The Urge: Our History of Addiction

by Carl Erik Fisher

As a psychiatrist-in-training fresh from medical school, Carl Erik Fisher came face to face with his own addiction crisis, one that nearly cost him everything. Here, he investigates the history of this age-old condition.

Humans have struggled to define, treat, and control addictive behaviour for most of recorded history, including well before the advent of modern science and medicine. The Urge is a rich, sweeping history that probes not only medicine and science but also literature, religion, philosophy, and sociology, illuminating the extent to which the story of addiction has persistently reflected broader questions of what it means to be human and care for one another.

Fisher introduces us to the people who have endeavoured to address this complex condition through the ages: physicians and politicians, activists and artists, researchers and writers, and of course the legions of people who have struggled with their own addictions. He also examines the treatments and strategies that have produced hope and relief.

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

Genres: Nonfiction, History, Psychology, Science, Addiction, Audiobook, Sociology

400 pages, Paperback

First published January 25, 2022

About the author

Carl Erik Fisher is an addiction physician and bioethicist. He is an assistant professor of clinical psychiatry at Columbia University’s Division of Law, Ethics, and Psychiatry. He also maintains a private psychiatry practice focused on addiction.

He is the author of the nonfiction book The Urge: Our History of Addiction, published by Penguin Press in January 2022. His writing for the public has appeared in The New York Times, The Washington Post, The Guardian, Nautilus, Slate, Scientific American MIND, and elsewhere. His academic writing has been published in JAMA; The American Journal of Bioethics; The Journal of Medical Ethics; and The Journal of Law, Medicine, and Ethics, among others. He also is the host of the Flourishing After Addiction podcast, an interview series exploring addiction and recovery.

Reviews

[Morgan Blackledge · Rating 5 out of 5]

The Urge is Addiction Psychiatrist Carl Eric Fisher’s historical deconstruction of the notion of addiction, the American culture of addiction recovery, and the American addiction treatment industrial complex (🏥 <=💊 =>🏭).

Fisher’s historical telling traced much of the genesis of the American addiction/recovery culture to the works of Benjamin Rush, the founding father of addiction medicine who, as early as 1784 asserted that alcoholism is a disease that should be treated not a moral failing to be punished. His works helped launch the American temperance movement.

Boozy Dudes:

Before Alcoholics Anonymous (AA) and before the Oxford Group that AA was modeled after, there was the Washingtonians: a self help, or rather “temperance society” (as they referred to it), founded on Thursday, April 2, 1840 by a group of drunks (GOD), namely a group of six alcoholic craftsmen (William Mitchell, David Hoss, Charles Anderson, George Steer, Bill M'Curdy, and Tom Campbell) at Chase's Tavern on Liberty Street in Baltimore, Maryland.

Their basic tenet was that by relying on one another, sharing their experience strength and hope, and thereby creating an atmosphere of safety, and nonjudgmental convivial fellowship, they could mutually support each other in their sobriety.

Members reached out to other "drunkards" (the term alcoholic didn’t exist yet) and sponsor them in sobriety, and so on.

The Washingtonians differed from other agents in the temperance movement in so far as they affixed their focus on helping and healing individual rather than fixing society.

In the truest sense, it was a “bottom up, populist, mutual help movement”.

In the end, the Washingtonians were undone by entanglements in politics and internecine fighting.

Kind of like an IRL old school Subreddit.

The Washingtonians demise influenced the architecture of Alcoholics Anonymous, inspiring their emphasis on anonymity and remaining politically agnostic.

Opium Eaters:

Confessions of an English Opium-Eater is lThomas De Quincey’s 1821, memoir about his laudanum (opioid) addiction and its effect on his life. Unlike the recovery memoirs of today, Confessions lauded the creative and spiritual benefits of opium and downplayed the risks.

Confessions of an English Opium Eater is a seminal text for the Romantic art/philosophy/cultural movement that emerged as an oppositional response to cold rationalism of the western enlightenment.

And (of course) romanticism was essentially the Philosophical operating system for what became the bohemianism and art/drug culture that found its pinnacle in the hippie movement of the 1960s.

Without all that, you would not have had records like Kind Of Blue, or Giant Steps, or The Black Saint And The Sinner Lady, or Sergeant Peppers, or American Beauty, or Pearl, or Electric Ladyland, or Physical Graffiti, or books like, On The Road, or Junkie, or Howell, or Electric Cool-aid Acid Test.

So fuck the fuck yeah to all of that!!!!

But also, it left the gate open for the Heroin epidemic of the 1950’s, 60’s, 70’s (not as much in the 1980s but still), 90’s and now.

Anyway….

Fisher’s most useful insights come from his scholarly examination of complex and difficult issues including, abstinence models, the medical model of addiction, harm reduction, physicians healthcare plans, managed care and the Malibu model, and even the third rail of addiction recovery topics, moderate use after problematic use, all skillfully and relevantly interlaced with a frank and vulnerable memoir of his own recovery from alcoholism and addiction.

That’s right.

Fisher grew up in an alcoholic household, became an addiction psychiatrist, became addicted himself, recovered, and wrote this beautiful book.

While this is far from the final word on this complicated and challenging subject. I can authoritatively endorse this book, as I am a professional, licensed therpaist, I have worked in the addiction recovery field for my entire career, I have read and researched extensively on the complex biological, psychological and social aspects of this issue, and I myself am in recovery. As such, I can reliably attest that this is a unique, and valuable addition to the addiction literature cannon.

Get it and read it now!

Great book.

I couldn’t put it down 😜.

Full of Great scholarship, great writing, historical insight, personal insight, expertise, and most importantly, humane goodness.

Thank you Dr. Fisher for this brave, reasonable book.

AWESOME 5/5

[Elyse Walters · Rating 5 out of 5]

Audiobook….read by Mark Deakins
….11 hours and twenty minutes

Behavior of addictions… substance abuse, epidemics… disease…root causes…treatments….recovery treatments….
….are just ‘some’ of the topics covered.

The overall book is as the cover says…”The Urge”…..(packed filled book) on ‘the history’ of addiction.
There are plenty of personal stories (in the context to describe the anatomy and physiology — as much as can humanly be possible in ‘understanding’ addiction.

The author, Carl Erik Fisher, is an addiction physician and bioethicist. He’s an assistant professor of clinical psychiatry at Columbia University.

Part of this book is a memoir.
Fisher doesn’t hold back any details about his family upbringing — family addictions—and his own history with addiction….(the shock to find himself needing to be treated as an inpatient for alcoholism when he was treating his patience for the same thing). He shared his baffling thoughts, resistance, denial, guilt, and shame, with keen eye preciseness.
This part of the book - and other personal-addiction stories had a rubbernecking type experience for me in the same way that taking my eyes off the road to stop and watch an accident, does.
I didn’t want to pull away from any real nitty-gritty-details of those ‘personal’ addictions.
And if I am honest …..I was searching for an ‘explosive’ answer ….
a sudden revelation, that a cure HAS BEEN FOUND….(in the same way we have found cures for other diseases.
Let me have my fantasy!
But …..
NOTICE….. the title does not say “The Cure”…. rather “The Urge”

The other parts of this book (non-memoir)….comes from years of research: brain disease, cultural dimensions, trauma, choice, drugs that might have created the culprit, environmental influences, isolation, stigma, criminalization, ….. and other examinations: be it physical, character, spiritual, or something entirely different.

Part of the book is dedicated to examining closely why some people get well and some people don’t. Don’t we all wish to understand this more? Have any of us escaped life ‘not’ being affected by addictions? (our own or other loved ones) ….

I can’t say I understood all the scientific aspects….(but I did learn plenty about various treatments—new and old ones), and the book is more than accessible for main stream readers. There is humor and humanity throughout as well.

“The Urge” had to be an incredible undertaking to write….
it’s a very valuable, non-judge-mental, significant contribution in the field of addiction study …… that anyone could benefit from….

It opens our hearts to the compassion and empathy that addiction plays in our personal lives (from any side of the coin) and the affects it has on society….
It’s an excellent book —(for those curious).
To me it was as important to read — in the same way it was to read “Emperor of All Maladies” — a biography of Cancer by
Siddhartha Mukherjee.

“The Urge” is drawn from experience and research…meticulous history of addictions. It explores the whys , compulsions, obsessions, doctor approaches, government policies, biological, psychological, social aspects of substance abuse and even minor addictions that may seem less serious — but affect people daily.

Remarkable…. Really outstanding!!

[Nevin · Rating 4 out of 5]

A very detailed historical account of addiction in America, dating back to early settlers in the 1400’s to current times. The author also is a recovering alcoholic and drug addict, which is peppered lightly throughout the book.

I learned so much about the historical account of addiction and how we dealt with it over time. Each administration, social and political movements had their own idea about addicts and addiction.

We need more compassion and support towards addicts/addiction, rather than full on “war”. The book ends with a very candid paragraph. Addiction is part of human existence. It will never go away. How we deal with it is the key to help those in need of our support and love!

The only criticism I have is I wished he told his personal story with a little bit more depth.

A solid ⭐️⭐️⭐️⭐️

[Autum · Rating 4 out of 5]

4.5** coming from someone who has struggled and been surrounded by addiction their entire life, this was extremely informative. I’ll write a longer review when I’m done moving, but this was a necessary read. I highly recommend this.

[britt_brooke · Rating 3 out of 5]

Like many Americans, I have close family members who have battled for control over addiction (to varying degrees). Better understanding our loved ones is always effort well spent. That said, this book is so dry. I’d have preferred a straight memoir of Fisher’s experiences or a history of addiction, rather a mix of both, but no one asked me, and rightfully so. Still, it’s a worthwhile companion to Dopesick, Empire of Pain, and the like.

[notgettingenough · Rating 4 out of 5]

One can read this as a thorough and engaging sociological account of why and how we continue to fail as a society to 'deal' with addiction. Fisher builds up a picture of Churchill's 'Those that fail to learn from history are doomed to repeat it', but it's more complicated than that, of course, as he takes pains to delineate in his multidisciplinary complex analysis. He manages to stay calm despite the anger one can feel behind some of his words as he describes the failures of the US.

He details the behaviour of doctors who are complicit in the addiction process, not to mention the pharma companies. I can't speak for the US, but in other parts of the world it is often the local pharmacist who educates the unwitting potential addict presenting an unnecessary script provided by a doctor whose motives must be questioned. I had a friend a while back who broke his ankle in Melbourne and when he gave his script to the local chemist, the reaction was something like this: you know that's a highly addictive opiate and you don't need anything like that for your condition. Errrm, no he didn't. A dozen years ago I presented such a script to a pharmacy in Geneva and although it was filled, it was with the greatest of reluctance and I more or less had to promise not to use it....a promise I kept.

What Pharma like Purdue has learned from history is that to repeat history is to fill their coffers. Doctors fill their appointment books and create any amount of work for their associates. Lesson: if history is to be changed, it will be by people who need it to change.

From The House Hearing THE ROLE OF PURDUE PHARMA AND THE SACKLER FAMILY IN THE OPIOID EPIDEMIC, Chairwoman Maloney's opening statement.

For too long, justice has been out of reach for millions of American families whose lives have been ravaged by our Nation's
opioid epidemic. For decades now, parents and family members have watched with broken hearts as their loved ones struggled with opioid addiction.

Since 1999, nearly half a million lives have been cut short by opioid overdoses in the United States alone. These lives were taken from us too soon. They were taken unnecessarily and they were taken unfairly. For each life lost, there have been many other family members--aunts, siblings, children, and loved ones--left to pick up the pieces.

And right there in the middle of all this suffering was Purdue Pharma, the manufacturer of a highly addictive prescription painkiller, OxyContin. This company played a central role in fueling one of America's most devastating public health crises. Purdue has generated more than $35 billion in revenue since bringing OxyContin to market.

Purdue has been owned by the Sackler family since 1952. The Sackler family has profited enormously from the OxyContin business. Since bringing this painkiller to market, the family has withdrawn more than $10 billion from the company. Purdue has now admitted that after it got caught in 2007, after it pled guilty and paid a fine, it continued to commit crimes for another decade, like nothing happened.

Documents obtained by our committee by the Department of Justice and by state attorneys general say that members of the family were directly involved with the day-to-day operations of the company. And they launched an incredibly destructive, reckless campaign to flood our communities with dangerous opioids.

At the behest of the Sackler family, Purdue targeted high-volume prescribers to boost sales of OxyContin, ignored and worked around safeguards intended to reduce prescription opioid misuse, and promoted false narratives about their products to steer patients away from safer alternatives and deflect blame toward people struggling with addiction. And most despicably, Purdue and the Sacklers worked to deflect the blame for all that suffering away from themselves and on to the very people struggling with the OxyContin addiction.

Yet despite years of investigation and litigation, no member of the Sackler family has ever admitted to any wrongdoing, taken any responsibility for the devastation they caused, or even apologized for their actions. In their settlement with the Justice Department, Sackler family members admitted no liability.

I believe it was appropriate that Purdue pleaded guilty to criminal charges because that's what it was, a crime. It was a crime against the American people. And with all the evidence that the Sackler family was directly involved and produced criminal actions, they were pulling the strings in fact, they should not escape accountability for these criminal actions this time around.

Today, for the first time, two members of the Sackler family, David Sackler and Kathe Sackler, will be testifying publicly before the American people about their role in the opioid crisis. They held senior positions in the company and on the board of directors. As these documents shows, they placed their insatiable thirst for personal wealth over the lives of millions of American families they destroyed.

It is my hope that today's hearing will give the American people, including the scores of victims who have had their families shattered, an opportunity to hear directly from those responsible for these atrocities.

rest is here: https://alittleteaalittlechat.wordpre...

[John Devlin · Rating 2 out of 5]

(2.5) the author seems like a nice fellow, and his history of addiction moves forward nicely…tobacco, gin, rum, opiates, barbiturates, amphetamines.

I could do without the hand waves to racism and class that grow more attenuated as the 21st century approaches, but overall there’s nothing to poke holes in…yes, his desire to see a gamut of holistic applications to addictions is pie in the sky in the face of governmental bureaucracy and a seemingly endless desire all these fixers have for more and more money…

He advocates harm reduction, something I had agreed with until I saw the last ten years in places like SF, Seattle and LA, where junkies make parks uninhabitable with their cast off free needles and a homeless industrial complex grew up to make drug abuse a chronic condition that needs these folks to exist in an eternal state of deterioration…

Finally, ozempic has shown it can sate the brain centers that charge folks to gorge themselves…interesting to see what effect these type of drugs can have on other addictions…

[Karl Hafer, Jr. · Rating 5 out of 5]

Profoundly useful book and I particularly appreciate the author's use of his own experience throughout. Highly recommend, as it helped shape the way I think about addiction.

One of the best attributes is that Fisher isn't peddling a specific treatment regime and, where he had opinions, he discloses and talks about them openly.

[Sarah Ferencz · Rating 3 out of 5]

This was a slow but interesting read. TLDR: we still don't really understand addiction, it's not genetic, and more emphasis needs to be placed on individualized recovery.

[aPriL does feral sometimes · Rating 3 out of 5]

‘The Urge: Our History of Addiction’ by Carl Erik Fisher disappointed me. It certainly is focused telescopically, and thus seemed myopic to me, on a history of the use of the word addiction, basically. His sources are mostly from what has been written in America about addiction. Most of the book is quotes and restatements of documents and articles from science and psychological research papers and academic newspaper/magazine interviews. They reveal social attitudes and sympathies have been the main driving forces in thinking about addiction, which have tainted scientific theories and medical/religious treatments for addictions through hundreds of years. I think the author has a bias to see addiction sympathetically, and it affected his book as well, a case of not seeing the speck in his own eye while pointing out the specks obscuring the vision of other researchers. There ARE a lot of different specks in the atmosphere surrounding addictions, though! I read more than a hundred books a year, and I have thought sometimes I am an addict of reading, probably to escape real life, which might be why some people drink or use drugs to excess, right? Shut up.

I have copied the book blurb:

”Named a Best Book of the Year by The New Yorker and The Boston Globe -An authoritative, illuminating, and deeply humane history of addiction—a phenomenon that remains baffling and deeply misunderstood despite having touched countless lives—by an addiction psychiatrist striving to understand his own family and himself

“Carl Erik Fisher’s The Urge is the best-written and most incisive book I’ve 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 understanding. He seamlessly blends a gripping historical narrative with memoir that doesn’t 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

As a psychiatrist in training fresh from medical school, Carl Erik Fisher found himself face-to-face with an addiction crisis that nearly cost him everything. Desperate to make sense of his condition, he turned to the history of addiction, learning that our society’s current quagmire is only part of a centuries-old struggle to treat addictive behavior. A rich, sweeping account that probes not only medicine and science but also literature, religion, philosophy, and public policy, The Urge introduces us to those who have endeavored to address addiction through the ages and examines the treatments that have produced relief for many people, the author included. Only by reckoning with our history of addiction, Fisher argues, can we light the way forward for those whose lives remain threatened by its hold.The Urge is at once an eye-opening history of ideas, a riveting personal story of addiction and recovery, and a clinician’s urgent call for a more nuanced and compassionate view of one of society’s most intractable challenges.”

This was a non-fiction cozy in my opinion. For instance, the author describes his addiction to alcohol as a problem for him throughout the book because he was often late in showing up at work or remembering where he had been in his off-hours. The biggest mental block he seemingly had to deal with was admitting he was drinking too much alcohol too often that was causing him to be late for work. If he kept showing up late at the hospital for his shifts, or failed any drug tests, he couldn’t be a doctor. He finally permitted himself to be involuntarily committed when he had a couple of days of delusions that scared him and his family and friends. This is seemingly as deep as his bottom was before he finally admitted he was an alcoholic. Maybe it was his bottom because he is an upper-class white guy with a lot of financial and networking privileges while training to be a doctor. What was the bottom for him seems like a mildly wild Spring break to me. At least, this is the impression from what he is willing to reveal in these pages.

The entire book appeared very genteel, keeping the tone at a quiet level. Fisher walks down a very narrow road of explanations and history focused on philosophical/medical ideas pro and con about the changing meaning of and feelings of shame about addiction. The medical or psychological ‘cures’ (apparently cures are very very rare indeed) throughout history reflect either supportive or punitive fixes to the problems of addiction. It is all described in severely censored or obfuscating academic-speak.

The fixes for addiction were dependent more on social/religious mores of whatever decade where solutions were being tried out in approaching the problem of addiction, and nothing else, based on the documentation, papers and articles the author has researched and quoted from. Politics and religion obviously does not make for good science.

I know people really like this book. I liked the history, especially in reading about those decades I personally lived through. There is no question the author is accurate about the history because of the academic sources he has used. I did not have a problem with the author mixing academic information in with his own and others’ personal experiences with addiction. However, because of the genteel high-end philosophical academic manner in which the book is written I felt the author’s was seemingly trying to sooth anxious fears of sensitive readers of his book. The doctor describes how addiction throughout history is defined whenever there is apparently a problem of not being able to stop using drugs or alcohol. But he does so with an airbrushing out of any disturbing details, sticking the landing to pinpoint precision on the meaning of addiction and how political and medical society handled it in academic philosophical ideas. Although he does generally mention addiction is a problem because people are unable to stop taking drugs despite the ongoing degrading of their quality of life, causing terrible shame, he really really really avoids getting into any explicit reasons why people have shame or why being unable to stop despite growing degradation is a problem. From how he has approached writing about the subject of addiction with academic-speak full of euphemisms, apparently to veil the uglier aspects of an addicted person’s life, if one had absolutely no awareness of the fallout from being addicted to drugs and alcohol, it actually could cause an ignorant reader to feel it was silly to be very upset about addiction. Such an ignorant reader would gasp at the brief descriptions of the inadequate and sometimes cruel solutions to force people to stop drinking or using drugs, although censored carefully in description by the author. Of course, the author does describe finally the delusions he had had, publicly acting out under the influence of mixing drugs and alcohol one night, finally an explicit explanation of why he felt shame, although he could not accept that he was an addict at that moment. The ignorant reader might wonder if personal psychotic delusions are the reason drugs and alcohol abuse is bad from what can be gleaned in the book, causing the shame (as well as being late for work too much). But except for being unable to stop using drugs, and that one mention of delusions, and being late for work a lot, there is nothing else in this book about symptoms, or damages, such as the permanent physical effects on the body from long-time abuse of drugs. Or about how relationships are destroyed, or financial stability disappears, or senseless beatings of children and animals occur, and other forms of extreme violence and uncontrolled general mayhem are set loose by drunken sprees which never seem to end for years, particular the horrors of vehicle crashes while driving drunk. I liked the history, but not the genteel airbrushing about the actual effects of alcohol and drugs on people’s lives, using academic-speak about what the fuss is all about if someone is addicted to using drugs and alcohol too much. After all, isn’t it the behavior of people under the influence of alcohol and drugs the first clue that something is wrong? So why avoid describing behaviors which cause concern about an individual in the first place?

The book has photographs and illustrations, as well as extensive Notes and Index sections.

[James B · Rating 5 out of 5]

Thanks to Netgalley and Penguin Press for the ebook. This book is a unique take on addiction and recovery because it takes on the subject from so many angles. The author talk about addiction through the ages and all the way to America today. He weaves in addiction through literature, with De Quincey, Burroughs etc. He also tells the stories of his addicted patients as he moves through becoming a doctor and later working at a university. And, most startlingly, he lets us into his own addictions with alcohol, Adderall and others and his denial and eventual recovery. A beautiful and honest account.

[James S. · Rating 2 out of 5]

The word that comes to mind with this book is "disjointed." The author flits from topic to topic and from anecdote to anecdote not only every chapter, but often on the same page, or even in the same paragraph. In addition to this, I couldn't figure out what his argument was. I'm not sure he knows what it is. None of this was helped by the pedantic first chapter, 20 pages debating how to define addiction (is there anything less interesting than a philosophical discussion about how to define something?). His personal stories about struggling with alcoholism are compelling, but they're too sparsely scattered throughout. Fascinating topic, frustrating book.

[Jessica · Rating 4 out of 5]

The overall theme of this book is that there is no exact line between addicted and non-addicted. Instead, problems with addiction differ for everybody so it's better to think of it as being on a spectrum.

The handling of addiction in the past was not ideal. Prohibition and making drugs illegal just doesn't work. In addition to that, we have a tendency to make some drugs legal because they are prescribed pharmaceuticals and other drugs illegal because we have deemed them as being more dangerous. This causes a divide between the people who can afford the "right" legal drugs and the poor and underprivileged who take the "wrong" illegal drugs. But as we have learned, the legal pharmaceuticals can be just as dangerous.

The author doesn't spend a lot of time reminding us of the power and influence of pharmaceutical companies but you can make your own inferences from the content in the book. It's something we shouldn't forget.

The last chapter tells us that we can do better. There are harm reduction strategies that we could be using but with government influencing what can be done, many are hesitant to try these strategies. Even those who have special licenses often don't want the trouble it might bring.

At times, the flow of this book felt a little disjointed and I had trouble getting grounded. I'm not likely to remember a lot of the historical references. History is just not really my thing. However, I enjoyed the process of reading this even if I didn't take everything in. From what I wrote above, I can tell that I remember some of the bigger ideas in the book and I will recognize them when they come up again.

[Sarah Paolantonio · Rating 4 out of 5]

For years long before I became sober from alcohol and for years long before I even had trouble with alcohol I've been reading about addiction, drug use, and sobriety in the form of nonfiction narratives, essay collections, and memoirs. There's a lot out there. But there's nothing like The Urge. I thought it might start too early in time, as NF narratives often go *way back* to logical beginning in a linear sense but an unnecessary starting point for modern readers. But it does not. The text is not floury. It is approachable. And that is the first step.

Fisher is an addiction physician, professor, and in recovery for addiction. And because his approach to this book stems from being an academic and professionally trained bioethicist and as a human being with his own experiences of use, addiction, and sobriety it makes him the strongest storyteller who has seen (and felt) the urge from all angles. Without these personal experiences Fisher would not have understood this topic as well, no matter what kind of clinical or academic training he had. There are great tidbits in these stories. He explores the origin of the word addict (first used in writing to describe the pope, of all people), the origin of the word "junkie", the beginning of the modern alcoholism movement, the opioid epidemic (past and present), and the public opinion and what narratives cemented the racist, sexist misunderstanding of those who use and how they're painted by society at large (just to name a few topics).

There are diagnostics here about those who use drugs and those who have opinions about people who use drugs. Fisher addresses the inequalities of the clinical, legal, and medical systems that have been in place for eons and how they favor and benefit the white and wealthy. He offers stories from his patients to place detailed experience with historical situations so readers can associate faces to these stories that seem so global while they have always been local.

Personally, I got what I came for. As a writer and human being I am always asking whether or not I can call myself an addict because it was so easy for me to stop drinking. The word addict is sharp in my mouth; it does not belong to me. But Fisher asks and answers this same question about himself, about his patients, and about temperance and intemperance figures long before our modern times: who is allowed to call themselves what? No matter what our experiences are, how are we all allowed to be labeled the same thing that seems to, historically, have such a harsh connotation, no matter what our involvement in use and sobriety may be? I won't give you Fisher's answer; and I won't tell you that the manuscript I've been working on for years has the same answer to this question. (Or, at least that my query letter asks and answer these questions.) It's something I've been writing through and exploring within myself for years. It's nice to see someone with authority call it what I know it to be, not that I need his permission, but seeing it in the wild helps confirm my thesis.

This book is for anyone struggling with addiction, sobriety, or anyone touched by these experiences. From what I've found in living and in reading, we all have someone in our life struggling with drugs and or alcohol, or we are struggling ourselves. I also know the more I talk about my own experiences the more it becomes normal for those around me, thus making it more approachable for anyone else who might want to share a story of their own. Fisher's diagnostic instinct to not neatly wrap up and point to exactly one thing pushes his book apart from the many that have come before it.

"We all suffer from a divided self," Fisher writes. This is true for all people and I think if everyone read this book we might all move toward a better conversation and plan to help those in our lives who need help, if only that help is to simply just listen.

[Scribe Publications]

The Urge is an absolutely brilliant exploration of humanity’s ever-present struggle with addiction, or what psychiatrist Carl Erik Fisher calls ‘the terrifying breakdown of reason.’ Dr Fisher’s firsthand experience, as both a doctor and a patient, gives The Urge a layer of insight that deepens its historical focus. Readers will walk away with a nuanced grasp of the high stakes of our broken medical system and the bias baked into our understanding of addiction and mental illness in general. This book is special — as edifying as it is electrifying, as meaningful as it is humane.
Susannah Cahalan, Author of Brain On Fire

Carl Erik Fisher expertly weaves his own story of addiction into a comprehensive and fascinating narrative. The Urge is an engaging read that also helps us gain a fuller picture of our own nature and how society has capitalised on it to drive addiction. Even as an addiction psychiatrist and researcher, I learned a great deal from this book.
Dr Judson Brewer, PHD, Author of Unwinding Anxiety

Thoughtful, moving, and wonderfully informative, Carl Erik Fisher’s The Urge arrives just in time to help us, as a nation, rethink our failed war on drugs. In telling his own story, that of a young physician wrestling with both alcohol and rehab, Dr. Fisher humanises the struggles that ensnare so many of us. Addiction, this marvellous book makes clear, is confounding, seductive, and elusive. In facing it without prejudice, we can learn a lot about ourselves.
Dr Mark Epstein, Author of The Trauma of Everyday Life and Advice Not Given

This thoughtful, wise, and thoroughly researched book is sure to be a crucial contribution to our understanding of addiction — a crisis that demands a deeper, more truthful conversation.
Johann Hari, Author of Chasing the Scream


Carl Erik Fisher’s The Urge is the best-written and most incisive book I've 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 doesn't self-aggrandise; 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

The Urge is an insightful, thought-provoking, and beautifully written book that stands to revolutionise our understanding of one of medicine’s — and society’s — most challenging problems. Carl Erik Fisher is a masterful physician-writer who is equally attentive to the grand sweep of history and the subtleties of each individual’s experience of addiction. A remarkable achievement.
Siddhartha Mukherjee, author of The Emperor of All Maladies

This courageous, urgent book tells the story of addiction, narrating its history, the author's own mêlées with alcohol and stimulants, and the narrative of other people’s struggles, which he has grappled with as a clinician. In poignant, episodic accounts, he describes historical conflicts that remain alive today, when we view addiction sometimes as a social circumstance, sometimes as a biological disease, and sometimes as a personal failure. Fisher has undertaken the difficult but necessary job of reconciling these multiple points of view.
Andrew Solomon, author of Far from the Tree and The Noonday Demon

[Cristian1185 · Rating 5 out of 5]

Recorriendo la historia del consumo de drogas en el mundo, para centrarse posteriormente en las experiencias específicas de Inglaterra y EEUU, el autor conjuga lo anterior con su propia experiencia vital como consumidor de sustancias, para confeccionar y entregarnos un libro íntimo, doloroso y lúcido al respecto del fenómeno del consumo de drogas a lo largo de la historia de la humanidad.

Nuestra historia de la adicción es un libro de divulgación científica, que potencia su contenido con la historia personal del psiquiatra Carl Erik Fisher, médico experto en adicciones y en bioética, testimonio vivo de las consecuencias del abuso de drogas. El libro nos permite visitar los momentos cruciales en la historia de las adicciones, insertando diversas reflexiones y pausas para ponderar el impacto de estas en relación con el marco de valores, normas y leyes de las sociedades en donde el autor pone la lupa.

Desde el modelo de 12 pasos de AA hasta el modelo de reducción de daños, el autor visita los diversos enfoques de trabajo en torno al consumo problemático de drogas, contextualizando sus orígenes, precedentes y alcances, como así también sus principales dificultades y logros, a partir de una mirada centrada en la historia y en la cultura.

Un libro necesario. Desmitifica, informa, y sobre todo, responde al fenómeno del consumo de sustancias desde una postura respetuosa, integral y cercana, proponiendo una mirada centrada en la persona, sus particularidades, potencialidades, recursos y necesidades.

Quizás faltó profundizar en la relación del consumo con el problema del narcotráfico, aún pese a que el autor si pondera el vínculo existente entre lo primero y las causas ambientales que lo ocasionan, particularmente las voluntades políticas y económicas tras la aceptación o no del uso de sustancias.

[Bonnie Brody · Rating 5 out of 5]

"The Urge, Our History of Addiction" by Carl Erik Fisher is a very important book for both the clinician, the patient, and any reader with an interest in the sociocultural history of addiction. This book is also a memoir of the author's addiction and recovery and he explores and analyzes how addiction has been viewed and treated over the centuries.

Dr. Fisher is an addiction physician and bioethicist. He is also an assistant professor of psychiatry at Columbia University in New York. He maintains a private practice specializing in integrative approaches to addiction. In addition, his writing has appeared in scientific and literary journals.

As a clinical social worker, I often have clients with addiction or substance abuse issues. Many of them are in denial and don't realize how their substance use impacts other aspects of their lives. It takes compassionate and focused therapy over time to help them see how their substance abuse is integrated into their choices and actions. Dr. Fisher does a great job of discussing some newer therapeutic interventions such as harm reduction and motivational interviewing that can be used to bring clients through denial. He also values the medical aspects of treatment for opioid addiction.

The book is very well-written and accessible to anyone with an interest in the topic. Dr. Fisher explores addiction as it is viewed in philosophy, literature, medicine, psychotherapy, etc. He is widely read and knowledgeable, making the book a real page turner. His own memoirs are personal and intimate, especially when he discusses his family of origin.

I recommend this book for any professional who deals with addiction and anyone else who has ever wondered how addiction has been perceived and treated over the ages.

[Sophia · Rating 3 out of 5]

This book was okay. It was well written for a general audience- by which I mean the author is eloquent and the subject matter is interesting. My main problem with it is that it purports to be a history of addiction and then really only discusses alcohol use in the last 200 years in an American context. A book for general readers is never going to be able to go into depth on such a broad topic. But I was still interested in what he had to say. Not much was new for me in this book though.

[J. Joseph · Rating 3 out of 5]

Written as a mélange of history, medical science, philosophy, ethics, and personal anecdotes, The Urge aims to present a humanizing account of addiction through the centuries up to present day. Fisher does not mean to make excuses for addiction, nor the detrimental effects it can have on the lives of those who suffer or those around them. Rather, he wants us readers and listeners to remember that at the end of the day there is a person with values and beliefs behind the disease.

The book is broken into 4 main sections, each with 2-3 chapters. The first section focuses on defining the term "addiction" and understanding it's history. The second focuses largely on the ontology of addiction - in other words, what exactly is it, is it separate from the person or a part of them, is it a vice or weakness of specific types of individuals, and so on. The third focuses largely on the socio-politics of addiction, primarily regarding religious influence on how addiction was(is) handled in North America. Finally, the fourth section covers the legal and systems repercussions of addiction and the various wars on drugs, penal system dominance in treating addiction, and the structures of (and values hidden within) rehabilitation. Throughout all four sections, Fisher provides anecdotes of his own experiences as well as general level medical science information about the topics he's covering in each chapter.

One of the biggest take-aways from this history-science-memoir book is how Fisher himself experienced/experiences addiction and recovery, and how these pushed him into his current specialties. He's an addictions physician, bioethicist, professor of clinical psychiatry, and psychiatrist focusing on addictions. Most folks will know three of those four jobs - the fourth, bioethicists, are a field of professionals who specialize in the ethical, moral, and social aspects and repercussions of healthcare decisions. I myself am a clinical bioethicist - someone who interacts with patients, families, and clinical teams to navigate these issues - so viewing addition through Fisher's lens was familiar to me and enlightening. I also appreciated that he included an extensive author's note at the beginning of the book explaining his use of terms, how the history of terms has changed and therefore there will be outdated language, and so on. This alone demonstrated the care and empathy he put into the book. Now, all this said, I did also find this book really dry (pun not intended). It was a good book, but it also wasn't entirely memorable for me and at times I struggled to maintain my attention.

[Gavin · Rating 4 out of 5]

A comprehensive history of addiction, from the earliest poem about a dice roller, on through gin mills in post-industrial London and 19th century temperance movements in the States, onward to the American opioid crisis of today. And not just a history, but a look at each piece of the addiction puzzle – the vice, the psychology, society's reaction, prohibition, relaxation, criminalization, marginalization, compassion. While the text is dense at times, Carl (41 at time of publishing) comes out of the weeds with his own journey as a psychiatrist and recovering alcoholic/drug user throughout each chapter, which kept the pace up in an otherwise jam-packed book, and added a stroke of humanity. I impressed my ER nurse wife with my sudden knowledge of methadone, and I now have a stance on abstinence vs. treatment:

"A fundamental shift in our thinking would be the best way to help people like Josie – letting go of the ideal of a "drug-free" world and instead prioritizing policies and treatments that accept the fact that drug use and addiction are facts of life, unlikely to leave us anytime soon."

After reading this book I am more empathetic, perhaps a bit more outraged, and ultimately more at peace with my own addictive inclinations (chocolate, winning, just one more beer).

[Omar Zahran · Rating 5 out of 5]

This is one of the most fascinating and interesting books I've read this year. The author, a doctor who has struggled with addiction himself, tells the history of addiction from the lens of a societal point of view and how systems were in place to mistreat people.

Fisher weaves between well researched history and personal experiences flawlessly to highlight stigmas of addicts, corrupt systems that have created crises, and how drugs were introduced throughout history.

He tackles the rise of drugs, the proliferation of addition, and how treatment has varied over the years. This is the definitive book to read if you have an interest in how this world treats addiction. An incredible and necessary read.

[Abby Koepke · Rating 3 out of 5]

Fine but I wasn't drawn in wanting more hence the two months it took to read/listen to this. Painted addiction in a new light for me. I can better understand those around me with addictions and be kinder to them.

[Sarah Rayman · Rating 4 out of 5]

Wonderful read. I can’t wait for Annie to finish it so we can talk about it!!!!!!

[Claire · Rating 4 out of 5]

"Addiction is profoundly ordinary: a way of being with the pleasures and pains of life, and just one manifestation of the central human task of working with suffering. If addiction is part of humanity, then, it is not a problem to solve. We will not end addiction, but we must find ways of working with it: ways that are sometimes gentle, and sometimes vigorous, but never warlike, because it is futile to wage a war on our own nature."

[Jackson Snyder · Rating 5 out of 5]

This book would be lame if the author hadn’t struggled with addiction himself. He provides lots of good insight that adds to the points he makes and helps you understand them.

[MJ · Rating 3 out of 5]

This is equal parts historical deep dive and personal memoir. He spells out how patterns of addiction happen again and again in society. I found that his conclusions didn't seem that unique and potentially he wrote this early on in his own recovery.

[Ryan · Rating 3 out of 5]

I bet we all think we know addiction when we see it, but that's probably wrong.

The Greek model, akrasia, in which our will cannot overcome some urge, probably still captures something of what's going on when we are in the throws of an addiction. Our will might not want to drink or smoke or gamble, but we find ourselves doing it anyway. It sounds very similar to how Stephen King depicts addiction in his novels (and in his memoir). It recalls how George W. Bush depicts addiction in his memoir. I can’t help but recall this line from Louis CK: “I don’t stop eating when I’m done. I stop eating when I hate myself.” But I'm not sure akrasia helps us to build a model for responding to addiction.

To illustrate the limits of our understanding... Is addiction well understood as a disease? It's harmful, but it doesn't seem to respond to a specific medicinal treatment. Is it caused by substance abuse? If so, what's happening when we gamble? Fisher further presents evidence that most soldiers addicted to heroin in Vietnam were able to kick it upon their return to the USA. How much of alcoholism is genetically determined? Fisher suggests that studies find a range from 25 to 70% influence--I'm not sure how one would reach that conclusion but it's pretty broad. Can a culture go through such trauma and loss that it becomes more likely to drink to excess? Fisher suggests it can happen.

It is also interesting (and IMHO productive) to read about how addicts try to kick their bad habits. There are many subreddits devoted to these goals, including stopdrinking, loseit, etc. One trend I notice is that some people can take control of their diet through mechanical eating (this works for me) while others find that abhorrent. Some drinkers find AA useful while others can't stand it. It's also common to find people who find a program doesn't work for them at first, but a year later they can make a go of it. Are both addiction and recovery from addiction variable and idiosyncratic models?

To study addiction, as Carl Erik Fisher does in The Urge: Our History of Addiction, is to study alcoholism, Augustinian lust, prohibition, zero tolerance policies, treatments, and still more. But I was most interested in how poorly we understand addiction. Not surprisingly, the best chapter, imho, comes near the end and is titled "Understanding Addiction."

3.5 stars.

[chasingholden · Rating 4 out of 5]

The Urge is a truly wonderful and unique way of enjoying the history of addiction whether you are new to the topic or rather familiar with it. Weaving personal stories from his patients with examples from literature, popular culture, and intimate pieces of his own reality as well.

Perfectly laid out this book is a welcome gem to the genre of addiction literature and the brilliance of Carl Erik Fisher shines once again.

Thank you so much to netgalley and publishers for providing an e-copy for me to read and leave my honest opinion. This is a subject that has always fascinated me and I am happy to say this book did not disappoint! Don't forget to pick up your copy as soon as possible!

[Olivia · Rating 5 out of 5]

This might just be one of my favourite reads of the year. The book is incredibly well-researched, with a coherent structure that alternates between historical accounts of addiction phenomena around the globe and anecdotal accounts of life as a person in America with addiction. Fisher's every word feels weighted with intention; I truly appreciated the writing's cognizance of addiction as a context-dependent experience that extends beyond clinical diagnosis.

[Catherine Holloway · Rating 5 out of 5]

I am a person who has really good control over my own urges, so I've found the existence of addiction baffling. I've watched many documentaries and read many books trying to understand it. This is the first piece of media I've consumed that makes sense.