They also cause constipation, and in
some people cause itchiness.
All of these things are important
for [psychologists] to know because
it enhances our credibility with drug
users — we’re not only emphasizing
the potential negative effects, but we
understand the positive effects as well.
People who take drugs by and large are
not stupid. They take them for some of
these effects that we are describing, not
for the addictive effects that we focus on.
Another important point is that
most people who take drugs don’t meet
criteria for addiction. So if you’re only
focusing on those limited effects related
to pathology and addiction, you have
alienated the vast majority of drug users.
Some of your studies that
have gotten the most attention
are those that show that
people who use cocaine and
methamphetamine react in a
logical way if you give them the
choice between the drug and a
reward. Can you talk about that?
The bottom line is that if you present
people who meet criteria for addiction
with a choice between the drug and an
attractive alternative, you can shift the
drug-taking behaviors if the alternative is
attractive enough. People will choose the
alternative reward instead of the drug.
This has been shown in lab animals,
in work we’ve done with crack cocaine
users and work that we’ve done with
It’s one of the most effective
treatments we have, but it gets no or
limited attention, in part because it’s not
sexy. You don’t have a brain-imaging
picture to show people, and so people
are not interested. And to me, that’s a
shame. It’s probably one of the most
powerful technologies we have, and
people are ignoring it.
We did a Monitor article on
a program like that at Johns
Hopkins a few years ago. The
researchers give people jobs,
where the price of admission is a
clean drug test.
That’s right. You’re giving them job
training skills, you’re teaching them
how to perform and behave in the
workplace. These folks hadn’t had this
sort of level of education previously. It’s
so innovative — I just have a great deal
of respect for the work people like Steve
Higgins at the University of Vermont
and Ken Silverman at Johns Hopkins
are doing. Those people are taking this
work out to the clinic, and they are
using these procedures to help people
deal with their drug addiction. So at
some level I feel almost guilty talking
about my lab, when these guys have
been doing this work for years. They are
partly the reason that I am so vociferous
Recently, you’ve begun
advocating the decriminalization
of all drugs. Can you talk about
how your research led you to
decide that was the right drug
It took me a long time to come to this
position, but I’ve come to it based on
the fact that I now know that our drug
policies are based on false assumptions.
The vast majority of people who use
drugs don’t get in trouble with drugs.
The data we’ve collected for years show
For example, the drugs that we
are really concerned with, in terms
of overdose [deaths], are heroin and
opioids. When you look at the data, you
see the overwhelming majority of these
people died not from the drug but from
ignorance, because they combined them
with alcohol or with another sedative.
That’s what kills them.
When we start to see that sort
of stuff, that our drug policies are
based on misapprehensions and
inappropriate assumptions, and couple
this with the fact that we arrest 1. 5
million people every year for drugs
— 80 percent of those for simple
possession — something is very wrong.
Then when you start to look at the
fact that if you have a drug-related
violation, it decreases the likelihood
of your getting a job, it decreases
the likelihood of your making a
contribution to society. And the racial
disparities in our enforcement of the
drug laws, that just sickens me.
Decriminalization is not legalization.
People still can get fined or receive
some administrative sanction for drug
possession, like a traffic violation.
We can still send a message that we
disapprove of this. But the disapproval
should not ruin people’s lives like it has
You’ve said that the goal of
a drug-free society is not
realistic. So what drug policy is
Well, you think about it in the same
way you think about tobacco and
alcohol. What is our goal with those
drugs? We know people use those drugs
to alter their consciousness, so we have
to teach people to live with these drugs
as safely as possible. The same is true
with these other drugs. You just teach
people how to live with these drugs, to