by Edward M. Brecher and the Editors of Consumer Reports Magazine, 1972
Chapter 52. LSD today: the search for a rational perspective
The use of LSD by 1970 had become endemic in the United States among some segments of the youthful white society, much as peyote became endemic in the American Indian society a century earlier. But the great majority of LSD users, having learned how to use the drug, no longer engage in behavior of the type which engenders headlines or necessitates hospitalization.
But what of the long-range effects of LSD on its users, as distinct from the acute immediate effects? By far the best data on long-range LSD effects have been assembled by two psychologists at the University of California at Los Angeles, Drs. William H. McGlothlin and David 0. Arnold.1 In 1967, they secured from three Los Angeles psychiatrists the names of men and women who had received LSD during the period 1956-1961. Some were patients who had received the drug as part of their psychotherapy; others were healthy volunteers who had participated in LSD experiments. The long-term effects on these two different classes of users were determined separately, and compared.
Some of these early LSD users, moreover, had discontinued the drug at the end of the therapy or experiment; others had gone on to use blackmarket LSD. The long-term effects on these disparate groups were also compared.
The psychiatrists who used LSD in psychotherapy had also, of course, provided psychotherapy without LSD to other patients. In ingenious ways a control group was drawn from these non-LSD patients receiving psychotherapy-matched in as many ways as possible to the group that received LSD. And a second control group was also set up to match the patients who bad subsequently taken LSD nonmedically. Thus a variety of intergroup comparisons and contrasts was possible.
In all, 247 patients and volunteers who had taken LSD before 1962 were included in the study. They were intensively interviewed, subjected to a battery of psychological tests, and asked to fill out a lengthy questionnaire. Their automobile driving records were checked, and the birth certificates of their babies. In many cases the wives or husbands of the LSD users were also questioned. It is quite possible, of course, that some long-term effects of LSD, favorable or adverse, may have escaped the numerous McGlothlin-Arnold checks; but if so, they were almost certainly rare, or mild, or both.
The researchers found that only 58 of the 247 patients and volunteers continued to use LSD nonmedically after their therapy or the experiment was discontinued. Only 22 of these 58 took more than ten subsequent LSD trips. Only one of the 22 used LSD oftener than once a week; this exception took it twice a week. Only one or two others took LSD even once a week. None of the users showed a pattern of increasing use. Finally, all but three users either discontinued LSD use altogether after a few years or else took only one, two, or three trips a year thereafter. Only 9 of the original 247 took LSD in 1967. The pattern of use among the 22 (out of 247) who took more than ten nonmedical trips is shown in Table 4.
As shown in the column at the far right of Table 4, 9 of the 22 users indicated that they might take LSD in the future, while 8 thought they would not and 5 were undecided.
Of the 58 who used LSD nonmedically, only one said he discontinued LSD because it was unavailable. Thus, law-enforcement efforts to curb availability of LSD did not account for the decline in use. Despite the fact that the McGlothlin-Amold study was conducted mostly in 1967 and 1968, at the height of the anti-LSD publicity, only 9 of the 58 said they stopped for fear of bad trips or physical harm. The reasons given for either continuing or discontinuing LSD use are shown in the following table.2
Reasons for continuing
Mystical experiences 4
Euphoria, pleasure 3
Reasons for discontinuing
Concern about bad trips; physical or mental harm 9
No need; had enough 10
Prefers nondrug methods 5
Illegality; current bad reputation 4
Doesn't like effect 3
Need to integrate with therapy 2
Prefers peyote 1
LSD unavailable 1
"Compulsive patterns of LSD use," Drs. McGlothlin and Arnold concluded, "rarely develop; the nature of the drug effect is such that it becomes less attractive with continued use and in the long term, is almost always self-Iiiniting."3 They give this explanation:
There are several reasons why hallucinogens would not be expected to give rise to long-term chronic abuse'of the type frequently encountered with most other mind-altering drugs. First, of course, there is no development of phvsiological dependence. Second, at least for those hallucinogens for which reliable data are available, daily use leads to rapid buildup of tolerance, such that for practical purposes these drugs cannot be used more than twice a week without losing much of their impact. Equally relevant is the fact that the intense emotional effects of hallucinogens produce a type of psychological satiation which, for most persons, results in much longer intervals between use than is necessary to avoid tolerance effect. A third reason why the hallucinogens appear not suitable for long-term use is their lack of dependable effects. Habitual drug users seek to satisfy particular needs-escape, euphoria, anxietv relief, feeling of inadequacy, etc. To qualify for long-term use, a drug must consistently produce the type of mood alteration desired. Hallucinogens are quite inconsistent in terms of mood alteration, and in addition, often produce a feeling of increased awareness which is incompatible with the need for escape and withdrawal. The fourth and probably most important reason to expect individuals to decrease rather than increase their hallucinogen use over time is to be found in the characteristics of the drug effect. As described earlier, the major effect of the hallucinogens is to temporarily suspend the normal mode of perception and thinking. The utility of the experience lies in the uniqueness of the new modes of perception and thought which become available tinder these conditions. However, as one repeats the experience rnanv times, what was initially unique becomes more commonplace and there is a process of diminishing returns. The effect of hallucinogens is indeed "a trip," and trips tend to lose their appeal when repeated too often.6
This pattern of declining use, and of stopping LSD altogether, does not, however, mean that LSD use is dying out. On the contrary, new users are continuously being recruited. Indeed, LSD use among high-school and college students is believed to have reached a new high in 1970.* What the evidence indicates is that LSD is, for almost all users, a phase to be lived through rather than a continuing way of life.
The great majority of the 247 LSD users in the McGlothlin-Arnold sample reported, years later, that their experience with the drug had benefited them. "These reports of change show a fairly consistent pattern," Drs. McGlothlin and Arnold note-"more understanding of self; more tolerance of others; less egocentricity; a less materialistic and aggressive orientation; and more appreciation of music, art, and nature." 8 The proportions reporting such favorable effects were very high; among 97 patients who received LSD only in therapy, for example, 94 percent reported "more understanding of self and others." Among 58 patients who in addition used black-market LSD, 95 percent reported this effect. Sixty one percent of the former group and 63 percent of the latter reported "less anxiety.")
* A December 1970 Gallup poll of 1,063 students on 61 college campuses indicated that 14 percent had tried LSD-as compared with 4 percent reporting LSD use in a comparable poll one year earlier. Six percent in the 1970 poll reported having taken LSD during the previous month.7
But here the importance of controlled studies leaps into view. When the patients who had received psychotherapy without LSD, and the non-LSD users who were matched to the black-market users, were asked the same questions, they also reported that through the years they had become "more understanding of self and others," suffered less anxiety, were more tolerant of the viewpoints of others, and so on.10 In only two respects did the favorable reports of LSD users differ significantly from the favorable reports of nonusers the patients who had used black-market as well as psychotherapeutic LSD reported "more appreciation of music" and " more appreciation of art" much oftener than their matched control group. (This was not true of the patients who received LSD only in psychotherapy and their control group.)
In sum, the McGlothlin-Amold study found most LSD users still convinced, from seven to twelve years after their first use of LSD, that the drug experience had significantly benefited them-but matched non-LSD users reported similar self-improvement.
LSD bad a long-term effect in reducing alcohol consumption in only a modest proportion of cases .12 But the subjects in this study were not alcoholics.
When the records of the California Department of Motor Vehicles were checked for accidents and traffic violations, no significant differences were found between the LSD users and the control groups.13
All of these findings are subject to qualification. The LSD users in the sample, all of whom had used LSD before 1961, were not typical of the later generation of "hippie" users. Many in the sample had received LSD only a few times. They were in general older and better established in life. The findings are nevertheless of great importance-for they demonstrate the modest effects of the LSD itself, as distinct from the effects of the other aspects of the LSD-using hippie subculture in the 1960s.
It is commonly believed that LSD affects the beliefs and values of the LSD subculture, changes attitudes, alienates users from society, reduces political and organizational activity, and so on. Drs. McGlothlin and Arnold explored all of these possibilities in their sample of 247 LSD users by means of tests and rating scales. Minor differences were found between the LSD users and the control groups-but the overall conclusion was negative: "There is little evidence that a few, administrations of LSD will produce measurable lasting personality, belief, value, attitude, or behavior changes in a relatively unselected population of adults. 14 To the extent that such changes appear in LSD subcultures, they are quite probably traceable to nonpharmacological aspects of the subculture.
Twenty-six of the 247 LSD users in all categories felt that LSD had harmed them in various ways. Many of the same 26 also felt that it had helped them. The same effect that some users considered beneficial others considered harmful. Thus, while two-thirds of the LSD users listed "more tolerant of opposing viewpoints" as a benefit of LSD, the comment was also made: "When you see both sides it is more difficult to decide, and therefore less efficient in the Western sense." Another negative comment: "I was unprepared to have my world and moral structure broken down and it has taken time and much effort to rebuild." Several of the comments were ambivalent: "It loosened me up in a way that is both positive and negative-like an artist that previously could draw precise work. Afterward he could draw freely, but not precisely." "I have lost some of my goals. I don't know if this is harm-my boss would say so." 15
"Seven respondents [out of 247] felt their LSD experiences had contributed to increased anxiety and/or depression," Drs. McGlothlin and Arnold noted. "Three thought they bad suffered some physical harm, e.g., numbness and tingling in legs and impaired eyesight. One individual felt his LSD use had resulted in memory loss and another stated it had caused serious marital conflict. Three regarded it as a painful memory of a horrible experience, and two others thought they 'would be better off without knowledge of the means to escape to another world."' "I The striking fact, however, is the rarity of such negative comments. At a time when the country was being warned that LSD was the greatest threat to the nation -worse even than the Vietnam war-221 out of 247 people with LSD experience bad no negative comments whatever to make about the drug's long-range effects on themselves.
Subjective reports, of course, do not tell the whole story. In addition to asking respondents whether they thought they bad been banned, Drs. McGlothlin and Arnold diligently searched for objective evidence of harm. They found very little.
Suicides. Among approximately 140 users who first took LSD as part of a scientific experiment, there were no suicides. Among approximately 140 users who received LSD as part of their psychotherapy, one committed suicide within two years of his last LSD use and 6 committed suicide from two to ten years after the last use.17 No comparable figures are available on the suicide rate among psychotherapy patients who do not receive LSD.
Psychosis. One LSD-linked psychotic reaction occurred among the 247 LSD users in this sample. This patient "received three LSD treatments in psychotherapy, was hospitalized for one week following the third exposure, and was unable to work for an additional three months." 18 Another patient had been hospitalized for psychiatric illness before taking LSD. Thereafter, she suffered a "nervous breakdown" of two years' duration, which she herself attributed to LSD. The "breakdown" did not require hospitalization however-and it did not occur until four years after her last LSD experience."
Flashbacks. In reporting on the flashback phenomenon, Drs. McGlothlin and Arnold emphasized that while "a spontaneous experience subjectively described as LSD-like" may follow LSD use, there is no certainty that such an experience was caused by the use of the drug.20 The investigators asked the 247 LSD users three related questions:
Subsequent to your use, have you experienced any uncontrolled LSD-like experiences without using drugs?
What were they like?
Did you find them frightening or disturbing?
Thirty-six of the LSD users did experience something that might be considered a flashback.
Eight of them reported "mild, pleasant phenomena related to environment or self-suggestion." One recalled, for example, that "music [that bad been] played during LSD session brings back some of the feelings." Another &scribed his "flashback" as a feeling of oneness with the world."
Seven reexperienced "minor perceptual changes"-for instance, seeing a flash in the periphery of the visual field. Whether such "minor perceptual changes" are more or less common among people who have not taken LSD was not discussed.
Six LSD users out of the 247 reported experiencing "vague anxiety" for example, fear of driving a car-which they described as similar to the initial part of the LSD trip.
Seven reported unusual phenomena related to sleep, sex, or alcohol intoxication. For example, one reported an intense fear of death experienced while drunk on alcohol. Why this was attributed to the LSD rather than to the alcohol was not indicated.
This left eight reports of what might properly be considered brief "psychotic" flashbacks among the 247 LSD users. Five of these were perceptual changes: recurring undulation of visual field, seeing objects as weird animals, repeats or "playbacks" of frightening scenes experienced on an LSD trip, auditory hallucinations. The other three were depersonalization experiences-as if the mind had left the body. One of these experiences occurred while the subject was driving a car, and an accident followed.
"In summary," Drs. McGlothlin and Arnold concluded, "the majority of the descriptions cited relatively minor, isolated events. Only one case fits Horowitz's definition of 'repeated intrusions of frightening images in spite of volitional efforts to avoid them.' In very few instances does there appear to be substantial evidence of a causal relationship between the LSD experiences and the incidents described. In the large majority of cases, there seems to be nothing more than the association of two events bearing certain similarities." 21
Drs. McGlothlin and Arnold did not discuss the possible relationship between LSD flashbacks and nondrug recurrences of emotion-laden experiences. They did suggest, however, that reports of flashbacks among youthful "hippie" LSD users "may be related to their relative instability and a tendency to use the hallucinogens frequently * in high doses," or to the fact that these users "are exceptionally suggestible, prone to believe in all kinds of magical and fanciful phenomena ." 22
* That is, once or twice a week.
Effects on thinking. Drs. McGlothlin and Arnold suggest rather tentatively one possible long-term effect of repeated LSD use-an effect that, they point out, is often viewed as favorable rather than unfavorable. They call this a "structure-loosening" effect .23 LSD proponents call it a "mind expanding" effect. The effect is a subtle one, and no cogent description of it has been found. More research is clearly called for on this point-as well as more serious consideration of whether the effect (if it in fact exists) should be welcomed or worried about. Meanwhile, it would seem evident that the "mind-expanding" or "mind-loosening" effect here referred to differs appreciably from the "mind-rotting" effect widely publicized in the 1960s.
Brain damage. Drs, McGlothlin and Arnold selected from their sample 16 "heavy" LSD users who had taken at least 20 and as many as 1,100 LSD trips, nonmedical as well as medical; most of the 16 bad also used other LSD-like drugs (peyote, mescaline, psilocybin, mushrooms, DMT, etc.). A control group, matched with the heavy LSD users in as many ways as possible but with no use of LSD or LSD-like drugs, was also selected .24
The 16 heavy users were interviewed by Dr. Daniel X. Freedman. Each interview lasted from one to two hours, and was specifically directed "toward detecting any clinical evidence of organic impairment-" 25 The psychiatric interviews did not reveal clinically significant signs of organic impairment in behavior or life situations. For some, there were characterological and psychological features which were somewhat eccentric; but, over-all, the ability to judge, to acquire competence and new learning, to focus attention and concentrate, to recall and retrieve relevant information, appeared intact. Where unusual personality traits were encountered, they seemed to have been present in the pre-LSD life history, style, and subculture of the subjects ." 26
The Freedman interviews established that LSD, at least in this sample of heavy users, had produced no evidence of brain damage of a kind that could be identified by a skilled psychiatric interviewer. But what of subtler forms of brain damage-impairments that can be diagnosed only through precise psychological tests? To check for these subtler forms of injury, Drs. McGlothlin and Arnold gave both the heavy LSD users and the nonuser controls thirteen psychological tests of the kinds most likely to reveal brain damage.
With respect to twelve of these thirteen tests, the LSD users did a little better on some and a little worse on others than the controls; the differences were not significant in either direction .27 In this respect, the MeGlothlin-Arnold study confirmed a parallel study by Drs. Sidney Cohen and A. E. Edwards, who gave a battery of fifteen such tests to 30 young people who had taken 50 or more LSD trips. Drs. Cohen and Edwards found no significant difference on thirteen out of the fifteen tests between the heavy LSD users and a control group.28
When Drs. McGlothlin and Arnold compared their test results with those of Drs. Cohen and Edwards, a curious inconsistency emerged. The two tests on which LSD users in the Cohen-Edwards sample had done significantly less well than their controls were a test for visual perception, known as "Trail-Making A," and a test for spatial orientation. In the McGlothlin-Arnold study, heavy LSD users also showed somewhat poorer scores on those two tests, but the differences were not significant. Moreover, the heavy users did somewhat better than their controls in a quite similar test, "Trail-Making B ." 211 On even closer analysis, some features of the McGlothlin-Amold results tended to confirm the Cohen-Edwards findings on the "Trail-Mak-ing A" and spatial-orientation tests, while others tended to cast further doubt on tfiem.
The one test in the McGlothlin-Arnold battery on which the heavy LSD users did significantly less well than the controls was the Halstead category test-a nonverbal measure of the ability to discern abstract principles. But when Drs. Cohen and Edwards had given the same test to their sample they "found no difference between LSD and comparison groups. . . ." 30
The whole issue might be summarized succinctly: Who knows? Maybe heavy LSD users do significantly less well on these three tests and maybe they don't. And even if it were proved that they do less well, the question whether this is due to brain damage or some other factor-less interest in passing tests, for example-would remain unanswered.
Taken together, the Coben-Edwards and McGlothlin-Amold studies would appear to rule out the possibility of major brain damage from LSD, even after scores or hundreds of trips. Further studies on larger populations, of course, might reveal some form of brain damage that is subtle, or rare, or both-but the same could be said of further studies of virtually any other substance.
Babies born to LSD users. Drs. McGlothlin and Arnold have also provided by far the best available evidence concerning possible damage to babies born to LSD users. In cooperation with a pediatrician, Dr. Robert S. Sparkes, they traced the outcome of 120 live births occurring among their sample of 247 LSD users.31 These births fell into four categories.
The McGlothlin group concluded that "there is no evidence of a relation between parental LSD exposure and major congenital defects in their off spring." 32
The group noted two limitations on their study. First, like LSD users generally, few of the parents had used LSD in high dosages over long periods of time. Second, the study did not rule out the possibility that LSD on rare occasions might cause a birth defect. The same might be true, of course, of virtually any other substance. Subject to these qualifications, there was no evidence that LSD, taken either by the mother or the father, "increased the risk of having a child with a congenital defect." 33
The McGlothlin-Sparkes-Amold study casts little light, it should be stressed, on the effects of LSD taken by the mother during pregnancy; in only twelve of the pregnancies was LSD taken. Nor is there any other reliable study on this point, either for LSD or for many other drugs. Hence the advice given by Consumers Union to readers of Consumer Reports 34 concerning medicines in general during pregnancy applies equally to LSD:
These precautions apply equally to LSD and to medicaments in general. When presented in this general framework, young women are far more likely to respect the recommended precautions than when they are presented as if they applied to LSD alone, in an anti-LSD campaign that many young people discount.
Spontaneous abortion. In addition to the search for birth defects, the McGlothlin-Sparkes-Arnold study also inquired into the incidence of spontaneous abortions (miscarriages). They reported three findings:
* A woman of childbearing age should assume that she is potentially pregnant during any month when she engages in sexual intercourse without adequate contraceptive measures.
The spontaneous abortion rate was somewhat high-15 percent among those who took LSD only medicinally, but this was still "Within the usual range."
The spontaneous abortion rate was lower when only the father took LSD.
Among women who took LSD nonmedicinally (usually black-market LSD), the spontaneous abortion rate was shockingly high: 50 percent. Of the ten spontaneous abortions in this group, however, five were accounted for by one woman-and she had had one abortion before taking LSD. "Habitual aborters," who lose one baby after another, are well known in the medical literature among women who do not take LSD; it was hardly significant that one habitual aborter should be found in this LSD-using group.
The somewhat higher spontaneous abortion rate among the mothers who took LSD, however, did appear to be significant even when the one habitual aborter was excluded. Drs. McGlothlin, Sparkes, and Arnold therefore cautiously concluded: "There is some indication that the use of LSD prior to conception by women may increase the incidence of spontaneous abortions, although the data do not permit the establishment of a clear-cut causal relationship." -'-'
The findings of the McGlothlin group were published as the lead article in the Journal of the American Medical Association for June 1, 1970. With a few exceptions, the mass media found little newsworthy in the reassuring aspects of the study; but they heralded in headlines the cautious statement that there was some evidence that LSD might increase the incidence of spontaneous abortions.*
* Thus the Los Angeles Times-Washington Post Service syndicated to newspapers an account of the McGlothlin-Sparkes-Arnold Study which began: "A woman who takes LSD may have more chance of having a miscarriage than a woman who does not, though she takes the drug before she gets pregnant, a University of California at Los Angeles study shows. The Detroit News ran this syndicated dispatch on June 4, 1970, under the headline: "LSD May Foster Miscarriages." The twelve- paragraph dispatch noted in a single sentence in the third paragraph the McGlothlin-Sparkes-Arnold finding that "LSD has no discernible. effect on a couple's chances of having a deformed or premature baby." A press release sent to science writers by Medical World News went even farther in this direction. The release was headed:
NEW STUDIES ON LSD LINK MENTAL ILLNESS, ABORTIONS TO ITS USE.37 Six paragraphs were devoted to the McGlothlin-Sparkes-Arnold study. There was no mention whatever of the finding-the first such finding on a large scale in the historic, of LSD research -that 106 of the 120 babies were born in good health without birth defects, and that the other 14 cases were about what would be expected if the parents had not taken LSD. Yet to a country that had been warned to expect an epidemic of malformed "LSD babies," this was surely a sensational finding, which the public was entitled to know.
The question of subtle chromosome damage which does not affect the children of LSD users but which may affect subsequent generations is too complex to be reviewed in detail here. The essential point is that LSD is at most a trivial factor in the problem. Yale University investigators, for example, studied 4,500 consecutive births in New Haven. Twenty-two of the 4,500 babies showed visible chromosome abnormalities. None of the parents of the 22 affected babies reported having taken LSD. The study concluded that about 20,000 babies with visible chromosome abnormalities are born in the United States each year to parents who do not take LSD. All 14 of the babies in the sample whose parents did report taking LSD had normal chromosomes.38
Consumers Union's conclusions and recommendations concerning LSD appear in Part X.