THE AMOTIVATIONAL SYNDROME AND CANNABIS USE WITH EMPHASIS ON THE CANADIAN SCENE

Ian Campbell

Faculty of Arts Sir George Williams University

Concordia University Montreal, Quebec, Canada

Interest in the amotivational syndrome appears to have been greatest in Canada from about 1968 to 1973. Since that time, there seems to have been a decreasing interest in the subject among scholars and among that diminishing part of the public involved in debates concerning drugs and their effects.

The subject was carefully reviewed by a Commission of Inquiry of the Canadian Government * on which I had the privilege to serve. We submitted a report on cannabis in 1972, the research findings and conclusions of which were sustained in our final report that was submitted 1 year later.

The commission reviewed all major studies of the effects of cannabis use. We were certainly aware that many foreign studies, particularly in the East, had led to a conclusion that heavy cannabis use produced a state of apathy, inactivity, and self-neglect. However, we were unable to accept their findings as either conclusive or necessarily applicable to the Canadian situation and were concerned about the adequacy of their methodologies. We noted the general absence of comparable control groups in these studies and the absence of data on the representativeness of the samples. We were aware of the dangers of making cross-cultural comparisons. North American studies were generally of little more help. Many, if not most, were found to be methodologically inadequate; moreover, in most cases the subjects were multiple drug users, and it was therefore difficult or impossible to reach conclusions about the effects of a particular drug. Within Canada, we found very few useful studies. The most impressive work in Canada was an incomplete study by the Addiction Research Foundation of Ontario. It attempted to examine the social and personal effects of cannabis use. During the study, the subjects were required to live in an experimental hospital ward. They were healthy young males without mental or physical illness and with about 2 years of marijuana experience prior to the study. In our report, we described the experiment in detail,? and because a final report has not yet been issued, it appears useful to review our statement here.

The project was organized around a model “microeconomy” system which ap- proximated some aspects of normal socio-economic behaviour. Subjects were given

* The Commission of Inquiry into the Non-Medical Use of Drugs was established on May 29, 1969 and submitted its final report on December 14, 1973. The members of the Commission were Gerald LeDain (chairman), Marie-AndrCe Bertrand, Ian Campbell, Heinz Lehmann, and Peter Stein.

t This work had not been reported at the time of the publication of the commis- sion’s report on cannabis and was therefore reported in greater detail than usual. Unfortunately, the illness of the present principal investigator has so far prevented complete analysis of the data.

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the opportunity to engage in productive behaviour in the ward for which they were paid in the form of cash value tokens which could be exchanged for everyday needs or desires. Certain minimal life-maintaining conditions were provided without charge; the bed and cleaning services, heat and light were free. All other items were paid for by the subjects with the . . . tokens. These tokens could be exchanged, for example, for food, candy, cigarettes, beverage alcohol, newspapers, records, baths, medical in- formation about themselves, access to a gymnasium, to films and other recreational facilities, trips outside in the company of staff members and, in some conditions, marijuana cigarettes.

The costs of goods and services purchased in the ward were generally matched to realistic prices and, in turn, the subjects' earning potential was comparable to that which might occur with similar work in the outside world. . . . Subjects were paid on a piecework basis for completed items (woven woollen belts) which met strict quality standards. A subject might typically earn several hundred dollars per week. Unspent tokens could be saved and exchanged at the end of the experiment for the cash equivalent. Some subjects accumulated several thousand dollars. . . . Twenty subjects were employed in the first phase of the main study-10 each in experimental and placebo groups. . . . The experimental group was required to smoke marijuana cig- arettes, while the control group was initially scheduled to smoke inactive placebo cigarettes only. The final experimental treatment regime was as follows: ( a ) Erpen'rnentul group. For the first eighteen days no cannabis was allowed. For the next week marijuana cigarettes (containing 8 mg of THC) were available for pur- chase. For the following fifty-one days a mandatory minimum dose was given, plus whatever marijuana subjects wished to purchase. During this period the mandatory dose of THC was increased in stages from 16 mg (two cigarettes) per day for 27 days, to 24 mg (three cigarettes) for fifteen days, and then finally to 30 mg (two cigarettes) for nine days. Then followed a twelve-day period when cannabis was again available only on purchase-no minimum dose was required. In the remaining ten days of the experiment, cannabis use was not allowed. (b ) Control group. After an initial base-line period, inactive placebo cigarettes were administered to the control group. After forty-three days of placebo, a small daily dose of 4 mg of THC was given (for six days) increasing abruptly to a high dose of 30 mg on each of two days. A twelve-day free-purchase period ensued, during which marijuana cigarettes containing 15 mg of THC were available. A final cannabis-free period followed.

The second phase of the main study was conducted under conditions generally similar to those described in phase 1, but, in addition, was designed to explore the effects of cannabis when it is freely available for purchase and consumed in quantities determined only by the individual's own desires.

Preliminary conclusions of the Addiction Research Foundation Team $ were set out in our report:

No gross behavioural changes appeared during the experiments. . . . No evidence was found of social deterioration, or a decline in concern over personal hygiene or general physical condition. . . . No significant alterations in intellectual functioning were detected. . . .

In general, subjects reported that mandatory consumption of large doses of mari- juana for long periods of time were subjectively unpleasant (to the extent that some threatened to leave the experiment and thereby forfeit a high proportion of their earnings). . . .

When large mandatory doses of marijuana were introduced after long periods of abstinence in the laboratory, work productivity tended to be depressed. Discontinua- tion of marijuana use after a prolonged period of forced daily smoking of high doses

t C. G. Miles, G. Congreve, P. Devanyi, R. Gibbons, J. Marshman, and J. Rankin.

Campbell: Amotivational Syndrome in Canada 35

resulted in an increase in productivity. When the work output of subjects on a man- datory high dose was compared to that of subjects who consumed only the amounts they desired (which were, in fact, relatively small quantities) the forced-dose group showed dramatically lower average productivity, which was most pronounced in the first few weeks. Some behavioural adaptation or tolerance to this effect of the drug seemed to develop over the course of the experiment and differences between the mandatory and free-purchase groups were minimal towards the end of the experi- mental period. The researchers suspect that this productivity decrement is due more to a reduction in time spent working, rather than to inefficient performance.

Recognizing the relatively short period of this experiment and the highly repetitive nature of the work, the commission concluded that this study lends “support to the notion that cannabis, in certain circumstances, may reduce motivation for performing certain manually conducted tasks.” However, we cautioned that work of greater “intellectual or artistic variety” might have yielded different results.

The commission did not find conclusive evidence to support the position that cannabis use produced changes of personality that could be termed an amotivational syndrome. We felt that many of the symptoms generally de- scribed under this term could be associated with changes in values that stemmed from other sources. However, we did not conclude that the question had been finally answered and argued that there was cause for continuing concern and research.

More than the other members of the commission, I was and remain con- cerned that a significant drop in motivation is a consequence that may, in some individuals, be associated with the continued use of several psychoactive drugs, including cannabis. I stress, however, that I do not find it as a unique con- sequence of cannabis use, because I have seen the same symptoms in a large number of chronic and heavy users of alcohol.

My concern about the possibility of a relationship between persistent can- nabis intoxication and a deterioration in motivation derives in large part from my observations over a 4-year period, 1968-72. In 1972, I was able to identify, by name, 206 of the estimated 275 students who used cannabis during that year 8 and was able to hold tape-recorded interviews with 127 of them. A year by year analysis of final examination averages of these students showed that the greater their use of cannabis, the greater the tendency for a decline in final averages. Final averages dropped in 77% of the heaviest users and in 32% of the lightest users. The heavy users also had a higher failure rate and lower averages than did the light users. All of these facts could be attributed to many sources, including their heavy cannabis use, their participation in a subculture that did not tend to stress academic success or the acceptance of such values as planning, punctuality, concern with the future, and rationality, which tend to be associated with academic success, or to a general decline in motivation. My interviews with and observations of these students certainly suggested that apathy increased and vitality diminished as frequency of cannabis intoxication increased.

I was able to examine essays and examinations written by many students whose grades had been analyzed. In this exercise, I compared material written toward the end of the year prior to their heaviest use, at various points through the year of heaviest use, and early in the following year after a summer vacation

5 Total enrollment in the university was approximately 1000 students.

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when cannabis had not been used or used only slightly. In examining this work, I was concerned with the way material was organized and handled rather than with its content. It seemed very clear that after periods in which the students had smoked cannabis four, five, or more times per week for 4-6 weeks, there was a lessening in the quality of abstracting and synthesizing. However, the quality of abstraction and synthesizing returned after the summer vacation when the students were free or largely free of cannabis use for as long as 4 months. It seems not unreasonable to hypothesize that a loss of synthesizing and ab- stracting capacity could yield a change in motivation and, at least in part, account for the apathy and other behavior that would be described as the amotivational syndrome. On reflection, it appears that what I had described as an impairment of abstracting and synthesizing ability could be better described as a lessening of the capacity to perceive relationships of appropriateness. Such an impairment would surely influence the use that these students made of their potential and could well affect their motivation. I am not persuaded, however, that this effect is related uniquely to cannabis but more likely to the use of several drugs, including, in some cases, alcohol.

Canadian research has not produced conclusive evidence to support the hypothesis of an amotivational syndrome associated with cannabis use, although there is some experimental evidence of a decline in productivity among heavy users in an experimental setting. My studies of university students suggest a loss of ability to synthesize and abstract, or to perceive appropriateness in some situations, after periods of frequent and heavy cannabis use.