The Bitter and/or Better Medicine of Drug Abuse
| Author | Stanley F. Yolles |
| Published date | 01 July 1973 |
| Date | 01 July 1973 |
| DOI | http://doi.org/10.1177/002204267300300302 |
| Subject Matter | Article |
In the current profile
of
the use and abuse
of
illicit
drugs,
there isevidence that most individuals within the popula-
tion are involved in some facet
of
the
"drug
problem,"
either directly or indirectly. There is further evidence
that the problem itself has become apolitical issue, as
well
as projected solutions to the problem. Simul-
taneously, as medical and other health professionals
search for answers to effective treatment
of
minors whose
legal statusis changing, there;s evidence that asignificant
number
of
young people have become "turned
off"
by
drugs and are seeking alternate pursuits. As a result, the
quest for "alternatives to drug
abuse"
is an increasing
concern among various communities
of
interest through-
out
the United
States.
THE
BITTER
AND/OR
BETTER
MEDICINE
OF
DRUG
ABUSE
Stanley F. Yolles,
M.D.
tNot long ago, I attended a meeting in San Diego at which Dr. Daniel X. Freedman
re
erre
to young people generally as
"the
great stoned age," This is more than a
~r~onl~
pun. Historians, looking at our society in retrospect, might very well call
rentire period The Great Stoned Age becauseof the total involvement of our popula-
Ion in drugs and drug abuse.
,Everyone of us is affected in some way by the use and abuse of drugs that affect
~tn~
~~d
mood; and as a society we have become overwhelmingly concerned with
eIllicit abuse
of
drugs that are sold and used illegally. , . ,
tr
ff!h~oughout
the United
States,
reaction to drug use, drug abuse, and the
illicit
th
a
IC
In drugs has progressed from mythology and hysteria, through concern about
, e problem and growing awareness of its roots and its scope, to a national involvement
In the search for practical solutions to the drug dilemma.
~he
involvement is total. It
ranges
from the White House to local neighborhoods
~nd
tncludes as active participants the President of the United
States,
the Cabinet,
fe
Congress,
and such diverse
segments
of the population as members of the armed
lorces, of collegiate, ghetto and street cultures, of ex-addict "families" and of most
Deal
clubs and organizations in every community.
h In the past three years, development of personal and public attitudes about drugs
th~S
produce
aconflict which various
segments
of the
populatio~
see~
to resolve
oug~
public
pressures
and political power. I
assume
that people trained In the,health
6rofesslons know that the drug abuse problem cannot be legislated
o~t
of
eXlsten~e
, y statute.However, as a Nation, we continue to act as though there
IS
some magic
O the legislative process and that the
"right
kind"
of laws
will
solve the problem.
Tn
the face of it, this simplistic attitude should be ridiculous to, thoughtful people.
heproblems attending the useand misuseof dangerous
substances
IS
far more complex.
~~.
Yolles is Professor and Chairman of the Department of .psychiatry, State University of N.ew
A;k
.at.
Stony Brook. He was formerly Director,
NationallnstlMe
of
~~ntal.
Health and
ASSOCIate
fmmlstrator for Mental Health Services and Mental Health AdmInistration, U.s. Department
oHealth, Education and Welfare. This article is revised from an address presented at adrug
SYmposium
in Yonkers, New York, in April, 1972.
Summer
1973 201
What a society
selects
as crucial to perceive about drugs, and what it ignores,
tells us a great deal about the cultural fabric of that society. In the United
States,
few people have been able to analyze the subjective thinking surrounding most pro-
nouncements about the drug problem. Objectivity is a scarce commodity in the area
of drug
abuse,
even among professionals trained to analyze human behavior. Fact
continues to give way to value judgements.
In spite of the millions of words that have been written and spoken about drug
abuse, there is still a wide spectrum of views regarding the problem itself and the
meansto control the problem.
There are those who continue to place their faith in the
system
of law enforcement
and criminal justice, as the best means to achieve control.
These
are people who
believe that drug
abuse,
of itself, is a crime.
There are others who believe that the use of drugs is a matter of taste and style
of life, since in their view people use drugs in their
search
for a new or a more
pleasant reality, and have a right to do so.
Drug abuse has become a major political phenomenon and the physician who
agrees
to enter any part of the drug field finds himself immersed in a maelstrom of
political forces designed more to define and establish sanctions than to learn more
about the effects of drugs on humans or to treat those who experience
adverse
conse-
quencesof taking drugs.
The late Dr. lawrence Kolb, who had along and distinguished career asa pioneering
psychiatrist in thefield of narcotic addiction and drug
abuse,
wrote in 1965 the following
cogent comment:
"In
approaching the problem, we should keep in mind that this country
suffers
lessfrom the
disease
than from the misguided frenzy of suppressing."
This entire paper could be devoted to the development of
these
and other social
philosophies.
Instead
I mention them merely to illustrate one thing: that everyone
who
discusses
the subject of drug abuse does so on the basis of a value judgement
of one sort or another.
I
will
take the following premise:
that-since
a drugged
state
is not a productive
state,
andsinceour society's valuesstill continue to bebasedon productive
abilities-we
as professionals have the responsibility to treat addiction, to limit the
adverse
effects
of drug-taking, and to offer acceptable alternatives to "drug highs" to young people
and adults throughout the population.
Our
society feels that drug abuse is a threat
to its security, both in terms of a past
status
quo and in the expectation of future
chemical discoveries. As professionals, therefore, we must accept the fact that drug
abuse is a major public health problem of national and worldwide concern. It is also
a problem that is growing at an alarming rate.
I am saying that professionals no longer have the
excuses
which have been used
for
years
to minimize medical and scientific interest and participation in the drug
field. The profession's responsibility has been intimately linked with addiction and
drug abusefor many, many years-and not solely through treatment.
Leplative
History
The inexpert prescription of narcotics before, during and after World War I is
a matter of general knowledge.
In 1909, the U.S.Government sought to promote international action and to control
world traffic in narcotics by passing "an Act to prohibit the importation and use of
opium for other than medicinal purposes."
The Hague Convention of 1912 established an international obligation to control
the domestic market, as well as foreign trade, in opiates. This eventually culminated
in the adoption of the "Single Convention" at the United Nations conference on drugs
202
JOURNAL
OF
DRUG
ISSUES
in 1961. The United
States
became a signatorof that treaty during the
Johnson
Adminis-
tration.
The basic federal narcotic statute was the Harrison Act of 1914. It was primarily
a revenue statute and made no direct mention of addicts or addiction.
The Harrison Act was the result of a ferment in the area of social reform which
fc~urred
in the period just before World War I. Public concern brought about such
,eglslation as the Pure Food and Drug Act, and
statutes
setting standards for meat
Inspection, mine safety and the purity of
streams,
as well as other
statutes
designed
to eliminate white slavery and to control the use of alcohol. The Mann Act was a
Product of the period and Congressman
James
Mann was also one of the leading
~roponents
of the Harrison Act. Therefore, theHarrison Act shouId be viewed historically
In the context of the nation's early efforts to reduce what were called "social crimes."
.
State
laws designed to control the use of morphine or cocaine in the 1890s had
faIled in their intent; so reform-minded citizens appealed to the federal government
to take over where the
states
had been ineffective.
However, early Supreme Court decisions relating to the
possession,
importation
a~.
use of
narcotics-in
terms of taxing
powers-made
it extremely restrictive and
dIfficult for physicians to treataddicts in any way acceptable to law enforcement officials.
TheTreasury Department, charged with administering the Harrison Act, amplified these
e~rly
~ecisions
in drawing up its regulations. Implicit in them was the feeling that
~
dIctIon was not a
sickness,
but a
willful
indulgence meriting punishment rather
t an medical treatment.
I At no time did the public or govemmental officials take acomprehensive, analytical
~k
at all the known facts of the drug
scene.
There was not much comment about
?Plum use in the United
States
until after the Civil War. This war was said to have
~creaSed
the abusive use of opium not only among the maimed and suffering soldiers,
t also among their "anguished" families.
In the years between the Civil War and World War I, the use of opiates like heroin
and morphine in the United
States
had become so great,compared with other nations,
that some scientists called heroin or morphine addiction
"the
American
disease."
The federal government
stated
that there was an average consumption in the World
~ar
I period of 36 grains of opium per capita in the United
States,
whereas in France
'!
Was
three grains and in Germany, two grains. In other words, the per capita consump-
t~on
of opiates in the United
States
from 1900 to World War I was about 18 times
t"at of Germany.
Throughout the late 19th and early 20th century, writers in both the United
States
and.Europe only hinted that emotional instability had any causal relation to opium
addIction. In none of the writings of this earlier time was there recognition of the
fact that the majority of addicts are fighting emotional conflicts with tranquilizing drugs.
And certainly, in advocating
statutes
to control addiction, none of the proponents
mentioned the fact that many successful persons have been chronic addicts and were
able to lead worthwhile, constructive lives. Prior to the enactment of the Harrison
~arcotic
Act in 1914, therewas no feeling among the generalpublic that opiate addiction
adappreciable adverseeffectson work habits. At that time, addicts worked as regularly
and as efficiently asany other group of people.
The list of names of great men who were also, and unfortunately, addicts is a
lon~one.
Despite their addiction, thesepeoplecontributed much to society'sbetterment.
Besides
Coleridge, DeQuincy, Gabriel, Dante,
Rosetti,
Edgar
Allen Poe, and the com-
PO~r
Moussorgsky,there were such renowned Englishmenas George Crabbe, William
11lberforce, Sir Isaac Milner, SirJohn
Erskine,
Arthur
Symons,
and FrancisThompson,
o all of whom England remains proud.
Wilberforce, a prominent philanthropist and a member of Parliament, became con-
cerned with the problem of slavery of Negroes and advocated the legislation which
abolished England's slave trade. Sir
Isaac
Milner, a noted scholar, served as president
Summer
1973 203
of Queens College, Cambridge, and as Dean of Carlyle. Sir
John
Erskine
was an accom-
plished lawyer and orator, a member of the House of Lords, and Lord Chancellor
of
England
in 1806.
It is of interest that of these eight men, six lived to be 70 or more
years
old.
I might add that one of our statesmen-John Randolph-was also addicted, as was
one of our leading
surgeons,
Halstead.
More recently, medicine would find it difficult to defend prescription practices
which provide patients with an almost unlimited supply of pain killers, barbiturates,
amphetaminesand other drugs whose properties are now known to be addictive.
As a general statement, it is also fair to saythat the medical professionas a whole
for many
years
rejected its responsibility in the problem of drug abuse control,
as
well as in accepting drug addicts as patients and participating in drug
research.
I
know, after
years
of experience, that when one mentions professional responsibility
in the drug field, some physicians throw up their hands; others just throw up. Either
reaction is understandable. However, the profession, like Scrooge, now has another
chance to
reverse
its past sins of omission or commission. Whether we can be as
effective with drug
abusers
as
Scrooge
was with the Cratchit family remains to be
seen.
But at least there is evidence that people want help from health professionals
in many communities, as overtones of criminality recede in drug abuseprograms and
are
superseded
by a treatment milieu.
There is further evidence of support on which health professionals can base
acceptance of general responsibility by all medical and scientific disciplines. For
example, as recently as April, 1969, bills were introduced in the
Congress
which-in
attempting to strengthen drug control measures-proposed punitive procedures includ-
ing mandatory minimum penalties for simple
possession
of marijuana. But this time,
the medical and scientific communities spoke out. Public and governmental attitudes
were debated and changed. Attitudes were catalyzed by the concerned few, and high
on that Iist was the work of the Committee of Concerned Scientists, who put their
professional
research
careers
on the block and
refused
to retreat.
Out of all this came a legislative compromise: the Comprehensive Drug Abuse
Prevention and Control Act of 1970. Under provisions of that statute, the Nation for
the first time had the opportunity to devise treatment, rehabilitation and prevention
programsrelated to narcotic addiction, drug abuseand drug dependence. Our responsi-
bility as professionals, of course, became viable as a result of this opportunity, for
the terms of the Comprehensive Drug Act are quite different and far
less
punitive
than anyone could have forecast three
years
aRO.
Title I of the Act established mechanisms for development of actual treatment pro-
grams,
realexperimentation in rehabilitative
measures
andfor a prevention potential.
Marijuana has, for the first time, been taken out of the legislativecategory of narcotic
drugs. And also, for the first time, simple
possession
and first use of marijuana are
no longer felonies, but misdemeanors. Mandatory minimum penalties have also been
eliminated in all drug abuse court actions.
Reflecting our professional point of view, the
statute
also established for the first
time a medical responsibility in determining the risk of danger inherent in each of
the dangerous drugs. The Attomey General makes the final decision in this regard,
but is required to follow the recommendations of the
Secretary
of Health, Education,
and Welfare.
Since that time, President Nixon has by executive order established the Special
Action Office for Drug Abuse Prevention to direct and coordinate all federal programs
relating to drug abuse and appointed Dr.
Jerome
K.
Jaffe
as the federal drug abuse
"czar."
The
Congress
earlier this month provided legislative authority for funding this
office.
I realize that there
will
be a great majority of health professionals who
will
not
choose to become full-time professionals in drug
abuse.
But the way in which the
204
JOURNAL
OF
DRUG
ISSUES
programs
develop
will
affect the quality of counsel, service and treatment provided
by all professionals-whether within the programs or in private practice.
Professional
Objectives
We need to discuss the current
status
of our efforts and agree on some objectives,
so that the explosive proliferation of drug abuse programs born out of ignorant hope
can be replaced by something more effective.
. In the face of increased drug use and abuse, it is difficult to
assess
our
progress
In solving the drug problem. However, I think we are beginning now to realize that
although prevention of drug abuse is the ultimate objective, the immediate objectives
should be designed as acceptable
steps
along the road to prevention.
This, of course, calls for a rejection of the all-or-none attitude on the part of the
pU~lic,
the governments and the health professions. In this context, the goals of any
national, stateor local community program for treatment, rehabilitation and prevention
can be summarized asfollows:
The program should operate to minimize the adverse consequences of drug-taking;
toreducethe progressive useof
drugs-including
escalation to more and moredangerous
drugs-and
the spread of multiple drug use; and to find means to change situations,
Conditionsand attitudes that cause recruitment into drug
abuse.
How
this is done is worthy of the joint attention and comment of all the health
Professions.
Iwould like to summarize some of the components of the drug scene
asbackground information on which future planning should be based.
As recently as 1969, most Americans, including health professionals, usually consi-
dered all kinds of illicit drug behavior to be one phenomenon, extending from minor
ehxperimental
use of a drug through serious involvement and dependency. This is not
t e case. Differentiation must be made among at least four different types of
users:
1. The uninitiated and the abstainers-the uninitiated has not had illicit drug
experience. The abstainer has tried
illicit
drugs once or twice and rejected
the experience.
2. The experimenter, who sporadically tries an
illicit
drug. In his case, use is
not a part of his life style.
3. The moderate user, who periodically and with some regularity
uses
illicit
drugs
primarily for recreation. In his case use contributes a segment of his life style.
4. Theinvested user, who regularly
uses
illicit
drugs. For him, drugs have
assumed
a central role in his life style and his coping mechanisms.
. . .It is important for health professionals to understand three
bases
from which to
initiate their work.
First,ratios
of
risk in abusing drugs vary among the groups of
users
I have mentioned.
~alculation
of the relative importance of these risksto individuals and to society may
Influence the areaof the problem to which the professionalwishes to
address
himself.
Second,because
research
investigators have identified the major drug cultures and
non-cultures within the population, means of coping with the drug problem can be
related to work within any of these groups.
Third, we need to remind ourselves of something the profession has known for
~
long time: that the drug habit is a way of life which takes the user out of real
"d
feand occupies all his time and thought. Somefree themselves; mostdo not. Therefore,
a dlcts for the most part
need
sustained help over a long' period of time; and the
Post-addict definitely needs support in the community. Until the professions actively
~c~ept
this fact in practice, no currently-known treatment can or
will
be effective.
tIS a paradox that physicians agree, for example, that an amputee needs longterm
redh~bilitative
care and this is provided for him. The sameis not true of the narcotic
a diet, who may be, in other ways, as disabled as is the amputee, but who cannot
COunt
on any longterm rehabilitative help. Any drug abuseprogram must provide for
an open-ended rehabilitation service, whose supportive help
may
include anything
Sununer
1973 205
from housing to job training, but must include a pledge of continuing involvement
to meet the addicts' changing
needs.
The
Treatment
Alternatives
The current development of methadone maintenance programs in the treatment
of heroin addiction is a case in point.
Under
Federal
regulationsset forth in 1971, methadone may be used in drug mainte-
nance programs on an experimental basis" under closely supervised conditions. The
use of methadone is
seen
by the Food and Drug Administration and the National
Institute of Mental Health as part of a total rehabilitation program which includes
counseling, occupational training and appropriate psychotherapy. As an investigational
drug, it is available to community clinics for "controlled, scientific programs designed
to rehabilitate drug addicts."
In actuality, however, the approach to methadone programs has already become
too uniform and too rigid. Any hope for
success
within the program must be based
on the adaptation of a methadone therapy to each individual's needs; and this
will
of necessitycall for rehabilitative follow-up far beyond that which is presently provided.
The proliferation of methadone maintenance programs in efforts to treat heroin
addiction makes it our professional responsibility to consider the questions related
to the safety and efficacy of a treatment which substitutes one addiction for another,
as the
lesser
of two evils. If the professions follow the lead of the public's wishful
thinking that methadone may be a universal panacea to the heroin
problem-then
its experimental prescription
will
be perverted, the caveats to be considered
will
be
ignored, and it is possible that the entire problem of narcotic addiction
will
be com-
pounded by a hastyand casual effort to find an easyway out of thedilemmas surrounding
the useof heroin.
At any rate, to have any pragmatic value for the treatment of addiction to morphine-
like drugs, the medication employed, whether it be a drug substituteor a drug antagonist,
musteliminate the euphoric appeal of heroin; preclude abstinence symptoms; produce
no toxic or dysphoric effects; be orally effective; have long duration; be medically
safe; be of moderate cost; and be compatible with normal social roles. Obviously
no such treatment modality has asyet been evolved. Furtherdevelopment of the useful-
ness
of each chemotherapeutic approach must involve extensive experimentation, if
professionals, addicts and society are not to become victims of a
series
of ill-considered,
under-controlled fads in experimental treatment.
The prescription of amphetamines in the treatment of obesity
presents
an example
of utilization of a drug which could well have been controlled, but came into general
use prior to the time when it
started
to be abused. We are now trying to correct
that mistake and some groups within the medical profession have contributed to the
recognition that amphetamines are indeed dangerous drugs by imposing prescription
controls on themselves. Quite recently, the Federal govemment hasdrastically reduced
the quotas of amphetamines that can be legally manufactured in the United
States
in 1972. This is a beginning; but the pharmaceutical companies could, themselves,
assume
an active role in achieving further limitations in the supply of amphetamines.
Incidence of
Drull
Use
Statistics on the use of dangerous drugs are imprecise, but they are illustrative
in
assessing
the comparative usage of specific drugs in determining a national drug
abuse profile. In 1969, the number of
users,
categorized by the drug used, has been
OEd.
Note:
New
regulations
(37
F.R.
6940) issued by the Commissioner of Food and Drugs on
April
6, 1972 changed the status of methadone from an investigational drug to that of a new
drug.
206
JOURNAL
OF
DRUG
ISSUES
estimated as follows: Heroin, 250,000; LSD, 1 million; Amphetamines, taken orally,
4million; Marijuana, anywhere from 10 to 20 million; Barbiturates, 2million. The
number of
persons
who inject amphetamines (mainlining), mix barbiturates with other
drugs, or useinhalants other than glue sniffing cannot be estimated, except to
assume
f~m
observation and anecdotal evidence that their numbers are small in comparison
With the above estimates.
The increasing incidence, especially among young people, of polydrug use is one
of the most difficult problems facing treatment personnel. So, although recognition
of the dangerous effects of amphetamines
will
not solve this part of the problem,
It may serve to alert physicians to the rate of risk involved in prescribing the drugs.
The problems of limiting the national supply of thesedrugs, as well as all the others
arebeyond the scope of my remarks here.
How
much effect limitation of the availability
of
illicit
drugs has on the scope of the problem is one of the intemational riddles
of Our times and is involved with the entire
process
of control of drug-related crime.
From the health professional's point of view, this facet of the drug dilemma is
~st
illustrated by his quandary in relation to marijuana.
Cannabis
throughout recorded
history has had medicinal
uses.
It has also been used for centuries in other cultures
as a sedative and relaxant, and as a recreational drug. But its widespread use in the
~nited
States
escalated so quickly and so recently that little precise knowledge of
t e effects of the drug could be sought.
. What
research
had been done was limited by legal strictures and was further com-
plicated by the fact that no means had been found to
assure
a uniform potency in
research
samples. Equally perplexing, in any effort to pin down the factsabout marijuana
u~,
are the social overtones. A few
years
ago, marijuana smoking was a gesture of
~Issent
and defiance on the part of young people. Today, the useof marijuana has
Increased
throughout widening age groups and economic and social settings.
To date, the federal government has achieved several major objectives:
It hasmade
Cannabis
research
"respectable," so that highly competent
researchers
a~
no longer adverse to entering the field for fear of adverse publicity and colleague
disapproval.
It has made available in standard dosage forms of known potency a wide variety
of natural and synthetic materials basic to continued research.
Present
overseas
research efforts concerned with the chronic effects of
Cannabis
are being expanded.
Studies
of actual
users
in the United
States
continue to be complicated by the
fact that marijuana use is illegal and frequently involves the threat of
severe
penalties.
As a result, the obtaining of accurate information on the extent and changing patterns
of use is made more difficult. Clearly, much more needs to be learned about the
~areers
of marijuana
users,
including their use of other drugs, and the social factors
Influencing their behavior.
Today, the real issueon marijuana, in the public consciousness, is a political one.
The issue appears to be not whether the drug
causes
physical damage, but whether.
~ts
use has spread so widely that, like alcohol, the social costs of efforts to prohibit
Its
Use
exceed the physical risksof use.
. No scientist-whether physician, sociologist or basic
research
investigator-ccan
In good conscience advocate legalizing marijuana use on the basis of scientific know-
ledge, since the knowledge
necessary
to make such a determination does not as yet
~xist.
It would be helpful in taking some of the hypocrisy out of the drug problem
If SCientists-like any other
individuals-would
admit that the marijuana controversy
rnust be debated on political, legal lines and public health lines until more scientific
data are in.
The present situation
vis-a-vis
marijuana use can be improved through legal reform
and by a truly adequate funding of research. Given the resources, I am sure that the
definitive determination of the effects of
Cannabis
use could be reached. Anything
Summer
1973 207
less
is merely lip service and compounds the fables and value judgementsthat surround
the use of this drug.
Actually, some of the marijuana fables have already been disproved. For a time,
one of the popular put-ons was the cry among young people that marijuana is for
us what martinis are for you. This ploy was effective for a time in that it set parents
and the establishment back on their heels and also led many adults to try marijuana.
In reality, however, this was never true, they have always used both drugs. In 1971,
surveys
of drug use in the junior and senior high schools showed a marked increase
in the use of all of the drugs of abuse with the exception of tobacco. Alcohol use,
which somehad
suggested
might be replaced by marijuana, showed the largestapparent
increase.
The physician's role in reference to counselling and treatment of marijuana abuse
is difficult to define. There are viable findings that marijuana can cause psychotic
reactions in some
users.
It is now obvious that the effects on the "pothead" or invested
userare different from the effects of experimental or occasional use. There is increasing
evidence that like LSD, marijuana can affect the motivational set of those who abuse
it. How the physician deals with this so-called "amotivational syndrome" can only
be decided in each individual case. However, physicians, like other citizens, have
a responsibility to
search
for altematives to drug abuse, as well as to treat those who
are already involved with drugs.
Alternatives
to
Drug
Abuse
During 1971, a spontaneous
search
for altematives to drug abuse that could be
provided to young people in their communities involved a literally countless number
of individualsand groupswithin a wide range of urban, suburban and rural communities.
In an effort to channel these experiments into effective action, the
Federal
government
began developing a program of support through conferences and technical
assistance
to community groups.
How
much impact attemptssuch asthese to provide positive, acceptable alternatives
to drug abuse
will
have, remains to be seen. However, these kinds of projects mark
a beginning; from the point of view of the physician as a citizen, there can be no
reason
why a doctor in a given community could not serve as the anchor-man for
such an altematives project.
The next horizon for the health professions must be to develop means to prevent
illness as well as to treat
disease.
If this is ever to come about, the
physician-of
whatever specialty-must concern himself with the entire breadth of the human con-
dition.
Those physicians responsible for the training of health professionals are beginning
to enrich the curricula in medical schools and health sciences centers as a means
to achieve this objective. And in this context, every medical student should have the
opportunity for training in treatment modalities for drug abuse, since the problems
related to drug abuseare among the human conditions which can no longer be ignored
by medical practitioners and must receive emphasis in the modern medical curriculum.
The need for additional
research
is also obvious; but all the studies in the world
will
avail us nothing unless we learn how to
reverse
the concept of chemical
escape.
For many people, drug abuse begins with purchases in the local drug store; with
prescriptions too casually issued in a doctor's office; and with easy
access
for all
members of the family to the contents of home medicine
chests.
Quite definitely,
drug abuse is not confined to illegal drugs and the illicit market.
We can talk about risks; but young people have always taken risks and, for too
many kids, the risks seemfar
less
than the threat of an environment which they perceive
as empty of reality and filled with contrivance. So, in addition to providing a physical
rush, drugs serve to improve the drug user's environment. For, if there is nothing in
the external environment that can be counted on as really
"real,"
then people turn
208
JOURNAL
OF
DRUG
ISSUES
With
desperation to the inner environment. In the tradition of
Descartes,
Hume and
Berkeley,
when the bloom is off the peach, we acknowledge that, whatever their source
and
substance,
our feelings exist. And in a world stripped of the genuine in favor
of imagery, all that many have left to
assure
themselves of the reality of feeling is
to amplify
them-quickly;
now-with
their own imagery by blowing their minds with
drugs.
It is not enough to be alive. It is
necessary
to feel alive. And the question too
many young people ask, if one can get them to put those amorphous feelings into
Words,
is: How do you feel alive without drugs when everything around you is dead?
Some restraint in the unnecessary prescription of drugs would serve to
lessen
the
demand for mind and mood-changing chemicals. This, in turn, would affect the supply
manufactured for legal
purposes
and, hopefully, make it easier for enforcement officials
~o
control the supply of drugs now available through illegal
markets.
The media and
Industry must reduce the barrage of appeals and encouragement to use more and
more chemicals to relax, to sleep, to be alert, and to
assauge
minor
aches.
We are rapidly moving into an area of understanding of brain function, leading
toward the artificial alteration of human behavior. Our technology will increasingly
Provideus with highly potent synthetic materialsand through the
mass
media to inform
anyone who can read, listen or look about these dangerous
substances.
In the face of this, what
standards
of social behavior do we wish to maintain?
I think the fact of ever increasing drug use is finally getting to us. If the situation
Continues
on its present track, it
will
not be enough for us to continue to hope, like
Mr. Micawber that "something
will
turn
up."
The magic of chemistry
will
turn to
~ust,
unlesswe turn up somethingelse, like the psychological substitutes to drug addic-
tion and dependence.
Respect
for all drugs must be taught through every avenue available to individuals
of all
ages.
But beyond the respect for drugs, Americans must be motivated to.flod
out for themselves that the world is not changed for the better when individuals retreat
from troubles via a magic pill. A drug may remove the
persons
from the world for
a time, but the world remains unchanged, including thedimensions of the drug depen-
dence problem.
Surnrner
1973 209
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