Friday, February 16, 2024

The Urge: Our History Of Addiction

The Good Drug / Bad Drug Myth

Carl Erik Fisher discusses “The Urge: Our History of Addiction” with Leslie Jamison

In the 1980s, seemly overnight, crack cocaine exploded throughout the U.S. The media was saturated with stories of an unimaginably powerful new drug, and the moral panic was supercharged by racist stories about dangerous Black and Brown users infecting white America. Physicians and researchers followed suit, describing crack as a superdrug, the most addictive drug known to man, one that would cause almost instantaneous addiction. Soon, the star of that story became dopamine, a neurotransmitter that had been a relatively obscure molecule.

Dopamine was supposed to govern the pleasure center in the brain, responsible for all the good feelings produced by food, sex, and drugs. This explanation became immensely fashionable during the crack scare. Dopamine was called the master molecule of addiction, and fueled by the popularity of neuroimaging in the 1990s, the story was that drugs hijack the natural reward system of the brain through dopamine.

Misguided ideas about dangerous drugs drive ideas about addiction, causing us to miss the full picture of potential benefits and harms.

Drug Epidemics Are Nothing New

We are in the midst of a tragic overdose crisis. This is a mass-casualty event that is killing over 100,000 Americans a year. As awful as this is, its not unique. Since the beginning of modern commerce over 500 years ago, drug epidemics have wracked the modern world with disturbing regularity.

For example, from the 1500s on, tobacco use exploded across Europe and Asia. Anti-tobacco writers called it a plague intolerable. Then, in the early days of American independence, there was a massive epidemic of alcohol, supercharged by cheap molasses from slave plantations being turned into rum by enormously profitable distilleries. The first American opioid epidemic occurred in the 1860s and 1870s, fueled by the unspeakable trauma of the Civil War, the pharmacological enthusiasm of American doctors striving to capture market share, and the development of new, powerful ways of delivering opioids, such as the purification of morphine and the development of the hypodermic syringe.

The Urge By Carl Erik Fisher Review Against The War On Drugs

A psychiatrist and former addict cautions against conflating drug use with harm in this fascinating historical survey

George Santayanas aphorism Those who cannot remember the past are condemned to repeat it doesnt make an appearance in this book. But it could well serve as the subtitle. For if ever a field should heed the lessons of history it is the making of policy on alcohol and other drugs, and their associated addictions. Carl Erik Fisher takes the reader on a vivid tour over several thousand years of multiple cycles of science, medicine and literature, woven together by the thread of the authors own alcohol and amphetamine addiction and treatment. It is made even more emphatic and moving because he is also a psychiatrist who treats such patients.

At the end of 2021, the British government set out a once in a lifetime policy for tackling drug crime and drug use. It was a remarkable document not least because it contained no references to any previous research in this field as if the last two millennia had taught us nothing. The authors of that report should now read this book and realise how wrong most of their ideas are, how their new vision will probably repeat a relentless cycle of failed policy approaches. Given that they are unlikely to do so, I will try to summarise the key messages from Fishers book.

The first key message from Fishers book: dont conflate drug use with addiction or even with harm

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The Urge: Our History Of Addiction

An authoritative, illuminating, and deeply humane history of addictiona phenomenon that remains baffling and deeply misunderstood despite having touched countless livesby an addiction psychiatrist striving to understand his own family and himself

Carl Erik Fishers The Urge is the best-written and most incisive book Ive read on the history of addiction. In the midst of an overdose crisis that grows worse by the hour and has vexed America for centuries, Fisher has given us the best prescription of all: understanding. He seamlessly blends a gripping historical narrative with memoir that doesnt self-aggrandize the result is a full-throated argument against blaming people with substance use disorder. The Urge is a propulsive tour de force that is as healing as it is enjoyable to read.Beth Macy, author of Dopesick

Even after a decades-long opioid overdose crisis, intense controversy still rages over the fundamental nature of addiction and the best way to treat it. With uncommon empathy and erudition, Carl Erik Fisher draws on his own experience as a clinician, researcher, and alcoholic in recovery as he traces the history of a phenomenon that, centuries on, we hardly appear closer to understandinglet alone addressing effectively.

The Urge is at once an eye-opening history of ideas, a riveting personal story of addiction and recovery, and a clinicians urgent call for a more expansive, nuanced, and compassionate view of one of societys most intractable challenges.

The Term Addiction Should No Longer Be Used To Describe It

Foundations of Addictions Counseling 3rd Edition Paperback US Edition ...

I was educated in both medical school and treatment that addiction was a disease.

Distinct from the rest of the population, it was in a devastated state.

This is a faulty belief that stems from our history, and it does more harm than good.

A rise in hostility and despair toward people with mental health issues can be traced back to biological factors.

In 1784, Dr. Benjamin Rush enjoyed a rare vacation in Pennsylvanias backcountry in the summer after the Revolutionary War had ended.

Postwar poverty and societal upheaval affected him.

Rum and whiskey were common, as was binge drinking.

It wasnt uncommon for Americans to start their day with an alcoholic beverage rather than a cup of coffee, and they would drink it throughout the day, as well as at mealtimes, because water was viewed as unhealthy.

When Rush returned to Pennsylvania, he labeled chronic intoxication as a disease of the brain.

Rush, on the other hand, argued that medicine could only partially solve the problem since he also understood the importance of social and economic policy.

The alcoholism movement in the 1940s and 1950s used the term illness as a rallying cry to get hospitals to open their doors to those with alcoholism.

As a result of the medical communitys near-total retreat from addiction therapy during this time period, they attempted to gain traction by using disease as a lingua franca.

This idea of sickness has evolved over half a century.

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The Good Vs Bad Drug Myth

In the 1980s, crack cocaine surged across the United States, seemingly out of nowhere.

New reports of an unimaginably potent new drug and racist stories about the dangers of black and brown users infecting white America fueled the publics moral panic.

Physicians and experts referred to crack as a superdrug,the most addictive drug known to man, and nearly immediate addiction.

It wasnt long before dopamine, a neurotransmitter that had previously been underappreciated, became the focus of attention.

For many years, scientists believed that dopamine was in charge of regulating the brains pleasure center, which is where all of the pleasurable emotions associated with food, sex, and drugs are generated.

During the crack epidemic, this theory became a popular one.

For many years, neuroimaging and its associated theories about dopamines role in addiction perpetuated a myth that drugs work by interfering with the brains natural reward system.

Its typical to hear people say things like this about addiction, but its untrue.

Some of the most prominent academics in the field still fail to grasp this.

When it comes to dopamine, its not about liking its about desire and longing.

The brain is bombarded with dopamine by crack, but other drugs dont release it in the same way.

Dopamine hijacking, however, was a great expression of widespread social problems and gave support for law-and-order crackdowns in the war on drugs..

Stop Calling Addiction A Disease

In both medical school and rehab, I was taught that addiction was an extreme mental illness: a disease. It was a damaged condition, discretely divided from the rest of the normal population. This is a misleading idea rooted in our history, and it does more harm than good.

Biological explanations for mental disorders increase aversion and pessimism toward people with psychological problems.

In 1784, following the Revolutionary War, one of the Founding Fathers, a physician named Benjamin Rush, took a rare vacation through the Pennsylvania backcountry. He was struck by the postwar poverty and social upheaval. Whiskey and rum were everywhere, and binge drinking was widespread. Americans drank alcohol, not coffee, to wake up before workthen for the elevens , then again in mid-afternoon, before dinner, and morenot to mention at meals themselves, as water was thought to be unhealthy. Rush returned to Pennsylvania and began calling habitual drunkenness a disease. But Rush was only arguing that medicine could help in part, as he recognized that social and economic policies were also central to the problem.

The word disease became a plank of alcoholism activism in the 1940s and 1950s, when advocates were trying to force open the doors of hospitals. This was a period of harsh stigma against people with addictionto the point that the medical profession had almost totally retreated from attempting treatmentso they used disease language to try getting a foothold.

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We Will Not End Addiction

Addiction is part of usits not a curable disease. But this is not to say there isnt anything we can do, because there is. One of the key things is bringing addiction care into the mainstream.

Once I returned to my psychiatry residency and started to see my own patients, I did an intake interview with a young guy with alcohol problems, drinking about four to five drinks a night. His problems werent nearly as bad as my own had been, but my supervisor still said we had to turn him away from our clinic. And my supervisor was a compassionate, caring clinician. The issue is structural stigmapolicies and practices that exclude people from opportunities to heal.

There are innumerable ways we can help alleviate the harms of addiction without waging a violent war against it. We must expand harm reduction efforts like safe consumption facilities, overdose prevention sites, syringe service programs, and other crucial services that reduce drug harms and provide an opportunity to connect with people. We must support all the different varieties of recovery, and support recovery as a long-term process.

To listen to the audio version read by author Carl Erik Fisher, download the Next Big Idea App today:

Addiction Is A Human Universal

The Urge: Our History of Addiction by Carl Erik Fisher

A little more than a year after I graduated from medical school, I went on a drinking and Adderall binge that got me admitted to the psychiatric ward at Bellevue Hospital. I was sent to a specialized rehab for doctors, and in time, returned to my training under supervised treatment.

Fast forward a few years, and I felt pretty stable in my recovery. I had joined the psychiatry and bioethics faculty at Columbia, and I was training as an addiction medicine specialist. But despite studying neuroscience and psychology, I was troubled by some huge, unresolved questions about my conditionmainly, what exactly had gone wrong in me?

I got little help from my home disciplines of medicine and science, which were riven by bitter divisions about theories of addiction. I had the sense that other fields could help, so I started looking to history, philosophy, and more. I found that addiction is an idea with a long and enriching history. The words origin encapsulates a key lesson: addiction is a human universal.

Addiction comes from theology. When the word first entered the English language, it didnt mean a disease, but a strong devotion. It could be positive or negative you could addict yourself to naughty practices like necromancy, or good pursuits like prayer. It wasnt a status, but an action. Addiction was not something that happened to youit was something you did.

Addiction was not something that happened to youit was something you did.

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Will We Ever Understand Addiction

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Our History of AddictionBy Carl Erik Fisher

Our culture, ever on the lookout for easy, unambiguous answers to the predicament of being flawed and often unhappy humans, is a sucker for all-encompassing, reductive paradigms like addiction and, more recently, trauma. What these tropes share is a medley of explanations, depending on whom you listen to, some of them leaning toward nurture and some toward nature and some again toward a perfect storm of both.

The nurture camp depends on an elasticized frame of psychological reference that aims to link addiction to psychic wounds and self-destructive behavior going back to family dysfunction and socioeconomics. The nature camp posits neuroscience as the cause, making wobbly claims for an as yet unprovable biological origin of addiction some sort of neurological dysfunction predicated on inconclusive interpretations of brain imaging that focused not long ago on dopamine as the culprit. And sometimes the travails of addiction are ascribed to an intrinsic vulnerability that is exacerbated by external factors.

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