Professor Michael Beaubrun of the University of the West Indies was the guest speaker at a joint dinner meeting of the Congress sessions on cannabis and on alcohol. The address provides comparative data from the British West Indies and posits social class and personality factors in the drug of choice — cannabis or alcohol. Beaubrun cites a high correlation between extroversion and heavy drinking; with a preponderance of cyclothymie personalities who are successful in Western cultures, alcohol becomes the "establishment" choice while personality attributes in the "culture of poverty" may lead to cannabis preference.
In giving this address, I feel a little like the eunuch's brother — you know the story of the eunuch who was left behind by the sultan in charge of his harem and when the sultan returned and found three of his wives were pregnant, he asked him for the explanation and the eunuch said, "Well, sir, you see while you were away I was down with flu and I asked my brother to take over. You see, sir, he is not cut out for the job!" I too am not cut out for the job. So if you'll accept my remarks in the light of an after dinner speech rather than a serious contribution to the scientific literature, I will proceed.
The title of my paper is "Cannabis or Alcohol" and it is not as you might think, the choice being offered by the stewardesses on Air Jamaica instead of tea or coffee. It may be that one day it will be, but my guess is that it won't be for quite some time, because the war about cannabis is still being hotly waged and it looks as though it will be for some time. The decision as to which drug is permitted or used in what culture will continue to be made on irrational grounds, or grounds of economic expediency, rationalized afterwards by double-blind controls — you know the blind leading the the blind. But I think that I don't need to stress to an anthropological audience how irrational has been the behavior of mankind through the ages in the sanctioning of psychotropic substances. Yet, I would suggest to you that these choices have not always been quite so capricious as they might seem. A proper study of any given culture usually reveals the reasons why a particular drug has become the drug of choice of a culture or any subgroup within it. In the search for ways of coping with anxiety and depression and ways of making life more meaningful, mankind through the ages has turned to psychoactive substances. The history of drug use is at least as old as agriculture. It would seem that cultures learn to coexist with drugs by adopting rules and by adopting a set of values and attitudes about them and incorporating this into their way of life. Problems with drugs seem related to the attitudes, customs and rules for their use and non-use. Such attitudes and customs are built into the superego of the growing child by the normal processes of socialization, that is to say, by imitation and conditioning. In those cultures where the rules are inconsistent or conflicting, ambivalence, guilt and anxiety arise and problems tend to be created. Where new drugs are introduced into cultures that have no rules for them, there often exists a period of crisis.
McGlothlin pointed out to us that the two drugs most widely used in the world are cannabis and alcohol. He also drew our attention to the fact that cannabis is usually the drug of the have-nots and alcohol the chosen drug of the establishment. It has frequently been suggested that this correlation is no accident, that in fact, there is a causal relationship involved. Two main reasons for this correlation are usually suggested: either (1) that the effect of cannabis is such that it enables the failure to retreat from the world and forget his failures; or (2) that the effect of the drug is such that it actually interferes with his motivation to succeed, or, if not his motivation to succeed, his efficiency and productivity, so that in fact he doesn't get on in the rat-race.
Tonight I'd like to talk to you about our experiences in Jamaica where cannabis has been used for over 100 years, certainly for the whole of this century by the Afro-Jamaicans, and where alcohol has been used for centuries. I'd like to examine the evidence from studies in Jamaica that might help us understand the factors underlying use and non-use of alcohol or cannabis by different socioeconomic and cultural groups, and try and answer two questions: Is the relationship between cannabis use and low socioeconomic status a causal one and, what is the relationship between cannabis and alcohol? Is it possible that in some situations cannabis may be a desirable alternative to alcohol?
Between August 1970 and December 1971, the Research Institute for the Study of Man and the Medical School of the University of the West Indies carried out a joint collaborative study, a major multidisciplinary study on the long-term chronic use of cannabis in Jamaica, under the aegis of the National Institute of Mental Health, Center for the Studies of Narcotic and Drug Abuse. Detailed anthropological studies were undertaken in seven areas of Jamaica before the clinical studies began. From four of these locations a representative sample of thirty chronic users of cannabis and thirty matched controls was selected and persuaded to remain in the University Hospital for six days and nights undergoing intensive studies — medical, psychological and psychiatric, including EEG findings. The subjects were matched for age, sex, occupation, income, and social class.
The major study has not as yet been published but there were three papers this morning referring to it; the psychiatric findings will appear in the March 11, 1974 edition of the American Journal of Psychiatry and there have been other references to it in the literature. I will refer to it as the main background for the points I wish to make tonight, or the guesses I will hazard.
Cannabis has been smoked in Jamaica for nearly 130 years. Though we have evidence that the hemp plant was present in Jamaica as early as the late eighteenth century, the habit of smoking cannabis is thought to have been introduced into Jamaica only in the mid-nineteenth century by East Indian indentured laborers who came to the West Indies after the abolition of slavery. Vera Rubin and Lambros Comitas have documented well the evidence that the Indians introduced cannabis, based on the complex of cultural beliefs about ganja, "the ganja complex," the methods of preparation and use of the drug and the Hindu names used — like ganja, kali, chilam pipe, etc., all in use among working-class Jamaicans today. These are easily identifiable with similar phenomena described by the Indian Hemp Commission Report (1969) in 1894. The working-class Jamaican uses ganja as a sovereign remedy for all ills. He uses it to give him energy for work and to relax after work. He believes that giving it to school children makes them brighter and sharpens their understanding. In addition to being a kind of general tonic, he also attributes to it some mystical powers, for example that it wards off evil spirits. This complex of beliefs, attitudes and customs is believed to have been diffused to the Jamaican working class, the descendants of African slaves, and especially to the Rastafarians, a long-haired Afro-Jamaican politico-religious cultural group who preach a back-to-Africa destiny and claim Haile Selassie as their God. The growing child in working-class Jamaica is gradually socialized into the use of ganja and has many respectable smoking role models. He is fed it as an infusion even in his infant bottle. He may begin smoking it at the age of seven or eight, but is usually initiated in his early teens by one of his peers or in a group smoking experience which has many of the features described by Dr. Rubin this morning as a rite de passage. His response to this initial smoking experience validates his role as a smoker or non-smoker in the ganja subculture. An initial unpleasant experience may result in his avoiding ganja thereafter and seems to validate his role as a non-smoker.
The anthropological studies of Rubin, Comitas et al., together with the work of Yawney on the Rastafarians, show us clearly how the culture has developed "built in" controls to minimize the ill effects of this drug, for example, the screening mechanism for validating the non-smoking role of those who have "no head for it." The beliefs that you should not smoke when you are angry or on an empty stomach, and above all, the experience of learning to "titrate" so as to achieve the result you need or expect and no more — these are the things that the child learns and I think they are important to the fact that the drug has little ill effect in working-class Jamaica. I can't give you the detailed report of this 500-page manuscript but on the whole, ganja comes out remarkably well from the study. The findings show very little long-term damage: in the medical studies only a slight impairment of respiratory function and slight changes in hemaglobin on long-term use (which you would expect) and blood pressure changes.
The psychological tests did not reveal any significant difference between smokers and non-smokers at all. The psychiatric findings, which have been published elsewhere, show no differences between the ganja smokers and non-smokers in the incidence of mental illness or of abnormalities of mood or of behavior. Nor did the groups differ significantly with regard to criminal records or the use of other drugs, or in upward or downward social mobility. One finding that was significant relates to the incidence of mental illness in the family. Although there was equal incidence of mental illness among smokers and non-smokers, smokers were found to have more mental illness in the family than non-smokers. This seemed to suggest that in fact ganja might be playing a protective role against mental illness, because one would expect a high incidence of psychotic illness in the families of persons with mental illness. It may be that the smoking was protective.
I would like to examine the evidence on the vexed question of the amotivational syndrome. The anthropological findings of the Jamaica cannabis study indicated that chronic use of cannabis, even heavy use, did not seem to result in a loss of motivation or striving toward conventional goals. But one substudy by Dr. Joseph Schaeffer did demonstrate decreased efficiency and productivity immediately after smoking, that is acute smoking, not chronic smoking. The frequency and quantity of use of cannabis also was clearly correlated with socioeconomic status in the villages studied. Heavy smoking was always highly correlated with poverty.
This morning Dr. Schaeffer told us how he and his wife studied the households of cannabis users and made careful recordings with a portable videotape and film, of every movement during periods of agricultural work and kept detailed records of food eaten and energy expended. They also made objective measurements of energy metabolism in special tests. There seems little room for doubt that the subjective descriptions of increased energy output at work are supported in fact by the objective findings. But much of energy may be wasted. Schaeffer reports that in agricultural pursuits, "total space covered, or amount accomplished, or number of plants reaped is usually reduced per unit of time after smoking, and the total number of movements taken to complete the required task is increased after smoking." He also notes, however, that social cohesiveness is enhanced.
Schaeffer was cautious in drawing conclusions from his findings but he does say "intuitively we feel that cannabis use is subtly related to population, land and economic pressures. To oversimplify: land resources in Valley.(the name given to this village) are relatively scarce. The topography is not conducive to cultivation. Average farms are small. Common agricultural products in the area do not bring high market profits. A population decrease has ended due to the international pressures against migration and other difficulties of city life. Two results are particularly significant to our concern: (1) the inhabitants of Valley have a vested interest in decreasing total cultivated acreage and consolidating production; (2) social cohesiveness among farmers is now more appropriate than rugged competition."
Note the suggestion that "there may be a vested interest in decreasing total cultivated acreage and reducing competition." I find this thesis may be a little hard to accept in full but it does seem that where social conditions are such that upward social mobility is almost blocked and increased work output results in negligible profits you might expect a lessening of motivation to work. Cannabis seems to be a valuable source of motivation in that it enables the farmers to work hard at repetitive and dull tasks like weeding, which have little reward. Such a situation with rigid economic class lines may be compared to the caste barriers of India where lower caste use of cannabis may serve the short term interests of the middle class as well as it may serve to prevent attempts to overthrow the system or interfere radically with its workings.
Cannabis plays a number of other less obvious roles as it is an unseen subsidy for the economy and a valuable though prohibited small cash crop, as you were told by Lambros Comitas this morning.
How does this compare with alcohol? Now I think that there is little doubt that anyone who attempted to use alcohol regularly for energy, for work in the way that the villagers in Jamaica use cannabis would soon come to a nasty cropper. He would rapidly develop dependency and physical damage. Not only loss of efficiency would result, but other problems. In fact, the closest thing to this perhaps would be the delta alcoholic of wine drinking countries like France. The nearest thing we have to this is the regular consumption of small quantities of wine and we know how damaging that can be.
Alcohol is a major ingredient in our way of life in the Caribbean and Jamaica is no exception. Rum, the by-product of sugar cane, has been central to our way of life since the days of the buccaneers and today social life in the working class revolves around the rum shop. In the upper circles it revolves around the club and the cocktail party and consumption is very high. What is remarkable is that the rates of alcoholism seem to vary tremendously from island to island in the Caribbean.
A number of interacting variables seem to be responsible for this. High rates of alcoholism are found (1) where tourism is highly developed and the country's own national identity is poorly delineated and disparaged; [Examples of this would be the Bahamas and the U.S. Virgin Islands. It is thought there that the tourist provides a role model to emulate — someone who is constantly playing and drinking and never seems to work] (2) where indigenous Indian populations exist, for example Aruba; (3) where East Indians (Hindus and Moslems) are a large part of the population; [Examples of this would be Trinidad and Guyana] and finally, (4) another variable would be where French cultural influences predominate, like Martinique and Guadeloupe.
In all of these places the rates of admission for alcoholism to mental hospitals vary from 20 to 55% of total admissions and the percentage of male admissions is very much higher than that. What is pertinent to my theme tonight is that by far the lowest hospital admission rates for alcoholism for the entire region are found in Jamaica --- less than 1% in most years. Compare this with figures of 55% in some of the other places.
Raymond Prince who worked for two years at the 3000-bed mental hospital in Jamaica reported: "Of 600 admissions to one typical ward over a two-year period, less than 2% suffered such problems; not a single case of chronic brain syndrome associated alcoholism was seen and we encountered neither delirium tremens nor alcoholic hallucinosis. The few alcohol-linked disturbances were middle class persons or foreigners." Now note that Jamaica is also the ONLY island where cannabis use is widespread and endemic among the working class — until very recently the only one where there was any smoking of cannabis at all.
The other piece of evidence is a field study of Jamaican drinking practices in four different socioeconomic areas conducted by my students in 1966 which showed that the lowest rates of heavy drinking were found among the Jamaican working class, the very group in which ganja smoking was most prevalent. On the basis of this, I hazarded the guess that ganja smoking might in fact be an alcohol substitute protecting poor Jamaicans from becoming alcoholics.
Prince, Greenfield, and Marriot followed this up with a study of 106 consecutive male admissions to the Mental Hospital. Of these, 24% used ganja regularly once a day or more, 40% had never used it and the rest were occasional users. Using a key informant technique, they estimated that at least as many males in the community from which the sample was drawn used ganja once a day or more in the same way. The subsequent anthropological studies have shown that this estimate of ganja smoking outside of the hospital is probably an underestimate, indicating that ganja smokers are probably underestimated in the ganja population in the mental hospitals, again evidence pointing toward the opposite to its being productive of psychosis.
Prince et al., found that ganja use was greatest among low income males between 15 and 35 years of age and that they tended to use less as they grew older. Comparing this with our field study of drinking practices which showed that heavy drinking peaked in the mid to late forties, they concluded that as people grow older and a little more affluent they turned to alcohol, adopting middle-class values. This may not be exactly how it happens but certainly there were fewer problems from both alcohol and cannabis.
In view of the fact that few working-class people were hospitalized as a result of either cannabis or alcohol, they concluded that ganja was a benevolent alternative effectively protecting poor Jamaicans from the damage due to alcohol.
The subsequent large-scale cannabis study in Jamaica could not prove this but did not disprove it and, in fact, did give it some support. From the data obtained by the psychiatrists and the anthropological field workers, we observed that, although not teetotallers, the cannabis smokers usually drank beer rather than rum, and that in those of the smokers' families where an alcoholic was found, we were usually told that he was the only one who didn't smoke. It did seem as though cannabis smokers were moderate drinkers while their non-smoking peers were more likely to take alcohol to excess.
What then were the factors determining drug choice? Prince suggested only an economic motive, ganja being cheaper than alcohol (and it may be that this is significant), but it seems there may be a more complex relationship involving not merely an economic factor but personality factors as well.
Attempts have been made to account for the use of cannabis in terms of the function it serves. But we were repeatedly reminded today that the effect of any drug is a complex interaction of factors including culture. Briefly, the effect of any drug on the individual is the product of (1) the pharmacological action of the drug; (2) the personality of the user; (3) his mental set; and (4) the setting in which he uses it. The last two are considerably colored by cultural factors which determine the expectations of the user.
I would like to consider the factor of personality. In our field survey of drinking practices, we gave each of our 1800 respondents a shortened version of the Eysenck Personality Inventory and found a very positive correlation between high extroversion and heavy drinking. In fact, there was a linear correlation significant at 0.05. Neuroticism did not show any significant correlation. So extroversion is highly correlated with excessive drinking. We used the same tool in the ganja study and got no significant correlation with extroversion. I think this is important. As in the classic study by Carstairs on the use of daru and bhang by the Rajputs and Brahmins, the worldly aggressive extroverts were the ones who chose alcohol. The priestly Brahmins were not poor, because in India they enjoyed high caste for religious reasons, but in most of the Western world the schizothymic personality is less likely to succeed materially than the cyclothymie. It is widely recognized that manic depressive families (i.e. the cyclothymies or people with allied constitutions) are overrepresented at the top of the economic ladder or find their way there, while schizothymics, or the relatives of schizophrenics, tend to drift downwards and to be overrepresented among the poor. Might this be a simple answer to the correlation between cannabis use and poverty? It's too simplistic perhaps to suggest that all the poor are schizothymics and all the rich are cyclothymies, but it could be that there is a significant proponderance of cyclothymie personalities (extroverts) at the top, a sufficient number of them to set the mode and make this the accepted way of life, and this may be why alcohol becomes the establishment drink.
The more introverted — the poet, the academic, the seeker after an inner subjective reality and meaning, and the rugged individualist — may prefer cannabis but they do not really have an unfettered choice.
One of the reasons why the Minnesota Multiphasic Personality Inventory (MMPI) and other personality measures have not given us clear profiles of drinkers versus cannabis smokers is that the profiles are muddied because schizoids, as well as neurotics and other depressives, all abuse alcohol where there is no sanctioned alternative. Is it possible that if a clear choice were available, each equally and comparably priced, that we might find that the extroverts preferred alcohol while the introverts would take cannabis; neurotics might choose either and psychopaths both? This is a simplistic formulation but you know what I mean. I don't mean really cyclothymics and schizothymics but only recognizable profiles. I say simplistic because obviously the relationship between personality and culture is a complex one. Personality is not simply inherited, it is also molded by the culture itself and there is a two-way relationship involved, as well as genetic factors.
Now the pharmacological action of cannabis and alcohol, the other variable. Alcohol after all is a sedative and is needed by those who develop high anxiety levels while striving and competing, those with high levels of aggression, high belligerence. While cannabis is a complex drug, it is a stimulant and a euphoriant, also something of a sedative and something of an hallucinogen. It may be that this is needed more by the less aggressive folk — those unable to communicate, tending to inaction, to dreaming, seekers-after meaning.
What answers can we find to the questions that I posed at the start of the talk? First, the causal relationship between cannabis and poverty — is there a causal relationship in this correlation? Well, I think the truth is that from our data so far the answer is still uncertain. Clues suggest rather that it is the personality attributes prevalent in the culture of poverty which leads to cannabis preferences, rather than the self defeating nature of cannabis itself. There is some evidence the other way, so it is rather difficult to give a fair answer to this.
The other question posed was — can cannabis be used as an alcohol substitute? I think in certain situations, in certain places and in certain cultures, it can. There are situations, as we have shown in Jamaica, in which cannabis use may be functional and probably protective against the dangers of alcohol. There is no doubt that alcohol causes more physical damage, dependency and a number of other problems. Going back to the classic study by Carstairs on daru and bhang among the Rajputs and Brahmins, I think his ideas are still probably right, despite the recent apparent invasion of the Western middle class by cannabis, which I believe is a temporary phenomenon. Cannabis, as Carstairs postulated, is ill-suited to success in the materialist Western world and it is unlikely that it would succed as a drug of choice, in, say, the United States.
What lessons can be learned from the Jamaican experience? If we cannot substitute cannabis for alcohol, we can note that in Jamaica the reason that cannabis works among the poor is because the cultural rules are so well defined; the screening mechanisms, the validation of non-smoking, the other things. We must learn folkways which would enable us to better cope with the drug of choice we already have here — alcohol. We may have to develop the attitudes and practices best calculated to cope with it. This has been advocated in a number of reports, for example, the Cooperative Commission on Alcoholism.
But let us not forget Prince's original finding that the reason that cannabis was being used instead of alcohol in Jamaica in the first instance was probably an economic one. It is really quite simple. Ganja is cheaper than alcohol in Jamaica and freely available to the poor. I think we have among us here, people who have also noted the economic factor. Dr. DeLindt of Canada pointed to the importance of beverage price in reducing overall consumption of alcohol and reducing the ill effects. And I think this is part of the lesson that comes out of the Jamaican experience. Perhaps the pricing of whatever is the drug of election or putting it out of reach is one of the ways of dealing with the situation, not forbidding it, because forbidding it only produces the forbidden fruit complex, which makes it all the more desirable. On this note, I think I will end. Thank you.