Recreational drug use is often portrayed in popular culture and music. To further highlight this illustration, probably the best known musical cliché of recent decades was “sex, drugs, and rock’ n’ roll,” while the Billbooard charts have been filled with songs involving drugs, such as Eric Clapton’s Cocaine or the Rolling Stones’ Sister Morphine and Mother’s Little Helper. Popular culture portrays not just recreational drug use but tragedy associated with drugs, for example, the deaths of guitarist Jimi Hendrix, Janis Joplin, and Jim Morrison and many others. Of course, not all common-use drugs are understood as dangerous or associated with tragedy. We found clear evidence of two very different modes of entry among the respondents, namely recreational abusers and therapeutic self-medicators. However, it is important to note tht these were not mutually exclusive categories of offenders. In other words, these two categories were not completely dichotomous. As is usually the case, real life seldom fits cleanly into nice, neat categories. In fact, we were able to identify a number of cognitive and behavioural themes that were common to almost all of the drug-using pharmacists interviewed. These themes were expressed by nearly all of the drug-abusing pharmacists that we interviewed, regardless of how the individual initially began their illicit drug abuse career. The existence of these common themes suggest that pharmacy-specific occupational contingencies play a center role in the onset and progression of illicit use of prescription medicines. #RandolphHarris 1 of 20

Intuitively, it should not be surprising that pharmacists would steal prescription medicines as a way of treating their own physical ailments. After all, they have been exposed to years of pharmacy training that emphasized the beneficial, therapeutic potential of these medicines. Each pharmacist has dispensed the medicines to hundreds of patients and then watched the drugs usually produce the predicted beneficial results. They have all read the literature and drug inserts detailing the chemical composition of drugs and studied the often dramatic curative effects of the chemical substances. Pharmacists, more so than any other member of society, are keenly aware of how and why drugs work. There was strong evidence to suggest that both the therapeutic self-medicators and the recreational abusers actively used the years of pharmacological knowledge that they had acquired. In their eyes, it made perfect sense that they should put their pharmacy knowledge to work on themselves. This application of knowledge can be seen in the comments of a 40-year-old female self-medicator: “So, in 1986 I was sent to the psychologist. That was when I was forced to recognize that I had an alcohol problem. And I recognized that I had to do something. And in my brilliant analysis, I made a decision that since alcohol was a central nervous system depressant, the solution for me was to use a central nervous system stimulant. That would solve my alcohol problem. So I chose the best stimulant that I had access to, and that was [pharmaceutical grade] cocaine. I started using cocaine in 1986. I never thought that it would progress. I never thought it was going to get worse. I thought, ‘I’m just going to use it occasionally.’” #RandolphHarris 2 of 20

Similar trends were observed among the recreational abuser group, only here, the applied use of drugs was based upon more recreational motives. Almost all of the therapeutic self-medicators and recreational abusers described how they became masters of quickly diagnosing their own ailments or emotional needs and then identifying the appropriate pharmacological agent that would remedy the problem. Moreover, as professionals, they were confident that they would be able to self-regulate their drug intake so as to never become addicted. All of the respondents drew upon their social status as pharmacists to convince themselves that their drug use would not progress into dependency. They recall being adamant in their view that personally they were immune from such problems, believing that only stupid, naïve people became addicted to drugs. As a 40-year-old female self-medicator put it, “I’m a pharmacist, I know what I am doing.” A 39-year-old male self-medicator went so far as to say: “I mean, we know more [about the effect of drugs] than doctors. We have all the package inserts. We have the knowledge. We know a lot about the drugs, so what’s the big deal?” Elsewhere we refer to this denial mechanism as a “paradox of familiarity,” because familiarity can breed consent, not contempt toward prescription drug use. Members of both categories of pharmacists claimed that they had never been warned about the dangers of drugs, insisting instead that their training had only stressed the beneficial side of prescription medication. #RandolphHarris 3 of 20

To further highlight this illustration, a 48-year-old male misuser stated: “I never had anybody come right out and tell me that [prescription drug abuse] was probably unethical and illegal because they assumed that we knew that. But nobody ever said this is something that is not done.” Let without guidance on the issues, some pharmacists assumed that self-medication was acceptable behaviour. To this end, a 39-year-old female self-medicator said: “It’s [self-medication] just part of it [the pharmacy job]. It’s just accepted because we know so much. I’m sure it’s the same way when the doctors do it. It wasn’t a big stretch to start going “You know, I got a headache here, maybe I should try one of these Percocets [narcotic analgesic]?” Many pharmacists spoke about their prescription drug theft/use as if it were an entitlement that went along with being a pharmacist. Much like a butcher always has fresh meat at home or a car dealer always drives a state-of-the-art automobile, pharmacists will always have the best drugs. This theme is illustrated in an exchange that occurred between the interviewer and a45-year-old-male pharmacist: “Why take plain Aspirin or plain Tylenol when you’ve got this [Percocet-narcotic analgesic]? It works better….[so] you don’t even have to struggle with it. I really believed that I had license to do that…as a pharmacist. I mean with all that stuff sitting there, you know. Oh, my back was just killing me during that period of time and this narcotic pain reliever is sitting right there. I thought, ‘why should [I] suffer through back pain when I have this bottle of narcotics sitting here?” #RandolphHarris 4 of 20

The above-mentioned themes involve cognitive dimensions of the pharmacists’ drug abuse in that they speak to common motivational and justification themes that were present in all of the interview. Perhaps more important is the fact that there was a common behavioural characteristic shared by all 50 pharmacists. In ever case, occasional prescription drug abuse eventually gave way to an advanced addictive state that was marked by an enormous intake of drugs, unmistakable habituation, and the constant threat of physical withdrawal. Members of the recreational abuser and therapeutic self-medicator groups alike routinely reported daily use levels exceeding 50-100 times the recommended daily dosage. One pharmacist reported that his drug use regimen progressed to 150 Percocets [strong narcotic analgesic] per day. Another individual reported injecting up to 200 mg of Morphine each day. Still another respondent described a daily use pattern that, among other things, included 5g of cocaine. Invariably, these advanced levels of drug use led to clear signs of habituation and the constant threat of physical withdrawal. At this point, the individual recalls growing increasingly desperate. Consider the following quote from a 44-year-ol male pharmacist who was in charge of ordering the narcotics at the independent retail pharmacy where he worked: “I was ordering excessive quantities and chasing down tracks. That’s what I used to do. I was really reaching my bottom. I would chase these delivery trucks down in the morning because I didn’t come to my store until mid-afternoon. I was in withdrawal in the morning and I was without drugs, so I had to have it. #RandolphHarris 5 of 20

“I was just going nuts. Many mornings I had gone to work sweating. It would be 30 degrees (Fahrenheit), it would be January, and the clerk would say, ‘you look sick,’ and I would say, ‘It’s the flu.’ So I would pay the delivery guys extra money to deliver my drugs first or I would chase the delivery trucks down in the morning. I knew the trucks delivered at 6 in the morning, they came by my area, and I would get up early and chase the trucks down the highway. I would go in excess of 100 miles an hour trying to catch up with this truck and flag it down.” The advanced stages of drug addiction invariably produced traumatic physical psychological outcomes. Eventually, “out-of-control” drug use patterns along with the realization of chemical dependency left the pharmacists in a problematic mental state. It was at this point that al of the pharmacists recalled coming to grips with their addiction. This personal realization was accompanied by a shift in the way they thought about their drug use. They no longer denied that situation by drawing upon recreational or therapeutic explanations. Instead, they finally admitted the dire nature of their situation and became more and more reclusive. In short, all of the respondents grew to realize that they had a drug problem, turning then to fear and ignorance to foster the final weeks or months of their drug addiction. Two identifiable criminal career trajectories were observed among the pharmacists who we interviewed: recreational abusers and therapeutic self-medicators. #RandolphHarris 6 of 20

Careful scrutiny of contemporary drug theory, policy, and practice in all areas, from prescription pharmaceuticals to illegal recreational drugs, reveals numerous apparent inconsistencies and pervasive incoherence. This results, in part, from a kind of silo thinking in which attention to drug theory and drug policy, however sophisticated in its own realm, is encapsulated within distinct professional, practical, and economic spheres or “silos.” Silos are descriptively and prescriptively dense but stand isolated from each other in an empty landscape. In other words, people in one arena of drug theory, policy, or practical programs have plenty to say to each other about the way things are and the way things should be with respect to drugs, but they don’t talk much across the open spaces between their areas of focus. Not only do they not talk much between their fields, for reasons to be explored, they cannot really do so. Clearly, our discussion of the therapeutic self-medicator category goes far beyond what is present in the existing literature. However, the first documentation of recreational drug use among health professionals, had minimal impact on the way that the various healthcare professions think about or address problem of substance abuse within their ranks. The pharmacy profession has been especially reluctant to address the reality of the prescription drug abuse situation. For instance, existing self-reports and interview research on drug using pharmacists largely ignores the recreational origins of drug use and, instead, describes the affected individuals as having misplaced therapeutic motivations. This assumption is reinforced by published biographical accounts of recovering drug using pharmacists. While principally intended to raise awareness among fellow pharmacists, these confessionals consistently emphasize the well-intentioned motives behind the individuals’ destructive drug use past. #RandolphHarris 7 of 20

Information is called observable when it is available symmetrically to both parties, and verifiable when it can be proved to third parties such as a court. In practice, this is a matter of cost, and the standard of proof required. Contracts that are intended to be enforced in a court of law can only stipulate actions that are conditioned on verifiable information; courts cannot judge whether a breach of the contractual terms has occurred if they cannot verify whether the circumstances that call for an action have actually transpired. However, observable information can be the basis for contracts that are enforced by extralegal or private methods, because the two parties can know fully well whether a breach has occurred. Such extralegal methods of enforcement come in to broad types. One is enforcement by insider third parties with specialized knowledge that enables them to verify information that outsider general courts of law cannot; arbitrators in industry associations are the most prominent enforcers of this kind. The second is based on a relationship or ongoing interaction between the parties; a breakup of this relationship constitutes the punishment that may deter one of the parties from breaching. This covers many possibilities. The same two parties may meet repeatedly; the two may not have a direct repeated interaction with each other, but each may interact with others in a group or network that transmits information about any breach to all members and collectively sanctions the miscreant, using ostracism in business interactions or social relationships or both. #RandolphHarris 8 of 20

The distinction between observable and verifiable information is standard in the economic theory of contracts. The New York Stock Exchange developed its internal rules and procedures for dispute resolution, and even Taiwanese shoe manufacturers and Western fashion houses performed dispute-resolution functions in addition to their primary matchmaking ones. One may think that these alternative methods of private ordering must suffer a crippling disadvantage relative to the government’s courts, namely their lack of coercive power to ensure that their decisions are obeyed. However, the difficulty is often nonexistent or easily overcome. First, the sanctions available for private ordering are often very effective. Breach of contract can be deterred in ongoing relationships by the threat that the miscreant will be barred from future business with this particular partner or the group; this can be buttressed by social ostracism if the group fosters social ties among its business members. Sometimes this threat may be even more severe than the fines that courts would impose in the matter. If the threat is credible, in the sense of being a part of the strategies in the subgame-perfect equilibrium of the repeated game that constitutes the ongoing relationship, then the contract is self-enforcing. Second, arbitrators may have similar sanctions at their disposal; if they can bar the miscreant from the industry association, they can instantly put one out of business, which can be a more effective sanction than the fines the courts will impose. Of course, the feasibility of such sanctions depends on the availability of the requisite information, and in the case of repeated interactions, on how highly the participants value the future relative to the present. #RandolphHarris 9 of 20

Finally, courts recognize the informational advantage of the alternative institutions. Therefore when a relational or implicit contract serves such an informational purpose, courts refuse to intervene to modify its terms, or to insert missing provisions, or to overrule the availability of discretion to one party. They also enforce the awards of industry arbitration tribunals, using the government’s power of coercion to obtain compliance if the loser in the arbitration attempts to defy the ruling. In the United States of America, this has been so since 1920; in the international context, over 100 countries now accede to the 1958 New York Convention of the Recognition and Enforcement of Arbitral Awards. By providing for the appointment of industry-expert arbitrators, who can make many factual determinations more accurately and less expensively than a judge or jury can, the rules greatly expand the “contractible” aspects of an exchange. The use of stream-lined procedures together with the appointment of expert adjudicators transforms considerations that in the public legal system would have been only observable to the parties…into considerations that are also verifiable…thereby encouraging transactors to enter into more complete contracts. The point is not that arbitrators have access to more information. Any relevant information can be elicited and brought before the court by either party to the dispute through the legal process of discovery. Conversely, many arbitration forms do not allow discovery, although the arbitrator can request additional information. #RandolphHarris 10 of 20

The key is how information is used; industry arbitrators can use their expertise to interpret it—make factual determinations—more accurately and at a lower cost than non-specialized courts can. This is the sense in which verifiability should be interpreted in this context. Arbitration is used in other contexts for other reasons. In international transactions, each party may suspect that the other country’s courts will be biased in favour of its own nationals; this can deter them from entering into contrast that may end up in national courts. Therefore both may agree ex ante to settle any disputes in an agreed international forum of arbitration. Several of these exist, based in London, Paris, Stockholm, et cetera. They differ in their procedures (degree of formality, time taken, fees charged, et cetera) and the range of legal traditions they cover (civil, common, Islamic, et cetera). These affect the choice of forum by the parties to each transaction. These forums usually lack the expertise that industry-specific forums can provide. Therefore they are not likely to lower costs or improve verifiability and permit more complete contracts; instead, removing the suspicion of bias may be their most important function. The different modes of private and official governance can interact in various ways. To further highlight the illustration, if an ongoing relationship based on the superior observability of information by the two parties breaks down, the best alternative available to the parties may be recourse to a contract based on verifiable information enforceable in a court of law, not total cessation of transactions. #RandolphHarris 11 of 20

And if an arbitrator’s award is not enforceable by direct sanctions such as fines, it may nonetheless form part of a relational arrangement where the arbitrator can terminate the miscreant’s access to future trades. Not only do modes like arbitration evolve and apply to provide governance for transactions where they have an informational advantage and can reduce transaction costs, but also transactions take forms that adapt to the available information and governance. As for the emergence and prevalence of barter and countertrade in post-Soviet Russia in this way: The advantage of paying with goods rather than money is that they can be earmarked s property of the creditor. Money is fungible and liquid; a buyer can hide money easily if he chooses to renege on his promised payment to the seller. Goods in a barter or countertrade contract are more difficult to hide, and therefore can act as deal-specific collateral that mitigates opportunism. When it comes to systems of integration, rising complexity in the economy calls for more sophisticated integration and management. In a not atypical case Nabisco, the food company, as to fill 500 orders a day for literally hundreds of thousands of different products that must be shipped from 49 factories and 13 distribution centers, and at the same time take into account 30,000 different sales promotional deals with its customers. Managing such complexity requires new forms of leadership and an extremely high order of systemic integration. That, in turn, requires greater and greater volumes of information to pulse through the organization. #RandolphHarris 12 of 20

To hold everything together—to track all the components and products, to synchronize deliveries, to keep engineers and marketers appraised of each other’s plans, to alert the R&D people to the needs of the manufacturing side and, above all, to give management a coherent picture of what is going on—billions of dollars are being poured into electronic networks that link computers, data bases and other information technologies together. This vast electronic information structure, frequently satellite based, knits whole companies together, often linking them into the computers and networks of suppliers and customers as well. Other networks link networks. Japan has targeted $250 billion to develop better, faster network. All these changes further accelerate the pace of operations and transactions. Economies of speed replace economies of scale. Competition is so intense and the speeds required so high that the old “time is money” rule is increasingly updated to “every interval of time is worth more than the one before it.” Time becomes a critical variable as reflected in “just-in-time” deliveries and a pressure to reduce DIP or “decisions in process.” Slow, sequential, step-by-step engineering is replaced by “simultaneous engineering.” Companies wage “time-based competition.” Expressing the new, it is clear that money moves at the speed of light. Information has to move faster. Thus acceleration pushed Third Wave business closer and closer to real time. #RandolphHarris 13 of 20

Taken together, these ten features of the Third Wave economy, among many others, add up to a monumental change in how wealth is created. The conversion of the United States of America, Japan and Europe to this new system, though not yet complete, represents the single most important change in the global economy since the spread of factories brought about by the industrial revolution. This historical transformation, picking up speed in the early-to mid-1970, was already fairly well advanced by the 1990s. Unfortunately, much of America’s economic thinking was left behind. Global markets of energy and mineral resources are undergoing far reaching irreversible changes, and so are perceptions about the policies needed to provide their stable supply. Global demand is surging due to a dramatic increase of consumption by the fast-growing large emerging economies. Experts project that, absent significant changes in policy or technology, global energy consumption will increase nearly 50 percent over the next 30 years. Energy consumption is growing faster than the GDP in many countries. On the supply side, uncertainties and destabilization risks are exacerbating due to rising political instability in exporting countries, periodical redirections of sales from external to domestic markets by leading suppliers, and, to a certain extent, a depletion, in some major producing countries, of existing deposits in the absence of new ones whose discovery and exploitation could make up for the loss. #RandolphHarris 14 of 20

Therefore, oil and some other natural resources are becoming more and mor attractive targets for speculators. In these circumstances, countries highly dependent on natural resources imports, especially those that do not have their own powerful resource multinationals, get increasingly concerned about supply destabilization risks. Predictions about an all-out resource war or bitter fights among buyers for limited amounts of oil or metallic ores look like an exaggeration. However, buyers’ competition for particular kinds of resources within particular periods of time due to particular circumstances is becoming a more frequent phenomenon. For instance, the Philippines and Vietnam protested to China against its patrol boats hindering their oil exploration activities near the disputed Spratly Islands in the South China Sea. China demanded that its neighbours stop exploration work in this area. Tensions rose as the United States of America declared that the South China Sea was in the sphere of its national interest and that it would stand by the Philippines as its ally. Now, when it comes to supernatural affairs, the angels are “sent forth to minister to the heirs of salvation,” reports Hebrews 1.14, but not to take the place of Christ or the Holy Spirit. The apocalypse seems to show that this ministration of angels to the saints on Earth is a ministration for war in the spiritual realm against the forces of Satan; but there is little indication given of ministry in any other way. #RandolphHarris 15 of 20

After the first Advent, when there was great angelic activity over the wondrous event of the Father brining the “Firstborn: of the new race (Romans 8.29) into the inhabited Earth (Hebrew 1.6), and again at the Advent of the Holy Spirit on the Day of Pentecost to begin His work of forming a Body like unto the Risen Head—and during the early years of the Church—the employment of an angel in direct and visible communication with believers seems to give way to the work and ministry of the Holy Spirit. The entire work of witnessing to Christ, and leading the Church into all truth, has been committed to the Holy Spirit. Therefore all intervention of “angels” or of audible voices from the spiritual realm purporting to be from God may be taken as counterfeits of psychopathological offenders, whose supreme object is to substitute the workings of their own wicked offenders in the place of God. In any case, it is best and safest in these days of peril to keep in the path of faith and reliance upon the Holy Spirit of God working through the Word of God. Man, the microcosm, the mirror of reality has structures of beings found in him, and are found analogously in the subhuman realm. Selfhood, inner awareness, freedom and destiny—all are verified analogously in subhuman beings. Furthermore, the concepts of courage, love, power, and justice are used to describe analogously the characteristics of all beings and of being-itself. The point we wish to make is that this use of analogy based on human experience seems to yield valid knowledge. #RandolphHarris 16 of 20

Moving up now to the relationship between man and God, one would expect that on the same principle, but with proper adjustments, man could get an analogous knowledge of God. Symbols are not a means of knowing God, but rather a way of speaking about Him. If one wishes to talk about God, finite material must be used, and this is justified by the fact that all finite beings participate in being-itself. Without such an analogy nothing could be said about God. However, the analogia entis is in no way able to create a natural theology. It is not a method of discovering truth about God; it is the form in which every knowledge of revelation must be expressed. In this sense anlogia entis, like “religious symbol,” points to the necessity of using material taken from finite reality in order to give content to the cognitive function in revelation. What is boils down to is that analogy or symbolism is the expression of an encounter with God. Through the revelatory experience is far more than an intellectual communication—it is primarily a reunion with the ground of being—it contains a cognitive element conveyed by symbols which are qualified as channels of communication by their participation in being-itself. Yet, it seems not, for every creature participates in being-itself, and yet not everything is a religious symbol, although it has the potentiality to become one. What is the decisive ingredient of symbolism beyond ontological participation? These symbols are not arbitrary interpretations of the concrete revelatory experiences. However, they appear within this experience itself. They are not created intentionally, but they are born in the same dimension in which the revelatory experience takes place. In and through its symbols the religious encounter with reality opens up the dimension of reality in which ultimacy appears. There is no other way of expressing our encounter with the holy than in symbols. #RandolphHarris 17 of 20

From the standpoint of the counselor who finds one’s role ambiguous, it seems more than likely that exploration of a developmental perspective would help resolve the conflicts implicit in one’s professionalization. For the psychotherapist who thinks of oneself as a physician who cures sickness, or who avoids this and speaks only of the “difficulties of living,” there may appear to be no conflict in one’s role. One may be satisfied to reduce symptoms of disorder, to solve the problem presented and to think of oneself primarily as someone who relieves distress, without defining one’s goals beyond that. However, apparently more and more thoughtful counselors do not think they can stop there, or do any permanent good, unless they leave their patients better able to cope with later problems and future strains. Some even feel that their job to plan for the optimal development of their clients, or to organize clients to plan for their own. The ambiguous feelings of the professional who presumes to assist in the personal problems of family members may be all to the good if these are construed in a framework of family relations which includes oneself. The concept of transference goes only part way. The client in the course of the counselor-client interaction frequently construes the counselor as a figure representative of previous others, with whom relations have been unresolved but are thus worked out through the interviews. The difficulty, however, from the client’s standpoint, is that no matter how versatile one’s counselor may be, and no matter how facile or fantastic one’s own imagination, the range of persons with whom a person needs intimate discourse in order to achieve one’s optimal development of self far exceeds the resources of this single relationship. #RandolphHarris 18 of 20

Moreover, there is the fact that the client must pay in cold cash for the kind of communication which the best families afford on a basis of affectional reciprocity; thus the most sacred disclosures hover at times on the verge of something equivalent to prostitution. Regardless of ethics and their enforcement by professional insistence upon its eventual termination, and the limitation of reciprocity to monetary reward; in a word, the elaboration of this relationship lead nowhere. The best hope for fruition of any gains that accrue is tht they serve as a bridge to the regeneration of their client’s involvement in a quasi-family constellation which includes near-rivals and critics, models and admirers, other ages and other genders, in both work and play. Only through others can one obtain the continual characterizations of self essential to valid knowledge of self. Research and experience have already shown that the human being, from birth until death, almost to the degree that the fish requires water, thrives only in social interaction. Neglect, isolation, loneliness, solitary confinement, and deteriorative influences very hard to endure, even though every physical condition of survival is met. And among all kinds of interaction, the most potent of all for personal development are those characterized by the unconditional acceptance of family relations. Only here is the listener who always finds more in the person than one presents in one’s actual behaviour. #RandolphHarris 19 of 20

Only here is the audience that never grows tried. Only here is the person of similar background, for whom every aspect of the culture—of class and ethic experience—resonates with comparable meaning. That a counselor could ever aspire to duplicate these functions of the optimal family is beyond the hope of those who have thought and written about it. In a sense this analysis of the implicit or potential demands on the counselor’s role both justifies and specifies a therapeutic approach. It also shows that one’s role must be transcended by more adequate institutions for providing each client with a stable constellation of significant others, who can be the precisely appropriate self-definers at each critical stage in one’s personal development. For the person whose actual family has failed one the solution suggested by this analysis is the invention of effective quasi-families. The process by which each person contributes to the self-knowledge of others, and others contribute to one’s knowledge of oneself, it immanent in human society. Where self-knowledge and self-control are deficient relative either to norms or ideals, the best means for reversing these deficiencies is effective utilization of all available knowledge of how selves originate, operate, and co-operate. Recognition that some tasks are beyond the powers of the unassisted individual does not mean that society must be divided into two classes, therapists and their patients. It means, or at least can be made to mean, joint action to perform these tasks. Such an approach is as relevant and applicable to the tasks of counseling agencies as to the other types of family agencies. #RandolphHarris 20 of 20

CRESLEIGH MEADOWS AT PLUMAS RANCH

Plumas Lake, CA |

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