‘It’s not the chemicals, it’s your cage.’
This great illustration spotlights the topic of addiction we covered a few months ago by sharing a post by Johann Hari
Author of “Chasing The Scream: The First and Last Days of the War on Drugs”
Johann Hari isn’t the only one talking about how wrong we are about addiction.
Enter Dr. Carl Hart
What follows is a story and interview from High Times Magazine…
Dr. Carl Hart is not your average scientist. Having studied abuse and addiction for the past 16 years, he has come to the conclusion that most of what is accepted as fact regarding drugs, even in academia, is based on Drug War propaganda and has little scientific basis. Since 1998 — when he became the first tenured African-American professor in the sciences at Columbia University — Hart has been studying the effects of drugs on real human beings, not lab rats, and what he’s found might surprise you. He will tell you that crack in itself doesn’t make people violent, that methamphetamine alone will not make you look like one of those grisly “after” photos in the public service ads, and that cocaine and heroin are not as addictive as is commonly believed. His efforts are detailed in the book High Price: A Neuroscientist’s Journey of Self- Discovery That Challenges Everything You Know About Drugs and Society (Harper- Collins, 2013).
As a young man growing up in the poorer sections of Miami, Hart witnessed firsthand the effects of crack on the African-American community. After a brief flirtation with a hip-hop career and a stint in the Air Force, he dedicated himself to science, receiving an MA and PhD in experimental psychology and neuroscience, and set out to uncover the truth about how drugs affect the brain. As a member of both the Drug Policy Alliance and the National Advisory Council on Drug Abuse, he brings an uncompromising vision to the table in terms of both drug policy and drug-law reform.
We caught up with Hart at his office on the Columbia University campus.
Can you tell me a bit about the drug research program here at Columbia? I’ve been seeing your ads for years in the Village Voice soliciting “healthy drug users” for study. A friend of mine once theorized that agents were using that as a ruse to get the phone number of every drug user in New York.
Yeah, we do have that problem. The program here started in 1992 by Marian Fischman and HerbKleber. As a graduate student, Marian, and her PhD mentor, Bob Schuster, were the first people since Sigmund Freud to give cocaine to people in a lab and study them. Bob Schuster, some people might remember, was the director of NIDA [the National Institute on Drug Abuse] for a while under Reagan, but he wasn’t a drug warrior like those folks … he was pretty cool, actually. I came here in 1998.
We’ve been giving drugs to users — marijuana, cocaine, crack, methamphetamine and heroin — and studying their effects for more than 20 years. It’s still going strong; we are still trying to develop various treatments, trying to figure out what the real effects of these drugs are. We’re one of few programs in the country that does this type of work.
You mention in your book how a single drug arrest could have ended the upward trajectory of President Obama’s life, and that the penalty for drug crimes should not be so severe that a young person is unable to recover and stake a claim in society. Do you see this changing at all?
I certainly see us talking about it in a more rational way, so yeah, I think we’re in a moment, man. I believe you know this as well as me: We haven’t been here before. I think society is finally getting it — that we’re punishing people so severely for drug-related violations when, in fact, the crimes that they engage in are about the equivalent of traffic violations. So society is getting there, it’s changing, but the thing that I would make sure people understand is that we need to continuously put pressure on politicians to do more, because they are happy just to do nothing — it’s easier to do nothing. The world is changing, it’s no longer flat, but we have to continuously remind them that it’s no longer flat—meaning that it is getting better, but we still need to continue the work.
You discuss the racial stigmatization of drugs and how it affects policy. One example is the sentencing disparity between crack and powder cocaine in the 1980s. People are willing to admit today that those laws were racially discriminatory, but they’re not so quick to acknowledge that this discrimination is still inherent in drug enforcement policies such as “stop and frisk.” For instance, in 2012, a New York City police officer in the Bronx chased 18-year-old Ramarley Graham, who was black, into his grandmother’s house under the false suspicion that he had a gun, then shot him dead in the bathroom as he was trying to flush a bag of weed down the toilet. The officer was not indicted, and the case barely made the national news. Would you consider this institutionalized racism?
Yeah, absolutely. I wrote about this — institutional racism — in the book. The problem with America as it relates to race and drugs is that we’re still looking for the Klansman with his white sheet on, and we’re still looking for people that use the “N-word.” That’s our frame in terms of how we think about race in the country: that if you don’t wear a white sheet and don’t use the N-word, you’re not a racist.
Yes, there is institutional racism. For example, the NYPD has a number of black and Hispanic cops, and yes, they participate in institutional racism. We had a mayor, Michael Bloomberg, who was racist — when you have “stop and frisk” policies that deleteriously impact one racial group versus others, and you support that policy as mayor, that makes you a racist. People didn’t call him out because Bloomberg wasn’t wearing a white sheet and he didn’t the N-word — but as long as we don’t call these folks out, it’s going to be perpetuated. Because, ultimately, even though it’s institutional racism, people are responsible for the racism. People like Mayor Bloomberg are responsible for that kind of racism.
Have you studied marijuana much?
Yeah, marijuana was the first drug that I studied in people—I think I’ve published a dozen or more papers on marijuana.
What is something a HIGH TIMES reader might not know about marijuana?
A study I published in 2001 showed that people who were tolerant to marijuana’s effects didn’t show any sort of cognitive changes when you gave them cognitive tests while they were intoxicated. So if folks were tolerant of marijuana-related effects, they could smoke a joint, be high, and perform cognitively at the same level as someone who was not high. Tolerance protects folks from a number of negative effects, and that’s one of them. So that might be of interest to HIGH TIMES readers.
What else? We were the people who reported on marijuana withdrawal. I know people don’t like to really hear that — the marijuana withdrawal story. It’s important to put this one in context. What we did was, we brought people into the lab who smoked every day — multiple joints a day — and then abruptly shut them off. And you could see marijuana withdrawal in some of them — not in all, but in some. With marijuana withdrawal, people’s sleep is disrupted; they don’t eat as much; they’re more irritable. It looks kind of like tobacco withdrawal or something like that. It’s gone in about four days, depending on the level of marijuana usage. When we think about marijuana withdrawal, it’s certainly not life-threatening, but it can be irritating. So when people say, “Well, you can’t possibly have withdrawal from marijuana” — well, people will have withdrawal from any drug that they’ve been using for an extended period of time. We get withdrawal from caffeine; it’s not a big deal, but it’s real.
These days, I find myself arguing with a lot of journalists who are just getting their toes wet in this field about whether or not marijuana is addictive. What’s your take on this?
When we think about addiction, we’re usually thinking about the DSM criteria. [The DSM, or Diagnostic and Statistical Manual of Mental Disorders, is the standard reference work for mental-health professionals in the United States.] Can people meet those criteria for marijuana addiction? Of course—people can meet those criteria for any drug addiction. When we look at the numbers of people who meet the criteria for marijuana, it’s less than 10 percent. But when you look at people who meet the criteria for alcohol, it’s 10 to 15 percent; cocaine, it’s 15 to 20 percent; tobacco, it’s a third of the people who use that drug; heroin, about a quarter. So, certainly, of all these drugs, marijuana is probably one of the least addictive.
But addiction has less to do with the drug itself and more to do with the people who use it. Because when we think about addiction, the main criteria are that you used more of the drug than you intended to use; you used despite some knowledge of psychological or physical problems; you have made several unsuccessful attempts to cut down or quit; and so on. Tolerance can be a criterion; withdrawal symptoms can be a criterion. So it’s no big deal whether a drug is “addictive” or not; it’s how your use of it compares to everything else.
It seems like you have more of an issue with the word “addiction” and the way it’s defined.
The way some people define it, and the way the current DSM defines it, too.
I hate the current DSM — it’s too easy now for anything to become “addiction.” There are about a dozen symptoms, and all you need is two. Craving can be one, and tolerance can be another. So somebody says, “Man, I really crave smoking a joint, but I’m in school, so I know I can’t smoke, but I still have this intense craving for it”–and if they also have some level of tolerance or something else of that nature [i.e., another of the symptoms listed in the DSM], they actually meet the criteria for addiction. It makes absolutely no sense.
You could meet the same criteria for pizza.
That’s exactly right, and that’s the problem I have. Is marijuana “addictive”? I think that’s sort of a stupid conversation.
People are acclimating to the idea of legal marijuana, but when you mention legalizing heroin and cocaine, that’s a line that people are seldom ready to cross. Is there a case to be made for legal cocaine or legal heroin?
Absolutely. But the general public, they’re not ready for it yet because they’re ignorant. Most people are ignorant about drugs — they believe the hype. For example, you have people who are marijuana smokers or some other drug user, and they know that they’ve been lied to about whatever drug they use.
But they don’t extend that knowledge to other things, to other drugs. But if they were to think critically about what they’ve been told about their drug of choice and then apply it to some other drug, they’ll come to the conclusion that “Hey, I might have been wrong, I may have been mis- led; let me think about this.”
So that’s what I’m trying to do with the book: I’m trying to make sure people under- stand that there’s a case to be made for all these drugs to be legal. There’s a strong case, a compelling scientific case, to be made for it — but you can’t make the case if you’re arguing with a bunch of idiots, with people who don’t pay attention to evidence.
How would a legal heroin or cocaine program look?
Same as it would for alcohol. But the thing is, you have to have a corresponding increase in education — proper education. For example, in our society, when we think about heroin, people always talk about heroin overdoses. That’s so rare, it’s not even worth talking about. The reason why people die from heroin is because they combine it with another sedative. That’s the major reason — a sedative like alcohol or a benzo or something like that. So you have to make sure that people who are using heroin avoid these other sedatives, because that increases the risk. For cocaine, people need to understand that it disrupts food intake and disrupts sleep — not as bad as amphetamines, but it certainly can do that. So cocaine users need to know that they need to be attending to their sleep and eating habits. All of these things would need to be in place before a drug becomes more widely available.
People also need to understand something about dosage, like with alcohol. We know that we don’t go out and buy a fifth and drink the whole thing in one night. We may keep a fifth for days, for weeks, for months, because we know how to dose ourselves properly. People need to be educated.
People use these drugs because these drugs work for some purpose, and largely because they decrease anxiety, they facilitate some social interactions, all these things—things that make people happy. I assure you that these drugs can be safely used in a way that makes people happy — if we had the proper education.
One of the more interesting parts of your book describes your experiences with NIDA and the Office of National Drug Control Policy, and how those organizations are filled with so-called medical professionals repeating age-old Drug War propaganda. It seemed like a formative moment for you.
Yeah, man. People who I respected, people I had read for my graduate education — I thought they knew what they were talking about. And then I could see that they were making shit up, and that they were presenting caricatures of drug users.
Another thing I didn’t really talk about much in this book — though I will in the next book — is my own sort of learning through hanging out with people who use drugs, and through my own drug use. Hanging out in the culture with people who were responsible drug users, not the caricatures, not the ones who are on the street — for the most part, those people would be on the street anyway, even if drugs were not involved. You start putting all that stuff together, and you start listening to the scientists talk about drugs, and you can see who actually knows something about drugs and who doesn’t. Because the ones that don’t, they talk about drug use as being simply like a, b and c. What the fuck? That’s like saying people are simply a, b and c.
Under what conditions are you talking about? What type of people? Who are you talking about?
And so it became really frustrating, trying to have a conversation with scientists that was outside that narrow, pathological frame. That narrow, pathological frame doesn’t fit the majority of drug users, so what are we doing? That’s where all of our money is going, but we are missing an opportunity to actually educate the public about this. We’re missing the opportunity to tell people what’s really going on.
So, yeah, you’re right — I’m still on those boards, and it remains frustrating. Look at the scientific literature today. The same thing happens. One of the exercises I do in my class is, when I get papers to read, I’ll show the class what the introduction says about marijuana or something; it will talk about these horrible effects that marijuana has. You can count on the fact that more than half of your class has probably tried marijuana, so you ask the class: “How many of these effects have occurred to you?” And they just laugh. But that’s the scientific literature: pregnancy, loss of jobs, all of these horrible effects that they describe — and this is somebody submit- ting a paper for publication on marijuana? Are you kidding me? Certainly, that can happen, but it’s an extreme aberration. And it’s okay to say that as long as you say that this is an extreme aberration; this isn’t the norm. So we’re only focused on the extreme aberration, but it’s presented like “This is what happens after using marijuana”; “This is what happens after using cocaine”; “This is what happens after you use heroin” and it is the extreme case.
So my class gets an opportunity to see that, if they’re saying this about marijuana — a drug that you all know a little something about — imagine what they’re saying about heroin.
Do you worry that your book will make it difficult to get more research grants?
Nah, I don’t, no. Research grants are not my major concern. I’m far more worried that young people will come along and read the literature long after I’m gone and be like, “What the fuck was their problem? Why weren’t they more honest?” In other words, why were we, as a field, so politically motivated and not data-driven? I’m far more worried about that. I’m far more worried about my own children being able to look at what I’ve written and know that it came from someone who was honest and had some integrity. I worry about the future. I’m trying to make sure that history knows that I did the right thing.
Before we let you go, we’d love for you to circle back to Johann Hari and watch his brilliant Ted talk