Balding, Wrinkled, and Stoned

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LSD and mescaline, which are often whipped up in unpoliced labs in uncontrolled ways, present different problems. The condition that the experts call HPPD (hallucinogen persisting perception disorder) and that users call flashbacks is a very real problem. But Halpern says it is relatively rare, striking mostly people who use LSD specifically. But there are other risks too. Some trips have ended catastrophically, with suicides or fatal accidents. In other cases, the disaster was not physical but emotional. "There were a lot of people who decompensated into major mental illness," says Dr. Charles Grob, a professor of psychiatry at UCLA's school of medicine. "But you could make the case that these were people who were vulnerable to begin with."

COCAINE The coke party started late for most boomers--not until the 1980s--but when it hit, it hit hard. Even cocaine apologists admit that the drug is dangerously addictive and sometimes lethal. Coke-triggered strokes and heart attacks--both of which can occur in people with no known cardiovascular disease--are the real deal, caused by the sudden elevation of blood pressure and spasms of vessels. "The damage can be done suddenly and acutely," says Raicht, "or slowly and chronically."

Whether periodic cocaine use develops into disabling addiction can be something of a crapshoot. "There's a tendency for most people who have any kind of stake in conventional life to modulate their use and not let it get out of hand," says Craig Reinarman, a sociologist at the University of California at Santa Cruz and a co-author of two books on cocaine. For most people, he says, the breaking point for cocaine use is about an eighth of an ounce a week. But that's just a very general rule, and for many people, the threshold can be lower. And when it comes to crack--crystallized and smoked instead of snorted--addiction, often from the first use, is much harder to avoid.

HEROIN Easily the most lethal of the gang of four, heroin frequently hooks users for the rest of their lives, unless it simply kills them first. One long-term study, published in May 2001 in the Archives of General Psychiatry, followed 581 male heroin users from 1962 to 1997. Nearly half the subjects were dead by the time the study ended. Of those still alive, many were self-medicating with multiple other illicit drugs or alcohol and 67% smoked cigarettes. Not surprisingly, heroin users suffer from a wide range of medical ills, including hypertension, liver and pulmonary diseases and HIV. But the most common cause of death from heroin is overdose, with 22% of the subjects in the long-term study dying that way. Some of the health problems associated with heroin come from the impurities it is cut with. Overdoses often spring from an uncut batch that is unexpectedly pure.

The ultimate impact of any of those drugs, of course, depends on the users. No one has yet been able to tease out the precise mix of genetics, temperament and environment that makes one person a recreational user and another a lifelong addict, but clearly there is no single cause. "There are inherited components, hormonal components, psychosocial variables such as poverty," says Provet. And then, of course, there is mere opportunity--something the '60s provided in abundance.