The Urge: Our History of Addiction

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Release Date: 
January 18, 2022
Penguin Press
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Anyone with a drug or alcohol dependency problem will, at least some of the time, feel that nobody knows their pain. But Carl Erik Fisher—a New York psychiatrist who battled his own alcohol issue—has written a compassionate book to help get them heard—and appropriately treated.

Fisher interweaves the history of addiction with his own situation, which involved binge drinking, denial, a near loss of his medical career, and involuntary commitment. If he’s passionate about his subject, it’s in part because he’s been there himself. He argues that “get tough” zero tolerance programs for addicts don’t work, that total abstinence is not always applicable, that addiction without treatment is not a death sentence—many addicts recover on their own, that senseless regulations prevent physicians from prescribing useful medication, and—above all—there is not a single “addictive personality.”

The history of addiction can be told in vignettes:

  • John Frith, the first person to use the word “addict” in English, was a Cambridge graduate imprisoned in the Tower of London for heresy, and then burned alive;
  • A Mohegan Indian Christian preacher named Samson Occum, who thundered against drunkenness among native populations during the 1770s, raised the astounding sum of £11,000 on a crusade through Great Britain. The money was to have gone to establishing a native school, but instead it was stolen and used to start what became Dartmouth College—which enrolled only 19 native students in its first 200 years of existence;
  • “The Gin Craze” was the first urban drug epidemic, upending London in the mid-18th century;
  • Benjamin Rush was an early medical champion of compassion for and treatment of alcoholics, but his approach to curing yellow fever—removing up to 80 percent of a patient’s blood—undoubtedly killed hundreds;
  • Minister Lyman Beecher, father of Harriet Beecher Stowe, was an early leader of the temperance movement, and believed that alcohol “was simply too dangerous to be used in any quantity”;
  • In an 1884 paper, “On Coca,” Sigmund Freud offered “a song of praise to this magical substance”—cocaine. He pushed the drug’s therapeutic benefits, and prescribed it to a close friend, who became dependent. Later, he changed his mind;
  • Aspiring writer Thomas de Quincy was swept up in the first opioid crisis, and wrote the celebrated Confessions of an English Opium-Eater in 1821. He thought the drug was a gateway to the transcendent, and claimed in the book that he had stopped using the substance without a problem, but in fact he remained a user until his death. Other British Romantic opium eaters included John Keats, Lord Byron, and Sir Walter Scott;
  • Politicians and the media have frequently employed racist tropes to build fear of criminal addicts. Newsweek warned that crack cocaine was “transforming the ghetto” and was “rapidly spreading into the suburbs.” 

Although the book does castigate the Sackler family for promoting Oxycontin in a reckless manner, it doesn’t have much to say about the drug itself, which remains a scourge. It would have been useful to know which treatments work best against this very contemporary plague. Another bit of erratum: The Urge is sparsely illustrated, but for some reason the 1846 Currier illustration “The Drunkards Progress” appears twice.

Dr. Fisher has written a very useful book that tracks both addiction and our treatment of it through the ages. His use of his own story at strategic junctures is effective, and offers hope for a lasting recovery—despite the fact, as the author makes abundantly clear, that “the medical system is coming up woefully short in its treatment of addiction.” His RX for improvement includes “expanding harm reduction, expanding the workforce and improving the quality of care, and removing unnecessary barriers to medical practice.”

Did you know that physicians right out of medical school can prescribe morphine? But if they want to give patients the medication buprenorphine, used to treat opioid dependence, they need a special license from the DEA, which fewer than 10 percent of eligible medical providers actually possess? That’s what he’s talking about.