Chronicle Book Review: High Price

High Price: A Neuroscientist's Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society, by Dr. Carl Hart (2013, Harper/Harper Collins Publishers, 340 pp., $26.99 HB)

Dr. Carl Hart grew up black and poor in Miami in the 1970s and 1980s, learned discipline from his desire to be a professional athlete, joined the armed forces, and wandered almost by happenstance into a career in the neurosciences. Now, Hart is at the pinnacle of his field -- a respected researcher in drug effects, the first African-American to become a tenured professor in the sciences at Columbia University, and a member of the National Advisory Council on Drug Abuse and Dependency. And he has some things to say.

Some of those things contradict the conventional wisdom, but Hart has the cred -- both street and academic -- to state them. Although it is the addict or problematic drug user who is too often the media's face of drug use or the subject of scientific research, he notes, the vast majority of drug users are not addicts or problematic. And yes, that even extends to the most demonized drugs, like crack. While we were told one hit could get you strung out, it turns out only a small fraction of crack consumers are addicts, he points out.

Hart also has good, practical advice -- naive drug users shouldn't take drugs the same way experienced users do, for example, or get enough sleep! -- based not only on scientific research, but also personal observation and experience. Now at the pinnacle of his profession, he also wants to restore some sanity to our drug policies.

Dr. Hart has come a long way from the mean, if sun-splashed, streets of Miami, and with High Price, he takes you along for the ride. The journey is well worth it. Part memoir, part social history, part drug science, part plea for sanity on the issues of drugs, race, and class, High Price is revelatory as well as readable, illuminating as well as incisive, as impassioned as it is important.

While Hart grew up the wrong color and in a family scrabbling to hang on to its lower middle class status, his is, above all, an American story -- a story of coming of age, overcoming adversity, and striving for success and understanding in a world seemingly stacked against him. It's also the story of the American working class, buffeted by the de-industrialization that began in the 1970s, targeted by Reagan Republicans with cuts in social programs in the 1980s, and mostly dealt with by "tough on crime" and "tough on drugs" policies that have been in place ever since. That the malignant swelling of the nation's prison population is tied to Reagan era policies ( though many of them enacted by Democratic legislators) too often goes unnoted.

But of course, Hart isn't an unhyphenated American, he's African-American, and that means he carries an additional burden, the assumption too many make of criminality based on little more than his skin color. He wasn't expected to succeed, but to become a number, like so many of his peers. And, as he notes, but for the grace of god he could have gone down that path. He recounts the teenage criminality of he and his peers, making the stark point that a single arrest could make the difference between a career as a scientist and a career as an ex-con car washer. Some of his friends, no better or worse than he, had that unfortunate first encounter with law enforcement and the criminal justice system and never recovered: Educational opportunities blocked, job opportunities lost, they were essentially assigned to the scrap heap.

For some of them, it was a drug bust. Slinging dope was and is a way of life for the marginalized poor, an income, although not a great one, and a way to achieve status and respect. But of course, it's also a ticket to the slammer, particularly if you're poor and of color, without the resources available to middle class white folks. One thing Hart makes crystal clear is just how stacked the deck is against the urban poor, and that alone makes his book worth noting.

Hart grew into young adulthood imbibing the conventional wisdom about how drugs had had such a devastating impact on his community, but he also began to start thinking critically about the mismatch between rhetoric and reality. At some point along the way, he had a Chris Rock moment.

"You know what they say, crack is destroying the ghetto," Rock once famously observed. "Yeah, like the ghetto was so nice before crack. They say that shit like everyone in the 'hood had a yacht, a mansion, and a swimming pool, and crack came by and dried it all up."

As Hart began studying psychology and eventually neuroscience, he began noticing that the effects of crack cocaine widely touted in media and political discourses didn't match the science. In fact, he observed, most of the devastating effects attributed to crack could more fairly and accurately be attributed to poverty. Crack didn't bring guns to the ghetto; they were already there. Crack didn't bring broken families to the ghetto; they were already there. It may not have helped, but it was not the root cause of the problem.

"The effect of crack, when it had one, was mainly to exacerbate the problems that I'd seen in my home and in the hood since the 1970s," he wrote. "The drug's pharmacology didn't produce excess violence."

The studies on which he embarked, moving on from observing the effects of drugs on rats to observing their effects on people, led him to a startling -- and eye-opening -- conclusion: "Much of what we are doing in terms of drug education, treatment and public policy is inconsistent with scientific data."

Hart's critique extends to the science itself. He describes famous experiments where rats or monkeys alone in a cage will repeatedly press a lever to get more drugs, up to the point of death itself. But he then explains how those doses are many times higher than those any human would use, and he makes the crucial point that obsessive drug-taking behavior is reduced when the lab animals are part of a community and when they have other options.

Based on his scientific research, as well as his own observations and historical research (and musical and lyrical inspiration from the likes of Bob Marley and Public Enemy), Hart decided he needed to speak out against the injustices of the war on drugs. He became a board member of the Drug Policy Alliance, he began speaking to groups large and small, and High Price is part of that same education project.

This is not your typical drug policy tome. It's not a paean to pot, nor is it a dry academic treatise. But it is important, not only because it provides a voice for the voiceless peers he left behind, but also because it is a science- and evidence-based clarion call for a smarter and more human approach to drugs, one that situates drugs and problematic drug use within the broader social context. And it's a damned good read, too.