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Contents

Preface xix Specific Risk Factors 19

Specific Protective Factors 21
Present-day Concerns 21
Part One  Drugs in Society/
Club Drugs 21
Drugs in Our Lives 1
Nonmedical Use of Prescription Pain Relievers 21

Chapter 1 ■ Drugs . . . in Focus: Facts about

Drugs and Behavior Today 1
By the Numbers . . . 2
Social Messages About Drug Use 3
Two Ways of Looking at Drugs and Behavior 4
A Matter of Definition: What Is a Drug? 5
■ He a l t h L i n e :Defining Drugs: Olive Oil,
Curry Powder, and a Little Grapefruit? 6
Instrumental Drug Use/Recreational Drug Use 6
Drug Misuse or Drug Abuse? 7
■ D r u g s . . . i n F o c u s : Drug Abuse and the
College Student: An Assessment Tool 8
Drugs in Early Times 9
Drugs in the Nineteenth Century 10
Drugs and Behavior in the Twentieth Century 11
Drugs and Behavior from 1945 to 1960 12
Drugs and Behavior after 1960 12
■ Q u i c k C o n cep t C h ec k 1 . 1 :
Understanding the History of Drugs and
Behavior 13
Present-Day Attitudes toward Drugs 14
Patterns of Drug Use in the United States 14
Illicit Drug Use among High School Seniors 15
Illicit Drug Use among Eighth Graders and Tenth
Graders 16
Illicit Drug Use among College Students 16
Alcohol Use among High School and College Students 16
Tobacco Use among High School and College Students 17
Drug Use and Drug Perceptions 17
Illicit Drug Use among Adults Aged Twenty-Six and
Older 18
Making the Decision to Use Drugs 19
■ Q u i c k C o n cep t C h ec k 1 . 2 :
Understanding Present-Day Drug Use in the United
States 19
Club Drugs 22
Nonmedical Use of Prescription Stimulant Medications 23
Nonmedical Use of Over-the-Counter Cough-and-Cold
Medications 23
Why Drugs? 23
■ P o r t r a i t : From Oxy to Heroin—
The Life and Death of Erik 24
Summary 24 / Key Terms 25 / Endnotes 26
ChapTer 2
Drug-Taking Behavior: Personal
and Social Issues 28
By the Numbers . . . 29
Drug Toxicity 30
■ D r u g s . . . i n F o c u s : Acute Toxicity in
the News: Drug-Related Deaths 32
■ Q u i c k C o n cep t C h ec k 2 . 1 :
Understanding Dose-Response Curves 33
The DAWN Reports 33
Emergencies Related to Illicit Drugs 34
Drug-Related Deaths 34
Judging Drug Toxicity from Drug-Related Deaths 35
Demographics and Trends 35
From Acute Toxicity to Chronic Toxicity 36
Behavioral Tolerance and Drug Overdose 37
■ Q u i c k C o n cep t C h ec k 2 . 2 :
Understanding Behavioral Tolerance through
Conditioning 38
Physical and Psychological Dependence 39
Physical Dependence 39
Psychological Dependence 39
Diagnosing Drug-Related Problems: The Health
­Professional’s Perspective 41

Contents ■ vii
Special Circumstances in Drug Abuse 43 Introducing the Nervous System 69
Drug Abuse in Pregnancy 43 The Peripheral Nervous System 70
Drug Abuse and HIV Infection 43 Sympathetic and Parasympathetic Responses 70
The Central Nervous System 71
■ Effects of Psychoactive Drugs
He a l t h L i n e :
Understanding the Brain 72
on Pregnant Women and Newborns 44
The Hindbrain 73
Drugs, Violence, and Crime 45
The Midbrain 73
Pharmacological Violence 45
The Forebrain 73
Economically Compulsive Violence 46
Systemic Violence 47 ■ Q u i c k C o n cep t C h ec k 3 . 2 :
Governmental Policy, Regulation, and Laws 48 Understanding Drugs and Brain Functioning 74
Efforts to Regulate Drugs, 1900–1970 48 Understanding the Neurochemistry of Psychoactive
Rethinking the Approach toward Drug Regulation, Drugs 74
1970–Present 49 Introducing Neurons 74
Drug Law Enforcement and Global Politics 50 Neuronal Communication 75
Drug Influences on Neuronal Communication 76
■ Portrait: Pablo Escobar—Formerly Known
The Major Neurotransmitters in Brief:
as the Colombian King of Cocaine 51
The Big Seven 76
■ He a l t h L i n e : Harm Reduction as a National Physiological Aspects of Drug-Taking Behavior 78
Drug-Abuse Policy 53 The Blood–Brain Barrier 78
Summary 54 / Key Terms 55 / Endnotes 55
■ D r u g s . . . i n F o c u s : Endorphins,
■ Point/Counterpoint I: Should We Endocannabinoids, and the “Runner’s High” 79
Legalize Drugs in General? 58 Biochemical Processes Underlying Drug Tolerance 80

■ Q u i c k C o n cep t C h ec k 3 . 3 :
Understanding Cross-Tolerance and
Chapter 3 Cross-Dependence 80
How Drugs Work in the Body Physiological Factors in Psychological Dependence 81
and on the Mind 60 ■ He a l t h L i n e : Drug Craving and the Insula
of the Brain 82
By the Numbers . . . 61 Psychological Factors in Drug-Taking Behavior 82
How Drugs Enter the Body 61 Expectation Effects 83
Oral Administration 61
■ P o r t r a i t : Nora D. Volkow—A Scientist-
Injection 62
General in the War on Drugs 84
Inhalation 63
Drug Research Procedures 85
Absorption through the Skin or Membranes 63
Summary 85 / Key Terms 86 / Endnotes 86
How Drugs Exit the Body 64

■ D r u g s . . . i n F o c u s : Ways to Take
Drugs: Routes of Administration 65
Part TWO Legally Restricted
Factors Determining the Behavioral Impact of Drugs 66
Drugs in Our Society 89
Timing 66
Drug Interactions 67
Chapter 4
Cross-Tolerance and Cross-Dependence 67
The Major Stimulants: Cocaine
■ Q u i c k C o n cep t C h ec k 3 . 1 :
Understanding Drug Interactions 67
and Amphetamines 89
■ He a l t h Ale r t : Adverse Effects of Drug– By the Numbers . . . 90
Drug and Food–Drug Combinations 68 The History of Cocaine 90
Individual Differences 69 Cocaine in Nineteenth-Century Life 91

viii ■ Contents
■ He a l t h Ale r t : Cocaine after Alcohol:
The Risk of Cocaethylene Toxicity 91
Freud and Cocaine 92
■ Drugs . . . in Focus: What Happened
to the Coca in Coca-Cola? 93
■ Q u i c k C o n cep t C h ec k 4 . 1 :
Understanding the History of Cocaine 94
Acute Effects of Cocaine 94
Chronic Effects of Cocaine 95
He a l t h Ale r t : The Physical Signs
■
of Possible Cocaine Abuse 95
Medical Uses of Cocaine 96
How Cocaine Works in the Brain 96
Present-Day Cocaine Abuse 96
From Coca to Cocaine 97
From Cocaine to Crack 97
■ Drugs . . . in Focus: Crack Babies
Revisited: What Are the Effects? 99
Patterns of Cocaine Abuse 100
Treatment Programs for Cocaine Abuse 100
■ D r u g s . . . i n F o c u s : Paco: A Cheap
Form of Cocaine Floods Argentine Slums
and Beyond 100
■ Portrait: Robert Downey Jr. and
Others—Cleaning Up after Cocaine 101
Amphetamines 103
The Different Forms of Amphetamines 103
The History of Amphetamines 104
How Amphetamines Work in the Brain 104
Acute Effects of Amphetamines 104
Chronic Effects of Amphetamines 105
Methamphetamine Abuse 105
Present-Day Patterns of Methamphetamine Abuse
■ Drugs . . . in Focus: Methamphetamine
and the Heartland of America 107
Methamphetamine-Abuse Treatment 107
■ Q u i c k C o n cep t C h ec k 4 . 2 :
Understanding Patterns of Cocaine and
Methamphetamine Abuse 108
Medical Uses for Amphetamines and Similar
Stimulant Drugs 108
■ “Bath Salts” as a New Form
He a l t h L i n e :
of Stimulant Abuse 109
Stimulant Medications for ADHD 109
Other Medical Applications 110
Stimulant Medication and Cognitive
Enhancement 111
Summary 111 / Key Terms 112 / Endnotes 112
■ Should
P o i n t / C o u n t e r p o i n t II :
Cognitive Performance-Enhancing Drugs Be
Used by Healthy People? 116
Chapter 5
Opioids: Opium, Heroin, and Opioid
Pain Medications 118
By the Numbers . . . 119
Opium in History 119
The Opium War 121
Opium in Britain and the United States 122
Morphine and the Advent of Heroin 123
Opioids in American Society 124
Opioid Use and Heroin Abuse after 1914 124
Heroin Abuse in the 1960s and 1970s 125
Heroin and Other Opioids since the 1980s 126
■ Q u i c k C o n cep t C h ec k 5 . 1 :
Understanding the History of Opium and
Opioids 127
Effects on the Mind and the Body 127
How Opioids Work in the Brain 128
Patterns of Heroin Abuse 129
Tolerance and Withdrawal Symptoms 130
The Lethality of Heroin Abuse 130
■ Q u i c k C o n cep t C h ec k 5 . 2 :
Understanding the Effects of Administering
and Withdrawing Heroin 131
Heroin Abuse and Society 132
105 Treatment for Heroin Abuse 132
Heroin Detoxification 132
Methadone Maintenance 133
Alternative Maintenance Programs 134
Behavioral and Social-Community
Programs 134
Medical Uses of Opioid Drugs 134
■ He a l t h Ale r t : Sustained-Release
Buprenorphine: A New Era in Heroin-Abuse
Treatment 135
Beneficial Effects 135
Prescription Pain Medication Misuse and Abuse 137
OxyContin Abuse 137
Responses to OxyContin Abuse 137
Contents ■ ix
■ P o r t r a i t : David Laffer—Pharmacy Robber ■ He a l t h Ale r t : MDMA Toxicity: The
and Killer of Four 138 Other Side of Ecstasy 158
Abuse of Other Opioids Pain Medications 138 Hallucinogens Related to Acetylcholine 159
Prevalence of Nonmedical Use of Opioid Pain Amanita muscaria 159
Medications 138 The Hexing Drugs and Witchcraft 159
Summary 139 / Key Terms 140 / Endnotes 140 Miscellaneous Hallucinogens 160
Phencyclidine (PCP) 161
Acute Effects of PCP 161
Chapter 6 ■ Q u i c k C o n cep t C h ec k 6 . 1 :
LSD and Other Hallucinogens 143 Understanding the Diversity of
Hallucinogens 161
By the Numbers . . . 144 Patterns of PCP Abuse 162
A Matter of Definition 144 Ketamine 162
Classifying Hallucinogens 145 ■ Q u i c k C o n cep t C h ec k 6 . 2 :
Lysergic Acid Diethylamide (LSD) 146 Understanding PCP 163
■ Drugs . . . in Focus: Strange Days Salvia divinorum 163
in Salem: Witchcraft or Hallucinogens? 147 Summary 163 / Key Terms 165 / Endnotes 165
The Beginning of the Psychedelic Era 147

■ P o r t r a i t : Timothy Leary—Nutty Professor

or Psychedelic Visionary? 149
Acute Effects of LSD 149
Effects of LSD on the Brain 150
Patterns of LSD Use 151
Facts and Fiction about LSD 151
Will LSD Produce Substance Dependence? 151
Will LSD Produce a Panic Attack or Psychotic
Behavior? 151
Will LSD Increase Your Creativity? 152
Will LSD Damage Your Chromosomes? 152
■ He a l t h Ale r t : Emergency Guidelines
for a Bad Trip on LSD 152
Will LSD Have Residual (Flashback) Effects? 153
Will LSD Increase Criminal or Violent Behavior? 153
Psilocybin and Other Hallucinogens Related to
Serotonin 154
Lysergic Acid Amide (LAA) 154
■ He a l t h L i n e : Bufotenine and the Bufo
Toad 155
Dimethyltryptamine (DMT) 155
Harmine 156
Hallucinogens Related to Norepinephrine 156
Mescaline 156
DOM 156
■ D r u g s . . . i n F o c u s : Present-Day
Peyotism and the Native American Church 157
MDMA (Ecstasy) 157
Chapter 7
Marijuana 167
By the Numbers . . . 168
A Matter of Terminology 168
The History of Marijuana and Hashish 170
Hashish in the Nineteenth Century 170
Marijuana and Hashish in the Twentieth Century 170
The Anti-Marijuana Crusade 171
Challenging Old Ideas about Marijuana 172
Acute Effects of Marijuana 172
Acute Physiological Effects 173
Acute Psychological and Behavioral Effects 173
■ Q u i c k C o n cep t C h ec k 7 . 1 :
Understanding the Effects of Marijuana 174
■ Drugs . . . in Focus: The Neurochemical
“Yin and Yang” of Cannabis 175
Effects of Marijuana on the Brain 175
Chronic Effects of Marijuana 176
Tolerance 176
Withdrawal and Dependence 176
Cardiovascular Effects 177
Respiratory Effects and the Risk of Cancer 177
Effects on the Immune System 178
Effects on Sexual Functioning and Reproduction 178
Long-Term Cognitive Effects and the Amotivational
Syndrome 178

x ■ Contents
The Gateway Hypothesis 179
The Sequencing Question 179
The Association Question 180
The Causation Question 180
■ Q u i c k C o n cep t C h ec k 7 . 2 :
Understanding the Adverse Effects of Chronic
Marijuana Abuse 181
Patterns of Marijuana Smoking 181
Causes for Concern 182
■ He a l t h Ale r t : A Synthetic Marijuana
called Spice 182
Medical Marijuana 183
Muscle Spasticity and Chronic Pain 183
■ Portrait: Marcy Dolin—Marijuana
Self-Medicator 183
Nausea and Weight Loss 184
The Medical Marijuana Controversy 184
The Issues of Decriminalization and Legalization 185
Summary 186 / Key Terms 187 / Endnotes 187
Part THREE Legal Drugs
in Our Society 191
Chapter 8
Alcohol: Social Beverage/Social
Drug 191
By the Numbers . . . 192
What Makes an Alcoholic Beverage? 192
Alcohol Use through History 194
Alcohol in Nineteenth-Century America 194
The Rise of the Temperance Movement 195
The Road to National Prohibition 196
The Beginning and Ending of a “Noble
Experiment” 196
Present-Day Alcohol Regulation by Taxation 196
Patterns of Alcohol Consumption Today 197
Overall Patterns of Alcohol Consumption 197
■ Multiple Ways of Getting
He a l t h L i n e :
a Standard Drink 198
■ Drugs . . . in Focus: Visualizing the
Pattern of Alcohol Consumption in the United
States 199
Problematic Alcohol Consumption among College
Students 200
Alcohol Consumption among Adolescents 200
■ Q u i c k C o n cep t C h ec k 8 . 1 :
Understanding Alcoholic Beverages 201
The Pharmacology of Alcohol 201
The Breakdown and Elimination of Alcohol 201
Measuring Alcohol in the Blood 202
■ He a l t h L i n e : Gender, Race, and
Medication: Factors in Alcohol Metabolism 203
Effects of Alcohol on the Brain 204
Acute Physiological Effects 204
Toxic Reactions 205
Heat Loss and the Saint Bernard Myth 205
■ He a l t h Ale r t : Emergency Signs and
Procedures in Acute Alcohol Intoxication 205
Diuretic Effects 206
Effects on Sleep 206
Effects on Pregnancy 206
Interactions with Other Drugs 206
Hangovers 206
Acute Behavioral Effects 207
Blackouts 208
Driving Skills 208
Preventing Alcohol-Related Traffic Fatalities among
Young People 209
■ Portrait: Candace Lightner—Founder
of MADD 209
Alcohol, Violence, and Aggression 210
■ Drugs . . . in Focus: Alcohol, Security,
and Spectator Sports 211
■ D r u g s . . . i n F o c u s : Caffeine, Alcohol,
and the Dangers of Caffeinated Alcoholic Drinks 212
Sex and Sexual Desire 212
Alcohol and Health Benefits 212
■ Q u i c k C o n cep t C h ec k 8 . 2 :
Understanding the Data from Balanced Placebo
Designs 213
■ He a l t h Ale r t : Guidelines for Responsible
Drinking 214
Strategies for Responsible Drinking 215
Summary 215 / Key Terms 216 / Endnotes 216
Chapter 9
Chronic Alcohol Abuse
and Alcoholism 220
Alcoholism: Stereotypes, Definitions,
and Life Problems 221

Contents ■ xi
By the Numbers . . . 221
Problems Associated with a Preoccupation with
Drinking 221
Emotional Problems 223
Vocational, Social, and Family Problems 223
Physical Problems 223
■ He a l t h L i n e :A Self-Administered
Short Michigan Alcoholism Screening Test
(SMAST) 224
Hiding the Problems: Denial and Enabling 224
■ Q u i c k C o n cep t C h ec k 9 . 1 :
Understanding the Psychology of
Alcoholism 225
Alcohol Abuse and Alcohol Dependence: The Health
Professional’s Perspective 225
Physiological Effects of Chronic Alcohol Use 226
Tolerance and Withdrawal 226
Liver Disease 226
Cardiovascular Problems 227
Cancer 227
Dementia and Wernicke-Korsakoff
Syndrome 228
Fetal Alcohol Syndrome (FAS) 228
■ He a l t h L i n e : Alcoholism Screening
­Instruments in Professional Use 230
Patterns of Chronic Alcohol Abuse 230
Gender Differences in Chronic Alcohol Use 231
Alcohol Abuse among the Elderly 231
The Family Dynamics of Alcoholism: A Systems
Approach 232
Children of an Alcoholic Parent or Parents 232
The Genetics of Alcoholism 233
The Concept of Alcoholism as a Disease 234
Approaches to Treatment for Alcoholism 235
Biologically Based Treatments 235
■ P o r t r a i t : Bill W. and Dr. Bob—Founders
of Alcoholics Anonymous 237
Alcoholics Anonymous 237
■ He a l t h L i n e : Is Controlled Drinking
­Possible for Alcoholics? 238
■ Drugs . . . in Focus: The Non-Disease
Model of Alcoholism and Other Patterns of
­Substance Abuse 239
■ Q u i c k C o n cep t C h ec k 9 . 2 :
Understanding Alcoholics Anonymous 240
SMART Recovery 240
xii ■ Contents
Chronic Alcohol Abuse and Alcoholism in the
Workplace 240
Summary 241 / Key Terms 242 / Endnotes 242
■ P o i n t / C o u n t e r p o i n t III : Should
Alcoholism Be Viewed as a Disease? 246
Chapter 10
Nicotine and Tobacco Use 248
By the Numbers . . . 249
Tobacco Use through History 249
Politics, Economics, and Tobacco 250
Snuffing and Chewing 250
Cigars and Cigarettes 250
Tobacco in the Twentieth Century 251
Health Concerns and Smoking Behavior 252
■ African Americans, Smoking,
He a l t h L i n e :
and Mentholated Cigarettes 252
The Tobacco Industry Today 253
The Tobacco Settlement of 1998 254
The Tobacco Control Act of 2009 254
Tobacco Regulation and Global Economics 254
What’s in Tobacco? 254
Carbon Monoxide 255
Tar 255
Nicotine 256
The Dependence Potential of Nicotine 256
The Titration Hypothesis of Nicotine
Dependence 256
Tolerance and Withdrawal 257
Health Consequences of Tobacco Use 257
■ He a l t h L i n e :Visualizing 400,000
to 440,000 Annual Tobacco-Related Deaths 257
Cardiovascular Disease 257
Respiratory Diseases 258
Lung Cancer 259
Other Cancers 259
Special Health Concerns for Women 260
The Hazards of Environmental Smoke 260
■ He a l t h Ale r t : Signs of Trouble from
Smokeless Tobacco 261
Patterns of Smoking Behavior and Use of Smokeless
Tobacco 261
■ Q u i c k C o n cep t C h ec k 1 0 . 1 :
Understanding the Effects of Tobacco Smoking 262
The Youngest Smokers 262
 Attitudes toward Smoking among Young People 262 Potential Health Benefits 284
Smokeless Tobacco 263 Potential Health Risks 285
Cigars 264 Cardiovascular Effects 285
Tobacco Use around the World 264 Osteoporosis and Bone Fractures 285

■ P o r t r a i t : Sigmund Freud—Nicotine ■ He a l t h L i n e : Coffee, Genes, and Heart

Dependence, Cigars, and Cancer 265 Attacks 286
Quitting Smoking: The Good News and the Bad 265 Breast Disease 286
The Good News: Undoing the Damage 266 Effects during Pregnancy and Breastfeeding 286
The Bad News: How Hard It Is to Quit 266 Panic Attacks 286
Dependence, Acute Toxicity, and Medical
■ How to Succeed in Quitting
He a l t h L i n e : Applications 287
Smoking—By Really Trying 268
Tolerance 287
Nicotine Gums, Patches, Sprays, and Inhalers 268
Withdrawal 287
The Role of Physicians in Smoking Cessation 268
Craving 287
A Final Word 269
Acute Toxicity of Caffeine 287
Summary 270 / Key Terms 271 / Endnotes 271
Prescription Drugs Based on Xanthines 288
Caffeine and Young People: A Special Concern 288
Chapter 11 ■ Drugs . . . in Focus: Energy Shots 289
Caffeine 275 Summary 289 / Key Terms 290 / Endnotes 290

Coffee 276
By the Numbers . . . 276
Coffee in Britain and North America 276
Major Sources of Coffee 277
The Caffeine Content in Coffee 277
■ Drugs . . . in Focus: Why There Are No
(Live) Flies in Your Coffee 278
Tea 278
Tea in Britain and North America 278
The Chemical Content in Tea 279
Chocolate 279
How Chocolate Is Made 280
The Chocolate Industry Today 280
The Xanthine Content in Chocolate 280
■ He a l t h L i n e :Chocolate, Flavanols, and
Cardiovascular Health 281
Soft Drinks 281
Caffeine from OTC Drugs and Other Products
■ P o r t r a i t : Milton S. Hershey and the Town
Built on Chocolate 282
Caffeine as a Drug 282
■ Q u i c k C o n cep t C h ec k 1 1 . 1 :
Understanding Caffeine Levels in Foods and
Beverages 283
Effects of Caffeine on the Body 283
Effects of Caffeine on Behavior 283
Part FOUR Enhancers and
Depressants 293
Chapter 12
Performance-Enhancing Drugs
and Drug Testing in Sports 293
Drug-Taking Behavior in Sports 294
By the Numbers . . . 294
What Are Anabolic Steroids? 294
Anabolic Steroids at the Modern Olympic Games 295
■ Portrait: Lance Armstrong: From Honor
to Dishonor 297
Anabolic Steroids in Professional and Collegiate Sports 297
Performance-Enhancing Drug Abuse and Baseball 297
■ D r u g s . . . i n F o c u s : Suspension
­ enalties for Performance-Enhancing Drug Use
P
281
in Sports 298
The Hazards of Anabolic Steroids 299
Effects on Hormonal Systems 299
Effects on Other Systems of the Body 300
Psychological Problems 300
Special Problems for Adolescents 301
■ Q u i c k C o n cep t C h ec k 1 2 . 1 :
Understanding the Effects of Anabolic
Steroids 301

Contents ■ xiii
Patterns of Anabolic Steroid Abuse 301 Nonbenzodiazepine Depressants 324
The Potential for Steroid Dependence 302
■ He a l t h Ale r t : The Dangers of Rohypnol
Counterfeit Steroids and the Placebo Effect 303
as a Date-Rape Drug 324
■ He a l t h Ale r t : The Symptoms of Steroid Zolpidem and Eszopiclone 325
Abuse 304 Buspirone 325
Nonsteroid Hormones and Performance-Enhancing Beta Blockers 325
Supplements 304 Antidepressants 325
Human Growth Hormone 304
■ Q u i c k C o n cep t C h ec k 1 3 . 1 :
Dietary Supplements as Performance-Enhancing
Aids 305 Understanding the Abuse Potential in Drugs 326
Nonmedical Use of Stimulant Medication in A Special Alert: The Risks of GHB 326
Baseball 306 Acute Effects 326
Current Drug-Testing Procedures and Policies 306 Protective Strategies for Women 326
The Forensics of Drug Testing 306 ■ P o r t r a i t : Patricia White, GHB, and the
■ D r u g s . . . i n F o c u s : Pharmaceutical “Perfect” Crime 326
Companies and Anti-Doping Authorities: A New Inhalants through History 327
Alliance 307 Nitrous Oxide 328
Sensitivity and Specificity 308 Ether 329
Masking Drugs and Chemical Manipulations 308 Glue, Solvent, and Aerosol Inhalation 329
Pinpointing the Time of Drug Use 309 The Abuse Potential of Inhalants 329
Acute Effects of Glues, Solvents, and Aerosols 330
■ Q u i c k C o n cep t C h ec k 1 2 . 2 :
The Dangers of Inhalant Abuse 330
Understanding Drug Testing 310
The Social Context of Performance-Enhancing ■ He a l t h Ale r t : The Signs of Possible
Drugs 310 Inhalant Abuse 330
Summary 311 / Key Terms 312 / Endnotes 312 Patterns of Inhalant Abuse 331

Chapter 13
Depressants and Inhalants
By the Numbers . . . 316
Barbiturates 316
Categories of Barbiturates 317
Acute Effects of Barbiturates 317
■ D r u g s . . . i n F o c u s : Resistol and
Resistoleros in Latin America 332
The Dependence Potential of Chronic Inhalant
315 Abuse 333
Responses of Society to Inhalant Abuse 333
■ Q u i c k C o n cep t C h ec k 1 3 . 2 :
Understanding the History of Inhalants 334
Summary 334 / Key Terms 335 / Endnotes 336

■ Drugs . . . in Focus: Is There Any Truth Part Five Medicinal Drugs 339
in “Truth Serum”? 318
Chronic Effects of Barbiturates 319
Chapter 14
Current Medical Uses of Barbiturates 319
Patterns of Barbiturate Abuse 319 Prescription Drugs, Over-the-
Nonbarbiturate Sedative-Hypnotics 320 Counter Drugs, and Dietary
The Development of Antianxiety Drugs 320 Supplements 339
Benzodiazepines 321
Medical Uses of Benzodiazepines 321 By the Numbers . . . 340
Acute Effects of Benzodiazepines 322 The History of Prescription Drug Regulations 341
Chronic Effects of Benzodiazepines 322 Procedures for Approving Prescription Drugs 342
How Benzodiazepines Work in the Brain 323 Phases of Clinical Testing for Prescription Drugs 342
Patterns of Benzodiazepine Misuse and Abuse 323 Patents and Generic Forms of Prescription Drugs 344

xiv ■ Contents
 Speeding Up the FDA Approval Process 344
Procedures for Approving OTC Drugs 345
Are FDA-Approved Drugs Safe? 346
■ Q u i c k C o n cep t C h ec k 1 4 . 1 :
Understanding the FDA Approval Process 346
The Issue of Speed versus Caution 346
Patterns of Prescription Drug Misuse 347
Unintentional Drug Misuse through Prescription
Errors 347
■ He a l t h L i n e : The Potential for Death by
Prescription Error 348
■ He a l t h L i n e :Doctor Shopping for
Prescription Drugs 349
Patterns of Prescription Drug Abuse 349
Major OTC Analgesic Drugs 349
Aspirin 350
Acetaminophen 351
Ibuprofen 351
Naproxen 352
OTC Analgesic Drugs and Attempted Suicide 352
■ Q u i c k C o n cep t C h ec k 1 4 . 2 :
Understanding OTC Analgesic Drugs 352
Other Major Classes of OTC Drugs 352
Sleep Aids 352
Cough-and-Cold Remedies 353
The Pharmaceutical Industry Today 353
■ Portrait: Ryan Haight and the Ryan Haight
Act of 2008 354
Dietary Supplements 355
■ Drugs . . . in Focus: What We Know
about Nine Herbal Supplements 356
Summary 357 / Key Terms 358 / Endnotes
■ Should
P o i n t / C o u n t e r p o i n t IV :
Prescription Drugs Be Advertised to the General
Public? 360
Chapter 15
Drugs for Treating Schizophrenia
and Mood Disorders 362
The Biomedical Model 363
By the Numbers . . . 363
Antipsychotic Drugs and Schizophrenia 364
The Symptoms of Schizophrenia 364
The Early Days of Antipsychotic Drug Treatment 364
■ Mercury Poisoning:
He a l t h L i n e :
On Being Mad As a Hatter 365
Antipsychotic Drug Treatment 365
First-Generation Antipsychotic Drugs 365
Second-Generation Antipsychotic Drugs 366
Third-Generation Antipsychotic Drugs 367
Effects of Antipsychotic Drugs on the Brain 367
Drugs Used to Treat Depression 368
■ P o r t r a i t : The Melancholy President—
Abraham Lincoln, Depression, and Those “Little
Blue Pills” 369
First-Generation Antidepressant Drugs 369
Second-Generation Antidepressant Drugs 370
Third-Generation Antidepressant Drugs 370
■ He a l t h Ale r t : SSRI Antidepressants
and Elevated Risk of Suicide among Children
and Adolescents 371
Effects of Antidepressant Drugs on the Brain 371
The Effectiveness of Specific Antidepressant Drugs 372
Drugs for Other Types of Mental Disorders 372
Mania and Bipolar Disorder 372
■ Q u i c k C o n cep t C h ec k 1 5 . 1 :
Understanding the Biochemistry of Mental
Illness 373
Autism 373
Off-Label Usage of Psychotropic Medications 374
Psychiatric Drugs, Social Policy, and
Deinstitutionalization 374
■ D r u g s . . . i n F o c u s : Psychiatric Drugs
and the Civil Liberties Debate 375
Summary 375 / Key Terms 376 / Endnotes 376
358
Part Six Prevention and
Treatment 379
Chapter 16
Substance-Abuse Prevention 379
By the Numbers . . . 380
Levels of Intervention in Substance-Abuse
Prevention 380
■ Q u i c k C o n cep t C h ec k 1 6 . 1 :
Understanding Levels of Intervention in Substance-
Abuse Prevention Programs 381
Strategies for Substance-Abuse Prevention 381
Resilience and Primary Prevention Efforts 382
Contents ■ xv
 Measuring Success in a Substance-Abuse Prevention
Program 382
A Matter of Public Health 382
■ He a l t h L i n e : The Public Health Model and
the Analogy of Infectious Disease Control 383
■ P o r t r a i t : Dr. A. Thomas McLellan Goes
to Washington (Briefly) 384
Lessons from the Past: Prevention Approaches That
Have Failed 384
Reducing the Availability of Drugs 384
Punitive Measures 385
Scare Tactics and Negative Education 385
Objective Information Approaches 386
Magic Bullets and Promotional Campaigns 386
Self-Esteem Enhancement and Affective
Education 386
Hope and Promise: Components of Effective School-Based
Prevention Programs 387
Peer-Refusal Skills 387
Anxiety and Stress Reduction 387
Social Skills and Personal Decision Making 387
An Example of an Effective School-Based Prevention
Program 387
■ He a l t h L i n e : Peer-Refusal Skills: Ten Ways
to Make It Easier to Say No 388
Drug Abuse Resistance Education (D.A.R.E.) 389
■ Q u i c k C o n cep t C h ec k 1 6 . 2 :
Understanding Primary Prevention and
Education 389
Community-Based Prevention Programs 390
Components of an Effective Community-Based
Program 390
Alternative-Behavior Programming 391
The Influence of Media 391
An Example of an Effective Community-Based Prevention
Program 391
Family Systems in Primary and Secondary
Prevention 392
Special Role Models in Substance-Abuse Prevention 392
■ D r u g s . . . i n F o c u s : Substance Use and
Abuse among Young Mothers 393
Parental Communication in Substance-Abuse
Prevention 393
The Triple Threat: Stress, Boredom, and Spending
Money 394
Multicultural Issues in Primary and Secondary
Prevention 394
Prevention Approaches in Latino Communities 394
xvi ■ Contents
Prevention Approaches in African American
Communities 395
Substance-Abuse Prevention in the Workplace 395
The Economic Costs of Substance Abuse in the
Workplace 396
Drug Testing in the Workplace 396
The Impact of Drug-Free Workplace Policies 397
Yes, You: Substance-Abuse Prevention and the College
Student 397
Changing the Culture of Alcohol and Other Drug Use in
College 398
Substance-Abuse Prevention on College Campuses 398
■ He a l t h L i n e : Alcohol 101 on College
Campuses 399
Substance-Abuse Prevention Information 399
Summary 400 / Key Terms 401 / Endnotes 401
■ P o i n t / C o u n t e r p o i n t V : Should We
Continue to D.A.R.E. or Should We Give it up? 405
Chapter 17
Substance-Abuse Treatment:
Strategies for Change 407
By the Numbers . . . 408
Designing Effective Substance-Abuse Treatment
Programs 409
The Biopsychosocial Model for Substance-Abuse
Treatment 409
Intervention through Incarceration and Other Punitive
Measures 409
Substance-Abuse Treatment and Law Enforcement 410
■ D r u g s . . . i n F o c u s : Penalties for Crack
versus Penalties for Powder Cocaine: Correcting
an Injustice 413
Prison-Alternative Treatment Programs 414
Drug Courts 414
■ P o r t r a i t : Monsignor William O’Brien—
Founder of Daytop Village 415
Prison-Based Treatment Programs 416
Substance-Abuse Treatment in the Workplace 416
The Personal Journey to Treatment and Recovery 417
Rehabilitation and the Stages of Change 417
Stages of Change and Other Problems in Life 418
■ Q u i c k C o n cep t C h ec k 1 7 . 1 :
Understanding the Stages of Change in Substance-
Abuse Treatment 419
The Impact of Family Systems on Treatment and Principles to Maximize the Chances of Successful
Recovery 419 Treatment 423
Family Dynamics in Drug Abuse 419 Needing versus Receiving Substance-Abuse
Enabling Behaviors as Obstacles to Rehabilitation 420 Treatment 423
Survival Roles and Coping Mechanisms 421 A Final Note: For Those Who Need Help . . . 424
Resistance at the Beginning, Support along Summary 425 / Key Terms 426 /
the Way 421 Endnotes 426
Finding the Right Substance-Abuse Treatment
Program 421 Credits 429
Judging the Quality of the Treatment Facility 422 Index 433

Contents ■ xvii
This page intentionally left blank
Preface
In today’s world, drugs and their use have the
potential for good and for bad. As a society and as indi-
viduals, we can be the beneficiaries of drugs—or their
victims. This perspective continues to be the mes-
sage of Drugs, Behavior, and Modern Society, Eighth
Edition. As has been the case since the first edition, this
book introduces the basic facts and major issues con-
cerning drug-taking behavior in a straightforward, com-
prehensive, and reader-friendly manner. A background
in biology, sociology, psychology, or chemistry is not
necessary. The only requirement is a sense of curiosity
about the range of chemical substances that affect our
minds and our bodies and an interest in the challenges
these substances bring to our society and our daily lives.
These challenges can be framed in terms of three fun-
damental themes.
The role of drug-taking behavior throughout history—
First of all, present-day issues concerning drug misuse
and abuse are issues that society has confronted for a
long time. Drugs and drug-taking behavior are conse-
quences of a particularly human need to feel stronger,
more alert, calmer, more distant and dissociated from
our surroundings, or simply good. It is the misuse and
abuse of chemical substances to achieve these ends
that have resulted in major problems in the United
States and around the world.
The diversity in psychoactive drugs in our society—
There is an enormous diversity among drugs that
affect the mind and the body. We need to educate
ourselves not only about illicit drugs such as cocaine,
amphetamines, heroin, hallucinogens, and marijuana
but also about legally available drugs such as alcohol,
nicotine, and caffeine. Drugs, Behavior, and Modern
Society has been designed as a comprehensive survey
of all types of psychoactive drugs, addressing the issues
of drug-taking behavior from a combination of psy-
chological, biological, and sociological perspectives.
The personal impact of drug-related issues in our lives—
Finally, we need to recognize that, like it or not, the
decision to use drugs is one of life’s choices in contem-
porary society, regardless of our racial, ethnic, or reli-
gious background, how much money we have, where
we live, how much education we have acquired,
whether we are male or female, and whether we are
young or old. The potential for misuse and abuse is a
problem facing all of us.
New To This Edition
The Eighth Edition of Drugs, Behavior, and Modern
Society is divided into six sections:
Part One (Chapters 1–3): Drugs in Society/Drugs in
Our Lives
Part Two (Chapters 4–7): Legally Restricted Drugs in
Our Society
Part Three (Chapters 8–11): Legal Drugs in Our
Society
Part Four (Chapters 12 and 13): Enhancers and
Depressants
Part Five (Chapters 14 and 15): Medicinal Drugs
Part Six (Chapters 16 and 17): Prevention and
Treatment
As you will see, chapters about particular drugs have
been grouped not in terms of their pharmacological or
chemical characteristics but, rather, in terms of how
readily accessible they are to the general public and
today’s societal attitudes toward their use. The last sec-
tion of the book concerns itself with prevention and
treatment. In addition, several special features through-
out the book will enhance your experience as a reader
and serve as learning aids.
This text is available in a variety of formats—digital
and print. To learn more about our programs, pricing
options, and customization, visit www.pearsonhighered
.com.
By the Numbers . . .
At the beginning of each chapter, a feature called By the
Numbers . . . provides an often surprising and provoca-
tive insight into current viewpoints and research. It is pre-
sented in a brief, quantitative format that draws you into
the chapter and sets the stage for further exploration.
Quick Concept Checks
Sometimes, when the material gets complicated, it is
good to have a quick way of finding out whether you
understand the basic concepts being explained. Each
chapter of this book includes, from time to time, a
Quick Concept Check, where you can see in a minute
Preface ■ xix
or two where you stand. Some of the Checks are in a
matching format; others involve interpreting a graph or
diagram. In some cases, you will be asked to apply the
principles you have learned to a real-world situation.
Portraits
Seventeen Portrait features, one in each chapter, take you
into the lives of individuals who either have influenced our
thinking about drugs in our society or have been affected
by drug use or abuse. Some of these people are known to
the public at large, but many are not. The subjects of these
Portraits include a brutal drug trafficker (Pablo Escobar,
Chapter 2), a movie star ­(Robert Downey Jr., Chapter 4),
a convicted killer (David L ­ affer, Chapter 5), a cultural
icon (Timothy Leary, Chapter 6), and a depressive U.S.
­President (Abraham Lincoln, Chapter 13). All the Por-
traits put a human face on discussions of drugs and behav-
ior. They remind us that we are dealing with issues that
affect real people in all walks of life, now and in the past.
Drugs . . . in Focus
There are many fascinating stories to tell about the role
of drugs in our history and our present-day culture,
along with important facts and serious issues surround-
ing drug use. A total of 26 Drugs . . . in Focus features
are presented in the Eighth Edition. The topics of these
features cover a wide range, from questions about the
origins of the word coca in Coca-Cola (Chapter 4) and
possible hallucinogenic witchcraft in seventeenth cen-
tury Salem, Massachusetts, (Chapter 6), to future possi-
bilities of gene doping in the Olympics (Chapter 12) and
the present-day use of “truth serum” in terrorist interro-
gations (Chapter 13).
Health Line
Helpful information regarding the effectiveness and safety
aspects of particular drugs, specific aspects of drug-taking
behavior, and new medical applications can be found in
22 Health Line features throughout the book. Health
Line topics include understanding the neurological basis
for drug craving (Chapter 3), the controversy over the use
of stimulant medications as “smart pills” (Chapter 4), con-
cerns over a new synthetic marijuana called Spice (Chap-
ter 7), the risks of smoking mentholated cigarettes among
African Americans (Chapter 10), “­ doctor-shopping” and
prescription pain medications (Chapter 14), and alcohol
prevention programs like Alcohol 101 on college cam-
puses (Chapter 16), to name a few.
xx ■ Preface
Health Alert
Information of a more urgent nature is provided in
14 Health Alert features. You will find important
facts that you can use to recognize the signs of drug
misuse or abuse and ways in which you can respond
to emergency drug-taking situations, as well as useful
Internet links where you can go for assistance. Health
Alert topics in the Eighth Edition include strategies
to avoid adverse effects of drug-drug and food-drug
combinations (Chapter 3), the risks of cocaine com-
bined with alcohol (Chapter 4), emergency guide-
lines for adverse reactions to LSD (Chapter 6) or
alcohol (Chap­ter 8), and the dangers of Rohypnol as
a date-rape drug (Chapter 13).
Point/Counterpoint Debates
Drug issues are seldom black or white, right or wrong.
Some of the most hotly debated questions of our day
concern the use, misuse, and abuse of drugs. These
issues deserve a good deal of critical thought. This is
why at specific locations in this book, I have taken five
important controversies concerning drugs, collected
the key viewpoints pro and con, and created a Point/
Counterpoint debate based on a simulated conversa-
tion that two hypothetical people might have on that
question. The ­Point/Counterpoint features appear at
the end of the chapter that deal specifically with the
controversy addressed in the debate. I invite you to
read these debates carefully and try to arrive at your
own position, as an exercise in critical thinking. Along
with considering the critical thinking questions for
further discussion that follow each Point/Counter-
point feature, you may wish to continue the debate in
your class.
Supplements
Pearson Education is pleased to offer the following sup-
plements to qualified adopters.
Instructor’s Manual and Test Bank
(0-205-04839-0)
This Instructor’s Manual and Test Bank provides
instructors with support material, classroom enrich-
ment inform­ation, and wealth of assessment questions.
Corresponding to the chapters in the text, each of the
manual’s 17 chapters contains discussion questions, lec-
ture outlines, video suggestions, and a test bank, which
includes an extensive set of multiple choice, true/false
and essay questions.
MyTest Test Bank
(0-205-04837-4)
This test bank is available in computerized f­ormat,
which allows instructors to easily create and print quiz-
zes and exams. Questions and tests can be authored
online, allowing instructors ultimate flexibility and
the ability to efficiently manage assessments anytime,
anywhere. Instructors can easily access existing ques-
tions, edit, create, and store using simple drag and
drop Word-like controls. For more information, go to
www.PearsonMyTest.com.
PowerPoint Presentation
(0-205-04836-6)
The PowerPoint Presentation is an exciting interactive
tool for use in the classroom. Each chapter pairs key
concepts with images from the textbook to reinforce
student learning.
MyPsychLab
(www.mypsychlab.com)
This online study resource offers a wealth of anima-
tions and practice tests, plus additional study and
research tools. With this edition, there are now new
assessments, web and video/media links, and flash
cards. www.pearsonhighered.com
An Invitation to Readers
I welcome your reactions to Drugs, Behavior, and Mod-
ern Society, Eighth Edition. Please send any comments
or questions to the following address: Dr. Charles
F. ­Levinthal, Department of Psychology, 135 ­Hofstra
­University, Hempstead, NY 11549. You can also com-
municate by fax at 516 463-6052 or at the following
email address: charles.f.levinthal@hofstra.edu. I look
forward to hearing from you.
Acknowledgments
In the course of writing the Eighth Edition, I have received
much encouragement, assistance, and expert advice from
a number of people. I have benefited from their generous
sharing of materials, knowledge, and insights. I am par-
ticularly indebted to Dr. Elizabeth Crane, Substance
Abuse and Mental Health Services Administration, U.S.
Department of Health and Human Services; Charles F.
Miller, Office of Policy and Interagency Affairs, National
Drug Intelligence Center, U.S. Department of Justice;
Dr. Patrick M. O’Malley, Institute for Social Research,
The University of Michigan, Ann Arbor; and Lawrence
Payne, Office of Public Affairs, Drug Enforcement
Administration, U.S. Department of Justice.
I am fortunate to have worked with a superb team
at Pearson. I am especially indebted to my editor,
Susan Hartman, my program manager, Reena Dalal,
and my senior project manager, Revathi ­Viswanathan.
Their professionalism and talents contributed so much
to the production quality of this book and are greatly
appreciated. A number of manuscript reviewers made
invaluable suggestions as I worked on the Eighth
Edition. I thank all of them for their help: Marge Murray-
Davis, Minnesota State University; Philip Langlais,
Old Dominion University; Robin Joynes, Kent State
University; Chris Jones-Cage, College of the Desert;
Susan Fellows, California State University, Dominguez
Hills; Toni Watt, Texas State University; Larry Ashley,
University of Nevada; Frank White, University of North
Dakota; Jennifer Graham, Penn State University;
Christopher Goode, Georgia State University; Andy
Harcrow, The University of Alabama; Robert Carr,
University of South Dakota; John Gampher, University
of Alabama at Birmingham; Bengie Cravey, Darton State
College; Lee Ancona, University of North Texas; Sidney
Auerbach, Rutgers University; Christopher Correia,
Auburn University; Perry Fuchs, UT Arlington; Edith
Ellis, College of Charleston; Neil Rowland, University
of Florida; William Cabin, Richard Stockton College.
On a more personal note, there are others who
have given me their support over the years and to whom
my appreciation goes beyond words. As always, I thank
my mother-in-law, Selma Kuby, for her encouragement
and love.
Above all, my family has been a continuing source
of strength. I will always be grateful to my sons David
and Brian, and to my daughters-in-law Sarah and Karen,
for their love and understanding. I am especially grate-
ful to my wife, Beth, for her abiding love, support, and
complete faith in my abilities. The Eighth Edition is
dedicated to my grandsons, Aaron Matthew Levinthal
and Michael Samuel Levinthal.
Charles F. Levinthal
Preface ■ xxi
This page intentionally left blank
Part One
Drugs in Society/Drugs in Our Lives

Ch ap ter

Drugs and 1
Behavior Today After you have completed
this chapter, you should
have an understanding of

▶ Basic terminology concerning

drugs and drug-taking behavior

▶ The origins and history of

drugs and drug-taking
Mike was seventeen, soon to be a high school senior—an
behavior
age when life can be both terrific and terrifying. He looked
▶ Present-day patterns of drug
at me with amazement, telling me by his expression that use in the United States
either the question I was asking him was ridiculous, or the
▶ Risk factors and protective
answer was obvious. “Why do kids do drugs?” I had asked. ­factors for drug-taking
behavior
“It’s cool,” he said. “That’s why. Believe me, it’s impor-
tant to be cool. Besides, in my life, drugs just make me feel ▶ Current problems with club
drugs and the nonmedical
better. Smoking some weed, chilling out with a little Vicodin, use of prescription pain
spinning with some Addies—it’s a way of getting away from relievers and prescription
stimulant medications
stuff. You know that everybody does it. At least all of my
friends do it. And it’s easy to get them. A helluva lot easier
than beer.”
The conversation was over. But as he started to leave,
Mike seemed to notice the concern on my face. “Don’t
worry about me,” he said with a smile, “I can handle it.
I can handle it just fine.”

1
There is no question that we live in a world where
drugs are all around us. Thousands of Internet web
sites offering information about drug use are just a
click away. We are continually bombarded with news
about drug-related arrests of major drug traffickers
and ordinary citizens, news about popular celebrities
and their latest involvement with drugs, news about
drugs intercepted and confiscated at our borders and
widespread drug use in the major cities and small
towns of America.
It also seems impossible to avoid the reality of
drugs in our personal lives. One in four adults in the
United States, according to one survey, report that
drugs have been a cause of trouble in their family. At a
time when the economy and related matters dominate
our concerns about the present and the future, about
two out of three Americans continue to worry about
drug use either a fair amount of time or a great deal.
In school, you have been taught the risks involved in
drug use, and most of you have contended with the
social pressure to engage in drug-taking behavior with
your friends. You may or may not have been success-
ful in doing so. You also may have noticed your lo-
cal pharmacy starting to look increasingly like a bank,
with the installation of panic alarms, bulletproof glass,
and security cameras, as pharmacists turn to protect-
ing themselves from people robbing them for their
supplies of oxycodone and other prescription pain
medications.1
Making matters more complicated and difficult
for us, drug-related problems in our contemporary
by the numbers . . .
61,533 On an average day in 2011, the
number of U.S. adolescents, aged
12 to 17 years old, who binged on
alcohol
3,192 The number in 2011 who smoked a
cigarette for the first time. Average
age: 17.2 years old.
449,000,000 The number of results that come up
from searching the word “drugs” on
Google.®
Source: Information from the Google® search engine,
2013. Substance Abuse and Mental Health Services
Administration (2012). Results from The 2011 National
Survey on Drug Use and Health: Detailed Tables.
Rockville, MD: Substance Abuse and Mental Health
Services Administration, Tables 2.73A and 4.6B.
2 ■ Part One Drugs in Society/Drugs in Our Lives
society extend beyond illegal drugs such as heroin,
cocaine, amphetamines, LSD and other hallucino-
gens, and (except for certain U.S. states) marijuana.
In fact, while many of these drugs continue to wreak
havoc on lives and communities throughout America,
it can be argued that the adverse effects associated
with legally sanctioned drugs such as alcohol, nico-
tine, and certain prescription and nonprescription
medications are more far-reaching. The abuse of
these drugs affects far greater numbers of people, de-
spite our efforts to regulate their use. Here are some
facts about legally sanctioned drugs as we proceed
through the second decade of the twenty-first cen-
tury in America:
■ Regular consumption of alcohol often begins in
junior high school or earlier, despite the fact that
twenty-one is the minimum legal age for purchas-
ing alcoholic beverages. In the United States
alone, more than 38 million adults, 1 in 6 in the
population, admit to having binged on alcohol at
least four times in the last month, with more than
80,000 deaths each year attributed to excessive
drinking. One in 10 children and teenagers in the
United States (about 7.5 million) live with at least
one parent who has an alcohol problem. On college
campuses nationwide, binge drinking continues to
be a major problem and a significant factor in date-
rape assaults and other forms of violent behavior
(Chapter 8). We pay a heavy price for problems as-
sociated with chronic alcohol abuse and alcoholism
on a social and personal level (Chapter 9).
■ About one in eleven high school seniors report
smoking cigarettes daily, despite the fact that it is ille-
gal for those younger than 18 years old (19 years old
in some U.S. states) to purchase tobacco products.
While the current prevalence rate is less than half
the prevalence rate in 1990s when the figure was
about 1 in 5, underage smoking remains a significant
public-health issue (Chapter 10)—for good reason.
Nearly 80 percent of all adult smokers smoked their
first cigarette and became regular smokers before
they were 18 years old.2
■ Prescription drug abuse, particularly with respect
to pain medications such as oxycodone and hydro-
codone (Chapter 5), has reached epidemic propor-
tions. In New York State alone, prescriptions for
pain medication have risen 82 percent from 2007
to 2010, along with significant increases in hospital
admissions and deaths due to nonmedical use of
these drugs. Since 2008, unintentional drug poison-
ing (principally from prescription medications) has
 become the leading cause of injury death among
people 25 to 64 years old, exceeding fatalities due to
motor vehicle accidents. Nationwide, more than 700
pharmacies in 2012 experienced an armed robbery
specifically for prescription drugs, about twice as
many as in 2006.3
It will be important, therefore, to address the issues of
drugs that are legally sanctioned in our society as well
as drugs that are not.
Whether we like it or not, the decision to use
drugs of all types and forms, legally sanctioned or not,
has become one of life’s choices in America, as well
as in societies around the world. Every segment of so-
ciety is affected. The availability of drugs and the po-
tential for drug abuse present a challenge for people
of all ages, from the young to the elderly. The conse-
quences of drug-taking behavior can be observed in
the workplace and retirement communities as well
as on street corners, in school yards, and on college
campuses. Drug use is going on in the homes of every
community, large or small. The social and personal
problems associated with drug use extend in one way
or another to men and women of all ethnic and racial
groups, geographic regions, and socioeconomic levels.
No groups and no individuals should believe them-
selves exempt.4
The purpose of this book is to answer your ques-
tions and address your concerns about the wide range
of drugs and the many forms of drug-taking behavior in
our society today. You might even find answers to ques-
tions you never thought about.
The nonmedical use of prescription medications has become
a significant public health concern. In 2011, an estimated
24 million Americans over the age of 26 reported using a pain
medication for nonmedical reasons at some point in their
lifetime.
Social Messages
about Drug Use
Unfortunately, we live in a social environment that sends
us mixed messages about drug-taking behavior. The im-
ages of Joe Camel, the Marlboro Man, and the Virginia
Slims Woman in print advertisements for cigarettes are
remnants of an increasingly distant past, but at one time
they were iconic (and highly effective) symbols in mar-
keting campaigns designed to convey the attractiveness
of smoking to the public, particularly to young people.
They are gone now as a result of federal regulations over
cigarette advertising that were established in 1998. For
decades, warning labels on cigarette packs and public
service announcements have cautioned us about the se-
rious health hazards of tobacco use, but the fact remains
that about one in four adult Americans today are cur-
rent cigarette smokers, and the prevalence rate has been
slow to decline (see Chapter 10).
Beer commercials during telecasts of football games
and other athletic events are designed to be entertaining
and to associate beer drinking with a lifestyle filled with
fun, friendship, sex, and romance, but we are expected to
abide by the tagline at the end of the ad to “drink respon-
sibly” or “know when to say when.” The ramifications
of the social messages inherent in these commercials
are significant. It has been established that the degree of
positive expectancies about alcohol (viewing drinking as
a way of gaining social acceptance, for example) predicts
the onset age of drinking and the tendency to engage in
high-risk alcohol use over time (see Chapter 8).
Major political figures, including U.S. presidents
and vice presidents, as well as candidates for these offices
and a host of public officials on local and national levels,
have admitted smoking marijuana earlier in their lives.
In recent years, regulatory policy in some U.S. states has
changed dramatically, making marijuana legally avail-
able either for medical purposes or general use by adults.
Yet the U.S. federal government position on marijuana
remains unchanged, stipulating that the drug is an illegal
substance, officially classified since 1970 as a Schedule I
controlled substance, defined as a drug with a high po-
tential for abuse and no accepted medical use—in the
same category as heroin (see Chapters 2 and 7).
Anti-drug media campaigns are designed to dis-
courage young people from becoming involved with
drugs in general. At the same time, we observe a never-
ending stream of sports figures, entertainers, and other
high-profile individuals engaging in drug-taking be-
havior. Even though the careers of these people are
frequently jeopardized, and in some instances, lives
Chapter 1 Drugs and Behavior Today ■ 3
are lost (see Chapter 2), powerful pro–drug-use mes-
sages continue to influence us. These messages come
from the entertainment industry and traditional media
sources, as well as from web sites on the Internet. 5 As
confusing and often contradictory as these messages are,
they represent the present-day drug scene in America.
Two Ways of Looking
at Drugs and Behavior
In the chapters ahead, we will look at the subject of
drugs and behavior in two basic ways.
First, we will examine the biological, psychological,
and sociological effects of consuming certain types of
drugs. The focus will be on the study of specific sub-
stances that alter our feelings, our thoughts, our percep-
tions of the world, and our behavior. These substances
are referred to as psychoactive drugs because they have
the ability to alter the functioning of the brain and
hence produce changes in our behavior and experience.
Psychoactive drugs that traditionally receive the great-
est amount of attention are referred to as illicit (illegal)
drugs. Criminal penalties are imposed in the United
States on their possession, manufacture, or sale. The best-
known examples are heroin, cocaine, and (except in some
U.S. states) marijuana, as well as a wide range of so-called
“club drugs,” such as methamphetamine (meth), Ecstasy,
LSD, PCP, ketamine, and GHB. Other equally important
psychoactive substances, however, are licit (legal) drugs,
such as alcohol, nicotine, caffeine, and certain prescrip-
tion medications. In the cases of alcohol and nicotine,
­legal access carries a minimum-age requirement.
Second, we will focus on the complex interplay
of circumstances in our lives that lead to drug-taking
behavior. We will examine the possibility that drug
use is, at least in part, a consequence of how we feel
about ourselves in relation to our family, friends, and
acquaintances, to our life experiences, and to the
community in which we live. We will also examine
psychoactive drugs: Drugs that affect feelings,
thoughts, perceptions, or behavior.
illicit drugs: Drugs whose manufacture, sale, or
possession is illegal.
licit drugs: Drugs whose manufacture, sale, or
possession is legal.
drug dependence: A condition in which an individual
feels a compulsive need to continue taking a drug. In
the process, the drug assumes an increasingly central
role in the individual’s life.
4 ■ Part One Drugs in Society/Drugs in Our Lives
the biological factors that may predispose us to drug-
taking behavior. An exploration into the reasons why
some individuals engage in drug-taking behavior,
whereas others do not, will be a primary topic of
discussion.
Understanding the interplay between drug-tak-
ing behavior and society is essential when we con-
sider the dangerous potential for drug use to become
drug dependence. As many of us know all too well,
a vicious circle can develop in which drug-taking be-
havior fosters more drug-taking behavior, in a spiral-
ing pattern that can be extremely difficult to break.
Individuals showing signs of drug dependence dis-
play intense cravings for the drug and, in many
cases, require increasingly greater quantities to get
the same, desired effect. They become preoccupied
with their drug-taking behavior, and it becomes evi-
dent that their lives have gotten out of control (see
Chapter 2).
Ultimately, an understanding of drug dependence
requires an examination of biological as well as psycho-
logical and sociological factors (see Figure 1.1). On a
biological level, the use of psychoactive drugs modifies
the functioning of the brain, both during the time when
Psychoactive Drugs
Physiological Impact
on the Brain
Drug-Taking Behavior Society
Biological Psychological Sociological
Factors Factors Factors
Figure 1.1
The Biopsychosocial Model: Understanding the interplay of
drugs, behavior, and society.
the drug is present in the body and later, when the
drug-taking behavior stops. Drug dependence, there-
fore, produces long-lasting brain changes. As Alan Lesh-
ner, former director of the National Institute on Drug
Abuse (NIDA), has put it, a “switch” in the brain seems
to be thrown following prolonged drug use. It starts as
a voluntary behavior, but once that switch is thrown, a
pattern of drug dependence takes over. On a psycho-
logical and sociological level, drug dependence can be
viewed as the result of a complex interaction of the in-
dividual and his or her environment. We cannot fully
understand the problem of drug dependence without
being aware of the social context in which drug-taking
behavior occurs. As we will see in Chapter 17, the rec-
ognition that drug dependence can be defined in terms
of biological, psychological, and social components has
important implications for designing effective treat-
ment programs.6
Which drugs have the greatest potential for creating
drug dependence? How can someone escape drug de-
pendence once it is established? What factors increase
or decrease the likelihood of drug-taking behavior in the
first place? These are among the questions we will con-
sider next, as we examine the impact of drugs and drug-
taking behavior on our lives.
A Matter of Definition:
What Is a Drug?
Considering the ease with which we speak of drugs and
drug use, it seems that it should be relatively easy to explain
what we mean by the word drug. Unfortunately, there are
significant problems in arriving at a clear definition.
The standard approach is to characterize a drug as a
chemical substance that, when taken into the body, alters
the structure or functioning of the body in some way. In
doing so, we are accounting for examples such as medi-
cations used for the treatment of physical disorders and
mental illnesses, as well as for alcohol, nicotine, and the
typical street drugs. Unfortunately, however, this broad
definition could also refer to ordinary food and water.
Because it does not make much sense for nutrients to
be considered drugs, we need to refine our definition by
adding the phrase excluding those nutrients considered to
be related to normal functioning.
But we may still be on slippery ground. We can
now effectively eliminate the cheese in your next pizza
from being considered a drug, but what about some ex-
otic ingredient in the sauce? Sugar is safely excluded,
even though it has significant energizing (and therefore
behavioral) effects on us, but what about the cayenne
pepper that burns your tongue? Where do we draw the
line between a drug and a nondrug? It is not an easy
question to answer.
We can learn two major lessons from this seem-
ingly simple task of defining a drug. First, there is prob-
ably no perfect definition that would distinguish drugs
from nondrugs without leaving a number of cases that
fall within some kind of gray area. The best we can do
is to set up a definition, as we have, that handles most
of the substances we are likely to encounter. However,
significant practical difficulties may still arise. As we will
see in Chapter 14, the fact that dietary supplements are
currently not regulated in the United States has resulted
from a governmental decision that these particular
substances are not to be considered drugs in the same
category as prescription or nonprescription (over-the-
counter) medications. Whether or not this distinction is
an arbitrary one continues to be a matter of debate.
The second lesson is more subtle. We often draw
the distinction between drugs and nondrugs not in terms
of their physical characteristics but, rather, in terms of
whether the substance in question has been intended
to be used primarily as a way of inducing a bodily or
psychological change.7 By this reasoning, if the pizza
maker intended to put that spice in the pizza to make
it taste better, the spice might not be considered a drug;
it would simply be another ingredient in the recipe. If
the pizza maker intended the spice to intoxicate you or
quicken your heart rate, then it might be considered a
drug (See Health Line on page 6).
Ultimately, the problem is that we are trying to reach
a consensus on a definition that fits our intuitive sense of
what constitutes a drug. We may find it difficult to de-
fine pornography, but (as has been said in the halls of
the U.S. Supreme Court) we know it when we see it. So
it may be with drugs. Whether we realize it or not, when
we discuss the topic of drugs, we are operating within a
context of social and cultural values, a group of shared
feelings about what kind of behavior (that is, what kind
of drug-taking behavior) is right and what kind is wrong.
The judgments we make about drug-taking behav-
ior even influence the terminology we use when refer-
ring to that behavior. When we say “drug misuse” and
“drug abuse,” for example, we are implying that some-
thing wrong is happening, that a drug is producing some
harm to the physical health or psychological well-being
of the drug user or to society in general.
drug: A chemical substance that, when taken into
the body, alters the structure or functioning of the
body in some way, excluding those nutrients consid-
ered to be related to normal functioning.
Chapter 1 Drugs and Behavior Today ■ 5
 Health Line
Defining Drugs: Olive Oil, Curry Powder, and a Little Grapefruit?
An ever-increasing number of reminders about the blurri-
ness of the distinction between drugs and nondrugs come
from research on the chemical properties of specific foods
we eat on a daily basis. For example, in 2005 it was found
that freshly pressed olive oil contains large amounts of
oleocanthal, a compound that inhibits the activity of cy-
clooxygenase enzymes in exactly the same way as ibupro-
fen, a popular nonsteroidal anti-inflammatory medication
(see Chapter 14). Essentially, olive oil reduces inflamma-
tion in the body in a drug-like manner. By this definition,
olive oil could be classified as a drug.
This discovery provides a biochemical clue to under-
standing the well-documented but puzzling health benefits
of a Mediterranean (olive oil-based) diet, which leads to a
lower risk of cancer, heart disease, and other chronic disor-
ders, despite its heavy emphasis on fat and salt. This particu-
lar diet may also lower the risk of clinical depression.
Another example is the spice turmeric, used com-
monly in most commercial curry powders, as well as add-
ing the bright yellow color in many mustards. The active
ingredient of turmeric, called curcumin, has been credited
with several medicinal benefits. Curcumin apparently
has antioxidant, anti-inflammatory, antiviral, antibacte-
rial, and antifungal properties with potential benefits in
the treatment of cancer, diabetes, arthritis, Alzheimer’s
disease, and other chronic disorders. In 2005 alone, nearly
300 technical and scientific papers cited the drug-like activ-
ity of ­curcumin—three times the number reported in 2000.
If the regulatory hurdles established by the U.S. Food and
But by what criteria do we say that a drug is being
misused or abused? We cannot judge on the basis of
whether the drug is legal or illegal, since decisions about
the legality of a psychoactive drug are more often made
as a result of historical and cultural circumstances than
on the physical properties of the drug itself. Tobacco,
for example, has deeply rooted associations in American
history, dating to the earliest colonial days. Although it
is objectionable to many individuals and harmful to the
health of the smoker and others, tobacco is nonetheless
a legal commodity, although its commercial availability
is limited to adults. Alcohol is another legal commodity,
available within the bounds of the law, even though it can
be harmful to individuals who become inebriated and to
others who may be affected by the drinker’s drunken be-
havior. The difficulty of using a criterion based on legality
is further complicated by differences in religious attitudes
toward these substances in some societies in the world.
6 ■ Part One Drugs in Society/Drugs in Our Lives
Drug Administration with respect to long-term safety can be
overcome, curcumin could provide an inexpensive alterna-
tive to several currently available prescription drugs.
Still another example is grapefruit. A common flavo-
noid called naringenin, found in grapefruit, has a specific
inhibitory effect on the secretion of hepatitis C virus from
infected liver cells. Nontoxic amounts of naringenin
reduced hepatitis C virus secretion by as much as 80 per-
cent. People taking certain prescription medications have
to be careful if they are eating grapefruit at the same time.
The interaction effects will be covered in Chapter 3.
As we continue to learn more about the therapeutic
or drug-interacting effects of common foods and spices, the
customary exclusion of nutrients in the definition of drugs
becomes increasingly problematic. In the future, we might
be hearing people say that they are taking olive oil, curry
powder, or a little grapefruit extract for “medicinal reasons.”
Sources: Beauchamp, G. K.; Keast, R. S. J.; More, D.; Lin,
J.; Pika, J.; Han, Q.; Lee, C. H.; Smith, A. B.; and Breslin, P.
A. S. (2005). Phytochemistry: Ibuprofen-like activity in extra-
virgin olive oil. Nature, 437, 45–46. Hampton, Tracy (2008,
April 2). Grapefruit compound battles hepatitis C. Journal
of the American Medical Association, 1532. Sanchez-Ville-
gas, A.; Delgado-Rodriguez, M.; Alonso, A.; Schlatter, J., et
al. Association of the Mediterranean dietary pattern with
the incidence of depression. Archives of General Psychia-
try, 66, 1090–1098. Stix, G. (2007, February). Spice healer.
Scientific American, pp. 66–69.
Instrumental Drug Use/
Recreational Drug Use
It is useful to base our discussion about drug abuse and
misuse by answering a simple but fundamental ques-
tion: What is the intent or motivation of the drug user
with respect to this kind of behavior? In terms of the in-
tent of the individual, drug-taking behavior can be clas-
sified as either instrumental or recreational.8
By instrumental use, we mean that a person is tak-
ing a drug with a specific socially approved goal in mind.
The user may want to stay awake longer, fall asleep more
quickly, or recover from an illness. If you are a medi-
cal professional on call over a long period of time or a
instrumental use: Referring to the motivation of a
drug user who takes the drug for a specific purpose
other than getting “high.”
 Licit Illicit Figure 1.2

Legal Status Four categories of drug-taking behavior,

derived from combinations of the user’s
Taking Valium with a Taking amphetamines goal and the drug’s legal status.
prescription to relieve without a prescription to Source: Adapted from Goode, E. (2008).
anxiety stay awake the night before Drugs in American Society (7th ed.).
Instrumental a test New York: McGraw-Hill, p. 14.
Use

Taking No Doz to stay Taking morphine without a

awake on a long trip prescription to relieve pain

Goal

Having an alcoholic drink Smoking marijuana to

to relax before dinner
Recreational
Use
Smoking a cigarette or a
cigar for enjoyment
get high
Taking LSD for the
hallucinogenic effects

long-distance truck driver, your taking a drug with the
goal of staying alert is considered acceptable by most
people. Recovering from an illness and achieving some
reduction in pain are goals that are unquestioned. In
these cases, drug-taking behavior occurs as a means toward
an end that has been defined by our society as legitimate.
The legal status of the drug itself or whether we agree
with the reason for the drug-taking behavior is not the is-
sue here. The instrumental use of drugs can involve pre-
scription and nonprescription, or over-the-counter, drugs
that are licitly obtained and taken for a particular medical
purpose. Examples include an antidepressant prescribed
for depression, a cold remedy for a cold, an anticonvulsant
drug to control epileptic seizures, and insulin to maintain
the health of a person with diabetes. But the instrumental
use of drugs can also involve drugs that are illicitly
obtained, such as an amphetamine or other stimulant
drug that has been procured by illegal means to help a
person stay awake and alert after hours without sleep.
In contrast, recreational use means that a person
is taking the drug not as a means to a socially approved
goal but for the purposes of experiencing the effect of
the drug itself. The motivation is to enjoy a pleasur-
able feeling or positive state of mind. Whatever happens
as a consequence of recreational drug-taking behavior
is viewed not as a means to an end, but as an end onto
itself. Drinking alcohol and smoking tobacco are two
examples of licit recreational drug-taking behavior.
Involvement with street drugs, in the sense that the goal
is to alter one’s mood or state of consciousness, falls into
the category of illicit recreational drug-taking behavior.
Although this four-group classification scheme, as
shown in Figure 1.2, can help us in understanding the
complex relationship between drugs and behavior, there
will be instances in which the category is less than clear.
Drinking an alcoholic beverage, for example, is considered
recreational drug-taking behavior under most circum-
stances. If it is recommended by a physician for a speci-
fied therapeutic or preventive purpose (see Chapter 8),
however, the drinking might be considered instrumental
in nature. Thus, whether drug use is judged to be recre-
ational or instrumental is determined in no small part by
the circumstances under which the behavior takes place.
Drug Misuse or Drug Abuse?
How do the terms drug misuse and drug abuse, fit into this
scheme? Drug misuse typically applies to cases in which
recreational use: Referring to the motivation of a
drug user who takes the drug only to get “high” or
achieve some pleasurable effect.
drug misuse: Drug-taking behavior in which a prescrip-
tion or over-the-counter drug is used inappropriately.
drug abuse: Drug-taking behavior resulting in some
form of physical, mental, or social impairment.

Chapter 1 Drugs and Behavior Today ■ 7

a legal prescription or over-the-counter (OTC) medication
is used inappropriately. Many instances of drug misuse in-
volve instrumental goals. For example, drug doses may be
increased beyond the level of the prescription in the mis-
taken idea that if a little is good, more is even better. Or
doses may be decreased from the level of the prescription
to make the drug supply last longer. Drugs may be contin-
ued longer than they were intended to be used; they may
be combined with some other drug; or a prescription drug
Drugs . . . in Focus
Drug Abuse and the College
Student: An Assessment Tool
In a research study conducted at Rutgers University, a cutoff
score of five or more “yes” responses to the following twenty-
five questions in the Rutgers Collegiate Substance Abuse
Screening Test (RCSAST) was found effective in correctly
classifying 94 percent of young adults in a clinical sample
as problem users and 89 percent of control individuals as
nonproblem users. It is important, however, to remember that
the RCSAST does not by itself determine the presence of sub-
stance abuse or dependence (see Chapter 2). The RCSAST is
designed to be used as one part of a larger assessment battery
aimed at identifying which young adults experience problems
due to substance use and specifically what types of problems
a particular individual is experiencing. Here are the questions:
1. Have you gotten into financial trouble as a result of
drinking or other drug use?
2. Is alcohol or other drug use making your college life
unhappy?
3. Do you use alcohol or other drugs because you are shy
with other people?
4. Has drinking alcohol or using other drugs ever caused
conflicts with close friends of the opposite sex?
5. Has drinking alcohol or using other drugs ever caused
conflicts with close friends of the same sex?
6. Has drinking alcohol or using other drugs ever dam-
aged other friendships?
7. Has drinking alcohol or using other drugs ever been
behind your losing a job (or the direct reason for it)?
8. Do you lose time from school due to drinking and/or
other drug use?
9. Has drinking alcohol or using other drugs ever inter-
fered with your preparations for exams?
8 ■ Part One Drugs in Society/Drugs in Our Lives
may (in violation of instructions) be shared by family mem-
bers or given to a friend.
Drug misuse can be dangerous and potentially lethal,
particularly when alcohol is combined with drugs that
depress the nervous system. Drugs that have this particu-
lar feature include antihistamines, antianxiety drugs, and
sleeping medications. Even when alcohol is not involved,
however, drug combinations can still represent serious
health risks, particularly for the elderly, who often take a
10. Has your efficiency decreased since drinking and/or
using other drugs?
11. Do you drink alcohol or use other drugs to escape
from worries or troubles?
12. Is your drinking and/or using other drugs jeopardizing
your academic performance?
13. Do you drink or use other drugs to build up your
self-confidence?
14. Has your ambition decreased since drinking and/or
drug using?
15. Does drinking or using other drugs cause you to have
difficulty sleeping?
16. Have you ever felt remorse after drinking and/or using
other drugs?
17. Do you drink or use drugs alone?
18. Do you crave a drink or other drug at a definite time daily?
19. Do you want a drink or other drug the next morning?
20. Have you ever had a complete or partial loss of mem-
ory as a result of drinking or using other drugs?
21. Is drinking or using other drugs affecting your reputation?
22. Does your drinking and/or using other drugs make you
careless of your family’s welfare?
23. Do you seek out drinking/drugging companions and
drinking/drugging environments?
24. Has your physician ever treated you for drinking and/
or other drug use?
25. Have you ever been to a hospital or institution on
account of drinking or other drug use?
Source: Bennett, M. E.; McCrady, B. S.; Frankenstein, W.;
Laitman, L. A.; Van Horn, D. H. A.; and Keller, D. S. (1993).
Identifying young adult substance abusers: The Rutgers
Collegiate Substance Abuse Screening Test. Journal of
Studies in Alcohol, 54, 522–527. Reprinted with permission
of the authors of the RCSAST.
large number of separate medications. This population is
especially vulnerable to the hazards of drug misuse.
In contrast, drug abuse is typically applied to cases
in which a licit or illicit drug is used in ways that produce
some form of physical, mental, or social impairment
(See Drug in Focus on p. 8). The primary motivation for
individuals involved in drug abuse is recreational. Drugs
with abuse potential include not only the common street
drugs but also legally available psychoactive substances,
such as caffeine and nicotine (stimulants), alcohol and
inhaled solvents (depressants), and a number of pre-
scription or OTC medications designated for medical
purposes but used by some individuals exclusively on a
recreational basis. In Chapter 5, we will examine con-
cerns about the abuse of opioid pain medications such
as Vicodin, OxyContin, and Percocet, among others. In
these particular cases, the distinction between drug mis-
use and drug abuse is particularly blurry. When there is
no intent to make a value judgment about the motiva- In a wide range of world cultures throughout history, halluci-
tion or consequences of a particular type of drug-taking nogens have been regarded as having deeply spiritual pow-
ers. Under the influence of drugs, this modern-day shaman
behavior, we will refer to the behavior simply as drug use.
communicates with the spirit world.
Before examining the major role that drugs and
drug-taking behavior play in our lives today, however, it
South America. The hardy cannabis plant, the source of
is important to examine the historical foundations of drug
marijuana, grew practically everywhere.
use. We need to understand why drug-taking behavior
Some of this curiosity may have been sparked by
has been so pervasive over the many centuries of human
observing the unusual behavior of animals as they fed
history, and why drug-taking behavior remains so compel-
on these plants. Within their own experience, people
ling for us in our contemporary society. We also need to
made the connection, somewhere along the line, be-
understand the ways in which our society has responded
tween the chewing of willow bark (the source of mod-
to problems associated with drug use. How have our at-
ern-day aspirin) and the relief of a headache or between
titudes toward drugs changed over time? How did people
the eating of the senna plant (a natural laxative) and the
feel about drugs and drug-taking behavior one hundred
relief of constipation.9
years ago, fifty years ago, twenty years ago, or even ten
Of course, some of these plants made people sick,
years ago? These are questions that we will now address.
and many of them were poisonous and caused death.
However, it is likely that the plants that had the strang-
Drugs in Early Times est impact on humans were the ones that produced
hallucinations. Having a sudden vision of something
totally alien to everyday life must have been overwhelm-
Try to imagine the accidental circumstances under
ing, like a visit to another world. Individuals with prior
which a psychoactive drug might have been discovered.
knowledge about such plants, as well as about plants
Thousands of years ago, perhaps a hundred thousand
with therapeutic powers, would eventually acquire great
years ago, the process of discovery would have been as
power over others in the community.
natural as eating, and the motivation as basic as sim-
The accumulation of knowledge about conscious-
ple curiosity. In cool climates, next to a cave dwelling
ness-altering substances would mark the beginning of
may have grown a profusion of blue morning glories or
shamanism, a practice among primitive societies, dat-
brightly colored mushrooms, plants that produce hal-
ing back by some estimates more than forty thousand
lucinogens similar to LSD. In desert regions, yellow-
orange fruits grew on certain cacti, the source of the
hallucinogenic drug peyote. Elsewhere, poppy plants, shamanism: The philosophy and practice of healing
the source of opium, covered acres of open fields. Coca in which diagnosis or treatment is based on trancelike
states, on the part of either the healer (shaman) or
leaves, from which cocaine is made, grew on shrubs the patient.
along the mountain valleys throughout Central and

Chapter 1 Drugs and Behavior Today ■ 9

years, in which an individual called a shaman acts as
a healer through a combination of trances and plant-
based medicines, usually in the context of a local reli-
gious rite. Shamans still function today in remote areas
of the world, often alongside practitioners of modern
medicine. As we will see in Chapter 6, hallucination-
producing plants of various kinds play a major role in
present-day shamanic healing.
With the development of centralized religions in
Egyptian and Babylonian societies, the influence of sha-
manism gradually declined. The power to heal through
one’s knowledge of drugs passed into the hands of the
priesthood, which placed greater emphasis on formal
rituals and rules than on hallucinations and trances.
The most dramatic testament to the development
of priestly healing during this period is a 65-foot-long
Egyptian scroll known as the Ebers Papyrus, named
­after a British Egyptologist who acquired it in 1872. This
mammoth document, dating from 1500 b.c., contains
more than eight hundred prescriptions for practically
every ailment imaginable, including simple wasp stings
and crocodile bites, baldness, constipation, headaches,
enlarged prostate glands, sweaty feet, arthritis, inflamma-
tions of all types, heart disease, and cancer. More than
a hundred of the preparations contained castor oil as a
natural laxative; some contained “the berry of the poppy,”
which we now recognize as the Egyptian reference to
opium. Other ingredients were quite bizarre: lizard’s
blood, the teeth of swine, the oil of worms, the hoof of
an ass, putrid meat with fly specks, and crocodile dung
(excrement of all types being highly favored for its ability
to frighten off the evil spirits of disease).10
How successful were these strange remedies? It is
impossible to know because no records were kept on
what happened to the patients. Although some of the
ingredients (such as opium and castor oil) had true
medicinal value, much of the improvement from these
concoctions may have been psychological rather than
physiological. In other words, improvements in the pa-
tient’s condition resulted from the patient’s belief that
he or she would be helped—a phenomenon known as
the placebo effect. Psychological factors have played a
critical role throughout the history of drugs. The impor-
tance of the placebo effect as an explanation of some
drug effects will be examined in Chapter 3.
Along with substances that had genuine healing
properties, some psychoactive drugs were put to less posi-
tive use. In the early Middle Ages, Viking warriors ate
the mushroom Amanita muscaria, known as fly agaric,
and experienced a tremendous increase in energy, which
resulted in wild behavior in battle. They were called Ber-
serkers because of the bear skins they wore, but this is
the origin of the word “berserk” as a reference to reckless
and violent behavior. At about the same time, witches
operating on the periphery of European society created
“witch’s brews,” mixtures made of various plants such as
mandrake, henbane, and belladonna, creating strange
hallucinations and a sensation of flying. The toads that
they included in their recipes didn’t hurt either: We
know now that the sweat glands of certain toads contain
a chemical related to dimethyltryptamine (DMT), a
powerful hallucinogenic drug (see Chapter 6).11
Drugs in the Nineteenth Century
By the end of the nineteenth century, the medical profes-
sion had made significant strides with respect to medicinal
healing. Morphine was identified as the active ingredient
in opium, a drug that had been in use for at least three
thousand years and had become the physician’s most reli-
able prescription for the control of pain due to disease and
injury. The invention of the syringe made it possible to
deliver the morphine directly and speedily into the blood-
stream. Cocaine, having been extracted from coca leaves,
was used as a stimulant and antidepressant. Sedative pow-
ers to calm the mind or induce sleep had been discovered
in bromides and chloral hydrate.
There were also new drugs for specific purposes or
particular diseases. Anesthetic drugs were discovered
that made surgery painless for the first time in history.
Some diseases could actually be prevented through the
administration of vaccines, such as the vaccine against
smallpox introduced by Edward Jenner in 1796 and the
vaccine against rabies introduced by Louis Pasteur in
1885. The discovery of new pharmaceutical products
marked the modern era in the history of healing.12
The social picture of drug-taking behavior dur-
ing this time, however, was more complicated. By the
1890s, prominent leaders in the medical profession and
social reformers had begun to call attention to societal
problems resulting from the widespread and uncon-
trolled access to psychoactive drugs. Remedies called
shaman (SHAH-men): A healer whose diagnosis
or treatment of patients is based at least in part on
trances. These trances are frequently induced by
hallucinogenic drugs.
Ebers Papyrus: An Egyptian document, dated approxi-
mately 1500 b.c., containing more than eight hundred
prescriptions for common ailments and diseases.
placebo (pla-CEE-bo) effect: Any change in a per-
son’s condition after taking a drug, based solely on that
person’s beliefs about the drug rather than on any physi-
cal effects of the drug.

10 ■ Part One Drugs in Society/Drugs in Our Lives


Around 1900, heroin was advertised as a completely safe rem-
edy for common ailments, along with aspirin. No one knows
how many people became dependent on heroin as a result.
patent medicines, sold through advertisements, ped-
dlers, or general stores, contained opium, alcohol, and
cocaine and were promoted as answers to virtually all
common medical and nonmedical complaints.
Opium itself was cheap, easily available, and com-
pletely legal. Most people, from newborn infants to the
elderly, in the United States and Europe “took opium”
during their lives. The way in which they took it, how-
ever, was a critical social factor. The respectable way was
to drink it, usually in a liquid form called laudanum. By
contrast, the smoking of opium, as introduced by Chi-
nese immigrants imported for manual labor in the Amer-
ican West, was considered degrading and immoral. Laws
prohibiting opium smoking began to be enacted in 1875.
In light of the tolerant attitude toward opium drinking,
the strong emotional opposition to opium smoking may
be viewed as more anti-Chinese than anti-opium.13
Like opium, cocaine was in widespread use and was
taken quite casually in a variety of forms during this pe-
riod. The original formula for Coca-Cola, as the name
suggests, contained cocaine until 1903 (see Chapter 4),
as did Dr. Agnew’s Catarrh Powder, a popular remedy for
chest colds. In the mid-1880s, Parke, Davis, and Company
(since 2002, merged with Pfizer, Inc.) was selling cocaine
and its botanical source, coca, in more than a dozen forms,
including coca-leaf cigarettes and cigars, cocaine inhal-
ants, a coca cordial, and an injectable cocaine solution.14
A Viennese doctor named Sigmund Freud, who
was later to gain a greater reputation for his psychoana-
lytic theories than for his ideas concerning psychoactive
drugs, promoted cocaine as a “magical drug.” In an in-
fluential paper published in 1884, Freud recommended
cocaine as a safe and effective treatment for morphine
addiction. When a friend and colleague became heavily
addicted to cocaine, Freud quickly reversed his position,
regretting for the rest of his life that he had been initially
so enthusiastic in recommending its use (see Chapter 4).15
Drugs and Behavior
in the Twentieth Century
By 1900, the promise of medical advances in the area of
drugs was beginning to be matched by concern about
the dependence that some of these drugs could pro-
duce. For a short while after its introduction in 1898,
heroin (a derivative of morphine) was completely legal
and considered safe. Physicians were impressed with its
effectiveness in the treatment of coughs, chest pains,
and the respiratory difficulties associated with pneumo-
nia and tuberculosis. This was an era in which antibiotic
drugs were unavailable, and pneumonia and tuberculo-
sis were among the leading causes of death.16
Some physicians even recommended heroin as a
treatment for morphine addiction. Its powerful addictive
properties, however, soon became evident. The enactment
of laws restricting access to heroin and certain other psy-
choactive drugs, including marijuana, would eventually
follow in later years, a topic discussed further in Chapter 2.
At the beginning of the twentieth century, neither
the general public nor the government considered al-
cohol a drug. Nonetheless, the American temperance
movement dedicated to the prohibition of alcohol con-
sumption, led by the Women’s Christian Temperance
Union and the Anti-Saloon League, was a formidable
political force. In 1920, the Eighteenth Amendment to
the U.S. Constitution took effect, ushering in the era of
national Prohibition, which lasted for thirteen years.
Although successful in substantially reducing the
rates of alcohol consumption in the United States, as
well as the number of deaths from alcohol-related dis-
eases, Prohibition also succeeded in establishing a na-
tionwide alcohol distribution network dominated by
sophisticated criminal organizations.17 Violent gang
wars arose in major American cities as one group battled
another for control of the liquor trade.
By the early 1930s, whatever desirable health-
related effects Prohibition may have brought were per-
ceived to be overshadowed by the undesirable social
changes that had come along with it. Since its end
in 1933, the social problems associated with the era
patent medicine: Historically, a drug or combination
of drugs sold through peddlers, shops, or mail-order
advertisements.
Chapter 1 Drugs and Behavior Today ■ 11
of Prohibition have often been cited as an argument
against the continuing restriction of psychoactive drugs
in general.
Drugs and Behavior
from 1945 to 1960
In the years following World War II, for the first time,
physicians were able to control bacteria-borne infectious
diseases through the administration of antibiotic drugs. Al-
though penicillin had been discovered in a particular spe-
cies of mold by Alexander Fleming in 1928, techniques for
extracting large amounts from the mold were not perfected
until the 1940s. Also during that time, Selman Waksman
found that a species of fungus had powerful antibacterial
effects; it was later to be the source of the drug streptomycin.
In the field of psychiatry, advances in therapeutic
drugs did not occur until the early 1950s, when quite ac-
cidentally a group of psychoactive drugs were discovered
that relieved schizophrenic symptoms without producing
heavy sedation. The first of these, chlorpromazine (brand
name: Thorazine), reduced the hallucinations, agitation,
and disordered thinking common to schizophrenia. Soon
after, there was a torrent of new drugs, forming the basis
not only for the treatment of schizophrenia but also the
chlorpromazine (chlor-PRO-mah-zeen): An antipsy-
chotic (antischizophrenia) drug. Brand name is
Thorazine (THOR-a-zeen).
The famous Woodstock Festival concert drew an estimated 500,000 people to a farm in
upstate New York in the summer of 1969. According to historian David Musto, the peaceful-
ness of such a gigantic gathering is considered to have been due, at least in part, to the
widespread use of marijuana, as opposed to alcohol.
12 ■ Part One Drugs in Society/Drugs in Our Lives
treatment of mental illness in general. It was a revolution
in psychiatric care, equivalent to the impact of antibiotics
in medical care a decade earlier.
In the recreational drug scene of post–World War II
America, a number of features stand out. Smoking was
considered romantic and sexy, and smoking was common-
place. In 1955, regular cigarette smoking involved more
than half of all male adults and more than one-quarter of
all female adults in the United States. It was the era of the
two-martini lunch; social drinking was at the height of its
popularity and acceptance. Cocktail parties dominated
the social scene. There was little or no public awareness
that alcohol or tobacco use constituted drug-taking behav-
ior. In contrast, the general perception of certain drugs
such as heroin, marijuana, and cocaine was simple and
negative: They were considered bad, they were illegal, and
“no one you knew” had anything to do with them. Illicit
drugs were seen as the province of criminals, the urban
poor, and nonwhites.18 The point is that an entire class
of drugs were, during this period, outside the mainstream
of American life. Furthermore, an atmosphere of fear and
suspicion surrounded people who took such drugs. None-
theless, for the vast majority of Americans, drugs were not
considered an issue in their lives.
Drugs and Behavior after 1960
During the 1960s, basic premises of American life—the
beliefs that working hard and living a good life would
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"Jan!" Lynne was shocked, then vaguely frightened. "I don't know—I
guess maybe not," she said. "But Jan, I can't help it. That's the way I
am."
Janet sighed and said, "In that case I'm sorry for you." She changed
the subject quickly as Ray came wandering in, gave Lynne an
unhappy look, then crossed the room and turned on the vidarscreen.
Peace of an uneasy sort reigned for the next hour.
"When are they assigning your new member?" Lynne asked as the
picture, a documentary about solar heat, came to an end.
"Not for a day or so," said Ray. He looked at her piteously. "We—
we're going to miss you, Lynne. I wish I understood...."
"You're going to be too busy," Lynne told him. "And don't worry about
me, Ray. I've already talked to Jan."
"You mean you're not angry about us?"
Lynne shook her head, glanced at Janet, was again startled by the
blazing hatred that was beamed her way. She wondered what it must
feel like to hate in such thorough fashion. She was relieved when
she heard Mother Weedon talking to someone at the door.
A moment later the widow entered and said, "This is Rolf Marcein,
kids. He's going to be staying with us a little while." She introduced
the three of them to the newcomer.
Lynne barely acknowledged the greeting. She was too startled. The
most recent addition to Mother Weedon's charmed circle appeared,
in the semi-dark room, to be the man who had given her her walking
papers that morning on the eightieth floor of the brain-station tower.
He was tall, dark, lanky, saturnine. His name was Marcein. At least
that was something Lynne hadn't known before. And then she
noticed that this Marcein's face was not so pale, that his eyes were
brighter, his manner and movements more athletically poised than
the man on the eightieth floor. Mother Weedon pressed the polarizer
to let more light into the room, since the vidarbox was not on. The
stranger's tan, seen in the light, was startling, especially to Lynne,
who had seen his pale double so recently.
His double—that meant his twin, she thought. And if his twin worked
in the brain-station, then this man must be a Martian. Certainly that
would account for his tan, caused by living under the thin
atmosphere of the red planet—as it would account for an athletic
poise acquired during the hardships of Martian existence.
You're right, of course. I am Dolf's twin and I am from Mars.
It took her almost a full second to realise the thoughts had not been
spoken. She was telepathic again, aware not only of the newcomer's
thoughts but of those of the others in the room—though not as much
aware of theirs as of Rolf Marcein's.
She looked at him with something like panic, saw his brilliant dark
eyes upon her, noted that he wore his clothes well, that there was
something almost lupine in his grace, something almost
overpowering....
You must know you're beautiful yourself, Lynne Fenlay—if soft and
unawakened. I have an idea I could turn the trick....
It was like a blow. Not only could she read his thoughts, Lynne
realised—but he could read hers. She felt her face flame and a
sudden surge of resentment toward his arrogance that forced her to
leave the room lest she reveal the weakness it caused. And as she
left his soft laughter rang like hailstones in her ears.

III
The days that followed Rolf Marcein's arrival at Mother Weedon's
became, to Lynne, a period of waiting. It was a period of waiting
games as well. No summons came from the eightieth floor of the
brain-station to give her a clue as to the nature of her next
assignment. For the first time in her life she found herself hung in a
vacuum with nothing definite to do or to look forward to.
Naturally she wondered whether Rolf Marcein might not be the
answer to this facet of her problem. But not even her growing
telepathic abilities could pry a response out of his mind. He seemed
to be visiting the home planet on the vaguest sort of business—
something to do with development and transport of specially-bred
plant and animal stock for the red planet.
It seemed absurd on the face of it that such an obviously able
adjustee should be returned to Earth on such a mission, especially
with every gram of interplanetary ship-space at a premium. Yet either
it was truth or Rolf had developed some method of screening his
thoughts against telepathic probing—a frightening idea in itself.
He hung around Mother Weedon's most of the time. As a result
Lynne saw a lot of him throughout the days and evenings, a fact
which both pleased and alarmed her unreasonably. It was during the
third night of his stay that he invaded, or tried to invade, her nights
as well.
Before drifting off to sleep she found herself dwelling on him with
relaxed reverie. Ray and Janet had had some sort of quarrel and the
atmosphere that evening had been far from pleasant. It was a relief
to lie alone, to let her thoughts roam and quest as they would.
Rolf had talked of Mars during a stroll to the bazaar-mart during the
afternoon. He had described a boar-hunt on Earth's sister-planet
during a night when both Deimos and Phobos were describing their
rapid orbits across the cloudless sky.
The pig, as man's most adaptable food-animal, had been the first
livestock imported to Mars less than three decades earlier. Now,
according to Rolf, the animals had in large measure reverted to their
feral state and constituted a menace to man and his works alike.
"We used flashlights and small-arms paralyzers on that hunt," Rolf
said. "We flushed a whole herd of them in an erosion-gully along the
border of the Great Southern Canal—didn't get so much as a smell
of the brutes until we were right on top of them.
"At that we managed to nab a baker's dozen for de-tusking and
redomestication. Ferkab, it was touch and go for a bit! One big brute
slipped under my ray and if I hadn't been lucky enough to jam my
flashlight tube into his mouth he'd have taken my leg off."
"What does ferkab mean?" Lynne asked, a little annoyed at feeling
an atavistic thrill from the account of the primitive hunt.
To her delight Rolf actually blushed beneath his tan. He began with,
"I don't think you'd appreciate its meaning," then recalled her
telepathic powers and shut up and blushed more deeply.
At which it had been Lynne's turn to feel her face grow hot. The
meaning of ferkab, an approximate translation of certain graphically
illustrated ancient Martian runes, was explicit to the point of
bawdiness. Yet on Mars, apparently, it was used in mixed company.
So, lying half asleep, Lynne not surprisingly visualised the boar hunt
as Rolf had described it. She could see his weatherproof aluminum
clothing gleaming in the pale light of the swift tiny moons, shining in
the occasional ray of a flashlight as he and his shadowy companions
worked their way along the eroded bank of the canal.
Then the sudden rustle and thump and grunting of the beasts as
they came charging out of their threatened shelter, their vast
menacing shapes with huge tusks and little red eyes glittering in the
confused crisscross of flashlight rays. She saw the paralyzers' brief
glow, heard the thud of falling animal bodies, saw the sudden rush of
one furious beast inside the protective sweep of Rolf's hand-weapon,
saw his quick graceful evasive movement, heard the champ of
savage tusks crushing the hard alloy of the metal tube.

Once, on the vidarscreen, she had watched a toreador do his dance

of death with a furious bull, in an historical show. Rolf, she thought,
was slim as a toreador, slim and graceful and equally accustomed to
facing danger and death as an accepted part of life.
Then, she told herself scornfully, she was reverting to the primitive
as if she were a Martian sow herself. She thought of the word ferkab
and what it meant and felt her face grow hot in the darkness. For she
could visualise Rolf and—herself—in a way she had never been able
to think of herself with Ray Cornell.
It's not confined to Mars, darling, came the sudden probe of Rolf's
thought over hers. But it takes a Martian to be the best.
Reverie was obliterated by rage. She sent back a string of thoughts
that should have blistered Rolf's brains—if he had any decency. He
withdrew before her counterattack and she wondered if he really did
have any decency—or if her rage were all she had pretended.
She was cool to him the next day—and the arrival of the new
member of the group-machine gave her opportunity to avoid him.
Her replacement was a dark stocky quiet young man named Alan
Waters and he seemed quite smitten with her—a fact which made
Janet visibly jealous. Lynne found herself quite enjoying her triumph.
But the day after, when the other three reported for work at the brain-
station and Mother Weedon visited the bazaar-mart for some needed
household supplies, Lynne found herself looking at a mischievously
contrite Rolf across the breakfast table.
He said, "I'm sorry if I've offended you, Lynne. Apparently I made the
mistake of thinking you had blood in your veins."
Lynne acted without volition for the first time since early babyhood.
She picked up the plastisaucer in front of her and flung it across the
neoplast tabletop at him. He ducked and for a moment his dark eyes
blazed with laughter and then he sensed her distress and helped her
with the atocleaner.
She tried to apologize but the words refused to come. And he never
mentioned the incident afterward. Instead he took her for a walk
through the park and talked to her of the more feral beauties of his
own planet. "It's far wilder than this," he told her, gesturing at the
neat clusters of trees and flowers, the perfectly clipped hedges about
them. "Wilder and deadlier and far more beautiful."
"This is perfection," she told him.
"And perfection is death," was his reply.
"I thought Mars pretty much a dead planet," she said.
"It's a vast mausoleum," he said, his eyes lighting. "A mausoleum
visited by new life, a mausoleum in which the very souls of the dead
themselves seem beginning to stir. It's raw new life burgeoning on
the old."
He talked on and she felt the beginnings of small responses stir
within her and frighten her. For she had been conditioned to Earth
and to wish for Mars was wrong. Finally he stopped and faced her
and captured both her hands in his incredibly strong ones.
"Lynne," he said. "I haven't much longer here. I want to take you
back home with me. Will you come?"
"Home—on Mars?" she countered. The idea was impossible. Yet,
somewhere within herself, she wanted to go. Then the reasons, the
millions of reasons why she couldn't say yes, came flooding up
within her. Surely Rolf knew them—or did he?
"You know the system and the reasons behind it," she reminded him.
"You have a twin right here in the city. I've talked to him—it was he
who gave me my walking papers from the group-machine."
"He told me," said Rolf quietly. "He told me a lot about you. Enough
so I wanted to see you and get to know you. Now that I do know you
I want you to go back with me. Can't you see, darling? There's little
use for telepaths on Earth. On Mars we need them desperately. I
think I can arrange a transfer."
"But my brother is already there," she told him a little desperately. "I
—we—they can't leave two of us on one planet. And what right have
I to ask him to come to Earth? He's not conditioned."
"But maybe he'd like to come back," Rolf suggested. "Maybe he's not
happy on Mars."
"It's not just that," she said miserably. Nor was it. For the first time
the entire system by which the Mars project was functioning seemed
to her vastly unfair. Until that moment she had accepted it,
considered it as immutable as the need for the sun itself.
The Earth Government, which was what the U.N. had evolved into
after its first tortured half-century of birth, was determined not to
repeat upon alien planets the mistakes of imperialism and
colonization that had caused the home planet all but to tear itself to
pieces during the twentieth century.
No convicts, no misfits, no refugee cultists were to be sent out to
settle the newly-opened red planet—instead, the cream of Earth's
best trained, most gifted and strongest young men and women were
to do the preliminary settling. For it would still be many years before
the arid world would be able to support much humanity.
There had been protests—chief among them a group of eugenicists
who felt that loss of such a large group of qualified young folk would
cost the home planet more genetically and socially than it could
afford. The answer had been genetically-induced twins on the part of
parents qualified to pass a wide variety of mental, physical and
psychiatric tests, open to all who wished to join the project.

One of each set of such induced identical twins was early selected to
go to Mars, the other to remain on Earth. Thus Earth lost nothing, yet
had its potential Martians, ready for conditioning and training in
special seminaries for lifetime work on the red planet. When one of a
pair of twins was a girl, the other a boy, the boy was the one sent out
—since life on Mars was still a rugged affair. Thus it was that Lynne
had been reared for an Earth-career while her brother, Revere, had
been educated and coached for a Mars-life.
Lynne's entire twenty-four years had been passed for the purpose of
integration into and work for the improvement of humanity on her
native planet. The very idea of Mars was terrifying, as was the idea
of traveling there through space. She simply couldn't endure the
wrench of the trip, the separation from all that mattered.
Rolf stood there quietly, letting her thoughts flow without interruption.
Then he said, "I see—but it's not as bad as all that, darling. After all,
I made the trip in reverse."
"But that's different—you're a man!" she protested.
"Nor is being a man as bad as you seem to think," he said and she
sensed that he was teasing her and was grateful for the change in
mood. Before she realized what she was doing she called him
mentally a thoroughly bawdy Martian word.
"Where did you learn that?" he asked, startled.
"Where do you think?" she countered—and enjoyed seeing him
blush again. They had a pleasantly innocuous time together the
remainder of that day and evening.
The following morning Lynne awoke from another horrible nightmare
of alien worlds to find her headache back in full force. So bad was it,
in fact, that after making a half-hearted effort to get up she fell back
on her plastomat, actually moaning a little. She felt as if she were
undergoing some long-forgotten sort of Inquisition torture.
Rolf walked into her room within the hour and so sick was Lynne that
she didn't even protest his presence. He said, "Lynne, darling, you've
got to get over this. Believe it or not you're killing me."
"Then stay in your own mind." She managed a whisper of a smile.
"You're like a bad tooth," he said inelegantly. "You know it's going to
hurt if you touch it but you can't stop running your tongue over it."
"Oh, shut up," she said rudely. "So now I'm an ulcerated tooth. I've
never had one so I wouldn't know."
"Nor have I," he replied promptly. "But I've read about them. Come
on. I'm going to take you to Centromed and get you fixed up."
"I'm too ill to move," she quavered, alarmed at the prospect.
But he simply moved in and took over, virtually forcing Lynne firmly
but gently into her clothes, getting her downstairs and onto a moving
strip, escorting her through the prophylactic entrance of the huge
vertical cross of the Centromed, giving her in charge of a stern-faced
but kindly physician in white, who put her in turn in the hands of a
giant red-headed nurse in steropants and white cap.
Lynne never did find out what they did with her. She recalled lying
down and looking up at a hypnotic ceiling, drifting quickly into
merciful unconsciousness. When she recovered her headache was
gone and she had a sense of having undergone an important
experience.
"Miss Fenlay," the doctor said, "you're undergoing a period of mental
growth and change that in your case seems to make such suffering
periodic."
"What can I do about it?" she asked in panic.
"I believe your trouble is one of environment," he replied. "During this
period of readjustment you find familiar surroundings unsufferable. In
plain English, you need a change."
"But how am I to get it?" she asked.
"That is hardly our department," he told her. "You'll have to take it up
with your Integration Chief, I'm afraid. Naturally we'll be glad to make
a recommendation for transfer on medical grounds."
"Thanks—thanks a lot," she said uncertainly. She walked out of the
building and discovered it was already late afternoon. Unsureness
chewed at her for the first time in her well-ordered life. The headache
was gone but it might return if she didn't make a change—and she
didn't want to leave the only home she'd ever known.
Rolf rose from an alloybanc on which he had been sitting and said,
"Headache gone, Lynne? You look upset."
"Headache's gone," she replied. "But it may come back."
"Not if I can help it," he told her and she took his arm in hers and
squeezed it to show her appreciation. Rolf might be a barbarian, she
thought, but he had been kind and helpful.
"Thanks for the crumb anyway," he told her and her confusion grew
almost to tears. They rode back to Mother Weedon's in silence.
Because of her fear at finding herself becoming so dependent on
Rolf she flirted outrageously with Alan Waters, the team
replacement, after dinner. When he followed her out into the garden
and told her he was madly in love with her she didn't exactly
discourage him. Just then her soul and body alike craved
appreciation.
A furious Ray Cornell interrupted their third kiss. He strode through a
gap in the hedge-wall and pulled Waters from her roughly and said,
"They told me I'd find you two out here."
"What right have you to interfere?" countered Waters.
"This!" snapped Ray, throwing a clumsy punch at his rival, who threw
one back in return.
Lynne let out a gasp of alarm and tried to move between them but
was brushed rudely to the ground. So hard did she land that for a
moment the world seemed to swim.
She shook her head to clear it, felt the alarm gongs she had come to
know preceded a return of her headache. Then she saw a third taller
male figure take Ray in one hand, Alan in the other and pull them
apart by the collars of their bolo packets as if they were a couple of
dogs squabbling over a bone.
"You men are supposed to work together," he said quietly. Then, his
voice rising a half-tone and increasing in force, "Why in farb don't
you?" With which he cracked their heads together with stunning
force, tossed them to the turf like a pair of sacks and came over to
help Lynne gently to her feet. She collapsed into his arms, for the
first time let his lips seek hers, responded to them.
Later—how much later she didn't know, for during that day and
evening she seemed destined to lose large chunks of time—she
looked up at him, reveling in his controlled strength and leanness.
"Rolf," she said, "I'm sorry—that was my fault."
"You'd have been less than a woman if you hadn't done something
like it to put me in my place," he whispered.
"But it seems so cheap now," she said. "And my head...."
"It wasn't cheap because you didn't know," he told her. "As for your
head, you need a change. You're going to get one. You're leaving
with me for Mars tonight."
"But, Rolf—" she began.
"Come on, honey," he told her. "It's all arranged. We've only got a
couple of hours to make the ship."
She walked back to Mother Weedon's with his arm around her,
stumbling a little from time to time like a blind woman. She was going
to Mars and the mere idea scared her almost to death.

IV
Lynne, who had been largely brought up on stories of pioneer space-
flights in which the passengers had to endure tremendous initial
acceleration, was pleasantly surprised by the takeoff. She probably
would have known better had her conditioning and training not
geared her to such complete uninterest in anything beyond the
atmosphere that she seldom thought of the stars except as pretty
lights in the sky.
She did have to strap herself to her bunk before the immense silver
teardrop rose slowly upward toward space—but as the stewardess
explained in routine tones the strap was a mere precaution against a
possible lurch caused by brief failure of one of the launching jets.
And within five minutes after takeoff a tiny sign lit up over the cabin
door that read UNFASTEN BELTS—SMOKING PERMITTED.
She sat up and loosened the strap and swung her feet to the deck,
noted her roommate was doing likewise. In the turmoil of catching
the Mars-ship Lynne had had little time to notice her. She managed
to recall that her name was Joanna-something and that she was an
expert in animal husbandry. She was a handsome immense South
African girl whose dark complexion wore traces of both Caucasian
and Oriental, as well as Hamitic ancestry. She offered Lynne one of
the new skinless cigarettes.
"You on Integration business?" she asked.
Lynne, who knew nothing of affairs on Mars, probed quickly and
discovered what the girl had in mind was a coordination trip by an
Earth Government executive. She shook her head, said, "No, I'm
going for good. I understand there's a job there for me."
The African girl regarded her curiously, then said, "I don't want to
sound rude but aren't you a bit old to be going home?"
"I guess maybe I am." Looking more closely at her cellmate Lynne
saw that for all her evident maturity she was still a girl in her late-
middle teens. "They came after me."
As the girl nodded uncomprehendingly Lynne wondered if what she
had uttered as a polite brush-off lie might not be the truth. There was
a definite pattern of continuity to events following her first headache
and her non-variant answers at the brain-station.
"Let's go to the saloon and see the stars," Joanna suggested.
It seemed like a good idea—besides, Lynne wanted to talk to Rolf, to
discover if there actually was considered motive behind her
apparently aimless emigration to the red planet.
She said, "How long does this trip take anyway?"
Joanna's jaw dropped and her black-satin hair gleamed with liquid
highlights as she shook her head. "Crehut, you are green!" she
exclaimed. Then, assuming sociability with an effort, "You're mighty
pretty though. The trip takes a little more than one Earth-day."
"Thanks—I see," replied Lynne. She felt she was beginning to see a
lot of things. Along with her archaic ideas about the rigors of a
space-ship takeoff, she had apparently retained some mighty
obsolete theories about the speed of space-travel, at least on the
Earth-Mars run. In her mind it was a matter of weeks if not months,
depending upon the relative positions of the two planets.
A little over one Earth-day—if her growing feeling that she was the
victim or core of some vast unseen conspiracy were correct, then
there would have been plenty of time for Rolf to be summoned from
Mars after her non-variant answers had given the brain-station
bosses the clue to her newly-developed telepathic powers.
But why all the secrecy? It didn't take her long to find an answer.
Had she been asked immediately to come to Mars she would have
refused point-blank to make the trip. Her conditioning, her whole life
would have forced her to reply in the negative.
So Rolf Marcein had been sent for with orders to make her want to
leave Earth with him, by fair means or foul. And he had not hesitated
to employ the foul. She felt her whole body blush as she recalled
some of the brazen suggestions he had made, some of her
responses, especially to his embraces earlier that evening.
It was going to be a very interesting session, she decided, as she
followed the girl into the single small but beautifully compact central
lounge or saloon that space requirements permitted on the Mars-
ship. She looked around but failed to see his tall figure and saturnine
face—treacherous face, she thought—among the half-dozen
passengers already reclining in plastolounges, watching the amazing
panorama projected on the ceiling from the viewplate recorders in
the prow and stern of the huge space-vessel.
She followed Joanna to a chair, tried to share the girl's tremulous
excitement. After all, she thought, she had felt much the same on
emerging from the seminary to take her first position as a data-
recording supplement for the biggest of all cybernetics machines, the
"brain" that occupied six thousand acres of the Sahara Desert.
"Look!" the girl whispered enthusiastically. "There's X-Three, the last
of the derelict space-stations."
Lynne watched the oddly complex structure, that resembled a pair of
unrooted pyramids fastened point to point, as it revolved slowly
across and out of the plane of vision.
"What do they use it for now, Joanna?" she murmured.
"Nothing," the girl said with a trace of scorn.
Lynne knew she should have known about that. She recalled now a
vidar newscast in which the abandonment of the last of the space-
stations had been mentioned. In the years before A-engines were
finally perfected space-stations were vitally necessary as change-
over stops for interplanetary rocket flights. But once fuel ceased to
be a problem they had been used merely as meteor-warning points
and weather stations.
In the first function they had proved useless—in fact one of them had
been destroyed by a large space-missile—and weather forecasting
and control were practised far more efficiently by electronic mastery
of the Heaviside Layer. Lynne shouldn't have forgotten—but when
she heard it the matter of space-stations had been utterly
unimportant in her life.
A steward in space-black bolo and clout offered them vari-flavored
colafizzes from a rack strapped about his waist. Lynne wondered at
this mode of serving the drinks while she sipped hers but decided
not to ask Joanna. She didn't want to appear a total numbskull to a
girl whose whole life had consisted of conditioning for Mars.
She found out soon enough when Rolf Marcein walked into the
saloon before she had finished sipping her drink. She rose to greet
him, to haul him off somewhere so they could talk alone—and as she
did so she automatically dropped her colafizz in the receptacle ready
to receive it in one arm of her plastolounge.
Joanna made a grab for it as it bounced off and rose lazily in the air
and turned slowly over. The African girl caught it before it released
any of the liquid remaining in it, pushed it firmly down into the hollow
space reserved for it, where it was magnetically held.
But Lynne was not paying much attention. She was having enough
trouble holding herself upright as her feet displayed an astonishing
reluctance to keep on the floor while the rest of her wanted to
describe a lazy parabola across the saloon. She did an off-to-Buffalo
and wound up against Rolf's chest with his arms about her.
Embarrassed she whispered fiercely, "Put me down, you marlet!"
He grinned at her infuriatingly, replied, "I'm no marlet—that's a very
nasty word on Mars and most of these people understand it. Don't
you know you're in space?"
He set her gently back on her feet, holding her steady with one hand
gripping an upper arm. She knew she looked like an idiot, felt certain
everyone in the saloon was laughing at her. "I thought they had
artificial gravity on these ships," she said.
"They do," he told her. "But it's nothing like Earth-gravity. It would use
up all power if it were. You'll learn to navigate. Come on, I'll show you
how." He led her unprotesting into one of the corridors outside the
saloon.
She pulled herself free, promptly smacked her head none too gently
against the corridor wall. "I don't want a lesson now," she told him
angrily. "Besides, why aren't I sick?"
"You would be," he informed her with what she interpreted as a smug
expression, "if you hadn't been given your full quota of shots in the
Centromed this afternoon. You don't think they'd have allowed you
aboard otherwise, do you?"
"You had it all figured out, didn't you?" she snapped at him angrily.
"I'll give odds you even said something to Alan and Ray tonight that
got them involved in that horrible brawl!"
"It was nothing," he said with false modesty, flicking a non-existent
speck of dust from a bare forearm. "Just a bit of premeditated
Machiavelli. Anyone could have managed it."
"What are you trying to do to me?" she asked him desperately. "I'll
even bet my headaches were induced. Why pick on me? I don't want
to go to Mars—I never wanted to go there."
"Maybe because I'm in love with you," he said simply.
She ignored the intensity of his dark eyes, said, "You're not in love
with me. You didn't come to Earth until that twin of yours at the brain-
station sent you a message I was telepathic. You've only made love
to me to get me to Mars—for some selfish purpose of your own. Try
and deny it."
"In view of your current mood," he replied quietly, "I'd be seven kinds
of a sand-lurtonk to try. You seem to have things all figured out
yourself. Very well, it's your privilege to look at my actions any way
you choose. But my purpose is not selfish!"
Something in the ring of his voice, in the determined set of his lower
face, told her he was speaking the truth. She said, "All right, what
purpose gives you the right to come to Earth, to violate everything I
cherish, to make me a voluntary kidnapee, to wreck my life and drag
me off to a planet I haven't even been trained for? What's to prevent
me from reporting it and having you arrested?"
"Nothing," he replied, "except that I'd probably be released as soon
as we reached Mars. If you still feel like this when we get there
tomorrow I shan't stand in the way of your returning." There was a
new sag in his shoulders, a weariness to the lines about his mouth.
"Oh, great!" she retorted. "Smash my job, my personal life, then say
you won't try to stop me from going back to it. How can you go
around with so few ethics? What sort of person are you anyway?"
"A very serious one—a very worried one," he told her quietly and her
quick probe of his thoughts revealed him again to be speaking the
truth. He captured both her arms again, held her gently against the
wall, and so great was the hypnotic force of his personality that
despite her anger toward him she made no move to break away.
"You have a right to know—now," he told her. "I'm a Martian, a third
generation one, even though I was born and trained on Earth.
Conditions out there are only just beginning to be fit for human
infants. We're building the biggest thing Man has ever accomplished
on Mars—making a barren ruined planet live again, making it fit for
men and women and babies to inhabit.
"Right now we're up against the greatest danger we've faced since
the first few desperate years—maybe an even greater threat. We
can't see it, we don't even know what it is. But men and women on
Mars are going mad. Only a few of us can reach them—and thanks
to a condition of the planet we're all too overloaded to do the
psychiatric work we should do. We need telepaths."
A flash of something she had heard or read somewhere about the
red planet occurred to her. She said, "But doesn't the atmosphere or
something of Mars encourage telepaths? You're one. Why come to
Earth for them? Why pick on me?"
"Because," he told her with the patience of exasperation, "we need
at least to maintain those telepaths we have—which aren't nearly
enough. You don't seem to realise that a genuine two-way telepath,
even among fourth generation Martians, occurs only about once in
eleven thousand six hundred births. And we need more than the few
we have for communications alone."
"Communications!" Lynne was honestly shocked. "Do you mean to
tell me that Mars has no—"
"No form of lateral electronic communications functions reliably on
Mars," he told her bluntly as if admitting a fact he hated to mention
about the planet he loved. "Don't ask me why—it's just so, that's all.
Crehut, do you think our best scientific brains haven't tried? They
believe the thinness of the atmosphere and the resulting weakness
of the Martian Heaviside Layer has something to do with it. We get
messages from Earth and the other planet-stations clearly and, with
the ato-reduced time lag, in a matter of seconds."
"And you have to use telepaths to transmit and receive?" She was
almost incredulous but her mind informed her he was telling the truth
without reserve.
"Whatever we can't heliograph or send over wire cables," he said
unhappily. "And the climate of Mars is rough on cables. Above the
ground the winds snap 'em. Underground they rot or the czanworms
eat through them. Now do you begin to understand?"
"A—little," she replied hesitantly, unable to maintain her entirely
justified anger against his sincere appeal. "But what about this threat
—this madness? What is it?"
"We don't know." His face was shadowed. "There may still be life-
forms on Mars of which we know nothing—or perhaps
manifestations of those we thought safe that are dangerous. But
something apart from atmosphere or weather or diet or drink is
creating insanity. And it seems to be affecting our telepaths rather
than others. Maybe our telepathic minds are more open to whatever
the influence is. I don't know." His expression turned grim. "I've never
allowed them—it—to affect me."
All at once she remembered the nightmare, the being alone in the
crystal tower, the crowding in upon her of unseen things that
whispered dreadful alluring suggestions, the sense of panic. She
began to understand it with growing certainty.
Lynne said, "My brother—Revere—he's one of those who's been
affected, isn't he?"
He hesitated, evidently felt the probe of her questing brain, nodded
reluctantly. He said, "Your brother is one of them. The purt of it is we
don't dare send him back to Earth."
"I understand." She shuddered, felt a reassuring hand on her
shoulder, added, "He's mad, isn't he." It was statement, not query.
"I'm afraid so—at least part of the time," he replied. "But don't worry.
We have marvelous clinics on Mars. Once we get him to one of them
there's a good chance of a cure."
"You mean he isn't getting care now?" she asked, shocked.
Rolf shook his head, replied, his voice low, "Not yet—not until you
replace him. That's how short-handed we are. We've lost too many
the last few months. And there simply aren't any replacements.
That's why I rushed to Earth when I heard about you, why perhaps I
used unscrupulous methods to get you to come. There are less than
a million people on all of Mars."
She understood his unspoken analogy. Less than a million people—
less than a hundred telepaths, to maintain communications over the
entire planet. Then she thought of something else, said, "My
headaches—they're telepathic, aren't they? Caused when my
brother has one of his attacks?"
"That's right as nearly as we can judge," he told her. "You seem to
have an intense sympathetic affinity. It's not unusual between
identical telepaths."
"And there aren't many of those," she said idly. She looked at him.
"How about your brother, Rolf. Isn't he...?"
"Unfortunately not," he replied. "He has some tendency toward
E.S.P. but insufficiently strong to be reliable."
Lynne sensed his thoughts shifting to his brother, then to hers—and
was astounded by the depth of dislike he suddenly projected. It
came as another shock and she said, "You hate my brother, don't
you, Rolf? If you didn't you'd have managed to get him the care he
must have to survive."
"I don't hate your brother," he said wearily and she realised he spoke
the truth. What he felt for Revere Fenlay was the rather arrogant
dislike and distrust toward a weaker man that is so frequent among
the strong. Lynne resented it, resented him, bitterly.
She said, "Then why haven't you replaced him? You're a telepath—
why haven't you given him relief?"
Again he looked defeated and, with feminine illogic, her heart went
out to him. He said, "I wish I could—unfortunately I'm not permitted
to go out in the field alone."
Annoyed by her heart's betrayal she let herself think, Ah, an
armlounge admiral, a user of men who saves his own skin! She
watched anger wash defeat from his face, for a moment felt fear at
its intensity. Then, without a word, he turned and left her alone in the
corridor.
She felt a cheap victor as with difficulty she made her way back to
her cabin. Nor was her self-esteem lifted when Joanna, sitting up in
her bunk, said, "You must be real zwirch, Fenlay, if Marcein came for
you. He's Communications Integrator for the whole ruddy planet—a
real big bomb. How about introducing me before we land?"

V
To her considerable surprise in view of her emotionally upset
condition, Lynne slept like the proverbial top. It took the combined
efforts of Joanna and the stewardess to get her awake and up and
dressed in time for the landing outside of New Samarkand. After a
momentary breathless hovering pause the big ship set itself down so
gently there was a hardly perceptible jar as it touched ground.
Feeling cumbrous in cold-resistant parkaed coverall and curiously
alone despite the cluster of passengers that waited with her in the
airlock foyer, Lynne looked about her for Rolf Marcein. She felt a
certain residue of guilt for her treatment of him during their last
session, despite the justification of her anger. Here, on the threshold
of an alien planet—his planet—she needed him.
He might have betrayed her and her brother, kidnapped her, all but
seduced her—yet he was the sole human being she knew here. Her
eyes sought him desperately, finally saw him working his way
through the waiting passengers toward her.
He thrust an oddly-shaped little packet toward her, said, "Here—
fasten it on. It's an oxyrespirator—you'll need it. Use it whenever you
feel faint."
His manner was gravely polite and his thoughts were carefully
masked. He hadn't, she decided, forgiven her for that armlounge
admiral insult of the night before. She sent her apologies mentally,
received only a curt acknowledgement. She began to feel miserable.
Then, abruptly, the port was opened. With his arm steadying her
Lynne stepped out onto the escaramp platform, a couple of hundred
meters above the flat blast-scarred surface of the field. A thin chill
wind cut her face, a wind from out of a sky darker than that of Earth.
Her first reaction was of gauntness, of barrenness beyond anything
she had known on her home planet. The grounds around the Sahara
brain-center in which she had served her apprenticeship had been
lush with tropical growths—and even the desert around them had
been warm. But the vast reddish expanse of the spaceport looked
cold and uninviting—even the row of oddly-shaped metal buildings at
its edge had a shabby eroded untended appearance.
Her second reaction, as she rode the ramp down was of
breathlessness. The icy air stung the insides of her nostrils, as it did
her face, but failed to fill her lungs. Panic swept over her and she