High Price

between what we were measuring and what happened in real-world drug-using settings was not strong enough to matter. Dr. McCance-Katz was at UCSF on sabbatical at the time and I mentioned these concerns to her, which is how I got invited to do my second postdoc, at Yale. Even there, however, I still had no clear path to that elusive goal of a real job, a permanent tenure-track position. I wasn’t sure I’d ever be able to support my family doing the work I loved. And now, I sometimes hated it. A job at Walmart started to look good by contrast.
    To make matters worse, after only months, I learned that Dr. McCance-Katz was soon going to be leaving Yale, which meant my job there would end as well. The viciousness and underhandedness of the competition I experienced during this postdoc was beyond anything I’d ever been faced with before. For example, when I learned that Dr. McCance-Katz was leaving Yale to accept a job elsewhere, I met with a senior member in the department who promised me a faculty position within the department. Later, when I attempted to follow up on the position, this person claimed to have no recollection of our previous conversation, saying that I must have misremembered.
    Fortunately, it was at this point that I met Herb Kleber, who was then the director of the division on substance abuse in the department of psychiatry at Columbia. I had a friend who worked with him and said that his program at Columbia was going to be expanding. She introduced us at a scientific meeting and he tried to recruit me with the promise of a faculty position. I was especially excited about the idea of working at Columbia because his wife, Marian Fischman, studied crack cocaine administration in humans. She’d published a paper in the prestigious Journal of the American Medical Association showing that crack and powder cocaine were pharmacologically indistinguishable. 5 I eagerly prepared to visit New York for my interview.
    However, when I met with Marian, virtually the first thing she said was “I don’t know what Herb told you, but we don’t have a faculty position. We can only offer you another postdoc.” Given the amnesia I was starting to see at Yale, I ultimately agreed to do a third postdoc at Columbia. I didn’t know when this job limbo would end or for how long I could stand it. I certainly wasn’t receiving the rewards of a scientific career that had been expected.
    Marian, however, promised that she would do everything she could to help me get a permanent position. She was true to her word. It was at Columbia that I would ultimately get a tenure-track job and reach tenure itself. And in my research there I began finding, as I’d suspected, that humans do respond to cocaine quite similarly to how they respond to other reinforcing experiences. Like the rest of us, people who are addicted to crack cocaine are sensitive not only to one type of pleasure but also to many. While severe addiction may narrow people’s focus and reduce their ability to take pleasure in nondrug experiences, it does not turn them into people who cannot react to a variety of incentives. I began the work that illustrated this as a Columbia postdoc, a job I held from September 1998 through June 1999.
    In the study I briefly described in the preface to this book, cocaine users were given a choice between various doses of cocaine and various amounts of vouchers for cash or merchandise. 6 On average, on the street, our participants spent $280 a week on cocaine. These were not casual or irregular users.

    Marian Fischman’s research group when I arrived at Columbia in 1998. From left, Marian is the fifth person standing. Herb Kleber is seated next to me.
    Our procedure worked like this. First, we recruited frequent crack users through ads in the Village Voice and from referrals by other users provided by those who replied to the ads. Then we screened the volunteers for health problems that would ethically preclude their participation in cocaine research (for example, heart disease). We also screened their urine to ensure that it was positive for cocaine, though we did not reveal that we were confirming their use in this fashion.
    Those who were cleared to participate were paid to stay for two to three weeks in a ward at Columbia-Presbyterian Hospital in Harlem (now New York–Presbyterian). Before we did any of this, of course, we’d applied for and received special licenses to work with illegal drugs on human subjects and been