The Urge

October 15, 2021
Smart phones, video games, coffee, cigarettes, junk food, gambling. Fisher, a psychiatrist and a patient recovering from addiction, wonders, ""Is everyone somewhere on the addiction spectrum?"" What factors--biological, psychological, social, cultural--play a role? He reviews addiction, remedies, and recovery throughout human history and adds a discussion of his personal battle with substance use disorder (alcohol and the stimulant Adderall). The irony of his predicament does not escape him. ""I went from being a newly minted physician in a psychiatry residency program at Columbia University to a psychiatric patient at Bellevue."" He participates in a rehab program for doctors, resumes his professional training, and becomes an addiction medicine specialist. His historical overview of addiction includes discussion of Prohibition, Alcoholics Anonymous, the 1980s ""War on Drugs,"" the U.S. Narcotic Farm (Narco) in Kentucky, breakthroughs (methadone, buprenorphine), racial inequities, two opioid epidemics, tobacco, and crack cocaine. Fisher identifies four recurrent responses to addiction across history: prohibitionist (criminalization, punishment), reductionist (science-based handling), therapeutic (medical treatment), and mutual support (grassroots healing). A unique perspective on a frustrating, often devastating problem.

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Starred review from October 25, 2021
Fisher, an assistant professor of clinical psychiatry at Columbia University, makes a striking debut by skillfully combining a cultural history of addiction with his own story of recovery. He first looks to ancient philosophers and thinkers, noting that early definitions of addiction hinged on a "gray area between free will and compulsion." This anticipated the contemporary notion that mental disorders, including addiction, exist on a continuum. Fisher focuses mainly on the U.S., where the idea of addiction as a disease gained traction around the time of the Revolutionary War and later spawned religious temperance movements, Alcoholics Anonymous, and the war on drugs. He also shows how treatments have swayed between compassionate, rehabilitative approaches and prohibitive crackdowns, and argues that the current quality of care is "woefully" inadequate. Along the way, he shares plenty of moving stories of the scientists, preachers, and patients on the front lines of addiction and movingly recounts his own struggle with alcohol and Adderall addiction while he was a physician in Columbia's psychiatry residency program: "The fear, shame, and strategizing were exhausting." There's as much history here as there is heart. Agent: Libby McGuire, The Gernert Company.

November 15, 2021
A blend of memoir, critique, and history of the impact of addiction and the struggle to treat it. Despite the subtitle, this is more than standard history. Fisher, an addiction physician and professor of clinical psychiatry at Columbia, presents an account of his own struggles with addiction; his experience as a psychiatrist treating people with intractable addiction issues; a history of humanity's struggles with addictive substances; and a scathing critique of government policy toward drugs and drug abuse. Fisher has synthesized an enormous amount of material and is on firm ground when he writes on what he knows. Steeped in the history of medicine, his accounts of how doctors and self-help pioneers have dealt with addiction are vivid and well informed, and his insights into Alcoholics Anonymous and other therapeutic programs are buttressed by vast experience. He shows tremendous empathy for addicts and their challenges, and his personal story, of an addiction that almost derailed his medical career, is powerful and dramatic. However, his critiques of government policy toward addiction are largely one-sided. His chief targets are laws and programs that demand abstinence to ensure recovery, but Fisher skates over the other side: why those programs are popular and why many authorities believe they work. He also filters issues through the lenses of race and class, whether germane or not. For example, writing about a crucial Supreme Court decision on the legality of a Black man's drug arrest, he labels judges of the time "old white men," suggesting they were racist and out of touch. That may have been true, but their 1962 decision decisively favored more rights for the accused. After robust and sustained criticism of most current approaches to treating addiction, readers will hope for more information about what does work, but recommendations for the "pragmatic and pluralistic perspective" remain general. Readers familiar with the issues will engage; those seeking more insight into what causes this "baffling" human burden--and how they can manage it in their own lives--should look beyond this book. A useful but flawed personal and professional examination of addiction and how it has impacted humans and baffled experts.

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