I love Dr. Carl Hart.

He’s a science hero.

And he’s a social justice hero.

His other book High Price was a shot to the heart.

(Read my review of it here: https://www.goodreads.com/review/show/928298699)

High Price is so brave (daring even) and so honest that reading it is like watching someone walk across a tightrope without a net.

I am so deeply inspired by Dr. Hart.

Reading High Price normalized many of my (outsider - non-traditional student/therpaist) experiences in academia and in the mental health field.

It felt like a good supportive friend, or a powerful ally, speaking directly to me and saying (in essence) be who you are.

Hold on to your truth and speak it freely.

There is space for you here.

Your experience matters.

Your perspective matters.

Only Dr. Hart’s experiences, and achievements, and risks, and bravery are exponentially amplified (in comparison to mine) by his concurrent experiences of racism.

I feel absurd and awkward saying all of this.

But…

As a white man, I have been afforded countless breaks, second (third, forth, fifth, keep going) chances, privileges and opportunities that have allowed me to succeed in situations where other less privileged people would have been either excluded or thrown in jail forever.

I don’t say that out of guilt.

I’ve quite simply had some EXTREMELY lucky breaks that had absolutely nothing to do with my merits as an individual, and probably everything to do with the fact that I’m a white man.

I don’t feel guilty.

I feel proud of my accomplishments.

But I have to acknowledge my privilege.

I would have to be in utter denial or totally fucking ignorant to avoid this realization. And, you can call me a lot of shit, but I am neither of those things (at least on this subject).

The fact that Dr. Hart can be as honest as he is, and in so doing, incur the enormous risk that he does, by simply speaking his mind, and being open and outspoken about his opinions and behaviors.

I’m humbled.

I’m inspired.

And I feel challenged to aspire to similar bravery.

With the complete foreknowledge that there is no fucking way I could be so outspoken, and so fucking brave, and so fucking honest, and draw my line, and hold my mud, like Dr. Carl fucking Hart.

He’s a hero to me.

That being said.

I think he’s so wrong, about so many things in this book, that I don’t even know where to begin.

Let’s start with all the shit I think he’s right about.

His primary argument is, that people are not dying of drug abuse, they are dying of ignorance.

The general public is so woefully under educated on the subject of psychopharmacology and elicit drug use, as to render them (and by them I mean almost everyone, including most doctors and medical professionals, and especially politicians, lawmakers and law-enforcement) ignorant to the point of being extremely fucking dangerous.

In short, the world needs an emergency education on drugs, and drug use, of all varieties, including over-the-counter medications, and prescription medications, and legal drugs including alcohol and now weed, and also (obviously) illicit drugs of abuse such as amphetamines, opioids, and benzodiazepines in particular.

I couldn’t agree more.

This type of ignorance is killing people by the truckload. Literally 45 minutes of education could change all that. We need to provide everyone with enough education to be informed consumers of medical and recreational drugs.

Dr. Hart is clearly right about the fact that there are two drug policies, one for white people and one for black and brown people.

No amount of counter argument could convince me that drug related legislation and law-enforcement is not inherently biased against poor people, and people of color.

We need to radically reform drug law.

We need to decriminalize, and even legalize drug use.

The data is in.

Dr. Hart is (in my humble opinion) right about so much other stuff, but on these two issues, there can be no honest doubt.

The other thing Dr. Hart has completely convinced me of is, the assertion that “harm reduction” doesn’t go far enough, and actually needs to be retired as a concept.

We as a society, need something so much more robust than our current harm reduction attempts.

We need a full court press, society wide revision of our drug laws, drug policies, drug education, and drug abuse treatment system.

And we need honest, high quality, peer reviewed, and replicated science to utilize in these efforts.

100% yes to all that.

Here’s where I’m unsure.

Dr. Hart claims that much of the neuroscience that has been coming out of the drug abuse research community is biased, or outright dishonest.

I’m not gonna argue with him about the neuroscience. He’s an insider neuroscientist researcher with the national Institute on drug abuse (NIDA).

So I’m going to have to remain agnostic on many of the claims in this book, regarding misinterpretation, or misrepresentation of neuroscience findings, that overstate the harmful effects of drugs on the brain.

I’ll take his word for it, but all of my own research (literature review not original neuroscience research) paints a very different picture.

Here are some of the issues where I think Dr. Hart is wrong, or only partially right.

One of the most confusing and frustrating issues raised in the book was Dr. Hart’s claims that children are being taken away from their parents due to marijuana use. I am a therapist and am as such, a mandated reporter of child and elder abuse. I also work with addicted populations.

If it were true, that children get taken away from their parents because their parents use drugs, the foster care system would be even more bursting at the seams than it already is.

I have consulted with mental health specialist lawyers on many occasions on this exact issue. According to my research, drug use alone, even serious drug use does not constitute abuse or neglect.

I work in California, and will concede that this may be very different in different states. But it has been my experience that child and protective services will not take children out of the home unless there is overt abuse and neglect.

And it has to be bad.

I worked with one family, where the mom and dad were divorced. The mother was a homeless heroin and crack addicted prostitute. The mother squatted in an abandoned building with her 3 children, ages 8, 10 and 16. The 16-year-old was providing protection for the mom while she turned tricks. The dad was a gainfully employed, very responsible, very good parent. He was trying to get custody of the children. And the department of child protective services would not separate the children from their mother.

During my time working in a methadone clinic in South Central LA. I worked with many pregnant women who were addicted to heroin, and transitioned over to methadone. This is a very common issue. And again, the department of child protective services does not intervene in such cases.

Later in my career, I worked with one woman, who was more than 7 months pregnant, who was drinking a handle of vodka and smoking two packs of cigarettes a day.

And this was not considered reportable.

If drug use was enough to get your kids taken away.

Almost nobody would have their kids.

Dr. Harts claims that children commonly get taken away because of parental marijuana use it’s so utterly contrary to my experience that I have literally no idea what to make of it.

Additionally:

I think Dr. Hart downplays the harmful effects, and the risks associated with recreational drug use.

Dr. Hart bravely “comes out of the closet“ about his recreational heroin and amphetamine use.

And I’m completely blown away.

He really has me thinking, and rethinking many of my assumptions regarding the use value of these drugs.

But from my perspective.

As someone who has worked on the front line of drug addiction treatment.

And as someone who has been exposed, and forever effected, by the tragedy, the death, and the misery elicited by addiction.

Rendering these issues as minority cases, as I feel Dr. Hart does, is ignorant at best, and intellectually dishonest at worst.

I have this problem with a lot of researchers.

They don’t spend enough time with actual people, actually suffering, and actually dying from drug addiction.

And simply put.

I do.

So no.

You can’t tell me that only a small percentage of users have a problem with heroin.

While statistically it is true, that only about 10% or less of the people who use heroin, cocaine, amphetamine, and alcohol become problem users.

The problem is.

The only real way to find out if you’re one of those 10%. Is the hard way. It is Russian roulette. And we need to be extremely cautious about the way we communicate the relative risks.

It is true that the VAST majority of people that use drugs recreationally, use them responsibly, and without inordinate harm.

And most problem drug users stop using without intervention, by the time they’re around 37.

In other words they outgrow it.

Additionally, most problem drug users have serious extenuating circumstances including stress, trauma, mood disorders and other forms of mental illness, that contribute significantly to their problem drug use.

Yes that’s absolutely true.

Given that, I believe that the number of people that have these type of “mental health” risk factors, is vastly underestimated.

Granted, I work as a therpaist in addiction treatment, and the clients I work with are a biased sample to be sure.

That being said, I have worked with innumerable people, that have suffered tremendously, that were either unaware of how impactful their mental health issues were, or were intentionally under reporting out of shame and fear.

One men’s group I ran consisted of about 15 young men, most of them from blue collar backgrounds, almost exclusively intervenous drug users. Early in the group, one of the men opened up about his history of sexual abuse, after which the rest of the men in group became quiet and pensive. One by one, each of them, without exception, opened up about how they had been either raped as adults or molested as children. For almost all of them, it was the first time they had dared to tell anyone.

Equally as disturbing but probably less surprising. I have run groups of all women, where every woman in the group had been drugged and raped.

And these are quite simply the most dramatic examples.

Actually, I have heard much much MUCH worse.

But.

Simply put.

There are a lot of people out there, who look great on the outside, who seem high functioning, and who are suffering tremendously on the inside.

Many of whom are either in denial, or simply too scared to admit it to anyone else.

And I think this silent “minority” it’s actually a little closer to the majority.

I think some people use drugs to expand their consciousness and explore their mind.

Others used drugs and alcohol to have fun and unwind.

But a lot of people use drugs to numb the pain.

And almost everybody is a little of both.

I think Dr. Carl Hart has an important message.

And I also think that his activist agenda tilts his message to the left, in order to balance the scale.

But I think the real deal is.

We actually need a synthesis of the dialectic that he’s so eloquently identifies.

This is an important book.

This is a must read.

And it’s so fucking wrong in so many ways.

But I love him.

And I love his work.

And so, I highly recommend this book, with the strongest endorsement, coupled with the strongest reservations I can issue.

5/5 thoughtful, cautious stars ⭐️/