Another type of possible mental deterioration or subtle personality and behavioral changes associated with heavy long-term cannabis use is the amotivational syndrome.

This syndrome has been described world-wide in its extreme form when the most potent preparations are, used (Miras, 1967; Chopra. and Chopra, 1957; Chopra et aL, 1942; Christozov, 1965; Indian Hemp, 1893; Benabud, 1957; Warnock, 1903). Its most extreme form depicts a loss of interest in virtually all activities other than cannabis use. The resultant lethargy social and personal deterioration and drug preoccupation may be comparable to the skid row alcoholics' state.

Benabud (1957) describes the occurrence of this syndrome in individuals chronically intoxicated with hashish. These individuals are unlikely to show conventional levels of motivation. Also the time required to obtain and consume enough drug to maintain this state is not likely to leave much time for other pursuits. The passive user tends to lose interest in work and other long-term goals.

The question of whether there exists a significant causal as opposed to an associative or correlational relationship, only attracted attention when the traditionally achievement-oriented Western youth adopted cannabis use. The traits of passivity or amotivation are commonly described among heavy cannabis user throughout the world.

A number of Eastern authors have expressed the opinion that this is a result of organicity from chronic cannabis use in large amounts, without objective studies being performed.

Recently the term has been used to describe the behavior of numbers of young Americans who are for a variety of reasons dropping out of school, refusing to prepare themselves for traditional adult roles and smoking marihuana.

This type of social maladjustment is not comparable in magnitude to that described in other cultures. However, the individual may lose the desire to work, to compete, to face challenges. Old interests and concerns are lost and the individual's life, becomes centered around his compulsive drug use. In addition, the individual may ignore personal hygiene, experience loss of sex drive and avoid social interaction (Mirin et al., 1970; Smith, 1968).

West (1970) and McGlothlin and West (1968) have described a clinical syndrome as a result of observations of regular marihuana users for four years. Their clinical impressions are that these individuals show subtle changes in personality over time which might represent an organic syndrome. These include diminished drive, lessened ambitious decreased motivation, apathy, shortened attention span, loss of effectiveness, introversion, magical thinking, derealization and depersonalization, decreased capacity to carry out complex plans or prepare realistically for the future, a peculiar fragmentation in flow of thought, and a progressive loss of insight.

Another psychiatrist, Powelson (1971), has also concluded on the basis of over five years clinical experience with drug users at the University of California, Berkeley, that the effects of marihuana are cumulative. He, feels that after a period of prolonged use a disorder of thinking characterized by a lack of coherence and a pathological thinking process results.

These disturbing findings are being reported more frequently, especially in adolescent and young-adult groups. Recently, tentative and preliminary data (Francois et al., 1970; White et al., 1970) has been presented on a group of 19 hospitalized 14-to-20-year-old patients with behavioral disorders who had used marihuana and other drugs heavily.

In addition to "amotivation," they showed primitive and magical modes of thought and low frustration tolerance. Subtle EEG patterns were detected although this finding is not uncommon in adolescents with behavior problems.

The researchers are presently carrying out a study in non-hospitalized adolescents without behavioral disorders who have similar patterns of drug use in order to clarify their findings.

Kornhaber (1971) believes that at least twice daily marihuana use for a year, in a 13-to-18-yearold population, has a deleterious effect upon the developing adolescent. The intoxicated state facilitates a regression from logical-mathematical thought processes to a more primitive conceptual mode of fantasy and magical thinking and impairs learning ability and judgment by decreasing attention and concentration. Thus, the developing youth turns away from reality toward fantasy and from structure and activity to passive dependency.

Kornhaber suggests that marihuana facilitates the development of normal adolescent turmoil into a pathological state. However, he feels that the existence of the syndrome depends partially on the individual's vulnerability to the drug influence.

A possibly milder variation of this syndrome has been clinically observed by Scher (1970) in individuals in the 20-to-30 age group who have used marihuana daily for five years while apparently functioning normally in society with good jobs, often creative ones. These individuals begin to experience a vague sense of functioning at reduced efficiency level. Thus, the disabilities experienced are personal and internal ,and constitute a vague neurotic depressive-like syndrome,.

In addition to the methodological problems of (Establishing causative as opposed to associative relationships, it is also very difficult to obtain a sample of heavy cannabis users in the West who have not had substantial experience, with other drugs, especially the strong hallucinogens.

Koridiaber (1971) has described a sample of 50 adolescent psychiatric patients who used marihuana daily and also took other drugs. He concluded that marihuana exercised a "chronic, tranquilizing, psychomotor-depressant effect" among these patients, and facilitated regression, fantasy and magical thinking. School performance, participation in sports, and personal hygiene also declined. He reported improvement in school performance, mood and the underlying depressive symptoms for many patients four to six weeks after discontinuing marihuana use.

Given there is a fairly strong tendency for heavy cannabis users to be passive and apathetic, to emphasize the present over the future, and to choose fantasy over rationality, there are several ways by which this relationship might come about (McGlothlin, 1972).

First,, persons who already exhibit these, traits may simply be attracted to the use of cannabis. Sociologists tend to favor this explanation, arguing that the relationship between cannabis use and various behavioral indicators is not causal, but simply one manifestation of a general pattern of youthful deviance or rebellion (Goode, 1970).

Utilizing a large sample, Johnson (1971) found that marihuana use is associated with impaired school performance and several forms of deviance; however, other indicators such as premarital sex and high school truancy predicted the dependent variable as well or better. Tobacco and alcohol use were nearly as good predictors as marihuana.

A second related explanation is that the illegal. context in which the drug is taken forces the adoption of a nonconforming life style. The users is thus further alienated from the dominant culture through his close ties with the cannabis-using group.

Third, cannabis use and associated activities may largely substitute for other interests. The individual may focus so much of his time and energy on cannabis that he has little time for other endeavors.

Fourth, heavy cannabis use may act pharmacologically to produce a chronic tranquilized state. Although the acute phase of intoxication is relatively short, there is some evidence of a lethargic hangover effect (Haines & Green, 1976).

Fifth, personality and behavior changes may result through the routine process of learning via exposure. If an impressionable youth spends a great deal of his time in the world of cannabis intoxication, he may learn to think in a similar manner when not intoxicated. In particular, he may learn to choose the drug fantasy as an alternative to solving personal problems and facing adult responsibility.

A related explanation is that cannabis acts as a catalyst, creating a condition which facilitates change, providing other necessary conditions are present. Cannabis, along with the strong hallucinogens, produces a kind of mind-loosening effect in which mechanisms providing structure and stability to perception of self-image, environment, time sense,, etc., are temporarily suspended.

The, more frequent users welcome this effect and report utilizing the loosening effect of the drug to achieve further personality change in the direction of less conformity and more spontaneity, that is. the "hang-loose ethic" (Suchman, 1968; Simmons and Winograd, 1966).

In addition, the cannabis intoxication produces a heightened suggestibility which likely makes the user more amenable to adopting the attitudes and values of the subculture in which the drug is taken. At a minimum, it may be concluded that the effects of cannabis can reinforce and provide a rationalization for previously existing tendencies.

Finally it is possible that chronic cannabis use can result in organicity (Soueif, 1967).

In summary, if cannabis use produces personality and behavior changes via one or more of the above mechanisms, the extent of such changes is likely to be strongly related to the amount consumed and the age of the user. According to evidence found in Western literature, frequent use may be quite disruptive during the formative years of adolescence.

On the other hand, the Eastern literature indicates that, although the very heavy user (200 mg. THC or more per day) is largely incapacitated, manual laborers often function adequately while consuming amounts containing 30 to 50 mg. THC per day (Roland and Teste, 1958; Chopra and Chopra, 1939). Similarly, many musicians and entertainers in the United States have lived productive lives while using marihuana (Winick, 1960).