The following is a conversation with Carl Hart, Department Chair and Professor of Psychology
at Columbia University. He's the author of several books on the topic of drugs,
including his most recent, called Drug Use for Grown-Ups, that challenges us to, quote,
use empirical evidence to guide public policy even if it makes us uncomfortable.
His research on drugs, including hard drugs like heroin and cocaine, challenges much of what we
think we know about drugs and their role in society. His main thesis is that drug addiction
has less to do with the drugs themselves and more to do with co-occurring psychiatric disorders,
such as depression and schizophrenia, and socioeconomic factors, such as unemployment,
underemployment, and resource deprivation within the community. In addition, he believes that we
should legalize all drugs, so that if people choose to use them, they could do so responsibly
and openly and get help if needed in a controlled, safe environment. His ideas are controversial,
but are fundamentally grounded in empirical data and rigorous scientific studies. I don't know if
his conclusions are right, but they are at least worth thinking about. So I ask that you consider
these ideas with an open mind and, as always, make sure you exercise your critical thinking skills
in making decisions about substances you put in your body. You are a free thinking being,
the main character, if you will, the hero in a story that's being written by you.
So at the end of the day, you are responsible for the choices you make, so choose wisely.
This is the Lex Friedman podcast. To support it, please check out our sponsors in the description.
And now, here's my conversation with Carl Hart. I think it is bold and powerful to admit to using
in your private life the drugs that you study in your research, including heroin and cocaine.
So let me ask, what is the experience of taking heroin like? What happens to the body? What happens
to the mind when you take it? Well, you know, I take MDMA, cannabis, and all the rest of these
drugs too, I've tried those drugs. The experience in the body and the mind, I don't really know what
people want to know in that regard. It's like saying, what is the experience of having an orgasm
in the body and the mind? Or some other sort of event that you really enjoy. So I don't really
know what people... Is that what poetry is for, for describing these kinds of experiences? I mean,
I guess, given MDMA, given psilocybin, in the full context of that, maybe it's more useful to say,
what are the differences in experiences that your mind goes through, like chemically, biologically,
so like keeping it strictly to the sort of the biology of it versus the full environmental
human experience. Yeah. See, this is a mistake that people make all the time. They try to act as if
biology is the only determinant of drug effects. And that's just not how it works. You need the
environment. You need the cage, as they say. If you don't have the cage, you don't get the full
extent of the effects. And so like you can take MDMA and have an awful time. You can have a time
in which you get paranoid and so forth. And then you can take it, that drug under the right conditions
and it just be like one of the best moments you've ever had. It certainly enhance a number of my
relationships. But I've also had some times with MDMA that haven't been so lovely when the people
who you are hanging out with, you don't know them, you're distrustful and all of those kind of things.
So it's important to put context in it. Now, we can talk about drugs at a biochemical level,
at a biological level, and we kind of do that in this country with this fascination with neuroscience.
And that's an inappropriate kind of fascination in the way we talk about it. So we can talk about
opioids and then we can talk about endogenous opioid system in the brain. We can talk about
dopamine and other sort of monoamine transmitters and what opioids are doing to them. And we can
do the same thing with MDMA. And we won't be any closer to understanding the sort of experience
that is induced by these drugs. Certainly the experience that we all seek. You know what I'm
saying? So getting a positive experience or getting a negative experience is strongly
defined by the environment. Strongly dependent upon it. But the environment is a short word
that can describe a lot of things. So would you say the environment is important to the people
where you are currently in your life? Or is it also dependent on the full trajectory of your
psychology, of your life experiences, of your parents, of the people you came up with, of the
trauma you've experienced, of the hopes and dreams that were crushed or not, or the opposite,
or the success levels, or all those things? Like what are the interesting sort of landscape
of experiences that contribute to how you actually feel when you take a drug?
Right on. So all of those things are important. But you know, like if someone had trauma in
childhood and they did the work and they dealt with it, that's not so important in this case.
But if they didn't deal with it and that trauma is being triggered in that event, in that moment,
then it's important. But let's just take somebody like me. I'm 54 years old. I'll be 55 this month
actually. And you know, I've done a lot of work in terms of figuring out who I am. And I'm comfortable
with myself. And I know how to set limits for whatever it is I'm doing. And so I know I need
to work out. I know I need to eat well. I know I need to sleep well. I know I need to be in an
environment with people within my trust. And then if all of those things are met, oh, it's likely
to be a good time. You know what I'm saying? But if I haven't slept, if I haven't worked out,
if I don't feel good, it won't be a good time. But I try and be responsible and take care of my
eating habits, sleeping habits, make sure my responsibilities are taken care of. And so when
I'm in that moment, I just enjoy that moment. I'm there. I'm not thinking about a bill that
I didn't pay. I'm not thinking about, oh, I forgot to do this for my kid. I'm not thinking about that
because all of those things are taken care of. If they're not taken care of, it will impact
the experience. And it may negatively impact the experience. Well, that is the counterintuitive,
even controversial finding from your recent book. So we should kind of, I know it seems obvious to
you, but I think a lot of people here in this would think it's quite non-obvious. So in your
new book, Drug Use for Grown Ups, you write for the finding section. I discovered that the predominant
effects produced by the drugs discussed in this book are positive. It didn't matter whether the drug
in question was cannabis, cocaine, heroin, methamphetamine, or psilocybin. Overwhelmingly,
consumers express feeling more altruistic, empathetic, euphoric, focused, grateful, and tranquil.
They also experienced enhanced social interactions, a great sense of purpose and meaning,
and increased sexual intimacy and performance. This constellation of findings challenged my
original beliefs about drugs and their effects. I had been indoctrinated to be biased toward
the negative effects of drug use. But over the past two plus decades, I had gained a deeper,
more nuanced understanding. These words are very counterintuitive to a lot of people. I think,
like you also mentioned in the book and elsewhere, people have come around to maybe psilocybin,
being once such drug, maybe cannabis being once such drug. But you also mentioned other drugs,
like cocaine, heroin, methamphetamine. Can you just linger on this point? How do we get
the positive effects of those drugs and why in the media and the general conception we have of
these drugs is that they were going to make a bad life worse or ruin a good life?
Well, so your first question was, how do we harness the positive effects? How do we
increase the likelihood of getting the positive effects? Again, like I said, we want to make sure
that people are responsible and they've handled their responsibilities, make sure they eat well,
sleep well, exercise, all of those sorts of things play an important role. And also,
if they know exactly what they're getting, and then they're not paranoid about, oh,
it's something contaminated in some adulterin, it's in my drug. So you want to make sure you
know exactly what you have. Once you satisfy those kind of things, you understand the dose
and potency, you understand all of those things to decrease any sort of anxiety you might have
about the substance itself, it increases the likelihood that you will have a better time.
So anxiety is the big one. You need to remove the anxiety.
Anxiety is critical. It's huge. Many of the negative effects that we see with drugs have
to do with anxiety. And not necessarily anxiety because the drug induced it, it's the anxiety
that the situation induced a lot of times. And then you ask, well, why does this sound counter
intuitive? Why does the media report differently? Well, because there's money in reporting the
negative effects almost exclusively. Think about writing a newspaper article. It's really easy to
get the population all ginned up about something like an opioid crisis, overdoses. And you don't
even have to tell people how to keep people safe if you're talking about overdose. You don't even
have to say why people are dying from overdoses. Like overdoses in our country happen largely
because people get contaminated drug because people are combining sedatives and they don't know that
this enhances the respiratory depressing effects of drugs. They don't know. But when you read
these newspaper articles, they don't say this. They don't say how to keep people safe. All they do
is frighten the population. There's money in that. And then we think about people who write
TV shows, the people who write movies. Most of the stuff written about drugs is just bullshit.
I think about, I love going to watch comedians. And the comedians, when they talk about drugs,
again, most of the things that they say about drugs is bullshit. I mean, you can say the
stupidest things about drugs and be believed. You can write a movie and you don't even have
to develop your characters if you throw drugs into the mix. You say, oh, he's a drug dealer.
You don't have to say anything about that person's background or about that person
being developed as a character because the population think they know. And the writer
is lazy and does not do any sort of development. Just think about any more. Let's think about
the Sopranos, for example. They have a new program coming out. So let's think about them for a
second. The Sopranos is a show in which the lead character Tony kills people for a living. That's
what he does, right? This character actually made sympathetic for him when he is besmirching and
denigrating his nephew, Christopher, for using a drug. And we feel sympathy for Tony, the character,
who just killed somebody, who is a horrible person, but being a drug user is a worse person.
And that's what the show wants us to believe. Tony's a racist murderer, all of these things,
but we feel sympathy for him. But we don't feel sympathy for anyone who uses drugs.
That's some crazy shit. I mean, and the American public buys into it. That's wild to me,
and that we all bought into this crap. And that's what we do in damn it, everything
that's in film, on television. And it's like, what's wrong with you people? So why aren't
there not more stories of grown-ups using drugs, the full spectrum of drugs that we're talking
about? Why isn't there? So we talked offline about Joe Rogan. He's somebody who started smoking weed
later in life, which is an interesting story. Like when he's already very successful,
and he has a very interesting way of describing his experience with weed, that it was like
enhancing his productivity. Actually, I think he says it increases his anxiety a little bit in a
way that was productive, like paranoia, not anxiety. And so that's an interesting story of an adult
talking about the use of weed for productivity purposes. But you don't get those stories very
often. Why? I think fear, people are afraid that they will be belittled, dismissed, all of these
things. That's a drug addict or some negative thing. But cannabis is lightweight. Come on.
You can admit cannabis these days. And the fact that I don't know when Joe started, but if he did
start later in life, that's cool. I mean, you are mature, developed. You have developed some
responsibility skills, all of these kind of things. This is a good thing. You don't want people to
engage in any kind of behaviors when they're young and immature that might put them in harm's way.
And so we want people to be developed at least. I mean, whether it's being in a relationship
with a partner or whether it's driving an automobile, all of these things that can be
potentially harmful but extremely beneficial if you are responsible enough to handle them,
you want people to be mature. So that's a good thing.
So how are you supposed to, like somebody like me, somebody like Joe, how are you supposed to
understand what the dangers are, what the negative effects are? So you said automobile
relationships. I think I have a reasonably, it's crappy, but reasonable understanding of
all the troubles I can get with in relationships and what things to avoid. Same thing with driving
a car. I have no idea. I'm in the dark in terms of what are the things to be careful about,
what to avoid with drug use when we're talking about the heavy drugs.
Have you ever drank alcohol? Yes, I'm Russian. I know, I drink a lot. But I understand that
because culture, I came up, I was taught a lot of like, this is what you don't do,
and this is what you do. This is when you drink a lot. I mean, you see the effects,
you see the, there's a lot of negative examples. There's positive examples of social
stimulant. There's examples of great artists using alcohol to sort of, I don't know,
to help be the catalyst for that magic moment for, you know, all of that. I don't, I have some
examples now, especially in America, the same with weed. More and more, you're starting to get a lot
of stories of psychedelics of different kinds. There's psilocybin where you have mushrooms or
even MDMA used sort of positively. There's kind of like negative stories in the past about acid,
about LSD being used, ultimately for productive ends, but it destroyed the person. That's kind
of how the story goes. It was like a trade-off. You take, it's like, what is it? Robert Johnson
sold his soul to the devil to learn guitar? Like it's a trade-off. You could take the drug,
you're going to create some good stuff, but you have to pay for it. Those are the stories.
That's some bullshit we tell children. Come on. That's exactly right. You're exactly right. These
fairy tales, these cautionary tales that we tell people, we have to grow up. That's what the book
is about, drug use for grown-ups. You know, we tell people, Pinocchio, if you lie, your nose grow,
who believes that? Who believes that there are fairy tales, but that's exactly what these stories
are. They're in the same vein as those kind of stories, as Pinocchio. You know, like you said,
when you were learning about alcohol, you were told what to do, what not to do, so forth. The
same can be true with MDMA, with cocaine, with heroin. The same is true, because there are
some times when there are some potential dangers that you should avoid. And I wrote about some of
them. Certainly in my work, just throughout all of my writings, I talk about those kind of things,
and other people talk about these things. The problem is, is that we're getting our education
from bullshit sources, from people who believe in this kind of Pinocchio thing, and it just
does not fit with the evidence and the evidence we all publish in the scientific literature.
All these things that I'm saying, it's there in the literature. I mean, a place like Columbia,
we give these drugs thousands of doses every year. Do you think we would be doing this,
and we do this with research grants that's funded by the public's taxpayer's dollars?
Do you think we would be allowed to do this if these drugs were so dangerous? It's just
nonsense. And the drugs we're talking about, they are all approved for medical use,
somewhere in the world. And the studies you conduct, they're basically asking what kinds
of questions. So you take the full range of drugs you're talking about, from marijuana,
to cell-cybin, to MDMA, to cocaine and heroin. What is the study looking at? Like,
what the actual experience with the positive and negative effects of the experience on the drug are
in the control conditions? Yeah. So we did these kind of experiments with alcohol,
nicotine, all these drugs in order to have an empirical database to tell people
exactly what these drugs do and what they don't do, the conditions under which the drugs will
produce positive effects, the conditions under which the drugs were more likely to produce
negative effects. All of this information is important for society to know, and we do know.
And that's why we're collecting the data. We're collecting the data to help us with treatment
if someone is having problems with these data. Hopefully, we'll understand more about
how to help them deal with their problems based on some of the research that we're doing.
So what kind of negative effects are we looking out for? Like, what are the properties of drugs
we should be careful about? Is it addictive properties? How addictive it is? How destructive
or painful, whatever, the withdrawal processes? What kind of things are we looking out for?
Yeah, those are certain kind of questions we certainly have asked because like something
like, right, cocaine versus alcohol or heroin when it comes to withdrawal of physical dependence.
Like cocaine has a very limited sort of withdrawal symptoms. I mean, it's hard to see. Same is true
with methamphetamine, but with heroin, you certainly can see a withdrawal syndrome that's
unpleasant, but with alcohol, that withdrawal can actually kill you. So heroin is unpleasant and
not lovely, but with alcohol withdrawal, that's the one that's the most dangerous. I mean,
all of these kind of questions we want to know answers to. And so when we think about heroin
or some other drugs and you say like, what kind of negative effects? Negative effects,
we don't talk about much in the society. The main thing that really concerns me about like heroin
use really is constipation. So if people are using heroin on a regular basis and then they have a
sort of slowing of their gut modality, they're likely to increase constipation. And that's
not good. I mean, for your general health, but we never talk about that in this society. And
that's probably the most important thing aside from the fact that people get contaminated
street drugs and that sort of stuff and increase the likelihood of maybe dying from some contaminant
or people who are inexperienced and they're mixing heroin with other sedatives, that's not good.
But the constipation is a huge one. And then other sort of drugs, negative effects,
like the amphetamines, all of the amphetamines, they disrupt sleep, food intake, all of these
things are so critical for sustaining human life. But we never talk about that because it's not as
sexy as this nonsense that people write about like addiction. Addiction has almost nothing to do
with the drugs themselves. And I make that comment because the vast majority of users for any drug
never become addicted. And so if the vast majority of users don't become addicted,
then you have to move beyond the drug when you're talking about the phenomenon interest,
in this case, addiction. And so when we think about addiction, it has much more to do with
our psychosocial environment than the drug itself. But that's not sexy.
So addiction is even the property of the environment, not a property, a result of the
environment. It certainly can be. There are people who are suffering from co-occurring
mental illness like depression, anxiety, I mean, that's within the person, of course,
and that increases the likelihood for addiction. So that could, that's not so much the environment.
But there are people who, for example, they have chronic unrealistic expectations heaped on them.
Those people are more likely to have some problems with drug. There are people who are
just immature, not developed, having developed responsibility skills. They are likely to have
some problems if they engage in some of these behaviors. There are people who lost their jobs,
COVID, factories went away, a wide range of things. And those people used to have standing
in their community. Now they have none. Those people might be susceptible to having a drug
related problem if they indulge. All of these kind of issues are far more important than the drug
itself. And so they could seek escape in the particular drug. I mean, there is a biochemical
thing to each of these drugs. And some pull you in harder than others when you need to escape,
right? When you're not doing well in life. What evidence you have for that?
I don't. Yeah, because there is none. There is absolutely none. I mean, people say stuff like
that. And that's the problem. That's precisely the problem. See, I'm operating from limited personal
evidence. Well, this is a problem though, but we have a scientific database. We don't need
personal evidence for this. We have in my book, I try to go through some of the science so people
could understand and understand. It's like, when you have a math problem, you don't want people
saying, well, you know, I feel like this. Fuck what you feel. What does the data say?
So one of the problems with the data. So one data is there's the studies that you're doing. This is
excellent research work, but there's some of the drugs that are illegal. Yes. And some are legal.
So you have just, it's unfortunate that some of the drugs are illegal or whatever you believe,
but there's not enough of a data set of public and the open use that's like in the wild data set.
It'd be nice to do thousands of people and see from all the different kinds of environments
and all that kind of stuff to get an understanding. I think we have a substantial database,
but people just ignore it. Got it. That said, let me ask you the question of legalization.
So should, in your view, all drugs be legalized? The drugs that people seek
certainly should be legally regulated and available to adults. So when I say the drugs
people seek like cannabis, MDMA, cocaine, heroin, those drugs certainly should be available. And
some of the psychedelics that people seek. Now, the thing about it is that some people
think that, oh, it'll be a free fall. These drugs are available to everyone. That's not true. I mean,
it will be, there will be age requirements and maybe other requirements, but they should be
available. And we should also do like what we do with alcohol. We can put enough alcohol in a bottle
to kill you, but we don't. So we regulate it such that the amount that's in the bottle
enhances the safety and minimizes the potential harms. We can do the same thing with these other
drugs. And we can also say, okay, we won't be selling intravenous preparations of any of these
drugs. The drugs that the routes of administration will be oral and, I don't know, let's say
intranasal. Again, routes of administration, the dose that you have in each unit all can minimize
harm based on how you do these things. And we can do that. We have the technology. We have to know
how. So you're actually making me think about alcohol a little bit. So if I were, say, the drugs
become legalized in the way you're describing, and me, Lex, wanted to, as an adult, explore some
of these drugs, what are some procedures do you think for sort of safe positive exploration of
those drugs? The reason I say I'm thinking about alcohol, because I don't think besides not putting
enough alcohol in a bottle to kill you, I don't think anyone ever gave me specific instructions.
I think it's kind of word of mouth and examples of people doing the wrong thing. You kind of get
it through osmosis that way. Is that basically what we would do, this kind of free exploration of
use? No, we have to change our education about these things. I mean, let's just take a drug like
cocaine. Cocaine is a stimulant. And you want to make sure people understand that they shouldn't be
taking cocaine here bedtime. And you know, they need to get a certain amount of hours of sleep.
And they need to get up in the morning. Cocaine probably isn't a drug for you at night. Certainly
not. Certainly not amphetamines at night for most people. And also, if you want to make sure that
you, they need to understand that cocaine can also disrupt your food intake, not as much as the
amphetamines, but all of these kinds of things people need to know so they can have proper nutrition
and they can time their drug use around these other important functions that's the same human
life. So we have to make sure that we educate people. We can't just throw people in a while.
That's stupid. I gotta tell you, I mean, for me, and even giving your book and for people
listening to this, it's still tough to hear that the thing we should be concerned about with cocaine
is the same as with caffeine. Don't take it before bed. And the thing we should be concerned with
heroin is constipation. Yeah. Okay. But the questions that I keep wanting to ask you,
I should be asking the same things of alcohol. But when you're not doing well psychologically,
in the ways you described, when the environment is not right,
there's some aspect in which saying that drugs can be used responsibly and effectively and mostly
positive can give those folks a pass to use it instead of working on themselves and fixing their
environment first. What do you want me to say to that? I mean, they have access to alcohol,
they have access to it. Yeah. You know, we live in this country called the United States where
our Declaration of Independence says that we are free to live like we want to live so long as we
don't disrupt other people from doing the same. But it's remarkable to me how we try to control
the behaviors of other people. That's just remarkable. Yeah. And that's partially what your
book is about. I mean, it's not just about drugs, it's about freedom. That's the bigger issue that
we can't get to. It's like this issue of freedom. And freedom comes with a tremendous amount of
responsibility. I am responsible for my neighbors, my brothers. I mean, I can't impede their freedoms.
Like some people think that their freedom supersedes everybody else's freedoms. No.
And that's what I'm trying to remind people in this book. I am responsible to you as a citizen.
And we're in this together. And I tried to make that point in the book and people
have conveniently ignored things like that. Do you think the war on drugs has done more
positive or negative for the world? It depends on which world you live in. The war on drugs has
been hugely beneficial to law enforcement, to the media, to people who make bullshit TV shows,
the Sopranos, the wire, all of those shows, they benefit from this kind of nonsense.
Who else have benefited? People who provide treatment, many of them benefit from the war
on drugs. The folks who do urine testing for drugs, they've all benefited. They're making mad
money. People who run prisons, the phone companies who charge the prisoners, the people who run the
hotels that are around the prisons where people's family have to come and stay, the restaurants,
they are making out like bandits. But many of us are getting screwed. As a society,
in general, we're getting screwed. But there are people who are just benefiting handsomely.
That's why it continues. Politicians benefit. I mean, whether you're Democrat or Republican,
you have the same stance on drugs anyway, so they all benefit from this.
So many questions I want to ask you because you're challenging a lot of beliefs that people have
about drugs, about society in general. So it's difficult for me to ask the right questions
here. But if you could, if you were with a sort of a snap of a finger, change the world,
what from a policy perspective would you, and from just a, I don't know,
human to human perspective, what would you like to see in the United States of America?
In terms of that fix, is some of the problems we're discussing here?
First of all, we wouldn't be arresting anybody for drugs anymore. That would go away.
The folks who are in prison for drugs, that would go away. Their records would be expunged.
That would just go away. And then we work on a system to make sure that responsible adults can
legally obtain these substances. And we will have a corresponding educational system to
teach people how to do this. That's where I would start initially.
Yeah, the arresting for drug use or anything drug related is absurd, especially in the context of
how destructive alcohol is, and tobacco. Alcohol can be destructive to some people,
but alcohol also is a hugely beneficial drug, to be honest, which I couldn't have gotten through
through. Many of the sort of receptions and functions I had to go through as the chair of the
department without alcohol. Yeah, you have a line I really liked. The vast amount of
predictably favorable drug effects intrigued me. So much so that I expanded my own drug use to
take advantage of the wide array of beneficial alcohol specific drugs can offer. The part that
entertained me was this. To put this in personal terms, my position as department chairman from
2016 to 2019 was far more detrimental to my health than my drug use ever was. There is a
standard we're treating drugs, certain kinds of drugs that's completely different than the
standard we're treating everything else in our lives. It's almost difficult to snap out of it
as I'm listening to you and reading your work. It's difficult because it's like,
why is everybody living this idea that certain drugs are so horribly destructive and others are
not? And we just kind of fix that idea. And then there's this narrative. I hate to be so cynical
to think that there is just like a system that just propagates narratives. I always kind of think
that truth wins out. Truth is the best narrative. I believe that too. Obviously, that's why I'm
out here and subjecting myself to this sort of criticism and so forth. Because I believe that
truth ultimately wins out, but I might be wrong. But I have to live my life like it's true. Otherwise,
then I have no hope. Then why be here? Well, kind of, if you can steal man or at least show respect
to a criticism, I'm sure you've received quite a bit of criticism for your work. I've heard quite
a bit of BS criticism, sort of ignorant stuff that don't actually pay attention to your work.
But is there some pushback that makes you think twice?
People say I'm presenting a too rosy picture of drugs. I don't want to do that. I don't want
people to think that I'm not aware of the potential negative effects of any activity,
including drug use. And so I do acknowledge that there are potential harms associated with drugs.
I acknowledge that in the book. But the fact remains the beneficial effects far outweigh
the potential harmful effects. And we have technology information to help people to
minimize the likelihood of those negative effects. But this sort of approach that we have where we
say we're only exclusively presenting the harmful effects and that should make people keep people
safe. I just have a problem with that. But I certainly, I take the point that people say
there are negative effects. Absolutely. I absolutely agree.
What do you, if I can just talk about specific drugs, what's the difference between opioids
and benzos, for example? Specifically, I mean, these are drugs that you often read about being
misused at scale. I mean, the misuse is the problem, right? No matter what the drug is.
And that's actually what you're pushing for is education. And it should be, it should be legal
and should be good. So people should know what's the difference in proper use, positive use,
and misuse. I mean, one public figure who's been going through this is Jordan Peterson.
He's been public about his struggle of getting off benzos, the withdrawal he's going through.
I mean, what are your thoughts about the misuse of benzos or opioids and so on,
the epidemic that people talk about? Yeah, I don't know Jordan's specific case,
but certainly with benzodiazepines in general, we talked about withdrawal earlier. When I said
that alcohol withdrawal, you can die. So benzos and alcohol, they're closely related.
So benzo withdrawal too can kill you just like alcohol. So when we think about the effects
that benzodiazepines produce, think about the effects that alcohol produced. They're comparable
or similar. And so I know that it's a difficult one to wean yourself off if you develop the
dependence, but we have protocols for that. And I hope he's okay.
Since you say we have protocols for that, but for my understanding was that
like the protocols aren't standardized. It feels like a lot of doctors aren't as helpful as they
could be in this process. Like it's a bit of a mess. Certainly with withdrawal, they're more
standardized than anything. So like if someone is going through alcohol withdrawal, there is a
standard protocol that most physicians in this business, they follow. The same is true with
benzo withdrawal. But the thing where it gets murky is when they're treating addiction itself.
So when you're thinking about the substance use disorder in the DSM, not just withdrawal,
but the entire addiction, that's where you have this sort of divergence or diversity in terms
of approaches. And many of those approaches are rubbish.
Can you just elaborate technically what the term addiction means that you're referring to?
When I use the term addiction, I'm referring to the diagnostics statistical manual of the
American Psychiatric Association number five now, the DSM five.
That's never been wrong, right?
I'm just kidding. That point is well taken. And your point is that
their definition of substance use disorder, that's addiction. That's what I'm talking about.
But that definition continues to evolve. And so you're right. They still are working it out.
We get new information from scientific studies and so forth. And so it's supposed to be incorporated
into the DSM. But there are some problems with the DSM, like for example, they also have this
sort of once an addict, always an addict thing. And there's no evidence to support that.
But it's evolving. And it's the definition that people in science and medicine use. And so we
all know we're talking about the same language when we call someone a substance use disorder
patient or someone who meets criteria for addiction. We all are speaking the same language.
We're not saying that simply because this person use heroin, they are an addict. That's not what
we're saying. You have to meet these criteria where you have disruptions in your psychosocial
functioning. That's one. And two, you, the person are distressed by these disruptions.
So people have to meet those two basic criteria before we say they are addicted.
So once an addict, always an addict, this idea. So I've,
I mean, some of it is always mapped to the person, right? But just the people I've interacted with
who have struggled with alcohol addiction. I don't know what the proper term is.
Because it seems like with alcohol anonymous, the process of putting that addiction behind you
is a very, very long process. It's surprisingly long to me. That almost seems like a whole life.
Like it's not always an addict, but it takes decades. It seems like what is that? What can you
maybe just, from your understanding as a scientist, from your understanding as a human who studies
human nature, why does it take so long to treat, to deal with that addiction?
Well, you cited alcohol anonymous, right? And so I don't think of alcohol anonymous as like a
treatment that I would send any relative to, you know, like for a drug related problem.
You know, I think alcohol anonymous AA is really good for social interactions, making sure people
have a social group and they have peers. I mean, that's a good thing. We all need that social
interaction. But I don't think they know much about drugs. That's not, that's, it's like saying,
well, you know, my uncle broke his knee and he has this support group and they said this.
And then we follow that. That doesn't make any sense. But in our society, judges even
sentence people to go to AA. Are you kidding me? But that's the kind of thing that has been allowed
to happen in this society because we think of drugs as this moral failing or drug addiction,
as this moral failing. And any idiot can provide treatment and no disrespect to AA because I think
what they do is a lot more than what some people do because at least they have this social,
these social interactions, you have a social group. That's better than what a lot of these
other idiots out here do. Well, in that social support group, unrelated to the drug, it helps
cure some of the environment issues you might be in. That's the whole point. So we kind of coupled
the drug to the environment. But the reality is, as you argue, most of the problems come from the
environment. Certainly with people who are experiencing drug related problem with most of
the people, not all, but most. There are differences that psychedelics and psilocybin
has versus alcohol. I personally think I've enjoyed both experiences in different ways.
Is it possible or are we getting into the realm of poetry to describe the benefits,
like how the different drugs alter the mind and the places it can take you
that produce a positive experience? Yeah. No, it's very real. Some drugs take people
in places that other drugs can't. And that's very real. I have friends, some of them you know,
they, for example, say that they've never had an experience like the one they had
with ayahuasca. And they've done a number of sort of things. But they did the ayahuasca
in a setting with a shaman and this group. And they felt like they actually began to heal or
solve some problems that they were trying to solve for some years. And that's great. That's
great for them. And nothing else does it for them like that. And that's absolutely fantastic.
All I argue is that if that kind of thing happens for you with ayahuasca, with psilocybin,
with some other psychedelic, why isn't it possible that heroin does that for someone
or cocaine does that for someone else? Or MDMA does it for someone? That's it.
That's interesting to imagine like a shaman for heroin. Like why not? And or cocaine,
you said creating an environment for yourself for use of these different substances. And that
environment has a very strong impact on the actual experience that you have. But I mean, so
cocaine is an upper and then- Yeah, the way we define drugs like uppers and downers,
that's a really kind of inappropriate way, but it's a quick way. So we certainly say
cocaine is an upper or stimulant, but it depends on the activity of the person before they take
the drug. Say like if you're like really active before taking a drug like cocaine,
it might actually calm you. So it all depends on the activity of the person before they take
the drug. I remember, I don't know if you know Matthew Johnson is- Of course. He did all these
studies on or I remember just reading a paper. I didn't get a chance to talk with him much about
it, but it was about condom use and cocaine and then you know what like the doses and whether
people are more or less likely. Like the unsafe thing there is the using or not using or not using,
I guess condoms during sexual intercourse. I don't know. I just, I love that these drugs that have
connotation probably because of Hollywood negative connotations are actually being
studied by science and then the actual impact they have and what are the negative effects.
Again, in those studies often the positive effects are difficult to quantify, I think.
Maybe I guess you can from self-report and so on. The positive effects are not difficult
to quantify. You ask people about their euphoria. You can see how well people are getting along.
Like in our studies that we have people sometimes in groups and you see how well they get along
on the various drug conditions or placebo conditions. It's really, it's not that difficult.
Then you can see these amazing studies with Rick Doblin looking at MDMA and combined with therapy,
like how you can overcome certain PTSD things or depression and so on.
Yeah, it's really interesting. It's really interesting. I got to ask you because you
mentioned the wire. Do you think the wire, you think movies like Transpotting,
do you think they're ultimately destroyed? Because, okay, yes, they celebrate murder,
right? The Godfather a little bit. Yeah. But another one, I mean, it's like these racist
ass motherfuckers and they also are killing people, but yet they say, we don't do drugs.
What kind of shit is that? I mean, people who are doing drugs,
psilocybin or whatever. The thing is, we're trying to be better people and trying to make
our society better and you're killing people and you are denigrating people for using drugs.
Are you fucking kidding me? We let them get away with that as a society.
Do you see those movies? I apologize if I'm not sufficiently informed. Do you see them as
denigrating drugs? Of course. I mean, Godfather. Yes, that's right. That's a good example.
The Godfather, the Sopranos is all about that. I mean, Christopher is using heroin in the Sopranos
and they have an intervention in one season and they are denigrating him.
Are you kidding me? You just cut somebody's head off. Yeah. But to be fair, they were
denigrating, I think, all drugs. And then they're drinking alcohol in the butter bean.
First of all, they're killing people. They don't have any space,
none, to denigrate somebody who's just trying to alter their consciousness. Are you kidding me?
And not bothering anyone else. But there's a lot of other mob movies that Scarface celebrates
the murder and the drugs equally. So, I mean, it doesn't, it celebrates all of the,
just not just drugs or so on. It's all those movies. You know, I loved all those movies.
I'm from Miami. I loved Scarface. I even liked the Sopranos that I started looking at that
shit with a critical eye and see what it's doing. But Scarface is dependent upon the American viewer
or having a certain view of people who deal in drugs. And that view is that these people
are animals basically. And in the end, the animal kills himself with too much cocaine and he was
high. And that's what they show. And so it's like, what the fuck? So it's leveraging as playing into
not the better angels of our nature.
Don't take away these great movies from me. But it's true. You have to think about them
critically in the content. Wait, wait, wait, wait, wait. I like these movies. It's not a matter
of taking away. It's a matter of making the writers be more honest to the reality. That's,
that's it. That's true. That's really true. And the writers, the people, the culture, all of it.
I mean, they write these things. You know, I just think about some, some hip hop artists, they say,
like, this is real. This is my experience and so forth. And that's how these movie writers,
they write this bullshit and then say, well, this is real. Anyway, I get so upset talking about it
because I know the harm it's doing. And I know those kind of movies are the reason that we have
this war on drugs. And all of these people are going to jail because of those kind of movies.
In the epilogue of your book, you quote James Baldwin, you cannot know what you will discover
on the journey, what you will do with, what you find, or what you find will do to you.
So let me ask, how has drug use or the study of drugs changed you as a human being?
It just helped me think about other people's experience, right? So how other, how we're all
connected, like going to Northern Ireland, I don't know if you know much about the situation with
the troubles and what those people went through. And so I see people there. Northern Ireland,
by the way, is all white. And you see those people there suffering for the same reasons that people
in Appalachia are suffering for. Neglected by politicians who told them lies about drugs
and not dealing with the real problems like West Virginia, for example, their waters polluted,
the factories have gone away, people are desperate, and they're blaming drugs. Are you kidding me?
So the politicians don't have to bring back the jobs. So we don't have to really make sure
they have clean drinking water, things of that nature. And so those people are connected to the
people in Northern Ireland. They're connected to the people in Brownsville. They're connected to
the people in other places in the United States for the same reason. They're connected to the people
in Sao Paulo, Brazil. Same thing. People are catching hell for the same reason in the Philippines
for the same reason. And that's why I feel so strongly about this thing, because I know
there are people getting paid and their paycheck is predicated on subjugating and the suffering of
those other people. So when we hear about the destructive effects of drugs, it's essentially
a scapegoat for the failures of leaders and politicians to help alleviate the suffering
of people in those communities. Absolutely. It's so easy to say, I'm going to rid your community
of drugs. I'm going to put more cops on the street. If you want a problem, not to be solved,
just give it to the military or the cops. You had a tough childhood growing up in Miami,
like you said. What memory stands out in particular that was formative
and helping make you the man you are? That's so hard to say. My grandmother was really important.
So maybe just her trying to make sure that I think critically. I guess that's the biggest one.
So you moved in with your parents split? Six, seven. What have you learned about life from her?
Be self-sufficient, be critical, and keep your eyes open, and watch out for the okidoke.
That's what this whole drug thing is about. It's the okidoke. It really boils down to
a simple thing. We're all similar in that we're all just trying to live our life,
trying to take care of our kids. We want the best for our kids, all of us. But yet, somehow,
we've been made to believe that we're different in that way. Fundamentally, we're all the same.
So when people are seeking to feel pleasure, to feel better, why don't we celebrate that?
Instead, we denigrate people for that. I mean, if I feel better, I'm more likely to treat you well.
I gotta say still though, you're going against the grain, and you're at Columbia.
It takes a lot of guts to sort of speak out about these ideas so boldly.
I don't know how to ask this question. Where do you find the guts? Because it's also,
perhaps, inspirational to others in different disciplines that are sort of taken on the
conventional wisdom of the day and challenging it. What does it take to do that? What advice
would you give to others like you kind of a little bit afraid to do so?
Well, once you know, you cannot not know, as they say. And so I have to look in the mirror. And then,
looking in the mirror, I have to face myself. Have I lived honestly? And if I can't face myself,
then what am I doing here? That's how I see it. One of the things that people don't really talk
about with drugs and people who die from some drug related death. And I've been thinking about this
a whole lot over the past couple of years. It's like some of these drugs can take you to a place
where you feel so optimistic and positive about humans, our fellow humans. And you want to do
your best to contribute because you know the possibilities of what we can be as a society.
And then you come up with resistance and you, like you say, there's a lot of resistance and
people just have a hard time. And so if you know humans can be better and they refuse to be better,
why be here as someone who knows that we can do this better? I certainly don't want to do it the
way we're doing it. So you kind of see drugs as mechanisms for potentially elevating the human
spirit, sort of making people feel better. So you want to communicate that message. So it's that
plus the fact that drugs that use the scapegoat to not alleviate the suffering of certain communities.
So those two things.
And one of the main points of the book too was to try and get people to understand
possibilities that we could have if we embraced certain drug use, if we allowed adults to do
this sort of thing. Relationships can be better. Why range of beneficial effects people would be
or can learn to be more magnanimous. All of these pro-social things that we say we value.
In your previous book, High Price, you talk about rap and DJing, chapter five.
There's a nice picture of you DJing from 1983. So let me ask, who in your view, this is the
toughest question of this interview, is the greatest hip-hop artist of all time? Maybe give
some candidates. Oh, wow. Who is the greatest hip-hop artist? I don't know if I'm qualified
to make that back because I have to go back to like Gil Scott Herron. Like people think of him
as one of the fathers of hip-hop. That's my all-time favorite. And people like Chuck D from
Public Enemy, some of the things that they were doing, I was really digging. But even though
I was digging like Public Enemy, but even they got it wrong on drugs. Even Gil Scott Herron
got it wrong on drugs. But they were doing so much other good stuff. It helped me to develop
as a person. And so I think my son is a hip-hop artist now. I think those folks who are in the
game now, they are a lot more qualified to talk about who's the greatest hip-hop artist. I'm
not qualified. The evolution. I mean, have you tracked the evolution from sort of the 90s with
Wu Tang and Tupac and Biggie and then to what we have today? So there's just been a crazy
amount of progress. It's almost difficult to track. Yeah. I mean, I really love what they're doing.
I like what they accept the part where they get over 40 and they become fucking cops on TV.
I mean, other than that, I dig what's that about. Yeah, I don't understand that. But that's what
they do. Again, this sort of glorification of cops, that's dangerous for a society. And those
cats who do that kind of thing, I have a problem with that. Is it all sort of to push back a little
bit? Because I come from the Soviet Union where there's a huge amount of corruption. And when I
see what's going on with cops in this country, there's a lot of proper criticism you can apply,
but relative to other places. Well, in so many ways, this country is incredible.
Is your criticism towards cops or towards what cops are asked to do?
Yeah, towards what cops are asked to do. Cops provide the shield for politicians and those
in power. Absolutely, because I was in the military. I spent four years in the military
and I did what I was told to do. And I was ignorant and thought I was doing the right thing.
And I did what I was told to do. And so just like these guys are doing what they're told to do.
But no, my real beef is with the power structure, the folks who are telling them what to do.
And also the folks who go play cops on television, that imagery, that sort of glorifying cops,
that's a problem in a democracy. Yeah, all sides of the glorification of the drug war is a problem.
If I can just linger on a little longer in terms of the effects of drugs on the positive
like mind-expanding components of it, what have mind-altering drugs teach you about the human
mind? Not even like a biochemical, but just like the human mind is amazing, right? The places it
can go. Are there some insights you've learned from studying drugs about the mind?
Yeah, can I start from a neurochemical perspective first and then we'll go larger?
Just from a neurochemical perspective, I mean, everything I know about the brain,
I learned through drugs because of my interest in drugs. So I learned a lot about dopamine neurons
in certain regions of the brain about neuropinephrine neurons and a wide range of other sort of how
neural transmission happened because of drugs. And so that's a really valuable tool, lessons for me.
But then when we think that we move out a bit and we think more globally, what have I learned in
terms of the mind from drugs? I have really learned how to be more forgiving of people
and myself and more tolerant of people and certainly learned a lot more about empathy
as a result of drug use. And like I said earlier, I'm learning what we can be as a species and it's
quite incredible, but because of drugs. Yeah, there's a certain property of drugs in different ways.
They take you out of your body. They help you evaluate yourself from like a third person
perspective. It's almost like you have a consciousness in here and you get to step
outside of it a little bit. I mean, that's kind of what meditation does to all of these processes.
That's what a hell of a good workout does to it. It makes you evaluate yourself and that somehow
that allows you to be forgiving to yourself and forgiving to others, sort of empathize.
It trains that part of your brain. So stepping outside of yourself, not taking yourself too
seriously, that process. And different drugs do that in different ways. Obviously, I don't know
from personal experience on some of them, but I'm now curious. It's unfortunate that the
and the Hollywood and different stories we have demonize certain drugs and sort of basically,
I don't know, make it difficult for people like me to explore those ideas. But then
I'm really thankful for people like you who are pushing the science forward and are unafraid to
talk about this kind of stuff. Because I'm really fascinated with consciousness on the engineering
side. I really want to build robots that are that have elements of intelligence and motion,
even consciousness. And for that, we need to understand it ourselves. And drugs is
all the different kinds of drugs. If you safely seems like an incredible tool to understand ourselves.
And if we're limiting ourselves from certain drugs, because of certain political games that
being played, it's sad. And people know this a lot of middle to upper class people know this.
The illicit drug trade business is a multi-million dollar industry, multi-billion dollar industry
that could not be supported by people who are poor. And that has to be supported by a lot of
customers. And a lot of people around the world know this. They're in the closet. And in the book,
I call for them to get out of the closet. So we can start being more honest and we can take the
pressure off of those people who are not as privileged. Like I said, you're brave, you're
bold. I got to ask you for some advice. What advice would you give to a young person today?
High school, maybe undergrad and college, thinking about their career, thinking about how to live
a life they can be proud of. Yeah, whatever career they choose, just make sure that they
dedicate themselves to it and be the best at what they do first. That's what you have to do first.
Like people see me advocating for this position 30 years of science is in these opinion, this view.
And trust me, I would be dismissed if I didn't know my shit, if I was not. Yeah, you did the
work, you proved yourself, you're legit and by the people in the eyes of the people who know.
Absolutely. So that's the main thing that I would encourage people to do, really know your craft.
If you know your craft and then maybe you will be a service to your fellow citizens. There are so
many people out here faking the phone and they don't know their craft and they're not a service
to the people that they claim to serve. And that's a problem. And when you have a fairer number of
people like that in positions of power, your society is going to crumble. What about the
scientific path? You recommend people get a PhD? Not necessarily. You know, like my own children,
I don't recommend that. So science can, certainly my science can be a very petty sort of space to
be in. But it was the only sort of path that I had. And so I had to do it. But I would really
encourage people to just do something that they enjoy and something that makes them happy,
because the greater number of happy people in our society, the better off we all are.
All right. Since you mentioned happiness, gotta ask you about the pursuit of happiness and the
ridiculous question about meaning. Do you think this life has meaning? What do you think is the
meaning of life? I'm sorry. I certainly hope it has meaning. I mean, I'm certainly trying to live
mine like it has meaning. You know, I really love my life now. I just got back from Geneva.
I spent the summer abroad in Europe and trying to be in a more civilized place where you can
enjoy yourself as an responsible adult. And then it allowed me to decompress and then come back here.
The thing about coming back here is that you have to be ready to fight. And I don't want to fight
anymore. You know, I just want to be able to help a society and people. And so I'll have to,
like, keep a place in Europe to go and decompress and then come back to be able to tolerate this
situation. So life for me has a lot of meaning. I'm enjoying life. And this is like the greatest,
the best part of my life ever right now at this moment. So it's the joy, but you also enjoy the
fight a little bit or? No, I don't really, I'm tired of that. You know, it's like, why? You're
trying to, I'm trying to help people to see how they can be happy. And then people are fighting me
on that. I don't want to be happy. I want to be ignorant. Leave me alone. That's what people are
saying. Well, so what is the source of joy for you when you decompress? MDMA is a source, you know,
in a place where you don't have to worry about laws. That's like Europe. You can feel really free.
Yeah. Heroin can even be a nice space if I'm in my own head. But with others, MDMA is great.
So good friends, good food. The usual. Yeah, yeah. Family, love. Yeah, that's right. Carl,
you're an incredible human being. You really make me think everyone listens to this.
You're, I mean, I'm really glad you exist. I know you say you don't like the fight,
but I'm really glad you're fighting the fight because it's going to help a lot of people.
It's going to help at the very least help a lot of people think and challenge the
conventions of the day. And maybe challenge them to find joy. I really appreciate you
spending your valuable time with me. This was an awesome conversation. Thank you so much for
talking to me. Thank you for having me, man. Thanks for listening to this conversation with Carl
Hart. To support this podcast, please check out our sponsors in the description. And now,
let me leave you with some words from Frank Zappa. A drug is not bad. A drug is a chemical compound.
The problem comes in when people who take drugs treat them like a license to behave like an asshole.
Thank you for listening and hope to see you next time.