Carl Hart is a psychologist at Columbia University. Please support this podcast by checking out our sponsors:
- InsideTracker: https://insidetracker.com/lex and use code Lex25 to get 25% off
- Ten Thousand: https://www.tenthousand.cc/ and use code LEX to get 15% off
- Four Sigmatic: https://foursigmatic.com/lex and use code LexPod to get up to 60% off
- ExpressVPN: https://expressvpn.com/lexpod and use code LexPod to get 3 months free

EPISODE LINKS:
Carl's Twitter: https://twitter.com/drcarlhart
Carl's Website: https://drcarlhart.com
Drug Use for Grown-Ups (book): https://amzn.to/3lVpq2Y

PODCAST INFO:
Podcast website: https://lexfridman.com/podcast
Apple Podcasts: https://apple.co/2lwqZIr
Spotify: https://spoti.fi/2nEwCF8
RSS: https://lexfridman.com/feed/podcast/
Full episodes playlist: https://www.youtube.com/playlist?list=PLrAXtmErZgOdP_8GztsuKi9nrraNbKKp4
Clips playlist: https://www.youtube.com/playlist?list=PLrAXtmErZgOeciFP3CBCIEElOJeitOr41

OUTLINE:
0:00 - Introduction
1:53 - The experience of drugs
12:57 - Drug use for grownups
18:40 - Studies on drugs
19:50 - Negative effects of drugs
25:18 - Should all drugs be legalized
30:47 - War on drugs: positive or negative
36:39 - Proper, positive, and misuse of drugs
40:59 - Recovery
47:53 - Drug depiction in movies
51:24 - How the study of drugs changed Carl
53:48 - Formative memories
58:16 - Greatest hip hop artist of all time
1:01:38 - What mind altering drugs teach us
1:05:45 - Advice for young people
1:07:51 - The meaning of life

SOCIAL:
- Twitter: https://twitter.com/lexfridman
- LinkedIn: https://www.linkedin.com/in/lexfridman
- Facebook: https://www.facebook.com/lexfridman
- Instagram: https://www.instagram.com/lexfridman
- Medium: https://medium.com/@lexfridman
- Reddit: https://reddit.com/r/lexfridman
- Support on Patreon: https://www.patreon.com/lexfridman

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 Grownups, 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.

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 wanna 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.

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 sort of the biology of it versus the full environmental human experience.

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 that drug under the right conditions and it just be like 1 of the best moments you've ever had.

It certainly enhanced 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.

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 won't be any closer to understanding the sort of experience that is induced by these drugs.

Certainly the experience that we all seek.

So getting a positive experience or getting a negative experience is strongly defined by the environment.

But the environment is a very, it's a short word that can describe a lot of things.

So would you say the environment is important, are 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?

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.

And 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.

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.

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 hearing this would think it's quite non-obvious.

So in your new book, Drug Use for Grownups, 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 that create a 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 2 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 1 such drug, maybe cannabis being 1 such drug, but you also mentioned other drugs, like cocaine, heroin, methamphetamine.

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?

How do we increase the likelihood of getting the positive effects?

Again, like I said, we wanna 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, it's something contaminated in some adulterant, it's in my drug.

So you wanna 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 1, you need to remove the anxiety.

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 like, well, why does this sound counterintuitive?

Well, because there's money in reporting the negative effects almost exclusively.

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.

But when you read these newspaper articles, they don't say this.

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 when, and the writer is lazy and does not do any sort of development.

Just, just think about any, oh, let's think about the Sopranos, for example.

You know, they have a new program coming out.

The Sopranos is a show in which the lead character Tony Kills people for a living.

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.

That's what the show wants us to believe.

Tony's a racist, a murderer, all of these things, but we feel sympathy for him.

But we don't feel sympathy for anyone who uses drugs.

I mean, and the American public buys into it.

That is, that's wild to me, 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 are there not more stories of grownups using drugs?

The full spectrum of drugs that we're talking about.

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 just productivity it actually I think he says like it increases 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.

People are afraid that they will be belittled, dismissed, all of these things as a drug addict or some negative thing, but cannabis is lightweight, come on.

You can emit 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.

You have developed some responsibility skills, all of these kind of things.

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 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?

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.

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.

But I understand that because culturally I came up, I was taught a lot of like, this is what you don't do, and this is what you do.

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 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 on 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, like for productive ends, but it destroyed the person.

Robert Johnson sold his soul to the devil to learn guitar.

You could take the drug, you're gonna create some good stuff, but you have to pay for it.

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 grownups.

We tell people, Pinocchio, if you lie, your nose grow.

But that's exactly what these stories are.

They're in the same vein as those kind of stories, as Pinocchio.

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 kinds 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, at 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, taxpayers' dollars.

Do you think we would be allowed to do this if these drugs were so dangerous?

I mean, 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 we're talking about from marijuana to psilocybin to MDMA to cocaine and heroin.

Like what the actual experience with the positive and negative effects of the experience on the drug are in control conditions?

Yeah, so we did these kinds 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 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?

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 something like crack cocaine versus alcohol or heroin when it comes to withdrawal or physical dependence.

Like cocaine has a very limited sort of withdrawal symptoms.

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 1, that's the most dangerous.

I mean, all of these kind of questions we wanna 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 motility, 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.

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 phenomena 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 a property of the environment, not a property, a result of the environment.

There are people who are suffering from a 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 And those people are more likely to have some problems with drugs.

There are people who are just immature, not developed, haven't 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.

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 a 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 the escape, right?

I mean, people say stuff like that, and that's 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.

It's like when you have a math problem, you don't want people saying, well, you know, I feel like this.

So 1 of the problems with the data, so 1 data is there's the studies that you're doing, this is excellent research work, but there's some of the drugs are illegal.

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 you got 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.

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 will be a free-for-all.

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.

Do these, the drugs that the routes of administration will be oral and I don't know, let's say intranasal.

See all Lex Fridman transcripts on Youtube

Carl Hart: Heroin, Cocaine, MDMA, Alcohol & the Role of Drugs in Society | Lex Fridman Podcast #233