor. Illicit manufacturing, distribut- become involved in drug abuse and what can be ing, dispensing, and possession of stimulants and done to help prevent this.

80 WHAT IS LSD?

A powerful man-made chemical, D-lysergic acid drug's popularity may be dropping, at least insome diethylamide, generally called LSD, was first devel- areas of the country, as its potential ill effects be- op.ed in 1938 from one of theergot alkaloids. Ergot come better known. is a fungus that grows as a rust on rye and other cere'als. LSD is so powerful that a singleounce is What are its physical effects? enough to provide 300,000 average doses. An average dose of LSD, amounting to a speck, Legally classified as a hallucinogena mind- has an effect that usually lasts from about 8 to 10 affecting drugLSD is noted mainly for producing hours. Users take it in capsule form or in a sugar strong and bizarre mental reactions io people, and cube, cracker, or cookie, or they can lick it off a striking distortions in their physical senses, in what stamp or other object impregnated with the drug. and how they see, touch, smell, and hear. Except for It increases the pulse and heart rate. It also causes government-approved use for research, the drug is a rise in blood pressure and temperature, dilated illegal in the United States. Yet it is unlawfully eye pupils, shaking of the hands and feet, cold produced in makeshift laboratories, and many peo- sweaty palms, a flushed face or paleness, shivering, ple, including up to 7 percent of the students on chills with goose pimples, irregular breathing, nau- some campuses, have taken it. sea, and loss of appetite. Other less known but powerful hallucinogens or The drug is not physically addicting in the way psychedelic (mind-manifesting) drugs include pe- that narcotics are. That is, the body not develop yote, mescaline, psilocybin. DMT, and STP. a physical need for LSD or physical sickness when it is withdrawn. Why do people take LSD? Reasons given by users for taking LSD include: What are its psychological effects? "curiosity," "for kicks," "to understand myself bet- People who use LSD say that it has a number of ter,- or a quest for religious or philosophical in- effects. The first effects, they indicate, are likely to sights. At various times in history, substances as be sudden changes in their physical senses. Walls diverse as alcohol, ether, opium, and nitrous oxide may appear to move; colors seem stronger and more 0o-called laughing gas) have also been claimed brilliant. Users are likely to "see" unusual patterns capable of providing an easy and instant path to unfolding before them. Flat objects seem to stand wisdom, or to religious or philosophical insights. out in three dimensions. Taste, smell, hearing, and Today these -consciousness expanders" of an earlier touch seem more acute. One sensory impression day are regarded as merely commonplace substances may be translated or merged into another; for ex- without any mystical properties whatever. ample, music may appear as a color, and colors Recent surveys and hospital reports show that the may seem to have taste.

31 3 One of the most conhising yet common reactions Studies of chronic LSD users indicate that they among users is the feeling of two strong and op- continue to suffer from an overload of stimulaticm posite emotions at the same timethey can feel to their senses. Researchers believe this may explain both happy and sad a[ once or relaxed and tense. the regular oser's inability to think clearly and to Arms may feel both heavy and light at the sanle concentrate on a goal. time: Users also report a sensation of losing the normal Is LSD dangerous? feeling of boundaries between body and space. Recent reports from hospitals in areas where LSD Sometimes they believe they can fly or float with is used without close medical supervision warn of ease. definite dangers. These dangers include: Effects can be different at different times in the Panic. Because he cannot stop the drug's same individual. Researchers have found that even action, the user may get panicky and fear that he is in carefully controlled studies responses to the drug losing his mind. cannot be predicted. For this reason, users refer to 2, Paranoia. He may become increasingly suspi- "good trips" or "had trips" to describe their ex- cious, felling that someone is trying to harm him or periences. control his thinking. This feeling generally lasts 72 Among LSD's other effects on the user is the loss hours after the drug has worn off. of his sense of time. He doesn't know how much 3. Recurrence. Days, weeks, or even months after time is passing, hut he does remain conscious. the individual has stopped using LSD. the things he saw and felt while on the drug may recur and make Does the drug affect thinking? him fear he is going insane. Scientists report that the LSD user can reason 4. Accidental death. Because the LSD user may logically, up to a point, while undergoing the drug's feel that he can fly or float in the air, he may try to effects. He usually remembers after the drug wears leap out of a high window or from other heights off much of what happened to him. He may, for and fall to his death. Or he may drive or walk in example, have become fascinated with an object in front of a moving car because he thinks he can't be the room, like a chair or a vase. On larger doses, he harmed. may feel mystical and report a sense of rebirth or new insights. But he is often unable to explain his Does LSD cause mental illness? experience to others. Many medical authorities Reactions resulting from use of LSD range from feel that chronic or continued use of LSD changes great worry, panic, and deep depression to border- values and impairs the user's powers of concentra- line and severe mental derangement. Medical ex- tion and ability to think. This may lead to a tend. perts point out that the overwhelming worries and ency to drop out of society. fears that can accompany the LSD experience are sometimes disturbing enough to cause acute and Does LSD increase creativity? even long-lasting mental illness. Some users believe that LSD can heighten their senses, and help to make them more creative. But Does LSD cause birth defects? studies of paintings, writings, and other works pro- A number of investigators are s udying the effects duced by drug users have failed to support this of LSD on chromosomes. These are the tiny threads viewpoint. In many cases, works performed by pen. of matter in the nucleus of every cell that carry ple after they used LSD appeared to be noticeably genetic or hereditary information and guide repro- pooret than before. duction. Several scientists have reported that the drug causes chromosomal damage or changes when How does the drug act? it is added to a tissue culture of white blood cells. Just how LSD works in the body is not yet known. Others report that the chromosomes of individuals But it stems to affect the levels of certain chemicals who presumably have taken LSD show unusual in the brain and to produce changes in the brain's breaks. They warn that this may possibly cause ab- electrical activity. normalities in the offspring of LSD users. Animals experiments with LSD suggest that the Some researchers have reported fetal damage brain's normal filtering and screening-out process when LSD was given to pregnant rats and mice, and becomes blocked, causing the brain to become others have described human birth defects in new- flooded with unselected sights and sounds. borns whose mothers said they took LSD.

32 33 No conclusive or direct link has yet been found regulated by the Bureau of Narcotics and Dangerous between LSD and chromosomal breaks, nor has it Drugs, Department of Jwaice. The law provides been found that such breaks cause birth defects. strict penalties for anyone who illegally produces, Some changes in the cells are temporary and not sells, possesses with intent to sell, or disposes of permanent. But the preliminary evidence is arous- dangerous drugs like LSD. Conviction can bring ing the concern of scientists. a fine of $10,000 and/or imprisonment for up to Until further research throws more light on the five years. For persons over 18 years ef age who question, medical authorities warn that the drug sell or give drugs to anyone under 21, the law pro- must he considered a definite risk, and women of vides a penalty of up to 10 years in jail and a fine of child-bearing age are particularly advised not to use up to $15,000. Second and tubsequent such offenses the drug. may he penalized by up to 15 years imprisonment and/or a $20,000 fine, Merely possessing this drug Are there special hazards for young users? illegally witlt:Jut intention of selling it can bring a The strong sensations and clash of moods the drug fine of 51,000 and/or one year in prison. Some state causes can be frightening, even for a mature per- laws are even more severe. son. For young people who are still undergoing What are NIMH activities in LSD? emotional development and who seek a realistic hold on ways of solving problems and ways of The National Institute of Mental Health is the living, the effects of LSL can be -ren more fright- primary federal agency responsible for supporting ening and confusing. The growing brain is more and overseeing research on LSD. It possesses the vulnerable than the adult brain to all mind-alter- only legal supply of the drug in the United States. ing drugs. The NIMH Center for Studies of Narcotic and Drug Abuse is currently supporting 58 research Does LSD have medical uses? projects which include surveys of the extent of the use of LSD by students and by the general popu- The drug has been tested widely as a possible lation; LSD's biological, psychological, and genetic treatment for mental and emotional illnesses, and effects in animals and in humans; basic studies to for alcoholism. In studies so far, it has failed to explain the drug's action and to chart its course help the severely ill. But under controlled condi- through the body; and long-range projects to study tions, neurotics and alcoholics have made some LSD users and their culture. improvement, according to investigators. The work Investigators are about to complete a series of is not complete, but follow-up studies indicate that studies to determine the value of the drug as a treat- these improvements are not always lasting. ment for alcoholism and emotional problems, and The drug is a valuable tool in biomedical re- as a way to provide some mental relief for persons search, but its therapeutic value may be limited with terminal illness. They are also searching for to special cases. new ways to treat people who suffer from the drug's bad side effects. How does the law view LSD? Research in this area is expected to grow until Because LSD is a dangerous drug when not used science has found more answers to the many clues- for research under medical supervision, it is closely tions LSD has raised.

40 33 Chart Listing Drugs, Medical Uses, Symptoms (Question marks indicate

Chemical or Classification Medical use How taken Name Slang name trade name Sourc

H., Horse, Scat, Semi-Synthetic Injected or Junk, Smack, Diacetyl- (from Narcotic Pain relief Heroin Scag, Stuff, morphine Sniffed Harry Morphine) Morphine Natural Pain relief Swallowed Morphine White stuff, M. sulphate (from Opium) Narcotic or Injected Natural (from Opium) , Semi- Ease Pain Swallowed Codeine Schoolboy MethylmorphineSyn thetic (fromNarcotic and coughing Morphine) Swallowed Dolophine Narcotic Pain relief Methadone Dolly Amidone Synthetic or Injected Corrine, Gold Stimulant, Sniffed, Dust, Coke, Methylester of Natural Local Cocaine (from coca, Local Anesthesia Injected or Bernice, Flake, benzoylecgonine Anesthesia Swallowed Star Dust, Snow NOT cacao) Relaxant, Pot, Grass, Euphoriant, Smoked, Marijuana Hashish, Tea, Cannabis sativa tural None in U.S. Swallowed, In high doses or Sniffed Gage, Reefers Hallucinogen Barbs, Blue Sedation, Devils, Candy, Phenobarbital Sedative- Relieve high Swallowed Yellow Jackets,Nembutal, Synthetic blood pressure, or Injected Barbiturates Phennies, Seconal, :oypnotic epilepsy, hyper- Peanuts, Amytal thyroidism Blue Heavens Bennies, DexiesBenzedrine, Relieve mild Speed, Wake- Dexedrine, Sympatho- depression, con-Swallowed Amphetamines Ups, Lid Prop- Desoxyn, Meth-Synthetic mimetic trol appetite or Injected pers, Hearts, amphetamine, and narcolepsy Pep Pills Methedrine Experimental Acid, Sugar, Semi-Synthetic study of mental d-lysergic acid (from ergot Halluci-nogen Swallowed LSD Big D, Cubes, diethylamide function, T rips alkaloids alcoholism

AMT, Dimethyl- DMT Businessman's Synthetic Hallucinogen None Injected High triptamine

3,4,5-trimeth- Natural Mescaline Mese. oxyphenethyl- Hallucinogen None Swallowed amine (from Peyote) (2-dimethyl- Natural amino) ethylin- Hallucinogen None Swallowed Psilocybin do1-4-oldihydro- gen phosphate Psilocybe) Natural Booze, Juice, Ethanol (from grapes, Sedative Solvent, Swallowed Alcohol etc. ethyl alcohol grains, etc. via hypnotic Antiseptic fermentation)

Smoked, Stimulant- Sedative, Fag, Coffin Nicotinia Natural Emetic Sniffed, Tobacco nail, etc. tabacum sedative (nicotine) Chewed

34 41 Produced and their Dependence PotenOals conflict of opinion) Physical Mental Organic Usual Dose Duration Effects Long-term dependence dependence damage of effect sought symptoms potential potential potential Euphoria, Prevent Addiction Varies 4 hrs, withdrawal Constipation Yes Yes discomfort Loss of Appetite Euphoria, Prevent Addiction 15 Milligrams 6 hrs. withdrawal Constipation Yes Yes discomfort Loss of Appetite Euphoria. Addiction Prevent Yes 30 Milligrams 4 hrs. wi ihdrawal Constipation Yes discomfort Loss of Appetite Prevent Addiction 10 Milligrams 4-6 hrs. withdrawal Constipation Yes Yes No discomfort Loss of Appeti Excitation Depression Varies Varies, ShortTalkativeness Convulsions No Yes Yes? Relaxation, in- creased eupho- 1-2 Cigarettes 4 hrs. ria, Perceptions,Usually None No Yes? No Sociability Addiction w/ severe with- Anxiety 50-100 drawal symp- Yes Yes Yes Milligra_ 4 hrs. reduction, toms, Possible Euphoria convulsions, toxic psychosis Loss of Appetite 2.5-5 Alertness Delusions No? Yes Yes? Milligrams 4 hrs. Activeness Hallucinations Toxic psychosis sightful ex- May intensify 100-500 periences, exhil-existing psy- No? Micrograms 10 hrs. aration, Distor-chosis, panic No No? tion of senses reactions Insightful ex- periences, exhil- 1-3 Milligram Less than I hr.aration, Distor- No No? No? tion of senses Insightful ex- periences, exhil- 350 Micrograms12 hrs. aration, Distor- No No? No? tion of senses Insightful ex- periences, exhil- 25 Milligrams 6-8 hrs. aration, Distor- No No? No? tion of senses Cirrhosis Sense alterationToxic psychosis Varies 1-4 hrs. Anxiety reduc- Neurologic dam-Yes Yes Yes tion, Sociabilityage, Addiction Emphysema, Lung cancer, Calmness mouth & throat Yes Yes Varies Varies Sociability cancer, cardio- Yes? vascular dam- age, loss of appetite

35 WHAT ARE NARCOTIC DRUGS? The term narcotic refers, generally, to opium and For example, the addict comes to depend on the pain-killing drugs made from opium, such as heroin, drug as a way to escape facing life. morphine, paregoric, and codeine. These and other Narcotic use can become even more of an escape opiates are obtained from the juice of the poppy than expected, because large or unexpectedly pure fruit. Several synthetic drugs, such as Demerol and doses canand not uncommonly doresult in Dolophine, are also classed as narcotics. Opiates death. are widely used in medicine as pain killers. Co- caine, made from coca leaves, and marihuana, are What is the effect of heroin? classified legally but not chemically as narcotic Typically, the first emotional reaction to heroin drugs. is reduction of tension, easing of fears, and relief Since heroin appears to be the narcotic used by from worry. Feeling "high" may be followed by a most addicts today, the following questions and period of inactivity bordering on stupor. answers deal mainly with heroin. Heroin, which is usually mixed into a liquid solution and injected into a vein, appears to dull What is narcotic addiction? the edges of reality. Addicts have reported that When the abuser of a narcotic gets "hooked" heroin "makes my troubles roll off my mind," and meaning addictedhis body requires repeated and "makes me feel more sure of myself." larger doses of the drug. Once the habit starts, larger The drug depresses' certain areas of the brain, and larger doses are required to get the same effects. and may reduce hunger, thirst, and the sex drive. This happens because the body develops a tolerance Because addicts do not usually feel hungry, their for the drug. hospital care may include treatment for malnu- One of the signs of heroin addiction is withdrawal trition. The drug may also reduce feelings of pain. sickness. When the addict stops using the drug, he Withdrawal symptoms appear in the addicted may sweat, shake, get chills, diarrhea, nausea, and person about 18 hours after the drug has been dis- suffer sharp abdominal and leg cramps. Modern continued. treatments help the addict through these withdrawal In general, many factors influence the effects of stages. Science now has new evidence that the body's the drug. These include the user's personality, the physical addiction may last much longer than pre- size and frequency of dose, and how the drug is viously believed. taken. There is another kind of drug dependence con- nected with the use of narcotics. This is known Who takes narcotics? as psychological dependence. That is, taking the Studies by the U.S. Public Health Service show drug also becomes a habit for emotional reasons. that heroin addiction today is found chiefly arnong

36 43 young men of minority groups in ghetto areas. Of and a sentence of 5 to 20 years for the first offense, the more than 60,000 known addicts listed by the and 10 to 4t) years for further offenses. A person Bureau of Narcotics and Dangerous Drugs, more who sells narcotics to someone tinder 18 is refused than half live in New York Stateand most of parole and probation, even for the first offense. If these in New York City. Recent figures show that the drug is heroin, he can be sentenced to life im- more than half of the addicts are under 30 years prisonment or to death. ofagc. The Harrison Act has served as a model for most Narcotic addiction in the United States is not state laws, and both federal and state judges have limited to the heroin users. Some middle-aged and generally imposed severe sentences for narcotics older people who take narcotic drugs regularly viola tions. to relieve pain can also become addicted. So do some people who can get drugs easily, such as doc- What is the medical view of addiction? tm-s, nurses, and druggists. Studies show that this Medical anthorities say that the inklict is a sick type of addict has personality and emotional diffi- person. He needs treauuent for his physical addic- culties not much different from other regular nar. tion and withdrawal sickness. Then, he needs help cotic users. to keep from going back to drug use after his with- drawal. What is the life of an addict like? The most difficult part of an addict's treatment Many addicts admit that, once on drugs, getting comes after he is out of the hospital. The doctors a continued supply becomes the main object of their can help get him off the drug and help to restore lives. Concentration on getting drugs frequeny his health, but it is harder to keep him from picking prevents the addict from continuing- either his edu- up the habit again, for many reasons. Drug taking cation or his job. His health is often bad. He may may have become his way of life, including il be sick one day from the effects of withdrawal and friends he has and the kind of job he can get. He sick the next from an overdose. Statistics indicate may not have a healthy enough personality to want the life span of the drug-dependent individual may to make a fresh start in life or to enjoy normal be drastically shortened. He is usually in trouble pleasures. with his family and almost always in trouble with A number of rehabilitation approaches to the the law. problems are being tested. Rehabilitation means physical, mental, emotional, social, and vocational Does addiction lead to crime? rebuilding. With many addicts, it can take all of Some stuides suggest that many of the known these efforts combined to keep their lives from being narcotic addicts have had some trouble with the law wasted. before they became addicted. Once addicted, they One experimental technique to help addicts in- may b:come even more involved with crhne be- volves maintenance treatment in community clinics, cause it costs so much to support the heroin habit. where the addict can go regularly to take a drug that For example, an addict may have to spend as much effectively blocks the "high" he would feel from as $75 or $100 to buy his day's supply of heroin. his heroin. Addicts who have stayed off the drug for Most authorities agree that the addict's involve- a number of years report that close supervision and ment with crime is not a direct effect of the drug it- continued treatment once they returned home from self, but turning to crime is usually the only way he the hospital were the main factors in their rehabili- has of getting that much money. His crimes are tation. nearly always thefts or other crimes against prop- In a New York City halfway house, a self-help erty, and not ofen crimes of passion or violence. program run by former addicts is being tried as a way to help people break the drug habit. One of What are the legal penalties? the features of Day-top Village is the "no nonsense" The Harrison Act of 1914, which provides that treatment the new patients get from the senior illegal possession of narcotics is punishable by fines members of the house. They hold frank and open and/or imprisonment, established federal penalties group discussions several times a week, and gain for illegal narcotics usage. Sentences can range from status and privileges only by hard work, honesty, 2 to 10 years for the first offense, 5 to 20 years for and staying off drugs. The treatment program lasts the second, and 10 to 20 years for further offenses. a year. Illegal sale of narcotics can mean a fine of $20,000 Because the rebuilding of a life can require many

37 414 services and special programs, this chance for ad- The National Institute of Mental Health of the dicts was very limited in the past. Now a new Ipw U. S. Department of Health, Education, and Wel- the Narcotic Addict Rehabilitation Act of 1966 fare and the Department of Justice administer the gives certain addicts a choice of treatment instead Act. of imprisonment, and if th,:y are not charged with a Under more recent legislation, states and corn- crime, the right to receive treatment instead of munitie can receive federal support through the neglect. The law also provides for the first time that NIMH for specialized training programs, and for a complete range ot rehabilitation services will be the construction, staffing, and operation of new ad- made available to addicts in their own home com- diction treatment facilities on a jobit federal-state munities. 1)asis. What is the Narcotic Addict Rehabilitation Act of What is being done to learn more about addiction? 1966? The Act provides that: The National Institute of Mental Health operates I. An addict charged with a nonviolent federal Clinical Research Centers at Lexington, Kentucky, offense who elects to be committed for treatment and Fort Worth, Texas. Scientists at the centers do instead of prosecuted for his crime can be com- research on patterns of drug usage, on effects of mitted to the Secretary, Department of Health, drug use, and on antidotes for narcotic addiction. Education and Welfare, for examination, treatment, These centers were formerly Public Health Service and rehabilitation. hospitals for addicts and will treat addicts under 2. An addict already convicted of a crime can the new Act until community hospital facilities are be committed to the Attorney General for a treat- Available. ment period of no more than 10 years, or for the At the Lexington center, Institwe scientists are maximum period of sentence that could be imposed working with comparatively new drugs, cyclazocine for his conviction. and naloxone. Early clinical trials suggest that regu- 3. An addict not charged with an offense can lar doses of these drugs can help prevent heroin re- lie civilly committed to the Secretary for treatment lapse by decreasing the addict's desire for heroin. upon his own application, or that of a relative or In addition, the NIMH Center for Studies of another "related individual." Narcotic and Drug Abuse supports research, train- Care of the addict after his release from the hos- ing, and services dealing with problems of addic- pital is a key aspect of his treatment. tion.

38 DEPENDENCE ON BARETURATESAND OTHER SEDATIVE DRUGS In today's society, anxiety, tension states, insom- In the United States, these drugs can be purchased nia, and other manifestations of stress are canmon. on the black market and are being used either Many persons seek relief by self-medication with alone or in combinations, particularly with heroin, alcohol, and over-the-counter and prescription seda- amphetamines, or alcohol. tives. Unfortunately, social acceptance of this kind The dependence-producing qualities of the bar- of self-medication seems to be increasing. biturates were not immediately recognized, but they have become increasingly clear since 1940. It should Historical Note be noted, however, that the long-acting barbiturates, Drug abuse is probably as old as the earliest such as phenobarbital, are less apt to be abused civilizations. Man has used great ingenuity in identi- than the short-acting barbiturates. fying substances which ease tensions, but for cen- In the 1950's, a new class of drugs, the so-called turies available agents remained relalively static, minor tranquilizers, began to appear. They have a limited to botanicals and their derivatives. Then, barbiturate-like action and can produce both psy- in the1850's, modern chemistry oPened a new chological and physical dependence. They quickly chapter with the introduction of bromides as seda- found widespread use, found their way to the black tives. With use, however, came misuse and abuse market, and have been abused in much the same which often resulted in intoxication and psychotic manner ae the barbiturates. (See the Appendix for a or delirious complications. The bromide problem list of barbiturates and othe1 sedatives and hyp- began t:-) abate in the 1930's but only because the notics.) compounds were replaced by other sedatives, pri- marily the barbiturates. Definition of the Problem The first barbiturate, Veronal, was introduced in Barbiturate Production in the U. S. 1903, and a large number of others followed in quick succession. The short-acting barbiturates, especially A survey by the Food and Drug Admin stration pentobarbital, secobarbital, and amobarbital, came indicates that in 1962 approximately one million into widespread use within the last 20 to 30 years. pounds of barbituric acid derivates were available Like the bromides, they have been subject to abuse. in the United States. This one-year inventory is enough to supply approximately twenty-four 100- This statement was prepared by the AMA Committee on mg (11/2-grain) doses to every man, womq, and Alcoholism and Addiction, reviewed by the Council on Drugs. child in the country. An estimated 50% of these and approved by the Council on Mental Health. drugs were the short- and inLermediate-acting bar- Reprinted from the Journal of the American Medical Asso- ciation, August 25, 065. Copyright American Medical Asso- biturates which are particularly subject to abuse. ciation. Since it is considered probable that the available supply mirrors demand, current production of all the sante patient. It should be noted that there are sedative drugs doubtless exceeds legitimate nledical some groups in society, subject to special tension need by a considerable margin. situations, for whom certain forms of "escape" are socially acceptable. In these groups, barbiturate Use of Sedatives abuse may be found particularly in adolescents and By Physicians: Each of the barbiturates and other younger adults,litallcases, however, the drug- drugs with a barbiturate-like action listed in the dependent person has found something that he Appendix has specific clinical indications in the knows will give him "relief" from tensions and practice of medicine. Many medical problems, in anxieties which to him are unb2arable. everyday practice, are efficaciously met by the proper Ba rbitura te dependence has sne characteristic in and judicious use of these drugs. common with all other states of drug dependence. The psysician relies heavily on the barbiturates It is almost always a chronic relapsing disorder, and for the treatment of insomnia. These compounds cycles of withdrawal and reversion to drug use are are convenient and reasonably effective, despite cer- likely to occur in most cases. In all cases, continuing tain adverse reactions such as "hang-over," develop- treatment of the dependency state and any under- ment of tolerance, occasional rashes, and paradoxi- lying emotional disorder is essential, even though cal excitation. there is intermittent, periodic, or even continuing By Patients: Although barbiturates and similar .drug use. compounds require physician prescription, a num- ber of substances with unpredictable sedative or Patterns of Abuse hypnotic action are available over the counter. Types of 1 b users Amonfthese are the antihistaminesantiemetics, Essentially there are four types of barbiturate- scopolamine, and bromides. drug abuse, and they overlap only occasionally. Abuse of Sedatives I. In the first group are persons seeking the seda- tive (hypnotic) effects of the drug in order to deal -Abuse" is used to describe self administration of with states of emotional distress, excessive quantities of barbiturates leading to toler- 2. In the second group there is a paradoxical ance, physical and psychological derenclence, men- reaction of excitation that occurs after tolerance tal confusion, and other symptoms of abnormal be- has developed because of prolonged use. The drug havior, The groundwork for drug abuse may often now stimulates rather than depresses and is taken be established by therapeutic misuse by the physi- to exhilarate and animate the person to so-called cian: however, many persons will seek drug supplies increased efficiency, from sources'other than the physician. Excessive use S. In a third group arc persons who take barbitu- is likely to result in the user becoming wholly de- rates to counteract abuse effects of various stimulant pendent on barbiturates to the exclusion of other drugs such s the amphetamines. They set up a values in life. Many dependent persons seek to avoid mutually reciprocating, cyclical pattern of stimu- reality, pin relief from tensions and anxieties. They lation-sedation. take these drugs in lieu of or in addition to alcohol 4. In the fourth category, barbiturate abuse is or opiates.Others follow the same procedure in found in combination with other types of drug search of paradoxical excitation and new thrills. abuse, mainly alcohol and/or opiates. Many alco- Psychiatric Considerations holics attempt to counteract the withdrawal effects of alcohol with barbiturates. Frequently, alcohol Generally any patient whose psychological de- and barbiturates are combined in an attempt to ob- pendence on a barbiturate drug has reached a de- tain effects that surpass thme of either. gree sufficient to constitute drug abuse has some form of underlying psychopathology. The excessive Diagnosis of Misuse and Abuse use of barbiturates usually induces additional psy- chopathologic changes. The barbiturate-dependent General person, in these cases, is directly comparable to the The physician should suspect dependence on opiate-dependent person. sedatives if members of the family report that the The underlying reasons why an individual takes patient is sedated, confused, ataxic, incoordinate, barbiturates vary from person to person and may and irritable. even serve different purposes at different times for Early diagnosis of barbiturate abuse and/or de-

40 4 "/ pendence is often difficult: In many cases, drug Amobarbital (Amytal) dependence or intoxication is diagnosed only after Aprobarbital (Alorate) hospitalization of the patient for some other clinical Butabarbital(Butisol) condition. Often the first objective finding of bar- Diallylbarbituric acid (Dial) biturate dependence isthe onset of acute with- Probarbital (I pral) drawal, perhaps a single, unexplained grand mal Talbutal (Lotusate) seizure brought on by sudden abstinence. Vinbarbital (Devinal) Cyclobarbital (Phanodorn In toxicat ion Heptabarbital (Medontin) Intoxication with barbiturates resembles intoxi- Hexer:hal (Ortal) cation with alcohol. Symptoms and signs include Pentobarbital (Nembutal) various degrees of clouding of consciousness with Secobarbit.(Seconal) impairment of mental functioning, confusion and Hexobarbital (Cyclonal, Evipal, Sombulex) poor judgment, euphoria or depression, loss of emo- Methitural (Nevaval) tional control, irritability, abnormal behavicr, and Methohexital (Brevital) orcasimially convulsions or signs of a toxic psychosis. Thiainylal (Surital) Thiopental (Pentothal) Withdrawal Syndrome Allylbarbituric acid (Sancloptal) Butethal (Neonal) Sudden and abrupt withdrawal of barbiturates Cyclopentenylallylbarbituric acid (Cyclopal, from a person who is physically dependent results in Cyclopen) definite abstinence signs and symptoms. Their in- Butallylonal (Pernocton) tensity varies according to the dose taken, the length of time the patient has been physically dependent, Drugs With Barbiturate-Like Action the degree ofintoxication produced by doses con- Chlormezanone(Trancopal) sumed, and individual factors which remain incom- Emylcarnate (Striatran) pletely understood. Meprobamate (Equanil, Milto Even though no treatment is given, the entire Oxanamide (Quiactin) withdrawal syndrome is usually a self-limited condi- Phenaglycodol (Ultran) tion.Clinical recovery appears to be complete and Mebutamate (Capla) no organic sequelae are known to occur. However,' Carisoprodol (Soma patients have died during uncontrolled, untreated Hydroxyzine (Atarax, Vistaril) barbiturate-withdrawal syndromes. Ectylurea (Levanil, Nostyn) Ethchlorvynol (Placidyl) Appendix Methyprylon (Noludar) Hypnotic and sedative drugs comprise a large Ethinamate (Valmicl) group of chemically unrelated substances which Chlordiazepoxide (Librium) have :he common property of inducing sedation Hyclroxyphenamate (Listica) and sleep with small quantities and anesthesia with Mephenoxalone (Trepidone) large quantities. Barbital and its congeners repre- Carbromal (Adalin) sent the largest single group of these compounds. Bromisovalum (Bremural) The following drugs are on the U.S. market: Chloral Betaine (Beta-Chlor) Glutethimide (Doriden) Barbiturates Chloral Hydrate (Somnos, Noctec, Loryl) Barbital (Veronal) Diazepam (Valium) Mephoharbital (Mebaral) Methylparafynol (Dormison) Metharbi:-1 (Gemorril) Petrichloral (Periclor) Phenobarbital (Luminal) Buclizine (Softran)

41 DEPENDENCE ON AMPHETAMINES AND OTHER STIMULANTDRUGS Stimulant drugs of the amphetamine type have mine abuse, i.e. unsupervised self-administration. It been used in medical practice for the past 35 years. also has become increasingly clear that many physi- During this period identifiable patterns of abuse cians have not fully appreciated the inherent dan- and misuse have been established, and it has been gers in prescribing these medications, and that in demonstrated that, for many persons, these sub- many cases their presumably therapeutic actions can stances have dependence-producing characteristics constitute misuse of the drugs. which can bring about serious clinical and personal The degree to which the abuse of stimulant drugs problems. However, unlike that with narcotics or stems from over-prescribing or from black market barbiturates, over-medication with stimulants does sales is not known. However, the problem is serious hot lead to physical dependence. Abuse of these enough to warrant concern and an exarnination of substances arises from and is perpetuated solely by the use, misuse, and abuse of the stimulants. psychic needs to overcome depression or fatigue or to attain the euphoric and excitatory effects asso- Historical Note ciated with the drugs. The main stimulant drugs are amphetamine and The routes to dependence on stimulant drugs are methamphetamine. Both were synthesized in the varied. Some start in the physician's office where a 1920's. The amphetamines, however, have a much prescription for amphetamine is given as treatment greater capacity for stimulation of the central nerv- for depression or as an adjunct to weight reduction. ous system. With small doses of amphetamines, this Most cases, however, stern from illiLit channels stimulation is limited to elevation of mood and the where drugs are sold indiscriminately to a variety induction of a state of 'well-being.' As the dosage of customers, such as truck drivers who waw. io stay is increased, apprehension, volubility, tremor, and awake during long hauls or teenagers and young excitement occur. adults looking for "kicks." It soon became apparent that the amphetamines The actual incidence and prevalence of cases of were effective in retarding fatigue-induced deterio- drug dependence of the amphetamine type are un- ration in psychomotor performance and that, under known. Clinical experience in the United States and medical supervision, they had some appropriate use other countries indicates an increase in ampheta. for weight reduction of obese persons. During the past 15 years, a number of amphetamine-like sub- This statement was prrpared by the AMA Committee on stances have been marketed as anorexiants. These Alcoholism and Addiction, rev1ewed by the Council on Drugs, drugs also stimulate the central nervous system to and approved by the Council on Mental Health. varying degrees and therefore have a potential for Reprinted From The Journal of The American Medical As- sociation, September 19, 1966, Vol. 197, pp. 11923-1027, Copy- psychic disturbance and dependence. right 1966, by American Medical Association. Amphetamine-type drugs were in widespread use

42 49 before their dependence-producing properties were Abuse of Stimulants recognized. However, theirabilitydo cause en- None of the drugs considered here is legally avail- phoria, dysphoria, and psychic sthnulation did lead abie without prescription. Large quantities, how- tothe removal of amphetamine from over-the- ever, are available on the black market and, for counter nasal inhalers. Restricting the legal acquisi- example, thonsands of potnids have been confiscated ! tion of stimulants to prescription medications did in stops along the nation's major trucking routes. not, however, put an end to their misuse or abuse; The drugs are also sold "on the street" in lower today these drugs are part of a major medical and socio-economic neighborhoods and in "beatnik" or social problem. "bohemian" gathering places. The bulk of the illicit In 1965, concern in the United States about the supplies apparently are diverted from legitimate growing problems of drug dependence and abuse channels and handled by fraudulent wholesalers led to the passage of legislation, supported by the and other "front" organizations. An unknown per- American Medical Association, that gives the Food centageis obtained from unethical druggists or and Drug Administration authority to control the through forged or altered prescriptions. manufacture and distribution of substances haying There has been an alarming increase in the num- a potential for abuse, i.e. stimulants, depressants, ber of "spree" amphetamine abusers, usually teen- andhallucinogens. The Drug AbuseControl agers or young adults, who use the drugs in a social Amendments of 1965 require that detailed records setting for "kicks" or as an "experience." Many of be kept on the manufacture, shipment, and distribu- tion (including pharmacy prescription records) of these persons combine stimulants with other drugs, the drugs covered. This law should be useful in including alcohol, and "experiment" with the effects reducing the amount of these drugs diverted to obtained from the various combinations, Not in- illicit channels. Amphetamine-type drugs are also frequently, stimulants are taken intravenously by illegally synthesized for distribution on the black serious drug abusers. More often, they are taken market, and this traffic will be difficult to control. orally inthe form of amphetamine-barbiturate combinations. Definition of the Problem Patterns of self-medication with amphetamine- A survey by the Food and Drug Administration type drugs are varied. Some persons start taking indicated that, in 1962, over 100,000 lbs. of ampheta- stimulants to counteract effects resulting from abuse mine and methamphetamine products were avail- of barbiturates or alcohol, thus developing a cycli- able in the United States, The amount in this one- cal pattern of sedation-stimulation in which. to a year inventory is enough to supply 250 mg of these degree, each type of abuse counter-balances the stimulants to every man, woman, and child in the effects of the other. Other persons try to achieve country, i.e. 25 to 50 doses per person. both effectssimultaneously. In these cases,the U.ce and Misuse of Stimulants clinical problem is of a dual naturf.. Other dependence-prone persons, who have been Amphetamine-type drugs, in the usual dosage introduced to stimulants as an anorexiant or to range, make most individuals more alert, more combat fatigue or depression, become chronic abus- wakeful (often to the point of insomnia) , and less ers. They often obtain their stimulants by "shop- aware of fatigue, and may produce euphoria or ping" from one physician to another. Some develop dysphoria. The drugs have some proper medical use in a few situations where an individual 'most' con- a relatively mild form of psychic dependence in tinue to perform adequately for an abnormally long which, although believing that the drugs are essen- time. The physician should judge carefully what tial to maintain their daily routine, they do not constitutes a 'must situation. increase the dosage rr itch beyond usual therapeutic Physicians are frequently requested to prescribe limits. The more prevalent pattern of abuse is the stimulants for a variety of nonmedical reasons. Con- one in which the person self-administers the drug trolled studies have shown that amphetamines can withincreasingfrequencyandinincreasing drive trained athletes to increased performance in amounts to get the desired euphoric effects. individual events involving strength and endurance. With all dangerous drugs, the principal hazards However, it has also been shown that this practice of self-medication is that the abuser often is incapa- can, by artificially pushing the athlete beyond his ble of accurai ely evaluating his performance and normal endurance level, be harmful or even fatal. is likely to overmedicatea practice that, in neu-

43

414 -854 0 - 71 - 4 rotic or dependence-prone petss, often leach to increased mental alertness, a heightened sense of chronicabuse. well-being (euphoria ), and relief from the emotional tone of depression. Psychiatric Considerations As with types of drug dependence, abuse of the Withdrawal amphetamine-type drugs almost invariably reflects There is no evidence that persons develop physi- some underlying form of psychopathology. Am- cal dependence to stimulant drugs, and abrupt with- phetzunine dependence is a medical syndrome: a drawal will not produce seizures; nor isitlife- symptom complex that usually reflects some form of threatening, even for large-dosage, chronic abusers psychological and behavioristic disorder that has or persons with amphetamine psychosis. Depending preceded and predisposed the patietu to drug abuse. on the intensity of the abuse, all measurable traces The stimulant is commonly used as an "adjustive" of amphetamine should disappear from the body in mechanism to help the person "de4t" with problems from two to seven days. of living and emotional difficulties. Abe e consti- Although thereis no characteristic abstinence tutes a "reaching out- for something without which syndrome, the abrupt discontinuance of ampheta- the patient feels relatively helpless, and there isa mines is not without complications. Withdrawalcan continuum between what constitutesill-advised uncover an underlying depression or it may pre- "self-medication" and full abuse. cipitate a depressive reaction, often with a suicidal The underlying reasons for drug abusevary from potential. There also is some evidence that incer- person to person, and the drug may serve different tain persons amphetamine intoxicationcan pre- purposes at different times for the same patient. cipitate a schizophrenic episode. Usually, the amphetamine-dependent patientis, In many persons whose stimulant intake masks consciously or unconsciously, seeking to attainone chronic fatigue, withdrawal is followed bya two- or or more of the following effects: relief from fatigue, three-day ileriod of intense tiredness and sleepiness.

44 DRUG DEPENDENCE: ITS SIGNIFICANCE AND CHARACTERISTICS NATHAN B. EDDY, M.D., Consultant, National Institutes of Health; H. HALBACH, Dr. med., Chief, Pharmacology and Toxicology, World Health Organization, Geneva; HARRIs ISBELL, M.D., Professor of Medicine and Head, Section of Clinical Pha_macology. University of Kentucky; MAURICE H. SERVERS, M.D., Professor of Pharmacology, The University of Michigan. The Term 'Drug Dependence' pendence of morphine type, of cocaine type, or of Much thought and discussion have been devoted cannabis type. Other types of drug dependence, such to finding a term that will cover all kinds of drug as those of the barbitux ate and amphetamine types, abuse. The component in common appears to be continue to present problems, and their description dependence, whether psychic or physical or both. under the general term of drug dependence, while Hence, use of the term 'drug dependence' with a it may help to delineate those problems, in no way modifying phrase linking it to a particular type of suggests or affects the measures to be taken to solve drug is recommended for both of the terms drug them. addiction and drug habituation This recommenda- Some drugs induce physical dependence, which is tion has been endorsed by the WHO Scientific an adaptive state that manifests itself by intense Group on Evaluation of Dependence-Producing physical disturbances when the administration of Drugs (l964). the drug is suspended or when its action is affected Drug dependence is a state of psychic ox physical by the administration of a specific antagonist. Thesi. dependence, or both, on a drug, arising in a person disturbances, i.e., the withdrawal or abstinence syn- following administration of that drug on a periodic dromes, are made up of specific arrays of symptoms or continuous basis. and signs of psychic and physical nature that are It must be emphasized that drug dependence is a characteristic for each drug type. These conditions general term that has been selected for its applica- are relieved by re-administration of the same drug bility to all types of drug abuse and thus carries no or of another drug of similar action. connotation of the degree of risk to public I-alth Many of the drugs that induce dependence, es- or need for any or a particular type of drug cwitrol. pecially those that create physical dependence, also The agents controlled by international treaties and induce tolerance. Both drug dependence and drug by national narcotics laws continue to be those that abuse may occur without the development of are morphine-like, cocaine-like, or cannabis-like, the demonstrable tolerance. use of which may result, respectively, in drug de- Drugs that are capable of inducing dependence Excerpted from World Health Organization Bulletin, 1965. may also be associated with psychotoxic effects that 32,721-733. are manifested by profound alterations in behavior.

45 These eIlects may occur with a single large close or (pent consequences. For society also, the resultant during the course of continued administration, or harm is chiefly related to the preoccupation of the they may be precipitated by withdrawal of the drug individual with drug-taking; disruption of inter- following continued administration. The pattern of personal rela tic nships, economic loss, and crimes abnormal behavior is, within limits, characteristic against property are frequent consequences. The for each drug type, but wide variation occurs in abstinence syndrome appears a few hours after the individualresponsesdepending,amongother last dose, peaks in 24-4S hours. Most severe symp- things, upon the preexisting mental state of the toms usually disappear within ten days, person involved. The characteristics of drug dependence show Drug Dependence of Barbitnrat, -Alcohol Type significant differences from one generic type to The signs and symptoms of barbiturate and of another, a situation that makes it mandatory LO alcohol intoxication are similar, as are the signs and establish clearly the pattern for each type of drug symptoms of abstinence from these drugs. Barbitu- dependence. rates will suppress alcohol abstinence phenomena, and alcohol will suppress, at least partially, the Characteristics of Drug Dependence symptoms of barbiturate withdrawal. The two drugs Drug Dependence of Morphine Type are essentially addictive and interchangeable in The outstanding and distinctive characteristic of chronic intoxications; these similarities justify the dependence on morphine and morphine-like agents term "dependence of barbi.urate-alcohol type," but is that the major elementspsychic and physical there are psychological and sociological differences, dependence, as well as tolerancecan be initiated so that barbiturate and alcohol dependence will be by the repeated administration of small doses and described separately. increase in intensity in direct relationship to an increase in dosage. This characteristic implies that Drug dependence of barbiturate type dependence -m drugs of this generic type may be While dependence on drugs of the barbiturate created witnin the dosage range generally used for type presents certain simila'ities to dependence on thet-apeutic purposes, and that its mechanism may drugs of the morphine type, in detail there is a be set in motion Ly the first dose administered. characteristically different picture both during the The characteristics of dependence of the mor- course of intoxication and during withdrawal. It is phine type are: a state arising from repeated administration of a (a) Strong psychic dependence, which manifests barbiturate on a continuous basis, generally in itself as an overpowering drive or compulsion amounts that exceed the usual therapeutic dose to continue taking the drug and to obtain it by levels. There is a strong desire or need to continue any means, for pleasure or to avoid discomfort. taking the drug, a need that can be satisfied by the (b) An early development of physical dependence drug taken initially or by another with barbiturate- which increases in intensity, paralleling in- like properties. There is a psychic dependence on crease in dosage_ This requires a continuation the effects of the drug that is related to subjective of administration of the same drug, or an and individual appreciation of those effects, and allied one, to maintain a semblance of homeo. there is physical dependence requiring the presence stasis and to prevent the appearance of the of the drug for the maintenance of homeostasis and symptoms and signs of withdrawal. With- resulting iri a characteristic and self-limited absti- drawal of the drug or administration of a nence syndrome when the drug is withdrawn. specificantagonistprecipitatesadefinite, Tolerance to barbiturates does develop and, with characteristicandself-limitedabstinence relatively low doses, it will become evident within syndrome. seven days. 71tere is, in contrast with tolerance to (c)Development of tolerance that requires an morphine-like drugs, a limit to the dose to which increaseindosagetoobtaintheinitial a person can become tolerant. This limit is a charac- pharmacodynarnic effects. teristic of the individual patient and varies widely. With drug dependence of the morphine type, During the chronic intoxication of continuing harm to the individual is, in the main, irdirect, administration, there is some persistence of sedative arising from preoccupation with drug-taking- per- action, ataxia, etc. through the incomplete develop- sonal neglect, malnutrition and infection ace fre- ment of tolerance, which makes the individual

46 5,3 accident-prone. There is also impairment of mental tinuous drinking there is a slight but definite in- ability, confusion, increased emotional instability, crease in the amount of ingested alcohol required and risk of sudden overdosage. to maintain a given blood level. In addition, some The abstinence syndrome is the most characteris- sort of physiological and psychological adaptation tic and distinguishing feature of drug dependence occurs so that the alcoholic appears less intoxicated of the barbiturate type. It begins to appear within and is less impaired in performance tests at a given the first 24 hours of cessation of drug-taking, reaches concentration of blood alcohol thanisanon- peak intensity in two or three days, and subsides alcoholic. Tolerance to alcohol, however, isin- slowly. Symptoms constituting the abstinence syn- complete and never reaches the degree seen with drome, in approximate order of appearance include: morphine-like agen ts. anxiety, involuntary twitching of muscles, tremor of Physical dependence on alcohol definitely occurs, hands and fingers, progressive weakness, dizziness, and the abstinence syndrome resulting when the distortion in visual preception, nausea, vomiting, intake of ,Llcohol is reduced below a itical level insonmia, weight loss, a precipitous drop in blood is manifested by tremors. sweating. nausea, tachy- pressure on standing, convulsions of a gTand-mal cardia, rise in temperature, hyper-reflexia, postural type, and delirium resembling alcoholic delirium hypotension and, in severe grades, convulsions and tremens or a major psychotic episode. delirium. The last-mentioned condition is charac- In drug dependence of the barbiturate type, the terized by confusion, disorientation, delusions and detrimental .effect on the individual sterns in part vivid visual hallucinations. The intensity of the from his preoccupation with drug-taking, but more alcohol abstinence syndrome probably varies with particularly from the untoward effects of large doses the duration and amount of alcol 11 intake. of the drug. By analogy, all agents which produce barbiturate-like sedation, because of the relief of Drug Dependence of Cocaine Type anxiety, mental stress, etc should produce some Cocaine is the prototype of the stimulant drugs psychfr dependence and, for the reasons enumerated that are capable, in high dosage, of inducing eu- for dosage increase, physical dependence when a phoric excitement and hallucinatory experiences. sufficient concentration in the organism has been These properties rank it high in the esteem of c attained. perienced drug abusers and lead to the highest degree of psychic dependence. Drug dependence of alcohol type Abuse of cocaine takes several forms. The most Drug dependence of the alcohol type may be said common is the centuries-old custom of coca-leaf to exist when the consumption of alcohol by an chewing, which is practised habitually by certain individual exceeds the limits that are accepted by Indians of the high Andes. With this form of abuse, his culture, if he consumes alcohol at times that are release of the alkaloid and its absorption generally deemed inappropriate within that culture, or if his are too slow or quantitatively too small to induce intake of alcohol becomes so great as to injure his mental changes that would leadto abnormal health or impair his social relationships. Since the behavior, as described below. use of alcoholic beverages is a normal, or almost Diminished need for cocaine as a local anaesthetic normal, part of the cultures of many countries, and contiol of the world supply has reduced the dependence on alcohol is usually apparent as an total illicit use of this drug, but coincidentally there exaggeration of culturally accepted drinking pat- has developed a most dangerous type of abuse terns, and the manifestations of dependence vary intravenous injection. In the most advanced form, accordingly in a characteristic fashion with the this type of abuse involves administration at fre- cultural mode of alcohol use. quent intervals, as short as 10 minutes, the user As with other drugs, psychic dependence on alco- desiring the ecstatic thrills associated with this prac- hol results from an interplay between the pharma- tice. This type of abuse appeals particularly to codynamic effects of the drug and the personality persons with psychopathic tendencies, which are problems of the user. Other reasons not consciously often unmasked by the drug. The induced feeling verbalized, may include needs to express mascu- of great muscular and mental strength leads the linity, to remove behavioral controls so that aggres- individual to overestimate hicapabilities. This, sive imvulses may be expressed, and to blot out associated with paranoid delusions and auditory, completely a hostile, threatening world. visual and tactile hallucinations, often makes the Tolerance to alcohol does develop. During con- user a very dangerous individual, capable of sericus

47 antisocial acts, Digestive disorders, nausea, loss of Among the more prominent subjective effects of appetite, emaciation, sleeplessness, and occasional cannabis, for which it is taken occasionally, periodi- convulsions are commonly experienced by cocLine cally or chronically, are:hilarity, often without abusers of this type. Long-standing, continuing mis- apparent motivation; carelessness; loquacious eu- use of cocain( alone at a high level is rare, however. phoria, with increased sociability as a result: distor- The user reaches such a state of excitement that he tion of sensation and perception, especially of space voluntarily seeks sedation. A frequent current prac- and time, with the latter reinforcing psychic de- ticeisto antagenize the exciting effects by the pendence and being valued under special circum- alternate administration of morphine or some other stances; impairment of judgment and memory; dis- depressant drug, or by the injection of two types of tortion of emotional responsiveness; irritability; and drug in combination, the cocaine-heroin mixture confusion. Other effects, which appear especially ('speedball') being particularly popular. after repeated administration and as more experi- No physical dependence on cocaine develops and, ence is acquired by the user include: lowering of the consequently, no characteristic abstinence syndrome sensory :hreshold, especially for optical and acousti- is noted on abrupt withdrawal. But severe depres- cal stimuli, thereby resulting in an intensified feel- sion may occur and delusions may persist for some ing for works of art, paintings and music; hallucina- time after withdrawal. tions, illusions, and delusions that predispose to Since cocaine undergoes rapid destruction in the antisocial behavior; anxiety and aggressiveness as a orga,iism, large quantities can be given during a possible result of the various intellectual and sen- 24-hour period. Indeed, in man as much as 10 gin sory derangements; and sleep disturbances. daily mo be used when the drug is administered in Typically, the abuse of cannabis is periodic but, relatively small doses at short intervals. even during long and continuous administration, no In sumluary, then, the characteristics of drug evidence of the development of physical dependence dependence of the cocaine type are: can be detected. There is, in consequence no charac- (a) Strong psychic dependence. teristic abstinence syndrome when use of the drug is (b) No development of physical dependence and, discontintied. therefore, absence of a characteristic absti- Whether administration of the drug is periodic nence .syndrome when the drug is withdrawn. or continuous, tolerance to its subjective and psycho- (c) Absence of tolerance; rather, there is sensitiza- motor effects has not been demonstrated. tion to the drug's effects in some instances. Whereas cannabis often attracts the mentally un- (d) A strong tendency to continuation of adminis- stable and may precipitate temporary psychoses in tration,as incoca-leaf chewing, or rapid predisposed individtulls, no unequivocal evidence is repetition of the dose, as in the current prac- available that lasting mental changes are producua. tice of intravenous administration. Quantita- Drug dependence of the cannabis type is a state tively,theeffectsarestrikinglydifferent, arising from chronic or periodic administration of according to the mode of abuse. cannabis or cannabis substances (natural or syn- Cocaine is probably the best example of a sub- thetic). Its characteristics are: stance to which neither tolerance nor physical de- (a) Moderate to strong psychic dependence on pendence develops and with which psychic depend- account of the desired subjective effects_ ence can lead to a profound and dangerous type of (b) Ab:,.'.,ce of physical dependence, so that there drug abuse. is no characteristic abstinence syndrome when Drug Dependence of Cannabis (Marihuana) Type the drug is discontinued. It is not known with absolute certainty which of (c) Little tendency to increase the dose and no the chemical structures that have been isolated from evidence of tolerance. Cannabis sativa L. is responsible for the typical For the individual, harm resulting from abuse of cannabis effects, but these can nevertheless be cannabis may include inertia, lethargy, self-neglect, described as constituting an entity that varies in feeling of increased capability, with corresponding degree according to the concentration of the active failure, and precipitation of psychotic episode& principle or principles it: the plant and the prepara- Abuse of cannabis facilitates the association with tions obtained therefrom, and to the mode of appli- social groups and sub-cultures involved with more cation_ These effects are also producible by certain dangerous drugs, such as opiates or barbiturates. synthetic substances of similar chemical structure. Transition to the use of such drugs would be a

48 5' consequence ofthisassociation rather than an Although the amphetamines do not induce physi- inherent effect of cannabis. The harm society cal dependence, as measured by the criterion of a derived from abuse of cannabis rests in the eco- characteristicand reproducibleabstinencesyn- nomic consequences of the impairment ofthe drome, it would be inaccurate to state that...ith- mdividuars socialfunctions andhis enha ced drawal from very large dosages is symptomless. The proneness to asocial and antisocial behavior. sudden withdrawal of the stimulant drug which has masked chronic fatigue and the need for sleep now Drug Dependence of Amphetamine Type permits these conditions to appear in an exaggerated fashion. Thus, the withdrawal period is characteris- The capacity of the amphetamines and drugs with similar pharmacological properties to elevate mood tically a state of depression, both psychic and physi- cal, which probably reinforces the drive to resume and induce a state of well-being is probably largely the basis for their value and widespread use as the drug. In this regard, it is much less important stimulants and anorexiants. Since such therapy and does not compare in magnitude with those that commonly involves continuous and prolonged ad- occur with morphine, barbiturates, alcohol and other drugs that create physical dependence. With- ministration, the users of these drugs may develop drawal of drugs of the amphetamine type is never varying degrees of psychic dependence upon them. threatening to life and requires psychological rather This fact establishes the basis for abuse, where the dosage may be increased in both quantity and than somatic therapy. frequency of administration in order to attain a The use of amphetamines by self-administration continuing stimulation and state of elation. When has increased consistently in recent years, ostensibly carried to an extreme, the psychotoxic effects of as anti-fatigue agents in situations in which itis large amounts of drugs of the amphetamine type desired to remain mentally alert for long periods without sleep or rest or to permit increased physical may lead to aggressive and dangerous antisocial performance. The use of amphetamines as sumu- behavior. lants has also increased markedly in persons who The abuse of this class of &LI& triginates in and abuse alcohol and/or barbiturates; in many such is perpetuated by the psychic drive to attain maxi- instances there is dependence on more than one mum euphoria; no physical dependence is created. drug. In such cases, the prognosis is poor, the relapse ualitatively, the psychological effects are in many rate is high, and continued dependence on one or respects similar to those produced by cocaine. more drugs is the rule, especially in prepsychotics or A unique feature of the amphetamines is their individuals with latent schizophrenia. capacity to induce tolerance, a quality possessed by few central nervous system stimulants. Although Drug Dependence of iChat Type tolerance develops slowly, a progressive increase in Khat (Catha edulis Forssk.) is cultivated and con- dosage permits the eventual ingestion of amounts sumed in circumscribed areas of East Africa and the that are several hundredfold greater than the origi- Arabian peninsula. The common, and quantita- nal therapeutic dose. Apparently, all parts of the tively most profitable, mode of application is by way central nervous system do not become tolerant at of chewing the tender parts of the plant in as fresh the same rate, so that the user will continue to a state as possible. experience increased nervouwess and insomnia as Drug dependence of the kirk type is, under the the close is increased. Although an individual may circumstances of itstraditional consumption by survive the oral administration of very large quanti- chewim;, characterized by: ties,such ingestion 'may produce profound be- (a) Moderate but often persistent psychic depend- havioral changes that are often of a psychotic ence as long asits maintenance isatall re,including hallucinations,delusions,etc. practical. These !suet effects are much more likely to occur (b) Lack of physkal dependence. afteri%Ltz .u.v.is injection than after ingestion. (c) Absence of tolerance. '.,,..avenous route is employed rat- the The habitual and, in particular, the exaggerated expres.: of obtaining bizarre mental effects consumption of khat may, on account of its non- often associated with sexual tunetions, even to the amphetamine ingredients (tannins) damage the in- point of orgasm. This type ce -buse has been in- dividual's health. The social and economic conse- creasingly frequent in recent yea-s with the chang- quences of dependence on khat consist, in the main, ing patterns of drug abuse in various countries. of the alienation of the user's funds and the erosion

49 5E3 of his working capacity and concern both the two or three days is ihe custornar7 pattern; pro- individual and the community. longed or continuous use is unusual. Periodic, rather than continuous, nse is favoured by difficulty in ob- Drug Dependence of Hallucinogen (LSD) Type taining the drugs, rapid development and disappear- Drugs of this type include lysergic acid diethyla- ance of tolerance, and lack of physical dependence rnide LSD, a seinisynthetic derivative of ergonovine; on these drugs. psilocybin, an indole found in a mushroom ('teo- Drugs of the LSD type induce a state of excitation nanacatl,' Psilocybe mexicana); mescaline, the most of the central ncrvous system and central autonomic active alkaloid present in the buttons of a small hyperactivity manifested by changes in mood (usu- cactus ('mescal,"peyote,' Lophophora williamsii), ally euphoric, sometimes depressiv), anxiety, dis- and in the seeds of some morning glory varieties tortion in sensory perception (chiefly visual), visual ('ololiuqui,' Rivea corymbosa L. Hall f.; Ipomcea hallucinations, delusions, depersonalization, dilata- violacea L.), the active principle of which is closely tion of the pupils, and increases in body tempera- related to LSD. The mushrooms, cactais buttons and ture and blood pressure. the morning glory seeds are used by certain Ameri- Psychic dependence on drugs of the LSD type can Indian tribes in religious ceremonies or are varies greatly, but it usually is not intense. The employed by medicine men or women of these tribes thrill-seekers and non-conformists may enjoy the in treating illness, usually in ritualistic fashion. Such effects of these agents and may wish to repeat them, religious and ritualistic use does not seem to lead but if such agents are not readily available, these frequently to drug dependence. The drugs possess a persons will either do without them or substitute particular attraction for certain psychologically and another substance. A minority of users may develop socially maladjusted persons who have difficulty in such strong psychic dependence on those substances conforming to usual social norms. These include that they wreck their careers by persisting in using frustrated non-conformists and curious thrill-seeking the drugs despite strong social condemnation. adolescents and young adults. The drugs are taken No evidence of physical dependence can be de- for thrills (-kicks"), to alter mood, to change and tected when the drugs are withdrawn abruptly_ clarify perception, to induce reveries, and to obtain A high degree of tolerance to LSD and to psilo- "psychological insight" into the personality prob- cybin develops rapidly and disappears rapidly_ Tol- lems of the user. Generally, the drugs are taken erance to mescaline develops more slowly_ Persons orally and in the company of other users. Ingestion who are tolerant to any of these three drugs are of a single dose or of several doses over a period of cross-tolerant to the other two.

50 USE, MISUSE AND ABUSE OF AMPHETAMINE-TYPE DRUGS MmipacE SEEVERS, Ph.D., M.D., Professor and Chairman, Department of Pharmacology, The University of Michigan Medical School Stimulant drugs of the amphetamine type are appetite in weight reduction programs. This is subject to extensive and increasing misuse and abuse undoubtedly the largest area for physician misuse. In the United States. Estimates suggest 70 tablets of The patient begins to abuse the drug compte.sively amphetamine and amphetamine-type are produced and often seeks other sources of supply to fulfill his legally in the United States for every man, woman, increased need as tolerance develops. and child. This is almost three times the estimated Amphetamines in moderate dosage (5-10 mg) are yearly production of barbiturates. This, in spite of capable of rendering most individuals more alert, the fact that stimulants have less logical value in more wakeful (often to the point of insomnia), and medicine than depressants. Although illicit manu- less aware of fatigue. Dumping large amounts of facture of amphetamines exists and is apparently on surplus amphetamines on the post-war Japanese the increase, no estimates of production are avail- market where it was, at that time, available without able. It is safe to state that the total production is prescription, established a serious drug-abuse prob- greatly in excess of proper medical need. At least lem,especially among juveniles.Probably,the 71 preparations of or containing amphetamine-type greatest use in the U. S.is by truck drivers and drugsre available on the American market for students. prescription use. These are listed in the attached A principal hazard of general use of these drugs Appendix. by self-administration lies in the fact that the user The use of these stimulants chronically in alcohol is rarely capable of making satisfactory evaluation and barbiturate addicts in an effort to increase of his performance and is most likelyto over- mental or physical performance is a most dangerous medicate, commonly leading to chronic abuse in practice since it permits the subject to take larger neurotic and poorly balanced individuals. and larger quantities of depressant drugs leading to The use of amphetamines in athletics is more mental and physical deterioration. In the same wide-spread than is generally admitted. In contrast hazardous category is the regular use of ampheta- to the situation with mental performance, studies mines in the morning to antagonize hang-over have demonstrated that amphetamines are capable effects from the 'spree' use of excessive alcohol and of driving trained athletes to increased performance barbiturates. in individual athletic events involving strength and Amphetamine-type drugs are prescribed to reduce endurance. Presented at the National Institute on Amphetamine Abuse Amphetamines possess capacity to stimulate the at Southern Illinois University, February 1966, central nervous system. In small doses, this is limited

51 to elevation of mood and the induction of a state of Nobese Tilden-Yates) 'well-being.' As the dosage is increased. apprehen- Plui mos Preparations (Cooper, Tinsley) sion, volubility, tremor, and excitement occur and Edrisal w /Codeine (Smith Kline k French) with larger doses hallucinations, and even convul- Compound Containing Dextro-Atnphetamine sions; the, latter being more prominent after large Phosphate doses given intravenously. Abuse of this class of Obocell (Neisler) substances arises from and is perpetuated solely by Compounds ConLaining Carboxyphen the psychic drives to attain maximum euphoria. Bont nt (Carnrick) -Physical dependence does not develop. Qua lita- Bon tril Timed Tablets (Carnrick) tively, these psychologic effects are similar to those produced by cocaine. A unique feature of the Compounds Con!aning Dextro-Ampl tamine amphetamines is their capacity to produce toler- Hydrochloride ancc. This property ispossessed by only a few Bamadex Sequels (Lederle) central nervous system stimulants. Although toler- Curban (Pasadena Research) ance develops slowly,progressive increments in Gevrestin (Lederle) dosage permit ingestion of amounts hundreds of Timed Amodex Capsules (Fellows-Testagar) times greater than the original therapeutic dose. Timed Pymadex Capsules (Fellows-Testagar) Although amphetamines do not induce physical Compounds Containing Dextro,Amplictamine dependence as measured by the criterion of a charac- Sulfate teristic and reproducible abstinence syndrome, it Amphaplex (Palmedico) would be inaccurate to say that withdrawal of large Amplims Improved (Roerig) doses is symptomless. However, it is not comparable Amsustain (Key Pharmaceuticals) to the withdrawal of morphine, barbiturates, alco- Amvicel (Stuart) hol and other substances which create physical Amvicel-X(10) (Stuart) dependence. It is never life-threatening. Amvicel-X(15) (Stuart) In closing, it could be pointed out that the am- Appetrol (Wallace) phetamine problem is only one facet of a much Appetrol-S.R. (Wallace) larger drug abuse problem which probably involves Daprisal (Smith Kline & French) 5% of the adult population of the United States, Dexalme-S Duracap Timed Action Capstiks (Meyer The same factors, emotional immaturity becoming Dexamyl (Smith & French) manifest more commonly in unfavorable environ- Dexedrine Sulfate (Smith Kline & French) mental circumstances and precipitated by stressful Dramamine-D (Searle) situations, are common to all types of drug abuse Eskatrol Spansule Capsules (Smith Kline & French) and require the same type of treatment. Theptine (Smith Kline & French) Compounds Containing Amphetamine Thora-Dex (Smith Kline & French) Amphaplex (Palmedico) Vi-Dexemin (Smith Kline & French) Amvicel (Stuart) Vio-Dex Tirnelets (Rowell) Amvicel-X(10) (Stuart) Zamatam (Marion) Amvicel-X(15) (Stuart) Zamitol (Marion) Biphetamine (Strasenburgh) Compounds Containing Dextro-Amphetamine Biphetainine-T (Strasenburgh) Tannale Obetrol (Obetrol) Nalertan Tabules (Neisler) Obocell (Neisler) Synatan (Neisler) Quadamine (Tutag) Compounds Containing Methampheta Compounds Containing Amphetamine Phosphate, Hydrochloride Monobasic, Racernic Ambar (Robins) Strascogesic (Strasenburgh) Amertal (Merit) Compounds Containing Amphetamine Sulfate Amphaplex (Palmedico) Benzedrine Sulfate (Smith Kline & French) Carrtussin Syrup (Carrtone) Dex-Sed-10 (Carrtone) Desbutal (Abbott) Dex-Sed-15 (Carrtone) Desbutal Gradumet (Abbott) Edrisal (Smith Kline & French) Desoxyn (Abbott)

52 5 Desoxyu Gradument (Abbott) Compomuis Co aining Methamplietamine Ger Bets Filmtab (Abbott) Preparations Meditussin (Palmedico) Amphaplex (Palmedi Methedrine (B. W..3:: Co.) Obetrol (Obetrol) Obedrin (Massengill) Span-RD (Metro Med) Obedrin-LA Tablets (Massengill) Drugs With Ampheta zin -like Action Obestat Ty-Med (Lemmon) Meratran (pipradrol) Opidice (Boyle) Ritalin (ruethylphenidate) Secodrin (Premo) Tennate (diethylpropion) Span-RD (Metro Med) Preludin (phenmetrazine)

53 PHARMACOLOGIC THERAPY IN NARCOTIC DEPENDENCE JEROME I-I. JAFFE, IVLD., Department of Psychiatry, The University ofChicago, Chicago, Illinois There is among young heroin users a high inci- dysphoric effects that patients will continue with dence of hepatitis, bacterial endocarditis, abscesses, treatment; it must be orally effective, Iong-acting, and occasional fatal overdoses, even when pure medically safe, and compatible with normal per- heroin in known amounts is available for self- formance in work and at school and with responsible administration. The social productivity of these behavior in society." heroin users is also below that of their own peer It had been known for more than a decade that groups, suggesting that they are either preoccupied low oral doses of methadone would allay the post- with drug use, living from one high to the next, or withdrawal-abnormality type of narcotic hunger. that in some way their capacity or motivation for What Dole and Nyswander were the first to observe productive activity is reduced. In the interest of was that when the dose of methadone isgradually reducing this antisocial activity and its accompany- increased so that it can be given in large oral doses, ing social deterioration and human misery, the it induces a cross-tolerance of such a degree that the New York Academy of Medicine in 1955, and again euphoric effects of other narcotics, even in relatively in 1963, encouraged medical research on the use of high doses, cannot be felt. Dole and coworkers have narcotks in the treatment of compulsive narcotics referred to this high degree of tolerance as -narcotic users. blockade." Thus, the pharmacological rationale of Methadone Maintenance the methadone maintenance treatment is based on To date, the most thorough study of the use of two actions of methadone; relief of "narcotic hun- such agents has been conducted by Dole an! ger" (of the persistent post-withdrawal abnormality Nyswander and their coworkers (1965, 1966, 1968). variety), and blockade of euphoric effects. Do'e and Nyswander started from the position that The technique of stabilization on methadone used it sc:ented "reasonable to look for some medication by Dole and coworkers consisted of a gradual (6 to to block the abnormal reactions of addicts of heroin 8 week) escalation of dose. When the rate at which and permit them to live as normal citizens in the the dose is increased is kept below the rate of toler- community. Any puch medication, to be of practical ance development most patients do not experience value, must meet a number of stringent conditions: euphoria or other psychological effects of narcotics, it must eliminate the euphoric appeal of heroin and even during stabilization. Since tolerance apparently the abstinence symptoms that draw addicts back to develops more slowly to autonomic effects, constipa- drug use; it must be sufficiently free from toxic or tion, decreased libido, and increased perspiration FromPsychopharmacology:Ten Years of Progress. may persist for some time after the patient is fully

54 6 tolerant to other effects. The modal stabilization with physical dependence, then patients on metha- dose is approximately 100 mg/clay. done are addicted. However, there is little resem- Reports on the current statusof We Dole- blance between the behavior that patients exhibit Nyswander snely (1967) indicate that over two- while on oral methadone and the behavior of the thirds of the more than 700 former chronic heroin same patients while on intravenous heroin; and users now in treatment are either working or going most workers in this field have tried to emphasize to school, or both. Many of these patients have been that addiction is not an appropriate synonym for in treatment for more than three years. The amount physical dependence. of known antisocial)ehavior among treated pa- Some narcotic antagonists such as cyclazocine and tients is remarkably low when one considers that the nalorphine have mild analgesic and psychotonii- patients selected were largely those who had failed metic effects. Tolerance develops to these effects, but to achieve abstinence after many years of drug use, does not seem to develop to the narcotic blocking repeated withdrawal treatments and multiple jail action. In common with nalorphine, cyclazocine sentences. The current cumulative conviction rate is produces a variety of physical it idence that is in reported to be 3%. Another dramatic effect of treat- many ways entirely distinct frol_ lat produced by ment is the decrease in the frequency of the use of any other drugs. illicit narcotics, verified objectively by means of From a pharmacological viewpoint, the patient thin-layer chromatography of urine specimens taken who takes a narcotic antagonist regularly can expect each time the- patient comes for medication, lt is not to avoid the development of physical dependence clear whether the decrease in heroin use is a result even if he continues to use narcotics, and the likeli- of the "blockade" of heroin-induced euphoria or the hood of a fatal overdose is markedly reduced, if not alleviation of "narcotics hunger," but the less im- eliminated. For patients, the idea of being relatively pressive results obtained with cyclazocine suggest insensitive to narcotics may bolster their capacity that the relief of "hunger" may be the more im- to avoid using illicit drugs. portant factor. The acceptability of this procedure is also another of its remarkable features, with many Recent Developments: Amphetamine-Antagonists drug users waiting for an opportunity to obtain Can the rationale for the use of narcotic antago- such treatment. Itisnot, however, successful in nists in opiate dependence be extended to other every case, and 10-15% of patients accepted for forms of compulsive drug use? Schuster and Wilson, treatment are eventually discharged for unaccept- at the University of Michigan, and the author, at able behavior or for failure to progress. the University of Chicago, have been seeking phar- Criticisms of the use of methadone in the rehabili- macological technics for modifying the self-admin- tation of the heroin user have ranged from dis- istration of amphetamines, cocaine, and related appointment with the experimental design of the agents. Among the agents that have been shown to study to condemnation of the effort on what appears block or attenuate the effects of amphetamines are to be largely moralistic grounds. Other criticisms the phenothiazines, butyrophenones, depleters of include the charge that (1) it is merely substituting norepinephrine, and inhibitors of the synthesis of the euphorigenic actions of methadone for those of norepinephrine. heroin; (2) it is merely substituting one addiction for another. It would be patently moralistic to reject Speculations on the future of Pharmacotherapy in a useful therapeutic agent merely because the medi- the treatment and prevention of narcotic depend- cine makes the patient feel good. It would also be ence: inappropriate to conclude that patients maintained It has been repeatedly observed that many Ameri- on methadone require or request frequent increases can drug takers use more than one drug (e.g., opiates in dose. Indeed, it is the experience of all who have plus b-rbiturates and amphetamines), sometimes worked with methadone maintenance that after the for synergistic effects, but often becauge their drug stabilization period patients can be maintained on of first choice is not available. It is not unlikely that the same dose for months, .-ind in some cases for such multi-drug users would also shift to alternative years. substances if, because of some pharmacological inter- Patients maintained on methadone are, of course, vention, the effects of their preferred drug could physically dependent and will exhibit withdrawal not be obtained. According to Nyswander (1967), symptoms if the drug is discontinued. Obviously, if some patients maintained on methadone who began one chooses to define addiction as being synonymous to use alcohol excessively accepted additional treat-

55 continued detectable effect on the overall rate of narcotics ment with disolfiram as a condition for admissions, or the treatthent with methadone. arrests, the number of hospital At present the number of compulsive narcotics crime rate. However, the advent of such patently users under treatment in the UnitedStates by all "medical" approaches and the generally favorable forms of pharmacological therapy combined isstill reports of their effectiveness havealready had a well under 2% of the estimated total number of major impact on the conceptualization of the prob- users. Under the circumstances,it would be un- lem, an impact that is likely to be felt increasingly reasonable to expect such treatments to have a over the next few years.

56 TOBACCO (NICOTINE). LouisGOODMAN,M D., and A.GILMAN,PH.D. About 600 billion cigarettes are smoked annually There is evidence that smoking increases blood in the United States alone. The acute effects of pressure and heart rate. And, although there is no tobacco smoking are due primarily to the nicotine proof that use of tobacco causes arteriosclerosis or content. Next to caffeine, nicotine is the substance results in angina pectoris, the induced cardiovascu- most widely used for its effect on mood. lar activity may trigger attacks. Effects of tobacco In each of 36 studies summarized in the 1964 smoking on motor and secretory activities of the Report of the U.S. Public Health Service on "Smok- gastrointestinal tract have not been found to be ing and Health," a positive correlation was observed significant, except in unusual cases. A relatively between the incidence of lung cancer and cigarette rare sequence to the tobacco habit is a gradualor smoking; approximately 11cigarette smokers die occasionally suddendecrease in visual acuity. from cancer of the lung for one nonsmoker. Fur- As stated above, tobacco's effects are due primarily ther, correlation between the use of cigarettes and to nicotine. Nicotine is an alkaloid which constitutes cancers of the oral cavity, larynx, and esophagus has from 0.5% to 8% of tobacco, averaging about 1.5% been demonstrated. The rate of pulmonary emphy- in cigarettes. It is one of the most potent drugs sema is also greater for chronic smokers. known and one of the most toxic, acting with a The use of tobacco has long been suspected as a rapidity comparable to that of cyanamide. cause of Buerger's disease inasmuch as more than Although nicotine in the lath century was used 90% of victims of the disease are smokers and treat- in American medicine as an emetic, nauseant, ex- ment is useless if patients continue to use tobacco pectorant and antiasthrnatic, it now has no thera- in any form. peutic applications. It acts on a variety of nerve Nasal, pharyngeal and bronchial irritation may cells and centers and has both stimulant and depres- occur as a result not only of ingestion of nicotine sant phases of action. For example, it both increases but of the irritation from the many other constitu- and slows the heart rate; it affects arteries which ents of tobacco or its smoke. Mucosa' injury may can influence heart rate; itt_;:.n cause changes in result from these causes and from the heat generated blood pressure; it can produce a hormone discharge in smoking. which accelerates cardiac rate and raises blood pressure. Excerpted from The Pharmacological Basis of Therapeutics, Nicotine markedly stimulates the central nervous by Louis Goodman. M.D., and A. Gilman, Ph.D., copyright C) by Macmillan Company. Used with permission of Mac- system. Appropriate doses produce tremors in both millan Company. man and laboratory animals; with somewhat larger

57 milk of doses, the tremor is followed byconvulsions. The liver, secondarily in the kidney, Itmg and excitation of respiration is a particularlyprominent lactating women. the central Poisoning may occur from accidental ingestion of action of nicotine. Since stimulation of is nervous system is followed bydepression, death can insecticide sprays in which nicotine is present. It both central said that the nicotine content of one cigarapproxi- result from failure of respiration due to but swallowed in paralysis and to blockade of the musclesinvolved in mates two lethal doses for man, the form of tobacco, nicotine is much lesstoxic than respira tion. subjectsparticularlynon- would be anticipated. Apparently the gastricabsorp- In some sensitive don of nicotine from tobacco taken bymouth is smokersthe smoking of one cigarette will inhibit much of the a water diuresis for 2-3 hours.Nicotine may result delayed so that vom:ting removes in increased motor activity of the boweland occa- tobacco from the stomach. sionally in diarrhea. Depending on thedose, the Tolerance to nicotine develops when the com- stimulating effect of nicotine on the gut is followed pound is taken repeatedly, as is evidenced by the confirmed tobacco smokers who are unaffected by by a stage of diminished intestinal tone and motor marked activity. amounts of the alkaloid which would cause Nicotine is excreted from the body mainlyin the symptoms in the beginner.

58 FACT SHEET ON FEDERAL NARCOTIC AND DANGEROUS DRUGLAWS Bureau of Narcotics and Dangerous Drugs, U.S. Department ofjustice, Washington, D.C. 20537 The term -narcotic drugs" includes opium and compound, sell, deal in, dispense or transfer nar- its derivatives such as heroin and morphine; coca cotic drugs must be registered and pay a graduated leaves and its derivatives, principally cocaine; and occupational tax. The law also imposes a commod- the "opiates" which are specially defined synthetic ity tax upon narcotic drugs produced in or imported narcotic drugs. Four principal statutes--the Nar- into the United States and sold or removed for cotic Drugs Import and Export Act, the Harrison consumption or sale. Narcotic Act, the Narcotics Manufacturing Act of Under the Harrison Act, sales or transfers of nar- 1960 and the Marihuana Tax Actcontrol narcotic cotic drugs must be recorded on an official order drugs and marihuana. These laws are designed to form. However, the transfer of narcotic drugs from insure an adequate supply of narcotics for medical a qualified practitioner to his patient and the sale and scientific needs, while at the same time they are of these drugs from a pharmacist to a patient with planned to curb, if not prevent, the abuse of nar- a lawfully written doctor's prescription are excep- cotic drugs and marihuana. In addition to these tions to this requirement. laws, there are other Federal legislative measures to NARCOTICS MANUFACTURING ACT OF lend additional cont-col over narcotic drugs. Since, 1960: The Narcotics Manufacturing Act of 1960 however, they are designed primarily to aid enforce- develops a system of licensing manufacturers to pro- rnent of the major statutes, they are not discussed duce narcotic drugs. It also provides a method to here. set manufacturing quotas for the basic classes of NARCOTIC DRUGS IMPORT AND EXPORT narcotic drugs, both natural and synthetic, insuring ACT: The Narcotic Drugs Import and Export Act that an adequate supply of each drug will be avail- authorizes the import of crude opium and coca able for medicine and science. leaves for medical and scientific. needs in the United MARIHUANA TAX ACT: The Marihuana Tax States. Import of other narcotic drugs is prohibited. Act requires all persons who import, manufacture, Manufactured drugs and preparations may be ex- psoduce, compound, sell, deal in, dispense, pre- ported under a rigid system of controls to assure scribe, administer, or give away marihuana to regis- that the drugs are used for medical needs only in ter and pay a graduated occupational tax. No com- the country of destination. modity tax is imposed on this drug. However, a HARRISON NARCOTIC ACT: The Harrison tax is imposed upon all transfers of marihuana at Narcotic Act sets up the machinery for distribution the rate of $1 per ounce, or fraction of an ounce, of narcotic drugs within the country. Under the if the transfer is made to a taxpayer registered under law, all persons who import, manufacture, produce, the act.

59 6 6 PENALTY PROVISIONS: iliegal sale or illegal Drug atul Cosmetic Act passed in 1965lid amended impcilation of all narcotic drugs and marihuana in 1968. can mean a penalty of 5 to 20 years in prison and DRUG ABUSE CONTROL, AMENDMENTS: the possibility of a $20,000 fine in addition. A These amendments control drug abuse in two ways. second or subsequent offense receives a penalty of One, they provide for stronger regulations in the 10 to 40 years in prison with a possible $20,000 fine. manufacture, distribution, delivery, and possession. There can be no probation or suspension of these Two, they provide strong crMiinal penalties against offenses. persons who deal in these drugs illegally. The penalties for all so-called possession type of Thus, all registered manufacturers, processors and offenses range between 2 and 10 years in prison for their suppliers, wholesaler druggists, pharmacies, the first offense and between 5 and 20 years for the hospitals, clinics, public health agencies, and re- second offense. For a third or subsequent offense, search laboratories must take an inventory, keep thc penalty can be from 10 to 40 years in prison. accurate records of receipts and sales of these drugs There can be no probation or suspension of sen- and make their records available to Bureau of Nar- tence for a second or subsequent offense. cotics and Dangerous Drug agents for examination. Because of the serious nature of narcotic addiction No prescription for a controlled drug older than among young persons, the law establishes special 6 months can be filled nor can refills be made more penalties for the sale of narcotic drugs to a minor. than five times in the 6 month period. The penalty for unlawful sale of heroin to a minor PENALTY PROVISIONS: Illegal possession of by an adult is a 10 year mandatory sentence in the dangerous drugs can mean a maximum penalty prison, while a penalty of 10 to 40 years in prison of 1 year in prison or a $1,000 fine, or both. How- is levied when marihuana or other narcotic drugs ever, the offender may be placed on probation for are sold to a minor. a first offense. If he meets the condition of his pro- In 1966 special legislation was enacted to allow bation, the court may set aside his conviction. A those violators who are narcotic addicts to return second offense allows for probation, but does not to useful, productive lives. The Narcotic Addict allow for the conviction to be set aside. The third Rehabilitation Act provides: (1) civil commitment offense calls for a maximum prison term of 3 years of certain addicts in lieu of prosecution for Federal or a fine of $10,000, or both. offenses, (2) sentencing of addicts to commitment for A person who illegally produces, counterfeits, treatment after conviction of Federal offenses, (3) sells, manufactures or possesses dangerous drugs civil commitment of persons not charged with any with intent to sell, may receive a maximum penalty criminal offense, (4) rehabilitation and posthospital- of not more than 5 years in prison or a $10,000 fine, ization care programs and assistance to States and or both. localities. All states have either adopted the Uniform Nar- Because of the serious consequences of drug abuse cotic Act recommended in 1937 for the specific pur- among young people, special penalties are provided pose of making all state narcotic laws analogous, for those over 18 years of age who sell or give any or modified it to fulfill the state's individual needs. of the controlled drugs to persons under the age of Similartothe Federal laws,state laws restrict 21. The first offense carries a maximum penalty of legitimate traffic to qualified manufacturers, whole- 10 years in prison, or a line of $15,000, or both; a salers, druggists, practitioners and researchers. second offense increases the maximum prison term FEDERAL DANGEROUS DRUG LAWS: Three to 15 years, or a fine of not more than $20,000, or groups of dangerous drugsdepressants, stimulants, both. and hallucinogensare corttrolled by the Drug Many states have adopted legislation for danger- Abuse Control Amendments to the Federal Food, ous drugs similar to the controls at the Federal level.

60 CHRONOLOGY OF IMPORTANT FEDERAL LEGISLATION REGARDING NARCOTICS AND DANGEROUS DRUGS 1906Federal Pure Food and Drug Act. Regulates the use of and possession of stimulants, depressants and hallu- patent medicioes containing opiates. cinogens. Tlal also provide strong criminal penalties 1914Harrison Narcotic Drug Act. Regulates manufacture against pesons who deal in these drugs illegally. The and distribution vf morphine, cocaine and other nar- Food and Drug Administration of the Department of cotics within the country. Still the chief federal law Health, Education and Welfare was given stronger for controlling illicit narcotic traffic. enforcemero powers to prevent drug counterfeidng. 1922Narcotic Drugs Import and Export Act. Provides heavy The amendments were effective February 1. 1966. penalties forillegal import and export of narcotic 1966Narcotic Addict Rehabilitation Act. A significant step drugs. toward treatment and rehabilitation of narcotic ad- 1937Marihuana Tax Act. Marihuana was placed under dicts. This legislation, effective February, 1967, provides federal control through taxing power, providing the for civil commitment. same type of controls over marihuana as the 1914 1968Drug Abuse Control Amendments to Federal Food, legislation placed over narcotic drugs. Drug and Cosmetic Act of 1965 increase the penalties 1946Harrison Narcotic Act Amendment. The 1914 law was for anyone who illegally produces, sells or disposes of amendedtoincludesyntheticsubstanceshaving dangerous drugs, and imposes misdemeanor penalty addiction-formingoraddiction-sustainingqualities for possession. similar to cocaine or morphine. 1969A Supreme Court decision removed two of the Federal 1951Boggs Amendment. Introduced mandatory minimum Government's major legal weapons against marihuana sentences for all narcotic drug and marihuana offenses traffic when it held that the Marihuana Tax Act is and prohibited suspension of sentences and probation unenforceable when the accused claims Fifth Amend- for second offenders. ment privilege against self-recrimination. Also, it de- 1956Narcotic Drug Control Act. Raised mandatory mini- clared as unreasonable the law's presumption that a mum sentences. With the exception of first offenders man with marihuana in his possession knows that It for possession only, it prohibits suspended sentences, was imported illegally, thus violating due process of probation and parole. law. 1960Narcotics Manufacturing Act. Provides for licensing and establishment of manufacturing quotas forall NoTE: Existing State legislation dealing with dangerous manufacturers of narcotic drugs. drugs is not uniform; laws vary widely in terms of drugs I965The Drug Abuse Control Amendments to the Federal included and the penalties invoked. Persons dealing with Food, Drug and Cosmetic Act provide for stronger drug abuse education should learn their State laws and city regulation of the manufacture, distribution, delivery, ordinances on marihuana, narcotics and dangerous drugs.

61 3/SUPPLEMENTARY REPORTS ON DRUGS

LEGAL ASPECTS or DRUG ABUSE NEIL L. CHAYET, Ll.B., Member of the Faculties of Boston University LawSchool, Tufts University dical School and Tufts University Dental School Answers to the questions of how to stem the tide offense and 20 to 50 years for a second offense. of drug abuse and bridge tbe gulf which separates Georgia offers 20 years to life for the first offense, the generations will in all probability not be found and a mandatory death penalty for the second in law. Drug abuse may only be a tiny corner of offense. the larger problem of rebellion and unrest among One of the most objectionable features oi the youth, yet we must deal with each facet of the prob- lawn is the fact that a person with a drug problem lem and when the law ruins lives, fabricates crimi- is discouraged from seeking medical help. Massa- nals out of whole cloth and debases itself in the chusetts law requires physicians and hospitals treat- eyes of our youth, it must be carefully scrutinized. ing persons suffering from the chronic use of nar- cotic drugs to furnish the Department of Public The Present Legislative Structure Health a statement giving name, address, height, In surveying State and Federal legislative action, weight, date of birth, color of eyes, color of hair, one sees a spectrum running from imposition of date treated and the name of the narcotic drug the the harshest penalties to failure to enact any legis- person used or suffered from. The physician who lation at all. The majority of States approach the refuses to Lomply with this law which constitutes legislative control of drugs in a uniform manner a mandatory breach of the confidentiality of the that ignore:: varying physiological and psychologi- physician-patient relationship may be punished by cal effects on the body. Federal legislation, unlike a fine of $2000 or two years in jail forthe first the State acts based largely on the Uniform Narcotic offense. The argument that such a statute constitutes Act passed in 1937, distinguishes between "hard" an invaluable, indispensable aid to law enforcement drugs (opium, morphine, etc.) and the "soft" drugs has not been borne out by facts and figures which (marihuana). Many States subsequently followed have been requested from the Department of Public this division of "hard- and "soft- drugs. The States Health by the Massachusetts Medical Society. continued to use the "soft- drug classification when the depressant and stimulant drugs as well as the Federal Law hallucinogens came into popul:- rity. The effect of The Ferleral law is filled with inconsistencies. this was an incongruous jumble of statutory provi- Until June of 1968, possession of LSD was not pun- sions in no way relating punishment to the poten- ished under Federal law, although manufacture and tiality for physical harm. sale were: The theory was that it is better for the A second basic flaw in the laws of many States, law to use its efforts to curb trafficking in the drug a flaw which follows naturally from the improper than it is to punish those who are users of the drug; classification, is the establishment of penalties which this made sense and was the beginning of a sophis- are greatly out of proportion to the crime com- ticated approach to the drug abuse problem. Con- mitted. In Massachusetts, to offer another person a gress voted to punish possession of LSD in June marihuana cigarette and have this person accept it 1968 by one year in jail or a $1,000 fine, a penalty carries a penalty of ten to 25 years for the first far milder than the penalty for possession of marl-

63 60 lmana, a substance less dangerous than LSD. One these th ugs. The incidence of drug use i iuhicaEctl who possesses marihuana may get a possible sen- in the spiraling number of arrests and reported in tence in a Federal penitentiary of from two to ten the surveys taken among young people suggest that years. A person who is convicted of sellingmari- itis not. The gangster-style raids, the ineffective huana without having secured and paid for the prosecution, and the inconsistent results of justice, appropriate tax stamp is punished by a mandatory depending upon the orientation of the police, five-year penitentiary sentence and this sentence prosecutor and judge, make it clear that we are due canuot be suspended nor the violator placed on for a change. probation.* The judge has no choice but to send This is not to say that drug abuse is to be con- the person away to a Federal penitentiary for five doned; in fact, drug abuse strikes a blow at the very years. Apparently Congress has seen fit to escalate fiber of our society; if every time a young person is the penalties in the realm of LSD, ru.er than to bored or faced with an anxiety-producing situation, he "turns on" or "turns off" or whatever the current review the unrealistic marihuana penalties. terminology is, how is he ever going to mature or make a significant contribution to the society which Impact of Present Legislation needs his participation and his ideas and his drive The question must ultimately be asked as to so badly? It is far more likely, however, that the whether the punitive orientation of the present drug answer lies in research, in treatment, in education, laws is effectively deterring young people from using and most important, in frank discussion of the prob . lem, rather than in the application of harsh punitive Punishment for non-payment of tax stamp was declared unconstitutional by the Supreme Court in May 1969. measures which can do little more than give a From Drugs and Youth, Charles C. Thomas Publishers, crintinal orientation to a youngster already severely 1969, disturbed.

64 THE MARIHUANA PROBLEM: AN OVERVIEW WILT lAM H. McGI.OTHIN, Ph.D., Research Psychologist, U.C.L.A. Institme of Government and Public AC:airs, Los Angeles and Louis J_ LYON WEST, M.D., Chairman, Department of Psychiatry, University of Oklahoin School of Medicine Current knowledge of the use of marihuana, its a variety of rannabis-induceu physical ailments. physical and mental effects, and its relation to crime Conjunctivitis is the most frequent, followed by and to other drug use are reviewed. The authors chronic bronchitis and various digestive ailments. feel that a reappraisal of he sacial end legal policies Sleep difficulties frequently occur, as is the case with regarding marihuana use is needed in view of the opiate users in this country. It is interesting to note rapid increase inits use despite the severe legal that from 25 to 70 percent of regular hashish users penalties prescribed. in two Eastern surveys reported some impairment The combination of a very rapid increase in mari- in physical health due to the use of the drug. huana use and the severe penalties prescribed for There have been several cases of marihuana- violation of the marihuana laws has brought about induced temporary psychosis reported in this coun- a social crisis. These two phenomena are not neces- try. Panic reactions are not uncommon among in- sarily independent. The extreme legal penalties and experienced users, and such reactions occaskmally the gross exaggerations of the consequences of mari- develop into a F.sychotic episode. These very rarely huana use as fostered by the Federal Bureau of last more than a day or so, and ihey do not usually Narcotics make it an ideal target for rebellious require hospitalization. youth to point to as an example of adult hypocrisy. On the other hand, in India and other Eastern countries, cannabis has long been regarded Ls an Physical and Mental Effects important cause of psychosis. One study reported that 25 percent of some 2,300 men admitted to No long-term physical effects of marihuana use psychiatric hospitals were diagnosed as having can- have been demonstrated in this country, although nabis psychoses; of the total male admissions 70 more current studies are needed before this issue percent of the patients admitted to sinoking can- can be resolved with any degree of certainty. Eastern nabis, and one-third were regular users. These studies of chronic users, who ciDnsume several times studies are definitely not in agreement with the the amounts generally used in this country, report findings in this country. and many Western authori- American journal of Psychiatry, volume 125, pages 370-378, ties question the adequacy of both the diagnoses September, 1968. Copyright 1968, the American Psychiatric made and the methodology of the studies them- Association. selves.

65 While systematic studies of the recent wave of of intakc, oral vs, inn avenous, for example; young marihuana users are not yetavailable, clinical Ca};icity for self-titration to control effect; protec- observations indicate that regular marihuana use tion against overdose; availability of an antidote; may contribute to the developmentof more passive, specific effects attainable without unpredictable side inward-turning, amotivational personality charac- effects; predictable length of action; hangover or teristics. For numerous middle-class students, the other short-term properties which may spill over to subtly progressive change front conforming achieve- a ffect work or other activities; ability to return to ment-oriented behavior to a state of relaxed and normalcy on demand; and ability to detect the drug, careless drifting has followed their use of significant as for monitoring drivers. etc. amounts of marihuana. One of the most neglected questions in evaluat- ing drug effects concerns the individual benefits Relation of Marihuana to Other Drug Use which motivate the user. Drug use in many instances Althoogh present-day marihuana has not been may well be an attempt to 'alleviate symptomsof shown to predispose to herohi use, it does play a psychiatric illness through self-medication. In some role in initiation to other potent drugs, particulaily cases, marihuana use might postpone or prevent LSD. To the extent that marilmana contributes to more serious manifestations of an illness. Especially a general disregaid for the realistic consequencesof for recreational drugs, such as alcohol and mari- behavior in young persons, its use increases the huana, an objective assessment of user motivation probability of the abuse of other more dangerous should consider: effectiveness in produciug pleasure, drugs. Many marihuana users would welcome the relaxation, and aesthetic appreciation; enhancement opportunity to try hashish and, if it were available, of appetite and other senses; enhancement of inter- many would probably continue to use it in prefer- personal rapport, warmth, and emotionality; utility ence to the low-potency marihuana. Of course,the of variety or newness or perception and thinking; use of hashish does not necessarily lead to excess any and enhancement of enjoyment of vacations, week- more than does a preference fordistilled liquor ends, or other periods devoted to recreation, over beer or wine. However, the history ofmind- and pleasure. altering drugs shows that excessive indulgence in- I n considering the effectiveness of legal sanctions creases sharply as more potent preparationsof a against the use of a drug, three related questions given drug become available. must be considered at the outset!1) How many persons would abuse the drug if legal conuols were Social Policy removed or not adopted? 2) Do the laws deter use, Social policy with respect to marihuana and other or perhaps encourage it, as has been suggested with psychoactive drugs has many dimensions. The most relation to rebellious youth? 3) Is the drug abuser will basic issueis whether or not the prohibition of a sick person who, if one drug is prohibited, behavior whose direct effects are limited to the find another drug or some equally destructive imtividual is within the function of die state. Those behavior as a substitute? who feel it is not argue that the state has no more Clearly, if the law protects against a non-existing right to intervene with respect to the use of harmful harm, society is better off without the law. The re- drugs than it does with regard to harmful over- cent elimination of all laws pertaining to written eating. pornography in Denmark, for example, apparently Those who take the contrary position argue that resulted in no ill effects. The incidence of mar-. the harms are not limited to the individual but huana use as opposed to LSD use supports the posi- burden society in a variety ot ways; hence the state tion that legal penalties are by no means the over- is entitled to prohibit in; use in the public interest riding determiner of drug usage. The number of An objective assessment of the threat or benefit persons who have used marihuana is several times to society resulting from the non-medical use of a that for LSD and is increasing in spite of severe drug should consider; physiological effects resulting penalties. LSD usage is apparently declining because from occasional or chronic use; tendency to produce of concern over the hazards rather than because of physiological or psychological dependence as a func- any deterrent effect of the relatively moderatelaws. tion of period use; release of antisocial behavior; The argument that the drug abuser would simply efF.ct on motor activity, especially driving safety; find another means of escape or self-destructive and tendency to produce long-lasting personality behavior if the drug were not available is probably changes. Other relevant considerations are: cost; only partially correct. It is clear that persons are ability to control and measure potency; convenience more vulnerable to thc abuse of drugs atcertain

66 times in their lives, such as during adolescence or cies and laws. What we have at present is all assort- other highly stressful periods. If a potential drug- nzent of approaches which are not only lacking in of-abuse is unavailable at these times, an undesir- consistency but often operate in clearly opposite able chain of events may well be avoided. directions. Much of the incongruity is based on un- Concerning the kind of drug-control laws which recognized attitudes and fears which must be made should be enacted and enforced, there is general conscious and explicit before a congruent policy agreement that the government has not only the can emerge. One means of forcing some of the most right but also the obligation to enforce certain glaring ioconsistencies into perspective is to treat prac!_4-es with regard to the distribution of drugs. alcohol abuse and drug abuse as a single problem. Rfgulation, as opposed to prohibition, permits Part of the lack of congruence among drug poli- the orderly control of potency and the conditions of cies in this country may be due to the fact that sale, such as age of purchaser, hours of sale, and licensing. It also permits taxation and eliminates economic and technological factors are changing at the snpport of organized crime as well as the crimi- a faster rate than are cultural attitudes and values. nogenic aspects of forcing the user to deal with The drug laws in this country have always been an illegal sources. On the other hand, prohibition of attempt to legislate morality, although they nave sale clearly indicates social disapproval, whereas been justified io terms of preventing antisocial acts. opens sale does not. These laws and attitudes evolved at a time when the Arguments for criminal sanctions against the drug Protestant ethic and the competitive achievement- user primarily stress:1) their deterrent effect and oriented valcstem were very much in dominance. 2) the aid such laws give to enforcement agencies The freely chosen, passive withdrawal to life of in apprehending sources of supply. Major argu- drug-induced fantasy was an extremely threatening ments against such laws stress that enforcement concept. inevitably encourages the violation of constitutional Now we are told we are verging on an economy guarantees of privacy, as well as various other prac- of abundance rather than scarcity; an age of auto- tices, such as informers posing as students, hippies, mation will eliminate half or more of the labor or other potential drug users, which are ethically force necessary for the production of goods. The questionable though technically legal. concept of work will have to be redefined to include The social control of drug use is most difficult to non-productive pursuits which are now considered handle via legal means when the drug in question hobbies; a guaranteed annual income program will permits both use and abuse: e.g., alcohol and mari- likely be in effect within five or ten years. The chil- huana. The problem of penalizing the majority dren of today's middle class have never experienced because of the abuse by the minority was specifically a depression or any appreciable difficulty in satisfy- dealt with by the Supreme Court at the time of the ing their material needs. They do not share the Volstead Act. The Court ruled that the state had the materialistic value system to the same extent as their right to deny access to alcohol to those who would not abuse it in order to remove the temptation from parents because they have little fear of material those who would abuse it. deprivation. On a few occasions, exceptions have actually been There also appears to be an increasing acceptance carved out of the law to permit use of a drug other, of pleasure in its own right rather than as some- wise prohibited: e.g sacramental use of wine and thing that needs to be earned as a reward for hard religious use of peyote by the Indians. More fre- work. If the age of economic abundance, automa-. quently, society has informally disregarded the en- tion, and greatly increased leisure time becomes a forcement of the Iaw for various groups, conditions, reality, exces4ve drug use will be seen as a threat or in certain districts of the city. For example, dur- to the individualnot as a threat to society. ing the 40s, police frequently overlooked the use of In conclusion, whether or not the age of abun- matihuana by jazz musicians because they were dance arrives, social policy, with some minor rever- otherwise productive and did not cause trouble. sals, will probably move in the direction of perimt- Another meam of allowing use but controlling ting greater individual freedom with respect to drug abuse is through compulsory treatment. use. Society will promote the concept of allowing adults the privilege of informed decision. The cru- Conclusion cial problem that will remain is that of protecting What is especially needed is a concerted effort to those who are too young to make an informed produi_e congruence among the various drug poli- decision. 73 67 PRE VENTION OF DRUG ABUSE STANLEY F. YoLeEs, M.D., Director, National Institute of Mental Health

Prevention and Education of drug abuse, one must look beyond the specific problems of such agents as LSD, marihuana, am- Prevention and education efforts aimed at the phetamines and barbiturates to some of the under- student population demand careful preparation and lying causes' of widespread drug use and abuse. We implementation. Even high-schoolstudentsare live in a drug-oriented culture. From aspirin to extremely sophisticated about drugs. We are con- sleeping pills,from tranquilizersto the pill," stantly impressed at speaking appearances before Americans of all ages are ingesting drugs in greater high school and college audiences about: variety and number than ever before. If we are to I. The extent of accurate knowledge mixed with get to the root of this problem of drug abuse, we misinformation about all drugs, not Fist LSD and must investigate and identify the underlying prob- marihuana, but barbiturates, amphetamines, etc.; lems which lead people to choose to distort or ward and off reality with drugs. 2. The suspicion with which students approach One way of conceptualizing the problem is to information supplied by "official sources." view drug abuse in the student population in the Scare techniques are not only ineffectual but even broader context of the nature and extent of "cas- detrimental to conveying needed information about ualties- of the educational system. Through our hazards of drug abuse. With the present incidence interest in school and college mental health, sui- of marihuana use, many students have either experi- cide prevention, and alcoholism, we have become enced or observed first-hand the effects of this drug. increasingly aware that a fair percentage of our They know that psychoses or other grave conse- brightest and most competent youth are not -suc- quences are not an inevitable conccmitant of smok- ceeding" in their encounter with the higher educa- ing one marihuana cigarette. To be effective, a preventive educational effort tional system. must be carefully tailored to specific population Behavioral scientists use the term "alienation" in groups and must be based on the best educational describing the cross-generational disease epitomized and scientific footing available. by the 'youth-coined term "don't trust anyone over 30." Alienation has been characterized as: "rebel- Alienation lion without a cause .. .rejection without a pro- In trying to understand scientifically the problem gram ..- arefusal of what is without a vision of what should be.- Excerpted from Testimony Before the Subcommittee on juvenile Delinquency of the Committee on the judiciary, Lapses in communication between generations U.S. Senate, March '968. were noted by Greek philosophers over 2,000 years 68 74 ago, and more recently were manifested in American future is unknown but certainly horrible. Since you society by the so-called "lost generation" of the cannot alter the world or determine the direction in 1920's and the "silent generation" of the 1950's. whi-h it will go, you must alter your state of con- However, the current problem of alienation in the sciousness and perception, that is, see and experience United States is wider, deeper, and more diffuse the world through a 'high.' Any alteration is accep- than at any previous time in our history. It affects table, and thus, the barbiturate user can describe to the rich and the poor, the college student and the you the joys of a 'drowsy high' and the amphetamine school drop-out, the urban and the rural youngster. user will talk about the 'high' he gets on benzedrine The number of persons, both young and old, beset and likewise for the LSD, marihuana, and heroin by alienation is far greater than ever seen in any abuser. All that is important is in one's subjective previous generation. state. Perceptions and beliefs of the square world or Because many alienated youngsters question the the non-drug world are superficial, distorted, mean- relevance of major societal values ,and institutions, ingless ...." This rejection of many goals of society, they find themselves unable to learn from the vari- the unwillingness to model themselves on any stable ous opportunities that presently are available to adult leaders and the inability to acquire the nec= them. As Freedman and Brotman point out. . . essa. y attitudes and skills for responsible adult be- "To ask one of the youngsters, as one of the authors havior, make urgent the development of new and did, 'Where's the action?' elicits a scornful answer: innovattve approaches to bridge to intergenerational "There's only action if you have a high.- The impli- gap. cation is clear; what is meaningful is the subjective If this is not done, there are serious dangers that state. If an undrugged state is defective, myopic, large proportions of current and future generations why not alter perception through drugs and create will reach adulthood embittered towards the larger a new 'reality?' Some youngsters who feel helpless society, unequipped to take on parental, vocational to accommodate to or change an unacceptable and other citizen roles, and involved in some form world, consciously choose to alter their own . . of socially deviant behavior. If we are to solve the Their most frequent statement is that life is a 'drag.' problem of drug abuse, it is critical for us to focus It lacks meaning for there is no engagement; the on and try to solve the root causes of alienation.

69 DRUG USE AND STUDENT VALUES KENNETH KENISTON, Pn.D., Associate Professor ofPsychiatry, School of Medicine, Yale University In the comments to follow,I will argue that Furthermore, once a student is admitted to college, student drug use is closely related to pressures on higher admission standards have meant that more American students, and is but a variant of values could be demanded. of him; students who a genera- Ameri- tion ago would have done A work now findthem- that are shared by many and perhaps most The can undergraduates today. Tobe sure, only a small selves doing only C work with the same effort. minority turn toward drugs; but the members of sheer volume of required reading and writing has this minority group are but first cousins tothe increased enormously; in addition, thequality of more normal college student. Inparticular, the work expected has grown by leaps andbounds. student drug use; shares with his non-drug-using Finally, for a growing number of young Americans, classmates an active search for meaning through collegeisbut a .stepping stone to professional and graduate school after college; and as aresult, intense personal experience. increas- In order to understand the values shared by many consistent academic performance in college American college students, we 'must begin by con- inglbecomes a prerequisite for admission to a sidering some of the pressures that affect today's desirablebusinessi school,medicalschool,law school or graduate school. students. With regard to drug use, two pressures in the are particularly important:the pressure toward Not only have academic pressures mounted cognitive professionalism, and the pressure toward past generation, but these pressureshave become increas- psychological nurnLing. more and more cognitive. What matters, ingly, to admissions committees andcollege graders Cognitive Profession) is the kind of highly intellectual,absi.racting, rea- well on in soning ability that enables a student to do The past two dec7.6;-s have seen a revolution college 13,ards, graduate records and otheradmis- our expectations aboutcollege students. Rising graduate standards of academic performance inprimary sion tests, andonce he is in college or of the war, schoolto turn out consistently high gradesthat and secondary schools, the baby boom academic the slowness with which majorAmerican universi- will enable him to overcome the next ties have expanded their sizeall haveresulted in hurdle. And while such intellectual and cognitive increasing selectivity by the admissions officesof the talents are highly rewarded, collegesincreasingly most prestigious American collegesand universities. frown upon emotional, non-intellectual and pas- sionate forms of expressiea. Presented at National Association of StudentPersonnel In contrast to these cognitive demands, there are Administrators Drug Education Conference,Washington, extremely few countervailing pressures to become D.C., November 1966.

70 more feeling, morally responsible, courageous, artis- variety andintensity01externalstimulations, tically perceptive, emotionally balanced, or inter- imagery and excitation to which most Americans personally subtle Inunan beings. On the contrary, are subjected. For lack of a better label, I will term the most visible pressures on today's students are the condition one of increasing "stimulus flooding." in many ways anti-emotional, impersonal, quanti- Most individuals in most societies have at some tative aud numerical. point in their lives had the experience of being so Increasingly, then, one of the ma ior pressures overcome by external stimulation aud internal on American students is a pressure to performwell feelings that they gradually find themselves growing academically, to postpone and delay emotional satis- numb -and unfeeling. Medical students, for example, factions until they are older, to refine and sharpen commonly report that after their first and often continually their cognitive abilities. As a result, intense reactions to the cadaver in the dissecting students today probably work harder than students room, they simply'stopfeeling anything' with in any other previous generation; a bad course or regard to the object of their dissection. Or we have a bad year means to many of them that they will all had the experience of listening to so much not get into graduate senool. Taking a year off in- good music, seeing so many fine paintings, being creasingly means running the danger of getting so overwhelmed by excellent cooking that we find drafted and being sent to Vietnam. ourselves simply unable to respond further to new Thus, while the systematic quest for cognitive stimuli. Similarly, at moments of extreme psychic competence occupies much of the time and effort of pain and anguish, most individuals "go numb,- no the pre-professional student attoday's selective longer perceiving the full implications of a cata- colleges, this pursuit does little to inform the stu- strophic situation or no longer experiencing the dent about life's wider purposes. One of the pe- full range of their own feelings. culiar characteristics of professional competence This psychological numbing operates, I submit, is that even when competence is attained, all of at a great variety of levels for modern man. Our the other really important questions remain un- experience from childhood onward with the con- answered: what life is all about, what really matters, stantly flickering images and sounds of television, what to stand for, how much to stand for, what is films, radio, newspapers, paperbacks, neon signs, meaningful, relevant and important, what is mean- advertisements and sound trucks, numbs us to many ingless, valueless and false. Thus, for many stu- of the sights and sounds of our civilization. The dents, the pursuit of professional competence must exposure of the most intelligent men to a vast be supplemented by another, more private and less variety of ideologies, value systems, philosophies, academic quest for the meaning of life. Academic political creeds, superstitions, religions and faiti,s efforts seem, to a large number of students, divorced numbs us, I think, to the unique claims to validity from the really important "existential" and "ulti- and the special spiritual and intellectual values of mate" questions. ln this way, the student's private each one: we move among values and ideologies as search for meaning, significance and relevance are in a two-dimensional landscape. experienced as unconnected with or opposed to his In all these respects, modern men confront the public exertions for grades, academic success and difficultproblems of keeping stimulation from professional competence. How students search for without to a manageable level, while at the same significance and relevance of course varies enor- time protecting themselves against being over- mously from individual to individual; but as I will whelmed by their own inner responses to the later suggest, drug use seemsto a small group of stimuli from the outer world. Defenses or barriers studentsa pathway to the pursuit of meaning. against both internal and external stimulation are, Stimulus Flooding and Psychological Numbing of course, essential in order for us to preserve our Every society contains pressures and demands intactness and integrity as personalities. From ear- which its members simply take for granted. Thus, liestchildhood, children develop thresholds of the pressure for extremely high levels of cognitive responsiveness and barriers against stimulation in efficiency seems to most of us a necessary and an order to protect themselves against being over- even desirable aspect of modern society, Our re- whelmed by inner or outer excitement. Similarly sponse to the second social pressure I want to discuss in adulthood, comparable barriers, thresholds and is even more unreflective and automatic. This defenses are necessary, especially when we find our- second pressure has to do with the sheer quantity, selves in situations of intense stimulation.

71 7. Thus, in at least a minority of Americans, the dents to be worn out, insincere, Or superficial. normal capacity to defend oneself agpinst undue Simi lin ly,thegreatclassicpoliticalideologies, stimulation and inner excitationisexaggerated whether they be political liberalism, conservatism, and automatized, so that it not only protects but marxism, or fascism, arouse relatively little interest walls off the individual from inner and outer ex- among most undergraduates. Nor does the "Ameri- perience. In such individnals, there develops an can kVay of Life," as epitomized by 1003/4 Ameri- acute sense of being trapped in their own shells, canism and free enterprise, stir most students to unable to break through Oteir defenses to make enthusiasm, much less provide them with answer:, contact with experience or with other people, a about life's ultimate purposes. sense of being excessively armored, separated from One by one, then, many of the traditional sources their own activitiesasby aninvisiblescreen, of meaning have disappeared at the very same estranged from their own feelings and from poten- time that ademic life itself, because of its intense tially emotion-arousing experiences in the world. pressore and professional specialization, seems to Presumably most of us have had some inkling of many iindents increasingly irrelevant to their major this feeling of inner deadness and outer flatness, existential concerns. Where, then, do students turn? especially in times of great fatigue, let-down, or depression. The world seems cold and two-dimen- The Cult 9f Experience sional; food and life have lost their savor; our The cult of experience has often been discussed activities are merely going through the motions, as a defining characteristic of American youth cul- our experiences lack vividness, three-dimensionality, tures. Central to this cult is a foetus on the present and intensity. Above all, we feel trapped or shut on Loday, on the here-and-now. Thus, rather than in our own subjectivity. defer gratification and enjoyment for adistant Each of the two pressuresIhave discussed future, immediate pleasure and satisfactionare cognitive professionalism and stimulus flooding emphasized. Rather than reverence for thetra- evoke characteristic responses among today's Ameri- ditions of the past, experience in the present is can tudents. The pressure for cognitive profes- stressed. Psychologically, then, such human qualities sional competence leads to a search for meaning in as control, planning, waiting, saving, and postpon- other areas of life; the feeling and fear of psycho- ing on the one hand, and revering,recalling, logical nnmbing leads to a pursuit, even a cult, remembering and respecting on the other, are of experiences for its own sake. And use and abuse equally deemphasized. In contrast, activity, adven- of psychoactive drugs by students is closely related ture, responsiveness, genuineness, spontaneity and to these two themes in student values. sentience are the new experiential values. Since neither the future nor the past can be assumed to The Search for Meaning hold life's meaning, the meaning of life must be Among today's self-conscious students, the state- sought within present experience, within the self, ment, "I'm having an identity crisis" has become a within its activity and responsiveness in the here- kind of verbal badge of honor, a notch in the gun, and-now. a scalp at the belt. But although the term "identity crisis" can be easily parodied and misused, it points Disaffiliation and Drugs to fundamental issues of adolescence in all societies The two student values I have discussedthe that are particularly heightened in our own society. search for meaning and the cult of experience Since academic pursuits, on the whole, tell the stu- are intimately related to the pressures I have out- dent so little about life's ultimate purposes, students lined earlier. The search for meaning is made more are turned back upon their own resources to answer urgent by the amount of time and energy the aver- questions like, "What does life mean? What kind age student must spend in.pre-professional academic of person am I? Where am I going? Where do I pursuits that often appear to him irrelevant to his come from? What really matters?" basic concerns. And the cult of experience is inten- To understand this search for meaninger must sified by the fear or feeling in many undergraduates recallthat many, of ,thetraditional avenues to that, instead of becoming more open to themselves meaning and significance have dried up. Tradi- and to experience, they are becoming increasingly tional religious faith is not, for most sophisticated numbed and closed off from all that is exciting and undergraduates, a means of ascertaining the mean- beautiful. Both of these values are, as well, related ing of life: traditional religions often seem to au- to the use and abuse of drugs by students. For such 72 78 is the cultism and propaganda that surrounds drugs, A second characteristic of disaffiliates is a more especially the hallucinogens, that many students or less intense feeling of estrangement from their have come to feel that states induced by these drugs own experience. Such students are highly aware of will automatically produce a revelation of life's the masks, facades and defenses people erect to meaning, or at least an experience which itself will protect themselves; and not only do they criticize be highly significant and illuminating. Similarly, these defenses in others, but even more strongly to the undergraduate who 1eeis himselfunduly in themselves. These feelings of estrangement are walled-off from experience, drugs like the hallucino- often accompanied by considerable depression and gens and the amphetamines (which intensifyand a strong sense ot perzional isolation. Indeed, de- alter orainary states of consciousness) tnay seem a pression following the loss of an important relation- chemical sledge hammer for breaking out of his ship is commoufly found in the immediate back- shell. ground of the student who begins to abuse drugs. Obviously, despite the congruence of drug use For the student with intensified c_eelings of estrange- with important student values in American colleges. ment from himself and others, drugs that promise the vast majority of American students do not seek to heighten experience seem a tempting way out of meaning and experience primarily via psychoactive his shell, compounds. Despite the presence of some values A third relevant characteristic of disaffiliates is a winch are consistent with drug use, most students fantasyotfusion and merger, which contrasts have other values that argue against drug use. It is sharply with their current feelings of estrangement. only a minority who are persuaded to choose drugs In the background, many of these students have as a primary means of searching formeaning. a concept of au din-ost mystical fusion with nature, I doubt that itis possible to present an exact with their own inner lives, or above all with other portrait of the type of student who is likely to use people- -a kind of communication that requires no and abuse drugs. My own experience with student wor.is, a kind of onenes with nature or the world drug-users convinces me that there are many dif- that has characterized intense religious experience fetent motives for drug use and abuse, and there for centuries, a special kind of automatic oneness are many different factorspsychological,socio- with another. For an undergraduate with an especial logical, cultural and situationalthat determine longing for oneness with others, the hallucinogens whether one student will use drugs while another are especially tempting. For one characteristic of will not. But despite the diversity of student types the drug experience is a weakening or breaking who may become involved in drug use, there is, down of the boundaries of the self such that many I believe, one type that is particularly prone to individualsinfactreportfeelinesofoneness, drug abuse. I will call such students 'disaffiliates,' merger and fusion with others. and will summarize some of the factors that pre- On several grounds,then,thedisaffiliateis dispose these students toward drug abuse. The strongly attracted by drugs. defining characteristic of the disaffiliate is his gen- eralized rejection of prevalent American values, Drug Use and Student Values which he rejects largely on esthetic, cultural and it will not do to repudiate students who misuse humanistic grounds. Such students are rarely politi- drugs as moral leperr, and addicts without trying to cal activists, and they are rarely concerned with the understand their motives for drug use, and the issues of economic, social and political justice that values and goals they pursue. These motives are agitate many of their classmates. For these students, rarely simply anti-social or thrill-seeking. On the the problem is not political or social, but esthetic: contrary, they almost always involve a legitimate American society is ugly, trashy, cheap and com- (if misguided) search for ultimate meaning and mercial; it is dehumanizing; its middle-class values contact with the world. In dealing with individual are seen as arbitrary, materialistic, narrowand hypo- drug users,then, we must attempt to provide critical. Thus, those conventional values which the student with alternate routes to attain his valid deem experimentation with drugsor experimen- goals. Although student drug users are a small tation of all kindsillicit, are strongly rejected minority, they point to the inability of our society by disaffiliates; for them, what matters is somehow to enlist the commitments of a talented minority_ to seek a way out of the 'air conditionednightmare' If we could understand why, it might point not of American society. only to how we could "cure- drug users, but, even 73 more important, how we niiglit "cure'' colleges and us ng drugs he is making a statement about now society. he wants to live his life, And we can, perhaps, in As for counseling student drig userspotential our own Jives and by our own examples, suggest and actual-1 think it important to acknowledge that moral courage, a critical awareness of the that the question of drug use is, in the last analysis, defects of our society, a capacity for intense experi- not a medical issue, but an existential, philosophical ence and the ability to relate genuinely to other and ethical issue. Student drug users are, as a group, people are not tile exclusive possessions of drug- extremely knGwledgeable about the possible bad users. effects of drug use; they can usually teach their In the long run, those of us who are critical of counselors, deans and advisors a good deal about student drug abuse must demonstrate to our stu- the potential bad side effects of drugs. They will dents that there are better and more lasting ways to arguewithconsiderablevaliditythatsociety experience the fullness, the depth, the variety and does not prohibit the use of other psychoactive the richness of life than that of ingesting psycho- compounds (e.g., alcohol, tobacco) which in some active chemicals. Consciousness-expansion seems to ways are far more dangerous than many of the me not the sole prerogative of psychoactive com- hallucinogens or amphetamines. In the last analysis, pounds, but of education in its fullest sense. then, whether one chooses or not to use drugs in full consciousness of their possible bad effects and Thus, insofar as we can truly and honestly help the legal implications of drug use, becomes an our students to become educated in the fullest existential rather than a medical decision. It is a sense, we will be able to provide alternative routes matter of how one chooses to live one's life, how to the pursuit of meaning, the quest for experience, one hopes to seek experience, where and how one and the expansion of consciousness. Obviously, searches for meaning. To be sure, I doubt that we much of what passes for education in America fails can hope to persuade students that drugs are to accomplish any of these high objectives. As long ethically, humanly or existentially undesirable if as it continues to fail,I suspect that drugs will they are not already persuaded. But I think we can continue to be a problem on our campuses and at least help the student confront the fact that in in our society.

74 DRUGS AND PERSONAL VALUES RICHARD H. RI-UM, PH.D., Director, Psychopharmacology Project, Institute forthe Study of Human Prob- lems, Stanford University I am here to talk, about values and drug use. supplement ordinary life but rather to bring the For myself, I cannot divorce the notion of values person back to where he once was or to put him in a from the business of motives and of the social and position where he can function adequately. Tradi- historical context. Let me start by making an ob- tionally the usc of psychoactive drugs has been for servation. It is simply that drug use today is in the relief of pain and anxiety. These, the tran- many ways not different from drug use not only quilizers as well as the narcotics, comprise the yesterday but two or three thousand years ago. largest category of drugs used medically. The motives associated with the use of drugs occur again and again. In this regard I suggest that in Studies of Student Drug Use traditional societies the introduction of drug use We were involved in some pilot studies of normal has been associated with two radically different population drug use. To me a critical question is kinds of goals, or if you will, values; that is, for what do ordinary people do? What is the norm? religious or medical purposes. What happens? What is the convention in our The religious orientation has essentially been an society with reference to the use of drugs? When expanding one. It proposes that there is something I say drugs I mean psychoactive drugs, those drugs more in this world than the ordinary self and whicn alter mind and mood and cycles of sleep that the person can have access to that greater and wakefulness. Having done this other work, power. The person with this orientation uses drugs we have been involved in the last year in the because he desires to experience that power, to get studies of student drug use. close to it, to know what it is. It may be an ecstatic Let me share with you some of the troubles we supplement in the sense that one has experiences run into when we are trying to assess student drug ordinarily denied. One has an orgy or a delight use. The drugs in our college studies have covered or a spasm of joy, whatever you want to call it, or it quite a broad range. We have been interested in may be a profound mystical experience or simply the stimulants, the mild ones and the strong ones, a sensitive and beautiful feeling. in the analgesics and the opiates, in tranquilizers The other theme, the medical theme, has been both mild and strong, in the psychoenergizers or that of healing or pain killing. It does not seek to anti-depressants, in the hallucinogens (which, by the way, rarely cause hallucinations), and we have Presented at Nationul Association of Student Personnel Administrators Drug EducationConference,Washington, been interested in the intoxicants. In addition, we D.C., November 1966. can't help but be interested in tobacco since that

75 is a very common addictim; drug if we dare to use physicians on pharmacotherapies that there may the word "addiction." also be a simultaneous growth in the medical as A second problem is getting adequate data once well as the nonmedical employment of these sub- we know what drugs we care about. People often stances. don't know what they have been taking. Certainly, Ai miller premise that brings us together with a over their lifetime they would be unlikely to know shared concern is that there are ill effects which are their exact history of drug use. Even if people do associated with drug use. know at least some of the substances they have Another thing that many of us assume is that been taking, they may not be willing to tell you what is bad about drug use is not just a matter about it. So we can get under-reporting when we ask of physiological or psychologicalilleffects but, some students about what they really did yesterday rather, that it is part of an unsettling social package. or what it is they plan to do tomorrow. One sees illicit use occuring in association with Another problem which you may run into on other social trends in student behavior, trends not your own home grounds, is access to institutions. appooved by some of us, trends which can jostle For instance, we are trying to study high school or shake us up a bit. In may be that theentire drug use, yet it will be a cold day in hell when they pattern of conduct "bugs" us and that student let us in any high school to do our studyand for drug use is something on which we can locus our a lot of good reasons such as the fears of the board worries. Implicit in that worry may be our aware- of (!ducation, the newspapers, and the community. ness that there are changes in values and standards Another problem we have, which is a technical that go beyond beards and sandals, changes that one but which really interferes with much dis- reflect fundamental challenges to social codes which cussion, has to do with the definition of "use." adults hold and which the elders think students "He is a pothead. He is a user," meaning that a also ought to hold. Here we are asking ourselves, student when 19, did one evening, in company what is acceptable conduct? What is an acctptable with others, illegally acquire and illegally possess goal in rife? What are acceptable means to those marihuana and further did take three puffs of a goals? "joint." That can be one definition of a drug user. Unquestionably, student use of exotic drugs in Or again, "Yes, he is a real LSD user," which might any regular way doesitselfchallenge conduct mean that a student took LSD once two years ago standards that many thought were pretty stable, and wouldn't touch it now for love or money. So standards one thought were going to stay with us when we talk about use we have to be careful to for awhile. specify what kind of use. As we approach our college populations we are Characteristics of Student Drug Users well advised to discriminate between those who have In assuming that drug use is increasing among used an illicit or exotic drug in an exploratory students to an unknown point, it is less and less fashion, and those who are committed users, the easy to make generalizations about the character- people whose lives are built around drug use. istics of users; more different kinds of people are Now, assirming that we have found out what is involved. in the old days, two years ago perhaps, happening on the campuses with regard to drug one could propose that people smoke pot because use,let us consider some of the premises upon they are rebellious characters, thumbing their noses which we are beginning to operate, one of which at the system and trying dangerous behavior. That is that students in some colleges are using more was all very fine to say as long as pot smoking was drugs without medical supervision. highly disapproved and had to be rebellious. But Our concern then is over the social-use of drugs, now when you have campuses where "X" number in particular the exotic and illicit drugs, not alcohol of kids are using pot and it is the thing to do, the or tobacco even though those are potentially dan- student would be ashamed if he did not. It would gerous indeed. From an epidemiological standpoint be foolish to assume that one particular kind of one should also ask, "Are students using more personality or attitude or social background is drugs in approved ways as well?" That is, are alco- associated with what is now popular experimental hol and tobacco more used than five years ago, or behavior. That is to say on some carc.ouses anyone are medically prescribed drugs being used more can be expected at least to try marihuana regardless often as well? One suspects that with increasing of whether he continues with that behavior later. medical care and with the increasing reliance of We already have diversity in student conduct and 76 82 we shall get increasing diversity. As we all know, seems to me, is the sense of alarm which outweighs the kinds of people who are going to be innovators the evidenceat.hand. The public assigns very and those who are going to be followers are likely peculiar priorities to their worries about dritgs and to be different from one another in many ways. the most peculiar priority is to put heroin at the So it is we must not lump the metives and personali- top of the list. There are very few college students ties of student drug users in one common category. who will ever take it, and there are fewer who would Diversity there will also be the rule. become dependent if they did. A problem rarely mentioned and which we must call attention to when we accept our premise of Counter Action expanding drug use, is the role of physicians in Considering public alarm over stu&nt drug use, contributimA- to the expanded use. From our pilot we cannot help but face the special risk thatis survey we have some evidence that the people who generated by public anxiety itself. That is the risk became exotic drug users, and this tends to be a of our being forced to be premature in our actions. well-educated young sample in a normal popula- We are all in a spot. The danger is that we will act tion, had larger exposure to medical care. Their impulsively when the parents call and say 'What parents had been more interested in giving them are you doing? What kind of a university is that? drugs, they had been taken to the doctor more often I heard there is marihuana on the campus. Stamp when they were kids, and they learned to take drugs. it out!' The alarm is a demand upon us, yet we They had become drug optimists, if you will, and should be very cautious not to let emotion drive us I suspect many of its are drug optimists. We give into corners. a great vote of confidence to the pharmaceutical We talk about risks, but let us not forget that industry and to modern medicine. So we should not most of the psychoactive drugs employed these days overlook the role of the physician as an instructor are used because of benefits. We use barbiturates in drug use. We believe we can control our insides to go to sleep, we use tranquilizers to reduce agi- with these little capsules. It is a very simple belief-- tation in hospital wards. We use aspirin to get rid yet its ramifications are immense. How could we of headaches, we use alcohol for pleasure. Let us expect our children not to take drugs if this is what not overlook the fact that there are benefits associ- we have taught them? ated with use. If not, there would probably be very few users and neither a pharmaceutical nor a liquor Consequence of Student Drug Ur& industry. And so it is that people enjoy marihuana Things I worry about and I gather that you worry and they Lltjoy LSD. about are dependency, or addiction as it is some- What we must do is to balance the benefits against times called, crime, immorality, traffic accidents, the dangers, but in alarm let us not speak as though psychosis, suicide, illness, some kind of tissue or we were unaware of the reasons for the being of metabolic change either acute or chronic, person- these substances. Of course, we should also not for- ality changes of an undesirable sort, or an undesir- get that some of the benefits are a placebo effect. able shift in social conduct or values. One might also include the embarrassment, pain and tragedy Summary and Recommendations of arrest for the individual and the embarrassment In summary, we believe that exotic drug use is for his family and institution. increasing, and we know that risks as well as felt We must be cautious before leaping into the fray benefits are there. We care enough about our stu- with warnings to kids about what is going to happen dents to want to reduce any dangers they face, yet if they use such and such. Usually we do not really we hesitate to restrict their freedoms and indeed, know. The whole problem of assessing risk has to we may be unable to restrain their conduct by be related to different kinds of people using a administrative action. The question of the efficacy drug dosage, kinds of circumstances, and so forth. of disciplinary, punitive or controlling actions as a Then, if we knew all of that, we could say, "Okay, means of influencing drug use goes beyond the con- jack, if you take this drug in this way, here are sideration of student conduct, extending to the the probabilities of it going sour." Given the ab- current state and federal laws as well. Although sence of facts and given also our common sense I think one can show an influence of the criminal that these powerful agents can do damage, one law on the supply and distribution of drugs and of the most important things to be aware of, it quite possibly on decisions initially to use or not

77 83 to use a drug, I am dubious if the punishment- also be aiming, as we do in much of education for control method makes much of a dent upon the civilization, at the development by students them- convinced or committed user group. If that is the selves of group norms and nner standards which case, it would mean that we do not lose much by sensibly guide their conduct. reluctance or inabiiity to apply sanctions against 1 further suggest that educational efforts not be drug use. limited to students alone, but directed at the drug I think the course best open to us in dealing with gatekeepers. Here I mean physicians, parents, phar- student drug use is that to which we arein con- macologists in our laboratories, our campus pro- junction with our studentsall dedicated. That is fessors and the graduate students. I suspect we shall education. We are all educators and we must have find that with each new socially used drug these great hopes for knowledge as a means of guiding people will be the channels for learning attitudes, lives or we would not be in the business. Why not use, and sources of supply. If we want to have an then remain consistent to our calling and to our impact we must talk to those who are models, those beliefs and emphasize fact-finding and information- who are the opinion leaders for them and that giving as means to acquaint students with the sig- is as it must befor education is a business of nificance and effects of exotic drug use? We can exchange, a dialogue, not a one-way street.

78 84 MOTIVATIONS FOR STUDENT DRUG UoE RICHARD H. BLUM, PH.D., Director, Psychopharmacology Project, Institutefor the Study of Human Prob- lems, Stanford University In traditional societies one finds the simultaneous examined as a social exchange and as a learning use of drugs for healing and religiousends. In phenomenon. such societies one also finds, but more rarely, a third Some aspects of drug diffusion seem fairly con- orientation associated with the individual use of sistent from campus to campus and are even con- drugs. Here the drug is associated with a decrease sistent over the last few thousand years. For ex- in the individual's ability to function and in his ample, young people usually learn to take drugs capacity for both work and experience, as seen in from people who are older. Females tend to take the disabled drug user. Such inadequacy is some- them from males. People with higher status give times disguised behind a philosophy of drug enjoy- them to people of lower status. Leaders dis!rOute ment or a commitment to a drug-using group. I do them to followers. Given such patterns, it is hard to infer a single not think we should overlook this function in those set of values or motives in the diffusion of drugs on who use drugs ostensibly for other purposes. It may campuses. Indeed as drug use becomes common well be that people want to withdraw. among students, one can say that a sophomoreis But in looking at the secular use of drugs, which exhibiting normal social behavior in taking mari- is what we are concerned with in their non-medical huana for the first time from a senior. Normal of use on the campus, we must be cautiousand not course by no means implies that it is wise. become overly psychological in attributing reasons Another important feature which we find in the to drug users. The substances being used areall study of committed drug users, as opposed to people social drugs. They are part of the social scene. They who are merely experimenting, is that the reasons are part of what people do together,Anybody who for continuing to take the drug are frequently dif- smokes a cigarette in a conversation or who takes a ferent from the reasons for starting it. For example, drink with others knows this. Thus when we talk one starts to smoke because one'sfriends and par- about newly popular drugs, like LSD or marihuana, ents smoke, bccause it is the thing to do, orbecause we must note that some of the reasonsfor their one is sociable or curious aboutsmoking. But the adoption have to do, in part, with their function cigarette can become very personal. One gets to in sociability. The diffusion of drugs must be need the cigarette. Those of you who have become cigarette addicts are aware that the present desire Presented at National Association of Student Personnel w stave off withdrawal symptoms, to stay content, Adm inistratorsDrug EducationConference. Washington. D.C.. November 1966, to suppress tension, or just to have something to do 79 8 with your hands, is quite different from the :Jriginal The drug serves them not in an unscrewing function exploration and sociability that led you to smoke but perhaps in a pain-reducing function. When a your first cigarette. doctor ponders when to give morphine he weighs Perhaps we can examine the functions of drug the utility of the drug in terms of its capability to use_ What does it do for the guy? How does he act? reduce pain. In the case of a disturbed student's What seems to be happening? What does his group pondering when to self-medicate with a social drug, do and what impact does it have on the social he may also weigh its utility for pain-reduction. His system of which itis a part? Then at the same due or aim is. "I don't want to hurt." He is not time we are free to ask the previous questions: What pursuing pleasure; he may merely hurt less than is it that the drug user says he believes, says is his usual when on drugs. motivation for use? We can compare his actions A student I know is a very capable and sweet with his statements and test them for consistency guy. He is also a rather heavy user. He uses it, he and as part of this analysis watch our own col711- tells meand I have also watched himwhenever ter-reactions to his behavior and statements, since he is going to be with a group, because he gets our own reactions may very well be part of the nervous and tense otherwise. A little LSD or mari- system which underlies that which is happening huana calms him down and allows him to function. among student drug users. Others of us might take scotch or cigarettes but LSI3 I suggest that one of the fundamental orientations does that for him. Such psychopathology as his which might be used to discriminate those who is minor, but without much looking we can see continue to use drugs (LSD in particular but mari- serious illness among some drug users. Another huana and some of the others too) from those who important way of using drugs has to do with the reject their use is an inside versus outside orien- partial resolution of some of the difficulties of tation. Introversion and extraversion are terms for growing up. Many human beings are stuck with what we are dealing with here. In interviews with psychosexual complexes. A guy or a girl during and observations of drug-using people, one senses college years can be exposed to all kinds of relation- 'an emphasis on the value of what is going on inside ships and impulses which do not get handled as he their heads, on looking at it, and on the importance would like. By using drugs he can sometimes succeed of intemal experience. But among non-users, I in reducing not only the anxiety but also the desire. think there is more interest in external experience, An example, itis a curious thing that there is in what is going on between people, with an em- among the users of the mind-altering substances phasis on looking for explanations and for direc- a lot of talk about "making out," about sex and free tions and solutions on the outside. In our LSD lovebut damned little activity. I think that the study this seemed very clear. function of the drug in reducing sexuality cannot As alternate terms for inner-outer or for intro- be ignored. It is not that sex is no longer important version-extraversion, one can say egocentric versus but rather that the student can accept a new value, other-centered, selfish versus sociable, or profound, one which says, "It is all right to be nonsexual and sensitive and esthetic versus materialistic and shal- to concentrate on other things." That may or may low. The terms you use depend on what system you not be a neurotic solution. buy and how you feel about it. In this initial con- Another pathologically relevant use of drugs has centration on the inner orientation, let us assume to do with the reduction of intimacy in human for a moment that there may be some worth to this relationships. in this society you cannot get away category of experience. What are the satisfactions with that without lying. We are supposed to like or values associated with an emphasis oninternal each other. The acceptable thing is to go out and experience? The kind we had better consider first mix and be a good guy, get along, be affectionate which I think are rather importantare essentially or at least smooth, to love a lot or a littlebut psychopathological functions. above 'all to seek and be with others. The use of Psychopathology of Drug Use drugs may remove people from intimacy and may Some people hurt themselves or others and can do it in a way which can be lied about very easily, be said to be screwed-up characters. If we will accept because they say, "I am becoming more intimate. this for the moment as a definition of "psycho- I am feeling loved. I am a lovely guy. You are a pathology," I suggest that some proportion of drug lovely guy. We are lovely together." Saying that, users, students and others, are fouled-up people. they crawl back into their shells where they do not 80 86 have to look at one another again. One achieves this want to cut off our drug supply or to punish us are "lovingly- and has not hurt anyone and has learned very bad fellows indeed." a new value system to justify one's pathology. I watch it often. I believe it to be there. If itis, Religion and Mystique I will be delighted; if it is not, I will not be sur- Now let us look at some other aspects of use. We prised. must not ignore the religious and mystical functions which students attribute to drugs and the religious Interpersonal Pathology and mystical experiences which they say they had All drng use certainly cannot be conceived in under drugs. Nobody knows really what goes on terms of ,ndividual pathology, nor can all use be inside anybody's else's head, not even with the aid explained simply in terms of private feelings, or of an EEG machine. When something new happens neurotic or even psychotic idiosyncrasies. We there- in our heads, as in a drug reaction, one has to inter- fore have to deal with interpersonal pathology, the pretit.That interpretation can be helped by nasty things people do to one another with or with- teaching. There is no doubt that drug users tend out excuse. Drugs do not produce any special new to teach each other what is going on inside the nastiness in human beings. We are all capable of all head, Somebody joins a group of kids and whether kinds of misbehavior without taking any drug. One by accident or propensity, he likes them. They say of the great dangers, one of the great nonsenses in to him, "We use marihuana or LSD and we are criminology and other fields is to blame bad be- having a religious experience." They give him the havior on drugs. You will hear someone say, "He drug in a setting where his experience is formulated took heroin and became a bad boy.- The fact is as a religious one and he believe ; that is what that if he is bad boy and takes heroin, he remains a happened. On the other hand, w. ,en one's brain bad boy and is going to stay a bad boy until some- is turned off by a response to toxic ,igs one has thing elsenot heroinhappens. That he treats to substitute something else, somethil, ' lean, on people badly can be accounted for not in terms and to interpret the world with. At t mom ent of drug use but in terms of how others have treated of organic anxiety, itiscritically in1:3,-1.ant for him. Thus much psychopathology is really an inter- somebody to come in with supports, wi a belief personal phenomenon. Much behavior under drugs system to replace that which disappeared when the is nasty, take the aggressive drunk for example, and complicated circuits were shorted out. we dare not ignore it. But the chances are that it is I will run through a list of other things that I the person and the situation, not the drug, which think are relevant to the use of drugs by students, are accountable. The drug just changes the em- and which we can see have belief systems 1, a phasis. around them, One aspect is the dirillusionrn,_,., the Another thing that happens in drug useit is not unhappy response of disillusienment with a harsh pathological but human and does not bode well for life and an unkind society that comes one day to all societyis the ethnocentrism one sees in the de- young people. Living anywhere is hard work. Living velopment of drug-using groups. As in any other in a competitive society is hard work and often social group, an emphasis can be placed, call it tribal not much fun. It is very nice to find a way out or fraternal, on valuing the insider and on deni- through the back door or any other door we can grating or rejecting the outsider. In studying the find. A new system of values which promises a way way-out drug users one just cannot miss this char- out will be attractive. Some of the drug culture acteristic. It hits you in the face and does not make mechanisms allow one a private way out while for good conversation or pleasant relationships. For maintaining a public facade of accommodation, for the in-group fellows a drug can become a symbol it does not go all the way out, just part of the way of group-belongingness and worth. That in-group out. feelingis accentuated simply by the realities of Another function of the drug we see expressed is illicit drug use, which require a pseudodelinquent a creative and esthetic one. Drug use is equated tie and a wariness about the punishment potential with beauty and sensitivity. Some quite competent existing in the square out-group society. After a artists feel a debt to LSD or pot for freeing them or group has clustered about a supply source it can for helping them to be creative. These are the re- develop defensive justifications which say, "Won- ports of their personal experience. When competent derful, a fine bunch of people we are, but those who artists say that, we must respect their beliefs even

81 8 though we suspect they owe more credIt to them- folk. Of course, there can be irony in the new selves and less to the drug. morality, as in the old. It values life and it values Another aspect of drug use has to do with our others, but an emphasis on inner experience can much-vaunted rationality. I think students are tired put the person in the position of not really being of rationality and things associated with itfore- able to act in a way that can be of any help to sight, control, discipline, the Protestant ethic bit, another. The irony can be a feeling of private love grace gained only in later lifefor they are hard unassociated with the capacity to love or to engage to live with. To be irrational, to be allowed to have in a genuine community life. an ecstatir_ experience, even a mushy one, that is not Ironically too, one value that is rarely set forth La3 bad if one must live with the rational computer is that of fun. A lot of people take a drug because it night and day, as these kids are beginning to have is fun, yet it is a curious fact that so few can admit to dc, toit.People employ ideologies to excuse their I might add that thisis happening to some simple pleasures or to justify pain, when that occurs. stuients while they watch their own parents, older In the new morality may also be found the "cool friends, their teachers and deans, and say, "Is that rebellion." To Ilse marihuana or LSD confronts going to be me? Help, I want out!" You may call colleges and parents with something that shocks the tam irrational until one day you also have had it hell out of them. One cannot ignore the fact that and when that clay comes you also look for the door there is shock and rebellion in what is done, but that leads out. :hisis a rebellion conducted for the most part Another set of notions I suspect may be associated behind the privacy of one's own walls. Such rebel- with student drug use are those delightful feelings lion, an undeclared war, if you willand I do not of invulnerability, the beautiful young belief that mean to exaggerate its importance since we all go "Nothing can hurt me." Some have ways of proving through rebcllions= has the delightful capacity of it. "I climb mountains because I will not be killed letting one be a rebel without being identified as mountain climbing, or I will drive ninety miles an such, or letting one's most significant act occur in hour because my car has a special charm." Drug use such a way that nobody can clobber the rebel for it. represents for some what a psychiatrist would call A final aspect of student drug use is critically a counter-phobic response. For others, the invul- important It can put us in an awkward position, for nerable feeling results only because they had had the university is a place where people are supposed a good life, well protected and pretty sweet, and to do new things. The university is an institution they just never got the idea that something bad for innovation, a place where the old is supposed might happen. to be analyzed and challenged and where, when the Morality old is not any good, one learns to throw it out. The universityisa land of hope and promise.It Another drug-relevant element that I think is demands experimentation. So it is that a university part of the "I am a beautiful child" syndrome is the is a place to do experiments that fail and experi- potion that "I am basically a fabulous person, and ments that succeed. That value is one which the if I don't feel that way at the moment I can become kids have learned and I think we are all glad they that way by just seeing further into my real self have. We cannot forget that out of ten experiments the pure one uncontaminated by the adult cesspool which they conductintellectually, socially, or per- world," That hope of being beautiful or complex is certainly understandable. It is a poetic desire, sonallywe are very lucky if they win on one, although others might call it vanity. because in winning on one presumably all of us Another drug-relevant element which I think is have gained a bit and benefited. Nevertheless, they part of the value-system, although I do not know are going to be losers on the other nine. how many people subscribe to it, is part of a new We hope to let them continue their experimen- morality. The new morality ,prizes private experi- tation and to be able to tell us to go to hell. At the ence, inner sensation. It values freedom, art, non- same time we must try to warn them from what we restraint, pacificism, protection of life, and nonag- know, if we know it, when a particular experiment gressiveness. The new morality is associated with might go sour in such a way that they are no longer anarchistic beliefs, expressed optimism, a feeling of able to conduct further social or personal experi- separateness from the adult world, and not too ments. Let us guide our drug programs by these much respect for the sacred cows of middle-aged lights. 82 8 THE MYTH OF ALIENATION AND TEEN-AGE DRUG USE: COMING OF AGE IN MASS SOCIETY WINFIELD W. SALISBURY, PH.D., and FRANCES R. FERTIG, B.A., Department of Sociology, San Jose State College, San Jose, California

The Concept of Alienation mous decision making. the value of self-expression, creativity, concern for others, and spontaneity, The meaning of term alienation, as used here, is a state of rejecting the dominant culture and Motives Behind Drug Use its institutions. Political activists, hippies, and com- pulsive drug users, in terms of this definition, are Looking beyond the social myth which stereotypes very likely to be alienated. Most high-school and young drug-users in terms of alienation and emo- college students who experiment with marihuana tional disturbance, what motives do we see operating are not. The majority of them are qiute normal, in their behavior which would cause them to view probably superior, teen-agers. "tripping out" or "getting stoned" as desirable? The curiosity drive is one good reason_ Characteristics of Teen-age Drug Users A second factor is that drugs are medicine. When asked to -explain"(i.e., justify)their behavior, Consider briefly what the typical teen-age drug teen-age drug users often point to the fact that users are like. commercial drug industries advertise continually They are white. They are upper-middle and mid- the benefits of taking pills for every kind c,` 'physical dle-class. In a high school predominantly upper- or psychic discomfort, including such vague ills as middle class marihuana use(depending on the nervous tension." Young people realize that drugs grade) varied from 16 to 31% for boys, and 12 to can be abused but often feel that their parents' 28% for girls. in a lower-middle class high school, use of tranquilizers, barbiturates, amphetamine and the boys' use was 6-12%, and the girls' use was alcohol is more irresponsible and dangerous than 3-6%. their own use of pot and LSD. 'They are affluent. They tend to be humanitarian, A third item is that drugs are fun. In the authors' and to value self-exploration. They are rarely .interviews with teen-age users the most common "rebels" or "revolutionaries" against our society; response to the question of Why?' was, "It's fun!" they are intent (albeit often clumsily) upon express- In spite of the Protestant Ethic, there has developed ing fulfilling values they have learned in the home. in America a pleasure-seeking ethos. With the help Their parents have emphasized the humanitarian of alcohol and pep pills, parents are often pursuing goals of self-actualization, individuality, autono- fun themselves with the energy of the Furies. If we Published inCalifornia SchoolHeahh, Winter, 1968. reject marihuana in the face of this hypocrisy, what

83 sort of respect will we have left to draw on when been accentuated by the conditions under which the a student starts using "acid," "speed"(ampheta- current generation of teen-agers have been raised. mine) and "smack" (heroin)? If a teacher is to op- The most dramatic revolution of the past 25 years pose our fun-oriented ethos, he must have a thor- is the emergence of an advanced information tech- oughly examined philosophical position from which nology creating new concepts in space, time, and to do so. How many of us can say this? And, if we human relationships. Today's students are the first do noi: oppose the right to have fun, on what generation to be raised on TV, cinemascope, stereo grounds are so many of us judgmental and indig- sound, and u ansistor radios. As Marshall McLuhan nant about the use of marihuana by students? has described, the electrified mass media give us Next comes sensuality. This is really a sub-cate- instant communication; messages race to bombard gory of "fun," but a very special one. We mentioned our senses from everywhere. Thriving on the infor- above that the senses of touch and taste have been mation explosion, youth create happenings, en- very neglected in our culture. Therefore, the ex- vironmental art which amplifies the simultaneous ploration of them provides a special fascination for stimulation of all the senses. young people. Almost every marihuana party,and Next in importance is the increasing automation many LSD trips, involve a period when everyone and cybernation of work and education, Our youth gets the "hungries" and explores as wide a variety have not only observed technology streamline their of taste delights as is available. More crucial, how- schools and their fathers' jobs; they have now come ever, is the increase in cutaneous sensitivity, because to expect as a matter of cow se vast changes in their one aspect of thisis sexual stimulation. Our in- work and leisure situations. This is the first genera- quiries have not revealed much interest insex tion to be prepared psychologically for a science- during LSD trips. There is no doubt, however, that fiction future. teen-agers have discovered that pot makes the ex- Another crucial influence is the birth-control pill, ploration of sex more delightful. As far as we can a piece of technology that creates new attitudesand tell, this has not 'meant an increase in sexual ex- expectations about sexuality in teen-agers. Again, ploitation or carelessness. The hippies, whom the this is the first generation to grow up with the mass media use to create this kind of impression, knowledge that virtually 100% effective birth con- seem to have been emotionally disturbed and sexu- trol is available. ally rebellious before dropping out into the drug The H-Bomb is yet another influence shaping the subculture. world view of today's youth. An unprecedented The problem, it seems, is that teen-agers are more familiarity with world events and the obvious fail- permissive about both drugs and sex than are older ure of our society to deal with the H-Bomb and generations, so that itis easy to read into the other world crises have produced disillusionment situation a causal connection that is not necessarily among the youth. there. This is a generational change that parents A final condition that must be considered is the themselves have helped to create. Today, parents wealth, the leisure and the indulgence available to themselves, although sometimes unwilling to admit children in this same period. it, are more permissive about sex and sensuality The next thing to consider is what kind of teen- than they were 20 years ago. age subculture will be created by these conditions. Many serious scholars believe that LSD does produce :In experience similar to those described Negative Aspects of Teen-age Subculture by the great mystics. Testimony to this effect has Irreverence toward the past. Young people today been maue by Alan Watts, Allen Ginsberg, Dr. John tend to ignore tradition and have no heroes and Aiken, Husibn Smith and William Stace, a Prince- are ignorant of past social movements similar to ton professor, considered the foremost authority on those 'hey start themselves. It never occurs to them mystical religion in the United States. that anybody in the past has tried to form a utopia, formed a commune, discussed the value of freer Adolescence at Mid-Century sensuality, thought of having a companion before The aspects of American culture which support marriage, or started a peace movement. the permissive use of drugsthe enjoyment of The old judgmental-conformity aspect of teen- leisure, the desire for self-development, and the age subculiure still seems to be with us. At some curiosity about the nature of the inner selfhave high schools there is a lot of pressure among teen- 84 90 agers to use drugs; those who are not prepared developing among youth for the siniple life exem- emotionally may be pressured into using them. plified by the American Indian and the frontier Like their elders, they are leisure and consump- community. tion-oriented. This showed very prominently in the Another part of youth's romanticism is its anti- Haight-Ashbury during the "Summer of Love." The technological bias. These are the children that older hippies were concerned about developing a have been put through the IBM machine routine creative community around the concept of doing ever since they arrived for kindergarten. They have your own thing, the thing being some kind of work gone to hugc bureaucratic schools, high schools, in which you contributed to the community. colleges and universities. They are getting sick of What happened when 10,000 teeny-hoppers and anonymity and lack of personal attention. college students rolled into the Haight-Ashbury? A part of romanticism is the great suspicion o Doing their thing, for them, meant to consume; and society's "ego games." Again and again we have they consumed everything in sightthey ate all the heard young people attack viciously the kinds of Diggers' food; they wore all the Diggers' clothes: games their parents play in business, in marriage, they took in all the free concerts they could get; in social climbing, and so on. They are still quite and they wandered around, picking and chomping naive, and they are not aware of the games they, the flowers in Golden Gate Park. By the end of the themselves, playwith their elders, themselves, or summer, the Haight-Ashbury was a community each other. But at least there is an increasing aware- drained of its resources. ness that most of our interacting is based on games and facades, and maybe this will lead someone in Positive Aspects of Teen-age Subculture some distance future to create a culture free of Among youth today there is an awareness of hypo- games of exploitation and manipulation. critical use of tradition. The upper-middle class The next characteristic involves what the anthro- teen-age leaders, especially, see most of the hallowed pologist Gregory Bateson called the cultural ethos traditions of this country as delusions. They have the psychological orientation of youth subculture. begun to recognize, through their growing interest There are five of tqem and they are briefly: in Eastern mysticismtheir awareness of the con- An awareness of others. Young people today cept of "maya" which translates best as "social illu- dislike -ego trips." Marihuana makes you quiet, sion"that ideals of this kind are nothing but amenable, sociable; alcohol makes you obnoxiotts, verbal traditions, made-up games. And the question noisy and aggressive. Young people valuz a kind is: is the game worth the candle? They are begin- of "empathy" which they consider subtle but ning to look at the game and the candle, and will realistic. They want to see the real person behind not docilely accept the hallowed traditions. The the role, and they talk intheir lingo about current peace movement demonstrates that one of "auras" and "vibrations." Some identify "vibra- these questioned hallowed traditionsis the idea tions" as spiritual perceptions, but they may that you should be willing to die for your country legitimately involve some sort of sensitivity to without questioning the moral value of the war. subliminal perceptionor just projection. They are espousing a number of primitive Chris- They value self-actualization. This value seems tian precepts, which find their epitome of expression to reach its epitome among young drug users and in the more responsible, older hippie community in the hippie communiiy. One of the corollaries that is, the hippie community organized around of this value is that societyand particularly its a concern with mystical experience, and the com- school systemshould not interfere with the ex- munity of love. ploration of new experience. In fact, like the Young people are naive about the world because permissive and indulgent families they have come they have been "ghettoized" in suburbia. Upon from, young people feel society should provide going out into the larger community, they are the space, the time, and the tools necessary for shocked by the hypocrisy of their elders. this. When they find that instead, the bureaucracy The fourth positive trait is romanticism. Young interferes with exploration and self-actualization, people have begun to look for a kind of tribal iden- with the creative working out of their own indi- tity, and may come to look on their peer group as vidual and unique patterns, they become in- a tribe. This has always been characteristic of teen- dignant. agers, but now there seems to be a kind of nostalgia A fourth aspect of the new ethos is the permis-

85 91 siveness toward sensuality. Parents following child alienation of young drug users and how we can guidance concepts of the 1950's, began to feel combat it, the question may be completely off base. guilty about making their children feel repressed. The alienation, to the extent thatit occurs at They worried that Freudian theory might he all, is largely a function of the social reaction to right, even though they were still pretty inhibited drug use. Teachers and parents refuse to communi- themselves. Along with this reduction in repres- cate with the young about the problem, and to :ion, our students probably got more cutaneous recognize the fact that many students regard smok- stimulation during nursing, and during infant ing marihuana as a normal kind of social activity care in general, than previous generations. which is not dangerous to their health or their Fifth, they have certain dislike for what they morals. call hang-ups. They seem to want to remain more If we are going to handle this problem ade- flexible than their elders. They do not like rigid- quately, teachers, counselors and school nurses must ity, and do not want to be identified with a role. learn to overcome their fear of intimacy with their students and begin to communicate with them. Drugs and the Social Reaction Edgar Friedenberg, in his study of a Midwestern With this picture of modern American youth sub- high school, The Vanishing Adolescent, found that culture, perhaps we can better understand the most of the teachers were afraid of intimate relation- current interest of the young in exploring the use ships with their students. Most of them, he felt, were marihuana, LSD, and other psychedelic drugs. It is motivated by a fear that their aura of authority our thesis that drugs that increase sensitivity and would be undermined. He found the students were awareness were bound to appeal to young people bitter about the absence of any nitty-gritty discus- involved in the kind of cultural milieu just de- sions of life's real problems. Most of them regarded scribed. Young people who value self-exploration, the high school program as "irrelevant" to their sensuality, sharing, tenderness, who want to be sen- lives, apd remained only to obtain the "certificate" sitive while they see their parents hung-up in self- passport to jobs anu college. This problem, frankly, delusion and exploitive games, and who are skepti- rather than any inherent quality of the drugs, is cal of their elders' competence while they want to the reason that academic motivation drops precipi- create a better world, are going to value increased tously with the excessive use of marihuana. sensitivityabove thenerve-deadeningeffectof Whatever the reason, the fact is that most teachers alcohol. are afraid to get involved in discussing their stu- Older people see marihuana as having all sorts of dents' real, personal problems. Such discussions are evil potential and peculiar effects, while they them- emotionally strenuous and most teachers are already selves are popping down prescription pills. Young people, being more aware of the recent literature overworked. and having read some of the scientific studies on Yet, if we are to give our young people the ability marihuana, know that the old Narcotics Bureau to face the real world, and if we are to break the description of it is absurd. When the police depart- vicious circle of the self-fulfilling prophecy in drug ment's public relations officer comes to talk to school abuse, we must learn to confront our students classes, and tells them marihuana is a narcotic and honestly. We must learn the scientific facts about a very dangerous drug, they simply tune out. Cu': drugs so we can confront them with meaningful Unfortunately, when he alsotells them that evidence rather than outworn prejudice. With this heroin is dangerous, or that methamphetamine is combination of courage and information, a mean- dangerous, a certain number believe that they are ingful dialogue between young people and their being fed the same old baloney and proceed to teachers and parents can begin. The process of legal experiment with these dangerous drugs. suppression can never be a substituteforthis When we raise the question of the cause of the dialogue.

86 92 PREDISPOSITION TO ALCOHOLISM REVEREND STANLEY T. HELM, Mendocino State Hospital, Talmage, California One of the problems of the great emphasis on tion of adults are said to be users of alcoholic bever- drugs in our society today is that we forget that ages now. There are a number of human differences alcohol is a drug. We get things out of perspective in the reaction to taking any kind of substance. This by over-emphasizing the problems of drug use goes for drugs of all types. Many of these are prob- (which are very critical) but, much to our relief, ably questions of heredity or biochemical make-up, are able to forget the problems of alcohol which or social-cultural development, demands and ex- are a hundred more times critical in our society. pectations that are ours by reason of our existence It may not always be that way, if present trends in a particular culture. continue, but it is now. In our own studies, we took a sample of 200 The approach that we now use is a behavioral patients. We now have a report on that group of and social approach rather than thinking of alcohol people based on their own reports about their child- as a disease. There was a time when that was a hood, family life and other factors. Their major fairly useful concept because it did break down problem in growing up, they said, was due to either some of the stigma after being labeled an alcoholic. economic problems or parentalincompatibility. That is a large part of the problem, by the way, Very few of them said alcohol was a problem in the labeling process. I suspect that applies to drug their family life, even if their parents drank. In addiction as well as to mental illness. general, they present themselves as having a happy The general estimate of alcoholics now in our society is four and one half to five percent of all the kind of childhood and existence. According to them, adult citizens in the country. The proportion of their families, brothers and sisters, and teachers male to female alcoholics is decreasing. It is prob- liked them. They were fairly good students, remem- ably around four and one half to one. It used to be bered school in a pleasant way, felt they were higher than that. There are multiple causes, just as happy-go-lucky children. They went to Sunday there are in the field of mental illness. We have to School regularly without too much pressure and look at alcoholism as we do other types of behavioral they report this kind of experience in their back- difficulties as part of a long process. It generally ground. That leads us to believe they were afraid takes a fairly long time of fair quantities of drinking of hostilities and extremely sensitive to approval or to get into trouble. Some 75 percent of our popula- disapproval. Some of them may drink to lessen that intensity and that kind of feeling. Our group Excerpted from remarks to participants of a Marin County, California leadership training progTam in drug abuse educa- surprised us because they used a wide range of drugs tion, June 1968. other than alcohol. They may go from one type of 87 drug to another. Most of them stay with a sedative assert yourself without alienating mei!? What is a type of drug, not the stimulant types. feminine person in such a %corld as this? How ..an This project had led us to believe what we have yon recognir, your dependency needsand realisti- felt from the beginning that the emphasis on alco- cally meet them without being dominated exces- hol and alcoholism is a somewhat misleading one, sively or without being unhappy about it? How can just as the use and misuse of drugs is misleading in you accept the factthat you are feminine? How a sense. The emphasis must be on people amltheir can you achieve depth in interpersonalrelation- problems and conflicts and difficulties. The use and ships? How can you reduce anxiety by non-destruc- misuse of whatever it isis somehow an attribute tive methods? How can you find relief from guilt of that particular underlying difficulty: When we without depressionordespai:? How can you used LSD here in a research project, we found that achieve less sensitivity to the feelings or expecta- under the LSD experience only two of our patients tions of other people, to be tougher in some degree? reported thinking or images about alcohol. What How cart you achieve a personal sense of security they did report were other types of conflict with without undue reliance on others? How can you people or feelings or particular situations in their lessen the need to control others by devious and backgrounds with which they were in conflict. various means? How can you expresshostility We tried to differentiate the kinds of personalities toward others without self-destruction or guilt or we see most often. Men are in more difficultythan alienation? Those again are not unique questions women because of their drinking. They are "in only of alcoholics, but they are questions to alco- thicker" than women. They have suffered more loss. holics as well as to others in our society: They have fewer social resonrces. They have more In approaching the field of alcoholism we adopt conflict and they have more difficulty in achieving an auf:ade that is consistent, open, non-criticaland a different kind of life. Women have more normal non-punitive.Ifpunitivenesshelped,everyone kinds of personality patterns;they are inless would have been helped a long time ago, because psychic difficulty generally speaking. That is obvi- they have certainly had plenty. So the basic ap- ously not true for everybody, but itis generally proach to this particular type of problem is not per- true. missiveness, but simply non-punitiveness: One of the Most alcoholics we see have little tolerance for frustration. They have difficulty in coping with basic problems of all alcoholics in our society is that stress or withstanding anxiety. Emotional tension doors have been shut to them and the normal things and conflict are presentin family relationships that would have been open to them have been un- especially: There are strong feelings of alienation available. You go to an out-patient clinic dealing from their community or their family or, frequently, with mental problems and let them find out that they have high energy levels but poor impulse you are an alcoholic or drug user and see how far control: you get in their set-up. You find that you are out on There are some unique problems that arise for the street again. If these and other doors were open, women, as we have seen in our own study group would be a lot less difficult for alcohol and drug of women alcoholics. Some of these are: how do you abusers, and for society.

88 9 4 GLUE-SNIFFING: A REHABILITATION APPROACH JUDGE THEODORE RUBIN, Denver, Colorado juvenile Court and ROBERT C. HANSON, PH.D., Deparunent of Sociology, University of Colorado

Problem borhood peer group engages inue sniffing then the The inhalation of airplane cement fumes for the adolescent who joins the group will be exposed to purpose of intoxication occurs among adolescent glue-miffing behavior. Should he wish to remain boys and girls throughout urban areas and at all in the group, social control pressure from higher class levels in American society. Habituated users of status members will require him to learn the glue- glue began coming to the attention of the courts, sniffing activity. He will then be labeled a glue snif- schools, and other civic agencies in the late 1950s. fer by society, which leads to the expectation that he In Denver, about nine out of ten cases were boys will continue to sniff glue until the group breaks who lived in slum-like, deteriorating neighbor- up or until it changes its pattern of activities. hoods. Over 90 per cent of known users were Span- Alternative Rehabilitative Approaches ish-American boys, usually from large, multi-prob- lem families. The boys were frequently truant from The theory just presented suggests an obvious school, had failed one or more years, and were likely rehabilitation prescription: restructure the social to f:ail again. relationship and the socialization experiences of the glue sniffer in the home, at school, and among Theory neighborhood peers. Theobjectives of such restruc- Chronic intoxication through the habitual use of turing should be to help the glue sniffer develop a glue is a possible adolescent response to continual more favorable self-concept and a pattern of coping frustration produced by family disorganization and behavior to deal with current frustrations without school failure. Normal socialization processes which resorting to glue sniffing as an escape, and to change typically produce conformity to the norms of the his attitudes and actions from his current acceptance larger society are disrupted for children from un- of and engagement in delinquent behavior, prefer- stable homes with language and values different ably by changing the structure and activity patterns from those of Anglo middle-class society. A potential of his neighborhood friendship group. glue sniffer, hampered in his psychological and so- Ift contrast to a control group of glue sniffers who cial development by repeated frustration at hurae were assigned to court probation counselors in the and school, and exposed to deviant patterns of be- traditional manner, three experimental groups of havior in both home and neighborhood, is likely glue sniffers were set up to test the relative effective- to depend on neighborhood peer group relations in ness of alternative rehabilitation approaches. his search for recognition and affection. If a neigh- Group I consisted of a natural friendship group

89 in a deteriorating Spa ish-American neighborhood. later, the same tests wer2 administered to the cur- All eleven members of the original group were rent members of all groups. Court and schooldata known to the Court as delinquents and heavy glue provided additional objective measures of behav- sniffers. A regular court probation counselor was as. ioral changes. Since group membership changed signed to work full-time in the neighborhood in an over time due to residence changes, increasesdue to attempt to change the attitudes and behaviorof the new gine sniffers in the neighborhood,absences dur- group as a whole, in addition, membersof this ing the period the tests were given, and so on, com- group were assigned a specialteacher intheir plete data on each original case was impossible to junior high school from whom they received instruc- obtain. The results therefore were restricted to those tion and individual counseling as a regnlar class cases in each group for which test results wereavail- three hours each day. Both court and teacher coun- able at both measurement periods. For each test, selors were guided in the group approach by an change in a "favorable" direction was defined. For experienced group techniques consultant. Both each group the average amount of favorable or un- counselors established relations with and received favorable change was computed. cooperation from the parents, A Change Trend Summary table shows that the Group H was originally composed of a natural School Dynamic Group (Group I) changed in a group of seven neighborhood friendsfrom a differ- favorable direction on 34 of 42 measures and the entrun-down Spanish-Amerkanneighborhood. Local Leader Group (Group II) changed in a favor- With one exception, these boys were not known to able direction on 28 measures. These results contrast the Court, and, while glue sniffing was obviously oc- with the 16 favorable changes in the -Individual curring in the neighborhood, original members were Therapy Group (Group III) and 10 favorable reluctant to admit that they used glue habitually. changes in the Control Group. In the latter two The group was counseled by a young Spanish- groups, the tests indicate increasingdelinquency American college graduate. Over time, he estab- proneness despite a year of intensive therapy or tra- lished good relationships with the parents of the ditional probation counseling. boys. He also received guidance in the group ap- The trend results provide strong evidence for the proach from the Project's group techniques con- conclusion that the group approach is superior to sultant. As in Group I, the primary objective was to the individual case approach in attempts to rehabil- effect changes in delinquent attitudes anti behavior itate glue sniffers. The dramatic superiority of the by changing relationships and experiences of the School Dynamic Group in objective measures of group as a whole. This "local leader group"did not favorable change in behavior indicates the effective- have the advantage of special help in the school ness of continuous help and support in theschool system. system. The primary effort in a third experimental group was devoted to intensiveindividual therapentic Recommendations and Conclusions work with 13 known delinquent glue sniffers and First, a group techniques professional should be their parents. The counselor was a young college employed to train and guide probation counselors graduate with a social science background. He was assigned to employ the group approach in neighbor- guided in his therapeutic efforts by an experienced casework consultant. In this approach, nothing hoods with chronic problem glue sniffers. could be done to affect the attitudes and behavior Second, some counselors should move into com- of the glue sniffer's neighborhood friends. Help munity centers or other facilities in neighborhoods with school problems was given on an individual known to contain large numbers of glue-sniffing boys. It is difficult, but possible, to organize known basis. Finally, in the Control Group, only the brief face- glue sniffers into a solid supportive group and to to-face interviews with a court probation counselor change group standards and patterns of activity. could count as atempts to effectively manipulate the Third, special educational experiences should be socialization experience of known glue sniffers. provided for glue sniffers md other under-achieving children who reflect anti-social symptoms. A special Results teacher should be assigned to conduct class on a A series of behavioral, attitudinal, and psycho- group approach basis, providing bothinstruction logical tests were administered to the original mem- and counseling, and to work in conjunction with bers Of all four groups. Approximately one year the group techniques professional. 90 9 Fourth, when functioning groups begin to emerge socially acceptable and personally healthy pattcl-n in neignborhoods and in the school, meetings with should be released ,rom probation but allowed to re- parents and other family me,nbers should be held. main in the group, should he desire, as a model for The objective of such meetings would be to gain others and for his own further support and self- family member support for the goals of the group growth through participation in the group. Perhaps aproach, including more productive social and two years of involvement in this process will be school performance and the development of healthy necessary for the average habituated glue sniffer to self-concepts. When family members become aware stabilize the gains he has achieved. of the improved performance of the teenager, per- haps there will be an improvement in relations bc- Sixth, a similar group approach program can be .ween him, a (former) glue-sniffer, and his parents developed for glue-sniffing girls. Joint boy-girl pro- and siblings. gramming should be developed to provide construc- Fifth, a boy who has changed his behavior to a tive learning experiences in heterosexual relations.

91 9 7 4/DRUG FILMS

SUGGESTIONS ON THE USE OF FILMS IN DRUG ABUSE EDUCATION DAVID 0, WEBER, Film Consultant, California Department of Public Health, and JOSEPH FIORELLI,Audio- visual Specialist

Users of LSD say that the quality of a trip depends show in great detail the ways drugs can be abused. on several factors. One is the grade of acid taken. Some maintain a studiously determined distance. Another is dosagea fledgling will almost certainly Some are dramatizations, some documentaries, some fly on 250 micrograms while the same amount may lectures, some cinematic essays. Most are a cornbina- barely get a hardened tripster off the ground. Two tion. other essential factors are the "set" and the -set- Some project a tone of moral outrage, others a ting." tone of cool scientific detachment. Some attempt to Set means the ideas, the mood, the rationales a deal with a broad spectrum of drugsthese are few- user carries with him into the experience. If he is est in number and probably the most needed fearful, antagonistic before he begins his trip, he is others treat only one drug or one class of drugs. likely to have a bummer. Needless to say, none of these films will give audi- Or, if the setting is wrongunpleasant physical ences identical trips. surroundings, bad vibrations front those around It might be worthwhile to ponder in advance him, distracting noises or lights or musiceven a what functions a film should perform: positive set can be negated. For example, is one purpose of a drug film to The use of drug films to educate young people show teenagers how 11,!roin is prepared and injected, about dangers of drugs can be compared with the how marihuana is smoked, how glue is inhaledso use oi LSD. that they can recognize and avoid these situations First, the quality of films, as of drugs, varies when encountered? Should a film lie propaganda, widel, . Many Elms still in circulation have lost supplying the moral element to the classroom's dis- their potency through age. Hats, hems, automobiles, passionate discussions? outmoded slang, may distract from and vitiate the Should a film, because it lists a lot of doctors as message, no matter how timeless. Or, a film which consultants, be considered unimpeachable author- is up-to-date visually may be hopelessly marred by jingoistic phrases and atavistic attitudes. "Know ity? Or should it be questioned, and if necessary your dealer,- they say in the streets. Applied to demolished, in the presence of its audience? As set films, this translates to know something about the clown, of course, these are loaded questions. Un- producers of films whose use is contemplated and, fortunately, most drug films are similarly loaded. if at all possible, sample the close in advance by pre- The next consideration in selecting a drug abuse viewing them before an audience that will not be film, to continue our LSD metaphor, should be the harmed if the film is bad. set. What's the mood and character of the audience? In addition to quality, drug abuse films vary in Obviously, rural junior high school students will type. Some take the sociological approach, warning find little to identify with in a film about big-city against the loss of income, status, dignity, even free- junkies. Nor will ghetto blacks do much but cackle dom (if jailed) attendant upon addiction. Some are at the cinematic drug despair of an affluent, blond, purely descriptive of drugs and their effects. Some sports-car-driving Kampus-King protagonist. Only

93 98 through careful assessment of the set of an audience better to postpone the presentation entirely than to can a film user hope to un-ri it onrneaning.tilly. interrupt it for a lengthy repair job. Finally, the setting must be such that the trip will Room arrangements should be checked to assure be good, not bad. Most drug film audiences are cap- sufficient darkness and satisfactory viewing from all tive. They can't question the film about obscure seats. Materials should be racked and ready sothat points, they can't argue with it (though they can the film showing can start immediately after the in- catcall and mutter). If their boredom threshold is troduction. If something intervenes between the in- breached, they nod off. troduction and the showing, the meeting should be Guides to the use of films are difficult to set forth brought back into the proper setting by a reintro- because each teacher and teaching situation is dif- duction. ferent However, there are some basic rules that if Generally, no film should be used for educational purposes without oral introduction orexplanation. followed improve chances of success. The introducer can tellthe purpose of the film A good rule to start with is to be as wary of films showing, reasons for selecting the film, what to look as of drugs. Some precautions tobe kept in mind for in it, what questions or reactions will be dis- are: Don't trust a film to be good justbecause some- situation cussed after the showing. one says it is: no one film is good for every Ample discussion time should be scheduled to fol- . Don't trust even agood film Co contain only ac- con- low film showings The discussion period may con- curate information ... Don't trust one expert: tribute more to the desired objectives than the film sult several. showing. If possible, preview a film before ordering it. That Nothing should be permitted to interrupt a film failing, request delivery several days in advance of showing. Unless latercomers can enter without dis- the scheduled showing hi order to view it, prefer- tracting the audience, the entrance door should be ably with a few teachers or students whose opinions barred. and reactions will be helpful. Where practical, audiences should be kept small. Do not hesitate to use only portions instead of A large group can be separated into sub-groups if complete films,filmstrips, or tapes. Imaginative necessary. In intimate groups, comments andcriti- teachers have put together excellent shows by com- cisms come more freely, and there is opportunity to bining parts of several films. correct errors, misunderstandings, and inaccurate Before a showing, check equipment to be sure it inferences. is mechanically and optically. satisfactory. Ideally, Some think that, for teaching purposes, all films back-up projectors and sound equipment should should be shown twice, with a discussion period in be on hand in case of an equipment breakdown. If the middle and perhaps another one following. It there is a breakdown and no back-up, it is usually is a possibility to be considered,

94 9 9 ANNOTATED LISTING OF DRUG ABUSE FILMS CAUTION: No film gives all the answers, and some bring more problems than solutions. Preview any film before showing it, match the film to the audience, remembering that no film is suitable for every audience. Encourage viewers to discuss it pro and con afterwards. Purchase and rental prices are given where possible. Prints may often be borrowed from State or local health departments, film libraries, boards of education, and from regional offices of the Bureau of Narcotics and Dangerous Drugs. Free loan prints of many of these films may be obtained from the National Institute of Mental Health Drug Abuse Film Collection, National Audiovisual Center, General Services Admin., Washington,D.C. 20409

Length Purchase Title B&W or Coverage Target Producer or Or color Audience Distributor Rental DRUG ABUSE: THE 19 min. Barbiturate Jr & Sr. Film Distributors Purchase CHEMICAL BOMB color pills, methe- High School, International, $225 1969 drine, glue & suburban 2223 S. Olive St., Rental In- deliriants, Los Angeles 90007 formation marihuana on request CBS REPORTS : 52 min. Marihuana Sr. High Carousel Films, Inc.Purchase MARIHUANA B&W School, Adull1501 Broadway, $275 1968 General New York 10036 Rental $20 LSD: THE TRIP 28 mm. LSD Sr. High McGraw Hill Films,Purchase TO WHERE color School, AdultHightstown, $325 1968 New Jersey 08520 Rental $16 daily WORLD OF THE WEED 21 min. Marihuana Sr. High NET Film Service,Purchase 1968 B&W School, Col- Indiana University $125 lege, Adult Audio-visual Center,Rental Bloomington, Indi- $4.65 ana 47401 THE LAW: HOW 36 min. Marihuana Sr. High NET Film Service,Purchase EFFECTIVE IS IT? B&W School, Adult,Indiana University$180 1968 General Audio-visual Center,Rental Bloomington, Indi- $7.40 ana 47401

95 10 0 Length PUrchase Title B&W or Coverage Target Producer or Or color Audience Distributor Rental -RESEARCH REPORT: 36 min. Marihuana Adult NET Film Service,Purchase B&W (THC) Indiana University$180 THCTHE CHEMISTRY Audio-visual Center,Rental OF MARIHUANA Bloomington, Indi- $7.40 1968 ana 47401 20 min. LSD Jr. & Sr. _id Davis Purchase LSD, TRIPOR TRAP Productions, $240color 1908 color High School, College 2429 Ocean Park $120B&W Blvd. Santa Monica,No rental Calif. 90405 ESCAPE TO N WHERE 2 LSD, mar Suburban Sr.Professional Arts, Purchase $275 1968 color huana High School, Inc., P.O. Box 8484, Hashish Students, Universal City, Rental Heroin suburban California 91608 $27.50, Methamphet- adults 3 days amine THE DISTANT DRUMMER three LSD Adults National Institute Free 1968 22-min. Methedrine of Mental Health loan films Marihuana Drug Abuse Color Heroin Film Collection MARIHUANA 34 min. Marihuana ., Sr. H.S., Bailey-Film Asso- Purchase 1968 color College, ciates, 11559 $350 Adults Santa Monica Blvd.Rental Los Angeles 90025 $25, 3 days THE MIND BENDERS 26 min. LSD Sr. High National Medical LSD & THE color Psilocybin School Audiovisual Center HALLUCINOGENS Mescaline College Chamblee, Ga. 30005 1968 DMT

BEYOND LSD 25 min. Drug-taking"Middle Class Film Associates of Purchase 1968 color in general suburban Calif., 11559 Santa $300 adults Monica Blvd., Los Angeles, Calif. 90025 LSD: INSIGHT OR 28 min. LSD Jr., Sr. H.S. Asso- Purchase INSANITY? color Adults elates, 11559 $300 1968 Santa Monica Blvd.Rental Los Angeles 90025 $25, 3 days DRUGS & THE 18 mM. Aspirin, glue Jr., Sr. H.S. Churchill Films Purchase NERVOUS SYSTEM color AmphetaminesAdults 662 N. Robertson $170 color 1967 Barbiturates Blvd., Los Angele:i., Opiates, LSD Calif. 90069 Marihuaaa NARCOTICS: THE 2 min. Narcotics Jr., Sr. Charles Cahill & Purchase INSIDE STORY color LSD High School Assoc., Inc. $145 1967 Marihuana P.O. Box 2220 No rental Tranquilizers Hollywood, Calif. Sedatives 90028 THE HIPPIE 1 miii. LSD General McGraw-Hill FilmsPurchase TEMPTATION (Pt. I, Sr. High Hightstown, New $600 1967 31 min., School Jersey 08620 ($300 ea. Pt. II, 20) Adults part) color THE CIRCLE 6`7 min. Heroin Adult, McGraw-Hill Films,Purchase 1967 B&W General Hightstown, New $340 Jersey 08520 Rental $15 daily

96 Length Purchare Title B&W or Coverage Target Producer or or color Audience Distributor Rental THE SEEKERS 10 min. lictroin Sr. High State of New York 1967 color Marihuana School Drug Addiction LSD Control Commission Albany, N.Y. 12203 HOOKED 20 min. Heroin Jr., Sr Churchill Films, Purchase 1967 B&W High School Inc., 662 N. $125 Robertson Blvd. L.A., Calif. 90027 LSD: LETTVIN 54 min_ LSD, Adult, NET Film Service Purchase VS. LEARY B&W Marihuana general Indiana University $210 1967 Audiovisual CenterRental Bloomington, Ind. $8.90 47401 LSD 25 27 min. LSD Sr. High Professional Arts, Purchase 1967 color School, Col- Inc., P.O. Box 8484 $275 lege, Adults, Universal City, Colo General Calif. 91608 LSD 28 min. LSD U.S. Navy Audiovisual BranchPurcha e 1967 color personnel U.S. Navy, Penta- $119.39 gon, Washington, D.C. 20301 FIGHT OR FLIGHT 16 min. Heroin, LSD Jr., Sr. J & F Productions, Purchase 1967 color Marihuana High School Inc., Suite 700 $150 "Pills" 1401 Walnut StreetNo Rental alcohol Phila., Pa_ 19102 cough med_ FDA SPECIAL REPORT: 20 min_ AmphetaminesSr. High Precision Film Purchase DRUG ABUSEBENNIES B&W Barbiturates School Labs., 21 W. 46th $30.79 & GOOFBALLS Adults St., New York, N.Y. 10036 LSD: THE SPRING 54 min LSD Sr. High McGraw-Hill Films,Purchase GROVE EXPERIMENT B&W School, Col- Hightstown, New $2 1966 lege, Adults, Jersey 08520 Rent.:1 Professional $25 HIDE AND SEEK 14 min. Heroin Suburban Center for Mass Purchase 1966 color Marihuana College, Jr., Communication of $150 Sr. High Columbia Univ. Rental School Pres, 440 110th St.,$11 New York City 10025 NARCOTICS: WHY NOT 15 min. Heroin Jr., Sr. Charles Cahill & Purchase 1966 color Marihuana High School, Assoc., Inc., P.O. $175 col. "Pills" Adults Box 3220 $90 B&W Glue Hollywood, Calif. No rental 90028 NARCOTICS: PIT 28 min. Heroin Sr. High Film Distributors, Purchase OF DESPAIR color Marihuana School International, 2223 $275 1965 Beer S. Olive St., Los Cigarettes Angeles, Calif. 90007 NARCOTICS: THE 30 min. Heroin Sr. High Film Distributors, Purchase DECISION color Marihuana School International, 2223 $275 1961 "Pills" S. Olive St., L.A., Rental Alcohol Calif. 90009 $17.50 TOMORROW MAY 23 min. Heroin Sr. High Cinema Dept., Grad-Purchase BE DYING B&W "Pills" School uate Workshop, $138 1960 Alcohol College Univ. of Southern Rental Aspirin Calif., Univ. Park, $6.50 L.A., Calif. 90007 102 97 Length Purchase Title B&W or Coverage Target Producer or or color Audience Distributor Rental 31 min. roin Adults Carousel Films, Inc. Purchase THE LOSERS $145 1960 B&W Glue High School c/o Association "Pills" General Films, 600 Grand Rental Marihuana Ave., Ridgefield, $10, N.J. 07657 Postage SEDUCTION OF 10 iflin. Heroin Jr., Sid Davis Produc- Purchase color Marihuana High School tions, 2429 Ocean T120 col. THE INNOCENT $60 B&W 1960 "rills" Park Blvd., Santa Monica, Cal. 90405 No rental THE ADDICTED (PART II, 28 mM. Heroin Adult Association Films, Purchase B&W General Inc., 600 Grand Ave. $150 CRIMINAL OR PATIENT?) Rental 1958 Ridgefield, N.J. 07657 $8.50, Postage NKEY ON THE BACK 27 min. Heroin General McGraw-1..'ill FIlm9Purchase $140 1956 B&W Hightstovrn, New Jersey 08520 Rental $8 day THE DANGEROUS DRUGS 22 min. Barbiturates High School Narcotic EducationPurchase 1956 color Amphetamines General Foundation of $235 color Adults Amer., 5055 Sunset$125 B&W Blvd., Los Angeles,$12.50/day Calif. 90027 (col.) $6/day (B&W)

98 HOW TO PLAN A DRUG ABUSE

Sanford J. Feinglass, Ph.D. EDUCATION WORKSHOP

INTRODUCTION How to teach primary and secondary students essential. Skills in communicating with youth are about the dangers of drug and abuse is a problem also essential, as are systems and schedules of evalu- plaguing educators. Most realize that the simple ating progiants to monitor their effects and results. expedient of reaching for an all-purpose speaker, The element of over-riding importance in drug film or pamphlet is not the answer. Programs and education is the teacher. His role is not merely that techniques capable of effectively influencing young of a conduit of knowledge. He must, in addiction, people must be attuned to the complexideS and personify an active force in molding student actions anomalies that characterize today's youth scene. and beliefs. Honesty and integrity that will gain stu- Approaches to drug education must be as varied dent respect, ability to recognize and respond to as the numerous and diverse causes that motivate student problems. and needs, and to show care and varying types of students to turn to drugs. Some of concernthese are the prerequisites for a successful the common motivations are: peer pressure or in- mentor in the drug abuse education field, fluence;status search; rebellion against parents; revolt against the world and its institutions; bore- Directors charged with conducting inservice train- dom; curiosity; dislike of schools or teachers; myths ing to guide teachers in presenting effective drug about drugs. education have a difficult task. These guidelines Drug education may be taught in connection will, it is hoped, help in the endeavors of workshop with health education, social studies, history or directors. However, itis strongly urged that all other disciplines or several of them simultaneously. workshop directors attend an inservice workshop Starting in elementary grades, with focus on pre- before conducting their own. Experience in and ob- vention, is advisable. Above the primary level, pro- servation of the.t.-ecepts and suggesticns presented grams aimed at intervention may be required. At in the following pages will make them easier to all grades, a factual, nonmoralizing presentation is understand and to apply.

10 4 99 PHILOSOPHIES OF DRUG ABUSE EDUCATION In planning inservice teacher workshops that have on the age of the students and the situaticmin as their objective effective drug abuse education in a particular school. primary and secondary schools, here are some con- 4. Surveys show that motivations for drug abuse cepts to be considered: among the young are varied and frequently 1.Effective drug education should take into con- complex. Among them are: peel influence, de- sideration that we live in a drug-using society. sire for kicks, escape from feelings of inferiority, People look to drugs to alleviate a host of phys- relief from routine lives, easing of pain from iological, psychological and social discomforts, adolescent problems. To many young people, with varying degrees of success. Young people the old-time rituals of religion, country, family brought up on television have been told that and school have lost their appealand drugs, pills reduce anxiety and tension, provide buf- astrology, youth subculture, are among the sub- fers for everyday living, perform other near stitutes. Educational emphasis should be on miracles. There is a relationship between the ways of coping with youths' problems rather advertisements of tranquilizers to face daily than on picturing drug users as "depraved" in- living, liquor for celebration, and the use of dividuals, which has proved to be ineffectual. marihuana at a rock concert. 5,Untruths,exaggeration,sensationalismand 2. Some young people of all income levels adopt moralizing kill the effectiveness of drug educa- the theory that using marihuana is not vastly tion. If 20% of the students in a classroom of different from the use of alcohol, tobacco or 50 have used a drug, there are at least ten pills. Educational efforts that do not cover the studentscarefullymeasuringtheteacher's entire spectrum of drugs, including tobacco words against empirical knowledge. At least and alcohol, strike students as examples of 30 students will know the ten as users and be adult hypocrisy and deafen young ears. On the briefed 'by them. With -40 of the audience of 50 other hand, good response has been reported to in good position to judge the accuracy of a education that gives the facts about drugs, and teacher's statements about a drug he probably distinguishes between drug use, misuse and never hastried,any discrepancieswill be Juse. quickly noted and used to breed distrust of the 3. Young people, in relation to drugs, can be cate- total presentation. gorized as (I) those who will not abuse drugs or 6. Some drug use in school presumably stems from can easily be prevented from doing so, (2) ex- disaffection with the edualtional process. An perimenters, (3) abusers. just where the empha- interview with one student illustratesthis. sis should be in education about drugs depends Asked, "Do many kids go to school stoned?"

100 .10 the student's reply was "yes." The next question with most youths, threats make no impression. was, "Doesn't this impair your efficiency in They argue that the adult community commits school?" The answer, "Of course." After that, legal transgressions, why shouldn't we? "Well, why do you do it?" His answer was, "I 9.In distinguishing between drug use and abuse, wouldn't be able to stand school any other a useful definition for educators is that abuse way." This student's problems were not drugs oc urs when a drug is used in such a manner per se, but an unfavorable homeschool en. as to interfere with community-accepted stan- vironment. dards of economic,social,psychological or 7 An "all school" program Is no way to conduct physical well-being. It is important to recognize drug education. The normal rules of school are that all substances have abuse potentialsalt, suspended, all classes stop, students assemble, people are invited from the community, and sugar, aspirin, marihuana, whatever. one or two filmsoften sensational or lurid 10: The basic deterrents to drug use are evidently and more likely to breed drug use than to sup- not directly connected with drug,. Among them press itare shown. This "why it's dangerous are: Interest and participation in school pro- to use drugs" approach is lely to make many grams; alternatives !ia drug use offered in the teenagers feel that if they haven't tried drugs home and community; areawide to nationwide they're missing something. actions on issues in which youth are concerned. 8. Young people delight in pointing out the in- Youth's need to be involved in the current scene consistencies and hypocrisies in drug legisla- starting at the primary school level must be tion and enforcement, and while they should be recognized by educators, who can cite evidence informed of the penalties of drug possession and that drug abuse can be highly detrimental to use, nothing is to be gained from trying to de- the individual as well as destructive to public fend the inconsistencies of drug legislation. The welfare and advancement. If in addition drug fact that court records can jeopardize careers abuse education moves toward encouraging in teaching, medicine, law and government may communication between youth people and have some effect on college students. However adults, it can accomplish more.

101 OBJECTIVES OF INSERVICE TRAINING FOR DRUGABUSE EDUCATION Before plans are made for inservice training pro- d.Ability to evaluate written and at lio- grams, it is wise to determine objectiveswhich in visual materials about drugs. turn will help determine program content.Here e. Development of increased skillin en- are some guidelines for selecting objectives. couraging wise decision-making. A. Objectives for school administrators (those who f. .1ricreased awareness of the nature of the cannot attend may also profit if given reportsby youthful subculture and an accumula- educators who do attend): tion of subconscious knowledge to assist in verbal and non-verbal communication I.Transmittal of general information about drug problems in the nation, locality, com- skills. g.A valid aspect of inservice training would munity, school. be to encourage teachers to evaluate their 2. Briefings on national, state and local laws, own competence as drug educators,and and other legal aspects. to decide whether, because oftheir per- 3.Provision of information and evaluation of sonal convictions, they might do a greater programs in other school districts to combat service to students by not assuming the drug abuse. role of drug mentor. 4. Development or promotion of programs to 2. Changes in teachers' relationships with their combat local drug abuse. students: 5.Gaining supportforschool/district drug a.Development of more sympathetic atti- abuse programs. tudes towards youth, with increased un- B. Objectives for teachers enrolled ininservice derstanding of the stresses and problems training (all of the objectives cannot be achieved they face, and increased ability to propose in a single conference): rewarding alternatives to drug use. 1.Changes in teachers' knowledge, insights, at- b. Development of ability to show caring titudes, skills and concern for students who feel de- a.Increased .knowledge on drugspharma- prived of parental or other love. cological, psychosocial, or legalor all c.Ability to convey drug information to three. studentspharmacological, psychosocial, b.Ability to discriminate between fact and legalor all three, fiction regarding drugs. d.Increased ability to communicate with c.Ability to recognize personality problems students and to develop communicative related to drug abuse. skills. 102 10 e.Ability to contribute to students' sense of the nature and scope of drug abuse in the of personal work and integrity. local community. L Development of students' decision-mak- 2. To increase public and parental understand- ing abilities. ing of the tangible as well as intangible fac- g-Strengthening student skills in evaluating tors that contribute to drug abuse by youth. such influences as commercial ads, news reports, novels, dramas. 3. To help teachci-s work with parents of drug h. Development of student sensitivityto abusers. the feelings of others. 4. To demonstrate by the conduct of inse vice C. Objectives of inservice training in terms of par- training the serious concern of the school in ent and community relations: drug education for youth, and the need for 1. To increase public and parental awareness parental and community cooperation.

103 1_ '6 ORIENTATION PROGRAM Inservice training is often preceded by an orienta- community leaders such as the mayor, legisla- tion program to enlist school or school district sup- tors, judges, police officers and physicians, at- port for such training. The orientation program tend. may take several forms. It is recommended that students be included inthe audienLes of orientation programs. I.Length and timing Orientation sessions for the faculty of a school Preferably, known or suspected drug users as or school district can rangefrom one-hour well as non-users should be represented. Their after-sdiool programs to an all-day program or attendance will add to the credibility and va- two afternoon sessions of two orthree hours lidity of the programs and their critiques, if each, preferably on consecutive days. truthful, can provide valuable guidance for Orientation programs for parents and the future activities. general community, in addition to the school 4. Program content or school district personnel, wouldconsist of The content -of an orientation program will depend upon the objectives, the time allotted, one or more one-to-two-hour sessionsand fo- cus on general presentation of thedrug abuse the availability of speakers, the possibility of dilemma rather than on the contents of a spe- includingaudience-participationactivities, and other locally varying circumstances. Us- cific inservice training program usally, orientation programs attempt to give a 2. The director general briefing ou the local drug problem The orientation program director is usually and a preview of the forthcoming inservice the same person who serves as inservice train- training program. ing director. He (or she) should have super- 5.Orientation speakers, discussion leaders, con- visory status to get the necessary attention and sultants cooperation, working knowledge of the drug Speakers and discussion leaders for orientation field and its literature, and the ability to lo- sessions are in reach of most schools. The fol- cate and enlist experts as program leaders lowing section, "Selection of Inserviee Speak- and consultants. ers,Discussion Leaders, Consultants,- pre- 3. The invitees sents a comprehensive list of sources from Facultyincludingcounselors andnurses, which orientation speakers can be selected. school board members, administrators, super- Invited guests are most likely to attend orien- visors and PTA officers might be invited. For tation programs if the speakers and the orga- a community orientation program, efforts nizations they represent are known and re- should be made to have not only parents but spected in the community.

104 PLANNING AND CONDUCTING AN INSERVICE TRAINING WORKSHOP OR CONFERENCE

1.Scheduling and timing seen in continuous programming than when Inservice training can be scheduled in either time lapses between events. continuous or interrupted programs. Continu- Interaction between participants is facilitated, ous programming, which is the preferred, oc- particularly if all are housed in one location. cupies a full weekend, week or longer span of Continuous programming permits more flexi- uninterrupted time. Probably the most prac- bility in length and size of sessions and in tical is a two-to-seven day intensive workshop introducing innovative and experimental tech- or conference for teachers from one school or niques. one district. Summer is an excellent time to Time can be utilized more efficiently since the hold such a workshop if the teachers to be initial physical and psychological adjustments reached can allocate the time. need take place only once, and the atmosphere An interrupted program consists of a series of is more likely to be friendly, informal, co;.1- interspersed meetings, each from one to eight fortable, and conducive to learning. or so hours long. Some possibilities are: alter- Communication and sharing of experiences be- nate Saturdays, certain days or evenings of con- tween participants are easier. secutive weeks. Disadvantages of continuous workshops are: that only a comparatively small number can Continuous Workshops usually be accommodated and in view of time Advantages of continuous workshops are: pressures, difficulties in obtaining teacher sub- The concentrated approach facilitates produc- stitutes, and financial problems, it is difficult to ing attitudinal changes in teachers segarding find one time span convenient even to a small their students and their relationships with number of teachers. them. The reason: attitudes are most readily changed in connection with strong emotions, Interrupted Programming which are usually experienced only in sessions Advantages of interrupted programs are: longer than those possible in interrupted pro- They are less expensive. gramming. They are easier to program, as free time such Continuous programs isolate participants from as weekends, holidays and faculty days can be extraneous matters, permit uninterrupted at- tention. Such programming permits homework or read- Relationships and comparisons between speak- ing assignments. ers and other program events are more clearly Participants may keep their professional obli-

105 1 gations with the least interruption of timeand their undivided attention, providedesirable necessityof providing substitutes. A wider settings. range of I.ticipants are therefore, attracted. The inservice traintng director Particip. may select those sessions theywish Attributes helpful to a workshop or conference to attend,ifprofessional commitments pre- include: clude con tinuous a ttendance. a. Interest and someknowledge in the drug Interrupted programming is more likely to at- field, realization that there are complex tract school ordistrictadministrators and underlying issues, and desire to deepen others who can attend iodividual but not pro- and broaden his own perspectives. If a longed programs. director does not grow in personal under- It is easier to schedule outside expertssince standing through conducting a workshop, they are given a wider choice of dates. it is unlikely that he will add substantially Disadvantages of interrupted programs are: to the growth and knowledgeof the par- Field trips are difficult to fit in. ticipants. Some kinds of programs are difficult to schedule b. Wisdom ;n adolescent problems and psy- as, for example, those that mustbe presented in chology.Effective workshops not only connection with others to give balance. transmit information on drugs and drug Changes in attitudes or emotions are difficult to abuse, but survey the forces within society achieve in interrupted programming. and the educational system that contrib- inserv- ute to drug problems. Some general suggestions on timing of director must be ice training are: c. Evaluative ability. A As much advance notice as possible shouldbe able to evaluate written and audiovisual given to potential participants. For acontinu- material to rout out false or biased in- ous program, several monthswould not be too formation. far in advance. d. Contacts with youth. A workshop director Mott program directors avoid scheduling pro- must be able to turn to students to get grams during examination andregistration information on their attitudes, informa- periods and on holidays and days of such events tional levels, life styles. He must be able as elections and important sports orschool to consult students freely andfrequently events. However, for some purposesand par- including non-users,suspectedusers, ticipants, programming on such days may be and school drop-outs. suitable. It is often well to consult the conven- e; Respect of teachers. Inservicedirectors tion schedules of organizations to which work- must themselves be able tounderstand shop participants belong in order to avoid and respond to inservice trainees in order conflicts; although here, too, inservice training to help them increase their abilityto may sometimes be scheduled inconnection communicate with students. with conventions and may utilize some of the f. Related knowledge that will be helpful same speakers and program leaders. includes general information on runa- Forcontinuousprograms, accommodations ways, underachievement, protest move- may be more available andlower-priced at ments, sexual behavior and generaljuve- certain times of the year. nile delinquency. shouldpossesssufficient 2.Workshop locations g.The director One- or two-hour programs can beheld in authority to get things done, have ade- temporarily vacant facilities such as school quate financing, and berelieved of the rooms, auditoriums, governmentfacilities, or majority of other obligations in order to churches. For overnight or longer programs, concentrate on the workshop program. ideally a facility should be sought which is not 4.Inservice training participants pArt of the daily routine of theparticipants. Since inservice formats vary from weekend re- A motel outside the city, a mental or youthhos- treats to auditorium lecturs, no oneoptimum pital or treatment center, or other facility in number of participants for all varieties canbe which the participants will be isolated from set. As a rule, workshopstargetted to intensive their ordinary surroundings and can devote learning experiences and involving living ac-

106 11 commodations for several nights or longer do 5.Program content not have more than SO participants. A larger The title or theme of an inse.r workshop number is likely to be too cumbersome and im- will help determine its framework and should personal to effect personal changes. On the be chosen with more than cursory thought. other hand, a smaller number reduces oppor- Such phrases as "Leadership Training for Drug tunities kw interaction and intercommenica- Abuse Education" have specific implications tion and increases the cost per participant. that should be fulfilled, On the other hand, if Participants should represent the several dis- a title includes the phrase "drug abuse," this ciplines most likely to be involved in drug edu- should not close the gate to a discussion of cation:,ealth education, science, social stud- drug use. ies, nurses, etc., as well as school administration Within its time limitations, general inservice and guidance counseling. In the interests of training shOuld cover as broad a base as pos- facilitating integrated approaches in a school sible. Teachers need a good store of knowledge or school district, it is helpful to include teach- to hold their own with the free-thinking, curi- ers in grades from elementary through high ous young people most apt to turn to drugs. school. However, since the education directed Ill-prepared teachers may only turn student to primary and secondary school students will doubt and distrust of adults into alienation. differ, separate sessions or programs may be If all of the aspects of drug education cannot necessary to cover different material for vary- be covered in a training course, the principal ing age groups. categories can at least be enumerated to the Administratorsandsupervisorsshouldbe participants. A respectably complete list would urged to send their best-qualified personnel. include: This is easiest done if the inservice workshop a. Brief history of drugs and drug use. sounds important, and has the prestige afforded b. Pharmacology of drugs including alcohol by well-qualified speakers and program leaders. and tobacco: effects, addictive qualities. Participants should be those considered to have c. Psychosocialaspects:personalitiespre- good rapport with students. Not only will they disposed to drugs; society's stake in drugs; be the most effective in influencing youth after characteristicsof the drug subculture; the training, they will be able to contribute to value systems; moral implications; true the workshop the student point of view. and falsenotions about drugs; youth Inservice training for a specific target will, of alienation and protest; counseling serv- course, have a specific audience. For example, a ices. preventive program aimed at students who Legal aspects:local and Federal drug have not begun to experiment with drugs law enforcement; judiciary, parole and would be primarily directedto elementary probation; possible changes in laws; how grade teachers. Training that has the integra- to counsel apprehended youngsters. tion of teaching and referral services as its e. Research: latest findings on effects and goal would have a broader focusjoining side-effectsof drugs or lack of them; teachers with school counselors, nurses and statistics; future prognostications. psychologists: f. Student views on drugs vs. community Efforts should be made to assure that attend- views. ance is motivated by real concern with youth g. Financial aspects. rather than by curiosity, desire for prestige, h. Drugs in religious or mystical experiences_ or similar motives. Open-minded individuals, 1. Alternatives to turning on with drugs. as opposed to those known to have fixed or In all of the above, alternate viewpoints should hostile positions, would preferably be selected receive honest consideration. Diametric "good" except where inservice training might change and "bad" approaches are not helpful in drug an attitude or where an individual is included education. as a foil demonstrating the disadvantage of Intelligent and sophisticated students can often inflexibility. give good advice on program content and Participants should agree to remain through should be consulted. the entire training period, barring emergen- Instructional methods used in inservice train- cies, and to attend all sessions. ing will include both the standard techniques

107 112 of, say, an English literature course and ex- choice as his special assistant who is expert in periential group dynanncs methods such as the a particular field. Amherst approach in which students are given Another precautionto be notedisthata reading materia 1 presenting divergent opinions. balanced program does not mean a simple yes- Under a trained, well-versed teacher, discus- and-no format, unless the intention is to use sion is held analyzing the conflicting opinions conflictto spark discussion. Littleisto be and discrepancies.If conclusions cannot be gained from a program consisting of one articu- reached, students are assigned to obtain addi- late person arguing for legalization of mari- tional data and the process repeated until huana and another arguing against it. An ex- conclusions are forthcoming. Other experien- ample of a better format would be, assuming tial exercises are listed in the section on group no immediate change in the marihuanalaws, process activities. to examine from various viewpoints theposi- 6.Selection of workshop spiakers, program lead- tions of students who hold that marihuana laws ers, consultan ts areinequitableandthereforeshouldbe Within the limitations of budget and time, the viola ted. director will want to expose inservice trainees Where can one begin to look For program par- to the widest possible range ofspeakers and ticipants? One might start with activities in the other program leaders in terms of disciplines, community that deal with drug abusea half- attitudes and opinions. This does not mean way house, localresearch project, or drug presenting a miscellanea. Every speaker's phi- clinic. Those in touch with drug users might losopi,v or point of view should be knowr and be queried, such as operators of cafes and meet- reflected upon in advance. All speakers and ing places frequented by students as well as events should contribute to the over-all pur- disc jockeys, ministers and other adults who pose aml theme, should be the bestchoice for relate to youth. Opinions of studentsusers, the purpose, and should be placed on the pro- non-users and ifpossible drop-outs, should gram in the order most effective for titc.total surely be sought. Educators who have con- plan and pattern. ducted workshops report that their suggestions Locating qualified resource persons requires are often excePent. considerable time and effort. In most cases it Additional sources, and some of the types of will be by consulting large numbers of people individualsto be considered forW'orkshop and references and by asking many questions leadership, include: that the right programming decisions will be a. Colleges and universities: departmentsof made. Given for example the alternatives of an psychology, pharmacology, sociology, an- anestheologist who is chairman of a county thropology, medical schools, law schools, medical society and a general practitioner, a teachers colleges. workshop director might choose the firstun- b. Mental health units and societies; public less he found out by investigation that the prac- health agencies; other health organiza- titioner had done clinical research on use of tions. drugs and was sought after by young people as c. Physicians; psychiatrists. a medical authority and confidant. d. Police and law enforcement officers whp Spokesmen should be selected not for the relate to the community scene. authoritative positions they hold but for the e. juvenile courts; juvenile detention cen- authoritative information they can communi- ters; prison administrators. cate. What is wanted is not hearsay or opinion f. Student leaders of school and church or- based on vested interest or personal bias but a ganizations. statement of position founded on firsthand ex- g. Teachers conducting successful drug pro- perience, research, or observation. Individuals grams. in eminent positions whose rank is due to h. YMCA, Boy Scout and other youth or- administrative ability rather than specialized ganization leaders. knowledge may not be suitable for such assign- i. Social welfare organizations; child guid- ments. That is, an executive who is required to ance centers; hospital personnel. be a spokesman for his institution and to re- j. Press representatives; editors of under flect favorable light on it may not be as good a ground papers. 108 1i k. Musicians popular with student groups. tence of the speaker, his affiliations, and 1. VISTA and Job Corps staffs; the man- perhaps, briefly, the purposes of his pre- agers of runaway location centers found sentation. Many conference experts pro- in some localities. vide written biographies of all speakers, m. Ex-addicts; ex-alcoholics. including their addresses and phone mint- A factor to be kept in mind is that drug abuse bers, and confine oral introductions to is a controversial subject and some of the speak- names and affiliations only. ers at a workshop on drugs are likely to be e. Questions and answers. Sometimes itis controversial too. School or district administra- desirable to encourage the audience to in- tors sponsoring inservice training should be terrupt speakers with questions through- prepared to provide protection and defense for out their presentation. This bridges the workshop directors in case of complaints about gulf between speaker and listener, helps speakers and panelists who may be displeasing listeners become actively involved in the to some citizens. presentation, helps eliminate inattentive- Arrangements with workshop speakers, pro- ness. Speakers must be warned in advance gram leaders, consultants if this method is to be used. More usually, In making arrangements with inservice train- a period of time is allowed for questions ing speakers and progTam leaders, the director after a presentation. It should be under- should make clear the purpose and general stood by speakers and audience how long content of the conference or workshop, the size the period will be. Speakers and consul- and make-up of the audience, the topic and tants should be instructed not to answer scope the speaker is expected to cover, the questions outside their sphere of compe- period of time allotted and, in the case of a tence; otherwise remarks of a psychologist panel member, the range to be covered and the about phartnacology may, for example, names and affiliations of the other panelists. contradict statements made by a pharma- Similarly, the speaker should be asked to con- cologist at the same meeting. firm his understanding of the arrangements. f. Taping-Videotaping. If a program isto Details on whicn agreement should be reached be recorded on audio or video tape, clear- include: ance should be obtained from the speaker a. Money. It should be clearly stated when a in advance. Some schools and districts spFtaker is invited whether he will receive have standard release forms. If transcripts a fee or honorarium, whether travel and or excerpts of a presentation are to be other expenses will be reimbursed, and to printed for subsequent distribution, per- what extent. mission should be secured for this too and, b. It is advisable to know how and preferably, a copy sent to the speaker for when a program leader will arrive. Then, review. Where many quotations have been if it develops that planes are canceled, a used, a bibliography may be advisable. program change can be made. Speakers When taping is planned, recording equip- should be told whom to contact on arrival ment should be checked well in advance. or in case of emergency. g.Materialfordistribution.Ifsamples, c. Pre-Program discussion. Provision of op- printed matter, photos, or other material portunity for last-minute discussion be- are to be distributed as part of a presenta- fore programs is advisable. Some inservice tion, the material should be viewed by the directors ask program participants to ar- director in advance. Nothing should be rive a half-hour in advance of their pro- distributed without his knowledge. There grams, others hold joint meetings for a should be sufficient quantity for all mem- number of programs leaders at once. bers of the audience_ d. Introductions. Program participants must b. Audio, visual and audiovisual materials. provide biographical data so that they Audiovisualmaterialaccompanyinga can be accurately introduced. No more program should be previewed in advance than one minute should be allowed per by the director or his delegate, who should introduction. The only data that need play the tapes at the same sourA level to be given are the qualifications and compe- be used for the group presentation. Sound 11(1 109 distortions may show up at auditorium fi records, tapes and TV at high volumes, volumes that are not apparent at low vol- films, slides, and psychedelic lightsper- umes, Only by stressing to speakersthe haps simultaneouslymay enable inserv- neces,ity of clearing visual and audiovis- ice trainees to understand the appeal of ual plans in advance can a director be sensory inundation to youth. assuredthatproper equipment,from b: Peer group pressure. Much drug use is be- blackboards or chart stands to projectors lieved toresult from peer pressure. A and screens, will function smoothly. demonstration of peer pressure may he i. Post-program. Speakers, panelists and con- staged by having participantssitin a sultants should not be left dangling at the circle. The leader ot the exercise asks that conclusion of a program. An assistant one of the participantshe should not should be delegated to help them with de- specify or direct his reques r. to any indi- parture arrangements. vidualvolunteer to walk instt'.e the circle Group process activities formed by the seated participants. As this Group process and experiential techniques can volunteer strolls around the inner eirde, be included in inservice training to improve the leader asks if anyone cares to join him. participants' communication and awareness He encourages the stroller to describe his skills, increase their understanding and effec- feelings at being alone inside the circle, tiveness in dealing with youth, promote self- The "loner" will usually mention loneli- understanding, and facilitate non-verbal com- ness,discomfort,embarrassment, The munication with their students. leader continues to ask if anyone will join Inclusion of such activities in inservice work- the stroller, help him out. As participants shops will assist teachers who wish to use the eventually join the inner circle, the leader techniques as part of their own classroom in- enlarges the number of strollers at the ex- struction, after sufficient practice to learn to pense of the sitters, and elicits remarks do so effectively. from both strollers and sitters regarding Examples of experiential activities that may be their feelings, opinions about themselves scheduled during inservice training include: and the other group, and related com- a. Communication exercises: example ments, It will be seen that, as additional speaking precisely as audience listens care- sitters join the inner circle, they become fully, followed by a playback of the speech stronger in expressing opposition to the on tape. outer group and more indifferent to its b. Simulated experiences of acceptance and comments. It has been shown by experi- rejection (see "Breaking In" and "Break- ments that the expressions and comments ing Out" below). of both the inner and outer groups fre- c, Exercises to increase skill in observation. quently correspond closelytothe dis- d, Exercises utilizing group resources: See course of drug users (inner group) and "Joy" by William C. Schutz and "Schools non-users (outer). The exercise continues _Without Failure" by William Glasser, until the leader stops itto review and available front most sehoot libraries. analyze the participants' remarks. Ifit Inclusion of young people in group experiences continues long enough, itwill usually is suggested for the insight into youthful reac- reach a point where the inner group tions that can be gained thereby as well as for reaches a size that acts as a magnet to draw the feedback on potential use of the techniques heretofore uncommitted members of the with students. outer circle into the new inner group. Descriptions of some gLetipprocessesthat This is akin to peer group influence in might be demonstrated during inservice train- schools where a sizable drug-using group ing are given below. In all cases, it is advisable will suddenly mushroom into one of sub- to have a director trained in use of thetech- stantially larger size. niques conduct the sessions. Whilethisexerciseishighlyrecom- a. Sensory stimulatii. Iigh-degree sensory mended, it should be cautioned that, if stimulation isa characteristic of youth the leader is not skilled and the group culture. Multi-media presentations of hi- receptive, it may not be successful, 110 115 c. "Breaking out." A number ofinvesti- to a screen similarly moved. Participants' gators have suggested that the inability of chairs are moved or seats exchanged so youth to discontinue drug usage after ini- that neighbors arc varied. In some cases tial experimentation is due to inability to the site too is changed, the group moving break through acondition of confine- from one room to another or outside. ment. This may be demonstrated by hav- With transportation available, the change ing a leaderpreferably one with experi- can be to a different community. Properly ence in this techniqueask a participant done, such demonstrations impress upon to stand in the center of the room Stir- teachers the stimulation and vitalization rounded by a number of the participants that can attend change in or discard of with arms interlocked. The person on the ritualized procedures. inside attempts to break out of the confin- f. Illustration of frustration. The frustration ing circle. The difficulty of doing so is that can result from stereotyped teaching clearly illustrated. If the person is success- procedures may be demonstrated with the ful, the relief and profound psychological help of construction toys such as erector reaction can be shown by having him sets or creative blocks. Participants are describe his feelings. seated at tables with such sets and per- This exercise., after demonstration with mitted to create interesting and intriguing one person in toe center, can :repeated constructions without direction or inter- with two or three, to show that multiple ference. While participants' interestin participants reinforce each other and are their creations is still at peak level, the not as apt to give up the struggle as one leader suddenly orders the work disas- person operating alone. sembled. He then leads the participants, "Breaking in." A similar exercise can be with ever-increasing arbitrary directions, conducted by having a participant at- through the construction of useless, un- tempt to break into a circle (DI people aesthetic and unimpressive forms. As mime with arms interlocked. The purpose is to passes, the orders for manipulations be- illustrate the frustration and unhappiness come increasingly restrictive and stupid. experienced by individuals refused access "Hold A with your left harKI, thumb and to a circle and the difference in their index finger, and pick up B with the mental states when the barriers have been thumb and third _finger, right hand," etc. broken and access granted. Again, itis At some point the protests will begin. At best if the leader has had group process thistime,the exerciseis stopped and training. analysis takes place of how the frustration e. Breaking down formalized structures. The was built, for what reason, how it could stultifying effect of ritualized procedures have been relieved, why jx.rticipants fol- followed over and over again can be lowed instructicns they would have pre- demcinstrated by seating arrangements at ferred to disregard. Among other things, a workshop or conference. At the begin- this exercise will impress upon partici- ning, the participants are seated in the pants the advantages of lively, engaging, standard classroom pattern, in chairs fac- exciting teaching techniques. ing a teacher who lectures from his desk, 9.Field trips with blackboard behind. The same people Inservice training of more tha two or three are at his right, left, front and back every days' duration will usually include visits to claythe arrangement that students face, local institutions for observation or participa- year after year throughout their school don. Useful field trips include: careers. After several days, the conference a. Halfway houses, if they will permit oppor- director rearranges the chairs and desks, tunities to talk with patients and staff; ex- hasthespeaker sometimes addressing addicts on staffs may be especially helpful. from a lectern, at other times sitting or b. Juvenile detention centers, to observe cir- standing in the midst of the group. Peri- cumstances of arrest and incarceration odically, audiovisual equipment is moved and to hold discussions with staff and de- from one spot to another and projected fendan ts, Possibly, incarzeration in a de- Lib lii tention center or jail, for the expert:lice workshops for(1) educational value to the of being locked in, or working for one viewers; (2)to substitute for speakers or to day as all aide in a withdrawal hospital emphasize facts or precepts; (3) to help die or treatment cetiter forfirst-hand obser- audience learn to evaluate films and use then, vation of drug effects. effectively. c. Courthouses, for discussionswith judges, Fihn quality varies widely. Many films still in lawyers,prosecutors,probationofficers, circulation have lost tly_ir potency through age. possibly defendants. Hats,skirtlengths,automobiles, outmoded hospitalsand drugtreatment slang, nullify a message no matter how time- d. Menial be units, for discussions and observations. less. A film which is up-to-date visually may e. Youngpeoples'meetingplacesfolk marred by doted script and outdated attitudes. cliurches,stores,be-ins,parks,youth Any educator who shows a film he has not pre- centers. viewed himself does so at great risk, reg..idless drop- of who reconnuended it. Directors can illustrate 1. Turnstile houses for runaways and drug in houses for youtig drug addicts. this at workshops by showing ineffective Rock music hallspsychedelic sound and films as examples of what not to do. They can light showsradio stations with audience illustrate the advisability of previewing films participation rock programs. The work- before representatives of the ultimateaudience shop director should guide participants to by tape recording student reactions to afilm observe how adolescents react to sensory and playing this back to workshop participants bombaidment. Enjoyment of the stirnula- who have just seen die film and formed their Lion and inundation of sound, sight, own opinions. More often than notthere will words or lyrics, and of kinetic activity be great diversiq. (dancing) can be contrasted with unstimu- Where no suitable film for a specific purpose !ming activities of Cie classroom. Work- isto be found, an alternative that canbe shop participants might be urged to con- demonstrated at a workshop is to show not possibility trast their own feelings tthe end of an entire films but segments. Another evening at a rock dance with their feelings is to Acip a film at spots where meaningful dis- after a usual evening at home or in front cussion can take place, or where a film's weak- of TV. nesses can be discussed. h. Youth-audience movie houses. 11. Reading materials i. High school chemistry department orcol- If funds permit, providing a kit or binderof lege of pharmacology, for practical ob- carefully selected reading material for partici- servation and information about drugs. pants to keep for reference andreminders is Research laboratories to observe drug ex- benuicial. periments. In some situations a kit of materials may be k. Offices of hospital social workersobse.r- designed for special purpose or effect. For ex- va don and interviews. ample, a kit loading participants with more I. Where practical, visits to local schools for material than can possibly be digested in the investigation of (1) bad school situations, time allotted, or with poorly sekcted orir- and (2) good school programs. relevant material, can be used to bring home to Advantage should be taken of opportunities to the participating teachers the reactionsof stu- observe the drug scene from severalpoints of dents exposed to the same kind of inundation. view. For example, a visit to a hospital may The effect is compounded if homeworkassign- provide interviews with staff as they seethe ments are stressed. drug problem, as well as with patients;To Except where special situations such as the determine the best ways to conduct productive above prevail, a file or book of selectedmaterial interviews and to insure against failures, it is should provide information required asback- advisable for workshop directors or their as- ground for the subjects to be coveredand sistants to check out field trips and interviews should be both concise and as complete as pos- sible without duplicating the oral, taped or in advance, im- 10. Drug education films visual programs. The book can also offer Films about drugs may be shown at inservice portantmaterialwhicheithercannotbe 132 1i covered inthe workshop or, because of its for speakers, consultants, program 1 1- technical, statistical or special nature, is best ers, stair. put in writing. Samples of useful literature for d. Meeting rooms: Number requiredsizes distribution to students may be included, with req ii fredhourspernii LS (keys, ar- information as to source and cost. rangements with guards, passes)u till- Sometimes reading material is sent in advance ties (lights,heat,air-conclitioning) as preparation for a conference. While this furnishings (podium, desks, tables, can be helpful, it is usually difficult enough to chairs). get such a kit ready by opening day, let alone e. Equipmentotherthanaudiovisual: ahead of it. Blackboards,easels,bulletin boards If a kit of materials is not given workshop photocopying machinetelephones and participants, it is helpful to provide them with telepl lenumbersspeciallighting a program of the events scheduled, a listing of totepads, pencilsdrinking wai ci participantsnames, and abibliography of name tags. reference materials such as the one given at Audiovisual equipment:Public address the end of this guide to provide directors of system, microphonesrecorders and tapes orientation or inservice training with back projectors and screensTV, radio or ground information and ideas. phono cameraspermits or clearances 12. Housekeeping for use of materialbackup audiovisual A stinmlating, instructive, satisfying conference equipment. or workshop is most likely to be achieved when g.Printed material:Registration forms the director has adequate financing, sufficient programsinstruction sheetsreference authority, and deputies to look after house- books or kits. keeping details so that he can concentrate on h. Program items: Filmsreference books, the programming. Except forthe smallest dictionaries,phonograph recordsma- meetings, a secretary or assistant for physical terial for demonstration or distribution. arrangements is indispensable. i.Miscellaneous services: Greeting partici- Selecting a meeting site is not difficult for in- pantswake-up servicesemergency ar- terrupted programming, since usually all that rangementssecretarial helppayments is required is a comfortable and accessible place and check cashing. suited to the participants and program. A con- j.Publicity, photographs, press conferences tinuous program of a weekend or longer pre- if determined advisable. sents more problems. Ideally, it should be held lcEmergencyarrangements:Delaysab- at a facility that is not part of the participants' sences of speakers and program princi- daily routine. A motel on the outskirts of town, pals. accommodations at a mental hospital or youth 1. Evaluation: Questionnzires check treatment center, are the type of settings re- sheets. moved from daily living that are most con- m. Clean-up: Equipment removalhouse- ducive to concentrated and intensive learning. cleaningpaymentsthank-you letters. When the site is selected, a director or his as- n.Followup: Arrangements for future meet- sistant might use the following checklist of ings. services and arrangements likelyto be re- Miscellaneous suggestions made by directors of quired: successful workshops and confevences include a.Housing: Number of nightssingles and the following: doublescheck-in and check-out times a.Strive for informality. Study and learning pricesspecial requirements, if any. flourish in a friendly, cordial atmosphere, b. Means, Hours numbers for breakfasts, tend to be stunted by rigidity.Confer- lunches, dinnersspecial dietary require- ence directors are urged to encourage in- mentsbetween-mealsnacksfinancial formal communication and friendly ar- arrangements. rangements, of seats, lecterns, tables and c.Transportation: To meeting if required audiovisual and other equipment, and to from meeting if requiredfor field rearrange the seating from time to time. tripsparkingspecial transportation b.Record programs amenable totaping ii 118 or videotaping, such asspeeches, panel service training, and releL ,2(1time ar- discussions,proceedingsofdiscussion ranged. At the very least, a certificate of groups, group activities. Someof these attendance should be offered. Post-con- presentations, played back either immedi- ference letters to supervisors of inservice ately after a program or after intervening training participants will often help the programs, may spark urefuldiscussion. participants put to use what they have Some tapes may be useful for lending to learned. participants either for review or for use 13.Workshop programming in terms of 7 arks, at subsequent programs. They arealso length usefulincases of temporary absences While worksl-op programming must depend from sessions clue to emergencies. Record- on time and budget available,directors should ing and playback will be facilitated if a opt for the maximum in theknowledge that professional audiovisual consultant is on value obtained for the investment goes up ap- hand. preciably with each day and each $100 added to c.Provide time for impromptu discussion. the base. Information and insights can be gained A onc-day program is a minimumeffort It is from informal discussions following pro- better than no inservice (raining forteadiers, grams or during meal times orfree peri- but not as effective as longer programs because ods, particularly if speakers andother the subjects introduced must be limited and workshop leaders attend.(One should the time will be insufficient to change attitudes avoid allowing so much time that par- and skills significantly. Just as music canbe ticipants' feelings are dissipated.) heard on a small, AM radio, its sound is more d.Secretarial assistance. Details to which enjoyable if FM is added and still furtherim- fi- secretarial help can attend indude: proved with stereo or a custom-designedhigh nances, emergencies, arrangementsfor re- production of transcripts, speeches and fidelity system. other material, checking on equipment, Program contents are compared below in terms transportation arrangements. of program length, to indicate how much more can be presented and gained as thetime span is e.Credit for inservice trainng. If possible, increment credit should be given for in- increased.

114 WORKSHOP PROGRAMS OF VARYINGLENGTHS Suggested One-Day Program (Least di_ livemost Cultural influences and determinants in drug use expensive, in terms of returns) Field trips to treatment and rehabilitation center.; Definitions of drug use, misuse and abuse Exercises in communicationlistening to pop music Psychosocial issues and, especially, the lyrics; reactions of students, Pharmacology then teachers, to a drug film Interviews with students Analysis of existing drug education programs . Role of education Panel discussion presenting divergent points of view Suggested Weekend Program on basic issues and values involved in drug abuse. Increase the depth in coverage of topics listed above Panel could include young people, drug user, ,en- and add: forcement officer, and others, depending on views Legal aspects to be beard Discussions with former users Writing of guidelines for drug education for teach- Review of audiovisual materialsperhaps two drug ersfor students films and filmstrips, with subsequent discussion Suggested Two-Week Program periods A workshop of this length permits the m it innova- Suggested Three-Day Prograni tive and desirable program. The scope and depth Increase the depth in coverage of topics listed above of coverage of all topics listed above can be in- and add: creased, and the following added: Statistics History of drugs and drug problems Goals of drug abuse education Relation of drug abuse to other problems Additional field trips to community facilities Exercises in group processes Religion and drugs Assignmentsa day as an aide in a treatment facil- ity or youth center Discussions with students on a one-to-one or other Review of related materillsaudiovisual, printed, basis press Suggested Five-Day Program Development of instructional materialsguidelines, Increase, the depth in coverage of topics listed above pamphlets, audiovisuals. Review of them by teach- and add: ers or students invitedto workshop forthis Current research in drugs purpose

re 115 6/SELECTED REFERENCES

SELECTED R FERENCES IN DRUG ABUSE EDUCATION N.W., Washington, D.C. 20036; pi ice $2.00, quantity rates BOOKS upon request. Numbei 2.14-07816. BARBER, BERNARD. Drugs and Society. Russell Sage Founda- nuns. 11Avin (ea). The Drug Experience. Grove Press, New tion, New York 1967 ($6.50). A book on the sociology of Yoik 1965 (95e). First person accounts of addicts, writers, dt :igs which discusses therapeutic drugs, "religious- drugs scientists and (Abets regarding cannabis, opilisn, opiates, and -addictive" drugs and points out that substances called peyote, mushrooms and LSD. drugs must be studied from the physiological, the psycho- FARBER, S. M. AND WILSON, R. H. L.(eds.).Conflict and logical and social aspects. Includes matezial on the drug Creativity: Control of the Mind, Part II. McGraw-Hill, industry, testing of drugs, government control and super- New York 1963 (paper $2.95). Articles by Isbell en the vision, police approaches vs the socio-medical. history of American attitudes toward addiction and by BcaxEscEE. A. What You Should Know About Drugs and Beecher, Hollister and others on methodological problems Narcotics.AssociatedPress, 50 RnckefellerPlaza, New in researect on drugs. York, N.Y. 1020. 1969. $L00 Quantity rates available. A GOLDSMITH. RICHARD, The Poetry of Rock. Bantam Books, Inc. series of newspaper artirlex has been published in a 48-page 1969. (SLOG). Discussion of rock music and reprints of 70 book. representative modern songs. BLUM, RICHARD H., ET at, The Utopiates: The Use and Users HUXLEY, ALDOUS. The Doors of Perception and Heaven and of LSD-25. Atherton Press, New York 1964 ($8.00). A major Hell. Harper and Row, New York 1956 ($1.45). In the study of LSD use in a variety of settings, and of users, and 1940's researcher Humphrey Osmond gave Huxley some non-users. Contains chapters on the psychopharmacological, mescaline, precisely because he counted on Huxley's skill legal and social aspects of LSD. at describing his experiences in vivid detail. He did. BLUM, RICHARD, PH.D. 8, ASSOCIATES. Drugs Society and KEEVER, HEINRICH. Mescal and Mechanisms of Hallucinations. Droqs. Social and Cultural Observations. Drugs II: Students Phoenix Books,,licago, Ill. 1966 ($1.50). Mescaline, alka- a, Drugs. College and High School Observations. jossey- loid present in buttons of a small cactus, mescal, as related Bass Publishers, San Francisco, 1969 ($20. for two volumes). to LSD. These two volumes contain the results of eight years' re- LINDESMITH, ALFRED R. The Addict and the Law. Indiana search by Blum and his asSociates and include historical, ($7.50).Also cross-cultural, social and psychological studies on drug use UniversityPress,Bloomington, Ind.1965 Vintage Books($1.95). A discourse on the criminogcnic and abuse. They are based on work coveting over 200 cul- aspects of drug laws and police practice with a plea for a tures and 20,000 individual interviews and questionnaires, new way of looking at and tmating drug addicts. CHE1N, I. ET AL, with the collaboration of Daniel M. Wilner. LisicrruaN, RICHARD R. Drugs from A to Z: A Dictibnary. The Road to H: Narcotics, Delinquency, and Social Policy. ($12.50). Basic Books, New York. 1964. Major research study McGraw-Hill, New York_ 1969. ($6.95. Paper $2 95). A lexi- con with historical, pharmacological, medical and botanical in the field of narcotic addiction which includes some case data. Presents a desciciption of colloquial terms, jargon, and studies as well as statistics. COHEN, SIDNEY. The Beyond Within. Phe LSD Story. Athe- literary quotations about drugs and their abuse_ ncont, New York 1964 ($5.95). One of the early psychiatrists MASTERS, R. E. L. AND HOUSTON, JEAN. The Varieties of to explore the effects of LSD during the past 10 years Psychedelic Experience. Holt, Rinehart and Winston, New presents reports on "good trips" and "bad trips," discusses York 1966 ($7.95). Analysis of data based on first-hand -good" uses and -bad" uses- observations of 206 drug sessions and interviews with an ConEN, SIDNEY. The Drug Dilemtda. McGraw-Hill, New York additional 214 subjects who took the drug in a variety of 1968 ($4.95, paperback/$2.95). Concise description of drug settings. Discussion of the effects of drug taking with respect use, focusing on relationships between the agent, the host, to body image, perceptions of other persons, repressed and the setting. Drug abuse progenitors discussed. Excel- experiences, symbolism, religious and mystical experience, lent advice to parents and edum:ors on dealing with drug Nowias, HELEN H., PH.D. Drugs on the College Campus. problem. Anchor Books, Doubleday, New York ($.95). An exhaustive Drug Abuse: Escape to Nowhere, National Education Associa- appraisal in lay terminology which educators may find tion, Publication-Sales Department, 1201 Sixteenth Street, useful. It covers terminology, attitudes, chemistry, sociology, 116 121 law, moralits and ethicatinn as they affect both the user drug iiito desci the inood effects. physi!al effects. medical and society. 'Elie book contains an annotated bibliography, uses, misuses, and research. Fine for stui-o:nts and general a glossary, and Dr. Joel Fort's comprehensive chart, on drugs dist ribntion. mid their effects. Teoh Force Report Narcotics and I .1) 'Ig Abuse. Supt. of Ducal- Ronixsox, M. NiSWANM It. The Drug Addict as Patient. Grime nwnts, U.S. Government Printing Office, Washington. D.C. and Sti mini], New Yolk 1956 ($6.95). Pli,sicians who haNe 20102. 1967 ($1.00). Annotations and t:onsultains Papers of treated narcotic addicts describe various approaches used the Task Voice on Narcotics and Iffng Abuse, the Presi- in private practice and institutional ca,-e. It may be useful dent's C01111111sSion on Law Enforcement and Administra- to a wide variety of professional people in contact with tion of Justice. Gives recommendations for control, lesearch, addicts. education, treatment, civil commitment and coordination ncRore, Roarur S. Drugs and the 5inul. Glove Press, New of Federal level programs. Could be considered a textbook Yolk 1957 (95(). biochemist discusses the mental effects for ethicators, college and senior high school stint, tits. of chemicals in the brain and On the brain. Th. book IN The Crutch That Cripples. Drug Dependence. Committee on 12 years old but still generally valid. Alcoholism and Drug Depoidence, Council on Mental Senna. EDWIN M. Crimrs Wilitota De7ohllit Behavior 1 halili, American Medical Association, 535 Muth Deal limn and Public Policy. Prentice-Hall, Englewood Cliffs, N.J. Street, Chicago, Illinois 60610. (25e). Quantity rates. Brief 1965 ($1.95). 'Elie classic plea for attention to public policy pamphlet containing much information on dependence, concerning abortion, homosexuality and dnig-taking. medical nses of drugs. s,,iliptonis, where to get help, and SimmoNs. _VARY1.. AND WINOGRAD, BARRY. It's Happening. prevention of abuse. Brandon House, No. lion:, wood. California 1966 ($1.95). Thinhing About Drinhing (PHS 1683). Supt. of Documents, Widely read by college stlidents. This sociological study of U.S. Government Printing Office. Washington, D.C. 20402 the goals, ideals and activities of the affhlent college drug (20 cents each: $IS per 100). Produced by the National users is a "subcultmal" study written for the layman. Institute of Mental Health and the Children's Burean as a SoromoN, DAvm. LSD: The Conselohsness Expanding Drug, basis for discussion with yoting people of attitudes about P. Putnam's Sons, New York 1964 ($5.95). Reprinting of drinking. It reflects the latest findings in alcohol research. IS papers on LSD by Huxley, Osmond, Leary, Rast, Unger and others, PERIODICALS; SOLOMON, DAvin (ed), The Marihuana Papers. Bobbs-Merrill Drug Dependence. National ClearioMouse for Mental Health Co., Indianapolis, Ind. 19(i6 ($10.00). Reprint of sonic classic Information, NIMH, Chevy Chase, Md. 20015. Published at and out-of-print papers dealing with marihuana. Divided random intervals, Addressed to the scientific and medical into sections considering:I)historical, sociological and community and other concerned professionals. Contains cultural; 2) literary and imaginative, and 3) scientific. selected items covering recent developments in the field and TAYLOR, NORMAN. NarcoticsNatures Dangerous Gifts. Delta identifies citations to the ciffront abstracts available from Publishing Co.. New York 1963 (750). (Also Dell $1.65). NCMHI. Despite the misleading title, a sound lay description of UN Bulletin on Narratirs. United Nations Publications, Rm. many of the "mind-altering" drugs. 1059, UN Bldg., New York 10017, (gunnel .$2 per year). Official notices of reports of meetings and actions taken by PAMPHLETS United Nations, including World Health Organisation, Drugs of Abuse. Reprint from Food and Drug Administra- related to drugs. Contains original scientific research papers tion Papers, JulyAugust, 1967, Superi,Jeudent or Docu- and review articles. ments, U.S. Government Printing Office, Washington, D.C. The International journal of the Addictions. Issued serni- 20402. Number 1968-0-312-959. Colorful flyer on stimulants. annually by the Institute for the Stiffly of Drug Addiction, depressants, and hallucinogens. 680 West End Avenue, New York 10025, ($6.00 per year). Narcotics (PHS 1827), LSD (PHS 1828), Marihuana THS Piovides a worldwide forum of exchange among profes- 1829), The up and Down Drugs (PHS 1830). Supt. of Docu- sionals participating in research, training, and treatment in ments, U.S. GovernMent Printing Office, Washington, D.C. the held of addictions and substance misuse, An Inter. 20402. 5 cents each or $3 for 100 except Marihuana is $3.75 national edito: ial board, comprised of members of the va- for I00). These fliers, produced by the National Institute of ruts medical professions, focuses on all facets of substance Mental Health, use miestions and answers to describe each misuse--drng, alcohol, tobacco and food,

IL S. GOVERNMENT ',MUTING OFFICE1971 0 - 414-854

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