In providing an international view of the complex of mind-altering drugs and their abuse, it is important to avoid the ethnocentrism, emotionalism, semantic confusion, and propaganda that can easily dominate such discussions. For example, one man's beverage is another man's drug, one country's drug is another country's medication, and one agency's subsidized crop is another bureau's focus for criminal law enforcement. Further confusion can arise when the word "use" (one-time, occasional, frequent, or daily) of a drug is confused with "abuse," "dependency," or "addiction." Even one-time use of a disapproved or legally prohibited drug is frequently equated by society with addiction, criminality, sexual deviation, and insanity, whereas even regular and excessive use of a drug (such as alcohol in most societies) that is permitted and encouraged by the scientific and political Establishment is equated with ordinary use. Unfortunately, subtleties such as the dose, purity, and mode of administration of a drug, as well as the elapsed time since taking it and the concurrent use of other drugs, are conveniently glossed over in the usual discussions of this subject.

Because we are not dealing here with all biologically active drugs or substances but only with those having direct effects on consciousness (the "mind"), it is necessary to make explicit that there are no uniform, consistent effects, and, thus, none of the mind-altering (psychoactive) drugs is inherently harmless, vicious, or magical in its properties. What we often attribute solely to the drug's physical or physiological properties and loosely refer to as the drug effect is a complex interaction among these varied factors: its pharmacological properties; the personality, character structure, expectations, and attitudes of the individual taking the drug; and the sociocultural setting or context, including not only the broader social values but the subcultural ones, as well as the immediate environment. Only with this conceptual background can there be a meaningful discussion of drug "abuse," whether national or international.

Certain general principles must be enunciated for assessing or evaluating drug abuse in a given country or region. What is "abuse"? When is a "problem" really a problem as opposed to being a statutory crime, a smokescreen, or a scapegoat? In general, I would define drug "abuse" or "misuse" as ( regular, excessive) use of a drug to the extent that it is damaging to a person's social or vocational adjustment, or to his health, or is otherwise specifically detrimental to society. This seems a more meaningful and precise concept than the World Health Organization's term drug "dependency," which deals with the presumed medical and psychological effects of repeated administration of officially disapproved drugs and attempts to incorporate the old terms "habituation" ( psychological dependency) and "addiction" (physical dependency). Distorting and dominating the scientific concept of drug abuse is the reality that in all countries any use or possession of some drugs is a criminal offense, thus making by statute any detected use an "abuse."

Obviously, if one hopes for more than the usual anecdotal or self-serving statements of government agencies or diplomats, as many independent and separate criteria as possible need to be used in estimating the extent and pattern of drug abuse in various countries. Even in a society where the use of a particular drug is fully sanctioned, one cannot measure drug abuse with the same accuracy achieved in a census of population—and, indeed, in many of the underdeveloped nations, even the latter is not adequately done. Add to this the notorious unreliability of crime statistics, of "addict" statistics, and generalizations from the minority who show pathology ("sick" or "criminal") and come to public attention, and we see a few of the major defects. Thus, this assessment can only attempt to approach the ideal. In outlining what this ideal might be, we perhaps are performing an equally important task. The background of this assessment includes the historical drugs, the current religious beliefs and practices, social and legal policies, and the degree and consistency with which they are implemented, along with subcultural (youth, caste minorities, and so on) attitudes, medical and quasi-medical uses, and other local or regional factors.

Specific determinations to be imbedded within this matrix should include the following:

(1.) The amount of production and distribution for "legitimate" drugs such as alcohol (except in most Moslem countries), sedatives, and stimulants (except cocaine), local manufacturers' annual production figures, prescription or over-the-counter sales, detected illicit traffic or production, advertising and marketing studies, and number of retail outlets and their sales; for "illegal" drugs such as cannabis, opium, and LSD, the estimated areas of cultivation, police seizures (generally thought to represent at best 10 per cent of the amount being smuggled) , consumption, both gross and per capita for those over sixteen, and indigenous medical use. The world seizure figures for opiates is only 40 tons per year and for cannabis the figures (often listed in ounces to seem more impressive) are even less impressive.

(2.) Surveys of users (and sometimes abusers)—drinking practices, drug use, college drug use, and similar studies.

(3.) Estimates of use and abuse patterns made by users, distributors, police, government officials, public-health specialists, journalists, in-group members, and so forth.

(4.) Clinic, hospital, and other medical records of intoxication, toxic reactions, addiction, suicide attempts, "bad trips," deaths, and other drug-associated reasons (direct and indirect) for professional attention, treatment, or rehabilitation.

(5.) Arrest, jail, prison, and similar records involving drugs, both directly and indirectly.

(6.) Draft, military, social security, license, census, and related types of data.

(7.) Miscellaneous sources of information such as anthropological reports, intelligence information, botanical studies, accident and absenteeism figures, and social agency records.

In relating the above concepts, facts, and mind-altering drug groups to the world, we are—to leave the abstract—talking about some three and a half billion people of many highly diverse religions, races, languages, cultures, climates, and geographies. A majority of this world is immersed in a vicious cycle of disease, poverty, illiteracy, totalitarianism, and war, all of which may be conducive to drug use and all of which properly leads to drug abuse's receiving less attention and sensationalism than in the affluent or overdeveloped countries.

The most widely used and abused drug (excluding caffeine and nicotine) is alcohol. Cannabis is only a distant second in terms of use. Between a third and a half of the world's population probably use alcohol and probably in steadily increasing numbers and amounts, ranging up to 90 per cent of adults in some countries and including significant numbers of children in others. This pre-eminence of alcohol derives from its ancient history, cultural traditions, simple manufacture, enormous availability in a wide variety of forms and dosages with relative purity, generally low cost, and massive advertising-equating its use with all forms of happiness. The overall number of cannabis users is much more difficult to estimate (although its history is probably as long) because of its official illegality and more restricted distribution, but it must be in the hundreds of millions, including indigenous medical use. In the Western world, nonmedical users of narcotics are in the millions; sedative, stimulant, and tranquilizer users in the tens of millions; cocaine users in the millions; and LSD-type drug users in the millions. How many of these are abusers in the scientific sense or even in the legal sense is much more difficult to estimate even crudely, but we will at least make the attempt, region by region, in order of population.

ASIA

In this land area of some seven million square miles with approximately two billion people, the major psychoactive drugs used are alcohol, cannabis, opium, and heroin. There is also considerable use of other indigenous substances, as well as of manufactured sedative and stimulant drugs. With the exception of Japan, the entire region is underdeveloped socioeconomically, so, not unexpectedly, the typical users of what the laws refer to as "narcotics" come from the lower class, are male, and range in age from twenty to fifty. Because the laws and governmental practice reflect American values imposed either directly or through the United Nations, all users of "narcotics" are referred to and handled as addicts, although many—and in some countries most—are occasional or intermittent users, or use such substances as cannabis which are not addicting (productive of physical dependency). In many of the countries and with many of the users in most of the countries, drug use is traditional and even in the recent past was culturally sanctioned, although present laws prohibit use, except for alcohol.

Although individual or social causes and effects of drug use or abuse are difficult to determine—and sometimes difficult to separate—certain major trends are apparent. The countries where drug abuse is considered a major problem include Hong Kong, Iran, Thailand, Japan, Singapore, and South Korea with narcotics; Ceylon, Japan, and India with alcohol. In India and Pakistan there is widespread use of opium and cannabis in oral forms, frequently through licensed shops as "quasi-medical" use or as a common ingredient of indigenous medical prescriptions for a variety of disorders. Most countries of the region fail to recognize the widespread and growing use and abuse of both manufactured and home-made alcoholic beverages; and several officially deny their obvious involvement in the production and distribution of opium and heroin.

There is increasing use of heroin in Asia. As compared with the users of the traditional opium, those who use heroin do so more frequently and are, more often than in the past, addicted; and most use is by the young adult (eighteen to thirty) compared with the older-age groups with whom opium was popular.

The abruptly imposed bans (after World War II) on the traditionally accepted use of opium has been a direct cause of more people's using more dangerous drugs in greater amounts, as well as of the development of a flourishing illicit traffic with extensive corruption and criminality. Placing, or misplacing, the major emphasis on police apprehension and punishment of the user has failed in Asia as it has in America, both now and in the 1920's. There is an almost total lack of attention to the underlying socioeconomic and psychological bases of drug use; no adequate programs of rehabilitation are in operation; and data-gathering procedures are nonexistent or primitive.

With its 700 million people, China has a history of opium use dating back to the ninth century A.D., which was later actively fostered by England, France, the United States, and Japan between the eighteenth and twentieth centuries. In the 1920's, it was estimated that 25 per cent of the adult population used opium with general public support or acceptance of its use. In the mid-1930's, some ten million were said to be opium users, and, since then, not even crude figures are available except for Hong Kong. The internal and external wars, the succession of totalitarian regimes (also a factor in the rest of Asia), and the breaking off of cultural and diplomatic contacts by the United States has made it impossible to make an adequate assessment of the current situation. The reports of the few Western scientists (none of them drug experts), journalists, refugees, and agencies in Hong Kong and other adjacent areas indicate that there has been a major decrease in opium use in China and that alcoholism is a minimal problem. Reduced cultivation, governmental and peer-group (commune) pressures, and full employment are some of the factors apparently responsible for the decline. Contrary to the propaganda periodically disseminated by the American Federal Bureau of Narcotics, the unanimous view of government officials, both local and American, in neighboring countries is that the People's Republic of China is not actively involved in the narcotics traffic. Most Asian opium is grown in a contiguous four-country area: Thailand, Burma, Laos, and the Yunnan Province of China. Their total production is estimated at 1,000 tons per year. The farmers growing it are isolated mountain tribesmen for whom the opium poppy is the sole or major cash crop. The opium or the refined morphine or heroin funnels through Thailand supervised and guarded by several thousand Chinese Nationalist (Republic of China) troops, who are reported to have received financial assistance from the American Central Intelligence Agency. Thus, complex local and international socioeconomic roots of drug abuse flourish while entire societies are diverted to the "menace of the addict." Alcoholism, however, is believed to be uncommon in China because of the traditional mores which frown upon excessive drinking, public drunkenness, or drinking apart from meals.

Cannabis use, as a medicament for several diseases and as a euphorient, has been known in China since 2730 B.C. and referred to (with much the same polarities of thought as exist today) as either "liberator of sin" or "giver of delight." Again, little is known of contemporary use patterns, although it does not seem to be considered a problem even in Sinkiang Province, where past use has been best documented.

The British Colony of Hong Kong with a population of about four million (99 per cent Chinese) has an estimated 300,000 illicit narcotic users—mostly heroin addicts who often mix it with barbiturates. The nearby Portuguese Colony of Macao has an estimated 6,000 users, mostly opium; and Taiwan (Republic of China) is said to have 40,000 users, mainly of heroin and morphine.

India and Pakistan, with a joint population of some 600 million people, have a history of opium use dating back to the ninth century A.D. It was consumed by eating, drinking, or smoking by all social classes and both sexes, children as well as adults. Around the fourteenth century, it was introduced into the Hindu Ayurvedic and Moslem Unani systems of medicine. An 1893 Royal Commission report stated that its use was moderate with no evidence of harmful physical or moral effects; that its use was due to the universal tendency of mankind to take some form of drug to comfort or distract themselves; that it would be impractical and unenforceable to prohibit use or limit it to medical purposes because of the ceremonial and social uses to which it was put and its general public acceptance; and that an increastd consumption of alcohol would follow if opium were prohibited. India now legally produces about two thirds of the world's needs for medical opium.

Cannabis use has been known in India since 800 B.C. in the forms of bhang, ganja, and charas in beverage, confection, or pipe-smoking form. Since the seventh century, it has been used in Ayurvedic medicine and since the early nineteenth century in "Western" medicine for a range of complaints that include pain, insomnia, depression and other mental illness, and dysmenorrhea. The most detailed study that has yet been made of cannabis was the 1893 Report of the Indian Hemp Commission, which found no evidence of mental or moral injury or disease arising from moderate use and stated that such use produced the same effects as a moderate intake of whiskey. In contemporary India and Pakistan, there continues to be widespread indigenous medical, "quasi-medical," and illicit use of both opium and cannabis, probably more than a million users of each although the government estimate is around 200,000 each

Carstairs' (1954) study of daru (alcohol) and bhang (cannabis) use in an Indian village shows the strong partisan attitudes in two castes in favor of their intoxicant (and against the other drug). The psychological effects and associations and the different values and attitudes of the two groups are all shown to be involved in explaining the cleavage in choice.

The production and use of alcohol has a less precise but certainly a multicentury history that includes religious, dietary, medical, and entertainment uses. "Soma" was believed to have been one of the earliest fermented beverages. There are many millions of licit and illicit (since the Indian constitution properly considers alcohol in the same category as other undesirable drugs and several states [unsuccessfully] completely or partially prohibit its sale or use) consumers of alcohol. Despite religious—and sometimes legal—prohibition, alcohol is widely consumed in Pakistan. Considerable nonmedical use of barbiturates, chloral hydrate, and cocaine (500,000 users estimated in the 1930's) has also been reported.

Opium use in Iran dates back to 850 B.C., and by 1955 vhen it was prohibited, nearly 200 million people were estimated to be using it (mostly by smoking) for pleasure and treatment of various illnesses. There are now thought to be 500,000 opium users and 30,000 heroin users. Cannabis use appears to be minimal but alcohol is widespread despite the Moslem religious prohibition.

Thailand had a 200-year history of opium use prior to its banning in 1959. At present it has some 50,000 illicit narcotic users—mostly Thai but also Chinese and hill-tribes people—mostly of heroin in the cities (sometimes mixed with barbiturates) by inhalation. Cannabis, although illegal, is widely used without any apparent problems. Some amphetamine abuse and considerable alcoholism and drunk driving have become recognized in recent years. A plant (Mitragyna speciosa) known as "kratom" is also used but the exact pharmacological nature of its psychoactive effects is not yet known.

Japan has about 50,000 illegal narcotic users, mostly heroin (by injection) and 90 per cent Japanese (ten to fifteen years ago, 50 per cent were Korean and Chinese). Unlike the situation in the other Asian countries, this use seemed to be a new practice after the Second World War and, after widespread abuse of amphetamines, developed and receded. Barbiturate abuse is recognized as well as continued abuse of amphetamines and of a locally manufactured drug, Spa, which has mixed pharmacological effects. Alcoholism and drunk driving are major problems and are receiving increasing attention.

Opium was available in Ceylon through special shops until 1948 and there are now about 5,000 users, mostly Indian and Chinese. Cannabis use has a long history with about 200,000 users at present. Indigenous medical use includes use for relief of fatigue, improvement of appetite, aphrodisia, and treatment of insomnia. It is also sold as a powder which is smoked in a cigarette. As in India, alcohol use is taken seriously and, in fact, the most detailed alcohol statistics in Asia are kept in Ceylon. They show that alcohol is the most commonly used and abused mind-altering drug in the form of toddy (fermented palm-tree sap), arrack (distilled toddy), and "kasippu" (illegal arrack).

Burma has an estimated 100,000 narcotic users, mostly opium smokers in the Shan and Kachin states but also Chinese and Burmese in the cities. Cannabis is extensively used in the form of ganja, mainly by Indians but also by the Burmese. Beinsa (Mitragyna speciosa) leaves are chewed or used to make a syrup or powder which is eaten, smoked, or made into a "tea." Alcohol use is widespread and increasing.

Other Asian countries with recognized significant nonmedical use of narcotics (usually opium) include Singapore, Malaysia, Korea (heroin by injection), Laos, North and South Vietnam, and the Philippines. Indonesia, particularly in Sumatra, has extensive use of cannabis, and there are beginning problems with barbiturate, meprobamate, and amphetamine use and abuse. In Nepal there are also considerable use and production (some for export) of cannabis.

There is a theory of ethnic specificity which claims that Asians use opiates to satisfy their need for contemplation and passivity, that Africans use cannabis because of a need for fantasy and group experience, and that North Americans and Europeans use alcohol as a euphoriant because of their need for aggression, action, and extraversion.

Moving to the geographically ambiguous area of the Middle East, we find little factual information available despite the considerable involvement of several countries in the narcotics trade. Turkey is a major producer of illicit opium (as well as some for legal medical purposes) which is transported (raw or converted) through Syria to Lebanon, where underworld (Mafia) connections arrange its transshipment to Italy and France, on to the United States. Some use occurs in these countries but more widespread is the use of cannabis (usually in the concentrated form of hashish) and alcohol despite Moslem religious prohibitions and sometimes severe criminal penalties. In Saudi Arabia, Kuwait, and Yemen there is very extensive use of khat leaves, mostly grown in Ethiopia and containing an amphetamine-type stimulant. Concern has been expressed about the diversion of income and energy involved in this use.

AFRICA

In Africa there is much less diversity in terms of the pattern of drug use than in Asia. Again, the vast majority of the populations (except for the white South Africans) are in the low socioeconomic class, poor and uneducated. Both cannabis and alcohol are used widely in East, West, North, and South Africa under many different names, such as "kif" (Morocco) and "dagga" (South Africa) for cannabis. Several studies, some fairly extensive, have been published about various aspects of cannabis use in South Africa, Nigeria, Morocco, and Egypt. In general, they are designed to support the existing official government policy of prohibition of cannabis and are therefore highly selective and unscientific in their data and conclusions. To discuss two of the concepts used to indict cannabis (or other drugs officially disapproved by the establishments), its association with crime and with insanity, we see it in a context excluding alcohol, without control groups, without differentiation of substances (concentrated hashish or crude cannabis), and with a confusion of cause and effect. By labeling as "criminal" the use of a drug and arresting many of those who continue to use it, large and superficially impressive statistics can be compiled of "criminality" associated with the drug, but this is, of course, an entirely circular and statutory definition. Further, if most people are using the drug, it would follow that a large number of people arrested for actual crimes (against property or persons) would be users and their crime could be ascribed by the officials to the drug, particularly when those arrested are routinely asked (or it is suggested to them) whether they use cannabis. The second common association is with "insanity," so that any residents of the badly overcrowded and understaffed mental hospitals who give a history of cannabis use have their illness ascribed to this cause, even though in most, and perhaps all, instances they are schizophrenic or have an organic psychosis not causally related to the drug. Where actual problems exist, they appear to be caused by the sociolegal policies or by the underdeveloped socioeconomic conditions of the country. Alcohol consumption and production, legal and illegal, are heavy and growing throughout Africa, particularly in the large cities; it is associated with detribalization, loosening of family ties, industrialization, unemployment, and slums. There is a beginning awareness and documentation of abuses such as alcoholism, crime, drunk driving, job loss, liver damage, and so on. Only with the white South African has there been a special program established for alcoholism.

AUSTRALIA AND OCEANIA

In Australia and New Zealand, there is widespread consumption and advertising of alcohol with considerable tax revenue to the state ( as is also true with nicotine [cigarettes] and is the case in the other geographical areas although less in the underdeveloped nations). Alcoholism is well recognized as a problem affecting directly about 3 per cent of the population and causing much personal and financial loss to families, agencies, and businesses. Drunk driving is also receiving attention. Small narcotic, sedative, and stimulant "problems" are said to exist in several large cities. Several Pacific island peoples use such mind-altering substances as kava (Piper methysticum) without apparent problems or abuse.

SOUTH AND CENTRAL AMERICA AND CARIBBEAN

Diverse patterns of drug use occur in this (primarily) Spanish-speaking area of the world. In the combined areas of Bolivia, Peru, Colombia, and Argentina, some five million people use cocaine, predominantly poor Indians living at high Andean altitudes who have a long cultural tradition of use to relieve hunger, fatigue, and cold. The coca leaf is widely available for local use and its value as a cash crop extends to its purchase by the Coca Cola Company as a flavoring agent. Some consider the Indian use as abuse and it seems likely that it impairs individual and social development; however, it is probably secondary to the poor socioeconomic conditions and the failure of those in authority to bring about basic social reforms.

Cannabis use is widespread in Brazil ("maconha"), the West Indian islands, and Mexico (marijuana) with some considering it a problem or abuse; adequate scientific evidence is lacking to say more than it possibly involves excessive diversion of income and certainly results in interference with the lives of those imprisoned for its use. Mexico is the major producer of the tons of illicit marijuana and opium (heroin) which are exported to California and involve collusion and corruption on the part of local farmers (economically dependent on it), police, and other government officials.

A variety of other substances, including "piptadenias," snuffs such as "vilca" and "epena," "ayahuasca," "caapi," "yagé," psilocybin (Psilocybe-mexicana), and peyote are used for mind-alteration by large groups in various parts of this geographical area.

In most of the major cities there is some degree of abuse of sedatives and stimulants.

Alcohol use is extremely widespread in a great variety of local forms derived from indigenous plants and grains. Alcoholism and, to a lesser degree, drunk driving are increasingly recognized as problems, although—as would be expected—conceptualized and handled in a very different manner from "drugs." Chile has been the most active in talking about alcoholism and has an estimated 2 to 3 per cent of its people with this problem ("illness"). Two villages studied by Bunzel (1940) showed quite different ways of using alcohol. One where there was little aggression or discipline had heavy drinking from childhood but without guilt; the other where there was repression of sexual and aggressive impulses showed occasional drinking binges followed by severe guilt.

EUROPE

By far, alcoholism is the most serious problem of drug abuse in Europe and the most extensively used drug is alcohol. This is true in the East and West, in communist, socialist, and capitalist countries, and in North and South Europe. France has the biggest problem with some 10 per cent of its population alcoholic, and drunk driving as an important problem. Several liters of wine daily compose the average adult consumption; drinking is throughout the day; much drinking is by children; and there is the belief that wine is associated with virility. A fourth to a third of the economy is dependent, in fact, on the alcoholic-beverage industry. Russia, Switzerland, Finland, Norway, Denmark, Sweden, the Netherlands, and West Germany are the other countries with well-recognized alcohol-abuse problems, both alcoholism and drunk driving. It is probable that the other countries also have significant and growing problems despite official blindness or reluctance to accept the facts. In both communist and capitalist countries, large revenues accrue to their governments from the sale of alcohol (and cigarettes).

Considerable use and abuse of a wide variety of manufactured drugs, sedatives, stimulants, and tranquilizers are known to occur in most of the large cities in Western Europe, particularly barbiturates, amphetamines, and phenmetrazine (Preludin)—particularly among young people. Marijuana use is not infrequent, following this same pattern, and is most noted in Denmark, Sweden, and England (associated with West Indian and African immigrants). The intellectual, artistic, nonconformist, and alienated groups of these relatively affluent societies seem to seek out these drugs, and more recently are beginning to use LSD-25, especially in West Germany and England. Heroin or other narcotic use is relatively infrequent, as is cocaine, but both have received much attention in the mass media in England, where drastic attempts are being made to modify the traditional medical approach to this problem.

NORTH AMERICA

The alcohol pattern here is quite similar to that of Europe, with both Canada and the United States (six million alcoholics) having 3 per cent alcoholic populations and major drunk-driving problems (half the deaths and injuries on the roads are associated with alcohol consumption). Although the few laws controlling drinking are scarcely enforced, there are widespread violations, including those of laws limiting sales to individuals over the age of twenty-one. About a half of those in prisons commit their crimes in association with alcohol use; in many large cities a half of the arrests are for drunkenness; and a large proportion of divorces, loss of jobs, welfare costs, and deaths (cirrhosis, homicide, suicide) are related to alcohol. Despite this record, alcohol remains relatively uncontrolled and is massively advertised ($300 million yearly) to associate its use with youthfulness, sex, beauty, and happiness.

Narcotic addiction receives far more attention than alcohol from politicians and police, although it has always been a relatively small proportion of the total drug-abuse problem and amounts to no more than 100,000 people in the United States (one half in New York City) and a similar proportion in Canada. Most illicit addicts are Negro, Mexican, or Puerto Rican Americans from large urban slums, culturally deprived backgrounds, broken homes, and with early exposure and encouragement to use heroin (or marijuana).

Millions regularly use (mostly by physicians' prescriptions) sedatives, stimulants, and tranquilizers; abuse, physical dependency, and suicidal attempts are very extensive with these drugs. Enough barbiturates, as an example, are manufactured each year in the United States to provide thirty to forty average doses for every man, woman, and child.

Marijuana use is very extensive and increasing not only among minority groups but more among intellectuals, artists, nonconformists, and high school and college students who are alienated, dissatisfied, and rebellious. The number of users is certainly in the hundreds of thousands and involves mostly the middle class, despite—or sometimes because of—the severe and irrational criminal penalties. Little abuse is observed and the main problem is making use a crime by law. Except for the minorities (though about 250,000 Indian members of the Native American Church use peyote regularly as part of their religious ceremonies), the same subcultural groups are using LSD-25 and, less often, D.M.T. (dimethyltryptamine), mescaline (peyote), morning-glory seeds, or psilocybin. Indiscriminate use and a wave of artificially created hysteria have created more use and led to the passage of the same types of harmful and unenforceable criminal laws; as a result, promising legitimate treatment and research have been discouraged. A small but significant number of adverse reactions (bad "trips") are occurring with overblown newspaper accounts.

Glue sniffing, gasoline or solvent inhalation, and the use of nutmeg (Myristica fragrans) and miscellaneous other substances have also become popular with generally small numbers of people, usually teen-agers.

CONCLUSIONS

The abuse of mind-altering drugs is an important social and health problem in all geographical areas of the world and most countries. Alcoholism and the destructive legal-punitive approach to most other forms of drug abuse remain the two biggest problems in this field. Despite extensive laws, agencies, and institutions which have been set up to control those aspects of drug abuse perceived as problems, individual countries have only the crudest facts at their disposal. Elementary scientific principles such as probability theory, deductive and inductive reasoning, use of control groups, sampling techniques, and precise definition of terms are noticeably absent. Thus, with pseudo solutions and oversimplifications, the real problems grow worse and nonproblems are increasingly defined as problems, such as cannabis (marijuana) use.

Drug use and abuse should be considered by the countries of the world as sociological and public-health matters. Criminal sanctions should be used very selectively for clearly antisocial behavior (which, for the most part, occurs without relationship to drugs and rarely as a direct effect of a drug such as alcohol) and for the distribution and selling of drugs proven harmful. All advertising and direct encouragement of mind-altering drug use in the mass media should be banned or heavily taxed and regulated as to content.

Massive rededication of individual societies will be necessary to correct the complex sociopsychological roots of drug use and abuse, but only such emphasis on the roots has any chance of success. In the meantime, there should be simultaneous (well-funded) efforts to reduce the availability of all of these drugs; provision of outpatient rehabilitation programs for those whose health or social functioning - has been impaired by drug use; and the institution of general preventive public-health measures, such as education for youth and adults, the public and professionals.

The drug ( ged ) world serves as a barometer of human society —an indicator of underlying social illness and a warning of existing and approaching social storm. The storm is mounting.