High Price

by Carl Hart

  Importantly, using alternative reinforcers in treatment doesn’t make it more expensive, in part because it makes it more effective. When contingency management techniques are specifically applied not only to supporting recovery but also to developing skills that are in demand by employers, the costs are cut even further because the work itself produces value, not to mention reducing people’s need for government benefits.

  One study randomly assigned treatment-seeking cocaine users to either contingency management plus behavioral counseling or to a traditional twelve-step focused counseling treatment, which involves referring people to meetings of twelve-step groups like Alcoholics Anonymous and teaching them about the steps involved. Patients in the contingency management arm of the study received vouchers for merchandise whenever they had drug-free urines. Fifty-eight percent of participants in the contingency management group completed the twenty-four-week outpatient treatment—compared to just 11 percent in the twelve-step group. In terms of abstinence, 68 percent achieved at least eight weeks cocaine-free, versus just 11 percent in the twelve-step condition.8 And after the rewards are stopped, people in CM are no more likely to relapse than other treatment graduates. Since more people complete treatment with CM, this makes for an overall reduction in relapse.

  More than three dozen studies have now been conducted on contingency management, used in the treatment of opioid, cocaine, alcohol, and multiple-drug addiction.9 They show that contingency management typically does better than treatment that does not use it—and that larger, faster rewards are more effective than smaller and less quickly received incentives. This, again, is exactly what research on other types of behavior would predict. Cash, as we showed, is more effective than merchandise as a reinforcer.

  The most exciting CM research currently being conducted is work by Ken Silverman and his colleagues at Johns Hopkins University. They have developed what they call a “therapeutic workplace” in which CM is used to help train drug users for jobs in data entry. One study, for example, found that the therapeutic workplace nearly doubled abstinence rates from opioids and cocaine among pregnant and postpartum addicted women, from 33 percent to 59 percent in urine samples taken three times a week.10 And Silverman’s group has replicated these findings several times, in different populations of people with addictions.

  While there are multiple benefits to this line of research, one of the most important is that participants’ drug-taking behaviors are being replaced with real-world job skills. In this way, these programs ultimately pay for themselves by helping those who were formerly unemployable become productive workers. When alternative reinforcers are made available to those who formerly lacked them, drug problems can be overcome.

  And in my own case, at Columbia in the summer of 1999 I finally reaped the reward I’d been seeking for so long: a faculty position job at an Ivy League university. I’d continued putting in long hours, studying my human participants as intently as I’d once watched my rats (though, thankfully, I didn’t have to operate on the people). At the New York State Psychiatric Institute, in upper Manhattan, I would hole up in my office, analyzing data and thinking about my research. Although the cubicle-sized room had a window with a breathtaking view of the Hudson River, I kept the shade down: the only thing I wanted to see was my data or the research papers I was reading. By this point, I was studying the effects of marijuana and methamphetamine as well as crack cocaine, so I needed to familiarize myself with the literature on those drugs.

  And since our participants lived on-site 24-7, that’s pretty much when I was there, too, overseeing the lab assistants and making sure everything was going as it should. I liked getting to know the participants: it not only helped the experiments run more smoothly but also gave me insight into their world, which allowed me to do better science. I now try to minimize the extent to which theories or stereotypes influence my view of drug users, especially if they are standing before me and I can collect my own data.

  My mentor, Marian, was intensely supportive, always letting me know how much progress I was making and keeping me abreast of where I stood in terms of getting a faculty position. She told me late in 1998 that after I’d finished the year, I’d be getting a letter offering me a job, which would start on July 1. I felt immense pride when she told me—and even more so when the letter actually arrived, bearing Columbia’s official letterhead and saying, “We want you to join the faculty as an assistant professor of clinical neuroscience.” Indeed, that was probably the proudest moment of my life, the moment when I knew that I might be able to make a career of this science thing.

  I didn’t know that less than a year later, my world would be thrown into turmoil again, when I discovered that I had fathered a son, who was now sixteen, when I myself had been sixteen, back home.

  CHAPTER 14

  Hitting Home

  If the relationship of father to son could really be reduced to biology, the whole earth would blaze with the glory of fathers and sons.

  —JAMES BALDWIN

  Standing outside the VFW hall in Hollywood, Florida, I heard a young man cursing loudly, saying what sounded like my name repeatedly amid the string of profanities. I had been talking to my younger brother Ray and some of my cousins. We were attending Grandmama’s funeral reception. It was October 13, 2004.

  I’d had many more professional successes since becoming an assistant professor at Columbia in 1999: I had been awarded a multimillion-dollar grant from the National Institute on Drug Abuse (NIDA), making me an independent researcher running my own lab. I’d published about two dozen papers and had been asked to join NIDA’s African American Researchers and Scholars Work Group, which advises the agency’s director on drug-related issues unique to black people. I was making good progress toward tenure.

  But as I’d worked my way up in academia, I’d also grown ever further away from my family. To put it bluntly, my emotional growth had not paralleled my professional achievements. Indeed, in many ways, I wasn’t emotionally much different from the child I’d been when I’d left home. When something went wrong in my relationships, my main way of coping was to ignore it, suppress my feelings about it, or simply cut myself off from the person or people involved. That’s what I’d done with my family. Not surprisingly, they were hurt by what they saw as my snobbish behavior, seeing my refusal to spend much time with them as evidence that I thought I was above them or was embarrassed by the way they lived.

  From my perspective, I didn’t know how to comfortably reach across the experiential and intellectual gap that now separated us. I didn’t have the emotional tools. Ever since I’d joined the air force, it had gotten harder and harder to negotiate the vast differences between my world and theirs. Each step in my education moved me only further away, through forces mainly beyond my control. The more I tried to negotiate the mainstream, the more time I spent primarily with white academics, the less I felt able to communicate easily with my family. The distance stymied me.

  Also, I didn’t want to admit, even to myself, that I was catching hell in the white world. Trying to learn their language and cultural norms was more difficult and exhausting than my macho exterior would allow me to concede. Frankly, I was getting my ass kicked and had no one to talk with about how to deal with it and simultaneously maintain my sense of my own blackness. In college, I had Jim Braye to mentor me, but even he never had to deal in White America as a black, dreadlocked academic/researcher with three gold teeth, working at an Ivy League university.

  At work, there was no one to whom I related. At home, Robin did her best to help me deal, but there were things about the black American experience that were foreign to her as a white woman. I also kept many of my concerns quiet, in order to avoid hurting her feelings. For example, I felt I just couldn’t tell her when I wanted to go to community events alone, knowing that black people self-censor around even the most down and well-meaning whites.

  Robin also wasn’t fully aware of how often I had to grin and bear it when I felt I ha
d been screwed over because of a racial slight. I had been the lowest-paid postdoc within our group at Columbia, despite having done two previous postdocs, which should have given me some seniority. My wife couldn’t understand why I wasn’t visibly outraged at every instance of a slight. Of course, most black people know that if they responded to the majority of explicit and oblique insults they receive on a daily basis, they would not only be exhausted but would also be quickly labeled hypersensitive and therefore, be marginalized. Staying cool is the best defense.

  Still, the fake smile and air of detachment all wear on you. There were days when I couldn’t just keep it inside and move on. All whites were the enemy when I felt like that. To protect Robin, I didn’t express this stuff out loud and tried to suppress even the thoughts and feelings I had about it, but that itself began to eat away at me. I felt trapped and constrained by all these conflicting demands. I couldn’t help starting to resent her, even though I knew it wasn’t her fault. I know she felt the effects of this struggle.

  But when I went back home to Florida, I faced an entirely different set of challenges. I tried my best not to seem condescending. However, even the way I spoke now began to seem like an insult to my family and friends there. Having broadened my vocabulary and begun talking in the way that the mainstream considers grammatically correct, it became more difficult with each passing year to relax my pronunciation of words toward my childhood speech patterns.

  Lord knows I tried to be fluent in both street and mainstream vernacular in order to avoid being viewed as a traitor. I tried to show that I could, as Wideman put it in his classic memoir Brothers and Keepers, “chase pussy . . . fight, talk trash, hoop with the best. . . .” But now my normal speech was no longer that of the streets of South Florida. I felt like a fraud trying to pronounce words in the way that I had when I was coming up. So, I would remain relatively silent in order not to be branded an impostor or worse. That too made it harder and harder for me to connect to my siblings and cousins.

  I’d watch myself interacting with but not connecting to siblings and cousins with whom I had been through hell and back. As a child they had looked after me, had seen that I was safe, had given me pocket change. Now I didn’t even speak their language. Despite having read books by black authors describing similar phenomena, I couldn’t let go of my pride and say, “Hey bruh, sis, or coz, I’m struggling . . .” Instead I began avoiding them, and the years quickly passed. Brothers, sisters, and cousins were now grandparents, and my nieces and nephews were now mothers and fathers.

  When I was sued over the paternity of my son Tobias, the rift that had been dealt with by slowly cutting contact became overt and acute. It was most pronounced with my sister Joyce, the one I’d been closest with as a child and the person who felt most strongly that I now thought I was “better than” the rest of the family. She was the sister who most expressed the hurt and pain of our separation. She also had very strong views about Tobias.

  A photo of my mom (kneeling) and siblings. Kneeling, from left, Ray, Gary, and me. Standing, from left, Joyce, Patricia, Beverly, Brenda, and Jackie.

  At first I had denied that it was even possible that he was my child—and I told everyone as much. I just couldn’t believe it could be true. To make matters worse, Joyce insisted that he was my son, long before I could bring myself to accept it. She said she’d seen me with his mother, which I didn’t think possible since we’d been together only that one time.

  “Fuck Carl Hart,” the young man in the parking lot outside the VFW said, now distinctly. I looked up from my conversation and saw a young dark-skinned brother with dreads, wearing long jean shorts and a T-shirt. He had multiple tattoos and several gold teeth. He didn’t look like anyone I knew but seemed to be in his teens or early twenties.

  “You fucking talking to me?” I said, getting ready to get into it. My brother Ray pulled me aside. We were at a funeral reception, after all.

  “That’s Tobias,” he said as he tried to calm me down. Ray suggested that I could probably understand why someone in his situation might be angry with me. I just stared. I had had no idea that he was going to be there. I’m sure he showed up because my mother and his maternal grandmother were friends and he’d somehow learned from them that I would be visiting. Naively, I hadn’t even considered the possibility that he might attend Grandmama’s funeral. Ray pulled me away and Tobias left. But that was my unfortunate first encounter with my son.

  By that time, I had already been paying child support for three or four years. The paternity suit had been settled almost immediately after I’d gotten the DNA results. I still didn’t feel any emotional or psychological connection with him and I hadn’t had any contact with his mother, other than through the court papers. But I did feel a tremendous amount of guilt about my handling of the situation.

  Tobias took matters into his own hands. The day after the funeral, he came over to my sister Brenda’s house, where I was staying, in order to apologize for how he’d behaved. Now only slightly more prepared for the encounter, I began to talk with him, or shall I say, I began to watch myself listening to him talk. I felt as dissociated from myself in my dealings with him as I was with the rest of my family.

  Tobias was twenty-one at the time and had brought his own son, who was just a toddler. I picked the little boy up and played with him, but it didn’t sink in until later, when everyone began teasing me, that I was actually a grandfather and this was my grandson. Smiling and interacting with the little guy was a welcome distraction.

  Meanwhile, Tobias and I tentatively approached each other, trying to figure out how to negotiate some kind of relationship. I did understand why he was angry; I knew that I had desperately wanted to spend more time with my own father when I was growing up. I imagined how I would have felt if Carl Sr. had denied even being my dad and didn’t even want to meet me after he’d been forced to pay child support.

  I didn’t think I had the right to say much, so I listened and thought maybe I could learn something. I was surprised at how happy Tobias was simply to be speaking with me, despite my cautious demeanor. Perhaps I was a better actor than I thought. I learned that he had grown up to be homophobic and hardened and also that he clearly knew how to take care of himself in the world from which I had once come.

  I did explain to him that I’d had no idea that he’d even been born: his mother and I barely spoke the night we’d spent together or immediately afterward, let alone communicated months later about her being pregnant as a result. First he responded to this defensively, saying, “Damn, you blaming my mom?” I backed off. I said we’d both been young and I didn’t know what she was thinking. I didn’t mean to blame her. Maybe she was scared, I suggested.

  It was then that he told me that she’d told him that some other brother was his father, a guy she’d been seeing at one point when he was growing up. He’d also apparently been told at least once that his real father was dead, so he’d received a number of different, conflicting stories about his paternity.

  I wasn’t sure what to do with this information. The best I could do was to say again that she and I had both been too young and that he shouldn’t be too hard on her. I changed the subject.

  “So what are you doing work-wise?” I asked.

  He said, “Shit, you know what I do.”

  I didn’t quite get it. Maybe I didn’t want to.

  “I’m slinging,” he said, meaning that he was a street-level pharmacist. He seemed almost to be daring me to make something of it. I didn’t know what he knew about my profession or area of interest as a researcher, but I did know that he was trying to tell me that he was strong and didn’t need anything from anyone. I asked a few questions to show him that I got that, along the lines of “How’s business? You making enough to handle your responsibilities?” He nodded affirmatively.

  And when there was an awkward pause, I found myself questioning him about his education and trying to emphasize the importance of completing high school or getting a GED,
though, at some level, I knew this was only a bandage for what amounted to a cancer by this point. I really was at a loss for words. I was accustomed to helping people solve problems by teaching and I was in that mind-set when we spoke, wanting to fix him and make it all right. Of course, that wasn’t possible: here he was, a young, uneducated black man in a world that had no use for him, a fate I’d only narrowly avoided myself.

  But advice wasn’t what he wanted from me then anyway, I later recognized. All he wanted was to speak with his father, to tell him about his hopes and dreams and life. He wanted me to know that he was going to be a good father, that he was a good person. He wanted that affirmation from the man who had brought him into the world, just like I’d wanted from my own father as a child.

  Meanwhile, I was still struggling with the fact that he was my son and that he actually was in the life I might have had myself if I’d stayed in Miami. I kept looking at him, but I really didn’t see any of myself there other than in his defiance. I sure recognized that angry swagger and desperate need for respect. I didn’t want to, but I did.

  And truthfully, I didn’t really want to look very closely. At the time, I didn’t want to think too much about the other path my life could have taken, and be forced again to contemplate the differences between where I was now and the person I’d been growing up. I was surrounded by the starkness of that difference every time I came home. Still, we did manage to leave the lines of communication open.

  And as I got to know him, I thought about the alternative reinforcers my other sons have had available to them that Tobias had either not been exposed to or not found ways to experience. I realized, too, that meeting Tobias had been especially shocking in comparison with my first encounters with my two other sons. The birth of my son Damon had been one of the deepest, most joyous, and most memorable experiences of my life. And by the time my son Malakai arrived six years later, I felt that I was actually starting to get the hang of this dad thing.