This research was supported by Public Health Service grant MH-13484 from the National Institute of Mental Health. We wish to thank Dr. Arthur Chandler, Dr. Sidney Cohen, and Dr. Oscar Janiger for generously permitting the use of their records and for aiding in the contacting of respondents. Mr. Carlos Garcia aided in the interviewing, and Miss Kay Jamison and Mrs. Judith Bernstein assisted in the analysis.

 

UNTIL a few years ago, marijuana use in this country was largely  confined to two groups: minorities in the lower socioeconomic classes; and persons associated with entertainment and other art-related pursuits. Recent attention has focused on the rapidly increasing number of middle-class youths who are currently using the drug with varying frequencies? While it is the last group which is of primary social concern, it is the older groups which afford the opportunity to examine stabilized patterns of marijuana use and its long-term relationship to other individual and social behavior. Robins, Darvish, and Murphy have recently reported on a longitudinal study of Negro men who used marijuana as adolescents. The present study is based on a sample of adults, 93 percent white, about forty years of age, and generally of above average education and economic status, who typically first used marijuana some 20 years ago and continued to do so on a regular basis for a period of several years. It presents information on motivation for use, patterns of use, reported effects, use of other drugs, background and behavioral characteristics of the user, and personality and attitude correlates.

 

The data on marijuana use reported here are part of a larger follow-up study of the effects of LSD. In that study 247 persons who received LSD from one of three physicians in either experimental or psychotherapy settings during the period 1955-61 were personally interviewed in 1967-68. Their introduction to the study was via a letter from the physician who initially had administered the LSD. All interviews were done by two of the authors and one other person. Rapport was good, and with very few exceptions there was no indication that respondents withheld or distorted information regarding drug use.

Forty-four percent (108) of the 247 respondents interviewed reported some experience with marijuana. Table 1 presents amount of marijuana use as a function of the period of introduction. It is of interest to note that of the 51 persons who first tried marijuana during 1961-68 (typically in the 30-40 age range), only three have continued to use it on a more than casual basis.

 

Twenty-nine of the 57 respondents introduced to marijuana prior to this period have at some time used it on a regular basis (two or more times per week). We cannot, however, generalize from these data to the larger population since persons with a continuing interest in marijuana most probably would be more motivated to volunteer for an LSD experiment than would a person who had tried marijuana and not found the experience to his liking.

For the purposes of the present study, the sample of interest is restricted to the 29 respondents shown in Table 1 who were initiated to marijuana prior to 1961 and have at some time used it two or more times per week for a minimum of two years.

 

Fourteen of this group indicated they were using marijuana regularly at the time of the interview ; 7 that they were no longer using it at all. Sixteen of the 29 had used it on a daily basis at some period. The group consisted of 22 males and 7 females, with a mean age of 40. The median year of introduction to marijuana was 1948 and the median age 18. All but four had attended college and ten held bachelor's or advanced degrees. Thirteen were working in the art-related professions, such as artist, musician, writer, entertainer, designer, and so forth.

 

were introduced to marijuana well before the current influx of usage among middle-class groups, they generally first tried it in adolescence, and they subsequently used it on a regular basis, typically for a period of several years. For purpose of comparison, two other samples were selected from the 247 respondents in the LSD follow-up study. One sample of 40 was obtained from the 139 persons who had never used marijuana. This sample was selected so as to match the regular-use marijuana group for sex, age, education, proportion in art-related professions, and conditions of LSD administration—that is, an experimental or psychotherapy setting. Since use of marijuana may be a function of opportunity as well as inclination, it is also of interest to compare the group of regular users with members of a second sample, who were initiated to marijuana during the same period but did not continue to use it. For this purpose, a sample of 22 was selected from the 28 respondents who had tried marijuana prior to 1961 but had never used it on a regular basis (16 of the 22 had used it less than 10 times). The basis of selection was on the same matching variables; however, because of the limited number of persons in this category, equating was only approximate for age of first marijuana use and the proportion in art-related professions.

 

MOTIVATION, PATTERNS OF USE, AND REPORTED EFFECTS

 

Before comparing the regular users, the short-term users, and the non-users of marijuana, reasons for use and reported effects will be described. Since the majority of short-term users had little experience with the drug, this section is based on interviews with only the 29 regular users. Euphoria or "high" was the most frequent motivation cited; however, relaxing and tranquilizing effects were a close second, as shown in Table 2.2

The use of marijuana to enhance creative performance, especially by jazz musicians, has been reported by Winick, although studies of nonmusicians on tone discrimination tests (Aldrich; Williams et al.) have shown impairment. In response to a separate question, 18 of the 29 respondents in the current study indicated that they sometimes used marijuana to enhance creative productivity. This included 85 percent (11 out of 13) of those in the art-related professions. Some felt that marijuana was only useful for creativity when used in moderation, that there was a danger in that "the experiencing" might be substituted for "the doing," and that heavy users tend to be less critical in evaluating the quality of their own and others' works. Persons who used marijuana for writing generally reported that it was helpful in getting ideas and new perspectives, but not when it came to the actual writing

 

Seventeen of the 27 responding stated that the usual amount of marijuana smoked at one time was no more than one cigarette, while 7 indicated that their normal consumption was three or more cigarettes. Thirteen of the 29 reported that they limited their marijuana use to weekends and evenings. Small social groups were the most frequent setting for its use, although 13.indicated that they used it in all types of environments. Nineteen of the 29 stated that they sometimes worked while using marijuana. Of these, 6 reported greater competence, 8 impairment, and 5 no effect.

 

Questions were asked about both short- and long-term after-effects of marijuana use. Twelve of the 29 respondents reported that they sometimes experienced hangover effects the day following marijuana use. However, all but two stated that this effect occurred only after using large amounts, or in combination with lack of sleep. Lethargy was the most frequently reported symptom, followed by inability to concentrate, irritability, and headaches. Five of the 12 who reported experiencing hangover effects stated that they took amphetamines to relieve the symptoms.

 

Nine of the 29 respondents felt that their marijuana use had some longterm effects; 6 felt these effects to be positive, 2 negative, and 1 mixed. Positive effects reported included increased self-insight, tolerance, creativity, spontaneity, and sexual freedom. Negative effects reported were lung irritation, absent-mindedness, and less discipline and productivity.

 

For the 7 respondents who were no longer using marijuana at the time of interview, the reasons for stopping included concern over legal dangers, interference with work, impairment of communication, preference for alcohol or heroin, inability to achieve euphoric effects, and substitution of nondrug methods of altering consciousness.

 

USE OF OTHER DRUGS

 

Table 3 describes the use of other drugs for the regular users, the short-term users, and the non-users of marijuana. It is clear that those who are regular users of marijuana are considerably more prone to the use of other drugs, including alcohol, than are the two comparison samples. Seventy-nine percent (23) of the regular-user group have some history of heavy alcohol use (five or more drinks during a three-hour period, two or more times per week, for a minimum of two years). Four described themselves as alcoholics, although three were abstinent at the time of the interview. Robins, Dervish, and Murphy report a similar relationship between Negro adolescent marijuana use and subsequent medical and social problems associated with heavy drinking.

 

While it is obvious that these data do not support the current mythology that marijuana users eschew alcohol, there was some evidence that marijuana use reduces the amount of alcohol that would otherwise be consumed. Of the 6 currently using marijuana on a daily basis, 5 were currently in the less-thanone-drink-per-day category. In response to a separate question on the relationship between alcohol and marijuana use, 52 percent (15) of the entire sample and 79 percent of the 14 current regular users reported that the use of marijuana reduced their overall consumption of alcohol.

 

Frequent or regular use of stimulants was quite common (66 percent) among the regular users of marijuana. Twenty-eight percent (8) stated that they sometimes used amphetamines "to get high"; one respondent was incapacitated by amphetamine dependency at the time of the interview. Of the 16 with some nonmedical experience with opium, morphine, or cocaine, only 8 had used them more than ten times. Three of the 8 who had tried heroin had become addicted. The incidence of heroin addiction should be qualified by the fact that 2 of the 3 were in the medical LSD-therapy population as a result of their addiction. Numerous other mind-altering drugs were used to some degree, the more frequent being amyl nitrite (62 percent), methylphenidate (41 percent), methamphetamine (24 percent), nitrous oxide (24 percent), and dextromethorphan (21 percent).

 

In summary, 8 of the 29 regular users of marijuana developed serious dependence on drugs other than marijuana (alcohol, heroin, or amphetamine). If the 4 additional respondents with current daily consumption of eight or more drinks of alcohol and the one chronic LSD user are added to these, the combined total comes to 45 percent. The comparable incidence for the short-term users and non-users of marijuana groups is 5 percent in each, which is near the national average for alcohol dependency.

BACKGROUND AND BEHAVIORAL CHARACTERISTICS

 

First-born or only children are significantly overrepresented in the group of regular users of marijuana. A higher proportion of the regular-user group were raised in large cities, rated their parents' marriage as unhappy, and had fathers who used alcohol heavily. From a behavioral standpoint, the most striking difference in the three groups is in the area of marital stability. Twenty-five of the 29 regular users have married one or more times, and all but 3 (12 percent) of the first marriages ended in divorce or separation. By comparison, the percentages of first marriages still intact for the short-term user and non-user groups were 48 and 61 respectively. The regular-user group also evidenced a significantly higher incidence of residence changes and periods of unemployment, and a lower percentage of home ownership. However, residence changes and periods of unemployment were not significantly different when respondents with a history of alcoholism, heroin addiction, and amphetamine dependency were excluded.

 

MARIJUANA AND DRIVING

 

The effect of marijuana use on driving ability is of primary social concern, but as yet has not been examined in more than a preliminary manner.3 In the present study, inquiry was made concerning the effect of marijuana on driving competence. Four of the 29 in the regular-user group stated that they never drove under the influence of marijuana. Of the remaining 25, 16 reported driving ability was impaired; 2 others said that it was impaired, but felt that they compensated by driving more slowly; 6 stated that it had no effect on their driving competence; and 1 claimed to drive better. The reasons given for impairment were perceptual distortion, speed distortion, slower reaction time, diminished alertness, disorientation, greater distractibility, poor judgment, and less carefulness while driving.

 

The 1966-68 accident and traffic violations data were obtained from the California Department of Motor Vehicles .° On the basis of these limited data, both the regular and short-term marijuana users show a somewhat higher accident and violation rate than does the nonuser group; however, the differences are not statistically significant.

 

PERSONALITY AND ATTITUDE CORRELATES

Table 4 compares the regular-user, short-term user, and non-user samples5 on a number of personality, attitude, and alienation scales. Three related measures demonstrate that the regular-user group's interest in, and susceptibility to, altered states of consciousness ext6nds considerably beyond the drug-induced variety. The regular-user group is clearly differentiated from the comparison samples by belief in the validity of paranormal phenomena such as unidentified flying objects, astrology, and extrasensory perception; number of high scorers on the hypnotic susceptibility test (As) ; and the degree of involvement in nondrug methods of altering consciousness such as meditation, yoga, Zen, fasting, and so forth. Sixty-two percent (18) of the regular-user group have practiced one or more of the nondrug consciousness alteration methods, often for periods of several years. The regular-user group also stored significantly higher than the non-users on a shortened form of Zuckerman's sensation-seeking scale, which measures preferences for extremes, risk-taking, and the unfamiliar. Shortened forms of the Myers-Briggs Type Indicator and MarloweCrowne Social Desirability scale (Crowne and Marlowe), showed differences in the predicted direction, but did not reach statistical significance.°

 

The results for six attitude subscales are also shown in Table 4. It is not surprising that the largest differences among the three groups pertain to society's efforts to legally restrict individual freedoms in various areas. The greater skepticism of the regular-user group regarding the impartiality of legal processes is reflected in more frequent disagreement with items such as: "On the whole policemen are honest." They are also more tolerant of protest actions such as draft-card or flag burnings; and are more opposed to the legal control of behaviors such as abortion and homosexuality. With respect to American foreign policy, they are more strongly opposed to the Viet Nam war, more in agreement with unilateral disarmament in the interest of world peace, and less inclined to support chauvinism.

 

In terms of immediate versus delayed gratification, the regular-user group more strongly endorses items such as: "Most people miss the enjoyment of living through their preoccupation with future achievement." They also place a stronger emphasis on the influence of outside or chance events in the determination of success or failure.

 

In view of the fact that the respondents in all three groups had experienced the LSD state, it is of interest to note that the regular users of marijuana demonstrate a significantly more cultist viewpoint in response to the statement: "Persons who have taken LSD see the world in a way that others can never understand."

 

Alienation is often postulated as an explanatory variable for the recent upsurge of drug-taking among youth. In the present study, administration of Srole's anomie scale and a sociocultural alienation measure developed by Keniston revealed significantly higher scores for the regular users of marijuana in comparison with the non-users. Sample items from the sociocultural scale are: "I don't want to have to 'fit in' with American Society the way it is today," and "In the last analysis, the 'American way of life' is pretty shallow and tawdry." A measure of personal alienation, also from Keniston, yielded approximately the same score for all three groups. Samples of this scale are: "Sometimes I feel very worthless and inadequate," "Our lives don't have any real meaning or purpose," and "I don't have much in common with most people I meet."

 

Indices of political and organizational activity7 showed no difference among the three groups for the former and a significantly lower rating for the regular-user group on the latter. The political participation index was based on frequency of voting, contributing to political parties, writing to public officials, and so forth. The organizational involvement index consisted of membership, frequency of attendance, and level of interest in various church, social, civic, and professional groups.

 

DISCUSSION AND CONCLUSIONS

 

We must preface our generalizations by again calling attention to the special nature of this sample. It consists of persons who typically first tried marijuana in adolescence some 20 years ago, subsequently used it on a regular basis for a minimum of two years, and during the 1955-61 time period took LSD in a medical setting—half in psychotherapy and half as volunteers for experiments. Most of the data reported in this paper consist of comparisons between this group and two other samples from the LSD group of approximately the same age, sex ratio, education, and proportion in art-related professions. While these comparisons are valid, it is hazardous to conclude that another group, consisting, say, of persons who also used marijuana regularly during the same period but did not volunteer for LSD experiments or were not in psychotherapy, would yield the same findings when matched on appropriate variables with non-users. It is even more hazardous to generalize to the population of persons introduced to marijuana during the last few years, since they come from a much wider spectrum than do the highly selective groups who were exposed to marijuana two decades ago. In addition to the above caveats, there is, of course, the usual limitation that while this type of study may determine what variables are associated, it generally cannot establish causal relationships.

 

Obviously, there are numerous correlates of marijuana use, only a few of which have been described here. Dur ing the time period covered by the current study, opportunity was a major factor in determining who tried marijuana—most middle-class persons were simply never exposed to the drug. Others were undoubtedly deterred by concern over legal hazards. As is the case with other drugs, including alcohol, the majority of people who use marijuana heavily as adults begin its use in adolescence. Table 1 indicates that only one in 17 of the respondents introduced to marijuana during 1961-68 (typically in the 30-40 age range) has ever used it on a regular basis. Another variable of importance is occupation. Among the middle classes, persons in the entertainment field and other art-related professions are much more inclined to find marijuana to their liking than are other groups.8 They are also more likely to use it while working and to report that either it has no effect or it enhances their performance.

 

The correlates of marijuana use which form the most consistent pattern in the present study are: (1) those showing a continuing involvement in various means of altering consciousness; and (2) those depicting an unstructured and relatively unstable style of life. The search for altered states of consciousness is apparent in terms of the tendency to use, or at least experiment with, a wide variety of drugs other than marijuana, but it is also evidenced in various non-drug-use areas. Marijuana users are significantly more prone to non-drug-induced regressive states as measured by a hypnotic susceptibility test. They are much more likely to believe in the validity of astrology, ESP, and so forth. They have often practiced one or more disciplines such as meditation, yoga, or Zen for a period of several years. In terms of life-style, they prefer a high level of stimulation, uncertainty, and risk, rather than security and structure.

 

They evidence more than average work and residence instability and are especially unlikely to maintain a permanent marriage. They are more alienated from a sociocultural standpoint, but not in a personal sense—that is, their alienation does not take the form of pessimism, self-contempt, and barren interpersonal relations.

 

With regard to patterns of drug use, the marijuana user is more likely than the non-user to have had a history of heavy alcohol use; is much more likely to use amphetamines on a frequent basis, but is not especially attracted to sedatives and tranquilizers; is likely to have used LSD and other strong hallucinogens, but generally on an infrequent basis; and may experiment with the opiates, including heroin, but seldom becomes addicted. The association between marijuana and amphetamine use is of special interest. Five of the respondents indicated that they used amphetamines to overcome the lethargy resulting from heavy marijuana use. The fact that the majority of the remaining marijuana users also take amphetamines suggests that a pattern of alternating between the two drugs may develop without awareness of a causal relationship by the user.

 

For the group studied here, the drug which is most competitive with marijuana is clearly alcohol. Amphetamines are used frequently, but primarily in small quantities for their stimulant properties. Although various other drugs are used on a sporadic basis, alcohol and marijuana are the principal means of producing regular intoxications or "highs." While few persons simultaneously use marijuana and appreciable amounts of alcohol, it is not uncommon to use significant amounts of both drugs over a period of a few hours. Some persons indicate that the choice between alcohol and marijuana is largely a function of the social group they are with at the time. Other patterns of use include periods of months or years in which marijuana is used virtually to the exclusion of alcohol, or vice versa. There are definite qualitative differences in the intoxications produced by the two drugs, but the relaxing, tension-reducing, sense-ofwell-being effects are common to both. Among the regular users of marijuana in this study, the relaxing or tranquilizing effect was cited almost as often as euphoria as a major motivation for using marijuana.

 

The current rapid increase in marijuana use has raised a number of questions concerning the possible social impact of modifying present legal controls. For instance, if marijuana were legalized in the same manner as alcohol, what would be the net consequences to society? Those opposing such a move generally argue that legalization would simply compound an already serious alcoholism problem by adding to it a large group of marijuana abusers. Those favoring legalization argue that marijuana abusers would be drawn from the population who do, or would, use alcohol in excess. The results of the current study tend to support the latter position. From a behavioral standpoint there is no simple relationship of substituting one drug for the other, although the majority of marijuana users report that their use of marijuana reduces their total consumption of alcohol. No systematic attempt was made to explore harmful effects resulting from excessive use of alcohol; however, several respondents indicated that their use of alcohol had been considerably more disruptive than their

use of marijuana. Specific problems attributed to excessive use of alcohol were drunken driving, assaultive behavior, and inability to work. In addition, the degree of dependency was felt to be greater for alcohol.

 

In conclusion, if a white, middle-class, middle-aged person began using marijuana as an adolescent some 20 years ago, and continued to use it on a regular basis for several years, there is a high probability that he also has a history of fairly heavy use of the intoxicant that is somewhat more socially approved, alcohol. On the other hand, we have no basis for determining if the reverse would hold—that is, if marijuana were generally available and accepted, would most heavy alcohol users also smoke marijuana in significant amounts? From the results of the present study, it does not seem likely that marijuana use would totally replace alcohol for many persons; however, the overall consumption of alcohol might be reduced.

 

It does appear that alcohol and marijuana are likely to be the major mind-altering drugs of social concern in the future. In order for a drug to have a major impact on society, it must meet three requirements: (1) it must appeal to a relatively large proportion of the population; (2) it must be suitable for regular use over long periods of time; and (3) it must produce significant physical, psychological, or social behavioral change. Alcohol and marijuana are the only presently known intoxicants which satisfy these criteria. The opiates fulfill the second and third, but not the first requirement. The strong hallucinogens are much more dangerous than marijuana on a short-run basis, and they lack the properties which lead to frequent use over long periods of time. The amphetamines, sedatives, and minor tranquilizers appeal to a fairly large group, but only as a means for minor mood alterations—their use as intoxicants is limited to a small segment of the population for relatively short periods of time.

 

Thus, society is probably entering an era in which considerable effort will be expended in evaluating and contrasting the individual and social consequences of alcohol and marijuana use. Since the two substances are to some degree substitutive, studies will need to consider interactions as well as the separate effects. Alcohol will undoubtedly continue to be the most widely used intoxicant, but marijuana seems destined to continue to gain in popularity.

 

'See Blum et al.

Two respondents failed to respond to some of the items in Table 2.

'Crancer and Quiring found that 79 marijuana users identified through arrest records demonstrated a substantially higher traffic violation rate than did the general population (adjusted for age and sex distribution). The accident rate for the marijuana users was not appreciably higher than that for the comparison group. Waller reported similar findings for 308 drug users (not identified by type of drug). He found that alcoholics demonstrated higher rates than drug users for both accidents and traffic violations. Crancer et al. investigated performance on a driving simulator under alcohol and marijuana intoxications and found alcohol caused substantially greater impairment than did marijuana.

4 We should like to thank the California Motor Vehicles Department for supplying these data.

"The Myers-Briggs scales measure a preference for intuition and ideas over conventional and factual approaches (sensing intuition), and a casual, spontaneous style of life as opposed to one that is orderly and systematic (judgment-perception). The Marlowe-Crowne Social Desirability scale consists of items defined by behavior which is "culturally sanctioned and approved," but which is "improbable of occurrence."

 

REFERENCES

 

As, ARVID. "Hypnotizability as a Function of Nonhypnotic Experiences," J. Abnormal and Social Psychology (1963) 66:142-150.

ALDRICH, C. KNIGHT. "The Effect of a Synthetic Marijuana-like Compound on Musical Talent as Measured by the Seashore Test," Public Health Reports (1944) 59:431-433.

BLUM, RICHARD H., et al. Students and Drugs; Jossey-Bass, 1969.

CHAPIN, STUART F. Experimental Designs in Sociological Research; Harper, 1955.

CRANCER, ALFRED, and QUIRING, DENNIS L. "Driving Records of Persons Arrested for Illegal Drug Use," Police, in press.

CRANCER, ALFRED, et al. "Comparison of the Effects of Marijuana and Alcohol on Simulated Driving Performance," Science (1969) 164:851-854.

CROWNE, DOUGLAS P., and MARLOWE, DAVID.

"A New Scale of Social Desirability Independent of Psychopathology," J. Consulting Psychology (1960) 24:349-354.

KENISTON, KENNETH. The Uncommitted: Alienated Youth in American Society; Harcourt, Brace & World, 1966.

MYERS, ISABEL B. The Myers-Briggs Type Indicator; Princeton, Educational Testing Service, 1962.

ROBINS, LEE N., DARVISH, HARRIET S., and MURPHY, GEORGE E. "The Long-Term Outcome for Adolescent Drug Users: A Follow-Up Study of 76 Users and 146 Nonusers," in Joseph Zubin and Alfred M. Freedman (Eds.), The Psychopathology of Adolescence; Grune & Stratton, 1970.

SROLE, LEO. "Social Integration and Certain Corollaries: An Exploratory Study," Amer. Sociol. Review (1956) 21:709-716.

WALLER, JULIAN A. "Chronic Medical Conditions and Traffic Safety," New England J. Medicine (1965) 273:1413-1420.

WILLIAMS, EDWIN G., et al. "Studies on Marijuana and Pyrahexyl Compound," Public Health Reports (1946) 61: 1059-1083. WINICK, CHARLES. "The Use of Drugs by Jazz Musicians," Social Problems (1960) 7 :240- 253.

WOODWARD, JULIAN L., and ROPER, ELMO. "Orientation Toward the Political Process: Modes of Political Participation," in Heinz Eulau and Samuel J. Eldersveld (Eds.), Political Behavior; Free Press, 1956. ZUCKERMAN, MARVIN, et al. "Development of a Sensation-seeking Scale," J. Consulting Psychology (1964) 28:477-482.