A conversation with Columbia neuroscientist Dr. Carl Hart

Dr. Hart is a tenured professor at Columbia and expert on the science and pharmacology of illicit drugs.  He grew up in the Miami ghetto where he experienced first hand the scourge of drug addiction and the impact on his community.  He entered neuroscience with the goal of curing addiction, but he discovered during the course of his career, much to his surprise, that in fact drugs had little to do with the problems that he saw.  In fact, it was the draconian drug laws and heavy handed enforcement that created misery and injustice for members of his family and community, much moreso than the drugs themselves — which he now claims, based on his years of research, are not really so dangerous after all.

Dr. Hart recently published an autobiographical account: High Price: A Neuroscientist’s Journey of Self-Discovery that Challenges Everything You Know About Drugs and Society, which was reviewed glowingly by AddictionMyth: The Man Who Almost Cured Addiction. AM recently sat down with Dr. Hart for this informal interview conducted by email.

(Dr. Hart notes: While I provided answers to the questions below, please note that all of this information is covered in my book.)

AddictionMyth: You say that scientists are principally responsible for the spreading of drug myths, in conjunction with law enforcement, politicians and the media.  What about the role of the treatment industry and the addicts themselves?  Do they bear any responsibility for the public perception of the exaggerated level of misery caused by drug addiction?

Carl Hart: Yes, the treatment industry has a huge stake in the drug hysteria game. We are comfortable sending drug users to either jail or treatment, even though most don’t need either. The treatment industry benefits immensely from this situation and will fight wholeheartedly to protect their interest. Addicts too have bought in to this mindset, in part, because the current mindset reinforces the notion that they are strong for having survived this “awful” affliction (addiction).

AM: Groups like AA base their programs on the 12 Step model, which requires that one admit powerlessness (in Step One), and indeed are often rejected from the group if they do not admit this.  But this contradicts your research, which shows that ‘addicts’ indeed can exercise control over their drug of choice, if given appealing alternatives.  (And that AA has not been shown to be effective.)  Is it possible that  AA actually creates addicts through a brainwashing process of self-deception?

CH: (No answer.  But AM asked this same question at a book signing in LA, to which he answered to the effect that AA has its problems but it’s a valuable group for some people so we shouldn’t try to get rid of it.)

AM: You say that addiction is not highly related to either cravings or withdrawal symptoms.  Furthermore, there is as yet no scientific basis to the concept of an ‘addict brain’.  So then what is addiction?  What is left?  Do you believe that addiction is a choice?  If so, to what extent are sufferers aware of their choice?

CH: To meet the most widely accepted definition of addiction—the one in psychiatry’s Diagnostic and Statistical Manual of Mental Disorders, or DSM—a person’s drug use must interfere with important life functions like parenting, work, and intimate relationships. The use must continue despite ongoing negative consequences, take up a great deal of time and mental energy, and persist in the face of repeated attempts to stop or cut back. It may also include the experience of needing more of the drug to get the same effect (tolerance) and suffering withdrawal symptoms if use suddenly ceases.

AM: Have you ever met a real addict?

CH: Yes.

AM: You say that meth is similar to Adderal and therefore can’t be very dangerous.  But any drug that causes one to lose one’s teeth is obviously dangerous.  Could meth in fact be more dangerous than Adderal, despite the chemical similarity?  (Much like first generation antipsychotics are more dangerous than current ones.)

CH:  Of course, there have been the pictures of unattractive methamphetamine users in media accounts about how the drug is ravaging some rural town. We’ve also seen the infamous “meth mouth” images (extreme tooth decay). But consider this: methamphetamine and Adderall are essentially the same drug. Both drugs restrict salivary flow leading to xerostomia (dry mouth), one proposed mechanism of meth mouth. Adderall and generic versions are used daily and frequently prescribed—each year they are among the top one hundred most prescribed drugs in the United States—yet there are no published reports of unattractiveness or dental problems associated with their use. The physical changes that occurred in the dramatic depictions of individuals before and after their methamphetamine use are more likely related to poor sleep habits, poor dental hygiene, poor nutrition and dietary practices, and media sensationalism.

 

AddictionMyth greatly appreciates Dr. Hart’s time in preparing these answers, most of which are indeed contained in his book.  We are disappointed that he clearly believes in addiction, which is perplexing because he debunks each case of purported addiction in his book.  We would love to know more about the real addict he met who tried repeatedly to stop.  We appreciate that at least he discounts the incidence and severity of addiction.

We also suspect that meth is indeed more dangerous than Adderal, and the good Dr. has opened himself up to criticism on this point.  Of course maybe even our own experiences with both were influenced by media hysteria.

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