The Urge: A Review

I was very interested to read The Urge: Our History of Addiction by Carl Erik Fisher because the early press focused on one thing - that Dr Fisher, a psychiatrist and addiction specialist questioned whether it's more harmful or helpful to label addiction as a disease. I will come back to that.

Let me start by saying that addiction is something I have thought about a lot and continue to think about a lot. My father was an alcoholic and addict, my sister and step-sister as well. My son struggled with addiction. I briefly practiced in two treatment facilities, and also had relationships with two addicts. The field I spent 12 years dedicated to - obesity - draws many comparisons to addiction, for better or worse. And somehow, no matter how far I drift, my career comes back here.

I am a huge fan of learning from history. Humans have been around for awhile, and even though a lot has changed, a lot has not. The Urge, as a narrative history of addiction, is detailed, thoughtful, and engaging. Dr Fisher weaves his own story into the history lesson, drawing the reader along as the lessons learned over centuries offer insights into the personal lessons of his real-life experience with substance abuse. The result is compelling and deeply insightful.

The big lesson of this book should not surprise anyone who has ever known an addict or treated an addict: It's Complicated. Addiction (like obesity and a handful of other conditions) lives at the uncomfortable intersection of physical, physiological, mental, emotional, behavioral, sociological, and environmental health. Dr Fisher points out time and again that our attempts at addressing addiction generally amplify one or two of these areas at the expense of the others, like a game of treatment whack-a-mole. Yet, despite overwhelming and repeat failure, the methods may change but the deficiencies - and thus the results - remain the same.

How do we solve this? Learn from and study history and try to find a solution that isn't simply a modernized version of everything that has already been tried. This does not mean we should throw out things that work, but probably more that we need to look at the deficiencies and ask what we are missing that would allow for greater success.

The ultimate place that Dr Fisher leaves us is not in fact with a statement that addiction should not be labeled as or treated as a disease. I think he rightly points out that we just need to keep in mind that sometimes this is helpful, and sometimes it is harmful - and that this depends a lot on the individual and their unique circumstance. I also appreciate his words in conclusion that "recovery [from addiction] is less an individual journey than an communal experience." Anyone who has struggled with addiction, loved someone with an addiction, or treated someone with an addiction knows this is true. In the end, this engrossing history lesson/memoir leaves us with the message that addiction is - for better or worse - a "profoundly ordinary" example of human suffering. Our job as citizens of the world is to perhaps not attack it as a thing to be defeated, but rather to find a way to help those who suffer by embracing them. It is more a call to action than a recommended treatment plan, and one that I suggest is valuable reading for anyone in a related line of work.