This, chapter describes, in general terms, what is known about the relationship between the use of mind-altering (psychoactive) drugs and criminal behavior. Our definition of "crime is broad including dangerous as well as illicit conduct involved in accidents and suicide. Of necessity, we will also have to face the more general problem of the impact of drugs on behavior per se. It will be important, as well, to consider common misconceptions and to emphasize the limitations of our knowledge.

Psychopharmacologists, as well as scientists in other disciplines, have a great interest in learning what effects drugs have on human beings. Unfortunately, it is often difficult to establish what these effects are, since not only are the biochemical and neurophysiological processes involved both complex and difficult to isolate, but at the behavioral level, many determinants influence conduct aside from specific pharmacological effects. One example is the placebo effect, which is observed when a person is given an inert substance that he believes is chemically active. His response to the placebo can be remarkable—including rash, vomiting, and blood-pressure changes, on the one hand, or dramatic reductions in pain or disability, on the other. The placebo effect illustrates how other factors such as the subject's expectations and emotions, the doctor's or experimenter's instructions or expectations, and cues in the environment can all produce behavior changes1N which a naive observer might attribute to the pill itself. Even with quite powerful agents such as LSD or morphine, there can be strongly differing behavioral outcomes depending upon situational and personality factors. In addition, there are a number of drug factors, too—for example, the dosage of the drug, how it is administered, how often it is taken, the physiological state of the person at the time (nutrition, health, tolerance to drugs, possible physical dependency on drugs, and so on), and the presence of chemical antagonists or potentiating substances to counteract or enhance the specific effects. Even when attempts are made to control as many of these variables as possible, the choice of a measure for drug effects remains a challenging one. What kinds of behavior does one wish to observe over how long a period? How good are the instruments one has for making such a measure?

Given these problems in laboratory work, it is no surprise that attempts to assess the role of drugs in producing changes in behavior in real life are subject to serious limitations.

What can we say about the effects of mind-altering drugs on human beings? At the risk of error, we may offer the following statements. There are powerful agents which do affect the mind, mood, the biological cycles, the levels of energy, and the interpersonal behavior of humans. These agents are conventionally grouped into classes, those classifications representing what appear to be the most probable effects of the drugs. We can speak of intoxicants, sedatives, tranquilizers, stimulants, antidepressants, narcotics, and hallucinogens. These are already overlapping designations, since antidepressants are primarily stimulants, and tranquilizers may be classed as sedatives, as may narcotics. A particular drug such as alcohol may be classified, in addition, as a depressant or its effects may be rated as tranquilizing, sedating, or stimulating; it is also an intoxicant and its use can produce hallucinations (as in delirium tremens) . Marijuana is considered by some to be an intoxicant, by others a hallucinogen; in large doses it can be a depressant or sedative, and under the law it is called a narcotic, although medically a narcotic is usually an opium-derived drug or a synthetic opiate analog. Sometimes, euphoriants are discussed as a drug class, meaning substances producing a sense of happiness or wellbeing. For some people opiates produce euphoria, but for the majority they do not. Drugs such as heroin, tobacco, alcohol, and LSD are called euphoriants, even though it is common for people to become quite ill or upset when they take these drugs; indeed, the same person may become ill one time, happy another, and experience relatively few effects on a third occasion of use. It is also common on the same drug-taking occasion for a variety of different effects to occur; for example, with alcohol an initial lift may be followed by sickness and then sedation. These diverse effects are important because so much discussion of drugs simply assumes a highly regular and specific effect when, in fact, drug-influenced behavior is best thought of in terms of probabilities; the accuracy of these estimates of probable outcomes increases as one knows more about the dosage and circumstances of drug taking and the person who is receiving the drug. Another point must be made. The higher the dose of most mind-altering drugs, the easier it is to make predictions, for behavior becomes less and less subject to variability as toxic effects are produced; by "toxic effects" we mean the typical bad results of stupor, coma, shock, psychoses, and ultimately death, which can accompany overdoses of so many of the mind-altering substances.

When considering drug effects, we must examine the intentions of those who give the drug (if it is administered by another or given socially) and of those who take it. In examining intentions, we must also look at typical settings for drug use; these may be institutionalized in a formal way as in religious rituals, festivals, family dining, medical care, or pharmacological experiments, or settings may be more informal, having fewer festraints and consequently leading to a greater likelihood of behavior variability. Intentions and settings are strong predictors of behavior. Most of the mind-altering drugs are used with a variety of intentions and in many different settings; typically, there is both institutional and informal use. As an example, opiates are used medically in the United States to a great extent, but they are also employed—to a much lesser extent—informally (and without approval) for "kicks" or in unsanctioned self-medication to reduce psychological distress or physical pain. There are probably as many other intentions in drug use as there are individuals with interests or hopes—individuals who as children of our technologically oriented, drug-using society have learned that drugs are tools to be employed in controlling states of mind. What this means is that the same drug can be used to produce—or to try to produce—quite different effects depending upon who is using it, how, and where.

The reasons a person has for taking a drug initially are often quite different from the reasons he has for continuing its use; further, the reasons for continuing use may be different from the reasons either for stopping drug use or for being unable to stop For example an adolescent slum boy may initially take heroin partly because he has been taught the use of other illicit drugs (tobacco, alcohol, marijuana) and so has become oriented toward drug use, partly because some experienced acquaintance has heroin available and induces him to try it (appealing to curiosity, "manhood," not being ,"chicken), and partly because he is accustomed to delinquency and has no strong barriers of conscience or fear. After continuing this "social " use, the youngster may find himself teeling better, not just because of euphoria but because the drug dampens anxiety and "medicates" distress arising from his social-personal disorder. If addiction occurs—in this case physical and psychological dependency—use will continue even if the earlier happy mood has disappeared, even if increasing doses (tolerance-developing) will not produce euphoria; in fact, use now may be directed at maintaining an earlier level of adjustment or, possibly, at blotting out awareness. If use stops and painful withdrawal symptoms appear, the new motive is to continue use so as to prevent pain.

In another example, a college student may be introduced by the accident of association in a dormitory to LSD, marijuana, morning-glory seeds, and other illicit-exotic drugs, which constitute the pattern of multiple-drug interests of his "hippie" group. Originally curious, perhaps seeking religious experience or aesthetic revelations, he may continue because drug use dampens anxiety over his studies or career, helps him relax from pressure, or is symbolic of membership in a way of life that he finds pleasing. When he graduates and takes a job in the "square" world, there may be new pressures to make him conform which make him shift from the psychedelic crowd to conventional use of the social drugs alcohol and tobacco—a pattern he may continue without difficulty for the rest of his life.

A third illustration might be the working-class youngster whose Fundamentalist parents forbid use of social drugs. Personally maladjusted, he may associate in junior high with other troubled youths, from some of whom he learns to sniff gasoline, glue, paint thinner, and what-have-you. He graduates from these volatile intoxicants (if lucky, without liver damage) to the use of stimulants, such as "crystal" (rnethedrine) and perhaps barbiturates ("barbs") and cough syrups as well. At the same time, he is learning how to drink alcohol dangerously—that is, by consuming hard liquor in large amounts with his friends in secret. By the time he is thirty, he is socially misfit, on Skid Row or among its underworld neighbors, involved in petty crimes and dependent on alcohol. Since his drug use now centers on alcohol, he cannot abandon it without suffering serious physical and psychological distress; by continuing his alcoholism, he also guarantees continuing illness and a career of arrest for alcohol-related offenses (such as drunkenness and vagrancy).

In each of the foregoing cases, we can see a typical pattern of the use of a variety of mind-altering drugs in social and informal ways over time—a pattern which is shaped by associations, social circumstances, and perso*nality. Motives and consequences vary and approved drug use is accompanied by illicit use. The use of illicit drugs or the illegal behavior associated with illegal drugs may be part of a long history of delinquency, personal maladjustment, and social disadvantage, or it may be, as in the college user's case, isolated and not associated with other visible criminality.

In the foregoing illustrations several different types of "crimes" involving drug use occur. There is underage use of the otherwise approved substances tobacco and alcohol. There is disapproved use (whether or not illegal) of otherwise available materials (gasoline, cough syrups, morning-glory seeds, and so on). There is the disapproved but legal use of disapproved and legally unavailable substances (LSD—its use is not a crime in many states), and there is the illegal use of illegal substances (marijuana, heroin). There is also the use of an approved drug in ways that are illegal (disorderly conduct associated with adult alcohol use).

Our examples above failed to cite other kinds of "criminal" behavior involving drugs—for example, tax violations (bootlegging), illicit sales (a bar selling alcohol to minors), illicit traffic (importing heroin), or pharmaceutical-industry violations of federal regulations governing drug experimentation, advertising, sales, and so on. Each act might be viewed as criminal, although the actual standards of enforcement are such that one surmises most violations of drug laws or administrative codes are never made visible by identification, arrest, or prosecution. It follows that illicit-drug behavior, like most other criminality, is in large part a "dark-number" phenomenon; like the bottom of an iceberg, the biggest part remains unknown.

One aspect, then, of crimes involving drugs is those crimes that are defined by drug use itself. Here, we are dealing with the major effort of federal, state, and local law-enforcement narcotic units in identifying persons who traffic in or acquire for personal use the substances listed under the narcotic statutes—opiates, marijuana, cocaine—or under provisions of dangerous-drug laws (medically available drugs illegal to sell, acquire, or use without certification or prescription, such as amphetamines, barbiturates, tranquilizers, anesthetics, and the like) . With reference to heroin, estimates based on arrest figures for "addicts" (persons arrested for narcotic offenses) range between 100,000 and 200,000 persons.' There are no figures, and no reliable estimates, for the number of persons illicitly trafficking -In or using dangerous drugs. The presumption, based on some pilot studies of population drug use and on high school and college studies, is that many millions of Americans have had at least one-time experience in the use of illicit drugs. (We are excluding the millions of young Americans who are underage drinkers and smokers.)

A number of assumptions can be made in the enactment of criminal laws seeking to control distribution and use of mind-altering drugs. One set of assumptions accepts use by adults and seeks only to raise revenues (although perhaps a hidden premise is that such use is a luxury or a minor vice). Codes requiring taxes on tobacco and cigarettes are an illustration. Another assumption holds that drugs are dangerous to those receiving them unless professional supervision is exercised. The explicit goal of the law is the protection of the health of the citizen. Such goals are apparent in some aspects of dangerous-drug laws requiring a physician's prescription, as well as in recent, related legislation constraining production and distribution of LSD without punishing acquisition of use per se. A third assumption is that drug use produces behavior dangerous to others, so that penalties are justified not only in attempting to deter self-damaging use but also in preventing harm to others. Such an assumption has produced laws to prevent drunken driving, as well as a major emphasis in the argument for narcotic codes and dangerous-drug laws. Unlike the preceding "pragmatic" orientations, a fourth assumption, deeply rooted in Hebrew-Christian tradition, holds that certain acts are sinful regardless of consequences and that, specifically, drug use is an abuse of the flesh, an immoral act deserving of both prevention through threat of punishment and retribution should the act occur. Much of the effort against drug use, whether Prohibition efforts to prevent alcohol consumption, codes to protect the innocence of children by disallowing their drinking or smoking, or the punitive provisions of dangerous-drug and narcotic laws, may be viewed as enforcing these morals. Additional goals encountered elsewhere in the criminal law may also operate—for example, the desire to remove from public view those who act in ways offensive to public taste (drunk-and-disorderly laws), the belief in incarceration as an opportunity for penance or reflection after an offense, the catering to public demands for vengeance should morals be outraged, the possible need for recurring displays of prevailing codes which construct morality plays out of trials, and perhaps the trust that a law enacted stands as an educational lesson or that it serves as an ideal toward which citizens are encouraged to move. Underlying each of these beliefs, goals, or inferred functions is the general premise that the criminal law is a vehicle which shapes human behavior in the direction desired by the legislators and, as a corollary, that any untoward effects of the law on individuals or failures to shape behavior as desired are outweighted by the gains. A further premise is that the community has the right to intervene in what citizens do, even if what they do is a private act or one that takes place in a consenting or accepting group, which is the situation in most drug use.

We can readily see that each of these premises, explicit or implied, touches an area deeply involved in personal and social values. Turbulent emotion and strong attitudes exist regarding policies as diverse as how to raise and spend taxes, how to rear children, how to assess health, and how to view personal pleasure; they exist, too, in regard to whether one may or may not intrude in private behavior, what is the nature of sin, what should be the relation between criminal law and morality, and what are the effects of criminal laws. Given these issues, the fact of widespread and often increasing drug use (from alcohol to LSD), and the fact of widespread public concern about that drug use, it is no wonder that debates over drugs constitute a critical social issue.

There is no opportunity here to examine the premises of current or proposed laws or the social conflicts they reflect or generate. Two areas may be singled out for brief attention: one, the belief that drug use is harmful to drug users (whether these be one-time experimenters or chronic habitués) and the other, the belief that drug use leads a person to act in ways harmful to others.

Reasons for difficulty in assessing drug effects have already been discussed. Further examples illustrate problems in evaluating the damaging consequences of particular drugs. Cirrhosis of the liver is commonly associated with alcoholism. To what extent alcohol itself—in contrast to the life style which is the essence of being a down-and-out alcoholic—contributes to the disease is the question, for nutritional deficit, lack of hygiene, and other illness are also likely toylay a pathogenic role for the liver. Another illustration focuses on drug dependency. Physical dependency (tolerance, withdrawal symptoms) does occur with continuing opiate use, yet medical patients are given opiates rather than have them suffer pain. Upon release from the hospital, nearly all medical patients are able to return to a morphine-free adjustment without notable difficulty. Heroin addicts, on the other hand, can suffer excruciatingly during withdrawal and yet will return to the habit in a short time, fully aware that the cycle of habituation and "laying up" will be repeated. The questions are, when is physical dependency a dire enough consequence to prohibit drug administration and how serious a matter is physical dependency per se? Another example focuses on amphetamines, which are the only major class of drugs consistently reported as enhancing the performance of normal human beings (for short periods mostly in muscle-using tasks). Although they are used by drivers to combat fatigue and are prescribed by physicians for overweight and depressed persons, increasing numbers of cases of paranoid-like psychoses are also attributed to the drug. Yet no one knows enough about what the probabilities of a psychotic outcome are for a given patient to guide decisions as to whether or not to give amphetamines.

Other policy problems arising out of probable drug effects are equally bedeviling. For example, marijuana is, as used in the United States, a relatively mild drug with very few verified ill effects; yet, when widely used by poor people, as in North Africa, its use is assodated with apathy, stupor, and cannabis psychosis. What would happen in this country if it were legalized so that it could be used more frequently in heavier doses? LSD is widely claimed to be a drug which makes the user feel "more loving." Observers who do not use LSD report that users are not more loving, only more interpersonally dependent ( as may occur with many toxic substances that interfere with normal brain function) and more self-centered. Whom is one to believe—the happy user or the disapproving observer?

In spite of the difficulties, a number of general statements, not fully accurate, can be made summarizing effects damaging to individuals. These are as follows:

Most users—one-time, periodic, or chronic—of most mind-altering drugs do not appear to suffer bad effects defined as damage to health or personal adjustment. Likelihood of damage probably increases as larger amounts of drugs are consumed over longer periods of time. There are notable exceptions in both directions—for example, those one-time users of LSD who suffer psychosis, as well as those individuals who take a one-time overdose of morphine, barbiturates, or other psychoactive substances and suffer death; on the other hand, those who in a lifetime make heavy use of alcohol may suffer no ill effects, as illustrated by the heavy-drinking businessman.

Damaging effects on physical and psychological health vary depending upon the condition of the individual. His condition, in turn, is a function of his social and medical history. The one group most likely to be identified as suffering the ill effects of heroin dependency and alcoholism are poor males dwelling in large cities. Other groups that appear to be in a high-risk category are those who have greater exposure to drugs, or the opportunity to use drugs in informal settings, such as physicians and nurses, who have access to opiates, bartenders who are surrounded by alcohol, and persons whose physicians overprescribe barbiturates and tranquilizers.

Damage also appears related to whether or not a person has learned to use drugs safely. For example, children taught alcohol use in the home are less likely to become alcoholics than those who learn drinking with peers. Patients taught to use morphine as charges in the hospital are less likely to develop a habit than slum adolescents taught by older peers. Proper teaching not only transmits information on dosage and dangers but also attitudes about propriety of use, functions, and the like.

Damage associated with chronic use is probably closely interrelated to the functions of use. Persons engaging in self-medication (unsupervised and unsanctioned) to escape, solve problems, reduce anxiety, and the like seem to run greater risk than those using drugs for social facilitation, religious rituals, and specific medical problems. These functions are intimately associated with the structure of situations of use, formal versus informal.

Psychoactive agents, without known exception, pose potential dangers. The best epidemiological information on the extent of danger in social use is for alcohol and cigarettes; less adequate information is available about private users of "dangerous drugs." For example, about one out of every fourteen to twenty alcohol users becomes an alcoholic. One report shows 3 per cent of LSD users becoming psychotic (beyond the period of the "trip" itself). No one knows how many barbiturate users become disabled.

Dangers from these substances vary by substance and include dependency (physical and/or psychological), direct physiological effects (from slowed reflexes or irritability, to shock, coma, and death), related pathological changes (for example, cancer, cirrhosis, and CNS pyramidal syndromes), direct psychological effects (toxic psychoses, confusion, anxiety, and depression), indirect sociopsychological effects (a life orientation toward drugs, self-centering, ethnocentrism), and suicide. The latter, suicide, may result deliberately from an overdose of barbiturates or from a self-destructive life style as indicated by a chronic use of alcohol or barbiturates; or suicide may be accidental as in the case of an LSD user who leaps out a window thinking he can fly.

No clear conclusion is possible in regard to the effectiveness of criminal laws in reducing health risks to drug users. Prohibition and current marijuana statutes illustrate the failure of laws to prevent large segments of the population from using a particular drug. The relative unavailability of opiates in illicit channels demonstrates an apparent success of the law in controlling distribution of these substances. Similar laws attempting to control distribution of amphetamines and LSD do not seem remarkably effective, although no comparative evidence shows what would happen without controls over "dangerous drugs."

Some citizens believe that drug fiends are responsible for most crime. A larger body of less-extreme opinion holds that drug use does play an important role in contributing some degree of menace to the community. The evidence is not as clear as one would wish, but for some drugs it is sufficient to warrant agreement with the less-extreme statement. The evidence is equally clear that the extreme opinion—no doubt, reflecting serious concern and aroused emotion—is erroneous.

"Crime" itself is such a broad term, describing so many acts committed with or without apprehension by so many citizens, as to be useless for most discussion purposes. Comment here will be limited to dangerous behavior as such, including accidents, personal violence, and, to a limited extent, offenses against property. The evidence linking drug use to dangerous behavior is iinadequate. Nevertheless, many reports by public officials, both in testimony se ore legislative bodies or in the mass media, have linked crime to drug use. The consequence has been a pyramiding of conclusions based on unsupported opinion and fed by strong emotion, so that policy decisions have been made which cannot be defended on the basis of present knowledge. Illustrations of fact-free opinion include testimony to the effect that amphetamines play a significant role in auto accidents, that marijuana plays a causative role in crimes of violence, that marijuana is associated with unsafe driving, that heroin use leads to violence, that illicit drug use of any kind in adolescence creates or symbolizes disrespect for law and order as such or that it leads to criminal associations with subsequent induced criminality, that hallucinogens lead to violence, and'so on.

Underlying many of the unsupported statements are not only a lack of data on the drug-use habits of offenders and nonoffenders but an appalling failure to consider the total life pattern of persons committing offenses and the role of drugs in their lives. There can also be a remarkable lack of scientific logic which allows conclusions to be drawn within benefit of knowledge of controlled studies or analogous observations providing comparisons of drug-influenced behavior with behavior uninfluenced by drug effects. There is also a consistent failure to note the contamination which occurs when several drugs may be in use simultaneously or in close sequence—a pattern frequently found among drug-interested persons.

However, a few statements appear to be sound on the basis of present evidence. "Sound" does not mean true, only that these statements are reasonable estimates of probable relationships—estimates very likely to be revised as better research becomes available or as population behavior changes either in regard to drug use or criminal acts. These are as follows:

There is a strong link between the use of one drug and the occurrence of auto accidents (both injuries and fatalities) and pedestrian-auto accidents. The drug is alcohol. The evidence is that driving is impaired by alcohol use, that drinking drivers account for more than their fair share of accidents—either to themselves or visited upon others—and that alcoholics in particular account for a disproportionate share of auto accidents.

There is no evidence that the use of other drugs is strongly associated with actual accident incidents, although experimental work shows how driving skill or driving-related skills can be reduced by depressant-type drugs and by marijuana-like drugs. Clinical evidence, on the other hand, can be adduced which shows improvement in performance as anxiety interfering with motor behavior is dampened by drugs—for example, tranquilizers.

There is evidence that drug use is often an integral part of life among persons described as having criminal careers. Work among Skid Row dwellers shows an important portion of these have had criminal careers prior to their becoming alcoholics and that after becoming alcoholics their arrest record changes in the direction of more drunk-related offenses and fewer types of other crimes. Similarly, persons identified as addicts (arrested for narcotic-law violations) tend to have records of delinquency prior to and following their initial narcotic apprehensions. Some evidence suggests that adolescents involved in the use of volatile intoxicants, amphetamine-barbiturate mixes and the like, are involved in other forms of maladapted and delinquent behavior. Marijuana occupies an ambiguous position; among slum adolescents with delinquent histories, its use is not uncommon; among college students and successful professionals, it is also used, but in the latter cases without evidence of any associated criminality.

Whether or not heroin use influences later criminality is not clear. Since prior to the initial heroin experience itself the user is already very likely to be a delinquent associating with other delinquents, heroin cannot be assumed to "cause" his crime. Some argue that the cost of maintaining a habit does lead to increasing theft by addicts; others argue that as a depressant heroin prevents crimes of violence among those who might otherwise have been violent. Significantly, no evidence shows that heroin users steal more or more successfully than their delinquent peers not using heroin.

Seemingly, the chronic use of any mind-altering drug by persons with delinquent histories is not associated with successful criminal careers. One may argue that chronic drug use impairs performance and prevents any complex crime planning or execution. It can also be argued that those who become chronic users were less likely to be candidates for success in any career, criminal or otherwise, due to social or personal deficiencies. There is also evidence that those who become drug-oriented may thereby sacrifice opportunities to be selected for successful criminal careers, since the user does not enjoy the prestige or confidence of more active delinquents or successful (professional or organized) criminals.

There is reason to believe that drugs may play a role in crimes of violence. The strongest evidence links alcohol to assault and homicide. However, these crimes are also linked to histories of violent behavior, so that one suspects an enduring pattern of both violence and drug use (as well as much other social and personal disorder) among those identified as violent. Case-history evidence of a sort suggests non-chronic drug use may also occasionally be linked to violence, as, for example, impulse release under marijuana, erratic conduct accompanying hallucinogen use, and irritability associated with amphetamine use. Such case-history data have little epidemiological value and do not prove any significant relationship between the incidence of such drug use and violence. A more prudent view would anticipate drug-facilitated violence primarily in persons with histories of personal difficulties, loss of control, impeded judgment, and the like—again, just those persons likely to be both delinquent and drug-using. It is highly unlikely that a well-adjusted citizen would become violent under any dosage of any mind-altering drugs. Rare exceptions might be anticipated in toxic psychotic reactions to amphetamines, cannabis, or hallucinogens.

No adequate data show the impact of present criminal laws in preventing dangerous behavior. Whether delinquent adolescents are deterred from drug experimentation by laws or whether offenders involved in drug use plus other crimes are likely to be restored to abstinence and honesty through any form of probation, imprisonment, or parole is much open to question. However, present methods of medical-psychological treatment, voluntary or otherwise, are equally unable to prove their worth in "curing" the chronic drug user and/or criminal, although modern methods hold forth some promise in the former. We assume that some drug use which might have untoward consequences is deterred or, at least, interrupted by direct penalties and by controls over drug distribution. We also assume that other drug use is untouched. It is also possible that present punitive methods either confirm or exaggerate the asocial or antisocial behavior of other users.

CONCLUSION

Drug use is widespread in the United States. Most of that use is approved and occurs without evidence of damage to the user or to the community. Much illicit use also occurs and is presumed to be unrecognized and nondamaging. No known 'drug, by itself, can be shown to "cause" crime, although when the use of a drug is illegal, the "crime" clearly rests upon the person's decision to acquire, possess, or use the drug illicitly. Drugs can cause damage to psychological and physical health, and although these effects are infrequent in terms of the proportion of citizens using drugs so affected, the actua.1 numbers of persons suffering distress in association with drug use runs into the millions—for example, there are at least six million alcoholics in the United States.

A public concern which focuses on social drug dangers or drug abuse without also focusing on the drug user himself is misdirected. It is a person who employs a drug and a person who suffers harm himself or visits harm on others. It is what people do to themselves and to each other with or without drugs which justly arouses public concern or horror. It is, therefore, the person that must be attended to and the reasons for and consequences of his drug use that need to be established. Statistically, the persons most likely to harm or be harmed under circumstances in which drugs are implicated are most likely to be those who are already identified as suffering a variety of other deprivations, miseries, and deficiencies—primarily big-city, slum-dwelling males, with minority groups overrepresented. These groups are also overrepresented in the commission of crimes in the street. A useful perspective is one which sees drug use in the United States as common but drug abuse as uncommon—the latter to be taken as but one of many expressions of distress or disorder which are observable in the life of the user.

There is no question that drug use does occur in association with accidents and criminality. Strong doubts do exist about the role of drugs as being sufficient in "causing" crime; but it is likely that drug use influences the kinds of crimes committed. On the other hand, there is little question that drugs do play direct roles in accidents; alcohol is the acknowledged villain. Drugs also play a direct role in suicide, whether that act takes place outside of awareness or intentionally, and whether done suddenly or slowly.

Ideally, the hope is to prevent rather than to attempt to cure drug abuse and criminality. The evidence suggests that both honesty and safe drug use can be taught, but the apt pupil is already the one fortunate enough to be without severe social disadvantage or personal disorder. Consequently, the recommendation is for education and the prevention of poverty and misery—a prescription readily accepted by the "Great Society" but one which cannot yet be filled or administered to the many needy patients. In the meantime, it seems apparent that those who are untaught in safe drug use and who already have propensities for hurting themselves and others are well advised not to employ mind-altering drugs. Since these same people are unable to accept such easily given advice as to "shape up," "obey the law," "reform," or "keep healthy," it is ridiculous to assume they will be prudent in their use of drugs. Consequently, control over the distribution of drugs is in order.

Although it is one aim of narcotic and dangerous-drug laws to achieve that control, we lack evidence as how best to make laws which mold drug-use conduct.

Given that lack, we might suggest that the more extreme provisions of current drug laws are at least unkind and quite possibly destructive. If we accept the premise that the person abusing drugs is thereby giving signs of his own disorder, it would be well for those around him to take notice of that disorder—for the sake of their own safety as well as for his. If drug abuse is a sign of disorder, if it is a sign of distress, then we should ask whether it is effective to be so homeopathic in our approach—treating pain by giving pain? Without proof that it is effective, then both economy and kindness dictate that our attempts to control undesirable drug behavior emphasize features other than punishment. This is not to rule it out entirely—merely to suggest that flexibility and experimentation might better dictate our approaches until such time as we know more about how to influence drug-taking behavior or until such time that we conclude that we are quite unable, at least through policy decisions, to influence that behavior at all.

1 There are no bibliographical references in this article. The reader interested in more detailed discussion and in a bibliography is referred to the following: the President's Commission on Law Enforcement and the Administration of Justice, Task Force Report: Drunkenness and Task Force Report: Narcotics and Drug Abuse (Washington, D.C.: U.S. Government Printing Office, 1967).