Carl Hart is good on the basics of what we know, and don't know, about addiction and neuroscience. He's decent on telling the story of his life, and on public policy, minorities and the "War on Drugs." However, where parts 1 and 2 intersect, he sometimes seems to soft-pedal part 1 for the sake of part 2.
Neurotransmitters and neuroscience
When dopamine's prominent role in reward was first proposed, there were only about six known neurotransmitters: dopamine, norepinephrine, serotonin, acetylcholine, glutamate and GABA. Now there are more than a hundred. Furthermore, we now know that there are specific receptors -- or specialized structures that recognize and respond to a particular neurotransmitter -- for each neurotransmitter, and most neurotransmitters have more than one type of receptor. For example, dopamine has at least five receptor subtypes -- D1-D5. We also now know that hormones like oxytocin and testosterone can act as neurotransmitters.
But despite these ever-intensifying complexities, our theory about dopamine's role in reward has not been appreciably revised since it was first proposed [in the early 1990s]. And, as you will see later, a growing body of evidence casts doubt on this simplistic view of reward.I knew a fair amount of this before I read Hart's book. But, his directly applying it to addiction, combined with his ethnicity and sociological background, gave me the perfect excuse, or reason, to blog about it more directly.
Unfortunately, Nora Volkow, head of the US government's National Institute on Drug Abuse, is one of the biggest pushers of the dopamine theory. I'm not sure if I would go so far as to claim this is a new version of the "disease theory" of addiction, though, as Stanton Peele does. Especially given that Peele is one of the most tireless promoters of theories of addiction that largely deny the existence of addiction, one can usually depend on him to overswing, and therefore, take what he says with a 1/3 off grain of salt.
Now, public policy issues in the book
Skepticism of some of his claims
Nor does he seem to ask himself if he’s over-reacting to some of his own personal, and his larger background as an African-American’s, take on things like the “crack menace” or “reefer madness” long before that.
Related to both points, he doesn't ask, as a very rare minority Ph.D. neuroscientist, if some of his test subjects are "trying to help a brother out." I hate to stereotype, and I'm not a minority, but, I've been around a boatload of drinkers and users. I'm liberal enough to know the War on Drugs is a crock, but I've been plenty a person be sober or clean for years, even a decade or more, "slip," and not be able to get back on track.
Political issues, of his own
Finally, I raise at least a partial eyebrow at his crediting Maia Szalavitz for helping get the book done. Szalavitz at least has a few of her toes in the pool of right-wing funded journalism, or "journalism," or is at minimum a "fellow traveler." Her association with places like STATS.org, which, per Wiki, has connections with Scaife money, American Enterprise Institute, etc., and is affiliated with George Mason University, is a red alert right there. That would probably explain, per some Amazon reviewers, Hart visiting Fox News, and ... more than once! I suspect, per those Amazon reviewers who would be clueless as to why, this was to get "in" with libertarian Fox watchers, not the religious right. Hart explicitly calls for decriminalization, which is neither neuroscience nor memoir.
Related to that, I'm tired of libertarians, starting with Glenn Greenwald, talk about what a success drug decriminalization is in a place like Portugal when most of them know that Portugal has a better "safety net" than we do and spends more government money on it than we do now, and than many libertarians here are willing to pay.
Greenwald, and Hart here, if they want to propose this, then fine ... be honest with how much this costs. And, if you're either too lazy to have researched that, or are afraid to tell people that, or else are a committed enough economic libertarian that you don't want the government paying that price, then shut up about the "Portugal solution."
You can find the neuroscience work, including on neurotransmitters and related issues, from other neuroscientists, or else from psychiatrists doing research work. In many cases, it won't be explicitly tied to the decriminalization issues, and possible peddling of harm reduction over abstinence, which reportedly Hart has done on some of his TV appearances.
This is a book that has more froth than substance, after a first look.
There is a sort of political silver lining. Maybe the US needs a few more black libertarians of prominence, if that's what Hart is becoming, as well as black social conservatives.