Drug Use for Grown-Ups
I read Dr. Carl Hart's Drug Use for Grown-Ups slowly, over several weeks, and I'm still not sure what I think of all of it. That seems like the right response to a book meant to unsettle.
Dr. Hart is a neuroscientist at Columbia. He spent decades studying drugs and the brain, and the book is his argument that much of what we've been told about drugs is shaped more by fear and policy than by evidence. It's provocative on purpose. Some readers will put it down angry. I'd ask you to keep going anyway.
The part I keep returning to
I'm not going to summarize his arguments about policy. He makes them better than I can, and I'm a counselor, not a policymaker. What I keep returning to is something quieter underneath the whole book: the cost of shame.
Almost everyone I've sat with who struggled with a substance carried a second weight alongside it. The weight of what it meant about them. Weak. Broken. A bad parent. A person who can't be trusted. That second weight is often the heavier one, and it's the one that keeps people from telling the truth to their doctor, their partner, their therapist. It keeps them from asking for help until things are very bad.
Hart's book, whatever you make of the rest of it, is an argument against that shame. And on that point I'm with him entirely.
What I actually believe
Let me be plain, because this is my name on the page.
I don't encourage anyone to use drugs. I've seen what substances can take from a person and a family, and I take that seriously. I'm also honest with myself that alcohol, prescription medication, and cannabis are part of many of my clients' lives, and that pretending otherwise helps no one.
What I believe is this: people are more likely to be safe when they're not afraid to be honest. My job is to make honesty possible. That means no lectures, no flinching, no writing anyone off. If you tell me what you're using and why, we can talk about what it's doing for you, what it's costing you, and what you want. If you're hiding it, we can't talk about anything real.
Hart calls this treating people like grown-ups. I'd call it treating people like people.
If this is you
If you've been carrying something you've never said out loud, you can say it here. Nothing you tell me about your substance use will surprise me or change how I see you. It will just help me help you.
And if you're in crisis right now, please don't wait for an appointment. Call or text 988. It's free, it's confidential, and someone will answer.