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Weil was using marijuana himself. He made several reflections on its effects. But when he looked for exact information, he discovered that serious research had not been performed. He decided to do it himself.
He encountered substantial problems. The authorities feared he could turn the participant into dope fiends and hesitated for half a year before giving their consent. He also met difficulties in obtaining controlled marijuana for the experiments. But one of his teachers, the psychiatrist Norman Zinberg, joined in with him, and they finally could start the project.1
Among the participants, 8 were marijuana smokers and 9 non-users. Many of those having no previous experience with marijuana sensed they were smoking something different from ordinary tobacco. But they did not become "high" and did not evaluate the effects as pleasant.From an objective point of view, the effects would be the same in marijuana smokers and the non-users. Still, the subjectively experienced effect was totally different. The outcome confirmed the conclusion which the sociologist Becker had made some years before (chapter 4): Althoughthe inherent effects of cannabis are not very pleasant, people may learnto appreciate the feeling of" being different" which the effects bring about.
Labelling the effects as "being high" was also not a natural phenomenon. But non-specific internal cues may be interpreted, as the epinephrine study had shown (chapter 4).
Some years later, Weil draws parallels between intoxicants and so-calledactive placebos (chapter 4):2
"To my mind, the best term for marijuana ia active placeco - that is, a substance whose apparent effects on the mind are actually placebo effects in response to minimal physiological action. Pharmacologists sometimes use active placebos (in contrast to inactive placebos like sugar pills) in drug testing, for example, nicotinic acid, which causes warmth and flushing, has been compared with halluciogens in some laboratory experiments. But pharmacologists do not understand that all psychoactive drugs are really active placebos since the psychic effects arise from consciousness, elicited by set and setting, in response to physiological cues.
Thus, for most marijuana users, the occasion of smoking a joint becomes an opportunity or excuse for experiencing a mode of consciousness that is available to everyone all the time ... Not surprisingly, regular marijuana users often find themselves becoming high spontaneously."
"The results indicate that previous experience (with the substance) is a socialization process where the individual learns to identify and label the influence as being "high"".Not all researchers have concluded that the intoxicant is a necessary prerequisite for the experience of being "high". Psychiatrist in San Francisco and New York found that marijuana users became equally high from placebo as from marijuana, even though the active marijuana dose was quite significant.5 ,6 ,7 ,8 They concluded that "high" is learned and that it is triggered more by smell and taste than the active substance in marijuana, THC.
"The judgment of being "high" may be a function of interpretation, not of the symptoms as such. The response to marijuana is at least partly based upon pharmacology, but the interpretation of the symptoms which constitute the reaction is a vital factor in determining whether the individual is "high" or merely forgetful, light-headed etc."
Two groups of researchers studied the importance of the smoking ritual for experienced marijuana smokers.9 ,10 The intoxicant (marijuana extract or THC) was ingested by the mouth and compared to placebo. As cannabis is easily absorbed in the intestines, the chemical influence was the same as by smoking. But when the intoxicant was taken without the usual ritual, marijuana smokers felt the effects were only unpleasant.
A peculiar aspect of drug taking is the varying expectancies of the individual users. A Canadian group first recorded the individuals' expectancies about probable effects.11 Then they studied each individual's reaction upon marijuana. The reaction was highly influenced by the individual's initial expectations.
Another Canadian group demonstrated that after being instructed to stay "sober" during smoking, even characteristic effects as increased heart rate and erroneous judgment of time were absent.12
As with other intoxicants, different user groups experience very different psychological effects.
When USA prohibited marijuana in the thirties, an important argument was that marijuana made the (mainly Mexican) users aggressive. But now, one of the arguments against marijuana is that it makes the users passive. Cannabis intoxication is now often characterized by silent, introvert meditation.
Nevertheless, some street addicts claim cannabis to be a disinhibitor, while American college students seldom claim this. Within North America, significant differences have been demonstrated between effects on users in Montreal and users in California.13 Users mostly became introvert in Montreal and extrovert in California. Other researchers have reported that in some cultures, marijuana intoxication is characterized by aggression and transgression of norms, in others by quiet and peaceful behavior.14
It is also noteworthy that the many people who used cannabis as a medical drug in the 19th and the 20th century, obviously did not discover the ability of cannabis to make people "high".
Eighty young hospital employees were given amphetamine and placebo.The following year, Danish physicians made another study:16
More than half of those who got amphetamine, reported positive effects like feelings of increased energy and strength. A reduction in the need for sleep was reported as positive by some, while others reported they were bothered by sleep disturbances.
Twenty eight per cent of the participants considered the effect as more pleasant than placebo, while 18 % thought it was less pleasant. Positive effects were increased energy and well-being. The negative effects were restlessness, anxiety and insomnia.These findings were confirmed in further studies.17 ,18 At the start of the 2nd world war, it was an established fact that amphetamine reduces fatigue and the need for sleep. This was utilized in warfare. 180 million tablets were administered to American soldiers and 72 million to British soldiers. It was also used by Japan and Germany.19 ,20
After the war, amphetamine was used by many people when facing extraordinary efforts. It was common during preparation for exams, during night-time work and as "doping" at sport competitions. Later on, it was used as a slimming agent.
In the post-war period, users of amphetamine were ordinary people and nobody classified it as a dangerous drug. Nowadays, several people are highly surprised to hear that the stimulant Benzedrine, which they took during hard work in the forties or fifties, was identical with the present "hard drug" amphetamine.
Not all subsequent experiments confirmed that most people experience the effects of amphetamines as pleasant.21 ,22 But the dominating tendency is clearly positive.23 ,24 ,25 ,26 ,27 ,28 In one experiment, amphetamine was compared to morphine, heroin, a sleeping medicine and placebo.29 Amphetamine was the only drug which several of the participants said they gladly would take again.
The placebo studies of amphetamine are numerous and are especially reliable because most participants have no prior experience with the drug. Thereby, learned effects are eliminated.
Cocaine has been far less studied. In addition, most participants in experiments have been experienced cocaine users. In these studies, learned effects have been difficult to separate from the properties of the drug itself. But different types of research show that the effects of cocaine resemble the effects of amphetamine. Among other evidence, it has been shown by a placebo study:30
Experienced cocaine users were given amphetamine, cocaine and placebo by intravenous administration. The participants met great difficulties in discriminating the effects of amphetamine from those of cocaine. They experienced both drugs as pleasant.An experiment which administered cocaine to depressed psychiatric patients did not demonstrate favorable effects.31
The conclusion must be that amphetamine is experienced as pleasant and positive in a large proportion of people given the drug. The drug leads to a feeling of increased energy and often enhanced performance as measured by testing. Some people feel the drug is unpleasant because of restlessness, anxiety and sleep disturbances.
Cocaine seems to have largely the same effects.
The masking of symptoms of over-exertion may be dangerous. Amphetamine-using athletes and bicyclists have died during competitions.
Although certain drugs have favorable effects, this does not necessarily mean that these effects explain the addicts' use of the drugs.
We easily understand the attraction of amphetamine for an individual facing an extraordinary effort, just like diazepam (Valium) is taken to cope with anxiety. But only in exceptional cases32 is it the motive for an addict to achieve the drug's pharmacological effects (as established by research). Drug addicts most often take their drugs in other to "get high", "get a kick" and other vague labels intended to describe subjective experiences. In addition, drug-using subcultures produce colorful folklore on the drugs' effects, attributing varied and splendid effects to the drug.
There is an enormous difference between the scientifically established effects of a drug and labeling the effects as "being high" or "getting a kick". Soldiers using amphetamine during the last world war and students taking amphetamine before exams felt they became less tired and exhausted. They did not perceive the effects as more than just this. Classifying the effects as "highs" is a far more global and totally different phenomenon.
Labeling the drug as a substance giving "highs" or "kicks" links it to our culture's ideas about self-intoxication with drugs. The labeling establishes a link between amphetamine and alcohol, heroin and other substances which virtually have opposite effects. This is a highly unnatural link. There are no scientific basis to explain how the same people should consider as enjoyable these highly different drugs.
A female drug addict says:
"Last winter there was trouble in the supply of hash. So, I used amphetamine instead."Considering the chemical properties of the drugs, this corresponds to substituting penicillin with potatoes. The drugs have no pharmacological characteristics in common, merely a culturally learned idea that both drugs lead to "getting high".
The Department of Anesthetics at Harvard Medical School recorded the reactions in 386 patients receiving morphine. Only 3 reported something which might be labeled "euphoria". This finding led to an investigation of the psychological effects.33
In a pretest, 9 persons received morphine, heroin and amphetamine. The reports did not match the text-books: Opiates gave no "euphoria".The findings correspond to Becker's and Weil's findings with marijuana: People may grow accustomed to a chemical influence which is basically unpleasant.
In a more comprehensive study, the same three drugs were given in addition to a sleeping pill (a barbiturate) and placebo. The drugs were administered by intravenous injection to 80 persons, who belonged to one of three groups: Healthy, ill patients and addicts.
The majority of participants classified the effects of amphetamine as positive. Placebo and the sleeping pill were characterized as neutral. Morphine and heroin were largely classified as unpleasant, except by the addicts. Very few would consider taking them again - most of the participants would rather have placebo!
During the next years, more studies were published:34 ,35
Patients suffering from pain were given morphine, codeine or placebo. Psychological side-effects were particularly scrutinized. Morphine was clearly perceived as negative and worse than placebo.In every study, there has been a small minority claiming the opiate effect was pleasant.36 Is it feasible that the morphinist and the heroinist have a physical abnormality which accounts for his positive attitude towards the drug effects? In theory, this might apply to the few isolated abusers of medical drugs, but not to street addicts. Lots of people try the drugs once or twice and choose not to use them. Those who go on to become drug users, are those giving a positive answer to the crucial question: "Did you want to be together with those who used the drug?" Those who do not want to join the drug-using culture, seldom classify the effect as attractive.
In another study, 20 healthy college students were given injections with morphine, heroin and placebo. More than 90 % found the psychological effects of opiates were unpleasant. Again, the drugs were judged as more unpleasant than placebo.
This not only applies to opiates, but to most drugs of abuse - stimulants seem to be the only exception. Thus, recruitment to drug-using cultures is obviously based more on social than on biological criteria.
The number of studies of the research on psychological effects of opiates is limited. The studies do, however, seem to have a sound methodology. In most cases, participants had no previous experience with the drug and could hardly have been influenced by social learning.
The studies demonstrate conclusively that opiates are normally perceived as having unpleasant psychological effects. This conforms well with the wll-known fact that only a very small proportion of medical patients receiving opiates, want to continue use when the medical indication is absent. A university hospital in Boston reported that among 11 882 patients who were given morphine or other opiates, only four - 4 - became addicted.37
Drug addicts learn that opiates make you "high" or give you a "kick". But patients receiving morphine (in Britain, heroin is also prescribed) only expect relief of pain and do not experience more than that, except side-effects, most often nausea.
Different groups of drug users have different expectations and experience different psychological effects. The expectancies serve as self-fulfilling prophecies.
The most well-known hallucinogenic drug is LSD, synthesized during world war II and tested on humans a few years later. The drug tends to leave a strong impression on the user. But exactly which psychological effects LSD and other hallucinogenic drugs have, varies even more than the effects of other drugs. Effects seem to be extremely dependant on the set and setting.38
The question has been raised whether LSD itself has any psychic effects at all. But the drug obviously gives a strong feeling of change, of being different, while the interpretation of the effect is more determined by situation, personality and expectations.
A blind test with participants lacking experience with LSD, confirmed that the drug may trigger numerous psychic symptoms.39 Most participants found the effects were unpleasant.
Valium (diazepam) is a very popular drug in drug-using cultures. But in blind tests, most participants prefer placebo to Valium.40 ,41
Another group of substances which during the last few decades has achieved the status of being an attractive intoxicant, are the organic solvents (inhalants). Youngsters around puberty are the most frequent users. Their loud-voiced loss of inhibitions is often very visible and audible.
Although research has not been carried out, there are numerous "natural experiments".
Inhalation of solvents was common long before teenagers started sniffing. The big "sniffers" in our society are the professional house painters. They get symptoms of both long-term (chronic) and short-term (acute) intoxication with the very same solvents as youth use for sniffing.
Painters sometimes inhale large quantities of solvents. It may happen during the application of spraying paint and when they are working in inadequately ventilated rooms, within tanks etc. Other "sniffers" in construction use solvent-containing glue in large amounts to fix floor covering or other objects.
Craftsmen in these professions know the symptoms of solvent inhalation very well. They feel misty and sick and have a most unpleasant time. Sometimes they have to cease working because of the symptoms.
These craftsmen have neither experienced that solvents are disinhibitors nor that they give a pleasant intoxication. They do not expect getting "high" and consequently do not perceive the unpleasant effects as "being high".
Before inhalation of solvents became widespread in the sixties, another intoxicant was used by teenagers in Europe and North America. The intoxicant was a mixture of Coca Cola and aspirin. The mixture produced a "good mood" and loss of inhibitions. Some people considered this with a patronizing smile, saying the mixture did not induce a "real high".
What, then, is peculiar about the Coke-aspirin-intoxication? Is not getting "high" and "kicks" a learned phenomenon for other intoxicants as well?
There is an interesting difference: As opposed to other intoxicants,
Coke-aspirin did not induce distinct inner effects producing a sense of
"being different", effects which might be interpreted as "highs" or "kicks"
by user groups who have learnt it. Coke-aspirin can only give pure expectancy
effects, not learned interpretations of real bodily effects.
1.Weil,AT et al (1968): Clinical and Psychological Effects of Marijuana in Man. Science 162:1234-1242.
2.Weil,A (1972): The Natural Mind. Houghton Mifflin, Boston.
3.Carlin,AS et al (1972): Social Facilitation of Marijuana Intoxication: Impact of Social Set and Pharmacological Activity. J Abn Psychol 80:132-140.
4.Carlin,AS et al (1974): The Role of Modeling and Previous Experience in the Facilitation of Marijuana Intoxication. J Nerv Ment Dis 159:275-281.
5.Jones,RT & Stone,GC (1970): Psychological Studies of Marijuana and Alcohol in man. Psychopharmacol (Berlin) 18:108-117.
6.Jones,RT (1971): Tetrahydrocannabinol and the Marijuana-Induced Social "High", or the Effects on the Mind of Marijuana. Ann NY Acad Sci 191:155-161.
7.Jones,RT (1971): Marijuana-Induced "High": Influence of Expectation, Setting and Previous Drug Experience. Pharmacol Rev 23:359-369.
8.Galanter,M et al (1974): Marijuana and Social Behavior. A Controlled Study. Arch Gen Psychiat 30:518-521.
9.Jones,RT & Stone,GC (1970): Psychological Studies of Marijuana and Alcohol in Man. Psychopharmacol (Berlin) 18:108-117.
10.Waskow,IE et al (1970): Psychological Effects of Tetrahydrocannabinol. Arch Gen Psychiat 22:97-102.
11.Stark-Adamec,C et al (1981): The Subjective Marijuana Experience: Great Expectations. Int J Addict 16:1169-1181.
12.Cappell,HD & Pliner,PL (1973): Volitional Control of Marijuana Intoxication: A Study of the Ability to "Come Down" on Command. J Abn Psychol 82:425-434.
13.Adamec,C et al (1976): An Analysis of the Subjective Marijuana Experience. Int J Addict 11:295-307.
14.Rubin,C (ed.): Cannabis and Culture. Mounton Publ., Haag.
15.Bahnsen,P et al (1937): The Central Actions of Beta-aminopropylbenzene (benzedrine). Clinical Observations. JAMA 108:528-531.
16.Bahnsen,P et al (1938): The Subjective Effects of Beta-phenylisopropylaminsulfate on Normal Adults. Acta Med Scand 97:89-131.
17.Jacobsen,E & Wollstein,A (1939): Studies on the Subjective Effects of the Cephalotrophic Amines in Man. I. Beta-phenylisopropylamine Sulfate. Acta Med Scand 100:159-187.
18.Barmack,JE (1940): The Effect of Benzedrine Sulfate upon the Report of Boredom and Other Factors. J Psychol 5:125-133.
19.Morgan,JP (1980): Amphetamine. P.167-184 in Lowinson,JR & Ruiz,P (eds.): Substance Abuse. Clinical Problems and Perspectives. Williams & Wilkins, Baltimore & London.
20.Gossop,M (1982): Living With Drugs. Temple Smith, London.
21.Weiss,B & Laties,VG (1962): Enhancement of Human Performance by Caffeine and the Amphetamines. Pharmacol Rev 14:1-36.
22.Ross,S et al (1962): Drugs and Placebos: A Model Design. Psychol Rep 10:383-392.
23.Smith,GM & Beecher,HK (1960): Amphetamine, Secobarbital and Athletic Performance. II. Subjective Evaluations of Performance, Mood and Physical States. JAMA 172:1502-1514.
24.Laties,VG (1961): Modification of Affect, Social Behavior and Performance by Sleep-deprivation and Drugs. J Psychiat Res 1:12-25.
25.Lanzetta,JT (1956): The Effects of "Anxiety-Reducing" Medication on Group Behavior Under Threat. J Abnorm Soc Psychol 52:103-108.
26.Lyerly,SB et al (1964): Drugs and Placebos: The Effects of Instructions upon Performance and Mood under Amphetamine Sulfate and Chloral Hydrate. J Abn Soc Psychol 68:321-327.
27.Johanson,CE & Uhlenhuth,EH (1980): Drug Preference and Mood in Humans: d-amphetamine. Psychopharmacol 71:275-279.
28.de Wit,H, Uhlenhuth,EH & Johanson,CE (1986): Individual Differences in the Reinforcing and Subjective Effects of Amphetamine and Diazepam. Drug Alc Depend 16:341-360.
29.Lasagna,L et al (1955): Drug-Induced Mood Changes in Man. I. Observations in Healthy Subjects, Chronically Ill Patients, and Post Addicts. JAMA 157:1006-1020.
30.Fischman,MW et al (1976): Cardiovascular and Subjective Effects of Intravenous Cocaine Administration in Humans. Arch Gen Psychiat 33:983-989.
31.Post,RM et al (1974): The Effects of Cocaine on Depressed Patients. Am J Psychiat 131:511-517.
32.Khantzian,E (1985): The Self-Medication Hypothesis of Addictive Disorders: Focus on Heroine and Cocaine Dependence. Am J Psychiat 142:1259-1264.
33.Lasagna,L et al (1955): Op.cit.
34.Gravenstein,JS et al (1956): Dihydrocodeine. Further Development in Measurements of Analgesic Power and Appraisal of Psychologic Side Effects of Analgesic Agents. N Engl J Med 254:877-885.
35.Smith,GM & Beecher,HK (1962): Subjective Effects of Heroine and Morphine in Normal Subjects. J Pharmacol Exper Ther 136:47-52.
36.McAuliffe,WE (1975): A Second Look at First Effects: The Subjective Effects of Opiates in Addicts. J Drug Issues 5:369-399.
37.Porter,JC & Jick,H (1981): Addiction Rare in Patients Treated With Narcotics. N Engl J Med 302:123.
38.Wallace,AFC (1959): Cultural Determinants of Response to Hallucinatory Experience. Arch Gen Psychiat 1:58-69.
39.Kornetsky,C et al (1957): Comparison of Psychological Effects of Certain Centrally Acting Drugs in Man. Arch Neur Psych 77:318-324.
40.de Wit,H, Uhlenhuth,EH & Johanson,CE (1986): Individual Differences in the Reinforcing and Subjective Effects of Amphetamine and Diazepam. Drug Alc Depend 16:341-360.
41.Johanson,CE & Uhlenhuth,EH (1980): Drug Preference and Mood in Humans: Diazepam. Psychopharmacol 71:269-273.
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