Ending the War on Drugs: A Radical Take From Emerging Leader Dr. Carl Hart | The Fix
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Ending the War on Drugs: A Radical Take From Emerging Leader Dr. Carl Hart

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Because what would happen?

I don’t know what would happen. I really don’t care. It’s not justice. Maybe somebody would say, “You’re being soft on crime.” That’s some stupid shit. But that’s what we say, a lot. The thing is that the people who voted for the president should put pressure on him to change, because politicians will not make changes if there is no pressure. This is one of the most frustrating things to me, because it’s so clear. I ask people to think about if we punished people who were caught smoking marijuana more harshly than people who were caught putting marijuana in their brownies. It’s ridiculous. It’s the same sort of thing. But, in this country, we are allowed to have these baseless ideas and policies when they deleteriously affect groups that we don’t care about. We’re doing this interview in the backdrop of the cat who was killed on Staten Island over the weekend, the guy who was choked by the police. There’s a video, in which the police choke a black guy [Eric Garner] who they don’t even seem to have a reason to arrest, put a[n illegal] chokehold and they kill him. And so you see these kinds of things happening too frequently, and then society does nothing. So it’s the same sort of thing with the whole crack thing. Black people still represent more than 80 percent of the people arrested for crack and prosecuted at the federal level and under these laws. We still have this differential treatment.

Yeah, about 80-90% of the people that use drugs do so safely. They go to work, they pay their taxes, they take care of their families, and in some cases they even become president. 

Yet most of the people who are using crack are white, in fact. 

That’s right, that’s exactly right.

You made a comparison between the discussion about crack cocaine in the 80s and methamphetamine today, and the hyperbole around it, and the analogy that the methamphetamine users are purportedly rural, gay, and poor, which comprise several oppressed groups, and so it’s quite easy to attack them as well.

Absolutely. This is one of the things we use drug policy for, because it’s not cool in our society to say, “we don’t like gay people.” 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, that’s a fact, but we can put our law enforcement resources in their communities and say, they’re the people causing the problem. Their drug use is causing the problem, so we’re going after their drug use. But really, we’re going after them. And nobody really cares about poor white people. Nobody really cares about gay people. And so, when that happens, you can’t say you’re going after gay people, but you can say you’re going after this awful activity. “Methamphetamine is such a horrible drug.” It’s not, as you read in the book, it’s the same drug as Adderall, but you can say that it’s a horrible drug, it’s caused all these problems, and in the process, arrest all these people we don’t like. 

You point out that 90% of people that use drugs do not become drug addicts.

Yeah, about 80-90% of the people that use drugs do so safely. They go to work, they pay their taxes, they take care of their families, and in some cases they even become president. So, yeah, that’s a number that people don’t think about, and some people just don’t know. But it’s a fact, and we’ve been collecting these data for more than forty years and we’ve known this. 

I have to ask you about your experiments. 

The one that people like to ask about is the one where we offer money versus drugs. Those experiments grew out of the animal experiments, because when I was an undergraduate, people told us that if you allow an animal to self-administer a drug like cocaine or methamphetamine it would do so until it died. And then you can see the papers that people wrote and these animals actually did: primates, rats – they self-administered these drugs until death. But it wasn’t the whole story. When you look at the cages of those animals, the only thing that was there was a lever that led to drug administration. When you put other things in the cages of those animals, like a sexually receptive mate, a sweet treat, toys, or anything else, the animals wouldn’t self-administer the drugs until death. And in fact they engaged in those non-drug alternative behaviors a lot more than the drugs, in some cases. And so one of the things we thought would be interesting was to offer people non-drug alternatives, being money. And with the first experiments we offered something as low as five dollars or a hit of crack that’s worth more than five dollars, multiple times. And what you found was that these folks took crack on about half of the occasions and the money on the other half of the occasions.

When you increased the amount of money to something like $20, they almost never took the drug, they always took the money. That told us that drug-taking behavior, even in drug addicts, was sensitive to the availability of alternatives. If you provided alternatives, you could decrease drug-taking behavior. Now, that provided some clue about treatment for some people. For some people, they just didn’t have the proper amount of alternative reinforcers. Not for everyone of course, because some people might be addicted because they have co-occurring psychiatric disorders like depression, anxiety, schizophrenia, and you’ve got to treat those sorts of things, and other people, they may have just an inability to temper their behavior in multiple domains, and they just need to learn some better skills. But, for the sort of people where alternatives seem to be important, it was an important finding. It also told us that crack and methamphetamine were not so addictive that they would do anything to get a hit, like people had been saying. So those experiments were very important, and I think that the experiments told us what many people already knew—I’ve talked to several drug dealers and those kind of people, these days, and they’re like, “You opened my eyes in that it made me think about the people who bought drugs from me. You know, of course many of them had jobs, and they were doing their business.” But they said they never really focused on them. Of course, how else are you going to be able to buy drugs if you don’t have a job? Yeah, of course, there are people who don’t have jobs and they have other ways of getting money, but the majority of those people, they have jobs.

Can you tell me a little about “contingency management,” which you talk about as an effective way to combat drug addiction?

Contingency management grew out of those experiments that I described where you offer alternatives. What contingency management does is that it pays people a certain amount of money to submit drug-free urines. So, if you’re in treatment, and you come to a clinic, you submit drug-free urine, then you get $2.50 for that day. And then that may be escalated over time. The next day you come it might be $5, the next day $7.50. Contingency management has been shown to decrease cocaine use and all the rest of these sorts of things. The problem is when you take away the contingency, the money, sometimes the drug use returns. So what people have done is they have used these contingencies in different ways. So you not only are paying people for drug-free urines, but you’re training them, and you’re paying them for skills they acquire, data-entry skills for instance, skills that they can now trade in for a job. And so that seems to work a lot more effectively – when you train people with an employable skill, that seems to work. There is some work out of Johns Hopkins that Ken Silverman and his group have done that’s been incredible using these contingency management techniques. It’s just what we do with our children. When our children do well in school, they may get a toy that they want, or a video game, or something that they want which is shaping up these behaviors, in the same way that Ken Silverman is shaping up job-training skills. All of these things we do with our kids, but some people don’t have the resources to access – like me, I’m a middle class person, I could do this with my kid, but some people, certainly when I was growing up, my parents didn’t have that sort of access. It’s just basic logic; it’s what we all do anyway.

And we don’t put our kids in jail for bringing home C minuses, which is the alternative, quite often, when it comes to drug policy.

Yeah, we certainly do that, in terms of drugs. The thing is though, we don’t put all of our kids in jail, we put some kids in jail, the kids we don’t like, those are the ones who go to jail. That’s a problem, that’s one of the things I argue in the book, that we should decriminalize all drug possessions. I argue that because it just doesn’t seem to make any sense that we are arresting all of these people for these minor drug infractions. But arresting these people has created a large number of jobs for certain people in our society. And politicians look like they are doing their jobs. So a lot of people are benefiting from having these types of laws.

You say addiction is not an equal opportunity affliction, in that it affects the poor with more frequency than it does the middle class or the rich because the poor have fewer opportunities. That runs counter to my experience. If you have more money, maybe it just makes you better able to get by, to lessen the repercussions, so that there may be just as many rich drug addicts as poor. 

Well, no, you just hit it. The major thing I’m talking about are the consequences, what you just said. The fact is wealth can protect you from a number of things. You have heart disease. We all can get heart disease, but if you’re wealthy, you can deal with it better and the consequences can be not as severe as for poor people. Poor people die more often from HIV-related illnesses, not because they are more physically susceptible, but because they have limited resources to deal with it. The same is true of drug addiction. That’s all. I’m not saying that poor people are more likely to become drug addicts, but they are certainly more likely to have the negative consequences happen as a result of their drug addiction.

The last question I have is that I thought it was really interesting when you were talking about “set and setting,” the phrase popularized by Timothy Leary, about how drug effects are not determined just by their pharmacology, but by all the things that are going on in the environment. I was wondering if you could talk about that and its implications for the wider political sphere.

So, “set and setting.” First of all, people understand this easily when you think about alcohol - if you give the same alcoholic beverage to someone who doesn’t drink at all, you’ll see different effects, simply because one person is tolerant versus the other. We all get that. That is “the set.” The same is true with heroin, the same is true with cocaine: if you’ve got somebody who uses the drug on a more regular basis versus somebody who doesn’t. Marijuana - you know, someone can smoke a lot of weed, and they’re getting nice and blasted on their weed, but you give the same amount to some inexperienced person, you might see some paranoia, some anxiety, a wide range of negative effects. But that’s all about set. And so people should be cognizant of that. If you’re aware of that sort of thing, if you’re getting high with someone who’s more experienced, you don’t try and hang out, don't try to do the same amount as them, that’s stupid. And so you want to make sure people understand that you start off slowly. Crawl before you walk, that’s all that is. Setting. Setting is so important because if you’re using these psychoactive drugs, which are potentially dangerous, and they’re powerful, they can be at the right doses, if you’re getting high in a situation that is anxiety-provoking, uncomfortable, and you’ve taken a nice, large dose, that’s not good. You’re setting yourself up, particularly if you’re getting high with people you don’t know, you don’t trust. That’s a horrible situation. So you want people to understand that if you are getting intoxicated with any of these drugs, that you do it in a comfortable setting with people you trust. It changes the experience radically, and that has little to do with pharmacology itself, it has more to do with set and setting, and if people understood those things, they would have a better time.

Hallie Hart Hodenfield is a regular contributor to The Fix. She last interviewed Gabrielle Glaser.

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