an awareness of these interrelationships has increased, some programs have made the system and the treatment synonymous. Alcoholics Anonymous was one of the first such systems. During the last decade many therapeutic communities, relying on the pioneering experiences of Synanon, have emerged to deal with heroin, amphetamine and alcohol dependence. For many of these programs, particularly those dealing with severely dependent persons, a prerequisite to participation is a drug-free status. This is partially in recognition of the disruption attending interruption of drug-using patterns.

It might be useful at this point to relate this discussion of psychological dependence to the patterns of drug-using behavior developed in the previous Chapter. By definition, experimental use is not a recurrent drug-use pattern. Recreational and circumstantial use, if systematically repeated over a short or long period of time, would reflect the positive reinforcement underlying the notion of psychological dependence; but these, forms of drug-using beliavior, as we have defined them, are not sufficiently interwoven in the fabric of the users' lives to impair social functioning.

The functionally important area of the dependence continuum includes intensified and compulsive use. Intensified use may be of the regular long-term variety which involves continuous intoxication followed by periodic drug-free intervals of several days' duration-the intravenous amphetamine user, for example; or it may be of the regular daily use variety with long drug-free intervals during the day-the heavy social drinker, for example; or it may be of the intense episodic or spree variety-the patterned binge drinker, for example. The classic type of drug dependent person, of course, is the compulsive user who rarely has any drug-f ree intervals. The chronic alcoholic and heroindependent person are the most recognizable examples.

Physical Dependence: The Secondary Reinf orcer

All drugs which induce rewarding subjective responses have the capacity to become psychological reinforeers. Whereas this is the primary force leading to intensified or compulsive use patterns, certain drugs, when administered in sufficient dose and f requency, are capable of producing physiological changes requiring repetitive use in the, sense, that physical illness will ensue if the drug-taking behavior is not continued. This highly specific abstinence syndrome, which is what is generally meant by "physical dependence," can be reversed by readministration of the drug which causes it. Substitution of another drug or drugs from the same pharmacologic class can also accomplish reversal. Of course the symptoms themselves can be ameliorated by administration of substances from other pharmacological classes although these substances will not reverse the patho-physiological process of withdrawal.

Fear of drug-deprivation, with its attendant physical and psychological agonies, serves as a powerful secondary reinforcer for repeated and, in these cases, continuous drug use. In the absence of the drug or a substitute, behavioral disruption will occur. The intensity, length and nature of the disruption varies according to the drug, the method of administration, the dose and the length of tinie the drug has been used. The rapidity with which the physiologic need develops varies similarly.

Abrupt deprivation of use of certain stimulants, such as cocaine and amphetamines, following prolonged and continuous use, may precipitate a rebound withdrawal illness characterized by psychological letdown and depression, and by extreme exhaustion generally compounded by previous lack of sleep. The array of non-specific symptoms and signs results from continuous agitation, absolute insomnia and acidosis from food and water deprivation. In contrast to the highly specific morphine and barbiturate syndromes, this "withdrawal" illness can not be prevented by continued readministration of the drug.

Lastly, there exist a number of drugs, such ,is marihuana, bete] and nicotine, with mixed depressant and stimulant properties, which create strong anxiety when use of the drug is discontinued. Since no evidence has been adduced which implicates a physical dependence, the basis for this anxiety is presumably a function of psychological, social and cultural variables.

Summary

Drug dependence, in its broad sense, involves much of the world's population. Conceptually, drug dependence should be viewed as a continuum starting from a low degree of dependence as measured by

minimal individual preoccupation with drug-using behavior and minimal disruptive effects upon interruption of the behavior, and escalating to compulsive dependence as measured by total preoccupation with drug-using behavior and serious behavioral disruption attending deprivation of the drug. Drug dependence exists in innumerable patterns and in all degrees of intensity depending upon the nature of the drug, the route of administration, the dose and frequency of administration, other pharmacological variables, the pei@sonality of the user and the nature of the environment.

In this connection, it is important to discard the undimensional concept of individual loss of self-control which has long dominated scientific and lay concepts of "addiction." Most people who use psychoactive drugs do not succumb entirely to the phat-inaeologic. properties of the drugs. All of the factors which we have noted interrelate in distinctly different fashions with different individuals under different circumstances. For this reason, there can be no static model of drug dependence within which finite values are assigned to these various factors. Drucr dependence is a dynamic phenomenon, and the formulation of sociafpolicy must reflect its complexity and relativity.

Further, the primary basis of dependence for all drug use is psychological reinforcement based on reward. This re@vard is composed of two elements: it stems from whatever brain effects occur, some of which the user may experience subjectively, and from complicated sequences of psycho-social variables shaping the needs satisfied by the drug experience, and drugg-seeking behavior. When physical dependence is a part of chronic drug administration, the threat of the aversive effects of withdrawal serves as a powerful secondary reinforcer of the drug-using behavior.

Drug dependence is not necessarily harmful either to the individual or to society. The social cost of drug dependence is related directly to the intensity of user-preoccupation. The compulsive extreme of drug dependence may lead to disorders or defects of behavior with serious implications for the public safety, health and wel fare. However, many forms of drug dependence do not carry adverse social consequences, as is illustrated by the widespread chronic use of substances, such as tobacco and coffee, with such weak psychoactive properties that they are measurable largely in subjective ratherthan objective terms. Heavy and prolonged chronic use of the substances inay damage organ systems and result in injury to individual health. But they do not induce physical dependence or result in anti-social behavior even upon prolonged or excessive use. This factor distinguishes them from all other dependence-producing drugs.

WHO's appreciation of the need to separate social impact considerations from the simple description of drug dependence was stated clearly in its 1965 statement:

Further to clarify our meaning, the nature and significance of drug abuse may be considered from two points of view: one relates to the interaction between the drug and the individual, the other to the interaction between drug abuse and society. The first viewpoint is concerned with drug dependence and the, interplay between the pharmacodynamic actions of the drug and the psychological status of the individual. The second-the interaction between drug abuse and society-is concerned with the interplay of a wide range ofconditions, environmental, sociological, and econoinic. The 1957 Committee I tried to encompass both points of view when, in its definition of addiction, it listed characteristics of wbich some were pharmacodynamic and other psychological and socioeconomic, perhaps thereby compounding some of the existing confusion (Eddy et al., 1965).

EVALUATING THE SOCIAL IMPACT OF DRUG

DEPENDENCE

Any analysis of the social consequences of dependence, as they relate to public safety, health and welf are depends on both the degree of dependence and the characteristics of the drug, rather than on the fact of dependence itself.

Dependence, Health and Behavior

No rational social policy would aim to efin-iinate drug dependence per se. There are societies in which virtually an entire population is dependent on natural products of plant origin. Many of these plants, like the betel morsel, are used by millions of people and produce no striking effects on the central nervous system. The only subjective sensations are those of mildly pleasant stimulation. Psychological dependence is well established; many of the users spend much of their income to acquire the substance, and even the more intelligent users suffer a considerable mental letdown in its absence.

When the risk associated with a type of drug dependence does not involve drug-influenced behavior, but is rather limited to possible danger to individual health, it is the Commission's view that private normative choices should prevail, and that the social policy decision is of an entirely different order than that required by behaviorinfluencing drugs. As already noted in Chapter One, the primary policy consideration here is the behavioral impact on the public safety, health and welfare.

'The 1957 WHO Committee statement quoted earlier in this chapter on page 124.

With regard to stronger psychoactive drugs, however, repeated use may lead to intensified and compulsive patterns of use with the resultant neglect of other activities, to the point of decrement in or destruction of other social functioning. Whatever the appropriate legal policy toward availability of any given substance, and whatever the relative impact on behavior of chronic use of these substances, a crucial element of social policy must be to minimize the proportion of the population reaching high degrees of dependence on all such substances.

The Vulnerability Factor

The prevalence of high degrees of dependence seems to rest more in the nature of the soil than in the characteristics of the seed. The individual user, rather than the drug, is the core of the problem; compulsive drug use is generally thought to o(,Tur most frequently in emotionally unstable persons who have difficulty in coping with reality.

Drug dependence 1; is in this sense an -attempt at adaptation; the drug-dependent person seeks to alter his personal situation not by changing his environmental circumstances or his pattern of behavioral reaction but by modifying his affective reaction to and perception of those circumstances. Secondarily to this, his entire pattern of interacting with his environment may change.

The concept of psycho-social vulnerability rests on the notion that as environmental stresses and frustrations become stronger, an increasing proportion of the -otherwise susceptible population will respond through self-changing responses such as compulsive drug use. On the basis of this hypothesis, if an otherwise susceptible individual can either master the environment or remove himself from the adverse conditions, he may broaden his options and reduce the likelihood of drug dependence.

Although the data are inconclusive, many observers believe that American minorities, such as the Spanish-speaking, blacks and native Indians, have a higher risk potential to drug dependence in the sense that they are disproportionately poor and leave disproportionately higher percentages of drug-dependent persons. Since social and economic forces continue to restrict the upward mobility of these groups, particularly the young males, they remain at high risk to development of drug dependence.

Whatever the accuracy of this hypothesis, it is clear that certain populations in any society at any given time are more vulnerable to

'From this point, drug dependence will refer only to the compulsive end of the dependence continuum; drug-seeking behavior with a high degree of userpreoccupation.

intensified or compulsive drug use than others. The choice of di-tw varies within and across societies. Although this phenomenon has not been studied carefully, the Commission's impressionistic survey of consumption patterns in societies throughout the Nvorld indicates that the choice of substances has an affective component and differs amomy those segments of the population most susceptible to intensified or compulsive drug-using behavior.

In the United States, for example, the most vulnerable groul)s appear to demonstrate a preference for the depressants, particularly alcohol and heroin, which are most likely to obliterate rather flian intensify their awareness of their social condition and to reduce HI(, anxiety which wells up in reaction to this condition. In other socletles" however, the reverse may be true. Vulnerable populations in Japail turned to the stimulants after World War II. We should note, howe@-er, that a persuasive case can be made for the proposition that availability is the crucial determinant of chronic drug-using patterns ill am-

society.

For this reason, a comparison of different drugs in terms of relative danger to society is impossible. In each society a multitude of factors will determine the levels of use of different drugs, and the price which society bears as a result. At best, we can speculate about the cumulative social cost accruing f rom widespread chronic use of a drug under conditions of unrestrained availability. Comparisons between drugs would be based on their relative potential for reinforcement and on their relative capacity to influence behavior-. (See Table 111-1.)

Available cross-cultural information does suggest that there may be a maximum penetration level of drug dependence in any society. Even in Hong Kong where heroin is available and inexpensive, the prevalence of intensified and compulsive use does not exceed 4% of the entire population although this proportion is higher (about 11%) among males over 20 years of age. Similarly, heroin and opium are easily secured in Thailand, but the proportion of chronic smokers does not exceed 2% of the entire population or 10%, of the adult male populatl'OTI. In the United States, the proportions are roughly the same for chronic alcohol use: about 15% of the total population and about 15% of the middle-aged population. Available estimates also suggest that the level of chronic cannabis use in Egypt may be of the same order. Interestingly enough, the prevalence of chronic opium and morphine dependence in the United States at the turn of the century when availability was relatively unrestricted probably never exceeded 1% of the adult population.

As availability of a substance becomes more restricted through formal legal controls, the maximum penetration level of dependence probably becomes lower. Thus, under any given social policy in any (riven society there is probably a maximum social cost. On the other hand, no

matter how restricted the legal conditions of availability for a given substance, there is also likely to be a minimum penetration level. From this perspective, the best that a society can hope for is to reduce the level of intensified and compulsive use to that minimum, and keep it contained at that level.

The Relevance of Social Response

Finally, the adverse behavioral consequences of certain types of dependence may be tied to social policy and to institutional responses to the drug-using behavior. Among those dependent on highly reinforcing drugs, the level of dependence likely to be reached is increased by social policies which prohibit availability of the substance to the drug-dependent person. This is because the "hustle" necessary to acquire the drug will exaggerate the user's preoccupation with drug-seeking behavior. Similarly, prohibitory policies also increase the adverse social impact of drug-abstinence behavior of those physically dependent on the prohibited drugs. Consequently, appraisal of the social cost of a given type of dependence must also take into account the potentially counterproductive effects of the institutional response.

Present Social Impact

Turning now to the social impact of dependence on various substances in the United States today, we find first that public perception of the problem is not related either to the prevalence of dependence or to the environmental and pharmacologic aspects of the issue.

Alcohol

Alcohol dependence is without question the most serious drug problem in this country today. Alcohol users far outnumber those of all other drugs and are found along the entire continuum of dependence. The reinforcement potential of alcohol and its potential for behavioral disruption are high. Use of the drug is pervasive within the general population, and its ready availability facilitates the development of high degrees of dependence among vulnerable populations. The prevalence of intensified and compulsive use among the entire alcoholusing population is roughly 10%, and a serious decrement in social functioning is noticeable in half of this group.

While there are many abstainers and the number of non-dependent users is large, alcohol use nonetheless carries a substantial social cost. The risk of individual involvement is accentuated also by the pervasive sentiment which tends to exclude alcohol from classification as a drug, thereby eliminating it from the concept of "drug abuse" and the social problems which go by that name. As noted in Chapter One, according

to the National Survey, alcohol is regarded as a drug by only 39% of the adult population and 34% of the youth population. Twice-daily use of the drug is viewed as drug abuse by only 36% of the adults and 37% of the youth in contrast to the use of heroin "once in a while," which is regarded as drug abuse by 82% and 80% of these populations. Finally, only 7% of the public mentioned alcoholism as a serious social problem, as compared with the 53% who mentioned drugs.

Heroin

Heroin is a highly reinforcing drug and, in the present social context, demonstrates a selective attraction for high-risk, vulnerable populations, in particular those with minimal opportunities for a rewarding life style. The risks of compulsive use are exacerbated by the prevalence of intravenous administration and the rapid development of tolerance. The dependence continuum is compressed at the maximal end and movement through the phases of dependence is rapid. Even though the incidence of ever-use among the adult and youth populations is less than that of any other drug, the prevalence of dependence among the exposed population is high, though not as high as popular belief would suggest: available data suggest that 25% to 50% of those in high risk populations who try heroin may become dependent.

Heroin dependence is disproportionately high among the most vulnerable segment of the population; young males in the nation's urban centers. Because dependence tends to develop during the early years of adulthood, social and economic integration is inhibited at the most crucial time, to the detriment of the society in general and to the users' immediate social group in particular. For this reason, the social cost of heroin dependence is substantial. Unfortunately, present social policy tends to exacerbate this cost even more. Because of enormous pressures characterizing the present social-legal-medical response, a disproportionate degree of behavioral disorganization and disruption accompanies heroin dependence.

Barbiturates

Barbiturates are pharmacologically similar 'to alcohol, involving the same dependence liability and potential social impact. At the present time, however, no major social cost arising from compulsive use has been specifically identified. This is largely because these substances were hitherto distributed primarily through medical channels, and their use has been generally hidden. Recently, episodic barbiturate use has appeared increasingly in the streets among youth populations, posing serious problems in certain urban areas. For the most part, however, high degrees of dependence have not been apparent.

The Commission suspects that the prevalence of dependence may be much higher than is generally estimated. The depressant properties of the barbiturates have already attracted the same populations who are most vulnerable to alcohol and heroin dependence, and these drugs are often used in combination or as alternatives. Even more important, however, the frustrations so commonly felt among housewives appears to be fertile soil for the development of sedative, anti-anxiety responses. Increased barbiturate use in the past decade parallels the increase in alcohol dependence during the late 1950's among this same population.

The Commission believes that barbiturate dependence may be the modern equivalent of the hidden opiate dependence of the late 19th Century. Therefore, even though a verified social cost remains relatively low, the Commission attributes this fact less to the pharmacologic qualities of the drug than to the present medical orientation of the distribution system. As shown in our National Survey figures in Chapter Two, the incidence of barbiturate use outside the medical system has increased significantly in recent years and promises to result in more serious problems of episodic and multi-drug use in the future, and perhaps an increased prevalence of intensified and compulsive use patterns. Even so, the appropriate social response must be formulated in the context of continuing therapeutic needs within the medical system.

Amphetamines and Related Stimulants

Amphetamines and related stimulants, when administered intravenously, have a high reinforcement potential. Consequently, strong psychological dependence can develop, even though these drugs do not induce physical dependence. The potential social cost of amphetamine use, as measured by the prevalence of compulsive use, is much lower than with any of the depressants, largely because continued use of increasing amounts beyond the stage of pleasant mental and physical exhilaration leads generally to unpleasant and unbearable hyper-excitability through psychotic manifestations. For this reason, compulsive use is rarely sustained on a chronic basis.

This does not mean, however, that compulsive use of amphetamines cannot present a significant social problem. In post-war Japan, thousands of persons, particularly adolescents, turned to readily available methamphetamine. Enormous problems in social reconstruction were created. The establishment of special psychiatric hospitals and the formulation of stringent legal controls were necessary to curb the increased use. Fortunately, cultural homogeneity and national purpose facilitated effective measures to deal with this problem.

In the United States, compulsive use of amphetamines did occur among a highly vulnerable segment of the adolescent population during the middle and late 1960's, although the extent of this phenomenon was exaggerated at the time and has diminished rapidly since then. On the other hand, there is mushrooming evidence that large numbers of middle class adults, particularly women, have developed chronic using patterns of orally administered low dose stimulant preparations. Although this phenomenon may have been halted by modified prescription practices, most of the dependence on these substances at the present time does appear within the context of the medical distribution system. In contrast to the barbiturates, medical indications for the amphetamines and related stimulants are highly limited.

Cocaine

Laboratory experiments with animals have'demonstrated beyond dispute that cocaine is the most powerful reinforcer of all psychoactive substances. Although neither tolerance nor physical dependence develop, this drug has a higher potential social cost than the amphetamines.

Little social cost has actually been verified in this country. Although increasing, the incidence of use and the prevalence of chronic use remain relatively low. The route of administration normally employed, sniffing or "snorting," is less likely to induce high degrees of dependence than intravenous use. At the same time, cocaine has demonstrated its attraction to the same populations vulnerable to heroin dependence and to intensified amphetamine use, although this factor may be in part attributable to multi-drug use and an overlap in the acquisition ritual. Prudent policy planning demands that the nature of cocaine-using behavior be kept under close scrutiny, and that the currently inadequate data-base on cocaine and the behavioral concomitants of its use be significantly improved.

Hallucinogens

The dependence, liability of hallucinogens is relatively low. Although indiscriminate, sometimes daily use was not uncommon a few years ago, the combination of rapid tolerance, aversive side-effects and psychological satiation minimize the likelihood of intensified or compulsive use. For this reason, these drugs are generally utilized only for "spree" circumstantial or recreational use, generally with the goal of self-exploration or enhanced awareness. Consequently, dependence is not a, significant social concern, and attention should instead be focused on the behavior potentially influenced by the drug experience itself.

Cannctbi,g

Particularly in the doses commonly used in this country, cannabis is -not a highly reinforcing drug. This drug does not induce physical dependence and no significant degree of tolerance is developed. Although compulsive use of the more potent forms of cannabis does occur in cannabis-origin countries, there is no evidence that such a use pattern is developing in this country where use is generally experimental or intermittent and is confined primarily to the less potent forms. Although there is some evidence that the availability of hashish is increasing, the users generally titrate their doses to reach the desired effect. Finally, most persons using cannabis heavily in the United States can be classified as intensified rather than compulsive users. Consequently, dependence on marihuana is but a minor problem in the United States today. We should note, in this connect;.on that whatever tranquilizing effect marihuana has may be sought in alcohol and other sedative, anti-anxiety drugs. For this reason, the likely penetration level of cannabis dependence is fairly low.

II

DRUG INDUCED BEHAVIOR

A variety of social forces mold and reinforce desirable individual behavior. Can the momentary influence of a drug loosen the socialized restraints, inducing the individual to behave in ways he would not otherwise choose?

The history of psychopharmacology is replete with examples of behavior changes associated with the acute administration of drugs. A traditional, widely shared assumption of current thinking in biological science is that there are an infinite number of interactions between behavioral and pharmacological systems. The description of these interactions requires information about concomitant variations between the characteristics of the behaviors and of the drugs. Information about the behaviors should be specific with respect to factors such as intraindividual and interindividual variability, type of behavior and past behavioral history. Information about the drugs should be specific with respect to such items as dose-response relations, time-response relations, dose-order relations, localization of the site of drug action, dosage forms, routes of administration, absorption and distribution in the body and biological f ate.

Such drug and behavioral variables can be further modified by environmental variables such as set and setting. The resultant myriad of drug-induced changes in behavior cannot be fully understood unless all these underlying variables are so specified. Further-

more, recent advances in neurochemical research suggest that many drug effects on behavior are mediated by neurochemical events and that these relationships are reciprocal in the sense that changes in one may affect the state of the other.

If all of the-se possible combinations and permutations appear hopelessly confounded, it should simply caution us in making any premature generalizations about drug-behavior interactions. NVhile it is true that a full understanding of these interactions is restricted by the limits of present empirical data, the presence of such intricacies should temper an initial desire to simplify the drug-behavior story and encapsulate it in succinct clich6s suitable for mass media. Such attempts in the past have probably contributed to the need for this Commission in the first place and to do so again would be to ignore that information which the Commission has marshalled.

Nonetheless,there is a certain utility in discussing several impourtant ways in which drugs may affect behavior. Although the interaction among all of the drug-person-enviromnent variables will not be fully explored in this discussion, the Commission believes it important to sketch certain categories which are directly relevant to man's conduct. Since behavior has been defined by some as activity of an organism which is observable by the organism itself or by other organisms, drug-induced change in perception is a suitable place to begin.

IMPACT ON PERCEPTION

Perception is defined as those processes by which man receives or extracts information about the environment through sensory apparatus (for example, vision and audition). Drugs can alter the sensitivity of these systems and thereby alter perception.

Space and time relationships are examples of perceptions commonly affected by drugs. Marihuana, alcohol, hallucinogens and other drugs have been noted to expand or contract estimates of elapsed time or distance. For example, in simulated driving tests involving use of moderate doses of marihuana, some subjects perceived themselves to be driving at a speed faster than that actually being simulated. Similarly, some user-perceptions relating to enhanced sexual performance under the influence of marihuana are thought to relate to temporal distortions as well as to abolition of negative perceptions. Temporal distortions have also been described by amphetamine users who perceive themselves to be performing more activity in shorter time spans.

Drug effect may simply be a facilitating factor in many alterations of perceptions; the effect of setting, for example, cannot be overlooked. However, the occurrence of illusions and hallucinations seem less influenced than other perceptual changes by non-drug factors. Hallucinogens such as LSD increase the visual threshold in man, cause

arousal of the central nervous system and allow for hyperexcitation to visual and auditory events. Colors may seem more saturated and sounds may seem louder. Similarly the delirium trei"m associated with alcohol use is a state involving visual hallucinations and spatiotemporal distortions.

Drugs may also produce changes in specific anatomic areas of sensory organs. For example, several phenothiazines (used for tranquilizing and sedative effects) have produced pigmentary degeneration of the retina, and, occasionally, blindness. Some drugs, such as the anti-depressant imipramine, have even precipitated glaucoma in susceptible individuals.

Drugs may also interfere with the user's perception of his own abilities. Some studies have noted that student amphetamine users tended to overestimate their capacity to make sound judgments and solve mathernattical -problems, and aniplietarnine-using soldiers tended to overestimate their performance in certain routine monotonous tasks.

The important implication of any of these perceptual changes is that behavior may be altered from the expected to the unexpected unless the user is able to compensate for these eff ects as do some sophisticated users of marihuana and alcohol. The degree to which the altered behavior is of concern to society relates to the type of conduct which may be affected by the perceptual change. This could range from being late for an appointment to foolishly undertaking hazardous tasks.

IMPACT ON MEMORY

Man's behavior is dependent in part on what he has learned, either directly from experience or from others. To the extent that drug use or any other event affects man's ability to acquire knowledge or recall it, it may influence his ability to anticipate the consequences of his behavior. A full discussion of learning and memory processes is beyond the scope of this Report; indeed, these processes are currently the subject of intensive research, covering an entire range of variables from genetic ones to biochemical ones. The controversial nature of these investigations into learning and the inadequacy of the data on the impact of drug use on man's learning process preclude detailed consideration here. However, some general observations may be made regarding the influence of drugs on memory (short-term and longterm storage and retrieval).

Retention of acquired learning is hindered by amnesia or forgetfulness. Amnesia is a state of decreased retrieval produced by trauma or by chemicals; forgetfulness is a state of decreased retrieval produced by passage of time or by preoccupation with sensory input during time. Among the precipitators of amnesia are el ectro-convulsive shock, anoxia, anesthesia (barbiturate and ether), carbon dioxide and

certain antibiotics. With regard to psychoactive drugs in particular, anesthesia produced by either ultra-short-acting barbiturates or by ether can precipitate amnesia. Similarly, "blackouts" are commonly reported after drug-taking episodes, constituting a form of druginduced amnesia.

Drugs may also induce forgetfulness. It is common knowledge that moderate doses of barbiturates and alcohol can reduce or ablate newly acquired knowledge; in recognition of this phemonenon, a recently proposed highway safety device would require the driver to recall a randomly displayed series of numbers before being able to engage an automobile ignition system.

Occasionally recall may be facilitated by drugs. Marihuana, LSD, and ketamine act vicariously to retrieve stored iniages and "project" them into some sensory modality-vision, audition, smell. The use of short-acting and intermediate-acting barbiturates to facilitate recall of long-term memory in psychoanalysis or espionage (truth serum) is well documented. Finally, nitrous oxide has been shown in some circumstances to reduce forgetfulness.

ALTERATION OF MENTAL STATES

Profound mental changes, both transient and permanent, have been attributed to psychoactive drugs. These include some drastic changes in mood and psychological status. Humans are normally constrained by sets of socially-induced inhibitions from engaging in certain behaviors. Drugs such as alcohol and other sedative hypnotics tend to relieve these socially-inculcated anxieties thereby increasing the likelihood of the usually restrained behavior. The garrulousness and amorous behavior associated with cocktail parties and the unabashed laughter following marihuana use are examples of this disinhibition. Indeed such actions are so common as to form a battery of socially recognized excuses for normally embarrassing behavior. With prolonged use of high doses of some drugs, notably alcohol, and the barbiturates, general irritability increases and aggressive threatening acts may occur. The challenging conduct f requently encountered in bars constitutes a recognizable example.

Some drugs, notably amphetamines, cocaine and alcohol, can produce a sense of bravado and have reportedly been used intentionally to support the performance of daring acts. Euphoria associated with initial opiate experiences may promote thoughtless or indiscriminate actions. Amphetamines may induce garrulousness, hyperactivity, rash promises and the like. At the opposite pole, depressive states and suicidal acts are associated with drug taking, particularly with the sedative-hypnotic substances. This fact was overlooked when some

sedative-hypnotic, drugs were incorrectly promoter as tranquilizers appropriate for the treatment of depression.

Almost all psychoactive drugs can produce transient confusional and delusional states. The use of hallucinogens, particularly by naive, control-oriented individuals, can produce transient panic reactions, as the. user apparently loses control of his environment. Phencyclidine has been associated with panic states involving fear of suffocation arising f rom the drug's powerful action on the muscles of respiration; hydrocarbon inhalants have been associated with similar states of fear arising from displacement of oxygen in the inspired air. Acute confusional states occur with overdoses of alcohol, barbiturates and other sedative-hypnotic drugs. Alcohol and marihuana among' other drugs

have been known to produce depersonalization. I

Subacute and chronic psychotic episodes, particularly 'Paranoid reactions of a Tersecutory nature, are associated with the major stimulant drug&---cocaine, amphetamines and amphetamine-like substances. A prolonged "spree" use of stimulants may induce a psychosis 7 similar to that induced by the hallucinogens (LSD, psilocybin, mescaline and others). These drugs also have the specific capacity to induce an acute psychosis with a single effective dose even in so-called "normal" individuals. As with all of the drugs mentioned above, emotionally unstable individuals are especially susceptible to drug-induced behaviors of this type.

The exact relation between the drugs and these reactions is unclear. Although the acute reactions mentioned above are quite generally accepted as being at least partially drug related, the origins of the chronic psychoses, either drug-precipitated or residuals after termination of use, are much more debatable. Perhaps the most confusion and misinformation devolves about drug-induced "brain damage" and its relation to mental dysfunction.

With but few exceptions, disorders of behavior cannot be related specifically to detectable morphological change in the brain, either at the gross or microscopic level. Whereas gross and cellular changes have been associated with chronic alcoholism, and with very heavy intake of barbiturates and the hydrocarbons, profound behavioral and marked mental changes may also be observed following long-term, chronic use of most other potent psychoctive drugs without any detectable cellular alterations whatsoever. In fact, this is usually the case. Thus, any statement that no mental dysfunction occurs because no brain damage can be demonstrated is in error.

The social significance of these drug-induced mental changes is manifested in several ways. Those disruptions of mental function asso-

'This is probably due in part to sleep-deprivation which may last 5-10 days. It is well established scientifically that prolonged sleep-deprivation alone can induce an acute psychosis.

ciated with illusions and hallucinations, Confusional states, and the like, cause the individual to misinterpret his environmental impressions and react in an abnormal manner. This may take the form either of complete withdrawal and negativism, or at the other extreme, of violent and aggressive responses to situations which otherwise would not have been considered to be threatening. In either type of response, regard for welfare of self or others may be impaired or entirely lost leading to violent behavior and even to suicide and homicide.

IMPAIRMENT OF PSYCHOMOTOR FUNCTION

Depressant drugs as a class-alcohol, barbiturates, volatile hydrocarbons and a multitude of lesser drugs-with the common properties of inducing unconsciousness and anesthesia in large quantities, produce varying degrees of motor incoordination as a dose-related response. This phenomenon is so much a matter of common experience with the alcohol-consuming public that it hardly warants description.

These drugs impair the function of all of the highly integrated response mechanisms in the nervous system which control all coordinated acts such as ambulation, operation of motor vehicles and the like.' Depressant drugs by impairing higher brain functions and distorting or rendering inactive sensory input, or by rendering the user inattentive to these controlling signals, may make him completely incapable of performing complex voluntary actions. Unfortunately, such impairment may occur with quantities of drugs much smaller than those required to prevent the muscular response itself. Thus, the driver of a motor vehicle under the influence of relatively small quantities of alcohol may lose control, not because he is unable to perform the mechanical act of driving, but because his attention span is reduced, his vision is impaired, his memory of a turn in the road is obliterated or lie fails to hear the horn of a passing vehicle. In other words, simply because a drug user can "walk a straight line" after drinking does not necessarily qualify him to drive a motor vehicle.

Stimulant drugs, notably the amphetamines, have been widely used to permit truck drivers to endure long trips and athletes to carry on beyond their ordinary limits of endurance. Whereas such drugs may mask the subjective effects of fatigue, they do not correct the adverse effects of fatigue on attention, visual discrimination and other factors which control proper psychomotor functioning. Amphetamines were used by all belligerents in World War II to prolong psychomotor

" Less complicated psychomotor tasks do not require all of this biological machinery to be In action. For example, a blind person may feed and dress himself without the sensory input from vision and a deaf person can even operate a motor vehicle without auditory input, providing other sensory input is not impaired or distorted.

performance. It was common practice for Allied pilots to take these drugs after a bombing mission in Germany to permit them to get back to their home bases in England. A surprisingly large number made the return flight to England safely but crashed their planes on landing. The subtle effects of fatigue on psychomotor and other sensory components of proper psychomotor functioning are not corrected by this class or, for that matter, by any other class of drug.

SUMMARY

In summary, drug taking has the potential for affecting man's behavior in a number of overt as well as subtle ways. Drugs can affect perception, thereby influencing the way man regards his environment. Drugs can affect memory, thereby influencing man's capacity to anticipate the consequences of his actions. Drugs can alter mental states, thereby affecting his capacity to interpret and order his environment. Drugs can alter psychomotor function, thereby affecting man's capacity to respond appropriately to his environment.

These effects are neither uniformly negative nor uniformly predictable. The number of variables affecting the interaction between a drug, a person and his environment is perhaps limitless. We can state with assurance only that drug-induced behavior is as multi-faceted as all other human behavior.


IMPACT ON PUBLIC SAFETY

All other ends of government are secondary to its responsibility to ensure the public safety; and the cornerstone of any viable social organization must be that each individual have due regard for the life, limb and property of others. Fear that the drug user will violate this precept has been a common feature of the periodic cycles of public concern about drugs.

We have indicated that drugs can affect behavior in a multitude of ways, some subtle such as decrement in short-term memory, and others more overt such as aggressiveness and psychotic disorders. Naturally, public concern has always been greatest for drug-induced violence or assaultive behavior. But the public safety may also be endangered by drug-influenced recklessness or negligence. In this section, we will assess the impact of drug use in the two areas of the most concrete

interest: crime and driving.

DRUGS AND CRIME

Fifty-three percent of all adults surveyed in the National Survey spontaneously mentioned drugs as one of the most serious problems facing our nation and in need of attention. As noted in Chapter One, the "drug problem" coni, L, res lip many images and conveys many thing-to many people; but for 137c of all those who mentioned this problem, the primary concern was the relationship between drugs and crime.

When the National Survey queried the respondents directly on this question, it found that more than half of all adults and about twothirds of our youth believe that marihuana users often commit crime to buy more of the drug and that they "often commit crimes that they would not otherwise commit." The American public is even more convinced of heroin's direct relationship to crime; more than 907c of both youth and adults believe that "heroin users often commit crimes to get the money to buy more heroin" and that they often commit crimes that they would not have otherwise committed. The extent of agreement with these statements, however, was found to differ significantly according to both the age and drug experience of the respondent. (See Table III-4.)

In order to probe some of the factors responsible for this set of beliefs, respondents were also asked to indicate their experience with what they perceived to be drug-related crime. The data show that about one-third of the adults reported having experience at some time with someone breaking into their home or place of work to steal some property. Fifteen percent stated that the theft occurred at work, 19% indicated that it took place at home and 67% had no recollection of .such an incident. Then respondents were asked if they, personally, had ever been attacked, mugged or robbed or if another member of their household ever had such an experience, or if this bad happened to someone "they knew well." Again, about one-third (31%) responded affirmatively; that is, if they themselves did not have such an experience, they at least knew someone who had been victimized in this manner. These individuals were then asked if they had reason to believe that the attacker was a drug user or was under the influence of alcohol at the time of the offense. The data reveal that just under onefourth of those with such personal experience or knowledge believed that the criminal may have been a drug user. Specifically, 77o believed the attacker or robber was a drug user, 2% thought he was under the influence of alcohol, and 22% said they did not know.

In general, those who reported either being a victim or knowing a victim of personal crime were disproportionately young, college educated, and from a large metropolitan area, usually located in the Northeast. Users of marihuana and alcohol (behaviors which also correlate with age and education) were also disproportionately likely to have

been a victim or to have first-hand knowledge of one. Thus it appears that the generalized belief in the existence of a direct relationship between drug use and crime derives considerable reinforcement from the public's experience with both personal and property crime.

As the Commission noted in its first Report on marihuana, the relationship of drug use to criminal behavior is difficult to unravel. Its investigation requires more than an examination of the pharmacologi-

cal properties of a particular substance and their effects upon the individual user. Rather, additional factors to be considered include dosage level; the immediate and long-term physiological and psychological effects on the individual; frequency, intensity and duration of use; the purity, potency or type of drug used; the potentiating effects of drugs used in combination; personal expectations; motivations for use; set and setting; and the general impact and influence of the larger society upon the individual.

In order to assess the nature, direction and strength of the alleged relationship between drug use and antisocial behavior, particularly violent and non-violent criminal and delinquent behavior, the Commission examined several hundred documents in the professional and research literature and conducted a number of its own studies. Review of the professional and research literature, including a number of studies conducted either by or for the federal government, have led the Commission to conclude that it is difficult, if not impossible, to establish a direct relationship between crime and the use of various drugs; but if one cannot say that the use of any drug in and of itself is directly responsible for the commission of a criminal act, it is possible to demonstrate that drug use in combination with a number of physiological, psychological and social factors may assume an important role in the exacerbation of criminal, delinquent or other antisocial behavior.

In the pages which follow, we will briefly survey 11 selected classes of drugs ranging from alcohol to heroin relative to their pharmacologic potential for inducing criminogenic behavior, and to the empirical relationship of their use to crime and delinquency in selected poptlations. Then we will attempt to identify the major psychological, social and demographic characteristics of drug users, both criminal and noncriminal, and compare these with similar characteristics of non-drug users, both criminal and non-criminal. Next we will grapple with tl.e problems associated with inferring causation in the relationship between drug use and criminal behavior, regarding the impact of each on the other. Finally, we will address the larger issue of the impact of drug treatment and rehabilitation on that criminal conduct assumed to be related to drug use.

Drugs and Their Criminogenic Effects

All potent psychoactive drugs have been associated with crime, delinquency, heightened aggression, mental illness, reckless or negligent operation of a motor vehicle or other dangerous machinery and other forms of antisocial behavior. In a paper prepared specifically for the Commission, 'Enklenberg (1973) has examined the pharmacological properties of several drug classes, has analyzed the degree to which

they may be considered criminogenic, and has completed an exhaustive review of the research literature regarding the empirical relationship between drug use and the generation of criminal and delinquent behavior. This section draws substantially upon this special report to the Commission.

Alcohol

The major behavioral effects of alcohol derive from its depressant action on the central nervous system, also affecting the function of peripheral nerves, skeletal, smooth and cardiac muscle and other body tissues. Any behavioral stimulation which is observed is probably attributable to the suppression of inhibitory control mechanisms in various parts of the brain. Among the commonly observed acute effects of alcohol use are a reduction of anxiety, mild euphoria, some lack of muscular coordination, slurred speech, enhanced conviviality and assertiveness.

Low doses of alcohol, although said to improve functioning with regard to some simple motor or cognitive tasks, reduce the level of performance of such complex tasks as driving. When taken in moderate doses, alcohol has been found to reduce substantially motor skills as well as orderly thought processes and speech patterns. Higher doses of this substance may cause the user to become highly irritable and emotional and displays of anger and crying are not uncommon. Exceptionally high doses are known to cause stupor, unconsciousness and sometimes death.

The standard setting, dose-response function and personal expectations of the individual with regard to alcohol are, in part, responsible for his behavior while under its influence. When loss of control, whether physical or emotional, is an expected and recurrent reaction to alcohol use, the individual often feels justified in his belief that it was the drug which was responsible for his behavior.

Some researchers have advanced the theory that alcohol reduces anxiety related to sexual behavior and enhances sexual aggression; in fact, however, scientific opinion is split on the validity of this proposition.

Various empirical studies on the relationship between the use of alcohol and the commission of violent crime have shown that, in the case of homicide and other assaultive offenses, alcohol was used by at least half of the offenders directly prior to the crime (Shupe, 1964; Wolfgang, 1958; MacDonald, 1961; Voss and Hepburn, 1968). These studies also show that in alcohol-related violent crime, the violence is most often directed at relatives or friends who were drinking together.

Sex crimes have also 'been attributed to the use of alcohol. In a survey of sex offenders conducted by the Kinsey Institute for Sex Research, alcohol was reported as a factor in 67% of the sexual crimes against children and 39% of sexually aggressive acts against women (Gebhard, et al., 1967).

Molof (1967) found that youth who used alcohol were responsible for significantly more crimes of assault than their non-drinking counterparts, and Goodwin and his colleagues (1971) reported that the use of alcohol was significantly associated with other forms of antisocial behavior including poor school attendance, an unfavorable work record and excessive fighting.

Finally, some researchers have stated that a criminal may be prone to excessive drinking in order to increase courage in preparation for the commission of a crime.

Marihuwm 9

The initial effects of marihuana on the body can be compared with some of those attendant to alcohol use; mild euphoria, stimulation of the central nervous system and increased conviviality. The user experiences a pleasant heightening of the senses and relaxed passivity. In moderate doses the substance can cause short lapses of attention and slightly impaired memory and motor functioning. Heavy users have been known to become socially withdrawn and depersonalized and have experienced distortions of the senses.

Marihuana use is believed to reduce the inclination of the individual toward physical tasks, particularly those requiring sustained effort. The combination of aversion to sustained effort as well as the disruption of the thought processes and alteration of sensory perception occurring from high doses of marihuana is believed to act as a deterrent to those criminal acts which require, continuing physical effort and concentration. Only on verv rare occasions have individuals under the influence of this substance been shown to beconie agitated and even aggressive, and many of these persons had long histories of acting out behavior well prior to their marihuana use.

Motivations for use, personal expectations, along -with set and setting exert a strong influence upon the individual's behavioral responses to marihuana use. A person who believes that marihuana use does not culminate in loss of control can be expected to renialn nonassertive while under its influence.

'The Commission has already provided a detailed report of the research findings regarding the impact of marihuana on public safety (see Marihuana: A Signal of Misunderstanding, Appendix, Vol. 1, 1972, pp. 424-477). Presented here is a brief updated overview of these findings.

Because marihuana does not have high dependence liability, the cessation of use, regardless of frequency and intensity of prior consumption, does not induce the physical discomfort ,attendant to abstinence from other, more reinforcing substances such as heroin, barbiturates or amphetamines. Therefore, it is unlikely that even the heavy marihuana user will resort to crimes to sustain his level of use. It should be noted, however, that some individuals who sustain particularly heavy levels of use may become psychologically dependent upon the substance and may become somewhat more likely to engage in socially disapproved behavior and to become involved in multidrug use.

As with alcohol, marihuana is not an aphrodisiac and does not chemically induce sexual arousal. Although some observers believe that the sexual experience is enhanced by marihuana use, an equal number disagree with this theory. In its review of the available data, the Commission found no evidence to indicate that marihuana use results in heightened sexual aggressiveness.

From the facts stated above one can conclude that marihuana use is not ordinarily accompanied by or productive of aggressive behavior, thus contradicting the theory that it induces acts of violence. Indeed, the only crimes which can be directly attributed to marihuana-using behavior are those resulting from the use, possession or transfer of an illegal substance.

Barbiturates

Like alcohol, barbiturates cause depressant reactions and affect nerve, skeletal, smooth and cardiac muscle as well as other body tissues. Depending on the barbiturate used, the dosage administered and the emotional state of the individual, reactions to these drugs can range from mild sedation to coma and death. In general, individual reactions to these substances are closely parallel to those of alcohol.

Barbiturate use in low to moderate doses is generally unlikely to result in assaultive behavior, although high dose use of these drugs has been known to cause irritability and unpredictably violent behavior in some individuals (Bell and Fraser, 1950; DiMascio, 1968; McGrath, 1970; Eckerman, et al., 1971; Malmquist, 1971; Blum et al., 1972; Tinklenberg, 1973). For the individual accustomed to maintaining a high level of barbiturate use, cessation of that use may result in delirium, convulsions and other transient toxic disturbances which is usually life-threatening.

The increasingly common simultaneous use of alcohol and barbiturates must be considered when examining the relationship between barbiturate use and crime. In a study by Devenyi and Wilson (1971), it was discovered that 70% of the population (N = 129) of multiple drug users were known users of barbiturates as well as alcohol. As

mentioned previously, many of the effects of these substances on the individual are similar. It is not surprising, then, that persons who are regular users of barbiturates may also be or have been regular users of alcohol. Since a strong association between the use of alcohol and violent crime undoubtedly exists, it is not difficult to surmise that high level barbiturate use may also be linked to violent crime.

Amphetamines

The group of drugs known as amphetamines consists of synthetic chemicals causing stimulation of the central nervous system. Tbev are commonly referred to a "tippers" or "speed.` Some of the acute reactions produced by these substances include increased alertness, vigor, suppression of boredom and sometimes paranoia, assertive or assaultive behavior. Because of their reputation for increasing physical endurance, amphetamines have been used by athletes, truckers and other individuals who have found it necessary to sustain high levels of alertness and vigor. Some individuals, however, experience headache, palpitation, dizziness, confusion and sometimes delirium and fatigue.

The cessation of repeated use of high doses of amphetamines generally causes the user to feel irritable, fatigued and depressed; and a type of withdrawal occurs, although it is qualitatively different from and not as uniquely characteristic as the withdrawal syndrome associated with cessation of heroin use.

The influence of amphetamines on sexual behavior is largely dependent upon dosa$@el setting and Y)redisposing personality (Bell and Trethowan, 1961; Ellinwood, 1967). Use of these drugs over a short period of time, however, appears to induce no appreciable change ill performance although some increase in the enjoyment of the sex act (accompanying the delay of orgasm) has been reported. Anqrist and Grershon (1969) found that "increased promiscuity, compulsive masturbation, prostitution and intensification of sado-masochistic f antasies were all reported as consistent sequelae of Thigh level and high intensity] amphetamine use." Similar findings were also reported by Geerlings (1972). In sum, the research findings indicate that the direct effects of amphetamines on sexual behavior are complex and multidetermined.

Only a limited number of studies have focused on the relationship of amphetamine use to crime (Blum, 1967b. 1969; Eckernian, et al., 1971; Ellinwood, 1971, 1973; Malmquist, 1971; Smith, 1972; Tinklenberg, 1978). The majority of research conducted on this subject, however, shows that amphetamine users were disproportionately involved ill crimes of violence (assaults and robberies, for example). It has not been definitely determined, in this country however, that these crimes Ai-ere directly attributable to the acute reactions of the drug, although

it would appear likely that the paranoid states induced by this drug may be linked to dangerous conduct. This is confirmed by the close association between methamphetamine use and violent crime which occurred in Japan during the mid 1950's. This development was particularly striking because violent behavior is relatively rare among the Japanese and the incidence of this conduct decreased markedly when the use of amphetamines receded (Nagahama, 1968).

Opiates

Taken in small to moderate doses, the opiates can diminish pain, anxiety and tension and induce mild euphoria. Sustained high intensity use, unlike that of alcohol or barbiturates, does not cause slurring of speech or lack of muscular coordination, nor do these drugs induce the paranoid behavior generally resultant from the use of amphetamines. The effect of a particular dose of any of these substances is largely dependent on the means of administration. Injection of these substances reacts on the body more quickly than oral administration.", flowever, the latter often causes a more prolonged although less intense "high." All drugs included in this class have the potential for inducing dependence, and tolerance is built up rapidly.

The relationship of opiates to crime has been extensively investigated. The research conducted in this area has been limited primarily to: review of criminal records of known dependents in an effort to determine whether dependence predated or postdated criminal behavior; or a determination of the rates of dependence among criminal or mental hospital populations; or comparisons of criminal activity among dependents and non-dependents or among users and nonusers; or comparisons of pre- and posttreatment criminal activity; or comparisons of criminal behavior between dependents who remained in or successf ully completed treatment and those who dropped out of treatment or relapsed.

Regardless of the type of study, some common conclusions were apparent. First, the available data indicate that most known opiate (primarily heroin) dependent persons had long histories of delinquent or criminal behavior prior to their being identified as drug users, that opiate use becomes a further expression of delinquent tendencies, and that most heroin-dependent persons continue to be arrested subsequent to release from prisons, hospitals or treatment programs (Kolb, 1925, 1962; Anslinger, 1951; Anslinger and Tompkins, 1953; Morgan, 1965; Blum, 1967b; Winick, 1967; O'Donnell, 1969; Chambers, et al., 1970a; Friedman and Peer, 1970; Cuskey, et al., 1973; Friedman and Friedman, 1973; Jacoby, et al., 1973; Tinklenberg, 1973). Tn fact, opiatedependent persons tended to escalate the seriousness of their offenses

" Heroin is not consumed orally.

and to experience increased arrests over their pre-dependence rates, mostly for drug arrests and secondarily for crimes against property (Blum, 1967a; Friedman and Friedman, 1973; Jacoby, et al., 1973). As Blum (1967a) has noted, "there is no doubt that among addicts with a delinquent life-style, drug use is part and parcel of their other activities, crime included."

Other observers have focused their attention oil the criminogenic effects of opiate use, per se, and especially oil the necessity to resort to crime in order to support a habit (Dal, 1937; Pescor, 1943; Haines and McLaughlin, 1952; Mever, 1952; Tappan, 1960; Maurer and Vogel, 1962; Schur, 1962,1965; Duvall, et al., 1963; Lindesmith, 1965; Vaillant and Rasor, 1966; Cushman, 1971), and most note that the crimes committed for this purpose generally tend to be non-violent. money-making crimes (Bromberg and Thompson. 1937; Finestone, 1966, Kolb, 1962; Chein, et al., 1964; Schur, 1965; O'Donnell, 1966; Preble and Casey, 1969; Amsel, et al., 1971; Canadian Commission. 1972; Friedman and Friedman, 1973).

Indirect evidence linking the opiate (heroin) user to criminal behavior is provided by a number of persons administering treatment programs. Research findings indicate that when the drug users are active in a therapeutic program and presumably not itsing heroin, crirninal activity decreases. That is, when heroin use, decreases either bv treatment or other means, criminal behavior is also said to decrease (see, for example, Joseph and Dole, 1970; DuPont and Katon, 1971; McGlothlin, et al., 1972). This proposition and tl)e supporting data. however, will be scrutinized carefully in a later section.

Since drug-behavior interactions are complex processes involving the operation of multiple variables, the identification of a single factor as causal is bound to be incorrect and misleading. Tlie number of nondrug influences on the opiate user's behavior is large, involving ]lot only the immediate circumstantial or situational variables but what preceded them (personality, socioeconomic factors, etc.). Some observers focus their attention oil the contagious features of opiate use, that is, the spread of use is seen as largely attributable to drug availability, modeling bebavior, peer group pressures, conditioning and reinforcement (Chein, et al., 1964; Hughes, 1971; Goode, 1972b; Friedmail and Friedman, 1973). Despite significant and numerous attempts by skilled investigators to discover which of the many uon-pharmacological f actors assume, the greatest relative importance, generalization,, at this time are still premature.

In slim, the use of opiates ill tjje T71-lited States. particularly heroin use, increases the probabilities that all individual will engage in acquisitive crimes or other criminal behaviors. most of which are directly related to supporting the drug habit. However, the available evidence indicates that users of opiates are significantly less likely to commit

homicide, rape and assault than are users of alcohol, amphetamines and barbiturates. While there are no data directly comparing the criminal proclivities of opiate users with those of the general population, the evidence indicates that a disproportionate number of heroindependent persons have had long histories of deviance which began well prior to their use of and their official identification as users of heroin.

Cocaine

Cocaine is obtained from the leaves of Erythroxylon shrubs which grow in the Andes. It is a powerful stimulant to the central nervous system and its acute effects resemble those caused by the amphetamines, increased alertness and vigor and suppression of hunger, fatigue and boredom. Unlike the effects of amphetamines, the effects of cocaine last only a short time due to rapid detoxification, and no tolerance occurs. Chronic use, when and if it occurs, is attributable to psyebological rather than physical dependence.

Since cocaine produces many of the same reactions as amphetamines (e.g., paranoid reactions, impulsiveness and hostility), one would expect the user to be prone to aggressive action. Although there have been crimes against persons perpetrated by cocaine users, doctimentation of the drug's specific effect is often absent. Like the opiate user, the user of cocaine is more prone to commit crimes against property (Kolb, 1962; Lewin, 1964; Eckerman, et al., 1971; Woods and Downs, 1973).

Hallucinogens

The hallucinogens or "psychotomimetie" drugs can cause marked alterations in normal thought processes, perceptions and moods. Usually produced synthetically, this class of drugs includes lysergic acid diethylamide (LSD), dimethoxymethylamphetamine (STP), dimethyltryptamine (DMT), mescaline, phencyclidine and psilocybin. Of this family of drugs, LSD is the most potent and differs little from the other drugs except for intensity of induced reactions and side effects. Among the acute reactions of these drugs are dizziness, nausea, dilation of the pupils of the eyes, visual ,aberrations and heightened auditory acuity. According to Holister (1968) the individual first experiences somatic changes then perceptual alterations and finally psychic changes. The effects of any of these drugs on the, individual are largely dependent upon his expectations. his emotional outlook and the social action occurring around him. Although dependence does not develop with continued use, the individual may be prone to flashbacks and psychotic reactions even after use is discontinued.

Presently, there are no convenient methods for determining the tissue level of most hallucinogens; consequently, information regard-