One of the more articulate voices in the realm of addiction experts today is Carl Hart, who delivered a rousing TED Talk challenging our beliefs that drugs primarily cause addiction. In the talk he passionately offered evidence that poverty and crime are independent of drug problems, and that drugs including cocaine are far less addictive than we have been led to believe. In fact, he goes on to say that 80-90 percent of people who use illegal drugs never develop drug problems.
This is quite a big statement, but is it true?
The Cocaine Project
Back in the early 1990’s the World Health Organization and the United Nations Interregional Crime and Justice Institute funded what is perhaps the largest study ever done on cocaine use around the world. The Cocaine Project enlisted top researchers around the world to collect data on cocaine use in 22 cities in 19 countries. The purpose was to develop a base of scientific knowledge that could help shape drug policy.
When the summary results were released in March of 1995, representatives from the United States were not happy. In fact, they were livid and threatened to pull all funding from WHO if the report was published, because the evidence blew significant holes in US drug control policies.
To this day WHO denies that the report even exists. But it does because someone leaked it to the Transnational Institute and now you can read the entire Cocaine Project Briefing Kit and decide for yourself if Carl Hart is right.
The Suppressed Findings
I find it incredibly sad that the work of so many distinguished researchers could be suppressed so our government could perpetuate myths, stereotypes and lies just to perpetuate a war that never should have happened. So what did the report actually say (for those of you who want the cliff notes version)? Here are a few critical highlights:
- There is no average cocaine user, but most who use cocaine are experimental or occasional users, with compulsive and dysfunctional use far less common
- In most countries cocaine is not the drug associated with the greatest problems
- Health problems from the use of legal substances (alcohol, nicotine) are greater than health problems from cocaine use
- Use of coca leaves appears to have no negative health effects and has positive therapeutic, sacred and social functions for indigenous Andean populations
- Education, treatment and rehabilitation programmes should be increased to counterbalance the current over reliance on law enforcement measures
- Current national and local approaches which over-emphasize punitive drug control measures may actually contribute to the development of health-related problems
So when it comes to cocaine, Carl Hart was right. We need reform that puts science at the center of drug policy. We need evidence-based evaluations – like the Cocaine Project – of the abuse liability of objects of addiction, so that the powers that be can develop policies that serve the greater good.
We All Lose
In 2010, the book Rethinking Substance Abuse: What the Science Shows, and What We Should Do About It was published by the Guilford Press. The book promised to “bring together leading experts to describe what treatment and prevention would look like if it were based on the best science available.” While I was excited to read the book, I immediately wondered about the title. Why are the experts just focusing on substance abuse when we know that the universe of addictive behavior is much broader? How can a book that claims to be based on the best science available ignore the fact that addictions for most people come in packages; that is they struggle with multiple addictions to both substances AND behaviors including gambling, sex and food?
So I called Bill Miller who was one of the editors of the book and asked him my questions. And without mincing words, he said the answer was that the book project was funded by the Robert Woods Johnson Foundation that insisted the experts only focus on substances.
When those with money and political agendas shape the work of researchers and science, we all lose. We don’t get the truth. Instead:
- We now live in a country that incarcerates more citizens than any other country, most for violations of simple drug possession crimes
- If you happen to be male and black, you now have a 1 in 3 chance of spending some time behind bars (compared to 1 in 20 if you are male and white)
- If you struggle with addiction, you get treatment that often fails because it overly focuses on substance abuse and ignores behavioral addictions
- Our war on drugs continues…
I actually really enjoyed this article; definitely going to give that book a glance over at least. When the topic of the War on Drugs every comes up in conversation, at least one person says “it hurts me to see so many people addicted to (insert said drug), and not being able to help themselves; the government needs to do something!” as if the government is sitting back and letting all of this happen. In a few of my classes, it’s been noted that the media is run by the government and reports only on what the government wants the nation to know, not entirely the truth. What happened to the cases of Ebola in the country? It just stopped being reported about. I think that the government always makes something a huge deal for a short amount of time, to cover up something else. If this study is true, and legal substances are actually more addictive and more abused than any of the illegal drugs that the government is fighting, what are they really hiding? Why didn’t the government want this study released? Were they afraid that Americans would finally break out of the little box that they forced us into and push back? There is more to addictions than just the substance itself, it’s the behavior and what causes this person to continue to use and use whatever it is they’re addicted to. Yet, the government refuses to acknowledge more than just the substance, and make it a bigger deal than it actually is. The way the government hides the truth is what should be reformed, and we should all pay attention to how to actually help these addicts that want help rather than forcing them into treatment that fails over and over.
John Fitzgerald says
Thanks for the feedback and agree we need reform. Its true also that maybe we should offer people alternatives to treatment since most could benefit from less intensive interventions…say an online type of program that customizes to the persons needs :)
Fascinating article, thank you for sharing. It’s mind blowing that we have the evidence in hand and yet nothing in the larger scheme of things is being done. We can sit back all day and share this article to anyone and everyone, but what do you believe needs to happen for change to actually start taking place? We can’t wait several more decades, we have to catapult the change, but how? I rack my brain with this question constantly and am interested in your thoughts.
Leona French says
Greetings Dr. Fitzgerald,
When I began my drug education class this Fall, most of me experience and understanding was based solely on my own personal experience. I am grateful for my recovery and the tools I continue to learn to change the unhealthy perspective that I have been suffering with prior to the steps i have taken towards my own recovery. Carl Hart’s perspective has completely changed my thought process that illicit drugs cause addiction. The high percentage of individuals that use illicit drugs and do not become addicted is mind blowing for me. I suppose that is because I have been an addict/alcoholic since my childhood. I can accept that because of my life experiences, genetically and how I am wired I was more susceptible to becoming an addict/alcoholic. Drugs and alcohol education appears to be a better alternative then to continue to use the punitive approach to drugs.
It just frustrates and angers me to learn that our government hides research that disputes their own agenda. Their desire to be there for us and make a better society is only prevalent if individuals in the government and the elite are prospering as well. God forbid that our government actually holds themselves accountable and admits that its wrong to continue to financially support the policies generated from the War on Drugs.
I do not know what I can currently do to be a voice to change these policies that support the criminal justice method of addressing the drug issues within our society. I will keep my eyes and ears open to support causes that encourage drug education, treatment, and policies that involved the latter.
I really enjoyed your post. We are raised and told about how addictive drugs like cocaine are. When these certain drugs first come out the media can say anything negative about them and society believes it. In a Documentary I just watch called The House I Live In Dr Carl Hart talks about this. He said that when marijuana first came about there were commercials saying you would kill your mom if you did marijuana. Now look where we are at with marijuana. It blows my mind to now know that cocaine is not nearly addictive as we are told and a war on drugs that should have never happened. Did the government not publish that study because they already put so much money into the war on drugs? Is addiction more about people having an addictive nature? If you have not seen that documentary I highly recommend it.
Julie Steinbach says
Carl Hart certainly illuminated some very important points. When government (from any country) begins to censor new studies and information because it doesn’t serve its purposes, then the people are at the losing end of things. Generally speaking, we are a country built on innovation, science, new ideas, continually rethinking and changing based on empirical data. So why is it that the government chooses not to support change, but instead stifle it. The old saying “If it isn’t broke, don’t fix it”, does not apply here. The “war on drugs” that has been going on for a good 40 years has yielded very little in the way of data that supports the governments actions. I do not claim to know the extent of the effectiveness, and I am certain there are some positive outcomes. The problem is that the negatives seem to far out weigh anything good that has come from it. Drugs are a societal problem, a big one. I think we can all look at the data, and see that harsher minimum sentencing has done little to nothing to prevent drug, use and possession. The majority of these criminals are more than likely caught up in the cycle of addition and poverty. Incarceration alone does not address either one of these underlying issues. Without a direct focus on the risk factors and issues that cause and perpetuate drug use and addiction we will not get far.
John Fitzgerald says
Thanks Tyler for the comment and documentary recommendation, will check it out.
John Fitzgerald says
Yes, it can be frustrating living in a country where those in power do not wisely use what we have learned from science. Even when we acknowledge that science is not perfect and continually evolving, no good comes from hiding such a significant report. It is hard figuring out how to make our voices count, but perhaps that is part our life work. Thanks for the comment.
Hello Dr. Fitzgerald,
Your article is just amazing! I never really quite understand why, just why are the government hiding stuffs from the world. What are the reasons they want to keep us in the dark? It is so true when you said, “When those with money and political agendas shape the work of researchers and science, we all lose. We don’t get the truth.” They have the power and money to stop things that they don’t want to hear or things that they don’t want the society to know! It is sad to see how this world has come to. Those with money are in power and the weak and poor just have to listen. Dr. Fitzgerald, you are amazing, please keep doing what you love because for sure those that read your articles learned so much from it, like me for example.
Your article is certainly interesting and fascinating. I always knew that the government has more power than they seem to be. What I found interesting is that they tried to cover up the truth about cocaine! Why would they do that? Will it hurt them financially if the world know the truth about drugs? I feel like they are trying to keep us all in a box so they can control us. I also know that they are trying to distract us from what seems to be a bigger problem! We are just too blinded by the media to even know what is happening in the world that our governments are trying to keep us away from.
I just wanted to start by saying thank your for this article. I don’t really have any experience with drugs. I also know very little about drugs and the harm they can cause. I would say that the only idea I have about drugs is that they are harmful to people and they can become very addictive. I have very little knowledge on this subject. Just like many other people, all I know is that drugs are bad and not to do them. Yes, I might have taken DARE when I was younger but I didn’t know anything before this class. I think that the number one thing I will walk away from is knowing that cocaine is used to help people for medical purposes. Reading this article has helped changed my view on drugs a little and has helped me gain a little more insight.
John Fitzgerald says
Thank you, appreciate your kind words :)
I thought this article was very interesting and very eye opening. It was alarming to read the WHO was preventing crucial information to be released just because it would make drug control policies look bad. But we all know the war on drugs have not been successful and things need to change in our drug polices, that are in the best interest of the population in order to see change. I think it would be a great idea to make policies based off of scientific evidence because that seems more rational then making a policy because of the trends that they see. I think that if we incorporated scientific evidence with drug policies that it could have a greater effect on educating consumers about the risk associated with drug use because consumers can see that polices are being made to protect us, rather than trying to control us.
I’m really glad that you bring attention to the issue between heavy-handed policy built on a specific interest that runs counter to it’s public explanation.
This is one of my biggest point of contention with this type of policy, and the fact that in this case it degrades some of the most at-risk groups in our country, those who our government should (in my oppinion) focusing on protecting and assisting, is infuriating.
This post holds particular importance with me, as my goal is to eventually overhaul the failed health policies that prevent the knowledge, resources, and treatment from reaching those who need it most. This post also has a particular familial relevance that makes me even more impassioned to try and cut this underhanded dealing off at it’s roots.
My current worry is that I won’t be able to reach a point from which I can successfully launch an attack that would reform these corrupt policies, or that the redtape that’s already in place are too broad and layered for me to make any headway in this endeavor.
John Fitzgerald says
Daniel, appreciate your feedback. And I am glad to hear you have motivation to make a difference in health policy, we need people like you to keep pushing things forward. Today, with social media, blogs, and an ability for one person to reach millions, I do think you can make a significant difference. I would caution that efforts done without a peaceful, awakened heart are usually doomed to fail. We need to understand how the systems underlying these problems operate. My experience is that in general people are good, hard working, wanting to do right. Buy then end up in ineffective systems. So study systems science, as it will be among your best tools in figuring out where the leverage points are for change. Good luck!
Linah Alshagdli says
After listening to Dr. Carl Hart’s Ted talk, reading his book, and now this article- my understanding of drugs and addiction have changed dramatically. The idea that was spread around the world about drugs and their deadly effects on humans was really convincing to me. Also, campaigns like “Just Say No” has a great amounts of fear appeal that makes many young adults afraid of even talking about drugs. I’m very glad that I got the chance to get educated about drugs and learn about all the myths out their about them.
Travis Wang says
It’s a shame that many of our politicians have their own hidden agendas in making these laws and policies revolving around drug use. Unfortunately, drug use is still a heavily stigmatized topic with very strong passionate views on both sides of the argument. I myself use to believe the common misconception that “crackheads” (or any type of drug addict) would do ANYTHING and become desperate for more drugs. I have learned so much about this topic after reading Carl Hart’s book and feel that the “drug education curriculum” in public schools should be more comprehensive in the many different factors that potentially contribute to this problem. Nowadays, the normal drug education children receive is a typical “just say no” approach which clearly isn’t working. There needs to be more open minded discussion in an otherwise controversial topic with our students in schools and to the greater public.
Spencer Reichmuth says
Thanks for summarizing the conclusions made from the Cocaine Project research, and the response to the findings by the United States. I was unaware of this study, and find the size, scope, and collaborative nature of it extremely convincing and powerful. Somehow the War on Drugs has been constructed from and sustained with a combination of propaganda, misinformation, classism, and racism. To the list of noble tactics used, we can now add extortion. Imagine if the medical industry was predicated on such fallacious logic, instead of science: we would still be bloodletting to treat pneumonia. I fear the primary motivation behind the US’s belligerent denial of the scientific evidence concerning drug addiction is related to control of money. The supply-side War on Drugs requires tax dollars to pay for law enforcement. The demand-side approach of treatment, education, and quantity regulation which requires addiction experts, behavioral therapists, neurological scientists, psychologist, and medical doctors does not. I think studies like the Cocaine Project directly challenge the US’s premise to collect tax dollars, and thus aren’t received well. Obviously our prohibitive approach isn’t very effective, so positive outcomes must only be one dimension of our public policy. There is a fair amount of research indicating the positive effects of the treatment-base approach on economies, but there is nothing that I’m aware of that estimates the effect to a government’s tax revenues. Sadly, this very well may be the kind of research necessary to persuade the US government to do the right thing.
John Fitzgerald says
Well said Spencer, thanks for the feedback!
David Baron says
I appreciate this review on politics’ dominant role on how view drug policy over science. The cocaine project certainly gives further credit to the fact that anecdotes from our local law enforcement and politicians have more power than actual science. Through suppression, the government continue to wage their war on drugs unopposed.
Interestingly enough, just read Dr Carl Hart’s book, High price, which gives another excellent example of how fear and political opinion dominates drug policy. Dr Hart showcased the exaggerated claims regarding the differences between powder and crack cocaine which guided drug policy. Apparently according to Dr Hart, there were only 2 scientific publications on smokable cocaine in 1986, which was the same year when the law that created a 100:1 crack to powder sentencing ratio came into being. This drug policy was not based at all on the science, just on anecdotes and fear. Ironically, we now know that both forms produce essentially the same effect, the main difference being the route of administration. Even today the ratio is 18:1, still not 1:1, as the evidence suggests it should be.
Another book I just read, Chasing The Scream by Johann Harri, gives excellent background regarding a big player in the drug war, Harry Aslinger, Head of the federal bureau of narcotics, and his contributions to the drug war. You have likely read it, or some other account, but his story shows us that even from the start of the drug war, science was often disregarded in dictating drug policy.
My hope is that people like Dr Hart can begin to bring science to the forefront of this debate. How do we get the politicians to listen, past their conservative or liberal ideals, and evaluate the science with fresh eyes?
I think TED talks are a start, as well as making publications like these come out into the mainstream light, people need to know about the cocaine project, they need to know about Carl’s findings, and the findings of Bruce Alexander, and so many other’s that have already blown holes into many of the ideas that fuel the drug war today.
David Baron says
Hi Dr. Fitzgerald,
I just read Dr. Hart’s book, High price, and I have seen this same figure noted in his book regarding the 80 to 90 percent of people who use illegal drugs never develop a drug problem. The evidence from the cocaine project, using rigorous methods in 22 countries reported similar results, which I now know about thanks to your post.
In Dr. Hart’s book, I found an excellent example on the use of politics to overthrow what science says about a topic. In 1986, a law was passed which imposed a 100:1 crack to powder sentencing ratio that was entirely based on anecdotal reports. Carl continues to say that only 2 scientific publications at the time were based on crack’s effects, but were apparently irrelevant in the creation of the policy.
We know that crack and powder have a very similar chemical structure, one is the freebase form and the other is a neutral compound. These create the same high, the only difference the route by which the drug is administered. Even then, comparable highs are received when an user injects powder cocaine intravenously (of course dissolved). Its crazy to think that back then, for having 5 g of crack cocaine, you would get equivalent sentence to a person that had hundreds of grams of powder cocaine.
Even today the problem has not been rectified, we still have an 18:1 ratio, we should have a 1:1 based on the evidence.
Maybe the government has alternate motives for how their policy is created. The cocaine project reported in its findings that people who smoked crack cocaine or injected cocaine hydrochloride were mostly the socially marginalized and minority individuals.
Is our government targeting these individuals? Is there some profit to be made punishing individuals with great socio-economic strife?
When I see the works of people such as Dr Hart and yourself, telling us how it actually is, I have hope. How do we convince our politicians and our leaders to reform drug policy? Are they ignoring sound science for a hidden reason?
Thank you for sharing this Dr Fitzgerald.
Andreas Ahlstrom says
I recently finished the books Chasing the Scream by Johann Hari and High Price with Carl Hart after watching his TED Talk about a month ago. It is very scary when you realize how little facts and how much fiction that went into forming our current drug policies. Just like Dr. Hart believed when he was young, until very recently I too had embraced the myths, stereotypes and lies that we all heard about drugs. This misinformation had grave consequences for minorities since it led to the Anti-Drug Abuse Act of 1986 which resulted in much harsher punishment for the possession of crack cocaine than powder cocaine even though they are very similar chemically. My biggest takeaway is part of your critical highlight. So often do we forget about the harms legal drugs inflict on our society. While I intellectually know tobacco and alcohol are drugs (I don’t smoke but drink occasionally) I didn’t perceive them as threats. Meanwhile “real” drugs like cocaine, meth and heroin frightened me, and so did people who used them who in my mind were all addicts. That leads in to the original statement your article addressed, is it true that 80-90 percent of people who use illegal drugs never develop drug problems? I want to thank you for sharing the Cocaine Project, it was informative and definitely support Dr. Hart views which contradicts everything I ever learned about drugs. Crazy! While it is obvious you’re not a supporter of the war on drugs, are you also like Dr. Hart advocating for a decriminalization of all drugs, much like they did in Portugal in 2001? Lastly, I do agree wholeheartedly with you regarding money and political agendas in science and research. It has no place there regardless if it is related to drugs, climate change or anything in between. If we are to move forward with the intent of doing what is best for mankind, then there cannot be any hidden political agendas and money making schemes. Thank you for a great article.
Elizabeth T says
I had no idea this study existed and it really saddens me that our government would not make this information available to the public. It’s not surprising but its sad. Thank you for summarizing the report, I think that if more people knew about the report and that our government stopped it from being published then maybe there would be more of an outrage and things could change. I also find it very sad that our scientists are not studying what they feel they should be studying because of the fear of losing funding or never getting funding. As a woman who is going into the science field this makes me very uneasy about my decision.
John Fitzgerald says
Andreas, thanks for the feedback! As to decriminalization of all drugs, like most things, there are no simple or easy answers. I do think we as a society need to advocate for treatment far more than we do. As to the legal aspects, moving in the direction of decriminalization does make a lot of sense.