A Senate subcommittee has tried to implicate the use of marijuana in the My Lai episode. Stirred by this, the mass media have given sensational attention to the use of marijuana by U.S. servicemen in Viet Nam. Reviewing the considerable professional literature on the subject, the author finds that marijuana smoking is a significant problem but not as serious as the mass media seem to imply.

 

THE SUBJECT of marijuana smoking by American servicemen in Viet Nam has received considerable attention because of the attempts of the late Senator Thomas J. Dodd's subcommittee on juvenile delinquency to associate the use of marijuana with the incident at My Lai. In the summer of 1970, the nation's mass media erupted with tales of widespread marijuana use by Americans in Viet Nam. This was supposedly accompanied by such acts as soldiers' shooting at one another or at their own helicopters. Some of the accounts were gathered from former Army medical personnel who had served in Viet Nam. Estimates of regular marijuana use among the troops went as high as 90 percent.

 

This paper provides a review of the professional writings of Army medical personnel, current as of October 1970, regarding the extent and effects of marijuana use among GIs in Viet Nam. I have recently returned to civilian life after serving one year (October 1968 to October 1969) as an Army psychiatrist in Viet Nam and 11 months (October 1969 to September 1970) in the Office of the Surgeon General of the Army, Washington, D.C. In the latter job I became well acquainted with all aspects of the marijuana situation in Viet Nam.

 

I hope that this paper will provide some objectivity to an emotional subject. This hope is based on a number of assumptions. The first is that medical personnel really do have something to contribute. I think this is true because medical personnel, including mental health professionals, are scattered throughout Viet Nam at all echelons, and they have continually written about the problem.

 

The second assumption is that professionals arc allowed to write without censorship. In one of the studies to be reviewed (1), there was some initial obstruction on a local level.

 

This was corrected by the Surgeon General's Office. Generally there has not been and there is not now any censorship of professional writing about the marijuana problem in Viet Nam. For information purposes the Surgeon General asks to clear all manuscripts submitted for publication by active-duty personnel. During the 11 months I worked in the Surgeon General's Office, no manuscript on psychiatry was disapproved for clearance.

 

The third assumption is that what a person writes for professional publication, where thoughts are carefully set down for peer review, inherently has more objectivity than what he might say to a newspaper reporter or before a television camera.

 

One good source of information about marijuana in Viet Nam is the USARV (United States Army Vietnam) Medical Bulletin. This professional journal has been published bimonthly since January 1966 as the medium for exchange of medical information in the combat zone. It has been supplied to major military libraries, to some medical school libraries, and to the military medical departments of a number of foreign countries.

 

Incidence of Marijuana Use in Viet Nam

 

Huffman was the first clinical psychiatrist the Army assigned to Viet Nam; he served there from May 1965 to April 1966. He stated that marijuana smoking by the troops was known to be occurring, but that it was seldom mentioned as a problem in the two places (Nha Trang and Saigon) in which he had worked (2).

 

Since then there have been, as far as I know, five attempts by professionals to formally determine the extent of marijuana use in Viet Nam. The data to be presented have many inadequacies, but they are all there is on which to base any objective opinion.

 

In August 1967, Sapol and Roffman undertook a study at a large troop replacement center (Long Binh) in III Corps (1). Anonymous questionnaires filled out by 584 lower-grade enlisted men (E-6 and below) indicated that 30 percent had used marijuana in Viet Nam. Twenty-five percent of the positive responders had used marijuana 20 times or more.

 

In October 1968, two other studies were reported. Postel, a psychiatrist with the 4th Infantry Division at Pleiku, interviewed 50 psychiatric patients and gave anonymous questionnaires to 100 surgical patients (3). Fifty-six percent of the psychiatric patients admitted using marijuana while in Viet Nam; 30 percent stated they had used it more than five times. Among the surgical patients, 35 percent stated they had used the drug; 17 percent had used it more than five times.

 

Casper and associates (4), in the America! Division at Chu Lai, gave anonymous questionnaires to 46 psychiatric patients and 46 general medical patients. Fifty-two percent of the psychiatric patients and 33 percent of the general medical patients admitted using the drug. A continuation of this study by the same investigators showed that 36 percent of 268 other general medical patients and 28 percent of 234 soldiers leaving the country admitted using marijuana while in Viet Nam.

 

In the fall of 1969, at the large replacement center at Cam Ranh Bay, Stanton (5) gave 500 anonymous questionnaires to lower-grade enlisted men who were leaving the country. Preliminary results of the data analysis showed that 50 percent of the outgoing troops admitted using marijuana at least once in Viet Nam. About half of these had smoked marijuana 20 times or more. A small group of 63 outgoing officers was queried, and only one admitted using the drug. In addition, 59 senior noncommissioned officers were studied; two men said they had used the drug.

 

In early 1970, Treanor and Skripol (6) administered anonymous questionnaires to 1,076 airborne soldiers in 11 Corps. Preliminary data showed that 68 percent admitted to having used marijuana in Viet Nam, but only 31 percent had used it more than once or twice. There was a marked inverse relationship between rank and the extent of marijuana use.

 

On the basis of these studies, it appears that marijuana use in Viet Nam is common and seems to be increasing among lower-grade enlisted men in the Army. The two most recent studies indicated that from 25 to 31 percent of the troops are beyond the experimentation stage. While these figures are certainly significant, they are lower than those often put forward as representative by the mass media.

 

It can also be said that marijuana use among officers and senior noncommissioned officers is not common.

 

I was in Viet Nam at about the time these last two studies were conducted. Judging from the problem population that I came in contact with, I would have predicted a higher incidence of marijuana use than the statistics show. The marijuana smoker typically stated that "almost everybody smokes pot in my unit." This bias probably explains some of the apparent exaggeration in the mass media.

 

Effects of Marijuana Use in Viet Nam

 

Marijuana of a powerful variety grows well in Viet Nam and is readily available through local people. Furthermore, Vietnamese marijuana is often mixed with opium, which gives it a more potent effect.

 

Four of the five studies reported previously indicated that the marijuana smoker tends to have more disciplinary problems than the nonsmoker.

 

There is some indication in the studies reported that those who become psychiatric patients tend to use marijuana more than general medical patients do. The idea of both transient and prolonged marijuana-associated psychoses, with paranoid and organic features, is well accepted in Viet Nam (7, 8). Usually these psychoses occur in men with personality disorders who are heavy users. Talbott and Teague, however, have reported the occurrence of psychoses in apparently normal individuals after minimal contact with the drug (9).

 

The psychiatric casualty rate in Viet Nam is increasing. In 1968 the rate was 13 per 1,000 per year; in 1969 it was 15 per 1,000 per year; for the first six months of 1970, it was 24 per 1,000 per year (10). Increasing drug abuse is one of the reasons put forth in speculation about the causes of this rising rate.

 

Bey and Zecchinelli, however, on the basis of their experiences with the 1st Infantry Division in 1969 and 1970, took an opposite stand. They see marijuana as a helpful coping device in Viet Nam (11).

 

The relationship of marijuana to acts of violence is an area of uncertainty. The drug certainly makes people fearful and paranoid, and the literature vaguely mentions some aggression and violence associated with its use (12, 13). In their article, Talbott and Teague reported the case of an enlisted man who, while apparently high on marijuana, shot and killed another GI who had "Ho Chi Minh" written on his shirt as a joke. The first man then reported that he had killed Ho Chi Minh and expected praise. Such actual reports are rare, however, especially in view of the extent of marijuana use.

 

Imahara, a psychiatrist at the Long Binh stockade from late 1968 to late 1969, investigated the correlation between use of marijuana and violent crimes. His studies of prisoners were inconclusive and alcohol seemed to be implicated as much as marijuana (14).

 

It would appear that the use of marijuana in Viet Nam is sometimes associated with aggressiveness, especially of a bizarre nature. The evidence in the literature is not nearly as incriminating, however, as the mass media would imply.

 

While I was in Viet Nam, I heard many "horror" stories in which marijuana was somehow implicated. In a full year, however, while heading a psychiatric facility serving 45,000 troops, I came across no case in which there was definite evidence that aggression directed toward the self or toward others could be attributed primarily to marijuana. Marijuana was associated with ineffectiveness, panic states, and psychoses, but these did not usually have any sensational content. In my recollections, alcohol caused most of the trouble of a sensational variety.

 

To date the attempts to combat the use of marijuana in Viet Nam have been somewhat sporadic and have usually been left up to the initiative of the individual mental health worker. Recently Parrish, former psychiatric consultant for the Army in Viet Nam, and I reflected on this low-key approach in a review of Army mental health activities in the combat zone (15). In preparing the review we spoke with numerous mental health personnel who had served in Viet Nam. The consensus was that marijuana had thus far not seriously affected the military mission and that there was no real sense of urgency about eliminating it.

 

REFERENCES

 

1. Sapol E, Roffman RA: Marihuana in Vietnam. International Journal of the Addictions 5:1-42, 9. 1970

2. Huffman E: Which soldiers break down? Bull 10. Menninger Clin 34:343 -351, 1970

3. Postel WB: Marihuana use in Vietnam: a preliminary report. USARV Medical Bulletin 11:56-59, 11. 1968

4. Casper E, Janecek J, Martinelli H Jr: Marihuana in Vietnam. USARV Medical Bulletin 11:60-72, 1968 12.

5. Stanton MD: Drug use in Vietnam, in The Drug Abuse Controversy. Edited by Brown C, Savage C. Philadelphia, Lea & Febiger (in press) 13.

6. Treanor JJ, Skripol JN: Marihuana in a tactical unit in Vietnam. USARV Medical Bulletin 22:29-37, 14. 1970 15.

7. Colbach E, Crowe RR: Marihuana-associated psychosis in Vietnam. Milit Med 135:571-573, 1970

8. Heiman EM: Marihuana-precipitated psychoses in patients evacuated to CONUS. USA RV Medical Bulletin 9:75-77, 1968

9. Talbott JA, Teague JW: Marihuana psychosis. JA MA 210:299-302, 1969

10. Allen G (Medical Statistics Agency, Office of the Surgeon General): Personal communication, August 1970

11. Bey DR, Zecchinelli VA: Marihuana as a coping device in Vietnam. USARV Medical Bulletin 22:21-28,1970

12. Bloch HS: Army clinical psychiatry in the combat zone: 1967-1968. Amer J Psychiat 126:289-298, 1969

13. Fidaleo RA: Marihuana: social and clinical observations. USARV Medical Bulletin 8:58-59, 1968

14 Imahara J: Personal communication, June 1970

15. Colbach E, Parrish MD: Army mental health activities in Vietnam: 1965-1970. Bull Menninger Clin 34:333-342,1970