Dr Hart, a neurobiologist in the land of Civil Rights
Dr Hart’s biography on the Albatros Congress’ website is a masterpiece of understatement. Reference is made1 to his “therapies to reduce cocaine consumption“ and his commitment on behalf of underprivileged patients”. In fact, High Price’s author prescribes psycho stimulants in a medical environment, while denouncing the warfare waged against Afro-Americans in the name of the War on drugs. Seemingly out of place at the annual international congress of addictology, his lecture was in itself a small revolution. ASUD took this opportunity to find out a bit more on this neurobiologist, who fingers the futility of neurobiology.
ASUD: My first question is straight forward: why did you want to become a neurobiologist?
Dr Hart: When I was young — in the 70’s and even more so in the 80’s — crack was extremely prevalent in the black community, and I wanted to have a better understanding of the mechanisms of drug addiction. There was a consensus that crack was destroying the black community. I thought it was my duty to discover the neurobiological mechanisms of addiction, and to cure the members of my community. Poverty and unemployment, all these ills sprung from “crack cocaine”. So I determined to study drugs and the brain, from a scientific viewpoint.
ASUD: And at that time you believed in the power of medicine to cure people who take drugs?
Dr Hart: Absolutely! In biology you discover how much crack cocaine causes brain damage, and so why not use medication to cure people? What interested me was the concept of the medicalization of treatments for addiction.
ASUD: And how long did you pursue this course?
Dr Hart: For a decade. 1990 to 2000. In the U.S. this period was referred to as the “decade of brain”. Consequent funding was made available for the scientific study of the brain. And I was completely steeped in this medicalisation.
ASUD: When did you start having your first doubts on the medical treatment of dependency?
Dr Hart: After having published dozens of articles on as many different medications, I started telling myself: “Hum, they are not working that well after all!”
Not being poor and socially integrated conditions one’s drug usage. After noting this recurring fact thousands of times, my point of view started shifting, as the need to explore other fields of study.
ASUD: So you started investigating alternate means of treatment.
Dr Hart: I looked at the statistics. In 1998, my mentor’s motto was: “Show me the data”. And when I earnestly examined the data, I realized we were barking up the wrong tree. Our priorities were misguided, and should have been more of a psycho-social nature. The data was overwhelming. When I understood the significance of rigorously analyzing the data, I also found the direction I wanted to take.
ASUD: So, could you try to define — for our French readers — the relationship between addiction and racial discrimination?
Dr Hart: The relationship between drug addiction and discrimination? There isn’t any. What there is — is a correlation between drug policy and racial discrimination.
ASUD: So how can policy be changed?
Dr Hart: Part of the problem is that people who study drugs are mainly concerned with addiction. This is irrelevant, because 90% of the people who do drugs, are not dependent… In addition, if you tally drug abusers and dependent users, it only amounts to 10 to 20% of the people who take drugs.
ASUD: How could one stabilize recreational drug users, and prevent them from developing addictions?
Dr Hart: All right, let me give you the numbers for those who go from recreational to compulsive drug taking:
- 10% of those who drink alcohol will become dependent.
- 9% for marijuana
- 15 to 20% for cocaine
- 20% for heroin
- and 1/3 of those who light up their first cigarette.
Tobacco is plainly at the top of the list. The question really is what can a society do to prevent people from becoming dependent. And the answer is: plenty. First off, let’s face up to the real causes of addictions. There are many psychiatric comorbidities, schizophrenia, anxiety and severe depression are all major causes of dependency.
Another category of people develop dependencies because — shit — their life sucks, and they are making a rational choice in abusing drugs. And from their point of view, it’s not the worst thing they could choose…
ASUD: Is it the state’s responsibility to teach us how to use drugs?
Dr Hart: Let’s make an analogy with automobiles. Who’s responsibility is it to teach responsible driving? It’s up to the state to inform you that smoking a drug is safer than eating it. And to warn you “go easy on the dosage if you’re a novice”.
ASUD: By which authority? Doctors?
Dr Hart: What? No. Physicians must not have a monopoly on drug education. Who has the skills to educate people who do drugs? The State employs pharmacologists, educators and legal advisors. They should be used to regulate drug consumption in the same way air traffic is controlled.
ASUD: Are you implying that they should have experienced taking drugs?
Dr Hart: Must a surgeon have experienced an accident in order to treat the victim of one?
ASUD: Of course not, I’m referring to professionals who take into account the users’ perspective.
Dr Hart: Let’s just call that expertise. Opening up one’s mind in order to assimilate the user’s point of view is quite simply, being qualified.
ASUD: OK, I get it. Now I’d like to get your take on two French blind spots. The first one concerns the crime consisting in publicizing the positive aspects of drug taking. The second concerns the directive that no ethnic data may be gathered in any official document. How do these two blind spots relate to one another ?
Let’s talk about the first point. When I gave my lecture earlier today, I started out saying:
“ If this is the first time you are hearing about the positive aspects of drugs during a congress, this casts a serious doubt on the competency of the physicians in attendance. Your patients are suffering…” I was the first lecturer to speak, so of course all the following speakers admitted, “yes there are positive aspects in drug taking”.
The second point concerning racial profiling is just plain stupid. I can understand the generous spirit in which this regulation is enforced, but on a more practical level, it prevents any statistical evaluation of the extent of discrimination… You said French society pretends to be color blind, but in fact a certain part of public opinion — especially on the extreme right wing of the spectrum — spin race issues, in particular when dealing with drugs or prison. We need to know the truth on these issues. The one thing poor people need is the truth on these figures, they don’t have money or charisma, their only hope lies in the data.
ASUD: Is there a link between drug taking and identity disorders?
Dr Hart: Of course. I mentioned earlier that people do make rational choices. So yes, people who do drugs compulsively are experiencing trauma and pain.
Interview by Fabrice Olivet in Paris 06/06/2014