Prominent Columbia neuroscientist Carl Hart busts many commonly accepted myths about drugs, including the Addiction Myth, in his new book High Times: A Neuroscientist’s Journey of Self-Discovery that Challenges Everything You Know About Drugs and Society.

This is a wonderfully personal, rich, and realistic autobiography of a fascinating scientist and his iconoclastic experiments. It interweaves his personal history with his scientific career, along with the public policy around drug use. And while this might sound contrived, it actually works great for the most part, because as a black man who grew up poor, on the tough Miami streets, his science is inextricably bound with his personal life and history. To complete the book, he returns to the family and neighborhoods of his youth (and to the son he never knew he had), and describes the awkwardness and disappointment with brutal frankness.

Dr. Hart experienced first hand the ravages of addiction. His father drank every weekend and beat up his mother, putting her in the hospital on one occasion, and often showed up late for visitation, if he showed up at all, stinking drunk. He was the classic alcoholic (although he doesn’t actually claim to be one). His cousins got addicted to crack, moved into a squalid garage behind their mother’s house and stole from her. Returning to his old neighborhood after starting his study of psychology, in the midst of the crack epidemic of the 80’s, he was shocked by the poverty and violence that he saw: “I became convinced that crack had made everyone go crazy. And I soon decided to get involved in research that I thought could help do something about it.”

As a young neuroscientist, he was mesmerized by the dopamine hypothesis that became very popular in the 80’s and promised to explain the cause of addiction. It was his ambition to cure addiction, the scourge of the ghetto and which directly or indirectly left many members of his extended family dead or in jail. But he started to get discouraged. Recent experiments with nicotene showed that dopamine did not take the role as expected in pleasure, and furthermore, highly addictive heroin did not work the dopamine pathway at all.

What was going on here? The good doctor was starting to become skeptical. Time to start questioning everything. And this man was not afraid to do exactly that: he performed actual experiments on humans, with meth and coke. What he discovered would turn everything he knew upside-down, and contradict the conventional wisdom about drug use.

He showed that die-hard meth addicts would often choose cash over drugs when given a choice. They were generally well-behaved and polite, never violent, and never crawled across the floor in search of white particles to snort. Like any rational person, they would make a reasonable choice if given the opportunity. The images we have of them, as depicted by Hollywood dramas were completely false. Furthermore, while some people experienced cravings, they were manageable and there seemed to be little connection between cravings and actual use. This didn’t make sense. He recounts going to a drug meeting at ONDCP (drug czar), and the audience was much more interested in the stories by law enforcement of meth-addict mothers ripping their baby’s head off, and tales of superhuman strength. People who “had it all and and lost everything to drugs.” This ran completely counter to his own experience after years of research. He’d never seen this kind of behavior in his own subjects. Furthermore, he knew that meth was little different than the common drug adderol in terms of its chemical structure and effect on the mind and body.  What was going on? Were these stories even true?

And what about his own experience of his father’s alcoholism? After all he had seen addiction first hand, so how could he discount it? In fact, it turns out that his father had girls on the side, and used alcohol as a tool to deflect his wife’s nagging. He wasn’t addicted to alcohol. He just drank to make it easier to lie and cheat and avoid his familial responsibilities. (No surprise to AddictionMyth regulars: AA is just a club for philanderers one small crisis away from their next relapse.)

In the 80’s, crack was blamed for various social scourges, such as mothers abandoning their children. But was this really true? The good Doctor says no. He points out that his mother often left the children in the care of others for long periods, and she didn’t do drugs at all. It was just a socially common thing to do, and would happen without drugs. Furthermore, as a kid he often shoplifted and refused to do homework. And yet he did little drugs as a kid (so as not to affect his performance on the basketball court). This was the culture, and one cannot blame it on drugs.  (Though certainly, drugs make it easier to do these things, a point which seems to have been neglected by the author.)

The core problem is lack of options and opportunities. Far better to put our resources into improving education for the poor than prosecuting them on drug offenses. As the Dr proved, giving people good alternatives greatly diminishes drug use.

And what about his cousins who stole from their own mother to feed their crack addiction? In fact, he discovered that his own preconceptions were completely false. His cousins simply had no better options, given their poor education. What else to do other than buy into the myth and move out behind mom’s? These cousins introduced our protagonist to shoplifting and cigarettes at an early age. They were criminals and trouble makers well before they started using drugs. It’s not fair to blame their downfall on drugs.  Drugs don’t cause criminal behavior, although they certainly make it easier and more fun, if one is so inclined.  As shown on this blog, every “addiction” story quickly disintegrates under a little scrutiny.

Furthermore, he shows that media hype and the Drug War actually cause drug use: “Crack problems and the later increase in dealing-related murders followed the wave of media hype about them, rather than preceding them.” He saw it first hand, as his community bought into the propaganda. This revolutionary insight dawned on him gradually. We have the cause and effect all backwards. And in fact there is a long history of exaggerated and sensationalized claims about drugs that actually cause drug use. The violence and social neglect were always there.

The real problem among poor minorities is not drug abuse or addiction, but drug charges, which create a downward spiral that is almost impossible to break free of.  If he had ‘caught a case’ from his drug use early on, he certainly would not be where he is today.

To be fair to the Professor, he doesn’t actually claim that addiction is fake. In fact, at times he seems to believe in it, even though it seems like he never met a real addict in his life. Perhaps this is because he’s not quite there yet. Or perhaps he simply doesn’t want to unnecessarily jeopardize his funding (much of which comes from NIDA, run by the Myth-stress in chief Nora Volkow).

The history of science is a history of questioning and overturning the very assumptions upon which our current knowledge is based — the ideas which we cling to most avidly. We commend Dr. Hart for his scientific work in this noble tradition, and for this delightfully intimate record of it. His initial success can be gauged by the degree of oppobrium heaped upon him. Let’s hope it is fierce!

We look forward to his next work. If he is taking requests, may AddictionMyth propose: The Neuroscientist Who Discovered that “Drug Addiction” Was Completely Fake.

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Does he believe in addiction or not?   It seems he does, but at the same time he claims that withdrawals and cravings are not significant factors in addiction, and that it is not a disease.  So what is addiction?  He doesn’t say.

Although addicts did discuss drug-related issues, unless they were prompted, craving wasn’t their primary concern. (p. 257)

They didn’t seem overwhelmed by craving.  (p. 258)

Sometimes people would report severe craving but not use drugs; other times they’d use drugs in situations where they said they’d experienced no craving at all.  (p. 262)

The symptoms of heroin withdrawal look something like a case of the twenty-four-hour, or intestinal, flu.  Most of us have experienced these symptoms at some point in our lives.  This condition rarely is life-threatening.  (p. 264)

Physical dependence isn’t the primary reason for continued drug use.  (p. 264)

Crack isn’t really all that overwhelmingly good or superpowerfully reinforcing; it gained the popularity that it achieved in the hood because there weren’t that many other affordable sources of pleasure and purpose.  (p. 271)

A great deal of pathological drug use is driven by unmet social needs, by being alienated and having difficulty connecting with others.  (p. 90)

When people having appealing alternatives, they usually don’t choose to take drugs in a self-destructive fashion. (p. 94)

This implies that addiction is a form of self-destruction caused by unhappiness.  Perhaps a cry for help.  But not a compulsion or disease as we are taught.

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What about alcoholism?

But although alcohol was involved, I now know it wasn’t the real root of our problem. (p. 12)

Most of their fights had to do with real or imagined infidelity.  (p. 39)

Most men I knew had women on the side.  (p. 68)

Nonmonogamy was seen as an undeniable reality.  (p. 72)

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And what about the crack epidemic that wreaked havoc on the black community?

I’d seem some of my cousins become shells of their former selves and I blamed crack cocaine. (p. 3)

When crack cocaine came along, I completely bought the party line about its connection to violence and disorder. (p. 109)

Amp and Mike weren’t working or taking care of their families; they were stealing from their own mother in order to buy crack.  I didn’t think about how we’d all engaged in crime back home, even without using drugs.  I didn’t think about the difference the military had made for me. (p. 193)

I didn’t notice that the problems in my neighborhood that were later attributed to crack cocaine had actually preceded it.  (p. 211)

Although crack is often blamed for child abandonment and neglect and for grandmothers being forced to raise a second generation of children, all those things happened in my family well before crack hit the streets. (p. 16)

High unemployment preceded cocaine use.  The causal chain involved has been deeply misunderstood.  (p. 17)

Our current drug policies are based largely on fiction and misinformation.  (p. 326)

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What about the media portrayals of drug epidemics?

Falling for media interpretations and street myths about all of these experiences had originally misled and misdirected me. (p. 8)

Most of what we think we know about drugs, addiction, and choice is wrong. (p. 5)

Why are we so ready to blame illicit drugs for social problems like crime and domestic violence? (p. 14)

Incredible stories about a new drug’s effect can be told an accepted as fact.  This is so because few people have the experience with the drug to challenge questionable claims.  (p. 294)

Moral of the story: challenge claims about drug use and addiction.  Especially the kind that begin, “I know a guy who took meth once and….”  They are probably in the treatment industry!

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What about the science of addiction?

In terms of abstinence, 68 percent in Contingency Management programs achieved at least eight weeks cocaine-free, versus just 11 percent in the twelve-step programs. (p. 274)

Then I presented data from my studies showing that methamphetamine produced the same effects as the better-known prescription medication Adderall. (p. 289)

Study after study found that methamphetamine addicts had severe cognitive impairment.  (p. 298)

I concluded that methamphetamine addicts were overwhelmingly within the normal range on both measures.  I was essentially calling into question an entire body of research.  To my surprise, the reviewers’ comments were extremely laudatory.  (p. 307)

This simplistic thinking is the main thrust behind the notion that drug addiction is a brain disease.  It certainly isn’t a brain disease like Parkinson’s disease or Alzheimer’s.  We are nowhere near being able to distinguish the brain of a drug addict from that of a non-drug addict.  (p. 301)

There is no physical evidence to support the claim that methamphetamine causes one to become physically unattractive.  (p. 304)

The physical changes are more likely related to poor sleep habits, poor dental hygiene, poor nutrition and dietary practices, and media sensationalism.  (p. 305)

And scientists seeking research money from NIDA are well aware that they must emphasize the negative effects of drugs in order to get funded.  The overwhelming majority of information on drugs is biased toward the negative aspects of drug use.  (p. 306)

The older generation of anti-psychotics block dopamine receptors so extensively that the brain compensates by increasing the density of dopamine receptors.  The brain is now hypersensitive to dopamine, and after years of treatment, the person develops tardive dyskinesia and becomes even more susceptible to psychotic symptoms.  In other words, the treatment for psychotic symptoms can actually cause these symptoms.   (p. 315)

NIDA claims that addiction is a treatable disease: http://www.drugabuse.gov/publications/science-addiction

He dismisses the danger of meth with the claim that it is chemically equivalent to adderal.  But he admits that first generation anti-psychotics had permanent side effects compared to the newer alternatives, which are similar.  So why can’t meth be a more dangerous chemical than adderall?  Also, how does it cause meth mouth?  He dismisses it as poor hygiene/dry mouth, but this is not a satisfactory answer since any drug that causes poor hygiene is clearly dangerous.  Instead, I suspect that meth mouth occurs suddenly, and by the time it’s noticed it’s too late to save the teeth.

In summary, he is saying that drugs are addictive, but only for a small minority, and they are not as dangerous as we are often taught.  Whereas AddictionMyth says: Some drugs (like meth) are dangerous, but they are not addictive.

Bio and book: http://www.columbia.edu/cu/psychology/fac-bios/HartC/faculty.html