Report of the National Commission on Marihuana and Drug Abuse

Marihuana: A Signal of Misunderstanding

Chapter III

Social Impact of Marihuana Use

Implicit in existing social and legal policy toward marihuana is the view that society suffers in some way from use of the drug. When the widespread practice of marihuana smoking appeared in the United States in the early decades of the 20th century, the medical, law enforcement, newspaper, and legislative communities immediately indicted the drug. They assumed that the drug posed serious dangers to individual health; but more importantly, they viewed it as a menace to the public order. Crime, insanity and idleness were thought to be the inevitable consequences of its use.

That some of these original fears were unfounded and that others were exaggerated have been clear for many years. Yet, many of these early beliefs continue to affect contemporary public attitudes and concerns. Consequently, one of the Commission's most important tasks is to evaluate carefully all data relevant to the social impact of marihuana use. We must determine whether and in what respects social concern is justified. What is myth and what is reality?

The literature pertaining to the presumed effects and consequences of marihuana use still reveals a wide diversity of opinion about social impact. Careful scrutiny is inhibited by the prevalence of hearsay, rhetoric and undocumented assertions about the effects and consequences of marihuana use. Nonetheless, evidence is mounting and a number of significant trends have recently emerged. In the previous Chapter we explored the evidence regarding the nature and scope of contemporary marihuana use, and the effects of the drug on the individual user. Now we must consider the impact on society of behavior resulting from use of marihuana.

In dealing with the behavioral consequences of marihuana use, the Commission has made a concerted effort to review and evaluate the enormous body of existing popular and scientific literature, and has itself initiated new empirical research, including national surveys, retrospective studies and controlled laboratory experiments.

Awareness of the difficulties involved in investigating an inherently complex social phenomenon and applying its research findings to policy decisions has fostered particular sensitivity to the quality of previous and Commission-sponsored research. As such, considerable attention was given to such basic research questions as:

• What behavioral effects are most relevant in assessing the consequences of marihuana use?
• What measures produce the most valid data concerning given effects?
• What reliance should be placed on various research techniques, such as self-reporting, controlled experiments, clinical observations and statistical relationships?
• What generalizations can be made from particular populations studied?
• What are the limits of given data in terms of inference. interpredation and attribution of cause?

With respect to the Commission's own research program, the process of selection and allocation of resources was indeed difficult, and some areas of inquiry have undoubtedly been either neglected or shortchanged. Nonetheless, we believe that the studies undertaken and information gathered will add significantly to our understanding of the conditions and circumstances under which marihuana use is likely to affect adversely the public safety, public health and welfare, and dominant social order.

Marihuana and Public Safety

The belief that marihuana is causally linked to crime and other antisocial conduct first assumed prominence during the 1930's as the result of a concerted effort by governmental agencies and the press to alert the American populace to the dangers of marihuana use. Newspapers all over the country began to publish lurid accounts of "marihuana atrocities." In the absence of adequate understanding of the effects of the drug, these largely unsubstantiated stories profoundly influenced public opinion and gave birth to the stereotype of the marihuana user as physically aggressive, lacking in self-control, irresponsible, mentally ill and, perhaps most alarming, criminally inclined and dangerous. The combination of the purported effects of the drug itself plus the belief that it was used by unstable individuals seemed to constitute a significant danger to public safety.

Now, more than 30 years later, many observers are skeptical about the existence of a cause-effect relationship between marihuana use and antisocial conduct.

MARIHUANA AND CRIME

Over the years, there have been several hypotheses about the relationship between marihuana and antisocial conduct. The earliest view was that marihuana causes or leads to the commission of aggressive and violent criminal acts such as murder, rape and assault. These acts are committed, it has been argued, because marihuana allegedly produces a relaxation of ordinary inhibitions, a weakening of impulse control and a concomitant increase in aggressive tendencies while the user is under its influence.

Marihuana's alleged criminogenic role is not always limited to violent or aggressive behavior. Some commentators also postulate that marihuana leads to or causes non-violent forms of criminal or delinquent conduct, ranging from sexual promiscuity to grand larceny. Underlying this second causal hypothesis are the assumptions that marihuana frequently impairs judgment, distorts reality and diminishes, at least temporarily, the user's sense of personal and social responsibility. Regular or heavy use over an extended period of time is felt to interfere, perhaps irreversibly, with the orderly development of psychosocial and moral maturity.

As indicated above, however, a growing uncertainty prevails about the existence of a causal link between marihuana use and antisocial conduct. In fact, recent surveys, including several sponsored by the Commission, suggest that large segments of the professional public, particularly the law enforcement and criminal justice communities, are no longer willing to assert a cause-effect relationship but observe, instead, the existence of a statistical association.

The Issue of Cause and Effect

The controversy over the cause-effect relationship between marihuana use and criminal, violent or delinquent behavior poses a number of serious problems for the investigators Proponents and opponents of the causal view tend to rely on different kinds of evidence and to call upon different types of experts, thereby differing substantially in the kinds of information they accept as relevant, reliable or valid.

Practitioners, such as police and probation officers for example, frequently cite case examples in which apprehended offenders are found to be in possession of marihuana at the time of arrest. The mere presence of the drug or the fact that an offender is a known user of marihuana is sometimes deemed sufficient to establish a causal link between the marihuana and the offense.*

*In the widely publicized Licata case of the 1930's, for example, a 16-year-old cannabis user was charged with the ax murder of his family and the offense was directly attributed to the effects of marihuana. There was, however, no precise information available regarding the use of marihuana in relation to the crime. Nor, in the various accounts of the case, was there generally any reference to the fact that several of the boy's relatives had previously been committed to mental institutions; that the police had, about one year prior to the offense (and presumably before the youth's alleged use of marihuana) attempted to commit him for his bizarre behavior; or that shortly after the crime, the boy began to exhibit the symptoms of paranoid schizophrenia.

Empiricists, on the other hand, would deny that the simple presence of the drug constitutes a satisfactory demonstration of a causal relationship between marihuana use and the crime in question. They would defer, instead, to the results of empirical studies designed explicitly to test the assertion. Essentially, they emphasize that even if some offenders do use marihuana, an equal or larger number of offenders do not, and there are certainly large numbers of marihuana users in the population-at-large who never engage in the kinds of antisocial conduct deemed to be related to or caused by the use of the drug.

Proving any positive and direct relationship, be it causal or otherwise, between two inherently complex social phenomena is fraught with enormous difficulties. The relationship of marihuana use to crime, violence, aggression or juvenile delinquency presents no exception. Before examining the evidence with respect to the existence of a causal connection, certain basic considerations deserve at least brief mention here.

To prove, the existence of a positive and direct relationship, one would be required to demonstrate that the alleged offender was, indeed, a marihuana, user; that he was under the influence of the drug at the time he committed the offense; and that the crime was directly attributable to the effects of the marihuana. The kinds of evidence necessary to establish these facts are not easy to obtain.

First, evidence of the use of marihuana by the accused is generally dependent upon either direct admission of use, hearsay evidence, or inferences derived from knowledge of possession (that is, the offender was found to have marihuana on his person or in his possession at the time of arrest).

Second, because no chemical tests presently exist outside the laboratory to identify the presence of marihuana in the body of the accused, it is difficult if not impossible to prove that the offender was definitely under the influence of marihuana when he committed the offense.

Third, in order to prove that the marihuana represented the significant contributory or precipitating variable, all other factors possibly related to the offense would have to be examined and excluded.

The problems of validation are further compounded by additional variations in behavior attributable to: (a) the pharmacological potency of the drug; (b) possible adulteration of the marihuana; (c) the interaction of marihuana with other drugs simultaneously ingested; (d) differing individual response to similar dosage levels; (e) the time-action function; (f) the cumulative effect of marihuana use; and (g) various social, psychological and situational variables such as set and setting, individual expectations, personal predispositions or preexisting impulse disorders.

Despite the inherent complexities of the issue and the difficulties in securing reliable and valid evidence, a relatively large body of research is now available pertaining to the criminogenic effects of marihuana upon the individual and the nature and extent to which the drug constitutes a danger to public safety. In the following section, we present the available evidence and assess the strength and direction of the alleged relationships between marihuana use and violent or aggressive behavior and also non-violent forms of criminal and delinquent behavior.

Marihuana and Violent Crime

As indicated earlier, the belief that marihuana causes or leads to the commission of violent or aggressive acts first emerged during the 1930's and became deeply embedded in the public mind. Until recently, however, these beliefs were generally based on the anecdotal case examples of law enforcement authorities, a few clinical observations and several quasi-experimental studies of selected populations comprised of military offenders, convicted or institutionalized criminals or delinquents and small groups of college students. Few efforts were made to compare the incidence of violent or aggressive behavior in representative samples of both user and non-user populations.

Even in these early observations and investigations, however, no substantial evidence existed of a causal connection between the use of marihuana and the commission of violent or aggressive acts. Indeed, if any relationship was indicated, it was not a positive and direct causal connection but in inverse or negative statistical correlation.

Rather than inducing violent or aggressive behavior through its purported effects of lowering inhibitions, weakening impulse control and heightening aggressive tendencies, marihuana was usually found to inhibit the expression of aggressive impulses by pacifying the user, interfering with muscular coordination, reducing psychomotor activities and generally producing states of drowsiness, lethargy, timidity and passivity.

In fact, only a small proportion of the marihuana users among any group of criminals or delinquents known to the authorities and appearing in study samples had ever been arrested or convicted for such violent crimes as murder, forcible rape, aggravated assault or armed robbery. When these marihuana-using offenders were compared with offenders who did not use marihuana, the former were generally found to have committed less aggressive behavior than the latter.

In an effort to accumulate data on the relationship between marihuana use and aggressive or violent criminal behavior, the Commission sponsored several studies designed to assess the purported causal relationship.

First, the Commission wanted to tap the unique experience of the law enforcement and criminal justice communities. Representative samples of prosecuting attorneys, judges, probation officers and court clinicians were asked their opinions about the relationship between marihuana use and the commission of aggressive or violent criminal acts. When asked to evaluate the statement that "most aggressive acts or crimes of violence committed by persons who are known users of marihuana occur when the offender is under the influence of marihuana," three-quarters of the judges, probation officers and clinicians indicated either that the statement was probably untrue or that they were unsure of its accuracy. Of these three groups, a greater proportion of clinicians (76.5%) thought the statement false than did the probation officers (60%) and judges (44.2%).

In a separate mail survey of the chief prosecuting attorneys in the 50 states-the group which has often supported the causal hypothesis — 52% of the respondents stated that they either did not believe or were uncertain of the truth of the proposition that use of marihuana leads to aggressive behavior.

We have already noted that only a small fraction of the offender populations in past studies were found to have been arrested for crimes of violence. Similarly, in a Commission-sponsored study of 1,776 16-to-21-year-olds arrested in five New York counties for marihuana law violations between 1965 and 1969, only a small percentage had either previously or subsequently come to the attention of authorities for such offenses as assault or robbery. In fact, less than 1% of the offenders in this sample had been arrested for these offenses prior to their first marihuana arrest, and less than 3% were known to the Federal Bureau of Investigation for these offenses subsequent to their marihuana violation.

Perhaps more important than professional opinion or the incidence of violent offenses in an offender population, however, is the determination of the extent to which marihuana use is related to violent or aggressive behavior in the general population.

In a Commission-sponsored survey, face-to-face interviews were conducted with a representative sample of 559 West Philadelphia residents in order to ascertain the extent of marihuana use in this heterogeneous population and the relative involvement of marihuana users and non-users in violent criminal behavior. In corroboration of the earlier findings, the researchers found no significant differences in the proportions of users and non-users; who stated that they had committed any of the aggressive or violent crimes enumerated.

Further, no findings indicated that marihuana was generally or frequently used immediately prior to the commission of offenses in the very small number of instances in which these offense's did occur. In contrast, however, the aggressive and violent offenders in this sample did report with significantly greater frequency the use of alcohol within 24 hours of the offense in question.

These findings should be considered in light of an earlier West Coast study of disadvantaged minority-group youthful marihuana users, many of whom were raised in a combative and aggressive social milieu similar to that found in several of the West Philadelphia sampled neighborhoods. The data show that marihuana users were much less likely to commit aggressive or violent acts than were those who preferred amphetamines or alcohol. They also show that most marihuana users were able to condition themselves to avoid aggressive behavior even in the face of provocation. In fact, marihuana was found to play a significant role in youth's transition from a "rowdy" to a "cool," non-violent style.

The Commission is aware of the claim that a few emotionally unstable or impulsive individuals have become particularly aggressive or impulsive under the influence of marihuana. As we have noted, some newspaper accounts have attributed sensational homicides or sexual assaults to marihuana-induced transitory psychotic states on the part of the user. No evidence exists, however, to indicate that marihuana was responsible for generating or creating excessive aggressiveness or impulsivity in individuals having no prior history of impulse or personality disorder. The most that can be said is that in those rare instances, marihuana may have aggravated a preexisting condition.

In sum, the weight of the evidence is that marihuana does not cause violent or aggressive behavior, if anything, marihuana generally serves to inhibit the expression of such behavior. Marihuana-induced relaxation of inhibitions is not ordinarily accompanied by an exaggeration of aggressive tendencies.

No evidence exists that marihuana use will cause or lead to the commission of violent or aggressive behavior by the large majority of psychologically and socially mature individuals in the general population.

Marihuana and Non-Violent Crime

A second hypothesis reflecting the statements of significant numbers of government officials is that marihuana plays a major role in the commission of other, essentially non-violent, forms of criminal and delinquent behavior.

In general, those espousing this more general cause-effect relationship assume that the drug frequently produces, in addition to the lowering of inhibitions, impairment of judgment, distortion of reality and at least temporary reduction of a sense of personal and social responsibility. Indeed, the earlier stereotype of the marihuana user was that of an immoral, physically debilitated, psychologically unstable and criminally marginal man whose state of severely and irreversibly underdeveloped psychosocial and moral maturity was said to derive directly from his continued use of marihuana.

As indicated earlier, neither the inherent complexities of the issue nor the previously inconclusive empirical evidence has deterred the formulation and expression of strong opinions about the relationship of marihuana use to crime and delinquency. Opinion in this area, quite apart from the empirical evidence, has long assumed critical importance in the development of social policy.

The Commission has addressed the issue in three different ways. One was to assess the state of current public and professional opinion relative to the general proposition that marihuana causes or leads to the commission of criminal or delinquent acts. A second approach was to review the professional literature addressed to the issue, and a third was to initiate empirical investigations of our own.

The opinion surveys found that substantial numbers of persons raised serious questions about the existence of a causal relationship between marihuana use and criminal or delinquent behavior. Confusion and uncertainty about the existence of such a relationship have been expressed by both youth and adults, including practicing professionals in the criminal justice system.

Recent data suggest that some of this confusion may be the result of a fairly widespread misconception about the addiction potential of marihuana. To the extent that persons believe marihuana users are physically dependent on the drug, they may assume that, like the heroin user, the marihuana user commits his offenses in order to support what is perceived as a drug habit; and that, like the heroin model, offenses are committed more often in the desperate attempt to obtain the drug rather than under its influence following use. There is no evidence that this is the case, even for those who use the drug heavily.

In the Commission-sponsored National Survey, the respondents were asked whether they agreed or disagreed with the statement that "many crimes are committed by persons who are under the influence of marihuana." Fifty-six percent of the adult population and 41% of the youth indicated agreement. As in the Survey generally, there was a significant difference of opinion according to age in the adult population. While 69% of the over-50 age group agreed with this statement, only about one-third of the 18-to-25 age group and the 14-to-17-year-olds agreed. One of every four youth respondents and 18% of the adults said they were "not sure" of the existence of such a relationship between marihuana use and crime.

Much greater consensus exists, even between generations, regarding the association of alcohol and crime. While 56% of all adults expressed their belief that many crimes are committed by persons under the influence of marihuana, 69% of these same adults believed that alcohol was related in the same way. Only 7% felt unsure about the alcohol crime relationship, in contrast to 18% who expressed uncertainty about the relationship between crime and marihuana.

The Commission also surveyed opinion within the criminal justice community. A sample of 781 judges, probation officers and court clinicians replied to a questionnaire which asked respondents to indicate whether or not their professional experience led them to believe that "use of marihuana causes or leads to antisocial behavior in the sense that it leads one to commit other criminal or delinquent acts." Of all respondents, 27% believed this to be the case. Within each professional group, 34% of the judges, 18% of the probation officers and 2% of the clinicians indicated their agreement.

On the assumption that some proportion, however small, of marihuana users might ultimately be arrested for non-drug offenses, these officials were also asked to assess the relative truth of the statement that "most non-drug offenses committed by persons who are known users of marihuana or are found to have marihuana on their person or in their possession occur when the offender is under the influence of marihuana." Seventy-one percent of the responding judges, 75% of the probation officers and 85% of the court clinicians either thought the statement false or were unsure of its accuracy.

Respondents likewise rejected, however, the proposition that these crimes perpetrated by marihuana users occur when the offender is attempting to obtain the drug rather than while under its influence; 65.6% of the judges, 64.6% of the probation officers and 78.3% of the court clinicians either denied or were unsure of the truth of this proposition.

In short, marihuana, is not generally viewed by participants in the criminal justice community as a major contributing influence in the commission of delinquent or criminal acts.

This increasing professional skepticism is buttressed by the weight of research findings. A comprehensive review of the literature revealed that in the various offender populations studied for this purpose, only a small percentage were marihuana users. In only a handful of cases did researchers report that criminal conduct followed the use of marihuana. Generally, the rate of self -reported, non-drug crime did not significantly differ between users and non-users.

Both of the Commission-sponsored studies (the New York and Philadelphia studies referred to earlier) corroborated this research consensus. In the Philadelphia study, for example, less than 10% of the sample were known to the police, and there were no significant differences among marihuana users and non-users in the sample who reported the commission of major criminal acts when statistical controls were applied. Further, most of the first offenses committed by users occurred prior to their use of marihuana, and only in rare instances did the offenses immediately follow (within 24 hours) upon the use of marihuana (five cases out of 741 first offenses and 19 cases out of 516 most recent offenses).

Likewise, the New York study revealed that about one-fifth of the marihuana law violators arrested between 1965 and 1969 were found to have previous arrest records. Of those with previous arrests, the great majority of offenses (86%) involved traffic violations and minor violations of the vagrancy statutes. In but 10% of the cases the previous arrests were for assault, robbery, burglary or larceny.

In essence, neither informed current professional opinion nor empirical research, ranging from the 1930's to the present, has produced systematic evidence to support the thesis that marihuana use, by itself, either invariably or generally leads to or causes crime, including acts of violence, juvenile delinquency or aggressive behavior. Instead the evidence suggests that sociolegal and cultural variable's account for the apparent statistical correlation between marihuana use and crime or delinquency.

A Sociocultural Explanation

The persistent belief that some relationship exists between marihuana use and crime is not without statistical support. Undoubtedly, the marihuana user of the 1920's and 1930's was overrepresented in the nation's jails and penitentiaries and in the general crime and delinquency statistics. Especially during the late 1920's and early 1930's when the nation was preoccupied with lawlessness, the translation of this statistical correlation into a causal hypothesis is not surprising.

The increasing incidence of use in the mid-sixties by white, affluent, middle class, high school youth, college students and adults has occasioned a reevaluation of the marihuana user and a reexamination of the crime issue. The overwhelming majority of the new marihuana offenders have had no previous arrests, and come from the normally low risk, middle and upper socioeconomic population groups.

Recent public opinion surveys suggest that considerable social disapproval is attached to the "hippie" life style, unconventional mode of dress and apparent disregard for the law displayed by many of these individuals. Nonetheless, fewer persons are now willing to classify as criminal those marihuana users whose only contact with the law has been as a result of their marihuana use. Perceptions have undergone a change as a result of the increased usage of marihuana among youth of the dominant social class. Nonetheless, a statistical association remains.

First, the majority of both marihuana users and offenders other than actual marihuana law violators fall into the 14-to-25-year age group. Second, the majority of those arrested for marihuana law violations as well as other delinquent or criminal acts were, and to a much lesser degree, still are, drawn from the same "high risk" populations, such as minority groups, socially and economically disadvantaged, young, male, inner-city residents.

Third, various offender populations subjected to study often included a number of marihuana users, although it was not the marihuana violations per se but other, more serious criminal conduct that originally brought most of them to the attention of the authorities. Finally, during the past five years, marihuana law violators have increasingly swelled the crime and delinquency statistics; in most cases, their only contact with the law has been for these marihuana-specific offenses.

The Philadelphia study corroborated this continuing statistical association. The simple relationship between using marihuana and committing offenses was positive and statistically significant, and there was also a high correlation between frequency of smoking marihuana and committing offenses. These direct associations were reduced to insignificance, however, upon further analysis of the data, and other explanations for the coincidence of marihuana use and crime became evident. These included: race, education, age, the use of other drugs, and having drug-using friends.

We conclude that some users commit crimes more frequently than non-users not because they use marihuana but because they happen to be the kinds of people who would be expected to have a higher crime rate, wholly apart from the use of marihuana. In most cases, the differences in crime rate between users and non-users are dependent not on marihuana use per se but on these other factors.

In summary, although the available evidence suggests that marihuana use may be statistically correlated with the incidence of crime and delinquency, when examined in isolation from the other variables, no valid evidence was found to support the thesis that marihuana, by itself, either inevitably, generally or even frequently causes or precipitates the commission of crime, including acts of violence, or juvenile delinquency.

Within this framework, neither the marihuana user nor the drug itself can be said to constitute a danger to public safety. For, as two researchers have so cogently stated for the Commission, "Whatever an individual is, in all of his cultural, social and psychological complexity, is not going to vanish in a puff of marihuana smoke."

MARIHUANA AND DRIVING

Within the context of public safety another issue which merits attention is the extent to which drivers under the influence of marihuana constitute a hazard on the nation's streets and highways. Although in recent years increasing attention has been given to this issue, at present little empirical evidence exists to inform discussion.

To assess the actual and potential impact of marihuana on traffic safety, a number of basic research questions must be answered.

• the extent to which marihuana users actually drive while under the influence of the drug
• the extent to which marihuana users driving while "high" commit traffic violations and are involved in traffic accidents
• the amounts of marihuana consumed immediately prior to the commission of traffic violations or the involvement in traffic accidents and the drug's role in these events
• the nature and extent to which marihuana actually impairs psychomotor skills, judgment and driving performance

To date, the generalizations made concerning the effects of marihuana on driving behavior have generally been based on statistical studies of traffic violations and accidents and inferences drawn from more general studies of the physiological and psychological consequences of marihuana use, such as changes in pulse rate, reaction time, neuromuscular coordination, time estimation and spatial perceptions.

Such studies pose serious limitations in the nature, reliability and validity of the data. The basic problems derive from difficulties in identifying and attributing cause. A major obstacle in such retrospective analysis is the inability to separate the effects of marihuana from those possibly engendered by the use of other drugs, such as alcohol, tranquilizers and amphetamines. Finally, conclusive analysis is impossible until a reliable technique is developed for measuring the level of marihuana present in the body of the driver at the time of his violation or accident.

Prospective experimental studies of actual reactions to road conditions and traffic emergency situations would undoubtedly provide the most reliable and valid data, but such studies would themselves endanger the public and have not been undertaken. Researchers have relied, therefore, on controlled laboratory simulator studies and direct interviews with those who have admitted to driving while under the influence of marihuana.

With respect to the simulator studies, the available evidence suggests that while, in some cases, marihuana has produced interference with certain motor or mental abilities which affect driving behavior, these effects were generally believed to be readily overcome by the exercise of extreme caution by the driver and a significant reduction in speed.

The few driving simulator tests completed to date have generally revealed no significant correlations between marihuana use and driving disabilities. Comparison of the simulator scores of users and nonusers, however, did reveal small but non-significant differences in the number of speedometer errors made.

These simulator studies also examined the comparative effects of alcohol and marihuana on driving scores. The findings of one study, though controversial, suggested that intoxication resulting from low doses of marihuana was less detrimental to driving performance than was the presence of alcohol at the legally prohibited blood level of .10%.

The methodological limitations of the study raise serious questions about the reliability and validity of the findings. As one critic has noted, "It does not follow automatically that lack of effect of a drug on the simulated task will correlate with lack of effect on the actual task." Further, the use of dissimilar doses of alcohol and marihuana has led another critic to assert that "finding that a heavy dose of alcohol caused more impairment than a mild dose of marihuana is neither surprising nor helpful in assessing the relative effects of the two drugs in the relative doses in which they are normally used."

Recent research has not yet proven that marihuana use significantly impairs driving ability or performance. The Commission believes, nonetheless, that driving while under the influence of any psychoactive drug is a serious risk to public safety; the acute effects of marihuana intoxication, spatial and time distortion and slowed reflexes may impair driving performance. That the risk of injury may be greater for alcohol than for marihuana matters little.

Obviously, Much more research needs to be undertaken in this area. Hopefully, recent studies sponsored by the National Institute of Mental Health and other agencies will soon provide the concrete information that is needed.

Marihuana, Public Health and Welfare

As the feared threat to public safety through violent crime has diminished in recent years, policy-makers and the public have begun increasingly to view marihuana and other illicit drug use as a public health concern. The National Survey indicates that American adults regard drug abuse as the third most pressing problem of the day, closely following the economy and Vietnam. However, public attitudes reflect considerable confusion about the facts concerning marihuana and drugs in general.

This confusion has resulted from too little understanding of the motives for drug use as well as inadequate knowledge of the classification of drugs according to their main effects. Legal penalties have frequently mirrored this confusion, and the resulting inconsistencies cause many young people to lose confidence in adult authority. Even in the medical profession, much uncertainty is evident, and for most of the general public there is no clear authority to whom they can turn for guidance.

A PUBLIC HEALTH APPROACH

The Commission broadly defines public health concerns as all health problems which affect people en masse and are thereby difficult to treat on a traditional physician-to-patient basis. This category would include social and economic dependence and incapacity. A health problem which spreads to other susceptible members of the society cannot be controlled by the individual physician. This view coincides with the concept of preventive medicine, recognizing that all public health problems must be dealt with on both an individual and societal level.

To illustrate, the increasing incidence of deaths due to lung cancer subsequent to chronic, heavy tobacco usage is a major public health concern. In this instance, prevention of smoking and ascertaining the cause of the malignancies, rather than the individual treatment of each case by a physician, define the public health dimension. A major concern exists because the population at risk is large and growing, and the risk of harm is great.

In addition to the risk of large numbers of the populace being affected, the issue of contagion must also be examined. Unlike infectious diseases such as influenza and smallpox, where the person affected " catches" the ailment unintentionally, those individuals who use marihuana choose to come into contact with it. The contagion model is relevant only insofar as social pressure from proselytizing friends and social contacts play a role in spreading the use of the drug. This dimension exists with marihuana, as well as alcohol and tobacco.

After assessing the potential harm to the individual and society, the size of the population at risk and the contagion aspect, society must determine the nature of the control mechanism used to deal with the problem, and how much of its health resources, manpower and facilities will be allocated to meet the perceived threat to the public health. Therefore, an analysis of the relative risk of marihuana use must be undertaken. We must examine not only the effects of the drug on the individual but also determine which groups are at risk and why.

Practically all substances consumed by man are potentially dangerous to the physical or mental health of the individual if used irresponsibly or by particularly sensitive persons. Certain substances are sufficiently complex in their effects that societal control is necessary to reduce risk, for example, fluorides added to the water supply, prescription drugs, and food additives. The degree of concern and control varies, depending on relative public health dangers.

The Population At Risk

Before the dangers can be assessed, the population at risk must be defined. Viewing the public health picture on a large scale, the United States in 1972 may still be considered fortunate with regard to marihuana usage. While it is the third most popular recreational drug, behind alcohol and tobacco, it has not been institutionalized and commercialized.

Most of the Americans who have used marihuana have been merely experimenting with it. As noted in Chapter 1, there are 24 million Americans who have tried marihuana at one time or another, with 8.3 million still using it. Of those who have quit, most say they have simply lost interest in it. The same Survey shows that experience with marihuana peaks in the 18-to-25-year-old group and falls off sharply thereafter. A fact of some significance is that at least 71% of all adults (18-years and older) and 80% of youth (12-to-17-years) have never used marihuana at all.*

*In the self-administered instrument, several separate questions were utilized to elicit the respondent's experience with marihuana. This technique permitted an analysis of consistency of responses, and also minimized the possibility of non-response. Nevertheless, 14% of the adults and 6% of the youth did not respond to enough of these questions to ascertain whether they had ever tried marihuana or not.

The Survey also indicates that the majority of those youth and adults who continue to use marihuana do so intermittently, that is, between one and 10 times a month. These individuals are classified as intermittent marihuana smokers who use the drug for its socializing effects. They are, for the most part, ordinary Americans who are either in school or are employed.

About 2% of those who have ever used marihuana, or 500,000 people, now use the drug heavily. They use the drug several times a day. These individuals use marihuana for its personal drug effects in addition to its socializing effects. Generally, their life styles, values, attitudes, behaviors and activities are unconventional. Marihuana plays an important role in their lives. Because the risk of psychological, and perhaps physical, harm from marihuana increases with the frequency, quantity and duration of its use, these heavy marihuana users constitute the greatest at-risk population in the United States today.

The heavy marihuana user presents the greatest potential concern to the public health. It is the Commission's opinion that these heavy marihuana users constitute a source of contagion within American society. They actively proselytize others into a drug-oriented way of life. The effectiveness of peer group pressure has been described earlier in Chapter II.

We anticipate that this at-risk population would increase in number should a policy of institutionalized availability be adopted toward marihuana. Although marihuana is readily available illicitly in the United States today, a policy permitting its legal distribution could be expected to bring about an increase in users, with some percentage of them becoming heavy users. It is the availability of the drug, coupled with a governmental policy of approval or neutrality, that could escalate this group into a public health and welfare concern. While this is speculative, it is a concern which cannot be dismissed. The experience with the rise in the use of tobacco and alcohol makes clear the probable consequences of commercial exploitation.

Another concern of the Commission is the experience of other countries which have large heavy user populations. While the pattern of behavior in one country is not automatically similar to a pattern of behavior in another country, the existence of heavy user populations constitutes a serious public health concern which must be avoided in this country. The availability of the drug alone does not seem to determine increased usage; supply and governmental inaction appear to tip the balance toward increased use. The proportion of our population susceptible to this pattern of use is conjectural but good preventive public health requires limiting the number to an irreducible minimum.

Confusion and Fact

One of the primary sources of confusion surrounding the use of marihuana and other psychoactive drugs is the ambiguity of the term "drug abuse." In many quarters the excessive use of any drug is considered drug abuse, regardless of the effect of the drug on the individual or his behavior. In order to clarify this issue the Commission defines psychoactive drug abuse as follows:

It should be emphasized that demonstrable pathology of organ systems, including the brain, is not a necessary characteristic of psychoactive drug abuse. There are numerous non-psychoactive drugs which can induce extensive organ pathology but do not modify behavior; such drugs leave their imprint primarily on the individual, not on society. The Commission believes that many of the perplexing issues relating to psychoactive drugs, including marihuana, can be clarified if drug abuse refers only to the impact of drug-induced behavior on society.

Three types of such drug-induced behavior are considered unacceptable in most organized societies: (1) aggressiveness leading to violence; (2) loss of psychomotor control; (3) mental or physical disorder leading to social and economic incapacity or dependency.

This is not to say that society is unconcerned about the harmful effects of psychoactive drugs on the individual, or that such effects do not merit the attention of public health officials. Cigarette smoking, although affecting primarily the individual, is surely a matter of public health concern. We believe, however, that the term drug abuse, with its attendant societal disapprobation, should be reserved for drug taking which has a more direct effect on society through disordered behavior.

Beyond the confusion surrounding the term drug abuse, a rational evaluation of the public health impact of marihuana use is also inhibited by extensive misinformation about the drug. Recently, a great deal of research has increased significantly our knowledge about marihuana. Further research data are necessary before a conclusive statement about marihuana and public health can be made. However, enough is known today to discuss some of the public perceptions in detail. And sufficient data are presently available to allow for rational decision-making.

ASSESSMENT OF PERCEIVED RISKS

The Commission believes that marihuana is perceived by the American public to present the following risks to the public health:

• lethality
• potential for genetic damage or teratogenicity
• immediate adverse physical or mental effects
• long-term physical or mental effects including psychosis and "amotivation" syndrome
• "addiction" potential
• progression to other stronger drugs, especially heroin

Lethality

The Commission's National Survey revealed that 48% of adults believe that some people have died from marihuana use. A careful search of the literature and testimony of the nation's health officials has not revealed a single human fatality in the United States proven to have resulted solely from ingestion of marihuana. Experiments with the drug in monkeys demonstrated that the dose required for overdose death was enormous and for all practical purposes unachievable by humans smoking marihuana. This is in marked contrast to other substances in common use, most notably alcohol and barbiturate sleeping pills.

Of comparative note, 89% of all adults in the same Survey believe that some people have died from using alcohol. This indicates that public opinion regarding alcohol and its potential lethality is more accurate than it is for marihuana. At the same time, factual knowledge regarding the inherent danger in using a substance, for example alcohol, seemingly does not deter many persons from using it irresponsibly.

Potential For Genetic Damage

The thalidomide tragedies of the 1950's have taught us to ponder carefully the possibility of genetic damage subsequent to any drug use. The much publicized controversy regarding LSD and subsequent genetic damage has led investigators to study marihuana and its possible genetic effects. Although a number of studies have been performed, at present no reliable evidence exists indicating that marihuana causes genetic defects in man.

Early findings from studies of chronic (up to 41 years), heavy (several ounces per day) cannabis users in Greece and Jamaica also failed to find such evidence. In all its studies, the Commission found no evidence of chromosome damage or teratogenic or mutagenic effects due to cannabis at doses commonly used by man. However, since fetal damage cannot be ruled out, the use of marihuana like that of many other drugs, is not advisable during pregnancy.

Immediate Effects

The intoxicant effects of marihuana on the mental function of the user does have potential health significance both for the individual and others with whom he may come in contact. Because marihuana is a psychoactive drug, it is important to examine the acute toxic effects which may occur in certain predisposed individuals and which increase with the potency of the preparation.

The Commission has reviewed numerous clinical studies describing acute panic reactions and transient psychotic-like episodes which occur as acute effects of the drug intoxication. In addition, a predisposed individual might experience aggravation of a latent psychotic state or other underlying instability. Although severe abnormal psychological states are rare when compared to the total number of marihuana users, lesser problems are not rare, and they may endanger both the individual and those around him at the time of their occurrence. The individual contemplating use is not capable of predicting whether he is predisposed by his particular circumstances to an undesirable mental reaction. The undesirable consequences occurring while an individual is involved in complex tasks such as driving or operating machinery or tasks requiring fine psychomotor precision and judgment are all too imaginable.

From a public health point of view, the immediate effects of marihuana intoxication on the individual's organs or bodily functions are of little significance. By and large these effects, which have been carefully outlined in Chapter II of the Report, are transient and have little or no permanent effect upon the individual.

Effects Of Long-Term, Heavy Use

To determine the long-term chronic effects of heavy marihuana use, the Commission has carefully reviewed the world literature and contemporary studies of heavy, chronic (up to 41 years) cannabis users in the world. In addition, lower socioeconomic populations in Afghanistan, Greece, and Jamaica have been examined.

Effects On The Body

These recent studies in Greece and Jamaica report minimal physical abnormalities in the cannabis users as compared with their non-using peers.

Minimal abnormalities in pulmonary function have been observed in some cases of heavy and very heavy smokers of potent marihuana preparations (ganja or hashish). However, one study concluded the cause was smoking in general no matter what the substance. The other study could not express any conclusion because of the absence of a control population. Such decrements in normal pulmonary capacity may represent early warning signals in the development of chronic lung disease. They must be considered in any program of early prevention of disease and future disability.

No objective evidence of specific pathology of brain tissue has been documented. This fact contrasts sharply with the well-established brain damage of chronic alcoholism.

Effects On The Mind

No outstanding abnormalities in psychological tests, psychiatric interviews or coping patterns have been conclusively documented in studies of cannabis users in other countries of the world. Further research in this important area is necessary before definite conclusions can be drawn relating or linking marihuana to mental dysfunction because available psychological tests do not measure certain higher mental functions very accurately.

Cannabis use has long been known to precipitate short-term phychotic-like episodes in predisposed individuals or those who take excessive doses. Some observers report that the prevalence of short-term psychoses as well as the psychotic episodes of longer duration in heavy cannabis users are compatible with the prevalence rate of psychosis in the general population and, therefore, may not be attributable to cannabis use. In fact, some believe that in populations under stress where marihuana is widely used, occurrence of the acute psychotic-like episodes occur less often than one would expect in such a population. Other researchers have disagreed with these conclusions, and the matter is still controversial.

Effects On Motivation

The Commission is deeply concerned about another group of behavioral effects that have been described in other nations as being associated with the heavy, long-term use of cannabis. This behavioral condition has been termed the "amotivational syndrome." An extreme form has been reported in populations of lower socioeconomic males in several developing nations. These reports describe lethargy, instability, social deterioration, a loss of interest in virtually all activities other than drug use. This state of social and economic disability also results in precipitation and aggravation of psychiatric disorders (overt psychotic behavior) and possible somatic complications among very heavy, very long-term users of high potency cannabis products. However, in the populations so far observed in Jamaica, Greece, and Afghanistan, physical and psychosocial deterioration was not reported. The life styles of these populations appeared to be conditioned by cultural and socioeconomic factors. Some researchers believe cannabis may serve to keep these individuals stratified at this lower socioeconomic level.

The occurrence of a similar, though less intense, syndrome has been identified recently with heavy marihuana use among young persons in the Western world, including the United States. Some clinicians have described the existence of a complex of subtle social, psychological and behavioral changes related to a loss of volitional goal direction in certain individuals, including some long-term heavy users of marihuana. Such persons appear to orient only to the present. They appear, alienated from generally accepted social and occupational activities, and they tend to show a reduced concern for personal hygiene and nutrition.

Some clinicians believe that this picture is directly caused by the action of marihuana. However, other behavioral scientists believe that among impressionable adolescents, marihuana-induced suggestibility may facilitate the rapid adoption of new values and behavior patterns, particularly when the drug is taken in a socially alienated subculture that advocates and strongly reinforces such changes.

Whichever interpretation one accepts, the fact is apparent that the chronic, heavy use of marihuana may jeopardize social and economic adjustments of the adolescents. We believe this is one concern which merits further research and evaluation. On the basis of past studies, the chronic, heavy use of marihuana seems to constitute a high-risk behavior, particularly among predisposed adolescents. This consideration is especially critical when we consider the adolescent who is in the throes of a normally turbulent emotional process. The Commission has reviewed numerous reported studies and heard the testimony of several clinicians dealing with heavy users of marihuana who exhibit this particular behavior pattern. Although the United States does not, at the present time, have a large number of such persons within its population, the incidence is too frequent to ignore. Expanded epidemiologic studies are imperative to obtain a better understanding of this complex behavior.

Addiction Potential

Unfortunately, fact and fancy have become irrationally mixed regarding marihuana's physiological and psychological properties. Marihuana clearly is not in the same chemical category as heroin insofar as its physiologic and psychological effects are concerned. In a word, cannabis does not lead to physical dependence. No torturous withdrawal syndrome follows the sudden cessation of chronic, heavy use of marihuana. Although evidence indicates that heavy, long-term cannabis users may develop psychological dependence, even then the level of psychological dependence is no different from the syndrome of anxiety and restlessness seen when an American stops smoking tobacco cigarettes.

Progression To Other Drugs

As noted in Chapter II, to say marihuana leads to any other drug avoids the real issue and reduces a complex set of variables to an oversimplified premise of cause and effect. If any one statement can characterize why persons in the United States escalate their drug use patterns and become polydrug users, it is peer pressure. Indeed, if any drug is associated with the use of other drugs, including marihuana, it is tobacco, followed closely by alcohol. Study after study which the Commission reviewed invariably reported an association between the use of tobacco, and, to a lesser extent, of alcohol with the use of marihuana and other drugs.

The fact should be emphasized that the overwhelming majority of marihuana users do not progress to other drugs. They either remain with marihuana or foresake its use in favor of alcohol. In addition, the largest number of marihuana users in the United States today are experimenters or intermittent users, and 2% of those who have ever used it are presently heavy users. Only moderate and heavy use of marihuana is significantly associated with persistent use of other drugs.

Some persons in our society are interested in experimenting with a series of drugs, and there is no uniformity regarding which drug these multidrug users take first. In some cases, the drug used is a matter of preference; in others, a matter of availability; and in further instances, it matter of group choice.

Citizens concerned with health issues must consider the possibility of marihuana use leading to use of heroin, other opiates, cocaine or hallucinogens. This so-called stepping-stone theory first received widespread acceptance in 1951 as a result of testimony at Congressional hearings. At that time, studies of various addict populations repeatedly described most heroin users as marihuana users also. The implication of these descriptions was that a causal relationship existed between marihuana and subsequent heroin use. When the voluminous testimony given at these hearings is seriously examined, no verification is found of a causal relationship between marihuana use and subsequent heroin use.

Again, we must avoid polarity on this issue. To assume that marihuana use is unrelated to the use of other drugs would be inaccurate. As mentioned earlier, the heavy or very heavy marihuana users are frequently users of other drugs. The stepping-stone theory holds that the adolescent begins the use of illicit drugs with marihuana, and later proceeds to heroin in the search for greater thrills. The opposing viewpoint holds that the large majority of marihuana users never become heroin addicts and denies the validity of a causal relationship.

In the National Survey, among the adult respondents, 70% thought that marihuana makes people want to try stronger drugs such as heroin; 56% of the youth in the 12-to-17-year-old category agreed with the same statement. These perceptions contrast with another finding in the same Survey which revealed that 4% of current marihuana users have tried heroin. On the other hand, very few respondents perceived alcohol and tobacco to be precipitants of other drug use.

Studies of the escalation process demonstrate that the rates of progression vary from one group to another and from one segment of the population to another. There is no set proportion of marihuana users who "escalate" to the use of other drugs. The other drugs which some marihuana smokers use vary according to the social characteristics of the population in question. Within some groups, heroin may be the choice; in other groups, it may be LSD.

Marihuana use per se does not dictate whether other drugs will be used; nor does it determine the rate of progression, if and when it occurs, or which drugs might be used. As discussed in Chapter II, the user's social group seems to have the strongest influence on whether other drugs will be used; and if so, which drugs will be used.

PREVENTIVE PUBLIC HEALTH CONCERNS

The hallmark of a good health care delivery system is preventing as much illness as possible. This objective is achieved by means of immunizations, regular routine checkups, and educational programs.

Education programs regarding marihuana have been notably ineffective, partly due to an exaggeration of the effects of using the drug and partly because the effects of the opiates and marihuana have been compared inaccurately. As a result, many persons have developed a conscious or unconscious denial of nearly all dangers associated with marihuana use. Some educators believe that drug programs merely sharpen the curiosity of children and tempt them to use drugs which they otherwise would not use. Others believe that the responsibility should not be lodged with the schools but rather with the home or the community.

Because of the uncertainty about the efficacy of these, programs, education programs dealing with drug usage simply do not exist in the school systems of a number of major cities; in others, token programs are offered in response to the demand that something be done. Health educators have the responsibility to help this vulnerable group of Americans become aware of all options so that they are able to make enlightened choices.

The educational role of physicians and other clinical health personnel should not be underestimated. The National Survey shows that the public believes young people should receive information concerning marihuana first from schools and second from family physicians. The health professional has a unique position as both teacher and confidant to an individual struggling with a "drug abuse" problem. Honest, sincere, and confidential guidance from a physician may prevent later difficulties to both the individual and the society. The Commission believes that action must be taken to inform and support the physician in his role as confidant and counsellor to those seeking assistance.

Considering the current patterns of marihuana use in the United States, the need for treatment and/or rehabilitation does not appear necessary for the vast majority of persons who are experimenting with the drug or using it intermittently. Rather, these persons need to be realistically educated regarding the potential hazards they face. To this end, a comparison of the personal and public health risks of marihuana and those of heroin, cocaine, amphetamines, and other drugs would be useful.

A concern for public health also requires thoughtful consideration of the consequences of any change in public policy. We have objectively appraised the present scope of public health concerns concluding that the most serious risk lies with the population of heavy users, which is, at this time, quite small in this country.

Now, we must soberly consider the likely effect of adoption of a social policy of neutrality or approval toward marihuana use. Any legal policy which institutionalizes availability of the drug carries with it a likely increase in the at-risk population. This factor is not necessarily conclusive in itself, but it does weigh heavily for the policymaker. Even though the proportion of heavy users in the total using population might not increase if such a social or legal policy were adopted, the absolute number of heavy users would probably increase. Thus, we would have an increase in the at-risk segment of the populace. A greater stress would thereby be placed on the general health care delivery system in all the areas of health concern described earlier.

Regardless of emerging social policy, greater emphasis must be placed on educating our youth regarding the prospective dangers inherent in expanded marihuana use. This anticipatory guidance can serve to defuse or at least forestall a potentially serious social phenomenon.

Summary

From what is now known about the effects of marihuana, its use at the present level does not constitute a major threat to public health. However, this statement should not lead to complacency. Marihuana is not an innocuous drug. The clinical findings of impaired psychological function, carefully documented by medical specialists, legitimately arouse concern. These studies identify marihuana-related problems which must be taken into account in the development of public policy. Unfortunately, these marihuana-related problems, which occur only in heavy, long-term users, have been over generalized and overdramatized.

Two percent of those Americans who have ever used marihuana are now heavy users and constitute the highest risk group. Strong evidence indicates that certain emotional changes have taken place among predisposed individuals as a result of prolonged, heavy marihuana use. The clinical reports in the literature describing transient psychoses, other psychiatric difficulties, and impairment of cognitive function subsequent to use of marihuana and of other drugs do not prove causality but cannot be ignored.

The causes of these emotional difficulties are much too complex to justify general conclusions by the public or the press. The mass media have frequently promoted such clinical reports to appear as far reaching events affecting the entire population. The clinician sees only the troubled population of any group. In evaluating a public health concern, the essential element is the proportion of affected persons in the general group. The people responsible for evaluating public health problems must concern themselves with the proportion of people out of the total population who are affected by any specific condition. The highest risk groups should be identified as the source of primary concern. A recognition that a majority of marihuana users are not now a matter of public health concern must be made so that public health Officials may concentrate their attention where it will have maximum impact.

The concept of relative risk is crucial to an evaluation of the impact of marihuana on public health. We believe that experimental or intermittent use of this drug carries minimal risk to the public health, and should not be given overzealous attention in terms of a public health response. We are concerned that social influences might cause those who would not otherwise use the drug to be exposed to this minimal risk and the potential escalation of drug-using patterns. For this group, we must deglorify, demythologize, and deemphasize the use of marihuana and other drugs.

The Commission reemphasizes its concern about the small minority of heavy, long-term marihuana users who are exposed to a much greater relative risk of impaired general functioning in contemporary America. Public health officials should concentrate their efforts on this group. Fortunately, the group has to date not grown sufficently in size to warrant its being considered a major public health concern.

We retiterate, too, the public health implications of an increase in the at-risk population. We suspect that such an increase is most likely if a sudden shift in social policy significantly increased availability of the drug. One of the factors we consider in Chapter V when evaluating the various social policy options and legal implementations is the effect of each policy on incidence and patterns of use. Regardless of how heavy this particular variable will weigh in that process, we must state that a significant increase in the at-risk population could convert what is now a minor public health concern in this country to one of major proportions.

Marihuana And The Dominant Social Order

For more than 30 years it has been widely assumed that the marihuana user constitutes a threat to the well-being of the community and the nation. Originally, the users were considered to be "outsiders" or marginal citizens. Included were such people as hustlers, prostitutes, itinerant workers, merchant seamen, miners and ranchhands, water-front day laborers and drifters, many of whom were drawn from the lower socioeconomic segments of the population.

Concerns about marihuana use expressed in the 1930's related primarily to a perceived inconsistency between the life styles and values of these individuals and the social and moral order. Their potential influence on the young was especially worrisome. When marihuana was first prohibited, a recurrent fear was that use might spread among the youth. And in the late 1930's and 1940's, the attraction of young people to jazz music was thought to be in part related to marihuana use by this "outsider" population.

Throughout this early period, American society, in reaction to its fear of the unfamiliar, translated rumor about the criminality and immorality of the marihuana user into "unquestioned fact" which, in turn, was translated into social policy.

From the mid-thirties to the present, however, social perceptions have undergone significant change in response to the emergence of new and challenging social problems. As marihuana use has spread to include the affluent, middle class, white high school and college-age youth as well as minority group members of lower socioeconomic circumstances in urban core areas, the concept of marginality has become blurred.

Also, as the use of marihuana has increased, those individuals formerly labeled as marginal and threatening have been replaced by a more middle class, white, educated and younger population of marihuana smokers. A stereotyped user no longer exists, and therefore, the question now properly focuses on who poses a threat to the dominant order.

The Adult Marihuana User

Despite the fact that substantial numbers of adults use marihuana, society does not appear to feel greatly threatened by this group, probably because included in the group are a considerable number of middle class individuals who are regularly employed and whose occupational and social status appear to be similar to those of peers and colleagues who do not use marihuana.

In the course of its fact-finding effort, the Commission has met with several groups of socially and economically "successful" marihuana users in the professions of law, medicine, banking, education and business. In most cases, these persons, in their external appearances, seemed to be mature and responsible adults whose social attitudes and behavior did not mark them as radical ideologues or essentially irresponsible individuals.

For the most part, use of marihuana by adults has been found to be more directly related to the facilitation of social interaction (much like the adult use of alcohol in social gatherings) than to any other factor. Although their marihuana smoking behavior is illegal, most adult users are not ordinarily considered by their peers to be criminal nor is their use generally likely to result in arrest.

Because the adult user generally maintains low visibility, is primarily a recreational user, is not usually involved in radical political activity and maintains a life style largely indistinguishable from his non-using neighbors, he is not ordinarily viewed as a threat to the dominant social order. In short, aside from his use of marihuana, the adult recreational user is not generally viewed as a significant social problem.

The Young Marihuana User

The widespread use of marihuana by millions of young people of college and high school age has been viewed by many as a direct threat to the stability and future of the social order.

Many parents, adults in general, and government officials have expressed concern that young people who use marihuana often reject the essential values and traditions upon which the society is founded. Some have suggested that youthful marihuana use is, in itself, an indication of the rejection of responsibility and a sign of reckless hedonism which may well interfere with an orderly maturation process. Others see youthful marihuana use as part of a pattern of conduct which produces dropping out, underachievement and dependency.

In short, the mass character of youthful marihuana use has been frequently interpreted as a rejection of the institutionalized principles of law and a lack of concern for individual social responsibility, which threatens the social and political institutions.

Implicit in this view is the assumption that a young person who uses marihuana in spite of the law cannot be expected to assume an individually and socially responsible adult role. The strength of this fear is drawn largely from the vocal and visible "counterculture" to which marihuana is often tied. Not surprisingly, the concerns posed by an alternate youthful life style are extended to the drug itself.

Threats to the social order are often seen, for example, in the character of youthful leisure time activities, such as attendance at rock concerts, occasioned by the high mobility and affluence of today's youth. They are also seen in the new modes of speech and dress and in the seemingly casual manner of their day-to-day living. Equally troublesome for many, however, is the idea of intentional intoxication for purposes of recreation.

Such conduct and the more casual attitude toward sexual relationships as well as participation in radical politics have provoked increasing concern throughout the adult society. The National Survey illustrates the extent to which the older adult perceives youthful marihuana use as part of a much larger pattern of behavior which bodes ill for the future of the nation.

First, the older the adult respondent, the more likely he was to picture the marihuana user as leading an abnormal life. Only 9% of the over-50 generation agreed with the statement that "most people who use marihuana lead a normal life." Nineteen percent of the 35-to-49 age group and 29% of the 26-to-34-year-olds were of the same belief. Conversely, half of the young adults (18-to-25) considered most marihuana users normal. This fact is not surprising since many of their contemporaries are marihuana users.

Second, the marihuana user, as envisioned by adults, is typically a youthful dropout from society. He doesn't like to be with other people, is uninterested in the world around him, is usually lazy and has an above-average number of personal problems.

Third, the less optimistic the adult respondent was about the nation's youth, the more likely he was to oppose alteration of the marihuana laws and to envision major social dislocations if the laws were changed. Fifty-seven percent of the adult population in general agreed with the statement, "if marihuana were legal, it would lead to teenagers becoming irresponsible and wild." Among those adults who most disapproved of youthful behavior in general, 74% agreed with the quoted statement. Similarly, 84% of the non-approving adults favored stricter laws on marihuana.

As we discussed in Chapter I, marihuana's symbolic role in a perceived generational conflict has brought marihuana use into the category of a social problem. Today's youthful marihuana user is seen as a greater threat to the social order than either the marginal user of earlier times or the adult user of the present. Since the concerns about marihuana today relate mostly to youth, the remainder of this section will focus on these youth-related issues.

THE WORLD OF YOUTH

Youth of today are better fed, better housed, more mobile, more affluent, more schooled and probably more bored with their lives than any generation which has preceded them.

Adults have difficulty understanding why such privileged young people should wish to offend by their language and appearance and spend so much effort trying to discredit those institutions of society which have made possible the privileges which those youth enjoy. Many adults perceive the present level of youthful discontent to be of a greater intensity than has been true of past generations.

Marihuana has become both a focus and a symbol of the generation gap and for many young people its use has become an expedient means of protest against adult values.

Adults in positions of authority, parents, teachers, policy officials, judges, and others often view marihuana use as the sign of youth's rejection of moral and social values and of the system of government under which they live. The problem is that both youth and adults tend to make pronouncements and are frequently unable to reason together in logical fashion. Instead they overstate their positions in such a way that effective resolution of their differences becomes very difficult.

In effect, each group takes the rhetoric of the other at face value. For youth, however, marihuana use plays many roles, only one of which is a symbolic assault on adult authority and values.

Marihuana use, for many young people, has become a part of a ritual. It takes on the aspect of participating in a shared experience which, for some if not all, is enjoyable in itself. For many, it becomes an even more interesting experience because it is forbidden.

Some of the rituals concerned with the purchase, storage, preparation, and use of marihuana take on a mystique similar to the time of Prohibition when people went through certain rituals necessary to get a drink in a speak-easy. The three knocks and "Joe sent me" cues have been replaced by the not-so-secret handshakes, the new vocabulary of youth and other exclusionary devices to delineate the "in" group.

The use of marihuana is attractive to many young people for the sense of group unity and participation which develops around the common use of the drug. This sense tends to be intensified by a sense of "common cause" in those circumstances where users are regarded as social or legal outcasts.

They know, too, that many of their peers who share the marihuana experience and also share the designation of lawbreaker are, in reality, productive and generally affirmative individuals who are interested neither in promoting the downfall of the nation nor in engaging in acts which would harm the general well-being of the community.

In short, many youth have found marihuana use to be a pleasurable and socially rewarding experience. They have found that the continuance of this behavior has brought them more pleasure than discomfort, more reward than punishment.

Youth have increasingly come to see law enforcement activity directed at marihuana use as an unreasonable and unjustifiable rejection of their generation. Most of these youth have grown up with a positive image of the police as protectors of society. Now, many are confronted with the possibility of police intrusion into their private lives and the threat of a criminal record. The unfortunate result, in many instances, has been a blanket rejection and distrust of both the agents and institutions of government.

In part, marihuana use as a social behavior is an unintended byproduct of the formal and informal educational process. Some persons even suggest that youthful drug usage is a "success" in terms of the educational and socialization process. Our society values independence of thought, experimentation, and the empirical method, often reinforcing this attitude by such advertising cliches as "make up your own mind," "be your own man," "judge for yourself."

Although experimentation with regard to drugs should not be considered a "success," the Commission does believe that the educational efforts necessary to discourage this curiosity, which may be valuable in other matters, have not succeeded. We understand why teenagers and young adults encouraged over the years to make up their own minds have not been restrained by exaggerated accounts of marihuana's harmful effects, or by the more recent assertions that a true evaluation of marihuana uses requires more research. The Scottish verdict of "not proven" does little to restrain youthful curiosity.

In the previous Chapter, we emphasized the difference between the vast majority of experimenters and intermittent users and the small group of moderate and heavy users who generally use drugs other than marihuana as well. The former do not differ significantly from non-users on many indices of social integration. Various studies indicate that they maintain normal patterns of living and social interaction, and are employed, competent citizens.

On the other hand, there undoubtedly are a number of persons who have used marihuana and have exercised poor judgment, performed inadequately, or behaved irresponsibly while under the drug's influence, thus jeopardizing themselves or others. The fact remains, however, that a certain number of these persons were immature and irresponsible individuals even prior to marihuana use, who would be expected to have poor or impaired judgment whether or not marihuana was involved.

The marihuana user is not, for the most part, a social isolationist or a severely disturbed individual in need of treatment or confinement. Most users, young or old, demonstrate an average or above-average degree of social functioning, academic achievement and job performance. Their general image of themselves and their society is not radically different from that of their non-marihuana-using peers. The majority of both groups tends to demonstrate equal interest in corporate concerns.

Based upon present evidence, it is unlikely that marihuana users will become less socially responsible as a result of their marihuana use or that their patterns of behavior and values will change significantly.

WHY SOCIETY FEELS THREATENED

Society appears to be concerned about marihuana use primarily because of its perceived relationship to other social problems. We noted in the discussion of marihuana and public health that the focus of social concern should be the heavy users and the possibility that their numbers will increase. Here we consider the perceived impact of marihuana use upon the institutions and proclaimed goals of the society.

Dropping Out

Many parents have a genuine fear that marihuana use leads to idleness and "dropping out." During the 1960's, marihuana use, as well as the use of other psychoactive drugs, became equated with unconventional youth life styles. When a number of young people adopted unconventional life styles, many adults tended to view long hair, unkempt appearance and drugs as symbols of counterculture.

They concluded that anyone who allowed his hair to grow or gave little attention to his clothing or appearance was probably a drug user with little or no motivation to achieve and no interest in conventional goals.

A number of researchers and clinicians have observed the use of marihuana or hashish in other societies, particularly among poor, lower class males. Some have observed that many of these individuals are generally unmotivated and ordinarily appear to show little aspiration or motivation to improve their way of life, regardless of whether they are judged by the standards of the more prosperous members of their own society or by middle class standards of contemporary American society.

One of the problems with this type of analysis is that it fails to perceive the social and cultural realities in which the phenomenon takes place. In the Middle East and in Asia where hashish is used, the societies, in all instances, are highly stratified with people in the lower classes having virtually no social or economic mobility. Poverty, deprivation and disease were the conditions into which these people were born and in which they remain, regardless of whether they use cannabis. In this context, a person's resignation to his status in life is not likely to be caused or greatly influenced by the effects of cannabis. Any society will always have a certain number of persons who, for various reasons, are not motivated to strive for personal achievement or participate fully in the life of the community. Therefore, the determination is difficult to make whether cannabis use influences a person to drop out and, if it does, to what extent.

Some individuals possess particular personality as well as psychosocial characteristics which in specified instances could produce amotivation or dropping out. However, little likelihood exists that the introduction of a single element such as marihuana use would significantly change the basic personality and character structure of the individual to any degree. An individual is more likely to drop out when a number of circumstances have joined at a given point in his lifetime, producing pressures with which he has difficulty in coping. These pressures often coincide with situations involving painful or difficult judgments resulting from a need to adjust to the pressures of the social environment.

Many young people, particularly in the college population, are shielded in their earlier years from experiences which might be emotionally stressful or unpleasant. Some young people, so sheltered, are neither equipped to make mature and independent judgments nor prepared to enjoy the new-found freedom of the university or college in a mature and responsible way. Some of these students are often unable to cope with social or academic adversity. After being sheltered for so long, some of these young people may be easily attracted to experiences which promise new excitement and to fall under the influence of a peer group whose values and living patterns may be inimical to a productive, healthy and continuous process of personal growth and maturity. In these instances, marihuana serves as the medium by which these individuals encounter social and psychological experiences with which they are ill-equipped to cope.

Certain numbers of these young people have demonstrated what is described as amotivation long before the smoking of marihuana became fashionable. Adolescence is often a particularly difficult period of searching in many directions at the same time. In addition to seeking a concept of "self" the adolescent is, at the same time, attempting to comprehend the nature of the world around him and to identify his status and role in society.

Different individuals, with different backgrounds, socialization patterns, belief systems and levels of emotional maturity cope with the period of transition from childhood to adulthood in different ways. For a small number, dropping out might be one of these coping mechanisms whether or not they use marihuana. For others, the response to the difficult adjustments of adolescence takes other forms, some of which are more, acceptable, "normal" and easier for adults to understand.

The young person who does not find it possible to cope with the pressures of his adolescent developmental period in ways convenient to the understanding of adult society should not be rejected, stigmatized or labeled. He requires both support and understanding and the opportunity to participate in roles which have meaning for him and in ways in which he feels comfortable. For a certain number of young people, marihuana and the mystique of the experience eases this passage by helping them share their feelings, doubts, inadequacies and aspirations with peers with whom they feel safe and comfortable.

Dropping Down

Apart from the concern over youthful dropping out and idleness, there is also widespread concern about "dropping down" or underachieving.

Parents frequently express fear that marihuana will undermine or interfere with academic and vocational career development and achievement by focusing youthful interests on the drug and those associated with the drug subculture. Some parents make considerable sacrifices for their children to go to school, and the fears that marihuana might undermine the academic, emotional and vocational development of their young are quite understandable.

The Commission reviewed a number of studies related to marihuana use by high school and college youth. No conclusive evidence was found demonstrating that marihuana by itself is responsible for academic or vocational failure or "dropping down," although it could be one of many contributory reasons. Many studies reported that the majority of young people who have used marihuana received average or above-average grades in school.

In part, underachievement is related to a view of what one individual judges to be the achievement capacity of another. This judgment is often made without concern for what the individual himself feels about his potential, his interests and his goals. Perceptions about achievement also frequently fail to take into consideration the individual feelings about the goals of his peers and the values of the larger society, including the relative prestige and status attached to various academic programs, occupations and professions.

Youth and Radical Politics

Aside from the issue of unconventional life styles and the concerns evoked by them, the other major concern of the sixties which related to youth and drugs was radical politics.

During the latter half of the decade, youthful anti-war groups were organized on many of the nation's college campuses and high schools. These groups could be divided into two segments. The largest segment consisted of concerned, sometimes confused, frustrated and well-meaning petition signers and demonstrators. Within this large group there was a small coterie of individuals who constantly sought to turn the demonstration into a confrontation and to protest for peace by means of violence. The second segment consisted of organizations of individuals whose stated purpose was to undermine the social and political stability of the society through violent means.

What must be clearly understood, however, is that among the young people, and some not so young, who protested against the war in Vietnam, only a minority were bent on violence and manipulated and corrupted these otherwise peaceful demonstrations for their own purposes.

At the various gatherings, a number of the young people protesting in these mass groups did smoke marihuana. We will never know how many were initiated to marihuana use during the course of these peace demonstrations. The fact remains, however, that in the large campins, such as those in Washington, marihuana was involved in two ways. First, there was the "normal" use in which the smoking was part of the social experience. Individuals came together and smoked, in part, to acknowledge and strengthen group solidarity. Second, another quite different aspect of the marihuana use at these gatherings said, in effect, "we know it's illegal but go and arrest all of us for doing it. . . ." This aspect can perhaps best be characterized as a symbolic challenge to authority.

Unfortunately, however, the media, particularly television and some of the news magazines, sometimes portrayed the image of a group of young people plotting the overthrow of the nation by violent means while under the influence of marihuana. In those relatively few instances where explosives and other violent means were employed, the evidence points to a cold and calculated plan which was neither conceived nor executed under the influence of marihuana.

As a result of these protests and demonstrations, therefore, radical politics has been seen by many as a mechanism through which large numbers of young people would be introduced to marihuana as well as to other drugs. Radical political activity or mass political protest is viewed by some as a threat to the welfare of the nation and is assumed to be aided and encouraged by our enemies.

The involvement of large numbers of youth in political activism and the concomitant public concern about drug use have beclouded the issue of marihuana use and have led to a broadening of the concerns about marihuana on the part of adults.

Some of the radical movement's leaders abetted this tendency by pointing out the alleged irrationality and unfairness of the marihuana laws to recruit members to their ranks. Not surprising is the fact that 45% of the adult respondents in the National Survey felt that marihuana is often promoted by people who are enemies of the United States. Nor is it surprising that this belief is a function of age. While 22% of all young people (12-to-17 years of age) and 26% of young adults (18-to-25 years) identified marihuana with national enemies, more than one-half (58%) of those persons 50 years and older did so.

Youth and the Work Ethic

Of the many issues related to youth and the use of marihuana, one that greatly troubles many adults, is youthful attitudes toward work. The work ethic in our society is based on a belief that work is a good and necessary activity in and of itself.

The traditional view holds that work is not only a right and moral act but that it keeps people from mischief and from wasting time on harmful recreational pleasures. The rationale for this thesis is that work in American society has served as the primary means by which persons acquired the treasured symbols of society.

In fact, throughout much of our history, with the exception of the small number who inherited or married wealth, no ethical alternative to work existed. In recent years, the increased emphasis placed upon leisure time activities has resulted in shorter work weeks, longer vacation periods and more paid holidays.

Among the concerns of the adults about today's youthful attitudes toward work and leisure are that young people seem to enjoy their recreational pursuits so much that they forget that to a considerable degree their enjoyment is paid for by the labor of others.

Many young people do not express the same level of concern as their parents did about preparing themselves for a career and "getting ahead in the world." In part, this attitude is attributable to the fact that increasingly, the results of this labor are not tangible, material goods. Service occupations generally do not produce such tangible products, and even in manufacturing industries the individual worker is usually too remote from the product to feel any pride or interest in it. In both instances, the traditional symbol of the "manhood" of work, a tangible product, is no longer present.

In sum, society has become increasingly disturbed by certain attitudes of today's youth which seem to stress pleasure, fun, and enjoyment without a counterbalancing concern for a disciplined and sustained work effort. Nevertheless, the number of young people who view work as unimportant is small when compared to the total number of young people. The Commission has found no evidence to suggest that the majority of youth are unwilling or incapable of productive and disciplined work performance. In fact, the great majority of young people are performing their tasks in industry, the professions and education quite effectively.

Although many young people delay entry into the work force to enjoy the fruits of our prosperous society, this delay does not mean they will not one day contribute their best efforts to the continued growth and advancement of the nation.

The Changing Social Scene

The present confusion about the effects of youthful marihuana use upon the dominant social order is caused by a variety of interrelated social concerns, many of them emotionally charged issues, including anti-war demonstrations, campus riots, hippie life styles, the rising incidence of crime and delinquency and the increased usage of all illicit drugs. The focus of concern about marihuana is aggravated by the data overload mentioned in Chapter 1, by the outpouring of incidental information about the drug and its effects in a form and volume far beyond the capacity of the readers or listeners to assimilate or interpret. Rather than informing the public, much of the data disseminated has produced frustration and misinterpretation of the information presented.

Adult society, including parents and policy-makers, finds it difficult to comprehend and account for many of the attitudes and behavior of the young, including the use of marihuana. In many cases the adults are still influenced by the myths of an earlier period which overstated the dangers of the drug. At a time of great social change and turbulence, the tendency to depend on the "traditional wisdom," and its moral justification, is a strong one.

Just as youth must try to understand and appreciate the strengths of the institutions of our society, adults must try to understand the times through the eyes of their children. Where marihuana is concerned, society must try to understand its role in the lives of those who use it. The key to such understanding lies in the changes which have taken place in society within recent years and the effects these changes have had on succeeding generations of youth. The increased use of marihuana is only one of these effects.

One focal point in discussion between generations is the contrast between the use of marihuana and the use of alcohol. Many young people perceive that marihuana is less dangerous than alcohol in terms of its addiction potential and long-term physical and psychological consequences. Many believe also that marihuana and other psychoactive drugs make it possible to expand their perceptions and see this as a perfectly legitimate objective.

Viewed against the background of the profound changes of recent years in the fields of economics, politics, religion, family life, housing patterns, civil rights, employment and recreation, the use of marihuana by the nation's youth must be seen as a relatively minor change in social patterns of conduct and as more of a consequence of than a contributor to these major changes.

When the issue of marihuana use is placed in this context of society's larger concerns, marihuana does not emerge as a major issue or threat to the social order. Rather, it is most appropriately viewed as a part of the whole of society's concerns about the growth and development of its young people.

In view of the magnitude and nature of change which our society has experienced during the past 25 years, the thoughtful observer is not likely to attribute any of the major social problems resulting from this change to marihuana use. Similarly, it is unlikely that marihuana will affect the future strength, stability or vitality of our social and political institutions. The fundamental principles and values upon which the society rests are far too enduring to go up in the smoke of a marihuana cigarette.