SOCIAL AND CULTURAL CONCOMITANTS OF MARIHUANA USE

Although data concerning the social and cultural concomitants of cannabis use is inadequate in many respects, there are certain social constants concerning the moderate smoker which seem to hold true across a variety of studies conducted in many countries. The marihuana smoker tends to be young, male, and up until the present time, was predominantly drawn from members of lower socio-economic groups. There are no adequate figures available as to how long the moderate marihuana usage pattern persists, or as to how many of the moderate users progress to heavier use of cannabis, even apart from their possible progression to stronger drugs.

In the United States, marihuana. smoking tends to be a group activity, and group members are persons who have more than a casual aquaintance with one another—in sociological terms, the group is composed of significant others.

Induction of a neophyte into the use of the drug is ordinarily the province of a close peer, who socializes him into expectation of a pleasurable experience, and allays his dismay (if the initial experimentation turns out to be frightening or disagreeable) or continues to feed his hopes (if it does not prove to be as pleasurable as expected) by assuring him that it is all part of a learning experience. Females are quite frequently introduced to marihuana smoking by male companions.

Cannabis smoking itself has significant social elements of sharing, with ritual overtones. Even the fact that individuals seem to be oblivious of one another once the desired degree of high has been achieved should be considered in the context of the comfortable silences possible only among close friends.

Although the number and types of marihuana smokers in the United States are too diverse to be called a true subculture, it is a fact that within each of the diverse groups who use the drug, there, is a shared value system, of which cannabis use is only one part. Groups with very diverse value systems, for example motorcycle gangs like Hell's Angels and hippie residents of the early Haight-Ashbury, would both use cannabis, but obviously in the context of very different life styles.

But whatever the diverse value systems of the different groups of cannabis users the major presenting social fact to those charged with the protection of the nation's health, is that cannabis use tends to be an activity of the young, drawn from all social classes. It is comparatively easy to identify the population most at risk, but there is, at present, no completely clear definition of the most relevant parameters of risk, both for the individual and for society.

In the case of a society, it is possible, on the basis of even so gross a measure as the volume of research published in certain particular areas, to sketch out at least a preliminary outline of a risk hierarchy concerned with moderate cannabis use, and another such hierarchy concerned with excessive and/or chronic use.

So far as a community, or a society is concerned, three of the major areas of interest for moderate cannabis use have been these :

1. The possibility of progression to the use of either more or stronger marihuana, or to other stronger drugs (whether they be hallucinogens or narcotics) ;

2. The possibility of the development of psychic dependence and/or psychotic reactions;

3. The possibility of the commission of crimes while under the influence of cannabis.

Among the reputed effects of marihuana mentioned in many discussions in past years is that of progression to stronger drugs, especially the opiates. The usual explanation has been that marihuana use develops a "taste for drug intoxication" which leads to trying stronger drugs. There have been numerous debates on the subject. Now it is generally agreed that whatever association exists between use of marihuana and other drugs for a particular group must be examined for contingent or qualifying conditions.

More recently, it has been argued that marihuana use can substitute for use of alcohol. The explanation has been that marihuana provides relaxation and euphoria, as alcohol does, but in having less unpleasant side effects, will be seen as more desirable.

The first of these assertions (the progression hypothesis) has been detailed with evidence from several kinds of studies: compilation of hospital and prison records, sample surveys, and interview studies of selected populations. None, however, has been a prospective or longitudinal study designed specifically for the purpose of testing the progression hypothesis or, for that matter, the substitution hypothesis. Thus, conclusion about the relationship are based on evidence that is far from ideal for that purpose.

Recent observations that heavy involvement with drugs usually involves simultaneous use of two or more drugs in more or less planned patterns, should lead to a chancre in the question itself. That is, it should no longer be assumed that drug use always develops sequentially, the user being on one drug until he turns to another. The research question perhaps should be: Under what social or psychological conditions do persons use drugs of different kinds in various combinations and patterns?

THE PROGRESSION HYPOTHESIS

Long before the recent debate over this effect, the Indian Hemp Commission of 1893-94 found no evidence in the Indian population that marihuana use was a stepping stone to the use of opiates in any substantial number of people. It has been observed and reported innumerable times that American narcotic addicts in most cases have used marihuana before becoming addicted to the stronger drugs. This fact, by itself ,has been convincing to many. Among the heroin users studied by Chein' for example, 83 of a total of 96 had used marihuana previ- ously (9). In a study by Chapple, it was concluded that the connection between marihuana use and heroin addiction could not be accounted for simply on the basis that both drugs were available from the same illicit source (7). Although the authors' conclusions did not actually favor the progression hypothesis, a study by Ball, Chambers and Ball was cited frequently to show that over 70% of the addicts in the study had used marihuana prior to their use of heroin (1).

Gradually recognition has come that the answer to the question lay in a clearer formulation of the problem. Richard Blum stated in the Task Force Report of 1967:

With reference to the belief that marihuana causes heroin use in the sense that it predestines its user to go on to bigger things, there are two critical tests: one asks what proportion of marihuana users do not go on to heroin ; the other test asks if marihuana use is an inevitable and necessary precondition of heroin use, that is, can it be shown (a) that all heroin users first took marihuana, (b) that such marihuana use is the only factor common to heroin users, and (r) that the presence of this common factor can be shown experimentally to be a determinant of heroin use. The results of such tests are, of course, negative. Most persons who experimented with marihuana do not try heroin, some heroin users even in slum cultures . . . have not first tried marihuana, and among heroin users first trying marihuana a number of other common factors are also likely to be present. Among these may be experimentation with other illicit drugs reflecting a general pattern of drug interest and availability (3)•

A test of the last of the above hypotheses was carried out by Robins et al. on retrospective data collected from Negro men in their early thirties (18). Only a minority of marihuana users went on to try heroin; and drinking in turn usually preceded marihuana use. Marihuana use was associated with later alcoholism, however. The authors speculated that marihuana use may increase the risk of alcoholism, which itself appeared to account for some of the other adult troubles seen among those who also used marihuana.

The Ball, Chambers and Ball study should be summarized since it is so often cited and represents other studies in which opiate addicts are the initial group for investigation (1). These authors examined records and interviewed a portion of a sample of addicts admitted to Lexington and Fort Worth hospitals during 1965. They found not one but several patterns of association between marihuana and opiate use. One was a positive association found in sixteen States with high addiction rates. This was seen among those individuals who were apt to be deviant on most variables—arrest record, early arrest, earlier onset of opiate use, intravenous administration of opiates, heroin use, and obtaining drugs from underworld sources. The other pattern was a lack of association between marihuana smoking and opiate use, found in twelve Southern States, where opiates other than heroin were more typical. The authors concluded that the smoking of marihuana cigarettes does not necessarily lead to opiate addiction, but suggested that marihuana smoking had increased among opiate addicts in the 'U.S.

In one large student survey, evidence was clear that marihuana smoking was associated statistically with use of other drugs (4). More students had used it than any other illicit drug, though not more frequently than alcohol or tobacco. And more than any other illicit drug, it was correlated with other illicit drug use. Blum said in 1968, "Although there is still no evidence of any causal 'stair-step' effect such as that marihuana use leads to heroin, evidence does indicate . . . that an initial interest in drugs, which is necessarily expressed in taking one of many possible illicit-exotic substances, can lead to expanding drug interests and commitment to a life style in which drugs play a predominant role."

The details of relationships between drugs are being spelled out in recent reports. Some show that heavy (frequent, regular) use of a given drug (such as marihuana) is much more likely to be associated with use of other drugs than is light use or experimentation. In one study of college students, for example, the following percentages of users in each category of marihuana use had used other drugs (10) : 100% of daily marihuana users had used other drugs; 84% of weekly marihuana users had used other drugs; 22% of monthly marihuana users had used other druas • 20% of marihuana experimenters had used other drugs; 0% of marihuana abstainers had used other drugs.

Other drugs tried in order of frequency were : hallucinogens, "downers," "uppers," hashish, and hard drugs. Another study of nine campuses produced a similar finding: that the heavier the involvement with a given drug, the more likely it was that the student was involved in more than one drug (16) .

These studies seem to point toward a "drug proneness" factor. In fact, Blum's factor analysis of students' use of all drugs measured on five campuses indicates just that: "a general disposition toward psychoactive drug use . . . (that) . . . reflects the widespread willingness to use a variety of drugs as tools to alter states of consciousness, biological cycles, and social relations" (4). Blum also found two subsets of dispositions linking particular drugs. One factor was identified as style of drug use by source; the separate components were (a) conventional social-drug use, such as alcohol and tobacco and (b) the employment of illicit-exotic substances, expecially marihuana and the hallucinogens. Less clearcut was a style of reliance on prescription drugs. The place of opiates in this analysis was also unclear, but the proportion of the student body using opiates on any campus was miniscule-1-2%.

Findings from a recent study of marihuana smokers, mainly white middle-class, are consistent with a developing theory of multiple drug use (11). The most potent variable in determining use of drugs other than marihuana is how much the person smokes marihuana. At that point, heavy marihuana use, according to the author, tends to "implicate the individual in tense and extensive social interaction with other marihuana users," involves him with numerous marihuana users and in numerous marihuana-related activities, alters the role of marihuana as a relevant criterion in his conceptions of others, and changes his conception of himself as a drug user. Moreover, it increases the likelihood of his taking drugs, in addition to marihuana, of which the subculture approves. In middle class groups, the approved drug would most likely be LSD; in ghetto groups, heroin.

The above hypothesis was confirmed in another recent study that by chance had a preponderance of black over white respondents (12). In a group of marihuana users who had not used heroin at the time of the study, those who had had an opportunity to try heroin tended more often to be black, to have tried other drugs, to know heroin users, and be intensive users of other drugs.

In the next few years, more will be known about the chronological sequence of multiple drug use and some of the factors associated with changing use patterns. One study to begin in 1971 will be a longitudinal study of junior and senior high school students over a period of years, in which a determination will be made of sequence and duration of use of both illicit and legal drugs (20).

THE SUBSTITUTION HYPOTHESIS

The possibility that marihuana might serve as a substitute for alcohol has been suggested most often by drug "advocates." The common argument about the relative harmlessness of marihuana and alcohol implies in part that the former would be preferred and chosen instead of the latter. Almost all surveys where measures of use of both drugs have been cross-tabulated have shown, however, that there is clearly an association between drinking and using marihuana (2, 4) . (Usually use of tobacco is also associated.) The association is statistical, not causal, and questioning has not designed to show whether drinking preceded, accompanied, or followed the use of marihuana. Indeed, it may simply reflect the fact that marihuana users, based on education and family background, are less traditional or conservative in several respects. It is known though that for almost all adolescents, the first psychoactive drug was alcohol or tobacco.

Findings on the use of the two drugs in a follow up study in San Francisco has been reported as a reversal of the marihuana-alcohol relationship, however. There, marihuana users report less use of alcohol (15).

More extensive analysis of existing data and inclusion of these variables in future studies will illuminate these relationships.

CANNABIS AND CRIME

The arguments relating cannabis to crime generally fall into three major categories:

1. Loss of control during intoxication and indulgence in impulsive and irrational acts of violence, particularly in the case of a psychotic reaction;

2. Loss of a sense of moral discipline and inhibition, an increasing number of associates drawn from criminal ranks;

3. Direct contribution to crime by fortifying the criminally inclined to commit anti-social acts.

It is of interest to note that the Indian Hemp Commission, as far back as 1893, devoted itself to a consideration of all of the issues mentioned above, under the terms of its mandate which had to do with the effects of the consumption of hemp drugs on the "social and moral" conditions of the people.

In attempting to reach conclusions about the involvement of marihuana, users in violent crime, the Commission first distinguished between the moderate and the "excessive" user. Even in India at the time of the report, when there was a greater overall number of users, when the cannabis preparations in use were apt to be much stronger than the type used in the United States today, the greatest proportion of users tended to be moderate users.

The Commission began by asking approximately 1400 witnesses, drawn from diverse regions of India, this question: "Are consumers of cannabis offensive to their neighbors?" The theory behind the use of this question was of course, the idea that this kind of a query would serve to elicit any mention of aggressive or violent behavior, since these behaviors would be offensive to their neighbors. Only about 700 of the witnesses stated that they knew anything at all about the issue; which would lead one to conclude that they had not had any experience with offensive behavior on the part of their neighbors. Of the seven hundred witnesses who said that they did have some knowledge of the issue presented, six hundred stated that moderate consumers were not offensive to their neighbors and could not be distinguished from total abstainers. Of the one hundred witnesses who did find cannabis users offensive, most were referring to heavy users, and even so they were not speaking of aggressive behavior, but of behavior such as 'excessive coughing or expectoration," or the bad examples set to neighboring children.

When the issue was put even more precisely, and the Commission asked the witnesses direct questions about crime, a majority of the witnesses (8 to 1) held that moderate consumption of these drugs had no connection with crime in general, or with crime of any particular character. This is not to deny that some users of cannabis did commit crimes, but it should be borne in mind that the majority of cannabis users in India were drawn from the lower classes and the crime rate in this group (particularly the rate for violent crimes) then, as now, was higher than it was among the middle and upper classes.

In any event, the social threat of cannabis-induced violence rests not so much on the demonstration of the existence of a relationship, but on the prevalence of such violent incidents. The Indian Hemp Commission concluded that the overall incidence of cannabis-induced violence was negligible.

A good deal of the material on cannabis use in present day India relies on the research work of the Chopras, three physicians who have been writing about various aspects of cannabis consumption in their native country for the past thirty years. The Chopras' most recent statement, largely a summary of their previous work, (8) asserts, "With regard to premeditated crime in some cases the drugs (bhang, ganja and charas) not only. do not lead to it, but actually act as deterrents. One of the most important actions of cannabis is to quiet and stupefy the individual so that there is no tendency to violence."

Literature from Eastern countries, unlike that emanating from the West, provides some evidence that cannabis connected and/or supposedly cannabis-induced psychotic reactions are often accompanied by "excitation and impulsivity liable to produce serious anti-social reactions (19). It is likely that disruptive behavior plays a significant role in determining whether or not an individual with an acute cannabis psychosis is hospitalized. This behavior is most likely to be perceived and dealt with summarily, if the individual exhibiting it is a member of a lower socio-economic group.

One comparatively early study (1938), (17) is of particular interest in regard to cannabis and certain types of violent reactions. Investigators in South Africa administered dagga to hospitalized psychiatric patients and found that 35% of them exhibited marked motor excitement and were extremely irritable and assaultive. This is in marked contrast to the typical cannabis reaction of quiet euphoria and lassitude, and suggests the possibility that hyper-excitability and impulsive behavior may not be an uncommon reaction in severely disturbed individuals.

In the United Kingdom, the Wootton Commission stated (1968), (6), "The taking of cannabis has not so far been regarded, even by the severest critics, as a direct cause of serious crime." The LeDain Commission, in Canada, came to similar conclusions.

There have been few statistical studies which have addressed themselves to the overall incidence of detected crimes among cannibis users, but on balance they tend to show an associational basis between cannabis use and minor asocial or anti-social behavior, not between cannabis and major crime. Those studies which begin with a sample of persons arrested for cannabis offenses generally show a much higher positive correlation with other delinquent behavior than do studies which begin with a, more representative sampling of cannabis users. One study of the latter type is the one conducted by Richard Blum on five college campuses in the late sixties. Blum found, among college respondents, that of the 19% who said they had used marihuana, only 1% reported getting into fights while under the influence of the drug. This was in marked contrast to the statements about alcohol. About 94% of the total sample had tried alcohol, and 8% of these reported fights after drinking.

In the United States, we have had far fewer studies devoted to cannabis use among members of lower socio-economic groups and members of minorities than studies of marihuana usage on college campuses. One of these studies, however, The World of Youthful Drug Use, by Professor Herbert Blumer and his associates of the University of California, is a very comprehensive examination of the relationship between drug use and life style in general of members of deprived groups. This study indicates that although examples of violent crime, delinquency and arrests are far more common among deprived Mexican-Americans and Negroes than among college students, marihuana is no more likely to be associated with aggressive acts in this population than it is in the college population.

The Blumer study found that for the most part the population studied could be divided into two major culture groups—the "rowdy" and the "cool." The member of the rowdy group may be characterized as "aggressive, boisterous, wild and undisciplined. He is disposed toward fighting, seizes on any drug, but prefers alcohoT, and is ready to engage in the more serious and violent forms of delinquent behavior." The rowdies use marihuana, as do most other youths in the ghetto, but their use seems to be considerably less than average in this population. It would seem that the so-called calming effects of marihuana do not fit in with their personalities or their preferred life styles and they turn to other drugs.

The "cool" culture, according to Blumer, means "being unruffled in critical situations, keeping one's head, acting wisely, showing calm courage, controlling one's voice and behavior, being smart and not provoking trouble, but being able to handle oneself calmly in troublesome situations." A considerable number of youngsters make their way from the rowdy group to the ranks of the cools, and Blumer reports that "the passage from the rowdy type to a cool and mellow youngster, as it relates to the use of drugs, involved chiefly a shift to the smoking of marihuana." The young informants themselves believed that marihuana both produces and symbolizes a mellow mode of conduct that is opposed to that associated with rowdy behavior.

One of the most meaningful, if not the most meaningful ways of assessing the contribution of cannabis to aggressive behavior, and to crime and violence, is through a comparison with alcohol. The latter provides an established baseline through reliable statistics, as well as through everyday experience. Authors throughout the world when comparing the properties of alcohol and cannabis almost invariably conclude that the former is much more likely to be associated with violence.

In summary, and on balance, it would seem that cannabis use is a relatively minor contributor to major crimes and violence in any country in the world in which it is used.

1. Ball, John C., Chambers, C. D. & Ball, J.M. The association of marihuana smoking with opiate addiction in the United States. Journal of Criminal Law, Criminology and Police Science, 59 :172-182, June 1968.
2. Bogg, Richard, et al. Drugs and Michigan high school students. Report to House Special Committee on Narcotics, Michigan House of Representatives, Lansing, Michigan, 1969.
3. Blum, Richard. Mind altering drugs and dangerous behavior. In: President's Commission on Law Enforcement and Administration of Justice. Task Force Report: Narcotics and drug abuse. Washington, D.C., US Government Printing Office, 1967.
4. Blum, Richard H., & Associates. Students and drugs. (Vol. 2) San Francisco, :rossey-Bass, 1969.
5. Blumer, H. Add Center Project: The world of youthful drug use. Final report, School of Criminology, University of California, 1967, p. 26.
6. Cannabis. Report by the Advisory Committee on Drug Dependence. London, Her Majesty's Stationary Office, 1968. 79 p. (Also known as Wootton Committee Report)
7. Chapple, P. A. L. Cannabis-A study of eighty takers. British Journal of the Addictions, 61 :267-282, 1966.
8. Chopra, G. S. Man and marihuana. International Journal of the Addictions, 4 :215, June 1969.
9. Chein, Isador, Gerard, D., Lee, R. L., Rosenfeld, E., & Wilner, D. M. The road to H. New York, Basic Books, 1964.
10. Crompton, Evelyn (discussant). The marihuana problem. CLA. Interdepartmental Conference. Brill, Norman Q., moderator, Annals of Internal Medicine, 78:449-465, September 1970.
11. Goode, Erich. The marihuana smokers. New York, Basic Books, 1970.
12. Grupp, Stanley. Final summary report. NIMH grants 14157 & 17196. Marihuana and emergent drug use patterns. Ill. State Univ, Normal, Ill. December 1970.
13. Interim report of the Commission of Inquiry into the Non-medical Use of Drugs. (Berger Bldg., Metcalf Street, Ottawa, Canada ) Ottawa, Queen's Printer for Canada, 1970. (Also known as the LeDain Report)
14. Marijuana. Report of the Indian Hemp Drugs Commission 1893-1894, Silver Spring, Md., The Thomas Jefferson Press, 1969. (Introduction & Glossary by John Kaplan) Reprinted, original published in 1894.
15. McGlothlin, William, Arnold, D. 0., & Rowan, P. K. Marihuana use among adults, Psychiatry, (in press).
16. Mizner, George, Barter, J. T., & Werme, P. Patterns of drug use among college students. A preliminary report. American Journal of Psychiatry, 127 :55-64, July 1970.
17. Pretoria Mental Hospital, Report on an investigation conducted by the Medical Staff. Mental symptoms associated with the Smoking of dagga. South African Medical Journal, 12:85-88, 1938.
18. Robins, Lee, Darvish, 11., & Murphy, G. E. The long-term outcome for adoles.!ent drug users : A follow-up study of 76 users and 146 non-users. In: Zubin & Freedman, eds. Psychopathology of adolescence. Grune & Stratton, (in press).
19. Roland, J. L., & Teete, M. Le cannabisme an Maroc. Maroc-Medical, No. 387 :694-703, June 1958. ( Same article under the name Benabud, A.) Psychopathological aspects of the cannabis situation in Morocco, statistical data for 1956. UN Bulletin on Narcotics, 9 (4) :1-16, 1957.
20. Smith, Gene M. NIMH grant 19199. Drugs and personality. Massachusetts General Hospital, Boston, Mass.