Pubdate: Tue, 17 Sep 2013
Source: New York Times (NY)
Copyright: 2013 The New York Times Company
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Website: http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: John Tierney

TRACING ADDICTION OUTSIDE THE BRAIN

Long before he brought people into his laboratory at Columbia 
University to smoke crack cocaine, Carl Hart saw its effects 
firsthand. Growing up in poverty, he watched relatives become crack 
addicts, living in squalor and stealing from their mothers. Childhood 
friends ended up in prisons and morgues.

Those addicts seemed enslaved by crack, like the laboratory rats that 
couldn't stop pressing the lever for cocaine even as they were 
starving to death. The cocaine was providing such powerful dopamine 
stimulation to the brain's reward center that the addicts couldn't 
resist taking another hit.

At least, that was how it looked to Dr. Hart when he started his 
research career in the 1990s. Like other scientists, he hoped to find 
a neurological cure to addiction, some mechanism for blocking that 
dopamine activity in the brain so that people wouldn't succumb to the 
otherwise irresistible craving for cocaine, heroin and other 
powerfully addictive drugs.

But then, when he began studying addicts, he saw that drugs weren't 
so irresistible after all.

"Eighty to 90 percent of people who use crack and methamphetamine 
don't get addicted," said Dr. Hart, an associate professor of 
psychology. "And the small number who do become addicted are nothing 
like the popular caricatures."

Dr. Hart recruited addicts by advertising in The Village Voice, 
offering them a chance to make $950 while smoking crack made from 
pharmaceutical-grade cocaine. Most of the respondents, like the 
addicts he knew growing up in Miami, were black men from low-income 
neighborhoods. To participate, they had to live in a hospital ward 
for several weeks during the experiment.

At the start of each day, as researchers watched behind a one-way 
mirror, a nurse would place a certain amount of crack in a pipe - the 
dose varied daily - and light it. While smoking, the participant was 
blindfolded so he couldn't see the size of that day's dose.

Then, after that sample of crack to start the day, each participant 
would be offered more opportunities during the day to smoke the same 
dose of crack. But each time the offer was made, the participants 
could also opt for a different reward that they could collect when 
they eventually left the hospital. Sometimes the reward was $5 in 
cash, and sometimes it was a $5 voucher for merchandise at a store.

When the dose of crack was fairly high, the subject would typically 
choose to keep smoking crack during the day. But when the dose was 
smaller, he was more likely to pass it up for the $5 in cash or voucher.

"They didn't fit the caricature of the drug addict who can't stop 
once he gets a taste," Dr. Hart said. "When they were given an 
alternative to crack, they made rational economic decisions."

When methamphetamine replaced crack as the great drug scourge in the 
United States, Dr. Hart brought meth addicts into his laboratory for 
similar experiments - and the results showed similarly rational 
decisions. He also found that when he raised the alternative reward 
to $20, every single addict, of meth and crack alike, chose the cash. 
They knew they wouldn't receive it until the experiment ended weeks 
later, but they were still willing to pass up an immediate high.

These findings made Dr. Hart rethink what he'd seen growing up, as he 
relates in his new book, "High Price." It's a fascinating combination 
of memoir and social science: wrenching scenes of deprivation and 
violence accompanied by calm analysis of historical data and 
laboratory results. He tells horrifying stories - his mother attacked 
with a hammer, his father doused with a potful of boiling syrup - but 
then he looks for the statistically significant trend.

Yes, he notes, some children were abandoned by crack-addicted 
parents, but many families in his neighborhood were torn apart before 
crack - including his own. (He was raised largely by his 
grandmother.) Yes, his cousins became destitute crack addicts living 
in a shed, but they'd dropped out of school and had been unemployed 
long before crack came along.

"There seemed to be at least as many - if not more - cases in which 
illicit drugs played little or no role than were there situations in 
which their pharmacological effects seemed to matter," writes Dr. 
Hart, now 46. Crack and meth may be especially troublesome in some 
poor neighborhoods and rural areas, but not because the drugs 
themselves are so potent.

"If you're living in a poor neighborhood deprived of options, there's 
a certain rationality to keep taking a drug that will give you some 
temporary pleasure," Dr. Hart said in an interview, arguing that the 
caricature of enslaved crack addicts comes from a misinterpretation 
of the famous rat experiments.

"The key factor is the environment, whether you're talking about 
humans or rats," Dr. Hart said. "The rats that keep pressing the 
lever for cocaine are the ones who are stressed out because they've 
been raised in solitary conditions and have no other options. But 
when you enrich their environment, and give them access to sweets and 
let them play with other rats, they stop pressing the lever."

Drug warriors may be skeptical of his work, but some other scientists 
are impressed. "Carl's overall argument is persuasive and driven by 
the data," said Craig R. Rush, a psychologist at the University of 
Kentucky who studies stimulant abuse. "He's not saying that drug 
abuse isn't harmful, but he's showing that drugs don't turn people 
into lunatics. They can stop using drugs when provided with 
alternative reinforcers."

A similar assessment comes from Dr. David Nutt, a British expert on 
drug abuse. "I have a great deal of sympathy with Carl's views," said 
Dr. Nutt, a professor of neuropsychopharmacology at Imperial College 
London. "Addiction always has a social element, and this is magnified 
in societies with little in the way of work or other ways to find fulfillment."

So why do we keep focusing so much on specific drugs? One reason is 
convenience: It's much simpler for politicians and journalists to 
focus on the evils of a drug than to grapple with the underlying 
social problems. But Dr. Hart also puts some of the blame on scientists.

"Eighty to 90 percent of people are not negatively affected by drugs, 
but in the scientific literature nearly 100 percent of the reports 
are negative," Dr. Hart said. "There's a skewed focus on pathology. 
We scientists know that we get more money if we keep telling Congress 
that we're solving this terrible problem. We've played a less than 
honorable role in the war on drugs."
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MAP posted-by: Jay Bergstrom