• TABLE OF CONTENTS
HIDE
 Title Page
 Acknowledgement
 Preface
 Table of Contents
 Abstract
 Previous research and writing on...
 The urban setting of the study
 The study sample
 Marihuana in Costa Rica
 Smoking "set" and effects
 Marihuana and the life cycle
 Other attributes of amotivational...
 Glossary
 Appendix
 Bibliography
 Biographical sketch














Title: Costa Rican marihuana smokers and the amotivational syndrome hypothesis /
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Permanent Link: http://ufdc.ufl.edu/UF00097512/00001
 Material Information
Title: Costa Rican marihuana smokers and the amotivational syndrome hypothesis /
Alternate Title: Amotivational syndrome hypothesis, Costa Rican marihuana smokers and the
Physical Description: xii, 309 leaves : ill. ; 28 cm.
Language: English
Creator: Page, John Bryan, 1947-
Publication Date: 1976
Copyright Date: 1976
 Subjects
Subject: Marijuana -- Psychological aspects   ( lcsh )
Motivation (Psychology)   ( lcsh )
Anthropology thesis Ph. D   ( lcsh )
Dissertations, Academic -- Anthropology -- UF   ( lcsh )
Genre: bibliography   ( marcgt )
non-fiction   ( marcgt )
 Notes
Thesis: Thesis--University of Florida.
Bibliography: Bibliography: leaves 299-307.
Additional Physical Form: Also available on World Wide Web
General Note: Typescript.
General Note: Vita.
Statement of Responsibility: by John Bryan Page.
 Record Information
Bibliographic ID: UF00097512
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: alephbibnum - 000210265
oclc - 04185960
notis - AAX7086

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Table of Contents
    Title Page
        Page i
        Page i-a
        Page ii
    Acknowledgement
        Page iii
        Page iv
        Page v
    Preface
        Page vi
        Page vii
        Page viii
    Table of Contents
        Page ix
        Page x
    Abstract
        Page xi
        Page xii
    Previous research and writing on "amotivational syndrome"
        Page 1
        Page 2
        Page 3
        Page 4
        Page 5
        Page 6
        Page 7
        Page 8
        Page 9
        Page 10
        Page 11
        Page 12
        Page 13
        Page 14
        Page 15
        Page 16
        Page 17
        Page 18
        Page 19
        Page 20
        Page 21
        Page 22
        Page 23
        Page 24
        Page 25
        Page 26
        Page 27
        Page 28
        Page 29
        Page 30
        Page 31
        Page 32
        Page 33
        Page 34
        Page 35
        Page 36
        Page 37
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        Page 40
        Page 41
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        Page 44
        Page 45
        Page 46
        Page 47
        Page 48
        Page 49
        Page 50
        Page 51
        Page 52
        Page 53
    The urban setting of the study
        Page 54
        Page 55
        Page 56
        Page 57
        Page 58
        Page 59
        Page 60
        Page 61
        Page 62
        Page 63
        Page 64
        Page 65
        Page 66
        Page 67
        Page 68
        Page 69
    The study sample
        Page 70
        Page 71
        Page 72
        Page 73
        Page 74
        Page 75
        Page 76
        Page 77
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        Page 79
        Page 80
        Page 81
        Page 82
        Page 83
        Page 84
        Page 85
        Page 86
        Page 87
        Page 88
    Marihuana in Costa Rica
        Page 89
        Page 90
        Page 91
        Page 92
        Page 93
        Page 94
        Page 95
        Page 96
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        Page 121
        Page 122
        Page 123
        Page 124
        Page 125
        Page 126
        Page 127
        Page 128
    Smoking "set" and effects
        Page 129
        Page 130
        Page 131
        Page 132
        Page 133
        Page 134
        Page 135
        Page 136
        Page 137
        Page 138
        Page 139
        Page 140
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        Page 209
        Page 210
        Page 211
        Page 212
        Page 213
        Page 214
        Page 215
        Page 216
    Marihuana and the life cycle
        Page 217
        Page 218
        Page 219
        Page 220
        Page 221
        Page 222
        Page 223
        Page 224
        Page 225
        Page 226
        Page 227
        Page 228
        Page 229
        Page 230
        Page 231
        Page 232
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        Page 255
        Page 256
        Page 257
        Page 258
        Page 259
        Page 260
        Page 261
        Page 262
    Other attributes of amotivational syndrome: An overall assessment
        Page 263
        Page 264
        Page 265
        Page 266
        Page 267
        Page 268
        Page 269
        Page 270
        Page 271
        Page 272
        Page 273
        Page 274
        Page 275
        Page 276
        Page 277
        Page 278
        Page 279
        Page 280
        Page 281
        Page 282
        Page 283
        Page 284
        Page 285
        Page 286
        Page 287
        Page 288
        Page 289
        Page 290
        Page 291
        Page 292
        Page 293
    Glossary
        Page 294
        Page 295
        Page 296
        Page 297
    Appendix
        Page 298
    Bibliography
        Page 299
        Page 300
        Page 301
        Page 302
        Page 303
        Page 304
        Page 305
        Page 306
        Page 307
    Biographical sketch
        Page 308
        Page 309
        Page 310
        Page 311
Full Text











COSTA RICAN MARIHUANA SMOKERS AND THE
MOTIVATIONAL SYNDROME HYPOTHESIS









BY

JOHN BRYAN PAGE


A DISSERTATION PRESENTED TO THE GRADUATE
COUNCIL OF THE UNIVERSITY OF FLORIDA
IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE
DEGREE OF DOCTOR OF PHILOSOPHY









UNIVERSITY OF FLORIDA


1976















































Copyright 1976

John Bryan Page













ACKNOWLEDGMENTS


Many individuals, both here and in Costa Rica, deserve

my profuse thanks for their help in assembling and analyzing

the information contained herein, but foremost among them

are William E. Carter and Paul L. Doughty. Carter's badger-

like editorial supervision of the writing process, demanding

clarification and refinement of otherwise turgid prose and

byzantine explanations, gave this dissertation a degree of

readability that would never have been achieved without him.

He also piloted me through several false starts in my research,

eventually leading to the choice of motivational syndrome

as a study topic. Doughty should be credited especially

with having enough confidence in my ability to do research

as part of a transdisciplinary team to select me as one of

the anthropological field workers in the Costa Rican Project.

I am also indebted to him for his patient supervision of the

data collection and coding process.

The third co-principal investigator in the Costa

Rican Cannabis Use Study, Wilmer R. Coggins also contributed

to my work with his perspective as a medical doctor. Maryanna

Baden, the Project sociologist made several valuable contri-

butions to my work, including subject matching and the formu-

lation of personal information questionnaires and life history






interview schedules. T. A. Nunez and Otto Von Merinq both

made worthy editorial inputs as readers of the dissertation

who had not participated directly in the transdisciplinary

project from which my material comes.

My co-field worker, William R. True, made more direct

and indirect contributions to my research than I can possibly

recount in this brief space. From introducing me to a key

informant to discovering the representativeness of our

sample, he has been a constant positive influence. Other

co-workers, Claudine de Frenkel and Dina Krauskopf, also

were helpful in collecting needed information on some of

the most valuable subjects in the study sample. Richard

Chiofolo, the Project statistician, merits special thanks

for ironing out some computative problems in Chapter V.

The Project secretaries also deserve hearty thanks for

their help in making this dissertation possible. They

freed True and me from many administrative worries which

might have detracted from our research effort. Olga Fallas

Vardiman was instrumental in making our office as attractive

and efficient as possible during the early months of the

study. Zulema Villalta de Brenes, with her incredible

transcription speed, was largely responsible for the volume

of sociocultural data with which we were able to work. Her

administrative contributions to the Project during its

last months were also prodigious. Other members, Gerardo

Erak, Gerardo Valderrama, Martin Brenes, Marta Villalta,

and Elena Fallas all-helped to keep the office running







smoothly. Lic. Virginia de Barquero, head of the Office of

Stupifying Drugs in the Ministry of Health, was a constant

resource during my two years of field work. Her moral

support and administrative connections helped not only with

pursuing research goals, but also with mundane necessities

of personal comfort. Without Dona Virginia's help in the

field, the study would not even have begun.

Walter Serrano, the Project administrator in charge

of delivering subjects to the medical and psychological

tests, should also be thanked for his participation con-

nected with this dissertation. His energetic contact with

the subjects saved the day more than once when they turned

skiddish through misunderstandings. He consented to be

interviewed regarding his impressions of the informants

after he was no longer on the project payroll, and the

information so obtained was beneficial.

Finally, I should thank the subjects who participated

in the Project. Many did not "make the cut" to the final

matched pair sample, but all had an influence on the final

outcome. They cannot be mentioned by name, for obvious

reasons, but these participants deserve .credit for accepting

us into their confidence. Many expressed the hope that our

studies would lead to sufficient public understanding and

tolerance of their Cannabis use so that one day, they would

no longer have to hide. Hopefully, the following presenta-

tion will add to that understanding.













PREFACE


Selecting a site for the study of long term marihuana

use in Latin America poses three questions which must have

close attention. First of all, will the host government

give full cooperation to the investigators? Second, will

there be proper medical facilities and local personal

resources to carry out the study? Oddly enough, the third

and last question is, does a chronic marihuana using popu-

lation exist in the host country? William E. Carter, Ph.D.

and Wilmer R. Coggins, I1.D. found in their efforts to locate

a Latin American site for a field study of Cannabis use that

this was indeed the order of importance for the main con-

siderations in designating a study site. They encountered a

situation in Costa Rica where the government was anxious

to have a study of chronic marihuana use done there, the

local Social Security medical system had ample hospital

facilities and well-trained personnel to carry out the study,

and a population of long-term marihuana users existed in

the urban setting of San Jose in sufficient numbers to make

the study possible. Such a combination of advantages could

not be found in any of the other Latin American countries

which were considered as possible study sites.

Through an agreement with the Costa Rican Ministry of

Public Health, the Cannabis use study gained the cooperation

vi







of the Office of Stupifying Drugs and the assistance of

the Social Security medical care system. We were given office

space in the Ministry building, and Ministry staff aided us

in getting the office furnished and a secretary hired.

Setting up the administrative environment necessary to

carry out the study of an illegal activity had to involve

local police cooperation. The Costa Rican Minister of

Security arranged for contact between the local narcotics

police and the Project field workers wherein it was agreed

that we would not be arrested or harassed during the course

of our studies. Identification cards were issued to aid

implementing this policy. Similar cards were also to be

issued to subjects in the study so that arrest for marihuana

possession would not interfere with their participation.

These arrangements did not always function ideally, but

they were sufficient for us to carry out the study with only

minor difficulties.

The transdisciplinary design of the Costa Rican Cannabis

Use Study included biomedical, sociocultural, and psycholog-

ical phases which needed a central point of communications

with the co-principal investigators, Drs. Carter and Coggins,

and Paul L. Doughty, Ph.D. The Project office in the Ministry

of Health Building became the center from which project oper-

ations were supervised. William R. True, Ph.D. and I worked

out of the Project office, carrying out sociocultural studies

of marihuana use as well as helping to coordinate other

phases of the transdisciplinary study. This contact with all


vii







phases of the study provided a perspective on its overall

progress and quality which was useful in finally analyzing

the data related to motivational syndrome.

A wide variety of data is utilized in this treatment

of chronic marihuana use, including psychomotor,intellec-

tual function, personality, and attitude test results,

biomedical data, and, most heavily, sociocultural data.

Of the sociocultural data, the most important body of

material comes from the life history interviews elicited

from each of the 82 matched subjects. Consistency of data

collection was assured by the use of an interview schedule

developed by the collaboration of the field team with the

help of Drs. Doughty and Carter, as well as Maryanna Baden,

Ph.D. The 15,000 pages of transcribed interview materials

which resulted will continue to provide valuable information

and insights on urban Costa Rican life.


viii














TABLE OF CONTENTS
Page

ACKNOWLEDGMENTS iii

PREFACE vi

ABSTRACT xi

CHAPTER I PREVIOUS RESEARCH AND WRITING ON
MOTIVATIONALL SYNDROME" 1
Clinical Studies 6
Surveys and Quantitative Studies 24
Composite and Field Research Tactics 33
Overview Authors 09
Synthesis of the Existing Literature 45

CHAPTER II THE URBAN SETTING OF THE STUDY 54

CHAPTER III THE STUDY SAMPLE 70

CHAPTER IV MARIHUANA IN COSTA RICA 89
Preparations 96
Production 101
Forms of Use 105
Types 114
Medicinal Preparations 117
Pharmacological Content of Costa Rican
Cannabis 119
Content of Marihuana 120
Daily Levels of Marihuana Use 122

CHAPTER V SMOKING "SET" AND EFFECTS 129
The User Typology 129
Analysis of Smoking Environment Descriptions
by the Users 138
Subjective Effects of Marihuana Use 157
User Types and Subjective Effects 192
Summary' 213

CHAPTER VI MARIHUANA AND THE LIFE CYCLE 217
Initiation into Cannabis Use 217
Marihuana and School Performance 232
Marihuana and Work 245
Summary 260






Page


CHAPTER VII OTHER ATTRIBUTES OF MOTIVATIONAL
SYNDROME: AN OVERALL ASSESSMENT 263

GLOSSARY 294

APPENDIX 298

BIBLIOGRAPHY 299

BIOGRAPHICAL SKETCH 308













Abstract of Dissertation Presented to the Graduate
Council of the University of Florida in Partial
Fulfillment of Requirements For the Degree of
Doctor of Philosophy



COSTA RICAN MARIHUANA SMOKERS AND THE
MOTIVATIONAL SYNDROME HYPOTHESIS


By

John Bryan Page

June, 1976

Chairman: William E. Carter
Major Department: Anthropology

Seven behavioral attributes of motivational syndrome

are derived from a survey of the existing literature on

chronic Cannabis use. These attributes are tested for a

working class population in San Jose, Costa Rica's, using

intensive life history data from 41 chronic Cannabis users

and 41 non-using closely matched controls. Data on smoking

environments and subjectively perceived effects for this

population yield a user typology.

When this user typology is taken into account, compari-

son of school performance and work histories between users

and non-users yields no evidence of the motivational syn-

drome. Social adjustment difficulties, where they exist,

precede the initiation of marihuana use and lead directly






to documented variations in user type. This is corroborated

further by natural history observations. Additional measures,

such as psychological tests, electroencephalographs, and

detailed medical studies also fail to show evidence of the

seven behavioral attributes commonly associated with the

motivational syndrome.


xii













CHAPTER I
PREVIOUS RESEARCH AND WRITING
ON "AMOTIVATIONAL SYNDROME"


The behavioral and social ills which have been attributed

to Cannabis use are widely varied, and each seems to have a

corresponding negation elsewhere in the literature. Kolansky

and Moore (1972), Warnock (1903), Walsh (1894), McGlothlin

and West (1968), and others all find that users of Cannabis

become lazy and apathetic. Miles et al. (1975), Mendelson

and Meyer (1972), Rubin and Comitas (1975), and Hochman (1972)

see no laziness among Cannabis users, and some (Rubin and

Comitas 1975) even say that Cannabis use increases energy.

Bloomquist (1971) Williams et al. (1946), Warnock (1903),

and Kolansky and Moore (1972) say that Cannabis users are

slovenly and neglectful of personal hygiene. Kaplan (1970),

and Miles et al. (1975) find users to be no neater or dirtier

than non-users. Soueif (1967, 1971), Kolansky and Moore

(1971, 1972, 1975), Bindelglas (1973), and Brill et al.

(1970) consider learning and memory functions to be diminished

among chronic Cannabis smokers, while Beaubrun and Knight

(1973) do not see such a diminution of functions among their

sample of users. Soueif (1967), Kolansky and Moore (1972),

Robins et al. (1970), and Smith (1970) say that users of

Cannabis cannot work effectively at everyday jobs, but Rubin










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and Comitas (1975), Trice and Roman (1972), and Miles et al.

(1975) argue that users can and do. Users suffer from inabil-

ity to make and carry out long-term plans, according to

McGlothlin and West (1968), and Bindelglas (1973), but Hoch-

man (1972), and Melinger et al. (1976) do not find this to

be true for their sample of users.

Table 1 illustrates the positions taken by several of

the most prominent researchers who have dealt with some

aspects of the motivationall syndrome." We can see that

there is no unanimity among them regarding any single attribute

of the syndrome, and roughly half disagree with the other

half in finding symptoms of motivational syndrome among the

Cannabis users studied. This situation of diammretrical disa-

greement among Cannabis researchers leads to an atmosphere

of mutual sniping in which the scientific thrust of contri-

buting to the body knowledge about a still misunderstood

drug is lost in interdisciplinary squabbling. The reviews

which follow will treat these and other researchers' work

as even-handedly as possible, with the ultimate objective

of using their experience to build a theoretical position

from which to assess the validity of motivational syndrome.

The term motivational syndrome has been used loosely

in connection with all of the above-named social and behav-

ioral problems and their corresponding negations. Because

motivational syndrome is generally considered a "subtle"

or "insidious" kind of psycho-social disorder, those who

write about it have avoided naming a comprehensive set of








symptoms, or more accurately, behavioral attributes for it,

and relatively few authors have ventured to use the term

motivational syndrome to encompass those behavioral attributes.

This chapter will attempt to review the existing literature on

Cannabis use which deals most directly with behavioral and

social disorders sometimes called motivational syndrome, and

to derive a set of behavioral attributes suitable for compar-

ison with the data gathered in Costa Rica.

Early writing and research reports on the use of Cannabis

do not use the term motivational syndrome, even though the

India Hemp Commission Report (1893) contains some testimony

linking "laziness" and "sloth" to Cannabis use. The term

first appeared in modern scholarly writing in an article by

McGlothlin and West, "The Marihuana Problem: An Overview"

(1968). Both authors were experienced in the hippie-based

mind-expanding drug revolution of the mid-sixties. They

describe, in the manner of clinical psychiatry, a condition

they had observed among marihuana users with whom they had

come in contact in California clinical settings. McGlothlin

and West do not present motivational syndrome in a tone which

implies that they invented it, but they also do not refer to

another source for the term. They carefully qualify their

own use of the term, applying it only to "middle class students"

or "impressionable young persons." Their description of the

syndrome to which the term refers is brief:

S. subtly progressive change from conforming,
achievement-oriented behavior to a state of relaxed
and careless drifting has followed their use of
significant amounts of marihuana.




5



Such changes include apathy, loss of effec-
tiveness, and diminished capacity or willingness
to carry out complex, long-term plans, endure
frustration, concentrate for long periods, follow
routines, or successfully master new material.
Verbal facility is often impaired, both in speak-
ing and writing (372).

The authors readily admit that they have not controlled for

such factors as LSD use and social background, but they still

suspect marihuana use as a causative agent (Ibid.). Both

directly and indirectly, much of the work on marihuana use

which followed this article was influenced by it. Some

authors were not as cautious in their use of the term amoti-

vational syndrome as those who first used it.

There have been basically three approaches to study and

discussion of motivational syndrome as related to Cannabis

use. Clinical studies represent an approach which occurs

frequently, encompassing user populations both in the United

States and in other Cannabis using cultures. Impressionistic

accounts of direct personal contact with marihuana users, an

approach that the archaic literature contains in abundance,

appears as part of many comprehensive accounts of the drug

and its use. The quantitative analysis approach is the

newest of the three approaches, using questionnaires and often

large samples to obtain data on the consequences of Cannabis

use. Some researchers combine clinical and quantitative

methods to study these consequences. Authors who attempt

to offer an overview of Cannabis use usually include a mix-

ture of all of the above described approaches in their presen-

tation. The following series of brief reviews will deal with








clinical approaches first, followed by quantitative approaches,

and then mixed clinical, survey, and field research approaches.

Overview authors will be reviewed last, including some examples

of ancedotal writing on motivational syndrome.


Clinical Studies

Studies of Cannabis use which involve chronic users in

either a clinical psychiatric treatment setting (both inpatient

and outpatient) or a hospital experimental setting will be

called clinical studies in this review. We shall begin with

psychiatrists' assessments of the behavioral consequences of

Cannabis use, both in its North American setting and in its

other cultural settings.

Iolansky and Moore's clinical studies of marihuana use

form the basis for three prominent articles on the amotiva-

tional syndrome, also sometimes called "marihuana toxicity"

(1971, 1972, 1975). They find that there is a marked causal

relationship between marihuana use and what most writers

would call motivational syndrome.

During the past six years, we have seen a
clinical entity different from the routine syndromes
seen in adolescents and young adults. Long and care-
ful diagnostic evaluation convinced us that this
entity is a toxic reaction in the central nervous
system due to regular use of marihuana and hashish.
Contrary to what is frequently reported, we
have found the effect of marihuana not to be that
of a mild intoxicant which causes slight exaggera-
tion of usual adolescent behavior, but a specific
and separate clinical syndrome unlike any other
variation of the abnormal mainifestations of
adolescence (Kolansky and Moore 1972: 35).

They continue to list the salient traits of this "syndrome"








which include tiredness, mental confusion, slowed time sense,

difficulty with recent memory, incapability of completing

verbal thoughts, lack of concern for work or personal appear-

ance, and outbreaks of petulance and irrational anger (35-36).

The 1973 NIMH report on the current state of marihuana

research criticizes the Kolansky and Moore study because the

authors do not specify whether or not the patients were, or

had the opportunity to be, intoxicated with marihuana during

the interviews on which the authors reported (V-33). The

reviewers raise this question, because several of the symptoms

enumerated by Kolansky and Moore resemble commonly named

symptoms of acute marihuana intoxication, e.g., slowed time

sense, incapability of completing verbal thoughts, and diffi-

culty with recent memory. This may not be a legitimate

criticism, because chronic use of marihuana may in fact en-

tail states of intoxication that occupy many of the user's

waking hours. Thus, if serious behavioral aberrations

characterize the intoxicated state, then the chronic mari-

huana user would have constant difficulty functioning in

normal daily activities. The NIMH critique also points out

that the clinical method used by Kolansky and Moore, although

very efficacious in discovering complexes of pathological

symptoms that are of clinical interest, is not good for indi-

cating causal relationships between symptoms and other facets

of the individual patients' lives (V-34). This view is under-

lined in Rathod's assessment of Kolansky and Moore's work,

noting that the claimed "toxic reaction" was not buttressed

by any biochemical research (1975: 95).








Kolansky and Moore's 1971 article deals specifically

with adolescent behavior, and the concept of motivational

syndrome therein was rightly rebutted because of the diffi-

culty in separating the effects of smoking marihuana from the

embracing of counter-culture precepts of non-achievement and

altered social consciousness. In their 1972 article, Kolansky

and Moore assiduously avoid adolescence in the case histories

presented in order to connection motivational syndrome more

definitively to smoking marihuana. Adolescence is only one

of several possible crucial transitional periods to which man

in the course of life span is subject. By avoiding adoles-

cence in their discussion, Kolansky and Moore did not neces-

sarily avoid analogous transitional periods in the case

histories of individual subjects. For example, in group 1

case 1 in the 1972 article (37) the 41-year-old male studied

could easily have been approaching a transitional period

before his introduction to marihuana. This took place while

he, a married man, was dating a younger woman. The symptoms

which follow his adoption to the drug include "confusion,

distortion of time sense, apathy, forgetfulness, suspicious-

ness, and poor reality testing" (Ibid.). His personal

situation also deteriorated, both in his family and in his

business. To attribute the above sets of symptoms to mari-

huana use alone may be too simplistic. The precipitating

factor in their onset may just as easily by the middle-age

panic often seen in North American males.

A 28-year-old woman also cited in Kolansky and Moore's








case histories experienced deterioration in job performance

and general attitudes toward efficiency and personal grooming

after initiation of marihuana use (Ibid.). It is noted also

that her attitude toward her marriage changed, and several

love affairs resulted. This particular case points out the

error in unifactorial reasoning in the search for any kind

of psychological disorder. It appears the researchers wished

to find marihuana as the sole cause of this woman's ills,

when actually the situation was entirely too complex to

attribute her problems to marihuana smoking and nothing more.

This does not mean that marihuana could not have been a con-

tributing factor in her case. It simply allows for the

consideration of other equally important sources of upset as

contributory factors.

Crucial transitional periods analogous to that of

adolescence may be contributing factors in all of the cases

cited by Kolansky and Moore. Even more importantly, all of

these cases have been referred for psychological care and

treatment. A distorted, one-sided image of marihuana use

results from dealing only with cases whose recognized aberrance

has brought them to seek treatment. A clinical population by

definition represents only the segment of the total population

that is seen (or sees itself) as outside the normal range of

accepted behavior. Furthermore, the 13 cases cited involve

people whose marihuana use is of short duration (no more than

2 years) and their levels of consumption are not well-docu-

mented. It does not follow that since light marihuana use








accompanies psychological problems among some psychiatric

patients, marihuana necessarily causes the psychological

problems.

Clinical reports on the effects of Cannabis smoking are

by no means new to the psychiatric literature. The British

India Hemp Commission Report (1893) contains in its huge

volume of testimony a sizeable representation of psychiatrists

who had practiced in India. Walsh (1894) recognizes that

some people who use Cannabis put their mental health in

jeopardy.

. In a certain proportion, too, it is not very
improbable that, owing to the fact that these per-
sons are of a neuropathic diathesis, and in them a
tendency to insanity exists, and has always been
latent, hemp drugs in excess, or even quantities
which would not damage a man of robust nervous
constitution, have acted as an exciting cause,
making manifest mental weakness which might not
have shown itself in the absence of such indul-
gence (35).

This is the testimony of a clinician who had experience with

Cannabis toxicity in its most ancient cultural context. Walsh

recognizes that cases of pathological reaction to Cannabis use

probably have a close relationship with some pre-existing

tendency to mental disturbance. One of the syndromes connected

with such toxicity reactions is described in the following

symptomology:

. The vice grows in him [the user]; he neglects
his family and his business, falls into irregular
and disorderly habits, which alternate with periods
of self-reproach and mental depression (Walsh 1894:
32).

The above set of behavioral characteristics strikingly resemble








the current concept of the motivational syndrome, yet they

are used by Walsh to describe one of the toxic reactions

suffered by users with a pre-existing tendency toward mental

problems.

Walsh's concept of the relationship between mental

disturbance and Cannabis use is very difficult to dispute,

because patients suffering from Cannabis toxicity psychoses

often have no previous history of mental disturbance. Kolansky

and Moore (1972) include only cases with no psychiatric ante-

cedents in their case history accounts. This is their justi-

fication for claiming that Cannabis is the cause of their

patients' problems. It would be insufficient argument to point

out that stories of maniacal homicide appear constantly in

the news involving people with no history of psychiatric

disturbance. Rather, it is preferable to study a non-institu-

tionalized population of chronic Cannabis users to see if

the motivational symptomology holds for them. In this way,

we avoid prejudicing conclusions on the basis of a sample

that is already recognized as behaviorally aberrant.

Another early clinical study of the consequences of

Cannabis use appeared in the Journal of Mental Science (1903)

written by John Warnock, another Englishman of long experience

in dealing with an ancient Cannabis-using tradition. He finds

that the India Hemp Commission's findings do not agree with

his experience in Egypt with kif, a strong Egyptian Cannabis

preparation, and hashish. According to Warnock, kif was

sufficient cause of psychiatric problems among a high percentage








of the patients in the Cairo Sanitarium (103). He goes so

far as to name this Cannabis-caused syndrome "cannabinomania":

The term cannabinomania may be employed to des-
scribe the mental condition of many hasheesh users
between the above forms [acute cannabis-caused psy-
choses, including temporary intoxication, delirium
from hasheesh, mania from hasheesh, chronic mania
from hasheesh, and chronic dementia from hasheesh].
The individual is a good-for-nothing lazy fellow,
who lives by begging and stealing, and pesters his
relations for money to buy hasheesh, often assaulting
them when they refuse his demands. The moral degrada-
tion of these cases is their most salient symptom;
loss of social position, shamelessness, addiction
to lying and theft, and a loose, irregular life make
them a curse to their families (103).

The above description is not unlike many of the more recent

clinical and impressionistic accounts of motivational

syndrome. One major difference is that certain types of

aggression are incorporated in the description, a character-

istic which contrasts sharply with the passivity usually

attributed to long-term Cannabis users. The characteristics

contained in the above account which are most generalizable

among those cited for the user suffering from the motivational

syndrome are laziness, lack of order, and dedication of all

available resources to drug consumption.

Warnock indicates great familiarity with the cultural

differences between Indian and Egyptian Cannabis use tradition.

As Drake (1971: SS) also suggests, the difference in frequency

of Cannabis-precipitated mental illness between India and

Egypt may be due in part to the exclusive use of stronger,

resin-based preparations by the Egyptian users. Cultural

standards of use in India urge the Cannabis user to eschew








charas, the Indian equivalent of hashish, in favor of the less

concentrated preparations, bhang and ganja. The Egyptian user

typically seeks the depressant effects of heavy dosage and

strong preparations. Finally, Warnock addresses the epidem-

iological problem of "hasheesh mania:"

. Probably only excessive users, or persons
peculiarly susceptible to its toxic effects, become
so insane as to need asylum treatment. Whether the
moderate use of hasheesh has ill effects, I have no
means of judging. (109).

As he sees it, Cannabis use is responsible for mental illness

in Egypt, but still Warnock allows for the pre-existing ten-

dency toward mental illness in these cases. It is interesting

to note that, when addressing the problem of alcohol use as

opposed to hashish use, Warnock is not willing to make the

latter illegal and replace it with the former (105).

The authors cited above all attempt to generalize to

the population at large on the basis of clinical populations,

taking the basic position that Cannabis brings about increased

mental difficulties. Walsh and Warnock modify this position

by allowing for pre-existing tendencies toward psychological

disturbance, while Kolansky and Moore do not. Prince et al.

(1972), on the basis of a parallel data gathering situation,

attempt to reverse the generalization process by arriving at

exactly opposite conclusions. Extrapolating from the data

gathered inside the Bellevue Hospital in Kingston, Jamaica,

Prince, Greenfield, and Marriott concluded that ganja (the

Jamaican term for the form of Cannabis smoked there) is in

fact an alternative to alcohol, and, as such, is less likely








to lead to psychological distrubance (9). This kind of

clinical generalization is no more acceptable than those

mentioned earlier. All of the above mentioned studies lack

the perspective gained by familiarity with the normal, at-large

Cannabis-using population.

In the above account, it may seem that we slip into dis-

cussion of mental disturbance in general while addressing the

problem of motivational syndrome. This is no accident,

because Walsh and Warnock name the symptoms of motivational

syndrome among many other symptoms of mental disorder which

are also associated with Cannabis use. Kolansky and Moore's

work is more tightly associated with the specific charac-

teristics of the motivational syndrome, which they are instru-

mental in describing, but these other works which name parallel

symptoms in the context of a broader symptomology bring up the

central question in the motivational syndrome argument: Does

Cannabis use lead to patterns of behavior which are considered

outside the normal range of accepted behavior? Kolansky and

Moore say yes, Warnock says maybe, Walsh says not without

pre-existing dispositions or tendencies, and Prince, et al.

say not at all.

Among the existing clinical papers and treatises on

Cannabis use, the Chopras' of India (R.N.G.S., and E.C., 1942;

I.C. and R.N., 1957; G.S. and P.S., 1965; G.S., 1969) have

by far the most time depth. Their writing is based on years

of clinical experience in dealing with patients who have used

Cannabis in the complex and baroquely elaborate Cannabis using








tradition found in India. The clinical point of view, as

stated earlier, may distort the researcher's perception of

the consequences of Cannabis use, but the Chopras seem to be

an exception. They know something about the general popula-

tion of Cannabis users in India, and they temper their con-

clusions on that basis.

The following user typology developed by I.C. and II.R.

Chopra (1957) shows that they have a much more finely-tuned

sensitivity to the nuances of dosage level and usage set than

their North American counterparts:

Group I. This group consists of persons belonging to the
poorer classes, such as labourers, domestic servants,
etc. These people are the principal consumers of
ganja (and also charas, if they can get it). They
take these as food accessories in order to relieve
fatigue after their work and for mild euphoric effects
to relieve the monotony of their daily vocations and
existence. They necessarily stick to small doses as
a rule they are able to carry on with their ordinary
work. They suffer little or no injury to their gen-
eral health from the habitual use of the drug.

Group II. This is composed of those individuals who use
Cannabis in the same way as opium for its narcotic
effects. The members of this group are idlers and
persons mentally below average who take to the habit-
ual use of Cannabis in order to induce a state of
oblivion or to overcome feelings of inferiority and
the sense of inhibition. Ganja and Charas are
mostly used by this group and the damage to their
health is more perceptible than in the case of
Group I.

Group III. This includes individuals who use Cannabis in
order to obtain stimulant effects combined with intox-
icating effects, in the same way as alcohol. This
practice exists mostly amongst the idle and the rich
who wish to seek pleasure and new sensations, often
of a sexual nature. Such a use, prolonged and carried
to excess, is apt to cause injury to the gastro-intes-
tinal tract resulting in dyspepsia and impairment of
vitality and general health, and later in damage to
their nervous system. Sometimes other potent drugs








such as .nux vomica and dhatura are also mixed by
addicts to fortify themselves to perpetrate acts
of violence.

Group IV. This group consists mostly of religious
mendicants (sadhis and fakirs) and the priestly
classes. Cannabis drugs are used in all forms by
them in order to overcome the feeling of hunger and
to help them to concentrate on religious and medi-
tational objectives (15).

Low dosage levels among poor laborers correspond with the use

of Cannabis preparations for their fatigue-reducing properties.

Other low-dosage users consume Cannabis preparations for

specific religious ends. Those users among Group II are by

far the most problematic Cannabis users, but the Chopras

describe them as often being mentally deficient. Their dosage

levels are far beyond those of the Group I users, further

evidenced by their preference for the stronger Cannabis pre-

parations and their concentration on what the authors call

"narcotic" effects. Group III and Group IV, the pleasure-

seekers and the meditators, most closely resemble the Cannabis-

using patterns of North American users. North American drug

use by seekers of new stimuli and experience is well known

(cf. Goode 1970, 1972). Drug-connected religious mysticism

in the U.S. in both sacred religious and secular social

consciousness spheres, seems to parallel the Group IV pattern

closely. Group I, as I shall show in more detail, has a

parallel among Costa Rican marihuana users. Group II has

parallels in the Egyptian Cannabis use patterns described by

Warnock (1903) and Soueif (1967 and 1971) and also among some

Costa Rican marihuana smokers.








Asuni, an African psychiatrist who also writes on clinical

observation of chronic marihuana users in Nigeria, suggests

that people who occupy marginal places in society are prone

to use marihuana, as well as certain occupational groups, such

as taxi drivers, truck drivers, prostitutes and musicians

(1964: 20, 25). He seems to recognize some of the limitations

of clinical research, and does not attempt to establish mari-

huana as a cause of the frequent unemployment, loss of effi-

ciency, and tardiness seen in his subjects. Still, Asuni sees

some connection between marihuana use and these traits (27).

Perhaps further examination of the socio-cultural aspects of

Cannabis use would be useful in sorting out the influences

on the behavior of this particular group of Nigerian users.

Up to this point, discussion has been limited to the

various analyses of psychiatric observations in clinical

settings. Another variety of clinical study addressing the

problem of motivational syndrome has become numerous in

recent years, where subjects are placed in a closed laboratory

and given marihuana or some preparation of its psychotropic

derivatives to consume in that closed environment. This does

not really address the question of long-term use, since the

experimental subjects are either marihuana naive or have

relatively limited experience with the drug. However, the

closed laboratory method does afford the investigator with

assurance regarding the dosages of Cannabis administered and

the settings in which it is smoked. The first study of this

kind was done under the auspices of the La Guardia administration








in 1944, and users of long-term experience were studied. Some

psychological testing was done, but the investigators were

concentrating on acute rather than chornic effects, and so,

little difference between user and non-user groups was reported.

Williams, et al. carried out a similar experiment in 1946,

where six subjects were given marihunaa to smoke over a 30-

day period in a closed hospital setting. Psychological tests

were administered during and after the smoking period. Results

suggest that, during the acute period, the subjects experienced

a diminution of precision in motor and intellectual function,

as well as a lack of motivation and increased carelessness.

General clinical observations noted increased sleeping time,

general lassitude, social deterioration, and lack of personal

hygiene, but they also indicated lack of anti-social behavior

or psychotic reactions during the smoking period, even though

dosage ranged from nine to 26 cigarettes per day. All of the

above-named symptoms, some of which are identical to those

described for motivational syndrome, disappeared after the

end of the acute smoking period. This particular study points

out the danger of claiming, as do Kolansky and Moore, that

Cannabis use results in a lasting toxic reaction in the

users' nervous system. A complex of symptoms very close to

the ones named by Kolansky and Moore are, in Williams' et al.

research, apparently linked with the acute smoking experience,

vindicating the NIDA criticism of the Kolansky and Moore study

mentioned earlier.

A more recent example of the procedure carried out by









Williams et al. was performed by Lord (1971) on 37 student-

age subjects. Using the Minnesota Multiphasic Personality

Inventory (MMPI), Lord attempted to measure change in person-

ality as a result of marihuana administration. He found that

scores (anxiety and repression, respectively) for the subjects

who were given marihuana indicated lower levels of excitement,

energy, and enterprise (94). He makes the following statement

on the relationship between marihuana and motivational

syndrome:

. The present findings support both the LaGuardia
study and current clinical beliefs that marihuana does
cause a reduction of responsibility in individuals.
While the clinical statements regarding this trait are
stated in terms of long-term use of marijuana, both
the LaGuardia study and the present research imply that
these characteristics may also be manifested in short-
term use--even in single experiences with marijuana
(49).

Lord has fallen into the trap of making unqualified general-

izations on the basis of very limited and specific data. His

testing population was made up of young short-term users,

and they were tested after a single administration of the drug.

Lord indicates that he is aware of cultural influences that

impinge on the effects of marihuana (25-26) and yet he does

not bother to give any background information on his user

population other than to state age and sex. This failure to

define the user population in even minimal cultural terms

renders Lord's results nearly useless.

In seemingly a direct approach toward the motivational

syndrome problem Mendelson and Meyer (1972) placed 20 multiple

drug-using males in a hospital setting for 31 days. During








the entire period, the subjects were able to earn money for

tobacco and marihuana by manipulating an operant press-bar.

All subjects earned the maximum (an equivalent of $10 per day)

during the smoking period, and so, no direct relationship

between marihuana and decrease in work output was found.

Miles suggests (1975) that the $10 per day limit may have been

unrealistic, yielding an effect whereby even the least moti-

vated subjects could complete the output maximum without

discriminating the levels of achievement in the group. Also,

the task at hand was so simple that it could not be impaired

by marihuana consumption. Both of these arguments are legit-

imate, and they point out the limitations of over-simplified

laboratory-style experiments such as these. The rewards to

be had in the real world for industriousness are limited by

factors that are very different from the artificial ceiling

seen here. Practically all human tasks, even the most menial,

are too complex to be represented adequately by press-bar

performance.

Miles et al. (1975) performed an experiment in a hospital

setting which comes somewhat closer to replicating real world

conditions than did the Mendelson and Meyer study. Six

"healthy young marihuana smokers" were placed in a special

laboratory situation for 70 days during which they were given

a "job" that entailed the construction of wooden stools. The

subjects were paid for piece work, and after the first week

of the study, they took unanimous action to secure a "raise"

in pay. Miles notes that during a 28-day period in the study








when each subject was required to smoke 17 mg. of THC, produc-

tion and savings declined. The subjects had begun to spend

more time in passive entertainment, and they claimed that the

compulsory smoking was impeding their work output. Neverthe-

less, when a further increase in the piecework rate was insti-

tuted, production increased dramatically in spite of the continued

compulsory marihuana smoking. Miles also notes with regard

to the motivational syndrome that efficiency was not altered

even when production had dropped. That is, the subjects pro-

duced stools at the same rate per unit of working time during

the period of low productivity, but they spent less time working

until their wages were increased. He also found that, con-

trary to the Williams (1946) findings, the carefully monitored

behavior of the subject group indicated no change in personal

hygiene activities during the experimental period, and no

increase in sleep time. Even though this laboratory study

comes much closer than its predecessors to simulating a real

world situation, it still fails to reflect several important

factors which must be assessed adequately in order to make a

definitive statement concerning motivational syndrome. A

short-term study of 70 days cannot yield conclusions about

the consequences of a lifetime of smoking marihuana, because

performance findings, no matter how closely-monitored, do not

reflect how steadily an individual has worked during his life-

time, nor how faithfully he fulfills his other social obliga-

tions. Enthusiasm for a new job could account for the rises

in production during so brief a period. Nevertheless, Miles'








et al. results hint that perhaps users who are smoking moder-

ate amounts of Cannabis can function adequately and even show

signs of motivation while under a daily smoking regimen.

Several other authors have presented clinical-style

reports of their research on marihuana use which will be

encapsulated below. David Kupfer (1973) did an out-patient

clinical study of a small number of light marihuana smokers

in which some psychological testing was administered. His

most important conclusion regarding motivational syndrome

is that depression due to passage through a life crisis is

an important factor among patients exhibiting symptoms of

that syndrome (1322). Based on clinical examination alone

of five marihuana users, John Thurlow (1971) offers three

hypotheses for future consideration and research: 1) That

lack of initiative is a long-term effect of Cannabis use,

2) That other drugs used to adulterate marihuana caused this

lack of initiative, 3) That the connection between amotiva-

tional state and drug use is coincidental (182). Hendin

(1973) bases his article on clinical examination of 15

marihuana using students, finding that the student popula-

tion examined uses marihuana to curb aggression, or, in his

own words, a "surcease from competition" (270). Allen and

West (1968) write of their experience manning a clinic in

the Haight-Ashbury district, and they warn that chronic use

of marihuana could lead to "apathy, enervation, and psycho-

logical immobilization" (125). R. A. Shellow (1973) finds

that the chronically "stoned" person can be depressive in








character, with intolerance to pain and frustration, basing

his conclusion on limited clinical experience with chronic

users (32).

The clinical treatises on motivational syndrome which

have been reviewed in the preceding pages encompass two basic

kinds of Cannabis research experience. The first, exempli-

fied by Walsh (1894), Warnock (1903), and the Chopras (1942,

1957, 1969, 1971) involves long experience with Cannabis

users in mental institutions. The second, as in the work of

Miles, et al. (1975), and Mendelson and Meyer (1972) involves

relatively short-term clinical contact with users in an exper-

imental setting. Some clinicians, particularly Kolansky and

Moore (1971, 1972, 1975) are willing to state that Cannabis

use is a direct cause of the apathy, loss of productivity,

decrease of intellectual ability, and moodiness and irrit-

ability which they have observed among chronic marihuana users.

Others, including Walsh (1894), Warnock (1903), Asuni (1964),

and the Chopras (1942, 1957, 1969, 1971) prefer to allow for

consideration of other psychological and cultural factors in

determining the etiology of the aberrant behavior observed.

Still other clinical researchers, such as Miles, et al. (1975)

and Mendelson and Meyer (1972) do not observe the aberrant

behavior noted by other clinically-oriented researchers.

Clinical observations have listed and corroborated

several behavioral attributes of motivational syndrome which

deserve further attention. Apathy, lack of energy, loss of

productivity, decrease in intellectual abilities, moodiness








and irritability, sloth and disregard for personal hygiene,

and dedication of all available resources toward Cannabis

procurement all appear in clinical treatises on marihuana

use. The work of the experimental authors makes an indirect

contribution to further Cannabis use research by warning that

drug use should be studied and assessed in its natural setting

and in chronic, long-term forms in order to form valid con-

clusions about the impact of the drug use on the users' lives.

Many experienced clinicians provide important perspectives

on the cultural or psychological factors which impinge on the

behavior of Cannabis users. All of these contributions will

be carried into further analysis of the impact of Cannabis

use on the individual's accommodation in society.


Surveys and Quantitative Studies

Methods for measuring the influence of long-term Cannabis

use have often been quantitative in nature, especially in

the study of users in the United States. McGlothlin, Rowan

and Arnold (1970) managed to identify a sample of 51 adults

who had tried marihuana during adolescence. The mean age of

this group was 40, and their first experience with the drug

took place at least nine and sometimes as many as 20 years

before the beginning of the study. This group was broken down

into those who did not continue marihuana use for a signifi-

cant period of time and those who had continued use for a

period of at least two years at a rate of at least two times

a week (434). These groups of 29 and 22 subjects, respectively,








were contacted by mail and interviewed for points of personal

information. Several psychological scales including measures

of sensation seeking and social desirability were administered.

The authors found that the group which had experienced con-

tinued use of marihuana were much more unstructured and mer-

curial in their lifestyles than the other two groups (440).

The main indicators of this were in the frequent changes of

work and residence. The chronic user group also showed a

strong tendency to seek psychotropic states by other means,

ranging from the practice of Zen Buddhism to heroin use.

McGlothlin et al. recognize the difficulties in general-

izing on the basis of this kind of sample. The method of

procuring the sample immediately prejudiced it somewhat, since

the subjects were recruited from a group that had been adminis-

tered LSD either experimentally or therapeutically during the

early sixties (433). Such a subject group did not form the

kind of data base from which generalizations of any validity

could be made about the ultimate consequences of chronic

Cannabis use. Many were already psychiatric patients, and

the rest had at least subjected themselves to administrations

of LSD. Neither was there scientific control for problem

drug use areas, such as alcoholism and other addictions.

A much more reasonably conceived sample was procured by

Robins, Darvish and Murphy (1970) in their follow-up quanti-

tative study of lower class blacks in St. Louis. Choosing

from public school rolls, they identified a sample which con-

tained 146 non-users and 76 users of marihuana. This population








was broken down further into those who used (or had used

during adolescence) marihuana alone and those who participated

(or had participated) in multiple drug use and finally, those

who did not use marihuana at all. Using a personal interview

and access to several varieties of public record, including

police records, the authors made a comparison of the groups.

They found that, even though the groups were matched for dis-

tribution of what they considered to be crucial home environ-

ment variables (presence of parents, father's job level, etc.)

the user groups appeared to have performed less successfully

in society than the non-user group. The users were less

likely to have graduated from high school than the non-users

(164). Users tended to achieve lower job levels than the

non-users, whether or not they had dropped out of school (166).

Arrest frequencies for non-drug related offenses were higher

for the user groups.

Robins et al. attempted to control for other factors

which might have influenced the comparisons, first by matching

the subject groups at their starting points as children, and

then by controlling for varieties of drug use history. The

problem with the first controlling strategy is that the situa-

tions described by the school records which were used for

matching purposes may have changed radically by the time these

children reached adolescence, the time of drug use onset.

The authors could not guarantee, or even be fairly certain,

that the same home situation existed for their subjects as

adolescents as did for their subjects as children. The








second controlling strategy, for some reason, did not include

alcohol among the psychotropics which the authors called

"drugs," thereby removing from consideration a drug of known

influence on social adjustment. If those with heavy drinking

or alcoholic problems were compared with those who did not

have such problems, the authors might also have found an equally

striking difference between the two groups. Furthermore,

when the user groups were re-distributed according to duration

of marihuana use (those using fewer than five years and those

using more than five years) there was not a clear-cut progres-

sion in the frequency of the social ills mentioned earlier.

Some variables such as number of arrests were more frequent

for the group with less smoking experience than for those with

more smoking experience (175). If there were a causal rela-

tionship between marihuana use and failure to graduate from

high school or to secure a decent job, for example, then we

might reasonably expect for those tendencies to increase with

increased experience and dosage. This did not occur consis-

tently when the authors tested for duration of use. Problems

in control factors and causal statements thus mark the gener-

alizeability of Robins, Darvish and Murphy's otherwise well-

thought-out study.

That use of control factors to eliminate possible non-

drug influences on performance and productivity can yield other

results, is shown in Mellinger, Somers, Davidson, and Man-

heimer's study of University of California students (1975).

Robins, et al. found evidence supporting part of the








motivational syndrome hypothesis by controlling for child-

hood home environment; Mellinger, et al. found evidence

which rejected motivational syndrome when they controlled

for parents' level of education and several academic motiva-

tion variables. This study's methodology was relatively

impersonal, relying on non-contact modes of data elicitation,

especially mailed questionnaires which were self-administered.

Even though the response rate was fairly high, thereby

eliminating bias factors due to non-participation (12) such

a method is problematic in other ways, such as definition of

the relative levels of marihuana use and the use of other

drugs. These levels are difficult to establish using direct

observation and interview techniques; the chances are small

indeed that a mailed questionnaire could achieve real accuracy

on drug consumption questions. Still, Mellinger, et al.

report that drug use of any kind could not be singled out as

a significant factor in college drop-out rate (34). Much

more important in predicting dropout rate were the predis-

posing factors of family background, relationships with

parents in high school, and social values (35). The statis-

tical reasoning in this study is very sound, and it is one of

the few studies of motivational syndrome that attempt to

place the blame for poor performance or low motivation levels

on the socialization process of the individual, rather than the

use of a drug. The authors' arguments are robbed of impact

by the comparative superficiality of their data-gathering

procedures.








Soueif (1967, 1971) has attempted by large-scale

psychological testing of subject populations to establish the

consequences of long term Cannabis use among Egyptian kif

smokers. His first study in 1967 certainly is not lacking

in rigor of test design or execution, utilizing a user popu-

lation procured by means of key informants who led the researchers

through networks of personal interaction to identify a subject

population (6). In this way, Soueif had a stratified sample

in a natural setting for his study purposes. The main data-

gathering instruments in Soueif's study were interview

schedules which underwent extensive and rigorous pre-admninis-

tration testing for reliability and translation into colloquial

Arabic. These schedules were administered to three different

sample groups, one consisting of 204 urban hashish users from

Cairo, another of 49 semi-urban and rural hashish users from

upper Egypt, 115 controls from Cairo, and 40 controls from

upper Egypt. The study provides a wide range of data, including

some epidemiological inference on the extent of hashish con-

sumption in Cairo, and relative popularity of the various

methods of smoking the drug (7). Correlation coefficients

of contingency were estimated for some of the data elicited,

and it was found that positive correlations appeared between

monthly frequency of hashish use and the number of hours

worked per day. The author hints at some negative correlation

between quality of working conditions and amount of hashish

consumed (8). He is unwilling to make a statement about the

correlation between amount of hashish consumed and marital








status, because of inconsistencies between urban and rural

smokers in this regard. Soueif's statement on productivity

is vague and difficult to interpret; he states that users

claim lower quantity and quality of production while under the

influence of hashish and he attempts to correlate it with

specific cognitive and perceptual changes reported by the

users. He found that a fairly high correlation could be

estimated between productivity decline and disturbance in

time perception, and also to distortion of auditory perception

(10). Still, Soueif's work hovers very close to the question

of motivational syndrome without really addressing it. His

research (1967) design and user population are both among the

best to appear in the literature. Within the data gathered,

he may even supply sufficient information to make a much

more definitive statement on motivational syndrome, but he

does not go any further than to analyze the users' reports

of acute effects of the drug on productivity. As we have

already seen, this question is also in doubt. The interview

schedule used with Soueif's subjects contains a section on

family background and on work conditions, and these may have

yielded some work history information for the purpose of

studying chronic consequences of hashish use. For some reason,

Soueif's discussion does not enter this area.

Another Soueif study, completed in 1971, is less promising

because of its use of a prison population, but still is impres-

sive because of the size of the sample. The research involved

nearly 1700 subjects, including users and controls (17). This








time, both an interview schedule and a battery of largely

non-verbal psychological tests were administered. The problem

of motivational syndrome was again side-stepped by Soueif,

as he concentrated on comparing the results of the test

battery, and on pointing out social behavior variation within

the sub-groups of the user population. Nevertheless, Soueif

does report one difference between user and control groups

which might support part of the motivational syndrome argu-

ment. He found that the users on the whole were slower learners

than the controls (27) and that the controls scored consis-

tently higher on the test battery which included digit span,

tool matching, and other tests than did the users (28). One

of the often-cited symptoms of motivational syndrome is the

inability to learn new material or to concentrate, so the

results might be interpreted to exemplify this symptom in

Soueif's population.

Sampling problems here may have prejudiced this partic-

ular study in favor of the non-users. Soueif specifies that

the users were incarcerated exclusively for Cannabis-related

violations (17). Since hashish smoking is a widespread, and

often socially (if not governmentally) accepted custom, the

population of users from which the test population was drawn

by the method of arrest may be assumed to be large. Perhaps

the segment of the user population which at the time of the

study was not incarcerated can be said to be more astute in

avoiding detection than the segment in jail. This prejudice

might not work to the same extent on the population of other








criminals. For comparative purposes, it would be interesting

to have administered the 1971 tests on the 1967 user sample.

Two basic conclusions from Souief's work are of interest

and concern regarding motivational syndrome: first, that

users consider their work output to be diminished while under

the influence of hashish or craving for hashish (1967: 10)

and second, that users seem to be slower learners than con-

trols (1971: 27). The first conclusion disagrees with other

research already cited (Miles et al. 1975; Mendelson and

Meyer 1972) but is based on a much more solidly established

user population and therefore must be taken seriously. The

second may be due to sampling bias, but is worthy of further

investigation.

Other researchers who have used statistical analysis of

psychological data to study the consequences of ongoing mari-

huana use are reviewed below. Mirin et al. (1971) did compari-

sons between heavy and casual users on the basis of a psycho-

logical test battery. They found that heavy users (not con-

trolled for other drug use) tended to have higher scores on

a hostility scale of a moods test, but otherwise no signifi-

cant difference between the two groups in psychological test

variables (57). Student users were the subjects in Hogan's

study of marihuana use, and he found no significant differ-

ences among frequent users, occasional users and non-users

in school performance, and only minor nuance differences in

personality test scores (1970). Shean and Fechtman (1971), in

a comparatively superficial attempt to study the relation








between marihuana use and purpose in life, found that users

scored lower on this test than do non-users.


Composite and Field Research Tactics

Some researchers have a composite research tactic to

elicit several kinds of data on marihuana use. Hochman (1972),

for example, in addition to extensive clinical experience,

used a large-scale questionnaire to investigate some of the

consequences of marihuana use among students. A total of 2200

questionnaires were mailed out, which produced 64 percent

response. Roughly 90 of the subjects eventually submitted to

further interviews and testing. Hochman's interpretation of

his own results is possibly different from the interpretations

that might have been given by Kolansky and Moore of the same

research data. Users and non-users differed significantly in

interruptions of their academic careers and frequency of job

quitting because the job was "dull," and in indecision about

long-range plans, but Hochman finds no evidence supporting

motivational syndrome. His reasons for this interpretation

are that users and non-users do not differ in feelings of

life direction, age of first job, number of jobs, age at

marriage, number of times married, and number of times divorced.

These are only "halfway point" results of a study which is

not yet complete, so Hochman's statement are not final con-

clusions. Nevertheless, Hochman's methods deserve further

comment. The mailing technique in this case was favorably

modified to include some face-to-face contact with some of








the subjects, and, if the dosages reported by the users in the

sample were accurate, it could conceivably yield acceptable

results.

The problem, as in the Mellinger et al. study, is that

the author does not have enough assurance that the reported

levels and varieties of drug are accurate. Hochman has taken

the position that marihuana use in the North American sub-

cultural context represents a new movement in social sensitivity,

and perhaps a "buffer" against increased stress resulting

from living in a fast-paced, urban environment (61). This

position may at times supercede in importance the evidence

produced by his studies. He argues that the users he has

studied do not demonstrate the lassitude described by other

researchers, but he does not convince the reader that he was

dealing with a genuine chronic marihuana user. If they

were in fact long-term users the job or academic instability

and inability to make long-range plans remain questions of

marihuana use that are difficult to answer on the basis of

Hochman's research.

An author who supplies some cross-cultural perspective

using a mix of research tactics is T. A. Lambo of Nigeria

(1965). He has used both clinical and survey methods of ob-

taining data on the consequences of marihuana use. He con-

cludes that the cause-effect relationship between marihuana

use and low productivity or poor social adjustment cannot

be established on the basis of his research (9). As Warnock

and Walsh before him, Lambo does not rule out the possibility








of pre-existing psychological disorder in cases of mental

illness among Cannabis users (9). His survey results show

that crime, Cannabis use, absenteeism, and dismissal rate are

parts of a larger complex of social problems often resulting

from failure on the part of the individual to integrate his

personality sufficiently to "get along" in a changing social

environment (8). This concept, used by Hochman (1972: 61)

to illustrate his own "buffer" view, is important in consider-

ing cultural settings of marihuana use other than the North

American setting so prominent in the literature. Those areas

where marihuana use is considered deviant would tend to have

a population of socially marginal users, much like the ones

described in Lambo's work. Hochman assumes that marihuana

use in fact assuages the social pressures experienced by its

users, an assumption which would be contested by Lambo.

Lambo's description of Nigerian patterns of marihuana use

suggests that there exist among users several complementary

factors which contribute to that use, including participation

in a cultural ambience of societal marginality. The signifi-

cance of this concept will be amply illustrated in the descrip-

tion of Costa Rican patterns of Cannabis use.

Lambo also addresses another issue which is implicit in

much of the research on the use of marihuana and other drugs.

He doubts seriously that there exists in scientifically gener-

alizable form a "drug using personality" archetype. "Drug use

proneness" has been another way of wording this idea. Lambo

does not see among the Nigerian marihuana smokers he has








studied a set of personality characteristics which distinguish

the people most likely to abuse drugs from those who are not

(9). Sadava (1973) came to a similar conclusion in a longi-

tudinal study of college freshmen when he recognized that per-

sonality scale characteristics alone failed to predict ade-

quately whether or not an individual would end up using drugs.

He found that social environment also played an important

part in this outcome. The study of motivational syndrome's

validity leads to this question of the personality which is

predisposed to drug use. If tnere exist in the individual

drug user's personality certain elements or characteristics

which make him prone to use drugs, then these characteristics

may be part of a configuration which includes the tendency

to show motivational syndrome symptoms. The question of

"which came first?" is partially answered by Lambo and Sadava

when they suggest that beginning and continuing drug use often

depends heavily on conditions of social nurturance of that use.

Becker (1953) in a pioneering study of the process of

becoming a marihuana user, describes these conditions as he

negates the drug use proneness hypothesis (236). The central

message of Becker's study is that the people who instruct

the prospective user in Cannabis use must successfully rede-

fine the novice's first experience for him in good or bene-

ficial terms, regardless of his own first impression of that

experience (240). If this does not happen, the novice is

much less likely to continue to smoke marihuana. With this

principal in mind, the drug use proneness hypothesis becomes









less credible for marihuana smokers, and the question of

motivational syndrome cannot be applied to this hypothesis.

Re-stated in cultural rather than purely psychological terms,

drug use proneness may still be useful as a concept, although

its definition would become infinitely more complex than the

previous one.

The recently completed study of chronic marihuana users

in Jamaica (Rubin and Comitas 1975) also utilized a variety

of approaches to deal with the consequences of long term

Cannabis use, including psychological and medical testing and

extensive socio-cultural research. Beaubrun and Knight

(1973) state in an article based on the Jamaican research

that a comparison of 30 users' work histories with those of

30 matched non-users showed no difference between the two

groups (311). They go on to suggest that perhaps the lower-

class level of workers used in their study did not yield the

same results as would white-collar workers, whose complex

work tasks would be more affected by the drug than the tasks

of simple day-laborers. Beaubrun and Knight indicate that

they are not very familiar with the daily work schedules of

their subjects, who were hospitalized especially for the testing

period. This kind of perspective on the work habits of the

subjects would have been useful to add depth to the conclu-

sions of this phase of the Jamaican study.

Bowman and Pihl (1973) administered projective technique

formats to a sample of rural Jamaican users and non-users

(Beaubrun and Knight's sample was both urban and rural) also








in connection with the Jamaica study of chronic Cannabis

use. No essential difference was noted by the authors between

users and non-users, underlining the normality of ganja

smoking in Jamaica. Bowman and Pihl found also that the

users were able to compensate behaviorally for the effects

of the drug at increased dosages (169).

The most unusual branch of the Rubin and Comitas study

was the videotape sociocultural study on work efficiency and

Cannabis use done by Schaeffer. Carefully measuring amounts

of food and Cannabis consumed by rural agricultural workers,

and analyzing the videotapes of work party activity for kinetic

efficiency and speed, Schaeffer was able to determine that

workers under the influence of marihuana were working less

rapidly than when not smoking marihuana. The degree to which

'..o,. Lp;ed was reduced seemed to vary directly with the

heaviness of the dose. Users justified this drop in speed

by saying that their work was more thorough when under the

influence of marihuana. The tapes reveal that workers after

smoking performed significantly more movements per minute,

even though their work progressed more slowly. Nevertheless,

Schaeffer found that these significant differences were out-

weighed by the social importance of smoking Cannabis together

in a work party. Obviously, the Jamaican marihuana smoker's

approach to use of that drug is very different from the essen-

tially recreational approach of the North American user.

Schaeffer found that the drug does, in fact, reduce working

speed, but it is regarded by the workers as necessary to do









the job correctly and to maintaining a harmonious work group.

The latter values are so important that they eclipse the

former objective disadvantage. Schaeffer also found that in

the course of the yearly round of cultivating activities, the

difference in work speed caused by the Cannabis could not

otherwise go toward increased production because of the

limited landholdings of the farmers studied. In the present

situation, time that might have been saved by not smoking

ganja on the job would not have a productive outlet because

of limited land resources. These findings confirm the idea

that Cannabis and work can mix in some situations. Even so,

the tasks performed by the farm workers are rudimentary, and

such conclusions may not apply to an urban environment, where

worker's tasks are often more complex. Further evidence

regarding the urban user and his work is provided by the

Costa Rican study on chronic marihuana use.


Overview Authors

Some treatises on Cannabis use are written by authors

who have not conducted original research themselves, but

draw from the results of several researchers to synthesize

their own insights on the use of that drug. The following

segment of this review of the literature covers some of the

authors who have had something to say about amoti'ational

syndrome.

Anecdotal descriptions of long term marihuana users

appeared often in the volumes of the India Hemp Commission's








(1893) massive inquiry, but as the evidence was carefully

weighed, the Commission could not attribute directly to

Cannabis use any of the dire consequences described by their

witnesses. More recently, in the avalanche of publications on

marihuana and marihuana users, authors still employ the ance-

dotal case as an illustration. Kaplan (1970) provides the

example of Bill, the marihuana smoking mailman:

If you were to follow Bill around on his job,
it would be difficult if not impossible to dis-
cover if he was stoned. He walks steadily and
talks coherently--he controls his high. Two things
might give him away: he looks a little blank in
the eyes and he tends to stare at a bird, a tree,
a crack in the sidewalk a bit too long. Just for
a second, he is not quite there (166).

The rest of this passage depicts a successful adaptation of

daily marihuana use to a working lifestyle, but such descrip-

tions must be couched in a broad data base of established

validity before they can be accepted as generalizable to

some population of marihuana users. The body of data pro-

vided for Kaplan by G. Lewis Scott is not sufficiently

analyzed to justify this anecdote.

Even more unsatisfactory because of its source and its

inflammatory nature is a letter from the mother of an 18-year-

old dropout cited by Bloomquist (1971):

As a mother of an eighteen-year-old boy
charged with possession of marihuana, I most emphat-
ically say that I do not need scientific proof to
see what damage it can do. I watched my son travel
the typical road to ruin. . from a student who
enjoyed music, drama, and sports to a useless filthy
college dropout with no other aim in life than to
live in a carefree dream of distortion.
He went all the way . .. loss of appetite, long
deep sleeps after the drug wore off, short attention








span, poor memory, inability to read, talk, or even
communicate for more than a few minutes. His con-
tinued defiance is a definite hindrance to his
return to normal, as he had come to enjoy it so
much (160).

It is unfortunate than anecdotes such as this find their way

into print much more often than do objective scientific

statements. Testimony of the family members can be useful

in analyzing the social outcomes of marihuana use, but this

testimony cannot be accepted as it appears above in a defin-

itive causal statement.

Other authors attempting to present an overv'.iew of

marihuana use avoid the anecdotal description of the individ-

ual user. Grinspoon (1971) uses anecdotal material, but only

to illustrate points about subjective effects reported by

historical and literary figures, and never to depict life-

styles of users. Goode (1970) devotes a chapter to the

profile of the North American user, also avoiding the anec-

dotal account of user lifestyle by dividing the profile into

discreet factors such as age, sex, religion, education, etc.

Both of these authors are skeptical about the validity of

motivational syndrome, because of subcultural differences

between the user groups they have studied and the rest of

North American society (Goode 1972: 92-93; Grinspoon 1971:

289).

A conference at UCLA in which various marihuana researchers

on that campus participated, including two of the inventors

of the term motivational syndrome, produced some statements

on marihuana and its use. Louis Jolyon West, while at the








same time arguing against the existing marihuana laws, made

this statement:

. But the experienced clinician observes in
many of these individuals personality changes which
seem to grow subtly over long periods of time:
diminished drive, lessened ambition, decreased
motivation, apathy, shortened attention span, dis-
tractability, poor judgment, impaired communication
skills, loss of effectiveness, introversion, magical
thinking, derealization and depersonalization, dim-
inished capacity to carry out complex plans or pre-
pare realistically for the future, a peculiar frag-
mentation in the flow of thought, habit deterioration
and progressive loss of insight (Brill, et al. 1970:
461).

Clinical impressions such as these form a qualitative symptom-

ology of motivational syndrome much like the ones seen in

other works, but West is careful to say that he does not con-

sider his work to be definitive on the subject, pointing out

that further study of chronic marihuana use is needed. The

summary statement of the conference concentrated on West's

observations, but also presented Hochman's social evolution

theory of marihuana use among middle-class youth in the United

States. Here, the clinical and mixed statistical approaches

of marihuana research are juxtaposed, with the former attracting

somewhat more attention than the latter.

Another overview article worthy of some attention is

Bindelglas' "Conclusive Evidence and Marihuana" (1973). He

gives the testimony of non-Western clinical experts consider-

able weight as he outlines a symptomology of motivational

syndrome. The main symptoms of this condition, according to

Bindelglas, are "loss of interest and drive, sense of apathy

and tiredness, often accompanied by an unhappy, discontented








mood" (53). Along with these symptoms, Bindelglas enumerates

a number of "other clinical signs" including subtle decrease

in the ability to organize and to integrate multiple ideas,

impairment of the ability to develop new ideas and to think

creatively, gradual impairment of ability to discuss abstract

thought seriously, and deterioration of conversation (53).

This constellation of symptoms and "clinical signs" was culled

from West (1970), McGlothlin and West (1968), Kolansky and

Moore (1972), Bouquet (1951) and Benbud (1957). All of these

are decidedly clinical sources, but their combined corroborative

symptomologies help to remove some of the qualitative and

impressionistic aura which the individual studies cannot

avoid. Rathod (1975) criticizes clinical reports which, either

singly or in combination, attempt to present marihuana as a

cause of aberrant behavior because the clinicians often begin

with the presupposition that the claimed use of Cannabis on

the part of the patient is valid, and that it is the only

drug involved (96). Even though, as Bindelglas points out,

all of the clinicians corroborate each other, they may have

started their chain of inference on the very shaky footing

of assuming that marihuana was the only drug used by their

patients.

Brecher, in an article written for Consumer Reports (1975),

reviews some of the latest research on marihuana, including

recent statements on motivational syndrome by Kolansky and

Moore (1975) and Nahas (1975). Citing Schaeffer's Jamaican

research, he suggests that the term for discussion should









be "motivational syndrome," since those results show marihuana

use to be a necessary ingredient in the work party situation

(146). This comment may seem almost flippant, but it success-

fully expresses the need for some degree of cultural relativism

in the discussion of motivational syndrome. The cultural

values which the Jamaicans connect with marihuana smoking

must be very different from those of North American users who

find difficulty working at all under the influence of the

drug. Variations in the values attached to marihuana smoking

should be an important consideration in the study of amotiva-

tional syndrome.

Among the authors who survey the literature on marihuana

use, Trice and Roman (1972) have by far the most to say about

the relationship between marihuana and work. They introduce

their discussion by describing the difficulties in obtaining

truly objective information on this particular drug because

of the "armed camp" division between the pro- and the contra-

marihuana researchers (50). The lack of research on the

influence of marihuana on quality control in industry has

been, according to the authors, a major handicap in assessing

the relationship between that drug and work patterns (139).

From the evidence now available, they surmise that an exper-

ienced user is not likely to have problems in compensating for

the acute effects of marihuana on the job (145). Absenteeism

is a possible detriment to the users' work performance due to

physical disorders, such as head colds, which seem to accompany

marihuana use (138). An on-the-job difficulty encountered by








by users is the energy expenditure necessary to conceal the

smoking process itself (134). On the whole, Trice and Roman

do not consider moderate marihuana use to be a problem for

the worker of any greater or lesser magnitude than that of

moderate alcohol use (62).


Synthesis of the Existing Literature

In this review of the literature on motivational syndrome,

we have examined a wide variety of research strategies with

samples ranging from tiny hospitalized samples of six people

(Williams, et al. 1946) to 1700 in Soueif's prison sample (1971).

Many of the clinical studies concluded that they have detected

a degree of organic toxicity manifested in the motivational

syndrome which is a consequence of chronic marihuana use

(West 1970; Kolansky and Moore 1971, 1972, 1975; Chopra 1942;

Warnock 1903). Others (Walsh 1894; Lambo 1965; Eupfer 1973;

Thurlow 1971) looked for explanations other than Cannabis use

for observed symptoms. The authors of the closed environment

hospital studies (Mendelson and Meyers 1972; Miles 1975;

Williams, et al. 1946) were not totally in agreement on their

findings, but they considered marihuana not to produce lasting

symptoms of motivational syndrome among users. Large-scale

studies often found that Cannabis use alone could not be

blamed for the symptoms of motivational syndrome among users

(Mellinger, et al. 1975; Rubin and Comitas 1975; Hochman 1972;

Hogan 1970). However, Soueif (1967, 1971) found some evidence

that might be construed as supporting motivational syndrome








among Egyptian Cannabis users, and Robins, et al. (1970)

argued with some success that black adults who use Cannabis

during adolescence tended to have problems in adulthood which

could be attributable to their history of Cannabis use.

Researchers of all types were finding evidence supporting

motivational syndrome and evidence refuting it, both with

equal frequency.

Overview writers on marihuana also expressed both points

of view regarding motivational syndrome. Goode (1971),

Grinspoon (1971), Barber (1970), Trice and Roman (1972),

Rubin and Comitas (1973), and Kaplan (1970) all considered

motivational syndrome to be a part of a larger set of symp-

toms that are not necessarily caused by marihuana use.

Bindelglas (1973) McGlothlin and West (1968), Bloomquist

(1971) and Smith (1970) interpreted the evidence in favor

of marihuana as a causative agent for motivational syndrome.

The behavioral attributes listed below are derived from

many authors' research and thinking on the characteristics

of motivational syndrome. Not all of the behavioral attri-

butes in all of the discussed works are included in this

list. It is rather a distillation of all of the attributes

which have sufficient corroboration throughout the literature

to justify inclusion in a master list. If this list has any

cross-cultural applicability, then the Costa Rican evidence

will corroborate its behavioral attributes still further.

Confirming the existence of the same attributes in a different

cultural setting would support the hypothesis that Cannabis








use is a cause of those attributes. The behavioral attributes

of the motivational syndrome as they appear in the existing

literature are the following: 1) loss of interest and gen-

eral apathy and passivity (Bindelglas 1973; Kolansky and Moore

1971, 1972, 1975; McGlothlin and West 1968; Brill, et al.

1970; Smith 1970), 2) Loss of desire to work or maintain

business, loss of productivity (Walsh 1894; McGlothlin and

West 1968; Brill, et al. 1970; Smith 1970; Soueif 1967;

Robbins, et al. 1970), 3) Loss of energy, general state of

tiredness (Kolansky and Moore 1971, 1972, 1975; Brill, et al.

1970; Bindelglas 1973), 4) Depressed, moody state of mind,

inability to handle frustration (Kolansky and Moore 1971,

1972, 1975; Bindelglas 1973; Smith 1970; Walsh 1894; Brill,

et al. 1970), 5) Inability to concentrate, decrease in

ability to master new material or organize multiple ideas,

and impairment of verbal facility (McGlothlin and West 1968;

Bindelglas 1973; Soueif 1971; Bloomquist 1970), 6) Sloven-

liness in habits and appearance, including hygiene deterior-

ation (Walsh 1894; Kolansky and Moore 1972; Williams, et al.

1946; Smith 1970), 7) Dedication of all available resources

to procuring more Cannabis (Warnock 1903; Kolansky and Moore

1972; Smith 1970). Inability to make long-range plans and

carry them out was not included in this list of attributes,

because it is not necessarily absent among individuals who

otherwise show a high level of achievement. Many presidents

of the United States might be accused of suffering this same

"disorder."




























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The authors and researchers who refute motivational

syndrome also contribute valuable perspectives for the re-

searcher who would investigate this complex of phenomena.

Grinspoon (1969), Goode (1970, 1972), Barber (1970, Hochman

(1972), Mellinger et al. (1975), Brecher (1974) and Rubin

and Comitas (1973) unanimously warn that cultural factors

including multiple drug use and values of the sub-cultural

group with which marihuana use is connected may cloud the

cause and effect relationship between motivational syndrome

and marihuana use. Miles (1975) and Mendelson and Meyer

(1972) suggest that dosage levels should be well checked

and behavior observed closely. They also suspect that exper-

ienced users can compensate for the effects of marihuana

while performing everyday tasks. Rathod (1975) recommends

more field work in order to avoid the errors common to clini-

cal investigations of such questions.

In Table 2, the prominent researchers in Cannabis who

have dealt with motivational syndrome and related phenomena

are cross-tabulated with positive features of the various

Cannabis research efforts to date. The material tabulated

here shows that relatively few research designs employ more

than four of the six features. All of these features have

been noted as beneficial to the purpose of developing a

balanced perspective on Cannabis use during the preceding

reviews of individual studies. For example, the knowledge

that the researchers are in fact dealing with true chronic

users for whom other kinds of drug use was controlled








strengthens their inferences accordingly, as in the Mellinger

et al. study. On the other hand, McGlothlin's (1970) sample

selection procedure weakens his final conclusions by not

controlling adequately for LSD use.

Dosage documentation is an important weakness in many of

the studies shown in Table 2, as is knowledge of cultural

Cannabis use patterns. When the Cannabis researchers do not

demonstrate an adequate grasp of these two basic points of

information, they have difficulty making their conclusions

convincing.

One of the most striking gaps in the accumulating body

of knowledge on Cannabis use is the lack of studies on non-

institutionalized populations. Of the 17 researchers cited

here, only six deal with Cannabis users in their natural

settings. The others have based their inferences on study

of prison inmates, psychiatric hospital patients, or users in

other special clinical settings.

Availability of medical and basic personal data on the

user samples is a relatively strong design feature in most of

the research cited in Table 2. Nevertheless, these studies

suffer generally from a lack of supporting evidence with which

to rule out other influencing factors. Kolansky and Moore's

intensive clinical study, for this reason, can be dismissed

too easily because of their not being able to specify whether

or not their subjects were "stoned" during clinical sessions

(cf. Chapter 1). Even the Jamaica study (Rubin and Comitas

1975) which pioneered new socio-cultural approaches to the








study of Cannabis use, is diffuse with regard to the various

rural and urban ganja smokers who were tested medically and

psychologically and studied anthropologically.

At the bottom of Table 2, the Costa Rican study of

chronic, long term Cannabis use is included and evaluated.

Not only is this the first study of its kind to include so

many different kinds of intensive data gathering on such a

large user sample and their rigorously matched controls, but

it is the only Cannabis use study to gather all of these

different kinds of data on the same set of subjects. For

any given individual in the matched pair sample the study

files contain the results of a basic physical exam and lab

work-up, chest X-rays, EKG, intensive visual function studies,

lung function studies, a medical history, basic personal infor-

mation, sleep pattern information, psychological testing

results for motor function, intellectual function, personality,

and attitudes, and an average of 150 pages of transcribed life

history materials. Inferences based on this wide range of

information are likely to be stronger than those based on only

one or two varieties of information. With the above data

base at the disposal of the researcher, verification or

rejection of motivational syndrome's specific attributes

should be possible in an almost definitive sense. The chapters

which follow will utilize the body of data gathered during

the two years of research on chornic marihuana use in Costa

Rica directed by Carter, Coggins, and Doughty.







In order to establish the relationship between the Costa

Rican setting of the chronic marihuana study and the data

which will be analyzed, we shall begin in Chapter II with a

description of the urban environment from which the subject

population came, followed by a description of the subject

selection process. Patterns and levels of Cannabis consump-

tion will then be provided to document the subjects' status

as chronic users. A systematic study of subjective effects

of marihuana use will provide a heuristic means of determining

the impact of that use on the lives of the users. Once this

background and development materials have been presented,

the relationship between marihuana use and the specific

behavioral attributes: apathy, loss of productivity, lethargy,

irritability, decrease of intellectual abilities, slovenliness,

and dedication of all available resources to Cannabis procure-

ment, may be examined for applicability to the Costa Rican

case.

An entire chapter will be devoted to the impact of mari-

huana use in the life cycle, dealing specifically with the

presence or absence of "loss of desire to maintain business,

loss of productivity" among the users when compared with a

closely-matched non-user group. Because it causes the most

concern for the individual's adjustment in society, work and

school performance and life history data will be used to assess

this particular aspect of motivational syndrome for the

Costa Rican case.








"Loss of energy and tiredness" as well as "apathy and

passivity" will be compared to the Costa Rican research evi-

dence using socio-cultural data and also interpretation of

personality measures administered to the sample group by the

psychological investigators on the transdisciplinary research

team. "Depression, and moodiness" will be discussed in light

of psychological and socio-cultural data on the subject

sample, combined with some natural history-style observations.

The psychological battery administered to the sample of

Costa Rican users provides ample evidence for the assessment

of "inability to concentrate, memory loss, and decrease in

verbal ability." This will be combined with some socio-

cultural data and individual user testimony. The discussion

of "slovenliness" as an attribute of motivational syndrome

will bring in testimony by field staff other than the anthro-

pologists, as socio-cultural data. "Dedication of all avail-

able resources to procuring more Cannabis" will be tested

against the Costa Rican evidence field staff testimony, socio-

cultural data from the life history materials, and natural

history observations.














CHAPTER II
THE URBAN SETTING OF THE STUDY


San Jos6 occupies the gently undulating space between

two rivers, the Virilla to the north and the Maria Aquilar

to the south, which cut through the central intramontain

valley of Costa Rica. This rain-soaked valley, called the

meseta central, is the home of 55 percent of the Costa Rican

population. The original handful of Spanish settlers who

came to Costa Rica beginning in 1561 were attracted to the

rich soils of the region, as well as its temperate climate.

Nevertheless, Spanish colonial interest in Costa Rica was

not great, and the white population there did not attain

8000 by 1750 (Stone, 1975; 55). Costa Rica's rate of growth

remained slow during and after the colonial period. San

Jose's population in 1864 was still only 9000, even though

coffee had begun to take hold as a major cash crop, and some

efforts had been made to maintain contact with the inter-

national coffee markets (Stone, 1975; 82-87). International

coffee trade was eventually an influential factor in San

Jose's accelerated growth during the late nineteenth and

early twentieth centuries.

There is little cartographic record of the patterns of

urban growth during the earliest stages of San Jose's history,

but the history is clear enough to indicate that the early









settlement which later became the city began small and grew

very slowly. The hamlet of San JoseY was founded in 1737 when

its population was only a handful of families (Academia de

Geografi'a e Historia, 1952). At that time, it occupied little

more than the central hill on which are now found the Central

Park, the National Cathedral, the National Bank, and the

Union Club. The spurts of growth which brought big city status

to this country village are relatively recent in the city's

history. The population is still becoming accustomed to that

status.

The local pattern of addresses and directions reflects

the recentness of San Jose's transition into urban importance.

Natives of the city, who will be called Josefinos for the sake

of brevity, use a system of directions which resembles that

of a country town. The system uses known points of reference

from which the inquiring party is instructed to measure approx-

imate distances in the direction of one of the four co-ordinates

of the compass. In order to find a house in barrio Mexico,

for example, a Josefino will tell you to go 200 varas (one

vara is 33 inches) to the north of the barrio church and 25

varas east. This system is such a pervasive survival that

mail and other deliveries are still made according to varas

(or in deference to metric internationalism, in meters; which

for direction purposes are used interchangeably). A Josefino

is usually hard-pressed to give directions to an address

across town to a stranger who does not know the local points

of reference, using his momentary position as a reference








point. Neighborhood points of reference sometimes retain

their original place names for direction purposes long after

they have disappeared. Thus, the "old library," although still

used as a reference point, is now a large parking lot.

The township (municipalidad) of San Jose was officially

chartered in 1843, more than a century after the hamlet was

established. Forty-four years later in 1892, one of the first

censuses of good quality in Costa Rica recorded the population

of the city as less than 20,000 (Direcci6n General de Estad-

rstica, 1974; XIX).

San Jose's first major growth spurt took place during the

1920's, reflected in a 1927 census figure of 89,000 population

for the metropolitan area (Cuevas 1973: 5). New lower-class

settlement spread to the south of the central business and

residential districts. These southern barrios extended to,

and across, the banks of the Maria Aguilar River. Their popu-

lation developed a reputation for marihuana use which became

important to our earliest attempts to identify a group of

chronic users. A second growth spurt took place in San Jos&

during the late thirties and early forties, resulting in the

expansion of outlying towns to the south and east of central

San Jose, and doubling the 1927 metropolitan area population

by 1950 (Cuevas 1973: 5). [any of the users and non users

who entered the marihuana study during its later stages came

from these outlying zones.

Present-day San Jose has a metropolitan area population

of 436,862, according to the 1973 Census (Cuevas 1973: 7).








It is the center of a cluster of nearly-continguous cities

and towns with a total population of nearly 700,000. In a

very direct sense, San Jos6 is the hub of governmental,

industrial, and commercial activity for the busiest and most

populous zone of Costa Rica.

Roads from fair to excellent in quality connect the

central metropolitan area to the major surrounding towns,

none of which is more than twenty miles distant. Buses from

all over the country roll into San Jose bringing people ..'ho

must carry out their various transactions with the market

or the government there. Bus service to the city center

from other parts of the immediate metropolitan area and its

satellite cities is regular and affordable. In fact, all

bus service leads ultimately to San Jose, and no destina-

tion is important enough to bypass that central hub. There

is no direct bus communication, for example, between Heredia

and Cartago, the third and second-largest cities in Costa

Rica. Even within the metropolitan area, all bus routes

lead to the city center, with no direct intercommunication

among outlying areas unless they lie along a single bus route.

Public railroad lines also terminate and originate in the

capital's center. Transportation, then, is very centralized

in San Jose, and this gives the city an extremely dense

concentration of social interaction in its main business

district.

Central San Jose crackles with vigorous commercial

activity and the administration of governmental services.








Banks and large department stores dominate the area immediately

north of the central park. West of this shopping area, the

large markets dealing in wholesale and retail farm products

and cheap consumer goods cram the streets with commercial

activity. Hotels and government ministerial buildings are

the most imposing architectural features of the southern and

eastern sectors of the city, and three major government-run

hospitals occupy the area due west of the central park. Little

industry is in evidence in downtown San Jose, but the archi-

tecturally dominant buildings reflect the importance of this

central area in the daily lives of the inhabitants not only

of the metropolitan area, but of the entire meseta central.

One must come to the city center for a driver's license, to

buy a money order, to hospitalize a sick child or to get a

health certificate or a VD injection. One should go to the

city center in order to get the best price on avocadoes or

fabrics or ready-made clothes. Hard-bound books are sold only

in downtown San Jose.

Small businesses and residences occupy the spaces between

the more imposing structures in the downtown area. Shops,

bars, and restaurants present a jumble of storefronts on the

busiest streets in the main shopping zone to the North. The

market zone to the northwest is interspersed with shops of

lower quality as well as cheap boarding houses and hotels.

Here also are numerous handcraft shops where tailoring, shoe-

making, and myriad repair services are performed by artisans

who may live in the back of the shop. The southwest sector









of the city has a high concentration of low-life bars and

brothels, mingled with residences and more artisan shops

and artisan supply stores. The northeast and southeast

sectors of San Jose are the most residential, the former

containing some very upper-class housing, and the latter

mainly middle-class housing with some artisan shops, bars

and restaurants. All of these zones exist within a radius

of one mile from the central park.

San Jose's downtown area is the single most important

feature of the city for the purpose of studying marihuana

use. The reasons for this are twofold. First, as was

intimated earlier in the description of transportation net-

works and centralization of institutional and communication

functions, the downtown area is a communication switching

point with connections to all parts of the metropolitan

area and ultimately the entire country. Messages left with

key people in the city arrive reliably to recipients in the

penitentiary, any outlying residential neighborhood, and in

one case, even in the port city of Limon, 100 miles away.

Second, the downtown area of San Jose is important because

its intense activity has spawned a group of what are often

called "street people," who manage to make a living providing

marginal services for, or swindling or stealing from the

hordes of people who transact their business in San Jose each

day. "Street people" is a phrase often used to describe

hippie-like vagrants who often populate college towns

tPartridge, 1973), but they bear little resemblance to the








street people of San Jose. The gently predatory urban denizen,

whom Ramos (1956) calls the "urban sub-proletarian" occupies

himself in San Jos" shining shoes, "guarding" automobiles,

perpetrating minor gambling frauds, or committing petty larceny.

Often, a street person will engage in more than one of these

occupations concurrently. Such individuals have a wide range

of acquaintances in the city, and they are often key figures

in informal communications network among fellow "urban sub-

proletarians." They are also marginal to "decent" Josefino

society, and this quality makes them more immediately acces-

sible to anthropological research. The openness of the street

people has well-defined limits, and getting to know them takes

as long as for any other individuals in the subject sample.

Nevertheless, they were the first to give our study team any

idea that a chronic marihuana using population existed in

San Jose. Further description of this fascinating group of

inner city inhabitants will be offered later, including its

crucial effect on the intiation of chronic marihuana use.

Living in San Jos6 and its environs is a constant exercise

in maintaining social distance. Even though dwellings are

almost always contiguous, the city's inhabitants do not always

associate with their immediate neighbors, and they often pre-

fer to keep interaction on a formal and superficial level with

the family or individual next door (Rodriguez-Vega 1953: 29).

Despite the fact that Josefina families usually share their

neighbors' business involuntarily because of thin walls, they

prefer to form their strong social relations with people known








through family ties or other formal and informal associations.

Interviews with Costa Rican city dwellers in the study sample

showed that many desired a house with a private entrance where

they could "live tranquilly" (True 1976a: III-11). This ideal

living situation is seldom attained by Josefinos, so they must

maintain social distance in other ways.

Private houses in the city center and in the residential

barrios characteristically have a narrow front four to six

meters wide. The living space in these houses comprises a

single story which extends back from the entrance toward the

middle of the city block, ending in a garden or patio for

laundry purposes. Such a house may be occupied by one family,

or up to four different nuclear families. With similar struc-

tures and living situations on either side of the house, and

only thin walls separating them, city dwellers cannot expect

to maintain a high degree of privacy. Contiguous neighbors

in San Jose seem to compensate for this problem by maintenance

of social distance. They hear, but do not listen to, the

affairs of their neighbors. It was found during early survey-

style work in one residential barrio that people living next

door to each other are likely to know less about each other

than a door-to-door interviewer can find out in a brief inter-

view. Maintenance of social distance in this way protects

the individual's sense of privacy in a crowded situation.

Those neighbors in San Jose who demonstrate a tendency to

pay attention to their neighbor's business are called dispar-

agingly vino, which has the same sense as voyeur, and is








considered little better than the samoleon, or "peeping

tom."

Propinquity, then, and a sense of community with one's

neighbors cannot be considered realistically to form an

important part of the social fabric for urban life in San

Jose. Most Josefinos attach more importance to alternative

frameworks for social interaction, specifically, family ties

and informal personalistic associations. In either of these

frameworks, the individual associates with others because

he has chosen to do so, rather than being forced into social

relations by virtue of some accident of rental rates or near-

ness to work locations. Family ties seem to center on the

individual's parents among Josefinos, and sibling ties are

less emphasized. The individuals who participated in the

chronic marihuana stud, testified that the strength of the

bond between mother and son is particularly strong. More

than half of those questioned in the final sample indicated

that they preferred their mothers over their fathers, compared

with 13 percent who preferred their fathers and 21 percent who

liked both parents equally. Costa Rican mothers react

negatively to spatial separation from their sons, and many of

our subjects reported that their mothers were plunged into

a deep depression by their final departure from the parental

household. Some Costa Rican sons maintain daily contact with

their mothers even though they. live on opposite sides of town.

Informal associations may be formed among Josefinos in

a wide variety of ways. Workshop companions are often included








in an individual's circle of friends and acquaintances. The

clientele of a favorite bar or pool hall may also provide

lasting friendships and social contacts. Some informal social

ties are the product of going through grammar school or

reformatory together. Still others are formed in the course

of trying to deal with institutional structures such as the

social registry or the courts which are too complex or other-

wise impenetrable to handle without the benefit of such asso-

ciations.

The individual city dweller in San Jose uses his familial

and informal social relations as part of his strategy to cope

with an urban environment laden with intimidating impersonal

agencies and intrusive stimuli. Wolf (1956) writes that the

anthropologist's job in an urban setting is to study human

behavior in the intersticial realms between institutional

structures. This concept applies very well to the situation

of urban Costa Ricans. San Josd is the center for the insti-

tutional activity in Costa Rica, and as a result, institutional

transactions take place in bewilderingly large-scale settings.

A person who approaches such transactions on a totally impersonal

level is likely to be faced with endless queues, confusing and

seemingly contradictory instructions, continuous retracing of

steps, and ultimately a low likelihood of success. However,

if he has a cousin who is a bank teller, or an old schoolmate

who works in the Ministry of Transportation, he utilizes these

social ties to facilitate the taking out of a loan or the

renewal of a driver's license. Even a person who has no








direct familial or personalistic ties with the institution

in question may have recourse to a friend who has friends or

family in helpful positions. In this way, the establishment

and maintenance of informal social relations is important to

the relative success with which the Josefino manages his

affairs in an environment dominated by large institutions.

Wolf aptly named the task of the anthropological team

in Costa Rica, because informal association networks were

important urban features which eventually led us to find a

group of long-term marihuana users. Among even the most

deviant segments of Josefino society, personalistic social

networks form the medium through which their participants

deal with the institutions that impinge on their lives. In

the case of the street people, their informal associations

are at best poorly connected with important institutions, and

they depend on the internal cohesiveness of their networks for

effectiveness. For example, some participants in a street

network are regularly picked up by police for "vagrancy."

When this happens, the prisoner sends word through the network

that he needs someone to sign an affidavit to certify that he

is not a vagrant. A participant in the same network with

sufficient respectability to sign the affidavit is then summoned

to the courthouse for this purpose. The research team found

that a wide variety of cheap legal services could be obtained

by participating in one particular system of informal associa-

tion among street people. Participants in such systems often

bemoan the fate that led them to associate with such "bad








company," but they exploit their networks constantly.

Responses to living in San Jose confuse the interpreta-

tion of Redfield's (1947) folk-urban hypothesis. San Jos4 is

the center of activity for all of Costa Rica's large institu-

tions, which operate ostensibly on an impersonal basis, and

this is in keeping with the concept presented in the continuum

of increased impersonal interaction in an urban setting. On

the other hand, Josefinos cope with impersonal institutional

structures by means of familial and personal ties, or the kinds

of ties that, according to the continuum, are supposed to

be strong in a rural village setting, but not in an urban

setting. Urbanists are finding this contradiction to be true

for most urban Latin Americans, as well as many other varieties

of city dwellers around the world.

We had first-hand experience of the workings of the

familial and personal networks among the poorest inhabitants

of San Jose, but the same kinds of social relations may be

dominant at much higher levels of Costa Rican society. Stone

(1975) argues that the Costa Rican elite infrastructure is

based on strong family ties which originated during the

sixteenth century. According to Stone, the descendants of as

few as six original families have supplied most of the high

governmental officials throughout the history of Costa Rica.

Possibly, the governmental institutions themselves may origin-

ally have been formed on the basis of familial relationships.

In the lowest strata of San Jos6 society, interpersonal

networks depend apparently very little on family relationships.








Since they are systems of interaction among people who are

considered deviant by most Josefinos, these networks are

usually based on fluid, informal ties which have less stability

than family ties. Nevertheless, some families are widely-

known and connected among street people.

The courtesies, services, and goods that flow among

participants in a given network vary according to the means

and station of those participants. For example, the inter-

change among elite Josefinos may take the form of government

jobs or banking advantages, while street people pass messages

into and out of prison or dispose of stolen articles through

personalistically-activated channels. Reciprocity governs

the manner of exchange in both of the above cases, sometimes

in the form of direct reciprocity, and sometimes generalized

reciprocity. Often, a good or favor corresponds to a similar

good or favor on the part of beneficiary, in which case the

reciprocity is direct. Generalized reciprocity is particularly

important in netw..orks where communication activity is intense.

For delivered messages or privileged information, the favor

is offered with the generalized expectation of some equal

favor to be extended at an unspecified time in the future.

A man in the penitentiary who scribbles an urgent message

for aid to be taken by a lottery salesman to a contact down-

town is not in a position to offer any immediate reward for

the service, yet he may be expected to do the same thing for

someone else '.hen he is able.

'Iembers of the marihuana study research team received








many emergency messages from jail, called "cables," in which

were handwritten requests for money or legal aid. The down-

town points where these messages were delivered was found to

be a useful place to send messages to participants in the

street people's interpersonal networks. Such messages were

usually delivered and answered within 24 hours, and they some-

times managed to reach people who were many miles from the

San Jose area.

The street people's interpersonal association systems

deal with more than communication, and the goods and services

which flow through these systems include marihuana and stolen

objects. The latter items are euphemistically called descuidos

or "unguarded things," and they are constantly being bought

and sold or passed along for sale by members of street people

networks. Each participant in the chain of circulation for

stolen objects can expect some small share in the profit.

Marihuana distribution occurs only on a relatively small

scale among street people, but it also carries some profit

for participants in the chain of circulation.

The anthropological research team found early in our

study of street people and their networks that people who

occupied crucial positions in the chains of distribution for

information, marihuana, and descuidos were likely to be key

people for making contact with chronic, long term marihuana

users. Some of these key people, called "brokers" b'y. True

(1976a) dealt only in marihuana and information, while others

were central in the distribution system of all three items.








Those who specialized in information were found in a part of

the inner city where many people interact constantly such as

the Central Park. This is a particularly active area because

buses from all over the metropolitan area load and unload there.

Some of our first contacts were made among information brokers

of the Central Park. Other brokers have an operations setting

which is outside the center of San Josd in a residential

barrio. The overall interaction density in this kind of oper-

ations setting is very low, compared to the bustle of downtown

San Josf, but the workings of the broker and his network

remain brisk. We were fortunate to gain the confidence of

several brokers and eventually to learn something of their

operations and the participants in their networks. These

participants later took part in our study of long term mari-

huana use.

San Josu provides a compact urban environment in which

to study a specific deviant behavior. Since it has not been

a major city for very long, its urban qualities are blended

with some survival of "country town" behavior. Josefinos

give directions in terms of varas and compass coordinates

despite the existence of an orderly system of street numbers,

but, in urban fashion, they seem to know very little about

their immediate next-door neighbors. However, Josefinos do

not deal with impersonal institutional structures, such as

governmental ministries, hospitals, and banks in an impersonal

manner. Interpersonal ties between friends and family become

the agencies through which the individual Josefino makes sense








out an otherwise bewildering array of necessary transactions.

These ties exist on all levels of society in San Jose. At

the lowest of these levels, the network of functional social

interaction consists of individuals who may be called street

people. Low-life street networks of informal association

provided initial contacts which led to further contacts in

our search for chronic marihuana smokers. The chapter which

follows will describe the process of following chains of

interaction in this social setting and the eventual procure-

ment of a group of long term smokers for our intensive study

of marihuana use and its effects.













CHAPTER III
THE STUDY SAI-PLE


As part of a trans-disciplinary team of researchers

with specific contractually stated study objectives, the

socio-cultural segment comprising three anthropologists

began with a clear idea of the number of people to be

studied, and the basic kinds of information to be gathered.

We were to locate 80 users of marihuana who had a minimum

of ten years' experience with the drug, and minimal exper-

ience with other kinds of drug use. The subjects were to be

males between the ages of 13 and 50 who were willing to

participate in a series of medical, psychological, and socio-

cultural studies spanning a two-year period. Concurrently,

we were also to find 160 non-marihuana-smokers who were

otherwise as identical to our user group as possible. Je

went into the field with tightly defined numbers and cultural

qualities in mind, and we were held to them by contract.

Scheduling of study activities was also tight from the

beginning, with a set timetable for completion of the various

research phases. July, 1973,marked the beginning of the

study with the first attempts on the part of the sociocultural

team to make contact with a user population. By the beginning

of January, 1974,we were to have identified marihuana users








and suitable controls in sufficient numbers to begin the

initial medical screening phase. This phase entailed passing

all subjects through a medical examination which included

electrocardiogram, opthamological examination, chest X-ray,

comprehensive blood, urine, and fecal analysis, neurological

examination, and general physical examination. Medical

history questionnaires and initial socio-cultural question-

naires were also administered on the same day that each

subject underwent the medical examinations.

The end of June, 1974, would see, according to the study

timetable, the end of the initial medical screening process

for all 240 selected subjects and the completion of initial

socio-cultural studies. From this pool of 240 screened

subjects, those who had not been eliminated for medical or

other reasons would be selected to form 40 matched pairs of

users and non-users. These were to be selected for the pur-

pose of intensive medical and psychological testing, as well

as in-depth elicitation of socio-cultural information from

each of the final 80 participants. The intensive studies

were to begin about July of 1974, and to end about March,

1975. Termination of the project, which had a planned ending

date of June, 1975, was to be completed during the concluding

three months.

The actual execution of the study schedule did not vary

radically from the initial plans, except that the intensive

medical testing continued sporadically until August, 1975.

It was decided at the time of the selection of the matched








pairs that some 12 medical screen test slots would be held

open for contingency purposes. These slots were later filled

with subjects who were considered to have characteristics

which matched them with other subjects who had already passed

through the initial medical screen. When the medical screening

process was finally tallied, 84 users and 156 non-users had

been given the initial tests.

Selection of the subjects who would participate in the

intensive studies was done on the basis of data elicited

during the initial medical screening period. The medical

data were assessed by Wilmer Coggins, the co-principal investi-

gator of the project in charge of medical studies, while the

socio-cultural criteria for matching were evaluated by Paul

Doughty and William Carter, in collaboration with Maryanna

Baden, and with NIDA contract officers Eleanor Carrol, Jean-Paul

Smith, and Stephen Szara.

Many subjects were eliminated from intensive participa-

tion in the second phase of the study because of medical prob-

lems, for which they were subsequently referred to appropriate

branches of the Costa Rican health care system for treatment.

Among these problems the commonest were positive serological

test for syphilis, pulmonary lesion shown in chest X-ray,

and non-correctable visual abnormalities. There were also

12 cases of serious disease diagnosed for which those subjects

were excluded from further testing. Table 3 shows the frequencies

of the various medical criteria used to eliminate subjects

from the selection process for the final group. Most of the








Table 3

Subjects Excluded from Matched-Pair Study
For Medical Reasons

Users Controls Total Signifi-
,1-,4 11-156 1-240 chance

Defects in visual 4
4 4 8 NS
acu ity
Defective color
3 13 16 HS
vision
Positive seriological
test for syphilis
Pulmonary lesion 8 17 25 US
Other serious disease
(incl. severe anemia,
heart disorders, 3 9 12 NS
subnormal mentality)
Total excludable
38 60 98 NS
defects
Total excludable 3 5
37 56 93 I S
subjects*

*Some subjects had more than one excludable defect.
(after Coggins, 1976; X-8)


differences between the large user and control groups in the

rate of occurrence of excludable defects were not significant

statistically. The case of positive syphilis tests may have

a cultural explanation. As we shall see later in more detail,

the users in the sample tended to have more street experience

in their life histories than the controls, including sexual

experience at an earlier age. With more sexual precocity and

more exposure to the streetside variety of sexual behavior,

contraction of a venereal disease becomes a stronger proba-

bility for the users than for the non-users.

Eleven subjects were eliminated for non-medical reasons,








Table 4

Subjects Excluded from Matched-Pair Study
for Reasons Other Than Medical Ones

Cause User Control Total
N-84 N-156 N-240

History of absention from
marihuana found to be N/A 2 2
inaccurate
History of marihuana use
1 N/A1
found to be inaccurate
Alcohol abuse interferes
with participation in 1 2 3
testing
Failure to keep appointments 2 1 3
Failure to cooperate with 2 2
medical test procedure

Totals 6 5 11

(after Coggins, 1976; X-10)

as shown in Table 4. The first two criteria in Table 4

represent people who managed to slip by the pre-screening and

cross-checking done by the anthropological team before testing

was begun. The final group of subjects comprised those whose

smoking or non-smoking reputations had stood up under extensive

cross-checking. Difficulties encountered during the medical

screen procedures account for the other three non-medical

criteria for elimination from the study.

The matched group was selected from a final pool of

qualified subjects which contained 41 marihuana smokers and

95 non-users. The matching procedure was complex, involving

a close match for each of six different variables. These

variables, taken from the results of medical history question-

naires and personal information elicited during the medical








screening process, were age, marital status, educational

level, employment level, alcohol use and tobacco use. Age,

alcohol use, and tobacco use were all reduceable to numerical

equivalents. This was done for tobacco use by expressing

it in pack years, or the number of years during which the

subject has smoked one pack of cigarettes per day. Alcohol

use was scored on the basis of a modified version of the

alcohol use questionnaire designed by the Costa Rican Center

for Studies on Alcoholism, which has a 0 to 17 scale. For

age, tobacco, and alcohol, all pairs had to be within four

points of each other in order to qualify as a matched pair.

Marital status, educational level, and occupation were

matched according to the meanings of these attributes in

Costa Rican society. For example, marital status has a

broad definition among lower-class Costa Ricans, including

stable free unions and serial free unions, as well as long

and short-term formal marriage. Therefore, stable free union

and long-term formal marriage were equated for matching

purposes, while experience with serial free unions was differ-

entiated from pure bachelorhood. The marital status matching

criterion had to be flexible, because of the shifting status

of many of the study participants.

Education for matching purposes was broken into five

categories, none, primary incomplete, primary complete,

secondary incomplete, and secondary complete. Other insti-

tutional socialization such as reformatory, orphanage, or

seminary was also taken into account. Matches could be made








between individuals within one "step" of each other. A

marihuana smoker who had completed four years of primary

school, for example, could be matched with a non-consumer

who had finished sixth grade.

Matching for occupation was done by using equatable

levels of employment, rather than exact job pairing. Lower-

class workers move interchangeably among jobs within their

level of employment, and the jobs within a given level were

deemed appropriate for matching purposes. Artisans who work

in construction, shoemaking, or tailoring were all considered

matchable with each other. Similar employment levels were

also recognized for skilled blue-collar jobs and for white-

collar jobs, although there were very few subjects in the

latter category.

The anthropological team began to seek contacts among

the user population in San Jos6 with the assumption that

long-term use of marihuana was pervasive in all levels of

Costa Rican society. After an initial sortie into the Univer-

sity atmosphere, it was discovered that marihuana use at the

level of ten years or longer in that context was almost

unheard-of, and that the general drug use ambience in the

University was in fact very similar to multi-drug use in

North America. This led to the suspicion that the lower-

class patterns of marihuana use described by early contacts

among street people were really the only patterns which would

ultimately become a source of long-term users who could

qualify for participation in our study. Musicians were at









first expected also to be a group which might produce suit-

able long-term users, but their drug of preference turned

out to be alcohol, and the musicians indicated very little

interest in or consumption of marihuana. Abortive attempts

to find qualified long-term users of marihuana among other

strata of Costa Rican society led to our eventual concentra-

tion on the working class as a source of users and of controls.

Contacts with street people were the anthropological

team's first breakthrough in learning something about chronic,

long term marihuana use in Costa Rica, and they came very

early in the study. In fact, Carter first spoke to some

eventually central informants in the street ambience during

a feasibility study two years before the full-scale study

actually began. These informants began by appearing very

open about their marihuana use, but they seemed to limit

their comments to aspects of use in their own social group,

demurring when asked about other people who might smoke

marihuana. The sequence of behavior on the part of the

street people, first openness, up to a point, and then reluc-

tance to introduce us to other long term users, was frustrating

to the anthropological team, but it was also understandable.

At the time our study was begun, it was punishable by law

to possess marihuana for either sale or personal use, with

a minimum term of six months (cf. Chapter IV). The street

people themselves had little to lose by revealing that they

smoked marihuana, because they were already well-known to

the general public as smokers. Other users of the drug, as








we shall see later, have much more to lose by imprudent

contact with unknown outsiders. Faced with this impasse in

the street people's networks, the anthropological team began

to formulate other means of gaining entry into the social

circles of other groups of long term users.

One of our tactics for attaining contact with other

long term users was a survey of cobbler shops, because we

understood from several sources that shoemakers were often

marihuana users. After mapping these artisan shops for much

of San Josd, we attempted to administer a vague health

questionnaire as a device to lead into conversation about

drug use. This was very unproductive, because most shoe-

makers were too busy during work hours to take time for

answering questions. Another tactic which was only slightly

more successful entailed administering a "health" question-

naire house-to-house in neighborhoods which were known to

have marihuana users among their residents. This tactic led

to the discovery, ironically, of a shoemakers' shop where

there were several qualified users. Otherwise, the daytime

door-to-door method did not produce sufficient contacts with

the user population to warrant its continuation.

The door-to-door tactic had its rewards, despite its

failure in the explicit task of finding chronic marihuana

smokers. The field workers were impressed by the lack of

community spirit in the neighborhoods surveyed. This impres-

sion led to the hypothesis that social ties were not formed

on the basis of propinquity. We also developed a feeling for








the natural gathering-places in the neighborhoods surveyed,

and this helped in carrying out other, more successful

research strategies.

Finally, on the advice of Carter, the anthropological

team selected bars, and other gathering-places in the barrios

where marihuana users were reputed to live. We frequented

these places, picking up whatever information possible. It

was felt that in these contexts, we would be encountering

prospective informants at a time when they would have a

moment to relax and talk, and in a place where they were

likely to be surrounded by friends, or trustworthy acquain-

tances. We used a straightforward manner of introducing

ourselves, in which we explained the objectives of our study

to whoever volunteered conversation. Initial reactions were

tentative in this atmosphere, but progress toward the needed

contacts was made steadily and encouragingly. The clientele

of the low-life bars in which we absorbed large amounts of

alcohol and moderate quantities of information were not

usually eligible to participate in the study because of

alcoholism. However, these individuals eventually managed

to supply sufficient information to lead us to make contact

either with qualified marihuana users, or with people who

knew qualified users. In this way, we began to exploit the

social networks among marihuana users, discovering both a

source of the needed study participants and a useful commun-

ications system.








Key people in the fabric of social interaction among

marihuana users eventually were indispensable in the estab-

lishment and maintenance of contact with users who participated

in our study. Called "brokers" by True (1976c) these key

people are at the hub of some phases of interpersonal rela-

tions among the participants in their respective networks of

interaction. They may, as outlined in the preceding chapter,

be brokers of information because they operate in a part of

the city where many people pass by. Brokers may also dis-

tribute marihuana on a small scale, and in that way, they

have developed extensive contacts with consumers and dis-

tributors of that drug. They may also be key people in other

kinds of illegal or extralegal business through which the'

have dealings with people throughout the city. Often, brokers

handle both information and some combination of other economic

activities.

Methods of contacting key people were varied, and in

retrospect, seem almost haphazard. One key individual was

contacted through regular shoeshines in the central park.

Another was contacted when one of the anthropological researchers

stumbled on his base of operations during a door-to-door sur-

vey. Another was approached at his streetcorner position on

the basis of a description by the drunken clientele of a

nearby bar. Another ke'y person approached the author during

an impromptu street concert. All told, there were no more

than seven key people, or brokers, who contributed their

contacts in the search for chronic marihuana users. We were








able to find all 84 of the users who participated in the study

through the social connections of this handful of key people.

The field research team made the acquaintance of an

estimated 1500 people during the course of the study, and

most of these people were introduced to us through key

people. These brokers were also instrumental in screening

prospective study subjects in both the user and the non-user

categories, because their knowledge of use or abstinence

patterns among the prospective subjects recruited from out-

side their immediate circles of influence was extensive. We

found repeatedly that although they almost never associated

with each other, people in the various marihuana user social

networks seemed to know each other. This was true for individ-

uals coming from widely separated sectors of San Jos6.

The following is a brief description of the beginnings

of a relationship with one key informant, and the mechanics

of continuing this relationship. After hearing from local

bar clientele about a "very intelligent" marihuana dealer

who operated nearby, one of the field researchers approached

this individual, whom we shall call Loqui, at his street-

corner base of operations. A week of standing on the street-

corner with Loqui yielded introduction to two or three users

among those who were constantly around the marihuana dealer,

but the researcher decided that he was not relating to this

particular social grouping. He could see that association

with Loqui was potentially productive, but he did not feel

comfortable working with Loqui's social group. He introduced








the author to Loqui in the hope that better relations with

this social group would result. The plan worked, and the

eventual contribution of Loqui's network of friends and

acquaintances was large. Through either direct or indirect

connections, Loqui was instrumental in introducing us to

roughly 40 of the 240 subjects who passed through the initial

medical screen, 15 of whom (seven controls and eight users)

became part of the matched pair participant group.

The process of winning Loqui's confidence was gradual.

A pair of special glasses for his mother, rides throughout

the city in an automobile, a serenade for his girlfriend,

and other minor favors contributed to confidence building.

Encounters with the police were probably the most important

factors in achieving the confidence of key informants,

because these confrontations removed suspicion that we were

somehow in league with the authorities, a suspicion that

appeared repeatedly in our early contacts. In spite of our

previous agreement with the police, they still saw fit to

cause minor incidents in our presence, fortunately also in

the presence of key informants. After two or three such

incidents, Loqui was convinced that we were not part of any

police effort.

Simple day-to-day participation in Loqui's streetcorner

group, where he dealt in marihuana and information, was suffi-

cient to get to know a large number of users and even some

non-users. However, many of the steadiest participants in

his immediate network were too young to be included in the








marihuana study, so Loqui eventually was asked if he knew

of more experienced users. He knew more long term users than

we had imagined, and through his own system of communica-

tions, Loqui was able to arrange meetings which allowed us

to explain the project to these "old timers" and solicit

their participation. Key informants from other networks were

often consulted at this point to ascertain the accuracy of

Loqui's marihuana use report for these prospective informants.

His reports were found to be correct so consistently that

we eventually decided that cross-checking was no longer

necessary for Loqui's contacts. The only case of elimination

of one of Loqui's contacts for non-medical reasons was for

other drug use not reported in the medical history (recorded

in Table 4 as "failure to cooperate with medical testing

procedures").

Our relationship to Loqui and his social network was by

no means exploitative. It was reciprocal in the sense that

our investigative team was able to offer services and some-

times goods in the context of the same interpersonal net

through which we were receiving information. When Loqui's

brother was arrested for marihuana dealing, we were able to

offer legal aid, and we eventually managed to free him. When

we needed to buy marihuana samples to submit for analysis,

he sometimes sold us the samples, thereby giving our rela-

tionship to him direct reciprocality.

Loqui's interpersonal relations were most intense in

his own neighborhood, although they did not generally involve






Distribution of


in Loqui's Network


Loqui's Corner


Figure A


Spatial


Participants


ScoCIS








his immediate neighbors. This may be illustrated by mapping

Loqui's informal associations with respect to residence

location, as in Figure A. We can see that there is a "nesting"

effect, whereby most of the relations are within a short

distance from Loqui's own residence. In spite of the rela-

tive narrowness of Loqui's associational net, some of the

lines of direct or indirect association extend to distant

parts of San Jose, and these led to contacts with other users

and controls who participated in the project.

Other associational networks tapped by the anthropological

team had much wider ranges throughout the city, and this

quality had favorable consequences for the eventual configur-

ation of the project sample. True (1976a) found that, compared

with recent analyses of the metropolitan area's more than

500 different neighborhoods, the zones from which the subject-

participants in our study came were fairly representative in

terms of socio-economic level and housing quality. Although

our sampling technique was not at all random, we managed to

identify a group of people whose general socio-economic

characteristics were quite comparable to those of much of

the rest of San Jose's working class population.

The ecological distribution of the subjects in the

final participant group was also fairly representative of the

San Jose metropolitan area. True and Doughty (1976a) collab-

orated to develop a typology of community from which the

subject population came, including central city zones, resi-

dential zones contiguous to the city center, housing projects








near the city, transitional peripheral zones, satellite

towns, squatter settlements, rural communities, and provincial

towns outside the San Jos4 metropolitan area (III-16-32).

According to their analyses of the 240 subjects for the initial

medical screen, and the 82 matched pair subjects, True and

Doughty found that both groups have roughly equal proportions

of users and non-users who reside in the various neighborhood

types. IJearly half of the subjects in both groups come from

either central city or residential contiguous zones, and all

other zones are represented in the sample. Analysis of per-

sonal income information for the sample of users and non-users,

when compared to 1973 Census data for the zones in which the

subjects live, shows that the earnings of the study sample

are representative of working class earnings of their neigh-

borhoods (III-36).

We did not begin the process of finding qualified parti-

cipants for the chronic marihuana use study project with any

set of criteria for making group representative of San Jose's

population. Indeed, we did not have any assurance that mari-

huana users were not completely deviant from the normal

Josefino pattern of life. If that had been the case, we would

not have selected a group that was at all representative of

the working class life style. Expedient methods had to be

used to identify and get to know individuals whose behavior

could at any time cause them to be jailed. Retrospective

analysis of the study sample allows us to say with confidence

that it was, in fact, representative of the Costa Rican working




87



class in the most crucial social and economic aspects. Never-

theless, we must say that this representativeness was seren-

dipitous. Later chapters will present further perspectives

on the relationship of the subject procurement procedure to

the formulation of the research problem of motivational syn-

drome.




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