The Big Idea: Carl Hart


Once, in Baltimore, in the 1980s, I tried to get out of jury duty.

The case concerned a street corner crack cocaine deal, and the judge asked those of us who’d been selected as potential jurors to approach the bench if there were any reasons we felt unable to be impartial. I stepped forward and told His Honor that I’d witnessed the ravages of crack in the hospital where I worked in a mostly poor, mostly African American neighborhood: the sudden cardiac deaths and the gunshot wounds and the sexually transmitted diseases and the addicted babies that resulted from sex-for-crack. I hated that drug too much to be rational about it, I said.

It was a cheap ploy, and the judge was unmoved. “For Chrissakes,” he bellowed. “You don’t have to like crack. All you have to do is decide if this guy sold it or not.”

Still, I hadn’t been dishonest. I really believed then that crack was an unusually addictive and dangerous drug responsible for much of the crime and poverty in the community where my patients lived. Media at the time reinforced this belief. A Time Magazine cover story about the “menace” of crack appeared just one month before I began working at the hospital.

My understanding of crack cocaine and its effects remained fixed for many years. But just recently, High Price, a new book by Columbia University neuroscientist Carl Hart, challenged what I thought I knew about crack, and about drugs, in general.

As a neuroscientist, Hart researches human behavior related to drugs. In one series of experiments he demonstrated that most people who regularly use crack cocaine will choose a cash prize of as little as five dollars over a hit of crack. He’s shown similar results with methamphetamine users. Experiments such as these have convinced him that the addictiveness of drugs such as crack and meth have been exaggerated.

Hart also argues that the violence associated with these drugs has been exaggerated. For example, in 1986, the year the Time cover story about crack appeared, drug use and homicide rates in the U.S. actually fell. That same year, the U.S. Drug Enforcement Agency issued a report stating that the media had misrepresented the extent of crack cocaine use. Hart argues that President Reagan’s “War on Drugs,” which included tough penalties for possession of even small amounts of illegal substances, was based not on science or fact but on misinformation and emotionalism—and racism. A disproportionate number of people of color were and still are incarcerated for drugs.

A literary agent who approached Hart with the idea of writing a book about drugs had in mind something like “The History of Crack Cocaine.” But Hart wanted to write a more personal book. He feels that his own life, as much as his research, attests to the wrongheadedness of current drug policy. Raised in a poor, African American neighborhood in Miami, exposed at an early age to domestic violence, guns, lousy schools, and drugs, Hart was at high risk for addiction. He did, in fact, use and sell drugs. Hart credits what psychologists call “alternative reinforcement”—such as the cash Hart offered his subjects in the crack and meth experiments—with steering him away from drugs. Sports, the military, mentors, and a love of literature, music and, above all, science, offered more satisfaction. His experience led him to believe that drug abuse prevention efforts should be directed away from the drugs themselves, and toward fighting racism and poverty and improving education.

Hart and his wife have two sons, now twelve and eighteen. He also fathered, unknowingly, a son at sixteen. In High Price, Hart writes movingly of meeting that son, Tobias, for the first time when Tobias was twenty-one and a father himself. Tobias had dropped out of high school and was dealing drugs. His first words to his father, in the parking lot outside a funeral, were: “Fuck Carl Hart.”

I spoke with Hart recently about his painful relationship with Tobias, now thirty, and also about drugs, racism, Trayvon Martin, and the “high price” a writer can pay, both personally and professionally, for expressing nonconformist views.


The Rumpus: In your book you connect your own story closely to a larger societal story about drugs and race. Were you concerned about over-interpreting your own story? Of making yourself too emblematic?

Carl Hart: That’s a great question. Of course, I worried about that because my critique of how we deal with drugs in society is just that—that we use these anecdotes to apply to everyone and the anecdotes are not representative. So, yeah, I was deeply concerned about that.

I have three boys. And I wanted to make sure it connected with them and then those guys who grew up like me, in environments like me. That was number one. And then I knew something about science that your New York Times reader would be interested in. So I was thinking about it in multiple ways: I’ll connect with the people who grew up like me first, and then the New York Times reader will be interested in the science because it’s so good and they want to be “in the know.” That’s how I looked at it. I wasn’t really thinking about the notion that the New York Times reader wouldn’t connect with my story because I really didn’t care. I was concerned that the folks who grew up like me connected with the story. For the New York Times reader, I was going to give them big ideas.

Rumpus: The subtitle of your book is “A Neuroscientist’s Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society.” How does your personal story challenge what the average person thinks about the war on drugs?

Hart: If you don’t grow up in those communities, or even if you do grow up in those communities, you might not have had the opportunity to talk to somebody that was actually “in the life,” somebody who actually knew something about it. If you have not had that opportunity you will accept the easy narrative. And so I was hoping that people would be open to walking through my story critically like I did. Because it challenged my own thinking about these things. When I learned how to think, and evaluated it more carefully, I challenged much of what I “knew,” even though I had been living this life.

Rumpus: Can you give an example of how your own relationship with drugs challenges what the average person understands about drugs?

Hart: I think about my cocaine use. I liked it. I thought it was a great drug. But I knew that if I was doing that almost exclusively, I wouldn’t be able to continue to also have significant others and a wide range of other things. And I wasn’t special. A number of people, including the people I was doing cocaine with, also behaved the same way. They were responsible people, paying taxes, etc. When I look at the data from the federal government, it turns out hundreds of thousands of us are doing the same thing. Looking at the data and at my drug use and evaluating it carefully just let me see that I wasn’t special, but my drug use challenged what I thought about cocaine. Because I would accept when I would say, “What happened to that person?” and someone would say, “They started using cocaine…they went downhill…” I would just accept that, even though I had a different experience and all these other people had a different experience. But I would throw that out because I thought my experience was an aberration.

Rumpus: So I’m hearing two things: one, that your drug use was a considered and rational choice. And second, that it wasn’t inconsistent with you being a highly functional, upstanding citizen. Plus, that there are many other people like you.

Hart: That’s right.

Rumpus: Having said that, you have three sons. If one of them told you he wanted to use cocaine, would you be okay with that?

Hart: The thirty-year-old, I didn’t have too much to do with his upbringing, so there are issues unresolved there. But the two that I raised: the twelve-year-old, when he gets older and comes to me with this conversation, and the eighteen-year-old—the major thing that I worry about are the adulterants in drugs. So, number one: make sure you don’t have adulterants in your drugs, make sure you trust the source. Number two: both of my kids have asthma, so I worry about them smoking anything. So I make sure they understand the risk. Also, they have little experience with drugs, and if they have little experience, you start with low doses and you take it in a place that you are extremely comfortable and you’re not worried about anyone coming, like the police.

Rumpus: You really don’t think of drugs in any moral context. You would never say to a child: “Drugs are wrong.”

Hart: Right.

Rumpus: Regarding the neurobiology of drug use, you’re skeptical about what’s known as the dopamine hypothesis—the idea that potentially addictive activities such as drug use or even video games and ‘Net surfing involve release of the neurotransmitter dopamine. Why?

Hart: Dopamine makes up less than one percent of the brain’s neurotransmitters. It’s a small portion. Dopamine is released when people are happy, angry, stressed. So it’s really hard to call this specific neurotransmitter “the pleasure neurotransmitter.” Much of the early work focused on dopamine and we were really looking for rewarding sorts of effects and sure enough, we only found that. But you can destroy the main dopamine-producing structures of the brain and you can still get an animal to self-administer drugs like cocaine.

Another thing is that with heroin, dopamine is not even really involved. We’ve known that for a long time. So the notion that dopamine is the brain reward neurotransmitter is inconsistent with the evidence and overly simplistic. The rule in the brain is more co-localization, co-release of neurotransmitters and not just one neurotransmitter. But our ability to study the brain has been limited because of our tools and our tools have only allowed us to look at one neurotransmitter and we haven’t looked so much into co-localization and co-release of transmitters. Our thinking is hampered by our tools.

Rumpus: You make the point that our thinking is hampered not only by the limits of our scientific tools, but also by racism. For example, you argue that the distinction that’s been made between crack and powder cocaine is based not on science but on racism—that crack, seen as more popular in African American communities, is inaccurately characterized as more addictive, more likely to produce violent behavior. How did this start? How did it get to the cover of Time? Who sat around a conference table one day and decided that black people used crack and that crack was especially addictive and likely to cause violence—when the data doesn’t support these assumptions?

Hart: We’re in a good moment to answer that question in terms of the role of race in drug policy. Since the 1960s, when we think about racism, we think about the guy in the white sheet, and we’ve been looking for somebody to say “nigger,” and that’s how we identify racism in the mainstream. And if we don’t have that, then racism is “not happening.”  But the guys in the white sheets have traded in the white sheets for a business suit. And nobody says “nigger” unless they’re stupid, really. But those are the only markers we have for racism in this country. So if you have those as markers, you can’t explain the complexity of race in drug policy—but I’m going to try to do that now.

If we want to think about racism and how it might play out in drug policy, we have to think about the trial of George Zimmerman. We think about the prosecution, when they said “race is not a factor.” It’s so dishonest. The prosecution said it, and the defense said it wasn’t about race. All these people have agreed and if you have agreement, it’s “reality.” In fact, it’s not reality! It’s certainly not my reality. It’s not my interpretation. But it’s the dominant interpretation in the mainstream so therefore it will be “reality”—even though it’s not true.  And that’s what’s happening with race and drug policy.

But the only thing that really matters are the outcomes. Who are you arresting for this drug versus that drug? How often are these people using the drug versus those people? Take crack cocaine. Particularly in the early days of the policy, ninety percent of the people being arrested were black, even though they didn’t use the drug at higher rates and even though their numbers in the general population are so low. How could that be? You could say, “well, if they weren’t using we wouldn’t catch them, so obviously they’re using the drug.” Yep, that’s true. But the thing is, you place all your resources in communities of color. And if you do that, you’re going to arrest black people. And that’s where the racism starts. Your decision to place your law enforcement resources in these communities is racism, but nobody has called people out on this. The law itself is not racist. But people’s decision about where we’re going to place our efforts, who we’re going to prosecute, who we’re not going to prosecute, is racism. And nobody’s calling them on it.

Rumpus: You’re saying that there’s this upside down logic where you make a drug illegal, you disproportionately enforce the law in a black community, and then you say: ”There’s something about this drug which makes people break the law in such high numbers.” It’s a self-fulfilling prophecy making you draw conclusions about the unusual criminality of a particular drug, and a particular group of people.

Hart: Yes. And you’re a writer, so you know this very well: writing in a nuanced way, getting at all the details in a way that remains interesting for the reader, is very difficult. So when you have the national narrative being “crack is awful and black people are using it,” why go against that narrative when you want to get that publication in The New York Times or wherever? It encourages people to play right into it.

Rumpus: What about methamphetamine? My association with meth is with white poverty.

Hart: And also gay people.

Rumpus: You write about your concern that meth is going down the road of crack cocaine; that its addictive properties and its association with violence are being exaggerated. And that the people who use it are being demonized and dehumanized. But that’s not really about race, is it?

Hart: This isn’t only about race. It’s about despised groups. If you’re a member of a despised group, look out! They’ll find a drug and associate you with its use. There are a lot of people in the gay community using methamphetamine and paying taxes and going to work and doing well.

Rumpus: At the beginning of the AIDS epidemic, this was part of the attitude: “That only happens to people who aren’t like me.” But as it became clear that the virus was present in the heterosexual, non-drug-using, white community, the dissociation wasn’t so easy anymore.

Hart: That’s exactly right.

Rumpus: Back to race, you’ve said that the “Southern strategy” [using often thinly-veiled racism to appeal to white, Southern voters] is alive and well under President Obama.

Hart: Yes. And I absolutely mean that. When Barack Obama stood up and said to the country—after the George Zimmerman verdict—when he gave his tepid remarks, he said, “We are a nation of laws.”  What the fuck? Part of this whole thing where crime is associated with certain groups, that’s all still very deep in the American consciousness. You associate crime with certain groups. Why do you need to remind the country that we are a nation of laws? We know that.

Rumpus: You weren’t at all moved, then, by those remarks. By “I could have been Trayvon” and “If I had a son, he would look like Trayvon.”

Hart: As a president, he has a difficult job. I don’t want to be on the bandwagon of dogging any president or anybody in positions where they have all these different constituencies. But, yeah. I thought that his remarks were weak. He didn’t say “racial discrimination,” he said something like “the application of law in the country is racially biased.” And the two examples he gave were the death penalty and drug laws. Two examples of racial discrimination. And in his four points of saying how the country could move forward, he didn’t mention drug laws. Didn’t say anything about them. He actually could do something about drug laws. He actually could push for things. He said nothing. He missed that opportunity. And the thing about it: he’s a smart man. But he doesn’t want to get into it. To me it seemed as though it was an attempt to placate people, and there’s no real action on these issues. I was disappointed.

Rumpus: Of course, some pundits (and Internet trolls) seized on the fact that Trayvon Martin had some cannabis in his system, and used that to promote the stereotype of the drug-crazed young black man.

Hart: Yes. I wrote an op-ed in the New York Times about that.

Rumpus: One more thing about Barack Obama. You mention in the book that if he had been a young man today, under current drug laws, he’d likely have been arrested and we’d never have heard any more about him. Are the laws now really more draconian than they were in the 1970s and 1980s?

Hart: One of the things that has happened is that our drug laws have been institutionalized now. If you want to say that somebody’s a bad person in a movie or in a television show or something about that, you say they sell drugs or they use drugs. You have rappers saying “stay off drugs, go to school”—empty verbal behavior. I think all of this became institutionalized in the early ’90s. And it’s become more and more solidified, more and more entrenched.

Rumpus: Given that the causes of drug use are many, and that you feel drug use itself isn’t always a problem, are there still changes in drug policy you’d like to see?

Hart: Yes. We should decriminalize all drugs. The assumptions on which our drug policies are based are flawed. Given that that’s the case and given that we arrest 1.5 million people a year and eighty percent are for drug possessions, we should at least give some release to those people, and decriminalization would be the most expedient way to do that. I also argue that we need to make our drug education more realistic so that people, even if they are using, are safe. That they live another day.

Rumpus: You’re not minimizing the fact that people die from drug use, live dysfunctional lives because of drugs, are you?

Hart: By no means. In fact, my approach is to keep those people safe, to make sure they have better education. For example, the actor who just died, Cory Monteith, I wrote a piece on The Huffington Post about his death. He died from a combination of heroin and alcohol. People rarely die from heroin alone, it’s the combination that’s deadly. Maybe we should blast that out as a public health education message. That way at least we’re keeping people safe. At least they’re not dying. But the way we’re currently educating people about heroin is to say that heroin is so awful. Heroin is not so much the problem. It’s when you combine it. It’s hard to die from heroin alone.

Rumpus: So you’re coming at this a scientist who wants to set aside the emotion and the moral judgment and say: “Let’s look at the reality of this.” To some, you might sound like an apologist, like someone who’s saying heroin is okay. But that’s not what you’re saying.

Hart: Right.

Rumpus: The epigraph of your book, from which you take the title, is a quote from the writer Tahar Ben Jelloun: “Intellectuals…who have had the courage to voice their opposition have often paid a very high price.” Have you paid a high price by writing this book? Do you feel like a whistleblower, a contrarian, a voice in the wilderness?

Hart: Yes, absolutely. I’ve had investigations of my lab because people didn’t like what I had to say. And when you have investigations and you’re doing research, you’re shut down for a while. You have to start all over again. So that’s one area where I paid a high price.

Rumpus: You mean you were investigated because you wrote the book?

Hart: No, this was before the book. I was saying these things. I was giving public lectures. I sit on a committee with the director of the National Institute on Drug Abuse, on her highest committee. I have yet to see her since the book has been out, and she and I have different views on this. It’s going to be interesting seeing what happens there. I know I don’t get invited to sit on as many committees as I used to, that sort of thing. So there’s a price that one pays. I’ve also paid a price in my personal life for sharing all this. I get in these weird e-mail exchanges with colleagues about these personal things.

Rumpus: Where they’re expressing disapproval of you?

Hart: Yeah. I can share one story with you. I got an e-mail from a colleague I respect and like, but we only see each other in passing. In the chapter where I’m talking about Tobias, the older kid…

Rumpus: Your thirty-year-old son?

Hart: Yes, that’s right. The colleague said, “I think you owe the reader some emotional closure about Tobias and his kids. And also, you should help him.” I wrote back and said, “Hey, Tobias is an adult, and I didn’t want to delineate all the things that I’ve done to help him because it felt cheap and self-congratulatory. And I didn’t want to tell all of Tobias’s business much more than I told. He is an adult and I can’t make him do certain things.” And in terms of the emotional closure I said, “That’s partly why I wrote the book and talk about it. Because I don’t have emotional closure. That’s the point. So I can’t give you what I don’t have.”  These kinds of weird exchanges break my heart, actually. They hurt my feelings.

Rumpus: How about the price in your family? Has Tobias read it? Your siblings?

Hart: Oh, man. Tobias hasn’t told me he’s read it yet. I’ve given him other books to read and he hasn’t read them. I didn’t want to embarrass him and I didn’t want to keep nagging him. So I’ll just let him do his thing. In terms of my siblings, three of them have read it and told me about it. I had them participate in the parts where I talk about them. I made sure that I got things right. The three who have read it really like it. The other folks who I haven’t heard from, I don’t know if they read it and don’t like it. We have never really called each other on a daily basis or talked to each other. So I don’t know.

Right now I receive e-mails every day about the book from strangers. A lot of support. But then there’s also criticism. I recently had one of my best friends commit suicide, so at this point I am emotionally fragile as it relates to the book and to life, so I haven’t been in a hurry or a rush to ask people what their opinion of the book is. That’s where I’m at.

Rumpus: Are you glad you wrote it?

Hart: Depends on the day that you ask.

Rumpus: How about today?

Hart: I am glad that people are trying to have a rational conversation about drugs. But I don’t know. I’m not sure. Some days I am. But today I don’t know. I’m less sure.


“The Big Idea” features interviews with writers, artists, scientists, activists, and others who take a long and broad view of an issue, problem, or concept, and pursue it over many years. Visit the archives here.


Featured image of Carl Hart © by Eileen Barroso.
Second image of Carl Hart © by Drug Policy Alliance.

Suzanne Koven MD, MFA is a primary care physician and writer-in-residence at Massachusetts General Hospital in Boston. Her writing has appeared in the New England Journal of Medicine, the Boston Globe, VQR, and elsewhere. Her interview column “The Big Idea” appeared at The Rumpus. Her memoir-in-essays, Letter to a Young Female Physician, will be published by W. W. Norton & Co. on May 4, 2021. More from this author →