Society is a long way off from understanding the "complex issues for why people really become addicted," says Dr. Carl Hart.
Democracy Now!was joined by the groundbreaking neuropsychopharmacologist Dr. Carl Hart. He is the first tenured African American professor in the sciences at Columbia University, where he is an associate professor in the psychology and psychiatry departments. He is also a member of the National Advisory Council on Drug Abuse and a research scientist in the Division of Substance Abuse at the New York State Psychiatric Institute. However, long before he entered the hallowed halls of the Ivy League, Hart gained firsthand knowledge about drug usage while growing up in one of Miami’s toughest neighborhoods. He recently wrote a memoir titled “High Price: A Neuroscientist’s Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society.” In the book, he recalls his journey of self-discovery, how he escaped a life of crime and drugs and avoided becoming one of the crack addicts he now studies.
Dr. Carl Hart, we welcome you to Democracy Now! The title of your book almost was the song we were just playing, “Trouble Man”?
Dr. Carl Hart: That was my vote, “Trouble Man,” but the publishers thought that it wasn’t 1973, so we should go with something more modern.
AG: Both your research findings will surprise many and also your own path in life. Let’s start by talking about, well, where you come from.
CH: Well, I come from — as you said, I grew up in the hood. And so, when we think about these communities that we care about, the communities that have been so-called devastated by drugs of abuse, I believed that narrative for a long time. In fact, I’ve been studying drugs for about 23 years; for about 20 of those years, I believed that drugs were the problems in the community. But when I started to look more carefully, started looking at the evidence more carefully, it became clear to me that drugs weren’t the problem. The problem was poverty, drug policy, lack of jobs — a wide range of things. And drugs were just one sort of component that didn’t contribute as much as we had said they have.
AG: So, talk about the findings of these studies. I mean, you’ve been publishing in the most elite scientific journals now for many years.
CH: Yes. So, one of the things that shocked me when I first started to understand what was going on, when I discovered that 80 to 90 percent of the people who actually use drugs like crack cocaine, heroin, methamphetamine, marijuana — 80 to 90 percent of those people were not addicted. I thought, “Wait a second. I thought that once you use these drugs, everyone becomes addicted, and that’s why we had these problems.” That was one thing that I found out. Another thing that I found out is that if you provide alternatives to people — jobs, other sort of alternatives — they don’t overindulge in drugs like this. I discovered this in the human laboratory as well as the animal laboratory. The same thing plays out in the animal literature.
AG: What do you mean? You’re saying that crack is not as addictive as everyone says?
CH: Well, when we think of crack — well, we have a beautiful example now, the past year: the mayor of Toronto, Rob Ford, for example. The guy used crack cocaine, and he did his job. Despite what you think of him and his politics, but he came to work every day. He did his job. The same is true even of Marion Barry. He came to work every day, did his job. In fact, he did his job so well, so the people of D.C. thought, that they voted for him even after he was convicted for using crack. But that’s the majority of crack cocaine users. Just like any other drug, most of the people who use these drugs do so without a problem.
AG: Compare it to alcohol.
CH: Well, when we think about alcohol, about 10 percent of the people — 10 to 15 percent of the people who use alcohol are addicted or meet criteria for alcoholism; for crack cocaine, about 15 to 20 percent — the same sort of thing when we look at the numbers. And we’ve known this in science for at least 60 years. We’ve known — I’m sorry, at least 40 years, we’ve known this sort of thing, but we haven’t told the public.
AG: So, you’re saying someone who has wine every night for dinner would not be considered an alcoholic in the same way if you take crack every day?
CH: Exactly. So, the criteria, to me — the way we judge whether someone is an addict is whether or not they have disruptions in their psychosocial functioning. Are they going to work? Are they handling their responsibilities? Or are they overindulging in the activity? And when we think about drugs like alcohol, wine every day, people can drink alcohol every day and still meet their responsibility. The same is true with crack cocaine. The same is true with powder cocaine. The same is true with marijuana. Think about it this way. The three most recent presidents all used illicit drugs, and they all have met their responsibilities. They’ve reached the highest levels of power. And we would be proud if they were our children, if they — despite the fact that they’ve all used illegal drugs.
AG: But they are saying they didn’t use them in a regular kind of way. I mean, who knows?
CH: Well, when we say “a regular kind of way,” for example, I use alcohol. I may use it once a month, twice a month, four times a month. It may vary, but that’s certainly regular. And so, when we think — I think the public, when they think of regular, they think of overindulging. And when people overindulge, like every day multiple times a day, it’s going to disrupt some of your psychosocial functioning. Now, that is a small number of people. Only a few people engage in behavior like that. And I assure you that if they engage in behavior like that, that’s not their only problem. They have multiple other problems.
AG: So why do some people get addicted to crack, and some people don’t?
CH: That’s a great question. People get addicted for a wide range of reasons. Some people have co-occurring or other psychiatric illnesses that contribute to their drug addiction. Other people get addicted because that’s the best option available to them; other people because they had limited skills in terms of responsibility skills. People become addicted for a wide range of reasons. If we were really concerned about drug addiction, we would be trying to figure out precisely why each individual became addicted. But that’s not what we’re really interested in. We are interested, in this society, of vilifying a drug. In that way, we don’t have to deal with the complex issues for why people really become addicted.
AG: Talk about brain science.
CH: Yeah, so we talk about — “talk about brain science,” that’s a real good question. Brain science, at some level, in terms of drug abuse, has become voodoo, in a sense, because people think — I mean, that’s not to be disrespectful, because that’s my favorite sort of science, by the way. But the way we have been thinking about brain science is that people show you pretty pictures, pretty images, and you think that that tells you something about how they behave. It doesn’t. And so, from that perspective, it concerns me deeply. But on the other side, I am — I marvel at what we are learning about how the brain works, in general. And so, we are not anywhere near being able to explain drug addiction with our brain science yet. But that doesn’t mean that we shouldn’t continue to try and figure out what’s going on in the brain.
AG: You’ve been testing humans. How does human experiments compare with rat and animal experiments?
CH: Depends on the question that you’re asking. For example, if you’re asking a question about simple neurochemistry. When we think about dopamine, and you’ve heard a lot about that neurotransmitter, it’s in the brains of rats, it’s in the brains of humans. If you want to know what dopamine — what cocaine does to dopamine, you can use a rat brain to figure that out as well as a human brain, and that’s pretty close. But when you start to talk about drug addiction and the complexities, drug addiction is a human sort of ailment, not an ailment in rats. What you can do in rats is maybe model one component, maybe two components of drug addiction, but understand that that model might be quite limited.
AG: Last year, one of the nation’s most prominent doctors announced he had shifted his stance in support of medical marijuana. That’s Dr. Sanjay Gupta, the chief medical correspondent for CNN, openly apologizing for his past reporting dismissing the medical uses of the drug.
Dr. Sanjay Gupta: I have apologized for some of the earlier reporting, because I think, you know, we’ve been terribly and systematically misled in this country for some time. And I — I was — I did part of that misleading. I didn’t look far enough. I didn’t look deep enough. I didn’t look at labs in other countries that are doing some incredible research. I didn’t listen to the chorus of patients who said, “Not only does marijuana work for me, it’s the only thing that works for me.” I took the DEA at their word when they said it is a Schedule I substance and has no medical applications. There was no scientific basis for them to say that.
AG: Your response to Dr. Sanjay Gupta, Carl Hart?
CH: On the one hand, I applaud Sanjay. But on the other hand, I might be embarrassed if I was a physician and I’m this late in the game. The evidence has been overwhelming for quite some time. And if you read the literature and have been reading the literature, this position or this change should have come earlier. But still, it takes some courage to say you were wrong. But I think that it’s been overstated how much praise he deserves.
AG: Dr. Carl Hart, can you talk about your life’s journey, how you ended up being the first African American scientist to be tenured at Columbia University?
CH: Well, that’s a question that society should answer. I mean, when we think about the numbers of African Americans who are in neuroscience and why — they’re low — and why the numbers are low, that’s an issue that the society hasn’t grappled with. And it’s related to some of this marijuana talk that we’re talking about. You played something about Kennedy earlier. Those kind of people, they sicken me, quite frankly, when we think about the role that racism has played in our drug enforcement, and those people don’t knowledge that? Those kind of — those types of practices have played a role in why African Americans are not in many areas in the United States.
AG: I want to go back to that clip right now. This is — you’re talking about former Congressmember Patrick Kennedy, who battled addictions himself, you know, through his time in Congress. He was on “Cross — “
CH: Which does not give him any sort of special qualification. That’s one thing we want to make clear. Because you are an addict does not give you some special insight about addiction.
AG: So let’s go to what Patrick Kennedy said on CNN last week.
Patrick Kennedy: Well, I’m also concerned about the minority community that’s now going to be targeted by these marijuana producers, because you look at the alcohol industry in this country. I’ll tell you what. More, you know, alcohol distributors are in minority neighborhoods by a factor of 10. I can’t even begin to tell you what the latest numbers are. You’re from the West Coast; you know what L.A. looks like.
Van Jones: Absolutely.
PK: Forget about it. There isn’t an equal — you know, and so, they have — it is insidious.
AG: That’s former Congressmember Patrick Kennedy, who co-founded the group Smart Alternatives to Marijuana. Dr. Carl Hart?
CH: So, when I think about what Patrick Kennedy says, if he was really concerned about the minority community, one thing that he would be talking about is this fact: Today, if we continue the same sort of drug enforcement policies, one in three African American males born today will spend some time in jail. I have three African American males; that means that one will spend some time in jail. If he was really concerned, he’d be worried about those kind of numbers. If he was really concerned, he’d understand that African American males make up six percent of this population, 35 percent of the prison population. That is abhorrent. And you never hear those people talking about those numbers.
And when we think about the dangers of marijuana from a scientific perspective, let’s really evaluate this. When we think about the dangers of marijuana, they are about the equivalent of alcohol. Now, I don’t want to somehow talk about the dangers of alcohol or to besmirch the reputation of alcohol, because I think that every society should have intoxicants. We need intoxicants. And every society has always had intoxicants. So alcohol is fine.
AG: Why do we need intoxicants?
CH: Makes people more interesting, decreases anxiety. Alcohol is associated with a wide range of health-beneficial effects — decreased heart disease, decreased strokes, all of these sorts of things. The same can be true of a drug like marijuana — helps people sleep better, can decrease anxiety at the right doses. All of these beneficial effects, we know.
And so, when we think — think about it this way. We have automobiles. They are potentially dangerous, particularly if you’ve been in New York City in these past couple of days, the icy roads and so forth. Now, in the 1950s, automobile accidents were relatively high. We instituted some measures — seat belts, speed limits, all of those sorts of things. That rate, even though we have more cars on the road, has dramatically decreased. If people are really concerned about the dangers of marijuana, we’d be teaching people how to use marijuana and other drugs more safely, because they’re not going anywhere.
AG: Go back to your life story, so how you ended up going from a real tough neighborhood in Miami to —
CH: Yeah, so, when we think about —
AG: — Columbia University and being an adviser on some of the most elite drug policy panels in the country.
CH: Yeah, so, when we think about how one comes from point A, in the hood, to point B, where I’m at now at the highest levels of academe, there are some things that I point out in my book that are clear, if we were serious in this society. One thing was we had welfare. We had this safety net for families like mine. I had seven siblings, and all of us are taxpayers today, but we were raised on welfare. Make no doubt about it: Without welfare, I wouldn’t be here. Without some of the programs that the government instituted for minorities in science, by — in medical science, that helped me get a Ph.D., those kinds of programs. I had mentors, a wide range of mentors. And they were white, black; they were men, women — a wide range of mentors. And I had a strong grandmother, and I had five older sisters who made sure that I stayed as close to the sort of beaten path as possible, so I didn’t stray too far.
AG: You’ve talked about really recognizing racism, not when you lived here, but when you lived outside the country. So, where did you go to college?
CH: I went to college in the Air Force, and I went to college at the University of Maryland, who had college campuses on Air Force bases.
AG: Why did you go into the military?
CH: I went into the military because I didn’t get a scholarship, a basketball scholarship I thought that I would get. And so —
AG: You were a big basketball player.
CH: I was a big basketball player. I played on some of the best all-star teams in Miami and so forth. Yeah, so, I didn’t get the basketball scholarship that I thought I should get, and so I went to the Air Force. It was the only option. And while — my time in the Air Force primarily was spent in England. And while in England, I got quite an education about American racism. In England, they have programs on a regular basis like the U.S. PBS series “Eyes on the Prize.” And I learned a lot about the U.S. sort of civil rights movement and history while in England. And the British were not bashful in their criticism of American racism, because they didn’t have to look at their own. And so, I learned — well, more importantly, my reality was corroborated while I was in England.
AG: So you come back to this country, and how did you end up at Columbia?
CH: So I came back to this country, finished off my undergraduate degree at the University of North Carolina in Wilmington, went to the University of Wyoming to do my Ph.D. — it was the only program that accepted me in the neuroscience Ph.D. program — got quite an education from Charlie Ksir about not only neuroscience, about society, and did a number of post-docs from — at the University of California in San Francisco, at Yale, at Columbia. And this is how I came to Columbia.
AG: You begin your book talking about a human experiment that you recently did. Explain it.
CH: Yeah, so, this particular experiment was featured in The New York Times recently. I had read the literature, the animal literature, showing that when you allow an animal to self-administer, self — press a lever to receive intravenous injections of cocaine, they will do so until they die. But then, when I looked at the literature more carefully, if you provide that animal with a sexually receptive mate, with some sweet treats like sugar water or something of that nature, they wouldn’t take the drug. They would engage in those other activities. So I thought it would be interesting to find out whether or not crack cocaine addicts could also have their drug-taking behavior altered or changed by providing an alternative. And in that experiment, we used as low as $ 5 cash. And when you do that, you can see that they will take the cash on about half of the occasions —
AG: Wait, explain the scene.
CH: OK, when you explain the scene, you have a person, you bring a person into the laboratory. They’re seated in a chair in front of a Macintosh computer, so they can indicate their choice. On the left would be drug; on the right would be money. And they would have five opportunities, separated by 15 minutes, for example. So, every 15 minutes, a nurse will come in and ask them to indicate their option.
AG: Who are these subjects?
CH: These participants are people who meet criteria for crack cocaine addiction. These are people who smoke crack cocaine on five days a week about. They spend about $ 200 to $ 300 a week on the drug. They are committed cocaine users. And we pass all of the ethical requirements to bring them into the laboratory. They have physical examinations. They’re carefully monitored by a nurse, a physician, and so forth.
AG: So, you have them sitting in front of the computer.
CH: They’re sitting in front of the computer, and every 15 minutes a nurse will come in and ask them to indicate their choice. And once they indicate their choice, the nurse will bring in the option that they selected, whether it’s crack cocaine, whether it’s the $ 5 option. And when you provide an alternative like $ 5, they’ll choose $ 5 on about half of the occasions and drug on the other half. But if you increase the alternative amount to something like $ 20, they will never take the drug; they’ll always take the money.
And so, people say — sometimes people say, “Well, they’re only selecting the money so they can use drug when they leave the hospital.” Now, one thing that was said about crack cocaine users is that they couldn’t make rational choices once they have cocaine on board or once they’re faced with the choice to take cocaine. Well, they demonstrate — if that’s even what they’re doing, they demonstrate that they can display, or do, a delayed gratification, which is a good thing. But I know that most of the people in those studies did not simply take the money to go buy drug when they left the study, because we paid some of their bills. They asked us — they saved up the money and asked us to write a check for certain bills and that sort of thing.
AG: Were you surprised by your findings?
CH: I was absolutely surprised, when I started collecting these data in 1999, 2000, because I had been fooled or hoodwinked, just like the American public, that crack cocaine addicts, they — if you present them with a choice to take crack cocaine, they would take every dose, and they’d be crawling on the floor looking for more. And that’s just absolutely false. That’s a myth.
AG: Finally, Dr. Carl Hart, your assessment of the media in dealing with the issue of drugs?
CH: You know, since I’m a professor, so I give people grades, I would say a D, D-minus, and I’d say scientists deserve maybe a D-plus to C-minus, because it’s not only the media. Scientists also contribute to this misinformation, in part because scientists are so afraid that whatever they say will be interpreted as being permissive, and therefore they say very little. Scientists’ first goal is not communication, it seems. It seems like their first goal is not to be wrong. And we’re missing an opportunity to help educate the American public about how to decrease harms related to drugs.
AG: You just talked about your three boys, that you have three sons.
CH: Yes.
AG: What do you say to young people about drugs and alcohol?
CH: Well, so, I think of these things just like I do any other potentially dangerous behavior, like driving an automobile. I make sure that I educate my kids on how to be safe in driving their car, how to be safe when they have sex. The same is true with drugs. I make sure I let them understand the potential positive effects, the potential negative effects, and how to avoid the potential negative effects. I’ve written about this on AlterNet.org, a letter to my son about how to use drugs safely or what you need to be aware of.
AG: Dr. Carl Hart, I want to thank you for being with us. He is the author of the new book, “High Price: A Neuroscientist’s Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society.” Dr. Carl Hart is associate professor of psychology and psychiatry at Columbia University.
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