Marijuana and the Adolescent Billiamin A. Alli, FRSH Dayton, Ohio

Growing marijuana use among young people, among teenagers in particular, poses serious problems that involve parents, society, law enforcement agencies, legislators, and health care professionals. This paper discusses the multifaceted problems surrounding marijuana use and suggests possible solutions. The marijuana problem is current. There is evidence of its growing use among young people today and a shift of its use to higher income groups. Mass media have aroused public interest and concern. Law enforcement agencies have been increasing their activity, finding sources of supply, and making arrests for possession and use. Simultaneously, legislators have wrestled with the problem of our current laws regarding marijuana, relaxing them, tightening them, or dropping them entirely. Medical reports of the physical and mental effects of marijuana use are conflicting, and social scientists are asking questions that will enable us to know: 1. the incidence and prevalence of marijuana use among young people-in high schools and in colleges; 2. how users differ from their non-user peer group; 3. what the real or perceived reasons are for using the drug; 4. what environmental influences promote or discourage the use of

marijuana; 5. how the drug is distributed in schools and in communities; 6. the psychological and social consequences of marijuana use, short and long-term. Confusion, misinformation, and lack of knowledge abound among professionals and non-professionals alike. Nevertheless, opinion is sharply divided between proponents and emotionally-charged opponents. One view holds that marijuana is harmful to mind and body, leads to crime and violence, and predisposes the user to heroin use; therefore, laws controlling it should be strictly enforced. The other side contends just as strongly that marijuana is no more harmful than alcohol, probably less so, and should Dr. Alli is President and Chairman, Board of Directors, Dayton Child Development Corporation, Dayton, Ohio. Requests for reprints should be addressed to Dr. Billiamin A. Alli, PO Box 155, Dayton, OH 45401.

not be restricted.

Physiological Action Marijuana has been known and used throughout the world for centuries, but its use in the United States is only 60 years old. The hemp plant, Cannabis sativa, from which marijuana is obtained, is a weed which grows virtually anywhere in a temperate climate, although 75 percent of the United States supply is smuggled from Mexico. The long fibers of the plant have textile uses, but marijuana has limited medicinal use. It is used specifically in patients with glaucoma and for prevention of pain in cancer patients. Numerous parts of the plant can be smoked, eaten, or drunk. They have become known by a variety of names such as hashish, bhang, ganja, kif, dagga, and marijuana. Marijuana, commonly used in the Americas and England, refers to the leaves and flowering tops of the cannabis plant which are dried, sometimes mixed with tobacco, and then typically rolled in paper and smoked as cigarettes. In the jargon of the street, they are called reefers, joints, or sticks. The content is known as hay, grass, pot, weed, igbo, or tea. Most cannabis used in this country is not as potent as the hashish indigenous to Middle East or Africa. The latter contains much more plant resin and the warmer climate in those areas is responsible for heightening the drug's effects. Cannabis is not a narcotic, although legally classified as such. Although it has been variously classified by its effects, no classification of mind-altering and behavior-changing drugs is indisputable. The effects depend more upon host reaction than upon the substance itself. Marijuana is thought by some to be a mild hallucinogen (others in this class are mescaline, psilocybin, and LSD). In other classifications, marijuana is an intoxicant, similar to alcohol and volatile substances such as glues, paint thinners, ether, etc. At times, mari-

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juana may act as a sedative.' The physical effects are primarily on the central nervous system, but the mode of action is poorly understood. Only recently, tetrahydrocannabinol, the active ingredient in cannabis, has been synthesized, making possible, at least, controlled-experimentation. Physiologically, marijuana raises the blood pressure, lowers body temperature somewhat, slows breathing, and dehydrates the body. It produces barbiturate-like sedation in low doses and LSD-like hallucination in high doses. It also lowers blood sugar levels and stimulates appetite. The first report of the National Commission on Marijuana and Drug Abuse indicates that the pulse rate and recumbent blood pressure increase and the upright blood pressure decreases. The eyes redden, tear secretion is decreased, the pupils become slightly smaller, the fluid pressure within the eyes lessens, and the eyeball rapidly oscillates (nystagmus).2 The first reactions occur in about one-half hour and effects can last up to 12 hours. There is tolerance to sedation, euphoria with heavy daily use (two-three weeks) and slower tolerance to hallucinatory activity of higher doses. Clinically, symptoms of marijuana intoxication are impossible to diagnose with certainty unless the substance is found on the person. There is no known detoxicant. The smoke itself is highly irritating to the mucosa of the lungs and eyes, possibly persons with pulmonary and/or eye diseases incur some risk; in some cases, chronic coughing results. Longlasting deleterious effects to the body have not yet been demonstrated; however, neither has there been enough long-term research to provide assurance to the contrary. An exception is that heavy chronic use may lead to the endocrine disorder, amotivational syndrome. Marijuana is not addictive in the same sense as "hard" narcotics. That is, no physical dependence occurs and there are no physical symptoms upon withdrawal.

Psychological Effects Psychological effects are highly individual and may vary in the same in677

dividual on different occasions. The effect probably depends on his mood at the outset, the time, and the circumstances. Most people find the psychic effects range from none at all, particularly on a first use, to an exhilarating "high." The subject may experience a feeling of well being, hilarity, euphoria, disorientation of time and space, distorted perception, impaired judgment and memory, irritability, and/or confusion. It has been suggested that marijuana might be responsible for automobile accidents, due to its central nervous system effects. With regard to this, reliable scientific data are lacking. Cranker et al,3 used marijuana compound to determine the effect of a "normal social marijuana high" on simulated driving performance among experienced marijuana smokers. Their findings suggested that motor performance was not impaired but that "alteration of time and space perception, leading to a different sense of speed generally resulted in driving more slowly" and more errors in speedometer reading. Thus, it appears to adversely affect attention and concentration abilities. Effects are doubtless related to dosage; however, there have been no studies on relating varied dosage to driving tasks. There is no evidence to show a direct correlation between marijuana smoking and crime. Among the population of students, artists, and other more "privileged" users in the United States, there is no recent evidence showing associated criminality. In the famous La Guardia Report of 1940 in New York City, marijuana was, surprisingly, found to be neither criminogenic nor associated with criminal subgroups.4 Marijuana has been described by many sources as potentially addictive or habit-forming. Regardless of the term used, when a person becomes habituated to a drug (marijuana), he/she uses it often and in fairly large amounts. Dependency potential in an individual is probably as important as the drug in the development of the drug dependent state. Actually, among drug users, there appears to be much interchanging of drugs and multihabituation.5 Recommended by World-Health Organization (WHO), the Expert Committee on Mental Health a decade ago, was a combined approach to the problems of alcohol and drug dependence.6 This was done for the following 678

reasons: 1. Similarities in causation and treatment and in the concepts underlying the educational programs required. 2. Drugs, including alcohol, are often used in combination with frequent transfer from one to another. 3. Many studies on alcohol have been carried out that might be applicable to drug abuse, of which much less is known. 4. Although public and official attitudes toward alcoholism have veered toward the therapeutic and away from the condemnatory, this has not yet happened to drug abuse.

Contemporary Dimensions Marijuana is at the forefront of public attention because it is part of the growing use of drugs among teenagers and young people in high schools and on college campuses all over the world. It is even known as the "campus drug." Furthermore, once, like heroin, a drug of the ghetto, its use now predominates among middle-class youth where heroin is practically unknown. This author quoted a study conducted at a West Coast university of 12,200 students, with 540 respondents showing a drug use of 21.1 percent. All of the students listed used marijuana and only 10 percent mentioned using other drugs. Similarly Alli states that "there can be little doubt concerning marijuana being the recreational drug of choice for adolescents in many parts of the world." While many (40 percent) of these students had begun using drugs while in college, nearly one fourth had smoked marijuana before going to college.5 Finally as representative of findings, Blum, in surveying five colleges on the West Coast, found a range of 10 to 30 percent and an average of 18 percent marijuana use. Overall trends would seem to show that college campuses on the West Coast have a high prevalence of marijuana smoking in high schools. Rossi states that it appears in smaller colleges of average academic caliber which are located farther from large urban areas. The use of marijuana and the hallucinogens is significantly lower than in the educational institutions in or near large urban areas.

The Users Little information is specific to the teenager 13 to 18 years of age. The college group including 17 and 18-yearolds has been studied much more and

information relating to this group is interpreted as having relevance. A distinction must be made here between the "heads" who are heavy/chronic users (six or more cigarettes a day) of marijuana and the experimenters, or light/occasional users. Those in latter group usually sooner or later discontinue the practice. They are typically the best students, those who will out of curiosity try new experiences for kicks. The heavy users tend to be those of lower than average or declining academic standing. The personality, as well as opportunity and encouragement, are crucial to continued use. It has been suggested that for a person to continue smoking cannabis after his first experiment, he must have (1) encouragement to persist through trials to obtain expected results; (2) encouragement to regard insults as pleasurable; (3) secondary rewards such as a sense of membership in a subculture; and (4) lack of competing sources of pleasurable experiences not having the disadvantages of cannabis.7 Kandel's study attempted to show a correlation between drug user and the drug use by peers, the hypothesis being that drug use by peers exerts a greater influence than drug use by parents.8 Her findings support the hypothesis. The use of drugs, marijuana primarily, is part of a student subculture strongly characterized by the "hang-loose" ethic and expressed in such other behavior as attending "happenings," reading underground newspapers, and engaging in random sexual intercourse. For such students, smoking marijuana serves as an expression of freedom from society and its unfair laws. In this way it serves much the same purpose that social drinking does for their parents and their law-breaking has the same social sanction as did drinking during Prohibition. It was found that as alcohol use increases, drug use decreases as does adherence to the hangloose ethic. This may also indicate that marijuana is a substitute for alcohol, not a supplement to it. In addition, the author's5 and other studies have shown that males are three times as likely to use marijuana as females and that smoking is most often done in groups.7 It is a social practice, unlike the use of heroin or other hard drugs. Its use compares with adolescent use of alcohol. Who are those who are most likely to become heavy users? Those with

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serious underlying neurotic conflicts or psychotic reactions are in greatest danger of becoming cannabis-dependent heavy users. Such a person may feel cut off from the prevailing culture. Personal problems, or a generally miserable life, especially if the individual sees himself rather than external forces as primarily responsible for his difficulties, might encourage dependence. Eells finds that "as the degree of marijuana usage increases, the importance of curiosity decreases; the importance of escape increases; and the importance of interesting and worthwhile experience as a primary reason for use decreases. Blum states that the best estimate is that experimentation is far more common than regular use and that heavy use (as occurs in Africa and Asia) is quite rare.1 How great a threat is marijuana to the health and wellbeing of young people? The answer must lie within research yet to come. But in the author's opinion, it seems clear that an adolescent in quest of self and new exciting experiences, may turn to a drug with hopes of finding what he seeks. That the use will constitute a threat to his physical, mental, or emotional health depends largely on the degree of his psychological problems and adjustments and the cultural patterns and morals of his peer group. Marijuana may constitute a threat to only a small proportion of users, yet with so many exhilerating life experiences-constructive and pleasurable-available to youth, such artificial "turning on" seems either wastefully unnecessary for the well adjusted, or dangerously delaying of constructive help for the troubled young person.

Treatment The American Medical Association advises the physician that he must identify the basic psychological problems underlying marijuana abuse and be supportive. In this task, he needs the collaboration of others possessing additional pertinent skills. Group help of the AlcoholicsAnonymous type seems to work. Encounter, Inc. is one such nonresidential rehabilitation program for teenage drug users who voluntarily seek this kind of help to break their habit. The program, since 1969, has been located in Greenwich Village in New York. Admitting one's need for love and group acceptance and then being

able to find and give of these feelings in the encounter setting appear to be the basic ingredients of this program. Another approach which combines study and treatment of those involved with dangerous drugs is the University of California Medical Center's new Youth Drug Unit. Correspondence claims that acceptance is voluntary for the stay of about two months. After a few days or weeks of resident treatment, the rest of the time is spent on a daily outpatient basis. But in order for treatment to be effective, a new medical environment must be developed to gain the confidence and trust of young people.

Legal Aspects The first marijuana law in the United States was passed by Congress in 1937. Use of the drug at that time was centered in New Orleans and little was known about it. But scare stories about its leading to a crime wave, prompted Congress to provide stiff penalties of up to five years (later raised to a maximum of 40 years) for any marijuana offense-selling, growing, possessing, or using. No probation was allowed for second offenders and a minimum sentence of five years was mandatory. Since then all states have adopted either this law or have comparably strict penalties. There has been past and is movement to liberalize or abolish laws against marijuana. In September 1967, the most thorough legal attack on antimarijuana laws ever made was launched in Boston. The test case involved the defense of two young college dropouts accused of possession of the drug with intent to sell. Both sides employed expert witnesses, and after a month-long consideration of the nonjury case, the judge then reaffirmed the laws calling marijuana a "harmful and dangerous drug." He did not find the penalties "cruel or unusual." Another blow to those who would like to legalize marijuana came a decade ago when a new international convention on narcotics was adopted by Congress in May 1967. In an atmosphere of controversy regarding the legalization of marijuana, this treaty was quietly passed without a single opponent's testimony being called for or heard. The strongest push given adoption of the treaty was the testimony of then 75-year-old H. J. Anslinger, former US Commissioner for Narcotics

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(a position he held for 32 years), and a formidable foe to any relaxing of legal control of narcotics, including marijuana. Anslinger believes that this treaty, which provides for control of sowing, processing, selling, etc, of drugs throughout the world means that marijuana will never be legalized in the United States. Anslinger's statement began to be disputed and defeated by a liberal public attitude toward marijuana use. In 1976, Dr. Peter Bourne, formerly President Carter's Director of the Office of Drug Abuse Policy testified before a Congressional hearing and affirmed that "present criminal sanctions against marijuana possession are counterproductive . . .the government is not making many cases for people with less than a ton of marijuana." Specifically, current decriminalization laws make simple possession of marijuana a civil infraction, subject to fine-much like a traffic ticket. Decriminalization has been endorsed by both the federal and state governments, and by the American Bar Association, the American Medical Association, and more recently, the National Council of Churches. However, despite such flexibility, many states retain punitive measures for simple possession. The opponent of decriminalization reasoned that lighter penalties will increase pot use and abuse and lead to more arrests and to experiments with more dangerous drugs. Therefore, there should be no point in easing the law. The recent stand of the Drug Enforcement Administration is that each drug violator should be calibrated on class 1, 2, and 3 criteria, based on quantitative indicators (amount and purity of drug seized) and "on the basis of intelligence information on the role of the arrested individual trafficking operation."9 The federal government while scrupulous is taking a more realistic approach to marijuana regulation.

Personal Deliberations Philosophical Value Base Many authorities believe that education, after healthy psychic development, is the most important factor in preventing drug abuse. Sound information upon which rational decisions can be made is important to the adolescent who will, after all, determine whether he takes the risks-physical, emotional, and legal-involved in drug use. 679

Education about drugs should be approached at the earliest toddler years in the context of drugs in the medicine chest and toxic substances around the house which must be handled as potential poisons. Parents and educators can give older children the facts about drugs. Most will appreciate the dangers if they are presented matter-of-factly and will see that it is a sign of maturity to reject rather than use drugs. Let children know the legal consequences of illegal drug use-that it could mean not only a term in ajuvenile institution, but also a limiting of their future life possibilities. Both the public and professionals need education to combat the distortions and misconceptions about marijuana, as there has been much deliberate misinformation "and distortion in the main issue." 10 There is a need for well-done health educational materials, such as films and pamphlets suited to the target population: sophisticated urban college students and suburban high school students. Educators, medical personnel, social scientists, religious leaders, lawyers, legislators, law enforcement agents, and public health workers are among the professionals to be given information about the drugalcohol-problem, including marijuana, so that they can provide factual and effective health education.

Alternative Solutions Public health and social workers can work with legal authorities, federal and state legislators, and the public. Through effective channels they can promote sound laws regulating marijuana which would be compatible with the facts about the "drug-scene" as we know it. This allows for revisions as new knowledge becomes available. Only with informed and interested professionals, working in concert from a common base of knowledge and with an enlightened public, can the necessary revisions in law and order, police procedures, medical practice, and public health programs be brought into significant being. Jessor, in his study of "predicting time of onset of marijuana use," succinctly states that the main factor leading to drug abuse in young people is permissiveness on the part of the parent."l This statement is echoed over and over again by those concerned with 680

the growing drug problem among youth. Adults, uncertain about setting limits for their children, tend to avoid establishing discipline and enforcing rules. This ultimately leads to more tolerance of deviance, less parental control and support, and more peer influence. It is this author's contention that parents, overly concerned with acquiring, spending, advancing economic and social position, or just following their own pursuits, simply abdicate the parental responsibility of discipline. Freedom, independence, and affluence without disciplined guidelines can be potent negative combinations for development of responsible and mature behavior in adolescence. Parents must afford a solid, unique bond which benefits children. This is the virtue of the family triangle from which children can learn. One can learn the value of love and the feelings parents have for one another. Later, this ability to love is reawakened and transferred to the next generation-"the love affiar bit -resulting in a real involvement or preoccupation. Adolescence can be a most difficult stage of life. Adolescents are preoccupied with the present, partly because they have not yet made the transition to adulthood. They have the energies and capacities to function as adults and to get involved in adult problems, and at the same time have the strength to ignore everything asked of them by adults. In short, not only must parents show their teenagers that they love and care by setting and enforcing reasonable standards of behavior, but also by showing honest interest in them, their activities, and their ideas. Parents must take time and make efforts to listen to their children and become genuinely involved in a dialogue to get to know them and their concerns. The task of an adolescent is to come to his own conclusion about the meaning of life and how society functions. Preparing for this is a dilemma. This is where the parent is greatly needed in helping them recognize the challenge and pleasure of a successful transition to adult life.

Public Health Recommendation It is a goal of public health to effectively reduce the incidence of marijuana abuse as a lifestyle choice,

especially among adolescents whose life patterns are not firmly set, by

providing them and their parents with: 1. accessible, up-to-date information about the law and the illegality surrounding marijuana, so that use and abuse choices can be made from knowledge rather than ignorance; 2. definitions of the responsibility of both the physician and the public; 3. systematic ways of identifying and changing self-defeating behaviors (of which marijuana abuse is one) and fostering self-management, and personal and family responsibility; 4. means of identifying resources within and without the community that enhance positive decision-making, problem-solving attitudes and communication skills. Basic research is of grave importance to gather epidemiological data on function and dysfunction, and consequences of marijuana use. The National Institute of Mental Health (NIMH) and local community health agencies could identify gaps in existing knowledge of marijuana-medical and social aspects of use and abuse, pharmacodynamic, relationship to crime and aggressive behavior in social and anti-social activities, driving, and use of other drugs. The NIMH should devise and execute a plan of research to be carried out in laboratories, schools, and communities and attempt to disseminate the findings. Literature Cited 1. Blum RH, Funkhouser-Balbaky ML: Mind-altering drugs and dangerous behaviors: Dangerous drugs. Task Force Report: Narcotics. 1972; 21-26 2. Marijuana: A signal of understanding. In National Commission on Marijuana and Drug Abuse: Washington, DC. First Report. Government Printing Office, 1972, p 57 3. Cranker A Jr, Dille JM, Delay JC, et al: Comparison of the effects of marijuana and alcohol on simulated driving performance. In Stanley Grupp (ed): Marijuana. Columbus, Ohio. Charles Merrill, 1971, pp 206-207 4. Mayor's Committee on Marijuana, New York City. The Problem of Marijuana in the City of New York. Lancaster, Jacques Cattell, 1944, p 35-51 5. Alli BA: Ganja in the tropics: Student drug users. Read before the American Family Movement on Family Response to Drug Problem. Pittsburgh, PA, Dec 16, 1977 6. In World Health Organization, Expert Committee on Mental Health: Report: Services for the Prevention and Treatment of Dependence on Alcohol and Other Drugs. United Nations Series No. 363, 1967, pp 5-45 7. Becker H: On becoming a marijuana user. In Stanley Grupp (ed): Marijuana. Columbus, Ohio. Charles Merrill, 1971, pp 29-144 8. Kandel K: Adolescent marijuana use: Role of parent and peers. Science 181:10671069, 1973 9. Moore MH: Buy and Bust. Lexington, Mass, DC Heath, 1977, p 202 10. Seiden R, Tomlinson K, et al: Patterns of marijuana use among public health students. Am J Public Health 65(6):616, 1975 11. Jessor R: Predicting time of onset ot marijuana use: A developmental study of high school youth. J Consult Clin Psychol 44(1):133, 1976

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