Dr. Carl Hart: Calling Addiction a Brain Disease Promotes Harmful Drug Policies

By Zachary Siegel 02/22/17

Hart argues that scientists need to further examine how socioeconomic factors impact drug use rather than leaning on the brain disease model.

Dr. Carl Hart
Photo via YouTube

Police chiefs, politicians and lawmakers have all publicly called addiction a brain disease. New Jersey Gov. Chris Christie, during his January State of the State address, soberly said, “Let me be clear to every New Jerseyan both in this chamber and in all of our 21 counties: Drug addiction is a disease. It is not a moral failing.” 

Like other areas of science and medicine, from climate change to vaccines, addiction has become politically loaded terrain. In a recent article for Nature, Dr. Carl Hart, the first tenured African-American professor of sciences at Columbia University, argues that the notion of addiction as a brain disease reinforces harmful drug policies that disproportionately criminalize minorities and the poor. 

Hart cites the policies surrounding crack and powdered cocaine as an example. 

“Today,” writes Hart, “many find the crack/powder laws repugnant because they exaggerate the harmful effects of crack and are enforced in a racially discriminatory manner, but few critically examine the role played by the scientific community in propping up the assumptions underlying these laws.” 

Between the mid ‘80s to early ‘90s, crack was (and arguably still is) symbolic of urban decay. Racial fears attached to crack translated into the Anti-Drug Abuse Act passed by Congress in 1986 that punished those who were caught with crack 100 times harsher than those caught with powdered cocaine. Both crack and powder cocaine are chemically one in the same; the only difference is they were used by different classes of people. Guess who used which. 

For Hart, calling addiction a brain disease rings a familiar chord. 

“If the real problem with drug addiction, for example, is the interaction between the drug itself and an individual's brain, then the solution to this problem lies in one of two approaches,” Hart writes. “Either remove the drug from society through policies and law enforcement (for example, drug-free societies) or focus exclusively on the ‘addicted’ individual's brain as the problem.” 

The problem with these options for Hart is that they ignore social determinants of addiction, like employment or socioeconomic status. Roughly 10% of people who try drugs become addicted, and among them you’ll find a high prevalence of depression, trauma and other problems like poverty and over-policed neighborhoods. 

As a neuroscientist, Hart doesn’t argue that understanding neurobiology is useless. Rather, he wants to see more research funding earmarked for social interventions that look at how problems beyond a person's brain mediate drug addiction. 

Hart’s view of drugs and society stem from growing up in an impoverished and mostly black Miami neighborhood. Only after serving in the Air Force was Hart able to pursue higher education. 

“Every time I look into the faces of my children or go back to the place of my youth, I am forced to face the decimation that results from the racial discrimination that is so rampant in the application of drug laws and is abetted by arguments poorly grounded in scientific evidence.”

Hart, a minority scientist with minority views, thinks his fellow scientists need to examine themselves. 

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Zachary Siegel is a freelance journalist specializing in science, health and drug policy. His reporting has also appeared in Slate, The Daily Beast, Salon, Huffington Post, among others. He writes often about addiction, sometimes drawing from his own experience. You can find out more about Zachary on Linkedin or follow him on Twitter.