Ego functioning and acute adverse reactions to psychoactive drugs' Murray P Naditch/ * Cornell Universify
Aldous Huxley descnbed his mescahne experience (Huxley, 1954) as an openmg of the doors of perception and a loosening of the structure through which perceptual information is filtered Since the time of Huxley's observations, a number of authors have observed the effects of LSD on a variety of perceptual and motor tasks and found that subjects did indeed respond to perceptual input m a manner that approximated primary process thinkmg, and less adaptive specifically ego-defensive, filtering (eg Abramson et al, 1955, Barr et al, 1972, Klee, 1963) Barr et al, m describing the reactions of subjects who had been given LSD to the Uloomoo-Takete and Color-Form tests of mental functioning describe a change in mental organization m the direction of greater openness or flmdity of mental concepts as one shifts from the normal to the altered state, an observation supportmg the thesis that primary-process functioning becomes more predominant m such states Moreover, presentations (brain processes on their way to becoming ideas or images) tend to be less subject to voluntary control (Holt, 1972), that is more peremptory or intrusive (Klein, 1967) [Barr et al, 1972] Although some users of psychoactive drugs have what appear to them to be psychologically profound experiences, other users have reported extremely disturbing, often terrifying, ex1 This research was supported m part by two grants from the National Institute of Mental Health (MH 2269-01 and DA 00606-01) 2 The author wishes to thank Patnca Colvin Alker and Jeff Hayas for their help m the processing of these data, and Mark Mendell, Ellen Goldner, Kenneth Pemne, and Chnstme Eddy who participated in the construction of the questionnaire and collection of the data 3 Requests for reprints should be sent to the author. Department of Psychology, Uns Hall, Cornell Umversity, Ithaca, New York 14850
306
Nadttch
penences accompanied by acute anxiety This paper is concerned with the relationships between these latter acute adverse reactions to psychoactive drugs and characteristic ego mechanisms of copmg and defense Fmdmgs of a number of authors are consistent with the conceptualization of the psychoactive drug expenence as a disruption and alteration of the normal ego defensive and coping mechamsms Cohen (1960) has suggested that adverse reactions to psychoactive drugs are more common among those with bnttle defensive structures Naditch (1974) found that acute adverse reactions to marijuana and to LSD and/or mescahne were positively related to higher scores on the MMPI subscales of pure schizophrema and to Haan's (1965) defensive regression, suggestmg that more primitive, less adequate, and more regressive defensive structures may have a higher hkelihood of bemg overwhehned dunng the drug expenence, leading to the development of acute adverse reactions A scale of maladjustment which differentiated student psychiatric chents at the mental health climc at the Umversity of Wisconsin from nonclient students was also related to the development of acute adverse reactions, suggesting that maladaptive coping mechamsms may be related to acute adverse drug experiences In that study there was also a small, but statistically sigmficant negative relationship between the MMPI subscale of pure paranoia and acute adverse reactions, suggesting that the perceptual vigilance associated with use of defensive projection may be effective in reducing the likelihood of developing an acute adverse reaction Klee and Weintraub (1959), on the other hand, found that people who used projection as a defense were more likely to have paranoid-like reactions to LSD The most comprehensive work m this area was done by Barr et al (1972) who admimstered LSD to a sample of male actors and observed their reactions Based on the results of Rorschachs and other tests administered to subjects during an LSD expenence, these authors found that preexistmg defense and copmg patterns were major determmants of perceived LSD effects A number of hypotheses related to the effects of specific ego mechanisms, some of which were suggested by Barr et al's (1972) findings, and others which logically follow from the
Ego functioning and psychoactive drugs
307
shared understanding of the manner m which ego mechamsms are considered to function, were examined m this study It was hypothesized that users who characteristically employ demal as an ego defense mechamsm would be less likely to expenence acute adverse reactions because of their capacity to block out and essentially remove themselves from the expenence This hypothesis is consistent with Barr et al's (1972) finding that subjects who were "prone to shut out their inner hfe" (p 155) while under the experience of LSD "tightened their rigid and inhibiting defenses and experienced only mimmal effect" (p 156) Barr et al, descnbed another group of subjects who were also charactenzed by "obsessive defenses and tight controls" (p 153), and who tended to "cover up depressive and aggressive trends and an inner turmoil which might otherwise plague them (p 153)." This group of subjects was able to avoid the regressive pressures of LSD reasonably effectively for a few hours, but then experienced a breakthrough of disturbing pnmaryprocess material which was associated with a great deal of anxiety and fear of permanent msamty. These observations suggest that use of repression as a primary ego defense should be ineffective m dealing with the psychoactive drug expenence Subjects high m defensive repression were hypothesized to be more hkely to handle the assault of the drug expenence and consequently to have an increased likelihood of developing acute adverse reactions Barr et al (1972) also found that subjects who were withdrawn, hostile and paranoid, and charactenzed by the use of projection also experienced strong fears of "going crazy" and high anxiety while using LSD Klee and Weintraub (1959) found that people who used projection as a defense were more likely to have paranoid-like reactions to LSD. On the other hand, the negative relationship between paranoia and acute adverse reactions found by Naditch (1974), suggests that attnbution of disturbing internal reactions to psychoactive drugs or to aspects of the environment rather thsm to oneself may be an effective way of dealing with potentially disturbing aspects of the psychoactive drug experience Given the small magnitude of effect m the Naditch (1974) finding, it was hy-
308
Nadttch
pothesized that subjects high m defensive projection would be more likely to have acute adverse reactions Drug users who characteristically use mtellectualization as a defense were hypothesized to have a lower likelihood of acute adverse reactions because they may be able to avoid and bind the anxiety accompanying disturbing aspects of the psychoactive drug experience by cogmtively controlhng affect The relationship between defensive regression and acute adverse reactions has been previously reported (Naditch, 1974), the tendency to use regression was positively associated with the development of acute adverse reactions Regression was also included in this analysis m order to examine its relative importance as a mechanism of defense m handling acute adverse reactions, and to examine the extent to which it makes an independent contribution in accounting for the variance m acute adverse reactions when the other mechanisms of defense and coping were considered simultaneously Haan (1963) has developed a model of ego functiomng which includes both defensive and coping ego mechamsms Both defense and coping mechanisms describe similar cogmtive and impulse control processes, although the properties of defense mechamsms more nearly approximate pnmary process thinking and tend to be more ngid, histoncally determined, distorting of reahty, and based on unconscious processes, while coping mechanisms tend to mvolve more choice and secondary process thinking A number of Haan's coping mechanisms were hypothesized to be related to acute adverse reactions Subjects with the capacity for regression m the service of the ego were hypothesized to have a lower likelihood experiencing acute adverse reactions This hypothesis is consistent with the findings of Barr et al (1972) who found that subjects who were open to pnmary process thinking, but who could also handle it well, tended to have elated reactions to LSD without any abnormal fears of loss of control or insanity The abihty to handle the cognitive and affective complexity and dissonance produced by the drug expenence should be useful in avoiding the development of acute adverse reactions Consequently, subjects with a higher tolerance of ambiguity were hypothesized to have a lower incidence of acute adverse reactions
Ego functioning and psychoactive drugs
309
Haan (1963) has also developed a measure of total copmg based on a summation of all the coping ratings she considers The increased flexibility to cope with various situations lmphed m this measure suggests the hypothesis that total coping should be negatively related to acute adverse reactions The measures of acute adverse reactions used m this analysis were based on retrospective data Consequently the amount of drug usage experience of subjects would be expected to effect the measure The more often a subject has used a psychoactive drug, the more opportunity the user will have had to have an acute adverse reaction Some of the ego mechanisms considered in this analysis were hypothesized to be related to the degree of drug usage In an earlier analysis of these data, regression was found to be positively related to both marijuana and to LSD use The regressive influence of psychoactive drugs also suggests the hypothesis that people high m regression m the service of the ego should be heavier users of psychoactive drugs No specific hypotheses were made about the relationship of the other coping and defense mechanisms to usage Given the possible importance of drug usage as an lntervemng variable, it was thought important to examme both the extent to which each of the ego mechamsms affected acute adverse reactions directly (independently of usage and of shared vanance with other ego mechamsms) and indirectly through their effects on usage Consequently, a hypothetical causal model will be presented so that this observation will be facilitated These hypotheses taken together, with some additional assumptions about the plausible ordering of these variables, suggest the hypothetical model shown m Figure 1 Each straight arrow representing a causal hypothesis is represented as a letter, there are twenty-three hypotheses Arrows A through H represent the hypotheses that lntellectuahzation, demal, repression, projection, regression, regression in the service of the ego, tolerance of ambiguity, and total coping respectively, will have direct effects on acute adverse reactions to marijuana Arrows I through R represent the hypotheses that this same respective set of independent vanables will directly effect acute adverse reactions to LSD The arrows marked Q and R represent the
310
Ncditch
hypotheses that the amount of drug usage expenence will directly effect acute adverse reactions The arrows marked S and T, and U and V represent the hypotheses that regression and regression in the service of the ego will each directly effect drug usage, and taken together with hypotheses Q and R, will also indirectly effect acute adverse reactions through effecting the rate of drug usage The significance of the remaimng straight and curved arrows m Figure 1 are discussed in the method and results sections METHOD
The data were collected using a self-admimstered questionnaire filled out by 483 male drug users contacted through a system of chain referrals for this purpose dunng the spring and strmmer of 1972 Questioimaires were returned so that responses were anonymous Approximately 92 percent of these subjects had used marijuana, 55 percent had used manjuana more than one htmdred tunes Fiftytwo percent had used LSD, and 55 percent had used mescalme Age was distributed with a mean of 214 years and a standard deviation of 2 9 years Ninety-five percent of the subjects were white, approximately 65 percent reported bemg students. Further details of the samphng technique and charactenstics of this sample have been descnbed elsewhere (Naditch, 1974) Measures Acute adverse reactions were measured using a twenty-three-item measure of retrospective expenence These items concerned recumng temble thoughts or feehngs, fear of loss of control, permanent msamty or lmpendmg death, despair, suicidal thoughts and strong negative affect Acute adverse reactions to manjuana and to LSD and/or mescalme were measured separately LSD and mescalme were combmed because a substantial portion of what is sold as mescahne is often composed of LSD and other additives For purposes of exposition LSD use will refer to the combmed index of LSD and/or mescalme use, and acute adverse reactions to LSD will refer to adverse reactions to either LSD and/or mescalme The development and method used for scormg the drug usage and acute adverse reaction measures, and statistics descnbmg the distnbutions of these and the drug usage measures, has been descnbed elsewhere (Naditch, 1974) Drug usage was measured separately for marijuana and for LSD and/or mescalme using both current rate and cumulative usage
Ego functioning and psychoactive drugs
311
measures. The analysis was done separately using current and cumulative usage measures These results were nearly identical To avoid redundance only results using the cumulative measures of drug usage expenence are reported in this paper Ego mechanisms were measured using the Haan (1963, 1965) measures Haan (1963, 1965) developed paper and pencil measures of defense and copmg mechamsms usmg MMPI and CPI items respectively based on clinical assessments of the vanous ego mechanisms Items which related to clinical assessments at the 01 level or greater for male subjects were used m this analysis Statistics related to the distnbutions of each of these measvires are shown in Table 1 in the results section Procedure A Pearson correlation matrix of all the vanables m the study was computed Stepwise multiple regression equations were computed with each term representmg one of the hypothesized effects of each ego mechanism on manjuana and LSD acute adverse reactions and usage Specifically these four equations were Xi = 13i 3 X3 -1- Pi 5 X|i + f-?1 6 Xg -f- /3i 7 X7 + ^18 ' 1 + ;8i 12 X12 Pi 11 1Si 9 X9 + Pi 10 ^ X2=l S24 X4 -1- P2 6 Xis + /?2 6 Xg P21 X7 + ^82 8 V ^ _L /32 11 • + ^82 12 X12 18 2 8 X9 + P2 10 ^ X3 = /83 9 X9 + Ps 10 ^^10 r X4 = ,84 9 X9 + P*10 J^10
Where Xi = Acute adverse reactions to manjuana X2 = Acute adverse reactions to LSD X3 = Manjuana usage X4 = LSD usage Xs = lntellectuahzation Xe = Demal X7 = Repression Xg = Projection X9 = Regression Xio = Regression m the service of the ego Xii = Tolerance of ambiguity X12 = Total copmg y8*s = The beta weights or standardized regression coefficients The remaining ego mechamsms not hypothesized to be related to two lands of drug usage were also regressed on usage m a step-
312
Naditch
wise fashion m order to explore other possible relationships All regressions were rerun including only those terms that were significant at at least the 05 level of significance The beta weights from these latter regressions were used as estimates of the degree of influence of each of the vanables m causing mcreased usage or acute adverse reactions These standardized beta coefficients are the equivalent of path coefficients m path analysis, and the four regression equations can be used to estimate the structural equations which describe the hypothetical causal model depicted m Figure 1 Path analysis uses the concept of residual vanables to account for the effects of vanables that were not included m the analysis The path coefficients for these residual vanables were estimated by the formula
where R* is the square of the multiple correlation coefficient This procedure has been descnbed elsewhere (Land, 1969, pp. 18-20, Naditch, 1974) All correlations and regressions had an N of 483 with the exception of those in which acute adverse reactions were included Correlations and regressions usmg acute adverse reactions to manjuana mcluded only those subjects who had used manjuana, N = 339 Correlations and regressions usmg acute adverse reactions to LSD/ mescahne included only those subjects who had used either LSD or mescalme, N = 236 In Figure 1, lettered straight arrows represent causal hypotheses Solid straight bnes represent confirmed hypotheses, and the path coefficients estimate magnitude of effect Dotted straight Imes represent rejected hypotheses Non-dotted straight lines that do not have letters corresponding to them represent non-hypothesized findings which are causally mterpreted Curved double-headed arrows represent associations between vanables about which no causal mterpretations are made The coefficients corresponding to straight arrows from residual vanables represent the effects of vanables not included in the analysis REStTLTS The zero-order correlation matrix of the ego mechamsms in
Table 1 shows that there are relations among a number of the mdependent vanables The zero-order correlations between each of the ego mechamsms and the two kinds of usage and acute adverse reactions m Table 2 mdicate that regression and regression m the service of the ego were each related to the
313
Ego functioning and psychoactive drugs
Acute
adverse reeictions to mari,uana
Acute eidverse reactions to LSD "2
Figure 1. Hypothetical Causal Model of the Relationship Between Ego Mechanisms, Manjuana and LSD Usage and Acute Adverse Reactions Note Lettered straight arrows represent causal hypotheses Sohd straight hnes represent confirmed hypotheses, and the path coefficients estimate magnitude of effect Dotted straight hnes represent rejected hypotheses Non-dotted straight hues that do not have letters corresponding to them represent non-hypothesized fmdings which are causally interpreted Curved double-headed arrows represent
314
Naditch
Tafofe 1 Correlation matnx and descnptive statistics of the defense and coping mechanisms Vanable X« Xa X, X, X. Xie
Inteilectuahzation Denial Repremon Protection Regression Regression in the service of the ego Xu Tolerance of ambiguity Xu Total coping
X
Aldous Huxley descnbed his mescahne experience (Huxley, 1954) as an openmg of the doors of perception and a loosening of the structure through which perceptual information is filtered Since the time of Huxley's observations, a number of authors have observed the effects of LSD on a variety of perceptual and motor tasks and found that subjects did indeed respond to perceptual input m a manner that approximated primary process thinkmg, and less adaptive specifically ego-defensive, filtering (eg Abramson et al, 1955, Barr et al, 1972, Klee, 1963) Barr et al, m describing the reactions of subjects who had been given LSD to the Uloomoo-Takete and Color-Form tests of mental functioning describe a change in mental organization m the direction of greater openness or flmdity of mental concepts as one shifts from the normal to the altered state, an observation supportmg the thesis that primary-process functioning becomes more predominant m such states Moreover, presentations (brain processes on their way to becoming ideas or images) tend to be less subject to voluntary control (Holt, 1972), that is more peremptory or intrusive (Klein, 1967) [Barr et al, 1972] Although some users of psychoactive drugs have what appear to them to be psychologically profound experiences, other users have reported extremely disturbing, often terrifying, ex1 This research was supported m part by two grants from the National Institute of Mental Health (MH 2269-01 and DA 00606-01) 2 The author wishes to thank Patnca Colvin Alker and Jeff Hayas for their help m the processing of these data, and Mark Mendell, Ellen Goldner, Kenneth Pemne, and Chnstme Eddy who participated in the construction of the questionnaire and collection of the data 3 Requests for reprints should be sent to the author. Department of Psychology, Uns Hall, Cornell Umversity, Ithaca, New York 14850
306
Nadttch
penences accompanied by acute anxiety This paper is concerned with the relationships between these latter acute adverse reactions to psychoactive drugs and characteristic ego mechanisms of copmg and defense Fmdmgs of a number of authors are consistent with the conceptualization of the psychoactive drug expenence as a disruption and alteration of the normal ego defensive and coping mechamsms Cohen (1960) has suggested that adverse reactions to psychoactive drugs are more common among those with bnttle defensive structures Naditch (1974) found that acute adverse reactions to marijuana and to LSD and/or mescahne were positively related to higher scores on the MMPI subscales of pure schizophrema and to Haan's (1965) defensive regression, suggestmg that more primitive, less adequate, and more regressive defensive structures may have a higher hkelihood of bemg overwhehned dunng the drug expenence, leading to the development of acute adverse reactions A scale of maladjustment which differentiated student psychiatric chents at the mental health climc at the Umversity of Wisconsin from nonclient students was also related to the development of acute adverse reactions, suggesting that maladaptive coping mechamsms may be related to acute adverse drug experiences In that study there was also a small, but statistically sigmficant negative relationship between the MMPI subscale of pure paranoia and acute adverse reactions, suggesting that the perceptual vigilance associated with use of defensive projection may be effective in reducing the likelihood of developing an acute adverse reaction Klee and Weintraub (1959), on the other hand, found that people who used projection as a defense were more likely to have paranoid-like reactions to LSD The most comprehensive work m this area was done by Barr et al (1972) who admimstered LSD to a sample of male actors and observed their reactions Based on the results of Rorschachs and other tests administered to subjects during an LSD expenence, these authors found that preexistmg defense and copmg patterns were major determmants of perceived LSD effects A number of hypotheses related to the effects of specific ego mechanisms, some of which were suggested by Barr et al's (1972) findings, and others which logically follow from the
Ego functioning and psychoactive drugs
307
shared understanding of the manner m which ego mechamsms are considered to function, were examined m this study It was hypothesized that users who characteristically employ demal as an ego defense mechamsm would be less likely to expenence acute adverse reactions because of their capacity to block out and essentially remove themselves from the expenence This hypothesis is consistent with Barr et al's (1972) finding that subjects who were "prone to shut out their inner hfe" (p 155) while under the experience of LSD "tightened their rigid and inhibiting defenses and experienced only mimmal effect" (p 156) Barr et al, descnbed another group of subjects who were also charactenzed by "obsessive defenses and tight controls" (p 153), and who tended to "cover up depressive and aggressive trends and an inner turmoil which might otherwise plague them (p 153)." This group of subjects was able to avoid the regressive pressures of LSD reasonably effectively for a few hours, but then experienced a breakthrough of disturbing pnmaryprocess material which was associated with a great deal of anxiety and fear of permanent msamty. These observations suggest that use of repression as a primary ego defense should be ineffective m dealing with the psychoactive drug expenence Subjects high m defensive repression were hypothesized to be more hkely to handle the assault of the drug expenence and consequently to have an increased likelihood of developing acute adverse reactions Barr et al (1972) also found that subjects who were withdrawn, hostile and paranoid, and charactenzed by the use of projection also experienced strong fears of "going crazy" and high anxiety while using LSD Klee and Weintraub (1959) found that people who used projection as a defense were more likely to have paranoid-like reactions to LSD. On the other hand, the negative relationship between paranoia and acute adverse reactions found by Naditch (1974), suggests that attnbution of disturbing internal reactions to psychoactive drugs or to aspects of the environment rather thsm to oneself may be an effective way of dealing with potentially disturbing aspects of the psychoactive drug experience Given the small magnitude of effect m the Naditch (1974) finding, it was hy-
308
Nadttch
pothesized that subjects high m defensive projection would be more likely to have acute adverse reactions Drug users who characteristically use mtellectualization as a defense were hypothesized to have a lower likelihood of acute adverse reactions because they may be able to avoid and bind the anxiety accompanying disturbing aspects of the psychoactive drug experience by cogmtively controlhng affect The relationship between defensive regression and acute adverse reactions has been previously reported (Naditch, 1974), the tendency to use regression was positively associated with the development of acute adverse reactions Regression was also included in this analysis m order to examine its relative importance as a mechanism of defense m handling acute adverse reactions, and to examine the extent to which it makes an independent contribution in accounting for the variance m acute adverse reactions when the other mechanisms of defense and coping were considered simultaneously Haan (1963) has developed a model of ego functiomng which includes both defensive and coping ego mechamsms Both defense and coping mechanisms describe similar cogmtive and impulse control processes, although the properties of defense mechamsms more nearly approximate pnmary process thinking and tend to be more ngid, histoncally determined, distorting of reahty, and based on unconscious processes, while coping mechanisms tend to mvolve more choice and secondary process thinking A number of Haan's coping mechanisms were hypothesized to be related to acute adverse reactions Subjects with the capacity for regression m the service of the ego were hypothesized to have a lower likelihood experiencing acute adverse reactions This hypothesis is consistent with the findings of Barr et al (1972) who found that subjects who were open to pnmary process thinking, but who could also handle it well, tended to have elated reactions to LSD without any abnormal fears of loss of control or insanity The abihty to handle the cognitive and affective complexity and dissonance produced by the drug expenence should be useful in avoiding the development of acute adverse reactions Consequently, subjects with a higher tolerance of ambiguity were hypothesized to have a lower incidence of acute adverse reactions
Ego functioning and psychoactive drugs
309
Haan (1963) has also developed a measure of total copmg based on a summation of all the coping ratings she considers The increased flexibility to cope with various situations lmphed m this measure suggests the hypothesis that total coping should be negatively related to acute adverse reactions The measures of acute adverse reactions used m this analysis were based on retrospective data Consequently the amount of drug usage experience of subjects would be expected to effect the measure The more often a subject has used a psychoactive drug, the more opportunity the user will have had to have an acute adverse reaction Some of the ego mechanisms considered in this analysis were hypothesized to be related to the degree of drug usage In an earlier analysis of these data, regression was found to be positively related to both marijuana and to LSD use The regressive influence of psychoactive drugs also suggests the hypothesis that people high m regression m the service of the ego should be heavier users of psychoactive drugs No specific hypotheses were made about the relationship of the other coping and defense mechanisms to usage Given the possible importance of drug usage as an lntervemng variable, it was thought important to examme both the extent to which each of the ego mechamsms affected acute adverse reactions directly (independently of usage and of shared vanance with other ego mechamsms) and indirectly through their effects on usage Consequently, a hypothetical causal model will be presented so that this observation will be facilitated These hypotheses taken together, with some additional assumptions about the plausible ordering of these variables, suggest the hypothetical model shown m Figure 1 Each straight arrow representing a causal hypothesis is represented as a letter, there are twenty-three hypotheses Arrows A through H represent the hypotheses that lntellectuahzation, demal, repression, projection, regression, regression in the service of the ego, tolerance of ambiguity, and total coping respectively, will have direct effects on acute adverse reactions to marijuana Arrows I through R represent the hypotheses that this same respective set of independent vanables will directly effect acute adverse reactions to LSD The arrows marked Q and R represent the
310
Ncditch
hypotheses that the amount of drug usage expenence will directly effect acute adverse reactions The arrows marked S and T, and U and V represent the hypotheses that regression and regression in the service of the ego will each directly effect drug usage, and taken together with hypotheses Q and R, will also indirectly effect acute adverse reactions through effecting the rate of drug usage The significance of the remaimng straight and curved arrows m Figure 1 are discussed in the method and results sections METHOD
The data were collected using a self-admimstered questionnaire filled out by 483 male drug users contacted through a system of chain referrals for this purpose dunng the spring and strmmer of 1972 Questioimaires were returned so that responses were anonymous Approximately 92 percent of these subjects had used marijuana, 55 percent had used manjuana more than one htmdred tunes Fiftytwo percent had used LSD, and 55 percent had used mescalme Age was distributed with a mean of 214 years and a standard deviation of 2 9 years Ninety-five percent of the subjects were white, approximately 65 percent reported bemg students. Further details of the samphng technique and charactenstics of this sample have been descnbed elsewhere (Naditch, 1974) Measures Acute adverse reactions were measured using a twenty-three-item measure of retrospective expenence These items concerned recumng temble thoughts or feehngs, fear of loss of control, permanent msamty or lmpendmg death, despair, suicidal thoughts and strong negative affect Acute adverse reactions to manjuana and to LSD and/or mescalme were measured separately LSD and mescalme were combmed because a substantial portion of what is sold as mescahne is often composed of LSD and other additives For purposes of exposition LSD use will refer to the combmed index of LSD and/or mescalme use, and acute adverse reactions to LSD will refer to adverse reactions to either LSD and/or mescalme The development and method used for scormg the drug usage and acute adverse reaction measures, and statistics descnbmg the distnbutions of these and the drug usage measures, has been descnbed elsewhere (Naditch, 1974) Drug usage was measured separately for marijuana and for LSD and/or mescalme using both current rate and cumulative usage
Ego functioning and psychoactive drugs
311
measures. The analysis was done separately using current and cumulative usage measures These results were nearly identical To avoid redundance only results using the cumulative measures of drug usage expenence are reported in this paper Ego mechanisms were measured using the Haan (1963, 1965) measures Haan (1963, 1965) developed paper and pencil measures of defense and copmg mechamsms usmg MMPI and CPI items respectively based on clinical assessments of the vanous ego mechanisms Items which related to clinical assessments at the 01 level or greater for male subjects were used m this analysis Statistics related to the distnbutions of each of these measvires are shown in Table 1 in the results section Procedure A Pearson correlation matrix of all the vanables m the study was computed Stepwise multiple regression equations were computed with each term representmg one of the hypothesized effects of each ego mechanism on manjuana and LSD acute adverse reactions and usage Specifically these four equations were Xi = 13i 3 X3 -1- Pi 5 X|i + f-?1 6 Xg -f- /3i 7 X7 + ^18 ' 1 + ;8i 12 X12 Pi 11 1Si 9 X9 + Pi 10 ^ X2=l S24 X4 -1- P2 6 Xis + /?2 6 Xg P21 X7 + ^82 8 V ^ _L /32 11 • + ^82 12 X12 18 2 8 X9 + P2 10 ^ X3 = /83 9 X9 + Ps 10 ^^10 r X4 = ,84 9 X9 + P*10 J^10
Where Xi = Acute adverse reactions to manjuana X2 = Acute adverse reactions to LSD X3 = Manjuana usage X4 = LSD usage Xs = lntellectuahzation Xe = Demal X7 = Repression Xg = Projection X9 = Regression Xio = Regression m the service of the ego Xii = Tolerance of ambiguity X12 = Total copmg y8*s = The beta weights or standardized regression coefficients The remaining ego mechamsms not hypothesized to be related to two lands of drug usage were also regressed on usage m a step-
312
Naditch
wise fashion m order to explore other possible relationships All regressions were rerun including only those terms that were significant at at least the 05 level of significance The beta weights from these latter regressions were used as estimates of the degree of influence of each of the vanables m causing mcreased usage or acute adverse reactions These standardized beta coefficients are the equivalent of path coefficients m path analysis, and the four regression equations can be used to estimate the structural equations which describe the hypothetical causal model depicted m Figure 1 Path analysis uses the concept of residual vanables to account for the effects of vanables that were not included m the analysis The path coefficients for these residual vanables were estimated by the formula
where R* is the square of the multiple correlation coefficient This procedure has been descnbed elsewhere (Land, 1969, pp. 18-20, Naditch, 1974) All correlations and regressions had an N of 483 with the exception of those in which acute adverse reactions were included Correlations and regressions usmg acute adverse reactions to manjuana mcluded only those subjects who had used manjuana, N = 339 Correlations and regressions usmg acute adverse reactions to LSD/ mescahne included only those subjects who had used either LSD or mescalme, N = 236 In Figure 1, lettered straight arrows represent causal hypotheses Solid straight bnes represent confirmed hypotheses, and the path coefficients estimate magnitude of effect Dotted straight Imes represent rejected hypotheses Non-dotted straight lines that do not have letters corresponding to them represent non-hypothesized findings which are causally mterpreted Curved double-headed arrows represent associations between vanables about which no causal mterpretations are made The coefficients corresponding to straight arrows from residual vanables represent the effects of vanables not included in the analysis REStTLTS The zero-order correlation matrix of the ego mechamsms in
Table 1 shows that there are relations among a number of the mdependent vanables The zero-order correlations between each of the ego mechamsms and the two kinds of usage and acute adverse reactions m Table 2 mdicate that regression and regression m the service of the ego were each related to the
313
Ego functioning and psychoactive drugs
Acute
adverse reeictions to mari,uana
Acute eidverse reactions to LSD "2
Figure 1. Hypothetical Causal Model of the Relationship Between Ego Mechanisms, Manjuana and LSD Usage and Acute Adverse Reactions Note Lettered straight arrows represent causal hypotheses Sohd straight hnes represent confirmed hypotheses, and the path coefficients estimate magnitude of effect Dotted straight hnes represent rejected hypotheses Non-dotted straight hues that do not have letters corresponding to them represent non-hypothesized fmdings which are causally interpreted Curved double-headed arrows represent
314
Naditch
Tafofe 1 Correlation matnx and descnptive statistics of the defense and coping mechanisms Vanable X« Xa X, X, X. Xie
Inteilectuahzation Denial Repremon Protection Regression Regression in the service of the ego Xu Tolerance of ambiguity Xu Total coping
X
