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HIGH PRICE EXCERPT ONE
Dr. Carl Hart
“The paradox of education is precisely this – that as one begins to become conscious one begins to examine the society in which he is being educated. ” – James Baldwin
About fifteen minutes later, the computer signaled that another hit was available.
“No, thanks, doc,” he said, raising his left hand slightly. He hit the space bar on the Mac in the way that he’d been trained to press to signal his choice.
Although I couldn’t know for sure whether he was getting cocaine or placebo, I knew the experiment was going well.
Here was a middle-aged brother, someone most people would label a “crackhead,” a guy who smoked rock at least four to five times a week, just saying no to a legal hit of what had a good chance of being 100 percent pure pharmaceutical-grade cocaine. In the movie version, he would have been demanding more within seconds of his first hit, bug-eyed and threatening—or pleading and desperate.
Nonetheless, he’d just calmly turned it down because he preferred to receive five dollars in cash instead. He’d sampled the dose of cocaine earlier in the session: he knew what he would get for his money. At five dollars for what I later learned was a low dose of real crack cocaine, he preferred the cash.
Meanwhile, there I was, another black man, raised in one of the roughest neighborhoods of Miami, who might just as easily have wound up selling cocaine on the street. Instead, I was wearing a white lab coat and being funded by grants from the federal government to provide cocaine as part of my research into understanding the real effects of drugs on behavior and physiology. The year was 1999.
In this particular experiment, I was trying to understand how crack cocaine users would respond when presented with a choice between the drug and an “alternative reinforcer”—or another type of reward, in this case, cash money. Would anything else seem valuable to them? In a calm, laboratory setting, where the participants lived in a locked ward and had a chance to earn more than they usually could on the street, would they take every dose of crack, even small ones, or would they be selective about getting high? Would merchandise vouchers be as effective as cash in altering their behavior? What would affect their choices?
Before I’d become a researcher, these weren’t even questions that I would think to ask. These were drug addicts, I would have said. No matter what, they’d do anything to get to take as much drugs as often as possible. I thought of them in the disparaging ways I’d seen them depicted in films like New Jack City and Jungle Fever and in songs like Public Enemy’s “Night of the Living Baseheads.” I’d seen some of my cousins become shells of their former selves and had blamed crack cocaine. Back then I believed that drug users could never make rational choices, especially about their drug use, because their brains had been altered or damaged by drugs.
And the research participants I studied should have been especially driven to use drugs. They were experienced and committed crack cocaine users, who typically spent between $100 and $500 a week on it. We deliberately recruited individuals who were not seeking treatment, because we felt that it would be unethical to give cocaine to someone who had expressed an interest in quitting.
The bookseller was seated in a small, bare chamber at Columbia-Presbyterian Hospital (now New York–Presbyterian) in upper Manhattan; his cocaine pipe had been lit by a nurse at his side with a lighter, who also helped monitor his vital signs during the research. I was watching him and several others in similar rooms through a one-way mirror; they knew we were observing them. And over and over, these drug users continued to defy conventional expectations.
Not one of them crawled on the floor, picking up random white particles and trying to smoke them. Not one was ranting or raving. No one was begging for more, either—and absolutely none of the cocaine users I studied ever became violent.I was getting similar results with methamphetamine users. They, too, defied stereotypes. The staff on the ward where my drug study participants lived for several weeks of tests couldn’t even distinguish them from others who were there for studies on far less stigmatized conditions like heart disease and diabetes.
To me, by that point in my career, their myth-busting behavior was no longer a surprise—no matter how odd and unlikely it may seem to many Americans raised on Drug Awareness Resistance Education (DARE) antidrug programs and “This is your brain on drugs” TV commercials. My participants’ responses—and those in the dozens of other studies we’d already run, as well as studies by other researchers around the country—had begun to expose important truths. Not just about crack cocaine and about addiction, but about the way the brain works and the way that pleasure affects human behavior. Not just about drugs, but about the way science works and about what we can learn when we apply rigorous scientific methods. This research was beginning to reveal what lies behind choice and decision-making in general and how, even when affected by drugs, it is influenced powerfully by other factors as well.
These experiments were potentially controversial, of course: the tabloids could have described me as a “taxpayer-funded pusher, giving ‘crackheads’ and ‘meth-monsters’ what they want.”
Nevertheless, I tried to keep the sensational stuff hidden in the mantle and cold language of science in my scholarly publications. I’d published dozens of papers in important journals, had been awarded prestigious fellowships and competitive grants to conduct research, and had been invited to join influential scientific committees. I cowrote a respected textbook that became the number-one text used to teach college students about drugs; I won awards for my teaching at Columbia University. But throughout my career I mainly tried to avoid controversy, fearing it might derail me from conducting the work I so loved.
Eventually, I realized that I could no longer stay silent. Much of what we are doing in terms of drug education, treatment, and public policy is inconsistent with scientific data. In order to come to terms with what I have seen in the lab and read in the scientific literature, there is nothing else to do but speak out. Using empirical data, not just personal anecdotes or speculation, I have to discuss the implications of my work outside the insulated and cautious scientific journals, which were my normal métier. Because basically, most of what we think we know about drugs, addiction, and choice is wrong. And my work—and my life—shows why.
As I monitored the people I was studying, I began to think about what had brought each of us to such different places. Why was I the one in the white coat—and not the crack cocaine smoker in the cubicle? What made us different? How did I escape the distressed neighborhoods I grew up in—and the adult lives marked by drugs, prison, violent death, and chaos that so many of my family and childhood friends have had? Why did I instead become a psychology professor at Columbia, specializing in neuropsychopharmacology? What allowed me to make such different choices?
These questions weighed on me even more heavily later in the year as I continued to conduct these experiments. Sometimes, while I watched the drug users contemplate whether to take another dose, I couldn’t help thinking about some of the choices I’d made during my youth. Marvin Gaye’s lyric from “Trouble Man” would run through my head, especially the lines about growing up under difficult circumstances, but eventually turning the tables to succeed. Usually, I tried to keep my past far behind me. But that part of my life had been called to my attention in an unavoidable and shocking way that spring.
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