Preliminary results (Freedman and Fink 1971, Fink and Dornbush 1971, Fink 1971) from an intensive medical, neurological, and psychiatric study of 31 male chronic hashish users in Greece, performed under contract to the National Institute of Mental Health, have revealed few abnormalities in these individuals. Non-users matched for socioeconomic, and psycho-cultural factors including life style, alcohol and tobacco consumption and nutrition and general health have not been studied.

In collaboration with Professors Miras and Stefanis in Athens, Fink and co-workers are studying a population of chronic hashish users that Professor Miras has known for many years. The population studied is composed of 31 male subjects ranging in age from 26 to 69 years with a mean of 46 years.

The subjects report starting hashish use at 13 to 35 years of age with a mean of 19. They have -used hashish from 10 to 49 years, with a median of 28 years. In the past they used an average of eight grams of hashish daily with a range of 2 to 24: grams daily. (The hashish it estimated to contain 4% THC on the average. Therefore, average daily use was 320 mg. of THC).

In the past, 27 of the subjects were daily -users and four used every other day. Frequently of hashish use per day was: once per day-2 subjects, twice per day-6 subjects, three times per day-14 subjects, four times per day-4 subjects, and five, or more times per day-5 subjects.

The men reported a reduction in drug use with time ascribed to increasing difficulty in obtaining adequate supplies due to increased enforcement of the drug regulations. At present they use an average of three grams of hashish daily (320 mg. of THC) with a range of one to 10 grams daily.

Twelve now use hashish daily, eight use, every other day and 11 use less frequently. Frequency of daily hashish use is: once per day-5 subjects, twice per day-12 subjects, three times per day-10 subjects, four times per day-2 subjects, and gve(sic) or more times per day-2 subjects.

The men are primarily hashish users. One has used opiates. Two are heavy users of alcohol and six report occasional to frequent use of alcohol at the present time. Tobacco is smoked by all subjects averaging 40 cigarettes per day.

Twenty-three of the subjects report periods of abstinence from hashish averaging ten months but up to three years. Hashish use is primarily social by 20 subjects, and 15 subjects smoke in solitude.

Pipes and cigarettes in which hashish is mixed with tobacco are used interchangeably. The usual time of smoking is after work (21 subjects) but 12 subjects smoke before work and five smoke anytime.

In this population, the median education is three-and-a-half years of school with a range of none to nine. Five of the men are illiterate. Twenty-one of the men are married, one is cohabiting, four are single and five are divorced or separated.

All of the married men are employed and support their families. The subjects report changing their jobs frequently and 11 had periods of unemployment from three to 120 months. Ten were classified as skilled workers and 21 as unskilled workers. Their jobs include selling scrap metals, general labor, cartage, messenger, maintenance assistants, etc.

Arrests are common and 19 report at least one non-hashish related arrest. Eighteen have been in regular military service, six were exempt because of hashish use and seven for other reasons.

Interestingly, 10 of the 15 wives interviewed prefer the behavior and attitudes of their husbands when they are using hashish compared to when they are drug-free.

In regard to family and personal background 20 had refugee parents, 13 had alcoholic or hashish using fathers, 26 had three or more siblings, 19 had dominant mothers. Fifteen of 21 had dominant wives. Seven reported broken homes under age 16.

Apparently, the subjects participation in society is consistent with their lower socioeconomic background. No gross behavioral deviation was detected I in this population.

Psychiatric status was evaluated by history and psychiatric interview. Nine have had psychiatric hospitalization of which three were in the military and related to hashish use. Two have, had psychiatric outpatient treatment. Eight had histories of neurotic traits during childhood. In their psychiatric evaluation, three men are considered to have psychiatric pathology. Two of these were considered sociopaths on the basis of homosexuality and criminal behavior. The third was diagnosed as a schizophrenic. No overt signs of any organic mental syndrome were detected. None of the three men were believed to require psychiatric intervention. The schizophrenic, although suspicious and withdrawal, is a successful business man and lives with his family on weekends.

Complete physical and neurological examination revealed three prominent findings. All had very poor dentition which the men ascribed to hashish smoking. Chronic bronchitis was detected in 14 of the men and emphysema in three others. This finding is not surprising because all subjects were tobacco cigarette smokers averaging 40 cigarettes per day, in addition to their very heavy hashish consumption. Enlarged livers were also found in nine of the 31 subjects.

Because no extensive psychological test battery has been developed or standardized in Greece, American tests were used. These tests are not culture-free, and it is possible that certain items or subtests were inappropriate for the subjects because they had not acquired the type of knowledge or skills required due to their poor level of education.

The Wechsler-Bellevue I.Q. tests were translated into Greek and administered. Because of these, factors, comparison of level of performance between these subjects and white middle class Americans is meaningless.

The mean I.Q. is 86 with a range of 69 to 109. The mean verbal is 90.3 and the mean performance was 83.6. The group of subjects performed lower than expected on digit symbol, digit span and similarities but higher than expected on comprehension, arithmetic, vocabulary and picture completion. The Ravens Progression Matrices showed a similar pattern and mean I.Q. The significance of these findings will depend on a comparison with a matched nonuser population.

Resting electroencephalograms were obtained in 30 subjects and evaluated independently by four experts. Twenty-five were within normal limits.

Testing was incomplete in one record. One record in a subject who had a head injury within the prior three months showed focal slowing.

Two of the four experts judged the remaining three, records as showing low degrees of average to low voltage theta activity indicative of cerebral dysfunction. The remaining two experts judged these records as within normal limits.

This medical and psychological data suggests some effects of very long term, very heavy hashish use. Without a matched comparison group, factors independent of hashish use, such as age, socioeconomic conditions, or environmental conditions, may account for the observed changes.

However, the researchers note that these men have survived chronic hashish use in high doses without gross behavioral deviation.