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Book Review

‘High Price’ by Carl Hart

An experienced voice rethinks the war on drugs

Columbia University neuroscientist Carl Hart used and sold drugs as a youth in Miami. He weaves personal stories with research to debunk what he considers myths about addiction.

EILEEN BARROSO

Columbia University neuroscientist Carl Hart used and sold drugs as a youth in Miami. He weaves personal stories with research to debunk what he considers myths about addiction.

Though President Nixon launched “The War on Drugs” in 1971, the most aggressive antidrug policies, including harsh mandatory prison sentences for possession of even small amounts of narcotics, were enacted during the Reagan administration. Thirty years later, 20 million Americans (roughly 1 in 15) use illegal drugs regularly. We seem to be losing the war. Some, including Columbia University neuroscientist Carl Hart, think we were fighting the wrong war to begin with.

In “High Price,” Hart argues that drugs are less a cause than a symptom of a broken society. He uses his own life story to illustrate the point that addiction, poverty, and crime are not inevitable consequences of drugs. Rather, he claims, drugs are an attractive diversion for people living in despair. It’s the causes of despair, Hart believes, not the drugs, on which we should be making war.

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Hart was born and raised in an African-American community in Miami amid domestic violence, poverty, abysmal schools, guns, and drugs. As a youth, he used and sold drugs, stole, held up a man at gunpoint, and unknowingly fathered a son at 16. Through a combination of hard work, luck, sports, a stint in the military, and a series of mentors, Hart avoided the fate of many of his family and friends: addiction, prison, early death.

Hart interweaves his moving and inspiring memoir with data from experiments — his own and other researchers’ — that mostly debunk what he considers myths about drug addiction. Particularly relevant are a series of experiments conducted in the 1970s, known as “Rat Park.” Researchers allowed two groups of rats to self-administer morphine. They housed the first group in stark cages, one rat to a cage. They placed the second group in an “enriched environment,” which offered opportunities to burrow, play, and copulate. The isolated rats drank 20 times more morphine-laced sugar water than those enjoying the Rat Park. These results have been reproduced using both cocaine and amphetamine.

In his own work, Hart has shown that humans, too, respond to what behavioral scientists call “alternative reinforcers,” challenging the conviction that these drugs are irresistible. He found that habitual users of crack cocaine will often choose a cash prize of as little as $5 over a hit of crack. When he offered methamphetamine addicts $5 or a large dose of meth, about half chose the cash. When he offered $20, nearly all did.

Hart is particularly interested in crack cocaine and methamphetamine as examples of how “emotional hysteria that stems from misinformation related to illegal drugs obfuscates the real problems faced by marginalized people.” Despite little hard evidence that smokable cocaine is more addictive or more likely to make people violent than powder cocaine, the legal penalties for possession of crack are far stiffer than for powder cocaine. This disparity has resulted in high rates of incarceration for young black men, making them less likely, Hart argues, to return as productive and drug-free members of their communities. He fears that current similar “hysteria” about the exaggerated addictive and crime-inducing properties of methamphetamine will similarly demonize — and further marginalize — meth users.

At times, “High Price” reads like two different books that have been forced together. Hart’s memoir, especially his description of meeting his now-adult son, is deeply honest and often painful. And his account of the ways in which scientific evidence has been ignored in the war on drugs is as alarming as it is fascinating. But Hart often gets trapped in his own narrative structure, such as in an awkward chapter in which he uses his own teenage sexual appetites as a springboard into a discussion of the neurochemistry of addiction.

For the most part, though, Hart’s personal story supports his broader argument. If drugs alone caused poverty, crime, and family dysfunction, Hart would have been unlikely to grow up to be a happily married father and tenured Ivy League faculty member. He owes his success to the many “alternative reinforcers” — especially educational opportunities — he wishes were more widely available.

Suzanne Koven is a primary care internist at Massachusetts General Hospital and writes the monthly “In Practice” column for the Globe. She can be reached at inpracticemd@gmail.com.
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