This is a remarkable book. Epidemiologist Leigh A. Henderson, as a consultant to the National Institute on Drug Abuse (NIDA) and NIDA Project Officer William J. Glass started with the government’s own survey data, worked with the authors of a new, individual and community-level ethnographic study, analyzed and interpreted these half-dozen data sets very conservatively, and ended up concluding that LSD is relatively safe and the laws far too severe. Some would say that these conclusions are still too conservative. Perhaps that’s the point: Even a conservative reading of government data will not support today’s absolutist attitudes and draconian laws.

The authors Henderson and Glass seem somewhat embarrassed by their conclusions. After all, the government looks at the same National Institute of Mental Health (NIMH) and NIDA data and concludes that LSD is very dangerous and severe laws are justified. Henderson and Glass, employed by or closely associated with NIDA and near the peaks of their careers, have nonetheless directly contradicted NIDA policy. In choosing to publish anyway (even without any direct references to the authors’ NIDA employment on the dust jacket or promotional literature – only in later conversations with this reviewer was the NIDA connection mentioned) they have chosen bravery over fear, and facts over shouts in a courageous contribution to rational, data-based policy making.

The book is really Henderson’s baby; she is the author of four of its seven chapters and co-author of the Introduction and the “Summary and Implications” chapter. “I started out not knowing anything about LSD, except its public reputation,” she said in our recent telephone conversation. “As my research proceeded, I became fascinated by the facts. It’s clear that policy on LSD is out of line with the data.” Henderson shares authorship with Glass and law enforcement and health researchers, yet the book retains a strong unity of theme: triangulating in on the truth about LSD use. The result is a methodologically innovative integration of quantitative and qualitative data – of emergency room admission statistics and a profile of a twenty-something LSD ring leader; of “national lifetime usage” data and quotes from interviews with experienced adolescents and hand-wringing parents.

The case studies

In Chapter 1, “What is a Trip – and Why Take One?” anthropologists James MacDonald and Michael Agar describe data they gathered through in-depth, ethnographic interviews with six adolescent LSD users and their parents in a community that had recently uncovered a major LSD distribution ring. (It’s a shame that MacDonald and Agar’s excellent chapter does not include the authors’ biographies or institutional affiliations.) Parental attitudes of concern contrast strikingly with the teens’ knowing discussions of their good and bad experiences with LSD. Even though these interviews ring true, they are still a biased sample – all of the kids interviewed were enrolled in a drug rehabilitation program; all claimed that frequent ingestion can lead to social and personal disintegration.

The history of LSD

In Chapter 2, “About LSD,” Henderson provides an excellent, data-based, and quite favorable review of the history, pharmacology, and clinical and therapeutic research, concluding with a factual review of the manufacturing and marketing of LSD. It is refreshing that Henderson allocates only three sentences to “the ‘60s;” rather, her focus is on safety, efficacy, and policy.

Henderson continues her review in Chapter 3, at this point focusing on the literature on “Adverse Reactions to LSD.” She finds them real, but rare and spends 20 pages adroitly separating myth from fact.

Analyzing the government’s data

In Chapter 4, “LSD Use and LSD Users: Questions and Answers About LSD,” Henderson analyzes the wide panoply of government survey data. Unfortunately, these data are generally derived from the tragic negative consequences of drug abuse – emergency room admissions or arrest statistics and the like – or are biased by the requirement to self-report illegal behavior, which is much more likely among those in treatment than “successful” users. Even by these biased standards, LSD emerges here as a remarkably safe “drug of abuse” that in no way can be called “epidemic.” A middle class drug ring

In a fascinating inside account of a middle-class drug distribution ring, clinical psychologist and forensic examiner Cynthia Favret’s “An LSD Distribution Network” (Chapter 5) takes us back to the community discussed in Chapter 1, this time, through interviews with an undercover narcotics investigator familiar with the exposed network and its 22-year old head. In addition to a very close rendering of the mind set of its protagonist, this chapter provides poignant quotes from friends and family that drive home the brutal reality of the government’s legal position on LSD. Favret’s treatment is especially effective coming after the relatively benign picture that emerges from Henderson’s chapters on the research and usage data.

Detection and the law

Chapter 6, “Legal Issues,” discusses detection, possession, and distribution issues in light of the debate over mandatory sentencing for drug offenders. Henderson discusses developments in detection technology since the 1970s, when inaccurate and expensive fluorescent spectroscopy and high-performance liquid chromatography (HPLC) detection tests were developed, and describes inexpensive and effective radioimmunoassay (RIA) tests that have recently become commercially available. Henderson also lists and discusses the wide range of federal and state (all 50 are listed) penalties for possession and sale of LSD, and in a devastatingly matter-of-fact way, compares these penalties with those governing similar doses of cocaine or heroin.

The key findings

Chapter 7, “Summary and Implications,” attempts to bring together all of the data sets described in the previous chapters and draw conclusions for policy on LSD for the 1990s. There is also a spectacular 258-item reference list containing within it the classic evidence – the bulwark of the logical argument – for the safety of LSD and, perhaps, for its efficacy as a psychiatric tool. Is the use of LSD increasing? What are the major issues with which a logical, fact-based LSD policy should be concerned? Marshalling all their logic and data together, Henderson, Glass, and Favret conclude:

• LSD use is relatively uncommon in comparison with use of alcohol, marijuana, or cocaine and misuse of prescription drugs. Long-term trends in LSD use show stability over the last fifteen years in both proportion (roughly 5% annually) and age (generally, 16-23) of users.
• LSD is primarily used by suburban white males in their late teens and early 20s. A shift in use from the upper level of this band to the lower level could contribute to the perception that use has increased among young adolescents.
• LSD is characterized by infrequent episodic use culminating in “maturing out” after two to four years.
• Adverse health consequences of LSD are comparatively rare, with “bad trips” being the most common adverse reaction. Nonetheless, severe bad trips are one of the primary reasons youths discontinue LSD use.
• Although some health consequences may be related to length of use, size of dose, and the interaction of other drugs, there is considerable uncertainty over why LSD adversely affects some individuals more severely than others.
• Despite dire warnings, LSD use doesn’t result in mental illness and does not damage genes or chromosomes.
• Black market LSD remains generally unadulterated, although manufacturing by-products do appear. In the 1960s, doses were reported to have ranged from 200 to 1000 micrograms; in the 1970’s, street samples ranged from 30 to 300 mcg; in the mid-1980s, the average was about 100 to 125 mcg; in the 1990s it is 20 to 80 mcg. Lower doses generally mean fewer bad trips.

Why LSD?

The authors point out the reasons why people like LSD: the perceptual intensity without a clouding of consciousness; the “compelling immediacy;” the “intensification of mood and emotions.” Others enjoy the group aspect of the drug; still others view LSD as an “emotional fitness test.” These motivations haven’t changed since the 1960s, according to studies cited by Henderson in Chapter 2. Adolescents are also attracted to LSD because it is physically easy to deal with – colorless, odorless, small and easy to conceal, inexpensive, until recently, hard to detect in blood or urine. LSD is also viewed as semi-natural and users tend to look down on users of “dangerous” drugs, such as cocaine and heroin. Who takes LSD?

The LSD user differs from the typical opiate user “in that LSD appeals to individuals who are often socio-economically advantaged, who have the opportunity for higher education and successful careers, yet who choose – at least for a time – not to follow societal norms.” The authors associate a number of traits – low self-esteem, rebelliousness, depression, aggressiveness, for example – with the use of LSD, but stress that they precede, rather than result from the use of drugs.

Adolescent users indicated that they used LSD because it was fun and because they were bored. “As a drug that tends to promote introspection and to heighten the senses, it has more to offer those in the relatively safe and pleasant surroundings [of the middle-class] than those in the more dangerous and unpleasant inner-city environment. In fact, the suburban youths interviewed seemed to take LSD as a controlled means of losing control. Riding a roller coaster may be an appropriate analogy; the ride is safe, but contains enough sense of danger to be thrilling.”

According to the authors, LSD “seems to appeal to a limited group of adolescents and an even smaller group of older persons who may still seek to identify with a particular subculture.” One major problem with the data used to support Henderson and Glass’ conclusions is their representativeness – did the sample that responded to the various surveys actually reflect the entire population? It is important to note that the divinity graduate student using a low dose to meditate or the quiet, 45-year old systems analyst using LSD “to think” are likely to be significantly underrepresented subsets of the data. In fact, the authors’ observation of a “maturing out” of LSD use might just as easily been interpreted as a “shrinking away” from the rigors of aggressive introspection.

The negatives

According to Henderson, the literature shows that the factors contributing to higher risk of a bad reaction to LSD are “a preexisting psychiatric disorder, and the use [of LSD] in conjunction with other drugs.” Under these circumstances “LSD may precipitate a more prolonged or severe psychotic reaction.”

While the authors aptly point out that we do not know the precise mechanism of LSD’s action, they also state outright that the research thus far clearly shows that LSD does not cause “organic damage, chromosomal damage, cancer, or birth defects. It is not particularly toxic…” The authors conclude that, “viewed strictly in the context of traditional drug-induced health consequences (measured in injury and death), LSD is less dangerous than most other illegal drugs.” Use by adolescents, they point out, “carries additional risks to psychologic maturation and academic performance much the same as do marijuana and other drugs typically used at this stage of life.” (The authors do note that “among younger students, inhalation of potentially lethal substances such as solvents and butane exceeds LSD use.”)

That the authors do not build on the data and their own analysis and conclude here that teen use of psychoactive drugs may reflect a non-pathological desire for rites of passage, should not detract from the value of their work in the current cultural context. One day, such a conclusion may guide government policy, but given the fragility of the support for today’s renewed research with psychedelics, the authors may have put together just the right book for the times. “We wanted to write a boring book about LSD, if that’s possible,” said Henderson, “we wanted to review the evidence, but not necessarily come down on any side of the issue. The facts speak loudly for themselves.”

The data sets

Even so, the fact base must be valid to be useful. Particularly in Chapter 4, Henderson and colleagues rely on a set of much-debated, yet much-cited government surveys of drug abuse. While it is beyond the scope of this review, to analyze in detail the validity of each data source used by the authors, we can review the major sources of bias (most of which are identified by the authors themselves) in the government data sets that were analyzed.

The National Household Survey of Drug Abuse (NHSDA) is a series of surveys designed to measure the use of alcohol, tobacco, and other drugs in the U.S. over time. Periodically conducted by NIDA since 1974, the survey was recently turned over to the newly-created Substance Abuse and Mental Health Services Administration (SAMHSA). Lead author Leigh Henderson, provided secondary analysis of these and other data sets under contract to NIDA and, after 1992, to SAMHSA.

In the NHSDA, information on illicit drug use is collected in the user’s home and so, despite an elaborate anonymity procedure, respondents may not tell the whole truth. At home data collection also under-represents the homeless, prison populations, people in nursing homes and treatment facilities, and the military, groups that might raise the statistics on use. As the book points out, with drugs that are less frequently used, such as LSD, this systematic under counting is even more likely.

The Monitoring the Future (High School Senior Survey) is designed to characterize use, trends, attitudes and beliefs among high school seniors. Since 1975, it has been conducted annually by the University of Michigan for NIDA. The survey does not include school dropouts (or truants on the day of the survey) and so likely underestimates school-age drug use.

The Drug Abuse Warning Network (DAWN) is sponsored by SAMHSA (previously by NIDA) and collects data from coroners, medical examiners and emergency room admissions, primarily to identify drug dangers and emerging trends. The DAWN statistics are controversial and Henderson systematically lays out the major threats to the validity of the data. For example, suicide attempts are included in DAWN statistics, but alcohol (without the presence of other drugs) is not. Mention of a particular drug does not mean the episode was caused by that drug. In fact, since half of the drug-related emergency room visits entail more than one drug, cause and effect generally cannot be established by DAWN data.

The Drug Use Forecasting (DUF) project, sponsored by the National Institute of Justice, tracks drug use among arrestees in 21 (non-representative) U.S. cities. DUF data are not meant to be normative. For example, male arrestees for drug offenses are under-counted in order to provide a broader sample of (drug use during the commission of) a wider range of offenses. Females are included regardless of the crime. Henderson points out that these data are nonetheless “frequently reported in the substance abuse literature, although [the full] reports are not published.” The Community Epidemiology Work Group (CEWG) was established by NIDA in 1976 to track rapidly changing patterns of drug use. The CEWG meets twice a year and publishes the proceedings. The CEWG uses a wide range of data sources and focuses “primarily on the harmful effects of drug use.”

Overall, the data sets upon which the government’s “war on drugs” is built come off here as woefully inadequate – subject to political agendas and thus miscontructed and misdirected from the start. The sense here is of researchers groping in a vast blackness by the light of a flickering match – not much is illuminated, but there is still enough heat to burn the fingertips of the unwary.

Conclusion

Other than the quality of the government’s data, there is little to detract from this dogged book. (Only Chapter 4 relies heavily on government statistics and Henderson spends much of this chapter teasing the truest interpretations out of the data.) Some may wish the authors had gone further in detailing the positive implications of the data. Yet, the book is likely to have even more impact precisely because it was authored “from within the belly of the beast” and, even without going that last 10% of the way, still draws sharply different conclusions from those of NIDA.

It was irksome that, beside Henderson and Glass, there were no biographies for the excellent co-contributors, James MacDonald, Michael Agar and Cynthia Favret. Were they separately hired by Henderson and Glass to gather qualitative data? Were they NIDA employees who couldn’t list their employer? – we are not told. (But they turn out to be academic colleagues working under sub-contract to Henderson and Glass and the omission a simple oversight.)

However, these complaints are minor. Henderson’s accomplishment with, LSD: Still With Us After All These Years, is, as a de facto representative of NIDA, to give us back the facts, the truth. She shines the light of 45 years of laboratory and clinical research onto a half-dozen venerable government surveys of dubious validity and finds the outlines of reality. Henderson then triangulates on this devil’s hybrid of lab research and survey data, by breathing life into it through real-world, contemporaneous interviews with those most affected by LSD use: the users, the dealers, and their families.

We need more such analyses of government data, not mere condemnation of their flaws, and we need more government researchers like Leigh Henderson and her “let-the-chips-fall-where-they-may” colleagues.