The Effectiveness of the Subculture in Developing Rituals
and Social Sanctions for Controlled Drug Use
Wayne Harding & Norman E. Zinberg
from: Drugs, Rituals and Altered States of Consciousness,
Brian M. DuToit, editor. ©1977, A. A. Balkema, Rotterdam
Introduction by Peter Webster
The following paper, from 1977, is an example of the high quality research into the use of psychedelics and other "drugs of abuse" that continued despite governmental restrictions and other discouragements to workers in the field of drug research. As with so many research projects, the findings were not at all what prohibitionist functionaries wanted or could accept, and such reports were often vehemently rejected by their sponsors, and ignored by the media who would have trumpeted the results on high had they supported Prohibition. The study here is of particular interest in that it indicates that drug users in today's societies tend to re-create in a modern context the methods and rituals of drug use seen in tribal societies which enable the drugs to be used safely and for certain defined purposes. The authors conclude:
"Our findings show that, contrary to conventional wisdom, controlled use of illicit drugs is possible and is fostered by subcultural rituals and social sanctions that support controlled use and curtail drug abuse... Ironically, the present attempt to eliminate all use of illicit drugs undermines users' ability to control them... What is clear is that the attempt to eliminate all use of these drugs contributes to their abuse by people who take them.
"Certainly decriminalization of marihuana should be extended beyond those few states which have adopted it, and federal penalties for use should be dropped. Further research on the possible medical applications of marihuana and the psychedelics should be undertaken, and results sufficiently publicized so that their public image as "bad" drugs can be dissipated. Heroin should be made available to physicians as a legitimate analgesic, and experimentation with heroin maintenance clinics for the treatment of addicts should also begin with careful control.
"Drug education programs which are no more than disguised campaigns to eliminate use should be replaced with genuine efforts to provide users and non-users with some rudimentary pharmacological data and with detailed information about the consequences of various patterns of use. Doctors, teachers, counselors, and others who encounter drug users should be instructed in how to distinguish use from abuse—it simply makes no sense to alienate and undermine those segments of the population of drug-takers who stand against abuse.
THE EFFECTIVENESS OF THE SUBCULTURE
IN DEVELOPING RITUALS AND SOCIAL SANCTIONS
FOR CONTROLLED DRUG USE 1
WAYNE M. HARDING & NORMAN E. ZINBERG, M.D.*
from: Drugs, Rituals and Altered States of Consciousness,
Brian M. DuToit, editor. ©1977, A. A. Balkema, Rotterdam
* Wayne Harding is a Research Associate at The Cambridge Hospital Norman Zinberg is a Faculty Member of Harvard Medical School at The Cambridge Hospital and of The Boston Psychoanalytic Institute.
In the United States, social and legal taboos against the nonmedical use of illicit drugs are reinforced by the prevailing view that these drugs are almost animately pernicious. According to this view, marihuana, LSD, cocaine, heroin, and other illicit drugs are so overpowering and/ or so dangerous that their continued use inevitably leads to drug abuse. The physiological and psychological damage evidenced by the most serious abusers of illicit drugs is regularly invoked as proof of this "pharmacomythology" (Szasz, 1975) .
There is nothing in the pharmacology of these drugs, however, that precludes the possibility that they can be used without being abused. Our study of controlled drug use, sponsored by The Drug Abuse Council, Inc., has located users of marihuana, psychedelics, and opiates who, like most alcohol users, manage to maintain regular non-compulsive use of these drugs, Analysis of longitudinal interview data indicates that this 'controlled' use is chiefly supported by emerging subcultural drug-using rituals and social sanctions. These rituals and social sanctions provide what the larger culture does not: instruction in and reinforcement for maintaining patterns of illicit drug use which do not interfere with ordinary functioning and methods for use which minimize untoward drug effects.
In this article we discuss these findings and the related work of other researchers. We also argue that existing subcultural rituals and social sanctions, elaborated and endorsed by the mainstream culture, could be a more humane and perhaps more effective means of preventing drug abuse than legal prohibition.
Serious consideration of such alternatives is especially timely given the recent actions of some states to significantly reduce the legal penalties surrounding the use of marihuana. It appears that these reductions have been prompted by a growing realization that our costly social policy has not succeeded in halting marihuana use by a large number of Americans. Thus far, however public debate over liberalization of drug laws has not taken into account changes in drug-using style.
DEFINITION OF TERMS
As used here. 'ritual' refers to the stylized, prescribed behavior surrounding the use of a drug. This behavior may include methods of procuring and administering the drug, selection of physical and social settings for use, activities undertaken after the drug has been administered, and methods of preventing untoward drug effects.
'Social sanctions' refers to the norms regarding how or whether a particular drug should be used. Social sanctions include both the informal and often unspoken values or rules of conduct shared by a group, and the formal laws and policies regulating drug use.2 These two aspects of social sanctions are not always consonant. Laws prohibiting use of illicit drugs may reflect the values of the majority of Americans but are often at odds with the values of drug users. Various segments of society thus observe quite different social sanctions (and rituals) although each segment is cognizant of and influenced by the other's. The relationship among the rituals and social sanctions of controlled illicit drug users, of compulsive users, and of the mainstream culture is a focus of concern in later portions of this paper.
Our use of the terms 'ritual' and 'social sanction' differs from the classic use of the terms 'ritual' and 'ritual belief' in anthropology. The distinction between drug-using rituals and social sanctions is one of behavior versus beliefs, or practice versus dogma. In anthropology, terms such as 'ritual beliefs' and 'ceremonial beliefs' are used instead of 'social sanctions' ( Leach, 1968) . We prefer 'social sanctions' for two reasons. First, this term emphasizes that beliefs are socially derived and reinforced. Second, 'social sanctions' conveys more clearly than 'ritual beliefs' the sense that behavior and belief are separable concepts. While it is true that rituals and ritual beliefs are intimately related, and sometimes virtually indistinguishable, we have found that different drug users ( heroin addicts versus controlled heroin users, for example) may share very similar drug-using rituals, yet subscribe to dichotomous social sanctions. In other words, social sanctions can be used to predict the type of drug use when rituals cannot.
The terms 'rituals' and 'ritual beliefs' have been applied most frequently to magical or religious phenomena. Goody and others have included secular events (e.g., civil marriage ceremony) under the rubric of ritual, but reserve the term to describe behavior in which "the relationship between means and ends is not intrinsic is either rational or non-rational" ( Goody, 1961) . What is usually excluded is any behavior which "is technical or recreational" ( Gluckman, 1962) .
Our use of ritual and social sanction violates this tradition in two distinct ways. First, we are applying these terms to drug use whether the goal of the user is recreation, improved mental or physical performance, or religious experience.3 Second, drug-using rituals and social sanctions include both rational and nonrational elements. The intravenous injection of heroin is causally related to the subsequent high while booting (drawing of blood back into the syringe and re-injecting one or more times ) is not, although users may believe that it is.
Our departure from the more restricted meaning of ritual is not without precedent among anthropologists. Klauser (1964), for example, discussed the cocktail party as a ritual. It is worth explaining, however, why the concept 'ritual', even in modified form, is so aptly applied to drug use.
Within very broad limits, the objective and subjective effects of a psychoactive drug depend as much on how the drug is used and the expectations of the user as on its chemical properties. Booting does increase some heroin users' sense of euphoria. A placebo can alleviate pain as effectively as morphine provided the user believes he is receiving an analgesic. Tobacco acts as a powerful hallucinogen in some Amazonian tribes where it is used infrequently in high doses (Weil, 1972). These are but a few examples of the mutability of drug effect which can be attributed to the discrete influence of rituals and social sanctions, whether rational or nonrational, on the drug user. Szasz (1975) similarly justifies applying the term to drug use because it reveals the enormous range in the consequences of that use which are otherwise hidden by a strictly pharmacological perspective:
Perhaps because of all the major modern nations, the United States is the least tradition bound, Americans are most prone to misapprehend and misinterpret ritual as something else: the result is that we mistake magic for medicine, and confuse ceremonial effect with chemical cause.
Finally, in this paper we are mainly interested in drug-using rituals and social sanctions of a specific kind: those which foster controlled drug use. Drinking muscatel from a bag-wrapped bottle while squatting in a doorway, or soliciting psychedelics from strangers on a street corner is not a controlling ritual. The positive social status attached to the ability to withstand extraordinarily high doses of LSD, the risk involved in getting loaded on barbiturates and alcohol, or the size of one's heroin habit does not constitute a controlling social sanction. In the following section we outline the nature of social sanctions and rituals which do promote control, using alcohol as an example. This discussion will provide a basis from which to examine the existing subcultural social sanctions and rituals which facilitate the controlled use of illicit drugs and inhibit their abuse.
RITUALS, SOCIAL SANCTIONS,
AND CONTROLLED ALCOHOL USE
Although alcohol is a powerful and addictive psychoactive drug which can produce profound physiological and psychological damage, the vast majority of Americans who drink alcohol manage to control it. There are an estimated 105 million drinkers in the United States compared to some 8 million alcoholics (New York Times, April 9, 1973). Widespread controlled alcohol use can be understood in terms of culturally based rituals and social sanctions which pattern the way the drug is used .
Alcohol-using rituals define appropriate use by limiting consumption to specific occasions or circumstances. Having a highball before dinner, wine with a meal, a few drinks at a cocktail party, a beer with the boys after work, or a drink at a business luncheon are examples. Positive social sanctions permit and even encourage moderate use of the drug: one need only consider the occasions when a drink is offered to appreciate how well alcohol is integrated into the culture as an approved social intoxicant. This social acceptance of alcohol is paralleled by the minimal legal restrictions on its consumption, and by the negative sanctions which condemn promiscuous use and drunkenness. "Know your limit," "Don't drink and drive," "Don't mix drinks," and "Never drink before noon" are familiar proscriptions.
The internalization of these social sanctions and rituals begins in early childhood. The child sees his parents and other adults drinking. He learns the possibilities of excess and the varieties of acceptable drinking patterns from newspapers, movies, magazines, and television. As he matures, he develops a more unconscious than conscious sense that alcohol use can be pleasant, controlled, and socially approved. In some cases, this socialization process is more direct—children sip wine at religious rituals and celebrations, or taste their parents' drinks. Many authorities believe that a gradual and careful early introduction to alcohol by parents contributes to restrained adult use.4
Many adolescents drink without parental permission, and some test the wisdom of the social sanctions and rituals with which they are already familiar by getting drunk and nauseated. However, the central issue of this testing is not so much how to drink as it is how long the adolescent must defer approved social drinking. Neither the adolescent nor his parents have much fear that occasional undercover experimentation will seriously or permanently disrupt social relationships and performance at school or work. Throughout this period of early use, the adolescent has numerous adult role models for controlled use and he can easily find friends who share his interest in drinking as well as his resolve to avoid compulsive use.
At some point the young user receives direct or tacit approval for drinking from parents and other significant adults, marking the end of family-centered socialization in the use of alcohol.5 As the user begins to drink in public, he melds the general culture's rituals and social sanctions and his previous learning into an individualized but socially acceptable pattern of alcohol use. Social reinforcement for controlled use continues throughout adult life.
Obviously the influence of rituals and social sanctions on the alcohol user is partial and imperfect. Other variables—social forces, personality factors, and perhaps genetic differences—also influence how groups and individuals use the drug. The social sanctions and rituals associated with controlled use are not uniformly distributed in the culture. Some ethnic groups (e.g., the Irish) tend to lack strong sanctions against drunkenness and have a correspondingly high incidence of alcoholism (Wilkinson, 1970) . Furthermore, even when functioning rituals and social sanctions are available, family-centered socialization may break down. Nonetheless, prevailing rituals and social sanctions exert a discernible, and crucial, moderating influence over the way most Americans use alcohol.
The importance of such rituals and social sanctions has been dramatized by the disastrous effects of the introduction of alcohol to societies which lacked them. American Indian tribes demonstrate long-standing, controlled, highly ritualized use of naturally occurring psychoactive plants such as jimson weed and peyote (LaBarre, 1938). The Indians' legendary susceptibility to alcoholism stems essentially from a lack of similar cultural conventions for the use of the white man's drug. Because the Indian has rejected and has been denied full membership in American society, his inculturation in alcohol-using rituals and social sanctions has been retarded. Consequently, alcoholism persists among Indians and the "consequences of alcohol use are frequently deep inebriation, rather than courtly pleasantries" (Freedman, 1974). Wilkinson (1970) reports that when the Eskimos of Frobisher Bay, Baffin Island, were first granted legal permission to drink, their lack of previous cultural experience and guidelines for alcohol use resulted in pronounced abuse .
A similar problem exists for Americans who use illicit drugs. It is not at all surprising that so many of these people wind up as compulsive users. There are virtually no socially accepted models for the controlled use of these drugs, no positive cross-generational education in how to use them, and no reinforcement or assistance in moderate use (Abrams, 1972)6 The mainstream culture not only fails to assist controlled, illicit drug use, it actively discriminates against it. Any and all use of illicit drugs is prohibited. Persons who use these drugs are regarded as deviant: either as sick and in need of counseling and rehabilitation, or as criminal and deserving of punishment. It is clear that use and abuse of illicit drugs must be understood from a socio-cultural as well as a pharmacological perspective.
REVIEW OF PREVIOUS RESEARCH
By and large, the research literature reflects the reigning cultural outlook on illicit drug use in that it fails to differentiate between use and abuse. One reviewer of 35 recent studies states that their most serious flaw is that "they have lumped together all drug users without considering the extent of their use" ( Heller, 1972) .
Patterns of drug abuse such as heroin addiction have been singled out for intensive study, but there has been little effort to delineate patterns of use lying between the extremes of abstinence and abuse or compulsive use. The lack of a definite typology for drug-using behavior bespeaks the continuing and pervasive tendency to confound quite different patterns of drug consumption.
The terms in the literature which are closest to controlled use are 'chipping', 'occasional use', 'experimenting', and 'tasting'. 'Chipping' and 'occasional use' are usually associated with heroin and the opiates. 'Taster' (Kaplan, 1971) and 'experimenter' (Keniston, 1968-69) have been specifically applied to marihuana and psychedelic users. All these terms refer to irregular, nonaddictive, or minimally abusive drug use, but do not necessarily connote the elements of moderation, regularity, stability, and non-abuse which we mean by controlled use.
A computer search of the MEDLINE file7 covering a 47-month period (January 1969 through November 1972) produced no articles specifically concerning occasional use of any drug. An informal search for mention of occasional use, however, yielded several allusions to occasional use. Jordan Scher (1961, 1966) mentions the existence of controlled heroin use in work done through the Cook County Narcotic Project. Isador Chein et al. (1964) note the existence of "long continued, nonaddictive heroin users." Howard Becker (1963) discusses occasional marihuana use as a stage preceding regular use during which "the individual smokes sporadically and irregularly" because he has not yet established a reliable source for the drug. W.H.Dobbs (1971) warns that not all applicants to methadone programs who are using heroin may be drug dependent. John Newmeyer (1974) found some heroin users who, he feels, should not be regarded as representative of a junkie population because they "could sample heroin without becoming addicted."
The focus in each of these sources is more on regular than controlled use, and little importance is attached to different using patterns. The authors do not seriously consider regular controlled use as a stable use pattern for a significant number of people.
To our knowledge only one published study ( Douglas Powell, 1973), also sponsored by The Drug Abuse Council, Inc., focuses specifically on occasional drug use or occasional users. Powell interviewed subjects who had been occasional users of heroin for at least three years without becoming physically addicted. Many of the using patterns described in Powell's report, however, appear so unstable or so damaging that they lie outside the patterns of controlled use we are investigating. Still, Powell's study supports our efforts in that he established the existence of occasional ( if not controlled) heroin users and he found that such users "are responsive to research and can be studied reliably with relatively simple techniques."
METHODS OF THE DAC STUDY
The major goals of the Drug Abuse Council study are:
1. to locate controlled users of marihuana, psychedelics, and opiates;
2. to describe such users and their various patterns of use; and
3. to identify factors which stabilize and destabilize controlled use. Potential subjects were initially solicited through universities, advertisements in the underground press, and a variety of social service agencies including halfway houses, drug treatment programs, and counseling centers. Once underway, we found, as Powell did, that after completing the screening/interview procedure, subjects were often willing to refer drug-using friends and acquaintances to the project. Six indigenous data gatherers ( i.e. members of the drug-using subculture) were recruited to assist in locating and interviewing subjects.8
The following are the minimum criteria developed for participation in the project.
1. Subjects had to have used marihuana, a psychedelic, or an opiate for at least one year.
2. Subjects had to be willing to participate in follow-up interviews.
3. A subject had to have used the drug frequently enough to be considered a regular user, but not so frequently that he was physically addicted to it ( in the case of opiates ) or that his level of use was likely to interfere with effective personal and social functioning. No precise cutoff points for frequency of use were established. In practice, a marihuana user who had used only a dozen times in the previous year was not selected because his use seemed too infrequent to be regarded as regular, and a weekly user of psychedelics was not selected because such frequency suggested a possibly abusive drug-using pattern.
4. When subjects were polydrug users, all of the drugs used ( including alcohol) had to be used rather than abused. A subject who was a moderate bi-weekly heroin user, but who was physiologically addicted to barbiturates, was not eligible to participate.
Interviews lasted from one and one half hours to two hours or more. Subjects were paid approximately $10 per interview. A flexible interview schedule was adopted to allow the interviewers to pursue interesting issues as they arose. For each subject data were gathered on his history of drug use ( including alcohol); his relations to work and school, as well as to family and mates; his relations with drug-using and non-drug-using peers; his physical health and emotional stability; details of drug-using situations; and basic demographic variables such as age, years of schooling, and social class.
Profile of the sample
For approximately two years interview data have been gathered on 105 controlled users.9 The sample consists of 66 white males, 24 white females, 9 black males, and 6 black females. Subjects range in age from 14 to 70 years with most in the 18- to 25-year-old age bracket. Eighty-seven interviewees demonstrate controlled use of marihuana, 42 have used psychedelics in a controlled way, and 46 are controlled opiate users ( categories overlap) . Follow-up interviews have been conducted and are still in progress.
We found that the 105 controlled users can be distinguished from compulsive users along several dimensions. Subjects maintain ties to institutions like work or school, and regular social relationships with non-drug users as well as users. Drug use is important to these subjects but is only one of many other activities, relegated to leisure time. Most subjects are deviant only by virtue of their drug use. Some have a history of criminal activity or school disciplinary problems, which does not generally overlap their controlled use of a drug. No subjects manifest physiological or psychological impairment as a result of controlled use .
Our data contradict the notion that the period of controlled use is a brief transition stage ending in abuse or abstinence. Subjects with relatively short histories of controlled use—slightly over one year, for example—are included in the sample to clarify the manner in which controlled use is first established. Long-term follow-up will reveal how stable these subjects' patterns of use are. The majority of subjects, however, have been controlled users for several years, and some have maintained controlled use for as long as ten years.
RITUALS, SOCIAL SANCTIONS, AND CONTROLLED
MARIHUANA, PSYCHEDELIC, AND OPIATE USE
Having outlined our methods and profiled the sample, we will confine ourselves here to a discussion of preliminary findings on the relation between rituals, social sanctions, and controlled use.10 The most striking feature of the DAC subjects is that they have acquired and adhere to rituals and social sanctions which provide a structure and a mythology for maintaining controlled use and avoiding untoward drug effects.11
Acquisition of rituals and social sanctions took place over the course of subjects' illicit drug-using careers. The details of this process varied among subjects: some had been controlled users from the outset of their drug-taking; others had been through one or more periods of compulsive use before firmly establishing control. Virtually all subjects, however, required the assistance of other users to construct appropriate rituals and social sanctions out of the folklore and practices of the diverse subculture of drug takers.
It is this association ( often fortuitous ) with one or more controlled users which provides the necessary reinforcement for avoiding compulsive use. The using group redefines what is a highly deviant activity in the eyes of the larger culture, as an acceptable social behavior within the group. It reifies social sanctions and rituals and institutionalizes controlled use. This is consistent with Jock Young's (1971) observations of drug use in London where he found that some groups "contain lore of administration, dosage, and use which tend to keep . . . lack of control in check, plus of course, informal sanctions against the person who goes beyond these bounds."
All but two of the DAC subjects have been connected to a controlled using group. Although subjects sometimes use drugs alone, upwards of 80 per cent of their use takes place with others. Use in the company of drug abusers is rare. Controlled heroin users, for example, tend to limit their contact with heroin addicts to those occasions when it is necessary to obtain their drug and to decline invitations to shoot up with their addict-suppliers.
While association with controlled drug-using groups is the primary source of controlling rituals and social sanctions for illicit drug use, it appears that the alcohol education process may be a secondary source, especially in the case of marihuana use. Subjects often draw pointed comparisons between social drinking and their use of illicit drugs. Younger subjects apply the same language—phrases like getting high and getting off—to both alcohol and illicit drugs. Subjects describe social gatherings where both alcohol and marihuana are available and where an individual's preference for one of these drugs over the other is interpreted as a matter of personal choice rather than as a symbolic ideological statement about being in or out of the drug culture. Some subjects treat alcohol and marihuana in much the same way. John L., 26, is enrolled full time in a university and holds down a part-time job. When he returns home he usually has a drink or a joint before dinner, depending, he explains, on his mood and his plans for the remainder of the evening. It seems then that controlled users adapt alcohol-using rituals and social sanctions to their use of illicit drugs.
Taken as a whole the rituals and social sanctions toward controlled illicit drug use have several major features:
1. They define and approve controlled use and condemn compulsive use .
2. They limit use to physical and social settings conducive to a positive drug experience.
3. They incorporate the principle that use should be kept infrequent enough to avoid dependence/addiction and to maximize the desired drug effect .
4. They identify potential untoward drug effects and prescribe relevant precautions to be taken before and during use.
5. They assist the user in interpreting and controlling his drug high.
Rituals and social sanctions vary with the pharmacology of the three drug types we are investigating—marihuana, psychedelics, and opiates—and with the acceptability of these drugs within and outside the drug subculture. Therefore, the following, more detailed discussion of rituals and social sanctions proceeds by drug type.
Marihuana use is less ritualized than psychedelic and opiate use. Subjects use the drug in a wide range of settings and circumstances: before going to a movie, at a party, while watching television, or during a walk in the woods. Controlled users do not usually come together specifically to take marihuana; they meet to socialize and the drug is sometimes taken as an adjunct to the occasion. Marihuana is also more likely to be used alone than the psychedelics or opiates.
This flexibility in marihuana rituals is in part due to the pharmacology of the drug. Marihuana is a relatively mild and short-acting intoxicant. Our subjects, as experienced users, find no difficulty in controlling the drug high,12 and they are able to function normally if that becomes necessary. The high state, therefore, is compatible with a variety of public and private settings.13 A marihuana high is also easily arranged, requiring neither the apparatus to inject an opiate nor the planning to accommodate a 6- to 8-hour psychedelic high.
Flexibility in marihuana rituals can also be explained in terms of the drug's status. The expanding number of marihuana users as well as the growing acceptance of the drug among users and non-users alike14 has created an environment in which rigid external controls in the form of rituals are no longer necessary. They have been supplanted by controlling social sanctions which are less specific and can be adapted to various using circumstances. DAC subjects 25 years old and over who began using marihuana in the early to mid-1960's describe the more marked ritualization of that period. They recall with nostalgia and humor the dimly lit room, locked doors, music, candles, incense, people sitting in a circle on the floor, and one joint passed ceremoniously around the circle. They now regard this behavior as quaint and unnecessary. As the number of intermittent marihuana users has risen to some 8 million Americans and the number who have tried the drug to 26 million ( Boston Globe, 1974), marihuana use has lost much of its deviant character. Concurrently, social sanctions for controlled use have been strengthened and have become available throughout most of the using subculture.
Under these conditions considerable learning about controlled use can take place before use actually begins. The choice of whether or not to use marihuana has become a reality for American adolescents, and most are well aware before making that choice that marihuana does not cause people to go crazy or to fall apart. Younger DAC subjects ( 18 to 20 years) had known of teachers in their high schools who used marihuana. Many had older siblings who they knew used the drug. These subjects had also acquired a sense of what marihuana was like from friends, the underground press, popular music, novels, and other sources. Their first few experiences with marihuana were usually ritualized affairs with one or more newcomers introduced to the drug by a more experienced user in a secure setting.15 The experienced users typically provided guidance, demonstrated how best to smoke the drug, and soothed newcomers' lingering fears. Very quickly, though, neophyte users moved beyond these structured situations and began the process of adapting use to a variety of social settings. Most were able to locate friends with whom to use the drug and with whom they also shared non-drug-centered interests. The lack of highly specific rituals should not, therefore, be construed as evidence that controlled users are reckless in the way they use marihuana. Rather, the rituals that earlier served as rigid and external controls have been replaced over the last decade by more general but equally effective social sanctions. Due to growing familiarity with every aspect of marihuana use, these sanctions, like those of alcohol, are internalized; the rituals developed to support these sanctions no longer need to be so closely adhered to. Interviews with subjects reveal how these social sanctions operate to ensure control.
Subjects describe marihuana as a relatively innocuous drug, easily controlled, and difficult to abuse.16 Some expressed genuine surprise when we asked if they had ever had any difficulty in maintaining controlled use. Subjects are not, however, messianic about marihuana. They recognize its potential for abuse and offer guidelines for sensible use:
In spite of all the rationalizations about how good dope is, I don't see that I have to have a reason for getting high every time but yet getting high consistently without a reason for it seems to be a reason to sort of check things out with yourself.
Another subject comments that if marihuana is used too much the quality of the high declines and when this happens one should stop for a while and then return to a pattern of more infrequent use. Subjects generally subscribe to the ethic that they should not be high at work or at school. Susan S. works as a housekeeper several days a week. She explains that although she can clean when she is stoned, she prefers to restrict her drug use to leisure time.
Controlled users also express the idea that too much marihuana should not be used at any one time. There are two reasons cited for this:
1. to avoid transient but unpleasant panic reactions or paranoia, and
2. to keep the high controllable so that other activities can be better enjoyed .
While passing a joint around a group is no longer de rigueur, it still serves on many occasions to assist the process of adjusting the intensity of the high. It allows time to pass between each inhalation during which the user can monitor his own degree of intoxication. Several subjects state that when using alone or with one or two other people, they stop after several tokes to let the high catch up with them and then decide whether they want more. One subject comments that this is an especially sensible way to proceed when trying out a new batch of marihuana.
Psychedelics include a wide range of substances that vary both in potency and duration of effect: LSD, mescaline, peyote, psilocybin, MDA, DMT, and others. The illicit status of these drugs creates a major problem for the user; he cannot be certain what is in the drug he is sold.17 What is presumed to be mescaline may be LSD. It may be adulterated with PCP, amphetamines, and other substances—and its dosage can only be guessed at. Unlike the marihuana high, the psychedelic high18 usually lasts for several hours. It is an intensive though not uncontrollable experience, characterized by perceptual changes, sometimes of a hallucinatory or illusory nature. The risk of a bad trip is always present and to some degree increased by the lack of quality control over the drug. For these and other reasons, psychedelics are regarded as real, i. e., dangerous, drugs within the drug subculture. They do not have the widespread appeal of marihuana nor are they treated casually. Most of the rituals and social sanctions related to the psychedelics deal with making the drug experience as safe as possible for the user.
For the subjects, psychedelic use is almost invariably a drug-centered, group activity. Subjects talk about having others with them who can be relied upon to help cope with a bad trip or unforeseen events as a requisite for safe tripping: "I have to do it . . . with someone that I really know well, that I really trust, and there are some people like that." People who are less intimately acquainted are sometimes included in the group but if so, the trip is commonly preceded by a discussion in which everyone tries to get comfortable with one another, to determine who may need extra help or attention, and to establish ground rules for the trip. During this preliminary discussion, an experienced user may be assigned to act as a guide for a more inexperienced or uneasy user. Group members may decide to forbid wandering off from the group without letting someone know because it causes people to worry, and worrying is felt to be detrimental to a positive drug experience.
Subjects agree that planning the trip is an important matter,even when participants have taken the drug together before and feel quite close to one another. The need for structure varies, but pre-trip planning includes issues such as: what foods or beverages to take along, what activities to engage in during the trip, whether thorazine or niacin should be available in case of a bad trip, or whether talking people down is preferable to medicating them. This planning reaffirms the participants' sense of shared intentions and strengthens their capability to control the drug high.
Subjects are adamant about using psychedelics in a proper setting —a good place. For many this means tripping in a relatively secluded spot in the country. What seems important, however, is that the space is secure and comfortable. A city tripper said, "I'll take a walk outside but it'll always be with the notion that I can come back to this kind of sanctuary for myself in the house, and so it's no threat." This subject and many others expressed surprise and some disdain for users who violated the principle that psychedelic use is a taxing experience that should be confined to special settings:
I'm amazed that . . . I was living last year with a dude who's 17 years old and is from the West Coast. He was telling me that when he was going to junior high school he would just drop acid in the morning and go to school, which completely weirded me out . . . and just could ride with any kind of horrible thing . . . Amazing.
Another social sanction/ritual which subjects observe is the need to be internally prepared for psychedelic use. One subject describes this as "making peace with the public reality . . . mentally putting your house, your affairs, in order, you know, like, what's the Zen thing . . . emptying out the teacup first." Others talk simply about needing to be in a "good mood" and needing "energy" to undertake the experience. Some subjects appear to ritualize this internal process by tidying up the space in which they are going to use the drug.
All the conventions described above represent attempts to ensure a good trip and prevent a bad one. We now turn to the issue of how rituals and social sanctions may inhibit compulsive psychedelic use.
Subjects repeatedly advocate using psychedelics at no less than two-week intervals. In practice, their use is far less frequent than this—less than once a month is the most typical using pattern and, with time, use consistently becomes even less frequent. Avoidance of compulsive use, however, is probably not so much the consequence of negative sanctions as it is the result of a combination of two other factors:
1. the positive value controlled users attach to the consciousness-altering properties of psychedelics, and
2. the fact that tolerance to these consciousness-altering properties goes up very rapidly as use becomes frequent. Our subjects who are interested in experiencing precisely these effects find that too frequent use of the drug is counterproductive.
Some psychedelic users who are not interested in the consciousness-changing qualities of these drugs may become compulsive users. For them, it is the speedy, stimulating effects of psychedelics that are appealing19 -effects which are enhanced with larger, more frequent doses of the drug. Although we have little direct evidence to support it, we would guess that this kind of compulsive psychedelic user is associated with those groups in the subculture which negatively value consciousness change or do not recognize it as a primary drug effect.
By comparing older and younger subjects we have identified some shifts in psychedelic-using rituals and social sanctions. Subjects who began use in the mid-sixties share a sense that psychedelics should be used for "personal growth" rather than recreational purposes. They discuss tripping as an activity which is undertaken to accomplish a worthy goal—to learn more about oneself, to grow intellectually, to transcend ordinary perceptual boundaries, and so on. However, subjects who began use in the past five years have broadened their reasons for using psychedelics to encompass plainly recreational goals.
Younger subjects may trip for a highly rationalized purpose but they are equally inclined to trip simply to enjoy the high state. This trend is difficult to interpret and we have yet to make final judgments. We speculate, however, that the expanded goals of psychedelic users indicate a growing familiarity with psychedelics and less guilt about their use. Without wishing to demean the motives of older users we hypothesize that they needed to assign some constructive purpose to tripping to justify their use of drugs which were then seen as more dangerous and powerful .
We anticipate that as the psychedelic-using population grows, recreational use will increase and, as with marihuana, will become less ritualized although not less controlled. We do not expect, however, that psychedelic-using rituals will ever approach the degree of flexibility and diversity of marihuana-using rituals. Quite probably psychedelic use will become more acceptable and social sanctions more available; but because of the high impact, long duration drug effect and the related tendency to keep psychedelic use infrequent there is both less need and less social opportunity to internalize social sanctions. Thus, there will remain a dependence on rituals ( on external controls) which should limit the flexibility and diversity of psychedelic use.
The larger culture condemns the illicit use of opiates more than any other drug. Popular mythology about the evils of the opiates and heroin, in particular, extends deep into the drug subculture itself. Many of the marihuana and psychedelic users in the DAC study do not recognize the possibility of controlled opiate use, even though they have identified and dispelled many of the larger culture's myths about their own drugs of choice.20
The controlled opiate users21 in our study are painfully aware that they are seen as deviant. They tend to keep their use a closely guarded secret from everyone but their one or two dealers and other controlled opiate users. One of the researchers knew a woman he considered to be a reasonably close friend for several years, and although he had been previously involved in drug-related research, it was not until he became part of the DAC study that she felt free to "confess" that she had been a controlled heroin user all the while. ,
The relationship of controlled opiate users to addict/compulsive opiate users is as fraught with dangers and difficulties as it is necessary. One way controlled users can assert their normalcy is to spurn and condemn junkies, but they must rely on junkies to obtain opiates.22 Addicts do not understand and are often threatened by controlled users' peculiar relation to opiates. So, on the one hand, controlled users get poor quality opiates at great cost from junkies ("You're always getting burned"), while on the other hand, they are repeatedly and seductively invited to become full-fledged members of the junkie subculture. The controlled user's constant dilemma is to become friendly enough with an addict to establish a reliable contact for quality opiates, but not so friendly that his refusals to fully participate in the addict's subculture insult the dealer who might then cut off the supply.
Beset on all sides, controlled users are bound together in small isolated groups that develop idiosyncratic, rigid rituals and social sanctions. These groups are fragile and drug-centered because it is difficult to find controlled users who are compatible as friends—the inverse of the situation with marihuana we described earlier.
Most of the rituals of controlled opiate users are indistinguishable from those of compulsive users. In both groups, people squabble over who gets off first, belts are used as ties, eye-droppers are used instead of syringes, booting is common, andworks are cleaned but not boiled. The main reason for this ritual-sharing is that there is no highly visible, communicative population of controlled users from whom discrete rituals can evolve. Rituals are still being borrowed from the addict subculture—the only readily available source of expertise about the drug. There are also two other explanations for this phenomenon. First, while the life style of the addict is repugnant to most controlled users, they sometimes find the addict's bold outlaw stance attractive; partaking of the addict's ritual may be an expression of wistful identification. Second, several subjects were addicts before they became controlled users, and they have retained their former drug-using rituals (booting is probably the best example) .
Several controlled users have added new elements to the addict ritual. One subject, for example, shifts the emphasis away from getting off by tacking on middle-class amenities—he plays the good host by serving wine and food to his user guests ( this without any of the nausea which commonly accompanies opiate use) and all spend the evening together in conversation. Another user protects herself from a possible overdose by shooting a little of the drug, waiting to gauge its effect, and then shooting the remainder. By and large, however. controlled users' rituals are not well distinguished from those of compulsive users—especially in details of drug administration.
The social sanctions around controlled use are distinctive. Controlled users adhere to a variety of rules for opiates, most of which are summarized by the maxim: "Don't become dependent." They well appreciate that they can become addicted or compulsive users.
Ex-addict subjects have firm rules about frequency of use. One is a woman who has used heroin on an average of three to four times a month for over four years. Occasionally, when a break in her commitments to work and to her child permits, she goes on a using spree that lasts about a week. Even while on vacation, however, she will not use heroin more frequently than every other day. In general, subjects limit their opiate use far more than is needed to avoid addiction. One subject has confined his heroin use to weekends only for the past five years. One woman used heroin twice a month and on special occasions such as birthdays and New Year's, for a year and a half. Then, troubled by her tolerance to some of the drug's effects, she deliberately cut back use to only once a month. She ignored the fact that the variability in the potency of black market drugs could have accounted for her requiring the use of two bags instead of the usual one bag (on only two occasions) to obtain the same effects as when she used previously.
These and other examples indicate that many controlled users regard heroin as more rapidly addicting than is warranted, though they feel that it can be used moderately. This is understandable in view of the prevailing myths about heroin's power and the exposure controlled users have to addicts who have succumbed to the drug.
Controlled using subjects observe common sanctions against behaving like or becoming overly involved with junkies and compulsive users. Controlled users may chastise one another for manifesting irresponsible junkie-like behavior. Users who are unable to control the drug's effects may be chastised. A user of codeine-based cough syrup and of Doriden indicated that despite the somnolence induced by these drugs, people are expected to act responsibly— "One (cigarette) burn and you're thrown out. " Being cheated by dealers is a fact of life, but a controlled user who cheats fellow users is punished by being called a junkie. Controlled users frown upon spending too much money on heroin because it suggests the junkie's lack of control: "Just 'cause I had the money don't necessary mean I would cop . . . of course, I wouldn't steal to get the money to cop, there's no need for it 'cause I don't have a habit."
Shooting up like a junkie is O.K., but shooting up with junkies is not, because this symbolizes a loss of control. A couple who had regular access to opiates through the woman's addicted sister and brother-in-law stopped relying on them for opiates because of the social pressure to use the drug with them. They began borrowing a car and driving several miles to a copping site in another city where they knew they could obtain heroin from street dealers.
DISCUSSION AND NEW DIRECTIONS
Our findings show that, contrary to conventional wisdom, controlled use of illicit drugs is possible and is fostered by subcultural rituals and social sanctions that support controlled use and curtail drug abuse. We have also observed how the controlled use of alcohol is patterned by established, broad based rituals and social sanctions. These findings and observations strongly suggest that the evolution and widespread acceptance of social controls for illicit drugs, similar to those for alcohol, would provide a viable means of preventing drug abuse.
Ironically, the present attempt to eliminate all use of illicit drugs undermines users' ability to control them. Users receive no assistance from the larger culture for control. Instruction in how to use illicit drugs is now relegated to peer using groups which are, at best, an inadequate substitute for family-centered socialization. Association with controlled users is as much a matter of chance as it is of personal choice.23 Because illicit drug use must be a covert activity, newcomers are not presented with an array of using groups from which to choose. Early in their using careers, many DAC subjects became involved with groups in which members were not well schooled in controlled use, or with groups in which compulsive use and risk-taking were the norms. In both cases subjects went through periods when drug use interfered with their ability to function and when they frequently experienced untoward drug effects such as bad trips. These individuals were later able to achieve controlled use, but many are not. To revoke personal commitments and realign oneself with new using companions is a difficult and again uncertain process.
The culture's active opposition to illicit drug use also alienates users from adult guidance. Asking adults for advice or approval even in a guarded way is risky, and raises difficult issues for parents and users alike. The deviant subcultures become more attractive because they insulate the user from the mainstream culture's disapproval and facilitate drug use.
Of course, the mainstream culture's opposition to illicit drug use is not wholly negative in its effects. Present legal and social sanctions do dissuade some people from taking these drugs and no doubt influence others to abandon their use, thereby preventing some unknown quantity of abuse. Unfortunately, it is not clear how many people would take these drugs if they were given an unobstructed choice about it, nor is it clear how many would go on to become abusers. What is clear is that the attempt to eliminate all use of these drugs contributes to their abuse by people who take them.
It seems safe to assume that no matter how massive the investments in law enforcement and education, neither the drugs themselves nor people's interest in taking them will be eliminated. There is every indication that illicit drug use will continue to rise as it has over the last decade. Given this prognosis and the failings and high social costs of our present restrictive social policy, it seems not only reasonable but necessary to place illicit drugs under social control so that their abuse can be minimized.
Ideally, social management of drug use affords advantages which prohibition does not. Drug use is normalized with other life activities and is transformed from a covert to an overt activity subject to the pressures of public scrutiny. Drug users regulate themselves and other users . Social learning in proper ( controlled) drug use becomes available. Rituals and social sanctions provide freedom to pursue a recreational activity, albeit a complex and at times risky one, in an individualized way while discouraging detrimental drug-using behavior. Drug-taking loses its appeal as "forbidden fruit." Users who experience difficulties are more likely to seek assistance because they can do so without having to declare themselves deviant and morally bankrupt, and without the risk of punitive reprisals. The quality of drugs can be regulated and thus, untoward drug effects greatly reduced.
The chief difficulty in achieving social control over illicit drugs is that enormous changes would have to occur in both public attitude and social policy for effective controlling rituals and social sanctions to develop. Rituals and social sanctions cannot be supplied ready-made to drug users or potential users. We would, therefore, not recommend wholesale immediate legalization of marihuana, psychedelics, and the opiates precisely because too abrupt a shift in policy would leave many users without the elaborate social support needed to prevent abuse.
It is possible, however,
1. to alleviate major legal obstacles to their development, and
2. to provide more comprehensive and value-neutral information about licit and illicit drugs to the general population, making more user/ non-user contact and discussion possible and, in turn, permitting further dissemination of controlling conventions. Some steps could be taken now which would both strengthen the existing subcultural rituals and social sanctions and serve to demystify the power and danger of these drugs generally.
Certainly decriminalization of marihuana should be extended beyond those few states which have adopted it, and federal penalties for use should be dropped. Further research on the possible medical applications of marihuana and the psychedelics should be undertaken, and results sufficiently publicized so that their public image as "bad" drugs can be dissipated.24 Heroin should be made available to physicians as a legitimate analgesic, and experimentation with heroin maintenance clinics for the treatment of addicts should also begin with careful control.
Drug education programs which are no more than disguised campaigns to eliminate use should be replaced with genuine efforts to provide users and non-users with some rudimentary pharmacological data and with detailed information about the consequences of various patterns of use. Doctors, teachers, counselors, and others who encounter drug users should be instructed in how to distinguish use from abuse—it simply makes no sense to alienate and undermine those segments of the population of drug-takers who stand against abuse.
These recommendations represent the first in a number of changes which would be required before illicit drugs could be made available under minimal legal restraints. We cannot detail here the entire sequence of such changes. In general, we recommend that social policy keep better pace with developments among drug users themselves than has so far been the case.
In closing, we suggest that the policy goals and changes we have outlined are part of a larger historical process by which drugs are gradually incorporated into a culture and by which use replaces abuse as a dominant using pattern. Turning again to alcohol as an example, in the seventeenth and eighteenth centuries 75 to 80 per cent of those who drank were alcoholics (Harrison, 1964) . A few decades ago alcohol use was prohibited and the temperance movement pronounced it an evil and dangerous substance. Today 95 per cent of those who drink are controlled users. This figure might still be improved by further normalizing and not glorifying alcohol use, e.g., by banning advertising which relates alcohol use to sexual prowess.
In fact, illicit drugs are much further along in the process of becoming acceptable and controllable than the culture has been willing to acknowledge. If the incidence of untoward drug effects is an indication, we can see clear movement with respect to marihuana and the psychedelics. Becker (1963) notes that shortly after World War I the incidence of "panic reaction" to marihuana was higher than in the mid-1930's by which time marihuana use had increased in a number of groups. Today, such reactions are quite rare and are more typical of older (30+) users who have had no prior experience with marihuana. A few years ago the treatment of bad trips (resulting from use of psychedelics) accounted for as much as 20 to 35 per cent of hospital emergency admissions. Since that time psychedelic use has grown at a faster rate than the use of any other illicit drug ( Drug Use in America, 1973), but the number of hospital admissions has dropped markedly. As of July 1974 the Massachusetts Mental Health Center did not know when they last had such an admission, but they were sure that it had been years rather than months ago (Grinspoon, 1974) . The Haight Ashbury Free Medical Clinic, which furnishes emergency medical teams to rock concerts, reports ( Smith, 1975) that at a recent concert attended by some 10, 000 persons where psychedelics were openly distributed only two adverse reactions came to the attention of the medical team. In both cases, the patients were quickly quieted by talking with members of the team and sent home after fifteen to thirty minutes. A recent National Drug Abuse Council Survey Project shows that the majority of college and high school students who use drugs cannot be distinguished from many of those who do not and never have used drugs (Yankelovich, Skelly & White, 1975, Yankelovich, 1975) .
These data suggest that the development of controlled using patterns for illicit drugs by substantial numbers of users is probably a recent occurrence. The legal system is not able to and probably should not reflect every shift in using patterns. But, if controlled using patterns stabilize, as our work indicates they have for marihuana and the psychedelics, and viable social sanctions which permit this use develop, then in time the laws should respond to the new social position of the illicit drug and the drug user. Obviously, it is difficult to develop rituals and social sanctions which are against the law; both the drug user and the public must tolerate a serious amount of ambiguity and anxiety. The user takes real risks by breaking the law ( greater risks than are imposed by the chemistry of the drugs ), and the public suffers the disruptions of laws which now punish more than they deter.
It does not seem likely that this situation will be rectified immediately. However, it is possible to monitor changing using patterns in order to determine how best to integrate these changes into the legal system. Until now there has been considerable resistance not only to legal changes but even to recognition of changing drug-using patterns. The study and dissemination of new information on how people develop successful drug-using patterns can proceed without neglecting the study of drug abuse when it occurs. Our work shows that controlled use of illicit drugs exists in this country and is the result of subcultural rituals and social sanctions.
N O T E S
1. The material for this paper was gathered as part of a study of the social basis of drug abuse prevention funded by The Drug Abuse Council, Inc. 1828 L Street, N.W., Washington, D. C. The work of Richard C. Jacobson and Deborah Patt on that study was invaluable to this paper. Since July 1 1976 research on controlled use has continued under National Institute on Drug Abuse Grant No. 1 R01 DA 01360-OlAl. (back)
2. "In more tribal cultures social sanctions are rarely institutionalized in a body of abstract law. Principles of rightness which underlie the activities are largely tacit And they are not the subject of much explicit criticism, or even of very much reflective thought . . . Legislation, though it may occur, is not the characteristic form of legal action" (Redfield, 1971). (back)
3. Presumably drug use for religious purposes, such as the use of peyote by members of the Native American Church, would qualify as a ritual in the more classical sense. (back)
4. Wilkinson (1970) reviews the relevant research in his Appendix A. Several references to Wilkinson follow as his work on alcohol closely parallels our own on the social determinants of controlled illicit drug use. (back)
5. In many families the formal offer of a drink constitutes an important quasi-rite de passage from adolescence to adulthood. (back)
6. Research has shown that in abstinent families where parallel conditions exist with respect to alcohol, the potential for children becoming alcoholics is greatly enhanced (Wilkinson, 1970, Appendix A). (back)
7. The MEDLINE file contains 400,000 citations from 1,100 of the journals indexed for Index Medicus. (back)
8. Indigenous data gatherers were trained in interviewing technique. All interviews were tape recorded, allowing research staff to monitor their work. Three of the data gatherers were recruited from within the sample—two women and one man—and proved extremely capable and reliable. They contributed the bulk of the data which were not gathered by the research staff. (back)
9. Interviews have also been conducted with approximately 20 non-controlled drug users. Especially at the outset of the DAC study, potential subjects were referred to us who turned out, in fact. to be compulsive users. Interviews with these subjects provided valuable comparative data and were used as a basis to refine the interview schedule. (back)
10. Further information on methods and other aspects of our findings are reported elsewhere: (1) R. C. Jacobson & N. E. Zinberg, 1975, The social basis of drug abuse prevention. Drug Abuse Council Special Studies Series, SS-5. Washington, D. C.: The Drug Abuse Council, Inc. (2) N. E. Zinberg, 1975, Addiction and ego function. The Psychoanalytic Study of the Child, 30:567-588. (3) N. E . Zinberg, R. C. Jacobson & W. M. Harding, 1975, Rituals and social sanctions as a basis of drug abuse prevention. The American Journal of Drug and Alcohol Abuse, 2:165-182. (4) N. E. Zinberg & R. C. Jacobson, 1976, The natural history of chipping. The American Journal of Psychiatry, 133:37-40. (back)
11. While the influence of personality, family background, social class, availability of the drug, and other variables on drug use could be traced for individual subjects, no consistent relationship has been found between these factors and controlled use. (back)
12. Weil & Zinberg (1968) found differences in ability to control the drug high among naive and experienced marihuana users in a controlled setting. Becker (1963) observed that users' appreciation and control of the drug high is learned; and that this learning allows the user to function adequately while under the influence of marihuana. (back)
13. Users of the psychedelics and opiates were also able to control their highs but found it more difficult and usually limited use to protected settings. (back)
14. Most Americans view marihuana as an illicit, "bad" drug, but as less "bad" than heroin, LSD, cocaine, etc. (back)
15. In effect, new users recapitulate many of the elements of marihuana rituals of the early sixties in their preliminary use of the drug. (back)
16. We found it more difficult to locate marihuana and psychedelic abusers than controlled users. This situation was reversed for the opiates. (back)
17. Access to correctly labeled psychedelics is confined to a few knowledgeable, experienced, and wed connected users. One user in the DAC sample was able to obtain psychedelics from a reputable source, and often had the drugs tested by a chemist before use. (back)
18. There are substantive differences in the high states induced by the various psychedelics, which are beyond the scope of this article (Zinberg, 1974). (back)
19. Psychedelics are chemically related to amphetamines. We are presuming here that these compulsive users are, in fact, using psychedelics and not wrongly labeled amphetamines. (back)
20. Standing with the larger culture against opiate use may help marihuana and psychedelic users to view their own drug use as comparatively "good". (back)
21. The preponderance of controlled opiate subjects were heroin users who used dilaudid, codeine, and other pharmaceutical opiates on an occasional basis. Only three subjects did not use heroin ( see footnote following) . Therefore, discussion will center on heroin use. (back)
22. Three controlled users had regular access to opiates without going through a dealer: a physician who used morphine; a hemophiliac who could obtain pharmaceuticals from physicians under the pretense of relieving the pain of a hematoma; a user, whose drug of choice was codeine, who obtained cough syrup from a pharmacist willing to ignore existing legal regulations. These cases are described in some detail in Zinberg & Jacobson (1975). (back)
23. This is less true for marihuana users than for psychedelic and opiate users. (back)
24. We are not assuming that the results of this research will be uniformly positive. Whatever the results. by making these drugs the object of medical research the idea that no drug is inherently "good" or "bad", that any drug can be used in a variety of ways, would be advanced. (back)
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