Carl Hart: “HIGH PRICE: A Neuroscientist’s Journey of Self-Discovery That …” | Talks At Google


CARL HART: Thank you for having
me here at Google. I always enjoy coming
to Google. I was at Google in Irvine,
and the facilities are outstanding. Actually, you guys’ facilities
here are better than the ones out in Irvine. Don’t tell people
in Irvine that. I really enjoyed
my time there. So today what I’d like to do
is talk today about my new book called “High Price: A
Neural Scientist’s Journey of Self-Discovery That Challenges
Everything That You Know About Drugs and Society.” Since we
have a number of young people in the audience, I suspect that
there will be some things that you do know about
drugs, right? At least, I hope. So when I think about doing
these book talks, it’s a difficult thing to do to
encapsulate a whole book in a short talk. I’ll talk about 20 minutes or
so, maybe half an hour, and then I’ll open it up
for questions. And so trying to encapsulate a
whole book and in that period of time it is difficult. So what I like to do is to break
it up in three parts. The book is a hybrid. It is part memoir, part big idea
science book, and part policy book. And so, the reason why
I did the memoir– I told a deeply personal story,
and it causes me a great deal of anxiety to
share so many personal details about my life. But one of the reasons that I
did that was so that people who came or who come from where
I come from, so they could have someone to identify
with, partly. And I also told this deeply
personal story because I know that when we read books about
drugs and policy, only 10 people read them, or so,
because they’re boring. And I get it. Me too, I’m bored. But if you tell a story with
some personal details, some anecdotes, folks are more
likely to engage and read the story. But there’s a problem with
anecdotes and personal information. You can sometimes learn
something from it, learn by example. That’s a good thing. But the problem is you sometimes
inappropriately apply those anecdotes to more
general situations, and you make the mistake of taking
an anecdote that’s not representative. And so that’s why I included
the science to bolster, to support the anecdote. And then when you do this, you
come to some decisions that need to be made. You have learned something,
I learned something in the process. And when you learn something
you want to make suggestions, policy. You want to tell people
what we should do. With that said, I just like to
talk a little bit about the personal stuff. Now, people oftentimes ask me,
how did you go from the hood– a neighborhood entrenched with
poverty, and all the problems that come with it. How do you go from point A–
that being point A– to point B, to where you are
the first African American tenured professor in the
sciences at Columbia? How do you do that? How does someone do that? Well, one of the major forces
that helped me to do that– major contributing factors– was I was deeply involved
in sports when I was in high school. I played basketball throughout
high school, and this allowed me to stay plugged in to the
society, into school. It ensured that I would go to
school, because if I wanted to be on the school’s basketball
team, I had to actually go to school, right? It also required that I maintain
at least a 2.0 grade point average. It’s not as high as what they
make you maintain here at Google, but it was enough to
make sure that I at least graduated, right? So that kept me plugged in, it
ensured that I graduated. Another factor was that I have
five sisters who are older than I am, and a grandmother who
did their best to keep me on the straight and narrow
path as they could. I wasn’t always on the straight
and narrow path, of course, because I engaged in
petty crimes, sold a little drugs, did some drugs, those
sorts of things. But I knew I couldn’t get too
far off the path, because I would disappoint my sisters,
and I would disappoint my grandmother. And then I may also have
gotten kicked off the basketball team. So I had to keep things
in the check. I had to be in control,
to a certain extent. Another thing that was important
in my story was that there were programs when
I was growing up. There was a program called
Aid to Families with Dependent Children– AFDC. Some of you all might know that
as what we once knew it as welfare. That changed in 1996,
the Clinton administration changed that. There was also another program
in which people like me– young people like me– who
were from these poor backgrounds, there were summer
programs or summer jobs where we worked. Folks who were 14 years old
and older could get jobs. The government supported these
programs that kept us off the street, it put pocket change
in our pockets. Those programs are no longer
there, but those programs were critical in helping with
me move along. Well, I didn’t get the
basketball scholarship that I thought I was going to get. So instead, I had a guidance
counselor who also looked after me. She encouraged me to talk
to military recruiters. She actually knew how to
motivate me, so she simply said, if you talk to these
recruiters on this particular day, on these particular days,
I’ll let you out of class. And that worked. She knew what she was doing. I talked to various recruiters
and decided to go into the Air Force. The Air Force– my time in the Air Force
was all spent overseas. Most of my time was
spent in England– about three years in England. While in England, something
happened, something that’s critical to my developing
critical thinking skills. When I was in England, I started
to go to college where I really intensified my college,
because in the Air Force, there are college
campuses or college courses that are offered on base. While in England, I noticed
that the British were– they didn’t have the same
reservations about critiquing American society, particularly
as it relates to race. They were quite comfortable
showing documentary films about our racial history. I mean, these are things that
I already knew from being in the United States. At least I thought I knew. But I never had official
approval, or I never had my beliefs corroborated by an
official government. And so, in England, I got
really interested in the American Civil rights story. And in school I learned quite
a bit about it, and it just inspired me to continue my
education even further. So I began my education, really,
in England, and I continued it once I got
out of the Air Force. And I had mentors after I got
out of the Air Force, and throughout the Air Force, who
encouraged me to go on to get a Ph.D. And these mentors– without these mentors, I don’t
think I would have been able to continue on to get a Ph.D. So that’s the sort of
personal story. I tell that story in part
because I want people to know that I’m not special. Those components that were in my
environment that helped me move along, we certainly can do
this for other people if we wanted to, as a society. But society has decided that
certain groups of people or not so important, so we won’t
ensure that they have those type of components. So I’m not special. This is not an up from
slavery story. That’s not the story here. It’s a logical, rational story
that could happen to most people if we put these things
in their environment. OK, shifting gears
to the science. I went to graduate school to
study what I thought was the problem in my community. I had been told that drugs was destroying the black community. This is what I learned, and so
I thought, what better way to make a contribution, just like
my heroes who had made contributions previously– Fanny Lou Hamer, Malcolm X,
Martin Luther King, all of those folks had made previous contributions to the community. I wanted to do the same
thing in my own way. So I thought I’ll study the
brain, and the effects of drugs on the brain. I thought that drugs were
destroying the community, I’ll find out from a biological
perspective what’s going on, and once I figure that out, I
could help save the community. So I went to graduate school,
started studying drugs– or the effects of drugs
on the brains of rats. Drugs like morphine,
nicotine, cocaine. Trying to understand
what was happening. Now, during in my education,
one of the things that I learned was that, well, the most
of the people who take crack cocaine– the drugs that I thought was
really destroying the community– I learned that most of the
people that take that drug we’re not addicted. In fact, most of the people that
take that drug go to work and are responsible people. They are paying taxes, they’re
doing all the things that we want them to do. Some of them even worked
at Google. So when I learned that,
I wanted to know more. Was that the case
for all drugs? Turns out, yeah, that was
the case for all drugs. About 80, 90% the people who
use these drugs– crack cocaine, methamphetamine,
heroin– you name the drug, 80, 90% of
them do so without a problem. They are responsible citizens. Hmm. So that shattered one of the
sort of assumptions that I had about drugs and the
evils of drugs. Another assumption that was
shattered when I went to graduate school and I learned
more about drugs was that, as an undergraduate, we were all
told that you take a drug like cocaine, allow an animal
to self administer it. Put a catheter in their vein,
allow them to press a lever to receive a cocaine injection. The animal would do this until
the animal dies if you allow them unlimited access
to the drug. I learned that as an
undergraduate. Maybe some of you all learned
this as an undergraduate? Yeah. Right? And so, yep, sure enough, that
was the story, and that was one that helped me to understand
what was going on in my community– so I thought. As I looked at the data more
carefully, as I became a better, more critical thinker,
what I noticed was that if you provided alternatives for
the animal– alternative reinforcers– an alternative would be, for an
example, if you provided a sexually receptive mate in
the cage with the animal. No longer isolate animal, but
provide the animal with an alternative, a sexually
receptive mate. Or even some treat, like some
sugar water, or some activity, like a running wheel. If you provide these
alternatives, the animal no longer kills themselves
with the drug. They no longer exclusively
take the drug. These alternatives become more
attractive, in many cases. So I thought, hmm, that is what
happens in animals, but is that what happens
in humans? One of the earlier studies that
I did was I brought some crack cocaine addicts
into our lab. Of course, we passed all of
the ethical requirements, brought some research
participants who were crack cocaine addicts into the
lab, allowed them to self-administer– choose to take the drug,
if they want. But, in this case, we also
provided alternatives. The alternatives were something
like money– cash money– or merchandise vouchers, other
things, and you could vary the amount of money and
also the impact of the merchandise voucher. When you do that with escalating
doses or escalating amounts of money, you
can wipe out cocaine self-administration. The addicts no longer choose
to take cocaine. Instead, they take the money. Say, how much money? Well, if you provide the
addict with $1 as an alternative, they will
probably take a nice dose of cocaine. Well, any rational person
probably should do that– if they have experience with
cocaine, of course. For people at home, this is
not to encourage people to take cocaine. That’s not the goal. But if you provide the person
with $5 as the alternative, now they would choose the drug
on about half of the occasions, and the money on
about half of the occasion. And you can completely wipe out
self-administration of the drug if you provide $20
as the alternative. All of this is rational, and
that’s precisely how people who use drugs– people are
addicted to drugs– behave. Rational behavior. So now that myth was
shattered for me. I no longer thought that cocaine
addicts or any other addicts are motivated solely
by another hit of the drug. The science, the evidence,
just simply doesn’t support that. So another sort of more recent
myth that I discover had no foundations and evidence is this
notion that these drugs cause these cognitive
impairments in people, in the users. So one of the drugs that I now
study is methamphetamine. And if you look at
the literature on methamphetamine– whether it’s the scientific
literature or the popular literature– there’s this notion that this
drug causes all types of cognitive impairments. Well, last year I published
a critical review of the scientific literature, and I
concluded that we, in science, have overstated the extent
of cognitive impairments in this group. There are virtually none
found with this group. When you look at the literature
carefully, and you have the appropriate controls,
and the studies are rigorous, you don’t find these cognitive
impairments. Another myth shattered. And you can do this with
the brain imaging data. When you look at
methamphetamine, the same is true with the brain
imaging data. These negative effects have
been wildly overstated. And you know it makes sense
because when we think about methamphetamine as a drug– you all know Adderall, right? Everybody knows Adderall. Adderall’s the drug that we
prescribe for Attention Deficit Disorder. Children take it, adults take
it, writers take it, people who need to write programs
take it. A wide range of folks
take this drug. So when you look at Adderall,
the active ingredient is amphetamine. And then you compare it to
methamphetamine, they are essentially the same drug. Methamphetamine has an
additional methyl group that probably doesn’t contribute to
its biological activity or pharmacology. I have done the studies in which
I’ve compared the two drugs in the same people, and
I measured behaviors– from cognitive behavior,
subjective effects behavior, a wide range of behaviors, heart
rate, blood pressure– and found that the drugs exert
identical effects. But I’m not the only one
who’s done this. Other researchers have
also done this. We’ve known this since 1971,
when the first paper in this area was published in People. Yet the public seems
to think that methamphetamine is some new drug. It’s not new. It’s the same drug
as amphetamine. And we currently prescribe
amphetamines to our military. Some folks who are working
extended periods of time. So we have a long history with
amphetamines, and we know quite a bit about
amphetamines. And they can be useful in some
situations, of course. So that myth that
methamphetamine is so dangerous shattered. So in the book, I go down
a number of myths and I shattered them. And if these are not true– some
of these assumptions that we have about drugs are not
true- in led me then to say, well, what is our drug policy
based on if this information isn’t true? Well, our drug policy is
primarily driven by hysteria and misinformation. And the people who make our
drug policies are more concerned with sort of
faith-based thinking as opposed to evidence-based
thinking. And so, given that that’s the
case, I thought that in “High Price”, I like to talk to
the adults in the room. I’m trying to have an adult
conversation about drugs. And if you do that,
you have to say– people will say, well, what do
you think we should do, then? Given what you laid out. What do I think the
country should do? Well, I’m glad you asked. This is what I think the
country should do. Each year, we arrest 1.5 million
people for drugs. Each year. 80% or more of those people
are for simple possession. Just simply buying,
using drugs. Simple possession, not sales. That’s 80%. Also, when we look at the racial
disparities in our enforcement of drug laws, we
find, for example, you guys have heard the crack
cocaine powder cocaine disparity, right? Well, maybe you haven’t,
this is Google. All right, OK, let me
just explain it. In 1986, we passed legislation
that punished crack cocaine 100 times more harshly
than powder cocaine. Now, the only difference between
these drugs is that powder cocaine has
a hydrochloride salt attached to it. That hydrochloride salt prevents
it from being smoked. That’s the only difference. Now, the effects of cocaine
is determined by the base. Hydrochloride– powder cocaine has the
base, whereas crack cocaine is just a base. It’s just cocaine base. So they’re the same drug, but
we punish them differently. Now, what does that mean in
terms of drug enforcement, racial disparities? Crack cocaine, of course,
has a harsher penalty. 85% of the people who we arrest
and prosecute for crack cocaine offenses are black, even
though most of the people use crack cocaine are white. So you have these type of
disparities through the enforcement of all of our drug
laws, which has resulted into this situation. Right now, in the United States,
black men make up about 6% of the population. They make up 35, 40% of
the prison population. We have more people in our
prisons today than any other country that has inhabited
the earth. We have 5% of the world’s
population, 25% of the world’s prison population. All of this is mainly driven
by our current drug laws. So that leads me to say– and given what I know
about drugs– that we’ve been lied to about
the potential harms. Not that they’re not potentially
harmful, because we’ll come back to that. I just want people to understand
that I know that better than anyone. But since we’ve been lied to
about drugs and our policies are based on some false
assumptions, I’m arguing in “High Price” that we should
decriminalize all drugs, from methamphetamine to heroin,
to cocaine. Decriminalize everything. Now, some people say,
well, why should we legalize all drugs? That’s not legalization. Legalization is what we’re
doing with alcohol. Alcohol, you can purchase it,
people can sell it without fear of criminal prosecution
if they are 21 years and older. Decriminalization, sales of
these drugs remain illegal, and you can still be criminally
prosecuted. The thing that changes
is possession. Remember, we’re arresting 1.5
million people, 80% or so are for simple possession. Possession of these drugs under
decriminalization will be treated like a traffic
violation. You will no longer be subjected to a criminal offense. The drug’s still not legal, but
we won’t ruin your life. Because if you get a felony
for some drug charge, it decreases the likelihood that
you will get a job, you can be legally discriminated against
for some housing, some student loans, a wide range of things. Consider this, for example. Our last three presidents– the current president,
Barack Obama, George Bush, and Bill Clinton. Barack Obama used cocaine
and marijuana. George Bush used marijuana,
widely suspected of having used cocaine. Bill Clinton used marijuana– although he said he
didn’t inhale. Now, I could say some things
about that, if you were getting high with him and he
was blowing your marijuana, but I won’t. The point is, is that those
three guys all engaged in this illegal activity. They didn’t get caught. But if they did, if the war on
drugs was as intense as it is today, and one of those guys
would have gotten caught– and the one most likely to have
been caught is Barack Obama, because we’ve go after
the black people with a special sort of intensity with
this sort of thing, right? It one of those guys would have
got caught, they would not have become president. They all have made contributions
to the country, despite your politics,
that’s a fact. But the point is, if they
would’ve gotten caught, those contributions we would not
have benefited from. So I’m arguing in “High Price”
the same should be done with everyone else. Now, I also argue that if
you’re going to have decriminalization– I should just say briefly that
the idea of decriminalization is not new. The country of Portugal has
decriminalized all drugs, and they have done this since 2001,
and they are faring better than us on all of
the major indicators. And they are doing as well or
better than their European counterparts on all of
the major indicators. Levels of drug use, drug related
deaths, all of those sorts of things. And also, in this country, we
have decriminalized marijuana in a growing number of states. So decriminalization is
not something new. But if you have
decriminalization as I’m arguing, you have to also
increase the amount of realistic education
surrounding drugs. That means that you can no
longer run those public service announcements about this
is your brain on drugs. Are you guys old enough
to remember that? With the frying pan thing, and
the guy says, this is your brain on drugs? So you can no longer do those
type of advertisements and that type of propaganda. You must now have realistic
education. And you say, what does realistic
education look like? We can go down the line,
drug by drug, I do this in the book. Take methamphetamine. One of the major effects of
methamphetamine is that it keeps people awake. We know that sleep
disruption– chronic sleep disruption– is inconsistent with
good health. So if you have chronic sleep
loss, it’s associated with health consequences like
some types of cancers. It’s associated with psychiatric
illnesses, like psychotic disorders. So you want to make sure people
are getting sleep. If you’re taking amphetamine
that keeps you awake, you want to encourage folks who are
taking the drug not to take it near bed time. Methamphetamine is also good
at increasing cardio-based vascular activity– heart
rate, blood pressure. Number one killer in the United
States– heart disease. You want to tell people if you
have compromised cardiac functioning, you probably
don’t want to take amphetamines or other
stimulants, right? Heroin. What would realistic education
look like with heroin? Recently there’s been a number
of reports in the major press outlets about opioid and
heroin overdose deaths. Now, what these reports failed
to do is to say that 75% or more of these deaths are
not caused by heroin or the opiate alone. They’re caused by combining
heroin or another opiate with something like alcohol. So the major concern with a
drug like heroin is that people combine it
with alcohol. It increases the likelihood
of overdose. If you simply don’t combine
this drug with alcohol or another sedative, you
considerably decrease the risk for overdose. So what would realistic
education look like for cocaine? Today a large percentage of
cocaine is being cut with– or adulterated with– a
drug called levamisol. It is an animal dewormer, one of
its side effects is that it decreases white blood cell,
decreases the person’s ability to respond to infections,
and in extreme cases, people can die. So you want to make sure
that people were not taking bad cocaine. You want to test the cocaine
on the street. You want to let people know what
the real problem may be. The real problem may be this
adulterant, this cut product. So we can go on and on
about what realistic education would look like. Now, at this point, I see
a hand up, at least one. I think it’ll be better if
we– what do you think? You think we should open
it up for questions? We’ll do that. All right, we’ll do that. OK, we’ll open it up
for questions. You have to come to
the microphone. So now we have to
wait for you. You just interrupted me, and now
we have to wait for you. AUDIENCE: So I was wondering,
for example, when you say if you want to test for cocaine,
I think probably decriminalization would
not just do it. You probably would have
to legalize it. So I’m wondering why are
you stopping at that? Is it just a mini step to get
people to finally legalize it? CARL HART: Thank you. The question was why
am I not advocating for legalizing drugs? Great question, thank you. One of the things that I am
concerned that might happen. So, as you legalize drugs and
then you have opponents to legalizing drugs, they will be
waiting for any event to say that this is the negative
effects of legalizing drugs. Now, what I’m arguing is that
we inoculate the population from such hysteria and
misinformation by providing more appropriate education about
what drugs actually do, and what drugs don’t do. So if you have a more drug
literate society, you can no longer make these exaggerated
claims about a drug. Think about marijuana. In the 1930s, we said that
marijuana caused people to go out and murder their mothers. We did, and people
believed it. Harry Anslinger, he was the
commissioner of the Federal Bureau of Narcotics. He said that it was
the most dangerous drug known to mankind. And we, as a society,
believed it. Now, if you say that today,
people will look at you like you’re crazy, right? And rightfully so. And one of the reasons that
they would because we have increased amount of information
about marijuana today, in part because it is
now marijuana is the most widely used illicit
drug in the world. And so, it’s harder to fool
people with this information because of their own education,
because of better education about marijuana. But certainly, if we take
a drug like bath salts. If you make these exaggerated
claims about bath salts, far more people in this society are
more likely to believe it, even though it’s
an exaggeration and it’s not true. You see this today
with bath salts. People are saying these
kinds of things. Other questions? AUDIENCE: Hi. Good talk. Do you think that the
politicians that were initially promoting
the war on drugs– were they influenced by the bad
science, or did they have other reasons for pushing
this on the population? CARL HART: So, do I think that
the politicians were motivated by bad science? One thing I want to make clear
is that science is simply a methodology, and most
of it is not bad. It’s the interpretation from
science– if you look at the data, the data don’t lie. The politicians, I believe,
we’re more motivated by this fact– as a politician you
have constituents. They have problems, and they
expect you to help solve them. Drugs are excellent
scapegoats. So, if you have communities that
have high murder rates. I don’t know, for whatever
reason– you have increased amount of males at a certain
age, at a certain time, that certainly is a reason for
higher murder rates. You have unemployment,
people not working, a lot of idle time. All of these sort of things
contribute to the murder rate. But if you can say it’s because
of crack cocaine, all you have to do now as a
politician is to go after crack cocaine. Remove the crack cocaine, or
show the people that you’re putting lots of money into law
enforcement efforts in removing cocaine. And they think, oh, yeah,
Representative Johnson, he’s our man. He’s doing what we
want him to do. Even though crack cocaine has
little to do with the murder rate, little to do with the
fact that people are unemployed. But it’s an easy sort
of scapegoat. Yes. AUDIENCE: Hi. So admittedly, I don’t have
very much first hand experience with people using
hard drugs, but– CARL HART: You say that like
you’re embarrassed of it. AUDIENCE: No, I say that as,
I guess, a qualifier to my question, which is, a lot of
the things you said were, I found, pretty surprising. Like, if you offer a crack
cocaine addict $5, it’s a coin flip as to whether he’ll take
the money or the drugs. How does that square with the
sort of popular media image of junkies stealing from their
mothers or their grandmothers to fund their drug habit? CARL HART: Thank you
for that question. Certainly, you have people who
use drugs and they engage in those bad behaviors that
you just said. There are certain people who
will rob somebody to support their drug habit. We certainly can show that. Now, what people don’t
do, or what they fail to do is go deeper. So it’s like, well, was this
person robbing people before they used cocaine or whatever
drugs they’re using? Probably so, yeah. And then, when you look at the
majority of people use cocaine, are they engaged
in that behavior? Not no, but hell no. So when you have a more
comprehensive look at the data, those stories
don’t hold up. But those stories make
great films. They are great for documentary
filmmakers, who we think of as being more thoughtful. They are great for reporters,
they’re just great stories. Even though they’re more
fictitious or they’re less representative of the
broader picture. So it’s a hard sort of
image to get out of the American conscious. But they simply are
aberrations. AUDIENCE: Thank you. AUDIENCE: Hi. CARL HART: Hi. AUDIENCE: Some of the other
advocates of more sensible drug policy– like your colleague Professor
David Nutt in the UK– they very often compare the
harms of illegal drugs with legal drugs like alcohol, and
tobacco, and caffeine, and even horse riding. And that is very controversial
in the UK. But I think it highlights the
fact that these things are comparable, but only in a very
niche scientific community, and the public doesn’t really
like to compare their horse riding with their ecstasy. Well, because they call
the drug equasy. CARL HART: I hear you. AUDIENCE: So yeah, he wrote a
paper about comparing equasy with ecstasy. So, what do you think
about it? Do you think that comparison can
lead to more sensible drug policies, or does it hinder? CARL HART: Well, I’ll stick with
the comparison between the prescription drugs
or the legal drugs and the illegal drugs. Because, like my man here, I
don’t have much experience with horse riding. So one of the things that
concerns me sometimes when we make these comparisons with
alcohol or legal, prescription drugs in our zeal to show people
how comparable, say methamphetamine is to Adderall,
we vilify Adderall. And that’s not my goal, because
Adderall actually helps a large number
of people. And my goal is not to vilify
alcohol either, because the vast majority of people who
drink it do so safely, it contributes to the tax base. It also– well, it makes them more
interesting at parties sometimes, right? So I don’t want to vilify those
drugs, but it’s clear that the body does not make the
same distinctions that we make in society. So the body doesn’t make
a distinction between methamphetamine and Adderall. It doesn’t make that
distinction. That’s our own distinction. And that leads to us making drug
policies based on social factors, cultural factors,
rather than pharmacological factors. When you go through the history
of our drug policies, drug policy is based largely
on cultural and social factors, and less
on pharmacology. Because if that was the case,
our legal and illegal drugs would look differently. AUDIENCE: So I really enjoyed
your talk, thanks for coming. CARL HART: Thank you. AUDIENCE: I want to go
back to the issue of the legality of sales. Because most of what we, as
a society, perceive as the negative effects of illegal
drugs are due to their prohibition. You have gang issues with
sales, you have all that illegal money flowing around,
being used to buy guns and things like that. And it seems to me like, while
obviously, the arresting and throwing in jail of a huge
percentage of the population for simple possession is a worse
evil than all this gang violence, it seems like it’s a
very close second, and that getting rid of a lot of the
perceived negative effects of drugs in communities– like New York, which has a
history of having an issue with crack– could be a huge step in
trying to change the perception about drugs. Because when there’s less
violence or less theft around drugs, you would seem to have an
increased understanding of how it’s not necessarily
as big a problem. CARL HART: Is there a question? I’m sorry. AUDIENCE: I guess is there a
way that you think that we could focus on the legalization
of sales, or providing some legal outlet to
get clean drugs and legal drugs without and getting
some of the money out of these back channels? CARL HART: I see. I haven’t really thought about
legalization that far yet, because of our ignorance
with drugs. My goal as a
neuropsychopharmacologist is to help people understand drug
affects, more so than the legality in the markets and
that sort of thing. I’m less versed on that. And I recently wrote a piece in
the New York Times, saying that public intellectuals
should stick to their expertise. I’m going to take my own
advice with that one. Yes. AUDIENCE: Hi. Thanks so much for coming. CARL HART: Thank you. AUDIENCE: You mentioned
Portugal, and I’ve read a little bit about it, and it
seems they decriminalize and then also shifted some public
resources toward treatment and things that we would call soft
punishment, so when somebody who commits a criminal act gets
arrested for that act and they also happen to be on drugs
while they committed the act, they’ll have rehabilitation
programs that they’re sentenced to and
treatment programs. And I’m just wondering, is
there much science– because, certainly, drug
addiction is bad, and it can get people to do– is there much
science on what treatment methods actually work to get
someone off a drug that is causing them to do– CARL HART: Yeah. So in the book, I talk about
some of the treatment programs that we have. There’s a lot of good treatment
research going on in the country. One of things I describe is this
program or this strategy called contingency management,
where you, essentially, pay people to stay off drugs, and
you give them skills, so you increase the likelihood of them
getting jobs, and those sorts of things. So, yeah, I think
we’re doing– although there is this belief in
the country that treatment doesn’t work, that’s
just not true. There are a number of good
programs that are available to people. But the problem is, is that
there are also a lot of bad programs, and a number of people
go to those programs. I don’t talk so much about
treatment in the book. I do talk a little
bit about it. In this book, I’m not
as concerned– or the focus is not on the
10 to 20% of those users. The focus is on the 80, 90%. It’s been alluded to here, why
do we continue to do this awful strategy that I laid out,
when many of us think it doesn’t work? Well, we continue to do it, in
part, because of the frame that we’re talking about. The frame is either
jail or treatment. But the majority of the people
don’t need either. But that’s our current frame. And you have treatment providers
who have a huge stake in his drug hysteria game,
because they want to keep the laws and the way we
view drugs the same way. Because if the people are
not going to jail, they’re coming to them. And, of course, law enforcement
has a huge stake in continuing the same strategy
that we’re doing, because we spend $26 billion
a year on our controlling of drugs. 70% of that or so is going
to law enforcement. That’s a lot of money,
and there’s a lot of jobs at stake. And so, that frame is a narrow
one, and it’s one that I’m trying to break out of
in “High Price”. AUDIENCE: Thanks. Fascinating. AUDIENCE: Hi. Thank you for coming. CARL HART: Thank you. AUDIENCE: So I was curious
about your thoughts with regards to teenagers
and preteens. So decriminalization is based
on somewhat of an assumption that an individual can
make a choice. And when I was 16, I thought I
was able to make a choice, but in hindsight, I was
pretty stupid. CARL HART: But yet you work
at Google, and you are doing well in life. AUDIENCE: I manage. So what are your thoughts, with
regards to approaches, what’s the right framework for
a population that, perhaps, does need some protection? CARL HART: You have children? AUDIENCE: Nope. CARL HART: OK. Well, I do. I have a 12-year-old,
18-year-old, 30-year-old. So I get asked that question
a lot about children. You would deal with them in
terms of this subject in the same way you deal with them in
another potentially dangerous activities. Driving a car, you make sure
they have skills to do that. You make sure that they
understand under what conditions that should happen,
and how it should happen. Sexual behaviors. I’m sure you had sex at– I don’t know when. That’s a joke. But the point is is that that’s
certainly a potentially dangerous activity, and we
manage to make sure that our kids stay safe. The same is true with drugs. Give them the appropriate
amount of education. They understand that if you use
some drugs before school, that’s inconsistent with
the goals of this household, the family. And so, you just treat it just
like any other activity that might impact negatively
on their ability to do well in life. Thank you. AUDIENCE: So, I have a non-drug
question here. You mentioned in the first
section of your talk, while you were in England, that you
were able to sort of ground your knowledge of American
history there. For people who do not have the
opportunity to leave the country, especially when
they’re younger, is it possible to get that kind of
grounding in history now, is it easier or harder now, and
what sort of outlets are you aware of, if any, for
people to pursue? CARL HART: That was
a great question. Thank you. One of the things I try to do in
“High Price”, I try and aim it towards those folks, like me,
who grew up ignorant about our history here. So I hope that those people,
they’ll have more potential education or information in
books, like “High Price”, that’s one. And then people like me speaking
out, even though it’s popular to do this, pointing
out what the issues are. But you asked the question, is
it more difficult today or easier today than when
I was coming up. Think it’s more difficult for
young, ignorant people in the situation where I was in when
I was younger, in part, because they’re told that we
have a black president, and things are improved. But yet, rarely do we hear
anything coming from the official administration about
problems related to race in the country. And so, there was a time– when Ronald Reagan was
president, when I was coming up, for example– we were happy to criticize him,
particularly about all the things that he was not
doing for the community. Folks who are community
protectors now are a lot more reluctant to do those
sorts of things. So I think young, ignorant
people in those situations, I think they have it more
difficult now. AUDIENCE: I have a
lot of questions. So, my first question starts
with, because you touched on children, right? And one of the things I want
to know is, is there any science or evidence
behind what makes someone become an addict? Because I actually feel that
it permeates all walks of life, all colors. It’s more of a personality
thing. Are there any thoughts
on that? And then the second question
I have is, because I do have children. You mentioned having
a home, right? And having rules which clearly
you grew up in, right? But what about these communities
where there really aren’t those rules, because
there isn’t a nuclear family to keep younger kids today from
growing up and being just like those that are
around them? So how do you stop that? Because I couldn’t agree with
you more on the drug conversation. But how do you educate
them all together? CARL HART: Now, I should tell
you, it’s difficult for me– my working memory
has been taxed. So I need you to repeat
that first question. AUDIENCE: So, the first
question is, is there any evidence– CARL HART: Oh, personality. AUDIENCE: Just about
the personality. Because it does seem
to me, and I– CARL HART: Right on. I got you. AUDIENCE: I am totally a
proponent of drugs it is not a color thing. CARL HART: It’s OK, we don’t
have to do our personal divulging here, it’s
all right. AUDIENCE: Oh no, no, I mean,
I’m just saying if someone says it effects one race or
one gender or whatever disproportionally to the other,
I completely disagree. I think it’s a personality
thing. CARL HART: So a personality
thing. There is no evidence to support
the idea that somebody has an addictive personality. Although it works well in
terms of pop culture. But there’s no evidence
to support that’s. That’s one. And you’re right– drug addiction certainly
does not discriminate. That’s the fact. But you’re asking is there any
evidence for us to know what causes someone to become
addicted to drugs? A lot of science is looking
for the biological sort of explanation, as well
as it should. But I think that it’s more
simple than that. If we look at the criteria
for addiction– inability to cut down your use
of the drug, using the drug in situations that are places you
in, potentially, harm’s way, using the drug despite the fact
that you have knowledge that it causes you physical
or psychological problems. So, you go down the list of
these criteria, and these criteria mainly are sort
of behaviorally irresponsible people. And so, when you look at that
throughout, it tells you that even before the drug use,
folks may have been over-indulging or irresponsible
in some ways. Of course this isn’t the case
for everyone, but I think that’s a large component. And so I think that if we simply
look at the behaviors, help people to get better
skills, a wide range of things– how to be more
responsible, a wide range of things. So I think that we
have overlooked those sort of factors. Now, back to your second
question, about what about in the communities where
people don’t have rules, as you put it. Believe me, there are rules
in every social circle. There are rules. You may not understand those
rules, but there are rules. And I wouldn’t worry
about that so much. I’d worry more about making sure
that those communities, those people, have
a stake in the society, the larger society. And one way you do that is
make sure they have jobs. Make sure that they have
potential opportunities to contribute to the
larger society. Make sure they’re not
socially isolated. All of those are far more
important than us worrying about whether they have rules. And one of the things that
concerns me most of all is when I give this presentation
to certain groups, they say that they are concerned about
those communities, but that concern is disingenuous. Because their only concern when
someone like me comes along and say, hey,
we need to do something radically different. But when you look at– have you gone? Have you said anything? Have you contributed? Have you tried to change
the situation in those communities? No. And so, I think that the things
that I outlined– skills, jobs, all those– are far more important. AUDIENCE: One other thought. CARL HART: Sure. AUDIENCE: So you had said
originally you benefited from playing sports, I did, too. It kept me engaged in school,
I did well, it was one of those things. For you, you probably just
kept going, right? So in these communities where
there are no longer the programs that you had available
to you in tandem with your call for saying, OK,
let’s at least decriminalize drugs, are you also championing resources so that– because you do worry that it
only self-perpetuates. It becomes a self-fulfilling
prophecy if no one actually breaks that cycle of what they
believe is happening, even within the isolation of
these communities. CARL HART: Certainly. Your point is, is that
if we’re calling for decriminalization, that
alone is not going to solve the problem. I agree wholeheartedly. The goal is to also make sure
that our politicians, our population understand that we
have to provide skills, jobs, education about drugs, as well
as other, broader education. So I agree wholeheartedly, and
I certainly try to say that. Timeout? Heather? OK, Heather’s said
it’s time to go. All right. Thank you all very much.

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