On Carl Erik Fisher’s “The Urge”

CARL ERIK FISHER, author of The Urge: Our Story of Addiction, an artfully combined personal narrative and genealogy of the titular concept, became an alcoholic and dependent on Adderall during his medical training. After graduating from medical school at Columbia University, he began drinking regularly and heavily. A high achiever whose first addiction may have been his inexorable need to shine, Fisher began boozing in the big leagues, and day by day it got to the point where the promising young doctor with the disheveled appearance of a newbie was too late to retire Shift came New Year’s revelers. The young doctor tried to hide the hole he was digging himself into, but his superiors did not overlook the symptoms and spoke to him. At the time, however, the wall of reckless denial was impenetrable.

Rather than give up his liquid island of peace, Fisher secured a prescription for the stimulant Adderall. For all their encumbrances, tops are a true steroid for bar hopping endurance while maintaining their viability, at least for a while. Temporarily, the Adderall provided enough internal support for Fisher to find his Lethe in the bottle and still pay close attention to his patients. But the drug and alcohol eventually got him over the razor’s edge. And he knew it.

One night, Fisher stormed into his apartment building and asked a neighbor to call 911 for help. When Fisher resisted, a SWAT team was called, and after finally gaining access to his apartment, the Kevlar-clad senior officer calmly asked, “[A]Are you okay with me?” Fisher barked, “Probably not!” He was immediately tased, strapped in, and taken to the hospital. Fisher, who still considers himself recovering, was eventually sent to a doctor-only rehab center and, with a few setbacks and long periods of probation, he cobbled together years of sobriety.

Among the many merits of this study is Fisher’s heartfelt acknowledgment that in his ongoing game of self-destruction, he was ultra-privileged with what he calls “restoration capital”—the money, prestige, and patience of the labor supervisors. This capital is exactly what most people lack in the stranglehold of their own conflicting desires. For this reason, Fisher notes, “addiction is not an individual disease—it also comes from deep ancestral wounds,” ie, from inequality.

As for the general history of mind-altering concoctions, Fisher reminds us that alcohol played a major role in the subjugation of Native Americans, making them dependent on liquor, creating debt, and hampering their ability to wage war. Of course, white people were also lured into their own trap. According to Fisher, some of Washington’s troops were so drunk on the rum they stole in their surprise Christmas Eve victory at Trenton that they literally fell overboard while returning across the icy Delaware River.

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In the early 19th century, most Americans greeted the morning with a strong drink rather than coffee. “By the 1820s,” Fisher writes, “drinking had reached its all-time high: the average American drank about seven gallons of pure alcohol a year.” Translated into daily consumption, that equated to “more than five standard drinks daily for everyone 15 and older.” .

From alcohol to opiates to crack and the veritable army of legally mandated “mood stabilizers,” Fisher deftly describes the United States’ schizoid response to intoxication and later drug use. In the early 1800’s there were very popular temperance movements and much later, among many other things, Prohibition, Alcoholics Anonymous, Nixon’s War on Drugs, Nancy Reagan’s “Just Say No” and finally the crime of the “criminalization cure”. Not to destroy his anonymity (or mine, since I go to meetings too), but perhaps the most compelling pages of Fisher’s story are those devoted to Alcoholics Anonymous—its complex roots, its evolution, its ups and downs.

As a teetotaler, Nietzsche taught that “truth is a mobile army of metaphors.” For binary-minded Americans, the key metaphorical contenders have long been the notion that drinkers lack willpower and the belief that alcoholism is a “disease” in which whiskey, wine, or whatever has “hijacked” the brain. The disease model is widespread today, perhaps born out of a widespread belief that it destigmatizes substance abuse and spurs troubled souls to seek help. However, Fisher remains unconvinced that hypnotizing people into believing they have lost their agency is destigmatizing. He cites research that suggests the label and the “sickness” narrative are largely ineffective when it comes to helping people avoid robotic trips to the liquor store. Maybe so, but just as the ubiquitous ADD diagnosis has provided a narrative some have used to self-harm for their inability to focus, so the “disease” label has freed many heavy drinkers from leading their lives Sign Mr. John Barleycorn.

Fisher reduces purely reductionist depictions of drug abuse to rubble. First, there was the popular fantasy that addiction was all in the neurotransmitters. Then came the notion that whiskey cravings run in the genes. In Fisher’s assessment, the “causes of addiction are impossible to bring under one conceptual umbrella.” He writes:

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Some addictions are […] driven by nothing other than how rewarding the substance or behavior is […] Some addictions are […] determined by trauma, be it personal, intergenerational or societal […]

[A]All of these multiple influences intersect in a complex and dynamic matrix that changes drastically from person to person […] It’s not that addiction is or isn’t a brain disease or a social disease or a universal response to suffering – it’s all of these things and none of them at the same time because each level has something to add but can’t possibly tell the whole story […]

Addiction is deeply mundane: a way of dealing with the joys and pains of life, and just a manifestation of the central human task of working with suffering.

Though Aristotle may think it overkill, for Fisher, habitual means of self-regulation such as the almost obsessive need to bike 75 miles a week, to knit, or to write every day would be classified as addictions.

The way we talk to ourselves about ourselves plays a crucial role in self-education. That’s a truism, but it deserves an amen. Those of us who turn to the medicine and/or liquor cabinet to get away from the hustle and bustle should resist considering ourselves “sick” and instead remember that we are simply falling into an all-too-human, misguided one Patterns of coping with the demands of life are advised, disappointments and sometimes successes.

Is it really any wonder, then, that a single mom working two jobs with bosses so cheap with both their wages and their praise and compassion could yearn for a few hours of drunken rest? Or, again, is it surprising that a lonely fellow filled with anger, fear, and disappointment should fall into the habit of seeking solace in the dark, cool cave of a local bar?

For all his criticisms of the disease model, Fisher emphasizes that the medical community has the tools, some pharmaceutical (e.g., methadone), to help people get off the path of decline and liver failure. However, he says, that same community has been criminally negligent in making their “rich recovery resources” available, particularly to those who cannot present an insurance card at the clinic’s counter. In fact, even with an insurance card today, setting up a simple half-hour Zoom meeting with a psychiatrist can take months. All the while, the chant goes on: “What the country needs are more mental health resources.”

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According to the National Institutes of Health in 2018, “Approximately 6.6% (or 16 million) of US adults have used prescription stimulants in the previous year.” Not to mention the millions of young people these potent psychotropic drugs were originally intended for. The author is somewhat reticent about his past stimulant addiction, aside from the fact that he feels there are even fewer resources or strategies on this class of drugs to try to help people withdraw from what used to be called ” pep pills.”

It’s a Foucaultian point, but if there’s a gap in Fisher’s historical narrative, it’s the lack of emphasis on the influence of insurance companies and big pharma when it comes to the vocabulary and ways we think about our lives inner workings think, dictate. It is no coincidence that the neurochemical understanding of ourselves has been shaped by changes in psychotherapy insurance policies combined with inflated claims about the effectiveness of new psychotropic drugs.

“Show studies” is one of the piety of the time. The urge is replete with citations from scientific studies, some of which come to quite radical conclusions, such as: “About 70 percent of people with drinking problems improve without intervention.” Similarly, almost the same percentages of self-healers apply to drug addicts, with the subtext that the need for recovery groups is overestimated.

It may be a product of Fisher’s long Zen practice, but for all the finger-wagging in this far-reaching text, his voice as an author is clear and gentle. Crammed with common sense and wisdom, a salmagundi of history, science and sound opinion, The urge should ignite an urge for animated conversation and debate about our current understanding and treatment of the disease, which you can get at the corner store or from a doctor in the lab.


Gordon Marino received his PhD from the University of Chicago’s Committee on Social Thought. He is Professor of Philosophy and Director of the Hong Kierkegaard Library at St. Olaf College. He is the author of The Existentialist’s Guide to Survival: How to Live Authentically in an Inauthentic Age (Harper, 2018).

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