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Let’s quit abusing drug usersCarl Hart, TEDMED 2014There are some things you should know about me. I grew up in the hood in Miami. I came from a poor family, from a community where drug use was prevalent. I kept a gun in my car, engaged in petty crimes, used and sold drugs. But, I also stand before you today a professor at Columbia University who studies drug addiction.So I know what you’re wondering. How in the world did I get from there, to here?The fact is...on the streets of South Florida, where my family lived...on the wrong side of the tracks, the wrong side of the poverty line, and sometimes on the wrong side of the law...I should have been dead or in jail before my 17th birthday.Fortunately, a few key decisions changed my life course. After high school, I join the Air force. Joining the Air Force started me on the path to higher education and I ultimately earned my PhD in Neuroscience. I decided to study Neuroscience specifically because I wanted to fix the drug addiction problem. You see, I fully believed that the poverty and crime that my community faced was a direct result of crack cocaine. So, I reasoned, if I could cure drug addiction, I could fix the poverty and crime in my community. We were told, and I fully believed, thatcrack cocaine was so addictive that a user only needed one hit and they were hooked. So, in 1986, when congress passed laws punishing crack cocaine 100 times more harshly than powder cocaine, I thought that was quite appropriate. After all, 16 of 20 congressional black caucus members voted for this legislation! I thought it sent a clear message to crack dealers and users in places like my old neighborhood –we won’t tolerate you destroying our community!
But, I was unprepared for what I would learn as Imade my own contribution to understanding the neuroscience of drug addiction. And, what that meant for how I viewed the role of drugs in the poverty-and-crime cycle. I first began to question my thinking when I discovered that drugs like crack cocaineare not as addictive as I had been told. There is no drug in which one hit will make you an addict. The data clearly show, 80-90% of people who use drugs do not have a ‘drug problem’! They are responsible members of our society. They are employed; they pay taxes; they take care of their families. And in some cases, they even become President of the United States (show photo of last three U.S. Presidents). All three of these men reported using illegal drugs when they were younger. The point is not to tarnish the reputations of these men --they all served their country. My point is that their drug use did not result in an inevitable downward spiral leading to debauchery and addiction. And the experience of these men is the rule, not the exception --the overwhelming majority of drug users are not derelict addicts.The basis for the “one hit and you are hooked” idea comes from experiments done in the 1960s and 70s. Laboratory animals -when allowed unlimited access to drugs like cocaine and methamphetamine –will press a lever repeatedly to receive intravenous injections until it kills them. These early experiments confirm drug-seeking-until-death. But, that is not the whole story. The cages of these animals, in the experiments I just mentioned, onlycontained a lever that led to intravenous drug injections –nothing else. The most interesting part to me, however, was what happened when the animals were presented with a choice between the drug lever and non-drug alternatives such as toys, sexually receptive mates, or sweet treats. When given any other option, animals do not self-administer drugs until death. In fact, animals will often choose non-drug alternatives over drugs!In my own lab, I followed up on these findings using human participants. We recruited ‘crack addicts’ from the streets of NYC. By the way, my use of the term addict conforms to the DSM