Carl Hart was starting his career as a neuroscientist and beginning a professorship at Columbia University when he first heard reports of the crack epidemic that was supposedly wreaking havoc across black America. Motivated by a desire to help the community he came from, Hart began researching drug addiction and ways to help people. But along the way, he uncovered some inconvenient truths, in particular that the apparent epidemic of crack use in black communities was not supported by evidence. This led his career in an altogether different direction, a change in focus that culminated with his part-memoir, part-science book High Price, which looks at the war on drugs and its effects on marginalized groups in society. Hart met up with The Fix to talk about the book, the war on drugs and what he’s learned so far.
Hart and the Crack Epidemic
The crack epidemic occurred in the 1980s, with Nancy and Ronald Reagan drawing attention to the problem apparently afflicting black neighborhoods. Hart believed this, and he comments about how his favorite artists and filmmakers were buying into it too, as well as ordinary people blaming problems like unemployment and crime on the drug. He thought that by solving the drug issue, crime, unemployment and violence would be solved, too. However, when Hart started looking into the problem more deeply, he started to question the whole narrative. First, he noted the low levels of crack-cocaine abuse in comparison to powdered cocaine and marijuana, and his own (and other groups’) research led him to lose faith in the “one hit and you’re addicted” idea perpetuated about crack. Looking at historical accounts and news stories from years’ past, he started to realize that it was more about attacking groups we don’t like than stopping drug abuse. He noticed the discrepancies between the characteristics of most users and those of the people arrested for drugs and began to feel like a victim of fraud. Hart points out the similarities between cocaine and crack, with the former being identical to crack aside from a molecular bond to an inactive hydrochloride salt, which just makes the drug more stable and impossible to smoke. “And so what you’re really talking about is a route of administration difference, but people didn’t realize that, and so that’s where I started,” he says, pointing out that research shows intravenous and smoked cocaine have virtually identical effects. On the back of the Reagan-era hysteria, the sentence for crack was 100 times more severe than that for cocaine. Now, President Barack Obama has brought this down to 18 times’ more severe, but Hart still calls this “stupid,” comparing it to punishing people caught smoking marijuana more harshly than those caught eating it in brownies.
Drug War and Marginalized Groups
Although crack was a particular area of focus for Hart, he says it’s merely used as a vehicle to address deeper sociological problems in the book. When he first uncovered the reality behind the crack “epidemic,” he said he was stuck in the scientific institution and particularly the pressure to publish papers saying “drugs are bad.” He then realized that if he conducted reviews of the evidence, he could point out how the conclusions often don’t follow from the findings in a scientific setting. He got attention for this, and it ultimately led to being approached to write a book. He made the book part memoir to help him connect with the people who grew up in communities like his, and it allowed him to insert more opinion than would be allowed in scientific research. Much of his concern was about how drug laws appear to be used as a method of discriminating against groups we don’t like. He uses the crack epidemic as one example – despite more crack users being white, over 80 percent of those arrested with it are black. He also points to the methamphetamine abuse today and its association with both gay people and poor whites. “We can’t say that we don’t like poor, white people. But we can say that we don’t like some behavior that’s primarily associated with them, even though they don’t make up the majority of the users,” he says. “Their drug use is causing the problem, so we’re going after their drug use. But really, we’re going after them.”
Contingency Management
Hart’s most famous piece of research looked at what happened if you offered crack users either money or a hit of crack. This idea came from the famous experiments conducted on lab animals, where, if given the opportunity, they would self-administer drugs until they died. However, if you put them in a healthier situation – with a mate, toys or anything other than the drugs in their cage – they’d use a lot less. His experiments built on this by offering crack users $5 or a much more valuable hit of crack, and found that about half decided to take the money, contrary to the notion that crack users would do anything for a hit. When the reward was increased to $20, they almost always took the money. He points out that some people won’t respond to this type of treatment (especially when there are co-existing mental health issues, which have to be treated specifically), but it showed that alternative reinforcement could be a powerful technique. This led to a form of treatment called contingency management. This basically involves giving people in treatment incentives for submitting drug-free urine tests, starting at $2.50 the first day, for example, then increasing to $5, $7.50 and so on each consecutive day they submit a clean urine test. The only problem was that when the money was taken away, drug use often returned. This has been partially rectified, though, by combining the monetary rewards with skills training, helping users find employment and turn their lives around. This has been shown to be much more effective than the money-only approach.
Getting to the Root Cause
Hart aims to challenge our deeply-held beliefs about drugs, and look to deeper problems in society to begin to understand why people become addicted. While it’s easy to demonize crack or methamphetamine, it’s much more difficult to admit that a lack of opportunities, unfair distribution of punishment and institutionalized discrimination are significant contributors to the problem. He might not have easy solutions, but it’s clear that the right approach is to tackle the root cause of addiction in society, rather than declaring a misguided war on the substances themselves.