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Review of Carl Hart’s High Price A Neuroscientist’s Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society (2013)

Racism and Addiction

Dr. Carl Hart's High Price - A Neuroscientist's Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society (HarperCollins 2013), is an informative and inspirational read. High Price uniquely combines autobiography, science and behavioural psychology to challenge prevailing views of addicts and addiction. In his words, "the emotional hysteria that stems from misinformation related to illegal drugs obfuscates the real problems faced by marginalized people. This also contributes to gross misuses of limited public resources" (xi). Hart makes a critical contribution that should go a long way toward developing new and more effective treatments for addiction.

Addiction, Context and Behavioural Principles

The recent decades have been an age of new discoveries in neuroscience, and much emphasis has been placed on neuroplasticity and brain chemistry. Hart is cautious of a tendency to reduce "complex human behaviour to simplistic terms like addiction and with trying to blame specific brain chemicals for people's actions" (73).

He shifts the emphasis away from brain chemistry to behavioural principles and argues that mindset, context, and the presence or absence of alternative reinforcers affect whether or not drug use becomes drug abuse, and even whether or not the addicted user will choose to use drugs or not. He supports his very persuasive arguments with research, which includes human as well as animal experiments.

Hart clearly defines two critical concepts that are foundational to his argument - addiction and racism.

Addiction: "To meet the most widely accepted definition of addiction - the one in psychiatry's Diagnostic and Statistical Manual of Mental Disorders, or DSM - a person's drug use must interfere with important life functions like parenting, work, and intimate relationships. The use must continue despite ongoing negative consequences, take up a great deal of time and mental energy, and persist in the face of repeated attempts to stop or cut back. It may also include the experience of needing more of the drug to get the same effect (tolerance) and suffering withdrawal symptoms if use suddenly ceases" (13).

"More than 75% of drug users - whether they use alcohol, prescription medications, or illegal drugs - do not have this problem. Indeed, research shows repeatedly that such issues affect only 10-15% of those who try even the most stigmatized drugs, like heroin and crack. When I talk about addiction in this book, I always mean problematic use of this sort that interfered with functioning - not just ingesting a substance regularly" (13).

Racism: "Racism is the belief that social and cultural differences between groups are inherent and immutable, making some groups inalterably superior to others. While these ideas are bad enough when lodged in the minds of individuals, the most harm is done when they shape institutional behavior, for example, that of schools, the criminal justice system, and media. Institutionalized racism is often much more insidious and difficult to address than the racism of lone individuals, because there's no specific villain to blame and institutional leaders can easily point to token responses or delay meaningful action indefinitely" (14).

Racism, Marginalization and US Drug Policy

The seventeen chapters of High Price develop Hart's informed and persuasive argument that the political agenda behind US drug policy has historically exploited white fear and hatred of blacks, making inner city, "crime, drugs, and urban code for black in the eyes of many white people. Consequently, it gave legitimacy to policies that appeared to be color-blind on the surface but in reality inevitably resulted in increased black incarceration and disenfranchisement" (18).

Evidence from scientific studies shows that crack and powder cocaine are pharmacologically indistinguishable. However, "the law that created the 100:1 crack-powder sentencing ratio was based entirely on anecdotal reports" (291) that exaggerated the harms associated with crack compared to powder cocaine, which is viewed as the recreational drug of the wealthy.

The ratio has recently been reduced to 18:1, but this differentiation continues to disproportionately target, incarcerate and criminalize blacks. Although "news reports and popular media almost always showed black crack smokers," statistics tell another story: "nearly 90% of those sentenced for crack cocaine offenses were black, even though the majority of users of the drug were white" (292-3).

Poverty, Disenfranchisement and Drugs

Hart explains that "though the real proportion of people who became addicted to crack in the inner city was low, it was definitely higher than it was among the middle classes, just as is true for other addictions, including alcohol. Money has a way of insulating people from consequences. . . . The differences in the prevalence of crack problems are mainly related to economic opportunity, not special properties of cocaine. While drug rates are pretty similar across classes (and often, actually lower among the poor), addiction - like most other illnesses - is not an equal-opportunity disorder. Like cancer and heart disease, it is concentrated in the poor, who have far less access to healthy diets and consistent medical care) (271-2).

Furthermore, misinformation and the vilification of marginalized drug users has apparently been repeating itself with methamphetamine: "Like with crack cocaine in the mid-1980s, a relatively small number of individuals from a derided group were seen as users of methamphetamine. They were white but gay, poor, or rural" (294). A major concern for Hart is that the hysteria and ignorance that unfairly vilify drug users also decrease their willingness to seek help if needed.

Decriminalization vs. Legalization

Hart clearly distinguishes between these options.

Legalization: "Our current policies regulating alcohol and tobacco, for those of legal age, are examples of drug legalization: (323-4).

Decriminalization: "Under decriminalization, on the other hand, the acquisition, use, and possession of drugs can be punished by a citation much like traffic violations are. Mind you, drugs still are not legal, but infractions do not lead to criminal convictions - the one thing that has prevented so many from obtaining employment, housing, governmental benefits, treatment, and so on. This is crucial when you consider this fact: each year, more than 80% of arrests in the United States for drug offenses involves only simple possession. Sales of all illicit drugs, however, remain criminal offenses under decriminalization laws" (324).

Dr. Hart's book challenges established mindsets and is replete with the necessary scientific and statistical evidence to substantiate his statements and arguments. It is also a personal testimony of survival as well as an account of grief and loss associated with the disenfranchisement and vilification of targeted communities. It draws attention to the dehumanizing and racist impact of misguided US drug policies and criminal justice system. Hart's science-based information overturns prevailing stereotypes of drug users, indicates approaches to help addicts recover, and empowers individuals, groups and communities advocating for change and social justice.

This book is a "must read"!

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