Drug Abuse -- A Challenge For Ann Arbor

(EditoPf Note: The News today begins the serialized publication of the complete report of the Citizens' Blue Ribbon Committee for the Study of Drug Abuse.) )ST rsmU-ftG X This Citizens' Blue Ribbon Committee for the Study of Drug Abuse was given a threefold charge: to seek information on all aspects of the drug problem in Ann Arbor, to relay that information to the community, and to make broadly based recommendations for concrete action. The 33-member committee composed of youth, laymen, psychologists, social workers, doctors, ministers, lawyers and law enforcement officials held its first meeting on April 14, 1970. It was evident from the outset that each member had valuable experience with and knowledge about some aspect of drug use: legal, medical, cultural. The first task of the committee became to acquaint itself with its own resources. The decisión was made to meet weekly for the purpose of benefiting from each other's expertise, before seeking information from the general public or dividing into working subcommittees. Discussions during these weeks dealt with a wide range of questions about drug use. The difficul'ty in acquiring reliable information on the extent and kind of drug use in Ann Arbor was acknowledged. That a sense of the numbers of drug abusers could only be obtained through informal communicav tions networks and iiistit utional statistics continued to be a hardship for the committee. The committee also discussed the existing drug treatment facilities and services and their inadequacies, the need to créate a more stimulating school and recreational environment for the city's youth, and the effectiveness of state and federal laws regarding sale and possession of various abused drugs. Finally, we addressed the troublesome and more intangible issues of the social, political, psychological motivation for drug use; whether drug use could be considered a crime, an illness or a social valué alternative; whether drug regulation is required for the public's physicalpsychplogical welfare andor for social organization and functioning; and whether legal restrictiveness affects drug taking behavior and social attitudes. It was clear that despite each member's experience and expertise we all approached the massive problem of drug use in our society with a sense of confusión and despair. By the middle of May, the committee was able to formúlate substantive goals and to divide itself into three task f orces: 1) Community Education and Services 2) Treatment 3) Law Enforcement and Law Reform Each task force was assigned the responsibility to study and elabórate the initial goals. They were to make recommendations for (1) the formulation of a credible drug education program for both youth and parents; (2) the development of community and school programs to compete with drug use; (3) the establishment of a variety of treatment facilities equipped to deal with all drug users who seek help; (4) preparation of legislative proposals to make the punishments for drug abuse more realistic and humane. The subcommittees and the whole committee met on altérnate weeks through the month of June. In mid-June public hearings were held to gain further information about the proportions of the Ann Arbor drug problem, and to understand the community sentiment in regard to dealing with the problem. Special testimony was invited as well as that of the general public. The invited witnesses included a school nurse, junior and senior high school students, white panthers, a pharmacologist, a psychiatrist, a community aide to the Crisis Walk-in Clinic, the County Prosecutor and a State Senator. The public turnout was small. Before the committee recessed for the summer, each member was asked to submit a report of his own assessment of the deliberations and findings of the whole committee. In September, an executive committee was formeel to review the individual statements and those of the task forces. lts job was to idehtify areas for additional research and elaboration and to draft a report for presentation to the whole committee. The executive committee met weekly from September to December. The committee presented its concern about lack of drug treatment facilities to the Washtenaw County Community Mental Health Board, and encouraged the board to take action on a county-wide basis to créate treatment facilities and services. The committee met with Dr. Edward Pierce and Dr. Gwendolyn Hall in an attempt to facilitate their acquisition of funds for a methadone treatment program at the Summit Street Medical Center. Further meetings with the Community Mental Health Center and the Governor's Office of Drug Abuse culminated in a request for funds to underwrite this program. The proposal asks for approximately $110,000. Some 60 per cent of the money will come from the Federal Safe Streets Act funded through the Michigan office of Criminal Justice. Other funds will be provided by the Community Mental Health Model Cities Program, Washtenaw County Health Department, and the city of Ann Arbor. Finally, the executive committee has sifted and elaborated the information and ideas that had been obtained during the months of deliberations. We have attempted to present to this community a proposal which offers some realistic means to cope with a problem that often seems to defy solution. We are hopend that substantial improvements in dealing with the drug abuse problem in Ann Arbor will result if the recommendations of this committee are implemented. It must be emphasized that a complex problem requires a broad scale approach. The Extent of the Problem The charge of the commitee to make recommendations about the "drug problem" requires first that the extent of the problem be determined. One primary question is the incidence of use of the various types of drugs. However, a broader question is what we define to be drug abuse and consider as part of the drug problem. In one sense, every unlawful use of drugs is drug abuse. A more realistic point of view, perhaps, is that every drug has a potential for use and a potential for abuse, independent of its legal status. Certainly alcoholism is an instance of drug abuse, though lawful; similarly, we may evalúate some uses of illicit drugs as drug abuse and others not. A drug is abused to the extent that it interferes with the health and welfare of the person using it. Drug abuse thus defined includes many different patterns of use, for example; indiscriminate experimentation with drugs, or misuse of drugs as an avoidance of the problems of living. The most serious pattern of drug abuse is drug dependence. It is necessary to distinguish between different classes of drugs. The probability that a drug will be abused depends not only on the individual and the pattern of use but also on the drug. Thus, for example, heroin and other narcotics have a high liability to abuse and produce both physical and psychological dependence. Alcohol and sedatives such as the barbiturates are somewhat less likely to be abused but constitute an equally serious addiction problem, causing physical and psychological dependence. Stimulants such as the amphetamines are not physiologically addictive but can produce a great deal of psychological dependence. Hallucinogens such as LSD entail other dangers, such as adverse drug reaction (LSD panic or bad trip). Marijuana, the least potent and most innocuous of all, is non-toxic for a majority of those who use it, although some adverse reactions do occur. Psychological dependence on marijuana or stronger hallucinogens is uncommon, but may occur in certain individuals. The use of any drug is likely to be repeated to the extent that the drug experience is exciting or enjoyable to the user. With these distinctions in mind, then, we can begin to estímate the extent of the drug problem. First, what is the incidence of use of the various drugs? Statistical data on this question have been I gathered for various populations in various. places at various times; unfortunately, answers become quickly obsolete. Blue Ribbon Drug Report -Part I XÍ1US IUr tJAcUllfic, aií tü""'"v'" ■- x cent of college students surveyed in 1966-67 had used marijuana on one or more occasions; by 1968-69 a variety of studies indicated that this number had doubled. A 1969 study of "Drugs and Michigan High School Students" gives the íollowing estimates of drug use: marijuana 0-33 per cent; alcohol 48-81 per cent; hallucinogen 0-3 per cent; heroin 0 per cent. Also in 1969, a survey of Umversity of Michigan students revealed that 44.1 per cent had tried marijuana or hashish, 89.9 per cent alcohol, 12.2 per cent hallucinogens, 24.7 per cent amphetamines, and 16.9 per cent narcotics. It is difficult to evalúate such data or draw conclusions about this community in 1970. A study is presently under way by Dr. Richard Stuart of the School of Social Work (with Marjorie Schuman, a member of the committee) which will identify the high risk (i.e. high probability) populations for use of the vanous drugs and answer other questions about patterns of drug use in different age groups, including the motives for using drugs. Pfeliminary data from this study have been made available to the committee. " . Various other sources have provided the committee with informal kinds of information about the drug scène in Ann Arbor. Drug Help, a paramedical drug crisis center, receives 200-300 calis per month. A third of these calis are actual drug crises, mostly bad trips on LSD and other drugs. Another Va of the calis , request drug information about drugs that I have been or probably will be taken. The number of calis is increasing quite rapidly as Drug Help becomes better known to the community. In addition to these calis, an undetermined number of cases of adverse reactions to drugs, including drug overdose, are seen each month at University Hospital and St. Josephs Hospital Emergency Service. (Statistics were not available to the committee). An increasing number of Drug Help calis involve drug dependence, usually heroin. Three to five such calis are received each week, plus additional calis requesting information about drug dependence. Casual experimenting with heroin is becoming more and more common, following a similar development on the west coast, and we may expect drug dependence to increase accordingly . There are an estimated 500 narcotics addicts in Ann Arbor at the present time, 75 cases new in the last eight months. Drug abuse is a complex multifaceted problem which spans different population groups. Drug Help has been serving white middle class youth of high school and college age. Other drug problems inolving middle class persons, such as abuse of prescribed sedatives, tranquilizers, and stimulants, are seen by private physicians and it is impossible to estímate the extent of abuse. Drug abuse in the black community is known to involve hard drugs such as narcotics. This is somewhat represented by estimates from the Summit Street Medical Center (included in the estimated number of addicts above) and figures from the hospitals. Preliminary data from the Stuart study confirm the impression that young adult black males are a high risk group for the use of heroin. Drug use is no longer unconvential behavior among adolescents. Drugs are used as early as junior high school, perhaps earlier. Casual experimentation I ? t - - or the need to experience drugs first-hand includes initially tobáceo, alcohol, and marijuana and, for many, other drugs as well. Many students come to school intoxicated or under the influence of drugs. Use of hallucinogens, stimulants, and downers (depressants) is not uncommon. The casual use of heroin has been mentioned above, and is probably the greatest cause for alarm. Thu;, for example, in the preliminary sample of the Stuart study, junior high school girls as a group had one of the highest rates of use of narcotics. (One may hope that this finding will not hold true in the larger population being surveyed.) Drug-related problems include drug crises, drug dependence, the threat of accidental drug overdose, and other health problems common to users, such as hepatitis. Crimes such as theft are also a part of the drug problem, not as a direct effect of drug use but as an indirect consequence of the high cost of blackmarket drugs. It costs an estimated 530,000 a year in stolen goods to support a $10,000 drug habit. Other drug-related problems include those in which drug use may be incidental to difficulties and conflicts in the life situation, and in these cases it makes sense to consider drug abuse more as a symptom than as a primary problem. The community must bear the responsibility for management of drug problems in the form of treatment and services. A more complex issue, however, is raised by the druj use which presents no "problems," i.e. drug use which the individual does not recognize to he a problem but which nevertheless cause the community concern. The cost to the community is the loss of many of its young people to the extent that the young are involved with drugs and also to the extent that that the young are disillusioned and disappointed with the way the society responds to the drug issue. The situation is alienating also for a society which cannot understand the drug subculture nor its disregard for traditional values. This lack of understanding breeds fear and distrust on both sides; both are aspects of the "drug problem."