Drug Users Need Treatment,’ Says President Obama. Not So Fast, Says Dr. Carl Hart


This confuses me… yes to decriminalize/legalize all drugs/medications… allow prescribers to treat/maintain all people who need or abuse opiates.. provide pharmaceutical grade medications… Where do you draw the line between “education” and “talk therapy” or is there a “line “?

“For too long we’ve viewed drug addiction through the lens of criminal justice,” President Obama said yesterday at a conference in Atlanta. “The most important thing to do is reduce demand. And the only way to do that is to provide treatment—to see it as a public health problem and not a criminal problem.”

At least one expert totally disagrees. Earlier this month at South by Southwest Interactive (SXSWi), Columbia University neuropsychopharamacologist Carl Hart gave a talk called “Mythbusting the Drug War With Science” in which he explicitly made the case that the notion that “drug addiction is a health problem that requires treatment” is exactly the wrong way to look at the use of drugs in the United States.

“Politicians today, whether Republican or Democrat, are comfortable with saying that we don’t want to send people to jail for drugs; we will offer them treatment.” Hart said in Austin. But “the vast majority of people don’t need treatment. We need better public education, and more realistic education. And we’re not getting that.”

Why does he say most people don’t need treatment? Because—contrary to widespread perceptions—the vast majority of drug users aren’t addicts. “When I say drug abuse and drug addiction, I’m thinking of people whose psycho-social functioning is disrupted,” he said later in the talk. But for more than three-quarters of drug users (and we’re not just talking about marijuana here, either), that description doesn’t apply.

This overturns the conventional wisdom on drug addiction, but Hart thinks that’s a good thing. We’ve all been fed a diet of panic-inducing misinformation about what drugs actually do to our brains, he says.

Most of us were taught that drugs like cocaine are so addictive that a rat in a laboratory experiment will continue to press a lever to receive the substance—to the exclusion of all its other physical needs—until it actually dies. Hart said at first even he believed that finding to be true. But it turns out, those studies weren’t what they were cracked up to be.

“When you have the rat in a cage alone, and there’s nothing else for the rat to do, the rat will repeatedly choose to take cocaine,” he said. “That’s logical. If the only thing you had to do in your life was press a lever to receive cocaine, what are you doing? I hope you’re pressing for the cocaine.”

But if additional stimuli are introduced to the environment, the finding completely falls apart.

“When you enrich the rat’s environment such that you provide something like a sweet drink, or a sexually receptive mate, or some other alternative, the rat doesn’t repeatedly take cocaine,” he explained. “In fact, it’s difficult to get the rat to self-administer or press the lever to take cocaine if you provide the rat with food!”

When he tried to replicate the experiment with drug-addicted humans instead of rats, he found they too behaved logically, choosing, say, $20 in cash as opposed to a $10 hit of coke. “This ‘hijacking’ of the brain’s reward system, that’s a nice sexy metaphor,” he said. “But what we said was that cocaine addicts could not inhibit certain types of responses. They could not delay gratification. They had cognitive impairment such that they couldn’t engage in this long-term planning.” Yet repeatedly in tests, they did.

Once you realize that drugs don’t actually rewire people’s brains, making them unable to function, you can start to focus on things that matter more—like preventing overdoses. The way to do that, according to Hart, is through educational initiatives, not treatment programs.

“Now, if we are concerned about overdose deaths, we need to know how these people are dying,” he said. “The vast majority [75 percent] of people who die from a heroin-related overdose do so because they combine it with another sedative, like alcohol or benzodiazepines….The public health education message is simple: If you’re going to use heroin or another opioid, don’t combine it with another sedative.”

The message should obviously vary according to the substance in question and the population you’re trying to educate. When talking to young people about marijuana, for instance, we should teach them not to start out with large doses. “And if you do and you get anxious, be cool,” he said. “You’re going to be OK!”

The main problem with methamphetamines, meanwhile, is that they disrupt people’s sleep and reduce their food intake. “Sleep is probably the most important biological function. If you don’t get enough sleep, you can get psychiatric illnesses and all types of different illnesses,” he said. “So when I think about education with methamphetamines, you want to make sure people are sleeping. You want to make sure people are eating. You also want to make sure people understand the risks in terms of cardiovascular concerns: If you have a cardiovascular-compromised system, it’s probably not the drug for you.”

These are all examples of harm reduction, something Hart believes we need a whole lot more of. “We can help keep people safe,” he said. “We haven’t made much progress in this regard, but we’re pretending that we are more compassionate people…by saying that we’ll give them treatment.”



8 Responses

  1. I am sick of this garbage, I need pain medication to get by at 29 years from serving in this nations Army. I have a spinal cord tumor, DDD, lumbar curvature, spondylosis that I never had before I joined the service. Now I have to feel like a drug addict when I need help with the pain from supporting a deployment and six emergency relief missions. I am so sick and tired of this country. Heroin has gone up 50% in most states due to the crack down on sick and ill patients. I never touched a drug in my life and I take my medication as prescribed. I swore an oath to the Constitution that we do not even follow anymore under the Obama administration!
    Signed an Angry Disabled Veteran

  2. All sarcastic levity aside, I am on the same page as Dr. Hart. Obama, Congress and their collective chorus of Sycophants that are all on the “treatment instead of prison” bandwagon are taking a step in the right direction. They haven’t arrived yet. Somewhere in their thinking, they are pressing for a completely drug free society. They think that it is possible to achieve this. They see their goal as an achievable. They see nothing amiss in their expectation. This is completely unrealistic. These are the same people who are all for comprehensive sex education programs in the schools and oppose any sort of abstinence education. Why? Because they know that kids are going to have sex regardless of what they are told. The comprehensive sex education programs are part of a harm reduction model. So why is this any different?

    The Nazarene taught the we would always have the “poor” with us. Most who read His words think of the “poor” in terms of economics. A better understanding of where he was coming from makes it patently clear that he was referring to anyone with unmet fundamental needs, both tangible and intangible. I do not care if the reader sees Him as the God in the flesh, a great teacher, a myth or the Flying Spaghetti Monster. The point is that what was taught is spot on. Anyone with any real experience in life can see that this idea is veritable and self evident.

    So what does this mean with respect to the War on Drugs, treatment vs. prison, harm reduction models and everything in between? Simply put, some people take drugs to fulfill some sort of unmet need because the drug gives the feeling of the need being met on some level. Is this a counterfeit? Sure it is. If one has a emptiness because the need is not met, given enough time, the the sufferer will take whatever they can get to fill that emptiness that the unmet need would normally occupy. This is the least common denominator. Consider the poverty and hopelessness that exists in the hood as prima fascia evidence for why drug use is higher in these economically depressed neighborhoods.

    Others take drugs recreationally because, as a surfactant works by making water wetter, so the drug makes fun even funner. Alcohol is a perfect example of this. Not everyone likes how alcohol makes them feel, or given the opportunity to sample other recreational substances, they find another that they prefer to alcohol. There are some drugs that make sexual intercourse more intense and there are people who will utilize those substances precisely for that purpose. Sex is fun. It feels good. Who wouldn’t want the experience to be more intense in terms of the pleasure factor?

    Now, I’m not condoning these kinds of things, but neither do I condemn them. Recreational drug use is not for me, but who am I to impose my opinions, values and viewpoints on others? Apparently, I’m not the the State. The State has no problem imposing it’s values on others. The problem is that the imposition usually includes guns, the threat of punishment and/or death for defying the State’s impositions. That statement could just as well as be applied to the drug cartels that have turned places like Ciudad Juarez into a war zone with more murders annually than there are days in a year. The comparison should be considered, but that is another discussion for another time.

    My salient point is that unless the State can reliably identify and fulfill all potential unmet human needs and can provide alternative, completely safe recreation enhancers, there are going to be people who use drugs. it’s never going away and it will always be with us. Sure, I think that treatment should be made available for people who want to quit and can’t obtain that goal on their own. For the rest of the drug using crowd, the best public policy is the same conceptually similar harm reduction model that the comprehensive sex education crowd utilizes with kids in the public school system. If the State stopped presuming to dictate at gunpoint it’s Neo-Puritanical philosophy of what it thinks best for society, and in turn, legalized all drugs of these types for manufacture, transport, sales, possession and use, then the institution of a comprehensive, substance-directed education program/harm reduction model would result in a reduction in crime, violence, morbidity and mortality. I really believe that the metrics, (when taken as a whole society and taken over a reasonable period of time) would show a healthier, more productive and stable society. Ultimately, the marketplace would demand safer alternatives to the current drugs and in a true free market, such development would occur. There’s another plus and another form of harm reduction.

    This really seems to be another self evident, auto-intuitive idea, at least imoho. How do I know this? I don’t know anything that hasn’t come to pass yet. I do know that what I and others like Dr. Hart are suggesting would dispense with the War on Drugs, the cartels, the hugely lucrative black market, the adulterated substances and the other ancillary items that create and propagate the violence, most of the gun-related crime, most of the burglaries, theft and robbery and really the majority of the things that one relates to drug use in 2016 America. Sure, there will be other problems, but such problems are going to be easier to deal with than the innumerable replicas of “Whack-a-Mole” that include all the current, more weighty, status quo problems that play out in every community in this nation. This is just another case where the current treatment is worse than the malady that gives the treatment raison d’être.

    So why is the State so loathe to try this. It always boils down to money, power and legitimacy.The State has invested too much into the bureaucratic systems that are part of the War on Drugs. They have been able to prevaricate, mostly through fear, the War on Drugs into the power that has nullified so many of our personal liberties; the State is loathe to give that up. The State will not willingly surrender all the power that it has usurped, including the obscenely lucrative “Civil Asst Seizure Program”. There’s the money sensibility again. The State has also spent over 100 years in the brainwashing the majority of the population into the current mindset that drugs and their users are morally bereft and criminal. So to do a sudden about face right now would call into question the certain aspects of the State’s legitimacy, seeing how the prisons and jails are stuffed past overfilling with drug offenders. The State would be admitting, de facto, that it is the reason that so many in this country suffer legal disabilities of one kind or another and are marginalized. The State does not want to take responsibility or be held accountable for for this hugely failed public policy that has wrecked the lives of tens of millions of it’s citizens over the last century. Right now, it’s commonly held that the drugs and the defective-in-character users are the culpable parties. To accept and facilitate such a paradigm shift would land the weight of all that squarely on the current Beltway Bunch and the bureaucratic institutions themselves. There has never been created a Madison Avenue PR firm that could spin that away from those that currently presume to rule over us.

    The State ultimately rules through fear. The War on Drugs is one of the best “fuels” that keeps the Furnace of Fear fired hotter than most any other item that the State has at it’s disposal. Again, if we want change, we collectively have to come together and do something. As Steve says, “If you do nothing, you get nothing.” The most effective something is a collective withdrawing of our consent to be ruled over in this area. The best way to accomplish that revocation is to shout a unified, collective “NO!” to the War on Drugs and tell the State to institute a harm reduction model.

  3. If the Truth in Advertising Laws were strictly followed and enforced, we’d see the FTC suing the DEA, the CIA, the CDC and the FDA for, at a minimum, complicity and conspiracy to commit fraud. “How?”, one inquires. It’s really this simple.

    The War on Drugs = The Drug Lord Price Support Program

  4. I have taken this opportunity to share my heartbreaking story in hopes these witch hunting Opiate ill informed skeptics will read and understand that I would have no life without Medically prescribed Opiates by a physicians care and strictly monitored monthly urine and blood test. Please remember that An Opinion Before A Thorough Investigation Is The Epitome Of Ignorance! And that a little more compassion from the Medical Field and its representatives could have saved my beautiful Stepdaughters life. Let me say this! A person who has a addictive personality will abuse anything that helps them feel better. I have taken Oxycontin for 12 years , I have had 26 major surgery’s in the past 9 years. I have so much physical pain I can not even get out of bed with out pain medication and when I run out I run out and just lay in bed praying the Lord relieve me of this horrible condition and I pray God you medically prescribed Opiate Pain medication skeptics never go through what I go through everyday of my life when the only thing you have to do is threaten what help I get, Shame on you! There will always be drug abuse and as the so called war on drugs has failed miserably every since the Government declared it. Now ,all this is doing is giving help and aid to the illegal Heroin cartel’s and drug pushers business pushing them to knew heights in the Black Market of Heroin while depriving folks as me of relief . Trying to label us legitimate Chronic Pain Sufferers as some type of Junkie and trying to align Chronic Pain Sufferers with Heroin Addicts in this horrible Witch Hunt !

    My Stepdaughter committed suicide 4 years ago because of being treated like a drug addict by some of her family , friends and doctors when all along she suffered from Lupus and Fibromialgia which I believe was brought on by a deadly car crash at 18 , she told me between that which I was being put through and what they were putting her through She was not going to live her life in such a hell brought on by people like these Opiate Pain Medication Witch hunters that are on a witch hunt to out law Opiate pain medications that give us Chronic Pain sufferers some sort of a life . As a retired Police officer and worked directly close to the DEA, these people do not have a clue how thrilled they are making the illegal Heroin trade and think of my Late Stepdaughter as they continue on with this Witch Hunt movement to outlaw opiates! Just like the slaughter of The 20 Children and 5 Teachers at Sandy Hook Elementary School, if there would have just been gun laws , my God they were Gun Laws , the guns that murdered all those 20 children were all registered and owned by a school teacher! You fight Drug Addiction in Elementary education by teaching all children the dangers of Booze and Tobacco which if these witch hunters want for us to know the real truth but they do not. I miss my Stepdaughter so much and some of us will continue on with the fight to protect our right to feel better and function without fear of these witch hunters trying to convince us to commit suicide or be forced to street drugs or the Legal government Boozers . And they are trying to do exactly THAT!
    The under line real truth is THESE witch hunters would rather us Chronic Pain sufferers commit suicide are and DRINK all the BOOZE we can drink! The Federals legalized ( ALCOHOL) knowing its a more deadly drug than Strychnine. And just because the DEA has miserably failed with their war on illegal drugs why do they want to deprive us sick people of our Constitutional Rights to be Happy in that pursuit of with Professional Physicians monitoring legally prescribed Opiate Pain Medicines that give us relief of this horrible malady of Chronic Pain ! May God have mercy on their miserable souls they that seek to destroy us Chronic Pain Sufferers only and little hope of temporary relief of this horrible sickness.

  5. Where dose this leave a person like me ? Nerve damage . The dea scares doctors not to treat pain , I have no doctor . My pain makes me wish for death because it’s untreated, I never had problems with opiods never abused never needed rehab never needed to slowly stop taking them . They just helped with pain . Seems there is never a mention of people with nerve damage just addicts and abusers . I did try to take my life because of this never ending pain , they say this is a behavior problem? To not be treated while forced to have mandatory health care insurance and I’m the one with the problem ? So I should lay in bed in pain the rest of my days and not get treatment and if I don’t like it I have a behavior problem? Not crazy,not an addict, not an abuser,just a patient with no doctor and no medicine.

    Thank for all you do .

    • You have to become your own doctor. Search for alternative medicines, like cannabis and Kratom. Gain access in whatever way you can, even in the underground market. Don’t forget to be prepared for the consequences of this kind of survival, legally, financially, and emotionally.

      Don’t let doctors and insurance companies decide your fate. Take control. I did it. You can, too.

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