Drugs are everywhere, both figuratively and literally. At any given moment, a large percentage of people nearly everywhere in the World are using one or more drugs as a medical requirement, a lifestyle choice, or to satisfy a desire or addiction. The consequences of drug use, from prescription pharmaceuticals to illicit substances, are felt on a daily basis by the individual and society at large. The recreational abusers unanimously agreed that there was no shortage of socially acceptable experimental drug use while in pharmacy school. For those who were interested, this environment provided ample opportunity to refine and expand their usage. One 48-year-old male pharmacist described the makeup of his pharmacy school cohort as follows: “There was a third of the pharmacy students in school because Mom and Dad or Grandfather or Uncle Bill were pharmacists, and they looked up to them and wanted to be one. Good enough. They had never seen a pharmacy. A [second] third had been in the [Vietnam] war. They were a pharmacy tech in the war or had worked in a pharmacy. They had the experiential effect of what pharmacy is and found a love for it or a desire to want it…Then you had the other third over here, and we were just drug addicts…It had nothing to do with altruism. We didn’t know what the practice was all about, but we did know that we got letters after our names, guaranteed income if we didn’t lose our letters, and we had access to anything [drugs] we needed.” Many of the recreational abusers claimed that they specifically sought out fellow pharmacy students who were willing to use prescription drugs. The most common locus for these associations were in pharmacy-specific fraternities. The respondents said that there was usually ample drug use going on in these organization and that they allowed them the opportunity to cautiously scout out and identify with other drug users. #RandolphHarris 1 of 19

Once they were connected with other drug users, the prescription drug use of all involved parties increased. This type of small-group drug use allowed for access to an expanded variety of drugs, a broader pharmacological knowledge base, and even larger quantities of drugs. However, numerous respondents clearly stated that these drug-based associations were tenuous and temporary in nature. Over time, as the intensity of their drug use increased, the recreational abusers described how they became more reclusive and guarded and selective in their relationships, fearing that their heightened use of prescription drugs would come to be defined as a problem by their fellow pharmacy students. One 43-year-old male pharmacist said: “You get the sense pretty quickly that you are operating [using] on a different level. Those of us that were busily stealing [prescription drugs] from our internship sites began to tighten our social circle. We might party a little bit with the others but when it came to heavy use, we kept it hush, hush.” Unlike other pharmacy students who were genuinely experimenting with drugs on a short-term basis, these recreational abusers noticed an added intensity associated with their own prescription drug use. While most of these recreational abusers entered pharmacy school with some prior experiences in recreational street drug use, their pre-college prescription drug use was usually not extensive. As such, it was not until they got into pharmacy school that they began to develop more pronounced street an prescription drug use habits. #RandolphHarris 2 of 19

A 38-year-old female pharmacist discusses this transition into increased usage in the following interview excerpt: “I went off to pharmacy school. That was a 3-year program. I had tried a few things [before that], but I would back off because it was shaming for me not to get straight A’s. The descent to hell started when I got to pharmacy school. There were just so many things [prescription drugs] available and to many things that I thought I jut had to try. It might be a different high; it might be a different feeling, anything to alter the way that I just felt. I was pretty much using on a daily basis by the time I got to my last year.” Once the recreational abusers got into a permanent practice setting, they quickly deduced that they had free reign over the pharmacy stock. At first, they referenced other pharmacists for normative or behavioural guidance in access or using the prescription drugs. However, they soon realized that their nearly unrestricted access meant that they could not try any drugs that they wanted without guidance, and most did. More importantly, increased access allowed the young pharmacists to habitually and secretly use the drugs that they liked most. Not surprisingly the levels and frequency of their drug use usually skyrocketed shortly after entering pharmacy practice and going more solo with their use. A 41-year-old male pharmacist explained: “By the time I got to pharmacy school in 1971, I was smoking dope probably every day or every other day, and drinking with the same frequency, but not to the point of passing out kind of stuff. Then in 1971, that was also the year that I discovered barbs [barbiturates]. I had never had barbs up until I got to pharmacy school. So it was like ’75 or ’76 [when I got out of pharmacy school], I was using heavy Secondals and Quaaludes and Ambutols [all barbiturates]. I withdrew and it [the heavy misuse] just took off.” #RandolphHarris 3 of 19

At the start, the recreational abusers’ drug use was openly displayed and took on an air of excitement, much like others’ experimentation with street or prescription drugs. However, as it intensified over time, the majority described how they slowly shielded their use from others. They thought it important to appear as though they still had the situation under control. As physical tolerance and psychological dependence increasingly progressed, these individuals began to lose control. Virtually all of the recreational abusers eventually developed serious prescription drug use habits. Using large quantities and sometimes even multiple drug types, their prescription drug use careers were usually marked by a steep downward spiral. This trend was clearly evidenced in the hand-sketched life history timeline that was drawn by each respondent. What started out as manageable social drug experimentation persistently progressed to increasingly more secretive drug abuse. In almost every case, it took several years for the drug use to reach its peak addictive state. The intense physical and psychological effects of the drug use meant that the recreational abuser’s criminal/deviant career was punctuated by a very “low bottom.” Commonly identified signs of “bottoming out” included life-threatening health problems, repeated dismissals from work, having action taken against their pharmacy licenses, habitual lying, extensive cover-ups, divorces, and suicide attempts. By all accounts, the personal and professional lives of these recreational abusers suffered heavily from their drug abuse. In the end, most were reclusive and paranoid—what started out as collective experimentation ended in a painful existence of solitary addiction. #RandolphHarris 4 of 19

The criminal/deviant career paths of the remaining 27 interviewees (54 percent) fit a different substantive theme. To differentiate these individuals from the recreational abusers, we call this latter group of pharmacists “therapeutic self-medicators.” One of the defining characteristics of this ground was that they had little or no experience with street or prescription drug use prior to entering pharmacy school. In fact, many of these individuals did not even use alcohol. What little drug involvement they did report was usually occasional experimentation with marijuana or other “soft” drugs. If they had ever used prescription drugs, it was done legitimately under the supervision of a physician. Members of this group did not begin their illicit prescription drug use until they were well into their formal pharmacy careers. The onset of the therapeutic self-medicators’ drug use was invariably attributed to a problematic life situation, accident, medical condition, or occupationally related pain. When faced with such problems, these pharmacists turned to familiar prescription medicines for immediate relief. Rather than reporting a recreational, hedonistic, or pleasure motivation, these pharmacists simply decided to use readily available prescription drugs to treat their own medical maladies. The therapeutic self-medicators unanimously insisted that their prescription drug use was never recreational—that they never used drugs solely for the euphoric effects. Instead, their drug use was focused on specific therapeutic goals. This trend is illustrated in the comments of a 33-year-old male pharmacist: “There was no recreation involved. I just wanted to press a button and be able to sleep during the day. I was really having a touch time with this sleeping during the day. I would say by the end of that week I was already on the road [to dependency]…the race had started.” #RandolphHarris 5 of 19

Other pharmacists described how their drug use began as a way of treating insomnia, physical trauma (exempli gratia, a car accident, sports injury, or a broken bone), or some chronic occupationally induced health problem (exempli gratia, arthritis, migraine headaches, leg cramps, or back pain). It is important to point out that during their earliest stages of their drug use, these individuals appeared to be “model pharmacists.” Most claimed to have excelled in pharmacy school. Moreover, occupational and career success usually continued after they entered full-time pharmacy practice. Personal appraisals, as well as annual supervisory evaluations, routinely described these individuals as hard working and knowledgeable professionals. Since they were usually treating the physical pain that resulted from the rigors of pharmacy work, all of the therapeutic self-medicators described how their prescription drug use started and progressed under seemingly innocent, or even honorable, circumstances. In many cases, they were treating the physical pain that resulted from the rigors of work. Instead of taking time off from work to see a physician, they chose to simply self-medicate their own ailments. A 50-year-old male pharmacist described this situation as follows: “When I got to Walgreen’s the pace there was stressful. We were filling 300 to 400 scripts a day with minimal support staff and working 12, 13 hours days. The physical part bothered me a lot. My feet and my back hurt. So, I just kept medicating myself until it got to the point where I was up to 6 to 8 capsules of Fiorinol-3 [narcotic analgesic] a day. #RandolphHarris 6 of 19

Without exception, the therapeutic self-medicators described how they always engaged in solitary and secretive drug use. Although they usually kept their drug use to themselves, many claimed that their initial use was shaped by their interactions with co-workers. That is, they got the idea to begin self-medicating from watching a co-worker do so or merely followed the suggestion of a concerned senior pharmacist who was seeking to help them remedy a physical malady, such as a hangover, anxiety, physical pain. To further highlight this illustration, a 38-year-old male pharmacist described an incident that occurred soon after being introduced to his hospital supervisor: ‘I remember saying one time that I had a headache. [He said] “got take some Tylenol-with-Codeine elixir [narcotic analgesic].’ I would never have done that on my own. He was my supervisor at the time, and I said, ‘okay, if you think I should.’ He said, ‘that’s what we do.’ I guess that started the ball rolling a little bit mentally.” Members of the therapeutic self-medicator group took notice of the drug-related behaviours and suggestions of their peers but never acted upon them in the company of others. Instead, they maintained a public front condemning illicit prescription drug use but quietly followed through on the suggestive behaviours when in private. #RandolphHarris 7 of 19

Whereas the recreational abusers used drugs to get high, the therapeutic self-medicators saw drug use as a means to a different end. Even as their drug use intensified, they were able to convince themselves that the drugs were actually having a beneficial effect on their work performance. This was not all together inaccurate, since they began using the drugs to remedy some constraining health problem that was detracting from their work efficiency. Some therapeutic self-medicators looked to their notion of professional obligation to justify their drug use. To further highlight this illustration, in describing his daily use of Talwin, a Schedule II narcotic analgesic, a 43-year-old male pharmacist maintained: “I thought I could work better. I thought I could talk better with the nurses and patients. I thought I could socialize better with it.” This type of convenient, altruistic-based explanation was quite common among the therapeutic self-medicators. That is, they were adept at convincing themselves that their patients and employers needed them to produce at a certain level. When their performance fell below this level, they turned to prescription medicines as a way of neutralizing whatever inhibiting force that was deemed responsible. At first, the pharmacists’ therapeutic self-medication behaviours seemed to work well. They remedied the problematic situation (pain, insomnia, et cetera) which allowed them to return to normal functioning. However, over time, they began to develop a tolerance for the drugs and thus had to take larger quantities to achieve the same desired effects. #RandolphHarris 8 of 19

The following interview excerpt from a 50-year-old male pharmacist offers a good overview of the life history of a therapeutic self-medicator: “Well, I didn’t have a big problem with that [early occasional self-medication behaviour]. I wasn’t taking that much. It was very much medicinal use. It was not an everyday thing. It really was used at that point for physical pain. But that’s when I started tampering with other things and started trying other things. I would have trouble sleeping so I would think, ‘You know, let’s see what the Dalmane [benzodiazepine] is like?’ When I was having weight problems… ‘Let’s give this Tenuate [amphetamine] a try.’ And I just started going down the line treating the things that I wanted to treat. And none of it got out of hand. It wasn’t until I came down here [to Sacramento]…that things really started to go wild.” In generally took between 5 and 10 years for these pharmacists to progress into the later stages of drug abuse. That is, they were able to control their use for a long time without it interfering with their personal or professional life. A handful of therapeutic self-medicators were not so lucky. For them, there was less time between the onset of their use and their entry into drug treatment. Their progression was much faster. This trend is illustrated by the comments of a 49-year-old male pharmacist: “About two or three years after I had my store, I was working long, long hours. Like 8.00 to 8.00 Monday through Saturday and some hours on Sunday. And my back hurt one day. It was really killing me and I started out with two Empirin-3 [narcotic analgesic]. Just for the back pain. I mean I hurt, my back hurt, my head hurt. I don’t know why, but I just reached for that bottle and I knew it was against the law to do that, but I did it any way. Man I felt good. I was off and running. This was eureka. That was it. It progressed. I started taking more and more then I finally…” #RandolphHarris 9 of 19

The key to self-medicator’s fast-paced progressive drug use seemed to lie in the given individual’s perceived need to treat a wider and growing array of physical ailments. It got to the point that many “drug thirsty” pharmacists recognize that they were actively seeking out or inventing ailments to treat in themselves. As a 40-year-old female put it, “I had a symptom for everything I took.” Several other quotes illustrate this tendency for therapeutic self-medicators to invent ailments. In all, there were 27 pharmacists who fit into the category of therapeutic self-medicators. These individuals were admittedly naïve about drug abuse when they entered their pharmacy careers. They were either counseled or convinced themselves that there was no harm in the occasional therapeutic use of prescription medicines. The normative and behavioral advanced in their deviance were gained largely by exploiting or manipulating their professional position and knowledge. The therapeutic self-medicators always used their drugs in private and kept their use from others around them. Over time, their false confidence and denial that allowed their drug use to significantly progress. Once their façade was broken, these pharmacists awoke to the reality that they were chemically dependent on one or more of the drugs that they so confidently had been dispensing to themselves. If you have a drug addiction, consider seeking help from the church or a trusted medical professional. Counseling of family members by persons and agencies outside their family is very old, probably as old as humanity. Nevertheless, the process of differentiation, specialization, and professionalization which had brough into being agencies staffed by full-time counseling personnel is decidedly recent. #RandolphHarris 10 of 19

And the application of the concepts and findings of social science to counseling is more recent still. Since counseling agencies were started a few decades ago their methods and philosophy have only become systematized in some areas of their work. The rapidity and unevenness of their growth—further consumed by conflicting schools of thought—makes generalization risky, but for any appraisal of their place in the institutions affecting American families some rough summery of their emergence is necessary. The development of family counseling agencies can be schematized in several ways. When their characteristic techniques in successive periods are considered, it may be said that they proceeded from moral exhortation and sanction, through individual guidance or therapy, to procedures adapted to work with groups. Some of these group methods are oriented to conventional individual psychology, others stress interactional conceptions. When the doctrines rather than the techniques of the agencies are considered, it appears that successive periods saw emphasis on religion and morals, then on individual psychology or psychiatry, and finally on social psychology or sociology. As mentioned before, these phases of development have overlapped and still do. Also, certain family agencies primarily devoted to activities like medical care or economic rehabilitation carry on family counseling, although it is not their main duty. Every family-serving professional, whether lawyer, clergyman, teacher, or even architect, can rarely avoid being asked to advise on matter for which the psychiatrist, social worker, and clinical psychologist are especially trained. #RandolphHarris 11 of 19

The quest for guidance goes far beyond a mere demand for information. Similarly, many agencies listed as primarily engaged in counseling do not always limit their work to guidance, advice, and insight, but may offer such services as recreation, participation in clubs, or education. From the standpoint of their personnel, it might be fairer to survey and evaluate counseling agencies according to their success in reaching goals they have set for themselves.  The main focus of attention of counselors in the strict sense intended is the personalities of their clients. To be sure, questions of vocational guidance or family budgeting frequently involve personality questions, and cannot be avoided or isolated in a doctrinaire manner from economic concerns. It is only when personality problems are paramount in the concern and responsibility of the agency, however, that it will be called a counseling agency. Or all types of family agencies, the counseling agencies are most conspicuously bunched at the second or therapeutic phase. They show an especially lively interest and experimental attitude to group therapy. A number of mental hospitals are actively experimenting with various forms of milieu and play therapy as major tools for providing large numbers of patients not merely with custody but with psychiatric care. Crime prevention bureaus in certain cities are exploring the value of clubs for delinquent modeled after Alcoholics Anonymous, and some experiments in group rehabilitation are actually going on with correctional institutions. While much of the development through official and professional channels is still handicapped by an individualistic approach, some agencies in theory and procedure are adopting a much more interactional outlook. #RandolphHarris 12 of 19

Yet even where community organizers have set up community councils and conducted community self-surveys, the therapeutic motive had in the end predominated, and tended to lead to clinics and casework. Inevitably such observations appear disparaging, yet the intent is not to criticize or condemn but merely to note the direction these developments have taken. The feeling that progress is not as rapid as originally hoped, and that some sort of ceiling is soon reached by efforts aimed only at correction psychopathology, had pervaded several studies of social work. Various kinds of families in trouble had characteristic persons or groups to which they turned when in trouble. In the same way, each family counseling agency appears to attract a characteristic clientele. When an agency had recruited as its clientele all that segment of the community which habitually turns with its kind of problem to that kind of agency, its operations are likely to settle into a routine procedure. Its progress then becomes measured mainly in terms of technique, such as its interview methods or efficiency in spending its means. Only where it can set before citizens a creative succession of new and positive goals does it have a fair chance to avoid such a ceiling of routinization. There are still immense areas and many strata of communities in the United States of America which barely enjoy the philanthropic or charitable phase of development of counseling agencies; there are many more which have yet to reach professional standards at the therapeutic phase; and there are only a handful who have made the step from individual casework to group work. #RandolphHarris 13 of 19

It may thus seem premature to suggest inadequacies in the therapeutic approach. Yet there is no apparent reason, other than the failure to conceive goals beyond adjustment, to prevent the adoption of a beneficial, planning approach to the functions of counseling agencies. Psychological offenders are able to counterfeit the voice of God because of the ignorance of believers that they can do so, and their ignorance also of the true principle of God’s way of communication with His children. The Lord said: “My sheep know My voice….,” id est, My way of speaking to My sheep. He did not say this voice was an audible voice, nor a voice giving directions which were to be obeyed apart from the intelligence of the believer; but, on the contrary, the word “know” indicates the use of the mind, for although there is knowledge in the spirit it must reach the intelligence of the man, so that spirit and mind become of one accord. The question whether God now speaks by His direct voice audibly to men needs consideration at this point. A careful study of the epistles of Paul—which contain an exhaustive summation of God’s will for the Church, the Body of Christ, even as the books of Moses contained God’s will and laws for Israel seems to make it clear that God, having “spoke to us in His Son,” no longer speaks by His own direct voice to His people. Nor does it appear that, since the coming of the Holy Spirit to guide the Church of Christ into all truth, He frequently employs angels to speak or to guide His children. #RandolphHarris 14 of 19

God must be approached cognitively through the structural elements of being-itself because God is the ground and the structure of being. The structural elements serve as symbols which are rooted in and point toward their ground. However, before speaking symbolically of God, the theologian must make at least one nonsymbolic statement about Him. Otherwise there would be an infinite series of symbols pointing ever onward, for it is the nature of symbols not to rest in themselves, but to point. That statement that God is being-itself is a nonsymbolic statement. It means what it says directly and properly. After this, nothing else can be said about God as God which is not symbolic. Our ability to speak about God depends upon whether or not the finite can be used to asset something about the infinite. The infinite is being-itself, and everything finite participates in it. The analogia entis gives us our only justification of speaking at all about God. Thus, by its participation in the ground of being, them meaning of the symbol is affirmed. Yet, at the same tie, its proper meaning is negated, for the ground of being transcends its structural elements; the ground is also the abyss. Religious symbols operate in two directions. They bring the infinite down to the finite by concretizing it; and they elevate the finite by revealing its participation in the infinite. For example, if God is symbolized as “father” or “king,” He is brought down to the level of human relationships. Yet simultaneously fatherhood and kingship are consecrated, for their theonomous depth, their holy character is revealed. #RandolphHarris 15 of 19

When it comes to resolving disputes, there are reasons for using private ordering when pertaining to information. In this context we have a threefold key distinction, between private, observable, and verifiable information. Consider a transaction between two parities. Information is private when it is available to one of the parties but not the other. Sometimes the informed party wants to convey the information truthfully to the other party, but must do so in a credible way because the uninformed party will be wary of strategic misrepresentation. Id the two parties’ interests are well aligned, mere declaration (cheap talk) may work. Otherwise the informed party has to look for a costly action (signal) that credibly conveys the truth of the matter, because that action would not have been optimal had the information been different. Sometimes the uninformed party can devise tests (screening or mechanism design), requiring the informed party to undertake actions that will reveal the truth. They theory of asymmetric information is now a standard part of economic theory. Signaling and screening can be parts of contracts between the two parties. For example, if the seller of a car knows its quality much better than the buyer can find our by inspection, then a warranty may serve as a signal of quality. However, the terms of such a contract cannot specify actions to be taken under circumstances that only one of the parties can observe, because that party would have every reason to misrepresent the circumstances so as to avoid taking a costly action. #RandolphHarris 16 of 19

Thus the warranty cannot specify the circumstances under which a part of the car has to be replaced in such a ways that only one party can observe them. If the buyer is the sole judge of whether the transmission operates satisfactorily, he may claim that it is unsatisfactory at the slightest excuse and obtain a new one. Contracts must implicitly or explicitly give each party the discretion to act on the basis of its private information. To address environmental challenges of our time, it is crucial to overcome existing global stereotypes and think of alternative approaches. The time is ripe to go far beyond the UNFCCC framework (though it does not mean a call to bury it altogether) and, first of all, to make it clear that today’s environmental issues should be looked upon from a much wider angle than the one of the climate change talks. We are facing a really big global problem of the deterioration of the natural environment on our Mother Earth, which includes deforestation, extinction of many species of plants and animals, air pollution, water contamination, more and more frequent extreme weather events, unbearable noise levels in the cities, and so on. Obviously, the problem is not limited to CO2 emissions or rising temperatures. Every country or groups of countries must do their utmost to find and implement the solutions taking into account their development stage, economic and social conditions, financial and technological capabilities, and so on. Comprehensive environmental solutions have to be well balanced with policies and measure aimed at achieving other key social and economic goals. #RandolphHarris 17 of 19

Countries should actively exchange information and experience in this area, launch joint projects (both at the bilateral and multilateral level) where possible, and set binding or nonbinding environmental targets for themselves if they consider them useful. The UN should not be looked upon as the only coordinator of international efforts—furthermore, it is unlikely to be the most efficient coordinator. Definitely, the West should actively assist developing countries working to preserve and improve their natural environment—financially, technologically, and intellectually. However, it has to be made clear that, especially in the area of financing, limits exist as most Western economies themselves are facing touch fiscal constraints. Perhaps other countries should be willing to accept the role of one of the major sources of global environmental financing. With the economies of Japan and Europe recovering from World War II, American firms face heavy competitive fire. Constant innovation is needed to compete—new ideas for products, technologies, processes, marketing, finance. Something on the order of 1,000 new products are introduced into America’s supermarkets every month. Even before the model 486 computer replaced the model 386 computer, the new 586 chip was on its way. Thus smart firms encourage workers to take initiative, come up with new ideas and, even if necessary, to “throw away the rulebook.” Work units shrink. The scale of operations is miniaturized along with many of the products. Vast numbers of workers doing much the same muscle work are replaced by small, differentiate work teams. #RandolphHarris 18 of 19

Big businesses are getting smaller; small businesses are multiplying. In just 30 years, the number of IBM employees has gone from 370,000 to 288,300. As its employees are being pecked to death by small manufacturers around the World, to survive, it lays off many workers and splits itself into thirteen different—smaller—business units. In the Third Wave system, economies of scale are frequently outweighed by diseconomies of complexity. The more complicated the firm, the more the left hand cannot anticipate what the right hand will do next. Things fall through the cracks. Problems proliferate that may outweigh any of the presumed benefits of sheer mass. The old idea that bigger is necessarily better is increasingly outmoded. Struggling to adapt to high-speed changes, companies are racing to dismantle their bureaucratic Second Wave structures. Industrial-era complies typically had similar tables of organization—pyramidal, monolithic and bureaucratic. Today’s markets, technologies, and consumer needs change so rapidly and put such varied pressures on the firm, that bureaucratic uniformity is on its way out. The search is on for wholly new forms of organization. “Re-engineering,” for example, the current buzzword in management, seeks to restructure the firm around processes rather than market or compartmentalized specialties. Relatively standardized structures give way to matrix organizations, “ad hocratic” project teams, profit centers, as well as to a growing diversity of strategic alliances, joint ventures and consortia—many of these crossing national boundaries. Since markets change constantly, position is less important than flexibility and maneuverability. #RandolphHarris 19 of 19

CRESLEIGH MEADOWS AT PLUMAS RANCH

Plumas Lake, CA |

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