High Price

become a heavy drinker (although she nonetheless always met her occupational and family obligations). And she had her first child at age nineteen but married the father a few months after the child’s birth. They are still together. But she is not the sister who stabbed a woman in a fight over a man and was later stabbed herself in a similar situation. The sister who got into those altercations does not have substance abuse problems.
    One of my sisters’ husbands was arrested in connection with a deadly shooting but not convicted—but that is not the brother-in-law who went to rehab for crack cocaine abuse. And the in-law who did have a crack problem? He went on to get a job in plumbing, has a house twice the size of mine, and is a loving father and husband.
    Where was the connection between drugs and problems here? Among my family—just as I was beginning to understand from the research as well—the link between addiction and other forms of dysfunctional behavior was not as prominent as the stereotypes suggest. In some cases, alcohol use or its aftereffects exacerbated violence: for example, when my father beat my mother. Some of my cousins had struggled with crack. But illicit drugs and addiction were far from the greatest threats to our safety and chances of success. There seemed to be at least as many—if not more—cases in which illicit drugs played little or no role than there were situations in which their pharmacological effects seemed to matter. And if the drug highs themselves didn’t explain behavior, for me that meant behavior related to lack of drugs—that is, craving—was even further away from allowing us to predict it.
    I had left my San Francisco postdoctoral position disillusioned by the whole concept of craving. Some addicts certainly reported drug craving: there was no doubt about that. But it didn’t really predict whether they relapsed, according to the majority of research. Sometimes people would report severe craving but not use drugs; other times, they’d use drugs in situations where they said they’d experienced no craving at all. It seemed to me that it would be much more useful to study people’s actual decisions about whether to take drugs, rather than focus so much on what they said about what they wanted or craved in some hypothetical future. That’s why I responded with enthusiasm when Dr. McCance-Katz had suggested I do a postdoc with her at Yale.
    Although I didn’t get to study drug-taking decisions at Yale, at least with Dr. McCance-Katz, I was able to observe people’s behavior while under the influence, not just their ratings of their desires to use drugs. That brought me closer to the types of experiments I really wanted to do so I could understand the real effects of drugs, not just our projections of them.
    In order to find people to participate in our research in New Haven, I also had to interview many drug users. At the time, I wasn’t even making a distinction between drug use and addiction. Despite what I was starting to learn, I still thought all illegal drug use was problematic and that most people engaged in it were headed for addiction if indeed not already there. I didn’t distinguish between addictive use that interferes with major life functions like relationships and work, and controlled use that is pleasurable and not destructive.
    Like the addicted people I was studying, I was influenced by my social milieu. Everyone around me in the addiction field acted as though pathological use was more common than controlled use. Certainly if you read the scientific literature unskeptically, this is the impression with which you are left. Consequently, when I interviewed users at this time whose lives seemed unscathed by their drug use, I figured I just hadn’t yet become skillful enough to ferret out their denial. After speaking with dozens of them, though, I started to think twice. Maybe I wasn’t the one who was wrong.
    I thought back on what I’d learned about behavior and how it is affected by punishment and reward, going back to B. F. Skinner. Were drugs really that different from other reinforcers or pleasures? I looked at the existing data on that question. In the animal research, the graphs representing how hard an animal is willing to work for a food or drug reward were almost identical: make access easy and provide few alternatives and animals will definitely eat a lot of sweet or fatty food or take a lot of cocaine or heroin.
    However, the