As part of its Truthout Progressive Pick of the Week series, Dr. Carl Hart’s “High Price: A Neuroscientist’s Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society” is now available, shipped directly from Truthout. Click here to make a minimum contribution of $30 and receive a compelling personal and professional account of why the war on drugs is doomed to fail.
Twenty years ago, when acclaimed neuroscientist Carl Hart began studying drugs, he was motivated by a desire to help communities like the one in which he grew up: poor communities of color that had been, he believed, ravaged by the crack “epidemic.” The media craze around crack headlines was swirling to a fever pitch at the time – the late ’80s and early ’90s – and, Hart writes, “I became utterly convinced that crack cocaine was the cause of everything that I now saw as wrong with the neighborhood.”
However, nothing is that straightforward, in the world or in High Price, and Hart’s work in the lab called into question some of his most deeply rooted assumptions.
As the DARE program hit its full stride and the aftermath of Nancy Reagan produced ever-more-terrifying tales of drugs’ disastrousness, Hart was piecing together a more complex picture—one in which most drug users don’t become addicted (in fact, only a small percentage do), and in which even the most taboo drugs can have positive effects.
Hart began studying the effects of drugs like crack and methamphetamine on humans (he always uses controlled doses and studies only people who use regularly anyway) and found that many well-known “facts” about drugs actually bordered on mythology. He started discovering that drug users – even those who were “experienced and committed” (and sometimes, addicted) – made choices based on a wide range of factors, just as the rest of us do. He writes, “I found out people with addictions weren’t driven only by drugs.” For many drug users, poverty, housing, food and other basic concerns were of foremost concern. In fact, Hart found in his lab, many regular drug users, presented with alternatives like cash or vouchers for merchandise, chose the alternatives over the drugs. Similarly, in experiments where drug-tested patients were rewarded with merchandise vouchers if their urine came back drug-free, the relapse rate proved relatively low – demonstrating that they weren’t simply trading the vouchers for another hit.
As Hart worked to navigate this new research path, he reflected on the impact of the crack “epidemic” on his neighborhood in fresh ways. Poverty, violence and crime always had been present – only now, they were being reframed as the result of a drug, a personal choice. In other words, Hart writes, “Problems in my neighborhood that were later attributed to crack cocaine had actually preceded it.” The universal blame assigned to crack, he writes, served to mask systemic problems – things that aren’t personal choices – like entrenched poverty, institutionalized racism, and the underfunding of education and skill-building programs that might help youths develop sustainable, fulfilling futures.
High Price is not your typical science text: It’s written in chronological order, weaving memoir together with neurological findings and policy analysis. The choice to write from this personal vantage isn’t immediately evident; Hart never struggled with addiction himself, nor does he center his story around particular loved ones whose lives were consumed by drugs. But it soon becomes clear that the absence of those circumstances is why the memoir-based structure is crucial. Hart occasionally used drugs throughout his youth and early adulthood, but those experiences didn’t suck him into a vacuum of addiction; instead, he focused on other rewards that were available to him, such as athletic achievement (in high school) and educational advancement (in later years). Meanwhile, in the impoverished community he left behind in Miami, many of his old friends and family members had slid into heavy involvement with drugs. These included a son he fathered at 15 and discovered 16 years later; when the two finally meet each other, Carl discovers his son is “slinging” – in other words, he’s a “street-level pharmacist.” (A few years later, this son has been incarcerated for a drug violation and still has not graduated high school.)
Carl’s friends and family members had started their lives with scant available “alternative reinforcers,” and for many, that range of options had shrunk considerably, because of involvement with the criminal justice system. As drug charges translated into criminal records and criminal records bred increased susceptibility to future arrests – a near-inevitability for black men in marginalized neighborhoods – opportunities for education and legal jobs evaporated quickly, and few alternative reinforcers remained.
Hart’s own experience vividly illustrates the potential of education and other positive rewards to encourage people to make decisions that will serve them well, averting addictive patterns. Just as the crack user in Hart’s lab chose $20 over another hit, he contends, more big-picture rewards are crucial: rewards like giving poor kids of color a “stake in society,” interrupting the cycle of poverty and shifting societal structures so that those kids have a wider range of choices for their future. The key is not a futile attempt at all-out drug prevention: Hart’s occasional drug use demonstrates that using drugs (as opposed to developing compulsions or extreme addictions) can, for some, be compatible with living a happy, fulfilled, sustainable existence.
That said, High Price doesn’t disregard the suffering of those who are truly addicted to drugs, whose addictions interfere painfully with their lives. Rather, the book reveals that those addicts are a minority of drug users, and not acknowledging that fact obscures and trivializes actual pain of addicts, making it more difficult to determine strategies for actually helping them. The book also reveals that in attending to those who are dealing with drug problems, we must address the psychosocial and economic factors that are driving them to use drugs in excess.
So High Price isn’t simply asserting that the war on drugs has failed. Hart is saying that this “war” is founded on false assumptions, presuming drug use as a cause rather than an effect (or in many cases, a side activity that plays a role in many people’s lives). There’s no such thing as a good drug war, or a “successful” drug war. Instead of maintaining an “irrational focus on eliminating certain drugs,” which targets people of color and deposits many youth in an unending cycle of incarceration, Hart contends that we should concentrate public policy energy around confronting the core problems that decimate communities like the one in which he grew up.
However, unlike many books and films on the topic of drugs, High Price doesn’t provide a set of go-to solutions – nor does it locate a set of easy problems. Instead, it complicates the lens through which we view drugs, in terms of science and politics, allowing us to reassess how our assumptions permit ineffective – and sometimes harmful – policies to persist. No matter our political persuasion or what drug-related philosophies we adhere to, High Price challenges us to re-examine the evidence beneath our talking points and to acknowledge the tangled network of entrenched public problems that have, for so long, been stuffed into the rubric of an all-encompassing, society-spanning file labeled, simply, “Drugs.”
I spoke with Hart for the story behind the book:
Maya Schenwar: There’s an increasing amount of publicity around the fact that the war on drugs isn’t working, and there’s more and more coverage in the media about the way in which that war has failed. What was fascinating to me about your book was that you’re challenging the premise on which that war is based—you’re not just talking about how its strategies failed, you’re talking about how the assumptions it’s based on are flawed. That a lot of the ideas we take for granted about drug use and drug abuse simply aren’t true. Can you talk a little bit our misperceptions of addiction?
Carl Hart: The assumptions we hold are not backed up by good evidence. One example: When I was in college and graduate school, I was taught how bad Ecstasy was. Then I looked at the research that studied it, and the dosages given in the studies were so high—no one would ever take those dosages. If you gave people a dose that high of nicotine, it would kill them.
When I began my research on rats, I started seeing how drugs like cocaine were not causing the effects that people said they did. So I started studying humans. And case by case, the previous studies were not holding up. It wasn’t true that most cocaine users would do anything for another hit. Researchers had started suspending critical thinking. There’s money in the status quo, in studying substance abuse; everyone has an interest in maintaining this frame, even if they act like they don’t. It’s hypocrisy.
MS: One thing you wrote about that I thought was really important is that most people who use illegal drugs are not addicts. Yet there’s this mythology that drug use automatically equals drug abuse. Why is our culture so quick to buy into the idea that any use of illegal drugs constitutes a problem?
CH: One of the reasons we have these beliefs is because so few people in the general population actually use these drugs, and they see these drugs as primarily engaged in by members of a despised group. Society then makes up incredible stories about these drugs, which are used by small numbers of people in groups we don’t like anyway – poor people, black people, even young people. The stories say their situations are fucked up because of those drugs, instead of looking at everything else going on in their lives.
MS: That brings up an important aspect of your book – you chose to write it as part-memoir, which worked to foreground how race and poverty play into the way the war on drugs is carried out and the effects it has. You tell personal stories that show how all kinds of problems are blamed on crack and other drugs when really their sources are things like poverty and racism and the injustices of the criminal justice system. Why have all these huge social problems been attributed to personal choices to take drugs? And why have all of us been buying this idea for 30 years?
CH: The memoir portion was deeply difficult to do. But a lot of times people talk about drugs’ effects without context, and I wanted to provide the context of my life, my community. I wanted people to see that there are things we can place in people’s environments that increase the likelihood of success. Things like sports, summer programs, other opportunities for kids. When these kinds of programs are cut, there’s backlash – and the scapegoat becomes these drugs that most of these folks don’t use regularly. Now you can blame things on the drugs, and not the policies.
Even in those communities, you have people agreeing about crack cocaine destroying the community. They’re saying, “I know it because I’ve seen it with my own eyes.” Then there’s the media and the government spreading this message. … There is a buy-in from a diverse group of professionals. I’m telling them their ideas aren’t right – and they don’t want to hear it.
MS: You’ve mentioned how there aren’t many studies that acknowledge the positive effects of illegal drugs, which is funny because sometimes those effects manifest very similarly to the effects of legal drugs. At one point, you compared methamphetamine and Adderol, for example. This made me think about how in some ways, the scheduling of some drugs as illegal and some drugs as legal comes across as arbitrary.
CH: It’s not arbitrary, but it has little to do with pharmacology. It certainly doesn’t have much to do with potency. Nicotine is one of most potent drugs in the world. The reasons go back to these despised groups – when a drug is associated with them, it often becomes illegal.
This happens through history: Cocaine became associated with black people in the South. The concern with opium was that there were all these Chinese people using it – even though the average user was a 30- to 50-year-old white woman. Marijuana became associated with Mexicans and black people. And meth was restricted when people like bikers and hippies – and young people – were seen to be the ones using that drug.
MS: It was always a mystery to me how that scheduling happened. Until a couple of years ago, I didn’t even think of it as a historical thing or a racial thing.
CH: That’s an interesting point. Scientists who I took classes from and learned from, they all know this. But when they’re writing about drugs for the public, they don’t talk about it, because it’s not helpful for them to say. The number one goal of scientists is keeping their grants. Helping people is not the priority. People are talking about how to enhance their budget first.
MS: I was really intrigued by the section of your book about alternative reinforcers, especially paying addicts to stop using. The results you got with direct cash reinforcements were really encouraging – paying addicts not to use was actually more successful than 12-step programs. Obviously, this doesn’t really fit in with our traditional cultural framework for addressing addiction. Can you explain a little bit about why alternative reinforcements like cash work, when it comes to treating addicts?
CH: I think about it same way we think about raising children. Sometimes people will do things just because they’re new. … And drugs do offer some temporary relief from boredom or other problems. If there are no other options, they might keep doing them because they can’t do anything besides that. So we want people to have a variety of positive options and reinforce those positive options; it decreases the likelihood of behaviors we discourage. This is not a new idea – it goes back to BF Skinner. So, I just wanted to know: does this behavioral science apply to drug addicts too? Turns out it does!
We make up incredible stories – that addicts will do anything for another hit of the drug. You hear about people who use meth having those four-day orgies – that they just can’t stop. … But those stories are inconsistent with biology. We see it in the lab: After a while people have had enough. And if they have options for something else to do, [they] might not choose that discouraged behavior in the future.
MS: Toward the end of the book, you talk about your decision to speak out on drug laws and drug policy and that you have to tread a fine line so that you don’t come off as an activist, because that might affect how your scientific research is perceived. How necessary is the portrayal of yourself as objective?
CH: I used to think I could convince everyone I’m objective – but people are deluded if they think I’m not going to be judged based on the fact that I’m a black man. I’ll always be viewed as an aberration. I’m the only black tenured professor in the sciences at Columbia. So, I try to do the best science I can do. … But we also need to be responsible citizens. So, I am trying to be the best scientist I can be while still doing the right thing.
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