The Urge: A History of Addiction in the United States

2022-04-05

Carl Erik Fisher’s new book The Urge is “one of those hybrid history/memoirs that illuminates an important subject through personal experience,” wrote Chris Vognar in his review for the Boston Globe. “Fisher digs deep into the history of addiction. He uses sociology, literature, criminology, and, yes, psychology, to explore how societal attitudes have fluctuated through the centuries, from condemning addicts as deadbeats to treating addiction as a disease. Doggedly researched, layered with empathy, The Urge pulls back multiple curtains at once in examining an ailment that will likely never go away.”Learned behavior, brain disease, or self-medication: compulsive substance use and behavioral addictions are hard to pin down. In part one of The Urge, Fischer provides a historical overview of the perplexing “behavior in search of a name.” Addiction is “not a tumor or a bacterium” but is “often explained in terms of a dichotomy of free choice versus total compulsion” but “many people with addiction feel themselves occupying a confusing middle ground between free choice and total loss of control.” We learn that the first person to use the word “addict” was apparently John Frith in 1533, who had converted to Protestantism and was burned alive for heresy. Fisher refers to Augustine’s Confessions as “the first addiction memoir,” and throughout the book, he talks about his own alcohol use disorder and subsequent recovery.Dr. Fisher identifies four main approaches to addiction over the years: prohibitionist, therapeutic, reductionist, and mutual help. The prohibitionist approach is exemplified by the eponymous Prohibition of the 1920s and the now much-discredited “War on Drugs” of the 1970s. As most people understand by now, outlawing particular substances and treating users as criminals have not put an end to addiction in America. According to Fisher, the history of addiction is filled with “overly simplistic attempts to reduce complex phenomena” which have “often misled more than they have helped.” Reductionist approaches have led to many harmful “cures”: “Though it’s a crowded field, Leslie Keeley … probably takes first prize,” Fisher writes. Keeley’s "Double Chloride of Gold" treatment “made millions of dollars, more than 500,000 people with addiction took his cure between 1880 and 1920.” Keeley—a medical doctor—famously claimed that “drunkenness is a disease and I can cure it.”Dr. Keeley’s evidence-free cure counts as quackery today, of course, but Fisher is also somewhat skeptical of the brain disease paradigm promoted by the National Institute on Drug Abuse (NIDA). Calling addiction “primarily” a brain disease goes too far for Fisher. “A single scientific explanatory model cannot possibly explain the essence of a complex system.” Therapies should be evidence-based and although not medical treatment, Fisher praises the “grassroots wisdom of mutual-help” groups—even if they may not be right for everybody. Like Maia Szalavitz in her influential 2016 book Unbroken Brain, Fisher emphasizes that addiction is not primarily about substances. “Addiction does not proceed inevitably from use. Most people who use drugs — including crack, methamphetamine, and heroin — do not develop significant problems. In studies spanning decades, no more than 10 to 30 percent of people who use drugs develop significant substance use disorders. Drugs are not ‘addictive’ in themselves; they don’t cause addictions in isolation.”This echoes Szalavitz’s conclusion in Unbroken Brain: “By itself, nothing is addictive; drugs can only be addictive in the context of set, setting, dose, dosing pattern, and numerous other personal, biological, and cultural variables. Addiction isn’t just taking drugs. It is a pattern of learned behavior.”Addiction journalist Johann Hari, the author of Chasing the Scream, a history of drug criminalization, famously stated that the opposite of addiction isn't sobriety but connection. Fisher would agree. His book analyzes in detail settings and cultural variables that were important factors in recurring drug epidemics around the world such as the British “Gin Craze” of the 18th century or the more recent American opioid epidemic. “When addiction epidemics strike, we want to know why,” writes Fisher. But a complex situation with a multitude of factors is too often reduced to a simplistic scenario. “What is necessarily a complex web of intersecting forces is too often reduced to one simplistic story: trauma, brain disease, an evil and unstoppable drug, a bad pill-mill doctor, a hereditary taint, or a weak will, or poor morals.” While certain alcohol, pharma, and tobacco industries cannot exactly be viewed as blameless—Fisher regards many such companies as “addiction supply industries”—they are only part of the problem. “Epidemics are never caused solely by an inherent power of the drugs themselves, or the efforts of the addiction supply industries; there is often if not always, social wounding underneath, driving the substance use.” In 2016, Surgeon General Vivek Murthy opened his landmark report on addiction in America with the blunt statement that “the United States has a serious substance misuse problem.” Despite decades of expense and effort “substance misuse remains a public health crisis,” he wrote then. Among other steps, Dr. Murthy called for improved access to evidence-based treatment services but six years later, still only ten percent of people with addiction receive any kind of treatment. In The Urge, Dr. Fisher accuses the medical system of “coming up woefully short in its treatment of addiction.” There are “massive barriers to receiving mental healthcare in general but the problem is even more pronounced for people with substance use disorder.” The medical profession “must embrace the care of this population, as stigmatized attitudes about addiction remain a tremendous barrier to care.” Like many other physicians, Fisher advocates the full use of the FDA-approved medications for opioid use disorder, but he also emphasizes that each case of addiction is different and that “a growing body of research on recovery outcomes has clearly shown that people overcome addiction in a variety of ways.”There is no need to demonize addiction, as it is “profoundly ordinary: a way of being with the pleasures and pains of life, and just one manifestation of the central human task of working with suffering.”Valiant Living Professionals Program for Men strives to restore lives from addictions, intimacy disorders, and their influence on all aspects of life. Our trained staff utilizes the most progressive therapy techniques to offer the highest quality of care. We provide individual therapy, group therapy, psycho-educational classes, workshops, and more to help restore the focus on a purposeful life disrupted by intimacy disorders and substance addictions.If you or a loved one has turned to drugs or alcohol to keep up with work and manage a high degree of daily stress, don’t hesitate to reach out for help by calling us today at 303-952-5035.

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