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3.94 AVERAGE
3.94 AVERAGE
challenging
hopeful
informative
inspiring
slow-paced
informative
medium-paced
I found this book an informative read relating to western (most American) ideas behind addiction. Well written and easy to read, with a good mix of the author’s personal experiences, medical science and history
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
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
informative
medium-paced
informative
reflective
slow-paced
challenging
informative
medium-paced
challenging
informative
slow-paced
A great book for most of its course, in which Fisher intertwines the sociological, psychological and religious takes on addiction, plus the developing scientific research in more modern times, and justified and unjustified conclusions drawn from all of this, with his own personal story of addiction and the family story behind that.
It’s almost a full five stars five-star book, but the last chapter doesn’t quite live up to the promise. And, that and one other thing led me to a reluctant four stars.
First, Fisher notes “process” addictions in this book, though his focus is on “substance” addictions. That said, he notes the first literary mention of an addiction, from 1000 BCE, from the Rig Veda, is about a process addiction, specifically gambling.
One really good thing is riffing on philosopher Harry Frankfurt and the “willing” vs the “unwilling” addict. The unwilling addict picks up on classical Greek’s akrasia, and the likes of Paul and Augustine bemoaning doing things they don’t want to do. The willing addict? Whether in denial about the costs of their addiction, in denial about addiction, or accepting it and not giving a damn, it’s party on. (It’s interesting that he only mentionos Augustine and not Paul, though.)
Fisher also notes that language is an “issue” in the field of addiction studies, but, while “substance use disorder” and “substance abuser” are the technical terms, “addict” is what he normally uses, as less cumbersome and other things.
At about the same place in the book, Fisher first check-marks different theories of addiction that have arisen over the centuries, even millennia. He notes that these tended to vary between moral scold types, sciency types, and sociological ones, with some overlap. In general, though, most proponents of a certain type of addiction were “one idea” persons, as in “Addiction is caused by X” means it’s caused solely or almost solely by X. Fisher politely but firmly rejects one-bullet theories.
That includes the most recent one-bullet theories, neuroscience theories, which are often still stuck in early-1990s “it’s all about dopamine” ideas.
In reality, stimulants are the only drugs that directly target dopamine centers, Fisher says. Other drugs do that more indirectly. Ditto for process addictions.
Nora Volkow comes in for strongly critical scrutiny, especially various versions of her claim that drugs “hijack the brain,” which is based on a simplistic understanding of dopamine plus a too-neuroscience focused view of addiction.
Fisher himself, in addition to rejecting one-bullet theories of addition, strongly favors including psychological and sociological components, while also stressing that racist misapplications of sociology must be rejected. (The crack epidemic quickly became more a problem for suburban whites than urban Blacks, but details of that, as well as criminal justice and other reactions to the issue, were swept under the rug.)
Related to this, Fisher talks well about how stigmas, usually based on race and/or class, affect societal response to addiction.
Then, it’s back into history. Apparently 1700s gin was like 151 rum. And, that’s why the lower classes got “hooked,” and from there, we get more discussions of classism in societal reactions to addiction.
Cannabis got its first modern “cult” in 1830s Paris (under Louis Philippe, interestingly) shortly after the big opium takeoff in Britain.
Per the above note on 1700s gin, the book is good on other history. For example, Fisher notes that Prohibition was passed by 18th Amendment at the end of World War I, which he notes was the height of US xenophobia, plus “beer-loving” (my words) German-Americans were politically sidelined because … the war. He adds that the prohibition movement, and its success, as well as all the other issues, helped boost the “Second Klan.”
As for “illicit” drugs? On the tails of the Harrison Act, the first large-scale poppy fields came to Mexico.
Chapter on Mary Mann is great, including her, not official AA, as biggest early pusher of the “disease theory.” Fisher notes that, today, belief in the disease theory is the single most likely signifier of relapse.
BIG observation on page 224, which directly addresses my wondering as to why primary care doctors, or GPs, aren’t on the “front lines” of addiction support more. (Fisher also applies it to psychiatrists.)
“To this day, attempts to get family physicians or psychiatrists to deal with alcohol and drug issues regularly fail because of stigma, limited training, and a lack of institutional and structural support — reflecting and reinforcing the structural stigma of a separate system.”
The final chapter, “Recovery,” was a bit of a letdown. He finally gets to “secular” alternatives, as well as “atheist” ones. SMART is the only one mentioned by name. Lifering’s not there, nor is Women for Sobriety. And, for those who may be able to moderate, it’s also surprising that Moderation Management isn’t listed by name.
Related, on AA? He talks repeatedly about “original AA” and what Bill Wilson actually meant and other things. Well, since he had a whole chapter about Marty Mann, he should know that talking about “original AA” is akin to “originalism” as an alleged constitutional law theory.
It’s not enough to drop it a star, but if we did have half stars, it would be 4.5.
That said, there’s one other thing missing, and … that probably does put it at 4 stars.
Fisher, at the start of the book, talks about the first literary reference to addiction being about gambling. There are “Anonymous” groups today for that and other process addictions, and catch-all secular alternatives groups are sometimes asked to help with this, sex addiction and more.
And yet, after the Rig Veda reference, these other addictions are basically not mentioned. It’s like the Rig Veda reference was only to talk about the antiquity of addiction discussion, and after that, the book is entirely substance addictions.
==
Couple of minor issues.
One, the US Civil War death rate as percentage of US population was NOT 3x that of WWII. It was more like 6x.
Jeffrey Amherst is the one and only clearly documented case of “smallpox blankets.”
It’s almost a full five stars five-star book, but the last chapter doesn’t quite live up to the promise. And, that and one other thing led me to a reluctant four stars.
First, Fisher notes “process” addictions in this book, though his focus is on “substance” addictions. That said, he notes the first literary mention of an addiction, from 1000 BCE, from the Rig Veda, is about a process addiction, specifically gambling.
One really good thing is riffing on philosopher Harry Frankfurt and the “willing” vs the “unwilling” addict. The unwilling addict picks up on classical Greek’s akrasia, and the likes of Paul and Augustine bemoaning doing things they don’t want to do. The willing addict? Whether in denial about the costs of their addiction, in denial about addiction, or accepting it and not giving a damn, it’s party on. (It’s interesting that he only mentionos Augustine and not Paul, though.)
Fisher also notes that language is an “issue” in the field of addiction studies, but, while “substance use disorder” and “substance abuser” are the technical terms, “addict” is what he normally uses, as less cumbersome and other things.
At about the same place in the book, Fisher first check-marks different theories of addiction that have arisen over the centuries, even millennia. He notes that these tended to vary between moral scold types, sciency types, and sociological ones, with some overlap. In general, though, most proponents of a certain type of addiction were “one idea” persons, as in “Addiction is caused by X” means it’s caused solely or almost solely by X. Fisher politely but firmly rejects one-bullet theories.
That includes the most recent one-bullet theories, neuroscience theories, which are often still stuck in early-1990s “it’s all about dopamine” ideas.
In reality, stimulants are the only drugs that directly target dopamine centers, Fisher says. Other drugs do that more indirectly. Ditto for process addictions.
Nora Volkow comes in for strongly critical scrutiny, especially various versions of her claim that drugs “hijack the brain,” which is based on a simplistic understanding of dopamine plus a too-neuroscience focused view of addiction.
Fisher himself, in addition to rejecting one-bullet theories of addition, strongly favors including psychological and sociological components, while also stressing that racist misapplications of sociology must be rejected. (The crack epidemic quickly became more a problem for suburban whites than urban Blacks, but details of that, as well as criminal justice and other reactions to the issue, were swept under the rug.)
Related to this, Fisher talks well about how stigmas, usually based on race and/or class, affect societal response to addiction.
Then, it’s back into history. Apparently 1700s gin was like 151 rum. And, that’s why the lower classes got “hooked,” and from there, we get more discussions of classism in societal reactions to addiction.
Cannabis got its first modern “cult” in 1830s Paris (under Louis Philippe, interestingly) shortly after the big opium takeoff in Britain.
Per the above note on 1700s gin, the book is good on other history. For example, Fisher notes that Prohibition was passed by 18th Amendment at the end of World War I, which he notes was the height of US xenophobia, plus “beer-loving” (my words) German-Americans were politically sidelined because … the war. He adds that the prohibition movement, and its success, as well as all the other issues, helped boost the “Second Klan.”
As for “illicit” drugs? On the tails of the Harrison Act, the first large-scale poppy fields came to Mexico.
Chapter on Mary Mann is great, including her, not official AA, as biggest early pusher of the “disease theory.” Fisher notes that, today, belief in the disease theory is the single most likely signifier of relapse.
BIG observation on page 224, which directly addresses my wondering as to why primary care doctors, or GPs, aren’t on the “front lines” of addiction support more. (Fisher also applies it to psychiatrists.)
“To this day, attempts to get family physicians or psychiatrists to deal with alcohol and drug issues regularly fail because of stigma, limited training, and a lack of institutional and structural support — reflecting and reinforcing the structural stigma of a separate system.”
The final chapter, “Recovery,” was a bit of a letdown. He finally gets to “secular” alternatives, as well as “atheist” ones. SMART is the only one mentioned by name. Lifering’s not there, nor is Women for Sobriety. And, for those who may be able to moderate, it’s also surprising that Moderation Management isn’t listed by name.
Related, on AA? He talks repeatedly about “original AA” and what Bill Wilson actually meant and other things. Well, since he had a whole chapter about Marty Mann, he should know that talking about “original AA” is akin to “originalism” as an alleged constitutional law theory.
It’s not enough to drop it a star, but if we did have half stars, it would be 4.5.
That said, there’s one other thing missing, and … that probably does put it at 4 stars.
Fisher, at the start of the book, talks about the first literary reference to addiction being about gambling. There are “Anonymous” groups today for that and other process addictions, and catch-all secular alternatives groups are sometimes asked to help with this, sex addiction and more.
And yet, after the Rig Veda reference, these other addictions are basically not mentioned. It’s like the Rig Veda reference was only to talk about the antiquity of addiction discussion, and after that, the book is entirely substance addictions.
==
Couple of minor issues.
One, the US Civil War death rate as percentage of US population was NOT 3x that of WWII. It was more like 6x.
Jeffrey Amherst is the one and only clearly documented case of “smallpox blankets.”
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 (