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'|1Iürr D. rRY

UtfurdE of Gficega

Visible and InvisibleConsequences

Toward New Models ofDrug Action

The Prevention of Drug

BibliograPhY

Acknowledgements

Biographical Notes

Index ' "

ofiiA&erhie;.

7.

8.

9.

67

78

Misuse 98

119

r24

126

r29

- Preface :- ,... ' ,' . ,' . :'

t. The Risks and Problems ofDrug Misuse

2. Mystification by the, Pharmaceutical Indrrstry

. - t _ : : _ '

Mystification by the ,l , :Medical, Profession

The Vicious Qyqls ef -.

Mystification'

Illegal Drug Use andMystification in the

. Y6uth Culture '

. : ,Mystification in the Judgement

of Drug Effects: ' . ' "

uu

vr

l6

24

38

45

oJ .

4.

J .

6.D I

Prefuce

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Last year, 202 million legal prescriptions forpsychoactive drugs-stimulants, sedatives, tranquil-izers, antidepressants-. were filled in pharmacies forpersons who saw their physicians first. During a timewhen the attention of both the public and mostofficials is concentrated upon the use of "illegal"

drugs, this steadn marked increase in the giving andtaking of legally prescribed or purchased psychoac-tive drugs has gone relatively unnoticed. From timeto time warnings have been issued to the efiect thatthe increased use of such drugs represents a veryserious public health problem and that their con-tinued misuse has very serious consequences. Suchwarnings have gone largely unheeded, and the pre-scribing and taking of psychoactive drugs have notabated.

Mystification anil Drug Misusa deals with themystification that surrounds the giving and taking ofdrugs, both legal and illegal, and describes howmystification, as practiced by the pharmaceutical in-dustry; the medical profession, and the youth cul-ture, contributes to the growing misuse and abuse ofpsychoactive drugs.

XKXKXKXKXKXKXKXKXKXKXK

"When the individual feels,the community reels."

ALDOUS HUXLEY

Braae New World

llte consider all druggiving and drug taking

si$in one broad conceptüal framework because we

taä,UaA" issues aitaching to the use and mis-

ä.n.s"l itrugs ar9 liqilar to those attachirig to

t "t" äa.i*"t" of illicit drugs* --Ältho,tgh

most of the current voluminous

*riti"g "b""t'th" misuse of drugs concerns $e mis;

irc?"ptpho"ctioe agents- by- ro33-8 pe-ople' and

#riyin" use of drugs obtained illegally' urc feel

;;lt d".tf the use and misuse of drugs by young

äpf" wUtä paying so litde attention to the grorv-

il'i'use *a tisute.öf .p,ytho"ctive agents-in- general'

üüu O*. prescribed by phy-sicians and those ob-

"i*a "r." ttre counter without prescription' - is

lighty niskaaing and un-productive' This broader

o."rrpL,it leads to conclusions about what social

;;tiä* ought to be regarding the -prevention. of

ärug abuse-which-ar1 vgry difierent from those im-

oüeä Uv most of the current discussions about

foycnoaäve drugs in medical joumals and the mass

media'

fun Franciscolannry 1971

HnNnv L. LSNNIRDLron J. EpsrrrnAr.rqor,o BsRNsrmNDoNar,o C. Rersou

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The Risks and Problems

of Drug Misuse

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In the giving and taking of.drugs'.one pays

for whai one gäts. Tt" double entries in this ledger

"ä i- oft."'iSnot"-d.1ltl are too easily denied by

,f,. voutitf"f uier of illegal drugs who thinks that

u*äto-.rtting for nothing, who considtl -o{yä-."iil-.di"t. sensory- experience' the ecstatic high

ää rr".ao. from anxiety, without attending to the

;;;;"1 ancl group costs exacted' The inevitable

äü "f drug irse äre also strenuously denied by

ti*" "aoo.u"tes of "legal" drugs-physicians who

är"Uy and consistently prescribe tranq-uilizers -andä"tiuär. Part of contemPor"ry medical mytholo-gy

i, tn"t atogt somehow do not exact the-same price

ho. th" u-ser when -hey are prescri'ed"by a phy-

sician and that a patient ann get relret trom hrs

,"-o*-t and escäpe from his troubles through

pryiUo"aiu. drugs,-providing they are duly pre-

scribed.t

rWe do not wish to minimize the considerable 4if'ferences between legal and illegal ilru-gs in terms of dosertaodardizadon and purity of tlle cheorcal €omPouno'

. : Mystitcalion and Ilrug ttiruse :.' .

.'

When physicians prescribe any drugs, theyare or should be aware of the range of possible sideefiects. Under certain circumstances, with manydrugs, the advantages may be clearly outweighed bythe disadvantages. Penicillin, for example' causesallergic reactions in some and is fatal for a smallnumber of patients. The use of Penicillin in thepresence of severe infections involving penicillin-iensitive microorganisms is not subject to question,but the use of penicillin for minor or nonspecificinfections (which is unfortunately not a rare Ptac-tice) is properly deploreil by sophisticated physicians. The risks involved in such promiscuous druguse, especially when a drug of considerable Potencyis involved, are simply not outweigheil by potentialbenefits. Furthermore, the issue becomes more com-plex when a drug known to have serious adverseiide efie.t, in a siiable number of patients (for ex-ample, Chloromycetin) is administered, becauseoth;r treatments have failed. Here the danger to thepatient is considerable because the infection is ar-rested.

Only when the effects of a drug are fairly wellknown can the value of using it be assessed in rela-tion to its possible dangers and costs. Unfortunately,such knowledge is not available for most psychoac-tive drugs for two main reasons. First, psychoactivedrugs have been used for only a comParatively shorttime. Second, their action tends to be less specificand more diffuse than that of other drugs in medicaluse. They not only alter body Processes as do otherdrugs but also afiect a whole complex of psychological and social processes connecting the individualwith his physical and human environment. Thus,

. . . '.,.'

:.., T[e.,ßfr13; "i a 1lotten"' of Drug Misuse

ffignswnffmilffi,:fföiiir'"v g'"' not themselves suffered

;r;:ää e*p"ile"tt"' This denial of hidden costs

ä"ä*ry dcursruith the use of illegal drugs'

Those in the meorcal profession oI'h:. y,tl'l

culture who are inclined to deny or make lrgnt ot

it'ä,.".. of such unanticipated and hidden con-

;;"ä;;; of psychoactive ärt'gt may profitably

ääalt ,rt. o"ioitottutt error of that most astute

äiä., of human e-xperience Sigmund -Freud' As

i. äll t""*", Freud was fascinated by the proper-

;*; ;;"; and advocated its use for the treat-

liäi ri *t.rt"logical and nen'ous conditions' He

ää';t;;il basis of.his own experience with the

ärug, "od on that basis he considered it to be non-

ääi;. and without serious side effects' As a mat-

äoTfa;, Freud saw cocaine as most useful in the

ir*Ä."t of "adictions and employed it in the treat-

ä."i J,ft" morphine addictiän of his friend and

;;ä.-"g". Ernst Fieischl-Marxow' Freud had to wit-

ness for many years ro come ttre 9ufie1i1g which he

ü"J un*itti"gty induced in his close hiend'"-- - In letieis to his financee, Martha Bernays''

Freud extolled the benefits of cocaine' which he took

2E. L. Freud (ßd.\, The Letters ol Signund Freuil(New York: Mcctaw-Aitt, 1960)' pp' 195' 145'

E

' . : i i i ' , , : ' r . . . l l , . . t : ,1 . ,

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before important social gatherings, to cure hismieraine heatlaches, and to facilitate his writing.

On"January 20, 1886, Freud tells i\{artha of his visit

to üi, t"".h.t,,tle renowned'psychiatrist under

whom he.was studyin$ in Paris. "Charcot Ins re-minded us once more of our appointment of Tues'

dav morning. . . . We drove there in a carriage.

. ,' . R. was-terribly neruous' I quite calm with the

helo of a small dose of cocaine, although his success

was' assured and I had realions to fear making ablunder."

In another letter Freud writes:

I was suficring from migraine, th-e thiril attach

this weik, by the way, although I am other-

wke in excillent health-I sttspect the tartar

sauce I had fot lunch in Flei'sch(s room d'is'

asreeil with me-I took sorne cocaine, watched

tte migraine aanish at once, uent on writing

*t babe, as well as a letter to Prof " Mend'el,

büt'l was so wound uP that I had to go on

working and writing and couldn't get to. sleep

before Iour in tle morning ' Tod'ay I am in flne

fettle again, uery pleased, with my .paper, which'is short but contains sonle ilery important in'

lormation anil, should raise my esteem again in

ihr ryrt of the public. [Emphasis ours']

It does not appear from this letter that Freud

recoqnized the possible connection between his use

of cäcaine and his being wound up or his inability

to qet to sleep until four' More serious, however, was

fäa's exträpohting from his own experience with

cocaine to "äuo."t. its use in psychiatric Practice

''i t,t* *ito ,"oi,rtotr"tt or rlrug Misuse

*T,#ffi?i.;-Jiltr#i#i;il:il:

äffitrt*dtrtuffid*ä*[t##*-#',iäiäffi:'#'r?'-ää"ä to-tlit^e''�q:l]^:lff'nt with resard to the

cor and benefits ot cocalnc'"* -Io later years Freud refused to use any drugs'

.u.r, tor"rn. t"iie{ of pain' since he did not rvish to

*ä.n.. the "clouding of consciousness" which he

äfitiä an inevitabtJaccompaniment of sedative

ä"tAg.ti. medication' It may be rvell.to keep

.il. ilfurlt-rio" in mind when confronted by the

ääJ a"t it is after all the user of drugs rvho'

iri-U* l*it of experience, is the best judge of-drug

ä;;;;i drug dangers', one should not simplv

;?;;ä,h. juägment of a user as to the benefrts

ää-."rt" ".*iinf from drug-use' But.since.psycho-

active drugs simultaneously atect a varlety ot Pnysro-iä-r, piy.tt"logical, and social functions' the

,n"rr.. t ttt. question of recognizing a-nd describ,ing

;;;" and ckts is too complex -to be arrived at

l.r.fv tftto"gtt individual subjective experience'

In adäition to the judgment of the user,

ourely medical criteria are relevant' But so also are

it.-p..*""t and social values of the patient' his

ä.iiv, u"a community. For example, a physically

sThe Lile anil Work of Sigmunil Freud, Yol' I(Ner York: Basii Books, 1957) ' P' 85'

: t , '

- . , ' l , l ' " ' ' l t , r t ' , ' , " - . . , ' :

a-ctive patient may prefer to remain ,.anxious,l ratherthan ruffer- the physical lethargy induced by a rran_quurzrng drug. A mature and creative individualmay choose to take LSD in the hope of achievins anew synrhesis, yet be aware of the iotential risksln_volved in taking this hallucinogänic drus. Wharthen is the justification for the mledical proiession'sor,the community's persuading or forcing one ind.i-vidual to take the drug and a säcond to ab"stain fromits use? Perhaps disregard of individual options isjustified when the individual may unwittingly en-danger his own life or the lives.oi others in"takingor failing to take a -drug. But even here compleiquestions of value arise.

In 1387, six monks were imprisoned becausethey climbed Mount Pilatus, the hishest mounrainnear Lucerne, Switzerland.a At the tite such under-t:kings were viewed as a challenge to God or todemons. Not until the middle of tlie nineteenth cen_tury did mountain climbing become Eenerallv ac_ceptable. Mountain climbing is now a rerpi.tedactivity, and men who risk iheir lives atteÄptingnew and dangerous ascents .receive widesöreaäsympathy and admiration. particularly danserousascents take their yearly toll of the lives of äoun_taineers, yet each new dangerous exploration isgreeted with admiration for the couragä of the menwho think they can succeed.

, Many-people who have taken hallucinogenicdrugs argue that they too are explorers, that the"v areaware of the risk involved, but that the ,'trip', isworth the risk. Yet, society imposes severe legalianc_

^ . . ̂ __n Y, Imseng, ..Erstbesteigung des Sudlenz,,, 1g70, inSAAS-FE Informaiion rg7o /7r", sü.hd*ik*ii,' vjJri"iä.

- . r t , , , . : , . . . , . . , , . , : . . :

MYrtificatim and Ikog 'Iüsc

During the four'years of th'e war she hail been

exposid to'the äan more dange-ro1ts radiation

at'the Roentgen ü,Waratus' A slight deteriora'

tion in the b"lood,'innoying and pai.nful burns

on the hands, which sometirnes dried' uP and

ii*iti*rt suppurated, were not, after all'-such

o"r't seoere bäi'shrnents for the number of rishs

tt i naa ,un! . . - Mme. Pierre Curi'e dieil at

Sansellemoz on July 4, 1934' The disease was

an ablastic bernicious anernia of rapid, leuerishdnäIobrneÄt, The bone tnarrou d'id not react'

i"oboirtv because it hail been iniureil' by a long

äccumuiation ol railiations'0

These examples bring to mind the fate. of

Timothy Leary, whä pioneered in the investigation

J it"tt*ittog.ttic drugs such as LSD and psilocy-

bin. Whatevär history'i final judgment of this com-

olex man, it is clear that he made serious errors ot

i"ac*."t *ith regard to both the beneficial and the

ä;;;;r;"t efiects öf these drugs' The ceaseless s-earch

whiih led him to ingest these drugs quite Probablycontributed to his rather extreme position on drugs

and other matters.When one sees young Persons who have ad-

ventured along the drug route, -clothed il rags'

ohvsicallv ill ind mentally dulleil, wandering the

itt..tt, tit.y remind one of the victims and-survivors

"n,tt. bo"it"t party, that group of in-trepid 9io1e.e1swho, unaware of the heavy snowfalls rn ttte Ärgn

Sierras, attempted to cross hom Nevada to UaIr-

io*i".'Witnoüt accunrte knowledge of the weather'

Doubledan 1938)' P. 377.

The Risks anrt Problems of Ilrug Mnsuse

dons on those who gamble their health or their livesin drug-taLing, just as it once penalized those whowished to ascend high mountains. One must surelyask why it is considered so admirable to risk one'slife climbing mountains while it is considered soreprehensible to risk it taking drugs.

Unfortunately, pioneers, those treading un-charted paths, are often caught unaware by nerr andunforeseen hazards. This is certainly true of thosewho pioneer in the discovery and use of new tech-nologies. For instance, Wilhelm Roentgen the dis-coverer of X rays, could not fully recognize theuntoward efiects of continued exposure to X rays

' and many early workers died of overexposure. Wil-liam Halsted, the first surgeon in the United Statesto use cocaine extensively as an anesthetic in sur-gery, became addicted to it as a result of using him-.self as a subject in his experiments with it.6 MarieCurie similarly fell victim to radium poisoning.

' She uas working . . . with the singular im-prud,ence which was usual with.her. She hailalways scorned, the precautions which she sosewrly imposeiL on her pupik. . . . Her blooil,

' content was abnormal. What ol it? . . . Forthirty-fiue years Mrne. Curie hail hanilled ra-dium and breathed, the emanation of railiurn.

rJones. op. cit. Vol. l, p. 95: "In the same year,W, W. HäIsted, Ämerica's greateit surgeon and one of thefounders of modern surgdry, iniected fcocaine] into thenerves with success and thus'laid the baiis of nörve block-ing for surgical purposes. He paid dearly, however, for hissuccess, for he acquired a severe addiction to cocaine, and ittook a long course of hospital treatment to free him fromit, He was öne of the first new drug addicts."

l ,

l,.trf" Riski and Problds of Drog Misure

the mountainous terrain' the means of protection

läi"ti irt" heavy snowfall and hard winter' many

fi äää*,'f t.h..D-?T":-?ä?.1',1':f t"*llX'"Täoaid a heavY Ph)'srcar Prl(ädvised efiort'"*""-

ln the light of the range of costs t""tl-"j-ll

ä'"L.#:?,11","#:lt","'':#T:i\1;'i.:Tl::i:öä:;;; ..r,t ,.d up-on.the use of.ille€al +ryst T1,rr"i trt. steady, maiked -increase in the giving anc

äü;';i i.#ilv prescribed or purchased-psvcho-

ffiä a*g,"t'"; g-':'"f.il:I*f:::t ä:time to time warmngs nave-De.clr t""""" ':-,:::^-:.::,

Jl"i,rt" increased usä of such drugs rePresents a ver)

;ä; public health ptoblem and' in terms ot

cumulative consequences' that their abuse.has very

,ät", t.*rrt. A iormer'president of -the American

il;ä;üGeneral Praciice stated' "I have become

o""i.r"-.1"..*ed about the use' overuse' and abuse

äi'üä orv.rti" drugs-particularly the ones -most

ä*ä""'üi ;;i;J,'äqoiti""' I bälieve thtse.drugs

;;;-;;; o'nlv used wrönglv' to excess' and without

ää"""ä. i"är.ation but ihat in many instances their

ffiiläi'Jte-'s. t'u' led to dcpendencr' habitla-

i.-ott, u"a addiction with all of the consequent re-

sults." ?"*'-' So.h warnings have gone largely unhe"ded'

and the steady increise in the prescribing and tarrng

ä;ö;;;i". a'og' has noi abated' These druss

? c. Witten, address given to t{re em5.rical1 lga'".y ot ö"*ä-A;:,':",#,iitf::::ffirY:f 'il:"i€:fDrüs Debend'enq and' aaiätf ääii,v oiirict Branch' American Psychiatric AssG

ciation, Marth l0' 1966'

' D-fFtification . and'Drug Mirrrsi

include energizers, so-called tranquilizers,.psycho-. stimulants sudi', as amphetamines, sedatives, and

hypnotics (both barbituiates an<l,nonbafbiturates)-In 1969 phar:nacists filledrrirore'than 202 rni[io'tprescriptions for such compounds, of which 80 mil-lion wele new prescriptions (the rest were refrlls), ina total populationo!,200 million people.e These fig-ures would- be substaritially higher were they to in-clude hospital and clinical usage. At the same thatprescriptions for legal drugs are on the increase, esti-mates show the use of illegal drugs,to be increasingas well.

In whatever way this major scientifi'c and so-cial development:will' ultimately be appraised, theintroduction of psychoactive drugs into psychiatry,

. into medical practice, aird into the community atlarge has generated a bewildering array of medical,ethical, legal, and behavioral scientific questions-'questions of fact and theory-the implications ofwhich have not yet begun to receive the attentionthey most surely deserve. Nor; indöed, has thete everbeen a major effort to inventory the complex ques-tions and issues involved,

. ' .:. We have elsewhere attempted to ofier a com-prehensive and general framework for thinkingäbout psychoactive drugs, their uses and efiects.o

- This book, however, deals with one of these signiß-cant areas, namely, the mystification that surrounds

s M.rBalter, address given to the American PublicHealth Association, Houstonl October 1970.

e H. L. Lennard, L. I. Epstein, A, Bernstein, andD, C. Ransom. Drup Giaing-and-Drue Tahing: An Intro'iluction to Sociophaimacolo-gy (Chicagö: Unive-rsity of Chi.

_ öago Press, in preparation).

t : . 1 " ' , t - r .

,: ' : ;

Tbe'Risli and Frqbleüs of Drug'ttlio"te, ' --.. " " ' . ' : ' ' : :the grving and taking ofdrugs, both legal and itlegal'

' utta"a.r.iiUes how oystification, as practiced by the

pharmaceuticul indujtry, the medical profession, and

ihe vouth culture contributes to the growrng mruse

andäbuse of PsYchoactive drugs'- The piocess o{ mystification involves the tlefi-

nition of issues and situations in such a'way as to

obscure their most basic and important features'

The way in which a situation is rendered may some-

times aPPear to be favorable to one Party at an-

other's pärry expense. However, the consequences

of mystificaiion often prove detrimental to all se8-

menti of a system. Thö act of mystification' by defl-'

nition, tends to induce a mystified or confused state'

that is, however, not necessarily felt as such' The

mvsdfied party, while confused, may even view his

mystifiersäs benevolent and helplul.

that it is carried out implicitly rather than explicitly'- making it harder to recognize the misleading- con-

strucd;n of the situation. Whenever we detect

mystification, we are alerted to the Presence of a

.ottfli.t that is being evaded or that is unrecognizedbv those involved. In this book we reveal some of

the elements of the pervasive mystification that sur-

rounds current psyChoactive drug use and that in

turn contributeJ to un ever increasing misuse of

these drugs.Drug abuse has traditionally referred to the

ohysiological, psychological, and social problems as-

iociatea wittt ihe ilIegal, ixcessive use of dtugs lor"nonmedical"

PurPoses' The term ilrug abuse con'

iures up imagCs of heroin addicts, traumatic with-ärawal,'pushers, and the underworld trafrc in drugs

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with :which ,tbese are connected-'More resent\, 1oth6se stereorypes have been:added the colloquialdescriptions a'cia neaa and speed' freak. Problemsassociäted with drug abuse have tended to be formu-lated in such terms-as the recruitment of "suscepti-

ble" young persons into illegal drug use and the

eu"tttr.l ptyii.ut and psyehological deterioration if

thev persist in such use.'

' ' At the same time most of the research on

psvchoactive agents, their usefulness, and efiect has

Leen based ott- u .y*pto-, disease, and treatmentmodel. Information collected within this frameworkhas been limiied to än assessment of the efiects of :druss on symptoms associated with emotional dis-to.ü"rr.., ind attention to other drug efiects has

senerally focused upon troublesome physiologicaliide effeäts. But attention clearly needs to be paid to

other pervasive problems by studying the relationbetweä drug uiage and psychological, social, andinteractional functi,ons and patterns. This relation'ship includes the efiects of drugs upon social groupsanä settings, considering effects on both the druggedand the nändrugged particiPants.

Before one can propose a Program tor the

or.u.rräo'r,-oi il"s;#;ä; ,,..d, tJ kno* ubootihe functions drni giuittg and drug taking serve forphysicians as well as for patients. We need to learnäläut tft" nature of the iocial settings and systemswhich encourage people to seek drug solutions forpersonal and social problems. lVe need to know

' iohether the use of drugs furthers intimacy and re-latedness among persons and satisfies their need for

. novel experieniet or whether':certain'rmodes and.;"functioniot interaction are being sacrificeöby theii '

,,. r-r r',n.nq- ßirL" aoü }ioblcqr oIPryg Mrsut' .

use or w-hether both r-esults occur' More significantly

Iä]*. "..4 to explore an unchatted territory re-

-.äins how the rntroduction of drug into social

,9ä;.:"ü" rh" ParticiPants in these systems.(hm-

üä nospital wards, neighborhoods' societies)' For

ää&,'h"; -"''y p.t'ions on what sorts of drugs

ili-r'tbo.rt what sorlts of changes in a social -systemli;"*ÄJä C;rtaintl -utterutions

of 'le psvchologi-

ä *a social modes of behavior of a significant seg'

;#;i;ptp;Iation can be -e-xpected to alter the

lopulation-aJa whole in significant resP€cts'- -""t"'-i; "adition to the obvious types of drug

abuse, the mere volume of increased drug use may

lirl- rt"u" dysfunctional side efiects' leading to a

,"Urf. "t secändary kind of drug abuse'.In the sam€

ä"v ttt"t too many cars on the road results in an out-

;o,äöffiio'that for which they wer-e-designed

-o n.t ,r. from place to place comfortably,' safely'

ouickfy-at extensive Pattern of drug ingestton m.ay

,itrderiut the very goals for which they were rnrtrarry

il;;dJ. Thus, ihä problem mav n9! b: so difierent

from the one we now experience with tqe Po[utronof our earthly environment' The introductron ano

;;t;;;-f prv'.hou.tiu. drugs in the hum,-an-popula-

;i;;-iuv i"p..r""t anothei kincl of pollution' one

which mav älso have the potential for prectprtatrng

an ecological catastrophe. An ecological model may

i"i..JU? relevant to'an understanding of drug use

and its consequences uPon Patterns of human rnter-

acdon and the quality of human exPerience'In this boäk we discuss the major segments ot

our society which are generating increased drug-use'

We first äiscuss the role of the pharmaceutrcal rn-

dustry, which in the efiort to expand i$ market ot

; ,' 'Mystification and "Drug Misuse

botl presciption and nonprescription drygs fas pr9-moted is products by engaglng in mptification Wcthen examine the role of the medical profession indrug misuse: the factors which encourage physicians' drug prescriptions and the considerationswhich make it likely for some Patients to be givenpsvchoactive druer while others are not. The closereiationship betieen the pharmaceutical industryand the -.di.ul profession receives our attentionnext, Both groups are interested in defining moreand more problems as medical ones in order to jus-

tifv both ahedicat model and tJre intervention witJrdrugs. We show how the pharmaceutical industry,the

"mass media, physicians, and Patients are wit-

tingly or unwittingly locked in a vicious cycle ofmutual mystification in which the problems of thehuman condition are increasingly medicalized.Mystification, however, is also prevalent in theyouth culture. We suggest that young people oftenemploy psychoactive drugs in waln and for purposeswhich-aie'not dissimilar to those promulgated bythe pharmaceutical industry and medical professionand-which are analogous to the way in which manyadults use alcohol.

Following tJre discussion oI these major so-cial elements is a treatment of the user as a judge ofdrug efiects. We argue that misjudgment of thenature of drug action is common among users andpresent evidence for this point. A model expJainingmisjudgment of drug effects is presented.

. .:' .Next we turn to costs and examine some con-s€querlaes, visible and hidden, of excessive drug use.We raise the issue of side efiects, both physical andsocial, and explore some larger dysfunctions of drug

.,:i I "O" Risks anil eroUlns of Diug

taking. An examination of the models of drug action

i-Jiiit in the use or, rather, misuse of psychoactive

änigr then follows' We suggest an alternate, more

"ppiopti"te_model of drug action and the treatment

of dtug Problems."li is at this point that we deal with the larger

societal matrix anä discuss the efiect of rapid oocial

.ftu"S. o" increased drug-use. Finally, we conclude

ifre b"ook with recommendations to the medical pro-

i.rsion, edocators, and the public at large regarding

social policies for the Prevention of drug misuse'

Th"r. i..o-*endationJ follow from the conceptual

frum.wotk developed in the book, a framework that

includes a considäradon of legal and illegal drugs,

medical and nonmedical aspects of drug use, and the

effects of drugs upon,Persons other than the user'

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