High Price

cleared by an ethics committee called an institutional review board (IRB). Then we obtained the cocaine from a pharmaceutical company, keeping it locked in the pharmacy with other controlled substances, using careful procedures to account for all of it.
    On days participants were scheduled to smoke cocaine, each one would sit in a small room with a computer at a desk, where we could observe them through a one-way mirror. A nurse was in a nearby room, monitoring her or his vital signs and lighting the crack pipe when cocaine was chosen. When they smoked crack, participants were blindfolded so that they couldn’t see the size of the rock they were getting. We didn’t want them to have visual cues that might amplify or diminish their expectations about the hit.
    At the very start of each day, before having to make any choices, participants had a “sample” trial. That meant that they were allowed to try the dose of cocaine we were making available that day and to see and hold the cash or merchandise vouchers on offer. Both the researchers and the participants were blinded as to whether actual cocaine or placebo was placed in the crack pipe. After the user had sampled the day’s dose, he or she would participate in five “choice trials,” spaced fifteen minutes apart. When a choice was available, an image of two squares would appear on the computer and the participant had to either click the left (crack) or right (voucher) side of the mouse to indicate their choice.
    In order to actually get the drug or voucher, they then had to press the space bar on the keyboard two hundred times. During their first four choice sessions, the choice was between a voucher for five dollars in cash or the day’s cocaine dose; during the last four, they had the choice of the dose or the five-dollar merchandise voucher.
    Again, the results were similar to those seen comparing different rewards in the animal literature and in earlier human trials. When larger cocaine doses were available, users almost always chose cocaine over the cash or merchandise voucher. So far, this was congruent with the idea that addiction makes people place drugs first. But the rest of the data demolished that theory, showing that lower doses were often resisted. Despite the popular conception that addicted people will choose any dose of drug over any other experience—especially once they’ve already had a taste of it to kindle their craving—this is not what we find in the lab. Even around drugs, addicted people are not simply slaves to craving. They can make rational choices.
    This was the case even though the alternative in each choice had only a maximum value of five dollars. In total, our participants could earn up to fifty dollars each day by participating in two complete sessions, which was a significant sum given their usual low income. But if the “first hit produces irresistible craving” theory were true, any dose should have had infinite value during the moment of choice. The cocaine users shouldn’t have been able to think beyond the five dollars to the fifty—or about the particular dose, if the idea that people with addiction are totally out of control once they start using drugs is true.
    Nonetheless, on average, users in our studies smoked two fewer doses of cocaine when the alternative was cash as opposed to merchandise. 7 This meant that cash money was 10 percent more effective than vouchers in suppressing cocaine use. The conventional wisdom about addictive behavior being completely irrational couldn’t at all account for this result. If people addicted to cocaine always went for drugs no matter what, there should have been no difference.
    Because our findings were so different from what most people have been taught about drugs, critics sometimes argued that they only really showed that these crack users were saving their money to buy more cocaine on the street later. That itself, however, doesn’t even support the conventional view of addiction. Weren’t addicted people supposed to be unable to resist drugs that were in front of them and be incapable of saving up for drugs or anything else later? And why would someone turn down pure pharmaceutical cocaine in a legal setting in favor of possibly being beat on the street and getting stepped-on (adulterated) drugs illegally in the future? That would truly be irrational under the logic of the idea of addiction as something that “hijacked” the brain and took control of the will