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Mitch Twists Hart’s Gist

Last week’s adulatory piece on Carl Hart’s book “Drug Use for Grown-Ups” evoked disagreement from AVA reader Terry Miller. Her comment —”A horrible horrible book by a man who should not be teaching students”— was 100 times more honest than some of the criticism coming from Dr. Hart’s professional colleagues.

Exactly as Hart foresaw, “peddlers of pathology” are raising the specter of addiction in an attempt to discredit his thesis. The February 7 Times Book Review ran a letter by Mitchell S. Rosenthal, owner of the Phoenix House chain of treatment centers, dissing Hart’s book and promoting his own business. In closing, Rosenthal wrote, astonishingly, “I agree with Hart that the ‘war on drugs’ has failed, but his war on the reality of addiction is far more dangerous.” Two weeks earlier the Times had run a review stating that Hart disputed the notion that the War on Drugs has been a failure. Rosenthal was “agreeing” with a point antithetical to the very important one Hart had made! You’d think an editor would have consulted the book itself to confirm that their reviewer had it right —she did—and then rejected Rosenthal’s letter or respectfully asked him to cut the shit.

Rosenthal’s letter was doubly duplicitous. By pretending to agree with Hart, the treatment magnate tries to come off as a reasonable, unprejudiced man,  when in fact he is biased and vindictive. If and when there’s ever a decline in the number of US drug users mandated to get “treatment” by courts, employers, schools and other sources of authority, Mitch Rosenthal’s Phoenix House empire will lose revenue. 

In the spring of 1996 I had an assignment from The New Yorker to write a piece about Proposition 215, the ballot initiative to legalize marijuana for medical use in California. The piece was scheduled to run the week before the election or the week after. It was spiked at the last minute, according to my editor, Hendrik Hertzberg, at the urging of ‘Tina’s guru on drug issues,’ a man named Mitch Rosenthal. ‘Tina’ was the top editor at the NYer. Mitch Rosenthal ran the Phoenix House chain of treatment centers and had made millions of dollars thanks to marijuana prohibition. On November 12 the Village Voice ran a much-shortened version of my Prop 215 piece and the New Yorker sent a $3,000 ‘kill fee’ —a lot more than I’d ever been paid for magazine pieces that actually got published.

When US Drug Czar Gen. Barry McCaffrey retired in 2000 at the end of Bill Clinton’s term, he went to work for Rosenthal pitching “treatment” as an alternative to incarceration. 

The Harm in ‘Harm Reduction’

The Wall St. Journal ran a review of “Drug Use for Grown-ups” by Dr. Sally Satel that actually was fair and balanced. Unfortunately, Satel’s piece contains a misstatement of fact reminiscent of Rosenthal’s. “As a psychiatrist,” she writes,  ”I know that some people can be responsible users of even the most feared drugs. But the pill mills of Appalachia and the needle-strewn streets of San Francisco show how devastating unfettered access to drugs can be. Mr. Hart promotes treatment and harm reduction (e.g., clean needles, safe-injection rooms, testing for contaminants), but he doesn’t offer a detailed blueprint for keeping drugs away from the people whose lives can be ruined.”

Far from promoting harm reduction, Hart skewers the phrase. It’s hard to mistake his point-of-view; chapter three is entitled “Beyond the Harms of Harm Reduction.” First he defines it: “an attempt to reduce negative consequences associated with drug use. Providing clean needles and syringe to an intravenous heroin user is an example of harm reduction because it decreases the person’s chances of contracting a blood-borne infection from sharing contaminated injection equipment. Instructing a festival-goer to drink lots of fluids, to stay well hydrated, if the individual takes a diuretic drug such as MDMA or methamphetamine, is another example of harm reduction...

 “Each one of us on a daily basis takes measures to prevent illness and to improve our health and safety: we brush our teeth, wear seatbelts, use condoms, exercise. We don’t call it harm reduction, we call it common sense, prevention, education, or some other neutral name... The term harm reduction is used almost exclusively in connection with drug use and has negative connotations... [It] preoccupies us with drug-related harms. The connection between harms and drug use is reinforced repeatedly through our speech. This connection in turn narrows our associations, conversations, feelings, memories, and perceptions about drugs and those who partake. Perhaps even worse, it relegates drug users to an inferior status. Surely, only a feeble-minded soul would engage in an activity that always produces harmful outcomes, as the term implies.”


  1. Wineguy February 23, 2021

    Mr. Hart does a great disservice to current drug users, former addicts and many others who work in rehabilitation of addicts. This is a rather self serving, Hey look at Me book and Hart gets his mandatory 15 minutes and NYT review under his CV. I await is future publication,” How I overcame my self infatuation and addiction.” That is, if he survives this stage of denial.

  2. fred gardner February 23, 2021

    Is wine your drug of choice? Assuming you drink in moderation and could quit any time without missing it (mild withdrawal), you prove Hart’s point.
    As for his future, want to place a little side bet?

  3. izzy February 23, 2021

    But wine is not a drug, it’s a locally important industry. And now acceptably positioned in polite society, much as cannabis hopes to be. The term “wino” has almost disappeared from our lexicon, though the behavior is now widespread and even exalted. So much is in the eye of the beholder these days.

    • Douglas Coulter February 23, 2021

      Harm reduction is having a designated driver when you go out wine tasting

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