Until now, our discussion has been focused on particular substances identifiable either as a particular plant or a particular chemical. In the following two chapters we deal with classes of substances—the classes unsatisfactorily defined in terms of probable pharmacological effects and conventionally called stimulants and hallucinogens. Within these classes particular substances will be identified and a brief his-torical commentary offered. More extensive histories will be found in Lewin (reissue, 1964) and de Ropp (1957).

NATURAL STIMULANTS

Among the naturally occurring stimulants that we discuss (either plants ingested directly or products derived from plants and processed for consumption without elaborate chemical preparation) are coffee, tea, betel, kola nut, kava, and khat. We also classify coca as a stimulant although it has analgesic properties.

Tea. Tea was first known in China, according to legend, about 2700 B.C. but verifiably only in A.D. 350. Its cultivation was encouraged by Buddhist priests, according to Ukers (1965 ), in order to combat wine intemperance in China. Tea taxation began in 780 as cultivation spread. Diffusion outside of Asia did not occur until the age of exploration and colonial commerce. The Dutch brought the first tea to Europe in 1610; the first English advertisement for tea appeared in 1658. Claims for its efficacy were in terms of health and mood. The English maintained monopolistic control over its Indian production (when it was indigenous) for several hundred years (1600-1858)—a factor in the American Revolution since the Tea Act of 1773 was fol-lowed by the Boston Tea Party. According to Ukers, Americans shifted from tea to coffee following this period of protest and lack of supply during the Revolutionary War. We see that political sentiment, taxa-tion, and, ultimately, availability influenced that shift. Americans now, according to Ukers, drink twenty-five times as much coffee as tea. In England the trend was the reverse; the English, beginning as coffee drinkers, shifted to tea as a consequence of the advertisement and sub-sequent production and availability provided by the East India Com-pany. In part, English use also copied the practices of its leaders. Queen Catherine had begun tea drinking by the 1660's, and the Duchess of Bedford introduced the afternoon tea to counteract her "sinking feel-ing"—a testimonial to tea's stimulating effects. Tea drinking as a social ritual without magical overtones is still to be found in the English tea ceremonial and in the more elaborate Japanese tea ceremony.

Coffee. Coffee was probably indigenous to Abyssinia but was first placed under cultivation in Arabia in the 1300's (Wilson, 1965). It was initially employed, according to Wilson, during religious cere-monials (by dervishes in particular, says Lewin, 1964 )—a practice resisted by the conservative priesthood, who argued that it was intoxi-cating and therefore religiously prohibited by the Koran. The use of coffee together with khat developed in the Arab world, the belief being that the two had a mutually enhancing (potentiating) effect. Both sub-stances became disapproved, especially as the coffee house itself de-veloped. Throughout the Arab Near East, these coffee centers became institutionalized as places where men with leisure time congregated. In urban areas these centers became places not only for political dis-cussion but, in the eyes of religious and political authorities, places in which rebellion and opposition were fomented (El Mahi, 1962a, 1962b)1. Thus, both coffee-house frequenters and coffee-house owners became subject to criminal penalties, including death. In spite of prohibition of an extreme sort, coffee drinking spread in the Arab world. (See also Lewin, reissue 1964.)"

Introduced in Europe in the 1500's, coffee was claimed to have medical and religious virtues. European introduction was not without resistance, however. Lewin reports that some German princes decreed physical punishment to users; others limited use to the aristocracy while prohibiting it to middle classes and peasantry. Frederick II of Prussia instituted a high tax and also proposed that beer rather than coffee be drunk since he had been reared on beer. Medical advice too claimed dangers, but physicians were not in agreement. Lewin notes that use in France also began with the aristocrats and that the lower classes copied the upper classes in drinking it.

The coffee house became a London institution beginning in 1652 with the much-written-about establishment in St. Michael's Alley. In England the coffee house became a social center where politics, intellectual exchange, and business were transacted but the English, unlike the Arab rulers, did not view the public meetings as a threat to the realm. Advertisements appeared at the same time with daims for medical and mood-elevating properties. By the end of the 1600's, cof-fee houses had spread through Europe; in the United States in the early,1700's, they also became meeting places for men of the world. As demand increased, cultivation was expanded to Java, Ceylon, and, later, to the Americas and Hawaii. Wilson states that introduction to America was by a French naval officer who in 1723 obtained a plant from Louis XV's hothouse, where they were guarded as plants of great value.

Coca and Cocaine. Coca has been intensively cultivated in Peru since 1000 A.D., perhaps earlier ( Mortimer, 1901), and slightly cultivated over a broader region of the entire continent. Among the Incas, who grew and used it, coca was an integral part of religious ceremonies. It was regarded as a sacred emblem of strength, endurance, and fertility; offerings of it were made on all important occasions. Legend indicates that its early use was confined to the court and no-bility of the Inca kingdom, but by the time of the Spanish conquest its use was almost universal. Aside from its religious significance, it played an important role in allaying hunger, fatigue, and cold; storehouses containing coca were placed along the roads for use by messengers and troops.

At first, after Pizarro's conquest in 1532, the conquistadores paid off their Indian slave labor with the coca plant.' However, be-ginning about 1560, both political and Catholic Church authorities set about to eradicate coca use on religious, medical, and humanistic grounds. "The plant is only idolatry and the work of the devil . . . it shortens the life of many Indians . . . they should therefore not be compelled to labour and their health and lives should be preserved" (cited in Lewin, 1964, p. 76). Nevertheless, the prohibition was to no avail and coca became a monopoly of the government and, later, of private entrepreneurs. It continued to be the currency of wages to near-slave laborers. The Indians themselves also used it as money, at least shortly after the conquest (de Cieza, 1553). The Pope (Leo XIII) himself approved after using coca "to support his ascetic retirement."

The active element, cocaine, was isolated from coca by Nei-mann in 1858. Taylor (1963) credits Gaedecke in 1855; Jones (1953) says 1859. It was soon used as a local anesthetic and Germans opened plantations and factories in Peru, an enterprise defeated by competi-tion from the Dutch, whose Java-grown coca proved superior. After its medical introduction into Europe, it was heralded by Freud in 1884 as a cure for morphinism. It was, for many morphine addicts, a very satisfactory "cure," for its use as a euphoriant expanded rapidly; ac-cording to Lewin cocainists were concentrated among physicians, writ-ers, and other well-placed persons. This would be expected since their access to physicians and to knowledge of the drug would be easier, proceeding along lines of acquaintance within a social dass. By 1886, cocaine addiction was a matter of considerable alarm in Germany, where use had occurred among lower- as well as upper-class persons. In America the famous surgeon Halsted discovered its use in nerve blocking but, in the process, himself became dependent on it. Freud ( Jones, 1953 )' was slow to assess the risk of cocainism, at first blaming the hypodermic injection method which he in 1885 had recommended (his own professor, Scholz, having perfected the syringe).

The use of cocaine continued to spread; the initial pattern was one in which its introduction was by and into wealthier groups. In Egypt (de Monfried, 1930), it was preferred by the upper class over the unfashionable hashish. In the United States it was introduced into popular life by means of conunercial folk medicine. Dr. Pemberton's "French Wine of Coca, the Ideal Tonic" was offered in Georgia with the opening of the first soda fountain in a drugstore as such (Wilson, 1959)—an institution which quickly became part of American life. Coca as an ingredient in home remedies and in soft drinks developed until early in the twentieth century when the Pure Food and Drug Laws were passed (1906). In India it was introduced in 1880 and spread along main routes of commerce from one urban center to the next (Chopra, 1935 ). Since it is chewed as a quid, its use spread pri-marily among persons already accustomed to chewing psychoactive substances; in India these are the betel chewers.

We have few accurate data on its use in advanced societies at this time. There are reports (Bewley, 1966) of an increase in cocaine consumption among English young people interested in illicit-exotic drugs; there it is obtained by prescription and then redistributed among social acquaintances. Heroin users enjoy its employment in sequence with heroin; other users prefer cocaine for itself. Considering the po-tentials of the drug for producing euphoria (and later irritability, ex-citement, and delusional states), it is quite likely that the drug-oriented young people in Western countries will show an interest in cocaine, and since many are now familiar with hypodermic injection methods, some will begin to use the substance. We do not regard this as a happy prospect. In South America, where among Indians coca and not co-caine is employed, use has remained extensive among the high Andean folk in Bolivia, Peru, and Colombia--especially among males. In Bo-livia miners are still paid in coca leaf (Sotiroff, 1965). Given the hunger, cold, and pain of Alti Plano life, given the awful taste of frozen potatoes, which are the dietary mainstay, given, in high alti-tudes, the fatigue of workers whose average age at death is between thirty and thirty-five, it is not surprising that a feeling-suppressant, analgesic, and stimulating drug is required. Coca is not sufficient as a mood alterer; consequently, the Indians also use alcohol when they can afford it. When Indians leave the Alti Plano to venture to the lowland cities, Sotiroff reports that their coca chewing is reduced dramatically. Considering the reported capacity for interrupting the practice and the ugliness of upland life, it is understandable why some argue that coca is in no sense a dangerous drug. Others (for example, Granier-Doyeux, 1964, including those who have proposed programs for the suppres-sion of coca use, have considered it addicting and have attributed to the drug some of the worse features of Indian life. Similarly, some (among them Bejarano, 1961) of those critical of coca use have emphasized it as a necessary and, subsequently, an undesirable element in the ex-ploitation of Indian labor.

Kava. This substance, Piper methysticum, appears at one time to have been widely consumed in Oceania. It was used ritually in similar ways throughout Polynesia (Lester, 1941, 1942) wherever available. There is reason to believe that migrating groups used to kava drinking continued rituals focused on the drug even when their migra-tions carried them to places where the plant did not grow. In Fiji kava drinking was restricted to men of the priestly or ruling class. Observa-tions in 1750 showed it to be a religious ceremonial of great impor-tance; however, in 1829, a warrior chief, Ratu Tanoa, killed the last of the Fiji priests and, having thus obtained rather than ascribed status (to use the jargon), he desired to keep the ritual while eliminating its religious symbolism, which reflected to the glory of the priests. He turned it into a political ceremony to honor the head of the state, him-self, rather than the priest-god. Its drinking spread to other ritual po-litical occasions, so that installation ceremonies for all chiefs came to include kava drinking. Indeed, without such a proper installation, islanders did not acknowledge a chief—a fact which suggests that the transfer of the ritual from religious to political realms did not eliminate the interpersonal style of relationship between follower and leader, re-gardless of whether the leader was priest or chief. Ratu Tanoa, a clever man, had no doubt anticipated that ritual, awe, and magic would remain even if objects of authority shifted. By the late 1930's, women had come to drink kava, a practice which suggests seculariza-tion coincident with European occupation and a change in Fiji life styles.

Lewin notes that in other islands its use was individual as well as ceremonial, although primary employment was magical-medical. The kava plantation itself was consecrated in part to the dangerous gods, a part to the gods of sleep, and a part to the family using the substance. By Lewin's time the portion of the gods had been, in most islands, discarded. Festival use continued as did use on sociopolitical occasions, in entertaining guests, and in medical care. In some places, Lewin says that it was consumed as a daily beverage. Kava drinking eventually began among European settlers although it was cla,ss-linked; at first it was more respectable to abstain since only "inferior whites" drank it. (This brings to mind the tobacco edicts in England enjoining one against acting like a savage.) Interisland diversity was observable in its use by some along with singing, elsewhere not; in some places ceremonial use was abandoned and private use only remained; else-where, rituals continued; in some islands (Samoa) women as well as men participated, elsewhere not. For the most part, missionaries op-posed kava drinking, the Presbyterians more than Anglicans. When alcohol was available, kava drinking tended to decline. Whether or not the resulting individual disorder and cultural disruption can be ascribed wholly to alcohol or, as is more likely, to the general response to the West—which brought disease, technology, Christianity, clothing, co-lonialism, and other blessings--is not certain.

A welcome collection of articles on kava has appeared recently ( Efron, Holmstedt, and Kline, 1967)1. Holme,s (in Efron) describes the function of kava in Samoa. In earlier days warriors consumed it prior to battle; today, as well as in the past, its use is related to reli-gious, social, and political practices. Some healing properties have also been ascribed to the drug. Holmes suggests that kava drinking fits into the Polynesian veneration for village and social organization; kava etiquette dramatizes the system of rank and prestige. Quite possibly such traditions have stabilized the culture and aided it in resisting Western impact. Gajdusek (in Efron et al.). describes the use of kava on an island in the New Hebrides, an island where it had not been usect before. Elsewhere in these islands, kava drinking has been asso-ciated with the cargo-cult response to wartime technology and, sym-bolically, as part of a resistance campaign against missionary dictates —some directed against kava itself. The drinking that Gajdusek de-scribes on this particular island is associated with dannishness and a withdrawal from outside contacts, including mission work or local gov-ernment. Nevertheless, these islanders continue to attend church and do not use kava as a direct protest. Without ceremony and informally, adult males use it each evening; females do not employ it. Use does not seem to enhance sociability, but rather it is taken in private houses in such a way that individuals can achieve solitary stupor. Ford's descrip-tion (in Efron et al.) emphasizes how use does differ even on islands dose together. He notes that in Melanesia it may be given as a liba-tion to the gods but not drunk by islanders. Ford's Fiji observations record its earlier religious importance, which, as Lester found, had shifted to a political employment. He describes contemporary use as highly integrated with other activities; the drug itself is pleasant, but integrated with dancing, feasting, gift giving, and social ceremonials—marriage, birth, death, and hospitality—it enhances social activities and interpersonal ties, providing symbolic as well as social and—perhaps secondarily only—mind-altering gratifications. Ford observes that the preparation of kava, by chewing the root, is widely found in Asia as a way of producing fermented rice, maize, or cassava. He further notes that premastication of food by mothers for infants is so widespread that any culture might have discovered a fermented beverage by general-izing the technique. In any event, kava preparation gives further evi-dence of the importance of generalization on techniques of preparation and use, by means of which a variety of psychoactive substances come to be discovered and employed in diverse cultures. Kava use is also a good example of how, within the same culture area, rather considerable differences can exist in the styles and significance of use of one drug—differences not attributable on the basis of present evidence to gr'oss institutional, ethnic, or socioeconomic variations.

Betel. The areca nut, or betel, and the betel leaf, which is chewed as a quid, are given earliest notice, according to Lewin, by Theophrastus in 340 B.c. Use was widespread in Persia by 600 A.D. for, by that time, over 30,000 betel-selling shops were described by the historian Ferishta (cited by Lewin) in one town. Indians by the tenth century used it as a "national custom" and it is assumed that Arabian travelers, so important for drug diffusion during medieval times, brought it to their countries and to Africa from India. Contemporary use extends from points on the west coast of Africa through India to Southeast Asia and parts of Oceania. It is a commercial product used by men and women but it may be turned to particular interests; for example, Lewin says that Burmese monks used it to inspire self-reflec-tion. A mild substance ordinarily producing a pleasant sensation in the mouth (for those used to it) as well as stimulation, it is nevertheless said to be the focus of compulsive use; Lewin is of the opinion that its use is helpful dige,stively in Far Eastern diet.

Our observations indicate that mixing several psychoactive ma-terials together is a world-wide practice, as is taking such different substances in one or another sequence. In the case of betel, in Thailand it is chewed with Mitragyna speciosa, which according to Schultes (in Efron et al., 1967 ) has narcotic properties. Ford (also in Efron et al.) calls attention to the similarity between kava and betel in terms of effects—betel being chewed by people west of kava-drinking regions. Betel chewing can also be sodal, for sharing the mixture, Ford says, is important in establishing friendships, in courtship, and in marriage. Far less involved with ceremony and etiquette than kava, betel use, nevertheless, is a social as well as an individual activity.

Khat. In Ethiopia and East Africa, khat was eaten before 1200 A.D. but initial dates of its use are unknown (El Mahi, 1962a). Lewin gives a date of 1332 for its first mention in Ethiopia. Its eating was and is an individual rather than a ritual activity, although it was favored by mystics and, early, by intellectuals. Khat has also been employed in folk medicine; khat spittle, for example, was placed on the female genitalia to assuage labor pain. Ascetics used it as an aid in austerity. El Mahi says its use as a social facilitator is valued to pro-mote good feeling and exchange in social intercourse. As so often oc-curs with drugs, the khat user may employ other substances either in sequence or simultaneously—particularly coffee and tobacco and, per-haps, hashish. Opposition to khat use has been based on religious grounds, some Moslems contending it is an intoxicant and therefore forbidden; on pragmatic grounds it has been opposed since some chronic users display irritability and depression; it has been opposed on rnedical grounds—by Lewin, for example—because of cardiac dis-turbance, loss of appetite, loss of sexual interest, and other distress when it has been used excessively. On other grounds it is argued that khat cultivation occurs instead of much-needed food cultivation in the agri-culturally unproductive Arab areas, that its leisure enjoyment displaces time that might be spent in work, and that poor individuals spend money on khat that would be better spent on food and self-care. Re-cently there have been governmental expressions of opposition to khat reflecting these arguments.

SYNTHETIC STIMULANTS

Synthetic stimulants, of which the amphetamines are the most important in terms of nonmedical use, are a twentieth-century product and thus without a history in the conventional sense. Nevertheless, their use is so widespread and such an interesting epidemiological phenom-enon that the pharmaceutical class should not be ignored. Since they were initially employed by physicians for treatment of depression, fa-tigue, and overweight, a market in proprietary remedie,s soon devel-oped, especially for inhalers and other anti-allergy devices. The euphoriant capability was soon noted and benzedrine-containing inhalers came to be used by young people in the United States in the late 1930's without any self-medicating intent. Actual self-medication may have occurred in the sense that, according to some reports, amphetamines actually suppress certain kinds of agitated, juvenile, "psychopathic" behavior (Eisenberg, 1963; Pasamanick, 1951). State laws followed prohibiting benzedrine in over-the-counter remedies.

A related development occurred in Sweden following the intro-duction into medical practice of phenacetin, an analgesic with stimu-lating properties, in 1918 (Grimlund, 1963). First used to reduce muscle spasms and initially available without prescription, phenacetin was used on a daily basis by workers in several Swedish towns to in-crease work output, relieve headache, and so on. Near-ritual use de-veloped morning and evening and, by the time of the study in the 1950's, considerable overdose use was widespread in the various worker groups. Inquiries revealed that use had begun either in response to social suggestion when no discomfort was present or was self-ini6ted when pains occurred. Continued use was attributed to the desire to maintain high work pace and because a habit had presumably set in. Because of the serious renal damage it caused, insuring health authori-ties placed the drug under prescription control; workers then substi-tuted a new and less harmful (to kidney function) over-the-counter preparation. Retrospective analysis of the reasons for the popularity of the drug suggests that rapid technological change was a stress for workers who felt more was required of them; the medicine stimulated them and, psychologically, made them feel more secure. Workers who were satisfied with themselves and their jobs did not take phenacetin; those who were anxious about their work, who were afraid of being fired, or who had poor interpersonal relations did use it.

A later Swedish increase in nonmedical stimulant use is de-scribed by Bejerot (1966). Beginning with oral amphetamine con-sumption by Bohemian artists, writers, and actors in Stockholm in the 1940's, it spread downward in terms of status so that asocial and crim-inal groups adopted it by the 1950's. In 1958, an increased illicit sup-ply, brought in from Spain, allowed increasing nonmedical use, at which time other urban centers became involved and younger people became interested. One out of ten persons arrested in Stockholm in 1965 was taking phenmetrazine intravenously, concentration of use being in the twenty-to-thirty age group and among males; a few were also alcoholics. Important in each case was that an experienced user had taught a novitiate the method of injection, drug preparation, and, presumably, the source of supply. Beyond delinquents, rootless young-sters have become involved, as well as an increasing number of females (our inference from the data Y.

Bejerot comments that the syringe itself is an object of consid-erable interest to users; to employ it is a status device, but beyond that there is a ritualistic preoccupation. One is reminded of the preoccupa-tion with the needle on the part of "dope fiends" in the United States —a feature suggestive of the independent importance of the means of injection regardless of what is injected. One may interpret this either on psychoanalytic grounds by proposing a considerable mutilative or sexual significance to injection or on the grounds of a conditioning process whereby the instrument leading to reward (the drug effect) takes on reward value itself. In either case, the correspondence be-tween oral satisfactions derived from smoking and preoccupation with the hypodermic apparatus and act is not to be overlooked. Given a commitment to a method, the substitution of drugs with it takes on more than simple replacement function, becoming a part of "play" or a compulsive focus on the method of administration itself. If such is the case, then further substitution of drugs—once the intravenous tech-nique has been learned—is to be expected in any population in which injection has taken on importance. Such a phenomenon is visible in hippie groups' substitution of methedrine for DMT, LSD for methe-drine, and who-knows-what as a next step.

At about the same time that the Swedish were experiencing the spread of amphetamine use, so were the Japanese ( Masaki, 1956).. Use was attributed to availability after the war of large military sup-plies of amphetamines and to marked changes in social life following defeat in war and democratization of government. Young people, in fact, began to use amphetamines in such numbers that a survey in one city in the early 1950's showed 5 per cent of those sixteen to twenty-five had used them; among these nonmedical users, about one fourth of the group was considered dependent on the drugs or suffering ill effects. By 1954, over half a million users were estimated, with half suffering dependency; a later report suggested one and a half million users, almost all of whom were young people. No users over the age of forty were reported. There was a particularly high concentration of use among delinquents; one third of one sample of reformatory inmates had experience with the drug. More recent reports (Ministry of Health and Welfare, Japan, 1964)' show use to be high among show-business people, artists, and waitresses, as well as among wilder youngsters. Lambo (1965) reports that in Nigeria nonmedical amphetamine use is increasing among students (urbanized Western-trained population)1 along with an increase in the use of barbiturates, alcohol, and can-nabis. He attributes such social use to migration and subsequent cul-tural instability as newcomers under stress try to adapt to city life. In contrast, in India, where widespread wake-amine experience among wealthier urban young people is also encountered (Banerjee, 1963Y, use of amphetamines is restricted to combat fatigue for studying and work. (These same differences by setting, in the intent and associated frequency and pattern of amphetamine use, are to be seen between different colleges in student drug-use data reported in the companion volume.)

England has also been experiencing an increase in nonmedical and disapproved amphetamine use among young people. Bewley (1966) describes how initial postwar use was of nasal-inhaler conté`nts. Later, pills and tablets were taken, especially in combination with barbiturates ("purple hearts"). Localized in Soho, a swinging recrea-tional area of London, the drugs were stolen and resold in cafes and bars. Scott and Willcox (1965) indicate that most use was occasional and festive without delinquent involvement; chronic users were young-sters with personality disorders who came from unfavorable family backgrounds. In response to public concern generated in part by news-papers, a Drug Misuse Act was passed in 1964, making it an offense to possess amphetamines without medical authority. However, medical prescription hardly guarantees limited use, for a study by Kiloh and Brandon (1962). shows that 500 persons in an English town of 250,000 had become dependent on amphetamines in consequence of medical prescription. Most of these were middle-aged women. An extrapolated estimate gives a rate of 1/1000 or 2/1000 in England for such iatro-genic dependency. As for illicit use, Bewley estimates that it, too, is about 1/1000 to 2/1000. Further data on risks and sources of the drug are to be found in Kalant (1966)s.

The pattern in the United States appears quite similar to that in England, Japan, and Sweden, although adequate data are lacldng. Our own pilot study of a normal population ( Chapter Eleven)' and the student data in the companion book show that quite a number of younger citizens have had experience with illicitly obtained ampheta-mines. Production figures for the United States for 1962 (Blum and Funkhouser-Balbaky, 1965) show four and a half billion tablets pro-duced, or twenty-five tablets per citizen. The Food and Drug Admin-istration estimates indicate half of these were consumed without a medical prescription. Popular reports and the few available studies suggest that unsanctioned use is concentrated among show-business and conununication-media people, delinquents, drug-experimenting high school and college youth, rootless hippies, and probably a little-known sample of females originally receiving the drug from physicians. Al-though social and psychological factors must play a partial role in ac-counting for amphetamine dependency, the self-medicating aspects—as in treating depression—must not be overlooked, nor should the fact that continued ingestion by itself can lead to a habit which, in the case of many drugs, is reinforced by physiological as well as psychological dis-tress upon withdrawal.

SUMMARY

None of the natural stimulants has been shown to be damaging to the majority of the population of users, although, as with any psychoactive drug, heavy ingestion can lead to distress; even so, strictures against use have been imposed either during the period of introduction —as group codes form within a society where the substance is used— or when a new authority has been imposed on an existing culture. An example of the first is the reaction against coffee by political leaders when it was introduced in the Moslem world and Germany. An example of the second is the anticoffee morality of such religious groups as Mormons or Adventists. An example of the third kind of opposition is found in missionary disapproval of kava drinking in Polynesia or in Spanish edicts against coca in Peru. Sociopolitical perspectives, economic conditions, religious and moral values regarding stimulation and pleasure, and snobbery based on racial, cultural, or status features can all influence views of whether a drug is good, bad, or indifferent.

Ordinarily, natural stimulants have been introduced into a society by conventional routes of commerce; the rapid expansion of commerce and associated readiness to receive new goods have occurred about the same time—in the 1600's and 1700's in the Western world
—at which time acceptance of coffee, tea, cocoa, and tobacco came into use. Popular acceptance is facilitated when that which is new and rare is first tried or owned by those of wealth and high status. Gen-erally, people who can afford a very new product are in touch with travelers and merchants and are, perhaps, less bound by convention. They in turn are copied by people lower on the prestige ladder. High-prestige people—whether bishops, kings, artists, or intellectuals—are also in a good position to advertise a product. In Western countries initial acceptance has been followed by rapid commercial exploitation. As with any international commerce, the subsequent history of drug availability and price has been affected by political events.

Not all stimulants are accepted. Coca never became popular in Europe, perhaps because of initial Spanish disapproval and its reputation as an aid in exploiting Indian labor, perhaps because of bulk and the graceless quid chewing and subsequent saliva-dripping consequence, and quite possibly because its pharmaceutical effects were—and are—unnecessary for the ordinary Westerner.

In regard to the natural stimulants, two different historical patterns of use suggest themselves. One shows development of Ifse in advanced societies (China, India, Europe) with no real evidence for ceremonial practices, either religious or medical, except as incidental to popular noninstitutionalized use. The use of tea or cocaine in medi-cine, of tea by priests or in aesthetic social rituals, or khat or coffee by dervishes is as such a secondary ritual. Tea, coffee, cocaine, betel, khat—as well as cocoa and kola nut, maté, and so on—are in the category of popular or casual drugs. Coca and kava are different, for originally in native cultures their use was only in association with magico-religious practices conducted by authorities. These substances were also status symbols in the sense that authorities controlled access and employment. With both drugs, as societies changed diffusion oc-curred, so that use became more popular and uncontrolled and no longer ritual—that is, the process of secularization took place. It is interesting that conquering colonials—whether represented by mis-sionaries or conquistadores--opposed these drugs. We wonder whether the opposition was as symbolic as the use. May not opposition to a drug practice occur simply because the drug is seen as expressive of an older way of life and as a symbol that vests power in the political-religious institutions which are disapproved? In both of the above in-stances, we must consider that there was no continuing opposition to drugs per se; missionaries were tolerant (perhaps we should say they looked the other way) of the potent drug alcohol when it was introduced in Polynesia, where they fought the milder kava. The Spanish opposed coca chewing until they realized not only that it could not be eliminated under conditions of life as they were—and are--in the Alti Plano, but that coca chewing could be of use to them in ways com-patible with their own colonial institutions, which were designed to keep laborers at work in the mines and fields. What we are suggesting is that colonial opposition was itself symbolic, since unified, "occupy-ing-power" opposition to a mild stimulant occurred only—as far as we can see—when the stimulant represented ceremonials integral to the native culture's religious and political authority, rather than when the stimulant was much more widely used but not in ways sacred to that local authority. Insofar as that opposition did destroy remaining institutions of native authority, it was, of course, functional as well. One sees something of the same thing in the Moslem mullah-sultan decrees against coffee; there the drug was—according to El Mahi (1962a) —a convenient focus when the attack was actually against those groups with feared political potential whose members drank coffee. Lewin disagrees and suggests that opposition was merely based on misinformation which indicated that coffee was intmdcating. It need not be an either/or situation; quite likely, misinformation is nec-essary to justify an attack which also has latent—or at least unstated—sociopolitical implications. It is of interest that in each instance the attack -finally failed; coffee use expanded, while coca and kava use continued. We stress that much better data are needed about all of the hazy sociopolitical aspects of drug use.

As far as the synthetic stimulants are concerned—and cocaine as a manufactured derivative is functionally one of these in social if not pharmacological perspective—cocaine was isolated by a medical scientist and within a few short years was prodaimed medically effi-cacious as a mood elevator, painkiller, local anesthetic, and cure for morphinism. Within a short time after its medical use began, some people commenced to try it on themselves without medical super-vision. At first, these were physicians, men with access to supplies; later, they were intellectuals and professionals who knew physicians or had other access. Somewhat later, public supplies appeared and use was taken up by criminal groups. During this same short period, the dis-covery of cocaine dependency and toxicity was made. Public knowl-edge of that discovery probably played some part in inhibiting further spread of cocaine use; professional application of that knowledge in limiting distribution of it probably played a larger role. Nevertheless, some illicit popular use of cocaine continues to this day.

'The popular use of the amphetamines is a different story; widespread use has arisen subsequent to widespread over-the-counter or by-prescription sales. Prodigious quantities have been manufactured. "Epidemics" of use center among the fifteen-to-thirty age group in Japan, Sweden, England, and the United States--four of the most technically advanced nations. There is no evidence that use itself—whether by entertainers, drivers, studying students, partying youth, or delinquents--leads to ill effects; some who take amphetamines in excessive doses do suffer toxic reactions, while others taking them on a chronic basis show dependency. Current limited evidence suggests that excessive and chronic use is increasing and that among drug-oriented groups intravenous injection has replaced oral administration. With that, new public-health problems arise (such as hepatitis and ab-scesses), along with presumption that methedrine users (the drug mainly so employed ) will also experiment with injection of other drugs which can further complicate their health and adjustment to life,Fas-cination with the needle, the up-down drug cycle ( heroin-cocaine-heroin, amphetamine-barbiturate-amphetamine, LSD-thorazine-LSD, and so on), and the cultural-pharmacological significance of being "high" for young people are facets of amphetamine use which merit much attention.

1 The practice of paying laborers with drugs in lieu of cash also occurs in Guatemala, where alcohol was used to pay Indian laborers (Bunzel, 1940); in Scotland, where bottlers paid laborers in spirits (Phillipson, 1964); in Egypt, where they were paid in hashish, and in Ethiopia, where they were paid in khat.

2 We have not prepared a separate section on barbiturates. Their his-tory is modem, their use widespread, their ill effects well documented. Their epidemiology has yet to be written. An interested reader is referred to Fort (1964b), Brooke and Glatt (1964), and Blum (1967c).