hearing someone mention that “staging an intervention,” “bottoming out,” or “relapsing,” few people reading this will need to search to follow the implications. Ideas and idioms related to addiction and recovery have been fully integrated into the common culture, the common references by which we understand and navigate everyday life.
All in all it’s kind of weird. That was not always so. And it has been accompanied by an inflation of the term “addiction” itself. Originally limited to addiction to a fairly narrow range of substances, it now applies to pretty much any compulsive behavior that is considered undesirable. (As usual, the satirists at The Onion nailed this trend early on with a headline: “I’m like a chocoholic, but for booze.”)
Such loose reference to addiction may reflect a general increase in public awareness of the problem, which encompasses approximately 14.5 million people with alcohol use disorders and three million opioid addicts in the United States. But acknowledging the reality of addiction and drawing rational attention to it are very different things, and Carl Erik Fisher’s The Urge: Our History of Addiction (Penguin Press) underscores that difference with a compelling narrative full of both promising developments and missed opportunities.
The author is a Assistant Professor of Clinical Psychiatry at Columbia University, and he is also an addict. He recognizes this from the start and fills in the details along the way while keeping the memoiristic aspect secondary to his project. The Urge is a narrative history of the ideas, policies, and practices that have emerged over the centuries. The book focuses largely on substance addictions, but cites “The Gambler’s Lament” from the Rig Veda, an ancient Indian scripture, as a recognizable evocation of the addict’s experience: “The dice are characterized as inciting, humiliating, searing, wanting to sear, (temporarily ) give like a child, then in turn smite the victor, drenched with honey, with strength… You roll down and then jump up quickly, forcing the man without hands to serve you.” The same words might apply to a syringe or a tube be valid.
This struggle to regain control after losing (again and again) runs through Fisher’s account of working as a young resident psychiatrist at a prestigious university hospital while being addicted to various substances to relieve stress. He hasn’t ruined his career or himself, thanks in large part to the medical profession’s self-care precautions: there are special treatment programs to deal with addicted doctors. “In rehab,” Fisher writes, “he met second- and even third-time doctors who had relapsed exactly as planned after their own five-year monitoring contracts expired.” (Status has its privileges.) A recurring focus in the book is the social inequality packaged in the stigma attached to certain intoxicants — gin in the 18th century, for example, or crack cocaine more recently — and the repression imposed on their users, while others a enjoy good reputations when backed by established industries like…heroin?
Yes, heroin. “First produced on a large scale on a commercial scale by Bayer in 1898,” notes Fisher, it was “at first touted as a safe, modern alternative to morphine” until it was associated with “[the] poor teenager, often of immigrant parents, who is unintelligent, greedy and rude, and increasingly banding together with others like him in the new urban phenomenon of menacing ‘gangs’.” When the moral alarm sounded, “medical providers controlled access much more tightly than people with fewer resources, pushed into smaller, informal markets in vice boroughs — poorer, racially mixed neighborhoods where authorities segregated gambling, prostitution, saloons, and other frowned upon businesses.” A drug is known to be dangerous when people deemed dangerous use it take, and so the vicious circle turns.
Close what is admittedly too short an article to do The Urge justice, I should note that its overlaying of literary, social, medical, and political narratives challenges any understanding of addiction that reduces it to one-dimensional causes, or a single therapeutic approach, or promotes a single outcome. “It’s not that addiction is or isn’t a brain disease or a social disease or a universal response to suffering,” Fisher writes. “It’s all of those things and none of them at the same time because each layer has something to add but can’t possibly tell the whole story.” develop addiction”.
That doesn’t mean you can’t do anything about it. Chapter by chapter presents accounts of what have been useful treatments in many cases. But the other side of the story consists of efforts to enforce one approach or ban another for various political, economic, and moral reasons. “The best we can say,” Fisher concludes, is that “multiple influences intersect in a complex and dynamic matrix, changing drastically from person to person, and even changing over the course of an individual’s lifetime.” It should be part of the general understanding of addiction that one size does not fit all.