with approved conduct, we avoid analyzing the motivations of similar behaviors.

As noted earlier, we do not verbalize the motivation for alcohol use in terms of pleasure but rather in terms of the drug's function as a relaxant, as a social lubricant, and as a beverage. We do not think about the alcohol experience as an altered state of consciousness but rather as a means to some other end, such as promoting conviviality or stimulating conversation.

Within the medical setting, the individual is increasingly making the decision to use medically approved drugs and selecting them according to their capacity to alter his mood. The National Survey shows that 15% of the adult population reported that they "take a pill to calm down or cheer up" when they feel "out of sorts . . . not really sick, but nervous, or depressed or under stress." Eighteen percent of the public reported that they used alcohol for similar purposes. The use of a variety of new mood altering drugs to cope with stress is undoubtedly a significant social development, particularly among women. This option to employ drugs for what is essentially an individual diagnosis of felt needs has, to a large extent, changed public perception concerning the role of the drugs as mood alterants in our society.

Whatever the biological and psychological foundations for the common human desire to alter consciousness, policy makers must recognize that drugs have always been used for this purpose. Most societies have institutionalized at least one form of drug-induced mood alteration; only the drugs differ, not the essential purpose. Instead of assuming that mood alteration through some drugs is inherently objectionable, while similar use of others is not, the public and its leaders must focus directly on the appropriate role of druginduced mood alteration. It is no longer satisfactory to defend social disapproval of use of a particular drug on the ground that it is a “mind-altering drug" or a "means of escape." For so are they all.

Drugs and Individual Responsibility

Implicit in present policy is the concern that many individuals cannot be trusted to make prudent or responsible decisions regarding drug-taking. Certain drugs are thought to possess even greater powers than they have, including the capacity to overbear individual will. Most people are not accustomed to thinking about drug effects in terms of probabilities and uncertainties, of dose-response curves, of multiple effects (some desirable and some undesirable), of reactions which vary from individual to individual and from time to time in the same individual.

the individual's capacity to control his behavior is reflected in hypotheses such as "drugs cause crime" or "drugs cause dropping out” or "drugs cause mental illness." Any perceived correlation between use of the drug and the unwanted consequence is attributed to the drug, removing the individual from any and all responsiblity. Similarly, while it is true that certain drugs offer more intense psychological rewards than others, seduction characteristics are attributed to all psychoactive drugs, suggesting a chain of progression from light to heavy use, from weak to stronger drugs, all without the intervention of individual choice.

A drug has no effect until it interacts with an organism. The effects of any drug, psychoactive drugs included, are mainly dose related. At low or moderate doses they are determined mainly by non-drug factors, such as the psychological characteristics of the individual, the reasons why he uses the drug, what he expects the effects will be, the physical and social setting in which he uses it, and how he perceives its use or non-use in relation to self-defined goals. Further, how his friends, his sub-culture, and his society define and respond to his drug use are equally important factors. These psychological and social criteria not only influence the reaction to a specific drug but they are key factors in determining use or non-use, selection of substance, and the pattern and circumstances of use.

An Overview of the Present Response

Because of this confusion about objectives, the formal institutional response to the drug problem has been more reflexive than rational, more situation-oriented than strategic. The ad hoc responses to use of specific psychoactive drugs have interfered with examination of the fundamental questions relating to behavior patterns and the appropriate means of social control.

Research has provided us with an almost endless stream of psychoactive substances. The tendency is to identify a new substance, determine its potential hazards as a chemical and then to insert it into the existing system. This procedure tends to perpetuate the public focus on the drugs rather than on the prevention of behavior about which society is concerned. When the drug appears in the streets, as it inevitably does, social institutions respond as if the behavior was unanticipated, and because they are ill-prepared to deal with the situation, an atmosphere of crisis is generated.

Because the focus has always been on the elimination of prohibited substances altogether and on the elimination of the street use of therapeutically useful drugs, social institutions have directed primary at

tention to the problem of use of specific drugs. Patterns of drug-using behavior have been ignored except as an afterthought of intervention. When increases in prohibited drug use continue to escalate, policy makers respond, not by reassessing the problem from different perspectives, but rather by pressing for ever-more costly mechanisms of control; costly both in terms of resources and important social values. Drug policy can be thus summed up: increased use of disapproved drugs precipitates more spending, more programs, more arrests and more penalties, all with little positive effect in reducing use of these drugs.

Details of the present institutional response share the confusion of purpose which characterizes the entire social response. We will sketch a few of the key features here although these matters will be considered in some depth in Chapter Four.

Risk-Education

An important operating assumption of the present response is that if people are educated about the risks of drug taking, they will not use drugs. It is presumed that presentation of information regarding dangers and risks can quiet curiosity and the desire for anticipated pleasant psychological sensations, the factors which account for most individual drug experiences.

Society's experience in attempting to discourage use of substances not labeled as drugs is instructive. Campaigns have been mounted in the past, both through the mass media and the schools, about the dangers of alcohol use and cigarette smoking. Facts have been marshaled, scientific opinion has been mobilized, and the adverse consequences of use of these drugs have been amply demonstrated by the number of alcoholics within the United States and the number of persons dying yearly from heart disease, lung cancer and other respiratory ailments. Still the consumption of alcohol continues and the number of persons smoking cigarettes increases.

This same kind of educational effort has been directed at the illicit drugs with no apparent impact on behavior. Little insight has been gained as to why this approach has not worked with alcohol and cigarettes, or as to whether risk-oriented curricula may actually arouse interest rather than dampen it. Further, assuming that such programs might be useful, little thought has been given to how to transmit the information, the assumption again being that the facts speak for themselves. This vast expenditure of time, money and effort has apparently paid few measurable social dividends, and those that have claimed success have done so not on the basis of scientific proof, but on the basis of impressions and anecdote.

If information about risks and moral suasion is insufficient to convince many people not to use drugs, it is assumed that the threat of a criminal sanction will do so. While a criminal proscription does function as a deterrent to some degree for all behavior, the strength of this factor varies according to the nature of the offense, the characteristics of the actor, the probability of detection and the certainty of punishment. With regard to drug consumption, all of these factors diminish the utility of the criminal sanction. Drug consumption is an expressive conduct which normally occurs in private among groups which are least influenced by legal condemnation. In addition, the consumption-related offenses are no longer supported by the strong social consensus which once existed, and the emerging ambivalence is reflected in the dispositional decisions of police, prosecutors and

courts.

4

We note that drug consumption offenses have not been remarkably successful in curtailing use in general. However, it is important here, as elsewhere, to distinguish between different patterns of drugtaking behavior. On the one hand, the law may deter indiscrete use and continued use of a prohibited drug. On the other hand, experimental behavior, particularly by youth, is unlikely to be deterred by the law alone. For those who are dependent upon prohibited drugs, such as the heroin-dependent person, the deterrence concept is functionally inapplicable.

Sickness

Anyone choosing to use drugs, despite the enumerated risks, moral suasion and threat of criminalization, is often considered abnormal, emotionally ill and weak of character. The last decade has seen the pendulum of legislative opinion swing toward the belief that drug dependence and even drug use is a "medical" problem, that it can be "treated," and that the user can be "rehabilitated." Like many ideas which aim to correct those previously in vogue, the medical approach has itself become a runaway concept. Policy makers have adopted policy guidewords such as "treatment," "rehabilitation," "contagion," and "epidemic," without regard to their utility in the present context. The "sickness" label has been attached to all users of prohibited drugs without regard to their patterns of drug-taking behavior. While

Throughout this Report, consumption-related offenses will refer to offenses such as use, possession for personal use, presence in a place where prohibited drugs are being used. Unless stated otherwise, "possession" means possession for personal use.

very few question that persons compulsively using drugs are in need of some form of therapeutic assistance, the same is rarely true for the experimental and recreational user. To label drug users in general as mentally ill is to place a large segment of American society in need of formal medical assistance.

With regard to drug dependence in particular, the public has been led to believe that this condition is as definable and treatable as ordinary illnesses of the body. In reality, there is not, at the present time, any generally applicable cure for drug-dependent persons let alone non-dependent users of drugs. "Success" in treatment programs has been difficult to define, reflecting the complex relationship between drug use, social functioning and mental health. Even when measured against their own criteria for evaluation, most treatment programs can demonstrate only limited "success."

Public policy is committed to the treatment and rehabilitation of all drug-dependent persons. While thousands of persons have been aided by treatment efforts in recent years, social objectives continue to outstrip professional understanding of the condition and official capacity to deliver the necessary services.

Perpetuating the Problem

Because of the intensity of the public concern and the emotionalism surrounding the topic of drugs, all levels of government have been pressured into action with little time for planning. The political presures involved in this governmental effort have resulted in a concentration of public energy on the most immediate aspects of drug use and a reaction along the paths of least political resistance. The recent result has been the creation of ever larger bureaucracies, ever increasing expenditures of monies, and an outpouring of publicity so that the public will know that "something" is being done.

Perhaps the major consequence of this ad hoc policy planning has been the creation, at the federal, state and community levels, of a vested interest in the perpetuation of the problem among those dispensing and receiving funds. Infrastructures are created, job descriptions are standardized, "experts" are created and ways of doing business routinized and established along bureaucratic channels. During the last several years, drug programming has become a multi-billion dollar industry, one administering to its own needs as well as to those of its drug-using clientele. In the course of well-meaning efforts to do something about drug use, this society may have inadvertently institutionalized it as a never-ending project.

All of these responses stem from one fundamental flaw in present drug policy: the problem is defined incorrectly. The uneasiness which the Commission has encountered among thoughtful observers and