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 CONFUSION AND DRUGS
CLORINDA G. MARGOLISt

Drugs have emerged, suddenly and dramatically, as a major

social problem. The rise in illegal drug use, for instance, has
provided a lucrative market for organized crime, inflating the costs
of illegal drugs-particularly addictive drugs-far beyond the fi-
nancial means of most addicts.: To support their habit, addicts
regularly turn to robbery, burglary, prostitution, and trafficking in
illegal drugs. At least one-half of the serious crimes committed in
this country are due to the efforts of heroin addicts to maintain
their habit. The cost to our criminal justice system of trying to
control drug traffic is considerable, 2 and the effort shows no sign
of being effective. In Washington, D.C.'s Model Cities, a recent
survey reveals that one boy in five between the ages of 15 and 19
and almost two men in five between the ages of 20 and 24 are
heroin addicts. Their criminal activities are estimated to cost $328
million yearly in robberies, thefts, etc.2 Treatment programs, fin-
anced largely by federal dollars, are costly and reveal an extra-
ordinarily high rate of recidivism. As the drug problem increases
and viable solutions continue to elude us, citizen and professional
groups seek to investigate as well as they can the relevant aspects
of current drug use, with an eye to possibly fruitful courses of
action-particularly legislative. Unfortunately, criteria for assessing
drug problems are unclear; drug research yields equivocal results;
and even our definitions of addiction and drug abuse are tenden-
tious and ambiguous. Before turning to certain detailed questions
regarding the legal and medical status of addicts, therefore, we
might usefully consider an overview of drug use in contemporary
society. In fact, this paper attempts to place the drug issue within
a larger social context and to explore some sources of confusion that

t Chief of Consultation and Education Services, Jefferson Community Mental

Health/Mental Retardation Center, Thomas Jefferson University. Ph.D. 1968, Uni-
versity of Cincinnati.-ED.
1. See Stachnik, The Case Against Criminal Penalties for Illicit Drug Use, 27
AML PSYCHOLOGIST 637, 639-40 (1972).
2. See Packer, Decriminalizing Heroin, THE NEW REPuaLIC, June 3, 1972, at 11.
3. See Atkins, The Epidemiology of Heroin, 12 THm ScmiNcas 8-9 (No. 3, 1972).

1023
1024 WAYNE LAW REVIEW [Vol. 19

bear directly on proposals for the social and legal management of

the problem.

I. PRESENT CONFUSIONS

To construe the drug issue-in particular, drug addiction-as

merely a legal or medical problem is utterly to fail to appreciate
the complexities of drug use in our society today. Alarmed parents,
sincere professionals, and concerned legislators have of course joined
forces in the search for immediate ways to alleviate what looks to
them like an epidemic, a wave of increasing drug use accompanied
by the most serious social hazards. Not surprisingly, they tend to
view the drug problem simplistically, as a relatively straightforward
problem that will lend itself to equally straightforward solutions:
"tougher sentences for pushers"; "addicts are sick"; "if parents
were only stricter." Unfortunately, drug use is deeply embedded
in the variable and conflicting patterns that make up the social
and cultural climate of our country today. Only by examining
these patterns and the very nature of drug use in relation to exist-
ing social pressures can we begin to formulate a convincing picture
of the drug scene in the relevant moral, medical, legal, and cultural
terms. There are, of course, a good many issues of social concern
that cannot possibly be effectively explored if isolated from the
dynamics of a total society-for instance, aggressiveness, violence,
juvenile delinquency. Such issues-the drug problem among them-
do not lend themselves to any simple, univocal, "right" construction.
I wish to concentrate chiefly on the conceptual complexities.
For instance, by reviewing several subgroups who assess drug use
in quite different ways, I should like to demonstrate the futility
of expecting to discover simple, objective criteria that express a
general consensus about what constitutes good and bad drug use.
Then, offering further, frequently overlooked, distinctions regarding
the patterns of drug use, I should like to conclude by suggesting
some respects in which drugs might even be viewed as useful for
future societies.
Some commentators claim, on historical grounds, that drug use
increases in unstable societies. 4 Given the uncertainties and in-
securities of our own transitional society, we should expect to see
increasing drug use. But the instability of our society is, at best,
only part of a much more complicated picture. Not only are we

4. E.g., McGlothlin, Introduction, 27 J. SocIAL IssuEs 1, 4 (No. 3, 1971).

1973] CONFUSION AND DRUGS 1025

beset with a rapidly changing world, but an efficient pharmacology

now produces an enormous number of synthetic substances that
alter physical and mental states in obviously sought-after ways. No
longer need we depend upon often inaccessible plants, fungi, and
similar natural sources to help soften the stresses of life; we antici-
pate, if they are not already at hand, a range of synthetic chemicals
that will alter, on demand, many feelings, conditions, moods, modes
of perception and thinking.5 So our drug patterns may be a function
of technologically favored habits as much as of social instability.
Let us remind ourselves briefly of some prominent complaints
that may have contributed to the present social climate. Needless
to say, all are highly argumentative-though, since they are con-
vincing to considerable segments of the population, they cannot
but affect public attitudes and policies regarding drugs. Since World
War II, there has been an enormous increase in urban problems,
said to be due, for instance, to overcrowding and the decline in
quality in housing, schools, municipal and clinical services, and the
like.6 Large numbers of unskilled persons continue to move to the
city with the initial goal of employment and are gradually, reduced
to welfare roles. 7 As the country's deprived persons have become
more insistent and more frustrated, confidence in political and
even the principal service institutions has declined. Violence and
rebellion are on the increase and are increasingly directed against
just those institutions essentially charged with providing safety,
knowledge, and care for people.8 The apparently marked increase
in our social ills has made such institutions less effective and more
rigid than ever-undermining further their own authority and
often causing them to blunder in ways that activist critics can use-
fully exploit. As positions become polarized, tensions erupt in
numberless small incidents, leading at times even to large-scale riots
and demonstrations. An unpopular war and its detailed coverage
5. Brenner, Coles and Meagher describe a second generation of synthetic hallu-
cinogens-DMT, STP, and MDA. DMT, if taken by mouth, is said to induce mild,
short-lived, dreamlike states; STP is thought to act much like LSD in producing per-
ceptual distortions; MDA has been described as a "two-hour orgasm." J. BRENNR, I.
COLES & D. MEAGHER, DRUGS AND YOUTH 71-73 (1970) [hereinafter BRENNER].
6. See, e.g., Hartman, The Politics of Housing, 9 Soc=Ty 30 (No. 9, 1972).
7. In the years after 1949, unemployment in agricultural areas forced millions
vf rural inhabitants (mainly black) to migrate to the cities. See F. PsrvN & R. CLoW-
ARD, RFGULATING THE POOR 214 (1971).
8. A vivid description of urban decay is provided in Rogin, East New York-
'This place makes Bedford Stuyvesant look beautiful', N.Y. TIMs, Mar. 28, 1971, §
6 (Magazine), at 80.
1026 WAYNE LAw REvmw [Vol. 19

by the press is widely taken to have exposed not only how careless,
brutal, and incompetent Americans can be both in combat and in
the formation of public policy, but also how much money is being
spent on a vast military program and on related expenses, while
humane services go begging. An increased population has fathered
a youth culture that believes itself to have repudiated the values
of loyal bourgeois America. Television has exposed the ugliness
and delusion that lie behind the comfortable American Dream.
The easy transition from documentaries to the news to the usual
family shows to the glossy commercials forces us all to witness the
deep disorder of contemporary life-and confuses us. Many Ameri-
cans are discarding older traditional ties, realigning themselves in
subgroups espousing newer and as yet untested ideologies. Con-
fusion and conflict are inevitable.
If we may judge from our present condition, it appears that a
technologically advanced society can evolve much more rapidly
than its people can accommodate to the changes entailed thereby-in
terms of their personal lives, their values, and the adherence to
given social institutions. New jobs, new forms of education, new
and unfamiliar living arrangements force people into roles for
which their parents' generation provides no model. In fact, the
gap in understanding between families, generations, and cultural
groups continues to widen and conflicting views about societal
values compete for power and authority. 9
I agree with those who hold that there is no simple way to
discover what the "right" kind of life for man is. 10 Different men
in different cultures have always preferred different ways of life
and probably have been convinced that their own preferences were
the correct ones. Most people are inclined to think that a choice of
values can be straightforwardly justified by reference to some ob-
jective criterion, even though they are uncertain how to specify
such a criterion or how to vindicate it. In the context of our
present question, we must realize that, although people admit to
very strong feelings and opinions about the "drug problem," it is
quite impossible to establish absolute criteria by which to assess
drug use. The very terms "drug use," "abuse," and even "addiction"
have become value-laden, reflecting the partisan views of different
groups within our society. For instance, the classification of drugs
as dangerous or useful, of persons as drug abusers or reasonable

9. See, e.g., C. REICH, THE GREENING OF AMERICA (1970).

10. E.g., J. MARGOLIS, VALUES AND CONDUCT (1971).
1973] CONFUSION AND DRUGS 1027

drug users, or of acceptable and unacceptable methods for dispensing

drugs tend to be much more closely linked to convictions about
proper and admissible conduct than to the active properties of the
drugs involved. The point is often overlooked, for many people,
reacting to well-publicized stories of young people dying from
overdoses of heroin, simply regard heroin addiction as the paradigm
case of drug abuse-and generalize wildly. Frightened-whether as
parents or as professionals-they lump all unfamiliar drug use to-
gether, label it "bad," and try to organize somewhat frantic efforts
to snuff out the problem at a stroke. 1' Regardless of the facts, public
policies and attitudes congeal around the objectives of funded
agencies and governmental authority. Also, of course, prejudice
tends, uncritically, to link other putatively undesirable social pat-
terns with drug abuse-rock and roll concerts and long hair, for
example. The pattern is familiar. So the very effort to understand
the issue of drug abuse is affected both by a fairly pervasive ignor-
ance and fear regarding the facts and by the variable ideologies
that interested persons may hold regarding the dangers and bene-
fits of the drugs in question.

II. SUBGROUPS USING DRUGS

There are any number of groups in the world that use drugs
in ritualistic ways and in ways unfamiliar to us.' 2 We shall concern
ourselves here, however, with describing only certain quite familiar
drug-using subgroups within our own culture. Group I may be
viewed as victims, in the sense that members of the group are
usually from the lower classes, often ghetto inhabitants, who have
experienced considerable emotional and physical deprivation and
11. The following pointless question and answer is typical of what is found
in a great number of pamphlets distributed by the federal government as well as
private sources:
What Can A Parent Do To Help A Child Who Is Abusing Dangerous Drugs
or Narcotics?
Talk about it and try to understand why this behavior is taking
place. Ideally, a relevant alternative to drug misuse can be figured out. In-
creased family interest and involvement in the child's daily activities will help.
Professional advice may be desirable. Some communities have programs run
by ex-users ....
National Clearinghouse for Drug Abuse Information, A Federal Source Book: Answers
to the Most Frequently Asked Questions About Drug Abuse, June 1971, at 4.
12. In the United States, peyote, an hallucinogen derived from the peyote cactus,
is used legally by members of the Native American church in their religious services.
BRENNEt 68.
1028 WAYNE LAW RE iEw [Vol. 19

whose subculture characteristically encourages immediate gratifica-

tion as opposed to extended planning for future benefits. Having
few skills, little money, and no competitive education, persons in
this group tend to drift easily into alcohol or heroin addiction.
Both alcohol and heroin offer opportunities for socializing and be-
longing, although social patterns are somewhat more prominent in
drinking groups. Skid row is not the only formula, of course. A
common sight in the downtown areas of large cities is a group of
15 or 20 black men, usually middle-aged or older, sitting on crates,
benches, or old chairs on the sidewalk, often outside the local bar,
drinking wine from early morning till dark. Essentially, these men
have adopted a passive orientation in their lives, asking little, aim-
ing at keeping calm, and watching-without undue pain-life as it
passes before them. Those addicted to heroin differ to some extent
in age and in the activity needed to support an expensive habit.
Also, addiction to heroin can be developed in a matter of weeks,
whereas addiction to alcohol may take years. Either habit requires
money, but the excessive cost of heroin forces the addict into al-
most constant hustling. Odd jobs and welfare checks can often keep
the modest alcoholic afloat. The alcoholic actually resembles the long-
term rather than the short-term heroin addict, the addict who has
long ago lost the thrill of using heroin and who has accepted addic-
tion as his natural condition. These addicts are the ones who
normally do well on methadone maintenance programs, since, with
methadone, their craving for heroin is controlled. 13 The aim of
long-term addicts and alcoholics is a simple one: merely to keep
their physical addiction satisfied. Their expectations are modest;
their participation in the activities of the rest of society, marginal.
They view drugs not as a problem or a social issue but as a neces-
sary part of life.
Group II includes persons from the working class, often with
strong ethnic ties, often small home-owners, who typically hold
rather strict and serious views about behavior. The strongest com-
plaints about the dangers of drug abuse are often heard from this
group. Their own addictive pattern-sometimes highly developed-
consists of regular, even heavy drinking and the frequent use of
certain nonprescription and prescription drugs. Normally, they

13. See Johnston & Williams, Abstinence, Relapse Patterns Among Heroin Addicts
Receiving Methadone Treatment on an Outpatient Basis, in Third Nat'l ConE. on
Methadone Treatment, Proceedings (Nov. 14-16, 1970) (Public Health Service Pub.
No. 2172).
19731 CONFUSION AND DRUGS 1029

resist experimenting with marijuana as vigorously as they resist

the use of heroin. They typically equate drug use and drug experi-
mentation with the breakdown of American values, promiscuity,
disregard for parental and family ties, and contempt for God and
country. They feel baffled and angry by the rapid change they see,
and are inclined to look for uncomplicated explanations. Since
their livelihood is dependent on acquired skills rather than on
their own level of education, they tend to hold strong views about
the value of education, conceiving it more as a secure road to success
along well-defined paths than as a way of opening up a choice
among widely differing life styles. In Group II, both men and
women seldom consider alternatives to their established way of
living. Their values are straightforward-working hard, maintaining
a family home, obtaining a share of worldly goods, and holding a
respectable position in a circumscribed community. To move out-
side one's framework is to court disaster. Members of this group
would not consider otherwise respectable citizens, who take drugs
normally but not necessarily by prescription, drug abusers. It is
the heroin addict and the youthful experimenter who, in their
view, are chiefly responsible for the drug problem. Drugs are seen
as intrinsically evil; but alcohol, even the generous use of alcohol,
as well as the use of legitimatized drugs, is not considered by
them to be part of the drug problem at all.
Perhaps the most interesting, certainly the most publicized,
group are those young people popularly (at least at one time
popularly) known as "hippies," who now include a broad run of
young adults from middle-class families. By now, there is a well-
established youth culture whose members prefer "grass" to alcohol,
who have experimented with different drugs-notably the hallucino-
gens-and who have, following a period of experimentation, either
routinized their drug use or ended it in a comfortable fashion.
Members of Group III have often been associated with the peace
movement, with efforts to develop new life styles, with the emerg-
ence of communes, and with a growing (if at times inconsistent)
contempt for the more obviously commercial values of American
life. They have also championed folk art and folk singing, certain
fashionable art styles (for instance, acid rock), and, on their own
claim, have sought a simpler-presumably more natural-way of
living than America has more characteristically supported. The
search for greater self-awareness, as well as the desire to establish
more intimate relationships, has played a central role in their use
1030 WAYNE LAW REviEw [Vol. 19

of drugs. Many young people have moved through drug experi-

mentation to other forms of self-awareness-for instance, meditation,
yoga and even dietary regimens. The life style appearing within
this group includes "ripping off the system," getting on welfare,
using food stamps to purchase organically grown food, opening
candle shops and unusual businesses, and teaching new art forms
like group motion. Members of Group III may give up drugs al-
together or settle for a socialized and somewhat ritualized use of
marijuana. They tend, however, to view drugs as having some in-
trinsic value, at least those drugs they have adopted. They often
view certain drugs, particularly the hallucinogens, as facilitating
an increased and deepened understanding of life and society, and
as affording therefore a wider selection of life styles than the
"straight" society would allow. 14
The last group I shall describe, Group IV, is a group of middle-
to upper-middle class adults, often professional people, who see
themselves as liberal and sophisticated. They are relatively secure
in their professional and social roles and pursue a comfortable
existence. They are less concerned with respectability than with
enjoying themselves and gaining novel experiences. They pay at-
tention to newer fashions in living and are willing to try them
out without actually rejecting their own well-established standards
of behavior. They are pleased, for instance, to include themselves
in the "pot-smoking" generation though they are not willing to
reject drinking. Some experiment with hallucinogens, but they are
noticeably reluctant to try anything they consider dangerous. They
may use prescription amphetamines, tranquilizers, and barbiturates
in what they regard as a responsible way-the prescriptions usually
reading "Take When Needed." Members of this group see potential
dangers in the use of drugs, particularly the hard drugs, but they
take considerable pride in their tolerance of youthful and bold
experimenters.
Agreement among these four groups on the proper characteriza-
tion of drug use could hardly be expected. Their opinions differ
considerably on relevant legal issues, on methods of treating addicts,
and even on the seriousness of drugs and drug-related problems.

III. ADDICTION

The drugs attracting most attention today are the opiates:

14. A colorful and perceptive description of a late 1960's hippie group, The
Merry Pranksters, is found in T. WOLFE, THE ELcrc KOoL-AiD Acm Tasr (1968).
1973] CONFUSION AND DRUGS 1031

heroin, methadone, morphine, and cocaine; the amphetamines:

benzedrine, dexedrine, and methedrine; the barbiturates:nembutal,
seconal; marijuana and the hallucinogens: LSD, mescaline, psilo-
cybin; and alcohol. Not only do these drugs affect individuals
differently because of their different chemical properties, but in-
dividual responses to any given drug show considerable variation. 15
Standard descriptions of drug responses are difficult to provide be-
cause responses depend very heavily on the expectations and emo-
tional states of those using the drug. Experiments with placebos
confirm the effect of self-persuasion. Also, differences1 6in response
may arise because of the different modes of drug use.
Addiction seems to be relatively easy to define since it appears
to be a physiological state in which body chemistry is so changed
that, without continuing drug use or suitable substitution of one
drug for another, characteristic physical and psychological discom-
fort directly result. Heroin is currently the most publicized example
of an addictive drug. When heroin is not available to him, the
addict experiences withdrawal symptoms beginning with restlessness
and anxiety and culminating about 36 hours after the last dose in
severe stomach and muscle cramps, vomiting, diarrhea and other
"flu-like symptoms."': Discomfort from complete or partial with-
drawal occurs frequently among heroin addicts, since they often
find that larger and larger doses are needed to obtain a good "high."
As their drug intake increases, they achieve fewer "highs" but find
they suffer withdrawal symptoms when deprived of the drug. The
habit changes then, shifting from the pursuit of pleasurable sensa-
tions to the avoidance of pain.
This kind of addiction is well known, but let me review some
of its features. Normally, the addict originally chooses to experiment
with the drug and then continues until he becomes addicted. He
is also, usually, aware of the effect the drug is having on him. This
is not to say he is fully aware of the hazards involved, or under-
stands he is- experiencing the effects of the drug he is taking. As
addiction develops, he becomes aware of the painful sensation of
craving the drug. He learns that taking the drug reduces the dis-
comfort. He may want to rid himself of his addiction and may

15. See, H. NOWLIs, DRUGS ON THE COLLEGE CAMPUS 11 (1969). See also Hanlon,
'Aspects of Design and Analysis in PsychotropicDrug Studies, in DRUGS AND THE BRAIN
161 (P. Black ed. 1969).
16. See Hanlon, supra note 15, at 162.
17. BRENNER 84-85.
1032 WAYNE LAW REVIEW [VOL 19

actually try to, alone or by submitting to prescribed treatment; or,

the law may force him to accept treatment or be imprisoned,
thereby restricting his use of the drug.
Not all forms of physiological addiction, however, follow this
pattern, although they do involve an appropriately altered physio-
logical state. Consider the patient who has undergone major surgery
and suffers sufficiently to justify the prescription of addicting doses
of morphine. Children, relatively unsophisticated patients, or even
alert patients skillfully managed in a hospital setting may not be-
come aware of being addicted to morphine during hospitalization.
In fact, even when the drug is withdrawn, symptoms appear that
they often do not directly link to the reduction or removal of the
drug. The patient will, of course, feel quite ill, but he may not
see the drug as a means of providing relief. If questioned, he is
likely to link the drug to the removal, say, of pain connected with
an operation, and not think of it as relief from such symptoms as
nausea, cramps, and chills. In such cases, the addict typically does
not select the drug, and does not experiment with it or gain any
focused pleasure. The responsibility and decision are entirely his
physician's. Such an addict is hardly inclined to identify himself
as an addict; the initiation and termination of his addiction is
managed entirely by another agent, often without his being aware
of it.
A similar kind of addiction appears among newborn infants
born to addicted mothers. These babies are found to be physio-
logically dependent upon heroin, say, and their addiction must be
treated at once. Detoxification usually takes a couple of weeks. Here
again, the patient is not aware of being an addict and the addiction
is neither formed by nor under the control of the addict himself.
Responsibility for addiction and subsequent detoxification are en-
tirely the concern of others.
In such cases, the physical state of addiction may be quite
similar to that of the voluntary addict, but the social implications
are strikingly different. In the paradigm case, the agent takes the
drug because he wants to; he is, in this sense, responsible for his
addiction. On familiar assessments, he would be labelled bad, im-
moral, a lawbreaker, possibly weak or even mentally disturbed. He
might be described as having such deepseated emotional difficulties
that his freedom is judged to have been impaired, leaving him
incapable of choosing what is in his best interest, or his addiction
might be judged a symptom of mental illness-in which case, he
might be subject to medical treatment rather than to punishment
19731 CONFUSION AND DRUGS 1033

as a criminal. Such considerations are obviously not relevant to the

surgery patient or newborn child. In those cases, the addict (if we
may call him such) is not thought to be bad or mentally ill. He is
only a victim of circumstances, a temporary addict, and not properly
termed a drug addict at all. Still, he will show the usual pattern
of physical addiction.
Psychological addiction raises classification problems, since we
cannot readily isolate distinct and regular symptoms as a reliable
basis for labelling. In fact, one might well question whether psycho-
logical addiction can properly be treated as a distinct medical
entity, bound up as it is with personal and culturally approved
goals, attitudes, feelings, forms of behavior, and the like. Psycho-
logical addiction may be fairly illustrated by the problem drinker,
who has not yet reached or who may never reach a point at which
he experiences actual withdrawal symptoms when deprived of alco-
hol but who cannot (as we say) control drinking impulses that are
effectively and obviously damaging his health. Again, his behavior
when drinking may cause himself and others considerable distress.
There are, in fact, various magazine questionnaires that provide
for self-examination on a problem-drinking scale and offer advice
regarding medical or psychological help on the basis of one's score.
So the category is clearly widely recognized. Undoubtedly, similar
questionnaires will emerge for drug users in the near future.
Drugs like the amphetamines similarly complicate the concept
of addiction. Methedrine taken by injection or large doses of
amphetamines taken orally may fairly be regarded as paradigm
forms of psychological addiction. Typically, such drug use is illegal,
although, in cases of obesity, excessive amounts of amphetamines
are sometimes prescribed and may be obtained legally. In the current
jargon, persons who take such large doses are known as "speed
freaks," and they often damage their physical and psychological
health quite seriously. As in the case of heroin addiction, these
addicts normally choose to experiment with, and to continue using,
amphetamines. As tolerance increases, greater amounts are needed
to reach a "high." A high is seen as a desirable state because of the
euphoria and feelings of self-confidence and energy induced; but
there follows after a "high" a distinct mood of depression accom-
panied by extreme irritability, anxiety and finally a deep sleep-
the entire pattern or elements of the pattern being known as "crash-
ing.""' More amphetamines can be taken to avoid crashing, though

18. See, e.g., Rossi, PharmacologicalEffects of Drugs Which Are Abused, 142 Am.
1034 WAYNE LAW REvIEw [Vol. 19

some turn to the barbiturates to soften these effects. Physically con-

sidered, this sort of drug use puts a great strain on the body since
one becomes hyperactive, loses appetite, and tends to become in-
somniac. The body does not need the drug in any physiological
sense, even when the body's resources are exhausted. But psycho-
logically, the "speed freak" finds himself adjusting to an extremely
high level of arousal which, when absent, leaves him feeling de-
spondent, withdrawn, and unable to perform many normal routines.
The excessive use of amphetamines results in so much emotional
damage that one may well become psychotic or severely-even fatally
-ill physically. 19 Like heroin addicts, such abusers typically use drugs
in amounts they know to be dangerous. They probably also recognize
their dependence on the drug. But they are not inclined to de-
scribe themselves as addicts because the absence of the drug does
not leave them with the physical symptoms of withdrawal and
intense craving.
Currently, national attention is being focused on housewives,
professional persons, businessmen, truck drivers, and athletes who
tend to use amphetamines frequently or regularly together with
barbiturates. 20 These drugs may be obtained through legal channels
and are taken with varying frequency and dosage. Some among the
group, athletes and truck drivers for instance, tend to take ampheta-
mines on specific occasions in order to improve performance or
to ward off fatigue. On the other hand, some housewives tend to
rely on the regular use of the drug to alleviate feelings of boredom
and mild depression. Initial use may well have been suggested by
physicians, especially in the case of housewives, to control weight
or as mood elevators. In such cases, there is bound to be little or
no sense of wrongdoing and no inclination to think of addiction.
Even now, attempts are being made to reclassify amphetamines as
dangerous drugs, though it is not clear who is abusing these drugs
and what constitutes dangerous use.2 1 It is even less clear how to
J. OF PHARMACY at 165 (No. 4, 1970).
19. See, e.g., id. 164-65.
20. E.g., Graham, Amphetamine Politics on Capitol Hill, 9 TRANSACTION 14 (Jan.
1972).
21. The Comprehensive Drug Abuse Prevention and Control Act of 1970 in its
final form transferred only liquid methedrine into a category of stricter controls.
This represented a victory for the drug companies since only five of the 6,000
members of the amphetamine family fall into this category. The evidence pointing
to dangers and misuse of amphetamines was presented at hearings in both the
House and Senate. Estimated figures suggest that at least eight billion pills are
manufactured annually. See generally Graham, supra note 20.
1973] CONFUSION AND DRUGS 1035

determine psychological addiction to amphetamines. Who is to de-

cide? The user, since he feels that he needs the drug? The physician,
since he sees his patient regularly taking a drug beyond safe use?
Or that segment of the public which believes no drugs should be
taken unless a person is physically ill? One sees, for instance,
charges in the press against the allegedly indiscriminate use of
amphetamines and the insistence that they should be used only for
hyperactive children and cases of narcolepsy. Would such a policy,
say, reasonably assign others taking amphetamines to the category
of drug abusers? Would a 60-year-old woman who has been taking
5-milligram tablets of dexedrine for 30 years and often forgets to
take her daily dose be considered a drug abuser or psychologically
addicted? Would the athlete whose performance improves when
given dexedrine be considered psychologically addicted? Would he
be addicted if, say, his performance improved on being given a
placebo instead of the amphetamine? The question of what con-
stitutes psychological addiction and dependency remains; and if
we allow the category to stand, how are we to judge whether par-
ticular states are desirable or undesirable?
Consider, too, the use of amphetamines in treatment of hyper-
active children. Hyperactivity has been successfully treated with
stimulant drugs for several decades. 22 In a recent study of the effect
of Ritalin on hyperactive children, it was noted that not only did
children using the drug improve their performance on tests in
which they had previously shown an abnormal number of errors,
but their performance improved in tasks in which they had previ-
ously shown no deficiency at the behavioral level; these children
were more attentive, less easily distracted, less impulsive, and more
efficient in their classroom work.2 3
Conceptual difficulties suggest themselves. The hyperkinetic
child, for instance, actually disrupts his own performance and is
quite unable to continue in the classroom setting without medi-
cation-a pattern that has been explicitly categorized as a medical
problem, often linked with a diagnosis of minimal brain damage (a
useful catch-all). However, since a significant number of such chil-
dren demonstrate improved classroom performance under medica-
tion, teachers, parents and physicians see the possible advantage of
22. See Laufer 8- Denhoff, Hyperkinetic Behavior Syndrome in Children, 50 J.
PrnxrAmucs 463, 470-74 (1957).
23. Sykes, Douglas & Morgenstern, The Effect of Methylphenidate (Ritalin) on
Sustained Attention in Hyperactive Children, 25 PSYCHOPHARMACOLOGIA (Berl.) 262,
272 (1972).
1036 WAYNE LAW REviEw [Vol. 19

offering drug treatment to a larger and larger population. 24 What

begins as a putative medical issue slips gradually and innocently
into an issue of behavioral control and social direction. Decisions
regarding drug use here are obviously not in the hands of the
children affected, although they may well notice a relationship
between taking pills and more acceptable classroom behavior. When
such relationships are regularized, would we describe such children
as psychologically addicted?
The last two drugs I shall mention-alcohol and marijuana-I
deliberately link, since both are used primarily to enhance social
encounters. Widespread use of alcohol has resulted in an estimated
9 million alcoholics, the features of whose addiction resemble some
of those already ascribed to heroin addiction. 25 An even larger num-
ber of people may be deemed dependent on alcohol, but perhaps
their behavior may be construed more in terms of ritualized con-
duct than in terms of psychological addiction. The use of marijuana
seems to resemble the latter pattern most closely. A large number26
of Americans drink regularly, with well-established drinking habits.
Parties, holiday celebrations, night-time entertainment, in fact most
social events, tolerate or encourage ritual drinking. And yet, despite
evidence that alcohol abuse constitutes a considerable danger both
to alcoholics and the general public with traffic accidents, crimes of
violence, and family disruption, most people have accepted alcohol
as a regular part of the contemporary scene and have learned to
control its use.2 7 Since drinking typically occurs in the company of
others, relevant groups tend to protect their members. A wife may
drive if her husband has had too much to drink, suggestions may
be made to the host to make the next drink weaker, and so on.
The amenities are expected to be observed while drinking, but
allowances are made for the uninhibiting effects of alcohol. In fact,
people are expected, and often even encouraged, to speak more
freely and behave in more intimate ways while drinking. What may

24. The use of drugs to control hyperactivity in children for the benefit of
the class as well as for the children affected has been suggested: "[T]he damage
that one hyperkinetic child can wreak on the education of other children in a class-
room can be as serious as the danger to physical health posed by a carrier." L.
Arnold, Letter to the Editor, 48 PaDiAniucs 496, 497 (1971).
25. See 3 DRUGS & DRUG ABUSE EDUC. N wsLrTE 3 (Mar. 1972).
26. Perhaps 70 million Americans drink regularly. CooPERATIvE COMM'N ON THE
STUDY OF ALCOHOLISM, ALCOHOL PROBLEMS: A REPORT TO THE NATION 3 (T. Plauts
comp. 1967).
27. See generally N. Krrrim, THE RIGHT TO BE DIFFERENT 261-96 (1971).
1973] CONFUSION AND DRUGS 1037

be discouraged is the increase in hostile or violent behavior which

often accompanies heavy drinking. Friends often step in at such a
time to help one home or to help one sober up. Coffee is regularly
offered at the end of a party that includes heavy drinking to effect
a restoration of predrinking behavior and to signal its desirability.
The pattern is a familiar one. Somewhat less familiar to the general
public is the regular use of marijuana by the young as alcohol is
used by the parent generation. Most college students admit to having
at least tried "grass" and many actually use it quite regularly in a
variety of settings.28 At outdoor concerts, for instance, grass smoking
may safely be anticipated, inducing a heightened feeling of cama-
raderie within a given audience. Getting "stoned" on a regular
basis may sound like psychological dependence, but it may be de-
scribed as easily and as accurately in terms of habits of social
behavior approved by an influential segment of the population.
Evidence of psychologically damaging effects is much less compelling
than that regarding alcohol-possibly because the intoxicating agent
in marijuana, THC, usually occurs in a very low concentration.
Most marijuana in this country is smoked, reducing the potency
of the drug even further. 9 Higher doses and chronic use may
conceivably lead to some impairment of intellectual and motor
functions. 0 However, at the present time, there is little evidence
that smoking marijuana constitutes a serious health or social hazard.
In fact, seen as a mild intoxicant used in a ritualized way in social
situations, it may well be our most harmless drug.

IV. FUTURE DEVELOPMENT IN THE USE OF DRUGS

What is needed is some measure of agreement among profes-

sionals, politicians, legislators, and corporation and community
leaders about how to institutionalize and regulate the use of selected
drugs and how to direct drug abusers to treatment, rehabilitation,
and the like. Also, we need to investigate new drugs and new uses
of drugs in terms of the problems and pressures of contemporary
and future society. In a word, we need to consider a radical change
in the social model in terms of which we view the use and abuse
of drugs. Thus, where the concept of addiction is difficult to define
in terms of physical medicine and where criticism of drug use

28. See BRENNER, supra note 5, at 87.

29. Hollister, Current Research on Marijuana,27 J. SocL Issuts 25, 25 (No. 3,
1971).
80. Id.
1038 WAYNE LAW REVIEW [Vol. 19

largely reflects partisan values, it would seem more promising to

stop viewing drug use primarily in terms of sickness, criminality,
and evil and to opt instead quite frankly for a model of social
control-supporting socially endorsed values and possibly permitting
even a broadened but controlled licensed drug distribution, as
suggested for instance by Zinberg and Robertson. 31 Obviously, the
details of a social control model would need to be carefully worked
out in the light of contemporary and anticipated social issues. It
would, however, provide a framework for defining socially accept-
able drug behavior and for endorsing the use of selected drugs in
reducing deviant behavior. Within this framework, people would
be urged to explore a number of life styles and to take responsi-
bility for their own drug use. Increased experimentation and con-
trolled research into the effects of drugs would actually improve
the quality of information. Correspondingly, an informed educa-
tional program would enable individual persons to manage their
own drug patterns at least knowledgeably. Furthermore, we could
take note more effectively of whatever drugs are actually ingested
with our food and from the environment and plan our policies of
social control more rationally. The average citizen obviously knows
very little about the effect of the various drugs, additives, and
other chemicals impinging upon his life.
Although our ability to alter behavior by the use of drugs is
far from precise, it is by no means primitive. Some have already
begun to speculate, for instance, about using drugs to reduce de-
structive tendencies. London is considering the possibility of con-
trolling aggressive behavior by chemical means or by means of
brain implants, suggesting an alternative to our present penal
policy: for, at the present time, we vacillate between a punitive
and rehabilitative model regarding the control of aggressive or
criminal behavior.3 2 And though it is clear that, at present, public
attitudes would resist such a change of policy, it is generally de-
plored-by ordinary citizens and professionals alike-that prisoners
are so often victimized by beatings, solitary confinement, homosexual
assaults, and other traumas. There is, in fact, evidence strongly

31. They suggest that marijuana be regulated, like alcohol, by determining

grades and quantities which would be sold at specific places. Use of marijuana
could be restricted, like alcohol, to adults only in the home or certain private places.
Licenses would have to be obtained to sell marijuana. N. ZINBERG & J. ROBERTSON,
DRUGS AND THE PUBLIC 254 (1972).
1973) CONFUSION AND DRUGS 1039

indicating that prison experience

33
tends to increase rather than to
reduce aggressive behavior.
In his Presidential Address to the annual meeting of the Ameri-
can Psychological Association in 1971, Kenneth B. Clark stirred
up a good deal of controversy when he urged his colleagues to de-
velop a "peace pill" to keep people in power from abusing their
power. Given man's technological capacity to destroy himself, Clark
felt we must develop instruments (possibly chemical) to manage
to some extent the moral sensibilities of men.3 4 Reviewing the un-
favorable letters he received afterwards, Clark concluded that his
critics held the destruction of mankind to be not too high a price
to pay for his present level of freedom. But he points out that, in
many countries-India, Ireland and Indochina among others-
cruelty and destruction have reached a threshold of intolerable
suffering, and he urges us to use our technology to reduce the
chances that some nonrational or immoral decision may destroy
the human race.35 The moral for more restricted problems is clear.
A social control model might, for instance, permit the wide-
spread use of drugs in the face of stressful social conditions. For
example, overpopulation alone may force us to make available a
range of drugs that can reduce the sense of pressure in tense quarters
or increase feelings of well-being under conditions of crowding.
Also, if a growing population is to be maintained by further
mechanization and with reduced manpower needs, we may well
be forced to alter the high value we place on work and to encourage
life styles which will not endanger the economy. For instance, such
a society might direct human energies into artistic pursuits or the
like; but it might also be inclined to support an increasing number
of persons as drug addicts, either on welfare rolls or by means of
free clinics. Needless to say, a shortage of manpower would lead
to entirely different policies.
Still, the point of the social control model is not merely negative:
it is not concerned merely with reducing unwanted behavior but
with identifying new patterns of behavior to be explored and pro-
moting greater satisfaction and well-being under changing conditions

32. See id. For a full account of our shifting models in the criminal justice
system, see KrrnuE, supra note 27, at 12-32.
33. "[Vjengeance evokes vengeance." K. MENNINGER, TIE CRIME OF PUNISHMENT
214 (1966).
34. Warren, Clark's 'Peace Pill' Proposal-A Year Later, 3 APA MONITOR 1 (Sept.
Oct. 1972).
35. Id. 6.
1040 WAYNE LAW REViEW [Vol. 19

of social life. Kline, for example, notes the following areas for the
useful application of selected drugs, leading to increased comfort:
the regulation of sexual responses (say, increasing sexual activity
at appropriate times); the prolongation or shortening of memory
(for instance, to improve efficiency or reduce the effects of painful
memories); the promotion of, or relief from, guilt (where social
responsibility might be developed if deficient sensitivity or over-
sensitivity were correspondingly adjusted); and the monitoring of
sensitivity to foster or terminate mothering behavior, shorten or pro-
long experienced time, and deepen the sense of beauty and awe.8 6 In
fact, the social control model is already in use in methadone pro-
grams, where one form of addiction is substituted for another and
heroin addicts can maintain themselves at minimal cost. Would
heroin maintenance clinics be very different? Also, hyperactive
children, as we have seen, are controlled by the use of amphetamines,
chiefly for social and collective values. Even the astronauts control
their waking and sleeping behavior with pills, and birth control
pills are hardly used for medical reasons alone. We may well ask,
of what possible use is our technology if we refuse to explore its
potentialities with courage and with a sense of the possibility of
rationally altering our patterns of institutionalized life? The issue
at stake is not merely decriminalization or divestment: these are
merely instruments of change. The issue, rather, concerns the con-
ception of rational planning under conditions of significant social
change and, in particular, change that requires a review of habitual
values and prevailing norms of conduct.

36. Kline, The Future of Drugs and Drugs of the Future, 27 J. SOCIAL IssuS 73,
82-86 (No. 3, 1971).