Author's Response

It is evident from the discussants' comments that the problem to which my paper is addressed is widespread and troublesome in every area of the United States. I have no reason to dispute Dr. Ungerleider's figures; indeed, I have been deliberately conservative in my own estimates of incidence. I am also able to share his impressions concerning the advantages of a preexisting relationship with the patient for the management of drug use.

Since writing the paper, I have had an opportunity to see in psychotherapy a 16-year-old boy who was referred specifically because of uncontrolled LSD usage. He had contrived to allow his parents to learn about his involvement with drugs, and he came willingly to treatment because, though consciously unconcerned about his “psychedelic” inclinations, he had other specifically neurotic problems for which he decidedly did want help.

In this case, where the boy was already deeply—albeit with unconscious ambivalence—committed intellectually to the ideology of drug use, it was clearly out of the question to impose a prohibition. We both understood that I considered his drug use a symptom, and he was willing to approach it as such, though he devoted most of his attention (quite appropriately) to his feelings of depression, emotional estrangement and apathy.

My interpreting the relationship between these feelings and the recent divorce of his parents and their subsequent remarriages to the instability and insecurity in the early years of his life and the disruption that followed, and to his social unease in a new environment, enabled him to focus on his school work and to reduce

his reliance on drugs to manageable proportions, i.e., smoking marijuana on weekends and taking an occasional “light” LSD trip in social contexts.

Subsequently, however, though he was using drugs less than before, he began dealing in them occasionally in order both to assure his own supply and to keep his friends supplied as well (this with altruistic rationalizations).