A Neuroscientist's Quest To Debunk Harmful Misconceptions About Addiction

Columbia neuroscientist Carl Hart untangles the reasons researchers have gotten so much wrong about addiction—and how it's fueled our obsession with the War on Drugs.

Bill O’ Reilly was using his compassionate voice, sweeping his hands dramatically toward the guest in front of him. "The prevalence of [pot smoking] is overwhelming now," he said to Columbia University neuroscientist Carl Hart on his show earlier this year. "So you’re going to have a lot of casualties on the battlefield."

Hart, sporting an academic’s olive blazer and hair swept back in thick dreads, cut in quickly. "That’s not true. Let’s talk about the statistics. Let’s talk about the data."

Hart explained that the proportion of 12th graders smoking pot had actually plummeted since 1978—from 37% then to 22% today. O’Reilly vehemently disagreed with the figure. "Take it up with the National Institutes of Health," the host snapped.

Hart wouldn't let him have that one. "I am a council member on the National Institutes of Health. Your number is wrong."

Carefully explaining just how flawed some numbers are in drug science is a big part of Carl Hart’s job these days. Last year, he published a memoir summarizing decades of work correcting distorted ideas about how drugs affect the brain. The book also dug deep into Hart’s childhood—as a kid growing up in a tough Miami neighborhood, he saw exactly how drugs impacted those around him. More importantly, he saw how drug policy shaped by incorrect scientific conclusions ravaged his community, largely one of color.

Today, Hart continues to challenge status quo assumptions about the frequency of addiction and how drug use affects people. He’s even held Eric Holder to task for calling heroin use in the country "an epidemic." Instead, Hart argues that the number of true addicts is much smaller, and when addiction does occur, it’s often because of environmental factors, rather than hardwired doom in the brain. His conclusion: Much of what we’ve been taught about drugs is wrong.

With more than $40 billion being spent on anti-drug efforts a year, it’s not a message that many people want to hear. But when mass incarceration, often for misdemeanor drug possession charges, affects communities of color so deeply that health studies can’t conduct statistically sound surveys on the population not in prison, it’s a message that could disrupt the social order. We spoke to Hart about how he reached his conclusions and what it takes to speak truth to power in the scientific community.


Fast Company: I want to go back to that first moment, when you realized that maybe your assumptions about crack cocaine were wrong. Can you describe when that was?

CARL HART: You know how these things happen. They accumulate over time. I would go to talks, and I would listen to scientists characterize drug addicts or drug takers or drug takers, and their characterization just seemed inconsistent with what I had seen growing up. And not only that—what I had seen in the laboratory. So that made me question things on the one hand. And then I read the literature, and then people make claims, they draw conclusions, they've done a study. And then you look at the data, and the claims and conclusions that they've drawn are not even consistent with their own data. And so all of these things as they accumulate increase my confidence to say, "Hey, this is wrong, and we have to do something about it."

Why do you think other scientists, who are also supposed to be objective, have not applied their critical thinking skills in this respect?

One of the things we know about people is that people are not very courageous in general. You know, and they're not bad people, either. So you think about any kind of injustices that have happened, it wasn't that most of the people were evil. They were just apathetic and indifferent. It's hard to go against the grain when the assumptions are that these things are awful. And if you're going to say that assumption is flawed, now you have to prove that they're flawed, and you have to maybe participate in some arguments, and you may have to have heated discussions and most people would just prefer to avoid that sort of thing and just continue not to question those assumptions. Now, we cannot get around the fact that most of the scientists are white. And we still in the United States have segregation, extensively. Not only in our residential areas, but in our workplaces. As a result, we as the scientists, do not have to see the consequences of their flawed assumptions in their communities. They don't have to see the impact of these flawed assumptions on the people whom they love. So all of these things kind of keeps the system going in the way that it goes. So when we talk about workplace—making our society more diverse—this is what we're talking about. We're not talking about diversifying a workplace or society for the sake of having different colors.

The image we have of scientists is people who are cold and dispassionate. But what you're saying is that you need to have many different experiences charged by passion inform the process of generating knowledge.

Yeah, the notion that scientists are dispassionate—first of all, that's wrong. Scientists are extremely passionate. There are a number of scientists who are upset about what I say. And they are passionate in part because this has implications for budgets. You want to see some passion? You should see every year when we reallocate the NIH budget. You'll see some passionate scientists.

I can imagine.

They are extremely passionate. But they are extremely passionate about issues about which they care.

So when did you first get the idea to design the cocaine versus cash experiment?

Other people had done similar experiments. It's hard to say, because as scientists, all of our work builds on other people's work. So some of the work that I admired the most were those animal studies with primates as well where they gave the primates a choice between drug and banana chip or something like that. I thought they were just cool manipulations of behavior. My training was neuroscience, you know, so I was learning all this stuff about dopamine. When I was discovering what was happening with the behavioral stuff, providing these alternatives, these alternatives were shifting behaviors far more dramatically than these pharmacological and neuroscience manipulations. And I thought that was so cool. You can have these manipulations without these invasive techniques.

A similar study you did with meth had similar results, which you published, excoriating many popular notions about addiction. Yet you argue that journalists remain more interested in telling crime stories featuring brain-addled addicts. Why do you think that is?

The same reason that people like Breaking Bad. The same reason that people like The Wire. There's just so much drama. It's not real, of course. But people like the drama, and they like to pretend or believe that they have some insight into some underground activity, so they are not as boring as they are. It gives them an opportunity for them to think they're hip, stuff like that. It's like this…what do you call it…their Ghetto Tour Guide. They have a way to see the hood that is removed. And that is what filmmakers do. Many documentary filmmakers. Shows like The Wire. Shows like Breaking Bad. It's like that Joni Mitchell line that I love. She said, "I'm frightened by the Devil, but I'm drawn to those ones that ain’t afraid."

It’s not like your work is devoid of drama. You've testified for mothers who have had their children taken away because of their drug use. Can you tell me about some of those cases?

Those cases are basic and simple. It's some of the easiest stuff I've done and it's had the biggest impact. All I do in those cases is I provide education for the courts. The judge ends up asking me questions more so than the attorneys because the country is so naïve about drugs and sex. When I started testifying for these cases, judges thought that if the mother tested positive for marijuana, they thought the urine sample tells them something about the mother's level of intoxication. It doesn't. Marijuana stays in the system for up to two weeks in some cases. And a person can test positive but not have smoked for several days. And then they go about their life and function like a normal person, without any intoxication, no problem. That sort of basic level of information, many in the courts were unaware of. That's one.

They were also unaware of the fact that if you smoke marijuana, it doesn't mean that you have a problem with the drug. Or if you use any drug, it doesn't mean you have a problem with the drug. It just means that you use the drug. And they didn't think of illegal drug use in those ways. They thought, it's illegal, then it means you have a problem. And so I have to educate them that no, that's not how it works, there's a set of criteria that people have to meet in order to be diagnosed as a drug addiction or drug related problem. So I just do simple things like that. I ask simple questions like, "Did the mother handle her responsibility?" Oftentimes we're talking about kids. Are the kids going to school? Are the kids fed? Are they clothed? Are they clean? All of those sorts of things. If you answer yes, the mother's done all sorts of these kinds of things, there's a decreased likelihood that the mother has a problem with drugs. And oftentimes the mother is saying, "Yeah, I've smoked before, I've smoked marijuana, but that's when I'm having my myopic moment, when I'm off, when I'm not rearing or taking care of kids." It's a Friday night or something. But that level of information apparently wasn't available to the court, previously.

Tell me a little bit about the decision to use your own experience to walk people through the science that you've done. That must have been a difficult choice.

It was. So I had to decide who I was writing the book for. And once I decided who I was writing the book for it became more manageable. I was writing the book for young black folks that society had told that they were worthless. That their life was worth less than anybody else's life. I had to make a connection with them to show that I too had lived. I, too, was not perfect. I too have something to contribute to this society, just like they do. So that made the decision somewhat easier, but it was still difficult when you tell so much about people's personal lives. Like my personal life, that was a lot easier. But me telling about my parents' personal lives and other people's lives, that's much more difficult. And that's where most of my reservations and hesitations came.

How did your friends and colleagues in the Ivy League respond to the publication? Did anything change?

It's hard to say. People are not honest in this world. In the hood, you have a problem with somebody, you have to deal with it. The outcome is pretty immediate. And you deal with those things in a more direct way. In mainstream, in the academy, nobody really tells you what they think. Some people say they love it. And I suspect those are the only comments that I'll get. The ones who don't don't say anything, they just politely dismiss it, I don't know.

What about your mom and your family and your friends?

My mom and dad, that's the most difficult one, because they are seen in not necessarily the most positive light. I tried to explain to help them understand. They said they do. But it's hard. I know it's difficult for them. And friends, I don't know. They haven't said anything, because they probably didn't read it.

Have you heard from the people you were trying to reach out to?

Oh yeah. I get letters and emails from prisons, from academic institutions, people pursuing undergraduate degrees, PhDs, medical degrees. They write every day. It's overwhelming what I receive from them. And yeah, I hear from them constantly.

You've mentioned several times in the book that your own kids are in the age group that's at risk for drug use. How do you deal with what they're taught in school about drugs versus your own research?

My 13-year-old and now 19-year-old, they can teach drugs. So whenever they get told information in school, they're often correcting the information of their teachers. So they're confident enough in what they know, and they're confident enough to speak out. I don't worry about them with drug education or people telling them misinformation because they've been immersed in drugs since they were able to talk.

How do you think that's shaped their own choices?

They think critically. They challenge people. They make sure that people have evidence to support their positions. So drugs were used as a way to teach critical thinking in my household. And not just about drugs, but about race, about the hypocrisy in the country, on so many levels. My kids are really into social justice.

Speaking of social justice, can you illustrate the link between science, and policy, and human rights?

One of the conclusions that I've come to is that drug policy is changing. When you have Eric Holder making statements about drugs and the president making statements about drugs, we're in a different world now. It's no longer as flat, this world. [But] drug abuse science has rendered itself irrelevant in the most important topic of its day. Nobody cares what the scientist thinks. In some part, because the scientists have been absent, or they have been part of the problem here. And so they are irrelevant now that the world is no longer flat—and the scientists are saying it was flat, they're irrelevant. When you think about this issue, you think about Colorado, Washington, as the country moves to liberalize drug policy, who's asking scientists? Who cares what they think? As a scientist, that would embarrass me. Which is why I'm glad that I've tried to be as honest as possible and tried to make sure the public understands what the real issues are. But by and large most scientists, they're irrelevant, because they've been AWOL on this issue.

At the same time, bad science can do extensive damage. When I was reading your book I thought about phrenology and the old type of pseudosciences that basically formed the justification for eugenics. How do you undo bad science that's kind of settled in the minds of the public like that?

Well you know, it isn't the science that's bad. It's the researchers and their interpretation of the data. That's the real problem. I mean you do science and we all have limitations in our studies. We can't help it. Each study can only add a piece of the puzzle. So the science itself is not bad. It's the scientists and their interpretation. Which is precisely why I say they're irrelevant. Their interpretations have been shaped by assumptions that are flawed, and their assumptions are not only flawed but have been shaped by political motivations. You know who's funding your research, and you want to make sure your interpretations of the data are in line with the funders' perspective. That's damning as a scientist. And that's the major problem. And you say how to go about changing that. I'm trying to expose it. I'm trying to let everybody know that there's this huge conflict of interest. When we study drugs and abuse our focus is almost exclusively on pathology. Yet most of the effects of drugs are not pathological, so what does that mean for what gets published in the literature, what gets published in the popular press. We have this disproportionate skew on pathology. We don't have a comprehensive understanding of drugs do and don't do, and we certainly haven't shared that with the public.

When you say that that the effects of drugs largely aren't pathological, where do we see the effects of drugs instead?

Do you drink alcohol?

Yes.

And what does it do?

It's a depressant?

Well, say you have a boring work function. It makes it more tolerable, makes you more interested in these boring people, I don't know. It decreases your anxiety, it makes it easier to interact with folks and makes it bearable. The same thing is true with heroin or cocaine. And those are the dominant effects of drugs right there. Uninteresting, really. They're kind of mundane or run of the mill. Those are the major effects of drugs. Not the woman who used heroin and now she's selling her body. That's an extreme aberration.

[Broken Pill: Image Point Fr via Shutterstock]

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1 Comments

  • Thornton Thomas Lewis

    So are you basically saying that just like drinking alcohol in moderation, taking narcotics in moderation should not be considered pathology or abuse? Because if you are I agree. I know people who function well and even better in society with the aid of moderate narcotic or hallucinogen use!