DRUG EMERGENCIES IN CROWDS: AN ANALYSIS OF "ROCK MEDICINE", 1973-1977
John Newmeyer & Gregory Johnson
John A. Newmeyer received his Ph.D. from the Department of Social Relations at Harvard University in 1970. Since then, he has taught at San Francisco State University and the University of San Francisco, and has served as Epidemiologist and Research Director for the Haight-Ashbury Free Medical Clinic. Among his publications are. "Pleasure, Punishment, and Moral Indignation" and, "The Heroin Epidemic in San Francisco: Estimates of Incidence and Prevalence", both in collaboration with Gregory Johnson. Dr. Newmeyer presently divides his time between demographic research work in San Francisco and viticulture in Napa Valley.
Gregory L. Johnson is Assistant Professor of Sociology at the University of Massachusetts, Boston. Since receiving his Ph.D. from the Department of Sociology at Harvard University in 1973 he has been engaged in studies in several diverse areas, including religious behavior. television audiences, and drug use. Among his publications are, "The Hare Krishna and the Counterculture" and, "Conversion as Cure: The Delancey Street participation in the 1979 Boston Marathon."
The rock concert is the environment for one of themost popular and spectacular 'rituals of controlled drug use, ' For some persons, however, such publicdrug use elicits "bad trips" . This paper outlines thenature of adverse reactions recorded by the RockMedicine Section of the Haight-Ashbury Free MedicalClinic at San Francisco area rock concerts between1973 and 1977. A careful analysis of these reactionsreflects the drug-taking patterns of the larger youthculture. The analysis also delineates the peculiarnature of "crowd dysphoria" in the rock concertenvironment. The paper identifies a trend away fromLSD and toward "downers'' after 1973, whichforeshadowed the dominance of alcohol among the1977adverse-reaction victims.
Oakland Coliseum stands on a barren expanse of land between the East Bay Freeway and the West Oakland ghetto. One enters the Coliseum up a long ramp which opens up to the floor of the open-air stadium. It is 11:00 A.M. on a summer Saturday; thousands of rock fans are awaiting the start of the musical festival known as "A Day on the Green". Many are recumbent, stretched out on the grass. Others are pursuing more purposeful tasks-picnicking, playing frisbee, amorously embracing, or taking drugs. They are waiting while the opening act, Norton Buffalo, tunes up on stage. Five hours later when the main act, The Grateful Dead, comes on stage, this lazy crowd will be transformed. It will stand, sway, and dance with the music.
At the opposite, quieter end of the field stand the emergency-care facilities of the Rock Medicine Section of the Haight-Ashbury Free Medical Clinic. These facilities--a dugout on the field, and a nearby "quiet room" and mini-hospital within the bowels of the Stadium--are staffed by some sixty volunteers, including physicians, nurses, drug counselors, and field spotters/stretcherbearers. The facilities employ an intake/triage function, wherein persons needing care are given it immediately on the field or in the dugout, or are directed (or carried) to the mini-hospital. Also employed is the "talk down" or "quiet" room, outfitted with brightly-colored cushions and blankets and soft lighting, designed to create a calm atmosphere for persons suffering from "bad trips".
Rock concerts are the ultimate expression of allegiance to the youth culture of the Sixties and Seventies. These concerts provide thousands of young people with the opportunity to see and be seen by fellow rock music fans, and generally to immerse themselves in a resonant cultural experience far removed from everyday American life. From the outset, an important ingredient of the rock-concert experience has been the use of drugs, in a social atmosphere supportive of that usage. From the first passing-of-joints at Jefferson Airplane concerts at the Fillmore Auditorium in the mid-1960's to the mass LSD ingestion at Grateful Dead concerts in the 1970's, drugs have been an inseparable part of the rock music scene. By charting patterns of drug use at rock concerts, we can also chart the changing fashions of drug use in the youth culture as a whole.
The great majority of concertgoers will elect to get high on one drug or another, during the course of a day's entertainment. Aside from intensifying the musical experience, drug-taking is a way of becoming more actively involved in the concert. Sitting and listening to music for several hours is an inherently passive experience. By taking drugs, one can alter one's own body and mind in an active way. Thus, for many concertgoers, drug-taking permits a closer communion with the performers; for others, drug use allows the self to be more compellingly affected by the rhythms and imagery of the music and lyrics.
Most of the people at these concerts use drugs without adverse reaction. For these people, acid-tripping with the Grateful Dead may be an occasional weekend diversion in the time honored tradition equivalent to tailgate, whiskey-lubricated parties at football games, or six packs and hot-dogs at baseball games. Such public drug use may correspond to what Zinberg and Harding (1977) have identified as rituals of controlled drug use, involving social sanctions which structure and limit the experience. However, these controls-which usually operate only at the small-group level-may break down when applied to a group the size of a rock music crowd. Some persons participating in mass LSD ingestion or in the casual passing of PCP laced joints may not have internalized the subcultural sanctions which structure the experience. Such people may become anxious and upset, feelings intensified by the overstimulation of the large and active crowd which surrounds them. Or they may become physically ill, or incapacitated, or aggressively acting-out. It is these "adverse reactions" we will focus upon.
Adverse Drug Reactions at Rock Concerts During 1977
The Rock Medicine Section provided medical coverage at thirty rock concerts during the last seven months of 1977. Eleven of these concerts took place at Winterland in San Francisco, thirteen were at the San Francisco Cow Palace, five took place at the Oakland Stadium, and one, the "Hooker's Ball", occurred at the San Francisco Civic 'Center. The estimated total attendance at all thirty concerts was 521,400, of which more than half were accounted for by the five "Days on the Green" at the Oakland Stadium. At the thirty concerts, the Rock Medicine Section recorded a total of 1,006 major medical problems. of which 696 or 69% were primarily problems related to drug or alcohol abuse.1
The breakdown of drug problems by the location of the concerts was as follows:
Among the 120 cases of multiple drug use, the following number of mentions were recorded for each drug-category:
An index of a drug's relative prominence can be constructed by dividing the 17.3% multiple drug use cases according to the proportion of the 290 multiple use mentions ascribed to a particular drug category, and adding it to the solitary-use percentages. For example, for alcohol the index is 60.2% + 99 (17.3%) - 66.1%. The overall "Occurrence Indexes" were:
It is seen that alcohol completely dominated the substance-abuse treatment clientele of the Rock Medicine Section during the latter part of 1977. Simple intoxication accounted for three out of every five of the substance-abuse problems
treated by the Section; alcohol also figures in more than four-fifths (99 out of 120) of the instances of multiple drug use. From the Occurrence Index, it is fair to describe alcohol as having accounted for two-thirds of the substance-abuse treatment incidents of the Section. All forms of alcohol figured in this abuse picture, but hard liquor and particularly tequilla were prominent during 1977. It was noteworthy that the Winterland concerts were much less, and the Cow Palace concerts much more, dominated by alcohol than was the case for the treatment population as a whole. This may be a function of the varying degree of vigilance of Bill Graham's doorkeepers, who are instructed to confiscate all alcoholic beverages.
The psychedelics as a group were next in order of prominence, accounting for about one-sixth (16.0%) of the total Occurrence Index. Cases where LSD alone was mentioned were nearly twice as common as cases where PCP alone was mentioned (41 v. 23), but a number of the "other psychedelics" may well have been PCP in the guise of "mescaline", "psilocybin", "THC", or "mushrooms". Problems relating to psychedelic use occurred proportionately more often at the Winterland concerts, and less often at the Cow Palace concerts. Thus, at the Winterland concerts, about 1.7 alcohol-alone problems were treated for each psychedelic alone problem; at the Cow Palace, this ratio was more than eleven to one.
A special analysis was made of the PCP-problem clientele. Thirty-six cases where PCP or PCP-in-combination was cited as the main drug problem, were investigated. The median age of this victim population was 19.5; 58% were male and all but one were Caucasians. Of those whose address was known, four resided in San Francisco, seven on the Peninsula, ten in the East Bay, one in Marin County, and rive outside of the Bay Area. In none of these respects was the PCP victim population significantly different from the substance-abuse victim population as a whole. Of the 36 cases, four were noted as having been particularly violent during treatment; other symptoms commonly mentioned were "rigid", "disoriented", "stumbling", "hyperactive", "unresponsive", and "incoherent". More than half of the PCP victims had used the drug in combination with alcohol, which frequently contributed to the nature of the problem.
Third in order or prominence among the 1977 clientele was cannabis. A surprisingly high proportion of the substance-abuse cases-62, or 8.9%--were ascribed to marijuana or hashish use alone. Nearly all of these persons, however, manifested what the Rock Medicine Section terms the "Crowd Syndrome". Symptoms of the Crowd Syndrome are dizziness, nausea, exhaustion, and/or weakness. The syndrome appears to result from a combination of the cannabis-stoned state with hypoglycernia (resulting from inadequate nutrition during the previous 24 hours) and the crush and confusion of a large crowd. Thus, proportionately more Crowd Syndrome cases occurred in the highly closed-in atmosphere of Winterland, as opposed to the moderately closed-in setting of the Cow Palace or the open environment of the Oakland Stadium. In most cases of this syndrome, complete relief was obtained after a quiet rest plus consumption of a high-energy food, such as a sugared drink.
All other drugs combined accounted for only 6.3% of the total Occurrence Index. These other drugs were especially rare among the "single drug use" mentions: "uppers" (amphetamines, Ritalin, etc.) accounted by themselves for only seven cases out of 696, "downers" (barbiturates, Quaalude, etc.) for only five opiates for just three, and cocaine for a single case. Most of the contribution of these drugs to the total Occurrence Index came from a poly drug context --- almost always in combination with alcohol and/or a psychedelic. Thus, it is Rock Medicine's experience that these four drug-categories play a very minor role in the drug problems manifested among Bay Area concertgoers. Rock Medicine's findings corroborate those of the H.A.F.M.C.'s Medical Section which, among recent samples of its "counter cultural" client population, has found a small and declining extent of usage of "uppers", "downers", and opiates, and a negligible incidence of reported problems among the still-large population of cocaine users.
To some degree, the 1977 data demonstrated that the lead performing group at a concert influenced the frequency and type of drug problems seen. Only five of the thirty concerts experienced a rate of drug problems of more than 2.0 per thousand: the Grateful Dead at Winterland on December 31 (5.5 problems/1,000); Be Bop Deluxe at Winterland on September 10 (3.0); the Grateful Dead at Winterland on December 29 (2.9); Santana at the Cow Palace on December 31 (2.1); and Ted Nugent at the Cow Palace on August 28 (2.1). Evidently, New Year's Eve had a role in encouraging the more excessive use of drugs. Also, the Grateful Dead concerts were impressive in the high frequency of psychedelics, especially LSD, among the problem-mentions. The Beach Boys at the Cow Palace on December 28 had the lowest incidence of drug problems: .3 per thousand. To our surprise, three groups with a decidedly now-flower-child quality had rather moderate incidences of drug problems: Kiss (1.0), the Doobie Brothers (1.5), and the Led Zeppelin (1.0 and 1.4 at two different concerts). The first two of these, however, were remarkable in that almost all of the drug problems that were treated were blamed on alcohol.
At two recent Days on the Green, the Rock Medicine Section was able to distribute questionnaires to samples of the audience who were not being treated for medical or drug-use problems. Ninety-two persons were selected in the first of these "general audience samples". and 62 in the second. One of the questions asked in this (anonymous) questionnaire was, "What drugs have you taken so far today?" The replies permitted a rough estimate to be made of the drug intake of the Oakland Stadium audience:
If we assume that these drug-use patterns apply to the total population of 521,400 concertgoers examined in 1977, then we can make the following very rough estimates of the frequency with which various categories of drug use lead to one's being treated by Rock Medicine for an adverse drug reaction:
The general nature of recreational drug use in 1977 among Bay Area concertgoers is clearly apparent: whatever the locale, whatever the lead group, whatever the time of day or year, booze reigns supreme. But was this always the case? Let us examine some historical data.
Music, Drugs, and the Evolution of Youth Culture
The 1969 Woodstock Festival attracted an estimated 450,000 rock fans and witnessed thousands of adverse hallucinogenic drug experiences. The knowledge of the shortage of medical personnel, medications, equipment, and treatment space at Woodstock prompted emergency health workers to anticipate future events. At subsequent rock concerts, entire medical apparatuses would be established (or even required), including sunburn medication, drug antagonists, drug counselors, and (in some cases) helicopters. Ironically, none of the subsequent concerts witnessed problems as dramatic as those at Woodstock. Watkins Glen, the 1973 site of the largest rock concert in history (600,000) had only about 1,000 adverse drug reactions 2 ; of these, most were from alcohol or sedative-hypnotics. Unlike Woodstock, only about 200 adverse reactions from psychedelics were recorded (James, 1974).
Changing patterns in drug usage in the concert going population were particularly illustrated by the Haight-Ashbury Free Medical Clinic's study of emergency patients at two 1973 rock concerts (Gay, Elsenbaumer, and Newmeyer, 1972). The older, San Francisco-resident Grateful Dead fans were primarily LSD users. As is still true today, 'Me Grateful Dead audience mainly consisted of 1960s' "flower children" grown older, who used LSD as an ingredient in the enjoyment of the Dead's music. By contrast, the Led Zeppelin audience foreshadowed the shift away from psychedelics. The Zeppelin fans were younger, more suburban, and were oriented toward "downer" drugs such as alcohol and Quaalude. It was observed, in the Zeppelin audience, that the soporific nature of these drugs appeared to create a "large-scale social anesthesia" (ibid., p. 200). As an analysis of the 1973-1977 Rock Medicine experience shows, the "downer/alcohol syndrome" of the 1973 Zeppelin concert anticipated the dominant drug abuse trends at future concerts. To the extent these concerts reflect larger drug use patterns, they also reflect changes in behavior in the youth culture as a whole.
In an effort to assess these trends, we aggregated data from five different groups of concerts: (1) three large outdoor concerts during 1973, two at the Oakland Stadium and one at Kezar Stadium in San Francisco; (II) three large outdoor concerts at the Oakland Stadium during 1974; (111) two large outdoor concerts during 1975, one at the Oakland Stadium and one at Kezar; (IV) sixty-one indoor concerts during 1974 and 1975, sixty at Winterland and one at the Cow Palace; and (V) the thirty indoor and outdoor concerts of 1977, described above. We obtained estimates of attendance at each of these concerts, from which we could calculate an estimate of "person-days" of attendance and hence of being "at risk" to drug problems which the Rock Medicine Section would treat. Thus, six persons attending a concert at Winterland for four hours would constitute twenty-four person-hours or one person-day of attendance. The aggregate statistics by drug-category for the five concert-groups are shown in Table 1. The figures in parentheses indicate the number of cases per 1,000 person-days of concert attendance, for the given drug).
An examination of Table 1 discloses the following trends:
1) The incidence of problems involving alcohol was much higher in 1977 than in previous years. For every thousand person-days of concert-attendance during 1977, a little more than three instances of treatment for simple intoxication were recorded.
2) The incidence of problems ascribed to LSD has declined dramatically. The 1977 concerts saw 85% fewer LSD-only drug problems, per thousand person-days, than the 1973 concerts. Despite this profound decline, LSD remains the third most often-cited among the drug problems, after alcohol and cannabis. And our questionnaires indicate that, in 1977, between 10 and 20% of a concert crowd will be "tripping"-a proportion not different from 1973's.
3) PCP has emerged as a significant contributor to Rock Medicine's drug-problem clientele. Even in 1977, though, PCP was cited only a little more than half as often as LSD. However, many problems may have been caused by PCP ingestion but blamed on other drugs - particularly "other psychedelics" and marijuana.
4) Cannabis-marijuana and hashish-returned in 1977 to the prominent position it had had in the 1973 concerts. Most cannabis problems took the form of the Crowd Syndrome described above. That cannabis should play a non-negligible role in the treatment picture is not surprising, considering the dominance of the drug among the consumption patterns of the concert-goers. It is estimated that between 50% and 80% of each of the concert audiences consumed at least some cannabis on the premises, or just prior to arriving.
5) During the period 1974 to 1977 (Groups II-V), no other drug-group has accounted for as much as one treatment case per ten thousand person-days of attendance. Thus, such candidates as opiates, "downers", "uppers", and cocaine can essentially be ignored as far as the visible drug-problem population is concerned. It is certainly possible that these drugs are widely consumed--cocaine would especially be worth scrutinizing here-but they are simply not contributing to the treatment load.
Discussion: Crowd Behavior and Psychiatric Emergencies
Why do rock concerts provoke psychiatric emergencies? A full answer to this question requires an understanding of the nature and effects of collective behavior. Following Roger Brown's (1954) comprehensive analysis of the forms of "mass phenomena", we can interpret the outdoor rock concert as a form of "expressive crowd" rather than simply an "audience". As Brown states, the audience " congregates in order to be affected and directed, not in order to act," (p. 865) whereas the "expressive crowd" (such as the fiesta, the harvest dance, and the primitive orgy) exhibits "revelrous behavior as a release from the humdrum routine of normal life" (p. 863). The revelrous character of the outdoor rock concert has always been one of its essential ingredients. The first huge outdoor concert, Woodstock, involved lengthy travel and preparation. Participants engaged in camping, picnicking, amorous encounters, drug use, and general celebration. Aside from the musical performance, the fiesta-like excitement of the crowd itself has always been an attraction. People come to see and be seen, and to be part of a collective expression of the youth culture. Even today, Bill Graham, the impresario of San Francisco's outdoor concerts, packages and publicizes his events as a "Day on the Green" rather than simply as seven hours of listening to music. "We've always thought of the Day on the Green as a social event as well as a musical event," states Graham (Elwood, 1978).
The great majority of participants in such "expressive crowds" do not radically alter their behavior. But for some, the presence of a crowd seems to loosen social controls and trigger inner pathologies: "within crowds, self-consciousness and social responsibility are diminished, resulting in a relaxation of self-restraint" (Turner, 1959). Most prior writing (LeBon, 1947; Canetti, 1964) has suggested that this breakdown of social control is expressed in interpersonal violence. However, an understanding of rock concert crowds suggests that interpersonal violence is rare 3. As our experience at rock concerts demonstrates, the breakdown of social control can be channeled internally as well as externally--especially if disapproval of interpersonal violence is a perceived social value.
Once social controls are relaxed, subsequent behavior can be expressed in one of two directions. On the one hand, crowds may incite violent behavior such as fistfights, looting, lynchings, and beatings. The frequent mayhem among sports audiences (especially at football, hockey, and soccer events) is behavior of this type. On the other hand, crowds may provoke intrapsychic turmoil, upsetting an individual's internal equilibrium. Thus, at rock concerts, some people may find themselves in a group using a drug they have never used before. Others who regularly take a certain drug may find themselves unable to handle it in a crowd situation. Following Zinberg and Harding's aforementioned analysis of rituals of controlled drug use, these people may be those who have not internalized the subcultural controls which successfully structure the drug experience.
Once these cases of psychiatric emergencies began to appear regularly, a rock concert tradition developed. Concertgoers came to expect to see some zany, bearded, glassy-eyed fellow running about, claiming to be God. Responding to this situation, rock music promoters hired emergency medical teams, a development which further established the rock music/drug emergency tradition. To some extent, the forces of expectation may also operate on potential drug-users. They learn that the concert is a legitimate place to "flip out" and that treatment is available if they-do. They also learn that externalized violence, of the sort displayed freely by soccer fans, is very rare at rock concerts--and that such behavior would be highly disapproved. Thus, the internal route -of-release of anxiety, panic, or other dysphoric feelings is further strengthened.
In an effort to understand more fully the nature of psychiatric and medical emergencies among rock music crowds, we intend to investigate several issues at future Bay Area concerts. We will seek answers to the following questions:
1) With what frequency do the victims of adverse drug reactions use specific drugs outside of the concert setting?. In other words, to what degree does the concert experience engender drug use of a type and intensity not seen in people's ('ordinary " lives?
2) With what frequency have the victims had other adverse drug reactions? That is, does the concert provoke reactions which wouldn't occur in "private" settings?
3) What proportion obtain their drugs at the concert? Here, we wish to ascertain whether concertgoers-and especially those who suffer adverse drug reactions--are impelled, by the concert atmosphere, to use drugs they have not planned to use.
4. How do the demographic characteristics of the victims compare to a sample of untreated members of the audience? In other words, what kind of person is most likely to internalize dysphoria, and why?
This paper has summarized data gathered by the Rock Medicine Section of the HaightAshbury Free Medical Clinic at San Francisco Bay Area rock concerts between 1973 and 1977. During this period, we have witnessed a marked shift in adverse drug reactions, away from LSD and toward alcohol and PCP. In comparing treatment records with surveys of drug use in the 1977 general audience, we discovered that alcohol, PCP, and barbiturates had the highest incidence of adverse reactions per thousand users; LSD, though still used widely, apparently provokes a far smaller incidence of treatment cases than was the case in 1973.
In contrast to crowds which incite externally -directed dysphoria (such as the violence of soccer or hockey fans) the rock concert crowd primarily provokes internally-directed dysphoria. In part, these emergencies are generated by the loosening of social controls characteristic of all such crowds. Moreover, the large crowds seemed to break down the subcultural controls on drug use, so essential for safe and successful drug experiences. In future concerts, we intend to pursue some of these issues by further studying the context of drug acquisition and use as well as drug-use and personal histories.
1. The wide range of adverse drug reactions treated by the Rock Medicine Section can be grouped into two general categories:
(A) Internalized dysphoria, ranging from the Crowd Syndrome at one extreme, through physical sickness, to drug-induced panic at the other extreme:
||Weakness, disorientation, fainting
||Nausea, vomiting, stumbling, "drunk"
||LSD, PCP, other
||"Talk down", rest,
(B) Externalized dysphoria, such as fighting, destructive behavior, or other acting-out. This type of adverse drug reaction is perhaps one-tenth as common as internalized dysphoria; it is usually ascribed to use of alcohol and/or PCP, or (occasionally) to use of "downer" drugs such as barbiturates or Quaaludes. The Rock Medicine Section treats some three to six fight-related injuries in a typical Day on the Green,
2. Our analysis of the decline in psychedelic-provoked bad trips parallels that of Bunce (1978). He suggests that the decline in LSD "freak outs" in the 1970's is a result of a new generation of users who define the substance in a reactional, non-dangerous fashion and, as a consequence of these "light-weight" expectations, are less likely to suffer adverse reactions.
3. The one major incident of rock concert violence was provoked by the Hells Angels at Altamont, California in 1969. This incident remains a vivid memory because it represented such a dramatic contrast to the positive spirits of previous and subsequent concerts.
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