Particularly frequent in the addicts as compared to the controls are a number of features: lack of a father-figure in many cases, the high frequency of a cool or hostile attitude by the father-figure when present, father-figure with an unstable work history, and extremely weak day-to-day relationships between the boy and his father. In most cases, the mother-figure was more important in the daily life of the boy-especially after early childhood.

I have, of course, struck only the highlights of our various studies, but, even so, the very variety of data must be quite confusing at first listening. Perhaps it may be helpful if I were to tell you, in admittedly oversimplified form, how the picture adds up to me.

Forms of behavior like delinquency and drug addiction-and, for that matter, any other form of behavior—do not take place in a vacuum. They are carried out in a physical and social context which plays an important role in determining their likelihood of occurrence and the specific forms that they take.

Obviously, for example, no one would take narcotics if there were none available to be taken. This is a basic fact even though it is extremely difficult to hold it in balanced perspective. For one thing, it dangles before us the tantalizing objective of eliminating narcotics addiction by making narcotics unavailable. This objective is so tantalizingly real that it makes it difficult to bear in mind various complicating factors. For instance: (1) the fact that reduced supply without a corresponding reduction in demand raises the market value of narcotics and, hence, places an additional premium on smuggling and also puts increased pressure on the addict so that he must increase his own criminal activities to be able to support his habit; and (2) the fact that law enforcement is effective in controlling behavior only to the extent that its sanctions are stronger, more certain, and more immediate than the potential rewards of violating the law. But, more fundamentally, the basic fact is that a supply of narcotics is simply a necessary condition for taking them and not an impelling force. Hence, eliminating the necessary condition would not in itself eliminate the impelling forces and these would continue to have some kind of consequence even though they could no longer lead to drug addiction. If we were to go into this matter further, therefore, we would have to face up to the question, if the channel to addiction were irrevocably closed, into what other channels would the unaltered impelling forces push the individual-and would these alternatives be preferable to addiction?

Now, my purpose in making these remarks is not to evaluate the law-enforcement approach, but merely to illustrate that the environment does influence behavior and that even when some aspects of this role are obvious, they are not necessarily simple. I have, however, digressed from my main purpose which was to give my interpretation of the available information about the determinants of drug use. Let me return to this.

There are segments of communities in which there is a relative breakdown of the web of interpersonal relationships which forms the fabric of human society at its best. The individual has no real roots in a permanent community. His position is such that he experiences himself as standing essentially alone against the rest of the world. The fellow human beings with whom he comes into contact are compelled by force of circumstances, if not by personal predilection, to scrabble around, each for his own needs-and he does not have the security of knowing that, should he need their support, he can rely upon them for this. He shares in the common dreams of a good life, however he may interpret the latter, but the bleak circumstances of his situation give him no realistic expectations of ever being able to achieve it, and he is confronted by an endlessness of days. There does not appear to be any real point in working toward a brighter future, only in seizing upon the pleasures of the moment. The standards of behavior which are so highly valued by other segments of society have, at best, only negative significance for him-for living up to them can only protect him from an additional burden of trouble rather than provide him with the missing satisfactions of living. Perhaps, there are also constructive possibilities open to a person in such an environment; but almost everyone that he meets is in a like situation to his own, and their communicated perceptions and the observable events of their lives only reinforce his view of human society and of his own future-that is, the constructive possibilities, if they exist, are not easy to see.

This is the kind of environment which is the breeding ground of delinquency and crime, alcoholism, drug addiction when drugs are widely available, and a variety of other antisocial and socially maladaptive behaviors. Such an environment can, no doubt, come into being in a variety of ways. In New York

City, it is associated with the triad of neighborhood characteristics I have already mentioned-widespread poverty, low level of education, and high proportion of broken families and other deviant family arrangements-and with a large number of other related characteristics that are brought out in our analysis of the neighborhood data. Also, we should not forget that where antisocial behavior becomes widespread, a new norm tends to emerge which is not only consistent with the prevailing atmosphere but which also makes such behavior acceptable and even desirable.

The prevailing atmosphere of degenerated interpersonal relationships that characterize the neighborhood can be markedly counteracted by one's experiences in a cohesive family group. Such experience can give one a sense of human solidarity, a feeling of belonging, respect for the integrity and value of the individual human being, and the long-range motivation of things worth living for. But in the kind of environment that I have been describing, the family itself is especially vulnerable as is evidenced by the high proportion of abnormal family arrangements in the high use areas.

Even in the best residential areas, poor family relationships in the early life experience of a person can go pretty far toward creating an atmosphere of degenerated interpersonal relationships such as that I have described as characteristic of our deteriorated neighborhoods-that is, a lack of security in one's fellow human beings, a sense of every one being out for himself, a sense of futility, of not really belonging, and so on. Now, place such a disrupted family in the midst of such a deteriorated neighborhood and the effect must be immeasurably enhanced. It is precisely from such disrupted families in such deteriorated neighborhoods that the bulk of our delinquents and drug users come, Yet, after all, a person is still a being who is more or less capable of resisting the pressures of his environment, of responding differentially to its various aspects, and of helping to shape it to his own ends. I do not mean to imply that the enviroment played no role in making him what he is. The history of a person's interactions with the enviroment that go into shaping his personality, however, involves not merely the order of environmental conditions that I have described, but also many more sublte and more or less idosyncratic events occurring in a particular order in time in an infinite series of epigenetic cycles, It is as a net product of such a history that an individual stands, at any given period of time, more or less against his immediate environment and also more or less vulnerable to it.

Now, there are some individuals who, on the one hand, do not have strong internalized restraints and who, on the other hand, have various neurotic and other needs such as an accumulated fund of hostility against man and society, an urge to maintain a sense of personal integrity in the face of society at large, a desire to share in the social goods that seem to be denied them, a need to conform to the behavior standards of the deviant social circles in which they move, and so on-such individuals are inclined to act in what we regard as an antisocial manner. If these needs are strong enough, and the inner restraints weak enough, such people will become delinquents and criminals in the best of environments. Suppose, however, that the balance of needs and restraints is not essentially different than in the average member of our society. Place a person with such needs in an enviroment which is favorable and conducive to antisocial behavior-an environment such as I have described-and he too is likely to become a delinquent. The stronger the needs and the more conducive the environment to delinquency, the more certain does eventual delinquency and crime become.

If drugs become available on a large scale-in the highest drug use area of the city, 45 percent of the eighth grade boys indicated they knew one or more heroin users personally, close to 40 percent claimed to have actually seen someone taking heroin, and 10 percent said that they themselves have already had the opportunity to try it out-with such easy access to drugs, a new wide-open channel of delinquent activity becomes available. And many try it out; but not all of them become addicted. In fact, our study of juvenile gangs brought out the existence of regular weekend users who have not developed increased tolerance and need or withdrawal symptoms after several years of use. Addiction apparently depends not merely on continued use, but also on psychological, and perhaps physiological, predisposition. This is not to gainsay the possibility that there may be some limit of prolonged use beyond which everyone would become addicted-and, of course, the frequency and size of intake is undoubtedly a factor.

Many of the delinquents who experiment with heroin do, of course, become addicted. There are other addicts, however, who have not responded to the delinquency-producing vectors of their environment by becoming delinquent, but who nevertheless display personality patterns that are in close harmony with the social atmosphere of their neighborhoods. These are the unaggressive, withdrawn, dysphoric individuals who even at best would find it difficult to relate to other people. In an environment which fully justifies a pessimistic outlook and in which it is at best difficult to establish wholesome interpersonal relationships, they are totally lost souls. To them, narcotic drugs like heroin offer a quick and royal route to meeting the challenge of living. Heroin and its related subculture gives them a sense of well-being and of social acceptability and participation. If the price is a terrible one to pay-and, as our data indicate, it is one of which they are likely to be all too imperfectly aware-the pseudo-rewards, especially in the "honeymoon stage," are far more glittering than anything else their environment offers them. Given heroin, these young people are doomed.

This, then, is the interpretation of juvenile narcotics use that I offer you. I must remind you, however, that our studies were not simply academically motivated. If so much of our initial efforts were oriented toward elucidating and explaining the phenomena, it was at least in part because we had to understand the nature of the problem before we could hope to offer any worthwhile ideas that might contribute to doing something about it.

During the past year, our thinking has moved in the direction of the problem of rehabilitation and prevention. We are now in the midst of a followup study of 30 boys released from Riverside Hospital and we hope to gain much practical insight into their problems and the role of the community in the posthospitalization period.

As to prevention, we have come to the conclusion that it is not feasible to conceive of worthwhile community action programs with a narrowly defined goal of preventing drug use. We perceive drug use among juveniles as one symptom among many and we envisage a program aimed at helping personally damaged and environmentally deprived youths to grow up into healthy adultsand that means not users, not delinquents, not mental patients, not recluses. But this is a topic for another paper.

EXHIBIT No. 12

[Reprinted from the Bulletin of the Vancouver Medical Association, vol. XXXI, No. 4] ARGUMENTS FOR AND AGAINST THE LEGAL SALE OF NARCOTICS

(By G. H. Stevenson, M. D.)

Drug addiction has been an increasing problem in British Columbia in recent years and a cause of concern to the general public, the merchants, the police, the courts, the Provincial government and the medical profession. In spite of very diligent efforts on the part of the police and the courts, the number of addicts in the Province appears to be on the increase, and there is obviously a large illegal traffic in narcotic drugs to supply their demand. It is estimated that there are 5,000 addicts in Canada, nearly 2,000 of whom are located in British Columbia. Convictions in British Columbia under the Opium and Narcotic Drug Act amounted to 265 in 1953, and were 66 percent of all such convictions in the entire country. Ontario, with 31⁄2 times the population of British Columbia, had only 99 convictions in 1953 (and only 70 in 1952). The reasons for the unduly large proportion of addiction in British Columbia are complicated and need not be gone into fully in this paper. However, it should be noted that more than 70 percent of British Columbia's addicts began their addiction in this Province (almost all of them in Vancouver) and there now exists in Vancouver an increasing colony of addicts who have what appears to be a dependable black market supply of their drug addiction-heroin. Most of the men of this colony support themselves by illegal means-shoplifting, theft, breaking and entering, and by selling narcotics periodically, whereas the women, who constitute one-quarter to one-third of the total number, support themselves largely by prostitution and by assisting the men in criminal activities. There are some addicts who hold regular employment for varying lengths of time and most addicts have had periodic employment. However, it is obvious that such a large group of relatively unemployed and delinquent

people must cost the citizens a large annual sum of money in stolen goods, police and court prosecutions and maintenance in prison.

It might be mentioned at this point that some people believe there is a large body of nondelinquent addicts in the community, who are presumed to work steadily and to be otherwise well-adjusted persons. The writer has not been able to find heroin or morphine users in this category. There doubtless are a few such persons, chiefly in the medical and related professions, but anyone who has had professional relationships with such persons realizes their erratic undependability and the hazard they are to their patients when under narcotic influence. There are also nondelinquent persons addicted to the barbiturates and pethidine (demerol), who secure their supplies on medicl prescription. These substances are highly addictive and physicians need to be aware of these dangerous features in prescribing them. As addictions they can be more damaging to the unfortunate user of them than the more common drugs of addiction-alcohol, morphine, heroin. The failure of the police to prevent a steady flow of illicit narcotic drugs to the addicts and the failure of prison sentences to cure them (most addicts return to narcotics soon after leaving prison), coupled with the steadily increasing numbers of addicts in British Columbia, have led the public to seek some other solution to what has so far been an insoluble problem. The methods proposed by the committee of addiction of the Vancouver Community Chest and Council (1), in their report of July 1952, supported in December 1952, by a brief to the Federal Government were mainly (1) amendments to the Opium and Narcotic Drug Act to make a distinction between traffickers and users, (2) the setting up of treatment and rehabilitation facilities for addicts who want to be cured, and (3) the establishment of "narcotic clinics" where registered addicts might legally receive narcotic drugs in minimum required dosages.

At this point it might be stated that the Federal Government has increased the penalties for illegal trafficking in narcotic drugs (2). A request has also been made recently to the British Columbia government by the Vancouver Community Chest for the authorization of payment to hospitals for withdrawal treatment of addicts and for the setting up of rehabilitation facilities. No action, however, has been taken by the Federal Government to permit the establishment of "narcotic clinics" where addicts might obtain drugs legally. What are the arguments for the establishment of such "clinics"?

The chest's committee report states some of them:

"3. The Federal Government should be urged to modify the Opium and Narcotic Drug Act to permit the Provinces to establish narcotic clinics where registered narcotic users could receive their minimum required dosages of drug. "The establishment of this register of narcotic addicts would maintain a constant checkup on the number of addicts by any community. It would also protect the life of the addict and support him as a useful member of society. The assistance would hasten his rehabilitation, or at least reduce the amount of his addiction since many of the stresses of the addict's life would be reduced.

"This action would within a reasonable time eliminate the illegal drug trade. The decision to modify the Opium and Narcotic Drug Act in this way would be most violently opposed by those who profit from drug trafficking, and one should expect opposition and interference from such criminals. Nevertheless, no addict will willingly strive for $20 to $50 per day through criminal activities, if unadulterated drugs could be obtained for a few cents at a Government-operated clinic. The operation of such clinics would not entail any reduction in the vigilance of law-enforcement agencies."

Addicts themselves enlarge on or add to these arguments as follows:

1. If drugs were legally available, the cost of drugs would be nominal and the addict could easily support a modest habit from his wages.

2. He would not be in constant conflict with the police nor would he be sent to gaol.

3. Absence of police arrests and gaol sentences would enable him to work steadily, advance in his work and maintain himself and his family in respectability.

4. Employers are reluctant to employ anyone with a record of gaol sentences, especially addicts, a situation which legal sale would obviate.

5. If he could buy his drugs legally, he would not have to pay the exorbitant prices demanded on the black market (the only market now available) and which, to pay, he has to secure money illegally, as the average habit of 4 or 5 capsules a day costs him at present at least $15 a day and up to double that amount.

6. Lengthy gaol sentences interrupt work and family life and force the addict into a continuous life of crime.

7. The addict states that he is less of a danger with heroin in him than he or other people are with alcohol in their circulation. He contends that with heroin he only wants to be quiet and relaxed, whereas the alcohol user is apt to be aggressive, quarrelsome, and dangerous.

8. If drugs were legal they would lose their glamor and adolescents would not be attracted to them as they are now. Some addicts claim, too, that having learned to like narcotics, they resent the legal prohibition and are all the more determined to get them, in much the same way as in the days of alcohol prohibition, when many people thought it smart to outwit the police, patronize the bootleggers and generally show their defiance of the alcohol prohibition law.

These arguments sound attractive. Nearly every addict quotes them and believes in them. Many people believe that legal sale is the answer to them. Books and articles favoring legal sale have been published (3, 4). The chest's recommendations were supported by quite a number of groups, as well as certain newspapers, some newspapers, some members of Parliament and of the Provincial legislature. Support of the plan of legal sale rests on the apparent reasonableness of these arguments, the increasing number of addicts in British Columbia, the increase in crime which is attributed to addicts, and the failure of the police to prevent a large black market in Vancouver. A part of the support may be due to the belief that narcotics may not be as harmful as is commonly believed. There are those, too, who, holding such a belief, consider it only fair and right that a person who prefers morphine or heroin to alcohol has as much right to them legally as he has to alcohol legally.

It should, of course, be stated that this recommendation of the chest's committee was not a de novo recommendation. Legal sale in various forms has been known and practiced in various countries for many years, even centuries.

The best known example of extensive legal use of narcotics (in this case, opium) is China (5-10), where over 200 years' opium smoking was openly indulged in. True, from time to time, Imperial edicts were issued forbidding the smoking of opium, but these were never seriously enforced, and by the treaty of 1858 between China and England, opium was legally imported into China for smoking, and continued to be legally used until well into the 20th century.

It might be mentioned at this point that the actual deleterious effects of narcotic drugs, on the individual user as well as on society generally, are also a matter of controversy. That the Chinese Government should repeatedly try to stop opium smoking by its nationals implies that the Government must have come to the conclusion that opium smoking was a bad thing. They believed it exerted a deteriorating influence on the users and that it conduced to national poverty and social degradation. Suffice it to say here that the habitual use of narcotics has unfavorable effects on both the individual and society, but that these effects have been largely overstated by the opponents of the use of narcotics. Compared with a very commonly used narcotic, alcohol, the deleterious effects of the opium derivatives may be qualitatively and quantitatively less than those of alcohol. In their habit forming propensities, however, and in the narrow margin of safety between social use and addiction, the opium group is more hazardous than alcohol, but in all other respects, alcohol may be the more dangerous of the two.

This uncertainty concerning the actual deleterious effects of the opium group is responsible for the two extreme points of view held in Canada at the present time. The Opium and Narcotic Drug Act has been framed with the concept that narcotics are highly dangerous, that society has to be protected against them, and that persons who illegally secure narcotics, even minute amounts, must be punished severely, a minimum compulsory gaol sentence of 6 months being mandatory, with maximum sentences up to 7 years for illegal possession of drugs, and up to 14 years for trafficking.

On the other hand, people who favor legal sale of narcotics have presumably come to the opinion that narcotics use per se is not too serious a matter, to either the individual or society, and that people who prefer heroin to alcohol should have the legal right to the drug of their preference, under properly and legally supervised conditions. In this connection, it might be noted that many careful observers in China were of the opinion that opium for the oriental was much the same as alcohol to the occidental, that either could be abused, but that the majority of both races used their favorite drug in moderation without unfavorable consequences.