by Carl Hart
Nonetheless, you should know that scientists have studied nearly all of the popular recreational drugs in people. We have learned a great deal about the conditions under which either positive or negative effects are more likely to occur. Unfortunately, this knowledge is rarely disseminated to the public, primarily because of the irrational belief that it might lead one to engage in drug use. In light of the fact that there are already more than 20 million Americans who use illegal drugs regularly, it seems that a rational approach—one that aims to reduce drug-related harms—would be to share what we’ve learned with drug users and those in positions to help keep them safe. Otherwise, it seems that we do society a major disservice.
If more people were aware of a few simple facts that we’ve learned, this would substantially enhance public health and safety. First, inexperienced drug users should be discouraged from taking drugs in the manner in which experienced users do. Experienced users tend to take drugs in ways that get them to the brain quickly, that is, by smoking or intravenous injection. Because smoking and shooting drugs intravenously produce more potent effects, the likelihood of harmful consequences is increased with these methods. Alternatively, taking a drug by mouth is usually safer than other ways of consuming drugs for two reasons: (1) the stomach can be pumped in case of an overdose, which isn’t possible with smoked or injection overdoses; and (2) some of the drug will be broken down before reaching the brain, resulting in fewer drug effects.
Second, healthy sleep habits should be stressed for all drug users because prolonged sleep loss can cause deterioration of mental functioning. In severe cases, even without drugs, hallucinations and paranoia may also occur. Because amphetamines and cocaine reliably reduce fatigue and offset performance decrements, some may repeatedly take these drugs to lessen problems associated with sleep loss. This is a less than ideal approach. One of the most consistent effects of stimulants is the disruption of sleep, which means that repeated use can exacerbate problems related to sleep loss. Given the vital role that sleep plays in healthy functioning, regular users of stimulants should be mindful of their sleep durations and avoid drug use near bedtime.
Finally, certain drug combinations should be avoided because they increase the risk of overdose. The heroin-alcohol combination and oxycodone-diazepam combination are two popular examples. While it is theoretically possible to die from an overdose of any of these drugs alone, in practical terms this is extremely rare. But each year there are several thousand deaths in the United States in which the use of these combinations is mentioned. In virtually every overdose death involving an opioid, for example, some other substance is present. Most of the time it is alcohol. One should always take care when combining two drugs or any drug with alcohol.
“Thank you for your time and thoughtful questions and comments,” I said to the secret-science clubbers as I prepared to exit the stage. But before I could leave, dozens of people lined up and huddled around me. Some had pressing follow-up questions, while others wanted to share their stories, seek advice, or just say thanks. It was reminiscent of a time when I used to watch my DJ mentor and brother-in-law, Richard “Silky Slim,” skillfully convey to each person that his or her opinion mattered. Unfortunately, Silk didn’t go on to become the well-known entertainer that we all thought he would. Instead he was convicted of a drug charge and served more than a decade in federal prison.
Since his release, he and I have spoken at great length about his experiences with the justice system and the unfairness of our current drug policies. To be honest, his story is one that provides motivation for me to do my best to change the way we regulate the illegal drugs discussed in this book. Whenever I write something relevant on the topic, I send him a copy. Here’s a recent text message I received from him in response to an op-ed that I published calling for the elimination of the sentencing disparities between powder and crack cocaine:3 “Hey brother Carl, Great fucking piece you wrote man. That made my heart start racing again just thinking about the injustice I had to endure. Thanks man, that was beautiful! God Bless.” I sincerely hope that my efforts help to prevent many of the policy mistakes that were made in the past.
Acknowledgments
I would like to thank two people who helped nurture this book along a path that proved to be more difficult than I initially thought: Claire Wachtel and Maia Szalavitz. Claire went far beyond her editorial responsibilities by serving in multiple roles. Thank you for treating me like a writer and for being my sounding board, clinical psychologist, and friend. Without your subtle but clear and firm guidance, this book would have been a superficial and uninteresting read. Maia, your professionalism is unmatched. You kept me on schedule despite my best efforts to delay and avoid dealing with difficult personal issues within these pages. I am also deeply appreciative of your teaching me how to write an engaging story. This is not a lesson taught in most science education programs.
Melissa and Marc Gerald, of course minus your efforts, this project would not have been undertaken. While serving on an NIH grant review committee with Melissa, late one evening at dinner, she suggested that I meet with her literary agent brother about writing a book. I thought she was just being kind by indulging my atypical ideas. As it turned out (and I am grateful), Marc agreed with her and put the Agency Group’s best efforts into seeing the project through to completion. Sasha Raskin, my coagent, thanks for being patient with my endless inquiries about the publishing process.
On most days, I feel fortunate to have an intellectual home at Columbia University in the departments of psychology and psychiatry and the Institute for Research in African-American Studies, where I learn from some of the most talented thinkers. I owe a tremendous debt to my many coauthors, colleagues, and students. These individuals took the time to teach me about drugs, science, and life. The arguments and discussions in which we engaged helped to shape several of the ideas put forth in this book. I am particularly indebted to Charles Ksir, James Rose, Fredrick Harris, Robert Krauss, Norma Graham, Lynn Paltrow, Rae Silver, Catalina Saldaña, and Susie Swithers. Some of these individuals even read and reacted to early drafts of the manuscript.
To my family, thank you all for your support and allowing me to share your stories. Robin’s early encouragement provided much of the fuel that helped me power through some inevitably difficult portions of the process. Writing this book would have been impossible were it not for the sharp memories of Jackie, Brenda, Beverly, Patricia, Joyce, Gary, and Ray. In addition, Ray’s ability to find obscure newspaper articles about Carver Ranches and our childhood friends is truly amazing. His research helped me to tell a richer story.
Finally, I would be remiss if I did not acknowledge a few government programs for their contributions toward my physical and intellectual development without which this book might not have been written: Aid to Families with Dependent Children (welfare as we once knew it), the National Institute on Drug Abuse’s Supplemental Grant for Minorities in Biomedical and Behavioral Research, and the National Institute of Mental Health–Society for Neuroscience Predoctoral Minority Fellowship. In recent years, programs aimed at redressing past American racial discrimination have come under attack. Without such programs, however, I seriously doubt that I would have become the scientist, educator, and tax-paying citizen that I am today.
Notes
CHAPTER 1: WHERE I COME FROM
1. J. C. Anthony, L. A. Warner, and R. C. Kessler, “Comparative Epidemiology of Dependence on Tobacco, Alcohol, Controlled Substances, and Inhalants: Basic Findings from the National Comorbidity Survey,” Experimental and Clinical Psychopharmacology 2 (1994): 244–68; L. A. Warner et al., “Prevalence and Correlates of Drug Use and Dependence in the United States. Results from the National Comorbidity Survey,” Archives of General Psychiatry 52, no. 3 (March 1995): 219–29; M. S. O’Brien and J. C. Anthony, “Extra-Medical Stimulant Dependence Among Recent Initiates,” Drug and Alcohol Dependence 104 (2009): 147–55; Substance Abuse and Mental Health Services Administration, Results fr
om the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH series H-44, HHS publication no. (SMA) 12-4713 (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012).
2. Gwendolyn Mink, Poverty in the United States: An Encyclopedia of History, Politics, and Policy (Santa Barbara, CA: ABC-CLIO, 2004), vol. 1, p. 187.
3. Linda Swanson, “Racial/Ethnic Minorities in Rural Areas: Progress and Stagnation,” U.S. Department of Agriculture Economic Research Service, AER731 (August 1996), www.ers.usda.gov/publications/aer731/aer731g.pdf. Also Manning Marable, How Capitalism Underdeveloped Black America (London: Pluto Press, 1983), p. 45.
4. Substance Abuse and Mental Health Services Administration, Office of Applied Studies, Results from the 2004 National Survey on Drug Use and Health: National Findings, DHHS publication no. SMA 05-4062, NSDUH series H-28, 2005, http://www.oas.samhsa.gov/p0000016.htm#2k4.
5. Thomas P. Bonczar, “Prevalence of Imprisonment in the U.S. Population, 1974–2001,” U.S. Department of Justice, Bureau of Justice Statistics Special Report, NCJ 197976 (August 2003), www.policyalmanac.org/crime/archive/prisoners_in_US_pop.pdf.
CHAPTER 2: BEFORE AND AFTER
1. B. A. Pan, M. L. Rowe, J. D. Singer, and C. E. Snow, “Maternal Correlates of Growth in Toddler Vocabulary Production in Low-income Families,” Child Development 76, no. 4 (July–August 2005): 763–82, http://www.ncbi.nlm.nih.gov/pubmed/18300434; M. L. Rowe, “Child-Directed Speech: Relation to Socioeconomic Status, Knowledge of Child Development and Child Vocabulary Skill,” Journal of Child Language 35, no. 1 (February 2008): 185–205, http://www.ncbi.nlm.nih.gov/pubmed/16026495; M. L. Rowe and S. Goldin-Meadow, “Differences in Early Gesture Explain SES Disparities in Child Vocabulary Size at School Entry,” Science 323 (February 2009): 951–53, http://www.ncbi.nlm.nih.gov/pubmed/19213922.
2. P. K. Piff et al., “Having Less, Giving More: The Influence of Social Class on Prosocial Behavior,” Journal of Personality and Social Psychology 99, no. 5 (November 2010): 771–84;M. W. Kraus, S. Côté, and D. Keltner, “Social Class, Contextualism, and Empathic Accuracy,” Psychological Science 21, no. 11 (November 2010): 1716–23.
CHAPTER 3: BIG MAMA
1. D. K. Ginther et al., “Race, Ethnicity, and NIH Research Awards,” Science 333 (2011): 1015–9.
2. C. M. Mueller and C. S. Dweck, “Praise for Intelligence Can Undermine Children’s Motivation and Performance,” Journal of Personality and Social Psychology 75, no. 1 (July 1998): 33–52.
CHAPTER 4: SEX EDUCATION
1. R. A. Wise, “The Neurobiology of Craving: Implications for the Understanding and Treatment of Addiction,” Journal of Abnormal Psychology 97 (1988): 118–32; G. F. Koob, “Drugs of Abuse: Anatomy, Pharmacology and Function of Reward Pathways,” Trends Pharmacological Sciences 13 (1992): 177–84.
2. J. Olds and P. Milner, “Positive Reinforcement Produced by Electrical Stimulation of the Septal Area and Other Regions of Rat Brain,” Journal of Comparative and Physiological Psychology 46 (1954): 419–27.
3. C. Hart and C. Ksir, “Nicotine Effects on Dopamine Clearance in Rat Nucleus Accumbens,” Journal of Neurochemistry 66 (1996): 216–21; C. Ksir et al., “Nicotine Enhances Dopamine Clearance in Rat Nucleus Accumbens,” Progress in Neuro-Psychopharmacology and Biological Psychiatry 19 (1995): 151–56.
4. W. A. Cass et al., “Differences in Dopamine Clearance and Diffusion in Rat Striatum and Nucleus Accumbens Following Systemic Cocaine Administration,” Journal of Neurochemistry 59 (1992): 259–66.
5. J. Zhu et al., “Nicotine Increases Dopamine Clearance in Medial Prefrontal Cortex in Rats Raised in an Enriched Environment,” Journal of Neurochemistry 103 (2007): 2575–88; J. Zhu, M. T. Bardo, and L. P. Dwoskin, “Distinct Effects of Enriched Environment on Dopamine Clearance in Nucleus Accumbens Shell and Core Following Systemic Nicotine Administration,” Synapse 67 (2013): 57–67.
6. G. F. Koob, “Drugs of Abuse: Anatomy, Pharmacology and Function of Reward Pathways.”
7. L. Hechtman and B. Greenfield, “Long-Term Use of Stimulants in Children with Attention Deficit Hyperactivity Disorder: Safety, Efficacy, and Long-Term Outcome,” Paediatric Drugs 5, no. 12 (2003): 787–94.
CHAPTER 5: RAP AND REWARDS
1. H. R. White and M. E. Bates, “Cessation from Cocaine Use,” Addiction 90, no. 7 (July 1995): 947–57.
2. A. J. Heinz et al., “Marriage and Relationship Closeness as Predictors of Cocaine and Heroin Use,” Addictive Behaviors 34, no. 3 (March 2009): 258–63.
3. M. D. Resnick et al., “Protecting Adolescents from Harm: Findings from the National Longitudinal Study on Adolescent Health,” Journal of the American Medical Association 278, no. 10 (1997): 823–32.
4. B. K. Alexander, R. B. Coambs, and P. F. Hadaway, “The Effect of Housing and Gender on Morphine Self-Administration in Rats,” Psychopharmacology 58 (1978): 175–79; P. F. Hadaway et al., “The Effect of Housing and Gender on Preference for Morphine-Sucrose Solutions in Rats,” Psychopharmacology 66 (1979): 87–91.
5. C. Chauvet et al., “Effects of Environmental Enrichment on the Incubation of Cocaine Craving,” Neuropharmacology 63 (2012): 635–41; M. D. Puhl et al., “Environmental Enrichment Protects Against the Acquisition of Cocaine Self-Administration in Adult Male Rats, but Does Not Eliminate Avoidance of a Drug-Associated Saccharin Cue,” Behavioural Pharmacology 23 (2012): 43–53; D. J. Stairs, E. D. Klein, and M. T. Bardo, “Effects of Environmental Enrichment on Extinction and Reinstatement of Amphetamine Self-Administration and Sucrose-Maintained Responding,” Behavioural Pharmacology 17 (2006): 597–604.
6. M. E. Carroll, S. T. Lac, and S. L. Nygaard, “A Concurrently Available Nondrug Reinforcer Prevents the Acquisition or Decreases the Maintenance of Cocaine-Reinforced Behavior,” Psychopharmacology (Berlin) 97, no. 1 (1989): 23–29.
7. M. Lenoir et al., “Intense Sweetness Surpasses Cocaine Reward,” PLoS One 2, no. 8 (August 2007): e698.
8. M. A. Nader and W. L. Woolverton, “Effects of Increasing the Magnitude of an Alternative Reinforcer on Drug Choice in a Discrete-Trials Choice Procedure,” Psychopharmacology (Berlin) 105, no. 2 (1991): 169–74.
9. S. T. Higgins, W. K. Bickel, and J. R. Hughes, “Influence of an Alternative Reinforcer on Human Cocaine Self-Administration,” Life Sciences 55, no. 3 (1994): 179–87.
CHAPTER 6: DRUGS AND GUNS
1. National Household Survey on Drug Use and Health, 2010, http://www.samhsa.gov/data/NSDUH/2k10Results/Web/HTML/2k10Results.htm#7.1.5.
2. Christopher J. Mumola and Jennifer C. Karberg, U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics Special Report, Drug Use and Dependence, State and Federal Prisoners, 2004.
3. Ibid.
4. P. J. Goldstein, H. H. Brownstein, P. J. Ryan, and P. A. Bellucci, “Crack and Homicide in New York City: A Case Study in the Epidemiology of Violence,” in Craig Reinarman and Harry G. Levine, eds., Crack in America: Demon Drugs and Social Justice (Berkeley: University of California Press, 1997), pp. 113–30.
5. S. R. Dube et al., “Childhood Abuse, Neglect, and Household Dysfunction and the Risk of Illicit Drug Use: The Adverse Childhood Experiences Study,” Pediatrics 111, no. 3 (March 2003): 564–72, http://pediatrics.aappublications.org/content/111/3/564.long.
CHAPTER 7: CHOICES AND CHANCES
1. Anna Aizer and Joseph J. Doyle Jr., “Juvenile Incarceration and Adult Outcomes: Evidence from Randomly-Assigned Judges,” National Bureau of Economic Research, February 2011.
2. U. Gatti, R. E. Tremblay, and F. Vitaro, “Iatrogenic Effect of Juvenile Justice,” Journal of Child Psychology and Psychiatry 50 (2009): 991–98.
3. T. J. Dishion, F. McCord, and J. Poulin, “When Interventions Harm: Peer Groups and Problem Behavior,” American Psychologist 54 (1999): 755–61.
4. Campaign for Youth Justice, “Critical Condition: African American Youth in the Criminal Justice System,” September 25, 2008, p. 1, http://www.campaignforyouthjustice.org.
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sp; 5. Ibid., pp. 16, 27.
CHAPTER 8: BASIC TRAINING
1. Jeffrey Haas, The Assassination of Fred Hampton: How the FBI and the Chicago Police Murdered a Black Panther (Chicago: Lawrence Hill Books, 2009).
2. R. Balko, “Overkill: The Rise of Paramilitary Police Raids in America,” white paper, 2006.
3. Office of National Drug Control Policy, National Drug Control Strategy: Data Supplement 2011 (2012), http://www.whitehouse.gov/sites/default/files/ondcp/policy-and-research/2011_data_supplement.pdf.
4. Craig Reinarman and Harry G. Levine, eds., Crack in America: Demon Drugs and Social Justice (Berkeley: University of California Press, 1997), p. 19.
5. Edith Fairman Cooper, The Emergence of Crack Cocaine Abuse (New York: Novinka Books, 2002), p. 49.
6. L. D. Johnston et al., Monitoring the Future: National Survey Results on Drug Use, 1975–2011, vol. 1, Secondary School Students (Ann Arbor: Institute for Social Research, University of Michigan, 2012).
CHAPTER 9: “HOME IS WHERE THE HATRED IS”
1. M. Daly and M. Wilson, “Competitiveness, Risk Taking, and Violence: The Young Male Syndrome,” Ethology and Sociobiology 6 (1985): 59–73.
2. L. D. Johnston et al., Monitoring the Future: National Survey Results on Drug Use, 1975–2011, vol. 1, Secondary School Students (Ann Arbor: Institute for Social Research, University of Michigan, 2012).
3. Sudhir Venkatesh, Gang Leader for a Day: A Rogue Sociologist Takes to the Streets (New York: Penguin Press, 2008); Sudhir Venkatesh, Off the Books: The Underground Economy of the Urban Poor (Cambridge, MA: Harvard University Press, 2006).